Growth & development
On examination, you note a 12-year-old girl to have enlargement of her breast and areola but no separation of their contour and sparse growth of straight pubic hair along the labia. Which of the following is the appropriate Tanner staging for this patient?
Tanner stage 3 breast and Tanner stage 2 pubic hair
What vaccines are contraindicated during pregnancy?
measles, mumps, and rubella (MMR) vaccine
A 2-year-old infant is scheduled for a hepatitis A virus vaccination. At the time of her well-child clinic visit, the child was experiencing a moderate respiratory illness. She has notable rhinorrhea and cough. Her mother is reporting that she has not been eating well. Her vitals are: heart rate 120 beats/minute, respiratory rate 36 breaths/minute, and oxygen saturation 90% on room air. Physical examination is remarkable for bilateral expiratory wheezing. Her respiratory symptoms and physical examination findings had improved with albuterol, but the child continues to appear to have respiratory symptoms that warrant further management. The mother of the child is asking if the immunization can be deferred to a later date. What is the only precaution to all vaccine administrations?
moderate-to-severe acute illness
A 6-year-old child is following up with you for a well-child care clinic visit. You note that the child has received only 3 polio vaccinations. The last vaccination was given at 5 years of age. The 1st and 2nd were given at 2 and 4 months of age. What would you recommend based on the number of polio vaccines the child has received?
no further polio vaccination recommended
A 12-year-old boy presents to you for a well-child care clinic visit. You recommend the child to receive the human papillomavirus (HPV) vaccine. This vaccine can protect against which of the following diseases in this patient?
penile cancer
A girl can copy a triangle, play soccer, and make her own peanut butter sandwich. What else can she likely do at this time?
print her first name
For girls 8 years old or older with Tanner stage 2 breast development,
reassurance should be given that the child is presenting with normal pubertal development, and routine examinations at the normal recommended intervals are all that is needed for follow-up.
A 12-month-old infant with primary complement deficiency is scheduled for vaccinations. Concern has arisen for the administration of vaccinations in the context of the child's immunocompromised state. What vaccination is contraindicated in a child who is immunocompromised?
rotavirus vaccine
A 12-year-old boy presents to you after falling off his motorbike. The high speed incident led to a degloving injury to his upper extremities. The wounds will require multiple debridement and intravenous antibiotic therapy. The last tetanus vaccine he received was given 6 years ago. The parents report that he has received 2 previous doses of tetanus-containing vaccines. What should you recommend based on his tetanus vaccination status?
tetanus booster and tetanus immunoglobulin
A pregnant woman in her third trimester is following up with you to review her immunization schedule. She wants to minimize potential infections early on in her child's infancy, and is inquiring about what vaccinations can be given to her in the third trimester. Which vaccine should you offer her?
tetanus, diphtheria, and acellular pertussis (Tdap) vaccine
By 6, a child should be able to
walk down stairs with alternating feet without using a railing, balance on one foot for > 8 seconds, hop on one foot for at least 15 feet, skip, walk backward heel-to-toe, and jump backward.
A 16-year-old boy with a history of chronic variable immunodeficiency is severely immunocompromised. He is scheduled to go on an international trip with his local church to Sub-Saharan Africa. The parents are inquiring what vaccinations are required prior to travel. What vaccine may be contraindicated for this patient?
yellow fever vaccine
The mother of a 6-month-old infant is concerned regarding the child's scheduled delivery of an influenza vaccination. The mother started initiating solid foods into the child's diet. She has noticed that, on a single occasion, the child had large red patches of skin when ingesting egg products. Since that event, the child has not had any issues with egg products. Which of the following observation is not a reason to administer the influenza vaccination?
It is universally required for school entry.
A 7 YEAR OLD WITH TYPE 1 DM IS ABOUT TO RECEIVE INJECTABLE INACTIVATED INFLUENZA VACCINE, TRIVALENT (HV3). HIS PARENTS AND HE SHOULD BE ADVISED THAT:
LOCAL IMMUNIZATION REACTIONS ARE COMMON
Which interventions are recommendations suggested as preventive services for neonates? (Select all that apply.)
