Unit 2 Review Questions Flashcards
What is the purpose of utilizing the AAS tool in practice?
IPV screening tool in the pregnant population (five-question screen that involves the following open-ended
questions)
What is the BEST way to successfully obtain social history info from adolescent?
questionnaire (most often adolescents feel more comfortable divulging this info on paper)
To conduct a bimanual examination on a patient, how should this be performed?
using one or two fingers in the vagina with the other hand placed on the abdomen
The overall highest rate of syphilis in men occurs during which age group?
20-24yr
What tool is used to categorize genital development?
SMR (sexual maturity rating)
When going to insert the speculum, what can the FNP do simultaneously to help distract attention from the placement of the speculum?
touch the inner aspect of the patient’s thigh or apply gentle pressure to the perineum (away from the introitus)
while inserting the speculum
School-aged children – teens are most likely to drown in what conditions?
large bodies of water (swimming pools/open water)
During the physical exam of a 5-6-year-old patient, the FNP will assess/observe and perform what universal
screening(s)?
US: hearing, vision
assess/observe for:
- ocular motility
- malocclusion
- fine/gross motor skills
- gait
First conspicuous sign of puberty for girls?
breast buds (occurs between 8-11yr)
The repeat BP is 120/80. What category is this considered? Likely, the cause of the previous falsely elevated BP
reading was?
normal BP; white coat syndrome, improper cuff size/measurement techniques, or use of stimulants
Regarding the positioning of the patient during a pelvic exam, the appropriate placement is?
dorsal lithotomy position AFTER equipment / supplies are ready (Patients with orthopedic or other physical
disabilities require accommodation for proper positioning and comfort)
During adolescence, substance abuse is limited to what?
experimentation with tobacco and ETOH
You inquire from the patient whether he is taking steps to actively lose weight in which he states he has increased
physical exercise and monitoring weight loss per week. From the previous BMI of 95th percentile to his current 93%
- would you instruct the patient to continue losing weight OR maintain weight?
maintain weight (age 12-18yr: once you’ve reached 85 to <95% range, you can maintain weight); however, being this patient is still considered OVERWEIGHT you would reiterate the need for continued physical activity daily (60min per day) and healthy eating choices.
During the physical exam of a 7-8-year-old patient, the FNP will assess/observe?
- malocclusion
- SMR (1st time this happens)
- hip/knee/ankle function
- gait
What age is puberty complete by? A: 15-16 B: 16-17 C: 16-18 D: 17-18
C
What is the primary cause of unintentional injury?
MVA
What are some clues to substance abuse seen in adolescents? SELECT ALL THAT APPLY? A: delinquency B: elevated mood C: chronic fatigue D: generalized physical complaints
A, C, D (truancy, failing grades, problems with interpersonal relationships, delinquency, depressive affect, chronic fatigue, and unexplained physical complaints)
Age 6-7: copies a __; defines words by __; knows if it’s _______ or _______ (time of day); draws a person with how many details? __; reads several ____-syllable words; knows approx. how many words?
triangle what is morning/afternoon 12 1 2560 words
The developmental passage from childhood to adulthood includes which of the following - SELECT ALL THAT APPLY!
A: completes puberty
B: establishes an identity while maintaining closeness with family
C: prepare career
D: develops socially and emotionally
E: moves from abstract to concrete thinking
A, C, D (establishes own identity and separates from family; moves from concrete to abstract thinking)
What is the formula for BMI?
weight and height (kg/m2)
What screening should begin at 12 years old?
Depression screening
Patient presents to the ED with tachycardia, HTN, elevated core body temp, hyperreflexia, tremors, seizures, nausea/vomiting. What substance do you suspect they are withdrawing from?
alcohol, barbiturates, or benzos
What age does rapid physical, emotional, cognitive, and social development begin? A: 9-10 B: 12-13 C: 11-12 D: 13-14
C
Hearing screenings are conducted at which aged visits?
5, 6, 8, 10, 11-14yr and 18-21 yr
Age 7-8yrs: counts by ___ and ___; ties shoes; copies a _____; knows what about a calendar? draws a man with ____ details? what type of arithmetic can they complete?
Answer: 2s and 5s; diamond; day of the week (not date/year); 16 details; adds/subtracts 1-digit #s
Middle childhood is considered what age group?
7-10 yr old
What are the 3 leading causes of MORTALITY in adolescence?
unintentional injury, suicide, homicide
T or F: axillary hair will show before pubic hair (occurs 1 year early)
False (pubic hair precedes axillary hair by 1 year)
How many fasting lipid profiles should be obtained?
2 with the results averaged for evaluation of the CVD risk
When conducting anticipatory guidance, what age do you 1st discuss pregnancy and STI protection?
11 years old
What is the FNP 1st priority during the first few minutes of the interview process? A: assess the social history B: ask about school and interests C: developmental screening D: explain the process of the interview
B (1st few minutes determines entire visit: ask neutral, nonpersonal questions – allows adolescent to become comfortable)
The cause of secondary HTN is?
an underlying health condition (premature birth, LBW, congenital heart disease, renal dysfunction)
What screening should be performed once between 15-18 yr. visits?
HIV screening
What is the primary cause of death in children < 15 years old?
fire-arm related injuries
When conducting anticipatory guidance, what age do you discuss switching from booster seat to seat belt in back seat of car?
Answer: 9-10 years old
What ages have BP and height, weight and BMI collected at annual visits?
5-21 y/o
BP 1st begins @ 3 yr. old annually
What is a CRITICAL first step in office-based interventions when working towards treatment of substance abuse in
an adolescent?
assessment of the patient’s readiness for change
After the FNP elicits information indicating substance abuse seems to be present, what information is pertinent to collect next?
extent and circumstances of the problem (how much do you drink a day? What do you drink? How long has this occurred?)
