Module 3 (Ch. 6, 19, 20, 18, 14) COPY Flashcards
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?
Ask the child’s parents whether they read to the child.
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?
Reassure the parent that this is normal
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
telegraphic speech.
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?
Most bilingual children are able to shift from one language to another when appropriate.
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?
Allow the child to explore and experiment while providing appropriate limits.
- 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?
Toddlers may be interested in other children but usually do not engage in interactive play
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?
Realism
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?
“Tell me about your child’s daily habits.”
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?
To make an appointment for an initial dental examination
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?
Place a variety of nutritious foods on the child’s plate at each meal.
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?
“I let my baby cry a while to learn to be patient.”
A child has a difficult temperament. What will the primary care pediatric nurse
practitioner tell the parent about managing this child’s behavior?
It is important for the parent to learn to manage criticism and power struggles.
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?
Take time to actively listen to the parent’s and child’s perceptions of the problem
- The primary care pediatric nurse practitioner attempts to learn more about the
emotional health of an 18monthold child through which assessment strategy?
Observation of the child with caretakers in structured and unstructured situations
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?
Refer the child to a mental health specialist for evaluation and treatment
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?
Ask the parent if the child is slow to warm up to other new situations
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?
The significance of this loss must be reworked at each developmental level.
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?
“Fear of imaginary creatures does not usually occur at this age
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?
Play therapy
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?
Assess for environmental stress, parental dysfunction, and maternal depression.
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?
Generalized anxiety disorder (GAD)
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?
Cognitivebehavioral therapy
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?
Cutting his hair so that it is too short to pull
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?
Ask the mother about the child’s relationship with the father
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?
Determining suicidal ideation and risk of suicide
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?
Cognitivebehavioral therapy
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?
Refer the child to a child psychiatrist for evaluation of bipolar disorder. Correct
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?
Engage the parent in positive parenting strategies to facilitate appropriate child coping
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?
Anorexia nervosa
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
flexibility.
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
executive function.
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
about friends and activities at school.
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?
504
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?
Activation
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?
Moderatedose stimulant
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?
Overresponder
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?
Maintaining predictable routines as much as possible
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?
Ask the parent to describe the child’s earlier behaviors from infancy through preschool
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?
Autism spectrum disorder
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?
Cardiovascular prescreening
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?
Continuing the medication as prescribed
A parent who encourages competitiveness in a child who excels at a single sport but not in others may also encourage a sense of
insecurity.
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?
“I’ll need to work more on my outside shot.”
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
selfesteem.
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?
Help the child identify skills and activities that he is good at.
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?
Stereotyping and typecasting
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
body image
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?
Encourage the child to engage in regular physical activity.
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?
Sleep disorders at this age can have longterm impacts on learning
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?
Referral to a sleep disorder clinic for a sleep study
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?
15 to 18 hours
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?
Bedsharing with infants greatly increases the risk of SIDS.
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?
Understanding that sleep resistance is a common developmental problem
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?
Leaving the room as the child is falling asleep and returning at intervals to check on
the child
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?
Melatonin
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?
That this is probably a benign, temporary type of a sleep disorder
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?
Making sure that stairs are blocked and doors are locked
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
ferrous sulfate.
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?
A program of sleep hygiene and gradual sleep extension
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?
Positive airway pressure therapy