Unit 1 Flashcards
1
Q
<p>What universal screenings are required for @ birth?</p>
A
<p>Answer: hearing, bilirubin, blood (PKU, congenital hypothyroidism, SS), congenital heart disease</p>
2
Q
<p>A PKU screening was performed before 24 hours of age, when should it be re-tested?</p>
A
<p>Answer: by 2nd week</p>
3
Q
<p>Untreated hyperphenylalaninemia results in what?</p>
A
<p>Answer: intellectual disability, light complexion, eczema, seizures, hyperactivity</p>
4
Q
<p>It is essential that \_\_\_ restrictions be instituted shortly after birth to prevent the neurodevelopmental effects of PKU.</p>
A
<p>Answer: Phenylalanine; dietary</p>
5
Q
<p>What are the 3 screening methods for PKU?</p>
A
<p>Answer: Guthrie Bacterial Inhibition Assay (BIA), Automated fluorometric assay, Tandem mass spectrometry</p>
6
Q
<p>Which newborn screening tests are mandatory state requirements?</p>
<p>1. CBC and UA
2. Thyroid function test and PKU
3. PKU and alpha-fetoprotein
4. Glucose and thyroid function tests</p>
A
Answer: 2 - thyroid function test and PKU
7
Q
<p>T or F: PKU screening should only be performed after the newborn has ingested formula or breast milk.</p>
A
<p>Answer: true</p>
8
Q
<p>All newborn infants should receive screening for congenital hypothyroidism. What two labs do you check?</p>
A
<p>Answer: TSH and T4</p>
9
Q
<p>True or False: The FNP understands that specimens obtained in the first 24-48 hours of age for screening CH may be falsely elevated for
TSH regardless of the screening method?</p>
A
<p>Answer: true (abnormal results should be confirmed immediately with a venous T4 AND TSH level)</p>
10
Q
<p>An infant with congenital hypothyroidism is being discharged home. The FNP would instruct the parents to:
A. Watch for constipation and slow pulse as signs of toxicity
B. Reduce the medication as symptoms decrease
C. Give the medication as a single dose in the early morning
D. Expect weight loss until the child adjusts to the dose</p>
A
<p>Answer: thyroid replacement is lifelong maintenance therapy and should be given as one dose in the morning</p>
11
Q
<p>An infant with an abnormally pitched cry may demonstrate a genetic disorder or other problems, such as: A. Hypothyroidism B. Hypertelorism C. Cleft Palate D. Pyloric stenosis</p>
A
<p>Answer: Infants with hypothyroidism often have an abnormally pitched cry because of lethargy and delayed mental responsiveness</p>
12
Q
<p>What two tests can be used to screen for sickle cell disease?</p>
A
<p>Answer: Thin-layer isoelectric focusing (IEF) or High-performance liquid chromatography (HPLC)</p>
13
Q
<p>T or F: Only HPLC has high sensitivity and specificity for sickle cell anemia</p>
A
<p>Answer: False (Both have extremely high sensitivity and specificity)</p>
14
Q
<p>At what month should confirmatory testing occur for sickle cell disease?</p>
A
<p>Answer: 2 months</p>
15
Q
<p>An FNP is caring for an infant who tested positive for sickle cell anemia. What prophylactic medication should be given by age 2 months?</p>
A
<p>Answer: Penicillin</p>
16
Q
<p>What immunization is important to be given at recommended intervals for infants with sickle cell disease? A. Pneumococcal B. MMR C. DTaP D. Varicella</p>
A
<p>Answer: pneumococcal</p>
17
Q
<p>If newborn fails hearing screening, what must the FNP instruct the parent to do?</p>
A
<p>A: Follow up with audiologist</p>
18
Q
What age must hearing be confirmed?
A
Answer: 3 months old (due to delayed language)
19
Q
What well-check visits include maternal depression screening?
A
Answer: 1, 2, 4, 6 months
20
Q
What age do primary teeth usually erupt?
A
Answer: 7 months (per hays)
21
Q
So, knowing that when do you start oral health screenings – Which visits are they required?
A
Answer: 6mo, 9mo (continued thereafter until establishing a dental home – dental home must be established by 12 mo of age)
22
Q
Stands alone, follows 1 step commands, imitates peek a boo. What is the child’s expected age?
A
Answer: 9-11 mo
23
Q
Lifts head, turns side to back, smiles - what age?
A
Answer: 1-2 mo
24
Q
What age does a child develop a mature pincer grasp?
