NR 602 NR quiz

NR 602 NR quiz1 NR 602 NR quiz 1. The following are risk factors for hypertension in children and teens (choose all that apply): being obese. being exposed to second-hand smoke. 2. In evaluating a 9-year-old child wi ...

NR 602 NR quiz1 NR 602 NR quiz 1. The following are risk factors for hypertension in children and teens (choose all that apply): being obese. being exposed to second-hand smoke. 2. In evaluating a 9-year-old child with a healthy BMI during a well visit, a comprehensive cardiovascular evaluation should be conducted by the following methods (choose all that apply): Obtain fasting lipid profile. / Assess diet and physical activity. 3. At what age is it appropriate to recommend dietary changes to parents if overweight or obesity is a concern? 12 months old 4. The following are risk factors for type 2 diabetes mellitus in children and teens (choose all that apply): hyperinsulinemia: abnormal weight-to-height ratio.: Native American ancestry. 5. Screening children with a known risk factor for type 2 diabetes mellitus is recommended at age 10 or at onset of puberty, and should be repeated how often? every year. 6. Prediabetes in children is defined as (choose all that apply): impaired fasting glucose (glucose level ≥100 mg/dL or 6.2 mmol/L) but ≤125 mg/dL or 7 mmol/L). impaired glucose tolerance (2-hour postprandial ≥140-199 mg/dL or 7.8 mmol/L-11 mmol/L). 7. Risk factors for dyslipidemia in children include (choose all that apply): family history of lipid abnormalities. family history of type 2 diabetes mellitus. 8. Screening cholesterol levels in children with one or more risk factors begins at what age? . 2 years 8. An acceptable level of total cholesterol (mg/dL) in children and teens is: <170 mg/dL or 9.4 mmol/L. 9. low birth weight, and poor infant growth are risk factors for type 2 diabetes True 10. Prediabetes in children is defined as impaired fasting glucose (glucose level ≥100 mg/dL or 5.6 mmol/L but ≤125 mg/dL or 7 mmol/L) or impaired glucose tolerance (2-hour postprandial ≥140-199 mg/dL or 7.8 mmol/L-11 mmol/L) or an A1C of 5.7% to 6.4%. True 11. Screening for type 2 diabetes begins at age _10___ or at onset of puberty and continues every 2 years until adulthood; at that point, the adult guidelines should be followed. 12. The AAP screening guidelines for total cholesterol levels in children and adolescents aged 2 to 19 years old are as follows: Acceptable level is < __170___ mg/dL (<9.4 mmol/L), borderline is 170-199 mg/dL (9.4 mmol/L-11 mmol/L), and high is >200 mg/dL (≥11.1 mmol/L) 13. Children should be screened for family history of cardiovascular disease (CVD) beginning at age _3___ and should be periodically updated annually or as required by risk factors during non-urgent health visits. 14. For at-risk children, fasting lipid levels should be tested after __2__ years of age (but no later than 10 years of age) and should be retested in 3-5 years if the values fall within the reference range. 15. Body mass index (BMI) should be measured beginning at age __2__.2 16. For children between 12 months and 2 years of age for whom overweight or obesity is a concern, the use of __REDUCED___ fat milk would be appropriate. 17. Beginning at age _5__ if BMI is ≥ 85th percentile, intensify dietary and activity changes to the parent. 18. Infection with Corynebacterium diphtheriae usually causes: Pseudomembranous pharyngitis 19. The tetanus infection is caused by ___CLOSTRIDIUM TETANI _____, an anaerobic, gram-positive, sporeforming rod. This organism is found in soil and is particularly potent in manure. 20. Sources of lead that can contribute to plumbism include select traditional remedies such as azarcon and greta. True 21. Patients with plumbism present with which kind of anemia? Microcytic, hypochromic 22. Intervention for a child with a lead level of 5 to 44 mcg/dL usually includes all of the following except: Chelation therapy 23. Ingested lead inactivates heme synthesis by inhibiting the insertion of iron into the protoporphyrin ring. This leads to the development of what kind of anemia? microcytic, hypochromic 24. __Basophilic ________ stippling is often noted on red blood cell morphology in lead poisoning. 25. Lead is significantly toxic to the solid organs, bones, and nervous system 26. Long-term complications of __LEAD______ poisoning include behavior or attention problems, poor academic performance, hearing problems, kidney damage, reduced IQ, and slowed body growth. 