Exam (elaborations) NR 602

NR 602 FINAL EXAM GUIDE /NR 602 FINAL EXAM ACTUAL EXAM GUIDE WITH COMPLETE 300+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ What is transposition of the great arteries? - ANSWER Aorta and Pulmonary artery are switched Name the viral exanthem that has a rash which is small white spots with a reddened background that occur on the inside of the cheeks? - ANSWER Koplix spots seen in measles Which two viral exanthems have cephlocaudal spread? - ANSWER Rubella and Measles ( head to body spread) What is cryptorchidism? - ANSWER undescended testes A 6 month old presents for a well-visit, upon assessment you note continued cryptorchidism. What is treatment? - ANSWER Refer to surgeon by 9-15 months A 9 month old presents for a well-visit. On exam you note scrotal swelling that doesn't appear to bother the patient. On further investigation, the scrotum is equal bilaterally and skin is pink and warm. What is diagnosis and treatment? - ANSWER Hydrocele Tx: should resolve on its own, if persistent for more than 1 year will refer to surgery. A 1 month old 2 weeks post circ. presents with complaint of red irritated head of penis. Mother reports seeing purulent discharge when changing diaper with fowl smell. What is the diagnosis and treatment? - ANSWER Balanitis- common in uncircumcised and post circ. Bactrim orally and bacitracin ointment. A 7 year old female presents with complaint of fever, weight loss, and joint pain. Upon reviewing her chart you note she has been seen multiple times this year for reoccurring infections. What is the differential diagnosis and possible treatment? - ANSWER Leukemia- common childhood cancer Dx: CBC, peripheral smear, and bone marrow biopsy A 13 year old female presents with complaint of nasal congestion, yellow nasal discharge, fever, and hyposmia (decreased smell) x 10 days. Upon exam patient has maxillary and facial tenderness. What is diagnosis and treatment? - ANSWER Bacterial rhino-sinusitis Amoxicillin- low risk patient Augmentin- daycare, recent antibiotics use, mod/sev illness. Rocephin 50mg/kg IM. 3rd gen cephalosporin CEFdinir, CEFposoxime, CEFuroxime A mother presents with newborn for first check-up, when reviewing the chart from birth you discover that the baby was found to have a atrial septal defect. What symptoms do you expect to see? What education can be provided to the mother? - ANSWER Patient will most likely be asymptomatic, hole between atriums didn't close like it was supposed too. Will hear split S2 heart sounds Education: small ASD will close on its own, watchful waiting. Medium to large ASD will require surgery. What is pulmonary atresia? - ANSWER Baby isn't born with valve to pulmonary artery, lack of blood flowing to lungs for oxygenation. Patient presents with a generalized rash, the mother tells you the new lesions appear daily. Upon inspection the rash is vesicular, pruritic, and covers all the body. Which organism is most likely to cause? - ANSWER Varicella Zoster (chickenpox) Patient presents with a slapped cheek appearance and a lacy reticular rash on the body. Reports fever previously then developed rash. What is the dx and tx? - ANSWER 5ths disease (parvovirus-19) Treat symptoms, rash will disappear in 2-3 weeks. AVOID IN PREGNANCY! When are lead levels checked? - ANSWER 12 and 24 months Positive 5 What lead level needs treatment? - ANSWER 45 What are red flags for headaches in pediatrics? - ANSWER Sudden onset Worsening patterns Systemic illness Focal neurological signs Papiledema Treatment for migraines in pediatrics - ANSWER Beta blockers, antidepressants, anticonvulsant, CCB Mother presents with 1 year old who appears to have Genu Varum. What teaching would you provide? - ANSWER Genu Varnum (bow leg) is normal up to 2 years of age. Your child's legs are likely like that because they had to rotate to fit into your uterus. - if they remain by 3, we will consider other disease processes or refer to ortho. Causes of bow legs? - ANSWER - Blounts disease- growth disorder Mother presents to the clinic with her son who has cystic fibrosis. What education should the nurse practitioner provide for the mother as far as expectations? - ANSWER -Child will be above 50th percentile for weight and height -diet should include high fat and whole milk -there should be no person-to-person interactions with other cystic fibrosis patients Mother presents to the clinic with her nine-year-old child who was hit in the head with a baseball bat. Upon exam the patient is AAOX3 But is complaining of a headache, fatigue, and slight nausea. Mother denies any loss of consciousness. What is the diagnosis and treatment? - ANSWER Traumatic brain injury/concussion TX: watchful waiting, have child return in 1-2 weeks for recheck. - gradually return to non-sports activities after no more than 2 to 3 days of rest -May use Tylenol for headache What are red flags following a traumatic brain injury? - ANSWER -watery discharge from nose or ears -vomiting more than two times -seizures -memory loss -unequal pupils -increased drowsiness What should pediatric patients be started on if they are positive for sickle cell? - ANSWER -referral to pediatric