Exam 1: Quizzes/Test Bank Flashcards
Which of the following procedures is least likely to improve vaccination rates over several years?
Providing posters in the waiting room about vaccinations in general
Which of the following is false?
Regarding vaccines
Missed vaccination opportunities are a minor contributor to low vaccination rates in many practices.
Which administration route is incorrect?
For immunizations
Hep B, IM, in the outer quadrants of the buttock of a child
Which of the follow is incorrect?
Hep B is an attenuated live viral vaccine
Which is not a valid contraindication?
For MMR, allergy to eggs
Which of the following DTaP immunization records, although late at times, is otherwise entirely within the recommended guidelines?
3, 4, 6, and 15 months
Which of the following is false?
The Vaccine Injury Compensation Program provides compensation for permanent and non-permanent injuries temporaily associated with any recommended vaccination.
Which of the following is a contraindication to further doses of DTaP vaccine?
Anaphylaxis after DTaP
Which statement about the routine schedule is false?
The first dose of MMR is ideally given from 15-19 months of age
A single mother of an infant worries that living in a household with only one parent will cause her child to be maladjusted. To help address the mother’s concerns the PCP NP will suggest:
Developing consistent daily routines for the child
During a well child exam, the PCP learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father’s job layoff. What will the NP do?
Suggest counseling to learn ways to handle stress.
During a well child assessment of an 18 month old child, the PCP observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the NP do?
Offer the child a book or a toy to look at
Which recommendation will a PCP make when parents ask about ways to discipline their 3 y/o child who draws on the walls with crayons?
Provide a roll of paper for drawing and teach the child to use this.
The PCP conducts a well baby exam on an infant and notes mild gross motor delays, but no delays in other areas. Which initial course of action will the NP recommend?
Teach the parents to provided exercises to encourage motor development
The PCP is examining a newborn infant recently discharged from the NICU after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the NP do in this situation?
Point out the tasks that the infant can preform while conducting the assessment
The PCP sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the NP about community services and resources for their child. What should the NP do initally?
Ask the parents if they have an individualized family service plan (IFSP)
The PCP has a cohort of patients who have special health care needs. Which is an important role of the NP when caring for these children?
Care coordination and collaboration
The PCP preforms 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, takes solid foods 3x/day, and occasionally takes water from a cup. What will the PCP counsel the parent to promote optimum dental health?
To make an appointment for an initial dental examination
The PCP enters an exam room and finds a 2 month old infant in a car seat on the exam table. The infant’s mother is playing a game on her smart phon. The NP interprets this behavior as:
Moderate concern for parenting problems
A mother brings her 9 month infant in for a routine visit. What milestone would be appropriate for the NP to ask if the infant is meeting?
Rolls back to stomach and stomach to back
A 5 day old infant comes in for a newborn check up. On assessment of the newborn you note that the skin is jaundice in color. The anterior fontanel is slightly sunken. Per mom, the infant have only had 2 diapers today. The infant is strictly breastfed and this is the moms 1st child. She states baby is having trouble latching on. A bili level is sent and comes back at 18. You identify this newborn to be dehydrated and is most likely to have breast milk jaundice. Which nursing intervention(s) will be required for this baby?
All of the above: phototherapy, providing support and education for the lactating mom, strict monitoring of I/O
Apgar scores measure heart rate, RR, reflex irritability, color, and:
Muscle tone
A mother on the postpartum unit asked to have her infant back from the nursery so that she can breastfeed. The nurse brings the newborn to the room and hands the baby to the mother. She asks the mother to let her know how long the baby feeds. What vital step did the nurse forget to take before giving the baby to the mother?
The nurse should have identified the baby’s ID band the the mother’s
Excessive heat loss results in which of these?
Depletion of glucose levels
A mother has just delivered her new baby a few hours ago. She asks the nurse if she can bathe the baby because he has blood on him. The best response from the nurse would be:
Its important that we not bathe the baby too soon after birth. Lets wait until later in the day.
A 4-week old infant is brought to the ED. Mom states the baby hasn’t been eating well and has had decreased diapers for 2 days. The baby has been sleeping more and has been hard to wake up. On assessment, you find that the baby is difficult to arouse, is hypotonic and temperature is 35.4 rectally. What is an important lab value to check?
Blood glucose
A pregnant woman with a history of a clotting disorder is required to self-administer heparin during her pregnancy. After delivery, the infant will be at greater risk for:
Decreased Vitamin K
A part of injury prevention is making and keeping infant appointments. The required checkups and vaccinations are at:
2, 3, 6, 9 months and 1 year
Your are taking care of an infant who was admitted with dehydration. His weight is 6kg. You have been monitoring his I/O’s. What would you expect the infants urinary output to be in order to maintain adequate hydration?
13 ml/kg/hr
A mother brings her newborn daughter to the ED with concerns that she is having vaginal bleeding. You know this is normal and called what?
