ANCC AGACNP - Frances Guide Review Exam 531 Questions with Verified Answers,100% CORRECT

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ANCC AGACNP - Frances Guide Review Exam 531 Questions with Verified Answers You want to get more funding for your hospital's Rapid Response Team. How should you present this issue to the committee?... a. Stress importance of the team (look up evidence about how team affects outcomes) b. Describe how to improve and expand the team - CORRECT ANSWER a. stress importance of team What is the best way for the AGACNP to get involved in policy making? a. attend legislative days at the state capitol b. join a hospital committee c. write your local congressman d. review literature and give more in-services - CORRECT ANSWER b. join a hospital committee What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? a. join a hospital committee b. petition the government c. bill for independent services d. start your own practice - CORRECT ANSWER c. bill for independent services Which of the following is considered a high acuity role for the AGACNP? a. primary care clinic b. cardiology office c. community health department d. minute clinic - CORRECT ANSWER b. cardiology office What is the best way to advocate for gay and lesbian population? a. participate in a high state or national level b. join a non-profit advocacy group c. consider lobbying the government d. start at your facility - CORRECT ANSWER d. start at your facility Answers are worded differently. "decrease bias in healthcare" "create in-servises in healthcare" "obtain funding to increase access" Which of the following is most important to evaluate statistical significance when reviewing the literature? a. consider the sample size b. make sure the confidence interval is tight c. see if the p-value is less than the alpha-coefficient d. determine the error rate - CORRECT ANSWER a. consider the sample size When closing a practice, the NP is required to do all of the following except a. give the patient adequate time to find another provder b. keep all of the patient's records for a minimum of five years c. send a certified letter with a return receipt requested d. provide names of other providers for future care - CORRECT ANSWER c. send a certified letter with a return receipt requested Which of the following components of an evidenced based research process is the most important for NP to participate in? a. specifying methods of data collection b. formulating the hypothesis c. carefully reviewing the literature d. formulating the research problem - CORRECT ANSWER d. formulating the research problem A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander - CORRECT ANSWER a. libel Can you tell the patient's wife, for her protection, that her husband has HIV? - CORRECT ANSWER No, not without his permission How can the ANCP prepare to get involved in future mass casualty event? - CORRECT ANSWER Pre enroll in disaster volunteer program An 80 year old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? - CORRECT ANSWER Medicaid Your patient is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: - CORRECT ANSWER Pays after insurance and 3rd party payers have paid You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that workds. What ethical principles does this challenge? - CORRECT ANSWER Veracity and fidelity Health literacy - CORRECT ANSWER Average american: 8th grade level Quality assurance - CORRECT ANSWER A process for evaluating the care of patients using established standards of care to ensure quality CPI - CORRECT ANSWER Measures structure, processes, and outcomes A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based policies to establish clinician-family communication standards in the unit. These policies should include: - CORRECT ANSWER Guidelines for having discussions with family members that are geared toward establishing treatment goals Which clinical scenario does the NP evaluate for a quality improvement process change? - CORRECT ANSWER An increased incidence of postoperative sternal wound infections Goals set forth in healthy people 2020 by the US department of Health and Human services include: - CORRECT ANSWER elimination of health disparities (and increased QOL/LOL) Based on the individual's culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership with the patient by: - CORRECT ANSWER Tailoring his or her communication style to the patient's preference A 70 year old patient with a history of DM, HTN, OAs, and a new diagnosis of CAD, is being discharged. The adult-gerontology acute care NP teaches the patient that the first point of contact for health care needs is the: - CORRECT ANSWER PCP The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource provides the strongest level of evidence? - CORRECT ANSWER A systematic review (meta analysis) What legislation allowed NPs to be recognized Medicare providers in all geographical areas with their own provider number? - CORRECT ANSWER Balanced Budget act True/false: restraining an unwilling patient is grounds for malpractice? - CORRECT ANSWER False, if they are a danger you can restrain Patient presents to the clinic for routine f/u and passes out. You revive the patient and admit overnight. Which of the following would qualify as incident to billing? - CORRECT ANSWER Temperature and weight recording The NP program initiated, primarily, because of what issue in healthcare at the time? - CORRECT ANSWER Pediatric physician shortage Elderly patient takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do? - CORRECT ANSWER Ask him to speak candidly with you Patient calls to complain about bills and states he has Medicare, which should cover all costs. You explain: - CORRECT ANSWER Since you are healthy, exams are not covered Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient... - CORRECT ANSWER No, HIPPA Patient in ER not doing well, primary MD calls: - CORRECT ANSWER Give him info NP working on ESRD research project. A colleague renal specialist asks for patient info on your patients: - CORRECT ANSWER HIPAA breach Who enforces HIPAA? - CORRECT ANSWER Office of Civil Rights/Dept Health and Human Services Who isn't covered by HIPAA? - CORRECT ANSWER Law enforcment/municipal offices, CPS/Schools, employers/workman's comp, life insurance Insurance company calling to verify some patient appointments? - CORRECT ANSWER Answer by picking out that there is already a medical release signed by the patient and give the requested information to them Benchmarking - CORRECT ANSWER How institution compares with similar organizations Managed care - CORRECT ANSWER Know what this is and how it has improved costs, something about putting caps on payments Peer review - CORRECT ANSWER Timely, not anonymous, and NP knows how peer review will impact yearly evaluation Sensitivity vs specificity - CORRECT ANSWER Sensitivity: true positives, specificity: true negatives There was a question where a patient had a multinodular goiter and wanted to know why the NP was not going to do periodic US and fine needle biopsy in monitoring for some kind of cancer or complication. The answer I picked was that these tests were not very specific to detect the cancer Reliability - CORRECT ANSWER When implementing a new study, tested over and over, the consistency of a measurement or the degree to which an instrument measures the same way over time Validity of results in an article - CORRECT ANSWER P-value, probability of falsely rejecting the null hypothesis, want it to be <0.05 Statistical significance - CORRECT ANSWER Look at sample size and p value Privileging - CORRECT ANSWER May be granted in full or part by the hospital, credentialing committee is made of physicians Who determines scope of practice? - CORRECT ANSWER State practice acts but institutional bylaws may further restrict practice (facility limited scope of practice) Informed consent - CORRECT ANSWER A state indicating patient has received adequate instruction/information regarding aspects of care to make a prudent, personal choice regarding such, includes risks and benefits, competence: ability to communicate, understand, reason, differentiate good and bad Case management - CORRECT ANSWER Mobilize, mointor, and control resources that a patient uses during course of an illness while balancing quality and cost, "move patients through the system appropriately" 50-60 year old patient ith a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? a. consult CM b. Consult SW c. refer to Oncology d. refer to Hospice - CORRECT ANSWER a. consult CM Nondisclosure - CORRECT ANSWER Not disclosing patient PHI without permission Negligence - CORRECT ANSWER Failure of individual to do what any reasonable person would do, resulting in injury to the patient When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? - CORRECT ANSWER Nonmaleficence Living will - CORRECT ANSWER Health care proxy/POA NP sees a patient for HF and performs an H&P. What % is expected to be paid? - CORRECT ANSWER Medicare pays 80% of the total bill, pt pays 20%, NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure 80% of that 85% Focus of palliative care - CORRECT ANSWER Basic improvement in QOL of anyone with an illness at any stage Hospice - CORRECT ANSWER <6m to live Scope of practice: integration of care across the acute illness continuum with: a. collaboration b. coordination of care c. research based clinical practice - CORRECT ANSWER a. collaboration Collaboration - CORRECT ANSWER True partnership in which all players have the desire power, share common goals, and recognize/accept separate areas of responsibility/activity Patient is getting d/c'd and need wound care, pulmonary, and follow up. NP's role is to: - CORRECT ANSWER Coordinate services Government is moving towards being cost effective. What is the best way? - CORRECT ANSWER Allow NP to treat a wider variety of patients Protected health information: discussion between the NP and consultant on case - CORRECT ANSWER Considered clinical relevance How should the ACNP stay up to date with current information? - CORRECT ANSWER Evidence based guidelines Which medicare is Hospice covered under? - CORRECT ANSWER Medicare A A patient presents to the Er with c/o CP and SOB. The NP misinterprets the EKG and admits the patient fro further monitoring without consulting cardio. Later in the shift, the patient decompensates and goes into cardiac arrest. The patient was resuscitated but sustained permanent brain damage. What grounds of malpractice is the NP accountable for? - CORRECT ANSWER Lack of skill Healthcare exchange - CORRECT ANSWER Health insurance marketplaces, organizations in each state through which people can purchase health insurance You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do you approach this problem? a. ask the patients treated how care can be improved b. look back at prior treatment given to see how outcomes can be improved c. form a standardized tx plan for all patients that can be used by all