A
Answer: 12 mo
25
Child is building blocks with 3-4 cubes, able to scribble, and follows 2-step commands. what age?
Answer: 18 mo
26
At what age does a child verbalize the need to potty?
Answer: 2 years
27
What age does the child sit independently?
Answer: 6-8mo
28
What age does a child crawl?
Answer: 9 mo (per hays)
29
What age does child run?
Answer: 18 mo
30
What age should the child be able to walk backwards?
Answer: 30 mo (2.5 years)
31
What age should be using pronouns?
Answer: 24 months
32
When should child be holding crayon with fist?
Answer: 3 years
33
Can a 4-5-year-old tie shoes?
Answer: no, only laces shoes
34
What age copies a circle?
Answer: 3 years
35
What age copies a cross?
Answer: 4 years
36
What age copies a triangle?
Answer: 5 years
37
What age draws vertical lines?
Answer: 2 years
38
What age can scribble?
Answer: 18 mo
39
What age will imitate scribbling?
Answer: 15 mo
40
What age uses tricycle?
Answer: 3 (for tri)
41
Which age alternates feet up the stairs?
Answer: 4 years
42
What age kicks a ball?
Answer: 2 years
43
What age throws a ball?
Answer: 18 mo
44
Which age does parallel play?
Answer: 2 years (think 2 lines are parallel)
45
What age does cooperative play?
Answer: 4 years (double the age = 4 years)
46
What age reaches with 1 hand?
A: 6-8mo (transfers objects between hands, wants to play with it, babbles about object)
47
What age reaches with both hands and puts object in mouth?
Answer: 3-5 mo (drooling baby)
48
What age has 4 words phrases?
Answer: 4 years (4 words)
49
What age says you me and I and makes 3 cube bridge?
Answer: 3 years (3 pronouns, 3 cubed bridge)
50
What age jumps with 2 feet?
Answer: 2 years (2 feet)
51
What age has vocal of 4-20 words?
Answer: 18 mo (the age is a number within that 4-20 range)
52
What age has 1-2-word vocabulary?
Answer: 12 mo (1-2*)
53
What age coos?
Answer: 3-5 mo (the drooling baby)
54
What age babbles?
Answer: 6-8 mo (talking about the cool object they just grabbed with 1 hand)
55
What age draws a circle for a person?
Answer: 4 years
56
What age draws a person with appendages eyes and no torso?
Answer: 4-5 years
57
What age follows 1 step commands?
Answer: 9 mo
58
What age follows 2 step commands?
Answer: 18 mo (double it)
59
What ages do you conduct anemia and lead blood test?
Answer: 12 mo and 2 years (double it)
60
What ages do you perform developmental screening?
Answer: 9, 18, 30 mo
61
What age do you conduct ASD screen?
Answer: 18 mo, 24 mo (2 year)
62
What is the earliest age a child can be diagnosed with ASD?
Answer: 2 years
63
What are the 4 most common early characteristics of autism?
Answer: Consistent failure to orient to one’s name, regard people directly, use gestures, and develop speech
64
What age should universal vision screenings start?
Answer: 3 years
65
What tests are used for vision screenings?
Answer: visual acuity / HOTV or LEA symbols
66
What age can you stop screening for the red reflex?
Answer: 3 years; when they start reading the chart?
67
What is assessed in a vision screening for a birth - 3 years?
Answer: inspection, alignment, visual acuity, red reflex
68
What age should audiometry be performed?
Answer: birth and 4 years
69
By age 3, what vaccines should you have received?
A: all 3 hep B; 4Dtap; all 3 RV, 3-4 HiB, 3 IPV, 4 pcv13, 1 influenza, 1 varicella, 2 hepA, 1 MMR
70
Name 3 allergies that are contraindications to vaccines being administered?
Answer: eggs, gelatin, yeast
71
What vaccine should not be given to baby with gastroenteritis or hx of intussusception?
Answer: rotavirus
72
What vaccine should not be given to persons with a serious allergic reaction to yeast?
Answer: HepB (think B for bread)
73
What vaccine has a small increased chance of febrile seizures if given with the influenza vaccine?
A: PCV (think pneumonia + flu would be a HIGH fever)
74
Which vaccines are contraindicated during pregnancy?
A: MMR, IPV, varicella, HepA
75
Children or adolescents receiving long term aspirin therapy shouldn’t receive this vaccine?
Answer: LAIV
76
What law requires VIS?
