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Quiz Session - Attempts With Random Questions

PNCB CPNP-PC Exam Questions

Page 8 of 25

141.

Which statement regarding the treatment of attention-deficit/hyperactivity disorder (ADHD) in the pediatric patient is ACCURATE?

  • Coaching the child and caregiver to plan, minimize impulses, and deal with daily frustrations may decrease symptoms

  • Focusing on discipline is a key part of treatment

  • Pharmacologic treatment is the most effective management method

  • Parent education is of limited help in modulating levels of stimulation for home, school, and extracurricular activities

Correct answer: Coaching the child and caregiver to plan, minimize impulses, and deal with daily frustrations may decrease symptoms

Families need to be well educated about the disorder, as a large part of the treatment for ADHD involves parent-child management techniques. The goal of parent skills training is for parents to learn ways to optimize success by giving the child direction, setting goals and limits to improve compliance, increasing self-esteem, enhancing the parent-child relationship, and reducing struggles in the home.  "Coaching" assists a child or adolescent to develop skills that are difficult. Problem-solving, time management, and organizational skills, for example, as well as learning strategies, are some areas in which coaching is successful. 

While discipline is important, it is much more beneficial and powerful for parents to use positive reinforcement to promote positive behaviors and minimize conflicts in the child with ADHD. Pharmacologic treatment is an important part of managing ADHD; however, medication alone is usually not as effective as medication combined with behavior therapy. 

142.

Which of the following is true of the title "pediatric nurse practitioner"?

  • It is illegal for any person to utilize the title without a valid license

  • It can only be used by a pediatric nurse practitioner in active practice

  • It can be used by anyone who has met the educational requirements set forth by the AACN (American Association of Colleges of Nursing)

  • It indicates the individual has been certified by a nongovernmental organization

Correct answer: It is illegal for any person to utilize the title without a valid license

Professional designations, such as registered nurses (RNs), nurse practitioners (NPs), and advanced practice registered nurses (APRNs), are legally reserved for those persons with a valid license. 

The Nurse Practice Act protects the public from unlicensed nurses. Certification by a nongovernmental organization is now mandatory for licensure in most states in the USA, but it does not confer the title. Nursing has declared a set of Essentials for Master's Education in Nursing that must be met educationally. Once met, licensure must then be obtained to practice and to use the title.

Advanced Practice Registered Nurses (APRNs) provide continuity of care in the ambulatory care setting for underserved children with health conditions such as asthma, pneumonia, and vaccine-preventable conditions that might otherwise lead to greater use of costly emergency departments and hospitalizations. 

143.

You are seeing a healthy child at a routine well-child check. During your developmental assessment, you note that she is able to jump and climb up on furniture, kick a ball and throw a ball overhand. She scribbles in a circular pattern, but cannot yet copy a circle. She helps with getting herself dressed and is able to pull her pants down with assistance. 

She is MOST likely what age?

  • 24 months 

  • 12 months 

  • 36 months

  • 48 months 

Correct answer: 24 months

These are 24-month milestones. Some other milestones of this age include: building a tower of seven cubes, using two- to three-word sentences, asking simple questions, turning pages one at a time, and using a spoon.

A child that is 36 months old should be able to copy a circle. 

144.

Which of the following statements is CORRECT regarding the diagnosis of learning disabilities?

  • There are correctable causes of cognitive impairments and behavioral disturbances

  • Learning ability assessment can be performed by assessing developmental history

  • Learning disabilities are best diagnosed by positive laboratory findings using tests that are validated for this purpose

  • Neuropsychological testing is the gold standard for diagnosing learning disabilities

Correct answer: There are correctable causes of cognitive impairments and behavioral disturbances

Correctable causes of cognitive and behavioral disturbances include seizure disorder, recent head injury, and hearing and/or vision impairments.

