PNP-PC Certification Exam Latest 2024/2025 QUESTION AND ANSWER (HIGHLY RECOMMENDED), Exams of Nursing

Download PNP-PC Certification Exam Latest 2024/2025 QUESTION AND ANSWER (HIGHLY RECOMMENDED) and more Exams Nursing in PDF only on Docsity! PNP-PC Certification Exam Latest 2024 2025 QUESTION AND ANSWER (HIGHLY RECOMMENDED) FULLY SOLVED Vitamin supplementation for breastfeeding infants Vitamin D 400 IU per day at 2 months to adolescence Vitamin B12 for mothers who are strict vegetarians s/t possible neuro abnormalities When and how much iron should be added for exclusively breastfed infants? Approximately 1mg/kg/day is recommended after 6 months of age and continue until the infant is taking 2 or more servings of iron-fortified cereal daily. Weight gain progression Initially 7-10%lost Regained within 7-14 days Double by 5 months Triples 1 year Quadruple by 2 years Tooth Eruption (Primary Teeth) Central Incisor 8-12 months (Lose them around 6-7 yrs) First molars 13-19 months Piaget's stages of cognitive development 1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational coginitive development Need at least 2 seperate test results to make an assessment of intellect Gross Motor Skills Sits alone: 7-9 mths Pulls to stand: 9-10 mths Stands alone: 11-12 mths Walks: 12-14 mths Walks up and down stairs: 22-24 mths Jumps: 24-28 mths Fine Motor Skills Reaches for objects: 3-4 mths Hand-to-hand transfer: 5-6 mths Pincer grasp: 8-10 mths Language Skills "Mama-Dada": 8-9 mths Waves bye-bye: 8-9 mths Points to body parts 15-18 mths Two-word sentences 18-22 mths 30-50 word vocabulary 22-24 mths Social Skills Responds to own name: 9-10 mths Clings to familiar adults: 9-10 mths Cries when parents leave: 10-12 mths Plays simple pretend: 10-12 mths Milestones 2-5 months Smiles and coos Watches a person's face intently Follows people and objects with eyes Laughs aloud Lifts head/chest when on stomach Holds head steady when pulled to sit Grasp rattle placed in hand Startles to loud noise Milestones by 6 - 9 months Babbles and combines vowels/consonant sounds Turns to sound Respond to name Rolls over Sits independently Transfers objects Supports weight on feet Uses thumb and fingers to pick up objects Crawls Milestones by 10 - 12 months Takes simaendently and plays Pulls to standing/cruises furniture subjective data what the person says about himself or herself during history taking; not obersved objective data information that is seen, heard, felt, or smelled by an observer; signs Ages and Stages Questionnaire (ASQ) Age: Birth-6yrs Definition: Assess communication, gross motor, fine motor, personal-social, and problem-solving skills Nursing Implication: A parental-report screening tool, scored completion to determine child's progress in each of the developmental areas Patient Health Questionnaire (PHQ-9) Age: 12yrs and Up A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression. When are lead levels checked? Obtain from 6 mths to 6 yrs, if risk assessment is significant Typical dose for all vaccines 0.5ml IM or SQ depending on vaccine, with the exception of influenza vaccine Hepatitis B vaccine -A series of 3 injections: first at birth to 2 months, then 1 to 2 months after first, and last one at 6 to 18 months. -Is the only vaccine that prevents cancer (liver) -1st dose prior to hospital discharge -2nd dose 1-2 mths of age Infant born to HBsAg positive mother -Administer HepB and 0.5 ml HBIG within 12 hours of birth -Test for HBsAg and antibody to HBsAg after 3 or more doses of Hep B series at age 9-18 mths If mothers HBsAg status is unknown -Determine/check status immediately after birth -Administer HepB within 12 hours after birth -If mother test positive, HBIG should be given no later than 1 week of age -Final dose should be given at 6 mths of age or later Rotavirus Vaccine (Rota) -Usually at 2, 4 and 6 months -Administer first dose at 6-14 weeks and each subsequent dose at 4-week interveals - MUST COMPLETE BEFORE 32 WEEKS OF AGE Contraindicated in those w/ hx of anaphylaxis to streptomycin Influenza Vaccine Annually 6-35 months = 0.25 ml IM 3 yrs or older = 0.5 ml IM Children 6 months to 8 yrs receiving a it for the 1st time should receive 2 doses. Children who have only received 1 dose should receive 2 doses. Those with egg allergy should receive in a medical setting with appropriate supervision for reactions. Measles, Mumps, Rubella (MMR) Live Vaccine 1st dose: 12-15 months 2nd dose: 4-6 years old If exposed or traveling to endemic areas it can be given as early as 6 months, but will need to continue primary series at appropriate time Varicella live attenuated Series of 2 doses between 12-15 months and 4-6 yrs min 3 yrs apart Give 2 doses after age of 2 months when no reliable hx of dz and no evidence of immunity available Contraindicated in pregnant women and immunocompromised persons; contraindicated in those with streptomycin allergy Hepatitis A Vaccine Series of 2 doses Starting at 12 months 6 months apart Meningococcal Vaccine (MenACWY) Series of 2 doses Ages 11-12 yrs and a booster at the age of 16 yrs