NRNP6541 Final Exam Latest 2021

NURS 6541 final

Question 1Asmall-for-gestational-age,dysmorphicnewborninfanthasmicrocephalyandslopingforehead, cutisaplasia(missingportionoftheskinandhair)ofthescalp,polydactyly,microphthalmia,and omphalocele. Which of these is the most likelydiagnosis?

•             Question2A 16-year-old girl has enuresis, frequent urination, a white vaginal discharge, and a dark rash around her neck. Her serum glucose level is 250 mg/dL, and her urinalysis is positive for 2+ glucose but is otherwise negative. Which of the following is the most likely diagnosis?

•             Question3Mark,age15,is5feettallandnweighs85pounds.Yoususpectanorexiaandknowthatthebest initial approach isto

•             Question4Which of the following is not a sign or symptom of congenital hypothyroidism?

•             Question5Whiledoinga5-year-oldwellchildexam,younoticetwosmallpatchesofhairloss.Brokenhairis present,asiserythemaandscaling.Onthebasisofthisinformation,whichoftheseisthelikely diagnosis?

•             Question6Hope is a 7-month-old who presents in January with a 1-day history of cough, yellow nasal discharge, and low-grade temp (T max 100°F). She was previously healthy. She does have 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office. Her chest, mouth, and ears are clear. You prescribe:

•             Question7Theparentsofan8-year-oldDownSyndromeboyarriveforhisannualwell-childvisit.Hewantsto participateinsports,includingtheSpecialOlympics.Untilfurtherexaminationcanbecompleted, which of the following sports would you suggest as beingsafe?

•             Question8Jason,age14,appearswithtenderdiscoidbreasttissueenlargement(2-3cmindiameter)beneath the areola. Your next action would beto

•             Question9You see a 7-year-old boy a day after he was bitten by his pet dog. According to the mother, the dog bit the child after he snuck up on the dog and grabbed his tail. The dog has had all its vaccinations, including rabies. The child has had no fever, has full movement of the injured limb, and has no sign of neurologic or vascular injury. The wound is on the child’s forearm, is not deep, and is not bleeding, but has developed about 2 cm of erythema surrounding the site. Which of the following is the most appropriate treatment?

•             Question10A head injury in which bruising or tearing of the cerebral structures occurs is a

•             Question11A14-year-oldhasa3-weekhistoryoffever,anorexia,andabdominalpain.Whatadditional symptom would cause the NP to suspect Crohn'sdisease?

•             Question12Which of the following should be done annually after 1 year of age in a child with Down syndrome?

•             Question13A previously healthy male has a 3-month history of increasing headaches, blurred vision, and personality changes. Previously he admitted to marijuana experimentation more than 1 year ago. On examination he is a healthy, athletic-appearing 17-year-old with decreased extraocular range of motion and left eye visual acuity. Which of the following is the best next step in his management?

•             Question14Kelly,your11-year-oldwellvisitpatient,presentstotheofficewithweightloss,polyuria,and polydipsia. Which of the following do you need to ruleout?

•             Question15A 3-week old presents to the office in January with a 1-week history of nasal congestion and occastional cough. On the night prior to the visit in infant developed a fever 102ºF rectally, was difficulttobreastfeed,andhadparoxysmalcoughingandnoisy,laboredbreathing.Onexam,you noteanill-appearinginfantwhoislethergicwithwheezing,tachypnea,andintercostalretractions. The infant is home with the mom at this time; however, has a sibling who is 4-years-old and is in daycareandrecentlyhadcoldsymptoms.IfthepatienthasbeendiagnosedwithRSVbronchiolitis,

which of the following would be the treatment of choice?

•             Question16Chest pain in young children is usually

•             Question17Maddie,age2,hadacompletebloodcount(CBC)drawnatherlastvisit.Itindicatesthatshehasa microcytichypochromicanemia.Whatshouldyoudonowatthisvisit?

•             Question18Most children with Duchenne muscular dystrophy become wheelchair dependent by what age?

•             Question19The following clinical description best matches which genetic disorder? A tall, thin 14-year- old boy has no signs of puberty. He was delayed in his speech development and always has done less well in school than his siblings. He is shy, and teachers report his activity is immature. Physical examination reveals breast development, and long limbs with a decreased upper segment/lower segment ration. He has small testes and phallus.

                Question20Of the following patients, which child should not receive a tuberculin skin test?

•             Question21A 10-year-old male presents with a fever of 102ºF and complaints of leg pains. His mother reports that he had an upper respiratory infecion with a sore throat about 2 weeks ago. No treatment was needed. On examination, he has tender and swollen knees bilaterally. His heart rate is 125 bpm and a blowing systolic murmur is heard at the apex. No murmur was noted at in the chart. The mostly diagnosis is:

•             Question22Whenaneonateisinitiallyprotectedagainstmeasles,mumps,andrubellabecausethemotheris immune, this is an example of which type ofimmunity?

•             Question23Sarah,age13,ismarkedlyobeseandhasapoorself-image.Howdoyoudifferentiatebetween compulsive eating andbulemia?

•             Question24Seborrheadermatitisiscommonforbothinfantsandadolescents.Whichisnotcorrectforthis condition?

•             Question25Whichchromosomalabnormalityisassociatedwithshortstatureingirls?

•             Question26Youseeapatientyoubelievehasfolliculitis.Whatmedicationwouldbethebesttotreatthis patient? The patient has noallergies.

•             Question27Antibiotictherapyisoneofthemainstaysoftreatmentforwhichofthefollowingcausesof wheezing?

