INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS
Pediatric Primary Care 6th Edition by Dawn Lee Garzon – Test Bank
Sample Questions
Chapter 1
Questions
Which region globally has the highest infant mortality rate?
Indonesia
Southern Asia
SubSaharan Africa
Syria
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?
Antibiotics
Optimal nutrition
Vaccinations
Water purification
3. Which is true about the health status of children in the United States? ID: 13348413856
Globalism has relatively little impact on child health measures in the U.S.
Obesity rates among 2 to 5yearolds have shown a recent significant decrease.
The rate of household poverty is lower than in other economically developed nations.
Young children who attend preschool or day care have higher food insecurity.
The primary care pediatric nurse practitioner understands that a major child health outcome associated with worldwide climate change is
cost of living.
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
focusing less on development and more on illness prevention and nutrition.
following guidelines established by theBright Futures
scheduling wellbaby visits to coincide with key developmental milestones.
seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due.
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Chapter 2
Questions
The primary care pediatric nurse practitioner is obtaining a medical history
about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history?
Complementary medications, alternative health practices, and chief complaint
Developmental delays, nutritional status, and linear growth patterns
Medication currently taking, allergy information, and family medical history
Speech and language development, beliefs about health, and previous illnesses
When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource?
DC: 03R
ICD10CM
ICSD3
NANDA International
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?
Altered elimination pattern
Elimination disorder
Encopresis
Parenting alteration
The primary care pediatric nurse practitioner is assessing a toddler whose
weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem?
Failure to thrive
Home care resources inadequate
Nutrition alteration – less than required
Parenting alteration
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The primary care pediatric nurse practitioner is performing a well child check
up on a 20monthold child. The child was 4 weeks premature and, according to a parent completed developmental questionnaire, has achieved milestones for a 15monthold infant. Which action is ?
Perform an indepth developmental assessment screen at this visit to evaluate this child.
Reassure the parent that the child will catch up to normal development by age 2 years.
Reevaluate this child’s development and milestone achievements at the 2year visit.
Refer the child to a specialty clinic for evaluation and treatment of developmental delay.
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
ask the parent to consider a possible speech delay and report any concerns.
continue to evaluate the child’s speech at subsequent visits. Co
refer the child for a speech and hearing evaluation.
tell the parent to spend more time in interactive conversations with the child.
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?
Administer a Childhood Autism Rating Scale (CARS) in the clinic.
Consult a specialist to determine appropriate early intervention strategies.
Refer the child to a behavioral specialist for further evaluation.
Tell the parent that this result indicates that the child has autism.
The primary care pediatric nurse practitioner learns that the mother of a 3
yearold 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?
Fine motor
Gross motor
Social/emotional
Speech and language
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When meeting with a new family, the primary care pediatric nurse practitioner
develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information?
CRAFFT
Ecomap
Genogram
Pedigree
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?
Ask the child’s parent why the child is so anxious.
Perform a physical assessment to rule out shortness of breath.
Reassure the child that there is nothing to be afraid of.
Review the purpose of this visit and any anticipated procedures.
The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschoolage child. How will the nurse practitioner assess
Ask the child how many books he has at home.
Ask the mother about her highest grade in school.
Ask the mother to determine the dose of a drug from a label.
Ask the mother to read a health information handout aloud.
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?
Threegeneration pedigree
Review of systems
Genogram
Ecomap
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?
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CRAFFT
HEEADSSS
PHQ2
RAAPS
The primary care pediatric nurse practitioner evaluates a schoolage child
whose body mass index (BMI) is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner document for this visit?
Metabolic syndrome
Nutritional alteration: more than required
Obesity
Rule out type 2 diabetes mellitus
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Chapter 3
Questions
The primary care pediatric nurse practitioner provides well child care for a
community of immigrant children from Central America. The pediatric nurse practitioner is surprised to learn that some of the families are Jewish and not Catholic. This response is an example of cultural
The primary care pediatric nurse practitioner learns that an AfricanAmerican
family lives in a neighborhood with a high crime rate and suggests that they try moving to
another neighborhood for the safety of their children. This is an example of
cultural sensitivity.
group bias.
individual privilege.
racial awareness.
The primary care pediatric nurse practitioner cares for children from a Native
American family and learns that they used many herbs to treat and prevent illness. Which approach will the pediatric nurse practitioner use to promote optimum health in the children?
Ask about the types of practices used and when they are applied.
Provide a list of harmful herbs and ask the family to avoid those.
Suggest that the family avoid using these remedies in their children.
Tell the parents to use the herbs in conjunction with modern medications.
The primary care pediatric nurse practitioner works with families from a
variety of cultures and socioeconomic classes. Which is an example of cultural humility in practice?
Giving health care advice that takes cultural differences into account
Identification of other cultures that may be superior to one’s own culture
Receptivity to learning about the perspectives of other cultures
Respecting other cultures while maintaining the views of one’s own
A Somalian immigrant mother is concerned that her 8yearold child is ID: 13348437937
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underweight. The primary care pediatric nurse practitioner notes that the child’s weight is at the 25th percentile. After realizing that the mother is comparing her child to a group of Americanborn children who are overweight, the pediatric nurse practitioner is able to convince the mother that this is a normal weight. Which domain of cultural competence does this represent?
Global
Interpersonal
Intrapersonal
Organizational
The primary care pediatric nurse practitioner in a community health center
meets a family who has recently immigrated to the United States who speak only Karon. They arrive in the clinic with a church sponsor, who translates for them. The pediatric nurse practitioner notices that the sponsor answers for the family without giving them time to speak. The pediatric nurse practitioner will
ask the sponsor to allow the family to respond.
develop the plan of care and ask the sponsor to make sure it is followed.
request that the sponsor translate written instructions for the family.
use the telephone interpreter service to communicate with the family.
The primary care pediatric nurse practitioner prescribes a twice daily inhaled
corticosteroid for a 12yearold child. At a well child visit, the child reports not using the medication on a regular basis. Which response by the pediatric nurse practitioner demonstrates an understanding of clientcentered care?
Asking the child to describe usual daily routines and schedules
Referring the family to a social worker to help with medication compliance
Reviewing the asthma action plan with the parent and the child
Teaching the child how the medication will help to control asthma symptoms
A primary care pediatric nurse practitioner working in a community health
center wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the pediatric nurse practitioner employ to ensure the success of such a program?
Asking community members to assist in researching and implementing a program
Designing a community garden approach that involves children and their parents
Gaining support from the corporate community to provide needed resources
Providing evidencebased information about the importance of a healthy diet
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The parents of a special needs child tell the primary care pediatric nurse
practitioner that they are planning a 3month 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
global application.
global awareness.
system application.
system awareness.
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?
Asking about physical, psychological, and emotional trauma
Determining the parents’ English language competency and literacy level
Learning about cultural preferences and complementary medicine practices
Reviewing the child’s previous health and illness records
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Chapter 4
Questions
A single mother of an infant worries that living in a household with only one
parent will cause her child to be maladjusted. To help address the mother’s concerns, the
primary care pediatric nurse practitioner will suggest
developing consistent daily routines for the child.
exposing her child to extended family members when possible.
not working outside the home during the first few years.
taking her child to regular play date activities with other children.
During a well child exam, the primary care pediatric nurse practitioner learns
that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father’s job layoff. What will the nurse practitioner do?