An adolescent comes to your clinic for an initial visit and appears closed-off and sullen. As the FNP, you know a cause of this could be? A: developmental delay B: drug use C: feeling afraid or judged D: depressed
C (your initial approach is IMPORTANT to the success of the interview process. PCP must behave simply,
honestly, without an authoritarian attitude)
15-17yr is classified as what stage of adolescence?
Middle
What is the GREATEST BARRIER to screening adolescents in the primary care setting for substance abuse?
insufficient time and lack of training
Age 9-10: knows ___, ___, ___ (related to calendar); names what in order? makes sentences with what three words in it? what arithmetic can they perform?
Answer: month, day, year; months in order; work/money/men; boy/river/ball; simple multiplication
When conducting anticipatory guidance, what age do you discuss making and keeping friends?
9-10 years old
T or F: most breast masses are benign and common
True
In a 4-yr. old patient with sickle cell, would you check their BP? How often?
children >3 yr. with underlying risk factors / obesity – BP should be checked at EVERY VISIT
22% of new HIV infects young and young adults ages _________ in the U.S.
13-24yrs
What is an example of tertiary prevention regarding STIs?
directed towards complications of specific illness (tx of PID BEFORE infertility develops)
Prior to the speculum exam of a virginal female, what should the FNP do?
one-finger exam of vagina – helps FNP identify the position of cervix/prepare patient for what’s to come
Match each breast issues with their appropriate characteristics.
- Fibroadenoma
- Fibrocystic change
- Abscess / Mastitis
- Galactorrhea
- Gynecomastia
- Mastalgia
- Papilloma tumor
a. Palpable fibroglandular mass located concentrically beneath the
nipple-areolar complex; can be unilateral or bilateral)
b. Caused by normal skin flora related to manipulation of periareolar
hair and nipple piercings; presents with breast pain,
erythema, and warm to touch
c. More common in adults; mild swelling and palpable nodularity in
the upper outer breast quadrants
d. Milky nipple discharge; typically benign; can be caused by
chronic nipple stimulation, certain psych drugs or illicit drug use
e. Unilateral bloody nipple discharge; REFER
f. Breast pain that is typically cyclic; occurs just prior to
menstruation
g. Non-tender, glandular, fibrous tissue; rubbery, smooth, wellcircumscribed,
mobile mass noted to the upper/outer quadrant of
breast; slow growing; US to evaluate
Answer: 1-G; 2-C; 3-B; 4-D; 5-A; 6-F; 7-E
Pubertal growth lasts about how many years?
2-4years (continues longer in boys)
EMR includes which of the following? SELECT ALL THAT APPLY! A: problem list B: VIS sheet C: allergies D: immunizations E: demographic data
A, C, D, E (demographic data, problem list, info about chronic medications, allergies, previous hospitalizations,
names of other physicians providing care for patient. Documentation of immunizations (inc. data required by National
Vaccine Injury Act) should be kept on second page)
What co-morbidities are associated with substance abuse in adolescents?
ADD/ADHD, bipolar disorder, depression, anxiety disorders “B-A-A-D”
What universal screenings will be conducted during the 10yr old visit?
hearing, vision
A BMI >99th percentile for age (must be same age / gender) indicates what?
severe obesity (associated with greatly increases risk of comorbidity)
Following a work-up of an adolescent patient, you’ve diagnosed this patient with stage 1 essential (primary)
hypertension. What would be the appropriate treatment regimen?
If no cause is identified and HTN is deemed essential antihypertensive therapy should be initiated as well as
counseling given regarding nutrition/exercise (60min/day). The 1st line medication: beta blockers or ACE inhibitors.
In ages >4yr, what could be mistaken for hearing loss?
inattention; hearing screening should be a part of attention problems work-up
What usually appears 2 years after growth of pubic hair for boys?
axillary hair, deepened voice, chest hair (occurs mid-puberty)
SMR1 vs. SMR5?
SMR1 = pre-puberty; SMR5 = adult maturity
What is the highest-risk group to contract HIV?
young men who have sex with men (particularly men of color)
What should prompt further evaluation and possible treatment from the FNP in a pediatric patient evaluated for
obesity?
an upward change (crossing of them) in BMI % in any range
What two components are essential to obtaining a thorough pediatric history?
parents objective reporting of face and subjective interpretation of their information (in older children, obtain
their own history of events as well)
What can the FNP do to make the insertion of the speculum more comfortable for the patient?
warm the speculum with tap water prior to insertion
A BMI <5th percentile for age (must be same age / gender) indicates what?
underweight
T or F: family history of substance abuse does not pose an increased risk the adolescent will also abuse drugs
False
T or F: mortality rates are highest in males vs. women
True
T or F: all children, regardless of general health or presence of CVD risks, between 9-11 yrs. should be screened for lipids and have repeat screening every 5 years thereafter if normal
True
50% of women in the U.S. are infected with this STD.
trichomoniasis
Patient presents to the ED with conjunctival injection, hypotension, sedation, hallucinations. What substance do you suspect they’ve used?
marijuana
During the interview process, the FNP recognizes who as their primary patient?
adolescent
What is the BEST WAY to screen for substance abuse among adolescents?
general psychosocial assessment
What is an example of primary prevention regarding STIs?
focuses on education and risk-reduction techniques (address sexuality routinely as part of well-checkups; discuss
STIs prevalence – make it real for them; make condoms available and discuss other forms)
T or F: HSV-1 and HSV-2 cause STIs
True
What is the aim of tertiary prevention technique employed to prevent substance abuse – give an example?
targets those who are substance users; ex: identify someone who drinks at parties, and provides them with
resources for safe rides home at night
You’ve completed your exam and move onto discussing patients BMI. After discussing this information with the
adolescent and their parent, you determine increased resistance and unwillingness to change from both parties. How
would you proceed?
early intervention is IMPORTANT to decrease future co-morbidities. Due to increased resistance to make lifestyle
modifications, the FNP should consider the use of Orlistat, a lipase inhibitor approved in children >12 yr. old. You
would still provide counseling regarding weight management in addition (age 12-18yr @ 95-98% should lose 2lb/wk).
