PEDS

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

The mother of a 6 month old infant is distressed because the infant can say "dada" but not "mama" and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond? 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. "At this age, your baby does not understand the meaning of sounds."

During an assessment of a 4 week old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend? A. Continuing to nurse the infant using the current pattern B. Nursing the infant for longer periods every 4 hours C. Supplementing with formula at the last nighttime feeding D. Waking the infant every 2 hours to nurse during the night

A. Continuing to nurse the infant using the current pattern

The primary care pediatric nurse practitioner is examining a 12 month old infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? 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. Perform an in depth developmental assessment.

The parent of a 5 month old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? A. The infant may be expressing a desire to play or to 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 gastrointestinal discomfort such as constipation.

A. The infant may be expressing a desire to play or to rest.

During a well baby examination of a newborn, the primary care pediatric nurse practitioner notes adduction of the right forefoot, with normal position of the mid- and hind-foot, along with a convex-shaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity? a. Grasp the heel with one hand and abduct the forefoot with the other hand. b. Observe both legs for medial and lateral rotations. c. Order anterior-posterior and lateral radiographs of both feet. d. Refer the infant immediately to a pediatric orthopedic specialist. .

ANS: A The foot position is characteristic of metatarsus adductus. The PNP should evaluate whether the deformity is rigid, requiring treatment by an orthopedist, or not. If the forefoot can be brought past the midline with the heel held in place, it is not considered to be a rigid deformity. Assessing legs for medial and lateral rotations is part of the exam for in-toeing. Radiographs are not routinely performed. Referral to an orthopedic specialist, if this is found to be rigid deformity, is not urgent

A child who plays soccer is in the clinic reporting pain and swelling in both knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition? a. Apply ice packs to both knees and avoid activities that cause pain. b. Begin quadriceps-stretching exercises now to prevent further injury. c. Obtain radiographic studies to rule out fractures or ligament tears. d. Refer to a pediatric orthopedic specialist to evaluate the need for surgery.

ANS: A The history of sports involving kicking a ball and the location and type of pain and swelling are consistent with Osgood-Schlatter disease (OSD). Management involves rest and ice and sometimes NSAIDs. Quadriceps-stretching exercises are not encouraged until the acute symptoms pass. Radiographic studies are not necessary. Referral is not indicated for OSD.

A child is brought to the clinic immediately after being stung by a wasp while playing in the yard. The physical examination reveals localized redness and edema at the site, along with abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment? a. Administer intramuscular epinephrine. b. Apply a topical glucocorticoid cream. c. Give oral diphenhydramine. d. Order a bronchodilator treatment.

ANS: A This child has signs of a severe reaction to the sting and should receive epinephrine first, followed by oral diphenhydramine and bronchodilators if wheezing. Topical glucocorticoids are used for mild, localized reactions.

A 14-year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition? a. Place the child on crutches or in a wheelchair to prevent weight-bearing. b. Provide information about weight loss to minimize further injury. c. Recommend seeing an orthopedic specialist as soon as possible. d. Refer the child to physical therapy to improve range of motion.

ANS: A This child's age, history, and symptoms are consistent with slipped capital femoral epiphysis. The child should be placed on crutches or in a wheelchair to prevent weight bearing. Obesity is often part of the history and should be managed, but the immediate need is to prevent further damage to the hip. Referral to orthopedics should immediately follow prevention of weight bearing. Physical therapy may be part of treatment after the epiphysis is stabilized.

A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? a. Discuss posture and exercise and ask about backpacks and books. b. Obtain radiographic studies of the entire spine and neck. c. Reassure the child's parent that functional scoliosis will self-resolve. d. Refer to an orthopedic specialist for evaluation and possible bracing.

ANS: A Unequal scapulas noted on standing can denote scoliosis and deserves a more thorough physical assessment. Functional scoliosis can be diagnosed by assessing curves in the spine in the Adams forward bending position. Although it is relatively benign, functional scoliosis can progress to structural scoliosis if not treated, which can be done with physical therapy or other means, such as exercises or removing external forces (carrying heavy loads, heavy one-sided backpacks) that place unequal pressures on the spine, to prevent progression. Radiographs may be necessary if this worsens. This will not self-resolve but must be managed to prevent progression. Orthopedic referral is not necessary at this early, modifiable stage.

7. The primary care pediatric nurse practitioner is performing a well baby examination on a 2-month-old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her? a. She may not be making as much breastmilk 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.

ANS: C Infants may have a growth spurt at 6 to 8 weeks, and mothers who are breastfeeding may be concerned that they are not making enough milk when they notice that the infant is fussy and wanting to nurse more often. The PNP should reassure the mother that this is expected. It is not necessary, since the infant is gaining weight appropriately, for the mother to keep a log. The mother should follow the infant's cues for feeding since the extra suckling will increase the milk supply to meet the growing infant's needs.