Pseudomenstruation
While interviewing a mother of an infant, you note that the mother gets frustrated as she explains that her baby has been up all night crying at least 3x a week for the last 2 weeks. She states that she has tried everything and feels hopeless. What would be the BEST response for you as the NP?
You are doing nothing wrong. This can be a common occurrence in infants and you should not feel guilty
The parent of a newborn infant asks the PCP when to intervene to help the infant’s future intellectual growth. What will the NP tell the parent?
Language and literacy skill begin at birth
The PCP preforms a well baby examination on a 7 day/old infant who is nursing well, according to mother. The NP notes the infant weighted 3250g at birth and 2990g when discharge on the second DOL. The infant weights 3080g at this visit. Which action is correct?
Schedule a weight check in 1 week
During an assessment of a 4 week old infant, the PCP 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 20g per day in the interval since last seen in clinic. What will the NP recommend?
Continuing to nurse the infant using the current pattern
The PCP is preforming a well baby examination on a 2 month old infant who has gained 25g per day in the last interval. The mother is nursing and tell the NP that her infant seems fussy and wants to nurse more often. What will the NP tell her?
The infant may be going through an expected growth spurt
The mother of a 6 week old breastfeeding infants tells the PCP that her baby, who previously had BM’s with each feeding, now has a BM once every 3rd day. What will the NP tell her?
This may be a normal for breastfed babies
The mother of a 3 month old child tells the PCP that it is “so much fun” now that her infant coos and smiles and wants to play. What is the important for the NP to teach this mother?
How to read the infant’s cues for overstimulation
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 NP tell this parent?
The infant may be expressing a desire to play or to rest
The mother of a 6 month old infant is distressed because the infant can say “dada” but not “mama” and asks the PCP why this is when she is the one who spends more time with the infant. How will the NP respond?
At this age, you baby does not understand the meaning of sounds
The PCP is preforming 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 NP recommend to the parents to improve speech and language skills in this infant?
Read simple board books to the infant at bedtime
The PCP is examining a 12 month old infant who was 6 weeks premature and observes 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 NP do first?
Perform an in-depth developmental assessment
The PCP is evaluating a 2 y/o with a documented speech delay. Screening at assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the NP do next?
Ask the child’s parents whether they read to the child
The PCP preforms 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 NP observes the the child has difficulty pronouncing “t”, “d”, “k”, and “g” sounds. Which action is correct?
Reassure the parent that this is normal
During a well child assessment of an 18 month old child, the PCP observes the child point to a picture of a dog and say “want puppy!” The NP recognizes this as an example of:
Telegraphic speech
The PCP is offering anticipatory guidance to the parents of an 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 NP tell the parents?
Most bilingual children are able to shift from one language to another when appropriate
The PCP 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 NP recommend?
Allow the child to explore and experiment while providing appropriate limits
The mother of a 3 y/o 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 other toddlers. What will the NP counsel the mother on?
Toddler may be interested in other children, but usually do not engage in interactive play
The parent of a 4 y/o points to a picture and says “that’s you sister.” The child responds by saying, “No! It’s my baby!” This is an example of which type of thinking in preschool age?
Realism
The parent of a 24 month old child asks the PCP when toilet training should begin. How will the NP respond?
“Tell em about your child’s daily habits”
The parents of a 3 y/o 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 NP tell the parents to do?
Place a variety of nutritious foods on the child’s plate at each meal
The PCP is examining a 6 y/o child who attends first grade. The child reports “hating” school. The parent states that the child pretends to be sick frequently in order to stay home from school. To further assess this situations, the NP will first ask the child:
to name one or two friends
The parent of a 10 y/o boy tells the PCP that the child doesn’t appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child’s sexual identity. The NP will tell the parent:
This attachment to other same gender children is how the child learns to interact with others
The parents of a 12 y/o child are concerned that some the child’s other classmates may be a bad influence on their child, who, they say, has been raised to believe in right and wrong. What will the NP tell the parent?
The pressures from outside influences may superseded parental teachings and should be confronted
During a well child exam of a schoolage child, the PCP learns that the child has been having angry episodes at school. The NP observes the child to appear withdrawn and sad. Which action is appropriate?
Ask the child and the parent about stressor at home
The PCP is preparing to conduct a well child assessment of an 8 y/o child. How will the NP being the exam?
Ask the child about school, friends, home activities, and sports
The parent of a 6 y/o child expresses concern that the child may have ADHD. Which screening tool will the PCP use to evaluate this possibilty?
Conner’s 3 Parent and Teacher Rating Scale
The parent of a 5 y/o child who has just begun kindergarten expresses concern that the child will have difficulty adjusting to the birth of a sibling. What will the NP recommend?
Having snack time with the child each day to discuss the school day
A school-age child has begun refusing all cooked vegetables. What will the PCP recommend to the parent?
