Advanced Nursing Practice in Pediatric Primary Care Practicum Q & A, Exams of Nursing

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NURSING 73 38.

Advanced Nursing

Practice in Pediatric

Primary Care

Practicum

Q & A w/ Rationales

1. Which of the following is a critical component of advanced nursing practice in pediatric primary care? a) Managing chronic conditions b) Immunization administration c) Conducting school physical examinations d) Providing prenatal care Answer: a) Managing chronic conditions Rationale: Advanced nursing practice in pediatric primary care involves the management of chronic conditions, which includes providing comprehensive care and ensuring proper management of complex health issues in children.
2. What role does an advanced practice nurse play in the pediatric primary care setting? a) Collaborating with other healthcare providers b) Assisting with daily operations of the facility c) Conducting community health education programs d) Assisting in administrative tasks Answer: a) Collaborating with other healthcare providers Rationale: Advanced practice nurses in pediatric primary care work collaboratively with physicians, therapists, and other healthcare professionals to provide optimal care for children.
3. In the pediatric primary care setting, what is the main focus of health promotion and disease prevention?

Answer: a) Prescribing medication and providing treatment Rationale: Advanced practice nurses in pediatric primary care have the authority to prescribe medication and provide necessary treatment for children with chronic conditions, in collaboration with physicians.

6. Which statement best reflects the role of an advanced practice nurse in pediatric primary care during the prenatal period? a) Performing prenatal ultrasounds b) Providing genetic counseling to parents c) Identifying potential risks to the developing fetus d) Administering routine vaccinations to pregnant women Answer: c) Identifying potential risks to the developing fetus Rationale: Advanced practice nurses in pediatric primary care play a crucial role during the prenatal period by identifying potential risks to the developing fetus and providing appropriate guidance to expectant parents.
7. What is the primary objective of a pediatric primary care practicum? a) Development of cultural sensitivity b) Acquiring expertise in surgical procedures c) Exposure to various administrative tasks d) Achieving proficiency in advanced clinical skills Answer: d) Achieving proficiency in advanced clinical

skills Rationale: The primary objective of a pediatric primary care practicum is to enable nursing students to develop advanced clinical skills required to provide comprehensive care to children in a primary care setting.

8. Which step is essential in the management of pediatric patients with developmental delays? a) Referring patients for outpatient surgery b) Prescribing medication to alleviate symptoms c) Conducting developmental screening assessments d) Administering routine vaccinations Answer: c) Conducting developmental screening assessments Rationale: Early identification of developmental delays in children is crucial for timely intervention. Advanced practice nurses in pediatric primary care conduct developmental screening assessments to identify any delays and refer patients for appropriate intervention services.
9. In the context of pediatric primary care, what is the scope of practice for advanced practice nurses? a) Prescribing medication and surgical interventions b) Administration of anesthesia during surgical procedures c) Performing complex diagnostic tests and procedures d) Conducting comprehensive health assessments and providing primary care services Answer: d) Conducting comprehensive health assessments

A. MMR and varicella B. Hepatitis B and rotavirus C. Influenza and pneumococcal D. Meningococcal and diphtheria-tetanus-pertussis Answer: B. Hepatitis B and rotavirus Rationale: The CDC recommends initiating the hepatitis B and rotavirus vaccinations at the 2-month well-child visit to provide early protection against these diseases. Case Study Question 3: A 10-year-old child with asthma requires a long-term control medication. Which medication is considered a preferred option for this age group? A. Montelukast B. Fluticasone C. Albuterol D. Ipratropium Answer: B. Fluticasone Rationale: Fluticasone is a preferred long-term control medication for asthma in children due to its efficacy in reducing airway inflammation and its favorable safety profile. Case Study Question 4: A 6-year-old child presents with symptoms suggestive of attention-deficit/hyperactivity disorder (ADHD). What is the initial step in the assessment and management of ADHD in primary care?

A. Initiate stimulant medication B. Conduct a thorough physical examination C. Refer the child to a child psychologist D. Obtain a detailed developmental history Answer: D. Obtain a detailed developmental history Rationale: Obtaining a detailed developmental history is the initial step in the assessment and management of ADHD in primary care, as it helps in understanding the child's behavior across different settings and developmental stages. Case Study Question 5: A 14-year-old adolescent presents with symptoms of depression. What evidence-based screening tool should be used to assess the severity of the adolescent's depressive symptoms? A. Pediatric Symptom Checklist B. Patient Health Questionnaire-9 (PHQ-9) C. Vanderbilt Assessment Scale D. Revised Children's Manifest Anxiety Scale Answer: B. Patient Health Questionnaire-9 (PHQ-9) Rationale: The PHQ-9 is an evidence-based screening tool commonly used to assess the severity of depressive symptoms in adolescents, making it suitable for this scenario. Case Study Question 6: A 3-year-old child presents with a rash and fever. The

