Chapter 08: Developmental Management in Pediatric Primary Care

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

MULTIPLE CHOICE

1. A single mother of an infant worries that living in a household with only one parent will cause
her child to be maladjusted. To help address the mother’s concerns, the primary care pediatric
nurse practitioner will suggest
a. developing consistent daily routines for the child.
b. exposing her child to extended family members when possible.
c. not working outside the home during the first few years.
d. taking her child to regular play date activities with other children.
ANS: A
Providers can teach parents that providing predictable, consistent, and loving care helps an
infant to learn trust and help influence positive brain development. Involving extended family
members and going to play dates are good ways to socialize children but are not essential to
learning trust. It may not be possible for her to be a stay-at-home mother.

2. During a well child exam, the primary care pediatric nurse practitioner learns that the parents
of a young child fight frequently about finances. The parents state that they do not fight in
front of the child and feel that the situation is temporary and related to the father’s job layoff.
What will the nurse practitioner do?
a. Reassure them that the child is too young to understand.
b. Recommend that they continue to not argue in front of the child.
c. Suggest counseling to learn ways to handle stress.
d. Tell them that the conflict will resolve when the situation changes.
ANS: C
Marital problems can result in child behavior difficulties and anxieties, and conflict can be
picked up by the child. The parents should try to learn to modify unhealthy behaviors, such as
increased conflict during stressful situations. Even when children do not understand, they pick
up on cues from the parents about anxiety and stress and can internalize these feelings.
Avoiding arguments in front of the child does not alleviate the underlying conflict and stress.
The behavior of fighting during this stressful situation may indicate a pattern of response to
stress and will only recur with each subsequent stressful period.

3. The primary care pediatric nurse practitioner is examining a newborn infant recently
discharged from the neonatal intensive care unit after a premature birth. The parent is upset
and expresses worry about whether the infant will be normal. What will the nurse practitioner
do in this situation?
a. Explain to the parent that developmental delays often do not manifest at first.
b. Perform a developmental assessment and tell the parent which delays are evident.
c. Point out the tasks that the infant can perform while conducting the assessment.
d. Refer the infant to a developmental specialist for a complete evaluation.
ANS: C
When discussing developmental delays with parents, it is important to be positive and to
initially focus on strengths. Explaining that developmental delays develop over time is true
but does not reassure the parent or help the parent cope with feelings. Referrals are not
indicated unless delays are present and may take time.