Question 1

A 2-month-old infant has increased head circumference from the 10th percentile at the 2-week exam to the 30th percentile today. What will the primary care pediatric nurse practitioner do?&#10;A) Order a magnetic resonance imaging exam of the infant's head.&#10;B) Refer the infant immediately to a pediatric neurosurgeon.&#10;C) Schedule frequent clinic visits to monitor head growth.&#10;D) Watch the infant closely over time if the rest of the exam is normal.

Accepted Answer

B

Question 2

The parent of a 4-day-old infant tells the primary care pediatric nurse practitioner that the infant was diagnosed with hydronephrosis while in utero and asks what will be done. What will the nurse practitioner tell this parent?

A) Renal function will be abnormal and will require lifetime treatment.
B) Spontaneous resolution often occurs within 6 months to a year of age.
C) The affected kidney will be non-functional but the other kidney will compensate.
D) The infant will eventually require renal transplantation for that kidney.

B

Accepted Answer

Hydronephrosis in utero does not necessarily indicate that the infant will have permanent kidney dysfunction. In many cases, hydronephrosis is due to a blockage or obstruction that may resolve on its own within 6 months to a year of age. Treatment may be necessary depending on the severity of the condition and any associated symptoms, but renal transplantation is not typically required.

Question 3

A 5-day-old infant who was delivered at home has abdominal distension and poor feeding. The mother is worried that the infant is constipated because he didn't have a first stool until yesterday and has only passed a small amount of meconium. What will the primary care pediatric nurse practitioner do?

A) Obtain a sweat chloride skin test to evaluate for possible cystic fibrosis.
B) Order an abdominal radiograph and refer the infant to a pediatric surgeon.
C) Prescribe glycerin suppositories to use as needed until bowel function is normal.
D) Suggest that the mother increase her fluid intake to help with constipation.

B

Accepted Answer

The infant's symptoms of abdominal distension and poor feeding, along with delayed passage of meconium suggest the possibility of meconium ileus, a potential complication of cystic fibrosis. An abdominal radiograph can confirm the presence of meconium and surgical intervention may be necessary. Option A may be considered later if meconium ileus or cystic fibrosis is confirmed. Option C may provide temporary relief, but doesn't address the underlying issue. Option D is not relevant to the current situation.

Question 4

The primary care pediatric nurse practitioner is performing a well-baby examination on a 7-day-old infant born to a Chlamydia-positive mother. The infant's eyes are clear without exudate. The infant is free from cough and lungs are clear. What will the primary care pediatric nurse practitioner do to prevent illness in this infant?

A) Administer a single dose of intramuscular ceftriaxone.
B) Obtain bacterial cultures of both conjunctivae.
C) Prescribe prophylactic erythromycin suspension.
D) Schedule a follow-up appointment in 1 week.

Accepted Answer

The answer of The primary care pediatric nurse practitioner is...

Question 5

The parent of a 4-week-old infant reports that the infant began having forceful vomiting 1 week prior, which has worsened over time. The infant continues to nurse well but is losing weight. A physical examination reveals a 90-g weight loss over the past 2 weeks, dry mucous membranes, and a sunken fontanel. What will the primary care pediatric nurse practitioner do?

A) Encourage the mother to nurse the infant more frequently for shorter duration.
B) Obtain serum electrolytes and hospitalize for surgical intervention.
C) Recommend oral rehydration fluids for 24 to 48 hours to correct dehydration.
D) Suggest trying a soy-based or hydrolyzed protein formula until vomiting resolves.

Accepted Answer

The infant's weight loss, dry mucous membranes, and sunken fontanel indicate severe dehydration, which cannot be corrected with oral rehydration fluids alone. Serum electrolytes should be obtained to evaluate for electrolyte imbalances, and the infant should be hospitalized for surgical intervention to correct the underlying cause of the vomiting. Choice A is not appropriate as the infant is already losing weight and is dehydrated. Choice C is not appropriate as the dehydration is severe and requires more aggressive treatment. Choice D is not appropriate as the vomiting is likely due to an underlying medical condition, rather than a formula intolerance.

Question 6

The parent of a 2-week-old infant reports that the infant was diagnosed with transient tachypnea of the newborn shortly after birth. The primary care pediatric nurse practitioner understands that, in this condition what is true?

A) Antibiotic therapy is generally necessary to prevent severe infection.
B) Home oxygen therapy is needed until the infant grows out of the condition.
C) Recovery is usually complete with minimal intervention and treatments.
D) Treatment with exogenous surfactant and mechanical ventilation is needed.

Accepted Answer

Transient tachypnea of the newborn is a self-limiting respiratory condition that typically resolves within 72 hours with supportive care such as oxygen therapy, continuous positive airway pressure (CPAP), and/or intravenous fluids. Antibiotic therapy is not necessary unless there is evidence of infection. Treatment with exogenous surfactant and mechanical ventilation is reserved for severe cases.

Deck 29: Perinatal Disorders