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CPN Study Questions 1-100 Exam 100 Questions with Verified Answers,100% CORRECT

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CPN Study Questions 1-100 Exam 100 Questions with Verified Answers A 6-week-old male infant is brought into the ED by his mother. He has a weeklong history of progressively worsening emesis that... is projectile in nature. What is his most likely diagnosis? A. Intussusception. B. Appendicitis. C. Pyloric stenosis. D. Pancreatitis. - CORRECT ANSWER C: Projectile vomiting in a 6 week-old male is the classic presentation for pyloric stenosis, obstruction of the pyloric sphincter between the gastric pylorus and the small intestine, caused by hypertrophy and hyperplasia of the circular muscle of the pylorus, which obstructs the sphincter. An 8-year-old male has contracted chicken pox (varicella virus). With which of the following family members can the child have contact? A. 20-year-old aunt on chemotherapy. B. 35-year-old uncle with HIV. C. 95-year-old grandfather on long-term steroid therapy. D. 2-year-old brother who has never had varicella but has had the vaccine - CORRECT ANSWER D: The 2-year-old brother, who has had the vaccine, is likely immune to varicella, so contact is safe. All of the other relatives have some form of immunosuppression from infection (HIV) or medications (chemotherapy and steroids) and should avoid contact with the patient A 5-year-old girl has a fever, headache, and complaints of a stiff neck. The physician suspects bacterial meningitis. What is the best test culture site to detect the bacteria? A. Lumbar puncture. B. Clean catch urine. C. Blood culture. D. Nasal swab. - CORRECT ANSWER A: Lumbar puncture is the method of choice for detecting the bacteria causing bacterial meningitis and sending a sample for culture, as meningitis infects the meninges and bacteria is present in the cerebrospinal fluid. A 2-year-old child has severe dental caries in the upper and lower front teeth, posterior aspects. What is the most likely cause for this type of caries? A. Lack of fluoridation in the water. B. Sleeping with water in a nighttime bottle. C. Low carbohydrate diet. D. Sleeping with sugared liquid in nighttime bottle - CORRECT ANSWER D: Caries in the posterior front teeth is a sign of sleeping with sugared drinks in the nighttime bottle (such as juice) because fluid pools in the mouth when the child falls to sleep. ***Which of the following patients will likely need surgical correction of his/her fracture?*** A. 10-year-old with humeral head fracture. B. 5-year-old with tuft fracture of the distal phalanx. C. 4-year-old with tuft fracture of the toe. D. 16-year-old with radial head fracture. - CORRECT ANSWER A: Humeral head fractures usually need open reduction and internal fixation to maintain proper future functioning. Distal phalanx and toe fractures are treated with splints and fracture of the radial head with a sling. An infant with a chronic respiratory condition should be offered all of the following vaccines EXCEPT: A. Hepatitis A. B. Hepatitis B. C. Hepatitis C. D. Influenza. - CORRECT ANSWER C: A vaccine for Hepatitis C does not currently exist. Hepatitis A, hepatitis B and influenza vaccines are all recommended for the infant A 14-year-old boy with leukemia is receiving an IV infusion of packed red blood cells. The client reports that he is feeling anxious and short of breath even though his respiratory rate is 24. What should the nurse do in this situation? A. Give a dose of ibuprofen (Motrin). B. Give a dose of acetaminophen (Tylenol). C. Give a dose of diphenhydramine (Benadryl). D. Stop infusion and notify physician. - CORRECT ANSWER D: Anxiety and the sensation of breathlessness are signs of possible anaphylactic shock, a reaction to the packed red blood cells, so the nurse should stop the infusion immediately and notify the physician. As part of counseling for a 7-year-old child with mild persistent asthma, the nurse tells the client's family that the most reliable indicator of worsening asthma is: A. Coughing. B. Fever. C. Decreased peak flow. D. Fatigue. - CORRECT ANSWER C: A decreased peak flow is the most reliable indicator that asthma may be worsening. It is therefore vital that the client's family know what the baseline is so that any deviation can be quickly addressed. Coughing and fever may trigger asthma, so peak flows should be monitored. Fatigue may result from poor oxygenation but alone it is not a reliable indicator of worsening asthma. ***A patient is experiencing dizziness, shortness of breath, lightheadedness, and nausea caused by encephalitis. Which of the following descriptions most accurately describes the patient's condition?*** A. metabolic acidosis B. respiratory alkalosis C. metabolic alkalosis D. respiratory acidosis - CORRECT ANSWER B: Respiratory alkalosis results from hyperventilation, during which extra CO2 is excreted, causing a decrease in carbonic acid (H2CO3) concentration in the plasma. Symptoms include tachycardia, arrhythmias, lightheadedness, nausea, and vomiting. 10-year-old male with sickle cell disease comes into the ED complaining of pain in his legs due to a vaso-occlusive crisis. In addition to IV fluids, what is the other initial treatment for this client? A. Elevate legs. B. Ace wrap to legs. C. Nitroglycerine paste. D. Pain medication. - CORRECT ANSWER D: In addition to IV fluids, the other primary initial treatment for sickle cell crisis resulting in vascular occlusion is pain medication because pain is often severe. Other treatments include oxygen, hydroxyurea (anti-sickling medication), blood transfusions if anemia is pronounced, and antibiotics if the crisis was triggered by an infection. 14-year-old male with renal failure is given an arteriovenous fistula (shunt) for future dialysis. How does the nurse assess the shunt post-operatively for patency? A. Assess for bruit and thrill. B. Monitor blood pressure on that arm. C. Ease of venipuncture at shunt site. D. Rate of flow during dialysis. - CORRECT ANSWER A: The patency of an AV shunt is assured by assessing for bruit and thrill. Continuous wave Doppler ultrasound can also assess patency. Venipuncture and blood pressure measurements should never be done on the arm with an AV shunt. nurse is admitting a 16-year-old female to the mental health unit with a diagnosis of bulimia and anorexia. What OTC medications should the client's belongings be screened for as they may interfere with treatment? A. Imodium. B. Acetaminophen (Tylenol). C. Laxatives. D. Ibuprofen (Motrin). - CORRECT ANSWER C: People with eating disorders, such as bulimia and anorexia, often use laxatives as well as diuretics to control weight. New patients should be checked for these items. Bulimics may purge by vomiting after eating. 