TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
1. 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 (M-CHAT) tool, which indicates several areas of concern.
What will the nurse practitioner do?
A. Administer a Childhood Autism Rating Scale (CARS) in the clinic.
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.:
ANS : C
Rationale The M-CHAT is a screening tool and is useful for detecting behaviors that may
indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and
significant positive predictive value. If these behaviors are detected, the PNP should refer
the child to a specialist for further assessment, using more diagnostic tools. The CARS may be
used but requires specialty training and proper credentials. Until the diagnosis is determined,
strategies for intervention are not discussed. The M-CHAT is a screening tool and is not
diagnostic.
2. 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
ANS: A
Rationale The three-generation pedigree is used to map out risks for genetic diseases in
families, as well as conditions with modifiable risk factors. The review of systems is used to
evaluate the history of the child's body systems. The genogram is an approach to developing
a family database to provide a graphic representation of family structure, roles, and
problems of recurring significance in a family. The ecomap is used to identify relationships in
the family and community that are supportive or harmful.
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
3. The primary care pediatric nurse practitioner is performing a well child check-up on a
20-month-old child. The child was 4 weeks premature and, according to a parent-
completed developmental questionnaire, has achieved 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. Re-evaluate 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.:
ANS: A
Rationale This child should be at a 19-month adjusted age for prematurity so, according to
the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to
evaluate this delay. Waiting to see if the child will "catch up" or assuring the parent that this
will happen will cause the delays to become more severe. A referral to a specialty clinic
should not be made solely on the basis of the parent-completed questionnaire but only after
further evaluation of possible delays.
4. When formulating developmental diagnoses for pediatric patients, the primary care
pediatric nurse practitioner may use which resource?
A. DC: 0-3R
B. ICD-10-CM
C. ICSD-3
D. NANDA International
ANS: A
Rationale The DC: 0-3R refers to the Diagnostic Classification of Mental Health and
Developmental Disorders of Infancy and Early Childhood and is useful for developmental
problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth
Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
is the International Classification of Sleep Disorders - 3rd edition. NANDA International is
used to label problems in the functional health domain.
5. 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 this?
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.:
ANS: A
Rationale The "newest vital sign," or health literacy, can be determined quickly by asking
the parent how many children's books are in the home. Greater than 10 books in the home
is an independent positive predictor of adequate parent health literacy. The other
questions may determine a specific level of literacy in general but are not as efficient.
6. The primary care pediatric nurse practitioner learns that the mother of a 3-year-old
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:
ANS: D
Rationale Maternal depression in the first year of life has been associated with poorer
language development at 3 years of age.
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
7. 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:
ANS: C
Rationale Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized
for reimbursement purposes. "Altered elimination pattern" and "Parenting alteration" are
NANDA International diagnoses and are not recognized for reimbursement. "Elimination
disorder" is a developmental diagnosis.
8. 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 pre-kindergarten 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.:
ANS: D
Rationale 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
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
immunizations. The PNP should explain the purpose and any anticipated procedures for this
visit to help put the child at ease.
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:
ANS: C
Rationale The genogram is an approach to developing a family database to provide a
graphic representation of family structure, roles, and problems of recurring significance in a
family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is
used to identify relationships in the family and community that are supportive or harmful.
The pedigree is used to identify potential genetic disorders.
10. 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:
ANS: C
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
Rationale A problem should never be included on the problem list that is not supported by
subjective and objective data found and recorded in the database. This child has a BMI that
suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that
is determined by laboratory data, which has not been evaluated yet. Nutritional alteration
is a NANDA diagnosis and not acceptable for reimbursement. "Rule out" should not be used
as a diagnosis, but may be considered part of a plan.
11. 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. -
ANS: B
Rationale Development should be monitored over time and within the context of the child's
overall well-being, rather than at an isolated testing session. The child has normal
development in observed measures and appears to hear and understand well. By parental
report, the child is able to speak. The PNP should continue to evaluate speech over time, since
this refusal to speak may be associated with shyness or intimidation in the clinic. It is not
necessary to tell the parent that the child has a possible speech delay. Unless an actual
speech delay is observed, a referral is not indicated, nor is it necessary to implement a home
therapy.
12. 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
1. 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 (M-CHAT) tool, which indicates several areas of concern.
