BURNS PEDIATRIC ALL FINAL EXAM QUESTIONS
AND ANSWERS SURE A+
✔✔10. 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?
a. Metabolic syndrome
b. Nutritional alteration: more than required
c. Obesity
d. 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.
✔✔11. 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 :
,a. ask the parent to consider a possible speech delay and report any concerns.
b. continue to evaluate the child's speech at subsequent visits.
c. refer the child for a speech and hearing evaluation.
d. 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.
✔✔12. 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?
a. CRAFFT
b. HEEADSSS
c. PHQ-2
d. 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.
✔✔13. 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?
a. Failure to thrive
b. Home care resources inadequate
,c. Nutrition alteration - less than required
d. 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.
✔✔14. 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 medications, 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 -
✔✔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.
✔✔1. The primary care pediatric nurse practitioner learns that an African-American
family lives in a
neighborhood with a high crime rate and suggests that they try moving to another
neighborhood for
the safety of their children. This is an example of
a. cultural sensitivity.
b. group bias.
c. individual privilege.
d. racial awareness. - ✔✔ANS: C
Privilege can be individual- or group-based and refers to the often unconscious lack of
understanding of
what other groups must deal with. The PNP is not aware that the family may lack the
resources to move,
, may be fearful of moving to a "white" neighborhood, or may even feel safe around
people that they know.
Cultural sensitivity is an awareness of and respect for other cultures. Group bias is a
prejudice, based on
cultural, racial, or ethnic differences, toward a group of people. Racial awareness would
describe an
awareness of cultural differences based on race.
✔✔2. 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 - ✔✔ANS: A
Recent history that includes trauma, loss, and refugee camp experience may
exacerbate difficulties
adjusting to life in the U.S. and can lead to acute and chronic physical and mental
health concerns. All of
the other parts of the history will be necessary, but this should be a priority, since the
family has escaped a
war-torn country.
✔✔3. 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 :
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. - ✔✔ANS: D
Federally funded managed care networks and community health centers are required to
have interpreters
accessible for clients with limited English proficiency. A commercial telephone
interpreter service has
been shown to be as effective as an "in-person" interpreter. Relying on family members
or community
members may not be reliable and may jeopardize patient confidentiality. This interpreter
is answering for
the clients without hearing what they have to say, which can compromise care.
AND ANSWERS SURE A+
✔✔10. 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?
a. Metabolic syndrome
b. Nutritional alteration: more than required
c. Obesity
d. 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.
✔✔11. 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 :
,a. ask the parent to consider a possible speech delay and report any concerns.
b. continue to evaluate the child's speech at subsequent visits.
c. refer the child for a speech and hearing evaluation.
d. 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.
✔✔12. 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?
a. CRAFFT
b. HEEADSSS
c. PHQ-2
d. 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.
✔✔13. 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?
a. Failure to thrive
b. Home care resources inadequate
,c. Nutrition alteration - less than required
d. 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.
✔✔14. 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 medications, 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 -
✔✔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.
✔✔1. The primary care pediatric nurse practitioner learns that an African-American
family lives in a
neighborhood with a high crime rate and suggests that they try moving to another
neighborhood for
the safety of their children. This is an example of
a. cultural sensitivity.
b. group bias.
c. individual privilege.
d. racial awareness. - ✔✔ANS: C
Privilege can be individual- or group-based and refers to the often unconscious lack of
understanding of
what other groups must deal with. The PNP is not aware that the family may lack the
resources to move,
, may be fearful of moving to a "white" neighborhood, or may even feel safe around
people that they know.
Cultural sensitivity is an awareness of and respect for other cultures. Group bias is a
prejudice, based on
cultural, racial, or ethnic differences, toward a group of people. Racial awareness would
describe an
awareness of cultural differences based on race.
✔✔2. 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 - ✔✔ANS: A
Recent history that includes trauma, loss, and refugee camp experience may
exacerbate difficulties
adjusting to life in the U.S. and can lead to acute and chronic physical and mental
health concerns. All of
the other parts of the history will be necessary, but this should be a priority, since the
family has escaped a
war-torn country.
✔✔3. 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 :
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. - ✔✔ANS: D
Federally funded managed care networks and community health centers are required to
have interpreters
accessible for clients with limited English proficiency. A commercial telephone
interpreter service has
been shown to be as effective as an "in-person" interpreter. Relying on family members
or community
members may not be reliable and may jeopardize patient confidentiality. This interpreter
is answering for
the clients without hearing what they have to say, which can compromise care.
