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A 6-year-old child presents with a high-grade fever, sore throat, and enlarged tonsils with white patches. The child has difficulty swallowing and complains of neck pain. Which of the following is the most appropriate next step in management?
erform a rapid strep test rder a throat culture
efer the child for tonsillectomy wer: B
anation: The presentation of a high-grade fever, sore throat, enlarged ls with white patches, difficulty swallowing, and neck pain is consiste a possible streptococcal pharyngitis (strep throat). The most appropria tep in management is to perform a rapid strep test (option B). This te ides rapid results and helps identify the presence of group A Streptoco eria, which is the most common cause of bacterial pharyngitis. If the r test is positive, antibiotics can be initiated. If the rapid strep test is tive, a throat culture (option C) can be performed to further confirm t nosis. Empirical administration of antibiotics (option A) without rming the presence of group A Streptococcus is not recommended.
rral for tonsillectomy (option D) is not indicated as the first-line agement for strep throat.
Administer antibiotics empirically
P
O
R
Ans Expl
tonsi nt
with te
next s st
prov ccus
bact apid
strep
nega he
diag confi Refe man
A 14-year-old adolescent presents with a history of recurrent episodes of depression and exhibits symptoms of irritability, poor concentration, and changes in appetite and sleep patterns. The nurse practitioner suspects major
depressive disorder (MDD). Which of the following interventions is considered first-line treatment for MDD in adolescents?
Selective serotonin reuptake inhibitors (SSRIs)
Cognitive-behavioral therapy (CBT)
Tricyclic antidepressants (TCAs)
wer: B
anation: First-line treatment for major depressive disorder (MDD) in escents typically involves cognitive-behavioral therapy (CBT). CBT is f psychotherapy that focuses on identifying and changing negative
ght patterns, improving coping skills, and promoting behavioral chang een shown to be effective in treating depression in adolescents and is rally preferred as the initial treatment option. Selective serotonin reup itors (SSRIs) may also be used as adjunctive treatment or as a standal ment option in moderate to severe cases of MDD. Tricyclic antidepres As) are generally not recommended as the first-line treatment for MD escents due to their side effect profile. Electroconvulsive therapy (EC ved for severe cases of depression that are unresponsive to other ments or in cases of urgent clinical need.
year-old child presents with recurrent episodes of wheezing, coughing
Electroconvulsive therapy (ECT) Ans
Expl
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shortness of breath, particularly at night or with exercise. The nurse practitioner suspects asthma. Which of the following medications is considered a long-term controller medication for asthma in children?
Albuterol (short-acting beta-agonist)
Montelukast (leukotriene receptor antagonist)
Ipratropium (anticholinergic)
Prednisone (systemic corticosteroid) Answer: B
Explanation: Montelukast, a leukotriene receptor antagonist, is considered a long-term controller medication for asthma in children. It is used as an adjunctive therapy to prevent and control asthma symptoms in children.
mmatory mediators involved in the pathogenesis of asthma. Albuterol
-acting beta-agonist and is used as a rescue or quick-relief medication asthma symptoms. Ipratropium is an anticholinergic medication that sed in combination with other bronchodilators in certain cases. Prednis ystemic corticosteroid and is typically used as a short-term treatment
exacerbations of asthma.
-year-old child is admitted to the pediatric intensive care unit followi re traumatic brain injury. The nurse practitioner assesses the child's le ciousness using the Glasgow Coma Scale (GCS). Which of the follow ngs would indicate the most severe impairment of consciousness?
ye opening to pain (2) comprehensible sounds (2) ocalizes to pain (5) pontaneous eye opening (4)
Montelukast works by blocking the action of leukotrienes, which are
infla is a
short for
acute may
be u one
is a s for
acute
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seve vel of
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Answer: B
Explanation: The Glasgow Coma Scale (GCS) is a tool used to assess the level of consciousness in patients with traumatic brain injury. The scale consists of three components: eye opening, verbal response, and motor response. Each component is assigned a score, and the cumulative score represents the level of
consciousness. In the GCS, lower scores indicate more severe impairment of consciousness. In this case, "Incomprehensible sounds" (2) indicates a lower level of consciousness compared to "Eye opening to pain" (2), "Localizes to pain" (5), and "Spontaneous eye opening" (4).
