Download NURS 631 Advanced Health Assessment - Exam #2: Questions and Answers and more Exams Nursing in PDF only on Docsity!
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Holosystolic murmur heard best at Apex, may transmit to axilla and sternum.
- correct answer ✅Mitral Regurgitation Symptoms of Mitral regurgitation - correct answer ✅may be asymptomatic for decades, then SOB, Fatigue, HF What increases the murmur of Mitral regurgitation, what decreases the murmur? - correct answer ✅Decrease murmur = stand up Increase murmur = clench fist Common causes of mitral regurgitation - correct answer ✅Congenital abnormality, Rheumatic Heart disease, acute endocarditis, Chordae tendinae dysfunction... Mid-systolic grade II-III/VI, best heard between L. sternal border and apex. - correct answer ✅physiologic murmur - specifically "Still's Murmur" (usually ages 3-6) Harsh, crescendo-decrescendo systolic murmur best heard at right sternal border. Can radiate to the neck - correct answer ✅Aortic Stenosis
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What are the common symptoms of Aortic Stenosis - correct answer ✅Chest pain, syncope, exercise intolerance, dyspnea, CHF. May have a long latent period before sx. what are patients at risk for with severe aortic stenosis - correct answer ✅Sudden Death! What am I associated with .... Medium pitched CONTINUOUS murmur in both systole/diastole. Usually harsh, machinery like noise. Loud, sometimes a thrill is present. (heard best L infraclavicular fossa and pulmonic area) - correct answer ✅patent ductus arteriosus Mid-to late systolic murmur, may have a mid-systolic click best heard over the lower left sternal border. - correct answer ✅Mitral Valve Prolapse what are the symptoms associated with MVP? - correct answer ✅Most people are asymptomatic. May have chest pain, palpitation, mild dyspnea, fatigue, anxiety.
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Which murmurs are louder during inspiration? (left or right) - correct answer ✅Right Which murmurs are louder during expiration? (left or right) - correct answer ✅Left Early, mid, or late systolic OR pansystolic Medium pitched murmur best heard at the lower left sternal border. Can radiate to the right sternal border? - correct answer ✅Tricuspid Regurgitation/Insufficiency What is associated with a Pansystolic, louder in midsystole. best heard at LSB with radiation to the RSB. May have systolic THRILL at LLSB. Increased murmur with Valsalva. - correct answer ✅Ventricular Septal Defect In a fetus, blood flows from the right atrium to the left atrium through the __________. - correct answer ✅Foramen ovale In a fetus, the connection between the pulmonary artery and aorta is the ___________. - correct answer ✅Ductus arteriosus
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_________ brings blood back from the fetus to the placenta - correct answer ✅umbilical artery ________ brings blood from the placenta to the fetus - correct answer ✅umbilical vein Which 3 CHD are associated with INCREASED pulmonary blood flow - correct answer ✅PDA, ASD, VSD What are symptoms associated with Patent Ductus arteriosus? - correct answer ✅may be asymptomatic, or CHF, bounding peripheral pulses, WIDE pulse pressure, II-V Harsh machinery like CONTINUOUS murmur best heard left clavicle, 1st/2nd L ICS. What is the treatment for PDA? - correct answer ✅Indomethacin to effect closure Blood flows from Left to Right Atrium through an opening. Can result in R atrium and ventricle distention, and increased pulmonary blood flow. - correct answer ✅Atrial Septal Defect
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chest xray of tetralogy of Fallot - correct answer ✅boot shaped heart lack of connection between right atrium and right ventricle - correct answer ✅Tricuspid atresia (TA) Symptoms of Tricuspid atresia? - correct answer ✅cyanosis at birth or a fews days after, difficulty feeding, week suck, clubbing, tachycardia, tachypnea, crackles.. Treatment for Tricuspid atresia? - correct answer ✅IV PGE1 (prostoglandin) to keep the PDA open. then surgery. Position for Tet spell to help relieve cyanotic episode - correct answer ✅cradled in knee position Obstructive blood flow disorders (three) - correct answer ✅1. coarctation of the aorta
- Aortic stenosis
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- pulm stenosis Narrowing/constriction of the aorta is ____________. symptoms include: __________ - correct answer ✅Coartication of the aorta. BP is increased in heart and upper portions of the body, decreased BP in lower portions of the body. Sx: tachypnea, poor feeding, cool lower extremities, older children> leg pain, dizziness, syncope. *BOUNDING pulses in upper extremities, weak pulses in lower extremities. Coartication of aorta are at high risk for - correct answer ✅hypertension, rupture aorta, AA, Stroke Narrowing of the aortic valve is ____________. Sx associated with it include __________ in pediatrics. - correct answer ✅Aortic stenosis. SX: dif. feeding, fatigue, CP with activity, faint pulses, CHF, shock in AS newborns (severe), sudden death r/t dysrhythmias.
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NORMALLY, the ________ side of the heart has higher pressure than the _________ side of the heart - correct answer ✅Left side has higher pressure than the Right side Left to Right sided CHD are (ASD, VSD, PDA) are ______________. (cyanotic or acyanotic) - correct answer ✅Acyanotic Right to Left disorders are acyanotic or cyanotic? - correct answer ✅Cyanotic (blue) Leading ACQUIRED caused of heart disease in children? - correct answer ✅Kawasaki Disease Criteria for diagnosis of Kawasaki disease - correct answer ✅1. fever >5 days unresponsive to Abt.
