BURNS' PEDIATRIC PRIMARY CARE 7TH EDITION TEST BANK LATEST 2023-2024 QUESTIONS WITH ANSWER, Exams of Nursing

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Chapter 1: Health Status of Children: Global and NationalPerspectives

1. Which region globally has the highest infant mortality rate? A. Indonesia B. Southern Asia C. SubSaharan Africa Correct D. Syria
2. The primary care pediatric nurse practitioner understands that, to achievethe greatest worldwide reduction in child mortality from pneumonia and diarrhea, which interventionismost 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 majorchild 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, theprimary care pediatric nurse practitioner is adhering to the most recent AmericanAcademy of Pediatrics Recommendations for Preventive Pediatric Health Care guidelinesby A. focusing less on development and more on illness prevention and nutrition. B. following guidelines established by the Bright 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 aredue. 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
5. A 16 - year-old male has received a pink-slip from the police for inpatientpsychiatric treatment. The teen has been expressing thoughts of hanging himself because Life sucks. Thenursingstaff should consider placing the child:
6. With peers.
7. In an area where he can be watched one-on-one.
8. With aroommate thatisexpressing the sameconcerns.
9. In an area close to an external door. ANS: 2
10. Learning disabilities in children have scientifically been linked to:
11. Poornutrition.
12. The environment in which the child lives.
13. Genetics.
14. Watching more than four hours of television a day.ANS: 3
15. A mental health nurse has assessed a child and determined that the childexhibits behavioral challenges. When the school nurse explains this to a teacher, the best description wouldbe:

.

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 thisbehavior pattern for the last week. The reason a child may revert back to this behavior pattern is because of:
6. Hallucinations.
7. Behavioral challenges.
8. Delusions.
9. Stress. ANS: 4
10. An 18 - year-old male has called the crisis line for help. The crisis nurserecognizes the intervention needs may consist of all of the following except:
11. Discussing the individuals everyday activities.
12. Recognizing that the patient may be in a catharsis state.
13. Expressing empathy toward the caller.
14. Avoiding entropy. ANS: 1
15. An 8 - year-old boy with a history of hallucinations and violent behavior hasbeen place in a seclusion room at the hospital because he has been hurting others. The nurse checks on thepatient and realizes she must take him out of the seclusion room when:
16. 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
5. A child has been exhibiting the MacDonald Triad. These behaviors include:
6. Enuresis, pushing others, and pyromania.
7. Swinging a cat by the tail, bed-wetting, and lighting paper on fire in thetrash can.
8. Playing with other children, laughing, and conversing with adults.
9. Playing with a campfire, watching television, and seeking adult attention.ANS: 2
10. A teenager diagnosed with borderline personality disorder should havedischarge planning instructions of:
11. A consistent caregiver.
12. Monitoring of media, such as the Internet, television, and video games.
13. Obtaining support from family and friends.
14. Seeking medical attention when the teenager feels good.ANS: 3
15. A mental health nurse is teaching the mother of a child with executivefunctioning issues ways to help her child. Interventions the mother should use include:
16. Placing visual aids on the bathroom mirror so that the child will follow themorning routine.
17. Give the child a choice in foods to eat.
18. Allowing the child to ask for help when needed.
19. 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 severalyears of severe neglect by her birth family. The adoptive family hasbeen reporting that Ellie is angry a lot, manipulative with her teachers, and does not seek positive attention. The nurse working with Elliewill need to:
12. Provide education on decreasing stimuli in the home environment that triggers the anger.
13. Realize Ellie may have attachment issues related to her previous historyand will need to encourage the family to be active in her care.
14. Support the family in the decision-making process of continuing to let Ellielive in the home.
15. Discuss inpatient therapy to decrease Ellies manipulative behavior patterns. ANS:
16. An infant displays depression by:
17. Smiling at strangers.
18. Bonding to someone other than the immediate family.
19. Crying more than anaverage infant.
20. 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 upuntil the last quarter of school. She has been hanging out by herself and does not want to talk to himanymore. The mental health nurse should:
14. Realize that this is a natural part of growing up.
15. Perform a mental health screening to check for depression.
16. Attempt to get the adolescent to discuss why she does not like her father anymore.
17. Let the adolescent talk when she is ready.ANS: 2
18. Ateenshouldbechecked fordepression at physician visit(s).
19. Every

.