What will the nurse practitioner do?
A. Administer a Childhood Autism Rating Scale (CARS) in the clinic.
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.:
ANS : C
Rationale The M-CHAT is a screening tool and is useful for detecting behaviors that may
indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and
significant positive predictive value. If these behaviors are detected, the PNP should refer
the child to a specialist for further assessment, using more diagnostic tools. The CARS may be
used but requires specialty training and proper credentials. Until the diagnosis is determined,
strategies for intervention are not discussed. The M-CHAT is a screening tool and is not
diagnostic.
2. 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
ANS: A
Rationale The three-generation pedigree is used to map out risks for genetic diseases in
families, as well as conditions with modifiable risk factors. The review of systems is used to
evaluate the history of the child's body systems. The genogram is an approach to developing
a family database to provide a graphic representation of family structure, roles, and
problems of recurring significance in a family. The ecomap is used to identify relationships in
the family and community that are supportive or harmful.
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
3. The primary care pediatric nurse practitioner is performing a well child check-up on a
20-month-old child. The child was 4 weeks premature and, according to a parent-
completed developmental questionnaire, has achieved 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. Re-evaluate 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.:
ANS: A
Rationale This child should be at a 19-month adjusted age for prematurity so, according to
the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to
evaluate this delay. Waiting to see if the child will "catch up" or assuring the parent that this
will happen will cause the delays to become more severe. A referral to a specialty clinic
should not be made solely on the basis of the parent-completed questionnaire but only after
further evaluation of possible delays.
4. When formulating developmental diagnoses for pediatric patients, the primary care
pediatric nurse practitioner may use which resource?
A. DC: 0-3R
B. ICD-10-CM
C. ICSD-3
D. NANDA International
ANS: A
Rationale The DC: 0-3R refers to the Diagnostic Classification of Mental Health and
Developmental Disorders of Infancy and Early Childhood and is useful for developmental
problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth
Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
is the International Classification of Sleep Disorders - 3rd edition. NANDA International is
used to label problems in the functional health domain.
5. 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 this?
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.:
ANS: A
Rationale The "newest vital sign," or health literacy, can be determined quickly by asking
the parent how many children's books are in the home. Greater than 10 books in the home
is an independent positive predictor of adequate parent health literacy. The other
questions may determine a specific level of literacy in general but are not as efficient.
6. The primary care pediatric nurse practitioner learns that the mother of a 3-year-old
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:
ANS: D
Rationale Maternal depression in the first year of life has been associated with poorer
language development at 3 years of age.
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
7. 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:
ANS: C
Rationale Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized
for reimbursement purposes. "Altered elimination pattern" and "Parenting alteration" are
NANDA International diagnoses and are not recognized for reimbursement. "Elimination
disorder" is a developmental diagnosis.
8. 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 pre-kindergarten 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.:
ANS: D
Rationale 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
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
immunizations. The PNP should explain the purpose and any anticipated procedures for this
visit to help put the child at ease.
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:
ANS: C
Rationale The genogram is an approach to developing a family database to provide a
graphic representation of family structure, roles, and problems of recurring significance in a
family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is
used to identify relationships in the family and community that are supportive or harmful.
The pedigree is used to identify potential genetic disorders.
10. 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:
ANS: C
, TEST BANK FOR NR602 PEDIATRIC EXAM STUDY SET WITH RATIONALES
Rationale A problem should never be included on the problem list that is not supported by
subjective and objective data found and recorded in the database. This child has a BMI that
suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that
is determined by laboratory data, which has not been evaluated yet. Nutritional alteration
is a NANDA diagnosis and not acceptable for reimbursement. "Rule out" should not be used
as a diagnosis, but may be considered part of a plan.
11. 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. -
ANS: B
Rationale Development should be monitored over time and within the context of the child's
overall well-being, rather than at an isolated testing session. The child has normal
development in observed measures and appears to hear and understand well. By parental
report, the child is able to speak. The PNP should continue to evaluate speech over time, since
this refusal to speak may be associated with shyness or intimidation in the clinic. It is not
necessary to tell the parent that the child has a possible speech delay. Unless an actual
speech delay is observed, a referral is not indicated, nor is it necessary to implement a home
therapy.
12. 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
