Adv Ped Nursing Test 1
Which region globally has the highest infant mortality rate?
Southern Asia
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." Explanation: At 6 months, infants delight in vocalizing sounds that they learn by imitation but do not ascribe meaning to the sounds they make. Infants can say "mama" but without meaning. Babies make sounds on purpose by imitating what they hear. A preference for one sound early in speech does not indicate a hearing deficit.
Which assessment factors are included in a 5-minute APGAR score?
- Heart rate -Respiratory Rate - Skin Color - Muscle tone Explanation: Heart and respiratory rates, skin color and muscle tone are assessed at both the 1 and 5 minute APGAR scoring. While crying has a positive affect on respirations, crying is not a focus of the assessment
Which interventions are recommendations suggested as preventive services for neonates?
-Breastfeeding -Screening neonates for sickle hemoglobinopathies -Newborns screened for phenylketonuria (PKU) before being 24 hours old should be rescreened by 2 weeks old. -Screening for developmental hip dysplasia
When providing post delivery information regarding her infant, the nurse will confirm to the mother that which fetal cardiac structures have no function after her child is born?
-Foramen ovale -Ductus arteriosus Explanation: The foramen ovale and ductus arteriosus are no longer necessary and close.
The nurse will contribute which neonate characteristics noted in the first period of reactivity to sympathetic system changes?
-Transient rales -Tachycardia -Alertness Explanation: The first period of reactivity includes sympathetic system changes, such as tachycardia, rapid respirations, transient rales, grunting, flaring and retractions, a falling body temperature, hypertonus, and alertness. Parasympathetic system changes during the first period of reactivity include the initiation of bowel sounds and the production of oral mucus. After an interval of sleep, the newborn enters the second period of reactivity. During this time, the oral mucus production again becomes evident, the heart rate becomes labile, the newborn becomes more responsive to endogenous and exogenous stimuli, and meconium is often passed.
The primary care pediatric nurse practitioner is performing a well baby examination on a 2-week-old infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent to keep a sleep log and will teach the parent that which amount of sleep per day is optimal for this infant?
15 to 18 hours Explanation: Newborns sleep up to 8.25 at night and 8.25 hours during the day.
An adolescent exhibits mild depressive symptoms and tells the primary care pediatric nurse practitioner that he is most concerned about difficulty falling and staying asleep. The adolescent does not want to take medication to treat the depressive symptoms. What will the nurse practitioner recommend?
A program of sleep hygiene and gradual sleep extension Explanation: Depression is linked to sleep problems and both predict and are predicted by a diagnostic cluster that includes ODD, GAD, and depression. One study found that gradual sleep extension combined with sleep extension advice had a beneficial effect on depressive symptoms of adolescents with chronic sleep reduction. Sedatives will not affect depression. Cognitive therapy is useful for insomnia related to anxiety. Antidepressants do not necessarily treat insomnia.
The primary care pediatric nurse practitioner cares for children from a Native American family and learns that they used many herbs to treat and prevent illness. Which approach will the pediatric nurse practitioner use to promote optimum health in the children?
Ask about the types of practices used and when they are applied. Explanation: The challenge, when working with families from different cultural backgrounds, who use alternative or complementary medicines, is to find ways to achieve a mutual understanding of the differences and to negotiate an acceptable plan of care. The first step is to begin a discussion about these practices. Providing a list of harmful herbs, suggesting that the family avoid certain herbs, and suggesting that the herbs are only an adjunct to "modern medicine" will sound disparaging and will convey a sense of mistrust.
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. Explanation: Infants with ankyloglossia may have difficulty feeding if the tongue does not extend well. The PNP should first assess feeding difficulties and then may refer for a lactation consultant or consider a frenulectomy.
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?
Asking about physical, psychological, and emotional trauma Explanation: Recent history that includes trauma, loss, and refugee camp experience may exacerbate difficulties adjusting to life in the U.S. and can lead to acute and chronic physical and mental health concerns. All of the other parts of the history will be necessary, but this should be a priority, since the family has escaped a war-torn country.