-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? (Select all that apply.)
-Foramen ovale -Ductus arteriosus
A 17-year-old boy will be entering college as a freshman this year. During your visit with him, you perform an overview of his vaccination status. He has never received conjugate meningococcal vaccine. How many doses of the meningococcal vaccine is/are indicated in this adolescent?
1
An 8-year-old boy presents for a well-child clinic visit. The mother is requesting an influenza vaccination this fall. She reports that he received his initial influenza vaccination at 3 years of age (when he received 2 doses six weeks apart) and has received one yearly since then. How many doses of the influenza vaccinations should the child receive this year?
1
You are reviewing the vaccination records of a 15-year-old child. You note that the child has had 4 vaccines of diphtheria, tetanus, and acellular pertussis (DTaP) at 2, 4 and 6 months of age and then at age seven. What should you recommend for further DTaP vaccine administration on today's visit?
1 dose of Tdap vaccine
You are evaluating a 3-year-old child after a measles outbreak was reported in the local school district. The child had been in contact with a child diagnosed with measles less than 24 hours prior to today's visit. The child had 1 dose of MMR vaccine at 13 months of age. What would you recommend for this child?
1 dose of measles, mumps, and rubella (MMR) vaccine
The mother of a newborn asks you when her child will start staring at her mother's face and when the newborn will begin raising her head during tummy time. The most common age for these milestones is which of the following?
1 month
WHAT IS RECOMMENDED TOTAL DAILY SCREEN TIME FOR A YOUNG CHILD?
1-2 HOURS
A 10-year-old child presents for a well child check. He is currently living in a shelter with his family. A tuberculin skin test is placed. Which of the following meets the minimum criteria for a positive test in 48 hours?
10 mm diameter of induration
AT WHAT AGE SHOULD A CHILD BE ABLE TO IMITATE HOUSEWORK?
18 MONTHS
AT WHICH AGE IS ANTICIPATORY GUIDANCE ABOUT TOILET TRAINING READINESS MOST HELPFUL?
18 MONTHS
A child can walk up steps using two feet per step with hand held, sits himself in a small chair, and can carry toys while walking. Based on this description of the child's gross motor development, how old is he?
18 months
An infant smiles at his father when he talks to him and pushes his chest off the table when prone, but he does not laugh out loud or roll yet. What is his most likely age?
2 months
A 12-month-old boy with a history of sickle cell disease presents for a well-child clinic visit. Review of the child's vaccinations is being undertaken. Which vaccine is not indicated for this child at this time?
23-valent pneumococcal vaccine (PPS23)
An 8-year-old child who recently immigrated to the United States is undergoing her first vaccinations during today's well-child visit. You are planning to provide the measles, mumps, rubella, and varicella (MMRV) vaccine. What is the minimal interval that you can provide the second dosage?
3 months
A child can alternate feet going up the stairs, copy a circle, and use pronouns. He cannot button his clothing, print his name, or skip. What is his most likely age?
3 years
When should a healthy child have the ability to ride a tricycle?
3 years of age.
An infant is starting to roll over, coo, and laugh out loud, but cannot sit or use a raking grasp. What is the most likely age of this baby?
4 months
WHICH OF THE FOLLOWING AGES IN A HEALTHY INFANT'S LIFE IS PARENTAL ANTICIPATORY GUIDANCE ABOUT TEETHING MOST HELPFUL?
4-6 MONTHS
HOW MANY WORD PHRASES SHOULD A 5 YEAR OLD BE ABLE TO SPEAK?
5 WORDS
During a well-child visit, a boy transfers a rattle from one hand to another, rakes beads with four fingers, bangs a block on the exam table, and tries to get objects within his reach. If this child has achieved developmental milestones at the typical age, what is this boy's age?
6 months
A 2-month-old girl infant presents for a well-child clinic visit. She was born full-term, andreceived hepatitis B virus (HBV) vaccination at birth. You are scheduled to provide another dose of HBV vaccine. The parents ask when final dose of HBV vaccine can be administered. What should you tell them?
8 weeks following second dose
Which of the following children would you refer for additional testing for suspected speech and language developmental delay?