10-year-old is accidentally shot in the forearm by a small caliber firearm. The wound enters the dorsum of the forearm and exits on the ventral side. The patient is ambulatory and has minor pain at the site. What test is likely needed for evaluation of the injury? A. Arteriogram. B. CT of arm. C. MRI of arm. D. Ultrasound of arm - CORRECT ANSWER A: An arteriogram is needed to assess the vascular supply in the arm after a gunshot wound to ensure that no injury to the ulnar and radial artery has occurred. A 17-year-old female with severe acne wants treatment for her condition. What form of treatment requires the patient use 2 forms of contraception and sign a consent form? A. Benzoyl peroxide cream. B. Tetracycline (Sumycin) pills. C. Isotretinoin (Accutane) pills. D. Ultraviolet light treatment. - CORRECT ANSWER C: Accutane is a vitamin A derivative and can lead to severe birth defects if given to pregnant females. Two forms of contraception and a lengthy consent form are needed. Benzoyl peroxide and ultraviolet light treatment pose no risks to the fetus. Tetracycline has a low risk during the first trimester of pregnancy but can cause discoloration of the child's teeth if taken during the second trimester. An 8-year-old with suspected appendicitis is evaluated. The physician asks the child to lie on his left side and extend the hip, eliciting pain in the RLQ. What is this test called? A. Rovsing's sign. B. Psoas sign. C. Kernig's sign. D. Brudzinski's sign. - CORRECT ANSWER B: The Psoas sign consists of extension of the thigh while lying on the left side and causes pain with a posterior pointing appendix. Rovsing's sign also assesses for appendicitis and elicits referred pain in the right lower quadrant with palpation in the left lower quadrant. Kernig's sign and Brudzinski's sign are used to assess for meningitis. In order to collect proper blood culture samples, which of the following actions should the nurse take? A. Sterilize the antecubital fossa with iodine. B. Draw sample from femoral site. C. Cleanse the site with alcohol. D. Shave collection site. - CORRECT ANSWER A: In order to minimize contaminants, blood cultures are taken from the antecubital fossa after sterilizing with iodine and wearing sterile gloves. Alcohol cleansing does not sterilize, and shaving can break the skin, increasing the chance of contamination. Samples are not routinely drawn from the femoral site. The child of a celebrity client is admitted to a nursing floor, and the nurse taking care of this patient notices a medical assistant not involved in the care of the patient looking at her chart. What would be the most appropriate course of action? A. Confront medical assistant and make her apologize. B. Notify nursing supervisor of HIPAA violation. C. Place chart in locked cabinet. D. Place chart at end of client's bed. - CORRECT ANSWER B: An unauthorized person's looking at any patient's chart is a clear HIPAA violation and must be reported to the supervisor in charge so that appropriate disciplinary action can be taken. A 7-year-old female is newly diagnosed with celiac disease. What is the best choice for a carbohydrate food source for this patient? A. Baked potato. B. Pasta. C. Bread. D. Saltine crackers. - CORRECT ANSWER A: Only the potato is a suitable source of carbohydrate for a person with celiac disease. Celiac disease is an allergic sensitivity to gluten in wheat products. Pasta, bread, and saltine crackers are all made with flour, which contains gluten. The parents of a newborn male ask you about the benefits of circumcision. It is appropriate to inform them that circumcision seems to decrease the risk of transmission of which of the following sexually transmitted diseases? A. Human papillomavirus (HPV). B. Syphilis. C. HIV. D. Hepatitis C. - CORRECT ANSWER C: Circumcision has been shown to decrease the rates of transmission of HIV but does not affect rates of syphilis, HPV, or hepatitis C. A 15-year-old female is diagnosed with a newly-acquired infectious disease. Which of the following is NOT a mandatory reportable disease to the health department? A. TB. B. Varicella. C. Syphilis. D. Rabies. - CORRECT ANSWER B: Varicella (chickenpox) is not a reportable disease, and most children are vaccinated for varicella; however, the CDC requires reporting of TB, syphilis, and rabies as these are public health concerns. Following an exposure to a TB-infected family member, a twelve-year-old male is screened for TB with a PPD (Mantoux) test. After administration of the test, when should he be brought back for reading of the result? A. 24 to 36 hours. B. 36 to 48 hours. C. 48 to 72 hours. D. 72 to 96 hours. - CORRECT ANSWER C: PPD tests should be read 48 to 72 hours after administration. Any sign of induration is measured. Induration of 15 mm or blistering is a positive finding for general screening, but if the person has been exposed to someone with active TB, then 10 mm induration is considered positive. A newborn is scheduled for a chloride sweat test. For which genetic disorder does this test screen? A. Muscular dystrophy. B. Cystic Fibrosis. C. Trisomy 18. D. Fragile X. - CORRECT ANSWER B: A chloride sweat test is used in the diagnosis of cystic fibrosis, which affects excretion of sodium and chloride in the sweat. A child with cystic fibrosis will have up to 5 times the normal level of sodium and chloride in his sweat. A teenage female at a school health clinic asks the nurse what she can do to prevent contracting the human papilloma virus (HPV). All of the following would be considered suitable means of prevention EXCEPT: A. Abstinence. B. Condom use. C. Gardasil vaccine. D. Intrauterine devices. - CORRECT ANSWER D: IUD's offer no protection for HPV and only provide birth control. Abstinence, condom use, and Gardasil vaccine, recommended for girls/women ages 9 to 26, all provide protection against HPV. Which of the following children has a fracture most likely caused by abuse? A. 6-month-old