NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated, Exams of Nursing

Download NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated and more Exams Nursing in PDF only on Docsity! NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 1 | 23 Strabismus Correct Answer: Misalignment of the eyes. Lazy eye or cross-eyed. Results in loss of depth perception and double vision. Assessment techniques to detect strabismus Correct Answer: Red light reflex Cover-uncover test Deviation of the weak eye outward Correct Answer: Exotropia Deviation of the weak eye inward Correct Answer: Esotropia Visual axis of one eye is higher than the fellow fixating eye Correct Answer: Hordeolum Correct Answer: Sty; an acute infection of a sebaceous gland of the eyelid Obstruction of the sebaceous glands or eyelid. Staphylococcal aureus is the most common causative organism. What might a patient with a hordeolum complain of Correct Answer: Swollen, red, painful lesion on the lid margin Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Internal - under eyelid Painful swelling Typically develops suddenly Treatment for a hordeolum Correct Answer: Warm compresses-20 minutes qid Antimicrobial ointment or drops Good eye hygiene and hand washing Chalzion Correct Answer: Chronic inflammation of the eyelid. Blocked meibomian gland - may result from internal hordeolum. NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 2 | 23 Often not painful but sensation of pressure. Develop over weeks to months. Clinical finding of chalzion Correct Answer: Mild erythema and edema of the eyelid that resolves and results in a painless, non-pigmented mass Itchiness of the eyelid Pimple or abscess in either lid External - next to eyelash Treatment of chalzion Correct Answer: Erythromycin drops or ointment if hordeolum is present Cellulitis develops - treat with erythromycin or cephalexin Most important vital sign for a patient with an eye complaint Correct Answer: Visual acuity Peritonsillar abscess (PTA) Correct Answer: Collection of pus or fluid around the tonsil Symptoms of PTA Correct Answer: Increased fever Anorexia Drooling Dyspnea Restless & irritable Muffled voice Stridor Respiratory distress Physical exam findings of PTA Correct Answer: Fiery red asymmetric swelling of one tonsil Uvula is often displaced and often forward Large, tender lymphadenopathy Management of PTA Correct Answer: Aspiration of the abscess may be performed for accurate diagnosis and treatment. NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 5 | 23 Treatment options for otalgia in AOM Correct Answer: Tylenol or ibuprofen Benzocaine (Auralgan, Americaine otic) Warm compresses Is it okay to not prescribe antibiotics for AOM in children? Correct Answer: Yes - in children with uncomplicated AOM (no fever or less than 102, unilateral, less than 7 days). Must teach parents what signs and symptoms to return for How to manage otalgia at home Follow-up plan in place Differential diagnosis for AOM Correct Answer: OME Mastoiditis Dental abscess Sinusitis Lymphadenitis Parotitis PTA Trauma TMJ 1st principal of management of AOM Correct Answer: Pain management Ibuprofen or tylenol Benzocaine Warm/cold compress of ears 1st line of treatment for AOM Correct Answer: Amoxicillin 80 - 90 mg/kg/day BID for 10 days If use of antibiotics for AOM in last 3 monthsm, antibiotic of choice? Correct Answer: Augmentin 80 - 90 mg/kg/day BID for 10 days If either Amoxicillin or Augmentin fail, referal to ENT NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 6 | 23 Alternative antibiotic management of AOM if PCN allergy Correct Answer: 1st line: Cefdinir, cefuroxime 2nd line: Azithromycin, clarithromycin 3rd line: Rocephin 1 or 3 days IM Bullous Myringitis Correct Answer: Mycoplasma pneumonia AOM in which bullae form between the inner and middle layers of the TM and bulge outward Intensely painful Treat with a macrolide When do you refer a pt for tympanostomy tubes? Correct Answer: Over 3 confirmed ear infections in 6 months OR 4 or more episodes in 12 months Treatment of children with AOM and tympanostomy tubes Correct Answer: Oral antibiotics + topical: Floxin otic (Ofloxacin) [1 yr - 12 yr] 