CLIPP latest exam questions and answers, Exams of Nursing

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CLIPP latest exam questions and answers Infants born to adolescent women - Greater risk for lower birth weight Greater risk for vertically acquired sexually transmitted diseases Poorer developmental outcomes HEEADSSS - Home Education /Employment Eating disorder screening Activities / Affiliations /Aspirations Drugs (including alcohol, tobacco, steroids) Sexuality Suicidal behavior (along with depression and mental health concerns) Safety (abuse, fights, weapons, seatbelts, etc.) Small for Gestational Age (SGA) - Diagnosed at time of birth Up to 70% are small simply due to constitutional factors determined by maternal ethnicity, parity, weight or height CLIPP latest exam questions and answers Risks: Hypoglycemia Hypothermia Polycythemia Intrauterine Growth Restriction (IUGR) - Has not reached its growth potential at a given gestational age due to one or more causative factors Noted during the pregnancy Factors that increase the risk of HIV transmission from mother to infant - Frequent, unprotected sex during pregnancy Advanced maternal HIV disease (high viral load) Membrane rupture greater than 4 hours prior to delivery if mother is not on antiretroviral therapy CLIPP latest exam questions and answers TORCH - TOxoplasmosis Rubella CMV Herpes type 2 Other transplacental infections, including HIV, hepatitis B, human parvovirus, and syphilis Routine Newborn Medications - Vitamin K Hepatitis B vaccine Erythromycin, tetracycline or silver nitrate (prevent gonococcal conjunctivitis) Congenital CMV Sequelae - Hearing loss is often progressive Developmental delays Hepatosplenomegaly and rash, can be expected to resolve spontaneously within weeks Breastfeeding - Recommended for the first 6 months of life CLIPP latest exam questions and answers -Breastfeeding plus complementary foods until the infant is at least 12 months of age Breast milk plus fortifier is recommended for premature babies Nurse their babies whenever there are signs of hunger (8-12 times per day) Maternal benefits include decreased risk of breast and ovarian cancer and osteoporosis Newborn Screening - Metabolic Disorders Congenital deafness CMV Follow-up - Audiometry Ophthalmoscopy, Vision Function CLIPP latest exam questions and answers Neurologic Examination/Developmental Assessment by Primary Care Physician Neurology and/or Neuropsychology Referral eczema treatment - protect skin by lubricating extensively using anti-inflammatories in short bursts (hydrocortisone) treating associated skin infections aggressively antihistamines to help with itch weight age - age at which he patients weight would plot at je 50th percentilw height age - age at which the patients height would plot at the 50th percentile adhd symptoms - inattention hyperactivity CLIPP latest exam questions and answers resolves with rest precordial catch syndrome - most common cause of chest pain in an adolescent benign kernicterus - staining od the basal gamglia and cranial nerve nuclei by bilirubin -result of high levels of unconjugated bilirubon cephalohematoma - Subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery -swelling does not extend across a suture line -blood is reabsorbed and will contribute to hyperbilirubinemia caput succedaneum - edematous swelling over the presenting portion of the scalp of an infant -overlies the periosteum and the swelling crosses suture lines -swelling consists of serum and would not cause hyperbilirubinemia CLIPP latest exam questions and answers Timing of Neonatal Screen - Optimal time for testing is ≥ 24 hours after birth -Specimen obtained before 24 hours of age may miss PKU and other disorders with metabolite accumulation If the first specimen was obtained prior to 24 hours, a second specimen should be obtained in the next one to two weeks Neonatal screen disorders that cause jaudice - Congenital hypothyroidism Galactosemia Normal 5 year old heard rate - 80 to 100 beats per minute Macule - Flat, discolored spot Papule - Small, well-defined solid bump Vesicle - Small, well-defined, fluid-containing bump Pustule - Small, well-defined bump containing purulent material CLIPP latest exam questions and answers Plaque - Small, raised, differentiated patch or area on a body surface Desquamation - Shedding of the outer layer of skin surface Enterovirus rash - Erythematous and maculopapular and may involve the palms and soles. Infrequently, it can be petechial Meningococcemia rash - Caused by the bacteria Neisseria meningitidis, the onset is abrupt and accompanied by fever, chills, malaise, and prostration Initial rash may be urticarial, maculopapular, or petechial (marked by small, purplish, hemorrhagic spots) Can become purpuric, marked by large hemorrhages into the skin Scarlet fever - Rash, caused by infection with group A