lOMoARcPSD|17706574
Midterm Study Guide: Sept 2022
Nurse Practitioner Roles (Pediatric NP, Primary Care NP, Acute Care NP)
Pediatric primary care serves as the primary interface between the child/family and the health
system, except in the case of serious emergencies. The emphasis is on health promotion and
protection, and disease and/or disability prevention. It is designed to be a first contact point, not
simply a point of entry into the health system. It is also designed to be the “hub” of coordination,
providing continuity, as well as integrating subsequent care, regardless of where the care is delivered
and who provides it. As comprehensive, continuous, and person-centered care, primary care is the
ideal place for the establishment of the individual and family medical home.
Primary care PNPs, much like those in the early days with Dr. Ford, provide primary care, which
includes well-child care and the prevention and/or management of both common pediatric acute
illnesses and chronic conditions.
Acute care PNPs provide care for acutely, critically, and chronically ill children who are unstable,
experiencing life-threatening illness, are medically fragile and/or technologically dependent.
Tertiary Care: requires both specialized expertise and equipment
Quaternary Care: requires highly specialized expertise and highly unusual or specialized equipment
Sudden Infant Death Syndrome (SIDS):
Q: The primary care pediatric nurse practitioner is counseling a new parent about ways to reduce the
risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing
SIDS? A: Bedsharing with infants greatly increases the risk of SIDS.
American Academy of Pediatrics (AAP) recommendations for newborn sleep practices:
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, lOMoARcPSD|17706574
To prevent SIDS: the Guide to Clinical Preventive Services (U.S. Preventive Services Task Force,
2014) and/or the Advisory Committee on Heritable Disorders in Newborns and Children (Advisory
Committee, 2017) recommend the following preventive services for neonates:
• Prenatal screening for Rh(D) incompatibility; human immunodeficiency virus (HIV); hepatitis B;
syphilis; chlamydia and gonorrhea
• Promoting breastfeeding
• Screening neonates for sickle hemoglobinopathies to identify newborns who may benefit from
antibiotic prophylaxis to prevent sepsis
• Screening for congenital hypothyroidism for all newborns within the first 4 days of life
• Screening for phenylketonuria (PKU) for all newborns before discharge from the nursery. Newborns
who are tested before they are 24 hours old should receive a repeat screening test by 2 weeks old.
• Topical ocular prophylaxis of all newborns to prevent ophthalmia neonatorum
• Screening for developmental hip dysplasia
Immunizations (schedules, anticipatory guidance, therapeutic communication, side effects)
Click here for the CDCs children’s immunization schedule (up to age 18).
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Healthy People objectives related to vaccination:
1. To reduce the number of children who do not receive vaccines by age 2.
2. To maintain the vaccination coverage of the first and second doses of the measles, mumps,
rubella (MMR) vaccine.
3. To increase the coverage of 4 doses of diphtheria, tetanus, and pertussis by age 2.
Therapeutic communication:
• Acknowledge and respect the trusted relationship between provider and parent.
• Communicate a strong shared commitment with the parent to the health and well-being of their
child.
• Listen to and query parents’ reasons for refusing or delaying vaccines; not all vaccine-hesitant
individuals have the same concerns.
• Be familiar with misconceptions and controversies regarding vaccines and be prepared to address
them (e.g., thimerosal-free vaccines).
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, lOMoARcPSD|17706574
• Emphasize the safety of vaccines, the extensive testing before licensure, and the post-licensure
safety surveillance programs. Explain the serious consequences of not vaccinating.
• Educate the family about the safety of multiple vaccines to be given at the same time. Mention that a
healthy infant’s/child’s immune system capably fights off an estimated 2000 to 6000 germs (antigens)
daily when playing, eating, and breathing. The number of antigens in any combination of vaccines on
the current schedule is much lower than the daily exposure to many substances (150 antigens for the
entire Advisory Committee on Immunization Practices [ACIP] schedule) (American Academy of
Pediatrics [AAP], 2018a ).
