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Burns Pediatric Primary Care 7th Edition All Chapters Complete Test Bank

Burns' Pediatric Primary Care 7th Edition Test Bank Chapter 1: Health Status of Children: Global and National Perspectives 1. Which region globally has the highest infant mortality rate? A. Indonesia B. Southern Asia C. SubSaharan Africa Correct D. Syria 2. The primary care pediatric nurse practitioner understands that, to achieve the greatest worldwide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? A. Antibiotics B. Optimal nutrition C. Vaccinations Correct D. Water purification 3. Which is true about the health status of children in the United States? . 56 A. Globalism has relatively little impact on child health measures in the U.S. B. Obesity rates among 2to5yearolds have shown a recent significant decrease. Correct . 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. 4. 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. Correct D. pollution. 5. 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 PediatricsRecommendations for Preventive Pediatric Health Care guidelines by A. focusing less on development and more on illness prevention and nutrition. B. following guidelines established by theBright Futures publication. C. scheduling wellbaby visits to coincide with key developmental milestones. Correct D. seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due. Chapter 2. Unique Issues in Pediatrics 1. A nurse is explaining the therapeutic milieu to a new nurse. The best explanation of this term would be: 1. The place where the child is receiving care. 2. Group therapy. 3. Personal interactions between patients and staff. 4. All of the above are correct. ANS: 4 2. A 16-year-old male has received a pink-slip from the police for inpatient psychiatric treatment. The teen has been expressing thoughts of hanging himself because Life sucks. The nursing staff should consider placing the child: 1. With peers. 2. In an area where he can be watched one-on-one. 3. With a roommate that is expressing the same concerns. 4. In an area close to an external door. ANS: 2 3. Learning disabilities in children have scientifically been linked to: 1. Poor nutrition. 2. The environment in which the child lives. 3. Genetics. 4. Watching more than four hours of television a day. ANS: 3 4. A mental health nurse has assessed a child and determined that the child exhibits behavioral challenges. When the school nurse explains this to a teacher, the best description would be: . 1. The child may exhibit physical outbursts. 2. The child may exhibit violence toward others. 3. The child may be defiant or have tantrums. 4. The child will need special interventions for learning. ANS: 3 5. A child that has not exhibited enuresis in four years has exhibited this behavior pattern for the last week. The reason a child may revert back to this behavior pattern is because of: 1. Hallucinations. 2. Behavioral challenges. 3. Delusions. 4. Stress. ANS: 4 6. An 18-year-old male has called the crisis line for help. The crisis nurse recognizes the intervention needs may consist of all of the following except: 1. Discussing the individuals everyday activities. 2. Recognizing that the patient may be in a catharsis state. 3. Expressing empathy toward the caller. 4. Avoiding entropy. ANS: 1 7. An 8-year-old boy with a history of hallucinations and violent behavior has been place in a seclusion room at the hospital because he has been hurting others. The nurse checks on the patient and realizes she must take him out of the seclusion room when: 1. He is crying to be released. 2. He states, I will be a good boy now. . 3. He starts headbutting the window. 4. He complains that his parents will file a lawsuit. ANS: 3 8. A child has been exhibiting the MacDonald Triad. These behaviors include: 1. Enuresis, pushing others, and pyromania. 2. Swinging a cat by the tail, bed-wetting, and lighting paper on fire in the trash can. 3. Playing with other children, laughing, and conversing with adults. 4. Playing with a campfire, watching television, and seeking adult attention. ANS: 2 9. A teenager diagnosed with borderline personality disorder should have discharge planning instructions of: 1. A consistent caregiver. 2. Monitoring of media, such as the Internet, television, and video games. 3. Obtaining support from family and friends. 4. Seeking medical attention when the teenager feels good. ANS: 3 10. A mental health nurse is teaching the mother of a child with executive functioning issues ways to help her child. Interventions the mother should use include: 1. Placing visual aids on the bathroom mirror so that the child will follow the morning routine. 2. Give the child a choice in foods to eat. 3. Allowing the child to ask for help when needed. 4. Reminding the child to be nice to others. ANS: 1 . 11. Ellie, a 9-year-old girl, was adopted by a family at the age of 4 after several years of severe neglect by her birth family. The adoptive family has been reporting that Ellie is angry a lot, manipulative with her teachers, and does not seek positive attention. The nurse working with Ellie will need to: 1. Provide education on decreasing stimuli in the home environment that triggers the anger. 2. Realize Ellie may have attachment issues related to her previous history and will need to encourage the family to be active in her care. 3. Support the family in the decision-making process of continuing to let Ellie live in the home. 4. Discuss inpatient therapy to decrease Ellies manipulative behavior patterns. ANS: 2 12. An infant displays depression by: 1. Smiling at strangers. 2. Bonding to someone other than the immediate family. 3. Crying more than an average infant. 4. Looks away when an adult attempts to play with the infant. ANS: 4 13. A father reports that his adolescent daughter has gotten good grades up until the last quarter of school. She has been hanging out by herself and does not want to talk to him anymore. The mental health nurse should: 1. Realize that this is a natural part of growing up. 2. Perform a mental health screening to check for depression. 3. Attempt to get the adolescent to discuss why she does not like her father anymore. 4. Let the adolescent talk when she is ready. ANS: 2 14. A teen should be checked for depression at physician visit(s). 1. Every . 2. One 3. Monthly 4. Bi-yearly ANS: 1 15. When using the SAD FACES depression screen, it is important to assess: 1. Anhedonia. 2. Suicidal ideations. 3. Sleep patterns. 