LATEST EXAM - a) Providing comprehensive and coordinated care...

NGR6001

Pediatrics

LATEST EXAM

2024

• Which of the following is a key component of the pediatric primary care model?

a) Providing comprehensive and coordinated care for children and their families

b) Focusing on acute and episodic care for children with common illnesses

c) Referring children to specialists for most of their health needs

d) Limiting preventive and developmental services to well-child visits

Answer: A. The pediatric primary care model emphasizes providing comprehensive and coordinated care for children and their families, including preventive, acute, chronic, and developmental services.

• A 4-year-old child presents to the clinic with a fever of 38.5°C, sore throat, and

enlarged cervical lymph nodes. The nurse practitioner suspects streptococcal pharyngitis and orders a rapid antigen detection test (RADT). The test result is negative. What is the most appropriate next step for the nurse practitioner?

a) Prescribe antibiotics empirically based on the clinical presentation

b) Order a throat culture to confirm the diagnosis

c) Reassure the parents that the child has a viral infection and provide symptomatic

treatment

d) Repeat the RADT in 24 hours to rule out a false negative result

Answer: B. A throat culture is the gold standard for diagnosing streptococcal pharyngitis and should be performed when the RADT result is negative and the clinical suspicion is high.

• A 12-year-old child with type 1 diabetes mellitus comes to the clinic for a routine

follow-up visit. The nurse practitioner reviews the child's blood glucose logs and notes that the child has frequent episodes of hypoglycemia, especially before lunch and after physical activity. The nurse practitioner also notes that the child's hemoglobin A1c level is 9.5%, indicating poor glycemic control. What is the most likely explanation for this paradoxical finding?

a) The child is experiencing the Somogyi effect, a rebound hyperglycemia caused by

excessive insulin dosage or action

b) The child is experiencing the dawn phenomenon, an early morning rise in blood

glucose due to increased growth hormone secretion

c) The child is experiencing diabetic ketoacidosis, a life-threatening complication of

insulin deficiency

d) The child is experiencing insulin resistance, a reduced response of peripheral tissues

to insulin action Answer: A. The Somogyi effect is a phenomenon in which excessive insulin dosage or action leads to hypoglycemia, which triggers counter-regulatory hormones such as glucagon, cortisol, and epinephrine to raise blood glucose levels, resulting in rebound hyperglycemia. This can mask poor glycemic control and cause wide fluctuations in blood glucose levels.

• A 6-month-old infant is brought to the clinic for a well-child visit. The nurse

practitioner assesses the infant's growth and development using standardized charts and tools. Which of the following developmental milestones would be expected for an infant of this age?

a) Sitting without support, babbling, transferring objects from one hand to another

b) Rolling over, cooing, grasping objects with the whole hand

c) Crawling, saying "mama" and "dada", picking up small objects with thumb and index

finger

d) Pulling up to stand, waving bye-bye, pointing to objects of interest

Answer: A. Sitting without support, babbling, and transferring objects from one hand to another are typical developmental milestones for a 6-month-old infant.

• A 10-year-old child with asthma comes to the clinic for an asthma action plan review.

The nurse practitioner asks the child about his asthma symptoms, medication use, and peak expiratory flow (PEF) readings over the past month. The child reports having asthma symptoms more than twice a week, but not daily; using his short-acting beta- agonist (SABA) inhaler more than twice a week, but not daily; and having a PEF of 80% of his personal best on most days. According to the National Asthma Education and Prevention Program (NAEPP) guidelines, what is the child's current level of asthma control?

a) Well controlled

b) Not well controlled

c) Very poorly controlled

d) Intermittent

Answer: B. The NAEPP guidelines classify asthma control into three levels: well controlled, not well controlled, and very poorly controlled. A child with not well controlled asthma has symptoms more than twice a week, but not daily; uses SABA more than twice a week, but not daily; has any limitation in normal activity; has a PEF of 60-80% of personal best; or has one or more nighttime awakenings per month.