Counsel on sedentary lifestyle and electronic use recommendations. Schedule follow-up with patient in 4 weeks.
What complications can occur when adolescents use ecstasy? SELECT ALL THAT APPLY! A: decline of immediate/delayed memory B: insomnia C: pulmonary HTN D: increased appetite
A, B, C, D (decline of immediate and delayed memory, mood sleep and appetite alterations, cardiomyopathy,
pulmonary edema, and pulmonary hypertension)
What is the MOST commonly used indicator to measure size and growth patterns on children and teens in the US?
CDC growth charts
Prior to this discussion, you complete your physical exam and note this patients BP is 91%. What does this value
indicate regarding the patient? What would you do first? What things should be considered?
suggests pre-HTN; you must reassess BP in that visit and evaluate if patient has any risk factors
What are the screening tools for IPV?
RADAR tool and HITS tool (AAS Tool)
When conducting anticipatory guidance, what age do you begin addressing bullying?
5 years old, until 14 years old
How can the FNP aid in STD prevention?
Risk assessment & education, pre-exposure vaccines, ID asymptomatic pts & pts with symptoms, effective
diagnosis treatment counseling & follow-up, eval treatment and follow-up with sex partners
What complications can occur when adolescents use marijuana? SELECT ALL THAT APPLY! A: bradycardia B: elevated BP C: bronchoconstriction D: increases fertility E: ADHD F: issues with coordination / memory
B, E, F (tachycardia, hypertension, bronchodilation, decrease fertility, learning problems, coordination, and
memory)
During the physical exam of an 8-year-old patient, the FNP will conduct what universal screening?
hearing
vision
T or F: the FNP should have another female staff chaperone should be present with male examiners
True
T or F: 11-21yr have annual visits
True
The bimanual examination of the patient allows the FNP to palate what?
uterus and adnexa for size, position, and tenderness
When conducting anticipatory guidance, what age do you discuss weight?
9-10 years old
Major causes of morbidity are related to what two factors?
psychosocial and poverty
HSV-1 is often established in children via oral route by what age?
5 years old
What is NOT a good predictor of physiologic or psychosocial development?
chronological age
What is the most common STD cause of visible genital warts?
Herpes Simplex Virus
Age 5
we have the kindergartner. this boy is ready to relate to peers, knows ___. brain is ___% of its adult weight, Able to complete pencil/paper tasks better
Cognitive: _________ stage (focuses on 1 variable in problem at a time);
Activities: catch a ball, skips, copies a ___, tells age, understands concept of _, knows __ from __ hand, draws recognizable person with _ details; per the parent: can complete simple ____, little awareness of ______
right from left 90% preoperational stage copies a cross 8 details complete simple chores little awareness of danger
7-10 age range is MOST concerned with? A: magical thinking / imaginative play B: peers and school C: sports & extracurricular D: academia and school
Answer: B
When conducting anticipatory guidance, what age do you 1st discuss being physically active at least 60min per day?
11 years old, until 21 years old
When conducting anticipatory guidance, what age do you begin addressing safeguarding info from online, talk
about worries, inquire about activities most liked in school?
7 years old
A patient presents to your clinic to discuss the results of the ultrasound evaluating a fibroadenoma. Results indicate the mass measures <5cm. The FNP knows the indicated treatment for this is to?
monitor for growth or regression over 3-4 mo (>5cm, undiagnosed breast masses that are enlarging or have
overlying skin changes, or any suspicious mass with hx of previous malignancy à REFER!)
What is the 2nd leading cause of death in ages 1-3yr?
drowning
What is the most common/highest BACTERIAL STD in the US among adolescent and young women?
Chlamydia / Gonorrhea
Epididymitis is most commonly seen caused by what bacteria in males?
C trachmomatis and N gonorrhea
What is the aim of secondary prevention technique employed to prevent substance abuse – give an example?
aims to prevent progression from initiation to continuance/maintenance; ex: Alateen (supports children of alcoholic parents)
Age 8-9: defines words better than by use; what type of arithmetic can they perform?
Answer: use; borrowing/carrying in add/subtraction
What are the correct order specimens should be obtained?
- vaginal pH, 2. saline and 3. KOH wet preparations, 4. cervical cytology (Pap) screening if indicated, and 5.
endocervical swabs for gonorrhea and Chlamydia
What must you obtain in order to diagnose a patient with hypertension?
2 or more elevated BPs (in ADDITION to the 1st elevated BP) separated in time & >95th percentile for 2 visits) –
SO TOTAL OF 3 BPs!
Why do adolescents’ experiment with tobacco and ETOH?
part of establishing independence and attempt to identify with peer groups
What recreational drugs have increased in their use by adolescents?
OTC cough/cold meds
What is the appropriate age to begin checking BP during annual visits?
3 years old
When conducting anticipatory guidance, what age do you instruct to consume milk 3x/day?
7-8 years old
When conducting anticipatory guidance, what age do you 1st discuss dating / sexual situations, NO means NO?