with a spiral fracture of the femur. B. 5-year-old with a wrist fracture. C. 8-year-old with a clavicle fracture. D. 15-year-old with an avulsion fracture of the ankle. - CORRECT ANSWER A: Spiral fractures in children are considered due to abuse until proven otherwise. These fractures result from a twisting force that the child would not be able to perform on her own. Which of the following conditions increases the risk of testicular cancer? A. Undescended testes. B. Umbilical hernia. C. Inguinal hernia. D. Hiatal hernia. - CORRECT ANSWER A: An undescended testis increases the risk of testicular cancer in adulthood in the affected testis as well as the contralateral testis. Hernias are unrelated to incidence of testicular cancer. A 2-year-old client with a corneal abrasion needs to be examined. What is the best positioning for this client? A. Restrained on papoose board. B. Restrained by parent on gurney. C. Under sedation in an operative room. D. Held on a parent's lap - CORRECT ANSWER D: Difficult examinations should be initially attempted while the child is sitting on a parent's lap. This will allow examination while under the calming care of the parent. Restraints are psychologically traumatic and should be used as a last resort only. Sedation in the operating room is not necessary Following a diagnosis of cystic fibrosis in their infant child, the parents should be educated in all of the following EXCEPT: A. Genetic counseling. B. Sign language. C. Home chest percussions. D. Dietary modifications. - CORRECT ANSWER B: CF is not directly associated with deafness, so education in sign language is not indicated although repeated treatment with antibiotics (aminoglycosides) can cause sensorineural hearing deficit. Cystic fibrosis is an autosomal recessive disease and the parents should receive genetic counseling about the risk of the disease in future offspring. CF has both pulmonary and pancreatic manifestations so chest percussions and dietary modifications would be appropriate. Which of the following medications has been linked to the development of Reye's syndrome when given to febrile children? A. Acetaminophen (Tylenol). B. Naprosyn (Aleve). C. Aspirin. D. Ibuprofen (Motrin). - CORRECT ANSWER C: Use of aspirin in febrile children has been linked to the development of Reye's syndrome, a severe respiratory condition. Therefore, aspirin is not recommended for use in children. Fever in children is usually treated with acetaminophen or ibuprofen. A newborn with jaundice is treated with outpatient ultraviolet light therapy. What blood test is tested to ensure that the jaundice is clearing? A. Bilirubin. B. CBC. C. AST. D. Amylase. - CORRECT ANSWER A: Jaundice is caused by an elevation of bilirubin, which is monitored to ensure treatment success. As red blood cells break down, bilirubin forms and is excreted through the liver, but the infant's liver may be immature and unable to remove bilirubin fast enough, so bilirubin levels in the blood rise. Ultraviolet light helps to break down bilirubin. A 2-month-old male is being evaluated for gastroesophageal reflux. What is the best test to confirm this diagnosis? A. CT scan. B. Barium enema. C. Upper GI barium series D. Night-time Ph probe - CORRECT ANSWER D: A nighttime Ph probe requires a special monitoring device be inserted through the nose and down the esophagus to assess for acid reflux into the esophagus, confirming the diagnosis. A 16-year-old female is undergoing an evaluation for possible juvenile rheumatoid arthritis. What lab test serves as a marker for general inflammation? A. Monospot. B. Erythrocyte sedimentation rate. C. White blood count (WBC). D. Mean corpuscular volume (MCV) - CORRECT ANSWER B:The erythrocyte sedimentation rate is a non-specific marker for inflammation and would be elevated with rheumatoid arthritis. Monospot tests for the Epstein-Barr virus, which causes mononucleosis. WBC tests for infection, and MCV assesses the average volume of red blood cells. A 7-year-old female is evaluated for possible leukemia. She is scheduled for a bone marrow biopsy the next morning. What part of the body should be listed on the consent form for the biopsy? A. Radius. B. Skull. C. Posterior pelvis. D. Calcaneus (heel). - CORRECT ANSWER C: The posterior superior pelvic area is the preferred choice for bone marrow biopsy site because it is a large flat bone. The skull is too thin and the radius and calcaneus too small. While performing trauma resuscitation on a 5-year-old male, neither peripheral nor central IV access can be obtained. The physician orders an intraosseous line. What is the best site on the body for this line? A. Radius. B. Proximal anterior tibia. C. Skull. D. Medial malleolus. - CORRECT ANSWER B: An intraosseous line is inserted into the proximal anterior tibia in infants and children to 5 years old for rapid infusion of fluids and medications if another IV site is not accessible. The medial malleolus is used for older children and adults. Other possible sites include the distal femur, clavicle, humerus, and ileum. A 5-year-old is diagnosed with probable "Fifth's disease" caused by Parvovirus B19 although she does not yet have a rash. Which of the following should the child avoid? A. Contact sports. B. Tylenol. C. Pregnant women. D. Spicy food - CORRECT ANSWER C: Parvovirus B19 can cause birth defects if contracted by a pregnant mother, so the child should be counseled to avoid anyone pregnant until the disease resolves. Parvovirus B19 is contagious in the time from onset until the bright red rash occurs on the cheeks and a lacy rash on the body. Once the rash appears, the child is probably no longer contagious and can resume normal contacts and activity A 13-year-old female is diagnosed with Clostridium difficile colitis. What is the most probable cause of this infection? A. Recent antibiotic use. B. Travel to Central America. C. Drinking from a stream. D. Eating undercooked pork - CORRECT ANSWER A: The most common cause for C. difficile colitis is recent antibiotic use that disrupts the normal colonic flora, allowing overgrowth of the offending bacteria. C. difficile produces a lethal cytotoxin (Toxin B) and an endotoxin with cytotoxic action (Toxin A), which cause fluid to accumulate in the colon and severe damage to mucous membranes. A 14-year-old male is suspected of having infectious mononucleosis. What Point