Ch. 24: The Pediatric Examination
Well child visit
A visit to the medical office for the administration of immunizations and evaluation of growth and development.
The average heart rate and respirations between birth and 6 months of age is: A 130 bpm and 20-40/min B 140 bpm and 30-60/min C 110 bpm and 20-40/min D 100 bpm and 15-35/min
A) 130 bpm and 20-40/min
The deltoid site is located at A 2 fingers below the shoulder B Lower half of the arm C Upper outer buttocks D Middle third of the thigh
A) 2 fingers below the shoulder
Assessment of blood pressure should start at age A 3 years B 2 years C 8 years D 5 years
A) 3 years
The most important use of growth charts is to A Assess the child's individual growth pattern B to assess the pulse rate. C Identify children with prehypertension D Identify children with type 2 diabetes E All of the above
A) Assess the child's individual growth pattern
All of the following are problems associated with childhood obesity except A Asthma B High blood pressure C Skin disorders D Type 2 diabetes
A) Asthma
Which of the following is NOT included in a well-child visit? A Collection of a throat specimen B Evaluation of growth and development C Physical examination D Administration of immunizations
A) Collection of a throat specimen
Measuring pediatric blood pressure helps to identify children at risk for developing A Hypertension B Type 2 diabetes C Juvenile rheumatoid arthritis D Heart disease E All of the above
A) Hypertension
If PKU is left untreated, it can lead to A Mental retardation B Aplastic anemia C Spinal curvature D Malnutrition
A) Mental retardation
What immunizations are included in a DTaP injection? A Diphtheria, polio, tetanus B Diphtheria, pertussis, tetanus C Dysentery, pertussis, mumps D Diphtheria, rubella, rubber
B) Diphtheria, pertussis, tetanus
Which of the following is a primary component of well baby visits? A Diagnostic tests B Immunizations C Evaluation and management D Treatments
B) Immunizations
Which of the following is an important reason for weighing a child? A To anticipate the weight of the following siblings B To determine the proper dosage of medication for the child C To compare the child's weight with weights of other children of the same age D To determine if the child is deficient in vitamins and minerals E To assess the rate of brain growth
B) To determine the proper dosage of medication for the child
_______ 10. The blood specimen for a newborn screening test is obtained from the infant's earlobe.
False
________ 10. If phenylketonuria (PKU) is left untreated, it can lead to malnutrition.
False
________ 3. Length is measured with the child standing with his or her back to the measuring device.
False
________ 4. Measuring pediatric blood pressure helps to identify children at risk for type 1 diabetes.
False
________ 5. It is best not to tell a child that an immunization will hurt.
False
________ 6. The length of the needle used for a pediatric IM injection depends on the amount of medication being administered.
False
________ 7. An MMR injection includes the following immunizations: measles, meningitis, and rubella.
False
________ 9. Before administering a pediatric immunization, the National Childhood Vaccine Injury Act (NCVIA) requires that the parent sign a consent form.
False
________ 2. The first well-child visit is usually scheduled 4 weeks after birth of the infant.
False - (3-5 days)
________ 4. Blood pressure should be taken for a child starting at 8 years of age.
False - age 3
________ 7. The resistance of the body to pathogenic microorganisms or their toxins is known as inflammation.
False - immunity
35. Why can the PKU screening test be performed earlier on infants on formula compared with breast-fed babies?
Formula contains phenylalanine whereas "first breast milk" or colostrum does not.
16. What is the importance of measuring blood pressure in children?
Helps to identify children at risk for developing hypertension as adults.
b. 6-month-old infant:
HepB DTaP-3rd PCV13-1st IPV-3rd
a. 2-month-old infant:
HepB-2nd RV-1st DTaP-1st Hib-1st PCV13-1st IPV-1st
c. 12-month-old infant:
HepB-3rd PCV13-4th IPV-3rd IIV LAIV (IIV annual only)
24. Why is the vastus lateralis muscle recommended as a good site for giving an intramuscular injection to an infant or young child? How is this site located?
It is located on the anterior surface of the midlateral thigh, away from major nerves and blood vessels, and is large enough to accommodate the injected medication. To locate, divide the mid-anterior thigh into thirds, injection is administered into the middle third of the thigh.
What is the purpose of the well-child visit?
Physician progressively evaluates the growth and development of the child.
10. What is the purpose of measuring head circumference?
Screening measure for microencephaly and macroencephaly.