Reassure them that the child is too young to understand.
Recommend that they continue to not argue in front of the child.
Suggest counseling to learn ways to handle stress.
Tell them that the conflict will resolve when the situation changes.
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?
Allow the parent to put the child in a “timeout.”
Ask the parent about usual discipline practices.
Offer the child a book or a toy to look at.
Stop the exam since the child has reached a “meltdown.”
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?
Give the child washable markers so the drawings can be removed easily.
Provide a roll of paper for drawing and teach the child to use this.
Put the child in “timeout” each time the child draws on the walls.
Take the crayons away from the child to prevent the behavior.
The primary care pediatric nurse practitioner conducts a well baby exam on ID: 13348411118
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an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend?
Consult a developmental specialist for a more complete evaluation.
Prepare the parents for a potentially serious developmental disorder.
Refer the infant to an early intervention program for physical therapy.
Teach the parents to provide exercises to encourage motor development.
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?
Explain to the parent that developmental delays often do not manifest at first.
Perform a developmental assessment and tell the parent which delays are evident.
Point out the tasks that the infant can perform while conducting the
assessment.
Refer the infant to a developmental specialist for a complete evaluation.
The primary care pediatric nurse practitioner sees a developmentally delayed
toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially?
Ask the parents if they have an individualized family service plan (IFSP).
Consult with a physician to ensure the child gets appropriate care.
Inform the family that services are provided when the child begins school.
Refer the family to a social worker for assistance with referrals and services.
The primary care pediatric nurse practitioner has a cohort of patients who
have special health care needs. Which is an important role of the nurse practitioner when
caring for these children?
Care coordination and collaboration
Developing protocols for parents to follow
Monitoring individual education plans (IEPs)
Providing lists of resources for families
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
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health?
To begin brushing the infant’s teeth with toothpaste
To consider weaning the infant from breastfeeding
To discontinue giving fluoride supplements
To make an appointment for an initial dental examinationt
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
a sign that the mother has postpartum depression.
extremely concerning for potential parental neglect.
of moderate concern for parenting problems.
within the normal range of behavior in early parenthood.
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Chapter 5
Questions
The parent of a newborn infant asks the primary care pediatric nurse practitioner
when to intervene to help the infant’s future intellectual growth. What will the nurse practitioner tell
the parent?
Cognitive learning begins during the toddler years.
Intellectual growth begin when speech develops.
Language and literacy skills begin at birth.
Preschool is an optimal time to begin general learning.
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 ?
Follow up at the 2month checkup.
Refer to a lactation consultant.
Schedule a weight check in 1 week.
Suggest supplementing with formula.
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?
Continuing to nurse the infant using the current pattern
Nursing the infant for longer periods every 4 hours
Supplementing with formula at the last nighttime feeding
Waking the infant every 2 hours to nurse during the night
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?
She may not be making as much breastmilk as before.
She should keep a log of the frequency and duration of each feeding.
The infant may be going through an expected growth spurt.
The infant should stay on the previously established nursing schedule.
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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?
Her baby is probably constipated.
It may be related to her dietary intake.
She should consume more water.
This may be normal for breastfed babies.
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?
Appropriate ways to stimulate and entertain the infant
How to read the infant’s cues for overstimulation
The importance of scheduling “play dates” with other infants
To provide musical toys to engage the infant
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?
The infant may be expressing a desire to play or to rest.
The parent should give ibuprofen for teething pain before nursing.
This is an indication that the infant is ready for solid foods.
This may indicate gastrointestinal discomfort such as constipation.
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?
“At this age, your baby does not understand the meaning of sounds.”
“Babies at this age cannot make the ‘ma’ sound.”
“Most sounds made by babies at this age are accidental.”
“This may mean that your baby doesn’t hear well.”
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?
Provide educational videos that focus on language.
Read simple board books to the infant at bedtime.
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Sing to the child and play lullabies in the baby’s room.
Turn the television to Sesame Streetduring the day.
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?
Perform an indepth developmental assessment.
Reassure the parent that this is normal for a premature infant.
Refer the infant to a developmental specialist.
Suggest activities to improve fine motor skills.
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Chapter 6
Questions
The primary care pediatric nurse practitioner is evaluating a 2yearold with a
documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next?
Ask the child’s parents whether they read to the child.
Give parents educational materials to encourage speech.
Refer the child to an early intervention program.
Suggest that they purchase ageappropriate music videos.
The primary care pediatric nurse practitioner performs a developmental
assessment on a 32monthold child. The child’s parent reports that about 70% of the child’s speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing “t,” “d,” “k,” and “g” sounds. Which action is ?
Evaluate the child’s cognitive abilities.
Obtain a hearing evaluation.
Reassure the parent that this is normal.
Refer the child to a speech therapist.
During a well child assessment of an 18monthold child, the primary care
pediatric nurse practitioner observes the child point to a picture of a dog and say, “Want
puppy!” The nurse practitioner recognizes this as an example of
holophrastic speech.
receptive speech.
semantic speech.
telegraphic speech.
The primary care pediatric nurse practitioner is offering anticipatory guidance
to the parents of a 12monthold child. The parents are bilingual in Spanish and English and have many Spanishspeaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the pediatric nurse practitioner tell the parents?
Children who learn two languages simultaneously often confuse them in conversation.
Children with multilanguage proficiency do not understand that others cannot do this.
Learning two languages at an early age prevents children from developing a dominant language.
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Most bilingual children are able to shift from one language to another when appropriate.
The primary care pediatric nurse practitioner is counseling the parents of a
toddler about appropriate discipline. The parents report that the child is very active and curious, and they are worried about the potential for injury. What will the pediatric nurse practitioner recommend?
Allow the child to explore and experiment while providing appropriate limits.
Be present while the child plays to continually teach the child what is appropriate.
Let the child experiment at will and to make mistakes in order to learn.
Say “no” whenever the child does something that is not acceptable.
The mother of a 3yearold child takes the child to a play group once a week. ID: 13348437961 She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother?
The child probably is very shy but will outgrow this tendency with repeated
exposure to other children.
The toddler may have a language delay that interferes with socialization with other children.
Toddlers may be interested in other children but usually do not engage in interactive play.
Toddlers need more structured play to encourage interaction and socialization with others.
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?
Animism
Artificialism
Egocentrism
Realism
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?
“Begin by reading to your child about toileting.”
“Most children are capable by age 2 years.”
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“Tell me about your child’s daily habits.”
“We should assess your child’s motor skills.”
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?
To begin brushing the infant’s teeth with toothpaste
To consider weaning the infant from breastfeeding
To discontinue giving fluoride supplements
To make an appointment for an initial dental examination t
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?
Allow the child to choose foods for meals to improve caloric intake.
Place a variety of nutritious foods on the child’s plate at each meal.
Prepare mashed potatoes and chicken strips for the child at mealtimes.
Suggest cutting out snacks to improve the child’s appetite at mealtimes.
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Chapter 7
Questions
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
about school performance and grades.
why school is so distressing.
to name one or two friends.
whether bullying is taking place.
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
children at this age who prefer interactions with samegender peers usually have a homosexual orientation.
children experiment with sexuality at this age as a means of deciding later sexual orientation.
this attachment to other samegender children is how the child learns to interact with others.
to encourage mixedgender interactions in order to promote development of sexual values.
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?