4. All of the above ANS: 4 16. A school nurse is giving an in-service to teachers on bullycide. The main reason for the teaching is so that: 1. Teachers are aware bullying occurs. 2. Teachers are able to identify students who are risk. 3. Teachers can be aware of the fact that suicides can happen due to bullying by others. 4. Teachers are aware of their role in causing bullycide. ANS: 3 17. An adolescent with a known history of bipolar disorder is in the school nurses office because a teacher reported that she was talking fast and acting like she was God. The school nurse assesses the girl and notes that: 1. She is probably in a manic phase and needs to be treated professionally. 2. She has had too much sleep and is now hyperactive. 3. She forgot to take her medications today. 4. She requires some food and rest before going back to class. ANS: 1 Chapter 3. Genetics and Child Health Questions 1. What is true about haploid cells? . 44 C. Each contains 23 paired chromosomes. D. Each one contains 23 chromosomes. Correct E. Replication produces two identical cells. F. They replicate via the process of mitosis. 2. What does the following genetic notation symbol mean 47,XX,6q? . 50 A. Male with deletion of chromosome 6 B. Female with deletion of chromosome 6 C. Male with deletion on the long arm of chromosome 6 D. Female with deletion on the long arm of chromosome 6 Correct 3. A child has a recessive genetic disorder that is homozygous for that mutation. . 46 What is most likely about this child’s parents? A. Neither parent has a copy of that gene mutation. B. Only the mother has a copy of that gene mutation. C. Only the father has a copy of that gene mutation. D. Each parent has one copy of that gene mutation. Correct 4. Which type of mutation is responsible for many singlegene genetic disorders? . 36 A. Copy number variations B. Nucleotide repeat expansions C. Point mutations Correct D. Single nucleotide polymorphisms (SNP) . 5. Cystic fibrosis is a recessive disease requiring the presence of a gene mutation . 38 on both alleles inherited from the parents. Which type of genetic disorder is this? A. Chromosome B. Mitochondrial C. Monogenetic Correct D. Multifactorial . 6. The primary care pediatric nurse practitioner is counseling a couple about genetic risks and learns that one parent has neurofibromatosis, an autosomal dominant disorder, and the other parent does not. What will the nurse practitioner include when discussing this disorder and its transmission? C. Children must inherit a gene from both parents to develop the disease. D. Each child born to this couple will have a 50% risk of having the disease. Correct E. This type of disorder characteristically skips generations. F. Unaffected offspring may still pass on the disease to their offspring. 7. A family medical history conducted during a well baby exam for a newborn girl reveals that hemophilia A, an Xlinked recessive disorder, is present in males in three previous generations in the mother’s family, whose father had the disease. What will the primary care pediatric nurse practitioner tell the parents about the risk of this disease in their children? E. All of their sons will be affected by the disease. F. Any sons they have will not be affected by the disease. G. Daughters have a 50% chance of being carriers of the disease. Correct H. Their daughter has a 25% chance of having the disease. 8. What is an important responsibility of the primary care pediatric nurse practitioner . to help determine genetic risk factors in families? E. Assessing physical characteristics of genetic disorders F. Knowing which genetic screening tests to perform G. Making appropriate referrals to pediatric geneticists D. Obtaining a threegeneration pedigree for each family Correct 9. Which diagnostic study may be ordered when the provider wishes to detect the . presence of additional genetic material on a chromosome? A. Chromosomal microarray B. FISH Correct D. Karyotype E. Molecular testing 10. Which type of testing will the primary care pediatric nurse practitioner recommend . for a couple concerned about the potential for having children with cystic fibrosis? A. Biochemical testing B. Carrier testing Correct C. FISH testing D. Karyotype testing Chapter 4. Environmental Issues Questions 1. What has been the result of passage of the Toxic Substances Control Act. (TSCA) of 1976? G. A mandate for corporations to disclose known toxic chemicals H. A requirement that all manufactured chemicals undergo toxicity testing I. Authorization of the EPA to require testing and reporting of some chemicals Correct J. Development of a mechanism to report reactions to toxic chemicals 2. Many European nations use the “precautionary principle” to help regulate potentially toxic chemicals. What does this mean? G. Chemicals must be proven to be safe before being introduced into the environment. Correct H. Corporations may be exempt from testing if their costs in doing so are too high. I. Regulators must demonstrate risk to the public before banning a chemical. J. Without a strong risk, corporations need not release data about their products. 3. During a clinic visit, a child’s rapid capillary screening test for lead reveals a level of 11 mcg/dL. What will the primary care pediatric nurse practitioner do next? I. Institute lead abatement measures in the child’s home. J. Monitor lead levels monthly until decreased. K. Order a venous sample to test for lead levels. Correct L. Test the child’s siblings and parents for lead. 4. A child has a lead level of 25 mcg/dL. Once lead abatement measures are instituted, what is an important intervention to help prevent permanent damage H. Chelation therapy I. Dietary changes C. Followup testing Correct . D. Testing family members 5. A child whose parent works in a factory pr esents with swelling of the extremities, pain and weakness in the pelvis, and an erythematous maculopapular rash. Which industrial toxin will the primary care pediatric nurse practitioner suspect in this child? A. Lead B. Mercury C. Organophosphates Correct D. Phthalates 6. When counseling a mother who smokes about preventing exposure to smokingrelated risks to her nursing newborn, what will the primary care pediatric nurse practitioner tell her? F. If she quits now, her child will not have longterm effects from exposure. G. Prenatal smoke exposure does not cause respiratory effects after the infant is born. H. Smoking outdoors or near an open window prevents exposure to tobacco smoke. I. Thirdhandsmoke exposure risks may last for years even if the mother quits now. Correct 7. A child who has been playing in a public park is brought to the clinic with wheezing, vomiting, diarrhea, and drooling. A physical exam reveals a low heart rate and diaphoresis. What will the primary care pediatric nurse practitioner suspect as a cause for these symptoms? B. Arsenic consumption C. Lead poisoning C. Organophosphate exposure Correct D. Phthalate ingestion 8. A parent asks about ways to limit exposure to risks associated with plastics. Besides avoiding using plastic containers when possible, what else will the primary care pediatric nurse practitioner recommend? A. Avoid heating foods and liquids in plastic containers. Correct B. Clean plastic containers well using the dishwasher. C. Use only plastics stamped with “#7” on the bottom. D. Used canned food products whenever possible. 