Peds Test 1

1. The mother of a 6-month-old 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."

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.

"If the helmet is free from marks, you may use it."

1. The parent of a 24-month-old child asks the primary care pediatric nurse practitioner when toilet training should begin. How will the pediatric nurse practitioner respond?

"Tell me about your child's daily habits."

1. The primary care pediatric nurse practitioner is performing a well child assessment on a 13-year-old 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 patient's age at thelarche

1. The parents of a 12-year-old 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?

The pressures from outside influences may supersede parental teachings and should be confronted

1. An adolescent female who is sexually active and who has not had the HPV vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her?

The vaccine will not protect her from any HPV oncogenic types acquired previously

1. The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 6-year-old child who has Down syndrome. What will the nurse practitioner tell the parents about physical activity and sports in school?

Their child should have a cervical spine evaluation before participation in sports.

1. The mother of a 6-week-old 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?

This may be normal for breastfed babies.

1. According to recent research, which populations may have higher rates of under-immunization than others?

Those with higher rates of graduate degrees

1. The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old 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 make an appointment for an initial dental examination

The primary care pediatric nurse practitioner performs a physical examination on a 9-month-old 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 make an appointment for an initial dental examination

1. A 15-year-old 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?

To work with a dietician to improve healthy weight gain

The mother of a 3-year-old child takes the child to a play group once a week. She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother?

Toddlers may be interested in other children but usually do not engage in interactive play.

The primary care pediatric nurse practitioner is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the nurse practitioner recommend?

Vitamin D

The primary care pediatric nurse practitioner performs an initial well baby exam on a 1-week-old 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?

Waking the infant up at least every 3 hours to nurse

The mother of a 2-month-old 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?

Weigh the infant to assess for a growth spurt.

1. The parent of a school-age child who has asthma tells the primary care pediatric nurse practitioner that the child often comes home from school with severe wheezing after gym class and needs to use his metered-dose inhaler right away. What will the nurse practitioner do?

Write the prescription for two metered-dose inhalers with spacers.

1. A 3-year-old child whose immunizations are up-to-date has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?

Administer the MMR vaccine to help prevent disease.

1. A 2-month-old infant will receive initial immunizations, and the parent asks about giving medications to increase the infant's comfort and minimize fever. What will the primary care pediatric nurse practitioner recommend?

Administering ibuprofen or acetaminophen as needed

1. The mother of a 16-year-old 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?

Adolescents often need counseling to help them cope with life events.

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.

1. The mother of a 15-year-old 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

1. A 10-year-old 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?

Continuation of physical and cognitive rest

1. During an assessment of a 4-week-old 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 4-hour 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

1. The primary care pediatric nurse practitioner evaluates a 4-year-old 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?

Examination for labial adhesions

1. The primary care pediatric nurse practitioner is evaluating a 4-year-old 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.

1. A preschool-age child is brought to clinic for evaluation of a rash. The primary care pediatric nurse practitioner notes an intense red eruption on the child's cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?

Expect a lacy, maculopapular rash to develop on the trunk and extremities.

1. 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?

Language and literacy skills begin at birth.

1. When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated?

Lymphocytes

1. A 5-year-old child who received VariZIG after exposure to varicella while immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child?

MMR, Varivax, Tdap

1. The parent of an infant asks why some vaccines, such as MMR, are not given along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary care pediatric nurse practitioner tell this parent?

Maternal antibodies neutralize some vaccines and are delayed until 12 months.

The mother of a nursing infant expresses concern about whether high-cholesterol foods will increase her infant's risk of hyperlipidemia. What will the primary care pediatric nurse practitioner tell her?

Maternal dietary cholesterol intake does not affect the infant's serum cholesterol values.

The primary care pediatric nurse practitioner is offering anticipatory guidance to the parents of a 12-month-old child. The parents are bilingual in Spanish and English and have many Spanish-speaking 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?

Most bilingual children are able to shift from one language to another when appropriate.

1. The mother of a newborn asks the primary care pediatric nurse practitioner about the benefits of breastfeeding. What will the nurse practitioner tell her?

Nursing her baby exclusively for at least 4 months will help her infant to resist infections.

