Pediatric Nurse Practitioner Exam Questions, Exams of Nursing

Download Pediatric Nurse Practitioner Exam Questions and more Exams Nursing in PDF only on Docsity! NURS 629 Ped chapter questions for all 4 test combined Maryville University 1. The primary care pediatric nurse practitioner performs a vision screen on a 4 month old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do? - Correct answer Refer the infant to a pediatric ophthalmologist. 2. During a well child exam on a 4yearold child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend? - Correct answer Test the child's vision in 1 month. Correct 3. During a well child assessment of an African American infant, the primary care pediatric nurse practitioner notes a dark red brown light reflex in the left eye and a slightly brighter, red orange light reflex in the right eye. The nurse practitioner will - Correct answer . refer the infant to an ophthalmologist 4. The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate - Correct answer ocular alignment. 5. The primary care pediatric nurse practitioner applies fluorescein stain to a child's eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate? - Correct answer There is too much stain on the cornea 6. A toddler exhibits exotropia of the right eye during a coveruncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment? - Correct answer Patching of the unaffected eye for 2 hours each day 7. The primary care pediatric nurse practitioner performs a well child examination on a 9monthold infant who has a history of prematurity at 28 weeks' gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam? - Correct answer At 12 months of age 8. During a wellbaby assessment on a 1weekold infant who had a normal examn when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis? - Correct answer Chlamydia trachomatis conjunctivitis 9. The primary care pediatric nurse practitioner performs a well baby assessment of a 5dayold infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct? - Correct answer Admit the infant to the hospital immediately. 14. A schoolage child has a history of chronic otitis media and is seen in the clinicmwith vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressureequalizing tubes and a pearlywhite lesion on one tympanic membrane. Which condition is most likely? - Correct answer Cholesteatoma the parent of a 4monthold infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant? - Correct answer Auditory brainstem response (ABR) 2. The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of 180 mm H 2 O. What does this value indicate? - Correct answer Negative ear pressure 13. A child who was treated with amoxicillin and then amoxicillinclavulanate for acute otitis media is seen for followup. The primary care pediatric nurse practitioner notes dullgray tympanic membranes with a visible airfluid level. The child is afebrile and without pain. What is the next course of action? - Correct answer Monitoring ear fluid levels for 3 months Correct 12. The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2 yearold child who has a history of three ear infections in the first 6 months of life. The child's tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child? - Correct answer An analgesic medication and watchful waiting an 18 month old child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H 2 O. What is the recommended treatment for this child? - Correct answer An analgesic medication and watchful waiting 4. A 7monthold infant has had two prior acute ear infections and is currently on the 10th day of therapy with amoxicillinclavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child's ear infection? - Correct answer Refer the child to an otolaryngologist. 8. A 3monthold infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, lowpitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely? - Correct answer Ventricular septal defect 9. An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect? - Correct answer Oxygen desaturation 10. A 9monthold infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect? - Correct answer Coil insertion in the catheterization laboratory A 5yearold child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do? - Correct answer Refer the child to the cardiologist immediately 7. A 6yearold child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child's blood pressure is classified as - Correct answer stage 1 hypertensive 12. The primary care pediatric nurse practitioner is performing a well child examination on a schoolage child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child's health maintenance regime? - Correct answer Cardiology clearance for sports participation 19. A 12yearold child whose BMI is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child? - Correct answer Referral to a nephrologist or cardiologist 13. The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend? - Correct answer Evaluation by a cardiologist prior to participation 18. A 12yearold child whose weight and BMI are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include - Correct answer renal function and plasma renin tests 16. An adolescent female has a history of repaired tetralogy of Fallot. Which long term complication is a concern for this patient? - Correct answer Mitral valve prolapse 15. A 5yearold child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition? - Correct answer Coarctation of the aorta 14. During a routine well child exam on a 5yearold child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect? - Correct answer Pulmonic stenosis In a respiratory disorder causing a checkvalve obstruction, which symptoms will be present? - Correct answer Air entry on inspiration with expiratory occlusion 5. A schoolage child has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefyred tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative. What is the next step in management for this child? - Correct answer Perform a followup throat culture 2. A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child? - Correct answer Wheezing 