Pediatric Burns Primary Care 7th Edition Test Bank questions with correct answers 2023-202, Exams of Pediatrics

Download Pediatric Burns Primary Care 7th Edition Test Bank questions with correct answers 2023-202 and more Exams Pediatrics in PDF only on Docsity! Pediatric Burns Primary Care 7th Edition Test Bank questions with correct answers 2023-2024 Chapter 1: Health Status of Children: Global and National Perspectives 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 achieve the greatest worldwide reduction in child mortality from pneumonia and diarrhea, which intervention is most 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? . 133484138 56 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 major child 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, the primary care pediatric nurse practitioner is adhering to the most recent American Academy of PediatricsRecommendations for Preventive Pediatric Health Care guidelines by A. focusing less on development and more on illness prevention and nutrition. B. following guidelines established by theBright 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 are due. 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. 13. A father reports that his adolescent daughter has gotten good grades up until the last quarter of school. She has been hanging out by herself and does not want to talk to him anymore. The mental health nurse should: 1. Realize that this is a natural part of growing up. 2. Perform a mental health screening to check for depression. 3. Attempt to get the adolescent to discuss why she does not like her father anymore. 4. Let the adolescent talk when she is ready. ANS: 2 14. A teen should be checked for depression at physician visit(s). 1. Every . 2. One 3. Monthly 4. Bi- yearly ANS: 1 15. When using the SAD FACES depression screen, it is important to assess: 1. Anhedonia. 2. Suicidal ideations. 3. Sleep patterns. 4. All of the above ANS: 4 16. A school nurse is giving an in-service to teachers on bullycide. The main reason for the teaching is so that: 1. Teachers are aware bullying occurs. 2. Teachers are able to identify students who are risk. 3. Teachers can be aware of the fact that suicides can happen due to bullying by others. 4. Teachers are aware of their role in causing bullycide. ANS: 3 17. An adolescent with a known history of bipolar disorder is in the school nurses office because a teacher reported that she was talking fast and acting like she was God. The school nurse assesses the girl and notes that: 1. She is probably in a manic phase and needs to be treated professionally. 2. She has had too much sleep and is now hyperactive. 3. She forgot to take her medications today. 4. She requires some food and rest before going back to class. ANS: 1 Chapter 3. Genetics and Child Health Questions 1. What is true about haploid cells? . 133484076 44 C. Each contains 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? . 133484076 50 A. Male with deletion of chromosome 6 B. Female with deletion of chromosome 6 C. Male with deletion on the long arm of chromosome 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. . 133484076 46 What is most likely 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 is responsible for many singlegene genetic disorders? . 133484076 36 A. Copy number variations B. Nucleotide repeat expansions C. Point mutations Correct D. Single nucleotide polymorphisms (SNP) . 5. Cystic fibrosis is a recessive disease requiring the presence of a gene mutation . 133484076 38 on both alleles inherited from the parents. Which type of genetic disorder is this? A. Chromosome B. Mitochondrial C. Monogenetic Correct D. Multifactorial . 6. The primary care pediatric nurse practitioner is counseling a couple about genetic risks and learns that one parent has neurofibromatosis, an autosomal dominant disorder, and the other parent does not. What will the nurse practitioner include when discussing this disorder 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 the disease. 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 newborn girl reveals that hemophilia A, an Xlinked Besides avoiding using plastic containers when possible, what else will the primary care pediatric nurse practitioner recommend? A. Avoid heating foods and liquids in plastic containers. Correct B. Clean plastic containers well using the dishwasher. C. Use only plastics stamped with “#7” on the bottom. D. Used canned 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 are organic or not. Which foods are on this 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 Assessment Questions 1. 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 chief complaint L. Developmental delays, nutritional status, and linear growth patterns M. Medication currently taking, allergy information, and family medical history N. Speech and language development, beliefs about health, and previous illnesses Correct 2. When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? A. DC: 03R Correct K. ICD10CM L. ICSD3 M. NANDA International 3. The primary care pediatric nurse practitioner sees a 3yearold child who chronically withholds stools, in spite of the parents’ attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate thirdparty reimbursement? M. Altered elimination pattern N. Elimination disorder C. Encopresis Correct D. Parenting alteration 4. 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? J. Failure to thrive K. Home care resources inadequate L. Nutrition alteration – less than required D. Parenting alteration Correct . 5. The primary care pediatric nurse practitioner is p erforming a well child checkup 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 visit to evaluate this child. Correct K.Reassure the parent that the child will catch up to normal development by age 2 years. L. Reevaluate this child’s development and milestone achievements at the 2year 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 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 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 with the 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 nurse practitioner do? 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 a 3yearold child has been treated for depression for over 5 years. Which aspect of this child’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 behavioral and emotional problems. Which tool will the nurse practitioner use to record this information? C. CRAFFT D. Ecomap C. Genogram Correct D. Pedigree 10. 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 prekindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially? A. Ask the child’s parent why the child is so anxious. B. Perform a physical assessment to rule out shortness 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 literacy in 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 and tobacco use. Which assessment tool will the nurse practitioner use? A. CRAFFT Correct A. HEEADSSS B. PHQ2 C. RAAPS 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 whose parents 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 trauma Correct 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 1. A child born with Dandy Walker malformation is receiving palliative care in the pediatric unit. A nurse should: 1. Provide the parents, patient, and family members with supportive care during this time. 2. Ask the parents to be part of the plan of care as much as possible. 3. Attempt to provide a primary nurse for this particular patient on each shift. 4. All of the above are correct. ANS: 4 2. A head circumference is being measured at a 4 month olds well- baby checkup. It is noted that the head circumference has not grown since the previous assessment. The nurse should: 1. Ask the mother about the childs nutrition. K. L. . M. N. . 2. Notify the doctor. 3. Re-measure the head circumference, check developmental milestones, assess the nutritional status, and discuss the findings with the doctor. 4. Document the normal findings. ANS: 3 3. A child with a diagnosis of schizencephaly is assigned to a new nurse on the pediatric floor. The new nurse has not worked with a child with this diagnosis before. A career nurse discusses the plan of care needed for the child with the new nurse. It will be important to: 1. Assess the side of the body that has paralysis for any lesions or sores. 2. Let the patient do as much as possible for activities of daily. 3. Discourage the patient to move the paralyzed side of the body. 4. Provide full care for the patient. ANS: 1 4. A nurse is assessing a 6-month-old boys suture lines. The nurse notes that the baby has craniosynostosis. The nurse should be concerned because: 1. The suture line closure will not allow the brain to grow. 2. This can lead to hydrocephalus. 3. The child will have immediate developmental delays because of the lack of space for the brain to grow. 4. The child will not require surgery. ANS: 1 5. A child that had a shunt placed four years ago for hydrocephalus is in the emergency room complaining of a rapid onset of vomiting and increased lethargy. The nurse knows that the child will need: 1. Nothing, as this is a normal complication and not an emergency. 2. To be placed on IV fluids to help maintain an electrolyte balance. 3. Small amounts of fluids until the vomiting has subsided. 4. To consider this a neurological medical emergency and check the childs head circumference. ANS: 4 6. Night terrors can occur in adolescents because of: 1. Emotional stress. 2. Alcohol use. 3. Bullying. 4. All of the above can trigger night terrors in adolescents. ANS: 4 7. When speaking with a family about their 9-year-old daughters nightmares, it is important to ask: 1. If the child has a history of daytime napping. 