Module 4 (Ch. 25, 34, 28) Flashcards
An 8yearold child is diagnosed with systemic lupus erythematosus (SLE), and
the child’s parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell
the parent?
Periods of remission may occur but there is no permanent cure.
The primary care pediatric nurse practitioner examines a child who has had
stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse
practitioner will refer the child to a rheumatology specialist to evaluate for
oligoarticular JIA
The primary care pediatric nurse practitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child?
Ophthalmology
The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg
child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum
amount the child will receive per dose?
250 mg
The parent of a schoolage child who is diagnosed with oligoarticular JIA asks the
primary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend?
Swimming
A 12yearold child is brought to the clinic with joint pain, a 3week history of low
grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive.
Which test may be ordered to confirm a diagnosis of SLE?
Antidoublestrand DNA antibodies
The primary care pediatric nurse practitioner is reviewing the rheumatology plan
of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes?
Use UVA and UVB sunscreen daily.
An adolescent female reports poor sleep, fatigue, muscle and joint paint, and
anxiety lasting for several months. The primary care pediatric nurse practitioner notes point
tenderness at several sites. What will the nurse practitioner do next?
Refer the adolescent to a rheumatologist for further evaluation.
A child has a fever and arthralgia. The primary care pediatric nurse practitioner
learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order?
ASO titer
The primary care pediatric nurse practitioner sees a child for followup care after
hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child?
Aspirin is given for 2 weeks and then tapered to discontinue the medication
An 8yearold boy has a recent history of an upper respiratory infection and
comes to the clinic with a maculopapular rash on his lower extremities and swelling and tenderness in both ankles. The pediatric nurse practitioner performs a UA, which shows proteinuria and hematuria and diagnoses HSP. What ongoing evaluation will the nurse practitioner perform
during the course of this disease?
Blood pressure measurement
A 10yearold child has a 1week history of fever of 104°C that is unresponsive to
antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do?
Order a baseline echocardiogram today and another in 2 weeks
The primary care pediatric nurse practitioner is evaluating an 11monthold infant
who has had three viral respiratory illnesses causing bronchiolitis. The child’s parents both have seasonal allergies and ask whether the infant may have asthma. What will the nurse practitioner tell the parents?
Although it is likely, based on family history, it is too soon to tell.”
The primary care pediatric nurse practitioner is examining a schoolage child who has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metereddose inhaler. What will the nurse practitioner order?
Spirometry testing
A schoolage child who uses a SABA and an inhaled corticosteroid medication is
seen in the clinic for an acute asthma exacerbation. After 4 puffs of an inhaled shortacting B2 agonist (SABA) every 20 minutes for three treatments, spirometry testing shows an FEV1 of 60% of the child’s personal best. What will the primary care pediatric nurse practitioner do next?
Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely.
A child who has been diagnosed with asthma for several years has been using a
shortacting B2agonist (SABA) to control symptoms. The primary care pediatric nurse practitioner learns that the child has recently begun using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of
75% of personal best. What will the nurse practitioner do next?
Add a daily inhaled corticosteroid.
An adolescent who has asthma and severe perennial allergies has poor asthma
control in spite of appropriate use of a SABA and a daily highdose inhaled corticosteroid. What will the primary care pediatric nurse practitioner do next to manage this child’s asthma?
Refer to a pulmonologist for omalizumab therapy.
An adolescent who has exerciseinduced asthma (EIA) is on the high school track ID: 13348419888 team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs
of albuterol via a metereddose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do?
Order a daily inhaled corticosteroid medication.
A schoolage child with asthma is seen for a well child checkup and, in spite of
“feeling fine,” has pronounced expiratory wheezes, decreased breath sounds, and an FEV1less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child’s parent administers the daily mediumdose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child’s status. What will the nurse practitioner do?
Teach the child and parent how to use home PEF monitoring.
The parent of a schoolage child reports that the child usually has allergic rhinitis
symptoms beginning each fall and that nonsedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the primary care pediatric nurse practitioner do?
Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season.
A 4monthold infant has a history of reddened, dry, itchy skin. The primary care
pediatric nurse practitioner notes fine papules on the extensor aspect of the infant’s arms, anterior
thighs, and lateral aspects of the cheeks. What is the initial treatment?
Moisturizers
The primary care pediatric nurse practitioner is performing a wellbaby checkup on a 6monthold infant and notes a candida diaper rash and oral thrush. The infant has had two
ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do?
Order a CBC with differential and platelets and quantitative immunoglobulins.
A 9monthold infant has developed two teeth since the 6month checkup. The
local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to
promote healthy dentition at this visit?
Apply sodium fluoride varnish to the infant’s teeth.
What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures?
Give the infant a cold teething ring or wet washcloth to chew.
An 18monthold child has horizontal, bright white lines along the upper gum line
of the teeth. What is the most important question the primary care pediatric nurse practitioner will
ask the child’s parents?
