Module 3 (Ch. 6, 19, 20, 18, 14)

Question 1

he primary care pediatric nurse practitioner is evaluating a 2­year­old with a

documented speech delay. Screenings to assess motor skills and cognition are normal, and the child passed a recent hearing test. What will the pediatric nurse practitioner do next?

Answer 1

Ask the child’s parents whether they read to the child.

Question 2

The primary care pediatric nurse practitioner performs a developmental

assessment on a 32­month­old child. The child’s parent reports that about 70% of the child’s speech is intelligible. The pediatric nurse practitioner observes that the child has difficulty pronouncing “t,” “d,” “k,” and “g” sounds. Which action is correct?

Answer 2

Reassure the parent that this is normal

Question 3

During a well child assessment of an 18­month­old child, the primary care

pediatric nurse practitioner observes the child point to a picture of a dog and say, “Want

puppy!” The nurse practitioner recognizes this as an example of

Answer 3

telegraphic speech.

Question 4

The primary care pediatric nurse practitioner is offering anticipatory guidance

to the parents of a 12­month­old child. The parents are bilingual in Spanish and English and have many Spanish­speaking relatives nearby. They are resisting exposing the child to Spanish out of concern that the child will not learn English well. What will the pediatric nurse practitioner tell the parents?

Answer 4

Most bilingual children are able to shift from one language to another when appropriate.

Question 5

The primary care pediatric nurse practitioner 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 pediatric nurse practitioner recommend?

Answer 5

Allow the child to explore and experiment while providing appropriate limits.

Question 6

6. The mother of a 3­year­old child takes the child to a play group once a week. ID: 13348437961 She expresses concern that the child plays with toys but does not interact with the other toddlers. What will the primary care pediatric nurse practitioner counsel the mother?

Answer 6

Toddlers may be interested in other children but usually do not engage in interactive play

Question 7

The parent of a 4­year­old points to a picture and says, “That’s your sister.”

The child responds by saying, “No! It’s my baby!” This is an example of which type of thinking

in preschool­age children?

Answer 7

Realism

Question 8

The parent of a 24­month­old child asks the primary care pediatric nurse

practitioner when toilet training should begin. How will the pediatric nurse practitioner respond?

Answer 8

“Tell me about your child’s daily habits.”

Question 9

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 9

To make an appointment for an initial dental examination

Question 10

The parents of a 3­year­old 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 primary care pediatric nurse practitioner tell the parents to do?

Answer 10

Place a variety of nutritious foods on the child’s plate at each meal.

Question 11

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?

Answer 11

“I let my baby cry a while to learn to be patient.”

Question 12

A child has a difficult temperament. What will the primary care pediatric nurse
practitioner tell the parent about managing this child’s behavior?

Answer 12

It is important for the parent to learn to manage criticism and power struggles.

Question 13

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?

Answer 13

Take time to actively listen to the parent’s and child’s perceptions of the problem

Question 14

4. The primary care pediatric nurse practitioner attempts to learn more about the
   emotional health of an 18­month­old child through which assessment strategy?

Answer 14

Observation of the child with caretakers in structured and unstructured situations

Question 15

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?

Answer 15

Refer the child to a mental health specialist for evaluation and treatment

Question 16

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?

Answer 16

Ask the parent if the child is slow to warm up to other new situations

Question 17

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?

Answer 17

The significance of this loss must be reworked at each developmental level.

Question 18

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?

Answer 18

“Fear of imaginary creatures does not usually occur at this age

Question 19

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?

Answer 19

Play therapy

Question 20

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?

Answer 20

Assess for environmental stress, parental dysfunction, and maternal depression.

Question 21

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?

Answer 21

Generalized anxiety disorder (GAD)

Question 22

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?

Answer 22

Cognitive­behavioral therapy

Question 23

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?

Answer 23

Cutting his hair so that it is too short to pull

Question 24

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?

Answer 24

Ask the mother about the child’s relationship with the father

Question 25

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?

Answer 25

Determining suicidal ideation and risk of suicide

Question 26

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?

Answer 26

Cognitive­behavioral therapy

Question 27

A 13­year­old child has exhibited symptoms of mild depression for several weeks. ID: 13348419846 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?

Answer 27

Refer the child to a child psychiatrist for evaluation of bipolar disorder. Correct

Question 28

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?

Answer 28

Engage the parent in positive parenting strategies to facilitate appropriate child coping

Question 29

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?

Answer 29

Anorexia nervosa

Question 30

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

Answer 30

flexibility.

Question 31

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

Answer 31

executive function.

Question 32

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

Answer 32

about friends and activities at school.

Question 33

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?

Answer 33

504

Question 34

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?

Answer 34

Activation

Question 35

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?

Answer 35

Moderate­dose stimulant

Question 36

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?

Answer 36

Over­responder

Question 37

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?

Answer 37

Maintaining predictable routines as much as possible

Question 38

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?

Answer 38

Ask the parent to describe the child’s earlier behaviors from infancy through preschool

Question 39

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?

Answer 39

Autism spectrum disorder

Question 40

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?

Answer 40

Cardiovascular pre­screening

Question 41

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?

Answer 41

Continuing the medication as prescribed

Question 42

A parent who encourages competitiveness in a child who excels at a single sport but not in others may also encourage a sense of

Answer 42

insecurity.

Question 43

A school­age child enjoys playing basketball but doesn’t make the intramural

team. Which response by the child is characteristic of the concept of a growth mindset?

Answer 43

“I’ll need to work more on my outside shot.”