11 years old, until 21 years old
What would prompt the clinician to check a patients BP in children <3 yr. old?
hx of prematurity (<32 wks), congenital heart disease, recurrent UTIs, renal disease, family hx of renal disease,
organ transplant, bone marrow transplant, on meds that increase BP (think about patients with ADHD – stimulants), sickle cell disease, increased ICP
An 8yr old patient presents to your clinic with a BMI-for-age of 89th percentile. When you check the chart from
previous visit, you note her BMI-for-age was 95th percentile 6 months ago. What weight status category is this
patient currently? What weight status category were they at their last visit? As the FNP, how would you proceed?
overweight currently, obese at previous visit; this change in weight especially given the timeframe it occurred
prompts the FNP to discuss with the patient whether they have any concerns regarding weight, and if they are trying to lose
weight. Explore the patients eating habits and discuss with the parent if you’ve noticed any changes in behavior around
mealtime or sudden increase in activity. Inspect patients back (possible bruising associated with increased sit-ups)
What is the GYN disorder commonly requires hospitalization and is most common in teen girls?
PID
Patient presents to the ED with respiratory depression, pulmonary edema, hypotension, and decreased body
temperature. What substance do you suspect they’ve used?
opioids
Mild depression symptoms of short duration due to recent stressful life event is considered?
adjustment disorder with depressed mood
Higher risk in one area is frequently associated with?
problems with another
Regarding puberty in boys, what is the order in which each physical change begins?
A: height spurt, testes growth, penis growth, pubic hair
B: testes growth, height spurt, penis growth, pubic hair
C: height spurt, testes growth, pubic hair, penis growth
D: penis growth, testes growth, height spurt, pubic hair
B
What is the primary intervention for a pediatric patient with HLD?
diet and weight management strategies
Beginning at the 15-yr. visit, what should the FNP begin screening for?
tobacco, alcohol, drug use
What is the chief cause of death from a fire?
smoke inhalation
Patient returns to your clinic for his 4-wk follow-up appointment. His BMI is re-checked and is 93%. What weight
status category is this?
overweight
At what age is it appropriate to ask adolescents whether or not they want their parents involved in their medical
visits?
18 yr. old
Patient presents to the ED with nystagmus, decreased core body temp, hyporeflexia, ataxia, and nausea/vomiting.
What substance do you suspect they’ve used?
ETOH
Proctitis, procolitis, enteritis is more common among which persons?
those who participate in anal intercourse
What are the characteristics that define MDD?
several depressive symptoms cluster together over time, are persistent 2 weeks or more, and cause impairment
What is the age appropriate visual acuity for a 3-5-year-old?
20/40
What LDL level warrants pharmacologic therapy when family hx of heart disease is present?
> 160mg/dl
Following the appointment, you conduct a “self-assessment” on yourself and how you handled that patient
encounter. You are comfortable with your recommendations because you are aware that this 13-yr. old male is
expected to enter what stage of growth and development?
puberty (growth spurt – 13.5-14yr old; with maintaining a healthy lifestyle, this issue could in fact correct itself)
What is the PREFERRED METHOD to obtain a patients BP?
auscultation
What ages will have a lipid screening performed?
once, 9-11 yr. visit and once, 17-21yr visit (lipid profile)
You’ve determined the BP should be re-checked in this current visit – and decide to do so yourself. What are the
appropriate steps to take? When determining the proper cuff size for this patient you choose?
sit in quiet room for at least 3-5min, feet uncrossed on floor; measure in right arm for consistency (avoids false
low readings from left arm in the case of coarctation of aorta); arm at heart level supported; length should be 80-100% of
circumference of arm and width 40% à adult cuff)
What is the leading cause of death in the US in which research has documented that the atherosclerotic process
begins in childhood?
CVD
Patient presents to the ED with hallucinations, anxiety, paranoia, dilated pupils, dry mouth. What substance do you suspect they’ve used?
LSD/mushrooms/nutmeg/jimson weed (hallucinogens)
At the beginning of the intimate violence assessment, what should be offered to the female to waylay fears of being
targeted?
framing statement (shows that screening is done universally and not because IPV is suspected, ensures patient is aware of confidentiality of discussion, and exactly what state law mandates that a PCP must disclose)
Any ____ line discrepancy between two eyes (even within passing range ages >6yr) should be ________!
2; REFER TO OPTHO!
What are the risk factors related to chlamydia / gonorrhea?
early age at sexual debut; lack of condom use; multiple partners; prior STI; hx of STI in a partner; sex with partner
who is 3 yr. or older
How should the speculum be inserted into the patient’s vagina?
posteriorly with a downward direction to avoid the urethra [medium Pedersen speculum is most often used in
sexually experienced patients; a narrow Huffman is used for virginal patients]
T or F: A medical home is not a place. It is a way for children and families to receive health care from a primary
care provider they know and trust.
True
Patient presents to the ED with hyper alertness, increased energy, confident, dilated pupils, and an arrythmia on the monitor. What substance do you suspect they’ve used?
Cocaine
What drug has increased in use RECENTLY in adolescence?
ecstasy
When performing the speculum exam, what should the FNP inspect?
vaginal walls and cervix (anatomical abnormalities, inflammation, and lesions; quantity and quality of discharge
adherent to the vaginal walls and pooled in the vagina)
During the physical exam of a 9-10-year old, the FNP will assess/observe?
signs of self-injury, SMR, examine back (anticipatory guidance requires you to inquire about concerns with
weight, often the period of time when eating disorders can begin)
A BMI between 85th-95th percentile for age (must be same age / gender) indicates what?
overweight
The warning signs for intimate partner violence include which of the following – SELECT ALL THAT APPLY!
