Nursing Board Practice Test Compilation

Nursing Practice Compilation

PEDIATRIC FUNCTIONAL HEALTH PATTERN (sample)

PEDIATRIC FUNCTIONAL HEALTH PATTERN

A. Health Perception-Health Management Pattern

            Usually the child’s health is fair as describe by the mother but now it’s already poor. She said that in maintaining the child’s health she provided the child with nutritious food as much as possible and giving all the needs of the child like nice dress and proper hygiene. She gave the child time to play with other kids. The child’s immunization was complete.

            The child was admitted to the hospital because of the on & off fever for 2 days PTA. The mother did not know really the real cause of the illness because it occurs suddenly. It began on May 1, 2010 in the afternoon that the child was warm to touch and feels headache. The child was given paracetamol to relieve the fever but his fever didn’t subside. The child was hospitalized last February 2009 because of typhoid fever as stated by his mother. They expect that the child will get well soon as soon as possible so that the child will not suffer from staying in the hospital.

            During her pregnancy, the mother had her complete pre-natal check-up during her pregnancy stage. She did not take any medications & no complications during pregnancy.

B. Nutritional-Metabolic Pattern

            The child’s appetite is usually good but upon hospitalization the child’s appetite is poor. He doesn’t like to eat rice and vegetables. He was breastfed for 2 years and 4 months and then switch to formula fed. He can consume 4-5 bottles of Bearbrand milk in 24hrs but with mixed feeding of “lugaw” and rice with soup. Each feeding of milk is 250 ml. She started to introduce solid food when her child was 6 months old. The child likes to eat vegetables and fruits. They were not fun of going to fast food or restaurants. The mother was concern about the child’s health because he usually bought street foods rather than eat his mother prepared food.

C. Elimination Pattern

 The child defecates once a day, usually every morning with soft, brown, formed & moderate in amount stool. He was toilet trained. The child doesn’t have any problems in his urination. He doesn’t have any trouble in his skin.

D. Activity-Exercise Pattern

            Walks with steady gait, runs with few falls, walks on toes, stands on one foot, jumps, kicks ball, throws ball overhand. He participated in basketball games.

            The child could eat using spoon and fork. He doesn’t want to be helped. The child doesn’t need help in toileting since he knows where to defecate and urinate. He defecates and urinates on their comfort room. The child can dress by himself, bath and brush his teeth.

            The child watches TV for more than an hour He loves to watch cartoons. He watches with his parents. He was prohibited watching action movies to avoid being violent when he grows up.

E. Sleep-Rest Pattern

            The child usually sleeps 8pm & wakes at 6am. He sleeps 10 hrs a day without naps. The child’s usual sleep routine was singing with his parents & listening bedtime stories.  He had no usual sleep pattern problem.

F. Cognitive-Perceptual Pattern

         The child did not have any sensory perception deficits. He was 7 years old and a grade 2 pupil. He is an average pupil in his class.

G. Self-Perception Pattern

         The mother feels bad about her child’s illness and she was concerned about the wellness of the child. The child verbalizes that he feels restless.

H. Role-Relationship Pattern

The child uses appropriate words for his age. Spoken language in their home is bisaya. The child has one sibling. He was the eldest. Both the child’s parents do the decision making and in disciplining the child.  There was no marital problem and violence in the family.

I. Sexuality-sexual Functional Pattern

         The child did not verbalize any sexual curiosity according to her mother. The child always plays with boys and he loves to play basketball.

J. Coping-Stress Management Pattern

         The child learns to decide for himself and if greater decisions are to be made he would ask approval from his parents. There were no losses for the past year. When the child is stress he turns to her mother. When the child was frustrated he plays with his playmates. He was afraid of her mother when she brings stick to spank him.

K. Value-Belief System

         The whole family was Roman Catholic as claimed by the mother. The mother just likes to be prayed for her child’s wellness.

Health History Write-Up Sample

HEALTH HISTORY

Reason for Seeking Care

            “Fever with rashes for 6 days PTA”

Present Health History

Last February 4, 2010 at 4:00 in the afternoon, Bebe Kho was requested by her teacher to sweep the scattered garbage and clean the comfort rooms located just behind their classroom. There, she claimed that she was bitten by a stripe-colored mosquito. She also verbalized that there are plenty of mosquitoes in their house that bite her from time to time.

