Exam 1

Question 1

The primary care pediatric nurse practitioner is obtaining a medical history about a child. To intergrate both nursing and medical aspects of primary care, which will be included in the medical history ?

A. Complementary medications, alternative health practices, and chief complaint

B. Developmental delays, nutritional status, and linear growth patterns.

C. Medication currently taking, allergy information, and family medical history.

D. Speech and language development, belief about health, and previous illnesses.

Answer 1

D. Speech and language development, belief about health, and previous illnesses.

Question 2

When formulating development diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource?

A. DC:03R

B. ICD10cm

C. ICSD3

D. NANDA international

Answer 2

A. DC:03R

Question 3

The primary care pediatric nurse practitioner sees a 3 year old child who chronically withholds stools, in spite of the parents’ attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement?

A. Altered elimination pattern

B. Elimination disorder

C. Encopresis

D. Parenting alteration.

Answer 3

C. Encopresis- a condition which a child resists having a bm, causing impacted stool to collect in the colon and rectum and lead to leakage.

Question 4

The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that he child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem?

A. Failure to thrive

B. Home care resources inadequate

C. Nutrition alteration-less than required

D. Parenting alteration.

Answer 4

D. Parenting alteration.

Question 5

The primary care pediatric nurse practitioner is performing a well child checkup on a 20 month old child. The child was 4 weeks premature and, according to a parent completed developmental questionnaire, has achieved a milestones for a 15 month old infant. Which action is correct?

A. Perform an in-depth developmental assessment screen at this visit to evaluate this child.

B. Reassure the parent that the child will catch up to normal development by age 2 years.

C. Reevaluate this child’s development and milestone achievements at the 2 year visit.

D. Refer the child to a specialty clinic for evaluation and treatment of developmental delay.

Answer 5

A. Perform an in-depth developmental assessment screen at this visit to evaluate this child.

Question 6

The primary care pediatric nurse practitioner performs a developmental assessment on a 3 year old child and notes normal cognitive, fine motor, and gross motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says, The nurse practitioner will?

A. Ask the parent to consider a possible speech delay and report any concerns.

B. Continue to evaluate the child’s speech at subsequent visits.

C. Refer the child for a speech and hearing evaluation.

D. Tell the parent to spend more time in interactive conversations with the child.

Answer 6

B. Continue to evaluate the child’s speech at subsequent visits.

Question 7

The parent of a toddler is concerned that the child may have autism. The primary care pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (MCHAT) tool, which indicates several areas of concerns. What will the nurse practitioner do?

A, Administer a Childhood Autism Rating Scale (CARS)

B. Consult a specialist to determine appropriate early intervention strategies.

C. Refer the child to a behavioral specialist for further evaluation.

D. Tell the parent that this result indicates that the child has autism.

Answer 7

C. Refer the child to a behavioral specialist for further evaluation.

Question 8

The primary care pediatric nurse practitioner learns that the mother of a
3yearold child has been treated for depression for over 5 years. Which aspect of this child’s development will be of the most concern to the nurse practitioner?

A. Fine motor
B. Gross motor
C. Social/emotional
D. Speech and language

Answer 8

D. Speech and language

Question 9

When meeting with a new family, the primary care pediatric nurse
practitioner develops a database that identifies family members and others living in the household,
relationships with others outside the household, and significant behavioral
and emotional problems. Which tool will the nurse practitioner use to record this information?

A. CRAFFT
B. Ecomap
C. Genogram
D. Pedigree

Answer 9

C. Genogram

Question 10

A child is in the clinic for evaluation of an asthma action plan. The primary
care pediatric nurse practitioner notes that the child’s last visit was for a
prekindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do
initially?

A. Ask the child’s parent why the child is so anxious.
B. Perform a physical assessment to rule out shortness of breath.
C. Reassure the child that there is nothing to be afraid of.
D. Review the purpose of this visit and any anticipated procedures.

Answer 10

D. Review the purpose of this visit and any anticipated procedures.
Correct

Question 11

The primary care pediatric nurse practitioner is evaluating health literacy
in the mother of a new preschool-age child. How will the nurse practitioner assess

A. Ask the child how many books he has at home.
B. Ask the mother about her highest grade in school.
C. Ask the mother to determine the correct dose of a drug from a label.
D. Ask the mother to read a health information handout aloud.

Answer 11

A. Ask the child how many books he has at home.

Question 12

The mother of a newborn tells the primary care pediatric nurse practitioner
that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk?
A. Three-generation pedigree.
B. Review of systems
C. Genogram
D. Ecomap

Answer 12

A. Three generation pedigree

Question 13

The primary care pediatric nurse practitioner is performing a well-child
assessment on an adolescent and is concerned about possible alcohol and
tobacco use. Which
assessment tool will the nurse practitioner use?
A. CRAFFT
B. HEEADSSS
C. PHQ2
D. RAAPS

Answer 13

A. CRAFFT

Question 14

The primary care pediatric nurse practitioner evaluates a school-age child
whose body mass index (BMI) is greater than the 97th percentile. The nurse
practitioner is concerned about possible metabolic syndrome and orders
laboratory tests to evaluate this. Which diagnosis will the nurse practitioner
document for this visit?

A. Metabolic syndrome
B. Nutritional alteration: more than required
C. Obesity
D. Rule out type 2 diabetes mellitus

Answer 14

C. Obesity

Question 15

A single mother of an infant worries that living in a household with only
one parent will cause her child to be maladjusted. To help address the mother’s
concerns, the primary care pediatric nurse practitioner will suggest

S. developing consistent daily routines for the child.
T.exposing her child to extended family members when possible.
U. not working outside the home during the first few years.
V.taking her child to regular play date activities with other children.

Answer 15

S. developing consistent daily routines for the child.

Question 16

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?

R. Reassure them that the child is too young to understand.
S. Recommend that they continue to not argue in front of the child.
T. Suggest counseling to learn ways to handle stress.
U. Tell them that the conflict will resolve when the situation changes.

Answer 16

T. Suggest counseling to learn ways to handle stress.

Question 17

During a well-child assessment of an 18monthold 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?

S. Allow the parent to put the child in a “timeout.”
T. Ask the parent about usual discipline practices.
U. Offer the child a book or a toy to look at.
V. Stop the exam since the child has reached a “meltdown.”

Answer 17

U. Offer the child a book or a toy to look at.

Question 18

Which recommendation will a primary care pediatric nurse practitioner
make when parents ask about ways to discipline their 3yearold child who draws on the walls with crayons?

O. Give the child washable markers so the drawings can be removed easily.
P. Provide a roll of paper for drawing and teach the child to use this.
Q. Put the child in “timeout” each time the child draws on the walls.
R. Take the crayons away from the child to prevent the behavior.

Answer 18

P. Provide a roll of paper for drawing and teach the child to use this.

Question 19

The primary care pediatric nurse practitioner conducts a well-baby exam on an infant and notes mild gross motor delays but no delays in other areas.
Which initial course of
action will the nurse practitioner recommend?

P. Consult a developmental specialist for a more complete evaluation.
Q. Prepare the parents for a potentially serious developmental disorder.
R. Refer the infant to an early intervention program for physical therapy.
S. Teach the parents to provide exercises to encourage motor
development.

Answer 19

S. Teach the parents to provide exercises to encourage motor

development.

Question 20

The primary care pediatric nurse practitioner is examining a newborn
infant recently discharged from the neonatal intensive care unit after premature
birth. The parent is upset and expresses worry about whether the infant will be normal. What will the nurse
practitioner do in this situation?

L. Explain to the parent that developmental delays often do not manifest at
first.
M. Perform a developmental assessment and tell the parent which delays are
evident.
N. Point out the tasks that the infant can perform while conducting the assessment.
O. Refer the infant to a developmental specialist for a complete evaluation.

Answer 20

N. Point out the tasks that the infant can perform while conducting
the
assessment.

Question 21

The primary care pediatric nurse practitioner sees a developmentally delayed
toddler for an initial visit. The family has just moved to the area and asks the nurse practitioner about community services and resources for their child.

What should the nurse practitioner do initially?

L. Ask the parents if they have an individualized family service plan
(IFSP).
M. Consult with a physician to ensure the child gets appropriate care.
N. Inform the family that services are provided when the child begins
school.
O. Refer the family to a social worker for assistance with referrals and
services.

Answer 21

L. Ask the parents if they have an individualized family service plan
(IFSP).

Question 22

The primary care pediatric nurse practitioner has a cohort of patients who
have special health care needs. Which is an important role of the nurse
practitioner when caring for these children?
N. Care coordination and collaboration
O. Developing protocols for parents to follow
P. Monitoring individual education plans (IEPs)
Q. Providing lists of resources for families

Answer 22

N. Care coordination and collaboration

Question 23

The primary care pediatric nurse practitioner performs a physical examination
on a 9montholdinfant 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?

I. To begin brushing the infant’s teeth with toothpaste
J. To consider weaning the infant from breastfeeding
K. To discontinue giving fluoride supplements
L. To make an appointment for an initial dental examination.

Answer 23

L. To make an appointment for an initial dental examination

Question 24

The primary care pediatric nurse practitioner enters an exam room and finds
a 2monthold infant in a car seat on the exam table. The infant’s mother is playing a game on her smartphone. The nurse practitioner interprets this behavior as

H. a sign that the mother has postpartum depression.
I. extremely concerning for potential parental neglect.
J. of moderate concern for parenting problems.
K. Within the normal range of behavior in early parenthood.

Answer 24

J. of moderate concern for parenting problems.

Question 25

A mother brings her 9-month infant in for a routine visit. What milestone would be appropriate for the doctor to ask if the infant is meeting?

1. Walking
2. Speaking in two-word phrases
3. Rolls back to stomach and stomach to back
4. All of the above

Answer 25

3. Rolls back to stomach and stomach to back

Question 26

A 5 day old infant comes in for a newborn checkup. On assessment of the newborn, you note that the skin is jaundice in color. The anterior fontanel is slightly sunken. Per mom, the infant has only had 2 diapers today. The infant is strictly breastfed and this is the mom’s first child. She states the baby is having trouble latching on. A bilirubin level is sent and comes back at 18. You identify this newborn to be dehydrated and is most likely to have breast milk jaundice. Which nursing intervention(s) will be
required for this baby?

1. Phototherapy
2. Providing support and education for the lactating mother
3. Strict monitoring of intake and output
4. All of the above

Answer 26

4. All of the above.

Question 27

Apgar scores measure heart rate, respiratory rate, reflex irritability, color
and :
11. Rigidity
2. Muscle tone
3. Birth weight
4. Capillary refill

Answer 27

2. 2. Muscle tone

Question 28

A mother on the postpartum unit asked to have her infant back from the
nursery so that she can breastfeed. The nurse brings the newborn to the
room and hands the baby to the mother. She asks the mother to let her know
how long the baby feeds. What vital step did the nurse forget to take before
giving the baby to the mother?
1. The nurse should have made sure that the baby was latching correctly
2. The nurse should have identified the baby’s ID band with the mothers
3. The nurse should have the mother speak with a lactation consultant
4. The nurse should have asked the mother how long she planned to feed

Answer 28

2. The nurse should have identified the baby’s ID band with the mothers

Question 29

Excessive heat loss results in which of these?

1. RDS
2. Depletion of glucose levels
3. Jaundice
4. Increase in surfactant levels

Answer 29

2. Depletion of glucose levels

Question 30

A mother has just delivered her new baby a few hours ago. She asks the nurse if she can bathe the baby
because he has blood on him. The best response from the nurse would be.

1. Sure, let me get you some soap and washcloths
2. Why dont you get some rest, there will be lots of time for bathing
3. Its important that we not bathe the baby too soon after birth. Lets wait till
   later in the day.
4. Sure, but why don’t you feed the baby.

Answer 30

3. It’s important that we not bathe the baby too soon after birth. Lets wait till later in the day.

Question 31

A 4-week old infant is brought to the ED. Mom states that the baby hasn’t
been eating well and has had decreased diapers for 2 days. The baby has been sleeping more and has been hard to wake up. On assessment, you find that the baby is difficult to arouse, is hypotonic and temperature is 35.4 rectally. What is an important lab value to check? Choose the best answer.
1. Complete metabolic panel
2. Liver panel
3. Blood glucose
4. PTT

Answer 31

3. Blood glucose

Question 32

A pregnant woman with a history of a clotting disorder is required to selfadminister heparin during her

pregnancy. After delivery, the infant will be at greater risk for:
1. Low blood sugar
2. Decrease Vitamin K
3. Increased Vitamin K
4. High blood sugar

Answer 32

2. Decrease Vitamin K

Question 33

A part of injury prevention is making and keeping infant appointments. The required checkups and vaccinations are at:

1. 3 months, 6 months, 9 months
2. 2 months, 4 months, 6 months and 1 year
3. 2 months, 4 months, 6 month, 9 months and 1 year
4. 2 months, 4 months, 9 months and 1 year

Answer 33

3. 2 months, 4 months, 6 month, 9 months and 1 year

Question 34

You are taking care of an infant who was admitted with dehydration. His
weight is 6kg. You have been watching his I & Os. What would you expect the infant’s urinary output to be
in order to maintain adequate
hydration?
1. 0.52 ml/kg/hr
2. 0.52.5 ml/kg/hr
3. 13 ml/kg/hr
4. As long as he is having wet diapers it doesn’t matte

Answer 34

3. 13 ml/kg/hr

Question 35

A mother brings her newborn daughter to the ER with concerns that she
is having vaginal bleeding. You know this is normal and called what?
1. Pseudomenstruation
2. Milia
3. Vernix caseosa
4. Toxicum

Answer 35

1. Pseudomenstruation

Question 36

While interviewing the mother of an infant, you note that the mother gets
frustrated as she explains that her baby has been up all night crying at least 3 times a week for the last 2 weeks. She states that she has tried everything and feels hopeless. What would be the BEST response from
you as the nurse?

1. Believe me, I know. I have a newborn too.
2. Have you tried warm milk?
3. Its ok to be frustrated and feel overwhelmed.
4. You are doing nothing wrong. This can be a common occurrence in infants and you should not feel guilty.

Answer 36

4. You are doing nothing wrong. This can be a common occurrence in infants and you should not feel guilty.

Question 37

The parent of a newborn infant asks the primary care pediatric nurse
practitioner
when to intervene to help the infant’s future intellectual growth. What will the nurse practitioner tell the parent?

W. Cognitive learning begins during the toddler years.
X. Intellectual growth begins when speech develops.
Y. Language and literacy skills begin at birth.
Z. Preschool is an optimal time to begin general learning.

Answer 37

Y. Language and literacy skills begin at birth.

Question 38

The primary care pediatric nurse practitioner performs a well-baby examination
on a 7dayold 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?

V. Follow up at the 2month
checkup.
W. Refer to a lactation consultant.
X. Schedule a weight check-in for 1 week. 
Y. Suggest supplementing with formula.

Answer 38

X. Schedule a weight check-in for 1 week.

Question 39

During an assessment of a 4weekold infant, the primary care pediatric nurse the practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4hour the period during the night. The infant has gained 20 grams per day in the interval since last seen in the clinic. What will the nurse practitioner recommend?

V. Continuing to nurse the infant using the current pattern.
W. Nursing the infant for longer periods every 4 hours
X. Supplementing with formula at the last nighttime feeding
Y. Waking the infant every 2 hours to nurse during the night

Answer 39

V. Continuing to nurse the infant using the current pattern.

Question 40

The primary care pediatric nurse practitioner is performing a well-baby
examination on a 2 month old infant who has gained 25 grams per day in the last interval. The mother is nursing and tells the nurse practitioner that her infant seems fussy and wants to nurse more often. What will the nurse practitioner tell her?
S. She may not be making as much breastmilk as before.
T. She should keep a log of the frequency and duration of each feeding.
U. The infant may be going through an expected growth spurt.
V. The infant should stay on the previously established nursing schedule

Answer 40

U. The infant may be going through an expected growth spurt.

Question 41

The mother of a 6weekold breastfeeding infant tells the primary care pediatric
nurse practitioner that her baby, who previously had bowel movements with
each feeding now has a bowel movement once every third day. What will the nurse practitioner tell her?

T. Her baby is probably constipated.
U. It may be related to her dietary intake.
V. She should consume more water.
W. This may be normal for breastfed babies.

