NR602 Final Study Guide CORRECT QUESTIONS & ANSWERS, Exams of Nursing

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NR602 Final Study Guide CORRECT QUESTIONS

& ANSWERS

Treatment of mild of moderate dehydration - ANSWER - oral hydration solutions

• continue breastfeeding with ORS supplement
  • offer young child 20mL/kg per hour
• offer older child er 100mL of ORS every 5 mins
• combine with IV therapy as needed
• avoid juice, soft drinks, and sport drinks Treatment of severe dehydration - ANSWER - IV therapy of LR or NS
• under 1 = 30mL/kg over first hour, then 70mL/hr for following 6 hours, and 100mL/kg from 6 to 24 hours
• over 1 = 30mL/kg over first 30 minutes and 70mL/kg for the following 3 hours. Reassess every 15 to 30 minutes Mild dehydration - ANSWER 3-5% decrease in weight Moderate dehydration - ANSWER 6-10% decrease in weight Severe Dehydration - ANSWER 11-15% decrease in weight Colic - ANSWER Crying for no apparent reason that lasts for 3 hours or more per day and occurs 3 days or more per week in an otherwise healthy infant younger than 3 months of age. Appendicitis - ANSWER Inflammation of the appendix that leads to distention and ischemia that can result in necrosis, perforation, and peritonitis, or abscess formation. Signs and symptoms of appendicitis - ANSWER pain, nausea and vomiting, anorexia, fever

Result findings of appendicitis - ANSWER - CBC may show increased WBC with an increased neutrophil

• UA can show small numbers of WBC (<20) and RBC (<20) An increased risk when having diarrhea is - ANSWER dehydration Acute diarrhea is typically caused by - ANSWER Viruses like rotavirus, bacteria, and parasites Rotovirus is common in children age - ANSWER 3 to 15 months Chronic diarrhea can be caused by - ANSWER Antibiotic treatment of another condition, poor absorption of starches and sugars, food allergies, laxative abuse in eating disorders, hyperthyroidism, or IBS Acute cases of diarrhea treatment includes - ANSWER Supportive care such as fluid and electrolyte replacement and/or anti diarrheal based on age Chronic cases of diarrhea treatment includes - ANSWER Treating underlying cause Appendicitis fever - ANSWER Neither sensitive nor specific; many children are a febrile or low grade fever. High fever in appendicitis - ANSWER Consider perforation Rovsing's sign or rebound tenderness - ANSWER Pressure deep in LLQ with sudden release elections RLQ pain; strong suggest peritoneal irritation Esophageal FB lodge at three spots most commonly - ANSWER - Thoracic inlet where skeletal muscle changes to smooth muscle
• mid-esophagus where the aortic arch and carina overlap the esophagus
• lower esophageal sphincter (LES).

Symptoms of Esophageal FB - ANSWER Choking, gagging, and coughing. Excessive salivation, dysphagia, food refusal, emesis/hematemesis, or pain in the neck, throat, or eternal notch Enuresis - ANSWER Voluntary or involuntary urination at an age when toilet training should be complete. Secondary enuresis - ANSWER Present when children have been dry for more than 6 to 12 months and then begin wetting Nocturnal enuresis - ANSWER Incontinence during sleep Diagnosis of enuresis - ANSWER Minimum age of 5 years old and one episode a month for a duration of 3 months Drug treatment for enuresis - ANSWER Desmopressin acetate (DDAVP) children 6 and older

• oral 0.2mg daily at bedside; max 0.6mg/kg
• oral 120mcg melt at bedtime; max 240mcg/day Diagnosis - ANSWER UA is recommended and culture should be done if there are clinical symptoms to warrant it. Suspicious UA findings - ANSWER Foul odor, cloudiness, nitrites, leukocytes, alkaline pH, proteinuria, hematuria, pouring, and bacteriuria Adolescents with uncomplicated pyelonephritis treatment - ANSWER - amoxicillin clavulanate (875/125mg BID)
• cipro (500mg BID or ER 1000mg daily) Infants over 1 month with uncomplicated pyelonephritis can be treated with - ANSWER cefixime cephalexin

