Chapter 17: Nutrition

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

MULTIPLE CHOICE

1. The primary care pediatric nurse practitioner provides anticipatory guidance for a 6-month-old
infant who is breastfed who takes 400 IU of vitamin D daily. The parent reports that the infant
has begun taking cereals, fruits, and vegetables in addition to nursing. What will the nurse
practitioner recommend to promote healthy nutrition?
a. Begin supplementing with iron.
b. Continue to nurse as long as desired.
c. Discontinue the vitamin D supplement.
d. Stop breastfeeding at 1 year of age.
ANS: B
Infants who are breastfed should exclusively nurse until age 6 months and then may continue
breastfeeding, supplemented with appropriate foods for 1 year or longer as long as desired by
both infant and mother. It is not necessary to supplement with iron unless there is a
documented iron deficiency. Vitamin D supplements should continue for all breastfed infants
until 1 year old.

2. The parent of a toddler tells the primary care pediatric nurse practitioner that the family has
adopted a plant-based diet and the child is receiving rice and almond milk instead of cow’s
milk. The nurse practitioner will counsel the parents about:
a. calcium deficiency.
b. excess caloric intake.
c. excess fat intake.
d. protein deficiency.
ANS: D
Plant-based milks are low in protein and young children who consume them are at risk for
protein deficiency. They are not low in calcium, high in calories, or high in fat.

3. The parent of a 12-month-old infant asks the primary care pediatric nurse practitioner why 2%
cow’s milk is recommended instead of whole milk. What will the nurse practitioner tell this
parent?
a. Whole milk is usually not fortified with vitamin D.
b. 2% milk is higher in essential proteins and minerals.
c. Young children don’t need the extra calories found in whole milk.
d. Younger children need a limited amount of fats.
ANS: D
The AAP recommends transitioning to unflavored 2% or fat-free cow’s milk in the second
year of life. Whole milk contains vitamin D and contains similar amounts of proteins and
minerals. Children can get calories from other sources; the reason for giving 2% milk is to
minimize fat intake.

4. The primary care pediatric nurse practitioner sees a 3-year-old child whose parents report is a
picky eater in spite of their continued efforts to provide nutritious meals. The parents ask
whether a multivitamin is necessary. How will the nurse practitioner respond?
 a. Ask the parents to provide a 3-day food diary.
b. Prescribe a daily multivitamin with iron.
c. Reinforce the need to meet DRIs each day.
d. Tell them that supplements are unnecessary.
ANS: A
Although most children who are “picky eaters” eat a balanced diet over time, it is worth
assessing the situation using a 3-day diet history to determine whether key nutrients are being
missed and if the child needs an MV supplement. MVs are not usually necessary and iron is
not given unless there is a deficiency. It is not necessary to meet DRIs every day. Supplements
may be necessary after data is collected.

5. The primary care pediatric nurse practitioner is examining a toddler who is below the 3rd
percentile for weight even though the parents claim that the child eats “constantly.” What will
the nurse practitioner do initially?
a. Evaluate the child’s feeding and elimination behaviors and ask the family to
describe mealtime routines.
b. Recommend giving a multivitamin and offering high-calorie foods, such as ice
cream.
c. Refer the child to a feeding evaluation clinic for a swallow study and evaluation of
possible GERD.
d. Suggest that the parents supplement the child’s food intake with a high-calorie
formula.
ANS: A
When a child doesn’t thrive, it is first necessary to evaluate feeding and elimination behaviors
and mealtime routines to determine what the child’s actual intake is along with the types of
foods that are eaten. Only after the underlying causes are discovered will the PNP prescribe
treatment options.

6. The mother of a 6-year-old child tells the primary care pediatric nurse practitioner that the
child only wants to eat French fries and hamburgers and refuses most vegetables. What will
the nurse practitioner recommend?
a. Giving the child a multivitamin since this is a phase
b. Having the child eat vegetables before getting the hamburger
c. Providing a variety of healthy foods at each meal
d. Putting extra lettuce and tomatoes on hamburgers
ANS: C
Parents are responsible for the foods their children eat, and it is their responsibility to provide
healthful foods. Children should be exposed to a variety of healthy foods but not forced to eat
any of them. However, parents should not bribe children with the reward of getting the
unhealthy food that they want. With a well-balanced diet, not eating a vegetable prepared at
one meal, for example, will not compromise the child’s health, so a multivitamin is not
necessary if the overall diet is healthy. Allowing hamburgers and adding desired foods again
puts the child in control.

