Health Promotion
C. Do not revaccinate this patient at this time The recommendation of CDC is NOT to revaccinate this patient. After initial vaccination with PCV13 at age 65 and subsequent vaccination with PPSV23 1 year later, no revaccination is recommended in this patient.
A 75yo adults asks for the pneumonia vaccine. His immunization record indicates that he had one at age 65 and another a year later. What is the recommendation of the CDC about how the NP should handle his request? A. Revaccination is recommended now B. Revaccination is recommended every 5 years after age 65 years C. Do not revaccinate this patient at this time D. He should have received one at 70 years
B. Toddler
A child who is 15 months old is referred to as an: A. infant B toddler C. preschooler D. youngster
D. Half-life less than 24 hours
A criterion for medication choice in an older adult is: A. Long half-life to prevent frequent dosing. B. Dosing of 3-4 times daily C. Pill color and shape for easy identification D. Half-life less than 24 hours
C. Nonstop crying (3h or more) within 48 hours of receiving the immunization Nonstop crying for 3h or more (and) occurring within 48 hours of the immunization is not a specific contraindication, but it is a precaution. This means careful consideration must be given to the benefits and risks of the vaccine under these circumstances. The body temperature that should cause concern is 105 F within 48 hours of immunization. This is also a precaution for subsequent DTaP immunization. Vomiting and injection site soreness are not contraindications or concerns after DTaP.
A side effect of DTaP that should be reported is: A. Temperature of 103 within 72 hours of receiving the immunization B. Vomiting within 7 days of receiving the immunization C. Nonstop crying (3h or more) within 48 hours of receiving the immunization D. Injection site soreness lasting greater than 2 days
B II
A young female has breast buds bilaterally. This represents Tanner Stage: A. I B. II C. III D. IV
B. Yes, but not more than 1-2 drinks/day A good rule of thumb for alcohol consumption in older adults is no more than 1-2 drinks/day after age 65. If the patient is cognitively impaired, abstinence is recommended. The type of alcohol is not of great importance. Beer, wine, and hard liquor all contain alcohol, which has the potential to impair older adults. The reason alcohol should be limited or avoided is b/c of decreased lean body mass and decreased total body water in aging bodies.
An octogenarian asks the NP if it is OK for him to have an alcoholic beverage in the evenings. There is no contraindication. How should the NP respond? A. Yes, but not more than 4 days/week B. Yes, but not more than 1-2 drinks/day C. No, you will increase your risk of falling and injury D. It depends on the type of alcohol you would like to consume
C. Constipation To improve tolerance, the NP can suggest 500 mg daily for a week, then 500 mg BID 1 week, then TiD daily. The patient should be encouraged to increase the intake of fruits, veggies, fluid, and fiber. Weightbearing exercise and vitamin D intake should be encouraged to improve bone density.
An older adult has osteopenia. Her healthcare provider has recommended calcium 500 mg TID. What is the most common side effect of calcium supplementation? A. Stomach upset B. Diarrhea C Constipation D. Mild nausea initially
D. Infants Newborns are less than 1 month, Toddlers are greater than 1 year up to 3 years
Babies up to one year of age are called: A. Newborns B. Toddlers C. Newbies D. Infants
D. 36 months
Head circumference should be measured until a child has attained: A. 12 months of age B. 18 months C. 24 months D. 36 months
A. Breast Mammography should be performed every 1-2 years
In older adult females, which screening test has demonstrated greatest reduction immortality from cancer? A Breast B. Cervical C. Ovarian D. Lung
A who are allergic to eggs It is attenuated and given once at 12 months, then repeated at 4-6 years
MMR immunization is safe in children: A. who are allergic to eggs B. younger than 1 year C. when given every 5 years D. if they are at least 5 years of age
A. 2 years This does not necessarily mean a lipid profile, though these are recommended between 18 and 21 years. Risk factors for dyslipidemia include family history of dyslipidemia, premature CVD, or DM; personal hx fo BMI >85% for age and gender, or history of other systemic diseases like Kawasaki disease or renal disease.
Risk assessment for dyslipidemia should begin at: A. 2 years B. 6 years C. 18 years D. 21 years
C. scalp edema This is common in newborns. It is a result of pressure over the presenting part. This results in some ecchymosis of the scalp. While this may be disturbing to new parents who observe this in their newborn, it will resolve in a few days and is harmless.