augmentin UTI symptoms in neonates - ANSWER Jaundice, hypothermia, failure to thrive, sepsis, vomiting or diarrhea, cyanosis, abdominal distention, lethargy UTI symptoms in infants - ANSWER Malaise, irritability, difficulty feeding, poor weight gain, fever, vomiting or diarrhea, malodor, dribbling, abdomen pain or colic UTI symptoms in toddlers and preschoolers - ANSWER Altered voiding patterns, malodor, abdominal/flank pain, enuresis, vomiting or diarrhea, malaise, fever, diaper rash UTI symptoms in school-age and older - ANSWER Frequency, urgency, discomfort, malodor, enuresis, abdominal/flank pain, fever/chills, vomiting or diarrhea, malaise. Congenital Hypothyroidism is defined as - ANSWER Abnormality in development of the thyroid gland during fetal life or a problem with the ability of the thyroid to make thyroid hormone. Congenital Hypothyroidism is the most common cause of - ANSWER preventable mental retardation Untreated congenital hypothyroidism leads to - ANSWER Irreversible brain damage and variable degrees of growth failure, deafness, and neurologic abnormalities signs and symptoms of congenital hypothyroidism - ANSWER - decreased activity

• poor feeding and weight gain
  • small stature or poor growth
    • jaundice
• hoarse cry Physical exam findings of congenital hypothyroidism - ANSWER - course facial features
• mottled, cool and dry skin
• developmental delay

• umbilical hernia
  • goiter Glucose in UA positive indications - ANSWER - Metabolic disorder (diabetes)
• recent high glucose intake
• oral corticosteroids
• galactose is Ketones in UA positive indications - ANSWER - dehydration
• starvation
• missed breakfast
• strenuous exercise
• stress
• fever
• metabolic problems (diabetes) Protein in UA positive indications - ANSWER - renal disease
• Orthostatic proteinuria
• dehydration PE findings of esophageal FB - ANSWER Respiratory symptoms such as steroid, wheezing, cyanosis, or dyspnea. Cervical swelling, erythema, or subcutaneous crepitation may indicate perforation. Drooling or pooling of secreations Swallowing lithium batteries greater than or equal to 20mm - ANSWER Emergency endoscopy for removal due to erosion or ulceration within 2 hours of ingestion Abdomen FB - ANSWER Then to pass through the remainder for the GI tract without difficulty unless greater than 5cm in diameter or 2cm in thickness

Abdomen FB symptoms - ANSWER Abdomen distention or pain, vomiting, hematochexia, and unexplained fever Rectal FB - ANSWER Small blunt objects will pass on own but large or sharp object should be retrieved after sedation to relax sphincter intussusception - ANSWER Part of the small intestine retracts into itself causing ischemia of the bowel. Symptoms of intussusception - ANSWER - Episodic abdominal pain with vomiting every 5 to 30 minutes. Vomiting is nonbilious initially.

• Some have no pain.
• screaming iwth drawing up of the legs with periods of calm, sleeping or lethargy
• stool, possible diarrhea with blood (currant jelly)

Physical exam of intussusception - ANSWER - lethargy

• fever may or may not be present
• glassy-eyed and groggy almost if sedated
• sausage like mass may be felt in RUQ with emptiness in RLQ (Dance sign)
• abdomen often distended and tender to palpating
• grossly blood or guaiac-positive stools Blood in UA positive indications - ANSWER - micro negative for RBCs = chemicals, illness, or drugs, burns, muscle trauma, physical child abuse, myositis, strenuous exercise
• micro positive for RBCs = external excoriation or renal problems Nitrite in UA positive indication - ANSWER Bacteria causing UTI Leukocytes in UA positive indication - ANSWER - pyuria (WBC in urine)

