TEST BANK
Pediatric Primary Care
Catherine E. Burns, Ardys M. Dunn, Margaret A. Brady, Nancy B. Starr, Catherine G. Blosser, Dawn Lee Garzon
6th Edition
,Table of Contents
Chapter 01 Health Status of Children-Global and Local Perspectives 1
Chapter 02 Child and Family Health Assessment 3
Chapter 03 Cultural Perspectives for Pediatric Primary Care 8
Chapter 04 Developmental Management in Pediatric Primary Care 12
Chapter 05 Developmental Management of Infants 16
Chapter 06 Developmental Management of Early Childhood 19
Chapter 07 Developmental Management of School-Age Children 23
Chapter 08 Developmental Management of Adolescents 28
Chapter 09 Introduction to Functional Health Patterns and Health Promotion 33
Chapter 10 Nutrition 38
Chapter 11 Breastfeeding 42
Chapter 12 Elimination Patterns 46
Chapter 13 Physical Activity and Sports for Children and Adolescents 50
Chapter 14 Sleep and Rest 57
Chapter 15 Sexuality 61
Chapter 16 Values, Beliefs, and Spirituality 65
Chapter 17 Role Relationships 67
Chapter 18 Self-Perception Issues 72
Chapter 19 Coping and Stress Tolerance-Mental Health and Illness 75
Chapter 20 Cognitive-Perceptual Disorders 81
Chapter 21 Introduction to Disease Management 85
Chapter 22 Prescribing Medications in Pediatrics 91
Chapter 23 Pediatric Pain Management 94
Chapter 24 Infectious Diseases and Immunizations 97
Chapter 25 Atopic, Rheumatic, and Immunodeficiency Disorders 107
Chapter 26 Endocrine and Metabolic Disorders 114
Chapter 27 Hematologic Disorders 120
Chapter 28 Neurologic Disorders 125
Chapter 29 Eye Disorders 130
Chapter 30 Ear Disorders 135
Chapter 31 Cardiovascular Disorders 140
Chapter 32 Respiratory Disorders 147
Chapter 33 Gastrointestinal Disorders 153
Chapter 34 Dental and Oral Disorders 158
Chapter 35 Genitourinary Disorders 163
Chapter 36 Gynecologic Disorders 169
Chapter 37 Dermatologic Disorders 174
Chapter 38 Musculoskeletal Disorders 183
Chapter 39 Perinatal Disorders 187
Chapter 40 Common Injuries 191
Chapter 41 Genetic Disorders 194
,Chapter 42 Environmental Health Issues 197
Chapter 43 Complementary Health Therapies in Pediatric Primary Care-An Integrative
Approach 200
Chapter 44 Strategies for Managing a Pediatric Health Care Practice 203
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
Chapter 1: Health Status of Children: Global and Local Perspectives
Burns: Pediatric Primary Care, 6th Edition
MULTIPLE CHOICE
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.
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
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.
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
______________________________________________________________________________________________
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Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
nations.
d. Young children who attend preschool or day care have higher food insecurity.
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
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.
______________________________________________________________________________________________
2|Page
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
Chapter 2: Child and Family Health Assessment
Burns: Pediatric Primary Care, 6th Edition
MULTIPLE CHOICE
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.
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
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, an 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.
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Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
d. Refer the child to a specialty clinic for evaluation and treatment of developmental
delay.
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
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.
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
ANS: D
Maternal depression in the first year of life has been associated with poorer language
development at 3 years of age.
______________________________________________________________________________________________
4|Page
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
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
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.
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
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
______________________________________________________________________________________________
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Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
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
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Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
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.
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Pediatric Primary Care
Catherine E. Burns, Ardys M. Dunn, Margaret A. Brady, Nancy B. Starr, Catherine G. Blosser, Dawn Lee Garzon
6th Edition
,Table of Contents
Chapter 01 Health Status of Children-Global and Local Perspectives 1
Chapter 02 Child and Family Health Assessment 3
Chapter 03 Cultural Perspectives for Pediatric Primary Care 8
Chapter 04 Developmental Management in Pediatric Primary Care 12
Chapter 05 Developmental Management of Infants 16
Chapter 06 Developmental Management of Early Childhood 19
Chapter 07 Developmental Management of School-Age Children 23
Chapter 08 Developmental Management of Adolescents 28
Chapter 09 Introduction to Functional Health Patterns and Health Promotion 33
Chapter 10 Nutrition 38
Chapter 11 Breastfeeding 42
Chapter 12 Elimination Patterns 46
Chapter 13 Physical Activity and Sports for Children and Adolescents 50
Chapter 14 Sleep and Rest 57
Chapter 15 Sexuality 61
Chapter 16 Values, Beliefs, and Spirituality 65
Chapter 17 Role Relationships 67
Chapter 18 Self-Perception Issues 72
Chapter 19 Coping and Stress Tolerance-Mental Health and Illness 75
Chapter 20 Cognitive-Perceptual Disorders 81
Chapter 21 Introduction to Disease Management 85
Chapter 22 Prescribing Medications in Pediatrics 91
Chapter 23 Pediatric Pain Management 94
Chapter 24 Infectious Diseases and Immunizations 97
Chapter 25 Atopic, Rheumatic, and Immunodeficiency Disorders 107
Chapter 26 Endocrine and Metabolic Disorders 114
Chapter 27 Hematologic Disorders 120
Chapter 28 Neurologic Disorders 125
Chapter 29 Eye Disorders 130
Chapter 30 Ear Disorders 135
Chapter 31 Cardiovascular Disorders 140
Chapter 32 Respiratory Disorders 147
Chapter 33 Gastrointestinal Disorders 153
Chapter 34 Dental and Oral Disorders 158
Chapter 35 Genitourinary Disorders 163
Chapter 36 Gynecologic Disorders 169
Chapter 37 Dermatologic Disorders 174
Chapter 38 Musculoskeletal Disorders 183
Chapter 39 Perinatal Disorders 187
Chapter 40 Common Injuries 191
Chapter 41 Genetic Disorders 194
,Chapter 42 Environmental Health Issues 197
Chapter 43 Complementary Health Therapies in Pediatric Primary Care-An Integrative
Approach 200
Chapter 44 Strategies for Managing a Pediatric Health Care Practice 203
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
Chapter 1: Health Status of Children: Global and Local Perspectives
Burns: Pediatric Primary Care, 6th Edition
MULTIPLE CHOICE
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.
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
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.
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
______________________________________________________________________________________________
1|Page
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
nations.
d. Young children who attend preschool or day care have higher food insecurity.
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
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.
______________________________________________________________________________________________
2|Page
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
Chapter 2: Child and Family Health Assessment
Burns: Pediatric Primary Care, 6th Edition
MULTIPLE CHOICE
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.
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
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, an 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.
______________________________________________________________________________________________
3|Page
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
d. Refer the child to a specialty clinic for evaluation and treatment of developmental
delay.
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
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.
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
ANS: D
Maternal depression in the first year of life has been associated with poorer language
development at 3 years of age.
______________________________________________________________________________________________
4|Page
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
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
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.
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
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
______________________________________________________________________________________________
5|Page
,______________________________________________________________________________________________
Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
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
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Test Bank - Pediatric Primary Care, 6th Edition (Burns, 2017)
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.
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