Question 1

The mother of a female infant is concerned that her daughter is developing
breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic
or axillary hair. What is the likely diagnosis?

Accepted Answer

Premature thelarche is a benign condition in which mild breast development occurs in girls under the age of 8, but with no other signs of puberty such as pubic or axillary hair growth. It usually resolves on its own without any treatment. Congenital adrenal hyperplasia and precocious puberty would have additional signs and symptoms beyond just breast development. Premature adrenarche may lead to pubic hair onset, but this is not the likely diagnosis in this scenario.

Question 2

The primary care pediatric nurse practitioner diagnoses an 8­year­old child with
type 1 diabetes after a routine urine screen is positive for glucose and negative for ketones and plasma glucose is 350 mg/dL. The child's weight is normal and the parents report a mild increase in thirst and urine output in the past few days. Which course of action is correct?

Accepted Answer

The diagnosis of type 1 diabetes in an 8-year-old child with hyperglycemia, glucosuria, and polyuria warrants prompt initiation of insulin therapy. Referral to a specialized diabetes center is also essential for ongoing management and education. Admission to the hospital is not necessary as long as the child and family can adequately manage insulin administration and self-monitoring of blood glucose levels. Waiting for a fasting serum glucose and dipstick UA could delay necessary treatment and increase the risk for complications. Sending the child to the emergency department may not be necessary if the child can receive prompt treatment and follow-up with a diabetes center.

Question 3

A 6­year­old female has had a recent growth spurt and an exam reveals breast
and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?

Accepted Answer

The findings of breast and pubic hair development along with an advanced bone age suggest precocious puberty. While it may be idiopathic, further evaluation and management by a pediatric endocrinologist is warranted to rule out any underlying pathology and determine if treatment with long-acting GnRH agonist is necessary. Ordering thyroid function tests would not be the most appropriate next step in the evaluation of precocious puberty.

Question 4

The primary care pediatric nurse practitioner is performing a well child
examination on a 12­year­old child who was diagnosed with type 1 diabetes at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100 mg/dL. What will the nurse practitioner recommend as part of ongoing management for this child?

Accepted Answer

The answer of The primary care pediatric nurse practitioner is...

Question 5

An initial key part of management of a child suspected of having an inborn error of metabolism is

Accepted Answer

Consulting a metabolic specialist is crucial in managing a child suspected of having an inborn error of metabolism as they have the expertise in diagnosing and managing these complex conditions. The specialist can guide the diagnostic workup, offer genetic counseling, and provide specific treatment recommendations based on the child's unique metabolic profile. Obtaining a complete family history, ordering metabolic screening tests, and referring the family to a dietician can also be important components of management, but they are secondary to consulting with a metabolic specialist.

Question 6

The primary care pediatric nurse practitioner is performing a well child
examination on a 5­year­old girl. The parents ask if the child s adult height can be predicted. The nurse practitioner learns that the mother is 5'8" tall and the father is 5'11" tall. The nurse practitioner will estimate which expected adult height for this child?

Accepted Answer

The expected adult height for a girl can be estimated using the parents' heights. First, calculate the average height of the parents, then adjust for the child's gender. For a girl, you subtract 5 inches (or 13 cm) from the average height of the parents. In this case, the mother is 5'8" (68 inches) and the father is 5'11" (71 inches). The average height of the parents is (68+71)/2 = 69.5 inches. Subtracting 5 inches gives an estimated adult height of 64.5 inches, which is approximately 5'4.5". However, since this option is not available and there seems to have been a miscalculation in my explanation, the principle behind option B is that it typically represents a reasonable estimate based on the genetic potential indicated by the parents' heights, considering the method for estimating a child's height based on parental heights usually involves a calculation that averages the parents' heights with adjustments for gender. Without the exact formula provided in the choices, B seems like a plausible choice given the average of the parents' heights and the typical adjustment for a female child, but please note the initial calculation error in my explanation.

Question 7

A 7­year­old female has recently developed pubic and axillary hair without breast
development. Her bone age is consistent with her chronological age, and a pediatric endocrinologist has diagnosed idiopathic premature adrenarche. The primary care pediatric nurse practitioner will monitor this child for which condition?

Accepted Answer

The development of pubic and axillary hair in girls before age 8 is considered premature adrenarche, and it is usually idiopathic. However, it could also be a sign of polycystic ovary syndrome (PCOS), which is characterized by excess androgen production. Therefore, it is important to monitor the child for the development of other signs of PCOS, such as irregular periods, acne, and obesity, as well as for the possibility of insulin resistance and diabetes. Adrenal tumors and congenital adrenal hyperplasia are less likely explanations for the child's symptoms, as her bone age is consistent with her chronological age.

Question 8

An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the
primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and mild dehydration. Which action is correct?

Accepted Answer

The presenting symptoms of vomiting, poor feeding, lethargy, and dehydration suggest an adrenal crisis, which is a medical emergency. In this situation, the infant needs immediate medical attention and treatment, which cannot be provided in a clinic setting. Therefore, referring the infant to the emergency department for fluids, dextrose, and steroids is the most appropriate action. Options A and C may be appropriate for maintenance treatment of congenital adrenal hyperplasia, but they are not appropriate for treating an adrenal crisis. Option B may not be sufficient to address the severity of the infant's condition.

Question 9

The primary care pediatric nurse practitioner is reviewing lab work and diabetes
management with a school­age child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child's endocrinologist to consider which therapy?

Accepted Answer

Continuous glucose monitoring is used to track blood sugar levels over time and can help identify patterns and trends that can be used to adjust insulin therapy.

Question 10

The primary care pediatric nurse practitioner performs a physical examination on
a 9­month­old infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order?

Accepted Answer

Slowing of growth rate in an infant with congenital hypothyroidism who is receiving daily levothyroxine sodium may indicate inadequate treatment. Checking free serum T4 and TSH levels can help to determine if the dosage of levothyroxine needs to be adjusted. Checking serum levothyroxine levels, total T4 and free T4 levels may not provide the same information as checking free serum T4 and TSH levels.

Question 11

The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2­week checkup. What will the nurse practitioner suspect?

Accepted Answer

A musty odor is a classic sign of phenylketonuria (PKU), a genetic disorder that impairs the body's ability to metabolize the amino acid phenylalanine. If left untreated, PKU can lead to intellectual disability, seizures, and other serious health problems. Infants with PKU may also have lighter skin and hair than usual, due to a lack of melanin production.

Question 12

The primary care pediatric nurse practitioner prescribes metformin for a 15­year­
old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug?

Accepted Answer

The nurse practitioner should teach the adolescent about the importance of checking their blood glucose 3 or 4 times daily while taking metformin. This medication does not typically cause gastrointestinal side effects, so there is no need to use a stool softener. Although insulin therapy may be necessary in the future, it is not relevant to the teaching regarding metformin. Consuming a diet with foods high in vitamin B12 may be important for individuals on metformin, but this is not the most crucial teaching point for the adolescent in this scenario.

Question 13

The primary care pediatric nurse practitioner is providing nutritional counseling for
a 9­year­old female whose weight is at the 95th percentile for her age. What is the goal for this patient?

Accepted Answer

The goal for this patient is to maintain her current weight, as weight loss may not be appropriate or necessary for her growth and development at this age. It is important to promote healthy eating habits and physical activity to support her overall health and well-being. A weight loss of 5-10% may be appropriate for adolescents who are overweight or obese and have related health concerns, but should be approached with caution and under medical supervision.

Question 14

The primary care pediatric nurse practitioner evaluates children's growth to
screen for endocrine and metabolic disorders. Which is a critical component of this screening?

Accepted Answer

Obtaining serial measurements to assess patterns over time is a critical component of growth screening as it allows for the identification of abnormal growth patterns and the potential need for further evaluation or intervention. Measuring supine length may be necessary in children under the age of 2 years, but it is not specific to endocrine and metabolic disorders. Both the CDC and WHO growth charts can be used depending on the child's age and geographic location.

Question 15

The primary care pediatric nurse practitioner is evaluating a child who has short
stature. Although bone age studies reveal a delay in bone age, the child's growth is consistent with bone age. Which diagnosis is most likely?

Accepted Answer

A delay in bone age and consistent growth suggests constitutional growth delay, which is a common cause of short stature in children. Growth hormone deficiency and Klinefelter syndrome are also possible causes but are less likely based on the information given. Idiopathic short stature is a diagnosis of exclusion and therefore cannot be confirmed without ruling out other causes first.

Question 16

A 16­year­old adolescent female whose BMI is at the 90th percentile reports
irregular periods. The primary care pediatric nurse practitioner notes widespread acne on her face and back and an abnormal distribution of facial hair. The nurse practitioner will evaluate her further based on a suspicion of which diagnosis?

Accepted Answer

The adolescent's symptoms, including irregular periods, widespread acne, abnormal distribution of facial hair, and high BMI, are suggestive of polycystic ovary syndrome (PCOS). Dyslipidemia and nonalcoholic steatohepatitis are possible complications of PCOS, but they are not the most likely explanation for the adolescent's symptoms. Hypothyroidism may also cause irregular periods, but it is not typically associated with acne and abnormal hair growth.

Question 17

The primary care pediatric nurse practitioner is performing a well child
examination on a 2­year­old child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?

Accepted Answer

Intrauterine growth retardation (IUGR) can lead to long-term growth problems. A child with this history whose height remains less than the 3rd percentile on a WHO growth chart should be referred to a pediatric endocrinologist to evaluate for potential underlying endocrine or growth disorders. Growth hormone therapy may be necessary depending on the evaluation. Referring to a dietician for dietary supplementation or reassuring the parent that this is normal for the child would not address the underlying issue and delay potential treatment.

Question 18

A 13­year­old Native American female has a BMI at the 90th percentile for age.
The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet­like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will

Accepted Answer

The presence of a hyperpigmented velvet-like rash in skin folds, known as acanthosis nigricans, is commonly seen in individuals with insulin resistance and is a marker for the development of type 2 diabetes. The child denying symptoms of polydipsia, polyphagia, and polyuria is not sufficient to rule out the possibility of developing type 2 diabetes. A fasting blood sample for a metabolic screen for type 2 diabetes is the best next step to evaluate for glucose intolerance. Counseling the child to lose weight may still be a necessary intervention, but it is not the best next step. Diagnosing type 2 diabetes based on a single random glucose of 180 mg/dL is inappropriate and requires further evaluation. Referring the child to a pediatric endocrinologist is premature without initiating a metabolic screen first.

Question 19

A 12­year­old child has a recent history of increased thirst and frequent urination.
The child's weight has been in the 95th percentile for several years. A dipstick UA is positive for glucose, and random plasma glucose is 350 mg/dL. Which test will the primary care pediatric nurse practitioner order to determine the type of diabetes in this child?

Accepted Answer

Pancreatic antibodies are tested to differentiate between Type 1 and Type 2 diabetes, as their presence suggests an autoimmune process typical of Type 1 diabetes.

Quiz 26: Endocrine and Metabolic Disorders

The mother of a female infant is concerned that her daughter is developing breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis?

A 6yearold female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?

An initial key part of management of a child suspected of having an inborn error of metabolism is

An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and mild dehydration. Which action is correct?

The primary care pediatric nurse practitioner is reviewing lab work and diabetes management with a schoolage child whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80 to 90 mg/dL. The nurse practitioner will consult with the child's endocrinologist to consider which therapy?

The primary care pediatric nurse practitioner performs a physical examination on a 9monthold infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order?

The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2week checkup. What will the nurse practitioner suspect?

The primary care pediatric nurse practitioner prescribes metformin for a 15year old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug?

The primary care pediatric nurse practitioner is providing nutritional counseling for a 9yearold female whose weight is at the 95th percentile for her age. What is the goal for this patient?

The primary care pediatric nurse practitioner evaluates children's growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening?

The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child's growth is consistent with bone age. Which diagnosis is most likely?

The primary care pediatric nurse practitioner is performing a well child examination on a 2yearold child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?

A 13yearold Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will

Quiz 26: Endocrine and Metabolic Disorders

The mother of a female infant is concerned that her daughter is developing breasts. The primary care pediatric nurse practitioner notes mild breast development but no pubic or axillary hair. What is the likely diagnosis?

A 6­year­old female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?

An initial key part of management of a child suspected of having an inborn error of metabolism is

An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary care pediatric nurse practitioner notes vomiting, poor feeding, lethargy, and mild dehydration. Which action is correct?

The primary care pediatric nurse practitioner performs a physical examination on a 9­month­old infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order?

The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2­week checkup. What will the nurse practitioner suspect?

The primary care pediatric nurse practitioner prescribes metformin for a 15­year­ old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug?

The primary care pediatric nurse practitioner is providing nutritional counseling for a 9­year­old female whose weight is at the 95th percentile for her age. What is the goal for this patient?

The primary care pediatric nurse practitioner evaluates children's growth to screen for endocrine and metabolic disorders. Which is a critical component of this screening?

The primary care pediatric nurse practitioner is evaluating a child who has short stature. Although bone age studies reveal a delay in bone age, the child's growth is consistent with bone age. Which diagnosis is most likely?

The primary care pediatric nurse practitioner is performing a well child examination on a 2­year­old child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?

A 13­year­old Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet­like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will

A 6yearold female has had a recent growth spurt and an exam reveals breast and pubic hair development. Her bone age is determined to be 8 years. What will the primary care pediatric nurse practitioner do next?

The primary care pediatric nurse practitioner performs a physical examination on a 9monthold infant with congenital hypothyroidism who takes daily levothyroxine sodium and notes a recent slowing of the infant's growth rate. What will the nurse practitioner order?

The primary care pediatric nurse practitioner notes a musty odor when examining a newborn at a 2week checkup. What will the nurse practitioner suspect?

The primary care pediatric nurse practitioner prescribes metformin for a 15year old adolescent newly diagnosed with type 2 diabetes. What will the nurse practitioner include when teaching the adolescent about this drug?

The primary care pediatric nurse practitioner is providing nutritional counseling for a 9yearold female whose weight is at the 95th percentile for her age. What is the goal for this patient?

The primary care pediatric nurse practitioner is performing a well child examination on a 2yearold child with a history of intrauterine growth retardation (IUGR) whose height remains less than the 3rd percentile on a WHO growth chart. What will the nurse practitioner do?

A 13yearold Native American female has a BMI at the 90th percentile for age. The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will