All practice questions

A pediatric nursing team is reviewing normal developmental markers to improve their triage and anticipatory guidance protocols. Match each cluster of observed developmental behaviors with the most appropriate age of the child.

Match each clinical scenario describing a medication adverse effect or monitoring requirement in a patient with a rheumatologic condition to the most likely responsible pharmacologic agent.

A $24$-year-old woman with type $1$ diabetes mellitus presents to the emergency department with abdominal pain, nausea, and Kussmaul respirations. She is diagnosed with diabetic ketoacidosis. Her initial laboratory results demonstrate a serum glucose of $600$ mg/dL and a serum potassium of $5.8$ mEq/L. She is tachycardic and hypotensive.

Arrange the following interventions in the correct chronological order as her treatment progresses over the next several hours.

An obese 58-year-old male with a 5-year history of essential hypertension arrives at the urgent care center due to intense, throbbing pain in his left foot that began abruptly during the night. He reports that even the weight of his bedsheet on the foot causes excruciating discomfort. His vital signs are within normal limits. Examination reveals a markedly swollen, red, warm, and tender left first metatarsophalangeal joint. The overlying skin is tense but intact, with no evidence of puncture wounds or purulent drainage. Which of the following is the most appropriate next step in the management of this patient's acute symptoms?

A 66-year-old man is brought to the emergency department by his wife due to severe, progressively worsening shortness of breath over the past 24 hours. He has a history of essential hypertension, type 2 diabetes mellitus, and a 45-pack-year smoking history. The patient reports a dry, hacking cough. His wife notes that he has been sleeping in his recliner for the past two nights because he feels like he is "smothering" when lying flat in bed.

Temperature is 37.0°C (98.6°F), blood pressure is 175/100 mm Hg, pulse is 112/min, and respirations are 26/min. Oxygen saturation is 89% on room air. The patient is diaphoretic, sitting upright, and using accessory muscles of respiration. Jugular venous pressure is estimated at 10 cm H2O. Pulmonary auscultation reveals a prolonged expiratory phase with diffuse, loud, bilateral expiratory wheezes; no crackles are appreciated. Cardiac auscultation reveals a regular tachycardia with a prominent S4 gallop. Trace bilateral pitting edema is present at the ankles.

Laboratory results are as follows:
Sodium: 138 mEq/L
Potassium: 4.2 mEq/L
Chloride: 104 mEq/L
Bicarbonate: 16 mEq/L
Blood urea nitrogen: 30 mg/dL
Serum creatinine: 1.6 mg/dL
Lactate: 4.1 mmol/L
Thyroid-stimulating hormone: 2.5 µU/mL (normal: 0.5-5.0 µU/mL)
Free T4: 0.6 ng/dL (normal: 0.9-2.4 ng/dL)

An arterial blood gas on room air reveals:
pH: 7.30
pCO2: 33 mm Hg
pO2: 64 mm Hg

A chest radiograph demonstrates cardiomegaly, peribronchial cuffing, and prominent upper lobe vessels, with no focal consolidations.

Which of the following is the most appropriate next step in management for this patient?

A 24-month-old boy is brought to the clinic for a routine well-child visit. His parents have no specific concerns. On developmental assessment, the boy is able to run well, kick a ball, and walk up and down the stairs placing both feet on each step. He can build a tower of six cubes, turn the pages of a book one at a time, and remove his shoes. He has a vocabulary of approximately 50 words, uses two-word phrases, and his speech is understood by strangers about half of the time. When in the waiting room, he plays with his own toys alongside other children but does not directly interact with them. Physical examination is unremarkable. The pediatrician provides anticipatory guidance to the parents regarding the developmental milestones expected over the upcoming year. Which of the following skills is this patient most likely to acquire by his next annual visit at 36 months of age?

A 54-year-old man with a history of alcohol use disorder and liver cirrhosis is brought to the emergency department vomiting bright red blood. His blood pressure is 85/55 mm Hg, and his pulse is 122/min. Arrange the following management steps in the most appropriate sequential order.