• inflammation from irritation or infection of vulva, vagina, or urethra, bladder or kidney inflammation with or without infection Urobilinogen in UA positive indication - ANSWER - hemolytic disease
• hepatic disease Bilirubin in UA positive indication - ANSWER - hepatic disease
• biliary obstruction What can be given or child 6 and older for dysuria - ANSWER Phenazopyridine TID
• 12mg/kg/day for 6-12 year olds
• 200mg for 12 and older unipolar depression - ANSWER presents in late childhood or early adolescence and can have a longstanding impact on quality of life. Unipolar depression treatment - ANSWER Selective Serotonin Reuptake Inhibitors (SSRI)
• should be started at low doses with dose increase or medication change only after 4 weeks. Paroxetine - ANSWER has been associated with increased suicidal thinking and actions in children and adolescents and should not typically be used to treat depression in this population Bipolar depression - ANSWER rapidly cycling moods and mixed episodes characterized by symptoms of both mania and depression together. Screening tool for Bipolar depression - ANSWER Young Mania Rating Scale (YMRS) treatment for bipolar depression - ANSWER combination of medications and psychotherapy

SSRI and bipolar depression - ANSWER SSRIs are not recommended as a mono therapy due to increased risk of trigger manic episodes or rapid cycling Bipolar depression referral - ANSWER Anyone who screens positive for mania Generalized Anxiety Disorder - ANSWER excessive or unrealistic worry about everyday life events that are out of proportion too he impact of the events. Self-regulation - ANSWER Ability to recognize and control impulses, mange stress and emotions, and exert self control Executive functioning - ANSWER Cognitive processes underline planning, goal-directed activity, and problem-solving, include attention, working memory, and inhibitory control Sensory processing - ANSWER Measures tactile sensitive, taste-smell sensitivity, movement, under- responsiveness, auditory filtering, low energy and weakness, visual and auditory processing Information processing - ANSWER How information is received, processed, and stored, as well as how it then produces output Autism Spectrum Disorder screening - ANSWER Recommended at 18 months and 24 months early signs of autism - ANSWER - avoiding eye contact

• showing little interest in peers or caretakers
  • limited language abilities
• frustration with minor changes in routine
• repetitive behaviors Mittelschmerz - ANSWER Pain during ovulation, often presents with acute lower quadrant pain similar to acute appendicitis and may lead to misdiagnosis and unnecessary surgery

Amenorrhea - ANSWER The absence of a menstrual period and is classified as primary or secondary Primary dysmenorrhea - ANSWER - Almost always associated with ovulation cycles

• usually occurs within the first 6 months after menarche
  • typical age of onset if 16 to 25
• symptoms increase in severity with age Primary dysmenorrhea causes - ANSWER - turners syndrome
• kallmann syndrome (low LH and FSH)
• obstructed vagina
• uterine dysplasia
• eating disorder
• excessive exercise Secondary dysmenorrhea causes - ANSWER - pregnancy
• contraception
• antidepressants
• chemotherapy
• PCOS
• premature ovarian failure
• hypothyroidism Risk factors for primary dysmenorrhea - ANSWER - age under 30
• BMI under 20
• tobacco use
• early menarche
• history of sexual abuse
• premenstrual emotional symptoms
• history of pelvic surgery

• depression Primary dysmenorrhea treatment - ANSWER - NSAIDs to decrease overproduction of prostaglandins to reduce pain
• Combined oral contraceptives to suppress ovulation and proliferation of endometrial tissue to decrease prostaglandins and reduce menstrual flow
• heat application to the abdomen
• herbs and vitamin supplements such as vitamin E may provide some relief secondary dysmenorrhea - ANSWER Pain due to an underlying pelvic pathology
• is suspected if pain occurs during the first few cycles after menarche or starts after the age of 25 or there is no improvement with the use of NSAID or oral contraceptives Most common cause of secondary dysmenorrhea - ANSWER Endometriosis Endometriosis - ANSWER Growth or multiple growths (polyps) of endometrial tissue found outside of the uterine cavity Endometriosis symptoms - ANSWER - dysmenorrhea
• painful intercourse (dyspareunia)
• rectal pain with defecation
• urgent micturition Endometriosis treatment - ANSWER - NSAIDs or oral contraception
• conservative surgical management (D&C)
• hysterectomy Uterine Fibroids - ANSWER Benign tumors of the uterine myometrium
• range in size
• single or multiple

Most common indication for hysterectomy - ANSWER uterine fibroids Abnormal uterine bleeding (AUB) - ANSWER Bleeding that is atypical in frequency, regularity, duration, and timing Structural abnormalities associated with AUB - ANSWER - Polyps