Answer 41

W. This may be normal for breastfed babies.

Question 42

The mother of a 3monthold the child tells the primary care pediatric nurse practitioner that it is “so much fun” now that her infant coos and smiles and wants to play. What is important for the nurse practitioner to teach this mother?
A. Appropriate ways to stimulate and entertain the infant
B. How to read the infant’s cues for overstimulation.
C. The importance of scheduling “play dates” with other infants
D. To provide musical toys to engage the infant

Answer 42

B. How to read the infant’s cues for overstimulation.

Question 43

The parent of a 5monthold is worried because the infant becomes fussy but
doesn’t always seem interested in nursing. What will the nurse practitioner
tell this parent?
P. The infant may be expressing a desire to play or to rest.
Q. The parent should give ibuprofen for teething pain before nursing.
R. This is an indication that the infant is ready for solid foods.
S. This may indicate gastrointestinal discomfort such as constipation.

Answer 43

P. The infant may be expressing a desire to play or to rest.

Question 44

The mother of a 6monthold infant is distressed because the infant can Say “dada” but not “mama” and asks the primary care pediatric nurse practitioner why this is when she is the one who spends more time with the infant. How will the nurse practitioner respond?

R. “At this age, your baby does not understand the meaning of
sounds.”
S. “Babies at this age cannot make the ‘ma’ sound.”
T.“Most sounds made by babies at this age are accidental.”
U. “This may mean that your baby doesn’t hear well.”

Answer 44

R. “At this age, your baby does not understand the meaning of sounds.”

Question 45

The primary care pediatric nurse practitioner is performing a well-child
examination on a 9month old infant whose hearing is normal but who responds to verbal cues with only single-syllable vocalizations. What will the nurse practitioner recommend to the parents to improve speech and language skills in this infant?
L. Provide educational videos that focus on language.
M. Read simple board books to the infant at bedtime.
N. Sing to the child and play lullabies in the baby’s room.
O. Turn the television to Sesame Street during the day.

Answer 45

M. Read simple board books to the infant at bedtime.

Question 46

The primary care pediatric nurse practitioner is examining a 12monthold
Infant who was 6 weeks premature and observes that the infant uses a raking motion to pick up small objects. The PEDS questionnaire completed by the parent did not show significant developmental delays. What will the nurse
practitioner do first?

G. Perform an in-depth developmental assessment.
H. Reassure the parent that this is normal for a premature infant.
I. Refer the infant to a developmental specialist.
J.Suggest activities to improve fine motor skills

Answer 46

G. Perform an in-depth developmental assessment.

Question 47

The 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?

A. Ask the child’s parents whether they read to the child.
B. Give parents educational materials to encourage speech.
C. Refer the child to an early intervention program.
D. Suggest that they purchase age-appropriate
music videos.

Answer 47

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

Question 48

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?

A. Obtain a hearing evaluation.
B. Reassure the parent that this is normal.
C. Refer the child to a speech therapist.
D. Evaluate the child’s cognitive abilities.

Answer 48

B. Reassure the parent that this is normal.

Question 49

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

A. receptive speech.
B. semantic speech.
C. telegraphic speech.
D.holophrastic speech.

Answer 49

C. telegraphic speech.

Question 50

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?

A. Children who learn two languages simultaneously often confuse them in conversation.
B. Children with Multilanguage proficiency do not understand that others
cannot do this.
C. Learning two languages at an early age prevent children from developing
a dominant language.
D. Most bilingual children are able to shift from one language to
another when
appropriate.

Answer 50

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

Question 51

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?

A. Allow the child to explore and experiment while providing appropriate limits.
B. Be present while the child plays to continually teach the child what is appropriate.
C. Let the child experiment at will and to make mistakes in order to learn.
D. Say “no” whenever the child does something that is not acceptable.

Answer 51

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

Question 52

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?
U. The child probably is very shy but will outgrow this tendency with repeated
exposure to other children.
V. The toddler may have a language delay that interferes with socialization
with other
children.
W. Toddlers may be interested in other children but usually do not
engage in
interactive play.
X. Toddlers need more structured play to encourage interaction and
socialization with others.

Answer 52

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

Question 53

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 preschool-age children?
P. Animism
Q. Artificialism
R. Egocentrism
S. Realism

Answer 53

S. Realism

Question 54

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?
N. “Begin by reading to your child about toileting.”
O. “Most children are capable by age 2 years.”
P. “Tell me about your child’s daily habits.”
Q. “We should assess your child’s motor skills.”

Answer 54

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

Question 55

The primary care pediatric nurse practitioner performs a physical examination
on a 9month old 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?
D. To begin brushing the infant’s teeth with toothpaste
E. To consider weaning the infant from breastfeeding
F. To discontinue giving fluoride supplements
G. To make an appointment for an initial dental examination.

Answer 55

G. To make an appointment for an initial dental examination

Question 56

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?
D. Allow the child to choose foods for meals to improve caloric intake.
E. Place a variety of nutritious foods on the child’s plate at each
meal.
F. Prepare mashed potatoes and chicken strips for the child at
mealtimes.
G. Suggest cutting out snacks to improve the child’s appetite at mealtimes.

Answer 56

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

Question 57

The primary care pediatric nurse practitioner is examining a 6yearold
Child who attends first grade. The child reports “hating” school. The parent
states that the child pretends to be sick frequently in order to stay home from school. To
further assess this situation, the nurse practitioner will first ask the child
E. about school performance and grades.
F. why school is so distressing.
G. to name one or two friends.
H. whether bullying is taking place.

Answer 57

G. to name one or two friends.

Question 58

The parent of a 10yearold
boy tells the primary care pediatric nurse practitioner that the child doesn’t
appear to have any interest in girls and spends most of his time with a couple of other boys. The parent is worried about the child’s sexual identity. The nurse practitioner will tell the parent
D. children at this age who prefer interactions with same-gender peers
usually have
a homosexual orientation.
E. children experiment with sexuality at this age as a means of deciding
later sexual orientation.
F. this attachment to other same-gender children is how the child
learns to interact with others.
G. to encourage mixed-gender interactions in order to promote the development of sexual values.

Answer 58

F. this attachment to other same-gender children is how the child learns to interact with others.

Question 59

The parents of a 12yearold child is concerned that some of the child’s older
classmates may be a bad influence on their child, who, they say, has been
raised to believe in right and wrong. What will the primary care pediatric nurse practitioner tell the parent?

D. Allowing the child to make poor choices and accept consequences is
important for
learning values
E. Children at this age have high regard for authority and social norms, so
this is not
likely to happen
F. Moral values instilled in the early school age
period will persist throughout childhood.
G. The pressure from outside influences may supersede parental teachings and should be confronted.

Answer 59

G. The pressure from outside influences may supersede parental teachings and should be confronted.

Question 60

During a well child exam of a schoolage child, the primary care pediatric nurse practitioner learns that the child has been having angry episodes at school. The nurse practitioner observes the child to appear withdrawn and sad. Which action is appropriate?
A. Ask the child and the parent about stressors at home.
B. Make a referral to a child behavioral specialist
C. Provide information about anger management
D. Suggest consideration of a different classroom

Answer 60

A. Ask the child and the parent about stressors at home.

Question 61

The primary care pediatric nurse practitioner is preparing to conduct a
well-child assessment of an 8yearold child. How will the nurse practitioner begin the
exam?

X. Ask the child about school, friends, home activities, and sports.
Y. Discuss the purpose of the visit and explain the procedures that will be
performed
Z. Offer age-appropriate
information about usual developmental tasks
AA. Provide information about healthy nutrition and physical activities

Answer 61

X. Ask the child about school, friends, home activities, and sports.

Question 62

The parent of a 6yearold
child expresses concern that the child may have ADHD. Which screening tool will the primary care pediatric nurse practitioner use to evaluate this possibility?
Q. Behavioral and Emotional Screening System for Children (BESS2)
R. Behavioral Assessment for Children – 2nd ed. (BASC2)
S. Conner’s 3 Parent and Teacher Rating Scale
T. Pediatric Symptom Checklist (PSC)

Answer 62

S. Conner’s 3 Parent and Teacher Rating Scale

Question 63

The parent of a 5yearold
child who has just begun kindergarten expresses concern that the child will have difficulty adjusting to the birth of a sibling. What will the primary care
pediatric nurse practitioner recommend?
A. Allowing the child opportunities to discuss feelings about the baby
B. Giving the child-specific baby care tasks to promote sibling bonding
C.Having snack time with the child each day to discuss the school
day.
D. Providing reassurance that the sibling will not replace the child

Answer 63

C.Having snack time with the child each day to discuss the school
day.

Question 64

A school-age child has begun refusing all cooked vegetables. What will the primary care pediatric nurse practitioner recommend to the parent?
A. Allow the child to make food choices since this is usually a phase
B. Ensure that the child has three nutritious meals and two nutritious snacks each
day.
C. Prepare vegetables separately for the child to encourage adequate
intake
D. Teach the child how important it is to eat healthy fruits and vegetables

Answer 64

B. Ensure that the child has three nutritious meals and two nutritious snacks each
day.

Question 65

The primary care pediatric nurse practitioner performs a physical examination on a
12yearold child and notes poor hygiene and inappropriate clothes for the
weather. The child’s mother appears clean and well dressed. The child reports getting 6 to 7 hours of sleep each night because of texting with friends late each evening. What action by the nurse practitioner will
help promote healthy practices?
A. Discuss setting clear expectations about self-care with the mother.
B. Give the child information about sleep and self-care
C. Reassure the mother that this “noncompliance”
is temporary
D. Tell the mother that experimenting with self-care behaviors is normal

Answer 65

A. Discuss setting clear expectations about self-care with the mother.

Question 66

During a well child exam on a 5yearold child, the primary care pediatric nurse practitioner assesses the child for school readiness. Which finding may be a factor in limiting school readiness for this child?
A. Adherence to daily family routines and regular activities
B. Having two older siblings who attend the same school
C. Parental concerns about bullying in the school.
D. The child’s ability to recognize four different colors

Answer 66

C. Parental concerns about bullying in the school.

Question 67

The primary care pediatric nurse practitioner is examining a school-age
child who complains of frequent stomach pain and headaches. The parent reports that the child misses several days of school each month. The child has a normal exam. Before
proceeding with further diagnostic tests, what will the nurse practitioner
initially ask the parent?
L. About the timing of the symptoms each day and during the week.
M. How well the child performs in school and in extracurricular activities
N. If the parent feels a strong need to protect the child from problems
O. Whether there are any unusual stressors or circumstances at home

Answer 67

L. About the timing of the symptoms each day and during the week.

Question 68

The primary care pediatric nurse practitioner is evaluating recurrent
stomach pain in a school-age child. The child’s exam is normal. The nurse practitioner learns that the child reports pain most evenings after school and refuses to participate in sports but does not have nausea or vomiting. The child’s grandmother recently had gallbladder surgery. Which action is correct?

A. Encourage the child to keep a log of pain, stool patterns, and
dietary intake.
B. Order radiologic studies and laboratory tests to rule out systemic
causes
C. hen symptoms
subside
D. Refer the child to a counselor to discuss anxiety about health problems

Answer 68

A.Encourage the child to keep a log of pain, stool patterns, and dietary intake.

Question 69

The primary care pediatric nurse practitioner is performing a well child
assessment on a 13yearold
female whose mother asks when her daughter’s periods may start.
Which information will the nurse practitioner use to help estimate the onset
of periods?
A. The age of the mother’s menarche
B. The patient’s age at thelarche.
C. When adrenarche occurred
D. Whether linear growth has stopped

Answer 69

B. The patient’s age at thelarche.

Question 70

The primary care pediatric nurse practitioner is examining a 15yearold
female who reports having her first period at age 13. She states that she has had five periods in the last year, with the last one 2 months prior. She participates in basketball at school. Which action is correct?
H. Perform biometric screening to determine lean body mass.
I. Prescribe oral contraceptives pills to regulate her periods.
J. Reassure her that this is perfectly normal at her age.
K. Refer her to an endocrinologist for hormonal evaluation.

Answer 70

H. Perform biometric screening to determine lean body mass.

Question 71

During a well-child assessment of a 13yearold
male, the primary care
pediatric nurse practitioner notes small testicles and pubic and axillary hair.
To further evaluate
these findings, the nurse practitioner will ask the patient about
H. alcohol and tobacco use.
I. changes in voice.
J. increase in height and weight.
K. participation in sports.

Answer 71

K. participation in sports.

Question 72

The mother of a 16yearold
male was recently divorced after several years of an abusive relationship and tells the primary care pediatric nurse practitioner that the adolescent has begun skipping school and hanging out with friends at the local shopping
mall. When she confronts her child, he responds by saying that he hates her. What will the
nurse practitioner tell
this mother?

X. Adolescence is marked by an inability to comprehend complex situations.
Y. Adolescence is typically marked by tempestuous and transient episodes.
Z. Adolescents normally have extreme, disruptive conflicts with their parents.
AA. Adolescents often need counseling to help them cope with life
events.

Answer 72

AA. Adolescents often need counseling to help them cope with life
events.

Question 73

The primary care pediatric nurse practitioner is performing a well child
exam on a 12yearold
female who has achieved early sexual maturation. The mother reports that she
spends more time with her older sister’s friends instead of her own classmates. What will the nurse practitioner tell this parent?
B. Early maturing girls need to identify with older adolescents to feel a sense of belonging.
C. Girls who join an older group of peers may become sexually
active at an earlier age.
D. Spending time with older adolescents indicates a healthy adjustment to
her maturing body.
E. The association with older adolescents will help her daughter
to gain social maturity

Answer 73

C. Girls who join an older group of peers may become sexually
active at an earlier
age.

Question 74

The mother of a 15yearold
adolescent female tells the primary care the pediatric nurse practitioner that her daughter has extreme mood swings prior to her periods, which the adolescent vehemently denies. When asked if she notices anything different just before her periods, the adolescent points to her mother and says, “She gets really hard
to live with.” This demonstrates which characteristic of adolescent thinking?
R. Apparent hypocrisy
S. Imaginary audience
T. Overthinking
U. Personal fable

Answer 74

R. Apparent hypocrisy

Question 75

The primary care pediatric nurse practitioner is performing an exam on an
adolescent male who asks about sexual identity because of concern that a
friend is worried about being gay. Which response will the nurse practitioner make in this situation?
W. Provide the teen with a questionnaire to gain information about his
sexuality.
X. Remind the adolescent that mandatory reporting requires disclosure to
parents.
Y. Suggest that the adolescent discuss sexual concerns with his parents.
Z. Tell the adolescent that, unless he is at risk, what he says will be
confidential.

Answer 75

Z. Tell the adolescent that, unless he is at risk, what he says will be
confidential.

Question 76

The parent of a 14yearold child tells the primary care pediatric nurse practitioner that the child skips classes frequently in spite of various
disciplinary measures, such
as grounding and extra homework and is earning Cs and Ds in most classes.
What will the nurse
practitioner recommend?
C. Counseling for emotional problems
D. Development of an Individual Education Plan
E. Evaluation for possible learning disorders.
F. Referral for a behavioral disorder

Answer 76

E. Evaluation for possible learning disorders.

Question 77

The parent of a 14yearold
child tells the primary care pediatric nurse practitioner that the adolescent has expressed a desire to be a vegetarian, is refusing all meat served at home, and wants the family to eat vegetarian meals. What will the nurse practitioner tell the parent?
U. Do not allow a vegetarian diet in order to maintain appropriate limits for
the adolescent.
V. Provide vegetarian options for the adolescent that preserve adequate
nutrition and protein intake.
W. Suggest that the adolescent prepare appropriate vegetarian
dishes to complement
family meals.
X. Tell the adolescent that a vegetarian diet may be considered in
adulthood but not while living at home.

Answer 77

W. Suggest that the adolescent prepare appropriate vegetarian
dishes to complement
family meals.

Question 78

The primary care pediatric nurse practitioner is performing a well-child
exam on a 17yearold
female whose mother is present during the history. The mother expresses
concern that her daughter wishes to have an eyebrow piercing and states that she is opposed to the idea.
What will the nurse practitioner do?
V. Provide information about piercings and encourage continued
discussion.
W. Remind the adolescent that her mother is responsible for her health.
X. State that piercings are relatively harmless and are an expression of
individuality.
Y. Suggest that she wait until she is 18 years old and can make her own
decisions.

Answer 78

V. Provide information about piercings and encourage continued discussion.

Question 79

The parent of a 16yearold
tells the primary care pediatric nurse practitioner
that the teen was recently caught smoking an electronic cigarette
(cigarette). What will the nurse practitioner tell this parent?
P. Ecigarette use may be a risk factor for later substance abuse.
Q. Experimentation with e-cigarettes does not lead to future tobacco use.
R. Most teens who experiment with tobacco usually do not become addicted.
S. This form of nicotine ingestion is safer than regular cigarettes.