0.3% - 5 gtts BID x 10 days Ciprodex (Cipro) [>6 months] 4 gtts BID x 7 days perforated tympanic membrane Correct Answer: Hole in eardrum Occurs in association with AOM Trauma - blow to ear, blasts, ear cleaning, FB insertion Perforated Tympanic Membrane s/s Correct Answer: Loss of hearing Blood drainage from the ear Pain Whistling sound when blowing nose or sneezing Spontaneous relief of pain w/ AOM NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 7 | 23 What medications are NOT safe to give with a perforated tympanic membrane? Correct Answer: Gentamycin Neomycin Tobramycin What medications are SAFE to give with a perforated tympanic membrane? Correct Answer: Fluoroquinolones Cholsteatoma Correct Answer: Result of chronic ear infections Involves the formation of an epidermal inclusion cyst of the middle ear or mastoid As it grows, destroys the surrounding structures Acquired or congenital S/S vertigo, hearing loss,pearly white lesion on or behind TM Mastoiditis Correct Answer: Suppurative infection of the mastoid cells Most common in children < 2 y.o. Accompanies AOM Antibiotics for AOM may mask mastoiditis w/ normal TM S/S: fever, otalgia, concurrent AOM unresponsive to antibiotics, postauricular swelling Urgent ENT referral At what age should visual screening begin? Correct Answer: 4 Can use the objects chart or E chart If strabismus is still present at what age should they ber refered for intervention? Correct Answer: 6 months At what age: NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 10 | 23 Symptoms of allergic conjuctivitis Correct Answer: Bilateral **Severe itching **Mucoid - string-like clear discharge Injected conjunctiva - more light pink than red Allergic shiners Allergic crease Rhinitis Treatment of allergic conjunctivitis Correct Answer: Based on removing exposure to allergen/irritant Cool compresses Remove contact lenses (risk for corneal abrasion when rubbing eyes) Artificial tears Oral or topical antihistamine may be used - Zaditor, Elestat, Optivar Topical decongestants - AK-con Mast-cell stabilizer - Alomide, Patanol, Alocril Major differences between viral, bacterial, and allergic conjunctivitis Correct Answer: Viral - profuse clear discharge, bilateral, URI symptoms Bacterial - purulent discharge, no URI symptoms, unilateral at onset Allergic - mucoid, stringy clear discharge, intensely itchy dacryostenosis Correct Answer: narrowing of lacrimal ducts prevents tears from flowing into the nasal mucosa opening dacryocystitis Correct Answer: inflammation of the nasolacrimal duct => can result in infection Symptoms of dacryostenosis Correct Answer: Continuous or intermittent tearing, stickiness, and mucoid d/c at inner canthus Blepharitis in lids & lashes Expression of thin mucopurulent exudate from punctum lacrimale Tenderness & swelling over lacrimal duct Eyelids stuck hut on awakening Fever Management of dacryostenosis Correct Answer: Warm compresses NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 11 | 23 Use cotton balls w/ warm water & rub from inside of eye to out Daily massage of the lacrimal sac Resulting bacterial conjunctivitis - erythromycin ointment or fluroquinolones When to refer dacryostenosis? Correct Answer: If persists over 1 - 2 weeks w/ interventions What is blepharoptosis? Correct Answer: Drooping of the upper eyelids affecting one or both eyes Congenital or acquired What is nystagmus? Correct Answer: Involuntary, rhythmic movements of one or both eyes Movement can be horizontal, vertical, rotary, or mixed Congenital or acquired Present 6 wks - 3 months if congenital Pediatric Cataract Correct Answer: Partial or complete opacity of the lens - 1 eye or both Most common cause of abnormal pupillary reflex Congenital - genetic i.e. down syndrome or albinism, family hx Acquired - use of systemic or ocular corticosteroids, prematurity, CNS anomalies Retinopathy of Prematurity (ROP) Correct Answer: Primarily caused by early gestaional age w/ LBW Abnormal growth of the retinal vessels in incompletely vascularized retinas of premies Incompletely vascularized retina in state of hypoxia -> stimulates production of vascular endothelial growth factor (VEGF) Higher supplemental