A school-age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed? a. Application of a figure-eight clavicle brace for 6 to 8 weeks b. Hospitalization for traction of the affected extremity and shoulder c. Immobilization with a sling to support the affected extremity d. Referral to an orthopedic specialist for possible surgical reduction

ANS: C Most children with fractured clavicle can be treated with sling immobilization for 3 to 4 weeks. Figure-eight clavicle braces are uncomfortable and have questionable effectiveness; they are used if displacement leads to decreased shaft length. Hospitalization for traction is not indicated. Surgical reduction is uncommon and used for open fractures, neurovascular compromise, multiple trauma, rib cage fractures, and severe displacement.

A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do? a. Obtain a chest radiograph to evaluate possible causes for these symptoms. b. Order an electrocardiogram to rule out potential cardiovascular disease. c. Recommend NSAIDs, stretching exercises, and ice packs to the area. d. Refer the child to a pediatric orthopedist for evaluation and treatment.

ANS: C The child has symptoms and a history consistent with costochondritis. Treatment is symptomatic with analgesics, ice packs, and exercise and rest. Chest radiographs offer no diagnostic value, except to rule out other causes. Unless heart sounds are abnormal, or there are other signs of cardiovascular disease, an ECG is not indicated. Referral is not necessary unless symptoms persist.

1. The primary care pediatric nurse practitioner performs a well baby examination on a 7-day-old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct? a. Follow up at the 2-month checkup. b. Refer to a lactation consultant. c. Schedule a weight check in 1 week. d. Suggest supplementing with formula.

ANS: C This infant lost about 8% of its birth weight, which is normal and, since discharge home, has gained at least 15 grams per day, which is also normal. The PNP should schedule a weight check in a week to make sure the infant regains its birth weight, since most should regain this in 10 to 14 days and since this loss of birth weight is at the high end of normal. It is not necessary to refer to a lactation consultant or supplement with formula, since the infant is gaining weight adequately.

A child has a 1-cm laceration on the forehead proximal to the hairline after running into a pole while playing sports. To minimize the risk of infection, the primary care pediatric nurse practitioner will irrigate the wound and a. allow the wound to heal by secondary intention. b. delay closure of the wound for several days. c. refer the child to a plastic surgeon for wound closure. d. suture the wound within 6 hours.

ANS: D Children are less likely than adults to get wound infections, with an infection rate from sutured lacerations at 2%. The PNP should clean and suture the wound. Wounds from animal bites are often left to heal by secondary intention to prevent infection. Referral to a plastic surgeon is necessary for cosmetic reasons. Delaying closure for several days is recommended for heavily contaminated wounds and those caused by high-velocity missile injuries, crush injuries, and explosion injuries.

A school-age child sustained a contusion on the front of one thigh while playing football and reports some difficulty flexing the foot on the affected side. What will the primary care pediatric nurse practitioner do to treat this injury? a. Place the child on crutches and limit weight-bearing until symptoms subside. b. Prescribe acetaminophen with hydrocodone along with NSAIDs. c. Recommend rest, ice packs, compression, and elevation of the extremity. d. Refer the child to an orthopedic specialist for immediate evaluation and treatment.

ANS: D Children with contusions that restrict movement or sensation and those affecting the quadriceps muscle may include compartment syndrome. These children should be referred to orthopedic specialists immediately so that the compartment pressure does not result in irreplaceable damage. The other options may be performed in consultation with a specialist.

A child is bitten by a snake near a swimming pool in an area where copperhead snakes are known to inhabit, although the parents cannot describe the snake. An examination of the bite reveals a severe local reaction at the site with edema and intense pain. What will the primary care pediatric nurse practitioner do first? a. Administer narcotic analgesics to provide comfort. b. Begin treatment with oral amoxicillin-clavulanate for 5 days. c. Clean the wound and administer tetanus prophylaxis. d. Transport the child by ambulance to a medical center

ANS: D If a venomous snakebite is suspected, rapid transportation to a medical center with referral to appropriate specialists and antivenin therapy is indicated. Narcotics may impair clinical evaluation. Non-venomous snakebites are treated with oral antibiotics if signs of infection are present after the wound is cleaned and tetanus prophylaxis is given.

4. The mother of a 6-week-old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? a. Her baby is probably constipated. b. It may be related to her dietary intake. c. She should consume more water. d. This may be normal for breastfed babies.

ANS: D Infants begin to have fewer bowel movements and may have bowel movements ranging from once or twice daily to once every other day when breastfed. Unless there are other signs, the baby is probably not constipated. The mother does not need to change her intake of foods or water, unless constipation is present.

The primary care pediatric nurse practitioner is preparing to close a laceration on a child's forehead using topical skin adhesive. What is the correct way to apply this product? a. Apply the adhesive between the wound margins and then hold the edges together. b. Apply the adhesive to the wound and then secure the edges with surgical tape. c. Have the child remain still for 15 to 20 minutes after the adhesive is applied. d. Hold the wound edges together and apply the adhesive on top of the skin.

