Chapter 35 review pediatrics
Skeletal growth in girls is completed between 15 and 16 years of age and in boys between ages 17 and 18.
A. True
Strep throat may result in damage to the heart valves if not treated properly with antibiotics.
A. True
The CDC recommends annual flu vaccinations for all healthy children from age 6 months up to the 19th birthday and for their caregivers as well.
A. True
The goals of treatment for cystic fibrosis are to prevent bronchial obstruction and to treat malabsorption of nutrients.
A. True
The symptoms associated with an asthma attack are caused both by bronchospasms and by inflammation of the bronchioles.
A. True
One of the most serious health problems associated with cystic fibrosis is the formation of thick mucus in the bronchioles, which may lead to pulmonary obstruction.
A. True
A child's head circumference should be measured to the closest _______ inch.
1/4
Studies have shown that a child who is obese between the ages of ___________ has an 80% chance of becoming an obese adult.
10 and 13
Pregnant women infected with parvovirus B19 have an increased risk of miscarriage, and the fetus may suffer from severe anemia.
A. True
A varicella infection in pregnant women may cause stillbirth or birth defects.
A. True
All states screen newborns for cystic fibrosis using either a genetic or blood test.
A. True
Children who are allergic to eggs cannot be vaccinated against chickenpox.
A. True
Cystic fibrosis life expectancy is 35 to 40 years with no cure for the disease.
A. True
Immunization with Varivax may prevent the development of shingles in the future.
A. True
Failure to thrive may be diagnosed if
A. the child has cystic fibrosis. B. a problem exists with the parent-child relationship. C. the child is below the 3rd percentile for weight. D. All of the above
Denver II developmental screening tests should be given when?
A.Age 3 to 4 months B.Age 10 months C.Age 3 years D.All of the above
What is the leading cause of death and injury in adolescents?
Accidents
___________ is the medical term for a congenital malformation that occurs during fetal development.
Anomaly
Which common medication is not recommended for children, because it has been linked to a sometimes fatal disease?
Aspirin
Which of the following immunizations is administered IM?
B. Hep B D. Pneumococcal Both B and D
A rescue inhaler is used to treat the inflammation that occurs during an asthma episode.
B. False
Children with hand-foot-and-mouth disease can be allowed back to day care if the sores are present only in the mouth.
B. False
Infants with a low-grade fever should not receive any immunizations until their temperature is normal.
B. False
Infants with diarrhea should be weighed with the diaper on to prevent transmission of potentially infectious material.
B. False
Meningitis is spread by means of contaminated food and water.
B. False
The most common complication of infection with coxsackievirus is dehydration caused by vomiting and diarrhea.
B. False
Viral meningitis is treated with hospitalization and IV antiviral medications.
B. False
Which of the following measurements are not included in most pediatric examinations?
Blood pressure
What is the best method of preventing Reye's syndrome?
Children with viral infections should not be given aspirin products.
Tetanus is part of which immunization?
DPT
In which illness or condition are dehydration and subsequent electrolyte imbalance of particular concern when the disorder occurs in children?
Diarrhea
___________ is diagnosed when a child has two or more watery or apparently abnormal stools within 24 hours.
Diarrhea
49. Which of the following inherited disorders is an X-linked genetic disease that causes progressive muscle degeneration and usually develops between 3 and 5 years of age?
Duchenne's muscular dystrophy
Which of the following vaccine responses should be reported to the physician immediately?
E. All of the above A. High fever B. Swelling at the site of injection C. Urticaria and breathing difficulties D. Severe headache or convulsions
Which of the following infectious diseases is caused by parvovirus B19 with outbreaks most common in the winter and spring?
Fifth disease
During which period in a child's life is weight gain the fastest in proportion to the child's total weight
First 6 months
_______________ is the medical term for the spaces covered by thick membranes between the sutures of an infant's skull.
Fontanelles
Which human characteristic is not measured by the Denver II Developmental Screening Test?
Intelligence
Which statement is true about croup?
It is caused by edema and spasm of the vocal cords.
Which of the following theories discusses the preoperational stage that is characterized by language development?