On February 8, 2010, patient’s voice became hoarse. Two days after, February 10, 2010, Bebe Kho experienced fever associated with left temporal non-radiating continuous headache with a pain scale of 7/10. However, there was no sign of bleeding such as epistaxis and hematemesis. Her tonsils were already enlarged and have purulent exudates. She was then brought to the nearby clinic in Simbulan for check-up. Bebe Kho was diagnosed with Acute Tonsillitis and was given antibiotic, Cefalexin 50mg, orally for 5 days. The patient claimed that she had loss of appetite, body malaise, and pain during swallowing which she scaled 3/10. Home management included cold compress applied on the forehead and a mixture of one tablespoon of salt in a glass of water which the patient gargled every four hours. Despite the effort to manage the fever, it still persisted for three days.

On February 13, 2010, rashes were noted on Bebe Kho’s trunk. At home, she was asked to drink at least 2 glasses of tawa-tawa decoction a day because her father anticipated that she might have acquired dengue since it’s also rampant in their place. Moreover, one of their neighbors has had dengue fever a week prior to the onset of Bebe Kho’s fever. The next day, her headache subsided but she still had fever.

Bebe Kho continued to be febrile for 6 days and the rashes spread to her entire body despite the home management. On the morning (unrecalled time) of February 16, 2010, Mr. and Mrs. Kho decided to bring the patient at Simbulan General Hospital. CBC was done in the hospital with the following results: Hgb-14.0g/dL, Hct-42.1vol.%, WBC-2.4x10³µL, RBC-3.49x10³µL, MCV-86.2fL, MCH-26.9pg, MCHC-31.2g/dL, and platelet count-53(120x10³)µL. Differential count of: Segmenters-48% and Lymphocytes-52%. These results prompted Bebe Kho’s parents to admit her to Valencia Sanitarium and Hospital. They left for VSH at 6PM riding on a motorcycle.

Bebe Kho together with her parents arrived at Valencia Sanitarium and Hospital Emergency Room at 8:38PM on February 16, 2010 with vital signs of: T-35.9^oC, PR-80bpm, RR-28bpm, BP-100/70mmHg. Physical Examination findings: enlarged tonsils without exudates, dry parched lips, Petechial rashes multiple in abdomen and upper extremities. IV infusion of PLR ŤL @ 35 gtts/min on right arm was started.

The doctor ordered the following:

ü  DAT except dark colored foods

ü  Labs:

o   repeat CBC

o   platelet count serial

o   Hct and platelet every 4 hours

o   U/A

o   serum albumin

o   SGPT, APTT, PTT

o   ABO blood typing

ü  3 units of fresh frozen plasma properly crossmatched with patients blood type

ü  monitor v/s q 30 min.

ü  record and monitor I & O q shift.

At 9:50 pm new doctor’s orders were made. This included fast drip 100 cc of Plain Lactated Ringer’s; refer for systolic BP ≤ 70 mmHg, diastolic BP ≤ 50 mmHg; narrow pulse pressure ≤ 20 mmHg or any unusualities; IV to follow PLR ŤŤL @ 31 gtts/min.

On Feb. 17 at 12:20 pm during doctor’s rounds, orders were made such as changing the IVF to D₅LR ŤL. During the doctor’s rounds at 2:15PM, the patient still had fever and inflamed tonsils, thus, the doctor ordered to start Paracetamol 750 mg/3 mL q 4h for 37. 8^OC or above.

Past Health History

  Bebe Kho’s family lives in Purok Daghang Lamok, Fantasea, Bukidnon. Their house is located approximately 10 meters away from a banana plantation and is surrounded by huge trees. Mrs. Kho mentioned that during rainy months, the incidence of dengue fever is increased. Some of her control measures included the use of mosquito nets, changing of water and scrubbing the sides of their flower vase once a week, and destroying breeding places of mosquito by cleaning their surroundings. However, she added that when it is raining, she hangs their washed clothes just below their roof’s eaves. She also said that she has a collection of potted bromeliads placed outside the house. Further, she mentioned about the tadjao (a rubber made jar) with cover they placed outside their house that serves as rain water reservoir. She’s aware that these are potential breeding sites for mosquitoes.

Bebe Kho was born, together with her twin sister Bubu Kho, on August 9, 2000, full term, at Maternity Hospital in Cagayan de Oro City via elective Caesarean Delivery. According to the mother, it took more or less 20 seconds before the baby was able to cry. She also observed that Bebe Kho’s upper and lower extremities were slightly cyanotic. Bebe Kho suffered from respiratory distress resulting to her prompt confinement in NICU; however, her mother cannot recall the medications and treatment that were given to the neonate. After one week, the patient was discharged with improved condition evidenced by pinkish body and extremities and good cry. Patient had her BCG vaccine right after birth. She received her first dose of DPT and OPV six weeks after birth. DPT2 and OPV2 were given four weeks thereafter. She completed the third dose of DPT and OPV before she reached 5 months old. When she was 9 months old, she was immunized with measles vaccine, thus completing her immunization before reaching one year old.

