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- A child has a 1-cm laceration on the forehead proximal to the hairline after running into a pole while playing sports. To minimize the risk of infection, the primary care pediatric nurse practitioner will irrigate the wound and a. a. allow the wound to heal by secondary intention. b. b. delay closure of the wound for several days. c. c. refer the child to a plastic surgeon for wound closure. d. d. suture the wound within 6 hours. - ansANS: D Children are less likely than adults to get wound infections, with an infection rate from sutured lacerations at 2%. The PNP should clean and suture the wound. Wounds from animal bites are often left to heal by secondary intention to prevent infection. Referral to a plastic surgeon is necessary for cosmetic reasons. Delaying closure for several days is recommended for heavily contaminated wounds and those caused by high-velocity missile injuries, crush injuries, and explosion injuries.
- According to the 2007 NHIS analysis of the use of CAM therapy, use was higher among : a. a. families whose parent or parents had a college education. b. b. Hispanic and African-American populations. c. c. persons who had not recently taken prescription medications. d. d. those living in households earning less than $65,000. - ansANS: A The NHIS review showed that CAM use was higher in households with at least one college- educated parent. CAM use was also higher in non-Hispanic Caucasians, persons who had taken prescription drugs within the past 3 months, and those living in households with incomes higher than $65,000.
- The mother of a 15-year-old female expresses concerns that her daughter may be sexually active because she's had a steady boyfriend for over a year. The primary care pediatric nurse practitioner learns that the family is Catholic and that the mother had an abortion when she was 16 years old. What will the nurse practitioner do initially?
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a. a. Explore the mother's feelings about her own past experience. b. b. Offer to prescribe contraception to prevent pregnancy. c. c. Recommend that the mother discuss this with her daughter. d. d. Suggest that the mother talk to a priest about her daughter. - ansANS: A An initial step when assisting families to manage ethical and behavioral issues is to assist parents and children in values clarification. Before offering other suggestions, the PNP should help the mother to clarify her own feelings. The other options may be necessary after values are clarified.
- The parent of a 4-year-old 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 preschool-age children? a. a. Animism b. b. Artificialism c. c. Egocentrism d. d. Realism - ansANS: D Children at this age are developing their ability to establish causality. Nominal realism occurs when children think that one type of thing can only be called by one name. All dogs are dogs and not various breeds. Animism refers to the belief that objects possess person-like qualities. Artificialism occurs when children think things are caused by a controlling force. Egocentrism is when children see things only as they relate to themselves.
- The parent of a school-age child reports that the child usually has allergic rhinitis symptoms beginning each fall and that non-sedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the primary care pediatric nurse practitioner do? a. a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season. b. b. Prescribe a decongestant medication as adjunct therapy during pollen season. c. c. Recommend adding diphenhydramine to the child's regimen for additional relief. d. d. Suggest using an over-the-counter intranasal decongestant. - ansANS: A Intranasal corticosteroids are a key component in long-term therapy to manage symptoms
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sneakers/shoes, require ciprofloxacin to cover potential Pseudomonas infection and to protect against an osteomyelitis. Amoxicillin-clavulanate is used in other puncture wounds with signs of infection. Clindamycin is used for similarly wounded children allergic to penicillins. TMP- SMX is used if MRSA is cultured.
- The mother of a 2-month-old infant tells the primary care 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? a. a. Recommend pumping her breasts after feedings. b. b. Refer the mother to a lactation consultant. c. c. Suggest supplementation with formula. d. d. Weigh the infant to assess for a growth spurt. - ansANS: D Infants have growth spurts about every 3 to 4 weeks that increase their breast milk needs. Until the mother's milk supply catches up, the infant will act hungry and want to nurse more frequently. The PNP should evaluate for this growth spurt and then instruct the mother to feed her baby more often to increase her milk supply. Since the infant is hungry, the infant should nurse. It is not necessary to refer for a lactation consultation or to supplement with formula.
