621 Exam 1: module 1 and 2

formal operational stage

-12 yrs+ -people begin to think logically about abstract concepts

inadmissible conditions for u.s immigration purposes

-active: TB, syphillis -STI -no documentation of vaccines -disorders w/ harmful behaviors -drug abuse or addiction

healthy people 2020

-address specific disparities in childhood -increased early intervention services -improved screening for autism/developmental delays -increase in primary care providers

where to find health supervision guidelines

-american academy of pediatrics -bright futures

essentialist view of culture

-ethnic minorities have static set of traits -oversimplifies, applies traits to all members of groups -may stereotype pt, families, communities *BAD*

contraindications to motivational interviewing

-immediate risk of harm to self or others -medical conditions that may alter the pt LOC of emergency treatment -moderate to severe cognitive impairments

bright futures guidelines

-prevention-based, developmental oriented care -parent tools to empower families to be active partners

increased access to APNs in primary care can

-reduce cost -improve outcomes -provide continuity of care for underserved children with chronic conditions

what does the united nations convention on the rights of children do

-set minimum entitlements and freedoms for children globally -advises gov. to provide healthcare, clean water, environment, and food -emphasis on strength of families -founded on principle of respect for dignity and worth of each person

barriers to effective well child-care

-time constraints -low reimbursements -lack of provider education in current strategies to id child development -lack of community referral sources to assist

6. An 18-year-old male has called the crisis line for help. The crisis nurse recognizes the intervention needs may consist of all of the following except: 1. Discussing the individuals everyday activities. 2. Recognizing that the patient may be in a catharsis state. 3. Expressing empathy toward the caller. 4. Avoiding entropy.

1. Discussing the individuals everyday activities.

14. A teen should be checked for depression at __________ physician visit(s). 1. Every 2. One 3. Monthly 4. Bi-yearly

1. Every

two ways to respond to change talk

1. normalize 2. reflective listening

Piaget's stages of cognitive development

1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational

Three Talk Model (Shared Decision Making)

1. team talk 2. option talk 3. decision talk

Erkison's stages

1. trust vs mistrust (0-1) 2. autonomy vs shame and doubt (1-3) 3. initiative vs guilt (3-5) 4. industry vs inferiority (school age) 5. identity vs role confusion (10-20) 6. intimacy vs isolation (20-30) 7. generativity vs stagnation (40-50) 8. integrity vs despair (60)

general health status of children in the US

17% are obese (poor diet w/ high sugar and saturated fats) -1/5 live in food insecure houses

preoperational stage

2-7 yrs old -child uses language -symbolic thinking

2. A 16-year-old male has received a pink-slip from the police for inpatient psychiatric treatment. The teen has been expressing thoughts of hanging himself because Life sucks. The nursing staff should consider placing the child: 1. With peers. 2. In an area where he can be watched one-on-one. 3. With a roommate that is expressing the same concerns. 4. In an area close to an external door.

2. In an area where he can be watched one-on-one.

Model of cultural competence

3 interconnected themes: -awareness -engagement -application

3. The primary care pediatric nurse practitioner sees a 3yearoldchild 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 third party reimbursement? 1. Altered elimination pattern 2. Elimination disorder 3. Encopresis 4. Parenting alteration

3. Encopresis

7. An 8-year-old boy with a history of hallucinations and violent behavior has been place in a seclusion roomat the hospital because he has been hurting others. The nurse checks on the patient and realizes she must take him out of the seclusion room when: 1. He is crying to be released. 2. He states, I will be a good boy now. 3. He starts headbutting the window. 4. He complains that his parents will file a lawsuit.

3. He starts headbutting the window.

16. A school nurse is giving an in-service to teachers on bullycide. The main reason for the teaching is sothat: 1. Teachers are aware bullying occurs. 2. Teachers are able to identify students who are risk. 3. Teachers can be aware of the fact that suicides can happen due to bullying by others. 4. Teachers are aware of their role in causing bullycide.

3. Teachers can be aware of the fact that suicides can happen due to bullying by others.

5. A child that has not exhibited enuresis in four years has exhibited this behavior pattern for the last week.The reason a child may revert back to this behavior pattern is because of: 1. Hallucinations. 2. Behavioral challenges. 3. Delusions. 4. Stress.

4 stress

1. A nurse is explaining the therapeutic milieu to a new nurse. The best explanation of this term would be: 1. The place where the child is receiving care. 2. Group therapy. 3. Personal interactions between patients and staff. 4. All of the above are correct.

