Peds Chapter 28, CPNP
12. A child who has sustained a head injury after falling on the playground is brought to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric nurse practitioner notes slight slurring of the child's speech and the child has vomited twice in the exam room. Which course of action is warranted? a. Admit the child to the hospital for a neurology consult. b. Observe the child in the clinic for several hours. c. Order a head CT and observe the child at home. d. Send the child home with instructions for followup.
a
7. Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients? a. Calcium and vitamin D b. Fatsoluble vitamins c. Iron and zinc d. Sodium and potassium
a
9. 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? a. Discuss setting clear expectations about self-care with the mother b. Give the child information about sleep and self-care c. Reassure the mother that this "non-compliance" is temporary d. Tell the mother that experimenting with self-care behaviors is normal
a
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 The nurse practitioner observes the child to appear withdrawn and sad.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? a. Ask the child and the parent about stressors at home b. Make a referral to a child behavioral specialist c. Provide information about anger management d. Suggest consideration of a different
a
The mother of a 15yearold adolescent female tells the primary care pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different just before her periods, the adolescent points to her mother and says, "She gets really hard to live with." This demonstrates which characteristic of adolescent thinking? a. Apparent hypocrisy b. Imaginary audience c. Overthinking d. Personal fable
a
The mother of a newborn infant asks the primary care pediatric nurse practitioner about pumping her breasts when she returns to work in 2 months. What will the nurse practitioner include in teaching this mother? a. Frozen breast milk may be stored up to 3 months in a 0° F freezer. b. Once she begins pumping the infant should drink only pumped breast milk. c. Pumped breast milk must be discarded after 3 days when stored in the refrigerator. d. Unused defrosted breast milk may be stored in the refrigerator for 48 hours.
a
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? a. Ecigarette use may be a risk factor for later substance abuse. b. Experimentation with ecigarettes does not lead to future tobacco use. c. Most teens who experiment with tobacco usually do not become addicted. d. This form of nicotine ingestion is safer than regular cigarettes.
a
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? a. Cutting is a way of dealing with emotional distress. b. It is a method of fitting in with other adolescents. c. The behavior is common and will usually stop
a
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? a. Continue to offer a variety of foods without forcing the child to eat them. b. Offer snacks to make up for calories the child misses by not eating the vegetables. c. Prepare dishes the child likes to ensure that a vegetable is eaten at each meal. d. Require the child to take 1 to 2 bites of each food at each meal
a
The primary care pediatric nurse practitioner evaluates a 4yearold girl whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially? a. Examination for labial adhesions b. Palpation for abdominal masses c. Screening for potential child abuse d. Urine culture and sensitivity
a
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? a. Ask the parent about bathroom facilities in the child's day care. b. Refer the child to a gastroenterologist for evaluation of pathology. c. Suggest putting the child in diapers and resuming toilet training in a few weeks. d. Tell the parent that this represents a developmental delay.
a
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? a. Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis b. Reassure the parent that the child probably gets distracted and puts off voiding until it is urgent. c. Refer the child to a pediatric urologist for evaluation of possible vesicoureteral reflux. d. Suggest a bladder retraining program and use of a nighttime bedwetting alarm.
a
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 correct? a. Encourage the child to keep a log of pain, stool patterns, and dietary intake b. Order radiologic studies and laboratory tests to rule out systemic causes c. Reassure the child and encourage resuming sports when symptoms subside d. Refer the child to a counselor to discuss anxiety about health problems
a
The primary care pediatric nurse practitioner is examining a 15yearold female who reports having her first period at age 13. She states that she has had five periods in the last year, with the last one 2 months prior. She participates in basketball at school. Which action is correct? a. Perform biometric screening to determine lean body mass. b. Prescribe oral contraceptives pills to regulate her periods. c. Reassure her that this is perfectly normal at her age. d. Refer her to an endocrinologist for hormonal evaluation.
a
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? a. Ask the mother if the infant has any feeding difficulties. b. Refer the infant for a possible frenulectomy. c. Schedule an appointment with a lactation consultant. d. Suggest that the mother feed breast milk by bottle.
a
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? a. About the timing of the symptoms each day and during the week b. How well the child performs in school and in extracurricular activities c. If the parent feels a strong need to protect the child from problems d. Whether there are any unusual stressors or circumstances at home
a
The primary care pediatric nurse practitioner is examining a toddler who is below the 3rd percentile for weight even though the parents claim that the child eats "constantly." What will the nurse practitioner do initially? a. Evaluate the child's feeding and elimination behaviors and ask the family to describe mealtime routines. b. Recommend giving a multivitamin and offering highcalorie foods, such as ice cream. c. Refer the child to a feeding evaluation clinic for a swallow study and evaluation of possible GERD. d. Suggest that the parents supplement the child's food intake with a highcalorie formula.