Allowing the child to make poor choices and accept consequences is important for learning values
Children at this age have a high regard for authority and social norms, so this is not likely to happen
Moral values instilled in the early schoolage period will persist throughout childhood
The pressures from outside influences may supersede parental teachings be confronted
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?
Ask the child and the parent about stressors at home
Make a referral to a child behavioral specialist
Provide information about anger management
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D. Suggest consideration of a different classroom
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assessment of an 8yearold child. How will the nurse practitioner begin the exam?
A. Ask the child about school, friends, home activities, and sports
Discuss the purpose of the visit and explain the procedures that will be performed
Offer ageappropriate information about usual developmental tasks
Provide information about healthy nutrition and physical activities
The parent of a 6yearold child expresses concern that the child may have ADHD.
Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility?
Behavioral and Emotional Screening System for Children (BESS2)
Behavioral Assessment for Children – 2nd ed. (BASC2)
Conner’s 3 Parent and Teacher Rating Scale
Pediatric Symptom Checklist (PSC)
The parent of a 5yearold child who has just begun kindergarten expresses concern
that the child will have difficulty adjusting to the birth of a sibling. What will the primary care pediatric nurse practitioner recommend?
Allowing the child opportunities to discuss feelings about the baby
Giving the child specific baby care tasks to promote sibling bonding
C. Having snack time with the child each day to discuss the school day
D. Providing reassurance that the sibling will not replace the child
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care pediatric nurse practitioner recommend to the parent?
Allow the child to make food choices since this is usually a phase
Ensure that the child has three nutritious meals and two nutritious snacks each day Corret
Prepare vegetables separately for the child to encourage adequate intake
Teach the child how important it is to eat healthy fruits and vegetables
The primary care pediatric nurse practitioner performs a physical examination on a
12yearold child and notes poor hygiene and inappropriate clothes for the weather. The child’s mother appears clean and well dressed. The child reports getting 6 to 7 hours of sleep each night because of texting with friends late each evening. What action by the nurse practitioner will help promote healthy practices?
Discuss setting clear expectations about selfcare with the mother
Give the child information about sleep and selfcare
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Reassure the mother that this “noncompliance” is temporary
Tell the mother that experimenting with selfcare behaviors is normal
During a well child exam on a 5yearold child, the primary care pediatric nurse
practitioner assesses the child for school readiness. Which finding may be a factor in limiting school
readiness for this child?
Adherence to daily family routines and regular activities
Having two older siblings who attend the same school
Parental concerns about bullying in the school
The child’s ability to recognize four different colors
The primary care pediatric nurse practitioner is examining a schoolage child who
complains of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the nurse practitioner initially ask the parent?
About the timing of the symptoms each day and during the week
How well the child performs in school and in extracurricular activities
If the parent feels a strong need to protect the child from problems
Whether there are any unusual stressors or circumstances at home
The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in
a schoolage child. The child’s exam is normal. The nurse practitioner learns that the child reports pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child’s grandmother recently had gallbladder surgery. Which action is ?
Encourage the child to keep a log of pain, stool patterns, and dietary intake
Order radiologic studies and laboratory tests to rule out systemic causes
Reassure the child and encourage resuming sports when symptoms subside
Refer the child to a counselor to discuss anxiety about health problems
Continue
Chapter 8
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Questions
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?
The age of the mother’s menarche
The patient’s age at thelarche
When adrenarche occurred
Whether linear growth has stopped
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 ?
Perform biometric screening to determine lean body mass.
Prescribe oral contraceptives pills to regulate her periods.
Reassure her that this is perfectly normal at her age.
Refer her to an endocrinologist for hormonal evaluation.
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
alcohol and tobacco use.
changes in voice.
increase in height and weight.
participation in sports.
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?
Adolescence is marked by an inability to comprehend complex situations.
Adolescence is typically marked by tempestuous and transient episodes.
Adolescents normally have extreme, disruptive conflicts with parents.
Adolescents often need counseling to help them cope with life events.
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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?
Earlymaturing girls need to identify with older adolescents to feel a sense of belonging.
Girls who join an older group of peers may become sexually active at an earlier age.
Spending time with older adolescents indicates a healthy adjustment to her maturing body.
The association with older adolescents will help her daughter to gain social maturity.
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?
Apparent hypocrisy
Imaginary audience
Overthinking
Personal fable
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?
Provide the teen with a questionnaire to gain information about his sexuality.
Remind the adolescent that mandatory reporting requires disclosure to parents.
Suggest that the adolescent discuss sexual concerns with his parents.
Tell the adolescent that, unless he is at risk, what he says will be
confidential.
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?
Counseling for emotional problems
Development of an Individual Education Plan
Evaluation for possible learning disorders
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Referral for a behavioral disorder
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?
Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent.
Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake.
Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals.
Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home.
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?
Provide information about piercings and encourage continued discussion.
Remind the adolescent that her mother is responsible for her health.
State that piercings are relatively harmless and are an expression of individuality.
Suggest that she wait until she is 18 years old and can make her own decisions.
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?
Ecigarette use may be a risk factor for later substance abuse.
Experimentation with ecigarettes does not lead to future tobacco use.
Most teens who experiment with tobacco usually do not become addicted.
This form of nicotine ingestion is safer than regular cigarettes.
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?
Cutting is a way of dealing with emotional distress.
It is a method of fitting in with other adolescents.
The behavior is common and will usually stop.
This type of behavior is a type of suicide attempt.
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Chapter 9
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Questions
The primary care pediatric nurse practitioner is performing a focused problem
assessment on a child who has asthma and learns that one of the child’s parents smokes around the child in spite of being advised against this. The nurse practitioner recognizes this as a possible
alteration in which functional health pattern? A. Cognitiveperceptual
Health perception
Rolerelationship
Valuesbeliefs
The primary care pediatric nurse practitioner examines an infant whose weight is
below the 3rd percentile and whose mother does not comply with the feeding regimen. When attempting to enlist the help of the infant’s grandmother, the grandmother says, “My daughter was like this when she was a baby and she turned out all right.” Which approach will the nurse practitioner take to improve the outcome for this infant?
Ask the grandmother about her daughter’s health during childhood.
Explain that the condition is potentially serious if not treated.
Give the grandmother and mother information about normal growth.
Refer the family to a social worker to investigate possible neglect.
The primary care pediatric nurse practitioner provides patient teaching for
children newly diagnosed with irritable bowel syndrome (IBS). At which stage of development will children be able to understand the link between stress and the symptoms of the disease?
Concreteoperational stage
Formaloperational stage
Preconceptual stage
Sensorimotor stage
The primary care pediatric nurse practitioner is counseling an obese adolescent
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whose parents both have type 2 diabetes mellitus. Which health behavior prediction
model is
useful when the nurse practitioner discusses lifestyle changes with this client?
Behavioral change model
Health belief model
Health promotion model
Transtheoretical model
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The primary care pediatric nurse practitioner is counseling a schoolage child
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?
Asking the child to try to use the inhaler at least once daily
Discussing whether the child wants to participate in athletics
Obtaining pre and posttreatment spirometry testing D. Providing written information about inhaled corticosteroids
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
Contemplation
Precontemplation
Preparation
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
go over with the adolescent about the health risks associated with smoking.
recommend avoiding friends who smoke and making new friends.
remind the adolescent about the struggles associated with quitting smoking.
suggest that the teen consider taking up a sport or other physical activity.
