NU580 Midterm Exam Review

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Purdue University Globle

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

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Date

NU580 Midterm Exam Review

Pediatric Nursing Practice Questions and Answers

1. What is true about Cyclic Vomiting Syndrome (CVS)?

A. Lasts for days
B. Requires SSRIs to stop symptoms
C. Not be associated with a headache
D. Requires pain medication and Zofran

Answer: C. Not be associated with a headache

2. A 5-day-old infant presents with jaundice, a slightly sunken anterior fontanel, decreased wet diapers, and breastfeeding difficulties. Bilirubin level is 18 mg/dL. Which nursing interventions are required?

A. Phototherapy
B. Provide breastfeeding support and education
C. Strict monitoring of intake and output
D. All of the above

Answer: D. All of the above

3. An infant admitted with dehydration weighs 6 kg. What urinary output indicates adequate hydration?

A. 0.5 mL/kg/hr
B. 0.5–2.5 mL/kg/hr
C. 1–3 mL/kg/hr
D. Wet diapers alone are sufficient

Answer: C. 1–3 mL/kg/hr

4. A 5-year-old child with asthma is prescribed an oral steroid and a short-acting beta-adrenergic medication through a metered-dose inhaler for acute symptoms. What education is most important?

A. Provide an asthma action plan
B. Explain medication effects and side effects
C. Provide information about spirometry testing
D. Explain medication use at school

Answer: A. Provide an asthma action plan

5. A child with severe asthma does not respond to conventional treatments. A pulmonology referral is ordered. What should the pulmonologist provide?

A. Confirm the diagnosis for parents
B. Recommend alternative disease management strategies
C. Emphasize medication adherence only
D. Take over all chronic illness management

Answer: B. Recommend alternative disease management strategies

6. An 18-month-old child has a rectal temperature of 100.4°F (38°C). The child is playful, drinking fluids, and has slightly decreased appetite. What should the nurse practitioner recommend?

A. Give antipyretic medication
B. Bring the child to the clinic immediately
C. Offer extra fluids and call if symptoms change
D. Order laboratory testing

Answer: C. Offer extra fluids and call if symptoms change

7. A 10-year-old child reports shooting pain in both legs with aching, tingling, and burning sensations. The child cannot identify specific pain locations. What type of pain is suspected?

A. Chronic pain
B. Neuropathic pain
C. Somatic pain
D. Visceral pain

Answer: B. Neuropathic pain

8. A 3-year-old child recovering from injuries after a motor vehicle accident requires pain assessment. Which method is appropriate?

A. Use a detailed pain discrimination scale
B. Ask the child to describe pain as no pain, a little pain, or a lot of pain
C. Ask about exact pain intensity and location
D. Depend only on nonverbal behaviors

Answer: B. Ask the child to describe pain as no pain, a little pain, or a lot of pain

9. A 4-year-old child after orthopedic surgery points to “1” on a faces pain scale. What should the nurse practitioner do next?

A. Assess vital signs and mobility without pain
B. Refill narcotic medication
C. Recommend acetaminophen only
D. Teach parents to give medication based only on pain reports

Answer: A. Assess vital signs and mobility without pain

10. A developmentally and cognitively disabled 10-year-old child cannot communicate pain before multiple surgeries. What pain assessment tool should the parent be taught to use?

A. Comfort Scale
B. FLACC Scale
C. NCCPCR
D. Nonverbal observations

Answer: C. NCCPCR

11. A 4-month-old infant is undergoing a painful procedure. Besides local anesthesia, which intervention provides additional analgesic effects?

A. Providing toys
B. Singing or music
C. Sucrose solution
D. Swaddling or cuddling

Answer: C. Sucrose solution

12. An adolescent female reports moderate dysmenorrhea. Ibuprofen 400 mg every 6–8 hours controls pain. What should the nurse practitioner recommend?

