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.
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.
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.
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.
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.
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.
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."
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
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
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
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.
1. 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
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