Burns Pediatric Final Exam Study Guide Correct 100%

1. 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. - Answer ANS: C There is growing evidence that climate change is having a dramatic effect on food crops that leads to food distribution issues and food insecurity among families. 2. The primary care pediatric nurse practitioner understands that, to achieve the greatest world-wide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? a. Antibiotics b. Optimal nutrition c. Vaccinations d. Water purification - Answer ANS: C Rotavirus is the most common cause of diarrhea globally and Strep pneumonia is the leading cause of pneumonia, and together these are the leading infectious causes of childhood morbidity and mortality globally. Both are vaccine-preventable diseases. Antibiotics to treat pneumonia, optimal nutrition, and clean water all help to reduce morbidity and mortality, but vaccination prevents the diseases from occurring. 3. 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 on 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. - Answer ANS: C In the most recent AAP Recommendations for Preventive Pediatric Health Care, there is a greater emphasis on behavioral and developmental issues and a recommendation that well child care be based on child and family development rather than the periodicity of immunization schedules. This will require a revision of the current recommendations in Bright Futures. 4. 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-year-olds 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. - Answer ANS: B Obesity rates are a major concern for child health in the U.S. but recently have stabilized in the rate of increase and have declined among 2- to 5-year-olds between 2004 and 2013. Globalism has an increasing effect on child health in the U.S. The rate of household poverty in the U.S. is higher than in other economically developed nations. Young children who attend preschool or day care have lower food insecurity. 5. Which region globally has the highest infant mortality rate? a. Indonesia b. Southern Asia c. Sub-Saharan Africa d. Syria - Answer ANS: C Although Sub-Saharan Africa and Southern Asia together account for 81% of the infant mortality rate globally, Sub-Saharan Africa has the highest infant mortality rate in the world. 1. The parent of a toddler is concerned that the child may have autism. The primary care pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M-CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do? a. Administer a Childhood Autism Rating Scale (CARS) in the clinic. b. Consult a specialist to determine appropriate early intervention strategies. c. Refer the child to a behavioral specialist for further evaluation. d. Tell the parent that this result indicates that the child has autism. - Answer ANS: C The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic. 2. The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk? a. Three-generation pedigree b. Review of systems c. Genogram d. Ecomap - Answer ANS: A The three-generation pedigree is used to map out risks for genetic diseases in families, as well as conditions with modifiable risk factors. The review of systems is used to evaluate the history of the child's body systems. The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The ecomap is used to identify relationships in the family and community that are supportive or harmful. 3. The primary care pediatric nurse practitioner is performing a well child check-up on a 20-month-old child. The child was 4 weeks premature and, according to a parent-completed developmental questionnaire, has achieved milestones for a 15-month-old infant. Which action is correct? a. Perform an in-depth developmental assessment screen at this visit to evaluate this child. b. Reassure the parent that the child will catch up to normal development by age 2 years. c. Re-evaluate this child's development and milestone achievements at the 2-year visit. d. Refer the child to a specialty clinic for evaluation and treatment of developmental delay. - Answer ANS: A This child should be at a 19-month adjusted age for prematurity so, according to the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to evaluate this delay. Waiting to see if the child will "catch up" or assuring the parent that this will happen will cause the delays to become more severe. A referral to a specialty clinic should not be made solely on the basis of the parent-completed questionnaire but only after further evaluation of possible delays. 4. When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? a. DC: 0-3R b. ICD-10-CM c. ICSD-3 d. NANDA International - Answer ANS: A The DC: 0-3R refers to the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and is useful for developmental problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3 is the International Classification of Sleep Disorders - 3rd edition. NANDA International is used to label problems in the functional health domain. 5. 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. - Answer ANS: A The "newest vital sign," or health literacy, can be determined quickly by asking the parent how many children's books are in the home. Greater than 10 books in the home is an independent positive predictor of adequate parent health literacy. The other questions may determine a specific level of literacy in general but are not as efficient. 6. 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 - Answer ANS: D Maternal depression in the first year of life has been associated with poorer language development at 3 years of age. 7. The primary care pediatric nurse practitioner sees a 3-year-old child who chronically withholds stools, in spite of the parents' attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement? a. Altered elimination pattern b. Elimination disorder c. Encopresis d. Parenting alteration - Answer ANS: C Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized for reimbursement purposes. "Altered elimination pattern" and "Parenting alteration" are NANDA International diagnoses and are not recognized for reimbursement. "Elimination disorder" is a developmental diagnosis. 