2. One
3. Monthly
4. Bi-yearly ANS: 1
5. When using the SAD FACES depression screen, itis important to assess:
6. Anhedonia.
7. Suicidal ideations.
8. Sleep patterns.
9. All of the above ANS: 4
10. A school nurse is giving an in-service to teachers on bullycide. The mainreason for the teaching is so that:
11. Teachers are aware bullying occurs.
12. Teachers are able to identify students who are risk.
13. Teachers can be aware of the fact that suicides can happen due to bullyingby others.
14. Teachers are aware of their role in causing bullycide.ANS: 3
15. An adolescent with a known history of bipolar disorder is in the schoolnursesoffice because a teacher reported that she was talking fast and acting like she was God. The schoolnurseassesses the girl and notes that:
16. She is probably in a manic phase and needs to be treated professionally.
17. She has had too much sleep and is now hyperactive.
18. She forgot to take her medications today.
19. Sherequires somefoodandrestbefore going backtoclass.ANS: 1 Chapter 3.Geneticsand Child Health Questions
20. What is true about haploid cells? . 13348407644 C. Eachcontains 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 onthelongarmofchromosome 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 Whatis mostlikely 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 isresponsible formany singlegenegenetic disorders? . 13348407636 A. Copy numbervariations B. Nucleotide repeat expansions C. Point mutations Correct D. Single nucleotide polymorphisms (SNP)

.

5. Cystic fibrosis isarecessive disease requiring the presence ofagene mutation . 13348407638 on both alleles inherited from the parents. Which type of genetic disorder isthis? A. Chromosome B. Mitochondrial C. Monogenetic Correct D. Multifactorial

.

6. The primary care pediatric nurse practitioner is counseling a couple aboutgenetic risks and learns that one parent has neurofibromatosis, an autosomaldominant disorder, and the other parent does not. What will the nurse practitioner include when discussingthisdisorder 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 thedisease. 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 newborngirl 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 willthe primary care pediatric nurse practitioner tell the parents about the risk of this disease intheirchildren? 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% chanceofbeing carriers ofthedisease.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 todetect the . presence ofadditional genetic material ona 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 cysticfibrosis? A. Biochemical testing B. Carrier testing Correct C. FISH testing D. Karyotype testing Chapter 4. Environmental Issues Questions
11. 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
12. 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 introducedinto the

environment. Correct H. Corporations may be exempt from testing if their costs in doing soare 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 revealsa 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 inthis child? A. Lead B. Mercury C. Organophosphates Correct D. Phthalates
6. Whencounseling amother whosmokes about preventing exposureto smokingrelated risks to her nursing newborn, what will the primary care pediatric nursepractitioner 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 theinfant is born. H. Smoking outdoors or near anopen windowprevents exposuretotobacco smoke. I. Thirdhandsmoke exposure risks may last for years even if themother 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 lowheart 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 tolimit exposure torisksassociated withplastics.

Besides avoiding using plastic containers when possible, what else will theprimary care pediatric nurse practitioner recommend? A. Avoid heating foods and liquids in plastic containers. Correct B. Clean plastic containers well using the dishwasher. C. Useonly plastics stamped with “#7” onthe bottom. D. Usedcanned 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 areorganic or not. Whichfoods areonthis 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 AssessmentQuestions
10. 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 chiefcomplaint L. Developmental delays, nutritional status, and linear growth patterns M. Medication currently taking, allergy information, and family medicalhistory N. Speech and language development, beliefs about health, and previous illnesses Correct
11. When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? A. DC: 03R Correct K. ICD10CM L. ICSD M. NANDA International
12. The primary care pediatric nurse practitioner sees a 3yearoldchild who chronically withholds stools, in spite of the parents‟ attempts to stop the behavior, requiring frequent treatments with laxative medications. Whichdiagnosis will the nurse practitioner use to facilitate thirdparty reimbursement? M. Altered elimination pattern N. Elimination disorder C. Encopresis Correct D. Parenting alteration
13. The primary care pediatric nurse practitioner is assessing a toddler whoseweight and body mass index (BMI) are below the 3rd percentile for age. Thenurse practitioner learns that the child does not have regular mealtimes and is allowed to carryabottle of juice around at all times. The nurse practitioner plans to work with this family todevelop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem?

