Module 1 (Ch. 4,5,10,11, 24, 33, 27)

Question 1

The mother of a 6­month­old 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

Answer 1

“At this age, your baby does not understand the meaning of sounds.”

Question 2

A 5­year­old child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given

Answer 2

DTaP

Question 3

The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from the neonatal intensive care unit after a premature birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse practitioner do in this situation?

Answer 3

A. Point out the tasks that the infant can perform while conducting the assessment.

Question 4

An 18­month­old child who developed upper respiratory symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?

Answer 4

Prescribe oseltamivir and follow closely

Question 5

A single mother of an infant worries that living in a household with only one parent will cause her child to be maladjusted. To help address the mother’s concerns, the primary care pediatric nurse practitioner will suggest

Answer 5

developing consistent daily routines for the child

Question 6

The primary care pediatric nurse practitioner is examining a toddler who is below the 3rd percentile for weight even though the parents claim that the child eats “constantly.” What will the nurse practitioner do initially?

Answer 6

Evaluate the child’s feeding and elimination behaviors and ask the family to describe mealtime routines.

Question 7

The primary care pediatric nurse practitioner is performing a well child examination on a school­age child who has a history of cancer treated with cranial irradiation. What will the nurse practitioner monitor in this child?

Answer 7

Leukoencephalopathy

Question 8

The primary care pediatric nurse practitioner sees a 12­month­old infant who is being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy­red, sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child’s condition?

Answer 8

RBC folate, iron, and B12 levels

Question 9

The mother of a 6­week­old 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

Answer 9

This may be normal for breastfed babies

Question 10

During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father’s job layoff. What will the nurse practitioner do?

Answer 10

Suggest counseling to learn ways to handle stress

Question 11

A toddler is seen in the clinic after a 2­day history of intermittent vomiting and diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3­second capillary refill, 2­ second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend

Answer 11

Oral rehydration solution with follow­up in 24 hours

Question 12

A 2­month­old infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis

Answer 12

Immunization history (Chlamydia Pneumonia with staccato cough)

Question 13

During an assessment of a 4­week­old 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

Answer 13

Continuing to nurse the infant using the current pattern

Question 14

The primary care pediatric nurse practitioner is performing a well baby examination on a 2­month­old 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

Answer 14

The infant may be going through an expected growth spurt.

Question 15

32. A school­age child has fever of 104°F, sore throat, vomiting and malaise. The primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper­like rash on the child’s neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness?

Answer 15

Prescribe oral amoxicillin

Question 16

31. A 7­year­old child whose immunizations are up­to­date has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated?

Answer 16

Hospitalization for diagnosis and treatment with antibiotics

Question 17

The primary care pediatric nurse practitioner is performing an initial well child exam on a 3­year­old child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do?

Answer 17

Perform antibody titers and reimmunize the child.

Question 18

The parent of a toddler tells the primary care pediatric nurse practitioner that the family has adopted a plant­based diet and the child is receiving rice and almond milk instead of cow’s milk. The nurse practitioner will counsel the parents about

Answer 18

protein deficiency.

Question 19

During a well child assessment of an 18­month­old child, the primary care pediatric nurse practitioner observes the child becoming irritable and uncooperative. The parent tells the child to stop fussing. What will the nurse practitioner do

Answer 19

Offer the child a book or a toy to look at.

Question 20

An 18­month­old child has a 1­day history of intermittent, cramping abdominal pain with non­bilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis

Answer 20

Intussusception

Question 21

Which lab value is most concerning in an infant with fever and a suspected bacterial infection?

Answer 21

A. C­reactive protein of 11.5 mg/L (Correct) B. Lymphocyte count of 8.7 C. Platelet count of 475 D. White blood cell count of 14

Question 22

The parent of a school­age child reports that the child is on a gluten­free diet. When questioned about the reason for this diet, the parent states that the child has fewer stomach aches since beginning the diet but has never been diagnosed with celiac disease. The parent reports using gluten­free grain products for all family members. The nurse practitioner will tell this parent that gluten­free diets

Answer 22

may be deficient in essential nutrients.

Question 23

A 3­year­old child whose immunizations are up­to­date has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action

Answer 23

Administer the MMR vaccine to help prevent disease.