Ensure that the child has 3 nutritious meals and 2 nutritious snacks each day
The PCP preforms a physical exam on a 12 y/o child and notes poor hygiene and inappropriate clothes for the weather. The child’s mother appears clean and well dressed. The child reports getting 6-7 hours of sleep each night because of texting with friends late each evening. What action by the NP will help promote healthy practices?
Discuss setting clear exceptions about self-care with the mother
During a well-child exam of a 5 y/o child, the PCP assesses the child for school readiness. Which finding may be a factor limiting school readiness for this child?
Parental concerns about bullying in the school
The PCP is examining a school age child who complain of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before proceeding with further diagnostic tests, what will the NP initially ask the parent?
About the timing of the symptoms each day and during the week
The PCP is evaluating recurrent stomach pain in a school age child. The child’s exam is normal. The NP learns that the child reports pain most evenings after school and refuses to participate in sports, but does not have N/V. The child’s grandmother recently had gallbladder surgery. Which action is correct?
Encourage the child to keep a log of pain, stool patterns, and dietary intake
The PCP is preforming a well child assessment on a 13 y/o F whose mother asks when her daughter’s periods may start. Which information will the NP use to help estimate the onset of periods?
The patient’s age at thelarche (breast budding)
The PCP is examining a 15 y/o F who reports having her first period at age 13. She states that she has had five periods in the last year, with the last on 2 months prior. She participates in basketball at school. What action is correct?
Perform biometric screening to determine lean body mass
During a well child assessment of a 13 y/o M the PCP notes small testicles, pubic and axillary hair. To further evaluate these findings, the NP will ask the patient about:
Participation in sports
The mother of a 16 y/o M was recently divorced after several years of an abusive relationship and tells the PCP that the adolescent has begun skipping school and hanging out with friends at the local shopping mall. When she confronts her child, he responds by saying that her hates her. What will the NP tell this mother?
Adolescents often need counseling to help them cope with life events
The PCP is performing a well child exam on a 12 y/o F who has achieved early sexual maturation. The mother reports that she spends more time with her older sister’s friends instead of her own classmates. What will the NP tell this parent?
Girl who join an older group of peers may become sexually active at an earlier age
The mother of a 15 y/o adolescent female tells the PCP that her daughter has 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 point to her mother and says “she gets really hard to live with.” This demonstrates which characteristic of adolescent thinking?
Apparent hypocrisy
The PCP is preforming 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 the NP make in this situation?
Tell the adolescent that, unless he is at risk, what he says will be confidential
The parent of a 14 y/o child tells the PCP that the child skips classes frequently in spite of various disciplinary measures, such as grounding and extra homework and is earning C/D’s in most classes. What will the NP recommend?
Evaluation for possible learning disorders
The parent of a 14 y/o child tells the PCP that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the NP tell the parent?
Suggest that the adolescent prepare appropriate vegetarian dishes to complement the family meals
The PCP is preforming a well child exam on a 17 y/o F whose mother is present during the history. The mother expressed concern that her daughters wishes to have an eyebrow piercing and states that she is opposed to the idea. What will the NP do?
Provide information about piercings and encourage continued discussion
The parent of a 16 /o tells the PCP that the teen was recently caught smoking an e-cigarette. What will the NP tell this parent?
E-Cigarette use may be a risk factor for later substance abuse
The parent of an adolescent reports noting cutting marks on the teen’s arms and asks the PCP what it means. What will the NP tell this parent?
Cutting is a way of dealing with emotional distress
The PCP is preforming a focused problem assessment on a child who has asthma and learns that one of the child’s parents smokes around the child in spite of being advised against this. The NP recognizes this as a possible alteration in which functional health pattern?
Health perception
The PCP examines an infant whose weight is below the 3rd percentile and whose mother does not comply with the feeding regiment. When attempting to enlist the help of the infant’s grandmother, the grandmother says “my daughter was like this when she was a baby and she turned out all right.” Which approach will the NP take to improve the outcome for this infant?
Ask the grandmother about her daughter’s health during childhood
The PCP provides patient teaching for children newly diagnosed with IBS. At which stage of development will children be able to understand the link between stress and the symptoms of the disease?
Formal operational stage
The PCP is counseling an obese adolescent whose parents both have Type 2 Diabetes. Which health behavior prediction model is useful when the NP discusses lifestyle changes with this client?
Health belief model
The PCP is counseling a school-age child about asthma management strategies. The child states that it is “too much trouble” to remember to use an ICS medication 2x daily and reports feeling fine inspite of exhibiting expiratory wheezes. Which action uses the health belief and self-efficacy model to teach this child about asthma management?
Obtaining pre and post-treatment spirometry testing
An adolescent who is overweight expresses a desire to lose weight in order to participate in sports but tell the PCP he doesn’t want to give up sweets and soft drinks because he enjoys them too much. Which stage of change does this represent?
Contemplation
