FNP 2 Exam 1 blueprint GNRS5670
CORRECT QUESTIONS &
ANSWERS(GRADED A+)
· Health literacy- - ANSWER ● Mutual understanding and health planning
● Assessing and fostering health literacy- ability to read/communicate ,
evaluate/interpret health information
● Low health literacy affects health status- increased ED use, fewer preventative
measures, poor treatment management
● Screening tools include FOG index, SMOG, Flesch-Kincaid Readability tests, Rapid
estimate of Adolescent literacy in medicine
● Be clear in communication- avoid jargon, speak clearly, use a variety of education
materials, written materials at 5th grade level.
Leading causes of death and prevention - ANSWER Diarrhea and pneumonia are the
leading causes of mortality and morbidity (rotavirus and strep pneumoniae most
common causes)
● Successful vaccinations have decreased mortality
Global food- what effects global food? - ANSWER ● Hunger and under-nutrition occur
without access to safe, nutritious foods
● Occurs in both developing and industrialized countries
● Climate change and its effects on crops and food distribution
● Undernutrition an important determinant of maternal/child health
● Breastfeeding increases survival rates
● Large number of child poverty in our country (1 in 5) below federal poverty level
AAP recommendations for preventive pediatric health care - ANSWER ● American
Academy of Pediatrics
○ Number of health directives greater than time available to pediatric care providers
○ Uncoupling of periodicity of visits and immunizations to a greater emphasis on healthy
growth/developmental surveillance
○ Developmental monitoring- ask parents about concerns, accurate and information
observations of children (Ages and Stages questionnaire, PHQ-9, Pediatric Symptom
Checklist)
● Bright Futures
○ Prevention-based, developmentally oriented care
○ Parent tools to empower families to be active partners
HEENT - ANSWER ● Know symptoms and treatment for the following:
Otitis media
Otitis media with effusion
Otitis externa
,strep / CENTOR criteria
mono
sinusitis
conjunctivitis
○
Otitis media: positioning - ANSWER ■ Pulling the ear downward, outward, and
backward can enhance visualization of the EAC and TM in infants and small children. In
older children and adolescents, the ear is lifted upward and backward, slightly away
from the head.
■ Otitis media: - ANSWER Acute infection of middle ear
■ Otitis media:AAP guidelines: presence of three components to diagnose AOM: -
ANSWER ● Recent, abrupt onset of middle ear inflammation and effusion (pain,
irritability, otorrhea, fever)
● MEE confirmed by bulging TM, limited/absent mobility by pneumatic otoscopy, air-
fluid level behind TM, otorrhea
● Signs/symptoms of inflammation - distinct erythema of TM, pain
■ Otitis media:Table 30-4 - characteristics of different types of AOM - ANSWER table
30-4 (ch 36 7th edition, ch 29 5th edition)
■ Otitis media: Often follows eustachian tube dysfunction (ETD)
■ Common causes of ETD: - ANSWER ● Upper respiratory infection
● Allergies
● Environmental tobacco smoke
■ Otitis media: ETD leads to - ANSWER functional obstruction/inflammation, decrease
in protective ciliary action
■ Negative pressure pulls fluid from mucosal lining and accumulates - bacteria grows in
fluid
■ Young children have shorter, more horizontal, more flaccid eustachian tubes
■ Otitis media: Most common pathogens - ANSWER S. pneumoniae, nontypeable, H.
