Nurs 629 Exam 3 (Maryville) Questions and Answers 2023
Otitis media pathogens - Correct Answer Caused by: S. Pneumoniae (most common);
- Influenzae, M. Catarrhils
Otitis media Symptoms: - Correct Answer Fever, Pain, discharge from ear, tugging at ear, irritability, crying, lethargy, decreased appetite, decreased sleep, Recent URI Objective findings in otitis media - Correct Answer Red, bulging OM; Retracted with pus; no movement of TM, Inability to see landmarks; occasional hole in TM Treatment for AOM + Conjunctivitis d/t : H. Influenzae - Correct Answer Amoxicillin- clavulanate 80-90 mg/kg/day BID x 10 days
Treatment for AOM d/t S. Pneumoniae (most common): - Correct Answer Amoxicillin
80-90 mg/kg/day BID x 10 days (high dose) Treatment for AOM with PCN Allergy: Non-Type 1: - Correct Answer Cefdinir, Cefuroxime Treatment for AOM with PCN Allergy: Type 1: - Correct Answer Azithromycin, clarithromycin OR Ceftriaxone 1-3 days Predisposing factors of otitis externa: - Correct Answer Frequent moisture, local trauma, aggressive cleaning, Allergies/skin conditions Causative organisms for otitis externa: - Correct Answer Psuedomonas aeruginosa (20- 60%); Staphylococcus Aureus (10-70%); 10% fungal infection Symptoms of otitis externa: - Correct Answer Discharge from ear, recent history of swimming or placing something in the ear, low-grade fever, pain with movement of tragus, decreased hearing, redness around ear Objective findings of otitis externa: - Correct Answer Otalgia ( inner or outer ear pain), discharge, fullness, itching, pain with movement of tragus, redness around ear, decreased hearing.Treatment of pain and therapeutic management of otitis externa: - Correct Answer Warm compresses, Auralgan, prednisone, Tylenol/ibuprofen, Wick (abx applied to wick ) 1 / 3
When to wick with otitis externa: - Correct Answer If lumen is reduced to >50%, wicks can help ensure delivery of topical abx to medial canal.Treatment of otitis externa: - Correct Answer Topical fluroquinolones (Ciprofloxacin, Ofloxacin), ibuprofen and apap for pain, neomycin/polymixin b/hydrocortison otic (antibiotic/steroid) Hallmark sign of otitis externa: - Correct Answer Traction of pinna elicits pain When do we begin hearing tests in clinic for children - Correct Answer 4 years old What is a normal audiology test result and how are results read - Correct Answer Normal -10 to +15 The higher the number, the greater the loss, Severe loss 71-90 (learning disability, limited vocabulary), Profound loss 90 Risk factors related to elevated cholesterol - Correct Answer Obesity, Diabetes, Hypertension, Family history: Coronary heart disease prior to age 55, Hyperlipidemia, Diabetes Clinical findings for tetralogy of Fallot: - Correct Answer Cyanosis: caused by blood low in oxygen, Shortness of breath and rapid breathing, especially during feeding or exercise, Loss of consciousness, Clubbing of fingers and toes, Poor weight gain, delayed growth, Polycythemia, metabolic acidosis, Systolic murmur at 2nd left ICS & holosystolic murmur at LLSB What criteria would you have to consider inpatient admission in a patient with pneumonia - Correct Answer Infants less than 4 months old, Infant with poor feeding, grunting, O2 saturation <92%, respiratory rate >70 , Older child with grunting, inability to tolerate oral intake, oxygen saturation ≤ 92 percent, respiratory rate > 50 breaths per minute, Any age: Comorbidities (e.g., chronic lung disease, asthma, unrepaired or incompletely repaired congenital heart disease, diabetes mellitus, neuromuscular disease) Visual acuity of a 2-month-old - Correct Answer • Vision is 20/400 • Fix and follow objects Viral conjunctivitis etiology (causative agent): - Correct Answer Adenovirus is the most
common cause. Other causes: HSV, herpes zoster, and varicella
Viral conjunctivitis symptoms: - Correct Answer o Watery discharge (profuse and clear), foreign body sensation, redness o URI symptoms are common including sore throat and fever o Itchy conjunctiva and swollen eye lids o Often bilateral Viral conjunctivitis Clinical findings - Correct Answer o Normal visual acuity, PERRLA, EOMI, Fundus normal o Mucoid-profuse watery discharge o Mild, diffuse injection and itching o *Preauricular lymphadenopathy 2 / 3
Viral conjunctivitis Treatment: - Correct Answer Symptomatic Only - Warm or cool compresses, Strict hand hygiene Pharyngitis - Correct Answer Typically viral Causative organism for bacterial pharyngitis - Correct Answer Group A Beta Hemolytic strep Subjective findings for strep pharyngitis: - Correct Answer Rapid onset of sore throat, abdominal pain, headache, dysphasiay Objective findings for strep pharyngitis: - Correct Answer Fever >103, Swollen glands, anorexia, lack of uri s/sx, irritability, Exudative tonsils, scarlatina rash, strawberry tongue, anterior cervical lymphadenopathy Treatment for strep pharyngitis - Correct Answer Amoxicillin 5mg/kg/day x10 days If allergy to first line tx for strep pharyngitis, what do you prescribe? - Correct Answer Cephalosporin or macrolide (azithromycin) Therapeutic tx for strep pharyngitis (in addition to abx) - Correct Answer Warm water gargle/apap/ibu Education re strep pharyngitis: - Correct Answer Discard toothbrush after 24hs on an abx and after treatment completion
When may pt return to school with strep pharyngitis: - Correct Answer This is
contagious. May return to school after 24 hours on abx Scarlet fever: - Correct Answer Occurs secondary to strep throat and progresses to acute rheumatic fever if no intervention Is scarlet fever common or rare? - Correct Answer Rare Subjective/Objective findings of scarlet fever: - Correct Answer Scarlatina begins on face and spreads down and out/strawberry tongue/Fever/pharyngitis Treatment of scarlet fever: - Correct Answer amoxicillin 50-80 mg/kg/day x7 days
Classic triad of mononucleosis Pharyngitis: - Correct Answer Fever, equative
pharyngitis POSTERIOR cervical lymphadenopathy Subjective sx of mononucleosis: - Correct Answer malaise, fatigue, headache, anorexia,
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