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NR 602 Final exam with Complete Solutions
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NR 602 Final exam with Complete Solutions
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NR 602 Final exam with CompleteSolutions
Step 1 Asthma approach-Intermittent ☑️Correct Ans-symptoms 2x or less per week
asymptomatic and normal PED
requires SABA 2 days/week
no interference with normal activities
brief exacerbations
nighttime symptoms 2x or less a month
lung fx- FEV>80% predicted
Step 2 Asthma Approach-Mild persistent ☑️Correct Ans-Symptoms >2 x a week, less
than once per day
requires SABA more than 2days/week, no more than once a day
exacerbations may affect activity
nighttime symptoms 3-4x a month
FEV> 80% predicted
Step 3 Asthma Approach-Moderate Persistant ☑️Correct Ans-daily symptoms
daily use of SABA
some limitations
2x or more per week exacerbations
nighttime symptoms more than 1x per week, not nightly
FEV >60% but <80%
Step 4 Asthma Approach-Severe Persistent ☑️Correct Ans-continual symptoms
requires SABA multiple x a day
extremely limited activity
nighttime symptoms 7x a week
FEV <60%
Tx of asthma ☑️Correct Ans-Stepwise approach
step 1: SABA PRN
step 2: low dose ICS
Step 3: low dose ICS+ LABA or medium dose ICS
step 4: Medium dose ICS+LABA
Step 5: high dose ICS+ LABA
Step 6: High dose ICS+LABA + corticosteroid
Step 6 Asthma Approach ☑️Correct Ans-
,Bulbar/palpebral conjunctival infection ☑️Correct Ans-May be unilateral or bilateral
Leukocoria ☑️Correct Ans-abnormal appearance of a white film in the pupil; immediate
referral to pediatric ophthalmologist warranted
Causes: retinal detachment, cataract, retinal dysplasia, newborn retinoblastoma
Visual screening in children ☑️Correct Ans-At least once between ages 3-5 y/o
according to USPSTF
AOM ☑️Correct Ans-RF: genetics, males, Native American, siblings, low economic
status, ages 6mo-3y, winter, supine bottle feeding, daycare, tobacco smoke
S/S of AOM ☑️Correct Ans-erythema, otalgia, bulging TM, absent cone of light
Dx of AOM ☑️Correct Ans-Audiometry, tympanometry, possible lateral neck xray to r/o
mass
TX of AOM ☑️Correct Ans-uncomplicated: supportive with tylenol/ibuprofen; watchful
waiting 48-72 in 6m-2y/o; <5 benzocaine otic drops
1st line antx: amoxicillin 80-90mg/kg/day Q12 x 10days
if allergy to PCN- augmentin, cefuroxime
Bacterial rhinosinusitis ☑️Correct Ans-Preceded by URI-typically worsens after 5-7
days- not resolved in 2 weeks
Sx of bacterial rhinosinusitis ☑️Correct Ans-Purulant nasal congestion, drainage, facial
pain, headache, fever
No imaging required- if no improvement refer to ENT
Bronchiolitis ☑️Correct Ans-Usually caused by RSV
wheezing present
<2 y/o
other causes; influenza, adenovirus, rhinovirus
S/s of bronchiolitis ☑️Correct Ans-Increased work of breathing, prolonged expiration,
grunting, retractions, nasal flaring
Croup sx ☑️Correct Ans-Low grade fever, URI symptoms, barking cough, inspiratory
stridor can occur
Croup dx ☑️Correct Ans-Made from symptoms
Croup tx ☑️Correct Ans-Glucocorticoids possibly
0.6mg/kg-1mg/kg
, humidified air
bronchodilators
Lead poisoning ☑️Correct Ans-Inactivated heme synthesis by inhibiting insertion of
iron-leads to microcytic hypochromic anemia
Source of lead poisoning ☑️Correct Ans-Lead based pain
Those at risk for lead poisoning ☑️Correct Ans-Children 2-3 y/o
summer months
Lead poisoning testing ☑️Correct Ans-Children with Medicaid need lead level @ 12
months and 24 months-capillary finger stick with venous sample as f/u
AAP recommends 6-9-12-18-24 mo as well as 3-4-5-6 y/o
Lead levels ☑️Correct Ans-<5 is normal
>69 requires chelation
Genu varum ☑️Correct Ans-Bow legged as a result of uterine position- normal finding
up to 3y/o
Legg-Calve-Perthes Disease ☑️Correct Ans-Avascular necrosis of femoral head-
epiphyses associated with trauma, synovitis
Legg-Calve-Perthes Disease RF ☑️Correct Ans-Associated with low birth weight,
socioeconomic status, or white race
Legg-Calve-Perthes Disease s/s ☑️Correct Ans-Onset of painful limp of thigh, knee, or
hip worse with activity, not relieved by rest
restricted by abduction and rotation of affected hip
Legg-Calve-Perthes Disease Tx ☑️Correct Ans-Abduction brace or long leg cast
Congenital Hip Dysplasia s/s ☑️Correct Ans-Thick fold asymmetry, leg length
inequality, walking children- painless limp
Congenital Hip Dysplasia Dx & Tx ☑️Correct Ans-Positive Barlow maneuver, ortolani or
Allis sign
US for <4 months, X-ray AP of pelvis >4 months
Tx: refer to orthopedist, pavlik harness, child should be seen weekly to prevent skin
breakdown, necrosis
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