Peds exam 1 FNP

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? A. Encourage the child to begin by engaging in swimming or cycling. B. Exercise will help lower total cholesterol and lowdensity lipoproteins. C. Schoolage children need 60 minutes of moderate exercise daily. D. Strength training exercises are not safe for school age children.

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

You are 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 you make in this situation? a. Provide the teen w/a questionnaire to gain info about his sexuality. b. Remind the adolescent that mandatory reporting requires disclosure to parents. c. Suggest that he discuss sexual concerns w/his parents. d. Tell him that, unless he is at risk, what he says will be confidential.

D

A 13yearold child has exhibited symptoms of mild depression for several weeks. The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do? A. Administer an ADHD diagnostic scale and consider an ADHD medication. B. Consult with a child psychiatrist to prescribe an antidepressant medication. C. Reassure the parent that this behavior is common after mild depressive symptoms D. Refer the child to a child psychiatrist for evaluation of bipolar disorder.

D. Refer the child to a child psychiatrist for evaluation of bipolar disorder.

You are performing a well child exam on a 9mo whose hearing is normal but who responds to verbal cues w/only single syllable vocalizations. What will you recommend to the parents to improve speech/language skills in this infant? a. Provide educational videos that focus on language. b. Read simple board books to the infant at bedtime. c. Sing to the child and play lullabies in the baby's room. d. Turn the TV to Sesame Street during the day.

B

During a well child examination on a 4monthold infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parentinfant relationship? A. "I can sense a difference in my baby's cries." B. "I let my baby cry a while to learn to be patient." C. "My baby prefers to nurse in a darkened room." D. "My baby seems very sensitive to loud noises."

B. "I let my baby cry a while to learn to be patient."

A middleschoolage child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation? A. Prescribe shortterm antidepressants for this situational depression. B. Refer the child to a mental health specialist for evaluation and treatment. C. Schedule extended appointments for counseling and mental health interventio. D. Suggest that the child have close followup by a school counselor.

B. Refer the child to a mental health specialist for evaluation and treatment.

The parent of a 3yearold 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? a. Leaving the room as the child is falling asleep and returning at intervals to check on the child b. Offering a reward for each night the child falls asleep without the parent in the room c. Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors d. Taking away a favorite activity or video for each night the child fusses about the parent not being in the room

A

The parent of a 5mo is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will you tell this parent? a. The infant may be expressing a desire to play or rest. b. The parent should give ibuprofen for teething pain before nursing. c. This is an indication that the infant is ready for solid foods. d. This may indicate GI discomfort such as constipation.

A

The parent of an adolescent reports noting cutting marks on the teen's arms and asks you what it means. What will you tell the parent? a. Cutting is a way of dealing w/emotional stress. b. It's a method of fitting in w/other adolescents. c. The behavior is common and will usually stop. d. This type of behavior is a type of suicide attempt.

A

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? a. Bedsharing with infants greatly increases the risk of SIDS. b. Breastfeeding does not appear to have any influence on SIDS risk. c. Infants who attend day care have a higher than usual incidence of SIDS. d. There is no difference in SIDS rates in immunized versus nonimmunized infants.

A

You are examining a 12mo who was 6wks 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 you do first? a. Perform an in-depth developmental assessment. b. Reassure the parent that this is normal for a premature infant. c. Refer the infant to a developmental specialist. d. Suggest activities to improve fine motor skills.

A

You are examining a 15yo female who reports having her first period at 13yo. She states that she has had 5 periods in the last year, w/the last one 2mo prior. She participates in basketball at school. Which action is correct? a. Perform biometric screening to determine lean body mass. b. Prescribe oral contraceptive pills to regulate her periods. c. Reassure her that this is perfectly normal at her age. d. Refer her to an endocrinologist for hormonal eval.

A

You are performing a well child exam on a 17yo female whose mom is present during the hx. The mom expresses concern that her daughter wishes to have an eyebrow piercing and states that she is opposed to the idea. What will you do? a. Provide info about piercings and encourage continued discussion. b. Remind her that her mom is responsible for her health. c. State that piercings are relatively harmless and are an expression of individuality. d. Suggest that she wait until she is 18yo and can make her own decisions.

A

The parent of a school age child reports that the child doesn't like being alone in rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse practitioner tell the parent? A. "Fear of imaginary creatures does not usually occur at this age." B. "I may need to refer your child to a pediatric mental health specialist." C. "Your child is expressing normal fears for a schoolage child." D. "Your child may be watching too much violence on television."

