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NR602 Pediatric Midterm Study Set
1. 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 (M-CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do? Administer a Childhood Autism Rating Scale (CARS) in the clinic. Consult a specialist to determine appropriate early intervention strategies. Refer the child to a behavioral specialist for further evaluation. Tell the parent that this result indicates that the child has autism.: ANS: C The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic.
2. The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried
that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk? Three-generation pedigree Review of systems Genogram Ecomap: ANS: A The three-generation pedigree is used to map out risks for genetic diseases in fami- lies, as well as conditions with modifiable risk factors. The review of systems is used to evaluate the history of the child's body systems. The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The ecomap is used to identify relationships in the family and community that are supportive or harmful.
3. The primary care pediatric nurse practitioner is performing a well child check-up on a 20-month-
old child. The child was 4 weeks premature and, according to a parent-completed developmental questionnaire, has achieved milestones for a 15-month-old infant. Which action is correct? Perform an in-depth developmental assessment screen at this visit to evaluate this child. Reassure the parent that the child will catch up to normal development by age 2 years.
Re-evaluate this child's development and milestone achievements at the 2-year visit. Refer the child to a specialty clinic for evaluation and treatment of develop-
Fine motor Gross motor Social/emotional
Speech and language: ANS: D Maternal depression in the first year of life has been associated with poorer language development at 3 years of age.
7. The primary care pediatric nurse practitioner sees a 3-year-old child who chronically withholds
stools, in spite of the parents' attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diag- nosis will the nurse practitioner use to facilitate third-party reimbursement? Altered elimination pattern Elimination disorder Encopresis Parenting alteration: ANS: C Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized for reimbursement purposes. "Altered elimination pattern" and "Parenting alteration" are NANDA International diagnoses and are not recognized for reimbursement. "Elimination disorder" is a developmental diagnosis.
8. A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse
practitioner notes that the child's last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially? Ask the child's parent why the child is so anxious. Perform a physical assessment to rule out shortness of breath. Reassure the child that there is nothing to be afraid of. Review the purpose of this visit and any anticipated procedures.: ANS: D The PNP should remember that young children are learning "scripts" for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease.
9. When meeting with a new family, the primary care pediatric nurse practition- er develops a
database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information? CRAFFT Ecomap Genogram
measures and appears to hear and understand well. By parental report, the child is able to speak. The PNP should continue to evaluate speech over time, since this refusal to speak may be associated with shyness or intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay. Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a home therapy.
12. The primary care pediatric nurse practitioner is performing a well child assessment on an
adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use? CRAFFT HEEADSSS PHQ- RAAPS: ANS: A The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens.
13. The primary care pediatric nurse practitioner is assessing a toddler whose weight and body
mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem? Failure to thrive Home care resources inadequate Nutrition alteration - less than required Parenting alteration: ANS: D Because the PNP is planning to intervene by helping the parents to provide appro- priate food habits, the correct diagnosis should be "Parenting alteration." "Failure to thrive" is a medical diagnosis and requires a medical and social evaluation to rule out organic causes or detect neglect. "Home care resources inadequate" would be used if the PNP suspects that the family lacks adequate funds to purchase food. "Nutrition alteration" is a NANDA diagnosis and would be used if the PNP planned to consult with a dietician or give nutritional information.
14. The primary care pediatric nurse practitioner is obtaining a medical history about a child. To
integrate both nursing and medical aspects of primary care, which will be included in the medical history? Complementary medications, alternative health practices, and chief complaint Developmental delays, nutritional status, and linear growth patterns Medication currently taking, allergy information, and family medical history Speech and language development, beliefs about health, and previous illness- es: ANS: D An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language devel- opment), functional health problems (beliefs about health), and diseases (chief complaint). The other examples all use domains associated with the traditional medical model and do not contain nursing aspects associated with functional health problems.
15. During a well child exam, the primary care pediatric nurse practitioner learns that the parents of
a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father's job layoff. What will the nurse practitioner do? Reassure them that the child is too young to understand. Recommend that they continue to not argue in front of the child. Suggest counseling to learn ways to handle stress. Tell them that the conflict will resolve when the situation changes.: ANS: C Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period.
