APN 3 Exam 1 study guide(100% Guaranteed)
When does the anterior fontanel and posterior fontanel close? correct answers Anterior by 18-19
mo (Burns 109)
- 12-18 mo per exam review with Dr. P
Posterior 6-12 weeks (Burns)
-1-2 mo per exam review with Dr. P
What teeth erupt first and at what age? correct answers Central lower incisors erupt around 6
months.
Lateral incisors around 8 months.
Is a newborn screening mandatory in all states? correct answers - Yes (Burns p. 75)
- The Recommended Uniform Screening Panel screenings that are performed vary from state to
state.
The mature pincer grasp is noted by? correct answers 10 months (p. 96)
Described the Moro (Startle) Reflex. correct answers The Moro or startle
- The baby throws back his or her head, extends out his or her arms and legs, cries, then pulls the
arms and legs back in.
- To see the Moro / startle reflex, the child will be placed face up on a soft, padded surface. The
head is gently lifted with enough support to just begin to remove the body weight from the pad.
The head is then released suddenly, allowed to fall backward for a moment, but quickly
supported again
Describe the Tonic Neck (Fencer Pose) Reflex. correct answers - When a baby's head is turned to
one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is
often called the fencing position.
- To look for the tonic neck reflex, put your baby on their back and gently turn their head so their
face is looking left. When this reflex happens, the left arm will reach out straight and the right
arm will flex next to the head.
When do you expect a child can put 2 words together? correct answers Toddler imitates two-
word combinations at age 18-24 months (Burns; pg 113).
When does a child drink from a cup? correct answers Starts drinking from a cup at 15 months
(drinking from a cup with little spilling at 18 months) (Burns; pg 111).
When would you expect a child to walk down steps using alternating feet? correct answers
Walks downs stairs using alternating feet at 48 months (Burns; pg 111)
How much Vit D from birth to 12 months is recommended for all breast-fed infants and infants
who receive unfortified formula? correct answers 400 IU of Vitamin D daily is recommended for
all breastfed infants and infants who receive an unfortified formula from birth until 1 year old.
(Burns; pg 223).
,When does the head lag disappear from supine to sitting position? correct answers 4 months (p.
94)
When performing a physical exam on a toddler, what part of the exam do you do last? correct
answers -Ears and throat.
-Or what causes most distress.
What is the first food infants are introduced to? At what age? correct answers - Infant rice cereal
is typically one of the first solid foods offered and should be spoon fed; not mixed in a bottle or
cup. (Burns; pg 101)
- If not already started, solids should begin at 6 months. (Burns, pg 102).
In evaluating a child with failure to thrive, the most important part of the assessment is? correct
answers Assess weight
What are the two major causes of failure to thrive? correct answers - 3 basic causes:
#1 inadequate caloric intake
#2 inadequate caloric absorption
#3 excessive caloric expenditure. The most common cause is nutritional deficiency without an
underlying medical condition (p.796).
What are causes for a jittery newborn? correct answers i. Benign
ii. Sepsis
iii. Intracranial Hemorrhage
iv. HIE (Hypoxic Ischemic Encephalopathy)
v. Hypoglycemia
vi. Hypocalcemia
vii. Hypomagnesemia
viii. Drug withdrawal
ix. Maternal medications during pregnancy (SSRI)
What is Caput Succedaneum? correct answers i. Swelling and bruising in the parietal regions of
the scalp
ii. Superficial swelling that crosses suture lines
iii. Edema on skull/head d/t pressure/trauma during birth
iv. Pitting edema, bruises, abrasions
v. No treatment required; resolves in a few weeks to months
,vi. Monitor of hyperbilirubinemia, hypotension, and anemia (pg 84).
What is a cephalohematoma? correct answers Blood under the periosteum
Does not cross the suture line and manifest a few hours after birth
- Collection of blood on the outer surface of the skull resulting from friction between the
mother's pelvis and the baby's skull during the birth process
- DOES NOT CROSS SUTURE LINES
- D/t trauma from a possibly difficult delivery. No treatment needed, resolves in a few weeks to
months - monitor for hyperbilirubinemia, hypotension, anemia (p. 84).
What examination test do you do when checking for hip dysplasia? correct answers Barlow Test
Ortolani Test
Galeazzi Sign correct answers Galeazzi Sign: The examination is performed with the child lying
supine and their hips flexed to 45 degrees with knees flexed to 90 degrees, and feet on examining
table. In this position, look for symmetry in the level of the knees (quickly, in wriggly little
children, and repeat two - three times for consistency).
Galeazzi's test is positive if the height of the knees is asymmetrical
Barlow Test correct answers Barlow test is a provocative test to dislocate an unstable hip by
stabilizing the pelvis and flexing and adducting the opposite hip applying a posterior force.
Ortolani Test correct answers Ortolani test reduces the recently dislocated hip by flexing and
abducting hip and lifting the femoral head anteriorly into the acetabulum; a "clunk" is felt when
it enters acetabulum.