4. All of the above are correct.

12. An infant displays depression by: 1. Smiling at strangers. 2. Bonding to someone other than the immediate family. 3. Crying more than an average infant. 4. Looks away when an adult attempts to play with the infant.

4. Looks away when an adult attempts to play with the infant.

4. The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem? 1. Failure to thrive 2. Home care resources inadequate 3. Nutrition alteration - less than required 4. Parenting alteration

4. Parenting alteration

concrete operational stage

7-11 yrs -children gain the mental operations that enable them to think logically about concrete events

how long do you have post arrival as an immigrant to get a medical screening

90 days then the CDC notifies agencies of those needing treatment

10. The primary care pediatric nurse practitioner is examining a child whose parents recently emigrated from a war torn country in the Middle East. Which is a priority assessment when performing the patient history? A. Asking about physical, psychological, and emotional trauma B. Determining the parents' English language competency and literacy level C. Learning about cultural preferences and complementary medicine practices D. Reviewing the child's previous health and illness records

A. Asking about physical, psychological, and emotional trauma

7. The primary care pediatric nurse practitioner prescribes a twice daily inhaled corticosteroid for a 12 year old 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 client centered care? A. Asking the child to describe usual daily routines and schedules b. Referring the family to a social worker to help with medication compliance c. Reviewing the asthma action plan with the parent and the child d. Teaching the child how the medication will help to control asthma symptoms

A. Asking the child to describe usual daily routines and schedules

2. When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource? A. DC: 03R B. ICD10CM. c. ICSD3 d. NANDA International

A. DC: 03R

10. A mental health nurse is teaching the mother of a child with executive functioning issues ways to helpher child. Interventions the mother should use include: 1. Placing visual aids on the bathroom mirror so that the child will follow the morning routine. 2. Give the child a choice in foods to eat. 3. Allowing the child to ask for help when needed. 4. Reminding the child to be nice to others.

ANS: 1

17. An adolescent with a known history of bipolar disorder is in the school nurses office because a teacher reported that she was talking fast and acting like she was God. The school nurse assesses the girl and notes that: 1. She is probably in a manic phase and needs to be treated professionally. 2. She has had too much sleep and is now hyperactive. 3. She forgot to take her medications today. 4. She requires some food and rest before going back to class.

ANS: 1

11. Ellie, a 9-year-old girl, was adopted by a family at the age of 4 after several years of severe neglect by her birth family. The adoptive family has been reporting that Ellie is angry a lot, manipulative with herteachers, and does not seek positive attention. The nurse working with Ellie will need to: 1. Provide education on decreasing stimuli in the home environment that triggers the anger. 2. Realize Ellie may have attachment issues related to her previous history and will need to encourage the family to be active in her care. 3. Support the family in the decision-making process of continuing to let Ellie live in the home. 4. Discuss inpatient therapy to decrease Ellies manipulative behavior patterns.

ANS: 2

13. A father reports that his adolescent daughter has gotten good grades up until the last quarter of school.She has been hanging out by herself and does not want to talk to him anymore. The mental health nurse should: 1. Realize that this is a natural part of growing up. 2. Perform a mental health screening to check for depression. 3. Attempt to get the adolescent to discuss why she does not like her father anymore. 4. Let the adolescent talk when she is ready.

ANS: 2

8. A child has been exhibiting the MacDonald Triad. These behaviors include: 1. Enuresis, pushing others, and pyromania. 2. Swinging a cat by the tail, bed-wetting, and lighting paper on fire in the trash can. 3. Playing with other children, laughing, and conversing with adults. 4. Playing with a campfire, watching television, and seeking adult attention.

ANS: 2

3. Learning disabilities in children have scientifically been linked to: 1. Poor nutrition. 2. The environment in which the child lives. 3. Genetics. 4. Watching more than four hours of television a day.

ANS: 3

4. A mental health nurse has assessed a child and determined that the child exhibits behavioral challenges. When the school nurse explains this to a teacher, the best description would be: 1. The child may exhibit physical outbursts. 2. The child may exhibit violence toward others. 3. The child may be defiant or have tantrums. 4. The child will need special interventions for learning.

ANS: 3

9. A teenager diagnosed with borderline personality disorder should have discharge planning instructions of: 1. A consistent caregiver. 2. Monitoring of media, such as the Internet, television, and video games. 3. Obtaining support from family and friends. 4. Seeking medical attention when the teenager feels good.