influenzae, M. catarrhalis, and S. pyogenes are most common
■ Viruses usually initial causative factor, but most AOM caused by bacteria or
combination bacteria/virus
■ Otitis media:Clinical findings - history - ANSWER ● Rapid onset of symptoms
● Ear pain/pulling in infant
● Irritability in infant/toddler
● Otorrhea
● Fever
■ Otitis media:Consider these key factors: - ANSWER ● Prematurity
, ● Craniofacial abnormalities/congenital syndromes
● Risk factors
● Lethargy, dizziness, tinnitus, unsteady gait
● Sudden hearing loss
● Stuffy nose, rhinorrhea, sneezing
■ Otitis media:Clinical findings - physical examination - ANSWER ● Presence of MEE
○ Bulging TM
○ Decreased translucency of TM
○ Absent or decreased mobility of TM
○ Air-fluid level behind TM
○ Otorrhea
● Middle ear inflammation
○ Erythema of TM
○ Distinct otalgia interfering with sleep/activity
○ Increased vascularity/obscured or absent landmarks
○ Red, yellow, purple ™
○ Thin-walled, sagging bullae filled with straw-colored fluid (bullous myringitis)
● Otitis media:Diagnostic studies - ANSWER ○ Pneumatic otoscopy - easiest, most
efficient
○ Tympanometry
○ Tympanocentesis to identify organism - refer
■ Otitis media:Management - ANSWER ● Table 30-5 (ch 36 7th ed, ch 29 5th ed)
● Pain management
○ Ibuprofen or acetaminophen
○ Topical analgesics if TM intact as adjunctive therapy - no longer available
○ Distraction, oil application, external heat/cold
● Otitis media:Antibiotics (Table 30-7 for dosage (ch 36 7th ed, 29 5th ed) - ANSWER ●
Amoxicillin (80-90 mg/kg/day) divided twice daily - first-line if no AOM in past 30 days,
no conjunctivitis, no PCN allergy
● Beta-lactam coverage if treated in past 30 days, allergy to PCN, concurrent
conjunctivitis, recurrent OM that has not responded to amoxicillin
● Ceftriaxone for vomiting child
● Clindamycin for ceftriaxone failure only if susceptibilities known
● Prophylactic antibiotics not recommended
■ Otitis Externa:Clinical findings - diagnostic studies - ANSWER ● Not necessary to
culture unless improvement not seen with treatment
■ Otitis Externa:Differential diagnosis - ANSWER - AOM with perforation, TTO, chronic
suppurative OM, necrotizing OE, cholesteatoma, mastoiditis, posterior auricular
lymphadenopathy, dental infection, eczema
CORRECT QUESTIONS &
ANSWERS(GRADED A+)
· Health literacy- - ANSWER ● Mutual understanding and health planning
● Assessing and fostering health literacy- ability to read/communicate ,
evaluate/interpret health information
● Low health literacy affects health status- increased ED use, fewer preventative
measures, poor treatment management
● Screening tools include FOG index, SMOG, Flesch-Kincaid Readability tests, Rapid
estimate of Adolescent literacy in medicine
● Be clear in communication- avoid jargon, speak clearly, use a variety of education
materials, written materials at 5th grade level.
Leading causes of death and prevention - ANSWER Diarrhea and pneumonia are the
leading causes of mortality and morbidity (rotavirus and strep pneumoniae most
common causes)
● Successful vaccinations have decreased mortality
Global food- what effects global food? - ANSWER ● Hunger and under-nutrition occur
without access to safe, nutritious foods
● Occurs in both developing and industrialized countries
● Climate change and its effects on crops and food distribution
● Undernutrition an important determinant of maternal/child health
● Breastfeeding increases survival rates
● Large number of child poverty in our country (1 in 5) below federal poverty level
AAP recommendations for preventive pediatric health care - ANSWER ● American
Academy of Pediatrics
○ Number of health directives greater than time available to pediatric care providers
○ Uncoupling of periodicity of visits and immunizations to a greater emphasis on healthy
growth/developmental surveillance
○ Developmental monitoring- ask parents about concerns, accurate and information
observations of children (Ages and Stages questionnaire, PHQ-9, Pediatric Symptom
Checklist)
● Bright Futures
○ Prevention-based, developmentally oriented care
○ Parent tools to empower families to be active partners
HEENT - ANSWER ● Know symptoms and treatment for the following:
Otitis media
Otitis media with effusion
Otitis externa
,strep / CENTOR criteria
mono
sinusitis
conjunctivitis
○
Otitis media: positioning - ANSWER ■ Pulling the ear downward, outward, and
backward can enhance visualization of the EAC and TM in infants and small children. In
older children and adolescents, the ear is lifted upward and backward, slightly away
from the head.