16. The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes
mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? Consult a developmental specialist for a more complete evaluation. Prepare the parents for a potentially serious developmental disorder. Refer the infant to an early intervention program for physical therapy.
19. Which recommendation will a primary care pediatric nurse practitioner make when parents
ask about ways to discipline their 3-year-old child who draws on the walls with crayons? Give the child washable markers so the drawings can be removed easily. Provide a roll of paper for drawing and teach the child to use this. Put the child in "timeout" each time the child draws on the walls. Take the crayons away from the child to prevent the behavior.: ANS: B Discipline involves training or education that molds appropriate behavior and is used to teach the child what is permitted and encouraged. Providing an appropriate outlet for drawing helps to teach the child where to use the crayons. Using washable markers allows the parents to clean the walls but does not teach the child appropriate behaviors. Timeout and taking away the crayons are forms of punishment, or a loss of privileges, that are administered as a form of retribution.
20. The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old
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 : a sign that the mother has postpartum depression. extremely concerning for potential parental neglect. of moderate concern for parenting problems. within the normal range of behavior in early parenthood.: ANS: C A parent who seems disinterested in a child raises moderate concerns for parenting problems. It does not necessarily signal postpartum depression. It is not a mark for extreme concern. It is not within the expected range of behaviors.
21. During a well child assessment of an 18-month-old 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? Allow the parent to put the child in a "timeout.": ANS: C The child has exhibited early signs of misbehavior. At this stage, distraction and active engagement may be used to stop more problems from occurring. It is not necessary to use a timeout because the child hasn't reached the point where cooperation is impossible. The PNP should model appropriate interventions by offering the child a distraction and may ask the parent
about discipline practices later in the visit. The child is not at a "meltdown" state.
22. The primary care pediatric nurse practitioner performs a physical exami- nation 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? To begin brushing the infant's teeth with toothpaste To consider weaning the infant from breastfeeding To discontinue giving fluoride supplements To make an appointment for an initial dental examination: ANS: D The American Academy of Pediatric Dentistry recommends a first dental examina- tion at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued.
23. 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? Care coordination and collaboration Developing protocols for parents to follow Monitoring individual education plans (IEPs) Providing lists of resources for families: ANS: A Care coordination is one of the key elements for children with special health care needs. PNPs are especially suited for this role and have the unique skills to function as care coordinators. Care for these children should involve shared decision making and individualized care and not "cookbook" approaches. The PNP may advocate for children's health care needs for the IEP but does not monitor these. The PNP should not just give parents lists of phone numbers but should assist them to make appointments.
24. 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 : developing consistent daily routines for the child. exposing her child to extended family members when possible. not working outside the home during the first few years.
that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4-hour 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? Continuing to nurse the infant using the current pattern Nursing the infant for longer periods every 4 hours Supplementing with formula at the last nighttime feeding Waking the infant every 2 hours to nurse during the night: ANS: A Infants who are encouraged to breastfeed every 2 to 3 hours may have one longer stretch of 4 hours at night. This infant is gaining between 0.5 and 1 gram per day, which is appropriate. It is not necessary to alter the pattern of nursing or to supplement with formula.
28. The mother of a 6-week-old breastfeeding infant tells the primary care pe- diatric 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? Her baby is probably constipated. It may be related to her dietary intake. She should consume more water. This may be normal for breastfed babies.: ANS: D Infants begin to have fewer bowel movements and may have bowel movements ranging from once or twice daily to once every other day when breastfed. Unless there are other signs, the baby is probably not constipated. The mother does not need to change her intake of foods or water, unless constipation is present.
29. The mother of a 3-month-old 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? Appropriate ways to stimulate and entertain the infant How to read the infant's cues for overstimulation The importance of scheduling "play dates" with other infants To provide musical toys to engage the infant: ANS: B By 3 months, infants demonstrate a social smile and will become more active, alert, and responsive. Parents may mistakenly assume that the infant can handle more activity and
stimulation when this occurs, and the PNP should teach caregivers how to recognize infant cues for the need to rest or to have decreased stimulation.