A. "Fear of imaginary creatures does not usually occur at this age."

A 14yearold female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect? A. Anorexia nervosa B. Bulimia nervosa C. Depression D. Substance abuse

A. Anorexia nervosa

A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates and often spends time sitting quietly. What will the nurse practitioner do initially? A. Ask the mother about the child's relationship with the father. B. Consult with a child psychiatrist to prescribe medications. C. Recommend cognitive behavioral or psychodynamic therapy. D. Refer the family to a child behavioral specialist for counseling.

A. Ask the mother about the child's relationship with the father.

The parent of a 4yearold child reports that the child seems to be having trouble adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do? A. Ask the parent if the child is slow to warm up to other new situations. B. Reassure the parent that parallel play is common among preschoolage children. C. Recommend that the parent spend time encouraging the child to play with others. D. Suggest that the day care center may be neglecting the child.

A. Ask the parent if the child is slow to warm up to other new situations.

A 9yearold child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has recently begun sleeping in the parents' bed. Which initial action by the primary care pediatric nurse practitioner is appropriate? A. Assess for environmental stress, parental dysfunction, and maternal depression. B. Ask about recent traumatic events that may have precipitated this behavior. C. Consider a possible pediatric autoimmune neuropsychiatric disorder cause. D. Recommend firm insistence on school and activity attendance

A. Assess for environmental stress, parental dysfunction, and maternal depression.

The primary care pediatric nurse practitioner is discussing fitness and exercise with the parents of a 5yearold child who ask what kinds of activities are developmentally appropriate for their child. What will the nurse practitioner recommend? A. Bike riding B. Interactive play C. Martial arts D. Organized sports

A. Bike riding

The parent of a schoolage girl reports that the child has difficulty getting ready for school and is often late because of a need to check and recheck whether her teeth are clean and her room light has been turned off. What will the primary care pediatric nurse practitioner recommend to this parent? A. Cognitivebehavioral therapy B. Deferral of treatment until symptoms worsen C. Medication management with an SSRI D. Referral to a child psychiatrist

A. Cognitive behavioral therapy

The parent of a school age child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child? A. Generalized anxiety disorder (GAD) B. Obsessivecompulsive disorder (OCD) C. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) D. Separation anxiety disorder (SAD)

A. Generalized anxiety disorder (GAD)

How does the onset of the pubertal growth spurt compare in girls and boys? A. In girls, it occurs about 1 year before it appears in boys. B. In girls, it occurs about 3 years before it appears in boys. C. In boys, it occurs about 1 year before it appears in girls. D. It is about the same in both boys and girls.

A. In girls, it occurs about 1 year before it appears in boys. Correct Rationale A. Average age of onset is 9.5 years for girls and 10.5 years for boys. B. Although it may be true on an individual basis that puberty occurs 3 years before it appears in boys, the average difference is 1 year. C. Usually girls begin their pubertal growth spurt earlier than boys. D. Usually girls begin their pubertal growth spurt earlier than boys.

Which is an important consideration in preventing injuries during middle childhood? A. Most injuries occur in or near school or home. B. Peer pressure is not strong enough to affect risk-taking behavior. C. Injuries from burns occur with the highest frequency at this age because of the fascination with fire. D. Lack of muscular coordination and control results in an increased incidence of injuries.

A. Most injuries occur in or near school or home. Correct Rationale A. Most injuries occur near school or home. B. Peer pressure is significant in this age group. C. Automobile accidents, rather than burns, account for the majority of severe accidents in this age group, either as a pedestrian or passenger. D. School-age children have more refined muscle development, which results in an overall decrease in the number of accidents.

The parent of a 14yearold 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? A. Preseason conditioning B. Proper footwear C. Protective knee braces D. Stretching before practices

A. Preseason conditioning

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? A. Protein supplements B. Salt tablets C. Sports drinks D. Vitamin C

A. Protein supplements

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? A.Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure B. Moderate daily exercise such as walking for 20 minutes daily with increasing intensity as blood pressure drops C. Vigorous aerobic exercise combined with maximal strength training to lower blood pressure D. Vigorous aerobic exercise only to reduce blood pressure and then to maintain lowered blood pressure

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

A 12yearold 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? A. The child may continue to participate in soccer. B. The child should limit activity to nonaerobic sports. C. This condition is a contraindication for all sports. D. This condition predisposes the child to sudden cardiac death.

