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NURS 643- MIDTERM QUESTIONS & ANSWERS 2025 A+ GRADED
NURS 643- MIDTERM QUESTIONS & ANSWERS 2025 A+ GRADED Hordeolum — CORREC P ANS-Stye — inflammation of the lubricating glands of eyelids and lashes with acute onset — hurt: typically sce pustule — treatment: warm compresses, ltrytho QID Chalazion — CORRECT ANS—granulomatous cyst on the conjunctival aspect of the eyelid — nontender — warm compresses Conjunctivitis different types — CORRECT ANS—1, Bacterial: sticky, glucly eyclids, crusting, in winter months, associated with AOM 2. Viral: tearing, serous clear or muscus fluid, in spring/fall, associated with pharyngitis 3. Allergic: itching and watery — treatment with erytho and polytrim topical ophthalmia nconatorum — CORRECT ANS—nconatal conjunctivitis — during the first few months of life — causes: gonoccal (day 2-7 of life) or chlamydia (days 5-14 of life) or herpetic (within first 2 weeks) — typically need oral or IV antibiotics: ceftriaxone (G) or erytho (C) Daryostenosis — CORRECT ANS—blocked tear ducts — due to membrane at birth that covers the nasolacrimal duct which fails to break down quickly — treat by massaging out obstruction, if gets infected need antibiotics Eye trauma — CORRECT ANS—types: hemorrhage, abrasion, hyphemas, orbital fractures — can use fluoresecin eye stain ta detect forcign badies — treatment: flush with water for 20 mins, vision eval, antibiotic or steroid drops Periorbital cellulitis —- CORRECT ANS-— inflammation of the eye lid and surrounding tissue — bacterial infection, typically under 3 yrs — caused by HiB and Strep — needs antibiotics— medical emergency if becomes orbital cellulitis — extra ocular movements are intact Orbital cellulitis - CORRECT ANS-Emergency — infection of the orbital tissucs — cannot move eye or hurts to (entrapment), and diplopia Retinoblastoma — CORRECT ANS—Congenital malignancy tumor — mostly in those under 3 yrs : cat eye reflex (cukokoria), strabismus, red, painful cye, glaucoma, late sign= blindness — referral for complaints of hearing loss, vertigo or facial nerve dysfunction Otitis externa — CORRECT ANS—swimmer’s car : scant adorless scerction, mild discomfort and purities and modest erythema and edema, registers high on pain scale when pressing on tragus — Treatment: ENT referral if very bad/ swelling on outside, antibiotic and/or steroid drops for ears — typical: neomycin, polymyxin B, flaxcin — prophylaxis: dry cars after swimming, use cleaning drops, and can use blow dryer epistaxis — CORRECT ANS-— bleeding [rom the nase that is infrequent, mild and self-limiting — causes: mucosal irritation, trauma, infection, drug use — if over 20 mins or recurrent go ta the ER/PCP — treatment: 2 c's (calmn and compression), sit upright and lean forward, apply pressure ta septum or ice to lips for 10 mins Foreign body to the nase — CORRECT ANS-— chronic rhinitis is the most common cause — s/s: unilateral foul swelling, nasal discharge, recurrent, persistent, sometimes causes epistaxis — treatment: quick removal of objects, may need ENT — can cause sinusitis allergic rhinitis — CORRHCT ANS—— inflammation or irritation of the mucous membrane — s/s: allergic salute, allergic shiners, HA, issucs smelling, poor appetite, fatigue, boggy, pale nasal mucosa — treatment: antihistamines (Zyrtec, Claritin, Benadryl, topical nasal decongestants (afrin), intranasal steroids (most effective: flonase), intranasal antihistamines (astelin), intranasal anticholinergics (atrovent) Sinusitis - CORRECT ANS—inflammation of the sinuses — causes: obstruction, systemic disorder, dental infection, trauma — treatment only if over 10-14 days, typically need amox or augmentin — s/s: facial pain, headache, fever, cold symptoms, purulent discharge, periorbital swelling, dental pain, daytime cough Nasal fractures — CORRECT ANS — most common facial