NR602 Pediatric Midterm Study Set, Burns Ch. 7:
Development Management of School-Age Children, PNP
Exam Questions
1. 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?
a. Reassure them that the child is too young to understand.
b. Recommend that they continue to not argue in front of the child.
c. Suggest counseling to learn ways to handle stress.
d. Tell them that the conflict will resolve when the situation changes. -ANSWER : ANS: C
Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by
the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict
during stressful situations. Even when children do not understand, they pick up on cues from the parents
about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does
not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation
may indicate a pattern of response to stress and will only recur with each subsequent stressful period.
2. 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?
a. Consult a developmental specialist for a more complete evaluation.
b. Prepare the parents for a potentially serious developmental disorder.
c. Refer the infant to an early intervention program for physical therapy.
d. Teach the parents to provide exercises to encourage motor development. -ANSWER : ANS: D
The child who has mild delays in only one area may be managed initially by having the parent provide
appropriate exercises. If this is not effective, or if delays become more severe, referrals for evaluation or
early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so
this action is not indicated.
,3. 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?
a. Ask the parents if they have an individualized family service plan (IFSP).
b. Consult with a physician to ensure the child gets appropriate care.
c. Inform the family that services are provided when the child begins school.
d. Refer the family to a social worker for assistance with referrals and services. -ANSWER : ANS: A
Families with children who have developmental delays are eligible for early intervention services and
should have IFSPs in place. This family may have one from their previous community, and it can be used
as a starting point to determine needs. It is not necessary to consult with a physician to coordinate
community resources. Early intervention is provided from birth, according to federal law. Until the
specific referrals are known, the social worker is not consulted.
4. The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from
the neonatal intensive care unit after a 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?
a. Explain to the parent that developmental delays often do not manifest at first.
b. Perform a developmental assessment and tell the parent which delays are evident.
c. Point out the tasks that the infant can perform while conducting the assessment.
d. Refer the infant to a developmental specialist for a complete evaluation. -ANSWER : ANS: C
When discussing developmental delays with parents, it is important to be positive and to initially focus
on strengths. Explaining that developmental delays develop over time is true but does not reassure the
parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and
may take time.
5. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about
ways to discipline their 3-year-old child who draws on the walls with crayons?
a. Give the child washable markers so the drawings can be removed easily.
b. Provide a roll of paper for drawing and teach the child to use this.
c. Put the child in "timeout" each time the child draws on the walls.
d. Take the crayons away from the child to prevent the behavior. -ANSWER : ANS: B
Discipline involves training or education that molds appropriate behavior and is used to teach the child
what is permitted and encouraged. Providing an appropriate outlet for drawing helps to teach the child
where to use the crayons. Using washable markers allows the parents to clean the walls but does not
,teach the child appropriate behaviors. Timeout and taking away the crayons are forms of punishment, or
a loss of privileges, that are administered as a form of retribution.
6. The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old infant in a
car seat on the exam table. The infant's mother is playing a game on her smart phone. The nurse
practitioner interprets this behavior as :
a. a sign that the mother has postpartum depression.
b. extremely concerning for potential parental neglect.
c. of moderate concern for parenting problems.
d. within the normal range of behavior in early parenthood. -ANSWER : ANS: C
A parent who seems disinterested in a child raises moderate concerns for parenting problems. It does
not necessarily signal postpartum depression. It is not a mark for extreme concern. It is not within the
expected range of behaviors.
7. During a well child assessment of an 18-month-old 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?
a. Allow the parent to put the child in a "timeout."
b. Ask the parent about usual discipline practices.
c. Offer the child a book or a toy to look at.
d. Stop the exam since the child has reached a "meltdown." -ANSWER : ANS: C
The child has exhibited early signs of misbehavior. At this stage, distraction and active engagement may
be used to stop more problems from occurring. It is not necessary to use a timeout because the child
hasn't reached the point where cooperation is impossible. The PNP should model appropriate
interventions by offering the child a distraction and may ask the parent about discipline practices later in
the visit. The child is not at a "meltdown" state.
