Nokea
The primary care pediatric nurse practitioner is performing a well child examination on a school-age child who had complete repair of a tetralogy of Fallot (TOF) defect in infancy. What is important in this child's health maintenance regime?
- A. Cardiology clearance for sports participation
- B. Restriction of physical activity to avoid pulmonary complications
- C. Sub-acute bacterial endocarditis prophylaxis precautions
- D. Teaching about management of hypercyanotic episodes
Correct Answer: A
Rationale: Children who have had TOF repair must be cleared by cardiology before participation in sports.
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Urinary tract infection:
- A. Usually leads to vesico-ureteric reflux
- B. Is more common in boys than girls under a year of age
- C. In boys,is most commonly caused by Proteus mirabilis
- D. Is associated with constipation
Correct Answer: D
Rationale: Urinary tract infections (UTIs) are often associated with constipation in children, as stool retention can increase the risk of bacterial colonization in the urinary tract.
The mother of Gian, a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons, and that she recently had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to:
- A. Bananas
- B. Latex
- C. Kiwifruit
- D. Color dyes
Correct Answer: B
Rationale: Latex allergy is common in children with spina bifida and can cause cross-reactivity with certain fruits like bananas and kiwifruit.
Which clinical manifestation is included in toxic shock syndrome?
- A. Severe hypertension
- B. Subnormal temperature
- C. Erythematous macular rash
- D. Papular rash over extremities
Correct Answer: C
Rationale: One of the diagnostic criteria for toxic shock syndrome is a diffuse macular erythroderma. Hypotension is one of the manifestations. Fever of 38.9° C or higher is a characteristic. Desquamation of the palms and soles of the feet occurs in about 1 to 2 weeks.
A psychiatric referral is warranted in a preschool child with the following:
- A. Night terrors
- B. Separation anxiety
- C. Scared of ghosts
- D. Masturbation
Correct Answer: B
Rationale: Separation anxiety in a preschool child, especially if it is severe and persistent, may warrant a psychiatric referral to assess for anxiety disorders.
In the electrocardiogram of a 40-year old male, the QRS amplitude in lead I and aVF measured (+) 10 and (-)10mV respectively. The frontal QRS axis is
- A. (+) 15°
- B. (-) 45°
- C. (-) 75°
- D. (-) 90°
Correct Answer: B
Rationale: The frontal QRS axis is (-) 45° given the QRS amplitudes in leads I and aVF.