The term caput succedaneum refers to: A. cradle cap B. atopic dermatitis C. scalp edema D. asymmetric head shape
D. 75 years If he fails, he should be offered formal audiological evaluation within 3 months. In studies, screening annually resulted in greater adherence with using hearing assistive devices when hearing problems were identified.
At what age should hearing screening take place in older adults according to Assessing Care in Vulnerable Elders (ACOVE-2)? A. 60 years B. 65 years C. 70 years D. 75 years
A. 3 years BP should be measured immediately after birth and anytime a cardiac problem is suspected. After this time, BP screening should begin at 3 years, then annually. Taller and heavier children will have higher BPs. Use a pediatric BP table.
At what age should initial blood pressure screening take place? A. 3 years B. 4-6 years C. 6 years D. 6-10 years
A. An increase in testicular size A male with Tanner stage II development will have an increase in testicular volume from 1.5 mL or less, to up to 6 mL. The skin on the scrotum will begin to thin, redden, and enlarge. The penile length will remain the same. Males begin sexual maturity later than females. In the US, males begin sexual masturbation about 2 years later than females. Maturity begins in girls about 9-12 years.
A 13 yo male has exhibited the first sign that he is experiencing sexual masturbation. He has: A. An increase in testicular size B. An enlargement of the scrotum C. An increase in length of the penis D. Scrotal and penile changes
B Varicella and MMR Allergy test first with skin testing to establish sensitivity to gelatin
A 1 yo patient's mother reports allergy to gelatin. The mother describes the reaction as "lips swelling and breathing difficulties that necessitates a trip to the ED." Which immunizations should be avoided? A. Varicella, DTaP, and MMR B. Varicella and MMR C. IPV, DTaP, and Hep B D. Hep A and B, meningococcal
D. Could have a birth injury This is a startle reflex. The significance of this reflex is for evaluation of the central nervous system
A 12 month old infant has an asymmetric moro reflex. Which statement is true? A. Normal, develops later B. Indicates side of dominance C Could have hearing problem D. Could have a birth injury
A. Be given the vaccine The patient who reports recent exposure to an infectious disease should be vaccinated today unless something else contraindicates the immunization. Since he is 12 months old, he is old enough to receive varicella and MMR. Varicella should be given on the same day as MMR or the two vaccines must be separated by at least 4 weeks.
A 12-month-old is here today to receive the varicella immunization. A patient's mother reports that her 12-month-old child was exposed to chickenpox about a week ago. The NP should recommend that he: A. Be given the vaccine B. Wait 4 weeks to receive the vaccine C. Not receive varicella today b/c he is not old enough D. Receive MMR only today, not varicella
C. She is at risk for MMR but should not be immunized. This patient is at risk for rubella because she does not have a sufficient titer. The MMR immunization is an attenuated virus. Though an attenuated immunization is weakened, it is still considered live and so is contraindicated in anyone who may be immunocompromised. Since her CD4 cell count is unknown, she should not receive this immunization yet.. She may be able to receive the immunization if her CD4 count is normal.
A 20 yo student has an MMR titer that demonstrates an unprotective titer for rubella. She is HIV positive. Her CD4 cell count is unknown. Which statement is true? A. She should not receive the MMR immunization because she is low risk for the disease B. MMR is safe to give but she does not need this. C. She is at risk for MMR but should not be immunized. D. She should receive this. The immunization is not alive.
C. All routine immunizations at the usual time
A 2yo with sickle cell anemia should receive which vaccinations? A. All routine vaccinations at an accelerated rate B. All vaccinations at a decelerated rate C. All routine childhood immunizations at the usual time D. Immunizations should be limited in this group
D. Continue feeding every 2-4 hours Babies will lose about 10% of their birth weight in the first 3-4 days of life. This baby has lost about 8 ounces; this is about 10% of his birth weight. This is an appropriate weight loss in this time. He should rapidly gain this weight back. When children begin losing weight and growth slows, one consideration should be given to congenital cardiac anomalies. There is no need for the mother to return in 1 week, but should return for 2 month check.
