ATI PROCTORED PEDIATRIC FINAL ASSESSMENT EXAM 2021
1. A 6 month-old infant has a disconjugate gaze. The nurse practitioner observes that the 6 month old
... [Show More] tilts his head when looking at objects in the room. Which statement is true?
The infant will have an abnormal cover/uncover test.
2. The nurse practitioner sees a child who presents with fatigue and purpura on his lower extremities. His temperature is normal. The differential includes:
Acute leukemia
The presence of purpura must make the nurse practitioner consider platelet problems. Fatigue should prompt consideration of anemia. Both are seen in patients with leukemia. Acute leukemia must be considered because of the combination of fatigue and purpura. This child needs a CBC as soon possible. Kawasaki syndrome is an autoimmune disease that produces vasculitis of the mid-sized arteries. Henoch-Schonlein purpura could also be considered as part of the NP's differential, but this was not a choice.
3. An 8 year-old has a painful limp. He reports that his knee hurts medially. On exam he has pain with internal rotation of the hip. How should the NP manage this situation?
The NP should order a hip x-ray, CBC and ESR
In an 8 year-old, there are several diagnoses in the differential. One must consider Legg-Calve Perthes, transient synovitis of the hip, a slipped capital femoral epiphysis (SCFE), and a septic hip. This could be as benign as transient synovitis that does not require referral. All of the others mentioned would need urgent orthopedic referral. Once the diagnostics were completed, the NP would have a better idea about whether orthopedic referral was essential.
4. An adolescent complains of knee pain. He is diagnosed with Osgood-Schlatter disease. What assessment finding is typical?
The pain worsens with quadriceps contraction
In patients with Osgood-Schlatter disease, pain can be unilateral or bilateral. What is obvious on assessment is a swelling of the tibial tubercle. X-rays are not needed for diagnosis. Pain worsens with squatting or crouching and with contraction of the quadriceps muscle against resistance. An avulsion of the quadriceps tendon should be part of the differential for patients who exhibit severe pain.
5. A 2 month-old infant has an asymmetric Moro reflex. What statement is true?
The infant could have a birth injury
The Moro reflex is a startle reflex. Observation of the reflex is confirmed if the infant symmetrically flings his arms away from his body followed by an immediate flexion of both arms in response to simulating falling. If this is asymmetrical, it could indicate an injury during or after birth (more likely during birth) such as a brachial plexus palsy, hemiplegia, or even a fractured clavicle. The Moro reflex usually disappears between 3-6 months. The significance of this reflex is for evaluation of integration of the central nervous system. [Show Less]