Answer 79

P. Ecigarette use may be a risk factor for later substance abuse.

Question 80

The parent of an adolescent report noting cutting marks on the teen’s arms
and asks the primary care pediatric nurse practitioner what it means. What will the nurse practitioner tell this parent?
J. Cutting is a way of dealing with emotional distress.
K. It is a method of fitting in with other adolescents.
L. The behavior is common and will usually stop.
H. This type of behavior is a type of suicide attempt.

Answer 80

J. Cutting is a way of dealing with emotional distress.

Question 81

The primary care pediatric nurse practitioner is performing a focused
problem assessment on a child who has asthma and learns that one of the child’s
parents smokes around the child in spite of being advised against this. The nurse practitioner recognizes this as a possible
alteration in which functional health pattern?
A. Cognitiveperceptual
B. Health perception
C. Role relationship
D. Valuesbeliefs

Answer 81

B. Health perception

Question 82

The primary care pediatric nurse practitioner examines an infant whose weight is
below the 3rd percentile and whose mother does not comply with the feeding
regimen. When attempting to enlist the help of the infant’s grandmother, the
grandmother says, “My daughter was like this when she was a baby and she
turned out all right.” Which approach will the nurse practitioner take to
improve the outcome for this infant?

L. Ask the grandmother about her daughter’s health during childhood.
M. Explain that the condition is potentially serious if not treated.
N. Give the grandmother and mother information about normal growth.
O. Refer the family to a social worker to investigate possible neglect.

Answer 82

L. Ask the grandmother about her daughter’s health during childhood.

Question 83

The primary care pediatric nurse practitioner provides patient teaching for
children newly diagnosed with irritable bowel syndrome (IBS). At which stage of development will
children be able to understand the link between stress and the symptoms of
the disease
A. Concrete operational stage
B. Formal operational stage
C. Pre-conceptual stage
D. Sensorimotor stage

Answer 83

B. Formal operational stage

Question 84

The primary care pediatric nurse practitioner is counseling an obese
adolescent whose parents both have type 2 diabetes mellitus. Which health behavior prediction model is useful when the nurse practitioner discusses lifestyle changes with this client?
A. Behavioral change model
B. Health belief model
C. Health promotion model
D. Transtheoretical model

Answer 84

B. Health belief model

Question 85

The primary care pediatric nurse practitioner is counseling a school-age
child about asthma management strategies. The child states that it is “too much trouble” to remember to use an inhaled corticosteroid medication twice daily and reports feeling fine, in spite of exhibiting expiratory wheezes. Which action uses the health belief and self-efficacy model to teach this child about asthma management?
F. Asking the child to try to use the inhaler at least once daily
G. Discussing whether the child wants to participate in athletics
H. Obtaining pre and posttreatment spirometry testing
I. Providing written information about inhaled corticosteroids

Answer 85

H. Obtaining pre and post-treatment spirometry testing.

Question 86

An adolescent who is overweight expresses a desire to lose weight in order
to participate in sports but tells the primary care pediatric nurse practitioner
that he doesn’t want to
give up sweets and soft drinks because he enjoys them too much. Which
stage of change does
this represent?
A. Action
B. Contemplation
V. Precontemplation
W. Preparation

Answer 86

B. Contemplation

Question 87

The primary care pediatric nurse practitioner sees a 17-year-old client who quit
smoking almost a year prior but who reports having renewed cravings when
around friends who smoke. Using knowledge of the maintenance stage of change, the primary
care pediatric nurse
practitioner will

A. go over with the adolescent about the health risks associated with
smoking.
B. recommend avoiding friends who smoke and making new friends.
C. remind the adolescent about the struggles associated with quitting
smoking.
D. suggest that the teen consider taking up a sport or other
physical activity.

Answer 87

D. suggest that the teen consider taking up a sport or other physical activity.

Question 88

The primary care pediatric nurse practitioner is working with a 12yearold female
who has poor diabetes control. The child tells the nurse practitioner that the
parent forgets to remind her to check her blood sugars. Which action is correct?

E. Assess the parent’s knowledge about diabetes management.
F. Help the child develop a strategy to remember without parental
prompts.
G. Refer to a social worker to help the family overcome obstacles to care.
H. Remind the child’s parent about the importance of good diabetes
control.

Answer 88

F. Help the child develop a strategy to remember without parental prompts.

Question 89

The primary care pediatric nurse practitioner is counseling an obese
16yearold client about weight management. The adolescent says, “I know I need to lose weight, but I don’t want to give up all my favorite foods.” When using motivational interviewing
techniques, how will the nurse practitioner respond?

A. “Do you think there are any foods you could limit or do without
for a while?”
B. “I hear you telling me that you really don’t have a desire to lose weight.”
C. “If you can’t give up these foods, you won’t see the benefits of weight
loss.”
D. “In the long run, the sacrifices you make today will improve your
health.”

Answer 89

A. “Do you think there are any foods you could limit or do without for a while?”

Question 90

The parent of a newborn has quit smoking cigarettes within the past month and
reports feeling fidgety. Using a “reframing” technique, how will the primary care pediatric
nurse practitioner respond?
A. Explore ways that the parent can use this extra energy to do things for the
baby.
B. Remind the parent that this is a normal, temporary part of nicotine
withdrawal.
C. Suggest that the parent take up exercise to enjoy the benefits of not
smoking.
D. Tell the parent that, over time, these symptoms of withdrawal will subside.

Answer 90

A. Explore ways that the parent can use this extra energy to do things for the
baby.

Question 91

The primary care pediatric nurse practitioner is assessing the health
literacy of the parent of a toddler. Which tool will the nurse practitioner use to estimate reading level?
A. Flesch-Kincaid
Readability Test
B. Gunning Fog Index
C. Number of children’s books in the home
D. SMOG

Answer 91

D. SMOG

Question 92

The pediatric nurse practitioner provides primary care for a special
needs infant whose parent takes an active role in the infant’s care. The parent has a high school diploma and
asks many questions about her infant’s treatments. Which approach will the
nurse practitioner take
to ensure health literacy for this parent?
M. Ask the parent to read back all information given.
N. Encourage the parent to ask questions when confused.
O. Provide written materials presented at an 8th-grade level.
P.Reinforce written information with verbal instructions.

Answer 92

M. Ask the parent to read back all information given.

Question 93

A child who has attention-deficit/ 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 self-regulation component of
M. emotional control.
N. flexibility.
O. inhibition.
P. problem-solving.

Answer 93

N. flexibility.

Question 94

The primary care pediatric nurse practitioner cares for a preschool-age 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
P. executive function.
Q. information processing.
R. sensory processing.
S. social cognition.

Answer 94

P. executive function

Question 95

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
N. about friends and activities at school.
O. if balancing sports and homework is difficult.
P. to interpret material from a pie chart.
Q. to restate the content of something just read.

Answer 95

N. about friends and activities at school.

Question 96

The primary care pediatric nurse practitioner is evaluating a school-age
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?
A. 504
B. FAPE
C. IDEA
D. IEP

Answer 96

A. 504

Question 97

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?

e. Activation
f. Effort
g. Emotion
h. Focus

Answer 97

e. Activation

Question 98

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?

a. Lowdose stimulant
b. Moderate dose stimulant
c. Low-dose non stimulant
d. Moderate dose non-stimulant

Answer 98

b. Moderate dose stimulant

Question 99

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?

a. Dyspraxia
b. Over-responder
c. Sensory seeker
d. Underresponder

Answer 99

b. Over-responder

Question 100

The parent of a preschool-age 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?

a. Establishing a reward system for acceptable behaviors
b. Introducing the child to a variety of new experiences
c. Maintaining predictable routines as much as possible
d. Providing frequent contacts, such as hugs and cuddling

Answer 100

c. Maintaining predictable routines as much as possible

Question 101

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?
a. Administer an MCHAT screen to screen the child for communication and
socialization delays.
b. Ask the parent to describe the child’s earlier behaviors from infancy through preschool.
c. Reassure the parent that if symptoms weren’t present earlier, the likelihood of autism is low.
d. Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management.

Answer 101

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

Question 102

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?

a. Attention-deficit/hyperactivity disorder
b. Autism spectrum disorder
c. Executive function disorder
d. Sensory processing disorder

Answer 102

b. Autism spectrum disorder

Question 103

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?

a. A low-dose stimulant medication
b. A non-stimulant medication
c. Behavioral therapy only
d. Cardiovascular prescreening

Answer 103

d. Cardiovascular prescreening

Question 104

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?

a. Adding an alphaagonist medication
b. Changing to a non-stimulant medication
c. Continuing the medication as prescribed
d. Stopping the medication immediately

Answer 104

c. Continuing the medication as prescribed

Question 105

The primary care pediatric nurse practitioner provides anticipatory guidance for a 6-month-old infant who is breastfed who takes 400 IU of vitamin D daily. The parent reports that the infant has begun taking cereals, fruits, and vegetables in addition to nursing. What will the nurse practitioner recommend to promote healthy nutrition?

A. Begin supplementing with iron.

B. Continue to nurse as long as desired.

C. Discontinue the vitamin D supplement.

D. Stop breastfeeding at 1 year of age.

Answer 105

B. Continue to nurse as long as desired.

Question 106

The parent of a toddler tells the primary care pediatric nurse practitioner that the family has adopted a plant-based diet and the child is receiving rice and almond milk instead of cow’s milk. The nurse practitioner will counsel the parents about

A. calcium deficiency.

B. excess caloric intake.

C. excess fat intake.

D. protein deficiency.

Answer 106

D. protein deficiency.

Question 107

The parent of a 12monthold infant asks the primary care pediatric nurse practitioner why 2% cow’s milk is recommended instead of whole milk. What will the nurse practitioner tell this parent?

A. Whole milk is usually not fortified with vitamin D.

B. 2% milk is higher in essential proteins and minerals.

C. Young children don’t need the extra calories found in whole milk.

D. Younger children need a limited amount of fats.

Answer 107

D. Younger children need a limited amount of fats.

Question 108

The primary care pediatric nurse practitioner sees a 3yearold child whose parents report is a picky eater in spite of their continued efforts to provide nutritious meals. The parents ask whether a multivitamin is necessary. How will the nurse practitioner respond?

A. Ask the parents to provide a 3day food diary.

B. Prescribe a daily multivitamin with iron.

C. Reinforce the need to meet DRIs each day.

D. Tell them that supplements are unnecessary

Answer 108

A. Ask the parents to provide a 3day food diary.

Question 109

The primary care pediatric nurse practitioner is examining a toddler who is below the 3rd percentile for weight even though the parents claim that the child eats “constantly.” What will the nurse practitioner do initially?

A. Evaluate the child’s feeding and elimination behaviors and ask the family to describe mealtime routines.

B. Recommend giving a multivitamin and offering high calorie foods, such as ice cream.

C. Refer the child to a feeding evaluation clinic for a swallow study and evaluation of possible GERD.

D. Suggest that the parents supplement the child’s food intake with a high calorie formula.

Answer 109

A. Evaluate the child’s feeding and elimination behaviors and ask the family to describe mealtime routines.

Question 110

The mother of a 6yearold child tells the primary care pediatric nurse practitioner that the child only wants to eat French fries and hamburgers and refuses most vegetables. What will the nurse practitioner recommend?

A. Giving the child a multivitamin since this is a phase

B. Having the child eat vegetables before getting the hamburger

C. Providing a variety of healthy foods at each meal

D. Putting extra lettuce and tomatoes on hamburgers

Answer 110

C. Providing a variety of healthy foods at each meal

Question 111

The parents of a toddler tell the primary care pediatric nurse practitioner that they get frustrated trying to get the child to eat any vegetables other than squash and carrots. What will the nurse practitioner recommend?

A. Continue to offer a variety of foods without forcing the child to eat them.

B. Offer snacks to make up for calories the child misses by not eating the vegetables.

C. Prepare dishes the child likes to ensure that a vegetable is eaten at each meal.

D. Require the child to take 1 to 2 bites of each food at each meal.

Answer 111

A. Continue to offer a variety of foods without forcing the child to eat them.

Question 112

The primary care pediatric nurse practitioner is providing anticipatory guidance to the mother of a breastfed 6month old infant who asks about “baby-led weaning.” What will the nurse practitioner tell her about this practice?

A. “Foods given for this purpose do not meet all the child’s nutritional needs.”

B. “Giving infants control of the feeding process will help prevent obesity.”

C. “Infants are given soft, mashable table foods when able to selffeed.”

D. “Infants must be able to grasp and feed themselves from a spoon to do this.”

Answer 112

C. “Infants are given soft, mashable table foods when able to self-feed.”

Question 113

The primary care pediatric nurse practitioner is performing a well child examination on a 15yearold girl who consumes a vegan diet. Based on this assessment, which nutrients may this adolescent need to supplement?

A. Calcium, vitamin C, and vitamin A

B. Iron, folic acid, and B12

C. Magnesium, vitamin E, and zinc

D. Vitamin D, vitamin C, and phosphorus

Answer 113

B. Iron, folic acid, and B12.

Question 114

The primary care pediatric nurse practitioner is evaluating a school-age child who, after removal of a pituitary tumor, has altered hypothalamic control over hunger and satiety. The child is morbidly obese and expresses feeling depressed because of the obesity. What will the nurse practitioner recommend?

A. Developing a system to reward compliance with a dietary regimen

B. Restricting all access to food in the house and at school

C. Suggesting an afterschool exercise program to help with weight loss

D. Using a food diary to track all calories and food intake

Answer 114

B. Restricting all access to food in the house and at school

Question 115

When counseling an adolescent with a family history of hyperinsulinemia and type 2 diabetes, the primary care pediatric nurse practitioner will recommend avoiding

A. baked potato chips.

B. canned vegetables.

C. highfiber cereals.

D. processed breads.

Answer 115

D. processed breads.

Question 116

The parent of a school-age child reports that the child is on a gluten-free diet. When questioned about the reason for this diet, the parent states that the child has had fewer stomach aches since beginning the diet but has never been diagnosed with celiac disease. The parent reports using gluten free grain products for all family members. The nurse practitioner will tell this parent that gluten free diets

A. are generally low in sugar and fat.

B. are healthy and help prevent obesity.

C. may be deficient in essential nutrients.

D. provide adequate protein to meet daily needs.

Answer 116

C. may be deficient in essential nutrients.

Question 117

The primary care pediatric nurse practitioner performs a well-child assessment on a 6monthold infant whose mother reports having less breast milk because of stressors associated with pumping and returning to work. The nurse practitioner will provide resources to promote pumping and

a. discuss adding other foods to the baby’s diet.
b. encourage the mother to increase her fluid intake.
c. prescribe a multivitamin containing iron.
d. suggest offering only breast milk to the infant.

Answer 117

a. discuss adding other foods to the baby’s diet.

Question 118

The mother of a newborn asks the primary care pediatric nurse practitioner about the benefits of breastfeeding. What will the nurse practitioner tell her?

a. Breastfeeding for 9 months or longer will reduce the incidence of food allergies.
b. Breast milk is an excellent source of vitamin D, iron, and other essential nutrients for the baby.
c. Nursing her baby exclusively for at least 4 months will help her infant to resist infections.
d. There is a decreased risk of atopic dermatitis in babies who nurse for 12 months or longer.

Answer 118

c. Nursing her baby exclusively for at least 4 months will help her infant to resist infections.

Question 119

The primary care pediatric nurse practitioner learns that the mother of a newborn infant is being tested for tuberculosis after a positive TB skin test. What will the nurse practitioner tell the mother who states a desire to breastfeed her baby?

a. Breast milk is contraindicated if the mother has tuberculosis.
b. She may continue to nurse her baby since the risk of transmission is low.
c. That she can express breast milk and feed that to her infant
d. To give formula until results of tuberculosis testing are known

Answer 119

c. That she can express breast milk and feed that to her infant

Question 120

The primary care pediatric nurse practitioner sees a 3dayold nursing infant whose newborn metabolic screen is positive for galactosemia. The nurse practitioner refers the newborn to a specialist for immediate evaluation and will tell the mother

a. to continue to breastfeed her infant.
b. to give the infant a cow’s milk formula.
c. to supplement breast milk with formula.
d. to stop breastfeeding immediately.

Answer 120

d. to stop breastfeeding immediately.