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 ?
Assess the parent’s knowledge about diabetes management.
Help the child develop a strategy to remember without parental prompts.
Refer to a social worker to help the family overcome obstacles to care.
Remind the child’s parent about the importance of good diabetes control.
The primary care pediatric nurse practitioner is counseling an obese 16yearold ID: 13348422938 client about weight management. The adolescent says, “I know I need to lose weight, but I don’t
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want to give up all my favorite foods.” When using motivational interviewing techniques, how will the nurse practitioner respond?
“Do you think there are any foods you could limit or do without for a while?”
“I hear you telling me that you really don’t have a desire to lose weight.”
“If you can’t give up these foods, you won’t see the benefits of weight loss.”
“In the long run, the sacrifices you make today will improve your health.”
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?
Explore ways that the parent can use this extra energy to do things for the baby.
Remind the parent that this is a normal, temporary part of nicotine withdrawal.
Suggest that the parent take up exercise to enjoy the benefits of not smoking.
Tell the parent that, over time, these symptoms of withdrawal will subside.
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?
FleschKincaid Readability Test
Gunning Fog Index
Number of children’s books in the home
SMOG
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?
Ask the parent to read back all information given.
Encourage the parent to ask questions when confused.
Provide written materials presented at an 8th grade level.
Reinforce written information with verbal instructions.
Chapter 10
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Questions
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?
Begin supplementing with iron.
Continue to nurse as long as desired.
Discontinue the vitamin D supplement.
Stop breastfeeding at 1 year of age.
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
calcium deficiency.
excess caloric intake.
excess fat intake.
protein deficiency.
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?
Whole milk is usually not fortified with vitamin D.
2% milk is higher in essential proteins and minerals.
Young children don’t need the extra calories found in whole milk.
Younger children need a limited amount of fats.
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?
Ask the parents to provide a 3day food diary.
Prescribe a daily multivitamin with iron.
Reinforce the need to meet DRIs each day.
Tell them that supplements are unnecessary
The primary care pediatric nurse practitioner is examining a toddler who is below ID: 13348422916 the 3rd percentile for weight even though the parents claim that the child eats “constantly.” What
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will the nurse practitioner do initially?
Evaluate the child’s feeding and elimination behaviors and ask the family to describe mealtime routines.
Recommend giving a multivitamin and offering highcalorie foods, such as ice cream.
Refer the child to a feeding evaluation clinic for a swallow study and evaluation of possible GERD.
Suggest that the parents supplement the child’s food intake with a highcalorie formula.
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?
Giving the child a multivitamin since this is a phase
Having the child eat vegetables before getting the hamburger
Providing a variety of healthy foods at each meal D. Putting extra lettuce and tomatoes on hamburgers
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?
Continue to offer a variety of foods without forcing the child to eat them.
Offer snacks to make up for calories the child misses by not eating the vegetables.
Prepare dishes the child likes to ensure that a vegetable is eaten at each meal.
Require the child to take 1 to 2 bites of each food at each meal.
The primary care pediatric nurse practitioner is providing anticipatory guidance to
the mother of a breastfed 6monthold infant who asks about “babyled weaning.” What will the nurse practitioner tell her about this practice?
“Foods given for this purpose do not meet all the child’s nutritional needs.”
“Giving infants control of the feeding process will help prevent obesity.”
“Infants are given soft, mashable table foods when able to selffeed.”
“Infants must be able to grasp and feed themselves from a spoon to do this.”
The primary care pediatric nurse practitioner is performing a well child
examination on a 15yearold girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement?
Calcium, vitamin C, and vitamin A
Iron, folic acid, and B12
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Magnesium, vitamin E, and zinc
Vitamin D, vitamin C, and phosphorus
The primary care pediatric nurse practitioner is evaluating a schoolage child who,
after removal of a pituitary tumor, has altered hypothalamic control over hunger and satiety. The child is morbidly obese and expresses feeling depressed because of the obesity. What will the nurse practitioner recommend?
Developing a system to reward compliance with a dietary regimen
Restricting all access to food in the house and at school
Suggesting an afterschool exercise program to help with weight loss
Using a food diary to track all calories and food intake
When counseling an adolescent with a family history of hyperinsulinemia and type
2 diabetes, the primary care pediatric nurse practitioner will recommend avoiding
baked potato chips.
canned vegetables.
highfiber cereals.
processed breads.
The parent of a schoolage child reports that the child is on a glutenfree diet.
When questioned about the reason for this diet, the parent states that the child has fewer stomach aches since beginning the diet but has never been diagnosed with celiac disease. The parent reports using glutenfree grain products for all family members. The nurse practitioner will tell this parent that glutenfree diets
are generally low in sugar and fat.
are healthy and help prevent obesity.
may be deficient in essential nutrients.
provide adequate protein to meet daily needs.
Chapter 11
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Questions
The primary care pediatric nurse practitioner performs a well child assessment on
a 6monthold infant whose mother reports having less breast milk because of stressors associated with pumping and returning to work. The nurse practitioner will provide resources to promote pumping and
discuss adding other foods to the baby’s diet.
encourage the mother to increase her fluid intake.
prescribe a multivitamin containing iron.
suggest offering only breast milk to the infant.
The mother of a newborn asks the primary care pediatric nurse practitioner about ID: 13348443909 the benefits of breastfeeding. What will the nurse practitioner tell her?
Breastfeeding for 9 months or longer will reduce the incidence of food allergies.
Breast milk is an excellent source of vitamin D, iron, and other essential nutrients for the baby.
Nursing her baby exclusively for at least 4 months will help her infant to resist infections.
There is a decreased risk of atopic dermatitis in babies who nurse for 12 months or longer.
The primary care pediatric nurse practitioner learns that the mother of a newborn
infant is being tested for tuberculosis after a positive TB skin test. What will the nurse practitioner
tell the mother who states a desire to breastfeed her baby?
Breast milk is contraindicated if the mother has tuberculosis.
She may continue to nurse her baby since the risk of transmission is low.
That she can express breast milk and feed that to her infant
To give formula until results of tuberculosis testing are known
The primary care pediatric nurse practitioner sees a 3dayold nursing infant
whose newborn metabolic screen is positive for galactosemia. The nurse practitioner refers the newborn to a specialist for immediate evaluation and will tell the mother
to continue to breastfeed her infant.
to give the infant a cow’s milk formula.
to supplement breast milk with formula.
to stop breastfeeding immediately.
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The mother of a nursing infant expresses concern about whether highcholesterol
foods will increase her infant’s risk of hyperlipidemia. What will the primary care pediatric nurse practitioner tell her?
Breastfed infants have lower serum cholesterol levels than those who are not breastfed.
Maternal cholesterol levels affect the cardiovascular risk of breastfed babies.
Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol values.
She should limit her dietary cholesterol to prevent hyperlipidemia in her infant.
The primary care pediatric nurse practitioner is counseling the mother of a
newborn about breastfeeding her infant. Which supplements will the nurse practitioner
recommend?
Fatsoluble vitamins
Iron
Multivitamins with iron
Vitamin D
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?
Ask the mother if the infant has any feeding difficulties.
Refer the infant for a possible frenulectomy.
Schedule an appointment with a lactation consultant.
Suggest that the mother feed breast milk by bottle.
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?