ANS: D Topical adhesive is applied by holding the wound edges together (approximating the wound edges) and then applying the adhesive on top, often requiring two or three applications of the adhesive but allowing skin cooling between applications. The adhesive should not be applied between the wound margins or in the wound. Surgical tape and bandages are not used with topical adhesive. It is not necessary for the child to remain still after the adhesive is applied, since it dries quickly.

The mother of a 3 month old child tells the primary care pediatric nurse practitioner that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother? 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" with other infants D. To provide musical toys to engage the infant

B. How to read the infant's cues for overstimulation

The primary care pediatric nurse practitioner is performing a well child examination on a 9 month old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? 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 television to Sesame Street during the day.

B. Read simple board books to the infant at bedtime.

The mother of a 6 week old breastfeeding infant tells the primary care pediatric nurse practitioner that her baby, who previously had bowel movements with each feeding, now has a bowel movement once every third day. What will the nurse practitioner tell her? A. Her baby is probably constipated. B. It may be related to her dietary intake. C. She should consume more water. D. This may be normal for breastfed babies.

D. This may be normal for breastfed babies.

The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant's future intellectual growth. What will the nurse practitioner tell the parent? A. Cognitive learning begins during the toddler years. B. Intellectual growth begin when speech develops. C. Language and literacy skills begin at birth. D. Preschool is an optimal time to begin general learning.

C. Language and literacy skills begin at birth.

The primary care pediatric nurse practitioner performs a well baby examination on a 7 day old infant who is nursing well, according to the mother. The nurse practitioner notes that the infant weighed 3250 grams at birth and 2990 grams when discharged on the second day of life. The infant weighs 3080 grams at this visit. Which action is correct? A. Follow up at the 2month checkup. B. Refer to a lactation consultant. C. Schedule a weight check in 1 week. D. Suggest supplementing with formula.

C. Schedule a weight check in 1 week.

The primary care pediatric nurse practitioner is performing a well baby examination on a 2 month old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her? A. She may not be making as much breastmilk 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. The infant may be going through an expected growth spurt.

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 b. OCD c. PANDAs D. SAD (separation anxiety disorder)

GAD is characterized by over-concern about competence, significant self-consciousness, irritability and tantrums and poor sleep PANDAs- OCD & Tourette like symptoms

During a well child examination, a 15yearold female tells the primary care pediatric nurse practitioner that some of her friends have begun having sex. She has a boyfriend but denies engaging in sex with him. What will the nurse practitioner do initially? a. Ask her for her definitions of "sex." b. Discuss the risks of sexually transmitted diseases. c. Find out if she is considering sexual relations. d. Give her information about contraception.

a

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

The parent of a schoolage 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

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

The primary care pediatric nurse practitioner cares for a preschoolage child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. This child most likely has a disorder of a. executive function. b. information processing. c. sensory processing. d. social cognition.

a

The primary care pediatric nurse practitioner is evaluating a schoolage child who has been diagnosed with ADHD. Which plan will the nurse practitioner recommend asking the child's school about to help with academic performance? a. 504 b. FAPE c. IDEA d. IEP

a

The primary care pediatric nurse practitioner uses the Neurodevelopmental Learning Framework to assess cognition and learning in an adolescent. When evaluating social cognition, the nurse practitioner will ask the adolescent a. about friends and activities at school. b. if balancing sports and homework is difficult. c. to interpret material from a pie chart. d. to restate the content of something just read.

a

The parent of a school age 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 teh PCP recommend to this parent? a. CBT b. Deferral of treatment until symptoms worsen c., medication management with an SSRI d. Referral to a child psychiatrist

a. CBT CBT is used for mild to moderate symptoms of ECD.

1. The primary care pediatric nurse practitioner is preparing to close a laceration on a child's forehead using topical skin adhesive. What is the correct way to apply this product? a. Apply the adhesive between the wound margins and then hold the edges together. b. Apply the adhesive to the wound and then secure the edges with surgical tape c. Have the child remain still for 15 to 20 minutes after the adhesive is applied d. Hold the wound edges together and apply the adhesive on top of the skin

d

2. The primary care pediatric nurse practitioner is performing a well child examination on a 3yearold. The child's parent reports that the child has recently begun masturbating. What will the nurse practitioner counsel this parent? a. To allow the behavior whenever it occurs, since it is normal b. To discuss sexuality with the child c. To explore whether the child is being abused d. To teach the child about privacy and hand hygiene

d

3. A child has a 1cm laceration on the forehead proximal to the hairline after running into a pole while playing sports. To minimize the risk of infection, the primary care pediatric nurse practitioner will irrigate the wound and a. Allow the wound to heal by secondary intention b. Delay closure of the wound for several days c. Refer the child to a plastic surgeon for wound closure d. Suture the wound within 6 hours

d

6. A schoolage child sustained a contusion on the front of one thigh while playing football and reports some difficulty flexing his foot on the affected side. What will the primary care pediatric nurse practitioner do to treat this injury? a. Place the child on crutches and limit weight-bearing until symptoms subside. b. Prescribe acetaminophen with hydrocodone along with NSAIDs c. Recommend rest, ice packs, compression, and evaluation of the extremity d. Refer the child to an orthopedic specialist for immediate evaluation and treatment

