Health promotion and Well Child Care

Question 1

Specific Normal Findings and Common Variations

What causes large fontanels?

Answer 1

Chronically increased intracranial pressure
Subdural hematom
Ricket
Hypothyroidism
Osteogenesis imperfecta

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 29). Jones & Bartlett Learning. Kindle Edition.

Question 2

What does sunken fontanel indicate?

Answer 2

Sunken anterior fontanel is usually seen with severe dehydration (more than 10%)

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 29). Jones & Bartlett Learning. Kindle Edition.

Question 3

Hydrocephalus

Answer 3

excessively large head at birth or head that grows abnormally rapid; usually associated with distended scalp veins, widely separated cranial sutures, large and tense anterior fontanel, and “sunset eyes”
.

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 29). Jones & Bartlett Learning. Kindle Edition

Question 4

Head tilt

Answer 4

common causes include strabismus, central nervous system (CNS) lesions, or short sternocleidomastoid muscle (congenital torticollis)

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 30). Jones & Bartlett Learning. Kindle Edition.

Question 5

Caput succedaneum

Answer 5

diffuse edema of the soft tissue of the scalp that usually crosses suture lines; may be seen with bruising due to traumatic vaginal birth; seen at birth; no specific treatment necessary; usually resolves in 2–3 days

“Crosses suture”

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 30). Jones & Bartlett Learning. Kindle Edition.

Question 6

Cephalohematoma

Answer 6

subperiosteal collection of blood that does not cross suture lines; often does not appear until several hours after birth and may increase over 24 hours; no specific treatment indicated; resolves over a few weeks to months; observe for hyperbilirubinemia

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 30). Jones & Bartlett Learning. Kindle Edition.

Question 7

What disease demonstrates white area in pupil visible in photographs?

Answer 7

retinoblastoma

Question 8

Any white, grayish-white, or yellow-colored material in the cornea/lens
indicate what?

Answer 8

congenital cataracts

Question 9

Examining TM
younger than 3 vs greater than 3 years old

Answer 9

pull auricle down and back in children younger than 3 years of age; pull auricle up and back for children older than 3 years of age

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 32). Jones & Bartlett Learning. Kindle Edition.

Question 10

Gynecomastia in teenage male

Answer 10

Gynecomastia can be normal variant in males due to temporary estrogen/testosterone imbalance (usually begins at Tanner stage 2–3 and can last for 1–2 years); most commonly felt as small, tender, oval subareolar mass measuring up to 2–3 cm in diameter

Testicular tumor (testes must be palpated in any male with gynecomastia)

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 35). Jones & Bartlett Learning. Kindle Edition.

Question 11

Gynecomastia etiology

Answer 11

• Obesity or increased muscle (pseudogynecomastia)
• Testicular tumor (testes must be palpated in any male with gynecomastia)
• Medication usage—estrogen, steroids, tricyclic antidepressants (e.g., imipramine, respiridol, mellaril, amphetamines, digoxin, cimetidine)
• Klinefelter’s syndrome (47XXY)—associated with small penis and testes,

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 35). Jones & Bartlett Learning. Kindle Edition.

Question 12

Age of normal variation in prominent abdomen (potbelly)

Answer 12

normal in early childhood in sitting and supine positions due to poorly developed musculature; children up to 13 years of age may have prominent abdomen in standing position

Silbert-Flagg, JoAnne; Sloand, Elizabeth D.. Pediatric Nurse Practitioner Certification Review Guide (p. 35). Jones & Bartlett Learning. Kindle Edition.

Question 13

Labial adhesion management?

Answer 13

r/o ambiguous genitalia
Normal variant
No treatment since it will resolve on their own during puberty if no symptoms are associated