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NURS 5432 FAMILY I MIDTERM
EXAM
Birth to 6months calorie requirement - CORRECT ANSWER - 120kcal/kg/day 7 months to 1 year Calorie requirement - CORRECT ANSWER - 100 kcal/kg/day 2 to 10 years caloric requirements - CORRECT ANSWER - 100 to 70 kcal/kg/day Adolescent calorie requirements - CORRECT ANSWER - 45 kcal/kg/day (significant decrease) How much Vitamin D a day does an infant need starting at 2 months? - CORRECT ANSWER
- 400IU NOTE: this applies to both breast fed and formula fed infants How much Iron do infants who are exclusively breastfeeding need? - CORRECT ANSWER - 1 mg/kg/day of iron is recommended Absent red reflex could indicate these two things: - CORRECT ANSWER - Congenital Cataracts Retinoblastoma What issue with the eyes could indicate Gonococcus, chlamydia, or herpes? - CORRECT ANSWER - Purulent Eye Discharge Disconjugate gaze is considered abnormal, True or False? - CORRECT ANSWER - False: Disconjugate gaze is normal
What do response do we look for when testing the hearing if a Newborn? - CORRECT ANSWER - Startle Response A newborn has small white cysts on the palate and gums of the mouth. What's this and should it be a concern? - CORRECT ANSWER - Epstein pearls (common) Gross Motor: Good head control - CORRECT ANSWER - 2 - 3 months What is the Tonic Neck Reflex? - CORRECT ANSWER - Occurs when newborn's head is turned to the side, the arm on that side will extend while the opposite arm will contract - prepares the infant for voluntary reaching and may be a precursor to hand/eye coordination. What age (range) does Tonic neck for the fencing reflex appear? - CORRECT ANSWER - 2 - 3 months Gross Motor: Rolls back to front - CORRECT ANSWER - 5 - 6 months Gross motor: sits alone - CORRECT ANSWER - 7 months Gross Motor: Pulls to stand - CORRECT ANSWER - 9 - 10 months Gross Motor: stands alone - CORRECT ANSWER - 11 - 12 months Gross Motor: Walks - CORRECT ANSWER - 12 - 14 months Gross Motor: walks up and down stairs - CORRECT ANSWER - 22 - 24 months Gross Motor: jumps - CORRECT ANSWER - 24 - 28 months
Language: waves bye-bye - CORRECT ANSWER - 8 - 9 months Language: Understands "no" - CORRECT ANSWER - 9 - 10 months Language: Points to body - CORRECT ANSWER - 15 - 18 months Language: 2 word sentences - CORRECT ANSWER - 18 - 22 months Language: 30-50 word vocabulary - CORRECT ANSWER - 22 - 24 months What age range should a child be able to feed themselves with fingers and start to use a spoon? - CORRECT ANSWER - 13 - 18 months What age can an child: Walk backwards Throw a ball Stack 3-4 block? - CORRECT ANSWER - 18 months At what age does babbling reach a peak? - CORRECT ANSWER - 12 months What age is 75% of speech understandable? - CORRECT ANSWER - 3 years old By what age should they understand 100% of language? - CORRECT ANSWER - 4 years old and older (kindergarten age) Tanner Stage 1 (Pre-pubertal) Does either sex have pubic hair? Yes or No? - CORRECT ANSWER - No pubic hair for either sex
Which Tanner Stage does soft pubic hair start to appear for both sexes? - CORRECT ANSWER
- Tanner Stage II Tanner Stage II Female - CORRECT ANSWER - Breast buds appear Tanner Stage II Males - CORRECT ANSWER - Measurable testes enlargement Tanner Stage III Female - CORRECT ANSWER - Breast mounds form Tanner Stage III Male - CORRECT ANSWER - Penis begins to enlarge in size (LENGTH) Tanner Stage IV Female - CORRECT ANSWER - Breast enlargement forms "mound on mound" breast contour Tanner Stage IV Male - CORRECT ANSWER - Penis begins to Widen Tanner Stage V Female - CORRECT ANSWER - Breast takes on adult contour Tanner Stage V Male - CORRECT ANSWER - Penis and testes enlarge to adult size Name 4 Live Attenuated Vaccines: - CORRECT ANSWER - MMR Varicella Rotavirus FluMist What is the Live to Live rule? - CORRECT ANSWER - Administer live vaccines on the same day or at least 28 days apart to avoid immune interference What is the schedule of the Hepatitis B Vaccine? - CORRECT ANSWER - First: birth