- The parent of a newborn reports using echinacea for family members to help treat viral illnesses and feels that it is usually effective. What will the primary care pediatric nurse practitioner tell this parent? a. a. That echinacea has no known therapeutic effects and should not be given b. b. That the supplement should not be given to children under 2 years of age c. c. To give half the recommended adult dose until the child is 5 years old d. d. To wait until the infant is at least 1 month old before giving this product - ansANS: B Echinacea use should be restricted to children older than 2 years. Telling a parent who is convinced that a product works that it is not effective will prevent open communication between the parent and practitioner. Children under 2 years should not receive the supplement.
- The primary care pediatric nurse practitioner is providing anticipatory guidance to
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the mother of a breastfed 6-month-old infant who asks about "baby-led weaning." What will the nurse practitioner tell her about this practice? a. a. "Foods given for this purpose do not meet all the child's nutritional needs." b. b. "Giving infants control of the feeding process will help prevent obesity." c. c. "Infants are given soft, mashable table foods when able to self-feed." d. d. "Infants must be able to grasp and feed themselves from a spoon to do this." - ansANS: C Baby-led weaning is a concept where infants feed themselves, soft, mashable table foods that they grasp rather than being spoon-fed, allowing the infant more control. Foods given either by spoon or finger-fed will meet the child's nutritional needs. More research is needed to determine if this method affords protection from obesity by improving self-regulation. Infants must be able to sit without support and to reach and grasp for objects.
- The primary care pediatric nurse practitioner performs a developmental assessment on a 32-month-old 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? a. a. Evaluate the child's cognitive abilities. b. b. Obtain a hearing evaluation. c. c. Reassure the parent that this is normal. d. d. Refer the child to a speech therapist. - ansANS: C Intelligibility of speech reaches about 66% between the ages of 24 and 36 months. Tongue- contact sounds are more intelligible by age 5 years. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated, since these findings are within normal limits.
- The primary care pediatric nurse practitioner sees a 6-year-old child after a hospitalization for injuries sustained in a motor vehicle accident (MVA) in which the child's
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using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child's status. What will the nurse practitioner do? a. a. Have the parent administer all of the child's medications. b. b. Increase the ICS medication to a high-dose preparation. c. c. Reinforce teaching about the importance of using the SABA. d. d. Teach the child and parent how to use home PEF monitoring. - ansANS: D Home PEF monitoring is useful for children to identify when symptoms are worsening. This child does not appear to notice the presence of airway tightness or wheezing and so might benefit from PEF monitoring to know when to use the SABA. School-age children should be learning how to manage their chronic disease, so having the parent administer all medications is not the best choice, especially since use of the SABA is still dependent on the child's report of symptoms. Since the child responded well to administration of the SABA, increasing the dose of ICS should not be done unless better management is not effective. Reinforcing the teaching is part of the plan but, unless the child is aware of symptoms, may not occur.
- A toddler is brought to the clinic after grabbing the hot end of his mother's curling iron. An examination reveals a pale, yellow burned area to the palm of one hand. What is true about this burn? a. a. It may take up to 3 weeks to heal with scarring likely. b. b. Scarring is unlikely, with healing expected in 3 to 7 days. c. c. Surgical intervention and skin grafting are usually required. d. d. This type of burn usually heals without scarring in 7 to 14 days. - ansANS: A A deep partial-thickness burn appears pale and yellow and scarring is more likely to occur, with complete healing taking up to 3 weeks. A superficial burn is erythematous without blisters and heals in 3 to 7 days without scarring. A full-thickness burn involves extensive destruction of underlying tissues and requires surgical intervention and skin grafts. A superficial partial- thickness burn is red, mottled, moist, and painful and may scar, with healing in 7 to 14 days.
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- The parent of a 12-month-old 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? a. a. Whole milk is usually not fortified with vitamin D. b. b. 2% milk is higher in essential proteins and minerals. c. c. Young children don't need the extra calories found in whole milk. d. d. Younger children need a limited amount of fats. - ansANS: D The AAP recommends transitioning to unflavored 2% or fat-free cow's milk in the second year of life. Whole milk contains vitamin D and contains similar amounts of proteins and minerals. Children can get calories from other sources
- The primary care pediatric nurse is performing a well child examination on an adolescent who was adopted as a toddler. The parent reports that the child had been removed from an abusive home at age 3 years. What will the nurse practitioner evaluate in light of possible long-term effects of this early situation? a. a. Cognitive and psychosocial development b. b. Mental health and suicide risk c. c. Moral development and conscience formation d. d. Spirituality, faith, and religious affiliation - ansANS: B Findings of early research suggest that epigenetic changes may mediate the effect of prenatal and infant environment on mental health and disease in older children and adults. Adult suicide victims who were abused as children show decreased levels of a genetic marker of a stress reduction gene, suggesting that child abuse may have an epigenetic effect leading to prolonged stress and mental disorders.
