Child and Family Health Assessment Test Bank
Child and Family Health Assessment Test Bank
Burns: Pediatric Primary Care, 6th Edition
Chapter 2: Child and Family Health Assessment
Test Bank
Multiple Choice
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. Child and Family Health Assessment Test Bank.
d. Tell the parent that this result indicates that the child has autism.
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. Child and Family Health Assessment Test Bank.
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
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? Child and Family Health Assessment Test Bank.
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
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?
a. DC: 0-3R
b. ICD-10-CM
c. ICSD-3
d. NANDA International
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. Child and Family Health Assessment Test Bank.
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
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?
a. Fine motor
b. Gross motor
c. Social/emotional
d. Speech and language
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? Child and Family Health Assessment Test Bank.
a. Altered elimination pattern
b. Elimination disorder
c. Encopresis
d. Parenting alteration
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?
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
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. Child and Family Health Assessment Test Bank.
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
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?
a. Metabolic syndrome
b. Nutritional alteration: more than required
c. Obesity
d. Rule out type 2 diabetes mellitus
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. Child and Family Health Assessment Test Bank.
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
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? Child and Family Health Assessment Test Bank.
a. CRAFFT
b. HEEADSSS
c. PHQ-2
d. RAAPS
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?
a. Failure to thrive
b. Home care resources inadequate
c. Nutrition alteration – less than required
d. Parenting alteration
ANS: D
Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the correct diagnosis should be “Parenting alteration.” “Failure to thrive” is a medical diagnosis and requires a medical and social evaluation to rule out organic causes or detect neglect. “Home care resources inadequate” would be used if the PNP suspects that the family lacks adequate funds to purchase food. “Nutrition alteration” is a NANDA diagnosis and would be used if the PNP planned to consult with a dietician or give nutritional information. Child and Family Health Assessment Test Bank.
Week 9 Quiz
Question 1
0 / 1 point
A client presents to clinic for the first time. The provider discovers that the client was diagnosed with Prader-Willi Syndrome. What symptoms does the provider expect to find during this encounter?
Hyperphasia, obesity, and strabismus
Lethargy, stridor, and irritability
Low-set ears, short stature, and webbed neck
Flat nasal bridge, epicanthal folds, and heart murmur
Question 2
Child and Family Health Assessment Test Bank
0 / 1 point
A client with Prader-Willi syndrome, well-known to the clinic, presents today for an annual physical. This client is at higher risk and should be screened for what medical condition?
Depression
Pyloric Stenosis
Celiac disease
Type 2 diabetes mellitus
Question 3
0 / 1 point
A new client presents to the clinic to establish care. On exam, the provider notes the following: a long narrow face, high-arched palate and dental crowding, prominent ears, strabismus, macroorchidism, short stature, cognitive impairments and stereopathies. What would be the most likely diagnosis?
Fragile X
Prader-Willi
Angelman
Beckwith-Weidemann
Question 4
1 / 1 point
If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Failure to thrive, Central obesity, Enamel hypoplasia, Scoliosis, Motor delays, Mild intellectual disability and Compulsive hyperphagia; what would be the most likely diagnosis?
Fragile X
Prader-Willi
Angelman
Beckwith-Weidemann
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Child and Family Health Assessment Test Bank
Question 5
0 / 1 point
If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Seizures, Global developmental delays, Abnormal gait, arms held high/flexed elbows, Hypotonic trunk with hypertonic limbs (commando crawl), Feeding/growth problems, Acquired microcephaly, Speech delay, Spontaneous (persistent) social smile/fits of laughter, and Loves water. What would be the most likely diagnosis?
Fragile X
Prader-Willi
Angelman
Beckwith-Weidemann
Question 6
0 / 1 point
If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Omphalocele or umbilical hernia, macroglossia, facial features: Nevus flammeus, helical pits, prominent eyes, anterior ear lobe creases, Large placenta/long umbilical cord, Hypoglycemia, Cardiomegaly, Dental malocclusion with maxillary underdevelopment, and Articulation issues. What would be the most likely diagnosis? Child and Family Health Assessment Test Bank.
Fragile X
Prader-Willi
Angelman
Beckwith-Weidemann
Question 7
1 / 1 point
If a client is positive for any of the following categorical clinical findings and developmental deficiencies: tall, long limbs, aortic root dilatation, mitral valve prolapse/regurgitation, ectopia lentis, myopia, retinal detachment, exotropia/strabismus, spontaneous pneumothorax, connective tissue problems, pectus deformities, joint hyperextensibility. What would be the most likely diagnosis?What would be the most likely diagnosis?
Turner
DiGeorge
Marfan
Huntington
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Question 8
0 / 1 point
What is true about diploid cells? (select all that apply)
Each contains 23 paired chromosomes.
Each one contains 23 chromosomes.
Replication produces two identical cells.
They replicate via the process of mitosis.
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Question 9
0 / 1 point
Cystic fibrosis is a genetic disorder that affects the cells that produce mucus, sweat, and digestive juices. It is considered a recessive disease caused by a gene mutation on both alleles inherited from the parents. Which type of genetic disorder is this?
Chromosome
Mitochondrial
Monogenetic
Multifactorial
Question 10
1 / 1 point
Which diagnostic test is most appropriate when a provider wishes to identify and evaluate the size, shape, and number of chromosomes of a client? Child and Family Health Assessment Test Bank
Chromosomal microarray
Fluorescence in-situ hybridization
Karyotype
Molecular testing
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Karyotype testing is used to identify and evaluate the size, shape, and number of chromosomes
The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history?
a. Complementary medications, alternative health practices, and chief complaint
b. Developmental delays, nutritional status, and linear growth patterns
c. Medication currently taking, allergy information, and family medical history
d. Speech and language development, beliefs about health, and previous illnesses
ANS: D
An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language development), functional health problems (beliefs about health), and diseases (chief complaint). The other examples all use domains associated with the traditional medical model and do not contain nursing aspects associated with functional health problems. Child and Family Health Assessment Test Bank.