Answer: National Vaccine Childhood Injury Act (federal law)
77
The following are true contraindications for which vaccine: severe allergic reaction encephalopathy not attributable to another cause within
7 days of admin of the vaccine
Answer: DTaP
78
The national childhood vaccine injury act requires standardized consent forms for the administration of vaccines to children. The content on
the form for the medical record includes the vaccine lot number, nurse signature, injection/inoculation site, and:
1. Signature of parent or legal guardian
2. Education provided
3. Absence of contraindications
4. Vaccine expiration date
Answer: 1 and 4
1. Signature of parent or legal guardian
4. Vaccine expiration date
79
Which statement about the polyvalent pneumococcal vaccine is true?
1. It is recommended for children older than 2 years old with chronic diseases, including diabetes.
2. It is recommended to prevent OM and other pneumococcal infections in children younger than 2 years old
3. It may not be given concurrently with other vaccines
4. Severe systemic reactions are common after immunization.
Answer: 1
1. It is recommended for children older than 2 years old with chronic diseases, including diabetes.
80
The FNP understands that the only contraindication to Hep B vaccination is:
1. Pregnancy and lactation
2. History of poliomyelitis
3. Prior anaphylaxis or severe hypersensitivity
4. Mild viral illness
Answer: 3
3. Prior anaphylaxis or severe hypersensitivity
81
Immunizations and chemoprophylaxis offered routinely to pts 65-year-old and older are:
1. Tdap, influenza, and pneumococcal vaccine
2. Td, varicella, or shingles vaccine
3. Td and influenza; for those with a weakened immune system, offer the shingles vaccine
4. Influenza and Td to those who have not had vaccine in the past 10 years
Answer: 1
1. Tdap, influenza, and pneumococcal vaccine
82
The FNP understands that the following is considered an attenuated live virus vaccination:
1. Rubella and measles
2. Mumps and Hep B
3. Poliomyelitis and Hep B
4. Rubella and rabies
Answer: 1
1. Rubella and measles
83
The FNP understands that children who should not receive the measles vaccine are children who have severe allergic reactions to:
1. Fungi
2. Pollen
3. Pets
4. Neomycin
4
4. Neomycin
84
What type of immunity does a child develop after contracting chickenpox?
1. Active natural immunity
2. Active artificial immunity
3. Passive natural immunity
4. passive artificial immunity
Answer: 1 (exposure and infection with disease)
1. Active natural immunity
85
The FNP is assessing an 8-month-old infant in an immunization clinic. By this time, the infant should have received which immunizations?
1. All 3 Hep B, all RV series, 3 doses of the PCV series, and at least 2 doses of IPV
2. Hep B 1st and 2nd dose, all the DTaP, polio series, and MMR
3. DTaP first and second dose, MMR first dose, all Hep B series
4. Varicella, Tdap first dose, and Hep B first dose
Answer 1
1. All 3 Hep B, all RV series, 3 doses of the PCV series, and at least 2 doses of IPV
86
Which of the following patient situations requires the use of inactivated vaccines?
1. History of nonspecific allergies
2. Immunocompromised adult
3. Concurrent antimicrobial therapy
4. Mild acute illness
Answer 2
2. Immunocompromised adult
87
In taking the hx of a healthy 50-year-old man, the FNP determines the pt is an avid gardener and
spends much of his time enjoying outdoor
activities. A health maintenance recommendation for this pt is to obtain a:
1. Pneumococcal vaccine
2. Tdap/Td vaccine
3. Hep B vaccine
4. Varicella vaccine
Answer: 2
2. Tdap/Td vaccine
88
The advisory committee on immunization practices recommends that healthy older adults receive the Tdap booster vaccine:
1. Every 5 years
2. Every 10 years
3. at age 65
4. At age 50
Answer 3
3. at age 65
89
A 2-month-old infant received his immunizations, and 12 hours later, the mother calls and says the infant has a fever of 101F. What is the
most likely cause?
1. Vaccination for MMR
2. Combination of the diphtheria and the polio vaccinations
3. Presence of an infection when immunizations were given
4. Pertussis immunization
Answer: 4 (Out of all childhood vaccines, pertussis has the most adverse effects)
4. Pertussis immunization
90
What vaccine can be given to children younger than age 7 that are unable to tolerate pertussis component?
Answer: Td
91
Complete primary dentition (20 teeth) is usually present between?
Answer: 30-36mo
92
What is the safest place to ride for all children under 13 years old?
