Peds Chapter 26

15. The primary care pediatric nurse practitioner prescribes metformin for a 15yearold adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug? a. That insulin therapy will be necessary in the future b. The importance of checking blood glucose 3 or 4 times daily c. To consume a diet with foods that are high in vitamin B12 d. To use a stool softener to prevent gastrointestinal side effects

C

19. An initial key part of management of a child suspected of having an inborn error of metabolism is a. consulting a metabolic specialist b. obtaining a complete family history. c. ordering metabolic screening tests. d. referring the family to a dietician.

a

The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child's growth is consistent with bone age. Which diagnosis is most likely? a. Constitutional growth delay b. Growth hormone deficiency c. Idiopathic short stature d. Klinefelter syndrome

a

The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a schoolage child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child's endocrinologist to consider which therapy? a. Continuous glucose monitoring b. Continuous subcutaneous insulin infusion c. Selfmonitoring of blood glucose d. Use of a longacting insulin analogue

a

The primary care pediatric nurse practitioner performs a physical examination on a 9monthold infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order? a. Free serum T4 and TSH levels b. thyroxine level c. Total T4 and free T4 levels d. TSH and total T4 levels

a

The primary care pediatric nurse practitioner diagnoses an 8yearold child with type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child's weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct? a. Admit the child to the hospital for initial insulin management. b. Begin insulin and refer the child to a children's diabetes center. c. Order a fasting serum glucose and a dipstick UA in the morning. d. Send the child to the emergency department for fluids and IV insulin.

b

The primary care pediatric nurse practitioner is performing a well child examination on a 5yearold girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5'8" tall and the father is 5'11" tall. The nurse practitioner will estimate which expected adult height for this child? a. 5'11" tall b. 5'7" tall c. 5'8" tall d. 6' tall

b

13. The primary care pediatric nurse practitioner is performing a well child examination on a 12yearold child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child? a. Annual lipid profile evaluation b. Annual screening for microalbuminuria c. Comprehensive ophthalmologic exam d. Hypothyroidism screening every 5 years

c

14. A 13yearold Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will a. counsel the child to lose weight to prevent type 2 diabetes. b. diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL. c. order a fasting blood sample for a metabolic screen for type 2 diabetes. d. refer the child to a pediatric endocrinologist.

c

17. The primary care pediatric nurse practitioner is providing nutritional counseling for a 9yearold female whose weight is at the 95th percentile for her age. What is the goal for this patient? a. A loss of 10 to 15 pounds in 6 months b. An average weight loss of 2 pounds per month c. Maintenance of her current weight d. Weight loss of 5% of her current body weight

c

18. The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2week checkup. What will the nurse practitioner suspect? a. Galactosemia b. Glucose6phosphatase deficiency c. Phenylketonuria d. Urea cycle disorder

c

A 12yearold child has a recent history of increased thirst and frequent urination. The child's weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child? a. Fasting plasma glucose b. Hemoglobin A1C levels c. Pancreatic antibodies d. Thyroid function tests

c

A 7yearold female has recently developed pubic and axillary hair without breast development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition? a. Adrenal tumor b. Congenital adrenal hyperplasia c. Polycystic ovary syndrome d. Type 1 diabetes mellitus

c

The primary care pediatric nurse practitioner evaluates children's growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening? a. Measuring supine length in children over the age of 2 years b. Obtaining serial measurements to assess patterns over time c. Using the CDC growth chart for children under age 2 years d. Using the WHO growth chart for children over age 2 years

c

16. A 16yearold adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis? a. Dyslipidemia b. Hypothyroidism c. Nonalcoholic steatohepatitis d. Polycystic ovary syndrome

d

A 6yearold female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next? a. Order LH and FSH levels and a longacting GnRH agonist. b. Order thyroid function tests to exclude primary hypothyroidism. c. Reassure the parent that this is most likely idiopathic. d. Refer the child to a pediatric endocrinologist for management.

d

An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and dehydration. Which action is correct? a. Administer an intramuscular stress dose of hydrocortisone succinate. b. Administer intravenous fluids in the clinic and reassess hydration status. c. Prescribe an oral hydrocortisone in a replacement dose of 8 to 10 mg/M2. d. Refer the infant to the emergency department for fluids, dextrose, and steroids.

d

The mother of a female infant is concerned that her daughter is developing breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis? a. Congenital adrenal hyperplasia causing breast development b. Precocious puberty needing endocrinology management c. Premature adrenarche which will lead to pubic hair onset d. Premature thelarche which will resolve over time

d

The primary care pediatric nurse practitioner is performing a well child examination on a 2yearold child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do? a. Consider prescribing growth hormone therapy. b. Reassure the parent that this is normal for this child. c. Refer the child to a dietician for dietary supplementation. d. Refer the child to a pediatric endocrinologist.

d