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NR511 MIDTERM ACTUAL EXAM COMPLETE
QUESTIONS AND DETAILED ANSWERS|ALREADY
GRADED
A genetic predisposition toward allergic reactivity may be the most important etiological factor in all atopic conditions. Correct Ans- A personal or family history of all or part of the "atopic triad"—asthma, allergic rhinitis, and eczema—is often present. A worry in pediatric patient with epiglottis Correct Ans- can indicate that airway obstruction is imminent: stridor, restlessness, nasal flaring, as well as the use of accessory muscles of respiration Actinic Keratosis Correct Ans- a precancerous skin growth that occurs on sun-damaged skin. Acute Angle-Closure Glaucoma Correct Ans- Results in increased intraocular pressure (IOP). Is an emergency where left untreated, can cause blindness Acute Angle-Closure Glaucoma S/S Correct Ans- Occurs suddenly with a dramatic onset of symptoms, including blurred vision, red eye, unilateral pain, pressure, headache, seeing halos around lights and photophobia followed by loss of peripheral vision, then central vision loss.
Age-related cataracts tend to be Correct Ans- Bilateral in nature and may manifest as blurred or distorted vision, with complaints of a glare when driving at night or in bright light. Allergic rhinitis results from Correct Ans- immunoglobulin E (IgE)- mediated type I hypersensitivity to airborne irritants affecting eyes, nose, sinuses, throat, and bronchi Atopic Dermatitis Correct Ans- Excess inflammation; dry skin, redness, and itching from allergies and irritants. Almost always the itch occurs before the rash. Bacterial Conjunctivitis symptoms Correct Ans- Red eye with crusted eye lid. May have watery and itching eyes that may be associated with photophobia but visual acuity will be normal. Balanitis Correct Ans- Candidiasis in the glans of the penis Bilateral, high-pitched tinnitus may occur with Correct Ans- Severe hypertension (diastolic blood pressure exceeding 120 mm Hg); blood pressure should be evaluated via orthostatic measurements Blepharitis Correct Ans- Inflammation around the eyelid margins that is caused by staphylococcal infection at the lash base and dysfunctional Meiobian glands.
Classic sign of otitis external Correct Ans- tenderness on traction of the pinna and/or pain on applying pressure over the tragus. There is typically an erythematous ear canal, and usually a history of recent swimming; important to dry out the ear Conductive hearing loss: Correct Ans- Bone conduction is greater than air conduction, so the patient will report the bone conduction sound longer than the air conduction sound Confirmation of sinusitis Correct Ans- URI for at least 7 days, or the presence of 2 or more of the following signs and symptoms: colored nasal drainage, a poor response to decongestants, facial or sinus pain (especially if aggravated by postural change) and headache Diagnosis of acute otitis media Correct Ans- is made by otoscopic examination. The tympanic membrane will appear red and bulging with or without visible effusion. Light reflex is usually diminished or absent. Mobility is decreased (not increased). The external auditory canal is red and erythematous; Differential diagnoses for scabies Correct Ans- Atopic dermatitis, contact dermatitis and folliculitis Differential diagnoses for seborrhea keratosis Correct Ans- Benign pigmented nevi, pigmented basal cell carcinoma (BCC), and malignant melanoma
Differential diagnosis of hoarseness Correct Ans- Papillomatosis (which is related to an infection) Differential diagnosis to furuncle if located on axilla Correct Ans- Hidradenitis suppurativa (A long-term skin condition characterised by painful bumps under the skin. It usually occurs in the armpits, groin, buttocks or breasts) Dry eyes- what hx to focus on Correct Ans- Focus on current medications, any symptoms of fever, genital discharge, rash or joint pain; smoking history or second-hand smoke exposure Easy teaching for acne Correct Ans- Washing the face gently at least twice a day with an antibacterial soap Epidermal Inclusion Cyst Correct Ans- The client with an epidermal inclusion cyst will report a history of the cyst on the same site for months to years. In contrast, furuncles (boil) are an acute process, taking only several days to form. Another characteristic of an epidermal inclusion cyst is a cheesy white discharge with a strong odor when it is expressed. Epiglottis Correct Ans- A symptom cluster of severe throat pain with difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and fever but without pharyngeal erythema or cough is indicative of epiglottitis.
