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Acute Care NP Exam > Questions I got wrong on BoardVitals > Flashcards

Questions I got wrong on BoardVitals Flashcards

1
Q

How do you treat a regular, wide QRS tachycardia?

A

Synchronized cardioversion (with sedation if time permits)

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2
Q

Signs of Digoxin toxicity in the elderly

A

Anorexia, nausea, confusion

Bradycardia and arrhythmias are also common

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3
Q

In patient’s with acute decompensated heart failure that have previously been prescribed beta-blockers, ACE-I, ASA and antiarrhythmics, which medication should be stopped?

A

The antiarrythmic should be stopped given increase for mortality.

If beta-blockers were already being prescribed, they should not be stopped. You should not start a new beta-blocker however.

ACE-I are helpful to prevent remodeling and maintain appropriate blood pressure so that should not be stopped.

ASA should be continued in heart failure given concern for PE.

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4
Q

Treatment of new DVT - What is the measuring tool and what medications would you start

A

Wells Score

Active Cancer Treatment: +1 point
Calf swelling >3cm: +1 point
Swollen unilateral superficial veins: +1 point
Unilateral pitting edema: +1 point
Previous documented DVT: +1 point
Swelling of entire leg: +1 point
Localized tenderness along the deep vein system: + 1 point
Paralysis, paresis, or recent cast immobilization: +1 point
Recent bedridden ?3 days, major surgery: +1 point
Alternative diagnosis at least as likely: -2 pts

Greater than 2 points is considered high risk for DVT

Treat with Low Molecular Weight Heparin (Enoxaparin) or Unfractionated Heparin if GFR <40.

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5
Q

Doxycycline is most commonly used to treat

A

Tick-borne illnesses and pneumonia

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6
Q

Treatment of Bell’s Palsy

A

Corticosteroids

If concern for HSV/Varicella associated with Bell’s Palsy, can give antiretrovirals however should give Corticosteroids in addition to the antiretrovirals.

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7
Q

What is a prescription strength medication used in the treatment of motion sickness?

A

Scopolamine Patch
Should be changed every 3 days

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8
Q

Presentation and biggest risk factor for macular degeneration

A

Age is the biggest risk for for macular degeneration (over 60).

Presentation includes gradually progressive worsening of central vision, often that is worse at night, causing difficulty with reading and recognizing faces.

Fundoscopic exam reveals drusen (yellowish colored subretinal deposits in the macula)

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9
Q

What is the first line treatment for erectile dysfuction

A

5-phosphodiesterase inhibitors

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10
Q

Which malignancy is the most common cause of cardiac tamponade?

A

Lung carcinoma accounts for 40% of malignant pericardial effusions.

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11
Q

Triad of symptoms consistent with rhabdomyolysis and important electrolytes/labs to consider

A

muscle pain
weakness
dark urine

Should check K, often pt presents with hyperkalemia and elevated CK (5x upper limit of normal)

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12
Q

What qualifies as significant unintentional weight loss that warrants further assessment and evaluation?

A

5% reduction in 6-12 months

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13
Q

New York Heart Association functional class of heart failure

A

Class I - diagnosis of heart disease with no symptoms or limitations
Class II - Slight symptoms with exertion but not all the time. No symptoms at rest.
Class III - Marked decrease in ability to perform tasks due to symptoms but no symptoms at rest
Class IV - Symptoms at rest

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14
Q

First line treatment of acute bacterial rhinosinusitis

A

Amoxicillin Clavulanate (Augmentin)

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15
Q

What medication is commonly associated with esophageal irritation?

A

Potassium Chloride, tetracyclines and NSAIDs

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16
Q

Indications for surgical repair of a thoracic aortic aneurysm

A

Surgical repair is indicated for all symptomatic or ruptured thoracic aortic aneurysms.

For asymptomatic patients:
Aneurysm larger than 5.5cm
Aneurysm that grows more than 5mm in one year

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17
Q

What is acute chest syndrome and how is treated?

A

Acute chest syndrome occurs in sickle cell disease.
It is often precipitated by infection and has lung findings that can present similarly to PNA

Acute chest syndrome is treated with IVF, adequate pain control, blood products to maintain Hgb >10 and empiric antibx

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18
Q

Percent total body surface area

A

Rule of 9’s

Head and Neck - 9%
Each arm - 9%
Each leg - 18%
Posterior trunk - 18%
Anterior trunk - 18%
Perineum - 1%

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19
Q

Symptoms of acute carbon monoxide poisoning

A

Dizziness, lightheadedness
LOC
dull headache
Shortness of breath
Nausea, vomiting

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20
Q

What should you do for a patient on mechanical ventilation that begins to become agitated and experiences sudden drop in SaO2?

A

-Disconnect from ventilator and begin manual ventilation using an AMBU bag.
-If this is unsuccessful, assess for mucous plug causing desaturation and suction the patient
-If no improvement, conduct thorough physical exam and consider ABG, CXR, EKG.
-CT PE should be considered if suspicion for pulmonary embolism

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21
Q

Identify the clinical manifestations of acute reactive arthritis (Reiter’s syndrome)

A

Arthritis, conjunctivitis and sterile urethritis is suggestive of acute reactive arthritis

Make sure to also rule out disseminated gonoccocal infection

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22
Q

A patient presents with exertional chest pain without SOB and stable VS. EKG shows flat ST segments. What is the diagnosis?

