CMN568 Unit 1 Review QUESTIONS WITH COMPLETE VERIFIED SOLUTIONS 2024/2025, Exams of Nursing

Download CMN568 Unit 1 Review QUESTIONS WITH COMPLETE VERIFIED SOLUTIONS 2024/2025 and more Exams Nursing in PDF only on Docsity! CMN568 Unit 1 Review QUESTIONS WITH COMPLETE VERIFIED SOLUTIONS 2024/2025 Acute viral rhinitis The most common pediatric infectious disease; otherwise known as the common cold 14 days How long can symptoms of acute viral rhinitis last? sudden onset clear or mucoid rhinorrhea nasal congestion fever sore throat and cough erythematous nose, throat, and TMs What are the symptoms of acute viral rhinitis? S. Pneumoniae H influenza M catarrhalis B-hemolytic strept What are the common pathogens of acute bacterial rhinosinusitis Nasal congestion purulent nasal discharge facial pain/pressure cough headache fever What are the symptoms of acute bacterial rhinosinusitis? <30 days How long does acute bacterial rhinosinusitis last? Can be either Is onset of acute bacterial rhinosinusitis gradual or sudden? 10 The general rule of thumb when considering tx for acute bacterial rhinosinusitis is that diagnosis should not be made until symptoms last longer than ___ days without improvement OR worsening of symptoms within 10 days after initial improvement of symptoms Treat with abx immediately What should the NP do if the pt presents with focal signs of acute bacterial rhinosinusitis such as periorbital edema, severe sinus tenderness, or severe headache? False T or F: Routine sinus X rays are recommended for uncomplicated acute sinusitis NSAIDS or acetaminophen All pts with acute bacterial rhinosinusitis should receive pain/fever control with what meds? <3 days How long can nasal decongestants be used to help symptoms? intranasal corticosteroids Use of ______________ sprays are recommended in all adults and may be useful for children with underlying allergic sinusitis 4 Use of OTC oral decongestant, antihistamines and cough/cold preps are NOT recommended in children <_____ years of age. Pain medication humidified air saline nose drops A child comes in with acute nasal congestion and rhinosinusitis x10 days. The NP understands this is most likely an upper respiratory tract infection (viral). What would the tx regimen consist of? Amoxicillin 80-90 mg/kg/day divided bid or amoxicillin-clavulanate 80-90 mg/kg/day divided bid for x10-14 days A child comes to the clinic with acute nasal congestion and rhinosinusitis with mild symptoms x10-14 days without any improvement. The NP understands this is likely bacterial sinusitis. What is the first line abx and duration of tx? cephalosporin or amoxicillin-clavulanate A child with bacterial rhinosinusitis is being treated with amoxicillin and symptoms have not improved after 3 days. What is the second line abx that would be initiated? Beta-lactamase stable abx A child with severe symptoms or immunosuppressed has acute bacterial rhinosinusitis. What is the abx of choice? Recurrent sinusitis Defined as successive episodes of bacterial infections of the sinuses, each lasting less than 30 days & separated by intervals of at least 10 days Chronic sinusitis Defined as episodes of inflammation of the paranasal sinuses lasting more than 90 days 3-4 weeks Almost always unilateral and a high fever is present; soft palate and uvula are displaced toward the uninvolved side, if untreated a lateral pharyngeal abscess can occur and cause airway obstruction. May need hosp. admission. Retropharyngeal abscess Occurs most commonly during first 2 years of life and is caused by beta hemolytic streptococci and S. aureau. Suspect this in an infant or child with fever, respiratory symptoms, neck hyper-extension, dysphagia, drooling, dyspnea, and gurgling respirations. Immediate hospitalization is required with surgical consult Strep pneumoniae H. Flu Moraxella catarrahalis What are the most common organisms of AOM? Strep pneumoniae Body is least likely to rid itself of this organism. Widespread vaccination with pneumococcal conjugate vaccine has caused a decrease in infections caused by this one, though it is still common Hamophilus influenzae This is not the flue and it is not a virus, it is a bacteria. Most babies are immunized against this. AOM is often caused by unencapsulate, non-typeable. Viral upper respiratory infection AOM is often preceded by a _____________ infection with secondary bacterial infection. Acute otitis media fever, pain, decreased sleep, decreased appetite, middle ear effusion determined by pneumatic otoscopy or typanaometry. Inflammation of TM, red TM, bulging TM, decreased mobility of TM, decreased light reflex and visibility of landmarks. refer to physician What should you do if a child is under 3 months of age and presents with AOM meningitis The younger the child, the more likely to develop _______ after having AOM. In a child with fever or AOM, always assess for nuchal rigidity and pneumonia. mastoid Palpate the _______ area behind the ear for tenderness or swelling. retracted TM may be ______ in very early AOM but generally bulges as