Carla got her third dose of the polio vaccine after she turned 4 years old, her mother wants to know when she need to come back for the 4th dose. What should you tell her? - CORRECT ANSWER - If the 3rd dose is given after the child's 4th birthday then they will not require a 4th dose What is the age range recommended for the Human Papillomavirus (HPV)? - CORRECT ANSWER - Age 9-12 years old How many doses of HPV are needed if the child is younger than 15 years old? - CORRECT ANSWER - 2 doses How many doses of HPV are needed if the child is older than 15 years old? - CORRECT ANSWER - 3 doses Flu vaccine starts at what age? - CORRECT ANSWER - 6 months In children 6-35 months, what is the dose for the flu vaccine? - CORRECT ANSWER - 0.25ml IM In children 3 years old, what is the dose (amount) of flu vaccine given? - CORRECT ANSWER
- 0.5ml IM Children younger than 9 years old receive __ doses of the Flu vaccine, 1 month apart. - CORRECT ANSWER - 2 How many doses is the MMR vaccine? - CORRECT ANSWER - 2 doses: 12-15 months, 4- 6 years How many doses is Varicella vaccine? - CORRECT ANSWER - 2 doses
When can the first dose of Varicella be given? - CORRECT ANSWER - 12 months (12- 15 months) When must the Rotavirus vaccine be given (completed)? - CORRECT ANSWER - Between 28- 32 weeks of age When can the FIRST dose of the Rotavirus Vaccine be given? - CORRECT ANSWER - 6 weeks of age What age can you first give the Haemophilus Influenzae Type B Vaccine? - CORRECT ANSWER - Series begins at 6 weeks How many doses of HIB do you need for chicken ages 15-59 Months? - CORRECT ANSWER - 1 dose No doses of HIB are needed after 60 months of age, True or False? - CORRECT ANSWER - True Which pneumococcal vaccine is recommended for children over 2 with chronic conditions? - CORRECT ANSWER - PPSV Which pneumococcal vaccine is recommended for children under 5 year old? - CORRECT ANSWER - PCV Hepatitis A vaccine is two doses beginning at __ Months, separated by 6 months. - CORRECT ANSWER - 12 Meningococcal Vaccine First dose is from 11-12 years (7th grade shot Second dose is 16-18 years (college shot)
A. No meaningful three word phrases in a two-year-old. B. Does not use the spoon at 12 months. C. No response to name at 12 months. D. Does not sit without support at three months. - CORRECT ANSWER - C. No response to name at 12 months. How many word phrases should a 5 year old be able to speak? - CORRECT ANSWER - 5 words At what age should a child be able to imitate house work? - CORRECT ANSWER - 18 months MMR is a (live/killed) vaccine - CORRECT ANSWER - Live A nine-year-old child with no documentation of vaccinations comes for an MMR immunization. Her parent states the child has received " some" vaccinations, but no documentation is available. How many doses of MMR should the child receive and at what frequency? - CORRECT ANSWER - Two doses one month apart When considering vaccinating a pregnant woman with HV3 or HV4 , the NP considers that: A. LAIV is the preferred vaccine for pregnant women B. The burn child acquires some protection against influenza for up to 6 months after birth C. There is a small risk of the virus spreading to the fetus D. Immunization should not be done in the third trimester - CORRECT ANSWER - B. The burn child acquires some protection against influenza for up to 6 months after birth Angela is a 14-year-old female who has not received any dose of the hepatitis B VAX. One considering whether to initiate the vaccine series the NP realizes. - CORRECT ANSWER - Vaccines administration to 11-15 year olds adult dose of recombinant HBV vaccine is administered with a second dose 4-6 months later
A 28 year old pregnant female who is 6 weeks pregnant voices he intent to breastfeed her infant for at least 6 months. Her routine pre natal lab testing reveals she is not immune to varicella .When should she get her vaccinations? - CORRECT ANSWER - She should be advised to receive two appropriate times doses of VZV vaccine after giving birth What age does PAP screening begin? (American cancer society) - CORRECT ANSWER - 25 years old What age does PAP screening begin? (ACOG) - CORRECT ANSWER - 21 years old For women who are > 65 years old, three consecutive negative cytology results or two consecutive negative HPV co-tests within 10 years (most recent within 5 years) should CONTINUE OR DISCONTINUE Pap screening? - CORRECT ANSWER - Discontinue Pregnancy: cervical lesion may progress during pregnancy but often regress postpartum. True or False? - CORRECT ANSWER - True Pregnancy considerations Colonoscopy is avoided during pregnancy unless the patient is high risk for invasive cancer. True or False? - CORRECT ANSWER - True Gardasil 9 (human papillomavirus vaccine) is recommended for females age 11-12 years old to protect them from _____ cancer - CORRECT ANSWER - Cervical Upon physical exam of someone who you suspected had cervical cancer what would you expect to find? - CORRECT ANSWER - External HPV lesions Ulcerative cervical lesions What's a friable cervix? (HPV) - CORRECT ANSWER - A cervix that bleeds easily when touched
