Pediatrics Final Exam Review with complete solutions.

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? a. Antibiotics b. Optimal nutrition c. Vaccinations d. Water purification c. Vaccinations What is an important responsibility of the primary care pediatric nurse practitioner to help determine genetic risk factors in families? a. Assessing physical characteristics of genetic disorder. b. Knowing which genetic screening tests to perform. c. Making appropriate referrals to pediatric geneticists. d. Obtaining a three-generation pedigree for each family. d. Obtaining a three-generation pedigree for each family. All of the following are suitable interventions for a child diagnosed with several complex health conditions EXCEPT? a. Maintaining the child's routine vaccinations as well as a yearly flu shot. b. Providing diagnosis and treatment for the child's acute onset of ear fullness and pain. c. Providing an explanation regarding the use and care of the client's respiratory support equipment. d. Discussing the expected physical implications of puberty with the patient's parents. XXXXXXXXXXX What has been the result of passage of the Toxic Substances Control Act (TSCA) of 1976? a. A mandate for corporations to disclose known toxic chemicals. b. A requirement that all manufactured chemicals undergo toxicity testing. c. Authorization of the EPA to require testing and reporting of some chemicals. d. Development of mechanism to report reactions to toxic chemicals. c. Authorization of the EPA to require testing and reporting of some chemicals. Which type of testing will the primary care pediatric nurse practitioner recommend for a couple concerned about the potential for having children with cystic fibrosis? a. Biochemical testing b. Carrier testing c. FISH testing d. Karyotype testing b. Carrier testing Many European nations use the "precautionary principle" to help regulate potentially toxic chemicals. What does this mean? a. Chemicals must be proven to be safe before being introduced into the environment. b. Corporations maybe exempt from testing if their costs in doing so are too high. c. Regulators must demonstrate risk to the public before banning a chemical. d. Without a strong risk, corporations need not release data about their products. a. Chemicals must be proven to be safe before being introduced into the environment. The primary care pediatric nurse practitioner (PNP) prescribes a twice daily inhaled corticosteroid for a 12-year-old 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 client-centered care? a. Asking the child to describe usual daily routines and schedules b. Referring the family to a social worker to help with medication compliance c. Reviewing the asthma action plan with the parent and the child d. Teaching the child how the medication will help to control asthma symptoms a. Asking the child to describe usual daily routines and schedules What is the foundational basis of patient-and-family centered care (PFCC)? a. The family is to be considered when patient care is being planned b. The patient has ultimate control over health care decisions. c. A family member acts as the patient's surrogate decision maker. d. The patient is the focus of the primary care providers attention. b. The patient has ultimate control over health care decisions. Which is true about the health status of children in the United States? a. Globalism has relatively little impact on child health measures in the U.S. b. Obesity rates among 2 to 5 years old have shown a recent significant decrease. c. The rate of household poverty is lower than in other economically developed nations. d. Young children who attend preschool or day care have higher food insecurity b. Obesity rates among 2 to 5 years old have shown a recent significant decrease. What is the criteria for Supplemental Security Income (SSI) approval? a. The existing impairment is chronic b. The impairment is life threatening c. The family is unable to cover health care costs d. The child is a ward of the state b. The impairment is life threatening Which region globally has the highest infant mortality rate? a. Indonesia b. Southern Asia c. SubSaharan Africa d. Syria b. Southern Asia Which complex health condition is the result of chromosomal defect causing varied physical and emotional symptoms? a. Cerebral Palsy b. Prader-Willi Syndrome c. Cystic Fibrosis d. Diabetes b. Prader-Willi Syndrome The primary care pediatric nurse practitioner understands that a major child health outcome associated with worldwide climate change is: a. Cost of living b. Education c. Nutrition d. Pollution c. Nutrition 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? a. Asking community members to assist in researching and implementing a program b. Designing a community garden approach that involves children and their parents c. Gaining support from the corporate community to provide needed resources d. Providing evidence-based information about the importance of a healthy diet a. Asking community members to assist in researching and implementing a program 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 implement what intervention to help with communication? a. Ask the sponsor to allow the family to respond. b. Develop the plan of care and ask the sponsor to make sure it is followed. c. Request that the sponsor translate written instructions for the family. d. Use the telephone interpreter service to communicate with the family. d. Use the telephone interpreter service to communicate with the family. 