Download NU664A Final Exam | Questions and Answers | 100 out of 100 | Graded A| Correct Solutions - and more Exams Nursing in PDF only on Docsity!
NU664A Final Exam | Questions and
Answers | 100 out of 100 | Graded A| Correct
Solutions - Regis
In the United States, the most common cause of myocarditis in children is: Viruses The characteristic that is most concerning in the school-aged child with a cardiac murmur. Progressive exercise intolerance A parent of a child with a history of a benign cardiac murmur states she read that children with heart disease need to have an antibiotic before dental procedures. How would you answer the mother as the PNP? Certain children do need an antibiotic to prevent something called bacterial endocarditis, but these are children who have had a surgical repair done. Your next patient is a 12-year-old male here for his well-child exam. When reviewing his height, weight, and BMI, it is noted that his BMI is in the 90th percentile. The mother states that her child is "big-boned" and is not concerned of any cardiovascular disease risk. What would you discuss with the mother? Although a risk of cardiovascular disease exists, with a healthy diet and regular exercise, your son likely will be able to reduce his BMI and reduce his risk. Your next patient is a 5-year-old child with a history of moderate persistent asthma. He has been wheezing and coughing for the past two days, and his mother brings him in today for evaluation. He has been using albuterol every four hours. His respiratory rate is 13 breaths per minute; his
lungs are clear to auscultation; and no retractions are noted. What may be your assessment and intervention based on this information? Your child is breathing slower than normal for his age. We need to send him to the ER for further intervention. Your next patient is a 6-year-old male here for his annual influenza vaccine. He has a history of mild persistent asthma. What would you discuss for medications when reviewing his asthma action plan? Your child should continue his low-dose inhaled corticosteroid daily and add albuterol as needed for an exacerbation. Which of the following is a common cause of acquired coronary artery disease in children? Kawasaki disease Your next patient is a 14-year-old female who presents to your office with a complaint of syncope at school. She had just stood up from her chair at the end of the day, felt dizzy and nauseous, and then woke up on the floor. She did not hit her head and woke up within 30 seconds. What is your impression, and what would you do next? At this age, children may have these episodes called neurally mediated syncope. We will schedule an EKG. A child is brought to the clinic immediately after being stung by a wasp while playing in the yard. The PE reveals localized redness and edema at the site along with abdominal tenderness, watery eyes and generalized hives. What is the initial treatment? Administer IM epinephrine
Platelets/Coagulation function disorders ITP-Hemophilia A,B and von Willebrand's A 9 month old infant is brought to the clinic today by her parents for her well check. A finger stick lead is completed with a result of 6 micrograms/deciliter (mcg/dl). The parents ask if this is fine. What will the PNP do? We will need to repeat this lab through venipuncture at a local laboratory. A complete blood count on a 12-month old infant reveals microcytic hypochromic anemia with a Hgb of 9.5 g/dL. The infant has mild pallor with not hepatosplenomegaly. The PNP suspects: Iron-deficiency anemia A toddler who presents with anemia and reticulocytopenia has a history of a decrease in energy and increase in pallor beginning after a recent viral infection. How will the PNP treat this child? Closely observe the child's symptoms and lab values The PNP evaluates a 5 yo who presents to the office with pallor and reveals a Hgb of 8.5 g/dL and Hct of 31%. How would this patient be managed? Prescribe elemental iron and recheck labs in one month The PNP is managing care for a child diagnosed with iron-deficiency anemia who has an initial hemoglobin of 8.8 g/dL and hematocrit of 32% who has been receiving ferrous sulfate as 3mg/kg/day of elemental iron for 4 weeks. The child's current lab work reveals elevations in Hgb/Hct and reticulocytes with a H/H 10.5/36. What is the next step of management?
Continue current dose of ferrous sulfate and recheck labs in 1-2 months sickle cell disease §Complex chronic disorder characterized by hemolysis, unpredictable acute complications that may become life threatening-chronic organ damage. §Autosomal recessive in heritance pattern §Routine newborn screening identifies most children. Hereditary spherocytosis §Hemolytic anemia-deficiency or abnormality of the RBC membrane protein-reduces the RBC surface area. §RBCs assume spherical shape. §RBCs sequestered and prematurely destroyed in the spleen §Jaundice usually appears in the newborn period Neutropenia §Decrease in the number of circulating neutrophils and bands §Results from decreased cellular production or peripheral pooling §Seen in preterm infants and those with intrauterine growth retardation. §Largest group are children receiving chemotherapy Absolute Neutrophil Count (ANC) The percentage and actual number of mature circulating neutrophils; used to measure a patient's risk for infection. The higher the numbers, the greater the resistance to infection. (%neutrophils + %bands) * WBC / 100
Children with sickle cell anemia should be on prophylactic penicillin starting at this age: 3 months of age Which of the following statements is true about immunizations during the treatment of childhood cancer? Children with cancer do not receive any immunizations while being treated with chemotherapy. Your next patient is a 10-year-old with a history of hereditary spherocytosis and is scheduled for a splenectomy. Which of the following interventions is not correct for this patient? Treating the fever with antipyretics and only start antibiotics if a source is identified such as UTI or strep throat. Your next patient is a 6-year-old male here for a rash under his nose for about three days. He remembers scratching his nares and causing them to bleed a little about one week ago. When assessed, the PNP notes several vesicles and honey-colored crusted lesions. What is the diagnosis? Impetigo Your next patient is a six-month-old infant who just completed amoxicillin for otitis media. The mother states her child is better except for a diaper rash. Upon examination, you note red scaly plaques in the diaper area with satellite lesions to his upper thighs. What would you do next as the PNP? Your child has a rash that is likely due to a fungus, Candida, and commonly occurs after taking antibiotics. I will prescribe nystatin to be applied to the diaper area.