Question 24

A 12­month­old infant exhibits poor weight gain after previously normal growth patterns. There is no history of vomiting, diarrhea, or irregular bowel movements, and the physical exam is normal. What is the next step in evaluating these findings

Answer 24

Feeding and stooling history and 3­day diet history

Question 25

A school­age child has recurrent diarrhea with foul­smelling stools, excessive flatus, abdominal distension, and failure­to­thrive. A 2­week lactose­free trial failed to reduce symptoms. What is the next step in diagnosing this condition

Answer 25

Serologic testing for celiac disease

Question 26

The primary care pediatric nurse practitioner has a cohort of patients who have special health care needs. Which is an important role of the nurse practitioner when caring for these children

Answer 26

Care coordination and collaboration

Question 27

The parent of a 2­month­old infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns

Answer 27

Question the parent’s reasons for concern about immunizations.

Question 28

The primary care pediatric nurse practitioner evaluates a 5­year­old child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient?

Answer 28

Prescribe elemental iron and recheck labs in 1 month

Question 29

The primary care pediatric nurse practitioner is examining a newborn who is breastfeeding and notes the presence of an ankyloglossia. What will the nurse practitioner do next

Answer 29

Ask the mother if the infant has any feeding difficulties.

Question 30

The primary care pediatric nurse practitioner is providing anticipatory guidance to the mother of a breastfed 6­month­old infant who asks about “baby­led weaning.” What will the nurse practitioner tell her about this practice

Answer 30

“Infants are given soft, mashable table foods when able to self­feed.”

Question 31

A school­age child has a 3­month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management?

Answer 31

Referral for esophagogastroduodenoscopy (EGD)

Question 32

The primary care pediatric nurse practitioner sees a 3­year­old child whose parents report is a picky eater in spite of their continued efforts to provide nutritious meals. The parents ask whether a multivitamin is necessary. How will the nurse practitioner respond

Answer 32

Ask the parents to provide a 3­day food diary.

Question 33

The primary care pediatric nurse practitioner is managing care for a child diagnosed with iron­deficiency anemia who had an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3 mg/kg/day of elemental iron for 4 weeks. The child’s current lab work reveals elevations in Hgb/Hct and reticulocytes with a hemoglobin of 10.5 g/dL and a hematocrit of 36%. What is the next step in management of this patient?

Answer 33

Continue the current dose of ferrous sulfate and recheck labs in 1 to 2 months

Question 34

The primary care pediatric nurse practitioner is examining a 5­year­old child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white cell blood count. The nurse practitioner will refer this child to a specialist for

Answer 34

bone marrow biopsy.

Question 35

A 3­year­old child who attends day care has had a fever, nausea, and vomiting several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child?

Answer 35

Supportive care

Question 36

The primary care pediatric nurse practitioner is performing a well child examination on a 9­month­old 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

Answer 36

Read simple board books to the infant at bedtime.

Question 37

A 2­month­old infant will receive initial immunizations, and the parent asks about giving medications to increase the infant’s comfort and minimize fever. What will the pediatric nurse practitioner recommend

Answer 37

Administering ibuprofen or acetaminophen as needed

Question 38

A toddler who presents with anemia and reticulocytopenia has a history of a gradual decrease in energy and increase in pallor beginning after a recent viral infection. How will the primary care pediatric nurse practitioner treat this child?

Answer 38

Closely observe the child’s symptoms and lab values.

Question 39

The mother of a nursing infant expresses concern about whether high­cholesterol foods will increase her infant’s risk of hyperlipidemia. What will the primary care pediatric nurse practitioner tell her?

Answer 39

Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol values.

Question 40

A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action

Answer 40

Teach the parents which signs and symptoms to report.

Question 41

The primary care pediatric nurse practitioner performs a physical examination on a 9­month­old infant and notes two central incisors on the lower gums. The parent states that the infant nurses, takes solid foods three times daily, and occasionally takes water from a cup. What will the pediatric nurse practitioner counsel the parent to promote optimum dental health

Answer 41

To make an appointment for an initial dental examination

Question 42

The primary care pediatric nurse practitioner 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 nurse practitioner recommend?

Answer 42

Teach the parents to provide exercises to encourage motor development

Question 43

he primary care pediatric nurse practitioner is reviewing medical records for a newborn that is new to the clinic. The toddler’s mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti­retroviral prophylaxis, and did not breastfeed. What is the correct management for this child

Answer 43

Consult with a pediatric HIV specialist

Question 44

The mother of a 6­year­old child tells the primary care pediatric nurse practitioner that the child only wants to eat French fries and hamburgers and refuses most vegetables. What will the nurse practitioner recommend?

