Burns Pediatric 4,,Peds Exam 1 Weeks 2/3 CH 4, 5, 6, 7, 8, Peds test 1, Exam 1 Week 1 CH 10, 12, 13, 22, NR602 Pediatric Midterm Study Set, Burns Ch. 7: Development Management of School-Age Children, PNP Exam Questions, Exam 2 Pediatrics 21,22,24,25,26,

1. 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? a. Reassure them that the child is too young to understand. b. Recommend that they continue to not argue in front of the child. c. Suggest counseling to learn ways to handle stress. d. Tell them that the conflict will resolve when the situation changes. - Answer ANS: C Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period. 2. The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? a. Consult a developmental specialist for a more complete evaluation. b. Prepare the parents for a potentially serious developmental disorder. c. Refer the infant to an early intervention program for physical therapy. d. Teach the parents to provide exercises to encourage motor development. - Answer ANS: D The child who has mild delays in only one area may be managed initially by having the parent provide appropriate exercises. If this is not effective, or if delays become more severe, referrals for evaluation or early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so this action is not indicated. 3. 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? a. Ask the parents if they have an individualized family service plan (IFSP). b. Consult with a physician to ensure the child gets appropriate care. c. Inform the family that services are provided when the child begins school. d. Refer the family to a social worker for assistance with referrals and services. - Answer ANS: A Families with children who have developmental delays are eligible for early intervention services and should have IFSPs in place. This family may have one from their previous community, and it can be used as a starting point to determine needs. It is not necessary to consult with a physician to coordinate community resources. Early intervention is provided from birth, according to federal law. Until the specific referrals are known, the social worker is not consulted. 4. 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? a. Explain to the parent that developmental delays often do not manifest at first. b. Perform a developmental assessment and tell the parent which delays are evident. c. Point out the tasks that the infant can perform while conducting the assessment. d. Refer the infant to a developmental specialist for a complete evaluation. - Answer ANS: C When discussing developmental delays with parents, it is important to be positive and to initially focus on strengths. Explaining that developmental delays develop over time is true but does not reassure the parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and may take time. 5. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3-year-old child who draws on the walls with crayons? a. Give the child washable markers so the drawings can be removed easily. b. Provide a roll of paper for drawing and teach the child to use this. c. Put the child in "timeout" each time the child draws on the walls. d. Take the crayons away from the child to prevent the behavior. - Answer ANS: B Discipline involves training or education that molds appropriate behavior and is used to teach the child what is permitted and encouraged. Providing an appropriate outlet for drawing helps to teach the child where to use the crayons. Using washable markers allows the parents to clean the walls but does not teach the child appropriate behaviors. Timeout and taking away the crayons are forms of punishment, or a loss of privileges, that are administered as a form of retribution. 6. The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old 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. a sign that the mother has postpartum depression. b. extremely concerning for potential parental neglect. c. of moderate concern for parenting problems. d. within the normal range of behavior in early parenthood. - Answer ANS: C A parent who seems disinterested in a child raises moderate concerns for parenting problems. It does not necessarily signal postpartum depression. It is not a mark for extreme concern. It is not within the expected range of behaviors. 7. During a well child assessment of an 18-month-old 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? a. Allow the parent to put the child in a "timeout." b. Ask the parent about usual discipline practices. c. Offer the child a book or a toy to look at. d. Stop the exam since the child has reached a "meltdown." - Answer ANS: C The child has exhibited early signs of misbehavior. At this stage, distraction and active engagement may be used to stop more problems from occurring. It is not necessary to use a timeout because the child hasn't reached the point where cooperation is impossible. The PNP should model appropriate interventions by offering the child a distraction and may ask the parent about discipline practices later in the visit. The child is not at a "meltdown" state. 8. The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old 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? a. To begin brushing the infant's teeth with toothpaste b. To consider weaning the infant from breastfeeding c. To discontinue giving fluoride supplements d. To make an appointment for an initial dental examination - Answer ANS: D The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued. 9. 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? a. Care coordination and collaboration b. Developing protocols for parents to follow c. Monitoring individual education plans (IEPs) d. Providing lists of resources for families - Answer ANS: A Care coordination is one of the key elements for children with special health care needs. PNPs are especially suited for this role and have the unique skills to function as care coordinators. Care for these children should involve shared decision making and individualized care and not "cookbook" approaches. The PNP may advocate for children's health care needs for the IEP but does not monitor these. The PNP should not just give parents lists of phone numbers but should assist them to make appointments. 