Answer: middle back seat
93
How long should you stay rear facing?
Answer: as long as possible; until they max out their height & weight on the car seat
94
What age would be sitting with booster?
Answer: Typically, 8-12 year
95
When can the child use a lap and shoulder belt?
Answer: shoulder belt must lie across middle of chest and shoulder; lap belt across upper thigh; tall enough to sit against back seat with knees bent
over edge of seat without slouching typically 10-11 years old
96
What’s an indication the child has outgrown the booster seat?
Answer: shoulders are above top harness slots; tops of ears reach top of seat
97
When should car seats be replaced?
Answer: moderate-severe car crashes
98
Child Safety crib bars should be no more than how many inches apart?
Answer: 2 3/8
99
Crib mattresses should have no more than _ fingers fitting between mattress and side of crib?
Answer: 2
100
When should you remove bumpers from crib?
Answer: when child can push up
101
What temperature should water heater be set at?
Answer: 120F
102
Ways to prevent accidental poisoning include?
Answer: Keep everything high up; use back burners, childproof everything (latches on cabinets)
103
What could you run water over to test it before bathing child?
Answer: meat or candy thermometer; the inside of your arm/back of hand will suffice....
104
What are signs of hunger?
Answer: sucking, rooting, fussing, hands in mouth (full out crying is a LATE SIGN)
105
What are signs baby is full?
Answer: Closes mouth, turns head
106
If baby sleeps past 4 hours, what you instruct mom to do?
Answer: wake baby up to eat
107
How often should the mother breastfed baby per day?
Answer: 8-12x
108
How many diapers do you expect to see in babies?
Answer: 6-8 wet diapers
109
How many stools should babies have a day?
Answer: 3-4x (1/2 of wet diapers)
110
What color do you expect a baby who is breastfed to have?
Answer: yellow, green, seedy, pasty
111
If a mother is vegan or had a gastric bypass and is breastfeeding, what could result in need for supplementation?
Answer: b12 deficiency
112
What do you tell a mother who is exclusively breast feeding that she needs to take?
Answer: VitD
113
For the first 6 months of life, what should babies be fed?
Answer: only breast milk or iron-fortified formula
114
How often should a mom who is bottle feeding give milk?
Answer: 2oz every 2-3 hour (20 oz per day)
115
What should you instruct mom is essential to do while bottle feeding?
Answer: look at baby to promote bonding; don't prop bottle
116
What is considered normal stool for a bottle-fed baby?
Answer: yellow-brown pudding
117
How should temperature be checked?
Answer: rectal
118
What temp warrants evaluation?
Answer: 100.4 or higher (especially in less than 3 mo old)
119
Babies should always be placed on their ____ for sleeping?
Answer: backs
120
The cord clamp is removed in about how many hours?
Answer: 24hr
121
How long does it take stump to dry up and fall off?
Answer: 10-12 days
122
How should you instruct mom to clean stump?
Answer: water, air dry; keep diaper below stump (signs/symptoms of infection: purulent drainage, foul odor, redness)
123
Babies who are circumcised should keep what in place for 1st 24 hours?
Answer: petroleum gauze on penis
124
After removal, what should the mother do to care for circumcised penis?
Answer: clean area with water, monitor for infection (discourage soap)
125
How long does it take for circumcision to heal?
Answer: 5-7 days
126
T or F: VIS must be given prior to vaccination, prior to each dose of a multi-series, and must be given regardless of age of the recipient
Answer: true
127
What are the providers responsibilities regarding VIS?
Answer: distribute to everyone getting vaccinated; record specific info in patients EMR (edition date of VIS, date VIS is provided, office address,
name of person giving vaccine, date vaccine is administered, vaccine manufacturer and lot number, have guardian sign)
128
Patient has a low-grade fever, runny nose, mild diarrhea - can they be vaccinated?
Answer: yes
129
Patient is taking Tamiflu can they receive vaccine?
Answer: may need to wait because Tamiflu may affect how the body responds to some vaccines
130
What are the reasons not receive vaccine
Answer: chronic health condition (cancer), weakened immune system (undergoing chemotherapy, on certain meds after transplant), had severe
allergic reaction to previous dose of vaccine
131
When is it okay for a child with cancer to receive a live vaccine?
Answer: Remission, 90 days post-chemo
132
How long should live virus vaccination be delayed if an immunoglobulin or blood product was given?
Answer: 3-11months
133
Should a congenitally immunodeficient child be immunized with live vaccines?