A 3-day-old infant weighed 8 pounds at birth. Today, he weighs 7.5 lbs. How should this be managed? A. Assess the baby for cardiac anomaly B. Add an extra feeding in the AM and PM C. Have the mother return to reweigh the baby in 1 week D. Continue feeding every 2-4 hours
C. Refer him for a colonoscopy Tumurs don't consistently excrete blood. The reason multiple are performed is to increase the likelihood of identifying blood. The patient needs to have a colonoscopy performed for examination of the colon. The standard of practice is to refer all positive colon cancer screens for colonoscopy.
A 58 yo patient has an annual exam. A fecal occult blood test was used to screen for colon cancer. Three were ordered on separate days. The first test was positive. The last two were negative. How should the NP proceed? A. Rescreen in 1 year B. Perform a 4th exam C Refer him for a colonoscopy D. Examine him for hemorrhoids
B. Child has OM with temp of 103 This is considered moderately ill. Any moderately ill child with or without fever can be vaccinated as soon as they are recovering and not considered acutely ill.
A 6 month old child comes into the clinic for immunizations. Which item below allows a delay in getting immunizations today? A. Child is on antibiotics B. Child has OM with temp of 103 C. Mom is pregnant D. Child has a family member on chemo
B. The infant will have an abnormal cover/uncover test The cover/uncover test is used to assess strabismus, a common cause of disconjugate gaze. Stabismus represents a non parallelism of the visual axis of the eyes. This results in the ability of both eyes to focus on the same object at the same time. At 6 months of age, a disconjugate gaze and tilting of the child's head is a red flag. This child needs referral to an ophthalmology. While an ocular tumor could be present, this is unlikely and not the action that should be taken today. (See esotropia, hypotropia, hypertrophic, exotropia)
A 6 month old infant has a disconjugate gaze. The NP observes that the 6 month old tilts his head when looking at objects in the room. Which statement is true. A. Nystagmus will be present. B. The infant will have an abnormal cover/uncover test C. The patient's vision is 20/200 D. He needs a CT to rule out an ocular tumor.
D She does not need the immunization
A 67 yo patient presents an immunization record that reflects having received the PCV13 immunization when she was 65 years old. She received the PPSV23 immunization one year later. Which statement below reflects the current standard of practice recommended by ACIP and CDC for this patient? A. She should be revaccinated today B. She should receive the immunization every 5 years C. She can elect to receive it today if she has COPD D. She does not need the immunization
D. Hep B, DTaP, IPV, MMR The minimum length of time between hepatitis B, DTaP, IPV, and MMR is 1 month. Therefore, he can receive all of this today. He should not receive another varicella today. The minimum length of time between varicella immunizations is 3 months if he is younger than 13 years of age.
A 7 yo entered the clinic 1 month ago. There was no evidence that the had any immunizations. He was given the vaccinations listed on his vaccination record at the time of his visit. If he returns today, which immunizations can he receive? A. Hepatitis B, Td, Hib, polio, MMR B. Hep B, Td, IPV, MMR, Varicella C. IPV only D. Hep B, DTap, IPV, MMR
C Hep B, Tdap, Varicella, MMR
A 7 yo enters the NP's clinic. There is no evidence that the has received any immunizations. What should be administered today? A. Hep B, Tdap, Hib, IPV, MMR B. Td, Hib, IPV, varicilla C. Hep B, Tdap, Varicella, MMR D. Hep B, IPV, varicella, MMR
C. She does not need any testing b/c she is asymptomatic The obvious risk is for cardiac events. Evidence does not support routine EKG or cardiac testing in pts who are asymptomatic. She should be told about symptoms to watch for and to stop immediately if chest pain or SOB develops. This exercise will help her develop improved conditioning, reduce her risk of many chronic diseases, including CVD, reduce the risk of falls, and decrease functional limitations. Exercises for older adults fall into 4 categories: aerobic, muscle strengthening, flexibility, and balance.
A 74 yo who retired as a store clerk last year would like to start an exercise program. She tells the NP that she would like to start walking 15-20 minutes daily. Which statement is correct regarding the patient? A. She should have a stress test prior to initiating a walking program B. She should have an EKG performed in the clinic today. C. She does not need any testing b/c she is asymptomatic D. She should have labs and EKG performed prior to starting.
C He should be treated with a statin Numerous studies and learned authorities have found that lipid-lowering drug therapy decreases the incidence of coronary heart disease and vascular events in middle-aged and older adults. The current recommendation is to screen and treat lipid abnormalities in patients who are at risk for a cardiac event. It is unclear whether treatment of middle-aged and older adults at low risk for cardiac events is beneficial.
