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NRNP BUNDLED EXAMS 2023/24
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Final exam nov 15, 2023 NRNP 6531 QUESTIONS AND ANSWERS
An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the rapid onset of severe low-back pain accompanied by abdominal pain t... [Show More] hat is gradually worsening. The patient appears pale and complains that he does not feel well. During the abdominal exam, the nurse practitioner detects a soft pulsatile mass just above the umbilicus as she palpates this area with her hand. Which of the following conditions is most likely? Abdominal aortic aneurysm Which of the following laboratory test is sensitive for evaluating the renal function Estimated glomerular filtration rate (eGFR) Which of the following groups has been recommended to be screened for thyroid disease? Women aged 50 years or older All of the following patients should be screened for diabetes mellitus except: A 30-year-old White man with hypertension A 40-year-old White woman with a body mass index (BMI) of 32 complains of colicky pain in the right upper quadrant of her abdomen that gets worse if she eats fried food. During the physical exam, the nurse practitioner presses deeply on the left lower quadrant of the abdomen and the patient complains of pain on the right side of the lower abdomen. What is the name of this finding? Rovsing's sign Which of the following symptoms characterize this disorder? 1.Ritualistic behaviors that the patient feels compelled to repeat. 2. increased axiety when attempting to ignore or suppress the repetitive behaviors. 3.frequent intrusive and repetive thoughts and impluses All the above Which of the following medications is indicated for the treatment of obsessive-compulsive disorder? Paroxetine (paxil CR) Which of the following conditions is most likely? Injury to the meniscus of the right knee Which of the following actions is the best course for patient? Refer him to an orthopedic specialist The patient's symptoms are highly suggestive of what condition? A 55-year-old male patient describes an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved immediately when he stopped. Angina pectoris A 55-year-old male patient describes an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved immediately when he stopped. Which of the following would you recommend to this 55-year-old patient? Consult ith a cardiologist for further evaluation A faun tail nevus is a sign of which of the following? Spina bifida A new mother is planning to breastfeed her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (APA) during the first few days of life? Vit D drops An asthmatic exacerbation is characterized by all of the following symptoms except: Chronic coughing A 76-year-old woman reports that for the previous 4 months, she has noticed severe stiffness and aching in her neck and both shoulders and hips that is worsened by movement. She reports having a difficult time getting out of bed because of the severe stiffness and pain. It is difficult for her to put on a jacket or blouse or to fasten her bra. Along with these symptoms, she also has a low-grade fever, fatigue, loss of appetite, and weight loss. Starting yesterday, the vision in her right eye has progressively worsened. She has annual eye exams and denies that she has glaucoma. Which of the following conditions is most likely? Polymyalogia rheumatic (PMR) A 28-year-old woman with a history of hypothyroidism presents to an urgent care clinic complaining of numbness and tingling in the fingertips of both her hands for several hours. On examination, both radial pulses are at +2 and equal bilaterally. The patient reports that over the past few months she has had identical episodes, each lasting several hours. During these episodes, the skin changes color from blue to white, and then to dark red. Eventually, it returns to normal and the tingling and numbness disappear. Which of the following conditions is best described? Raynaud's phenomenon A fracture on the navicular area of the wrist is usually caused by falling forward and landing on the hands. The affected wrist is hyperextended to break the fall. The nurse practitioner is aware that all of the following statements are true regarding a fracture of the scaphoid bone of the wrist except: These fractures always require surgical intervention to stabilize the joint Glucosamine sulfate is a natural supplement that is used for which of the following conditions? Osteoarthritis The best form of aerobic exercise for a patient with severe rheumatoid arthritis is: Swimming The nurse practitioner examines a 4-week-old boy whose mother reports that he has cried for at least 3 hours a day at the same time of day since birth. What is the main goal in the clinical evaluation of this infant? Rule out any physiological cause for the crying spells A 22-year-old sexually active woman is complaining of amenorrhea and new-onset bloody vaginal spotting. On examination, her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse practitioner order initially? Urine pregnancy test A 44-year-old woman who is undergoing treatment for infertility complains of not having had a menstrual period for a few months. The night before, she started spotting and is now having cramp-like pains in her pelvic area. Her blood pressure (BP) is 160/80 mmHg, pulse is 110 beats/min, and she is afebrile. Her labs reveal mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely? Inevitable abortion The Pap smear result for a 22-year-old sexually active college student whose partner uses condoms inconsistently reveals a large number of white blood cells and blood along with inflammatory changes. During the speculum exam, the cervix bled very easily (friable), and a small amount of purulent discharge was present on the cervical surface. No cervical motion tenderness was noted during the bimanual vaginal exam. What is the next step in the management of this patient? Advise the patient be tested for chlamydia and gonorrhea All of the following are infections that affect mostly the labia and vagina except: Chlamydia trachomatis Medicare Part B will pay for all of the following services except: Eyeglasses and routine dental care Which of the following individuals is more likely to be affected by alpha thalassemia anemia? 