STU 25SUM1 Pediatric Competency Exam
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Free STU 25SUM1 Pediatric Competency Exam Questions
The first and most obvious sign of precocious puberty in a 7-year-old female is:
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Pubarche
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Leukorrhea
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Rapid onset acne
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Breast enlargement
Explanation
The Correct Answer is:
D. Breast enlargement.
Detailed Explanation:
The first and most obvious sign of precocious puberty in girls is usually thelarche, or breast development. This occurs due to premature activation of the hypothalamic-pituitary-gonadal axis, leading to increased estrogen secretion. It is the earliest visible indication that puberty has begun before the age of 8 in females.
Pubarche (appearance of pubic hair) and leukorrhea (vaginal discharge) occur later as estrogen effects progress. Rapid onset acne is not a primary sign of precocious puberty but may develop later as androgen levels increase.
Therefore, breast enlargement (thelarche) is the earliest and most distinct clinical marker of precocious puberty in a 7-year-old girl.
After performing a physical examination on a 4-year-old patient, the nurse practitioner suspects physical abuse. The nurse practitioner’s primary legal responsibility is to:
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discuss the physical assessment findings with the caregivers
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report the suspected abuse to child protective services
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refer the family to the appropriate support group
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assist the family in identifying resources and support systems
Explanation
The Correct Answer is:
B. report the suspected abuse to child protective services.
Detailed Explanation:
When child abuse is suspected, the nurse practitioner is legally mandated to report it immediately to child protective services (CPS) or the appropriate authorities. The role of the healthcare provider is not to prove abuse but to ensure the child’s safety by initiating an investigation. Timely reporting is required by law in all U.S. states, and failure to report can result in legal consequences for the provider. Documentation of findings should be objective, accurate, and include quotes from the child when possible.
The pregnancy test for a 15-year-old female is positive. Which test(s) are NOT usually performed during the first trimester of pregnancy?
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Blood type, Rh, and antibody screens
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Screening for STDs
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A purified protein derivative (PPD)
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Alpha-fetoprotein (AFP)
Explanation
The Correct Answer is:
D. Alpha-fetoprotein (AFP).
Detailed Explanation:
Alpha-fetoprotein (AFP) screening is not performed during the first trimester; it is typically done between 15 and 20 weeks of gestation as part of the second-trimester maternal serum screening (quad screen). AFP helps identify potential neural tube defects, abdominal wall defects, and chromosomal abnormalities such as Down syndrome. During the first trimester, standard laboratory evaluations focus on establishing maternal health, detecting infections, and identifying potential risks to the pregnancy.
The enlargement of both nasal openings during inspiration is known as:
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nasal grunting
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nasal stridor
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nasal flaring
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nasal obstruction
Explanation
The Correct Answer is:
C. nasal flaring.
Detailed Explanation:
Nasal flaring refers to the widening of the nostrils during inspiration and is a classic sign of increased respiratory effort. It indicates that the child is struggling to move air into the lungs, often due to respiratory distress caused by conditions such as bronchiolitis, pneumonia, or asthma. Nasal flaring is especially significant in infants and young children because they are primarily nasal breathers. Prompt assessment and intervention are essential to prevent respiratory failure.
What condition would contraindicate examination of the pharynx?
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Peritonsillar abscess
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Acute epiglottitis
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Uvulitis
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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.
A 9-month-old infant is diagnosed with Candida albicans infection in the diaper area. The nurse practitioner appropriately prescribes:
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topical aqueous gentian violet 1% applied three times a day for 5 days
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dose-appropriate oral fluconazole (Diflucan) for 7 days
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topical clotrimazole applied 3 times a day for 7 days
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topical hydrocortisone cream 1% applied three times a day for 10 days
Explanation
The Correct Answer is:
C. topical clotrimazole applied 3 times a day for 7 days.
Detailed Explanation:
Candidal diaper dermatitis is a fungal infection caused by Candida albicans, often appearing as a bright red rash with satellite lesions. The first-line treatment is a topical antifungal, such as clotrimazole, nystatin, or miconazole. Clotrimazole 1% cream should be applied two to three times daily to the affected area for about a week or until symptoms resolve. It is safe and effective for infants, and maintaining a clean, dry diaper area helps prevent recurrence.
A 10-year-old child presents to the outpatient clinic with dehydration. The nurse practitioner administers a bolus of IV fluids. Before adding potassium to the fluids, the nurse practitioner should first assess:
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recent fluid intake
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urinary output
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capillary refill
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last bowel movement
Explanation
The Correct Answer is:
B. urinary output.
Detailed Explanation:
Before adding potassium to IV fluids, the nurse practitioner must confirm that the child has adequate urinary output. Potassium is excreted through the kidneys, and adding it when urine output is impaired can cause dangerous hyperkalemia, leading to cardiac arrhythmias or cardiac arrest. Ensuring normal renal function and urine production confirms that the kidneys can safely handle additional potassium and maintain proper electrolyte balance during rehydration therapy.
Which of the following heart rates would be of concern in an otherwise healthy 10-year-old patient?
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60 beats per minute
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73 beats per minute
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100 beats per minute
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120 beats per minute
Explanation
The Correct Answer is:
D. 120 beats per minute.
Detailed Explanation:
The normal resting heart rate for a 10-year-old child ranges from 70 to 110 beats per minute. A heart rate of 120 bpm is considered tachycardic and may indicate an underlying issue such as fever, anxiety, dehydration, pain, anemia, or infection. Persistent tachycardia in a calm, afebrile, and otherwise healthy child warrants further evaluation to rule out cardiovascular or metabolic causes.
A pregnant adolescent female is diagnosed with iron deficiency anemia and treated with elemental iron. To determine the effectiveness of the supplementation, the nurse practitioner instructs the adolescent to return:
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for a CBC 4 weeks after initiating therapy
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for an Hgb/Hct level 4 weeks after initiating therapy
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for an Hgb level 8 weeks after initiating therapy
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for a serum ferritin level 10 weeks after initiating therapy
Explanation
The Correct Answer is:
B. for an Hgb/Hct level 4 weeks after initiating therapy.
Detailed Explanation:
When treating iron deficiency anemia in pregnancy, the effectiveness of oral iron supplementation is evaluated by checking hemoglobin (Hgb) and hematocrit (Hct) about 4 weeks after therapy begins. A rise in hemoglobin of approximately 1 g/dL after 4 weeks indicates an adequate response to treatment. If there is no improvement, factors such as poor adherence, malabsorption, or continued blood loss should be investigated. Continued monitoring every few months is appropriate once levels begin to normalize, and iron therapy should continue for about 3 months after correction to replenish iron stores.
Primary amenorrhea may be attributed to:
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polycystic ovarian syndrome (PCOS)
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hyperprolactinemia
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Turner’s syndrome
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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.
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