A. The child may continue to participate in soccer.

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? a. Ask the child's parents whether they read to the child. b. Give parents educational materials to encourage speech. c. Refer the child to an early intervention program. d. Suggest that they purchase age-appropriate music videos.

ANS: A Language development requires oral-motor ability, auditory perception, and cognitive ability, which this child has been shown to have, as well as the psychosocial-cultural environment to motivate the child to engage in language use. The PCPNP's initial step should be to determine whether the parents provide such an environment. Educational materials may be used after it is determined that these are useful. Early intervention may be used if the speech delay persists. Music videos do not necessarily engage the child in expression of speech

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

ANS: A The "newest vital sign," or health literacy, can be determined quickly by asking the parent how many children's books are in the home. Greater than 10 books in the home is an independent positive predictor of adequate parent health literacy. The other questions may determine a specific level of literacy in general but are not as efficient.

The parents of a prepubertal 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? A. Avoiding strength training programs until after puberty to minimize the risk for injury B. Enrolling their daughter in a program that uses fixed weight machines or resistance bands C. Having their daughter participate in weight training 4 or 5 times each week for maximum effect D. Making sure that their daughter begins with the greatest weight tolerable using lower repetitions

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

The nurse is reviewing with a group of school age parents about what to expect regarding their school-aged children. What information should the nurse include? (Select all that apply.) A. The average weight gain is 7 lbs per year. B. The average increase in height is 2 inches per year. C. Children this age like to collect groups of things like coins. D. They really want to please their parents and teachers. E. The developmental task for this age is initiative. F. Children this age are able to understand sports and social rules.

B. The average increase in height is 2 inches per year.Correct C. Children this age like to collect groups of things like coins.Correct D. They really want to please their parents and teachers.Correct F. Children this age are able to understand sports and social rules.Correct

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? A. After 3 weeks, she may begin lifting weights but not full sports. B. After 4 weeks, she may return to full play and practice. C. At 4 weeks, she must have an exam to determine fitness for play. D. She may engage in moderate exertion and practice after 3 weeks.

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

The parent of a 12yearold 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? A. Children with SCT should not play any contact sports. B. Children with SCT may not play for NCAA schools in college. C. Children with SCT should follow heat acclimatization guidelines. D. Children with SCT should not participate in organized sports.

C. Children with SCT should follow heat acclimatization guidelines.

An adolescent has recently begun doing poorly in school and has stopped participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient? A. Administering a diagnostic rating scale for depression B. Considering a shortterm trial of an antidepressant medication C. Determining suicidal ideation and risk of suicide D. Referring the adolescent to a mental health specialist

C. Determining suicidal ideation and risk of suicide

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? A. Bicycle riding is not safe for children with seizures. B. Contact sports should be avoided. C. Direct supervision of some activities is necessary. D. Underwater sports are not recommended.

C. Direct supervision of some activities is necessary.

The school nurse is discussing dental health with children in first grade. Which information should the nurse include in the presentation? A. Teach the children how to floss teeth properly. B. Recommend using a toothbrush with hard nylon bristles. C. Emphasize the importance of brushing before bedtime. D. Recommend using nonfluoridated toothpaste approved by the American Dental Association.

C. Emphasize the importance of brushing before bedtime. Correct Rationale A. Parents should help with flossing until children develop the dexterity required, which occurs at about the time of third grade. B. A toothbrush with soft nylon bristles is recommended. C. Children should be taught to brush their teeth after meals and snacks and before bedtime; the children should already have been instructed in this regard. D. The American Dental Association recommends fluoridated toothpaste for this age group.

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? A. Permanent discontinuation of all strenuous and aerobic activities B. Enrollment in a conditioning program to improve performance C. Evaluation for underlying cardiac causes of this symptom D. Treatment for exercise-induced asthma with a bronchodilator

C. Evaluation for underlying cardiac causes of this symptom

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? a. Cosleeping with the child to help alleviate possible nighttime fears b. Referral to a sleep disorders clinic for evaluation of sleepdisordered breathing c. Reintroducing a second, morning nap time to compensate for lost sleep d. Understanding that sleep resistance is a common developmental problem