•             Question28Which of the following symptoms are most suggestive of pneumonia in a young child?

•             Question29An11-year-oldhasbeendiagnosedwithmildintermittentasthma.Whichofthefollowingisnota routine part of the clinicalmanagement?

•             Question30 Generalized absence seizures usually occur in which age group?

                Question31 Whichtestisroutinelyrecommendedforapreparticipationsportsphysical?

•             Question32Ahealthy,thriving4-year-oldmalehashadsuddenepisodesofdrawinghiskneestohischestand crying like he is in acute pain for the last 5 hours. These episodes are separated by quiet times whenheappearsnormalandcomfortable.Heisnotvomitingandhasnothadabowelmovement today. What is the most likelydiagnosis.

                Question33A 15-day-old infant has respiratory distress. A quick observation suggests she has slight cyanosis, hepatosplenomegaly, and features consistent with Down Syndrome. The cardiac examination demonstrates a loud first heart sound, a low-pitched, mid-diastolic murmur at the lower left sternal border, and a harsh apical holosystolic murmur in the mitral area.

Which of the following cardiac conditions most likely explains her heart findings?

•             Question34Anex-preemiewithbronchopulmonarydysplasiahasbeendischargedtohomefromtheNICU.One potential problem area that requires close monitoringis

                Question35A 16-year-old presents with pharyngitis, cough, and high fever. Her chest x-ray reveals bilateral pulmonaryinfiltrates.Herwhitebloodcellcountisnormalandtheneutrophilcountisnormal.The most likely etiologyis

•             Question36Which of the following vaccines provides protection against a common type of sepsis/meningitis?

•             Question37A mother brings a 2-year-old to your office with the complaint that she passes 5 to 10 watery stoolsperdaythatoftencontainundigestedfood.ThechildappearshealthyandhasnootherGI symptoms. She is acting, eating, and voiding normally. Weight gain is normal and the mother statessheoftendrinks(herfavoritedrinkisKool-Aid)insteadofeating.Thebestmanagementfor this conditionis:

•             Question38Sixmonthsafterbeingdiagnosedwithwhatappearstobeinsulin-dependentdiabetes,the5-year- old in the case presentation has a significant decrease in his insulin requirement. Which of the following is the most likelyexplanation?

•             Question39Grace,age15,hasbeendiagnosedwithacne.Whichofthefollowingisnottruewiththis condition?

•             Question40Allofthefollowingistreatmentforachildwithphimosisexcept

                Question41Primary dysmenorrhea is due to

•             Question42Childreninchildcarefacilitiesareatgreaterriskofbeingexposedtowhichofthefollowing infections?

•             Question43A 14-month-old child has lower extremity bowing, a waddling gait, genu varum, and is atthe 5th percentile for height. Laboratory data include low-normal serum calcium, moderately low serum phosphate, and elevated serum alkaline phosphatase levels, hyperphosphaturia, and normal parathyroid levels. Which of the following is the most likelydiagnosis?

•             Question44Achildhasdevelopedhersecondperirectalabscessin6months.Sheshouldbeevaluatedfor which of the followingconditions?

•             Question45The classic radiographic finding of croup is

                Question46Whatistheprimarytreatmentfortesticulartorsion?

•             Question47Youseea7-year-oldwithapositivestoolcultureforSalmonellaenteriditis.Theappropriate therapy for a non-dehydrated childis

•             Question48Riley,a12-year-oldgirl,hasscaly,hyperpigmentedlesionsina"Christmastree"distribution.Itis predominantlyonhertrunk.Onelesionisonherbuttockthatislargerthantheother,atabout4 cm in diameter. What is yourdiagnosis?

•             Question49You are on call and receive a phone call from the parents of a 13-year-old known asthmatic. She has been having chest tightness and a worsening cough for 48 hours. She has significant nasal dischargethatbegan14daysagoandintermittentcomplaintofheadache.Sheisnowrunninga low-gradefever.Herpeakflowthelast48hoursis70–80%ofpersonalbest.Hertemperatureright now is 101.7°F. She is on salmeterol with corticosteroid (Advair) and PRN albuterol. Which of the following is mostappropriate?

 •            Question50Whichofthefollowingtherapeuticoptionsiscommonforthetreatmentofbothbeestingsandbite wounds?

•             Question51Acommonpresentingsymptomofinflammatoryboweldiseaseis

•             Question52Newborn R.T. has a vascular lesion that will not fade as she gets older. What is your diagnosis?

•             Question53Ana is a 14-year-old female and has not yet started her menstrual cycle. The history is noncontributoryandthephysicalisnormal.Momstartedhermenstrualcycleat14-yearsofage. Ana'sbreastdevelopmentandpubichairbeganaboutayearago.Momisveryconcerned.The most appropriate initial step would beto

•             Question54The diet of a 3-year-old with cystic fibrosis should be supplemented with which of the following?

•             Question55Whichofthefollowingobjectivedataareassociatedwithsignificantlybetterlong-termoutcomes in children born with open spinabifida?

•             Question56Individualswithchronicadrenalinsufficiencyoftenhave

                Question57A healthy 8-month-old infant presents with diarrhea but no dehydration. What is the best advice togive to the parents?

•             Question58An essential test in the evaluation of a 2-year-old being managed for Kawasaki disease is

                Question59Inmildtomoderateattacksofacuteasthma,Albuterolshouldbegivenevery4-6hoursprnand routine medication shouldbe

•             Question60Which fo the following foods would be most appropriate for a child with celiac disease?