2. What medications the child takes during the day. 3. How often the child consumes caffeine. 4. All of the above should be part of the assessment. ANS: 4 8. A quality of a partial seizure is: 1. Status epilepticus. 2. Tonic movements. 3. Fluttering eyelids. 4. Clonic movements. ANS: 4 9. A mother is asking the nurse why her daughter continues to have temporal lobe seizures even though she is on medication. The nurse knows this is occurring because: 1. The medication may not be in the therapeutic range. 2. Temporal lobe seizures do not respond well to medications. 3. The daughter may be missing doses of her medication. 4. The food her daughter eats may have a negative reaction with the medication, causing more seizures. ANS: 2 10. Which of the following types of epilepsy are photosensitive? 1. Juvenile myoclonic epilepsy 2. Temporal lobe epilepsy 3. Febrile seizures 4. Childhood absence epilepsy ANS: 1 1. A child who had a seizure one hour ago is exhibiting signs of paralysis on the left side of the body. . Chapter 8. Developmental Management in Pediatric Primary Care Questions 1. 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 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 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? 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 to learn ways to handle stress. 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 and uncooperative. 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 practitioner make when parents ask about ways to discipline their 3yearold child who draws on the walls with crayons? O. Give the child washable markers so the 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 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? 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 newborn infant recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation? L. Explain to the parent that developmental delays often do not manifest at first. M. Perform a developmental assessment and tell the parent which delays are evident. N. Point out the tasks that the infant can perform while conducting the assessment. Correct D. Refer the infant to a developmental specialist for a complete evaluation. 7. 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 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 begins school. 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 who have 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. 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? 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 and finds a 2monthold 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 H. a sign that the mother has postpartum depression. I. extremely concerning for potential parental neglect. J. of moderate concern for parenting problems. Correct 4. Sure, but why dont you feed the baby ANS: 3 7. A 4 week old infant is brought to the ED. Mom states that the baby hasnt been eating well and has had decreased diapers for 2 days. The baby has been sleeping more and has been hard to wake up. On assessment, you find that the baby is difficult to arouse, is hypotonic and temperature 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. PT T ANS: 3 8. 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: 1. Low blood sugar 2. Decrease Vitamin K 3. Increased Vitamin K 4. High blood sugar ANS: 2 . 9. A part of injury prevention is making and keeping infant appointments. The required checkups and vaccinations are at: 1. 3 months, 6 months, 9 months 2. 2 months, 4 months, 6 months and 1 year 3. 2 months, 4 months, 6 month, 9 months and 1 year 4. 2 months, 4 months, 9 months and 1 year ANS: 3 10. You are taking care of an infant who was admitted with dehydration. His weight is 6kg. You have been watching his I & Os. What would you expect the infants urinary output to be in order to maintain adequate hydration? 1. 0.52 ml/kg/hr 2. 0.52.5 ml/kg/hr 3. 13 ml/kg/hr 4. As long as he is having wet diapers it doesnt matter ANS: 3 11. A mother brings her newborn daughter to the ER with concerns that she is having vaginal bleeding. You know this is normal and called what? 1. Pseudomenstruation 2. Milia 3. Vernix caseosa 4. Toxicu m ANS: 1 12. While interviewing the mother of an infant, you note that the mother gets frustrated as she explains that her baby has been up all night crying at least 3 times a week for the last 2 weeks. She states that she has tried everything and feels hopeless. What would be the BEST response from you as the nurse? 1. Believe me, I know. I have a newborn too. 2. Have you tried warm milk? 3. Its ok to be frustrated and feel overwhelmed. 4. You are doing nothing wrong. This can be a common occurrence in infants and you should not feel guilty. ANS: 4 Chapter 10. Developmental Management of Infants Questions 1. 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. 2. 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 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? 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. 3. During an assessment of a 4weekold 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? A. Continuing to nurse the infant using the current pattern Correct W. Nursing the infant for longer periods every 4 hours X. Supplementing with formula at the last nighttime feeding Y. Waking the infant every 2 hours to nurse during the night 4. 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 fussy and 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 with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? T. Her baby is probably constipated. U. It may be related to her dietary intake. V. She should 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 and wants 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 fussy but 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 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? 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 with only 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 Streetduring the day. GG. Children who learn two languages simultaneously often confuse them in conversation. HH. Children with Multilanguage proficiency do not understand that others cannot do this. II. Learning two languages at an early age prevents children from developing a dominant language. X. Most bilingual children are able to shift from one language to another when appropriate. Correct 5. 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. • Correct • 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. • T. The mother of a 3yearold child takes the child to a play group once a week. . 13348437961 6. 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. V. The toddler may have a language delay that interferes with socialization with other children. W. Toddlers may be interested in other children but usually do not engage in interactive play. Correct X. Toddlers need more structured play to encourage interaction and socialization with others. 7. The parent of a 4yearold 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 preschoolage children? P. Animism Q. Artificialism R. Egocentrism D. Realism Correct 8. The parent of a 24monthold child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond? N. “Begin by reading to your child about toileting.” O. “Most children are capable by age 2 years.” K. “Tell me about your child’s daily habits.” Correct L. “We should assess your child’s motor skills.” 9. The primary care pediatric nurse practitioner performs a physical examination on a 9monthold 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? D. To begin brushing the infant’s teeth with toothpaste E. To consider weaning the infant from breastfeeding F. To discontinue giving fluoride supplements D. To make an appointment for an initial dental examination Correct 10. The parents of a 3yearold 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? D. Allow the child to choose foods for meals to improve caloric intake. E. Place a variety of nutritious foods on the child’s plate at each meal. Correct F. Prepare mashed potatoes and chicken strips for the child at mealtimes. G. Suggest cutting out snacks to improve the child’s appetite at mealtimes. Chapter 12. Developmental Management of Middle Childhood Questions 1. The primary care pediatric nurse practitioner is examining a 6yearold 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 EE. about school performance and grades. FF. why school is so distressing. GG. to name one or two friends. Correct HH. whether bullying is taking place. 2. The parent of a 10yearold boy tells the primary care pediatric nurse practitioner that the child doesn’t appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child’s sexual identity. The nurse practitioner will tell the parent DD. children at this age who prefer interactions with samegender peers usually have a homosexual orientation. EE. children experiment with sexuality at this age as a means of deciding later sexual orientation. FF. this attachment to other samegender children is how the child learns to interact with others. Correct GG. to encourage mixedgender interactions in order to promote development of sexual values. 