18. What occurs if the blood pressure cuff is too small or too large?
Small - too high Large - too low
21. Why should the child's genitalia be cleansed before applying a pediatric urine collector?
To prevent contaminants from entering the urine specimen.
________ 1. A pediatrician is a medical doctor who specializes in the diagnosis and treatment of disease in children.
True
________ 1. A well-child visit is also referred to as a health maintenance visit.
True
________ 2. A reason for weighing a child is to determine proper medication dosage.
True
________ 3. Growth charts can be used to identify children with growth abnormalities.
True
________ 5. Using a blood pressure cuff that is too large for the child can result in a falsely low reading.
True
________ 6. The vastus lateralis muscle site is recommended for administering an injection to an infant.
True
________ 8. A Vaccine Information Statement explains the benefits and risks of a vaccine in lay terminology.
True
________ 8. The recommended route of administration for an MMR vaccine is subcutaneous.
True
________ 9. The hepatitis B vaccine can be given to a newborn.
True
Procedures performed by MA during pediatric visits (Well check and Sick visit)
Vital signs Weight Visual acuity Assisting with physical examination
Toxoid
A toxin (poisonous substance produced by a bacterium) that has been treated by heat or chemicals to destroy its harmful properties. Administered to prevent infectious disease.
17. What criteria must be followed to determine the correct cuff size for a child?
Assess child's arm circumference; midpoint between acromion process (shoulder) and olecranon process (elbow) 80%-100%
What is the appropriate needle gauge used when administering pediatric immunizations? A 18-20 gauge B 22-25 gauge C 20-21 gauge D 21-22 gauge
B) 22-25 gauge
The first pediatric well-child visit is usually scheduled at A 4 months B 3 to 5 days C 1 month D 2 months
B) 3 to 5 days
Head circumference is measured in A Millimeters B Centimeters or inches C Grams D Microns
B) Centimeters or inches
19. What three factors must be taken into consideration when determining if a child has hypertension?
-age -height -gender
7. List the two positions that can be used to safely carry an infant.
-cradle position -upright position
32. According to the NCVIA, what information must be recorded in the patient's medical record after a pediatric immunization has been administered?
-date of administration of the vaccine -manufacturer and lot number of vaccine -signature and title of health care provider who administered the vaccine -name and address of medical office
14. List five guidelines for preventing childhood obesity.
-encourage active play -do not use food for reward, comfort, or bribes -limit television, video, and computer time -do not make the child eat when they are not hungry -do not frequently eat at fast-food restaurants
9. Why is it important to measure the growth (weight and height or length) of a child during each office visit?
-evaluate the progress of a child -determine whether the growth is normal
1. What are the components of the well-child visit?
-history and physical exam -immunizations -anticipatory guidance to provide parents with info to prepare them for upcoming developmental events and promoting their child's well being
33. The newborn screening test screens for which metabolic diseases?
-phenylketonuria -biotinidase deficiency -congenital adrenal hyperplasia -maple sugar urine disease -congenital hypothyroidism -galactosemia -homocystinuria -sickle cell anemia
2. What topics are commonly included in anticipatory guidance?
-safety -nutrition -sleep -play -exercise -development -discipline
20. List three reasons for collecting a urine specimen from a child.
-screen for the presence of disease as part of a general physical examination -to assist in the diagnosis of a pathologic condition (UTI) -to evaluate the effectiveness of therapy
5. What procedures are often performed by the medical assistant during pediatric office visits?
-temp -pulse -respiration -blood pressure -measurement of weight and height -measurement of visual and hearing acuity -assisting with the physical examination
25. At what age can the deltoid site be used to administer an IM injection to a child? Explain the reason for this.
18 months old; deltoid is too small
22. What gauge and length (range) of needle are recommended for giving an intramuscular injection to a child?
22-25gauge and 5/8-1inch
What gauge and length(range) of needle are recommended for giving a pediatric subcutaneous injection
23-25guage and 1/2-5/8inch
15. According to the American Academy of Pediatrics, at what age and how often should blood pressure be measured in children?