Question 121

The mother of a nursing infant expresses concern about whether highcholesterol foods will increase her infant’s risk of hyperlipidemia. What will the primary care pediatric nurse practitioner tell her?

a. Breastfed infants have lower serum cholesterol levels than those who are not breastfed.
b. Maternal cholesterol levels affect the cardiovascular risk of breastfed babies.
c. Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol values.
d. She should limit her dietary cholesterol to prevent hyperlipidemia in her infant.

Answer 121

c. Maternal dietary cholesterol intake does not affect the infant’s serum cholesterol values.

Question 122

The primary care pediatric nurse practitioner is counseling the mother of a newborn about breastfeeding her infant. Which supplements will the nurse practitioner recommend?

a. Fatsoluble vitamins
b. Iron
c. Multivitamins with iron
d. Vitamin D

Answer 122

d. Vitamin D

Question 123

The primary care pediatric nurse practitioner is examining a newborn who is breastfeeding and notes the presence of an ankyloglossia. What will the nurse practitioner do next?

a. Ask the mother if the infant has any feeding difficulties.
b. Refer the infant for a possible frenulectomy.
c. Schedule an appointment with a lactation consultant.
d. Suggest that the mother feed breast milk by bottle.

Answer 123

a. Ask the mother if the infant has any feeding difficulties.

Question 124

The primary care pediatric nurse practitioner performs an initial well-baby exam on a 1weekold infant who is breastfeeding and who is at birth weight. The mother tells the nurse practitioner that her baby is already sleeping 5 or 6 hours at night. What will the nurse practitioner recommend?

a. Consultation with a lactation specialist to assess intake
b. Pumping her breast during the night to maintain milk supply
c. Supplementing the last feeding of the day with formula
d. Waking the infant up at least every 3 hours to nurse

Answer 124

d. Waking the infant up at least every 3 hours to nurse

Question 125

The mother of a newborn infant asks the primary care pediatric nurse practitioner about pumping her breasts when she returns to work in 2 months. What will the nurse practitioner include in teaching this mother?

a. Frozen breast milk may be stored up to 3 months in a 0° F freezer.
b. Once she begins pumping the infant should drink only pumped breast milk.
c. Pumped breast milk must be discarded after 3 days when stored in the refrigerator.
d. Unused defrosted breast milk may be stored in the refrigerator for 48 hours.

Answer 125

a. Frozen breast milk may be stored up to 3 months in a 0° F freezer.

Question 126

The mother of a 2monthold infant tells the primary care pediatric nurse practitioner that she is afraid her breast milk is “drying up” because her baby never seems satisfied and wants to nurse all the time. Which action is correct?

a. Recommend pumping her breasts after feedings.
b. Refer the mother to a lactation consultant.
c. Suggest supplementation with formula.
d. Weigh the infant to assess for a growth spurt.

Answer 126

d. Weigh the infant to assess for a growth spurt.

Question 127

The mother of a 15monthold infant tells the primary care pediatric nurse practitioner that she wishes to continue nursing her child for another year, if possible. What will the nurse practitioner recommend?

a. Breastfeed only at bedtime to establish meal patterns.
b. Clean the toddler’s teeth each time after breastfeeding.
c. Offer the breast just prior to meals to maintain milk supply.
d. The toddler should continue to be breastfed “on demand.”

Answer 127

b. Clean the toddler’s teeth each time after breastfeeding.

Question 128

The primary care pediatric nurse practitioner is performing an assessment on a 1weekold newborn with slightly elevated bilirubin who is breastfeeding well and who has gained 30 grams in the past 24 hours. The infant is stooling and voiding well. The nurse practitioner suspects breast milk jaundice. Which action is correct?

a. Order home phototherapy and closely monitor bilirubin levels.
b. Reassure the mother that the bilirubin level will drop in a few days.
c. Recheck the serum bilirubin and infant’s weight in 24 hours.
d. Recommend that the mother pump her breast milk for a couple of days.

Answer 128

c. Recheck the serum bilirubin and infant’s weight in 24 hours.

Question 129

The primary care pediatric nurse practitioner is performing a well child exam on a 4monthold infant who is nursing exclusively. The mother reports that the infant has had a marked decrease in the number of stools each day, from 3 to 5 stools each day to only one stool every other day. How will the nurse practitioner respond?

a. Ask the mother to describe the color and consistency of the stools.
b. Explain to the mother that breastfed infants should have daily stools.
c. Recommend using a glycerin suppository as needed.
d. Suggest to the mother that she increase her intake of fluids.

Answer 129

a. Ask the mother to describe the color and consistency of the stools.

Question 130

The primary care pediatric nurse practitioner is performing a well-child exam on a 12monthold infant. The parent tells the nurse practitioner that the infant has predictable bowel and bladder habits and asks about toilet training. What will the nurse practitioner tell this parent?

a. It is too early to begin introducing the child to the toilet, and the parent should wait until the child is at least 2 years old.
b. Placing the child on a “potty” chair helps the child associate elimination cues with the toilet.
c. Predictability of elimination patterns indicates readiness for toilet training, and the parent can begin this process.
d. The parent should wait until other signs of toilet training readiness occur before introducing the child to the toilet.

Answer 130

b. Placing the child on a “potty” chair helps the child associate elimination cues with the toilet.

Question 131

The primary care pediatric nurse practitioner is performing a well child exam on a 24monthold child. The parent tells the nurse practitioner that the child is being toilet trained and expresses frustration that on some days the child uses the toilet every time and on other days not at all. What will the nurse practitioner do?

a. Advise the parent to make the child get clean clothes after an accident.
b. Ask the parent about the child’s toilet habits and understanding of toilet training.
c. Recommend using an awards system to encourage toilet use.
d. Suggest that the parent place the child on the toilet at predictable intervals

Answer 131

b. Ask the parent about the child’s toilet habits and understanding of toilet training

Question 132

The primary care pediatric nurse practitioner is discussing toileting issues with the parent of a 3yearold toddler who reports that the child has been toilet trained for several months but has recently been refusing to have bowel movements and is becoming constipated. What will the nurse practitioner do?

a. Ask the parent about bathroom facilities in the child’s daycare.
b. Refer the child to a gastroenterologist for evaluation of pathology.
c. Suggest putting the child in diapers and resuming toilet training in a few weeks.
d. Tell the parent that this represents a developmental delay.

Answer 132

a. Ask the parent about bathroom facilities in the child’s day care.

Question 133

The primary care pediatric nurse practitioner is evaluating a 5yearold child who has frequent soiling of stool associated with stomach aches and decreased appetite for the past 2 months. The parent states that the child has two or fewer formed bowel movements each week and has been toilet trained for about 2 years. Which initial assessment will the nurse practitioner make?

a. History of neurogenic conditions
b. Recent adjustments in the family
c. Recent illnesses, fluid intake, changes in diet
d. Toilet training history

Answer 133

c. Recent illnesses, fluid intake, changes in diet

Question 134

The primary care pediatric nurse practitioner is managing a 6yearold child who has chronic constipation and encopresis. The nurse practitioner has ruled out neurogenic etiology. The parents report that the child was difficult to toilet train as a toddler. What is key to managing this child’s condition

a. Encouraging use of maintenance medications for at least 2 months after resolution of constipation
b. Referral to a mental health consultant to manage problems in the parent-child dyad
c. Spending time with the parents to uncover their feelings about their child’s condition
d. Teaching the parents that the symptom of stool retention is often voluntary for the child

Answer 134

a. Encouraging use of maintenance medications for at least 2 months after resolution of constipation

Question 135

The parent of a 5yearold child tells the primary care pediatric nurse practitioner that the child has been using the toilet to urinate for since age 3 but continues to defecate in “pullups.” The nurse practitioner learns that the child has predictable bowel movements and a physical examination is normal. What will the nurse practitioner recommend?

a. Providing a reward system to offer incentives when the child uses the toilet
b. Put the child back in diapers and resume toilet training in a few months.
c. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation
d. Use of polyethylene glycol until the child is able to use the toilet regularly

Answer 135

c. Putting the child on the toilet for 5 to 10 minutes at the usual time of defecation

Question 136

The primary care pediatric nurse practitioner evaluates a 4yearold girl whose parent reports frequent urination in the evenings on weekdays, incontinence after voiding. The parent reports that the child has soft-formed stools 5 or 6 times weekly. Which assessment will the nurse practitioner make initially?

a. Examination for labial adhesions
b. Palpation for abdominal masses
c. Screening for potential child abuse. Urine culture and sensitivity

Answer 136

a. Examination for labial adhesions

Question 137

The primary care pediatric nurse practitioner is concerned that a toddler may have vesicoureteral reflux based on a history of dysfunctional voiding patterns and a series of urinary tract infections. Which intervention is appropriate?

a. Initiating a bladder retraining program
b. Ordering a voiding cystourethrogram
c. Referral to a urologist for evaluation
d. Treatment with prophylactic antibiotics

Answer 137

c. Referral to a urologist for evaluation

Question 138

The primary care pediatric nurse practitioner is evaluating a 4yearold female child for enuresis. The parents reports that the child has never been dry at night and has recently begun having daytime incontinence, usually when at preschool. The nurse practitioner learns that the child does not appear to have an abnormal urine stream. What will the nurse practitioner do next?

a. Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis
b. Reassure the parent that the child probably gets distracted and puts off voiding until it is urgent.
c. Refer the child to a pediatric urologist for evaluation of possible vesicoureteral reflux.
d. Suggest a bladder retraining program and use of a nighttime bedwetting alarm.

Answer 138

a. Examine the urethral meatus and labia and obtain a dipstick clean catch urinalysis.

Question 139

The primary care pediatric nurse practitioner is counseling the parent of an 8yearold child who has primary nocturnal enuresis. The nurse practitioner recommends an enuresis alarm, but the parent wishes to use medication. What will the nurse practitioner tell the parent?

a. Anticholinergic medications are most commonly used for enuresis.
b. Drug therapy is an effective way to achieve long-term control.
c. Drug therapy is safest when the nasal spray form is used.
d. The combination of alarm therapy and intermittent drug therapy.

Answer 139

d. The combination of alarm therapy and intermittent drug therapy.

Question 140

The primary care pediatric nurse practitioner counseling the parent of an overweight school-age child about improving overall fitness. What will the nurse practitioner include?

a. Encourage the child to begin by engaging in swimming or cycling.
b. Exercise will help lower total cholesterol and low-density lipoproteins.
c. Schoolage children need 60 minutes of moderate exercise daily.
d. Strength training exercises are not safe for schoolage children.

Answer 140

a. Encourage the child to begin by engaging in swimming or cycling.

Question 141

The parent of a child who has asthma asks the primary care pediatric nurse practitioner about whether the child may engage in strenuous exercise. What will the nurse practitioner tell the parent?

a. Children with asthma should be excluded from vigorous exercise and most strenuous sports.
b. Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity.
c. Physical activity has been shown to improve overall pulmonary function in children with asthma.
d. Vigorous exercise helps improve symptoms in children with poorly controlled asthma.

Answer 141

b. Children with asthma show improved aerobic and anaerobic fitness with moderate to vigorous/physical activity.

Question 142

The primary care pediatric nurse practitioner is discussing lifestyle changes with an adolescent who has hypertension. What will the nurse practitioner recommend about exercise for this client?

a. Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure
b. Moderate daily exercise such as walking for 20 minutes daily with increasing intensity as blood pressure drops
c. Vigorous aerobic exercise combined with maximal strength training to lower blood pressure
d. Vigorous aerobic exercise only to reduce blood pressure and then to maintain lowered blood pressure

Answer 142

a. Regular to vigorous activity initially with a combination of resistance and aerobic exercise to maintain lower blood pressure.

Question 143

The PCP is offering anticipatory guidance to the parents of a 6-year-old child who has down syndrome. what will the PCP recommend about exercise?

a. children with down syndrome get frustrated easily when engaging in sports
b. children with down syndrome should not participate in strenuous aerobic activity
c. their child should have a cervical spine evaluation before participation in sports
d. their child should. only participate in sports sanctioned by the special olympics

Answer 143

c. Their child should have a cervical spine evaluation before participation in sports.

Question 144

The primary care pediatric nurse practitioner is discussing fitness and exercise with the parents of a 5yearold child who ask what kinds of activities are developmentally appropriate for their child. What will the nurse practitioner recommend?

a. Bike riding
b. Interactive play
c. Martial arts
d. Organized sports

Answer 144

a. Bike riding

Question 145

The parents of a prepubertal female who is on the local swim team tell the primary care pediatric nurse practitioner that their daughter wants to begin a strength training program to help improve her swimming ability. What will the nurse practitioner recommend?

a. Avoiding strength training programs until after puberty to minimize the risk for injury
b. Enrolling their daughter in a program that uses fixed weight machines or resistance bands
c. Having their daughter participate in weight training 4 or 5 times each week for maximum effect
d. Making sure that their daughter begins with the greatest weight tolerable using lower repetitions

Answer 145

b. Enrolling their daughter in a program that uses fixed weight machines or resistance bands

Question 146

The parent of a 14yearold child asks the primary care pediatric nurse practitioner how to help the child prevent injuries when basketball tryouts begin later in the school year. Which recommendation will be of most benefit?

a. Preseason conditioning
b. Proper footwear
c. Protective knee braces
d. Stretching before practices

Answer 146

a. Preseason conditioning

Question 147

The primary care pediatric nurse practitioner is counseling a parent about bicycle helmet use. The parent reports having a helmet used a year previously by an older child and wonders about using it for a younger child since they are so expensive. What will the nurse practitioner tell the parent?

a. “As long as the helmet does not have cracks, you may use it.”
b. “If the helmet is free from marks, you may use it.”
c. “You may continue to use a helmet up to 10 years.”
d. “You should always purchase a new helmet for each child.”

Answer 147

b. “If the helmet is free from marks, you may use it.”

Question 148

The primary care pediatric nurse practitioner is performing a well child examination on a high school age adolescent who plays football who has hypercalciuria. Which dietary supplement will the nurse practitioner question the adolescent about?

a. Protein supplements
b. Salt tablets
c. Sports drinks
d. Vitamin C

Answer 148

a. Protein supplements

Question 149

The primary care pediatric nurse practitioner is performing a preparticipation sports physical examination on a 14yearold male who will be on the wrestling team at school. What will the nurse practitioner include when discussing healthy practices with this adolescent?

a. Risks associated with repeatedly losing and gaining weight
b. The need for an electrocardiogram or echocardiogram prior to participation
c. The need to consume 20 to 30 grams of protein after exercise
d. To consume water with CHO prior to activity lasting up to an hour

Answer 149

a. Risks associated with repeatedly losing and gaining weight

Question 150

The primary care pediatric nurse practitioner is evaluating a heart murmur during a preparticipation examination of a high school athlete. Which finding would be a concern requiring referral to a cardiologist?

a. A murmur that is louder when squatting and softer when standing
b. A murmur that is quieter when squatting and louder with a Valsalva maneuver
c. A murmur with narrow and variable splitting of S2
d. A systolic murmur that is grade 1 or 2

Answer 150

b. A murmur that is quieter when squatting and louder with a Valsalva maneuver

Question 151

The parent of a 12yearold child who has sickle cell trait (SCT) asks the primary care pediatric nurse practitioner whether the child may play football. What will the nurse practitioner tell this parent?

a. Children with SCT should not play any contact sports.
b. Children with SCT may not play for NCAA schools in college.
c. Children with SCT should follow heat acclimatization guidelines.
d. Children with SCT should not participate in organized sports.

Answer 151

c. Children with SCT should follow heat acclimatization guidelines.

Question 152

The parent of a child newly diagnosed with epilepsy asks the primary care pediatric nurse practitioner if the child will ever be able to participate in gym or sports. What will the nurse practitioner recommend?

a. Bicycle riding is not safe for children with seizures.
b. Contact sports should be avoided.
c. Direct supervision of some activities is necessary.
d. Underwater sports are not recommended.

Answer 152

c. Direct supervision of some activities is necessary.

Question 153

The primary care pediatric nurse practitioner diagnoses a high school basketball player with mononucleosis. The adolescent asks when she may resume play. What will the nurse practitioner tell her?

a. After 3 weeks, she may begin lifting weights but not full sports.
b. After 4 weeks, she may return to full play and practice.
c. At 4 weeks, she must have an exam to determine fitness for play.
d. She may engage in moderate exertion and practice after 3 weeks.

Answer 153

c. At 4 weeks, she must have an exam to determine fitness for play.