A

Unstable angina

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23
Q

Treatment of fever of unknown origin

A

Fever of unknown origin is a temp greater than 101 on at least 2 occasions lasting for at least 3 weeks.

Treatment includes broad diagnostic work up. If no identifiable etiology is found and the patient is hemodynamically stable, it is reasonable to treat with antipyretics and monitor for resolution of fevers

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24
Q

Treatment of acute pericarditis

A

NSAIDs and colchicine

Glucocorticoids are indicated if the patient is allergic to NSAIDs or is pregnant

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25
Q

What is a Jefferson fracture?

A

Burst fracture of C1

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26
Q

Centor Criteria for strep pharyngitis

A

Tonsillar exudates
Anterior lymph nodes are palpable
Fever greater than 101
No cough

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27
Q

Difference in clinical presentation of gastric ulcers and duodenal ulcers

A

Gastric ulcers:
–have pain 1-3 hours after eating and pain is not relieved by food or antacids.
–May have nocturnal pain or heartburn
–Pain is midline

Duodenal Ulcers:
–Usually relieved with food and antacids.
–Pain generally 1 inch or farther from the midline

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28
Q

Risk factors for gout

A

Older age
Male gender
African American
Genetics
Diet - high protein, ETOH
Diuretics

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29
Q

First line treatment of Crohn’s Disease

A

Enteric-coated PO budesomide

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30
Q

Classic presentation of Crohn’s Disease

A

Fatigue, prolonged diarrhea with abdominal pain, weight loss, fevers

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31
Q

Achille’s Tendonitis - clinical presentation and treatment

A

Overuse injury that is thought to be due to poor vascularity 2-6cm proximal to the insertion of the achilles tendon.
It presents as pain, warmth and swelling exacerbated by exercise
On exam, there will be notable thickening of the tendon and difficulty with ROM
Treatment is modification of activity and change in shoes as well as eccentric exercises to stretch and strengthen muscle fibers

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32
Q

How often should a fecal immunochemical testing be done on an average-risk for colorectal cancer patient (no family hx, no concerning findings)

A

Annually

Every 10 years for the same patient with a standard colonoscopy

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33
Q

When would you order a CT scan for a patient with pancreatitis?

A

No need for CT scan on a patient with pancreatitis when the patient is stable and the diagnosis is straight forward unless the patient’s condition deteriorates.
Ultrasound could be considered on admission to look for gallbladder disease or gallstones
CT would only be helpful within the first 72 hours to assess for necrotizing pancreatitis and would only be indicated if the patient were becoming significantly worse

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34
Q

What is the most common type of cancer in the US

A

Skin Cancer

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35
Q

Normal limits of Swan Ganz Catheter:
Central Venous Pressure

A

Central Venous Pressure: 2-6mmHg - Used to measure right sided filling pressure and measures volume status
If low, then likely hypovolemia

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36
Q

What does the pulmonary artery pressure and wedge pressure on a Swan Ganz catheter measure

A

Normal wedge pressure 4-12mmHg

Measures left side of the heart filling pressures.
When both are diminished, likely hypovolemia
When both are elevated, likely left sided heart failure or cardiac tamponade

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37
Q

Treatment of rosacia

A

Metronidazole gel and avoidance of triggers for rosacia including alcohol, the sun, spicy foods

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38
Q

What are the indications for emergent hemodialysis? (What would we be concerned for in a patient that missed hemodialysis?)

A

Symptomatic uremia (pericarditis, neuropathy, unexplained AMS)
Significant fluid overload
Refractory hyperK
Refractory metabolic acidosis

Compare all labs to baseline as they could be chronically elevated due to CKD

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39
Q

Patients with which immunoglobulin deficiency have a high risk of reaction when receiving blood products?

A

IgA deficiency

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40
Q

Medicare direct reimbursement for NPs is permitted under which federal law?

A

Balanced Budget Act of 1997
Gives NPs reimbursement up to 85%

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41
Q

When should we conduct screening for peripheral artery disease per the United States Preventative Services Task Force?

A

No screening is indicated
PAD can be assessed using the ankle brachial index - systolic blood pressure at the ankle over the systolic blood pressure at the brachial.
Should be 1. Less than 1 is concern for PAD

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42
Q

Clinical presentation of inhalation anthrax and treatment

A

Presents similar to PNA however can rapidly deteriorate and CXR often shows mediastinal widening consistent with mediastinitis.

Treatment for inhaled anthrax is IV ciprofloxacin and clindamycin

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43
Q

What is Kehr’s Sign?

A

LUQ or flank pain with referred pain to the left shoulder with splenic trauma

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44
Q

What is the FRAX score and what does it help predict?

A

FRAX score is the best way to determine future fracture risk/probability
Calculated from her age, sex, body mass index and dichotomized risk factors such as:
–prior fragility fracture
–parental hx of hip fracture
–current tobacco use
–long term oral glucocorticoid use
–rheumatoid arthritis
–high alcohol consumption

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45
Q

Which age groups do women have similar stroke risk to men

A

Ages 25-34 and over 85 years old

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46
Q

In the ilium, which type of tumor is most common?