D

The parent of a child who has asthma asks the PCP about wether the child may engage in strenous exercise. What will the PCP tell the parent? a. children with asthma should be excluded from vigorous exercise and most strenuous ports b. child with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity c. physical activity has been shown to improve overall pulmonary function in children with asthma d. vigorous exercise helps improve symptoms in children with poorly controlled asthma

b. children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity

The PCP is offering anticipatory guidance to the parents of a 6-year-old child who has down syndrome. what will the PCP recommend about exercise? a. children with down syndrome get frusted easily when engagin in sports b. children with down syndrome should not participate in strenous aerobic activity c. their child should have a cervical spine evaluation before participation in sports d. their child should. only participate in sports sanctioned by the special olympics

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

During a well child examination, the primary care pediatric nurse practitioner learns that a 5yearold 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? a. Establishing a graduated extinction program and good sleep hygiene b. Making sure that stairs are blocked and doors are locked c. Referral to a sleep disorder clinic for evaluation of a parasomnia d. To awaken the child when these occur and asking about nightmares

B

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. A program of sleep hygiene and gradual sleep extension b. A sedativenarcotic will help both sleep and depression c. Cognitive therapy can help the adolescent to sleep better d. Using an antidepressant will improve sleep patterns

A

During an assessment of a 4wk old, you learn that the breastfed infant nurses every 2hrs during the day but is able to sleep for 4hrs at night. The infant has gained 20g/day in the interval since last seen in clinic. What will you recommend? a. Continue to nurse the infant using the current pattern. b. Nurse the infant for longer periods q4h c. Supplement w/formula at the last nighttime feeding. d. Wake the infant q2h to nurse during the night.

A

The mom of a 15yo adolescent female tells you that her daughter h as 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 mom and says, "She gets really hard to live with." This demonstrates which characteristic of adolescent thinking? a. Apparent hypocrisy b. Imaginary audience c. Overthinking d. Personal fable

A

The mom of a 6mo is distressed because the infant can say "dada" but not "mama" and asks you why this is when she is the one who spends more time w/the infant. How will you respond? a. At this age, your baby does not understand the meaning of sounds. b. Babies at this age cannot make the "ma" sound. c. Most sounds made by babies at this age are accidental. d. This may mean that your baby doesn't hear well.

A

The parent of a 16yo tells you that the teen was recently caught smoking an e-cig. What will you tell this parent? a. E-cig use may be a risk factor for later substance abuse. b. Experimentation with e-cigs does not lead to future tobacco abuse. c. Most teens who experiment w/tobacco usually don't become addicted. d. This form of nicotine ingestion is safer than regular cigs.

A

The mom of a 3mo tells you that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for you to teach this mom? a. Appropriate ways to stimulate and entertain the infant. b. How to read the infant's cues for overstimulation. c. The importance of scheduling "play dates" w/other infants. d. To provide musical toys to engage the infant.

B

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? a. Allow the child to explore and experiment while providing appropriate limits. b. Be present while the child plays to continually teach the child what is appropriate. c. Let the child experiment at will and to make mistakes in order to learn. d. Say "no" whenever the child does something that is not acceptable.

ANS: A The child who is securely attached uses the parents as a base from which to safely explore the world. Toddlers learn by doing and need to experiment to gain mastery over the environment. It is important that parents are present for safety, but parents should not be ever-present and controlling. Parents should be close by and should intervene if the child is at risk for injury. Continual criticism and the use of the word "no" can make the toddler feel powerless.

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? a. Allow the child to choose foods for meals to improve caloric intake. b. Place a variety of nutritious foods on the child's plate at each meal. c. Prepare mashed potatoes and chicken strips for the child at mealtimes. d. Suggest cutting out snacks to improve the child's appetite at mealtimes.

ANS: B Young children should have three meals and two nutritious snacks each day. The parents' responsibility is to provide nutritious foods and allow children to choose how much they will eat. Children who are allowed to choose foods will likely make selections that are not healthy. Parents should be discouraged from preparing separate meals for their children. Snacks are necessary to maintain adequate intake and energy.

The primary care pediatric nurse practitioner learns that the mother of a 3-year-old child has been treated for depression for over 5 years. Which aspect of this child's development will be of the most concern to the nurse practitioner? a. Fine motor b. Gross motor c. Social/emotional d. Speech and language

ANS: C Adverse childhood experiences (ACEs) and parental depression can cause toxic stress, which may affect the security of the infant-caregiver relationship leading to an increased risk of social-emotional problems later in life

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? a. Evaluate the child's cognitive abilities. b. Obtain a hearing evaluation. c. Reassure the parent that this is normal. d. Refer the child to a speech therapist.