3 years and older, measured annually
Typical schedule for well-child visits
3-5 days 1 month 2 months 4 months 6 months 9 months 15 months 18 months 24 months 30 months 3 years Yearly thereafter
3. What is the usual schedule for well-child visits?
3-5 days; 1 month; 2 month; 4 month; 6 month; 9 month; 12 month; 15 month; 18 month; 24 month; 30 month; 3 years; 4 years; and once a year thereafter
After administration of an immunization, the NCVIA requires that all of the following be documented in the medical record except the A Signature of the child's parent or guardian B Manufacturer and lot number of the vaccine C Name and address of the medical office D Date the VIS was given to the parent
A) Signature of the child's parent or guardian
Which of the following is required by the NCVIA before an immunization is administered? A The parent must be provided with information on the benefits and risks of the immunization B The child must be promised a sticker after the injection C The expiration date of the vaccine must be checked three times D The parent must sign a consent form
A) The parent must be provided with information on the benefits and risks of the immunization
What is the purpose of measuring head circumference? A To screen for microencepyhaly and macroencephaly B To determine if the fontanelles are closing properly C To determine if normal brain development is taking place D To assess the nutritional state of the infant
A) To screen for microencepyhaly and macroencephaly
What term is used for a suspension of attenuated or killed microorganisms that stimulate antibody production in an individual? A Vaccine B Antiserum C Antitoxin D Toxoid
A) Vaccine
a. An infant younger than 12 months of age:
Anterior thigh (vastus lateralis)
All of the following are reasons for obtaining a urine specimen from a pediatric patient except A To diagnose a pathologic condition B To prevent urinary tract infections C To evaluate the effectiveness of therapy D To screen for the presence of disease
B) To prevent urinary tract infections
Which location is usually used to administer an IM injection to a pediatric patient? A Ventrogluteal B Vastus lateralis C Gluteal D Deltoid
B) Vastus lateralis
30. What information must be provided to parents as required by the NCVIA?
Benefits and risks of childhood immunizations.
How is the vastus lateralis site located in an infant and young child? A Divide the buttocks into quadrants and administer the injection into the upper outer quadrant B Divide the lateral thigh into thirds and administer the injection into the upper third C Divide the mid-anterior thigh into thirds and administer the injection into the middle third D Divide the upper arm into thirds and administer the injection into the middle third
C) Divide the mid-anterior thigh into thirds and administer the injection into the middle third
Which of the following is a recommended vaccine for travelers? A MMR B HBV C HAV D DTaP
C) HAV
Which of the following is a blood-borne pathogen? A Tuberculosis B Influenza C Hepatitis C D Rubella
C) Hepatitis C
All of the following information is included in a VIS except A Publication date of the VIS B Reporting an adverse reaction C Lot number of the vaccine D Benefits and risks of the immunization
C) Lot number of the vaccine
What immunizations are included in an MMR injection? A Meningitis, mumps, rubella B Measles, mumps, chickenpox C Measles, mumps, rubella D Measles, hepatitis, rubella
C) Measles, mumps, rubella
Which of the following is the most appropriate action of the medical assistant when a patient is suspected of being a victim of child abuse? A Alert the parents' clergy of your suspicions B Ask the parents about it C Notify the local child protective agency D Leave it out of documentation
C) Notify the local child protective agency
Which of the following sites can be used to obtain a blood specimen for a newborn screening test? A Lateral surface of the finger B Earlobe C Plantar surface of the heel D Big toe
C) Plantar surface of the heel
The newborn screening test typically screens for the presence of all of the following diseases except A Congenital hypothyroidism B Sickle cell anemia C Pneumonia D Phenylketonuria
C) Pneumonia
For which of the following patient disorders is a medical assistant required to wear a mask while taking the patient's medical history? A AIDS B Food poisoning C Diphtheria D Rheumatic fever E Hepatitis C
C) Rheumatic fever
Which of the following indicates that the proper cuff size has been elected for a pediatric patient? A The cuff is positioned at least 1 inch above the bend in the elbow B The bladder is centered over the antecubital space C The bladder of the cuff encircles 80-100% of the child's arm D The cuff fits snugly on the child's arm
C) The bladder of the cuff encircles 80-100% of the child's arm
Why is it important to develop a rapport with a pediatric patient? A To prevent the child from crying B To prevent inaccurate test results C The child is more likely to be cooperative during procedures D To reduce the pain when administering injections
C) The child is more likely to be cooperative during procedures
How is length measured? A The child lies in a prone position B The child sits in a chair with both feet flat on the floor C The child lies in a supine position D The child stands with his or her back to the measuring device
C) The child lies in a supine position.
