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NR602 Pediatric Midterm Study Set
Questions and Correct Detailed Answers with
Rationales All Graded A+ (Newest Update)
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. - CORRECT ANSWER>>> 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. 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 - CORRECT ANSWER>>> ANS: A The three-generation pedigree is used to map out risks for genetic diseases in families, 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. The primary care pediatric nurse practitioner is performing a well child check-up on a 20- monthold 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 developmental delay. - CORRECT ANSWER>>> ANS: A 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 primary care pediatric nurse practitioner may use which resource? DC: 0-3R ICD- 10 - CM ICSD- 3 NANDA International - CORRECT ANSWER>>> ANS: A
laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement? Altered elimination pattern Elimination disorder Encopresis Parenting alteration - CORRECT ANSWER>>> 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. - CORRECT ANSWER>>> 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 practitioner develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information? CRAFFT Ecomap
Genogram Pedigree - CORRECT ANSWER>>> 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 laboratory tests to evaluate this. Which diagnosis will the nurse practitioner document for this visit? Metabolic syndrome Nutritional alteration: more than required Obesity Rule out type 2 diabetes mellitus - CORRECT ANSWER>>> ANS: C A problem should never be included on the problem list that is not supported by subjective and objective data found and recorded in the database. This child has a BMI that suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data, which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for reimbursement. "Rule out" should not be used as a diagnosis, but may be considered part of a plan. The primary care pediatric nurse practitioner performs a developmental assessment on a 3year-old child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says. The nurse practitioner will : 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.
Because the PNP is planning to intervene by helping the parents to provide appropriate 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. 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 illnesses - CORRECT ANSWER>>> ANS: D An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language development), 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. 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. - CORRECT ANSWER>>> 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. 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. - CORRECT ANSWER>>> 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 effective, 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 delayed 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. Inform the family that services are provided when the child begins school. Refer the family to a social worker for assistance with referrals and services. - CORRECT ANSWER>>> ANS: A
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. - CORRECT ANSWER>>> 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 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." - CORRECT ANSWER>>> 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. 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? 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 - CORRECT ANSWER>>> ANS: D The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled
The primary care pediatric nurse practitioner performs a well baby examination 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. - CORRECT ANSWER>>> 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 weight, since most should regain this in 10 to 14 days and since this loss of birth weight is at the high end of normal. It is not necessary to refer to a lactation consultant or supplement with formula, since the infant is gaining weight adequately. 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? Cognitive learning begins during the toddler years. Intellectual growth begin when speech develops. Language and literacy skills begin at birth. Preschool is an optimal time to begin general learning. - CORRECT ANSWER>>> ANS: C General learning and acquisition of skills for later reading and writing begin at birth, not in kindergarten or first grade, and these skills grow with everyday loving interactions between infants and caregivers. Cognitive learning changes during toddler years but begins at birth. Intellectual growth is not tied to speech alone. During an assessment of a 4-week-old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend?
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 - CORRECT ANSWER>>> 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. The mother of a 6-week-old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? 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. - CORRECT ANSWER>>> 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. 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 - CORRECT ANSWER>>> 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
The primary care pediatric nurse practitioner is performing a well child examination on a 9month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? Provide educational videos that focus on language. Read simple board books to the infant at bedtime. Sing to the child and play lullabies in the baby's room. Turn the television to Sesame Street during the day. - CORRECT ANSWER>>> ANS: B The best way to improve language skills is to read to children. As long as the reading includes positive interactions with the baby and the reader, the baby is learning language. Educational videos, music, and television are all passive media and do not involve this interaction. The parent of a 5-month-old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? The infant may be expressing a desire to play or to rest. The parent should give ibuprofen for teething pain before nursing. This is an indication that the infant is ready for solid foods. This may indicate gastrointestinal discomfort such as constipation. - CORRECT ANSWER>>> ANS: A At this age, infants may cry when they are tired or need social interaction and not just when they are hungry. The PNP should teach parents about this change in social development so they can be responsive to their infant's needs. Solid foods are not added until age 6 months. Teething usually does not begin until at least 6 months. GI discomfort usually occurs after eating. The primary care pediatric nurse practitioner is examining a 12-month-old infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? Perform an in-depth developmental assessment. Reassure the parent that this is normal for a premature infant.
Refer the infant to a developmental specialist. Suggest activities to improve fine motor skills. - CORRECT ANSWER>>> ANS: A When developmental screening indicates an infant is not progressing at the expected rate, additional testing to determine the degree of delay is necessary. A referral may be needed if a delay is determined. This is not normal for this degree of prematurity; infants should develop a pincer grasp by 9 to 10 months of age. 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? Animism Artificialism Egocentrism Realism - CORRECT ANSWER>>> 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. The primary care pediatric nurse practitioner performs a developmental assessment on a 32month-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. - CORRECT ANSWER>>> ANS: C Intelligibility of speech reaches about 66% between the ages of 24 and 36 months. Tonguecontact sounds are more intelligible by age 5 years. This child exhibits normal speech for
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." - CORRECT ANSWER>>> 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. 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 appropriate. Let the child experiment at will and to make mistakes in order to learn. Say "no" whenever the child does something that is not acceptable. - CORRECT ANSWER>>> ANS: 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 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? 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 - CORRECT ANSWER>>> ANS: D The American Academy of Pediatric Dentistry recommends a first dental examination 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. During a well child assessment of an 18-month-old child, the primary care pediatric nurse practitioner observes the child point to a picture of a dog and say, "Want puppy!" The nurse practitioner recognizes this as an example of holophrastic speech. receptive speech. semantic speech. telegraphic speech. - CORRECT ANSWER>>> ANS: D Syntax, or the structure of words in sentences or phrases, is developed in stages between the ages of 8 months and 3.5 years. Telegraphic speech begins at about 18 months of age when children speak in phrases with many words omitted, so that the sentence sounds like a telegram. Holophrastic speech is the use of a single word to express a complete idea. Receptive speech refers to the ability to understand a word without necessarily being able to use the word. Semantics is the understanding that words have specific meanings. The primary care pediatric nurse practitioner is evaluating a 2-year-old with a documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next? Ask the child's parents whether they read to the child. Give parents educational materials to encourage speech. Refer the child to an early intervention program.