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 implement what intervention to help with communication? a. Ask the sponsor to allow the family to respond. b. Develop the plan of care and ask the sponsor to make sure it is followed. c. Request that the sponsor translate written instructions for the family. d. Use the telephone interpreter service to communicate with the family. d. Use the telephone interpreter service to communicate with the family. Support for a child with complex health issues may require the use of what high level tech equipment? a. Urinary catheter b. Enteral feeding pump c. A handheld magnifier d. Crutches b. Enteral feeding pump 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? a. Giving health care advice that takes cultural differences into account b. Identification of other cultures that may be superior to one's own culture c. Receptivity to learning about the perspectives of other cultures d. Respecting other cultures while maintaining the views of one's own c. Receptivity to learning about the perspectives of other cultures 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 Preventive Pediatric Health Care Guidelines by: a. Focusing less on development and more illness prevention and nutrition. b. Following guidelines established by the Bright Futures publication c. Scheduling well baby visits to coincide with key developmental milestones. d. Seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due. c. Scheduling well baby visits to coincide with key developmental milestones. What is the greatest barrier to securing home health care for a child with complex medical needs? a. Shortage of trained service providers b. Reimbursement for needed skilled nursing services c. Parent resistance to accepting such service d. Acquiring the necessary service related referral b. Reimbursement for needed skilled nursing services The primary care pediatric nurse practitioner is examining a child whose parents recently emigrated from a war-torn country in the Middle East. Which is a priority assessment when performing the patient history? a. Asking about physical, psychological, and emotional trauma b. Determining the parents' English language competency and literacy level c. Learning about cultural preferences and complementary medicine practices d. Reviewing the child's previous health and illness records a. Asking about physical, psychological, and emotional trauma 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? a. Ask about the types of practices used and when they are applied. b. Provide a list of harmful herbs and ask the family to avoid those. c. Suggest that the family avoid using these remedies in their children. d. Tell the parents to use the herbs in conjunction with modern medications. a. Ask about the types of practices used and when they are applied. 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? a. CRAFFT b. Ecomap c. Genogram d. Pedigree c. Genogram 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? a. Complementary medicines, alternative health practices, and chief complaint b. Developmental delays, nutritional status, and linear growth patterns c. Medication currently taking, allergy information, and family medical history d. Speech and language development, beliefs about health and previous illnesses d. Speech and language development, beliefs about health and previous illnesses What is the strongest predictor of health regarding the pediatric patient? a. The early identification of existing health problems b. Health literacy of the parent(s) and/or caregiver(s) c. Access to specialized healthcare professionals d. Past experience with same of similar health issues b. Health literacy of the parent(s) and/or caregiver(s) 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 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 school age period will persist throughout childhood d. The pressures from outside influences may supersede parental teachings and should be confronted d. The pressures from outside influences may supersede parental teachings and should be confronted The primary care pediatric nurse practitioner 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 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 a. About the timing of the symptoms each day and during the week The primary care pediatric nurse practitioner 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 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. c. to name one or two friends. 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? a. Empower the child to make decisions and assume more responsibilities. b. Help the child identify skills and activities that he is good at. c. Spend time each evening helping the child with homework to improve grades. d. Work with the teacher to set appropriate limits on school behavior. b. Help the child identify skills and activities that he is good at. 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? a. Children who learn two languages simultaneously often confuse them in conversation. b. Children with Multi-language 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. d. Most bilingual children are able to shift from one language to another when appropriate. A parent who encourages competitiveness in a child who excels at a single sport but not in others may also encourage a sense of which characteristic? a. competence. b. insecurity. c. significance. d. worthiness. b. insecurity. The primary care pediatric nurse practitioner 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 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. c. The infant may be going through an expected growth spurt. A school-age 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? a. "I didn't play well on the day of the tryouts." b. "I'll just have to find another sport I'm good at." c. "I'll need to work more on my outside shot." d. "I'm probably too short to be really good at this sport." c. "I'll need to work more on my outside shot." 