Module 4 (Ch. 25, 34, 28)

Question 1

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?

Answer 1

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

Question 2

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

Answer 2

oligoarticular JIA

Question 3

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

Answer 3

Ophthalmology

Question 4

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?

Answer 4

250 mg

Question 5

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?

Answer 5

Swimming

Question 6

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

grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive.

Which test may be ordered to confirm a diagnosis of SLE?

Answer 6

Anti­double­strand DNA antibodies

Question 7

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?

Answer 7

Use UVA and UVB sunscreen daily.

Question 8

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?

Answer 8

Refer the adolescent to a rheumatologist for further evaluation.

Question 9

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?

Answer 9

ASO titer

Question 10

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?

Answer 10

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

Question 11

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?

Answer 11

Blood pressure measurement

Question 12

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?

Answer 12

Order a baseline echocardiogram today and another in 2 weeks

Question 13

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?

Answer 13

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

Question 14

The primary care pediatric nurse practitioner is examining a school­age child who has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered­dose inhaler. What will the nurse practitioner order?

Answer 14

Spirometry testing

Question 15

A school­age child who uses a SABA and an inhaled corticosteroid medication is

seen in the clinic for an acute asthma exacerbation. After 4 puffs of an inhaled short­acting B2­ agonist (SABA) every 20 minutes for three treatments, spirometry testing shows an FEV1 of 60% of the child’s personal best. What will the primary care pediatric nurse practitioner do next?

Answer 15

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

Question 16

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?

Answer 16

Add a daily inhaled corticosteroid.

Question 17

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?

Answer 17

Refer to a pulmonologist for omalizumab therapy.

Question 18

An adolescent who has exercise­induced asthma (EIA) is on the high school track ID: 13348419888 team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs
of albuterol via a metered­dose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do?

Answer 18

Order a daily inhaled corticosteroid medication.

Question 19

A school­age child with asthma is seen for a well child checkup and, in spite of

“feeling fine,” has pronounced expiratory wheezes, decreased breath sounds, and an FEV1less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child’s parent administers the daily medium­dose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child’s status. What will the nurse practitioner do?

Answer 19

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

Question 20

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?

Answer 20

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

Question 21

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?

Answer 21

Moisturizers

Question 22

The primary care pediatric nurse practitioner is performing a well­baby checkup on a 6­month­old infant and notes a candida diaper rash and oral thrush. The infant has had two
ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do?

Answer 22

Order a CBC with differential and platelets and quantitative immunoglobulins.

Question 23

A 9­month­old infant has developed two teeth since the 6­month checkup. The

local water supply contains fluoride. What will the primary care pediatric nurse practitioner do to

promote healthy dentition at this visit?

Answer 23

Apply sodium fluoride varnish to the infant’s teeth.

Question 24

What will the primary care pediatric nurse practitioner recommend to the parent of an infant who is teething who asks about comfort measures?

Answer 24

Give the infant a cold teething ring or wet washcloth to chew.

Question 25

An 18­month­old child has horizontal, bright white lines along the upper gum line

of the teeth. What is the most important question the primary care pediatric nurse practitioner will

ask the child’s parents?

Answer 25

If the child is still drinking milk from a bottle

Question 26

A 4­year­old child who has had extensive dental surgery to treat dental caries has

white spot lesions on the primary teeth. How often should this child receive fluoride varnish

applications?

Answer 26

Every 3 to 6 months

Question 27

The parents of a formula­fed newborn report that they get their drinking water

from a well. What will the primary care pediatric nurse practitioner recommend to provide adequate fluoride for this infant?

Answer 27

Testing the fluoride level of their water source

Question 28

What will the primary care pediatric nurse practitioner teach the parent of an infant about cleaning the child’s teeth?

Answer 28

To use a smear of toothpaste and not to rinse the mouth

Question 29

A parent asks about ways to promote dental health in school­age children while on a family vacation that are convenient while camping and picnicking. What will the pediatric nurse practitioner recommend?

Answer 29

Offering gum containing xylitol after meals

Question 30

An adolescent has localized bleeding of the gums when brushing the teeth. An

exam of the mouth reveals the presence of plaque and calculus on the teeth, which are not loose.

What will the primary care pediatric nurse practitioner recommend?

Answer 30

Consistently brushing and flossing the teeth twice daily

Question 31

A school­age child has had herpes stomatitis for a week and continues to

complain of pain. What will the primary care pediatric nurse practitioner recommend?