a
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 a. Encouraging use of maintenance medications for at least 2 months after resolution of constipation b. Referral to a mental health consultant to manage problems in the parentchild dyad c. Spending time with the parents to uncover their feelings about their child's condition d. Teaching the parents that the symptom of stool retention is often voluntary for the child
a
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? a. Provide information about piercings and encourage continued discussion. b. Remind the adolescent that her mother is responsible for her health. c. State that piercings are relatively harmless and are an expression of individuality. d. Suggest that she wait until she is 18 years old and can make her own decisions.
a
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? a. Ask the mother to describe the color and consistency of the stools. b. Explain to the mother that breastfed infants should have daily stools. c. Recommend using a glycerin suppository as needed. d. Suggest to the mother that she increase her intake of fluids.
a
The primary care pediatric nurse practitioner is preparing to conduct a well child assessment of an 8yearold child. How will the nurse practitioner begin the exam? a. Ask the child about school, friends, home activities, and sports b. Discuss the purpose of the visit and explain the procedures that will be performed c. Offer age-appropriate information about usual developmental tasks d. Provide information about healthy nutrition and physical activities
a
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 a. discuss adding other foods to the baby's diet. b. encourage the mother to increase her fluid intake. c. prescribe a multivitamin containing iron. d. suggest offering only breast milk to the infant.
a
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? a. Ask the parents to provide a 3day food diary. b. Prescribe a daily multivitamin with iron. c. Reinforce the need to meet DRIs each day. d. Tell them that supplements are unnecessary
a
1. When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by a. bending the infant at the waist to touch fingers to toes. b. extending the leg at the knee with the infant supine. c. flexing the infant's neck to touch chin to chest. d. turning the infant's head from side to side.
b
10. The parents of an 18monthold child bring the child to the clinic after observing a brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of 103.1°F, and the primary care pediatric nurse practitioner notes a left otitis media. The child is alert and responding normally. What will the nurse practitioner do? a. Order a lumbar puncture, complete blood count, and urinalysis. b. Prescribe an antibiotic for the ear infection and reassure the parents. c. Refer to a pediatric neurologist for anticonvulsant and antipyretic prophylaxis. d. Send the child to the emergency department for EEG and possible MRI.
b
5. During a well baby exam on a 9monthold infant, the parent reports that the baby always uses the left hand to pick up objects and asks if the baby will be lefthanded. What will the primary care pediatric nurse practitioner do? a. Explain that it is too soon to tell which hand the infant will prefer later. b. Perform a careful assessment of fine and gross motor skill c. Teach the parent to encourage the infant to use both hands. d. Tell the parent that a hand preference usually develops between 6 and 12 months.
b
9. A child who has had a single nonfebrile seizure has a normal neurologic exam. Which diagnostic test is indicated? a. CT b. EEG c. MRI d. Polysomnography
b
A school-age child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent? a. Allow the child to make food choices since this is usually a phase b. Ensure that the child has three nutritious meals and two nutritious snacks each day c. Prepare vegetables separately for the child to encourage adequate intake d. Teach the child how important it is to eat healthy fruits and vegetables
b
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? a. Breastfeed only at bedtime to establish meal patterns. b. Clean the toddler's teeth each time after breastfeeding. c. Offer the breast just prior to meals to maintain milk supply. d. The toddler should continue to be breastfed "on demand."
b
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? a. Developing a system to reward compliance with a dietary regimen b. Restricting all access to food in the house and at school c. Suggesting an after-school exercise program to help with weight loss d. Using a food diary to track all calories and food intake
b
The primary care pediatric nurse practitioner is performing a well child assessment on a 13yearold female whose mother asks when her daughter's periods may start. Which information will the nurse practitioner use to help estimate the onset of periods? a. The age of the mother's menarche b. The patient's age at thelarche c. When adrenarche occurred d. Whether linear growth has stopped
b
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? a. 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. b. Placing the child on a "potty" chair helps the child associate elimination cues with the toilet. c. Predictability of elimination patterns indicates readiness for toilet training, and the parent can begin this process. d. The parent should wait until other signs of toilet training readiness occur before introducing the child to the toilet.
b
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? a. Earlymaturing girls need to identify with older adolescents to feel a sense of belonging. b. Girls who join an older group of peers may become sexually active at an earlier age. c. Spending time with older adolescents indicates a healthy adjustment to her maturing body. d. The association with older adolescents will help her daughter to gain social maturity.
b
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? a. Advise the parent to make the child get clean clothes after an accident. b. Ask the parent about the child's toilet habits and understanding of toilet training. c. Recommend using an awards system to encourage toilet use. d. Suggest that the parent place the child on the toilet at predictable intervals.