A

Carcinoid

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47
Q

What is a Jone’s fracture

A

Acute fracture at the proximal diametaphyseal junction near the 5th metatarsal

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48
Q

First line treatment of chronic prostatitis

A

Fluoroquinolones are first line treatment - levofloxacin thought to be superior to ciprofloxacin due to recent resistance to cipro

Second line agent could be Bactrim

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49
Q

Difference between a MOLST and a Healthcare Proxy form

A

MOLST (Medical Orders for Life Sustaining Treatments)
—replaced the DNR form

Healthcare Proxy
–Simple document, legally valid which allows the patient to name someone to make health care decisions on the patient’s behalf if they are unable to make or communicate those decisions

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50
Q

What is the recommended daily sodium intake for a patient with hypertension that is attempting to make lifestyle changes?

A

Less than 1.5g/day of sodium

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51
Q

Treatment of anthrax infection, either aerosolized or cutaneous

A

Anthrax is a zoonotic infection
Grand majority of infections are cutaneous

Should be treated with doxycycline or ciprofloxacin for 60 days post exposure prophylaxis (PEP)

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52
Q

What is papilledema and what is characteristic physical exam finding

A

Papilledema refers to swelling of the optic disc caused by increased intracranial pressure.

Classic exam finding is optic disc bulging on fundascopic exam

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53
Q

What is the treatment for hyperhemolysis s/p blood transfusion?

A

Steroids, rituximab

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54
Q

What are clinical manifestations of acute ASA toxicity?

A

Tinnitus, vertigo, nausea, vomiting, diarrhea

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55
Q

What cancer would an elevated CA 125 suggest? What cancer would an elevated CA 19-9 suggest?

A

Elevated CA 125 suggest ovarian cancer

Elevated CA 19-9 suggests pancreatic cancer

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56
Q

Classic clinical presentation in pheochromocytoma and diagnostic testing that would confirm it

A

Episodes of headaches, diaphoresis and palpitations that are not related to exertion

Diagnostics:
24 hours urine catecholamine test

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57
Q

What does varus force mean?

A

Pushing away from the midline

Valgus is pushing the joint toward the midline

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58
Q

Why is giving corticosteroids after an MI dangerous?

A

Corticosteroids and some non-ASA NSAIDs can interfere with cardiac wall remodeling and scaring after a MI, which can leave the wall weak and prone to rupture

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59
Q

In cardiac tamponade, what values will you see on a right heart catheter?

A

High RA pressure
Equalization of the RA pressure, PA pressure and Wedge pressure

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60
Q

What is the most common bacterial cause of PNA?

A

Streptococcal pneumoniae

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61
Q

What is tumor lysis syndrome and what electrolytes are commonly affected by tumor lysis syndrome?

A

Tumor lysis syndrome describes massive tumor cell lysis with the release of intracellular material, resulting in an onc emergency.

Often happens with cytoxin iniation

Often presents as severe nausea, vomiting and diarrhea after a few days of initiation of cytoxin

Usually present with hypocalcemia

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62
Q

Seizures characterized by a sudden loss of muscle tone that result in a fall or “drop seizures”

A

Atonic seizures

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63
Q

What test could be done to confirm the diagnosis of peripheral artery disease?

A

Ankle brachial index

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64
Q

Treatment of post-herpatic neuralgia after herpes zoster infection

A

Gabapentin or tricyclic antidepressants

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65
Q

EKG changes in TCA overdose

A

Prolonged QRS interval

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66
Q

Cardiogenic shock: What is it and what is a sign of decreased perfusion?

A

Cardiogenic shock is characterized by the failure of the heart to pump effectively resulting in decreased cardiac output and decrease in tissue and organ perfusion.

Symptoms include cool, mottled skin, oliguria, and clouded sensorium

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67
Q

Vitamin C deficiency: What are the symptoms

A

Scurvy
Malnourished individuals who do not eat enough vegetables.
Hemorrhagic skin lesions that usually appear in a perifollicular pattern on the legs
Also include fatigue, bleeding gums, ecchymosis, petechiae, hyperkeratosis

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68
Q

On a pulmonary function test, what are the classic signs of obstructive disease?

A

Increased residual volume (volume left over) and total lung capacity
Decreased tidal volume and decreased total capacity
Decreased forced expiratory volume over 1 second
FEV1:FVC is less than 80%

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69
Q

Common electrolyte abnormalities in SIADH and treatment

A

HypoNa because of diminished urinary output and water retention
Treatment is fluid restriction

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70
Q

Antibiotic of choice for aspiration PNA

A

Clindamycin
–Good for broad spectrum coverage

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71
Q

When is screening for lung cancer indicated?

A

Annual lung cancer screening is recommended for all adults between the ages of 55-80 with a 30 pack year history who are current smokers or quit less then 15 years ago.

High resolution pulmonary CT

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72
Q

A deficiency of ____ during the first trimester of pregnancy is associated with neural tube defects.

A

Folate

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73
Q

The use of Lisinopril during pregnancy can lead to ______.