10. 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 : a. developing consistent daily routines for the child. b. exposing her child to extended family members when possible. c. not working outside the home during the first few years. d. taking her child to regular play date activities with other children - Answer ANS: A Providers can teach parents that providing predictable, consistent, and loving care helps an infant to learn trust and help influence positive brain development. Involving extended family members and going to play dates are good ways to socialize children but are not essential to learning trust. It may not be possible for her to be a stay-at-home mother. 1. 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 A. developing consistent daily routines for the child. B. exposing her child to extended family members when possible. C.not working outside the home during the first few years. D.taking her child to regular play date activities with other children. - Answer A. developing consistent daily routines for the child. 2. 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? A.Reassure them that the child is too young to understand. B.Recommend that they continue to not argue in front of the child. C.Suggest counseling to learn ways to handle stress. D.Tell them that the conflict will resolve when the situation changes. - Answer C.Suggest counseling to learn ways to handle stress. 3. 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? A.Allow the parent to put the child in a "timeout." B.Ask the parent about usual discipline practices. C.Offer the child a book or a toy to look at. D.Stop the exam since the child has reached a "meltdown." - Answer C.Offer the child a book or a toy to look at. 4. 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? A.Give the child washable markers so the drawings can be removed easily. B.Provide a roll of paper for drawing and teach the child to use this. C.Put the child in "timeout" each time the child draws on the walls. D.Take the crayons away from the child to prevent the behavior. - Answer B.Provide a roll of paper for drawing and teach the child to use this. 5. The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? A.Consult a developmental specialist for a more complete evaluation. B.Prepare the parents for a potentially serious developmental disorder. C.Refer the infant to an early intervention program for physical therapy. D.Teach the parents to provide exercises to encourage motor development. - Answer D.Teach the parents to provide exercises to encourage motor development. 6. 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? A.Explain to the parent that developmental delays often do not manifest at first. B. Perform a developmental assessment and tell the parent which delays are evident. C. Point out the tasks that the infant can perform while conducting the assessment. D. Refer the infant to a developmental specialist for a complete evaluation. - Answer C. Point out the tasks that the infant can perform while conducting the assessment. 7. 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? A. Ask the parents if they have an individualized family service plan (IFSP). B. Consult with a physician to ensure the child gets appropriate care. C. Inform the family that services are provided when the child begins school. D. Refer the family to a social worker for assistance with referrals and services. - Answer A. Ask the parents if they have an individualized family service plan (IFSP). 8. 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? A. Care coordination and collaboration B. Developing protocols for parents to follow C. Monitoring individual education plans (IEPs) D. Providing lists of resources for families - Answer A. Care coordination and collaboration 9. 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? A. To begin brushing the infant's teeth with toothpaste B. To consider weaning the infant from breastfeeding C. To discontinue giving fluoride supplements D. To make an appointment for an initial dental examination - Answer D. To make an appointment for an initial dental examination 10. 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. a sign that the mother has postpartum depression. B. extremely concerning for potential parental neglect. C. of moderate concern for parenting problems. D. within the normal range of behavior in early parenthood. - Answer C. of moderate concern for parenting problems. 1. 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? A. Cognitive learning begins during the toddler years. B. Intellectual growth begin when speech develops. C. Language and literacy skills begin at birth. D. Preschool is an optimal time to begin general learning. - Answer C. Language and literacy skills begin at birth. 2. 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 correct? A. Follow up at the 2month checkup. B. Refer to a lactation consultant. C. Schedule a weight check in 1 week. D. Suggest supplementing with formula. - Answer C. Schedule a weight check in 1 week A healthy newborn is expected to lose 7% to 10% of the birth weight, but should regain that weight within the first 2 weeks or so after birth. During their first month, most newborns gain weight at a rate of about 1 ounce (30 grams) per day. 3. 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? A. Continuing to nurse the infant using the current pattern B. Nursing the infant for longer periods every 4 hours C. Supplementing with formula at the last nighttime feeding D. Waking the infant every 2 hours to nurse during the night - Answer A. Continuing to nurse the infant using the current pattern A healthy newborn is expected to lose 7% to 10% of the birth weight, but should regain that weight within the first 2 weeks or so after birth. During their first month, most newborns gain weight at a rate of about 1 ounce (30 grams) per day. 4. 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? A. She may not be making as much breastmilk as before. B. She should keep a log of the frequency and duration of each feeding. C. The infant may be going through an expected growth spurt. D. The infant should stay on the previously established nursing schedule. - Answer C. The infant may be going through an expected growth spurt. 