Chapter 25: Introduction to Disease Management

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

MULTIPLE CHOICE

1. The primary care pediatric nurse practitioner uses a shared decision-making (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.
ANS: B
Patients who feel that they have been an active participant in the SDM process have improved
health outcomes. SDM does not require significantly more time per encounter. The PNP
remains actively involved in this collaborative process and will have improved satisfaction
along with the patients and families.

2. The primary care pediatric nurse practitioner diagnoses a 5-year-old child with asthma and
prescribes an oral steroid and a short-acting beta-adrenergic medication via a metered-dose
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
ANS: B
It is important to consider where the patient and family are in the trajectory of disease
diagnosis and management when providing education. They do not need all information in
one visit. Once the acute symptoms are managed, education for long-term management can
begin, including an asthma action plan, spirometry testing, and school management.

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 follow-up
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.
ANS: B
 Most parents are alert to subtle changes in their children, so it is important to listen attentively
when they voice their concerns. Children who have special health care needs merit closer
observation and follow-up than the average, thriving child. The child has a normal exam, so
does not need labs or X-rays or hospitalization, but the PNP should make sure the parent is
able to reach the provider when needed and should schedule an office follow-up to evaluate
changes in the child’s status. Reassuring the parent that things are fine only minimizes the
parent’s concerns.

4. The primary care pediatric nurse practitioner is preparing to perform a well child examination
on a 5-year-old 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. What will the nurse practitioner do:
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.
ANS: A
The mother is experiencing chronic sorrow, which involves feelings of anger, sadness, guilt,
or failure and which may be experienced at various times during her child’s life. The PNP
should be understanding about the mother’s anger and allow her to express her feelings. The
other options do not acknowledge her feelings or remove her sorrow.

5. 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 school-based 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
ANS: B
Children and youth with special health care needs should receive care in a medical home, and
the PNP’s main role is to coordinate care across specialties and disciplines to ensure
continuity of care. The other options describe tasks that may be performed by other members
of the child’s health care team and are not the primary role of the PNP.

6. 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
ANS: C
 The conventional radiograph is the least expensive test and will identify a foreign body. Even
though it involves radiation, it does not require sedation or anesthesia. An ultrasound is highly
dependent on operator experience but is not usually used for a quick location of a foreign
body. The CT scan is expensive and has a relatively large radiation exposure and is more
useful for identifying calcifications and fresh blood, along with abnormalities of blood
vessels. The MRI is expensive and requires sedation or anesthesia and is used to identify soft
tissue lesions.

7. The primary care pediatric nurse practitioner is assessing an ill 2-month-old 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.
ANS: C
Management of an acute illness in a 1- to 2-month-old infant depends on the results of
diagnostic studies, the appearance of the infant, and whether the infant can be followed up
within 24 hours. This infant does not appear to have a bacterial infection, is alert, and has
parents who can provide appropriate care and can bring the infant to the clinic in the morning
for follow-up. Unless a bacterial infection is suspected, antibiotics are not indicated. It is not
necessary to admit the infant to the hospital. The infant is hydrated and does not need
intravenous fluids.

8. 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.
ANS: A
Demonstration and return demonstration can be useful when teaching parents how to
administer oral medications to infants and young children. Since most outpatient medications
for children are oral suspensions, it is best to teach parents how to administer these and for
children to learn how to take them. Hiding the medication in food or fluids often results in the
medication not being taken if the child refuses the food or fluid. Giving the medication via
another route does not teach the child or parent how to use liquid oral medications. Offering a
reward is not usually recommended for something that the child is expected to do.

9. 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.” What does the nurse practitioner
expects the pulmonologist to do?
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.
ANS: B
A consult implies that the person being consulted will make recommendations for disease
management but that the primary care provider will continue to manage the patient’s care. The
consult in this case is not to confirm the diagnosis but to determine other treatment options.
There is no indication that nonadherence is the issue. The PNP has not asked the
pulmonologist to assume care for this child.

10. 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 do what?
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.
ANS: A
To avoid a data breach if a mobile device is lost, the user must disconnect from the device. It
is not enough to notify the families, since the information is still on the device.