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NURS 629 exam 4-with 100% verified answers-2024-2025.docx
Typology: Exams
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Rovsing sign – answer apply pressure to lower left abdomen. Pain felt on right side of abdomen when pressure released.
essentials for childs mental health – answer predictable home, childcare, school routines Migraine – answer unilateral, pulsating, occasional photophobia. Iron deficiency anemia - answer*Microcytic, hypochromic. Most common cause is poor dietary intake/ breastfeeding risk. Prevalence is 25% of children between ages 10-15 mos. Depression Comorbidities – answer anxiety disorder, mixed anxiety/depression. ADHD, conduct/learning/oppositional defiant disorders. SAD, eating disorders, stress. Depression risk factors – answer attention, conduct, learning disorders. Chronic illness (diabetes). abuse/neglect. other trauma or natural disasters. *Separation anxiety. PHQ9 – answer depression screening tool for ages 11 and up signs of PTSD – answer re-experiencing trauma thru intrusive distressing recollections of event, flashbacks, nightmares. Avoidance of places, people, and activities that are reminders of trauma, and emotional numbness. Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, easily irritated and angered. *Extreme temper tantrums in preschool aged kids. slipped capital femoral epiphysis risk factors – answer Obesity, males, sports, femoral retroversion, hypothyroidism, avg age presentation is 12y/o for females and 13y/o for males. slipped capital femoral epiphysis clinical findings: - answer limping, knee/hip pain, pain worse with activity, localized pain to ant thigh or knee. May be unable to bear wt all together, loss of internal rotation of hip with flexion, affected extremity is usually shorter. Loss of abduction and extension slipped capital femoral epiphysis DX and TX - answer-xray. Always refer to peds ortho. Keep non wt bearing until surgical eval.
Scoliosis - answermost common type is idiopathic. *In order to confirm suspected, get AP and lateral standing Xray view of spine Bactrim - answertreatment of choice for UTI in children TX for gastroenteritis - answersmall, frequent amounts of oral rehydration solution Appendicits - answerConstant periumbilical pain shifting to RLQ. Worsens over period of 4hrs. Pain subsides as it migrates to RLQ and then worsens with movement, deep respir, and coughing.Pain/Fever are late sign, leading to perforation. Vomiting. *Elevated WBC. Neural mediated syncope - answermost common form of fainting/ frequent ED visits. Happens in part of nervous system that regulates BP. Place pt reclining position to restore blood flow/ consciousness. Situational syncope, vasovagal, reflex, neurocardiogenic part of it. Residual findings are pallor, fatigue, diaphoresis Cardiac syncope - answercauses: bradycardia, tachycardia, hypotension, exercise triggered. Palpitations. Residual findings: incontinence, disorientation, or injury. Goiter - answercommonly found on exam with hyperthyroidism DM1 treatment goals - answerachieve normal growth/development. Achieve optimal glycemic control. + psychosocial adjustment to diabetes. Hgb A1C <
DM managament - answerDM1= start on insulin. Check BG 6-10x/day. Monitor urine/ blood for ketones in prolonged hyperglycemia. Exercise moderate-vigorous & bone strengthening 3x/week. BG goal during exercise 90-250 and have carbs available. DM eye exams - answerat 10y/o or puberty and on, initial dilated and comprehensive eye exam
after having DM for 3-5 yrs. F/u recommended in opthamol Q2 years pending risk level E coli - answermost common cause of UTI in children Red flags for sensory processing disorder - answeroverly sensitive to touch, noise, smell; poor self-esteem; afraid of failing at new tasks; lethargic and slow; always on go; impulsive; distractible/leaves tasks uncompleted; clumsy, slow, poor motor skills/ handwriting. signs of normal cognition development in toddlers: - answeremerging empathy, understanding social rules, constructing narratives, reciprocity in play. executive functions required for self-regulation - answerInhibition, Flexibility, Emotional control Education for febrile seizures - answerNot actual seizure; best prevention is tylenol/ ibuprofen alternate Q4hr; hydrate & rest; seek emergency care if seizure lasting longer than 5 minutes Mgmt & TX reflux - answerKeep breastfeeding; formula fed= 2 week trial of extensively hydrolyzed formula or amino acid based to exclude CMA and thicken formula. screening with known risk factors for DM2 recommended at 10y/o onset of puberty and repeat= - answerevery other year increased risk of DM - answerimpaired fasting BG (>100 but <125); impaired glucose tol (2hr post prandial 140-199) rates of UTI among uncircumcised infant boys are much higher than circumcised by - answeras much as 20% most likely to be presentation of UTI in 20 month old? - answerFever
ideal method for obtaining urine sample for culture in 18 month female with suspected uti? - answersuprapubic aspiration UA of 10 month old with UTI, NP knows - answer20% of UA can be normal child 2 months- 2 years with UTI, antibiotic therapy for - answer7-14 days 12 month old with fever, suspected UTI, vomited 5x in last 7hours, last wet diaper ~6hrs ago. Prepare to - answerarrange for child to be admitted to hospt preferred urinary tract imaging for 22 month old with 1st time febrile UTI - answerRenal bladder ultrasound (RBUS) most compelling reason to get RBUS instead of voiding cystogram (VCUG)? - answernoninvasive test VCUG indicated - answerif UTI recurrent rehydrate child with moderate dehydration with - answeroral rehydration. as effective as IV fluid and less costly when considering antidiarrheals and antimotility in young children with gastroenteritis, NP knows - answerthese agents should be avoided. most common cause of viral gastroenteritis - answerNorovirus to obtain most accurate hydration status, ask about - answertime of last urination
signs of severe dehydration - answeranuria, tears absent, and cap refill approx ~ sec hydration status can be determined by - answerwatch BP, HR, skin turgor, presence of dry lips, oral mucosa 8 months with intermittent random episodes of vomiting, AB bloating, currant jelly stools, irritability with poor appetite. growth/lethargic, sausage like mass on Right side - answerintusseception 4 weeks, forceful vomiting, wt down, seems hungry, sucks on bottle no problem. poss cause and findings= - answerround olive like mass in RUQ most common type of cancer in kids - answerAcute Lymphoblastic leukemia avoid this with celiac spruce - answerAvoid gluten (wheat, barley, rye) 14 y/o M with several months of recurrent bloating, stomach upset, occasional loose stools. Difficulty gaining wt, short. Symptoms worse after crackers, cookies, and breads. No blood in stools. - answerCeliac disease 10 y.o M with sudden scrotal pain upon awakening. severe N/V. Exam= tender, warm swollen L scrotum. Cremasteric reflex negative and urine no findings. - answerTesticular torsion. Refer to ED
14 y/o M plays bball, complains of swelling and pain on bilat knees. Exam= tenderness over tibial tuberosity bilat knees - answerOsgood-schlatter 17y/o M feeling something in L scrotum. Palpation is soft, movable, blood vessels that feels like 'bag of worms' under scrotum skin. testicle not swollen or red. - answerVaricocele lead poisoning can cause - answerMicrocytic Anemia Beta thalassemia minor considered - answermicrocytic anemia Rovsing's sign - answeracute abdomen, such as during ruptured appendix 8 y/o with DM1 seen for 3 day hx of urinary frequency and nocturia. UA is neg blood and nitrites, + large amt of leukocytes and ketones. Trace protein. Best initial test - answerUrine culture/sensitivity 11 y/oM with sickle cell anemia woke up painful penile erection that wont go away. - answerRecommend immediate referral to ED