A 9-month-old who is not babbling
AT WHAT AGE SHOULD A CHILD BE ABLE TO TIE THEIR SHOES?
AGE 6-7
A HEALTH 3 YEAR OLD CHILD IS IN YOUR OFFICE FOR WELL-CHILD CARE.WHAT WOULD YOU EXPECT THIS CHILD TO BE ABLE TO DO
ALTERNATE FEET WHEN CLIMBING STAIRS
During an evaluation of a 12-month-old girl with bronchiolitis, there is concern for possible language delay. The parents report she does not have any words and does not say "mama" or "dada." Her past medical history is only positive for being born large for gestational age. Her parents report they speak Spanish with each other and English with her 11-year-old sibling. The only significant family medical history is depression in the mother. Of the following, which is a risk factor for this girl's expressive speech delay?
Maternal depression
While assessing the developmental reflexes of a full-term 4-month-old, which of the following findings would you consider abnormal and would warrant further evaluation?
Absence of the plantar grasp
A 6-month-old infant presents to you for his well-child examination. While surveilling his development, you note that he looks at you when you call his name, laughs, squeals, and vocalizes to answer after you talk. Which of the following is the correct assessment of this infant's speech and language development?
Age-appropriate expressive and receptive language development
A mother presents to you with her toddler for a well-child examination. You hand her a written questionnaire and explain that these questions are a screening tool for signs of an autism spectrum disorder. Which of the following would have been the most appropriate screening test to use in this scenario?
Modified Checklist for Autism in Toddlers
How many words can a healthy 9 to 12-month-old child say?
Around five words.
When assessing a supine 1-month-old infant, the clinician turns the infant's head to one side, causing extension of the infant's extremities on the side toward which the head was turned and flexion of the extremities on the baby's contralateral side. Which of the following reflexes is this baby exhibiting?
Asymmetric tonic neck reflex
A 30-month-old boy urinates in the toilet a few times each day but occasionally wets his pants. He wears a diaper at night. He usually lets his parents know when he needs to void and pulls his pants down by himself. His mother brings home his new baby sister, and he starts to wet his pants several times each day and begins to avoid the toilet. How should you advise the parents?
Back off toilet training during this stressor until he starts to feel comfortable again.
A 1-year-old boy presents to the clinic for a routine follow-up. At his previous clinic visit, he was noted to have normal development and age-appropriate feeding skills. During this visit, you also assess for normal development. Which of the following statements represents normal and expected feeding skills for this patient?
Begins feeding independently and grabbing cup with two hands
At what age would you expect a child to complete the gross motor developmental milestone of catching a bounced ball?
By 4 years of age.
YOUR ARE EXAMINING AN 18 MONTH OLD BOY WHO IS NOT SPEAKING ANY DISCERNIBLE WORDS. HE HAS NOT SAID "MAMA" OR "DADA" YET. WHAT DO YOU DO?
CONDUCT FURTHER EVALUATIONS OF MILESTONE ATTAINMENT
A 15-month-old boy presents to the clinic with his parents for a well-child appointment. The parents express concern that he could be developmentally delayed because of his lack of self-feeding skills. Which of the following may warrant a referral to the state's early child development identification program?
Child is unable to pick up small foods (e.g., peas)
An 18-month-old child presents to the clinic for a well-child visit. The parents express concern that their child has behavior that may be a sign of possible developmental delay. According to the Centers for Disease Control and Prevention's recommendation to act early, which of the following behaviors could be a sign of development delay in this child?
Does not notice or mind when her parents leave or pick her up from childcare
A 15-month-old girl infant presents for vaccinations. The child was just adopted from a nation with high rates of hepatitis A virus (HAV) infection. There is no HAV vaccine available in her native country. Both the adoptive parents and child are healthy appearing. The child receives the first HAV vaccination today in clinic. What immunization would you recommend for the adoptive parents of this child?
HAV vaccine
WHICH OF THE FOLLOWING STATEMENTS IS TRUE ABOUT THE HEPATITIS B VIRUS (HBV) VACCINE?