• Emphasize the balance between risk and benefits of vaccination and that the risk associated with
diseases is greater than the risk of a serious adverse vaccine reaction. Clarify that vaccines have the
same effect on the immune system that the active disease does—without the morbidity and/or
mortality seen in active disease.
• Provide a vaccine information statement (VIS) or other printed educational materials from the CDC
VIS resources at https://www.cdc.gov/vaccines/hcp/vis/index.html.
Immuz side effects:
The MMR, varicella zoster, influenza, hepatitis B, meningococcal, and tetanus–containing vaccines
are linked to anaphylaxis.
Vaccine injections can cause syncope, fainting, deltoid bursitis, shoulder pain, and loss of shoulder
motion.
After MMR, febrile seizures (benign and without sequelae) and measles inclusion body encephalitis
(rare) in immunocompromised children can occur within a year of vaccination.
Varicella zoster vaccine has a causal relationship to some adverse events (e.g., chickenpox rash;
pneumonia, meningitis, hepatitis in children with immunodeficiencies; viral reactivation leading to
meningitis or encephalitis).
Anticipatory Guidance Newborn:
According to the American Academy of Pediatrics recommendations for preventive pediatric health
care and the Bright Futures Guidelines, providers should offer anticipatory guidance in all of the
following areas: family support, child development, mental health, healthy weight, healthy
nutrition, physical activity, oral health, healthy sexual development and sexuality, safety and
injury prevention, and social determinants of health; they should also provide educational
counseling and support services
The aim of primary care for children is to promote health, growth, and development in a safe
environment. The FNP provides clinical expertise and care focusing on child development, health
promotion, disease prevention, and anticipatory guidance or proactive counseling that addresses the
expected physical, psychological, and developmental changes, at each well-child visit.
The AAP well-child visits at 2 weeks and then at 2, 4, 6, 9, 12, 15, 18, and 24 months, annually up to
age 6, and every 2 years from age 6 through adolescence.
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, lOMoARcPSD|17706574
Anticipatory Guidance Adolescent years:
Anticipatory guidance should be individualized to help the adolescent understand, respond to, and
take responsibility for their own behavior and development. Separate discussions need to be
conducted with parents to help them understand and support their child’s maturation and need for
independence. In these discussions, the provider should clarify what values and expectations parents
have for their child and how the teenager perceives those expectations. Some discussion points are
outlined in each of the adolescent phases discussed later. They should be incorporated into the
health supervision visit, but they are not all-inclusive, and they should not be covered exhaustively at
each visit.
Phases of Adolescence
One simple way to understand adolescence is to divide it into three psychosocial developmental
phases: (1) early, 11 to 14 years old or junior high school; (2) middle, 15 to 17 years old or high
school; and (3) late, 18 to 21 years old or college, work, or vocational-technical school.
Each phase is characterized by certain behavior. Understanding such behavior assists in the
evaluation of areas of concern to the adolescent or family. Within each developmental phase,
adolescents deal with issues of autonomy, body image, identity development, and peer group
involvement.
Q: The FNP has high suspicion that a child is being abused by a parent. Which of the following
actions is legally appropriate?
● The FNP can release all medical records to law enforcement without parent authorization.
● The FNP can release records of a child even if they are not the reporter of the abuse.
● The FNP must have parental authorization to release records to CPA.
● The FNP can release all medical records to attorneys without parent authorization or court
order.
Routine well-child visit: Anticipatory guidance topics vary according to child and family needs.
Limiting media time and pediatric obesity education may be appropriate for one family, while another
may need education on discipline. Thorough history taking is key to identifying pertinent topics. The
FNP must address all standard areas and additional parent concerns, keeping in mind that handouts
often go unread by families.
