NR602 Pediatric Midterm Study Questions
with 100% Correct Answers Graded A+.
The primary care pediatric nurse practitioner evaluates a school-age child whose body mass index (BMI)
is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic
syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner
document for this visit?
Metabolic syndrome
Nutritional alteration: more than required
Obesity
Rule out type 2 diabetes mellitus - ANS: C
A problem should never be included on the problem list that is not supported by subjective and
objective data found and recorded in the database. This child has a BMI that suggests obesity, so this
may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data,
which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for
reimbursement. "Rule out" should not be used as a diagnosis, but may be considered part of a plan.
The primary care pediatric nurse practitioner performs a developmental assessment on a 3-year-old
child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately
to verbal commands during the assessment but refuses to speak when asked questions. The parent tells
the nurse practitioner that the child talks at home and that most other adults can understand what the
child says. The nurse practitioner will :
ask the parent to consider a possible speech delay and report any concerns.
continue to evaluate the child's speech at subsequent visits.
refer the child for a speech and hearing evaluation.
tell the parent to spend more time in interactive conversations with the child. - ANS: B
Development should be monitored over time and within the context of the child's overall well-being,
rather than at an isolated testing session. The child has normal development in observed measures and
appears to hear and understand well. By parental report, the child is able to speak. The PNP should
continue to evaluate speech over time, since this refusal to speak may be associated with shyness or
intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay.
Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a
home therapy.
The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and
,is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner
use?
CRAFFT
HEEADSSS
PHQ-2
RAAPS - ANS: A
The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is
used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to
assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens.
The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index
(BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have
regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner
plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse
practitioner use for this problem?
Failure to thrive
Home care resources inadequate
Nutrition alteration - less than required
Parenting alteration - ANS: D
Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the
correct diagnosis should be "Parenting alteration." "Failure to thrive" is a medical diagnosis and requires
a medical and social evaluation to rule out organic causes or detect neglect. "Home care resources
inadequate" would be used if the PNP suspects that the family lacks adequate funds to purchase food.
"Nutrition alteration" is a NANDA diagnosis and would be used if the PNP planned to consult with a
dietician or give nutritional information.
The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate
both nursing and medical aspects of primary care, which will be included in the medical history?
Complementary medications, alternative health practices, and chief complaint
Developmental delays, nutritional status, and linear growth patterns
Medication currently taking, allergy information, and family medical history
Speech and language development, beliefs about health, and previous illnesses - ANS: D
An assessment model that integrates the nursing and medical aspects of primary care uses three
domains: developmental problems (speech and language development), functional health problems
(beliefs about health), and diseases (chief complaint). The other examples all use domains associated
with the traditional medical model and do not contain nursing aspects associated with functional health
,problems.
During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young
child fight frequently about finances. The parents state that they do not fight in front of the child and
feel that the situation is temporary and related to the father's job layoff. What will the nurse
practitioner do?
Reassure them that the child is too young to understand.
Recommend that they continue to not argue in front of the child.
Suggest counseling to learn ways to handle stress.
Tell them that the conflict will resolve when the situation changes. - 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.
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?
Consult a developmental specialist for a more complete evaluation.
Prepare the parents for a potentially serious developmental disorder.
Refer the infant to an early intervention program for physical therapy.
Teach the parents to provide exercises to encourage motor development. - 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.
The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit.
The family has just moved to the area and asks the nurse practitioner about community services and
resources for their child. What should the nurse practitioner do initially?
Ask the parents if they have an individualized family service plan (IFSP).
Consult with a physician to ensure the child gets appropriate care.
Inform the family that services are provided when the child begins school.
, Refer the family to a social worker for assistance with referrals and services. - 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.
The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from
the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about
whether the infant will be normal. What will the nurse practitioner do in this situation?
Explain to the parent that developmental delays often do not manifest at first.
Perform a developmental assessment and tell the parent which delays are evident.
Point out the tasks that the infant can perform while conducting the assessment.
Refer the infant to a developmental specialist for a complete evaluation. - 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.
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?
Give the child washable markers so the drawings can be removed easily.
Provide a roll of paper for drawing and teach the child to use this.
Put the child in "timeout" each time the child draws on the walls.
Take the crayons away from the child to prevent the behavior. - 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.