            Mrs. Kho claimed that she breastfed the patient for a week only following her discharge, because she thought that her twins were not satisfied of the breast milk and that they were not getting adequate nutrition from it. So she decided to give the twins formula milk, specifically Bonna, as a substitute.

At 6 months of age, mother recalled that Bebe Kho was dyspneic and had fever which prompted her to admit Bebe Kho to Laviña Hospital in Valencia City. Patient was diagnosed of Pneumonia. As far as Mrs. Kho remembered, Dr. Kisteria, patient’s pediatrician, ordered Salbutamol 1/2 nebule via face mask to be administered TID for 7 days.

At 1 year old, patient was admitted to Laviña Hospital after an episode of dyspnea for at most 3 hours. She was then given Salbutamol 1 nebule via face mask TID. The attending physician diagnosed the patient as asthmatic. Mother claimed that they use Baygon Katol, placed approximately 1 meter away from child’s bed, every night. The doctor instructed her parents to stop using Baygon to prevent the episode of dyspnea.

The patient was 4 years old when she had a fall. Bebe Kho’s mother was watching television in the living room while her twins were playing. The client accidentally fell from the bench which stood 14 inches from the floor. Mrs. Kho was fully unaware of what happened until their housemaid called her attention. Mrs. Kho managed it by applying cold compress over the patient’s left shoulder and she shifted to warm compress after four hours.

When the patient was already 6 years old, she had fever again which prompted immediate check up at Dr. Osorno’s clinic in Simbulan. Dr. Osorno advised the patient’s mother to admit the child in the hospital to confirm if she has UTI. The patient was prescribed of Cefalexin 50 mg TID. Since then, Mrs. Kho managed the patient’s fever with Paracetamol 250mg every 4 hours until it subsided. During this time, mother noticed that the patient is allergic to Cotrimoxazole, her medication for UTI, and in chicken’s egg and chicken meat.

The patient was transferred from a private Baptist school to Fairy Land Elementary School when she was in Grade 2 due to financial reasons. A man-made pond that contained tilapia and water lilies occupied the east side of the school. Located behind the classrooms were 4 public comfort rooms and nearby was an unused water-containing drum. The southern part of the school was all-laden with tall talahib grass.

Last August 2008, she had been hospitalized at Simbulan General Hospital due to Amoebiasis with Dr. Osorno as the attending physician. One day prior to that admission, she experienced abdominal pain and passed greenish watery stools. Bebe Kho’s parents were unable to remember the drugs prescribed by the doctor. She stayed in the hospital for 3 days. Mrs. Kho believed that it was due to the water that Bebe Kho drank two days before she manifested the symptoms. In addition, the family ceased drinking mineral water two days prior to the onset of the illness; instead, they got their water source from the faucet.

On the same year (exact date not remembered), the patient complained of dysphagia associated with fever for 3 consecutive days. Upon inspection, the mother noted red and swollen tonsils. Days prior to that, patient ate chocolates especially cloud 9. She could actually consume one big pack of chocolate a day. Again, she was brought for check up at Dr. Osorno’s clinic and was diagnosed of Acute Tonsillitis. The following medications were prescribed: Gargle of Bactidol TID, and erythromycin. Bebe Kho was also given maintenance multivitamins such as Ceelin syrup (alternate with Neotroplex syrup) and Growee syrup one tablespoon every after breakfast.

Introductions for Dengue fever (sample)