A

Organ malformation in the first trimester. Renal malformations or renal failure if taken in the second or third trimester

Should take nifedipine, labetalol, hydralizine

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74
Q

What is the highest risk for factor for developing a lacunar infarct?

A

Hypertension

Lacunar infarct represents a type of small vessel disease

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75
Q

What is the most common bacteria that could cause a catheter related blood stream infection?

A

Coagulase negative Staphylococcus such as S. epidermis

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76
Q

What would a typical peripheral blood smear show in a patient with acute lymphocytic leukemia and chronic lymphocytic leukemia

A

In an acute leukemia, the cells would be immature because they are being sent out so quickly. There would be an increase in blast cells.

In chronic lymphocytic leukemia, the cells are normocytic, meaning that they have completely matured. This suggests that the disease process has been underway for some time.

In both cases, there would be a lymphocyte predominance on peripheral smear to suggest that it is a lymphoid leukemia.

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77
Q

How would one diagnose polycystic kidney disease (PKD)?

A

renal ultrasound

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78
Q

Normal VBG

A

pH 7.35 - 7.45
PaO2 >90 75-89 - mild hypoxia <75 severe hypoxia
PaCO2 35 - 45
HCO3 18-24

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79
Q

What is the FiO2?

A

Fraction of oxygen per each inspiration

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80
Q

Trouble shooting vents: How could you decrease a plateau pressure?

A

Decrease tidal volume

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81
Q

What is the best diagnostic test for portal and splenic vein thrombosis, as in a patient with chronic pancreatitis?

A

Visceral angiography

Worsening abd pain could be caused by splenic or portal vein thrombosis in a patient with chronic pancreatitis.

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82
Q

Multiple myeloma: Clinical presentation, labs

A

Weakness, fatigue, bone pain, recurrent infections, recurrent infections, hypercalcemia sxs (n/v, thirst, loss of appetite)

Labs:
Hypercalemia
Anemia
Bone lesions
Renal Failure

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83
Q

What is the most common adult form of muscular dystrophy?

A

Myotonic muscular dystrophy
Usually isolates in certain muscles and patients can live for longer.

Duchenne Muscular Dystrophy has much more rapid course and patients often die earlier

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84
Q

What antibiotic would you choose for prophylactic treatment of recurrent UTIs?

A

Bactrim 40/200mg PO Daily
Macrobid 50-100mg PO Daily

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85
Q

What are the recommendations for women with a risk of osteoporosis as it pertains to D3 and calcium supplementation?

A

Women over the age of 65 who are community dwelling and at increased risk for falls should have Vit D supplementation.

They concluded however that there is not enough evidence for recommendation of dosages to prevent fractures in post-menopausal women.

They do recommend osteoporosis screening for all women over the age of 65 or younger with increased risk factors using the FRAX score
—Takes into account age, BMI, parental hx of fracture, alcohol and tobacco use

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86
Q

Heart sounds of someone with aortic stenosis

A

Late systolic murmur heard over the R second intercostal space and radiates to the carotid arteries.

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87
Q

Heart sounds of someone with Aortic regurgitation

A

Early diastolic murmur/ decrescendo murmur at the third left intercostal space

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88
Q

In a patient with a lacunar stroke, what is an important medication to consider starting to prevent future strokes?

A

Statin
Lacunar strokes are largely caused by atherosclerotic disease, so starting a statin can help reduce the risk of atherosclerosis.

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89
Q

Treatment of choice for mild ulcerative colitis

A

5-Aminosalycilic acid enema

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90
Q

Risk factors for secondary restless leg syndrome

A

Diabetes, hypothyroidism, iron deficiency, venous insuffiency, lumbosacral radiculopathy, spinal stenosis, hypoglycemia

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91
Q

Treatment of acute bacterial sinusitis

A

Amoxicillin is the first line

Could also consider Azithromycin or clarithromycin
Phenylephrine may be beneficial for symptom relief

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92
Q

What is an adverse reaction to phenytoin that is pushed too fast

A

Purple glove syndrome
Fosphenytoin does not have this risk and therefore is often preferred.

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93
Q

CHA2DS2-VASc Score: What does it stand for and when would you use it

A

CHF - 1pt
Hypertension - 1pt
Age >75 - 2pt
Diabetes - 1pt
Stroke - 2pt
Vascular Disease - 1pt
Age 65-74 - 1pt
Sex - Female - 1pt

Used to determine if pt should be anticoagulated

If they score more than 1 on this, they should be considered with treatment with a DOAC

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94
Q

Which vasopressor is associated with hypokalemia and lactic acidosis

A

Epinephrine

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95
Q

Most common bacteria associated with UTI

A

E. Coli

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96
Q

An epidural hematoma is caused by bleeding from ______

A

the middle meningeal artery.

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97
Q

Hypercalcemia: Causes, normal range, Physical manifestations

A

Usually caused by hyperparathyroid
Hypercalcemia: Ca of >10.5 or ionized calcium >5.3

Sxs:
Shorted QT interval
Muscle weakness
Delayed deep tendon reflexes
Vomiting
Constipation
Stupor

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98
Q

What bacteria most often causes toxic shock syndrome in a patient that is menstruating and using tampons.

