NURS 629 Exam 2 Questions With Verified Answers

Weight changes in 1st year of life - Answer Weight increases 6-8lbs, up to 20lbs in the 1st year of life When does the posterior fontanelle close? Anterior? - Answer posterior- 2 months, anterior- 9-18 mo when do the abdominal muscles close? - Answer 3 years When are the testicles descended? - Answer usually descended at birth, but spontaneous descent may occur in the first year after birth. (usually 6 months) what do you assess for with infants musculoskeletal system? - Answer leg fold symmetry hib abduction- no clicks Ortolani maneuver - Answer check hips for congenital dislocation, done until 1 yr old, should be smooth with no sounds , abnormal= feels like a clunk as head of femur pops back into place- positive ortolani sign Barlow maneuver - Answer place your index and middle finger over the greater tronchanter. Gently push both knees together at midline downwards. Positive:"Clunk" sounds or palpating trochangter being displaced by the index/middle finger Infantile eczema - Answer atopic dermatitis is an inflammation of genetically hypersensitive skin - local vasodilation in affected areas spongiosis or breakdown of dermal cells and formation of intradermal vesicles - rarely seen in breastfed infants until they begin to eat additional food - it is a symptom rather than a disorder - infant is oversensitive to certain substances Worse in winter why is acid reflux common in infants? - Answer their sphincters are not mature, break up feedings ~15mL, burp, then return. When does colic usually resolve? - Answer by 6 months Toddler weight gain per year - Answer 4-6lbs per year, grow 3 inches pe ryear In toddler always assess for? - Answer anterior fontanel (should be closed by 18 m-2 yrs. screen for strabismus tooth eruption- if no teeth by 18 mo= xray assess for hip dysplasia, gait, bowlegged -DTRs -Babinski + (dorsiflex) normal in infant less than 24 mo what age do you screen for hearing and vision? - Answer at 3 years School age children grow more steadily? - Answer 2 in/year 4-6lbs/ year In adolescence when does puberty begin in girls? - Answer 9-13 years when does puberty begin in boys? - Answer 11-14 years At what ages do puberty changes develop in girls? - Answer breast enlargement 8-13 yr axillary hair 11-13 yrs pubic hair 10-12 years menarche 10-16 years at what ages do puberty changes develop in boys? - Answer genital enlargement 9-13 yrs axiallary hair 12-14 yrs facial hair 11-14 yrs pubic hair 12-15 yrs Tanner Stages Girls - Answer 1. Preadolescent breasts, breast papilla elevated above breast wall. no pubic hair. 2. *puberty starts* Breast buds with areolar enlargement, papilla forms small mound. scant pubic hair, light pigment. 3. Breast and areola grow together in one mound. no separation. pubic hair more abundant. 4. Areola and nipple project as secondary mound. pubic hair abundant but smaller area than adult. menstruation starts. 5. Adult breast: Areola recedes, nipple retracts Tanner stages boys - Answer 1 prepubertal- no pubic hair, scrotum and pedis are childhood size 2 enlargement of scrotum- puberty starts. age11-13. increased testicular size, pubic hair scant and lightly pigmented. scrotum reddened and textured 3 (age 13-14) enlargement of penis (length). testicular growth. increase in pubic hair and pigment 4 (14-15) enlargement of penis (breadth). acne. voice changes. 5 (15-16) adult genitalia, mature pubic hair distribution. Red flags of neonate? - Answer Jaundice at birth (hemolysis). High-pitched cry. Irritable. "Floppy" (hypotonic). Poor reflexes red flags of 3 month - Answer inability to hold head. avoids eye contact, floppy. red flags at 6 months - Answer lack of babbling. does not laugh. inability to turn head past 180 degrees Red flags at 9 months - Answer Cannot sit without support, not indicating wants (Niner needs recliner, but doesn't want it) if infantile reflexes remain strong. does not bable does not bear weight on legs 2 year red flags - Answer Unable to speak meaningful two-word "sentences." Does not understand simple commands. Loss of speech, social skills, previously learned behaviors and/or does not say words by 16 months (autism). 1 year red flag - Answer Unable to support own weight. Lack of babbling. No response to smiles, poor eye contact, loss of previously learned skills (autism). 3 yr red flags - Answer Speech hard to understand or unclear speech. Unable to understand simple commands. Fall down often. Does not speak in sentences. No eye contact. Losses skills he or she once had. 4 yr red flags - Answer Unable to speak in full sentences. Inability to skip, run, hop. Cannot put on clothes without help. Unable to play with other kids. Unable to follow three-part commands. 5 yr red flags - Answer Unusually withdrawn. Not active. Trouble focusing on one activity for more than 5 minutes. 2 year normal activities - Answer Walks. Runs. Climbs stair up and down on own by holding onto handrails. Speech mostly understood by family. Follows two or three step instructions. Copies a line. PMH to address in sports physical - Answer ■ Look at PMH, meds and supplements, steroid use, previous injuries, immunization status, weight concerns, allergies, concussions, dizziness or fainting with physical exertion, family history related to sudden death, cardiac death, death with activity, and history of asthma, contacts or dental appliances that may require accommodations, mental health, sexual status, menstruation, alcohol/smoking/drug use sports physical cardiac questions - Answer ■ Chest pain, shortness of breath, feeling dizzy lightheaded or faint after physical activity ■ Cardiac anomalies, murmurs, high blood pressure, irregular heart rate - family cardiac history - displaced PMI with different positioning - changes in heart sounds with supine, standing and valsalva -asymmetric pulses contraindications for clearance from sports physical? - Answer ● Chest pains while exercising, congenital cardiac anomalies, hypertrophic cardiomyopathy, new murmurs, hypertension ● Family hx. Of sudden death under 50 or while playing sports, exertional syncope, symptoms of Marfan syndrome ● Marfan syndrome (2 or more of the following needs further evaluation: arm span longer than height, girls taller than 5.10 and boys taller than 6.0, kyphoscoliosis, pectus excavatum, myopia) who needs referral for f/u before clearance from sports physical? - Answer ● History of or current cardiac anomalies ● Family cardiac history (cardiomyopathies, prolonged QT, Marfan syndrome, significant dysrhythmias, cardiac death in 1st or 2nd degree relative before age 40, connective tissue disorders) ● History of or current concussions ● History of or current injuries ● Hernia ● Hypertension ● Murmur ● Irregular heart rate or rhythm ● Deformity, asymmetry, instability ● Poor visual acuity ● Liver or spleen enlargement ● Hernia ● Contagious skin conditions Red flags during sports physical ? - Answer ● Hypertension indicated by BP >135/85 mm Hg ● Coarctation of aorta indicated by decreased intensity of pulse in femoral pulse ● Hypertrophic cardiomyopathy indicated by systolic ejection murmur that intensifies with standing or Valsalva maneuver ● Marfan syndrome indicated by aortic (decrescendo diastolic murmur) or mitral insufficiency (holosystolic murmur) what conditions automatically disqualify teens from sports physical? - Answer carditis, diarrhea, fever? Questions related to concussion history? - Answer ● Location of hit (hit to front of head and on back of head when landed on the ground) ● Any LOC, seizures, amnesia