Case Study Question 8: A 16-year-old adolescent requests confidential care for contraception. What is the legal basis for providing confidential care to minors seeking reproductive health services? A. HIPAA regulations B. Title X funding C. Emancipation laws D. Mature minor doctrine Answer: D. Mature minor doctrine Rationale: The mature minor doctrine allows healthcare providers to provide confidential care to minors who demonstrate the maturity and understanding to make informed decisions about their reproductive health without parental consent. Case Study Question 9: A 7-year-old child presents with a laceration on the forearm that requires suturing. What is the most appropriate method for managing pain during the suturing procedure? A. Topical lidocaine cream B. Intranasal fentanyl spray C. Oral acetaminophen D. Subcutaneous injection of lidocaine Answer: A. Topical lidocaine cream Rationale: Topical lidocaine cream is a suitable method

for managing pain during suturing in children, as it provides local anesthesia without the need for injections. Case Study Question 10: A 5-year-old child is scheduled for a tonsillectomy due to recurrent tonsillitis. What postoperative complication should the nurse practitioner monitor for in the immediate postoperative period? A. Otitis media B. Hemorrhage C. Pneumonia D. Vocal cord paralysis Answer: B. Hemorrhage Rationale: Hemorrhage is a potential postoperative complication of tonsillectomy, and the nurse practitioner should closely monitor the child for signs of bleeding in the immediate postoperative period. Case Study Question 11: A 9-year-old child with type 1 diabetes presents for a follow-up visit. The nurse practitioner reviews the child's self-monitoring blood glucose records and notes frequent hypoglycemic episodes. What initial intervention should be implemented to address the hypoglycemia? A. Adjust insulin dosages B. Increase carbohydrate intake C. Initiate continuous glucose monitoring D. Educate the child on recognizing hypoglycemic symptoms

C. Fluid restriction in the evening D. Behavioral modification techniques Answer: D. Behavioral modification techniques Rationale: Behavioral modification techniques, such as bladder training and positive reinforcement, are recommended as the initial management approach for persistent nocturnal enuresis in young children. Case Study Question 14: A 8-year-old child with a history of frequent urinary tract infections (UTIs) presents for a follow-up visit. What preventive measure should the nurse practitioner recommend to reduce the risk of recurrent UTIs? A. Prophylactic antibiotic therapy B. Increased fluid intake C. Voiding after intercourse D. Cranberry juice supplementation Answer: B. Increased fluid intake Rationale: Increased fluid intake is a preventive measure that can help reduce the risk of recurrent UTIs in children by promoting frequent urination and flushing bacteria from the urinary tract. Case Study Question 15: A 11-year-old child is prescribed methylphenidate for attention-deficit/hyperactivity disorder (ADHD). What information should the nurse practitioner provide to the child and parents regarding medication administration?

A. Administer with food to enhance absorption B. Monitor for signs of tics and dyskinesias C. Discontinue medication during school holidays D. Avoid co-administration with vitamin C supplements Answer: B. Monitor for signs of tics and dyskinesias Rationale: Monitoring for signs of tics and dyskinesias is important when administering methylphenidate to children with ADHD, as these medication-related adverse effects should be promptly identified and managed. C:

1. A 10-year-old boy presents with a history of recurrent otitis media and sinusitis. He has been treated with multiple courses of antibiotics, but his symptoms persist. His physical examination reveals pale nasal mucosa, enlarged tonsils and adenoids, and fluid in both ears. What is the most appropriate diagnostic test to order for this patient? a) Allergy skin testing b) Nasal endoscopy c) Tympanometry* d) CT scan of the sinuses Rationale: Tympanometry is a test that measures the mobility of the tympanic membrane and the middle ear pressure. It can detect the presence of fluid in the middle ear, which is a common cause of recurrent otitis media and sinusitis in children. Allergy skin testing, nasal endoscopy,

therapy? a) Continue the same regimen b) Increase the dose of the inhaled corticosteroid c) Add a long-acting beta-agonist d) Step down the inhaled corticosteroid* Rationale: The goal of asthma therapy is to achieve and maintain good control of symptoms and lung function with the lowest possible dose of medication. According to the National Asthma Education and Prevention Program guidelines, if a patient has well-controlled asthma for at least three months, the therapy can be stepped down by reducing the dose of the inhaled corticosteroid by 25% to 50%. Increasing the dose of the inhaled corticosteroid or adding a long-acting beta-agonist are options for patients who have poorly controlled asthma.

4. A 4 - year-old boy is brought to the clinic by his father, who reports that his son has been having frequent nosebleeds for the past month. The nosebleeds occur spontaneously, last for about 10 minutes, and stop with pressure. The boy has no history of trauma, allergies, or bleeding disorders. His physical examination reveals no abnormalities except for some dried blood in his nostrils. What is the most likely cause of his nosebleeds? a) Foreign body b) Nasal polyps c) Anterior nasal septal erosion* d) Coagulopathy Rationale: Anterior nasal septal erosion is a common cause of nosebleeds in children. It is due to dryness and irritation

of the mucosa that covers the anterior part of the nasal septum, which contains many fragile blood vessels. Foreign body, nasal polyps, and coagulopathy are less common causes of nosebleeds in children and would have other associated findings or symptoms.

5. A 2-year-old girl is brought to the clinic by her mother, who reports that her daughter has been having recurrent episodes of wheezing and coughing for the past six months. The episodes are triggered by viral respiratory infections, cold air, exercise, or exposure to smoke or dust. The girl has no history of eczema or food allergies. Her physical examination is normal except for some expiratory wheezes on auscultation. What is the most likely diagnosis for this patient? a) Asthma* b) Bronchiolitis c) Cystic fibrosis d) Gastroesophageal reflux disease Rationale: Asthma is a chronic inflammatory disorder of the airways that causes reversible bronchoconstriction and increased mucus production. It is characterized by recurrent episodes of wheezing, coughing, chest tightness, and dyspnea that are triggered by various factors. Bronchiolitis is an acute viral infection of the lower respiratory tract that causes wheezing and coughing in infants and young children, but it is not a chronic condition. Cystic fibrosis is a genetic disorder that affects the exocrine glands and causes thick mucus to accumulate in the lungs, pancreas, and other organs. It is associated with chronic respiratory