25-year-old Chinese patient A nurse practitioner's right to practice is regulated under: The board of nursing A 25-year-old woman's last menstrual period was 6 weeks ago. She is complaining of nausea with vomiting in the morning and fatigue. Her breasts feel bloated. The nurse practitioner suspects that she is pregnant. Her symptoms would be considered: Presumptive signs of pregnancy A new patient who is a 40-year-old female postal worker is being evaluated for complaints of a new-onset erythematous rash on both cheeks and the bridge of the nose, accompanied by fatigue. She reports a history of Hashimoto's thyroiditis and is currently being treated with Synthroid 1.25 mg daily. Which of the following conditions is most likely? Lupus erythematosus A woman at 32 weeks gestation has a positive throat culture for Streptococcus pyogenes (strep throat). She denies allergies but becomes very nauseated with erythromycin. Which of the following is the best choice for this pregnant patient? Penicillin (Pen VK) The treatment plan of patients with AIDS who have CD4 counts of less than 200 cells/mm3 should emphasize: Preventive therapy for PCP What type of testing is recommended before starting a patient on a prescription of hydroxychloroquine (Plaquenil)? Comprehensive eye exam Pulsus paradoxus is best described as: A decrease in systolic blood pressure on inspiration Patients with Down syndrome are at higher risk for all of the following except: Melanoma [Show Less]
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NRNP 6560 Midterm exam questions and answers
Surgery risk classes Class 1: benefits outweigh risk, should be done Class 2a: reasonable to perform Class 2b: should be considered Class 3: rarely app... [Show More] ropriate General rules for surgery: testing ECG before surgery only if coronary disease, except when low risk surgery Stress test not indicated before surgery Do not do prophylactic coronary revascularization Meds before surgery - Diabetic agents: Use insulin therapy to maintain glycemic goals(iii) Discontinue biguanides, alpha glucosidase inhibitors, thiazolidinediones, sulfonylureas, and GLP-1 agonists - Do not start aspirin before surgery - Stop Warfarin 5 days before surgery. May be bridged with Lovenox. - Do not stop statin before surgery - Do not start beta-blocker on day of surgery, but may continue Assessment of surgical risk - Unstable cardiac condition (recent MI, active angina, active HF, uncontrolled HTN, severe valvular disease), concern with CAD, CHF. arrhythmia, CVD - patient stable or unstable? - urgency of the procedure (oncology will be time sensitive) - risk of procedure - nutritional status - immune competence - determine functional capacity (need to be more than 4 METS, more than 10 METs makes low risk) Low risk surgeries catarcts breast biopsy cystoscopy, vasectomy laporascopic procedures Plastic surgery intermediate risk surgeries Head/ neck surgery thyroidectomy Intraperitoneal Prostate Laminectomy Hip/ knee Hysterectomy cholecystectomy nephrectomy non majot intrathoracic High risk surgeries aortic/ cabg transplants spinal reconstruction peripheral vascular surgery Lee's revised cardiac risk index 6 points: High risk surgery = 1 CAD = 1 CHF = 1 Cerebrovascular disease = 1 DM 1 on insulin = 1 Creat greater than 2 = 1 1 = low risk 2 = moderate risk 3 = high risk SCIP pre-operative infection measures - Prophylactic antibiotics should be received within 1 h prior to surgical incision - be selected for activity against the most probable antimicrobial contaminants - be discontinued within 24 h after the surgery end-time Postoperative infection reduction methods - pre-op hair removal (clippers) - wash hands - normothermia - maintain euglycemia - urinary catheters are to be removed within the first two postoperative days Osteoarthritis: what, incidence Slow destruction of bones/ joint followed by production of replacement collagen which causes inflammatory changes - older than 60 - more female after 55 - more black than white women - men and women equal risk between 45 - 55 - abnormal height or weight (obesity) - repetitive movement - prior trauma (sprains/ dislocations) - diabetic neuropathy - genetic Osteoarthritis findings and diagnostics - Pain in weight bearing joints - stiffness after sitting, gets better when arising - feeling of instability on stairs - fine motor skills deficit - larger affected joints - Heberden nodules (bony bumps on the finger joint closest to the fingernail) - Bouchard's nodules (bony bumps on the middle joint of the finger) - limited ROM with crepitus - xr shows narrowing of joint space (need anteroposterior and lateral knee films bilaterally) - synovial fluid is clear and without WBC Osteoarthritis treatment Goal is to relieve symptoms, maintain/ improve function, and avoid drug toxicity Hand OA: - rest/ joint protection, with splinting - heat/ cold therapy - topical capsaicin - topical NSAID (trolamine salicylate) (especially for older than 75) - Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems) - tramadol - no opioids Hip/ knee OA: - weight reduction, cardiovascular exercises - transcutanous external nerve stimulator - acetaminophen - Topical NSAIDS (knee) - intraarticular corticosteroid injections - surgery (joint replacement) Rheumatoid arthritis: what, who chronic, systemic autoimmune disease that causes inflammation of connective tissue, first that of jionts them other soft tissues (renal, cardiovascular, pulm). TNF-alpha plays a big role - more women than men - unknown cause - Epstein Barr virus Rheumatoid arthritis: Findings and diagnostics - symmetric joint/ muscle pain, worse in the morning then gets better - weakness, fatigue - anorexia, weight loss - generalized malaise - swollen joints/ boggy feeling of joints with deformity of joints - warm, red skin on affected joints later: - pleural effusions and pulmonary nodules - inflammation of sclerea (scleritis) - pericarditis, myocarditis - splenomegaly (Felty's syndrome) - anemia (hypochromic, microcytic) with low ferritin - possibly: positive rheumatoid factor - XR: joint swelling, later cortical and space thinning - synovial fluid: yellow, thick with elevated WBC up to 100.000 Felty's syndrome rheumatoid arthritis, splenomegaly, neutropenia Rheumatoid arthritis treatment - early treatment better than stepwise - early referral rheumatologist - disease-modifying anti-rheumatic drugs (DMARDs): - methotrexate ( no alcohol, monitor renal and liver, give with folic acid) - cyclosporine - Gold preparations (can cause thrombocytopenia) - Hydroxychloroquine: antimalarial drug (may cause visual changes, monitor) - sulfasalazine, moderate RA - Leflunomide, moderate to severe RA - Etanercept - monitor liver function with DMARDs - screen for TB (skin test) and Hep B - surgery: joint debridement, joint replacement Gout: what, who Inflammatory disorder in response to high uric acid production/ levels in blood and synovial fluid causing crystallization which causes inflammation (Type A and Mediterranean) - impaired renal function which causes excess uric acid - foods high in purine, such as dairy, red meat, shellfish, beer Gout findings, diagnostics - acute painful joint, often great toe (warm, swollen) - pain at night - flank pain because of renal calculi - fever - leukocytosis - elevated erythrocyte sedimentation rate - tophi (bump under skin) on ear - limited joint motion - elevated serum uric acid (greater than 7mg/dl) - urate crystals seen with joint aspiration - xr: joint erosion and renal stones Gout treatment - NSAIDS: naproxen, ondomethacin, sulindac - Colchicine for those who do not tolerate NSAIDS (caution with renal impairment). Also for prophylaxis - Corticosteroids, if NSAIDS and colchicine not tolerated - 24hr urine for uric acid - Allopurinol after flare is over (100mg PO daily) - Biological modifiers of disease (BMD): Pegloticase. Not for asymptomatic. Treat with prophylaxis first. Monitor serum uric acid ANA. Tests in rheumatic disease: what, normal level, abnormal with. Antinuclear antibody (ANA). Normal: Titer 1.32 POsitive with: Sjogren's (SS), SLE (lupus), C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with. Determines hemolytic activity which speaks to level of inflammatory response Normal: men: 12-72. Women: 13-75 mg/dl Increased with: inflammatory disease Decreased with: RA, lupus, SS The radioallergosorbent test (RAST). Tests in rheumatic disease: what, normal level, abnormal with. measures presence/ increase antigen IgE normal: 0.01 - 0.04 mg/dl Increased with allergic reaction Erythrocyte sedimentation rate (ESR). Tests in rheumatic disease: what, normal level, abnormal with. rate at which RBC settle out of unclotted blood in 1 hr Normal: men: 0-7mm/hr, women: 0 - 25 mm/hr Increased with inflammation CRP. Tests in rheumatic disease: what, normal level, abnormal with. C-reactive protein, a non-specific antigen antibody Normal: trace to 6mg/ml Increased with infection and inflammation, RA. Decreased with succesfull RA treatment RF. Tests in rheumatic disease: what, normal level, abnormal with. Rheumatoid factor. antibody against IgG. Positive RF in most people with RA Corticosteroids and arthritis: what does it do and adverse effects Not for maintenance Use lowest dose Suppresses flares nausea, hyperglycemia, weight gain, adrenal insufficiency, mask infections NSAIDS and arthritis: what and adverse effects analgesic and anti-inflammatory give PPI concurrently to prevent GI complication Headache, htn, fluid retention, n/v, ulcers/ bleeding, abnormal liver function tests, rash, renal insufficiency Celebrex and Arthritis Analgesic and anti-inflammatory Fewer ulcers than with other NSAIDS Not recommended in renal or liver failure Screen for sulfa allergy May cause cardiovascular thrombotic event May cause GI adverse event subluxation: what, cause partial dislocation of a joint. Common sites: shoulder, elbow, wrist, hip, knee, patella, ankle, spine trauma, blunt force neuromuscular disease inflammatory joint disease, RA Loose ligaments Ehlers-Dantos syndrome (loose ligaments and overflexible joints- congenital) Findings and diagnostics subluxation Pain over affected area previous subluxation swelling around joints loss of ROM XR, CT, MRI show subluxation Increased WBC (stress response) Management of subluxation Early reduction, many spontaneously immobilization (splint, sling) PT NSAIDS for pain/ swelling Dislocation: what, cause Complete displacement of bone end and position in joint. Common sites: shoulder, elbow (nurse maid), wrist, hip, knee (emergency if loss of integrity of ACL and PCL), ankle/ foot high energy blunt force trauma congenital neuromuscular disorder inflammatory joint disease, RA Loose ligaments younger than 35 often, due to sports Often associated with fracture Findings and diagnostics dislocation severe pain over affected area hx of mechanism of injury numbness/ tingling distal to injury joint deformity shortened limb contusion/ laceration over affected joint decreased pulses distal to joint decreased rom decreased sensation distally due to nerve damage WBC elevated due to stress Hgb may be low due to bruising xr: dislocation (should get anteroposterior) CT scan for pelvic trauma to rule out hip/ pelvic fracture Order ultrasound for posterior knee dislocation: high incidence of popliteal artery injury McMurray test, Lachman Test, straight leg test McMurray: turn foot and bend knee. Positive with Meniscus injury Lachman test: Hold upper and lower leg, around knee, stretch. Hyperstretch: ACL injury Straight leg test: Pain when raising leg, while supine. Positive for herniated disk. Dislocation management Early reduction is essential: closed/ manual if no fracture. If fracture then may need surgery. Postreduction immobilization (splint, cast, sling) surgical repair of ligaments PT/ OT NSAIDS Muscle relaxant for muscle spasms Narcotics for short term use Soft tissue injury: definition, classifications, incidence Injury to non-bony tissue, such as muscle, ligament, tendon, bursa, cartilage, skin Classification: - Closed injury: contusion, hematoma, crush, strain (muscle), sprain (ligament, first to third degree), rupture (muscle and ligaments: instability, inability to move) - Open injury: laceration, abrasion, penetrating/ puncture, amputations trauma exercise/ overuse autoimmune (RA, SLE) obesity age (skin tear elderly) Findings and diagnostics soft tissue injury pain swelling feeling of instability of joint Ruptures/ muscle tear: decreased ROM, immediate swelling and hematoma, abnormal contour muscle, instability of joint, pain/ guarding, watch neurovascular integrity Ligaments/ sprain: pain on palpation and ROM, decreased ROM with moderate swelling, Lachman's test (hypermobile joint is positive sign) Strain/ muscle or tendon: swelling, decreased/ absent ROM, pain/ guarding Cartilage: swelling, click during McMurray's test (would indicate meniscus tear), pain/ guarding Bursa: swelling with boggy feeling, erythema over bursa, decreased ROM Skin: abrasion, laceration, puncture Soft tissue injury findings and diagnostics WBC increased, especially with bursitis Hgb decreased with massive hematoma Synovial