• A 15-year-old adolescent girl comes to the clinic for a sports physical examination.

The nurse practitioner performs a comprehensive history and physical examination, including a sexual and reproductive health assessment. The adolescent girl reports that she is sexually active with one male partner and that they use condoms inconsistently.She denies any history of sexually transmitted infections (STIs) or pregnancy. She also states that she has regular menstrual cycles of 28 days, with her last menstrual period starting 10 days ago. What is the most appropriate contraceptive method for this adolescent girl?

a) Combined oral contraceptive pills (COCs)

b) Progestin-only pills (POPs)

c) Depot medroxyprogesterone acetate (DMPA) injection

d) Levonorgestrel-releasing intrauterine device (LNG-IUD)

Answer: D. The LNG-IUD is a long-acting reversible contraceptive (LARC) method that is highly effective, safe, and convenient for adolescents. It has a failure rate of less than 1% and can prevent pregnancy for up to 5 years. It also has non-contraceptive benefits, such as reducing menstrual bleeding and dysmenorrhea. The LNG-IUD does not protect against STIs, so condom use is still recommended.

• A 2-year-old toddler is brought to the clinic for a routine immunization visit. The nurse

practitioner reviews the toddler's immunization record and notes that the toddler has received the following vaccines: three doses of DTaP, three doses of IPV, three doses of Hib, three doses of PCV13, two doses of HepB, two doses of RV, one dose of MMR, and one dose of Var. Which of the following vaccines should the nurse practitioner administer to the toddler at this visit?

a) DTaP, IPV, Hib, PCV13, HepA

b) DTaP, IPV, Hib, PCV13, HepB

c) DTaP, IPV, MMR, Var, HepA

d) DTaP, IPV, MMR, Var, HepB

Answer: C. The recommended vaccines for a 2-year-old toddler who has received the previous vaccines are DTaP (fourth dose), IPV (third or fourth dose), MMR (second dose), Var (second dose), and HepA (first dose).

• A 9-year-old child is brought to the clinic by his mother for evaluation of a skin rash.

The mother says that the rash started on the child's face and then spread to his trunk and extremities. She also says that the child had a fever and sore throat a few days before the rash appeared. The nurse practitioner examines the child and observes erythematous maculopapular lesions that are blanchable and non-pruritic. The lesions are more confluent on the face and more discrete on the rest of the body. The child's temperature is 37.8°C and his throat is slightly erythematous. What is the most likely diagnosis for this child?

a) Measles

b) Rubella

c) Scarlet fever

d) Roseola

Answer: B. Rubella, also known as German measles, is a viral infection that causes a mild fever and a rash that typically starts on the face and then spreads to the rest of the body. The rash is erythematous maculopapular lesions that are blanchable and non- pruritic. The rash lasts for about 3 days and then fades. Rubella may also cause lymphadenopathy, conjunctivitis, and arthralgia.

• A 7-year-old child with sickle cell anemia comes to the clinic for a routine follow-up

visit. The nurse practitioner reviews the child's laboratory results and notes that the child has a hemoglobin level of 8 g/dL, a hematocrit of 24%, a reticulocyte count of 15%, and a white blood cell count of 15 x 10^9/L. The nurse practitioner also notes that the child has not had any episodes of pain crisis or acute chest syndrome in the past year. What is the most appropriate management plan for this child?

a) Continue hydroxyurea therapy and folic acid supplementation

b) Start chronic transfusion therapy and iron chelation therapy

c) Start erythropoietin therapy and vitamin B12 supplementation

d) Start immunosuppressive therapy and corticosteroid therapy

Answer: A. Hydroxyurea is a disease-modifying agent that increases fetal hemoglobin production and reduces hemolysis, inflammation, and vaso-occlusion in sickle cell anemia. It can reduce the frequency and severity of pain crises and acute chest syndrome, as well as improve hematologic parameters such as hemoglobin level, reticulocyte count, and white blood cell count. Folic acid supplementation is recommended to support erythropoies