Streptococcus CLIPP latest exam questions and answers Retractions Paradoxical breathing paradoxical breathing - Occurs when the force of contraction generated by the diaphragm exceeds the ability of the chest wall muscles to expand the rib cage -As a result the chest is drawn inward with inspiration, and the abdomen rises due to downward displacement of abdominal contents Bordetella pertussis - Bacteria with triphasic course 1. Bordetella pertussis 2. Paroxysmal stage that follows lasts 4-6 weeks and is characterized by repetitive, forceful coughing episodes followed by massive inspiratory effort, which results in the characteristic "whoop" 3. Convalescent stage is entered. Episodic cough may persist for months Vaccine efficacy is only 70-90% Infections that cause respiratory distress - Boradetella pertussus Diphtheria CLIPP latest exam questions and answers Epiglottitis Retropharyngeal or parapharyngeal abscess Stridor - Due to airway narrowing above the thoracic inlet. Usually heard with inspiration, but can be biphasic if obstruction is severe Rhonchi - Coarse, low-pitched rattling sounds heard best in expiration. Thought to be due to secretions and narrowing of airways Crackles - Finer breath sounds heard on inspiration. Associated with either fluid in the alveoli or with opening and closing of stiff alveoli (as in interstitial disease). Sometimes described as either coarse or fine CLIPP latest exam questions and answers Chest fluoroscopy - Excellent radiographic test to evaluate for airway foreign body in an infant or toddler because it does not require the child to hold her breath. Is a dynamic evaluation that allows visualization of the airways over several breaths rather than a single breath, (as is the case with decubitus or inspiratory/expiratory films) Is performed with continuous and real-time imaging of the chest by the radiologist and is therefore generally available only during hours that a radiologist is immediately available. -Additional drawback to fluoroscopy is the additional radiation typically administered during the test compared with plain films Bronchiolitis - Acute bronchiolitis is a viral disease of the lower respiratory tract of infants and represents the most common cause of wheezing in infants. Bronchiolar obstruction due to edema, mucus, and cellular debris. Respiratory syncytial virus (RSV) is the most common cause, but other viruses such as influenza and parainfluenza may cause bronchiolitis as well Initially have mild upper respiratory tract symptoms and often a fever of 38.5-39 C. Respiratory symptoms can progress to cough, wheezing, dyspnea and irritability CLIPP latest exam questions and answers Productive cough - Often described as "wet" or "congested" by parents May indicate a lower-respiratory infection or problem The following should be looked for in a relevant review of systems for cough in a school-aged child - Change in voice Chest pain Choking event Fever Headaches Sore throat Signs and Symptoms of Sinusitis - Persistence of bilateral green nasal discharge lasting for more than one week Sore throat Fever Cough (especially at night) Malodorous breath Irritability CLIPP latest exam questions and answers Wheezing due to asthma - Musical or polyphonic noises that are continuous sounds rather than discontinuous and are typically expiratory in the majority of patients Cough syrup under 2 yo - over-the-counter (OTC) cough and cold products not be used for infants and children under 2 years of age. Acute otitis media - Typically develops 3-5 days after onset of upper respiratory symptoms. One of the more specific symptoms is otalgia (ear pain, tugging at ears). Other symptoms include fever, irritability, cough, anorexia and less commonly, vomiting and diarrhea. Ear exam - C = Color (gray, white, amber, blue, red or yellow) O = Other (bubbles, air-fluid interface, scarring, or perforation) M = Mobility (absent, reduced, normal, or hypermobile) CLIPP latest exam questions and answers P = Position (normal, retracted, or bulging) T = Translucency (opaque or translucent) Two pathogens most prevalent to cause Acute Otitis Media - Streptococcus pneumoniae Haemophilus influenzae, nontypeable First-line Therapy for Acute Otitis Media - Amoxicillin -effective against susceptible and intermediately resistant S. Pneumoniae -Is inexpensive -Tastes good -Has a relatively good safety profile, and -Is narrow in its spectrum of antibacterial activity. Use ABs to treat AOM - Unilateral w/ following sx 1. Toxic-appearing child 2. Persistent ear pain for 48 hours, or 3. Fever > 39 C within the past 48 hours CLIPP latest exam questions and answers Lasts > 15 minutes Occurs more than once in 24 hour period Focal Determining Severity of Illness - Determine if the person (child or adult) is still perfusing major organ systems: the brain, skin, kidneys and lungs Determine if the person has any