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    Exam Review

    1. A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin level of 9.5 g/dL. The infant presents with mild pallor and no hepatosplenomegaly. What is the most likely diagnosis?
      A)
      Sickle-cell anemia.
      B)
      Hereditary spherocytosis.
      C)
      Iron-deficiency anemia.
      D)
      Lead intoxication.
    2. A toddler presents with anemia and reticulocytopenia following a recent viral infection. The child has experienced a gradual decrease in energy and increased pallor. What is the appropriate management approach by the primary care pediatric nurse practitioner?
      A)
      Refer for transfusions to correct the anemia.
      B)
      Prescribe supplemental iron for 4 to 6 months.
      C)
      Consult with a pediatric hematologist.
      D)
      Closely observe the child's symptoms and lab values.
    3. During a well-child exam on a 4-year-old child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and observed that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?
      A)
      Refer to a pediatric ophthalmologist.
      B)
      Follow up with a visual acuity screen in 6 months.
      C)
      Test the child's vision in 1 month.
      D)
      Re-test the child in 1 year.
    4. The primary care pediatric nurse practitioner performs a vision screen on a 4-month-old infant and notes the presence of convergence with mild esotropia of the left eye. What will the nurse practitioner do?
      A)
      Reassure the parents that the infant will outgrow this.
      B)
      Patch the right eye to improve coordination of the left eye.
      C)
      Recheck the infant's eyes in 2 to 4 weeks.
      D)
      Refer the infant to a pediatric ophthalmologist.
    Page 1 of 7

    Exam Review

    1. A toddler who presents with anemia and reticulocytopenia has a history of a gradual decrease in energy and increased pallor beginning after a recent viral infection. How will the primary care pediatric nurse practitioner treat this child?
      A)
      Refer for transfusions to correct the anemia.
      B)
      Prescribe supplemental iron for 4 to 6 months.
      C)
      Consult with a pediatric hematologist.
      D)
      Closely observe the child's symptoms and lab values.
    2. What will the primary care pediatric nurse practitioner teach the parents of a child who has newly placed pressure equalization tubes (PET) in the ears?
      A)
      The child should use earplugs when showering or bathing.
      B)
      PET will help by reducing the number of ear infections the child has.
      C)
      The tubes will most likely remain in place for 3 to 4 years.
      D)
      Parents should notice improved hearing in their child.
    3. A toddler who presents with anemia and reticulocytopenia has a history of a gradual decrease in energy and increased pallor after a recent viral infection. How will the primary care nurse practitioner treat this child?
      A)
      Refer for transfusions to correct the anemia.
      B)
      Prescribe iron for 4 to 6 months.
      C)
      Consult with a hematologist.
      D)
      Closely observe the child's symptoms and lab values.
    4. The primary care nurse practitioner performs a well-baby examination on a 4-month-old infant who is exclusively breastfed, and whose mother plans to introduce only small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant receives adequate iron, what will the practitioner recommend?
      A)
      Monitoring the infant's hemoglobin and hematocrit at every well-baby checkup.
      B)
      Elemental iron supplementation of 3 mg/kg/day for the duration of breastfeeding.
      C)
      Offering iron-fortified formula to ensure adequate iron intake.
      D)
      Elemental iron supplementation of 1 mg/kg/day until cereals are added.
    Page 2 of 7

    Exam Review

    1. The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of -180 mm H₂O. What does this value indicate?
      A)
      Middle ear effusion.
      B)
      Tympanic membrane perforation.
      C)
      Negative ear pressure.
      D)
      A normal tympanic membrane.
    2. A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical medication. What is the next step in treatment for this child?
      A)
      Irrigate the external auditory canal with saline.
      B)
      Prescribe an oral antibiotic medication.
      C)
      Insert a wick into the external auditory canal.
      D)
      Order systemic corticosteroids.
    3. A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with antibiotic/corticosteroid drops. What is the next step in treatment for this child?
      A)
      Irrigate the external auditory canal with saline.
      B)
      Prescribe an oral antibiotic medication.
      C)
      Insert a wick into the external auditory canal.
      D)
      Order systemic corticosteroids.
    4. A school-age child comes to the clinic for evaluation of excessive bruising. The primary care pediatric nurse practitioner notes a history of a respiratory infection 2 weeks prior. The physical exam is negative for hepatosplenomegaly and lymphadenopathy. Blood work reveals a platelet count of 60,000/mm³ with normal PT and aPTT. How will the nurse practitioner manage this child's condition?
      A)
      Admit to the hospital for IVIG therapy.
      B)
      Refer to a hematologist.
      C)
      Begin a short course of corticosteroid therapy.
      D)
      Teach to avoid NSAIDs and contact sports.
    Page 3 of 7