A 76 yo patient who is very active has elevated cholesterol and LDLs. He had been treated for hypertension for >10 years with near normal BPs. What is the current recommendation for managing his lipids? A. No treatment should take place since his age exceeds 75 years B. He should be treated with an aspirin only C. He should be treated with a statin. D. The benefits of treating this patient do not exceed the risk of using a statin or aspirin.
C. 2 years of age Common developmental tasks for a 2 yo include: stacking five blocks, following two-step commands, using two-word phrases, kicking a ball, saying at least 20 words, and walking up and down stairs one step at a time.
A child who can stack a maximum of five blocks is probably: A. 1 year of age B. 15 months of age C. 2 years of age D. 3 years of age
D. Encephalopathy within 7 days after immunization This is an absolute contraindication. Fever of 105 or greater within 48 hours, seizures within 3 days are not specific contraindication, but benefits should outweigh risks before giving a second dose.
A contraindication to giving MMR vaccination is: A. family history of any adverse event after a dose B. fever of 104 within 72 hours of immunization C. seizures within 7 days of immunization D. Encephalopathy within 7 days after immunization
B. 3-4 days However, in premature infants, the level peaks at 5-7 days. This is diagnosed when the bilirubin level exceeds 5 mg/dL. It occurs in more than 60% of full-term infants.
A full-term newborn is diagnosed with hyperbilirubinemia. When would his bilirubin level be expected to peak? A 1-2 days B 3-4 days C 5-7 days D 7-10 days
B. secondary prevention
A mammogram in a healthy 50-year-old patient is an example of: A. primary prevention B. secondary prevention C. tertiary prevention D. quarternary prevention
D. None are contraindicated
A mother reports that her child is not allergic to chickens but is allergic to ducks and duck feathers. The child is 4 today. Which immunizations should he receive? A. Avoid flu, but all others ok B. Avoid hep B C. MMR and tetanus are contraindicated D. None are contraindicated
C. It is not advised in this patient at this time Patients with a life expectancy less than 5-10 years should forego colorectal cancer screening via colonoscopy.
A patient is 86 years old and functions independently He has HTN, hyperlipidemia, BPH, and flare-ups of gout. His last colonoscopy was at age 76 years. What should he be advised about having a colonoscopy? A. Colonoscopy is the preferred method for screening in older adults B. Colonoscopy is ill advised in older adults C. It is not advised in this patient at this time D. Screening is not necessary after age 80 years
D. You are eligible to receive it but you still may get shingles Patients must be at least 50. It is generally well tolerated but provides protection from shingles in 50-64% of patients. The incidence of postherpetic neuralgia is decreased up to 65% after immunization. The patient still may develop shingles after receiving the immunization. The vaccine may be offered regardless of whether the patient has a hx of shingles. However, since it is a live vaccine, it may be contraindicated b/c of steroid use or immune status.
A patient who is 62 yo asks if she can get the shingles vaccine. She has never had shingles but states that she wants to make sure she doesn't get it. What should the NP advise? A. The immunization will protect you from acquiring shingles B. You are not old enough to receive the immunization C. The immunization is offered only to those who have had shingles D. You are eligible to receive it but you still may get shingles
B. He can only change the content if he is of sound mind
A patient who wrote a living will has changes his mind about the initiation of life-sustaining measures. Which statement is true about this? A. He cannot change his mind regarding the content of the living will B. He can only change the content if he is of sound mind C. A healthcare provider is exempt from liability if they provide care outside the living will D. An attorney must be consulted if the living will is changed at any time
D. MMR immunization presents no risk to the child's mother, immunize now. MMR immunization in the child presents no risk to the pregnant mother. MMR is actually attenuated, also thought of as an inactivated form of the virus. Therefore, there is no risk to her. If the mother were pregnant, she should not be vaccinated. If she is contemplating pregnancy, she should avoid MMR for 4 weeks following immunization.
A pregnant patient is concerned because her 12 month-old needs an MMR immunization. What should the NP advise this patient? A. The MMR is a dead virus; therefore, there is no risk to the mother. B. Have the child wait until Mom delivers C. Have the child wait until Mom is in her 23th week or later before immunization. D. MMR immunization presents no risk to the child's mother, immunize now.
