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Burns' Pediatric Primary Care 7th Edition(All Chapters With Questions And Answers )Complete Test Bank

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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. Ind... onesia 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? . 13348413856 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? . 13348407644 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? . 13348407650 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. . 13348407646 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? . 13348407636 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 . 13348407638 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. . 13348437961 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 different just before her periods, the adolescent points to her mother and says, “She gets really hard to live with.” This demonstrates which characteristic of adolescent thinking? A. Apparent hypocrisy Correct S. Imaginary audience T. Overthinking U. Personal fable 7. The primary care pediatric nurse practitioner is performing an exam on an adolescent male who asks about sexual identity because of concern that a friend is worried about being gay. Which response will the nurse practitioner make in this situation? W. Provide the teen with a questionnaire to gain information about his sexuality. X. Remind the adolescent that mandatory reporting requires disclosure to parents. Y. Suggest that the adolescent discuss sexual concerns with his parents. Z. Tell the adolescent that, unless he is at risk, what he says will be confidential. Correct 8. The parent of a 14yearold child tells the primary care pediatric nurse practitioner that the child skips classes frequently in spite of various disciplinary measures, such as grounding and extra homework and is earning Cs and Ds in most classes. What will the nurse practitioner recommend? CC. Counseling for emotional problems DD. Development of an Individual Education Plan C. Evaluation for possible learning disorders Correct D. Referral for a behavioral disorder 9. The parent of a 14yearold child tells the primary c are pediatric nurse practitioner that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the nurse practitioner tell the parent? U. Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent. V. Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake. W. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. Correct X. Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home. 1 0. The primary care pediatric nurse practitioner is performing a well child exam on a 17yearold female whose mother is present during the history. The mother expresses concern that her daughter wishes to have an eyebrow piercing and states that she is opposed to the idea. What will the nurse practitioner do? V. Provide information about piercings and encourage continued discussion. Correct W. Remind the adolescent that her mother is responsible for her health. X. State that piercings are relatively harmless and are an expression of individuality. Y. Suggest that she wait until she is 18 years old and can make her own decisions. 11. The parent of a 16yearold tells the primary care pediatric nurse practitioner that the teen was recently caught smoking an electronic cigarette (ecigarette). What will the nurse practitioner tell this parent? P. Ecigarette use may be a risk factor for later substance abuse. Correct Q. Experimentation with ecigarettes does not lead to future tobacco use. R. Most teens who experiment with tobacco usually do not become addicted. S. This form of nicotine ingestion is safer than regular cigarettes. 12. The parent of an adolescent reports noting cutting marks on the teen’s arms and asks the primary care pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent? J. Cutting is a way of dealing with emotional distress. Correct K. It is a method of fitting in with other adolescents. L. The behavior is common and will usually stop. H. This type of behavior is a type of suicide attempt. Chapter 14. Introduction to Health Promotion Health Protection for Children & Families Questions 1. The primary care pediatric nurse practitioner is performing a focused problem assessment on a child who has asthma and learns that one of the child’s parents smokes around the child in spite of being advised against this. The nurse practitioner recognizes this as a possible alteration in which functional health pattern? A. Cognitiveperceptual B. Health perception Correct KK. Rolerelationship LL. Valuesbeliefs 2. The primary care pediatric nurse practitioner examines an infant whose weight is below the 3rd percentile and whose mother does not comply with the feeding regimen. When attempting to enlist the help of the infant’s grandmother, the grandmother says, “My daughter was like this when she was a baby and she turned out all right.” Which approach will the nurse practitioner take to improve the outcome for this infant? LL. Ask the grandmother about her daughter’s health during childhood. Correct MM. Explain that the condition is potentially serious if not treated. NN. Give the grandmother and mother information about normal growth. OO. Refer the family to a social worker to investigate possible neglect. 3. The primary care pediatric nurse practitioner provides patient teaching for children newly diagnosed with irritable bowel syndrome (IBS). At which stage of development will children be able to understand the link between stress and the symptoms of the disease? A. Concreteoperational stage B. Formaloperational stage Correct LL. Preconceptual stage MM. Sensorimotor stage 4. The primary care pediatric nurse practitioner is counseling an obese adolescent whose parents both have type 2 diabetes mellitus. Which health behavior prediction model is useful when the nurse practitioner discusses lifestyle changes with this client? A. Behavioral change model B. Health belief model Correct JJJ. Health promotion model KKK. Transtheoretical model 5. The primary care pediatric nurse practitioner is counseling a schoolage Child about asthma management strategies. The child states that it is “too much trouble” to remember to use an inhaled corticosteroid medication twice daily and reports feeling fine, in spite of exhibiting expiratory wheezes. Which action uses the health belief and selfefficacy model to teach this child about asthma management? FF. Asking the child to try to use the inhaler at least once daily GG. Discussing whether the child wants to participate in athletics C. Obtaining preand posttreatment spirometry testing Correct D. Providing written information about inhaled corticosteroids 6. An adolescent who is overweight expresses a desire to lose weight in order to participate in sports but tells the primary care pediatric nurse practitioner that he doesn’t want to give up sweets and soft drinks because he enjoys them too much. Which stage of change does this represent? A. Action B. Contemplation Correct V. Precontemplation W. Preparation 7. The primary care pediatric nurse practitioner sees a 17yearold client who quit smoking almost a year prior but who reports having renewed cravings when around friends who smoke. Using knowledge of the maintenance stage of change, the primary care pediatric nurse practitioner will AA. go over with the adolescent about the health risks associated with smoking. BB. recommend avoiding friends who smoke and making new friends. CC. remind the adolescent about the struggles associated with quitting smoking. DD. suggest that the teen consider taking up a sport or other physical activity.Correct 8. The primary care pediatric nurse practitioner is working with a 12yearold Female who has poor diabetes control. The child tells the nurse practitioner that the parent forgets to remind her to check her blood sugars. Which action is correct? EE. Assess the parent’s knowledge about diabetes management. FF. Help the child develop a strategy to remember without parental prompts. Correct GG. Refer to a social worker to help the family overcome obstacles to care. HH. Remind the child’s parent about the importance of good diabetes control. 