Epidermis Thinner outer layer-protective barrier between body and environment Dermis §Thicker middle layer-contributes strength, support and elasticity to skin §Underlying subcutaneous tissue-adipose tissue §Skin appendages-hair, nails, sweat glands, and sebaceous glands. Normal variations of the skin §Skin color and texture §Pigmentation of gingiva §Increased melanin in elbows or knees §Futcher/Ito line §Café au lait spots §Color alteration 12 y.o. female presents to the clinic after being bit by a dog on the face. Abrasion with 2 puncture wounds on the upper right cheek, approximately 1 inch below the eye. The area is slightly erythematous, with a small amount of bruising and raised area along the cheekbone. Cleanse the area with what? Treat with what? Using normal saline, irrigate the wounds using high pressure (greater than 4 pounds per square inch) and high volume (greater than 1 L). Isolated puncture wounds should not be irrigated, instead soak the wound in a diluted solution of tap water and povidone-iodine for 15 .minutes • Prescribe a 3- to 5-day course of prophylactic antibiotics
A PNP working in a community health center wishes to develop a program to assist impoverished children and families to have access to healthy foods. Which strategy will the PNP employ to ensure the success of such a program? Asking community members to assist in researching and implementing a program A child has a lead level of 25 mcg/dL. Once lead abatement measures are instituted, what is an important intervention to help prevent permanent damage in this child? Follow up testing The parent of a 1-week old is concerned about the unusual shape of their child's head. In the physical exam, which of the following signs would not support the diagnosis of craniosynostosis? A palpable lesion at the occipital region. A 4 year old child with PE tubes in both ears has otalgia in one ear. The PNP is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the NP do? Order ototopical corticosteroid/antibiotic drops. A two month old infant will receive initial vaccines, and the parent asks about giving medication to increase the infants comfort and minimize fever. What will the PNP recommend? Administer acetaminophen as needed. A toddler exhibits exotropia of the right eye during a cover-uncover screen. The PNP will refer to pediatric ophthalmologist to initiate which treatment? Patching the unaffected eye for 2 hrs./day
A 10 year old child has had abdominal pain for 2 days which began in the periumbilical are and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis? Appendicitis with perforation A 16-year-old female reports breast tenderness and "lump". The PNP palpates a small fluid- filled mass in her right breast. A pregnancy test is negative. Which action is correct? Order an ultrasound of the mass. Since adolescents and young adults between 16 and 23 years of age have the highest incidence of meningococcal disease, the recommendation for vaccination is: First dose at 11-12 years of age, followed by a booster at 16 years of age. A 5-year-old who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The PNP notes mild shortness of breath with exertion and upon questioning learns that the child has recently complained of dizziness. What will the NP do? Refer to cardiology immediately We have an expert-written solution to this problem! §The PNP is preparing to close a laceration on a child's forehead using topical skin adhesive. §What is the correct way to apply this product? Hold the wound edges together and apply the adhesive on top of the skin
In addition to the routine PCV 13 vaccine series, sickle cell anemia patients older than 2 years of age should receive this once and then a booster in 5 years. PPSV Prophylactic penicillin should be initiated in children with sickle cell anemia by this age. 2 to 3 months of age What type of hemorrhage would be expected with severe factor VIII deficiency? spontaneous hemarthrosis or spontaneous hemorrhage PCP should screen for this at sports physicals or with a complaint of syncope, chest pain or palpitations? sudden cardiac death Stage of hypertension in a child with a blood pressure above the 99th percentile for age, sex and height Stage II Hypertension diagnostic studies for syncope Orthostatic Vital Signs, Hgb, 12 lead EKG, Echo, Possible Exercise Testing
Stills, innocent, functional or physiologic murmur Midsystolic murmur, louder in supine position or with inspiration Tetralogy of Fallot A grade III to V harsh systolic ejection murmur at the left mid to upper sternal border. There may be a palpable thrill and a holosystolic murmur at the LLSB. Often treated with Selsun blue shampoo. cradle cap or seborrheic dermatitis HSP Most common vasculitis in children. laboratory findings consistent with sickle cell HCT of 20% to 29% Hgb 6 to 10 Elevated Retic Count Normal to increased WBC MCV greater than 80 Acne An inflammatory disorder of the pilosebaceous unit in which excess bacteria accumulate
First line treatment for comedonal acne benzoyl peroxide 5% or tretinoin 0.025% or Adapalene 0.1% gel treatment for tinea capitis griseofulvin for 6 to 8 weeks First line treatment for allergic rhinitis Oral H1 antihistamines and/or intranasal steroids Treatment for 3 year old with intermittent asthma SABA prn Treatment for Kawasaki IVIG and High dose aspirin A 9-year-old boy presents with a fever of 102 and leg pains. Mother reports he had an upper respiratory infection with a sore throat approximately 2 weeks ago which subsided without therapy. On physical exam, he has tender, swollen knees bilaterally. His heart rate is 120 beats per minute and a blowing systolic murmur is heard at the apex. No murmur previously noted. The most likely diagnosis is. Rheumatic Fever Most common congenital heart disease
Ventricular septal defect (VSD) What is the next step if you have a 13 year old patient with a high blood pressure? Repeat blood pressure at the end of the visit. Have patient come in just to take blood pressure on two subsequent accounts. Have blood pressure taken in another environment. What is needed to diagnosis hypertension? Have to have 3 elevated blood pressure readings Subacute bacterial endocarditis (SBE) a slowly developing type of infective endocarditis — an infection of the lining of your heart ( endocardium ) Who do you treat for SBE prophylactically? Children with cardiac valves Children with joint surgeries Red flags for murmurs Grade 3 or higher You can reassure a parent about a murmur if you can suppress the sound