27. Unless deleading procedures have been performed, however, most homes built before __1957 contain lead-based paint. 28. A diet low in calcium, iron, zinc, magnesium, and copper and high in fat, which is a typical diet for children living in _____poverty_____, enhances oral lead absorption 29. In older homes, the point of greatest risk is the __window ___ because their sills and the putty have high lead concentration. Because toddlers (age 2 to 3) are the ideal height to reach them and are often drawn to open ones, they are at greatest risk and summer is the riskiest season. window 30. Symptoms of elevated __LEAD____ levels include abdominal pain and cramping, aggressive behavior, anemia, constipation, difficulty sleeping, headaches, irritability, loss of previous developmental skills in young children, low appetite and energy, and reduced sensations. Very high levels can result in vomiting, staggering walk, muscle weakness, seizures, or coma. 31. A measure of __5____ mcg/dL is now used to identify children with elevated blood lead levels. 32. Most children with lead levels of 5-44 mcg/dL are treated with removal from the source, improved nutrition, and ___IRON ___ therapy. 33. Those with lead levels of 45-50 mcg/dL are treated with a ___CHELATION__agent such as succimer, in addition to the previously listed interventions. 34. For children with lead levels of greater than 51 mcg/dL, hospital admission with expert evaluation is likely the most prudent course to avoid serious problems (including ___ENCEPHALOPATHY__) associated with markedly elevated lead levels 35. Which of the following represents the best choice of clinical agents for a child who has had a history of penicillin allergy who requires antimicrobial therapy? Cefdinir3 36. The clinical presentation of UTI in children can be without the classic symptoms such as frequency, dysuria, or flank pain. True 37. In younger children, UTI often manifests as ___IRRITABLITY_, ___LETHARGEY __, and __FEVER___ with no obvious focal infectious source. 38. Older children with UTI often present with __ABDOMINAL ___ pain, unexplained fever, or both; as children approach puberty, flank pain becomes more common 40. UTI______ should be considered in infants and young children 2 months to 2 years old with unexplained fever, particularly in boys younger than 6 months and girls younger than 2 years who have a temperature greater than or equal to 39°C (≥102.2°F). 41. A _____URINALYSIS____ should be obtained in a child with unexplained fever or symptoms that suggest a UTI; however, 20% from UTI cases return a false-negative result. 42. Any of the following findings are suggestive, although not diagnostic, of UTI: positive leukocyte esterase, positive nitrite, more than __5____ white blood cells (WBCs) per high-power field in spun specimen, and bacteria present in unspun Gramstained specimen. 43. An acceptable method because of the low rate of skin and fecal contamination is a urine specimen collection via bag or from the diaper. False, unacceptable because of the high rate of contamination 44. a single documented UTI in a child must be taken seriously. If an infant or young child 2 months to 2 years old with suspected UTI is assessed as toxic, dehydrated, or unable to retain oral intake, ___HOPITALIZATION___is advised. 45. Oral amoxicillin, TMP-SMX, or a second-or third-generation __CEPHALOSPORIN________ is recommended as options for initial therapy for UTI in children 46. The use of _TMP-SMX______ has a small risk of treatment failure. 47. Current evidence-based practice recommendations for UTI in Children indicate a _7____ to ___14___ day course of antibiotics because the outcomes are superior to a 1-to 3-day course in preventing spread of infection and subsequent renal scarring. 48. Although fluoroquinolone antibiotics have not been widely used in children, ciprofloxacin is approved by the U.S. Food and Drug Administration (FDA) for use in pediatric patients for the treatment of UTI; this use is approved starting at age __1__ years old. 49. Urinary tract imaging should be considered for all children with UTI, particularly if this occurs before toilet training. true 50. The two mainstays for imaging for UTI in young children are _RENAL BLADDER ULTRACOUND _____(RBUS) and voiding cystourethrography (VCUG) 51. RBUS is an easily obtained, noninvasive test but can miss a small number of high-grade ___REFLUX_____ cases 52. The benefits of ___RBUS_______ (no radiation exposure, non-invasive, minimal discomfort for child and parents), however, outweigh the slight increase in specificity of VCUG 53. A __RENAL______ scan is useful for detecting renal scarring, a finding present after infection, but is not recommended for routine, initial evaluation of young child with their first febrile UTI.4 54. ___VCUG_____ only is indicated if RBUS reveals hydronephrosis, scarring, or other findings that would suggest either high-grade vesicoureteral reflux (VUR) or obstructive uropathy, as well as other atypical or complex clinical circumstances. 