9. The primary care pediatric nurse practitioner is counseling an obese 16yearold client about weight management. The adolescent says, “I know I need to lose weight, but I don’t want to give up all my favorite foods.” When using motivational interviewing techniques, how will the nurse practitioner respond? Y. “Do you think there are any foods you could limit or do without for a while?” Correct Z. “I hear you telling me that you really don’t have a desire to lose weight.” AA. “If you can’t give up these foods, you won’t see the benefits of weight loss.” BB. “In the long run, the sacrifices you make today will improve your health.” 10. The parent of a newborn has quit smoking cigarettes within the past month and reports feeling fidgety. Using a “reframing” technique, how will the primary care pediatric nurse practitioner respond? Z. Explore ways that the parent can use this extra energy to do things for the baby. Correct AA. Remind the parent that this is a normal, temporary part of nicotine withdrawal. BB. Suggest that the parent take up exercise to enjoy the benefits of not smoking. CC. Tell the parent that, over time, these symptoms of withdrawal will subside. 11. The primary care pediatric nurse practitioner is assessing the health literacy of the parent of a toddler. Which tool will the nurse practitioner use to estimate reading level? T. FleschKincaid Readability Test U. Gunning Fog Index V. Number of children’s books in the home D. SMOG Correct 1 2. The pediatric nurse practitioner provides primary care for a special needs infant whose parent takes an active role in the infant’s care. The parent has a high school diploma and asks many questions about her infant’s treatments. Which approach will the nurse practitioner take to ensure health literacy for this parent? M. Ask the parent to read back all information given. Correct N. Encourage the parent to ask questions when confused. O. Provide written materials presented at an 8th grade level. P. Reinforce written information with verbal instructions. . Chapter 15. Behavioral and Mental Health Promotion Questions 1. A child who has attentiondeficit/ hyperactivity disorder (ADHD) has difficulty stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the selfregulation component of MM. emotional control. NN. flexibility. Correct OO. inhibition. PP. problemsolving. 2. The primary care pediatric nurse practitioner cares for a preschoolage child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. This child most likely has a disorder of PP. executive function. Correct QQ. information processing. RR. sensory processing. SS. social cognition. 3. The primary care pediatric nurse practitioner uses the Neurodevelopmental Learning Framework to assess cognition and learning in an adolescent. When evaluating social cognition, the nurse practitioner will ask the adolescent NN. about friends and activities at school. Correct OO. if balancing sports and homework is difficult. PP. to interpret material from a pie chart. QQ. to restate the content of something just read. 4. The primary care pediatric nurse practitioner is evaluating a schoolage child who has been diagnosed with ADHD. Which plan will the nurse practitioner recommend asking the child’s school about to help with academic performance? A. 504 Correct TTT. FAPE UUU. IDEA VVV. IEP . . . . . 5. The parent of a child diagnosed with ADHD tells the primary care pediatric . nurse practitioner that the child gets overwhelmed by homework assignments, doesn’t seem to know which ones to do first, and then doesn’t do any assignments. T he nurse practitioner tells the parent that this represents impairment in which executive function? A. Activation Correct HH. Effort II. Emotion JJ. Focus 6. The primary care pediatric nurse practitioner is considering medication options for a schoolage child recently diagnosed with ADHD who has a primarily hyperactive presentation. Which medication will the nurse practitioner select initially? A. Lowdose stimulant B. Moderatedose stimulant Correct X. Lowdose nonstimulant Y. Moderatedose nonstimulant 7. The parent of a 4yearold child reports that the child gets upset when the hall light is left on at night and won’t leave the house unless both shoes are tied equally tight. The primary care pediatric nurse practitioner recognizes that this child likely has which type of sensory processing disorder? A. Dyspraxia B. Overresponder Correct EE. Sensory seeker FF. Underresponder 8. The parent of a preschoolage child who is diagnosed with a sensory processing disorder (SPD) asks the primary care pediatric nurse practitioner how to help the child manage the symptoms. What will the nurse practitioner recommend? II. Establishing a reward system for acceptable behaviors JJ. Introducing the child to a variety of new experiences C. Maintaining predictable routines as much as possible Correct D. Providing frequent contact, such as hugs and cuddling 9. The primary care pediatric nurse practitioner is performing an examination on a 5yearold child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the nurse practitioner do first? A. Administer an MCHAT screen to screen the child for communication and socialization delays. CC. Ask the parent to describe the child’s earlier behaviors from infancy through preschool. Correct DD. Reassure the parent that if symptoms weren’t present earlier, the likelihood of autism is low. EE. Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management. 10. The primary care pediatric nurse practitioner is examining a 3yearold child who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the nurse practitioner suspect? A. Attentiondeficit/hyperactivity disorder B. Autism spectrum disorder Correct DD. Executive function disorder EE. Sensory processing disorder 11. The primary care pediatric nurse practitioner is selecting a medication for a 12yearold child who is newly diagnosed with ADHD. The child is overweight, has a history of an atrial septal defect at birth, and reports mild shortness of breath during exercise. What will the nurse practitioner prescribe? W. A lowdose stimulant medication X. A nonstimulant medication Y. Behavioral therapy only D. Cardiovascular prescreening Correct 12. The primary care pediatric nurse practitioner is conducting a followup examination on a child who has recently begun taking a lowdose stimulant medication to treat ADHD. The child’s school performance and home behaviors have improved. The child’s parent reports noticing a few tics, such a twitching of the eyelids, but the child is unaware of them and isn’t bothered by them. What will the nurse practitioner recommend? Q. Adding an alphaagonist medication R. Changing to a nonstimulant medication C. Continuing the medication as prescribed Correct I. Stopping the medication immediately . . . . Continue . Chapter 16. Breastfeeding Questions 1. The primary care pediatric nurse practitioner provides anticipatory guidance for a 6monthold infant who is breastfed who takes 400 IU of vitamin D daily. The parent reports that the infant has begun taking cereals, fruits, and vegetables in addition to nursing. What will the nurse practitioner recommend to promote healthy nutrition? QQ. Begin supplementing with iron. RR. Continue to nurse as long as desired. Correct SS. Discontinue the vitamin D supplement. TT. Stop breastfeeding at 1 year of age. 2. The parent of a toddler tells the primary care pediatric nurse practitioner that The family has adopted