d

9. A child is bitten by a snake near a swimming pool in an area where copperhead snakes are known to inhabit, although the parents cannot describe the snake. An examination of the bite reveals a severe local reaction at the site with edema and intense pain. What will the primary care pediatric nurse practitioner do first? a. Administer narcotic analgesics to provide comfort b. Begin treatment with oral amoxicillin-clavulanate for 5 days c. Clean the wound and administer tetanus prophylaxis d. Transport the child by ambulance to a medical center

d

9. A parent is concerned that a 12monthold child is "bowlegged." A physical examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the correct action for the primary care pediatric nurse practitioner? a. Observe the child's condition over time to assess progression. b. Order physical therapy to prevent progression of symptoms. c. Reassure the parent that the child will outgrow this deformity d. Refer to a pediatric orthopedic specialist for treatment.

d

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

During a well child examination of a 6yearold girl, the primary care pediatric nurse practitioner notes that the child becomes embarrassed and resists taking off her underwear for the exam. What should the nurse practitioner infer from this observation? a. The child has been sexually molested. b. The child is feeling violated by the examiner. c. The parent is exhibiting regressive behavior. d. This is a normal reaction in a child of this age.

d

The mother of a 3monthold male infant tells the primary care pediatric nurse practitioner that she occasionally notices he has a penile erection just after nursing. What will the nurse practitioner tell the mother? a. Infants should be prevented from masturbating. b. The infant is conscious of the pleasure associated with nursing. c. This is a form of infantile priapism. d. This is a normal, reflexive behavior at this age.

d

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

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 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

The primary care pediatric nurse practitioner is providing anticipatory guidance to the parent of a schoolage boy. The parent expresses concerns that the child prefers to play with dolls, is worried that the child will be a homosexual, and asks what can be done to prevent this from happening. What will the nurse practitioner tell this parent? a. Homosexual identity formation cannot be predicted by early childhood behavior. b. Masculinizing boys from an early age helps to determine heterosexual orientation. c. Sexual orientation identification begins late in adolescence and not in childhood. d. The development of sexual orientation is generally a multifaceted process.

d

The primary care pediatric nurse practitioner is selecting a medication for a 12yearold child who is newly diagnosed with ADHD. The child is overweight, has a history of an atrial septal defect at birth, and reports mild shortness of breath during exercise. What will the nurse practitioner prescribe? a. A lowdose stimulant medication b. A nonstimulant medication c. Behavioral therapy only d. Cardiovascular prescreening

d

The parent of a child diagnosed with ADHD tells the PCP that the child gets overwhelmed by homework assignments, doesn't seem to know which ones to do first, and then doesn't do any assignments. The PCP tells the parent that this represents impairment in which executive function? a. activation b. effort c. emotion d. focus

a. activation helps individuals organize, prioritize and begin activities

A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outburts and tantrums 2 months prior. The PCP learns that the child refused to play with usual playmates and often spends time sitting quietyly. What will the PCP do initially> a. ask the mother about the child's relationship with the father b. consult iwth child psych to prescribe meds c. recommend cbt d. refer the family to a child behavioral specialist for counseling

a. ask the mother about the child's relationship with the father the child is exhibiting signs of PTSD (investigating relationship with the father can reveal a source of violence)

A 9-year-old child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned b/c the child has recently begun sleeping in the parents' bed . Which initial action by the PCP 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 attendence

a. assess for environmental stress, parental dysfunction and maternal depression the child shows symptoms of separation anxiety disorder; environmental stress, parental dysfunction and maternal depression are risk factors for this disorder PTSD - assess for trauma OCD & tourette like symptoms - assess for autoimmune neuropsych

1. A child is brought to the clinic after falling from a swing and scraping both knees and hands. An examination reveals abraded skin with oozing serous fluid and blood, along with dirt and grime from the playground surface. What will the primary care pediatric nurse practitioner do to minimize the risk of infection? a. Apply povidone-iodine to all areas b. Irrigate gently with normal saline c. Rinse with hydrogen peroxide d. Scrub the abraded areas with alcohol

b

1. A schoolage child has a fractured wrist with a SalterHarris Type II fracture, according to the radiologist. What is true about this type of fracture? a. Growth disturbance of the long bones of the arm is likely b. There is a metaphyseal fragment on the compression side of fracture. c. There is usually a compression or crushing injury to the physis. d. This will require anatomic reduction using an open approach.

b

2. A schoolage child steps on a nail while wearing tennis shoes and develops cellulitis in that foot. The child's immunizations are uptodate. What antibiotic will the pediatric nurse practitioner empirically prescribe? a. Amoxicillin-clavulanate b. Ciprofloxacin c. Clindamycin d. Trimethoprim-sulfamethoxazole

b

3. A 3yearold child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do? a. Consider maltreatment as a possible cause of injury. b. Gently attempt a supination and flexion technique. c. Immobilize the arm with a sling and refer to orthopedics. d. Obtain a radiograph of the child's right arm and elbow.