Consultation with a lactation specialist to assess intake
Pumping her breast during the night to maintain milk supply
Supplementing the last feeding of the day with formula
Waking the infant up at least every 3 hours to nurse
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?
Frozen breast milk may be stored up to 3 months in a 0° F freezer.
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Once she begins pumping the infant should drink only pumped breast milk.
Pumped breast milk must be discarded after 3 days when stored in the refrigerator.
Unused defrosted breast milk may be stored in the refrigerator for 48 hours.
The mother of a 2monthold infant tells the primary care 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 ?
Recommend pumping her breasts after feedings.
Refer the mother to a lactation consultant.
Suggest supplementation with formula.
Weigh the infant to assess for a growth spurt.
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?
Breastfeed only at bedtime to establish meal patterns.
Clean the toddler’s teeth each time after breastfeeding.
Offer the breast just prior to meals to maintain milk supply.
The toddler should continue to be breastfed “on demand.”
The primary care pediatric nurse practitioner is performing an assessment on a 1
weekold 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 ?
Order home phototherapy and closely monitor bilirubin levels.
Reassure the mother that the bilirubin level will drop in a few days.
Recheck the serum bilirubin and infant’s weight in 24 hours.
Recommend that the mother pump her breast milk for a couple of days.
Chapter 12
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Questions
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?
Ask the mother to describe the color and consistency of the stools.
Explain to the mother that breastfed infants should have daily stools.
Recommend using a glycerin suppository as needed.
Suggest to the mother that she increase her intake of fluids.
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?
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.
Placing the child on a “potty” chair helps the child associate elimination cues with the toilet.
Predictability of elimination patterns indicates readiness for toilet training, and the parent can begin this process.
The parent should wait until other signs of toilet training readiness occur before introducing the child to the toilet.
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?
Advise the parent to make the child get clean clothes after an accident.
Ask the parent about the child’s toilet habits and understanding of toilet training.
Recommend using an awards system to encourage toilet use.
Suggest that the parent place the child on the toilet at predictable intervals.
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?
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Ask the parent about bathroom facilities in the child’s day care.
Refer the child to a gastroenterologist for evaluation of pathology.
Suggest putting the child in diapers and resuming toilet training in a few weeks.
Tell the parent that this represents a developmental delay.
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?
History of neurogenic conditions
Recent adjustments in the family
Recent illnesses, fluid intake, changes in diet
Toilet training history
The primary care pediatric nurse practitioner is managing a 6yearold child
who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child’s condition?
Encouraging use of maintenance medications for at least 2 months after resolution
of constipation
Referral to a mental health consultant to manage problems in the parentchild dyad
Spending time with the parents to uncover their feelings about their child’s condition
Teaching the parents that the symptom of stool retention is often voluntary for the child
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?
Providing a reward system to offer incentives when the child uses the toilet
Put the child back in diapers and resume toilet training in a few months.
Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation
Use of polyethylene glycol until the child is able to use the toilet regularly
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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?
Examination for labial adhesions
Palpation for abdominal masses
Screening for potential child abuse
Urine culture and sensitivity
The primary care pediatric nurse practitioner is concerned 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?
Initiating a bladder retraining program
Ordering a voiding cystourethrogram
Referral to a urologist for evaluation
Treatment with prophylactic antibiotics
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?
Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis.
Reassure the parent that the child probably gets distracted and puts off voiding until it is urgent.
Refer the child to a pediatric urologist for evaluation of possible vesicoureteral reflux.
Suggest a bladder retraining program and use of a nighttime bedwetting alarm.
The primary care pediatric nurse practitioner is counseling the parent of an 8
yearold 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?
Anticholinergic medications are most commonly used for enuresis.
Drug therapy is an effective way to achieve longterm control.
Drug therapy is safest when the nasal spray form is used.
The combination of alarm therapy and intermittent drug therapy is best.
Chapter 13
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Questions
The primary care pediatric nurse practitioner counseling the parent of an
overweight schoolage child about improving overall fitness. What will the nurse practitioner include?
Encourage the child to begin by engaging in swimming or cycling.
Exercise will help lower total cholesterol and lowdensity lipoproteins.
Schoolage children need 60 minutes of moderate exercise daily.
Strength training exercises are not safe for schoolage children.
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?
Children with asthma should be excluded from vigorous exercise and most strenuous sports.
Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity.
Physical activity has been shown to improve overall pulmonary function in children with asthma.
Vigorous exercise helps improve symptoms in children with poorly controlled asthma.
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
Moderate daily exercise such as walking for 20 minutes daily with increasing intensity as blood pressure drops
Vigorous aerobic exercise combined with maximal strength training to lower blood pressure
Vigorous aerobic exercise only to reduce blood pressure and then to maintain lowered blood pressure
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?
Children with Down syndrome get frustrated easily when engaging in sports.
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Children with Down syndrome should not participate in strenuous aerobic activity.
Their child should have a cervical spine evaluation before participation in
sports.
Their child should only participate in sports sanctioned by the Special Olympics.
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?
Bike riding
Interactive play
Martial arts
Organized sports
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?
Avoiding strength training programs until after puberty to minimize the risk for injury
Enrolling their daughter in a program that uses fixed weight machines or resistance bands
Having their daughter participate in weight training 4 or 5 times each week for maximum effect
Making sure that their daughter begins with the greatest weight tolerable using lower repetitions
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? A. Preseason conditioning
Proper footwear
Protective knee braces
Stretching before practices
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?
“As long as the helmet does not have cracks, you may use it.”
“If the helmet is free from marks, you may use it.”
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“You may continue to use a helmet up to 10 years.”
“You should always purchase a new helmet for each child.”
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?
Protein supplements
Salt tablets
Sports drinks
Vitamin C
The primary care pediatric nurse practitioner is performing a preparticipation
sports physical examination on a 14yearold male who will be on the wrestling team at school. What will the nurse practitioner include when discussing healthy practices with this adolescent?
Risks associated with repeatedly losing and gaining weight
The need for an electrocardiogram or echocardiogram prior to participation
The need to consume 20 to 30 grams of protein after exercise
To consume water with CHO prior to activity lasting up to an hour
The primary care pediatric nurse practitioner is evaluating a heart murmur
during a preparticipation examination of a high school athlete. Which finding would be a
concern requiring referral to a cardiologist?
A murmur that is louder when squatting and softer when standing
A murmur that is quieter when squatting and louder with a Valsalva maneuver
A murmur with narrow and variable splitting of S2
A systolic murmur that is grade 1 or 2
The parent of a 12yearold child who has sickle cell trait (SCT) asks the
primary care pediatric nurse practitioner whether the child may play football. What will the nurse practitioner tell this parent?
Children with SCT should not play any contact sports.
Children with SCT may not play for NCAA schools in college.
Children with SCT should follow heat acclimatization guidelines.
Children with SCT should not participate in organized sports.
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The parent of a child newly diagnosed with epilepsy asks 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?
Bicycle riding is not safe for children with seizures.
Contact sports should be avoided.
Direct supervision of some activities is necessary.
Underwater sports are not recommended.
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?
After 3 weeks, she may begin lifting weights but not full sports.
After 4 weeks, she may return to full play and practice.
At 4 weeks, she must have an exam to determine fitness for play.
She may engage in moderate exertion and practice after 3 weeks.
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?
The child may continue to participate in soccer.
The child should limit activity to nonaerobic sports.
This condition is a contraindication for all sports.