a plantbased diet and the child is receiving rice and almond milk instead of cow’s milk. The nurse practitioner will counsel the parents about TT. calcium deficiency. UU. excess caloric intake. VV. excess fat intake. WW. protein deficiency. Correct 3. The parent of a 12monthold infant asks the primary care pediatric nurse practitioner why 2% cow’s milk is recommended instead of whole milk. What will the nurse practitioner tell this parent? RR. Whole milk is usually not fortified with vitamin D. SS. 2% milk is higher in essential proteins and minerals. TT. Young children don’t need the extra calories found in whole milk. UU. Younger children need a limited amount of fats. Correct 4. The primary care pediatric nurse practitioner sees a 3yearold child whose parents report is a picky eater in spite of their continued efforts to provide nutritious meals. The parents ask whether a multivitamin is necessary. How will the nurse practitioner respond? WWW. Ask the parents to provide a 3day food diary. Correct XXX. Prescribe a daily multivitamin with iron. YYY. Reinforce the need to meet DRIs each day. ZZZ. Tell them that supplements are unnecessary 5. The primary care pediatric nurse practitioner is examining a toddler who is below the 3rd percentile for weight even though the parents claim that the child eats “constantly.” What will the nurse practitioner do initially? KK. Evaluate the child’s feeding and elimination behaviors and ask the family to describe mealtime routines. Correct LL. Recommend giving a multivitamin and offering highcalorie foods, such as ice cream. MM. Refer the child to a feeding evaluation clinic for a swallow study and evaluation of possible GERD. NN. Suggest that the parents supplement the child’s food intake with a Highcalorie formula. 6. The mother of a 6yearold child tells the primary care pediatric nurse practitioner that the child only wants to eat French fries and hamburgers and refuses most vegetables. What will the nurse practitioner recommend? Z. Giving the child a multivitamin since this is a phase AA. Having the child eat vegetables before getting the hamburger C. Providing a variety of healthy foods at each meal Correct D.Putting extra lettuce and tomatoes on hamburgers 7 . The parents of a toddler tell the primary care pediatric nurse practitioner that they get frustrated trying to get the child to eat any vegetables other than squash and carrots. What will the nurse practitioner recommend? GG. Continue to offer a variety of foods without forcing the child to eat them. Correct HH. Offer snacks to make up for calories the child misses by not eating the vegetables. II. Prepare dishes the child likes to ensure that a vegetable is eaten at each meal. JJ. Require the child to take 1 to 2 bites of each food at each meal. 8. The primary care pediatric nurse practitioner is providing anticipatory guidance to the mother of a breastfed 6monthold infant who asks about “babyled weaning.” What will the nurse practitioner tell her about this practice? KK. “Foods given for this purpose do not meet all the child’s nutritional needs.” LL. “Giving infants control of the feeding process will help prevent obesity.” MM. “Infants are given soft, mashable table foods when able to selffeed.” Correct NN. “Infants must be able to grasp and feed themselves from a spoon to do this.” . 9. The primary care pediatric nurse practitioner is performing a well child examination on a 15yearold girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement? A. Calcium, vitamin C, and vitamin A B. Iron, folic acid, and B12 Correct FF. Magnesium, vitamin E, and zinc GG. Vitamin D, vitamin C, and phosphorus 10. The primary care pediatric nurse practitioner is evaluating a schoolage child who, after removal of a pituitary tumor, has altered hypothalamic control over hunger and satiety. The child is morbidly obese and expresses feeling depressed because of the obesity. What will the nurse practitioner recommend? A. Developing a system to reward compliance with a dietary regimen B. Restricting all access to food in the house and at school Correct FF. Suggesting an afterschool exercise program to help with weight loss GG. Using a food diary to track all calories and food intake 11. When counseling an adolescent with a family history of hyperinsulinemia and type 2 diabetes, the primary care pediatric nurse practitioner will recommend avoiding Z. baked potato chips. AA. canned vegetables. BB. highfiber cereals. CC. processed breads. Correct 12. The parent of a schoolage child reports that the child is on a glutenfree diet. When questioned about the reason for this diet, the parent states that the child has fewer stomach aches since beginning the diet but has never been diagnosed with celiac disease. The parent reports using glutenfree grain products for all family members. The nurse practitioner will tell this parent that glutenfree diets S. are generally low in sugar and fat. T. are healthy and help prevent obesity. U. may be deficient in essential nutrients. Correct V. provide adequate protein to meet daily needs. Chapter 17. Nutrition Questions 1. The primary care pediatric nurse practitioner performs a well child assessment on a 6monthold infant whose mother reports having less breast milk because of stressors associated with pumping and returning to work. The nurse practitioner will provide resources to promote pumping and UU. discuss adding other foods to the baby’s diet. Correct VV. encourage the mother to increase her fluid intake. WW. prescribe a multivitamin containing iron. XX. suggest offering only breast milk to the infant. 2. The mother of a newborn asks the primary care pediatric nurse practitioner about . benefits of breastfeeding. What will the nurse practitioner tell her? XX. Breastfeeding for 9 months or longer will reduce the incidence of food allergies. YY. Breast milk is an excellent source of vitamin D, iron, and other essential nutrients for the baby. ZZ. Nursing her baby exclusively for at least 4 months will help her infant to resist infections. Correct AAA. There is a decreased risk of atopic dermatitis in babies who nurse for 12 months or longer. 3. The primary care pediatric nurse practitioner learns that the mother of a newborn infant is being tested for tuberculosis after a positive TB skin test. What will the nurse practitioner tell the mother who states a desire to breastfeed her baby? VV. Breast milk is contraindicated if the mother has tuberculosis. WW. She may continue to nurse her baby since the risk of transmission is low. C. That she can express breast milk and feed that to her infant Correct D. To give formula until results of tuberculosis testing are known 4. The primary care pediatric nurse practitioner sees a 3dayold nursing infant whose newborn metabolic screen is positive for galactosemia. The nurse practitioner refers the newborn to a specialist for immediate evaluation and will tell the mother AAAA. to continue to breastfeed her infant. BBBB. to give the infant a cow’s milk formula. CCCC. to supplement breast milk with formula. DDDD. to stop breastfeeding immediately. Correct 5. The mother of a nursing infant expresses concern about whether high cholesterol foods will increase her infant’s risk of hyperlipidemia. What will the primary care pediatric nurse practitioner tell her? OO. Breastfed infants have lower serum cholesterol levels than those who are not breastfed. PP. Maternal cholesterol levels affect the cardiovascular risk of breastfed babies. QQ. Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol values. Correct RR. She should limit her dietary cholesterol to prevent hyperlipidemia in her infant. 