INTRODUCTION             Dengue fever, also known as breakbone fever, dandy fever (because of pain in the joints and bones and the way the patient seems to be walking on his toes) is an acute febrile disease caused by infection with one of the serotypes of dengue virus which is transmitted by mosquito genus Aedes; a benign syndrome caused by several arthropod-borne viruses, is characterized by biphasic fever, myalgia or arthralgia, rash, leukopenia, and lymphadenopathy.             There are at least four distinct antigenic types of dengue virus, members of the family Flaviviridae. In addition, three other arthropod-borne (amboviruses) cause similar or identical febrile diseases with rash.             The causative agent is the arbovirus, namely, Onyong-onyong, Chikungunya, West Nile, Flavirus; it is transmitted by bite of an infected mosquito, principally the female Aedes Aegypti, it is a day biting (they appear two hours after sunrise and two hours before sunset), it has a limited and low- flying movement, breeds on clear- stagnant water for drinking or bathing and in rainwater collected in any container, has grey wings and white stripes on the body and white bands on the legs. It is characterized by capillary permeability, abnormalities of homeostasis, and in severe cases, a protein- losing shock syndrome (dengue shock syndrome).  It is currently thought to have an immunopathologic basis.             Epidemics were common in temperate areas of the America, Europe, Australia, and Asia until early in the 20th century. Dengue fever and dengue-like disease are now endemic in tropical Asia, tropical Africa. Dengue fever occurs frequently among travelers to these areas.             Most disease occurs in older children and adults. Because A. aegypti has a limited range, spread of an epidemic occurs through viremic human beings and follows the main lines of transportation. Sentinel cases may infect household mosquitoes; a large number of nearly simultaneous secondary infections give the appearance of a contagious disease. Where dengue is endemic, children and susceptible foreigners may be the only persons to acquire overt disease, adults having become immune.             The incubation period is 5-7 days. The clinical manifestations are variable and are influenced by the age of the patient, in infants and young children the disease may be undifferentiated or characterized by fever for 5-7 days, pharyngeal inflammation, rhinitis, and mild cough. A majority of infected older children and adults experience sudden onset of fever, with temperature rapidly increasing to 39.4-41.1 degree Celsius, usually accompanied by frontal or retro-orbital pain, particularly when pressure is applied to the eyes. Occasionally, severe back pain precedes the fever (black-break fever). A transient, macular, generalized rash that blanches under pressure may be seen during the first 24-48 hr of fever. Myalgia and arthralgia occur soon after the onset and increase in severity. Joint symptoms may be particularly severe in patients with chikungunya or onyong-onyong infection. From the 2nd-6th days of fever, nausea and vomiting are apt to occur, and generalized lymphadenopathy, cutaneous hyperesthesia or hyperalgia, taste aberrations, and pronounced anorexia may develop.  The pathopnomonic sign of Dengue/Hemorrhagic Fever is Herman’s sign. It appears on the upper and lower extremities, purplish or violaceous red with blanched areas about 1 cm or less in size. Grade 1 manifestations/ and signs and symptoms. ·         Sudden  high fever for 5-7 days; sore throat ·         Redness of the eyeballs, swollen face ·         Pain: periorbital, joints, bones, abdomen, head, on eye movement ·         Nausea and vomiting Pathological changes a.    Petechiae b.    Herman sign: general redness of the skin c.    Macular or measles-like rash on the palms and spreads up the arms, body and legs. Fades slowly and followed by branny desquamation of the skin. Grade 2- signs and symptoms of grade 1 plus ·         Bleeding a.    Epistaxis (nose) b.    Gums c.    Gastric * Hematemesis (vomiting of blood) * Melena (passage of blood) * Hematochezia (stool with fresh blood)             Grade 3- signs and symptoms of grade 2 plus evidence of circulatory failure ·         Cold, clammy skin ·         Hypotension ·         Very rapid but weak pulse ·         Very rapid respiration Grade 4-signs and symptoms of grade 3 plus signs of hypovolemic shock (due to excessive bleeding/ blood loss). May lead to death if uncontrolled. The Diagnostic and laboratory exams to be considered are Tourniquet or Rumpel Leede Test; it is a presumptive test for capillary fragility, Platelet count that it should be below or <150,000cu.Mm for positive results of dengue and it should be done every six hours, and hematocrit count that it should be above or > 0.34-0.54 because of hemoconcentration. Life Cycle of a Mosquito Under optimal conditions, the egg of a mosquito of the genus Aedes can hatch into larvae in less than a day. The larva then takes about four days to develop in a cocoon from which adult mosquitoes will emerge after two days. Three days after the mosquito has bitten someone and taken in the blood, she will lay eggs and the cycle begins again.  Some facts about mosquitoes: ·         Only the female Aedes mosquito bites as it needs protein in blood to develop eggs. ·         The mosquito becomes infectious after about 7 days, it has bitten a person carrying the virus. It is the extrinsic incubation period, during which the virus replicates in the mosquito and reaches the salivary glands. ·         Peak is bite at dawn and dusk. ·         The average lifespan of a mosquito of the genus Aedes in Nature is 2 weeks ·         Mosquitoes may lay eggs about 3 times in his life, and about 100 eggs are produced each time. ·         The eggs can live in dry conditions until approximately 9 months, after which they can hatch if it is subject to conditions, example:  food and water

 

DIAGNOSTIC TESTS (sample)