fracture — r/o CSF rhinorrhea and septal hematoma — need to see surgeon Pharyngitis - CORRECT ANS—— Strep is inflammation of tonsils and pharynx due to beta group a strep — s/s: abrupt onset. cervical lymphadenopathy. exudate, fever, malaisc, anorexia, abd pain, headaches —test; nead positive strep test/ culture to treat — treat with amox or penicillin — untreated can lead to sinusitis, pharyngeal abscess, pcritonsillar abscess, nephritis/glomerulonephritis, and rhcumatic fever — replace toothbrush in 24 hours after antibiotics started Tonsillitis - CORRECT ANS—mast common is viral infection — they abd breathe — less clastic Upper respiratory tract infections — CORRECT ANS—— URI, OM, tonsillitis, croup — Viruses: all colds, flu, most coughs, and most sore throats — bacterial: car infections, sinus infections, and strep — go to pep if symptoms last longer than 10 days, severe pain, coughing up thick green/ bload, and SOB — treatment= supportive mostly— tylenol and motrin, dont give cough because typically overlap meds, hydration, wash hands Lower respiratory tract infections - CORRECT ANS—— bronchiolitis and pneumonia Croup — CORRECT ANS—3 types: acute spasmadic, laryngotracheabronchitis, and acute epiglottitis — stridor: harsh noise on inspiratory (larynx) or expiratory (trachea) associated with infections or congenital — stertor: low pitched snoring sound on inspiratory, loudest over neck, associated with small jaw and atresia — Steeple sign on x ray Spasmodic croup — CORRECT ANS—"midnight" croup — Jaryngeal obstruction, typically viral in winter/fall in children 1-3 yrs — associated with allergic reaction or viral antigens — s/s: stridor, barking cough, awakes suddenly, resp distress, mild URI — treat with warm, humidified mist and cool air Acute Laryngotrachcobranchitis —- CORRECT ANS—caused by para influenza, RSV, flu, mycoplasma pna — most common under 5 — s/s: URI, resp distress. stridor, retractions, barking cough, fever, sore throat, decreased PO — treat with supportive (hol shower, cool mist), steroids, rac epi — with rac epi- need to monitor for rebound symptoms Epiglottitis - CORRECT ANS-medical emergency — cardinal signs: drooling, dysphagia, dysphonia (difficully talking), distressed resp efforts — deo not leave child if suspected and DO NOT swab — x ray shows thumb sign on lateral film — treatment: steroids, 02, intubation, HIB vaccine, ceftriaxone — typically ages 2-5 yrs — typically bacterial cause Foreign body aspiratory — CORRECT ANS-— risk factors: diameter of airway, dental development, explorers, and distraction — cammon badies: hot dogs, peanuts, button battcrics, coins, grapes, balloons, candy, toys — s/s: choking, cough, gagging, stridear, wheezing (unilateral), decreased breath sounds, cyanosis — want to get x ray with inspiratory and expiratory films — s/s: cough, wheezing. hamoptysis, excessive sweating at night. fatigue, fever, abd pain, poor suck, weight loss — late signs: infection in middle ear, mastoid, joints, skin, kidneys — test with ppd (>5 mm need x ray, > 15 consider they are +), xray (xray shows patchy/holes in lungs) and spulum smear and culture (gold standard) — screen annually for those high risk — treaiment: combo drugs— isoniazid, rilampin, pyrazinamide, ethambutol lor several « months (monitor LI*Ts) Pertussis Gvhooping cough} — CORRECT ANS—caused by Bordetella pertussis virus— yery contagious — typically in those under 4 not vaccinated s: low grade fever, ¥Y, apnea, exhaustion, runny nose, paroaxysms— high pitched whoop cough : 1 catarrhal (URI with cyanosis/apnea), 2 paroxysmal (cough and — 3 stag dyspnea}, 3 covalescent (recovery)— can last up to 12 weeks — culture can take up to 7 days — complications: apnea, pna, seizures, encephalitis, death — treat with azithro VACCINES: 2, 4, 6, 15-18 mos, 4-6 yrs (Dtap), 11-12 yrs, 13-18 yrs, and Q5-10 yr booster (Tdap) Asthma — CORRECT