1. The primary care pediatric nurse practitioner performs a well child examination on a 1-month-old. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant's care?

Obtain regular absolute neutrophil counts.

1. During a well child assessment of an 18-month-old 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?

Offer the child a book or a toy to look at.

1. A child with a history of a pustular rash at the site of a cat scratch on one arm now has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do?

Order an immunofluorescent assay (IFA) for serum antibodies.

1. An 18-month-old child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered?

PCV13

1. During a well child exam on a 5-year-old 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?

Parental concerns about bullying in the school

1. The primary care pediatric nurse practitioner is evaluating a 5-year-old 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?

Recent illnesses, fluid intake, changes in diet

The primary care pediatric nurse practitioner is performing an assessment on a 1-week-old 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?

Recheck the serum bilirubin and infant's weight in 24 hours.

1. The primary care pediatric nurse practitioner reviews the immunization records of an 18-month-old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do?

Recommend the next dose of MMR vaccine at 4 to 5 years of age.

1. 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?

Referral to a urologist for evaluation

1. 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?

Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure

1. The primary care pediatric nurse practitioner is performing a pre-participation sports physical examination on a 14-year-old 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

1. 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

1. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3-year-old child who draws on the walls with crayons?

Provide a roll of paper for drawing and teach the child to use this.

1. The primary care pediatric nurse practitioner is performing a well child exam on a 17-year-old 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.

1. The parent of a 5-year-old 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 "pull-ups." The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend?

Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation

1. The parent of a 2-month-old infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns?

Question the parent's reasons for concern about immunizations.

1. The primary care pediatric nurse practitioner is performing a well child examination on a 9-month-old 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?

Read simple board books to the infant at bedtime.

The parent of a 4-year-old 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 preschool-age children?

Realism

1. An adolescent has a TB skin test prior to working as a volunteer in a hospital. The adolescent is healthy and has not travelled to or from a TB-endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do?

Reassure the adolescent that this is a negative screen.

1. A 9-month-old infant has had a fever of 103°F for 2 days and now has a diffuse, maculopapular rash that blanches on pressure. The infant's immunizations are up-to-date. What will the primary care pediatric nurse practitioner do?

Reassure the parent that this is a mild, self-limiting disease.

The primary care pediatric nurse practitioner performs a developmental assessment on a 32-month-old 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 correct?

Reassure the parent that this is normal

The primary care pediatric nurse practitioner sees a 3-day-old 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 stop breastfeeding immediately.

1. The primary care pediatric nurse practitioner is reviewing medical records for a newborn that is new to the clinic. The toddler's mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti-retroviral prophylaxis, and did not breastfeed. What is the correct management for this child?

Consult with a pediatric HIV specialist.

1. The primary care pediatric nurse practitioner is evaluating a heart murmur during a pre-participation examination of a high school athlete. Which finding would be a concern requiring referral to a cardiologist?

A murmur that is quieter when squatting and louder with a Valsalva maneuver

1. The primary care pediatric nurse practitioner is examining a school-age 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

1. A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?

Ask about recent tick bites

1. The primary care pediatric nurse practitioner is counseling an adolescent who was recently hospitalized for an asthma exacerbation and learns that the child usually forgets to use twice- daily inhaled corticosteroid medications that are supposed to be given at 0800 and 2000 each day. Which strategy may be useful in this case to improve adherence?

Ask the adolescent to identify two times each day that may work better.

1. The primary care pediatric nurse practitioner is preparing to conduct a well child assessment of an 8-year-old child. How will the nurse practitioner begin the exam?

Ask the child about school, friends, home activities, and sports

1. During a well child exam of a school-age 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

The primary care pediatric nurse practitioner is evaluating a 2-year-old 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.

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.

1. The primary care pediatric nurse practitioner is performing a well child exam on a 4-month-old 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.

1. The primary care pediatric nurse practitioner is discussing toileting issues with the parent of a 3-year-old 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?

Ask the parent about bathroom facilities in the child's day care.

1. The primary care pediatric nurse practitioner is performing a well child exam on a 24-month-old 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?