A: argue with partner when instructed to do something
B: report what they are doing to partner
C: wear long sleeves during winter
D: discuss the partners angry outbursts with friends
B, D
Patient presents to the ED with sleepiness, memory loss, and begins to have a seizure. What substance do you believe is the cause?
GHB
The perception of danger decreases as old drugs reappear is considered what?
“Generational Forgetting”
What is the #1 cause of death in adolescents, ages 16-19yrs)?
unintentional injury with higher risk in males
T or F: substance abuse is more of a personal symptom and maladjustment more than a cause of issues
False (substance abuse is a symptom of personal and social maladjustment as often as it is a cause)
What age is pubertal growth competed for boys?
not until age 18 yr.
Sexually active adolescents and young adults ages 15-24 yrs. of age (females <25yr) are infected with this STD?
HPV
T or F: adolescence is typically a time in life where sickness occurs often
False [typically a healthy time of life]
According to the CDC, how should the provider obtain a sexual history from an adolescent?
utilize the 5 P’s framework (Sexual Health Assessment (It is helpful to ask the adolescent directly what behaviors
are practiced “What types of sexual experiences have you had?” rather than, “Are you sexually active?” because this can
be interpreted in different ways. For example, the CDC suggests the 5 P’s framework for a provider to obtain a sexual
history)
When conducting anticipatory guidance, what age do you 1st discuss refraining from riding in car with someone
under the influence?
11 years old
What are the two principles that must be present for anticipatory guidance?
age-appropriate and timely
What constitutes severe dyslipidemia?
LDL > 190mg/dl (In this case, the FNP should consider pharmacological therapy)
What is the BEST way to obtain a lipid panel?
venipuncture or finger stick (point of care lipid testing)
Growth spurts happen first in what gender?
girls (2 years before boys)
During the physical exam of a 11-21yrs old patient, the FNP will assess/observe?
- acne
- acanthosis nigricans (skin condition that causes areas of dark in the armpits, neck, groin – sign of obesity or type 2 DM)
- atypical nevi (noncancerous moles; people who have them are @ increased risk of developing melanoma)
- piercings
- signs of abuse and self-injury
According to the ACOG clinical guidelines, who does it recommend we screen for intimate partner violence?
non-pregnant women @ routine OBGYN visits, family planning and preconception visits; pregnant women @
various times over course of pregnancy (1st prenatal visit, at least once per trimester, postpartum check-up)
What is the most common thermal injury in kids?
sunburn (requires minimum of 30SPF, reapply every 2 hours when in water)
What smoking cessation treatment recommendations are specific for teens?
nicotine gum and patches
What are the 5 A’s of smoking cessation?
ask (abut tobacco use from all pt.), advise (about quitting), assess (willingness/motivation to quit), assist (in quit
attempt), arrange (for follow-up)
What is the hallmark of motivational learning?
“change talk” – patient is given the opportunity to tell PCP why it’s important to change vs. telling PCP convincing reasons why it is NOT important to make changes
The predominant cause of genital infection in teen-young adults is what STD?
HSV-1
What are the 15 components encompassed in the comprehensive pediatric history?
MISS Meds (chronic) Immunizations Screening Sexual/Social Hx
BIRD Birth hx Illness (present) Reasons for visit Development
OLD
ROS
Problem List
Demographic data/Diet
FAM
Family Hx
Allergies
Medical hx
What standard measure correlates with more accurate measures of body fatness?
BMI
An adolescent patient presents to the ED with complaints of vaginal discharge and abdominal pain. Does the FNP
need to obtain parental consent prior to evaluating/treating patient?
NO!
What is the MOST successful way to combat obesity?
anticipatory guidance or early intervention in childhood (vs. delayed intervention when weight gain becomes
severe)
Motivational Interviewing: What is this?
style that guides patients towards behavior change by helping resolve ambivalence
When conducting anticipatory guidance, what age do you 1st discuss spending time with family and taking
responsibility for your schoolwork?
11 years old, until 21 years old
The STD with the highest incidence occurring between 16-30yr.
Vulvovaginal candidiasis
What elements are included in vision screening for ages 5-21yr?
inspection of eye/eyelids, assessment of fixation/following, fundoscopic exam, eye chart testing (ALL ages); 5
years old also need corneal light reflex and cover testing performed – tests for strabismus
What can the FNP do to decrease an adolescent’s apprehension to their 1st pelvic exam
provide sensitive counseling and age-appropriate education (purpose of the examination, pelvic anatomy, and the
components of the examination); conduct exam in an unhurried manner; use diagrams and models to facilitate discussion;
time should be allotted for the adolescent to ask questions
T or F: psychiatric disorders are common among drug abuse in the pediatric patient
True
When conducting anticipatory guidance, what age do you discuss making and keeping friends, inquire about what
friends like to do together, and reinforce values?
9-10 years old
T or F: no increases in incidence are seen when family hx of depression is present
False
18-21yr is classified as what stage of adolescence?
Late
Those who have multiple sex partners have this STD.
bacterial vaginosis
Vulvovaginal candidiasis is caused by what bacteria?
C. albicans
T or F: chaperones must be present during an adolescent pelvic exam or a stressful/painful procedure
True
What is the STD associated with almost all cervical cancers?
HPV
What does confidentiality NOT extend to?
life-threatening situations
What age does peak of puberty occur for boys?
13 ½ - 14 yr
When performing a breast examination on a female patient, the FNP knows the correct positioning is?
A: supine with arms by her side
B: supine with the opposite arm from breast examined raised above the head
C: supine with the same arm from breast examined raised above the head
D: supine with both arms raised above the head
C [use finger pads to palpate breast tissue in concentric circles starting at outer borders of breast tissue along
sternum, clavicle, axilla à moving towards areola; compress areola to check for discharge; palpate supraclavicular / infraclavicular and axillary regions for lymph nodes]
A BMI of >95th percentile for age (must be same age / gender) indicates what?
obese
When conducting anticipatory guidance, what age do you 1st discuss eating foods rich in folate and avoid
ETOH/drugs if considering pregnancy?