55. A 4-year-old child presents with fever; exudative pharyngitis; anterior cervical lymphadenopathy; and a fine, raised, pink rash. The most likely diagnosis : Scarlet fever 56. An 18-year-old woman has a chief complaint of "a sore throat and swollen glands" for the past 3 days. Her physical examination reveals exudative pharyngitis, minimally tender anterior and posterior cervical lymphadenopathy, and maculopapular rash. Abdominal examination reveals right and left upper quadrant abdominal tenderness. The most likely diagnosis is: . infectious mononeuclosis 57. Kawasaki disease most commonly occurs in what age group? children aged 1 to 8 years 58. For acute phase illness (usually lasts about 11 days), fever with T104ºF (40ºC) lasting5 days, polymorphous exanthem on trunk, flexor regions, and perineum, erythema of the oral cavity ("strawberry tongue") with extensively chapped lips, bilateral conjunctivitis usually without eye discharge, cervical lymphadenopathy, edema and erythema of the hands and feet with peeling skin (late finding, usually 1-2 weeks after onset of fever), no other illness accountable for the findings. Usually in children age 1-8 years Treatment with IV immunoglobulin and PO aspirin during the acute phase is associated with a reduction in rate of coronary abnormalities such as coronary artery dilatation and coronary aneurysm. Expert consultation and treatment advice about aspirin use and ongoing monitoring warranted. Kawasaki disease 60. Rates of urinary tract infection (UTI) among uncircumcised infant boys are how much higher than those in circumcised boys? as much as 20% 61. Which of the following is most likely to be part of the clinical presentation of UTI in a 20-month-old child? Fever 62. Which of the following is considered the ideal method for obtaining a urine sample for culture and sensitivity in an 18-month-old-old girl with suspected UTI? Suprapubic aspiration 63. When choosing an antimicrobial agent for the treatment of UTI in a febrile female child who is 16 months old, the NP considers that: The use of an oral third-generation cephalosporin is acceptable if GI function is intact 64. When evaluating the urinalysis of a 10-month-old infant with UTI, the NP considers that: . 20% of urinalysis can be normal 65. In children 2 months to 2 years old with UTI, antimicrobial therapy should be prescribed for: 7 to 14 days 66. The preferred urinary tract imaging study for a 22-month-old girl with first-time febrile UTI is: Renal-bladder ultrasound 67. VCUG is indicated: WHen UIT is recurrent 68. The urinary tract abnormality most often associated with UTI in younger children is: . Vesicourethral reflux 69. Signs of severe dehydration include (choose all that apply): Anuria, tear absent, capillary refill of approximately 3 seconds 70. The onset of symptoms of food poisoning caused by Staphylococcus species is typically how many hours after the ingestion of the offending substance? 1-4 71. The onset of symptoms in food poisoning caused by Salmonella species is typically how many hours after the ingestion of the offending substance? 12-24 72. What percentage of body weight is typically lost in a child with moderate dehydration? 6-10% 73.Clinical features of shigellosis include all of the following except: Vomiting 74. acute gastritis usually does not have a fever true5 75. Asking about the last urination is a helpful way of evaluating dehydration. If the child has voided within the previous few hours, the degree of dehydration is minimal. True 76. Because they contain inappropriate glucose and electrolyte composition, sports drinks such as Gatorade (tm), soda, and most fruit juices are _______INAPPROPRIATE ___for rehydration. inappropriate 77. The use of antidiarrheal agents is usually discouraged because of the risk of increasing the severity of illness if toxinproducing bacteria are the causative agent. true 78. Warning signs during acute gastroenteritis include ____FEVER___ coupled with _BLOODY__or __PUS__- filled stools. If these are present, a bacterial source of infection such as shigellosis should be considered. Stool culture should be obtained, and appropriate antimicrobial therapy should be initiated. 