NU580 Final Exam

Student Name

Purdue University Globle 

NU580 FNP II – Primary Care of Children and Adolescents’ Health

Prof. Name

Date

NU580 Final Exam 

1. What is the next step for a 30-month-old toilet-trained girl with daytime enuresis, dysuria, low-grade fever, and a negative dipstick urinalysis?

A. Begin empiric treatment with trimethoprim-sulfamethoxazole.
B. Discuss behavioral interventions for toilet training.
C. Reassure the child’s parents.
D. Send the urine to the laboratory for culture.

Answer: D. Send the urine to the laboratory for culture.

2. How should a child with dysuria, frequency, fever, and a urine culture showing 50,000–100,000 colonies of E. coli be treated?

A. Observe without treatment.
B. Repeat the urine culture.
C. Increase oral fluid intake only.
D. Treat with antibiotics for a urinary tract infection (UTI).

Answer: D. Treat with antibiotics for a urinary tract infection (UTI).

3. How should a school-aged child with dysuria, foul-smelling urine, and a positive dipstick for leukocyte esterase and nitrites be treated?

A. Nitrofurantoin for 10 days.
B. Prescribe trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 3–5 days.
C. Delay treatment until culture results are available.
D. Encourage increased fluid intake only.

Answer: B. Prescribe trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 3–5 days.

4. What should parents be told after their child with nephrotic syndrome responds well to steroid therapy?

A. Steroids should never be used again.
B. Steroids will be used when relapses occur.
C. Surgery is usually required.
D. The disease is permanently cured.

Answer: B. Steroids will be used when relapses occur.

5. What is the appropriate treatment when a child with nephrotic syndrome improves from 3+ to 1+ proteinuria?

A. Stop steroid therapy immediately.
B. Continue steroids and salt restrictions until the urine is negative for protein.
C. Begin antibiotic therapy.
D. Restrict all fluids.

Answer: B. Continue steroids and salt restrictions until the urine is negative for protein.

6. How should a child with post-streptococcal glomerulonephritis presenting with edema, hypertension, and tea-colored urine be managed?

A. Prescribe oral antibiotics and follow up in one week.
B. Encourage increased oral fluid intake.
C. Treat as an outpatient with diuretics.
D. Refer the child to a pediatric nephrologist for hospitalization.

Answer: D. Refer the child to a pediatric nephrologist for hospitalization.

7. What should be done when a unilateral, smooth, firm abdominal mass is palpated in a 2-year-old child?

A. Schedule a routine follow-up in one month.
B. Begin empiric antibiotics.
C. Obtain abdominal massage for comfort.
D. Refer the child to an oncologist immediately.

Answer: D. Refer the child to an oncologist immediately.

8. How is a retractile testis in a 6-month-old infant managed?

A. Observe until puberty.
B. Refer the infant to a pediatric urologist or surgeon for possible orchiopexy.
C. Begin testosterone therapy.
D. No treatment is necessary.

Answer: B. Refer the infant to a pediatric urologist or surgeon for possible orchiopexy.

9. What should be done for a 9-month-old infant with scrotal swelling, fussiness, and a tender, difficult-to-reduce scrotal mass?

A. Apply ice packs and observe.
B. Refer immediately to a pediatric surgeon.
C. Prescribe oral antibiotics.
D. Schedule elective surgery in several weeks.

Answer: B. Refer immediately to a pediatric surgeon.

10. What should parents know about using probiotics for infant colic?

A. Probiotics cure infant colic.
B. All infants should receive probiotics.
C. Probiotics are FDA-approved for infant colic.
D. There is no conclusive evidence about using probiotics to treat colic.

Answer: D. There is no conclusive evidence about using probiotics to treat colic.

11. What is the next step for a premature toddler with poor weight gain and refusal of solid foods despite a normal barium swallow?

A. Repeat the barium swallow.
B. Refer for surgery.
C. Begin tube feeding.
D. Perform a video fluoroscopy swallowing study.

Answer: D. Video fluoroscopy swallowing study.

12. How should a toddler with mild to moderate dehydration from vomiting and diarrhea be managed?

A. Admit for IV fluids immediately.
B. Prescribe antibiotics.
C. Restrict oral intake.
D. Provide oral rehydration solution (ORS) with follow-up in 24 hours.

Answer: D. Oral rehydration solution (ORS) with follow-up in 24 hours.

13. What should be done for a 9-year-old with recurrent vomiting, headaches, abnormal eye movements, and mild ataxia?

A. Prescribe antiemetics only.
B. Refer to a pediatric neurologist.
C. Observe for one week.
D. Refer to a pediatric gastroenterologist for further workup.

