EXAM TEST FOR NR602 2023/2024

EXAM TEST FOR NR602 2023/2024 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? Administer a Childhood Autism Rating Scale (CARS) in the clinic. Consult a specialist to determine appropriate early intervention strategies. Refer the child to a behavioral specialist for further evaluation. Tell the parent that this result indicates that the child has autism. - CORRECT ANSWER-ANS: C The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic. 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? Three-generation pedigree Review of systems Genogram Ecomap - CORRECT ANSWER-ANS: A The three-generation pedigree is used to map out risks for genetic diseases in families, as well as conditions with modifiable risk factors. The review of systems is used to evaluate the history of the child's body systems. The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The ecomap is used to identify relationships in the family and community that are supportive or harmful. 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 parentcompleted developmental questionnaire, has achieved milestones for a 15-month-old infant. Which action is correct? Perform an in-depth developmental assessment screen at this visit to evaluate this child. Reassure the parent that the child will catch up to normal development by age 2 years. Re-evaluate this child's development and milestone achievements at the 2-year visit. Refer the child to a specialty clinic for evaluation and treatment of developmental delay. - CORRECT ANSWER-ANS: A This child should be at a 19-month adjusted age for prematurity so, according to the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to evaluate this delay. Waiting to see if the child will "catch up" or assuring the parent that this will happen will cause the delays to become more severe. A referral to a specialty clinic should not be made solely on the basis of the parent-completed questionnaire but only after further evaluation of possible delays. When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? DC: 0-3R ICD-10-CM ICSD-3 NANDA International - CORRECT ANSWER-ANS: A The DC: 0-3R refers to the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and is useful for developmental problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3 is the International Classification of Sleep Disorders - 3rd edition. NANDA International is used to label problems in the functional health domain. 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? Ask the child how many books he has at home. Ask the mother about her highest grade in school. Ask the mother to determine the correct dose of a drug from a label. Ask the mother to read a health information handout aloud. - CORRECT ANSWERANS: 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. 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? Fine motor Gross motor Social/emotional Speech and language - CORRECT ANSWER-ANS: D Maternal depression in the first year of life has been associated with poorer language development at 3 years of age. 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? Altered elimination pattern Elimination disorder Encopresis Parenting alteration - CORRECT ANSWER-ANS: C Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized for reimbursement purposes. "Altered elimination pattern" and "Parenting alteration" are NANDA International diagnoses and are not recognized for reimbursement. "Elimination disorder" is a developmental diagnosis. 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? Ask the child's parent why the child is so anxious. Perform a physical assessment to rule out shortness of breath. Reassure the child that there is nothing to be afraid of. Review the purpose of this visit and any anticipated procedures. - CORRECT ANSWER-ANS: D The PNP should remember that young children are learning "scripts" for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease. 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? CRAFFT Ecomap Genogram Pedigree - CORRECT ANSWER-ANS: C The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is used to identify relationships in the family and community that are supportive or harmful. The pedigree is used to identify potential genetic disorders. 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? Metabolic syndrome Nutritional alteration: more than required Obesity Rule out type 2 diabetes mellitus - CORRECT ANSWER-ANS: C A problem should never be included on the problem list that is not supported by subjective and objective data found and recorded in the database. This child has a BMI that suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data, which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for reimbursement. "Rule out" should not be used as a diagnosis, but may be considered part of a plan. 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 : ask the parent to consider a possible speech delay and report any concerns. continue to evaluate the child's speech at subsequent visits. refer the child for a speech and hearing evaluation. tell the parent to spend more time in interactive conversations with the child. - CORRECT ANSWER-ANS: B Development should be monitored over time and within the context of the child's overall well-being, rather than at an isolated testing session. The child has normal development in observed measures and appears to hear and understand well. By parental report, the child is able to speak. The PNP should continue to evaluate speech over time, since this refusal to speak may be associated with shyness or intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay. Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a home therapy. 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? CRAFFT HEEADSSS PHQ-2 RAAPS - CORRECT ANSWER-ANS: A The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens. 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? Failure to thrive Home care resources inadequate Nutrition alteration - less than required Parenting alteration - CORRECT ANSWER-ANS: D Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the correct diagnosis should be "Parenting alteration." "Failure to thrive" is a medical diagnosis and requires a medical and social evaluation to rule out organic causes or detect neglect. "Home care resources inadequate" would be used if the PNP suspects that the family lacks adequate funds to purchase food. "Nutrition alteration" is a NANDA diagnosis and would be used if the PNP planned to consult with a dietician or give nutritional information. 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? Complementary medications, alternative health practices, and chief complaint Developmental delays, nutritional status, and linear growth patterns Medication currently taking, allergy information, and family medical history Speech and language development, beliefs about health, and previous illnesses - CORRECT ANSWER-ANS: D An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language development), functional health problems (beliefs about health), and diseases (chief complaint). The other examples all use domains associated with the traditional medical model and do not contain nursing aspects associated with functional health problems. 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? Reassure them that the child is too young to understand. Recommend that they continue to not argue in front of the child. Suggest counseling to learn ways to handle stress. Tell them that the conflict will resolve when the situation changes. - CORRECT ANSWER-ANS: C Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period. 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? Consult a developmental specialist for a more complete evaluation. Prepare the parents for a potentially serious developmental disorder. Refer the infant to an early intervention program for physical therapy. Teach the parents to provide exercises to encourage motor development. - CORRECT ANSWER-ANS: D The child who has mild delays in only one area may be managed initially by having the parent provide appropriate exercises. If this is not effective, or if delays become more severe, referrals for evaluation or early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so this action is not indicated. The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially? Ask the parents if they have an individualized family service plan (IFSP). Consult with a physician to ensure the child gets appropriate care. Inform the family that services are provided when the child begins school. Refer the family to a social worker for assistance with referrals and services. - CORRECT ANSWER-ANS: A Families with children who have developmental delays are eligible for early intervention services and should have IFSPs in place. This family may have one from their previous community, and it can be used as a starting point to determine needs. It is not necessary to consult with a physician to coordinate community resources. Early intervention is provided from birth, according to federal law. Until the specific referrals are known, the social worker is not consulted. 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? Explain to the parent that developmental delays often do not manifest at first. Perform a developmental assessment and tell the parent which delays are evident. Point out the tasks that the infant can perform while conducting the assessment. Refer the infant to a developmental specialist for a complete evaluation. - CORRECT ANSWER-ANS: C When discussing developmental delays with parents, it is important to be positive and to initially focus on strengths. Explaining that developmental delays develop over time is true but does not reassure the parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and may take time. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3-year-old child who draws on the walls with crayons? Give the child washable markers so the drawings can be removed easily. Provide a roll of paper for drawing and teach the child to use this. Put the child in "timeout" each time the child draws on the walls.