itioner is assessing the infant's heart sounds. Which of the following ngs would be consistent with a ventricular septal defect (VSD)?
loud, harsh systolic murmur at the left sternal border
continuous machinery-like murmur throughout systole and diastole high-pitched, blowing diastolic murmur at the left upper sternal bord soft, blowing holosystolic murmur at the apex
wer: A
anation: Ventricular septal defect (VSD) is a common congenital hear ct characterized by an abnormal opening in the ventricular septum, ca munication between the left and right ventricles. The characteristic ultatory finding in VSD is a loud, harsh systolic murmur at the left ste er. This murmur is caused by the turbulent blood flow across the defe ng ventricular systole. The other options listed are not consistent with al murmur findings of VSD.
A 3-month-old infant is diagnosed with congenital heart disease. The nurse pract
findi
A
A
A er
A
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com
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A 10-month-old who is otherwise healthy has had emesis with intermittent periods of intense crying and is passing red stool. Which of the following actions should be done FIRST?
Order a complete blood count
Obtain an abdominal ultrasound
Obtain an abdominal radiograph
Schedule surgical evaluation for the next day Answer: B
ointestinal pathology. The first step in the evaluation should be obtain bdominal ultrasound. This imaging modality can provide valuable mation about the gastrointestinal tract, such as identifying any structu rmalities, bowel obstructions, or intussusception. It is a non-invasive a
rocedure, making it an appropriate first step in the diagnostic worku ring a complete blood count (option A) may be considered if there ar of dehydration or suspected infection. An abdominal radiograph (opt ay be helpful in certain situations but is less sensitive and specific pared to an ultrasound. Scheduling a surgical evaluation for the next d on D) may be necessary if the child's condition deteriorates or if there
of a surgical emergency, but it is not the first step in the evaluation ess.
-year-old patient presents with abdominal pain, diarrhea, and weight l ical examination reveals mouth ulcers and perianal skin tags. Which o
Explanation: The presenting symptoms of emesis, intense crying, and passing red stool in an otherwise healthy 10-month-old raise concern for possible gastr ing
an a
infor ral
abno nd
safe p p.
Orde e
signs ion
C) m
com ay
(opti are
signs proc
A 12 oss.
Phys f the
following conditions should be suspected?
Crohn's disease
Irritable bowel syndrome
Celiac disease
Ulcerative colitis
Answer: A
Irritable bowel syndrome (option B) typically presents with abdomin nd changes in bowel habits but does not cause weight loss or intestinal manifestations like mouth ulcers and skin tags. Celiac disea on C) is an autoimmune disorder characterized by an immune reactio n, leading to malabsorption and gastrointestinal symptoms, but it does ally cause perianal skin tags. Ulcerative colitis (option D) is another f flammatory bowel disease, but it primarily involves the colon and rect oes not typically present with mouth ulcers or perianal skin tags.
year-old child with sickle cell disease presents to the emergency rtment with severe pain crisis. The nurse practitioner plans to initiate p agement using intravenous opioids. Which of the following opioids is monly used for acute pain management in children?
orphine
Explanation: The combination of abdominal pain, diarrhea, weight loss, mouth ulcers, and perianal skin tags is suggestive of Crohn's disease. Crohn's disease is a chronic inflammatory condition that can affect any part of the gastrointestinal tract, commonly involving the terminal ileum and colon. Symptoms include abdominal pain, diarrhea (which can be bloody), weight loss, and extraintestinal manifestations such as mouth ulcers and perianal skin tags. al
pain a
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(opti n to
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of in um,
and d
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depa ain
man com
M
Oxycodone
Fentanyl
Codeine Answer: A
Explanation: Morphine is a commonly used opioid for acute pain management
in children. It is effective in providing analgesia and has a well-established dosing regimen for pediatric patients. Morphine can be administered intravenously and is available in various formulations suitable for different routes of administration. Oxycodone, fentanyl, and codeine are also opioids used for pain management, but they may have specific indications or considerations and may not be as commonly used as morphine in the pediatric population.
ch of the following medications has the GREATEST risk for medicati ced pancreatitis?
