Download NU 664 Exam 1 (100 out of 100) Questions and Verified Answers (GRADED A) and more Assignments Nursing in PDF only on Docsity!
NU 664 Exam 1 (100 out of 100) Questions
and Verified Answers (GRADED A)
Gold standard for CAP diagnosis: Chest x-ray If CAP symptoms present but no obvious signs of infection on CXR treatment is... Same as if CXR was positive Immunizations for people over 65 or younger people with comorbidities such as asthma, CHF COPD: Pneumonia and flu vaccines Who is at risk for CAP? Extremes of age, smokers, alcoholics, GERD, chronic disease, institutionalization CAP presentation in adults: Cough (may be nonproductive), dyspnea, fever, hemoptysis, chest pain, fatigue, tachycardia If lymphocytes are elevated? Indicative of viral process If monocytes are elevated?
Indicative of chronic process If eosinophils are elevated? Indicative of asthma, allergic reaction If basophils are elevated? Indicative of chronic process If neutrophils are elevated? Indicative of acute bacterial process CAP: patient present with symptoms of chills, fever, chest pain, productive cough with purulent sputum, positive chest x-ray, and patient had URI last week? Streptococcus pneumonia: gram + In the United States, the most common cause of myocarditis in children is: Viruses Your next patient is a 5-year-old child with a history of moderate persistent asthma. He has been wheezing and coughing for the past two days, and his mother brings him in today for evaluation. He has been using albuterol every four hours. His respiratory rate is 13 breaths per minute; his lungs are clear to auscultation; and no retractions are noted. What may be your assessment and intervention based on this information? Your child is breathing slower than normal for his age. We need to send him to the ER for further intervention.
Topical diphenhydramine and magnesium hydroxide. A 4 year old child with PE tubes in both ears has otalgia in one ear. The PNP is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the NP do? Order ototopical corticosteroid/antibiotic drops. The parent of a 1-week old is concerned about the unusual shape of their child's head. In the physical exam, which of the following signs would not support the diagnosis of craniosynostosis? A palpable lesion at the occipital region. A toddler exhibits exotropia of the right eye during a cover-uncover screen. The PNP will refer to pediatric ophthalmologist to initiate which treatment? Patching the unaffected eye for 2 hrs./day The most typical radiograph finding with a diagnosis of asthma Hyperinflation Nasal mucosa pale, boggy and edematous with allergic shiners Allergic rhinitis The category on your asthma action plan when you have had exposure to a known trigger, are coughing with wheezing, have a tight chest and are coughing at night. Yellow or cautious phase
Classification of asthma severity for a child who is 6 years old who has symptoms 3 days a week, uses his inhaler daily for exercise, but not otherwise, has minor limitation to activity and wakes 3 times a month with cough mild persistent asthma Should not be used to treat asthma in children under the age of 4? dry powder inhalers In addition to the routine PCV 13 vaccine series, sickle cell anemia patients older than 2 years of age should receive this once and then a booster in 5 years. PPSV cradle cap or seborrheic dermatitis Often treated with Selsun blue shampoo. Bilateral conjunctival injection, 5 days of fever, cervical lymphadenopathy, polymorphous exanthema, changes in peripheral extremities Kawasaki Disease First line treatment for allergic rhinitis Oral H1 antihistamines and/or intranasal steroids Treatment for 3 year old with intermittent asthma
Corneal abrasion A 4-month-old w/1-week hx of nasal congestion and occasional cough. Prior evening Temp 102F refused to breastfeed and had coughing and noisy labored breathing. On exam ill-appearing infant who is lethargic w/ tachypnea, wheezing, and intercostal retractions. Does not attend daycare but has a 3-year- old sibling who is in daycare and who recently had a "cold". Considering the clinical presentation what is the most likely cause of the infant's illness? RSV bronchiolitis A 6 year old hx of cough for 10 days, Fever 101.5 F in the past 24 hrs. Decrease appetite and complain of abdominal pain. Breathing faster than normal. Given the information, what is the most likely dx? Pneumonia A 12 day old concerned about breathing. Feeding stops breathing for 10 seconds. Eats well never appeared pale/cyanotic, and has never become limp during any of these episodes. What would the PNP discuss w/ the parents? I know this can be concerning. This can be a normal variant for infants. A child is diagnosed with community acquired pneumonia and will be treated as an outpatient. Which antibiotic will the PNP choose? Amoxicillin A school-aged child has had nasal discharge and a daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child? Amoxicillin 45mg/kg/day (treatment of acute rhinosinusitis (ARS) based on duration of symptoms without clinical improvement in symptoms)
The parent of a 3-month old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant? Begin a trial of extensively hydrolyzed protein formula for 2-4 weeks. PNP performs the vision screen on a four month old and notes the presence of convergence and accommodation with esotropia of the 1eft eye. What will the NP do? Refer the infant to a pediatric ophthalmologist What radiographic finding is diagnostic for croup? Steeple sign (Subglottic airway narrowing at the cricoid cartilage) A school-age child who has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3 F. An examination reveals petechiae on the soft palate, beefy-red tonsils with yellow exudate, and scarlatiniform rash. A rapid antigen detection test (RADT) is negative, what is the next step in the management for this child? Perform a follow-up throat culture We have an expert-written solution to this problem! Fluorescein staining could be used to detect this. Corneal abrasion Confirming the diagnosis that newborn chlamydia conjunctivitis would be best done by obtaining this. Culture of conjunctival scrapings