This condition predisposes the child to sudden cardiac death.
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?
Permanent discontinuation of all strenuous and aerobic activities
Enrollment in a conditioning program to improve performance
Evaluation for underlying cardiac causes of this symptom D. Treatment for exerciseinduced asthma with a bronchodilator
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?
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Continuation of cognitive rest only
Continuation of physical and cognitive rest
Continuation of physical rest only
Returning to play
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?
That amenorrhea in female athletes is not concerning
That she should begin a program of plyometrics and strength training
To consider a different sport, such as volleyball
To work with a dietician to improve healthy weight gain
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?
Creatine
Dehydroepiandrosterone (DHEA)
Ephedra
Growth hormone
Chapter 14
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Questions
The primary care pediatric nurse practitioner is performing a well child
examination on a 4yearold child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent?
Most sleep disorders are benign and will be outgrown.
Sleep disorders are symptomatic of underlying behavior problems.
Sleep disorders at this age can have longterm impacts on learning.
The child will need longer daytime naps to compensate for lost sleep.
The parent of a schoolage child who is overweight tells the primary care
pediatric nurse practitioner that the child seems to crave highcalorie, highcarbohydrate foods, even when full. The nurse practitioner learns that the child is often irritable and sleepy at school in spite of sleeping 9 or 10 hours each night. What will the nurse practitioner recommend?
Assessment of leptin and ghrelin hormone levels
Consultation with a dietician to develop an appropriate diet
Referral to a sleep disorder clinic for a sleep study
Taking one or two naps each day to increase the amount of sleep
The primary care pediatric nurse practitioner is performing a well baby
examination on a 2weekold infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent to keep a sleep log and will teach the parent that which amount of sleep per day is optimal for this infant?
10 to 12 hours
12 to 15 hours
15 to 18 hours
18 to 20 hours
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?
Bedsharing with infants greatly increases the risk of SIDS.
Breastfeeding does not appear to have any influence on SIDS risk.
Infants who attend day care have a higher than usual incidence of SIDS.
There is no difference in SIDS rates in immunized versus nonimmunized infants.
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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?
Cosleeping with the child to help alleviate possible nighttime fears
Referral to a sleep disorders clinic for evaluation of sleepdisordered breathing
Reintroducing a second, morning nap time to compensate for lost sleep
Understanding that sleep resistance is a common developmental problem
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
Offering a reward for each night the child falls asleep without the parent in the room
Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors
Taking away a favorite activity or video for each night the child fusses about the parent not being in the room
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?
Diphenhydramine
Lorazepam
Melatonin
Zolpidem
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?
That if this occurs again, to question the child about nightmares
That this is a sign of sleep walking and could be dangerous
That this is a type of sleep terror which will resolve over time
That this is probably a benign, temporary type of a sleep disorder
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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?
Establishing a graduated extinction program and good sleep hygiene
Making sure that stairs are blocked and doors are locked
Referral to a sleep disorder clinic for evaluation of a parasomnia
To awaken the child when these occur and asking about nightmares
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
clonazepam.
ferrous sulfate.
gabapentin.
sertraline.
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 program of sleep hygiene and gradual sleep extension
A sedativenarcotic will help both sleep and depression
Cognitive therapy can help the adolescent to sleep better
Using an antidepressant will improve sleep patterns
A child with Down syndrome who has sleepdisordered breathing with
obstructive sleep apnea continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse practitioner will refer the child to a sleep disorder clinic to discuss which therapy?
Craniofacial surgery
Oral appliances
Positive airway pressure therapy
Supplemental oxygen
Chapter 15
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Questions
The mother of a 3monthold male infant tells the primary care pediatric
nurse practitioner that she occasionally notices he has a penile erection just after nursing.
What will the nurse practitioner tell the mother?
Infants should be prevented from masturbating.
The infant is conscious of the pleasure associated with nursing.
This is a form of infantile priapism.
This is a normal, reflexive behavior at this age.
The primary care pediatric nurse practitioner is performing a well child
examination on a 3yearold. The child’s parent reports that the child has recently begun
masturbating. What will the nurse practitioner counsel this parent?
To allow the behavior whenever it occurs, since it is normal
To discuss sexuality with the child
To explore whether the child is being abused
To teach the child about privacy and hand hygiene
The parent of an 8yearold child tells the primary care pediatric nurse
practitioner that the child has begun to ask questions about why a schoolmate has “2 daddies” and wonders how to talk to the child about this. What will the nurse practitioner recommend?
Beginning a discussion about different types of sexual relationships and samesex partners
Discussing the issue with the child in terms of the parent’s religious values and norms
Explaining that not all families are the same and what is most important is that they
love and care for their children
Telling the child that some adult relationships are complicated and will be understood when the child is older
The primary care pediatric nurse practitioner is performing a well child exam
on an 8yearold girl and notes the presence of breast buds. What will the nurse practitioner include when initiating anticipatory guidance for this patient?
A discussion about the risks of pregnancy and sexually transmitted diseases
Information about sexual maturity and menstrual periods
Material about the human papillomavirus vaccine
Sexual orientation and the nature of sexual relationships
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The primary care pediatric nurse practitioner is counseling the parents of a
13yearold female who has Down syndrome about sexual maturation. What will the nurse practitioner tell these parents?
It is important to discuss and support healthy sexuality.
Providing too much information about sexuality may be confusing given the child’s cognitive level of understanding.
Suppressing periods with contraceptives will lessen their daughter’s distress.
They should give her information about periods but not about sexuality.
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?
Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult.
Separate the parent from the adolescent to discuss the adolescent’s concerns in private.
Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors.
Tell the parent that this information is a routine part of adolescent well child examinations and must be included.
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?
Ask her for her definitions of “sex.”
Discuss the risks of sexually transmitted diseases.
Find out if she is considering sexual relations.
Give her information about contraception.
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?
The child has been sexually molested.
The child is feeling violated by the examiner.
The parent is exhibiting regressive behavior.
This is a normal reaction in a child of this age.
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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?
Homosexual identity formation cannot be predicted by early childhood behavior.
Masculinizing boys from an early age helps to determine heterosexual orientation.
Sexual orientation identification begins late in adolescence and not in childhood.
The development of sexual orientation is generally a multifaceted process.
Chapter 16
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Questions
The primary care pediatric nurse is performing a well child examination on an
adolescent who was adopted as a toddler. The parent reports that the child had been removed from an abusive home at age 3 years. What will the nurse practitioner evaluate in light of possible longterm effects of this early situation?
Cognitive and psychosocial development
Mental health and suicide risk
Moral development and conscience formation
Spirituality, faith, and religious affiliation
While the primary care pediatric nurse practitioner is discussing anticipatory
guidance with the mother of a 12 month old, the child repeatedly pulls objects out of the mother’s purse. Each time, the mother slaps the child’s hands as she takes the objects away. What will the nurse practitioner recommend to help the mother manage this child’s misbehavior in a developmentally appropriate manner?
Keep her purse up high and out of the child’s reach.
Place acceptable objects in her purse for the child to find.
Say “No!” instead of slapping the child’s hands.
Use timeout each time the child gets into the purse.
The mother of a 15yearold female expresses concerns that her daughter may
be sexually active because she’s had a steady boyfriend for over a year. The primary care pediatric nurse practitioner learns that the family is Catholic and that the mother had an abortion when she was 16 years old. What will the nurse practitioner do initially?