3. The parents of a 12yearold child are concerned that some of the child’s older classmates may be a bad influence on their child, who, they say, has been raised to believe in Correct G. Order radiologic studies and laboratory tests to rule out systemic causes H. Reassure the child and encourage resuming sports when symptoms subside I. Refer the child to a counselor to discuss anxiety about health problems Chapter 13. Developmental Management of Adolescents/Young Adults Questions 1. The primary care pediatric nurse practitioner is performing a well child assessment on a 13yearold female whose mother asks when her daughter’s periods may start. Which information will the nurse practitioner use to help estimate the onset of periods? A. The age of the mother’s menarche B. The patient’s age at thelarche Correct II. When adrenarche occurred JJ. Whether linear growth has stopped 2. The primary care pediatric nurse practitioner is examining a 15yearold female who reports having her first period at age 13. She states that she has had five periods in the last year, with the last one 2 months prior. She participates in basketball at school. Which action is correct? HH. Perform biometric screening to determine lean body mass. Correct II. Prescribe oral contraceptives pills to regulate her periods. JJ. Reassure her that this is perfectly normal at her age. KK. Refer her to an endocrinologist for hormonal evaluation. 3. During a well child assessment of a 13yearold male, the primary care pediatric nurse practitioner notes small testicles and pubic and axillary hair. To further evaluate these findings, the nurse practitioner will ask the patient about HH. alcohol and tobacco use. II. changes in voice. JJ. increase in height and weight. KK. participation in sports. Correct 4. The mother of a 16yearold male was recently divorced after several years of an abusive relationship and tells the primary care pediatric nurse practitioner that the adolescent has begun skipping school and hanging out with friends at the local shopping mall. When she confronts her child, he responds by saying that he hates her. What will the nurse practitioner tell this mother? XX. Adolescence is marked by an inability to comprehend complex situations. YY. Adolescence is typically marked by tempestuous and transient episodes. ZZ. Adolescents normally have extreme, disruptive conflicts with parents. AAA. Adolescents often need counseling to help them cope with life events. Correct . 5. The primary care pediatric nurse practitioner is performing a well child exam on a 12yearold female who has achieved early sexual maturation. The mother reports that she spends more time with her older sister’s friends instead of her own classmates. What will the nurse practitioner tell this parent? BB. Earlymaturing girls need to identify with older adolescents to feel a sense of belonging. CC. Girls who join an older group of peers may become sexually active at an earlier age. Correct DD. Spending time with older adolescents indicates a healthy adjustment to her maturing body. EE. The association with older adolescents will help her daughter to gain social maturity. 6. The mother of a 15yearold adolescent female tells the primary care pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different just before her periods, the adolescent points to her mother and says, “She gets really hard to live with.” This demonstrates which characteristic of adolescent thinking? A. Apparent hypocrisy Correct S. Imaginary audience T. Overthinking U. Personal fable 7. The primary care pediatric nurse practitioner is performing an exam on an adolescent male who asks about sexual identity because of concern that a friend is worried about being gay. Which response will the nurse practitioner make in this situation? W. Provide the teen with a questionnaire to gain information about his sexuality. X. Remind the adolescent that mandatory reporting requires disclosure to parents. Y. Suggest that the adolescent discuss sexual concerns with his parents. Z. Tell the adolescent that, unless he is at risk, what he says will be confidential. Correct 8. The parent of a 14yearold child tells the primary care pediatric nurse practitioner that the child skips classes frequently in spite of various disciplinary measures, such as grounding and extra homework and is earning Cs and Ds in most classes. What will the nurse practitioner recommend? CC. Counseling for emotional problems DD. Development of an Individual Education Plan C. Evaluation for possible learning disorders Correct D. Referral for a behavioral disorder 9. The parent of a 14yearold child tells the primary c are pediatric nurse about asthma management strategies. The child states that it is “too much trouble” to remember to use an inhaled corticosteroid medication twice daily and reports feeling fine, in spite of exhibiting expiratory wheezes. Which action uses the health belief and selfefficacy model to teach this child about asthma management? FF. Asking the child to try to use the inhaler at least once daily GG. Discussing whether the child wants to participate in athletics C. Obtaining preand posttreatment spirometry testing Correct D.Providing written information about inhaled corticosteroids 6. An adolescent who is overweight expresses a desire to lose weight in order to participate in sports but tells the primary care pediatric nurse practitioner that he doesn’t want to give up sweets and soft drinks because he enjoys them too much. Which stage of change does this represent? A. Action B. Contemplation Correct V. Precontemplation W. Preparation 7. The primary care pediatric nurse practitioner sees a 17yearold client who quit smoking almost a year prior but who reports having renewed cravings when around friends who smoke. Using knowledge of the maintenance stage of change, the primary care pediatric nurse practitioner will AA. go over with the adolescent about the health risks associated with smoking. BB. recommend avoiding friends who smoke and making new friends. CC. remind the adolescent about the struggles associated with quitting smoking. DD. suggest that the teen consider taking up a sport or other physical activity.Correct 8. The primary care pediatric nurse practitioner is working with a 12yearold female who has poor diabetes control. The child tells the nurse practitioner that the parent forgets to remind her to check her blood sugars. Which action is correct? EE. Assess the parent’s knowledge about diabetes management. FF. Help the child develop a strategy to remember without parental prompts. Correct GG. Refer to a social worker to help the family overcome obstacles to care. HH. Remind the child’s parent about the importance of good diabetes control. . 9. The primary care pediatric nurse practitioner is counseling an obese 16yearold client about weight management. The adolescent says, “I know I need to lose weight, but I don’t want to give up all my favorite foods.” When using motivational interviewing techniques, how will the nurse practitioner respond? Y. “Do you think there are any foods you could limit or do without for a while?” Correct Z. “I hear you telling me that you really don’t have a desire to lose weight.” AA. “If you can’t give up these foods, you won’t see the benefits of weight loss.” BB. “In the long run, the sacrifices you make today will improve your health.” 10. The parent of a newborn has quit smoking cigarettes within the past month and reports feeling fidgety. Using a “reframing” technique, how will the primary care pediatric nurse practitioner respond? Z. Explore ways that the parent can use this extra energy to do things for the baby. Correct AA. Remind the parent that this is a normal, temporary part of nicotine withdrawal. BB. Suggest that the parent take up exercise to enjoy the benefits of not smoking. CC. Tell the parent that, over time, these symptoms of withdrawal will subside. 11. The primary care pediatric nurse practitioner is assessing the health literacy of the parent of a toddler. Which tool will the nurse practitioner use to estimate reading level? T. FleschKincai d Readability Test U. Gunning Fog Index V. Number of children’s books in the home D. SMOG Correct 1 2. The pediatric nurse practitioner provides primary care for a special needs infant whose parent takes an active role in the infant’s care. The parent has a high school diploma and asks many questions about her infant’s treatments. Which approach will the nurse practitioner take to ensure health literacy for this parent? M. Ask the parent to read back all information given. Correct N. Encourage the parent to ask questions when confused. O.Provide written materials presented at an 8th grade level. P. Reinforce written information with verbal instructions. . . . . Chapter 15. Behavioral and Mental Health Promotion Questions 1. A child who has attentiondeficit/ hyperactivity disorder (ADHD) has difficulty stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the selfregulation component of MM. emotional control. NN. flexibility. Correct OO. inhibition. PP. problemsolving. 2. The primary care pediatric nurse practitioner cares for a preschoolage child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. This child most likely has a disorder of PP. executive function. Correct QQ. information processing. RR. sensory processing. SS. social cognition. 3. The primary care pediatric nurse practitioner uses the Neurodevelopmental Learning Framework to assess cognition and learning in an adolescent. When evaluating social cognition, the nurse practitioner will ask the adolescent NN. about friends and activities at school. Correct OO. if balancing sports and homework is difficult. PP. to interpret material from a pie chart. QQ. to restate the content of something just read. 4. The primary care pediatric nurse practitioner is evaluating a schoolage child who has been diagnosed with ADHD. Which plan will the nurse practitioner recommend asking the child’s school about to help with academic performance? A. 504 Correct TTT. FAPE UUU. IDEA VVV. IEP . . . . . 