If the child is still drinking milk from a bottle
A 4yearold child who has had extensive dental surgery to treat dental caries has
white spot lesions on the primary teeth. How often should this child receive fluoride varnish
applications?
Every 3 to 6 months
The parents of a formulafed newborn report that they get their drinking water
from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant?
Testing the fluoride level of their water source
What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child’s teeth?
To use a smear of toothpaste and not to rinse the mouth
A parent asks about ways to promote dental health in schoolage children while on a family vacation that are convenient while camping and picnicking. What will the pediatric nurse practitioner recommend?
Offering gum containing xylitol after meals
An adolescent has localized bleeding of the gums when brushing the teeth. An
exam of the mouth reveals the presence of plaque and calculus on the teeth, which are not loose.
What will the primary care pediatric nurse practitioner recommend?
Consistently brushing and flossing the teeth twice daily
A schoolage child has had herpes stomatitis for a week and continues to
complain of pain. What will the primary care pediatric nurse practitioner recommend?
Topical application of diphenhydramine and Maalox
A child has several shallow mucosal lesions on the buccal mucosa and tongue that are surrounded with an erythematous halo and covered by yellow plaques. What will the primary care pediatric nurse practitioner recommend?
Chlorhexidine gluconate
During a well child exam, the primary care pediatric nurse practitioner notes
yellowishwhite serpentinebordered lesions on the anterior portion of a child’s tongue. What will
the nurse practitioner do?
Reassure the parent that these are benign lesions.
A 4yearold child who has asthma has teeth with smooth, cuppedout teeth on the chewing surfaces. Which is the most likely explanation for this finding?
Gastroesophageal reflux
An adolescent female reports facial pain and frequent popping of her jaw. An
exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do?
Recommend ice packs, NSAIDs, and a soft diet.
A 5yearold child is hit in the face with a baseball bat and is brought to the clinic
by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment?
Refer the child to a dentist immediately for further examination.
A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the
primary care pediatric nurse practitioner recommend to promote dental health in this child?
Daily chlorhexidine gluconate rinses
When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by
extending the leg at the knee with the infant supine.
To evaluate brain tissue disorders in infants, which test is useful?
Ultrasonography
A female infant who was developing normally stops meeting developmental
milestones at age 12 months and then begins losing previously acquired skills. What will the primary care pediatric nurse practitioner expect to tell the parents about this child’s prognosis?
The child’s intellectual development will not progress further.
A 14yearold child has a headache, unilateral weakness, and blurred vision
preceded by fever and nausea. The child’s parent reports a similar episode several months prior. The primary care pediatric nurse practitioner will consult with a pediatric neurologist to order
neuroimaging with magnetic resonance imaging (MRI
During a well baby exam on a 9monthold infant, the parent reports that the baby
always uses the left hand to pick up objects and asks if the baby will be lefthanded. What will the primary care pediatric nurse practitioner do?
Perform a careful assessment of fine and gross motor skills.
The pediatric nurse practitioner provides primary care for a 5yearold child who
has cerebral palsy who exhibits athetosis and poor weight gain in spite of receiving highcalorie formula to supplement intake. The child has had several episodes of pneumonia in the past year. Which specialty consultation is a priority for this child?
Surgery for possible fundoplication and gastrostomy
Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?
Calcium and vitamin D
A child with a recent history of URI reports tingling and pain in one ear followed by
sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do?
Prescribe oral prednisone 1 mg/kg/day initially
- A child who has had a single nonfebrile seizure has a normal neurologic exam.
Which diagnostic test is indicated?
Electroencephalogram (EEG)
The parents of an 18monthold child bring the child to the clinic after observing a
brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of
103.1°F, and the primary care pediatric nurse practitioner notes a left otitis media. The child is alert and responding normally. What will the nurse practitioner do?
Prescribe an antibiotic for the ear infection and reassure the parents.
An adolescent female reports unilateral headache pain associated with abdominal
pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for 6 months but reports little relief from symptoms. What will the primary care pediatric nurse practitioner do?
Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours
A child who has sustained a head injury after falling on the playground is brought
to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric nurse practitioner notes slight slurring of the child’s speech and the child has vomited twice in the exam room. Which course of action is warranted?
Admit the child to the hospital for a neurology consult
The primary care pediatric nurse practitioner performs a well baby exam on a
term 4monthold infant and observes flattening of the left occiput, bossing of the right occiput, and anterior displacement of the left ear. The parents report performing various positioning maneuvers, but say that the baby’s head shape has worsened. What will the nurse practitioner recommend to correct this finding?
Refer the infant for orthotic cranial molding helmet therapy
A 4yearold child who has previously met developmental milestones is not toiled
trained. The primary care pediatric nurse practitioner notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child?
Tethered cord