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: a. Holophrastic speech b. Receptive speech c. Semantic speech d. Telegraphic speech d. Telegraphic speech The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool-age child. How will the nurse practitioner assess this? a. Ask the child how many books he has at home. b. Ask the mother about her highest grade in school. c. Ask the mother to determine the correct dose of a drug from a label. d. Ask the mother to read a health information handout aloud. a. Ask the child how many books he has at home. 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? a. Dwelling on negatives b. Expecting too much c. Negating the child's feelings d. Stereotyping and typecasting d. Stereotyping and typecasting The primary care pediatric nurse practitioner is evaluating a 16-year-old 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 a. body image. b. personal identity. c. role performance. d. selfesteem. d. selfesteem. The parent of an adolescent female tells the primary care pediatric nurse practitioner that the child may be the victim of cyber-bullying at school but won't talk about it with her parents. What is the nurse practitioners initial response? a. Ask about the adolescent's school performance and friends. b. Interview the adolescent separately from the parent. c. Reassure the parent that suicide is a rare response to bullying. d. Suggest that the parent discuss this with the school counselor. b. Interview the adolescent separately from the parent. The mother of a 16-year-old 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. d. Adolescents often need counseling to help them cope with life events. The primary care pediatric nurse practitioner is performing a well child exam on a 12 year old 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. Early maturing 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 daughterto gain social maturity. b. Girls who join an older group of peers may become sexually active at an earlier age. 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. c. Point out the tasks that the infant can perform while conducting the assessment. 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. c. Language and literacy skills begin at birth. The primary care pediatric nurse practitioner is performing an examination on a 2-year-old 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? a. Evaluation of financial resources, medical insurance, and access to health care and medications b. Providing a list of websites and communitybased support groups for grandparents parenting grandchildren c. Referral to a social worker to help the child deal with emotional conflict related to separation from the parent d. Teaching the grandparent about the need for consistency in routines and discipline for the child a. Evaluation of financial resources, medical insurance, and access to health care and medications The primary care pediatric nurse practitioner is performing a well child exam on a 17 year old female whose mother is present during the history. The mother expresses concernthat her daughter wishes to have an eyebrow piercing and states that she is opposed to the idea. What will the nurse practitioner do? a. Provide information about piercings and encourage continued discussion. b. Remind the adolescent that her mother is responsible for her health. c. State that piercings are relatively harmless and are an expression of individuality. d. Suggest that she wait until she is 18 years old and can make her own decisions. a. Provide information about piercings and encourage continued discussion. When providing well child care for an infant in the first year of life, the primary care pediatric nurse practitioner demonstrates an understanding of the current guidelines when taking what action? a. Focusing less on development and more illness prevention and nutrition. b. Following guidelines established by the Bright Futures publication c. Scheduling well baby visits to coincide with key developmental milestones. d. Seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due. c. Scheduling well baby visits to coincide with key developmental milestones. The parent of a 14 year old 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 behavioral disorder c. Evaluation for possible learning disorders 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. a. Cutting is a way of dealing with emotional distress. The primary care pediatric nurse practitioner is examining a 15 year oldfemale 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 actionis 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 a. Perform biometric screening to determine lean body mass Which assessment findings suggest that the neonate is demonstrating stabilization of physiological functions? a. Temperature: 97.7° F b. Heart rate: 200 bpm c. Systolic pressure: 100 mm Hg d. Respiratory rate: 28 breaths/minute a. Temperature: 97.7° F The primary care pediatric nurse practitioner learns that the mother of a 3-year-old 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? a. Fine motor b. Gross motor c. Social/emotional d. Speech and language c. Social/emotional A 10 year old is hit in the head with a baseball during practice and is diagnosed with concussion, even though no loss of consciousness occurred. The primary carepediatric 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? a. Continuation of cognitive rest only b. Continuation of physical and cognitive rest c. Continuation of physical rest only d. Returning to play b. Continuation of physical and cognitive rest The parent of a 4-year-old who has difficulty initiating and maintaining sleep has tried several non-pharmacological methods with variable success and asks about medications. What will the primary care pediatric nurse practitioner recommend? a. Diphenhydramine b. Lorazepam c. Melatonin d. Zolpidem c. Melatonin A 15 year old 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? a. That amenorrhea in female athletes is not concerning b. That she should begin a program of plyometrics and strength training c. To consider a different sport, such as volleyball d. To work with a dietician to improve healthy weight gain d. To work with a dietician to improve healthy weight gain During a well-child examination of a 6-year-old 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? a. The child has been sexually molested. b. The child is feeling violated by the examiner. c. The parent is exhibiting regressive behavior. d. This is a normal reaction in a child of this age. d. This is a normal reaction in a child of this age. 