A

Staph aureus

Strep pyogenes can also cause toxic shock syndrome however it is usually associated with a skin or soft tissue rash

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99
Q

What is the first line therapy for immune thrombocytopenia?

A

Prednisone 1mg/kg/day

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100
Q

What is the most common cause of a new seizure disorder in patients over 60

A

Vascular disease

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101
Q

What is the target A1c for patients >65 years old?

A

<8.0 - helps prevent episodes of hypoglycemia and falls

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102
Q

What is the treatment for vitiligo

A

Topical corticosteroids

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103
Q

What are the CD4 cutoffs for prophylactic treatment of pneumocystis jiroveci pneumonia and what is the treatment

A

Bactrim for CD4 count of less than 200.

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104
Q

Pulmonary function tests in restrictive pulmonary disease

A

Decreased Forced Vital Capacity (FVC) and decreased total lung capacity

Both FEV1 and FVC are reduced so the FEV1:FVC would be normal

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105
Q

In order to wean a patient off of a ventilator, what should the spontaneous rapid shallow breathing index be?

A

<105

106
Q

Medication of choice in a patient with symptomatic a-fib (presyncope, palpitations) with hx of MI and LVEF 20%.

A

Amiodarone

107
Q

Best treatment for patients with mixed urge and stress urinary incontinence

A

Behavioral Therapies

108
Q

Treatment of CAP

A

Inpatient treatment:
Fluoroquinolone or Macrolide (Azithromycin) and a third generation cephalosporin (Ceftriaxone)

Outpatient treatment:
Azithromycin

109
Q

Treatment of HAP

A

Need broad spectrum and MRSA coverage

Vanc and Cefepime

110
Q

What are some lifestyle modifications that could help reduce the risk of nephrolithiasis?

A

Decreased sodium intake and increase fluid water intake

111
Q

What is the treatment for a patient with a DVT and a malignancy

A

LMWH - Enoxaparin daily

The pt is at risk for thrombosis from the DVT and bleed from the tumor, therefore only LMWH

112
Q

What is the best prognostic indicator for patients with COPD

A

FEV1

113
Q

Clinical presentation and initial treatment of ankylosing spondylitis

A

Back pain that has a slow onset and is a dull, aching pain
Heel pain that originates from the Achilles tendon and plantar fascia
Uveitis

Treatment is with NSAIDS

114
Q

What to do when you have a wide complex tachycardia and the patient is awake and stable other than tachycardia

A

Amiodarone

Synchronized cardioversion could be considered if the patient was unstable

115
Q

What test do you use to diagnose an Achilles tendon tear

A

Thompson test

116
Q

Sarcoidosis: Clinical presentation

A

Rash on lower extremities
Erythema nodosum on the upper extremities

Also can present with hilar adenopathy, fatigue, arthralgias

Usually symptoms resolve with time

117
Q

What is the only treatment modality noted to decrease mortality in patients with COPD

A

Oxygen therapy

118
Q

EKG changes in Wolf Parkinson White Syndrome

A

slow, slurred uprise of the Q wave, wide QRS complex, short PR interval, T wave abnormalities, ST abnormalities

119
Q

Treatment of quadriceps tendonitis

A

In the acute phase, treatment is rest, ice and NSAIDs

Cryotherapy can help lower tissue metabolism and help reduce secondary hypoxic injury

120
Q

Electrolytes that usually are deficit during DKA

A

Bicarb

121
Q

What is the most appropriate method of determining the severity of a splenic injury

A

CT with contrast

122
Q

How long should patients undergo anticoagulation before cardioversion in patients with atrial fibrillation that has lasted longer than 48 hours

A

3 weeks

For patients that went into a-fib within the last 48 hours who have a CHA2DSVASc score of >1, should start on DOAC immediately.

123
Q

What is the most common cause of euvolemic hyponatremia

A

SIADH

124
Q

What is the first line vasopressor in septic shock

A

Norepinephrine

125
Q

What is the most common extra-renal complication of polycystic kidney disease?

A

Colonic diverticular disease with an increased risk of perforation

126
Q

What is the first line treatment of dementia

A

Cholinesterase inhibitors
–Donepezil
-Galantamine
-Rivastigmine
-Tacrine

Memantine is an NMDA receptor antagonist and is used as an adjunct with a cholinesterase inhibitor in moderate-severe dementia

127
Q

What is the confirmatory test needed to diagnose sarcoidosis?

A

Tissue biopsy

128
Q

What are absolute contraindications to receive fibrinolytic therapy during a STEMI

A

Prior intracranial hemorrhage
Structural cerebral vascular lesion or neoplasm
Ischemic stroke within the last 3 months
Suspected aortic dissection
Active bleeding
Significant closed head or facial trauma in the last 3 months
Intracranial or intraspinal surgery within the last 2 months

129
Q

Which toxic alcohol is associated with optic disc changes and intoxication when ingested?

A

Methanol

130
Q

What is the earliest marker for diabetic neuropathy?