■ Otitis media: - ANSWER Acute infection of middle ear
■ Otitis media:AAP guidelines: presence of three components to diagnose AOM: -
ANSWER ● Recent, abrupt onset of middle ear inflammation and effusion (pain,
irritability, otorrhea, fever)
● MEE confirmed by bulging TM, limited/absent mobility by pneumatic otoscopy, air-
fluid level behind TM, otorrhea
● Signs/symptoms of inflammation - distinct erythema of TM, pain
■ Otitis media:Table 30-4 - characteristics of different types of AOM - ANSWER table
30-4 (ch 36 7th edition, ch 29 5th edition)
■ Otitis media: Often follows eustachian tube dysfunction (ETD)
■ Common causes of ETD: - ANSWER ● Upper respiratory infection
● Allergies
● Environmental tobacco smoke
■ Otitis media: ETD leads to - ANSWER functional obstruction/inflammation, decrease
in protective ciliary action
■ Negative pressure pulls fluid from mucosal lining and accumulates - bacteria grows in
fluid
■ Young children have shorter, more horizontal, more flaccid eustachian tubes
■ Otitis media: Most common pathogens - ANSWER S. pneumoniae, nontypeable, H.
influenzae, M. catarrhalis, and S. pyogenes are most common
■ Viruses usually initial causative factor, but most AOM caused by bacteria or
combination bacteria/virus
■ Otitis media:Clinical findings - history - ANSWER ● Rapid onset of symptoms
● Ear pain/pulling in infant
● Irritability in infant/toddler
● Otorrhea
● Fever
■ Otitis media:Consider these key factors: - ANSWER ● Prematurity
, ● Craniofacial abnormalities/congenital syndromes
● Risk factors
● Lethargy, dizziness, tinnitus, unsteady gait
● Sudden hearing loss
● Stuffy nose, rhinorrhea, sneezing
■ Otitis media:Clinical findings - physical examination - ANSWER ● Presence of MEE
○ Bulging TM
○ Decreased translucency of TM
○ Absent or decreased mobility of TM
○ Air-fluid level behind TM
○ Otorrhea
● Middle ear inflammation
○ Erythema of TM
○ Distinct otalgia interfering with sleep/activity
○ Increased vascularity/obscured or absent landmarks
○ Red, yellow, purple ™
○ Thin-walled, sagging bullae filled with straw-colored fluid (bullous myringitis)
● Otitis media:Diagnostic studies - ANSWER ○ Pneumatic otoscopy - easiest, most
efficient
○ Tympanometry
○ Tympanocentesis to identify organism - refer
■ Otitis media:Management - ANSWER ● Table 30-5 (ch 36 7th ed, ch 29 5th ed)
● Pain management
○ Ibuprofen or acetaminophen
○ Topical analgesics if TM intact as adjunctive therapy - no longer available
○ Distraction, oil application, external heat/cold
● Otitis media:Antibiotics (Table 30-7 for dosage (ch 36 7th ed, 29 5th ed) - ANSWER ●
Amoxicillin (80-90 mg/kg/day) divided twice daily - first-line if no AOM in past 30 days,
no conjunctivitis, no PCN allergy
● Beta-lactam coverage if treated in past 30 days, allergy to PCN, concurrent
conjunctivitis, recurrent OM that has not responded to amoxicillin
● Ceftriaxone for vomiting child
● Clindamycin for ceftriaxone failure only if susceptibilities known
● Prophylactic antibiotics not recommended
■ Otitis Externa:Clinical findings - diagnostic studies - ANSWER ● Not necessary to
culture unless improvement not seen with treatment
■ Otitis Externa:Differential diagnosis - ANSWER - AOM with perforation, TTO, chronic
suppurative OM, necrotizing OE, cholesteatoma, mastoiditis, posterior auricular
lymphadenopathy, dental infection, eczema