- The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12-month-old child. The parents are bilingual in Spanish and English and have many Spanish-speaking 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? a. a. Children who learn two languages simultaneously often confuse them in
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d. d. Recommend that the mother pump her breast milk for a couple of days. - ansANS: C Infants with breast milk jaundice who are gaining weight and thriving should continue to breastfeed and be monitored for the development of pathologic jaundice. It is not necessary to order phototherapy or discontinue breastfeeding unless pathologic jaundice is present. The bilirubin may remain elevated up to 3 months.
- A child has a fever and arthralgia. The primary care pediatric nurse practitioner learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order? a. a. Anti-DNase B test b. b. ASO titer c. c. Rapid strep test d. d. Throat culture - ansANS: B This child has symptoms and a history consistent with ARF. The ASO titer peaks in 3 to 6 weeks and will confirm a recent strep infection. The anti-DNase B test will also confirm a recent strep infection, but this doesn't peak until 6 to 8 weeks after the initial infection. A rapid strep test and throat culture do not differentiate the carrier state from a true infection.
- A child is brought to the clinic immediately after being stung by a wasp while playing in the yard. The physical examination reveals localized redness and edema at the site, along with abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment? a. a. Administer intramuscular epinephrine. b. b. Apply a topical glucocorticoid cream. c. c. Give oral diphenhydramine. d. d. Order a bronchodilator treatment. - ansANS: A This child has signs of a severe reaction to the sting and should receive epinephrine first, followed by oral diphenhydramine and bronchodilators if wheezing. Topical glucocorticoids are used for mild, localized reactions.
- An adolescent will begin taking the combination oral contraceptive pill (OCP).
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Which supplement will the primary care pediatric nurse practitioner caution the adolescent to avoid while taking OCPs? a. a. Ginkgo b. b. Kava c. c. St. John's wort d. d. Valerian - ansANS: C St. John's wort may increase blood pressure and increase clearance of OCPs, causing breakthrough bleeding. Ginkgo increases the risk of bleeding and should not be given with salicylates, APAP, or NSAIDs. Kava and valerian can increase drug effects of sleepiness, especially with benzodiazepines and anesthetics.
- During a well child examination of a school-age child from a family who recently immigrated from Africa, the primary care pediatric nurse practitioner learns that the child has been involved in many arguments at school. The parents are concerned that their child will never fit in with classmates. How will the nurse practitioner address this situation? a. a. Assess the conditions in the country of origin prior to immigration. b. b. Recommend counseling to determine underlying causes of this behavior. c. c. Stress that this may be a normal response to feeling different at school. d. d. Suggest that the child may be responding to being bullied by others. - ansANS: A Many children who exhibit signs of spiritual distress can express this by being angry or withdrawn. Trauma or violence to the self or to others can contribute to spiritual distress. The PNP should evaluate conditions in the country of origin since it is likely that the family may have escaped war or persecution prior to immigration. Once underlying conditions are known, the PNP can recommend options or try to explain the behavior to parents.
- The mother of a newborn asks the primary care pediatric nurse practitioner about the benefits of breastfeeding. What will the nurse practitioner tell her? a. a. Breastfeeding for 9 months or longer will reduce the incidence of food allergies. b. b. Breast milk is an excellent source of vitamin D, iron, and other essential nutrients for the baby. c. c. Nursing her baby exclusively for at least 4 months will help her infant to resist infections. d. d. There is a decreased risk of atopic dermatitis in babies who nurse for 12
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Young children should have three meals and two nutritious snacks each day. The parents' responsibility is to provide nutritious foods and allow children to choose how much they will eat. Children who are allowed to choose foods will likely make selections that are not healthy. Parents should be discouraged from preparing separate meals for their children. Snacks are necessary to maintain adequate intake and energy.
