NURS 5433 FINAL 300 COMPREHENSIVE TEST
PAPER QUESTIONS AND SOLUTIONS GRADED
A+
◉ Influenza Vaccine.
Answer: can give 6 months and older, any trimester of pregnancy
contraindicated in Guillian Barre syndrome, otherwise can get even
with egg allergy
Antivirals: oseltamivir, zanamivir, baloxavir, peramivir
◉ Fifth Disease.
Answer: viral illness caused by parvovirus B19 that primarily effects
kids (5-15 y.o)
prodrome: low grade fever, headache, fatigue, cold like symptoms
Rash: "slapped cheek" rash and reticular lacy rash on trunks, arms,
legs, pink/red, lasts 1-3 weeks, irritated by warmth, friction, and sun
,transmission: respiratory droplets and direct contact with
secretions, vertical transmission from mother to fetus
management: supportive care - rest, hydration, infection control,
monitor blood cell counts
Immunocompromised may get IVIG
adults may get arthritis, more severe in adults, self-limiting
can also cause anemia
◉ pregnant woman exposed to fifth disease.
Answer: Can cause fetal complications (hydrops fetalis, stillbirth,
miscarriage)
Check:
vaccinated or previous infection?
serologic testing IgG and IgM
fetal monitoring
B19 assay and IgM to confirm diagnosis
consult specialist
NAAT or PCR for immunocompromised
,◉ Rocky Mountain Spotted Fever.
Answer: caused by rickettsia recketsii (tick borne) from dog ticks or
wood ticks
Can cause organ failure
s/s: high fever, malaise, headache, muscle aches, N/V, petechial rash
(small, flat, red/purple spots on wrists/ankles that spread to palms,
trunk, arms and appears 2-5 days after onset)
Tx: Doxycycline 100 mg BID x 5-7 days in adults, 2.2mg/kg in
children BID x5-7 days
or Chloramphenicol in pregnancy
◉ Diagnostics for RMSF.
Answer: Indirect fluorescent antibody (IFA)
ELISA, PCR
CBC and liver enzymes (increased WBCs and thrombocytopenia)
◉ Lyme Disease.
Answer: borrelia burgdorferi (tickborne)
black legged deer tick, tick attached >36 hours
, incubation 3-30 days after bite
Prophylactic tx: >36 hours attached, 200mg single dose or 4.4mg/kg
in kids given within 72 hours of tick removal
s/s: fever, HA, muscle/join pain, fatigue, bulls eye rash with central
clearing, lymphadenopathy
Dx: ELISA, PCR of CSF, Western blot
Tx: Doxycycline 100mg BID x10 days
pregnancy or kids- Amoxicillin 500mg TID x14 days
Cefuroxime 500mg BID x14 days
◉ Disseminated Lyme.
Answer: Neurologic Lyme
Can cause meningitis, radiculopathy
Tx: IV Ceftriaxone 2g daily x14-21 days
IV Penicillin G or oral Doxycyline if mild
Lyme Carditis (heart block, myocarditis)
PAPER QUESTIONS AND SOLUTIONS GRADED
A+
◉ Influenza Vaccine.
Answer: can give 6 months and older, any trimester of pregnancy
contraindicated in Guillian Barre syndrome, otherwise can get even
with egg allergy
Antivirals: oseltamivir, zanamivir, baloxavir, peramivir
◉ Fifth Disease.
Answer: viral illness caused by parvovirus B19 that primarily effects
kids (5-15 y.o)
prodrome: low grade fever, headache, fatigue, cold like symptoms
Rash: "slapped cheek" rash and reticular lacy rash on trunks, arms,
legs, pink/red, lasts 1-3 weeks, irritated by warmth, friction, and sun
,transmission: respiratory droplets and direct contact with
secretions, vertical transmission from mother to fetus
management: supportive care - rest, hydration, infection control,
monitor blood cell counts
Immunocompromised may get IVIG
adults may get arthritis, more severe in adults, self-limiting
can also cause anemia
◉ pregnant woman exposed to fifth disease.
Answer: Can cause fetal complications (hydrops fetalis, stillbirth,
miscarriage)
Check:
vaccinated or previous infection?
serologic testing IgG and IgM
fetal monitoring
B19 assay and IgM to confirm diagnosis
consult specialist
NAAT or PCR for immunocompromised
,◉ Rocky Mountain Spotted Fever.
Answer: caused by rickettsia recketsii (tick borne) from dog ticks or
wood ticks
Can cause organ failure
s/s: high fever, malaise, headache, muscle aches, N/V, petechial rash
(small, flat, red/purple spots on wrists/ankles that spread to palms,
trunk, arms and appears 2-5 days after onset)
Tx: Doxycycline 100 mg BID x 5-7 days in adults, 2.2mg/kg in
children BID x5-7 days
or Chloramphenicol in pregnancy
◉ Diagnostics for RMSF.
Answer: Indirect fluorescent antibody (IFA)
ELISA, PCR
CBC and liver enzymes (increased WBCs and thrombocytopenia)
◉ Lyme Disease.
Answer: borrelia burgdorferi (tickborne)
black legged deer tick, tick attached >36 hours
, incubation 3-30 days after bite
Prophylactic tx: >36 hours attached, 200mg single dose or 4.4mg/kg
in kids given within 72 hours of tick removal
s/s: fever, HA, muscle/join pain, fatigue, bulls eye rash with central
clearing, lymphadenopathy
Dx: ELISA, PCR of CSF, Western blot
Tx: Doxycycline 100mg BID x10 days
pregnancy or kids- Amoxicillin 500mg TID x14 days
Cefuroxime 500mg BID x14 days
◉ Disseminated Lyme.
Answer: Neurologic Lyme
Can cause meningitis, radiculopathy
Tx: IV Ceftriaxone 2g daily x14-21 days
IV Penicillin G or oral Doxycyline if mild
Lyme Carditis (heart block, myocarditis)
