Pediatric Primary Care 6th Edition by Dawn Lee Garzon – Test Bank

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Pediatric Primary Care 6th Edition by Dawn Lee Garzon – Test Bank

 

Sample  Questions

 

Chapter   1

Questions

 

 

Which region globally has the highest infant mortality rate?

 

Indonesia

 

Southern Asia

 

Sub­Saharan Africa

 

Syria

 

 

 

 

The primary care pediatric nurse practitioner understands that, to achieve the

 

greatest world­wide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective?

 

Antibiotics

 

Optimal nutrition

 

Vaccinations

 

Water purification

 

 

 

 

3.  Which is true about the health status of children in the United States? ID: 13348413856

 

Globalism has relatively little impact on child health measures in the U.S.

 

Obesity rates among 2­ to 5­year­olds have shown a recent significant decrease.

 

The rate of household poverty is lower than in other economically developed nations.

 

Young children who attend preschool or day care have higher food insecurity.

 

 

 

 

The primary care pediatric nurse practitioner understands that a major child health outcome associated with worldwide climate change is

 

cost of living.

 

 

 

 

 

 

 

When providing well child care for an infant in the first year of life, the primary

 

care pediatric nurse practitioner is adhering to the most recent American Academy of PediatricsRecommendations for Preventive Pediatric Health Care guidelines by

 

focusing less on development and more on illness prevention and nutrition.

 

following guidelines established by theBright Futures

 

scheduling well­baby visits to coincide with key developmental milestones.

 

seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due.

 

 

 

ID: 13348411196

 

 

ID: 13348411184

 

 

ID: 13348411178

 

 

ID: 13348411198

Chapter   2

Questions

 

 

The primary care pediatric nurse practitioner is obtaining a medical history

 

about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history?

 

Complementary medications, alternative health practices, and chief complaint

 

Developmental delays, nutritional status, and linear growth patterns

 

Medication currently taking, allergy information, and family medical history

 

Speech and language development, beliefs about health, and previous illnesses

 

 

 

When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource?

 

DC: 0­3R

 

ICD­10­CM

 

ICSD­3

 

NANDA International

 

 

 

 

The primary care pediatric nurse practitioner sees a 3­year­old child who

 

chronically withholds stools, in spite of the parents’ attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third­party reimbursement?

 

 

Altered elimination pattern

 

Elimination disorder

 

Encopresis

 

Parenting alteration

 

 

 

 

The primary care pediatric nurse practitioner is assessing a toddler whose

 

weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem?

 

Failure to thrive

 

Home care resources inadequate

 

Nutrition alteration – less than required

 

Parenting alteration

 

 

ID: 13348411182

 

 

ID: 13348411172

 

 

ID: 13348411192

 

 

ID: 13348411176

The primary care pediatric nurse practitioner is performing a well child check­

 

up on a 20­month­old child. The child was 4 weeks premature and, according to a parent­ completed developmental questionnaire, has achieved milestones for a 15­month­old infant. Which action is ?

 

Perform an in­depth developmental assessment screen at this visit to evaluate this child.

 

Reassure the parent that the child will catch up to normal development by age 2 years.

 

Re­evaluate this child’s development and milestone achievements at the 2­year visit.

 

Refer the child to a specialty clinic for evaluation and treatment of developmental delay.

 

 

 

The primary care pediatric nurse practitioner performs a developmental

 

assessment on a 3­year­old child and notes normal cognitive, fine­motor, and gross­motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says. The nurse practitioner will

 

ask the parent to consider a possible speech delay and report any concerns.

 

continue to evaluate the child’s speech at subsequent visits.   Co

 

refer the child for a speech and hearing evaluation.

 

tell the parent to spend more time in interactive conversations with the child.

 

 

 

The parent of a toddler is concerned that the child may have autism. The

 

primary care pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M­CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do?

 

Administer a Childhood Autism Rating Scale (CARS) in the clinic.

 

Consult a specialist to determine appropriate early intervention strategies.

 

Refer the child to a behavioral specialist for further evaluation.

 

Tell the parent that this result indicates that the child has autism.

 

 

 

 

The primary care pediatric nurse practitioner learns that the mother of a 3­

 

year­old child has been treated for depression for over 5 years. Which aspect of this child’s development will be of the most concern to the nurse practitioner?

 

Fine motor

 

Gross motor

 

Social/emotional

 

Speech and language

 

 

ID: 13348411194

 

 

ID: 13348411174

 

 

ID: 13348411180 this?

 

 

ID: 13348411186

 

 

ID: 13348411188

When meeting with a new family, the primary care pediatric nurse practitioner

 

develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information?

 

 

CRAFFT

 

Ecomap

 

Genogram

 

Pedigree

 

 

 

 

A child is in the clinic for evaluation of an asthma action plan. The primary

 

care pediatric nurse practitioner notes that the child’s last visit was for a pre­kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially?

 

Ask the child’s parent why the child is so anxious.

 

Perform a physical assessment to rule out shortness of breath.

 

Reassure the child that there is nothing to be afraid of.

 

Review the purpose of this visit and any anticipated procedures.

 

 

 

 

The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool­age child. How will the nurse practitioner assess

 

Ask the child how many books he has at home.

 

Ask the mother about her highest grade in school.

 

Ask the mother to determine the  dose of a drug from a label.

 

Ask the mother to read a health information handout aloud.

 

 

 

 

The mother of a newborn tells the primary care pediatric nurse practitioner

 

that she is worried that her child will develop allergies and asthma. Which tool will the nurse

 

practitioner use to evaluate this risk?

 

Three­generation pedigree

 

Review of systems

 

Genogram

 

Ecomap

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use?

 

 

ID: 13348411190

CRAFFT

 

HEEADSSS

 

PHQ­2

 

RAAPS

 

 

 

 

The primary care pediatric nurse practitioner evaluates a school­age child

 

whose body mass index (BMI) is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner document for this visit?

 

Metabolic syndrome

 

Nutritional alteration: more than required

 

Obesity

 

Rule out type 2 diabetes mellitus

 

 

 

 

 

 

 

 

ID: 13348437935

 

 

ID: 13348437931

 

 

ID: 13348437923

 

 

ID: 13348437929

Chapter 3

Questions

 

 

The primary care pediatric nurse practitioner provides well child care for a

 

community of immigrant children from Central America. The pediatric nurse practitioner is surprised to learn that some of the families are Jewish and not Catholic. This response is an example of cultural

 

 

 

 

 

 

 

 

 

The primary care pediatric nurse practitioner learns that an African­American

 

family lives in a neighborhood with a high crime rate and suggests that they try moving to

 

another neighborhood for the safety of their children. This is an example of

 

cultural sensitivity.

 

group bias.

 

individual privilege.

 

racial awareness.

 

 

 

 

The primary care pediatric nurse practitioner cares for children from a Native

 

American family and learns that they used many herbs to treat and prevent illness. Which approach will the pediatric nurse practitioner use to promote optimum health in the children?

 

Ask about the types of practices used and when they are applied.

 

Provide a list of harmful herbs and ask the family to avoid those.

 

Suggest that the family avoid using these remedies in their children.

 

Tell the parents to use the herbs in conjunction with modern medications.

 

 

 

 

The primary care pediatric nurse practitioner works with families from a

 

variety of cultures and socioeconomic classes. Which is an example of cultural humility in practice?

 

Giving health care advice that takes cultural differences into account

 

Identification of other cultures that may be superior to one’s own culture

 

Receptivity to learning about the perspectives of other cultures

 

Respecting other cultures while maintaining the views of one’s own

 

 

 

 

 

A Somalian immigrant mother is concerned that her 8­year­old child is ID: 13348437937

 

 

ID: 13348437933

 

 

ID: 13348437939

 

 

ID: 13348437927

underweight. The primary care pediatric nurse practitioner notes that the child’s weight is at the 25th percentile. After realizing that the mother is comparing her child to a group of American­born children who are overweight, the pediatric nurse practitioner is able to convince the mother that this is a normal weight. Which domain of cultural competence does this represent?

 

 

Global

 

Interpersonal

 

Intrapersonal

 

Organizational

 

 

 

 

The primary care pediatric nurse practitioner in a community health center

 

meets a family who has recently immigrated to the United States who speak only Karon. They arrive in the clinic with a church sponsor, who translates for them. The pediatric nurse practitioner notices that the sponsor answers for the family without giving them time to speak. The pediatric nurse practitioner will

 

ask the sponsor to allow the family to respond.

 

develop the plan of care and ask the sponsor to make sure it is followed.

 

request that the sponsor translate written instructions for the family.

 

use the telephone interpreter service to communicate with the family.

 

 

 

 

The primary care pediatric nurse practitioner prescribes a twice daily inhaled

 

corticosteroid for a 12­year­old child. At a well child visit, the child reports not using the medication on a regular basis. Which response by the pediatric nurse practitioner demonstrates an understanding of client­centered care?

 

Asking the child to describe usual daily routines and schedules

 

Referring the family to a social worker to help with medication compliance

 

Reviewing the asthma action plan with the parent and the child

 

Teaching the child how the medication will help to control asthma symptoms

 

 

 

 

A primary care pediatric nurse practitioner working in a community health

 

center wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the pediatric nurse practitioner employ to ensure the success of such a program?

 

Asking community members to assist in researching and implementing a program

 

Designing a community garden approach that involves children and their parents

 

Gaining support from the corporate community to provide needed resources

 

Providing evidence­based information about the importance of a healthy diet

 

H.

 

I.                     ID: 13348437925

 

J.

 

K.                   ID: 13348437941

The parents of a special needs child tell the primary care pediatric nurse

 

practitioner that they are planning a 3­month visit to their home country in Africa. The pediatric nurse practitioner assists the family to obtain a sufficient supply of medications and formula and to make sure that the child’s equipment can be transported and used during the trip and at the destination. This is an example of

 

 

global application.

 

global awareness.

 

system application.

 

system awareness.

 

 

 

 

The primary care pediatric nurse practitioner is examining a child whose

 

parents recently emigrated from a war­torn country in the Middle East. Which is a priority assessment when performing the patient history?

 

Asking about physical, psychological, and emotional trauma

 

Determining the parents’ English language competency and literacy level

 

Learning about cultural preferences and complementary medicine practices

 

Reviewing the child’s previous health and illness records

 

 

 

 

 

 

 

 

ID: 13348411124

 

 

ID: 13348411128

 

 

ID: 13348411116

 

 

ID: 13348411134

Chapter   4

 

Questions

 

 

A single mother of an infant worries that living in a household with only one

 

parent will cause her child to be maladjusted. To help address the mother’s concerns, the

 

primary care pediatric nurse practitioner will suggest

 

developing consistent daily routines for the child.

 

exposing her child to extended family members when possible.

 

not working outside the home during the first few years.

 

taking her child to regular play date activities with other children.

 

 

 

 

During a well child exam, the primary care pediatric nurse practitioner learns

 

that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father’s job layoff. What will the nurse practitioner do?

 

 

Reassure them that the child is too young to understand.

 

Recommend that they continue to not argue in front of the child.

 

Suggest counseling to learn ways to handle stress.

 

Tell them that the conflict will resolve when the situation changes.

 

 

 

 

During a well child assessment of an 18­month­old child, the primary care

 

pediatric nurse practitioner observes the child becoming irritable and uncooperative. The

 

parent tells the child to stop fussing. What will the nurse practitioner do?

 

Allow the parent to put the child in a “timeout.”

 

Ask the parent about usual discipline practices.

 

Offer the child a book or a toy to look at.

 

Stop the exam since the child has reached a “meltdown.”

 

 

 

 

Which recommendation will a primary care pediatric nurse practitioner make

 

when parents ask about ways to discipline their 3­year­old child who draws on the walls with crayons?

 

Give the child washable markers so the drawings can be removed easily.

 

Provide a roll of paper for drawing and teach the child to use this.

 

Put the child in “timeout” each time the child draws on the walls.

 

Take the crayons away from the child to prevent the behavior.

 

 

 

 

 

The primary care pediatric nurse practitioner conducts a well baby exam on ID: 13348411118

 

 

ID: 13348411130

 

 

ID: 13348411132

 

 

ID: 13348411120

 

 

ID: 13348411122

an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend?

 

Consult a developmental specialist for a more complete evaluation.

 

Prepare the parents for a potentially serious developmental disorder.

 

Refer the infant to an early intervention program for physical therapy.

 

Teach the parents to provide exercises to encourage motor development.

 

 

 

 

The primary care pediatric nurse practitioner is examining a newborn infant

 

recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation?

 

Explain to the parent that developmental delays often do not manifest at first.

 

Perform a developmental assessment and tell the parent which delays are evident.

 

Point out the tasks that the infant can perform while conducting the

 

assessment.

 

Refer the infant to a developmental specialist for a complete evaluation.

 

 

 

 

The primary care pediatric nurse practitioner sees a developmentally delayed

 

toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially?

 

Ask the parents if they have an individualized family service plan (IFSP).

 

Consult with a physician to ensure the child gets appropriate care.

 

Inform the family that services are provided when the child begins school.

 

Refer the family to a social worker for assistance with referrals and services.

 

 

 

 

The primary care pediatric nurse practitioner has a cohort of patients who

 

have special health care needs. Which is an important role of the nurse practitioner when

 

caring for these children?

 

Care coordination and collaboration

 

Developing protocols for parents to follow

 

Monitoring individual education plans (IEPs)

 

Providing lists of resources for families

 

 

 

 

The primary care pediatric nurse practitioner performs a physical examination

 

on a 9­month­old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental

 

 

ID: 13348411126

health?

 

To begin brushing the infant’s teeth with toothpaste

 

To consider weaning the infant from breastfeeding

 

To discontinue giving fluoride supplements

 

To make an appointment for an initial dental examinationt

 

 

 

 

The primary care pediatric nurse practitioner enters an exam room and finds

 

a 2­month­old infant in a car seat on the exam table. The infant’s mother is playing a game on her smart phone. The nurse practitioner interprets this behavior as

 

a sign that the mother has postpartum depression.

 

extremely concerning for potential parental neglect.

 

of moderate concern for parenting problems.

 

within the normal range of behavior in early parenthood.

 

 

 

 

 

 

ID: 13348413814

 

 

ID: 13348413806

 

 

ID: 13348413802

 

 

ID: 13348413804

Chapter   5

 

Questions

 

 

The parent of a newborn infant asks the primary care pediatric nurse practitioner

 

when to intervene to help the infant’s future intellectual growth. What will the nurse practitioner tell

 

the parent?

 

Cognitive learning begins during the toddler years.

 

Intellectual growth begin when speech develops.

 

Language and literacy skills begin at birth.

 

Preschool is an optimal time to begin general learning.

 

 

 

 

The primary care pediatric nurse practitioner performs a well baby examination

 

on a 7­day­old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is ?

 

 

Follow up at the 2­month checkup.

 

Refer to a lactation consultant.

 

Schedule a weight check in 1 week.

Suggest supplementing with formula.

 

 

 

 

During an assessment of a 4­week­old infant, the primary care pediatric nurse

 

practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4­hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend?

 

 

Continuing to nurse the infant using the current pattern

 

Nursing the infant for longer periods every 4 hours

 

Supplementing with formula at the last nighttime feeding

 

Waking the infant every 2 hours to nurse during the night

 

 

 

 

The primary care pediatric nurse practitioner is performing a well baby

 

examination on a 2­month­old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her?

 

She may not be making as much breastmilk as before.

 

She should keep a log of the frequency and duration of each feeding.

 

The infant may be going through an expected growth spurt.

 

The infant should stay on the previously established nursing schedule.

 

R.

 

S.                       ID: 13348413816

 

T.

 

U.                       ID: 13348413812

 

V.

 

W.                      ID: 13348413818

 

X.

 

Y.                       ID: 13348413810

 

Z.

 

AA.                    ID: 13348413808

The mother of a 6­week­old breastfeeding infant tells the primary care pediatric

 

nurse practitioner that her baby, who previously had bowel movements with each feeding, now has

 

a bowel movement once every third day. What will the nurse practitioner tell her?

 

Her baby is probably constipated.

 

It may be related to her dietary intake.

 

She should consume more water.

 

This may be normal for breastfed babies.

 

 

 

 

The mother of a 3­month­old child tells the primary care pediatric nurse

 

practitioner that it is “so much fun” now that her infant coos and smiles and wants to play. What is

 

important for the nurse practitioner to teach this mother?

 

Appropriate ways to stimulate and entertain the infant

 

 

How to read the infant’s cues for overstimulation

 

 

 

 

The importance of scheduling “play dates” with other infants

 

To provide musical toys to engage the infant

 

 

 

 

The parent of a 5­month­old is worried because the infant becomes fussy but

 

doesn’t always seem interested in nursing. What will the nurse practitioner tell this parent?

 

The infant may be expressing a desire to play or to rest.

 

The parent should give ibuprofen for teething pain before nursing.

 

This is an indication that the infant is ready for solid foods.

 

This may indicate gastrointestinal discomfort such as constipation.

 

 

 

 

The mother of a 6­month­old infant is distressed because the infant can say

 

“dada” but not “mama” and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond?

 

“At this age, your baby does not understand the meaning of sounds.”

 

“Babies at this age cannot make the ‘ma’ sound.”

 

“Most sounds made by babies at this age are accidental.”

 

“This may mean that your baby doesn’t hear well.”

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a 9­month­old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant?

 

Provide educational videos that focus on language.

 

Read simple board books to the infant at bedtime.

 

L.

 

M.                  ID: 13348413820

Sing to the child and play lullabies in the baby’s room.

 

Turn the television to Sesame Streetduring the day.

 

 

 

 

The primary care pediatric nurse practitioner is examining a 12­month­old infant

 

who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first?

 

Perform an in­depth developmental assessment.

 

Reassure the parent that this is normal for a premature infant.

 

Refer the infant to a developmental specialist.

 

Suggest activities to improve fine motor skills.

 

 

 

 

ID: 13348437949

 

 

ID: 13348437957

 

 

ID: 13348437947

 

 

ID: 13348437959

Chapter   6

 

Questions

 

 

The primary care pediatric nurse practitioner is evaluating a 2­year­old with a

 

documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next?

 

Ask the child’s parents whether they read to the child.

 

Give parents educational materials to encourage speech.

 

Refer the child to an early intervention program.

 

Suggest that they purchase age­appropriate music videos.

 

 

 

 

The primary care pediatric nurse practitioner performs a developmental

 

assessment on a 32­month­old child. The child’s parent reports that about 70% of the child’s speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing “t,” “d,” “k,” and “g” sounds. Which action is ?

 

 

Evaluate the child’s cognitive abilities.

 

Obtain a hearing evaluation.

 

Reassure the parent that this is normal.

 

Refer the child to a speech therapist.

 

 

 

 

During a well child assessment of an 18­month­old child, the primary care

 

pediatric nurse practitioner observes the child point to a picture of a dog and say, “Want

 

puppy!” The nurse practitioner recognizes this as an example of

 

holophrastic speech.

 

receptive speech.

 

semantic speech.

 

telegraphic speech.

 

 

 

 

The primary care pediatric nurse practitioner is offering anticipatory guidance

 

to the parents of a 12­month­old child. The parents are bilingual in Spanish and English and have many Spanish­speaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the pediatric nurse practitioner tell the parents?

 

Children who learn two languages simultaneously often confuse them in conversation.

 

Children with multi­language proficiency do not understand that others cannot do this.

 

Learning two languages at an early age prevents children from developing a dominant language.

 

EE.

 

FF.                    ID: 13348437953

 

GG.

 

HH.                   ID: 13348437945

 

II.

 

JJ.                     ID: 13348437955

Most bilingual children are able to shift from one language to another when appropriate.

 

 

 

The primary care pediatric nurse practitioner is counseling the parents of a

 

toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend?

 

Allow the child to explore and experiment while providing appropriate limits.

 

Be present while the child plays to continually teach the child what is appropriate.

 

Let the child experiment at will and to make mistakes in order to learn.

 

Say “no” whenever the child does something that is not acceptable.

 

 

 

 

The mother of a 3­year­old child takes the child to a play group once a week. ID: 13348437961 She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother?

 

The child probably is very shy but will outgrow this tendency with repeated

 

exposure to other children.

 

The toddler may have a language delay that interferes with socialization with other children.

 

Toddlers may be interested in other children but usually do not engage in interactive play.

 

Toddlers need more structured play to encourage interaction and socialization with others.

 

 

 

The parent of a 4­year­old points to a picture and says, “That’s your sister.”

 

The child responds by saying, “No! It’s my baby!” This is an example of which type of thinking

 

in preschool­age children?

 

Animism

 

Artificialism

 

Egocentrism

 

Realism

 

 

 

 

The parent of a 24­month­old child asks the primary care pediatric nurse

 

practitioner when toilet training should begin. How will the pediatric nurse practitioner respond?

 

“Begin by reading to your child about toileting.”

 

“Most children are capable by age 2 years.”

 

P.

 

Q.                   ID: 13348437951

 

R.

 

S.                   ID: 13348411130

“Tell me about your child’s daily habits.”

 

“We should assess your child’s motor skills.”

 

 

 

 

The primary care pediatric nurse practitioner performs a physical examination

 

on a 9­month­old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health?

 

 

 

To begin brushing the infant’s teeth with toothpaste

 

To consider weaning the infant from breastfeeding

 

To discontinue giving fluoride supplements

 

To make an appointment for an initial dental examination             t

 

 

 

 

The parents of a 3­year­old child are concerned that the child has begun

 

refusing usual foods and wants to eat mashed potatoes and chicken strips at every meal and snack. The child’s rate of weight has slowed, but the child remains at the same percentile for weight on a growth chart. What will the primary care pediatric nurse practitioner tell the parents to do?

 

Allow the child to choose foods for meals to improve caloric intake.

 

Place a variety of nutritious foods on the child’s plate at each meal.

 

Prepare mashed potatoes and chicken strips for the child at mealtimes.

 

Suggest cutting out snacks to improve the child’s appetite at mealtimes.

 

 

 

 

 

 

ID: 13348437983

 

 

ID: 13348437975

 

 

ID: 13348437977

 

 

ID: 13348437967

Chapter   7

Questions

 

 

The primary care pediatric nurse practitioner is examining a 6­year­old child who

 

attends first grade. The child reports “hating” school. The parent states that the child pretends to be sick frequently in order to stay home from school. To further assess this situation, the nurse practitioner will first ask the child

 

 

about school performance and grades.

 

why school is so distressing.

 

to name one or two friends.

 

whether bullying is taking place.

 

 

 

 

The parent of a 10­year­old boy tells the primary care pediatric nurse practitioner

 

that the child doesn’t appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child’s sexual identity. The nurse practitioner will tell the parent

 

children at this age who prefer interactions with same­gender peers usually have a homosexual orientation.

 

children experiment with sexuality at this age as a means of deciding later sexual orientation.

 

this attachment to other same­gender children is how the child learns to interact with others.

 

to encourage mixed­gender interactions in order to promote development of sexual values.

 

 

 

The parents of a 12­year­old child are concerned that some of the child’s older

 

classmates may be a bad influence on their child, who, they say, has been raised to believe in right and wrong. What will the primary care pediatric nurse practitioner tell the parent?

 

Allowing the child to make poor choices and accept consequences is important for learning values

 

Children at this age have a high regard for authority and social norms, so this is not likely to happen

 

Moral values instilled in the early school­age period will persist throughout childhood

 

The pressures from outside influences may supersede parental teachings be confronted

 

 

During a well child exam of a school­age child, the primary care pediatric nurse

 

practitioner learns that the child has been having angry episodes at school. The nurse practitioner observes the child to appear withdrawn and sad. Which action is appropriate?

 

Ask the child and the parent about stressors at home

 

 

Make a referral to a child behavioral specialist

 

Provide information about anger management

 

MM.

 

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OO.

 

PP.                  ID: 13348437987

 

QQ.

 

RR.                  ID: 13348437971

 

D. Suggest consideration of a different classroom
5.  The primary care pediatric nurse practitioner is preparing to conduct a well child ID: 13348437965
assessment of an 8­year­old child. How will the nurse practitioner begin the exam?
A. Ask the child about school, friends, home activities, and sports

 

Discuss the purpose of the visit and explain the procedures that will be performed

 

Offer age­appropriate information about usual developmental tasks

 

Provide information about healthy nutrition and physical activities

 

 

 

The parent of a 6­year­old child expresses concern that the child may have ADHD.

 

Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility?

 

Behavioral and Emotional Screening System for Children (BESS­2)

 

Behavioral Assessment for Children – 2nd ed. (BASC­2)

 

 

Conner’s 3 Parent and Teacher Rating Scale

 

 

 

Pediatric Symptom Checklist (PSC)

 

 

 

 

The parent of a 5­year­old child who has just begun kindergarten expresses concern

 

that the child will have difficulty adjusting to the birth of a sibling. What will the primary care pediatric nurse practitioner recommend?

 

Allowing the child opportunities to discuss feelings about the baby

 

Giving the child specific baby care tasks to promote sibling bonding

 

C. Having snack time with the child each day to discuss the school day
D. Providing reassurance that the sibling will not replace the child
8.  A school­age child has begun refusing all cooked vegetables. What will the primary ID: 13348437969
care pediatric nurse practitioner recommend to the parent?

 

Allow the child to make food choices since this is usually a phase

 

Ensure that the child has three nutritious meals and two nutritious snacks each day Corret

 

Prepare vegetables separately for the child to encourage adequate intake

 

Teach the child how important it is to eat healthy fruits and vegetables

 

 

 

The primary care pediatric nurse practitioner performs a physical examination on a

 

12­year­old child and notes poor hygiene and inappropriate clothes for the weather. The child’s mother appears clean and well dressed. The child reports getting 6 to 7 hours of sleep each night because of texting with friends late each evening. What action by the nurse practitioner will help promote healthy practices?

 

 

Discuss setting clear expectations about self­care with the mother

 

 

 

Give the child information about sleep and self­care

 

 

ID: 13348437981

 

 

ID: 13348437985

 

 

ID: 13348437979

Reassure the mother that this “non­compliance” is temporary

 

Tell the mother that experimenting with self­care behaviors is normal

 

 

 

During a well child exam on a 5­year­old child, the primary care pediatric nurse

 

practitioner assesses the child for school readiness. Which finding may be a factor in limiting school

 

readiness for this child?

 

Adherence to daily family routines and regular activities

 

Having two older siblings who attend the same school

 

 

Parental concerns about bullying in the school

 

 

 

 

The child’s ability to recognize four different colors

 

 

 

 

The primary care pediatric nurse practitioner is examining a school­age child who

 

complains of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the nurse practitioner initially ask the parent?

 

 

About the timing of the symptoms each day and during the week

 

 

How well the child performs in school and in extracurricular activities

 

If the parent feels a strong need to protect the child from problems

 

Whether there are any unusual stressors or circumstances at home

 

 

 

The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in

 

a school­age child. The child’s exam is normal. The nurse practitioner learns that the child reports pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child’s grandmother recently had gallbladder surgery. Which action is ?

 

Encourage the child to keep a log of pain, stool patterns, and dietary intake

 

 

Order radiologic studies and laboratory tests to rule out systemic causes

 

Reassure the child and encourage resuming sports when symptoms subside

 

Refer the child to a counselor to discuss anxiety about health problems

 

 

 

 

 

 

 

Continue

Chapter   8

 

 

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Questions

 

 

The primary care pediatric nurse practitioner is performing a well child

 

assessment on a 13­year­old female whose mother asks when her daughter’s periods may start. Which information will the nurse practitioner use to help estimate the onset of periods?

 

The age of the mother’s menarche

 

 

The patient’s age at thelarche

 

 

 

 

 

 

When adrenarche occurred

 

Whether linear growth has stopped

 

 

 

 

The primary care pediatric nurse practitioner is examining a 15­year­old

 

female who reports having her first period at age 13. She states that she has had five periods in the last year, with the last one 2 months prior. She participates in basketball at school. Which action is ?

 

 

Perform biometric screening to determine lean body mass.

 

Prescribe oral contraceptives pills to regulate her periods.

 

Reassure her that this is perfectly normal at her age.

 

Refer her to an endocrinologist for hormonal evaluation.

 

 

 

 

During a well child assessment of a 13­year­old male, the primary care

 

pediatric nurse practitioner notes small testicles and pubic and axillary hair. To further evaluate

 

these findings, the nurse practitioner will ask the patient about

 

alcohol and tobacco use.

 

changes in voice.

 

increase in height and weight.

 

participation in sports.

 

 

 

 

The mother of a 16­year­old male was recently divorced after several years

 

of an abusive relationship and tells the primary care pediatric nurse practitioner that the adolescent has begun skipping school and hanging out with friends at the local shopping mall. When she confronts her child, he responds by saying that he hates her. What will the nurse practitioner tell this mother?