6. The primary care pediatric nurse practitioner is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the nurse practitioner recommend? BB. Fatsoluble vitamins CC. Iron DD. Multivitamins with iron D. Vitamin D Correct 7. The primary care pediatric nurse practitioner is examining a newborn who is breastfeeding and notes the presence of an ankyloglossia. What will the nurse practitioner do next? KK. Ask the mother if the infant has any feeding difficulties. Correct LL. Refer the infant for a possible frenulectomy. MM. Schedule an appointment with a lactation consultant. NN. Suggest that the mother feed breast milk by bottle. 8. The primary care pediatric nurse practitioner performs an initial well baby exam on a 1weekold infant who is breastfeeding and who is at birth weight. The mother tells the nurse practitioner that her baby is already sleeping 5 or 6 hours at night. What will the nurse practitioner recommend? OO. Consultation with a lactation specialist to assess intake PP. Pumping her breast during the night to maintain milk supply QQ. Supplementing the last feeding of the day with formula D. Waking the infant up at least every 3 hours to nurse Correct 9. The mother of a newborn infant asks the primary care pediatric nurse practitioner about pumping her breasts when she returns to work in 2 months. What will the nurse practitioner include in teaching this mother? A. Frozen breast milk may be stored up to 3 months in a 0° F freezer. Correct HH. Once she begins pumping the infant should drink only pumped breast milk. II. Pumped breast milk must be discarded after 3 days when stored in the refrigerator. JJ. Unused defrosted breast milk may be stored in the refrigerator for 48 hours. 10. The mother of a 2monthold infant tells the primary c are pediatric nurse practitioner that she is afraid her breast milk is “drying up” because her baby never seems satisfied and wants to nurse all the time. Which action is correct? HH. Recommend pumping her breasts after feedings. II. Refer the mother to a lactation consultant. JJ. Suggest supplementation with formula. KK. Weigh the infant to assess for a growth spurt. Correct 11. The mother of a 15monthold infant tells the primary care pediatric nurse practitioner that she wishes to continue nursing her child for another year, if possible. What will the nurse practitioner recommend? DD. Breastfeed only at bedtime to establish meal patterns. EE. Clean the toddler’s teeth each time after breastfeeding. Correct FF. Offer the breast just prior to meals to maintain milk supply. GG. The toddler should continue to be breastfed “on demand.” 12. The primary care pediatric nurse practitioner is performing an assessment on a 1weekold newborn with a slightly elevated bilirubin who is breastfeeding well and who has gained 30 grams in the past 24 hours. The infant is stooling and voiding well. The nurse practitioner suspects breast milk jaundice. Which action is correct? W. Order home phototherapy and closely monitor bilirubin levels. X. Reassure the mother that the bilirubin level will drop in a few days. Y. Recheck the serum bilirubin and infant’s weight in 24 hours. Correct Z. Recommend that the mother pump her breast milk for a couple of days. Chapter 18. Elimination Questions 1. The primary care pediatric nurse practitioner is performing a well child exam on a 4monthold infant who is nursing exclusively. The mother reports that the infant has had a marked decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every other day. How will the nurse practitioner respond? YY. Ask the mother to describe the color and consistency of the stools. Correct ZZ. Explain to the mother that breastfed infants should have daily stools. AAA. Recommend using a glycerin suppository as needed. BBB. Suggest to the mother that she increase her intake of fluids. 2. The primary care pediatric nurse practitioner is performing a well child exam on a 12monthold infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent? BBB. It is too early to begin introducing the child to the toilet, and the parent should wait until the child is at least 2 years old. CCC. Placing the child on a “potty” chair helps the child associate elimination cues with the toilet. Correct DDD. Predictability of elimination patterns indicates readiness for toilet training, and the parent can begin this process. EEE. The parent should wait until other signs of toilet training readiness occur before introducing the child to the toilet. 3. The primary care pediatric nurse practitioner is performing a well child exam on a 24monthold child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do? XX. Advise the parent to make the child get clean clothes after an accident. YY. Ask the parent about the child’s toilet habits and understanding of toilet training. Correct ZZ. Recommend using an awards system to encourage toilet use. AAA. Suggest that the parent place the child on the toilet at predictable intervals. 4. The primary care pediatric nurse practitioner is discussing toileting issues with the parent of a 3yearold toddler who reports that the child has been toilet trained for several months but has recently been refusing to have bowel movements and is becoming constipated. What will the nurse practitioner do? OOOO. Ask the parent about bathroom facilities in the child’s day care. Correct PPPP. Refer the child to a gastroenterologist for evaluation of pathology. QQQQ. Suggest putting the child in diapers and resuming toilet training in a few weeks. RRRR. Tell the parent that this represents a developmental delay. 5 . The primary care pediatric nurse practitioner is evaluating a 5yearold child who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make? SS. History of neurogenic conditions TT. Recent adjustments in the family C. Recent illnesses, fluid intake, changes in diet Correct D. Toilet training history 6. The primary care pediatric nurse practitioner is managing a 6yearold child who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child’s condition? A. Encouraging use of maintenance medications for at least 2 months after resolution of constipation Correct EE. Referral to a mental health consultant to manage problems in the parentchild dyad FF. Spending time with the parents to uncover their feelings about their child’s condition GG. Teaching the parents that the symptom of stool retention is often voluntary for the child 7. The parent of a 5yearold child tells the primary care pediatric nurse practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in “pullups.” The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend? OO. Providing a reward system to offer incentives when the child uses the toilet PP. Put the child back in diapers and resume toilet training in a few months. QQ. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation Correct RR. Use of polyethylene glycol until the child is able to use the toilet regularly . . . . 8. The primary care pediatric nurse practitioner evaluates a 4yearold girl . whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially? A. Examination for labial adhesions Correct RR. Palpation for abdominal masses SS. Screening for potential child abuse TT. Urine culture and sensitivity 9. The primary care pediatric nurse practitioner is co ncerned that a toddler may have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of urinary tract infections. Which intervention is appropriate? KK. Initiating a bladder retraining program LL. Ordering a voiding cystourethrogram C. Referral to a urologist for evaluation Correct D. Treatment with prophylactic antibiotics 10. The primary care pediatric nurse practitioner is evaluating a 4yearold female child for enuresis. The parents reports that the child has never been dry at night and has recently begun having daytime incontinence, usually when at preschool. The nurse practitioner learns that the child does not appear to have an abnormal urine stream. What will the nurse practitioner do next? LL. Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis. Correct MM. Reassure the parent that the child probably gets distracted and puts off voiding until it is urgent. NN. Refer the child to a pediatric urologist for evaluation of possible vesicoureteral reflux. OO. Suggest a bladder retraining program and use of a nighttime bedwetting alarm. 11. The primary care pediatric nurse practitioner is counseling the parent of an 8yearold child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent? HH. Anticholinergic medications are most commonly used for enuresis. II. Drug therapy is an effective way to achieve longterm control. JJ. Drug therapy is safest when the nasal spray form is used. KK. The combination of alarm therapy and intermittent drug therapy is best. Correct . Chapter 19. Physical Activity and Sports Questions 1. The primary care pediatric nurse practitioner counseling the parent of an overweight schoolage child about improving overall fitness. What will the nurse practitioner include? CCC. Encourage the child to begin by engaging in swimming or cycling. Correct DDD. Exercise will help lower total cholesterol and lowdensity lipoproteins. EEE. Schoolage children need 60 minutes of moderate exercise daily. FFF. Strength training exercises are not safe for schoolage children. 2. The parent of a child who has asthma asks the primary care pediatric nurse practitioner about whether the child may engage in strenuous exercise. What will the nurse practitioner tell the parent? FFF. Children with asthma should be excluded from vigorous exercise and most strenuous sports. GGG. Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity. Correct HHH. Physical activity has been shown to improve overall pulmonary function in children with asthma. III. Vigorous exercise helps improve symptoms in children with poorly controlled asthma. 3. The primary care pediatric nurse practitioner is discussing lifestyle changes with an adolescent who has hypertension. What will the nurse practitioner recommend about exercise for this client? A.Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure Correct BBB. Moderate daily exercise such as walking for 20 minutes daily with increasing intensity as blood pressure drops CCC. Vigorous aerobic exercise combined with maximal strength training to lower blood pressure DDD. Vigorous aerobic exercise only to reduce blood pressure and then to maintain lowered blood pressure . 4. The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 6yearold child who has Down syndrome. What will the nurse practitioner tell the parents about physical activity and sports in school? A. Children with Down syndrome get frustrated easily when engaging in sports. SSSS. Children with Down syndrome should not participate in strenuous aerobic activity. TTTT. Their child should have a cervical spine evaluation before participation in sports. Correct D. Their child should only participate in sports sanctioned by the Special Olympics. 5. The primary care pediatric nurse practitioner is discussing fitness and exercise with the parents of a 5yearold child who ask what kinds of activities are developmentally appropriate for their child. What will the nurse practitioner recommend? A. Bike riding Correct UU. Interactive play VV. Martial arts WW. Organized sports 6. The parents of a prepubertal female who is on the local swim team tell the primary care pediatric nurse practitioner that their daughter wants to begin a strength training program to help improve her swimming ability. What will the nurse practitioner recommend? HH. Avoiding strength training programs until after puberty to minimize the risk for injury II. Enrolling their daughter in a program that uses fixed weight machines or resistance bands Correct JJ. Having their daughter participate in weight training 4 or 5 times each week for maximum effect KK. Making sure that their daughter begins with the greatest weight tolerable using lower repetitions 7. The parent of a 14yearold child asks the primary care pediatric nurse practitioner how to help the child prevent injuries when basketball tryouts begin later in the school year. Which recommendation will be of most benefit? A. Preseason conditioning Correct SS. Proper footwear TT. Protective knee braces UU. Stretching before practices 8. The primary care pediatric nurse practitioner is counseling a parent about bicycle helmet use. The parent reports having a helmet used a year previously by an older child and wonders about using it for a younger child since they are so expensive. What will the nurse practitioner tell the parent? UU. “As long as the helmet does not have cracks, you may use it.” VV. “If the helmet is free from marks, you may use it.” Correct MM. “You may continue to use a helmet up to 10 years.” NN. “You should always purchase a new helmet for each child.” 9. The primary care pediatric nurse practitioner is performing a well child examination on a high school age adolescent who plays football who has hypercalciuria. Which dietary supplement will the nurse practitioner question the adolescent about? A. Protein supplements Correct PP. Salt tablets QQ. Sports drinks RR. Vitamin C 1 0. The primary care pediatric nurse practitioner is performing a preparticipation sports physical examination on a 14yearold male who will be on the wrestling team at school. What will the nurse practitioner include when discussing healthy practices with this adolescent? A. Risks associated with repeatedly losing and gaining weight Correct LL. The need for an electrocardiogram or echocardiogram prior to participation MM. The need to consume 20 to 30 grams of protein after exercise NN. To consume water with CHO prior to activity lasting up to an hour 11. The primary care pediatric nurse practitioner is evaluating a heart murmur during a preparticipation examination of a high school athlete. Which finding would be a concern requiring referral to a cardiologist? AA. A murmur that is louder when squatting and softer when standing BB. A murmur that is quieter when squatting and louder with a Valsalva maneuver Correct CC. A murmur with narrow and variable splitting of S2 DD. A systolic murmur that is grade 1 or 2 12. The parent of a 12yearold child who has sickle cell trait (SCT) asks the primary care pediatric nurse practitioner whether the child may play football. What will the nurse practitioner tell this parent? J. Children with SCT should not play any contact sports. K. Children with SCT may not play for NCAA schools in college. L. Children with SCT should follow heat acclimatization guidelines. Correct M. Children with SCT should not participate in organized sports. 13. The parent of a child newly diagnosed with epilepsy asks the primary care pediatric nurse practitioner if the child will ever be able to participate in gym or sports. What will the nurse practitioner recommend? C. Bicycle riding is not safe for children with seizures. D. Contact sports should be avoided. E. Direct supervision of some activities is necessary. Correct F. Underwater sports are not recommended. 14. The primary care pediatric nurse practitioner diagnoses a high school basketball player with mononucleosis. The adolescent asks when she may resume play. What will the nurse practitioner tell her? B. After 3 weeks, she may begin lifting weights but not full sports. C. After 4 weeks, she may return to full play and practice. D. At 4 weeks, she must have an exam to determine fitness for play. Correct E. She may engage in moderate exertion and practice after 3 weeks. 15. A 12yearold child who plays soccer is diagnosed with vocal cord dysfunction. What will the primary care nurse practitioner say when the child’s parents ask about continued sports participation? A. The child may continue to participate in soccer. Correct B. The child should limit activity to nonaerobic sports. C. This condition is a contraindication for all sports. D . This condition predisposes the child to sudden cardiac death. 