CMN 571 - TEST REVIEW QUESTIONS
As a Nurse practitioner caring for young children, how would you perform the vision
portion of the health supervision assessment? How would you screen this young child?
what is normal? what is not? - Answer -Birth to around 3 years of age should include:
+Assessing movement, alignment, pupils, and red reflex.
-- Starting around 2 months their eyes should begin tracking movement.
-- Starting around 3 months, the corneal light reflex can be performed to assess for
misalignment.
-- Cover testing begins at 6 months.
At 3 years, a formal visual acuity test should be completed (with either a tumbling E
chart or picture chart). Children who do not coorperate with test should be reassessed
in 1 month - if still does not cooperate with test, they need to be refered.
REFER - All preterm infants, those with down syndrome, and those with family history of
amblyopia, strabismus, retinoblastoma, and retinal degeneration.
Abnormalities include:
+ abnormal red reflex
+ poor fixation on objects at 3 months
+ asymmetry in light reflex
+ presence of refixation movement in cover test
+ vision acuity less than 20/40 for kids aged 3-5 years (or a 2 line difference between
the eyes).
Dr. Montgomery
Please review Hay page 233 table 9-3 (recommended vision screening in the primary
care office). It is also important to know the minimal appropriate visual acuity when
testing a young child. At three years old formal visual acuity needs to be tested, and you
would expect to find a minimal acceptable acuity of 20/40. This information would be
important to review again (hint hint)
Hays page 233
Eating habits to be encouraged by parents of children with obesity - Answer -The best
answer is scheduled mealtimes, as many of you have noted. No sodas at all is the best
advice for parents.
How many minutes of daily physical activity is recommended for children? - Answer -60
minutes/daily is the general recommendation for all children. The question was about all
children, not just those with HTN.
A very high total cholesterol level in a child most likely has a diagnosis of
___________? - Answer -JAMA Screening for Lipid Disorders in Children and
, Adolescents US Preventive Services Task Force Recommendation Statement- pg 628,
first paragraph--
Children with *familial hypercholesterolemia* can have TC and LDL-C levels 2 to 3
times higher than those of unaffected children. ..1 The burden of familial
hypercholesterolemia is attributable to premature cardiovascular events in adulthood
resulting from long-term exposure to elevated serum cholesterol levels and
atherosclerosis.
Dr. Lang:
Correct, with a very high total cholesterol, FH is the most probable diagnosis in children.
Recommendations about playing sports for a child with Osgood Schlatter's Disease. -
Answer -Bright Futures, pg. 94: "The athlete may participate [in sports] if he or she is
not limping at the end of a game or practice."
Dr. Lang:
The application question included that the child had been playing sports without
problems. The child may be released to play sports by the family practitioner.
Activities expected in children in the concrete thinking stage. - Answer -Dr. Lang:
Hay, pg. 79: "Concrete operations typically begin after age 6..the child is able to order,
number, and classify because these activities are related to concrete objects in the
environment..."
USPSTF recommendation guidelines for children with high BMI - Answer -USPSTF
Guidelines, Obesity in Children and Adolescents, p. 80:
"Refer patients to comprehensive moderate- to high-intensity programs that include
*dietary, physical activity, and behavioral counseling components*."
Dr Lang
Age of children recommended to have routine lipid screening by AAP and NHLBI. -
Answer -USPSTF Lipid Sreening JAMA article p. 632 "The National Heart, Lung, and
Blood Institute's Expert Panel on Integrated Guidelines for Cardiovascular Health and
Risk Reduction in Children and Adolescents and the American Academy of Pediatrics'
Bright Futures recommend universal screening before adolescence (ages 9 to 11 years)
and again after puberty (ages 17 to 21 years)".
Dr. Lang:
Yes, this is the correct answer.
Immunizations needed for 9 year old, when up to date at age 6. - Answer -Influenza is
the only vaccine recommended. The next set of vaccines start in the 11-12 age group.
per CDC vaccine schedule.