Developmental history alone is inadequate for diagnosis. Thorough assessment includes identification of risk factors, observation for characteristics of learning disorders, and consideration of other causes of learning problems (familial, decreased academic achievement, attention deficits, etc.). In addition, medical history is important to factor in as well.

Multiple causes of learning disabilities may be determined by laboratory findings, such as metabolic causes, toxin exposure, and chromosomal abnormalities. However, there is no single laboratory analysis for diagnosing learning disorders. Many individuals with developmental delay do not have any laboratory abnormalities. There is no gold standard for diagnosing learning disabilities; neuropsychological testing helps in confirming the diagnosis.

145.

A 17-year-old male comes into your pediatric clinic concerned about possible exposure to HIV after having sexual relations with another male. He admits to having some identity confusion and thinks he may be homosexual. You do not want to treat this patient because you believe that homosexuality is morally wrong.

Which of the following is TRUE?

  • It is legal but unethical to refuse to treat this patient

  • You should advise the patient to seek treatment at an emergency department

  • You have a legal obligation to treat this patient

  • You should terminate the patient-provider relationship and advise the patient to obtain treatment from a different provider

Correct answer: It is legal but unethical to refuse to treat this patient 

Healthcare professionals take an oath to serve the sick and provide care to all patients within their scope of practice. Denial of care to any class of patients is unethical, even for reasons involving personal beliefs and morals. 

A provider-patient relationship is a voluntary relationship that cannot be forced on either side, and although it is legal to refuse to treat a patient, it is not ethical. It is important to support and validate the adolescent throughout the process of developing his awareness of and commitment to a sexual orientation, and to provide a safe environment in which to access health care.

146.

Ninety percent of children who experience school refusal (phobia) have:

  • A psychiatric diagnosis 

  • Learning challenge(s)

  • Vision and/or hearing problem(s)

  • Problems in the home, such as neglect, abuse, or an absent parent 

Correct answer: A psychiatric diagnosis 

School refusal, or school phobia, involves severe difficulty or refusal to attend school, severe emotional upset when attempting to go to school, the absence of significant antisocial disorders, and staying at home with the parents' knowledge. Ninety percent of children who experience school refusal have a psychiatric diagnosis. The prevalence ranges from 1% to 4% of all school-age children. 

This disorder includes, but is not limited to, separation anxiety disorder, simple and social phobias, and depression. Unexcused absences peak with the beginning of school attendance and again at 11 to 13 years old. 

Management involves behavioral measures in combination with supportive counseling of parents. Children with more severe presentations should be referred to a mental health specialist, and may benefit from interventions such as cognitive-behavioral therapy (CBT), or medication.  

147.

You are seeing a 3-year-old male, brought in by his mother, with a rash on his lower abdomen. You suspect the rash is contact dermatitis from the metal on his jean button. 

Which of the following agents is the MOST likely cause of the rash?

  • Nickel

  • Copper

  • Zinc

  • Brass

Correct answer: Nickel

Contact dermatitis is an acute or chronic inflammation of the skin resulting from a hypersensitivity reaction to a substance (either irritants or allergens). 

A common cause of dermatitis is contact with nickel (nickel dermatitis), which is found in many metals on clothing (belts, snaps, buttons, eyeglasses) and in jewelry. Findings include a localized rash in a specific area (sharp borders) that has been in contact with the irritant and associated itching. 

Management includes appropriate skin care, recognizing and eliminating offending agents, and treating inflammation (e.g., burow solution soaks or oatmeal baths, cool compresses, applying mild topical corticosteroids). Complete resolution may take 2-3 weeks. Refer to a dermatologist or an allergist for patch testing if the dermatitis worsens, fails to respond, or recurs. 

148.

Which geographic region or country holds the HIGHEST rate of infant mortality?

  • Southern Asia

  • Sub-Saharan Africa

  • China

  • Democratic Republic of the Congo

Correct answer: Southern Asia

The highest rates of infant mortality occurred in two geographic regions: 39% of newborn deaths occurred in southern Asia and 38% in sub-Saharan Africa.