ANS: C Intelligibility of speech reaches about 75% by 3 years of age. Tongue-contact sounds are more intelligible by age 5 years. This child exhibits normal speech for age. It is not necessary to perform a cognitive assessment based on these findings. Referrals for hearing and speech evaluations are not indicated, since these findings are within normal limits.

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? a. The child probably is very shy but will outgrow this tendency with repeated exposure to other children. b. The toddler may have a language delay that interferes with socialization with other children. c. Toddlers may be interested in other children but usually do not engage in interactive play. d. Toddlers need more structured play to encourage interaction and socialization with others.

ANS: C Parallel play is common among toddlers who, although they may be fascinated by other children, generally do not engage with peers in an interactive manner. This does not mean that the child is shy or has a language delay, although in preschool years, the development of symbolic language increases interactive play. Children need both structured and free play, but structured play will not increase interaction during this normally parallel period.

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? a. "Begin by reading to your child about toileting." b. "Most children are capable by age 2 years." c. "Tell me about your child's daily habits." d. "We should assess your child's motor skills."

ANS: C To assess the parent's understanding of toilet readiness, the nurse practitioner will ask the parents about the child's daily habits and routines to see if the child has predictable patterns that can be the basis for toilet training. While providing storybooks about toileting can help children learn, the first step is to assess toilet readiness. Even though many children are capable at this age, evaluating personal readiness is key to beginning toilet training. Assessment of motor skills may be a second step.

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? a. Children who learn two languages simultaneously often confuse them in conversation. b. Children with multi-language proficiency do not understand that others cannot do this. c. Learning two languages at an early age prevents children from developing a dominant language. d. Most bilingual children are able to shift from one language to another when appropriate.

ANS: D Most children who are bilingual are able to sort out the languages in conversation but may "code-switch" at times for clarity as they speak. They seem to understand that not everyone has this ability. Most children who are bilingual develop a dominant language.

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 what type of speech? a. Holophrastic b. Receptive c. Semantic d. Telegraphic

ANS: D Syntax, or the structure of words in sentences or phrases, is developed in stages between the ages of 8 months and 3.5 years. Telegraphic speech begins at about 18 months of age when children speak in phrases with many words omitted so that the sentence sounds like a telegram. Holophrastic speech is the use of a single word to express a complete idea. Receptive speech refers to the ability to understand a word without necessarily being able to use the word. Semantics is the understanding that words have specific meanings

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, take solid foods three times daily, and occasionally take water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimal dental health? a. To begin brushing the infant's teeth with toothpaste b. To consider weaning the infant from breastfeeding c. To discontinue giving fluoride supplements d. To make an appointment for an initial dental examination

ANS: D The American Academy of Pediatric Dentistry recommends a first dental examination at the time of eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride supplements should not be discontinued.

The parent of a schoolage 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 a. clonazepam. b. ferrous sulfate. c. gabapentin. d. sertraline.

B

You are performing a well child assessment on a 13yo female whose mom asks when her daughter's periods may start. Which info will you use to help estimate the onset of periods? a. The age of the mom's menarche b. The pt's age at thelarche c. When adrenarche occurred d. Whether linear growth has stopped

B

You are performing a well child exam on a 12yo female who has achieved early sexual maturation. The mom reports that she spends more time w/her older sister's friends instead of her own classmates. What will you tell this parent? a. Early-maturing girls need to ID w/older adolescents to feel a sense of belonging. b. Girls who join an older group of peers may become sexually active at an earlier age. c. Spending time w/older adolescents indicates a healthy adjustment to her maturing body. d. The association w/older adolescents will help her daughter to gain social maturity.

B

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. What will the nurse practitioner tell the parent? A. "As long as the helmet does not have cracks, you may use it." B. "If the helmet is free from marks, you may use it." C. "You may continue to use a helmet up to 10 years." D. "You should always purchase a new helmet for each child."

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

The primary care pediatric nurse practitioner is evaluating a heart murmur during a preparticipation examination of a high school athlete. Which finding would be a concern requiring referral to a cardiologist? A. A murmur that is louder when squatting and softer when standing B. A murmur that is quieter when squatting and louder with a Valsalva maneuver C. A murmur with narrow and variable splitting of S2 D. A systolic murmur that is grade 1 or 2

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

Which is descriptive of the social development of school-age children? A. Identification with peers is minimal. B. Children frequently have "best friends." C. Boys and girls play equally well with children of either gender. D. Peer approval is not yet an influence toward conformity.