As a Nurse practitioner caring for young children, how would you perform the vision
portion of the health supervision assessment? How would you screen this young child?
what is normal? what is not? - Answer -Birth to around 3 years of age should include:
+Assessing movement, alignment, pupils, and red reflex.
-- Starting around 2 months their eyes should begin tracking movement.
-- Starting around 3 months, the corneal light reflex can be performed to assess for
misalignment.
-- Cover testing begins at 6 months.
At 3 years, a formal visual acuity test should be completed (with either a tumbling E
chart or picture chart). Children who do not coorperate with test should be reassessed
in 1 month - if still does not cooperate with test, they need to be refered.
REFER - All preterm infants, those with down syndrome, and those with family history of
amblyopia, strabismus, retinoblastoma, and retinal degeneration.
Abnormalities include:
+ abnormal red reflex
+ poor fixation on objects at 3 months
+ asymmetry in light reflex
+ presence of refixation movement in cover test
+ vision acuity less than 20/40 for kids aged 3-5 years (or a 2 line difference between
the eyes).
Dr. Montgomery
Please review Hay page 233 table 9-3 (recommended vision screening in the primary
care office). It is also important to know the minimal appropriate visual acuity when
testing a young child. At three years old formal visual acuity needs to be tested, and you
would expect to find a minimal acceptable acuity of 20/40. This information would be
important to review again (hint hint)
Hays page 233
Eating habits to be encouraged by parents of children with obesity - Answer -The best
answer is scheduled mealtimes, as many of you have noted. No sodas at all is the best
advice for parents.
How many minutes of daily physical activity is recommended for children? - Answer -60
minutes/daily is the general recommendation for all children. The question was about all
children, not just those with HTN.
A very high total cholesterol level in a child most likely has a diagnosis of
___________? - Answer -JAMA Screening for Lipid Disorders in Children and
, Adolescents US Preventive Services Task Force Recommendation Statement- pg 628,
first paragraph--
Children with *familial hypercholesterolemia* can have TC and LDL-C levels 2 to 3
times higher than those of unaffected children. ..1 The burden of familial
hypercholesterolemia is attributable to premature cardiovascular events in adulthood
resulting from long-term exposure to elevated serum cholesterol levels and
atherosclerosis.
Dr. Lang:
Correct, with a very high total cholesterol, FH is the most probable diagnosis in children.
Recommendations about playing sports for a child with Osgood Schlatter's Disease. -
Answer -Bright Futures, pg. 94: "The athlete may participate [in sports] if he or she is
not limping at the end of a game or practice."
Dr. Lang:
The application question included that the child had been playing sports without
problems. The child may be released to play sports by the family practitioner.
Activities expected in children in the concrete thinking stage. - Answer -Dr. Lang:
Hay, pg. 79: "Concrete operations typically begin after age 6..the child is able to order,
number, and classify because these activities are related to concrete objects in the
environment..."
USPSTF recommendation guidelines for children with high BMI - Answer -USPSTF
Guidelines, Obesity in Children and Adolescents, p. 80:
"Refer patients to comprehensive moderate- to high-intensity programs that include
*dietary, physical activity, and behavioral counseling components*."
Dr Lang
Age of children recommended to have routine lipid screening by AAP and NHLBI. -
Answer -USPSTF Lipid Sreening JAMA article p. 632 "The National Heart, Lung, and
Blood Institute's Expert Panel on Integrated Guidelines for Cardiovascular Health and
Risk Reduction in Children and Adolescents and the American Academy of Pediatrics'
Bright Futures recommend universal screening before adolescence (ages 9 to 11 years)
and again after puberty (ages 17 to 21 years)".
Dr. Lang:
Yes, this is the correct answer.
Immunizations needed for 9 year old, when up to date at age 6. - Answer -Influenza is
the only vaccine recommended. The next set of vaccines start in the 11-12 age group.
per CDC vaccine schedule.
