NRNP 6541 Week 9 Knowledge Check Quiz Answer Key
Module 3: GI, Renal and GU, Hematological, and Metabolic and Endocrine Conditions
As you complete Module 3, you will measure your understanding of the key topics in Weeks 7–9 with another 20-question Knowledge Check. Keep in mind this formative assessment is designed to help you prepare for the Final Exam in Week 11, and for gaining practice in question content and formats for the Family Nurse Practitioner certification test.
To prepare:
Review Learning Resources from Weeks 7, 8, and 9, using the topic list, below, as a guide.
Module 3 Knowledge Check topics will include the following:
Signs of gastrointestinal conditions
Diagnosis, treatment, management, and prevention of gastrointestinal disorders
Signs of renal and genitourinary conditions
Diagnosis, treatment, and management of renal and genitourinary conditions
Gynecologic disorders in girls and teens
Signs of hematologic conditions
Signs of metabolic and endocrine conditions
Hyperbilirubinemia in infants
Diagnosis, treatment, and management of hematologic conditions
Diagnosis, treatment, and management of metabolic and endocrine conditions
Socio-cultural considerations in treating/working with patients and families
Evidence-based strategies for patient/family health promotion and education
Knowledge Check
You are required to answer 20 questions, randomly selected. You will have 1 attempt for each question. Each question is worth 1 point.
By Day 7 of Week 9
Complete
and
submit
your Knowledge Check.
NRNP 6541 Week 9 Knowledge Check Quiz Answer Key
Attempt History
Attempt
Time
Score
LATEST
Attempt 1
Time:2
7 minutes
Score:
20 out of 20
Correct answers will be available on Apr 29 at 10:59pm.
Score for this quiz:
20
out of 20
Submitted Apr 24 at 7:24pm
This attempt took 27 minutes.
Question 1
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pts
An adolescent female has heavy periods that are also irregular. The physical exam is normal. A complete blood count reveals a hemoglobin of 7.9 g/dL. What test will the primary care nurse practitioner order next?
Ultrasound of pelvis
C-reactive protein
Coagulation studies
Thyroid function
CORRECT: C
Coagulation studies
Chp 43–If the patient’s hemoglobin is low, coagulation studies should be ordered to rule out bleeding disorder as cause of heavy menstrual bleeding. CRP is ordered if infection is suspected. Thyroid function is indicated if systemic disease is suspected. A pelvic ultrasound is ordered if a mass is palpated, anomaly is suspected, bimanual exam cannot be completed, or if the condition is unresponsive to treatment.
Question 2
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pts
A 13-year-old Native American female has a body mass index (BMI) at the 90th percentile for age. The primary care nurse practitioner notes the presence of a hyperpigmented velvet-like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will take what action?
Refer the child to a pediatric endocrinologist.
Counsel the child to lose weight to prevent type 2 diabetes.
Order a fasting blood sample for a metabolic screen for type 2 diabetes.
Diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL.
CORRECT: C
Order a fasting blood sample for a metabolic screen for type 2 diabetes.
Chp 39–This child has three risk factors for type 2 diabetes: Native American ethnicity, overweight, and acanthosis nigricans. The PCP should perform metabolic screening on a fasting blood sample to diagnose this. Lifestyle changes may be necessary to control the disease if diagnosed, but this child may already have the disease, and management options aren’t clear until the diagnosis is made. Diagnosis is based on a random glucose >200 mg/dL. It is not necessary to refer this child until a diagnosis is made.
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Question 3
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pts
A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care nurse practitioner suspects what disorder?
Hereditary spherocytosis
Lead intoxication
Iron-deficiency anemia
Sickle-cell anemia
CORRECT: C
Iron-deficiency anemia
Chp 38–Iron-deficiency anemia is the most common type of anemia in infants and children, accounting for approximately 90% of cases. It is characterized by decreased hemoglobin, with microcytic, hypochromic RBCs. Hereditary spherocytosis is characterized by pallor and jaundice with splenomegaly. Lead intoxication is accompanied by neurobehavioral problems. Sickle-cell anemia involves the presence of HgbS.
