STU 25SUM1 Pediatric Competency Exam
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Free STU 25SUM1 Pediatric Competency Exam Questions
The nurse practitioner is following a 6-month-old infant diagnosed with cryptorchidism. The right testis is undescended. The nurse practitioner should:
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continue to monitor until age 12 months
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order a scrotal computed tomography (CT) scan
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order a scrotal ultrasound
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refer the patient to a pediatric urologist
Explanation
The Correct Answer is:
D. refer the patient to a pediatric urologist.
Detailed Explanation:
Cryptorchidism (undescended testis) should resolve spontaneously by 6 months of age in most infants. If the testis remains undescended beyond this point, referral to a pediatric urologist is recommended. Early referral ensures timely evaluation and potential orchiopexy (surgical correction) before 12–18 months of age to preserve fertility potential and reduce the risk of testicular cancer. Imaging studies like ultrasound or CT scans are not routinely needed before referral, as they rarely change management.
In a fully developed term infant, at age 6 weeks the nurse practitioner should expect the triangular-shaped posterior fontanel to be:
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closed
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open
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pulsatile
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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.
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.
The nurse practitioner diagnosed a 3-year-old with type 1 diabetes mellitus. After initiating insulin therapy, establishing glycemic control is paramount. The glycemic target for this child should be:
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hemoglobin A1c (HbA1c) <6.5%
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hemoglobin A1c (HbA1c) <7.0%
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hemoglobin A1c (HbA1c) <7.5%
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hemoglobin A1c (HbA1c) <8.0%
Explanation
The Correct Answer is:
C. hemoglobin A1c (HbA1c) <7.5%.
Detailed Explanation:
For young children with type 1 diabetes, such as this 3-year-old, the recommended glycemic goal is HbA1c <7.5%, according to the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD). Slightly higher targets are acceptable in this age group because they are at greater risk for hypoglycemia, which can adversely affect brain development. The goal is to balance adequate glycemic control with safety and to prevent both acute complications (like hypoglycemia or DKA) and long-term vascular damage.
A 16-year-old male is 3 months post radical orchiectomy (without radiation or chemotherapy) for testicular cancer. He presents to the nurse practitioner for a routine exam. Based on this patient's history, the nurse practitioner should include as part of the evaluation:
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A serum prostate-specific antigen (PSA) measurement
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Ultrasound of the scrotum
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Computerized tomography (CT) scan of the chest and abdomen
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A rectal exam
Explanation
The Correct Answer is:
C. Computerized tomography (CT) scan of the chest and abdomen.
Detailed Explanation:
Following radical orchiectomy for testicular cancer, surveillance is critical to detect metastasis or recurrence, which most commonly occurs in the retroperitoneal lymph nodes and lungs. Therefore, a CT scan of the chest and abdomen is the recommended imaging modality for follow-up evaluation at this stage (typically every 3–6 months in the first year).
A 10-year-old patient was recently diagnosed with generalized anxiety disorder (GAD). In addition to psychological treatment, the medication that should be considered for initial treatment is:
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an anxiolytic
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a benzodiazepine
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a selective serotonin reuptake inhibitor (SSRI)
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an antipsychotic
Explanation
The Correct Answer is:
C. a selective serotonin reuptake inhibitor (SSRI).
Detailed Explanation:
For children and adolescents diagnosed with generalized anxiety disorder (GAD), selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacologic treatment. SSRIs such as fluoxetine (Prozac), sertraline (Zoloft), or escitalopram (Lexapro) have strong evidence for efficacy and safety when combined with cognitive-behavioral therapy (CBT). They help reduce excessive worry, restlessness, and somatic symptoms by increasing serotonin availability in the brain. Medication should be started at a low dose and titrated gradually while monitoring for behavioral activation or suicidal ideation.
When reviewing the complete blood cell count report for a child suspected of having a viral infection, the suspicion increases with elevated:
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neutrophils
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lymphocytes
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eosinophils
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basophils
Explanation
The Correct Answer is:
B. lymphocytes.
Detailed Explanation:
An elevated lymphocyte count (lymphocytosis) on a complete blood count (CBC) is most commonly associated with viral infections. Lymphocytes are white blood cells that play a crucial role in the immune response to viruses by producing antibodies and coordinating cellular immunity. Common viral illnesses that cause lymphocytosis include Epstein–Barr virus (mononucleosis), cytomegalovirus, measles, mumps, and rubella.
The assessment of a 4-year-old child’s visual acuity demonstrates 20/30 vision in the left eye and 20/40 vision in the right eye using the Snellen eye chart. This means:
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that vision is normal for age
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that vision is abnormal and further testing is warranted
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the patient may not be able to read and should be tested with the picture or “E” eye charts
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an astigmatism is present
Explanation
The Correct Answer is:
B. that vision is abnormal and further testing is warranted.
Detailed Explanation:
By age 4, most children should have visual acuity of at least 20/30 in each eye. A difference of two or more lines between the two eyes (e.g., 20/30 in one and 20/40 in the other) is considered abnormal and may indicate amblyopia (lazy eye), refractive error, or astigmatism. This finding warrants referral to a pediatric ophthalmologist for comprehensive evaluation. Early detection and correction are essential to prevent permanent vision loss due to amblyopia.
A 15-year-old patient presents to the clinic requesting levonorgestrel (Plan B One-Step). The nurse practitioner knows that unconditional confidentiality can be maintained if:
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state and federal laws allow unconditional confidentiality
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facility policies and procedures allow unconditional confidentiality for adolescents
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no sexual abuse or exploitation is involved
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it is in accordance with guidelines set forth by professional organizations
Explanation
The Correct Answer is:
C. no sexual abuse or exploitation is involved.
Detailed Explanation:
In most states, minors can consent to confidential reproductive health services, including contraception and emergency contraception such as levonorgestrel (Plan B). However, confidentiality is not absolute. The nurse practitioner must report any suspicion of sexual abuse, coercion, or exploitation, as mandated by law. If none of these are present, the provider can maintain unconditional confidentiality to protect the adolescent’s privacy and promote access to safe reproductive care.
Tachycardia in an infant between birth and age 1 month is a heart rate:
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between 90 and 110 beats per minute
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between 115 and 140 beats per minute
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between 150 and 170 beats per minute
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greater than 180 beats per minute
Explanation
The Correct Answer is:
D. greater than 180 beats per minute.
Detailed Explanation:
For newborns and infants under 1 month, the normal resting heart rate ranges from 100 to 160 beats per minute. A sustained heart rate greater than 180 beats per minute is considered tachycardia and warrants immediate evaluation. Causes may include fever, dehydration, anemia, pain, anxiety, or more serious conditions such as supraventricular tachycardia (SVT). Persistent tachycardia in neonates can lead to decreased cardiac output and should be assessed urgently to identify and treat the underlying cause.
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