Chapter 01: Health Status of Children: Global and National Perspectives

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

MULTIPLE CHOICE

1. Which region globally has the highest infant mortality rate?

a. Indonesia

b. Southern Asia

c. Sub-Saharan Africa

d. Syria

ANS: B

Although Sub-Saharan Africa and Southern Asia together account for 77% of the infant

mortality rate globally, Southern Asia has the highest infant mortality rate (39%) in the world

followed closely by Sub-Saharan Africa (38%).

2. The primary care pediatric nurse practitioner understands that, to achieve the greatest

world-wide reduction in child mortality from pneumonia and diarrhea, which intervention is

most effective?

a. Antibiotics

b. Optimal nutrition

c. Vaccinations

d. Water purification

ANS: C

Rotavirus is the most common cause of diarrhea globally and Strep pneumonia is the leading

cause of pneumonia, and together these are the leading infectious causes of childhood

morbidity and mortality globally. Both are vaccine-preventable diseases. Antibiotics to treat

pneumonia, optimal nutrition, and clean water all help to reduce morbidity and mortality, but

vaccination prevents the diseases from occurring.

3. Which statement correctly reflects the health status of children in the United States?

a. Globalism has relatively little impact on child health measures in the U.S.

b. Obesity rates among 2- to 5-year-olds have stabilized below Health People 2020

goal of 9.4%.

c. The rate of household poverty is lower than in other economically developed

nations.

d. Young children who attend preschool or day care have higher food insecurity.

ANS: B

Obesity rates are a major concern for child health in the U.S. but recently have stabilized at

8.9%. Globalism has an increasing effect on child health in the U.S. The rate of household

poverty in the U.S. is higher than in other economically developed nations. Young children

who attend preschool or day care have lower food insecurity.

4. The primary care pediatric nurse practitioner understands that what major child health

outcome is dramatically associated with worldwide climate change?

a. Housing

b. Education

c. Nutrition

d. Pollution

ANS: C

There is growing evidence that climate change is having a dramatic effect on food crops that

leads to food distribution issues and food insecurity among families.

5. When providing well child care for an infant in the first year of life, the primary care pediatric

nurse practitioner demonstrates an understanding of current guidelines when taking what

action?

a. Focusing less on development and more on illness prevention and nutrition.

b. Following guidelines established by the Bright Futures publication.

c. Scheduling well-baby visits to coincide with key developmental milestones.

d. Seeing the infant at ages 2, 4, 6, and 12 months when immunizations are due.

ANS: C

In the most recent AAP Recommendations for Preventive Pediatric Health Care, there is a

greater emphasis on behavioral and developmental issues and a recommendation that well

child care be based on child and family development rather than the periodicity of

immunization schedules.

Chapter 02: Unique Issues in Pediatrics

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

MULTIPLE CHOICE

1. What is the foundational basis of patient-and-family centered care (PFCC)?

a. The family is to be considered when patient care is being planned

b. The patient has ultimate control over health care decisions

c. A family member acts as the patient’s surrogate decision makes

d. The patient is the focus of the primary care provider’s attention

ANS: B

While all options are correct statements, the foundational basis of PFCC is the patient has

ultimate control over health care decisions.

2. Which assessment question best demonstrates the primary care provider’s understanding of

effectively dealing with the greatest challenge to providing dual patient care?

a. To the parent: “Do you feel comfortable providing in-home care for your child?”

b. To the child: “When would you like your physical therapy sessions to be

scheduled?”

c. To the parent: “What are your feelings about going to family therapy to help with

this transition?”

d. To the child: “When did you first notice the pain in your knees?”

ANS: B

One of the greatest challenges is how to access, acknowledge, and include the child’s voice,

which is often lost and/or overridden in health care. By directly asking the child their opinion

or feelings, the PCP is providing for the child’s voice to be heard and acknowledged. None of

the other options addresses that need.

3. Which intervention best demonstrates a pediatric nurse primary care pediatric nurse

practitioner’s understanding of effective pain assessment?

a. Providing instructions regarding the Faces pain assessment tool to parents of all

newly admitted children

b. Assisting in the development of a child-centered pain assessment scale

c. Reviewing the documentation regarding the child’s pain assessment 30 minutes

after analgesic medication was administered

d. Explaining to both the child and the parents why pain medication will be delivered

intravenously

ANS: B

In the past, clinicians and researchers have relied on adult-developed and adult-centered tools

and approaches, which have been “adapted” for use with children by adding pictures and/or

simpler language. There is increasing realization that data from adapted, adult-centered

models have has not adequately captured the voices and/or experiences of children. Engaging

in the development of an assessment tool that is child focused is the best demonstration of

understanding. All other options rely on adaptation of adult-centered tools or focus on

standard pain management related interventions.

4. Which theorist is responsible for presenting an alternative theory to those established theories

that focus on how the pediatric patient thinks?

a. Piaget

b. Vygotsky

c. Skinner

d. Bandura

ANS: B

Vygotsky and Siegler both provide pediatric primary care with a new understanding or

alternative lens through which to view children and childhood regarding how they think and

process information. The other options represent traditional theorists: Piaget does focus on

how children think while Skinner and Bandura are concerned with how children’s learning

and behavior is affected by experiences.

5. What is the strongest predictor of health regarding the pediatric patient?

a. The early identification of existing health problems

b. Health literacy of the parent(s) and/or caregiver(s)

c. Assess to specialized healthcare professionals

d. Past experience with same of similar health issues

ANS: B

The health literacy possessed by parents/caregivers is one of the strongest predictors of the

health of a pediatric patient. While the other options enhance good health outcomes, they are

all influenced by appropriate health literacy.