Downloaded by Nicholas Marks ()
Midterm Study Guide: Sept 2022
Nurse Practitioner Roles (Pediatric NP, Primary Care NP, Acute Care NP)
Pediatric primary care serves as the primary interface between the child/family and the health
system, except in the case of serious emergencies. The emphasis is on health promotion and
protection, and disease and/or disability prevention. It is designed to be a first contact point, not
simply a point of entry into the health system. It is also designed to be the “hub” of coordination,
providing continuity, as well as integrating subsequent care, regardless of where the care is delivered
and who provides it. As comprehensive, continuous, and person-centered care, primary care is the
ideal place for the establishment of the individual and family medical home.
Primary care PNPs, much like those in the early days with Dr. Ford, provide primary care, which
includes well-child care and the prevention and/or management of both common pediatric acute
illnesses and chronic conditions.
Acute care PNPs provide care for acutely, critically, and chronically ill children who are unstable,
experiencing life-threatening illness, are medically fragile and/or technologically dependent.
Tertiary Care: requires both specialized expertise and equipment
Quaternary Care: requires highly specialized expertise and highly unusual or specialized equipment
Sudden Infant Death Syndrome (SIDS):
Q: The primary care pediatric nurse practitioner is counseling a new parent about ways to reduce the
risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing
SIDS? A: Bedsharing with infants greatly increases the risk of SIDS.
American Academy of Pediatrics (AAP) recommendations for newborn sleep practices:
Downloaded by Nicholas Marks ()
, lOMoARcPSD|17706574
To prevent SIDS: the Guide to Clinical Preventive Services (U.S. Preventive Services Task Force,
2014) and/or the Advisory Committee on Heritable Disorders in Newborns and Children (Advisory
Committee, 2017) recommend the following preventive services for neonates:
• Prenatal screening for Rh(D) incompatibility; human immunodeficiency virus (HIV); hepatitis B;
syphilis; chlamydia and gonorrhea
• Promoting breastfeeding
• Screening neonates for sickle hemoglobinopathies to identify newborns who may benefit from
antibiotic prophylaxis to prevent sepsis
• Screening for congenital hypothyroidism for all newborns within the first 4 days of life
• Screening for phenylketonuria (PKU) for all newborns before discharge from the nursery. Newborns
who are tested before they are 24 hours old should receive a repeat screening test by 2 weeks old.
• Topical ocular prophylaxis of all newborns to prevent ophthalmia neonatorum
• Screening for developmental hip dysplasia
Immunizations (schedules, anticipatory guidance, therapeutic communication, side effects)
Click here for the CDCs children’s immunization schedule (up to age 18).
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Healthy People objectives related to vaccination:
1. To reduce the number of children who do not receive vaccines by age 2.
2. To maintain the vaccination coverage of the first and second doses of the measles, mumps,
rubella (MMR) vaccine.
3. To increase the coverage of 4 doses of diphtheria, tetanus, and pertussis by age 2.
Therapeutic communication:
• Acknowledge and respect the trusted relationship between provider and parent.
• Communicate a strong shared commitment with the parent to the health and well-being of their
child.
• Listen to and query parents’ reasons for refusing or delaying vaccines; not all vaccine-hesitant
individuals have the same concerns.
• Be familiar with misconceptions and controversies regarding vaccines and be prepared to address
them (e.g., thimerosal-free vaccines).
Downloaded by Nicholas Marks ()
, lOMoARcPSD|17706574
• Emphasize the safety of vaccines, the extensive testing before licensure, and the post-licensure
safety surveillance programs. Explain the serious consequences of not vaccinating.
• Educate the family about the safety of multiple vaccines to be given at the same time. Mention that a
healthy infant’s/child’s immune system capably fights off an estimated 2000 to 6000 germs (antigens)
daily when playing, eating, and breathing. The number of antigens in any combination of vaccines on
the current schedule is much lower than the daily exposure to many substances (150 antigens for the
entire Advisory Committee on Immunization Practices [ACIP] schedule) (American Academy of
Pediatrics [AAP], 2018a ).