healthcare staff d. form individualized tx plans that can be used by all healthcare staff - CORRECT ANSWER c. form a standardized tx plan for all patients that can be used by all healthcare staff You have transferred a patient to the SNF. The MD in charge at that facility calls for info about the patient's medical care, what do you do? a. direct him to look it up in the EMR b. refuse to share protected health information c. instruct him to call the department head d. share the information he requests - CORRECT ANSWER d. share the information he requests Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do? a. administer PRBCs as needed b. call the ethics committee c. continue to research alternative treatments d. ask the family to give permission now that he's unconscious - CORRECT ANSWER c. continue to research alternative treatments What is the best way to make sure a patient will follow up as instructed? a. instruct the patient to schedule the appointment b. ask the patient the best time they can go to an appointment c. have the office manager to schedule the appointment d. schedule the appointment for the patient - CORRECT ANSWER d. schedule the appointment for the patient Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserves life, but states that the patient would not want to be on a ventilator. What should you do? a. consult neurology to come interview the family b. document the situation carefully in the chart c. call a clergy member to offer support d. call the ethics committee - CORRECT ANSWER d. call the ethics committee A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in "years". You: a. refer her to a gynecologist b. schedule her to come back next week for the PAP at another appt c. perform the pap today d. do a vaginal exam only, and refer the PAP to a gyno - CORRECT ANSWER b. schedule her to come back next week for the PAP at another appt A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: a. refer her to gynecologist b. schedule her to come back c. perform the PAP today d. do a vaginal exam only, and refer the PAP to a gyno - CORRECT ANSWER a. refer to gynecologist Discharge planning is udnerway for a patient who has been very dehabilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? a. hospice b. home health care c. SNF d. private duty RN - CORRECT ANSWER c. SNF Your patient presents to ED w/ R wrist pain. She states, "it's my fault; I should have had dinner ready on time." What do you do? a. Tell her not to go home bc it's not safe b. XR the wrist c. call the police d. consult psych - CORRECT ANSWER b. XR the wrist Now the husband presents to the ED with drug overdose. What is your action? a. Hand him off to anothe rpractitioner b. call the police c. consult psych d. treat him without prejudice - CORRECT ANSWER d. treat him without prejudice The medical resident obtained consent for an operative procedure. on your visit, the patient is confused/ refusing the procedure a. cancel the surgery b. have the wife sign another consent c. call the resident to clarify the patient was not confused when he signed the first consent d. consult neurology - CORRECT ANSWER c. call the resident to clarify the patient was not confused when he signed the first consent Your HIV positive patient is preparing to discharge when he tells you not only that he has passed the virus to his wife, but also that he plans to kill her when he gets home. How do you respond? a. call the police b. consult psych c. consult social work d. document his statements - CORRECT ANSWER b. consult psych Your clinical student breaks the sterile field. HOw do you handle this situation? a. discuss it with the student b. report it to the charge nurse c. report it to the unit manager d. inform the faculty in charge of the student - CORRECT ANSWER a. discuss it with the student You are the NP on call for the night. The nurse calls you to report the patient is decompensating. Who do you direct her to call? a. the ER physician b. anesthesia c. an NP present on another unit currently d. the attending MD who is at home - CORRECT ANSWER d. the attending MD who is at home A code you are in does not go well, and staff members afterwards are criticizing each other. How do you deal with the situation? a. schedule an in service to discuss common code mistakes b. meet with each team member individually c. set up exercises to increase collaboration during a code d. meet with all who participated in the code and have a one-time briefing - CORRECT ANSWER d. meet with all who participated in the code and have a one-time briefing Your patient is not doing well and family/wife is at bedside crying. Yo are preparing to talk to the family. What do you do first? a. place a social work consult b. explicitly explain the situation, the outcomes and care involved c. ask if the patient has an advanced directive d. set up a family meeting in a room with a specific time and date - CORRECT ANSWER c. ask if the patient has an advance directive Your patient is not conscious. HIs advance directive states he wants to be a DNR, but his family says they want him to be a full code. How do you respond? a. tell her the decision goes to the next of kin b. call the ethics committee c. comply with her wishes and make him a full code d. tell her you can't go against the advance directive - CORRECT ANSWER d. tell her you can't go against the advance directive A patient comes to the ED at a community hospital who is 29 weeks pregnant. She says her water has broken. Her VS are stable. What do you do? a. transfer her to a tertiary facility b. contact her OB/GYN for treatment advice c. admit to l/d d. consult the nurse midwife - CORRECT ANSWER a. transfer her to a tertiary facility Your 51F patient is getting ready to discharge when she tells you she hasn't had a mammogram in 3 years. What do you do? - CORRECT ANSWER Refer to PCP for outpatient discharge Your patient's imaging reveals he has metastatic cancer. The family, in accordance with their culture, request that you not share the test results to spare him distress. How do you respond? - CORRECT ANSWER Ask the patient what he wants to know about his prognosis 35yo F presents with c/o bilateral wrist pain. You suspect spouse abuse. You notice a handgun in her purse. What would be your next action? - CORRECT ANSWER Call security to ensure safety Adult child of a patient reports that her father has expressed desire to commit suicide and has a hx of ETOH and depression. The best response would be to? - CORRECT ANSWER Hospitalize the patient and start pscyhotherapy You notice that another NP in your group is frequently contact by pharmacy for prescription errors. How do you handle the situation? - CORRECT ANSWER Address it directly with the NP Your patient voices concerns because he has lost his insurance and worries his children will no longer have coverage for medical expenses. What do you do? - CORRECT ANSWER Consult case management 80yo patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the NP: - CORRECT ANSWER Provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery A 40yo female patient with no PMH is admitted with bilateral PE. W/u reveals a psoitive result for lupus anticoagulant, and anticoagulant therapy is planned. The patient verbalizes concern about her ability to manage the appointments and the follow up care. The NP's most effective intervention si to: - CORRECT ANSWER Arrange follow up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge What procedure does the AGACNP perform to evaluate cytology, only, in the tumor? - CORRECT ANSWER Fine needle biopsy A patient has fully recovered from septic shock due to bacteremia and has been accepted to a LTC facility for continuation of abx. ID has not seen the patient in two days. The NP: - CORRECT ANSWER Contacts the ID MD to determine the appropriate abx duration 32yo M presented with a gunshot wound (GSW) to the FA. Injuries are negligible and pt is stable. Pt reports the shot was an accident during hunting. What should the NP do? - CORRECT ANSWER Report to the police. All GSW must be reported What is the most important when assessing status? - CORRECT ANSWER Level of alertness or hx of symptoms A woman of child bearing age c/o abdominal pain. What level of exam do you document? - CORRECT ANSWER Detailed A diabetic patient complains of abd pain. Which type of exam do you conduct? - CORRECT ANSWER Comprehenxive What qualifies patient for HHC - CORRECT ANSWER Home bound, has a prescription, requires care services, wound care, select care Patient is refusing care? - CORRECT ANSWER Let them refuse, educate, and search for alternatives Guy in ER needs refill on ritalin - CORRECT ANSWER research alternatives Knowledge deficit in ICU, what would you do for nurses? - CORRECT ANSWER In services A patient has advanced dementia, ESRD, and HF, what do you do for him? - CORRECT ANSWER Transfer from acute to palliative care Your 24m patient has been out hiking on vacation. He shows you the following rash, and thinks he has Rocky Mountain Spotted Fever. What is his diagnoses? - CORRECT ANSWER Lyme disease (Erythema migrans/bullseye rash), both are treated with doxycycline Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to? a. shame because she feels the illness is her fault b. embarrassment from the examination c. a sign of respect d. a normal response - CORRECT ANSWER c. a sign of respect Your patient speaks only spanish and you need to evaluate his pain. What do you do? a. ask a family member to translate for you b. utilize the hospital's interpreter service c. call over the Hispanic housekeeper and ask her to translate d. Use a visual pain scale - CORRECT ANSWER D. use a visual pain scale 58yo Japanese male with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the Ed warrant admission? a. age b. gender c. pain level d. ethnicity - CORRECT ANSWER d. ethnicity (underestimates pain, taught to be stoic, pain is probably much more severe) A 77yo male patient's wife cares for him at home .Which statement by the wife indicates a need for a SNF? a. my husband needs more help with his ADLs b. I can't lift him out of bed anymore c. he has lost 20 pounds d. he has trouble swallowing and I'm worried he will choke on his food - CORRECT ANSWER a. my husband needs more help with his ADLs Which psychiatric disorder is most commonly diagnosed, yet least commonly treated? a. bipolar disorder b. alzheimer disease c. depression d. dementia - CORRECT ANSWER c. depression Your patient with PNA is noted to have a heavy drinking habit. 