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? a. Protein supplements b. Salt tablets c. Sports drinks d. Vitamin C a. Protein supplements The primary care pediatric nurse practitioner sees a 3-day-old 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 do what? a. Continue to breastfeed her infant. b. Give the infant a cow's milk formula. c. Supplement breast milk with formula. d. Stop breastfeeding immediately. d. Stop breastfeeding immediately. The parent of a school age 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 a. clonazepam b. ferrous sulfate c. gabapentin d. sertraline b. ferrous sulfate 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? a. Permanent discontinuation of all strenuous and aerobic activities b. Enrollment in a conditioning program to improve performance c. Evaluation for underlying cardiac causes of this symptom d. Treatment for exercise induced asthma with a bronchodilator c. Evaluation for underlying cardiac causes of this symptom The parent of a school-age child who is overweight tells the primary care pediatric nurse practitioner that the child seems to crave high-calorie, high carbohydrate 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? a. Assessment of leptin and ghrelin hormone levels b. Consultation with a dietician to develop an appropriate diet c. Referral to a sleep disorder clinic for a sleep study d. Taking one or two naps each day to increase the amount of sleephigh-carbohydrate c. Referral to a sleep disorder clinic for a sleep study During a well-child examination, a 15-year-old female tells the primary care pediatric nurse practitioner that some of her friends have begun having sex. She has a boyfriend and denies engaging in sex with him. What will the nurse practitioner do initially? a. Ask her for definitions of "Sex" b. Discuss the risks of sexually transmitted disease c. Find out if she is considering sexual relations d. Giver her information about contraception a. Ask her for definitions of "Sex" 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. A murmur that is louder when squatting and softer when standing b. A murmur that is quieter when squatting and louder with a Valsalva maneuver c. A murmur with narrow and variable splitting of S2 d. A systolic murmur that is grade 1 or 2 b. A murmur that is quieter when squatting and louder with a Valsalva maneuver The parent of a 12-year-old 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? a. Children with SCT should not play any contact sports b. Children with SCT may not play for NCAA school in college c. Children with SCT should follow heat acclimatization guidelines d. Children with SCT should not participate in organized sports c. Children with SCT should follow heat acclimatization guidelines The mother of a 3-month-old 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? a. Infants should be prevented from masturbating. b. The infant is conscious of the pleasure associated with nursing. c. This is a form of infantile priapism. d. This is a normal, reflexive behavior at this age. d. This is a normal, reflexive behavior at this age. The primary care pediatric nurse practitioner performs an initial well baby exam on a 1-week-old 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? a. Consultation with a lactation specialist to assess intake b. Pumping her breast during the night to maintain milk supply c. Supplementing the last feeding of the day with formula d. Waking the infant up at least every 3 hours to nurse d. Waking the infant up at least every 3 hours to nurse The primary care pediatric nurse practitioner is performing a well child examination on a 3-year-old. The child's parent reports that the child has recently begun masturbating. What will the nurse practitioner counsel this parent? a. To allow the behavior whenever it occurs, since it is normal b. To discuss sexuality with the child c. To explore whether the child is being abused d. To teach the child about privacy and hand hygiene d. To teach the child about privacy and hand hygiene The parent of a toddler tells the primary care pediatric nurse practitioner that the family has adopted a plant-based diet and the child is receiving rice and almond milk instead of cow's milk. The nurse practitioner will counsel the parents about: a. Calcium deficiency b. Excess caloric intake c. Excessive fat intake d. Protein deficiency d. Protein deficiency 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? a. Bicycle riding is not safe for children with seizures. b. Contact sports should be avoided. c. Direct supervision of some activities is necessary. d. Underwater sports are not recommended. c. Direct supervision of some activities is necessary. A child with Down syndrome who has sleep disordered 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? a. Craniofacial surgery b. Oral appliances c. Positive airway pressure therapy d. Supplemental oxygen c. Positive airway pressure therapy The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 6 year old child who has Down syndrome. What will the nurse practitioner tell the parents about physical activity and sports in school? a. Children with Down syndrome get frustrated easily when engaging in sports. b. Children with Down syndrome should not participate in strenuous aerobic activity. c. Their child should have a cervical spine evaluation be fore participation in sports. d. Their child should only participate in sports sanctioned by theSpecial Olympics. c. Their child should have a cervical spine evaluation be fore participation in sports. 