A 72-year-old man is brought to the emergency department by his son due to worsening shortness of breath, increased cough, and progressive lethargy over the past 48 hours. The son notes that the patient's baseline morning cough has been producing thick, yellowish sputum since yesterday. The patient has a history of severe chronic obstructive pulmonary disease (COPD) and hypertension. His temperature is 38.1°C (100.6°F), blood pressure is 134/82 mm Hg, pulse is 108/min, and respirations are 26/min. Pulse oximetry shows 88% on room air. Physical examination reveals an increased anteroposterior chest diameter. Lung auscultation demonstrates bilateral diffuse wheezing and a prolonged expiratory phase. There are no crackles, jugular venous distension, or lower extremity edema.

Laboratory testing shows:
Leukocyte count: 12,500/mm³
Thyroid-stimulating hormone (TSH): 2.5 µU/mL (normal: 0.5-5.0)
Free thyroxine (T4): 1.2 ng/dL (normal: 0.9-1.7)

Arterial blood gas on room air:
pH: 7.28
PaCO₂: 65 mm Hg
PaO₂: 55 mm Hg

Which of the following is the most appropriate initial pharmacological management?

A $65$-year-old man with a history of a renal transplantation presents to the emergency department with a $1$-day history of fever, severe headache, and confusion. His temperature is $39.2^\circ\text{C}$ ($102.6^\circ\text{F}$), blood pressure is $110/70\text{ mm Hg}$, and pulse is $115/\text{min}$. Physical examination reveals nuchal rigidity and bilateral papilledema. He is suspected of having acute bacterial meningitis. Arrange the following diagnostic and therapeutic steps in the most appropriate sequential order for managing this patient.

A $48$-hour-old male neonate is evaluated in the well-baby nursery due to a newly developed, rapidly spreading rash. The infant was born at $39$ weeks gestation via spontaneous vaginal delivery to a $28$-year-old mother. The mother's prenatal history is notable for a primary genital herpes simplex virus infection at $14$ weeks gestation, which was treated with oral valacyclovir; she had no prodromal symptoms or active lesions at the time of delivery. The infant's vital signs are temperature $37.3^\circ\text{C}$ ($99.1^\circ\text{F}$), heart rate $142$/min, and respiratory rate $42$/min. He is breastfeeding vigorously and has normal tone. Skin examination reveals numerous $2$-mm to $3$-mm firm, pale-yellow pustules, each situated on a wide, blotchy erythematous base. The lesions are scattered over the thorax, abdomen, and proximal thighs, while the palms, soles, and oral mucosa remain entirely clear. A smear of the pustular contents is performed to rule out infectious etiologies, showing no microorganisms. Based on the most likely diagnosis, which of the following best describes the underlying pathophysiology of this infant's cutaneous findings?

A full-term male newborn is evaluated in the hospital nursery on his third day of life. The parents express concern about a sudden skin eruption that appeared on his chest and arms earlier this morning. The infant was born via uncomplicated spontaneous vaginal delivery to a 28-year-old primigravida mother who had regular prenatal care and tested negative for Group B Streptococcus. He is breastfeeding vigorously and producing adequate wet diapers. Vital signs include a temperature of 37.0°C (98.6°F), heart rate of 138/min, and respiratory rate of 40/min. Physical examination reveals a well-appearing, alert neonate. Skin examination shows scattered 1- to 2-mm yellow pustules, each surrounded by a large, irregularly shaped erythematous macule. The lesions are present on the trunk, back, and proximal extremities, but the palms and soles are completely spared. No other abnormalities are noted. Which of the following is the most appropriate next step in management?

Match each pediatric clinical presentation to its most likely underlying enzymatic deficiency.

A $32$-year-old G2P1 at $35$ weeks gestation is hospitalized for preeclampsia with severe features. She is receiving continuous intravenous magnesium sulfate and oxytocin for labor induction. Over the past $4$ hours, her total urine output has been $45$ mL. She now reports profound weakness and blurry vision. Her blood pressure is $155/95$ mmHg, and heart rate is $88$/min. Her respiratory rate is $10$/min, and oxygen saturation is $91\%$ on room air. Neurologic examination reveals no muscle contraction upon percussion of the patellar tendons. Fetal heart rate monitoring demonstrates a baseline of $130$/min, minimal variability, and recurrent late decelerations with $60\%$ of contractions.