Answer 44

Providing a variety of healthy foods at each meal

Question 45

A 9­month­old infant has had a fever of 103°F for 2 days and now has a diffuse, maculopapular rash that blanches on pressure. The infant’s immunizations are up­to­date. What will the primary care pediatric nurse practitioner do?

Answer 45

Reassure the parent that this is a mild, self­limiting disease.

Question 46

The parent of a 5­month­old is worried because the infant becomes fussy but doesn’t always seem interested in nursing. What will the nurse practitioner tell this parent

Answer 46

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

Question 47

A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?

Answer 47

Ask about recent tick bites

Question 48

14. An 18­month­old child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered?

Answer 48

PCV13

Question 49

The primary care pediatric nurse practitioner is examining a 2­month­old infant with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step

Answer 49

Performing a catheterized urinalysis to screen for leukocytes and nitrites

Question 50

A 2­year­old child who has SCA comes to the clinic with a cough and a fever of 101.5°C. The child currently takes penicillin V prophylaxis 125 mg orally twice daily. What will the primary care pediatric nurse practitioner do?

Answer 50

Admit the child to the hospital to evaluate for sepsis.

Question 51

The mother of a newborn asks the primary care pediatric nurse practitioner about the benefits of breastfeeding. What will the nurse practitioner tell her

Answer 51

Nursing her baby exclusively for at least 4 months will help her infant to resist infections.

Question 52

The parents of a toddler tell the primary care pediatric nurse practitioner that they get frustrated trying to get the child to eat any vegetables other than squash and carrots. What will the nurse practitioner recommend

Answer 52

Continue to offer a variety of foods without forcing the child to eat them.

Question 53

The primary care pediatric nurse practitioner is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the nurse practitioner recommend

Answer 53

Vitamin D

Question 54

The mother of a 2­month­old infant tells the primary care pediatric nurse practitioner that she is afraid her breast milk is “drying up” because her baby never seems satisfied and wants to nurse all the time. Which action is correct?

Answer 54

Weigh the infant to assess for a growth spurt.

Question 55

The primary care pediatric nurse practitioner reviews a child’s complete blood count with differential white blood cell values and recognizes a “left shift” because of

Answer 55

an elevated neutrophil count.

Question 56

Which recommendation will a primary care pediatric nurse practitioner make when parents ask about ways to discipline their 3­year­old child who draws on the walls with crayons?

Answer 56

Provide a roll of paper for drawing and teach the child to use this

Question 57

An adolescent female who is sexually active and who has not had the HPV vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her

Answer 57

A. The vaccine will not protect her from any HPV oncogenic types acquired previously

Question 58

The primary care pediatric nurse practitioner is examining a 12­month­old 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?

Answer 58

Perform an in­depth developmental assessment.

Question 59

The primary care pediatric nurse practitioner sees a developmentally delayed toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child. What should the nurse practitioner do initially?

Answer 59

Ask the parents if they have an individualized family service plan (IFSP).

Question 60

The parent of a 12­month­old infant asks the primary care pediatric nurse practitioner why 2% cow’s milk is recommended instead of whole milk. What will the nurse practitioner tell this parent

Answer 60

Younger children need a limited amount of fats.

Question 61

The primary care pediatric nurse practitioner provides anticipatory guidance for a 6­month­old infant who is breastfed who takes 400 IU of vitamin D daily. The parent reports that the infant has begun taking cereals, fruits, and vegetables in addition to nursing. What will the nurse practitioner recommend to promote healthy nutrition

Answer 61

Continue to nurse as long as desired.

Question 62

A 9­year­old girl has a history of frequent vomiting and her mother has frequent migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the correct action

Answer 62

Refer to a pediatric gastroenterologist for further workup

Question 63

The primary care pediatric nurse practitioner is performing an assessment on a 1­ week­old newborn with a slightly elevated bilirubin who is breastfeeding well and who has gained 30 grams in the past 24 hours. The infant is stooling and voiding well. The nurse practitioner suspects breast milk jaundice. Which action is correct

Answer 63

recheck the serum bilirubin and infant’s weight in 24 hours.

Question 64

A toddler is receiving long­term antibiotics to treat osteomyelitis. Which laboratory test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child?