fluid aspiration: WBC with inflammation, RBC with bleeding into joint, crystals with gout Xr will reveal swelling MRI (knee/ shoulder) location and degree of injury Soft tissue injury management PRICE (protection, rest, ice, compression, elevation) possible immobilization surgery, if rupture, grade III ligaments sprain, septic bursa, wound closure PT NSAIDS Muscle relaxant Opioids - short term Broad spectrum ab's (cephalexin, cefazolin) Fracture Classification - Gustillo - Closed - Open: Type 1: wound smaller than 1cm Type 2: wound larger than 1cm, moderate contamination Type 3: high degree of contamination, severe fracture instability, soft tissue damage. T3A: soft tissue coverage adequate, T3B: extensive injury soft tissue, exposed bone, T3C: open fracture with arterial injury - Incomplete or complete - stress - traumatic/ pathologic - displaced/ non-displaced Type of fracture lines Transverse Spiral Oblique Comminuted Logtitudinal butterfly segmental impacted Salter-Harris Fracture Classification Concerns growth plate S: straight across growth plate A: Above growth plate L: BeLow growth plate T: Through growth plate R: ERaser of growth plate (Rammed) Cause of fractures Trauma, tumor, osteoporosis, drugs (prednisone), nutritional deficiency (Vit D), neuromuscular disorders Findings and diagnostics of fractures Pain History of traumatic event Neuromuscular dystrophy: headache (autonomic dysreflexia) Deformity of limp Diminished/ absent pulses ecchymosis and swelling xr, always order anteroposterior and lateral CT scan for pelvic and spinal fractures MRI for suspected spinal cord injury Mortise view (leg inward) for ankle to check talus bone oblique films for humerus, femur, ankle DEXA scan to determine degree of osteoporosis Acute Fractures Management - ABC care (Airway, breathing, circulation), musculoskeletal second survey - fluid resuscitation - early reduction of fracture - cover open wounds - surgical irrigation and debridement for open fracture - Ab's: Cefazolin for gram pos. Clindamycin for tetani infection - pain: opioids - tetanus shot of unknown - calcium upon discharge for osteoporosis - cement injection in bone with vertrebroplasty Fractures: Reduction - Orthopedic surgeon referral - buddy-tape toe fracture for immobilization - radius/ ulna: splint with ace-wrap, unless open - post reduction xr - check neurovascular function pre and post reduction - intramedullary rodding for closed femoral and tibial fracture - external fixation for open fracture Compartment syndrome: what, who Increased pressure in tissue limits the circulation and function of the contents within that space (compartment: bone, blood vessel, nerves, muscle, soft tissue). Most often in arms and legs (most compartments), also abdomen Men under age 35 stemming from fracture of tibia stemming from splint, cast, scar increased swelling due to hemorrhage, coagulation disorder, infiltrated iv site, trauma/ surgery, burn, bite Compartment syndrome finding and diagnostics pain out of proportion to injury hx of trauma paresthesia heaviness in affected extremity Six P's: Pain on passive stretch Paresthesia Paralysis of affected limb (late finding) Pulses, bounding first then pulseless later Pallor of affected limb Polar/ poikilothermia (ice cold limb) Elevated WBC Hyperkalemia (tissue necrosis) CPK and LDH elevated Myoglobin in urine Elevated compartment pressure (normal 0-8) Clinical diagnosis, MRI may confirm Acute renal failure (due to myoglobinuria) Compartment syndrome management Non surgical: - limb at heart level (do not elevate) - remove bandages/ immobilizers - diuretic - neurovascular checks - CRRT/ dialysis to treat ARF - intracompartmental pressure monitoring Surgical: - fasciotomy, with delayed closure of wounds (negative pressure wound vac) - skin grafting - amputation if septic from necrotic tissue Restorative: - functional splinting - ROM - early prostethic fitting post amputation Low back pain - four major syndromes 1. Back strain 2. Disk herniation 3. Osteoarthritis/ disk degenration; osteophyte (bone spur) 4. Spinal stenosis: narrowing spinal foramen leading to spinal nerve entrapment Specific findings for back pain - numbness - saddle anesthesia (CA, mass) - bowel, bladder dysfunction (emergency surgery) - pain worse at rest (CA, tumor, infection) - Discitis, epidural abcess (IV drug use) - Decreased rom - Radiculopathy (pain down leg), not with OA - Crossover straight leg test: herniated disk - back, buttock, leg pain when ambulating (neurogenic claudication with spinal stenosis). Also positive straight leg raise test with spinal stenosis xr anteroposterior, to rule out scoliosis, bone spur MRI for soft tissue structure, bulging disk CT for bony imaging Cauda Equina Syndrome Spinal cord compression from metastatic lesion to spine. Causes: gradual to sudden weakness and inability to move/ lift legs, bowel/ bladder incontinence, diminished sensation in legs: saddle. Surgical emergency! Low back pain management Nonsurgical: - rest - ice/ heat (alternate) - NSAIDS - antispasmodics (diazepam, flexeril) - opioid short-term, to promote mobility - anticonvulsants and antidepressants for neuropathic pain - PT - weight loss - epidural steroid injection Surgical: - Foraminotomy or diskectomy - spinal fusion Herniated disk: what, who Bulging or protrusion of nucleus through a defect in the annulus of spine, may cause nerve entrapment - Trauma - Obesity/ sedentary lifestyle - Age 35 - 45 - Often located at L4- L5, L5 - S1 Herniated disk findings and diagnostics - Decreased/ absent reflexes - Atrophy of muscles - limp - possible straight leg raise test/ radiculopathy - limited rom spine - xr anteroposterior and lateral of spine - CT with and without dye: detects bony defects - MRI: detects soft tissue defects - myelogram - EMG (tests nerve innervation) Herniated disk L4 root finding (disk between L3 and L4) - quadriceps weak, difficulty extending quadriceps (have pt squat and rise) - pain and numbness radiating into medial malleous - diminished/ absent knee jerk Herniated disk L5 root finding (disk between L4 and L5) - dorsiflexion of great toe and foot weak (have pt walk on heels of feet) - pain and numbness into lateral calf and between first toe web space Herniated disk S1 root finding (disk between L5 and S1) - weakness of plantar flexion of great toe and foot (have pt walk on toes) - pain along buttock, lateral leg and lateral aspect of foot and posterior calf - diminished achilles calf Herniated disk management