b
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? a. Calcium, vitamin C, and vitamin A b. Iron, folic acid, and B12 c. Magnesium, vitamin E, and zinc d. Vitamin D, vitamin C, and phosphorus
b
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? a. Begin supplementing with iron. b. Continue to nurse as long as desired. c. Discontinue the vitamin D supplement. d. Stop breastfeeding at 1 year of age.
b
10. 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? a. Adherence to daily family routines and regular activities b. Having two older siblings who attend the same school c. Parental concerns about bullying in school d. The child's ability to recognize four different colors
c
11. An adolescent female reports unilateral headache pain associated with abdominal pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for 6 months but reports little relief from symptoms. What will the primary care pediatric nurse practitioner do? a. Add acetaminophen and ondansetron to the naproxen regimen. b. Consider prophylactic therapy with a betablocker or anticonvulsant drug. c. Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours. d. Refer the adolescent to a pediatric neurologist for neuroimaging studies.
c
3. A female infant who was developing normally stops meeting developmental milestones at age 12 months and then begins losing previously acquired skills. What will the primary care pediatric nurse practitioner expect to tell the parents about this child's prognosis? a. Cognitive development will be normal but motor skills will be lost. b. Physical and speech therapy will help the infant regain lost skills. c. The child's intellectual development will not progress further. d. This is a temporary condition with full recovery expected.
c
4. A 14yearold child has a headache, unilateral weakness, and blurred vision preceded by fever and nausea. The child's parent reports a similar episode several months prior. The primary care pediatric nurse practitioner will consult with a pediatric neurologist to order a. a lumbar puncture. b. an electroencephalogram (EEG). c. neuroimaging with magnetic resonance imaging (MRI). d. positron emission tomography (PET) scan.
c
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? a. Giving the child a multivitamin since this is a phase b. Having the child eat vegetables before getting the hamburger c. Providing a variety of healthy foods at each meal d. Putting extra lettuce and tomatoes on hamburgers
c
The mother of a newborn asks the primary care pediatric nurse practitioner about the benefits of breastfeeding. What will the nurse practitioner tell her? a. Breastfeeding for 9 months or longer will reduce the incidence of food allergies. b. Breast milk is an excellent source of vitamin D, iron, and other essential nutrients for the baby. c. Nursing her baby exclusively for at least 4 months will help her infant to resist infections. d. There is a decreased risk of atopic dermatitis in babies who nurse for 12 months or longer.
c
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? a. Breastfed infants have lower serum cholesterol levels than those who are not breastfed. b. Maternal cholesterol levels affect the cardiovascular risk of breastfed babies. c. Maternal dietary cholesterol intake does not affect the infant's serum cholesterol values. d. She should limit her dietary cholesterol to prevent hyperlipidemia in her infant.
c
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 a. Children at this age who prefer interactions with same-gender peers usually have a homosexual orientation b. Children experiment with sexuality at this age as a means of deciding later sexual orientation c. This attachment to other same-gender children is how the child learns to interact with others d. To encourage mixed-gender interactions in order to promote development of sexual values
c
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? a. Do not allow a vegetarian diet in order to maintain appropriate limits for the adolescent. b. Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake. c. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. d. Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home.
c
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? a. Counseling for emotional problems b. Development of an Individual Education Plan c. Evaluation for possible learning disorders d. Referral for a behavioral disorder
c
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? a. Providing a reward system to offer incentives when the child uses the toilet b. Put the child back in diapers and resume toilet training in a few months. c. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation d. Use of polyethylene glycol until the child is able to use the toilet regularly
c
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? a. Allowing the child opportunities to discuss feelings about the baby b. 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
c
The parent of a 6-year -old child expresses concern that the child may have ADHD. Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility? a. Behavioral and Emotional screening system for children (BESS-2) b. Behavioral assessment for children - 2nd ed. (BASC-2) c. Conner's 3 parent and teacher rating scale d. Pediatric symptom checklist (PSC)
c
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 a. are generally low in sugar and fat. b. are healthy and help prevent obesity. c. may be deficient in essential nutrients. d. provide adequate protein to meet daily needs.
c
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? a. Initiating a bladder retraining program b. Ordering a voiding cystourethrogram c. Referral to a urologist for evaluation d. Treatment with prophylactic antibiotics
c
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? a. History of neurogenic conditions b. Recent adjustments in the family c. Recent illnesses, fluid intake, changes in diet d. Toilet training history
c
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 a. About school performance and grades b. Why school is so distressing c. To name one or two friends d. Whether bullying is taking place
c
The primary care pediatric nurse practitioner is performing an assessment on a 1weekold newborn with a slightly elevated bilirubin who is breastfeeding well and who has gained 30 grams in the past 24 hours. The infant is stooling and voiding well. The nurse practitioner suspects breast milk jaundice. Which action is correct? a. Order home phototherapy and closely monitor bilirubin levels. b. Reassure the mother that the bilirubin level will drop in a few days. c. Recheck the serum bilirubin and infant's weight in 24 hours. d. Recommend that the mother pump her breast milk for a couple of days.