- bilateral conjunctival injection (no exudate)
- inflammatory changes to oral mucosa (erythema of lips or oropharynx, STRAWBERRY TONGUE, fissuring of lips
- peripheral extremity edema, erythema, periungual desquamation
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- polymorphous rash (urticarial or pruritic)
- cervical lymphadenopathy (unilateral, anterior cervical) heart sound that represents increase force of ATRIAL contraction and ventricular distention. - correct answer ✅s4 - always pathologic "TENNESSEE" heart sound associated with rapid ventricular filling. best heard in lateral decubitus position. -Can be normal ages <40 - correct answer ✅s3 - "kentucky" condition where fungal or bacteria invade traumatized endocardial surfaces, most common the valves. most commonly occurs with underlying structural defects - correct answer ✅Infective endocarditis 80% of all IE in children is Staph (gram+) 3 Gram postive organisms - correct answer ✅Staph, Strep, Enterococcus
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Creamy yellow, sharply demarcated structure in funduscopic exam - correct answer ✅optic disk A:V ratio - normal - correct answer ✅2:3 or 3: ophthalmoscope question. which color do you use to see near objects; and to use for farsighted eyes - correct answer ✅Black opthalmoscope question: which color diopter would you use to see far/distant objects and to use with nearsighted eyes - correct answer ✅Red What does 20/200 mean? - correct answer ✅At 20 ft a patient can read what a person with normal vision can reat at 200 ft. the larger the second number the worse the vision.. 20/200 is also considered legally blind. myopia - correct answer ✅impaired far vision "nearsightedness" Presbyopia - correct answer ✅impaired near vision
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symptoms associated with ACUTE angle closure glaucoma - correct answer ✅severe pain, N/V, halos around lights, photophobia, cornea cloudy. pupil mid dilated and fixed. Tx: Urgent referral Lateral rectus muscle of the eye is controlled by which Cranial nerve? - correct answer ✅VI Inferior oblique (up/out), superior rectus (up/in), medial rectus is controlled by which cranial nerve? - correct answer ✅III The superior oblique (down/out)muscle is controlled by which cranial nerve?
- correct answer ✅IV edema of the bulbar conjunctiva. - correct answer ✅Chemosis microscopic or visible blood layering in the anterior chamber of the eye. usually after blunt trauma. Urgent referral necessary - correct answer ✅Hyphema
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acute onset of floaters - correct answer ✅retinal detachment blindspot around area of normal vision or decreased vision - correct answer ✅scotoma - associated with glaucoma, optic nerve disorder, or visual pathway disorder. deviation in the anteroposterior axis of the eye - correct answer ✅Strabismus an involuntary, rapid and repetitive movement of the eyes. Usually the movement is side-to-side - correct answer ✅nystagmus double vision - correct answer ✅diplopia leading cause of IRREVERSIBLE vision loss in the industrialized world - correct answer ✅Macular degeneration which part of vision is lost in macular degeneration? - correct answer ✅primarily central vision
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Eye exam findings of a pt with Hypertension - correct answer ✅Copper wiring, silver wiring, AV nicking, tapering, banking, cotton wool (soft exudates), hard exudates, superficial retinal "flame shaped" hemorrhages Eye exam findings of a pt with diabetic retinopathy - correct answer ✅microaneurysms (first sign), dot blot hemorrhages, , retinal edema and hard exudate, neovascularization (proliferative retinopathy). enlargement of the globe of the eye - correct answer ✅bupthalmos what can bupthalmos be a sign of in infants - correct answer ✅glaucoma, increased IOP OU means ____ - correct answer ✅both eyes OD means _____ - correct answer ✅right eye OS means_______ - correct answer ✅left eye
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What is the risk of otitis media with effusion - correct answer ✅hearing loss Treatment for effusion - correct answer ✅document each visit presence and duration of effusion. watchful waiting.. usually resolves in about 3 months. Referral if at high risk for having dev. delays. most common pathogen for acute bacterial sinusitis? - correct answer ✅# Strep pneumoniae. other causes include: H. influenza, Moraxella catarrhalis. clamydia pneum. and strep pyogenes Antiobiotic treatment for acute BACTERIAL rhinosinusitis? - correct answer ✅---mild/mod ABRS with no risk of resistance is Amoxicillin/clavulanate 45mg/kg/day divided BID. ---with increased risk of resistance Amox/clavulanate 90mg/kg/day divided BID. Why is Augmentin given for ABRS rather than just Amoxicillin? - correct answer ✅cluvulanate is used to treat H. flu and M. cattarrhalis - common causes of ABRS. Amoxillicin covers strep pneumo
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What are alternative treatments for ABRS if there is a penicillin allergy? - correct answer ✅Doxycycline OR Clindamycin + 3rd gen cephalosporin OR respiratory quinolone First line treatment for acute strep Pharyngitis (GABHS) - correct answer ✅Penicillin Penicillin V = oral x10 dyas Penicillin G = IM single dose Treatment of Group A Strep pharyngitis for a pt with penicillin allergy. - correct answer ✅Clindamycin, azithromycin, clarithromycin characteristic symptom is a barking cough. what am I - correct answer ✅Laryngotracheitis "croup" what is the treatment for croup with stridor at rest - correct answer ✅Hospitilization. racemic epi nebulizer, steroids, mist with oxygen