Question 154

A 12yearold child who plays soccer is diagnosed with vocal cord dysfunction. What will the primary care nurse practitioner say when the child’s parents ask about continued sports participation?

a. The child may continue to participate in soccer.
b. The child should limit activity to nonaerobic sports.
c. This condition is a contraindication for all sports.
d. This condition predisposes the child to sudden cardiac death.

Answer 154

a. The child may continue to participate in soccer.

Question 155

The parent of a high school basketball player tells the primary care pediatric nurse practitioner that the adolescent becomes short of breath only when exercising. What will the nurse practitioner recommend?

a. Permanent discontinuation of all strenuous and aerobic activities
b. Enrollment in a conditioning program to improve performance
c. Evaluation for underlying cardiac causes of this symptom.
d. Treatment for exerciseinduced asthma with a bronchodilator

Answer 155

c. Evaluation for underlying cardiac causes of this symptom.

Question 156

A 10yearold is hit in the head with a baseball during practice and is diagnosed with a concussion, even though no loss of consciousness occurred. The primary care pediatric nurse practitioner is evaluating the child 2 weeks after the injury and learns that the child is still experiencing some sleepiness every day. The neurological exam is normal. The child and the parent are adamant that the child be allowed to return to play baseball. What will the nurse practitioner recommend?

a. Continuation of cognitive rest only
b. Continuation of physical and cognitive rest
c. Continuation of physical rest only
d. Returning to play

Answer 156

b. Continuation of physical and cognitive rest

Question 157

A 15yearold female basketball player who has secondary amenorrhea is evaluated by the primary care pediatric nurse practitioner who notes a BMI in the 3rd percentile. What will the nurse practitioner counsel this patient?

a. That amenorrhea in female athletes is not concerning
b. That she should begin a program of plyometrics and strength training
c. To consider a different sport, such as volleyball
d. To work with a dietician to improve healthy weight gain

Answer 157

d. To work with a dietician to improve healthy weight gain

Question 158

The primary care pediatric nurse practitioner is examining a 17yearold male who is on his high school swim team. The adolescent is concerned about “lumps” on his chest. The nurse practitioner notes a marked increase in weight since the last visit along with worsening of the adolescent’s acne. Given this set of symptoms, which performance-enhancing substance will the nurse practitioner be most concerned about and ask about?

a. Creatine
b. Dehydroepiandrosterone (DHEA)
c. Ephedra
d. Growth hormone

Answer 158

b. Dehydroepiandrosterone (DHEA)

Question 159

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?

a. Most sleep disorders are benign and will be outgrown.
b. Sleep disorders are symptomatic of underlying behavior problems.
c. Sleep disorders at this age can have long-term impacts on learning.
d. The child will need longer daytime naps to compensate for lost sleep.

Answer 159

c. Sleep disorders at this age can have long-term impacts on learning.

Question 160

The parent of a school-age child who is overweight tells the primary care pediatric nurse practitioner that the child seems to crave high-calorie, high-carbohydrate 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?

a. Assessment of leptin and ghrelin hormone levels
b. Consultation with a dietician to develop an appropriate diet
c. Referral to a sleep disorder clinic for a sleep study
d. Taking one or two naps each day to increase the amount of sleep

Answer 160

c. Referral to a sleep disorder clinic for a sleep study

Question 161

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?

a. 10 to 12 hours
b. 12 to 15 hours
c. 15 to 18 hours
d. 18 to 20 hours

Answer 161

c. 15 to 18 hours

Question 162

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?

a. Bedsharing with infants greatly increases the risk of SIDS.
b. Breastfeeding does not appear to have any influence on SIDS risk.
c. Infants who attend day care have a higher than usual incidence of SIDS.
d. There is no difference in SIDS rates in immunized versus nonimmunized infants.

Answer 162

a. Bedsharing with infants greatly increases the risk of SIDS.

Question 163

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?

a. Cosleeping with the child to help alleviate possible nighttime fears
b. Referral to a sleep disorders clinic for evaluation of sleep-disordered breathing
c. Reintroducing a second, morning nap time to compensate for lost sleep
d. Understanding that sleep resistance is a common developmental problem

Answer 163

d. Understanding that sleep resistance is a common developmental problem

Question 164

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?

a. Leaving the room as the child is falling asleep and returning at intervals to check on the child
b. Offering a reward for each night the child falls asleep without the parent in the room
c. Putting the child to bed at the same time every night and ignoring all sleep interfering behaviors
d. Taking away a favorite activity or video for each night the child fusses about the parent not being in the room

Answer 164

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

Question 165

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?

a. Diphenhydramine
b. Lorazepam
c. Melatonin
d. Zolpidem

Answer 165

c. Melatonin

Question 166

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?

a. That if this occurs again, to question the child about nightmares
b. That this is a sign of sleepwalking and could be dangerous
c. That this is a type of sleep terror that will resolve over time.
d. That this is probably a benign, temporary type of a sleep disorder

Answer 166

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

Question 167

During 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?

a. Establishing a graduated extinction program and good sleep hygiene
b. Making sure that stairs are blocked and doors are locked
c. Referral to a sleep disorder clinic for evaluation of a parasomnia
d. To awaken the child when these occur and asking about nightmares

Answer 167

b. Making sure that stairs are blocked and doors are locked

Question 168

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

a. clonazepam.
b. ferrous sulfate.
c. gabapentin.
d. sertraline.

Answer 168

b. ferrous sulfate.

Question 169

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. A program of sleep hygiene and gradual sleep extension
b. A sedativenarcotic will help both sleep and depression
c. Cognitive therapy can help the adolescent to sleep better
d. Using an antidepressant will improve sleep patterns

Answer 169

a. A program of sleep hygiene and gradual sleep extension

Question 170

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?

a. Craniofacial surgery
b. Oral appliances
c. Positive airway pressure therapy
d. Supplemental oxygen

Answer 170

c. Positive airway pressure therapy

Question 171

The mother of a 3monthold male infant tells the primary care pediatric nurse practitioner that she occasionally notices he has a penile erection just after nursing. What will the nurse practitioner tell the mother?

a. Infants should be prevented from masturbating.
b. The infant is conscious of the pleasure associated with nursing.
c. This is a form of infantile priapism.
d. This is a normal, reflexive behavior at this age.

Answer 171

d. This is a normal, reflexive behavior at this age.

Question 172

The primary care pediatric nurse practitioner is performing a well child examination on a 3yearold. The child’s parent reports that the child has recently begun masturbating. What will the nurse practitioner counsel this parent?

a. To allow the behavior whenever it occurs, since it is normal
b. To discuss sexuality with the child
c. To explore whether the child is being abused
d. To teach the child about privacy and hand hygiene

Answer 172

d. To teach the child about privacy and hand hygiene

Question 173

The parent of an 8yearold child tells the primary care pediatric nurse practitioner that the child has begun to ask questions about why a schoolmate has “2 daddies” and wonders how to talk to the child about this. What will the nurse practitioner recommend?

a. Beginning a discussion about different types of sexual relationships and samesex partners
b. Discussing the issue with the child in terms of the parent’s religious values and norms
c. Explaining that not all families are the same and what is most important is that they love and care for their children.
d. Telling the child that some adult relationships are complicated and will be understood when the child is older

Answer 173

c. Explaining that not all families are the same and what is most important is that they love and care for their children.

Question 174

The primary care pediatric nurse practitioner is performing a well child exam on an 8yearold girl and notes the presence of breast buds. What will the nurse practitioner include when initiating anticipatory guidance for this patient?

a. A discussion about the risks of pregnancy and sexually transmitted diseases
b. Information about sexual maturity and menstrual periods
c. Material about the human papillomavirus vaccine
d. Sexual orientation and the nature of sexual relationships

Answer 174

b. Information about sexual maturity and menstrual periods

Question 175

The primary care pediatric nurse practitioner is counseling the parents of a 13yearold female who has Down syndrome about sexual maturation. What will the nurse practitioner tell these parents?

a. It is important to discuss and support healthy sexuality.
b. Providing too much information about sexuality may be confusing given the child’s cognitive level of understanding.
c. Suppressing periods with contraceptives will lessen their daughter’s distress.
d. They should give her information about periods but not about sexuality.

Answer 175

a. It is important to discuss and support healthy sexuality.

Question 176

During a well child exam on a 13yearold female, the primary care pediatric nurse practitioner notes that the child is at Tanner Stage 3. During the exam, when the nurse practitioner initiates a conversation about healthy sexuality education, the parent states that this topic is “off limits.” What will the nurse practitioner do?

a. Ask the adolescent whether she wishes to discuss these matters since she is becoming an adult.
b. Separate the parent from the adolescent to discuss the adolescent’s concerns in private.
c. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors.
d. Tell the parent that this information is a routine part of adolescent well child examinations and must be included.

Answer 176

c. Spend private time with the parent to discuss how sexuality education reduces the risk of early sexual intercourse and risky sexual behaviors.

Question 177

During a well child examination, a 15yearold female tells the primary care pediatric nurse practitioner that some of her friends have begun having sex. She has a boyfriend but denies engaging in sex with him. What will the nurse practitioner do initially?

a. Ask her for her definitions of “sex.”
b. Discuss the risks of sexually transmitted diseases.
c. Find out if she is considering sexual relations.
d. Give her information about contraception.

Answer 177

a. Ask her for her definitions of “sex.”

Question 178

During a well child examination of a 6yearold girl, the primary care pediatric nurse practitioner notes that the child becomes embarrassed and resists taking off her underwear for the exam. What should the nurse practitioner infer from this observation?

a. The child has been sexually molested.
b. The child is feeling violated by the examiner.
c. The parent is exhibiting regressive behavior.
d. This is a normal reaction in a child of this age.

Answer 178

d. This is a normal reaction in a child of this age.

Question 179

The primary care pediatric nurse practitioner is providing anticipatory guidance to the parent of a schoolage boy. The parent expresses concerns that the child prefers to play with dolls, is worried that the child will be a homosexual, and asks what can be done to prevent this from happening. What will the nurse practitioner tell this parent?

a. Homosexual identity formation cannot be predicted by early childhood behavior.
b. Masculinizing boys from an early age helps to determine heterosexual orientation.
c. Sexual orientation identification begins late in adolescence and not in childhood.
d. The development of sexual orientation is generally a multifaceted process.

Answer 179

d. The development of sexual orientation is generally a multifaceted process.

Question 180

Which of the following statements best defines the term child
maltreatment?
a. intentional injury of a child
b. failure to provide what a child needs
c. not giving a child what he or she wants
d. accidental harm to a child by
someone

Answer 180

a. intentional injury of a child

Question 181

Which of the following statements best defines the term physical abuse?
a. bodily injury to a person that seems to have been inflicted by other than
accidental means
b. purposefully beating a child so that there are highly visible marks on the
childs body
c. use of the hands applied to a child in an excessively forceful manner
d. any damage to a child that involves the use of muscle-applied force

Answer 181

a. bodily injury to a person that seems to have been inflicted by other than
accidental means

Question 182

The school nurse observes parents interacting with a school-aged child and
notices that they do not show
any affection toward the child and there is no evidence of emotional support
or supervision. Later the nurse
learns from the child that he must take care of all his own hygiene tasks, has
to find something to eat on his
own, and his parents never say anything nice about him. The nurse at this
point believes that the parents are
engaging in:
a. physical abuse
b. psychological abuse
c. poor parenting
d. withholding of love

Answer 182

b.psychological abuse

Question 183

The majority of perpetrators of abuse to children reported to state Child Protective Service agencies as suspected victims of abuse and neglect are:

a. neighbors within one block
b. strangers
c. parents
d. relatives other than parents

Answer 183

c. parents

Question 184

The majority of child abuse victims falls into which of the following age ranges?

a. over 10 years
b. 8 to 10 years
c. 6 to 8 years
d. under 6 years

Answer 184

d. under 6 years

Question 185

Which of the following is the most common type of mistreatment of children?

a. physical abuse
b. neglect
c. sexual abuse
d. emotional maltreatment

Answer 185

b. neglect

Question 186

In the sociological model of family violence, family violence is viewed as:

a. a pattern of behavior that is passed from generation to generation
b. a pattern of harm within the nuclear family with no outside persons involved
c. any harmful action(s) between related persons no matter how distant the relationship is
d. harmful activities within a group designated as family no matter what the relationship

Answer 186

a. a pattern of behavior that is passed from generation to generation

Question 187

When family violence is passed from generation to generation, this type of abuse has which of the following characteristics?

a. It continues without changing to another type.
b. The form of abuse may change.
c. It usually gets more violent.
d. It is more detrimental to the child from generation to generation.

Answer 187

b. The form of abuse may change.

Question 188

Which of the following children is in a high-risk family for less nurturing and more hurtful behavior?

a. a child being raised by grandparents
b. a child who is forbidden from playing with other children
c. a child being raised by two men
d. a child in a nuclear family there both parents have full-time jobs

Answer 188

b. a child who is forbidden from playing with other children

Question 189

The social-interactional systemic perspective of child abuse and neglect says that the legitimization of violence in the family is due to which of the following factors?

a. family pathology of a genetic nature
b. increased availability of pornography
c. emphasis on hiding sexuality and not being open
d. society’s attitudes, beliefs, and values

Answer 189

d. society’s attitudes, beliefs, and values

Question 190

According to the social-interactional systemic perspective of child abuse and neglect, four factors place the family members at risk for abuse. These risk factors are the family itself, the caregiver, the child, and:

a. chronic poverty
b. genetics
c. the presence of a family crisis
d. the national emphasis on sex

Answer 190

c. the presence of a family crisis

Question 191

When caregivers lack knowledge about parenting, lack parenting skills, and are emotionally immature, the child often assumes which of the following roles?

a. victim
b. caregiver role toward the caregiver
c. regressed child of regressed caregivers
d. scapegoat

Answer 191

b. caregiver role toward the caregiver

Question 192

Which of the following examples best defines the term role reversal?

a. The child assumes a caregiver role toward the caregiver.
b. The good child takes on a bad child role.
c. A person who has been a good provider quits his or her job.
d. A lazy person becomes very productive in the family.

Answer 192

a. The child assumes a caregiver role toward the caregiver.

Question 193

When there is a depressed parent in the family, it is most likely that the depression will have which of the following effects?

a. will not affect the persons ability or performance in parenting
b. will cause the parent who is depressed to try harder to be a good parent
c. places the parent at risk for physically or emotionally abusing the children
d. will be seen in the child during the growing-up years

Answer 193

c. places the parent at risk for physically or emotionally abusing the children

Question 194

The nurse working in the pediatric clinic notices that a newborn seems particularly fussy. The mother verifies that this is a very fussy baby and that it is impossible to soothe the baby. In thinking through what to further assess and what to teach the mother, the nurse will keep in mind that fussy babies are:

a. often in some kind of pain
b. somewhat neurologically unstable
c. often victims of the mothers drug use
d. at greater risk for abuse

Answer 194

d. at greater risk for abuse

Question 195

Which of the following children are at greatest risk of abuse or neglect by the parents?

a. postmaturity babies
b. 13-year-old children
c. children with high intelligent quotient (IQ)
d. premature infants

Answer 195

d. premature infants

Question 196

An infant is separated from his parents for a few minutes while the nurse weighs him. The infant seems distressed and looks around for the mother. The mother soothes the infant then the nurse is through weighing him. This type of attachment between mother and baby is most likely which of the following types of attachment?

a. avoidant
b. disorganized
c. secure
d. strange

Answer 196

c. secure

Question 197

The nurse is caring for an infant who shows no distress then her parents leave, and then they return the infant ignores her parents. There was no evidence of distress while the parents were gone. This type of attachment between the infant and parents is most likely which of the following types of attachment?

a. secure
b. avoidant
c. ambivalent
d. detached

Answer 197

b. avoidant

Question 198

Asian parents bring their child to the hospital with what appears to be burns or abrasions on the neck, spines, and ribs. The parents use the words cao gao. The nurse is aware that these physical findings and the term cao gao refers to:

a. an Asian practice of burning and inflicting pain on children who wont obey
b. parents rubbing a pumice stone over a childs body to sand off evil spirits
c. rubbing a coin or a spoon heated in oil on an ill childs neck, spine, and ribs
d. burning incense on a rice paper on a childs upper body to bring good luck

Answer 198

c. rubbing a coin or a spoon heated in oil on an ill childs neck, spine, and ribs

Question 199

A child of Russian parentage is brought to the hospital with what appears to be second-degree burns. The nurse is aware of a Russian practice of treating headaches and abdominal pain by creating a vacuum under a cup or glass then a small amount of burning material is placed on the skin. This practice is called:

a. tassos
b. mal de vaso
c. ventosos
d. veritas

Answer 199

c. ventosos

Question 200

A child is brought to the pediatric clinic for immunizations for school. The parent wants the immunizations to be given in the arm. The nurse explains that at least one of the injections has to be given in the buttocks. When the nurse pulls the diaper down, the nurse sees bite marks around the genital and buttock area. Which of the following explanations is most likely?

a. A neighborhood toddler is in a biting stage.
b. This child is in a biting stage, and the parents bit him back to get him to stop biting.
c. The child is a victim of sexual or physical abuse.
d. This must have happened then the dog slept with the child.