B. Anovulation C. Pregnancy related events D. Atrophic vaginitis - CORRECT ANSWER - A. Foreign body in the vagina Abnormal Uterine bleeding in Post-Menopausal age is typically due to: A. Foreign body in the vagina B. Anovulation C. Pregnancy related events D. Atrophic vaginitis - CORRECT ANSWER - D. Atrophic vaginitis Why is progesterone know as the "weed killer"? - CORRECT ANSWER - Progesterone helps balance out the estrogen production. Progesterone inhibits endometrial growth Why is estrogen known as the "fertilizer"? - CORRECT ANSWER - Anovulation disrupts progesterone secretion leading to unopposed estrogen stimulation. Estrogen thickens the endometrium which eventually sloughs off irregularly When a patient has Anovulation what is the first lab test that should be completed? - CORRECT ANSWER - HCG (test for pregnancy) What does the P in PALM-COEIN stand for? - CORRECT ANSWER - Polyps What does the A in PALM-COEIN stand for? - CORRECT ANSWER - Adenomyosis: occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus What does the L in PALM-COEIN stand for? - CORRECT ANSWER - Leiomyoma: a group of benign smooth muscle tumors commonly present in premenopausal women (fibroids) What does the M in PALM-COEIN stand for? - CORRECT ANSWER - Malignancy
What does the C in PALM-COEIN stand for? - CORRECT ANSWER - Coagulopathy: 18% of women with AUB have underlying disease like VIN Willebrands Disease What does the O in PALM-COEIN stand for? - CORRECT ANSWER - Ovulatory dysfunction: common in PCOS, obesity, eating disorders or thyroid dysfunction What does the E in PALM-COEIN stand for? - CORRECT ANSWER - Endometrial dysfunction What does the I in PALM-COEIN stand for? - CORRECT ANSWER - Iatrogenic: cause by medical devices/medication (IUD) What does the N in PALM-COEIN stand for? - CORRECT ANSWER - Not classified yet Tyler is having some menstrual irregularities (irregular periods), when conducting a physical assessment what are some signs of Androgen Excess that she may present with? (4) - CORRECT ANSWER - 1. Acne
- Alopecia
- Hirsutism
- Obesity Why are two lifestyle modifications that can be done for individuals diagnosed with PCOS? - CORRECT ANSWER - Diet Exercise Weight Loss (even a 10% reduction) can significantly improve symptoms and insulin sensitivity Prior to starting a patient on hormonal birth control, a period can be induced using what medication? - CORRECT ANSWER - Provera 10mg PO daily for 5 days
What is vulvodynia? - CORRECT ANSWER - Severe vulvar pain with minimal pressure. Pain may occur with light touch or sexual activity Mary is a new mother. She is planning on breast feeding her baby girl and does not want to chance getting pregnant again too soon. Which contraceptive method would be the WRONG choice for her? SATA A. DEPOT Medroxyprogesterone Acetate shot B. Nexplanon C. ParaGard (Copper IUD) D. Oral contraceptive pill (estrogen only) E. Combined oral contraceptives pill (estrogen and progesterone) - CORRECT ANSWER - D. Oral contraceptive pill (estrogen only) E. Combined oral contraceptives pill (estrogen and progesterone) Avoid estrogen based birth control in breast feeding mothers because it causes lactation suppression How does estrogen help with birth control? (2) - CORRECT ANSWER - 1. Prevents ovulation by decreasing Follicle stimulating hormone (preventing egg recruitment)
- Thickens cervical mucous around the cervix making it harder for sperm to enter the uterus How does progestin help with birth control? (3) - CORRECT ANSWER - 1. Prevents the LH surge
- Thins the endometrium
- Thickens cervical mucus Which is the follow patients can use estrogen based birth control with the least amount of risks?