3. A 4yearold child with an upper respiratory tract infection has cloudy nasaldischarge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend? - Correct answer Saline rinses 4. A 5yearold child has enlarged tonsils and a history of four throat infections in the previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child's quality of sleep. The next step in managing this child's condition is to - Correct answer refer to a pulmonologist for polysomnography evaluation An adolescent has suspected infectious mononucleosis after exposure to the virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis? - Correct answer EBVspecific antibody testing 7. A schoolage child has had nasal discharge and daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child? - Correct answer Amoxicillin 45 mg/kg/day 8. After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment? - Correct answer Referral to a pediatric otolaryngologist 9. The parent of a toddler and a 4weekold infant tells the primary care pediatric nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant? - Correct answer Order azithromycin 10 mg/kg/day in a single dose daily for 5 days 10. A schoolage child has frequent nosebleeds. Nasal visualization reveals fresh clots and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action? - Correct answer Refer to an otolaryngologist for further evaluation 13. The primary care pediatric nurse practitioner evaluates a child who awoke with a sore throat and high fever after a nap. The child appears anxious and is sitting on the parent's lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next? - Correct answer Transport the child to the hospital via emergency medical services. A child is in the clinic because of symptoms of purulent, foulsmelling nasal discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child? - Correct answer Treat with antibiotics for urinary tract infection 3. A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child with dysuria and foulsmelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child? - Correct answer Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days 4. A preschoolage child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child? - Correct answer Order amoxicillin clavulanate 5. A 3yearold child has just completed a 7day course of amoxicillin for a secondfebrile urinary tract infection and currently has a negative urine culture. What is the next course of action? - Correct answer Obtain a renal and bladder ultrasound. A 9monthold infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed? - Correct answer TMPSMX; TMP 2 mg/kg as a single daily dose 12. A child who has nephrotic syndrome is on a steroids and a saltrestricted diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child's nephrologist, what is the correct course of treatment considering this finding? - Correct answer Continue with steroids and salt restrictions until the urine is negative for protein 13. A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals teacolored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition? - Correct answer Refer the child to a pediatric nephrologist for hospitalization. 16. A 6monthold infant has a retractile testis that was noted at the 2month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition? - Correct answer Refer the infant to a pediatric urologist or surgeon for possible orchiopexy 14. An adolescent has rightsided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition? - Correct answer Increasing fluid intake up to 2 L daily 15. During a well child examination of a 2yearold child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that? - Correct answer Refer the child to an oncologist immediately. 17. A 9monthold infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is difficult to reduce. What is the correct action? - Correct answer Refer immediately to a pediatric surgeon 18. The mother of a 12monthold uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do? - Correct answer Refer the child to a pediatric urologist. 19. An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren's sign). What will the nurse practitioner do? - Correct answer Refer the adolescent immediately to a pediatric urologist or surgeon 11. A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child's parents about this disease? - Correct answer "Steroids will be used when relapses occur." 7. The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent? - Correct answer That surgery to correct the condition is possible 9. A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely? - Correct answer HenochSchönlein purpura 10. An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition? - Correct answer Monitor for proteinuria at each annual well child examination. 8. A healthy 14yearold female has a dipstick urinalysis that is positive for 56 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient? - Correct answer "When was your last menstrual period (LMP)?" The primary care pediatric nurse practitioner is teaching a parent of a child with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in teaching? - Correct answer Have the child soak in a lukewarm water bath. 15. A schoolage child is brought to clinic after a pediculosis capitis infestation is reported at the child's school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp? - Correct answer Itching of the scalp, with skin excoriation on the back of the head 16. A 3yearold child has head lice. What will the initial treatment recommendation be to treat this child? - Correct answer Permethrin 17. A 9monthold infant has vesiculopustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and Sshaped burrow lesions on the parent's hands and wrists. What is the treatment for this rash for this infant? - Correct answer Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours 18. An adolescent has acne with lesions on the cheeks and under the chin.Which distribution is this? - Correct answer Hormonal 19. An adolescent has acne characterized by papules and pustules mostly on the forehead and chin. What will