STU 25SUM1 Pediatric Competency Exam
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Free STU 25SUM1 Pediatric Competency Exam Questions
Delayed puberty in an adolescent female who is below the third percentile in height may be associated with:
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Klinefelter syndrome
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Turner syndrome
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anorexia
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obesity
Explanation
The Correct Answer is:
B. Turner syndrome.
Detailed Explanation:
Turner syndrome (45,XO) is a chromosomal disorder that occurs in females and is characterized by short stature, delayed puberty, and gonadal dysgenesis (streak ovaries leading to estrogen deficiency). Because of this, affected girls fail to develop normal secondary sexual characteristics and typically experience primary amenorrhea. Other physical findings may include a webbed neck, low posterior hairline, widely spaced nipples, and coarctation of the aorta. The short stature often places the child below the 3rd percentile for height, which is a hallmark sign prompting further genetic evaluation.
A 15-year-old female who is sexually active suspects that she might be pregnant. If she were pregnant, the physical exam should reveal:
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a slight increase in blood pressure
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softening of the cervix
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alkaline vaginal pH
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hypopigmentation of the areolae
Explanation
The Correct Answer is:
B. softening of the cervix.
Detailed Explanation:
Softening of the cervix, known as Goodell’s sign, is an early physical indicator of pregnancy that typically appears around 4–6 weeks’ gestation. It results from increased vascularization and edema due to hormonal changes, particularly elevated estrogen levels. Other early physical findings may include Chadwick’s sign (bluish discoloration of the cervix and vagina) and Hegar’s sign (softening of the uterine isthmus). These changes occur well before fetal movement or uterine enlargement is apparent.
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 thrill palpated in the right clavicular region or in the upper right sternal border area is suggestive of:
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pulmonary valve stenosis
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aortic valve stenosis
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tetralogy of Fallot
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a ventricular septal defect
Explanation
The Correct Answer is:
B. aortic valve stenosis.
Detailed Explanation:
A thrill palpated in the right upper sternal border or right clavicular region is most characteristic of aortic valve stenosis. This condition produces a systolic ejection murmur best heard at the right second intercostal space, which often radiates to the neck and carotid arteries. The thrill occurs due to turbulent blood flow across the narrowed aortic valve. Children with aortic stenosis may present with exertional dyspnea, chest pain, or syncope as the disease progresses.
The definitive diagnosis of leukemia is made by:
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bone marrow aspiration with biopsy
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CT scan
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complete blood coun
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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.
A 13-year-old uncircumcised male patient has been treated for phimosis and returns to the nurse practitioner for follow-up. A referral should be made to the urologist if the adolescent:
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is unable to retract a previously retractable prepuce
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complains of difficulty keeping the glans penis clean
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desires to be circumcised
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states that he began experiencing nocturnal erections
Explanation
The Correct Answer is:
A. is unable to retract a previously retractable prepuce.
Detailed Explanation:
Phimosis is a condition in which the foreskin (prepuce) cannot be retracted over the glans penis. In young children, this is physiologic and usually resolves naturally by adolescence. However, if a previously retractable foreskin becomes non-retractable, this is pathologic phimosis, often caused by scarring, chronic inflammation, or infection (balanitis xerotica obliterans). This condition may lead to painful urination, recurrent infections, or paraphimosis and warrants referral to a urologist for further management, which may include surgical correction or circumcision.
An 18-year-old pregnant adolescent in her third trimester has dyspepsia despite previous treatment with Maalox. A safe choice for the nurse practitioner to prescribe is:
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ranitidine HCl (Zantac)
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sodium bicarbonate
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sodium citrate and citric acid (Bicitra)
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aluminum, magnesium, and simethicone (Gelusil)
Explanation
The Correct Answer is:
A. ranitidine HCl (Zantac).
Detailed Explanation:
Ranitidine (Zantac) is an H2 receptor antagonist that decreases gastric acid secretion, providing effective relief for dyspepsia unresponsive to antacids. It is considered safe for use during pregnancy, classified as Category B by the FDA, meaning animal studies have not demonstrated fetal harm and no controlled studies in pregnant women show risk. Ranitidine helps manage heartburn and gastroesophageal reflux symptoms without significantly affecting uterine blood flow or fetal development, making it a preferred option when antacids fail.
An adolescent was recently diagnosed with generalized anxiety disorder (GAD). When discussing the medication treatment plan, the nurse practitioner should inform the adolescent that:
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short-term use of benzodiazepines should be sufficient to eradicate the symptoms
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the majority of medications prescribed to manage GAD are nonaddictive
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the use of selective serotonin reuptake inhibitors (SSRIs) can produce immediate results
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alcohol consumption should be avoided
Explanation
The Correct Answer is:
B. the majority of medications prescribed to manage GAD are nonaddictive.
Detailed Explanation:
The first-line medications for treating generalized anxiety disorder (GAD) in adolescents are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications are nonaddictive and safe for long-term use under medical supervision. They help reduce excessive worry, irritability, and physical symptoms of anxiety by stabilizing neurotransmitter levels in the brain. The nurse practitioner should emphasize that improvement may take 2–6 weeks and that adherence to therapy is essential.
A newborns are classified according to their gestational age and weight. A newborn delivered at less than 34 weeks’ gestation is considered:
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preterm
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late preterm
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term
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postterm
Explanation
The Correct Answer is:
A. preterm.
Detailed Explanation:
Gestational-age categories are based on completed weeks. Any birth before 37 weeks is preterm. Within preterm, clinically important subgroups are: extremely preterm (<28 weeks), very preterm (28 w 0 d–31 w 6 d), and moderate (32 w 0 d–33 w 6 d). Thus, a baby born at <34 weeks is unequivocally preterm (specifically very or moderate preterm). These infants are at higher risk for respiratory distress (surfactant deficiency), apnea, thermoregulatory instability, feeding immaturity, hypoglycemia, sepsis, jaundice, and longer NICU stays. Management focuses on thermoregulation, respiratory support, early but cautious nutrition (often with parenteral support/fortification), infection prevention, and screening for complications (e.g., IVH, ROP).
Newborns receive vitamin K soon after birth because:
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the liver of a newborn does not produce enough vitamin K
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hemolysis of the fetal red blood cells increases coagulation requirements
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the newborn diet lacks vitamin K
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newborns are born with a sterile gut
Explanation
The Correct Answer is:
D. newborns are born with a sterile gut.
Detailed Explanation:
Newborns are routinely given an intramuscular injection of vitamin K (phytonadione) shortly after birth to prevent vitamin K deficiency bleeding (VKDB), formerly known as hemorrhagic disease of the newborn. This is necessary because newborns are born with a sterile intestinal tract, meaning they lack the gut bacteria responsible for synthesizing vitamin K. Without adequate vitamin K, the liver cannot produce clotting factors II, VII, IX, and X, leading to an increased risk of bleeding. The single vitamin K dose ensures proper coagulation until the intestinal flora mature and dietary intake supports sufficient levels.
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