1) Which of the following indicated need for further evaluation?
a. A 7 y/o girl with vaginal bleeding
b. A 7 years old girl with no true pubic hair
c.
... [Show More] A 12 years old boy with sparse, slightly pigmented pubic hair
d. A 12-year-old girl with breast buds
explanation: In newborn girls, withdrawal bleeding may occur as a normal response to maternal
estrogen leaving the infant’s uterine lining. Vaginal bleeding after the first few weeks of life and
before puberty is considered abnormal. Early vaginal bleeding can indicate trauma, foreign
bodies (toilet paper is the most common), vulvovaginitis, hemangiomas, benign polyps,
precocious puberty, or sexual abuse.
2) A young couple is being seen by the NP for preconception counseling. They express a wish
for pregnancy within the next 3 month and are very eager to know what they can do now to
“make the baby as healthy as possible”. Which of the following should the NP encourage to
decrease the chance of neural tube defect in the fetus?
a. Maternal alpha-fetoprotein level
b. Folic acid 0.4 mg daily
c. Rubella vaccine today
d. Vitamin E 400 IU daily
Explanation: Supplementation with folic acid decreases the development of neural tube defects,
such as spina bifida and anencephaly. Folic acid plays an essential role in neural tube closure.
Neural tube development/closure takes place in the fist 4 weeks of embryonic life (6 weeks’
gestation). U.S. Public Health Service and the CDC recommend that all women of childbearing
age consume 0.4 mg of folic acid daily to prevent tube defects.
3) A patient with a past history of documented coronary arterial blockage less than 70%
complains of chest pain several time p…. which is relived with nitroglycerin. Which is the most
appropriate initial action for the NP?
a. Refer to a cardiologist as soon as possible
b. Prescribe long-acting nitroglycerin
c. Order treadmill stress test
d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours
Explanation: The patient has at least a 70% occlusion of a major coronary artery.
For a patient to be considered for CABG, the coronary arteries to be bypassed must have
approximately a 70% occlusion (60% if in the left main coronary artery).
4) A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating:
a. Infection proximal to the nodes
b. A possible cancer diagnosis
c. Shorty nodes, a common normal variant in children [Show Less]