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Quiz Session - Attempts With Random Questions

PNCB CPNP-PC Exam Questions

Page 9 of 25

161.

Which of the following is TRUE regarding short message system (SMS) text messaging as a means of communication between patients and their pediatric health care setting?

  • The Joint Commission has banned the use of SMS for transmitting confidential health information

  • There are HIPAA compliant texting devices available on the market

  • Encrypted SMS text messaging platforms are approved as HIPAA compliant

  • Patients must sign a text messaging communication policy when initiating care at a health care facility

Correct answer: The Joint Commission has banned the use of SMS for transmitting confidential health information 

SMS text messages have been increasing steadily since the emergence of smartphone technology. Although texting can be an efficient means of communication, there are potentially considerable privacy and security risks associated with this means of communication. However, texting back and forth can be used, providing there are adequate controls in place. All providers need to have the ability to have secure health care communication with an encryption protection platform as part of their mobile device, assuring that if there is a loss of a mobile device, the user can be disconnected from the system to avoid data breach. In addition, protected health information (PHI) is not allowed to be stored on a personal mobile device if it is used on an open Wi-Fi network. There are no HIPAA secure devices for this purpose at this time. 

Traditional SMS text messaging is not HIPAA compliant, can be forwarded to anyone, and can forever stay on the sender's and receiver's server. For this reason, the Joint Commission has banned the use of SMS for transmitting confidential health information. Because not all patients want to receive SMS, patients must agree to the use of SMS messaging prior to a practice sending out reminders or tests, and a patient communication policy must be consented to and signed if the patient chooses.

162.

You suspect your 2-year-old patient has a severe shigella infection. Because this organism is particularly drug-resistant, which of the following antibiotics is MOST appropriate to treat this infection?

  • Ceftriaxone (Rocephin)

  • Ampicillin (Omnipen, Principen)

  • TMP-SMX (Bactrim, Sulfatrim)

  • Amoxicillin (Amoxil, Moxatag)

Correct answer: Ceftriaxone (Rocephin)

Shigella is a food-borne bacterial diarrheal disease presenting with abdominal cramps, fever, and diarrhea. Stools may also contain blood and mucus. Shigella is seen most commonly in children 6 months old to 3 years old. 

The incubation period varies from 1-7 days, but typically is 1-3 days. The illness generally lasts 4-7 days and is transmitted through food or water contaminated with human fecal material, usually person-to-person spread via fecal-oral transmission.

Treatment of Shigella with antibiotics shortens the duration of bacterial shedding and lessens clinical symptoms. Antibiotics are indicated if the disease is severe, or if the patient has dysentery or is immunocompromised. 

Oral ampicillin (amoxicillin less so) or TMP-SMX is recommended in the United States. However, resistance to these antibiotics has been reported world-wide. Therefore, in the absence of susceptibility testing, the use of IM ceftriaxone for 2-5 days for organism resistance is most appropriate in this situation.

163.

You are seeing a new patient today, a 12-month-old female whose family recently moved from out of state. The mother informs you that her daughter has had recurrent ear infections and upper respiratory infections, with two rounds of pneumonia since birth. In addition, she has severe eczema and seems to bruise easily. You note diffuse petechiae on the patient's body and decide to do a complete blood count (CBC), which shows thrombocytopenia.

Which of the following conditions does this patient MOST likely have?

  • Wiskott-Aldrich syndrome

  • Severe combined immunodeficiency (SCID)

  • DiGeorge syndrome

  • Selective IgA

Correct answer: Wiskott-Aldrich syndrome 

Wiskott-Aldrich syndrome is an X-linked recessive, immunodeficiency disorder characterized by the clinical triad of thrombocytopenia, eczema (atopic dermatitis), and recurrent infections. In addition, bloody stools and/or hemorrhage are often present as a result of thrombocytopenia, and EBV malignancy (Burkitt lymphoma) may be part of the clinical presentation in the patient with this syndrome.

The other answer choices are also pediatric primary immunodeficiency disorders but present differently.

164.