A primary care pediatric nurse practitioner working in a community health center wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the pediatric nurse practitioner employ to ensure the success of such a program?
Asking community members to assist in researching and implementing a program
The primary care pediatric nurse practitioner (PNP) 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?
Asking the child to describe usual daily routines and schedules Explanation: In a client-centered relationship, there is reciprocal communication and understanding. The PNP should be able to understand the client's perspective and unique situation. The first step is to evaluate possible reasons for nonadherence and not to make referrals or re-educate until potential barriers have been identified and negotiation with the client has occurred.
Which intervention best demonstrates a pediatric nurse primary care pediatric nurse practitioner's understanding of effective pain assessment?
Assisting in the development of a child-centered pain assessment scale.
The primary care pediatric nurse practitioner is counseling a new parent about ways to reduce the risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing SIDS?
Bed-sharing with infants greatly increases the risk of SIDS. Explanation: Bed-sharing with infants has been shown to have a five-fold increase in the incidence of SIDS, even with non-drug using and non-smoking parents; smoking, alcohol, and drug use increase this risk even further. Breastfeeding is recommended and is associated with a reduced risk of SIDS. Day care is not mentioned as increasing SIDS risk. Infants who are immunized have a 50% reduction in SIDS risk, according to research evidence.
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 after each breastfeeding. Explanation: One drawback to breastfeeding toddlers is the effect of prolonged contact with lactose on the teeth. Mothers should be cautioned to consult with a dentist and to clean the toddler's teeth. The mother may choose when and how often to breastfeed but should not allow "on demand" feedings. The breast should be offered after meals.
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 Explanation: Infants who are encouraged to breastfeed every 2 to 3 hours may have one longer stretch of 4 hours at night. This infant is gaining between 0.5 and 1 gram per day, which is appropriate. It is not necessary to alter the pattern of nursing or to supplement with formula.
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 what other intervention?
Discussing adding other foods to the baby's diet. Explanation: After 6 months, infants should continue to breastfeed while taking other nutrients, at least up to 1 year of age. The mother should be encouraged to continue breastfeeding while adding other nutrients. The mother has successfully breastfed up to this point and increasing fluids is not the source of the problem.
The parent of a school-age child tells the primary care pediatric nurse practitioner that the child is restless most nights and complains often that bugs are in the bed. After consultation with a sleep disorder specialist and subsequent evaluation of a ferritin level of 30, the nurse practitioner may expect to treat this child with what?
Ferrous sulfate Explanation: A ferritin level of less than 50 is associated with periodic limb movements (PLM). The treatment for this is ferrous sulfate 3 mg/kg per day. Clonazepam and gabapentin may be ordered if ferritin levels are normal and other organic causes of PLM have been ruled out. Sertraline may make PLM worse.
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. Explanation: Frozen breast milk may be stored up to 3 months in a well-regulated freezer. It is not necessary to use only pumped breast milk once this begins. Refrigerated breast milk may be stored up to 8 days. Once frozen breast milk is thawed it should be used within 24 hours.
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?
Genogram
What is the strongest predictor of health regarding the pediatric patient?
Health literacy of the parent(s) and/or caregiver(s)
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. Explanation: General learning and acquisition of skills for later reading and writing begin at birth, not in kindergarten or first grade, and these skills grow with everyday loving interactions between infants and caregivers. Cognitive learning changes during toddler years but begins at birth. Intellectual growth is not tied to speech alone.
The parent of a 3-year-old child tells the primary care pediatric nurse practitioner that the child has never been able to fall asleep without a parent in the room. The child has a new sibling and the parent is concerned that the toddler's cries will awaken the infant. What will the nurse practitioner counsel the parent?