J. Failure tothrive K. Home careresources inadequate L. Nutrition alteration – less than required D. Parenting alteration Correct

.

5. The primary care pediatric nurse practitioner is p erforming a well childcheckup 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 visitto evaluate this child. Correct K. Reassure the parent that the child will catch up to normal development byage 2 years. L. Reevaluate this child‟s development and milestone achievements at the2year 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 theassessment but refuses to speak when asked questions. The parent tells the nursepractitioner that the child talks at home and that most other adults can understand what the child says. Thenurse 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 withthe 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 nursepractitionerdo? 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 a3yearold child has been treated for depression for over 5 years. Which aspect of thischild‟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 behavioraland emotional problems. Which tool will the nurse practitioner use to record thisinformation? C. CRAFFT D. Ecomap C. Genogram Correct D. Pedigree
10. A child is in the clinic for evaluation of an asthma action plan. Theprimary 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 thenurse practitioner do initially? A. Ask the child‟s parent why the child is so anxious. B. Performaphysical assessment toruleoutshortness 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 literacyin 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 andtobacco use. Which assessment tool will the nurse practitioner use? A. CRAFFT Correct A. HEEADSSS B. PHQ C. RAAPS

14. The primary care pediatric nurse practitioner evaluates a schoolagechild whose body mass index (BMI) is greater than the 97th percentile. The nursepractitioner is concerned about possible metabolic syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitionerdocument 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 CareQuestions

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 inaneighborhood witha high crimerateand suggests thattheytrymoving 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 aNative American family and learns that they used many herbs to treat and preventillness. Which approach will the pediatric nurse practitioner use to promote optimum healthinthe 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 avariety 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 culturesCorrect 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 thatthe 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 isableto convince the mother that this is a normal weight. Which domain of culturalcompetencedoes this represent? A. Global B. Interpersonal Correct N. Intrapersonal O. Organizational

6. The primary care pediatric nurse practitioner in a community health centermeets a family who has recently immigrated to the United States who speakonly Karon. They arrive in the clinic with a church sponsor, who translates for them. Thepediatricnurse practitioner notices that the sponsor answers for the family without giving them time tospeak. 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 thefamily. Correct
7. The primary care pediatric nurse practitioner prescribes a twice dailyinhaled 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 nursepractitioner demonstrates an understanding of clientcenteredcare? A. Asking the child to describe usual daily routines and schedulesCorrect 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 healthcenter wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the pediatric nurse practitioner employtoensure the success of such a program? G. Asking community members to assist in researching and implementing a program Correct H. Designing acommunity garden approach that involveschildren andtheir parents I. Gaining support from the corporate community to provide needed resources J. Providing evidencebased information about the importance of a healthydiet
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 whoseparents 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 traumaCorrect 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
11. A child born with Dandy Walker malformation is receiving palliative care inthe pediatric unit. A nurse should:
12. Provide the parents, patient, and family members with supportive careduring this time.
13. Ask the parents to be part of the plan of care as much as possible.
14. Attempt to provide a primary nurse for this particular patient on each shift.
15. All of the above are correct. ANS: 4
16. A head circumference is being measured at a 4 month olds well-babycheckup. It is noted that the head circumference has not grown since theprevious assessment. The nurse should:
17. Ask the mother about the childs nutrition.
18. Notify thedoctor.
19. Re-measure the head circumference, check developmental milestones,assess the nutritional status, and discuss the findings with the doctor.
20. Document the normal findings. ANS: 3
21. Achild with a diagnosis of schizencephaly is assigned to a new nurse onthe pediatric floor. The new nurse has not worked with a child with this diagnosisbefore. Acareer nurse discusses the plan ofcare needed forthe child with the newnurse. Itwillbe important to:
22. Assess the side of the body that has paralysis for any lesions or sores.
23. Let the patient do as much as possible for activities of daily.
24. Discourage thepatient to move the paralyzed side ofthebody.
25. Provide full care forthepatient. ANS: 1
26. A nurse is assessing a 6 - month-old boys suture lines. The nurse notes thatthe baby has craniosynostosis. The nurse shouldbeconcerned because:
27. The suture line closure will not allow the brain to grow.
28. This can lead to hydrocephalus.
29. The child will have immediate developmental delays because of the lack ofspace for the brain to grow.