Which of the following diagnostic studies should be performed on a 5-year-old child with pharyngitis?

  • Rapid antigen detection test (RADT) and throat culture 

  • Anti-streptococcal antibody titers (ASO) and throat culture

  • Complete blood count (CBC) and throat culture

  • Anti-deoxyribonuclease B tests (anti-DNase B) and throat culture

Correct answer: Rapid antigen detection test (RADT) and throat culture

It is important to use RADT for patients with clinical features (including pharyngitis) consistent with Group A beta-hemolytic streptococcal infection (GABHS) to diagnose acute illness and avoid false-positive tests on patients who are carriers of streptococcus and do not need treatment. 

Testing for GABHS should be performed on children 3 years old and older with pharyngitis, because it is difficult to distinguish viral and streptococcal infections by history and physical examination. Therefore, an RADT and/or culture should be performed on children 3 years old and older who are symptomatic with pharyngitis. 

GABHS is rare in children younger than 3 years old, and testing for GABHS in children under 3 years old with asymptomatic household contact is not recommended. However, if there is a child in the home who is positive for GABHS, children younger than 3 should be tested. 

Whether back-up cultures are done following a negative RADT depends on the type and rapid strep testing, as the newest molecular tests do not need a back-up culture. However, negative RADT should be backed up by a throat culture if using a first- or second-generation RADT. 

ASO and anti-DNase B testing are not useful in the diagnosis of acute pharyngitis because these titers remain elevated for several months after the infection.

A CBC should be performed if infectious mononucleosis is suspected, as it can identify a lymphocytosis with atypical lymphocytes. This is, however, a nonspecific test.

165.

Which of the following scenarios is considered a breach of patient confidentiality in pediatric primary care?

  • Conducting sexual history with patient and parent present

  • Releasing medical records that have been subpoenaed

  • Reporting an infectious disease to the health department

  • Releasing a patient diagnosis to her insurance company

Correct answer: Conducting sexual history with patient and parent present

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that young females have an initial reproductive health visit between 13 and 15 years old to provide preventive care, anticipatory guidance, and screening. This visit is an ideal time to discuss the importance of confidentiality in the healthcare provider-patient relationship, with the patient and her parents. The sexual history should be completed with the parent(s) out of the room.

166.

In a 10-year-old child with a diagnosis of hypothyroidism, what is the MOST appropriate dosing of levothyroxine (Synthroid, Levoxyl)?

  • 4-5 mcg/kg/day

  • 6-8 mcg/kg/day

  • 2-3 mcg/kg/day

  • 5-6 mcg/kg/day

Correct answer: 4-5 mcg/kg/day

Hypothyroidism is treated with replacement doses of levothyroxine sodium. The dose varies by age and weight, and are once daily:

  • Birth to 3 months: 10-15 mcg/kg/day
  • 3 to 6 months: 8-10 mcg/kg/day
  • 6 to 12 months: 6-8 mcg/kg/day
  • 1 to 5 years: 5-6 mcg/kg/day
  • 6 to 12 years: 4-5 mcg/kg/day
  • >12 years: 2-3 mcg/kg/day
  • If growth and puberty are complete: 1.7 mcg/kg/day

Ongoing laboratory monitoring and follow-up are also age-dependent. Because normal thyroid function in the first 3 years of life is critical for normal development, more frequent monitoring is necessary for young infants and young children. Thyroid function testing is recommended 2 to 4 weeks after initiating therapy. The goal of treatment is to normalize TSH levels. Once this is accomplished, monitoring is based on the age of the child. 

167.

A 7-year-old female in the first grade is brought in for a clinic appointment by her parents because they are concerned that she is not yet reading, and is, therefore, falling behind her peers. They report that she struggles to identify letters correctly, write on the lines of the paper, and use scissors. Despite reassurance from her teachers that "she is a diligent student who tries hard and will catch up," they have sought extra assistance outside of school. They also report that she has difficulties interacting with other children her age and has very few friends when compared to her 10-year-old brother. Her teacher reports that she is quiet and shy and often overshadowed by her peers.