18 years old
A 13yr old patient presents to your clinic with a BMI-for-age of 95th percentile. You discuss the weight management
goals with this patient to determine the appropriate weight loss needed to maintain a healthy lifestyle. What would you recommend? What does the AAP recommend regarding sedentary lifestyle modifications?
Lose 2lb/wk (age 12-18yr); a max of 2hr/day of TV; at least 60min per day of physical activity
T or F: BMI directly measures fat
False (BMI is a reasonable indicator of body fatness for most children and teens)
T or F: the rate of depression in females approaches adult levels by age 18 yr
False – 15yr
Patient presents to the ED with euphoria, hyperalert, hyperactive, fever, flushed appearance to skin, and dry mouth.
What substance do you suspect they’ve used?
Amphetamines
What ages are height plotted on charts?
2-21yrs
What is the FIRST THING the FNP can do to aid in reduction of STI risk behavior PRIOR TO onset of sexual experimentation?
1st à help youth personalize their risk for STIs and encourage positive behaviors that minimize the risks (then
enhance communication skills with sexual partners about STI prevention, abstinence, and condom use)
What is an example of secondary prevention regarding STIs?
requires identification and treatment of STIs before infected individuals transmit to others (MUST BE CONFIDENTIAL; annual screening of all sexually active females <25 yr. for chlamydia/gonorrhea; pap smear 1st done at
21 years then every 3 years; HPV typing not recommended before age 30)
What is the age appropriate visual acuity for a >6-year-old?
20/30
When conducting anticipatory guidance, what age do you begin addressing both the adolescents and parental
concerns simultaneously?
11 years old
During the physical exam of a 11-17yrs old patient, the FNP will examine/perform?
- examine back/spine
- assess breasts / SMR (females)
- assess gynecomastia, SMR, testicular hydrocele, hernias, varicocele, masses (males)
What three drugs have decreased in their use over the last decade?
LSD, meth, cocaine
Age 8: mastered what?
Answer: volume
T or F: teaching a self-breast exam to healthy girls remains controversial
True (self-breast exam should be performed by those at increased risk of breast cancer [hx of malignancy, adolescents who are at least 10yrs post-radiation therapy to chest, adolescents 18-21 yr. old whose mother carry the BRCA1 or BRCA2 gene] and done after each menstrual period)
During the physical exam of a 7-year-old, the FNP will perform what universal screening?
None (“lucky number 7”)
What is commonly observed in adolescents as erythema surrounding the cervical os?
presence of a cervical ectropion (is the extension of the endocervical columnar epithelium outside the cervical os
onto the face of the cervix
In middle adolescence (ages 14-16 years), what psychosocial development characteristics are present? SELECT ALLTHAT APPLY!
A: uncomfortable with their bodies
B: atypical to have mood swings
C: formal operations and abstract thinking
D: sexually active but uses contraception
E: grounded in their self-image
F: yearn for independence and autonomy
C, F (Becomes more comfortable with their bodies; Mood swings are typical; Formal operations and abstract
thinking. Sexually active and don’t think they need to use contraception; Self-centered at times; Different self-images. They want to be independent and autonomous)
What does HEADSS stand for?
home, education, employment, activities, drugs, sexuality, suicide/depression
Age 7: academia intensifies; becomes more _________; language: what proficiency?
Answer: abstract; adult
According to Hays, for children 2-18yrs – what is the MOST appropriate way to determine obesity?
BMI chart
During the physical exam of an 18-21yrs old patient, the FNP will examine/perform specific to females/males?
- perform pelvic exam / pap smear @ 21yr (females)
- assess gynecomastia, SMR, testicular hydrocele, hernias, varicocele, masses (males)
What is the MOST frequently abused substance beginning in middle school?
ETOH (more common in boys; 2/3 of adolescents consume ETOH before graduation)
What LDL level in regard to pharmacologic therapy is DEPENDENT ON amount of risk factors present?
all patients @ > 130mg/dl
When conducting anticipatory guidance, what age do you instruct to consume milk 2-3x/day?
5-6 years old
What are the risk factors for CVD?
genetics, diet, and physical activity
What can you do to reduce the risk of acquiring preventable STDs?
administer preexposure vaccines (hep B, hep A, HPV)
What screening tools are used to evaluate for depression in adolescents?
CESD-R (screening test for depression and depressive disorder); CDI (a psychological assessment that rates the
severity of symptoms related to depression or dysthymic disorder in children and adolescents); Beck Depression Inventory
(21 question multiple choice self-report, measures severity of depression); RADS-2 (screening tool for adolescents with
depressive symptoms for individual practice settings or schools); PHQ-9 (9-question instrument given in primary care
setting to screen for the presence and severity of depression)
What is the MOST frequently abused substance beginning in middle school?
ETOH (more common in boys; 2/3 of adolescents consume ETOH before graduation)
A screening instrument used in primary care settings to question a patient regarding their substance use is called?
CAGE questionnaire (4 questions; employed after you’ve established patient is using – and want to inquire more about how they feel about using)
What screening tool used to evaluate for depression in adolescents is used for individual practice or schools?