The length of the needle used to administer an intramuscular injection to a child depends on A The amount of medication being administered B The age of the child C The size of the child D Whether the child is walking
C) The size of the child
Which of the following injection sites should be used to administer IM injections to infants and young children? A Deltoid B Dorsogluteal C Vastus lateralis D Ventrogluteal
C) Vastus lateralis
What is the needle length range for a pediatric IM injection? A 1 inch to 2 inches B (1/2) inch to 1(1/2) inches C (3/8) inch to (5/8) inch D (5/8) inch to 1 inch
D) (5/8) inch to 1 inch
A blood pressure cuff that is too large for a child may result in A Not being able to hear the first clear tapping sound B A blood pressure reading that is falsely high C Too much pressure being applied to the brachial artery D A blood pressure reading that is falsely low
D) A blood pressure reading that is falsely low
What is the term for the process of becoming immune through the use of a vaccine or toxoid? A Passive natural immunization B Passive artificial immunization C Inflammation D Active artificial immunization
D) Active artificial immunization
What is the recommended site for administering a subcutaneous injection to an infant younger than 12 months of age? A Lower back B Lower abdomen C Lateral part of the upper arm D Anterior thigh
D) Anterior thigh
An Apgar score _____ requires immediate intervention and continued evaluation. A Higher than 80 B Below 40 C Higher than 8 D Below 4
D) Below 4
Which of the following immunizations can be administered to a newborn? A Polio B DTaP C MMR D Hepatitis B
D) Hepatitis B
The resistance of the body to pathogenic microorganisms or their toxins is known as A Immunization B Inflammation C Contagious D Immunity
D) Immunity
Apical pulse is the preferred method for determining heart rate in which of the following groups? A Adolescents B Older adults C Adults D Infants
D) Infants
The child's genitalia should be cleansed before applying a pediatric urine collector to A Prevent false-negative test results B Protect the child from infection C Prevent irritation of the patient's skin from the adhesive D Prevent contaminants from entering the urine specimen
D) Prevent contaminants from entering the urine specimen
All of the following are used in determining if a child has hypertension except A Gender B Age C Height D Pulse rate
D) Pulse rate
Which of the following is the name of the vaccine given for chicken pox? A HiB B DPT C HBV D Varicella E IPV
D) Varicella
d. 5-year-old child:
DTaP-5th IPV-4th LAIV OR IIV-annual MMR-2nd VAR-2nch
a. DTaP:
Diphtheria, tetanus, acellular pertussis
Is required in all states by law A Is required in all states by law B Best to perform the test between 1 and 7 days after birth C The specimen is placed on a special filter paper D Positive results require further testing E All of the above
E) All of the above
Which of the following is a guideline for preventing childhood obesity? A Encourage active play B Do not use food as a reward C Limit television, video, and computer time D Limit the amount of junk food in the home E All of the above
E) All of the above
Which of the following procedures is performed by the medical assistant during a pediatric office visit? A Measurement of vital signs B Measurement of weight and height C Measurement of visual acuity D Assisting with the physical examination E All of the above
E) All of the above
13. What problems are associated with childhood obesity?
Higher blood pressure.
11. What is the primary use of growth charts?
Identify children with growth or nutrition abnormalities.
31. What information is included in a VIS?
In lay terminology, the benefits and risks of a vaccine, information about reporting an adverse reaction, how to get more information about childhood diseases and vaccines.
12. What is the primary cause of childhood obesity?
Kidney disease and to a lesser degree by heart disease.
b. A child that is 12 months of age or older:
Lateral part of the arm (deltoid)
9. What is the difference between height and length?
Length: measure in recumbent position (less than 24 months) Height: measure in standing position(older than 24 months)
23. Why is the dorsogluteal site not recommended for use as an intramuscular injection site in infants and young children?
May come dangerously close to the sciatic nerve. Serious trauma can result from incorrect administration of an injection in this area bc it's not well developed before they start walking.
b. MMR:
Measles, mumps, rubella
34. What are the symptoms of PKU if left untreated?
Mental retardation and other abnormalities such as tremors and poor muscle coordination.
Vaccine
Suspension of attenuated (weakened) or killed microorganisms. Administered to prevent infectious disease.
Sick-child visit
The child is exhibiting the signs and symptoms of disease, and the physician evaluates the patient's condition to arrive at a diagnosis and to prescribe treatment.
4. What is the purpose of the sick-child visit?
The child is exhibiting the signs and symptoms of disease, the physician evaluates the patient's condition to arrive at a diagnosis and to prescribe treatment.
6. Why is it important for the medical assistant to develop a rapport with the pediatric patient?
The child is more likely to cooperate during examination or procedure.