2 days post admit he becomes combative/agitated. What is tx? a. IV valium b. IV ativan c. PO librium d. lasix - CORRECT ANSWER c. PO librium Your patient has developed a fever of unknown origin. What is the next step? a. PO abx b. IV abx c. do nothing until diagnosis is confirmed d. tylenol - CORRECT ANSWER c. do nothing until diagnosis is confirmed How long will it take to begin to see healing in a pressure ulcer that has a clean, well-vascularized bed? a. 7 days b. 2-4 weeks c. 2 days d. 4-6 weeks - CORRECT ANSWER c. 2 days The patient has been in a bar fight and has a human bite on his hand. What should you do next? a. order PO abx b. order wound culture c. order IV abx d. measure the wound depth and width - CORRECT ANSWER a. Order PO abx Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication? a. compartment syndrome b. decrease in ROM ability c. septic shock d. osteomyelitis - CORRECT ANSWER d. osteomyelitis What is the strongest predictor of functional impairment prior to discharge of the elderly patient? a. advanced age b. incontinence c. cognitive impairment d. poor balance - CORRECT ANSWER c. cognitive impairment Your patient has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.2) a. give IVF b. antipyretic c. abx d. ice packs to groin and axilla - CORRECT ANSWER a. give IVF (Flush it out, this is neuroleptic malignant sydnrome) You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention? a. stop the TPN, remove the line, and place a new line for TPN b. start abx c. send cx d. change the guidewire - CORRECT ANSWER a. stop the TPN, remove the line, and place a new line for TPN Your patient has a fever 3 days post op, WBC are 15k, blood cultures negative, and Eos 9%. What is the diagnosis? a. viral infection b. bacterial infection c. malignant hyperthermia d. drug fever - CORRECT ANSWER d. drug fever (eos=allergic reaction, normal is 1-4%) What are protein supplements best used for? a. eliminate the need for lipids b. prevent anasarca (peripheral edema) c. aid in post op healing - CORRECT ANSWER c. aid in post op healing Which macronutrient of TPN significantly increases the osmolality of the solution? a. lipids b. dextrose c. mutivitamin d. potassium - CORRECT ANSWER b. dextrose Protein in nutrition for what reason? - CORRECT ANSWER maintain nitrogen balance along with metabolic needs, adjust protein weekly by measuring urinary urea nitrogen Which electrolyte are you most concerned about monitoring in cachexic patient? a. mag b. ca c. na d. k - CORRECT ANSWER d. k refeeding syndrome, hypokalemia and hypophosphatemia Which electrolyte do you monitor in refeeding syndrome? - CORRECT ANSWER Phosphorous (or potassium) Which lab do you monitor daily in a patient on nutritional supplements? a. BMP b. cbc c. abg d. blood culture - CORRECT ANSWER a. BMP (and monitor LFT's weekly) What alternative therapy can you order to relax the patient prior to procedure? a. massage b. aromatherapy c. music d. muscle relaxant - CORRECT ANSWER c. music What alternative therapy can you use to help/distract them from their pain during the procedure? - CORRECT ANSWER Guided imagery Which alternative therapy helps Parkinson's patients with coordination? a. acupuncture b. tai chi c. relaxation techniques d. hypnotherapy - CORRECT ANSWER b. tai chi (also helps prevent falls in elderly) Which 2 headaches are treated with triptans? - CORRECT ANSWER Migraines and cluster What kind of dressing do you use on a decubitus ulcer with necrotic tissue? - CORRECT ANSWER Hydrocolloid 45yo s/p double mastectomy 2 months ago. Now is c/o pain at the incision site - CORRECT ANSWER Neuropathic pain What does the leg/foot look like in a hip fracture - CORRECT ANSWER Internally or externally rotated Pt has a post op fever... - CORRECT ANSWER Give fluids WHO pain ladder... - CORRECT ANSWER Fentanyl patch for breakthrough cancer pain Best pain indicator... - CORRECT ANSWER Patient self report Best alternative therapy to decrease pain in clavicle fracture: - CORRECT ANSWER Therapeutic touch/reiki (hand or palm healing that transfers 'universal energy' has been used for cancer, emotional, or physical healing) Picture of gunshot wound to the R lung area - CORRECT ANSWER The answer is to allow the dressing to be sucked to the chest wall during the negative pressure of expiration Another answer was to let air blow out during inhalation Cocaine induced psychosis - CORRECT ANSWER s/s parnoia, delusions, hallucinations, 'cocaine bugs' under skin, mydriasis Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms with dilated pupils - CORRECT ANSWER Sympathomimetic (cocaine or meth) Antidepressant OD - CORRECT ANSWER s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension (can't see, can't pee, can't spit, can't shit) Antidepressant OD treatment - CORRECT ANSWER ICU if CNS or cardio toxic, activated charcoal NaHCO3 for dysrhythmias and maintain pH, benzos (valium) for seizure (if serotonin syndrome: dantrium/dantrolene sodium) ASA overdose - CORRECT ANSWER s/s n/v, tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis ASA overdose treatment - CORRECT ANSWER activated charcoal, NaHCO3 for severe acidosis of <7.1, monitor ABGs How do you treat group A strep on skin - CORRECT ANSWER TMP/SMX or Doxy/mino + beta lactam (1st generation cephalosporin, PCN, or amoxil) Pt has cellulitis of lower extremity with a wound, what do you treat with? - CORRECT ANSWER Based on the hospital sensitivity Mallampati grades for visualization of oral cavity: - CORRECT ANSWER 1. complete soft palate 2. complete uvula 3. uvula base only 4. none Osteomalacia - CORRECT ANSWER Softening of bones (PEDS rickets), most common cause is vitamin D deficiency (also phos, Ca, UVB light) Hospice vs palliative care - CORRECT ANSWER Pallitiatve care are still receiving treatment. Hospice is no curative treatment, has death dx, and <6m to live Venous stasis ulcer - CORRECT ANSWER Use compression stocking Indication for tetanus shot - CORRECT ANSWER Dirty wound and haven't had a tetanus shot in five years Tdap vaccine is an example of what type of immunity - CORRECT ANSWER Active immunity How often should a woman between the ages of 20-39 have a PAP with HPV - CORRECT ANSWER Q5y, PAP with cytology q3y If born on or after what year is it indicated to receive 2 doses of mumps vaccine? - CORRECT ANSWER 1957 What age does an individual receive zostavax? - CORRECT ANSWER 50 one time dose When should PSA levels be initiated and how often? - CORRECT ANSWER PSA levels every year >50y (and DRE) Annual PSA and DRE are indicated in what group? - CORRECT ANSWER African-american >40 and family hx of prostate cancer Pt has normal PAP smear and reports that she has not had an abnormal PAP for past 10 years. What is the appropriate age to DC? - CORRECT ANSWER 65-70 35yo Asian american is in good health. He is worried about life prolonging measures. What is the most likely cause of death for a man like him? - CORRECT ANSWER Unintentional injury (if he's African american, it's homicide <35 and heart disease at 35) What is the leading cause of death in African american males ages 40-59? - CORRECT ANSWER CAD What is the leading cause of deaths in hispanics in the US? - CORRECT ANSWER Heart disease The most common cause of hyponatremic hyperosmolality a. hyperglycemia b. hyperthyroidism c. adrenal insufficiency d. k sparing diuretics - CORRECT ANSWER a. hyperglycemia What method should you use to treat hyponatremia related to SIADH? a. bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200ml/hr d. 3% hypertonic saline ,calculated - CORRECT ANSWER d. 3% hypertonic saline, calculated What is a potential cause of hyperkalemia? a. carafate b. NSAIDs c. centrally acting HTN meds - CORRECT ANSWER b. NSAIDs Your patient has a Na of 128 and was treated with colloids 3 days ago. What is a treatment? - CORRECT ANSWER Restrict free water A 68yo patient had sx three days ago to repair a AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFT's are normal, no s/s CHF, the patient's laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0.8 mg/dL, PaCO2 of 37mmHg. Which is the most appropriate method to deliver nutrition? a. central line b. PIV c. G tube d. enteral feeding to the duodenum via a nasogastric small-bore tube - CORRECT ANSWER d. enteral feeding to the duodenum via a nasogastric small bore tube Your patient has a serum osmolality of 268 mOsm/kg and a serum sodium of 134 mEq/L. His urine has Na less than 10 mEq/L. You know that all of the following are possible explanations except: a. diarrhea b. diuretics c. dehydration d. vomiting - CORRECT ANSWER b. diuretics (Na<10 is nonrenal cause. Diuretics are associated with renal cause, urine na >20) A 61 year old female c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating 'abnormally' and she has been experiencing muscle spasms on occasion. You order and EKG and find decreased amplitude and broad T waves. Occasionally you also note prominent U waves. Of the following, which is the most likely diagnosis? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypermagnesemia - CORRECT ANSWER a. hypokalemia Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except: a. hypernatremia b. pneumothorax c. HHNK d. GI bleed - CORRECT ANSWER d. GI bleed 65yo male with c/o n/v/constipation x several days and a six pound weight loss. Pt s/p TKR severral weeks ago and reports not getting off the couch. What electrolyte is altered? - CORRECT ANSWER Hypercalcemia secondary to immoblity Pt with s/s of abd distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the patient has a fluid and electorlyte problem. Which of the following is he most likely experiencing? - CORRECT ANSWER Hyperkalemia ABG reads high HCO3 and pCO2 55mmHg. What electrolyte abnormality is most likely associated with these values? - CORRECT ANSWER Hypokalemia r/t metabolic alkalosis Pt has a fever and tachycardia, and hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status - CORRECT ANSWER Extracellular dehydration deficit Low serum Na and high serum osmolality - CORRECT ANSWER Hyperglycemia (Probably HHNK) A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give: - CORRECT ANSWER NS Low protein = Low BUN = - CORRECT ANSWER hypoosmolar hyponatremia (probably edematous, expect edema in Albumin <2.7) A patient who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lbs (59.9kg), is intubated and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2o. Clinical signs include tachycardia and hypotension. The initial treatment is to: - CORRECT ANSWER Replenish the volume by infusing a 0.9% sodium chloride solution Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse patient? - CORRECT ANSWER Hyponatremia What electrolyte should be monitored prior to administering succinylcholine? - CORRECT ANSWER K ASA overdose, which electrolyte do you monitor? - CORRECT ANSWER K (if low will prevent hte alkalinization of urine, which is the mainstay of treatment) What sx is associated with hepatotoxicity s/p acetaminophen toxicity? - CORRECT ANSWER Delirium Patient at high risk for hyperkalemia? - CORRECT ANSWER NSAIDs then ACEi Tube feeding side effects - CORRECT ANSWER Diarrhea: decrease the osmolality of the tube feeding What patient requires labs to be monitored closely after intiating Tf? - CORRECT ANSWER Alcoholic with decreased intake over the past 2-3 weeks What disorder can be ruled out using the Cosyntropin stimulation test? a. Cushing's b. DI c. Adrenal insufficiency d. SIADH - CORRECT