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NURS 629 exam 2 verified solutions|2024, Exams of Project Management

Durham UniversityProject Management

NURS 629 exam 2 verified solutions|2024

Typology: Exams

2023/2024

Available from 03/20/2024

johnNice
johnNice 🇺🇸

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NURS 629 exam 2
P a g e 1 | 18
1. Weight changes
in 1st year of life
2. When does
the posterior
fontanelle close?
Anterior?
3. when do the ab-
dominal muscles
close?
4. When are the tes-
ticles descend-
ed?
5. what do you as-
sess for with
infants muscu-
loskeletal sys-
tem?
6. Ortolani maneu-
ver
7. Barlow maneu-
ver
Weight increases 6-8lbs, up to 20lbs in the 1st year of life
posterior- 2 months,
anterior- 9-18 mo
3 years
usually descended at birth, but spontaneous descent may
occur in the first year after birth. (usually 6 months)
leg fold symmetry
hib abduction- no clicks
check hips for congenital dislocation, done until 1 yr old,
should be smooth with no sounds
, abnormal= feels like a clunk as head of femur pops back
into place- positive ortolani sign
place your index and middle finger over the greater
tronchanter. Gently push both knees together at midline
downwards.
Positive:"Clunk" sounds or palpating trochangter being
displaced by the index/middle finger
8. Infantile eczema atopic dermatitis is an inflammation of genetically hyper-
sensitive skin
- local vasodilation in affected areas
spongiosis or breakdown of dermal cells and formation of
intradermal vesicles
- rarely seen in breastfed infants until they begin to eat
additional food
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pf9
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pf12

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NURS 629 exam 2 P a g e 1 | 18

1. Weight changes **in 1st year of life

  1. When does** the posterior fontanelle close? **Anterior?
  2. when do the ab-** dominal muscles **close?
  3. When are the tes-** ticles descend- **ed?
  4. what do you as-** sess for with infants muscu- loskeletal sys- **tem?
  5. Ortolani maneu-** **ver
  6. Barlow maneu-** ver Weight increases 6 - 8lbs, up to 20lbs in the 1st year of life posterior- 2 months, anterior- 9 - 18 mo 3 years usually descended at birth, but spontaneous descent may occur in the first year after birth. (usually 6 months) leg fold symmetry hib abduction- no clicks check hips for congenital dislocation, done until 1 yr old, should be smooth with no sounds , abnormal= feels like a clunk as head of femur pops back into place- positive ortolani sign place your index and middle finger over the greater tronchanter. Gently push both knees together at midline downwards. Positive:"Clunk" sounds or palpating trochangter being displaced by the index/middle finger
  7. Infantile eczema atopic dermatitis is an inflammation of genetically hyper- sensitive skin
    • local vasodilation in affected areas spongiosis or breakdown of dermal cells and formation of intradermal vesicles
    • rarely seen in breastfed infants until they begin to eat additional food

NURS 629 exam 2 P a g e 2 | 18

9. why is acid re- flux common in **infants?

  1. When does colic** **usually resolve?
  2. Toddler weight** **gain per year
  3. In toddler always** **assess for?
  4. what age do you** screen for hear- **ing and vision?
  5. School age chil-** dren grow more **steadily?
  6. In adolescence** when does pu- berty begin in **girls?
  7. when does pu-** berty begin in boys?
    • it is a symptom rather than a disorder
    • infant is oversensitive to certain substances Worse in winter their sphincters are not mature, break up feedings ~15mL, burp, then return. by 6 months 4 - 6lbs per year, grow 3 inches pe ryear anterior fontanel (should be closed by 18 m- 2 yrs. screen for strabismus tooth eruption- if no teeth by 18 mo= xray assess for hip dysplasia, gait, bowlegged
    • DTRs
    • Babinski + (dorsiflex) normal in infant less than 24 mo at 3 years 2 in/year 4 - 6lbs/ year 9 - 13 years 11 - 14 years
  8. breast enlargement 8-13 yr axillary hair 11 - 13 yrs