5. 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? A. Her baby is probably constipated. B. It may be related to her dietary intake. C. She should consume more water. D. This may be normal for breastfed babies. - Answer D. This may be normal for breastfed babies. 6. 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? A. Appropriate ways to stimulate and entertain the infant B. How to read the infant's cues for over stimulation C. The importance of scheduling "play dates" with other infants D. To provide musical toys to engage the infant - Answer B. How to read the infant's cues for over stimulation 7. 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? A. The infant may be expressing a desire to play or to rest. B. The parent should give ibuprofen for teething pain before nursing. C. This is an indication that the infant is ready for solid foods. D. This may indicate gastrointestinal discomfort such as constipation. - Answer A. The infant may be expressing a desire to play or to rest. 8. 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? A. "At this age, your baby does not understand the meaning of sounds." B. "Babies at this age cannot make the 'ma' sound." C. "Most sounds made by babies at this age are accidental." D. "This may mean that your baby doesn't hear well." - Answer A. "At this age, your baby does not understand the meaning of sounds." 9. 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? A. Provide educational videos that focus on language. B. Read simple board books to the infant at bedtime. C. Sing to the child and play lullabies in the baby's room. D. Turn the television to Sesame Streetduring the day. - Answer B. Read simple board books to the infant at bedtime. 10. 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? A. Perform an indepth developmental assessment. B. Reassure the parent that this is normal for a premature infant. C. Refer the infant to a developmental specialist. D. Suggest activities to improve fine motor skills. - Answer A. Perform an indepth developmental assessment. 1. 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? A. Ask the child's parents whether they read to the child. B. Give parents educational materials to encourage speech. C. Refer the child to an early intervention program. D. Suggest that they purchase ageappropriate music videos. - Answer A. Ask the child's parents whether they read to the child 2. 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 correct? A. Evaluate the child's cognitive abilities. B. Obtain a hearing evaluation. C. Reassure the parent that this is normal. D. Refer the child to a speech therapist. - Answer C. Reassure the parent that this is normal. 3. 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 A. holophrastic speech. B. receptive speech. C. semantic speech. D. telegraphic speech. - Answer D. telegraphic speech. 4. 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 Spanish speaking 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? A. Children who learn two languages simultaneously often confuse them in conversation. B. Children with multilanguage proficiency do not understand that others cannot do this. C. Learning two languages at an early age prevents children from developing a dominant language. D. Most bilingual children are able to shift from one language to another when appropriate. - Answer D. Most bilingual children are able to shift from one language to another when appropriate. 5. 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? A. Allow the child to explore and experiment while providing appropriate limits. B. Be present while the child plays to continually teach the child what is appropriate. C. Let the child experiment at will and to make mistakes in order to learn. D. Say "no" whenever the child does something that is not acceptable. - Answer A. Allow the child to explore and experiment while providing appropriate limits 6. The mother of a 3yearold child takes the child to a play group once a week. 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? A. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. B. The toddler may have a language delay that interferes with socialization with other children. C. Toddlers may be interested in other children but usually do not engage in interactive play. D. Toddlers need more structured play to encourage interaction and socialization with others. - Answer C. Toddlers may be interested in other children but usually do not engage in interactive play. 7. 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? A. Animism B. Artificialism C. Egocentrism D. Realism - Answer D. Realism 8. 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? A. "Begin by reading to your child about toileting." B. "Most children are capable by age 2 years." C. "Tell me about your child's daily habits." D. "We should assess your child's motor skills." - Answer C. "Tell me about your child's daily habits." 9. 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? A. To begin brushing the infant's teeth with toothpaste B. To consider weaning the infant from breastfeeding C. To discontinue giving fluoride supplements D. To make an appointment for an initial dental examination - Answer D. To make an appointment for an initial dental examination 10. 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? A. Allow the child to choose foods for meals to improve caloric intake. B. Place a variety of nutritious foods on the child's plate at each meal. C. Prepare mashed potatoes and chicken strips for the child at mealtimes. D. Suggest cutting out snacks to improve the child's appetite at mealtimes. - Answer B. Place a variety of nutritious foods on the child's plate at each meal. 1. 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 A. about school performance and grades. B. why school is so distressing. C. to name one or two friends. D. whether bullying is taking place. - Answer C. to name one or two friends. 2. 