the primary care pediatric nurse practitioner prescribe? - Correct answer Topical erythromycin with benzoyl peroxide 20. A child has an area of inflammation on the neck that began after wearing a handknot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment? - Correct answer Topical corticosteroids applied 2 to 3 times daily 21. An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend? - Correct answer Daily application of ketoconazole 2% topical cream 22. A child is brought to the clinic with a generalized, annular rash characterized by raised wheals with pale centers. On physical examination, the child's lungs are clear 4. A preschool age child has honeycrusted lesions on erythematous, eroded skin around the nose and mouth, with satellite lesions on the arms and legs. The child's parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated? - Correct answer Amoxicillin clavulanate 90 mg/kg/day for 10 days 6. An adolescent who recently spent time in a hot tub while on vacation has discrete, erythematous 1 to 2mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition? - Correct answer Prescribe topical keratolytics and topical antibiotics 5. A child is brought to clinic with several bright red lesions on the buttocks. The primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an "orange peel" look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for these lesions? - Correct answer Initiate empiric antibiotic therapy and follow up in 24 hours to assess response. A schoolage child has a fractured wrist with a SalterHarris Type II fracture, according to the radiologist. What is true about this type of fracture? - Correct answer There is a metaphyseal fragment on the compression side of fracture. 2. What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip? - Correct answer Dislocation of an unstable hip 3. A 3yearold child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do? - Correct answer Gently attempt a supination and flexion technique 4. A schoolage child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed? - Correct answer Immobilization with a sling to support the affected extremity 5. A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do? - Correct answer Recommend NSAIDs, stretching exercises, and ice packs to the area. 6. A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? - Correct answer Discuss posture and exercise and ask about backpacks and books 7. The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6monthold infant not previously noted in the medical record. What is the correct treatment? - Correct answer Surgical intervention 8. A 14yearold boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition? - Correct answer Place the child on crutches or in a wheelchair to prevent weightbearing 9. A parent is concerned that a 12monthold child is "bowlegged." A physical examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the correct action for the primary care pediatric nurse practitioner? - Correct answer Refer to a pediatric orthopedic specialist for treatment 10. A child who plays soccer is in the clinic reporting pain and swelling in both knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition? - Correct answer Apply ice packs to both knees and avoid activities that cause pain. 11. During a well baby examination of a newborn, the primary care pediatric nurse practitioner notes adduction of the right forefoot, with normal position of the mid and hindfoot, along with a convexshaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity? - Correct answer Grasp the heel with one hand and abduct the forefoot with the other hand. An 8yearold child is diagnosed with systemic lupus erythematosus (SLE), and the child's parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell the parent? - Correct answer Periods of remission may occur but there is no permanent cure 5. The parent of a schoolage child who is diagnosed with oligoarticular JIA asks theprimary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend? - Correct answer Swimming 6. A 12yearold child is brought to the clinic with joint pain, a 3week history of low grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive. Which test may be ordered to confirm a diagnosis of SLE? - Correct answer Antidoublestrand DNA antibodies 7. The primary care pediatric nurse practitioner is reviewing the rheumatology plan of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes? - Correct answer Use UVA and UVB sunscreen daily. 8. An adolescent female reports poor sleep, fatigue, muscle and joint paint, and anxiety lasting for several months. The primary care pediatric nurse practitioner notes point tenderness at several sites. What will the nurse practitioner do next? - Correct answer Refer the adolescent to a rheumatologist for further evaluation. 9. A child has a fever and arthralgia. The primary care pediatric nurse practitioner learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order? - Correct answer ASO titer 10. The primary care pediatric nurse practitioner sees a child for followup care after hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child? - Correct answer Aspirin is given for 2 weeks and then tapered to discontinue the medication 11. An 8yearold boy has a recent history of an upper respiratory infection and comes to the clinic with a maculopapular rash on his lower extremities and swelling and tenderness in both ankles. The pediatric nurse practitioner performs a UA, which shows proteinuria and hematuria and diagnoses HSP. What ongoing evaluation will the nurse practitioner perform during the course of this disease? - Correct answer Blood pressure measurement 12. A 10yearold child has a 1week history of fever of 104°C that is unresponsive to antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do? - Correct answer Order a baseline echocardiogram today and another in 2 weeks 13. The primary care pediatric nurse practitioner is evaluating an 11monthold infant who has had three viral respiratory illnesses causing bronchiolitis. The child's parents both have amount the child will receive