of Care Testing (POCT) device can be used to confirm this diagnosis? A. Urine dip. B. Monospot. C. Rapid strep test. D. Rapid influenza test - CORRECT ANSWER B: A Monospot test for Epstein-Barr virus is used to confirm infectious mononucleosis. The test requires one drop of serum mixed with a special solution. The test can confirm mononucleosis between 2 and 9 weeks after infection. It is not accurate during the incubation period. A 12-year-old female immigrant from the Philippines has a positive PPD (Mantoux) skin test. What vaccine given routinely in her native country can cause false positive PPD tests? A. Varicella. B. Yellow fever. C. Influenza. D. BCG. - CORRECT ANSWER D: BCG (Bacille Calmette-Guérin) is a tuberculosis vaccine routinely administered to children in countries with high incidences of childhood tuberculous meningitis. PPD can show false positive although PPD may still be used. QuantiFERON-TB®-TB Gold test is not affected by prior BCG vaccination Which of the following congenital hernias is more commonly seen in African-American children? A. Umbilical hernia. B. Inguinal hernia. C. Hiatal hernia. D. Femoral hernia. - CORRECT ANSWER A: Umbilical hernias are more common in African-American children. They usually resolve with growth of the child by age 4 and do not require surgical correction A 13-year-old female has the development of breast buds and sparse long, downy pubic hair. What Tanner stage does this development suggest? A. Tanner 1. B. Tanner 2. C. Tanner 3. D. Tanner 4. - CORRECT ANSWER B: Breast buds and sparse downy pubic hair are characteristics of Tanner stage 2. Tanner's 5 stages assess maturity of both males and females based on direct observation of breasts and genitals. Females are evaluated on breast development, onset of menses, and pubic hair distribution. Males are evaluation on penis and testes development and pubic hair distribution Apocrine sweat glands develop during onset of puberty. In which part of the body are these glands most commonly located? A. Scalp. B. Feet. C. Hands. D. Axilla - CORRECT ANSWER D: Apocrine sweat glands develop with the increase in hormones during the onset of puberty and are located primarily in the axilla and pubic area, opening into hair follicles. These sweat glands cause body odor. A 16-year-old male has hearing loss at the 4000-Hertz range on audiogram. What is the most common cause for such a hearing deficit? A. Cerumen in the ear canal. B. Prolonged exposure to noises over 100 decibels. C. Medulla oblongata tumor. D. Ruptured tympanic membrane. - CORRECT ANSWER B: Prolonged exposure to loud noises (music, power tools, firearms) can lead to high frequency hearing loss at the 4000-Hertz level, making it hard for the child to hear high-pitched voices and certain sounds, such as consonants. Digital hearing aids may be programmed to compensate for high frequency hearing loss Which of the following would NOT be considered a pediatric patient at high risk for dehydration? A. 4-year-old male with 30% body surface area burn. B. 7-year-old female with diabetic ketoacidosis C. 12-year-old male with hyperventilation due to anxiety D. 8-year-old male with cellulitis in the right arm. - CORRECT ANSWER D: Cellulitis, a bacterial skin infection, is not associated with dehydration. Burns, diabetic ketoacidosis, and hyperventilation may all contribute to dehydration in children. A 15-year-old female is evaluated for an intentional overdose of aspirin. The excessive ingestion of this medication puts the patient at risk for what acid-base disorder? A. Metabolic acidosis. B. Metabolic alkalosis. C. Respiratory acidosis. D. Respiratory alkalosis. - CORRECT ANSWER A: The ingestion of aspirin (salicylic acid) puts the patient at risk for a metabolic acidosis due to the acidic medication. Symptoms include drowsiness, confusion, headache, decreased blood pressure, flushed skin, nausea, vomiting, diarrhea and tachypnea. Symptoms consistent with a diagnosis of dehydration in children would include all of the following EXCEPT: A. Thirst. B. Bradycardia. C. Dry mucous membranes. D. Depressed fontanelles. - CORRECT ANSWER B: Tachycardia, not bradycardia, is a common sign of dehydration in pediatric patients. Children with dehydration typically are thirsty and have dry mucous membranes, reduced skin turgor, and depressed fontanelles (in infants). A 6-year-old female with dehydration due to vomiting is evaluated with a complete blood count (CBC). What lab finding is expected? A. Decreased mean corpuscular (cell) volume (MCV). B. Increased MCV. C. Increased hematocrit. D. Normal red cell distribution width (RDW). - CORRECT ANSWER C: Due to volume loss, the hematocrit will be elevated as red blood cells become more concentrated in the blood. The MCV test shows the average size of the red blood cells and helps to determine the type of anemia while RDW shows the variations in cell size, important for some types of anemia (such as pernicious anemia). What is the leading cause of death in children in developing countries? A. Accidental trauma. B. TB. C. AIDS. D. Infectious diarrhea. - CORRECT ANSWER D: Infectious diarrhea remains the leading cause of death in developing countries. Outbreaks of diarrhea are common in areas with poor sanitation that allows food and water to become contaminated with bacteria, such as E. coli or Shigella. What is the most common cause of viral (non-bacterial) diarrhea in pediatric patients? A. Rotavirus. B. Parainfluenza. C. Influenza. D. Parvovirus B19. - CORRECT ANSWER A: Rotavirus is the most common cause for viral diarrhea in children and may be accompanied by nausea and vomiting that lead to severe dehydration. Parainfluenza, influenza, and parvovirus B19 cause mainly upper respiratory illnesses. After a camping trip a 14-year-old male develops diarrhea, flatulence, steatorrhea, and abdominal cramping. The other campers who drank water from a stream also have similar symptoms. What is the most likely causative organism? A. Coli. B. Giardia Lamblia. C. Rotavirus. D. Shigella. - CORRECT ANSWER B: Giardia Lamblia is a parasite that is commonly spread via the drinking of contaminated water, especially streams that are contaminated with animal feces. A broad spectrum of gastrointestinal symptoms can occur. A 2-year-old female is undergoing an evaluation for celiac disease (sprue). Which of the following is NOT a risk factor for