nalapril uetiapine alproic acid ancomycin
wer: C
anation: Valproic acid has the greatest risk for medication-induced reatitis. Valproic acid is an antiepileptic medication commonly used i ment of seizure disorders and mood disorders. Although pancreatitis is dverse effect of valproic acid, it has been reported in the literature. T
mechanism of valproic acid-induced pancreatitis is not fully underst is thought to involve direct toxic effects on pancreatic cells and disru
Whi on-
indu
E
Q
V
V
Ans Expl
panc n the
treat a
rare a he
exact ood,
but it ption
of pancreatic enzyme secretion. Enalapril (option A) is an angiotensin- converting enzyme (ACE) inhibitor used to treat hypertension and heart failure and is not associated with pancreatitis. Quetiapine (option B) is an atypical antipsychotic used in the treatment of psychiatric disorders and does not have a significant association with pancreatitis. Vancomycin (option D) is an antibiotic commonly used to treat serious infections caused by gram-positive bacteria and is not known to be a major risk factor for pancreatitis.
dminister systemic corticosteroids
itiate continuous nebulized bronchodilator therapy erform a chest X-ray
dminister intravenous magnesium sulfate wer: B
anation: In the setting of an acute exacerbation of asthma that is not onding to initial treatment with inhaled bronchodilators, the most opriate next step in management is to initiate continuous nebulized chodilator therapy (option B). Continuous nebulized bronchodilator py, such as continuous albuterol, can help provide sustained chodilation and improve respiratory symptoms in severe cases of asth erbation. Administering systemic corticosteroids (option A) is also an rtant component of management and should be initiated early in the ment of acute asthma exacerbation. However, in this scenario, the ediate priority is to address the ongoing respiratory distress. Performi
A 10-year-old child with a history of asthma presents with acute exacerbation of respiratory symptoms. Despite initial treatment with inhaled bronchodilators, the child continues to have severe respiratory distress and wheezing. Which of the following is the most appropriate next step in management?
A
In
P
A
Ans Expl
resp appr bron thera
bron ma
exac impo treat
imm ng a
chest X-ray (option C) may be considered if there is concern for alternative or complicating diagnoses, such as pneumonia or pneumothorax, but it is not the most appropriate next step in managing an acute asthma exacerbation. Administering intravenous magnesium sulfate (option D) is a possible adjunctive therapy in severe asthma exacerbations, but it is typically considered after initial bronchodilator therapy and systemic corticosteroids have been initiated.
asal-bolus regimen with multiple daily injections iding scale insulin regimen
ontinuous subcutaneous insulin infusion (insulin pump) ong-acting insulin once daily
wer: A
anation: The most common insulin regimen for children with type 1 etes is the basal-bolus regimen with multiple daily injections. This reg ves administering a long-acting or basal insulin once or twice daily to ide a background insulin level, and rapid-acting or bolus insulin befor
to cover the postprandial rise in blood glucose. This regimen provid bility in insulin dosing and closely mimics the physiological insulin tion. Sliding scale insulin regimens are not recommended as the prim in regimen for children with type 1 diabetes. Continuous subcutaneou in infusion (insulin pump) is an alternative method of insulin delivery
e used in certain cases. Long-acting insulin once daily may not prov
A 9-year-old child is diagnosed with type 1 diabetes mellitus. The nurse practitioner is educating the child and the family about insulin administration. Which of the following insulin regimens is commonly used for children with type 1 diabetes?
B
Sl
C
L
Ans Expl
diab imen
invol
prov e
meals es
flexi
secre ary
insul s
insul that
may b ide
adequate coverage for postprandial glucose excursions.
A 5-year-old child presents with a persistent dry cough, low-grade fever, and wheezing. The cough is worse at night and during physical activity. Which of the following is the most likely diagnosis?
Asthma
Pneumonia
Bronchiolitis
anation: The persistent dry cough, wheezing, and exacerbation of ptoms at night and during physical activity are suggestive of asthma. ma is a chronic inflammatory condition of the airways characterized b chospasm, increased mucus production, and airway hyperresponsiven monly presents with symptoms such as cough, wheezing, and shortnes
h. The low-grade fever may be associated with an underlying respirat tion or inflammation. Pneumonia (option B) typically presents with a uctive cough, fever, and respiratory distress. Bronchiolitis (option C) i acterized by wheezing, cough, and respiratory distress, but it is more mon in infants and younger children. Allergic rhinitis (option D) usual ents with symptoms such as sneezing, itching, and clear nasal discharg out wheezing or significant cough.