• Adenomyosis
  • Leiomyoma
• Malignancy and hyperplasia Nonstructural abnormalities associated with AUB - ANSWER - coagulopathy
• ovulation y dysfunction
• endometrial
• iatrogenic
• not yet classified Pelvic Inflammatory Disease (PID) - ANSWER occurs in the upper female genital tract and includes any combination of endometriosis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis Toxic Shock Syndrome - ANSWER Severe illness with an acute onset characterized by fever, low blood pressure, a sunburn like body rash, and end-organ damage. Polycystic ovary syndrome - ANSWER Disorder that causes enlarged ovaries and ovarian cyst Treatment of GAD - ANSWER Combination of cognitive-behavioral therapy (CBT) and medication Medications options for GAD - ANSWER - SSRI first-line recommendation
• benzodiazepines for short-term treatment; such as phobias of dental or medical treatments

Obsessive compulsive disorder symptoms - ANSWER Persistent, intrusive thoughts (obsessions) and repetitive behaviors performed to decrease obsession-related anxiety (compulsions). Diagnostic criteria for OCD - ANSWER - time consuming (greater than 1 hour/day)

• disrupts normal routines, functioning, or relationships Screening tool for OCD - ANSWER Short Obsessive Compulsive Disorder Screener (SOCS) Treatment for OCD - ANSWER - Refer to mental health specialist
• first line for mild to moderate is psychotherapy or in combination with SSRI and clomipramine
• atypical antipsychotics in extreme cases Attention Deficit Hyperactive Disorder (ADHD) - ANSWER developmentally inappropriate levels of inattention, disorganization, hyperactivity, and impulsivity Symptoms of ADHD - ANSWER Lack of attention to details, careless mistakes, not listening, losing things, diverting attention, forgetfulness, poor problem solving, difficulty completing task, disorganized, difficulty sustaining mental effort, excessive talking, blurting things out, not waiting for ones turn, interrupting, fidgeting, leaving ones seat, running/climbing, trouble quiet playing. Diagnostic criteria of ADHD - ANSWER - at least six symptoms of inattention and/or hyperactivity- impulsivity that interfere with functioning or development
• symptoms interfere with social, academic, or occupational functioning
• symptoms persist for six months or longer
• symptoms are present in two or more settings PCOS symptoms - ANSWER - trouble conceiving or infertility
• mood changes
• acne
• fatigue
• insulin resistance

• high testosterone levels
• excessive body hair growth
• weight changes and trouble losing weight
• ovarian cyst
• low sex drive
• irregular or missed periods
• male pattern baldness thinning hair Cervical intraepithelial neoplasia (CIN) 1 - ANSWER Mild dysplasia
• treatment watchful waiting with annual pap Cervical intraepithelial neoplasia (CIN) 2 - ANSWER moderate dysplasia
• removal of precancerous cells via Loop electrosurgical procedures (LEEP), cold knife cone biopsy, or ablation and resection Cervical intraepithelial neoplasia (CIN) 3 - ANSWER severe dysplasia / carcinoma in situ Cervical intraepithelial neoplasia (CIN) 4 - ANSWER Cancer invasive Cyclical breast pain - ANSWER - coincides with menstrual cycle
• engorgement and tenderness
• symptoms worst before menstruation
• dull or achy
• fibrocystic breast most common cause Non-cyclical breast pain - ANSWER - unrelated to menstrual cycle
• specific location
• constant or intermittent
  • tightness or burning

• caused by mastitis, cyst, inflammatory cancer, idopathic Extra-mammary breast pain - ANSWER - unrelated to breast
• referred pain
• torn/strained chest or shoulder pain
• rib injury Galactorrhea - ANSWER Nipple discharge may be benign or pathological mastalgia or mastodynia - ANSWER Breast pain is one of the most commonly reports symptoms in women with breast concerns. Mastalgia - ANSWER 90% of cases are benign Cyclic mastalgia - ANSWER 70% of women experience Moderate to sever breast pain - ANSWER 10-22% of women experience Non cyclic mastalgia - ANSWER Less common 25% of women experience Mastalgia causes - ANSWER Combined estrogen and progestin contraceptives hormone therapy antidepressants digoxin methyldopa cimetidine spirnolactone