Answer: no
134
What is some barrier to vaccines?
Answer: parental concerns, need for multiple visits, cultural diff, financial constraints
135
Resistance developed in response to infection - What type of immunity?
Answer: active immunity
136
Give an example of naturally acquired active immunity?
Answer: contracting measles or chickenpox
137
What is an example of artificially acquired active immunity?
Answer: Vaccines
138
T or F: active immunity is permanent
Answer: True
139
The onset of active immunity is?
Answer: 2-4 weeks
140
Passive immunity is short term and long term?
Answer: short term
141
How does a person get passive immunity?
Answer: given antibodies to a disease
142
How does passive immunity naturally occur?
Answer: antibodies passed from mother to fetus during pregnancy
143
How does passive immunity artificially occur?
Answer: injection of antibodies (gamma globulin - IVIG)
144
Onset of passive immunity is? What is the duration?
Answer: within 24 hour of dose (immediate); 4-6 months
145
When a significant portion of the population is vaccinated what does this provide?
Answer: herd immunity (where the population prevents disease in the unprotected population)
146
What specific population is herd immunity effective for?
Answer: the population who cannot safely receive vaccines (immunocompromised etc.)
147
When checking a newborns reflexes - what are you ensuring?
Answer: the brain and nervous system is functioning properly
148
How do you elicit the rooting reflex?
Answer: stroke corner of babies mouth, baby turns head and opens mouth
149
How long does rooting reflex last?
Answer: 4 months
150
How do you elicit sucking reflex?
answer: touch roof of mouth
151
When is this (sucking reflex) considered fully developed?
Answer: 36 weeks utero
152
How do you elicit moro reflex?
Answer: startle baby in response to sound (head back, extends arms out)
153
How long does moro reflex last?
A: until 2 mo
154
What is tonic reflex?
Answer: fencing; head is turned to one side -- arm on that side stretches out - opposite arm bends up at elbow
155
How long does tonic reflex last?
Answer: until 5-7 mo
156
How do you elicit grasp reflex?
Answer: stroke baby’s palm (lasts 5-6 mo)
157
How do you elicit the stepping reflex?
Answer: hold upright with feet touching solid surface (lasts about 2 mo)
158
When is developmental surveillance conducte
Answer: done at every preventative visit throughout childhood
159
When is developmental screening conducted?
Answer: 9, 18, 30 mo
160
Why is developmental surveillance important?
Answer: early identification of developmental disabilities
161
What are the 3 things developmental surveillance + screenings promote?
Answer: healthy development, prevent delays, identify children with delays/disabilities early
162
What are key components of developmental surveillance?
Answer: ask about child’s learning, development, and behavior
163
A mother brings son to hospital for a routine checkup. You ask if the child is able to walk and mother states he hasn't yet walked. At what
age group should a child start walking and at what age group should you be worried if the child doesn’t walk?
A. 9 months, 12 months
B. 12 months, 18 months
C. 15 months, 18 months
D. 15 months, 2 years
Answer: B
B. 12 months, 18 months
164
If a newborn has an abnormal screening for Congenital Hypothyroidism (CH) then what is the appropriate follow up by the provider?
Answer: Some can be falsely elevated regardless of when they are drawn so first, we would do a repeat test (confirmatory test) at 2-4 days old and
begin with appropriate treatment with thyroid hormone replacement within 2 weeks after birth
165
If an infant is screened for PKU within the first 24 hours of life, what else should happen regarding this screening?
Answer: Repeat test by 2 weeks of life
166
When should treatment be started with an infant with PKU?
Answer: Immediately, or within first month of life
167
What labs are measured in the neonatal hypothyroid screen?
Answer: TSH and T4
168
When should treatment be initiated if they are positive for congenital hypothyroidism?
Answer: Within 2 weeks of birth (or at least within the first month)
169
What labs are monitored in a sickle cell screening?
Answer: Hemoglobin and reticulocytes; specifically, hemoglobin FS, FSC, FSA (S>A), IEF, HPLC
170
If positive for sickle cell, what is the name of the test that actually confirms that they have it?
Answer: Hemoglobin electrophoresis
171
Should solubility tests be used to confirm sickle cell?
Answer: No, they won’t identify hemoglobin variants except S
172
What age group should kids with sickle cell be taking penicillin prophylactically?
Answer: 2 months – 5 years
173
What immunizations should be given for sickle cell positive kids?