per dose? - Correct answer 250 mg The primary care pediatric nurse practitioner evaluates children's growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening? - Correct answer Obtaining serial measurements to assess patterns over time 8. An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and dehydration. Which action is correct? - Correct answer Refer the infant to the emergency department for fluids, dextrose, and steroids 9. The primary care pediatric nurse practitioner performs a physical examination on a 9monthold infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order? - Correct answer Free serum T4 and TSH levels 10. A 12yearold child has a recent history of increased thirst and frequent urination. ID: 13348407688 The child's weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child? - Correct answer Pancreatic antibodies 11. The primary care pediatric nurse practitioner diagnoses an 8yearold child with type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child's weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct? - Correct answer Begin insulin and refer the child to a children's diabetes center. 12. The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a schoolage child whose HbA 1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child's endocrinologist to consider which therapy? - Correct answer Continuous glucose monitoring 13. The primary care pediatric nurse practitioner is performing a well child examination on a 12yearold child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child? - Correct answer Comprehensive ophthalmologic exam 14. A 13yearold Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will - Correct answer order a fasting blood sample for a metabolic screen for type 2 diabetes. 15. The primary care pediatric nurse practitioner prescribes metformin for a 15year old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug? - Correct answer The importance of checking blood glucose 3 or 4 times daily 16. A 16yearold adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis? - Correct answer Polycystic ovary syndrome 17. The primary care pediatric nurse practitioner is providing nutritional counseling for a 9yearold female whose weight is at the 95th percentile for her age. What is the goal for this patient? - Correct answer Maintenance of her current weight 18. The primary care pediatric nurse practitioner notes a musty odor when examining ID: 13348411102 a newborn at a 2week checkup. What will the nurse practitioner suspect? - Correct answer Phenylketonuria 19. An initial key part of management of a child suspected of having an inborn error of metabolism is - Correct answer consulting a metabolic specialist 7. A 6yearold female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next? - Correct answer Refer the child to a pediatric endocrinologist for management. 2. The primary care pediatric nurse practitioner is performing a well child examination on a 5yearold girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5'8" tall and the father is 5'11" tall. The nurse practitioner will estimate which expected adult height for this child? - Correct answer 5'7" tall 3. The primary care pediatric nurse practitioner is performing a well child examination on a 2yearold child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do? - Correct answer Refer the child to a pediatric endocrinologist. 4. The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child's growth is consistent with bone age. Which diagnosis is most likely? - Correct answer Constitutional growth delay 5. The mother of a female infant is concerned that her daughter is developing ID: 13348411106 breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis? - Correct answer Premature thelarche which will resolve over time 6. A 7yearold female has recently developed pubic and axillary hair without breast development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition? - Correct answer Polycystic ovary syndrome During a well child examination on a 4monthold infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parentinfant relationship? - Correct answer B. "I let my baby cry a while to learn to be patient." 2. A child has a difficult temperament. What will the primary care pediatric nurse ID: 13348419824 practitioner tell the parent about managing this child's behavior? - Correct answer It is important for the parent to learn to manage criticism and power struggles 3. During a well child assessment of a preschoolage child, the parent voices concerns that, because the child has behavior problems at school, the child may have a mental health disorder. Which initial approach will provide the best information? - Correct answer . Take time to actively listen to the parent's and child's perceptions of the problem 4. The primary care pediatric nurse practitioner attempts to learn more about the ID: 13348419842 exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do? - Correct answer Engage the parent in positive parenting strategies to facilitate appropriate child coping. 19. A 14yearold female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect? - Correct answer Anorexia nervosa 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 - Correct answer flexibility 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 - Correct answer executive function. 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 - Correct answer about friends and activities at school 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? - Correct answer 504 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. The nurse practitioner tells the parent that this represents impairment in which executive function? - Correct answer activation 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? - Correct answer Moderatedose stimulant 7. The parent of a 4yearold child reports that the child gets upset when the hall light is left on at night and won't leave the house unless both shoes are tied equally tight. The primary care pediatric nurse practitioner recognizes that this child likely has which type of sensory processing disorder? - Correct answer Overresponder 8. The parent of a preschoolage child who is diagnosed with a sensory processing disorder (SPD) asks the primary care pediatric nurse practitioner how to help the child manage the symptoms. What will the nurse practitioner recommend? - Correct answer Maintaining predictable routines as much as possible 9. The primary care pediatric nurse practitioner is performing an examination on a 5yearold child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the nurse practitioner do first? - Correct answer Ask the parent to describe the child's earlier behaviors from infancy through preschool. 