ANSWER c. Adrenal insufficiency What side effect of levothyroxine is most likely to lead to non-compliance when first initiated? a. alopecia b. dyspepsia c. weight loss d. nevousness - CORRECT ANSWER a. alopecia You are treating a patient for hypothyroidism. Which lab value is monitored for treatment/synthroid effectiveness? a. T3 b. T4 c. TSH d. thyroxin index - CORRECT ANSWER c. TSH What method should you use to treat hyponatremia related to SIADH? a. Bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200mL/hr d. 3% hypertonic saline, calculated - CORRECT ANSWER d. 3% hypertonic saline, calculated For the past few months, 29yo Janine has been gaining weight while experiencing amenorrhea and increasingly severe acnes. She has gained more than 20 pounds, and you note that she is carrying her weight around her midline, with bilateral purple-ish striae across both flanks. You suspect CUshing's syndrome. Which of the following findings would not contribute to a diagnosis? a. urine free cortisol=360 ug/day (>50 abnormal) b. glycosuria c. wbc 19 d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol - CORRECT ANSWER d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol In cushing's, pituitary does not respond to dexamethasone. Which of the following is NOT a criteria of metabolic syndrome? a. BP>140/90 b. waist >40 in c. TG>150 d. HDL <40 - CORRECT ANSWER a. BP>140/90 It's 130/85 What are Cushing's labs/symptoms? - CORRECT ANSWER Increased BG, increased Na, decreased K Central obesity, moon face with buffalo hump, purple striae, amenorrhea What are Addison's disease labs/diagnosis/tx? - CORRECT ANSWER Decreased BG, decreased Na, increased K Cosyntropin test, positive if serum cortison <18mcg/dL in the morning Tx: florinef, hydrocortisone, steroid bolus Patient is hypotensive with Addison's disease. What is the treatment? - CORRECT ANSWER IVF (D5NS), dopaine/pressors don't work What is SIADH, lab values, and treatment? - CORRECT ANSWER Inappropriate water retention Hypothermia, hyponatremia, decreased serum Osm, increased urine Osm, urine sodium >20 mEq (kidney's trying to excrete water via salt) Tx: 3% hypertonic saline calculated Urine Na 28, serum Osm 250, urine Osm 115. What is suspected dx? - CORRECT ANSWER SIADH 23 yo female presents with DKA. Abg pH 7.3, glucose 520, BP 90/65, HR 120, and she is confused. Which of the following are not included in the initial management of DKA? a. isotonic fluids b. insulin infusion c. sodium bicarbonate d. supportive care - CORRECT ANSWER c. sodium bicarbonate Only indicated for DKA if pH <7.1 24 yo male presents with DKA. He is now confused and irritable. AbgL 7.29/33/22. Received isotonic fluids x 1 hour, BP 110/70, HR 90. Blood glucose is 550. What is the best IV fluid indicated? - CORRECT ANSWER 1/2 NS because BG>500 HHNK: what fluids should you use? - CORRECT ANSWER NS for massive fluid volume deficit, then 1/2 NS to hydrate the cell, then D51/2NS if on insulin gtt What are Hyperthyroidism labs? - CORRECT ANSWER High T3, high T4, resin uptake TSH >5, low TSH What are Hypothyroidsim labs? - CORRECT ANSWER Low T4, low resin uptake (T3 is not a reliable test), high TSH What are the s/s of thyroid storm/crisis? - CORRECT ANSWER Fever, goiter, tachycardia, low TSH What is the treatment for myxedema coma? - CORRECT ANSWER Loading synthroid followed by maintenance dose Patient with BP 210/110, headache, then BP decreases below 160s, what is 1st treatment? - CORRECT ANSWER Alpha blockers preoperatively, regitine/phentolamine, likely pheochromocytoma What is the first test you run when you see s/s of pheochromocytoma? - CORRECT ANSWER TSH What diagnostic test confirms pheochromocytoma? - CORRECT ANSWER CT DKA fluids? - CORRECT ANSWER IVF first, 1L in first hour, then 500mL/hr, use 1/2 NS if BG>500 What is the Somogyi effect? - CORRECT ANSWER Hypoglycemic at 3am then rebounds to hyperglycemia at 7am 15 year old patient with DMI reports increased BG in AM. The ACNP determines hyperglycemia is d/t dawn phenomenon? What should you do to his tx regimen? - CORRECT ANSWER Increase the insulin dosage at bedtime Your patient has a history of coagulopathy and is about to go to surgery. Which order is appropriate for DVT/bleeding prophylaxis? a. Heparin gtt b. lovenox c. coumadin d. pneumatic stockings - CORRECT ANSWER d. pneumatic stockings Which of the following is least likely to experience a DVT? a. 24yo Female on oral contraceptives b. 74 yo male post hip replacement c. 58 yo male liver patient d. paraplegic - CORRECT ANSWER c. 59 yo male liver patient The nurse calls you to report low BP in a CHF patient on the unit. You have IVF ordered, and the cardiologist has ordered Lasix. a. d/c the lasix b. leave the orders as they are c. call the cardiologist to discuss d. call the ethics committee - CORRECT ANSWER a. d/c the lasix You are assessing heart sounds preoperatively and hear a classic "aortic stenosis" type murmur, as well as a carotid bruit. There are no neurological symptoms. What should you order first? a. carotid US b. consultation to cardiology c. cancellation of surgery until next week d. echocardiogram - CORRECT ANSWER d. echocardiogram Which of the following is contraindicated for a patient receiving a renal angiogram? a. beta blocker b. alpha blocker c. calcium channel blocker d. ace inhibitor - CORRECT ANSWER d. ace inhibitor Your 45 yo male patient has new onset atrial fibrillation, but no other past medical history. What should you prescribe? a. tylenol b. ASA c. coumadin d. plavix - CORRECT ANSWER b. ASA - he is young with no risk factors/history Coumadin would be used in 65y+ or with positive risk factors/history Which is best used to diagnose pulmonary HTN? a. bubble study b. presence of peripheral edema c. cardiac catheterization d. 2D echo - CORRECT ANSWER d. 2D echo used for diagnosis, cardiac cath used for confirmation Your patient has overdosed on Lopressor. It has been 5-6 hours, what do you order? a. glucagon and atropine b. narcan c. activated charcoal d. flumazenil - CORRECT ANSWER a. glucagon and atropine Your patient is preoperative for an elective surgery. You notice a pulsating mass in the mid abdomen (AAA). What is next action? a. cancel the surgery b. order abdominal ultrasoud c. order abdominal CT d. document the mass carefully and send to surgery - CORRECT ANSWER b. order abdominal ultrasound Your patient is postoperative after an aneurysm clipping. Which intervention is used? a. maintain SBP 140-160 b. place patient in a quiet room c. encourage visitors d. start decadron - CORRECT ANSWER b. place patient in a quiet room Your 67yo patient has a BP of 168/92. On her second visit her BP is 158/88. What is your initial treatment plan? a. prescribe an AceI b. prescribe a mild diuretic c. teach lifestyle changes d. schedule a stress test - CORRECT ANSWER c. teach lifestyle changes Which of the following lipid panels shows 3 out of 4 abnormal values? a. TC 205, LDL 150, HDL 30, TG 300 b. TC 150, LDL 99, HDL 35, TG 145 c. TC 102, LDL 50, HDL 60, TG 102 d. TC 180, LDL 136, HDL 25, TG 160 - CORRECT ANSWER d. TC 180, LDL 136, HDL 25, TG 160 Your patient is an obese 38 yo female wiht the following fasting lipid panel: TC 270, LDL 168, HDL 28. What is your action? a. start a statin b. teach lifestyle changes c. prescribe metformin d. prescribe niacin - CORRECT ANSWER a. start a statin (key word, obese) Which med must be on the d/c list of a patient admitted for CHF? a. sotalol b. norvasc c. lisinopril d. losartan - CORRECT ANSWER c. lisinopril You have to pick out the CHF fro mthe stem distractors, and the answer is an ACE inhibitor 31 yo male with a blowing murmur occurring during S1 and galloping addition heart sound. Mumur is heard best at the base of the heart. What is MM? - CORRECT ANSWER Mitral regurgitation When d/c'ing an 85 yo female patient with stasis dermatitis, the NP includes instructions to: - CORRECT ANSWER Keep legs elevated while seated An older man is a smoker and has been for years. He has shiny hairless legs. Which diagnostic test would you order? a. ankle-brachial index b. arterial doppler c. venous doppler d. d-dimer - CORRECT ANSWER a. ankle brachial index PAD A 70 yo patient with acute systolic HF denies any functional limitations, is able to walk five blocks before tiring, and is euvolemic. Which medication is the first line therapy for this patient? - CORRECT ANSWER Lisinopril A patient with HF has dyspnea on exertion and sleeps all night while using 3 pillows. What is her NYHA HF stage? - CORRECT ANSWER Stage III Treatment of heart block? - CORRECT ANSWER Identify type, trancutaneous pacing, venous if can't capture, atropine if very symptomatic, plan for pacemaker, d/c all AV nodal blocking drugs Patient has an EF of 20% and a bronchospasm, what med caused it? - CORRECT ANSWER Beta blocker What BP is hypertensive emergency? - CORRECT ANSWER 220/110 What BP is hypertensive urgency? - CORRECT ANSWER 180/110 What lab should you check with new onset Afib and what is the treatment? - CORRECT ANSWER TSH, beta blocker What grade murmur do you first hear a thrill? - CORRECT ANSWER 4 On physical exam, you note a moderately loud MM with no thrill. What grade? - CORRECT ANSWER 3 Pt has low diastolic rumble murmur in the left lateral position with no radiation? - CORRECT ANSWER Mitral stenosis Patient presents with suspected mitral regurgitation. What physical findings would confirm? - CORRECT ANSWER S3 systolic MM Tricuspid regurgitation occurs in... - CORRECT ANSWER Right atrium Stages of heart failure? - CORRECT ANSWER NYHA Patient with history of HF, wet lung sounds, lower extremity edema, dyspnea, what is the cause of edema? - CORRECT ANSWER Increased hydrostatic capillary pressure What is the purpose of cardiac stress testing? - CORRECT ANSWER Differentiate ischemia vs infarction STEMI guidelines, "door to needle"? - CORRECT ANSWER 30 minutes STEMI guidelines, "door to balloon"? - CORRECT ANSWER 90 minutes Patient is post MI, on a beta blocker and statin. What do they need? - CORRECT ANSWER AceI Which drug prevents cardiac remodeling? - CORRECT ANSWER AceI Patient with 14 hours of chest pain presents to ED, next step of action? - CORRECT ANSWER Take to cath lab, fibrinolytic therapy 6 hour window has closed Pericarditis s/s - CORRECT ANSWER normal CXR, low grade temp, elevation of ST segment in ALL leads Best diagnostic test for Pericarditis - CORRECT ANSWER ECHO, at risk for tamponade Pericarditis treatment - CORRECT ANSWER NSAIDs A patient post CABG with abdominal distention, diagnosis? - CORRECT ANSWER Mesenteric infarct (risk factor cardiac surgery) Patient with PVD need to quit smoking, how would you address this using therapeutic communication? - CORRECT ANSWER Tell me how I can help you, what do you need Venous stasis ulcer tx? - CORRECT ANSWER Use compression stocking How patient with DM and heart disease can decrease LDL non-pharmacologically? - CORRECT ANSWER Diet and exercise, lifestyle changes Temporal arteritis requires immediate treatment to