RADS-2
What are some common medications associated with galactorrhea? SELECT ALL THAT APPLY! A: valproic acid B: amphetamines C: depakote D: atenolol E: hormonal contraceptives
A, B, D, E (see table 4-8 for full list, pp. 3 of SG)
Age 6: recognizes numbers, letters, words; learns to write (cause he’s now recognizing these things); beginning of concrete operations (INVOLVES MORE THAN 1 VARIABLE); order, number, classify (again due to ability to recognize numbers); magical thinking diminishes (CONCRETE THINKING); cause-effect is more understood à I relate to thinking as if he’s a little mathematician
Age 6 ½: mastered _____
6 1/2: length (think 6 ½” looks like a number that you’d see if you are using a ruler to measure something)
Depressive symptoms of lesser severity but persist over 1 year or more – this is considered?
dysrhythmic disorder
What is the primary cause of death in children, ages 12 and younger due to not wearing a seatbelt?
MVAs; instruct to ride in backseat; height requirements to transition from belt positioning booster to lap belt is
generally 4ft 9in between the ages of 8-12 years
Syphilis occurs predominantly in _______?
males who have sex with men
What is the purpose of utilizing the RADAR tool in practice?
The RADAR protocol summarizes key action steps the physicians should take in recognizing and treating patients
affected by IPV (steps include the following: (1) Routinely screen adult patients, (2) Ask direct questions,
(3) Document your findings, (4) Assess patient safety, and (5) Review options and referrals. The RADAR method has been
a very popular screening prompt that has been adopted nationally across numerous medical, community-based, mental
health, and legal organizations. Its goal is to reinforce care, support, and trust in the patient-provider relationship, ensure
appropriate follow-up care in subsequent patient visits, and refine ongoing physician education and expertise)
What should be conducted following the removal of the speculum?
conduct a bimanual examination
What are the risk factors for depression?
chronic medical illness, stress, pain; family hx; FEMALE; low income, self-esteem, support; prior depression; single/divorced/widow; TBI; YOUNGER AGE
T or F: depression in children increases with age with highest in adolescents
True
What age does rapid physical, emotional, cognitive, and social development end? A: 17-18 B: 18-19 C: 19-20 D: 18-21
D
New cases of primary/secondary syphilis are highest among which aged males?
15-19yr
When calculating non-HDL-C, a level >145mg/dl equates to what?
95th percentile and warrants follow-up
T or F: motivational learning is an appropriate tool to employ in all situations with the adolescent
False (not appropriate in medical / psychiatric instability)
11-14yr is classified as what stage of adolescence?
Early
What risk factors specific to adolescents increase their risk for contracting an STI?
smoking, ETOH use, dropping out of school, pregnancy, and depression
Health supervision visits: What tools can be used to elicit information regarding development?
formal parent-directed screening tools ASQ or PEDS is recommended (ASQ: (ages and stages questionnaire) –
family-friendly and creates the snapshot needed to catch delays and celebrate milestones; PEDS: a surveillance and
screening tool, for children 0 to 8 years; elicits and addresses parents’ concerns about development, behavior and mental
health)
Patient presents to the ED and appears euphoric, giddy, rhinorrhea, and hallucinating that quickly progresses to
respiratory depression. What substance do you suspect they’ve used?
Inhalants
What is the aim of primary prevention technique employed to prevent substance abuse – give an example?
prevents initiation of substance use; ex: DARE program
According to the USPSTF clinical guidelines, who does it recommend we screen for intimate partner violence?
women of childbearing age (GRADE B)
First measurable sign of puberty for girls?
height spurt
What age do you transition from addressing the concerns of the parent first to NOW including the adolescent?
11-12 (visit is conducted in two parts, one with adolescent and the other with parent present)
Bacterial vaginosis increases the risk for?
STDs
What risk factors are associated with vulvovaginal candidiasis?
antibiotic use, DM, pregnancy, HIV
T or F: Teenagers weight triples in adolescence
False; doubles [height increases by 15-20%; major organs double in size]
What is the MOST commonly used illicit drug used during middle or early HS?
marijuana
Early childhood is considered what age group?
5-7 y/o
When conducting anticipatory guidance, what age do you begin addressing the adolescents concerns only?
18 years old
Using CAGE questionnaire, what score would indicate highly suggestive of abuse?
2 or more
What should the FNP inspect 2nd during the exam?
prepare patient for insertion of the speculum
What is the MOST WIDELY used prescription drug by 12th graders?
Vicodin
What is the purpose of utilizing the HITS tool in practice?
HURT INSULT THREATEN SCREAM
Answer: screens for IPV (During the HITS assessment: a provider asks a patient the following: How often does your
partner physically Hurt you, Insult or talk down to you, Threaten you with harm, and Scream or curse at you? Each
category is graded on a scale of 1 (never) to 5 (frequently) and a sum of all the categories is generated. A total score of >
10 is suggestive of IPV)
The cause of primary (essential) HTN is?
idiopathic (most often genetics) ** high blood pressure that doesn’t have a known secondary cause**
When conducting anticipatory guidance, what age do you 1st discuss ETOH/drugs/vaping?
11 years old
What should the FNP inspect 1st during the exam?
external genitalia [note: SMR, estrogenization of the vaginal mucosa (moist, pink, and more elastic mucosa), shape of the hymen, size of the clitoris (2–5 mm wide is normal), unusual rashes or lesions on the vulva (folliculitis from shaving, warts or other skin lesions, and genital piercing or body art) [It can be helpful to ask an adolescent if she has any questions about her body during the inspection as she might have concerns that she was too shy to ask (normalcy of labial
hypertrophy)]
When conducting anticipatory guidance, what age do you discuss managing conflict non-violently?
11 years old, until 21 years old
In cases of alleged sexual abuse or assault, what should the FNP note during the exam?
presence of any lesions, lacerations, bruises, scarring, or synechiae about the hymen, vulva, or anus
A 4yr old patient presents to your clinic with a BMI-for-age of 96th percentile. What weight status category is this?