 

Adolescence is marked by an inability to comprehend complex situations.

 

Adolescence is typically marked by tempestuous and transient episodes.

 

Adolescents normally have extreme, disruptive conflicts with parents.

 

Adolescents often need counseling to help them cope with life events.

 

 

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ID: 13348413878

 

ID: 13348413870

 

ID: 13348413866

The primary care pediatric nurse practitioner is performing a well child exam

 

on a 12­year­old female who has achieved early sexual maturation. The mother reports that she spends more time with her older sister’s friends instead of her own classmates. What will the nurse practitioner tell this parent?

 

Early­maturing girls need to identify with older adolescents to feel a sense of belonging.

 

Girls who join an older group of peers may become sexually active at an earlier age.

 

Spending time with older adolescents indicates a healthy adjustment to her maturing body.

 

The association with older adolescents will help her daughter to gain social maturity.

 

 

 

The mother of a 15­year­old adolescent female tells the primary care

 

pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different just before her periods, the adolescent points to her mother and says, “She gets really hard to live with.” This demonstrates which characteristic of adolescent thinking?

 

 

Apparent hypocrisy

 

Imaginary audience

 

Overthinking

 

Personal fable

 

 

 

 

The primary care pediatric nurse practitioner is performing an exam on an

 

adolescent male who asks about sexual identity because of concern that a friend is worried about being gay. Which response will the nurse practitioner make in this situation?

 

Provide the teen with a questionnaire to gain information about his sexuality.

 

Remind the adolescent that mandatory reporting requires disclosure to parents.

 

Suggest that the adolescent discuss sexual concerns with his parents.

 

Tell the adolescent that, unless he is at risk, what he says will be

 

confidential.

 

 

 

 

The parent of a 14­year­old child tells the primary care pediatric nurse

 

practitioner that the child skips classes frequently in spite of various disciplinary measures, such as grounding and extra homework and is earning Cs and Ds in most classes. What will the nurse practitioner recommend?

 

Counseling for emotional problems

 

Development of an Individual Education Plan

 

Evaluation for possible learning disorders

 

 

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ID: 13348413884

 

ID: 13348413880

 

ID: 13348413876

Referral for a behavioral disorder

 

 

 

 

The parent of a 14­year­old child tells the primary care pediatric nurse

 

practitioner that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the nurse practitioner tell the parent?

 

Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent.

 

Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake.

 

Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals.

 

Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home.

 

 

 

The primary care pediatric nurse practitioner is performing a well child exam

 

on a 17­year­old female whose mother is present during the history. The mother expresses concern that her daughter wishes to have an eyebrow piercing and states that she is opposed to the idea. What will the nurse practitioner do?

 

Provide information about piercings and encourage continued discussion.

 

Remind the adolescent that her mother is responsible for her health.

 

State that piercings are relatively harmless and are an expression of individuality.

 

Suggest that she wait until she is 18 years old and can make her own decisions.

 

 

 

 

The parent of a 16­year­old tells the primary care pediatric nurse practitioner

 

that the teen was recently caught smoking an electronic cigarette (e­cigarette). What will the nurse practitioner tell this parent?

 

E­cigarette use may be a risk factor for later substance abuse.

 

Experimentation with e­cigarettes does not lead to future tobacco use.

 

Most teens who experiment with tobacco usually do not become addicted.

 

This form of nicotine ingestion is safer than regular cigarettes.

 

 

 

 

The parent of an adolescent reports noting cutting marks on the teen’s arms

 

and asks the primary care pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent?

 

Cutting is a way of dealing with emotional distress.

 

It is a method of fitting in with other adolescents.

 

The behavior is common and will usually stop.

 

This type of behavior is a type of suicide attempt.

 

 

 

 

 

=========================

 

 

Chapter   9

 

 

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Questions

 

 

The primary care pediatric nurse practitioner is performing a focused problem

 

assessment on a child who has asthma and learns that one of the child’s parents smokes around the child in spite of being advised against this. The nurse practitioner recognizes this as a possible

 

alteration in which functional health pattern? A.   Cognitive­perceptual

Health perception

 

Role­relationship

 

Values­beliefs

 

 

 

 

The primary care pediatric nurse practitioner examines an infant whose weight is

 

below the 3rd percentile and whose mother does not comply with the feeding regimen. When attempting to enlist the help of the infant’s grandmother, the grandmother says, “My daughter was like this when she was a baby and she turned out all right.” Which approach will the nurse practitioner take to improve the outcome for this infant?

 

Ask the grandmother about her daughter’s health during childhood.

 

Explain that the condition is potentially serious if not treated.

 

Give the grandmother and mother information about normal growth.

 

Refer the family to a social worker to investigate possible neglect.

 

 

 

 

The primary care pediatric nurse practitioner provides patient teaching for

 

children newly diagnosed with irritable bowel syndrome (IBS). At which stage of development will children be able to understand the link between stress and the symptoms of the disease?

 

Concrete­operational stage

 

Formal­operational stage

 

Pre­conceptual stage

 

Sensorimotor stage

 

 

 

 

 

The primary care pediatric nurse practitioner is counseling an obese adolescent

 

 

 

 

 

ID: 13348422928

 

 

whose parents both have type 2 diabetes mellitus. Which health behavior prediction

 

 

model is

 

 

useful when the nurse practitioner discusses lifestyle changes with this client?

 

Behavioral change model

 

 

Health belief model

 

 

 

 

 

Health promotion model

 

Transtheoretical model

 

 

ID: 13348422940

 

ID: 13348422924

 

ID: 13348422934

 

ID: 13348422946

The primary care pediatric nurse practitioner is counseling a school­age child

 

about asthma management strategies. The child states that it is “too much trouble” to remember to use an inhaled corticosteroid medication twice daily and reports feeling fine, in spite of exhibiting expiratory wheezes. Which action uses the health belief and self­efficacy model to teach this child about asthma management?

 

 

Asking the child to try to use the inhaler at least once daily

 

Discussing whether the child wants to participate in athletics

 

Obtaining pre­ and post­treatment spirometry testing D.   Providing written information about inhaled corticosteroids

 

 

An adolescent who is overweight expresses a desire to lose weight in order to

 

participate in sports but tells the primary care pediatric nurse practitioner that he doesn’t want to give up sweets and soft drinks because he enjoys them too much. Which stage of change does

 

this represent? A.    Action

Contemplation

 

Precontemplation

 

Preparation

 

 

 

 

The primary care pediatric nurse practitioner sees a 17­year­old client who quit

 

smoking almost a year prior but who reports having renewed cravings when around friends who smoke. Using knowledge of the maintenance stage of change, the primary care pediatric nurse practitioner will

 

go over with the adolescent about the health risks associated with smoking.

 

recommend avoiding friends who smoke and making new friends.

 

remind the adolescent about the struggles associated with quitting smoking.

 

suggest that the teen consider taking up a sport or other physical activity.

 

 

 

 

The primary care pediatric nurse practitioner is working with a 12­year­old female

 

who has poor diabetes control. The child tells the nurse practitioner that the parent forgets to remind her to check her blood sugars. Which action is ?

 

Assess the parent’s knowledge about diabetes management.

 

Help the child develop a strategy to remember without parental prompts.

 

Refer to a social worker to help the family overcome obstacles to care.

 

Remind the child’s parent about the importance of good diabetes control.

 

 

 

 

The primary care pediatric nurse practitioner is counseling an obese 16­year­old ID: 13348422938 client about weight management. The adolescent says, “I know I need to lose weight, but I don’t

 

 

ID: 13348422926

 

ID: 13348422930

 

ID: 13348422944

want to give up all my favorite foods.” When using motivational interviewing techniques, how will the nurse practitioner respond?

 

“Do you think there are any foods you could limit or do without for a while?”

 

“I hear you telling me that you really don’t have a desire to lose weight.”

 

“If you can’t give up these foods, you won’t see the benefits of weight loss.”

 

“In the long run, the sacrifices you make today will improve your health.”

 

 

 

 

The parent of a newborn has quit smoking cigarettes within the past month and

 

reports feeling fidgety. Using a “reframing” technique, how will the primary care pediatric nurse practitioner respond?

 

Explore ways that the parent can use this extra energy to do things for the baby.

 

Remind the parent that this is a normal, temporary part of nicotine withdrawal.

 

Suggest that the parent take up exercise to enjoy the benefits of not smoking.

 

Tell the parent that, over time, these symptoms of withdrawal will subside.

 

 

 

 

The primary care pediatric nurse practitioner is assessing the health literacy of

 

the parent of a toddler. Which tool will the nurse practitioner use to estimate reading level?

 

Flesch­Kincaid Readability Test

 

Gunning Fog Index

 

Number of children’s books in the home

 

SMOG

 

 

 

 

The pediatric nurse practitioner provides primary care for a special needs infant

 

whose parent takes an active role in the infant’s care. The parent has a high school diploma and asks many questions about her infant’s treatments. Which approach will the nurse practitioner take to ensure health literacy for this parent?

 

Ask the parent to read back all information given.

 

Encourage the parent to ask questions when confused.

 

Provide written materials presented at an 8th grade level.

 

Reinforce written information with verbal instructions.

 

 

Chapter   10

 

 

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Questions

 

 

The primary care pediatric nurse practitioner provides anticipatory guidance for a

 

6­month­old infant who is breastfed who takes 400 IU of vitamin D daily. The parent reports that the infant has begun taking cereals, fruits, and vegetables in addition to nursing. What will the nurse practitioner recommend to promote healthy nutrition?

 

 

Begin supplementing with iron.

 

Continue to nurse as long as desired.

 

Discontinue the vitamin D supplement.

 

Stop breastfeeding at 1 year of age.

 

 

 

 

The parent of a toddler tells the primary care pediatric nurse practitioner that the

 

family has adopted a plant­based diet and the child is receiving rice and almond milk instead of

 

cow’s milk. The nurse practitioner will counsel the parents about

 

calcium deficiency.

 

excess caloric intake.

 

excess fat intake.

 

protein deficiency.

 

 

 

 

The parent of a 12­month­old infant asks the primary care pediatric nurse

 

practitioner why 2% cow’s milk is recommended instead of whole milk. What will the nurse

 

practitioner tell this parent?

 

Whole milk is usually not fortified with vitamin D.

 

2% milk is higher in essential proteins and minerals.

 

Young children don’t need the extra calories found in whole milk.

 

Younger children need a limited amount of fats.

 

 

 

 

The primary care pediatric nurse practitioner sees a 3­year­old child whose

 

parents report is a picky eater in spite of their continued efforts to provide nutritious meals. The parents ask whether a multivitamin is necessary. How will the nurse practitioner respond?

 

Ask the parents to provide a 3­day food diary.

 

Prescribe a daily multivitamin with iron.

 

Reinforce the need to meet DRIs each day.

 

Tell them that supplements are unnecessary

 

 

 

 

The primary care pediatric nurse practitioner is examining a toddler who is below ID: 13348422916 the 3rd percentile for weight even though the parents claim that the child eats “constantly.” What

 

 

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ID: 13348422900

 

ID: 13348422912

 

ID: 13348422906

will the nurse practitioner do initially?

 

Evaluate the child’s feeding and elimination behaviors and ask the family to describe mealtime routines.

 

Recommend giving a multivitamin and offering high­calorie foods, such as ice cream.

 

Refer the child to a feeding evaluation clinic for a swallow study and evaluation of possible GERD.

 

Suggest that the parents supplement the child’s food intake with a high­calorie formula.

 

 

 

 

The mother of a 6­year­old child tells the primary care pediatric nurse practitioner

 

that the child only wants to eat French fries and hamburgers and refuses most vegetables. What

 

will the nurse practitioner recommend?

 

Giving the child a multivitamin since this is a phase

 

Having the child eat vegetables before getting the hamburger

 

Providing a variety of healthy foods at each meal D.   Putting extra lettuce and tomatoes on hamburgers

 

 

The parents of a toddler tell the primary care pediatric nurse practitioner that they

 

get frustrated trying to get the child to eat any vegetables other than squash and carrots. What will the nurse practitioner recommend?

 

Continue to offer a variety of foods without forcing the child to eat them.

 

Offer snacks to make up for calories the child misses by not eating the vegetables.

 

Prepare dishes the child likes to ensure that a vegetable is eaten at each meal.

 

Require the child to take 1 to 2 bites of each food at each meal.

 

 

 

 

The primary care pediatric nurse practitioner is providing anticipatory guidance to

 

the mother of a breastfed 6­month­old infant who asks about “baby­led weaning.” What will the nurse practitioner tell her about this practice?

 

“Foods given for this purpose do not meet all the child’s nutritional needs.”

 

“Giving infants control of the feeding process will help prevent obesity.”

 

“Infants are given soft, mashable table foods when able to self­feed.”

 

“Infants must be able to grasp and feed themselves from a spoon to do this.”

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a 15­year­old girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement?

 

Calcium, vitamin C, and vitamin A

 

 

Iron, folic acid, and B12

 

 

 

 

 

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Magnesium, vitamin E, and zinc

 

Vitamin D, vitamin C, and phosphorus

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a school­age child who,

 

after removal of a pituitary tumor, has altered hypothalamic control over hunger and satiety. The child is morbidly obese and expresses feeling depressed because of the obesity. What will the nurse practitioner recommend?

 

 

Developing a system to reward compliance with a dietary regimen

 

 

Restricting all access to food in the house and at school

 

 

 

 

 

Suggesting an after­school exercise program to help with weight loss

 

Using a food diary to track all calories and food intake

 

 

 

 

When counseling an adolescent with a family history of hyperinsulinemia and type

 

2 diabetes, the primary care pediatric nurse practitioner will recommend avoiding

 

baked potato chips.

 

canned vegetables.

 

high­fiber cereals.

 

processed breads.

 

 

 

 

The parent of a school­age child reports that the child is on a gluten­free diet.

 

When questioned about the reason for this diet, the parent states that the child has fewer stomach aches since beginning the diet but has never been diagnosed with celiac disease. The parent reports using gluten­free grain products for all family members. The nurse practitioner will tell this parent that gluten­free diets

 

are generally low in sugar and fat.

 

are healthy and help prevent obesity.

 

may be deficient in essential nutrients.

 

provide adequate protein to meet daily needs.

 

 

Chapter   11

 

 

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Questions

 

 

The primary care pediatric nurse practitioner performs a well child assessment on

 

a 6­month­old infant whose mother reports having less breast milk because of stressors associated with pumping and returning to work. The nurse practitioner will provide resources to promote pumping and

 

discuss adding other foods to the baby’s diet.

 

encourage the mother to increase her fluid intake.

 

prescribe a multivitamin containing iron.

 

suggest offering only breast milk to the infant.

 

 

 

 

The mother of a newborn asks the primary care pediatric nurse practitioner about ID: 13348443909 the benefits of breastfeeding. What will the nurse practitioner tell her?

 

Breastfeeding for 9 months or longer will reduce the incidence of food allergies.

 

Breast milk is an excellent source of vitamin D, iron, and other essential nutrients for the baby.

 

Nursing her baby exclusively for at least 4 months will help her infant to resist infections.

 

There is a decreased risk of atopic dermatitis in babies who nurse for 12 months or longer.

 

 

 

The primary care pediatric nurse practitioner learns that the mother of a newborn

 

infant is being tested for tuberculosis after a positive TB skin test. What will the nurse practitioner

 

tell the mother who states a desire to breastfeed her baby?

 

Breast milk is contraindicated if the mother has tuberculosis.

 

She may continue to nurse her baby since the risk of transmission is low.

 

That she can express breast milk and feed that to her infant

 

To give formula until results of tuberculosis testing are known

 

 

 

 

The primary care pediatric nurse practitioner sees a 3­day­old nursing infant

 

whose newborn metabolic screen is positive for galactosemia. The nurse practitioner refers the newborn to a specialist for immediate evaluation and will tell the mother

 

to continue to breastfeed her infant.

 

to give the infant a cow’s milk formula.

 

to supplement breast milk with formula.

 

to stop breastfeeding immediately.

 

 

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The mother of a nursing infant expresses concern about whether high­cholesterol

 

foods will increase her infant’s risk of hyperlipidemia. What will the primary care pediatric nurse practitioner tell her?

 

Breastfed infants have lower serum cholesterol levels than those who are not breastfed.

 

Maternal cholesterol levels affect the cardiovascular risk of breastfed babies.

 

Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol values.

 

She should limit her dietary cholesterol to prevent hyperlipidemia in her infant.

 

 

 

 

The primary care pediatric nurse practitioner is counseling the mother of a

 

newborn about breastfeeding her infant. Which supplements will the nurse practitioner

 

recommend?

 

Fat­soluble vitamins

 

Iron

 

Multivitamins with iron

 

Vitamin D

 

 

 

 

The primary care pediatric nurse practitioner is examining a newborn who is

 

breastfeeding and notes the presence of an ankyloglossia. What will the nurse practitioner do

 

next?

 

Ask the mother if the infant has any feeding difficulties.

 

Refer the infant for a possible frenulectomy.

 

Schedule an appointment with a lactation consultant.

 

Suggest that the mother feed breast milk by bottle.

 

 

 

 

The primary care pediatric nurse practitioner performs an initial well baby exam

 

on a 1­week­old infant who is breastfeeding and who is at birth weight. The mother tells the nurse practitioner that her baby is already sleeping 5 or 6 hours at night. What will the nurse practitioner recommend?

 

 

Consultation with a lactation specialist to assess intake

 

Pumping her breast during the night to maintain milk supply

 

Supplementing the last feeding of the day with formula

 

Waking the infant up at least every 3 hours to nurse

 

 

 

 

The mother of a newborn infant asks the primary care pediatric nurse practitioner

 

about pumping her breasts when she returns to work in 2 months. What will the nurse practitioner include in teaching this mother?

 

Frozen breast milk may be stored up to 3 months in a 0° F freezer.

 

 

 

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ID: 13348443915

 

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Once she begins pumping the infant should drink only pumped breast milk.

 

Pumped breast milk must be discarded after 3 days when stored in the refrigerator.

 

Unused defrosted breast milk may be stored in the refrigerator for 48 hours.

 

 

 

 

The mother of a 2­month­old infant tells the primary care pediatric nurse

 

practitioner that she is afraid her breast milk is “drying up” because her baby never seems satisfied

 

and wants to nurse all the time. Which action is ?

 

Recommend pumping her breasts after feedings.

 

Refer the mother to a lactation consultant.

 

Suggest supplementation with formula.

 

Weigh the infant to assess for a growth spurt.

 

 

 

 

The mother of a 15­month­old infant tells the primary care pediatric nurse

 

practitioner that she wishes to continue nursing her child for another year, if possible. What will the

 

nurse practitioner recommend?

 

Breastfeed only at bedtime to establish meal patterns.

 

Clean the toddler’s teeth each time after breastfeeding.

 

Offer the breast just prior to meals to maintain milk supply.

 

The toddler should continue to be breastfed “on demand.”

 

 

 

 

The primary care pediatric nurse practitioner is performing an assessment on a 1­

 

week­old newborn with a slightly elevated bilirubin who is breastfeeding well and who has gained 30 grams in the past 24 hours. The infant is stooling and voiding well. The nurse practitioner suspects breast milk jaundice. Which action is ?

 

Order home phototherapy and closely monitor bilirubin levels.

 

Reassure the mother that the bilirubin level will drop in a few days.

 

Recheck the serum bilirubin and infant’s weight in 24 hours.

 

Recommend that the mother pump her breast milk for a couple of days.

 

 

 

Chapter   12

 

 

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Questions

 

 

The primary care pediatric nurse practitioner is performing a well child exam

 

on a 4­month­old infant who is nursing exclusively. The mother reports that the infant has had a marked decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every other day. How will the nurse practitioner respond?

 

Ask the mother to describe the color and consistency of the stools.

 

Explain to the mother that breastfed infants should have daily stools.

 

Recommend using a glycerin suppository as needed.

 

Suggest to the mother that she increase her intake of fluids.

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child exam

 

on a 12­month­old infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent?

 

It is too early to begin introducing the child to the toilet, and the parent should wait until the child is at least 2 years old.

 

Placing the child on a “potty” chair helps the child associate elimination cues with the toilet.

 

Predictability of elimination patterns indicates readiness for toilet training, and the parent can begin this process.

 

The parent should wait until other signs of toilet training readiness occur before introducing the child to the toilet.

 

 

 

The primary care pediatric nurse practitioner is performing a well child exam

 

on a 24­month­old child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do?

 

Advise the parent to make the child get clean clothes after an accident.

 

Ask the parent about the child’s toilet habits and understanding of toilet training.

 

Recommend using an awards system to encourage toilet use.

 

Suggest that the parent place the child on the toilet at predictable intervals.

 

 

 

 

The primary care pediatric nurse practitioner is discussing toileting issues

 

with the parent of a 3­year­old toddler who reports that the child has been toilet trained for several months but has recently been refusing to have bowel movements and is becoming constipated. What will the nurse practitioner do?

 

 

ID: 13348417428

 

ID: 13348417422

 

ID: 13348417418

Ask the parent about bathroom facilities in the child’s day care.

 

Refer the child to a gastroenterologist for evaluation of pathology.

 

Suggest putting the child in diapers and resuming toilet training in a few weeks.

 

Tell the parent that this represents a developmental delay.

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a 5­year­old child

 

who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make?

 

 

History of neurogenic conditions

 

Recent adjustments in the family

 

Recent illnesses, fluid intake, changes in diet

 

Toilet training history

 

 

 

 

The primary care pediatric nurse practitioner is managing a 6­year­old child

 

who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child’s condition?

 

Encouraging use of maintenance medications for at least 2 months after resolution

 

of constipation

 

Referral to a mental health consultant to manage problems in the parent­child dyad

 

Spending time with the parents to uncover their feelings about their child’s condition

 

Teaching the parents that the symptom of stool retention is often voluntary for the child

 

 

 

The parent of a 5­year­old child tells the primary care pediatric nurse

 

practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in “pull­ups.” The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend?

 

Providing a reward system to offer incentives when the child uses the toilet

 

Put the child back in diapers and resume toilet training in a few months.

 

Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation

 

Use of polyethylene glycol until the child is able to use the toilet regularly

 

 

 

 

 

The primary care pediatric nurse practitioner evaluates a 4­year­old girl ID: 13348417430

 

 

ID: 13348417436

 

ID: 13348417420

 

ID: 13348417434

whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially?

 

 

Examination for labial adhesions

 

Palpation for abdominal masses

 

Screening for potential child abuse

 

Urine culture and sensitivity

 

 

 

 

The primary care pediatric nurse practitioner is concerned that a toddler may

 

have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of

 

urinary tract infections. Which intervention is appropriate?

 

Initiating a bladder retraining program

 

Ordering a voiding cystourethrogram

 

Referral to a urologist for evaluation

 

Treatment with prophylactic antibiotics

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a 4­year­old

 

female child for enuresis. The parents reports that the child has never been dry at night and has recently begun having daytime incontinence, usually when at preschool. The nurse practitioner learns that the child does not appear to have an abnormal urine stream. What will the nurse practitioner do next?

 

Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis.

 

Reassure the parent that the child probably gets distracted and puts off voiding until it is urgent.

 

Refer the child to a pediatric urologist for evaluation of possible vesicoureteral reflux.

 

Suggest a bladder retraining program and use of a nighttime bedwetting alarm.

 

 

 

 

The primary care pediatric nurse practitioner is counseling the parent of an 8­

 

year­old child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent?

 

Anticholinergic medications are most commonly used for enuresis.

 

Drug therapy is an effective way to achieve long­term control.

 

Drug therapy is safest when the nasal spray form is used.

 

The combination of alarm therapy and intermittent drug therapy is best.

 

 

 

Chapter   13

 

 

ID: 13348419808

 

ID: 13348417494

 

ID: 13348417484

 

ID: 13348417474

Questions

 

 

The primary care pediatric nurse practitioner counseling the parent of an

 

overweight school­age child about improving overall fitness. What will the nurse practitioner include?

 

Encourage the child to begin by engaging in swimming or cycling.

 

Exercise will help lower total cholesterol and low­density lipoproteins.

 

School­age children need 60 minutes of moderate exercise daily.

 

Strength training exercises are not safe for school­age children.

 

 

 

 

The parent of a child who has asthma asks the primary care pediatric nurse

 

practitioner about whether the child may engage in strenuous exercise. What will the nurse practitioner tell the parent?

 

Children with asthma should be excluded from vigorous exercise and most strenuous sports.

 

Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity.

 

Physical activity has been shown to improve overall pulmonary function in children with asthma.

 

Vigorous exercise helps improve symptoms in children with poorly controlled asthma.

 

 

 

The primary care pediatric nurse practitioner is discussing lifestyle changes

 

with an adolescent who has hypertension. What will the nurse practitioner recommend about exercise for this client?

 

 

A.

 

 

Regular to vigorous activity initially with a combination of resistance and aerobic

 

exercise to maintain lower blood pressure

 

 

Moderate daily exercise such as walking for 20 minutes daily with increasing intensity as blood pressure drops

 

Vigorous aerobic exercise combined with maximal strength training to lower blood pressure

 

Vigorous aerobic exercise only to reduce blood pressure and then to maintain lowered blood pressure

 

 

 

The primary care pediatric nurse practitioner is offering anticipatory guidance

 

to the parents of a 6­year­old child who has Down syndrome. What will the nurse practitioner tell the parents about physical activity and sports in school?

 

Children with Down syndrome get frustrated easily when engaging in sports.

 

 

ID: 13348417488

 

ID: 13348417478

 

ID: 13348417476

 

ID: 13348417496

Children with Down syndrome should not participate in strenuous aerobic activity.

 

Their child should have a cervical spine evaluation before participation in

 

sports.

 

Their child should only participate in sports sanctioned by the Special Olympics.

 

 

 

 

The primary care pediatric nurse practitioner is discussing fitness and

 

exercise with the parents of a 5­year­old child who ask what kinds of activities are developmentally appropriate for their child. What will the nurse practitioner recommend?

 

Bike riding

 

Interactive play

 

Martial arts

 

Organized sports

 

 

 

 

The parents of a pre­pubertal female who is on the local swim team tell the

 

primary care pediatric nurse practitioner that their daughter wants to begin a strength training program to help improve her swimming ability. What will the nurse practitioner recommend?

 

Avoiding strength training programs until after puberty to minimize the risk for injury

 

Enrolling their daughter in a program that uses fixed weight machines or resistance bands

 

Having their daughter participate in weight training 4 or 5 times each week for maximum effect

 

Making sure that their daughter begins with the greatest weight tolerable using lower repetitions

 

 

 

The parent of a 14­year­old child asks the primary care pediatric nurse

 

practitioner how to help the child prevent injuries when basketball tryouts begin later in the

 

school year. Which recommendation will be of most benefit? A.   Preseason conditioning

Proper footwear

 

Protective knee braces

 

Stretching before practices

 

 

 

 

The primary care pediatric nurse practitioner is counseling a parent about

 

bicycle helmet use. The parent reports having a helmet used a year previously by an older child and wonders about using it for a younger child since they are so expensive. What will the nurse practitioner tell the parent?

 

“As long as the helmet does not have cracks, you may use it.”

 

“If the helmet is free from marks, you may use it.”

 

 

ID: 13348419802

 

ID: 13348417492

 

ID: 13348417472

 

ID: 13348417490

“You may continue to use a helmet up to 10 years.”

 

“You should always purchase a new helmet for each child.”

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a high school age adolescent who plays football who has hypercalciuria. Which dietary supplement will the nurse practitioner question the adolescent about?

 

Protein supplements

 

Salt tablets

 

Sports drinks

 

Vitamin C

 

 

 

 

The primary care pediatric nurse practitioner is performing a pre­participation

 

sports physical examination on a 14­year­old male who will be on the wrestling team at school. What will the nurse practitioner include when discussing healthy practices with this adolescent?

 

Risks associated with repeatedly losing and gaining weight

 

The need for an electrocardiogram or echocardiogram prior to participation

 

The need to consume 20 to 30 grams of protein after exercise

 

To consume water with CHO prior to activity lasting up to an hour

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a heart murmur

 

during a pre­participation examination of a high school athlete. Which finding would be a

 

concern requiring referral to a cardiologist?

 

A murmur that is louder when squatting and softer when standing

 

A murmur that is quieter when squatting and louder with a Valsalva maneuver

 

A murmur with narrow and variable splitting of S2

 

A systolic murmur that is grade 1 or 2

 

 

 

 

The parent of a 12­year­old child who has sickle cell trait (SCT) asks the

 

primary care pediatric nurse practitioner whether the child may play football. What will the nurse practitioner tell this parent?

 

Children with SCT should not play any contact sports.

 

Children with SCT may not play for NCAA schools in college.

 

Children with SCT should follow heat acclimatization guidelines.

 

Children with SCT should not participate in organized sports.