Which of the following tests would be MOST appropriate to further assess her development?

  • Parent's Evaluation of Developmental Status (PEDS)

  • Vanderbilt Assessment Scale

  • Ages and Stages Questionnaire (ASQ)

  • Patient Health Questionnaire (PHQ)

Correct answer: Parent's Evaluation of Developmental Status (PEDS)

The PEDS is a parent interview screening/surveillance form that is designed to screen development, social-emotional, behavior, and mental health domains in the child, and identifies children at low, moderate, and high-risk for disabilities and delays. Parents are asked to complete ten questions, only taking a few minutes to complete them. 

It is appropriate for use from birth to 8 years old, and available in English, Spanish, Vietnamese, and many other languages, making it readily accessible for many families whose primary language is not English.

The Vanderbilt Assessment Scale is a tool that is used for school-age children and adolescents to evaluate inattention, hyperactivity, conduct disorders, and anxiety or depression. 

ASQ is used to screen for social-emotional development in the three- to 60-month-old child. 

PHQ is used for both children and adults as a psychosocial screening tool for depression and suicide.

168.

Which of the following antihypertensive medications for children is a direct vasodilator?

  • Hydralazine (Apresoline)

  • Labetalol (Trandate)

  • Losartan (Cozaar)

  • Amlodipine (Norvasc)

Correct answer: Hydralazine (Apresoline)

Hydralazine is in a class of medications called direct vasodilators, and acts directly on the blood vessel walls, relaxing muscles to allow blood to flow more easily. They are reserved for patients with hypertension that is extremely difficult to control and are sometimes used to treat a hypertensive crisis.

Labetalol is a beta-blocker. Losartan is an angiotensin-receptor blocker (ARB), and amlodipine is a calcium channel blocker (CCB).

169.

Which of the following statements is CORRECT regarding behavioral intervention in young children with cognitive-perceptual disorders?

  • Behavioral interventions should precede pharmacologic therapy for aggression

  • Pediatric mental health conditions are uncommon

  • Intentionally ignoring negative behavior is not helpful

  • Positive reinforcement should not be recommended

Correct answer: Behavioral interventions should precede pharmacologic therapy for aggression 

Behavior management is a set of specific interventions with the goal of modifying the physical and social environment to alter behavior. Multiple parenting programs exist that help caregivers give differential attention to and set up rewards and reinforcers for positive behavior, give clear and effective commands and structure, and establish safe and consistent discipline strategies, including intentionally ignoring negative behaviors.

Behavioral interventions are clearly effective and should be used initially exclusive of medication if the child is younger than 6 years old, symptoms are mild, and/or DSM criteria are not met.

170.

A 3-day-old male presents to the pediatric clinic with a 2-day history of serosanguinous discharge, edematous bulbar, and palpebral conjunctiva to both eyes. The mother reports that she had a vaginal birth at home, with a midwife present. You decide to treat the baby for N. gonorrhoeae conjunctivitis because the mother is unsure if prophylactic eye ointment was given. The birth was uncomplicated. Mom denies having a (sexually transmitted infection) STI before.

In the case that the prophylaxis eye ointment was given, what is the MOST likely cause of symptoms?

  • Chemical conjunctivitis

  • Chlamydial conjunctivitis

  • Gonococcal conjunctivitis

  • Ophthalmia neonatorum

Correct answer: Chemical conjunctivitis 

A prior common cause of conjunctivitis in the newborn was chemical conjunctivitis from the prophylactic administration of silver nitrate at birth, which is one reason the product is no longer recommended. 

Chemical conjunctivitis usually occurs in the first 24 to 72 hours of life and frequently manifests as nonpurulent drainage and edematous bulbar and palpebral conjunctiva. It generally resolves without specific treatment within 3 to 4 days.

Chlamydial and gonococcal conjunctivitis are two types of ophthalmia neonatorum, a neonatal infection contracted by newborns during delivery from a mother infected with either Neisseria gonorrhoeae or Chlamydia trachomatis. The U.S. Preventive Services Task Force recommends prophylactic topical 1% tetracycline or 0.5% erythromycin ointment administered within 24 hours after birth for prevention of gonococcal conjunctivitis, as this is the most serious cause of ophthalmia neonatorum owing to concerns of the bacteria causing corneal perforation and blindness. 