• Emphasize the balance between risk and benefits of vaccination and that the risk associated with
diseases is greater than the risk of a serious adverse vaccine reaction. Clarify that vaccines have the
same effect on the immune system that the active disease does—without the morbidity and/or
mortality seen in active disease.
• Provide a vaccine information statement (VIS) or other printed educational materials from the CDC
VIS resources at https://www.cdc.gov/vaccines/hcp/vis/index.html.
Immuz side effects:
The MMR, varicella zoster, influenza, hepatitis B, meningococcal, and tetanus–containing vaccines
are linked to anaphylaxis.
Vaccine injections can cause syncope, fainting, deltoid bursitis, shoulder pain, and loss of shoulder
motion.
After MMR, febrile seizures (benign and without sequelae) and measles inclusion body encephalitis
(rare) in immunocompromised children can occur within a year of vaccination.
Varicella zoster vaccine has a causal relationship to some adverse events (e.g., chickenpox rash;
pneumonia, meningitis, hepatitis in children with immunodeficiencies; viral reactivation leading to
meningitis or encephalitis).
Anticipatory Guidance Newborn:
According to the American Academy of Pediatrics recommendations for preventive pediatric health
care and the Bright Futures Guidelines, providers should offer anticipatory guidance in all of the
following areas: family support, child development, mental health, healthy weight, healthy
nutrition, physical activity, oral health, healthy sexual development and sexuality, safety and
injury prevention, and social determinants of health; they should also provide educational
counseling and support services
The aim of primary care for children is to promote health, growth, and development in a safe
environment. The FNP provides clinical expertise and care focusing on child development, health
promotion, disease prevention, and anticipatory guidance or proactive counseling that addresses the
expected physical, psychological, and developmental changes, at each well-child visit.
The AAP well-child visits at 2 weeks and then at 2, 4, 6, 9, 12, 15, 18, and 24 months, annually up to
age 6, and every 2 years from age 6 through adolescence.
Downloaded by Nicholas Marks ()
, lOMoARcPSD|17706574
Anticipatory Guidance Adolescent years:
Anticipatory guidance should be individualized to help the adolescent understand, respond to, and
take responsibility for their own behavior and development. Separate discussions need to be
conducted with parents to help them understand and support their child’s maturation and need for
independence. In these discussions, the provider should clarify what values and expectations parents
have for their child and how the teenager perceives those expectations. Some discussion points are
outlined in each of the adolescent phases discussed later. They should be incorporated into the
health supervision visit, but they are not all-inclusive, and they should not be covered exhaustively at
each visit.
Phases of Adolescence
One simple way to understand adolescence is to divide it into three psychosocial developmental
phases: (1) early, 11 to 14 years old or junior high school; (2) middle, 15 to 17 years old or high
school; and (3) late, 18 to 21 years old or college, work, or vocational-technical school.
Each phase is characterized by certain behavior. Understanding such behavior assists in the
evaluation of areas of concern to the adolescent or family. Within each developmental phase,
adolescents deal with issues of autonomy, body image, identity development, and peer group
involvement.
Q: The FNP has high suspicion that a child is being abused by a parent. Which of the following
actions is legally appropriate?
● The FNP can release all medical records to law enforcement without parent authorization.
● The FNP can release records of a child even if they are not the reporter of the abuse.
● The FNP must have parental authorization to release records to CPA.
● The FNP can release all medical records to attorneys without parent authorization or court
order.
Routine well-child visit: Anticipatory guidance topics vary according to child and family needs.
Limiting media time and pediatric obesity education may be appropriate for one family, while another
may need education on discipline. Thorough history taking is key to identifying pertinent topics. The
FNP must address all standard areas and additional parent concerns, keeping in mind that handouts
often go unread by families.
Downloaded by Nicholas Marks ()