Jean Piaget's developmental theory
What method of evaluation is used to detect microcephaly?
Measurement of the head circumference
Which statement is true about bacterial meningitis?
One type can be prevented by the Hib vaccine
Myringotomy may be required when a child suffers from chronic
Otitis media
Which of the following is commonly recommended for children with pediatric diarrhea and/or dehydration?
Pedialyte or Infalyte in small amounts
The common cold is caused by
a virus
Indicators of dehydration in children do not include which of the following?
Severe abdominal cramps
Which condition, if left untreated, can lead to heart and kidney disease?
Strep throat
A sore throat is commonly caused by
Streptococcus
Which child should be seen in the office today?
The child who has had more than six stools in the past 36 hours
The developmental theories of Sigmund Freud include which of the following principles?
The id, ego, and superego
Which of the following is a helpful approach to adolescent patients?
The medical assistant should recognize the importance of personal appearance to adolescents.
Treatment recommendations for children with otitis media include which of the following?
The prescription of antibiotics should be delayed for 48 to 72 hours.
Adolescents at the postconventional level display what behaviors?
They are learning to consider the greatest good for the greatest number when making decisions.
Which of the following infectious diseases is so contagious in its early stages that an exposed person who is not immune to the virus has a 70% to 80% chance of contracting the disease?
Varicella
A partial airway obstruction from a buildup of secretions that sounds like continuous dry rattling is called ____________.
rhonchi
A buildup of fluid in the middle ear is called ___________ otitis media.
serous
Another name for chickenpox is
varicella
Which of the following medications is used to cure influenza?
A. Antibiotics B.Antiviral meds C. Flu vaccine D. None of the above
When is skeletal growth in girls complete?
A. Between ages 15 and 16 C. When the growth plates of the long bones of the extremities have fused completely D. Both A and C
Cystic fibrosis is caused by
an altered gene carried by both parents.
The first dose of MMR vaccine should be administered at what age?
12 months
The varicella vaccine usually is administered to children in which age group
12 to 18 months
Routine head circumference measurement is recommended for children until age
3 years
Which statement is true about children with bronchiolitis?
A. Parental cigarette smoking may contribute to the problem. C. The symptoms are similar to those of asthma. E. Both A and C are true.
A child diagnosed with conjunctivitis can return to school after 24 hours of antibiotic treatment.
A. True
Adolescents stop growing when the epiphyseal plates of the long bones are no longer active.
A. True
Bacterial meningitis is much more serious than viral meningitis.
A. True
Children are considered overweight if the BMI for age is between the 85th and 94th percentiles; they are considered obese if the BMI is at or greater than the 95th percentile.
A. True
Children have reached approximately one-half their adult height by 2 years of age.
A. True
In pediatric patients, the normal range for the pulse rate increases as age decreases.
A. True
Newborns typically are given the first dose of HBV vaccine before they are discharged home.
A. True
One way to stop the harsh cough of croup is to take the toddler into an area with cool air.
A. True
Overweight and obese children may have sleep apnea.
A. True
Repeated episodes of otitis media may be due to childhood allergies.
A. True
Rescue inhalers are used for short-term prevention of bronchospasms in children.
A. True
Strep infections that are left untreated can lead to
A. scarlet or rheumatic fever. B.infections of the skin, bloodstream, or ears. C. pneumonia. D. All of the above
Possible signs that an adolescent may be considering suicide include
A. sexual promiscuity. C. giving away prized objects. Both A and C
Growth and development in children is determined by which of the following factors?
A.Nutritional status B. Parental and/or caregiver factors C. Presence of disease D. Environmental factors E. All of the above Correct
During which phase of growth does a child gain almost half of his or her adult weight, and the skeleton and organs double in size?
Adolescent period (12 to 18 years)
Medications that may be prescribed for children who have asthma symptoms two or more times a week include which of the following?
Advair Diskus
A newborn's respiratory rate should be around 20 breaths per minute.
B. False
Children with asthma have a productive cough accompanied by an inspiratory wheeze and shortness of breath.
B. False
Children with asthma typically have a productive cough with rales.
B. False
Children with croup should be prescribed antibiotics to prevent the spread of the infection.