9. A parent desires to buy only organic produce to avoid exposing a child to pesticides but complains that these foods are expensive. The primary care pediatric nurse practitioner provides a list of foods that are relatively safe whether they are organic or not. Which foods are on this list? A. Apples, celery, and peaches B. Potatoes, cherry tomatoes, and peaches C. Strawberries, grapes, and cucumbers D. Sweet corn, cantaloupe, and kiwi Correct Chapter 5. Child and Family Health Assessment Questions 1. 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? K. Complementary medications, alternative health practices, and chief complaint L. Developmental delays, nutritional status, and linear growth patterns M. Medication currently taking, allergy information, and family medical history N. Speech and language development, beliefs about health, and previous illnesses Correct 2. When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? A. DC: 03R Correct K. ICD10CM L. ICSD3 M. NANDA International 3. The primary care pediatric nurse practitioner sees a 3yearold 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 thirdparty reimbursement? M. Altered elimination pattern N. Elimination disorder C. Encopresis Correct D. Parenting alteration 4. 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? J. Failure to thrive K. Home care resources inadequate L. Nutrition alteration – less than required D. Parenting alteration Correct . 5. The primary care pediatric nurse practitioner is p erforming a well child checkup on a 20monthold child. The child was 4 weeks premature and, according to a parentcompleted developmental questionnaire, has achieved milestones for a 15monthold infant. Which action is correct? J. Perform an indepth developmental assessment screen at this visit to evaluate this child. Correct K. Reassure the parent that the child will catch up to normal development by age 2 years. L. Reevaluate this child’s development and milestone achievements at the 2year visit. M. Refer the child to a specialty clinic for evaluation and treatment of developmental delay. 6. The primary care pediatric nurse practitioner performs a developmental assessment on a 3yearold child and notes normal cognitive, finemotor, and grossmotor 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 D. ask the parent to consider a possible speech delay and report any concerns. E. continue to evaluate the child’s speech at subsequent visits. Correct F. refer the child for a speech and hearing evaluation. G. tell the parent to spend more time in interactive conversations with the child. 7. 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 (MCHAT) tool, which indicates several areas of concern. What will the nurse practitioner do? E. Administer a Childhood Autism Rating Scale (CARS) in the clinic. F. Consult a specialist to determine appropriate early intervention strategies. G. Refer the child to a behavioral specialist for further evaluation. Correct H. Tell the parent that this result indicates that the child has autism. 8. The primary care pediatric nurse practitioner learns that the mother of a 3yearold 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? D. Fine motor E. Gross motor F. Social/emotional D. Speech and language Correct . 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? C. CRAFFT D. Ecomap C. Genogram Correct D. Pedigree 10. 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 prekindergarten 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. Correct 11. The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschoolage child. How will the nurse practitioner assess C. Ask the child how many books he has at home. Correct D. Ask the mother about her highest grade in school. E. Ask the mother to determine the correct dose of a drug from a label. F. Ask the mother to read a health information handout aloud. 12. 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. Threegeneration pedigree Correct A. Review of systems B. Genogram C. Ecomap 1 3. 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 Correct A. HEEADSSS B. PHQ2 C. RAAPS 14. The primary care pediatric nurse practitioner evaluates a schoolage 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 Correct A. Rule out type 2 diabetes mellitus Chapter 6. Cultural Considerations for Pediatric Primary Care Questions 1. 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 O. collectivism. P. constructivism. Q. essentialism. Correct R. individualism. 2. The primary care pediatric nurse practitioner learns that an AfricanAmerican 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 N. cultural sensitivity. O. group bias. P. individual privilege. Correct Q. racial awareness. 3. The primary care pediatric nurse practitioner cares f or 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? O. Ask about the types of practices used and when they are applied. Correct P. Provide a list of harmful herbs and ask the family to avoid those. Q. Suggest that the family avoid using these remedies in their children. R. Tell the parents to use the herbs in conjunction with modern medications. 4. 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? M. Giving health care advice that takes cultural differences into account N. Identification of other cultures that may be superior to one’s own culture C. Receptivity to learning about the perspectives of other cultures Correct D. Respecting other cultures while maintaining the views of one’s own 5. A Somalian immigrant mother is concerned that her 8yearold 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 Americanborn 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 Correct N. Intrapersonal O. Organizational 6. 