NURS 562 Module 1 Exam With
Complete Solution
Angle closure glaucoma; suspect with these symptoms - ANSWER Severe
unilateral, deep eye pain
Photophobia
Cornea clouding
Pupil mid-dilated and fixed
Decrease in vision
Diffuse redness of the eye
treatment for Angle closure glaucoma - ANSWER Emergent ophthalmologist
referral
Tonometry study
Acetazolamide 500 mg IV or PO
Topical beta blocker
Dacryocystitis; suspect with these symptoms - ANSWER Chronic tearing
Mucoid or purulent discharge
Eyelash crusting
,Localized tenderness
Edema
Dacryocystitis; treatment - ANSWER Warm compresses
Gentle massage
Topical abx (Polytrim, Tobrex, Ciloxan) one drop every 6 hours
Systemic abx (Keflex, Augmentin, Erythrocin)
Orbital cellulitis; suspect with these symptoms - ANSWER Inflammation of
the eye tissue
Suspect with these symptoms
Unilateral swelling, erythema
Vision affected
Localized tenderness
Fever
Limited EOMs
Orbital cellulitis; treatment - ANSWER Immediate intervention
Ophthalmologist referral
,Hospitalization and IV abx
Most common etiology of CAP - ANSWER Strep pneumoniae (60-70%)
H. influenzae
Influenza virus
Legionella
Exam of CAP - ANSWER VS: Fever, tachycardia
Respiratory:
Tachypnea (RR>24), dyspnea
Rales that do not clear w/ cough, ronchi. Bronchial breath sounds, egophony
Dullness to percussion, tactile fremitus
DX workup of CAP - ANSWER CXR (AP and lateral)
May be normal early in course of disease
Single or multiple lobar consolidation
Immunosuppression may cause false negative result
Pulse oximetry
Sputum analysis
Not recommended for outpatients dx w/ CAP
, If to be obtained, recommend sample from first thing in the morning
If patient is to be admitted:
ABG, CBC, CMP, blood cultures x2
Do not recommend routine bronchoscopy
CAP abx - ANSWER Antibiotics:
Outpatient, previously healthy individuals, uncomplicated CAP
Macrolide*
Ex: Azithromycin 500mg x1 day, then 250mg x4d
*In U.S., macrolide resistant CAP > 40%, so recommend doxycycline instead
(UpToDate)
Doxycycline
Ex: doxycycline 100mg PO BID
Patients w/ comorbid conditions (heart or lung disease, liver or renal disease,
DM, ETOH abuse, malignancy, or immunosuppression):
Fluoroquinolone or B lactam + macrolide
Complete Solution
Angle closure glaucoma; suspect with these symptoms - ANSWER Severe
unilateral, deep eye pain
Photophobia
Cornea clouding
Pupil mid-dilated and fixed
Decrease in vision
Diffuse redness of the eye
treatment for Angle closure glaucoma - ANSWER Emergent ophthalmologist
referral
Tonometry study
Acetazolamide 500 mg IV or PO
Topical beta blocker
Dacryocystitis; suspect with these symptoms - ANSWER Chronic tearing
Mucoid or purulent discharge
Eyelash crusting
,Localized tenderness
Edema
Dacryocystitis; treatment - ANSWER Warm compresses
Gentle massage
Topical abx (Polytrim, Tobrex, Ciloxan) one drop every 6 hours
Systemic abx (Keflex, Augmentin, Erythrocin)
Orbital cellulitis; suspect with these symptoms - ANSWER Inflammation of
the eye tissue
Suspect with these symptoms
Unilateral swelling, erythema
Vision affected
Localized tenderness
Fever
Limited EOMs
Orbital cellulitis; treatment - ANSWER Immediate intervention
Ophthalmologist referral
,Hospitalization and IV abx
Most common etiology of CAP - ANSWER Strep pneumoniae (60-70%)
H. influenzae
Influenza virus
Legionella
Exam of CAP - ANSWER VS: Fever, tachycardia
Respiratory:
Tachypnea (RR>24), dyspnea
Rales that do not clear w/ cough, ronchi. Bronchial breath sounds, egophony
Dullness to percussion, tactile fremitus
DX workup of CAP - ANSWER CXR (AP and lateral)
May be normal early in course of disease
Single or multiple lobar consolidation
Immunosuppression may cause false negative result
Pulse oximetry
Sputum analysis
Not recommended for outpatients dx w/ CAP
, If to be obtained, recommend sample from first thing in the morning
If patient is to be admitted:
ABG, CBC, CMP, blood cultures x2
Do not recommend routine bronchoscopy
CAP abx - ANSWER Antibiotics:
Outpatient, previously healthy individuals, uncomplicated CAP
Macrolide*
Ex: Azithromycin 500mg x1 day, then 250mg x4d
*In U.S., macrolide resistant CAP > 40%, so recommend doxycycline instead
(UpToDate)
Doxycycline
Ex: doxycycline 100mg PO BID
Patients w/ comorbid conditions (heart or lung disease, liver or renal disease,
DM, ETOH abuse, malignancy, or immunosuppression):
Fluoroquinolone or B lactam + macrolide
