Adv Ped Nursing Test 1 (Burns) | Questions, Answers and Explanations

Adv Ped Nursing Test 1 (Burns) | Questions, Answers and Explanations Which region globally has the highest infant mortality rate? Southern Asia The primary care pediatric nurse practitioner understands that, to achieve the greatest world-wide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? vaccinations Explanation: Rotavirus is the most common cause of diarrhea globally and Strep pneumonia is the leading cause of pneumonia, and together these are the leading infectious causes of childhood morbidity and mortality globally. Both are vaccine-preventable diseases. Antibiotics to treat pneumonia, optimal nutrition, and clean water all help to reduce morbidity and mortality, but vaccination prevents the diseases from occurring. Which statement correctly reflects the health status of children in the United States? Obesity rates among 2- to 5-year-olds have stabilized below Health People 2020 goal of 9.4%. Explanation: Obesity rates are a major concern for child health in the U.S. but recently have stabilized at 8.9%. Globalism The primary care pediatric nurse practitioner understands that what major child health outcome is dramatically associated with worldwide climate change? Nutrition When providing well child care for an infant in the first year of life, the primary care pediatric nurse practitioner demonstrates an understanding of current guidelines when taking what action? Scheduling well-baby visits to coincide with key developmental milestones. What is the foundational basis of patient-and-family centered care (PFCC)? The patient has ultimate control over health care decisions Which assessment question best demonstrates the primary care provider's understanding of effectively dealing with the greatest challenge to providing dual patient care? To the child: "When would you like your physical therapy sessions to be scheduled?" Which intervention best demonstrates a pediatric nurse primary care pediatric nurse practitioner's understanding of effective pain assessment? Assisting in the development of a child-centered pain assessment scale. Which theorist is responsible for presenting an alternative therapy to those established theories that focus on how the pediatric patient thinks? Vygotsky Explanation: Vygotsky and Siegler both provide pediatric primary care with a new understanding or alternative lens through which to view children and childhood regarding how they think and process information. The other options represent traditional theorists: Piaget does focus on how children think while Skinner and Bandura are concerned with how children's learning and behavior is affected by experiences. What is the strongest predictor of health regarding the pediatric patient? Health literacy of the parent(s) and/or caregiver(s) The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history? Speech and language development, beliefs about health, and previous illnesses 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? Genogram A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner (PNP) notes that the child's last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially? Review the purpose of this visit and any anticipated procedures. Explanation: The PNP should remember that young children are learning "scripts" for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease. The primary care pediatric nurse practitioner cares for children from a Native American family and learns that they used many herbs to treat and prevent illness. Which approach will the pediatric nurse practitioner use to promote optimum health in the children? Ask about the types of practices used and when they are applied. Explanation: The challenge, when working with families from different cultural backgrounds, who use alternative or complementary medicines, is to find ways to achieve a mutual understanding of the differences and to negotiate an acceptable plan of care. The first step is to begin a discussion about these practices. Providing a list of harmful herbs, suggesting that the family avoid certain herbs, and suggesting that the herbs are only an adjunct to "modern medicine" will sound disparaging and will convey a sense of mistrust. The primary care pediatric nurse practitioner works with families from a variety of cultures and socioeconomic classes. Which is an example of cultural humility in practice? Receptivity to learning about the perspectives of other cultures Explanation: Cultural humility is defined as the lifelong commitment to developing mutually beneficial, nonpaternalistic partnerships and is based on a model of passive volition, receptivity, and being open to learning from others. Practitioners who have cultural humility are always seeking to learn about other cultures. Cultural humility involves asking questions, rather than giving answers. Cultural humility does not mean identifying one's own culture as inferior. Practitioners who are culturally competent are open to the influence of other cultures. The primary care pediatric nurse practitioner in a community health center meets a family who has recently immigrated to the United States who speak only Karon. They arrive in the clinic with a church sponsor, who translates for them. The pediatric nurse practitioner notices that the sponsor answers for the family without giving them time to speak. The pediatric nurse practitioner will implement what intervention to help with communication? Use the telephone interpreter service to communicate with the family. The primary care pediatric nurse practitioner (PNP) prescribes a twice daily inhaled corticosteroid for a 12-year-old child. At a well child visit, the child reports not using the medication on a regular basis. Which response by the pediatric nurse practitioner demonstrates an understanding of client-centered care? Asking the child to describe usual daily routines and schedules Explanation: In a client-centered relationship, there is reciprocal communication and understanding. The PNP should be able to understand the client's perspective and unique situation. The first step is to evaluate possible reasons for nonadherence and not to make referrals or re-educate until potential barriers have been identified and negotiation with the client has occurred. A primary care pediatric nurse practitioner working in a community health center wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the pediatric nurse practitioner employ to ensure the success of such a program? Asking community members to assist in researching and implementing a program The primary care pediatric nurse practitioner is examining a child whose parents recently emigrated from a war-torn country in the Middle East. Which is a priority assessment when performing the patient history? Asking about physical, psychological, and emotional trauma Explanation: Recent history that includes trauma, loss, and refugee camp experience may exacerbate difficulties adjusting to life in the U.S. and can lead to acute and chronic physical and mental health concerns. All of the other parts of the history will be necessary, but this should be a priority, since the family has escaped a war-torn country. 