O2 causes slowed VEGF = slowed vessel growth What is blepharitis? Correct Answer: Acute or chronic inflammation of eyelash follicles or meibomian sebaceous glands Bilateral Contaminated makeup or contact lens solution Corenal abrasion and symptoms Correct Answer: Damage to or loss of epithelial cells of cornea NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 12 | 23 Severe pain and photophobia Tearing Decreased vision Conjunctival erythema Sensation of FB Management of corneal abrasion Correct Answer: Minor abrasions heal spontaneously w/o scarring; topical anti-infectives; compresses Refer severe corneal injuries Otitis externa Correct Answer: Swimmer's ear- infection of outer ear Can involve the pinna or TM Most common pathogens of otitis externa Correct Answer: Pseudomonas & Staph Signs/Symptoms of otitis externa Correct Answer: Pain, severe, esp. w/ movement of the tragus (pushed) or pinna (pulled) Swollen EAC - may not be able to see TM which may be perf'd Red, crusty, or pustular speading lesions **Unilateral Low-grade fever Fullness Decreased hearing Differentials for otitis externa Correct Answer: AOM w/ perforation Chronic suppurative otitis media Necrotizing OE Mastoiditis Dental infection Eczema Herpes Zoster FB NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 15 | 23 -Saline nasal spray -Dedicated sinus irrigation two or more times a day -Oral analgesics for pain -Expectorants such as guaifenesin to liquefy sinus secretions and facilitate drainage -Anti- inflammatory topical steroids in nasal spray preparations Causes of epistaxis in pedatric population Correct Answer: Most common: Trauma Allergies Recent URI Dry air Others: Polyps Hemangiomas HTN Coagulopathy (prolonged & frequent episodes) Management of epistaxis in children Correct Answer: Sit upright and lean forward Apply pressure to boney structure for 10 min Packing and topical vasoconstrictor (Astrin) Air humidifier Sterile petroleum jelly or sterile saline gel What stage of tonsilar swelling are most children at? Correct Answer: 3 Should a patient who is drooling, having difficulty breathing, and exhibiting stridor be examined? Correct Answer: No, send directly to the ER w/o an exam Pharyngitis Correct Answer: inflammation of the throat or pharynx Most common cause is viral or group A beta hemolytic strep Usually has URI symptoms NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 16 | 23 Complications of pharygnitis Correct Answer: PTA RF Post-streptococcal glomerulonephritis How does mono differ from strep? Correct Answer: Usually no URI symptoms Fever N/V Rash Exposure to someone with mono Abd exam - check for liver or splenic enlargement Diagnostic tests for pharyngitis Correct Answer: Rapid antigen strep and culture for strep Mono spot if suspected & strep negative CBC w/ diff & LFTs if suspect mono Exudative pharyngitis Correct Answer: the white stuff! common in strep S/S of exudative pharyngitis Correct Answer: Rapid onset of sore throat Fever 103 - 104 Swollen anterior glands Children c/o abd pain, dec. appetitie, & vomiting HA No URI symptoms Dysphagia Irritability Physical exam findings of exudative pharyngitis Correct Answer: Strawberry tounge Rash Exudate on tonsils **Anterior cervical lymphadenopathy** Management of exudative pharyngitis Correct Answer: Throat culture -- gold standard Quick strep Mono spot if suspect mono - usually more exudate then strep 50% of kids w/ mono also have strep NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 17 | 23 Treatment of strep pharyngitis Correct Answer: Amoxicillin 50 - 80 mg/kg/day x 10 days If PCN allergy - cephalosporin or macrolide (1st choice) Warm water gargles Tylenol/NSAIDs Contagious! No school until on antibiotic for full 24 hrs What is the classic triad for the acute viral syndrome of Mono? Correct Answer: Fever Exudative pharyngitis Adenopathy (posterior cervical) S/S of mononucleosis Correct Answer: Fever, sore throat, swollen lymph glands, increased WBC, atypical lymphocytes, splenomegaly, enlarged liver Headache is usually the 1st symptom that appears before sore throat How long does mono last? Correct Answer: 3 - 4 week but can be up to 2 - 3 months Can