prevent? - CORRECT ANSWER Blindness in the affected eye Patient in the ER with sudden LOC and motor function. The ER diagnosis is TIA. The patient has right-handed weakness and numbness. Carotid studies are completed and reveal 92-95% occlusion bilaterally. What is the next step? - CORRECT ANSWER Patient to have left carotid explored first followed by the right one at a later date 62yo male presents with angina after his daily walk. Lipid panel reveals LDL 250, HDL 25, cholesterol 350, and triglycerides 250. You prescribe niacin. How would you explain the mechanism of action to the patient? - CORRECT ANSWER Niacin lowers LDL and increases HDL What among the following is a common cause of pancreatitis? a. moderate ETOH use b. medications c. abdominal trauma d. cholelithiasis - CORRECT ANSWER d. cholelithias Your patient is s/p liver transplant. He develops fever and his bile production decreases to 20 from 300. What should you do next? a. consider liver biopsy b. run a c&s on the bile c. call the surgeon to recommend an operation d. consult GI to rule out pancreatitis - CORRECT ANSWER a. consider a liver biopsy Which of the following displays a current or recent Hepatitis A infection? a. antibody-specific to IgG b. antibody specific to IgM c. hepatitis A core antibody d. hepatitis a surface antigen - CORRECT ANSWER b. antibody specific to IgM Your patient is post op cardiothoracic surgery. She devlops nausea, periumbilical abdominal pain, moderate lipase, LDH, ALT, decreased Bs. What is the diagnosis? - CORRECT ANSWER Mesenteric infarct Your patient complains of tarry stools, change in stool caliber, and constipation. What intervention is appropriate? a. order more testing b. consult surgery for posible colon cancer c. give PRBCs d. consult oncology for chemotherapy - CORRECT ANSWER a. order more testing Your patient has been on peritoneal dialysis long term, and develops a fever and cloudy peritoneal fluid. What do you order first? a. blood culture b. antibiotics c. culture the dialysis tube - CORRECT ANSWER c. culture the dialysis tube Most critical symptom for diagnosing peritonitis/bowel perforation? a. guarding b. rigidity c. distention d. rebound tenderness - CORRECT ANSWER b. rigidity What is GI angioplasty used to diagnose? a. hemorrhage of unknown cause b. uncontrolled bleeding c. cholelithiasis d. bleeding due to PVD - CORRECT ANSWER a. hemorrhage of unknown cause Your patient with sickle cell anemia is complaining of nausea and lack of sleep. What med is best? a. reglan b. zofran c. phenergan d. ativan - CORRECT ANSWER c. phenergan Patient presents with RLQ pain, 1-2 episodes of vomiting, and positive Psoas sign. What diagnostics are confirmatory for appendicitis? a. abd us and WBC 10-20 b. CT abd and elevated amylase c. abd us and elevated amylase d. ct abd and elevated amylase and lipase - CORRECT ANSWER a. abd us and WBC 10-20 (key is WBC, a CT would also work) 36yo with history of Crohn's disease arrives in the ER with c/o abd pain, frequent vomiting and water bowel movements. You notice high-pitched, tinkling bowel sounds and a transabdominal US reveals a partial SBO. Which is not necessary? a. NPO and IVF b. NGT for LIS c. immediate surgical consult d. monitor for spontaneous resolution - CORRECT ANSWER c. immediate surgical consult A nurse experiences a needle stick fro ma patient who has Non-a, non-b hepatitis. She has already had the HepB vaccine series. What is the next step? - CORRECT ANSWER Obtain blood samples from the patient and the RN 42 yo male with epigastric pain that is better after he eats? - CORRECT ANSWER Duodenal ulcer 65 yo ETOH use with 25y smoking history has dysphagia and epigastric pain. What is diagnosis? - CORRECT ANSWER GERD On CXR notes air under diaphragm? - CORRECT ANSWER Pneumoperitoneum Diverticulitis flare ups can be caused by? - CORRECT ANSWER Smoking What is the treatment of diverticulitis? - CORRECT ANSWER NPO dependent upon condition, IVF, IV abx (flagyl, cipro, ceftazidime, clinda, ampicillin) True/false: barium enema is indicated in the conservative management of diverticulitis? - CORRECT ANSWER False Lab values of acute pancreatitis? - CORRECT ANSWER GWGLA HBCABE Prognostic signs on admission Greater than 55yo WBC>16 Glucose >200 LDH>350 AST>250 Prognostic signs during first 48h Hct drop of >10 BUN increases >5 Calcium <8 Arterial O2 <60 Base deficit >4 Estimated fluid sequestration >6k nL Which disorder worsens epistaxis? - CORRECT ANSWER Cirrhosis, HIV Bowel obstruction antibiotic? - CORRECT ANSWER Zosyn 49 yo male presents with c/o abdominal swelling that progressed over 2 days. Patient also reports mucous-filled diarrhea and abdominal pain. Exam is significant for profound abd distention. You suspect SBO. What type of bowel sounds are associated? - CORRECT ANSWER High pitched, tinkling bowel sounds Profuse vomiting and variable epigastric pain are 2 symptoms of what diagnosis? - CORRECT ANSWER Proximal SBO What is the presentation and treatment of crohn's? - CORRECT ANSWER diarrhea, abdominal pain, abscess/fistulas Ts: flagyl/cipro Who is at risk of toxic megacolon? - CORRECT ANSWER Both crohn's and ulcerative colitis 48yo with fever, abdominal pain and bloody diarrhea with h/o chronic sinusitis, arthritis, and recent DVT. Which represents the most likely diagnosis and test to order? - CORRECT ANSWER Ulcerative colitis, sigmoidoscopy Young male with ulcerative colitis, what would be probable finding? - CORRECT ANSWER Rectosigmoid stricture Ulcerative colitis medications? - CORRECT ANSWER Canasa (mesalamine) suppositories or enemas for 3-12 weeks, hydrocortisone suppositories and enemas What abx do you use for ulcerative colitis? - CORRECT ANSWER Cipro/flagyl in severe colitis and high grade fever, leukocytosis with extreme numbers of immature neutrophils (bands >700/microL), and peritoneal signs or megacolon There is no role of abx in patients with severe colitis without signs/symptoms of systemic toxicity Treatment for fulminant ulcerative colitis without s/s of systemic toxicity? - CORRECT ANSWER IV steroids WHen would you find "thumb printing sign" on abdominal xray? - CORRECT ANSWER Mesenteric ischemia (ischemic colitis), pseudomembraneous colitis, and IBD Radiologic sign of bowel wall thickening Both husband and wife abuse ETOH. Woman has liver disease but husband does not? - CORRECT ANSWER Women are likely to get liver disease while drinking less than men What causes GI bleed in elderly? - CORRECT ANSWER Thin gastric membranes RF: Nsaid/asa/anticoagulant use Do not use protonix long term due to? - CORRECT ANSWER Increased risk of hip fracture Why would you pick a PPI over phenergan for treatment? - CORRECT ANSWER PPI can be used in combo with other dugs to control symptoms Patient on PD dialysis has an infected dialysis catheter. What is the first thing you do? - CORRECT ANSWER Remove the catheter You are a preceptor who is mentoring a student. The patient's s/s are broad and variable and include mild icteric symptoms. How should you educate your student? - CORRECT ANSWER Have the student review the clinical symptoms and query differential diagnosis What are the s/s of the icteric phase of hepatitis? - CORRECT ANSWER Jaundice, RUQ pain, clay stool, dark urine, weight loss, low grade fever, hepatosplenomegaly What are the s/s of the pre-icteric phase of hepatitis? - CORRECT ANSWER Fatigue, malaise, anorexia, n/v, headache, aversion to smoking and alcohol What is the most important assessment findin in determining a patient's mental status? a. orientation level b. attention c. memory d. affect - CORRECT ANSWER a. orientation level Your patient has a severe closed head injury. VS are listed. Which value is it crucial in evaluating him for brain death? a. pt had a gag/cough reflex b. pt is not normothermic Pt is not normotensive d. documenting family opinion on whether patient is brain dead - CORRECT ANSWER b. pt is not normothermic A nurse experiences a needle stick fro ma patient who has Non-a, non-b hepatitis. She has already had the HepB vaccine series. What is the next step? - CORRECT ANSWER Obtain blood samples from the patient and the RN Your patient has a closed head injury and is ventilated. His abg's are: pH 7.48, pCO2 35, FiO2 40%, pO2 60. What is the recommended action? a. increase the FiO2 to 60% b. decrease the tidal volume c. decrease the respiratory rate d. leave the setting as it is - CORRECT ANSWER d. leave the setting as it is (CO2 in head trauma, 35 is the goal) Your patient has suffered a spinal cord injury. What sign indicates recovery has begun? a. increase in DTRs b. bradycardia c. edema d. moderating respiratory rate - CORRECT ANSWER a. increase in DTRs Your patient presents to ED with ischemic stroke-like symptoms. Her BP is 160/90 and she is on norvasc. Symptom onset was 4 hours ago. Which of the following is a contraindication to fibrinolytic therapy? a. time b. PMH c. age d. BP - CORRECT ANSWER a. time Your patient is s/p craniotomy and is about to d/c home. You notice ataxic gait and holding the wall while walking. What is your action? a. consult PT b. discharge home c. make outpatient PT appointment d. 2nd guess the RN assessment - CORRECT ANSWER a. consult PT Patient has a hip fracture, carotid bruit, weakness, and confusion. What do you order? - CORRECT ANSWER Carotid us A patient was diagnosed with cauda equina syndrome and neurosurgery has been consulted. What is the NP responsibility in anticipation of surgery? a. discuss the MRI results and how the nerves are affected b. discuss rehab after surgery c. order small frequent meals to prevent nausea d. explain the surgery to the patient - CORRECT ANSWER a. disucss the MRI results and how the nerves are affected Your patient has had a CVA and is now having trouble feeding himself. Who do you consult? a. OT b. PT c. social work d. case management - CORRECT ANSWER a. OT (includes SLP) A patient has hyper active reflexes of the lower extremities. The adult-gerontology acute care nurse practitioner assesses for ankle clonus by: - CORRECT ANSWER Sharply dorsiflexing and maintaining the foot in this position, while supporting the knee Which muscle moves the eye from center to side and back? - CORRECT ANSWER Rectus There is a patient with a TBI and increasing hypercapneia/lethargy. The NP is worried about ICP, what should she consider? - CORRECT ANSWER Intubation to control CO2 What is the treatment for flare up of multiple sclerosis? - CORRECT ANSWER Steroids What is the pathology of multiple sclerosis? - CORRECT ANSWER Autoimmune disease, immune system attacking myelin What is the pathology of myasthenia gravis? - CORRECT ANSWER Reduction of the number of acetylcholine receptor sites at neuromuscular junction What are the s/s of myasthenia gravis? - CORRECT ANSWER Ptosis, diplopia, extremity weakness worse with exercise, respiratory difficulty What meds/tx of myasthenia gravis? - CORRECT ANSWER Anticholinesterase drugs like prostigmin, plasmapheresis, and immunosuppressives. Vent may be needed