4. The child will not require surgery. ANS: 1
5. Achild that had ashunt placed fouryears agoforhydrocephalus isin the emergency room complaining of a rapid onset of vomiting and increased lethargy. The nurseknows that the child will need:
6. Nothing, as this is a normal complication and notan emergency.
7. To be placed on IV fluids to help maintain an electrolyte balance.
8. Small amounts of fluids until the vomiting has subsided.
9. To consider this a neurological medical emergency and check the childshead circumference. ANS:
10. Night terrors can occur in adolescents because of:
11. Emotional stress.
12. Alcohol use.
13. Bullying.
14. All of the above can trigger night terrors in adolescents.ANS: 4
15. When speaking with a family about their 9 - year-old daughters nightmares,it is important toask:
16. If the child has a history of daytime napping.
17. What medications the child takes during the day.
18. How often the child consumes caffeine.
19. Alloftheabove should be part oftheassessment.ANS: 4
20. A quality of a partial seizure is:
21. Status epilepticus.
22. Tonic movements.
23. Fluttering eyelids.
24. Clonic movements.ANS: 4
25. A mother is asking the nurse why her daughter continues to havetemporallobe seizures eventhough she is on medication. The nurse knows this is occurring because:
26. The medication may not be in the therapeutic range.
27. Temporal lobe seizures do not respond well to medications.
28. The daughter maybe missing dosesofhermedication.
29. The food her daughter eats may have a negative reaction with the medication, causing more seizures. ANS:
30. Which of the following types of epilepsy are photosensitive?
31. Juvenile myoclonic epilepsy
32. Temporal lobe epilepsy
33. Febrile seizures
34. Childhood absence epilepsyANS: 1
35. A child who had a seizure one hour ago is exhibiting signs of paralysis ontheleft side of the body. Thenurse understands thechild is exhibiting signsof:
36. Lethargy due to previous seizure activity.
37. Postictal paralysis.
38. Permanent paralysis of the left side of the body.
39. Major brain damage that is going to have long-term effects.

ANS:

12. A child with a known history of Benign Rolandic Epilepsy is having aseizure during lunch at the middle school. The school nurse is called to the cafeteria. What is the schoolnurses priority at this time?
13. Prevent a possible choking incident by checking the students mouth forfood.
14. Lay the child down on the floor and make sure the area is safe.
15. Call the EMTs for help.
16. 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. Thenurse notes that the child isfluttering his eyes andsmacking his lips. Thenurseshould document thisseizureas:
14. Anabsence seizure.
15. A tonic-clonic seizure.
16. A myoclonic seizure.
17. Afebrile seizure. ANS: 1
18. A 9 month old is admitted to the pediatric unit for seizures of unknownorigin. The child has an EEG performed for several hours. The EEG notes several seizures occurring atdifferent intervals. The nurse knows this child:
19. Will develop at the same rate as his peers.
20. May have severe mental andphysical challenges duetothefrequent seizure activity.
21. May exhibit a slight cognitive delay as he grows.
22. Will grow out of having seizures. ANS: 2
23. A child has been status epileptics for the last 20 minutes. The child hasDepakote, Valporic Acid, and Diazepam gel ordered. The nurse should prepare which medication for administration at this time?
24. Depakote
25. Valporic acid
26. Diazepam
27. None of the medications. The child will stop on his own.ANS: 3
28. Care for a child during status epilepticus should include all of thefollowingexcept:
29. Turn the patient to the right side.
30. Loosen tight clothes.
31. Move toys out of the area to prevent injury.
32. Stay with the patient until the seizure has stopped.ANS: 1
33. The nurse is identifying the difference between primary headaches tosecondary headaches. Secondary headaches canoccur:
34. Because of stress.
35. In relation to low blood pressure.