16. The parent of a high school basketball player tells the primary care pediatric nurse practitioner that the adolescent becomes short of breath only when exercising. What will the nurse practitioner recommend? A. Permanent discontinuation of all strenuous and aerobic activities B. Enrollment in a conditioning program to improve performance C. Evaluation for underlying cardiac causes of this symptom Correct D. Treatment for exerciseinduced asthma with a bronchodilator 17. A 10yearold is hit in the head with a baseball during practice and is diagnosed with concussion, even though no loss of consciousness occurred. The primary care pediatric nurse practitioner is evaluating the child 2 weeks after the injury and learns that the child is still experiencing some sleepiness every day. The neurological exam is normal. The child and the parent are adamant that the child be allowed to return to play baseball. What will the nurse practitioner recommend? A. Continuation of cognitive rest only B. Continuation of physical and cognitive rest Correct A. Continuation of physical rest only B. Returning to play 18. A 15yearold female basketball player who has secondary amenorrhea is evaluated by the primary care pediatric nurse practitioner who notes a BMI in the 3rd percentile. What will the nurse practitioner counsel this patient? A. That amenorrhea in female athletes is not concerning B. That she should begin a program of plyometrics and strength training C. To consider a different sport, such as volleyball D. To work with a dietician to improve healthy weight gain Correct 19. The primary care pediatric nurse practitioner is examining a 17yearold male who is on his high school swim team. The adolescent is concerned about “lumps” on his chest. The nurse practitioner notes a marked increase in weight since the last visit along with worsening of the adolescent’s acne. Given this set of symptoms, which performance enhancing substance will the nurse practitioner be most concerned about and ask about? A. Creatine B. Dehydroepiandrosterone (DHEA) Correct A. Ephedra B. Growth hormone Chapter 20. Sleep Questions 1. The primary care pediatric nurse practitioner is performing a well child examination on a 4yearold child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent? GGG. Most sleep disorders are benign and will be outgrown. HHH. Sleep disorders are symptomatic of underlying behavior problems. III. Sleep disorders at this age can have longterm impacts on learning. Correct JJJ. The child will need longer daytime naps to compensate for lost sleep. 2. The parent of a schoolage child who is overweight tells the primary care pediatric nurse practitioner that the child seems to crave highcalorie, highcarbohydrate foods, even when full. The nurse practitioner learns that the child is often irritable and sleepy at school in spite of sleeping 9 or 10 hours each night. What will the nurse practitioner recommend? JJJ. Assessment of leptin and ghrelin hormone levels KKK. Consultation with a dietician to develop an appropriate diet C. Referral to a sleep disorder clinic for a sleep study Correct D. Taking one or two naps each day to increase the amount of sleep 3. The primary care pediatric nurse practitioner is performing a well baby examination on a 2weekold infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent to keep a sleep log and will teach the parent that which amount of sleep per day is optimal for this infant? EEE. 10 to 12 hours FFF. 12 to 15 hours C. 15 to 18 hours Correct D. 18 to 20 hours 4. 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? UUUU. Bedsharing with infants greatly increases the risk of SIDS. Correct VVVV. Breastfeeding does not appear to have any influence on SIDS risk. WWWW. Infants who attend day care have a higher than usual incidence of SIDS. XXXX. There is no difference in SIDS rates in immunized versus nonimmunized infants. . 5. The primary care pediatric nurse practitioner is counseling the parents of a toddler about sleep. The parents report that the toddler has recently begun resisting sleep and is often more irritable during the day. What will the nurse practitioner recommend? XX. Cosleeping with the child to help alleviate possible nighttime fears YY. Referral to a sleep disorders clinic for evaluation of sleepdisordered breathing ZZ. Reintroducing a second, morning nap time to compensate for lost sleep D. Understanding that sleep resistance is a common developmental problem Correct 6. The parent of a 3yearold child tells the primary care pediatric nurse practitioner that the child has never been able to fall asleep without a parent in the room. The child has a new sibling and the parent is concerned that the toddler’s cries will awaken the infant. What will the nurse practitioner counsel the parent? A.Leaving the room as the child is falling asleep and returning at intervals to check on the child Correct LL. Offering a reward for each night the child falls asleep without the parent in the room MM. Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors NN. Taking away a favorite activity or video for each night the child fusses about the parent not being in the room 7. The parent of a 4yearold who has difficulty initiating and maintaining sleep has tried several nonpharmacological methods with variable success and asks about medications. What will the primary care pediatric nurse practitioner recommend? VV. Diphenhydramine WW. Lorazepam C. Melatonin Correct D. Zolpidem 8. The parent of a 3yearold child tells the primary care pediatric nurse practitioner that after falling asleep in the living room and being awakened to go to bed one evening, the child appeared confused and disoriented for a period of time. What will the nurse practitioner counsel this parent? EEE. That if this occurs again, to question the child about nightmares FFF. That this is a sign of sleep walking and could be dangerous GGG. That this is a type of sleep terror which will resolve over time D. That this is probably a benign, temporary type of a sleep disorder Correct . 9. During a well child examination, the primary care pediatric nurse practitioner learns that a 5yearold child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with open eyes, and saying things that don’t make sense. What will the nurse practitioner recommend? A. Establishing a graduated extinction program and good sleep hygiene B. Making sure that stairs are blocked and doors are locked Correct OO. Referral to a sleep disorder clinic for evaluation of a parasomnia PP. To awaken the child when these occur and asking about nightmares 10. The parent of a schoolage child tells the primary care pediatric nurse practitioner that the child is restless most nights and complains often that bugs are in the bed. After consultation with a sleep disorder specialist and subsequent evaluation of a ferritin level of 30, the nurse practitioner may expect to treat this child with SS. clonazepam. TT. ferrous sulfate. Correct UU. gabapentin. VV. sertraline. 