What would be included in your physical exam? What labs would you order?
obese; physical exam: BP, distribution of adiposity (central vs. generalized), markers of comorbidities and genetic syndromes (Prader Willi syndrome); CONSIDER labs in patient with family hx or heart disease risk factors: fasting lipid profile, fasting glucose and/or hgb A1C, ALT)
In late adolescence (ages >17years), what psychosocial development characteristics are present? SELECT ALL
THAT APPLY!
A: Less self-centered
B: Dating becomes intimate
C: Concrete thinking and plans for future
D: Period of idealism
A,B,D (Becomes less self-centered and cares for others. Dating becomes more intimate. By 10th grade, 40% have
had sex and by 12th grade, 62% have had sex. Abstract thinking and plan for the future. Period of idealism)
Regarding puberty in girls, what is the order in which each physical change begins?
A: menarche, height spurt, pubic hair, breasts
B: height spurt, pubic hair, menarche, breasts
C: pubic hair, height spurts, breasts, menarche
D: height spurt, menarche, breasts, pubic hair
D
What age does peak of puberty occur for girls?
11 ½-12
Regarding puberty in boys and girls, what is the sexual maturity rating (SMR) based on?
pubic hair growth
According to Hays, what age do you begin screening for substance abuse? What tool is used?
> 11 years and older; CRAFFT screening tool
DISCREPENCY between HAYS table 4.3 and BRIGHT
SCREENINGS INFO link- states start @ age 15 years old tobacco/alcohol/drug use
What tool employed in a questionnaire is good to obtain a psychosocial history on the adolescent patient?
HEADSS assessment
Consequences of obesity NOW – SELECT ALL THAT APPLY! A: elevated BP and normal lipids B: increased insulin resistance C: OSA D: heartburn E: depression
B, C, D, E (high BP, HLD, impaired glucose tolerance, insulin resistance, type 2 DM, breathing issues – OSA and
asthma – joint/muscle discomfort, fatty liver dx, gallstones, GERD, self-esteem issues à depression as an adulthood)
Which age group/gender is ESPECIALLY PRE-DISPOSED to chlamydia, gonorrhea, and HPV infection?
adolescent female
What are the two most important components to ensure IPV screening is done correctly?
ensure staff receives training about IPV and training should be offered regularly
What age do you begin screening for STDs with a pap smear?
begin @ 21 years for both sexually experienced/inexperienced women à screen for cervical cx w/cytology every 3 years (ages 21-65yr)
T or F: consequences of obesity LATER include obese adults that have CVD, HTN, DM, and some cancers.
True
What screening tool used to evaluate for depression in adolescents is used in the primary care setting?
PHQ-9
According to the AAP, what is the recommendation for depression screening age?
12 years and older
When conducting anticipatory guidance, what age do you 1st discuss SNAP programs?
18 years old
According to the USPSTF, what age is recommended that clinicians screen for obesity?
6yr and older (refer as appropriate for comprehensive, intensive behavioral intervention to promote improvement
in weight status)
The PHQ-2 differs from the PHQ-9 in what way?
PHQ-2 may rule out but not definitively diagnose depression whereas PHQ-9 is the most common instrument
used for depression screening; the PHQ-9 is administered to confirm a positive PHQ-2 result
T or F: the adolescent cannot request to have mother or family member present during exam
True (facilitates reassurance for adolescent; although most instances an adolescent will request that the
examination occur confidentially
When conducting anticipatory guidance, what age do you 1st discuss refraining from texting and driving?
15 years old
What are some common medications associated with gynecomastia? SELECT ALL THAT APPLY! A: cimetidine B: cocaine C: haldol D: lorazepam E: amiodarone
A, C, E (see table 4-9 for full list, pp. 3 of SG)
In early adolescence (ages 10-13 years), what psychosocial development characteristics are present? SELECT ALL THAT APPLY!
A: feels more comfortable with same sex
B: thinks abstractly and doesn’t think about future
C: realistic goals about future
D: rapid growth and secondary sex characteristics
A, D [rapid growth and secondary sex characteristics, feels more comfortable with same sex, thinks concretely
and doesn’t think about future, vague and unrealistic professional goals]
T or F: pubic hair correlates more closely with breast development than height spurt
False (height spurt correlates more closely with breast development than pubic hair)
What screening tool used to evaluate for depression in adolescents is specific to depression or dysthymic disorder?
CDI
First sign of puberty in boys?
scrotal / testicle growth
T or F: The use of pharmacologic screening (urine drug tests or drug blood panel) should be reserved for situations in which patients’ behavior and/or medical condition is of sufficient concern
True (AAP recommends doing so in the ED only, not routine screening; outweigh practical and ethical drawbacks
of testing)
What is the MOST COMMON breast mass found in adolescence?
Fibroadenoma (67%); (fibrocystic change 15%, abscess/mastitis 3%)
Vision screenings are conducted at which aged visits?
5, 6, 8, 10, 12, and 15 yr. visits
What are the key elements to an effective adolescent drug treatment program?
family involvement, developmentally appropriate, and comprehensive approach to treatment
(1) In regard to the universal screening recommendations per Hays, what ages should lipid panel be checked?
(2) What ages (with RISK FACTORS PRESENT) would you want to conduct a fasting lipid screening?
(1) 9-11 yr. = universal lipid screen with non-fasting non-HDL cholesterol or fasting lipid profile; (17?)18-21 yr =
measure a non-fasting non-HDL cholesterol or fasting lipid profile in all once
(2) 2-8yr and 12-16yr
T or F: predicting progression from use to abuse in adolescence is challenging
True