5. The parent of a child diagnosed with ADHD tells the primary care pediatric . nurse practitioner that the child gets overwhelmed by homework assignments, doesn’t seem to know which ones to do first, and then doesn’t do any assignments. T he nurse practitioner tells the parent that this represents impairment in which executive function? A. Activation Correct HH. Effort II. Emotion JJ. Focus 6. The primary care pediatric nurse practitioner is considering medication options for a schoolage child recently diagnosed with ADHD who has a primarily hyperactive presentation. Which medication will the nurse practitioner select initially? A. Lowdos e stimulant B. Moderatedose stimulant Correct W. A lowdose stimulant medication X. A nonstimulant medication Y. Behavioral therapy only D. Cardiovascular prescreening Correct 12. The primary care pediatric nurse practitioner is conducting a followup examination on a child who has recently begun taking a lowdose stimulant medication to treat ADHD. The child’s school performance and home behaviors have improved. The child’s parent reports noticing a few tics, such a twitching of the eyelids, but the child is unaware of them and isn’t bothered by them. What will the nurse practitioner recommend? Q. Adding an alphaagonist medication R. Changing to a nonstimulant medication C. Continuing the medication as prescribed Correct I. Stopping the medication immediately . . . . Continue . Chapter 16. Breastfeeding Questions 1. The primary care pediatric nurse practitioner provides anticipatory guidance for a 6monthold infant who is breastfed who takes 400 IU of vitamin D daily. The parent reports that the infant has begun taking cereals, fruits, and vegetables in addition to nursing. What will the nurse practitioner recommend to promote healthy nutrition? QQ. Begin supplementing with iron. RR. Continue to nurse as long as desired. Correct SS. Discontinue the vitamin D supplement. TT. Stop breastfeeding at 1 year of age. 2. The parent of a toddler tells the primary care pediatric nurse practitioner that the family has adopted a plantbased diet and the child is receiving rice and almond milk instead of cow’s milk. The nurse practitioner will counsel the parents about TT. calcium deficiency. UU. excess caloric intake. VV. excess fat intake. WW. protein deficiency. Correct 3. The parent of a 12monthold infant asks the primary care pediatric nurse practitioner why 2% cow’s milk is recommended instead of whole milk. What will the nurse practitioner tell this parent? RR. Whole milk is usually not fortified with vitamin D. SS. 2% milk is higher in essential proteins and minerals. TT. Young children don’t need the extra calories found in whole milk. UU. Younger children need a limited amount of fats. Correct 4. The primary care pediatric nurse practitioner sees a 3yearold child whose parents report is a picky eater in spite of their continued efforts to provide nutritious meals. The parents ask whether a multivitamin is necessary. How will the nurse practitioner respond? WWW. Ask the parents to provide a 3day food diary. Correct XXX. Prescribe a daily multivitamin with iron. YYY. Reinforce the need to meet DRIs each day. ZZZ. Tell them that supplements are unnecessary 5. The primary care pediatric nurse practitioner is examining a toddler who is below . 13348422916 the 3rd percentile for weight even though the parents claim that the child eats “constantly.” What will the nurse practitioner do initially? KK. Evaluate the child’s feeding and elimination behaviors and ask the family to describe mealtime routines. Correct LL. Recommend giving a multivitamin and offering highcalorie foods, such as ice cream. MM. Refer the child to a feeding evaluation clinic for a swallow study and evaluation of possible GERD. NN. Suggest that the parents supplement the child’s food intake with a Highcalorie formula. 6. The mother of a 6yearold child tells the primary care pediatric nurse practitioner that the child only wants to eat French fries and hamburgers and refuses most vegetables. What will the nurse practitioner recommend? Z. Giving the child a multivitamin since this is a phase AA. Having the child eat vegetables before getting the hamburger C. Providing a variety of healthy foods at each meal Correct D.Putting extra lettuce and tomatoes on hamburgers 7 . The parents of a toddler tell the primary care pediatric nurse practitioner that they get frustrated trying to get the child to eat any vegetables other than squash and carrots. What will the nurse practitioner recommend? GG. Continue to offer a variety of foods without forcing the child to eat them. Correct HH. Offer snacks to make up for calories the child misses by not eating the vegetables. II. Prepare dishes the child likes to ensure that a vegetable is eaten at each meal. PP. Maternal cholesterol levels affect the cardiovascular risk of breastfed babies. QQ. Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol values. Correct RR. She should limit her dietary cholesterol to prevent hyperlipidemia in her infant. 6. The primary care pediatric nurse practitioner is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the nurse practitioner recommend? BB. Fatsoluble vitamins CC. Iron DD. Multivitamins with iron D. Vitamin D Correct 7. The primary care pediatric nurse practitioner is examining a newborn who is breastfeeding and notes the presence of an ankyloglossia. What will the nurse practitioner do next? KK. Ask the mother if the infant has any feeding difficulties. Correct LL. Refer the infant for a possible frenulectomy. MM. Schedule an appointment with a lactation consultant. NN. Suggest that the mother feed breast milk by bottle. 8. The primary care pediatric nurse practitioner performs an initial well baby exam on a 1weekold infant who is breastfeeding and who is at birth weight. The mother tells the nurse practitioner that her baby is already sleeping 5 or 6 hours at night. What will the nurse practitioner recommend? OO. Consultation with a lactation specialist to assess intake PP. Pumping her breast during the night to maintain milk supply QQ. Supplementing the last feeding of the day with formula D. Waking the infant up at least every 3 hours to nurse Correct 9. The mother of a newborn infant asks the primary care pediatric nurse practitioner about pumping her breasts when she returns to work in 2 months. What will the nurse practitioner include in teaching this mother? A. Frozen breast milk may be stored up to 3 months in a 0° F freezer. Correct HH. Once she begins pumping the infant should drink only pumped breast milk. II. Pumped breast milk must be discarded after 3 days when stored in the refrigerator. JJ. Unused defrosted breast milk may be stored in the refrigerator for 48 hours. 10. The mother of a 2monthold infant tells the primary c are pediatric nurse practitioner that she is afraid her breast milk is “drying up” because her baby never seems satisfied and wants to nurse all the time. Which action is correct? HH. Recommend pumping her breasts after feedings. II. Refer the mother to a lactation consultant. JJ. Suggest supplementation with formula. KK. Weigh the infant to assess for a growth spurt. Correct 11. The mother of a 15monthold infant tells the primary care pediatric nurse practitioner that she wishes to continue nursing her child for another year, if possible. What will the nurse practitioner recommend? DD. Breastfeed only at bedtime to establish meal patterns. EE. Clean the toddler’s teeth each time after breastfeeding. Correct FF. Offer the breast just prior to meals to maintain milk supply. GG. The toddler should continue to be breastfed “on demand.” 12. The primary care pediatric nurse practitioner is performing an assessment on a 1weekold newborn with a slightly elevated bilirubin who is breastfeeding well and who has gained 30 grams in the past 24 hours. The infant is stooling and voiding well. The nurse practitioner suspects breast milk jaundice. Which action is correct? W. Order home phototherapy and closely monitor bilirubin levels. X. Reassure the mother that the bilirubin level will drop in a few days. Y. Recheck the serum bilirubin and infant’s weight in 24 hours. Correct Z. Recommend that the mother pump her breast milk for a couple of days. Chapter 18. Elimination Questions 1. The primary care pediatric nurse practitioner is performing a well child exam on a 4monthold infant who is nursing exclusively. The mother reports that the infant has had a marked decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every other day. How will the nurse practitioner respond? YY. Ask the mother to describe the color and consistency of the stools. Correct ZZ. Explain to the mother that breastfed infants should have daily stools. AAA. Recommend using a glycerin suppository as needed. BBB. Suggest to the mother that she increase her intake of fluids. 2. The primary care pediatric nurse practitioner is performing a well child exam on a 12monthold infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent? BBB. It is too early to begin introducing the child to the toilet, and the parent should wait until the child is at least 2 years old. CCC. Placing the child on a “potty” chair helps the child associate elimination cues with the toilet. Correct DDD. Predictability of elimination patterns indicates readiness for toilet training, and the parent can begin this process. EEE. The parent should wait until other signs of toilet training 7. The parent of a 5yearold child tells the primary care pediatric nurse practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in “pullups.” The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend? OO. Providing a reward system to offer incentives when the child uses the toilet PP. Put the child back in diapers and resume toilet training in a few months. QQ. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation Correct RR. Use of polyethylene glycol until the child is able to use the toilet regularly . . . . 8. The primary care pediatric nurse practitioner evaluates a 4yearold girl . whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially? A. Examination for labial adhesions Correct RR. Palpation for abdominal masses SS. Screening for potential child abuse TT. Urine culture and sensitivity 9. The primary care pediatric nurse practitioner is co ncerned that a toddler may have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of urinary tract infections. Which intervention is appropriate? KK. Initiating a bladder retraining program LL. Ordering a voiding cystourethrogram C. Referral to a urologist for evaluation Correct D. Treatment with prophylactic antibiotics 10. The primary care pediatric nurse practitioner is evaluating a 4yearold female child for enuresis. The parents reports that the child has never been dry at night and has recently begun having daytime incontinence, usually when at preschool. The nurse practitioner learns that the child does not appear to have an abnormal urine stream. What will the nurse practitioner do next? LL. Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis. Correct MM. Reassure the parent that the child probably gets distracted and puts off voiding until it is urgent. NN. Refer the child to a pediatric urologist for evaluation of possible vesicoureteral reflux. OO. Suggest a bladder retraining program and use of a nighttime bedwetting alarm. 11. The primary care pediatric nurse practitioner is counseling the parent of an 8yearold child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent? HH. Anticholinergic medications are most commonly used for enuresis. II. Drug therapy is an effective way to achieve longterm control. JJ. Drug therapy is safest when the nasal spray form is used. KK. The combination of alarm therapy and intermittent drug therapy is best. Correct . Chapter 19. Physical Activity and Sports Questions 1. The primary care pediatric nurse practitioner counseling the parent of an overweight schoolage child about improving overall fitness. What will the nurse practitioner include? CCC. Encourage the child to begin by engaging in swimming or cycling. Correct DDD. Exercise will help lower total cholesterol and lowdensity lipoproteins. EEE. Schoolage children need 60 minutes of moderate exercise daily. FFF. Strength training exercises are not safe for schoolage children. 2. The parent of a child who has asthma asks the primary care pediatric nurse practitioner about whether the child may engage in strenuous exercise. What will the nurse practitioner tell the parent? FFF. Children with asthma should be excluded from vigorous exercise and most strenuous sports. GGG. Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity. Correct HHH. Physical activity has been shown to improve overall pulmonary function in children with asthma. III. Vigorous exercise helps improve symptoms in children with poorly controlled asthma. 3. The primary care pediatric nurse practitioner is discussing lifestyle changes with an adolescent who has hypertension. What will the nurse practitioner recommend about exercise for this client? A.Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure Correct M. Children with SCT should not participate in organized sports. . 13. The parent of a child newly diagnosed with epilepsy a sks the primary care pediatric nurse practitioner if the child will ever be able to participate in gym or sports. What will the nurse practitioner recommend? C. Bicycle riding is not safe for children with seizures. D. Contact sports should be avoided. E. Direct supervision of some activities is necessary. Correct F.Underwater sports are not recommended. 14. The primary care pediatric nurse practitioner diagnoses a high school basketball player with mononucleosis. The adolescent asks when she may resume play. What will the nurse practitioner tell her? B. After 3 weeks, she may begin lifting weights but not full sports. C. After 4 weeks, she may return to full play and practice. D. At 4 weeks, she must have an exam to determine fitness for play. Correct E. She may engage in moderate exertion and practice after 3 weeks. 15. A 12yearold child who plays soccer is diagnosed with vocal cord dysfunction. What will the primary care nurse practitioner say when the child’s parents ask about continued sports participation? A. The child may continue to participate in soccer. Correct B. The child should limit activity to nonaerobic sports. C. This condition is a contraindication for all sports. D . This condition predisposes the child to sudden cardiac death. 16. The parent of a high school basketball player tells the primary care pediatric nurse practitioner that the adolescent becomes short of breath only when exercising. What will the nurse practitioner recommend? A. Permanent discontinuation of all strenuous and aerobic activities B. Enrollment in a conditioning program to improve performance C. Evaluation for underlying cardiac causes of this symptom Correct D.Treatment for exerciseinduced asthma with a bronchodilator 17. A 10yearold is hit in the head with a baseball during practice and is diagnosed with concussion, even though no loss of consciousness occurred. The primary care pediatric nurse practitioner is evaluating the child 2 weeks after the injury and learns that the child is still experiencing some sleepiness every day. The neurological exam is normal. The child and the parent are adamant that the child be allowed to return to play baseball. What will the nurse practitioner recommend? A. Continuation of cognitive rest only B. Continuation of physical and cognitive rest Correct A. Continuation of physical rest only B. Returning to play of sleep per day is optimal for this infant? EEE. 10 to 12 hours FFF. 12 to 15 hours C. 15 to 18 hours Correct D. 18 to 20 hours 4. The primary care pediatric nurse practitioner is counseling a new parent about ways to reduce the risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing SIDS? UUUU. Bedsharing with infants greatly increases the risk of SIDS. Correct VVVV. Breastfeeding does not appear to have any influence on SIDS risk. WWWW. Infants who attend day care have a higher than usual incidence of SIDS. XXXX. There is no difference in SIDS rates in immunized versus nonimmunized infants. . 5. The primary care pediatric nurse practitioner is counseling the parents of a toddler about sleep. The parents report that the toddler has recently begun resisting sleep and is often more irritable during the day. What will the nurse practitioner recommend? XX. Cosleeping with the child to help alleviate possible nighttime fears YY. Referral to a sleep disorders clinic for evaluation of sleepdisordered breathing ZZ. Reintroducing a second, morning nap time to compensate for lost sleep D. Understanding that sleep resistance is a common developmental problem Correct 6. The parent of a 3yearold child tells the primary care pediatric nurse practitioner that the child has never been able to fall asleep without a parent in the room. The child has a new sibling and the parent is concerned that the toddler’s cries will awaken the infant. What will the nurse practitioner counsel the parent? A.Leaving the room as the child is falling asleep and returning at intervals to check on the child Correct LL. Offering a reward for each night the child falls asleep without the parent in the room MM. Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors NN. Taking away a favorite activity or video for each night the child fusses about the parent not being in the room 7. The parent of a 4yearold who has difficulty initiating and maintaining sleep has tried several nonpharmacological methods with variable success and asks about medications. What will the primary care pediatric nurse practitioner recommend? VV. Diphenhydramine WW. Lorazepam C. Melatonin Correct D. Zolpidem 8. The parent of a 3yearold child tells the primary care pediatric nurse practitioner that after falling asleep in the living room and being awakened to go to bed one evening, the child appeared confused and disoriented for a period of time. What will the nurse practitioner counsel this parent? EEE. That if this occurs again, to question the child about nightmares FFF. That this is a sign of sleep walking and could be dangerous GGG. That this is a type of sleep terror which will resolve over time D. That this is probably a benign, temporary type of a sleep disorder Correct . 9. During a well child examination, the primary care pediatric nurse practitioner learns that a 5yearold child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with open eyes, and saying things that don’t make sense. What will the nurse practitioner recommend? A. Establishing a graduated extinction program and good sleep hygiene B. Making sure that stairs are blocked and doors are locked Correct OO. Referral to a sleep disorder clinic for evaluation of a parasomnia PP. To awaken the child when these occur and asking about nightmares 10. The parent of a schoolage child tells the primary care pediatric nurse practitioner that the child is restless most nights and complains often that bugs are in the bed. After consultation with a sleep disorder specialist and subsequent evaluation of a ferritin level of 30, the nurse practitioner may expect to treat this child with SS. clonazepam. TT. ferrous sulfate. Correct UU. gabapentin. VV. sertraline. 