B. False
Colic can be a long-term GI disorder that persists through the toddler years.
B. False
Current pediatric growth charts can be downloaded from the FDA's website.
B. False
Duchenne's muscular dystrophy is an inherited disorder passed from father to son.
B. False
Fifth disease is caused by coxsackievirus and results in ulcer formation in the mouth and throat.
B. False
If a child has severe diarrhea, the parents should stop feeding the child to protect the GI tract from damage.
B. False
If diarrhea continues for longer than 4 days, medical intervention is needed to prevent serious complications.
B. False
Infants are expected to triple their birth weight within 6 months.
B. False
Piaget's sensorimotor stage is the stage in which children use logical thinking to start considering people other than themselves.
B. False
The DTaP vaccine provides immunity against diphtheria, tetanus, and polio.
B. False
The flu vaccine is recommended for any child age 3 months or older.
B. False
The medical assistant is not responsible for reporting child abuse to appropriate authorities.
B. False
Which of the following is a viral inflammation of the larynx and the trachea that causes edema and spasm of the vocal cords?
Croup
__________ is a viral inflammation of the larynx and the trachea just beneath it that causes edema and spasm of the vocal cords.
Croup
________________ is an inherited disorder, and both parents must be carriers.
Cystic fibrosis
A child with a serious respiratory reaction to disease may make a shrill, harsh sound during inhalation with difficulty breathing; this is called ____________.
Stridor
A 2-month-old infant is scheduled for immunizations. Which ones should the child receive and how should they be administered? The baby's father asks whether the vaccines will make his daughter sick. What can you tell him about the typical side effects of these vaccinations?
The normal schedule for age 2 months is: second dose of Hep B (IM), DtaP (IM), Hib (IM), IPV (SC or IM), ICV (IM or SC). Side effects include mild fever, irritability, drowsiness, and pain at the injection site, but symptoms are usually mild. The physician should be called if any symptoms appear serious.
You have learned a great deal in this chapter about how to interact therapeutically with children of all ages. Summarize the therapeutic approaches for infants, school-age children, and adolescent patients.
Therapeutic Approaches for Infants (0-12 months) Crying is normal; use distraction, but do not overstimulate. Keep the infant close to the caregiver; either have a parent hold the infant or keep the parent in the child's line of vision. Involve the parent as much as possible, depending on the task and the parent's level of comfort. Place a familiar object near the infant and keep frightening ones out of view. An infant's negative response to strangers usually develops at approximately 8 months; do not take rejection personally. Do not restrain the infant any more than necessary but be ready to use restraint at times to keep the infant safe (e.g., when administering injections). Encourage the caregiver to cuddle and hug the child after a procedure is finished. Unpleasant procedures will be associated with other objects, so do not use play areas for treatment and do not use a favorite toy or object during the procedure; offer it afterward for comfort. Therapeutic Approaches for School-Age Children (7-10 years) Allow choices when possible (e.g., which arm should be used for an injection). Make sure a parent is always present during examinations. Remove only as much clothing as needed for the examination or procedure. Explain the procedures in concrete terms; use pictures and diagrams when possible. Give the child time to ask questions. Explain what you need the child to do; children in this age group are often curious and cooperative if they know what is expected of them. Address the conversation to the child and involve him or her in the decision making as much as possible. Provide privacy. Therapeutic Approaches for Adolescents (12-18 years) The adolescent is self-conscious and strongly influenced by peers. Privacy is very important. Explain how a procedure might affect appearance. Do not be judgmental; listen without condemning. Encourage the teen to verbalize concerns and fears. Adolescents may regress to more childish behaviors when sick. Teens want to be treated as adults; they want to know what is being done and why. Encourage the teen to see the physician without the parent present.
Describe how to manage the following patient scenarios. a. A crying 8-month-old being seen today for possible otitis media b. A 4-year-old who requires vision screening c. An 8-year-old who needs a booster shot d. A 16-year-old female patient who is scheduled for her first Gardasil injection
a. Use distraction, involve the parents, ask an older sibling for help, allow a parent to hold the child. b. Explain the procedure in terms the child can understand; use praise to gain compliance; allow the child to handle the equipment. c. Offer a choice of shot locations; have a parent present to provide support; explain the procedure in concrete terms, talking directly to the child. d. Provide privacy, without the parents, if that is what the teenager wants; explain the purpose of the vaccine and the procedure for administering it; ask the patient if she has any questions.