11. An adolescent exhibits mild depressive symptoms and tells the primary care pediatric nurse practitioner that he is most concerned about difficulty falling and staying asleep. The adolescent does not want to take medication to treat the depressive symptoms. What will the nurse practitioner recommend? A. A program of sleep hygiene and gradual sleep extension Correct OO. A sedativenarcotic will help both sleep and depression PP. Cognitive therapy can help the adolescent to sleep better QQ. Using an antidepressant will improve sleep patterns 12. A child with Down syndrome who has sleepdisordered breathing with obstructive sleep apnea continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse practitioner will refer the child to a sleep disorder clinic to discuss which therapy? EE. Craniofacial surgery FF. Oral appliances C. Positive airway pressure therapy Correct D. Supplemental oxygen . Chapter 21. Sexuality Section Questions 1. The mother of a 3monthold male infant tells the primary care pediatric nurse practitioner that she occasionally notices he has a penile erection just after nursing. What will the nurse practitioner tell the mother? KKK. Infants should be prevented from masturbating. LLL. The infant is conscious of the pleasure associated with nursing. MMM. This is a form of infantile priapism. NNN. This is a normal, reflexive behavior at this age. Correct 2. The primary care pediatric nurse practitioner is performing a well child examination on a 3yearold. The child’s parent reports that the child has recently begun masturbating. What will the nurse practitioner counsel this parent? LLL. To allow the behavior whenever it occurs, since it is normal MMM. To discuss sexuality with the child NNN. To explore whether the child is being abused D. To teach the child about privacy and hand hygiene Correct 3. The parent of an 8yearold child tells the primary care pediatric nurse practitioner that the child has begun to ask questions about why a schoolmate has “2 daddies” and wonders how to talk to the child about this. What will the nurse practitioner recommend? GGG. Beginning a discussion about different types of sexual relationships and samesex partners HHH. Discussing the issue with the child in terms of the parent’s religious values and norms III. Explaining that not all families are the same and what is most important is that they love and care for their children Correct GGGGG. Telling the child that some adult relationships are complicated and will be understood when the child is older 4. The primary care pediatric nurse practitioner is performing a well child exam on an 8yearold girl and notes the presence of breast buds. What will the nurse practitioner include when initiating anticipatory guidance for this patient? A. A discussion about the risks of pregnancy and sexually transmitted diseases B. Information about sexual maturity and menstrual periods Correct AAA. Material about the human papillomavirus vaccine BBB. Sexual orientation and the nature of sexual relationships . 5. The primary care pediatric nurse practitioner is co unseling the parents of a 13yearold female who has Down syndrome about sexual maturation. What will the nurse practitioner tell these parents? OO. It is important to discuss and support healthy sexuality. Correct PP. Providing too much information about sexuality may be confusing given the child’s cognitive level of understanding. QQ. Suppressing periods with contraceptives will lessen their daughter’s distress. RR. They should give her information about periods but not about sexuality. 6 . During a well child exam on a 13yearold female, the primary care pediatric nurse practitioner notes that the child is at Tanner Stage 3. During the exam, when the nurse practitioner initiates a conversation about healthy sexuality education, the parent states that this topic is “off limits.” What will the nurse practitioner do? XX. Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult. YY. Separate the parent from the adolescent to discuss the adolescent’s concerns in private. ZZ. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors. Correct AAA. Tell the parent that this information is a routine part of adolescent well child examinations and must be included. 7. During a well child examination, a 15yearold female tells the primary care pediatric nurse practitioner that some of her friends have begun having sex. She has a boyfriend but denies engaging in sex with him. What will the nurse practitioner do initially? HHH. Ask her for her definitions of “sex.” Correct III. Discuss the risks of sexually transmitted diseases. JJJ. Find out if she is considering sexual relations. KKK. Give her information about contraception. 8. During a well child examination of a 6yearold girl, the primary care pediatric nurse practitioner notes that the child becomes embarrassed and resists taking off her underwear for the exam. What should the nurse practitioner infer from this observation? QQ. The child has been sexually molested. RR. The child is feeling violated by the examiner. SS. The parent is exhibiting regressive behavior. TT. This is a normal reaction in a child of this age. Correct . 9. The primary care pediatric nurse practitioner is providing anticipatory guidance to the parent of a schoolage boy. The parent expresses concerns that the child prefers to play with dolls, is worried that the child will be a homosexual, and asks what can be done to prevent this from happening. What will the nurse practitioner tell this parent? WW. Homosexual identity formation cannot be predicted by early childhood behavior. XX. Masculinizing boys from an early age helps to determine heterosexual orientation. YY. Sexual orientation identification begins late in adolescence and not in childhood. ZZ. The development of sexual orientation is generally a multifaceted process. Correct Chapter 22. Immunizations Questions 1. A 2monthold infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis? A. Day care attendance B. Immunization history Correct OOO. Medication history PPP. Past medical history 2. When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated? OOO. Bands PPP. Leukocytes C. Lymphocytes Correct D. Neutrophils 3. Which lab value is most concerning in an infant with fever and a suspected bacterial infection? A. Creactive protein of 11.5 mg/L Correct JJJ. Lymphocyte count of 8.7 KKK. Platelet count of 475 LLL. White blood cell count of 14 4. A toddler is receiving longterm antibiotics to treat osteomyelitis. Which laboratory test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child? A. Blood cultures B. Erythrocyte sedimentation rate (ESR) Correct c. Serum procalcitonin (ProCT) d. White blood count (WBC) 5. According to recent research, which populations may have higher rates of under immunization than others? A. Those with higher rates of Asians B. Those with higher rates of graduate degrees Correct C. Those with lower rates of poverty D. Those with lower rates of primary providers 6. The parent of a 2monthold infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns? KKK. Inform the parent that all vaccines may be given without thimerosol. LLL. Providing Vaccine Information Statements for the parent to review. MMM. Question the parent’s reasons for concern about immunizations. Correct NNN. Remind the parent that the infant is exposed to thousands of germs each day. 7. A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? SS. Administering multiple vaccines may trigger the development of type 1 diabetes. TT. The MMR may be linked to febrile seizures in immunocompromised children. Correct UU. There is some risk of CNS disorders associated with the hepatitis B vaccine. VV. Vaccines containing thimerosol are linked to pervasive developmental disorders. 8. A 2monthold infant will receive initial immunizations, and the parent asks about giving medications to increase the infant’s comfort and minimize fever. What will the pediatric nurse practitioner recommend? A. Administering ibuprofen or acetaminophen as needed Correct BBB. Avoiding antipyretics if possible to attain better immunity CCC. Giving ibuprofen and acetaminophen only after the vaccines DDD. Pretreating the infant with both ibuprofen and acetaminophen 9. The parent of an infant asks why some vaccines, such as MMR, are not given along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary care pediatric nurse practitioner tell this parent? LLL. Febrile seizures are more likely in younger infants with some vaccines. MMM. Maternal antibodies neutralize some vaccines and are delayed until 12 months. Correct NNN. The risk of adverse effects is lower for some vaccines after the first year. OOO. Too many vaccines at once can overwhelm the infant’s immune system. 