Leaving the room as the child is falling asleep and returning at intervals to check on the child Explanation: Leaving the room as the child becomes drowsy and checking on the child at intervals is called graduated extinction and allows parents to ensure safety while helping the child to initiate and maintain sleep independently. The other measures may result in the toddler becoming upset and crying, which would awaken the baby. Rewards and punishments are not necessarily successful.
During a well child examination, the primary care pediatric nurse practitioner learns that a 5-year-old child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with open eyes, and saying things that don't make sense. What will the nurse practitioner recommend?
Making sure that stairs are blocked and doors are locked Explanation: Parents of children with sleep walking should be assured that this is relatively benign but should make sure the house is secure so the child will not cause self-harm. Graduated extinction and sleep hygiene are used for children who have difficulty initiating or maintaining sleep. Referral to a sleep disorder clinic may be warranted if the child has an episode of leaving the house or some other dangerous activity. The child should be guided back to bed without awakening.
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. Explanation: Changes in the maternal diet do not produce changes in cholesterol values in infants. Breastfed infants tend to have higher cholesterol levels than other infants, but cholesterol is necessary for brain and retinal development.
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. Explanation: There is evidence that infants who exclusively breastfeed for at least 4 months have less risk for infection than infants breastfed for less time. However, infants who breastfeed exclusively for 9 months or for longer than 12 months may have increased risks for food hypersensitivities and atopic dermatitis. Breast milk is a poor source of vitamin D and iron.
The primary care pediatric nurse practitioner understands that what major child health outcome is dramatically associated with worldwide climate change?
Nutrition
Which statement correctly reflects the health status of children in the United States?
Obesity rates among 2- to 5-year-olds have stabilized below Health People 2020 goal of 9.4%. Explanation: Obesity rates are a major concern for child health in the U.S. but recently have stabilized at 8.9%. Globalism
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. Explanation: When discussing developmental delays with parents, it is important to be positive and to initially focus on strengths. Explaining that developmental delays develop over time is true but does not reassure the parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and may take time.
A child with Down syndrome who has sleep-disordered breathing with obstructive sleep apnea continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse practitioner will refer the child to a sleep disorder clinic to discuss which therapy?
Positive airway pressure therapy Explanation: Positive airway pressure therapy can be used to treat sleep-disordered breathing in children who have failed other therapies and even developmentally delayed children show improvement in behaviors after this therapy. Craniofacial surgery may be used in the presence of maxillofacial deformities that affect sleep-disordered breathing but is a last option. Oral appliances may be used if deformities can be corrected in this manner. Supplemental oxygen helps with oxygen saturations but not with disordered breathing patterns themselves.
The primary care pediatric nurse practitioner is performing a well child examination on a 8-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. Explanation: The best way to improve language skills is to read to children. As long as the reading includes positive interactions with the baby and the reader, the baby is learning language. Educational videos, music, and television are all passive media and do not involve this interaction.
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?
Receptivity to learning about the perspectives of other cultures Explanation: Cultural humility is defined as the lifelong commitment to developing mutually beneficial, nonpaternalistic partnerships and is based on a model of passive volition, receptivity, and being open to learning from others. Practitioners who have cultural humility are always seeking to learn about other cultures. Cultural humility involves asking questions, rather than giving answers. Cultural humility does not mean identifying one's own culture as inferior. Practitioners who are culturally competent are open to the influence of other cultures.
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. Explanation: Infants with breast milk jaundice who are gaining weight and thriving should continue to breastfeed and be monitored for the development of pathologic jaundice. It is not necessary to order phototherapy or discontinue breastfeeding unless pathologic jaundice is present. The bilirubin may remain elevated up to 3 months.
The parent of a school-age child who is overweight tells the primary care pediatric nurse practitioner that the child seems to crave high-calorie, high-carbohydrate foods, even when full. The nurse practitioner learns that the child is often irritable and sleepy at school in spite of sleeping 9 or 10 hours each night. What will the nurse practitioner recommend?