A. Patient with Von Willebrand disease B. Patient with history of blood clots C. Patient who has migraine with aura D. 35 year old patient who smokes cigarettes E. Patient with active breast cancer F. Patient with Liver Adenoma - CORRECT ANSWER - A. Patient with Von Willebrand disease Oral contraceptives maybe effective treatment for women with VWD who may experience menstrual bleeding. Which hormone(s) are in the Patch? - CORRECT ANSWER - Estrogen and progesterone How often is the patch replaced? - CORRECT ANSWER - applied q week x3 weeks than 1 week off, same as nuva ring Why is the patch taken off for one week? - CORRECT ANSWER - To allow for menses (period) Which hormone(s) are in the Ring? - CORRECT ANSWER - Estrogen and progesterone How is the Ring used? - CORRECT ANSWER - Inserted marginally for three weeks. 4th week removed What is the dose and frequency of the Depot shot? - CORRECT ANSWER - 150mg IM every 3 months What hormone(s) are in the Depot shot? - CORRECT ANSWER - Progesterone only
FSH is increased or decreased in menopause due to ovarian failure? - CORRECT ANSWER - Increased Lack of which hormone presents ovulation causing Anovulation and progesterone deficiency? - CORRECT ANSWER - Luteinizing hormone Women without a uterus should be treated with both estrogen and progesterone Hormone replacement therapy, True or False? - CORRECT ANSWER - False, Estrogen replacement therapy (Alone) is for women without a uterus What is the main risk that occurs if a woman WITH a uterus get HRT that has Estrogen without Progesterone? - CORRECT ANSWER - Increased risk of endometrial cancer if estrogen is given without progesterone to women with a uterus Which SSRI and SNRIs are used to reduce vasomotor symptoms in menopausal women? (4) - CORRECT ANSWER - 1. Paroxetine
- Venlafaxine
- Fluoxetine
- Citalopram Gabapentin reduced hot flashes but requires dosing and can cause mental fog, True or False? - CORRECT ANSWER - True Which of the following SERMs can be used for genitourinary syndrome of menopause and help with moderate to severe dyspareunia? A. Ospemofene B. Tamoxifen C. Raloxifene D. Toremifene - CORRECT ANSWER - A. Ospemofene 60mg PO daily
At what age is DEXA recommended for all women? - CORRECT ANSWER - all women ≥ 65 yr What is a fibroadenoma? - CORRECT ANSWER - Benign tumor of the breast that respond to hormonal changes If a fibroadenoma is suspected and the patient is < 35 years old, what type of diagnosis imaging should the NP prescribe? - CORRECT ANSWER - Ultrasound If a fibroadenoma is suspected and the patient is > 35 years old, what type of diagnosis imaging should the NP prescribe? - CORRECT ANSWER - Ultrasound AND Mammogram Genetic mutation in which two tumor suppressor genes is associated with breast cancer? - CORRECT ANSWER - BRCA1 and BRCA What age should you begin annual mammograms according to the American Cancer Society? - CORRECT ANSWER - Age 45- 54 How does Tamoxifen and Raloxifene help with breast cancer prevention? - CORRECT ANSWER - Tamoxifen is a SERM and is an estrogen. Tamoxifen works by blocking estrogen from binding to receptors on breast cancer cells, which prevents them from receiving the hormone they need to grow and multiply How does Anastrozole work to prevent breast cancer? - CORRECT ANSWER - Anastrozole helps prevent breast cancer by decreasing the amount of estrogen the body makes How does heparin impact a pregnant mother? - CORRECT ANSWER - Cause osteoporosis How do prostaglandins impact a pregnant mother? - CORRECT ANSWER - Stimulate uterine contractions