Non surgical: - functional bracing - rest - PT for muscle strengthening - heat/ ice alternate - weight loss - transcutaneous electrical nerve stimulator - NSAIDS - antispasmodic - Narcotics for short-term use - epidural steroid injection Surgical: - Laparoscopic diskectomy - hemilaminectomy - total disk replacement arthroplasty HIV and age - Can live beyond 50 years, but survival decreases after 45 yrs, unless tested. - Antiretroviral meds are approved for younger than 50yrs, so older pt's need close monitoring HIV etiology Africa/ Asia: heterosexually acquired Western nations: men who have sex with men, iv drug user, congenital spread Pathophysiology of HIV - HIV infects cells with CD4 receptor (macrophages, Tcells). Acute infection (high viral load) then latent (lower viral load). When CD4 is less than 200 AIDS and viral load increases again, this immunodeficiency - HIV is chronic and prgressive: HIV - acute retroviral syndrome, symptoms fever, chills fatigue diffuse erythematous rash HIV test may be negative, based on how long since infection HIV viral load increased, CD4 within normal range HIV - latent phase - asymptomatic - may have persistent lymphadenopathy - HIV load and CD4 load variable (ultimately HIV load high, CD4 low) Symptomatic HIV disease Symptoms: fever, chills, diarrhea, weight loss - infections: candidiasis/ thrush (oral, mucocutaneous, vaginal), shingles (herpes zoster), frequent bacterial infections AIDS, definition and diagnosis acquired immune deficiency syndrome CD4 low, below 500 and infection with opportunistic organism Or: CD4 below 200 Common oppertunistic organism in AIDS Pneumocystis jiroveci Cryptosporidium Candida albicans Advanced HIV infection: definition, symptoms, prognosis CD4 below 50 Wasting, fevers, fatigue Poor [Show Less]
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NRNP 6552 Part 1 questions and answers.
Asexual person who experiences little to no sexual attraction or desire for sexual activity Binary Gender person who is attracted to people with b... [Show More] oth male and female gender identities Cisgender individuals whose gender identity matches his or her natal sex Gay person with male gender identity attracted to others with male gender identity, umbrella term for non-heterosexual people Gender social construction assigning roles and attributes to a person based on their natal sex Gender Affirmation process that strives to better align gender expression, social perception, or physical appearance with gender identity gender expression outward expression of gender or gender identiy Gender identity Internal understanding of oneself in regard to gender Gender Nonconforming person who identifies as somewhere in between male and female, both male and female, or having no gender Intersex people whose chromosomes are neither XX or XY, whose genitals are ambiguous or incongruent with chromosomal makeup Lesbian personal with female gender identity who is primarily attracted to others with female gender identity Man a person who identifies as male, regardless of natal sex Natal female assigned female at birth based on appearance of genitalia Natal male assigned male at birth based on appearance of genitalia Natal sex sex designation assigned at birth based on the appearance of genitalia Nonbinary gender concept of gender that recognizes gender as existing on a spectrum rather than as a dichotomy Pansexual person who is attracted to people of all gender identities, not limited to those with binary gender identities Queer umbrella term to describe all people with non-heterosexual gender identities, historically used as a derogatory slur by those outside the LGBTQ community, Sex designation based on chromosome and genitalia Sexual orientation concept describing one's sexual attraction, identity, and behavior Transgender an umbrella term describing people whose gender identity or expression differs from their natal sex Transgender woman natal male who has a female gender identity Transgender man natal female who has a male gender identity [Show Less]
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NRNP 6635 Midterm Study questions and answers
Potassium Select the serum assessment that is used when prescribing drugs to treat psychiatric disorders in psychosomatic patients Erickson Select... [Show More] the theorist who developed the eight stages of the psychosocial life cycle Sexual abuse and Partner Betrayal Select two causes of dissociative amnesia AIMS Select the patient evaluation scale to be used before and during prescribing antipsychotic drugs Autism and Intellectual disability Select the two comorbid disorders with which Pica occurs most commonly 20% recover, 10% mild symptoms, 40% moderate symptoms, 30% no change or worse Select the prognosis range of untreated PTSD patients Sequential events Select the memory category retained in transient global amnesia that is absent in dissociative amnesia Eating with friends but not Family The following is NOT an endocrine change noted with anorexia nervosa Psychiatrist History and mental status examination Select the two most important elements of the psychiatric interview to establish a mental illness diagnosis. Patient Resistance Select the greatest impediment to treat anorexia nervosa patients. Central Apnea Select the sleep disorder in which cataplexy is a common symptom Hoarding Select the obsessive-compulsive disorder for which a patient is likely to initially seek help from a Primary Care Provider CAPS Select the rating scale used to assess obsessive-compulsive disorder 4 Select age after which encopresis may be correctly diagnosed Dysthymia Select the mood disorder that is worsened by chronic exposure to observing violence in television, movies, and video games Medical history Select a provider's most important knowledge area essential to a successful mental health interview of a child 6-8 weeks Select the minimum treatment time to assess the effectiveness of antidepressant drug therapy PTSD has recurrent, distressing dreams What is one main difference between acute stress disorder and PTSD? Short duration of symptoms Factors that indicate a good prognosis for PTSD disorders include all the following EXCEPT: Angina Pectoris Select the medical condition that must be excluded as a cause of somatic symptom disorder or hypochondriasis Appetite What is the most IMMEDIATE consideration in assessing depression in adolescents? Acetylcholine Select the neurotransmitter that is most involved in the