ANS: 3

15. When using the SAD FACES depression screen, it is important to assess: 1. Anhedonia. 2. Suicidal ideations. 3. Sleep patterns. 4. All of the above

ANS: 4

5. A Somalian immigrant mother is concerned that her 8 year old child is 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 American born 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? A. Global B. Interpersonal C. Intrapersonal D. Organizational

B. Interpersonal

3. Which is true about the health status of children in the United States? A. Globalism has relatively little impact on child health measures in the U.S. B. Obesity rates among 2-to-5 year olds have shown a recent significant decrease. C. The rate of household poverty is lower than in other economically developed nations. D. Young children who attend preschool or day care have higher food insecurity.

B. Obesity rates among 2-to-5 year olds have shown a recent significant decrease.

social learning theory

Bandura's view of human development; -social behavior is learned by imitating others

14. The primary care pediatric nurse practitioner evaluates a schoolage childwhose 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? A. Metabolic syndrome B. Nutritional alteration: more than required C. Obesity d. Rule out type 2 diabetes mellitus

C. Obesity

1. Which region globally has the highest infant mortality rate? A. Indonesia B. Southern Asia C. SubSaharan Africa D. Syria

C. SubSaharan Africa

2. The primary care pediatric nurse practitioner understands that, to achieve the greatest world wide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? A. Antibiotics B. Optimal nutrition C. Vaccinations D. Water purification

C. Vaccinations

4. The primary care pediatric nurse practitioner understands that a major childhealth outcome associated with worldwide climate change is A. cost of living. B. education. C. nutrition. D. pollution.

C. nutrition.

5. When providing well child care for an infant in the first year of life, the primarycare pediatric nurse practitioner is adhering to the most recent American Academy of PediatricsRecommendations for Preventive Pediatric Health Care guidelines by A. focusing less on development and more on illness prevention and nutrition. B. following guidelines established by theBright Futures publication. C. scheduling wellbaby visits to coincide with key developmental milestones. D. seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due.

C. scheduling wellbaby visits to coincide with key developmental milestones.

10. A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner notes that the child's last visit was for a prekindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner doinitially? A. Ask the child's parent why the child is so anxious. B. Perform a physical assessment to rule out shortness of breath. C. Reassure the child that there is nothing to be afraid of. D. Review the purpose of this visit and any anticipated procedures.

D. Review the purpose of this visit and any anticipated procedures.

1. The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history? A. Complementary medications, alternative health practices, and chief complaint B. Developmental delays, nutritional status, and linear growth patterns C Medication currently taking, allergy information, and family medical history D Speech and language development, beliefs about health, and previous illnesses

D. Speech and language development, beliefs about health, and previous illnesses

what three things help address food insecurity in US

SNAP, WIC, School breakfast program

ana code of ethics provision 4

The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.

ana code of ethics provision 2

The nurse's primary commitment is to the patient, whether an individual, family, group, or community.

ANA Code of Ethics Provision 1

The nurse, in all professional relationships, practices with compassion and the recognition of human dignity and worth that is present in every individual

12. The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk? A. Three generation pedigree b. Review of systems c. Genogram d. Ecomap

a. 3 generation pedigree

3. 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? a. Ask about the types of practices used and when they are applied. b. Provide a list of harmful herbs and ask the family to avoid those. c. Suggest that the family avoid using these remedies in their children. d. Tell the parents to use the herbs in conjunction with modern medications.

a. Ask about the types of practices used and when they are applied.

11. The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool age child. How will the nurse practitioner assess a. Ask the child how many books he has at home. b. Ask the mother about her highest grade in school. c. Ask the mother to determine the correct dose of a drug from a label. d. Ask the mother to read a health information handout aloud.

a. Ask the child how many books he has at home.