 

 

ID: 13348419804

 

ID: 13348417480

 

ID: 13348419806

 

ID: 13348417486

 

ID: 13348417498

The parent of a child newly diagnosed with epilepsy asks the primary care

 

pediatric nurse practitioner if the child will ever be able to participate in gym or sports. What

 

will the nurse practitioner recommend?

 

Bicycle riding is not safe for children with seizures.

 

Contact sports should be avoided.

 

Direct supervision of some activities is necessary.

 

Underwater sports are not recommended.

 

 

 

 

The primary care pediatric nurse practitioner diagnoses a high school

 

basketball player with mononucleosis. The adolescent asks when she may resume play. What will the nurse practitioner tell her?

 

After 3 weeks, she may begin lifting weights but not full sports.

 

After 4 weeks, she may return to full play and practice.

 

At 4 weeks, she must have an exam to determine fitness for play.

 

She may engage in moderate exertion and practice after 3 weeks.

 

 

 

 

A 12­year­old child who plays soccer is diagnosed with vocal cord

 

dysfunction. What will the primary care nurse practitioner say when the child’s parents ask

 

about continued sports participation?

 

The child may continue to participate in soccer.

 

The child should limit activity to non­aerobic sports.

 

This condition is a contraindication for all sports.

 

This condition predisposes the child to sudden cardiac death.

 

 

 

 

The parent of a high school basketball player tells the primary care pediatric

 

nurse practitioner that the adolescent becomes short of breath only when exercising. What will

 

the nurse practitioner recommend?

 

Permanent discontinuation of all strenuous and aerobic activities

 

Enrollment in a conditioning program to improve performance

 

Evaluation for underlying cardiac causes of this symptom D.   Treatment for exercise­induced asthma with a bronchodilator

 

 

A 10­year­old is hit in the head with a baseball during practice and is

 

diagnosed with concussion, even though no loss of consciousness occurred. The primary care pediatric nurse practitioner is evaluating the child 2 weeks after the injury and learns that the child is still experiencing some sleepiness every day. The neurological exam is normal. The child and the parent are adamant that the child be allowed to return to play baseball. What will the nurse practitioner recommend?

 

 

ID: 13348419800

 

ID: 13348417482

Continuation of cognitive rest only

 

Continuation of physical and cognitive rest

 

Continuation of physical rest only

 

Returning to play

 

 

 

 

A 15­year­old female basketball player who has secondary amenorrhea is

 

evaluated by the primary care pediatric nurse practitioner who notes a BMI in the 3rd

 

percentile. What will the nurse practitioner counsel this patient?

 

That amenorrhea in female athletes is not concerning

 

That she should begin a program of plyometrics and strength training

 

To consider a different sport, such as volleyball

 

To work with a dietician to improve healthy weight gain

 

 

 

 

The primary care pediatric nurse practitioner is examining a 17­year­old male

 

who is on his high school swim team. The adolescent is concerned about “lumps” on his chest. The nurse practitioner notes a marked increase in weight since the last visit along with worsening of the adolescent’s acne. Given this set of symptoms, which performance­ enhancing substance will the nurse practitioner be most concerned about and ask about?

 

Creatine

 

Dehydroepiandrosterone (DHEA)

 

Ephedra

 

Growth hormone

 

 

 

 

 

 

 

Chapter   14

 

 

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ID: 13348422992

 

ID: 13348422994

 

ID: 13348425700

Questions

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a 4­year­old child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent?

 

Most sleep disorders are benign and will be outgrown.

 

Sleep disorders are symptomatic of underlying behavior problems.

 

Sleep disorders at this age can have long­term impacts on learning.

 

The child will need longer daytime naps to compensate for lost sleep.

 

 

 

 

The parent of a school­age child who is overweight tells the primary care

 

pediatric nurse practitioner that the child seems to crave high­calorie, high­carbohydrate foods, even when full. The nurse practitioner learns that the child is often irritable and sleepy at school in spite of sleeping 9 or 10 hours each night. What will the nurse practitioner recommend?

 

 

 

Assessment of leptin and ghrelin hormone levels

 

Consultation with a dietician to develop an appropriate diet

 

Referral to a sleep disorder clinic for a sleep study

 

Taking one or two naps each day to increase the amount of sleep

 

 

 

 

The primary care pediatric nurse practitioner is performing a well baby

 

examination on a 2­week­old infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent to keep a sleep log and will teach the parent that which amount of sleep per day is optimal for this infant?

 

 

10 to 12 hours

 

12 to 15 hours

 

15 to 18 hours

 

18 to 20 hours

 

 

 

 

The primary care pediatric nurse practitioner is counseling a new parent

 

about ways to reduce the risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing SIDS?

 

Bed­sharing with infants greatly increases the risk of SIDS.

 

Breastfeeding does not appear to have any influence on SIDS risk.

 

Infants who attend day care have a higher than usual incidence of SIDS.

 

There is no difference in SIDS rates in immunized versus non­immunized infants.

 

 

ID: 13348422980

 

ID: 13348422986

 

ID: 13348425702

 

ID: 13348422982

The primary care pediatric nurse practitioner is counseling the parents of a

 

toddler about sleep. The parents report that the toddler has recently begun resisting sleep and is often more irritable during the day. What will the nurse practitioner recommend?

 

Co­sleeping with the child to help alleviate possible nighttime fears

 

Referral to a sleep disorders clinic for evaluation of sleep­disordered breathing

 

Reintroducing a second, morning nap time to compensate for lost sleep

 

Understanding that sleep resistance is a common developmental problem

 

 

 

 

The parent of a 3­year­old child tells the primary care pediatric nurse

 

practitioner that the child has never been able to fall asleep without a parent in the room. The child has a new sibling and the parent is concerned that the toddler’s cries will awaken the infant. What will the nurse practitioner counsel the parent?

 

 

A.

 

 

Leaving the room as the child is falling asleep and returning at intervals to check on

 

the child

 

 

Offering a reward for each night the child falls asleep without the parent in the room

 

Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors

 

Taking away a favorite activity or video for each night the child fusses about the parent not being in the room

 

 

 

The parent of a 4­year­old who has difficulty initiating and maintaining sleep

 

has tried several nonpharmacological methods with variable success and asks about medications. What will the primary care pediatric nurse practitioner recommend?

 

Diphenhydramine

 

Lorazepam

 

Melatonin

 

Zolpidem

 

 

 

 

The parent of a 3­year­old child tells the primary care pediatric nurse

 

practitioner that after falling asleep in the living room and being awakened to go to bed one evening, the child appeared confused and disoriented for a period of time. What will the nurse practitioner counsel this parent?

 

That if this occurs again, to question the child about nightmares

 

That this is a sign of sleep walking and could be dangerous

 

That this is a type of sleep terror which will resolve over time

 

That this is probably a benign, temporary type of a sleep disorder

 

 

ID: 13348422988

 

ID: 13348422998

 

ID: 13348422996

 

ID: 13348422984

During a well child examination, the primary care pediatric nurse practitioner

 

learns that a 5­year­old child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with open eyes, and saying things that don’t make sense. What will the nurse practitioner recommend?

 

 

Establishing a graduated extinction program and good sleep hygiene

 

 

Making sure that stairs are blocked and doors are locked

 

 

 

 

 

Referral to a sleep disorder clinic for evaluation of a parasomnia

 

To awaken the child when these occur and asking about nightmares

 

 

 

 

The parent of a school­age child tells the primary care pediatric nurse

 

practitioner that the child is restless most nights and complains often that bugs are in the bed. After consultation with a sleep disorder specialist and subsequent evaluation of a ferritin level of 30, the nurse practitioner may expect to treat this child with

 

 

clonazepam.

 

ferrous sulfate.

 

gabapentin.

 

sertraline.

 

 

 

 

An adolescent exhibits mild depressive symptoms and tells the primary care

 

pediatric nurse practitioner that he is most concerned about difficulty falling and staying asleep. The adolescent does not want to take medication to treat the depressive symptoms. What will the nurse practitioner recommend?

 

 

A program of sleep hygiene and gradual sleep extension

 

A sedative­narcotic will help both sleep and depression

 

Cognitive therapy can help the adolescent to sleep better

 

Using an antidepressant will improve sleep patterns

 

 

 

 

A child with Down syndrome who has sleep­disordered breathing with

 

obstructive sleep apnea continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse practitioner will refer the child to a sleep disorder clinic to discuss which therapy?

 

Craniofacial surgery

 

Oral appliances

 

Positive airway pressure therapy

 

Supplemental oxygen

 

 

 

 

Chapter   15

 

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ID: 13348443943

 

ID: 13348443941

 

ID: 13348443931

Questions

 

 

The mother of a 3­month­old male infant tells the primary care pediatric

 

nurse practitioner that she occasionally notices he has a penile erection just after nursing.

 

What will the nurse practitioner tell the mother?

 

Infants should be prevented from masturbating.

 

The infant is conscious of the pleasure associated with nursing.

 

This is a form of infantile priapism.

 

This is a normal, reflexive behavior at this age.

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a 3­year­old. The child’s parent reports that the child has recently begun

 

masturbating. What will the nurse practitioner counsel this parent?

 

To allow the behavior whenever it occurs, since it is normal

 

To discuss sexuality with the child

 

To explore whether the child is being abused

 

To teach the child about privacy and hand hygiene

 

 

 

 

The parent of an 8­year­old child tells the primary care pediatric nurse

 

practitioner that the child has begun to ask questions about why a schoolmate has “2 daddies” and wonders how to talk to the child about this. What will the nurse practitioner recommend?

 

Beginning a discussion about different types of sexual relationships and same­sex partners

 

Discussing the issue with the child in terms of the parent’s religious values and norms

 

Explaining that not all families are the same and what is most important is that they

 

love and care for their children

 

Telling the child that some adult relationships are complicated and will be understood when the child is older

 

 

 

The primary care pediatric nurse practitioner is performing a well child exam

 

on an 8­year­old girl and notes the presence of breast buds. What will the nurse practitioner include when initiating anticipatory guidance for this patient?

 

A discussion about the risks of pregnancy and sexually transmitted diseases

 

 

Information about sexual maturity and menstrual periods

 

 

 

 

 

Material about the human papillomavirus vaccine

 

Sexual orientation and the nature of sexual relationships

 

 

ID: 13348443937

 

ID: 13348443945

 

ID: 13348443933

 

ID: 13348443935

The primary care pediatric nurse practitioner is counseling the parents of a

 

13­year­old female who has Down syndrome about sexual maturation. What will the nurse practitioner tell these parents?

 

It is important to discuss and support healthy sexuality.

 

Providing too much information about sexuality may be confusing given the child’s cognitive level of understanding.

 

Suppressing periods with contraceptives will lessen their daughter’s distress.

 

They should give her information about periods but not about sexuality.

 

 

 

 

During a well child exam on a 13­year­old female, the primary care pediatric

 

nurse practitioner notes that the child is at Tanner Stage 3. During the exam, when the nurse practitioner initiates a conversation about healthy sexuality education, the parent states that this topic is “off limits.” What will the nurse practitioner do?

 

Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult.

 

Separate the parent from the adolescent to discuss the adolescent’s concerns in private.

 

Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors.

 

Tell the parent that this information is a routine part of adolescent well child examinations and must be included.

 

 

 

During a well child examination, a 15­year­old female tells the primary care

 

pediatric nurse practitioner that some of her friends have begun having sex. She has a boyfriend but denies engaging in sex with him. What will the nurse practitioner do initially?

 

Ask her for her definitions of “sex.”

 

Discuss the risks of sexually transmitted diseases.

 

Find out if she is considering sexual relations.

 

Give her information about contraception.

 

 

 

 

During a well child examination of a 6­year­old girl, the primary care pediatric

 

nurse practitioner notes that the child becomes embarrassed and resists taking off her underwear for the exam. What should the nurse practitioner infer from this observation?

 

The child has been sexually molested.

 

The child is feeling violated by the examiner.

 

The parent is exhibiting regressive behavior.

 

This is a normal reaction in a child of this age.

 

 

ID: 13348443939

The primary care pediatric nurse practitioner is providing anticipatory

 

guidance to the parent of a school­age boy. The parent expresses concerns that the child prefers to play with dolls, is worried that the child will be a homosexual, and asks what can be done to prevent this from happening. What will the nurse practitioner tell this parent?

 

Homosexual identity formation cannot be predicted by early childhood behavior.

 

Masculinizing boys from an early age helps to determine heterosexual orientation.

 

Sexual orientation identification begins late in adolescence and not in childhood.

 

The development of sexual orientation is generally a multifaceted process.

 

 

 

 

 

 

 

 

Chapter   16

 

 

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ID: 13348443949

 

ID: 13348443957

 

ID: 13348443953

Questions

 

 

The primary care pediatric nurse is performing a well child examination on an

 

adolescent who was adopted as a toddler. The parent reports that the child had been removed from an abusive home at age 3 years. What will the nurse practitioner evaluate in light of possible long­term effects of this early situation?

 

 

Cognitive and psychosocial development

 

 

Mental health and suicide risk

 

 

 

 

 

Moral development and conscience formation

 

Spirituality, faith, and religious affiliation

 

 

 

 

While the primary care pediatric nurse practitioner is discussing anticipatory

 

guidance with the mother of a 12 month old, the child repeatedly pulls objects out of the mother’s purse. Each time, the mother slaps the child’s hands as she takes the objects away. What will the nurse practitioner recommend to help the mother manage this child’s misbehavior in a developmentally appropriate manner?

 

 

Keep her purse up high and out of the child’s reach.

 

Place acceptable objects in her purse for the child to find.

 

Say “No!” instead of slapping the child’s hands.

 

Use timeout each time the child gets into the purse.

 

 

 

 

The mother of a 15­year­old female expresses concerns that her daughter may

 

be sexually active because she’s had a steady boyfriend for over a year. The primary care pediatric nurse practitioner learns that the family is Catholic and that the mother had an abortion when she was 16 years old. What will the nurse practitioner do initially?

 

 

Explore the mother’s feelings about her own past experience.

 

Offer to prescribe contraception to prevent pregnancy.

 

Recommend that the mother discuss this with her daughter.

 

Suggest that the mother talk to a priest about her daughter.

 

 

 

 

During a well child examination of a school­age child from a family who recently

 

immigrated from Africa, the primary care pediatric nurse practitioner learns that the child has been involved in many arguments at school. The parents are concerned that their child will never fit in with classmates. How will the nurse practitioner address this situation?

 

Assess the conditions in the country of origin prior to immigration.

 

Recommend counseling to determine underlying causes of this behavior.

 

Stress that this may be a normal response to feeling different at school.

 

Suggest that the child may be responding to being bullied by others.

 

 

ID: 13348443951

The primary care pediatric nurse practitioner sees a 6­year­old child after a

 

hospitalization for injuries sustained in a motor vehicle accident (MVA) in which the child’s grandfather was killed. The parent states that it is difficult to get the child to stop talking about the accident and is worried that the child will have permanent emotional scars. What will the nurse practitioner suggest?

 

Assure the child that he is safe and this won’t happen again.

 

Encourage the child to express and examine feelings.

 

Reassure the child that his grandfather is in heaven.

 

Redirect these conversations to happier topics.

 

 

Chapter   17

 

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ID: 13348434177

 

ID: 13348434199

 

ID: 13348434197

 

ID: 13348434181

Questions

 

 

During a well child examination on an infant who has colic, the primary care

 

pediatric nurse practitioner learns that the infant’s mother is 17 years old and that the father, who is in the military, was deployed to wartime duty shortly after the baby was born. To determine the immediate risk of child maltreatment for this infant, the nurse practitioner will ask about

 

childrearing and parenting styles.

 

role responsibilities of the parents.

 

spiritual beliefs and religious practices.

 

the location of extended family members.

 

 

 

 

The primary care pediatric nurse practitioner is examining a young child who has

 

cerebral palsy. Which part of the family history raises concerns about potential child maltreatment?

 

Child attends day care

 

 

Limited financial resources

 

 

 

 

 

Mother works outside the home

 

No membership in a church

 

 

 

 

The mother of two school­age children tells the primary care pediatric nurse

 

practitioner that she and the children’s father are divorcing and asks for advice to help the children

 

cope with the situation. The nurse practitioner will counsel her to

 

allow visitation only on weekends.

 

maintain her own social life.

 

notify the children’s teachers.

 

use a social support network.

 

 

 

 

Adolescent children are more likely to smoke cigarettes and drink alcohol if they live with

 

cohabitating parents.

 

grandparents.

 

homosexual parents.

 

single parents.

 

 

 

 

The primary care pediatric nurse practitioner is performing a well baby

 

examination on a newborn whose mother is 17 years old. The mother states that she is living with her parents and plans to finish high school. The maternal grandmother will care for the infant while she is in school. What will the nurse practitioner discuss with this mother at this visit?

 

 

ID: 13348434183

 

ID: 13348437903

 

ID: 13348434175

Early child intervention programs

 

Her needs for socialization with peers

 

Immunizations and well child visits

 

Referral to a community health nurse

 

 

 

 

The primary care pediatric nurse practitioner is performing an examination on a

 

2­year­old child who has been placed in emergency foster care with a grandparent after the child’s mother has been arrested for drug use. The child has a history of asthma with frequent exacerbations because of parental smoking. What is a priority for the nurse practitioner at this visit?

 

Evaluation of financial resources, medical insurance, and access to health care and medications

 

Providing a list of websites and community­based support groups for grandparents parenting grandchildren

 

Referral to a social worker to help the child deal with emotional conflict related to separation from the parent

 

Teaching the grandparent about the need for consistency in routines and discipline for the child

 

 

 

The primary care pediatric nurse practitioner is discussing newborn care with a

 

mother who is pregnant with triplets. When counseling the mother about feeding issues, the nurse practitioner will recommend

 

developing a plan to rotate breastfeeding for her infants.

 

making sure that the triplets are on the same feeding schedule.

 

pumping her breasts so she can feed breastmilk to all three.

 

supplementing with formula to ensure adequate nutrition.

 

 

 

 

The primary care pediatric nurse practitioner is assessing a special needs school­ ID: 13348434187 age child whose family has just moved to the area. What is a priority concern at this initial visit?

 

Asking the parents to describe the child’s illness, treatments, and unique needs

 

Connecting the family to local support groups, school programs, and resources

 

Gathering information about financial concerns related to the child’s condition

 

Providing expert information about the child’s condition and its management

 

 

 

 

The primary care pediatric nurse practitioner is counseling a family whose parents

 

are divorcing. To help support the children and reduce their stress through this process, the nurse practitioner will recommend

 

 

ID: 13348434189

 

ID: 13348437901

 

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allowing children to choose the custodial parent.

 

being open about ongoing parental conflicts.

 

establishing a single custody living arrangement.

 

maintaining a civil relationship when discussing children.

 

 

 

 

The primary care pediatric nurse practitioner learns that a school­age child

 

continues to hope that his parents will remarry 1 year after they have divorced. What will the nurse practitioner tell this child’s parents?

 

“If one of you remarries, he is more likely to understand that this is permanent.”

 

“This is a normal response and is an expression of hope that things will be OK.”

 

“You will need to help him accept the reality of the permanence of the divorce.”

 

“Your child is most likely blaming himself for your separation and divorce.”

 

 

 

 

The primary care pediatric nurse practitioner is examining an infant who has otitis

 

media and learns that the mother and child are homeless. Besides assisting the mother to obtain medication to treat this illness, what is a priority during this visit?

 

Assisting the mother to obtain transportation for health care needs

 

 

Determining well child examination history and immunization status

 

 

 

 

 

Making sure the family has access to WIC and food stamps resources

 

Obtaining a tuberculosis skin test and scheduling a return office visit

 

 

 

 

The primary care pediatric nurse practitioner suspects that the parent of a child

 

who is doing poorly in school is being abused by a partner. What is a priority response by the nurse practitioner?

 

Notifying the child’s school counselor about this problem

 

Referring the child and family to a social worker

 

Reporting this according to any mandated reporting laws

 

Suggesting that the parent avoid the abusive situation

 

 

 

 

The parent of an adolescent female tells the primary care pediatric nurse ID: 13348434179

 

practitioner that the child may be the victim of cyber­bullying at school but won’t talk about it with her parents. What is the nurse practitioner’s initial response?

 

Ask about the adolescent’s school performance and friends.

 

Interview the adolescent separately from the parent.

 

Reassure the parent that suicide is a rare response to bullying.

 

Suggest that the parent discuss this with the school counselor.

 

 

ID: 13348434193

 

ID: 13348434185

The primary care pediatric nurse practitioner is examining a young child who was

 

brought in by a grandmother for evaluation of a partial­thickness burn on one arm. The PNP suspects that this is an intentional injury, but the grandmother states that the parents are “just careless” and that the child is now living with her. What will the PNP do?

 

 

Flag this as a concerning incident in the child’s record.

 

Reassure the grandmother that she is doing the right thing.

 

Refer the child’s parents to a parenting resource center.

 

Report a suspicion of abuse to child protective services.

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a 12­year­old girl who

 

reports penile penetration of her vagina by her mother’s boyfriend the day before yesterday. The PNP reports this to the local child abuse hotline. What is the PNP’s next action?

 

Attaining a history of the abuse from the child

 

Obtaining urethral specimens for STI testing

 

Performing a colposcopic examination to evaluate for trauma

 

Referring the child to the ED for forensic specimen collection

 

 

 

Chapter   18

 

 

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ID: 13348437911

 

ID: 13348437913

 

ID: 13348437907

Questions

 

 

A parent who encourages competitiveness in a child who excels at a single sport but not in others may also encourage a sense of

 

competence.

 

insecurity.

 

significance.

 

worthiness.

 

 

 

 

A school­age child enjoys playing basketball but doesn’t make the intramural

 

team. Which response by the child is characteristic of the concept of a growth mindset?

 

“I didn’t play well on the day of the tryouts.”

 

“I’ll just have to find another sport I’m good at.”

 

“I’ll need to work more on my outside shot.”

 

“I’m probably too short to be really good at this sport.”

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a 16­year­old

 

adolescent male who is on the high school wrestling team and whose weight fluctuates as much as 7 or 8 pounds before matches. The child is eager to talk about the various trophies he has won. When he expresses confidence that he will get a wrestling scholarship for college, his father remarks that his grades will never be good enough for college, causing him to blame his teachers. The nurse practitioner may identify potential problems with

 

 

body image.

 

personal identity.

 

role performance.

 

self­esteem.

 

 

 

 

The primary care pediatric nurse practitioner sees a 10­year­old child whose

 

parent describes as a “class clown.” The child denies having problems at school, but acknowledges poor grades by saying, “I’m not very smart, I guess.” When counseling the parent about helping this child deal with this self­perception issue, the nurse practitioner will recommend which strategy?

 

Empower the child to make decisions and assume more responsibilities.

 

Help the child identify skills and activities that he is good at.

 

Spend time each evening helping the child with homework to improve grades.

 

Work with the teacher to set appropriate limits on school behavior.

 

 

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ID: 13348437909

 

ID: 13348437915

The primary care pediatric nurse practitioner is performing a well child

 

examination on a fussy toddler who has red hair. The child’s parent tells the toddler to stop being fussy and says, “red hair gives him such a temper.” Which common error that erodes self­esteem is this?

 

 

Dwelling on negatives

 

Expecting too much

 

Negating the child’s feelings

 

Stereotyping and typecasting

 

 

 

 

The parent of a 15­year­old male is concerned that he refuses to eat meals

 

with the family and consumes only protein drinks. The adolescent is on the track team at school and spends much of his time training and working out. The primary care pediatric nurse practitioner notes that his weight and BMI have dropped from the 20th percentile to the 3rd percentile in the past year. This child most likely has a problem with

 

 

body image.

 

personal identity.

 

role performance.

 

self­esteem.

 

 

 

 

The parent of a school­age child is concerned that the child is going to be

 

short like both parents and worries that he will have difficulty in school if he can’t participate in a variety of sports. What will the primary care pediatric nurse practitioner do to counsel this parent?

 

Encourage the child to engage in regular physical activity.

 

Overlook his or her own feelings about this physical characteristic.

 

Point out the accomplishments of other short people.

 

Steer the child into other activities at school.

 

 

 

 

 

Chapter   19

 

 

ID: 13348419834

 

ID: 13348419812

 

ID: 13348419816

Questions

 

 

During a well child examination on a 4­month­old infant, the primary care pediatric

 

nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent­infant relationship?

 

“I can sense a difference in my baby’s cries.”

 

“I let my baby cry a while to learn to be patient.”

 

“My baby prefers to nurse in a darkened room.”

 

“My baby seems very sensitive to loud noises.”

 

 

 

 

A child has a difficult temperament. What will the primary care pediatric nurse ID: 13348419824

practitioner tell the parent about managing this child’s behavior?

 

A difficult temperament is its own risk factor for maladjustment disorders.

 

Children with difficult temperaments need strict adherence to rules.

 

Having a difficult temperament limits intelligence and emotional maturity

 

It is important for the parent to learn to manage criticism and power struggles.

 

 

 

 

During a well child assessment of a preschool­age child, the parent voices

 

concerns that, because the child has behavior problems at school, the child may have a mental health disorder. Which initial approach will provide the best information?

 

Ask the parent whether other caregivers have voiced similar concerns.

 

Interview the child separately from the parent to encourage sharing of feelings.

 

Take time to actively listen to the parent’s and child’s perceptions of the problem.

 

Use a validated screening tool to ensure that all aspects of behaviors are evaluated.

 

 

 

 

The primary care pediatric nurse practitioner attempts to learn more about the ID: 13348419842

emotional health of an 18­month­old child through which assessment strategy?

 

Asking the child to tell a story using dolls and other props

 

Asking the child to draw a picture of him­ or herself and other family members

 

Interviewing the child separately from caretakers and parents

 

Observation of the child with caretakers in structured and unstructured situations

 

 

 

A middle­school­age child is skipping school frequently and getting poor grades

 

since the child’s father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation?

 

 

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ID: 13348419828

 

ID: 13348419840

 

ID: 13348419814

Prescribe short­term antidepressants for this situational depression.

 

Refer the child to a mental health specialist for evaluation and treatment.

 

Schedule extended appointments for counseling and mental health interventio.

 

Suggest that the child have close follow­up by a school counselor.

 

 

 

 

The parent of a 4­year­old child reports that the child seems to be having trouble

 

adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do?

 

Ask the parent if the child is slow to warm up to other new situations.

 

Reassure the parent that parallel play is common among preschool­age children.

 

Recommend that the parent spend time encouraging the child to play with others.

 

Suggest that the day care center may be neglecting the child.

 

 

 

 

The parent of a school­age child is concerned because the child has started to

 

express anger about a grandparent’s death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent?

 

Anger is an abnormal reaction to bereavement and loss in this age child.

 

Counseling is needed since the child has had sufficient time to resolve this issue.

 

Grief and bereavement lasting longer than a year may require medication.

 

The significance of this loss must be reworked at each developmental level.

 

 

 

 

The parent of a school­age child reports that the child doesn’t like being alone in

 

rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse

 

practitioner tell the parent?

 

“Fear of imaginary creatures does not usually occur at this age.”

 

“I may need to refer your child to a pediatric mental health specialist.”

 

“Your child is expressing normal fears for a school­age child.”

 

“Your child may be watching too much violence on television.”

 

 

 

 

The parent of a preschool­age child reports that the child often appears anxious

 

and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend?

 

Cognitive­behavioral therapy

 

Family therapy

 

Medication therapy

 

Play therapy

 

 

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ID: 13348419830

 

ID: 13348419844

 

ID: 13348419836

 

ID: 13348419820

A 9­year­old child exhibits school refusal and a reluctance to attend sleepovers

 

with classmates. The parent is concerned because the child has recently begun sleeping in the parents’ bed. Which initial action by the primary care pediatric nurse practitioner is appropriate?

 

Assess for environmental stress, parental dysfunction, and maternal depression.

 

Ask about recent traumatic events that may have precipitated this behavior.

 

Consider a possible pediatric autoimmune neuropsychiatric disorder cause.

 

Recommend firm insistence on school and activity attendance.

 

 

 

 

The parent of a school­age child reports that the child becomes frustrated when

 

unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child?

 

Generalized anxiety disorder (GAD)

 

Obsessive­compulsive disorder (OCD)

 

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)

 

Separation anxiety disorder (SAD)

 

 

 

 

The parent of a school­age girl reports that the child has difficulty getting ready

 

for school and is often late because of a need to check and recheck whether her teeth are clean and her room light has been turned off. What will the primary care pediatric nurse practitioner recommend to this parent?

 

 

Cognitive­behavioral therapy

 

Deferral of treatment until symptoms worsen

 

Medication management with an SSRI

 

Referral to a child psychiatrist

 

 

 

 

The parents of a 4­year­old boy are concerned because he has begun twisting

 

and pulling out his hair, especially when he is tired or stressed. What will the primary care pediatric

 

nurse practitioner recommend as part of an initial approach to treat this behavior?