B. Children frequently have "best friends." Correct Rationale A. Identification with peer group is an important factor toward gaining independence from families. B. Same-sex peers form relationships that encourage sharing of secrets and jokes and coming to each other's aid. C. There are more gender-specific groups during this particular age group. D. Conforming to the rules is an essential part of group membership.

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? A. Children with asthma should be excluded from vigorous exercise and most strenuous sports. B. Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity. C. Physical activity has been shown to improve overall pulmonary function in children with asthma. D. Vigorous exercise helps improve symptoms in children with poorly controlled asthma.

B. Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity.

An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk? A. Addition of risperidone therapy B. Cognitive behavioral therapy C. Family therapy D. Hospitalization

B. Cognitive behavioral therapy

The parents of a 4yearold boy are concerned because he has begun twisting and pulling out his hair, especially when he is tired or stressed. What will the primary care pediatric nurse practitioner recommend as part of an initial approach to treat this behavior? A. Consultation with a pediatric behavioral specialist B. Cutting his hair so that it is too short to pull C. Longterm antistreptococcal prophylaxis D. Medication with risperidol or clonidine

B. Cutting his hair so that it is too short to pull

The primary care pediatric nurse practitioner is examining a 17yearold 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? A. Creatine B. Dehydroepiandrosterone (DHEA) C. Ephedra D. Growth hormone

B. Dehydroepiandrosterone (DHEA)

A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do? A. Advise the parent that the child is exhibiting early symptoms of ADHD. B. Engage the parent in positive parenting strategies to facilitate appropriate child coping. C. Recommend evaluating the child for conduct or oppositional defiant disorder. D. Suggest putting the child in another day care center to ameliorate the problems.

B. Engage the parent in positive parenting strategies to facilitate appropriate child coping.

A 12-year-old child being seen in the clinic has not received the vaccine for the hepatitis B virus (HBV). What recommendation should the nurse make? A. One dose of HBV vaccine is needed at age 14 years. B. The three-dose series of HBV vaccine should be started. C. Only one dose of HBV vaccine will be needed sometime during adolescence. Incorrect D. The three-dose series of HBV vaccine should be started at age 16 years or sooner if the adolescent becomes sexually active.

B. The three-dose series of HBV vaccine should be started. Correct Rationale A. Three doses are necessary to achieve immunity. B. Adolescents should be vaccinated against hepatitis B at this age if it has not been done previously. C. Three doses are necessary to achieve immunity. D. The recommendation is that the hepatitis B vaccine series be started at birth. The American Academy of Pediatrics recommends vaccination by age 13 years.

A child with Down syndrome who has sleepdisordered 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? a. Craniofacial surgery b. Oral appliances c. Positive airway pressure therapy d. Supplemental oxygen

C

The parent of a 14yo tells you that the adolescent has expressed a desire to be vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will you tell the parent? a. Don't allow a vegetarian diet in order to maintain appropriate limits for the adolescent. b. Provide vegetarian options for the adolescent that preserve adequate nutrition and protein intake. c. Suggest that the adolescent prepare appropriate vegetarian dishes to complement family meals. d. Tell the adolescent that a vegetarian diet may be considered in adulthood but not while living at home.

C

The parent of a 14yo tells you that the child skips classes frequently in spit of various disciplinary measures, such as grounding and extra homework and is earning Cs and Ds in most classes. What will you recommend? a. Counseling for emotional problems b. Development of an Individual Education Plan c. Eval for possible learning disorders d. Referral for a behavioral disorder

C

The parent of a 4yearold 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? a. Diphenhydramine b. Lorazepam c. Melatonin d. Zolpidem

C

The parent of a newborn asks you when to intervene to help the infant's future intellectual growth. What will you tell them? a. Cognitive learning begins during toddler yrs. b. Intellectual growth begins when speech develops. c. Language and literacy skills begin at birth. d. Pre-K is an optimal time to begin general learning.

C

The parent of a schoolage child who is overweight tells the primary care pediatric nurse practitioner that the child seems to crave highcalorie, highcarbohydrate 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? a. Assessment of leptin and ghrelin hormone levels b. Consultation with a dietician to develop an appropriate diet c. Referral to a sleep disorder clinic for a sleep study d. Taking one or two naps each day to increase the amount of sleep

C

The primary care pediatric nurse practitioner is performing a well baby examination on a 2weekold 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? a. 10 to 12 hours b. 12 to 15 hours c. 15 to 18 hours d. 18 to 20 hours

C

The primary care pediatric nurse practitioner is performing a well child examination on a 4yearold 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? a. Most sleep disorders are benign and will be outgrown. b. Sleep disorders are symptomatic of underlying behavior problems. c. Sleep disorders at this age can have longterm impacts on learning. d. The child will need longer daytime naps to compensate for lost sleep.