adolescents go back to playing sports within 24 hours with mono? Correct Answer: Not if they have spleen enlargement. Must wait until spleen is no longer enlarged. Diagnostics for mono Correct Answer: Mono spot - 90% positive of cases May need to repeat if initially negative but symptoms persist. CBC LFTs Rapid strep EBV specific antibodies - VCA-IgM, VCA-AgG, EA, & EBNA Should concurrent strep with mono be treated with amoxicillin or PCN? Correct Answer: No, avoid rash by treating with erythromycin or a macrolide NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 20 | 23 Physical exam Management of impetigo Correct Answer: -Mupirocin or bactroban TID x 7-14 days if only a few lesions - Bacitracin TID x 7 - 14 days - Keflex (40 mg/kg/day x 10 days) or Erythromycin (30 - 50 mg/kg/day x 10 days) if systemic - Treatment fx switch to Septra b/c worry about MRSA -Reevaluate in 3-5 days -Gently wash with antibacterial soap to remove crust if Bactroban is used - Highly contagious - no school or daycare for 24 to 48 hrs - Wash sheets and pillowcases -Monitor for serious sequelae Macule Correct Answer: - flat, colored spot on the skin - Nonpalpable - <1 cm Papule Correct Answer: small, solid skin elevation < 1 cm Patch Correct Answer: A flat, discolored area on the skin > than 1 cm Vesicle Correct Answer: Fluid-filled < 1 cm Pustule Correct Answer: Raised spot on the skin containing pus < 1 cm Plaque Correct Answer: Raised, palpable a solid mass greater than 1 cm in diameter and limited to the surface of the skin Bullae Correct Answer: fluid filled blisters NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 21 | 23 > 1 cm Cyst Correct Answer: Raised, encapsulated, fluid-filled Wheal Correct Answer: raised red skin lesion due to interstitial fluid Circumscribed skin edema Crusts Correct Answer: Areas of dried pus and blood, commonly called scabs Varied colors Scales Correct Answer: Thin, flaking layers Lichenification Correct Answer: Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen). Furrows. Excoriation Correct Answer: Abraision or removal of epidermis, scratch or abraision Erosion Correct Answer: Oozing, moist area with loss of superficial epidermis Ulcer Correct Answer: Deeper than erosion with loss into the dermis What defines a throat infection? Correct Answer: - Temp >100.9F - Cervical lymphadenopathy w/ tonsillar exudate - +Group A beta-hemolytic strep (GABHS) What are indications for tonsillectomy? Correct Answer: - 7 infections in 1 year - 5-6 infections in 6 mo- 5 Infections /yr x 2yrs - Strep Carrier State - >3 Infections/yr x 3yrs - Recurrent Peritonsillar Abscess/Cellulitis - Suspicious Asymmetry Characteristics of an URI Correct Answer: **Gradual onset** Rhinorrhea - initially clear until day 3 changes to purulent back to clear w/ resolution by day 10 Sore throat Mild cough Low-grade fever NURS 629 Peds Exam 2. QUESTIONS WITH COMPLETE SOLUTIONS.(Verified Answers) Latest Updated 2024 Assured Success. Download To Pass P a g e 22 | 23 Virus-specific findings of a common cold Correct Answer: Mild injection of conjunctiva Red nasal mucosa w/ secretions of varying colors Mild erythema of the throat Anterior cervical lymphadenopathy Clear breath sounds Differentials for URI Correct Answer: Allergic rhinitis Rhinosinusitis Adenoiditis Treatment for URI Correct Answer: Symptomatic relief for fever, pain, and nasal congestion Acute Rhinosinusitis (ARS) Correct Answer: Persistent nasal symptoms for more than 10 days w/ URI, nasal drainage (purulent or discolored), cough Acute presentation w/ high fever, purulent rhinitis Lasts 10-30 days Treatment for ARS Correct Answer: Amoxicillin or Augmentin x 10 days Should be asymptomatic by day 7 If no change by 48 - 72 hours after start of antibiotics change tx of antibiotic Symptoms of viral pharyngitis Correct Answer: Pain Myalgia and arthralgia Fever Sore throat and dysphagia Rhinitis, cough, hoarseness, stomatitis, stridor, and conjunctivitis Non- specific rash or diarrhea Physical exam findings for viral pharyngitis Correct Answer: Erythema of the tonsils and pharynx Reactive cervical lymphadenopathy GABHS pharyngitis symptoms Correct Answer: Most common in 5 to 13 y.o.