Referral to a sleep disorder clinic for a sleep study Explanation: Obstructive sleep apnea has been suggested to be a contributing factor to the pathogenesis of obesity by inducing leptin resistance and increasing ghrelin levels, two hormones that regulate satiety. The child shows symptoms of these abnormalities by craving high-calorie comfort foods. The child should be evaluated for this underlying cause. Assessment of these hormone levels is not routinely done. Consultation with a dietician may be necessary at some point but does not get at the underlying problem. Increasing sleep time with naps has not been shown to counteract the obesity effect.
A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner (PNP) notes that the child's last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially?
Review the purpose of this visit and any anticipated procedures. Explanation: The PNP should remember that young children are learning "scripts" for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease.
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. Explanation: This infant lost about 8% of its birth weight, which is normal and, since discharge home, has gained at least 15 grams per day, which is also normal. The PNP should schedule a weight check in a week to make sure the infant regains its birth weight, since most should regain this in 10 to 14 days and since this loss of birth weight is at the high end of normal. It is not necessary to refer to a lactation consultant or supplement with formula, since the infant is gaining weight adequately.
When providing well child care for an infant in the first year of life, the primary care pediatric nurse practitioner demonstrates an understanding of current guidelines when taking what action?
Scheduling well-baby visits to coincide with key developmental milestones.
The primary care pediatric nurse practitioner is performing a well child examination on a 4-year-old child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent?
Sleep disorders at this age can have long-term impacts on learning. Explanation: Behavioral sleep disorders and sleep-disordered breathing before age 5 can result in increased special education needs in children by 8 years of age. Sleep disorders are not usually benign or outgrown. Sleep disorders can result in behavioral difficulties but are not symptomatic of behavioral problems. Sleep-disordered breathing disrupts all sleep; napping will not produce adequate quality sleep.
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?
Speech and language development, beliefs about health, and previous illnesses
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 do what?
Stop breastfeeding immediately. Explanation: Infants with galactosemia cannot consume galactose, which is in both cow's milk and breast milk. Since there is a potential for a life-threatening response, the mother should be instructed to stop nursing immediately.
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 Explanation: Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict during stressful situations. Even when children do not understand, they pick up on cues from the parents about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation may indicate a pattern of response to stress and will only recur with each subsequent stressful period.
Which assessment findings suggest that the neonate is demonstrating stabilization of physiological functions?
Temperature: 97.7° F Explanation: Temperature is considered stable when between (97.7° to 99.3° F [36.5° to 37.4° C]) in open crib after birth. Heart rate is normally 100 to 190 bpm. Systolic blood pressures greater than 96 mm Hg are considered significant hypertension in the newborn. Unlabored respirations at a rate of 30 to 60 breaths/minute is considered normal.
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. Explanation: A maternal diagnosis of active, untreated TB is a contraindication to nursing, but expressed breast milk may be fed to the infant. The mother may feed expressed breast milk; the milk itself is not contraindicated. Until active TB is ruled out, the mother should not breastfeed her infant. It is not necessary to feed formula if the mother can provide expressed breast milk.
The parent of a 3-year-old child tells the primary care pediatric nurse practitioner that after falling asleep in the living room and being awakened to go to bed one evening, the child appeared confused and disoriented for a period of time. What will the nurse practitioner counsel this parent?
That this is probably a benign, temporary type of a sleep disorder Explanation: This child most likely exhibits confusional arousal, which occurs when a child is awakened from a deep sleep during the first part of the night. It is most likely benign and temporary, usually diminishing by age 5 years. It is not a sign of nightmares or night terrors. It may be the start of sleep walking but is less likely.
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. Explanation: At this age, infants may cry when they are tired or need social interaction and not just when they are hungry. The PNP should teach parents about this change in social development so they can be responsive to their infant's needs. Solid foods are not added until age 6 months. Teething usually does not begin until at least 6 months. GI discomfort usually occurs after eating.