10. The primary care pediatric nurse practitioner is examining a 3yearold child who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the nurse practitioner suspect? - Correct answer Autism spectrum disorder 11. The primary care pediatric nurse practitioner is selecting a medication for a 12yearold child who is newly diagnosed with ADHD. The child is overweight, has a history of an atrial septal defect at birth, and reports mild shortness of breath during exercise. What will the nurse practitioner prescribe? - Correct answer Cardiovascular prescreening 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? - Correct answer Continuing the medication as prescribed The primary care pediatric nurse practitioner uses a shared decisionmaking (SDM) model when working with families of children with chronic health conditions. When using this model, the nurse practitioner can expect - Correct answer improved patient health outcomes 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? - Correct answer Encourage the parent to call when concerned and schedule a followup appointment the next day. 4. Which characteristic is the key criterion that identifies a child has having special needs? - Correct answer Health service requirements 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? - Correct answer Careful monitoring of attainment of developmental milestones 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 - Correct answer allow the mother to express her feelings, understanding that she is experiencing grief. 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? - Correct answer Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight. 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? - Correct answer Consult a pediatric infectious disease specialist. 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? - Correct answer Obtain regular absolute neutrophil counts. 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. What will the primary care pediatric nurse practitioner do? - Correct answer Reassure the parent that this is a mild, selflimiting disease. 20. A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do? - Correct answer Hospitalize the child for intravenous acyclovir. 21. A child whose parents have refused vaccines has been exposed to chickenpox, and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them? - Correct answer The child should stay home if any symptoms occur and may return in 1 week if no rash develops 22. An 18monthold child who developed upper respiratory symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do? - Correct answer Prescribe oseltamivir and follow closely 23. The primary care pediatric nurse practitioner is reviewing medical records for a newborn that is new to the clinic. The toddler's mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on antiretroviral prophylaxis, and did not breastfeed. What is the correct management for this child? - Correct answer Consult with a pediatric HIV specialist. 24. A 3yearold child whose immunizations are uptodate has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action? - Correct answer Administer the MMR vaccine to help prevent disease 25. A preschoolage child is brought to clinic for evaluation of a rash. The primary care pediatric nurse practitioner notes an intense red eruption on the child's cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash? - Correct answer Expect a lacy, maculopapular rash to develop on the trunk and extremities. 26. An unimmunized schoolage child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend? - Correct answer Assessment of maternal rubella titers 27. A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis? - Correct answer Ask about recent tick bites 28. A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action? - Correct answer Teach the parents which signs and symptoms to report 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 managng this infant's care? - Correct answer Incision and drainage of the abscess with culture 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? - Correct answer Order an immunofluorescent assay (IFA) for serum antibodies. 31. A 7yearold child whose immunizations are uptodate has a fever, headache,stiff neck, and photophobia. What course of treatment is indicated? - Correct answer Hospitalization for diagnosis and treatment with antibiotics 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. Correct - Correct answer A rapid strep test is positive. What will the nurse practitioner do to manage this child's illness? Prescribe oral amoxicillin. 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? - Correct answer Reassure the adolescent that this is a negative screen. Which lab value is most concerning in an infant with fever and a suspected bacterial infection? - Correct answer Creactive protein of 11.5 mg/L 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? - Correct answer Erythrocyte sedimentation rate (ESR) 5. According to recent research, which populations may have higher rates of under immunization than others? - Correct answer Those with higher rates of graduate degrees 6. The parent of a 2monthold infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns? - Correct answer Question the parent's reasons for concern about immunizations. 