 

Consultation with a pediatric behavioral specialist

 

 

Cutting his hair so that it is too short to pull

 

 

 

 

 

Long­term anti­streptococcal prophylaxis

 

Medication with risperidol or clonidine

 

 

 

 

A newly divorced mother of a toddler reports that the child began having difficulty

 

sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates

 

 

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ID: 13348419832

 

ID: 13348419822

and often spends time sitting quietly. What will the nurse practitioner doinitially?

 

Ask the mother about the child’s relationship with the father.

 

Consult with a child psychiatrist to prescribe medications.

 

Recommend cognitive behavioral or psychodynamic therapy.

 

Refer the family to a child behavioral specialist for counseling.

 

 

 

 

An adolescent has recently begun doing poorly in school and has stopped

 

participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient?

 

 

Administering a diagnostic rating scale for depression

 

Considering a short­term trial of an antidepressant medication

 

Determining suicidal ideation and risk of suicide D.   Referring the adolescent to a mental health specialist

 

 

An adolescent is diagnosed with major depression, and the mental health

 

specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk?

 

Addition of risperidone therapy

 

Cognitive­behavioral therapy

 

Family therapy

 

Hospitalization

 

 

 

 

A 13­year­old child has exhibited symptoms of mild depression for several weeks. ID: 13348419846 The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do?

 

Administer an ADHD diagnostic scale and consider an ADHD medication.

 

Consult with a child psychiatrist to prescribe an antidepressant medication.

 

Reassure the parent that this behavior is common after mild depressive symptoms

 

Refer the child to a child psychiatrist for evaluation of bipolar disorder.

 

 

 

 

A toddler has begun hitting and biting other children at a day care center and is

 

exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do?

 

Advise the parent that the child is exhibiting early symptoms of ADHD.

 

 

ID: 13348419838

Engage the parent in positive parenting strategies to facilitate appropriate child coping.

 

Recommend evaluating the child for conduct or oppositional defiant disorder.

 

Suggest putting the child in another day care center to ameliorate the problems.

 

 

 

 

A 14­year­old female comes to the clinic with amenorrhea for 3 months. A

 

pregnancy test is negative. The adolescent’s body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect?

 

Anorexia nervosa

 

Bulimia nervosa

 

Depression

 

Substance abuse

 

=

 

Chapter   20

 

 

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ID: 13348413832

 

ID: 13348413834

Questions

 

 

A child who has attention­deficit/hyperactivity disorder (ADHD) has difficulty

 

stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the self­regulation component of

 

emotional control.

 

flexibility.

 

inhibition.

 

problem­solving.

 

 

 

 

The primary care pediatric nurse practitioner cares for a preschool­age child

 

who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. This child most likely has a disorder of

 

 

executive function.

 

information processing.

 

sensory processing.

 

social cognition.

 

 

 

 

The primary care pediatric nurse practitioner uses the Neurodevelopmental

 

Learning Framework to assess cognition and learning in an adolescent. When evaluating

 

social cognition, the nurse practitioner will ask the adolescent

 

about friends and activities at school.

 

if balancing sports and homework is difficult.

 

to interpret material from a pie chart.

 

to restate the content of something just read.

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a school­age child

 

who has been diagnosed with ADHD. Which plan will the nurse practitioner recommend asking the child’s school about to help with academic performance?

 

504

 

FAPE

 

IDEA

 

IEP

 

 

 

 

 

The parent of a child diagnosed with ADHD tells the primary care pediatric ID: 13348413844

 

 

ID: 13348413846

 

ID: 13348413828

 

ID: 13348413824

 

ID: 13348413826

nurse practitioner that the child gets overwhelmed by homework assignments, doesn’t seem to know which ones to do first, and then doesn’t do any assignments. The nurse practitioner

 

tells the parent that this represents impairment in which executive function? A.   Activation

Effort

 

Emotion

 

Focus

 

 

 

 

The primary care pediatric nurse practitioner is considering medication

 

options for a school­age child recently diagnosed with ADHD who has a primarily hyperactive

 

presentation. Which medication will the nurse practitioner select initially? A.   Low­dose stimulant

Moderate­dose stimulant

 

Low­dose non­stimulant

 

Moderate­dose non­stimulant

 

 

 

 

The parent of a 4­year­old child reports that the child gets upset when the

 

hall light is left on at night and won’t leave the house unless both shoes are tied equally tight. The primary care pediatric nurse practitioner recognizes that this child likely has which type of

 

sensory processing disorder? A.   Dyspraxia

Over­responder

 

Sensory seeker

 

Under­responder

 

 

 

 

The parent of a preschool­age child who is diagnosed with a sensory

 

processing disorder (SPD) asks the primary care pediatric nurse practitioner how to help the

 

child manage the symptoms. What will the nurse practitioner recommend?

 

Establishing a reward system for acceptable behaviors

 

Introducing the child to a variety of new experiences

 

Maintaining predictable routines as much as possible D.   Providing frequent contact, such as hugs and cuddling

 

 

The primary care pediatric nurse practitioner is performing an examination on

 

a 5­year­old child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the nurse practitioner do first?

 

Administer an M­CHAT screen to screen the child for communication and

 

 

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ID: 13348413836

 

ID: 13348413830

socialization delays.

 

Ask the parent to describe the child’s earlier behaviors from infancy through preschool.

 

Reassure the parent that if symptoms weren’t present earlier, the likelihood of autism is low.

 

Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management.

 

 

 

The primary care pediatric nurse practitioner is examining a 3­year­old child

 

who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the nurse practitioner suspect?

 

 

Attention­deficit/hyperactivity disorder

 

 

Autism spectrum disorder

 

 

 

 

 

Executive function disorder

 

Sensory processing disorder

 

 

 

 

The primary care pediatric nurse practitioner is selecting a medication for a

 

12­year­old child who is newly diagnosed with ADHD. The child is overweight, has a history of an atrial septal defect at birth, and reports mild shortness of breath during exercise. What will the nurse practitioner prescribe?

 

 

A low­dose stimulant medication

 

A non­stimulant medication

 

Behavioral therapy only

 

Cardiovascular pre­screening

 

 

 

 

The primary care pediatric nurse practitioner is conducting a follow­up

 

examination on a child who has recently begun taking a low­dose stimulant medication to treat ADHD. The child’s school performance and home behaviors have improved. The child’s parent reports noticing a few tics, such a twitching of the eyelids, but the child is unaware of them and isn’t bothered by them. What will the nurse practitioner recommend?

 

Adding an alpha­agonist medication

 

Changing to a non­stimulant medication

 

Continuing the medication as prescribed

 

Stopping the medication immediately

 

 

 

 

===================

 

 

 

Chapter   21

 

 

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ID: 13348425786

Questions

 

 

The primary care pediatric nurse practitioner uses a shared decision­making

 

(SDM) model when working with families of children with chronic health conditions. When using this

 

model, the nurse practitioner can expect

 

considerably more time in each encounter.

 

improved patient health outcomes.

 

less PNP involvement in health care decisions.

 

lower provider and higher patient satisfaction.

 

 

 

 

The primary care pediatric nurse practitioner diagnoses a 5­year­old child with

 

asthma and prescribes an oral steroid and a short­acting beta­adrenergic medication via a metered­dose inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child’s family at this visit?

 

 

An asthma action plan

 

 

Effects and side effects of current medications

 

 

 

 

 

 

Information about spirometry testing

 

Instructions for medications at school

 

 

 

 

The parent of a child with complex health care needs tells the primary care

 

pediatric nurse practitioner that the child has had difficulty breathing the past two nights but can’t articulate specific symptoms. The child has normal oxygen saturations and a normal respiratory rate with clear breath sounds. What will the nurse practitioner do?

 

Admit the child to the hospital for close observation and monitoring of respiratory status.

 

Encourage the parent to call when concerned and schedule a follow­up appointment the next day.

 

Perform a complete blood count, blood cultures, and a chest radiograph to evaluate symptoms.

 

Reassure the parent that the child has a normal exam and is most likely not ill.

 

 

 

 

Which characteristic is the key criterion that identifies a child has having special ID: 13348425780

needs?

Cognitive function

Emotional health

Health service requirements

Medical diagnosis

 

 

 

ID: 13348425792

 

ID: 13348425766

 

ID: 13348425790

 

ID: 13348425774

The primary care pediatric nurse practitioner is performing a well baby

 

examination on a 2­week­old infant who was recently discharged home from the neonatal intensive care unit. The mother reports that the infant was born at 26 weeks’ gestation and states she was told that her baby will probably have developmental delays. What is the most important aspect of long­term management for this infant?

 

 

Careful monitoring of attainment of developmental milestones

 

Familiarizing the parent with laws that mandate educational support

 

Providing genetic counseling to the infant’s parents

 

Referral to social services for assistance with resources

 

 

 

 

The primary care pediatric nurse practitioner is preparing to perform a well child

 

examination on a 5­year­old child who has multiple developmental and cognitive delays. The child’s mother is angry and tells the nurse practitioner that her friends’ children are all preparing for kindergarten. The nurse practitioner will

 

allow the mother to express her feelings, understanding that she is experiencing grief.

 

reassure the mother that special educational opportunities are available for her child.

 

suggest that the mother find a support group with other children with special needs.

 

tell her that most schools provide services for children with special health care needs.

 

 

 

 

The parent of a toddler who has special health care needs is resistant to a

 

suggestion that her child needs a gastrostomy tube for nutrition. The toddler has fallen from the 10th percentile to the 5th percentile in the past few months and resists taking in appropriate amounts of food by mouth even with assistance from occupational therapy. What will the primary care pediatric nurse practitioner do?

 

Inform the mother that, since other options have failed, the gastrostomy tube is the only option.

 

Refer the child to a dietician to teach the mother the importance of adequate nutrition.

 

Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight.

 

Suggest that the gastrostomy tube may be tried temporarily and removed once the child gains weight.

 

 

 

What is the most important role of the primary care pediatric nurse practitioner

 

who provides care for a child with special health care needs who sees several specialists and receives community and school­based services?

 

Assessing the parent’s ability to perform home care tasks

Coordinating services to ensure continuity of care

Monitoring the family’s adherence to the health care plan

 

 

 

ID: 13348425788

 

ID: 13348425784

 

ID: 13348425772

 

ID: 13348425776

Ordering medications and other prescribed treatments

 

 

 

 

A toddler swallowed a coin several days prior. The child’s parent has not found

 

the coin in the child’s stool. Which imaging test will the primary care pediatric nurse practitioner

 

employ to evaluate this ingestion?

 

Abdominal ultrasound

 

Computed tomography

 

Conventional radiograph

 

Magnetic resonance imaging

 

 

 

 

The primary care pediatric nurse practitioner is assessing an ill 2­month­old infant

 

who is febrile and refusing most fluids. The preliminary blood work indicates a viral infection and shows that the infant is hydrated. The infant is alert. The infant’s parents are attentive and live close by. What will the nurse practitioner do?

 

Administer a parenteral antibiotic and antipyretic and send the infant home.

 

Admit the infant to an inpatient hospital unit for overnight monitoring.

 

Give the parents sick care instructions and follow up in the clinic in the morning.

 

Send the infant to the urgent care center for intravenous fluids.

 

 

 

 

A toddler is prescribed a liquid oral medication. The parent tells the primary care

 

pediatric nurse practitioner that the child refuses to take medications and usually spits them out. What will the nurse practitioner do?

 

Demonstrate oral medication administration with the toddler in the office.

 

Instruct the parent to hide the medication in a favorite food or beverage.

 

Order the medication to be given via another route if possible.

 

Tell the parent to offer the child a reward each time the medication is taken.

 

 

 

 

The primary care pediatric nurse practitioner orders a pulmonology consult for a

 

child who has severe asthma. The nurse practitioner writes “child with asthma refractory to conventional treatments needs suggestions for alternative treatments.” The nurse practitioner expects the pulmonologist to

 

confirm the medical diagnosis for the child’s parents.

 

make recommendations for disease management.

 

stress the importance of adherence to the medication regimen.

 

take over management of this child’s chronic illness.

 

 

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The primary care pediatric nurse practitioner cares for several families with

 

chronically ill children who text status updates about their children to a mobile device that has an encryption­ protection platform installed. If the nurse practitioner misplaces the mobile device, it is important to

 

 

disconnect the user from the system to avoid a data breach.

 

notify the families that their messages may be read by others.

 

obtain a new device as soon as possible to resume communication.

 

upload the messages from another remote device.

 

 

 

 

The parent of an 18­month­old child calls the clinic to report that the child has a

 

rectal temperature of 100.4°F (38°C). The child is playing normally, taking fluids well, and has a slightly reduced appetite. What will the primary care pediatric nurse practitioner recommend?

 

Administering an antipyretic medication

 

Bringing the child to the clinic for evaluation

 

Offering extra fluids and calling if symptoms change D.   Ordering outpatient lab work such as a CBC

 

 

 

The parent of a preschool­age child calls the clinic to report that the child has

 

clear, watery drainage from both eyes, mild erythema of the conjunctiva, and no fever or other

 

symptoms. What will the primary care pediatric nurse practitioner recommend?

 

Allow the child to go to preschool.

 

Bring the child to the clinic for a culture.

 

Keep the child home for 2 days.

 

Use antibiotic eyedrops for 3 days..

 

 

 

 

A parent brings a 4­month­old infant to the clinic who has had a low­grade fever

 

for 24 hours. The primary care nurse practitioner notes that the infant has a weak cry, slightly dry oral mucosa, mottled skin, and a respiratory rate of 65 breaths per minute and sleeps unless stimulated by the examiner,. What will the nurse practitioner do?

 

Administer oral fluids in the clinic.

 

Admit the infant to the hospital.

 

Order outpatient laboratory tests.

 

Send the infant home with close follow­up.

 

==

 

Chapter   22

 

 

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Questions

 

 

A pharmaceutical company has developed a new drug that was tested only

 

on adults. The FDA has declared this drug to have potential benefits for ill children. According to the Pediatric Research Equity Act (PREA), what may the pharmaceutical company be required to do?

 

Conduct pediatric drug studies to determine whether the drug is safe and effective in children.

 

Provide labeling stating that the safety and efficacy of the drug is not established for children.

 

Receive a patent extension for conducting pediatric studies to determine use in children.

 

Survey existing data about the drug to determine potential use in the pediatric population.

 

 

 

The primary care pediatric nurse practitioner prescribes a new medication for

 

a child who develops a previously unknown adverse reaction. To report this, the nurse

 

practitioner will

 

access the BPCA website.

 

call the PREA hotline.

 

log onto the FDA Medwatch website.

 

use the AAP online PediaLink program.

 

 

 

 

The primary care pediatric nurse practitioner is considering use of a relatively

 

new drug for a 15­month­old child. The drug is metabolized by the liver, so the nurse

 

practitioner will consult a pharmacologist to discuss giving the drug:

 

less often or at a lower dose.

 

more often or at a higher dose.

 

via a parenteral route.

 

via the oral route.

 

 

 

 

The primary care pediatric nurse practitioner is considering using a drug for

 

an “off­label” use in a child. The nurse practitioner has used the drug in a similar situation previously, has consulted a pharmacology resource and the FDA website, and has determined that there are no significant contraindications and warnings for this child. What else must the nurse practitioner do when prescribing this drug?

 

Discuss recommendations with the parents and document their consent.

 

Document anecdotal reports of previous use of the drug by other providers.

 

 

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Follow up daily with the parents to determine safe administration of the drug.

 

Report this use to the FDA Medwatch website for tracking purposes.

 

 

 

 

The primary care pediatric nurse practitioner is counseling an adolescent

 

who was recently hospitalized for an asthma exacerbation and learns that the child usually forgets to use twice­ daily inhaled corticosteroid medications that are supposed to be given at 0800 and 2000 each day. Which strategy may be useful in this case to improve adherence?

 

Ask the adolescent to identify two times each day that may work better.

 

Consider having the school nurse supervise medication administration.

 

Prescribing a daily oral corticosteroid medication instead.

 

Suggest that the parent enforce the medication regimen each day.

 

 

 

 

The primary care pediatric nurse practitioner is treating a toddler who has a

 

lower respiratory tract illness with a low­grade fever. The child is eating and taking fluids well and has normal oxygen saturations in the clinic. The nurse practitioner suspects that the child has a viral pneumonia and will

 

order an anti­viral medication and schedule a follow­up appointment.

 

prescribe a broad­spectrum antibiotic until the lab results are received.

 

teach the parents symptomatic care and order labs to help with the diagnosis.

 

write a prescription for an antibiotic to be given if the child’s condition worsens.

 

 

 

 

The single mother of a 4­year­old who attends day care tells the primary care

 

pediatric nurse practitioner that she had difficulty giving her child a twice­daily amoxicillin for 10 days to treat otitis media during a previous episode several months earlier because she works two jobs and is too busy. The child has an ear infection in the clinic today. What will the nurse practitioner do?

 

 

Administer an intramuscular antibiotic.

 

Order twice­daily amoxicillin for 5 days.

 

Prescribe azithromycin once daily for 5 days.

 

Reinforce the need to adhere to the plan of care.

 

 

 

 

The parent of a school­age child who has asthma tells the primary care

 

pediatric nurse practitioner that the child often comes home from school with severe wheezing after gym class and needs to use his metered­dose inhaler right away. What will the nurse practitioner do?

 

Recommend that the child go to the school nurse when symptoms start.

 

Review the child’s asthma action plan and possibly increase his steroid dose.

 

Suggest asking the school to excuse the child from gym class.

 

Write the prescription for two metered­dose inhalers with spacers.

 

 

 

 

 

Chapter   23

 

 

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Questions

 

 

The primary care pediatric nurse practitioner is evaluating a 10­year­old child

 

who is describing shooting pain in both legs associated with aching, tingling, and burning. The child is unable to pinpoint specific locations for this pain. Which type of pain does the nurse

 

practitioner suspect? A.   Chronic pain

Neuropathic pain

 

Somatic pain

 

Visceral pain

 

 

 

 

A 3­year­old child is recovering from injuries sustained in a motor vehicle

 

accident. How will the primary care pediatric nurse practitioner evaluate this child’s pain?

 

Ask the child to rate pain intensity on a 4­ to 5­item pain discrimination scale.

 

Have the child describe any pain as “no pain, a little pain, or a lot of pain.”

 

Question the child about the intensity and specific location of any pain.

 

Rely on nonverbal responses such as facial expressions and limb movements.

 

 

 

 

A 4­year­old child has just been released from the hospital after orthopedic

 

surgery on one leg following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate pain, the child points to the “1” on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next?

 

Assess the child’s vital signs and ability to walk without pain.

 

Refill the prescription for a narcotic analgesic medication.

 

Suggest that the parents give acetaminophen for mild pain.

 

Teach the parent to give analgesics based on the child’s report of pain.

 

 

 

 

A developmentally and cognitively disabled 10­year­old child who is unable to

 

communicate must undergo a series of surgeries, and the child’s parent asks how to know if the child is in pain and when to give pain medication. What will the primary care pediatric nurse practitioner teach this parent to use to assess this child’s pain?

 

Comfort scale

 

FLACC scale

 

NCCPC­R

 

Non­verbal observations

 

 

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ID: 13348428733 hours doesn’t

 

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The primary care pediatric nurse practitioner is preparing to perform a painful

 

procedure on a 4­month­old infant. Besides providing local anesthesia, what other pain control

 

method provides analgesic effects?

 

Providing toys

 

Singing or music

 

Sucrose solution

 

Swaddling or cuddling

 

 

 

 

An adolescent female reports moderate dysmenorrhea with periods and tells the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 completely control her pain. What will the nurse practitioner recommend?

 

Increasing the ibuprofen dose to 600 to 800 mg every 6 to 8 hours

 

Taking extra­strength acetaminophen 1000 mg every 4 to 6 hours

 

Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours D. Using extended­release naproxen 500 mg every 12 hours

 

 

 

What is the most important dose­limiting factor when prescribing acetaminophen with hydrocodone?

 

Acetaminophen dose

 

Gastrointestinal side effects

 

Pruritis symptoms

 

Urinary retention

 

 

 

 

An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant

 

(TCA) to treat phantom limb pain and reports that the medications are no longer effective.

 

What will the primary care pediatric nurse practitioner do?

 

Change the TCA to a selective serotonin reuptake inhibitor.

 

Evaluate the adolescent for drug­seeking behavior.

 

Increase the TCA dose and reevaluate in 2 to 3 weeks.

 

Refer the adolescent to a pain management specialist.

 

 

 

 

The parent of a school­age child with a chronic pain condition tells the

 

primary care pediatric nurse practitioner that the child has requested to stay home from school more often in the past few months. The child’s exam does not reveal any significant change in pathology, and a review of the child’s medications indicates appropriate dosing of analgesic medications. What will the nurse practitioner recommend?

 

Assessing the child’s pain every day to determine changes

 

B.

 

C.

 

Ensuring the child stays quiet in bed with videos when having pain

 

Having the child do homework when staying home from school

 

 

Requiring the child to go to school even during pain episodes

 

 

 

 

 

 

Chapter   24

 

 

 

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Questions

 

 

A 2­month­old infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis?

 

Day care attendance

 

Immunization history

 

Medication history

 

Past medical history

 

 

 

 

When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated?

 

Bands

 

Leukocytes

 

Lymphocytes

 

 

Neutrophils

 

 

 

 

Which lab value is most concerning in an infant with fever and a suspected bacterial infection?

 

C­reactive protein of 11.5 mg/L

 

Lymphocyte count of 8.7

 

Platelet count of 475

 

White blood cell count of 14

 

 

 

 

A toddler is receiving long­term antibiotics to treat osteomyelitis. Which laboratory

 

test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child?

 

Blood cultures

 

Erythrocyte sedimentation rate (ESR)

 

Serum procalcitonin (Pro­CT)

 

White blood count (WBC)

 

 

 

 

According to recent research, which populations may have higher rates of under­ ID: 13348428779 immunization than others?

 

Those with higher rates of Asians

Those with higher rates of graduate degrees

Those with lower rates of poverty

 

 

 

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ID: 13348428777 primary care

 

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Those with lower rates of primary providers

 

 

 

 

The parent of a 2­month­old infant is reluctant to have the baby vaccinated. What ID: 13348428749 is an initial step in responding to these concerns?

 

Inform the parent that all vaccines may be given without thimerosol.

 

Providing Vaccine Information Statements for the parent to review.

 

Question the parent’s reasons for concern about immunizations.

 

Remind the parent that the infant is exposed to thousands of germs each day.

 

 

 

 

A parent is concerned about vaccine adverse reactions. Based on an Institute of

 

Medicine report, what will the primary care pediatric nurse practitioner tell the parent?

 

Administering multiple vaccines may trigger the development of type 1 diabetes.

 

The MMR may be linked to febrile seizures in immunocompromised children.

 

There is some risk of CNS disorders associated with the hepatitis B vaccine.

 

Vaccines containing thimerosol are linked to pervasive developmental disorders.

 

 

 

 

A 2­month­old infant will receive initial immunizations, and the parent asks about giving medications to increase the infant’s comfort and minimize fever. What will the pediatric nurse practitioner recommend?

 

Administering ibuprofen or acetaminophen as needed

 

Avoiding antipyretics if possible to attain better immunity

 

Giving ibuprofen and acetaminophen only after the vaccines

 

Pre­treating the infant with both ibuprofen and acetaminophen

 

 

 

 

The parent of an infant asks why some vaccines, such as MMR, are not given

 

along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary

 

care pediatric nurse practitioner tell this parent?

 

Febrile seizures are more likely in younger infants with some vaccines.

 

Maternal antibodies neutralize some vaccines and are delayed until 12 months.

 

The risk of adverse effects is lower for some vaccines after the first year.

 

Too many vaccines at once can overwhelm the infant’s immune system.

 

 

 

 

The primary care pediatric nurse practitioner is performing an initial well child

 

exam on a 3­year­old child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do?

 

 

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Administer a booster dose of each vaccine to ensure immunity.

 

Find out whether the vaccines were provided by reliable suppliers.

 

Perform antibody titers and reimmunize the child.

 

Record the vaccines in the child’s electronic medical record.

 

 

 

 

The primary care pediatric nurse practitioner reviews the immunization records of

 

an 18­month­old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do?

 

Administer a reduced dose of MMR to ensure adequate immunity.

 

Obtain mumps, measles, and rubella titers to determine immunity.

 

Recommend the next dose of MMR vaccine at 4 to 5 years of age.

 

Repeat the MMR vaccine since the first dose was given too soon

 

 

 

 

A 5­year­old child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given?

 

DTaP

 

 

DTP

 

Td

 

Tdap

 

 

 

 

An adolescent female who is sexually active and who has not had the HPV

 

vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her?

 

Getting the vaccine now will still protect her from HPV oncogenic types even if already exposed

 

Receiving the HPV vaccine series will replace the need for regular cervical cancer screening

 

She will need to have Papanicolaou and pregnancy screening prior to receiving the vaccine

 

The vaccine will not protect her from any HPV oncogenic types acquired

 

previously

 

 

 

 

An 18­month­old child has bronchopulmonary dysplasia. To help prevent ID: 13348428761

pneumococcal disease, which vaccine will be ordered?

PCV7

PCV13

 

 

PCV23

 

PCV33

 

 

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ID: 13348428767

 

ID: 13348428737

 

ID: 13348428741

 

ID: 13348431601

A 5­year­old child who received VariZIG after exposure to varicella while

 

immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child?

 

 

MMR and Tdap

 

 

MMR, Varivax, Tdap

 

 

 

 

 

Tdap only

 

Varivax and Tdap

 

 

 

 

A 3­year­old child who attends day care has had a fever, nausea, and vomiting

 

several weeks prior and now has darkened urine and constipation along with hepatomegaly and

 

right upper quadrant tenderness. What treatment is warranted for this child?

 

HAV vaccine

 

Immunoglobulin G

 

Interferon­alfa

 

Supportive care

 

 

 

 

A 10­month­old infant who is new to the clinic has chronic hepatitis B infection.

 

What will the primary care pediatric nurse practitioner do to manage this infant’s disease?

 

Consult a pediatric infectious disease specialist.

 

Prescribe interferon­alfa.

 

Provide supportive care.

 

Consider use of lamivudine.

 

 

 

 

The primary care pediatric nurse practitioner performs a well child examination on

 

a 1­month­old. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care?

 

 

Obtain regular absolute neutrophil counts.

 

Perform routine skin cultures for herpes simplex virus.

 

Reinforce the need to give acyclovir indefinitely.

 

Stop the oral acyclovir at 2 months of age.

 

 

 

 

A 9­month­old infant has had a fever of 103°F for 2 days and now has a diffuse,

 

maculopapular rash that blanches on pressure. The infant’s immunizations are up­to­date. What will the primary care pediatric nurse practitioner do?

 

 

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Administer immunoglobulin G to prevent fulminant illness.

 

Perform serologic testing for human herpes virus ­6 and human herpes virus ­7.

 

Reassure the parent that this is a mild, self­limiting disease.

 

Recommend avoiding contact with pregnant women.

 

 

 

 

A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do?

 

Administer varicella immune globulin (VariZIG).

 

Hospitalize the child for intravenous acyclovir.

 

Order intravenous immunoglobulin as an outpatient.

 

Prescribe oral acyclovir for the duration of the illness.

 

 

 

 

A child whose parents have refused vaccines has been exposed to chickenpox,

 

and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them?

 

The child may attend day care as long as no rash is present even with mild fever or other symptoms.

 

The child should remain home and receive oral acyclovir for 5 days to prevent onset of symptoms.

 

The child should stay home until the 21­day incubation period has passed even if symptom free.

 

The child should stay home if any symptoms occur and may return in 1 week if no rash develops.

 

 

 

An 18­month­old child who developed upper respiratory symptoms 1 day prior is

 

brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?

 

 

Consider therapy with rimantadine.

 

Hospitalize for supportive treatment.

 

Prescribe oseltamivir and follow closely D.   Wait for cultures to determine treatment.

 

 

The primary care pediatric nurse practitioner is reviewing medical records for a

 

newborn that is new to the clinic. The toddler’s mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti­retroviral prophylaxis, and did not breastfeed. What is the  management for this child?

 

 

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Consult with a pediatric HIV specialist.

 

Discontinue cART after 4 weeks of age.

 

Obtain a CD4+ cell count and HIV RNA levels.

 

Reinforce the need to give cART for life.

 

 

 

 

A 3­year­old child whose immunizations are up­to­date has been exposed to

 

measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?

 

Administer the MMR vaccine to help prevent disease.

 

Give antiviral medications at the first sign of symptoms.

 

Give the child a dose of immune globulin to mitigate the response.

 

Reassure the parent that most exposed children will not get measles.

