TEST BANK FOR NELSON PEDIATRICS

Question . 1. Clinical findings are influenced by a child's developmental stage. Which of the following features of the physical examination is most strongly influenced by developmental stage? Skin turgor Respiratory rate Explanation: Respiratory rate is highest in the neonate and gradually becomes slower approaching adult rates in the preadolescent-adolescent age period. Respiratory rate may be influenced by serious pulmonary or airway infection or inflammation in addition to non-respiratory causes, such as fever, anxiety, acidosis, pain, heart failure, central nervous system disease, drugs (stimulants, depressants, aspirin), and toxins (ammonia). (See Chapter 49 in Nelson Textbook of Pediatrics, 17th edition.) Lung aeration Mitral valve closure Fontanel tension Question . 2. The vulnerable child syndrome most influences which of the following components of the well child assessment? Physical examination Observation Developmental assessment History Explanation: Parents perceive vulnerability due to many real or exaggerated risks: premature birth, difficult pregnancy, previous death of a child, disease in other siblings, or minor low-risk conditions in this child. The history is usually exaggerated, embellished, and quite detailed. (See Chapter 49 in Nelson Textbook of Pediatrics, 17th edition.) Growth Question . 3. During examination of an 8-mo-old child, the difficulty of optimal chest auscultation is due primarily to: Recent meal with gastric distention Rapid respiratory rate Stranger anxiety Explanation: Crying makes the chest physical examination almost impossible, except for detection of the grossest abnormalities,. If at all possible, the chest auscultation should be preceded by observation and then performed in the sleeping, calm, nursing, or feeding infant. (See Chapter 49 in Nelson Textbook of Pediatrics, 17th edition.) Transmitted nasal sounds Pliable chest wall Question . 4. Assessment of the state of well-being by observation relies mostly on the child's: Nutritional status Motor ability Visual behavior Interaction with parents Explanation: The interaction with the parents is most critical, as this is the child's "normal" environment and is free of additional factors such as stranger anxiety. As children come with all varieties of behaviors, it is essential to ask the parents if the observed behavior is "normal" for the child and, if not, how it is different. (See Chapter 49 in Nelson Textbook of Pediatrics, 17th edition.) State variation Question . 5. Based on an orientation to child development, when would you tell parents the highest risk of poisoning in children is present? 6 mo 1 yr 2 yr Explanation: Self-poisoning in toddlers occurs once they become ambulatory and are able to walk and climb. Consider no place safe, especially if there are older siblings. Also consider that child-proof medicine containers will rarely be a deterrent to a motivated toddler. Remember that plants, berries, and liquids also present risks for ingestion in this age group. (See Chapter 49 in Nelson Textbook of Pediatrics, 17th edition.) 4 yr 6 yr Question . 6. Injury control is a more appropriate term than accident prevention because accidents are: Not predictable Not preventable Random Not due to chance Explanation: Injuries have definable risks, are not random, and are both predictable and preventable. The term "accident" confuses our meaning and should no longer be used. (See Chapter 50 in Nelson Textbook of Pediatrics, 17th edition.) Not common Question . 7. Motor vehicle injuries lead the list of injury deaths for all ages and are most often associated with: Alcohol use Occupant injury Driver age younger than 17 yr Presence of more than two occupants in the car Night driving All of the above Explanation: All are risk factors that can be modified by behaviors and laws, such as a graduated driver's licensing program. (See Chapter 50 in Nelson Textbook of Pediatrics, 17th edition.) Question . 8. Risk factors for injury include all of the following except: Toddler age Female gender Explanation: After 1-2 yr of age, males have a much higher injury rate than females. This risk lasts until the 7th decade. Adolescent risk-taking behavior accounts for some of the difference during the teen years. (See Chapter 50 in Nelson Textbook of Pediatrics, 17th edition.) Poverty Front-seating in an automobile Chaotic family stress Question . 9. The proper age at which a child may cross a busy street alone after careful instruction is: 4-5 yr 6-7 yr 8-10 yr 10-12 yr Developmentally, children below this age are unable to understand the risk and judge such factors as car speed. Chronological age does not determine readiness, which requires instruction, trial runs with a parent, and parental judgment of the child's ability. (See Chapter 50 in Nelson Textbook of Pediatrics, 17th edition.) None of the above Question . 10. The majority of children with medical emergencies present to all of the following for care except: Pediatrician's office Children's hospital emergency department Explanation: Most children receive all or initial emergency care at sites other than a specialized pediatric emergency room in a children's hospital. (See Chapter 51 in Nelson Textbook of Pediatrics, 17th edition.) Community hospital emergency department Clinic Urgent care facility Question . 11. A general pediatric office should be prepared for emergencies. This preparedness includes all of the following except: Training in advanced trauma care Explanation: Although advanced life support is ideal, it is unrealistic for a general office to be prepared for advanced trauma care. The patient should be stabilized as best as possible, with placement of an airway and intravascular lines, and transported to a facility capable of caring for pediatric trauma patients as soon as possible. (See Chapter 51 in Nelson Textbook of Pediatrics, 17th edition.) Education of staff in CPR Policies for triage Procedure for resuscitation Transport protocols Question . 12. A 15-mo-old child is in your office with stridor at rest and cyanosis with the presumptive diagnosis of viral croup. You should do all of the following except: Transport immediately in the parent's car to the nearest emergency department Explanation: A cyanotic child in respiratory distress is at high risk for a respiratory arrest. No acutely ill child should be transported by the parents no matter how short the distance or how long the delay for EMS to arrive. (See Chapter 51 in Nelson Textbook of Pediatrics, 17th edition.) Administer oxygen Administer dexamethasone Administer racemic epinephrine Transport after EMS personnel arrive 20 min later Question . 13. Enhanced 911: Is one-touch dialing Identifies patient location Explanation: The location of the caller is automatically identified. This is especially important if the caller is unable to communicate their location (young age, coma, seizure, drug overdose, disability). (See Chapter 51 in Nelson Textbook of Pediatrics, 17th edition.) Triages bas