Answer 200

c. The child is a victim of sexual or physical abuse.

Question 201

A parent brings a toddler to the pediatric clinic. The nurse observes a number of bruises on the child in various stages of healing. The parent claims the toddler bruises easily. The best action on the part of the pediatrician and the nurse would be to:

a. believe the parents and schedule an appointment in 2 weeks
b. report this to child and family services and order a screening battery of bleeding and clotting blood work
c. check with the other parent or another caregiver to see what he or she might be able to add to this history
d. tell the parent that it is clear that he or she is lying and to tell the truth

Answer 201

b. report this to child and family services and order a screening battery of bleeding and clotting blood work

Question 202

When the nurse sees a child who has burns on the backs of the legs and the top of the buttocks, and an area that is not burned in the center of the buttocks, the nurse will:

a. tend to believe the parents who say the child got into the tub accidentally before it cooled off
b. suspect that the childs buttocks were held forcibly against the bottom of the tub
c. suspect that the parents poured hot liquids on some areas of the legs and buttocks
d. think that the child backed up against a heater or was held there by the parents

Answer 202

b. suspect that the childs buttocks were held forcibly against the bottom of the tub

Question 203

A child comes to the clinic with bruises that are yellow-brown and fading. Based on the characteristics of these bruises, how old is the injury?

a. 3 days
b. 4 days
c. 6 days
d. over 1 week

Answer 203

d. over 1 week

Question 204

The nurse notices that a child has reddish blue to purple bruises that have margins. How old are these bruises?

a. 5 days
b. 7 days
c. more than 10 days
d. less than 1 day

Answer 204

d. less than 1 day

Question 205

Which of the following explains why children between the ages of 1 and 5 are more at risk than older children for getting serious burn injuries?

a. They tend to aggravate and make their parents angry more than older children do.
b. Children this age are small and cannot fight back then parents are abusive.
c. The skin of a child is thinner and much more sensitive than an adults skin.
d. Children this age are more curious and tend to get into things very quickly.

Answer 205

c. The skin of a child is thinner and much more sensitive than an adults skin

Question 206

Which of the following statements best describes the term stocking or glove type burn?

a. The burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.
b. The parents have dipped the child into hot liquid while he or she was asleep.
c. The child was wearing a stocking or a glove then immersed in hot liquid.
d. The parent was wearing heavy gloves or stockings on his or her hands while immersing the child in hot liquids or hot scalding water.

Answer 206

a. The burn has the look of a stocking or glove because the child tried to protect him- or herself from being immersed in hot scalding water.

Question 207

What is meant by the term flexion burns?

a. a burn caused by a cigarette or other hot object applied to the elbow of a bent arm
b. the body part immersed in hot liquids is held in a flexed position
c. the burn is so serious the child cannot flex his or her extremity
d. the parent flexed his or her own arms to avoid being burned while burning the child

Answer 207

b. the body part immersed in hot liquids is held in a flexed position

Question 208

What is the characteristic pattern of the burn in a flexion burn?

a. tiger pattern
b. zigzag
c. concentric circles
d. zebra pattern

Answer 208

d. zebra pattern

Question 209

Most child abuse deaths occur for which of the following reasons?

a. neurological injuries, with most of these being head injuries
b. bleeding from cuts
c. smothering or serious lack of oxygen for any number of reasons
d. abdominal injuries

Answer 209

a. neurological injuries, with most of these being head injuries

Question 210

Which of the following is a classic sign of shaken baby syndrome?

a. chills and fever
b. fear and withdrawal
c. edema of the extremities and bloated appearance to the abdominal area of the body
d. retinal hemorrhage, usually bilaterally with subdural or subarachnoid hemorrhages

Answer 210

d. retinal hemorrhage, usually bilaterally with subdural or subarachnoid hemorrhages

Question 211

A father calls emergency medical services (EMS) for his 1-year-old infant who was vomiting and then experienced a series of seizures. Upon admission to the hospital, the infant was listless and irritable, had bradycardia, and had periods of apnea. The infant has now lapsed into a coma. Which of the following conditions will the nurse and the health care team members suspect and most want to rule out?

a. spinal meningitis
b. encephalitis
c. fever-induced seizures
d. shaken baby syndrome (SBS)

Answer 211

d. shaken baby syndrome (SBS)

Question 212

A parent brings a toddler to the pediatric clinic. The nurse observes a number of
bruises on the child in various stages of healing. The parent claims the toddler bruises easily. The best action on the part of the pediatrician and the nurse would be to:
a. believe the parents and schedule an appointment in 2 weeks
b. report this to child and family services and order a screening battery of
bleeding and clotting blood work
c. check with the other parent or another caregiver to see what he or she
might be able to add to this history
d. tell the parent that it is clear that he or she is lying and to tell the truth

Answer 212

b. report this to child and family services and order a screening battery of
bleeding and clotting blood work

Question 213

Common injuries to pediatric and adolescent female genital tract include
straddle injuries. These injuries result from a fall on a:
1. Bicycle.
2. Wagon.
3. Sidewalk.
4. Step.

Answer 213

1. Bicycle.

Question 214

A 2monthold infant has a staccato cough and fever. Which aspect of the history is most important in determining the diagnosis?

a. Day care attendance
b. Immunization history
c. Medication history
d. Past medical history

Answer 214

b. Immunization history

Question 215

When reviewing a white blood cell (WBC) count, the primary care pediatric nurse practitioner suspects a viral infection when which WBC element is elevated?

a. Bands
b. Leukocytes
c. Lymphocytes
d. Neutrophils

Answer 215

c. Lymphocytes

Question 216

Which lab value is most concerning in an infant with fever and a suspected bacterial infection?

a. Creactive protein of 11.5 mg/L
b. Lymphocyte count of 8.7
c. Platelet count of 475
d. White blood cell count of 14

Answer 216

a. Creactive protein of 11.5 mg/L

Question 217

A toddler is receiving longterm antibiotics to treat osteomyelitis. Which laboratory test will the primary care pediatric nurse practitioner order to monitor response to therapy in this child?

a. Blood cultures
b. Erythrocyte sedimentation rate (ESR)
c. Serum procalcitonin (ProCT)
d. White blood count (WBC)

Answer 217

b. Erythrocyte sedimentation rate (ESR)

Question 218

According to recent research, which populations may have higher rates of under immunization than others?
a. Those with higher rates of Asians
b. Those with higher rates of graduate degrees
C. Those with lower rates of poverty
d. Those with lower rates of primary providers

Answer 218

b. Those with higher rates of graduate degrees

Question 219

The parent of a 2monthold infant is reluctant to have the baby vaccinated. What is an initial step in responding to these concerns?

a. Inform the parent that all vaccines may be given without thimerosol.
b. Providing Vaccine Information Statements for the parent to review.
c. Question the parent’s reasons for concern about immunizations.
d. Remind the parent that the infant is exposed to thousands of germs each day.

Answer 219

c. Question the parent’s reasons for concern about immunizations.

Question 220

A parent is concerned about vaccine adverse reactions. Based on an Institute of Medicine report, what will the primary care pediatric nurse practitioner tell the parent?

a. Administering multiple vaccines may trigger the development of type 1 diabetes.
b. The MMR may be linked to febrile seizures in immunocompromised children.
c. There is some risk of CNS disorders associated with the hepatitis B vaccine.
d. Vaccines containing thimerosol are linked to pervasive developmental disorders.

Answer 220

b. The MMR may be linked to febrile seizures in immunocompromised children.

Question 221

A 2monthold infant will receive initial immunizations, and the parent asks about giving medications to increase the infant’s comfort and minimize fever. What will the pediatric nurse practitioner recommend?

a. Administering ibuprofen or acetaminophen as needed
b. Avoiding antipyretics if possible to attain better immunity
c. Giving ibuprofen and acetaminophen only after the vaccines
d. Pretreating the infant with both ibuprofen and acetaminophen

Answer 221

a. Administering ibuprofen or acetaminophen as needed

Question 222

The parent of an infant asks why some vaccines, such as MMR, are not given along with the other series of immunizations at 2, 4, and 6 months of age. What will the primary care pediatric nurse practitioner tell this parent?

a. Febrile seizures are more likely in younger infants with some vaccines.
b. Maternal antibodies neutralize some vaccines and are delayed until 12 months.
c. The risk of adverse effects is lower for some vaccines after the first year.
d. Too many vaccines at once can overwhelm the infant’s immune system.

Answer 222

b. Maternal antibodies neutralize some vaccines and are delayed until 12 months.

Question 223

The primary care pediatric nurse practitioner is performing an initial well child exam on a 3yearold child recently adopted from Africa. The adoptive parent has a record of immunizations indicating that the child is fully vaccinated. What will the nurse practitioner do?

a. Administer a booster dose of each vaccine to ensure immunity.
b. Find out whether the vaccines were provided by reliable suppliers.
c. Perform antibody titers and reimmunize the child.
d. Record the vaccines in the child’s electronic medical record.

Answer 223

c. Perform antibody titers and reimmunize the child.

Question 224

The primary care pediatric nurse practitioner reviews the immunization records of an 18monthold child and notes that the child received an MMR immunization 2 days prior to the first birthday. What will the nurse practitioner do?

a. Administer a reduced dose of MMR to ensure adequate immunity.
b. Obtain mumps, measles, and rubella titers to determine immunity.
c. Recommend the next dose of MMR vaccine at 4 to 5 years of age.
d. Repeat the MMR vaccine since the first dose was given too soon

Answer 224

c. Recommend the next dose of MMR vaccine at 4 to 5 years of age.

Question 225

A 5yearold child who has a history of pertussis infection as an infant is in the clinic for immunizations prior to kindergarten. Which vaccine will be given?

a. DTaP
b. DTP
c. Td
d. Tdap

Answer 225

a. DTaP

Question 226

An adolescent female who is sexually active and who has not had the HPV vaccine asks if she may have it. What will the primary care pediatric nurse practitioner tell her?

a. Getting the vaccine now will still protect her from HPV oncogenic types even if already exposed
b. Receiving the HPV vaccine series will replace the need for regular cervical cancer screening
c. She will need to have Papanicolaou and pregnancy screening prior to receiving the vaccine
d. The vaccine will not protect her from any HPV oncogenic types acquired previously

Answer 226

d. The vaccine will not protect her from any HPV oncogenic types acquired previously

Question 227

An 18monthold child has bronchopulmonary dysplasia. To help prevent pneumococcal disease, which vaccine will be ordered?

a. PCV7
b. PCV13
c. PCV23
d. PCV33

Answer 227

b. PCV13

Question 228

A 5yearold child who received VariZIG after exposure to varicella while immunocompromised during chemotherapy is in the clinic 5 months after stopping chemotherapy for kindergarten vaccines. What will the primary care pediatric nurse practitioner order for this child?

a. MMR and Tdap
b. MMR, Varivax, Tdap
c. Tdap only
d. Varivax and Tdap

Answer 228

b. MMR, Varivax, Tdap

Question 229

A 3yearold child who attends day care has had a fever, nausea, and vomiting several weeks prior and now has darkened urine and constipation along with hepatomegaly and right upper quadrant tenderness. What treatment is warranted for this child?

a. HAV vaccine
b. Immunoglobulin G
c. Interferonalfa
d. Supportive care

Answer 229

d. Supportive care

Question 230

A 10monthold infant who is new to the clinic has chronic hepatitis B infection. What will the primary care pediatric nurse practitioner do to manage this infant’s disease?

a. Consult a pediatric infectious disease specialist.
b. Prescribe interferonalfa.
c. Provide supportive care.
d. Consider use of lamivudine.

Answer 230

a. Consult a pediatric infectious disease specialist.

Question 231

The primary care pediatric nurse practitioner performs a well child examination on a 1monthold. The infant was recently discharged from the neonatal intensive care unit after treatment with parenteral acyclovir for a neonatal herpetic infection and is currently taking oral acyclovir. What will the nurse practitioner do to manage this infant’s care?

a. Obtain regular absolute neutrophil counts.
b. Perform routine skin cultures for herpes simplex virus.
c. Reinforce the need to give acyclovir indefinitely.
d. Stop the oral acyclovir at 2 months of age.

Answer 231

a. Obtain regular absolute neutrophil counts.

Question 232

A 9monthold infant has had a fever of 103°F for 2 days and now has a diffuse, maculopapular rash that blanches on pressure. The infant’s immunizations are uptodate. What will the primary care pediatric nurse practitioner do?

a. Administer immunoglobulin G to prevent fulminant illness.
b. Perform serologic testing for human herpes virus 6 and human herpes virus 7.
c. Reassure the parent that this is a mild, selflimiting disease.
d. Recommend avoiding contact with pregnant women.

Answer 232

c. Reassure the parent that this is a mild, selflimiting disease.

Question 233

A child who is immunocompromised has a fever and a rash consisting of macules papules, and pustules. What will the primary care pediatric nurse practitioner do?

a. Administer varicella immune globulin (VariZIG).
b. Hospitalize the child for intravenous acyclovir.
c. Order intravenous immunoglobulin as an outpatient.
d. Prescribe oral acyclovir for the duration of the illness.

Answer 233

b. Hospitalize the child for intravenous acyclovir.

Question 234

A child whose parents have refused vaccines has been exposed to chickenpox, and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them?

a. The child may attend day care as long as no rash is present even with mild fever or other symptoms.
b. The child should remain home and receive oral acyclovir for 5 days to prevent onset of symptoms.
c. The child should stay home until the 21day incubation period has passed even if symptom free.
d. The child should stay home if any symptoms occur and may return in 1 week if no rash develops.

Answer 234

d. The child should stay home if any symptoms occur and may return in 1 week if no rash develops

Question 235

An 18monthold child who developed upper respiratory symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?

a. Consider therapy with rimantadine.
b. Hospitalize for supportive treatment.
c. Prescribe oseltamivir and follow closely
d. Wait for cultures to determine treatment.

Answer 235

c. Prescribe oseltamivir and follow closely

Question 236

The primary care pediatric nurse practitioner is reviewing medical records for a newborn that is new to the clinic. The toddler’s mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on antiretroviral prophylaxis, and did not breastfeed. What is the correct management for this child?

a. Consult with a pediatric HIV specialist.
b. Discontinue cART after 4 weeks of age.
c. Obtain a CD4+ cell count and HIV RNA levels.
d. Reinforce the need to give cART for life.

Answer 236

a. Consult with a pediatric HIV specialist.

Question 237

A 3yearold child whose immunizations are uptodate has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?

a. Administer the MMR vaccine to help prevent disease.
b. Give antiviral medications at the first sign of symptoms.
c. Give the child a dose of immune globulin to mitigate the response.
d. Reassure the parent that most exposed children will not get measles.

Answer 237

a. Administer the MMR vaccine to help prevent disease.

Question 238

A preschoolage child is brought to clinic for evaluation of a rash. The primary care pediatric nurse practitioner notes an intense red eruption on the child’s cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?

a. This rash may be a prodromal sign of rubella or roseola.
b. The child will need immunization boosters to prevent serious disease.
c. This is a benign rash with no known serious complications.
d. Expect a lacy, maculopapular rash to develop on the trunk and extremities.

Answer 238

d. Expect a lacy, maculopapular rash to develop on the trunk and extremities.

Question 239

An unimmunized schoolage child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?

a. Assessment of maternal rubella titers
b. Intravenous immunoglobulin for the child
c. MMR vaccine for the mother and child
d. Possible termination of the pregnancy

Answer 239

a. Assessment of maternal rubella titers

Question 240

A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?

a. Ask about recent tick bites
b. Obtain a skin culture
c. Order blood cultures
d. Perform serologic testing

Answer 240

a. Ask about recent tick bites

Question 241

A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to or the length of time the ticks were attached. The child is asymptomatic. What is the action?

a. Administer a prophylactic single dose of doxycycline.
b. Perform serologic testing for IgG or IgM antibodies.
c. Prescribe amoxicillin three times daily for 14 to 21 days.
d. Teach the parents which signs and symptoms to report.