Answer: D. Refer to a pediatric gastroenterologist for further workup.

14. How should a child who swallowed a 6 mm metal bead found in the stomach be managed?

A. Schedule immediate endoscopic removal.
B. Have the parents watch for the object in the child’s stool.
C. Induce vomiting.
D. Begin laxative therapy.

Answer: B. Have the parents watch for the object in the child’s stool.

15. What is the likely diagnosis in a child with abdominal pain that migrates to the right lower quadrant followed by fever?

A. Appendicitis with perforation.
B. Gastroenteritis.
C. Constipation.
D. Mesenteric adenitis.

Answer: A. Appendicitis with perforation.

16. What initial diagnostic workup is recommended for a school-age child with recurrent abdominal pain, headaches, and a normal physical examination?

A. CBC, ESR, amylase, lipase, urinalysis, and abdominal ultrasound.
B. CT scan only.
C. Colonoscopy.
D. MRI of the abdomen.

Answer: A. CBC, ESR, amylase, lipase, urinalysis, and abdominal ultrasound.

17. What is an important component of treatment for functional abdominal pain associated with stress and school anxiety?

A. Long-term opioid therapy.
B. Surgical consultation.
C. Teaching about the brain-gut interaction causing symptoms.
D. Strict dietary restriction.

Answer: C. Teaching about the brain-gut interaction causing symptoms.

18. What is the next diagnostic step for a child with foul-smelling stools, abdominal distension, and failure to thrive after a failed lactose-free trial?

A. Colonoscopy.
B. Serologic testing for celiac disease.
C. Stool culture.
D. Hydrogen breath test.

Answer: B. Serologic testing for celiac disease.

19. What complication is commonly associated with Crohn disease in children?

A. Acute liver failure.
B. Intestinal obstruction with scarring and strictures.
C. Acute pancreatitis.
D. Nephrotic syndrome.

Answer: B. Intestinal obstruction with scarring and strictures.

20. How should poor weight gain in a 12-month-old infant with an otherwise normal examination be evaluated?

A. Begin appetite stimulants.
B. Obtain a feeding history, stooling history, and a 3-day diet history.
C. Order an MRI.
D. Refer immediately for surgery.

Answer: B. Obtain a feeding history, stooling history, and a 3-day diet history.

21. What can help shorten the course of acute diarrhea in a well-hydrated 2-year-old child?

A. Loperamide
B. Lactobacillus (probiotics)
C. Oral antibiotics
D. Clear liquid diet only

Answer: B. Lactobacillus (probiotics).

22. What condition is associated with a widely split second heart sound (S2) during expiration in a newborn?

A. Atrial septal defect (ASD)
B. Ventricular septal defect (VSD)
C. Patent ductus arteriosus (PDA)
D. Pulmonary stenosis

Answer: A. Atrial septal defect (ASD).

23. What type of murmur is a grade II vibratory midsystolic murmur that becomes louder when a child is supine?

A. Venous hum
B. Pulmonary flow murmur
C. Still’s murmur
D. Aortic stenosis murmur

Answer: C. Still’s murmur.

24. What should be done when a 6-month-old infant has a harsh grade IV/VI blowing murmur?

A. Reassure the parents.
B. Repeat the examination in one year.
C. Begin antibiotic therapy.
D. Refer to a pediatric cardiologist for further evaluation.

Answer: D. Refer to a pediatric cardiologist for further evaluation.

25. What is the likely diagnosis in a 3-month-old infant with crackles, poor feeding, hepatomegaly, and a holosystolic murmur?

A. Tetralogy of Fallot
B. Patent ductus arteriosus
C. Coarctation of the aorta
D. Ventricular septal defect (VSD)

Answer: D. Ventricular septal defect (VSD).

26. Which finding is expected in an infant with Trisomy 21 and a complete atrioventricular (AV) canal defect?

A. Bradycardia
B. Bounding peripheral pulses
C. Oxygen desaturation
D. Hyperactivity

Answer: C. Oxygen desaturation.

27. How is blood pressure classified when a child consistently has systolic values between the 95th and 99th percentiles?

A. Elevated blood pressure
B. Prehypertension
C. Stage 1 hypertension
D. Stage 2 hypertension

Answer: C. Stage 1 hypertension.

28. What initial tests are recommended for a 12-year-old with persistent hypertension?

A. Thyroid function tests and CBC
B. Liver function tests
C. Renal function studies and plasma renin levels
D. Lipid panel only

Answer: C. Renal function studies and plasma renin levels.

29. What is the next step if an obese child’s blood pressure remains elevated despite successful weight reduction?

A. Continue observation only.
B. Begin a high-sodium diet.
C. Repeat blood pressure in one year.
D. Refer to a pediatric nephrologist or cardiologist.