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 A. children at this age who prefer interactions with samegender peers usually have a homosexual orientation. B. children experiment with sexuality at this age as a means of deciding later sexual orientation. C. this attachment to other same gender children is how the child learns to interact with others. D. to encourage mixedgender interactions in order to promote development of sexual values. - Answer C. this attachment to other same gender children is how the child learns to interact with others. 3. 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? A. Allowing the child to make poor choices and accept consequences is important for learning values B. Children at this age have a high regard for authority and social norms, so this is not likely to happen C. Moral values instilled in the early schoolage period will persist throughout childhood D. The pressures from outside influences may supersede parental teachings and should be confronted - Answer ? D. The pressures from outside influences may supersede parental teachings and should be confronted 4. 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? A. Ask the child and the parent about stressors at home B. Make a referral to a child behavioral specialist C. Provide information about anger management D. Suggest consideration of a different classroom - Answer A. Ask the child and the parent about stressors at home 5. The primary care pediatric nurse practitioner is preparing to conduct a well child assessment of an 8yearold child. How will the nurse practitioner begin the exam? A. Ask the child about school, friends, home activities, and sports B. Discuss the purpose of the visit and explain the procedures that will be performed C. Offer age appropriate information about usual developmental tasks D. Provide information about healthy nutrition and physical activities - Answer A. Ask the child about school, friends, home activities, and sports 6. 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? A. Behavioral and Emotional Screening System for Children (BESS2) B. Behavioral Assessment for Children - 2nd ed. (BASC2) C. Conner's 3 Parent and Teacher Rating Scale D. Pediatric Symptom Checklist (PSC) - Answer C. Conner's 3 Parent and Teacher Rating Scale 7. 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? A. Allowing the child opportunities to discuss feelings about the baby B. 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 - Answer C. Having snack time with the child each day to discuss the school day 8. A schoolage child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent? A. Allow the child to make food choices since this is usually a phase B. Ensure that the child has three nutritious meals and two nutritious snacks each day C. Prepare vegetables separately for the child to encourage adequate intake D. Teach the child how important it is to eat healthy fruits and vegetables - Answer B. Ensure that the child has three nutritious meals and two nutritious snacks each day 9. 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? A. Discuss setting clear expectations about selfcare with the mother B. Give the child information about sleep and selfcare C. Reassure the mother that this "noncompliance" is temporary D. Tell the mother that experimenting with selfcare behaviors is normal - Answer A. Discuss setting clear expectations about selfcare with the mother 10. 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? A. Adherence to daily family routines and regular activities B. Having two older siblings who attend the same school C. Parental concerns about bullying in the school D. The child's ability to recognize four different colors - Answer C. Parental concerns about bullying in the school 11. 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 A. About the timing of the symptoms each day and during the week B. How well the child performs in school and in extracurricular activities C. If the parent feels a strong need to protect the child from problems D. Whether there are any unusual stressors or circumstances at home - Answer A. About the timing of the symptoms each day and during the week 12. 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 correct? A. Encourage the child to keep a log of pain, stool patterns, and dietary intake B. Order radiologic studies and laboratory tests to rule out systemic causes C. Reassure the child and encourage resuming sports when symptoms subside D. Refer the child to a counselor to discuss anxiety about health problems - Answer A. Encourage the child to keep a log of pain, stool patterns, and dietary intake 1. 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? A. The age of the mother's menarche B. The patient's age at thelarche C. When adrenarche occurred D. Whether linear growth has stopped - Answer B. The patient's age at thelarche 2. 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 correct? A. Perform biometric screening to determine lean body mass. B. Prescribe oral contraceptives pills to regulate her periods. C. Reassure her that this is perfectly normal at her age. D. Refer her to an endocrinologist for hormonal evaluation. - Answer A. Perform biometric screening to determine lean body mass. 3. 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 A. alcohol and tobacco use. B. changes in voice. C. increase in height and weight. D. participation in sports. - Answer D. participation in sports. 4. 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? A. Adolescence is marked by an inability to comprehend complex situations. B. Adolescence is typically marked by tempestuous and transient episodes. C. Adolescents normally have extreme, disruptive conflicts with parents. D. Adolescents often need counseling to help them cope with life events. - Answer D. Adolescents often need counseling to help them cope with life events. 5. 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? A. Earlymaturing girls need to identify with older adolescents to feel a sense of belonging. B. Girls who join an older group of peers may become sexually active at an earlier age. C. Spending time with older adolescents indicates a healthy adjustment to her maturing body. D. The association with older adolescents will help her daughter to gain social maturity. - Answer B. Girls who join an older group of peers may become sexually active at an earlier age. 6. 