D. Repeat TSH in 2-3 weeks
A pt who has been treated for hypothyroidism presents for her annual exam. Her TSH is 4.0 (normal = 0.4-3.8). She feels well How should she be managed? A. Continue her current dosage of thyroid replacement B Increase her replacement C. Decrease her replacement D. Repeat the TSH in 2-3 weeks
C. Pink tympanic membranes The TM normally becomes pink and can become red when a child is screaming or crying. This is probably due to flushing and hyperemia of the face that occurs with crying. A distorted or erythematous tympanic membrane with decreased mobility is suggestive of otitis media.
An NP examines a screaming 2 yo. A common finding is: A. Nasal discharge B. Increased respiratory rate C. Pink tympanic membranes D. Course breath sounds
C He has persistent strabismus
An infant is brought to the NP b/c his gaze is asymmetrical. Which finding indicates a referral to an ophthalmologist? A. He is 2 months old B. He is 3 months old C. He has persistent strabismus D. His red reflex is normal
C. Tolerability of the medication The oral agents are best and must be taken for 8-16 weeks (or longer) for adequate length of treatment. Additionally, the real difficulty lies in the ability of the olde adult's liver to handle this medication. They require greater amounts of the liver's resources for metabolism. A topical agent may be a better choice for an older adult.
An oral anti fungal agent is commonly used to treat tine unguium. The difficulty in treating an older adult with this infection is: A. Absorption of the medication B. Applying the medication BID C. tolerability of the medication D. Relative ineffectiveness of oral agents
C. 6 months Part of the screening should be for the need for fluoride supplementation. Oral health risk assessment should take place at 6 months, and 9 months, and referral to a dental home should take place by 1 year of age. Oral health risk assessment should continue periodically at health screening visits at 18, 24, and every 6 months until a dental home is established.
At what age should oral health risk assessment begin? A. At birth B. 3 months C. 6 months D. 1 year
A. once for all males aged 65-75 who have ever smoked
Screening for abdominal aortic aneurysm should take place: A. once for all males 65-75 who have ever smoked B. once for all men and women who have hypertension C. annually after age 75 years for males and females D. only if the patient has smoked and has hypertension
B. Breastfeeding Exposure to cigarette smoke, sucking on pacifiers increases the risk, unknown about Vitamin D
Which of the following will decrease the risk of AOM in a 6 month old A. Cigarette smoke exposure B. Breastfeeding C. Sucking on pacifiers D. Vitamin D supplementation
A. Increase in testicular size This is Tanner Stage II - increase in testicular volume from 1.5 ml or less to up to 6 ml. The skin on the scrotum will begin to thin, redden, and enlarge. The penile length will remain the same.
The 1st sign that a male child is experiencing sexual maturation is: A. Increase in testicular size B. Enlargement of the scrotum C. Increase in length of the penis D. Scrotal and penile changes
C. 18 months Other tasks: throwing a ball, saying 15-20 words, pointing to multiple body parts, pointing and naming objects in a book, and stacking 3-4 blocks
The age at which a child can first walk backwards is: A. 12 months B. 15 months C 18 months D 24 months
C. 12-14 yrs
The average age of pubertal growth spurt in North America boys is: A. 9.5-11.5 years B. 10-12 yrs C. 12-14 yrs D. 14-16 yrs
D. Equal to head circumference This is only performed if there is a suspected problem. The exception is in a premature infant where the head grows very rapidly. Normally, the head exceeds the chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24 months the head and chest circumference should be about equal and by 2 years of age the chest should be larger than the head. The chest circumference is measured at the nipple line.
The chest circumference of a 12 month old is: A. Routinely measured on well-child visits B. 1-2 cm larger than head circumference C. Smaller than head circumference D. Equal to head circumference
C. Chronic glucocorticoid therapy, age 70 years Women should be screened for osteoporosis starting at age 65 years, and sooner if risk factors are present. Males older than 65 years should be screened with DEXA scanning if they exhibit risk factors. Risk factors with the greatest impact on bone density include primary hyperparathyroidism, chronic glucocorticoid therapy and hypogonadism.