 

 

 

 

A preschool­age child is brought to clinic for evaluation of a rash. The primary ID: 13348428773

 

care pediatric nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?

 

This rash may be a prodromal sign of rubella or roseola.

 

The child will need immunization boosters to prevent serious disease.

 

This is a benign rash with no known serious complications.

 

Expect a lacy, maculopapular rash to develop on the trunk and extremities.

 

 

 

 

An unimmunized school­age child whose mother is in her first trimester of

 

pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric

 

nurse practitioner recommend?

 

Assessment of maternal rubella titers

 

Intravenous immunoglobulin for the child

 

MMR vaccine for the mother and child

 

Possible termination of the pregnancy

 

 

 

 

A child is brought to the clinic with a fever, headache, malaise, and a red, annular

 

macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?

 

Ask about recent tick bites

 

Obtain a skin culture

 

Order blood cultures

 

 

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ID: 13348428743

 

ID: 13348428769 verify the type best course of

Perform serologic testing

 

 

 

 

A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action?

 

Administer a prophylactic single dose of doxycycline.

 

Perform serologic testing for IgG or IgM antibodies.

 

Prescribe amoxicillin three times daily for 14 to 21 days.

 

Teach the parents which signs and symptoms to report.

 

 

 

 

A 10­month­old infant has an erythematous, fluctuant, non­draining abscess on

 

the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in

 

managing this infant’s care?

 

Consultation with a pediatric infectious disease specialist

 

Culture of any superficial open surface wounds

 

Empiric treatment with clindamycin

 

Incision and drainage of the abscess with culture

 

 

 

 

A child with a history of a pustular rash at the site of a cat scratch on one arm now

 

has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do?

 

Obtain a complete blood count and C­reactive protein.

 

Order an immunofluorescent assay (IFA) for serum antibodies.

 

Perform a needle aspiration of the affected lymph nodes.

 

Prescribe a 5­day course of azithromycin.

 

 

 

 

A 7­year­old child whose immunizations are up­to­date has a fever, headache, ID: 13348431603

stiff neck, and photophobia. What course of treatment is indicated?

Empiric treatment with oral antibiotics or intramuscular ceftriaxone

Hospitalization for diagnosis and treatment with antibiotics

 

 

Immediate vaccination with meningococcal vaccine

 

Outpatient lab work, including a CBC and blood and CSF cultures

 

 

 

 

A school­age child has fever of 104°F, sore throat, vomiting and malaise. The ID: 13348428789

 

primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are

 

 

ID: 13348428753

erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper­like rash on the child’s neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness?

 

 

Administer intramuscular ceftriaxone.

 

Hospitalize for further diagnostic tests.

 

Prescribe oral amoxicillin.

 

Refer to a pediatric infectious disease specialist.

 

 

 

 

An adolescent has a TB skin test prior to working as a volunteer in a hospital. The

 

adolescent is healthy and has not travelled to or from a TB­endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do?

 

Ask the adolescent about exposure to homeless persons.

 

Order a chest radiograph to rule out active TB.

 

Reassure the adolescent that this is a negative screen.

 

Refer the adolescent to an infectious disease specialist.

 

 

 

 

The primary care pediatric nurse practitioner is examining a 2­month­old infant ID: 13348428775

with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?

 

Admitting the infant to the hospital for LP and IV antibiotics

 

Obtaining a blood culture, erythrocyte sedimentation rate, and C­reactive protein

 

Performing a catheterized urinalysis to screen for leukocytes and nitrites D.   Prescribing empiric, broad­spectrum antibiotics with close follow­up

 

Chapter   25

 

 

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Questions

 

 

An 8­year­old child is diagnosed with systemic lupus erythematosus (SLE), and

 

the child’s parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell

 

the parent?

 

Complete remission occurs in some children at the age of puberty.

 

Periods of remission may occur but there is no permanent cure.

 

SLE can be cured with effective medication and treatment.

 

The disease is always progressive with no cure and no remissions.

 

 

 

 

The primary care pediatric nurse practitioner examines a child who has had

 

stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse

 

practitioner will refer the child to a rheumatology specialist to evaluate for

 

enthesitis­related JIA.

 

oligoarticular JIA.

 

polyarticular JIA.

 

systemic JIA.

 

 

 

 

The primary care pediatric nurse practitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child?

 

Cardiology

 

Ophthalmology

 

Orthopedics

 

Pain management

 

 

 

 

The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg

 

child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum

 

amount the child will receive per dose? A.   200 mg

250 mg

 

400 mg

 

450 mg

 

 

 

 

The parent of a school­age child who is diagnosed with oligoarticular JIA asks the

 

primary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend?

 

Running

 

 

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Swimming

 

Weights

 

Yoga

 

 

 

 

A 12­year­old child is brought to the clinic with joint pain, a 3­week history of low­

 

grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive.

 

Which test may be ordered to confirm a diagnosis of SLE? A.   Anti­double­strand DNA antibodies

Anti­La antibodies

 

Anti­Ro antibodies

 

Anti­Sm antibodies

 

 

 

 

The primary care pediatric nurse practitioner is reviewing the rheumatology plan

 

of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes?

 

Have the child rest between activities.

 

Obtain regular ophthalmology exams.

 

Participate in low­impact exercises.

 

Use UVA and UVB sunscreen daily.

 

 

 

 

An adolescent female reports poor sleep, fatigue, muscle and joint paint, and

 

anxiety lasting for several months. The primary care pediatric nurse practitioner notes point

 

tenderness at several sites. What will the nurse practitioner do next?

 

Evaluate the adolescent’s pain using a numeric pain scale.

 

Obtain ANA, CBC, liver function, and muscle enzymes tests.

 

Reassure the adolescent that this condition is not life­threatening.

 

Refer the adolescent to a rheumatologist for further evaluation.

 

 

 

 

A child has a fever and arthralgia. The primary care pediatric nurse practitioner

 

learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order?

 

Anti­DNase B test

 

ASO titer

 

Rapid strep test

 

Throat culture

 

 

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The primary care pediatric nurse practitioner sees a child for follow­up care after

 

hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child?

 

Aspirin is given for 2 weeks and then tapered to discontinue the medication.

 

Prophylactic amoxicillin will need to be given for 5 years.

 

Steroids will be necessary to prevent development of heart disease.

 

The child will need complete bedrest until all symptoms subside.

 

 

 

 

An 8­year­old boy has a recent history of an upper respiratory infection and

 

comes to the clinic with a maculopapular rash on his lower extremities and swelling and tenderness in both ankles. The pediatric nurse practitioner performs a UA, which shows proteinuria and hematuria and diagnoses HSP. What ongoing evaluation will the nurse practitioner perform

 

during the course of this disease? A.   ANA titers

Blood pressure measurement

 

Chest radiographs

 

Liver function studies

 

 

 

 

A 10­year­old child has a 1­week history of fever of 104°C that is unresponsive to

 

antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do?

 

Begin treatment with intravenous methyl prednisone.

 

Consider IVIG therapy if symptoms persist one more week.

 

Order a baseline echocardiogram today and another in 2 weeks.

 

Reassure the child’s parents that this is a self­limiting disorder.

 

 

 

 

The primary care pediatric nurse practitioner is evaluating an 11­month­old infant

 

who has had three viral respiratory illnesses causing bronchiolitis. The child’s parents both have seasonal allergies and ask whether the infant may have asthma. What will the nurse practitioner tell the parents?

 

“Although it is likely, based on family history, it is too soon to tell.”

 

“There is little reason to suspect that your infant has asthma.”

 

“With your infant’s history of bronchiolitis, asthma is very likely.”

 

“Your infant has definitive symptoms consistent with a diagnosis of asthma.”

 

 

 

 

The primary care pediatric nurse practitioner is examining a school­age child who ID: 13348419870 has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has

 

 

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several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered­dose inhaler. What will the nurse practitioner order?

 

 

Allergy testing

 

Chest radiography

 

Spirometry testing

 

Sweat chloride test

 

 

 

 

A school­age child who uses a SABA and an inhaled corticosteroid medication is

 

seen in the clinic for an acute asthma exacerbation. After 4 puffs of an inhaled short­acting B2­ agonist (SABA) every 20 minutes for three treatments, spirometry testing shows an FEV1 of 60% of the child’s personal best. What will the primary care pediatric nurse practitioner do next?

 

Administer an oral corticosteroid and repeat the three treatments of the inhaled SABA.

 

Admit the child to the hospital for every 2 hour inhaled SABA and intravenous steroids.

 

Give the child 2 mg/kg of an oral corticosteroid and have the child taken to the emergency department.

 

Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow

 

closely.

 

 

 

 

A child who has been diagnosed with asthma for several years has been using a

 

short­acting B2­agonist (SABA) to control symptoms. The primary care pediatric nurse practitioner learns that the child has recently begun using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of

 

75% of personal best. What will the nurse practitioner do next?

 

Add a daily inhaled corticosteroid.

 

Administer 3 SABA treatments.

 

Continue the current treatment.

 

Order an oral corticosteroid.

 

 

 

 

An adolescent who has asthma and severe perennial allergies has poor asthma

 

control in spite of appropriate use of a SABA and a daily high­dose inhaled corticosteroid. What will the primary care pediatric nurse practitioner do next to manage this child’s asthma?

 

Consider daily oral corticosteroid administration.

 

Order an anticholinergic medication in conjunction with the current regimen.

 

Prescribe a LABA/inhaled corticosteroid combination medication.

 

Refer to a pulmonologist for omalizumab therapy.

 

 

 

 

An adolescent who has exercise­induced asthma (EIA) is on the high school track ID: 13348419888 team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs

 

 

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of albuterol via a metered­dose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do?

 

 

Counsel the adolescent to decrease the number of practices each week.

 

Increase the albuterol to 4 puffs 20 minutes prior to exercise.

 

Order a daily inhaled corticosteroid medication.

 

Prescribe cromolyn sodium in addition to the albuterol.

 

 

 

 

A school­age child with asthma is seen for a well child checkup and, in spite of

 

“feeling fine,” has pronounced expiratory wheezes, decreased breath sounds, and an FEV1less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child’s parent administers the daily medium­dose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child’s status. What will the nurse practitioner do?

 

 

Have the parent administer all of the child’s medications.

 

Increase the ICS medication to a high­dose preparation.

 

Reinforce teaching about the importance of using the SABA.

 

Teach the child and parent how to use home PEF monitoring.

 

 

 

 

The parent of a school­age child reports that the child usually has allergic rhinitis

 

symptoms beginning each fall and that non­sedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the primary care pediatric nurse practitioner do?

 

Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season.

 

Prescribe a decongestant medication as adjunct therapy during pollen season.

 

Recommend adding diphenhydramine to the child’s regimen for additional relief.

 

Suggest using an over­the­counter intranasal decongestant.

 

 

 

 

A 4­month­old infant has a history of reddened, dry, itchy skin. The primary care ID: 13348419866

pediatric nurse practitioner notes fine papules on the extensor aspect of the infant’s arms, anterior

thighs, and lateral aspects of the cheeks. What is the initial treatment?

Moisturizers

 

 

Oral antihistamines

 

Topical corticosteroids

 

Wet wrap therapy

 

 

 

 

The primary care pediatric nurse practitioner is performing a well­baby checkup ID: 13348419886

 

on a 6­month­old infant and notes a candida diaper rash and oral thrush. The infant has had two

 

ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do?

 

Order a CBC with differential and platelets and quantitative immunoglobulins.

 

Order candida and pneumococcal skin tests and lymphocyte surface markers.

 

Refer the infant to an immunologist for evaluation of immunodeficiency.

 

Refer the infant to an otolaryngologist to evaluate recurrent otitis media.

 

 

Chapter   26

 

 

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Questions

 

 

The primary care pediatric nurse practitioner evaluates children’s growth to

 

screen for endocrine and metabolic disorders. Which is a critical component of this screening?

 

Measuring supine length in children over the age of 2 years

 

 

Obtaining serial measurements to assess patterns over time

 

 

 

 

 

Using the CDC growth chart for children under age 2 years

 

Using the WHO growth chart for children over age 2 years

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a 5­year­old girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5’8″ tall and the father is 5’11” tall. The nurse

 

practitioner will estimate which expected adult height for this child? A.   5’11” tall

5’7″ tall

 

5’8″ tall

 

6′ tall

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a 2­year­old child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?

 

 

Consider prescribing growth hormone therapy.

 

Reassure the parent that this is normal for this child.

 

Refer the child to a dietician for dietary supplementation.

 

Refer the child to a pediatric endocrinologist.

 

 

 

 

The primary care pediatric nurse practitioner is evaluating a child who has short

 

stature. Although bone age studies reveal a delay in bone age, the child’s growth is consistent with bone age. Which diagnosis is most likely?

 

Constitutional growth delay

 

Growth hormone deficiency

 

Idiopathic short stature

 

Klinefelter syndrome

 

 

 

 

The mother of a female infant is concerned that her daughter is developing ID: 13348411106

 

breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic

 

 

ID: 13348411104 mild

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or axillary hair. What is the likely diagnosis?

 

Congenital adrenal hyperplasia causing breast development

 

Precocious puberty needing endocrinology management

 

Premature adrenarche which will lead to pubic hair onset

 

Premature thelarche which will resolve over time

 

 

 

 

A 7­year­old female has recently developed pubic and axillary hair without breast

 

development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition?

 

 

Adrenal tumor

 

Congenital adrenal hyperplasia

 

Polycystic ovary syndrome

 

Type 1 diabetes mellitus

 

 

 

 

A 6­year­old female has had a recent growth spurt and an exam reveals breast

 

and pubic hair development. Her bone age is determined to be 8 years. What will the primary care

 

pediatric nurse practitioner do next?

 

Order LH and FSH levels and a long­acting GnRH agonist.

 

Order thyroid function tests to exclude primary hypothyroidism.

 

Reassure the parent that this is most likely idiopathic.

 

Refer the child to a pediatric endocrinologist for management.

 

 

 

 

An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and dehydration. Which action is ?

 

Administer an intramuscular stress dose of hydrocortisone succinate.

 

Administer intravenous fluids in the clinic and reassess hydration status.

 

Prescribe an oral hydrocortisone in a replacement dose of 8 to 10 mg/M2.

 

Refer the infant to the emergency department for fluids, dextrose, and steroids.

 

 

 

The primary care pediatric nurse practitioner performs a physical examination on

 

a 9­month­old infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant’s growth rate. What will the nurse practitioner order?

 

 

Free serum T4 and TSH levels

 

 

 

 

 

Serum levothyroxine level

 

 

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Total T4 and free T4 levels

 

TSH and total T4 levels

 

 

 

A 12­year­old child has a recent history of increased thirst and frequent urination. ID: 13348407688 The child’s weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child?

 

Fasting plasma glucose

 

Hemoglobin A1C levels

 

Pancreatic antibodies

 

Thyroid function tests

 

 

 

 

The primary care pediatric nurse practitioner diagnoses an 8­year­old child with

 

type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child’s weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is ?

 

 

Admit the child to the hospital for initial insulin management.

 

Begin insulin and refer the child to a children’s diabetes center.

 

Order a fasting serum glucose and a dipstick UA in the morning.

 

Send the child to the emergency department for fluids and IV insulin.

 

 

 

 

The primary care pediatric nurse practitioner is reviewing lab work and diabetes

 

management with a school­age child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child’s endocrinologist

 

to consider which therapy?

 

Continuous glucose monitoring

 

Continuous subcutaneous insulin infusion

 

Self­monitoring of blood glucose

 

Use of a long­acting insulin analogue

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a 12­year­old child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child?

 

Annual lipid profile evaluation

 

Annual screening for microalbuminuria

 

Comprehensive ophthalmologic exam D.   Hypothyroidism screening every 5 years

 

 

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A 13­year­old Native American female has a BMI at the 90th percentile for age.

 

The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet­like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will

 

counsel the child to lose weight to prevent type 2 diabetes.

 

diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL.

 

order a fasting blood sample for a metabolic screen for type 2 diabetes.

 

refer the child to a pediatric endocrinologist.

 

 

 

 

The primary care pediatric nurse practitioner prescribes metformin for a 15­year­

 

old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when

 

teaching the adolescent about this drug?

 

That insulin therapy will be necessary in the future

 

 

The importance of checking blood glucose 3 or 4 times daily

 

 

 

 

 

To consume a diet with foods that are high in vitamin B12

 

To use a stool softener to prevent gastrointestinal side effects

 

 

 

 

A 16­year­old adolescent female whose BMI is at the 90th percentile reports

 

irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis?

 

 

Dyslipidemia

 

Hypothyroidism

 

Nonalcoholic steatohepatitis

 

Polycystic ovary syndrome

 

 

 

 

The primary care pediatric nurse practitioner is providing nutritional counseling for

 

a 9­year­old female whose weight is at the 95th percentile for her age. What is the goal for this patient?

 

A loss of 10 to 15 pounds in 6 months

 

An average weight loss of 2 pounds per month

 

Maintenance of her current weight

 

Weight loss of 5% of her current body weight

 

 

 

 

The primary care pediatric nurse practitioner notes a musty odor when examining ID: 13348411102 a newborn at a 2­week checkup. What will the nurse practitioner suspect?

 

Galactosemia

 

Glucose­6­phosphatase deficiency

 

Phenylketonuria

 

Urea cycle disorder

 

 

 

 

An initial key part of management of a child suspected of having an inborn error ID: 13348407676

of metabolism is

consulting a metabolic specialist.

obtaining a complete family history.

ordering metabolic screening tests.

referring the family to a dietician.

 

 

Chapter   27

 

 

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Questions

 

 

The primary care pediatric nurse practitioner reviews a child’s complete blood

 

count with differential white blood cell values and recognizes a “left shift” because of

 

a decreased eosinophil count.

 

a decreased lymphocyte count.

 

an elevated monocyte count.

 

an elevated neutrophil count.

 

 

 

 

A complete blood count on a 12­month­old infant reveals microcytic, hypochromic

 

anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The

 

primary care pediatric nurse practitioner suspects

 

hereditary spherocytosis.

 

iron­deficiency anemia.

 

lead intoxication.

 

sickle­cell anemia.

 

 

 

 

The primary care pediatric nurse practitioner evaluates a 5­year­old child who

 

presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%.

 

How will the nurse practitioner manage this patient?

 

Prescribe elemental iron and recheck labs in 1 month.

 

Reassure the parent that this represents mild anemia.

 

Recommend a diet high in iron­rich foods.

 

Refer to a hematologist for further evaluation.

 

 

 

 

The primary care pediatric nurse practitioner is managing care for a child

 

diagnosed with iron­deficiency anemia who had an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3 mg/kg/day of elemental iron for 4 weeks. The child’s current lab work reveals elevations in Hgb/Hct and reticulocytes with a hemoglobin of 10.5 g/dL and a hematocrit of 36%. What is the next step in management of this patient?

 

Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months.

 

Discontinue the supplemental iron and encourage an iron­enriched diet.

 

Increase the ferrous sulfate dose to 4 to 6 mg/kg/day of elemental iron.

 

Refer the child to a pediatric hematologist to further evaluate the anemia.

 

 

 

 

The primary care pediatric nurse practitioner performs a well baby examination ID: 13348417410

 

on a 4­month­old infant who is exclusively breastfed and whose mother plans to introduce only

 

 

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small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron, what will the nurse practitioner recommend?

 

Elemental iron supplementation of 1 mg/kg/day until cereals are added

 

Elemental iron supplementation of 3 mg/kg/day for the duration of breastfeeding

 

Monitoring the infant’s hemoglobin and hematocrit at every well­baby checkup

 

Offering iron­fortified formula to ensure adequate iron intake

 

 

 

 

The primary care pediatric nurse practitioner reviews hematology reports on a

 

child with beta­thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner

 

do?

 

Evaluate serum ferritin.

 

Order Hgb electrophoresis.

 

Prescribe supplemental iron.

 

Refer for RBC transfusions.

 

 

 

 

The primary care pediatric nurse practitioner sees a 12­month­old infant who is

 

being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy­red, sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child’s condition?

 

 

Hemoglobin electrophoresis

 

 

RBC folate, iron, and B12 levels

 

 

 

 

 

Reticulocyte levels

 

Serum lead levels

 

 

 

 

A toddler who presents with anemia and reticulocytopenia has a history of a

 

gradual decrease in energy and increase in pallor beginning after a recent viral infection. How will

 

the primary care pediatric nurse practitioner treat this child?

 

Closely observe the child’s symptoms and lab values.

 

Consult with a pediatric hematologist.

 

Prescribe supplemental iron for 4 to 6 months.

 

Refer for transfusions to  the anemia.

 

 

 

 

The pediatric nurse practitioner provides primary care for a 30­month­old child

 

who has sickle cell anemia who has had one dose of 23­valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child?

 

Administer an initial meningococcal vaccine.

 

Begin folic acid dietary supplementation.

 

 

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Decrease the dose of penicillin V prophylaxis.

 

Give a second dose of 23­valent pneumococcal vaccine.

 

 

 

 

A 2­year­old child who has SCA comes to the clinic with a cough and a fever of

 

101.5°C. The child currently takes penicillin V prophylaxis 125 mg orally twice daily. What will the

 

primary care pediatric nurse practitioner do?

 

Admit the child to the hospital to evaluate for sepsis.

 

Give intravenous fluids and antibiotics in clinic.

 

Increase the penicillin V dose to 250 mg.

 

Order a chest radiograph to rule out pneumonia.

 

 

 

 

A school­age child comes to the clinic for evaluation of excessive bruising. The

 

primary care pediatric nurse practitioner notes a history of an upper respiratory infection 2 weeks prior. The physical exam is negative for hepatosplenomegaly and lymphadenopathy. Blood work reveals a platelet count of 60,000/mm3 with normal PT and aPTT. How will the nurse practitioner

 

manage this child’s condition?

 

Admit to the hospital for IVIG therapy.

 

Begin a short course of corticosteroid therapy.

 

Refer to a pediatric hematologist.

 

Teach to avoid NSAIDs and contact sports.

 

 

 

 

The primary care pediatric nurse practitioner is examining a 5­year­old child who

 

has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white cell blood count. The nurse practitioner will refer this child to a specialist for

 

 

 

bone marrow biopsy.

 

corticosteroids and IVIG.

 

hemoglobin electrophoresis.

 

immunoglobulin testing.

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a school­age child who has a history of cancer treated with cranial irradiation. What will the nurse practitioner monitor in this child?

 

Cardiomyopathy and arrhythmias

 

Leukoencephalopathy

 

Obesity and gonadal dysfunction

 

Peripheral neuropathy and hearing loss

 

Chapter   28

 

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Questions

 

 

When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by

 

bending the infant at the waist to touch fingers to toes.

 

extending the leg at the knee with the infant supine.

flexing the infant’s neck to touch chin to chest.

 

turning the infant’s head from side to side.

 

 

 

 

To evaluate brain tissue disorders in infants, which test is useful?

 

Computerized tomography

 

Head radiographs

 

Magnetic resonance imaging

 

Ultrasonography

 

 

 

 

A female infant who was developing normally stops meeting developmental

 

milestones at age 12 months and then begins losing previously acquired skills. What will the primary care pediatric nurse practitioner expect to tell the parents about this child’s prognosis?

 

Cognitive development will be normal but motor skills will be lost.

 

Physical and speech therapy will help the infant regain lost skills.

 

The child’s intellectual development will not progress further.

 

This is a temporary condition with full recovery expected.

 

 

 

 

A 14­year­old child has a headache, unilateral weakness, and blurred vision

 

preceded by fever and nausea. The child’s parent reports a similar episode several months prior. The primary care pediatric nurse practitioner will consult with a pediatric neurologist to order

 

a lumbar puncture.

 

an electroencephalogram (EEG).

 

neuroimaging with magnetic resonance imaging (MRI).

positron emission tomography (PET) scan.

 

 

 

 

During a well baby exam on a 9­month­old infant, the parent reports that the baby

 

always uses the left hand to pick up objects and asks if the baby will be left­handed. What will the primary care pediatric nurse practitioner do?

 

Explain that it is too soon to tell which hand the infant will prefer later.

 

Perform a careful assessment of fine and gross motor skills.

 

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Teach the parent to encourage the infant to use both hands.

 

Tell the parent that a hand preference usually develops between 6 and 12 months.

 

 

 

 

The pediatric nurse practitioner provides primary care for a 5­year­old child who

 

has cerebral palsy who exhibits athetosis and poor weight gain in spite of receiving high­calorie formula to supplement intake. The child has had several episodes of pneumonia in the past year. Which specialty consultation is a priority for this child?

 

 

Feeding clinic to manage caloric intake

 

Neurology to assess medication needs

 

Pulmonology for possible tracheotomy

 

Surgery for possible fundoplication and gastrostomy

 

 

 

 

Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?

 

Calcium and vitamin D

 

Fat­soluble vitamins

 

Iron and zinc

 

Sodium and potassium

 

 

 

 

A child with a recent history of URI reports tingling and pain in one ear followed by

 

sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do?

 

Initiate a short course of antibiotic therapy.

 

Perform diagnostic testing to rule out serious causes.

 

Prepare the parents for lifelong complications.

 

Prescribe oral prednisone 1 mg/kg/day initially.

 

 

 

 

A child who has had a single non­febrile seizure has a normal neurologic exam. ID: 13348422958

Which diagnostic test is indicated?

Computerized tomography (CT)

Electroencephalogram (EEG)

 

 

Magnetic resonance imaging (MRI)

 

Polysomnography

 

 

 

 

 

The parents of an 18­month­old child bring the child to the clinic after observing a ID: 13348422950

 

 

ID: 13348422970

 

ID: 13348422952

 

ID: 13348422976

brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of

 

103.1°F, and the primary care pediatric nurse practitioner notes a left otitis media. The child is alert and responding normally. What will the nurse practitioner do?

 

Order a lumbar puncture, complete blood count, and urinalysis.

 

Prescribe an antibiotic for the ear infection and reassure the parents.

 

Refer to a pediatric neurologist for anticonvulsant and antipyretic prophylaxis.

 

Send the child to the emergency department for EEG and possible MRI.

 

 

 

 

An adolescent female reports unilateral headache pain associated with abdominal

 

pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for 6 months but reports little relief from symptoms. What will the primary care pediatric nurse practitioner do?

 

 

Add acetaminophen and ondansetron to the naproxen regimen.

 

Consider prophylactic therapy with a beta­blocker or anticonvulsant drug.

 

Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours.

 

Refer the adolescent to a pediatric neurologist for neuroimaging studies.

 

 

 

 

A child who has sustained a head injury after falling on the playground is brought

 

to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric nurse practitioner notes slight slurring of the child’s speech and the child has vomited twice in the exam room. Which course of action is warranted?

 

 

Admit the child to the hospital for a neurology consult.

 

Observe the child in the clinic for several hours.

 

Order a head CT and observe the child at home.

 

Send the child home with instructions for follow­up.

 

 

 

 

The primary care pediatric nurse practitioner performs a well baby exam on a

 

term 4­month­old infant and observes flattening of the left occiput, bossing of the right occiput, and anterior displacement of the left ear. The parents report performing various positioning maneuvers, but say that the baby’s head shape has worsened. What will the nurse practitioner recommend to  this finding?

 

Allow the infant to sleep on the tummy when the parents are in the room.

 

Lay the infant in the “back to sleep” position, alternating the left and right occiput.

 

Order a head CT to evaluate the infant for craniosynostosis.

 

Refer the infant for orthotic cranial molding helmet therapy.

 

 

 

 

 

A 4­year­old child who has previously met developmental milestones is not toiled ID: 13348422972

 

trained. The primary care pediatric nurse practitioner notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child?

 

Arnold­Chiari malformation

 

Reye syndrome

 

Spina bifida cystica

 

Tethered cord

 

 

 

Chapter   29

 

 

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Questions

 

 

The primary care pediatric nurse practitioner performs a vision screen on a 4­

 

month­old infant and notes the presence of convergence and accommodation with mild esotropia

 

of the left eye. What will the nurse practitioner do?

 

Patch the right eye to improve coordination of the left eye.

 

Reassure the parents that the infant will outgrow this.

 

Recheck the infant’s eyes in 2 to 4 weeks.

 

Refer the infant to a pediatric ophthalmologist.

 

 

 

 

During a well child exam on a 4­year­old child, the primary care pediatric nurse

 

practitioner notes that the clinic nurse recorded “20/50” for the child’s vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend?

 

Follow up with a visual acuity screen in 6 months.

 

Refer to a pediatric ophthalmologist.

 

Re­test the child in 1 year.

 

Test the child’s vision in 1 month.

 

 

 

 

During a well child assessment of an African­American infant, the primary care

 

pediatric nurse practitioner notes a dark red­brown light reflex in the left eye and a slightly brighter,

 

red­orange light reflex in the right eye. The nurse practitioner will

 

dilate the pupils and reassess the red reflex.