c
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? a. "Foods given for this purpose do not meet all the child's nutritional needs." b. "Giving infants control of the feeding process will help prevent obesity." c. "Infants are given soft, mashable table foods when able to selffeed." d. "Infants must be able to grasp and feed themselves from a spoon to do this."
c
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? a. Breast milk is contraindicated if the mother has tuberculosis. b. She may continue to nurse her baby since the risk of transmission is low. c. That she can express breast milk and feed that to her infant d. To give formula until results of tuberculosis testing are known
c
13. The primary care pediatric nurse practitioner performs a well baby exam on a term 4monthold infant and observes flattening of the left occiput, bossing of the right occiput, and anterior displacement of the left ear. The parents report performing various positioning maneuvers, but say that the baby's head shape has worsened. What will the nurse practitioner recommend to correct this finding? a. Allow the infant to sleep on the tummy when the parents are in the room. b. Lay the infant in the "back to sleep" position, alternating the left and right occiput. c. Order a head CT to evaluate the infant for craniosynostosis. d. Refer the infant for orthotic cranial molding helmet therapy.
d
14. A 4yearold child who has previously met developmental milestones is not toiled trained. The primary care pediatric nurse practitioner notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child? a. ArnoldChiari malformation b. Reye syndrome c. Spina bifida cystica d. Tethered cord
d
2. To evaluate brain tissue disorders in infants, which test is useful? a. Computerized tomography b. Head radiographs c. Magnetic resonance imaging d. Ultrasonography
d
6. The pediatric nurse practitioner provides primary care for a 5yearold child who has cerebral palsy who exhibits athetosis and poor weight gain in spite of receiving highcalorie formula to supplement intake. The child has had several episodes of pneumonia in the past year. Which specialty consultation is a priority for this child? a. Feeding clinic to manage caloric intake b. Neurology to assess medication needs c. Pulmonology for possible tracheotomy d. Surgery for possible fundoplication and gastrostomy
d
8. A child with a recent history of URI reports tingling and pain in one ear followed by sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do? a. Initiate a short course of antibiotic therapy. b. Perform diagnostic testing to rule out serious causes. c. Prepare the parents for lifelong complications. d. Prescribe oral prednisone 1 mg/kg/day initially.
d
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 a. alcohol and tobacco use. b. changes in voice. c. increase in height and weight. d. participation in sports.
d
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? a. Adolescence is marked by an inability to comprehend complex situations. b. Adolescence is typically marked by tempestuous and transient episodes. c. Adolescents normally have extreme, disruptive conflicts with parents. d. Adolescents often need counseling to help them cope with life events
d
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 correct? a. Recommend pumping her breasts after feedings. b. Refer the mother to a lactation consultant. c. Suggest supplementation with formula. d. Weigh the infant to assess for a growth spurt.
d
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? a. Whole milk is usually not fortified with vitamin D. b. 2% milk is higher in essential proteins and minerals. c. Young children don't need the extra calories found in whole milk. d. Younger children need a limited amount of fats.
d
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 a. calcium deficiency. b. excess caloric intake. c. excess fat intake. d. protein deficiency.
d
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? a. Allowing the child to make poor choices and accept consequences is important for learning values b. Children at this age have a high regard for authority and social norms, so this is not likely to happen c. Moral values instilled in the early school-age period will persist throughout childhood d. The pressures from outside influences may supersede parental teachings and should be confronted
d
The primary care pediatric nurse practitioner is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the nurse practitioner recommend? a. Fatsoluble vitamins b. Iron c. Multivitamins with iron d. Vitamin D
d
The primary care pediatric nurse practitioner is counseling the parent of an 8yearold child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent? a. Anticholinergic medications are most commonly used for enuresis. b. Drug therapy is an effective way to achieve longterm control. c. Drug therapy is safest when the nasal spray form is used. d. The combination of alarm therapy and intermittent drug therapy.
d
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? a. Provide the teen with a questionnaire to gain information about his sexuality. b. Remind the adolescent that mandatory reporting requires disclosure to parents. c. Suggest that the adolescent discuss sexual concerns with his parents. d. Tell the adolescent that, unless he is at risk, what he says will be confidential.
d
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? a. Consultation with a lactation specialist to assess intake b. Pumping her breast during the night to maintain milk supply c. Supplementing the last feeding of the day with formula d. Waking the infant up at least every 3 hours to nurse
d
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 a. to continue to breastfeed her infant. b. to give the infant a cow's milk formula. c. to supplement breast milk with formula. d. to stop breastfeeding immediately.
d
When counseling an adolescent with a family history of hyperinsulinemia and type 2 diabetes, the primary care pediatric nurse practitioner will recommend avoiding a. baked potato chips. b. canned vegetables. c. highfiber cereals. d. processed breads.
d