There is an increased rate of incidents between 17 and 21 yrs of age Adolescence receiving 1st dose at or after 16 yrs: No booster necessary Should not be given to those pregnant or immunosuppressed Meningococcal B Vaccine recommended for children 10 years or older at risk for dz A human genetic disorder resulting from the presence of an extra chromosome 21; characterized by heart and respiratory defects and varying degrees of mental retardation. Physical findings of Trisomy 21 Microcephaly Flattened nose Hypertelorism (widely separated eyes d/t their flattened nose) Protruding tongue Inner epicanthal folds Upward slanting eyes Short broad hands/fingers Single Palmar crease Delayed Growth/Development Hypotonia Brushfield spots Other manifestations w/ Trisomy 21 Atlanto-axial instability (Neck instability between C1 and C2) Congenital heart disease Leukemia (Noted by Bruising) Early Dementia XXY (Klinefelter Syndrome) Male phenotype, No cardiac involvement Most common cause of hypogonadism and infertility in men. XXY (Klinefelter Syndrome) Phenotypical manifestations Long arms and legs, underdeveloped testes in boys, breast development., learning disability, tall stature XO Karyotype (Turner's Syndrome) Females sex chromosome abnormality Occurs in 1:2,000 - 2,500 births 95% don't survive in utero "Puffy babies" in utero XO Karyotype typical findings Lymphedema Webbed neck Low hairline "Shield-shaped" Chest (widely-spaced nipples) Bicuspid aortic valve, coarctation of aorta Infertility Tx for XO Karyotype Refer to endocrinology Growth hormone therapy Estrogen replacement therapy Marfan Syndrome Inherited disorder of fibrillin gene Abnormal development of elastic fibers Tendency to be tall with very long legs, arms, fingers and toes Life-threatening weakening of aorta may lead to rupture Antiseizure Therapies Multidisciplinary Consultations DiGeorge Syndrome congenital defect of the parathyroid, thymus, and conotruncal region of the heart resulting from partial deletion of the 22nd chromosome DiGeorge Syndrome Phenotypic presentation Increased susceptibility to infection Abnormal facies: Lateral displacement of inner canthi, short palpebral fissures, changes to appearance of eyes, and nose Congenital heart defects often resulting in neonatal morbidity/mortality Hypoparathyroidism w/ hypocalcemia (seizures in infancy) Cognitive/behavioral/psychiatric problems How many points are possible for each APGAR scale? There are 3 points possible for each area of assessment (appearance, pulse, grimace, activity, respirations) 0, 1, and 2 Appropriate for gestational age (AGA) Weight, length, and head circumference are between the 10th and 90th percentiles for gestational age. small for gestational age (SGA) a term for a baby whose birthweight is significantly lower than expected, given the time since conception Symmetric IUGR growth restriction in which the weight, length, and head circumference are all affected < 10th percentile Symmetric IUGR causes Genetic: Congential or chromosonal abnormaliities Intrauterine infection: viral, bacterial, protozoal, spirochete Inborn errors of metabolism Environmental: Drugs, alcohol, nicotine, x-ray exposure Asymmetric IUGR causes May be due to extra fetal compromise (usually occurs > 24 wks) chronic HTN Pre-eclampsia Renal disease Cyanotic heart disease Hemoglonopathies abruptio placentae multiple gestation altitude Asymmetric IUGR growth restriction in which the head circumference and length remains within normal parameters while the birth weight falls below the 10th percentile If present in large numbers, suspect tuberous sclerosis, xeroderma, pigmentosus, or generalized neurofibromatosis Mongolian spots Areas of deep bluish-gray pigmentation most commonly on the sacral aspect of a newborn Benign, flat, congenital birthmark Wavy borders and irregular shape Usually, last up to 1 yr after birth but may remain indefinitely Almost always disappear by puberty DON'T BLANCH Port wine stain Vascular birthmark (malformation) consisting of superficial and deep dilated capillaries in the skin Reddish to purplish discoloration of the skin Permanent R/O Sturge-Webber Syndrome (Serious neurological condition w/ sz, musculoskeletal weakness, developmental delays, glaucoma) IF IT CROSSES MIDLINE OR ON EYELID REFER Strawberry mark (Hemangiomas) Raised, soft, red lumps on the skin More common in premature infants Hypo/hyper-pigmented During the first year; usually begin to shrink and fade Measure at each visit Disappearance of reflexes Rooting 4 months Sucking 2 months Moro (Startle) 3-4 months Grasp (Palmar, Plantar) 5-6 months, 1-2 yrs Placing/Stepping 2-5 months Tonic Neck 3 months Babinski 12 months or when walking caput succedaneum diffuse edema of the fetal scalp that crosses the suture lines. reabsorbs within 2 to 3 days cephalohematoma Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines. INCREASES RISK FOR HYPERBILIRUBEMIA S/T BREAKDOWN OF RBC'S Deep blue sclera can indicate: osteogenesis imperfecta osteogenesis imperfecta colloquially known as brittle bone disease, is a group of genetic