171.

A 17-year-old female with intellectual disability (ID) is accompanied by her mother to the clinic to see you. The patient is being seen because her mother is insisting she gets an intrauterine device (IUD) placed. The patient is refusing contraceptive placement.

What should you do in this scenario?

  • Respect the patient's wishes

  • With the mother's consent, proceed with contraceptive placement

  • Obtain a court order

  • Call child protective services

Correct answer: Respect the patient's wishes

Thoroughly explain risks and benefits of long-acting contraceptives, as well as the risks of participating in unprotected sex, including STIs, pregnancy, and HIV, according to the patient's cognitive level of understanding. If the patient continues to refuse placement at that time, her wishes must be respected.

There are several fields in which minors (under 18 years of age) have the right to receive or refuse treatment, which include contraception use, abortion, and prenatal care, as well as drug, alcohol, and mental health services.

172.

Which of the following members of the pediatric health care team are responsible for identifying performance improvement projects?

  • All staff members

  • Administrative staff

  • Nursing team leaders

  • Primary care providers

Correct answer: All staff members

 All staff members are responsible for identifying performance improvement projects.

173.

Which of the following statements is TRUE concerning the supervision of the functions of advanced practice nurses (APNs)?

  • The nursing profession outlines the scope of practice and defines its boundaries

  • National laws regulate the scope of practice for advanced practice nurses (APNs)

  • Employers are responsible for ensuring that APNs practice within the boundaries defined by state practice acts

  • The APN may practice throughout the country as long as s/he is licensed in at least one state

Correct answer: The nursing profession outlines the scope of practice and defines its boundaries 

The nursing profession defines the boundaries of professional nursing practice by developing and enforcing the scope and standards of nursing practice, and by informing the public about the parameters of nursing practice.

Each state has its own rules and regulations about nursing practice; therefore, the functions, scope of practice, and titles may differ from state-to-state, especially at the advanced practice level. The practitioner must be licensed in the state in which s/he works. Each nurse practitioner (not their employer) is responsible for ensuring that they practice within the boundaries set by their particular state practice act, as well as within the limits of their own competency, the professional code of ethics, and professional practice standards.

174.

Which of the following is NOT considered to be a risk factor for the development of significant hyperbilirubinemia in the neonate?

  • Physiologic jaundice

  • Hemolytic anemia

  • A previous sibling required phototherapy

  • ABO or Rh incompatibilities in previous pregnancies

Correct answer: Physiologic jaundice

Physiologic jaundice is the most common type of jaundice in the newborn period with the infant showing no signs of illness. It generally lasts 10-12 days and resolves spontaneously without treatment. Early- and late-onset jaundice associated with breast-feeding are often included in the category of physiologic jaundice; however, breast-feeding is not a risk factor for the development of hyperbilirubinemia, as it almost always has a benign and transient course. 

The other answer choices are risk factors for developing significant hyperbilirubinemia. Other risk factors include:

  • Inborn error of metabolism
  • Early or severe jaundice
  • Ethnic or geographic origin associated with hemolytic anemia
  • Hepatobiliary disease
  • Sepsis risk for the infant
  • Macrosomic IDA

175.

Which of the following organizations ultimately decides whether or not to admit an immigration applicant to the United States?

  • U.S. Citizenship and Immigration Service

  • U.S. Department of State Consulates

  • Centers for Disease Control and Prevention (CDC)

  • The United States Embassy

Correct answer: U.S. Citizenship and Immigration Service

The ultimate decision to admit an applicant to the United States rests with the U.S. Citizenship and Immigration Service. The United States embassy or consulate in the individual's country of origin decides to grant or deny an immigrant visa. 

Health assessments are done by physicians in the applicant's country of origin. This panel of physicians is appointed by the U.S. Department of State Consulates, or by physicians in the U.S. (civil surgeons appointed by the U.S. Citizenship and Immigration Service). Applicants who present at port of entry to the United States with an inadmissible condition may be placed in isolation or quarantine, located at U.S. borders and staffed by the CDC.