8. The primary care pediatric nurse practitioner performs a physical examination on a 9-month-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?
a. To begin brushing the infant's teeth with toothpaste
b. To consider weaning the infant from breastfeeding
c. To discontinue giving fluoride supplements
, d. To make an appointment for an initial dental examination -ANSWER : ANS: D
The American Academy of Pediatric Dentistry recommends a first dental examination at the time of
eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the
infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers
should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride
supplements should not be discontinued.
9. 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?
a. Care coordination and collaboration
b. Developing protocols for parents to follow
c. Monitoring individual education plans (IEPs)
d. Providing lists of resources for families -ANSWER : ANS: A
Care coordination is one of the key elements for children with special health care needs. PNPs are
especially suited for this role and have the unique skills to function as care coordinators. Care for these
children should involve shared decision making and individualized care and not "cookbook" approaches.
The PNP may advocate for children's health care needs for the IEP but does not monitor these. The PNP
should not just give parents lists of phone numbers but should assist them to make appointments.
10. 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 :
a. developing consistent daily routines for the child.
b. exposing her child to extended family members when possible.
c. not working outside the home during the first few years.
d. taking her child to regular play date activities with other children -ANSWER : ANS: A
Providers can teach parents that providing predictable, consistent, and loving care helps an infant to
learn trust and help influence positive brain development. Involving extended family members and going
to play dates are good ways to socialize children but are not essential to learning trust. It may not be
possible for her to be a stay-at-home mother.
11. 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
Development Management of School-Age Children, PNP
Exam Questions
1. 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?
a. Reassure them that the child is too young to understand.
b. Recommend that they continue to not argue in front of the child.
c. Suggest counseling to learn ways to handle stress.
d. Tell them that the conflict will resolve when the situation changes. -ANSWER : ANS: C
Marital problems can result in child behavior difficulties and anxieties, and conflict can be picked up by
the child. The parents should try to learn to modify unhealthy behaviors, such as increased conflict
during stressful situations. Even when children do not understand, they pick up on cues from the parents
about anxiety and stress and can internalize these feelings. Avoiding arguments in front of the child does
not alleviate the underlying conflict and stress. The behavior of fighting during this stressful situation
may indicate a pattern of response to stress and will only recur with each subsequent stressful period.
2. 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?
a. Consult a developmental specialist for a more complete evaluation.
b. Prepare the parents for a potentially serious developmental disorder.
c. Refer the infant to an early intervention program for physical therapy.
d. Teach the parents to provide exercises to encourage motor development. -ANSWER : ANS: D
The child who has mild delays in only one area may be managed initially by having the parent provide
appropriate exercises. If this is not effective, or if delays become more severe, referrals for evaluation or
early intervention services are warranted. A mild delay does not necessarily signal a serious disorder, so
this action is not indicated.
,3. 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?
a. Ask the parents if they have an individualized family service plan (IFSP).
b. Consult with a physician to ensure the child gets appropriate care.
c. Inform the family that services are provided when the child begins school.
d. Refer the family to a social worker for assistance with referrals and services. -ANSWER : ANS: A
Families with children who have developmental delays are eligible for early intervention services and
should have IFSPs in place. This family may have one from their previous community, and it can be used
as a starting point to determine needs. It is not necessary to consult with a physician to coordinate
community resources. Early intervention is provided from birth, according to federal law. Until the
specific referrals are known, the social worker is not consulted.
4. The primary care pediatric nurse practitioner is examining a newborn infant recently discharged from
the neonatal intensive care unit after a 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?
a. Explain to the parent that developmental delays often do not manifest at first.
b. Perform a developmental assessment and tell the parent which delays are evident.
c. Point out the tasks that the infant can perform while conducting the assessment.
d. Refer the infant to a developmental specialist for a complete evaluation. -ANSWER : ANS: C
When discussing developmental delays with parents, it is important to be positive and to initially focus
on strengths. Explaining that developmental delays develop over time is true but does not reassure the
parent or help the parent cope with feelings. Referrals are not indicated unless delays are present and
may take time.