11. An adolescent exhibits mild depressive symptoms and tells the primary care pediatric nurse practitioner that he is most concerned about difficulty falling and staying asleep. The adolescent does not want to take medication to treat the depressive symptoms. What will the nurse practitioner recommend? A. A program of sleep hygiene and gradual sleep extension Correct OO. A sedativenarcotic will help both sleep and depression PP. Cognitive therapy can help the adolescent to sleep better QQ. Using an antidepressant will improve sleep patterns 12. A child with Down syndrome who has sleepdisordered breathing with obstructive sleep apnea continues to have symptoms in spite of tonsillectomy and Correct AAA. Material about the human papillomavirus vaccine BBB. Sexual orientation and the nature of sexual relationships . 5. The primary care pediatric nurse practitioner is co unseling the parents of a 13yearold female who has Down syndrome about sexual maturation. What will the nurse practitioner tell these parents? OO. It is important to discuss and support healthy sexuality. Correct PP. Providing too much information about sexuality may be confusing given the child’s cognitive level of understanding. QQ. Suppressing periods with contraceptives will lessen their daughter’s distress. RR. They should give her information about periods but not about sexuality. 6 . During a well child exam on a 13yearold female, the primary care pediatric nurse practitioner notes that the child is at Tanner Stage 3. During the exam, when the nurse practitioner initiates a conversation about healthy sexuality education, the parent states that this topic is “off limits.” What will the nurse practitioner do? XX. Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult. YY. Separate the parent from the adolescent to discuss the adolescent’s concerns in private. ZZ. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors. Correct AAA. Tell the parent that this information is a routine part of adolescent well child examinations and must be included. 7. During a well child examination, a 15yearold female tells the primary care pediatric nurse practitioner that some of her friends have begun having sex. She has a boyfriend but denies engaging in sex with him. What will the nurse practitioner do initially? HHH. Ask her for her definitions of “sex.” Correct III. Discuss the risks of sexually transmitted diseases. JJJ. Find out if she is considering sexual relations. KKK. Give her information about contraception. 8. During a well child examination of a 6yearold girl, the primary care pediatric nurse practitioner notes that the child becomes embarrassed and resists taking off her underwear for the exam. What should the nurse practitioner infer from this observation? QQ. The child has been sexually molested. RR. The child is feeling violated by the examiner. SS. The parent is exhibiting regressive behavior. TT. This is a normal reaction in a child of this age. Correct . 9. The primary care pediatric nurse practitioner is providing anticipatory guidance to the parent of a schoolage boy. The parent expresses concerns that the child prefers to play with dolls, is worried that the child will be a homosexual, and asks what can be done to prevent this from happening. What will the nurse practitioner tell this parent? WW. Homosexual identity formation cannot be predicted by early childhood behavior. XX. Masculinizing boys from an early age helps to determine heterosexual orientation. YY. Sexual orientation identification begins late in adolescence and not in childhood. ZZ. The development of sexual orientation is generally a multifaceted process. Correct Chapter 22. Immunizations Questions 1. A 2monthold infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis? A.Day care attendance B. Immunization history Correct OOO. Medication history PPP. Past medical history 2. When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated? OOO. Bands PPP. Leukocytes C. Lymphocytes Correct D. Neutrophils 3. Which lab value is most concerning in an infant with fever and a suspected bacterial infection? A. Creactive protein of 11.5 mg/L Correct JJJ. Lymphocyte count of 8.7 KKK. Platelet count of 475 LLL. White blood cell count of 14 4. A toddler is receiving longterm antibiotics to treat osteomyelitis. Which laboratory test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child? A. Blood cultures B. Erythrocyte sedimentation rate (ESR) Correct HHHHH. Serum procalcitonin (ProCT) IIIII. White blood count (WBC) . . . 133484287 77 . . 10. The primary care pediatric nurse practitioner is performing an initial well child exam on a 3yearold child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do? WW. Administer a booster dose of each vaccine to ensure immunity. XX. Find out whether the vaccines were provided by reliable suppliers. YY. Perform antibody titers and reimmunize the child. Correct ZZ. Record the vaccines in the child’s electronic medical record. 11. The primary care pediatric nurse practitioner reviews the immunization records of an 18monthold child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do? AAA. Administer a reduced dose of MMR to ensure adequate immunity. BBB. Obtain mumps, measles, and rubella titers to determine immunity. CCC. Recommend the next dose of MMR vaccine at 4 to 5 years of age. Correct DDD. Repeat the MMR vaccine since the first dose was given too soon 12. A 5yearold child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given? A. DTaP Correct RR. DTP SS. Td TT. Tdap 13. An adolescent female who is sexually active and who has not had the HPV vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her? GG. Getting the vaccine now will still protect her from HPV oncogenic types even if already exposed HH. Receiving the HPV vaccine series will replace the need for regular cervical cancer screening II. She will need to have Papanicolaou and pregnancy screening prior to receiving the vaccine JJ. The vaccine will not protect her from any HPV oncogenic types acquired previously Correct 14. An 18monthold child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered? A. PCV7 B. PCV13 Correct X. PCV23 Y. PCV33 . 15. A 5yearold child who received VariZIG after exposure to varicella while immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child? A. MMR and Tdap B. MMR, Varivax, Tdap Correct G. Tdap only H. Varivax and Tdap 16. A 3yearold child who attends day care has had a fever, nausea, and vomiting several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child? F. HAV vaccine G. Immunoglobulin G H. Interferonalfa D. Supportive care Correct 17. A 10monthold infant who is new to the clinic has chronic hepatitis B infection. What will the primary care pediatric nurse practitioner do to manage this infant’s disease? E. Consult a pediatric infectious disease specialist. Correct F. Prescribe interferonalfa. G. Provide supportive care. H.Consider use of lamivudine. 18. The primary care pediatric nurse practitioner performs a well child examination on a 1monthold. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care? C. Obtain regular absolute neutrophil counts. Correct D. Perform routine skin cultures for herpes simplex virus. E. Reinforce the need to give acyclovir indefinitely. F.Stop the oral acyclovir at 2 months of age. . 19. A 9monthold infant has had a fever of 103°F for 2 days and now has a diffuse, maculopapular rash that blanches on pressure. The infant’s immunizations are uptodate. F. Teach the parents which signs and symptoms to report. Correct 29. A 10monthold infant has an erythematous, fluctuant, nondraining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care? A. Consultation with a pediatric infectious disease specialist B. Culture of any superficial open surface wounds C. Empiric treatment with clindamycin D. Incision and drainage of the abscess with culture Correct 30. A child with a history of a pustular rash at the site of a cat scratch on one arm now has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do? A. Obtain a complete blood count and Creactive protein. B. Order an immunofluorescent assay (IFA) for serum antibodies. Correct C. Perform a needle aspiration of the affected lymph nodes. D . Prescribe a 5daycourse of azithromycin. 31. A 7yearold child whose immunizations are uptodate has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated? A. Empiric treatment with oral antibiotics or intramuscular ceftriaxone B. Hospitalization for diagnosis and treatment with antibiotics Correct C. Immediate vaccination with meningococcal vaccine D. Outpatient lab work, including a CBC and blood and CSF cultures C. 32. A schoolage child has fever of 104°F, sore throat, vomiting and malaise. The primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaperlike rash on the child’s neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness? A. Administer intramuscular ceftriaxone. B. Hospitalize for further diagnostic tests. C. Prescribe oral amoxicillin. Correct D. Refer to a pediatric infectious disease specialist. 33. An adolescent has a TB skin test prior to working as a volunteer in a hospital. The adolescent is healthy and has not travelled to or from a TBendemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do? A. Ask the adolescent about exposure to homeless persons. B. Order a chest radiograph to rule out active TB. C. Reassure the adolescent that this is a negative screen. Correct D. Refer the adolescent to an infectious disease specialist. 