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 H. ask the sponsor to allow the family to respond. I. develop the plan of care and ask the sponsor to make sure it is followed. J. request that the sponsor translate written instructions for the family. K. use the telephone interpreter service to communicate with the family. Correct 7. The primary care pediatric nurse practitioner prescribes a twice daily inhaled corticosteroid for a 12yearold 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 clientcentered care? A. Asking the child to describe usual daily routines and schedules Correct I. Referring the family to a social worker to help with medication compliance J. Reviewing the asthma action plan with the parent and the child K. Teaching the child how the medication will help to control asthma Symptoms 8. 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? G. Asking community members to assist in researching and implementing a program Correct H. Designing a community garden approach that involves children and their parents I. Gaining support from the corporate community to provide needed resources J. Providing evidencebased information about the importance of a healthy diet 9. The parents of a special needs child tell the primary care pediatric nurse practitioner that they are planning a 3month 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 E. global application. Correct F. global awareness. G. system application. H. system awareness. 10. The primary care pediatric nurse practitioner is examining a child whose parents recently emigrated from a wartorn country in the Middle East. Which is a priority assessment when performing the patient history? A. Asking about physical, psychological, and emotional trauma Correct E. Determining the parents’ English language competency and literacy level F. Learning about cultural preferences and complementary medicine practices G. Reviewing the child’s previous health and illness records Chapter 7. Children with Special Health Care Needs 1. A child born with Dandy Walker malformation is receiving palliative care in the pediatric unit. A nurse should: 1. Provide the parents, patient, and family members with supportive care during this time. 2. Ask the parents to be part of the plan of care as much as possible. 3. Attempt to provide a primary nurse for this particular patient on each shift. 4. All of the above are correct. ANS: 4 2. A head circumference is being measured at a 4 month olds well-baby checkup. It is noted that the head circumference has not grown since the previous assessment. The nurse should: 1. Ask the mother about the childs nutrition. 2. Notify the doctor. 3. Re-measure the head circumference, check developmental milestones, assess the nutritional status, and discuss the findings with the doctor. 4. Document the normal findings. ANS: 3 3. A child with a diagnosis of schizencephaly is assigned to a new nurse on the pediatric floor. The new nurse has not worked with a child with this diagnosis before. A career nurse discusses the plan of care needed for the child with the new nurse. It will be important to: 1. Assess the side of the body that has paralysis for any lesions or sores. 2. Let the patient do as much as possible for activities of daily. 3. Discourage the patient to move the paralyzed side of the body. 4. Provide full care for the patient. ANS: 1 4. A nurse is assessing a 6-month-old boys suture lines. The nurse notes that the baby has craniosynostosis. The nurse should be concerned because: 1. The suture line closure will not allow the brain to grow. 2. This can lead to hydrocephalus. 3. The child will have immediate developmental delays because of the lack of space for the brain to grow. 4. The child will not require surgery. ANS: 1 5. A child that had a shunt placed four years ago for hydrocephalus is in the emergency room complaining of a rapid onset of vomiting and increased lethargy. The nurse knows that the child will need: 1. Nothing, as this is a normal complication and not an emergency. 2. To be placed on IV fluids to help maintain an electrolyte balance. 3. Small amounts of fluids until the vomiting has subsided. 4. To consider this a neurological medical emergency and check the childs head circumference. ANS: 4 6. Night terrors can occur in adolescents because of: 1. Emotional stress. 2. Alcohol use. 3. Bullying. 4. All of the above can trigger night terrors in adolescents. ANS: 4 7. When speaking with a family about their 9-year-old daughters nightmares, it is important to ask: 1. If the child has a history of daytime napping. 2. What medications the child takes during the day. 3. How often the child consumes caffeine. 4. All of the above should be part of the assessment. ANS: 4 8. A quality of a partial seizure is: 1. Status epilepticus. 2. Tonic movements. 3. Fluttering eyelids. 4. Clonic movements. ANS: 4 9. A mother is asking the nurse why her daughter continues to have temporal lobe seizures even though she is on medication. The nurse knows this is occurring because: 1. The medication may not be in the therapeutic range. 2. Temporal lobe seizures do not respond well to medications. 3. The daughter may be missing doses of her medication. 4. The food her daughter eats may have a negative reaction with the medication, causing more seizures. ANS: 2 10. Which of the following types of epilepsy are photosensitive? 1. Juvenile myoclonic epilepsy 2. Temporal lobe epilepsy 3. Febrile seizures 4. Childhood absence epilepsy ANS: 1 1. A child who had a seizure one hour ago is exhibiting signs of paralysis on the left side of the body. The nurse understands the child is exhibiting signs of: 1. Lethargy due to previous seizure activity. 2. Postictal paralysis. 3. Permanent paralysis of the left side of the body. 4. Major brain damage that is going to have long-term effects. ANS: 2 12. A child with a known history of Benign Rolandic Epilepsy is having a seizure during lunch at the middle school. The school nurse is called to the cafeteria. What is the school nurses priority at this time? 1. Prevent a possible choking incident by checking the students mouth for food. 2. Lay the child down on the floor and make sure the area is safe. 3. Call the EMTs for help. 4. Notify the parents that their daughter is having a seizure. ANS: 1 . 13. An 18 month old is having a seizure when the nurse is assessing him. The nurse notes that the child is fluttering his eyes and smacking his lips. The nurse should document this seizure as: 1. An absence seizure. 2. A tonic-clonic seizure. 3. A myoclonic seizure. 4. A febrile seizure. ANS: 1 14. A 9 month old is admitted to the pediatric unit for seizures of unknown origin. The child has an EEG performed for several hours. The EEG notes several seizures occurring at different intervals. The nurse knows this child: 1. Will develop at the same rate as his peers. 