A

Microalbumin

It can be measured in an early morning urine albumin concentration

If elevated, should consider strict glycemic control and HTN treatment to avoid peripheral diabetic neuropathy

131
Q

What medication is used to treat von Willebrand Disease

A

DDAVP - Desmopressin

132
Q

Treatment for H. Pylori

A

Diagnosed via urea breath test

Treated with two antibx and a PPI

Metronidazole and Clarithromycin
Metronidazole and Amoxicillin
Amoxicillin and Clarithromycin

133
Q

What is the immediate treatment of a meniscus tear

A

Conservative management (rest, ice, NSAIDs)

134
Q

What type of thyroid disorder has a goiter

A

Hyperthyroidism

135
Q

Myxedema coma: How does it start, what are the symptoms, treatment

A

Usually occurs in a patient that has poorly treated hypothyroidism that is under physiologic stress (infection)

Presents with:
hypothermia
hypotension
bradycardia
hyponatremia
hypoglycemia
hypoxia

Usually has very high TSH, very low FT4

Treatment is with levothyroxine 400mcg IV, followed by levothyroxine 100mcg IV daily

136
Q

Lab results suggestive of SIADH

A

Serum hyponatremia
Normal serum osm

Elevated urine sodium
Elevated urine osm
Elevated urine Spec Grav

Very concentrated urine

137
Q

What is a third line treatment of severe asthma if supplemental O2, nebulized albuterol, and corticosteroids have not worked?

A

IV Magnesium

Causes smooth muscle relaxation

138
Q

What is the gold standard for diagnosing interstitial lung disease?

A

High resolution CT chest

139
Q

What is the role of an ACE-I in regards to preload/afterload?

A

ACE-I reduce afterload and therefore decrease the work of the heart
Also they decrease the remodeling of the heart due to CHF

140
Q

What is Brown-Sequard Syndrome?

A

Brown-Sequard (hemi cord) syndrome involves the dorsal column and the spinothalamic tract unilaterally producing weakness, loss of vibration and proprioception ipsilateral to the site of injury and loss of pain and temperature on the opposite side

141
Q

Treatment of hepatorenal syndrome

A

Albumin, midodrine, octreotide

They synergistically act to increase circulating volume and improve renal perfusion by reversing sustained renal vasoconstriction

142
Q

What is an advanced directive

A

It is a document that outlines the patient’s wishes and names a healthcare proxy

It can be overturned at any time by legal next of kin or the patient

143
Q

What is a complication of hypertensive crisis?

A

Intracerebral hemorrhage or subarachnoid hemorrhage or thrombus.

144
Q

Horner’s Syndrome: Causes, symptoms, diagnostics

A

Carotid dissection

Miosis, Ptosis, anhydrosis

Need to obtain MRA head and neck

145
Q

Signs of digitalis toxicity and drugs that can cause it

A

Bradycardia, PVCs, left bundle branch block

Diltiazem can potentiate the effects of digitalis

146
Q

What is the Somogyi effect?

A

When you give too much insulin in the evening (usually an intermediate acting agent such as NPH) and therefore causing hypoglycemia at night time, which leads to a cascade of glucose production resulting in hyperglycemia in the AM.

The treatment is to stop NPH in the evening.
Make sure to continue basal insulin

147
Q

Treatment of tricyclic antidepressive OD

A

Sodium bicarbonate

148
Q

Beta blockers are the cornerstone for management of what disease

A

CHF
Great at controlling the heart rate
Only provide a modest decrease in BP

149
Q

What does digoxin do to BP and HR

A

Increase contractility and decrease HR

Does not do much to BP

150
Q

What is the use for Dobutamine

A

Dobutamine is an IV inotropic medication indicated to support cardiac function and cardiac output.

Has Beta 1 and Beta 2 effects and causes mild vasodilation

Especially useful in afterload reduction in heart failure patients that cannot tolerate vasodilator therapy

151
Q

In a patient with an ischemic stroke that is hypertensive to 190/110, what the is the first medication given?

A

Labetalol

Need to get the BP below 185/110 in order to give tPA

152
Q

Pheochromocytoma: What is it, symptoms, diagnostics, treatment

A

Tumor forms (usually in the adrenal glands) that secretes catecholamines (epinephrine, norepinephrine) inappropriately

Patients will present with attacks of headaches, tremors, diaphoresis, palpitations, chest pain

Will become hypertensive and tachycardic

TSH will be normal
24 hour urine collection for metanephrines (catecholamine metabolites) should be collected

Treat patient symptomatically but will ultimately need to have tumor resected

153
Q

Treatment of a patient with heparin-induced thrombocytopenia who is currently being prescribed heparin

A

Stop heparin immediately and start on alternative anticoagulant (not warfarin)

If warfarin was being given, should give Vitamin K to return INR to normal until thrombocytopenia resolves

154
Q

What is a cardiac index that is associated with cardiogenic shock?

A

Cardiac index of <1.7

155
Q

SJS vs TEN

A

SJS covers less than 10% of total surface body area and involves purpuric rash with blisters and bulae involving oral, optic and genital mucosa.

TEN involves greater than 30% of total surface body area

10-30% is known at SJS/TEN

156
Q

What is the antibiotic choice to treat PNA caused by Legionella?