Ask the parent about the child's toilet habits and understanding of toilet training.

1. 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).

1. An unimmunized school-age child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?

Assessment of maternal rubella titers

1. 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?

At 4 weeks, she must have an exam to determine fitness for play.

1. The primary care pediatric nurse practitioner is discussing fitness and exercise with the parents of a 5-year-old child who ask what kinds of activities are developmentally appropriate for their child. What will the nurse practitioner recommend?

Bike riding

1. Which lab value is most concerning in an infant with fever and a suspected bacterial infection?

C-reactive protein of 11.5 mg/L

1. 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

1. The parent of a 12-year-old 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 follow heat acclimatization guidelines.

1. 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 show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity.

The mother of a 15-month-old 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?

Clean the toddler's teeth each time after breastfeeding.

1. A pharmaceutical company has developed a new drug that was tested only on adults. The FDA has declared this drug to have potential benefits for ill children. According to the Pediatric Research Equity Act (PREA), what may the pharmaceutical company be required to do?

Conduct pediatric drug studies to determine whether the drug is safe and effective in children.

1. 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?

Conner's 3 Parent and Teacher Rating Scale

1. A 10-month-old infant who is new to the clinic has chronic hepatitis B infection. What will the primary care pediatric nurse practitioner do to manage this infant's disease?

Consult a pediatric infectious disease specialist.

1. A 5-year-old child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given?

DTaP

1. The primary care pediatric nurse practitioner is examining a 17-year-old 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?

Dehydroepiandrosterone (DHEA)

1. 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?

Direct supervision of some activities is necessary.

1. The primary care pediatric nurse practitioner is considering using a drug for an "off-label" use in a child. The nurse practitioner has used the drug in a similar situation previously, has consulted a pharmacology resource and the FDA website, and has determined that there are no significant contraindications and warnings for this child. What else must the nurse practitioner do when prescribing this drug?

Discuss recommendations with the parents and document their consent.

1. The primary care pediatric nurse practitioner performs a physical examination on a 12-year-old 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 self-care with the mother

1. The parents of a pre-pubertal 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?

Enrolling their daughter in a program that uses fixed weight machines or resistance bands

1. A school-age child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent?

Ensure that the child has three nutritious meals and two nutritious snacks each day

1. A toddler is receiving long-term antibiotics to treat osteomyelitis. Which laboratory test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child?

Erythrocyte sedimentation rate (ESR)

1. The parent of a 16-year-old tells the primary care pediatric nurse practitioner that the teen was recently caught smoking an electronic cigarette (e-cigarette). What will the nurse practitioner tell this parent?

E-cigarette use may be a risk factor for later substance abuse.

1. The primary care pediatric nurse practitioner counseling the parent of an overweight school-age child about improving overall fitness. What will the nurse practitioner include?

Encourage the child to begin by engaging in swimming or cycling.

1. The parent of a 14-year-old 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?

Evaluation for possible learning disorders

1. The primary care pediatric nurse practitioner is evaluating recurrent stomach pain in a school-age 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?

Encourage the child to keep a log of pain, stool patterns, and dietary intake

1. The primary care pediatric nurse practitioner is managing a 6-year-old 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

1. 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?

Evaluation for underlying cardiac causes of this symptom

1. 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.

1. 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.

1. The primary care pediatric nurse practitioner is performing a well child exam on a 12-year-old 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?

Girls who join an older group of peers may become sexually active at an earlier age.

1. The parent of a 5-year-old 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?

Having snack time with the child each day to discuss the school day

1. A 7-year-old child whose immunizations are up-to-date has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated?

Hospitalization for diagnosis and treatment with antibiotics

1. A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do?

Hospitalize the child for intravenous acyclovir.

1. The mother of a 3-month-old 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?

How to read the infant's cues for overstimulation

1. A 2-month-old infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis?

Immunization history

1. A 10-month-old infant has an erythematous, fluctuant, non-draining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant's care?

Incision and drainage of the abscess with culture

1. The primary care pediatric nurse practitioner is examining a 12-month-old 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 in-depth developmental assessment.

1. The primary care pediatric nurse practitioner is performing an initial well child exam on a 3-year-old child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do?