Question 44

The primary care pediatric nurse practitioner is evaluating a 16­year­old

adolescent male who is on the high school wrestling team and whose weight fluctuates as much as 7 or 8 pounds before matches. The child is eager to talk about the various trophies he has won. When he expresses confidence that he will get a wrestling scholarship for college, his father remarks that his grades will never be good enough for college, causing him to blame his teachers. The nurse practitioner may identify potential problems with

Answer 44

self­esteem.

Question 45

The primary care pediatric nurse practitioner sees a 10­year­old child whose

parent describes as a “class clown.” The child denies having problems at school, but acknowledges poor grades by saying, “I’m not very smart, I guess.” When counseling the parent about helping this child deal with this self­perception issue, the nurse practitioner will recommend which strategy?

Answer 45

Help the child identify skills and activities that he is good at.

Question 46

The primary care pediatric nurse practitioner is performing a well child

examination on a fussy toddler who has red hair. The child’s parent tells the toddler to stop being fussy and says, “red hair gives him such a temper.” Which common error that erodes self­esteem is this?

Answer 46

Stereotyping and typecasting

Question 47

The parent of a 15­year­old male is concerned that he refuses to eat meals

with the family and consumes only protein drinks. The adolescent is on the track team at school and spends much of his time training and working out. The primary care pediatric nurse practitioner notes that his weight and BMI have dropped from the 20th percentile to the 3rd percentile in the past year. This child most likely has a problem with

Answer 47

body image

Question 48

The parent of a school­age child is concerned that the child is going to be

short like both parents and worries that he will have difficulty in school if he can’t participate in a variety of sports. What will the primary care pediatric nurse practitioner do to counsel this parent?

Answer 48

Encourage the child to engage in regular physical activity.

Question 49

The primary care pediatric nurse practitioner is performing a well child

examination on a 4­year­old child. The parent reports that the child snores frequently, often awakens during the night, and seems cranky during the day. What will the nurse practitioner tell this parent?

Answer 49

Sleep disorders at this age can have long­term impacts on learning

Question 50

The parent of a school­age child who is overweight tells the primary care

pediatric nurse practitioner that the child seems to crave high­calorie, high­carbohydrate foods, even when full. The nurse practitioner learns that the child is often irritable and sleepy at school in spite of sleeping 9 or 10 hours each night. What will the nurse practitioner recommend?

Answer 50

Referral to a sleep disorder clinic for a sleep study

Question 51

The primary care pediatric nurse practitioner is performing a well baby

examination on a 2­week­old infant. The parent is concerned that the infant sleeps too much. The nurse practitioner asks the parent to keep a sleep log and will teach the parent that which amount of sleep per day is optimal for this infant?

Answer 51

15 to 18 hours

Question 52

The primary care pediatric nurse practitioner is counseling a new parent

about ways to reduce the risk of sudden infant death syndrome (SIDS). What will the nurse practitioner include when discussing SIDS?

Answer 52

Bed­sharing with infants greatly increases the risk of SIDS.

Question 53

The primary care pediatric nurse practitioner is counseling the parents of a

toddler about sleep. The parents report that the toddler has recently begun resisting sleep and is often more irritable during the day. What will the nurse practitioner recommend?

Answer 53

Understanding that sleep resistance is a common developmental problem

Question 54

The parent of a 3­year­old child tells the primary care pediatric nurse

practitioner that the child has never been able to fall asleep without a parent in the room. The child has a new sibling and the parent is concerned that the toddler’s cries will awaken the infant. What will the nurse practitioner counsel the parent?

Answer 54

Leaving the room as the child is falling asleep and returning at intervals to check on

the child

Question 55

The parent of a 4­year­old who has difficulty initiating and maintaining sleep

has tried several nonpharmacological methods with variable success and asks about medications. What will the primary care pediatric nurse practitioner recommend?

Answer 55

Melatonin

Question 56

The parent of a 3­year­old child tells the primary care pediatric nurse

practitioner that after falling asleep in the living room and being awakened to go to bed one evening, the child appeared confused and disoriented for a period of time. What will the nurse practitioner counsel this parent?

Answer 56

That this is probably a benign, temporary type of a sleep disorder

Question 57

ring a well child examination, the primary care pediatric nurse practitioner

learns that a 5­year­old child has had several episodes of walking out of the bedroom after falling asleep, looking dazed, with open eyes, and saying things that don’t make sense. What will the nurse practitioner recommend?

Answer 57

Making sure that stairs are blocked and doors are locked

Question 58

The parent of a school­age child tells the primary care pediatric nurse

practitioner that the child is restless most nights and complains often that bugs are in the bed. After consultation with a sleep disorder specialist and subsequent evaluation of a ferritin level of 30, the nurse practitioner may expect to treat this child with

Answer 58

ferrous sulfate.

Question 59

An adolescent exhibits mild depressive symptoms and tells the primary care

pediatric nurse practitioner that he is most concerned about difficulty falling and staying asleep. The adolescent does not want to take medication to treat the depressive symptoms. What will the nurse practitioner recommend?

Answer 59

A program of sleep hygiene and gradual sleep extension

Question 60

A child with Down syndrome who has sleep­disordered breathing with

obstructive sleep apnea continues to have symptoms in spite of tonsillectomy and adenoidectomy and treatment with a leukotriene receptor antagonist medication and a nasal steroid spray. The primary care pediatric nurse practitioner will refer the child to a sleep disorder clinic to discuss which therapy?

Answer 60

Positive airway pressure therapy