- A school-age child sustained a contusion on the front of one thigh while playing football and reports some difficulty flexing his foot on the affected side. What will the primary care pediatric nurse practitioner do to treat this injury? a. a. Place the child on crutches and limit weight-bearing until symptoms subside. b. b. Prescribe acetaminophen with hydrocodone along with NSAIDs. c. c. Recommend rest, ice packs, compression, and elevation of the extremity. d. d. Refer the child to an orthopedic specialist for immediate evaluation and treatment. - ansANS: D Children with contusions that restrict movement or sensation and those affecting the quadriceps muscle may include compartment syndrome. These children should be referred to orthopedic specialists immediately so that the compartment pressure does not result in irreplaceable damage. The other options may be performed in consultation with a specialist.
- The mother of a 6-year-old 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? a. a. Giving the child a multivitamin since this is a phase b. b. Having the child eat vegetables before getting the hamburger c. c. Providing a variety of healthy foods at each meal d. d. Putting extra lettuce and tomatoes on hamburgers - ansANS: C Parents are responsible for the foods their children eat, and it is their responsibility to provide healthful foods. Children should be exposed to a variety of healthy foods but not forced to eat any of them. However, parents should not bribe children with the reward of getting the unhealthy
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food that they want. With a well-balanced diet, not eating a vegetable prepared at one meal, for example, will not compromise the child's health, so a multivitamin is not necessary if the overall diet is healthy. Allowing hamburgers and adding desired foods again puts the child in control.
- The parent of a 24-month-old child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? a. a. "Begin by reading to your child about toileting." b. b. "Most children are capable by age 2 years." c. c. "Tell me about your child's daily habits." d. d. "We should assess your child's motor skills." - ansANS: C To assess the parent's understanding of toilet readiness, the nurse practitioner will ask the parents about the child's daily habits and routines to see if the child has predictable patterns that can be the basis for toilet training. While providing storybooks about toileting can help children learn, the first step is to assess toilet readiness. Even though many children are capable at this age, evaluating personal readiness is key to beginning toilet training. Assessment of motor skills may be a second step.
- The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum amount the child will receive per dose? a. a. 200 mg b. b. 250 mg c. c. 400 mg d. d. 450 mg - ansANS: B The maximum dose is 40 mg/kg/day divided into 3 to 4 doses. 25 kg × 40 mg = 1000/ = 250 mg.
- The primary care pediatric nurse practitioner sees a 3-day-old 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 a. a. to continue to breastfeed her infant. b. b. to give the infant a cow's milk formula. c. c. to supplement breast milk with formula.
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a diet without breads and cereals. What will the primary care pediatric nurse practitioner caution the parents to look for on product labels that may indicate wheat products are present in foods? a. a. Casein b. b. Malt c. c. Miso d. d. Whey - ansANS: B Malt in a product may signal a hyperallergenic food for a child with wheat allergy. Miso contains soy. Casein and whey are dairy products.
- A school-age child who uses a SABA and an inhaled corticosteroid medication is seen in the clinic for an acute asthma exacerbation. After 4 puffs of an inhaled short- acting B2-agonist (SABA) every 20 minutes for three treatments, spirometry testing shows an FEV of 60% of the child's personal best. What will the primary care pediatric nurse practitioner do next? a. a. Administer an oral corticosteroid and repeat the three treatments of the inhaled SABA. b. b. Admit the child to the hospital for every 2 hour inhaled SABA and intravenous steroids. c. c. Give the child 2 mg/kg of an oral corticosteroid and have the child taken to the emergency department. d. d. Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely. - ansANS: D Children with an incomplete response (FEV1 between 40% and 69% of personal best) should be given oral steroids and instructed to continue the SABA every 3 to 4 hours with close follow- up. Hospitalization is not necessary unless severe distress occurs. An FEV1 less than 40% after treatment indicates a need to be seen in the ED.
- 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? a. a. Breastfed infants have lower serum cholesterol levels than those who are not
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breastfed. b. b. Maternal cholesterol levels affect the cardiovascular risk of breastfed babies. c. c. Maternal dietary cholesterol intake does not affect the infant's serum cholesterol values. d. d. She should limit her dietary cholesterol to prevent hyperlipidemia in her infant. - ansANS: C Changes in the maternal diet do not produce changes in cholesterol values in infants. Breastfed infants tend to have higher cholesterol levels than other infants, but cholesterol is necessary for brain and retinal development.