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? a. Co sleeping with the child to help alleviate possible nighttime fears b. Referral to a sleep disorders clinic for evaluation of sleep disordered breathing c. Reintroducing a second, morning nap time to compensate for lost sleep d Understanding that sleep resistance is a common developmental problem d Understanding that sleep resistance is a common developmental problem The primary care pediatric nurse practitioner is counseling a parent about ways to reduce the risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing SIDS? a. Bed sharing with infants greatly increases the risk of SIDS. b. Breast feeding does not appear to have any influence on SIDS risk c. Infants who attend day care have a higher than usually incidence of SIDS d. There is no difference in SIDS rates immunized versus non immunized infants 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? a. After 3 weeks, she may begin lifting weights but not full sports. b. After 4 weeks, she may return to full play and practice. c. At 4 weeks, she must have an exam to determine fitness for play. d. She may engage in moderate exertion and practice after 3 weeks. c. At 4 weeks, she must have an exam to determine fitness for play. The primary care pediatric nurse practitioner is performing a well child examination on a 15 year old girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement? a. Calcium, vitamin C, and vitamin A b. Iron, folic acid, and B12 c. . Magnesium, vitamin E, and zinc d.. Vitamin D, vitamin C, and phosphorus b. Iron, folic acid, and B12 The primary care pediatric nurse practitioner performs a well-child assessment on a 6-month-old 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 what other intervention? a. Discussing adding other foods to the baby's diet. b. Encouraging the mother to increase her fluid intake. c. Prescribing a multivitamin containing iron. d. Suggesting offering only breast milk to the infant. a. Discussing adding other foods to the baby's diet. The primary care pediatric nurse practitioner is performing a well child exam on a 4 month old 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? a. Ask the mother to describe the color and consistency of the stools. b. Explain to the mother that breastfed infants should have daily stools. c. Recommend using a glycerin suppository as needed. d. Suggest to the mother that she increase her intake of fluids. a. Ask the mother to describe the color and consistency of the stools. What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures? a. Administer oral ibuprofen or apply topical salicylates. b. Apply a topical anesthetic such a benzocaine to the gums. c. Give the infant a cold teething ring or wet washcloth to chew. d. Try Baby Orajel on the infant's gums several times daily. c. Give the infant a cold teething ring or wet washcloth to chew. 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. 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. a. Conduct pediatric drug studies to determine whether the drug is safe and effective in children. What intervention should the primary care provider (PCP) encourage all parents to implement to engage in the best management of potential serious child related injuries? a. Being aware of the causes of common childhood injuries b. Actively engaging in attentive parenting practices c. Actively supporting state and federal programs like Safe Kids USA d. Being proficient in basis pediatric life support techniques d. Being proficient in basis pediatric life support techniques The primary care pediatric nurse practitioner is assessing an ill 2-month-old 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 d. Send the infant to the urgent care center for intravenous fluids c. Give the parents sick care instructions and follow up in the clinic in the morning An adolescent takes ibuprofen, acetaminophen and a tricyclic antidepressant (TCA) to treat phantom limb pain and reports the medications are no longer effective. What will the PCP do next? a. change to TCA to a SSRI b. evaluate the adolescent for drug-seeking behavior c. increase the TCA dose and reevaluate in 2-3 weeks d. Refer to a pain management clinic d. Refer to a pain management clinic 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. 