The incidence of osteoporosis in older adults is high. Which characteristics below would increase the risk of osteoporosis in an older adult male patient? A. Low body weight, age 60 years B. Smoker, age 65 years C. Chronic glucocorticoid therapy, age 70 years D. Family history of hypothyroidism, age 65 years
B. Shifted the pathogenesis to fewer cases of S. pneumoniae The heptavalent pneumococcal conjugate vaccine (PCV13), Prevnar, protects children from 13 types of pneumococcal bacteria. It has reduced the incidence of ear infections caused by S. pneumonia and has reduced the incidence of recurrent ear infections and tube placement by 10-20%. The pathogenesis of AOM has shifted to more cases of H. influenza, but this organism is less likely to become resistant, as Strep pneumonia has.
The pneumococcal immunization in infants has: A. Decreased the episodes of acute otitis media due to H. flu B. Shifted the pathogenesis to fewer cases of S. pneumoniae C. Eradicated acute otitis media d/t S. pneumonia D. Improved the prognosis of AOE
B. Depression and malignancy Malignancy is the MCC. Depression is #2.
Two common causes of weight loss in older adults are: A. anorexia and depression B. depression and malignancy C. malignancy and social isolation D. financial limitations and hyperthyroidism
B. Stage 1 An average 8 yo would be expected to be prepubertal, which is Tanner 1. Pubertal changes can occur as early as 9-10 yrs in males or females. If changes occur prior to this, precocious puberty should be considered.
What Tanner stage corresponds to an average 8yo male? A. Stage 0 B. Stage 1 C. Stage 2 D. Stage 3
B. Daily PPI
What choice below would be beneficial to a 76 yo who takes daily oral steroids for COPD and now takes a daily aspirin for primary prevention of myocardial infarction? A. Screen for infection with H. pylori B. Daily proton pump inhibitor (PPI) C Antacids PRN heartburn D Daily use of low dose famotidine
C. 5 years Common developmental tasks for a 5yo include: ability to draw a person with a body, head, arms, and legs; recognize most letters and can print some; know his address and phone number; dress self without help; able to skip and tiptoe; and play cooperatively and enjoy a playmate's company
What is the earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers? A. 3 years B. 4 years C. 5 years D. 6 years
B. 4 years A 4 yo should have the dexterity to cut and paste. Therefore, this is the most appropriate age.
What is the earliest age the that an average child would appropriately receive construction paper and a pair of scissors with rounded points? A. 3 years B. 4 years C. 5 years D. 6 years
A. Undernutrition Some older adults have great challenges associated with eating and maintaining weight. They may be endentulous or have anorexia. Weight loss is associated with greater mortality in older adults than in patients who have not had recent weight loss. Clinically significant weight loss is usually considered to be about 4-5% of total body weight w/in 6-12 months. In older patients who do lose weight, they are less likely than younger adults to gain it back. This also increases risk of mortality.
What is the most common nutrition syndrome in older adults? A. Undernutrition B. Over nutrition C. Malnourishment D. Vitamin B12 deficiency
D. It has no proven benefit.
What is the recommendation for daily multivitamin supplementation in older adults? A. Supplementation reduces morbidity B. Supplementation reduces mortality C. it decreases the relative risk of dementia D. It has no proven benefit.
A. Screening starting at 50 years At age 50, average risk males should have PSA with or without DRE. If high risk due to family hx (1st degree relative with prostate CA before age 65) or race (African American), screening discussions should take place at age 40-45 years. If initial PSA is >2.5 ng/mL, annual testing should take place. If <2.5 ng/mL, test every 2 years
What is the recommendation from American Cancer Society for assessment of the prostate gland in a man who is 45 yo and of average risk for development of prostate cancer? He should have: A. Screening starting at 50 years B. PSA now C. PSA and DRE now D. DRE only
B. 3 years If the child is not cooperative, attempt again in 6 months, then at 4 years old. The usual vision of a 3yo is 20/50
What is the usual age for vision screening in young children? A. 2 years B. 3 years C. 4 years D. 5 years
B. Same day or at least 1 month apart MMR is attenuated. Varicella is live. Higher titers are achieved if given together as opposed to given separately.