AOM progresses 3 AFter symptoms of AOM have resolved, fluid may remain in the middle ear for up to ___ months. If longer, refer for a hearing test and consideration of PE tubes. OME There is conductive hearing loss during _______ 20 Hearing loss over ___ decibels after 3 months is considered significant Flat tympanogram fluid filled middle ear = __________ tympanogram with negative peak pressure obstructed eustachian tube =_________ AOM Diagnosis of _______ is based on signs of TM inflammation and effusion Amoxicillin 90 mg/kg/day divided bid x 5-7 days (max 1000mg/dose) First line treatment for AOM in children older than 2 years? Amoxicillin 90 mg/kg/day divided bid x10 days First line treatment for AOM in children under 2 years? cefuroxime cefpodoxime, or cefdinir What abx can be given for AOM if amoxil causes rash? Trimethoprim-sulfamethoxazole Azithromycin What abx can be given for AOM if amoxil causes urticaria or other serious allergic reactions? One time dose of IM ceftriaxone If a child is unable to take oral meds for AOM, what can be given instead? Amoxicillin-clavulanate (augmentin) Dose so that amoxil dose is 90 mg/kg/day If there is no improvement of AOM after 48-72 hours of amoxil, what should you switch to? H. flu If there is failure of amoxil to work, what is usually the causative organism for AOM? Amoxicillin-clavulanate If a child is being treated for AOM but received abx in the last month, what abx should be given? Cefuroxime or IM ceftriaxone What are the 2 best alternative to augmentin? Macrolides __________ are not very effective against H flu and s pneumoniae may be resistant. Auralgan What topical anesthetic drops can be used only if TM is intact? Erythromycin, clarithromycin, or azithromycin What abx are given to PCN allergic children. 2, 3, 4 Choose all that apply to watchful waiting for AOM in children. 1. Infant younger than 6 months 2. Child >/ 2 years old with bilateral AOM without otorrhea 3. Child 6 mo - 2 years with unilateral AOM without otorrhea 4. Child >/ 2 years old with unilateral AOM without otorrhea 5. Child 1 years old with unilateral AOM with otorrhea 6. Child 6 mo- 2 years with bilateral AOM without otorrhea glue ear severe OME; may cause severe, immobile, retraction of TM Otitis media with effusion middle ear effusion that occurs in response to allergies which cause inflammation and swelling of the eustachian tube or may be residual up to 16 weeks after AOM Otoscopy This is used to diagnose OME. There is more movement with negative pressure than positive except with glue ear where there is no movement light When using an otoscope on a child with OME, in come cases you will see only dullness and an interrupted _________ reflex and other times the incus will appear to be protruding. air-fluid An _______ line or bubbles behind the TM are sometimes seen with OME Otitis externa An inflammation of the ear canal usually caused by bacteria or fungus Fluoroquinolone drops What topical abx is used for OE? ciprodex fluoroquinolone drops with steroids for OE? silver nitrate can cause chemical conjunctivitis with horrible drainage in a new born? clarity In a well baby check, look for ______ of cornea and red reflex and drainage. chlamydia what is a leading cause of opthalmia neonatorum? Chronic dacryocystitis This is another common condition that causes drainage of he eye in the newborn, caused by partial nasolacrimal duct obstruction Augmentin M catarrhalis strep aureu What are common causes of bacterial conjunctivitis Redness and purulent drainage eyes matted in the morning unilateral or bilateral may have symptoms of URI Usually no adenopathy What are the S/S of bacterial conjunctivitis? Warm compresses Abx drops What is the tx for Bacterial conjunctivitis? Erythromycin Polymyxin trimethoprim Sulfacetamide Azithromycin Ciprofloxacin Levofloxacin Ofloxacin List the abx drops/ointments used for bacterial conjunctivitis Chlamydia N. Gonorrhea When are systemic abx required for bacterial conjunctivitis? Check visiual acuity and pupillary reaction What should you do if someone comes in complaining of eye pain? foreign body sudden onset of pain, tearing and redness in one eye Use anesthetic drops prior to exam, evert eyelid, remove object by flushing with NS or cotton tip applicator What should you do for someone with a foreign body in their eye? Corneal abrasion Sudden severe unilateral eye pain, tearing, redness Flourescein dye and woods or cobalt blue lamp What should be used to examine the eye for a corneal abrasion? Abx gtts or ointment Tylenol Atropine opthalmic DO NOT GIVE ANESTHETIC DROPS FOR HOME USE What is the tx for corneal abrasion? 