C

You are performing a well baby exam on a 2mo who has gained 25g/day in the last interval. The mom is nursing and tells you that her infant seems fussy and wants to nurse more often. What will you tell her? a. She may not be making as much milk as before. b. She should keep a log of the frequency and duration of each feeding. c. The infant may be going through an expected growth spurt. d. The infant should stay on the previously established nursing schedule.

C

You perform a well baby exam on a 7-day-old who is nursing well, according to mom. You note that the infant weighed 3250g at birth and 2990g when discharged on the 2nd day of life. The infant weighs 3080g at this visit. Which action is correct? a. Follow up at the 2mo checkup. b. Refer to lactation consultant. c. Schedule a wt check in 1wk. d. Suggest supplementing w/formula.

C

What nursing intervention to promote health during middle childhood would be appropriate? A. Stress the need for increased calorie intake to meet increased demands. B. Instruct parents to defer questions about sex until the child reaches adolescence. C. Reinforce the need for good dental hygiene because these are the years in which permanent teeth erupt. D. Advise parents that the child will need decreasing amounts of rest toward the end of this period.

C. Reinforce the need for good dental hygiene because these are the years in which permanent teeth erupt. Correct Rationale A. Caloric needs are diminished; however, a balanced diet is important to prepare for the adolescent growth spurt. B. Parents should approach sex education with a life span approach and respond to a child's questions with an answer appropriate to the child's age. C. Because the permanent teeth are present, it is important for the child to learn how to care for these teeth. D. School-age children often need to be reminded to go to sleep.

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. What guidance would be appropriate for the nurse to share with the parents? A. Organized sports, such as soccer, are not appropriate at this age. B. Competition is detrimental to the establishment of a positive self-image. C. Sports participation is encouraged if the sport is appropriate to the child's abilities. D. Girls should compete only against girls because at this age boys are larger and have more muscle mass.

C. Sports participation is encouraged if the sport is appropriate to the child's abilities. Correct Rationale A. Organized sports can provide safe, appropriate activities with supportive parents and coaches. B. School-age children enjoy competition. Parents and coaches need to recognize the child's abilities and teach proper techniques so the child can compete safely. C. The parents should help the child select a sport that is suitable to her capabilities and interests. D. Increased muscle mass in boys occurs at puberty. Before that, boys and girls can compete on the same teams.

During a well child assessment of a preschoolage child, the parent voices concerns that, because the child has behavior problems at school, the child may have a mental health disorder. Which initial approach will provide the best information? A. Ask the parent whether other caregivers have voiced similar concerns. B. Interview the child separately from the parent to encourage sharing of feelings. C. Take time to actively listen to the parent's and child's perceptions of the problem. D. Use a validated screening tool to ensure that all aspects of behaviors are evaluated.

C. Take time to actively listen to the parent's and child's perceptions of the problem.

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which developmental information should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about age 5 years. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

C. Transitory periods of lowered self-esteem are expected developmentally. Correct Rationale A. Self-esteem is influenced throughout adolescence. B. One aspect of self-esteem is a subjective judgment of one's worthiness. C. Self-esteem changes with development. Transient changes are expected, and with positive encouragement and support the changes are only temporary. D. Self-esteem is based on several components: competence, sense of control, moral worth, and worthiness of love and acceptance.

A condition in which the teeth are crowded, crooked, or out of alignment is known as______________?

Correct Responses: "Malocclusion, Malocclusion" Rationale Malocclusion is defined as a condition in which the teeth are crowded, crooked, or out of alignment. Factors such as heredity, cleft palate, premature loss of primary teeth, and mouth breathing lead to malocclusion.

During a well child exam of a 13yo male, you note small testicles and pubic/axillary hair. To further eval these findings, you will ask the pt about: a. ETOH/tobacco use b. Changes in voice c. Increase in ht/wt d. Participation in sports

D

The mom of a 16yo male was recently divorced after several years of an abusive relationship and tells you that the pt has begun skipping school and hanging out w/friends at the local shopping mall. When she confronts him, he responds by saying that he hates her. What will you tell the mom? a. Adolescence is marked by an inability to comprehend complex situations. b. Adolescence is typically marked by tempestuous and transient episodes. c. Adolescents normally have extreme, disruptive conflicts w/parents. d. Adolescents often need counseling to help them cope w/life events

D

The mom of a 6wk old breastfed infant tells you that her baby, who previously had BMs w/each feeding, now has a BM once every third day. What will you tell her? a. Her baby is probably constipated. b. It may be related to her diet. c. She should consume more water. d. This may be normal for breastfed babies.