-year-old patient presents with acute-onset severe headache, vomiting
Allergic rhinitis Answer: A
Expl sym
Asth y
bron ess. It
com s of
breat ory
infec
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with
A 14 , and
altered mental status. On physical examination, there is nuchal rigidity and photophobia. Which of the following is the most appropriate next step in management?
Perform a lumbar puncture
Order a head CT scan
Administer intravenous antibiotics
Initiate antiepileptic medication Answer: B
ased intracranial pressure or other structural abnormalities that may aindicate lumbar puncture. If the head CT scan does not reveal any aindications, a lumbar puncture (option A) should be performed to ob brospinal fluid for analysis and definitive diagnosis. Administering venous antibiotics (option C) should be considered after obtaining opriate cultures from the lumbar puncture and confirming the diagnosi erial meningitis. Initiating antiepileptic medication (option D) is not th
tep in management and should be considered if there is evidence of res or ongoing seizure activity.
year-old child presents with recurrent urinary tract infections (UTIs). T practitioner suspects vesicoureteral reflux (VUR) as the underlying c ch of the following diagnostic tests is most commonly used to confirm
nosis of VUR?
Explanation: The acute onset of severe headache, vomiting, altered mental status, nuchal rigidity, and photophobia raises concern for possible meningitis. The most appropriate next step in management is to order a head CT scan (option B). A head CT scan is performed first to evaluate for any signs of incre
contr
contr tain
cere intra
appr s of
bact e
first s seizu
A 4- he
nurse ause.
Whi the
diag
Voiding cystourethrogram (VCUG)
Renal ultrasound
Urine culture and sensitivity
Nuclear scintigraphy (DMSA scan)
year-old child with acute lymphoblastic leukemia (ALL) presents with grade fever, chills, and fatigue. The nurse practitioner suspects sepsis rs a blood culture. The appropriate site for obtaining a blood culture in is:
moral vein dial artery gular vein eripheral vein
wer: D
anation: When obtaining a blood culture in a child with suspected sep ppropriate site is a peripheral vein. The peripheral veins, such as thos rm or hand, are commonly used for blood culture collection in pediatr
Explanation: The most commonly used diagnostic test to confirm the diagnosis of vesicoureteral reflux (VUR) is a voiding cystourethrogram (VCUG). A VCUG involves the instillation of contrast material into the bladder followed by imaging with fluoroscopy during voiding. This test allows visualization of the urethra, bladder, and ureters and can determine the presence and severity of VUR. Renal ultrasound, urine culture and sensitivity, and nuclear scintigraphy (DMSA scan) may beused as adjunctive tests in the evaluation of VUR, but VCUG is the primary diagnostic test for confirming the diagnosis.
A 5- a
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orde this
child
fe
ra
ju
p Ans
Expl sis,
the a e in
the a ic
patients. It is a relatively less invasive site compared to central veins, and it allows for easier access and reduced risk of complications. The femoral vein, radial artery, and jugular vein are not typically used for obtaining blood cultures unless there are specific indications or circumstances requiring their use.
An acute care pediatric nurse practitioner’s new oncology service role will include lumbar punctures. The legal authority to perform this task is BEST determined by:
obtaining credentials through board certification
state board’s scope of practice for nurse practitioners
collaborating physician's determination of practitioner’s skills
wer: B
anation: The legal authority for a nurse practitioner to perform specifi such as lumbar punctures, is determined by the state board's scope o ice for nurse practitioners. Each state has its own regulations and elines outlining the procedures and responsibilities that nurse practitio uthorized to perform. It is essential for nurse practitioners to be famili hese regulations and work within the defined scope of practice to ens compliance and patient safety. While obtaining credentials through b fication, collaborating with a physician, and acquiring skills through a ational program are important aspects of professional development, th
mate determination of legal authority lies with the state board's scope o ice.
preparation obtained from the acute care educational program Ans
Expl c
tasks, f
pract
guid ners
are a ar
with t ure
legal oard
certi n
educ e
ulti f
pract