7. A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent? - Correct answer The MMR may be linked to febrile seizures in immunocompromised children 8. A 2monthold infant will receive initial immunizations, and the parent asks about giving medications to increase the infant's comfort and minimize fever. What will the pediatric nurse practitioner recommend? - Correct answer Administering ibuprofen or acetaminophen as needed 9. The parent of an infant asks why some vaccines, such as MMR, are not given along with the other series of immunizations at 2, 4, and 6 months of age. What will the primar care pediatric nurse practitioner tell this parent? - Correct answer Maternal antibodies neutralize some vaccines and are delayed until 12 months 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? - Correct answer Perform antibody titers and reimmunize the child. 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? - Correct answer Recommend the next dose of MMR vaccine at 4 to 5 years of age 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? - Correct answer DTaP 1. A pharmaceutical company has developed a new drug that was tested only basketball player with mononucleosis. The adolescent asks when she may resume play. What will the nurse practitioner tell her? - Correct answer At 4 weeks, she must have an exam to determine fitness for play. 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? - Correct answer The child may continue to participate in soccer 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? - Correct answer Continuation of physical and cognitive rest 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? - Correct answer Evaluation for underlying cardiac causes of this symptom 18. A 15yearold female basketball player who has secondary amenorrhea is evaluated by the primary care pediatric nurse practitioner who notes a BMI in the 3rd percentile. What will the nurse practitioner counsel this patient? - Correct answer To work with a dietician to improve healthy weight gain 19. The primary care pediatric nurse practitioner is examining a 17yearold male who is on his high school swim team. The adolescent is concerned about "lumps" on his chest. The nurse practitioner notes a marked increase in weight since the last visit along with worsening of the adolescent's acne. Given this set of symptoms, which performance enhancing substance will the nurse practitioner be most concerned about and ask about? - Correct answer Dehydroepiandrosterone (DHEA) 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? - Correct answer Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity 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? - Correct answer Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure 4. The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 6yearold child who has Down syndrome. What will the nurse practitioner tell the parents about physical activity and sports in school? - Correct answer . Their child should have a cervical spine evaluation before participation in sports. 5. The primary care pediatric nurse practitioner is discussing fitness and exercise with the parents of a 5yearold child who ask what kinds of activities are developmentally appropriate for their child. What will the nurse practitioner recommend? - Correct answer Bike riding 6. The parents of a prepubertal female who is on the local swim team tell the primary care pediatric nurse practitioner that their daughter wants to begin a strength training program to help improve her swimming ability. What will the nurse practitioner recommend? - Correct answer Enrolling their daughter in a program that uses fixed weight machines or resistance bands 7. The parent of a 14yearold child asks the primary care pediatric nurse practitioner how to help the child prevent injuries when basketball tryouts begin later in the school year. Which recommendation will be of most benefit? - Correct answer Preseason conditioning 8. The primary care pediatric nurse practitioner is counseling a parent about bicycle helmet use. The parent reports having a helmet used a year previously by an older child and wonders about using it for a younger child since they are so expensive. What will the nurse practitioner tell the parent? - Correct answer "If the helmet is free from marks, you may use it." 9. The primary care pediatric nurse practitioner is performing a well child examination on a high school age adolescent who plays football who has hypercalciuria. Which dietary supplement will the nurse practitioner question the adolescent about? - Correct answer Protein supplements 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? - Correct answer Ask the mother to describe the color and consistency of the stools 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? - Correct answer Placing the child on a "potty" chair helps the child associate elimination cues with the toilet. 3. The primary care pediatric nurse practitioner is performing a well child exam on a 24monthold child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do? - Correct answer Ask the parent about the child's toilet habits and understanding of toilet training 4. The primary care pediatric nurse practitioner is discussing toileting issues with the parent of a 3yearold toddler who reports that the child has been toilet trained for several months but has recently been refusing to have bowel movements and is becoming constipated. What will the nurse practitioner do? - Correct answer Ask the parent about bathroom facilities in the child's day care. 5. The primary care pediatric nurse practitioner is evaluating a 5yearold child who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make? - Correct answer Recent illnesses, fluid intake, changes in diet 6. The primary care pediatric nurse practitioner is managing a 6yearold child 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 - Correct answer protein deficiency 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? - Correct answer Younger children need a limited amount of fats. 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? - Correct answer Ask the parents to provide a 3day food diary. 