Module 2 Flashcards
During a well child exam, the primary care pediatric nurse practitioner learns that the parents of a young child fight frequently about finances. The parents state that they do not fight in front of the child and feel that the situation is temporary and related to the father’s job layoff. What will the nurse practitioner do?
- Suggest counseling to learn ways to handle stress.
- Tell them that the conflict will resolve when the situation changes.
- Recommend that they continue to not argue in front of the child.
-Reassure them that the child is too young to understand.
Suggest counseling to learn ways to handle stress.
During a well child assessment of an 18-month-old 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?
- Ask the parent about usual discipline practices.
- Offer the child a book or a toy to look at.
- Allow the parent to put the child in a “timeout.”
- Stop the exam since the child has reached a “meltdown.”
Offer the child a book or a toy to look at.
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?
- Schedule a weight check in 1 week.
- Refer to a lactation consultant.
- Follow up at the 2-month checkup.
- Suggest supplementing with formula.
Schedule a weight check in 1 week.
A 3-day-old newborn girl is here for a follow-up appointment. The patient was born via Cesarean section at 40 weeks gestation, weighing 2990g. The pregnancy had breech positioning but had consistent prenatal care. The infant received routine nursery care and passed screenings for hearing and cardiac. The first NBS is pending. The total serum bilirubin level was 4mg/dL at 36 hours. The first hepatitis B vaccine was administered in the hospital. In the last 24 hours, the infant passed a dark green stool and had 4 wet diapers. The current weight is 2850g, and the physical examination shows no abnormalities. Which of the following is correct?
Instruct the mother to begin supplementing with formula today.
Order a total serum bilirubin today.
A hip ultrasound should be scheduled for 6 weeks of age.
Order NBS #2 today. - 2nd test is to be done at 7-14 days
A hip ultrasound should be scheduled for 6 weeks of age.
The most common organisms causing pneumonia in newborn infants are:
- Staphylococcus aureus, pseudomonas, group A beta-hemolytic streptococcus
- Group B streptococci, gram-negative enteric bacilli, Chlamydia trachomatis
- Mycoplasma, Staphylococcus pneumoniae, Haemophilus influenzae
- Haemophilus influenzae, Staphylococcus pneumonia, herpes simplex
Group B streptococci, gram-negative enteric bacilli, Chlamydia trachomatis
Which of the following is currently the most prevalent organism to cause bacteremia in infants having a gestational age greater than or equal to 37 weeks and less than 42 weeks of age, are 8 to 60 days of age, and have a documented rectal temperature greater than or equal to 38.0 C (100.4 F).
- Escherichia coli (E. coli)
- group B Streptococcus (GBS)
- Listeria monocytogenes (L. monocytogenes)
- Staphylococcus aureus (S. aureus)
Escherichia coli (E. coli)
Preferences in selecting which inflammatory markers (IM) to use in evaluating infections have transformed over time as prominent bacterial pathogens that cause infection have changed and newer tests have been developed. Which one of the following laboratory markers is the most accurate based on its ability to detect invasive bacterial infections in a 30-day-old newborn?
C-reactive protein (CRP)
White blood cell (WBC)
Absolute neutrophil count (ANC)
Procalcitonin
Procalcitonin
Ms. Paris brings her 2-weeks-old infant girl to the office for her 2 weeks check up. Her check up is normal except for a large firm mass on the right clavicle. She moving all extremities without problem and her mother had not noticed the bump. She was a vaginal delivery weighing 8 lbs and 8 oz with Apgar score of 9 at 1 and 5 minutes. Management of this problem should include which of the following?
Magnetic resonance imaging of the right shoulder
Referral to an orthopedic surgeon
Reassurance and supportive care
A biopsy of the mass for culture and cytology
Reassurance and supportive care
The clavicle is the most commonly fractured bone in the delivery process. While some fractures are identified at birth, others may not be identified until callus formation is noted at about a week of age. Clavicular fracture may happen in any delivery , although there is a higher risk with large-for gestational-age infants. The clavicle will heal spontaneously. Monitor that the infant is moving arms symmetrically and equally.
The primary care pediatric nurse practitioner is performing a well-baby examination on a 7-day-old infant born to a Chlamydia-positive mother. The infant’s eyes are clear without exudate. The infant is free from cough and lungs are clear. What will the primary care pediatric nurse practitioner do to prevent illness in this infant?
- Prescribe prophylactic erythromycin suspension.
- Schedule a follow-up appointment in 1 week.
- Obtain bacterial cultures of both conjunctivae.
- Administer a single dose of intramuscular ceftriaxone.
