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Chapter 01: Health Status of Children: Global and National Perspectives Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition MULTIPLE CHOICE : 1. Which region globally has the highest infant mortality rate? ANS: B Although Sub -Saharan Africa and Southern Asia together account for 77% of the infant mortality rate globally, Southern Asia has the highest infant mortality rate (39%) in the world followed closely by Sub-Saharan Africa (38%). 2. 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? a. Antibiotics b. Optimal nutrition c. Vaccinations d. Water purification ANS: C 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. 3. Which statement correctly reflects the health status of children in the United States? a. Globalism has relatively little impact on child health measures in the U.S. b. Obesity rates among 2 - to 5-year-olds have stabilized below Health People 2020 goal of 9.4%. c. The rate of household poverty is lower than in other economically developed nations. d. Young children who attend preschool or day care have higher food insecurity. ANS: B a. Indonesia b. Southern Asia c. Sub-Saharan Africa d. Syria Obesity rates are a major concern for child health in the U.S. but recently have stabilized at 8.9%. Globalism has an increasing effect on child health in the U.S. The rate of household poverty in the U.S. is higher than in other economically developed nations. Young children who attend preschool or day care have lower food insecurity. 4. The primary care pediatr ic nurse practitioner understands that what major child health outcome is dramatically associated with worldwide climate change? a. Housing b. Education c. Nutrition d. Pollution ANS: C There is growing evidence that climate change is having a dramatic effect on food crops that leads to food distribution issues and food insecurity among families. 5. 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? a. Focusing less on development and more on illness prevention and nutrition. b. Following guidelines established by the Bright Futures publication. c. Scheduling well -baby visits to coincide with key developmental milestones. d. Seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due. ANS: C In the most recent AAP Recommendations for Preventive Pediatric Health Care , there is a greater emphasis on behavioral and developmental issues and a recommendation that well child care be based on child and family development rather than the periodicity of immunization schedules. Chapter 02: Unique Issues in Pediatrics Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition MULTIPLE CHOICE 1. What is the foundational basis of patient -and-family centered care (PFCC)? a. The family is to be considered when patient care is being planned b. The patient has ultimate control over health care decisions c. A family member acts as the patient’s surrogate decision makes d. The patient is the focus of the primary care provider’s attention ANS: B While all options are correct statements, the foundational basis of PFCC is the patient has ultimate control over health care decisions. 2. Which assessment question best demonstrates the primary care provider’s understanding of effectively dealing with the greatest challenge to providing dual patient care? a. To the parent: “Do you feel comfortable providing in -home care for y our child?” b. To the child: “When would you like your physical therapy sessions to be scheduled?” c. To the parent: “What are your feelings about going to family therapy to help with this transition?” d. To the child: “When did you first notice the pain in your knees?” ANS: B One of the greatest challenges is how to access, acknowledge, and include the child’s voice, which is often lost and/or overridden in health care. By directly asking the child their opinion or feelings, the PCP is providing for the child’s voice to be heard and acknowledged. None of the other options addresses that need. 3. Which intervention best demonstrates a pediatric nurse primary care pediatric nurse practitioner’s understanding of effective pain assessment? a. Provid ing instructions regarding the Faces pain assessment tool to parents of all newly admitted children b. Assisting in the development of a child -centered pain assessment scale c. Reviewing the documentation regarding the child’s pain assessment 30 minutes after analgesic medication was administered d. Explaining to both the child and the parents why pain medication will be delivered intravenously ANS: B In the past, clinicians and researchers have relied on adult -developed and adult -centered tools and approaches, which have been “adapted” for use with children by adding pictures and/or simpler language. There is increasing realization that data from adapted, adult -centered models have has not adequately captured the voices and/or experiences of children . Engaging in the development of an assessment tool that is child focused is the best demonstration of understanding. All other options rely on adaptation of adult -centered tools or focus on standard pain management related interventions. 4. Which theorist is responsible for presenting an alternative theory to those established theories that focus on how the pediatric patient thinks? a. Piaget b. Vygotsky c. Skinner d. Bandura ANS: B 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. 5. What is the strongest predictor of health regarding the pediatric patient? a. The early identification of existing health problems b. Health literacy of the parent(s ) and/or caregiver(s) c. Assess to specialized healthcare professionals d. Past experience with same of similar health issues ANS: B The health literacy possessed by parents/caregivers is one of the strongest predictors of the health of a pediatric patient. While the other options enhance good health outcomes, they are all influenced by appropriate health literacy. Chapter 03: Genetic and Genomics: The basics of child health Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition MULTIPLE CHOICE 1. What is true about haploid cells? a. Each contains 23 paired chromosomes. b. Each one contains 23 chromosomes. c. Replication produces two identical cells. d. They replicate via the process of mitosis. ANS: B Haploid cells each contain only 23 chromosomes, while diploid cells contain 23 paired chromosomes. Diploid cells replicate via the process of mitosis, producing two identical daughter cells. 2. What does the following genetic notation symbol mean 47,XX,6q -? a. Male with deletion of chromosome 6 b. Female with deletion of chromosome 6 c. Male with deletion on the long arm of chromosome 6 d. Female with deletion on the long arm of chromosome 6 ANS: D “XX” is a female. “q” indicates the long arm of a chromosome. “ -” indicates a deletion. None of the remaining options accurately describe the notation “q”. 3. A child has a recessive genetic disorder that is homozygous for that mutation. What is most likely about this child’s parents? a. Neither parent has a copy of that gene mutation. b. Only the mother has a copy of that gene mutation. c. Only the father has a copy of that gene mutation. d. Each parent has one copy of that gene mutation. ANS: D When a child has a recessive genetic mutation that is homozygous, the child has two copies of the mutation, each donated by the parents. Since it is recessive, parents may be carriers of the gene, having only one copy, and pass the disorder to the child when the child inherits two copies. Both parents have to donate this mutation to the child. 4. Which type of mutation is responsible for many single -gene genetic disorders? a. Copy number variations b. Nucleotide repeat expansions c. Point mutations d. Single nucleotide polymorphisms (SNP) ANS: C
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