8. A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner notes that the child's last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially? a. Ask the child's parent why the child is so anxious. b. Perform a physical assessment to rule out shortness of breath. c. Reassure the child that there is nothing to be afraid of. d. Review the purpose of this visit and any anticipated procedures. - Answer ANS: D The PNP should remember that young children are learning "scripts" for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease. 9. 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 - Answer ANS: C The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is used to identify relationships in the family and community that are supportive or harmful. The pedigree is used to identify potential genetic disorders. 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 - Answer 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. - Answer 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 - Answer 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 - Answer 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 - Answer 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. - Answer 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 - Answer 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. - Answer 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. 4. The primary care pediatric nurse practitioner provides well child care for a community of immigrant children from Central America. The pediatric nurse practitioner is surprised to learn that some of the families are Jewish and not Catholic. This response is an example of cultural : a. collectivism. b. constructivism. c. essentialism. d. individualism. - Answer ANS: C An essentialist view of culture, which dominates the health care literature, portrays an ethnic minority group as having a static set of traits and oversimplifies cultural information, applying traits to all members of the group. Assuming that all people from Central America are Catholic is an example of this oversimplification. Collectivism refers to a member of an ethnic group who perceives himself or herself to be intrinsically part of that group. A constructive view recognizes culture as complex and dynamic and sees people as individuals who may belong to multiple cultures simultaneously. Individualism recognizes the individual, and not the group, as the basic unit of survival. 5. 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. - Answer ANS: A The challenge, when working with families from different cultural backgrounds, who use alternative or complementary medicines, is to find ways to achieve a mutual understanding of the differences and to negotiate an acceptable plan of care. The first step is to begin a discussion about these practices. Providing a list of harmful herbs, suggesting that the family avoid certain herbs, and suggesting that the herbs are only an adjunct to "modern medicine" will sound disparaging and will convey a sense of mistrust. 6. 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 - Answer ANS: A Community collaboration can be fostered through community-based participatory research (CBPR), which is transformative research that bridges the gap between science and practice by actively engaging communities with formally trained researchers. In this type of research, community members formally participate in all aspects of the process, making the findings more relevant to the community it affects the most. Designing a community garden approach without first knowing whether the community needs or wants it does not ensure success. Gaining support from the corporate community without input from the affected community does not guarantee success. Giving evidence-based information does not involve the community members in research and does not increase success. 7. 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 - Answer ANS: C Cultural humility is defined as the lifelong commitment to developing mutually beneficial, nonpaternalistic partnerships and is based on a model of passive volition, receptivity, and being open to learning from others. Practitioners who have cultural humility are always seeking to learn about other cultures. Cultural humility involves asking questions, rather than giving answers. Cultural humility does not mean identifying one's own culture as inferior. Practitioners who are culturally competent are open to the influence of other cultures. 8. A Somalian immigrant mother is concerned that her 8-year-old child is underweight. The primary care pediatric nurse practitioner notes that the child's weight is at the 25th percentile. After realizing that the mother is comparing her child to a group of American-born children who are overweight, the pediatric nurse practitioner is able to convince the mother that this is a normal weight. Which domain of cultural competence does this represent? a. Global b. Interpersonal c. Intrapersonal d. Organizational - Answer ANS: B The interpersonal domain of cultural competence refers to how cultural competence is manifested between and among individuals and includes all relationships within the health care setting. The PNP becomes aware of cultural norms in body weight and uses this knowledge to discuss healthy weights with the parent. The global domain recognizes a movement toward integration and interconnection of the world population in economic, political, technological, and sociocultural terms. The intrapersonal domain refers to an understanding of the self to understand one's own cultural background. The organizational domain is knowledge of institutional culture and how it affects health care. 9. The primary care pediatric nurse practitioner 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 - Answer ANS: A In a client-centered relationship, there is reciprocal communication and understanding. The PNP should be able to understand the client's perspective and unique situation. The first step is to evaluate possible reasons for nonadherence and not to make referrals or re-educate until potential barriers have been identified and negotiation with the client has occurred. 