Half of all newborn deaths occurred in just five countries: India, Pakistan, Nigeria, the Democratic Republic of the Congo, and Ethiopia.

149.

Which of the following conditions is thought to be the MOST frequent reason for intestinal obstruction in children?

  • Intussusception

  • Hernias

  • Inflammatory bowel disease (IBD)

  • Impacted feces

Correct answer: Intussusception 

Intussusception involves a section of intestine being pulled antegrade into adjacent intestine with the proximal bowel trapped in the distal segment. It is thought to be the most common cause of intestinal obstruction in children. It most often occurs between 5 and 10 months of age and is also the most common cause of intestinal obstruction in children 3 months to 6 years old, with 80% of cases occurring before 2 years of age. In younger infants, it is generally idiopathic and responds to noninvasive treatments. 

Known medical factors, such as polyps, HSP, lipomas, foreign bodies, and rotavirus can be contributing factors in other children. Intussusception may be a complication of cystic fibrosis as well.

The other answer choices are less frequent reasons for pediatric intestinal obstructions.

150.

Which of the following is TRUE regarding advocacy within the pediatric advanced practice nurse (APN) profession?

  • Broader representation is needed from the APN community to have an impact on healthcare legislation

  • Most rules and regulations that rule advanced practice are created by nurses

  • APNs have a high comfort level with advocacy

  • Professional nursing organizations do not facilitate opportunities for APNs to branch out on their own with advocacy

Correct answer: Broader representation is needed from the APN community to have an impact on healthcare legislation

Although there are ample opportunities for pediatric APNs to engage in the healthcare policy process, not enough are actively engaged, thus making it probable for the practice to depend on policy decisions made by others. Broader representation and personal commitment from members within the APN community are the only way that APNs can have an impact on formulating health care policy and legislation.

151.

What is the MOST appropriate prophylactic treatment for infants at high-risk for adverse outcomes of a respiratory syncytial virus (RSV) infection?

  • Palivizumab (Synagis)

  • Bosutinib (Bosulif)

  • Bevacizumab (Avastin)

  • Imatinib (Gleevec)

Correct answer: Palivizumab (Synagis)

Palivizumab (Synagis) is the only product on the American market for use in infants at high risk for RSV. It is a humanized mouse monoclonal antibody and is administered intramuscularly in five (maximum) monthly injections during RSV season (usually November through March or April); it is generally well tolerated and has been shown safe and effective in reducing RSV hospitalizations in high-risk infants (by 39% to 82%). 

In the first year of life, it is recommended for infants born before 29 weeks and 0 days of gestation (during RSV season). 

152.

What is the MOST common pulmonary disease in a newborn? 

  • Neonatal respiratory distress syndrome (NRDS)

  • Transient tachypnea of the newborn (TTN) 

  • Bronchopulmonary dysplasia (BPD)

  • Respiratory syncytial virus (RSV)

Correct answer: Neonatal respiratory distress syndrome (NRDS)

NRDS, formerly known as hyaline membrane disease, is a syndrome caused by developmental insufficiency of pulmonary surfactant production and structural immaturity in the lungs. It can also be a consequence of neonatal infection. The result is alveolar atelectasis and decreased lung compliance. It is increasingly referred to as surfactant deficiency disorder (SDD). 

Most cases of NRDS occur in newborns before 37 to 39 weeks. The more premature the baby is, the higher the chance of respiratory distress syndrome (RDS) after birth. NRDS can also be due to genetic problems with lung development. Antenatal steroids, postnatal surfactant, and newer ventilation techniques have reduced mortality from RDS to approximately 10%.

History and clinical findings include: sibling who had RDS, maternal diabetes, cesarean delivery or induction of labor before the baby is full-term, problems with delivery that reduce blood flow to fetus/newborn, multiple pregnancy (twins or more), and preterm, precipitous delivery. 

