NURS 629 EXAM 3 Questions With 100% Correct Answers Graded A+ 2024/2025
-Differentiate between viral , allergic , and bacterial conjunctivitis . How to diagnose and treat each .
-Viral Conjunctivitis Watery discharge ( profuse and clear ) , foreign body sensation , grittiness ) redness URI sympto...
NURS 629 EXAM 3 Questions With 100%
Correct Answers Graded A+ 2024/2025
-Differentiate between viral , allergic , and bacterial conjunctivitis . How to diagnose and treat each .
-Viral Conjunctivitis Watery discharge ( profuse and clear ) , foreign body sensation , grittiness )
redness URI symptoms are common including sore throat and fever Red , itchy conjunctiva and
swollen eye lids Often bilateral Normal visual acuity , PERRLA , EOMI , Fundoscopic exam normal
Mucoid - profuse watery discharge Mild , diffuse injection and itching * Preauricular
lymphadenopathy Many times too with a sore throat Symptomatic only / supportive Warm ( drainage
) or cool ( itching ) compresses Strict eye hygiene and hand care to prevent spread
-Bacterial Conjunctivitis Redness , swelling , purulent discharge , itching No symptoms until eye
complaints began ; don't have URI symptoms beforehand Normal visual acuity , PERRLA , EOMI ,
FUND nl Diffuse injection ; early red eyes No ciliary injection Unilateral at onset Treatment Topical
antimicrobials x5-7D Warm compresses qid x10-20min Strict eye hygiene given contagion and hand
hygiene. Treatment 1. Trimethoprim / Polymyxin solution ( Polytrim ) 4 gtts q QID x7D 2. Tobramycin
0.3 % 1-2gtts q4H x7D 3. Ciprofloxacin 0.3 % solution 1-2gtts x2D then Q4H x5D 4. Alternate dosing
1gtt Q2H x1D , then 4x / D x5-6D 5 . Depends on what you are seeing in the area , what you suspect
for the causative organism for the infection , so getting that good hx on the pt , if anybody has been
exposed ; what is being passed around in your area .
-Allergic Conjunctivitis Symptoms Bilateral at onset Severe itching Mucoid - stringy - like clear
discharge Cobblestone papillary hypertrophy in tarsal conjunctiva Injected conjunctiva ( light pink
eye ; not the red you get with bacterial ) Other physical examination findings such as : 1. Allergic
shiners ( baggy , blue under the eyes ) 2. Allergic crease ( on their nose ; as if they have been wiping
their nose often ) 3. Rhinitis. Prevention Saline solution , artificial tears- help keys eyes moisturized
Cool compresses- to help with itching Topical Antihistamines Ketotifen ( zaditor ) , epinastine
( Elestat ) , and azelastine ( Optivar ) Topical decongestants Naphazoline hydrochloride ( AK - con )
Combinations of topical decongestant with topical antihistamine Mast - cell stabilizer Cromolyn ,
sodium and lodoxamide ( Alomide ) , Olopatadine ( Patanol ) , nedocromil ( Alocril )
Exam techniques used to identify an eye abnormality in an infant or young child.
-Red reflex - symmetry From newborn on , every exam
-Pupils reactive to light Are they squinting and closing their eyes with bright lights ? Turn room lights
off , are they opening their eyes PERRLA
-EOM 2mo old- starting to fix and follow objects Take their favorite toy , have mom move and notice
are they following -Funduscopic examination- 5y To make sure there is no cataract
-Visual acuity Visual acuity is the MOST important vital sign in pts with eye complaints complaints
documentation with every eye complaint Visual acuity screening starts at age 4 Make sure to
document this at every eye complaint visit and well child exam School physicals Begin visual acuity
with Snellen at age 4 Shapes can be tricky for the child if they are not good on their shape
recognition ; can use just the E which direction , but then they may have to know Left and Right; check
visual acuity with eye glasses on, use pinhole if necessary; record each eye separately and combined
If you find an abnormality, what doe sit mean with the eye, and what is normal variations. With an
infant, what would be normal things that happen with the eye, the mom and the dad may say this is
happening, no that's okay that's normal; certain PE things, let's say you didn't see a red reflex, you are
doing a cover/uncover test, what are you testing for and what if it's positive? What are you going to
find out?
-Amblyopia 1. Seen in early childhood 2. This is why astigmatisms are more common d / t eye shape is
more oblong oval - type shape than the concave , circular shape in adulthood
-Congenital cataracts 1. Screen for 2 . If red reflex is not normal , then do an ophthalmologic exam 3 .