10. The parents of a special needs child tell the primary care pediatric nurse practitioner that they are planning a 3-month visit to their home country in Africa. The pediatric nurse practitioner assists the family to obtain a sufficient supply of medications and formula and to make sure that the child's equipment can be transported and used during the trip and at the destination. This is an example of a. global application. b. global awareness. c. system application. d. system awareness. - Answer ANS: A Global application involves having a willingness and ability to adjust to the needs of clients, families, and communities both nationally and globally. Global awareness involves knowledge of diseases, political, and economic factors worldwide that affect health. System application involves assisting clients to overcome institutional barriers to effective interventions. System awareness is knowledge of these barriers. 1. During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father's job layoff. What will the nurse practitioner do? a. Reassure them that the child is too young to understand. b. Recommend that they continue to not argue in front of the child. c. Suggest counseling to learn ways to handle stress. d. Tell them that the conflict will resolve when the situation changes. - Answer ANS: C Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period. 2. The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? a. Consult a developmental specialist for a more complete evaluation. b. Prepare the parents for a potentially serious developmental disorder. c. Refer the infant to an early intervention program for physical therapy. d. Teach the parents to provide exercises to encourage motor development. - Answer ANS: D The child who has mild delays in only one area may be managed initially by having the parent provide appropriate exercises. If this is not effective, or if delays become more severe, referrals for evaluation or early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so this action is not indicated. 3. The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially? a. Ask the parents if they have an individualized family service plan (IFSP). b. Consult with a physician to ensure the child gets appropriate care. c. Inform the family that services are provided when the child begins school. d. Refer the family to a social worker for assistance with referrals and services. - Answer ANS: A Families with children who have developmental delays are eligible for early intervention services and should have IFSPs in place. This family may have one from their previous community, and it can be used as a starting point to determine needs. It is not necessary to consult with a physician to coordinate community resources. Early intervention is provided from birth, according to federal law. Until the specific referrals are known, the social worker is not consulted. 4. The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation? a. Explain to the parent that developmental delays often do not manifest at first. b. Perform a developmental assessment and tell the parent which delays are evident. c. Point out the tasks that the infant can perform while conducting the assessment. d. Refer the infant to a developmental specialist for a complete evaluation. - Answer ANS: C When discussing developmental delays with parents, it is important to be positive and to initially focus on strengths. Explaining that developmental delays develop over time is true but does not reassure the parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and may take time. 5. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3-year-old child who draws on the walls with crayons? a. Give the child washable markers so the drawings can be removed easily. b. Provide a roll of paper for drawing and teach the child to use this. c. Put the child in "timeout" each time the child draws on the walls. d. Take the crayons away from the child to prevent the behavior. - Answer ANS: B Discipline involves training or education that molds appropriate behavior and is used to teach the child what is permitted and encouraged. Providing an appropriate outlet for drawing helps to teach the child where to use the crayons. Using washable markers allows the parents to clean the walls but does not teach the child appropriate behaviors. Timeout and taking away the crayons are forms of punishment, or a loss of privileges, that are administered as a form of retribution. 6. The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old infant in a car seat on the exam table. The infant's mother is playing a game on her smart phone. The nurse practitioner interprets this behavior as : a. a sign that the mother has postpartum depression. b. extremely concerning for potential parental neglect. c. of moderate concern for parenting problems. d. within the normal range of behavior in early parenthood. - Answer ANS: C A parent who seems disinterested in a child raises moderate concerns for parenting problems. It does not necessarily signal postpartum depression. It is not a mark for extreme concern. It is not within the expected range of behaviors. 