Exam (elaborations) TEST BANK PEDIATRIC PRIMARY CARE 6TH EDITION BURNS, DUNN, BRADY

TEST BANK PEDIATRIC PRIMARY CARE 6TH EDITION BURNS, DUNN, BRADY Questions 1. 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 A. emotional control. B. flexibility. Correct C. inhibition. D. problemsolving. 2. 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 A. executive function. Correct B. information processing. C. sensory processing. D. social cognition. 3. 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 A. about friends and activities at school. Correct B. if balancing sports and homework is difficult. C. to interpret material from a pie chart. D. to restate the content of something just read. 4. 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? A. 504 Correct B. FAPE C. IDEA D. IEP 5. The parent of a child diagnosed with ADHD tells the primary care pediatric ID: 44 ID: 38 ID: 42 ID: 32 ID: 34 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 Correct B. Effort C. Emotion D. Focus 6. 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 B. Moderatedose stimulant Correct C. Lowdose nonstimulant D. Moderatedose nonstimulant 7. 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 B. Overresponder Correct C. Sensory seeker D. Underresponder 8. 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? A. Establishing a reward system for acceptable behaviors B. Introducing the child to a variety of new experiences C. Maintaining predictable routines as much as possible Correct D. Providing frequent contact, such as hugs and cuddling 9. 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? A. Administer an MCHAT screen to screen the child for communication and ID: 46 ID: 28 ID: 24 ID: 26 socialization delays. B. Ask the parent to describe the child’s earlier behaviors from infancy through preschool. Correct C. Reassure the parent that if symptoms weren’t present earlier, the likelihood of autism is low. D. Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management. 10. 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? A. Attentiondeficit/ hyperactivity disorder B. Autism spectrum disorder Correct C. Executive function disorder D. Sensory processing disorder 11. 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. A lowdose stimulant medication B. A nonstimulant medication C. Behavioral therapy only D. Cardiovascular prescreening Correct 12. 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? A. Adding an alphaagonist medication B. Changing to a nonstimulant medication C. Continuing the medication as prescribed Correct D. Stopping the medication immediately Continue ID: 40 ID: 36 ID: 30 Questions 1. 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 A. considerably more time in each encounter. B. improved patient health outcomes. Correct C. less PNP involvement in health care decisions. D. lower provider and higher patient satisfaction. 2. 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? A. An asthma action plan B. Effects and side effects of current medications Correct C. Information about spirometry testing D. Instructions for medications at school 3. 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? A. Admit the child to the hospital for close observation and monitoring of respiratory status. B. Encourage the parent to call when concerned and schedule a followup appointment the next day. Correct C. Perform a complete blood count, blood cultures, and a chest radiograph to evaluate symptoms. D. Reassure the parent that the child has a normal exam and is most likely not ill. 4. Which characteristic is the key criterion that identifies a child has having special ID: 80 needs? A. Cognitive function B. Emotional health C. Health service requirements Correct D. Medical diagnosis ID: 64 ID: 82 ID: 86 5. 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? A. Careful monitoring of attainment of developmental milestones Correct B. Familiarizing the parent with laws that mandate educational support C. Providing genetic counseling to the infant’s parents D. Referral to social services for assistance with resources 6. 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 A. allow the mother to express her feelings, understanding that she is experiencing grief. Correct B. reassure the mother that special educational opportunities are available for her child. C. suggest that the mother find a support group with other children with special needs. D. tell her that most schools provide services for children with special health care needs. 7. 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? A. Inform the mother that, since other options have failed, the gastrostomy tube is the only option. B. Refer the child to a dietician to teach the mother the importance of adequate nutrition. C. Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight. Correct D. Suggest that the gastrostomy tube may be tried temporarily and removed once the child gains weight. 8. 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? A. Assessing the parent’s ability to perform home care tasks B. Coordinating services to ensure continuity of care Correct C. Monitoring the family’s adherence to the health care plan ID: 92 ID: 66 ID: 90 ID: 74 D. Ordering medications and other prescribed treatments 9. 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? A. Abdominal ultrasound B. Computed tomography C. Conventional radiograph Correct D. Magnetic resonance imaging 10. 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? A. Administer a parenteral antibiotic and antipyretic and send the infant home. B. Admit the infant to an inpatient hospital unit for overnight monitoring. C. Give the parents sick care instructions and follow up in the clinic in the morning. Correct D. Send the infant to the urgent care center for intravenous fluids. 