NURS 629 Peds Exam 2 2024 QUESTIONS WITH
COMPLETE SOLUTIONS
Strabismus Correct Answer: Misalignment of the eyes. Lazy eye or cross-eyed.
Results in loss of depth perception and double vision.
Assessment techniques to detect strabismus Correct Answer: Red light reflex
Cover-uncover test
Deviation of the weak eye outward Correct Answer: Exotropia
Deviation of the weak eye inward Correct Answer: Esotropia
Visual axis of one eye is higher than the fellow fixating eye Correct Answer:
Hordeolum Correct Answer: Sty; an acute infection of a sebaceous gland of the eyelid
Obstruction of the sebaceous glands or eyelid.
Staphylococcal aureus is the most common causative organism.
What might a patient with a hordeolum complain of Correct Answer: Swollen, red, painful
lesion on the lid margin
Itchiness of the eyelid
Pimple or abscess in either lid
External - next to eyelash
Internal - under eyelid
Painful swelling
Typically develops suddenly
Treatment for a hordeolum Correct Answer: Warm compresses-20 minutes qid
Antimicrobial ointment or drops
Good eye hygiene and hand washing
Chalzion Correct Answer: Chronic inflammation of the eyelid.
Blocked meibomian gland - may result from internal hordeolum.
Often not painful but sensation of pressure.
Develop over weeks to months.
Clinical finding of chalzion Correct Answer: Mild erythema and edema of the eyelid that
resolves and results in a painless, non-pigmented mass
Itchiness of the eyelid
Pimple or abscess in either lid
,External - next to eyelash
Treatment of chalzion Correct Answer: Erythromycin drops or ointment if hordeolum is present
Cellulitis develops - treat with erythromycin or cephalexin
Most important vital sign for a patient with an eye complaint Correct Answer: Visual acuity
Peritonsillar abscess (PTA) Correct Answer: Collection of pus or fluid around the tonsil
Physical exam findings of PTA Correct Answer: Fiery red asymmetric swelling of one tonsil
Uvula is often displaced and often forward
Large, tender lymphadenopathy
Management of PTA Correct Answer: Aspiration of the abscess may be performed for accurate
diagnosis and treatment.
CT scan of the head and neck
Monitor airway at all times
ENT consult is essential
Usual Management
- IV antibiotics
- Inpatient management
At what age should hearing testing start? Correct Answer: 4
If a child's hearing test results are anything greater than -10 to +15, what is the 1st thing a
provider should do? Correct Answer: Check the ear with an otoscope for an obstruction with
cerumen or a foreign body
Risk factors for otitis media Correct Answer: Boys
1st born
Winter months
Bottle fed babies
Preemies
Daycare children
Children of smokers
, Acute otitis media epidemiology Correct Answer: 75% of cases are viral
Pathogens are most likely S. pneumoniae, H. influenzae, M. catarrhalis
H. influenzae - must treat with Augmentin (conjunctivitis + AOM) must treat with a topical
antibiotic for the eye
Symptoms of otitis media Correct Answer: Fever
Pain
Discharge from the ear
Tugging or batting at the ear - can be a teething or a comfort thing
Irritability, crying, lethargy
Decreased appetitie - chewing & swallowing can increase pressure in the inner ear
Decreased sleep
Recent URI
Signs of otitis media Correct Answer: Red, bulging TM
Retracted with pus
Decreased translucency of TM
No movement of the TM
Inability to see normal landmarks
Occasionally - hole in the TM
May not see TM if it has ruptured & there is pus & fluid
Acute Otitis Media (AOM) Correct Answer: effusion in the middle ear that occurs suddenly and
is associated with other signs of illness
Otitis Media with Effusion (OME) Correct Answer: An amber-yellow drum suggests serum in
middle ear that transudates to relieve negative pressure from the blocked eustachian tube. You
may note an air/fluid level with fine black dividing line or air bubbles visible behind drum.
Symptoms are feeling of fullness, transient hearing loss, popping sound with swallowing. Also
called serous otitis media (glue ear)
Signs of OME Correct Answer: Bulgining TM
Decreased or absent mobility of TM
Amber fluid or appearance of TM
Otorrhea
AOM in patients < 6 months of age Correct Answer: Antibacterial therapy
Criteria for antibacterial therapy for tx of AOM in patients 6 months - 2 years Correct Answer:
Fever over 102F
Bilateral infection
Severe otalgia
Longer than 7 days
Criteria for antibacterial therapy for tx of AOM in patients > 2 years Correct Answer: Fever over
102F
Bilateral infection
Severe otalgia
Longer than 7 days
Treatment options for otalgia in AOM Correct Answer: Tylenol or ibuprofen
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