7. During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the nurse practitioner do? a. Allow the parent to put the child in a "timeout." b. Ask the parent about usual discipline practices. c. Offer the child a book or a toy to look at. d. Stop the exam since the child has reached a "meltdown." - Answer ANS: C The child has exhibited early signs of misbehavior. At this stage, distraction and active engagement may be used to stop more problems from occurring. It is not necessary to use a timeout because the child hasn't reached the point where cooperation is impossible. The PNP should model appropriate interventions by offering the child a distraction and may ask the parent about discipline practices later in the visit. The child is not at a "meltdown" state. 8. The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? a. To begin brushing the infant's teeth with toothpaste b. To consider weaning the infant from breastfeeding c. To discontinue giving fluoride supplements d. To make an appointment for an initial dental examination - Answer ANS: D The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued. 9. The primary care pediatric nurse practitioner has a cohort of patients who have special health care needs. Which is an important role of the nurse practitioner when caring for these children? a. Care coordination and collaboration b. Developing protocols for parents to follow c. Monitoring individual education plans (IEPs) d. Providing lists of resources for families - Answer ANS: A Care coordination is one of the key elements for children with special health care needs. PNPs are especially suited for this role and have the unique skills to function as care coordinators. Care for these children should involve shared decision making and individualized care and not "cookbook" approaches. The PNP may advocate for children's health care needs for the IEP but does not monitor these. The PNP should not just give parents lists of phone numbers but should assist them to make appointments. 10. A single mother of an infant worries that living in a household with only one parent will cause her child to be maladjusted. To help address the mother's concerns, the primary care pediatric nurse practitioner will suggest : a. developing consistent daily routines for the child. b. exposing her child to extended family members when possible. c. not working outside the home during the first few years. d. taking her child to regular play date activities with other children. - Answer ANS: A Providers can teach parents that providing predictable, consistent, and loving care helps an infant to learn trust and help influence positive brain development. Involving extended family members and going to play dates are good ways to socialize children but are not essential to learning trust. It may not be possible for her to be a stay-at-home mother. 1. The primary care pediatric nurse practitioner performs a well baby examination on a 7-day-old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct? a. Follow up at the 2-month checkup. b. Refer to a lactation consultant. c. Schedule a weight check in 1 week. d. Suggest supplementing with formula. - Answer ANS: C This infant lost about 8% of its birth weight, which is normal and, since discharge home, has gained at least 15 grams per day, which is also normal. The PNP should schedule a weight check in a week to make sure the infant regains its birth weight, since most should regain this in 10 to 14 days and since this loss of birth weight is at the high end of normal. It is not necessary to refer to a lactation consultant or supplement with formula, since the infant is gaining weight adequately. 2. The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant's future intellectual growth. What will the nurse practitioner tell the parent? a. Cognitive learning begins during the toddler years. b. Intellectual growth begin when speech develops. c. Language and literacy skills begin at birth. d. Preschool is an optimal time to begin general learning. - Answer ANS: C General learning and acquisition of skills for later reading and writing begin at birth, not in kindergarten or first grade, and these skills grow with everyday loving interactions between infants and caregivers. Cognitive learning changes during toddler years but begins at birth. Intellectual growth is not tied to speech alone. 3. During an assessment of a 4-week-old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4-hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend? a. Continuing to nurse the infant using the current pattern b. Nursing the infant for longer periods every 4 hours c. Supplementing with formula at the last nighttime feeding d. Waking the infant every 2 hours to nurse during the night - Answer ANS: A Infants who are encouraged to breastfeed every 2 to 3 hours may have one longer stretch of 4 hours at night. This infant is gaining between 0.5 and 1 gram per day, which is appropriate. It is not necessary to alter the pattern of nursing or to supplement with formula. 4. The mother of a 6-week-old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? a. Her baby is probably constipated. b. It may be related to her dietary intake. c. She should consume more water. d. This may be normal for breastfed babies. - Answer ANS: D Infants begin to have fewer bowel movements and may have bowel movements ranging from once or twice daily to once every other day when breastfed. Unless there are other signs, the baby is probably not constipated. The mother does not need to change her intake of foods or water, unless constipation is present. 5. The mother of a 3-month-old child tells the primary care pediatric nurse practitioner that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother? a. Appropriate ways to stimulate and entertain the infant b. How to read the infant's cues for overstimulation c. The importance of scheduling "play dates" with other infants d. To provide musical toys to engage the infant - Answer ANS: B By 3 months, infants demonstrate a social smile and will become more active, alert, and responsive. Parents may mistakenly assume that the infant can handle more activity and stimulation when this occurs, and the PNP should teach caregivers how to recognize infant cues for the need to rest or to have decreased stimulation. 