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PEDIATRIC PRIMARY CARE 6TH EDITION BY DAWN LEE GARZON – TEST BANK 100% ANSWERS

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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. ID: 13348411196 ID: 13348411184 ID: 13348411178 ID: 13348411198 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 ID: 13348411182 ID: 13348411172 ID: 13348411192 ID: 13348411176 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 ID: 13348411194 ID: 13348411174 ID: 13348411180 this? ID: 13348411186 ID: 13348411188 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? ID: 13348411190 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 ID: 13348437935 ID: 13348437931 ID: 13348437923 ID: 13348437929 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 ID: 13348437933 ID: 13348437939 ID: 13348437927 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 H. I. ID: 13348437925 J. K. ID: 13348437941 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 ID: 13348411124 ID: 13348411128 ID: 13348411116 ID: 13348411134 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 ID: 13348411130 ID: 13348411132 ID: 13348411120 ID: 13348411122 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 ID: 13348411126 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. ID: 13348413814 ID: 13348413806 ID: 13348413802 ID: 13348413804 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. R. S. ID: 13348413816 T. U. ID: 13348413812 V. W. ID: 13348413818 X. Y. ID: 13348413810 Z. AA. ID: 13348413808 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. L. M. ID: 13348413820 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. ID: 13348437949 ID: 13348437957 ID: 13348437947 ID: 13348437959 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. EE. FF. ID: 13348437953 GG. HH. ID: 13348437945 II. JJ. ID: 13348437955 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.” P. Q. ID: 13348437951 R. S. ID: 13348411130 “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. ID: 13348437983 ID: 13348437975 ID: 13348437977 ID: 13348437967 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 MM. NN. ID: 13348437973 OO. PP. ID: 13348437987 QQ. RR. ID: 13348437971 D. Suggest consideration of a different classroom 5. The primary care pediatric nurse practitioner is preparing to conduct a well child ID: 13348437965 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 8. A school­age child has begun refusing all cooked vegetables. What will the primary ID: 13348437969 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 ID: 13348437981 ID: 13348437985 ID: 13348437979 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 ID: 13348413882 ID: 13348413872 ID: 13348413862 ID: 13348413868 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. ID: 13348413864 ID: 13348413878 ID: 13348413870 ID: 13348413866 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 ID: 13348413874 ID: 13348413884 ID: 13348413880 ID: 13348413876 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. ========================= Chapter 9 ID: 13348422936 ID: 13348422932 ID: 13348422942 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 ID: 13348422928 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 ID: 13348422940 ID: 13348422924 ID: 13348422934 ID: 13348422946 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 ID: 13348422926 ID: 13348422930 ID: 13348422944 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 ID: 13348422918 ID: 13348422902 ID: 13348422910 ID: 13348422908 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 ID: 13348422914 ID: 13348422900 ID: 13348422912 ID: 13348422906 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 ID: 13348422904 ID: 13348422920 ID: 13348419898 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 ID: 13348443911 ID: 13348443923 ID: 13348443919 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. ID: 13348443925 ID: 13348443917 ID: 13348443903 ID: 13348443921 ID: 13348443913 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. ID: 13348443907 ID: 13348443915 ID: 13348443905 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 ID: 13348417432 ID: 13348417426 ID: 13348417424 ID: 13348417416 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? ID: 13348417428 ID: 13348417422 ID: 13348417418 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 The primary care pediatric nurse practitioner evaluates a 4­year­old girl ID: 13348417430 ID: 13348417436 ID: 13348417420 ID: 13348417434 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 ID: 13348419808 ID: 13348417494 ID: 13348417484 ID: 13348417474 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. ID: 13348417488 ID: 13348417478 ID: 13348417476 ID: 13348417496 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.” ID: 13348419802 ID: 13348417492 ID: 13348417472 ID: 13348417490 “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. ID: 13348419804 ID: 13348417480 ID: 13348419806 ID: 13348417486 ID: 13348417498 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? ID: 13348419800 ID: 13348417482 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 ID: 13348422990 ID: 13348422992 ID: 13348422994 ID: 13348425700 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. ID: 13348422980 ID: 13348422986 ID: 13348425702 ID: 13348422982 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 ID: 13348422988 ID: 13348422998 ID: 13348422996 ID: 13348422984 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 ID: 13348443929 ID: 13348443943 ID: 13348443941 ID: 13348443931 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 ID: 13348443937 ID: 13348443945 ID: 13348443933 ID: 13348443935 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. ID: 13348443939 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 ID: 13348443955 ID: 13348443949 ID: 13348443957 ID: 13348443953 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. ID: 13348443951 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 ID: 13348434195 ID: 13348434177 ID: 13348434199 ID: 13348434197 ID: 13348434181 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? ID: 13348434183 ID: 13348437903 ID: 13348434175 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 ID: 13348434189 ID: 13348437901 ID: 13348434191 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 The parent of an adolescent female tells the primary care pediatric nurse ID: 13348434179 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. ID: 13348434193 ID: 13348434185 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 ID: 13348437917 ID: 13348437911 ID: 13348437913 ID: 13348437907 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. ID: 13348437919 ID: 13348437909 ID: 13348437915 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 ID: 13348419834 ID: 13348419812 ID: 13348419816 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.” A child has a difficult temperament. What will the primary care pediatric nurse ID: 13348419824 practitioner tell the parent about managing this child’s behavior? 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. The primary care pediatric nurse practitioner attempts to learn more about the ID: 13348419842 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? ID: 13348419848 ID: 13348419828 ID: 13348419840 ID: 13348419814 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 ID: 13348419818 ID: 13348419830 ID: 13348419844 ID: 13348419836 ID: 13348419820 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 ID: 13348419826 ID: 13348419832 ID: 13348419822 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. ID: 13348419838 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 ID: 13348413838 ID: 13348413842 ID: 13348413832 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 balanci [Show More]

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