24 hours When should someone with a corneal abrasion follow up? Blepharitis Redness irritation of eyelid margins, may be accompanied by dry eye symptoms and conjunctivitis bacterial overgrowth meibomian gland obstruction staph Causes of blepharitis? eyelid scrubs with baby shampoo, warm compresses and topical abx ointmen Treatment for blepharitis? Chalazion Obstruction of meibomian glands with inflammation and granuloma formation. S/s include eyelid nodule with localized redness Eye lid scrubs with baby shampoo, warm compresses and topical abx ointment Treatment for chalazion? Hordeolum (Stye) Tender red warm papule on eyelid caused by localized infection in the glands of Zeis of eyelid, usually with staph Warm compress may help lesion to point and drain topical abx with polysporin or sulamyd ointment treat blepharitis if present Treatment for hordeolum (stye) Preorbital cellulitis Redness and edema of eyelids, pain and fever. Vision and eye movement normal unless orbital cellulitis is present. It is caused by infection stemming from abrasion to eyelid, hordelum, dacryocystitis, or insect bite. Staph aureus S. pyogens What are most common organisms of preorbital cellulitis Positive bruckner test The difference in the quality of the red flex between both eyes 3 Retinoblastoma is the most common intraocular malignancy of childhood, usually preseting before age _____ years. Leukocroria White reflex in pupil Leukocoria What is the most common presenting sign of retinoblastoma? Glaucoma strabismus red eye What other 3 symptoms may also be present with retinoblastoma? Acute closed angle glaucoma Keratitis Acute anterior uveitis (iritis) What are 3 emergent eye conditions in the adult? Acute closed angle glaucoma Rapid onset of severe unilateral eye pain, blurred vision with halos around lights. May be accompanied by nausea and abd pain. Redness, cloudy appearing cornea, dilated nonreactive pupil, and eye feels hard on palpation. Risk factors include increased age, farsightedness, genetic factors, and certain medications. Refer immediately What should you do for a pt with acute closed angle glaucoma? Pseudomona aeruginosa moraxella gram neg bacilli staph Common bacterial causes of keratitis? Karatitis Hazy cornea that may have a central ulcer, hypopyon (pus in the anterior chamber), diffuse erythema, usually painful eye, photophobia, grittiness, foreign body sensation, and blurred vision Uveitis Usually immunologic, but may be infection or neoplastic. S/s include unilateral eye pain, photophobia, may have blurred vision; Perilimal erythema (redness concentrated at borner of cornea and sclera) and cornea may be cloudy, pupil usually small but reactive. viral conjunctivitis Watery discharge, no purulent drainage, no eye pain, not caused by bacteria H. flu short acting nasal decongestants The following drugs used to treat persistent epistaxis are in what drug class: oxymetazolin, phenylaphrine, oxumetazolin? Presbycusis 24 hours Close follow up for a child 4wk-3 mo without a toxic appearance should take place when? Full septic workup What is the management for toxic appearing infant >3 mos to preschool age? Stool culture What should be obtained if a child has diarrhea? CXR What diagnostic test is needed for a child >3 mos -preschool with a cough, dyspnea, or high WBC? UA What diagnostic test is needed for all girls with fever and <2 yo or males <6 mos, or uncircumcised males < 12 mos? antipyretics and close follow up What is tx for non toxic infant >3 mos to preschool age with fever <39c and no obvious source of infection? Antipyretics consider empiric abx close follow up What is the tx for a non toxic infant >3 mos to preschool age with fever >39c and WBC > 15,000? Otitis externa Cellulitis of the soft tissues of the external auditory canal? Pseudomona aeruginosa staph aureus aspergillus or other fungi What are the common pathogens of otitis externa? edema, erythema of canal, may be swollen shut; severe ear pain made worse by mobement of the pinna or tragus What are the s/s of the external canal with OE? purulent What type of drainage is seen with OE? periauricular or cervical lymphadenopathy What might be seen with OE? AOM with TM rupture or patent PE tubes furnculosis, mastoiditis What are diff. dx for OE? Gentle removal of debri from canal if possible; gently irrigate with NS and a bulb syringe. Pain control with Tylenol or ibuprofen If you are able to visualize the TM, how can you treat OE? Fluoroquinolone drops: Ciprofloxacin/dexamethasone (Ciprodex) 4 gtts BID x7 days What is the first line abx tx for OE pseudomonas and staph What organisms are covered with fluoroquinolone drops? Neomycin/polymyxinB/Hydrocortisone (Cortisporin otic) Which gtts are not safe to use if TM is perforated or if PE tubes are in place? Pope ear wick What should you use if canal is swollen to allow abx drops to get deep into the canal? Acute otitis media Acute infection of the middle ear space with inflammation and effusion bulging TM middle ear effusion What two things must be present to diagnose AOM? strep pneumoniae h flu m cat strept pyogenes What are the common pathogens of AOM? winter months What time of year does AOM and viral URI increase? AOM Ear pain, fever, bulging inflamed TM, effusion, loss of bony landmarks and light reflex, yellow or white effusion behind TM, and purulent drainage (orrorrhea) if TM is ruptured or patent PE tubes in place 5 days What is the duration of abx treatment for AOM in child >6 yo with mild-mod symptoms? 