6. The mother of a 6-month-old infant is distressed because the infant can say "dada" but not "mama" and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond? a. "At this age, your baby does not understand the meaning of sounds." b. "Babies at this age cannot make the 'ma' sound." c. "Most sounds made by babies at this age are accidental." d. "This may mean that your baby doesn't hear well." - Answer ANS: A At 6 months, infants delight in vocalizing sounds that they learn by imitation but do not ascribe meaning to the sounds they make. Infants can say "mama" but without meaning. Babies make sounds on purpose by imitating what they hear. A preference for one sound early in speech does not indicate a hearing deficit. 7. 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. - Answer ANS: C Infants may have a growth spurt at 6 to 8 weeks, and mothers who are breastfeeding may be concerned that they are not making enough milk when they notice that the infant is fussy and wanting to nurse more often. The PNP should reassure the mother that this is expected. It is not necessary, since the infant is gaining weight appropriately, for the mother to keep a log. The mother should follow the infant's cues for feeding since the extra suckling will increase the milk supply to meet the growing infant's needs. 8. The primary care pediatric nurse practitioner is performing a well child examination on a 9-month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? a. Provide educational videos that focus on language. b. Read simple board books to the infant at bedtime. c. Sing to the child and play lullabies in the baby's room. d. Turn the television to Sesame Street during the day. - Answer ANS: B The best way to improve language skills is to read to children. As long as the reading includes positive interactions with the baby and the reader, the baby is learning language. Educational videos, music, and television are all passive media and do not involve this interaction. 9. The parent of a 5-month-old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? a. The infant may be expressing a desire to play or to rest. b. The parent should give ibuprofen for teething pain before nursing. c. This is an indication that the infant is ready for solid foods. d. This may indicate gastrointestinal discomfort such as constipation. - Answer ANS: A At this age, infants may cry when they are tired or need social interaction and not just when they are hungry. The PNP should teach parents about this change in social development so they can be responsive to their infant's needs. Solid foods are not added until age 6 months. Teething usually does not begin until at least 6 months. GI discomfort usually occurs after eating. 10. The primary care pediatric nurse practitioner is examining a 12-month-old infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? a. Perform an in-depth developmental assessment. b. Reassure the parent that this is normal for a premature infant. c. Refer the infant to a developmental specialist. d. Suggest activities to improve fine motor skills. - Answer ANS: A When developmental screening indicates an infant is not progressing at the expected rate, additional testing to determine the degree of delay is necessary. A referral may be needed if a delay is determined. This is not normal for this degree of prematurity infants should develop a pincer grasp by 9 to 10 months of age. - Answer 1. 1. The parent of a 4-year-old points to a picture and says, "That's your sister." The child responds by saying, "No! It's my baby!" This is an example of which type of thinking in preschool-age children? a. a. Animism b. b. Artificialism c. c. Egocentrism d. d. Realism - Answer ANS: D Children at this age are developing their ability to establish causality. Nominal realism occurs when children think that one type of thing can only be called by one name. All dogs are dogs and not various breeds. Animism refers to the belief that objects possess person-like qualities. Artificialism occurs when children think things are caused by a controlling force. Egocentrism is when children see things only as they relate to themselves. 1. 2. The primary care pediatric nurse practitioner performs a developmental assessment on a 32-month-old child. The child's parent reports that about 70% of the child's speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing "t," "d," "k," and "g" sounds. Which action is correct? a. a. Evaluate the child's cognitive abilities. b. b. Obtain a hearing evaluation. c. c. Reassure the parent that this is normal. d. d. Refer the child to a speech therapist. - Answer ANS: C Intelligibility of speech reaches about 66% between the ages of 24 and 36 months. Tongue- contact sounds are more intelligible by age 5 years. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated, since these findings are within normal limits. 1. 3. 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. a. Children who learn two languages simultaneously often confuse them in conversation. b. b. Children with multi-language proficiency do not understand that others cannot do this. c. c. Learning two languages at an early age prevents children from developing a dominant language. d. d. Most bilingual children are able to shift from one language to another when appropriate. - Answer ANS: D Most children who are bilingual are able to sort out the languages in conversation but may "code switch" at times for clarity as they speak. They seem to understand that not everyone has this ability. Most children who are bilingual develop a dominant language. 