A

Macrolides - Azithromycin

157
Q

Cor Pulmonale

A

Common in patients with COPD. Right sided heart failure caused by pulmonary disease and pulmonary artery HTN

158
Q

In pre-renal AKI, what would we expect to see in a UA and in a fractional excretion of sodium test?

A

Hyaline casts in the UA

FENa <1%

159
Q

What is the antibiotic treatment choice to treat H. Pylori

A

Metronidazole, Clarithromycin and PPI
Amoxicillin, Clarithromycin and PPI
Metronidazole and Amoxicillin and PPI

160
Q

Which vitamin deficiency can cause night blindness and Bitot’s spots?

A

Vitamin A deficiency

161
Q

Treatment for uremic pericarditis

A

Dialysis

NSAIDs have not proven to be helpful in uremic pericarditis

162
Q

What are contraindications to the use of calcium channel blockers?

A

bradycardia
any degree heart block
CHF

163
Q

First line treatment of cluster headaches

A

100% O2 by nonrebreather

Sumatriptan

164
Q

What the symbol for a healthy male on a genogram?

A

A blank, open square

165
Q

What is a common presenting problem in patients with multiple myeloma

A

bone pain, usually of the lumbar spine
Pathologic fractures are also common

166
Q

What are common symptoms of multiple myeloma

A

bone pain
renal failure
anemia
hypercalcemia

167
Q

Diagnostic tests for Multiple Myeloma

A

Serum and urine assessment for monoclonal proteins

168
Q

What does a positive Squeeze Test indicated in a patient with a suspected ankle injury?

A

Syndesmotic injury
“High ankle sprain”

169
Q

Maisonneuve Fracture

A

Ankle injury that results in a fracture of the proximal fibula from rotation of the body around a planted foot

170
Q

Clinical manifestations of polycystic ovarian syndrome

A

Irregular periods
hyperandrogenism
Ultrasound that shows cysts

Testosterone will be elevated
LSH is greater than FH
High DHEA-S level

171
Q

Shock types and their Cardiac output, right atrial pressure, capillary wedge pressure and systemic vascular resistance

A

Septic Shock: High cardiac output, low right atrial pressure, low capillary wedge pressure and low systemic vascular resistance

Hypovolemic shock: Low cardiac output and high systemic vascular resistance

Cardiogenic shock: Low cardiac output, high right atrial pressure, high capillary wedge pressure and high systemic vascular resistance

Anaphylactic shock: Low cardiac output, low wedge pressure, low systemic vascular resistance

172
Q

Treatment for idiopathic thrombocytopenia

A

If platelet count is between 30,000 and 50,000, prednisone is the first course of action.

If the patient is to have a surgical procedure, would consider IV gamma globulin

173
Q

What are PO options to treat MRSA skin infection

A

Bactrim or Clindamycin

174
Q

What cranial nerve is implicated in Bells Palsy

A

Cranial nerve 7, the facial nerve

175
Q

What are three antihypertensives that are considered safe during pregnancy

A

Methyldopa, Labetalol, Nifedipine

176
Q

What causes splitting of S2 in a heart murmur?

A

Aortic stenosis

This is often caused by prior strep pharyngitis as a child

177
Q

Ig___ deficiency is associated with celiac disease

A

IgA

178
Q

What is the most common cause of acute tubular necrosis?

A

Ischemic injury

Nephrotoxins (like Gentamicin) are the second most common cause

179
Q

What is the reversal agent for serotonin syndrome?

A

Cyproheptadine

180
Q

Kernig’s Sign is an indication of what?

A

Meningitis

181
Q

What are the clinical features of mycoplasma pneumonia

A

Sounds viral
Non-productive cough
Not very high fevers
CXR that shows bilateral interstitial infiltrates

182
Q

What type of nutrition should be started in a patient with sepsis that is intubated

A

Enteral feedings (G-tube or NGT)

183
Q

What are the rules surrounding the Medicare Care Choices Model?

A

Allows current Medicare members to receive hospice care along with the their current Medicare benefits.

Eligibility requires:
-Patient must live in a traditional home (not a nursing home)
-Have Medicare A&B for the last 12 months
-Have a terminal diagnosis (specifically COPD, advanced cancer, Heart Failure, HIV/AIDS)

184
Q

What is the recommended treatment for unrelieved break through cancer pain

A

Sustained release Fentanyl patches

185
Q

What would be a treatment for metastatic bone cancer pain?

A

Bisphosphonates
Causes a decrease in bone mets and pain relief in the bones

186
Q

Define the stages of pressure ulcers

A

Stage 1: Intact skin with erythema that does not blanch: Color changes do not include purple or maroon discoloration - just red

Stage 2: Partial thickness loss of skin with exposed dermis; wound bed is viable, pink or red, moist; adipose tissue is not visible

Stage 3: Full thickness skin loss - adipose tissue is visible in the ulcer and granulation tissue and rolled wound edges are present. Slough or eschar might be present - IF SLOUGH OR ESCHAR IS PRESENT THEN IT IS UNSTAGEABLE

Stage 4: Full thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer - undermining and tunneling often present

187
Q

What are some considerations to help manage a pressure ulcer

A

Monitor for hypoalbuminemia to make sure that albumin is between 3.5-5.0
Wound care specialist consult
Dressing
—If it is weeping - hydrocolloid dressing