 

order auto­refractor screening of the eyes.

 

recheck the red reflex in 1 month.

 

refer the infant to an ophthalmologist.

 

 

 

 

The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate

 

color vision.

 

ocular alignment.

 

peripheral vision.

 

visual acuity.

 

 

 

 

The primary care pediatric nurse practitioner applies fluorescein stain to a child’s

 

eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate?

 

The cornea has not been damaged.

 

 

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There is too little stain on the cornea.

 

There is damage to the cornea.

 

There is too much stain on the cornea.

 

 

 

 

A toddler exhibits exotropia of the right eye during a cover­uncover screen. The

 

primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which

 

treatment?

 

Botulinum toxin injection

 

ive lenses

 

Occluding the affected eye for 6 hours per day

 

Patching of the unaffected eye for 2 hours each day

 

 

 

 

The primary care pediatric nurse practitioner performs a well child examination on

 

a 9­month­old infant who has a history of prematurity at 28 weeks’ gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam?

 

 

At 12 months of age

 

At 24 months of age

 

At 48 months of age

 

At 60 months of age

 

 

 

 

During a well­baby assessment on a 1­week­old infant who had a normal exam

 

when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts

 

of thick, purulent discharge. What is the likely diagnosis? A.   Chemical­induced conjunctivitis

Chlamydia trachomatis conjunctivitis

 

Herpes simplex virus (HSV) conjunctivitis

 

Neisseria gonorrhea conjunctivitis

 

 

 

 

The primary care pediatric nurse practitioner performs a well baby assessment of

 

a 5­day­old infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is ?

 

Administer intramuscular ceftriaxone 50 mg/kg.

 

Admit the infant to the hospital immediately.

 

Give oral erythromycin 30 to 50 mg/kg/day for 2 weeks.

 

Teach the parent how to perform tear duct massage.

 

 

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A preschool­age child who attends day care has a 2­day history of matted eyelids

 

in the morning and burning and itching of the eyes. The primary care pediatric nurse practitioner notes yellow­green purulent discharge from both eyes, conjunctival erythema, and mild URI symptoms. Which action is ?

 

 

Culture the conjunctival discharge.

 

Observe the child for several days.

 

Order an oral antibiotic medication.

 

Prescribe topical antibiotic drops.

 

 

 

 

A 14­year­old child has a 2­week history of severe itching and tearing of both

 

eyes. The primary care pediatric nurse practitioner notes redness and swelling of the eyelids along

 

with stringy, mucoid discharge. What will the nurse practitioner prescribe?

 

Saline solution or artificial tears

 

Topical mast cell stabilizer

 

Topical NSAID drops

 

 

Topical vasoconstrictor drops

 

 

 

 

The primary care pediatric nurse practitioner observes a tender, swollen red

 

furuncle on the upper lid margin of a child’s eye. What treatment will the nurse practitioner

 

recommend?

 

Culture of the lesion to determine causative organism

 

Referral to ophthalmology for incision and drainage

 

Topical steroid medication

 

Warm, moist compresses 3 to 4 times daily

 

 

 

 

The primary care pediatric nurse practitioner is treating an infant with lacrimal duct

 

obstruction who has developed bacterial conjunctivitis. After 2 weeks of treatment with topical antibiotics along with massage and frequent cleansing of secretions, the infant’s symptoms have not improved. Which action is ?

 

Perform massage more frequently.

 

Prescribe an oral antibiotic.

 

Recommend hot compresses.

 

Refer to an ophthalmologist.

 

 

 

 

A preschool­age child is seen in the clinic after waking up a temperature of ID: 13348411158

 

102.2°F, swelling and erythema of the upper lid of one eye, and moderate pain when looking from

 

 

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side to side. Which course of treatment is ?

 

Admit to the hospital for intravenous antibiotics.

 

Obtain a lumbar puncture and blood culture.

 

Order warm compresses 4 times daily for 5 days.

 

Prescribe a 10­ to 14­day course of oral antibiotics.

 

 

 

 

A school­age child is seen in the clinic after a fragment from a glass bottle flew into the eye. What will the primary care pediatric nurse practitioner do?

 

Refer immediately to an ophthalmologist.

 

Attempt to visualize the glass fragment.

 

Irrigate the eye with sterile saline.

 

Instill a topical anesthetic.

 

 

 

 

A school­age child is hit in the face with a baseball bat and reports pain in one

 

eye. The primary care pediatric nurse practitioner is able to see a dark red fluid level between the cornea and iris on gross examination, but the child resists any exam with a light. Which action is ?

 

Administer an oral analgesic medication.

 

Apply a Fox shield and reevaluate the eye in 24 hours.

 

Instill anesthetic eyedrops into the affected eye.

 

Refer the child immediately to an ophthalmologist.

 

 

Chapter   30

 

 

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Questions

 

 

The parent of a 4­month­old infant is concerned that the infant cannot hear.

 

Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss

 

in this infant?

 

Acoustic reflectometry

 

Audiometry

 

Auditory brainstem response (ABR) D.   Evoked otooacoustic emission (EOAE) testing

 

 

The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of ­180 mm H2O. What does this value indicate?

 

A normal tympanic membrane

 

Middle ear effusion

 

Negative ear pressure

 

Tympanic membrane perforation

 

 

 

 

An 18­month­old child with no previous history of otitis media awoke during the

 

night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child?

 

Amoxicillin 80 to 90 mg/kg/day in two divided doses

 

An analgesic medication and watchful waiting

 

Ceftriaxone 50 to 75 mg/kg/dose IM given once

 

Ototopical antibiotic drops twice daily for 5 days

 

 

 

 

A 7­month­old infant has had two prior acute ear infections and is currently on the

 

10th day of therapy with amoxicillin­clavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child’s ear infection?

 

Order a second course of amoxicillin­clavulanate.

 

Perform tympanocentesis for culture.

 

Prescribe clindamycin twice daily.

 

Refer the child to an otolaryngologist.

 

 

 

 

 

A 3­year­old child with pressure­equalizing tubes (PET) in both ears has otalgia in ID: 13348431627

 

 

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one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do?

 

 

Order ototopical antibiotic/corticosteroid drops.

 

Prescribe a prophylactic antibiotic medication.

 

Reassure the parent that this is a normal exam.

 

Refer the child to an otolaryngologist for follow­up

 

 

 

 

What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure­equalizing tubes (PET) in both ears?

 

Parents should notice improved hearing in their child.

 

PET will help by reducing the number of ear infections the child has.

 

The child should use earplugs when showering or bathing.

 

The tubes will most likely remain in place for 3 to 4 years.

 

 

 

 

A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend?

 

Cleaning ear canals well after swimming

 

Drying the ear canal with a hair dryer

 

Swimming only in chlorinated pools

 

Using cerumenolytic agents daily

 

 

 

 

A child complains of itching in both ears and is having trouble hearing. The

 

primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention?

 

 

Obtain a culture of the external auditory canal.

 

Order ototopical antibiotic/corticosteroid drops.

 

Prescribe oral amoxicillin­clavulanate.

 

Refer the child to an otolaryngologist.

 

 

 

 

A child who has otitis externa has severe swelling of the external auditory canal

 

that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child?

 

Insert a wick into the external auditory canal.

 

Irrigate the external auditory canal with saline.

 

Order systemic corticosteroids.

 

 

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Prescribe an oral antibiotic medication.

 

 

 

 

The primary care pediatric nurse practitioner notes a small, round object in a

 

child’s external auditory canal, near the tympanic membrane. The child’s parent thinks it is

 

probably a dried pea. What will the nurse practitioner do to remove this object?

 

Irrigate the external auditory canal to flush out the object.

 

Refer the child to an otolaryngologist for removal.

 

Remove the object with a wire loop curette.

 

Use a bayonet forceps to grasp and remove the object.

 

 

 

 

A 3­year­old child has had one episode of acute otitis media 3 weeks prior with a

 

normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order?

 

 

A referral for tympanocentesis

 

Amoxicillin twice daily

 

Amoxicillin­clavulanate twice daily

 

Intramuscular ceftriaxone

 

 

 

 

The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2­

 

year­old child who has a history of three ear infections in the first 6 months of life. The child’s tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child?

 

 

Amoxicillin twice daily for 10 days

 

 

An analgesic medication and watchful waiting

 

 

 

 

 

Antibiotic ear drops and ibuprofen

 

Ceftriaxone given once intramuscularly

 

 

 

 

A child who was treated with amoxicillin and then amoxicillin­clavulanate for acute

 

otitis media is seen for follow­up. The primary care pediatric nurse practitioner notes dull­gray tympanic membranes with a visible air­fluid level. The child is afebrile and without pain. What is the next course of action?

 

Administering ceftriaxone IM

 

Giving clindamycin orally

 

Monitoring ear fluid levels for 3 months D.   Watchful waiting for 48 to 72 hours

 

 

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A school­age child has a history of chronic otitis media and is seen in the clinic

 

with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure­equalizing tubes and a pearly­white lesion on one tympanic membrane. Which condition is most likely?

 

Cholesteatoma

 

Mastoiditis

 

Otitis externa

 

Otitis media with effusion

 

 

Chapter   31

 

 

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Questions

 

 

The primary care pediatric nurse practitioner is examining a 2­week­old infant and

 

auscultates a wide splitting of S2 during expiration. What condition may this finding represent?

 

Atrial septal defect

 

Coarctation of the aorta

 

Patent ductus arteriosis

 

Ventricular septal defect

 

 

 

 

The primary care pediatric nurse practitioner auscultates a new grade II vibratory,

 

mid­systolic murmur at the mid sternal border in a 4­year­old child that is louder when the child is

 

supine. What type of murmur is most likely?

 

Pathologic murmur

 

Pulmonary flow murmur

 

Still’s murmur

 

 

Venous hum

 

 

 

 

During a well child assessment, the primary care pediatric nurse practitioner

 

auscultates a harsh, blowing grade IV/VI murmur in a 6­month­old infant. What will the nurse

 

practitioner do next?

 

Get a complete blood count to rule out severe anemia.

 

Obtain an electrocardiogram to assess for arrhythmia.

 

Order a chest radiograph to evaluate for cardiomegaly.

 

Refer to a pediatric cardiologist for further evaluation.

 

 

 

 

The primary care pediatric nurse practitioner provides primary care for a 4­month­

 

old infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend?

 

Adding solid foods to the infant’s diet to increase caloric intake

 

 

Fortifying breast milk to increase the number of calories per ounce

 

 

 

 

 

Stopping breastfeeding and giving 30 kcal/ounce formula

 

Supplementing breastfeeding with 24 kcal/ounce formula

 

 

 

 

A 12­month­old infant who had cardiopulmonary bypass with RBC and plasma

 

infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit?

 

 

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MMR

 

OPV

 

PCV­13

 

 

Varivax

 

 

 

 

The primary care pediatric nurse practitioner performs a well child examination on

 

a 12­month­old child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child’s cardiologist to discuss whether the child needs which medication?

 

 

 

Amoxicillin

 

Capoten

 

Digoxin

 

Furosemide

 

 

 

 

During a well baby examination of a 6­week­old infant, the primary care pediatric

 

nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is ?

 

 

Follow­up in 1 week to assess the infant’s weight.

 

Order a chest radiograph and an electrocardiogram.

 

Reassure the parents that the exam is within normal limits.

 

Refer the infant to a pediatric cardiologist.

 

 

 

 

A 3­month­old infant who was previously healthy now has a persistent cough,

 

bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, low­pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?

 

 

Atrial septal defect

 

Coarctation of the aorta

 

Patent ductus arteriosis

 

Ventricular septal defect

 

 

 

 

An infant with trisomy 21 has a complete AV canal defect. Which finding,

 

associated with having both of these conditions, will the primary care pediatric nurse practitioner expect?

 

Crackles in both lungs

 

 

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Hepatomegaly

 

Oxygen desaturation

 

Peripheral edema

 

 

 

 

A 9­month­old infant has a grade III/VI, harsh, rumbling, continuous murmur in the

 

left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect?

 

 

Cardiopulmonary bypass surgery

 

 

Coil insertion in the catheterization laboratory

 

 

 

 

 

Indomethacin administration

 

Observation for spontaneous closure

 

 

 

 

A 5­year­old child who had a repair for transposition of the great arteries shortly

 

after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do?

 

 

Order an echocardiogram and chest radiograph.

 

Perform pulmonary function testing.

 

Reassure the parent that these symptoms are common.

 

Refer the child to the cardiologist immediately.

 

 

 

 

The primary care pediatric nurse practitioner is performing a well child

 

examination on a school­age child who had complete repair of a tetralogy of Fallot defect in

 

infancy. What is important in this child’s health maintenance regime? A.   Cardiology clearance for sports participation

Restriction of physical activity to avoid pulmonary complications

 

Sub­acute bacterial endocarditis prophylaxis precautions

 

Teaching about management of hypercyanotic episodes

 

 

 

 

The primary care pediatric nurse practitioner is performing a sports physical on an

 

adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend?

 

Avoidance of all sports to prevent sudden death

 

Clearance for any sports since this is mild

 

Evaluation by a cardiologist prior to participation D.   Low­intensity sports, such as golf or bowling

 

 

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During a routine well child exam on a 5­year­old child, the primary care pediatric

 

nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect?

 

 

Aortic stenosis

 

Patent ductus arteriosus

 

Pulmonic stenosis

 

Tricuspid atresia

 

 

 

 

A 5­year­old child has an elevated blood pressure during a well child exam. The

 

primary care pediatric nurse practitioner notes mottling and pallor of the child’s feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child’s back. The nurse practitioner will suspect which condition?

 

 

Aortic stenosis

 

 

Coarctation of the aorta

 

 

 

 

 

Patent ductus arteriosus

 

Pulmonic stenosis

 

 

 

 

An adolescent female has a history of repaired tetralogy of Fallot. Which long­ term complication is a concern for this patient?

 

Aortic stenosis

 

Chronic cyanosis

 

Mitral valve prolapse

 

Ventricular failure

 

 

 

 

A 6­year­old child has a systolic blood pressure between the 95th and 99th

 

percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th

 

percentile on three separate clinic visits. This child’s blood pressure is classified as

 

normotensive.

 

pre­hypertensive.

 

stage 1 hypertensive.

 

stage 2 hypertensive.

 

 

 

 

A 12­year­old child whose weight and BMI are in the 75th percentile has a

 

diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include

 

 

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complete blood count.

 

erythrocyte sedimentation rate.

 

renal function and plasma renin tests.

 

urinalysis and electrolytes.

 

 

 

 

A 12­year­old child whose BMI is greater than the 95th percentile has a blood

 

pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child’s BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner’s next step in treating this child?

 

Continued close monitoring of blood pressure

 

Ordering an echocardiogram or MRI

 

Prescribing an ACE inhibitor medication

 

Referral to a nephrologist or cardiologist

 

 

 

 

A 7­year­old child who has a history of a repaired congenital heart defect has

 

many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What

 

will the primary care pediatric nurse practitioner do next?

 

Admit to the hospital with a pediatric cardiology consult.

 

Obtain blood cultures and a CBC and consult a pediatric cardiologist.

 

Refer the child to a pediatric dental surgeon immediately.

 

Start prophylactic antibiotics such as penicillin twice daily for 2 weeks.

 

 

 

 

A 15­year­old female reports fainting at school in class on two occasions. The

 

adolescent’s orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist?

 

12­lead electrocardiogram

 

Echocardiogram

 

Tilt table testing

 

Treadmill exercise testing

 

 

Chapter   32

 

 

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Questions

 

 

In a respiratory disorder causing a check­valve obstruction, which symptoms will be present?

 

Air entry on inspiration with expiratory occlusion

 

Complete obstruction on inspiration and expiration

 

Narrowing of the lumen with increased air flow resistance

 

Obstruction of air entry with unimpeded expiratory air flow

 

 

 

 

A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?

 

Atelectasis

 

Barrel chest

 

Over­inflation

 

Wheezing

 

 

 

 

A 4­year­old child with an upper respiratory tract infection has cloudy nasal

 

discharge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend?

 

Antihistamines

 

Decongestant sprays

 

Saline rinses

 

Zinc supplements

 

 

 

 

A 5­year­old child has enlarged tonsils and a history of four throat infections in the

 

previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child’s quality of sleep. The next step in managing this child’s condition is to

 

continue to observe the child for two or more GABHS infections.

 

prescribe prophylactic antibiotics to prevent recurrent infection.

 

refer to a pulmonologist for polysomnography evaluation.

 

refer to an otolaryngologist for possible tonsillectomy.

 

 

 

 

A school­age child has an abrupt onset of sore throat, nausea, headache, and a

 

temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefy­red tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative. What is the next step in management for this child?

 

 

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Consider a sexual abuse diagnosis.

 

Obtain an anti­streptococcal antibody titer.

 

Perform a follow­up throat culture.

 

Prescribe amoxicillin for 10 days.

 

 

 

 

An adolescent has suspected infectious mononucleosis after exposure to the

 

virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis?

 

 

Complete blood count

 

 

EBV­specific antibody testing

 

 

 

 

 

 

Heterophile antibody testing

 

Throat culture

 

 

 

 

A school­age child has had nasal discharge and daytime cough but no fever for

 

12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child?

 

 

Amoxicillin 45 mg/kg/day

 

Amoxicillin 80­90 mg/kg/day

 

Amoxicillin­clavulanate 80­90 mg/kg/day

 

Saline irrigation for symptomatic relief

 

 

 

 

After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a

 

child continues to have mucopurulent nasal discharge along with induration, swelling, and

 

erythema of both eyelids. What is the next course of treatment?

 

Amoxicillin 80 mg/kg/day for 14 days

 

Amoxicillin­clavulanate for 10 to 14 days

 

  • Antibiotic ophthalmic drops for 5 to 7 days

 

  • Referral to a pediatric otolaryngologist

 

 

 

 

  • The parent of a toddler and a 4­week­old infant tells the primary care pediatric

 

nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant?

 

  • Administer the initial diphtheria, pertussis, and tetanus vaccine.

 

  • Instruct the parent to limit contact between the toddler and the infant.

 

  • Order azithromycin 10 mg/kg/day in a single dose daily for 5 days.

 

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  • Prescribe erythromycin 10 mg/kg/dose four times daily for 14 days.

 

 

 

 

  • A school­age child has frequent nosebleeds. Nasal visualization reveals fresh

 

clots and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action?

 

 

  • Cauterize the mucosa with silver nitrate sticks.

 

  • Order a topical vasoconstrictor medication.

 

  • Prescribe a barrier agent such as petrolatum jelly.

 

  • Refer to an otolaryngologist for further evaluation.

 

 

 

 

  • A child is in the clinic because of symptoms of purulent, foul­smelling nasal

 

discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous in

 

the nasal cavity. What will the primary care pediatric nurse practitioner do?

 

  • Attempt to remove the mass gently using alligator forceps.

 

  • Perform a saline nasal rinse using a water jet device.

 

  • Refer the child to a pediatric otolaryngologist.

 

  • Suction the mucoid mass using a bulb syringe.

 

 

 

 

  • A 2­year­old child is brought to the clinic after developing a hoarse, bark­like

 

cough during the night with “trouble catching his breath” according to the parent. The history reveals a 2 day history of low­grade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child?

 

 

  • Administer intramuscular dexamethasone.

 

  • Admit the child for inpatient hospitalization.

 

  • Give the child a racemic epinephrine treatment in the office.

 

  • Prescribe oral dexamethasone for 2 days.

 

 

 

 

  • The primary care pediatric nurse practitioner evaluates a child who awoke with a

 

sore throat and high fever after a nap. The child appears anxious and is sitting on the parent’s lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next?

 

  • Administer a broad­spectrum intravenous antibiotic.

 

  • Obtain blood and throat cultures and start antibiotic therapy.

 

  • Send the child to radiology for a lateral neck radiograph.

 

  • Transport the child to the hospital via emergency medical services.

 

 

 

ID: 13348407624

 

ID: 13348407600

 

ID: 13347936698

 

ID: 13348407612

  • A 5­month­old infant who has a 3­day history of cough and rhinorrhea has

 

developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant’s immunizations are up­to­date. The physical exam reveals a respiratory rate of 50 breaths per minute, coarse expiratory wheezing, and prolonged expiration. An oxygen saturation is 96% on room air. What is the recommended treatment for this infant?

 

 

  • Administer a trial of bronchodilators.

 

  • Obtain a viral culture of nasal washings.

 

  • Order an oral corticosteroid medication.

 

  • Recommend increased fluids and close follow­up.

 

 

 

 

  • A previously healthy school­age child develops a cough and a low­grade fever.

 

The primary care pediatric nurse practitioner auscultates wheezes in all lung fields. Which

 

diagnosis will the nurse practitioner suspect?

 

  • Atypical pneumonia

 

  • Bacterial pneumonia

 

  • Bronchiolitis

 

  • Bronchitis

 

 

 

 

  • A child is diagnosed with community­acquired pneumonia and will be treated as

 

an outpatient. Which antibiotic will the primary care pediatric nurse practitioner prescribe?

 

  • Amoxicillin

 

  • Azithromycin

 

  • Ceftriaxone

 

  • Oseltamivir

 

 

 

 

  • The primary care pediatric nurse practitioner manages care in conjunction with a

 

pediatric pulmonologist for a child with cystic fibrosis. Which medication regimen is used to facilitate airway clearance for this child?

 

  • Ibuprofen and azithromycin

 

 

  • Inhaled dornase alfa

 

 

 

 

 

  • Ivacaftor

 

  • Prophylactic clindamycin

 

 

Chapter   33

 

 

ID: 13348441159

 

ID: 13348441151

 

ID: 13348441137

Questions

 

 

  • The parent of an infant asks about using a probiotic medication. What will the ID: 13348441147

primary care pediatric nurse practitioner tell this parent?

 

  • Probiotic medications have demonstrated efficacy in treating colic.

 

  • Probiotics are not safe to use to treat infants who have colic.

 

  • There are no studies showing usefulness of probiotics to manage colic.

 

  • There is no conclusive evidence about using probiotics to treat colic.

 

 

 

 

  • A toddler who was born prematurely refuses most solid foods and has poor

 

weight gain. A barium swallow study reveals a normal esophagus. What will the primary care

 

pediatric nurse practitioner consider next to manage this child’s nutritional needs?

 

  • Consultation with a dietician

 

  • Fiberoptic endoscopy evaluation

 

  • Magnetic resonance imaging

 

  • Videofluoroscopy swallowing study

 

 

 

 

  • A toddler is seen in the clinic after a 2­day history of intermittent vomiting and

 

diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3­second capillary refill, 2­ second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend?

 

 

  • Anti­diarrheal medication and clear fluids for 24 hours

 

  • Bolus of IV normal saline in the clinic until improvement

 

  • Hospital admission for IV rehydration and oral fluids

 

  • Oral rehydration solution with follow­up in 24 hours

 

 

 

 

  • A 9­year­old girl has a history of frequent vomiting and her mother has frequent

 

migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the  action?

 

  • Begin using an anti­migraine medication to prevent headaches.

 

  • Prescribe ondansetron and lorazepam to help manage symptoms.

 

  • Reassure the parent that this is expected with cyclic vomiting syndrome.

 

  • Refer to a pediatric gastroenterologist for further workup.

 

 

 

 

 

  • The parent of a 3­month­old reports that the infant arches and gags while feeding ID: 13348441163

 

 

ID: 13348441161

 

ID: 13348441135

 

ID: 13348441153

 

ID: 13348441139

and spits up undigested formula frequently. The infant’s weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant?

 

  • Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks.

 

  • Institute an empiric trial of acid suppression with a proton pump inhibitor (PPI).

 

  • Perform esophageal pH monitoring to determine the degree of reflux.

 

  • Reassure the parent that these symptoms will likely resolve by 12 to 24 months.

 

 

 

 

  • A school­age child has a 3­month history of dull, aching epigastric pain that

 

worsens with eating and awakens the child from sleep. A complete blood count shows a

 

hemoglobin of 8 mg/dL. What is the next step in management?

 

  • Administration of H2RA or PPI medications

 

  • Empiric therapy for H. pylori (HP)

 

  • Ordering an upper GI series

 

  • Referral for esophagogastroduodenoscopy (EGD)

 

 

 

 

  • A 2­month­old infant cries up to 4 hours each day and, according to the parents,

 

is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal and the infant is gaining weight normally. What will the primary care pediatric nurse practitioner recommend?

 

 

 

  • A complete work­up, including laboratory and radiologic tests

 

 

  • Eliminating certain foods from the mother’s diet

 

 

 

 

 

 

  • Empiric treatment with a proton pump inhibitor medication

 

  • Stopping breastfeeding and beginning a hydrolyzed formula

 

 

 

 

  • A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract

 

shows a 6 mm cylindrical object in the child’s stomach. The child is able to swallow without difficulty

 

and is not experiencing pain. What is the  course of treatment?

 

  • Administer ipecac to induce vomiting.

 

  • Have the parents watch for the object in the child’s stool.

 

  • Insert a nasogastric tube to flush out the object.

 

  • Refer the child for endoscopic removal of the object.

 

 

 

 

  • A 10­year­old child has had abdominal pain for 2 days, which began in the

 

periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis?

 

  • Appendicitis with perforation

 

 

ID: 13348441143

 

ID: 13348441165

 

ID: 13348441155

 

ID: 13348441157

  • Gastroenteritis

 

  • Pelvic inflammatory disease (PID)

 

  • Urinary tract infection (UTI)

 

 

 

 

  • An 18­month­old child has a 1­day history of intermittent, cramping abdominal

 

pain with non­bilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis?

 

  • Appendicitis

 

  • Gastroenteritis

 

  • Intussusception

 

  • Testicular torsion

 

 

 

 

  • A school­age child has had abdominal pain for 3 months that occurs once or twice

 

weekly and is associated with a headache and occasional difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. According to Bishop, what is included in the initial diagnostic work­up for this child?

 

 

  • CBC, ESR, amylase, lipase, UA, and abdominal ultrasound

 

  • CBC, ESR, CRP, and fecal calprotectin

 

  • CBC, ESR, CRP, UA, stool for ova, parasites, and culture

 

  • Stool for H. pylori antigen and serum IgA, IgG, tTg

 

 

 

 

  • An adolescent is diagnosed with functional abdominal pain (FAP). The child’s

 

symptoms worsen during stressful events, especially with school anxiety. What will be an important

 

part of treatment for this child?

 

  • Informing the parents that the pain is most likely not real

 

  • Instituting a lactose­free diet along with lactobacillus supplements

 

  • Teaching about the brain­gut interaction causing symptoms D.   Using histamine2­blockers to help alleviate symptoms

 

 

 

 

  • A school­age child has recurrent diarrhea with foul­smelling stools, excessive

 

flatus, abdominal distension, and failure­to­thrive. A 2­week lactose­free trial failed to reduce symptoms. What is the next step in diagnosing this condition?

 

  • Lactose hydrogen breath test
  • Serologic testing for celiac disease
  • Stool for ova and parasites

 

 

 

ID: 13348441141

 

ID: 13348441149

ID: 13348441145

  • Sweat chloride test for cystic fibrosis

 

 

 

 

  • A child is diagnosed with Crohn disease. What are likely complications for this child?

 

  • Cancer of the colon and possible colectomy

 

  • Intestinal obstruction with scarring and strictures

 

  • Intestinal perforation and hemorrhage

 

  • Liver disease and sepsis

 

 

 

 

  • A 12­month­old infant exhibits poor weight gain after previously normal growth

 

patterns. There is no history of vomiting, diarrhea, or irregular bowel movements, and the physical

 

exam is normal. What is the next step in evaluating these findings?

 

  • Complete blood count and electrolytes

 

 

  • Feeding and stooling history and 3­day diet history

 

 

 

 

 

  • Stool cultures for ova and parasites

 

  • Swallow study with videofluoroscopy

 

 

 

 

  • A 2­year­old child has an acute diarrheal illness. The child is afebrile and, with

 

oral rehydration measures, has remained well hydrated. The parent asks what can be done to help shorten the course of this illness. What will the primary care pediatric nurse practitioner recommend?

 

  • Clear liquids only

 

  • Lactobacillus

 

  • Loperamide

 

  • Peppermint oil

 

 

Chapter   34

 

 

ID: 13348441179

 

ID: 13348441175

 

ID: 13348441177

ID: 13348441197

 

ID: 13348441187

Questions

 

 

  • A 9­month­old infant has developed two teeth since the 6­month checkup. The

 

local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to

 

promote healthy dentition at this visit?

 

  • Apply sodium fluoride varnish to the infant’s teeth.

 

  • Encourage the parents to make an initial dental appointment.

 

  • Prescribe oral fluoride supplementation.

 

  • Teach the parents how to brush the infant’s teeth with fluoride toothpaste.