153.

A 3-year-old male presents to the ER with his mother after two days of diarrhea and vomiting. He is lethargic, his eyes are sunken and his mucous membranes are dry. His skin turgor is poor, and his mom reports there are no tears when he cries. Upon exam, he is tachypneic and his capillary refill time (CRT) is prolonged. You confirm the diagnosis of rotavirus diarrhea.

What is the BEST rehydration therapy for this patient?

  • IV Lactated Ringer solution, 20 mL/kg body weight bolus

  • Oral rehydration solution (ORS) 100 mL/kg body weight over 4 hours

  • 5% dextrose in 1/2 normal saline IV at 1000 mL + 50 mL/kg for each kg over 10 kg

  • IV normal saline solution, 20 mL/kg of body weight over 4 hours

Correct answer: IV Lactated Ringer solution, 20 mL/kg body weight bolus

This patient is severely dehydrated; therefore, the most appropriate therapy is Lactated Ringer (LR) solution intravenously in boluses of 20 mL/kg body weight until perfusion and mental status improves. After improvement is seen, administer 100 mL/kg body weight ORS over 4 hours, or 5% dextrose in 1/2 normal saline IV at twice the maintenance fluid rates (1000 mL + 50 mL/kg for each kg over 10 kg).

Normal saline (NS) is less effective for treatment in cases of severe dehydrating diarrhea because it contains no bicarbonate or potassium. Therefore, use only NS if LR is not available, then supplement with ORS as soon as the patient can tolerate drinking. Plain glucose in water is ineffective and should not be used. 

154.

Which of the following genetic tests is used to identify and evaluate the size, shape, and number of chromosomes?

  • Karyotype

  • Fluorescence in situ hybridization (FISH)

  • Biochemical testing

  • Chromosomal microarray

Correct answer: Karyotype

Diagnostic genetic testing is used to confirm a diagnosis and is used in a symptomatic individual or in response to a positive screening test. Such tests are selected depending on the type or specific disease one is trying to confirm. The main types of diagnostic genetic testing are:

  • Karyotype
  • FISH
  • Biochemical testing
  • Chromosomal microarray
  • Molecular testing
  • Next generation sequencing

Karyotype testing is used to identify and evaluate the size, shape, and number of chromosomes.

FISH is used to locate and detect a specific area of a particular chromosome, including subtle missing, additional, or rearranged chromosomal material, by labeling a known chromosome sequence with fluorescent tags to see the location of genetic material. 

Biochemical testing is used to study the amount, activity level, or structure of proteins and enzymes that result from gene mutations.

Chromosomal microarray is used to detect microdeletions or duplications in any of the chromosomes but not specific gene mutations. 

155.

The breastfeeding mother should consume a minimum of how many additional calories per day?

  • 300

  • 200

  • 400

  • 500

Correct answer: 300

Maternal nutritional needs change during lactation. The characteristics of an appropriate diet in breastfeeding mothers are similar to that of a pregnant woman and include:

  • Daily caloric intake of 300 extra calories over the prepregnancy recommendations based on weight and activity
  • Generous intake of fruits and vegetables, whole grain breads and cereals, calcium-rich products, and protein-rich fish, meats, and legumes
  • Rich sources of calcium, zinc, folate, magnesium, and vitamin B6
  • Supplementation with calcium if mother is avoiding dairy
  • Supplementation of vitamin D if deficient

156.

Leukemia is the most common form of childhood cancer, accounting for up to 30% of all pediatric cancers. Which of the following types of leukemia accounts for nearly 80% of childhood leukemia cases?

  • Acute lymphocytic leukemia (ALL)

  • Acute myeloid leukemia (AML)

  • Chronic lymphocytic leukemia (CLL)

  • Chronic myeloid leukemia (CML)

Correct answer: Acute lymphocytic leukemia (ALL)

Leukemias are classified according to cell type involvement (lymphocytic or nonlymphocytic) and by cellular differentiation. ALL is characterized by predominantly undifferentiated white blood cells (WBCs). 

