BURNS PEDIATRIC EXAMS SCRIPT QUESTIONS AND
ANSWERS SURE A+
✔✔4. The primary care pediatric nurse practitioner 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 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 - ✔✔ANS: B
Thelarche, or the development of breast budding, generally precedes menarche by 2.5
years, so this
should be determined when attempting to predict this milestone. The age of the mother
at menarche is not
a reliable indicator. Adrenarche is related to adrenal and not gonadal development and
is less valid than
other secondary sex characteristics in assessing sexual maturation. Rapid linear growth
usually begins
after thelarche and peaks about a year later but is not used to predict menarche.
✔✔5. The mother of a 15-year-old 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 - ✔✔ANS: A
Apparent hypocrisy is the notion that rules apply differently to adolescents than to
others. The adolescent
who chalks up the conflict with her mother related to her premenstrual mood swings
does not see her own
role in the conflict. Imaginary audience is the perception that everyone is thinking about
them. Personal
fable is the idea that they are special. Overthinking involves making things more
complicated than they
need to be.
✔✔6. During a well child assessment of a 13-year-old 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. - ✔✔ANS: D
The initial sign of puberty in males is testicular enlargement. If this does not precede
other changes, the
PNP should consider whether the boy is taking exogenous anabolic steroids, common
among those who
wish to improve athletic ability. These findings are not concerning for alcohol or tobacco
use. Voice
changes and rapid growth may occur with pubic hair development, but the primary
concern is anabolic
steroid use.
✔✔7. 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. - ✔✔ANS: A
Self-injurious behavior (SIB) is used as a coping strategy to relieve distress, anger, and
stress. It is not
commonly done among adolescents and is not a way of fitting in with a peer group.
Because it indicates
underlying distress, adolescents must get help identifying these causes. Many have a
history of physical,
,sexual, or emotional abuse. Although individuals who engage in SIB are more likely to
attempt suicide in
the future, the act itself is not a suicide attempt.
✔✔8. The parent of a 14-year-old 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. - ✔✔ANS: C
Early adolescents begin to develop their own value system and may try value systems
other than the one
that they have learned from their family, which is a normal part of establishing personal
identity. The
parent may allow expression of other values, such as a vegetarian diet, as long as
nutritional needs are met
and the adolescent takes responsibility for preparing the food.
✔✔9. 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. -
✔✔ANS: D
Adolescents should be encouraged to divulge information about their sexuality to
providers by assuring
them that confidentiality will be maintained unless the health of the child or others is at
risk. The
adolescent may be trying to ask questions about himself in a manner that doesn't
implicate his own
sexuality, so the PNP should attempt to gain his confidence. Questionnaires may be
useful when
collecting information, but this adolescent has already begun a discussion about the
topic. An adolescent
, who is concerned about being gay may not be ready to come out to his parents.
✔✔10. 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 concern that her
daughter wishes to
have an eyebrow piercing and states that she is opposed to the idea. What will the
nurse practitioner
do?
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. -
✔✔ANS: A
Adolescents who pierce their noses or have strange haircuts may be irritating to
parents, but these are
ways of expressing individuality and help them to achieve psychosocial milestones. The
fact that the teen
and her mother are discussing this is a good sign that the adolescent isn't in complete
rebellion. The PNP
should provide accurate health information and encourage continued dialogue. Although
it is true that
piercings are relatively harmless, the PNP shouldn't "side" with the teen during an open
discussion or tell
the teen that the mother is "in charge."
✔✔11. 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. - ✔✔ANS: D
Adolescent brains respond differently to toxic stress, so counseling is indicated to help
them manage
serious events, such as family abuse and divorce. Early adolescents have concrete
thinking, but the formal
operational thinking occurs later. "Storm and stress" are not the norm in adolescence
nor are disruptive
periods of conflict.
ANSWERS SURE A+
✔✔4. The primary care pediatric nurse practitioner 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 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 - ✔✔ANS: B
Thelarche, or the development of breast budding, generally precedes menarche by 2.5
years, so this
should be determined when attempting to predict this milestone. The age of the mother
at menarche is not
a reliable indicator. Adrenarche is related to adrenal and not gonadal development and
is less valid than
other secondary sex characteristics in assessing sexual maturation. Rapid linear growth
usually begins
after thelarche and peaks about a year later but is not used to predict menarche.
✔✔5. The mother of a 15-year-old 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 - ✔✔ANS: A
Apparent hypocrisy is the notion that rules apply differently to adolescents than to
others. The adolescent
who chalks up the conflict with her mother related to her premenstrual mood swings
does not see her own
role in the conflict. Imaginary audience is the perception that everyone is thinking about
them. Personal
fable is the idea that they are special. Overthinking involves making things more
complicated than they
need to be.
✔✔6. During a well child assessment of a 13-year-old 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. - ✔✔ANS: D
The initial sign of puberty in males is testicular enlargement. If this does not precede
other changes, the
PNP should consider whether the boy is taking exogenous anabolic steroids, common
among those who
wish to improve athletic ability. These findings are not concerning for alcohol or tobacco
use. Voice
changes and rapid growth may occur with pubic hair development, but the primary
concern is anabolic
steroid use.
✔✔7. 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. - ✔✔ANS: A
Self-injurious behavior (SIB) is used as a coping strategy to relieve distress, anger, and
stress. It is not
commonly done among adolescents and is not a way of fitting in with a peer group.
Because it indicates
underlying distress, adolescents must get help identifying these causes. Many have a
history of physical,
,sexual, or emotional abuse. Although individuals who engage in SIB are more likely to
attempt suicide in
the future, the act itself is not a suicide attempt.
✔✔8. The parent of a 14-year-old 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. - ✔✔ANS: C
Early adolescents begin to develop their own value system and may try value systems
other than the one
that they have learned from their family, which is a normal part of establishing personal
identity. The
parent may allow expression of other values, such as a vegetarian diet, as long as
nutritional needs are met
and the adolescent takes responsibility for preparing the food.
✔✔9. 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. -
✔✔ANS: D
Adolescents should be encouraged to divulge information about their sexuality to
providers by assuring
them that confidentiality will be maintained unless the health of the child or others is at
risk. The
adolescent may be trying to ask questions about himself in a manner that doesn't
implicate his own
sexuality, so the PNP should attempt to gain his confidence. Questionnaires may be
useful when
collecting information, but this adolescent has already begun a discussion about the
topic. An adolescent
, who is concerned about being gay may not be ready to come out to his parents.
✔✔10. 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 concern that her
daughter wishes to
have an eyebrow piercing and states that she is opposed to the idea. What will the
nurse practitioner
do?
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. -
✔✔ANS: A
Adolescents who pierce their noses or have strange haircuts may be irritating to
parents, but these are
ways of expressing individuality and help them to achieve psychosocial milestones. The
fact that the teen
and her mother are discussing this is a good sign that the adolescent isn't in complete
rebellion. The PNP
should provide accurate health information and encourage continued dialogue. Although
it is true that
piercings are relatively harmless, the PNP shouldn't "side" with the teen during an open
discussion or tell
the teen that the mother is "in charge."
✔✔11. 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. - ✔✔ANS: D
Adolescent brains respond differently to toxic stress, so counseling is indicated to help
them manage
serious events, such as family abuse and divorce. Early adolescents have concrete
thinking, but the formal
operational thinking occurs later. "Storm and stress" are not the norm in adolescence
nor are disruptive
periods of conflict.