Explore the mother’s feelings about her own past experience.
Offer to prescribe contraception to prevent pregnancy.
Recommend that the mother discuss this with her daughter.
Suggest that the mother talk to a priest about her daughter.
During a well child examination of a schoolage child from a family who recently
immigrated from Africa, the primary care pediatric nurse practitioner learns that the child has been involved in many arguments at school. The parents are concerned that their child will never fit in with classmates. How will the nurse practitioner address this situation?
Assess the conditions in the country of origin prior to immigration.
Recommend counseling to determine underlying causes of this behavior.
Stress that this may be a normal response to feeling different at school.
Suggest that the child may be responding to being bullied by others.
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The primary care pediatric nurse practitioner sees a 6yearold child after a
hospitalization for injuries sustained in a motor vehicle accident (MVA) in which the child’s grandfather was killed. The parent states that it is difficult to get the child to stop talking about the accident and is worried that the child will have permanent emotional scars. What will the nurse practitioner suggest?
Assure the child that he is safe and this won’t happen again.
Encourage the child to express and examine feelings.
Reassure the child that his grandfather is in heaven.
Redirect these conversations to happier topics.
Chapter 17
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Questions
During a well child examination on an infant who has colic, the primary care
pediatric nurse practitioner learns that the infant’s mother is 17 years old and that the father, who is in the military, was deployed to wartime duty shortly after the baby was born. To determine the immediate risk of child maltreatment for this infant, the nurse practitioner will ask about
childrearing and parenting styles.
role responsibilities of the parents.
spiritual beliefs and religious practices.
the location of extended family members.
The primary care pediatric nurse practitioner is examining a young child who has
cerebral palsy. Which part of the family history raises concerns about potential child maltreatment?
Child attends day care
Limited financial resources
Mother works outside the home
No membership in a church
The mother of two schoolage children tells the primary care pediatric nurse
practitioner that she and the children’s father are divorcing and asks for advice to help the children
cope with the situation. The nurse practitioner will counsel her to
allow visitation only on weekends.
maintain her own social life.
notify the children’s teachers.
use a social support network.
Adolescent children are more likely to smoke cigarettes and drink alcohol if they live with
cohabitating parents.
grandparents.
homosexual parents.
single parents.
The primary care pediatric nurse practitioner is performing a well baby
examination on a newborn whose mother is 17 years old. The mother states that she is living with her parents and plans to finish high school. The maternal grandmother will care for the infant while she is in school. What will the nurse practitioner discuss with this mother at this visit?
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Early child intervention programs
Her needs for socialization with peers
Immunizations and well child visits
Referral to a community health nurse
The primary care pediatric nurse practitioner is performing an examination on a
2yearold child who has been placed in emergency foster care with a grandparent after the child’s mother has been arrested for drug use. The child has a history of asthma with frequent exacerbations because of parental smoking. What is a priority for the nurse practitioner at this visit?
Evaluation of financial resources, medical insurance, and access to health care and medications
Providing a list of websites and communitybased support groups for grandparents parenting grandchildren
Referral to a social worker to help the child deal with emotional conflict related to separation from the parent
Teaching the grandparent about the need for consistency in routines and discipline for the child
The primary care pediatric nurse practitioner is discussing newborn care with a
mother who is pregnant with triplets. When counseling the mother about feeding issues, the nurse practitioner will recommend
developing a plan to rotate breastfeeding for her infants.
making sure that the triplets are on the same feeding schedule.
pumping her breasts so she can feed breastmilk to all three.
supplementing with formula to ensure adequate nutrition.
The primary care pediatric nurse practitioner is assessing a special needs school ID: 13348434187 age child whose family has just moved to the area. What is a priority concern at this initial visit?
Asking the parents to describe the child’s illness, treatments, and unique needs
Connecting the family to local support groups, school programs, and resources
Gathering information about financial concerns related to the child’s condition
Providing expert information about the child’s condition and its management
The primary care pediatric nurse practitioner is counseling a family whose parents
are divorcing. To help support the children and reduce their stress through this process, the nurse practitioner will recommend
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allowing children to choose the custodial parent.
being open about ongoing parental conflicts.
establishing a single custody living arrangement.
maintaining a civil relationship when discussing children.
The primary care pediatric nurse practitioner learns that a schoolage child
continues to hope that his parents will remarry 1 year after they have divorced. What will the nurse practitioner tell this child’s parents?
“If one of you remarries, he is more likely to understand that this is permanent.”
“This is a normal response and is an expression of hope that things will be OK.”
“You will need to help him accept the reality of the permanence of the divorce.”
“Your child is most likely blaming himself for your separation and divorce.”
The primary care pediatric nurse practitioner is examining an infant who has otitis
media and learns that the mother and child are homeless. Besides assisting the mother to obtain medication to treat this illness, what is a priority during this visit?
Assisting the mother to obtain transportation for health care needs
Determining well child examination history and immunization status
Making sure the family has access to WIC and food stamps resources
Obtaining a tuberculosis skin test and scheduling a return office visit
The primary care pediatric nurse practitioner suspects that the parent of a child
who is doing poorly in school is being abused by a partner. What is a priority response by the nurse practitioner?
Notifying the child’s school counselor about this problem
Referring the child and family to a social worker
Reporting this according to any mandated reporting laws
Suggesting that the parent avoid the abusive situation
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practitioner that the child may be the victim of cyberbullying at school but won’t talk about it with her parents. What is the nurse practitioner’s initial response?
Ask about the adolescent’s school performance and friends.
Interview the adolescent separately from the parent.
Reassure the parent that suicide is a rare response to bullying.
Suggest that the parent discuss this with the school counselor.
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The primary care pediatric nurse practitioner is examining a young child who was
brought in by a grandmother for evaluation of a partialthickness burn on one arm. The PNP suspects that this is an intentional injury, but the grandmother states that the parents are “just careless” and that the child is now living with her. What will the PNP do?
Flag this as a concerning incident in the child’s record.
Reassure the grandmother that she is doing the right thing.
Refer the child’s parents to a parenting resource center.
Report a suspicion of abuse to child protective services.
The primary care pediatric nurse practitioner is evaluating a 12yearold girl who
reports penile penetration of her vagina by her mother’s boyfriend the day before yesterday. The PNP reports this to the local child abuse hotline. What is the PNP’s next action?
Attaining a history of the abuse from the child
Obtaining urethral specimens for STI testing
Performing a colposcopic examination to evaluate for trauma
Referring the child to the ED for forensic specimen collection
Chapter 18
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Questions
A parent who encourages competitiveness in a child who excels at a single sport but not in others may also encourage a sense of
competence.
insecurity.
significance.
worthiness.
A schoolage child enjoys playing basketball but doesn’t make the intramural
team. Which response by the child is characteristic of the concept of a growth mindset?
“I didn’t play well on the day of the tryouts.”
“I’ll just have to find another sport I’m good at.”
“I’ll need to work more on my outside shot.”
“I’m probably too short to be really good at this sport.”
The primary care pediatric nurse practitioner is evaluating a 16yearold
adolescent male who is on the high school wrestling team and whose weight fluctuates as much as 7 or 8 pounds before matches. The child is eager to talk about the various trophies he has won. When he expresses confidence that he will get a wrestling scholarship for college, his father remarks that his grades will never be good enough for college, causing him to blame his teachers. The nurse practitioner may identify potential problems with
body image.
personal identity.
role performance.
selfesteem.