oxymetholone chlorpromazine Fibroadenoma physical exam finding - ANSWER Discrete, smooth, round or oval, non-tender, mobile Cyst physical exam finding - ANSWER Discrete, tender, mobile, size may fluctuate with menstrual cycle Lipoma physical exam finding - ANSWER Discrete, soft, non tender, may or may not be mobile Women with milk discharge should be - ANSWER Screened initially for pregnancy and hyperprolactinemia Breast cancer typically presents as - ANSWER Firm, non tender, ill defined masses Red flag for breast cancer - ANSWER Unilateral bloody nipple discharge Herpes Simplex Virus - ANSWER Most common cause of genital ulcers and is more prevalent in women than men Herpes Simplex Virus symptoms - ANSWER Pain, itching, dysuria, urethral or vaginal discharge, and inguinal adenoapthy -may also have fever, myalgias, or headaches

• ulcerations may be present on genitals, anal region, and cervix Testing for HSV - ANSWER polymerase chain reaction (PCR) test Treatment for HSV - ANSWER - valacyclovir, acyclovir, and famciclovir
• encourage use of condoms
• recommend abstaining from sexual activity if symptomatic
• recommend informing sexual partners

Syphilis - ANSWER Bacterium that causes lesions or chancre at the site of entry

• chancre appear two to three weeks after infection and progresses from a papule to an ulcer Treatment for syphilis - ANSWER - Penicillin G - doxy if allergy to penicillin
• encourage use of condoms
• follow up in 6 months then yearly for repeat testing
• recommend informing sexual partners
• testing for HIV Gonorrhea - ANSWER - Urethritis with purulent drainage is the most common symptoms in males
• pain or burning with urination, vaginal discharge, or vaginal bleeding between periods in women
• symptoms emerge 2-5 days after exposure
• no lesions present Syphilis testing - ANSWER Serological testing Testing for Gonorrhea - ANSWER Nucleic acid amplification test (NAATs) Treatment for Gonorrhea - ANSWER - Ceftriaxone
• encourage use of condoms
• recommend informing sexual partners Chlamydia - ANSWER - urethritis and cervicitis that appears 7 to 21 days after exposure
• if left untreated can lead to PID
• no lesions present Testing for Chlamydia - ANSWER Nucleic acid amplification test (NAATs)

Treatment for Chlamydia - ANSWER - Doxycycline 100mg BID x7 days

• Azithromycin recommended in pregnancy
  • recommending informing sexual partners
    • encourage use of condoms
• recommend routine screening Tier 1 contraceptive - ANSWER 1% failure rate Tier 1 contraceptive types - ANSWER - progestin implants
• vasectomy
• IUD
• tubal ligation
• depot Medroxyprogesterone acetate (DMPA): Depo Tier 2 contraceptive - ANSWER 2-3% failure rate Tier 2 contraceptive types - ANSWER - combined oral contraceptive (COC) pillsL estrogen a nd progesterone
• monophonic oral contraceptive pill: progestin-only "mini pill"
• emergency contraception transdermal patch
• cervical ring Tier 3 contraceptive - ANSWER 20% failure rate Tier 3 contraceptive types - ANSWER - barrier methods
• condoms
• diaphragm
• cervical cap

• spermicidal form, film, sponge
  • natural family planning
• coitus interruptus (pullout) Early signs and symptoms of pregnancy - ANSWER - fatigue
• abdomen pain
• headache
• darkening of nipples
• sensitive breast
• rhinitis
• nausea
• frequent urination
• change in basal temp
• minor bleeding
• changes in taste
• menstrual delay Presumptive signs of pregnancy - ANSWER - amenorrhea (missed period)
• nausea and vomiting
• hyperpigmentation
• breast tenderness
• fetal movement Probably signs of pregnancy - ANSWER - uterine enlargement
• positive pregnancy test
• goodell's sign (softening of tip of cervix)
• Chadwick's sign (bluish tinged vagina and cervix)
• hegar's sign (softening of the uterus)
• ballottement

Positive signs of pregnancy - ANSWER - direct visualization of the fetus (ultrasound)

• fetal heart tones
  • fetal movement