Answer: PCV and polysaccharide vaccine
174
When do all infants need to be referred to a pediatric dentist?
Answer: 6 months after 1st tooth or 1 year old, whichever comes first; Continue to screen for dental home until 5 years old or continue to do oral
health assessments
175
What is the name of the common bacteria that colonizes in the baby’s mouth that increases the risk of caries?
Answer: Streptococcus mutans (MS)
176
When should all babies have the caries-risk assessment done?
Answer: By 6 months
177
At what age should oral hygiene start?
Answer: Birth. Start cleaning gums with soft moist cloth until they get teeth. Smear of tooth paste when teeth erupt with soft toothbrush
178
What type of toothpaste needs to be used once there are teeth present?
Answer: Fluoridated
179
When should kids be weaned from bottle?
Answer: 12-18 mo
180
How much juice is recommended per day for 1-6yos?
Answer: 4-6oz/day
181
What age do teeth begin to erupt?
Answer: 7 months (Hay p. 464)
182
What age lifts head with good head control?
What age lifts head with good head control?
183
What age sits independently?
Answer: 6-8 months
184
What age crawls?
Answer: 9-11 months
185
What age walks?
Answer: 12 months
186
What age runs?
Answer: 18 months
187
What age has ulnar grasp?
Answer: 3-5 months
188
What age do kids start to show signs of dominant hand?
Answer: Not before 1 year; most 18-30 months
189
What two well visits do autism screens need to be done?
Answer: 18 month and 2 year
190
What is the earliest age a child can be diagnosed with ASD?
Answer: 2 years old
191
When should you stop measuring head circumference at well visits?
Answer: 2 years (Bright Futures chart, 229)
192
When do you stop using the weight for length chart and start using the BMI chart on kids?
Answer: 2 years (p. 231-2/Bright Futures chart)
193
What age do kids typically start to stay on the same growth curve on the growth chart?
Answer: 18 months
194
When should blood pressure screening start?
Answer: 3 years if not high risk (p. 232)
195
When can you stop screening for the red reflex?
Answer: When the child can read the eye chart (p. 233 2nd paragraph under vision/hearing)
196
When can kids have first TB test?
Answer: 3 months (per Hay)
197
Most common leading cause of death in kids?
Answer: MVA
198
What supplement should be given for exclusively breastfed kids?
Answer: Vitamin D
199
What is the most common initial symptom of sickle cell occurring in up to 50% of children before age 3?
Answer: Hand-foot syndrome (dactylitis)
200
Along with prophylactic PCN, what other daily medication is recommended for kids with sickle cell anemia?
Answer: Oral hydroxyurea (p. 907)
201
When should you screen for maternal depression?
Answer: 1, 2, 4, 6 months
202
What are some risks associated with bilateral congenital hearing loss?
Answer: Family history, facial/cranial abnormalities, being in NICU for >2 days
203
When should initial screening for hearing loss be done?
Answer: Before hospital discharge; if born at home, done at first pediatric visit
204
All infants and toddlers should ride rear facing until what age according to the APA?
Answer: Rear facing until they reach height/weight limit
205
At what point should a child switch from the harness system to a booster with the seat belt?
Answer: Switch at 5 years, remain in booster seat until 8 years old and/or 4’9’’ (seat belt should fit appropriately at this time)
206
At what age should a child be able to walk backwards?
Answer: 30 months
207
When should children be using pronouns?
Answer: 24 months
208
When do children hold crayons with fingers?
Answer: 3 years old
209
What age group should ride in the back seat?
Answer: Riders younger than 13
210
If a child has a history of febrile seizures or a family history of febrile seizures should they receive the combined MMR and varicella vaccine
(MMRV)?
Answer: No, should receive separate administrations of MMR and VAR (Hay p. 269)
211
Children or adolescents receiving long term aspirin therapy shouldn’t receive this vaccine.
Answer: Live influenza
212
Which of the following products provides passive immunity?
Answer: Hepatitis B immune globulin (HBIG)
213
What vaccine should be deferred for a child with progressive neurological disorders until they are stable?
Answer: DTaP
214
You are making rounds in the nursery and examine the neonate of a mother who is HBsAg-positive. Your most appropriate action is to:
Answer: Give Hepatitis B immune globulin (HBIG) to the neonate
215
Which groups with no history of varicella infection or previous immunization should be targeted for vaccination?