Answer: D. Refer to a pediatric nephrologist or cardiologist.

30. What should be done for a child with a repaired congenital heart defect who presents with fever and poor dental health?

A. Admit to the hospital with a pediatric cardiology consultation.
B. Prescribe oral antibiotics and discharge home.
C. Schedule a dental appointment only.
D. Reassure the parents.

Answer: A. Admit to the hospital with a pediatric cardiology consultation.

31. What is the earliest symptom of acute lower airway obstruction in children?

A. Cyanosis
B. Retractions
C. Stridor
D. Wheezing

Answer: D. Wheezing.

32. What is recommended for a child with nasal congestion and cloudy nasal discharge affecting sleep?

A. Oral antibiotics
B. Nasal decongestants
C. Saline nasal rinses
D. Oral corticosteroids

Answer: C. Saline nasal rinses.

33. How should persistent rhinosinusitis with eyelid swelling and erythema be managed?

A. Continue supportive care at home.
B. Prescribe antihistamines.
C. Observe for 72 hours.
D. Refer to a pediatric otolaryngologist immediately.

Answer: D. Refer to a pediatric otolaryngologist immediately.

34. What is the appropriate action for a child with suspected epiglottitis presenting with stridor, drooling, and respiratory distress?

A. Examine the throat with a tongue depressor.
B. Obtain a throat culture.
C. Prescribe oral antibiotics.
D. Arrange emergency transport to the hospital via EMS.

Answer: D. Arrange emergency transport to the hospital via EMS.

35. Which medication is commonly used to facilitate airway clearance in children with cystic fibrosis?

A. Albuterol tablets
B. Inhaled dornase alfa
C. Oral prednisone
D. Montelukast

Answer: B. Inhaled dornase alfa.

36. What should be done when a 4-year-old has a visual acuity of 20/50 but had difficulty cooperating during testing?

A. Refer immediately to an ophthalmologist.
B. Prescribe corrective lenses.
C. Patch one eye.
D. Retest the child’s vision in one month.

Answer: D. Retest the child’s vision in one month.

37. What should be done when an infant has an abnormal red reflex?

A. Recheck at the next well-child visit.
B. Prescribe antibiotic eye drops.
C. Perform vision therapy.
D. Refer the infant to an ophthalmologist.

Answer: D. Refer the infant to an ophthalmologist.

38. What does the Hirschberg test evaluate?

A. Visual acuity
B. Ocular alignment
C. Color vision
D. Peripheral vision

Answer: B. Ocular alignment.

39. What does a cloudy cornea after fluorescein staining indicate?

A. Normal finding
B. Increased tear production
C. Damage to the cornea
D. Retinal detachment

Answer: C. Damage to the cornea.

40. What treatment is commonly initiated for exotropia in a toddler?

A. Immediate surgery
B. Corrective eyeglasses only
C. Topical antibiotic ointment
D. Patching of the unaffected eye for 2 hours each day

Answer: D. Patching of the unaffected eye for 2 hours each day.

41. What is the recommended management for a 9-month-old infant with resolved retinopathy of prematurity (ROP)?

A. Schedule a follow-up ophthalmologic examination at 12 months of age.
B. No further follow-up is needed.
C. Refer for immediate eye surgery.
D. Begin corrective lens therapy.

Answer: A. Schedule a follow-up ophthalmologic examination at 12 months of age.

42. What is the most likely diagnosis in a 1-week-old infant with eyelid swelling and thick purulent eye discharge?

A. Gonococcal conjunctivitis
B. Chlamydia trachomatis conjunctivitis
C. Allergic conjunctivitis
D. Viral conjunctivitis

Answer: B. Chlamydia trachomatis conjunctivitis.

43. What should be done for a 5-day-old infant with conjunctivitis, corneal opacity, and serosanguinous discharge?

A. Prescribe topical antibiotic drops and discharge home.
B. Admit the infant to the hospital immediately.
C. Schedule follow-up in 48 hours.
D. Observe without treatment.

Answer: B. Admit the infant to the hospital immediately.

44. How should bacterial conjunctivitis in a preschool-aged child be treated?

A. Oral antihistamines
B. Artificial tears only
C. Warm compresses only
D. Prescribe topical antibiotic drops.

Answer: D. Prescribe topical antibiotic drops.

45. What is the appropriate management for a child with a glass fragment in the eye?

A. Refer immediately to an ophthalmologist.
B. Irrigate the eye and remove the fragment in the office.
C. Apply an eye patch and observe.
D. Prescribe topical antibiotics only.

Answer: A. Refer immediately to an ophthalmologist.