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. Explanation: Infants may have a growth spurt at 6 to 8 weeks, and mothers who are breastfeeding may be concerned that they are not making enough milk when they notice that the infant is fussy and wanting to nurse more often. The PNP should reassure the mother that this is expected. It is not necessary, since the infant is gaining weight appropriately, for the mother to keep a log. The mother should follow the infant's cues for feeding since the extra suckling will increase the milk supply to meet the growing infant's needs.
What is the foundational basis of patient-and-family centered care (PFCC)?
The patient has ultimate control over health care decisions
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 second day. What will the nurse practitioner tell her?
This may be normal for breastfed babies. Explanation: Infants begin to have fewer bowel movements and may have bowel movements ranging from once or twice daily to once every other day when breastfed. Unless there are other signs, the baby is probably not constipated. The mother does not need to change her intake of foods or water, unless constipation is present.
Which assessment question best demonstrates the primary care provider's understanding of effectively dealing with the greatest challenge to providing dual patient care?
To the child: "When would you like your physical therapy sessions to be scheduled?"
The primary care pediatric nurse practitioner is counseling the parents of a toddler about sleep. The parents report that the toddler has recently begun resisting sleep and is often more irritable during the day. What will the nurse practitioner recommend?
Understanding that sleep resistance is a common developmental problem Explanation: Toddlers may develop sleep resistance as a normal part of their behaviors associated with increased autonomy or may have nighttime fears or night terrors. Parents should understand that this is common and transient. Co-sleeping may be practiced in some cultures but is not recommended. It is not necessary to refer to a sleep disorders clinic unless there are specific symptoms, such as snoring or restless sleep or sleepiness in spite of adequate sleep.
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 implement what intervention to help with communication?
Use the telephone interpreter service to communicate with the family.
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 Explanation: The level of vitamin D in breast milk may not be adequate for breastfed infants, so it should be given as a supplement. Human milk has more than adequate amounts of other vitamins. Iron is not present, but this is generally added at 6 months of age, when solid foods are added to the diet.
Which theorist is responsible for presenting an alternative therapy to those established theories that focus on how the pediatric patient thinks?
Vygotsky Vygotsky and Siegler both provide pediatric primary care with a new understanding or alternative lens through which to view children and childhood regarding how they think and process information. The other options represent traditional theorists: Piaget does focus on how children think while Skinner and Bandura are concerned with how children's learning and behavior is affected by experiences.
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 Explanation: Newborn infants should nurse every 2 to 3 hours in order to establish a routine and stimulate milk supply. The infant has regained birth weight, which is expected by age 2 weeks, so weight is not a concern and a lactation consultation is not warranted. The infant should continue to nurse during the night, so there is no need for the mother to pump her breasts or to supplement with formula. Using formula from a bottle also causes nipple confusion and should be avoided.
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. Explanation: Infants have growth spurts about every 3 to 4 weeks that increase their breast milk needs. Until the mother's milk supply catches up, the infant will act hungry and want to nurse more frequently. The PNP should evaluate for this growth spurt and then instruct the mother to feed her baby more often to increase her milk supply. Since the infant is hungry, the infant should nurse. It is not necessary to refer for a lactation consultation or to supplement with formula.
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. Explanation: Providers can teach parents that providing predictable, consistent, and loving care helps an infant to learn trust and help influence positive brain development. Involving extended family members and going to play dates are good ways to socialize children but are not essential to learning trust. It may not be possible for her to be a stay-at-home mother.
The parent of a 4-year-old who has difficulty initiating and maintaining sleep has tried several nonpharmacological methods with variable success and asks about medications. What will the primary care pediatric nurse practitioner recommend?
melatonin
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?
vaccinations Explanation: Rotavirus is the most common cause of diarrhea globally and Strep pneumonia is the leading cause of pneumonia, and together these are the leading infectious causes of childhood morbidity and mortality globally. Both are vaccine-preventable diseases. Antibiotics to treat pneumonia, optimal nutrition, and clean water all help to reduce morbidity and mortality, but vaccination prevents the diseases from occurring.