Arterial blood gas (room air):
pH: $7.29$
pCO $_2$: $54$ mmHg
pO $_2$: $62$ mmHg
HCO $_3^-$: $25$ mEq/L

Serum chemistry from $1$ hour ago:
Creatinine: $1.5$ mg/dL (baseline $0.7$ mg/dL)

What is the most appropriate next step in management?

Match each clinical vignette describing a characteristic gynecologic neoplasm with the serum tumor marker most likely to be elevated in that patient.

A multiparous patient at term delivers a healthy neonate via a spontaneous vaginal delivery. Twenty minutes following the intact delivery of the placenta, she develops profuse vaginal bleeding. Her blood pressure drops to 88/50 mm Hg, and her pulse rises to 122/min. Abdominal examination reveals a soft, enlarged uterus palpated above the umbilicus. A continuous intravenous oxytocin infusion was initiated upon placental delivery.

Arrange the following interventions in the correct escalating sequence for managing refractory postpartum hemorrhage due to uterine atony, from the immediate next step to the final definitive surgical treatment.

A 26-year-old woman presents to the clinic with a 9-month history of absent menses. Over the past 6 months, she has noticed a rapid increase in thick, dark hair on her face and chest, temporal hair thinning, and a noticeable deepening of her voice. She had menarche at age 12, and her menstrual cycles were previously regular, occurring every 28 days. She takes no medications and is not sexually active. Her body mass index is $23 \text{ kg/m}^2$. Vital signs are within normal limits. Physical examination reveals severe nodulocystic acne over the face and back, temporal balding, and notable clitoromegaly. A urine pregnancy test is negative. Serum thyroid-stimulating hormone and prolactin levels are within normal limits. Which of the following is the most appropriate next step in evaluation?

A 52-year-old woman is newly diagnosed with stress urinary incontinence. She is interested in a stepwise approach to her treatment, wanting to try the least invasive options first before considering surgery. Arrange the following management strategies for stress urinary incontinence in the correct sequential order from the most conservative (first-line) to the most invasive (definitive) therapy.

A $24$-year-old nulligravid woman comes to the clinic due to worsening lower abdominal pain and a new, foul-smelling vaginal discharge over the past $4$ days. She has a copper intrauterine device (IUD) that was inserted three years ago. She recently became sexually active with a new male partner. Her temperature is $38.2^\circ\text{C}$ ($100.8^\circ\text{F}$), blood pressure is $118/76\text{ mm Hg}$, and pulse is $92\text{/min}$. Speculum examination shows a yellow, mucopurulent discharge exuding from the cervical os, and the IUD strings are clearly visible in the vaginal vault. Bimanual examination reveals pronounced cervical motion tenderness and bilateral adnexal tenderness. There are no palpable adnexal masses, and a pelvic ultrasound is unremarkable aside from a properly positioned intrauterine device. A urine pregnancy test is negative. Which of the following is the most appropriate next step in management?

A 34-year-old man presents to the clinic for evaluation of a painless ulcer on his penis that appeared one week ago. He recently returned from a business trip where he had unprotected sexual intercourse with a casual partner. Physical examination reveals a 1-cm indurated, clean-based ulcer on the glans penis and bilateral non-tender inguinal lymphadenopathy. Serologic testing confirms a diagnosis of primary syphilis. The physician administers intramuscular benzathine penicillin G. During the visit, the patient is highly distressed and states, "I am married, and my wife cannot find out about this. It will destroy our family. You must promise to keep this strictly between us and not report it to anyone." Which of the following are appropriate next steps in the management of this patient? (Select all that apply)

An emergency department physician evaluates a 28-year-old female who sustained a left radial shaft fracture. During a private interview without her partner present, she tearfully discloses that her boyfriend deliberately pushed her off the porch during an argument. She adamantly refuses police involvement, stating she fears for her life if he finds out she told anyone. However, she expresses intense worry for her 5-year-old daughter, who is currently at home with the boyfriend, mentioning that he recently left severe bruises on the child's back. Which of the following is the most appropriate next step in management regarding legal reporting obligations?