in crisis How to conduct MMSE? - CORRECT ANSWER Have spouse leave the room Is the MMSe a reliable test? - CORRECT ANSWER Yes Dementia vs delirium? - CORRECT ANSWER Delirium: sudden transient clouded sensorium Dementia: gradual, permanent memory/intellectual What is the number one cause of death in dementia patients? - CORRECT ANSWER Pneumonia (aspiration) Patient with a 50% right sided carotid artery occlusion and right sided weakness that went away (TIA), what medication should be ordered? - CORRECT ANSWER ASA or plavix CVA tPA contraindication - CORRECT ANSWER CVA two months ago Chronic subdural hematoma presents with... - CORRECT ANSWER Insidious onset of HA, light-headedness, cognitive imapirment, apathy, somnolence, and occasionally seizure Chronic subdural hematoma managmeent - CORRECT ANSWER Surgical evacuation in patients with potential for recovery, if there is evidence of moderate to severe cognitive impairment, if progressive neurologic deterioration, or if clot thickness >= 10mm or midline shift >= 5mm Latest sign that you have missed herniation? - CORRECT ANSWER Pupil change and positive babinski Homonymous hemaniopia - CORRECT ANSWER Loss of visual field on same side on both eyes Left middle cerebral artery infarct symptom - CORRECT ANSWER aphasia Sensory cranial nerves - CORRECT ANSWER I, II, VIII Cranial nerves that are both motor and sensory - CORRECT ANSWER V, VII, IX, X Which cranial nerve is involved when you place hands on either side of the patient's face and ask them to chew? - CORRECT ANSWER V, trigeminal In Status epilepticus when the medications are not working, the patient is desaturating, and the family cannot decide on code status, what do you do? - CORRECT ANSWER Intubate What is Cauda equina syndrome? - CORRECT ANSWER Medical emergency, 18 nerve roots are in the cauda equine at the base of the spine. S/s include pain, numbness, tingling, low back pain radiating to legs S1-s2: weak plantar flexion with loss of ankle jerks, foot drop S3-s5: loss of bowel/bladder, muscle weakness, sensory loss in the dermatomal distribution of the affected nerve roots Cause: tumor, spinal stenosis, herniated disc, cancer, infection, inflammation What i the pathology of Parkinson's disease? - CORRECT ANSWER Imbalance between ACH and dopamine in the corpus striatum You are examining a patient with a PMH of seizures. Pt sustains a seizure lasting around 1 minute. What is the most appropriate intervention? - CORRECT ANSWER Valium 5-10 mg IV Initial action taken in a patient with new onset seizures? - CORRECT ANSWER CT scan 60 yo male presents to ER and his child reports he passed out on the care while driving, regained consciousness and was drooling and out of it. Patient's HR and BP are decreased. You give Nimodipine. What is the rational for administering Nimodipine to this patient? - CORRECT ANSWER Calcium channel blocker that counters vasospasm s/p CVA What CSF values are characteristic of bacterial meningitis? - CORRECT ANSWER Increased opening pressure, increased protein, increased WBC, decreased glucose Your patient has swallowed a foreign object (coin) and it is lodged in the Cspine area according to XR. How do you get it out? a. a surgery with forceps b. bronchoscopy c. tracheostomy d. allow the coin to pass - CORRECT ANSWER b. bronchoscopy Your patient has a gunshot chest wound. What kind of dressing does he need? - CORRECT ANSWER 3 sided dressing Allows air to escape, but not enter (and thus can be trapped) in the lungs, so as not to cause a tension pneumothorax when the patient exhales and air tries to enter the hole. This is why we have the patient take a deep breath and hold it when we pull a chest tube. Air won't enter the chest cavity when the lungs are full of air. Your patient is 3 days post appendectomy and develops dysphagia, drooling ,and expiratory stridor. What is going on? - CORRECT ANSWER Epiglottitis Your patient is ventilated and becomes confused with arm edema. What low cost test do you order? a. d-dimer b. us c. VQ scan d. ankle brachial index - CORRECT ANSWER b. us Your patient with VAP is on broad spectrum coverage including levaquin, cefepime, and vancomycin. Your culture comes back growing pseudomonas. What do you do now? - CORRECT ANSWER Narrow the spectrum (d/c vanc) Which of the following does not cause hypoxemia? a. hyperventilation b. hypoventilation c. decrease in atmospheric O2 d. right to left shunt - CORRECT ANSWER a. hyperventilation What is the initial finding in pulmonary embolism? a. respiratory acidosis b. respiratory alkalosis c. metabolic acidosis d. metabolic alkalosis - CORRECT ANSWER b. respiratory alkalosis Your 32 yo male patient has a history of MVR and c/o wheezing with exercise. What is your order? a. pulmonary consult b. PO steroids c. PFTs d. SABA - CORRECT ANSWER c. PFTs The mother of a 19 yo female calls you with concerns about her daughter's asthma attack. She tells you that she is SOB and has difficulty speaking in sentences. She adds that her usual medicine, alupent, is not working. Which of the following should the mother administer to treat the asthma attack? a. metaproterenol b. albuterol c. aqueous epinephrine d. ipratroprium bromide - CORRECT ANSWER d. ipratroprium bromide (anticholinergic) Alupent is albuterol, metaproterenol acts the same way and aqueous epinephrine should only be used if the patient won't cooperate A 36yo patient who has a history of asthma comes to the Ed in a fatigued state. She has difficulty speaking d/t respiratory distress but is able to explain that she is recovering from a cold, but her s/s are so severe that she came into the ED. HR is 118, FVC WDL, FEV 1 45% of expected value. You order metaproterenol 0.3 mL in 5% solution, but the patient does not respond. Now what? a. aqueous epinephrine b. albuterol c. methylprednisolone d. montelukast - CORRECT ANSWER c. methylprednisolone Your patient with asthma has decreased breath sounds on presentation. You give a nebulizer treatment. Now the SaO2 is decreased to 86% and there are no breath sounds. What do you do? a. stat nebulizer b. abg's c. epinephrine d. intubate - CORRECT ANSWER d. intubate A 51 year old male is admitted to the ED with severe dyspnea. The patient's history indicates emphysema. The NP orders O2, since the patient SaO2 dropped from 96% to 90%. However the NP also advises the attending RN to continue monitoring the patient because a. He has lost his hypoxemic respiratory drive b. He has lost his hypercapnic respiratory drive - CORRECT ANSWER b. he has lost his hypercapnic respiratory drive What is the earliest sign of Pna in the elderly patient? a. dyspnea/SOB b. tachypnea c. fever d. hypoxia - CORRECT ANSWER b. tachypnea Your patient is a 79 yo male japanese immigrant. What TB induration measurement is diagnostic? a. 3mm b. 7mm c. 11 mm - CORRECT ANSWER c. 11 mm Your asthmatic patient is on a SABA and ICS. She has no secretions but her symptoms are still not well controlled. What do you order next? a. salmeterol b. ipratroprium bromide c. montelukast d. metaproterenol - CORRECT ANSWER a. salmeterol (LABA) Your patient on albuterol has had multiple trips to the ER in the past three months. what should you add? - CORRECT ANSWER An ICS, flovent What is paradoxical abdominal and diaphragmatic movement? a. symptoms of anxiety disorder b. asthma ominous sign c. respiratory bacterial infection - CORRECT ANSWER b. asthma ominous sign Which of the following is reason to intubate in an asthmatic patient? a. RR in the 30s b. bad ABGs c. SaO2 in the 80s d. change in behavior - CORRECT ANSWER d. change in behavior What history do you ask about before you prescribe a sleep aid to your 69 yo patient? a. seizure b. depression c. heart disease d. OSA - CORRECT ANSWER d. OSA Your patient is an RN with a positive PPD. Her CXR comes back negative. What do you do now? - CORRECT ANSWER Offer 6 months INH Which national measure is most important to prevent VAP? - CORRECT ANSWER Increased HOB 30 degrees Patient with SOB and dry cough. CXR reveals generalized inflammation throughout, numerous poorly defined small (<5mm) opacities throughout both lungs, sometimes sparing the apices and bases - CORRECT ANSWER Pneumonitis What do you see on CXR with airspace disease? - CORRECT ANSWER Ground glass opacities (patchy or diffuse, resemble pulmonary edema) or rarely, as consolidation. A pattern of fine reticulation may also occur What is the diagnosis and treatment when XR reveals blunting of costophrenic angles? - CORRECT ANSWER Pleural effusion, tx: thoracentesis What is the diagnosis when CXR reveals Kerley B lines? - CORRECT ANSWER Pulmonary edema What are the lab values in exudative effusion? - CORRECT ANSWER Higher ratio of pleural protein and LDH to serum levels. Protein: pleural fluid/serum ratio >0.5 LDH: pleural/serum ratio >0.6 Pleural fluid LDH >2/3 upper limit of serum LDH When is the greatest risk for mechanically ventilated patient to contract VAP? - CORRECT ANSWER 48-72 hours Common bacteria in VAP? - CORRECT ANSWER Pseudomonous Treatment of Pseudomonous pneumonia? - CORRECT ANSWER zosyn/cefepime/meropenem + fluoroquinolone/azithromycin +- gentamycin 37 yo s/p ET intubation 2 days ago has fever, chills, and purulent sputum. CXR shows lung infiltrates. Which of the following regimen for the patient's condition? - CORRECT ANSWER Cefepime and ciprofloxacin Spontaneous pneumothorax is common in what disorder? - CORRECT ANSWER Marphan syndrome Most important HPI questions in patient with hemoptysis? - CORRECT ANSWER Amount of blood, previous episodes, dyspnea Pathophysiology of PE? - CORRECT ANSWER Failure of right ventricle What is the best non-pharmacologic treatment in a patient with end stage COPD? - CORRECT ANSWER Bipap (NIPPV) Which med decreases mortality in COPD? - CORRECT ANSWER LABA - ICS combo, advair (salmeterol/fluticasone) Example of a patient most likely to have emphysema? - CORRECT ANSWER 59 yo with increased AP diameter Maintstay of COPD treatment? - CORRECT ANSWER Symphathomimetics (albuterol) What PFTs show asthma? - CORRECT ANSWER Obstructive: decreases in FEV1, FEV 25-75, PEFR, FVC Most important in a status asthmatic patient who was extubated? - CORRECT ANSWER F/u with asthma specialist in 3-5 days A patient has TB and lives with 6 other people. Do you treat the 6 other people or test them? - CORRECT ANSWER Test them A patient who has HIV tests positive for TB, what is the treatment? - CORRECT ANSWER 4 drug regimen Pt presents with night sweats and dry cough with weight loss. You suspect TB. What is diagnostic? - CORRECT ANSWER Culture x 3 38 yo female immobilized for 4 months. Examining her before releasing you not dyspnea and tachycardia. You suspect PE, but VQ scan does not confirm. What is the next diagnostic test? - CORRECT ANSWER Pulmonary angiography What confirms the diagnosis of pneumonia? - CORRECT ANSWER Consolidation in the lungs on CXR Is the pneumonia vaccine recommended for asthmatics or smokers ages 19-64? - CORRECT ANSWER Yes An elderly woman who