2. May have severe mental and physical challenges due to the frequent seizure activity. 3. May exhibit a slight cognitive delay as he grows. 4. Will grow out of having seizures. ANS: 2 15. A child has been status epileptics for the last 20 minutes. The child has Depakote, Valporic Acid, and Diazepam gel ordered. The nurse should prepare which medication for administration at this time? 1. Depakote 2. Valporic acid 3. Diazepam 4. None of the medications. The child will stop on his own. ANS: 3 16. Care for a child during status epilepticus should include all of the following except: 1. Turn the patient to the right side. 2. Loosen tight clothes. 3. Move toys out of the area to prevent injury. 4. Stay with the patient until the seizure has stopped. ANS: 1 17. The nurse is identifying the difference between primary headaches to secondary headaches. Secondary headaches can occur: 1. Because of stress. 2. In relation to low blood pressure. 3. Because of concussions. 4. Because of migraines. ANS: 3 18. Cyclic vomiting may: 1. Last for days. 2. Require SSRIs to stop hurting. 3. Not be associated with a headache. 4. Requires pain medication and Zofran. ANS: 3 19. A child that has rhythmic, repetitive, involuntary movements is exhibiting: 1. Tremors. 2. Dystonia. 3. Contractures. 4. Tics. ANS: 2 20. Identify a therapeutic management technique for a child with a tic disorder. 1. Behavioral modification to suppress the tics 2. Administer anti-psychotic medications to reduce the tics 3. Education and support for the child and the family 4. Genetic counseling for the family ANS: 3 21. Identify a true statement about Tourettes Syndrome (TS) is that: 1. Manifestations rarely change once developed. 2. Children with TS do not have obsessive compulsive disorders. 3. The tics of TS can lead to mental deterioration. 4. The tics are involuntary, and the person cannot control the behavior. ANS: 4 22. The assessment a nurse performed on a 12-year-old boy demonstrated a positive Kernigs sign and a Brudzinskis sign. Identify the priority for the nurses next action. 1. Document the findings and note as normal. 2. Further assess the neurological function of the child and call the doctor with a report. 3. Explain to the patient that the assessment was abnormal and there is no a cause for concern. 4. Prepare the child for a lumbar puncture. ANS: 2 23. Results from cerebrospinal fluid that was tested for meningitis have been received by the nurse. The results indicate bacterial meningitis. The nurse knows this because the results show: 1. A low protein count and a low glucose count. 2. A low red blood cell count. 3. An elevated protein count and a low glucose level. 4. A normal protein count and a high glucose count. ANS: 3 . Chapter 8. Developmental Management in Pediatric Primary Care Questions 1. 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 S. developing consistent daily routines for the child. Correct T. exposing her child to extended family members when possible. U. not working outside the home during the first few years. V. taking her child to regular play date activities with other children. 2. 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? R. Reassure them that the child is too young to understand. S. Recommend that they continue to not argue in front of the child. T. Suggest counseling to learn ways to handle stress. Correct U. Tell them that the conflict will resolve when the situation changes. 3. During a well child assessment of an 18monthold 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? S. Allow the parent to put the child in a “timeout.” T. Ask the parent about usual discipline practices. U. Offer the child a book or a toy to look at. Correct V. Stop the exam since the child has reached a “meltdown.” 4. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3yearold child who draws on the walls with crayons? O. Give the child washable markers so the drawings can be removed easily. P. Provide a roll of paper for drawing and teach the child to use this. Correct Q. Put the child in “timeout” each time the child draws on the walls. R. Take the crayons away from the child to prevent the behavior. 5. 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? P. Consult a developmental specialist for a more complete evaluation. Q. Prepare the parents for a potentially serious developmental disorder. R. Refer the infant to an early intervention program for physical therapy. S. Teach the parents to provide exercises to encourage motor development. Correct 6. 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? L. Explain to the parent that developmental delays often do not manifest at first. M. Perform a developmental assessment and tell the parent which delays are evident. N. Point out the tasks that the infant can perform while conducting the assessment. Correct D. Refer the infant to a developmental specialist for a complete evaluation. 7. 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 aboutcommunity services and resources for their child. What should the nurse practitioner do initially? L. Ask the parents if they have an individualized family service plan (IFSP). Correct M. Consult with a physician to ensure the child gets appropriate care. N. Inform the family that services are provided when the child begins school. O. Refer the family to a social worker for assistance with referrals and services. 8. 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 Correct O. Developing protocols for parents to follow P. Monitoring individual education plans (IEPs) Q. Providing lists of resources for families 9. The primary care pediatric nurse practitioner performs a physical examination on a 9montholdinfant 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? I. To begin brushing the infant’s teeth with toothpaste J. To consider weaning the infant from breastfeeding K. To discontinue giving fluoride supplements D. To make an appointment for an initial dental examination Correct 10. The primary care pediatric nurse practitioner enters an exam room and finds a 2monthold 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 H. a sign that the mother has postpartum depression. I. extremely concerning for potential parental neglect. J. of moderate concern for parenting problems. Correct K. within the normal range of behavior in early parenthood. Chapter 9. Developmental Management of Newborns Multiple Choice 1. 