this disease? A. First degree relative with the disease. B. Recent travel to Mexico. C. Congenital trisomy 21. D. History of type 1 diabetes mellitus - CORRECT ANSWER B: Celiac disease is not infectious and not related to travel. Celiac disease (sprue) is sensitivity to gluten products and is more commonly seen in children with relatives with the disease, those with trisomy 21, or those with type 1 diabetes. A 6-year-old male grabbed a pot of boiling water off of a stove and has a burn on the dorsum of the forearm. The burn area is red with edema and thin-walled blisters. What classification of burn is this? A. First-degree burn. B. Second-degree burn. C. Third-degree burn. - CORRECT ANSWER B: A burn area that is red with blistering is consistent with a seconD:degree burn. A firstdegree burn would have erythema but no blistering, and a thirD:degree burn would be dry and leathery. Burns are not classified as fourth-degree. Antibodies exist in the body to respond to allergens and protect the body against disease. Which antibodies act primarily against parasitic infections? - CORRECT ANSWER A: IgE is the primary antibody used in the defense of parasitic infections and is involved in allergic responses. IgM increases in response to infection, and IgG provides a secondary response to infection. IgA provides immune response in mucous membranes and decreases with immunosuppression and some infections (gonorrhea). A child presents with history of fever for 2 days at 102 degrees F. At what age would the child likely need a spinal tap and full work up for sepsis based on the fever only? - CORRECT ANSWER A: Children less than 6 months of age have immature immune systems, so a fever in a 3- month-old child would necessitate a full work up for sepsis. In caring for a child with a history of HIV infection, which of the following immunizations should NOT be given to the child? - CORRECT ANSWER D: As the varicella vaccine is live, it should not be given to anyone with a potentially suppressed immune system, such as a child with HIV, as it may cause infection even in such a small dose. MMR, influenza and tetanus are not live vaccines and may be administered. Due to sickle cell disease, a 7-year-old female is considered to be asplenic from repeated splenic sequestration crises. What vaccine should she get to protect her from encapsulated bacteria? - CORRECT ANSWER C: Patients with no spleen function (either from removal after trauma or autoinfarction due to sickle cell disease) should have the pneumococcal vaccine to prevent infection with encapsulated bacteria Which of the following children over the age of 6 months should NOT be given the influenza vaccine? - CORRECT ANSWER D: A patient with streptococcal pharyngitis does not have a chronic medical condition for which influenza administration is recommended. Children with chronic diseases, such as renal disease, HIV, and type 1 diabetes, should receive the influenzae vaccine as influenza infection could be life threatening Which of the following patients would be most at risk from meningitis due to the severity of their current infection? - CORRECT ANSWER C: Peri-orbital cellulitis can spread to the central nervous system and lead to meningitis due to the venous drainage from this area. The infection can travel along vessels and nerve pathways into the lining of the brain. Peri-orbital cellulitis should be treated with antibiotics and the patient closely monitored. A 5-year-old with suspected meningitis is evaluated with a lumbar puncture. Which of the following lab results would NOT be consistent with a diagnosis of bacterial meningitis? - CORRECT ANSWER A: An elevated WBC, not a decreased level, is consistent with a diagnosis of bacterial meningitis along with elevated protein, decreased glucose, and cloudiness in the cerebrospinal fluid. Bronchodilators are used to improve respiratory function and relax pulmonary musculature. Which of the following medications is NOT a bronchodilator? A. Albuterol (Proventil). B. Theophylline. C. Prednisolone (Prelone). D. Levalbuterol (Xopenex). - CORRECT ANSWER C: Prednisolone is a corticosteroid and is used to reduce inflammation but is not a bronchodilator. Albuterol, theophylline, and levalbuterol are all bronchodilators used to treat asthma by increasing airflow. Cystic fibrosis patients can develop breathing difficulty due to the viscosity of their sputum. Which of the following medications is used as a mucolytic agent to thin out the mucous and help them breathe better? A. Acetylcysteine (Mucomyst). B. Albuterol (Proventil). C. Prednisolone (Prelone). D. Theophylline. - CORRECT ANSWER A: Mucomyst is a mucolytic agent that is used to thin secretions and is especially useful in patients with cystic fibrosis. Prednisolone is used to treat inflammation, and albuterol and theophylline are bronchodilators. Acute otitis media is a very common disease in early childhood. Many different bacteria can cause otitis media. Which of the following is NOT a common bacterial pathogen in acute otitis media? A. Haemophilus influenzae. B. Streptococcus pneumoniae. C. Clostridium difficile. D. Moraxella catarrhalis. - CORRECT ANSWER C: C. difficile is a bacterial pathogen found in the GI tract and is not a common cause of acute otitis media. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis can all cause otitis media Which of the following pediatric upper respiratory infections can lead to respiratory compromise and often requires intubation? A. Croup. B. Acute otitis media. C. Nasopharyngitis. D. Epiglottiditis. - CORRECT ANSWER D: Epiglottiditis is the acute inflammation of the epiglottis and is usually caused by Haemophilus influenza infection. Children often present sitting forward (tripod position) with their heads tilted backward to try to relieve the airway obstruction. In addition to possible intubation, oxygen and steroids are the mainstays of treatment. Cystic fibrosis is an inherited disease that affects the respiratory and digestive systems. What is the genetic etiology of cystic fibrosis? A. Autosomal dominant. B. Autosomal recessive. C. Y chromosome linked. D. Spontaneous mutation. - CORRECT ANSWER B: Cystic fibrosis is an autosomal recessive genetic disease, so both parents must pass on a recessive gene to the child. Parents of a child with CF should have genetic counseling so they are aware that they have a 1 in 