STU 25SUM1 Pediatric Competency Exam

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Free STU 25SUM1 Pediatric Competency Exam Questions

1.

An 11-year-old patient complains of pain after pitching during a baseball game. On examination, the NP notes increased pain in the right elbow with wrist flexion against resistance. This finding is most consistent with:

  • lateral epicondylitis

  • medial epicondylitis

  • ulnar collateral ligament injury

  • arthritis in the elbow

Explanation

The Correct Answer is:

B. medial epicondylitis.

Detailed Explanation:

Medial epicondylitis, also known as “pitcher’s elbow” or “golfer’s elbow,” results from repetitive wrist flexion and forearm pronation that strain the flexor tendons attached to the medial epicondyle. Pain is elicited with wrist flexion against resistance or palpation over the medial elbow. This overuse injury is common in young athletes who pitch or throw frequently. Treatment includes rest, ice, NSAIDs, activity modification, and gradual stretching and strengthening once symptoms improve.


2.

A 10-year-old patient is diagnosed with scabies. Appropriate treatment should include:

  • retapamulin topically twice a day for 5 days

  • one dose of permethrin cream 5% topically

  • topical clotrimazole 3 times a day for 7 days

  • hydrocortisone cream 1% topically three times a day for 10 days

Explanation

The Correct Answer is:

B. one dose of permethrin cream 5% topically.

Detailed Explanation:

Permethrin 5% cream is the treatment of choice for scabies in children and adults. It should be applied to the entire body from the neck down (including under fingernails and toenails) and left on for 8–14 hours before washing off. A second application one week later may be recommended to eliminate newly hatched mites. All household contacts should be treated simultaneously, and bedding, clothing, and towels should be washed in hot water to prevent reinfestation.


3.

In a fully developed term infant, at age 6 weeks the nurse practitioner should expect the triangular-shaped posterior fontanel to be:

  • closed

  • open

  • pulsatile

  • open and pulsatile

Explanation

The Correct Answer is:

A. closed.

Detailed Explanation:

The posterior fontanel is a small, triangular-shaped soft spot located at the junction of the occipital and parietal bones. In a full-term infant, this fontanel is usually closed by 6 to 8 weeks of age. It may still be palpable at birth, but it quickly ossifies during early infancy as cranial sutures fuse.

In contrast, the anterior fontanel
(diamond-shaped, between the frontal and parietal bones) remains open much longer—typically closing between 12 and 18 months—and may normally be flat or slightly pulsatile due to underlying cerebral blood flow.


4.

Pale and boggy nasal mucous membranes are common symptoms in children who have:

  • a foreign object in the nostril

  • sinusitis

  • chronic allergic rhinitis

  • acute bronchiolitis

Explanation

The Correct Answer is:

C. chronic allergic rhinitis.

Detailed Explanation:

Chronic allergic rhinitis is characterized by pale, boggy (edematous) nasal mucous membranes due to persistent inflammation caused by allergen exposure. Other common findings include clear nasal discharge, nasal congestion, sneezing, and allergic shiners (dark circles under the eyes). The pale, swollen mucosa results from chronic histamine release and vascular engorgement. Management includes allergen avoidance, antihistamines, and intranasal corticosteroids to reduce inflammation and improve airflow.


5.

Which choice is NOT a sign of sexual abuse?

  • Condyloma acuminata in a child older than 3 years

  • Bruising of the labia

  • Herpes in the anogenital area beyond the neonatal period

  • Labial adhesions

Explanation

The Correct Answer is:

D. Labial adhesions.

Detailed Explanation:

Labial adhesions are not a sign of sexual abuse. They occur commonly in prepubertal girls due to low estrogen levels, local irritation, or poor hygiene. The labia minora may partially fuse together, often asymptomatically, and the condition is benign. Management usually involves observation, good hygiene, and topical estrogen if symptomatic. There are no associations with trauma or sexual contact.


6.