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? A. Apparent hypocrisy B. Imaginary audience C. Overthinking D. Personal fable - Answer A. Apparent hypocrisy 7. 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? A. Provide the teen with a questionnaire to gain information about his sexuality. B. Remind the adolescent that mandatory reporting requires disclosure to parents. C. Suggest that the adolescent discuss sexual concerns with his parents. D. Tell the adolescent that, unless he is at risk, what he says will be confidential. - Answer D. Tell the adolescent that, unless he is at risk, what he says will be confidential. 8. 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? A. Counseling for emotional problems B. Development of an Individual Education Plan C. Evaluation for possible learning disorders D. Referral for a behavioral disorder - Answer C. Evaluation for possible learning disorders 9. 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? A. Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent. B. Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake. C. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. D. Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home. - Answer C. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. 11. 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? A. Ecigarette use may be a risk factor for later substance abuse. B. Experimentation with ecigarettes does not lead to future tobacco use. C. Most teens who experiment with tobacco usually do not become addicted. D. This form of nicotine ingestion is safer than regular cigarettes. - Answer A. Ecigarette use may be a risk factor for later substance abuse. 12. 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? A. Cutting is a way of dealing with emotional distress. B. It is a method of fitting in with other adolescents. C. The behavior is common and will usually stop. D. This type of behavior is a type of suicide attempt. - Answer A. Cutting is a way of dealing with emotional distress. 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? - Answer Health perception The primary care pediatric nurse practitioner examines an infant whose weight is below the 3rd percentile and whose mother does not comply with 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? - Answer Ask the grandmother about her daughter's health during childhood 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? - Answer Formal-operational stage The primary care pediatric nurse practitioner is counseling an obese adolescent whose parents both have type 2 diabetes mellitus. Which health behavior prediction useful when the nurse practitioner discusses lifestyle changes with this client? - Answer Health belief model The primary care pediatric nurse practitioner is counseling a school-age child about asthma management strategies. Teh 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 self-efficacy model to teach this child about asthma management? - Answer Obtaining pre- and post-treatment spirometry testing 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? - Answer Contemplation The primary care pediatric nurse practitioner sees a 17 year old 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: - Answer suggest that the teen considered taking up a sport or other physical activity. The primary care pediatric nurse practitioner is working with a 12 year old 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 correct? - Answer Help the child develop a strategy to remember without parental prompts. The primary care pediatric nurse practitioner is counseling an obese 16 year old client about weight management. The adolescent says, "I know I need to lose weight, but I don't want to give up all my favorite foods." When using motivational interviewing techniques, how will the nurse practitioner respond? - Answer Do you think there are any foods you could limit or do without for a while? 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? - Answer Explore ways that the parent can use this extra energy to do things for the baby. 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? - Answer SMOG The pediatric nurse practitioner provides primary care for a special needs infant whose parents 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 the parent? - Answer Ask the parent to read back all the information given. Which region globally has the highest infant mortality rate - Answer sub-saharan Africa The primary care pediatric nurse practitioner understands that, to achieve the greatest world-wide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? - Answer Vaccinations Which is true about the health status of children in the United States? - Answer Obesity rates among 2- to 5- year olds have shown a recent significant decrease. The primary care pediatric nurse practitioner understands that a major child health outcome associated with worldwide climate change is - Answer nutrition 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 Pediatrics Recommendations for Preventative Pediatric Health Care guidelines by: - Answer scheduling well baby visits to coinside with key developmental milestones The primary care pediatric nurse practitioner is evaluating a 2 year old 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? - Answer Ask the child's parents whether they read to the child. The primary care pediatric nurse practitioner performs a developmental assessment on a 32 month old child. The child's parent reports and 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 correct? - Answer Reassure the parent that this is normal During a well child assessment of an 18 month old 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: - Answer telegraphic speech The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12 month old child. The parents are bilingual in Spanish and English and have many Spanish-speaking 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? - Answer 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? - Answer Allow the child to explore and experiment whale providing appropriate limits. The mother of a 3-year old child takes the child to a play group once a week. 