4 chance of any additional children being born with CF. Due to insufficiencies in chloride channel function in cells, children with cystic fibrosis often need supplementation for proper digestion. What medication is commonly needed for these patients? A. Protein pump inhibitors. B. Pancreatic enzymes. C. Antacids. D. Laxatives. - CORRECT ANSWER B: Cystic fibrosis patients often need pancreatic enzymes supplementation because the pancreatic ducts may become plugged with mucous plugs. Fat-soluble vitamins A, D, E, and K assist with digestion. Constipation is common, but routine use of laxatives should be avoided. A nurse is advising a new mother on care of her newborn. The newborn has a cleft palate. What should NOT be advised regarding feeding of this infant prior to surgical correction? A. The infant should be fed slowly and burped frequently B. Special nipples should be provided for infants unable to suck adequately with a standard nipple C. Sucking should be stimulated by rubbing the nipple on the lower lip. D. The infant should be fed in the Trendelenburg (head down) position. - CORRECT ANSWER D: The infant should be fed in a semi-upright position rather than Trendelenburg to direct the formula away from the cleft and to the back of the mouth to prevent aspiration. Feeding slowly, burping often, using special nipples, and stimulating sucking by rubbing the nipple against the infants lower lip are all strategies to facilitate feeding. A 6-month-old male is diagnosed with an intussusception of the colon. What diagnostic test is often therapeutic in reducing the invagination of one part of the intestine into another? A. Barium enema. B. Ultrasound. C. CT. D. MRI - CORRECT ANSWER A: The pressure of a barium enema against the intussusception is often enough to reduce it, returning the intestine to its normal position, although the intussusception can recur and may require surgical repair New red blood cells are made by the bone marrow and transport oxygen and carbon dioxide. What is the life span of a red blood cell? A. 30 days. B. 60 days. C. 90 days. D. 120 days - CORRECT ANSWER D: The typical life span of a red blood cell is 120 days. Red blood cells contain hemoglobin, which carries oxygen to cells and carbon dioxide back to the lungs. Typical symptoms of anemia in a pediatric patient would include all of the following EXCEPT: A. Fatigue. B. Easy bruising tendency. C. Pink oral mucosa. D. Conjunctival pallor. - CORRECT ANSWER C: Pale, not pink oral mucosa would be present with anemia. Fatigue, bruising, and conjunctival pallor all indicate anemia. The red blood cell index that measures the size of the red blood cells and is useful in classifying anemia is: A. Hemoglobin. B. Hematocrit. C. Mean corpuscular volume. D. Platelets. - CORRECT ANSWER C: The mean corpuscular volume (MCV) measures the average size of the red blood cells. This helps to classify anemia as microcytic, normocytic, or macrocytic. A 2-year-old female is evaluated for iron deficiency anemia. Which of the following would NOT likely be found? A. Larger RBC size. B. Decreased hemoglobin level. C. Decreased RBC mass. D. Decreased oxygen carrying capacity of the blood. - CORRECT ANSWER A: A smaller RBC size (decreased MCV) rather than larger would be found in iron-deficiency anemia. Other indicators include decreased hemoglobin, decreased RBC mass, and decreased oxygen carrying capacity, as iron is necessary for the formation of hemoglobin, which carries oxygen. An African-American newborn is evaluated for a possible hemoglobinopathy. What is the most common hemoglobinopathy in this population, occurring in 1 in 375 live births? A. Thalassemia. B. Sickle cell disease. C. Babesiosis. D. Malaria. - CORRECT ANSWER B: Sickle cell disease is a genetic hemolytic disease and is the most common hemoglobinopathy in African-Americans. It causes sickling of the red blood cells because of abnormal strands in the hemoglobin. Idiopathic thrombocytopenic purpura (ITP) is an acquired disease causing hemorrhage. What circulating blood component is reduced with ITP? A. Platelets. B. Red blood cells. C. White blood cells. D. Iron. - CORRECT ANSWER A: ITP represents an acquired deficiency of platelets (thrombocytes) leading to increased risk of bleeding. ITP is believed caused by an autoimmune process. Normal minimal platelet count is 140,000 for newborns and 150, 000 for older children. If the platelet count drops below 50,000, the child is at high risk for hemorrhage Discharge instructions are being given to the parents of a child with iron deficiency anemia. Which of the following food choices would NOT be a good source of iron in the diet? A. Lean beef. B. Spinach. C. Chicken. D. Potatoes. - CORRECT ANSWER D: Potatoes do not provide a good source of iron in the diet. Green leafy vegetables, such as spinach, and all meats, including lean beef and chicken, are good iron sources. At which age would a blood pressure reading of 80/40 be considered normal? A. 16 years. B. 7 years. C. 12 years. D. 3 months - CORRECT ANSWER D: A blood pressure reading of 80/40 is considered in the normal range for infants of 3 months old. Blood pressure in older children varies according to height and weight. In analysis of an ECG, what component of the heart's function does the P-wave represent? A. Ventricular repolarization. B. Atrial depolarization. C. Ventricular depolarization. D. Resting period of the heart. - CORRECT ANSWER B: The P-wave represents atrial depolarization and is used to mark the starting point of a new PQRS wave, which represents right and left ventricular depolarization. The T-wave represents ventricular repolarization (a resting period). . Diuretic medications are used to manage edema in pediatric patients with heart failure. Which of the following medications is NOT a diuretic medication? A. Furosemide (Lasix). B. Enalapril (Vasotec). C. Spironolactone (Aldactone). D. Bumetanide (Bumex). - CORRECT ANSWER B: Enalapril is an angiotensin-converting enzyme inhibitor and is not a diuretic. Furosemide, spironolactone, and bumetanide are commonly-used diuretics A patent ductus arteriosus (PDA) results when the fetal ductus arteriosus fails to close and blood flows from the aorta back into the pulmonary circulation. In neonates this can often be closed without surgery using certain medications. What class of medications is often used to close this