b

4. The primary care pediatric nurse practitioner is performing a well child exam on an 8yearold girl and notes the presence of breast buds. What will the nurse practitioner include when initiating anticipatory guidance for this patient? a. A discussion about the risks of pregnancy and sexually transmitted diseases b. Information about sexual maturity and menstrual periods c. Material about the human papillomavirus vaccine d. Sexual orientation and the nature of sexual relationships

b

A child who has attentiondeficit/hyperactivity disorder (ADHD) has difficulty stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the selfregulation component of a. emotional control. b. flexibility. c. inhibition. d. problemsolving.

b

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

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. Cognitivebehavioral therapy c. Family therapy d. Hospitalization

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

The parent of a 4yearold child reports that the child gets upset when the hall light is left on at night and won't leave the house unless both shoes are tied equally tight. The primary care pediatric nurse practitioner recognizes that this child likely has which type of sensory processing disorder? a. Dyspraxia b. Overresponder c. Sensory seeker d. Underresponder

b

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

The primary care pediatric nurse practitioner is considering medication options for a schoolage child recently diagnosed with ADHD who has a primarily hyperactive presentation. Which medication will the nurse practitioner select initially? a. Lowdose stimulant b. Moderatedose stimulant c. Lowdose nonstimulant d. Moderatedose nonstimulant

b

The primary care pediatric nurse practitioner is examining a 3yearold child who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the nurse practitioner suspect? a. Attentiondeficit/hyperactivity disorder b. Autism spectrum disorder c. Executive function disorder d. Sensory processing disorder

b

The primary care pediatric nurse practitioner is performing an examination on a 5yearold child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the nurse practitioner do first? a. Administer an MCHAT screen to screen the child for communication and socialization delays. b. Ask the parent to describe the child's earlier behaviors from infancy through preschool. c. Reassure the parent that if symptoms weren't present earlier, the likelihood of autism is low. d. Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management.

b

The PCP is examining a 3-year-old child who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room floor moving a toy truck back and forth in a repetitive manner. Which disorder does the PCP suspect? a. adhd b. autism c. executive functioning disorder d. sensory processing disorder

b. autism

An adolescent is diagnosed with major depression and the PCP has prescribed fluoxetine. What other treatment is important to protect against suicide risk? a. addition of risperidone b. cbt c. family therapy d. hospitalization

b. cbt

A child is diagnosed w/ ADHD has difficulty stopping activities to begin other activities at school. The PCP understands that is is due to difficulty with what self regulation ability? a. emotional control b. flexibility c. inhibition d. problem solving

b. flexibility flexibility is under the control of executive functions in the cerebral cortex and is the ability to shift or transition between activities or thoughts Emotional control is the ability to modify emotional expression to the most adaptive expression Inhibition refers to the ability to stop or delay an initial response

1. The parent of an 8yearold child tells the primary care pediatric nurse practitioner that the child has begun to ask questions about why a schoolmate has "2 daddies" and wonders how to talk to the child about this. What will the nurse practitioner recommend? a. Beginning a discussion about different types of sexual relationships and samesex partners b. Discussing the issue with the child in terms of the parent's religious values and norms c. Explaining that not all families are the same and what is most important is that they love and care for their children Telling the child that some adult relationships are complicated and will be understood when the child is older

c

11. The primary care pediatric nurse practitioner is conducting a followup examination on a child who has recently begun taking a lowdose stimulant medication to treat ADHD. The child's school performance and home behaviors have improved. The child's parent reports noticing a few tics, such a twitching of the eyelids, but the child is unaware of them and isn't bothered by them. What will the nurse practitioner recommend? a. Adding an alphaagonist medication b. Changing to a nonstimulant medication c. Continuing the medication as prescribed d. Stopping the medication immediately

c

4. A schoolage child falls off a swing and suffers a closed fracture of the righ clavicle. How will this be managed? a. Application of a figureeight clavicle brace for 6 to 8 weeks b. Hospitalization for traction of the affected extremity and shoulder c. Immobilization with a sling to support the affected extremity d. Referral to an orthopedic specialist for possible surgical reduction

c

5. A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do? a. Obtain a chest radiograph to evaluate possible causes for these symptoms. b. Order an electrocardiogram to rule out potential cardiovascular disease. c. Recommend NSAIDs, stretching exercises, and ice packs to the area. d. Refer the child to a pediatric orthopedist for evaluation and treatment.