1. 4. The parents of a 3-year-old child are concerned that the child has begun refusing usual foods and wants to eat mashed potatoes and chicken strips at every meal and snack. The child's rate of weight has slowed, but the child remains at the same percentile for weight on a growth chart. What will the primary care pediatric nurse practitioner tell the parents to do? a. a. Allow the child to choose foods for meals to improve caloric intake. b. b. Place a variety of nutritious foods on the child's plate at each meal. c. c. Prepare mashed potatoes and chicken strips for the child at mealtimes. d. d. Suggest cutting out snacks to improve the child's appetite at mealtimes. - Answer ANS: B Young children should have three meals and two nutritious snacks each day. The parents' responsibility is to provide nutritious foods and allow children to choose how much they will eat. Children who are allowed to choose foods will likely make selections that are not healthy. Parents should be discouraged from preparing separate meals for their children. Snacks are necessary to maintain adequate intake and energy. 1. 5. The parent of a 24-month-old child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? a. a. "Begin by reading to your child about toileting." b. b. "Most children are capable by age 2 years." c. c. "Tell me about your child's daily habits." d. d. "We should assess your child's motor skills." - Answer ANS: C To assess the parent's understanding of toilet readiness, the nurse practitioner will ask the parents about the child's daily habits and routines to see if the child has predictable patterns that can be the basis for toilet training. While providing storybooks about toileting can help children learn, the first step is to assess toilet readiness. Even though many children are capable at this age, evaluating personal readiness is key to beginning toilet training. Assessment of motor skills may be a second step. 1. 6. The primary care pediatric nurse practitioner is counseling the parents of a toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend? a. a. Allow the child to explore and experiment while providing appropriate limits. b. b. Be present while the child plays to continually teach the child what is appropriate. c. c. Let the child experiment at will and to make mistakes in order to learn. d. d. Say "no" whenever the child does something that is not acceptable. - Answer ANS: A The child who is securely attached uses the parents as a base from which to safely explore the world. Toddlers learn by doing and need to experiment to gain mastery over the environment. It is important that parents are present for safety, but parents should not be ever-present and controlling. Parents should be close by and should intervene if the child is at risk for injury. Continual criticism and the use of the word "no" can make the toddler feel powerless. 1. 7. The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health? a. a. To begin brushing the infant's teeth with toothpaste b. b. To consider weaning the infant from breastfeeding c. c. To discontinue giving fluoride supplements d. d. To make an appointment for an initial dental examination - Answer ANS: D The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued. 1. 8. 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. a. holophrastic speech. b. b. receptive speech. c. c. semantic speech. d. d. telegraphic speech. - Answer ANS: D Syntax, or the structure of words in sentences or phrases, is developed in stages between the ages of 8 months and 3.5 years. Telegraphic speech begins at about 18 months of age when children speak in phrases with many words omitted, so that the sentence sounds like a telegram. Holophrastic speech is the use of a single word to express a complete idea. Receptive speech refers to the ability to understand a word without necessarily being able to use the word. Semantics is the understanding that words have specific meanings. 1. 9. The primary care pediatric nurse practitioner is evaluating a 2-year-old with a documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next? a. a. Ask the child's parents whether they read to the child. b. b. Give parents educational materials to encourage speech. c. c. Refer the child to an early intervention program. d. d. Suggest that they purchase age-appropriate music videos. - Answer ANS: A Language development requires oral-motor ability, auditory perception, and cognitive ability, which this child has been shown to have, as well as the psychosocial-cultural environment to motivate the child to engage in language use. The PCPNP's initial step should be to determine whether the parents provide such an environment. Educational materials may be used after it is determined that these are useful. Early intervention may be used if the speech delay persists. Music videos do not necessarily engage the child in expression of speech. 1. 10. The mother of a 3-year-old child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother? a. a. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. b. b. The toddler may have a language delay that interferes with socialization with other children. c. c. Toddlers may be interested in other children but usually do not engage in interactive play. d. d. Toddlers need more structured play to encourage interaction and socialization with others. - Answer ANS: C Parallel play is common among toddlers who, although they may be fascinated by other children, generally do not engage with peers in an interactive manner. This does not mean that the child is shy or has a language delay, although in preschool years, the development of symbolic language increases interactive play. Children need both structured and free play, but structured play will not increase interaction during this normally parallel period. 