Magnetic resonance imaging (MRI) A 14 -year-old female comes t o the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the pri mary care pediatric nurse practitioner suspect? - ANSWER -Anorexia nervosa Which type of heat -related illness involves a core body temperature of at least 104.9°F, acute mental status changes, absent sweat, and tachypnea? - ANSWER -
Heat stroke What percent age of burns is involved using the rule of nines if both front legs are burned? - ANSWER -18% Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial - and full -
thickness thermal injuries? - ANSWER -Silver sulfadiazine (Silvadene) A sunscreen with a sun -protection factor of at least what number will block most harmful ultraviolet radiation? - ANSWER -15 Which clinical feature is the first to be affected in increased i ntracranial pressure? - ANSWER -Decrease in level of consciousness The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client? - ANSWER -Clozapine A school -age child has a fractured wrist with a Salter Harris Type II fracture, according to the radiologist. What is true about this type of fracture? - ANSWER -
There is a metaphyseal fragment on the compression side of fracture. What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip? - ANSWER -Dislocation of an unstable hip A 3-year-old child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. Th e child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do? - ANSWER -Gently attempt a supination and flexion technique. A school -age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed? - ANSWER -Immobilization with a sling to support the affected extremity A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do? - ANSWER -
Recommend NSAIDs, stretching exercises, and ice packs to the area. A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? - ANSWER -Discuss posture and exercise and ask about backpacks and books. The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6 -month -old infant not previously noted in the med ical record. What is the correct treatment? - ANSWER -Surgical intervention A 14 -year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition? - ANSWER -Place the child on crutches or in a wheelchair to prevent weight -bearing. A parent is concerned that a 12 -month -old chi ld is "bowlegged." A physical examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the correct action for the primary care pediatric nurse practitioner? - ANSWER -Refer to a pediatric orthopedic specialist for treatment. A child who plays soccer is in the clinic reporting pa in and swelling in both knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain wors ening when asked to extend the knees against resistance. What is the treatment for this condition? - ANSWER -Apply ice packs to both knees and avoid activities that cause pain. During a well baby examination of a newborn, the primary care pediatric nurse practitioner notes adduction of the right forefoot, with normal position of the mid and hindfoot, along with a convex shaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity? - ANSWER -Grasp the heel with one hand an d abduct the forefoot with the other hand. During a well child examination on a 4 -month -old infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent -infant relationship? - ANSWER -"I let my baby cry a while to learn to be patient." A child has a difficult temperament. What will the primary care pediatric nurse practitioner tell the parent about managing this child's behavior? - ANSWER -It is important fo r the parent to learn to manage criticism and power struggles. During a well child assessment of a preschool -age child, the parent voices concerns that because the child has behavior problems at school, the child may have a mental health disorder. Which initial approach will provide the best information? JJJJ. Ask the parent whether other caregivers have voiced similar concerns. - ANSWER -Take time t o actively listen to the parent's and child's perceptions of the problem. The primary care pediatric nurse practitioner attempts to learn more about the emotional health of an 18 -month -old child through which assessment strategy? - ANSWER -Observation of t he child with caretakers in structured and unstructured situations A middle school age child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will the primary care pediatric nurs e practitioner manage this situation? - ANSWER -Refer the child to a mental health specialist for evaluation and treatment. The parent of a 4 -year-old child reports that the child seems to be having trouble adjusting to a new daycare and reportedly is alwa ys engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do? - ANSWER -Ask the parent if the child is slow to warm up to other new situations. The parent of a school -age child is con cerned because the child has started to express anger about a grandparent's death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent? - ANSWER -The significance of this loss must b e reworked at each developmental level. The parent of a school -age child reports that the child doesn't like being alone in rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse practitioner tell the parent? - ANS WER -"Fear of imaginary creatures does not usually occur at this age." The parent of a preschool age child reports that the child often appears anxious and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the be st type of referral that the primary care pediatric nurse practitioner could recommend? - ANSWER -Play therapy A 9-year-old child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has r ecently begun sleeping in the parents' bed. Which initial action by the primary care pediatric nurse practitioner is appropriate? - ANSWER -Assess for environmental stress, parental dysfunction, and maternal depression. The parent of a school -age child rep orts that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child? - ANSWER -Generalized anxiety disorder (GAD) The parent of a school -age girl rep orts that the child has difficulty getting ready for school and is often late because of a need to check and recheck whether her teeth