ANS—Triad: inflammation, bronchospasm, increased secretions — chronic disorder, allergic, or fam hx — goal of treatment is to minimize inflammation and treat acute symptoms start with SABA + ICS (start low) + Montelukast + LABA + oral steroid combo (concern for over use) Asthma Medications — CORRECT ANS-—Short acting Beta agonist (SABA) — Albuterol, Praventil —Long acting Beta agonist (.ABA)— Serevent —in haled corticosteroid (ICS)— flovent, pulmicart — combo meds: advair, symbicort Asthma cducation —- CORRHCT ANS-—— identify triggers — peak flow meter — asthma action plan — proper administration with spacer, refills, and compliance — decrease environmental allergens Bronchiolitis — CORRECT ANS-— yiral infection in lower airways — 80% caused by RSY, aldo can be adeno, paraflu, flu HMV, and mycoplasma pna — average averge 2 mos —2 yrs — s/s: nasal congestion, cough, tachypnea, fever, wheezc/rales, dyspnea, poor appetite RSY — CORRECT ANS—— virus that effects the lungs and breathing pathways — yaccine available for high risk infants and now all babies and mothers — treatment: supportive, frequent suctioning, hydration, antipyretics, dyspnea tension penumothorax — CORRECT ANS—— arises when air in the pleural space builds up enough pressure to interfere with venous return: leads to hypotension, tachycardia, and severe dyspnea — have trachea shilt and flattening of the diaphragm — needle decompression hypatonie infant — CORRECT ANS—inability Lo move against gravily — s/s: weak cry, poor suck, drooling, decreased spontaneous movements, delay of motor milestones, Irog leg posilion, arthrogryposis (muscle contracture), hip dislocation, pectus excayatum, loss of DTRs, flat midface and high palate — either neurological (lower motor and upper neuron) or systemic (sepsis, metabolic disorders, hypoglycemia, hypothyroidism) Upper vs lower motor neuron hypotonia infants — CORRECT ANS-— Upper: decreased IOC, low strength and normal reflexes— brain issucs: ex: trisomy 21, head injury, prader willi, mengititis — Lower: Anterior horn cells: profound weakness, muscle atrophy, absent reflexcs— ex: SMA, trauma, hematoma, abscess Nerves: weakness distally, reduced reflexes— ex: GS, hereditary sensory autonomic Neuromuscular junction: weakness of reflexes— ex: congenital myasthenia gravis, batulism, drugs Muscle: musele atrophy, reduced reflexes, weakness proximal more— ex: congenital muscular dystrophies, metabolic discase Epilepsy — CORRECT ANS-— recurrent alebrile seizures, one unprovoked seizures with the probability of more, diagnoses with cpilepsy syndrome — scizure of 5 mins or more — after want to check temp, glucose, electrolytes, AD levels, tox sercen, cbe, renal, LET Generalized seizure types — CORRECT ANS—— febrile— associated with rise in temp — tonic clonic— increased muscle tone, clonic tonie moyement, incontinence, posticatal stale — absence— sudden onset of staring, interrupling speech or aclivity— no post itchal states Partial seizure types — CORRECT ANS—— discharge in one hemisphere — simple partial scizure— no |.0C — dyscognitive scizure— change in loc Sudden Unexplained Death in Epilepsy (SUDEP) -— CORRECT ANS: frequent/uncontrolled seizures, not taking medication, change in medications, young isk factors: age, decrease IQ Epilepsy management — CORRECT ANS-— gencralized— valproic acid, lamotrigine, keppra — absence— ethosuximide, valproic acid, lamotrifine — focal— carbamazepine, lamotrigine, keppra — lennox gastaut— felbamate, ruifinamide, lamotrigine, topamax other treatments: kctogenctic dict, vagal nerve stimulator, and surgical medically intractable epilepsy typically resolye on own- can cause DD Juyenile myoclonic epilepsy — CORRECT ANS—— generalized epilepsy in adolescents — provoked by sleep deprivation and aleahol— typically happen after waking up — can have photosentivitivy scizure triggers — CORRHCT