A. Increase ibuprofen to 600–800 mg every 6–8 hours
B. Use acetaminophen 1000 mg every 4–6 hours
C. Use naproxen 500 mg initially, then 250 mg every 6–8 hours
D. Use extended-release naproxen 500 mg every 12 hours

Answer: C. Use naproxen 500 mg initially, then 250 mg every 6–8 hours

13. What is the most important dose-limiting factor when prescribing acetaminophen with hydrocodone?

A. Acetaminophen dose
B. Gastrointestinal side effects
C. Pruritus symptoms
D. Urinary retention

Answer: A. Acetaminophen dose

14. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant for phantom limb pain. The medications are no longer effective. What should the nurse practitioner do?

A. Change the tricyclic antidepressant to an SSRI
B. Evaluate for drug-seeking behavior
C. Increase the tricyclic antidepressant dose
D. Refer to a pain management specialist

Answer: D. Refer to a pain management specialist

15. A school-age child with chronic pain wants to stay home from school more often. The physical examination and medication review are unchanged. What should the nurse practitioner recommend?

A. Assess pain daily
B. Keep the child in bed during pain episodes
C. Have the child complete homework when staying home
D. Require school attendance despite pain

Answer: C. Have the child complete homework when staying home

16. A 2-week-old infant was diagnosed with transient tachypnea of the newborn shortly after birth. What does the nurse practitioner understand about this condition?

A. Antibiotics are usually required
B. Home oxygen is always needed
C. Recovery is usually complete with minimal intervention
D. Mechanical ventilation and surfactant are required

Answer: C. Recovery is usually complete with minimal intervention

17. A 2-month-old infant has a staccato cough and fever. Which history finding is most important?

A. Daycare attendance
B. Immunization history
C. Medication history
D. Past medical history

Answer: B. Immunization history

18. Research suggests which population may have higher rates of under-immunization?

A. Communities with higher Asian populations
B. Communities with higher graduate degree rates
C. Communities with lower poverty rates
D. Communities with fewer primary care providers

Answer: B. Communities with higher graduate degree rates

19. A parent of a 2-month-old infant is hesitant about vaccines. What is the best initial response?

A. Explain vaccines contain no thimerosal
B. Provide Vaccine Information Statements only
C. Ask about the parent’s concerns regarding vaccines
D. Remind the parent about exposure to germs

Answer: C. Ask about the parent’s concerns regarding vaccines

20. According to Institute of Medicine findings, what information should parents receive about vaccine risks?

A. Multiple vaccines cause type 1 diabetes
B. MMR may be associated with febrile seizures
C. Hepatitis B vaccine causes CNS disorders
D. Thimerosal vaccines cause developmental disorders

Answer: B. MMR may be associated with febrile seizures

21. A 2-month-old infant receives initial immunizations. What should the nurse practitioner recommend for comfort?

A. Give ibuprofen or acetaminophen as needed
B. Avoid all antipyretics
C. Give medication only after vaccines
D. Give both medications before vaccination

Answer: A. Give ibuprofen or acetaminophen as needed

22. An 18-month-old child received the MMR vaccine two days before the first birthday. What should the nurse practitioner do?

A. Give a reduced MMR dose
B. Obtain antibody titers
C. Recommend the next dose at 4–5 years
D. Repeat the MMR vaccine

Answer: D. Repeat the MMR vaccine

23. A 5-year-old child with previous pertussis infection needs kindergarten immunizations. Which vaccine is recommended?

A. DTaP
B. DTP
C. Td
D. Tdap

Answer: A. DTaP

24. Which statement best describes thelarche in female puberty?

A. Appearance of pubic hair
B. Appearance and maturation of breast tissue
C. Beginning of the first menstrual period
D. All of the above

Answer: B. Appearance and maturation of breast tissue

25. Congenital hypothyroidism is common in infants with Down syndrome. After initial thyroid screening, thyroid studies should be performed at least:

A. Every 2 months
B. Every month
C. Every 6 months
D. Yearly

Answer: D. Yearly

26. Children with Down syndrome have an increased risk of which malignancy?

A. Colon cancer
B. Leukemia
C. Pancreatic cancer
D. Bladder cancer

Answer: B. Leukemia

27. Children with Down syndrome may develop cervical spine instability. What symptoms should caregivers monitor?

A. Changes in reflexes
B. Changes in bowel function
C. All of the above
D. None of the above

Answer: C. All of the above

28. An 18-month-old child has ear pain, fever, erythematous bulging tympanic membrane, and no history of ear infections. What is the recommended treatment?