34. The primary care pediatric nurse practitioner is examining a 2monthold infant with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step? A. Admitting the infant to the hospital for LP and IV antibiotics B. Obtaining a blood culture, erythrocyte sedimentation rate, and Creactive protein C. Performing a catheterized urinalysis to screen for leukocytes and nitrites Correct D.Prescribing empiric, broadspectrum antibiotics with close followup Chapter 23. Dental Health and Oral Disorders Questions 1. A 9monthold infant has developed two teeth since the 6month checkup. The local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to promote healthy dentition at this visit? QQQ. Apply sodium fluoride varnish to the infant’s teeth. Correct RRR. Encourage the parents to make an initial dental appointment. SSS. Prescribe oral fluoride supplementation. TTT. Teach the parents how to brush the infant’s teeth with fluoride toothpaste. 2. What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures? QQQ. Administer oral ibuprofen or apply topical salicylates. RRR. Apply a topical anesthetic such a benzocaine to the gums. SSS. Give the infant a cold teething ring or wet washcloth to chew. Correct TTT. Try Baby Orajel on the infant’s gums several times daily. 3. An 18monthold child has horizontal, bright white lines along the upper gum line of the teeth. What is the most important question the primary care pediatric nurse practitioner will ask the child’s parents? A. If the child is still drinking milk from a bottle Correct MMM. If the child or the parents are brushing the teeth NNN. If they are brushing the child’s teeth twice daily OOO. If they have taken the child to a dentist 4. A 4yearold child who has had extensive dental surgery to treat dental caries has white spot lesions on the primary teeth. How often should this child receive fluoride varnish applications? JJJJJ. Annually KKKKK. Twice yearly C. Every 3 to 6 months Correct D. Every month 11. During a well child exam, the primary care pediatric nurse practitioner notes yellowishwhite serpentinebordered lesions on the anterior portion of a child’s tongue. What will the nurse practitioner do? UU. Order chlorhexidine gluconate rinses to treat the lesions. VV. Prescribe oral acyclovir to shorten the course of the disease. WW. Reassure the parent that these are benign lesions. Correct XX. Refer the child to a pediatric dentist for evaluation. 12. A 4yearold child who has asthma has teeth with smooth, cuppedout teeth on the chewing surfaces. Which is the most likely explanation for this finding? KK. Bruxism LL. Bulimia MM. Decreased saliva D. Gastroesophageal reflux Correct 13. An adolescent female reports facial pain and frequent popping of her jaw. An exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do? JJ. Recommend ice packs, NSAIDs, and a soft diet. Correct KK. Refer to a pediatric mental health specialist. LL. Refer to an orthodontist for a surgical intervention. MM. Suggest obtaining Botox injection treatments. 14. A 5yearold child is hit in the face with a baseball bat and is brought to the clinic by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment? I. Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days. J. Refer the child to a dentist for reimplantation of the avulsed teeth. K. Refer the child to a dentist immediately for further examination. Correct L. Remove the teeth, place them in saline, and refer the child to a dentist. . 15. A child with cerebral palsy receives all nutrition via gastrostomy t ube. What will the primary care pediatric nurse practitioner recommend to promote dental health in this child? A. Applying topical iodine every month B. Daily chlorhexidine gluconate rinses Correct I. Ordering medications to prevent drooling J. Prescribing prophylactic antibiotics Chapter 24. Intentional and Unintentional Injuries: Injury Prevention Child Maltreatment 1.Which of the following statements best defines the term child maltreatment? a. intentional injury of a child c. failure to provide what a child needs b. not giving a child what he or she wants d. accidental harm to a child by someone ANS: A 2.Which of the following statements best defines the term physical abuse? a. bodily injury to a person that seems to have been inflicted by other than accidental means b. purposefully beating a child so that there are highly visible marks on the childs body c. use of the hands applied to a child in an excessively forceful manner d. any damage to a child that involves the use of muscle- applied force ANS: A 3.The school nurse observes parents interacting with a school-aged child and notices that they do not show any affection toward the child and there is no evidence of emotional support or supervision. Later the nurse learns from the child that he must take care of all his own hygiene tasks, has to find something to eat on his own, and his parents never say anything nice about him. The nurse at this point believes that the parents are engaging in: a. physical abuse c. poor parenting b. psychological abuse d. withholding of love ANS: B 4.The majority of perpetrators of abuse to children reported to state Child Protective Service agencies as suspected victims of abuse and neglect are: a. neighbors within one block c. parents b. strangers d. relatives other than parents ANS: C MN . . . 5.The majority of child abuse victims fall into which of the following age ranges? a. over 10 years c. 6 to 8 years b. 8 to 10 years d. under 6 years ANS: D 6.Which of the following is the most common type of mistreatment of children? a. physical abuse c. sexual abuse b. neglect d. emotional maltreatment ANS: B 7. In the sociological model of family violence, family violence is viewed as: a. a pattern of behavior that is passed from generation to generation b. a pattern of harm within the nuclear family with no outside persons involved c. any harmful action(s) between related persons no matter how distant the relationship is d. harmful activities within a group designated as family no matter what the relationship ANS: A 8.When family violence is passed from generation to generation, this type of abuse has which of the following characteristics? a. It continues without changing to another type. b. The form of abuse may change. c. It usually gets more violent. d. It is more detrimental to the child from generation to generation. ANS: B 9.Which of the following children is in a high-risk family for less nurturing and more hurtful behavior? a. a child being raised by grandparents b. a child who is forbidden from playing with other children c. a child being raised by two men d. a child in a nuclear family there both parents have full- time jobs ANS: B 10.The social-interactional systemic perspective of child abuse and neglect says that the legitimization of violence in the family is due to which of the following factors? a. family pathology of a genetic nature b. increased availability of pornography c. emphasis on hiding sexuality and not being open d. societys attitudes, beliefs, and values ANS: D 11.According to the social-interactional systemic perspective of child abuse and neglect, four factors place the family members at risk for abuse. These risk factors are the family itself, the caregiver, the child, and: a. chronic poverty c. the presence of a family crisis b. genetics d. the national emphasis on sex ANS: C 12.When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally immature, the child often assumes which of the following roles? a. victim b. caregiver role toward the caregiver c. regressed child of regressed caregivers d. scapego at ANS: B 13. Which of the following examples best defines the term role reversal? a. The child assumes a caregiver role toward the caregiver. b. The good child takes on a bad child role. c. A person who has been a good provider quits his or her job. d. A lazy person becomes very productive in the family. ANS: A 14.When there is a depressed parent in the family, it is most likely that the depression will have which of the following effects? a. will not affect the persons ability or performance in parenting b. will cause the parent who is depressed to try harder to be a good parent c. places the parent at risk for physically or emotionally abusing the children d. will be seen in the child during the growing-up years ANS: C inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child’s family at this visit? A. An asthma action plan B. Effects and side effects of current medications Correct UUU. Information about spirometry testing VVV. Instructions for medications at school 3. The parent of a child with complex health care needs tells the primary care pediatric nurse practitioner that the child has had difficulty breathing the past two nights but can’t articulate specific symptoms. The child has normal oxygen saturations and a normal respiratory rate with clear breath sounds. What will the nurse practitioner do? PPP. Admit the child to the hospital for close observation and monitoring of respiratory status. QQQ. Encourage the parent to call when concerned and schedule a followup appointment the next day. Correct RRR. Perform a complete blood count, blood cultures, and a chest radiograph to evaluate symptoms. SSS. Reassure the parent that the child has a normal exam and is most likely not ill. 4. Which characteristic is the key criterion that identifies a child has having special needs? A. Cognitive function B. Emotional health C. Health service requirements Correct D. Medical diagnosis . 