Answer 64

Erythrocyte sedimentation rate (ESR)

Question 65

An unimmunized school­age child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?

Answer 65

Assessment of maternal rubella titers

Question 66

The primary care pediatric nurse practitioner reviews hematology reports on a child with beta­thalassemia minor and notes an Hgb level of 8 g/dL. What will the nurse practitioner do?

Answer 66

Evaluate serum ferritin.

Question 67

The primary care pediatric nurse practitioner sees a 3­day­old nursing infant whose newborn metabolic screen is positive for galactosemia. The nurse practitioner refers the newborn to a specialist for immediate evaluation and will tell the mother

Answer 67

to stop breastfeeding immediately.

Question 68

A 10­year­old child has had abdominal pain for 2 days, which began in the periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis

Answer 68

Appendicitis with perforation

Question 69

The mother of a newborn infant asks the primary care pediatric nurse practitioner about pumping her breasts when she returns to work in 2 months. What will the nurse practitioner include in teaching this mother

Answer 69

Frozen breast milk may be stored up to 3 months in a 0° F freezer.

Question 70

The primary care pediatric nurse practitioner is evaluating a school­age child who, after removal of a pituitary tumor, has altered hypothalamic control over hunger and satiety. The child is morbidly obese and expresses feeling depressed because of the obesity. What will the nurse practitioner recommend?

Answer 70

Restricting all access to food in the house and at school

Question 71

The parent of an infant asks about using a probiotic medication. What will the primary care pediatric nurse practitioner tell this parent?

Answer 71

There is no conclusive evidence about using probiotics to treat colic.

Question 72

A child is diagnosed with Crohn disease. What are likely complications for this child

Answer 72

Intestinal obstruction with scarring and strictures

Question 73

A complete blood count on a 12­month­old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects

Answer 73

iron­deficiency anemia.

Question 74

According to recent research, which populations may have higher rates of under­ immunization than others

Answer 74

Those with higher rates of graduate degrees

Question 75

A child whose parents have refused vaccines has been exposed to chickenpox, and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them

Answer 75

The child should stay home if any symptoms occur and may return in 1 week if no rash develops.

Question 76

The mother of a 3­month­old 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?

Answer 76

How to read the infant’s cues for overstimulation

Question 77

A 2­month­old infant cries up to 4 hours each day and, according to the parents, is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal and the infant is gaining weight normally. What will the primary care pediatric nurse practitioner recommend

Answer 77

Eliminating certain foods from the mother’s diet

Question 78

A 5­year­old child who received VariZIG after exposure to varicella while immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child?

Answer 78

MMR, Varivax, Tdap

Question 79

A school­age child comes to the clinic for evaluation of excessive bruising. The primary care pediatric nurse practitioner notes a history of an upper respiratory infection 2 weeks prior. The physical exam is negative for hepatosplenomegaly and lymphadenopathy. Blood work reveals a platelet count of 60,000/mm3 with normal PT and aPTT. How will the nurse practitioner manage this child’s condition?

Answer 79

Teach to avoid NSAIDs and contact sports

Question 80

25. A preschool­age child is brought to clinic for evaluation of a rash. The primary ID: 13348428773 care pediatric nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash

Answer 80

Expect a lacy, maculopapular rash to develop on the trunk and extremities.

Question 81

When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated

Answer 81

Lymphocytes

Question 82

A 10­month­old infant who is new to the clinic has chronic hepatitis B infection. What will the primary care pediatric nurse practitioner do to manage this infant’s disease?

Answer 82

Consult a pediatric infectious disease specialist

Question 83

The primary care pediatric nurse practitioner performs a well child examination on a 1­month­old. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care?

Answer 83

Obtain regular absolute neutrophil counts.

Question 84

A school­age child has had abdominal pain for 3 months that occurs once or twice weekly and is associated with a headache and occasional difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. According to Bishop, what is included in the initial diagnostic work­up for this child

Answer 84

CBC, ESR, amylase, lipase, UA, and abdominal ultrasound

Question 85

The pediatric nurse practitioner provides primary care for a 30­month­old child who has sickle cell anemia who has had one dose of 23­valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child?

Answer 85

Administer an initial meningococcal vaccine.