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? - Answer Toddlers may be interested in other children but usually do not engate in interactive play. The parent of a 4 year old 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 preschool-age children? - Answer Realism The parent of a 24 month old child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? - Answer Tell me about your child's daily habits. The primary care pediatric nurse practitioner performs a physical examination on a 9 month old 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 forma a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? - Answer To make an appointment for an initial dental examination. The parents of a 3 year old 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 and 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? - Answer Place a variety of nutritious foods on the child's plate at each meal. The parent of a newborn infant asks the NP when to intervene to help the infant's future intellectual growth. What will the NP tell the parent? - Answer Language and literacy skills begin at birth The NP performs a well baby examination on a 7 day old infant who is nursing well, according to the mother. The NP 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 the visit. Which action is correct? - Answer Schedule a weight check in 1 week. During an assessment of a 4 week old infant the NP learns that a breast fed infant nurses every 2 hours during the day but is able to sleep for a 4 hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the NP recommend? - Answer Continue the nurse the infant using the current pattern The NP is performing a well baby examination on a 2 month old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the NP that her infant seems fussy and wants to nurse more often. What will the NP tell her? - Answer The infant may be going though an expected growth spurt. The mother of a 6 week old breastfeeding infant tells the NP that her baby, who previously had bowel movements with each feeding, now has a BM once every third day. What will the NP tell her? - Answer This may be normal for breastfed babies. The mother of a 3 month old child tells the NP that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for the NP to teach this mother? - Answer How to read the infant's cues for over stimulation. The parent of a 5 month old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the NP tell this parent? - Answer The infant may be expressing the desire to play or rest. The mother of a 6 month old infant is distressed because the infant can say "dada" but not "mama" and asks the NP why this is when she is the one who spends more time with the infant. How will the NP respond? - Answer At this age, your baby does not understand the meaning of sounds. The NP is performing a well child examination on a 9 month old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the NP recommend to the parents to improve speech and language skills in this infant? - Answer Read simple board books to the infant at bedtime. The NP is examining a 12 month old 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 NP do first? - Answer Perform an in-depth developmental assessment. The NP is performing a well child assessment on a 13 year old female whose mother asks when her daughter's periods may start. Which information will the NP use to help estimate the onset of periods? - Answer The patents' age at thelarche The NP is examining a 15 year old 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 correct? - Answer Perform biometric screening to determine lean body mass. During a well child assessment of a 13 year old male, the NP notes small testicles and pubic and axillary hair. To further evaluate these findings, the NP will as the patient about. - Answer participation in sports. The mother of a 16 year old male was recently divorced after several years of an abusive relationship and tells the NP 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 NP tell this mother? - Answer Adolescents often need counseling to help them cope with life events The NP is performing a well child exam on a 12 year old female who has achieved early sexual maturation. The mother reports that she spends ore time with her older sister's friends instead of her own classmates. What will the NP tell this parent? - Answer Girls who join an older group of peers may become sexually active at an earlier age. The mother of a 15 year old adolescent female tells the NP 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? - Answer Apparent hypocrisy The NP 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 NP make in this situation? - Answer Tell the adolescent that, unless he is at risk, what he says will be confidential. The parent of a 14 year old child tells the NP 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 NP recommend? - Answer Evaluation for possible learning disorders. The parent of a 14 year old child tells the NP 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 NP tell the parent? - Answer Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. The NP is performing a well child exam on a 17 year old 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 NP do? - Answer Provide information about piercing and encourage continued discussion. The parent of a 16 year old tells the NP that the teen was recently caught smoking an electronic cigarette. What will the NP tell this parent. - Answer E-cigarette use may be a risk factor for later substance abuse. 