NURS 629 exam 2

  1. Red flags at 9 Cannot sit without support, not indicating wants (Niner months needs recliner, but doesn't want it) if infantile reflexes remain strong. does not bable does not bear weight on legs
  2. 2 year red flags Unable to speak meaningful two-word "sentences." Does not understand simple commands. Loss of speech, social skills, previously learned behaviors and/or does not say words by 16 months (autism).
  3. 1 year red flag Unable to support own weight. Lack of babbling. No re- sponse to smiles, poor eye contact, loss of previously learned skills (autism).
  4. 3 yr red flags Speech hard to understand or unclear speech. Unable to understand simple commands. Fall down often. Does not speak in sentences. No eye contact. Losses skills he or she once had.
  5. 4 yr red flags Unable to speak in full sentences. Inability to skip, run, hop. Cannot put on clothes without help. Unable to play with other kids. Unable to follow three-part commands.
  6. 5 yr red flags Unusually withdrawn. Not active. Trouble focusing on one activity for more than 5 minutes.
  7. 2 year normal ac- Walks. Runs. Climbs stair up and down on own by hold- tivities ing onto handrails. Speech mostly understood by family. Follows two or three step instructions. Copies a line.
  8. PMH to address Look at PMH, meds and supplements, steroid use, pre- in sports physi- vious injuries, immunization status, weight concerns, al- cal lergies, concussions, dizziness or fainting with physical exertion, family history related to sudden death, cardiac death, death with activity, and history of asthma, con- tacts or dental appliances that may require accommoda- tions, mental health, sexual status, menstruation, alco- hol/smoking/drug use

NURS 629 exam 2

  1. sports physical Chest pain, shortness of breath, feeling dizzy lighthead- cardiac ques- ed or faint after physical activity tions Cardiac anomalies, murmurs, high blood pressure, irreg- ular heart rate
    • family cardiac history
    • displaced PMI with different positioning
    • changes in heart sounds with supine, standing and valsalva
    • asymmetric pulses
  2. contraindica- ÏChest pains while exercising, congenital cardiac anom- tions for alies, hypertrophic cardiomyopathy, new murmurs, hyper- clearance from tension sports physical? Ï Family hx. Of sudden death under 50 or while playing sports, exertional syncope, symptoms of Marfan syn- drome Ï Marfan syndrome (2 or more of the following needs further evaluation: arm span longer than height, girls taller than 5.10 and boys taller than 6.0, kyphoscoliosis, pectus excavatum, myopia)
  3. who needs refer- ÏHistory of or current cardiac anomalies ral for f/u before Ï Family cardiac history (cardiomyopathies, prolonged clearance from QT, Marfan syndrome, significant dysrhythmias, cardiac sports physical? death in 1st or 2nd degree relative before age 40, con- nective tissue disorders) Ï History of or current concussions Ï History of or current injuries Ï Hernia Ï Hypertension Ï Murmur Ï Irregular heart rate or rhythm Ï Deformity, asymmetry, instability Ï Poor visual acuity Ï Liver or spleen enlargement Ï Hernia Ï Contagious skin conditions

42. what information is included in history of 2 year **old?

  1. what is the** HEADSS As- **sessment
  2. what do you look** at for ROS in 6- 9 months?
    • Feeling foggy or groggy
    • Concentration or memory problems
    • Confusion Include birth history in documentation of history of chil- dren until age 2, then when relevant after age 2 Ï Prenatal and birth history Ï Complications Feeding history- Breast, bottle, solids Developmental history- Developmental delays or parent concerns/ Milestones Psychosocial history- Sleep habits, behaviors, Social history- Where they live, other ppl in the home Environmental risks- Smoking, lead exposure Immunization history ÏH - home Ï E- education Ï A- activities Ï D- drugs Ï S- sexuality Ï S- suicide and depression Ï Drug and alcohol use ÏTemperament Ï Nasal symptoms Ï Cough Ï Vomiting or spitting up Ï Frequency & consistency of stools Ï Number of wet diapers Ï Use of extremities - equal? Ï Rashes Ï Immunizations
  3. ROS in toddlers? ÏTemperament Ï Frequency & consistency of stools Ï Number of wet diapers Ï Immunizations Ï Lead exposure