Limitation of abduction indicate DDH
Hip clicks are not pathological
When can you use whole milk to replace infant formula? correct answers The AAP recommends
transitioning to whole cow milk at 12 months old and continuing until 24 months to promote
healthy brain myelination (p. 223).
- Premature or low-birth weight infants who are exclusively breastfed require iron
supplementation for the first 12 months, and infants who are fed cow's milk before 12 months are
at high risk for iron deficiency anemia (p.223).
- Use iron-fortified cereals/formulas from 6-12 months.
What is the first sign of puberty in males? correct answers Testes enlargement
9-14 years old
, Male Tanner Staging correct answers 1) Stage 1: No changes to testes or scrotum (prepubertal);
no pubic hair,
2) Stage 2: No change to penis; initial enlargement of scrotum; sparse growth of long, straight,
downy, and slightly pigmented hair as base of penis
3) Stage 3: Increased length of penis; testes and scrotum further enlarged; hair darker, coarser,
and curly and spread sparsely over entire pubis
4) Stage 4: Increased size of penis with growth in diameter and development of glans, glans
larger and broader; scrotum darker; pubic hair more abundant with curling but restricted to pubic
area
5) Stage 5: Adult size penis, adult size testes; hair adult in quantity and type with spread to inner
surface of thighs
What is the first sign of puberty in females? correct answers Breast budding
8-13 years old
Female Tanner Staging correct answers 1) Stage 1: Prepubertal, no breast buds or presence of
pubic hair
2) Stage 2: Breast buds present with breast elevate and areola enlarged; pubic hair scant and light
in color
3) Stage 3: Further enlargement of breast and areola with no separation of their contours; pubic
hair with darker curls
4) Stage 4: Projection of areola and papilla to form a secondary mound (may not occur in all
girls); pubic hair is darker and thicker, but remains in the pubic area
5) Stage 5: Nipple projects; pubic hair darker, curly and spreads to medial thighs
What type of jaundice is pathological and when does it usually begin? correct answers -
Pathologic jaundice is typically considered to be jaundice that occurs too early, persists too long,
and or involves bilirubin levels that are too high.
- For example, jaundice appears in the first 24 hours of life as well as jaundice lasting longer
than 10-14 days are both considered pathologic, requiring attention
When does breast milk jaundice typically begin? correct answers - Early onset of breast milk
jaundice begins within 2-4 days of birth and occurs as a result of infrequent breastfeeding and
insufficient intake leading to decrease intestinal motility.
- Late breast milk jaundice develops 7 days after birth, peaks in the second or third week of life,
and frequently persists unless breastfeeding is interrupted.
When does the anterior fontanel and posterior fontanel close? correct answers Anterior by 18-19
mo (Burns 109)
- 12-18 mo per exam review with Dr. P
Posterior 6-12 weeks (Burns)
-1-2 mo per exam review with Dr. P
What teeth erupt first and at what age? correct answers Central lower incisors erupt around 6
months.
Lateral incisors around 8 months.
Is a newborn screening mandatory in all states? correct answers - Yes (Burns p. 75)
- The Recommended Uniform Screening Panel screenings that are performed vary from state to
state.
The mature pincer grasp is noted by? correct answers 10 months (p. 96)
Described the Moro (Startle) Reflex. correct answers The Moro or startle
- The baby throws back his or her head, extends out his or her arms and legs, cries, then pulls the
arms and legs back in.
- To see the Moro / startle reflex, the child will be placed face up on a soft, padded surface. The
head is gently lifted with enough support to just begin to remove the body weight from the pad.
The head is then released suddenly, allowed to fall backward for a moment, but quickly
supported again
Describe the Tonic Neck (Fencer Pose) Reflex. correct answers - When a baby's head is turned to
one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is
often called the fencing position.
- To look for the tonic neck reflex, put your baby on their back and gently turn their head so their
face is looking left. When this reflex happens, the left arm will reach out straight and the right
arm will flex next to the head.
When do you expect a child can put 2 words together? correct answers Toddler imitates two-
word combinations at age 18-24 months (Burns; pg 113).
When does a child drink from a cup? correct answers Starts drinking from a cup at 15 months
(drinking from a cup with little spilling at 18 months) (Burns; pg 111).
When would you expect a child to walk down steps using alternating feet? correct answers
Walks downs stairs using alternating feet at 48 months (Burns; pg 111)
How much Vit D from birth to 12 months is recommended for all breast-fed infants and infants
who receive unfortified formula? correct answers 400 IU of Vitamin D daily is recommended for
all breastfed infants and infants who receive an unfortified formula from birth until 1 year old.
(Burns; pg 223).
,When does the head lag disappear from supine to sitting position? correct answers 4 months (p.
94)
When performing a physical exam on a toddler, what part of the exam do you do last? correct
answers -Ears and throat.
-Or what causes most distress.
What is the first food infants are introduced to? At what age? correct answers - Infant rice cereal
is typically one of the first solid foods offered and should be spoon fed; not mixed in a bottle or
cup. (Burns; pg 101)
- If not already started, solids should begin at 6 months. (Burns, pg 102).