HEPATITIS B IMMUNIZATION SERIES SHOULD BE OFFERED TO ALL CHILDREN
A 32-month-old boy infant presents to you in respiratory distress. He was born outside of the United States and his parents report that he has never been vaccinated. He has brought by ambulance with 100% oxygen provided through a nonrebreather mask. The child has a toxic appearance and cannot tolerate food or drink by mouth. He is notably drooling and is sitting in a tripod position. Vitals are: respiratory rate 48 breaths/minute, heart rate 135 beats/minute, blood pressure 82/48 mm Hg, and oxygen saturation 84% on room air. Findings on physical examination are notable for inspiratory stridor, suprasternal and intercostal retractions, and nasal flaring. You are concerned about the diagnosis of epiglottitis. What vaccination would have minimized the likelihood of such an event occurring?
Haemophilus influenzae type B (Hib) vaccines
A 7-year-old boy in second grade is struggling with his academics skills His teacher says he scores average on an IQ test, but does poorly on academic test given in the classroom. Psychoeducational testing performed through his school shows that he has a discrepancy between his aptitude test scores and his academic scores. What does this most likely indicate?
He has a learning disability.
A 3-month-old male infant presents to the clinic for a check-up, and the parents have questions regarding infant feeding. Which of the following statements made by the parents is true?
He may show hungry cues like hand sucking
WHICH OF THE FOLLOWING IS A RED FLAG SYMPTOM AND WARRANTS FURTHER EVALUATION?
NO RESPONSE TO NAME AT 12 MONTHS
An 8-year-old girl presents to your office for evaluation of a parental concern of breast development that started shortly after her eighth birthday. On examination, you assess that she has Tanner 2 breast development with no other secondary sexual characteristic development. What is the appropriate next step in the treatment of this patient?
No further evaluation is needed
AN 11 YEAR OLD PRESENTS WITH NOT DOCUMENTED PRIMARY TETANUS IMMUNIZATION SERIES. WHICH OF THE FOLLOWING REPRESENTS THE IMMUNIZATION NEEDED?
ONE DOSE OF TDAP FOLLOWED BY TWO DOSES OF TD IN 1 AND 6 MONTHS
A 10-year-old boy has recently moved to the United States from India with his mother. He previously received the Bacille Calmette-Guerin (BCG) immunization. He denies cough, fever, or weight loss. A tuberculin skin test is placed. 48 hours later, the area of induration at the injection site measures 10 mm in diameter. Which of the following is the most appropriate next step in management?
Obtain interferon-gamma release assays
A 12-year-old was diagnosed with pertussis via a nasopharyngeal swab culture. Her mother is concerned that the child is not responding to vaccinations. What educational advice would you provide regarding the pertussis vaccination status?
Pertussis immunity has waned over time
A 12-month-old boy presents for a well-child exam. When assessing for developmental milestones, he hands the clinician a book upon request, takes three steps independently, and bangs two objects together. Which of the following social milestones can be expected from this 12-month-old child?
Plays peek-a-boo
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.
When suspecting a developmental delay in a 4-year-old girl, which of the following milestone behaviors could indicate a social developmental delay requiring further evaluation or treatment?
Prefers to play by herself rather than with other children at preschool
WHICH OF THE FOLLOWING STATEMENTS IS CORRECTS ABOUT THE VARICELLA VACCINE?
RARELY, MILD CASES OF CHICKENPOX (VARICELLA) HAVE BEEN REPORTED IN IMMUNIZED PATIENTS
A mother is concerned that her 6-month-old boy will develop a severe reaction to the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. She is worried because her now college-bound adolescent had a severe reaction to the vaccine that included high-grade fever, seizure, and hyper-responsive and hyporesponsive episodes. You review the medical records of the older son and discover that he received the whole-cell pertussis vaccine. What would you recommend regarding the administration of the DTaP vaccination in the younger son?
Reassure the mother about the difference between the whole-cell and acellular pertussis vaccine.
A 9-month-old boy presents to your office for his routine well examination. While observing him, you note that he uses a pincer grasp when picking up small objects, turns his head when you call his name, sits momentarily when propped on his hands, and says "dada" nonspecifically. What would be your recommendation for this patient based on your observations?
Refer to early intervention for a probable gross motor delay
A 28 YEAR OLD PREGNANT FEMALE WHO IS 6 WEEKS PREGNANT AND VOICESHER INTENT TO BREASTFEED HER INFANT FOR AT LEAST 6 MONTHS. HER ROUTINE PRENATAL LABORATORY TESTING REVEALS SHE IS NOT IMMUNE TO VARICELLA. WHICH OF THE FOLLOWING REPRESENTS THE BEST ADVISE FOR HER?
SHE SHOULD BE ADVISED TO RECEIVE TWO APPROPRIATELY TIMED DOSES OF VZV VACCINE AFTER GIVING BIRTH
WHEN ANSWERING QUESTIONS ABOUT HEPATITIS A VACCINE, YOU CONSIDERSTATING THAT IT:
SHOULD BE GIVEN TO ALL CHILDREN UNLESS CONTRAINDICATED
What fine motor skills are expected in a 12-month-old child?
Scribbles after a demonstration, uses a fine pincer grasp to pick up a pellet, holds a crayon, and attempts to build a tower of two cubes.
A 6-year-old presents to your office for her routine well-child examination. Her mother expresses concerns about her development. Which of the following would cause concern for a developmental delay?
She can hop on one foot for 2 to 3 seconds
A 9-month-old female infant presents to the clinic for a well-child visit. Which of the following statements made by the clinician about feeding skills at this age is correct?
She should be able to feed herself with fingers
While observing an 18-month-old at her well examination, you note that she is following one-step commands and is pointing to multiple body parts. The parents state that she says approximately 10 to 20 words. You discuss that she is on track with normal speech and language development currently. What is the appropriate anticipatory guidance to give her parents for what they can expect her progression to be by her 2-year-old examination in regards to her speech and language development?
She should be using two-word phrases
Which of the following defines an adolescent's sense of meaning and purpose, in which she has control, direction, and promise in the future?
Spirituality
An 8-month-old female infant presents to the clinic with her mother for a well-child exam. When the clinician attempts to examine the infant, she clings to her mother and cries. The mother asks why the infant always cries when brought to the clinician's office. Which of the following clinician responses is most appropriate?
Stranger anxiety is normal and expected at this age
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.
WHEN CONSIDERING VACCINATING A PREGNANT WOMAN WITH HV3 OR HV4, THE NP CONSIDERS THAT:
THE UNBORN CHILD ACQUIRES SOME PROTECTION AGAINST INFLUENZA UP TO 6 MONTHS AFTER BIRTH
WHICH OF THE FOLLOWING IS TRUE ABOUT THE MMR VACCINE?
THE VACCINE CONTAINS LIVE VIRUS
A 9 YEAR OLD CHILD WITH NO DOCUMENTATION OF VACCINATIONS COMES FOR AN MMR IMMUNIZATION UPDATE. HER PARENT STATES THAT CHILD HAS RECEIVED "SOME" VACCINATIONS, BUT NO DOCUMENTATION IS AVAILABLE. HOW MANY DOSES OF MMR SHOULD THE CHILD RECEIVE AND AT WHAT FREQUENCY.
TWO MMR DOSES 1 MONTH APART
A 12-year-old boy presents for his routine well examination. While examining him, you note enlargement in his testes and scrotum, with subtle changes in scrotal texture. He also has sparse pubic hair growth at the base of the penis. Which of the following is the appropriate assessment and plan for this patient?
Tanner stage 2; continue to check yearly at well examinations
What is an alternate name for the asymmetric tonic neck reflex normally seen in a newborn?
The fencing reflex.
A clinician is evaluating a 2-year-old girl at her well-child examination. Which of the following gross motor milestones would you expect to observe?
Throwing a ball overhand
According to the American Academy of Pediatrics Bright Futures guidelines, a 24-month-old child can be expected to demonstrate which of the following fine motor developmental milestones?