Answer 241

d. Teach the parents which signs and symptoms to report.

Question 242

A 10monthold infant has an erythematous, fluctuant, nondraining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant’s care?

a. Consultation with a pediatric infectious disease specialist
b. Culture of any superficial open surface wounds
c. Empiric treatment with clindamycin
d. Incision and drainage of the abscess with culture

Answer 242

d. Incision and drainage of the abscess with culture

Question 243

A child with a history of a pustular rash at the site of a cat scratch on one arm now has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do?

a. Obtain a complete blood count and Creactive protein.
b. Order an immunofluorescent assay (IFA) for serum antibodies.
c. Perform a needle aspiration of the affected lymph nodes.
d. Prescribe a 5day course of azithromycin.

Answer 243

b. Order an immunofluorescent assay (IFA) for serum antibodies.

Question 244

A 7yearold child whose immunizations are uptodate has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated?

a. Empiric treatment with oral antibiotics or intramuscular ceftriaxone
b. Hospitalization for diagnosis and treatment with antibiotics
c. Immediate vaccination with meningococcal vaccine
d. Outpatient lab work, including a CBC and blood and CSF cultures

Answer 244

b. Hospitalization for diagnosis and treatment with antibiotics

Question 245

A schoolage child has fever of 104°F, sore throat, vomiting and malaise. The primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are erythematous and covered with exudate; the tongue is coated and red; and there is a red, sand-paper like rash on the child’s neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child’s illness?

a. Administer intramuscular ceftriaxone.
b. Hospitalize for further diagnostic tests.
c. Prescribe oral amoxicillin.
d. Refer to a pediatric infectious disease specialist.

Answer 245

c. Prescribe oral amoxicillin.

Question 246

An adolescent has a TB skin test prior to working as a volunteer in a hospital. The adolescent is healthy and has not travelled to or from a TBendemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do?

a. Ask the adolescent about exposure to homeless persons.
b. Order a chest radiograph to rule out active TB.
c. Reassure the adolescent that this is a negative screen.
d. Refer the adolescent to an infectious disease specialist.

Answer 246

c. Reassure the adolescent that this is a negative screen.

Question 247

The primary care pediatric nurse practitioner is examining a 2monthold infant with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?

a. Admitting the infant to the hospital for LP and IV antibiotics
b. Obtaining a blood culture, erythrocyte sedimentation rate, and C Reactive protein
c. Performing a catheterized urinalysis to screen for leukocytes and nitrites
d. Prescribing empiric, broad-spectrum antibiotics with close follow-up

Answer 247

c. Performing a catheterized urinalysis to screen for leukocytes and nitrites

Question 248

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
U. considerably more time in each encounter.
V. improved patient health outcomes.
W. less PNP involvement in health care decisions.
X. lower provider and higher patient satisfaction.

Answer 248

V. improved patient health outcomes.

Question 249

The primary care pediatric nurse practitioner diagnoses a 5yearold child with
asthma and prescribes an oral steroid and a short acting beta-adrenergic medication via a metered dose 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?
A. An asthma action plan
B. Effects and side effects of current medications
C. Information about spirometry testing
D. Instructions for medications at school

Answer 249

B. Effects and side effects of current medications

Question 250

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?
P. Admit the child to the hospital for close observation and monitoring of respiratory status.
Q. Encourage the parent to call when concerned and schedule a follow-up
appointment the next day.
R. Perform a complete blood count, blood cultures, and a chest radiograph to evaluate
symptoms.
S. Reassure the parent that the child has a normal exam and is most likely
not ill.

Answer 250

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

Question 251

Which characteristic is the key criterion that identifies a child has having special
needs?
A. Cognitive function
B. Emotional health
C. Health service requirements
D. Medical diagnosis

Answer 251

c.Health service requirements

Question 252

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 long-term management for this infant
A. Careful monitoring of attainment of developmental milestones
B. Familiarizing the parent with laws that mandate educational support
c. Providing genetic counseling to the infant’s parents
d. Referral to social services for assistance with resources

Answer 252

a. Careful monitoring of attainment of developmental milestones

Question 253

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
Q. allow the mother to express her feelings, understanding that
she is experiencing
grief.
R. reassure the mother that special educational opportunities are available
for her child.
S. suggest that the mother find a support group with other children with
special needs.
T. tell her that most schools provide services for children with special
health care needs.

Answer 253

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

Question 254

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?
A. Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight.
B. Suggest that the gastrostomy tube may be tried temporarily and
removed once the child gains weight.
c. Inform the mother that, since other options have failed, the gastrostomy
tube is the only
option.
d. Refer the child to a dietician to teach the mother the importance of
adequate nutrition.

Answer 254

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

Question 255

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 school based services?
A. Assessing the parent’s ability to perform home care tasks
B. Coordinating services to ensure continuity of care
C. Monitoring the family’s adherence to the health care plan
D. Ordering medications and other prescribed treatments

Answer 255

B. Coordinating services to ensure continuity of care

Question 256

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?
a. abdominal ultrasound
b. computed tomography
c. Conventional radiograph
d. MRI

Answer 256

c. Conventional radiograph

Question 257

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?
S. Administer a parenteral antibiotic and antipyretic and send the infant home.
T. Admit the infant to an inpatient hospital unit for overnight monitoring.
U. Give the parents sick care instructions and follow up in the clinic in the morning.
V. Send the infant to the urgent care center for intravenous fluids.

Answer 257

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

Question 258

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?
CCC. Demonstrate oral medication administration with the toddler in
the office.
DDD. Instruct the parent to hide the medication in a favorite food or
beverage.
EEE. Order the medication to be given via another route if possible.
FFF. Tell the parent to offer the child a reward each time the medication is
taken.

Answer 258

c. Demonstrate oral medication administration with the toddler in the office.

Question 259

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
HHH. confirm the medical diagnosis for the child’s parents.
III. make recommendations for disease management.
JJJ. stress the importance of adherence to the medication regimen.
KKK. take over management of this child’s chronic illness.

Answer 259

III. make recommendations for disease management.

Question 260

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
a. disconnect the user from the system to avoid a data breach.
b. notify the families that their messages may be read by others.
c. obtain a new device as soon as possible to resume communication.
d. upload the messages from another remote device.

Answer 260

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

Question 261

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?
a. Administering an antipyretic medication
b. Bringing the child to the clinic for evaluation
C. Offering extra fluids and calling if symptoms change
D. Ordering outpatient lab work such as a CBC

Answer 261

c. Offering extra fluids and calling if symptoms change

Question 262

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?
NN. Allow the child to go to preschool.
OO. Bring the child to the clinic for a culture.
PP. Keep the child home for 2 days.
QQ. Use antibiotic eyedrops for 3 days..

Answer 262

n. Allow the child to go to preschool.

Question 263

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?
O. Administer oral fluids in the clinic.
P. Admit the infant to the hospital.
Q. Order outpatient laboratory tests.
R. Send the infant home with close follow-up.

Answer 263

P. Admit the infant to the hospital.

Question 264

The parent of a schoolage child who has asthma tells the primary care pediatric nurse practitioner that the child often comes home from school with severe wheezing after gym class and needs to use his metereddose inhaler right away. What will the nurse practitioner do?

a. Recommend that the child go to the school nurse when symptoms start.
b. Review the child’s asthma action plan and possibly increase his steroid dose
c. Suggest asking the school to excuse the child from gym class.
d. Write the prescription for two metereddose inhalers with spacers.

Answer 264

d. Write the prescription for two metereddose inhalers with spacers.

Question 265

The single mother of a 4yearold who attends day care tells the primary care pediatric nurse practitioner that she had difficulty giving her child a twice daily amoxicillin for 10 days to treat otitis media during a previous episode several months earlier because she works two jobs and is too busy. The child has an ear infection in the clinic today. What will the nurse practitioner do?

a. Administer an intramuscular antibiotic.
b. Order twice daily amoxicillin for 5 days.
c. Prescribe azithromycin once daily for 5 days.
d. Reinforce the need to adhere to the plan of care.

Answer 265

c. Prescribe azithromycin once daily for 5 days.

Question 266

The primary care pediatric nurse practitioner is treating a toddler who has a lower respiratory tract illness with a lowgrade fever. The child is eating and taking fluids well and has normal oxygen saturations in the clinic. The nurse practitioner suspects that the child has a viral pneumonia and will

a. order an antiviral medication and schedule a followup appointment.
b. prescribe a broadspectrum antibiotic until the lab results are received.
c. teach the parents symptomatic care and order labs to help with the diagnosis.
d. write a prescription for an antibiotic to be given if the child’s condition worsens.

Answer 266

c. teach the parents symptomatic care and order labs to help with the diagnosis.

Question 267

The primary care pediatric nurse practitioner is counseling an adolescent who was recently hospitalized for an asthma exacerbation and learns that the child usually forgets to use twice daily inhaled corticosteroid medications that are supposed to be given at 0800 and 2000 each day. Which strategy may be useful in this case to improve adherence?

a. Ask the adolescent to identify two times each day that may work better.
b. Consider having the school nurse supervise medication administration.
c. Prescribing a daily oral corticosteroid medication instead.
d. Suggest that the parent enforce the medication regimen each day.

Answer 267

a. Ask the adolescent to identify two times each day that may work better.

Question 268

The primary care pediatric nurse practitioner is considering using a drug for an “offlabel” use in a child. The nurse practitioner has used the drug in a similar situation previously, has consulted a pharmacology resource and the FDA website, and has determined that there are no significant contraindications and warnings for this child. What else must the nurse practitioner do when prescribing this drug?

a. Discuss recommendations with the parents and document their consent.
b. Document anecdotal reports of previous use of the drug by other providers.
c. Follow up daily with the parents to determine safe administration of the drug.
d. Report this use to the FDA Medwatch website for tracking purposes.

Answer 268

a. Discuss recommendations with the parents and document their consent.

Question 269

The primary care pediatric nurse practitioner is considering use of a relatively new drug for a 15monthold child. The drug is metabolized by the liver, so the nurse practitioner will consult a pharmacologist to discuss giving the drug:

a. less often or at a lower dose.
b. more often or at a higher dose.
c. via a parenteral route.
d. via the oral route.

Answer 269

a. less often or at a lower dose.

Question 270

The primary care pediatric nurse practitioner prescribes a new medication for a child who develops a previously unknown adverse reaction. To report this, the nurse practitioner will

a. access the BPCA website.
b. call the PREA hotline.
c. log onto the FDA Medwatch website.
d. use the AAP online PediaLink program.

Answer 270

c. log onto the FDA Medwatch website.

Question 271

A pharmaceutical company has developed a new drug that was tested only on adults. The FDA has declared this drug to have potential benefits for ill children. According to the Pediatric Research Equity Act (PREA), what may the pharmaceutical company be required to do?

a. Conduct pediatric drug studies to determine whether the drug is safe and effective in children.
b. Provide labeling stating that the safety and efficacy of the drug is not established for children.
c. Receive a patent extension for conducting pediatric studies to determine use in children.
d. Survey existing data about the drug to determine potential use in the pediatric population.

Answer 271

a. Conduct pediatric drug studies to determine whether the drug is safe and effective in children.

Question 272

The parent of a schoolage child with a chronic pain condition tells the primary care pediatric nurse practitioner that the child has requested to stay home from school more often in the past few months. The child’s exam does not reveal any significant change in pathology, and a review of the child’s medications indicates appropriate dosing of analgesic medications. What will the nurse practitioner recommend?

a. Assessing the child’s pain every day to determine changes
b. Ensuring the child stays quiet in bed with videos when having pain
c. Having the child do homework when staying home from school
d. Requiring the child to go to school even during pain episodes

Answer 272

c. Having the child do homework when staying home from school

Question 273

An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care pediatric nurse practitioner do?

a. Change the TCA to a selective serotonin reuptake inhibitor.
b. Evaluate the adolescent for drug seeking behavior.
c. Increase the TCA dose and reevaluate in 2 to 3 weeks.
d. Refer the adolescent to a pain management specialist.

Answer 273

d. Refer the adolescent to a pain management specialist.

Question 274

What is the most important dose limiting factor when prescribing acetaminophen with hydrocodone?

a. Acetaminophen dose
b. Gastrointestinal side effects
c. Pruritis symptoms
d. Urinary retention

Answer 274

a. Acetaminophen dose

Question 275

An adolescent female reports moderate dysmenorrhea with periods and tells the primary care pediatric nurse practitioner that 400 mg ibuprofen every 6 to 8 hours doesn’t completely control her pain. What will the nurse practitioner recommend?

a. Increasing the ibuprofen dose to 600 to 800 mg every 6 to 8 hours
b. Taking extra strength acetaminophen 1000 mg every 4 to 6 hours
c. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours
d. Using extended release naproxen 500 mg every 12 hours

Answer 275

c. Taking naproxen 500 mg initially and then 250 mg every 6 to 8 hours

Question 276

The primary care pediatric nurse practitioner is preparing to perform a painful procedure on a 4monthold infant. Besides providing local anesthesia, what other pain control method provides analgesic effects?

a. Providing toys
b. Singing or music
c. Sucrose solution
d. Swaddling or cuddling

Answer 276

c. Sucrose solution

Question 277

A developmentally and cognitively disabled 10yearold child who is unable to communicate must undergo a series of surgeries, and the child’s parent asks how to know if the child is in pain and when to give pain medication. What will the primary care pediatric nurse practitioner teach this parent to use to assess this child’s pain?

a. Comfort scale
b. FLACC scale
c. NCCPCR
d. Nonverbal observations

Answer 277

c. NCCPCR

Question 278

A 4yearold child has just been released from the hospital after orthopedic surgery on one leg following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate pain, the child points to the “1” on a faces rating pain scale. What will the primary care pediatric nurse practitioner do next?

a. Assess the child’s vital signs and ability to walk without pain.
b. Refill the prescription for a narcotic analgesic medication.
c. Suggest that the parents give acetaminophen for mild pain.
d. Teach the parent to give analgesics based on the child’s report of pain.

Answer 278

a. Assess the child’s vital signs and ability to walk without pain.

Question 279

A 3yearold child is recovering from injuries sustained in a motor vehicle accident. How will the primary care pediatric nurse practitioner evaluate this child’s pain?

a. Ask the child to rate pain intensity on a 4 to 5item pain discrimination scale.
b. Have the child describe any pain as “no pain, a little pain, or a lot of pain.”
c. Question the child about the intensity and specific location of any pain.
d. Rely on nonverbal responses such as facial expressions and limb movements.

Answer 279

b. Have the child describe any pain as “no pain, a little pain, or a lot of pain.”

Question 280

The primary care pediatric nurse practitioner is evaluating a 10yearold child who is describing shooting pain in both legs associated with aching, tingling, and burning. The child is unable to pinpoint specific locations for this pain. Which type of pain does the nurse practitioner suspect?

a. Chronic pain
b. Neuropathic pain
c. Somatic pain
d. Visceral pain

Answer 280

b. Neuropathic pain

Question 281

Which of the following is a consideration in the administration of
immunizations?
1. Immunizations can only be administered if a child is free from any
illnesses.
2. Caregivers should administer aspirin prior to the injection to prevent any
side effects.
3. Children should be isolated from other children for 24 hours after receiving
immunizations.
4. Caregivers should be advised that immunizations may cause a mild fever
or soreness and redness at the injection site.

Answer 281

4. Caregivers should be advised that immunizations may cause a mild fever
   or soreness and redness at the injection site.

Question 282

A vaccine that contains fragments of cells that stimulate an immune
response, but does not contain the
whole cell is known as a:
1. Toxoid.
2. Subunit.
3. Acellular.
4. Attenuated.

Answer 282

3. Acellular.

Question 283

Which of the following is true about immunizations containing thimersal
and autism?
1. Thimersal has been removed from all vaccines.
2. Only the MMR vaccine is associated with autism.
3. Thimersal has been linked to learning disabilities, but not autism.
4. Researchers have found no evidence that thimersal is linked to autism.

Answer 283

4. Researchers have found no evidence that thimersal is linked to autism.

Question 284

A 27-year-old mother has just delivered a healthy 7 lb. 3 oz. baby boy. Which of the following is true regarding the baby’s immunization schedule for Hepatitis B?
1. The infant will need two doses administered at least 6 months apart.
2. The infant should not receive the vaccine until at least 12 months of age.
3. The infant will not need any vaccines at this time because of passive
immunity from the mother.
4. If the mother is Hepatitis B surface antigen positive, the baby will need 0.5ml of Hepatitis B Immune
Globulin.