D

The parent of a 3yearold 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? a. That if this occurs again, to question the child about nightmares b. That this is a sign of sleep walking and could be dangerous c. That this is a type of sleep terror which will resolve over time d. That this is probably a benign, temporary type of a sleep disorder

D

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. What response by the nurse is based on what knowledge about children this age? A. Bullying at this age is considered normal. B. Children who bully others usually join gangs. C. Children who bully others usually have low self-esteem. D. Bullies often have difficulties developing and maintaining relationships.

D. Bullies often have difficulties developing and maintaining relationships. Correct Rationale A. Bullying is a maladaptive response to poor relationships with peers and lack of group identification. B .Bullying is a maladaptive response to poor relationships with peers and lack of group identification. C. Children who bully usually have strong self-esteem and little anxiety. D. Children who bully are defiant toward adults, antisocial, and likely to break school rules. They have little anxiety and strong self-esteem and may come from homes where physical punishment is used and there is a lack of parental involvement and warmth. In the long term, this negativity continues into adulthood, causing difficulties in developing and maintaining relationships.

A child has a difficult temperament. What will the primary care pediatric nurse practitioner tell the parent about managing this child's behavior? A. A difficult temperament is its own risk factor for maladjustment disorders. B. Children with difficult temperaments need strict adherence to rules. C. Having a difficult temperament limits intelligence and emotional maturity D. It is important for the parent to learn to manage criticism and power struggles.

D. It is important for the parent to learn to manage criticism and power struggles.

The primary care pediatric nurse practitioner attempts to learn more about the emotional health of an 18monthold child through which assessment strategy? A. Asking the child to tell a story using dolls and other props B. Asking the child to draw a picture of him or herself and other family members C. Interviewing the child separately from caretakers and parents D. Observation of the child with caretakers in structured and unstructured situations

D. Observation of the child with caretakers in structured and unstructured situations

The parent of a preschoolage child reports that the child often appears anxious and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend? A. Cognitivebehavioral therapy B. Family therapy C. Medication therapy D. Play therapy

D. Play therapy

Which is an important consideration related to childhood stress? A. Children do not have coping strategies. B. Children should be protected from stress. C. Parents cannot prepare children for stress. D. Some children are more vulnerable to stress than others.

D. Some children are more vulnerable to stress than others. Correct Rationale A. Children can be taught coping strategies. Supportive interpersonal relationships are essential to the psychological well-being of children. B. It is not feasible to protect children from all stress. C. Adults need to recognize signs of stress before they become overwhelming. Providing children with interpersonal security helps them develop coping strategies for dealing with stress. D. Children's age, temperament, life situation, and state of health affect their vulnerability, reactions, and ability to handle stress.

The parent of a schoolage child is concerned because the child has started to express anger about a grandparent's death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent? A. Anger is an abnormal reaction to bereavement and loss in this age child. B. Counseling is needed since the child has had sufficient time to resolve this issue. C. Grief and bereavement lasting longer than a year may require medication. D. The significance of this loss must be reworked at each developmental level.

D. The significance of this loss must be reworked at each developmental level.

The PCP is discussing fitness and exercise with the parents of a 5-year-old child who asks what kinds of activities are developmentally appropriate for their child. What witll the PCP recommend? a. bike riding b. interactive play c. martial arts d. organized sports

a. bike riding

The parent of a 14-year-old child asks the pcp how to help the child prevent injuries when basketball tryouts begin later in the school year. Which recommendation will be of most benefit? a. preseason conditioning b. proper footwear c. protective knee braces d. stretching before practices

a. preseason conditioning

The PCP is discussing lifestyle changes with an adolescent who has hypertension. What will the PCP recommend about exercise for this client? a. regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower BP b. moderate daily exercise such as walking for 20 minutes daily with increasing intensity as blood pressure drops c. vigorous aerobic exercise combined with maximal strength training to lower BP d. vigorous aerobic exercise only to reduce BP and then to maintain lowered BP

a. regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower BP