The primary care pediatric nurse practitioner sees a 10yearold child whose
parent describes as a “class clown.” The child denies having problems at school, but acknowledges poor grades by saying, “I’m not very smart, I guess.” When counseling the parent about helping this child deal with this selfperception issue, the nurse practitioner will recommend which strategy?
Empower the child to make decisions and assume more responsibilities.
Help the child identify skills and activities that he is good at.
Spend time each evening helping the child with homework to improve grades.
Work with the teacher to set appropriate limits on school behavior.
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The primary care pediatric nurse practitioner is performing a well child
examination on a fussy toddler who has red hair. The child’s parent tells the toddler to stop being fussy and says, “red hair gives him such a temper.” Which common error that erodes selfesteem is this?
Dwelling on negatives
Expecting too much
Negating the child’s feelings
Stereotyping and typecasting
The parent of a 15yearold male is concerned that he refuses to eat meals
with the family and consumes only protein drinks. The adolescent is on the track team at school and spends much of his time training and working out. The primary care pediatric nurse practitioner notes that his weight and BMI have dropped from the 20th percentile to the 3rd percentile in the past year. This child most likely has a problem with
body image.
personal identity.
role performance.
selfesteem.
The parent of a schoolage child is concerned that the child is going to be
short like both parents and worries that he will have difficulty in school if he can’t participate in a variety of sports. What will the primary care pediatric nurse practitioner do to counsel this parent?
Encourage the child to engage in regular physical activity.
Overlook his or her own feelings about this physical characteristic.
Point out the accomplishments of other short people.
Steer the child into other activities at school.
Chapter 19
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Questions
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?
“I can sense a difference in my baby’s cries.”
“I let my baby cry a while to learn to be patient.”
“My baby prefers to nurse in a darkened room.”
“My baby seems very sensitive to loud noises.”
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practitioner tell the parent about managing this child’s behavior?
A difficult temperament is its own risk factor for maladjustment disorders.
Children with difficult temperaments need strict adherence to rules.
Having a difficult temperament limits intelligence and emotional maturity
It is important for the parent to learn to manage criticism and power struggles.
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?
Ask the parent whether other caregivers have voiced similar concerns.
Interview the child separately from the parent to encourage sharing of feelings.
Take time to actively listen to the parent’s and child’s perceptions of the problem.
Use a validated screening tool to ensure that all aspects of behaviors are evaluated.
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emotional health of an 18monthold child through which assessment strategy?
Asking the child to tell a story using dolls and other props
Asking the child to draw a picture of him or herself and other family members
Interviewing the child separately from caretakers and parents
Observation of the child with caretakers in structured and unstructured situations
A middleschoolage child is skipping school frequently and getting poor grades
since the child’s father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation?
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Prescribe shortterm antidepressants for this situational depression.
Refer the child to a mental health specialist for evaluation and treatment.
Schedule extended appointments for counseling and mental health interventio.
Suggest that the child have close followup by a school counselor.
The parent of a 4yearold child reports that the child seems to be having trouble
adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do?
Ask the parent if the child is slow to warm up to other new situations.
Reassure the parent that parallel play is common among preschoolage children.
Recommend that the parent spend time encouraging the child to play with others.
Suggest that the day care center may be neglecting the child.
The parent of a schoolage child is concerned because the child has started to
express anger about a grandparent’s death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent?
Anger is an abnormal reaction to bereavement and loss in this age child.
Counseling is needed since the child has had sufficient time to resolve this issue.
Grief and bereavement lasting longer than a year may require medication.
The significance of this loss must be reworked at each developmental level.
The parent of a schoolage child reports that the child doesn’t like being alone in
rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse
practitioner tell the parent?
“Fear of imaginary creatures does not usually occur at this age.”
“I may need to refer your child to a pediatric mental health specialist.”
“Your child is expressing normal fears for a schoolage child.”
“Your child may be watching too much violence on television.”
The parent of a preschoolage child reports that the child often appears anxious
and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend?
Cognitivebehavioral therapy
Family therapy
Medication therapy
Play therapy
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A 9yearold child exhibits school refusal and a reluctance to attend sleepovers
with classmates. The parent is concerned because the child has recently begun sleeping in the parents’ bed. Which initial action by the primary care pediatric nurse practitioner is appropriate?
Assess for environmental stress, parental dysfunction, and maternal depression.
Ask about recent traumatic events that may have precipitated this behavior.
Consider a possible pediatric autoimmune neuropsychiatric disorder cause.
Recommend firm insistence on school and activity attendance.
The parent of a schoolage child reports that the child becomes frustrated when
unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child?
Generalized anxiety disorder (GAD)
Obsessivecompulsive disorder (OCD)
Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)
Separation anxiety disorder (SAD)
The parent of a schoolage girl reports that the child has difficulty getting ready
for school and is often late because of a need to check and recheck whether her teeth are clean and her room light has been turned off. What will the primary care pediatric nurse practitioner recommend to this parent?
Cognitivebehavioral therapy
Deferral of treatment until symptoms worsen
Medication management with an SSRI
Referral to a child psychiatrist
The parents of a 4yearold boy are concerned because he has begun twisting
and pulling out his hair, especially when he is tired or stressed. What will the primary care pediatric
nurse practitioner recommend as part of an initial approach to treat this behavior?
Consultation with a pediatric behavioral specialist
Cutting his hair so that it is too short to pull
Longterm antistreptococcal prophylaxis
Medication with risperidol or clonidine
A newly divorced mother of a toddler reports that the child began having difficulty
sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates
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and often spends time sitting quietly. What will the nurse practitioner doinitially?
Ask the mother about the child’s relationship with the father.
Consult with a child psychiatrist to prescribe medications.
Recommend cognitive behavioral or psychodynamic therapy.
Refer the family to a child behavioral specialist for counseling.
An adolescent has recently begun doing poorly in school and has stopped
participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient?
Administering a diagnostic rating scale for depression
Considering a shortterm trial of an antidepressant medication
Determining suicidal ideation and risk of suicide D. Referring the adolescent to a mental health specialist
An adolescent is diagnosed with major depression, and the mental health
specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk?
Addition of risperidone therapy
Cognitivebehavioral therapy
Family therapy
Hospitalization
A 13yearold child has exhibited symptoms of mild depression for several weeks. ID: 13348419846 The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do?
Administer an ADHD diagnostic scale and consider an ADHD medication.
Consult with a child psychiatrist to prescribe an antidepressant medication.
Reassure the parent that this behavior is common after mild depressive symptoms
Refer the child to a child psychiatrist for evaluation of bipolar disorder.
A toddler has begun hitting and biting other children at a day care center and is
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?
Advise the parent that the child is exhibiting early symptoms of ADHD.
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Engage the parent in positive parenting strategies to facilitate appropriate child coping.
Recommend evaluating the child for conduct or oppositional defiant disorder.
Suggest putting the child in another day care center to ameliorate the problems.
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?
Anorexia nervosa
Bulimia nervosa
Depression
Substance abuse
=
Chapter 20
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ID: 13348413834
Questions
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
emotional control.
flexibility.
inhibition.
problemsolving.
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
executive function.
information processing.
sensory processing.
social cognition.
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
about friends and activities at school.
if balancing sports and homework is difficult.