1. The primary care pediatric nurse practitioner is preparing to conduct a well child assessment of an 8- year-old child. How will the nurse practitioner begin the exam? a. Ask the child about school, friends, home activities, and sports b. Discuss the purpose of the visit and explain the procedures that will be performed c. Offer age-appropriate information about usual developmental tasks d. Provide information about healthy nutrition and physical activities - Answer ANS: A To build rapport with the child and parent, the PNP will begin by asking direct questions to the child, encouraging the child to share information about daily routines. The other answers list aspects of the well child visit that can be introduced after the initial conversation. 2. 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. - Answer ANS: C The earliest school-age psychosocial milestone occurs when children learn to separate easily from family, allowing them to go to school. Mastery of these skills enables them to develop and maintain peer friendships. Social interaction skills are necessary in order to develop mastery over school activities. Asking the child to describe why school is distressing may not elicit information, since the child may not be able to articulate this. Bullying is not the only reason for disliking school, but, if it is, will emerge during a discussion about friends and schoolmates. 3. A school-age child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent? a. Allow the child to make food choices since this is usually a phase b. Ensure that the child has three nutritious meals and two nutritious snacks each day c. Prepare vegetables separately for the child to encourage adequate intake d. Teach the child how important it is to eat healthy fruits and vegetables - Answer ANS: B Children have food jags that are generally self-limited. The parent's responsibility is to provide three nutritious meals and two nutritious snacks each day so that all available choices are acceptable. Allowing food choices may result in an overabundance of non-nutritious foods selected. It is not necessary to prepare separate dishes for a child who is going through a temporary phase. Teaching the child about nutrition is important but will not likely have much impact during this phase. 4. The parent of a 6-year-old child expresses concern that the child may have ADHD. Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility? a. Behavioral and Emotional Screening System for Children (BESS-2) b. Behavioral Assessment for Children - 2nd ed. (BASC-2) c. Conner's 3 Parent and Teacher Rating Scale d. Pediatric Symptom Checklist (PSC) - Answer ANS: C The Conner's Parent and Teacher Rating Scale is used to assess ADHD symptoms in children aged 6 to 18 years. The BESS-2 is used to evaluate social emotional and mental health in children. The BASC-2 is used to further assess children who have positive findings on the BESS-2. The PSC is used to assess cognitive, emotional, and behavioral problems in children. 5. The primary care pediatric nurse practitioner performs a physical examination on a 12-year-old child and notes poor hygiene and inappropriate clothes for the weather. The child's mother appears clean and well dressed. The child reports getting 6 to 7 hours of sleep each night because of texting with friends late each evening. What action by the nurse practitioner will help promote healthy practices? a. Discuss setting clear expectations about self-care with the mother b. Give the child information about sleep and self-care c. Reassure the mother that this "non-compliance" is temporary d. Tell the mother that experimenting with self-care behaviors is normal - Answer ANS: A Parents of school-age children should be advised to set clear limits for their children for cleanliness, healthy exercise, hours of sleep, and other health promotion behaviors to encourage the development of responsibility for these things. Giving the child information can be done along with setting expectations, but, at this age, the parent should still be supervising. While "non-compliance" is a part of this process, and is a means of asserting independence, parents need to discuss this with children to resolve the issue. 6. 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 - Answer ANS: D Although early school-age children learn values from their parents, these may be challenged as children learn that others have different values. Parents must confront and negotiate these issues daily with their children. While children may make poor choices and subsequently learn from the consequences, it is best for parents to actively discuss these issues with their children. Children do have a high regard for authority and social norms but may easily transfer this authority to other, less reliable people, such as peers. Moral values may not persist if other sources of authority become prominent. 7. The parent of a 10-year-old boy tells the primary care pediatric nurse practitioner that the child doesn't appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child's sexual identity. The nurse practitioner will tell the parent a. children at this age who prefer interactions with same-gender peers usually have a homosexual orientation. b. children experiment with sexuality at this age as a means of deciding later sexual orientation. c. this attachment to other same-gender children is how the child learns to interact with others. d. to encourage mixed-gender interactions in order to promote development of sexual values. - Answer ANS: C At age 10, children usually develop an intense same-gender relationship with a peer. This is how the child learns to expand the self, shares feelings, and learns how others manage problems. It does not indicate later sexual orientation and is not a characteristic of experimentation with sexuality. It is not necessary to encourage mixed-gender interactions.