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 developing consistent daily routines for the child. Explanation: 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. 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? Suggest counseling to learn ways to handle stress Explanation: 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. 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? Point out the tasks that the infant can perform while conducting the assessment. Explanation: 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. Which interventions are recommendations suggested as preventive services for neonates? -Breastfeeding -Screening neonates for sickle hemoglobinopathies -Newborns screened for phenylketonuria (PKU) before being 24 hours old should be rescreened by 2 weeks old. -Screening for developmental hip dysplasia When providing post delivery information regarding her infant, the nurse will confirm to the mother that which fetal cardiac structures have no function after her child is born? -Foramen ovale -Ductus arteriosus Explanation: The foramen ovale and ductus arteriosus are no longer necessary and close. The nurse will contribute which neonate characteristics noted in the first period of reactivity to sympathetic system changes? -Transient rales -Tachycardia -Alertness Explanation: The first period of reactivity includes sympathetic system changes, such as tachycardia, rapid respirations, transient rales, grunting, flaring and retractions, a falling body temperature, hypertonus, and alertness. Parasympathetic system changes during the first period of reactivity include the initiation of bowel sounds and the production of oral mucus. After an interval of sleep, the newborn enters the second period of reactivity. During this time, the oral mucus production again becomes evident, the heart rate becomes labile, the newborn becomes more responsive to endogenous and exogenous stimuli, and meconium is often passed. Which assessment factors are included in a 5-minute APGAR score? - Heart rate -Respiratory Rate - Skin Color - Muscle tone Explanation: Heart and respiratory rates, skin color and muscle tone are assessed at both the 1 and 5 minute APGAR scoring. While crying has a positive affect on respirations, crying is not a focus of the assessment Which assessment findings suggest that the neonate is demonstrating stabilization of physiological functions? Temperature: 97.7° F Explanation: Temperature is considered stable when between (97.7° to 99.3° F [36.5° to 37.4° C]) in open crib after birth. Heart rate is normally 100 to 190 bpm. Systolic blood pressures greater than 96 mm Hg are considered significant hypertension in the newborn. Unlabored respirations at a rate of 30 to 60 breaths/minute is considered normal. 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? Language and literacy skills begin at birth. Explanation: General learning and acquisition of skills for later reading and writing begin at birth, not in kindergarten or first grade, and these skills grow with everyday loving interactions between infants and caregivers. Cognitive learning changes during toddler years but begins at birth. Intellectual growth is not tied to speech alone. The primary care pediatric nurse practitioner performs a well baby examination on a 7-day-old 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? Schedule a weight check in 1 week. Explanation: This infant lost about 8% of its birth weight, which is normal and, since discharge home, has gained at least 15 grams per day, which is also normal. The PNP should schedule a weight check in a week to make sure the infant regains its birth weight, since most should regain this in 10 to 14 days and since this loss of birth weight is at the high end of normal. It is not necessary to refer to a lactation consultant or supplement with formula, since the infant is gaining weight adequately. During an assessment of a 4-week-old infant, the primary care pediatric nurse practitioner learns that a breastfed infant nurses every 2 hours during the day but is able to sleep for a 4-hour 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? Continuing to nurse the infant using the current pattern Explanation: Infants who are encouraged to breastfeed every 2 to 3 hours may have one longer stretch of 4 hours at night. This infant is gaining between 0.5 and 1 gram per day, which is appropriate. It is not necessary to alter the pattern of nursing or to supplement with formula. 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? The infant may be going through an expected growth spurt. Explanation: Infants may have a growth spurt at 6 to 8 weeks, and mothers who are breastfeeding may be concerned that they are not making enough milk when they notice that the infant is fussy and wanting to nurse more often. The PNP should reassure the mother that this is expected. It is not necessary, since the infant is gaining weight appropriately, for the mother to keep a log. The mother should follow the infant's cues for feeding since the extra suckling will increase the milk supply to meet the growing infant's needs. The mother of a 6-week-old 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 second day. What will the nurse practitioner tell her? This may be normal for breastfed babies. Explanation: Infants begin to have fewer bowel movements and may have bowel movements ranging from once or twice daily to once every other day when breastfed. Unless there are other signs, the baby is probably not constipated. The mother does not need to change her intake of foods or water, unless constipation is present. The parent of a 5-month-old is worried because the infant becomes fussy but doesn't always seem interested in nursing. What will the nurse practitioner tell this parent? The infant may be expressing a desire to play or to rest. Explanation: At this age, infants may cry when they are tired or need social interaction and not just when they are hungry. The PNP should teach parents about this change in social development so they can be responsive to their infant's needs. Solid foods are not added until age 6 months. Teething usually does not begin until at least 6 months. GI discomfort usually occurs after eating. The mother of a 6-month-old 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? "At this age, your baby does not understand the meaning of sounds." Explanation: At 6 months, infants delight in vocalizing sounds that they learn by imitation but do not ascribe meaning to the sounds they make. Infants can say "mama" but without meaning. Babies make sounds on purpose by imitating what they hear. A preference for one sound early in speech does not indicate a hearing deficit. The primary care pediatric nurse practitioner is performing a well child examination on a 8-month-old infant whose hearing is normal but who responds to verbal cues with only