congenital heart defect non-surgically? A. Antibiotics. B. Adrenergic steroids. C. Prostaglandin synthetase inhibitors. D. Beta blockers. - CORRECT ANSWER C: Prostaglandin synthetase inhibitors, such as indomethacin, can be used in neonates to close PDA's non-surgically. They are 80% effective if given within 10 days of birth. Some children require surgical repair. The most common congenital heart defect is: A. Patent foramen ovale. B. Atrial septal defect. C. Ventricular septal defect (VSD). D. Patent ductus arteriosus (PDA). - CORRECT ANSWER C: Ventricular septal defect, the most common congenital heart defect, is an abnormal opening in the septum between the right and left ventricles. Depending on the size of the defect, some may close spontaneously and others may require surgical closure using a graft. Which of the following congenital heart defects would lead to right ventricular hypertrophy and right heart failure if not treated? A. Aortic stenosis. B. Pulmonic stenosis. C. Coarctation of the aorta. D. Tricuspid atresia. - CORRECT ANSWER B: Pulmonic stenosis can lead to right heart failure if not treated. Pulmonic stenosis is a stricture of the pulmonary blood vessel that controls the flow of blood from the right ventricle to the lungs, resulting in right ventricular hypertrophy, as the pressure increases in the right ventricle, and decreased pulmonary blood flow. Aortic stenosis, coarctation of the aorta, and tricuspid atresia would lead to left heart failure. The most common cause for heart failure in children is congenital heart defects. Numerous medications can be used to improve functioning in addition to surgical procedures. Which of the following medications used in heart failure has a narrow therapeutic window requiring blood draws to monitor the blood level? A. Digoxin (Lanoxin). B. Propranolol (Inderal). C. Hydrochlorothiazide (HCTZ). D. Aspirin. - CORRECT ANSWER A: Digoxin has a narrow therapeutic window and requires monitoring for the blood level to prevent toxicity in children. Rheumatic fever is a systemic inflammatory autoimmune disease that occurs after an untreated infection with bacteria. What is the causative bacterium in rheumatic fever? A. Haemophilus influenza. B. Bacillus anthracis. C. Mycobacterium avis. D. Group A beta-hemolytic Streptococcus. - CORRECT ANSWER D: Rheumatic fever is an autoimmune disease that results from a response after an untreated infection with group A betA:hemolytic Streptococcus. RF can result in damage to the heart valves and to the joints. Rheumatic fever is assessed using the Jones criteria that divide the signs and symptoms of the disease into major and minor criteria. Which of the following characteristics is considered a minor and NOT a major criterion? A. Polyarthritis. B. Fever. C. Carditis. D. Chorea. - CORRECT ANSWER B: Fever, along with arthralgias and lab findings, such as elevated erythrocyte sedimentation rate and C:reactive protein, are considered minor Jones criteria. Polyarthritis, carditis, and chorea are major criteria. Rheumatic fever is diagnosed when 2 major criteria or one major and 2 minor criteria are met. Following a diagnosis of a urinary tract infection, an adolescent is counseled to maintain acidic urine to help speed healing of the infection. Which of the following liquids would NOT be a good choice? A. Cranberry juice. B. Prune juice. C. Carbonated sodas. D. Apple juice. - CORRECT ANSWER C: Carbonated sodas actually alkalinize the urine and are a poor choice in the treatment of a bladder infection. Cranberry juice apple juice, and prune juice are good choices to acidify urine. Citrus juices, such as lemonade and orange juice, alkalinize the urine. The most common genetic bone disease is osteogenesis imperfecta (OI). This is an inherited disorder that results from an abnormality in which of the following aspects of bone formation? A. Collagen synthesis. B. Calcium deposition. C. Phosphorus deposition. D. Iron deposition. - CORRECT ANSWER A: OI is a genetic disorder that results from the reduction in the synthesis of collagen, causing connective tissue and bone defects, such as "brittle bones," that lead to multiple fractures. A 14-year-old sustained a blow to the medial forearm. He has a fracture that is incomplete and does not extend all the way through the ulna. What is this type of fracture? A. Buckle fracture. B. Greenstick fracture. C. Bend fracture. D. Open fracture. - CORRECT ANSWER B: An incomplete fracture that does not fully extend through a bone is a greenstick fracture. A buckle fracture is common in children and involves an incomplete fracture with buckling of bone on one side only. Bend fractures involve bending of the soft bone without breaking. Open fractures break through the skin Duchenne's muscular dystrophy is the most common form of muscular dystrophy and causes progressive degeneration and weakness of the skeletal muscles. At what age is Duchenne's muscular dystrophy usually first evident? A. 6 months to 1 year. B. 12 to 15 years. C. 9 to 12 years. D. 3 to 5 years. - CORRECT ANSWER D: Muscular dystrophy is usually first evident at age 3 to 5 and observed with delays in motor development and weakness in the pelvic girdle. Children may have trouble standing and may fall easily. Calf muscles may begin to enlarge Which type of seizure is characterized by a sudden loss of muscle tone and then a postictal period of confusion? A. Tonic seizures. B. Clonic seizures. C. Atonic seizures. D. Absence seizures. - CORRECT ANSWER C: Atonic seizures are characterized by a loss of muscle tone and often a fall and then a period of confusion from a postictal state. Tonic seizures include muscle twitching and changes in consciousness. Clonic seizures are generalized seizures often accompanied by loss of consciousness. Absence seizures cause a lack of consciousness What should women of childbearing age consume in the preconceptual period to decrease their risk of neural tube defects in their children? A. Iron. B. Vitamin B12. C. Magnesium. D. Folic acid. - CORRECT ANSWER D: Additional folic acid (0.4 mg per day) is recommended to decrease the risk of neural tube defects during pregnancy. All women of childbearing age should have counseling regarding the importance of folic acid. The pituitary gland regulates many other components of the endocrine system and is composed of the anterior pituitary (adenohypophysis) and