79. Precocious puberty in girls has long been defined as the onset of secondary sexual characteristics before the child's __8TH _____ birthday. 80. In boys, precocious puberty is defined as the onset of secondary sexual characteristics before his _9TH_____ birthday. 81. Thelarche (the isolated appearance of breast development) is common as early as age __7__ . 82. . Pubarche (the appearance of pubic hair without other signs of puberty) as early as age __8_ in otherwise healthy girls. 83. A subset of girls, particularly girls with pubertal changes noted before their ___6TH___ birthday, often has significant health problems, however, such as ovarian or adrenal tumors. Expert evaluation and referral is indicated in these children. 84. Delayed puberty is defined as no evidence of sexual maturation (Tanner stage 1) in girls older than age _13___and in boys older than age ___14 __. 85. The most common reason for precocious puberty in girls is: estrogen.. early onset of normal puberty. 86. The most common reason for precocious puberty in boys is: .A select number of relatively uncommon health problems 87. Which of the following is noted in a child with premature adrenarche? Breast development 88. Girls typically grow to their adult height by 1 year before menarche 89. A 15-year-old male is found to be at Tanner stage 1 on exam. The least likely cause of this finding is: . a variation of normal based on ethnicity or familial factors 90. An innocent heart murmur has which of the following characteristics? becomes softer when the patient moves from supine to standing position 91. The murmur of atrial septal defect is usually: First found on a 2-to-6 month well-baby examination 92. A Still murmur: has a humming or vibratory quality 93. Grade 1-3/6 early systolic ejection, musical or vibratory, short, often buzzing, heard best midway between apex and LLSB. Softens or disappears when sitting, when standing, or with Valsalva maneuver Louder when supine or with fever or tachycardia Usual onset age 2-6 years; may persist through adolescence Benign condition Still (vibratory innocent murmur) 94. Grade 1-2/6 systolic ejection, high-pitched, heard best in pulmonic and aortic areas. Heard only in presence of increased cardiac output, such as fever, anemia, stress. Disappears when underlying condition resolves Usually seen without cardiac disease Most often heard in children and younger adults with thin chest walls Hemic Murmur 95. Grade 1-2/6 continuous musical hum heard best at upper right sternal border (URSB) and upper left sternal border (ULS) and the lower neck. Disappears in supine position, when jugular vein is compressed Common after age 3 years. Believed to be produced by turbulence in subclavian and jugular veins Benign condition Venous Hum 96. Grade 1-3/6 systolic ejection murmur, heard best at ULSB with widely split fixed S 2. Accompanying middiastolic murmur heard at fourth intercostal space (ICS) left sternal border (LSB); commonly caused by increased flow across tricuspid valve. Two times as common in girls Child is often entirely well or present with heart failure Often missed in the first few months of life or even entire childhood Watch for children with easy fatigability Cyanosis rare6 Atrial Septal Defect 97. Grade 2-5/6 regurgitant systolic murmur heard best at LLSB Occasionally holosystolic, usually localized. Thrill may be present and a loud P 2 with large left-to-right shunt. Usually without cyanosis Children with small-to moderate-sized left-toright shunt without pulmonary hypertension likely to have minimal symptoms Larger shunts may result in CHF with onset in infancy Ventricular septal defect 98. When counseling the family of an otherwise healthy 2-year-old child who just had a febrile seizure, you consider the following regarding whether the child is at risk for future febrile seizures (choose all that apply): The occurrence of one febrile seizure is predictive of having another. Intermittent diazepam can be used prophylactically during febrile illness to reduce risk of recurrence. 99. A simple febrile seizure actually is most likely to occur as fever is ___INCREASING _(increasing or decreasing) rather than at its peak; however, there is no evidence that the rapidity of the rate of increase is associated with febrile seizures. 