10. The primary care pediatric nurse practitioner is performing an initial well child exam on a 3yearold child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do? WW. Administer a booster dose of each vaccine to ensure immunity. XX. Find out whether the vaccines were provided by reliable suppliers. YY. Perform antibody titers and reimmunize the child. Correct ZZ. Record the vaccines in the child’s electronic medical record. 11. The primary care pediatric nurse practitioner reviews the immunization records of an 18monthold child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do? AAA. Administer a reduced dose of MMR to ensure adequate immunity. BBB. Obtain mumps, measles, and rubella titers to determine immunity. CCC. Recommend the next dose of MMR vaccine at 4 to 5 years of age. Correct DDD. Repeat the MMR vaccine since the first dose was given too soon 12. A 5yearold child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? A. DTaP Correct RR. DTP SS. Td TT. Tdap 13. An adolescent female who is sexually active and who has not had the HPV vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her? GG. Getting the vaccine now will still protect her from HPV oncogenic types even if already exposed HH. Receiving the HPV vaccine series will replace the need for regular cervical cancer screening II. She will need to have Papanicolaou and pregnancy screening prior to receiving the vaccine JJ. The vaccine will not protect her from any HPV oncogenic types acquired previously Correct 14. An 18monthold child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered? A. PCV7 B. PCV13 Correct X. PCV23 Y. PCV33 15. A 5yearold child who received VariZIG after exposure to varicella while immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child? A. MMR and Tdap B. MMR, Varivax, Tdap Correct G. Tdap only H. Varivax and Tdap 16. A 3yearold child who attends day care has had a fever, nausea, and vomiting several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child? F. HAV vaccine G. Immunoglobulin G H. Interferonalfa D. Supportive care Correct 17. A 10monthold infant who is new to the clinic has chronic hepatitis B infection. What will the primary care pediatric nurse practitioner do to manage this infant’s disease? E. Consult a pediatric infectious disease specialist. Correct F. Prescribe interferonalfa. G. Provide supportive care. H. Consider use of lamivudine. 18. The primary care pediatric nurse practitioner performs a well child examination on a 1monthold. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care? C. Obtain regular absolute neutrophil counts. Correct D. Perform routine skin cultures for herpes simplex virus. E. Reinforce the need to give acyclovir indefinitely. F. Stop the oral acyclovir at 2 months of age. 19. A 9monthold infant has had a fever of 103°F for 2 days and now has a diffuse, maculopapular rash that blanches on pressure. The infant’s immunizations are uptodate. What will the primary care pediatric nurse practitioner do? C. Administer immunoglobulin G to prevent fulminant illness. D. Perform serologic testing for human herpes virus 6 and human herpes virus 7. E. Reassure the parent that this is a mild, selflimiting disease. Correct F. Recommend avoiding contact with pregnant women. 20. A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do? D. Administer varicella immune globulin (VariZIG). E. Hospitalize the child for intravenous acyclovir. Correct F. Order intravenous immunoglobulin as an outpatient. G. Prescribe oral acyclovir for the duration of the illness. 21. A child whose parents have refused vaccines has been exposed to chickenpox, and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them? C. The child may attend day care as long as no rash is present even with mild fever or other symptoms. D. The child should remain home and receive oral acyclovir for 5 days to prevent onset of symptoms. E. The child should stay home until the 21day incubation period has passed even if symptom free. F. The child should stay home if any symptoms occur and may return in 1 week if no rash develops. Correct 22. An 18monthold child who developed upper respiratory symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do? B. Consider therapy with rimantadine. C. Hospitalize for supportive treatment. C. Prescribe oseltamivir and follow closely Correct D.Wait for cultures to determine treatment. 23. The primary care pediatric nurse practitioner is reviewing medical records for a newborn that is new to the clinic. The toddler’s mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on antiretroviral prophylaxis, and did not breastfeed. What is the correct management for this child? A. Consult with a pediatric HIV specialist. Correct B. Discontinue cART after 4 weeks of age. C. Obtain a CD4+ cell count and HIV RNA levels. D. Reinforce the need to give cART for life. 24. A 3yearold child whose immunizations are uptodate has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action? A. Administer the MMR vaccine to help prevent disease. Correct B. Give antiviral medications at the first sign of symptoms. C. Give the child a dose of immune globulin to mitigate the response. D. Reassure the parent that most exposed children will not get measles. 25. A preschool age child is brought to clinic for evaluation of a rash. The primary care pediatric nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash? A. This rash may be a prodromal sign of rubella or roseola. B. The child will need immunization boosters to prevent serious disease. C. This is a benign rash with no known serious complications. D. Expect a lacy, maculopapular rash to develop on the trunk and extremities. Correct 26. An unimmunized schoolage child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend? A. Assessment of maternal rubella titers Correct B. Intravenous immunoglobulin for the child C. MMR vaccine for the mother and child D. Possible termination of the pregnancy 27. A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis? A. Ask about recent tick bites Correct A. Obtain a skin culture B. Order blood cultures D. Perform serologic testing 28. A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action? C. Administer a prophylactic single dose of doxycycline. D. Perform serologic testing for IgG or IgM antibodies. E. Prescribe amoxicillin three times daily for 14 to 21 days. F. Teach the parents which signs and symptoms to report. Correct 29. A 10monthold nfant has an erythematous, fluctuant, nondraining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care? A. Consultation with a pediatric infectious disease specialist B. Culture of any superficial open surface wounds C. Empiric treatment with clindamycin D. Incision and drainage of the abscess with culture Correct 30. A child with a history of a pustular rash at the site of a cat scratch on one arm now has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do? A. Obtain a complete blood count and Creactive protein. B. Order an immunofluorescent assay (IFA) for serum antibodies. Correct C. Perform a needle aspiration of the affected lymph nodes. D . Prescribe a 5daycourse of azithromycin. 31. A 7yearold bchild whose immunizations are uptodate has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated? A. Empiric treatment with oral antibiotics or intramuscular ceftriaxone B. Hospitalization for diagnosis and treatment with antibiotics Correct C. Immediate vaccination with meningococcal vaccine D. Outpatient lab work, including a CBC and blood and CSF cultures C. 32. A schoolage child has fever of 104°F, sore throat, vomiting and malaise. T