pathophysiology of schizophrenia. Privacy Select the most important component of the patient-provider rapport. Cognitive-behaviour therapy CBT and SSRI antidepressants Select the most effective treatment for social anxiety disorder in children Echolalia All the following are key psychiatric findings when assessing speech and language in children EXCEPT: Concurrent substance abuse Select the factor that is required to cause PTSD from a stressor Generativity versus All the following are classes of coping mechanisms in the Model of Mental Health as Resilience where humans overcome stressful situations EXCEPT: Caudate Anatomical and functional neuroimaging studies have associated a decreased activation in what part of the brain with obsessive-compulsive behaviors? Secracy of eating rituals and Insisting weight loss has a medical cause Select the two complications in diagnosing patients with anorexia nervosa separation Select the anxiety disorder that emerges in ages 9 to 18 months. Dizziness and Constipation Select the two most common peripheral symptoms of anxiety Melatonin Select the hormone or neurotransmitter that is involved in regulating the 24-hour circadian sleep-wake cycle. unplanned travel Select the event most associated with the occurrence of dissociative fugue Intellect Select the neurodevelopmental disorder typically diagnosed in childhood negligent parenting Select the primary cause of reactive attachment disorder in children Depersonalisation disorder Select the psychiatric disorder for which drug and non-drug treatments are least effective Experienced Violence and natural disaster Select two events that are causes of dissociative trance disorder 6 months Select the time from occurrence of the stressor in which symptoms must appear to diagnose an adjustment disorder Magnesium Select the serum substance that should be measured to aid the diagnosis of restless leg syndrome. Dissociative disorder Select the DSM-5 disorder formerly called multiple personality disorder Seizures, Substance abuse, Narcissistic Personality Disorder Differential diagnosis for consideration when suspecting a cyclothymic disorder include: Chelation Therapy The following psychotherapy interventions is NOT a recommended in the treatment of PTSD: 2% placebo 4% drugs Select the difference in rates of suicidal thoughts and behaviors between placebo and drug in children and adolescents observed from random controlled trials of nine antidepressant drugs that resulted in the 2004 FDA "black box" warning in labeling of antidepressant drugs. Fluoxetine Select the drug that has been effective in treating social anxiety in children. 6 to 7 Select the youngest age range at which alarm therapy is effective to treat enuresis Prefrontal Cortex Which part of the brain is essential to the maintenance of attention? Weekly binge eating for at least 3 months and abuse of emetic drugs and substances Select two signs and symptoms of bulimia nervosa. withdrawal Select the behavior that best describes early onset bipolar disorder in children and adolescents Sexual assault Select the most common stressor of PTSD in women Vehicle accident Select the most likely stressor to cause an adjustment disorder Dopamine Select the neurotransmitter involved in obsessive-compulsive disorder (OCD) in children and adolescents based on the common comorbidity of tic disorder Opioid Analgesics Select the class of drugs most effective in treating pain disorder anorexia nervosa The most commonly occurring eating disorder Pain the disorder in which inflicting injury to self or others is common TMS and MRI Two imaging methods used to study anxiety disorders 20% incidence by age 18 Epidemiological fact about major depression in children and adolescents Hippocampus Brain region most implicated in the function of memory Insomnia Most common sleep disorder Intense Horror Factor that is required to cause PTSD from a stressor Male infants from 3-12 months The population in which rumination disorder occurs most frequently Suicidal Ideation the symptom least associated with manic and hypomanic episodes Psychosis Third most commonly reported psychiatric symptom Mildly depressed Characteristic in long sleepers (longer than 9 hours) that is absent in short sleepers (less than 6 hours) Cognitive Therapy and Hypnosis The two methods to treat dissociative amnesia Franz Gabriel Alexander Theorist who is credited with establishing the area of psychosomatic medicine persistent depression disorder in children and adolescents that is described by depressed or irritable mood for most of the day for a majority of days in at least one year generalized dissociative amnesia The type of dissociative amnesia is described by the inability to recall any events in a particular lifespan period 60%-90% Frequency range for heritability of Bipolar disorder Hallucinations and Irritability The two symptoms that result from prolonged sleep deprivation Voluntary Motor The function that is most affected by conversion disorder cognitive behavioral therapy The therapy for Insomnia that can be effective up to three years after discontinuation Well-Being The mental health model that is most associated with human interpersonal connection Anorexia and Seizures two medical conditions in which derealization and depersonalization are common adolescence The age stage of life in which identity crisis emerges History of substance abuse and duration of therapy the two most important factors that guide the decision to prescribe benzodiazepines to treat general anxiety 50-100 The mg/dL blood alcohol level range that is associate with causing impaired judgement and coordination Electronic Media The exposure to violence that is excluded as a DSM-5 diagnostic criterion for PTSD in children and adolescents Infancy The life stage at which emotional and social behavior begin Substance abuse and appropriate drug therapy The two events that are excluded as causes of dissociative trance disorder Cognitive therapy The non-drug therapy with the greatest evidence of effectiveness in treating major depression disorder few or lack of somatic symptoms and frequent provider visits The two common characteristics of illness anxiety disorder Dysthymia The alternate name for persistent depressive disorder Piaget The scientist most associated with the development of learning theory Paroxetine The drug proven most effective in treating PTSD [Show Less]
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NRNP 6541 EXAM QUESTIONS AND ANSWERS.