5. Which recommendation will a primary care pediatric nurse practitioner make when parents ask about
ways to discipline their 3-year-old child who draws on the walls with crayons?
a. Give the child washable markers so the drawings can be removed easily.
b. Provide a roll of paper for drawing and teach the child to use this.
c. Put the child in "timeout" each time the child draws on the walls.
d. Take the crayons away from the child to prevent the behavior. -ANSWER : ANS: B
Discipline involves training or education that molds appropriate behavior and is used to teach the child
what is permitted and encouraged. Providing an appropriate outlet for drawing helps to teach the child
where to use the crayons. Using washable markers allows the parents to clean the walls but does not
,teach the child appropriate behaviors. Timeout and taking away the crayons are forms of punishment, or
a loss of privileges, that are administered as a form of retribution.
6. The primary care pediatric nurse practitioner enters an exam room and finds a 2-month-old infant in a
car seat on the exam table. The infant's mother is playing a game on her smart phone. The nurse
practitioner interprets this behavior as :
a. a sign that the mother has postpartum depression.
b. extremely concerning for potential parental neglect.
c. of moderate concern for parenting problems.
d. within the normal range of behavior in early parenthood. -ANSWER : ANS: C
A parent who seems disinterested in a child raises moderate concerns for parenting problems. It does
not necessarily signal postpartum depression. It is not a mark for extreme concern. It is not within the
expected range of behaviors.
7. During a well child assessment of an 18-month-old 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?
a. Allow the parent to put the child in a "timeout."
b. Ask the parent about usual discipline practices.
c. Offer the child a book or a toy to look at.
d. Stop the exam since the child has reached a "meltdown." -ANSWER : ANS: C
The child has exhibited early signs of misbehavior. At this stage, distraction and active engagement may
be used to stop more problems from occurring. It is not necessary to use a timeout because the child
hasn't reached the point where cooperation is impossible. The PNP should model appropriate
interventions by offering the child a distraction and may ask the parent about discipline practices later in
the visit. The child is not at a "meltdown" state.
8. The primary care pediatric nurse practitioner performs a physical examination on a 9-month-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?
a. To begin brushing the infant's teeth with toothpaste
b. To consider weaning the infant from breastfeeding
c. To discontinue giving fluoride supplements
, d. To make an appointment for an initial dental examination -ANSWER : ANS: D
The American Academy of Pediatric Dentistry recommends a first dental examination at the time of
eruption of the first tooth and no later than 12 months old. Parents should be counseled to clean the
infant's teeth but with water only. Weaning from breastfeeding is not indicated, although mothers
should not let the infant nurse while sleeping to prevent milk from bathing the teeth. Fluoride
supplements should not be discontinued.
9. 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?
a. Care coordination and collaboration
b. Developing protocols for parents to follow
c. Monitoring individual education plans (IEPs)
d. Providing lists of resources for families -ANSWER : ANS: A
Care coordination is one of the key elements for children with special health care needs. PNPs are
especially suited for this role and have the unique skills to function as care coordinators. Care for these
children should involve shared decision making and individualized care and not "cookbook" approaches.
The PNP may advocate for children's health care needs for the IEP but does not monitor these. The PNP
should not just give parents lists of phone numbers but should assist them to make appointments.
10. 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 :
a. developing consistent daily routines for the child.
b. exposing her child to extended family members when possible.
c. not working outside the home during the first few years.
d. taking her child to regular play date activities with other children -ANSWER : ANS: A
Providers can teach parents that providing predictable, consistent, and loving care helps an infant to
learn trust and help influence positive brain development. Involving extended family members and going
to play dates are good ways to socialize children but are not essential to learning trust. It may not be
possible for her to be a stay-at-home mother.
11. 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