100. A familial tendency has been noted with febrile seizure, but is the condition predictive of the development of epilepsy? No 101. A simple febrile seizure is a benign, although frightening, common event in children _6___months to __5__years old; a child who has had one seizure is at increased risk for a recurrence. 102.Most children with febrile seizures do not need to be treated with medication. Daily phenobarbital and valproate, reduce risk and could prevent occurrence but risks outweigh the benefits …. true 103.In situations in which parental anxiety about febrile seizures is severe, intermittent oral diazepam (Valium) at the onset of febrile illness. True 104. Do antipyretics prevent febrile seizures? No 105. You exam a healthy 2 month old boy and note that his foreskin cannot be retracted. You consider that: In most instances the foreskin is not easily retractable until the child is about 3 years old. 106. You examine a thriving 4-week old boy, born at 39 weeks’ gestation, and note a painless, tense, non-reducible, relatively symmetric scrotal enlargement that brightly and evenly trans-illuminates. The parents state the scrotum always looks like this without change in size during the day. Bilateral testes 1 cm in length, are palpable and held within the scrotum. The penis is about 4cm in length. You consider these findings are most consistent with: Non-communicating hydrocele 107. Most of the time a non-communicating hydroceles will resolve on their own by the time the baby is 1 year old. True 108. Communicating or Non-communicating Hydrocele: A Fluid-filled scrotal sac; transilluminates, nontender, testes normal, however amount of fluid in scrotum (scrotal size) varies with position of neonate; larger with dependent upright position (day) and smaller after lying flat (upon awakening) . Due to communication, an infant is at risk for herniation of abdominal contents and should be referred to pediatric urologist or surgeon. Communicating 109. A ___NON COMMUNICATING ___hydocele occurs due to sealing of the abdominal cavity during gestation with residual trapped peritoneal fluid in the scrotal sac. 110. What does intussusception result in? Bowel Obstruction 111. What does pyloric stenosis result in? Thickening of pyloric valve so stomach can not empty properly 112. Approximately 4:1 male to female ratio. Pyloric Stenosis 113. Sudden onset colicky, severe, an intermittent abdominal pain. Intussusception 114. Accompanied by loose stools that are often described as currant jelly appearance (Mixture of blood and sloughed mucous). Intussusception 115. Most common time for symptoms onset = Approximately Age 3 weeks. Pyloric Stenosis 116. Post-fed projectile vomiting is present with the baby eager to eat again immediately post emesis Pyloric Stenosis7 117. Accompanied by a sausage-shaped abdominal mass. Intussusception 118. Olive Shaped abdominal Mass occasionally noted. Pyloric Stenosis 119. Usually occurs in the first year of life Intussusception 120. Intussusception is caused when a section of intestines invaginates into the adjoining intestinal lumen, causing bowel obstuction, if left untreated is uniformly fatal in __2____ to _5____ days. 121. Intussesception symptoms are often preceded by an upper respiratory tract infection. True 122. Puberty is the onset of Tanner Stage __2 _ 123. In a boy Tanner Stage _2 __ consists of testicular enlargement, scrotal skin reddening, sparse growth of long slightly pigmented pubic hair at base of penis. 123. Gynecomastia is usually found in males at which tanner stage/age? A 14 year old male at Tanner Stage 3 (lasts for 6 - 12 months) 124. You see a 17 year old female, as part of the visit you consider her risk factors for T2 Diabetes would likely include all of the following except: Family History of Type 1 DM 125. When should you consider doing T2DM screening in Children: - Overweight or Obese ( BMI > 85%) - Family Hx of T2DM 126. If child is overweight or obese initiate testing at age _10___ years or at onset of puberty if puberty occurs earlier. Frequency is every ___3 _ years. 127. Microcytic, Hypochromic, Elevated RDW is what kind of anemia? iron deficiency 128. Iron deficiency is most common in children 12-30 months True 129. For mild to moderate dehydration oral rehydration therapy with oral rehydration solution is as effective as parenteral therapy, easier to administer and more cost-effective True