c

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

The parent of a preschoolage child who is diagnosed with a sensory processing disorder (SPD) asks the primary care pediatric nurse practitioner how to help the child manage the symptoms. What will the nurse practitioner recommend? a. Establishing a reward system for acceptable behaviors b. Introducing the child to a variety of new experiences c. Maintaining predictable routines as much as possible d. Providing frequent contact, such as hugs and cuddling

c

A 13-year old has exhibited symptoms of mild depression for several weeks. THe parent reports feeling relieved that the symptoms have passed but is concerned that the child now seems to have boundless energy and an inability to sit still. What will the PCP do? a. administer an ADHD med b. consult with a child psych to prescribe an antidepressant med c. reassure the parent that his behavior is common d. refer the child to a child psych for evaluation of bipolar disorder

d. refer the child to a child psych for evaluation of bipolar disorder Children w/ ADHD symptoms and depression should be evaluated for bipolar disorder

The parent of a child diagnosed with ADHD tells the primary care pediatric nurse practitioner that the child gets overwhelmed by homework assignments, doesn't seem to know which ones to do first, and then doesn't do any assignments. The nurse practitioner tells the parent that this represents impairment in which executive function? e. Activation f. Effort g. Emotion h. Focus

e

10. The primary care pediatric nurse practitioner is examining a 12-month-old infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse practitioner do first? 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.

ANS: A When developmental screening indicates an infant is not progressing at the expected rate, additional testing to determine the degree of delay is necessary. A referral may be needed if a delay is determined. This is not normal for this degree of prematurity; infants should develop a pincer grasp by 9 to 10 months of age.

The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6-month-old infant not previously noted in the medical record. What is the correct treatment? a. Pavlik harness b. Spica cast c. Surgical intervention d. Triple diapering

ANS: C The 6- to 18-month-old infant with a dislocated hip is likely to require either closed manipulation or open reduction. The other interventions should be used in younger infants.

A parent is concerned that a 12-month-old child is "bow-legged." A physical examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the correct action for the primary care pediatric nurse practitioner? a. Observe the child's condition over time to assess progression. b. Order physical therapy to prevent progression of symptoms. c. Reassure the parent that the child will outgrow this deformity. d. Refer to a pediatric orthopedic specialist for treatment.

ANS: D In Blount disease, the bowing is asymmetrical; children with this disorder need immediate referral to an orthopedist. Physiologic bowing may self-resolve and may be managed with observation, physical therapy, and reassurance.

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

The PCP cares for a preschool age child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. the child most likely has a disorder related to what process? a. executive functioning b. information processing c. sensory processing d. social cognition

a. executive functioning children w/ prenatal drug or alcohol exposure often have executive function disorders, characterized by an inability to stop or delay a response or interrupt an inappropriate behavior & an inability to modify emotional exporession appropriately

The PCP is performing an exam on a 5-year-old child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism, but was told that it was too early to diagnose. What will the PCP do next? a. administer an M-CHAT screen to screen for communication and socialization delays b. ask the parent to describe the child's earlier behaviors from infancy through preschool c. reassure the parent that if symptoms weren't present earlier, the likelihood of autism is low d. refer the child to a pediatric behavioral specialist to develop a plan of treatment and management

b. ask the parent to describe the child's earlier behaviors from infancy through preschool The DSM5 criteria state that patient must show symptoms from early childhood if if the symptoms are not recognized until later in life The M-CHAT is used for infants and toddlers, not school-aged children

7. The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6monthold infant not previously noted in the medical record. What is the correct treatment? a. Pavlik harness b. Spica cast c. Surgical intervention d. Triple diapering

c

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

During a well child exam on a 13yearold female, the primary care pediatric nurse practitioner notes that the child is at Tanner Stage 3. During the exam, when the nurse practitioner initiates a conversation about healthy sexuality education, the parent states that this topic is "off limits." What will the nurse practitioner do? a. Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult. b. Separate the parent from the adolescent to discuss the adolescent's concerns in private. c. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors. d. Tell the parent that this information is a routine part of adolescent well child examinations and must be included.

c

The parent of a schoolage 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

2. The parent of a newborn infant asks the primary care pediatric nurse practitioner when to intervene to help the infant's future intellectual growth. What will the nurse practitioner tell the parent? a. Cognitive learning begins during the toddler years. b. Intellectual growth begin when speech develops. c. Language and literacy skills begin at birth. d. Preschool is an optimal time to begin general learning.

ANS: C General learning and acquisition of skills for later reading and writing begin at birth, not in kindergarten or first grade, and these skills grow with everyday loving interactions between infants and caregivers. Cognitive learning changes during toddler years but begins at birth. Intellectual growth is not tied to speech alone.

A toddler is brought to the clinic after grabbing the hot end of his mother's curling iron. An examination reveals a pale, yellow burned area to the palm of one hand. What is true about this burn? a. It may take up to 3 weeks to heal with scarring likely. b. Scarring is unlikely, with healing expected in 3 to 7 days. c. Surgical intervention and skin grafting are usually required. d. This type of burn usually heals without scarring in 7 to 14 days.

ANS: A A deep partial-thickness burn appears pale and yellow and scarring is more likely to occur, with complete healing taking up to 3 weeks. A superficial burn is erythematous without blisters and heals in 3 to 7 days without scarring. A full-thickness burn involves extensive destruction of underlying tissues and requires surgical intervention and skin grafts. A superficial partial-thickness burn is red, mottled, moist, and painful and may scar, with healing in 7 to 14 days.

