Table Of ContentPEDIATRIC NURSE
PRACTITIONER
CERTIFICATION
REVIEW GUIDE
Fifth Edition
Primary Care
Edited by
JoAnne Silbert-Flagg, DNP, CPNP, IBCLC
Assistant Professor
Johns Hopkins University School of Nursing
Baltimore, Maryland
Elizabeth Sloand, PhD, CRNP
Assistant Professor
Coordinator, Pediatric Nurse Practitioner Track
Johns Hopkins University School of Nursing
Baltimore, Maryland
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Library of Congress Cataloging-in-Publication Data
Pediatric nurse practitioner certifi cation review guide : primary care. — 5th ed. / [edited by] JoAnne Silbert-Flagg and Elizabeth
Sloand.
p. ; cm.
Rev. ed. of: Pediatric nurse practitioner certifi cation review guide / editors, Virginia Layng Millonig, Caryl E. Mobley. 4th ed.
c2004.
Includes bibliographical references and index.
ISBN-13: 978-0-7637-7598-8 (alk. paper)
ISBN-10: 0-7637-7598-3 (alk. paper)
1. Pediatric nursing—Outlines, syllabi, etc. 2. Examinations—Study guides. I. Silbert-Flagg, JoAnne. II. Sloand, Elizabeth. III.
Millonig, Virginia Layng. Pediatric nurse practitioner.
[DNLM: 1. Pediatric Nursing—Examination Questions. 2. Pediatric Nursing—Outlines. 3. Licensure, Nursing—standards—
Examination Questions. 4. Licensure, Nursing—standards—Outlines. 5. Nurse Practitioners--Examination Questions. 6. Nurse
Practitioners—Outlines. WY 18.2 P371b 2010]
RJ242.P43 2010
618.92(cid:2)00231—dc22
2009033408
6048
Printed in the United States of America
14 13 12 11 10 10 9 8 7 6 5 4 3 2 1
Contents
Preface viii Infant Growth and Development 10
Toddler and Preschooler Growth and
Acknowledgments ix
Development 13
Author Note x School-Aged Development 15
Adolescent Development 16
Contributors xi
The Changing American Family as Context
for Growth and Development 17
Chapter 1
Deviations in Physical Growth and
Test Taking Strategies
Behavioral Development 18
and Techniques 1
Health Supervision as Ongoing
Janice J. Hoffman
Surveillance, Screening, and Assessment
Self-Assessment Regarding Seeking of Physical Growth and Behavioral
Certifi cation 1 Development 31
Know the Test Plan 2 Questions 32
Develop a Specifi c Plan 2 Answers 35
Approaches to Test Taking 2 Bibliography 35
Maximizing Study Time 5
Chapter 3
Test Day 6
References 6 Health Promotion and Well Child
Care for Infants, Children, and
Chapter 2 Adolescents 37
Human Growth and Development 7 JoAnne Silbert-Flagg
M. Elizabeth M.Younger
Overview: Health Maintenance and Health
Human Growth and Development: Promotion 37
Underlying Theory and Science of Child Health Supervision 37
Child Health 7 The Pediatric History 38
iii
iv Contents
The Pediatric Physical Examination 42 Answers 133
Specifi c Normal Findings and Common Bibliography 134
Variations 44
Chapter 6
Selected Laboratory Tests and Values 54
Selected Screening Tests 57 Lower Respiratory Disorders 135
Special Examinations 59 Elizabeth Sloand
Problem-Oriented Health Record 62
Croup (Laryngotracheobronchitis) 135
Child Health Supervision Schedule of Visits
Foreign Body Aspiration 136
with Key Issues (Nutrition, Development,
Bronchitis 137
Screening, Immunizations, Anticipatory
Bronchiolitis 137
Guidance, and Health Education) 62
Pneumonia 138
Questions 77
Cystic Fibrosis (CF) 140
Answers 80
Asthma 142
Bibliography 80
Bronchopulmonary Dysplasia (BPD) 144
Apnea 146
Chapter 4
Tuberculosis (TB) 147
Eye, Ear, Nose, Mouth, and Throat
Questions 149
Disorders 81
Answers 151
Karen K. Buch
Bibliography 151
Head 81
Chapter 7
Eye 84
Ear 96 Dermatologic Conditions 153
Nose 103 Jeanne Steman Findlay
Mouth 106
Newborn Exanthema 153
Throat 110
Vascular Lesions 154
Questions 114
Melanocyte Cell and Pigmentation
Answers 117
Conditions 156
Bibliography 117
Papulosquamous Conditions 159
Dermatitis Conditions 161
Chapter 5
Burn Conditions 164
Cardiovascular Disorders 119
Bacterial Conditions 166
Peggy Dorr
Bacterial Conditions Involving
Congenital Heart Disease/Defects 119 Pilosebaceous Unit 168
Congestive Heart Failure (CHF) 120 Viral Conditions 170
Murmurs 122 Fungal Infections 172
Disturbances of Rate and Rhythm 123 Insect Conditions 176
Hypertension 125 Insect Infestations 179
Hypercholesterolemia 126 Miscellaneous Conditions of
Kawasaki Disease (Mucocutaneous Lymph Hypersensitivity 181
Node Syndrome) 127 Questions 184
Acute Myocardial Infl ammatory Answers 190
Disease 129 Reference Materials 191
Rheumatic Fever/Heart Disease 130 Bibliography 192
Questions 132
Contents v
Chapter 8 Questions 229
Answers 231
Gastrointestinal Disorders 193
Bibliography 231
Lindsay Wilson
Gastroesophageal Refl ux in Infancy Chapter 10
(GER) 193 Musculoskeletal Disorders 233
Pyloric Stenosis 194 Rachel Lyons
Acute Infectious Gastroenteritis 195
Torticollis (Wry Neck) 233
Pinworms (Enterobiasis vermicularis) 199
Developmental Dysplasia of the Hip
Infl ammatory Bowel Disease (IBD) 199
(DDH) 234
Chronic Diarrhea 201
Talipes Equinovarus Congenita
Malabsorption 201
(Clubfoot) 235
Acute Abdominal Pain 202
Metatarsus Adductus/Metatarsus
Functional Gastrointestinal Disorders 203
Varus 235
Constipation 205
Tibial Torsion (Internal) 236
Hepatitis 206
Genu Varum (Bowleg) 236
Hernia 208
Genu Valgum (Knock-Knee) 237
Questions 208
Transient (Toxic) Synovitis of the Hip 237
Answers 211
Legg-Calvé-Perthes Disease (LCPD) 238
Bibliography 211
Growing Pains 238
Chapter 9 Osgood-Schlatter Disease 239
Scoliosis (Idiopathic) 239
Infectious Diseases 213
Sports Injuries 240
Jody K. Roblyer
Slipped Capital Femoral Epiphysis 241
Septicemia (Sepsis) 213 Juvenile Idiopathic Arthritis 242
Diphtheria 214 Systemic Lupus Erythematosus 244
Pertussis (Whooping Cough) 215 Osteomyelitis 245
Infl uenza 216 Duchenne Muscular Dystrophy
Rubella (German Measles) 217 (DMD) 245
Rubeola (Red measles) 218 Questions 246
Roseola (Exanthem Subitum) 219 Answers 249
Fifth Disease (Erythema Infectiosum–EI) Bibliography 249
219
Varicella-Zoster Virus (VZV) Chapter 11
(Chickenpox) 220 Neurological Disorders 251
Mumps 221 Maureen C. Maguire
Cat Scratch Disease (CSD) 222
Seizure Disorders/Epilepsy 251
Rocky Mountain Spotted Fever
Febrile Seizures 255
(RMSF) 223
Headaches 255
Lyme Disease 223
Neurofi bromatosis (NF1) (von
Infectious Mononucleosis (IM) 225
Recklinghausen Disease) 257
Infant Botulism 226
Tuberous Sclerosis (TS) 258
Poliomyelitis 226
Tic Disorders 258
Tetanus (Lockjaw) 227
Head Injuries 260
Malaria 228
vi Contents
Meningitis 262 Iron Defi ciency Anemia 302
Brain Tumors 263 Sickle Cell Disease 303
Questions 264 Lead Poisoning (Plumbism) 305
Answers 267 Glucose-6-Phosphate Dehydrogenase
Bibliography 267 (G-6-PD) defi ciency 306
Bleeding Disorders 307
Chapter 12
Cancers 310
Genitourinary/Gynecological Disorders/ Immune Defi ciencies 314
Adolescent Pregnancy 269 Questions 316
Marlo A. Eldridge and MaryLou C. Answers 318
Rosenblatt Bibliography 318
Urinary Tract Infection (UTI) 269
Chapter 14
Enuresis 271
Endocrine Disorders 321
Cryptorchidism (Undescended
Malinda D. Duke
Testes) 272
Hydrocele 273 Thyroid Disorders 321
Hypospadias 273 Pituitary Disorder—Diabetes Insipidus
Phimosis and Paraphimosis 274 (DI) 326
Meatal Stenosis 274 Growth Disturbances 328
Testicular Torsion 275 Adrenal Gland Disorders 332
Labial Adhesions (Labial Fusion, Synechia Miscellaneous 335
Vulvae, Labial Agglutination) 275 Questions 344
Vulvovaginitis 276 Answers 347
Dysmenorrhea 277 Bibliography 347
Premenstrual Syndrome 278 Educational Web Sites 348
Genitourinary Trauma 279
Chapter 15
Glomerulonephritis (GN) 279
Multisystem and Genetic
Hydronephrosis 280
Disorders 349
Renal Tubular Acidosis (RTA) 280
Rita Marie John
Sexually Transmitted Infections 281
Contraception 288 Introduction 349
Issues of Pregnancy and Birth for the Congenital Diseases 350
Adolescent 290 Genetic Syndromes 359
Questions 293 Multisystem Disorders 366
Answers 298 Questions 369
Bibliography 298 Answers 371
Bibliography 372
Chapter 13
Hematologic/Oncologic/Immunologic Chapter 16
Disorders 299 Advanced Practice, Role Development,
M. Elizabeth M. Younger and Kathy Ruble Current Trends, and Health
Policy 373
ABO Incompatibility 299
Janet S. Selway
Rh Incompatibility 299
Neonatal Hyperbilirubinemia 300 Introduction 373
Hemoglobinopathies 301 Advanced Practice Nursing 373
Contents vii
Practice Issues 377 Questions 387
Professional Organizations 382 Answers 390
Health Policy 382 Bibliography 390
Types of Healthcare Delivery Systems 384
Health Insurance Portability and
Accountability Act of 1996 (HIPPA) 386 Index 393
FPrroenfatc/Eend Matter
Title
We are pleased to present the fi fth edition of the Pediat- disorders, endocrine, and multisystem and genetic dis-
ric Nurse Practitioner Certifi cation Review Guide from orders. The book concludes with a chapter on advanced
Jones and Bartlett Publishers. The book is a revision practice nursing, role development, current trends, and
of the 2004 text published by Health Leadership Asso- health policy.
ciates, edited by Virginia Layng Millonig and Caryl Mob- Pediatric Nurse Practitioner Certifi cation Review
ley. It has a dual purpose. The book serves pediatric Guide) presents the most updated information and
nurse practitioner (PNP) and family nurse practitioner current standards of practice for the NP in the pediatric
(FNP) graduates who are doing self-study preparation primary care setting. It examines all the content areas
for the PNP primary care certifi cation exam. Students required for the certifi cation examinations for PNPs in
and graduates can be overwhelmed when faced with primary care. Each system chapter presents common
the vast body of knowledge required for certifi cation. pediatric disorders followed by a defi nition of the dis-
This book brings together the most current and essen- order and its etiology/incidence, signs and symptoms,
tial information in an organized, concise, and compre- differential diagnosis, physical fi ndings, diagnostic tests,
hensive manner. This book also serves as a valuable and management/treatment. Practice test questions
clinical resource for practicing PNPs and FNPs in pedi- follow content in each chapter. This format enables the
atric primary care. reader to review essential information and to explore
The fi rst chapter of the book reviews test-taking areas that may require further study. Bibliographies and
strategies to help students plan their certifi cation pre- relevant web sites give the reader resources for further
paration, considers various approaches to test taking, discussion and study.
and helps students organize their study time. The sec- All chapter authors are specialists in their areas. Clin-
ond chapter reviews growth and development; the ical chapter authors are certifi ed PNPs and expert clini-
third chapter, which covers health promotion and cians who have practiced extensively in their specialty
well child care for infants, children and adolescents, area. The editors are faculty members at the Johns Hop-
includes expanded information on the promotion of kins University School of Nursing in the PNP primary
breastfeeding in the fi rst year of life. The subsequent care master’s degree program.
chapters of the book review the following systems: We hope that this review guide assists the PNP grad-
HEENT, cardiovascular, lower respiratory, dermatol- uate to become certifi ed and to provide competent and
ogy, gastrointestinal, infectious diseases, musculoskel- compassionate health care throughout their career to
etal, neurological, GU and GYN (including adolescent children, adolescents, and their families.
pregnancy), hematologic/oncologic and immunologic
viii
Acknowledgments
We are pleased to have had the opportunity to revise in the practice, who agreed to be my preceptor during
the work of Virginia Layng Millonig and Caryl Erhardt the residency portion of my DNP program at Columbia
Mobley. We owe additional thanks to each chapter au- University.
thor for her diligence, knowledge, and expertise. I have been fortunate to have the support of my par-
We are grateful to our professional colleagues who ents, Herbert and Betty Silbert, and my brother Brett
have mentored, supported, and taught us over the Silbert. They have provided encouragement as I pur-
years, particularly those at the Johns Hopkins Univer- sued my educational, professional, and personal goals.
sity School of Nursing. Lastly, and most importantly, I dedicate this book to my
JoAnne Silbert-Flagg and Elizabeth Sloand children, Christopher and Jennifer Flagg.
JoAnne Silbert-Flagg
As a practicing PNP for over 20 years at Columbia
Medical Practice in Columbia, Maryland, I have had I am personally indebted to my husband, Bob, who
the opportunity to provide pediatric primary care to a makes everything possible; my children Daniel, Chris-
generation of patients. I hope I have touched their lives tine, Rachel, and Rosie, who are a continued source of
as much as they have touched mine. Over the years, joy and pride; and to my parents Dorothy and Joseph
the pediatricians and PNPs in the practice have been for their ever-present encouragement and love.
a source of support and inspiration for me. I am espe- Elizabeth Sloand
cially indebted to R. Scott Strahlman, MD, a pediatrician
ix