disorders that all result in bones that break easily.The range of symptoms—on the skeleton as well as on the body's other organs—may be mild to severe. Symptoms found in various types of OI include whites of the eye (sclerae) that are blue instead, short stature, loose joints, hearing loss, breathing problems and problems with the teeth (dentinogenesis imperfecta). Potentially life-threatening complications, all of which become more common in more severe OI, include: tearing (dissection) of the major arteries, such as the aorta; pulmonary valve insufficiency secondary to distortion of the ribcage; and basilar invagination. Brushfield spots Salt and pepper speckling on the iris Associated with Down Syndrome Choanal atresia A narrowing or blockage of the nasal airway by tissue. It is a congenital condition Fish mouth Seen in fetal alcohol syndrome Macroglossia enlarged tongue excess growth hormone, mouth breathing, hypodontia common in down syndrome Hypothyroidism Mucopolysaccharidoses Microstomia Small mouth Observed in Trisomy 13 and 18 Macrostomia Large mouth Presented mucopolysaccharidoses Epstein pearls Small white cysts found on the gums and at the junction of the soft and hard palates Breast enlargement in infants Considered normal Flat abdomen in an infant Considered abnormal Ambiguous genitalia congenital malformations that prevent visual identification of childs sex. chromosome analysis to determine the genetic karyotype chrom 12 mutation leads to error in converting phenylalanine to tyrosine; ClinMan: fail to meet dev milestones, microcephaly, progressive neurological decline/MR, seizures, hyperactivity, LD, eczema. Diag: serum phenylalanine by 3 days old. Treatment: diet low in protein and starches, gene therapy, phenylalanine lowering agents. Galactosemia an inborn error of metabolism that makes infants unable to process galactose, resulting in a variety of physical problems in addition to intellectual disabilities; dietary intervention reduces potential for problems Infants may develop unrecognized sepsis sickle cell disease Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape. African American population Thalassemia Inherited defect in the ability to produce hemoglobin, usually seen in persons of Mediterranean background. Hypothyroidism A disorder caused by a thyroid gland that is slower and less productive than normal cognitive delays or intellectual disability neurologic abnormalities metabolic abnormalities In some cases it may be misses on initial newborn screening fetal alcohol syndrome (FAS) Irreversible condition Brain damage and developmental problems s/t prenatal alcohol exposure Abnormal facial features: Small eye openings, thin upper lip, smooth philtrum,, upturned nose, small head size Poor growth/weight gain Better prognosis if diagnosed prior to 6 yrs old Rubella German measles a viral infection characterized by a low-grade fever, swollen glands, inflamed eyes, and a fine, pink rash Cardiovascular symptoms and ophthalmic conditions Cytomegalovirus (CMV) herpes-type virus that usually causes disease when the immune system is compromised S/S microcephaly, sensorineural hearing loss, chorioretinitis (an inflammation of the choroid and retina of the eye) Herpes inflammatory skin disease caused by herpes virus characterized by small blisters in clusters s/s - affects the skin, mouth, ophthalmic, CNS, pulmonary manifestations Congenital syphilis undescended testes failure of one or both testes to move from the abdomen to the scrotum during fetal development Should be referred by 6 months Allis sign unequal leg length Galezzi sign uneven knee height lymph nodes 1cm inguinal 2cm cervical enlargement (palpable) maybe a normal variant -refer to make sure Supraclavicular nodes require aggressive investigation - refer hearing loss Loss of > 20 decibels Development of fears Stranger 6 - 8 months Separation 8 - 9 months Reasons why formula may be presued over breastmilk? convenience pain of breastfeeding not tolerable conditions/treatments that may pass on to infant via breastmilk (e.g. HIV, chemotherapy, CMV) Formula to consider for infants with reflux With higher whey content Why does infants needs to use whole milk when switching from formula? They need the fat content When should solid foods be introduced? 6 months What solid food is usually introduced first to babies? fortified cereals - Rice How long should you wait prior to introducing a new food to an infant? 3-5 days in between When can peanut puffs be introduced? 6 months When a local site of infection cannot be found consider the dx of UTI Especially in uncircumcised males Management for Fever Acetaminophen 10-15mg/kg q 4-6 hours Ibuprofen 5-10 mg/kg q 6-8 hours Do not alternate s/t risk of overdose peanut allergy -immune system mistakes the peanut as something harmful -releases symptom-causing chemicals into bloodstream -affects approximately 1% of the population may be recognized when they are introduced into the infant's diet Heart sounds - Point of maximal impulse Near the 4th intercostal space (ICS) midclavicular line (MCL)