has a history of lung dysfunction comes to your office. She presents with a number of respiratory symptoms. Most severe c/o head ache. What is the most likely respiratory diagnosis based on headache? - CORRECT ANSWER Acute bronchitis Your patient needs to start treatment with a DMARD for RA. Which is the least expensive? a. hydroxychloroquine b. sulfasalazine c. methotrexate d. leflunomide - CORRECT ANSWER c. methotrexate Where are bouchard's nodes located? a. DIPs b. PIPs c. MCP d. wrists - CORRECT ANSWER b. PIPs Which of the following is NOT an early sign of HIV/AIDS? a. fatigue/vague abdominal pain b. fever c. weight loss d. night sweats - CORRECT ANSWER a. fatigue/vague abdominal pain Which of the following patients is most likely to get HIV? a. sex worker who doesn't use condoms b. MSM who doesn't use condoms c. IV drug user - CORRECT ANSWER c. IV drug user Which of the following demonstrates the appearance of normal veins on a funduscopic examination? a. pale gray compared to arteries b. wider than arteries c. brighter red than arteries d. thinner than arteries - CORRECT ANSWER b. wider than arteries Your HIV patient has CMV. What is the appropriate treatment? a. cefazolin b. ciprfloxacin c. fluconazole d. gemcyclovir - CORRECT ANSWER d. gemcyclovir (CMV is a virus) Your patient has RA and her corticosteroids are not working. What is your next step? - CORRECT ANSWER Methotrexate Your patient stepped on a nail and does not know his last tetanus status. Do you give Td or Tdap? - CORRECT ANSWER Tdap In which patient would sarcopenia be the most expected finding? - CORRECT ANSWER Elderly patient Why are so many HIV patients noncompliant? - CORRECT ANSWER Decreased access to care Know HIV testing - CORRECT ANSWER Initial ELISA, confirmed with Western blot What is criteria for AIDS - CORRECT ANSWER CD4 <200 (800 is WDL) or <20%. Ideal virus load <5000 HIV patient with petechiae on legs (bone marrow suppression) and leg weakness (malaise). What should you test for? - CORRECT ANSWER CMV HIV med side effects - CORRECT ANSWER GI problems: n/v Skin rash, anemia ESR elevated ,what should you suspect? - CORRECT ANSWER RA, SLE, temporal arteritis, inflammation In addition to positive serum ANA, what diagnostic is supportive of diagnosis of SLE? - CORRECT ANSWER Leukopenia 28 yo female presents with fever, malaise, rash across the back and splinter hemorrhages, Hgb 10, positive ANA, UA, proteinuria, and elevated ESR. What is the suspected diagnosis? - CORRECT ANSWER SLE Which of the following drugs can cause lupus-like symptoms? - CORRECT ANSWER Procainamide RA treatment - CORRECT ANSWER methotrexate, DMARDs, corticosteroids, hydrochloroquine, gold salts What should you monitor while on methotrexate? - CORRECT ANSWER LFTs What is Felty's sydnrome? - CORRECT ANSWER RA + joint swelling + enlarged spleen + leukopenia Complication of RA Pt is c/o wrist/hand pain, swollen, and redness that is worse in AM and resolves as the day goes on. What diagnosis do you suspect and what diagnostic test would support it? - CORRECT ANSWER RA, increased ESR Pharmacologic treatment for OA - CORRECT ANSWER ASA, APAP (1st line), NSAIDs, Cox2 inhibitors (celebrex) Nonpharmacologic treatment for OA - CORRECT ANSWER Swimming How should you use a cane? - CORRECT ANSWER Opposite side 57 yo male with PMH of CV disease presents with c/o pain in both knees that is progressively worse throughout the day. What diagnosis do you suspect and what medication is contraindicated? - CORRECT ANSWER OA, celebrex is CI in patients with ARF, MI, and hx of cardiac disease What is associated with headache, fever, and elevated ESR? - CORRECT ANSWER Temporal arteritis Best way to verify your treatment is working for open angle glaucoma? - CORRECT ANSWER Tonometry (normal is 10-20 mmHg) Which med is not indicated in the management of closed angle glaucoma? - CORRECT ANSWER Alpha 2 adrenergic agonist (for open angle) 47 yo male comes in complaining of intense right eye pain which has worsened since he woke up. Eye exam: copious tearing/redness. What do you do to confirm the suspected diagnosis? - CORRECT ANSWER Sodium fluorescein stain for corneal abrasion What are elderly persons at risk for skin tears? - CORRECT ANSWER dermis thins with age Older lady with iron deficiency anemia is opening a jar and sustains a spiral fracture of her arm. Why? - CORRECT ANSWER Osteoporosis Your patient's abgs come back as follows: pH 7.37, HcO3 19, pCO2 24. What is the diagnosis? - CORRECT ANSWER Metabolic acidosis with resulting respiratory alkalosis Your anaphylactic patient is wheezing and states she feels like her throat is closing. What is the priority action? a. IV steroids b. give epinephrine c. intubate d. IV benadryl - CORRECT ANSWER c. intubate Your patient has tachycardia, anxiety, urticaria in recovery from a cardiac catheterization. What is the treatment? - CORRECT ANSWER IV methylprednisolone, H2 blocker, and IV benadryl What kind of shock is exhibited by the following values? PCWP 18, CI 2, SVR 1800 a. distributive b. cardiogenic c. obstructive d. hypovolemic - CORRECT ANSWER b. cardiogenic Only shock with high PCWP Your patient has had treatment for a hematoma. He is confused and combative. It is necessary that he lie still for several hours. What do you do? a. order paralytic b. bedside sitter c. insist the family stay at the bedside d. order sedation with holidays for neuro checks - CORRECT ANSWER d. order sedation with holidays for neuro checks Your ventilated patient has these settings: SIMV, FiO2 60%, PEEP 5. You notice pulmonary shunting. What is your best action? a. increase PEEP to 10 b. order a beta agonist inhaler c. increase FiO2 to 70% d. add +5 pressure support - CORRECT ANSWER a. increase PEEP to 10 Shunting is due to atelectasis Your intubated patient has sounds coming out from around the tube. What is the cause? a. mucous plug b. bronchospasm c. tracheoesophageal fistula d. cuff insufficiency - CORRECT ANSWER d. cuff insufficiency (air leak) The NP correctly identifies the expected hemodynamic profile of a patient in hypovolemic shock as being most closely represented by which of the following? a. CO 3.5, CVP 1, PCWP 4, SVR 700 b. CO 3, CVP 1, PCWP 3, SVR 1400 c. CO 3.5, CVP 1, PCWP 14, SVR 1300 d. CO 8.5, CVP 9, PCWP 14, SVR 1300 - CORRECT ANSWER b. CO 3, CVP 1, PCWP 3, SVR 1400 Everything is low except SVR A patient presents to the ED with intense abdominal pain that worsens when she coughs. A physical exam indicates abdominal tenderness, abdominal guarding. During the physical exam, the NP elicits RLQ pain when pressure is applied to LLQ. Her labs are: HR 140, SV 70, CVP 8, PCWP 4, SVR 600. Which of the following should be initiated for this patient? a. norepinephrine b. hydrocortisone suppositories c. epinephrine d. PRBC transfusion - CORRECT ANSWER a. norephinephrine A 42 yo female is brought to the Ed after spilling a pot of boiling water on her arms and chest. On exam you see that burned skin is broken, swollen with edema, and covered in blisters. She rates pain as "extremely painful". You determine that he patient has burns over 20% of her TBSA, Which of the following most accurately describes the patient's burns? a. 1st degree burn b. Full thickness burn c. Partial thickness burn d. 3rd degree burn - CORRECT ANSWER c. partial thickness burn Indicative of early septic shock? - CORRECT ANSWER Increased CO/CI (>8/4) First priority in a septic shock hypotensive patient? - CORRECT ANSWER ABC then IVF How would you know cardiogenic shock? - CORRECT ANSWER Only shock with high PCWP Pt was stung by a bee and is in respiratory distress, what do you do first? - CORRECT ANSWER Administer epinephrine 54 yo male s/p acute MI on levophed, epi, vasopressin and nitro. BP 160/75, now 81/50. Which med would you decrease? - CORRECT ANSWER Nitro What pathological finding can cause both cardiogenic and obstructive shock? - CORRECT ANSWER Cardiac tamponade Hypovolemic shock treatment? - CORRECT ANSWER IVF, tranfuse PRBC's as needed Cardiogenic shock treatment? - CORRECT ANSWER IVF then vasopressors: NE, dopamine, dobutamine, nitro IV if ischemia Obstructive shock causes and treatment? - CORRECT ANSWER PE, tension pneumothorax, tamponade Tx: IVF, maintain bp, treat underlying cause, vasopressors: NE, dopamine Anaphylactic shock treatment? - CORRECT ANSWER Airway, epi IM, benadryl IV/IM, IVF, consider ranitidine (H2 antagonist), inhaled beta agonist Neurogenic shock cause and treatment? - CORRECT ANSWER Spinal cord injury, regional anesthesia Tx: airway, IVF, vasopressors: dopamine, NE, ephedrine Septic shock treatment? - CORRECT ANSWER Blood cultures, IVF, vasopressors: NE, dopamine, dobutamine; abx within 1 hour Basic vent settings? - CORRECT ANSWER RR 12, PEEP 5-8, Vt 6-8mL/kg Lung protective ventilation - CORRECT ANSWER For ARDS, low tidal volume 4-8 mL/kg of ideal body weight. Can also adjust tidal volume to goal inspiratory plateau pressure <= 30. Decreased tidal volume = decreased risk of alveolar over distension and ventilator associated lung injury Patient is 2 days post extubation, is now stable but failed swallow eval in ICU. Can you transfer to step down? - CORRECT ANSWER Yes Patient is decompensating and family isn't sure what they want to do. What do you do? - CORRECT ANSWER Intubate What acid base imbalance indicates CRRT? - CORRECT ANSWER Metabolic acidosis What do you do to the vent in respiratory acidosis? - CORRECT ANSWER Increase RR Anion gap formula and normal value - CORRECT ANSWER (Na + K) - (HCO3 + Cl) Normal is 7-17 Central line is placed, pain develops, in respiratory distress, absent breath sounds: - CORRECT ANSWER Needle decompression Which valve condition is a CI for intra-arterial balloon pump? - CORRECT ANSWER Significant aortic regurgitation Aortic regurgitation is increased by counter pulsation Also: aortic dissection and big aortic aneurysm is CI Lab for rhabdo? - CORRECT ANSWER CK When to transfer burns? - CORRECT ANSWER Facial involvement Patient was burned in explosion. Burns feature moisture on the skin with blisters and redness. He was burned on each arm, his face, and his neck. The patient wants to know what kind and how much of his body was burned. The NP states? - CORRECT ANSWER 2nd degree burn to 28% of body Each arm is 9%, head is 9%, neck is 1% At bedside parasternal US reveals fluid in the pericardial sac. What is the initial action in managing this patient? - CORRECT ANSWER Emergent pericardiocentesis Cervical spine xr of guy who hung himself is inconclusive? - CORRECT ANSWER Leave collar on Testicular torsion treatment? - CORRECT ANSWER Emergency surgery A patient diagnosed with compartment syndrome should immediately receive what? - CORRECT ANSWER Referral for surgery Patient with tibia/fibula fracture started having s/s of compartment syndrome. What do you do next? - CORRECT ANSWER Measure intracompartmental pressure To check for other sources of bleeding in a pelvic fracture? - CORRECT ANSWER CXR and FAST scan There is a trauma patient who