Perform antibody titers and reimmunize the child.

1. The primary care pediatric nurse practitioner is examining a 15-year-old 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?

Perform biometric screening to determine lean body mass.

1. The primary care pediatric nurse practitioner is examining a 2-month-old infant with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?

Performing a catheterized urinalysis to screen for leukocytes and nitrites

The parents of a 3-year-old 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?

Place a variety of nutritious foods on the child's plate at each meal.

1. The primary care pediatric nurse practitioner is performing a well child exam on a 12-month-old 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?

Placing the child on a "potty" chair helps the child associate elimination cues with the toilet.

1. 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?

Point out the tasks that the infant can perform while conducting the assessment.

1. The single mother of a 4-year-old who attends day care tells the primary care pediatric nurse practitioner that she had difficulty giving her child a twice-daily amoxicillin for 10 days to treat otitis media during a previous episode several months earlier because she works two jobs and is too busy. The child has an ear infection in the clinic today. What will the nurse practitioner do?

Prescribe azithromycin once daily for 5 days.

1. A school-age child has fever of 104°F, sore throat, vomiting and malaise. The primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper-like rash on the child's neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child's illness?

Prescribe oral amoxicillin.

1. An 18-month-old child who developed upper respiratory symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?

Prescribe oseltamivir and follow closely

1. The parent of a 14-year-old 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?

Preseason conditioning

1. The primary care pediatric nurse practitioner performs a well baby examination on a 7-day-old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct?

Schedule a weight check in 1 week.

1. 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?

Suggest counseling to learn ways to handle stress.

1. The parent of a 14-year-old 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?

Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals.

1. A 3-year-old child who attends day care has had a fever, nausea, and vomiting several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child?

Supportive care

1. The primary care pediatric nurse practitioner conducts a well baby exam on an infant and notes mild gross motor delays but no delays in other areas. Which initial course of action will the nurse practitioner recommend?

Teach the parents to provide exercises to encourage motor development.

1. A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to verify the type or the length of time the ticks were attached. The child is asymptomatic. What is the best course of action?

Teach the parents which signs and symptoms to report.

1. 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?

Tell the adolescent that, unless he is at risk, what he says will be confidential.

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?

That she can express breast milk and feed that to her infant

1. A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent?

The MMR may be linked to febrile seizures in immunocompromised children.

1. A 12-year-old 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.

1. A child whose parents have refused vaccines has been exposed to chickenpox, and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them?

The child should stay home if any symptoms occur and may return in 1 week if no rash develops.

1. The primary care pediatric nurse practitioner is counseling the parent of an 8-year-old 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?

The combination of alarm therapy and intermittent drug therapy is best.

1. The parent of a 5-month-old 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.

1. The primary care pediatric nurse practitioner is performing a well baby examination on a 2-month-old 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?

The infant may be going through an expected growth spurt.

1. 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

The primary care pediatric nurse practitioner performs a well child assessment on a 6-month-old 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.

1. The primary care pediatric nurse practitioner is considering use of a relatively new drug for a 15-month-old child. The drug is metabolized by the liver, so the nurse practitioner will consult a pharmacologist to discuss giving the drug:

less often or at a lower dose.

1. The primary care pediatric nurse practitioner prescribes a new medication for a child who develops a previously unknown adverse reaction. To report this, the nurse practitioner will :

log onto the FDA Medwatch website.

1. The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old 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 :

of moderate concern for parenting problems.

1. The parent of a 10-year-old 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

this attachment to other same-gender children is how the child learns to interact with others.

1. The primary care pediatric nurse practitioner is examining a 6-year-old 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 :

to name one or two friends.

1. During a well child assessment of a 13-year-old 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

participation in sports.

The primary care pediatric nurse practitioner is treating a toddler who has a lower respiratory tract illness with a low-grade fever. The child is eating and taking fluids well and has normal oxygen saturations in the clinic. The nurse practitioner suspects that the child has a viral pneumonia and will

teach the parents symptomatic care and order labs to help with the diagnosis.

During a well child assessment of an 18-month-old 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

telegraphic speech.