hematology -begin penicillin VK 125 mg by mouth starting at 3 months. (Preventative for peds under 5 or high risk) -Do CBC, Retic count, and G6PD - vaccinations What additional preventative action should patients with sickle cell have? - ANSWER -routine blood pressure monitoring -Transcranial Doppler's up to 16 years old -Retinal exam starting at age 10 What vaccination should sickle cell patients have and why? - ANSWER -PCV13 (2m, 4m, 6m, 12m) -PPSV23 (24m, 5y-7y) -influenza (6m starting..) They are at higher risk for infection that could be deadly. A four month old infant's Mother calls and states the patient has a fever of 101.8 rectally. The mother reports that the patient has received her penicillin prophylaxis that was prescribed for sickle cell. There is no respiratory distress and the patient has good oral intake and normal urine output. What advice would you give the mother at this time? - ANSWER The mother should be advised to take the patient to the emergency department immediately for initiation of IV antibiotics and further evaluation Out of the following children who should be seen immediately? A.) A four month old who has had a fever of 101.2 x 2 days but is still playing and has good oral intake. B.) A two month old with a fever of 100.6 C.) A 13 year old with a fever of 103 D.) A 3 year old with a fever of 101.1 - ANSWER B Babies 3 months with a fever greater than 100.4 should be seen immediately Exclusively breast-fed infants should be started on what at four months of age? - ANSWER Iron supplementation Iron-fortified cereal and/or purred meats at 6 months What education should be provided for families of children taking iron supplements? - ANSWER -avoid administering with meals or milk -blood from the body enters right side of heart and pumped directly back out to body. Blood from lungs pumps to left ventricle then back to lungs. Ventricle Septal Defect (VSD) - ANSWER flaw in the septum that divides the two ventricles of the heart - baby is usually asymptomatic - will hear holosystolic murmur Tx: small will close, large needs surgery. What is Tetralogy of Fallot? - ANSWER Tetralogy means 4 1) pulmonary stenosis 2) overriding aorta (receives blood from left and right ventricle) 3) RVH (right ventricle hypertrophy) 4) VSD (ventricular septal defect) Most common cyanotic congenital heart disease in children patent ductus arteriosus (PDA) - ANSWER passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth Symptoms: wide pulse pressures Enlarged heart Respiratory issues What is the treatment for patent ductus arteriosus? - ANSWER NSAID- decrease prostaglandin which allow duct to close Surgery What are the risk factors for hypertension in children and teens? - ANSWER -being obese -Exposure to secondhand smoke In evaluating a nine-year-old child with a healthy BMI during a well visit, a comprehensive cardiovascular evaluation should be conducted by the following methods: - ANSWER -obtaining a fasting lipid profile -assess diet and physical activity At what age is it appropriate to recommend dietary changes to parents if overweight or obesity is a concern? - ANSWER 12 months What are the risk factors for type two diabetes in children and teens? - ANSWER -Hyperinsulinemia -Abnormal weight to height ratio -BMI 85 percentile -Native American ancestry When is screening for children with a known risk factor of type 2 diabetes recommended? And should Be repeated how often? - ANSWER Onset of puberty or Age 10 which ever comes sooner If normal, repeat at minimum of 3 year intervals, more frequently if BMI increasing. A 12 year old boy presents with his mother post pre-diabetes diagnosis. Upon reviewing the chart the patient is at 85 percentile For height and weight. The mother ask what they can do to prevent the patient from moving to full-blown diabetes. What would be your response? - ANSWER -patient should be encouraged to participate in at least 60 minutes of moderate to vigorous physical activity daily -muscle and bone strength training at least three days a week -Decrease sedentary behavior What is an A1c target for most children and adolescents with type two diabetes treated with oral agents? - ANSWER 7% Pre-diabetes in children is defined as? - ANSWER Impaired fasting glucose 100-125 -random glucose 140-199 What are the risk factors for dyslipidemia in children? - ANSWER Family history of lipid abnormalities Family history of type two diabetes mellitus At what age does screening cholesterol levels in children with one or more risk factors begin at? - ANSWER Age 2 A 17-year-old male presents post lipid labs, his total cholesterol Level is 150. What education would you provide? - ANSWER This is an acceptable total cholesterol level (170), Will recheck in 3 years Low birthweight and poor infant growth are risk factors for type two diabetes. True or false? - ANSWER True When should body mass index be measured? - ANSWER At age 2 A mother of a 14-month-old presents with concerns for her child being overweight. When you review the growth chart the patient is in the 99th percentile. What recommendation can be made? - ANSWER Patient can be switched to reduced fat milk instead of whole milk.