Turns book pages
REGARDING PHYSIOLOGICAL JAUNDICE IN THE NEWBORN, SELECT ALL CORRECT ANSWERS:
UNCONJUGATED BILIRUBIN IS ELEVATED RISK OF DEVELOPMENT OF HYPERBILIRUBINEMIA CAN BE REDUCED IN A BREASTFED INFANT WITH FREQUENT BREAST-FEEDING EVERY 2-3 HOURS PER 24 HOURS
ANGELA IS A 14 YEAR OLD FEMALE WHO HAS NOT RECEIVED ANY DOSE OF THE HBV VACCINE. WHEN CONSIDERING WHETHER TO INITIATE THE VACCINE SERIES, THE NP REALIZES:
VACCINE ADMINISTRATION TO 11-15 YEAR OLDSADULT DOSE OF RECOMBINANT HBV VACCINE IS ADMINISTERED WITH SECOND DOSE GIVEN 4-6 MONTHS LATER
An 8-year-old boy presents to the clinic with his mother for a routine visit. Based on his physical exam, you are concerned that he may be malnourished. Which of the following is the correct diagnostic criterion for failure to thrive?
Weight below the fifth percentile for sex and age over several checks
At 9 months old, an infant with normal gross motor development would be expected to be
able to sit alone, pull to stand, start creeping, and crawl with all four limbs straightened.
A 3-year-old child who recently immigrated to the United States is undergoing his first well-child care visit. The child has no significant past medical history. Review of his vaccination history indicates that the child received his pneumococcal vaccination through the administration of 5 heptavalent pneumococcal conjugate vaccine (PCV7) doses. What would you recommend for further pneumococcal vaccinations?
administration of 13-valent pneumococcal conjugate vaccine (PCV13)
What is a contraindication to use of the human papillomavirus (HPV) vaccine?
allergy to baker's yeast
The mother of a 4-year-old boy is concerned regarding future vaccinations for her child. She reports that the child has had worsening eczema, and recent findings on allergy skin testing have revealed multiple reactive allergens. The mother is concerned that the child will have an allergic reaction to the scheduled vaccination. What is the 1 contraindication that is common to all vaccines?
anaphylaxis to previous dose of vaccine
You are currently attending the delivery of a newborn in the delivery room. You are aware that the mother of the child is infected with hepatitis B virus (HBV). The child was born uneventfully. He is transferred to the newborn nursery for further monitoring. The child is 6 hours of age. You plan on providing vaccinations. What vaccination regimen would you administer?
both hepatitis B immunoglobulin (HBIG) and HBV vaccine
A child can hop and descend stairs with alternating feet. He cannot tie his shoes or skip with alternating feet. What else is he most likely able to do at this time?
copy a square
An infant can sit unsupported, use a raking grasp, and laugh out loud. She does not wave, say "mama," or clap her hands. What can her parents expect her to start doing in the next few months?
cruise
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.
A 4-year-old child is scheduled to receive her measles, mumps, and rubella (MMR) and varicella vaccines. She was recently evaluated at her allergist's office because her parents were concerned about the potential for food and environmental allergies. Positive skin and serum testing noted the following: eggs, peanut, gelatin, ragweed, and dog dander. Which of the following allergens is a contraindication to use of the varicella vaccine?
gelatin
A 1-month-old infant has immigrated to the United States. This is his first clinic visit in the States. The child was born as a full-term gestation. The parents report that he received an injection shortly after he was born and they reported it was to minimize bleeding concerns. You suspect that the injection was vitamin K. What vaccination would have been given to this infant at birth in the United States?
hepatitis B virus (HBV) vaccine
What is a contraindication for use of the rotavirus vaccine?
intussusception
Only being able to hop on one foot for 2 to 3 seconds
is a developmental milestone for a 4-year-old child.
Exposure to a homeless population
is a risk factor for exposure to tuberculosis.
A mother is concerned regarding the risk associated with receiving the measles, mumps, rubella, and varicella (MMRV) vaccine. Her 16-month-old child has a documented history of a seizure disorder and is currently on antiepileptic medication. He has not received any vaccination for measles, mumps, rubella or varicella. What would you recommend for the MMRV vaccination?
measles, mumps, and rubella (MMR) and varicella vaccines separately given
