ATI PEDIATRIC PROCTORED FINAL EXAM ASSESSMENT LATEST AID 2021
ATI PROCTORED PEDIATRIC FINAL ASSESSMENT EXAM 2021
1. A 6 month-old infant has a
... [Show More] disconjugate gaze. The nurse practitioner observes that the 6 month old 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.
6. A child has 8-10 medium brown café au lait spots > 1 cm in diameter. The differential diagnosis should include:
Neurofibromatosis
Neurofibromatosis (NF) is a common neurocutaneous disorder. The most common form is von Recklinghausen's NF. Approximately 85% of patients with NF have this type. The incidence is about 1 in 2600 individuals. Children with this disorder have cognitive deficits, learning disabilities and other neurological related problems. They should be referred for diagnosis and treatment.
7. Pharmacologic treatment for children with hypertension should be initiated for: Those who have diabetes
Pharmacologic treatment should be initiated for children who have both hypertension and diabetes, symptomatic hypertension, hypertension > 95% tile, when end-organ damage is present. Obesity is a risk factor, but is not a sole indicator of treatment.
8. Which of the following is appropriate for initiation of an 8 week-old with gastroesophageal reflux?
Small, frequent thickened feedings
Two strategies should be tried initially. First, avoidance of overfeeding is recommended. Hence, small, frequent feedings. Second, milk thickening agents appear to improve symptoms in infants who experience gastroesophageal reflux (GER). Thickened feedings significantly decrease frequency of reflux in most infants. Also, caloric content is increased and this may be helpful for patients who are underweight because of persistent GER. Generally, when medications are used, proton pump inhibitors are preferred over an H2 blocker like cimetidine. Changing formula generally does not help, however, a milk-free diet may help since 40% of infants with GER are sensitive to cow's milk protein. Thus, soy would not help. Positioning seems to be ineffective in relieving symptoms in infants.
9. A 7 year-old male presents with encopresis. The NP might expect: Constipation
The underlying cause of encopresis, repetitive soiling of stool by a child who is 4 years of age or older who should be potty trained, is usually chronic constipation. The ultimate goal is to reverse the constipation and establish normal bowel habits by the child. Having the patient use daily laxatives reverses constipation. Once he is able to have one soft bowel movement daily and a routine has been established, the laxatives are slowly weaned off. Attention to dietary factors must be addressed so that the child's diet will support a daily bowel movement.
10. The most common cause of pneumonia in very young children is:
A viral infection
In children less than 5 years old, the most common cause of pneumonia is a viral pathogen. Rarely are studies performed to identify viral pathogens, however one of the most common viral pathogens is respiratory syncytial virus (RSV). S. pneumoniae is a common cause of pneumonia in very young children, it is also implicated in elderly adults as a causative agent in pneumonia. In adolescents, Mycoplasma is the predominant pathogen.
11. A 12 year-old male with hip pain presents to the NP clinic. Hip pain has occurred with activity for the past 4-6 weeks but his pain is worse and now involves the knee. There is no history of trauma. How should the work-up be initiated?
Perform Trendelenburg's test in the office
There are several diagnoses in the differential. The assessment of this child should begin in the office. Asking the child to stand on the affected leg performs the Trendelenburg's test. If there are weak adductor muscles in the affected hip, a pelvic tilt will be visible in the unaffected hip. This can be found in children with a slipped capital femoral epiphysis, Legg-Calve-Perthes disease, or developmental dysplasia of the hip. After assessment of the hip, knee, and gait in the office, a hip x-ray to include AP and lateral should be ordered. The advantage of a sedimentation rate or C-reactive protein is that it will be elevated in patients with the aforementioned hip problems. It will be elevated in septic arthritis and other inflammatory causes of hip pain.
12. A two year-old with sickle cell anemia (SCA) should receive which immunizations? All routine childhood immunizations at the usual time
Children with sickle cell anemia should receive all the routine childhood immunizations at the usual time for administration, including annual flu immunization. Sickle cell cr [Show Less]