A. Amoxicillin 80–90 mg/kg/day
B. Analgesic medication and watchful waiting
C. Ceftriaxone injection
D. Antibiotic ear drops

Answer: B. Analgesic medication and watchful waiting

29. A 7-month-old infant has persistent otitis media despite amoxicillin and amoxicillin-clavulanate therapy. What is the next step?

A. Repeat amoxicillin-clavulanate
B. Perform tympanocentesis
C. Prescribe clindamycin
D. Refer to an otolaryngologist

Answer: D. Refer to an otolaryngologist

30. A child with pressure equalizing tubes has ear pain but no drainage, normal visualization of the tube, and a type A tympanogram. What should the nurse practitioner do?

A. Prescribe antibiotic/steroid ear drops
B. Give prophylactic antibiotics
C. Reassure the parent this is a normal exam
D. Refer immediately to ENT

Answer: A. Prescribe antibiotic/steroid ear drops

31. What should parents expect after placement of pressure equalizing tubes?

A. Improved hearing
B. Complete prevention of ear infections
C. Need for earplugs during every bath
D. Tubes remain for 3–4 years

Answer: A. Improved hearing

32. A child with recurrent otitis externa asks how to prevent future episodes. What should the nurse practitioner recommend?

A. Clean ear canals after swimming
B. Dry the ear canal with a hair dryer
C. Swim only in chlorinated pools
D. Use cerumenolytic agents daily

Answer: B. Dry the ear canal with a hair dryer

33. A child has itching, hearing difficulty, swelling of the ear canal, and severe pain with manipulation of the ear. What is the appropriate treatment?

A. Culture the ear canal
B. Order antibiotic/corticosteroid ear drops
C. Prescribe oral amoxicillin-clavulanate
D. Refer to ENT

Answer: B. Order antibiotic/corticosteroid ear drops

34. A child with otitis externa has severe ear canal swelling after two days of topical therapy. What is the next treatment step?

A. Insert an ear wick
B. Irrigate the ear canal
C. Give systemic corticosteroids
D. Prescribe oral antibiotics

Answer: A. Insert an ear wick

35. A small foreign object is located near the tympanic membrane in a child’s ear canal. What should the nurse practitioner do?

A. Irrigate the ear
B. Refer to an otolaryngologist
C. Remove with a wire loop
D. Use forceps

Answer: B. Refer to an otolaryngologist

36. A 3-year-old child develops recurrent acute otitis media after previous amoxicillin treatment. Tympanogram shows middle ear fluid and fever. What medication should be ordered?

A. Tympanocentesis referral
B. Amoxicillin alone
C. Amoxicillin-clavulanate
D. Intramuscular ceftriaxone

Answer: C. Amoxicillin-clavulanate

37. A 2-year-old child has acute otitis media with a history of frequent ear infections. What is the recommended treatment?

A. Amoxicillin for 10 days
B. Analgesics and watchful waiting
C. Antibiotic ear drops
D. Ceftriaxone injection

Answer: B. Analgesics and watchful waiting

38. A child treated for otitis media has persistent middle ear fluid but no fever or pain. What is the next step?

A. Ceftriaxone injection
B. Oral clindamycin
C. Monitor ear fluid for 3 months
D. Immediate antibiotic treatment

Answer: C. Monitor ear fluid for 3 months

NU580 Midterm Exam Review

39. A school-age child with chronic ear disease has vertigo, purulent drainage, and a pearly white lesion on the tympanic membrane. What condition is suspected?

A. Cholesteatoma
B. Mastoiditis
C. Otitis externa
D. Otitis media with effusion

Answer: A. Cholesteatoma