Ï Nutrition Ï Sleeping and eating patterns

  1. at what age do 2 years you stop mea- suring head cir- cumference?
  2. at what age is a 3 yrs BP check start- ed?
  3. well child Blood pressure, height, weight, BMI, ocular motility, red screenings reflex, pupil reaction, visual acuity, gums and teeth, café o le spots, bruising, birthmarks, nevi
  4. 2 month old vac- Heb B cines? DTaP IPV PCV RV
  5. 4 month old vac- DTaP cines Hib IPV PCV RV
  6. 6 months vac- Hep B cines DTaP Hib PCV Flu vaccine (yearly beginning at age 6 months)
  7. Anticipatory sleep on back with no stuffed animals, only small blankets Guidance: Sleeping
  8. anticipatory • Injury and Illness Prevention guidance for o Hot water thermostat less than 120 degrees
  • Play in side lying
  • Gets to sitting independently
  • Sits with wide base independently
  • Beginning reaching from sitting
  • Stands with support; takes stiff step or two with full support; bounces in standing no head lag
  1. 9 month fine mo- Has a crude pincer grasp tor skill Dominant hand preference evident able to point and pick up small objects. feeds self with finger
  2. fine motor skills • Grasps objects with both hands 6 months • Transfers objects from hand to hand
  • Shakes, bangs and drops objects
  1. gross motor • Sits independently skills 9 months • Crawling or creeping
  • May pull to stand Red Flags
  • Persistent standing on tip toes
  • Scissors motion of lower extremities
  • Persistence of primitive reflexes
  1. anticipatory • Social determinants of health: living situation, environ- guidance for ment, family support, WIC new born? • Parent and family health and well-being: maternal health and nutrition, transition home, sibling relationship, accept help, spend time with other children
  • Newborn behavior and care: infant capabilities, baby care, illness prevention, calming your baby
  • Nutrition and feeding: general guidance, 8 - 12 feedings for BF in 24hrs, at least 8 time if formula fed.
  1. anticipatory • Social determinants of health: same guidance first • Parent and family health and well-being: ask for help, week? rest and sleep when baby sleeps, spend time with other children
  • Newborn behavior and care: early brain development,

adjustment to home, calming, when to call MD, illness prevention, sing/read/talk to baby, avoid TV/Digital me- dia, help baby wake for feedings/diaper changes/undress- ing, calm baby by stoking head or gentle rocking, never hit/shake baby, take temp rectally, not by ear or skin, wash hands, avoid sun

  • Nutrition and feeding: same, should have 5 - 6 disposable wet diapers a day, 3 - 4 stools
  • Breast feeding every 1 - 3hrs daytime, 3 hours nighttime for 8 - 12 feedings
  • Formula feed 2 oz. every 2 - 3 hours
  • Safety: car seat safety, heat stroke prevention, safe sleep, rear facing car seat
  1. anticipatory • Social determinants: risks, environment, mold, no tobac- guidance 1 co use month • Parent and family health and well-being: postpartum checkup, maternal depression, family relationship
  • Infant behavior and development: sleeping, waking, fussiness, playtime, consider pacifier, no TV, do tummy time, calm baby by rocking or stoking head
  • Nutrition and feeding: same as 1st week
  • Safety: same
  1. anticipatory • Social determinants of health: risks, community agency, guidance 2 WIC, take time to self month • Post-partum checks, depression, anxiety
  • Infant behavior and development: hold, cuddle, talk, sing to, learn baby's temperament, pay attention to sleeping cues, feeding cues, tummy time, avoid TV
  • Nutrition and feeding: general guidance, first 6 months of life BF exclusively for ideal nutrition, same stool and wet diaper amounts
  • Safety: care seat safety, sleep safety, home environment: burns, drowning, falls
  1. anticipatory • Social determinants of health: reduce lead exposure, guidance 4 maintain social contacts, make time for self, make quality months child care arrangements
  1. anticipatory guidance 2 years meals and 2 - 3 snacks a day, encourage use of cup, continue breastfeeding if desired
    • Rear facing car seat until at least 2 years old
    • Never overheat baby
    • Do home safety checks: stair gates, barrier around space heaters, cleaning products, medications, electric cords
    • Help child express feelings like joy, anger, sadness, frustration
    • Encourage self-expression
    • Encourage free play for up to 60 min per day
    • Make time for learning through books, reading, talking, singing, exploring environment, limit TV
    • Model appropriate language, should follow simple 1 or 2 step commands
    • Begin potty training when ready, plan for frequent toilet breaks, teach to wash hands
    • Bike helmet, remove fire arms from home
  2. anticipatory • Anticipate anxiety/clinging in new situations guidance 18 • Spent time with child each day months • Be consistent with discipline
    • Wait until child is ready for toilet training, dry for about 2 - hour periods, read potty training books
    • Promote reading, physical activity, and safe play
    • Offer variety of healthy foods/snacks
    • 1 bigger meal, multiple small meals/snacks
    • 16 - 24 oz. of milk
  3. anticipatory • Use simple words and reading together, listen when guidance 2 1/2 child speaks yrs? • Encourage play with other children
    • Build independence by offering 2 acceptable options
    • Consider group child care, preschool programs, orga- nized playdates, encourage toilet training
  4. Healthy Weight/ • Underweight: less than 5th percentile BMI in children • Normal weight: 5th to 84th percentile
    • Overweight: 85th to 94th percentile
  • Obese: 95th to 99th percentile
  • Morbid (severe) obesity: greater than 99th percentile
  1. sleep in 3- 4 • By 3 - 4 months, should be sleeping through the night, month old taking several naps, and sleeping 15 hours per day
  2. feeding and nu- • Solids at 6 months, begin with rice cereal trition for in- • Introduce one food at a time fants? • Limit juice to 2 - 4 oz. per day, dilute
  • Avoid peanuts, hotdogs, raisins, grapes, popcorn, large chopped pieces of fruit and veggies to prevent choking
  • No cow's milk until 12 months
  1. 5 leading causes ËCongenital malformations: prevented with early prenatal of infant death? care, vitamin supplementation and folic acid, B12, iron Ë Low-birth weight complications: manage preexisting con- ditions, prenatal care, proper nutrition Ë SIDS: back to sleep Ë Complications from pregnancy: prenatal care and testing Ë Newborns with birth complications
  2. 5 leading causes ÏBike injury of death in child- Ï MVA hood? Ï Playground accidents Ï Poisoning Ï Obesity
  3. leading causes ÏUnintentional injuries, including motor vehicle accidents, of death in ado- more than half related to drug or alcohol use lescents? Ï Unwanted pregnancy, sexually transmitted disease (STD), eating disorders, and mood disorders
  4. Erickson stage 0 Trust Vs. Mistrust: to get, to give in return - 12 months
  5. Erickson stage autonomy- shave: to hold on, to let go 12 - 18 months & 18 - 36 months
  6. initiative vs guilt- to make things, to play