Associated with neurological disorders and cancer 4. Refer early on
-Strabismus 1. Normal in the newborn phase . 2. 4mo should be starting to disappear 3. If at 6mo is
still present , refer 4. Interventions early on with surgeries
-Ptosis 1. Can develop as early as the newborn phase 2. If eyelid is starting to sag , intervene early on
-Anisometropia 1. Screen for (asymmetric refraction between the two eyes)
, -Key is early detection and intervention Good trition such as vitamin - rich foods can help promote
good vision New guidelines and recommendations all the time , stay uptodate
-Strabismus Can be a normal variation at the newborn stage 4mo- starting to resolve 6mo- still
present , refer Misalignment of the eyes Lazy eye or cross - eyed Results in loss of depth perception
and double vision . Assessment Red light reflex 1 . Good indication if they are not aligned Cover -
uncover test 1. The weaker eye will be deviated Esotropia - focused inward 3-4mo Recognizes
parent's smile ( and smile ) , looks from near to far , focuses close again , beginning depth perception ,
follows 180 degrees , reaches toward toy , few exodeviations , esotropia abnormal Exotropia -
focused outward Hypertropia- deviated up or down Findings Intermittent exotropia 1 . Mom or dads
might notice when they are trying to focus on something it is evident Squinting 1 Maybe d / double
vision , inability to focus Nystagmus 1 . Eye will move ( first few weeks ) Refer to Ophthalmologists
Early on ; surgeries are early- depends .
-A normal neonate demonstrates disconjugate fixation , but convergence and accommodation
normally develop by 3 to 4 months of age with parallel alignment without nystagmus or strabismus by
5 to 6 months of age . Jerky eye movements can be seen until 2 months of age , after which time
smooth tracking movements are expected
-Know the difference between viral and bacterial respiratory infections . How are they treated ? What
are the indications for prescribing antibiotics ?
-Upper Respiratory Infection very similar in adult and pediatrics ; but with pediatrics , they get very
sick very rapidly Gradual onset , rhinorrhea , sore throat , mild cough , low - grade fever . Pt will have
red nasal mucosa , mild throat erythema , possible anterior cervical lymph nodes , chest will be clear
Most often viral Supportive treatment for viral URI < 2y : monitor closely for any signs of respiratory
distress and get the child a follow - up
-Sinusitis Inflammation and secondary infection or paranasal sinuses and adjacent nasal mucosa URI
symptoms > 10D without improvement ( prolonged period of symptoms ) Exception : Severe
symptoms with high fever and purulent drainage at onset lasting 3-4D Symptoms worse on day 6 or 7
of URI Bacterial v . viral Antibiotics will shorten the duration of illness 10D of Augmentin ,
Azithromycin , or Bactrim DS Decongestant , antihistamines , saline , and nasal steroids
-Pharyngitis Key : get a good hx to help differentiate if this is bacterial or viral ; strep or mono ?
History and Physical : Determine onset , duration , associated symptoms , exposure Onset : with strep
and mono- sore throat severe. Strep : many times they do not have any other URI symptoms Viral :
presents first with a runny nose and then sore throat develops with postnasal drainage Duration : did
this all of a sudden acutely come on and it is so severe they are here ? Has it slowly progressed with
other URI symptoms ? Some fatigue and other symptoms and then sore throat ? Associated
symptoms : bacterial strep throat many times there is not really any other associated symptoms ;
maybe fever , maybe nausea and vomiting vomiting , or a rash Known exposures : exposure is key ;
daycare or school- ask if there has been reported recent strep throat outbreaks 1. Typically viral ii .
Group A Beta Hemolytic Strep- 2nd most common Management Therapeutic : Amoxicillin ( 50-80mg /
kg / day ) - 10D ( usually the lower , 50mg ) PCN allergy- cephalosporin or macrolide ( first option for
PCN allergy ) Warm water gargles Tylenol / NSAIDs- fever and pain relief Mono- rare Management
Symptomatic treatment , unless severe Corticosteroids but limited proven indication Consult with
specialist if necessary other systems are involved
-Presentation and treatment of otitis media vs. otitis externa
-Otitis Media Most common Boys First born Winter months 1 . Increase in URIS Bottle fed babies
Preemies Craniofacial disorder or Down's Daycare children Children of smokers Symptoms Fever 1.
High or low grade Pain Discharge from the ear 1. Tympanic membrane has ruptured Tugging or
batting at the ear ' 1. Teething 2. Comforting thing when they are sleeping Irritability , crying , lethargy
Decreased appetite When they chew and swallow it can increase the pressure in the inner ear- if they
are already having pressure it is going to make it more painful Decreased sleep D / t pain Recent URI
Signs Red , bulging TM Retracted with pus Decreased translucency of TM No movement of the TM
Inability to see normal landmarks 1. D / t pus and the fluid Occasionally- hole in the tympanic
membrane. Diagnosis of AOM Associated symptoms 1. What presented first ? 2. Severity ? 3. Hx of
how many ear infections have they had ? 4. Recent ABX use ? a . Helps determine treatment Hx of
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