7 days What is the duration of abx treatment for AOM in child 2-6 yo with mild-mod symptoms? 10 days What is the duration of abx treatment for AOM in child <2 yo or all peds with severe symptoms? Amoxicillin 80-90 mg/kg/day divided BID (max 1000mg/dose) What is the first line tx for AOM in children? Amoxicillin 1000mg tid for 7-10 days (max 4000mg/day) What is the first line tx for AOM in adults? Trimethoprim-sulfamethoxozole Macrolides: 'mycins What abx can be used for AOM in children with a severe PCN allergy? Amoxicillin clavulanate ES or Rocephin What can be used to treat otitis conjunctivitis syndrome? Flouroquinolone otic derops What is the first line tx for child with tympanostomy tubes and otorrhea but no systemic symptoms such as pain or fever? Amoxicillin or other first line tx If the child has a recurrence of AOM >4 weeks, what should tx consist of ? Otitis media with effusion Presence of middle ear effusion without signs of acute inflammation; usually painless and may precede or follow an episode of AOM Pneumonococcal (PCV13) and yearly flu vaccine What vaccines can help prevent AOM? whitish or amber color what color of the TM may be seen with OME? NO abx Have child return in 4 week intervals refer if continues >3 months in children <3 yoa What is the tx for OME? tympanosclerosis scarring of the TM and middle ear structures resulting in conductive hearing loss tympanic membrane rupture presents with drainage from the ear, usually heals on own but may need repair. Keep water out of ear Cholesteatoma granulation tissue develops causing a greasy looking mass near a retraction pocket or perforation. Refer to ENT, surgery usually needed C. Allergen A 19 yo woman presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by: A. bacterium B. Virus C.Allergen D. injury C. Polymyxin Treatment options in bacterial conjunctivitis include all of the following eye preps except: A. polymyxin B plus trimethoprim D. Mrs. Allen is a 67 year old woman with type 2 diabetes who complains of seeing flashing lights and floaters, decreased visual acuity, and metamorphopsia in her left eye. The most likely diagnosis is: A. Open angle glaucoma B. central retinal artery occlusion C. anterior uveitis D. Retinal detachment A Which of the following is a common vision problem in the person with untreated primary open angle glaucoma? A. peripheral vision loss B. blurring of near vision C. difficulty with distant vision D. need for increased illumination B Primary open angle glaucoma is primarily caused by: A. hardening of the lens B. elevated intraocular pressure C. degeneration of the optic nerve D. hypotension in the anterior maxillary artery A Which of the following is most likely to be found on the funduscopic examination in a patient with untreated POAG? A. excessive cupping of the optic disk B. ateriovenous nicking C. papilledema D. flame shaped hemorrhages A Key diagnostic findings in POAG include which of the following? A. intraocular pressure greater than 25 mm Hg B. papilledema C. cup to disk ratio great than 0.4 D. sluggish pupillary response D Treatment options for POAG include all of the following topical ocular agents except: A beta adrenergic antagonists B. alpha2 antagonist C. prostaglandin analogues D. mast cell stabilizers B A 22 year old woman presents witha pimple on her right eyelid. Examination reveals a 2 mm pustule on the lateral border of the right eyelid margin. This is most consistent with: A. Chalazion B. Hordeolum C. Blepharitis D. Cellulitis A A 22 year old woman presents with a bump on her right eyelid. Examination reveals a 2 mm hard nontender swelling on the lateral border of the right eyelid margin. This is most consisten with: A. Chalazion B. Hordeolum C. Blepharitis D. Cellulitis B First line treatment for uncomplicated hordeolum is: A. topical corticosteroid B. Warm compresses to the affected area C. incision and drainage D. oral antimicrobial therapy B A potential complication of hordeolum is: A. conjunctivitis B. cellutitis of the eyelid C. corneal ulceration D. sinusitis C Initial treatment for a chalazion is: A. topical fluoroquinolone B. Topical corticosteroid C. warm compresses of the affected area D. surgical excision D A cutaneous reaction nearly always occurs with the use of amoxicillin in the presence of infection with: A. Herpes virus type 1 B. HPV C. adenovirus D. Epstein-barr virus C A 27 year old woman present with ABRS that has failed to respond to 5 days of treatment with amoxicillin. She reports that she experienced an allergic reaction to levofloxacin a few years ago that caused a rash as well as swelling of the lips and tongue. In deciding on a new antimicrobial, you consider avoiding the use of: A. Amoxicillin-clavulanate B. Azithromycin C. Moxifloxacin D. Cefpodoxime D A 45 year old man presents with otitis externa. Likely causative pathogens include all of the following except: A. P aeruginosa B. Staph. aureus C. Aspergillus D. M. Catarrhalis A Risk factors for otitis externa include all of the following except: