Module 2B (Ch. 39, 21, 41, 38)

Question 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

Answer 1

Irrigate gently with normal saline

Question 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

Answer 2

Ciprofloxacin

Question 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

Answer 3

suture the wound within 6 hours.

Question 4

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

Answer 4

Hold the wound edges together and apply the adhesive on top of the skin.

Question 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

Answer 5

It may take up to 3 weeks to heal with scarring likely.

Question 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?

Answer 6

Refer the child to an orthopedic specialist for immediate evaluation and treatment.

Question 7

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?

Answer 7

Irrigation of the wounds with high­pressure normal saline

Question 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?

Answer 8

Administer intramuscular epinephrine.

Question 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?

Answer 9

Transport the child by ambulance to a medical center

Question 10

The primary care pediatric nurse practitioner uses a shared decision­making (SDM) model when working with families of children with chronic health conditions. When using this model, the nurse practitioner can expect

Answer 10

improved patient health outcomes.

Question 11

The primary care pediatric nurse practitioner diagnoses a 5­year­old child with asthma and prescribes an oral steroid and a short­acting beta­adrenergic medication via a metered­dose inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child’s family at this visit?

Answer 11

Effects and side effects of current medications

Question 12

The parent of a child with complex health care needs tells the primary care pediatric nurse practitioner that the child has had difficulty breathing the past two nights but can’t articulate specific symptoms. The child has normal oxygen saturations and a normal respiratory rate with clear breath sounds. What will the nurse practitioner do?

Answer 12

Encourage the parent to call when concerned and schedule a follow­up appointment the next day.

Question 13

Which characteristic is the key criterion that identifies a child has having special needs?

Answer 13

Health service requirements

Question 14

The primary care pediatric nurse practitioner is performing a well baby examination on a 2­week­old infant who was recently discharged home from the neonatal intensive care unit. The mother reports that the infant was born at 26 weeks’ gestation and states she was told that her baby will probably have developmental delays. What is the most important aspect of long­term management for this infant?

Answer 14

Careful monitoring of attainment of developmental milestones

Question 15

The primary care pediatric nurse practitioner is preparing to perform a well child examination on a 5­year­old child who has multiple developmental and cognitive delays. The child’s mother is angry and tells the nurse practitioner that her friends’ children are all preparing for kindergarten. The nurse practitioner will

Answer 15

allow the mother to express her feelings, understanding that she is experiencing grief

Question 16

The parent of a toddler who has special health care needs is resistant to a suggestion that her child needs a gastrostomy tube for nutrition. The toddler has fallen from the 10th percentile to the 5th percentile in the past few months and resists taking in appropriate amounts of food by mouth even with assistance from occupational therapy. What will the primary care pediatric nurse practitioner do

Answer 16

Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight.

Question 17

What is the most important role of the primary care pediatric nurse practitioner who provides care for a child with special health care needs who sees several specialists and receives community and school­based services?

Answer 17

Coordinating services to ensure continuity of care

Question 18

A toddler swallowed a coin several days prior. The child’s parent has not found the coin in the child’s stool. Which imaging test will the primary care pediatric nurse practitioner employ to evaluate this ingestion?

Answer 18

Conventional radiograph

Question 19

The primary care pediatric nurse practitioner is assessing an ill 2­month­old infant who is febrile and refusing most fluids. The preliminary blood work indicates a viral infection and shows that the infant is hydrated. The infant is alert. The infant’s parents are attentive and live close by. What will the nurse practitioner do?

Answer 19

Give the parents sick care instructions and follow up in the clinic in the morning.

Question 20

A toddler is prescribed a liquid oral medication. The parent tells the primary care pediatric nurse practitioner that the child refuses to take medications and usually spits them out. What will the nurse practitioner do?

Answer 20

Demonstrate oral medication administration with the toddler in the office.

Question 21

The primary care pediatric nurse practitioner orders a pulmonology consult for a child who has severe asthma. The nurse practitioner writes “child with asthma refractory to conventional treatments needs suggestions for alternative treatments.” The nurse practitioner expects the pulmonologist to

Answer 21

make recommendations for disease management.