Question 4
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pts
The parent of a 3-month-old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant’s weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant?
Reassure the parent that these symptoms will likely resolve by 12 to 24 months.
Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks.
Prescribe motility agent such as erythromycin
Perform upper GI series to determine the degree of reflux.
CORRECT: B
Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks.
Chp 34–Formula-fed infants may be given a trial of a hydrolyzed protein formula to see if improvement occurs. A motility agent is not first line recommendation. Upper GI should be ordered only if anatomic abnormality or obstruction is suspected. The infant has warning signs of GERD that require further investigation and not just reassurance.
Question 5
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pts
A 30-month-old girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a low-grade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?
Reassure the child’s parents that the child does not have a urinary tract infection.
Begin empiric treatment with trimethoprim-sulfamethoxazole.
Send the urine to the lab for culture.
Discuss behavioral interventions for toilet training.
CORRECT: C
Send the urine to the lab for culture.
Chp 42–Females over age 24 months have a higher risk than males for UTI. This child is symptomatic, so her urine should be cultured even though the leukocyte esterase and nitrites are negative; urine in the bladder less than 4 hours may be tested as negative for leukocyte esterase. Empiric treatment may be initiated if the child had signs of sepsis. Behavioral interventions are not indicated – the child has dysuria and fever along with enuresis. Until the culture is found to be negative, it is not certain that the child does not have an UTI, and thus reassurance is not the correct action.
Question 6 – NRNP 6541 Week 9 Knowledge Check Quiz Answer Key
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pts
A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 3 mm cylindrical object in the child’s stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment?
Refer the child for endoscopic removal of the object.
Have the parents watch for the object in the child’s stool.
Administer ipecac to induce vomiting.
Insert a nasogastric tube to flush out the object.
CORRECT: B
Have the parents watch for the object in the child’s stool.
Chp 34–A small foreign body that is not corrosive or sharp and that has reached the stomach is most likely to continue to pass through the GI tract and no intervention is necessary. Inducing vomiting increases the risk of aspiration of the FB. NG tube removal and endoscopy are not indicated unless the object has the potential to damage the GI tract; most objects that are not sharp or corrosive that have reached the abdomen will pass through without causing damage.
Question 7
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The parent of an infant experiencing colic asks about using a probiotic medication. What will the primary care pediatric nurse practitioner tell this parent?
Probiotics are not safe to use to treat infants who have colic.
Some research suggests probiotics may be helpful to decrease fussiness but differences are noted among breastfed versus formula fed infants
Probiotic medications have demonstrated efficacy in treating colic.
There are no studies showing usefulness of probiotics to manage colic.
CORRECT: B
Some research suggests probiotics may be helpful to decrease fussiness but differences are noted among breastfed versus formula fed infants
Chp 34–Some suggest specific strains of
Lactobacillus
reuteri
may help relieve infantile colic. Probiotics may be used to decrease crying times and fussiness, with differences noted between infants who are exclusively breastfed and those who are not.
Question 8
1
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pts
A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely?
Systemic lupus erythematosus
Sickle cell disease
Rhabdomyosarcoma
Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
CORRECT: D
Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
Chp 42–IgAV (HSP) may presents with gross hematuria in the presence of abdominal pain with or without bloody stools, arthralgias, and a purpuric rash. Rhabdomyosarcoma is characterized by gross hematuria and voiding dysfunction. Sickle cell disease can cause gross hematuria but not always
Question 9
1
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pts
A child diagnosed with Group A beta-hemolytic streptococci (
GABHS
) 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals tea-colored urine with hematuria and mild proteinuria. What will the primary care nurse practitioner do to manage this condition?
Reassure the parents that this condition will resolve spontaneously.
Refer the child to a pediatric nephrologist for hospitalization.
Prescribe high-dose steroids in consultation with a nephrologist.
Prescribe a 10- to 14-day course of high-dose amoxicillin.
CORRECT: B
Refer the child to a pediatric nephrologist for hospitalization.
