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NR602 Pediatric Midterm Study Set
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- 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
RATIONALE The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate
autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic.
- The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk?
Three-generation pedigree Review of systems Genogram
Ecomap:
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 developmen- tal delay.:
ANS: A
RATIONALE This child should be at a 19-month adjusted age for prematurity so, according to the parent screen, is 4
months behind. The PNP should perform a more in-depth screen to evaluate this delay. Waiting to see if the child will "catch up" or assuring the parent that this will happen will cause the delays to become more severe. A referral to a specialty clinic should not be made solely on the basis of the parent-completed questionnaire but only after further evaluation of possible delays.
- When formulating developmental diagnoses for pediatric patients, the pri- mary care pediatric nurse practitioner may use which resource?
DC: 0-3R ICD-10-CM ICSD-
NANDA International:
ANS: A
RATIONALE The DC: 0-3R refers to the Diagnostic Classification of Mental Health and Developmental Disorders of
Infancy and Early Childhood and is useful for developmental problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3 is the International Classification of Sleep Disorders - 3rd edition. NANDA International is used to label problems in the functional health domain.
- The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool-age child. How will the nurse practitioner assess this?
Ask the child how many books he has at home. Ask the mother about her highest grade in school.
Ask the mother to determine the correct dose of a drug from a label. Ask the mother to read a health information handout aloud.: ANS: A
RATIONALE The "newest vital sign," or health literacy, can be determined quickly by asking the parent how many
children's books are in the home. Greater than 10 books in the home is an independent positive predictor of adequate parent health literacy. The other questions may determine a specific level of literacy in general but are not as eflcient.
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.
- 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.
- 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 Pedigree: ANS: C
The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is used to identify relationships in the family and community that are supportive or harmful. The pedigree is used to identify potential genetic disorders.
- The primary care pediatric nurse practitioner evaluates a school-age child whose body mass index (BMI) is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic syndrome and orders lab- oratory tests to evaluate this. Which diagnosis will the nurse practitioner doc- ument for this visit?
adults can understand what the child says. The nurse practitioner will :
ask the parent to consider a possible speech delay and report any concerns. continue to evaluate the child's speech at subsequent visits.
refer the child for a speech and hearing evaluation.
tell the parent to spend more time in interactive conversations with the child.-
: ANS: B
Development should be monitored over time and within the context of the child's overall well-being, rather than at an isolated testing session. The child has normal development in observed measures and appears to hear and understand well. By parental report, the child is able to speak. The PNP should continue to evaluate speech over time, since this refusal to speak may be associated with shyness or intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay. Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a home therapy.
- The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use? CRAFFT
HEEADSSS
PHQ-
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.
- 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
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 diflculties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period.
- The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend?
Consult a developmental specialist for a more complete evaluation. Prepare the parents for a potentially serious developmental disorder. Refer the infant to an early intervention program for physical therapy.
Teach the parents to provide exercises to encourage motor development.: ANS: D
The child who has mild delays in only one area may be managed initially by having the parent provide appropriate exercises. If this is not ettective, or if delays become more severe, referrals for evaluation or early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so this action is not indicated.
- The primary care pediatric nurse practitioner sees a developmentally de- layed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially?
Ask the parents if they have an individualized family service plan (IFSP). Consult with a physician to ensure the child gets appropriate care.
ment.
Refer the infant to a developmental specialist for a complete evaluation.: ANS: C When discussing developmental delays with parents, it is important to be positive and to initially focus on strengths. Explaining that developmental delays develop over time is true but does not reassure the parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and may take time.
- Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3-year-old child who draws on the walls with crayons?
Give the child washable markers so the drawings can be removed easily. Provide a roll of paper for drawing and teach the child to use this.
Put the child in "timeout" each time the child draws on the walls. 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.
- 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.
- During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child becoming irritable and uncoop- erative. The parent tells the child to stop fussing. What will the nurse practi- tioner 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
have special health care needs. Which is an important role of the nurse practi- tioner 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.
- 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.
taking her child to regular play date activities with other children.: ANS: A Providers can teach parents that providing predictable, consistent, and loving care helps an infant to learn trust and
help influence positive brain development. Involving extended family members and going to play dates are good ways to socialize children but are not essential to learning trust. It may not be possible for her to be a stay-at-home mother.
- The primary care pediatric nurse practitioner performs a well baby exam- ination on a 7-day-old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct?
Follow up at the 2-month checkup. Refer to a lactation consultant.
Schedule a weight check in 1 week. Suggest supplementing with formula.: ANS: C
This infant lost about 8% of its birth weight, which is normal and, since discharge home, has gained at least 15 grams per day, which is also normal. The PNP should schedule a weight check in a week to make sure the infant regains its birth