8. 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? a. Asking community members to assist in researching and implementing a program b. Designing a community garden approach that involves children and their parents c. Gaining support from the corporate community to provide needed resources d. Providing evidence based information about the importance of a healthy diet

a. Asking community members to assist in researching and implementing aprogram Correct

1 3. The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use? a. CRAFFT b. HEEADSSS c. PHQ2 d. RAAPS

a. CRAFFT

9. 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 a. global application. b. global awareness. c. system application. d. system awareness.

a. global application.

cultural competence

an inclusive approach to healthcare -must actively acquire cultural knodlege -cornerstone is sensitivity to culture of client, family, community

erikson's 1-3

autonomy vs shame and doubt

inequalities in the health of children are determined by

biosocial factors (where they are born, live, educated, age) according the WHO

what increases survival rate of infants in regards to nutrition

breastfeeding *undernutrition, low rates of breast feeding, and zinc deficiency contribute significantly to child mortality rates globally)

4. 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? a. Giving health care advice that takes cultural differences into account b. Identification of other cultures that may be superior to one's own culture c. Receptivity to learning about the perspectives of other cultures D. Respecting other cultures while maintaining the views of one's own

c. Receptivity to learning about the perspectives of other cultures

1. The primary care pediatric nurse practitioner provides well child care for a community of immigrant children from Central America. The pediatric nurse practitioner issurprised to learn that some of the families are Jewish and not Catholic. This response is an example of cultural a. collectivism. b. constructivism. c. essentialism. d. individualism.

c. essentialism.

9. When meeting with a new family, the primary care pediatric nurse practitioner develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information? A. CRAFFT B. Ecomap C. Genogram D. Pedigree

c. genogram

2. The primary care pediatric nurse practitioner learns that an African American 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 a. cultural sensitivity. b. group bias. c. individual privilege. d. racial awareness.

c. individual privilege.

the hallmark sign of readiness to change is

change talk

Vigotsky's Sociocultural Theory

cognitive development proceeds as a result of social interactions between members of a culture

change talk by looking forward

comparing the current situation with what it would be like to not have the problem in the future

6. 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 a. ask the sponsor to allow the family to respond. b. develop the plan of care and ask the sponsor to make sure it is followed. c. request that the sponsor translate written instructions for the family. d. use the telephone interpreter service to communicate with the family.

d. use the telephone interpreter service to communicate with the family.

2 leading causes of childhood mortality and morbidity are

diarrhea (rotavirus) and pneumonia (strep pna)

american academy of pediatrics guidelines

emphasis on behavioral and healthy grow development surveillance

food insecurity

exists when populations do not have physical and economic access to sufficient, safe, nutritions and culturally acceptable food to meet nutritional need

change talk for pt with difficulty changing

focus on being supportive as pt wants to change but is struggling

change talk by provoking extremes

for use when there is little expressed desire for change. have patient describe a possible extreme consequence

erikson's 10-20

identity vs role confusion *they need support, emotional support

majority of extreme poor live in which five countries

india china nigeria bangladesh congo

Individualism vs. Collectivism

individualism: belief in separation and autonomy of individuals. recognizes individual as basic unit of survival. mainstream US medical practices collectivism: persons are intrinsically part of group. emphasis on interdependence, affiliation, cooperation -often found in other cultures

erikson's 5-10

industry vs. inferiority

erikson's 3-5

initiative vs guilt

institutional racism

invisible, eurocentric assumptions that define values at expense of marginalized groups

strongest predictor of quality of care for u.s children

lack of health insurance

cultural humility

lifelong commitment to self-evaluation and self-critique to develop respectful relationships with communities

ethics

moral principles that govern a person's or the conducting of an activity

Freudian Stages of Development

oral stage (0-1.5) anal stage (1.5-3) phallic stage (3-6) latency stage (6 to puberty) genital stage (puberty & up)

motivational interviewing

person-centered. a form of collaborative conversation for strengthening a person's own motivation and commitment to change

piaget believes development _____ learning

precedes

national healthcare disparities report focuses on 4 components

prevention treatment management access to care

ethical dilemma vs ethical problem

problem: right versus wrong choices dilemma: right versus right choices

constructivist view of culture

recognizes culture as complex, dynamic, evolving, changing -acknowledges that pt belong to multiple cultures simultaneously -focus on individuality/uniqueness of each pt

cultural humility requires what

self-awareness accurate self opinion acknowledgement of limitations curiosity willingness to be changed

attachment theory

the idea that early attachments with parents and other caregivers can shape relationships for a person's whole life

ana code of ethics provision 6

the nurse facilitates improvement of the healthcare enviornment

ana code of ethics provision 5

the nurse has a duty to self to maintain competence and to continue professional growth

ana code of ethics provision 3

the nurse seeks to protect the health, safety, and rights of the patient

erikson's 0-1

trust vs mistrust

sensorimotor stage

understands world through senses and actions -0-2 yr