5. The primary care pediatric nurse practitioner is performing a well baby examination on a 2weekold infant who was recently discharged home from the neonatal intensive care unit. The mother reports that the infant was born at 26 weeks’ gestation and states she was told that her baby will probably have developmental delays. What is the most important aspect of longterm management for this infant? A. Careful monitoring of attainment of developmental milestones Correct LLLLL. Familiarizing the parent with laws that mandate educational support MMMMM. Providing genetic counseling to the infant’s parents NNNNN. Referral to social services for assistance with resources 6. The primary care pediatric nurse practitioner is preparing to perform a well child examination on a 5yearold child who has multiple developmental and cognitive delays. The child’s mother is angry and tells the nurse practitioner that her friends’ children are all preparing for kindergarten. The nurse practitioner will QQQ. allow the mother to express her feelings, understanding that she is experiencing grief. Correct RRR. reassure the mother that special educational opportunities are available for her child. SSS. suggest that the mother find a support group with other children with special needs. TTT. tell her that most schools provide services for children with special health care needs. 7. The parent of a toddler who has special health care needs is resistant to a suggestion that her child needs a gastrostomy tube for nutrition. The toddler has fallen from the 10th percentile to the 5th percentile in the past few months and resists taking in appropriate amounts of food by mouth even with assistance from occupational therapy. What will the primary care pediatric nurse practitioner do? YY. Inform the mother that, since other options have failed, the gastrostomy tube is the only option. ZZ. Refer the child to a dietician to teach the mother the importance of adequate nutrition. AAA. Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight. Correct BBB. Suggest that the gastrostomy tube may be tried temporarily and removed once the child gains weight. 8 . What is the most important role of the primary care pediatric nurse practitioner who provides care for a child with special health care needs who sees several specialists and receives community and schoolbased services? A. Assessing the parent’s ability to perform home care tasks B. Coordinating services to ensure continuity of care Correct C. Monitoring the family’s adherence to the health care plan D. Ordering medications and other prescribed treatments 9. A toddler swallowed a coin several days prior. T he child’s parent has not found the coin in the child’s stool. Which imaging test will the primary care pediatric nurse practitioner employ to evaluate this ingestion? HHH. Abdominal ultrasound III. Computed tomography C. Conventional radiograph Correct D. Magnetic resonance imaging 10. The primary care pediatric nurse practitioner is assessing an ill 2monthold infant who is febrile and refusing most fluids. The preliminary blood work indicates a viral infection and shows that the infant is hydrated. The infant is alert. The infant’s parents are attentive and live close by. What will the nurse practitioner do? SSS. Administer a parenteral antibiotic and antipyretic and send the infant home. TTT. Admit the infant to an inpatient hospital unit for overnight monitoring. UUU. Give the parents sick care instructions and follow up in the clinic in the morning. Correct VVV. Send the infant to the urgent care center for intravenous fluids. 11. A toddler is prescribed a liquid oral medication. The parent tells the primary care pediatric nurse practitioner that the child refuses to take medications and usually spits them out. What will the nurse practitioner do? CCC. Demonstrate oral medication administration with the toddler in the office. Correct DDD. Instruct the parent to hide the medication in a favorite food or beverage. EEE. Order the medication to be given via another route if possible. FFF. Tell the parent to offer the child a reward each time the medication is taken. 12. The primary care pediatric nurse practitioner orders a pulmonology consult for a child who has severe asthma. The nurse practitioner writes “child with asthma refractory to conventional treatments needs suggestions for alternative treatments.” The nurse practitioner expects the pulmonologist to HHH. confirm the medical diagnosis for the child’s parents. III. make recommendations for disease management. Correct JJJ. stress the importance of adherence to the medication regimen. KKK. take over management of this child’s chronic illness. . 13. The primary care pediatric nurse practitioner c ares for several families with chronically ill children who text status updates about their children to a mobile device that has an encryptionprotection platform installed. If the nurse practitioner misplaces the mobile device, it is important to YY. disconnect the user from the system to avoid a data breach. Correct ZZ. notify the families that their messages may be read by others. AAA. obtain a new device as soon as possible to resume communication. BBB. upload the messages from another remote device. 14. The parent of an 18monthold child calls the clinic to report that the child has a rectal temperature of 100.4°F (38°C). The child is playing normally, taking fluids well, and has a slightly reduced appetite. What will the primary care pediatric nurse practitioner recommend? NN. Administering an antipyretic medication OO. Bringing the child to the clinic for evaluation C. Offering extra fluids and calling if symptoms change Correct D. Ordering outpatient lab work such as a CBC 15. The parent of a preschoolage child calls the clinic to report that the child has who attends day care tells the primary care pediatric nurse practitioner that she had difficulty giving her child a twicedaily amoxicillin for 10 days to treat otitis media during a previous episode several months earlier because she works two jobs and is too busy. The child has an ear infection in the clinic today. What will the nurse practitioner do? WWW. Administer an intramuscular antibiotic. XXX. Order twicedaily amoxicillin for 5 days. YYY. Prescribe azithromycin once daily for 5 days. Correct ZZZ. Reinforce the need to adhere to the plan of care. 8. The parent of a schoolage child who has asthma tells the primary care pediatric nurse practitioner that the child often comes home from school with severe wheezing after gym class and needs to use his metereddose inhaler right away. What will the nurse practitioner do? GGG. Recommend that the child go to the school nurse when symptoms start. HHH. Review the child’s asthma action plan and possibly increase his steroid dose. TTT. Suggest asking the school to excuse the child from gym class. UUU. Write the prescription for two metereddose inhalers with spacers.Correct Chapter 27. Complementary and Integrative Health in Pediatrics Questions 1. The primary care pediatric nurse practitioner is performing a medication history on a child and learns that the child’s parents use various complementary treatments and remedies for the child. According to the American Academy of Pediatrics standard for providers, what will the nurse practitioner do? CCCC. Evaluate the safety and efficacy of each product and monitor use. Correct DDDD. Incorporate these therapies into standard care practices. EEEE. Recommend not using the products until the child is older. FFFF. Suggest that most of these treatments are not safe for children. 2. According to the 2007 NHIS analysis of the use of CAM therapy, use was higher among AAAA. families whose parent or parents had a college education. Correct BBBB. Hispanic and AfricanAmerican populations. CCCC. persons who had not recently taken prescription medications. DDDD. those living in households earning less than $65,000. 3. The parent of a child who has numerous allergies reports using herbal remedies to help treat the child because they are “natural” products. What will the primary care pediatric nurse practitioner suggest to this parent about using these products? XXX. Brandname herbal products have been tested for efficacy. YYY. Natural ingredients are usually safe for use in children. ZZZ. There are few interactions between drugs and supplements. AAAA. Use singleherb supplements whenever possible. Correct 4. Which label on a CAM therapy product verifies that a product meets standards for contamination, adulteration, manufacturing processes, and pharmacologic properties? . YYYYY. Generally Recognized as Safe (GRAS) ZZZZZ. National Sanitation Foundation International (NSF) AAAAAA. Natural Products Association (NPA) D. United States Pharmacopeia (USP) Correct 5. The parent of a newborn reports using echinacea for family members to help treat viral illnesses and feels that it is usually effective. What will the primary care pediatric nurse practitioner tell this parent? A. That echinacea has no known therapeutic effects and should not be given . B. That the supplement should not be given to children under 2 years of age WWW. To give half the recommended adult dose until the child is 5 years old XXX. To wait until the infant is at least 1 month old before giving this product 6. A child has wheat allergies and continues to have problems in spite of consuming a diet without breads and cereals. What will the primary care pediatric nurse practitioner caution the parents to look for on product labels that may indicate wheat products are present in foods? A. Casein B. Malt Correct GGG. Miso HHH. Whey 7. An adolescent will begin taking the combination oral contraceptive pill (OCP). Which supplement will the primary care pediatric nurse practitioner caution the adolescent to avoid while taking OCPs? NNN. Ginkgo OOO. Kava C. St. John’s wort Correct D. Valerian Chapter 28. Pediatric Pain and Fever Management Questions 1. The primary care pediatric nurse practitioner is evaluating a 10yearold child who is describing shooting pain in both legs associated with aching, tingling, and burning. The child is unable to pinpoint specific locations for this pain. Which type of pain does the nurse practitioner suspect?