cording to similarity, and past-present-future but focused on present and concrete rather than abstract.

  1. Piaget Con- 7 - 11 years-Children are able to see things from different crete Opera- points of view and to imagine events that occur outside tional Stage their own lives. Some organized, logical thought process- es are now evident and are able to order object by size, color gradient, etc. can understand that if 3+4=7 then 7 - 4=3. Understand that red square can belong to both red and square categories. Understand short wide cup holds same amount as tall and skinny cup. Thinking still tends to be tied to concrete reality
  2. Piaget For- 11+ - around the onset of puberty, children are able to rea- mal Operational son in much more abstract ways and to test hypotheses Stage using systematic logic. There is a much greater focus on possibilities and on ideological issues
  3. How to calculate ËWeight based in grams pediatric med- Ë mg/kg ications? Ë Dose on hand X quantity in mL = volume to be adminis- tered Ë Convert weight in lbs. to kg by dividing by 2.2. Round to the tenths place.
  4. 1 tsp =? mL 5 mL
  5. 1 tbsp=? mL 15 mL
  6. 1 oz=? mL 30 mL
  7. 16 oz=? lb 1 lb
  8. 2.2 lbs=? kg 1 kg
  9. When can you after 6 months start giving ibuprofen?
  10. 1 year

No honey before ?

  1. when can you give ASA? ask a doctor if under 2 - 3 years of under 24 - 35 lbs
  2. When can you give benadry?

    18 months

  3. what are the MMR and Varicella 12 month immu- **nizations?
  4. what immuniza-** tions are given at **4 - 6 yrs?
  5. What vaccines** are given at **11 - 12/
  6. HPV is given** **when?
  7. physical exam** findings that indicate neu- roimaging s/p **concussion?
  8. concussion fac-** tors associated with poor prog- nosis? : DTaP, IPV, MMR, VAR, Hep A Tdap and meningitis in 3 doses after age 14. 2 doses if given before age 14 (start at 11) Age < 2 years old
    • Recurrent vomiting
    • Loss of consciousness
    • Severe mechanism of injury
    • Severe or worsening headache
    • Amnesia
    • Non-frontal scalp hematoma
    • Glasgow Coma Score < 15
    • Clinical suspicion for skull fracture Older age (older children/adolescents) or Hispanic ethnicity
    • Lower socio-economic status
    • History of intracranial injury
    • Premorbid histories of mTBI or increased pre-injury symptoms