ALL accounts for about 80% of childhood leukemia cases, with a peak incidence between 2 and 6 years of age, and 56% of leukemia cases in adolescents. There have been dramatic improvements in survival for ALL over the past four decades, with outcomes approaching 90% in the latest studies. 

AML is less common in children than ALL and accounts for about 15% of leukemia cases in children and 31% of those in adolescents. 

157.

You are assessing a 1-day-old newborn in the nursery post delivery. The neonate was born to a first-time mother via vacuum extraction secondary to failure to progress after a prolonged second stage of labor. You note a collection of fluid on the parietal area of the head that does not cross the suture lines. There is no bruising noted. The remainder of the infant's exam is normal.

What is a major complication of this finding?

  • Hyperbilirubinemia

  • Seizure activity

  • Hydrocephalus

  • Erb's palsy

Correct answer: Hyperbilirubinemia 

This patient has a cephalhematoma secondary to trauma occurring during a difficult delivery, and subsequent use of a vacuum extractor. A cephalhematoma is a deep collection of blood in the subperiosteal area of the scalp that most often resolves spontaneously over a few weeks to months. Swelling in the parietal area that does not typically cross suture lines is common. Hyperbilirubinemia may ensue; therefore, close follow-up is indicated.

158.

Which of the following auscultatory findings would be indicative of a possible pathologic murmur?

  • Pansystolic murmur

  • Grade III localized murmur, varying in loudness

  • Murmur that is loudest at left lower sternal border (LLSB)

  • Systolic murmur that is vibratory in quality

Correct answer: Pansystolic murmur

A pansystolic murmur is generally associated with mitral valve regurgitation. If heard, you should refer the patient to a pediatric cardiologist for further evaluation.

The other answer choices are innocent murmurs that need only monitoring and generally do not require further action. 

159.

You are counseling parents on growth parameters for their healthy 6-month-old daughter at a well-child visit. The father asks how fast the child is likely to grow in height. Which of the following statements is accurate and will help to guide your answer?

  • Infant length increases an average of 1 inch a month during the first 6 months but slows during the next 6 months

  • Infant length increases an average of 1 cm a month from 6 months to 12 months

  • Infant length increases are steady and gradual through the first 12 months of life

  • By 12 months of age, there is almost a 50% increase in height from birth due to leg length increases

Correct answer: Infant length increases an average of 1 inch a month during the first 6 months but slows during the next 6 months

Infant length increases an average of 2.5 cm (1 inch) a month during the first six months but slows during the next six months. While weight gain is steady and gradual, length increase occurs in sudden spurts.

By six months of age, infants average 65 cm in length (25.5 inches) and increase to 72 cm (29 inches) by 12 months of age–almost a 50% increase from birth–due to truncal, not leg increases.

160.

Which of the following statements is CORRECT in regards to the diagnosis of ADHD in children?

  • Caucasian children are more likely to be diagnosed with ADHD than those who are African-American, Hispanic, or of other races/ethnicities

  • The average age of diagnosis is 9 years old

  • ADHD is one of the least commonly diagnosed disorders in childhood

  • Brain imaging studies have identified structural and functional differences in the temporal lobes and the hypothalamus

Correct answer: Caucasian children are more likely to be diagnosed with ADHD than those who are African-American, Hispanic, or of other races/ethnicities

ADHD is one of the most commonly diagnosed disorders in childhood. Children who are African-American, Hispanic, or of other races are 69% less likely to be diagnosed with ADHD than white children.

The average age of diagnosis is 7 years old, with children who have severe ADHD diagnosed earlier. Brain imaging studies have identified structural and functional differences in the frontal lobes and subcortical structures of the brain, indicating that brain development is drastically different from normal.

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