Answer: Day-care workers and individuals >8yo with HIV infection with CD4+ T-lymphocyte counts >=200
216
Pregnancy should be ruled out and prevented for 3 months with what vaccine?
Answer: MMR, MMRV (Hay p. 269)
217
Should a child ride in a car seat on an airplane?
Answer: Yes
218
What screenings should be performed at the 6-mo wellness visit?
Answer: Maternal depression, oral health = universal
219
What should be screened for at 4 months?
Answer: Maternal depression
220
Needle length for newborn?
Answer: 5/8 for newborns
221
Needle length for 1-20mo?
Answer: 1in in thigh
222
Needle length for 1y-18yr in thigh?
Answer: 1 ¼ in
223
PKU without treatment leads to what?
Answer: Intellectually disabled
224
What should bottle feeding parents do to promote bonding?
Answer: Eye contact with baby
225
True/False: Bottle-fed babies’ stool is yellow, green, or brown and may be seedy
Answer: False – breastfed babies
226
Fluoride varnish should be applied when?
Answer: When the first tooth erupts and every 6 months after
227
A healthy 6yo girl presents for care. Her parents request that she receive vaccination for influenza and report that she has not received the
vaccine in the past. How many doses of the influenza vaccine should she receive this flu season?
Answer: 2
228
When considering an adult’s risk for measles, mumps, and rubella (MMR), the NP considers the following:
Answer: Patients born before 1957 have a high likelihood of immunity against these diseases because of a history of natural infection
229
In which of the following groups is routine HBsAg screening recommended?
Answer: Pregnant women
230
Hepatitis B vaccine should not be given to a person with a history of anaphylactic reaction to:
Answer: Baker’s yeast
231
Of the following, the most common route of hepatitis A virus (HAV) transmission is:
Answer: Ingestion of contaminated food or water
232
When answered questions about HAV vaccine, the NP considers that it:
Answer: Should be offered to adults who frequently travel to developing countries
233
A 30-yr-old man with HIV lives with his two preschool-aged children. Which of the following statements best represents advice you should
give him about immunizing his children?
Answer: Immunizations should take place without regard for his health status.
234
A healthy 2-yr-old child is able to:
Answer: Speak in phrases of 2 or more words
235
A healthy 3-year-old child is expected to:
Answer: Give his or her first and last name
236
A healthy 6- to 7-month-old infant is able to:
Answer: Roll from back to stomach
237
When do they grasp cubes with raking motions?
Answer: 3-5 months
238
Screening tests for PKU? When are these performed ideally?
Answer: If tested before 24hrs, retest by 2 weeks of age; test after 24hrs of life and before hospital discharge
239
When to perform PKU screening for premature or infants with illnesses?
Answer: 7 days old
240
Treatment for congenital hypothyroidism?
Answer: Synthroid 10-15mcg/kg/d with serum monitoring done by 2 weeks of life, followed by a 30-day trial of decreased dosage/no meds after age
3
241
When is the latest confirmatory testing for sickle cell can be performed?
Answer: 2 months
242
What can reduce the number of cariogenic bacteria? How often is this recommended?
Answer: Chlorhexidine gluconate rinse in 3 months intervals
243
What are some high risks for caries?
Answer: Bottle feeding, bottle propping, low socioeconomic status, poor maternal oral hygiene, GERD, decreased salivary function, cariogenic diet,
lack of cleaning, orthodontic appliances, lack of dental home
244
Early childhood caries used to be called what? What causes it?
Answer: Baby bottle tooth decay or nursing bottle caries. Lack of adequate preventative care and poor feeding habits
245
What is ankyloglossia?
Answer: Tongue tie. The attachment is tight closer to the tip of the tongue or high up on the alveolar ridge that may restrict movement
246
What patient education should be provided to parents after varnish is applied?
Answer: Don’t brush teeth until next morning, soft foods
247
Child gives toys and says mama/dada at what milestone?
Answer: 12 months
248
What are the developmental milestones for 9-11mos?
Answer: Stands alone, walks along furniture, follows 1-step command
249
When does separation anxiety start?
Answer: 8-9mos (Hay p. 76)
250
Developmental milestones: laughs, anticipates food on sight, turns from back to side?
Answer: 3-5mos
251
Developmental milestones: walks backwards, begins to hop on 1 foot, uses prepositions?
Answer: 30 months
252
Holds crayon with fingers?
Answer: 3 years
253
Understands 2 step command, carries and hugs doll, feeds self?
Answer: 18 months
254
Throws ball, seats self in chair, dumps pellets from bottle?