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 NP tell this parent? - Answer Cutting is a way of dealing with emotional distress. The NP is examining a 6 year old 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 NP will first ask the child: - Answer to name one or two friends The parent of a 10 year old boy tells the NP 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 NP will tell the parent: - Answer this attachment to other same-gender children is how the child learns to interact with others The parents of a 12 year old 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 NP tell the parent? - Answer the pressures from outside influences may supersede parental teachings and should be confronted. During a well child exam of a school-age child, the NP learns that the child has been having angry episodes at school. The NP observes the child to appear withdrawn and sad. Which action is appropriate? - Answer Ask the child and the parent about stressors at home. The NP is preparing to conduct a well child assessment of an 8 year old child. How will the NP begin the exam? - Answer Ask the child about school, friends, home activities, and sports. The parent of a 6 year old expresses concern that a child may have ADHD. Which screening tool will the NP use to evaluate this possibility? - Answer Conner's 3 Parent and Teacher Rating Scale The parent of a 5 year old child who has just begun kindergarten expresses concern that the child will have difficulty adjusting to the birth of a sibling. What will the NP recommend? - Answer Having snack time with the child each day to discuss the school day. A school-age child has begun refusing all cooked vegetables. What will the NP recommend to the parent? - Answer Ensure that the child has three nutritious meals and two nutritious snacks each day. The NP performs a physical examination on a 12 year old child and notes poor hygiene and inappropriate clothes for the weather. The child's mother appears clean and well dressed. The child reports getting 6-7 hours of sleep each night because of texting with friends late each evening. What action by the NP will help promote healthy practices/ - Answer Discuss setting clear expectations about self-care with the mother. During a well child exam on a 5 year old child, the NP assesses the child for school readiness. Which finding may be a factor in limiting school readiness for this child? - Answer Parental concerns about bullying in the school The NP is examining a school-age 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 preceding with further diagnostic tests, what will the NP initially ask the parent? - Answer About the timing of the symptoms each day and during the week. The NP is evaluating recurrent stomach pain in a school-age child. The child's exam is normal. The NP learns that the child reports pain most evening 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 correct? - Answer Encourage the child to keep log of pain, stool patterns, and dietary intake. The NP is teaching a parent of a child with dry skin about hydrating the skin with bathing. What will the NP include in teaching? - Answer Have the child soak in lukewarm water bath.. A child will need an occlusive dressing to treat lichen simplex chronicus. What will the NP tell the parents about applying this treatment? - Answer Apply ointment before the dressing. When prescribing topical glucocorticoids to treat inflammatory skin conditions, the NP will: - Answer prescribe brand-name preparations for consistent effects. A pre-school age child has honey-crusted 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 similar rash. How will his be treated? - Answer Amoxicillin-clavulanate 90 mg/kg/day for 10 days A child is brought to clinic with several bright red lesions on the buttocks. The NP 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 course of treatment for these lesions? - Answer Initiate empiric antibiotic therapy and follow up in 24 hours to assess response. An adolescent who recently spent time in a hot tub while on vacation has discrete erythematous 1- to 2- mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the NP manage this condition? - Answer Prescribe topical keratolytics and topical antibiotics. An infant is brought to the 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? - Answer Topical nystatin cream applied several times daily. A school-age 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. - Answer Treat empirically with antifungal cream. A child has several circular, scaly lesions on the arms and abdomen, some of which have central clearing. The NP notes a smaller, scaly lesion on the child's scalp. How will the NP treat this child? - Answer Prescribe oral griseofulvin for 2 to 4 weeks. A child is diagnosed with tinea versicolor. What is the correct management of this disorder? - Answer Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks. An adolescent female has grouped vesicles on her oral mucosa. To determine whether these are called by HSV-1 or HSV-2 the primary care pediatric nurse practitioner will order which test? - Answer Viral culture A 4 year old 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 NP recommend as treatment? - Answer Topical diphenhydramine and magnesium hydroxide A previously healthy school-age child develops herpes zoster on the lower back. What will the NP do to manage this condition? - Answer Order burrow solution and warm soothing aths as comfort measures. A child has small, firm, flesh-colored papules in both axillae which are mildly puritic. What is an acceptable initial approach to managing this condition? - Answer Reassuring the parents that these are benign and may disappear spontaneously. A school-age child is brought to clinic after a pediculosis capitis infestation is reported at the child's school. If the child is positive, what will the NP expect to find on physical examination, along with live lice near the scalp? - Answer Itching of the scalp with skin excoration on the back of the head. A 3 year old child has head lice. What will the initial treatment recommendation be to treat this child? - Answer Permethrin A 9 month old infant has vesiculopustular lesion on hte palms and soles, on the face and neck, and in skin folds of the extremities. The NP notes linear and S shaped burrow lesions on the parent's hands and wrist. What is the treatment for this rash for this infant? - Answer Permethrin 5% cream applied to face, neck and body and rinsed off in 8 to 14 hours. An adolescent has acne with lesions on the cheeks and under the chin. What distribution is this? - Answer Hormonal An adolescent has acne characterized by pap