is hypotensive and blood transfusion is needed. What does this place the patient at risk for? - CORRECT ANSWER ischemic ATN LeFort criteria determined by? - CORRECT ANSWER malocclusion and XR showing broken palate and teeth Tx: trauma referral, stabilize and ship to tertiary hospital Which antiemetic blocks the 5-HTS serotoniin receptor and can cause extrapyramidal symptoms? a. ondanestron b. metoclopramide - CORRECT ANSWER b. metoclopramide What can contribute to Dilantin toxicity in patient with DM? - CORRECT ANSWER Hypoalbuminemia Which of the following anti epileptic drugs is the long term drug of choice for treating patients with convulsive status epilepticus? a. phosfenytoin b. diazepam c. phenytoin d. phenobarbitol - CORRECT ANSWER c. phenytoin Which of the following factors puts the patient at risk for drug toxicity? - CORRECT ANSWER CrCL <30 52 yo female is concerned with hormonal replacement therapy. What are the associated SE? - CORRECT ANSWER Gallstones, blood clots, and CVA Hormonal replacement therapy has been shown to improve what dx? - CORRECT ANSWER Osteoporosis What is dantroline sodium/dantrium treatment used for? - CORRECT ANSWER Serotonin syndrome, malignant hyperthermia, neuroleptic malignant syndrome Detrol LA side effects - CORRECT ANSWER Anticholinergic effects: drying- xerostomia, constipation, dyspepsia, dry eyes, dysuria, headache Ginseng SE - CORRECT ANSWER increases risk of bleeding Metformin SE - CORRECT ANSWER Lactic acidosis What should you monitor for when taking NSAIDs? - CORRECT ANSWER creatinine, hyperkalemia How long should you monitor the opiate niave? - CORRECT ANSWER 3 hours How do you know a patient understands his coumadin instructions? - CORRECT ANSWER They are getting their INR checked Tamoxifen side effects - CORRECT ANSWER Estrogen modulator: hot flashes, menopausal symptoms, vaginal dryness, hair thinning/loss, menstrual irregularities, pancytopenia, increased risk of DVT/CVA St John's wort side effects - CORRECT ANSWER decreases effectiveness of digoxin, increased risk of serotonin syndrome Succinylcholine precautions - CORRECT ANSWER Risk of malignant hyperthermia, increases K, Synthroid increases risk of what? - CORRECT ANSWER MI How to ensure adequate synthroid use? - CORRECT ANSWER Check TSH What is an expected finding in TCA overdose? - CORRECT ANSWER Prolonged QT What would you monitor postop with serotonin HT3? - CORRECT ANSWER Nausea (zofran is serotonin 5HT3 antagonist) What 2 herbs are associated with relieving menstrual symptoms? - CORRECT ANSWER Evening primrose and black cohosh Elderly patient takes an herbal root t o help fight colds, however has a history of renal insuficiency. Which herb could exacerbate his diagnosis? - CORRECT ANSWER Echinacea causes nephrotoxicity Which of the following is not an indicator of prerenal failure? a. BUN/Cr ratio >10:1 b. FeNa <1 c. specific gravity > 1.015 d. urine na >40 - CORRECT ANSWER d. urine na >40 A 34 year old female presents to the ED with severe flank pain, nausea, and vomiting. The patient states she had trouble urinating before the onset of her other s/s. A CT scan reveals a 2.5 mm stone in the L kidney just above the upper ureter. Which course of action is most appropriate? a. give IVF b. strain the urine immediately c. schedule lithotripsy - CORRECT ANSWER b. strain the urine immediately She may past stone on her own Your 33 yo female patient tells you she does not use protection during sexual intercourse. Cervical motion tenderness in addition to what other finding indicates PID? a. adnexal tenderness b. vaginal itching c. UTI d. no other symptoms - CORRECT ANSWER a. adnexal tenderness 53 yo male c/o dribbling and nocturia. You suspect BPH, PSA 3.2. What confirms the diagnosis? - CORRECT ANSWER Transrectal ultrasound A male patietn you have placed on an alpha blocker for BPH comes in complaining of increased urinary frequency. What do you do? - CORRECT ANSWER Leave it alone, the med is working A 78yo male patient with CHF develops a bacterial UTI secondary to indwelling foley catheter. Pt has known allergy to PCN and sulfonamides. The appropriate choice for antimicrobial therapy is? - CORRECT ANSWER Ciprofoxacin Patient with history of Afib has maintained NSR with sotalol, is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is? - CORRECT ANSWER IV Ceftriaxone A young female patient is in ED with vaginal discharge. After pelvic exam, the NP documents which finding? - CORRECT ANSWER Cervical motion tenderness Your female patient presents with mucopurulent cervical drainage, fever 102F, adnexal tenderness, and distended/rigid abdomen. What is the appropriate measure? - CORRECT ANSWER Call surgery and arrange for an ex lap and pelvic abscess drainage Lower UTI treatment - CORRECT ANSWER Bactrim, cipro, augmentin for 3d course Male patient with UTI on 3 day regimen of abx comes in requestion stronger abx, you order? - CORRECT ANSWER Levaquin (narrow the spectrum) UTI patient is allergic to PCN, you order? - CORRECT ANSWER Bactrim UTI during pregnancy, you order? - CORRECT ANSWER Amoxicillin, macrobid, keflex for 7 days Most common UTI etiology in women/men? - CORRECT ANSWER Ecoli in women/ proteus in men Difference between upper and lower UTI? - CORRECT ANSWER flank pain First test to order with a male presenting with BPH? - CORRECT ANSWER UA Treatment of BPH - CORRECT ANSWER 5 alpha reuctase inhibitors: finasteride (proscar) and dutaseride (avodart) At what age is the PSA screening indicated in non-African american male with no family hx? - CORRECT ANSWER 50 ATN causes? - CORRECT ANSWER Ischemia (prerenal/perfusion related), sepsis, and nephrotoxins (IV contrast) Wht is the leading cause of intrinsic acute renal failure? - CORRECT ANSWER Nephrotoxic drugs Renal disease gives what metabolic abnormality? - CORRECT ANSWER Metabolic acidosis, treat with IVF of NS and sodium bicarbonate as needed What is the cause of anemia in renal failure? - CORRECT ANSWER Decrease in erythropoietin production What is azotemia? - CORRECT ANSWER BUN >100, treatment is dialysis What should the dietary protein requirment be with chronic renal insufficiency? - CORRECT ANSWER <40g/day Chronic renal insufficiency results in what calcium imbalance? - CORRECT ANSWER Hypercalcemia (d/t secondary hyperparathyroidism, renal osteodystrophy) Gold standard for diagnosis of nephrolithiasis? - CORRECT ANSWER CT scan Most common types of stones - CORRECT ANSWER Calcium 80%, gout = uric acid, women = struvite 45yo M s/p abd surgery has now developed ARF: BUN 100/cr 4.5, what are indications for dialysis? - CORRECT ANSWER Increased K, metabolic acidosis, and encephalopathy Treatment for chlamydia? - CORRECT ANSWER Azithromycin Also give ceftriaxone to treat for gonorrhea which is often a coinfection Report to health department 25yo female presents with green vaginal discharg,e what is the diagnosis? - CORRECT ANSWER Gonorrhea What are the s/s of gonorrhea in males and females? - CORRECT ANSWER Males: asymptomatic, white/yellow-green discharge Females: dysuria, urinary frequency, abdominal pain, fever, n/v, yellow-green discharge Treatment for gonorrhea - CORRECT ANSWER Ceftriaxone 125mg IM x 1, cervical culture with Thayer martin media, also give zithromax 1 gm PO x 1 to treat for chlamydia which is often a coinfection Report to health department Patient is sexually active with gonorrhea who is not practicing safe sex, what do you do? - CORRECT ANSWER Educate Minor with STI, what do you do? - CORRECT ANSWER Have parents step out of room What is the confirmatory test for diagnosing syphilis? - CORRECT ANSWER Flourescent treponemal antibody absorption (FTA-ABS) When treating a patient diagnosed with syphilis, what drug allergy is most important to consider before initiating? - CORRECT ANSWER PCN allergy, treatment is PCN G Which lab value is expected in iron deficiency anemia? a. elevated MCHC b. elevated TIBC c. elevated MCV d. none of the above - CORRECT ANSWER b. elevated TIBC (>450) Which vitamin is appropriate for a postoperative patient with alcoholism? a. D b. K c. B1 d. A - CORRECT ANSWER c. BI (thiamine) Your patient is a 30 yo greek female with microcytic anemia who has just returned from the middle east. What lab is not expected in her anemia? a. low serum ferritin b. low hgb c. tibc 300 d. MCHC <32% - CORRECT ANSWER a. low serum ferritin (<15) What does allopurinol prevent in non-hodgkin's lymphoma? a. gout b. hypokalemia c. n/v d. tumor lysis syndrome - CORRECT ANSWER d. tumor lysis syndrome Your patient is on 5FU for chemotherapy. What symptoms are most likely to cause discontinuation of treatment? a. alopecia b. mouth sores c. n/v with mucosal irritation - CORRECT ANSWER c. n/v with mucosal irritation Which of the following is not associated with anemia of chronic disease? a. HIV b. COPD c. SLE d. ulceratie colitis - CORRECT ANSWER b. COPD A 32 yo patient who underwent an open splenectomy for a ruptured spleen is preparing for discharge. An ACNp review the potential complications with the patient. The NP emphasizes which instruction to the patient? - CORRECT ANSWER F/u with PCP for vaccinations 32 yo presents with c/o fever, night sweats, and unexplained weight loss. Upon exam you note a swollen cervical lymph node. A subsequent CXR reveals mediastinal adenopathy. What is the diagnosis? - CORRECT ANSWER Hodgkin's lymphoma Your patient had an appendectomy and chemo for symptomatic relief of cancer. Is this curative or adjuvant treatment? - CORRECT ANSWER Adjuvant Another name for macrocytic anemia? - CORRECT ANSWER Megaloblastic anemia Iron deficiency anemia labs? - CORRECT ANSWER Ferritin <15, TIBC >450 What race is at highest risk for cancer? - CORRECT ANSWER Black men Pernicious anemia, odd neuro sign? - CORRECT ANSWER Positive babinski sign Coagulation labs and what to give - CORRECT ANSWER Platelet 150-400, if low give platelets If clotting factors low (Factor V, VIII, PT, INR), give FFP If fibrinogen low (<170) give cryoprecipitate Hodgkin's lymphoma signs - CORRECT ANSWER Lymphedema in cervical chain Lymphoma present in R axilla and R neck. What stage? - CORRECT ANSWER 2, on same side of diaphragm Leukemia with low WBC, what to avoid infection? - CORRECT ANSWER Hand washing Leukemia + COPD, low WBC, CXR and abg normal, lungs diminished? - CORRECT ANSWER Give steroids and ventilate What is DIC confirmatory tests? - CORRECT ANSWER FDPs increased Passive immunity? - CORRECT ANSWER Immunoglobulin injections ITP treatment? - CORRECT ANSWER Steroids Sickle cell anemia crisis treatment - CORRECT ANSWER IVF for hydration (most important) Analgesics for pain Oxygen for hypoxemia Jehovah's witness needs transfusion but is refusing blood products. What alternative can you give? - CORRECT ANSWER Epogen or colony stimulating factor What is deficient in Von Willebrand disease? - CORRECT ANSWER factor VIII What is treatment of Von Willebrand disease? - CORRECT ANSWER DDAVP preoperatively [Show More]

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