posterior pituitary (neurohypophysis). Which of the following is NOT secreted by the anterior pituitary? A. Growth hormone. B. Thyroid stimulating hormone. C. Oxytocin D. Prolactin. - CORRECT ANSWER C: Oxytocin as well as antidiuretic hormone are the two secretions of the posterior pituitary gland. The anterior pituitary gland produces growth hormone, thyroid stimulating hormone, prolactin, adrenocorticotropic hormone, follicle stimulating hormone, betA:endorphin, and luteinizing hormone The islets of Langerhans in the pancreas secrete several hormones that regulate body functions. Which of the following is NOT a hormone secreted by the islets of Langerhans? A. Aldosterone. B. Insulin. C. Glucagon. D. Somatostatin. - CORRECT ANSWER A: Aldosterone is secreted by the adrenal gland. Insulin, glucagon, and somatostatin are all secretions by the islets of Langerhans. Following surgery for a brain tumor, a 6-year-old female exhibits symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following is NOT a classic symptom of SIADH? A. Fluid retention. B. Weight loss. C. Weakness. D. Decreased urinary output. - CORRECT ANSWER B: Weight gain, not weight loss is a cardinal sign of SIADH because of fluid retention and decreased urinary output caused by the hyponatremia resulting from increased secretion of antidiuretic hormone. Weakness is an additional sign of SIADH. What is the most common type of cancer in childhood? A. Kidney tumors. B. Brain tumors. C. Lymphomas. D. Leukemias. - CORRECT ANSWER D: Leukemias remain the most common type of cancer in childhood. Brain tumors are the most common SOLID tumors in children. Lymphomas are the third most common type of tumor. The most common type of kidney tumor is Wilm's tumor. During resuscitation of a 9-month-old male, what is the proper ratio of chest compressions to breaths? A. 1:1 B. 5:1 C. 10:2 D. 30:2 - CORRECT ANSWER D: The proper ratio of chest compressions to breaths in a child of 9 months is 30:2. Compressions should be done rapidly to a count of 30 followed by 2 breaths. Brain damage can occur within 4 minutes and death within 8 minutes if the brain is deprived of oxygen. Which of the following characteristics is NOT part of the Apgar scoring method for assessment of newborns? A. Heart rate. B. Respiratory effort. C. Skin color. D. Eye tracking - CORRECT ANSWER D: Eye tracking is not a component as the child is not able to focus well enough to track at birth. Heart rate, color, muscle tone, reflex irritability, and respiratory effort are the components of the Apgar scoring system. A 2-year-old male is found to be in ventricular fibrillation. What is the proper initial voltage for defibrillation? A. 20 J/kg. B. 15 J/kg. C. 10 J/kg. D. 2 J/kg. - CORRECT ANSWER D: The proper initial voltage for defibrillation of a 2-year-old child is 2 J/kg. If unsuccessful, the next shock is done with 2 to 4 J/kg and then 4 J/kg In the treatment of ventricular fibrillation in children what is the initial medication used if defibrillation is not effective? A. Amiodarone. B. Magnesium. C. Epinephrine. D. Lidocaine. - CORRECT ANSWER C: Epinephrine is the initial drug used in the treatment of ventricular fibrillation if defibrillation is not successful. Each dose of epinephrine is usually followed by an attempt at defibrillation. If epinephrine and defibrillation are ineffective, then an antiarrhythmic, such as amiodarone or lidocaine, is used. Magnesium sulfate is indicated with torsades de pointes (a variant form of VF). In cases of inability to obtain peripheral IV access, an interosseous line (IO) can be placed to infuse medications and fluid. Blood can also be aspirated and sent to the lab for analysis. Which of the following lab tests can NOT be done reliably from an IO sample? A. White blood cell count. B. Type and cross. C. Electrolytes. D. Hemoglobin count. - CORRECT ANSWER A: Lab analysis of a sample from an IO line is not accurate for WBC count or platelet count but can be used to type and cross match blood and for hemoglobin and electrolytes although it is less accurate than blood samples for calcium, potassium, and glucose levels. For a rapid-sequence intubation of a pediatric patient, paralyzing drugs are often used. One of the more commonly used medications is succinylcholine (Anectine). Which of the following is NOT a common side effect of the use of succinylcholine? A. Increased intracranial pressure. B. Decreased heart rate. C. Hypokalemia. D. Increased eye pressure. - CORRECT ANSWER C: Hypokalemia is not a common side effect of use of succinylcholine, but the drug can cause hyperkalemia, which may result in cardiac abnormalities, such as decreased heart rate. Increased intracranial pressure, increased blood pressure, and increased eye pressure are commonly seen and need to be monitored when using this medication. Depressed or inverted T-waves on ECG analysis can occur with many different clinical situations in pediatric patients. Which of the following is NOT a common reason for depressed or inverted T-waves? A. Hypokalemia. B. Myocarditis. C. Digitalis toxicity. D. Hyperthyroidism. - CORRECT ANSWER B: Hyperthyroidism commonly causes an increase in T-wave amplitude, not a decrease. Myocarditis, hypokalemia, and digitalis toxicity are common reasons for inverted or decreased Twaves. A child has a wide complex tachycardia and needs medication for this condition. Which one of the following medications used in the treatment of tachycardias commonly causes a brief asystolic episode that quickly resolves? A. Lidocaine. B. Amiodarone. C. Adenosine. D. Procainamide - CORRECT ANSWER C: Adenosine commonly causes a brief asystolic episode, which can be uncomfortable for the patient. Other side effects include a metallic taste in the mouth, chest pressure, flushing, nausea, dyspnea, arm tingling, and discomfort in the neck and jaw A 7-year-old has a history of intermittent blood in her stools. She and her mother are instructed on using stool Guaiac cards at home for analysis. Which of the following does NOT cause false positive results for stool Guaiac tests? A. Red meat. B. Fresh cherries. C. Horseradish. D. Vitamin C. - CORRECT ANSWER D: Vitamin C can cause false negative stool Guaiac results. Red meat, fresh cherries, and horseradish all can cause false positive results for the Guaiac test. [Show More]

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