What is the usual recommendation about administering MMR and varicella immunizations? A. They should not be given on the same day under any circumstances B. They should be given on the same day or at least one month apart C They cannot be given with flu vaccine D. They can be given only with live viruses
C. It contains significantly more virus than the chickenpox vaccine It contains 14 times the number of plaque-forming units of virus than the varicella vaccine
What is true regarding the shingles vaccine given to adults at or after age 50? A. It is a weakened form of the chickenpox virus. B. It is the same as the chickenpox virus C. It contains significantly more virus than the chickenpox vaccine D. It is not related to the chickenpox immunization at all
C. Keep a list of all your meds with you
What should the NP recommend to any elder taking medications? A. Have someone check your medications prior to taking them B. Never take your meds on an empty stomach C. Keep a list of all your meds with you D. Have a pharmacist review your list once a year
B. Less than 120 degrees
What temperature should be set on a water heater in the home of an older adult to prevent burn injury? A. Less than 110 degrees B. Less than 120 degrees C. Less than 130 degrees D. Less than 140 degrees
D. Discuss weaning from a bottle. This should happen at 1 year. Appropriate to discuss at 9 months.
What would be age appropriate anticipatory guidance for the parent of a 9 month old infant? A. Keep syrup of ipecac in case of accidental poisoning B Stranger anxiety will develop by 1 year of age C Your baby should be able to say 10 words before age 1 D. Discuss weaning from a bottle
D. 5-6 yrs Normal 3 yrs (when you first attempt to screen) is 20/50, normal 4 yrs is 20/40, normal 5 yrs is 20/30, normal 6 years is 20/20.
When does a child's vision approximate 20/20? A. 2 yrs B. 3 yrs C. 4 yrs D. 5-6 yrs
C. 3 years Also riding a tricycle, saying name, gender, age, copying a circle, recognizing some colors
When is a child first able to stand on one foot? A. 18 months B. 2 years C. 3 years D. 4 years
B. An INR of 2.0 in a patient taking warfarin
Which finding below is considered WNL? A. A diastolic murmur in an 18 yo B. An INR o f2.0 in a patient taking warfarin C. Cholesterol level of 205 in a 15 yo D. BP of 160/70 in a 75 yo
B. A 12 month old female Infants younger than 6 months and children older than 3 years typically do not exhibit stranger anxiety when the examiner enters the room. It most specifically develops at age 9 months.
Which patient below is most likely to experience stranger anxiety during a physical exam? A. 1 6 month old male B. A 12 month old female C. A 3 yo female D. a 4 yo female
C. Metabolism As the liver decreases in mass and potentially has a decrease in blood flow, drug metabolism is decreased. Consequently, lower doses of medications in older adults may be as efficacious as higher doses in their younger counterparts. Production of enzymes in the cytochrome P450 system may be decreased, which further impacts metabolism.
Which pharmacokinetic factor is influenced by a decrease in liver mass in an older adult? A. Absorption B. Distribution C. Metabolism D. Elimination
A. Give to immunocompetent adults 60 and older The zoster vaccine is currently FDA approved in immunocompetent adults age 50 and older. It should never be used to treat shingles.
Which recommendation below reflects CDC's recommendation for administration of the zoster vacine? A. Give to immunocompetent adults 60 and older B. Give to immunocompetent adults 65 and older C. Give regardless of immune status at age 50 D. Give regardless of immune status at age 60
B. Rooting Disappears when awake between 2-3 months, but lasts in sleep until 12 months
Which reflex may be present at 9 months of age during sleep? A. Moro reflex B. Rooting C. Stepping D. Tonic neck
D. Parachute A 1 month old should exhibit Moro, stepping, rooting, tonic neck (fencing) and Babinski reflexes. The parachute reflex is typically in the 6-9 month stage. This reflex can be observed when the infant extends the arms, hands, and fingers when suspended in the prone position and lowered quickly towards the table.
Which reflex would NOT be expected in a 1 month old? A. Moro B. Stepping C. Babinski D. Parachute
A. Moro, stepping, rooting And babinski. The tonic neck, or "fencing" reflex isn't exhibited until about 2-3 months of age. This is assessed by lying the baby on his back and turning his head to one side. If the reflex is present, he should extend his arm on the side that his head is turned. The opposite arm assumes a flexed position. This pose mimics a fencer and thus, the name.
Which reflexes might a 1-month-old infant be expected to exhibit? A. Moro, stepping, rooting B. Stepping, rooting, tonic neck C. Babinski, Moro only D. Fencing, stepping, rooting