Question 86

The primary care pediatric nurse practitioner learns that the mother of a newborn infant is being tested for tuberculosis after a positive TB skin test. What will the nurse practitioner tell the mother who states a desire to breastfeed her baby

Answer 86

That she can express breast milk and feed that to her infant

Question 87

The mother of a 15­month­old infant tells the primary care pediatric nurse practitioner that she wishes to continue nursing her child for another year, if possible. What will the nurse practitioner recommend

Answer 87

Clean the toddler’s teeth each time after breastfeeding.

Question 88

When counseling an adolescent with a family history of hyperinsulinemia and type 2 diabetes, the primary care pediatric nurse practitioner will recommend avoiding

Answer 88

processed breads

Question 89

The primary care pediatric nurse practitioner performs a well baby examination on a 7­day­old 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

Answer 89

Schedule a weight check in 1 week.

Question 90

An adolescent has a TB skin test prior to working as a volunteer in a hospital. The adolescent is healthy and has not travelled to or from a TB­endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do

Answer 90

Reassure the adolescent that this is a negative screen.

Question 91

A 2­year­old child has an acute diarrheal illness. The child is afebrile and, with oral rehydration measures, has remained well hydrated. The parent asks what can be done to help shorten the course of this illness. What will the primary care pediatric nurse practitioner recommend

Answer 91

Lactobacillus

Question 92

The primary care pediatric nurse practitioner reviews the immunization records of an 18­month­old child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do

Answer 92

Recommend the next dose of MMR vaccine at 4 to 5 years of age.

Question 93

The parent of an infant asks why some vaccines, such as MMR, are not given along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary care pediatric nurse practitioner tell this parent

Answer 93

Maternal antibodies neutralize some vaccines and are delayed until 12 months

Question 94

A child with a history of a pustular rash at the site of a cat scratch on one arm now has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do

Answer 94

Order an immunofluorescent assay (IFA) for serum antibodies

Question 95

A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent?

Answer 95

The MMR may be linked to febrile seizures in immunocompromised children

Question 96

The parent of a 3­month­old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant’s weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant

Answer 96

Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks

Question 97

The primary care pediatric nurse practitioner is performing a well child examination on a 15­year­old girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement?

Answer 97

Iron, folic acid, and B12

Question 98

The primary care pediatric nurse practitioner enters an exam room and finds a 2­month­old infant in a car seat on the exam table. The infant’s mother is playing a game on her smart phone. The nurse practitioner interprets this behavior as

Answer 98

of moderate concern for parenting problems

Question 99

A 10­month­old infant has an erythematous, fluctuant, non­draining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care

Answer 99

Incision and drainage of the abscess with culture

Question 100

A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium swallow study reveals a normal esophagus. What will the primary care pediatric nurse practitioner consider next to manage this child’s nutritional needs

Answer 100

Videofluoroscopy swallowing study

Question 101

An adolescent is diagnosed with functional abdominal pain (FAP). The child’s symptoms worsen during stressful events, especially with school anxiety. What will be an important part of treatment for this child

Answer 101

Teaching about the brain­gut interaction causing symptoms

Question 102

A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm cylindrical object in the child’s stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment?

Answer 102

Have the parents watch for the object in the child’s stool

Question 103

The primary care pediatric nurse practitioner performs a well child assessment on a 6­month­old infant whose mother reports having less breast milk because of stressors associated with pumping and returning to work. The nurse practitioner will provide resources to promote pumping and

Answer 103

discuss adding other foods to the baby’s diet

Question 104

The primary care pediatric nurse practitioner performs an initial well baby exam on a 1­week­old infant who is breastfeeding and who is at birth weight. The mother tells the nurse practitioner that her baby is already sleeping 5 or 6 hours at night. What will the nurse practitioner recommend?

Answer 104

Waking the infant up at least every 3 hours to nurse

Question 105

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

Answer 105

Language and literacy skills begin at birth

Question 106

A child who is immunocompromised has a fever and a rash consisting of macules, papules, and pustules. What will the primary care pediatric nurse practitioner do?

Answer 106

Hospitalize the child for intravenous acyclovir.

Question 107

5. The primary care pediatric nurse practitioner performs a well baby examination on a 4­month­old infant who is exclusively breastfed and whose mother plans to introduce only small amounts of fruits and vegetables in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron, what will the nurse practitioner recommend

Answer 107

Elemental iron supplementation of 1 mg/kg/day until cereals are added