2 year old speaks in 2 to 3 word sentences (family understands) Understands simple commands knows first name can copy straight line easily frustrated ... [Show More] goes up stairs using same foot 3 year old speaks in complete sentences speech understood by most strangers knows full name, has sexuality identity copies circle stack nine cubes throws ball overhead pedals tricycle walks up stairs with alternating feet Strabisma Eye disorder -Eyes unable to to focus on same object, can be bi or unilateral Tx: patching stronger eye to increase visual stimualtion of weaker eye esotropia inward turning of the eye exotropia outward turning of the eye hypertropia upward deviation of one eye hypotonia looks down head circumference obtained till 2 years old 0.5cm week 2cm 1 month Ventriculomegaly enlargement of cerebral ventricles caused by increased pressure of CSF fluid Craniosynostosis the premature fusing of the skull bones tx: NSG/plastics 1 month turns head Side to side head lag strong grasp reflex watches faces when spoken to 2 month Closing of posterior fontanelle; diminished tonic neck and Moro reflexes; decreased head lag, holds head upright, lifts head and chest while prone; social smile first appears 4 months babbles/raspberry sounds, push off with hands to elbows, brings hands to mouth, racking with hands, . head lag is gone. flips prone to supine 6 months sit up without support roll from front to back, back to front ba, da, ma, racking hand motion. begins to know if someone is a stranger 9 months pulls to stand pincer grasp peek a boo good bye. crawls. afraid of strangers 1 year supports own weigh, separation anxiety, climb stairs by crawling, pokes with index finger bangs two things together 4 year old draws a cross, hops on one foot up to 2 secs, names some colors some shapes 5 year old can draw square/triangle Piaget: Sensorimotor Stage 0-2 years- first stage, children learn entirely through the movements they make and the sensations that result. They learn they cause things to happen, they are separate from objects and people around them, things continue to exist even if they can't see them (object permanence) Piaget Preoperational Stage 2-7 years- Once children acquire langage they can use symbols to represent objects. Still egocentric thinking and they assume everyone sees things from the same viewpoint. Understand concepts like counting, classifying according to similarity, and past-present-future but focused on present and concrete rather than abstract. Piaget Concrete Operational Stage 7-11 years-Children are able to see things from different points of view and to imagine events that occur outside their own lives. Some organized, logical thought processes are now evident and are able to order object by size, color gradient, etc. can understand that if 3+4=7 then 7-4=3. Understand that red square can belong to both red and square categories. Understand short wide cup holds same amount as tall and skinny cup.(conservation) Thinking still tends to be tied to concrete reality Piaget Formal Operational Stage 11+ - around the onset of puberty, children are able to reason in much more abstract ways and to test hypotheses using systematic logic. There is a much greater focus on possibilities and on ideological issues Kawasaki disease (inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. TX: with high-dose aspirin and gamma globulin 75% of cases are under 5 years old. Angleman Syndrome - rare genetically inherited form of mental retardation due to the deletion or inactivation of specific genes on the maternally inherited chromosome 15 - lack of crawling or babbling, minimal speech, and frequent smiling and laughter. Inability to walk, move, or balance well (ataxia) [Show Less]
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NRNP 6566 WK1-5 Midterm questions and answers.
Describe cytochrome p450 system Cytochrome p450 system is a series of enzymes used to metabolize medications Inhibitors block metabolic activity f... [Show More] rom one or more CYP450 enzymes Inducers increase CYP450 enzyme activity by increasing enzyme synthesis Describe effect on low and high albumin levels on active drug levels especially for drugs that are highly protein bound Albumin is the plasma protein with the greatest capacity for binding drugs. Binding plasma proteins affect drug distribution into tissues, because only drug that is not bound is available to penetrate tissues, bind to receptors, and exert activity. As free drug leaves the blood stream, more bound drug is released from binding sites. Low albumin levels malnutrition, chronic illness Highly protein bound drugs can lead to toxicity in patients with low albumin levels, example malnutrition or chronic illness. This is because there are fewer than the normal sites for the drug to bind Describe the ways the hepatic first pass effect- which is metabolism during first pass through the liver Alternative routes include: suppository intravenous intramuscular inhalational aerosol transdermal sublingual These allow drugs to bypass the first-pass effect and be absorbed directly into systemic circulation Be able to calculate creatinine clearance using Cockgraft Gault equation: Male = 140-age times weight in kilograms divided by serum creatinine times 72. Women = CRCL (male) times 0.85 Describe what determines the frequency of drug administration half life plasma concentration Be familiar with the beers criteria and how to use it Potentially Inappropriate Medication Use in Older Adults to call attention to medications that are most commonly problematic and thus should be avoided in older adults Describe factors that affect absorption low blood state (shock or arrest), contact time with GI tract too fast (diarrhea = cant absorb), delayed stomach emptying (large meal = delayed absorption)Drug- to drug or drug to food interactions Describe the factors that affect distribution low albumin levels, body composition, cardiac decompensation (heart failure), age Describe the factors that affect metabolism genetics, age, organ function Describe factors that affect excretion affected by abnormal kidney or liver function, age, drug interactions Define narrow therapeutic index. How would you monitor a patient with a narrow therapeutic index? Therapeutic index is the dose range of effiency of med is optimized while side effects are minimized Narrow therapeutic index drugs are defined as those drugs where small differences in dose or blood concentration may lead to dose and blood concentration dependant, serious therapeutic failures or adverse drug reactions. You will need to monitor blood tests to monitor blood concentrations and dose adjustments accordingly. Describe how aging can affect absorption, distribution, metabolism and excretion decreased organ function, poorly tolerate drugs that require metabolism, lower rates of excretion decrease in small-bowel surface area, slowed gastric emptying, increase in gastric PH, changes in drug absorption With age, body fat generally increases and total body water decreases. Increased fat increases the volume of distribution for highly lipophilic drugs (for example, diazepam and chlordiazepoxide), which may increase their elimination half-lives. Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin and warfarin are examples of medications with a higher risk of toxic effects when serum albumin increases hepatic metabolism of many drugs through cytochrome P enzyme system decreases with age; decreasing 30-40% decreased renal elimination Identify 1st degree heart block cardiologist consult Order echo to rule out structural diagnosis, check thyroid levels, medications, electrolytes and identify and treat cause Identify 2nd degree heart block permanent pacemaker, continuous tele monitoring, possible transcutaneous pacing, determine cause; IV atropine if poor perfusion s/s every 3-5 minutes with max of 3mg if poor perfusion. No response to atropine, use dopamine, epinephrine, isoproterenol Identify 3rd degree heart block/complete heart block Permanent pacemaker, telemetry monitoring and transcutaneous pacing if needed, identify cause, IV atropine if s/s poor perfusion. If no response to atropine, use dopamine, epinephrine and isoproterenol Atrial fibrillation Stable- rate control versus rhythm control strategy (example: AV nodal blockers, antiarrhythmics, anticoagulation). Ablation may be needed if no response to medications Unstable- DCC/ cardioversion Atrial Flutter Cardioversion Rate control not as responsive as Afib Ventricular fibrillation Defibrillate and CPR Ventricular Tachycardia Stable- betablocker Amiodarone, sotalol, mexiletine to reduce number of shocks MG if torsades EPS / ablation Unstable - CPR, epinephrine vasopressin, amiodarone, lidocaine, magnesium, airway management Tachycardia vagal manuever, adenosine (6 or 12 mg), betablocker or calcium channel blocker. Know what conditions each class would be used to treat Dihydropyridine Calcium Channel Blockers nefedipine, amlodipine these primarily act on vascular smooth muscles Use this for hypertension Non-Dihydropyridine Calcium Channel blocker Diltiazem < verapamil Primarily act on the heart Use these for CP, SVT (verapamil), controlling irregular heart rate and lowering blood pressure (Diltiazem) CHADS 2 score anything greater than 3 is high risk and start anticoagulant 1 point for each with history of heart failure, hypertension, and diabetes mellitus Stroke is 2 points and greater than 75 years old is one point Hyperthyroidism heat intolerance fatigue anxiety nervousness manic confusion / restless emotional liability fine tremors diaphoresis hyperreflexia of deep tendon reflexes resting tachycardia, palpitations, afib exterional dyspnea low-grade fever increased appetite weight loss fine thin hair exopthalamus Graves Abnormal labs with hyperthyroidism elevated T3, T4, thyroid resin uptake, and free thyroxine index. Sometimes T4 is normal but T3 is always high Elevated sed rate Elevated antinuclear antibody, without evidence of lupus or autoimmune disorder Hypercalcemia and low h/h Treatment for hyperthyroidism propanolol (inderal) 10mg 4 times a day (up to 80 mg) Metoprolol 25 mg by mouth (Up to 50 mg) every 6*8 hours Antithyroid medications- methimazole (tapazole) initial dose is 30 to 60mg a day in three doses, and then maintenance of 5 to 15 mg daily If intolerant to tapazole, propylthiouracil initial dose is 300 to 600 mg a day in 4 doses, maintenance dosage is 100 to 150 mg daily in three doses Identify when cardioversion is indicated and relevant testing that should occur prior to it Unstable afib / flutter causing RVR, MI, hypotension or heart failure; WPW syndrome in a fib TEE should always proceed DCCV to rule out valve disease or thrombus Hypertension definition sustained BP of 140's over 90's for a sustained period of time Stage 1 is 140-159; and 90-99 diastolic Stage 2 is equal or greater than 160 over greater or equal to 100 diastolic Essential hypertension unknown cause 95% cases; onset 25 years old - 55 Secondary hypertension- related to known cause or disease process. This could be from estrogen uses, renal disease, pregnant, endocrine disorders Isolated systolic blood pressure- hypertension and systolic blood pressure greater than 140 over 90 Effectively treated with diuretics and long-acting calcium channel blockers Signs and symptoms of hypertension: headache in the morning, epitaxis, lightheadedness, visual disturbances, S4 present related to left ventricular hypertrophy, retinal changes, hematuria (which is rare) Hypertensive urgency severely elevated blood pressure 180 over 110 or higher without progressive target organ dysfunction signs and symptoms: severe headache, shortness of breath, epistaxis, severe anxiety treatment includes Clonidine (alpha-adrenergic stimulant 0.2 mg initial dose, then 0.1 mg every hour until controlled or total of 0.8 mg May experience sedation, possible rebound hypertension once stopped Captopril - ACE dose of 12.5 to 25mg Hypertensive emergency Severely elevated blood pressure 180 over 120 can occur with lower blood pressure if impending or progressive target organ dysfunction ( example : encephalopathy, intracranial hemorrhage, acute myocardial infarction, pulmonary edema with acute LV failure, unstable angina, dissecting aortic aneurysm or eclampsia First intervention - goal is to get blood pressure down to 160-180 or less than 105 diastolic. First drug choice is nicardipine 2.5 to 1.5 mg hour intravenously. Side effects include headache, hypotension, tachycardia, nausea/vomiting, fever, neck pain, indigestion Second medication is nipride 0.25 to 10 micrograms per kilogram per minute intravenously. Side effects include brady or tachycardia, nausea, abdominal pain, twitching, dizziness, headache, flushing, sweating, IV site irritation. This medication can cause rapid profound hypotension. Do not give this medication longer than 72 hours as there is a risk for cyanide poisoning. Nitroglycerin- 5 to 220 micrograms a minute intravenously. Side effects include dizziness, headache, hypotension, orthostatics, numbness/tingling, flushing, nausea/vomiting Other medications: Esmolol hydrochloride Lebetalol - commonly used with pregnant patients Apresoline- do not give to patients with Coronary artery disease and aortic dissection. this is a vasodilator, which decreases blood pressure but increases heart rate and retains fluid Minoxidil is another vasodilator. good for end stage renal patients Fenolodopam Hypertension medications based on history Non-African Americans can take thiazide diuretics, calcium channel blockers, ace inhibitors, ARBs (grade B) African Americans need thiazides, calcium channel blockers (grade b); grade c for patient with diabetes mellitus Adults equal to or greater than the age of 18 with chronic kidney disease- ace inhibitors, ARBS grade b - regardless of race or other comorbidities [Show Less]
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