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 sign that the mother has postpartum depression.
extremely concerning for potential parental neglect.
with 100% Correct Answers Graded A+.
The primary care pediatric nurse practitioner evaluates a school-age child whose body mass index (BMI)
is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic
syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner
document for this visit?
Metabolic syndrome
Nutritional alteration: more than required
Obesity
Rule out type 2 diabetes mellitus - ANS: C
A problem should never be included on the problem list that is not supported by subjective and
objective data found and recorded in the database. This child has a BMI that suggests obesity, so this
may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data,
which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for
reimbursement. "Rule out" should not be used as a diagnosis, but may be considered part of a plan.
The primary care pediatric nurse practitioner performs a developmental assessment on a 3-year-old
child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately
to verbal commands during the assessment but refuses to speak when asked questions. The parent tells
the nurse practitioner that the child talks at home and that most other adults can understand what the
child says. The nurse practitioner will :
ask the parent to consider a possible speech delay and report any concerns.
continue to evaluate the child's speech at subsequent visits.
refer the child for a speech and hearing evaluation.
tell the parent to spend more time in interactive conversations with the child. - ANS: B
Development should be monitored over time and within the context of the child's overall well-being,
rather than at an isolated testing session. The child has normal development in observed measures and
appears to hear and understand well. By parental report, the child is able to speak. The PNP should
continue to evaluate speech over time, since this refusal to speak may be associated with shyness or
intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay.
Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a
home therapy.
The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and
,is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner
use?
CRAFFT
HEEADSSS
PHQ-2
RAAPS - ANS: A
The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is
used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to
assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens.
The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index
(BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have
regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner
plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse
practitioner use for this problem?
Failure to thrive
Home care resources inadequate
Nutrition alteration - less than required
Parenting alteration - ANS: D
Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the
correct diagnosis should be "Parenting alteration." "Failure to thrive" is a medical diagnosis and requires
a medical and social evaluation to rule out organic causes or detect neglect. "Home care resources
inadequate" would be used if the PNP suspects that the family lacks adequate funds to purchase food.
"Nutrition alteration" is a NANDA diagnosis and would be used if the PNP planned to consult with a
dietician or give nutritional information.
The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate
both nursing and medical aspects of primary care, which will be included in the medical history?
Complementary medications, alternative health practices, and chief complaint
Developmental delays, nutritional status, and linear growth patterns
Medication currently taking, allergy information, and family medical history
Speech and language development, beliefs about health, and previous illnesses - ANS: D
An assessment model that integrates the nursing and medical aspects of primary care uses three
domains: developmental problems (speech and language development), functional health problems
(beliefs about health), and diseases (chief complaint). The other examples all use domains associated
with the traditional medical model and do not contain nursing aspects associated with functional health
,problems.
During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young
child fight frequently about finances. The parents state that they do not fight in front of the child and
feel that the situation is temporary and related to the father's job layoff. What will the nurse
practitioner do?
Reassure them that the child is too young to understand.
Recommend that they continue to not argue in front of the child.
Suggest counseling to learn ways to handle stress.
Tell them that the conflict will resolve when the situation changes. - 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.
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?
Consult a developmental specialist for a more complete evaluation.
Prepare the parents for a potentially serious developmental disorder.
Refer the infant to an early intervention program for physical therapy.
Teach the parents to provide exercises to encourage motor development. - 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.
The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit.
The family has just moved to the area and asks the nurse practitioner about community services and
resources for their child. What should the nurse practitioner do initially?
Ask the parents if they have an individualized family service plan (IFSP).
Consult with a physician to ensure the child gets appropriate care.
Inform the family that services are provided when the child begins school.
, Refer the family to a social worker for assistance with referrals and services. - 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.
The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from
the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about
whether the infant will be normal. What will the nurse practitioner do in this situation?
Explain to the parent that developmental delays often do not manifest at first.
Perform a developmental assessment and tell the parent which delays are evident.
Point out the tasks that the infant can perform while conducting the assessment.
Refer the infant to a developmental specialist for a complete evaluation. - 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.
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?
Give the child washable markers so the drawings can be removed easily.
Provide a roll of paper for drawing and teach the child to use this.
Put the child in "timeout" each time the child draws on the walls.
Take the crayons away from the child to prevent the behavior. - 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.
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 sign that the mother has postpartum depression.
extremely concerning for potential parental neglect.