Cystic fibrosis is diagnosed with a sweat test, which reveals
an elevated chlorine level.
Updated clinical guidelines for the diagnosis and management of otitis include all of the following except
antibiotics should provide immediate relief from symptoms.
Vaccines are _____________ so they trigger an immune response but do not cause the disease.
attenuated
The classic definition of __________ is a condition in which an infant between 2 weeks and 4 months of age has crying episodes that occur at least three times a week, last longer than 3 hours a day, and persist for at least 3 weeks.
colic
The medical term for pinkeye is _______________.
conjunctivitis
Children with cystic fibrosis develop steatorrhea because
lipase is absent from the pancreas.
The Hib vaccine prevents _____________.
meningitis
An infant with a small head circumference for size and age may be diagnosed with _______________.
microcephaly
Colic in infants is most often characterized by
mild abdominal distress and crying
By age 3, the child's vocabulary consists of
more than 2,000 words.
A middle ear infection is called
otitis media
You are responsible for making sure parents receive VIS forms when children are scheduled for immunizations. Summarize the guidelines for the use of these forms, including documentation procedures for the administration of vaccines.
• Before administering the vaccine, give the parents the most current VIS available for that particular vaccine. Allow them enough time to review the material and answer any questions they may have or refer concerns to the physician before administering the vaccine. • Document in the child's medical record the date the VIS was given and the publication date of the VIS (which appears on the bottom of the VIS). • To make sure the office has the most current VIS forms, either call the state health department or refer to the CDC site at www.cdc.gov/nip/publications/VIS/default.htm. • Informed consent must be signed and attached to the child's health record before immunizations are given. Documentation of immunization administration must include the date the vaccine was administered, the vaccine's manufacturer, the manufacturer's lot number, the type of vaccine, the exact site of administration if an injection was given, any reported or observed side effects, the name and title of the person administering the vaccine, and the address of the medical office where the vaccine was administered. • An official immunization booklet should be given to the parents and updated as needed to reflect the child's current immunization status.
Appropriately screening telephone calls can be a major challenge in a pediatric practice. Provide three questions for each of the following complaints that could provide important information about the condition of the child: • Pain • GI upset • Respiratory problems
• Onset, frequency, duration of pain? • On a scale of 1-10, how severe is the pain? • Where is the exact location? • Was there any accident involved (include details)? • Has the pain gotten worse over time? • Has the pain interfered with sleep? • Is there associated fever, vomiting, diarrhea, or rash? • Onset, duration, frequency of symptoms? Has the child been vomiting longer than 24 hours without improvement? • Is the child receiving clear liquids only? • Is the child dehydrated (dry mouth, no urination in 8-10 hours, listless)? • If the child has diarrhea, were there more than 5-6 watery stools in 12 hours? • Does the child have other symptoms (vomiting, fever over 103° F [39.4° C], rapid breathing)? • Onset, duration, frequency of symptoms? • Describe the child's breathing. • Has the child been diagnosed with a breathing disorder? • Is a prescribed treatment being used? • Are there any other signs or symptoms (severe headache, stiff neck, fever, cough)? • If the child is coughing, what does it sound like? • Are there signs of a sore throat or earache?
Robert Payne, a 9-year-old patient, is being seen today for an acute asthma attack. His mother wants to know what she can do to prevent these episodes. Summarize for her a minimum of four triggers that might cause Robert's asthmatic reaction.
• Respiratory infections, including infections caused by common cold viruses • Exposure to cigarette smoke • Stress • Strenuous exercise • Weather conditions, including cold, windy, or rainy days and extreme humidity • Allergies to animals, dust, pollen, or mold • Indoor air pollutants (e.g., paint, cleaning materials, chemicals, or perfumes) • Outdoor air pollutants, such as ozone