176.

A 9-month-old male is scheduled to be seen for a well-child visit and is current on his immunizations. What vaccine is he MOST likely to be eligible to receive at this visit?

  • Hepatitis B

  • Rotavirus

  • Measles, mumps, rubella (MMR)

  • Varicella

Correct answer: Hepatitis B

The Hepatitis B virus vaccine (HBV) is a 3- or 4-dose series with the first dose given within 24 hours of birth, dose 2 given at 1 month of age (1 month after first dose) and the last dose completed between 6 to 18 months of age (preferably 6 months after first dose).

Given orally, the rotavirus vaccine is either a 2- or 3-dose series that is recommended for infants between 6 to 32 weeks old (generally given at 2, 4, and 6 months). A 9-month-old infant, therefore, would be too old to receive this vaccine.

MMR and varicella should both be administered as a 2-dose series with the first dose occurring at 12 months (through 15 months of age) and the second dose between 4 to 6 years of age. Children can receive the second dose of MMR earlier as long as it is at least 28 days after the first dose or any other live vaccine. A 9-month-old infant would be too young to receive these vaccines.

177.

Which of the following actions creates a barrier to safe and effective pediatric health care?

  • Ineffective disclosure of errors to patients and their families

  • Input from various team members

  • Use of informatics to lead and inform team discussions

  • Raising an objection regarding the treatment plan to a team member with a higher level of healthcare education

Correct answer: Ineffective disclosure of errors to patients and their families 

Communication is essential for collaborative team care. Open and honest communication is necessary to manage emotionally difficult information with patients and families, including effective error disclosure or end-of-life information. In addition to openness and honesty, understanding and the ability to convey messages in a sensitive and respectful manner to both patients and colleagues is necessary for effective health care.

The other answer choices facilitate safe and effective health care in the pediatric population.

178.

Which of the following organizations is NOT involved in annually approving a unified recommended childhood immunization schedule for the United States?

  • World Health Organization (WHO)

  • Advisory Committee on Immunization Practices (ACIP)

  • American Academy of Pediatrics (AAP)

  • American Academy of Family Physicians (AAFP)

Correct answer: World Health Organization (WHO)

The ACIP of the Centers for Disease Control (CDC), the AAP, and the AAFP annually approve a new unified recommended childhood immunization schedule for the United States. Providers can download the most recent immunization schedules at the beginning of each calendar year from the CDC.

Other countries may follow the WHO schedule or determine their own recommendations. 

179.

Anorexia, growth retardation, skin changes, and immunologic abnormalities are all signs of a deficit in which of the following minerals?

  • Zinc

  • Iron

  • Magnesium

  • Calcium

Correct answer: Zinc

Zinc is a mineral that aids in cellular metabolism, growth, and repair. It is found in meats, animal products, seafood (especially oysters), and eggs. You should suspect a zinc deficiency in the child who presents with anorexia, growth retardation, skin changes, and immunologic abnormalities. 

Signs of too much zinc include GI upset, vomiting, acute toxicity, and impaired immune response.

180.

The initial sign of male puberty is:

  • Testicular enlargement

  • Development of pubic hair

  • Change in the voice

  • Rapid growth in height

Correct answer: Testicular enlargement 

The initial sign of puberty in males is testicular enlargement, on average occurring at 11.5 years old. The growth of the testes occurs approximately 6 months before the development of pubic hair in most males. Once puberty begins, the left testis generally hangs lower than the right. If testicular enlargement does not precede other changes, the provider should consider whether the adolescent is taking exogenous anabolic steroids. 

Change in the male voice coincides with peak height velocity (PHV). Rapid growth in height (PHV) tends to occur later in puberty for boys. Boys generally lag about 2 years behind girls, but 95% have their growth spurt between 12 and 16 years old. Males can continue to grow (although minimally) well beyond their teenage years, but most males complete linear growth by age 17. 

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