6. The mother of a 6-month-old infant is distressed because the infant can say "dada" but not "mama" and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond? 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."

ANS: A At 6 months, infants delight in vocalizing sounds that they learn by imitation but do not ascribe meaning to the sounds they make. Infants can say "mama" but without meaning. Babies make sounds on purpose by imitating what they hear. A preference for one sound early in speech does not indicate a hearing deficit.

9. The parent of a 5-month-old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? a. The infant may be expressing a desire to play or to 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 gastrointestinal discomfort such as constipation

ANS: A At this age, infants may cry when they are tired or need social interaction and not just when they are hungry. The PNP should teach parents about this change in social development so they can be responsive to their infant's needs. Solid foods are not added until age 6 months. Teething usually does not begin until at least 6 months. GI discomfort usually occurs after eating.

3. During an assessment of a 4-week-old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4-hour period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend? a. Continuing to nurse the infant using the current pattern b. Nursing the infant for longer periods every 4 hours c. Supplementing with formula at the last nighttime feeding d. Waking the infant every 2 hours to nurse during the night

ANS: A Infants who are encouraged to breastfeed every 2 to 3 hours may have one longer stretch of 4 hours at night. This infant is gaining between 0.5 and 1 gram per day, which is appropriate. It is not necessary to alter the pattern of nursing or to supplement with formula.

What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip? a. Dislocation of an unstable hip b. Dropping of the iliac crest with a raised leg c. Reduction of a dislocated hip d. Unequal knee heights in a supine child

ANS: A The Barlow maneuver dislocates an unstable or dislocatable hip posteriorly. Having the child raise a leg and watching for dropping of the iliac crest on that side is the Trendelenberg sign. The Ortolani maneuver reduces a posteriorly dislocated hip. Unequal knee heights in a supine child occur with a positive Galeazzi maneuver.

5. The mother of a 3-month-old child tells the primary care pediatric nurse practitioner that it is "so much fun" now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother? 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" with other infants d. To provide musical toys to engage the infant

ANS: B By 3 months, infants demonstrate a social smile and will become more active, alert, and responsive. Parents may mistakenly assume that the infant can handle more activity and stimulation when this occurs, and the PNP should teach caregivers how to recognize infant cues for the need to rest or to have decreased stimulation.

A child is brought to the clinic after falling from a swing and scraping both knees and hands. An examination reveals abraded skin with oozing serous fluid and blood, along with dirt and grime from the playground surface. What will the primary care pediatric nurse practitioner do to minimize the risk of infection? a. Apply povidone-iodine to all areas. b. Irrigate gently with normal saline. c. Rinse with hydrogen peroxide. d. Scrub the abraded areas with alcohol.

ANS: B Gentle irrigation with water or normal saline is the preferred method for cleaning a wound. Povidone-iodine, alcohol, and hydrogen peroxide should not be used on open wounds.

A school-age child steps on a nail while wearing tennis shoes and develops cellulitis in that foot. The child's immunizations are up-to-date. What antibiotic will the pediatric nurse practitioner empirically prescribe? a. Amoxicillin-clavulanate b. Ciprofloxacin c. Clindamycin d. Trimethoprim-sulfamethoxazole

ANS: B Plantar puncture wounds, particularly those wounds that occur following puncture of sneakers/shoes, require ciprofloxacin to cover potential Pseudomonas infection and to protect against an osteomyelitis. Amoxicillin-clavulanate is used in other puncture wounds with signs of infection. Clindamycin is used for similarly wounded children allergic to penicillins. TMP-SMX is used if MRSA is cultured.

8. The primary care pediatric nurse practitioner is performing a well child examination on a 9-month-old infant whose hearing is normal but who responds to verbal cues with only single syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant? 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 television to Sesame Street during the day.

ANS: B The best way to improve language skills is to read to children. As long as the reading includes positive interactions with the baby and the reader, the baby is learning language. Educational videos, music, and television are all passive media and do not involve this interaction.

A 3-year-old child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do? a. Consider maltreatment as a possible cause of injury. b. Gently attempt a supination and flexion technique. c. Immobilize the arm with a sling and refer to orthopedics. d. Obtain a radiograph of the child's right arm and elbow.

ANS: B This is most likely an annular ligament displacement injury, or "nursemaid's elbow." The primary provider can attempt to reduce the elbow using either a supination/flexion technique or a pronation technique. Consider maltreatment if recurrent dislocations or other symptoms or signs are present. If this fails after three attempts, immobilization and referral are indicated. Radiologic studies are rarely necessary.

A school-age child has a fractured wrist with a Salter-Harris Type II fracture, according to the radiologist. What is true about this type of fracture? a. Growth disturbance of the long bones of the arm is likely. b. There is a metaphyseal fragment on the compression side of fracture. c. There is usually a compression or crushing injury to the physis. d. This will require anatomic reduction using an open approach.

