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?
Administer a Childhood Autism Ratin...
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?
Administer a Childhood Autism Rating Scale (CARS) in the clinic.
Consult a specialist to determine appropriate early intervention strategies.
Refer the child to a behavioral specialist for further evaluation.
Tell the parent that this result indicates that the child has autism. Correct answer- ANS:
C
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.
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?
Three-generation pedigree
Review of systems
Genogram
Ecomap Correct answer- ANS: A
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.
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?
Perform an in-depth developmental assessment screen at this visit to evaluate this
child.
Reassure the parent that the child will catch up to normal development by age 2 years.
Re-evaluate this child's development and milestone achievements at the 2-year visit.
,Refer the child to a specialty clinic for evaluation and treatment of developmental delay.
Correct answer- ANS: A
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.
When formulating developmental diagnoses for pediatric patients, the primary care
pediatric nurse practitioner may use which resource?
DC: 0-3R
ICD-10-CM
ICSD-3
NANDA International Correct answer- ANS: A
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 is the International Classification of Sleep Disorders - 3rd edition.
NANDA International is used to label problems in the functional health domain.
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?
Ask the child how many books he has at home.
Ask the mother about her highest grade in school.
Ask the mother to determine the correct dose of a drug from a label.
Ask the mother to read a health information handout aloud. Correct answer- ANS: A
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.
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?
Fine motor
Gross motor
Social/emotional
Speech and language Correct answer- ANS: D
Maternal depression in the first year of life has been associated with poorer language
development at 3 years of age.
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?
Altered elimination pattern
Elimination disorder
Encopresis
Parenting alteration Correct answer- ANS: C
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.
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?
Ask the child's parent why the child is so anxious.
Perform a physical assessment to rule out shortness of breath.
Reassure the child that there is nothing to be afraid of.
Review the purpose of this visit and any anticipated procedures. Correct answer- ANS:
D
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.
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?
CRAFFT
Ecomap
Genogram
Pedigree Correct answer- ANS: C
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.
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?
Metabolic syndrome
Nutritional alteration: more than required
Obesity
, Rule out type 2 diabetes mellitus Correct answer- ANS: C
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.
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 :
ask the parent to consider a possible speech delay and report any concerns.
continue to evaluate the child's speech at subsequent visits.
refer the child for a speech and hearing evaluation.
tell the parent to spend more time in interactive conversations with the child. Correct
answer- ANS: B
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.
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?
CRAFFT
HEEADSSS
PHQ-2
RAAPS Correct answer- ANS: A
The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse.
The HEEADSSS is used as a psychosocial screening tool. The PHQ-2 is a rapid screen
for depression. The RAAPS is used to assess risk behaviors that contribute to most
morbidity, mortality, and social problems in teens.
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 the 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?
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