3. Because of concussions.
4. Because of migraines.ANS: 3
5. Cyclic vomiting may:
6. Last for days.
7. Require SSRIs tostop hurting.
8. Not be associated with a headache.
9. Requires pain medication and Zofran. ANS: 3
10. A child that has rhythmic, repetitive, involuntary movements isexhibiting:
11. Tremors.
12. Dystonia.
13. Contractures.
14. Tics. ANS: 2
15. Identify a therapeutic management technique for a child with a ticdisorder.
16. Behavioral modification to suppress the tics
17. Administer anti-psychotic medications to reduce the tics
18. Education and support for the child and the family
19. Genetic counseling for the family ANS: 3
20. Identify a true statement about Tourettes Syndrome (TS) is that:
21. Manifestations rarely change once developed.
22. Children with TS do not have obsessive compulsive disorders.
23. The tics of TS can lead to mental deterioration.
24. The tics are involuntary, and the person cannot control the behavior.ANS: 4
25. The assessment anurse performed ona 12 - year-old boy demonstrated apositive Kernigs sign and a Brudzinskis sign. Identify the priority for the nurses next action.
26. Document the findings andnote asnormal.
27. Further assess the neurological function of the child and call the doctorwith a report.
28. Explain to the patient that the assessment was abnormal and there is no acause for concern.
29. Prepare the child for a lumbar puncture.ANS: 2
30. Results from cerebrospinal fluid that was tested for meningitis have beenreceived by the nurse. The results indicate bacterial meningitis. The nurse knows this because theresultsshow:
31. A low protein count and a low glucose count.
32. A low red blood cell count.
33. An elevated protein count and a low glucose level.
34. A normal proteincount and a high glucose count.ANS: 3

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Chapter 8. Developmental Management in Pediatric PrimaryCare

Questions

1. A single mother of an infant worries that living in a household with onlyone 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 practitionerlearns that the parents of a young child fight frequently about finances. The parentsstate 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 tolearn waystohandlestress. 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 anduncooperative. 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 practitionermake when parents ask about ways to discipline their 3yearoldchildwho draws on the walls with crayons? O. Give thechild washable markers sothe 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 examon. aninfant andnotes mild gross motor delays but nodelays inother 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 newborninfant recently discharged from the neonatal intensive care unit after a prematurebirth. The parent is upset and expresses worry about whether the infant will be normal. What willthe nurse practitioner do in this situation?

L. Explain to the parent that developmental delays often do not manifest atfirst. M. Perform a developmental assessment and tell the parent which delays are evident. N. Point out the tasks that the infant can perform while conductingthe assessment. Correct D. Refer the infant to a developmental specialist for a complete evaluation.

7. The primary care pediatric nurse practitioner sees a developmentallydelayed toddler for an initial visit. The family has just moved to the area and asks thenurse 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 beginsschool. 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 whohave 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. Theparent states that the infant nurses, takes solid foods three times daily, and occasionally takeswater from a cup. What will the pediatric nurse practitioner counsel the parent to promoteoptimum 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 andfinds a 2monthold infant in a car seat on the exam table. The infant‟s mother is playing a gameon her smart phone. The nurse practitioner interprets this behavior as H. asign 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 NewbornsMultiple

Choice

1. 1. A mother brings her 9 month infant in for a routine visit. What milestonewould be appropriate for the doctor to ask if the infant is meeting?
2. Walking
3. Speaking in two word phrases
4. Rolls back to stomach andstomach to back
5. All of the above ANS: 3
6. 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 infantisstrictly 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 identifythis newborn to be dehydrated and is most likely to have breast milkjI aundice. Which nursing intervention(s) will be required for this baby?
7. Phototherapy
8. Providing support and education for the lactating mother
9. Strict monitoring of intake and output
10. All of the above ANS 4
11. Apgar scores measure heart rate, respiratory rate, reflex irritability, colorand :
12. 1. Rigidity
13. 2. Muscle tone
14. 3. Birth weight
15. 4. Capillary refill ANS: 2
16. 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 roomandhands the baby tothemother. Sheasks the mother tolet herknowhowlong the baby feeds. What vital step did the nurse forget to take before givingthe baby tothe mother?
17. 1. The nurse should have made sure that the babywaslatching correctly
18. 2. The nurse should haveidentified the babys IDbandwiththemothers
19. 3. The nurse should have the mother speak with a lactation consultant
20. 4. The nurse should have asked the mother how long she planned to feedANS: 2
21. Excessive heat loss results in which of these?
22. RDS
23. Depletion of glucose levels
24. Jaundice
25. Increase in surfactant levels ANS: 2
26. A mother has just delivered her new baby a few hours ago. She asks thenurse if she can bathe the baby because he has blood on him. Thebest response fromthe nurse would be.
27. Sure, let me get you some soap and washcloths
28. Why dont you get some rest, there will be lots of time for bathing
29. Its important that we not bathe the baby too soon after birth. Lets wait tilllater in the day.
30. Sure, but why dont youfeed the baby ANS: 3
31. A 4 week oldinfant is brought tothe ED. Momstates that the baby hasntbeeneating well and has had