ANS-—— illness, fever, diarrhea, vomitting — sleep deprivation — missed medications — slress— worry anxiely, anger — flashing lights — alcohol or drug abuse — menstrual cycle Types of headaches — CORRECT ANS—-1. primary: migraine, tension, cluster 2, secondary: meningitis, subarachnoid hemorrage, brain tumor, hydrocephalus, subdural hematoma red flags of headaches — CORRECT ANS—abnormal neuro exam, fever, stiff neck, yisual changes — sign of icp increase when headaches happen in the morning Migraines — CORRECT ANS—most common type — typically pulsating quality, moderate to severe pain, worse with activity but relieved with rest, can last up ta 3 days s/s: photophobia, N/V, can have aura some have abnormal symptoms: alteration of behavior, vomiting, abd pain, paroxysmal vertigo Status migrainosus — CORRECT ANS-—— longer than 72 hours, severe intensity — need hydration, caffeine and tordal Migraine treatment — CORRECT ANS—— Abortive therapies (e.g., sumatriptan, NSAIDs) —prophylaxis (c.g., propranolol, topiramate, CCBs, amitriptyline) Tension headache — CORRECT ANS—— last 30 mins to 7 days — pain bifrontal or diffuse or dull, associated with muscle contraction, fecls like squeezing and increases throughout the day — treat with stress and anxiety— tylenol and motrin Cluster headaches — CORRECT ANS-rare — attacks of several unilateral facial/orbital pain at least five attacks a day, sense of restless agitation, nasal congestion, cyclid edema, sweating — treat with abortive therapy with oxygen or triptans — yocal tics: coughing, throat clearing, sniffing, whistling, grunting, animal soungs, uttering of syllables, shouting — treatment: clonidine, haldoperidol, risperidonc Autism Spectrum Disorder (ASD) — CORRECT ANS—— developmental disability problems with learning, thinking, and problem solving — risk factors: genetic disorders (fragile x), valproic acid or thalidomide during pregnancy, children born to older adults — s/s: social communication deficits, nonyerbal/echo sounds, eve contact issues, difficult with censoring processing — sereen at 18 mos and 24 mos with MCAT tool — need ncurodeyclopmental specialist for diagnosis — treat with speech therapy, OT, skills training, I*] and behavioral therapy can treat with risperidone and aripiprazole ADHD types — CORRECT ANS—1. hyperactivity: remaining scated when required, fecling of restlessness, inappropriate running, cant excessive fidgeting, difficult play quiet, excessive talking, on the ga 2. impulsive: trouble waiting turn, blurting out answers, interruption/ intrusion 3. inattention: failure to attend to detail, carcless mistakes, seems to not listen when addressed, fails to follow through, avoids tasks the require consistent mental effort, forgetfulness Diagnosis of ADITD — CORRECT ANS—6 symptoms of types for 6 months or grealer — in at least 2 settings— teacher and home evals using vanderbilt assessment scales ADHD treatment — CORRECT ANS—— start with behavioral therapy first — first time= stimulants (ritalin or conserta, adderall) -— SE: decreased appetite, sleep problems, transient headache, stomachache, weight loss, increase HR, blood pres sure, growLh suppression — nonstimulant= stratlera — over meds: clonidine— SI°: bradycardia, headache, hypotension, rebound HTN MONITOR growth Infant botulism — CORRECT ANS-— descending neurological symptoms — caused by soil, honey, and corn syrups : constipation, muscle weakness, head lag, weak ery, drooling, irritability, difficulty sucking or feeding — treatment: botulism immune globulin (BIG) can progress to resp failure concussion systems affected: — CORRECT ANS—1, autonomic: photosensitivity, need a minule going [rom sitling to standing 2. cognition: brain energy level gets depleted quickly— hard to concentrate, remember and focus 3. emotions: chemical alternation— anxious/worried/sad 4. vestibular and oculomotor: eye pain/ motion sickness/ dizziness 