46. What should pediatric nurse practitioners consider when prescribing topical glucocorticoids?

A. Generic preparations are always identical to brand-name products.
B. Topical glucocorticoids have no differences in potency.
C. Prescribe brand-name preparations when consistent effects are necessary.
D. Use the strongest available steroid for all skin conditions.

Answer: C. Prescribe brand-name preparations when consistent effects are necessary.

47. How is hot tub folliculitis managed in adolescents?

A. Oral acyclovir
B. Oral griseofulvin
C. Systemic corticosteroids
D. Prescribe topical keratolytic agents and topical antibiotics.

Answer: D. Prescribe topical keratolytic agents and topical antibiotics.

48. What is the treatment for candidal dermatitis in an infant with erythema in the neck and flexural folds after antibiotic therapy?

A. Hydrocortisone cream
B. Bacitracin ointment
C. Mupirocin ointment
D. Topical nystatin cream applied several times daily.

Answer: D. Topical nystatin cream applied several times daily.

49. How should a child with tinea corporis and scalp involvement be treated?

A. Topical clotrimazole only.
B. Selenium sulfide shampoo alone.
C. Oral griseofulvin for 2–4 weeks.
D. Topical hydrocortisone cream.

Answer: C. Oral griseofulvin for 2–4 weeks.

50. What is the recommended treatment for tinea versicolor?

A. Selenium sulfide 2.5% lotion applied twice weekly for 2–4 weeks.
B. Oral amoxicillin.
C. Topical mupirocin.
D. Oral prednisone.

Answer: A. Selenium sulfide 2.5% lotion applied twice weekly for 2–4 weeks.

51. Which test differentiates HSV-1 from HSV-2 in adolescents with oral vesicular lesions?

A. Complete blood count (CBC)
B. Gram stain
C. Potassium hydroxide (KOH) preparation
D. Viral culture

Answer: D. Viral culture.

52. How is herpes zoster managed in an otherwise healthy school-aged child?

A. Burrow solution and warm soothing baths for comfort measures.
B. Intravenous acyclovir.
C. Oral antibiotics.
D. High-dose corticosteroids.

Answer: A. Burrow solution and warm soothing baths for comfort measures.

53. What physical findings are associated with pediculosis capitis?

A. Vesicular lesions on the scalp.
B. Thick yellow scales over the scalp.
C. Itching of the scalp with excoriations on the back of the head.
D. Diffuse hair loss without itching.

Answer: C. Itching of the scalp with excoriations on the back of the head.

54. How is scabies treated in a 9-month-old infant?

A. Topical hydrocortisone cream.
B. Permethrin 5% cream applied to the face, neck, and body, then washed off after 8–14 hours.
C. Oral fluconazole.
D. Topical mupirocin.

Answer: B. Permethrin 5% cream applied to the face, neck, and body, then washed off after 8–14 hours.

55. What acne distribution pattern is commonly seen on the cheeks and under the chin in adolescents?

A. Comedonal acne.
B. Nodulocystic acne.
C. Hormonal acne distribution.
D. Neonatal acne.

Answer: C. Hormonal acne distribution.

56. What is the preferred treatment for mild inflammatory acne with papules and pustules?

A. Oral isotretinoin.
B. Topical tretinoin alone.
C. Topical erythromycin with benzoyl peroxide.
D. Oral prednisone.

Answer: C. Topical erythromycin with benzoyl peroxide.

57. How is seborrheic dermatitis in an adolescent managed?

A. Daily application of ketoconazole 2% topical cream.
B. Oral terbinafine.
C. Oral cephalexin.
D. Topical mupirocin.

Answer: A. Daily application of ketoconazole 2% topical cream.

58. What is the initial treatment for acute urticaria after strawberry ingestion?

A. Intramuscular epinephrine for all patients.
B. Oral corticosteroids only.
C. Diphenhydramine 0.5–1 mg/kg/dose every 4–6 hours.
D. Topical hydrocortisone cream.

Answer: C. Diphenhydramine 0.5–1 mg/kg/dose every 4–6 hours.

59. How should Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) be managed?

A. Consult with a pediatric intensivist for admission to the pediatric intensive care unit (PICU).
B. Treat with topical antibiotics and discharge home.
C. Prescribe oral antihistamines.
D. Manage with outpatient follow-up only.

Answer: A. Consult with a pediatric intensivist for admission to the pediatric intensive care unit (PICU).

60. What is the appropriate management for pityriasis rosea?

A. Prescribe oral antibiotics.
B. Begin systemic corticosteroids.
C. Reassure the child’s parents that the rash is benign and self-limited.
D. Refer immediately to a dermatologist.

Answer: C. Reassure the child’s parents that the rash is benign and self-limited.