decreased diapers for 2 days. The baby has been sleeping more and hasbeenhard to wake up. On assessment, you find that the baby is difficult to arouse, is hypotonic andtemperature 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
5. 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:
6. Low blood sugar
7. Decrease Vitamin K
8. Increased Vitamin K
9. High blood sugar ANS: 2

.

9. A part of injury prevention is making and keeping infant appointments. The required checkups andvaccinations are at:
10. 3 months, 6 months, 9 months
11. 2 months, 4 months, 6 months and 1 year
12. 2 months, 4 months, 6 month, 9 months and 1 year
13. 2 months, 4 months, 9 months and 1 year ANS: 3
14. You are taking care of an infant who was admitted with dehydration. Hisweight is 6kg. You have been watching his I & Os. What would you expect the infants urinary output to beinorder to maintain adequate hydration?
15. 0.52 ml/kg/hr 2. 0.52.5 ml/kg/hr
16. 13 ml/kg/hr
17. As long as heis having wet diapers it doesnt matterANS: 3
18. A mother brings her newborn daughter tothe ER with concerns that sheishaving vaginal bleeding. You know this is normal and called what?
19. Pseudomenstruation
20. Milia
21. Vernix caseosa
22. Toxicum ANS: 1
23. While interviewing the mother of an infant, you note that the mother getsfrustrated as she explains that her baby has been upall night crying at least 3 times a week for the last 2weeks. She states that she has tried everything andfeels hopeless. What would bethe BEST response fromyouas the nurse?
24. Believe me, I know. I have a newborn too.
25. Haveyou tried warm milk?
26. Its ok to be frustrated and feel overwhelmed.

4. You are doing nothing wrong. This can be a common occurrence in infantsand you should not feel guilty. ANS: 4 Chapter 10. Developmental Management of InfantsQuestions
5. 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.
6. 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 practitionernotes that the infant weighed 3250 grams at birth and 2990grams when discharged on the second day oflife. Theinfantweighs 3080 gramsatthisvisit. 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.
7. During an assessment of a 4weekold infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during thedaybut is able to sleep for a 4hour periodduringthenight.Theinfanthasgained 20 grams perday intheiI nterval since last seen in the clinic. What will the nurse practitioner recommend? A. Continuing to nurse the infant using the current pattern Correct W. Nursingtheinfant forlongerperiodsevery 4 hours X. Supplementing with formula at the last nighttime feeding Y. Waking theinfant every 2 hourstonurseduring the night
8. 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 fussyand 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 witheach feeding, now has a bowel movement once every third day. What will the nurse practitioner tellher? T. Her baby is probably constipated. U. It may be related to her dietary intake. V. Sheshould 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 andwants 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 fussybut 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 canSay “dada” but not “mama” and asks the primary care pediatric nurse practitioner why this is whenshe istheonewhospendsmore time with the infant. How will the nurse practitionerrespond? 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 withonly 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 Street during the day.

10. The primary care pediatric nurse practitioner is examining a 12montholdInfant 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 EarlyChildhood Questions

1. The primary care pediatric nurse practitioner is evaluating a 2yearoldwith a documented speech delay. Screenings toassessmotor skills andcognitionare normal, and the child passed a recent hearing test. What will the pediatricnursepractitioner 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 ageappropriatemusic videos.

2. The primary care pediatric nurse practitioner performs a developmental assessment on a 32monthold child. The child‟s parent reports that about70% of the child‟s speech is intelligible. The pediatric nurse practitioner observesthat the child has difficulty pronouncing “t,” “d,” “k,” and “g” sounds. Whichactioniscorrect? 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 andsay, “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 Spanishand English and have many Spanishspeaking relatives nearby. Theyare resisting exposingthechild to Spanish out of concern that the child will not learn English well. What will thepediatricnurse 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 otherscannot do this. II. Learning two languages at an early age prevents children from developinga dominant language.