Question 22

The primary care pediatric nurse practitioner cares for several families with chronically ill children who text status updates about their children to a mobile device that has an encryption­ protection platform installed. If the nurse practitioner misplaces the mobile device, it is important to

Answer 22

disconnect the user from the system to avoid a data breach.

Question 23

The parent of an 18­month­old child calls the clinic to report that the child has a rectal temperature of 100.4°F (38°C). The child is playing normally, taking fluids well, and has a slightly reduced appetite. What will the primary care pediatric nurse practitioner recommend?

Answer 23

Offering extra fluids and calling if symptoms change

Question 24

The parent of a preschool­age child calls the clinic to report that the child has clear, watery drainage from both eyes, mild erythema of the conjunctiva, and no fever or other symptoms. What will the primary care pediatric nurse practitioner recommend

Answer 24

Allow the child to go to preschool

Question 25

A parent brings a 4­month­old infant to the clinic who has had a low­grade fever for 24 hours. The primary care nurse practitioner notes that the infant has a weak cry, slightly dry oral mucosa, mottled skin, and a respiratory rate of 65 breaths per minute and sleeps unless stimulated by the examiner,. What will the nurse practitioner do?

Answer 25

Admit the infant to the hospital.

Question 26

What is true about haploid cells?

Answer 26

Each one contains 23 chromosomes.

Question 27

What does the following genetic notation symbol mean 47,XX,6q­?

Answer 27

Female with deletion on the long arm of chromosome 6

Question 28

A child has a recessive genetic disorder that is homozygous for that mutation. What is most likely about this child’s parents?

Answer 28

Each parent has one copy of that gene mutation

Question 29

Which type of mutation is responsible for many single­gene genetic disorders

Answer 29

Monogenetic

Question 30

The primary care pediatric nurse practitioner is counseling a couple about genetic risks and learns that one parent has neurofibromatosis, an autosomal dominant disorder, and the other parent does not. What will the nurse practitioner include when discussing this disorder and its transmission

Answer 30

Each child born to this couple will have a 50% risk of having the disease.

Question 31

A family medical history conducted during a well baby exam for a newborn girl reveals that hemophilia A, an X­linked recessive disorder, is present in males in three previous generations in the mother’s family, whose father had the disease. What will the primary care pediatric nurse practitioner tell the parents about the risk of this disease in their children

Answer 31

Daughters have a 50% chance of being carriers of the disease.

Question 32

What is an important responsibility of the primary care pediatric nurse practitioner to help determine genetic risk factors in families

Answer 32

Obtaining a three­generation pedigree for each family

Question 33

Which diagnostic study may be ordered when the provider wishes to detect the presence of additional genetic material on a chromosome?

Answer 33

FISH

Question 34

Which type of testing will the primary care pediatric nurse practitioner recommend ID: 13348407640 for a couple concerned about the potential for having children with cystic fibrosis?

Answer 34

Carrier testing

Question 35

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

Answer 35

There is a metaphyseal fragment on the compression side of fracture

Question 36

What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip?

Answer 36

Dislocation of an unstable hip

Question 37

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?

Answer 37

Gently attempt a supination and flexion technique.

Question 38

A school­age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed

Answer 38

Immobilization with a sling to support the affected extremity

Question 39

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?

Answer 39

Recommend NSAIDs, stretching exercises, and ice packs to the area.

Question 40

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?

Answer 40

Discuss posture and exercise and ask about backpacks and books.

Question 41

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

Answer 41

Surgical intervention

Question 42

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

Answer 42

Place the child on crutches or in a wheelchair to prevent weight­bearing.

Question 43

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

Answer 43

Refer to a pediatric orthopedic specialist for treatment.

Question 44

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

Answer 44

Apply ice packs to both knees and avoid activities that cause pain.

Question 45

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?

Answer 45

Grasp the heel with one hand and abduct the forefoot with the other hand