Answer 31

Topical application of diphenhydramine and Maalox

Question 32

A child has several shallow mucosal lesions on the buccal mucosa and tongue that are surrounded with an erythematous halo and covered by yellow plaques. What will the primary care pediatric nurse practitioner recommend?

Answer 32

Chlorhexidine gluconate

Question 33

During a well child exam, the primary care pediatric nurse practitioner notes

yellowish­white serpentine­bordered lesions on the anterior portion of a child’s tongue. What will

the nurse practitioner do?

Answer 33

Reassure the parent that these are benign lesions.

Question 34

A 4­year­old child who has asthma has teeth with smooth, cupped­out teeth on the chewing surfaces. Which is the most likely explanation for this finding?

Answer 34

Gastroesophageal reflux

Question 35

An adolescent female reports facial pain and frequent popping of her jaw. An

exam reveals unilateral tender facial muscles and a deviation of the mandible to the affected side with opening of the mouth. What will the primary care pediatric nurse practitioner do?

Answer 35

Recommend ice packs, NSAIDs, and a soft diet.

Question 36

A 5­year­old child is hit in the face with a baseball bat and is brought to the clinic

by a parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial fractures. What is the recommended treatment?

Answer 36

Refer the child to a dentist immediately for further examination.

Question 37

A child with cerebral palsy receives all nutrition via gastrostomy tube. What will the

primary care pediatric nurse practitioner recommend to promote dental health in this child?

Answer 37

Daily chlorhexidine gluconate rinses

Question 38

When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by

Answer 38

extending the leg at the knee with the infant supine.

Question 39

To evaluate brain tissue disorders in infants, which test is useful?

Answer 39

Ultrasonography

Question 40

A female infant who was developing normally stops meeting developmental

milestones at age 12 months and then begins losing previously acquired skills. What will the primary care pediatric nurse practitioner expect to tell the parents about this child’s prognosis?

Answer 40

The child’s intellectual development will not progress further.

Question 41

A 14­year­old child has a headache, unilateral weakness, and blurred vision

preceded by fever and nausea. The child’s parent reports a similar episode several months prior. The primary care pediatric nurse practitioner will consult with a pediatric neurologist to order

Answer 41

neuroimaging with magnetic resonance imaging (MRI

Question 42

During a well baby exam on a 9­month­old infant, the parent reports that the baby

always uses the left hand to pick up objects and asks if the baby will be left­handed. What will the primary care pediatric nurse practitioner do?

Answer 42

Perform a careful assessment of fine and gross motor skills.

Question 43

The pediatric nurse practitioner provides primary care for a 5­year­old child who

has cerebral palsy who exhibits athetosis and poor weight gain in spite of receiving high­calorie formula to supplement intake. The child has had several episodes of pneumonia in the past year. Which specialty consultation is a priority for this child?

Answer 43

Surgery for possible fundoplication and gastrostomy

Question 44

Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?

Answer 44

Calcium and vitamin D

Question 45

A child with a recent history of URI reports tingling and pain in one ear followed by

sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do?

Answer 45

Prescribe oral prednisone 1 mg/kg/day initially

Question 46

9. A child who has had a single non­febrile seizure has a normal neurologic exam.
   Which diagnostic test is indicated?

Answer 46

Electroencephalogram (EEG)

Question 47

The parents of an 18­month­old child bring the child to the clinic after observing a
brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of

103.1°F, and the primary care pediatric nurse practitioner notes a left otitis media. The child is alert and responding normally. What will the nurse practitioner do?

Answer 47

Prescribe an antibiotic for the ear infection and reassure the parents.

Question 48

An adolescent female reports unilateral headache pain associated with abdominal

pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for 6 months but reports little relief from symptoms. What will the primary care pediatric nurse practitioner do?

Answer 48

Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours

Question 49

A child who has sustained a head injury after falling on the playground is brought

to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric nurse practitioner notes slight slurring of the child’s speech and the child has vomited twice in the exam room. Which course of action is warranted?

Answer 49

Admit the child to the hospital for a neurology consult

Question 50

The primary care pediatric nurse practitioner performs a well baby exam on a

term 4­month­old infant and observes flattening of the left occiput, bossing of the right occiput, and anterior displacement of the left ear. The parents report performing various positioning maneuvers, but say that the baby’s head shape has worsened. What will the nurse practitioner recommend to correct this finding?

Answer 50

Refer the infant for orthotic cranial molding helmet therapy

Question 51

A 4­year­old child who has previously met developmental milestones is not toiled
trained. The primary care pediatric nurse practitioner notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child?

Answer 51

Tethered cord