Schedule a follow-up appointment in 1 week
Infants born to Chlamydia-positive mothers have an increased risk of conjunctivitis and pneumonia and must be watched for development of these for several weeks after delivery – a few days to several weeks for conjunctivitis and 2 to 19 weeks for pneumonia.
IM ceftriaxone is given as prophylaxis for gonorrhea.
Routine bacterial cultures are not helpful.
Prophylactic erythromycin is not recommended because of an increased risk of hypertrophic pyloric stenosis.
Review Burns 6th Ed et al Chapter 39 or Burns 7th Ed. Chapter 29 Perinatal Conditions
A 3-day-old infant has a total serum bilirubin (TSB) level of 15.7 mg/dL after having a TSB of 10.8 mg/dL 24 hours prior. The infant nursed 8 times, had 7 wet diapers, and passed 4 stools in the past 24 hours. What is the indicated treatment for this infant?
- Suspend breastfeeding for 24 to 72 hours and have the mother save pumped breast milk.
- Recommend nursing every 2 hours, order a bili-blanket, and recheck TSB in 24 hours.
- Admit to an inpatient setting for phototherapy and every-12-hour bilirubin monitoring.
- Have the mother supplement with extra fluids and return to the clinic in 24 hours for a repeat TSB.
- Have the mother supplement with extra fluids and return to the clinic in 24 hours for a repeat TSB.
The parent of a 4-day-old infant tells the primary care pediatric nurse practitioner that the infant was diagnosed with hydronephrosis while in utero and asks what will be done. What will the nurse practitioner tell this parent?
The infant will eventually require renal transplantation for that kidney.
Spontaneous resolution often occurs within 6 months to a year of age.
The affected kidney will be non-functional but the other kidney will compensate.
Spontaneous resolution often occurs within 6 months to a year of age.
A 5-day-old infant who was delivered at home has abdominal distension and poor feeding. The mother is worried that the infant is constipated because he didn’t have a first stool until yesterday and has only passed a small amount of meconium. What will the primary care pediatric nurse practitioner do?
Order an abdominal radiograph and refer the infant to a pediatric surgeon.
Obtain a sweat chloride skin test to evaluate for possible cystic fibrosis.
Prescribe glycerin suppositories to use as needed until bowel function is normal.
Suggest that the mother increase her fluid intake to help with constipation.
Order an abdominal radiograph and refer the infant to a pediatric surgeon.
These are symptoms of Hirschprung disease, and evaluation and possible surgical intervention are necessary. Although failure to pass meconium in the first 24 to 48 hours may be an early sign of CF, this testing is part of newborn screening that should be obtained. Glycerin suppositories and increasing fluid intake are not indicated until the cause of the constipation is determined.
The primary care pediatric nurse practitioner is discussing newborn care with parents prior to the delivery of their first child. What will the nurse practitioner tell them about circumcision?
The benefits of the procedure outweigh the risks of the procedure.
There is no good evidence to support the practice.
Circumcision is a relatively painless procedure.
There is a slight increase in penile cancer in circumcised males.
The benefits of the procedure outweigh the risks of the procedure.
The parent of a 4-week-old infant reports that the infant began having forceful vomiting 1 week prior, which has worsened over time. The infant continues to nurse well but is losing weight. A physical examination reveals a 90-g weight loss over the past 2 weeks, dry mucous membranes, and a sunken fontanel. What will the primary care pediatric nurse practitioner do?
Recommend oral rehydration fluids for 24 to 48 hours to correct dehydration.
Suggest trying a soy-based or hydrolyzed protein formula until vomiting resolves.
Obtain serum electrolytes and hospitalize for surgical intervention.
Encourage the mother to nurse the infant more frequently for shorter duration.
Obtain serum electrolytes and hospitalize for surgical intervention.
This infant has symptoms characteristic of pyloric stenosis. Surgical intervention is necessary after dehydration and electrolyte imbalance has been corrected. The PNP may order lab work and admit to the hospital for a surgical consult. Infants with regurgitation disorders should nurse for shorter periods more frequently to prevent spitting up. Oral rehydration fluids are not indicated since the infant will vomit everything that goes into the stomach. Switching to other formulas is not indicated.
The primary care pediatric nurse practitioner performs a well baby exam on a 2-day-old infant and notes clusters of firm, yellow-white papules with a surrounding erythematous flare. What will the nurse practitioner do?
Encourage frequent cleansing with mild soap.
Prescribe a topical antibiotic medication.
Obtain a Wright-stained smear of the lesions.
Reassure the parents that no treatment is necessary.
Reassure the parents that no treatment is necessary. - Erythema Toxicum