1. A mother brings her 9 month infant in for a routine visit. What milestone would be appropriate for the doctor to ask if the infant is meeting? 1. Walking 2. Speaking in two word phrases 3. Rolls back to stomach and stomach to back 4. All of the above ANS: 3 2. A 5 day old infant comes in for a newborn checkup. On assessment of the newborn, you note that the skin is jaundice in color. The anterior fontanel is slightly sunken. Per mom, the infant has only had 2 diapers today. The infant is strictly breastfed and this is moms first child. She states baby is having trouble latching on. A bilirubin level is sent and comes back at 18. You identify this newborn to be dehydrated and is most likely to have breast milk jaundice. Which nursing intervention(s) will be required for this baby? 1. Phototherapy 2. Providing support and education for the lactating mother 3. Strict monitoring of intake and output 4. All of the above ANS 4 3. Apgar scores measure heart rate, respiratory rate, reflex irritability, color and : 1. 1. Rigidity 2. 2. Muscle tone 3. 3. Birth weight 4. 4. Capillary refill ANS: 2 4. A mother on the postpartum unit asked to have her infant back from the nursery so that she can breastfeed. The nurse brings the newborn to the room and hands the baby to the mother. She asks the mother to let her know how long the baby feeds. What vital step did the nurse forget to take before giving the baby to the mother? 1. 1. The nurse should have made sure that the baby was latching correctly 2. 2. The nurse should have identified the babys ID band with the mothers 3. 3. The nurse should have the mother speak with a lactation consultant 4. 4. The nurse should have asked the mother how long she planned to feed ANS: 2 5. Excessive heat loss results in which of these? 1. RDS 2. Depletion of glucose levels 3. Jaundice 4. Increase in surfactant levels ANS: 2 6. A mother has just delivered her new baby a few hours ago. She asks the nurse if she can bathe the baby because he has blood on him. The best response from the nurse would be. 1. Sure, let me get you some soap and washcloths 2. Why dont you get some rest, there will be lots of time for bathing 3. Its important that we not bathe the baby too soon after birth. Lets wait till later in the day. 4. Sure, but why dont you feed the baby ANS: 3 7. A 4 week old infant is brought to the ED. Mom states that the baby hasnt been eating well and has had decreased diapers for 2 days. The baby has been sleeping more and has been hard to wake up. On assessment, you find that the baby is difficult to arouse, is hypotonic and temperature is 35.4 rectally. What is an important lab value to check? Choose the best answer. 1. Complete metabolic panel 2. Liver panel 3. Blood glucose 4. PTT ANS: 3 8. A pregnant woman with a history of a clotting disorder is required to self- administer heparin during her pregnancy. After delivery, the infant will be at greater risk for: 1. Low blood sugar 2. Decrease Vitamin K 3. Increased Vitamin K 4. High blood sugar ANS: 2 . 9. A part of injury prevention is making and keeping infant appointments. The required checkups and vaccinations are at: 1. 3 months, 6 months, 9 months 2. 2 months, 4 months, 6 months and 1 year 3. 2 months, 4 months, 6 month, 9 months and 1 year 4. 2 months, 4 months, 9 months and 1 year ANS: 3 10. You are taking care of an infant who was admitted with dehydration. His weight is 6kg. You have been watching his I & Os. What would you expect the infants urinary output to be in order to maintain adequate hydration? 1. 0.52 ml/kg/hr 2. 0.52.5 ml/kg/hr 3. 13 ml/kg/hr 4. As long as he is having wet diapers it doesnt matter ANS: 3 11. A mother brings her newborn daughter to the ER with concerns that she is having vaginal bleeding. You know this is normal and called what? 1. Pseudomenstruation 2. Milia 3. Vernix caseosa 4. Toxicum ANS: 1 12. While interviewing the mother of an infant, you note that the mother gets frustrated as she explains that her baby has been up all night crying at least 3 times a week for the last 2 weeks. She states that she has tried everything and feels hopeless. What would be the BEST response from you as the nurse? 1. Believe me, I know. I have a newborn too. 2. Have you tried warm milk? 3. Its ok to be frustrated and feel overwhelmed. 4. You are doing nothing wrong. This can be a common occurrence in infants and you should not feel guilty. ANS: 4 Chapter 10. Developmental Management of Infants Questions 1. 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? W. Cognitive learning begins during the toddler years. X. Intellectual growth begin when speech develops. Y. Language and literacy skills begin at birth. Correct Z. Preschool is an optimal time to begin general learning. 2. The primary care pediatric nurse practitioner performs a well baby examination on a 7dayold 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? V. Follow up at the 2month checkup. W. Refer to a lactation consultant. X. Schedule a weight check in 1 week. Correct Y. Suggest supplementing with formula. 3. During an assessment of a 4weekold 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 4hour 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 Correct W. Nursing the infant for longer periods every 4 hours X. Supplementing with formula at the last nighttime feeding Y. Waking the infant every 2 hours to nurse during the night 4. The primary care pediatric nurse practitioner is performing a well baby examination on a 2monthold 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? S. She may not be making as much breastmilk as before. T. She should keep a log of the frequency and duration of each feeding. U. The infant may be going through an expected growth spurt. Correct V. The infant should stay on the previously established nursing schedule. . 5. The mother of a 6weekold 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? T. Her baby is probably constipated. U. It may be related to her dietary intake. V. She should consume more water. W. This may be normal for breastfed babies. Correct 6 . The mother of a 3monthold 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 Correct O. The importance of scheduling “play dates” with other infants P. To provide musical toys to engage the infant 7. The parent of a 5monthold is worried because the infant becomes fussy but doesn’t always seem interested in nursing. What will the nurse practitioner tell this parent? P. The infant may be expressing a desire to play or to rest. Correct Q. The parent should give ibuprofen for teething pain before nursing. R. This is an indication that the infant is ready for solid foods. S. This may indicate gastrointestinal discomfort such as constipation. 