Furuncle Correct Ans- Boil. Painful red bumps under the skin due to infection of hair follicles or in oil glands. It starts as red, tender lump at the infection area and may grow to form pus-filled lumps. Hallmark characteristics of HSV-1 or HSV-2 conjunctivitis Correct Ans- Skin vesicles (if present) and a corneal infection with a "dendrite" appearance Hallmark for viral conjunctivitis Correct Ans- Preauricular lymph node swelling and tenderness Herpes Simplex symptoms Correct Ans- - Blistering sores - either oral or genital
- Itching
- Pain during urination - in case of genital herpes
- Fever
- Headache
- Tiredness
- Lack of appetite herpes zoster (shingles) Correct Ans- Caused by varicella-zoster Characterized by a unilateral vesicular rash along a dermatome, most commonly a thoracic or lumbar dermatome. The rash begins as erythema, then changes to papular lesions that rapidly form vesicles. The vesicles rupture, releasing infectious fluid, and then form scabs.
Herpes Zoster ophthalmicus Correct Ans- •Is shingles involving the eye or the surrounding area. •Common signs include a rash of the forehead with swelling of the eyelid. There may also be eye pain and redness, inflammation of the conjunctiva, cornea or uvea, photophobia, mucoid discharge. Fever and tingling of the skin and allodynia near the eye may precede the rash. Cornea may be clear or cloudy Herpes Zoster Ophthalmicus first line of defense Correct Ans- Vaccination Herpes Zoster Ophthalmicus treatment Correct Ans- Antiviral medication (acyclovir), preferably initiated within 72 hours of rash onset Highly sensitive tests will lead to Correct Ans- positive findings for patients with a disease Hives Correct Ans- First step is making sure patient is not having any breathing difficulties. If so epi is needed. Otherwise, treat with antihistamines. If a client has persistent sore throat, fever and malaise and has not responded to treatment, tests for Correct Ans- infectious mononucleosis and streptococcal antibiotic sensitivity should be performed. Perform a Monospot test next
Medication for otitis media Correct Ans- Healthy pediatric clients with mild symptoms and no day-care attendance and no antibiotics within the past 90 days, the standard Amoxicillin dose is: 40-45 mg/kg/day PO in two divided doses for 10 days Mono S/S Correct Ans- •Fatigue, sore throat, and low-grade fever. •Nasal and throat mild erythema Edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. Mononucleosis will have what inflamed lymph nodes Correct Ans- posterior cervical lymph nodes No evidence that taking supplements such as Vitamin, E, C, and beta- carotene helps in the prevention and treatment of cataracts Correct Ans- True NPs are reimbursed at 85% of the physician's fee Correct Ans- True Overuse of decongestant nasal sprays can cause rebound rhinitis Correct Ans- Is characterized by nasal congestion without rhinorrhea following the short-term use of topical vasoconstrictive medications. Can be remedied by immediately stopping all topical decongestant use. The condition typically resolves after 2 to 3 weeks.
Part A of medicare Correct Ans- helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice Part B of medicare Correct Ans- Outpatient services; Provider visits; Surgery; Lab tests; Medical equipment; Preventative exams Part C of medicare Correct Ans- Wellness services; Vision exams; Hearing exams; Eye glasses; Hearing aids Part D of medicare Correct Ans- Prescription drugs Patient education on pediculosis Correct Ans- Itching may continue for up to a week after successful treatment because of the slow resolution of the inflammatory reaction caused by the lice infestation. Patients with Seborrhea Keratosis generally complain of what? Correct Ans- The typical client is an older white woman who complains of the cosmetic effects of the lesion. The client typically complains of the unsightliness of the lesion, itching, and constant irritation from friction or clothing. Pediculosis Correct Ans- infestation with lice. Pediculosis hallmark Correct Ans- nits are firmly cemented in place and, therefore, do not slide easily on the hair shaft, compared with dandruff scales. Sebaceous plugs result from plugged oil glands on the scalp and (unlike nits) do not originate on the hair shaft.