7. The parents of a toddler tell the primary care pediatric nurse practitioner that they get
frustrated trying to get the child to eat any vegetables other than squash and carrots. What will
the nurse practitioner recommend?
a. Continue to offer a variety of foods without forcing the child to eat them.
 b. Offer snacks to make up for calories the child misses by not eating the vegetables.
c. Prepare dishes the child likes to ensure that a vegetable is eaten at each meal.
d. Require the child to take 1 to 2 bites of each food at each meal.
ANS: A
Children reject new foods (food neophobia) for a variety of reasons and it sometimes takes as
many as 15 to 20 exposures to a food before they become accustomed to it and enjoy eating it.
Parents should offer the foods and remove them without comment if they are rejected in order
to avoid food battles. If the child refuses foods, parents should not give snacks to make up for
lost calories; the child will be hungrier at the next meal if no snack is given and may be more
likely to try something new. It is not concerning if the child misses a vegetable at a meal or
two. Requiring the child to take a certain number of bites only sets up a food battle.

8. The primary care pediatric nurse practitioner is providing anticipatory guidance to the mother
of a breastfed 6-month-old infant who asks about “self-feeding.” What will the nurse
practitioner tell her about this practice?
a. “Foods given for this purpose do not meet all the child’s nutritional needs.”
b. “Giving infants control of the feeding process will help prevent obesity.”
c. “Infants are given soft, mashable table foods when able to self-feed.”
d. “Infants must be able to grasp and feed themselves from a spoon to do this.”
ANS: C
Baby-led weaning is a concept where infants feed themselves, soft, mashable table foods that
they grasp rather than being spoon-fed, allowing the infant more control. Foods given either
by spoon or finger-fed will meet the child’s nutritional needs. More research is needed to
determine if this method affords protection from obesity by improving self-regulation. Infants
must be able to sit without support and to reach and grasp for objects.

9. The primary care pediatric nurse practitioner is performing a well child examination on a 15-
year-old girl who consumes a vegan diet. Based on this assessment, which nutrients may this
adolescent need to supplement?
a. Calcium, vitamin C, and vitamin A
b. Iron, folic acid, and B12
c. Magnesium, vitamin E, and zinc
d. Vitamin D, vitamin C, and phosphorus
ANS: B
Menstruating females are at risk for iron deficiency. Women of childbearing age should take
folic acid supplements. Children who eat a vegan diet will need B12 supplements. The other
options represent nutrients that do not have implications specific to menstruating females or
vegans.

10. When counseling an adolescent with a family history of hyperinsulinemia and type 2 diabetes,
the primary care pediatric nurse practitioner will recommend avoiding:
a. baked potato chips.
b. canned vegetables.
c. high-fiber cereals.
d. processed breads.
ANS: D
 High-glycemic foods, such as soda, sweetened juices, and processed breads, pastries, and
crackers are more quickly converted to serum glucose and stimulate a sharp rise in insulin
production and a subsequent rapid shift into hypoglycemia. To help prevent this in a child
with a family history of this disorder, the PNP should recommend avoiding processed breads,
pastries, and crackers. High levels of fructose and low fiber intake also contributes to this
phenomenon. Baked potato chips, canned vegetables, and high-fiber cereals do not contribute
to excess insulin production.

11. The parent of a school-age child reports that the child is on a gluten-free diet. When
questioned about the reason for this diet, the parent states that the child has fewer stomach
aches since beginning the diet but has never been diagnosed with celiac disease. The parent
reports using gluten-free grain products for all family members. The nurse practitioner will
tell this parent that gluten-free diets:
a. are generally low in sugar and fat.
b. are healthy and help prevent obesity.
c. may be deficient in essential nutrients.
d. provide adequate protein to meet daily needs.
ANS: C
Gluten-free grain products are often highly processed and not enriched with iron or folate.
Many are very low in protein, enough so that they are used for patients with metabolic
conditions such as PKU who need severe protein restrictions. They often have sugar and fat
added to them to improve taste and do not help prevent obesity.