 

 

 

 

  • What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures?

 

  • Administer oral ibuprofen or apply topical salicylates.

 

  • Apply a topical anesthetic such a benzocaine to the gums.

 

  • Give the infant a cold teething ring or wet washcloth to chew.

 

  • Try Baby Orajel on the infant’s gums several times daily.

 

 

 

 

  • An 18­month­old child has horizontal, bright white lines along the upper gum line

 

of the teeth. What is the most important question the primary care pediatric nurse practitioner will

 

ask the child’s parents?

 

  • If the child is still drinking milk from a bottle

 

  • If the child or the parents are brushing the teeth

 

  • If they are brushing the child’s teeth twice daily

 

  • If they have taken the child to a dentist

 

 

 

 

  • A 4­year­old child who has had extensive dental surgery to treat dental caries has

 

white spot lesions on the primary teeth. How often should this child receive fluoride varnish

 

applications?

 

  • Annually

 

  • Twice yearly

 

  • Every 3 to 6 months

 

  • Every month

 

 

 

 

  • The parents of a formula­fed newborn report that they get their drinking water

 

from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant?

 

  • Giving the infant a fluoride supplement

 

 

ID: 13348441171

 

ID: 13348441189

ID: 13348441183 primary care

ID: 13348441195

  • Testing the fluoride level of their water source

 

 

  • Using bottled water to prepare the infant’s formula

 

  • Using powdered formula with added fluoride

 

 

 

 

  • What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child’s teeth?

 

  • To allow the child to control the amount of toothpaste used

 

  • To choose a toothpaste with a mint flavor

 

  • To use a smear of toothpaste and not to rinse the mouth

 

 

  • To use a toothpaste containing whitening agents

 

 

 

 

  • A parent asks about ways to promote dental health in school­age children while on a family vacation that are convenient while camping and picnicking. What will the pediatric nurse practitioner recommend?

 

  • Getting fluoride varnish treatments prior to vacations

 

  • Giving the children fluoridated water after meals

 

  • Having the children use a chlorhexidine gluconate oral rinse

 

  • Offering gum containing xylitol after meals

 

 

 

 

  • An adolescent has localized bleeding of the gums when brushing the teeth. An

 

exam of the mouth reveals the presence of plaque and calculus on the teeth, which are not loose.

 

What will the primary care pediatric nurse practitioner recommend?

 

  • Consistently brushing and flossing the teeth twice daily

 

  • Referral to an oral surgeon for treatment

 

  • Rinsing the mouth daily with chlorhexidine gluconate

 

  • Using a xylitol­containing gum after meals

 

 

 

 

  • A school­age child has had herpes stomatitis for a week and continues to

 

complain of pain. What will the primary care pediatric nurse practitioner recommend?

 

  • Administration of a topical antiviral medication

 

  • Taking oral acyclovir for 5 to 7 days

 

  • Topical application of diphenhydramine and Maalox

 

 

  • Using a chlorhexidine gluconate rinse

 

 

 

 

  • A child has several shallow mucosal lesions on the buccal mucosa and tongue ID: 13348441185

 

that are surrounded with an erythematous halo and covered by yellow plaques. What will the

 

 

ID: 13348441191

 

ID: 13348441181

 

ID: 13348441199

 

ID: 13348441169

primary care pediatric nurse practitioner recommend?

 

  • Chlorhexidine gluconate

 

  • Diphenhydramine and Maalox

 

  • Oral acyclovir

 

  • Topical antiviral medication

 

 

 

 

  • During a well child exam, the primary care pediatric nurse practitioner notes

 

yellowish­white serpentine­bordered lesions on the anterior portion of a child’s tongue. What will

 

the nurse practitioner do?

 

  • Order chlorhexidine gluconate rinses to treat the lesions.

 

  • Prescribe oral acyclovir to shorten the course of the disease.

 

  • Reassure the parent that these are benign lesions.

 

  • Refer the child to a pediatric dentist for evaluation.

 

 

 

 

  • A 4­year­old child who has asthma has teeth with smooth, cupped­out teeth on the chewing surfaces. Which is the most likely explanation for this finding?

 

  • Bruxism

 

  • Bulimia

 

  • Decreased saliva

 

  • Gastroesophageal reflux

 

 

 

 

  • An adolescent female reports facial pain and frequent popping of her jaw. An

 

exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do?

 

  • Recommend ice packs, NSAIDs, and a soft diet.

 

  • Refer to a pediatric mental health specialist.

 

  • Refer to an orthodontist for a surgical intervention.

 

  • Suggest obtaining Botox injection treatments.

 

 

 

 

  • A 5­year­old child is hit in the face with a baseball bat and is brought to the clinic

 

by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment?

 

  • Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days.

 

  • Refer the child to a dentist for reimplantation of the avulsed teeth.

 

  • Refer the child to a dentist immediately for further examination.

 

  • Remove the teeth, place them in saline, and refer the child to a dentist.

 

  • · ID: 13348441173
  • A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the

 

primary care pediatric nurse practitioner recommend to promote dental health in this child?

 

  • Applying topical iodine every month

 

  • Daily chlorhexidine gluconate rinses

 

  • Ordering medications to prevent drooling

 

  • Prescribing prophylactic antibiotics

 

 

Chapter   35

 

 

ID: 13348434127

 

ID: 13348434131

 

ID: 13348434103

 

ID: 13348434125

 

ID: 13348434119

Questions

 

 

  • A 30­month­old girl who has been toilet trained for 6 months has daytime enuresis

 

and dysuria and a low­grade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step?

 

  • Begin empiric treatment with trimethoprim­sulfamethoxazole.

 

  • Discuss behavioral interventions for toilet training.

 

  • Reassure the child’s parents that the child does not have a urinary tract infection.

 

  • Send the urine to the lab for culture.

 

 

 

 

  • The clean catch urine specimen of a child with dysuria, frequency, and fever has

 

a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child?

 

  • Obtain a complete blood count and C­reactive protein.

 

  • Perform sensitivity testing before treating with antibiotics.

 

  • Repeat the culture if symptoms persist or worsen.

 

  • Treat with antibiotics for urinary tract infection.

 

 

 

 

  • A dipstick urinalysis is positive for leukocyte esterase and nitrites in a school­age

 

child with dysuria and foul­smelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child?

 

  • Order ciprofloxacin ER once daily for 3 days if the culture is positive.

 

  • Prescribe trimethoprim­sulfamethoxazole (TMP) twice daily for 3 to 5 days.

 

  • Reassure the child’s parents that this is likely an asymptomatic bacteriuria.

 

  • Wait for urine culture results to determine the  course of treatment.

 

 

 

 

  • A preschool­age child with no previous history has mild flank pain and fever but

 

no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture

 

is pending. Which is the  course of treatment for this child?

 

  • Hospitalize for intravenous antibiotics.

 

  • Order amoxicillin clavulanate.

 

  • Prescribe trimethoprim­sulfamethoxazole.

 

  • Refer for a voiding cystourethrogram.

 

 

 

 

  • A 3­year­old child has just completed a 7­day course of amoxicillin for a second

 

febrile urinary tract infection and currently has a negative urine culture. What is the next course of action?

 

  • Obtain a renal and bladder ultrasound.

 

 

ID: 13348434101

 

ID: 13348431699

ID: 13348434123

  • Prescribe prophylactic antibiotics to prevent recurrence.

 

  • Refer the child for a voiding cystourethrogram.

 

  • Screen urine regularly for leukocyte esterase and nitrites.

 

 

 

 

  • A 9­month­old infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed?

 

  • Amoxicillin 10 mg/kg as a single daily dose

 

  • Ceftriaxone IM 50 mg/kg as a single daily dose

 

  • Nitrofurantoin 1­2 mg/kg as a single daily dose

 

  • TMP­SMX; TMP 2 mg/kg as a single daily dose

 

 

 

 

  • The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the

 

primary care pediatric nurse practitioner how the disease will be treated. What will the nurse

 

practitioner tell this parent?

 

  • That long­term antibiotic prophylaxis will prevent scarring

 

 

  • That surgery to the condition is possible

 

 

 

 

 

  • that the child will most likely require kidney transplant

 

  • that the condition will probably resolve spontaneously

 

 

 

 

  • A healthy 14­year­old female has a dipstick urinalysis that is positive for 5­6 RBCs

 

per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient?

 

  • “Are you sexually active?”

 

  • “Are you taking any medications?”

 

  • “Have you had a recent fever?”

 

  • “When was your last menstrual period (LMP)?”

 

 

 

 

  • A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. ID: 13348434129

What diagnosis is most likely?

  • Henoch­Schönlein purpura

 

 

  • Rhabdomyosarcoma

 

  • Sickle cell disease

 

  • Systemic lupus erythematosus

 

 

 

 

  • An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent ID: 13348434107

 

first­morning voided specimen is negative. What will the primary care pediatric nurse practitioner

 

 

ID: 13348431697

 

ID: 13348431695

 

ID: 13348434121

 

ID: 13348434115

do to manage this condition?

 

  • Monitor for proteinuria at each annual well child examination.

 

  • Order a 24­hour timed urine collection for creatinine and protein excretion.

 

  • Reassure the parents that this is a benign condition with no follow­up needed.

 

  • Refer the child to a pediatric nephrologist for further evaluation.

 

 

 

 

  • A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner

 

provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child’s parents about this disease?

 

 

  • “Future episodes are likely to have worse outcomes.”

 

  • “Steroids will be used when relapses occur.”

 

  • “This represents a cure from this disease.”

 

  • “Your child will need to take steroids indefinitely.”

 

 

 

 

  • A child who has nephrotic syndrome is on a steroids and a salt­restricted diet for

 

a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child’s nephrologist, what is the  course of treatment considering this finding?

 

  • Begin a taper of the steroid medication while continuing salt restrictions.

 

  • Continue with steroids and salt restrictions until the urine is negative for protein.

 

  • Discontinue the steroids and salt restrictions now that improvement has occurred.

 

  • Relax salt restrictions and continue administration of steroids until proteinuria is gone.

 

 

 

 

  • A child who had GABHS 2 weeks prior is in the clinic with periorbital edema,

 

dyspnea, and elevated blood pressure. A urinalysis reveals tea­colored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition?

 

 

  • Prescribe a 10­ to 14­day course of high­dose amoxicillin.

 

  • Prescribe high­dose steroids in consultation with a nephrologist.

 

  • Reassure the parents that this condition will resolve spontaneously.

 

  • Refer the child to a pediatric nephrologist for hospitalization.

 

 

 

 

  • An adolescent has right­sided flank pain without fever. A dipstick urinalysis reveals

 

gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?

 

  • Extracorporeal shockwave lithotripsy (ESWL)

 

 

ID: 13348434109

 

ID: 13348434113

 

ID: 13348434111

 

ID: 13348434105

  • Increasing fluid intake up to 2 L daily

 

  • Percutaneous removal of renal calculi

 

  • Referral to a pediatric nephrologist

 

 

 

 

  • During a well child examination of a 2­year­old child, the primary care pediatric

 

nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the

 

midline. What is the next course of action that?

 

  • Order a CT scan of the chest, abdomen, and pelvis.

 

  • Perform urinalysis, CBC, and renal function tests.

 

  • Reevaluate the mass in 1 to 2 weeks.

 

  • Refer the child to an oncologist immediately.

 

 

 

 

  • A 6­month­old infant has a retractile testis that was noted at the 2­month well

 

baby exam. What will the primary care pediatric nurse practitioner do to manage this condition?

 

  • Reassure the parent that the testis will most likely descend into place on its own.

 

  • Refer the infant to a pediatric urologist or surgeon for possible orchiopexy.

 

  • Teach the parent to manipulate the testis into the scrotum during diaper changes.

 

  • Tell the parent that hormonal therapy may be needed to  the condition.

 

 

 

 

  • A 9­month­old infant is brought to the clinic with scrotal swelling and fussiness.

 

The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is

 

difficult to reduce. What is the  action?

 

  • Obtain an abdominal radiograph.

 

  • Refer immediately to a pediatric surgeon.

 

  • Schedule an appointment with a pediatric urologist.

 

  • Teach the parents signs of incarceration.

 

 

 

 

  • The mother of a 12­month­old uncircumcised male infant reports that the child

 

seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do?

 

  • Attempt to retract the foreskin to visualize the penis.

 

  • Order corticosteroid cream 3 times daily for 4 weeks.

 

  • Refer the child to a pediatric urologist.

 

  • Teach the mother to gently stretch the foreskin with cleaning.

 

  • · ID: 13348434117
  • An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea,

 

and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren’s sign). What will the nurse practitioner do?

 

  • Administer IM ceftriaxone and prescribe doxycycline twice daily for 10 days.

 

  • Encourage bed rest, scrotal support, and ice packs to the scrotum as tolerated.

 

  • Prescribe NSAIDs, limited activities, and warm compresses to the scrotum.

 

  • Refer the adolescent immediately to a pediatric urologist or surgeon.

 

 

Chapter   36

 

 

ID: 13348417456

 

ID: 13348417446

 

ID: 13348417452

 

ID: 13348417458

Questions

 

 

  • The primary care pediatric nurse practitioner needs to assess a potential hymenal

 

tear in a prepubertal female who is apprehensive about the exam. Which approach will the nurse

 

practitioner use?

 

  • Have the child sit frog­legged on the parent’s lap.

 

  • Place the child in the knee­chest position on the exam table.

 

  • Put the child supine on the exam table with her feet in the stirrups.

 

  • Refer the child for a speculum exam under sedation.

 

 

 

 

  • The primary care pediatric nurse practitioner is prescribing contraception for an

 

adolescent who has not used birth control previously. The adolescent has a normal exam and has no family history of cardiovascular and peripheral vascular disease or diabetes. Which preparation is used initially?

 

  • A combination oral contraceptive pills (OCP) with 30 to 35 mcg of estrogen and low progestin

 

  • A combination OCP with low androgenic potency, such as Ortho­Cyclen

 

  • A progestin­only mini­pill oral contraceptive

 

  • A subdermal implant contraception, such as Implanon or Nexplanon

 

 

 

 

  • An adolescent female tells the primary care pediatric nurse practitioner that she

 

had unprotected sexual intercourse 4 days prior and is worried she might become pregnant. What

 

will the nurse practitioner do?

 

  • Prescribe ulipristal acetate (Ella).

 

  • Recommend levonorgestrel (Plan B One Step).

 

  • Start a combination OCP at regular doses.

 

  • Suggest using the less expensive After Pill preparation.

 

 

 

 

  • A 4­year­old female who has had two urinary tract infections has persistent

 

dysuria and genital redness. The physical exam reveals a thin, flat membrane from the posterior fourchette almost to the clitoris. Which treatment is indicated?

 

  • Application of A&D ointment

 

  • Counseling about hygiene

 

  • Reassurance and observation

 

  • Use of estrogen­containing cream

 

 

 

 

 

  • A school­age female has had vulvovaginitis for 2 months. All cultures and tests ID: 13348417468

 

 

ID: 13348417450

 

ID: 13348417440

 

ID: 13348417448

 

ID: 13348417444

are negative, but the symptoms persist after treatment with both topical antibiotics and oral amoxicillin. What is the next course of action to treat this condition?

 

 

  • Estrogen cream at bedtime for 2 to 3 weeks

 

  • Referral to a pediatric gynecologist for further evaluation

 

  • Trimethoprim­sulfamethoxazole daily for 1 to 2 months

 

  • Workup for possible sexual abuse

 

 

 

 

  • A 16­year­old female reports dull, achy cramping pain in her lower abdomen

 

lasting 2 or 3 hours that occurs between her menstrual periods each month. The adolescent is not

 

sexually active. What is the treatment for this condition?

 

  • Abdominal ultrasound to rule out ovarian cyst

 

  • Oral contraceptives to suppress ovulation

 

  • Prostaglandin inhibitor analgesics and a heating pad

 

  • Referral to a pediatric gynecologist

 

 

 

 

  • A 17­year­old sexually active female who began having periods at age 14 reports

 

having moderate to severe dull lower abdominal pain associated predominantly with periods but that occurs at other times as well. The history reveals a recent onset of these symptoms. A pregnancy test is negative. Which course of action is most important?

 

 

  • Perform a full diagnostic workup to evaluate potential causes.

 

  • Prescribe a prostaglandin synthetase inhibitor.

 

  • Start a 3­ to 6­month trial of oral contraceptive pills.

 

  • Suggest using transcutaneous electrical nerve stimulation.

 

 

 

 

  • A 15­year­old female has a positive pregnancy test and asks the primary care

 

pediatric nurse practitioner not to tell her parents. She is tearful and says she isn’t sure she wants

 

to keep the baby. What will the nurse practitioner do first?

 

  • Determine the state­mandated reporting laws.

 

  • Encourage the adolescent to talk to her parents.

 

  • Obtain a social work consult to discuss adoption options.

 

  • Refer her to a prenatal care specialist for follow­up.

 

 

 

 

  • A 16­year­old female reports breast tenderness and a “lump.” The primary care

 

pediatric nurse practitioner palpates a small fluid­filled mass in her right breast. A pregnancy test is negative. Which action is ?

 

  • Obtain a CBC to rule out infection.

 

  • Order an ultrasound of the mass.

 

  • · ID: 13348417460
  • · ID: 13348417464
  • · ID: 13348417442
  • · ID: 13348417454
  • · ID: 13348417466
  • Prescribe NSAIDs to treat her discomfort.

 

  • Reassure her that the findings are normal.

 

 

 

 

  • A 16­year­old female has not had a menstrual period yet and is concerned. She

 

denies sexual activity. An exam reveals an adult sexual maturity rating. Which laboratory test will

 

the primary care pediatric nurse practitioner order initially?

 

  • Genetic test for Turner syndrome

 

  • Pituitary hormone tests

 

  • Pregnancy test

 

  • Thyroid function tests

 

 

 

 

  • An adolescent female has periods every 30 days that are consistently heavy and last from 5 to 8 days. What is her diagnosis?

 

  • Menometrorrhagia

 

  • Menorrhagia

 

  • Metrorrhagia

 

  • Polymenorrhea

 

 

 

 

  • An adolescent female has heavy periods that are also irregular. The physical

 

exam is normal. A complete blood count reveals a hemoglobin of 8.9 g/dL. What test will the

 

primary care pediatric nurse practitioner order next?

 

  • Coagulation studies

 

  • C­reactive protein

 

  • Thyroid function

 

  • Ultrasound of pelvis

 

 

 

 

  • A 14­year­old female has menometrorrhagia with moderate increase in menstrual flow and irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?

 

  • Iron supplementation and prostaglandin inhibitors

 

  • One OCP twice daily for 3 to 4 days and then daily

 

  • Progestin every day for 10 to 14 days

 

  • Referral to a pediatric gynecologist for treatment

 

 

 

 

  • A sexually active adolescent female tests positive for N. gonorrhoeae and C.

 

trachomatis. She tells the primary care pediatric nurse practitioner that she wants to be treated today since she is moving out of town the next day. What will the nurse practitioner order?

 

 

ID: 13348417462

  • Azithromycin 1 g PO in a single dose

 

  • Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each

 

  • Doxycycline 100 mg PO bid for 7 days

 

  • Erythromycin base 500 mg PO qid for 7 days

 

 

 

 

  • A 16­year­old sexually active female has a fever, bilateral lower abdominal pain,

 

and malaise. A speculum and bimanual exam reveals adnexal tenderness. The urinalysis is normal and cervical cultures are pending. What medications will the primary care pediatric nurse practitioner prescribe for this patient?

 

  • Azithromycin, doxycycline, and penicillin

 

  • Cefotaxime, azithromycin, and penicillin

 

  • Ceftriaxone, doxycycline, and metronidazole

 

  • Doxycycline, penicillin, and metronidazole

 

=

 

Chapter   37

 

 

ID: 13348425726

 

ID: 13348425744

ID: 13348425732

 

ID: 13348425748

 

ID: 13348425734

Questions

 

 

  • The primary care pediatric nurse practitioner is teaching a parent of a child

 

with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in

 

teaching?

 

  • Apply lubricating agents at least 1 hour after the bath.

 

  • Have the child soak in a lukewarm water bath.

 

  • Keep the child in the bath until the skin begins to “prune.”

 

  • Soaping should be done at the beginning of the bath.

 

 

 

 

  • A child will need an occlusive dressing to treat lichen simplex chronicus. What

 

will the primary care pediatric nurse practitioner tell the parents about applying this treatment?

 

  • Apply ointment before the dressing.

 

  • Plastic wrap should not be used.

 

  • The dressing should be applied to dry skin.

 

  • Change the dressing twice daily.

 

 

 

 

  • When prescribing topical glucocorticoids to treat inflammatory skin conditions, the primary care pediatric nurse practitioner will

 

  • initiate therapy with a high­potency glucocorticoid.

 

  • order lotions when higher potency is necessary.

 

  • prescribe brand­name preparations for consistent effects.

 

  • use fluorinated steroids to minimize adverse effects.

 

 

 

 

  • A pre­school age child has honey­crusted lesions on erythematous, eroded

 

skin around the nose and mouth, with satellite lesions on the arms and legs. The child’s parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated?

 

 

  • Amoxicillin 40 to 5 mg/kg/day for 7 to 10 days

 

 

  • Amoxicillin­clavulanate 90 mg/kg/day for 10 days

 

 

 

 

 

  • Bacitracin cream applied to lesions for 10 to 14 days

 

  • Mupirocin ointment applied to lesions until clear

 

 

 

 

  • A child is brought to clinic with several bright red lesions on the buttocks. The

 

primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an “orange peel” look and feel. The child is afebrile and does not appear toxic. What is the

 

 

ID: 13348425746

 

ID: 13348425724

 

ID: 13348425710

 

ID: 13348425742

course of treatment for these lesions?

 

  • Hospitalize the child for intravenous antibiotics and possible I&D of the lesions.

 

  • Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.

 

  • Obtain blood cultures prior to beginning antibiotic treatment.

 

  • Perform gram stain and culture of the lesions before initiating antibiotics.

 

 

 

 

  • An adolescent who recently spent time in a hot tub while on vacation has

 

discrete, erythematous 1­ to 2­mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition?

 

 

  • Culture the lesions and treat with appropriate IM antibiotics.

 

  • Hospitalize for incision and drainage and intravenous antibiotics.

 

  • Order an antistaphylococcal beta­lactamase­resistant antibiotic.

 

  • Prescribe topical keratolytics and topical antibiotics.

 

 

 

 

  • An infant is brought to clinic with bright erythema in the neck and flexural

 

folds after recent treatment with antibiotics for otitis media. What is the treatment for this

 

condition?

 

  • 1% hydrocortisone cream to affected areas for 1 to 2 days

 

  • Oral fluconazole 6 mg/kg on day 1, then 3 mg/kg/dose for 14 days

 

  • Topical keratolytics and topical antibiotics for 7 to 10 days

 

  • Topical nystatin cream applied several times daily

 

 

 

 

  • A school­age child has several annular lesions on the abdomen

 

characterized by central clearing with scaly, red borders. What is the first step in managing this

 

condition?

 

  • Fluoresce the lesions with a Wood’s lamp.

 

  • Obtain fungal cultures of the lesions.

 

  • Perform KOH­treated scrapings of the lesion borders.

 

  • Treat empirically with antifungal cream.

 

 

 

 

  • A child has several circular, scaly lesions on the arms and abdomen, some of

 

which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child’s scalp. How will the nurse practitioner treat this child?

 

  • Obtain scrapings of the lesions for fungal cultures.

 

  • Order prescription­strength antifungal creams.

 

  • · ID: 13348425750
  • · ID: 13348425722
  • · ID: 13348425738
  • Prescribe oral griseofulvin for 2 to 4 weeks.

 

  • Recommend OTC antifungal creams and shampoos.

 

 

 

 

  • A child is diagnosed with tinea versicolor. What is the management of ID: 13348425718 this disorder?

 

  • Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks

 

  • Oral antifungal treatment with fluconazole once weekly for 2 to 3 weeks

 

  • Sun exposure for up to an hour every day for 2 to 4 weeks

 

  • Using ketoconazole 2% shampoo on lesions twice daily for 2 to 4 weeks

 

 

 

 

  • An adolescent female has grouped vesicles on her oral mucosa. To

 

determine whether these are caused by HSV­1 or HSV­2, the primary care pediatric nurse

 

practitioner will order which test?

 

  • Direct fluorescent antibody test

 

  • Enzyme­linked immunosorbent assay

 

  • Tzanck smear

 

  • Viral culture

 

 

 

 

  • A 4­year­old child has clusters of small, clear, tense vesicles with an

 

erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment?

 

 

  • Mupirocin ointment applied to lesions 3 times daily

 

  • Oral acyclovir 20 to 40 mg/kg/dose for 7 to 10 days

 

  • Topical acyclovir applied to lesions 4 times daily

 

  • Topical diphenhydramine and magnesium hydroxide

 

 

 

 

  • A previously healthy school­age child develops herpes zoster on the lower

 

back. What will the primary care pediatric nurse practitioner do to manage this condition?

 

  • Order Burow solution and warm soothing baths as comfort measures.

 

  • Prescribe oral acyclovir 30 mg/kg/day in 4 doses/day for 5 days.

 

  • Recommend topical antihistamines to control itching.

 

  • Stress the need to remain home from school until the lesions are gone.

 

 

 

 

  • A child has small, firm, flesh­colored papules in both axillae which are mildly ID: 13348425752

pruritic. What is an acceptable initial approach to managing this condition?

 

 

ID: 13348425736

 

ID: 13348425706

 

ID: 13348425760

  • Application of trichloroacetic acid 25% to 50% using a dropper

 

  • Applying liquid nitrogen for 2 to 3 seconds to each lesion

 

  • Reassuring the parents that these are benign and may disappear spontaneously

 

  • Referral to a dermatologist for manual removal of lesions with curettage

 

 

 

 

  • A school­age child is brought to clinic after a pediculosis capitis infestation is

 

reported at the child’s school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?

 

  • Excoriated macules along the child’s collar and underwear lines

 

  • Inflammation and pustules on the face and neck

 

  • Itching of the scalp, with skin excoriation on the back of the head D.   Linear or S­shaped lesions in webs of fingers and sides of hands

 

 

 

 

 

 

  • A 3­year­old child has head lice. What will the initial treatment recommendation be to treat this child?

 

  • Lindane

 

  • Permethrin

 

  • Pyrethrin

 

  • Spinosad

 

 

 

 

  • A 9­month­old infant has vesiculopustular lesions on the palms and soles, on

 

the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and S­shaped burrow lesions on the parent’s hands and wrists. What is the treatment for this rash for this infant?

 

  • Ivermectin 200 mcg/kg for 7 to 14 days, along with symptomatic treatment for itching

 

  • Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours

 

  • Treatment of all family members except the infant with permethrin 5% cream and ivermectin

 

  • Treatment with permethrin 5% cream for 7 days in conjunction with ivermectin 200 mcg/kg

 

 

 

  • An adolescent has acne with lesions on the cheeks and under the chin. ID: 13348425708

Which distribution is this?

  • Athletic

 

 

 

ID: 13348425754

 

ID: 13348425758

 

ID: 13348425756

 

ID: 13348425714

  • Frictional

 

  • Hormonal

 

  • Pomadal

 

 

 

 

  • An adolescent has acne characterized by papules and pustules mostly on the

 

forehead and chin. What will the primary care pediatric nurse practitioner prescribe?

 

  • Azelaic acid applied daily at nighttime

 

  • Benzoyl peroxide applied twice daily

 

  • Topical erythromycin with benzoyl peroxide D.   Tretinoin applied nightly after washing the face

 

 

 

  • A child has an area of inflammation on the neck that began after wearing a

 

hand­knot woolen sweater. On examination, the skin appears chafed with mild erythematous

 

patches. The lesions are not pruritic. What is an appropriate initial treatment?

 

  • Application of a lanolin­based emollient

 

  • Burow solution soaks and cool compresses

 

  • Oral antihistamines given 4 times daily

 

  • Topical corticosteroids applied 2 to 3 times daily

 

 

 

 

  • An adolescent who had cradle cap as an infant is in the clinic with thick crusts

 

of yellow, greasy scales on the forehead and behind the ears. What will the primary care

 

pediatric nurse practitioner recommend?

 

  • Daily application of ketoconazole 2% topical cream

 

  • High­potency topical corticosteroids applied daily

 

  • Mineral oil and shampoo on the affected areas

 

  • Selenium sulfide shampoo twice weekly to the face

 

 

 

 

  • A child is brought to the clinic with a generalized, annular rash characterized

 

by raised wheals with pale centers. On physical examination, the child’s lungs are clear and there is no peripheral edema. A history reveals ingestion of strawberries earlier in the day. What is the initial treatment?