DIAGNOSTIC TESTS

February 16, 2009  Simbulan General Hospital		Results	Normal range	Interpretation
Hematocrit		42. 1%	32%-42%	Slightly elevated hemoconcentration
Hemoglobin		14.0 g/dl	10-17 g/dl	normal
RBC		3.49 x 103/µL	4.8-7.2 x 103/µL	Decreased Iron deficiency anemia, hemorrhage or blood loss, anemia, chronic infection
WBC		2,400 mm3	6,000-17,000 mm3	Decreased Leucopenia, hematopoietic disease, viral infection
Differential count:
Segmenters		48%	32%	Increased Viral infection
Lymphocytes		52%	25%-35%	Increased Viral infection
Platelet count		53,000 mm3	200,000-475,000 mm3	Decreased thrombocytopenia
MCV		82.6 fL	82-98fL	Normal
MCH		26.9 pg/cell	26-34pg/cell	Normal
MCHC		31.2g/dl	32-36g/dL	decreased
RDW-CV		14%
February 17, 2009 10PM		Results	Normal range	Interpretation
Hematocrit		42.2 gms%	32%-42%	Slightly increased
Hemoglobin		13.3 gms%	10-17 g/dl	normal
RBC		4.69 x 103/µL	4.8-7.2 x 103/µL	(in lower limit) Iron deficiency anemia, hemorrhage or blood loss, anemia, chronic infection
WBC		2,300 mm3	6,000-17,000 mm3	Decreased Leucopenia, hematopoietic disease, viral infection
Differential count:
Segmenters		48%	32%	Increased Viral infection
Lymphocytes		46%	25%-35%	Increased Viral infection
Monocytes		06%	4%-9%	normal
Control		11.6 sec.
Test		12.3 sec.
% activity		97.6%	100%
Ratio		1.03
INR		1.02	1.00-1.30	NORMAL
APTT: Control Test Ratio		36.0 sec. 33.9 sec. 0.9	33-45 sec	NORMAL
Clinical Chemistry:
Albumin		3.1g/dl	4-5.9g/dL	Hypoalbuminemia
SGPT		25.4vol/L	4-36vol/L
Platelet count		83,000 mm3	150,000-400,000 mm3	Decreased Idiopathic thrombocytopenic purpura, multiple myeloma, leukemias, anemias, acute rheumatic fever,
Feb 17, 2010 @7:45am	Results		Normal range	Interpretation
Hematocrit	35.9		32%-42%	Normal
Platelet count	86,000		150,000-400,000 mm3	Decreased thrombocytopenia

Feb 17, 2010 @ 1:15am	Results	Normal range	Interpretation
Hematocrit	36.5	32%-42%	Normal
Platelet count	80,000 mm3	150,000-400,000 mm3	Decreased thrombocytopenia

Feb 17, 2010 @ 9:00 am	Results	Normal range	Interpretation
Hematocrit	37.3	32%-42%	Normal
Platelet count	92,000	150,000-400,000 mm3	decreased

Feb 17, 2010 @ 1:35 pm	Results	Normal range	Interpretation
Hematocrit	35.2	32%-42%	Normal
Platelet count	110,000	150,000-400,000 mm3	decreased

Feb 17, 2010 @ 5:00 pm	Results	Normal range	Interpretation
Hematocrit	35.4	32%-42%	Normal
Platelet count	118,000	150,000-40,000 mm3	decreased

Feb 18, 2010 @ 7:30 am	Results	Normal range	Interpretation
Hematocrit	35.4	32%-42%	Normal
Platelet count	124,000	150,000-400,000 mm3	decreased
Feb 19, 2010 @ 8:40 am	Results	Normal range	Interpretation
Hematocrit	33.3	32%-42%	Normal
Platelet count	180,000	150,000-400,000 mm3	Normal

Valencia Sanitarium & Hospital Feb. 17, 2010	Results	Normal range	Interpretation
Urinalysis
Color	light yellow	Straw to dark yellow	Color change- due to drugs, diet or disease
Transparency	clear		Normal
pH	6.5	4.6-6.5	normal
Specific Gravity	1.005	Newborn: 1-1.02 Infants: 1.002-1.006 Adults: 1.016-1.022	decreased
Albumin	negative	30-50 g/
Glucose	negative	Negative	normal
Pus cells	1-4
Epithelial cells	few	Small amounts	Excessive – renal disease
Bacteria	few	None	If present- GUT infection/contamination of external genitalia

References:

Fishbach (2004) Manual of Laboratory and Diagnostic test, p. 72-73

Cherbecky (1997) Laboratory test and Diagnostic Procedures 2^nd ed. p. 592