Primary amenorrhea may be attributed to:

  • polycystic ovarian syndrome (PCOS)

  • hyperprolactinemia

  • Turner’s syndrome

  • ovarian failure

Explanation

The Correct Answer is:

C. Turner’s syndrome.

Detailed Explanation:

Primary amenorrhea is defined as the absence of menarche by age 15 in girls with normal secondary sexual characteristics or by age 13 in those without secondary sexual development. Turner’s syndrome (45,XO) is one of the most common chromosomal causes. It leads to gonadal dysgenesis, in which the ovaries fail to develop normally, resulting in low estrogen levels, elevated FSH and LH, and lack of menstrual onset. Affected individuals often present with short stature, webbed neck, widely spaced nipples, and streak gonads on imaging.


7.

Which one of the following sexually transmitted diseases (STDs) is NOT required to be reported to the Centers for Disease Control and Prevention (CDC)?

  • Syphilis

  • Gonorrhea

  • Hepatitis B

  • Human papillomavirus (HPV)

Explanation

The Correct Answer is:

D. Human papillomavirus (HPV).

Detailed Explanation:

Human papillomavirus (HPV) infection is not a nationally reportable disease to the CDC. Although HPV is the most common sexually transmitted infection in the United States, it is often asymptomatic, self-limiting, and difficult to track accurately. However, HPV-related conditions—such as cervical cancer and high-grade cervical dysplasia—are monitored through cancer registries and screening programs rather than case reporting.


8.

The definitive diagnosis of leukemia is made by:

  • bone marrow aspiration with biopsy

  • CT scan

  • complete blood coun

  • lumbar puncture with cerebrospinal fluid analysis

Explanation

The Correct Answer is:

A. bone marrow aspiration with biopsy.

Detailed Explanation:

While a complete blood count (CBC) may suggest leukemia by showing abnormal white blood cell counts, anemia, and thrombocytopenia, the definitive diagnosis requires a bone marrow aspiration with biopsy. This procedure allows for microscopic examination of the marrow to confirm the presence of malignant blast cells and to determine the leukemia type—such as acute lymphoblastic leukemia (ALL) or acute myelogenous leukemia (AML). Cytogenetic and molecular studies performed on the bone marrow sample also help guide prognosis and treatment.


9.

The preliminary management of a 6-year-old diagnosed with nocturnal enuresis (bedwetting) focused on behavioral modifications and positive reinforcement. Follow-up evaluation determines no significant improvement. The nurse practitioner should change the plan to include:

  • bowel cleansing

  • urine analysis

  • a bedwetting alarm

  • a referral to a pediatric urologist

Explanation

The Correct Answer is:

C. a bedwetting alarm.

Detailed Explanation:

A bedwetting alarm is the next step in managing nocturnal enuresis when initial behavioral and motivational strategies fail. It is considered the most effective long-term treatment for primary nocturnal enuresis. The alarm detects moisture and conditions the child to wake up at the sensation of a full bladder, promoting bladder control and nighttime dryness over time. Consistency and family support are key to success, with improvement often seen after several weeks of use.


10.

What condition would contraindicate examination of the pharynx?

  • Peritonsillar abscess

  • Acute epiglottitis

  • Uvulitis

  • Bacterial tracheitis

Explanation

The Correct Answer is:

B. Acute epiglottitis.

Detailed Explanation:

Acute epiglottitis is a life-threatening medical emergency caused most commonly by Haemophilus influenzae type b (Hib), though other pathogens may also be involved. Inflammation and swelling of the epiglottis can rapidly obstruct the airway. Pharyngeal or throat examination is contraindicated because inserting a tongue depressor or attempting visualization may trigger laryngospasm and complete airway obstruction. The diagnosis should be suspected based on symptoms—sudden onset of high fever, drooling, dysphagia, muffled “hot potato” voice, stridor, and sitting in a tripod position—and managed emergently by securing the airway in a controlled setting.


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