Answer 284

4. If the mother is Hepatitis B surface antigen positive, the baby will need 0.5ml of Hepatitis B Immune
   Globulin.

Question 285

A mother is bringing her 2-month-old son in for his well-child visit. He is due to receive his Diphtheria, Tetanus, and Pertussis vaccine. The nurse is educating the mother on the
possible side effects of the vaccine, which include:
1. Pain and swelling in the joints.
2. Irritability, loss of appetite, and seizures.
3. Nausea, vomiting, and abdominal pain.
4. Fever and decreased white blood cell count.

Answer 285

2. Irritability, loss of appetite, and seizures.

Question 286

When a fetus receives antibodies from the mother by way of the placenta,
this is known as:
1. Active immunity.
2. Natural Passive immunity.
3. Transmission immunity.
4. Attenuated immunity.

Answer 286

2. Natural Passive immunity.

Question 287

Which of the following is a high risk group among children and adolescents
for contracting Hepatitis B?
1. Those living in institutions
2. Individuals infected by sexual partners
3. Children who are hemophiliacs or are receiving frequent blood transfusions
4. All of the above

Answer 287

4. All of the above

Question 288

A 15-year-old girl has been diagnosed with Hepatitis B and will be starting
treatment with interferonalpha
(IFN). The nurse needs to educate the patient on this medication. Which of
the following should be
included in this education?
1. The medication reduces the replication of the Hepatitis B virus.
2. The patient needs to remain on treatment for one year.
3. Patients may develop resistance to Interferon-alpha over time.
4. Interferon-alpha has fewer side effects than Lamivudine, which is also
used to treat Hepatitis B.

Answer 288

1. The medication reduces the replication of the Hepatitis B virus.

Question 289

A 6-year-old boy with Varicella-zoster (chickenpox) and a visible rash is
being admitted to the hospital
for treatment of dehydration. Which of the following isolation precautions
needs to be taken?
1. Contact
2. Airborne
3. Contact and droplet
4. Contact and airborne

Answer 289

4. Contact and airborne

Question 290

The mother of a 4-year-old girl brings her daughter in to be evaluated for
a fever of 101 degrees and a
headache that has lasted for the past three days. The mother was concerned
this morning when the child
woke up and had reddened cheeks that looked like she had been slapped.
The nurse suspects the child has:
1. Impetigo.
2. Fifths disease.
3. German measles.
4. Hand-Foot-Mouth Disease

Answer 290

2. Fifths disease.

Question 291

. Which of the following should be considered in the administration of the
influenza vaccine?
1. The vaccine is contraindicated for individuals who are allergic to eggs or egg products.
2. The Live Attenuated Influenza Virus (LAIV) is a safe alternative for children
of any age.
3. The influenza vaccine is contraindicated in children with asthma and
wheezing within the past
12 months.
4. Since influenza has a bimodal seasonal pattern, children under 18 years of
age should receive
two doses of the vaccine.

Answer 291

1. The vaccine is contraindicated for individuals who are allergic to eggs or egg products.

Question 292

The period of time when a child begins to have mild signs and symptoms
until the main illness appears,
and which is associated with increased communicability, is referred to as:
1. Transmission.
2. Susceptibility.
3. Prodromal period.
4. Incubation period.

Answer 292

3. Prodromal period.

Question 293

Reyes Syndrome can be a life-threatening disease affecting the brain and
liver of children. The cause of
this disease comes from the ingestion of:
1. Ibuprofen during a viral illness.
2. Ibuprofen during a bacterial illness.
3. Aspirin or other salicylates during a viral illness.
4. Aspirin or other salicylates during a bacterial illness.

Answer 293

3. Aspirin or other salicylates during a viral illness.

Question 294

A mother brings in her 4-year-old daughter to be evaluated for a rash all
over her torso. The mother
states that the 4 year old was recently around her grandmother, who is
presently recovering from shingles.
The mother is now concerned that the child has contracted shingles. Which
of the following would be an
appropriate response by the nurse to the mother?
1. It is possible that she has contracted shingles from her grandmother.
2. She has contracted chickenpox since both diseases are from the same
virus.
3. She can only get shingles from someone who has chickenpox.
4. This rash does follow the normal pattern along a dermatome or particular
nerve fiber.

Answer 294

1. It is possible that she has contracted shingles from her grandmother.

Question 295

A 6-year-old boy is admitted to the hospital with a severe case of chickenpox with persistent fever. The
nurse monitors the child for which of the following complications?
1. Pneumonia
2. Kidney failure
3. Seizure activity
4. Rheumatic fever

Answer 295

1. Pneumonia

Question 296

The primary care pediatric nurse practitioner is performing a well baby 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?

a. Order a CBC with differential and platelets and quantitative immunoglobulins.
b. Order candida and pneumococcal skin tests and lymphocyte surface markers.
c. Refer the infant to an immunologist for evaluation of immunodeficiency.
d. Refer the infant to an otolaryngologist to evaluate recurrent otitis media.

Answer 296

a. Order a CBC with differential and platelets and quantitative immunoglobulins.

Question 297

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?

a. Moisturizers
b. Oral antihistamines
c. Topical corticosteroids
d. Wet wrap therapy

Answer 297

a. Moisturizers

Question 298

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?

a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season.
b. Prescribe a decongestant medication as adjunct therapy during pollen season.
c. Recommend adding diphenhydramine to the child’s regimen for additional relief.
d. Suggest using an over-the-counter intranasal decongestant.

Answer 298

a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season.

Question 299

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 medium dose 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?

a. Have the parent administer all of the child’s medications.
b. Increase the ICS medication to a high dose preparation.
c. Reinforce teaching about the importance of using the SABA.
d. Teach the child and parent how to use home PEF monitoring.

Answer 299

d. Teach the child and parent how to use home PEF monitoring.

Question 300

An adolescent who has exercise induced asthma (EIA) is on the high school track team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs
of albuterol via a metered dose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do?
a. Counsel the adolescent to decrease the number of practices each week.
b. Increase the albuterol to 4 puffs 20 minutes prior to exercise.
c. Order a daily inhaled corticosteroid medication.
d. Prescribe cromolyn sodium in addition to the albuterol.

Answer 300

c. Order a daily inhaled corticosteroid medication.

Question 301

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?

a. Consider daily oral corticosteroid administration.
b. Order an anticholinergic medication in conjunction with the current regimen.
c. Prescribe a LABA/inhaled corticosteroid combination medication.
d. Refer to a pulmonologist for omalizumab therapy.

Answer 301

d. Refer to a pulmonologist for omalizumab therapy.

Question 302

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?

a. Add a daily inhaled corticosteroid.
b. Administer 3 SABA treatments.
c. Continue the current treatment.
d. Order an oral corticosteroid.

Answer 302

a. Add a daily inhaled corticosteroid.

Question 303

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 short acting 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?

a. Administer an oral corticosteroid and repeat the three treatments of the inhaled SABA.
b. Admit the child to the hospital for every 2 hour inhaled SABA and intravenous steroids.
c. Give the child 2 mg/kg of an oral corticosteroid and have the child taken to the emergency department.
d. Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely.

Answer 303

d. Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely.

Question 304

The primary care pediatric nurse practitioner is examining a schoolage child who has has 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 metered dose inhaler. What will the nurse practitioner order?
a. Allergy testing
b. Chest radiography
c. Spirometry testing
d. Sweat chloride test

Answer 304

c. Spirometry testing

Question 305

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?

a. “Although it is likely, based on family history, it is too soon to tell.”
b. “There is little reason to suspect that your infant has asthma.”
c. “With your infant’s history of bronchiolitis, asthma is very likely.”
d. “Your infant has definitive symptoms consistent with a diagnosis of asthma.”

Answer 305

a. “Although it is likely, based on family history, it is too soon to tell.”

Question 306

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?

a. Begin treatment with intravenous methyl prednisone.
b. Consider IVIG therapy if symptoms persist one more week.
c. Order a baseline echocardiogram today and another in 2 weeks.
d. Reassure the child’s parents that this is a selflimiting disorder.

Answer 306

c. Order a baseline echocardiogram today and another in 2 weeks.

Question 307

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?

a. ANA titers
b. Blood pressure measurement
c. Chest radiographs
d. Liver function studies

Answer 307

b. Blood pressure measurement

Question 308

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?

a. Aspirin is given for 2 weeks and then tapered to discontinue the medication.
b. Prophylactic amoxicillin will need to be given for 5 years.
c. Steroids will be necessary to prevent development of heart disease.
d. The child will need complete bedrest until all symptoms subside.

Answer 308

a. Aspirin is given for 2 weeks and then tapered to discontinue the medication.

Question 309

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?

a. AntiDNase B test
b. ASO titer
c. Rapid strep test
d. Throat culture

Answer 309

b. ASO titer

Question 310

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?

a. Evaluate the adolescent’s pain using a numeric pain scale.
b. Obtain ANA, CBC, liver function, and muscle enzymes tests.
c. Reassure the adolescent that this condition is not life-threatening.
d. Refer the adolescent to a rheumatologist for further evaluation.

Answer 310

d. Refer the adolescent to a rheumatologist for further evaluation.

Question 311

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?

a. Have the child rest between activities.
b. Obtain regular ophthalmology exams.
c. Participate in lowimpact exercises.
d. Use UVA and UVB sunscreen daily.

Answer 311

d. Use UVA and UVB sunscreen daily.

Question 312

A 12yearold child is brought to the clinic with joint pain, a 3week history of lowgrade 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?

a. Antidoublestrand DNA antibodies
b. AntiLa antibodies
c. AntiRo antibodies
d. AntiSm antibodies

Answer 312

a. Antidoublestrand DNA antibodies

Question 313

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?

a. Running
b. Swimming
c. Weights
d. Yoga

Answer 313

b. Swimming

Question 314

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?

a. 200 mg
b. 250 mg
c. 400 mg
d. 450 mg

Answer 314

b. 250 mg

Question 315

The primary care pediatric nurse apractitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child?

a. Cardiology
b. Ophthalmology
c. Orthopedics
d. Pain management

Answer 315

b. Ophthalmology

Question 316

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

a. enthesitisrelated JIA.
b. oligoarticular JIA.
c. polyarticular JIA.
d. systemic JIA.

Answer 316

b. oligoarticular JIA.

Question 317

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?

a. Complete remission occurs in some children at the age of puberty.
b. Periods of remission may occur but there is no permanent cure.
c. SLE can be cured with effective medication and treatment.
d. The disease is always progressive with no cure and no remissions.

Answer 317

b. Periods of remission may occur but there is no permanent cure.

Question 318

An initial key part of management of a child suspected of having an inborn error of metabolism is

a. consulting a metabolic specialist
b. obtaining a complete family history.
c. ordering metabolic screening tests.
d. referring the family to a dietician.

Answer 318

a. consulting a metabolic specialist

Question 319

The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2week checkup. What will the nurse practitioner suspect?

a. Galactosemia
b. Glucose6phosphatase deficiency
c. Phenylketonuria
d. Urea cycle disorder

Answer 319

c. Phenylketonuria

Question 320

The primary care pediatric nurse practitioner is providing nutritional counseling for a 9yearold female whose weight is at the 95th percentile for her age. What is the goal for this patient?

a. A loss of 10 to 15 pounds in 6 months
b. An average weight loss of 2 pounds per month
c. Maintenance of her current weight
d. Weight loss of 5% of her current body weight

Answer 320

c. Maintenance of her current weight

Question 321

A 16yearold adolescent female whose BMI is at the 90th percentile reports irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis?

a. Dyslipidemia
b. Hypothyroidism
c. Nonalcoholic steatohepatitis
d. Polycystic ovary syndrome

Answer 321

d. Polycystic ovary syndrome

Question 322

The primary care pediatric nurse practitioner prescribes metformin for a 15yearold adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug?

a. That insulin therapy will be necessary in the future
b. The importance of checking blood glucose 3 or 4 times daily
c. To consume a diet with foods that are high in vitamin B12
d. To use a stool softener to prevent gastrointestinal side effects

Answer 322

b. The importance of checking blood glucose 3 or 4 times daily

Question 323

A 13yearold Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will

a. counsel the child to lose weight to prevent type 2 diabetes.
b. diagnose type 2 diabetes if the child has a random glucose of 180 mg/dL.
c. order a fasting blood sample for a metabolic screen for type 2 diabetes.
d. refer the child to a pediatric endocrinologist.

Answer 323

c. order a fasting blood sample for a metabolic screen for type 2 diabetes.

Question 324

The primary care pediatric nurse practitioner is performing a well child examination on a 12yearold child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child?

a. Annual lipid profile evaluation
b. Annual screening for microalbuminuria
c. Comprehensive ophthalmologic exam
d. Hypothyroidism screening every 5 years

Answer 324

c. Comprehensive ophthalmologic exam

Question 325

The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a schoolage child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child’s endocrinologist to consider which therapy?

a. Continuous glucose monitoring
b. Continuous subcutaneous insulin infusion
c. Selfmonitoring of blood glucose
d. Use of a longacting insulin analogue

Answer 325

a. Continuous glucose monitoring

Question 326

The primary care pediatric nurse practitioner diagnoses an 8yearold child with type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child’s weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct?

a. Admit the child to the hospital for initial insulin management.
b. Begin insulin and refer the child to a children’s diabetes center.
c. Order a fasting serum glucose and a dipstick UA in the morning.
d. Send the child to the emergency department for fluids and IV insulin.

Answer 326

b. Begin insulin and refer the child to a children’s diabetes center.

Question 327

A 12yearold child has a recent history of increased thirst and frequent urination. The child’s weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child?

a. Fasting plasma glucose
b. Hemoglobin A1C levels
c. Pancreatic antibodies
d. Thyroid function tests

Answer 327

a. Fasting plasma glucose

Question 328

An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and dehydration. Which action is correct?

a. Administer an intramuscular stress dose of hydrocortisone succinate.
b. Administer intravenous fluids in the clinic and reassess hydration status.
c. Prescribe an oral hydrocortisone in a replacement dose of 8 to 10 mg/M2.
d. Refer the infant to the emergency department for fluids, dextrose, and steroids.

Answer 328

d. Refer the infant to the emergency department for fluids, dextrose, and steroids.

Question 329

A 6yearold female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?

a. Order LH and FSH levels and a longacting GnRH agonist.
b. Order thyroid function tests to exclude primary hypothyroidism.
c. Reassure the parent that this is most likely idiopathic.
d. Refer the child to a pediatric endocrinologist for management.

Answer 329

d. Refer the child to a pediatric endocrinologist for management.

Question 330

A 7yearold female has recently developed pubic and axillary hair without breast development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition?

a. Adrenal tumor
b. Congenital adrenal hyperplasia
c. Polycystic ovary syndrome
d. Type 1 diabetes mellitus

Answer 330

c. Polycystic ovary syndrome

Question 331

The mother of a female infant is concerned that her daughter is developing breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis?

a. Congenital adrenal hyperplasia causing breast development
b. Precocious puberty needing endocrinology management
c. Premature adrenarche which will lead to pubic hair onset
d. Premature thelarche which will resolve over time

Answer 331

d. Premature thelarche which will resolve over time

Question 332

The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child’s growth is consistent with bone age. Which diagnosis is most likely?

a. Constitutional growth delay
b. Growth hormone deficiency
c. Idiopathic short stature
d. Klinefelter syndrome

Answer 332

a. Constitutional growth delay

Question 333

The primary care pediatric nurse practitioner is performing a well child examination on a 2yearold child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?

a. Consider prescribing growth hormone therapy.
b. Reassure the parent that this is normal for this child.
c. Refer the child to a dietician for dietary supplementation.
d. Refer the child to a pediatric endocrinologist.

Answer 333

d. Refer the child to a pediatric endocrinologist.

Question 334

The primary care pediatric nurse practitioner is performing a well child examination on a 5yearold girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5’8” tall and the father is 5’11” tall. The nurse practitioner will estimate which expected adult height for this child?

a. 5’11” tall
b. 5’7” tall
c. 5’8” tall
d. 6’ tall

Answer 334

b. 5’7” tall

Question 335

The primary care pediatric nurse practitioner evaluates children’s growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening?

a. Measuring supine length in children over the age of 2 years
b. Obtaining serial measurements to assess patterns over time
c. Using the CDC growth chart for children under age 2 years
d. Using the WHO growth chart for children over age 2 years

Answer 335

c. Using the CDC growth chart for children under age 2 years