Examination of TM Pull auricle down and back in children <3 Pull auricle up and back for children > Conductive hearing loss hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles Sensorineural hearing loss hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness Treatment of otitis externa Withdraw any foreign bodies or debri by gentle irrigation Topical abx drops (ofloxacin) Insert cotton wick if significant swelling Analgesics Avoid getting ear wet Etiology of AOM After viral URI Highest incidence 6-36 months Winter/spring males First line therapy for AOM Amoxicillin (cefdinir if allergy) Second line therapy for AOM
Augmentin (no improvement 48-72 hrs, recurrence within 1 month, concomitant conjunctivitis) Third line therapy for AOM Ceftriaxone If allergic to penicillin what do you treat the AOM with Cephalosporin If a child is being treated for an AOM and is vomiting or unable to tolerate oral medication what do you prescribe Rocephin IV or IM Otitis media with effusion what is the most common organism H. influenzae What is the most common cause of hearing loss in children otitis media with effusion Refer to ENT for AOM Persistent, resistant to treatment over 1-2 months; 3 infections in 6 months or 4 infections in 1 year Management/treatment of OME
What is the most common cause of otitis media Streptococcus pneumoniae What groups are at risk for AOM children younger than 24 months, recent beta-lactam drugs, exposed to large number of other children, immune deficiency, smoke exposure in household, bottle fed With otitis media with effusion when should a myringotomy or tympanostomy tubes be considered children 6 month to 12 years who have had bilateral effusion for a total of 3 months or longer with documented hearing deficiency or for children with recurrent AOM who have evidence of middle ear effusion at the time of assessment for tubes Otitis Externa most common organism pseudomonas aeruginosa Acute otitis externa discharge color scant white mucous Chronic otitis externa discharge bloody Fungal otitis externa discharge
fluffy, and white to off-white discharge but may be black, gray, bluish-green, or yellow Retinoblastoma Tumor arising from a developing retinal cell Leukocoria abnormal appearance of a white film in the pupil Management/treatment of retinoblastoma Curable if diagnosed early Urgent referral to pediatric ophthalmologist; eval within 72 hours Chemo, radiation, laser therapy and/or surgical removal Genetic counseling Hordeolum Infection of meibomian glands (internal) or glands of Zeis or Moll (external or stye) of eyelid Treatment of hordeolum Warm compress May use topical anti-infective ointment (erythromycin or bacitracin/polymyxin B) Refer if mass fails to disappear after several weeks Retinopathy of Prematurity (ROP) Involves abnormal growth of retinal vessels in incompletely vascularized retinas of premature infant
Bacterial conjunctivitis medications Erythromycin ophthalmic ointment Trimethoprim-polymyxin B ophthalmic ointment or drops (Polytrim)
2 months old Moxifloxacin or Moxeza (>4 months old) Levofloxacin (>1 year old) Treat conjunctivitis- otitis syndrome for otitis only, concurrent use of topical abx not needed Pneumonia treatment 3 months-5 years: amoxicillin 90mg/kg/d w or w/o azithromycin for 7-10 days Pneumonia treatment 5 or older: azithromycin or amoxicillin 90mg/kg/d for 7-10 days or penicillin G Penicillin Allergy: 3rd generation cephalosporin (non type 1 reaction) Macrolides, levofloxacin, clindamycin Physical findings of cystic fibrosis Wheezing and air trapping with barrel chest Productive cough Crackles Increased WOB Nasal polyps, chronic sinusitis Failure to thrive Hepatosplenomegaly Delayed puberty Diagnostic tests/findings of CF Pilocarpine iontophoresis sweat test (sweat chloride test) Genotyping Pertussis treatment Macrolides Azithromycin, erythromycin, or clarithromycin
Rhinosinusitis inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses; replaces the term sinusitis Treatment of rhinosinusitis Augmentin (when indicated) Topical nasal steroids NS nasal irrigation Mucolytics Treatment of mono Supportive Recheck weekly Diagnostic tests for mono Monospot Commercial diagnostic kits about 98% sensitive CBC with diff Liver enzymes EBV serology indicated in acutely ill pt with negative monospot and strong suspicion Throat culture Treatment of mono Supportive Recheck weekly Underlying lung diseases in older patients (COPD) Abrupt onset Fever, cough, chills, purulent sputum Pleuritic chest pain (+/-) Physician exam and chest xray consistent with consolidation Hemophilus influenza: Gram - Extremely ill patients (inpatient ICU) Often follows post influenza pneumonia Complications can include: empyema, lung abscess, pneumothorax
LEOGINELLA PNA ***
Outbreaks seen in communities/facilities Starts with URI but progresses to paroxysms of coughing (nonproductive "whoop"), convalescent phase can last 1-3 months Nasal swab or serology if patient presenting later in course BORDATELLA PERTUSIS NEW GUIDELINES FOR THE U.S. DUE INCREASED TO S. PNEUMONIAE >25% CAP (WITHOUT) COMORBIDITY OR RECENT ABX USE(within 3 mos) Doxycycline 100mg bid TREATING CAP IN PREGNANCY Consider combination BETA LACTAM therapy with: ceftriaxone, cefuroxime, or ampi-sulbactum + Azithromycin Mild COPD PFT
80% Moderate COPD PFT 50 - 79% Severe COPD PFT 30 - 49%
Very severe COPD PFT <29% Asthma severe persistent Continuous symptoms, frequent nocturnal symptoms, <60% FEV Moderate persistent asthma Daily symptoms, >1 time a week nocturnal symptoms, 60-80% FEV Mild persistent asthma
1 time a week but not daily symptoms, >2 times a month nocturnal symptoms, >80% FEV Intermittent asthma <1 time a week symptoms, <2 times a month nocturnal symptoms, >80% FEV Step 1 asthma treatment SABA prn Step 2 asthma treatment SABA prn + Low dose inhaled corticosteroid Step 3 asthma treatment