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. a. Demonstrate oral medication administration with the toddler in the office. Which PCP question, posed to a parent, best demonstrates participatory care when addressing the topic of childhood immunizations? a. "Do you want to hold your child while I give the shots due today?" b. "What are your feelings about childhood vaccinations?" c. "What shots do you want your child to receive at this visit?" d. "Do you have any questions about the shots that are due at this visit?" c. "What shots do you want your child to receive at this 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?Select one: a. Notifying the child's school counselor about this problem b. Referring the child and family to a social worker c. Reporting this according to any mandated reporting laws d. Suggesting that the parent avoid the abusive situation c. Reporting this according to any mandated reporting laws 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? a. Consistently brushing and flossing the teeth twice daily b. Referral to an oral surgeon for treatment c. Rinsing the mouth daily with chlohexidine gluconate d. Using a xylitol containing gum after meals a. Consistently brushing and flossing the teeth twice daily The single mother of a 4 year old who attends day care tells the primary care pediatric nurse practitioner that she had difficulty giving her child a twice daily 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 twice daily amoxicillin for 5 days. c. Prescribe azithromycin once daily for 5 days. d. Reinforce the need to adhere to the plan of care. c. Prescribe azithromycin once daily for 5 days. 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? a. Evaluate the safety and efficacy of each product and monitor use. b. Incorporate these therapies into standard care practices. c. Recommend not using the products until the child is older. d. Suggest that most of these treatments are not safe for children. a. Evaluate the safety and efficacy of each product and monitor use. 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? a. Brandname herbal products have been tested for efficacy. b. Natural ingredients are usually safe for use in children. c. There are few interactions between drugs and supplements. d. Use single herb supplements whenever possible. d. Use single herb supplements whenever possible. The primary care pediatric nurse practitioner is evaluating a 12-year-old 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? a. Attaining a history of the abuse from the child b. Obtaining urethral specimens for STI testing c. Performing a colposcopic examination to evaluate for trauma d. Referring the child to the ED for forensic specimen collection d. Referring the child to the ED for forensic specimen collection An 18-month-old 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? a. If the child is still drinking milk from a bottle b. If the child or the parents are brushing the teeth c. If they are brushing the child's teeth twice daily d. If they have taken the child to a dentist a. If the child is still drinking milk from a bottle The primary care pediatric nurse practitioner diagnoses a 5-year-old child with asthma and prescribes an oral steroid and a short-acting beta-adrenergic medication via a metered-dose 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 c. Information about spirometry testing d. Instructions for medications at school b. Effects and side effects of current medications 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 d. Magnetic resonance imaging c. Conventional radiograph 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? a. Child attends day care b. Limited financial resources c. Mother works outside the home d. No membership in a church b. Limited financial resources 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? a. Recommend ice packs, NSAIDs, and a soft diet. b. Refer to a pediatric mental health specialist. c. Refer to an orthodontist for a surgical intervention. d. Suggest obtaining Botox injection treatments. a. Recommend ice packs, NSAIDs, and a soft diet. The primary care pediatric nurse practitioner is considering use of a relatively new drug for a 15 month old 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. b. more often or at a higher dose. c. via a parenteral route. d. via the oral route. a. less often or at a lower dose. A 3 year-old child is recovering from injuries sustained in a motor vehicle accident. How will the PCP evaluate the child's pain? a. Ask the child to rate pain intensity on a 4 to 5 item pain discrimination scale b. Have the child describe pain as "no pain", " a little pain" or a "lot of pain" c. Question the child about the intensity and specific location of any pain d. Rely on non-verbal responses such as facial expressions and limb movements. b. Have the child describe pain as "no pain", " a little pain" or a "lot of pain" The primary care pediatric nurse practitioner is preparing to perform a well-child examination on a 5-year-old 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. 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. a. allow the mother to express her feelings, understanding that she is experiencing grief. 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? a. Applying topical iodine every month b. Daily chlorhexidine gluconate rinses c. Ordering medications to prevent drooling d. Prescribing prophylactic antibiotics b. Daily chlorhexidine gluconate rinses A 5-year-old 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? a. Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days. b. Refer the child to a dentist for reimplantation of the avulsed teeth. c. Refer the child to a dentist immediately for further examination. d. Remove the teeth, place them in saline, and refer the child to a dentist. c. Refer the child to a dentist immediately for further examination. A 4-year-old 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 PCP do next? a. assess the child's vital signs and ability to walk without pain 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 a. assess the child's vital signs and ability to walk without pain The parent of a school-age 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 metered dose 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. Suggest asking the school to excuse the child from gym class. d. Write the prescription for two metered dose inhalers with spacers. d. Write the prescription for two metered dose inhalers with spacers. 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