- 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? a. a. Allow the child to explore and experiment while providing appropriate limits. b. b. Be present while the child plays to continually teach the child what is appropriate. c. c. Let the child experiment at will and to make mistakes in order to learn. d. d. Say "no" whenever the child does something that is not acceptable. - ansANS: A The child who is securely attached uses the parents as a base from which to safely explore the world. Toddlers learn by doing and need to experiment to gain mastery over the environment. It is important that parents are present for safety, but parents should not be ever-present and controlling. Parents should be close by and should intervene if the child is at risk for injury. Continual criticism and the use of the word "no" can make the toddler feel powerless.
- The primary care pediatric nurse practitioner is preparing to close a laceration on a child's forehead using topical skin adhesive. What is the correct way to apply this product? a. a. Apply the adhesive between the wound margins and then hold the edges together. b. b. Apply the adhesive to the wound and then secure the edges with surgical tape. c. c. Have the child remain still for 15 to 20 minutes after the adhesive is applied. d. d. Hold the wound edges together and apply the adhesive on top of the skin. - ansANS: D
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animal has been vaccinated for rabies and the child's tetanus is current, so prophylaxis for both of these is not indicated. There is controversy about whether primary closure is appropriate. Reporting the animal is not a primary action.
- An adolescent who has asthma and severe perennial allergies has poor asthma control in spite of appropriate use of a SABA and a daily high-dose inhaled corticosteroid. What will the primary care pediatric nurse practitioner do next to manage this child's asthma? a. a. Consider daily oral corticosteroid administration. b. b. Order an anticholinergic medication in conjunction with the current regimen. c. c. Prescribe a LABA/inhaled corticosteroid combination medication. d. d. Refer to a pulmonologist for omalizumab therapy. - ansANS: D Children older than 12 years who have moderate to severe allergy-related asthma and who react to perennial allergens may benefit from omalizumab as a second-line treatment when symptoms are not controlled by ICSs. The PNP should refer children to a pulmonologist for such treatment. Daily oral corticosteroid medications are not recommended because of the adverse effects caused by prolonged use of this route. Anticholinergic medications are generally used for acute exacerbations during in-patient stays or in the ED. A LABA/ICS combination will not produce different results.
- The mother of a 15-month-old 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? a. a. Breastfeed only at bedtime to establish meal patterns. b. b. Clean the toddler's teeth each time after breastfeeding. c. c. Offer the breast just prior to meals to maintain milk supply. d. d. The toddler should continue to be breastfed "on demand." - ansANS: B One drawback to breastfeeding toddlers is the effect of prolonged contact with lactose on the
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teeth. Mothers should be cautioned to consult with a dentist and to clean the toddler's teeth. The mother may choose when and how often to breastfeed but should not allow "on demand" feedings. The breast should be offered after meals.
- The parent of a child who has numerous allergies reports using herbal remedies to help treat the child because they are "natural" products. What will the primary care pediatric nurse practitioner suggest to this parent about using these products? a. a. Brand-name herbal products have been tested for efficacy. b. b. Natural ingredients are usually safe for use in children. c. c. There are few interactions between drugs and supplements. d. d. Use single-herb supplements whenever possible. - ansANS: D Single-herb supplements should be used when possible to prevent side-effect confusion. Brand- name products have not necessarily been tested; randomized controlled trials have not been widely performed. "Natural" does not mean "safe." There are many drug-supplement interactions.
- The parent of a toddler tells the primary care pediatric nurse practitioner that the family has adopted a plant-based diet and the child is receiving rice and almond milk instead of cow's milk. The nurse practitioner will counsel the parents about a. a. calcium deficiency. b. b. excess caloric intake. c. c. excess fat intake. d. d. protein deficiency. - ansANS: D Plant-based milks are low in protein and young children who consume them are at risk for protein deficiency. They are not low in calcium, high in calories, or high in fat.
- The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old 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? a. a. To begin brushing the infant's teeth with toothpaste