8. The mother of a 6monthold 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? R. “At this age, your baby does not understand the meaning of sounds.” Correct S. “Babies at this age cannot make the ‘ma’ sound.” T. “Most sounds made by babies at this age are accidental.” U. “This may mean that your baby doesn’t hear well.” 9. The primary care pediatric nurse practitioner is performing a well child examination on a 9monthold 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? L. Provide educational videos that focus on language. M. Read simple board books to the infant at bedtime. Correct L. Sing to the child and play lullabies in the baby’s room. M. Turn the television to Sesame Streetduring the day. 10. The primary care pediatric nurse practitioner is examining a 12monthold 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? G. Perform an indepth developmental assessment. Correct H. Reassure the parent that this is normal for a premature infant. I. Refer the infant to a developmental specialist. J. Suggest activities to improve fine motor skills. Chapter 11. Developmental Management of Early Childhood Questions 1. The primary care pediatric nurse practitioner is evaluating a 2yearold 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? AA. Ask the child’s parents whether they read to the child. Correct BB. Give parents educational materials to encourage speech. CC. Refer the child to an early intervention program. DD. Suggest that they purchase ageappropriate music videos. 2. The primary care pediatric nurse practitioner performs a developmental assessment on a 32monthold 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? Z. Evaluate the child’s cognitive abilities. AA. Obtain a hearing evaluation. BB. Reassure the parent that this is normal. Correct CC. Refer the child to a speech therapist. 3. During a well child assessment of an 18monthold 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 Z. holophrastic speech. AA. receptive speech. BB. semantic speech. CC. telegraphic speech. Correct 4. The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12monthold child. The parents are bilingual in Spanish and English and have many Spanishspeaking 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? GG. Children who learn two languages simultaneously often confuse them in conversation. HH. Children with Multilanguage proficiency do not understand that others cannot do this. II. Learning two languages at an early age prevents children from developing a dominant language. X. Most bilingual children are able to shift from one language to another when appropriate. Correct 5. 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? • Allow the child to explore and experiment while providing appropriate limits. • Correct • Be present while the child plays to continually teach the child what is appropriate. • Let the child experiment at will and to make mistakes in order to learn. • Say “no” whenever the child does something that is not acceptable. • T. The mother of a 3yearold child takes the child to a play group once a week. . 61 6. 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? The child probably is very shy but will outgrow this tendency with repeated exposure to other children. V. The toddler may have a language delay that interferes with socialization with other children. W. Toddlers may be interested in other children but usually do not engage in interactive play. Correct X. Toddlers need more structured play to encourage interaction and socialization with others. 7. The parent of a 4yearold 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 preschoolage children? P. Animism Q. Artificialism R. Egocentrism D. Realism Correct 8. The parent of a 24monthold child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? N. “Begin by reading to your child about toileting.” O. “Most children are capable by age 2 years.” K. “Tell me about your child’s daily habits.” Correct L. “We should assess your child’s motor skills.” 9. The primary care pediatric nurse practitioner performs a physical examination on a 9monthold 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? D. To begin brushing the infant’s teeth with toothpaste E. To consider weaning the infant from breastfeeding F. To discontinue giving fluoride supplements D. To make an appointment for an initial dental examination Correct 10. The parents of a 3yearold 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? D. Allow the child to choose foods for meals to improve caloric intake. E. Place a variety of nutritious foods on the child’s plate at each meal. Correct F. Prepare mashed potatoes and chicken strips for the child at mealtimes. G. Suggest cutting out snacks to improve the child’s appetite at mealtimes. Chapter 12. Developmental Management of Middle Childhood Questions 1. The primary care pediatric nurse practitioner is examining a 6yearold 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 EE. about school performance and grades. FF. why school is so distressing. GG. to name one or two friends. Correct HH. whether bullying is taking place. 2. The parent of a 10yearold 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 DD. children at this age who prefer interactions with samegender peers usually have a homosexual orientation. EE. children experiment with sexuality at this age as a means of deciding later sexual orientation. FF. this attachment to other samegender children is how the child learns to interact with others. Correct GG. to encourage mixed gender interactions in order to promote development of sexual values. 3. The parents of a 12yearold 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? DD. Allowing the child to make poor choices and accept consequences is important for learning values EE. Children at this age have a high regard for authority and social norms, so this is not likely to happen FF. Moral values instilled in the early schoolage period will persist throughout childhood GG. The pressures from outside influences may supersede parental teachings and should be confronted Correct 4. During a well child exam of a schoolage child, the primary care pediatric nurse practitioner learns that the child has been having angry episodes at school. The nurse practitioner observes the child to appear withdrawn and sad. Which action is appropriate? A. Ask the child and the parent about stressors at home Correct PP. Make a referral to a child behavioral specialist QQ. Provide information about anger management D. Suggest consideration of a different classroom 5. The primary care pediatric nurse practitioner is preparing to conduct a well child . assessment of an 8yearold child. How will the nurse practitioner begin the exam? A. Ask the child about school, friends, home activities, a nd sports Correct Y. Discuss the purpose of the visit and explain the procedures that will be performed Z. Offer ageappropriate information about usual developmental tasks AA. Provide information about healthy nutrition and physical activities 6. The parent of a 6yearold child expresses concern that the child may have ADHD. Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility? Q. Behavioral and Emotional Screening System for Children (BESS2) R. Behavioral Assessment for Children – 2nd ed. (BASC2) C. Conner’s 3 Parent and Teacher Rating Scale Correct D. Pediatric Symptom Checklist (PSC) 7. The parent of a 5yearold child who has just begun kindergarten expresses concern that the child will have difficulty adjusting to the birth of a sibling. What will the primary care pediatric nurse practitioner recommend? U. Allowing the child opportunities to discuss feelings about the baby V. Giving the child specific baby care tasks to promote sibling bonding C.Having snack time with the child each day to discuss the school day Correct D. Providing reassurance that the sibling will not replace the child 8. A schoolage child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent? Y. Allow the child to make food choices since this is usually a phase Z. Ensure that the child has three nutritious meals and two nutritious snacks each day Correct AA. Prepare vegetables separately for the child to encourage adequate intake BB. Teach the child how important it is to eat h ealthy fruits and vegetables 9. The primary care pediatric nurse practitioner performs a physical examination on a 12yearold 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 selfcare with the mother Correct B. Give the child information about sleep and selfcare S. Reassure the mother that this “noncompliance” is temporary T. Tell the mother that experimenting with selfcare behaviors is normal 10. During a well child exam on a 5yearold child, the primary care pediatric nurse practitioner assesses the child for school readiness. Which finding may be a factor in limiting school readiness for this child? T. Adherence to daily family routines and regular activities U. Having two older siblings who attend the same school C. Parental concerns about bullying in the school Correct D. The child’s ability to recognize four different colors 11. The primary care pediatric nurse practitioner is examining a schoolage child who complains of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the nurse practitioner initially ask the parent? A. About the timing of the symptoms each day and during the week Correct M. How well the child performs in school and in extracurricular activities N. If the parent feels a strong need to protect the child from problems O. Whether there are any unusual stressors or circumstances at home 12. The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in a schoolage child. The child’s exam is normal. The nurse practitioner learns that the child reports pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child’s grandmother recently had gallbladder surgery. Which action is correct? A. Encourage the child to keep a log of pain, stool patterns, and dietary intake Correct G. Order radiologic studies and laboratory tests to rule out systemic causes H. Reassure the child and encourage resuming sports when symptoms subside I. Refer the child to a counselor to discuss anxiety about health problems Chapter 13. Developmental Management of Adolescents/Young Adults Questions 1. The primary care pediatric nurse practitioner is performing a well child assessment on a 13yearold female whose mother asks when her daughter’s periods may start. Which information will the nurse practitioner use to help estimate the onset of periods? A. The age of the mother’s menarche B. The patient’s age at thelarche Correct II. When adrenarche occurred JJ. Whether linear growth has stopped 2. The primary care pediatric nurse practitioner is examining a 15yearold female who reports having her first period at age 13. She states that she has had five periods in the last year, with the last one 2 months prior. She participates in basketball at school. Which action is correct? HH. Perform biometric screening to determine lean body mass. Correct II. Prescribe oral contraceptives pills to regulate her periods. JJ. Reassure her that this is perfectly normal at her age. KK. Refer her to an endocrinologist for hormonal evaluation. 3. During a well child assessment of a 13yearold male, the primary care pediatric nurse practitioner notes small testicles and pubic and axillary hair. To further evaluate these findings, the nurse practitioner will ask the patient about HH. alcohol and tobacco use. II. changes in voice. JJ. increase in height and weight. KK. participation in sports. Correct 4. The mother of a 16yearold male was recently divorced after several years of an abusive relationship and tells the primary care pediatric nurse practitioner that the adolescent has begun skipping school and hanging out with friends at the local shopping mall. When she confronts her child, he responds by saying that he hates her. What will the nurse practitioner tell this mother? XX. Adolescence is marked by an inability to comprehend complex situations. YY. Adolescence is typically marked by tempestuous and transient episodes. ZZ. Adolescents normally have extreme, disruptive conflicts with parents. AAA. Adolescents often need counseling to help them cope with life events. Correct . 5. The primary care pediatric nurse practitioner is performing a well child exam on a 12yearold female who has achieved early sexual maturation. The mother reports that she spends more time with her older sister’s friends instead of her own classmates. What will the nurse practitioner tell this parent? BB. Earlymaturing girls need to identify with older adolescents to feel a sense of belonging. CC. Girls who join an older group of peers may become sexually active at an earlier age. Correct DD. Spending time with older adolescents indicates a healthy adjustment to her maturing body. EE. The association with older adolescents will help her daughter to gain social maturity. 6. The mother of a 15yearold adolescent female tells the primary care pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything

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