 

  • Aqueous epinephrine 1:1000 subcutaneously

 

  • Cetirizine once in clinic and then once daily for 2 weeks

 

  • Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours D.   Prednisone 1 to 2 mg/kg/day for 1 week with rapid taper

 

 

ID: 13348425716

 

 

 

ID: 13348425728

 

ID: 13348425740

 

ID: 13348425712

  • A child who has been taking antibiotics is brought to the clinic with a rash.

 

The parent reports that the child had a fever associated with what looked like sunburn and now has “blisters” all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do?

 

  • Consult with a pediatric intensivist for admission to a pediatric intensive care unit.

 

  • Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months.

 

  • Prescribe systemic antihistamines and antimicrobial medications as prophylaxis.

 

  • Recommend analgesics, cool compresses, and oral antihistamines for comfort.

 

 

 

 

  • A school­age child has a rash without fever or preceding symptoms. Physical

 

examination reveals a 3­cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a “Christmas tree” pattern on the child’s back. What is the initial action?

 

  • Obtain a KOH preparation of a skin scraping to verify the diagnosis.

 

  • Prescribe topical steroid creams to shorten the course of the disease.

 

  • Reassure the child’s parents that the rash is benign and self­limited.

 

  • Recommend topical antihistamines and emollients to control the spread.

 

 

 

 

  • A child who has psoriasis, who has been using a moderate­potency topical

 

steroid on thick plaques on the extremities and a high­potency topical steroid on more severe plaques on the elbows and knees, continues to have worsening of plaques. In consultation with a dermatologist, which treatment will be added?

 

 

  • Anthralin ointment in high strength applied for 10 to 30 minutes daily

 

  • Calcipotriol cream applied liberally each day to the entire body

 

  • Oral steroids and methotrexate therapy until plaques resolve

 

  • Wideband ultraviolet therapy for 15 minutes twice daily

 

 

 

 

  • During a well child examination of an infant, the primary care pediatric nurse

 

practitioner notes 10 café au lait spots on the infant’s trunk. What is the potential concern associated with this finding?

 

  • Endocrine disorders

 

  • Malignancy

 

  • Neurofibromatosis

 

  • Sturge­Weber syndrome

 

 

 

 

 

  • The primary care pediatric nurse practitioner notes velvety, brown thickening ID: 13348425730

 

 

ID: 13348425720

of skin in the axillae, groin, and neck folds of an adolescent Hispanic female who is

 

overweight. What is the initial step in managing this condition? A.   Consultation with a pediatric dermatologist

  • Performing metabolic laboratory tests

 

  • Prescribing topical retinoic acid cream

 

  • Referral to a pediatric endocrinologist

 

 

 

 

  • An African­American child has recurrent tinea capitis and has just developed

 

a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do?

 

  • Monitor CBC, LFT, and renal function during therapy.

 

  • Order oral prednisone daily for 5 to 14 days.

 

  • Perform fungal cultures on family members and pets.

 

  • Prescribe oral itraconazole or terbinafine.

 

 

 

 

Chapter   38

 

 

ID: 13348434151

 

ID: 13348434145

 

ID: 13348434141

 

ID: 13348434153

 

ID: 13348434137

Questions

 

 

  • A school­age child has a fractured wrist with a Salter­Harris Type II fracture, according to the radiologist. What is true about this type of fracture?

 

  • Growth disturbance of the long bones of the arm is likely.

 

  • There is a metaphyseal fragment on the compression side of fracture.

 

  • There is usually a compression or crushing injury to the physis.

 

  • This will require anatomic reduction using an open approach.

 

 

 

 

  • What will the primary care pediatric nurse practitioner elicit when obtaining a

 

positive Barlow maneuver when screening for developmental dysplasia of the hip?

 

  • Dislocation of an unstable hip

 

  • Dropping of the iliac crest with a raised leg

 

  • Reduction of a dislocated hip

 

  • Unequal knee heights in a supine child

 

 

 

 

  • A 3­year­old child is brought to the clinic by a parent who reports that the

 

child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do?

 

 

  • Consider maltreatment as a possible cause of injury.

 

  • Gently attempt a supination and flexion technique.

 

  • Immobilize the arm with a sling and refer to orthopedics.

 

  • Obtain a radiograph of the child’s right arm and elbow.

 

 

 

 

  • A school­age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed?

 

  • Application of a figure­eight clavicle brace for 6 to 8 weeks

 

  • Hospitalization for traction of the affected extremity and shoulder

 

  • Immobilization with a sling to support the affected extremity

 

 

  • Referral to an orthopedic specialist for possible surgical reduction

 

 

 

 

  • A young adolescent reports chest pain associated with coughing and lifting.

 

Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do?

 

 

ID: 13348434135

 

ID: 13348434155

 

ID: 13348434149

 

ID: 13348434147

  • Obtain a chest radiograph to evaluate possible causes for these symptoms.

 

  • Order an electrocardiogram to rule out potential cardiovascular disease.

 

  • Recommend NSAIDs, stretching exercises, and ice packs to the area.

 

  • Refer the child to a pediatric orthopedist for evaluation and treatment.

 

 

 

 

  • A young adolescent female is observed to have mild unequal scapula

 

prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do?

 

  • Discuss posture and exercise and ask about backpacks and books.

 

  • Obtain radiographic studies of the entire spine and neck.

 

  • Reassure the child’s parent that functional scoliosis will self­resolve.

 

  • Refer to an orthopedic specialist for evaluation and possible bracing.

 

 

 

 

  • The primary care pediatric nurse practitioner elicits positive Ortolani and

 

Barlow signs in a 6­month­old infant not previously noted in the medical record. What is the

 

treatment?

 

  • Pavlik harness

 

  • Spica cast

 

  • Surgical intervention

 

  • Triple diapering

 

 

 

 

  • A 14­year­old boy who is overweight develops a unilateral limp with pain in

 

the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child’s condition?

 

  • Place the child on crutches or in a wheelchair to prevent weight­bearing.

 

  • Provide information about weight loss to minimize further injury.

 

  • Recommend seeing an orthopedic specialist as soon as possible.

 

  • Refer the child to physical therapy to improve range of motion.

 

 

 

 

  • A parent is concerned that a 12­month­old child is “bow­legged.” A physical

 

examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the  action for the primary care pediatric nurse practitioner?

 

  • Observe the child’s condition over time to assess progression.

 

  • Order physical therapy to prevent progression of symptoms.

 

  • Reassure the parent that the child will outgrow this deformity.

 

  • · ID: 13348434143
  • · ID: 13348434139
  • Refer to a pediatric orthopedic specialist for treatment.

 

 

 

 

  • A child who plays soccer is in the clinic reporting pain and swelling in both

 

knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition?

 

  • Apply ice packs to both knees and avoid activities that cause pain.

 

  • Begin quadriceps­stretching exercises now to prevent further injury.

 

  • Obtain radiographic studies to rule out fractures or ligament tears.

 

  • Refer to a pediatric orthopedic specialist to evaluate the need for surgery.

 

 

 

 

  • During a well baby examination of a newborn, the primary care pediatric

 

nurse practitioner notes adduction of the right forefoot, with normal position of the mid­ and hind­foot, along with a convex­shaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity?

 

  • Grasp the heel with one hand and abduct the forefoot with the other hand.

 

  • Observe both legs for medial and lateral rotations.

 

  • Order anterior­posterior and lateral radiographs of both feet.

 

  • Refer the infant immediately to a pediatric orthopedic specialist.

 

 

 

 

 

Chapter   39

 

 

ID: 13348431647

 

ID: 13348431637

 

ID: 13348431639

 

ID: 13348431653

Questions

 

 

  • A child is brought to the clinic after falling from a swing and scraping both

 

knees and hands. An examination reveals abraded skin with oozing serous fluid and blood, along with dirt and grime from the playground surface. What will the primary care pediatric nurse practitioner do to minimize the risk of infection?

 

 

  • Apply povidone­iodine to all areas.

 

  • Irrigate gently with normal saline.

 

  • Rinse with hydrogen peroxide.

 

  • Scrub the abraded areas with alcohol.

 

 

 

 

  • A school­age child steps on a nail while wearing tennis shoes and develops

 

cellulitis in that foot. The child’s immunizations are up­to­date. What antibiotic will the pediatric

 

nurse practitioner empirically prescribe?

 

  • Amoxicillin­clavulanate

 

  • Ciprofloxacin

 

  • Clindamycin

 

  • Trimethoprim­sulfamethoxazole

 

 

 

 

  • A child has a 1­cm laceration on the forehead proximal to the hairline after

 

running into a pole while playing sports. To minimize the risk of infection, the primary care

 

pediatric nurse practitioner will irrigate the wound and

 

  • allow the wound to heal by secondary intention.

 

  • delay closure of the wound for several days.

 

  • refer the child to a plastic surgeon for wound closure.

 

  • suture the wound within 6 hours.

 

 

 

 

  • The primary care pediatric nurse practitioner is preparing to close a

 

laceration on a child’s forehead using topical skin adhesive. What is the  way to apply this product?

 

  • Apply the adhesive between the wound margins and then hold the edges together.

 

  • Apply the adhesive to the wound and then secure the edges with surgical tape.

 

  • Have the child remain still for 15 to 20 minutes after the adhesive is applied.

 

  • Hold the wound edges together and apply the adhesive on top of the skin.

 

 

 

 

 

  • A toddler is brought to the clinic after grabbing the hot end of his mother’s ID: 13348431641

 

 

ID: 13348431651

 

ID: 13348431643

 

ID: 13348431649

 

ID: 13348431645

curling iron. An examination reveals a pale, yellow burned area to the palm of one hand. What is true about this burn?

 

 

  • It may take up to 3 weeks to heal with scarring likely.

 

  • Scarring is unlikely, with healing expected in 3 to 7 days.

 

  • Surgical intervention and skin grafting are usually required.

 

  • This type of burn usually heals without scarring in 7 to 14 days.

 

 

 

 

  • A school­age child sustained a contusion on the front of one thigh while

 

playing football and reports some difficulty flexing his foot on the affected side. What will the primary care pediatric nurse practitioner do to treat this injury?

 

  • Place the child on crutches and limit weight­bearing until symptoms subside.

 

  • Prescribe acetaminophen with hydrocodone along with NSAIDs.

 

  • Recommend rest, ice packs, compression, and elevation of the extremity.

 

  • Refer the child to an orthopedic specialist for immediate evaluation and treatment.

 

 

 

  • A child is bitten on one arm by a neighbor’s dog. The dog is immunized

 

against rabies and the child’s last tetanus immunization was 4 years prior. The wound edges are gaping and avulsed. What is an important initial intervention when treating this injury?

 

  • Administration of rabies prophylaxis and a tetanus booster

 

  • Debriding and suturing the wound to prevent infection

 

  • Irrigation of the wounds with high­pressure normal saline

 

  • Reporting the animal bite to the local animal control authority

 

 

 

 

  • A child is brought to the clinic immediately after being stung by a wasp while

 

playing in the yard. The physical examination reveals localized redness and edema at the site, along with abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment?

 

 

  • Administer intramuscular epinephrine.

 

  • Apply a topical glucocorticoid cream.

 

  • Give oral diphenhydramine.

 

  • Order a bronchodilator treatment.

 

 

 

 

  • A child is bitten by a snake near a swimming pool in an area where

 

copperhead snakes are known to inhabit, although the parents cannot describe the snake. An examination of the bite reveals a severe local reaction at the site with edema and intense pain. What will the primary care pediatric nurse practitioner do first?

 

  • Administer narcotic analgesics to provide comfort.

 

  • Begin treatment with oral amoxicillin­clavulanate for 5 days.

 

  • Clean the wound and administer tetanus prophylaxis.

 

  • Transport the child by ambulance to a medical center.

 

 

 

 

 

Chapter   40

 

 

ID: 13348407670

 

ID: 13348407664

 

ID: 13348407668

 

ID: 13348407672

Questions

 

 

  • The primary care pediatric nurse practitioner is discussing newborn care with

 

parents prior to the delivery of their first child. What will the nurse practitioner tell them about circumcision?

 

  • Circumcision is a relatively painless procedure.

 

  • The benefits of the procedure outweigh the risks of the procedure.

 

  • There is a slight increase in penile cancer in circumcised males.

 

  • There is no good evidence to support the practice.

 

 

 

 

  • The primary care pediatric nurse practitioner performs a well baby exam on a

 

2­day­old infant and notes clusters of firm, yellow­white papules with a surrounding

 

erythematous flare. What will the nurse practitioner do?

 

  • Encourage frequent cleansing with mild soap.

 

  • Obtain a Wright­stained smear of the lesions.

 

  • Prescribe a topical antibiotic medication.

 

  • Reassure the parents that no treatment is necessary.

 

 

 

 

  • A well­baby examination of a 3­day­old infant born to a primigravida mother

 

reveals swelling on the right parietal area of the scalp that stops at the suture line. What action

 

will the primary care pediatric nurse practitioner take based on this finding?

 

  • Assess the infant for sacral dimpling.

 

  • Observe the infant for hyperbilirubinemia.

 

  • Obtain a computerized tomography scan.

 

  • Perform serum coagulation studies.

 

 

 

 

  • The parent of a 2­week­old 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,

 

  • antibiotic therapy is generally necessary to prevent severe infection.

 

  • home oxygen therapy is needed until the infant grows out of the condition.

 

  • recovery is usually complete with minimal intervention and treatments.

 

  • treatment with exogenous surfactant and mechanical ventilation is needed.

 

 

 

 

  • The parent of a 4­week­old infant reports that the infant began having ID: 13348407654

 

forceful vomiting 1 week prior, which has worsened over time. The infant continues to nurse

 

 

ID: 13348407660

 

ID: 13348407658

 

ID: 13348407656

 

ID: 13348407666

well but is losing weight. A physical examination reveals a 90­g weight loss over the past 2 weeks, dry mucous membranes, and a sunken fontanel. What will the primary care pediatric nurse practitioner do?

 

  • Encourage the mother to nurse the infant more frequently for shorter duration.

 

  • Obtain serum electrolytes and hospitalize for surgical intervention.

 

  • Recommend oral rehydration fluids for 24 to 48 hours to  dehydration.

 

  • Suggest trying a soy­based or hydrolyzed protein formula until vomiting resolves.

 

 

 

 

  • A 5­day­old 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?

 

  • Obtain a sweat chloride skin test to evaluate for possible cystic fibrosis.

 

  • Order an abdominal radiograph and refer the infant to a pediatric surgeon.

 

  • Prescribe glycerin suppositories to use as needed until bowel function is normal.

 

  • Suggest that the mother increase her fluid intake to help with constipation.

 

 

 

 

  • The parent of a 4­day­old 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?

 

  • Renal function will be abnormal and will require lifetime treatment.

 

  • Spontaneous resolution often occurs within 6 months to a year of age.

 

  • The affected kidney will be non­functional but the other kidney will compensate.

 

  • The infant will eventually require renal transplantation for that kidney.

 

 

 

 

  • A 2­month­old infant has increased head circumference from the 10th

 

percentile at the 2­week exam to the 30th percentile today. What will the primary care pediatric

 

nurse practitioner do?

 

  • Order a magnetic resonance imaging exam of the infant’s head.

 

  • Refer the infant immediately to a pediatric neurosurgeon.

 

  • Schedule frequent clinic visits to monitor head growth.

 

  • Watch the infant closely over time if the rest of the exam is normal.

 

 

 

 

  • A 3­day­old infant has a total serum bilirubin (TSB) level of 15.7 mg/dL after

 

having a TSB of 10.8 mg/dL 24 hours prior. The infant nursed 8 times, had 7 wet diapers, and passed 4 stools in the past 24 hours. What is the indicated treatment for this infant?

 

  • Admit to an inpatient setting for phototherapy and every­12­hour bilirubin monitoring.

 

  • · ID: 13348407662
  • Have the mother supplement with extra fluids and return to the clinic in 24 hours for a repeat TSB.

 

  • Recommend nursing every 2 hours, order a biliblanket, and recheck TSB in 24 hours.

 

  • Suspend breastfeeding for 24 to 72 hours and have the mother save pumped breast milk.

 

 

 

  • The primary care pediatric nurse practitioner is performing a well­baby

 

examination on a 7­day­old infant born to a Chlamydia­positive 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?

 

  • Administer a single dose of intramuscular ceftriaxone.

 

  • Obtain bacterial cultures of both conjunctivae.

 

  • Prescribe prophylactic erythromycin suspension.

 

  • Schedule a follow­up appointment in 1 week.

 

 

 

 

Chapter   41

 

Questions

 

 

  • What is true about haploid cells? ID: 13348407644

 

  • Each contains 23 paired chromosomes.

 

  • Each one contains 23 chromosomes.

 

  • Replication produces two identical cells.

 

  • They replicate via the process of mitosis.

 

 

 

 

 

  • What does the following genetic notation symbol mean 47,XX,6q­?

 

 

 

 

 

ID: 13348407650

 

 

  • Male with deletion of chromosome 6

 

  • Female with deletion of chromosome 6

 

  • Male with deletion on the long arm of chromosome 6

 

 

  • Female with deletion on the long arm of chromosome 6

 

 

 

 

 

 

 

 

  • A child has a recessive genetic disorder that is homozygous for that mutation. ID: 13348407646

What is most likely about this child’s parents?

  • Neither parent has a copy of that gene mutation.
  • Only the mother has a copy of that gene mutation.
  • Only the father has a copy of that gene mutation.
  • Each parent has one copy of that gene mutation.

 

 

 

 

  • Which type of mutation is responsible for many single­gene genetic disorders? ID: 13348407636
  • Copy number variations
  • Nucleotide repeat expansions
  • Point mutations
  • Single nucleotide polymorphisms (SNP)

 

 

 

 

  • Cystic fibrosis is a recessive disease requiring the presence of a gene mutation ID: 13348407638

on both alleles inherited from the parents. Which type of genetic disorder is this?

  • Chromosome
  • Mitochondrial
  • Monogenetic
  • Multifactorial

 

 

 

ID: 13348407642

 

ID: 13348407648

  • The primary care pediatric nurse practitioner is counseling a couple about genetic

 

risks and learns that one parent has neurofibromatosis, an autosomal dominant disorder, and the other parent does not. What will the nurse practitioner include when discussing this disorder and its transmission?

 

  • Children must inherit a gene from both parents to develop the disease.

 

  • Each child born to this couple will have a 50% risk of having the disease.

 

  • This type of disorder characteristically skips generations.

 

  • Unaffected offspring may still pass on the disease to their offspring.

 

 

 

 

  • A family medical history conducted during a well baby exam for a newborn girl

 

reveals that hemophilia A, an X­linked recessive disorder, is present in males in three previous generations in the mother’s family, whose father had the disease. What will the primary care pediatric nurse practitioner tell the parents about the risk of this disease in their children?

 

  • All of their sons will be affected by the disease.

 

  • Any sons they have will not be affected by the disease.

 

  • Daughters have a 50% chance of being carriers of the disease.

 

  • Their daughter has a 25% chance of having the disease.

 

 

 

 

  • What is an important responsibility of the primary care pediatric nurse practitioner ID: 13348407634 to help determine genetic risk factors in families?

 

  • Assessing physical characteristics of genetic disorders

 

  • Knowing which genetic screening tests to perform

 

  • Making appropriate referrals to pediatric geneticists

 

  • Obtaining a three­generation pedigree for each family

 

 

 

 

  • Which diagnostic study may be ordered when the provider wishes to detect the ID: 13348407632

presence of additional genetic material on a chromosome?

  • Chromosomal microarray
  • FISH

 

 

  • Karyotype

 

  • Molecular testing

 

 

 

 

  • Which type of testing will the primary care pediatric nurse practitioner recommend ID: 13348407640 for a couple concerned about the potential for having children with cystic fibrosis?

 

  • Biochemical testing

 

  • Carrier testing

 

  • FISH testing

 

  • Karyotype testing

 

 

Chapter   42

 

 

ID: 13348431667

 

ID: 13348431669 in this child?

 

ID: 13348431661

Questions

 

 

  • What has been the result of passage of the Toxic Substances Control Act ID: 13348431673

(TSCA) of 1976?

 

  • A mandate for corporations to disclose known toxic chemicals

 

  • A requirement that all manufactured chemicals undergo toxicity testing

 

  • Authorization of the EPA to require testing and reporting of some chemicals

 

  • Development of a mechanism to report reactions to toxic chemicals

 

 

 

 

  • Many European nations use the “precautionary principle” to help regulate ID: 13348431665

potentially toxic chemicals. What does this mean?

 

  • Chemicals must be proven to be safe before being introduced into the environment.

 

  • Corporations may be exempt from testing if their costs in doing so are too high.

 

  • Regulators must demonstrate risk to the public before banning a chemical.

 

  • Without a strong risk, corporations need not release data about their products.

 

 

 

 

  • During a clinic visit, a child’s rapid capillary screening test for lead reveals a

 

level of 11 mcg/dL. What will the primary care pediatric nurse practitioner do next?

 

  • Institute lead abatement measures in the child’s home.

 

  • Monitor lead levels monthly until decreased.

 

  • Order a venous sample to test for lead levels.

 

  • Test the child’s siblings and parents for lead.

 

 

 

 

  • A child has a lead level of 25 mcg/dL. Once lead abatement measures are instituted, what is an important intervention to help prevent permanent damage

 

  • Chelation therapy

 

  • Dietary changes

 

  • Follow­up testing

 

  • Testing family members

 

 

 

 

  • A child whose parent works in a factory presents with swelling of the

 

extremities, pain and weakness in the pelvis, and an erythematous maculopapular rash. Which industrial toxin will the primary care pediatric nurse practitioner suspect in this child?

 

  • Lead

 

 

ID: 13348431671

 

ID: 13348431657

 

ID: 13348431659

 

ID: 13348431663

  • Mercury

 

  • Organophosphates

 

  • Phthalates

 

 

 

 

  • When counseling a mother who smokes about preventing exposure to

 

smoking­related risks to her nursing newborn, what will the primary care pediatric nurse practitioner tell her?

 

  • If she quits now, her child will not have long­term effects from exposure.

 

  • Prenatal smoke exposure does not cause respiratory effects after the infant is born.

 

  • Smoking outdoors or near an open window prevents exposure to tobacco smoke.

 

  • Third­hand smoke exposure risks may last for years even if the mother quits

 

now.

 

 

 

 

  • A child who has been playing in a public park is brought to the clinic with

 

wheezing, vomiting, diarrhea, and drooling. A physical exam reveals a low heart rate and diaphoresis. What will the primary care pediatric nurse practitioner suspect as a cause for these symptoms?

 

 

  • Arsenic consumption

 

  • Lead poisoning

 

  • Organophosphate exposure

 

  • Phthalate ingestion

 

 

 

 

  • A parent asks about ways to limit exposure to risks associated with plastics.

 

Besides avoiding using plastic containers when possible, what else will the primary care

 

pediatric nurse practitioner recommend?

 

  • Avoid heating foods and liquids in plastic containers.

 

  • Clean plastic containers well using the dishwasher.

 

  • Use only plastics stamped with “#7” on the bottom.

 

  • Used canned food products whenever possible.

 

 

 

 

  • A parent desires to buy only organic produce to avoid exposing a child to

 

pesticides but complains that these foods are expensive. The primary care pediatric nurse practitioner provides a list of foods that are relatively safe whether they are organic or not. Which foods are on this list?

 

  • Apples, celery, and peaches

 

  • Potatoes, cherry tomatoes, and peaches

 

  • Strawberries, grapes, and cucumbers

 

  • Sweet corn, cantaloupe, and kiwi

 

 

 

 

 

Chapter   43

 

 

ID: 13348431679

 

ID: 13348431685

 

ID: 13348431691

 

ID: 13348431677

 

ID: 13348431681

Questions

 

 

  • The primary care pediatric nurse practitioner is performing a medication history

 

on a child and learns that the child’s parents use various complementary treatments and remedies for the child. According to the American Academy of Pediatrics standard for providers, what will the nurse practitioner do?

 

  • Evaluate the safety and efficacy of each product and monitor use.

 

  • Incorporate these therapies into standard care practices.

 

  • Recommend not using the products until the child is older.

 

  • Suggest that most of these treatments are not safe for children.

 

 

 

 

  • According to the 2007 NHIS analysis of the use of CAM therapy, use was higher among

 

  • families whose parent or parents had a college education.

 

  • Hispanic and African­American populations.

 

  • persons who had not recently taken prescription medications.

 

  • those living in households earning less than $65,000.

 

 

 

 

  • The parent of a child who has numerous allergies reports using herbal remedies

 

to help treat the child because they are “natural” products. What will the primary care pediatric

 

nurse practitioner suggest to this parent about using these products?

 

  • Brand­name herbal products have been tested for efficacy.

 

  • Natural ingredients are usually safe for use in children.

 

  • There are few interactions between drugs and supplements.

 

  • Use single­herb supplements whenever possible.

 

 

 

 

  • Which label on a CAM therapy product verifies that a product meets standards for

 

contamination, adulteration, manufacturing processes, and pharmacologic properties?

 

  • Generally Recognized as Safe (GRAS)

 

  • National Sanitation Foundation International (NSF)

 

  • Natural Products Association (NPA)

 

  • United States Pharmacopeia (USP)

 

 

 

 

  • The parent of a newborn reports using echinacea for family members to help

 

treat viral illnesses and feels that it is usually effective. What will the primary care pediatric nurse practitioner tell this parent?

 

  • That echinacea has no known therapeutic effects and should not be given

 

 

ID: 13348431683

 

ID: 13348431687

 

 

  • That the supplement should not be given to children under 2 years of age

 

  • To give half the recommended adult dose until the child is 5 years old

 

  • To wait until the infant is at least 1 month old before giving this product

 

 

 

 

  • A child has wheat allergies and continues to have problems in spite of consuming

 

a diet without breads and cereals. What will the primary care pediatric nurse practitioner caution the parents to look for on product labels that may indicate wheat products are present in foods?

 

  • Casein

 

  • Malt

 

  • Miso

 

  • Whey

 

 

 

 

  • An adolescent will begin taking the combination oral contraceptive pill (OCP).

 

Which supplement will the primary care pediatric nurse practitioner caution the adolescent to avoid while taking OCPs?

 

  • Ginkgo

 

  • Kava

 

  • St. John’s wort

 

 

  • Valerian

 

 

Chapter   44

 

 

 

ID: 13348434163

 

ID: 13348434165

 

ID: 13348434167

 

ID: 13348434161

Questions

 

 

  • The primary care pediatric nurse practitioners who own a private nurse

 

practitioner–only practice wish to establish a satellite clinic in another part of the city after an analysis has determined that a need exists to serve a previously underserved population. What part of the business plan will these nurse practitioners revisit to guide this development?

 

  • Market analysis

 

  • Organizational chart

 

  • Strategic plan

 

  • Vision statement

 

 

 

 

  • The primary care pediatric nurse practitioner is interested in providing school­

 

based health­promotion services to children in inner city schools as a potential service. What

 

is the first step in developing such a program?

 

  • Describing the strategic plan

 

  • Developing an organizational chart

 

  • Formulating a vision statement

 

  • Performing a market analysis

 

 

 

 

  • When opening a new practice, two primary care pediatric nurse practitioners

 

obtain national practice identification numbers, federal tax employer identification numbers,

 

and business licenses to satisfy which part of the operations plan?

 

  • Financial policies

 

  • Financial reporting

 

  • Legal and governance operations

 

  • Retention of records

 

 

 

 

  • A private pediatric practice participates in the “meaningful use” program

 

managed by the state Medicaid program. Which is an example of a clinical quality measure associated with Stage 3 of meaningful use?

 

  • Development of an electronic prescribing system

 

  • Evaluating emergency department use in patients who have asthma action plans

 

  • Providing a patient portal to give access to medical information

 

  • Using electronic algorithms to enhance evidence­based decision­making

 

  • · ID: 13348434159
  • ID: 13348434169
  • · ID: 13348434171
  • The primary care pediatric nurse practitioner inserts a wick into the ear canal

 

of a patient who has otitis externa. When reporting this for medical billing, the nurse

 

practitioner will identify the

 

  • CMS code for the diagnosis.

 

  • CPT code for the diagnosis.

 

  • CPT code for the wick insertion.

 

  • ICD code for the wick insertion.

 

 

 

 

  • Why is it necessary to establish a “work week” for a practice?

 

  • To calculate benefits

 

  • To determine salaries and wages

 

  • To develop patient scheduling software

 

  • To help calculate overtime

 

 

 

 

  • A pediatric practice uses the patient­centered medical home (PCMH) model when providers

 

  • act as gatekeepers to decide when and where other services are provided.

 

  • assists adolescent children with special needs to find adult care providers.

 

  • encourages families to seek specialty services when possible to improve care.

 

  • establishes satellite clinics in local neighborhoods to increase practice revenue.

 

 

 

 

 

 

 

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