30. The mother of a 6-month-old 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? "At this age, your baby does not understand the meaning of sounds." "Babies at this age cannot make the 'ma' sound." "Most sounds made by babies at this age are accidental." "This may mean that your baby doesn't hear well.": ANS: A At 6 months, infants delight in vocalizing sounds that they learn by imitation but do not ascribe meaning to the sounds they make. Infants can say "mama" but without meaning. Babies make sounds on purpose by imitating what they hear. A preference for one sound early in speech does not indicate a hearing deficit.
31. The primary care pediatric nurse practitioner is performing a well baby examination on a 2-
month-old 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? She may not be making as much breastmilk as before. She should keep a log of the frequency and duration of each feeding. The infant may be going through an expected growth spurt. The infant should stay on the previously established nursing schedule.: ANS: C Infants may have a growth spurt at 6 to 8 weeks, and mothers who are breastfeeding may be concerned that they are not making enough milk when they notice that the infant is fussy and wanting to nurse more often. The PNP should reassure the mother that this is expected. It is not necessary, since the infant is gaining weight appropriately, for the mother to keep a log. The mother should follow the infant's cues for feeding since the extra suckling will increase the milk supply to meet the growing infant's needs.
32. The primary care pediatric nurse practitioner is performing a well child examination on a 9-
month-old infant whose hearing is normal but who re- sponds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language
Artificialism Egocentrism Realism: ANS: 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.
36. 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? Evaluate the child's cognitive abilities. Obtain a hearing evaluation. Reassure the parent that this is normal. Refer the child to a speech therapist.: ANS: 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.
37. The primary care pediatric nurse practitioner is offering anticipatory guid- ance 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? Children who learn two languages simultaneously often confuse them in conversation. Children with multi-language proficiency do not understand that others can- not do this. Learning two languages at an early age prevents children from developing a dominant language. Most bilingual children are able to shift from one language to another when appropriate.: ANS: D Most children who are bilingual are able to sort out the languages in conversation but may "code switch" at times for clarity as they speak. They seem to understand
that not everyone has this ability. Most children who are bilingual develop a dominant language.
38. The parents of a 3-year-old 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? Allow the child to choose foods for meals to improve caloric intake. Place a variety of nutritious foods on the child's plate at each meal. Prepare mashed potatoes and chicken strips for the child at mealtimes. Suggest cutting out snacks to improve the child's appetite at mealtimes.: ANS: B 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.
39. 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? "Begin by reading to your child about toileting." "Most children are capable by age 2 years." "Tell me about your child's daily habits." "We should assess your child's motor skills.": ANS: 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.
40. 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. Be present while the child plays to continually teach the child what is appro- priate.
Early intervention may be used if the speech delay persists. Music videos do not necessarily engage the child in expression of speech.
43. The mother of a 3-year-old child takes the child to a play group once a week. 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. The toddler may have a language delay that interferes with socialization with other children. Toddlers may be interested in other children but usually do not engage in interactive play. Toddlers need more structured play to encourage interaction and socialization with others.: ANS: C Parallel play is common among toddlers who, although they may be fascinated by other children, generally do not engage with peers in an interactive manner. This does not mean that the child is shy or has a language delay, although in preschool years, the development of symbolic language increases interactive play. Children need both structured and free play, but structured play will not increase interaction during this normally parallel period.
44. The primary care pediatric nurse practitioner is preparing to conduct a well child assessment of
an 8-year-old child. How will the nurse practitioner begin the exam? Ask the child about school, friends, home activities, and sports Discuss the purpose of the visit and explain the procedures that will be performed Offer age-appropriate information about usual developmental tasks Provide information about healthy nutrition and physical activities: ANS: A To build rapport with the child and parent, the PNP will begin by asking direct ques- tions to the child, encouraging the child to share information about daily routines. The other answers list aspects of the well child visit that can be introduced after the initial conversation.
45. The primary care pediatric nurse practitioner is examining a 6-year-old 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 : about school performance and grades. why school is so distressing. to name one or two friends. whether bullying is taking place.: ANS: C The earliest school-age psychosocial milestone occurs when children learn to separate easily from family, allowing them to go to school. Mastery of these skills