ANS: B With a Salter-Harris Type II fracture, a metaphyseal is present on the compression side of the fracture. Types I and II Salter-Harris fractures rarely show growth disturbances. Type V fractures have a compression or crushing injury to the physis. Anatomic reduction with an open approach is usually necessary for a Type III fracture.

A child is bitten on one arm by a neighbor's dog. The dog is immunized against rabies and the child's last tetanus immunization was 4 years prior. The wound edges are gaping and avulsed. What is an important initial intervention when treating this injury? a. Administration of rabies prophylaxis and a tetanus booster b. Debriding and suturing the wound to prevent infection c. Irrigation of the wounds with high-pressure normal saline d. Reporting the animal bite to the local animal control authority

ANS: C Animal and human bites need to be irrigated with normal saline using >5 psi of pressure. The animal has been vaccinated for rabies and the child's tetanus is current, so prophylaxis for both of these is not indicated. There is controversy about whether primary closure is appropriate. Reporting the animal is not a primary action.

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

10. A child who plays soccer is in the clinic reporting pain and swelling in both knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition? a. Apply ice packs to both knees and avoid activities that cause pain. b. Begin quadricepsstretching exercises now to prevent further injury. c. Obtain radiographic studies to rule out fractures or ligament tears. d. Refer to a pediatric orthopedic specialist to evaluate the need for surgery.

a

11. During a well baby examination of a newborn, the primary care pediatric nurse practitioner notes adduction of the right forefoot, with normal position of the mid and hindfoot, along with a convexshaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity? a. Grasp the heel with one hand and abduct the forefoot with the other hand. b. Observe both legs for medial and lateral rotations. c. Order anteriorposterior and lateral radiographs of both feet. d. Refer the infant immediately to a pediatric orthopedic specialist.

a

2. What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip? a. Dislocation of an unstable hip b. Dropping of the iliac crest with a raised leg c. Reduction of a dislocated hip d. Unequal knee heights in a supine child

a

5. A toddler is brought to the clinic after grabbing the hot end of his mother's curling iron. An examination reveals a pale, yellow burned area to the palm of one hand. What is true about this burn? a. It may take up to 3 weeks to heal with scarring likely b. Scarring is unlikely, with healing expected in 3 to 7 days c. Surgical intervention and skin grafting are usually required d. This type of burn usually heals without scarring in 7 to 14 days

a

5. The primary care pediatric nurse practitioner is counseling the parents of a 13yearold female who has Down syndrome about sexual maturation. What will the nurse practitioner tell these parents? a. It is important to discuss and support healthy sexuality. b. Providing too much information about sexuality may be confusing given the child's cognitive level of understanding. c. Suppressing periods with contraceptives will lessen their daughter's distress. d. They should give her information about periods but not about sexuality.

a

6. A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? a. Discuss posture and exercise and ask about backpacks and books. b. Obtain radiographic studies of the entire spine and neck. c. Reassure the child's parent that functional scoliosis will selfresolve. d. Refer to an orthopedic specialist for evaluation and possible bracing.

a

7. A child is bitten on one arm by a neighbor's dog. The dog is immunized against rabies and the child's last tetanus immunization was 4 years prior. The wound edges are gaping and avulsed. What is an important initial intervention when treating this injury? a. Administration of rabies prophylaxis and a tetanus booster b. Debriding and suturing the wound to prevent infection c. Irrigation of the wounds with high-pressure normal saline d. Reporting the animal bite to the local animal control authority

a

8. A 14yearold boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition? a. Place the child on crutches or in a wheelchair to prevent weightbearing. b. Provide information about weight loss to minimize further injury. c. Recommend seeing an orthopedic specialist as soon as possible. d. Refer the child to physical therapy to improve range of motion.

a

8. A child is brought to the clinic immediately after being stung by a wasp while playing in the yard. The physical examination reveals localized redness and edema at the site, along with abdominal tenderness, watery eyes, and generalized hives. What is the initial treatment? a. Administer intramuscular epinephrine b. Apply a topical glucocorticoid cream c. Give oral diphenhydramine d. Order a bronchodilator treatment

a

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

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 doinitially? 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

an adolescent has recently begun doing poorly in school and has stopped participating in sports and other extracurricular activities. Durin gthe 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 as hort-term trial of an antidepressant med 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 risk of suicide is highest during the 1st 4 weeks of a depressive episode

The PCP is performing a follow-up exam on a child who has recently begun taking a low-dose stimulant medication to treat ADHD. The child's school performance and home beviors have improved. The child's parents report noticing a few tics, such as twitching of the eyelids, but the child is unaware of them and isn't bothered by them. What will the PCP recommend? a. Adding an alpha-agonist medication b. changing to a non-stimulant medication c.d continuing the medication as prescribed d. stopping the medication immediately

c.d continuing the medication as prescribed tics may occur as a s/e of stimulant medications but do not need to be discontinued if there is a net benefit and the symptoms are not disturbing to the child