underlying conditions (e.g., sickle cell disease, HIV, neutropenia, diabetes mellitus) that place the person at risk Conditions that can lead to altered mental status that must be reversed quickly to prevent cellular damage - Hypoxemia Shock (septic, hypovolemic, cardiac) Hypoglycemia Poisoning Conditions that lead to acidosis and/or shock result in an altered mental status - Intussusception Sepsis CLIPP latest exam questions and answers Diabetic ketoacidosis (DKA) Renal failure Assessing breathing - Describing the effort and rate of breathing How the patient's lungs sound If the lungs are well oxygenated (Place a pulse ox) Shock - Inadequate delivery of substrates and oxygen to meet the metabolic needs of tissues Give fluids via intraosseous line in IV can't be placed Children & shock - Children can maintain a normal blood pressure until they are in profound shock Increased heart rate (tachycardia) Increased systemic vascular resistance (vasoconstriction): Can lead to difficulty obtaining a pulse oximeter measurement Increased heart contractility CLIPP latest exam questions and answers Increased venous tone Increased respiratory rate (tachypnea): The body's attempt to compensate for the metabolic acidosis caused by decreased oxygen perfusion of the tissues and cells non-blanching rash - Caused by bleeding underneath the skin infection-control issues for Meningococus - All household contacts and anyone having close contact during management of the patient should be treated: ciprofloxacin for adults and rifampin for children. Tetravalent Meningococcal Conjugate Vaccine (MCV4) - Given to children ages 11- 18 Given intramuscularly during the routine preadolescent immunization visit (at 11- 12 years) Booster dose should be given at age 16. Complications of Meningococcal Disease - Occur in 11% to 19% of patients: CLIPP latest exam questions and answers Fever - Temperature of ≥ 38.0°C (100.4°F) Low grade 38-39 (100.4 - 102.2) moderate 49 - 40 (102.2 - 104) high grade > 40 (> 104) >41 (105.8) is medical emergency Death usually > 46 Use rectum in small children H&P: The level and duration of a child's fever Mode of temperature measurement Failure to thrive (FTT) - Weight falls below the 3rd percentile CLIPP latest exam questions and answers Weight for height/length falls below the 3rd percentile The rate of weight gain slows compared with previous growth, crossing two or more major percentiles on the growth chart in a downward direction OPQRSTAAA - O = Onset P=Position Q=Quality R=Radiation S=Severity T=Timing A=Alleviating factors A=Aggravating factors A=Associated symptoms Functional Abdominal Pain - Children 4 to 18 years of age with chronic abdominal pain There are no alarming symptoms or signs CLIPP latest exam questions and answers The physical examination is normal, and The stool sample tests are negative for occult blood Treatment: Reassuring the parents and patient that no serious illness is present. Pediatric rectal exam - Aid in the diagnosis of: Gastrointestinal bleeding Intussusception Rectal abscess or Impaction "Red Flags" for Possible Crohn's Disease - Pain that awakens the child at night Pain that can be localized Involuntary weight loss or growth deceleration Extraintestinal symptoms (e.g., fever, rash, joint pain, aphthous ulcers, or dysuria) Sleepiness after attacks of pain CLIPP latest exam questions and answers Redundant skin on back of neck (nuchal skin) Hypotonia Diagnostic: Lymphocyte karyotype Increased rates of hypothyroidism Genetic possibilities for Down's - Trisomy 21 (47, XY,+21 in this boy) (the most common and most likely, regardless of the mother's age); An unbalanced chromosome translocation resulting in extra chromosome 21 material; Mosaicism for a trisomy 21 cell line. Turner syndrome - Physical findings such as: Webbed neck Low ear placement Edema of the hands and feet CLIPP latest exam questions and answers Hyperconvex nails, and A "shield" chest with widely spaced nipples Additional findings: Coarctation of the aorta is found in about 20% of affected girls. Short stature is common, and some girls are not diagnosed until early adolescence when they present with short stature and delayed sexual maturation (due to gonadal dysgenesis). Most have a normal IQ Sickle cell disease - substitution of valine for glutamic acid at the sixth amino acid position of the hemoglobin molecule Common surgeries: Tonsillectomy - Enlarged tonsils Cholecystectomy - Gallstones from anemia Risk of sepsis increased CLIPP latest exam questions and answers Periorbital edema - Often the first sign of hypoalbuminemia, which may be caused by either nephrotic syndrome or glomerulonephritis Treatment of primary nephrotic syndrome - Combined use of furosemide and 25% albumin is recommended only for those children with symptomatic edema Corticosteroids Sodium restriction to a level of 1500-2000 mg daily