Scabies Correct Ans- contagious skin disease transmitted by the itch mite. Transmitted through direct contact. Seborrhea Keratosis Correct Ans- Lesions are superficial epithelial growths that originate from the horny layer of the epidermis and are the result of a benign proliferation of immature keratinocytes. Seborrhea Keratosis is not considered malignant Correct Ans- True See table 19.1 for medications used to treat conjunctivitis Correct Ans- Self care for dry eyes Correct Ans- Wearing goggles when swimming; using a preservative-free artificial tears preparation; taking frequent rest periods from the computer and hand-held electronic devices Sensitivity of a test Correct Ans- proportion of true positives out of all patients with a designated condition Sensorineural loss of hearing Correct Ans- Comes from exposure to loud noises, inner ear infections, tumors, congenital and familial disorders, and aging. Severe tinnitus is associated with Correct Ans- depressive disorders and pt should be referred to psych
Sinusitis - most commonly affected sinus Correct Ans- Maxillary sinus Specificity of a test Correct Ans- the proportion of patients WITHOUT disease who have a NEGATIVE test Strategies to minimize symptoms of tinnitus include Correct Ans- Playing background music during the daytime and before sleep to mask the noise of tinnitus, smoking cessagionand decreasing the intake of caffeine, chocolate, alcohol, and salt Stye Correct Ans- subconjunctival hemorrhage Correct Ans- Bright red blood in a sharply defined area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage. subconjunctival hemorrhage risk factors Correct Ans- - valsalva type maneuvers, blood-thinners, diabetes and HTN.
- is self-limiting and resolves on it's own.
- Patients with visual changes or with more extensive hemorrhage should be referred to an ophthalmologist or ER. Sudden and severe IOP elevation can cause Correct Ans- Severe damage to the optic nerve
The problem with warts is they are easy to treat but reoccur often Correct Ans- True Things that spread warts Correct Ans- Abrading the skin, vigorous rubbing, shaving, and nail biting. Tinea Corporis Correct Ans- Annual lesions with scaly borders and central clearing on the trunk; has ring-shaped lesions (ring worm) with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk. Caused by a fungal infection. It's usually an itchy, circular rash with clearer skin in the middle. Ringworm gets its name because of its appearance. No worm is involved. Tinea Cruis Correct Ans- known as Jock itch. it is found in the groin area brownish-red lesions in groin area, pruritus, skin excoriation Tinea Pedis Correct Ans- fungal infection of the foot; athlete's foot Tinea unguium or onychomycosis Correct Ans- White or yellow nail discoloration,thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails
Tinea vesicular (versicolor) Correct Ans- A common fungal infection that causes small, discolored patches of skin. Tinnitus Correct Ans- Ringing or buzzing noise in one or both ears that may be constant or come and go, often associated with hearing loss. Treatment for actinic keratosis Correct Ans- Most often cryotherapy Treatment for resistant staphylococcal infections Correct Ans- Discontinue the Bacitracin and order a quinolone antibacterial ointment or a sulfacetamide/corticosteroid combination that, like erythromycin, has been shown to be effective against Staphylococcus. Treatment for Rosacea Correct Ans- Metronidazole cream is the mainstay of therapy, but it may take up to 6 to 8 weeks for a therapeutic response to be seen Treatment for scabies Correct Ans- Ivermectin (Stromectol) is the most common and best systemic treatment for scabies. Treatment for tine unguium Correct Ans- Topical antifungals such as nystatin, clotrimazole, miconazole, terbinafine, and circlopirox Treatment of Blepharitis Correct Ans- Bacitracin 0.5% ointment
middle ear pressure, may be relieved by the use of nasal steroids and oral decongestants What do the lesions of Seborrhea Keratosis look like Correct Ans- May reveal dark keratin plugs or firm, horny cysts on their surface. What problem can cause conductive hearing loss? Correct Ans- Serous otitis media What to do for hoarseness (Dysphonia) Correct Ans- Laryngoscopy When a referral for otitis media may be necessary Correct Ans- A change in hearing threshold greater than 25 dB and has speech and language delays would indicate more aggressive treatment is needed When impetigo lesions are present on the upper extremities what lymph node may be enlarged Correct Ans- Axillary nodes When the face has impetigo what lymph nodes are enlarged Correct Ans- cervical lymph nodes (and sometimes the preauricular and submandibular nodes) Who do we refer patients with actinic keratosis to Correct Ans- Dermatology
Who is at risk for fungal infections? Correct Ans- immunocompromised Diabetics Antibiotic therapy
