Deck 21: Introduction to Disease Management

Question 1

The primary care pediatric nurse practitioner uses a shared decision­making
(SDM) model when working with families of children with chronic health conditions. When using this model, the nurse practitioner can expect
A. considerably more time in each encounter.
B. improved patient health outcomes.
C. less PNP involvement in health care decisions.
D. lower provider and higher patient satisfaction.

Answer 1

improved patient health outcomes.

Question 2

The parent of a toddler who has special health care needs is resistant to a
suggestion that her child needs a gastrostomy tube for nutrition. The toddler has fallen from the 10th percentile to the 5th percentile in the past few months and resists taking in appropriate amounts of food by mouth even with assistance from occupational therapy. What will the primary care pediatric nurse practitioner do?
A. Inform the mother that, since other options have failed, the gastrostomy tube is the only option.
B. Refer the child to a dietician to teach the mother the importance of adequate nutrition.
C. Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight.
D. Suggest that the gastrostomy tube may be tried temporarily and removed once the child gains weight.

Answer 2

Set weight gain and food intake goals with the mother and schedule regular visits to monitor weight.

Question 3

The parent of a child with complex health care needs tells the primary care
pediatric nurse practitioner that the child has had difficulty breathing the past two nights but can't articulate specific symptoms. The child has normal oxygen saturations and a normal respiratory rate with clear breath sounds. What will the nurse practitioner do?
A. Admit the child to the hospital for close observation and monitoring of respiratory status.
B. Encourage the parent to call when concerned and schedule a follow­up appointment the next day.
C. Perform a complete blood count, blood cultures, and a chest radiograph to evaluate symptoms.
D. Reassure the parent that the child has a normal exam and is most likely not ill.

Answer 3

Encourage the parent to call when concerned and schedule a follow­up appointment the next day.

Question 4

The primary care pediatric nurse practitioner is preparing to perform a well child
examination on a 5­year­old child who has multiple developmental and cognitive delays. The child's mother is angry and tells the nurse practitioner that her friends' children are all preparing for kindergarten. The nurse practitioner will
A. allow the mother to express her feelings, understanding that she is experiencing grief.
B. reassure the mother that special educational opportunities are available for her child.
C. suggest that the mother find a support group with other children with special needs.
D. tell her that most schools provide services for children with special health care needs.

Question 5

Which characteristic is the key criterion that identifies a child has having special needs?
A. Cognitive function
B. Emotional health
C. Health service requirements
D. Medical diagnosis

Question 6

What is the most important role of the primary care pediatric nurse practitioner
who provides care for a child with special health care needs who sees several specialists and receives community and school­based services?
A. Assessing the parent's ability to perform home care tasks
B. Coordinating services to ensure continuity of care
C. Monitoring the family's adherence to the health care plan
D. Ordering medications and other prescribed treatments

Question 7

The primary care pediatric nurse practitioner cares for several families with
chronically ill children who text status updates about their children to a mobile device that has an encryption­ protection platform installed. If the nurse practitioner misplaces the mobile device, it is important to
A. disconnect the user from the system to avoid a data breach.
B. notify the families that their messages may be read by others.
C. obtain a new device as soon as possible to resume communication.
D. upload the messages from another remote device.

Question 8

A toddler swallowed a coin several days prior. The child's parent has not found
the coin in the child's stool. Which imaging test will the primary care pediatric nurse practitioner employ to evaluate this ingestion?
A. Abdominal ultrasound
B. Computed tomography
C. Conventional radiograph
D. Magnetic resonance imaging

Question 9

The parent of an 18­month­old child calls the clinic to report that the child has a
rectal temperature of 100.4°F (38°C). The child is playing normally, taking fluids well, and has a slightly reduced appetite. What will the primary care pediatric nurse practitioner recommend?
A. Administering an antipyretic medication
B. Bringing the child to the clinic for evaluation
C. Offering extra fluids and calling if symptoms change
D. Ordering outpatient lab work such as a CBC

Question 10

The primary care pediatric nurse practitioner diagnoses a 5­year­old child with
asthma and prescribes an oral steroid and a short­acting beta­adrenergic medication via a metered­dose inhaler to manage acute symptoms. Along with education about the prescribed medications, what information is important to give the child's family at this visit?
A. An asthma action plan
B. Effects and side effects of current medications
C. Information about spirometry testing
D. Instructions for medications at school

Question 11

The primary care pediatric nurse practitioner is assessing an ill 2­month­old infant
who is febrile and refusing most fluids. The preliminary blood work indicates a viral infection and shows that the infant is hydrated. The infant is alert. The infant's parents are attentive and live close by. What will the nurse practitioner do?
A. Administer a parenteral antibiotic and antipyretic and send the infant home.
B. Admit the infant to an inpatient hospital unit for overnight monitoring.
C. Give the parents sick care instructions and follow up in the clinic in the morning.
D. Send the infant to the urgent care center for intravenous fluids.

Question 12

A toddler is prescribed a liquid oral medication. The parent tells the primary care
pediatric nurse practitioner that the child refuses to take medications and usually spits them out. What will the nurse practitioner do?
A. Demonstrate oral medication administration with the toddler in the office.
B. Instruct the parent to hide the medication in a favorite food or beverage.
C. Order the medication to be given via another route if possible.
D. Tell the parent to offer the child a reward each time the medication is taken.

Question 13

The primary care pediatric nurse practitioner orders a pulmonology consult for a
child who has severe asthma. The nurse practitioner writes "child with asthma refractory to conventional treatments needs suggestions for alternative treatments." The nurse practitioner expects the pulmonologist to
A.
A. confirm the medical diagnosis for the child's parents.
B. make recommendations for disease management.
C. stress the importance of adherence to the medication regimen.
D. take over management of this child's chronic illness.

Question 14

A parent brings a 4­month­old infant to the clinic who has had a low­grade fever
for 24 hours. The primary care nurse practitioner notes that the infant has a weak cry, slightly dry oral mucosa, mottled skin, and a respiratory rate of 65 breaths per minute and sleeps unless stimulated by the examiner,. What will the nurse practitioner do?
A. Administer oral fluids in the clinic.
B. Admit the infant to the hospital.
C. Order outpatient laboratory tests.
D. Send the infant home with close follow­up.

Question 15

The parent of a preschool­age child calls the clinic to report that the child has
clear, watery drainage from both eyes, mild erythema of the conjunctiva, and no fever or other symptoms. What will the primary care pediatric nurse practitioner recommend?
A. Allow the child to go to preschool.
B. Bring the child to the clinic for a culture.
C. Keep the child home for 2 days.
D. Use antibiotic eyedrops for 3 days..

Question 16

The primary care pediatric nurse practitioner is performing a well baby
examination on a 2­week­old infant who was recently discharged home from the neonatal intensive care unit. The mother reports that the infant was born at 26 weeks' gestation and states she was told that her baby will probably have developmental delays. What is the most important aspect of long­term management for this infant?
A. Careful monitoring of attainment of developmental milestones
B. Familiarizing the parent with laws that mandate educational support
C. Providing genetic counseling to the infant's parents
D. Referral to social services for assistance with resources