Answer: 18 months
255
Rides trike using pedals, dresses w/supervision?
Answer: 3 years
256
What is the oldest a baby can be to receive the 1st dose of rotavirus vaccine?
Answer: Less than 15 weeks
257
What blood lead level is considered abnormal? At what level would chelation be indicated? What level is urgent?
Answer: Greater than 5 is abnormal, greater than 45 for chelation, above 70 is urgent
258
At what age do blood pressure screenings begin in a normal healthy child?
Answer: 3yrs
259
When does the word “no” affect them?
Answer: 6-8mos
260
Giving HBiG to an infant is an example of what type of immunity?
Answer: Passive (onset 24hrs, duration 4-6mo)
261
At what age can an infant track an object with BOTH eyes?
Answer: 3mos
262
What is assessed in a vision screening for a child birth – 3yrs?
Answer: Inspection, alignment, visual acuity
263
What are the universal screenings done at the 12mos visit?
Answer: Lead, anemia, oral health
264
When are the universal screenings completed for lead blood testing?
Answer: 1 and 2 yrs old
265
If 1st hearing test is failed, then what are the next steps in treatment?
Answer: Re-test and refer if necessary, by 3 months
266
How should a mother clean an infant’s gums?
Answer: Water on a soft cloth
267
The ADA only recommends dietary fluoride supplementation to who?
Answer: Children who are at risk for caries
268
What can excessive fluoride intake cause?
Answer: Dental fluorosis or mottled enamel
269
Children taking what dose of corticosteroids should not be given a live vaccine?
Answer: Greater than 20mg/d for 14+ days
270
By what age should a child have a caries risk assessment by a pediatrician?
Answer: 6 mos
271
When is it okay for a child with cancer to receive a live vaccine?
Answer: Remission, 90 days post chemo
272
When are HIB vaccines given?
Answer: 2, 4, 6, 12-15mos
273
When are Hep B vaccines given? Who should not receive a Hep B vaccine?
Answer: Birth, 1-2mos, 6-18mos; do not give if allergic to yeast
274
What are the vaccines given at the 1-1.5yr mark?
Answer: MMR, Hep A, VAR, Hib, PCV, DTaP
275
By what age should a child have received their 4th DTaP?
Answer: 15-18mos
276
When is influenza given? How many doses?
Answer: 6 mos, then annually; under 9 receiving for first time 2 doses in the first year 1 mo apart
277
How many total doses of IPV? When are they administered?
Answer: 4; 2, 4, 6-18mos, 4-6yrs
278
When should universal vision screenings start?
Answer: 3 years
279
When is autism screened for? When is the earliest it can be diagnosed?
Answer: 18 and 24mo; 24mos
280
When can children start receiving the LAIV (Live Attenuated Influenze Vaccine) flu vaccine?
Answer: 2 years; must receive inactive prior to 2yrs
281
What are the 3 parts to the well child visit?
Answer: Physical exam, growth and development, anticipatory guidance/health education prov
282
Name the live viruses. Can they be given together? What happens if you have to give them on separate visits?
Answer: MMR, MMRV, VAR, rotavirus, yellow fever; can be given together; if separately, give 4 weeks apart
283
What is required vaccine documentation?
Answer: Vaccine manufacturer, lot #, admin date, expiration date, VIS version and date, site, route (Hay p. 249)
284
Should a congenitally immunodeficient child be immunized with live vaccines?
Answer: no
285
How long should live virus vaccination be delayed if an immunoglobulin or blood product was given?
Answer: 3-11 months
286
What is the difference between DTaP and Tdap?
Answer: Tdap has the booster dose of diphtheria while DTap is the initial immunization
287
Which vaccines should be stored frozen?
Answer: Varicella-containing vaccines – MMRV, VAR, herpes zoster
288
At what age do infants develop the concept of object permanence?
Answer: 9-12mos (Hay p. 75)
289
What are the triad of symptoms associated with ADHD?
Answer: Impulsivity, inattention, hyperactivity (Hay p. 91)
290
Which subtype of ADHD do girls have a higher prevalence of? What about boys?
Answer: Girls—inattentive, boys—hyperactive
291
What are the 4 most common early characteristics of autism?
Answer: Consistent failure to orient to one’s name, regard people directly, use gestures, and to develop speech (Hay p. 94)
292
What does the AAP recommend regarding screen time?
Answer: None under age 2; over age 2, only 2hrs/day