In evaluating a child with failure to thrive, the most important part of the assessment is? correct
answers Assess weight
What are the two major causes of failure to thrive? correct answers - 3 basic causes:
#1 inadequate caloric intake
#2 inadequate caloric absorption
#3 excessive caloric expenditure. The most common cause is nutritional deficiency without an
underlying medical condition (p.796).
What are causes for a jittery newborn? correct answers i. Benign
ii. Sepsis
iii. Intracranial Hemorrhage
iv. HIE (Hypoxic Ischemic Encephalopathy)
v. Hypoglycemia
vi. Hypocalcemia
vii. Hypomagnesemia
viii. Drug withdrawal
ix. Maternal medications during pregnancy (SSRI)
What is Caput Succedaneum? correct answers i. Swelling and bruising in the parietal regions of
the scalp
ii. Superficial swelling that crosses suture lines
iii. Edema on skull/head d/t pressure/trauma during birth
iv. Pitting edema, bruises, abrasions
v. No treatment required; resolves in a few weeks to months
,vi. Monitor of hyperbilirubinemia, hypotension, and anemia (pg 84).
What is a cephalohematoma? correct answers Blood under the periosteum
Does not cross the suture line and manifest a few hours after birth
- Collection of blood on the outer surface of the skull resulting from friction between the
mother's pelvis and the baby's skull during the birth process
- DOES NOT CROSS SUTURE LINES
- D/t trauma from a possibly difficult delivery. No treatment needed, resolves in a few weeks to
months - monitor for hyperbilirubinemia, hypotension, anemia (p. 84).
What examination test do you do when checking for hip dysplasia? correct answers Barlow Test
Ortolani Test
Galeazzi Sign correct answers Galeazzi Sign: The examination is performed with the child lying
supine and their hips flexed to 45 degrees with knees flexed to 90 degrees, and feet on examining
table. In this position, look for symmetry in the level of the knees (quickly, in wriggly little
children, and repeat two - three times for consistency).
Galeazzi's test is positive if the height of the knees is asymmetrical
Barlow Test correct answers Barlow test is a provocative test to dislocate an unstable hip by
stabilizing the pelvis and flexing and adducting the opposite hip applying a posterior force.
Ortolani Test correct answers Ortolani test reduces the recently dislocated hip by flexing and
abducting hip and lifting the femoral head anteriorly into the acetabulum; a "clunk" is felt when
it enters acetabulum.
Limitation of abduction indicate DDH
Hip clicks are not pathological
When can you use whole milk to replace infant formula? correct answers The AAP recommends
transitioning to whole cow milk at 12 months old and continuing until 24 months to promote
healthy brain myelination (p. 223).
- Premature or low-birth weight infants who are exclusively breastfed require iron
supplementation for the first 12 months, and infants who are fed cow's milk before 12 months are
at high risk for iron deficiency anemia (p.223).
- Use iron-fortified cereals/formulas from 6-12 months.
What is the first sign of puberty in males? correct answers Testes enlargement
9-14 years old
, Male Tanner Staging correct answers 1) Stage 1: No changes to testes or scrotum (prepubertal);
no pubic hair,
2) Stage 2: No change to penis; initial enlargement of scrotum; sparse growth of long, straight,
downy, and slightly pigmented hair as base of penis
3) Stage 3: Increased length of penis; testes and scrotum further enlarged; hair darker, coarser,
and curly and spread sparsely over entire pubis
4) Stage 4: Increased size of penis with growth in diameter and development of glans, glans
larger and broader; scrotum darker; pubic hair more abundant with curling but restricted to pubic
area
5) Stage 5: Adult size penis, adult size testes; hair adult in quantity and type with spread to inner
surface of thighs
What is the first sign of puberty in females? correct answers Breast budding
8-13 years old
Female Tanner Staging correct answers 1) Stage 1: Prepubertal, no breast buds or presence of
pubic hair
2) Stage 2: Breast buds present with breast elevate and areola enlarged; pubic hair scant and light
in color
3) Stage 3: Further enlargement of breast and areola with no separation of their contours; pubic
hair with darker curls
4) Stage 4: Projection of areola and papilla to form a secondary mound (may not occur in all
girls); pubic hair is darker and thicker, but remains in the pubic area
5) Stage 5: Nipple projects; pubic hair darker, curly and spreads to medial thighs
What type of jaundice is pathological and when does it usually begin? correct answers -
Pathologic jaundice is typically considered to be jaundice that occurs too early, persists too long,
and or involves bilirubin levels that are too high.
- For example, jaundice appears in the first 24 hours of life as well as jaundice lasting longer
than 10-14 days are both considered pathologic, requiring attention
When does breast milk jaundice typically begin? correct answers - Early onset of breast milk
jaundice begins within 2-4 days of birth and occurs as a result of infrequent breastfeeding and
insufficient intake leading to decrease intestinal motility.
- Late breast milk jaundice develops 7 days after birth, peaks in the second or third week of life,
and frequently persists unless breastfeeding is interrupted.