11. 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? A. Demonstrate oral medication administration with the toddler in the office. Correct B. Instruct the parent to hide the medication in a favorite food or beverage. C. Order the medication to be given via another route if possible. D. Tell the parent to offer the child a reward each time the medication is taken. 12. 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 A. confirm the medical diagnosis for the child’s parents. B. make recommendations for disease management. Correct C. stress the importance of adherence to the medication regimen. D. take over management of this child’s chronic illness. ID: 88 ID: 84 ID: 72 ID: 76 13. 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 encryptionprotection platform installed. If the nurse practitioner misplaces the mobile device, it is important to A. disconnect the user from the system to avoid a data breach. Correct B. notify the families that their messages may be read by others. C. obtain a new device as soon as possible to resume communication. D. upload the messages from another remote device. 14. 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? A. Administering an antipyretic medication B. Bringing the child to the clinic for evaluation C. Offering extra fluids and calling if symptoms change Correct D. Ordering outpatient lab work such as a CBC 15. 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? A. Allow the child to go to preschool. Correct B. Bring the child to the clinic for a culture. C. Keep the child home for 2 days. D. Use antibiotic eyedrops for 3 days.. 16. 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? A. Administer oral fluids in the clinic. B. Admit the infant to the hospital. Correct C. Order outpatient laboratory tests. D. Send the infant home with close followup. E. F. ID: 68 G. H. ID: 78 I. J. ID: 70 K. L. ID: 94 Questions 1. 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? A. Conduct pediatric drug studies to determine whether the drug is safe and effective in children. Correct B. Provide labeling stating that the safety and efficacy of the drug is not established for children. C. Receive a patent extension for conducting pediatric studies to determine use in children. D. Survey existing data about the drug to determine potential use in the pediatric population. 2. 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 A. access the BPCA website. B. call the PREA hotline. C. log onto the FDA Medwatch website. Correct D. use the AAP online PediaLink program. 3. 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: A. less often or at a lower dose. Correct B. more often or at a higher dose. C. via a parenteral route. D. via the oral route. 4. 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? A. Discuss recommendations with the parents and document their consent. Correct B. Document anecdotal reports of previous use of the drug by other providers. ID: 07 ID: 01 ID: 09 ID: 05 C. Follow up daily with the parents to determine safe administration of the drug. D. Report this use to the FDA Medwatch website for tracking purposes. 5. 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 twicedaily 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? A. Ask the adolescent to identify two times each day that may work better. Correct B. Consider having the school nurse supervise medication administration. C. Prescribing a daily oral corticosteroid medication instead. D. Suggest that the parent enforce the medication regimen each day. 6. 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 A. order an antiviral medication and schedule a followup appointment. B. prescribe a broadspectrum antibiotic until the lab results are received. C. teach the parents symptomatic care and order labs to help with the diagnosis. Correct D. write a prescription for an antibiotic to be given if the child’s condition worsens. 7. 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? A. Administer an intramuscular antibiotic. B. Order twicedaily amoxicillin for 5 days. C. Prescribe azithromycin once daily for 5 days. Correct D. Reinforce the need to adhere to the plan of care. 8. 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? A. Recommend that the child go to the school nurse when symptoms start. B. Review the child’s asthma action plan and possibly increase his steroid dose. C. D. ID: 03 E. F. ID: 99 G. H. ID: 11 I. J. ID: 13 C. Suggest asking the school to excuse the child from gym class. D. Write the prescription for two metereddose inhalers with spacers. Correct Continue Questions 1. 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 B. Neuropathic pain Correct C. Somatic pain D. Visceral pain 2. 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? A. Ask the child to rate pain intensity on a 4to 5item pain discrimination scale. B. Have the child describe any pain as “no pain, a little pain, or a lot of pain.” Correct C. Question the child about the intensity and specific location of any pain. D. Rely on nonverbal responses such as facial expressions and limb movements. 3. 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? A. Assess the child’s vital signs and ability to walk without pain. Correct B. Refill the prescription for a narcotic analgesic medication. C. Suggest that the parents give acetaminophen for mild pain. D. Teach the parent to give analgesics based on the child’s report of pain. 4. 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? A. Comfort scale B. FLACC scale C. NCCPCR Correct D. Nonverbal observations ID: 27 ID: 25 ID: 21 ID: 17 5. The primary care pediatric nurse practitioner