    Exam Review

    1. A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema, marked swelling of the external auditory canal, and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention?
      A)
      Refer the child to an otolaryngologist.
      B)
      Obtain a culture of the external auditory canal.
      C)
      Prescribe oral amoxicillin-clavulanate.
      D)
      Order ototopical antibiotic/corticosteroid drops.
    2. During a well-baby assessment on a 1-week-old infant who had a normal exam when discharged from the newborn nursery 2 days earlier, the primary care nurse practitioner notes eyelid swelling, bulbar conjunctival injection, and thick purulent discharge. What is the most likely diagnosis?
      A)
      Herpes simplex virus (HSV) conjunctivitis.
      B)
      Neisseria gonorrhea conjunctivitis.
      C)
      Chemical-induced conjunctivitis.
      D)
      Chlamydia conjunctivitis.
    3. A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention?
      A)
      Refer the child to an otolaryngologist.
      B)
      Obtain a culture of the external auditory canal.
      C)
      Prescribe oral amoxicillin-clavulanate.
      D)
      Order ototopical antibiotic/corticosteroid drops.
    4. What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child’s teeth?
      A)
      To choose a toothpaste with a mint flavor.
      B)
      To use a smear of toothpaste and not to rinse the mouth.
      C)
      To use a toothpaste containing whitening agents.
      D)
      To allow the child to control the amount of toothpaste used.
    Page 4 of 7

    Exam Review

    1. A 2-year-old child who has sickle cell anemia (SCA) comes to the clinic with a cough and a fever of 101.5°F. The child currently takes penicillin V prophylaxis 125 mg orally twice daily. What will the primary care pediatric nurse practitioner do?
      A)
      Give intravenous fluids and antibiotics in clinic.
      B)
      Increase the penicillin V dose to 250 mg.
      C)
      Admit the child to hospital to evaluate for sepsis.
      D)
      Order a chest radiograph to rule out pneumonia.
    2. A 9-month-old infant has developed two teeth since the 6-month checkup. The local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to promote healthy dentition at this visit?
      A)
      Apply sodium fluoride varnish to the infant's teeth.
      B)
      Teach the parents how to brush the infant's teeth with fluoride toothpaste.
      C)
      Encourage the parents to make an initial dental appointment.
      D)
      Prescribe oral fluoride supplementation.
    3. The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2-year-old child who has a history of three ear infections in the first 6 months of life. The child's tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner do for this child?
      A)
      An analgesic medication and watchful waiting.
      B)
      Ceftriaxone given once intramuscularly.
      C)
      Antibiotic ear drops and ibuprofen.
      D)
      Amoxicillin twice daily for 10 days.
    4. A 4-year-old child who has asthma presents with cupped-out lesions on the chewing surfaces of the teeth. What is the most likely explanation for this finding?
      A)
      Gastroesophageal reflux.
      B)
      Bruxism.
      C)
      Decreased saliva.
      D)
      Bulimia.
    Page 5 of 7

    Exam Review

    1. A 5-year-old child is hit in the face with a baseball bat and is brought to the clinic by a parent. An exam reveals three front teeth are missing. Imaging studies are negative for facial fractures. What is the recommended treatment?
      A)
      Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days.
      B)
      Refer the child to a dentist immediately for further examination.
      C)
      Refer the child to a dentist for reimplantation of the avulsed teeth.
      D)
      Remove teeth, place them in saline, and refer the child to a dentist.
    2. The primary care pediatric nurse practitioner performs a well-child examination on a 9-month-old infant who was born prematurely at 28 weeks’ gestation and was treated for retinopathy of prematurity (ROP), with all symptoms resolved. When will the infant need an ophthalmologic exam?
      A)
      At 12 months of age.
      B)
      At 48 months of age.
      C)
      At 24 months of age.
      D)
      At 60 months of age.
    3. A toddler exhibits exotropia of the right eye during a cover-uncover test. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment?
      A)
      Occluding the affected eye for 6 hours per day.
      B)
      Patching of the unaffected eye for 2 hours each day.
      C)
      Botulinum toxin injection.
      D)
      Corrective surgery.
    4. A child who was treated with amoxicillin and then amoxicillin-clavulanate for acute otitis media is seen for follow-up. The primary care nurse practitioner notes dull-gray tympanic membranes with a visible air-fluid level. The child is afebrile and without pain. What is the next course of action?
      A)
      Administering ceftriaxone IM.
      B)
      Watchful waiting for 48 to 72 hours.
      C)
      Monitoring ear fluid levels for 3 months.
      D)
      Giving clindamycin orally.
    Page 6 of 7