Chp 42–This child has symptoms of post-streptococcal glomerulonephritis and signs indicating a need for hospitalization: elevated BP, edema, and dyspnea. The PNP should refer the child to a nephrologist for hospital admission and care. Amoxicillin is not indicated; this condition is an immunologic response to GABHS and not an infection. Steroids are not effective in treating this disease. Although the condition usually does self-resolve, the child needs hospitalization for close monitoring and follow-up.
Question 10
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pts
A sexually active adolescent female tests positive for N. gonorrhoeae and C. trachomatis. She tells the primary care nurse practitioner that she wants to be treated today since she is moving out of town the next day. What will the nurse practitioner order?
Ceftriaxone 250 mg IM and doxycycline 100 mg po bid for 7 days
Erythromycin base 500 mg PO qid for 7 days
Azithromycin 1 g PO in a single dose
Metronidazole 500 mg bid for 7 days
CORRECT: A
Ceftriaxone 250 mg IM and doxycycline 100 mg po bid for 7 days
Chp 43–Providers should refer to current CDC guidelines for STI treatment. For co-infection with chlamydia and gonorrhea, doxycycline AND ceftriaxone are used. Previously, azithromycin was used to treat chlamydia but this is no longer recommended for concerns of anorectal infections not treated adequately with azithromycin. Metronidazole is used to treat trichomoniasis. Erythromycin is not recommended.
NRNP 6541 Week 9 Knowledge Check Quiz Answer Key Question 11
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pts
A family is traveling with their children outside of the United States and asks for recommendations on how to avoid parasite infections. What is the most appropriate response?
Wash sheets in cold bottled water
Only drink unpasteurized milk
Wear shoes on potentially contaminated soil
Wash all produce with tap water
CORRECT: C
Wear shoes on potentially contaminated soil
Chp 34–Only pasteurized milk should be consulted. Tap water may be contaminated so bottle water is more often recommended. Wearing shoes on contaminated soil is recommended. Sheets should be washed in hot water with detergent.
Question 12
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pts
An adolescent has a TB skin test prior to working as a volunteer in a hospital. The adolescent is healthy and has not traveled to or from a TB-endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care nurse practitioner do?
Order a chest radiograph to rule out active TB.
Refer the adolescent to an infectious disease specialist.
Reassure the adolescent that this is a negative screen.
Ask the adolescent about exposure to homeless persons.
CORRECT: C
Reassure the adolescent that this is a negative screen.
Chp 35–In children 4 years and older without risk factors, induration must be at least 15 mm or greater to be considered to be a positive screen. It is not necessary to question the adolescent about possible exposures. Chest radiographs are ordered to evaluate for active TB in persons with a positive screen. Referral to an infectious disease specialist is done if active TB is present.
Question 13
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pts
A 6-year-old female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care nurse practitioner do next?
Refer the child to a pediatric endocrinologist for management.
Order LH and FSH levels and a long-acting GnRH agonist.
Order thyroid function tests to exclude primary hypothyroidism.
Reassure the parent that this is most likely idiopathic.
CORRECT: A
Refer the child to a pediatric endocrinologist for management.
Chp 39–Children with early puberty should always be referred to a pediatric endocrinologist for evaluation and management. The PNP may order lab work in consultation with an endocrinologist but should refer when this condition is suspected. Thyroid function tests are performed for isolated menarche. Reassuring the parent without completely diagnosing the condition is not indicated NRNP 6541 Week 9 Knowledge Check Quiz Answer Key.
Question 14
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pts
An adolescent has right-sided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?
Extracorporeal shockwave lithotripsy (ESWL)
Percutaneous removal of renal calculi
Referral to a pediatric nephrologist
Increasing fluid intake up to 2 L daily
CORRECT: D
Increasing fluid intake up to 2 L daily
Chp 42–The first line of therapy for all stone types is increasing fluids. ESWL may be indicated if symptoms worsen and stones are not passed. Percutaneous removal of renal calculi and referral to nephrology may be indicated with worsening symptoms.