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? - Correct answer Continue to offer a variety of foods without forcing the child to eat them. 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? - Correct answer Providing a variety of healthy foods at each meal Correct 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? - Correct answer The patient's age at thelarche 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? - Correct answer A. Perform biometric screening to determine lean body mass. 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 - Correct answer participation in sports. 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? - Correct answer Adolescents often need counseling to help them cope with life events. 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? - Correct answer Girls who join an older group of peers may become sexually active at an earlier age. 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? - Correct answer Apparent hypocrisy 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? - Correct answer Tell the adolescent that, unless he is at risk, what he says will be confidential 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? - Correct answer Evaluation for possible learning disorders 9. The parent of a 14yearold child tells the primary care pediatric nurse practitioner that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the nurse practitioner tell the parent? - Correct answer Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. 10. The primary care pediatric nurse practitioner is performing a well child exam on a 17yearold female whose mother is present during the history. The mother expresses concern that her daughter wishes to have an eyebrow piercing and states that she is opposed to the idea. What will the nurse practitioner do? - Correct answer Provide information about piercings and encourage continued discussion 11. The parent of a 16yearold tells the primary care pediatric nurse practitioner that the teen was recently caught smoking an electronic cigarette (ecigarette). What will the nurse practitioner tell this parent? - Correct answer Ecigarette use may be a risk factor for later substance abuse. 12. The parent of an adolescent reports noting cutting marks on the teen's arms and asks the primary care pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent? - Correct answer Cutting is a way of dealing with emotional distress. 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 - Correct answer to name one or two friends. 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 right and wrong. What will the primary care pediatric nurse practitioner tell the parent? - Correct answer The pressures from outside influences may supersede parental teachings and should be confronted 4. During a well child exam of a schoolage child, the primary care pediatric nurse practitioner learns that the child has been having angry episodes at school. The nurse practitioner observes the child to appear withdrawn and sad. Which action is appropriate? - Correct answer Ask the child and the parent about stressors at home 8. A schoolage child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent? - Correct answer Ensure that the child has three nutritious meals and two nutritious snacks each day an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend? - Correct answer Teach the parents to provide exercises to encourage motor development. 6. The mother of a 3yearold child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother? - Correct answer Toddlers may be interested in other children but usually do not engage in interactive play. 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 thinkin in preschoolage children? - Correct answer Realism 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? - Correct answer "Tell me about your child's daily habits." 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? - Correct answer To make an appointment for an initial dental examination 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? - Correct answer Place a variety of nutritious foods on the child's plate at each meal. 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? - Correct answer Language and literacy skills begin at birth. 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? - Correct answer Continuing to nurse the infant using the current pattern 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? - Correct answer The infant may be going through an expected growth spurt. 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? - Correct answer This may be normal for breastfed babies. 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? - Correct answer How to read the infant's cues for overstimulation 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? - Correct answer The infant may be expressing a desire to play or to rest. 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? - Correct answer . "At this age, your baby does not understand the meaning of sounds." 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? - Correct answer Read simple board books to the infant at bedtime. 10. The primary care pediatric nurse practitioner is examining a 12monthold infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? - Correct answer Perform an indepth developmental assessment. 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? - Correct answer Schedule a weight check in 1 week. 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 - Correct answer developing consistent daily routines for the child. 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? - Correct answer Suggest counseling to learn ways to handle stress. 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? - Correct answer Offer the child a book or a toy to look at. 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? - Correct answer . Provide a roll of paper for drawing and teach the child to use this. 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? - Correct answer Point out the tasks that the infant can perform while conducting the assessment 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