Question 15
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pts
An adolescent is diagnosed with functional abdominal pain (FAP). The child’s symptoms worsen during stressful events, especially with school anxiety. What will be an important part of treatment for this child?
Teaching about the brain-gut interaction causing symptoms
Informing the parents that the pain is most likely not real
Using histamine2-blockers to help alleviate symptoms
Instituting a lactose-free diet along with lactobacillus supplements
CORRECT: A
Teaching about the brain-gut interaction causing symptoms
Chp 34–This child has symptoms associated with stress, and treatment should be aimed at biobehavioral methods, beginning with teaching about the brain-gut interaction. Even though the pain is functional, it is real. Lactose-free diets and lactobacillus supplements may be used with documented lactose intolerance, although there is a lack of high-quality evidence of their effectiveness. H2-blockers should not be used unless dyspepsia is present.
Question 16
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pts
A preschool-age child is brought to clinic for evaluation of a rash. The primary care nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?
The child will need to stay home from school for at least one week
This rash may be a prodromal sign of rubella or roseola.
Expect a lacy, maculopapular rash to develop on the trunk and extremities.
The child will need immunization boosters to prevent serious disease.
CORRECT: C
Expect a lacy, maculopapular rash to develop on the trunk and extremities.
Chp 35–This “slapped cheek” rash is consistent with fifth disease, or erythema infectiosum, and will be followed by a lacy, maculopapular all-over rash. It is not a prodrome of rubella or roseola, and immunizations are not indicated. By the time the rash appears, the child is no longer contagious and can attend school/daycare.
Question 17
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pts
A 2-year-old child who has sickle cell anemia (SCA) comes to the clinic with a cough and a fever of 101.5°C. The child currently takes penicillin V prophylaxis 125 mg orally twice daily. What will the primary care nurse practitioner do?
Order a chest radiograph to rule out pneumonia.
Give intravenous fluids and antibiotics in clinic.
Admit the child to the hospital to evaluate for sepsis.
Increase the penicillin V dose to 250 mg.
CORRECT: C
Admit the child to the hospital to evaluate for sepsis.
Chp 38–Fever and pulmonary symptoms are two conditions warranting referral or emergency admission to the hospital to rule out sepsis and acute chest syndrome. Increasing the dose of penicillin V or giving IV antibiotics is not indicated.
Question 18
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pts
The primary care nurse practitioner is performing a well-child examination on a 12-year-old child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child? Comprehensive ophthalmologic exam Annual lipid profile evaluation Hypothyroidism screening every 5 years Total IgA CORRECT: A Comprehensive ophthalmologic exam Chp 39–Children who have been diagnosed for 3 to 5 years and who are over age 10 should be referred for annual comprehensive ophthalmologic exams. This child had a previous normal lipid profile and needs to be evaluated every 5 years and not annually. IgA should be ordered soon after diagnosis. Hypothyroidism screening should be done annually. NRNP 6541 Week 9 Knowledge Check Quiz Answer Key Question 19 1 / 1 pts A school-age child has a 3-month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management? Ordering an upper GI series Referral for esophagogastroduodenoscopy (EGD) Empiric therapy for pylori (HP) Ordering serum IgG titers CORRECT: B Referral for esophagogastroduodenoscopy (EGD) Chp 34–EGD is the procedure of choice in children for detecting PUD because it allows direct visualization of mucosa, localization of the source of bleeding, and collection of tissue specimens. Serum IgG titers may be useful but should not be the sole test used to start treatment or determine eradication. Empiric therapy for HP is not recommended due to increased antibiotic resistance. An upper GI series may have false negative findings. Question 20 1 / 1 pts A child is diagnosed with Crohn disease. What are likely complications for this child? Liver disease and sepsis Cancer of the colon and possible colectomy Intestinal perforation and hemorrhage Intestinal obstruction with scarring and strictures CORRECT: D Intestinal obstruction with scarring and strictures Chp 34–Intestinal obstruction with scarring and strictures are the major complications of CD. The other answers describe complications of ulcerative colitis. NRNP 6541 Week 9 Knowledge Check Quiz Answer Key Quiz Score: 20 out of 20
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