188
Q

What are negative outcomes of pressure ulcers

A

Because the pressure ulcer is usually at the coccix, concern for stool in the ulcer
-this can lead to osteomyelitis
-Can spread and move on to sepsis

189
Q

Normal body temp in Celsius

A

37C

Fever is considered 37.7C

190
Q

Common causes of fevers

A

Infection
Autoimmune disease (SLE, arteritis)
CNS disease (cerebral hemorrhage, brain tumor, MS) - thermoregulation problem
Malignant neoplastic disease (primary and liver mets of cancer)
Hematologic disease (lymphoma, leukemia)
CV disease (MI, phlebitis, PE)
GI Disease (inflammatory bowel disease, alcoholic hepatitis)
Endocrine (hyperthyroidism, pheochromocytoma)
Neuroleptic malignant syndrome

191
Q

What is an absolute contraindication for the use of succinylcholine?

A

Hyperkalemia

192
Q

What are the normal ranges of albumin and what happens if it is too low?

A

Normal albumin range is 3.5-5.0

Less than 2.7 - you will start to see edema

193
Q

Complications of enteral nutritional support

A

Enteral feedings - through the GI tract (G-tube)

Have to do with the solution itself and the gut’s inability to handle it

Aspiration
Diarrhea
Emesis
GI Bleed
Mechanical obstruction
Hypernatremia
Dehydration
Refeeding syndrome
—-hypophos, hypokalemia, hypomag, hypocalcemia, thiamine deficiency

194
Q

Complications of parenteral nutritional support

A

Feeding through the vasculature
–If less then 2 weeks needed, can use peripheral vein but otherwise will need central line

The complications occur due to the mode of delivery

Pneumothorax
Hemothorax
Arterial laceration
Air emboli
Catheter thrombosis
Catheter sepsis
Hyperglycemia
Hyperosmolar Hyperglycemic state

195
Q

Antibiotic treatment for animal bites

A

Human and animal bites: Should cover for staph and anaerobes
—-Amoxicillin Clavulanate (Augmentin)

Should treat for 3-7 days depending on the bite

196
Q

What does an acute rejection of an organ transplant look like and what should your initial action be?

A

Immediate failure of that organ
Flu like syndrome (fever, chills, malaise)

Should immediately biopsy the transplanted organ

197
Q

Most effective anti-rejection regimen for transplant patients

A

Three different immunosuppressants from three different classes

Corticosteroid: Methylprednisolone or prednisone
Antimetabolite: Azathioprine, Cellcept, cyclophsphamide (Cytoxan)
Calcineurin inhibitor: Tacrolimus, cyclosporine

198
Q

You must have had what disease in order to get Shingles

A

Chicken pox

Herpes Zoster is an acute vesicular eruption due to infection with varicella-zoster virus

199
Q

Management of herpes zoster

A

Cover the vesicles while they are oozing

Treatment:
Acyclovir
Famciclovir
Valacyclovir

If suspected ocular involvement, contact ophthalmology immediately

200
Q

What medications are given for post-herpatic neuralgia?

A

Gabapentin
Pregabalin

201
Q

At what age is the shingles vaccine indicated?

A

All adults >50 years old, regardless of previous shingles vaccine

202
Q

What are the two types of migraines?

A

Classic - Migraine with aura

Common - Migraine without aura

203
Q

Which cranial nerve is most implicated in migraine headaches?

A

Trigeminal nerve

204
Q

Treatment of cluster headaches

A

Inhalation of 100% O2
Sumatriptan SQ
Ergotamine tartrate aerosol inhalation may also be effective

205
Q

What is the difference between an advanced directive and a living will

A

Advanced directive:
Written statement of a patient’s intent regarding medical treatment

Living will:
Written compilation of statements in document format that specifies which life-prolonging measures one does and does not want to be taken if he/she becomes incapacitated
-In the US, most states recognize living wills as long as they are specific enough
-Often lists someone as the durable power of attorney if they should not be able to make decisions for themselves.
—This is the person that will be charged with making decisions if the patient is incapacitated
—-Same as a proxy
-Power of attorney must be in writing before it can be accepted

206
Q

What are the 6 mandated reporting diseases

A

Gonorrhea
Chlamydia
Syphilis
HIV
Tb
COVID-19

207
Q

What are the requirements for hospice

A

Need to have a terminal illness with a prognosis of 6 months or less.
Need to be CMO - no antibxs

208
Q

What are the types of Medicare and what is covered under each?

A

Medicare A:
Covers inpatient/hospitalization, SNF, home health services and/or hospice associated with the inpatient event: Most people qualify at 65 years old

Medicare B:
Covers physician services (NPs), outpatient hospital services, lab and diagnostic procedures, medical equipment and some home health services
-Supplemental coverage that requires pts to pay a premium
-NPs are reimbursed 85% of what a physician would make
-Medicare pays 80%, the patient is required to pay 20%

Medicare C:
Medicare A+B - now known as Medicare Advantage
-If pts are entitled to A and enrolled in B, they can pick all services through one provider organization under Part C

Medicare D: Limited prescription drug coverage
-Monthly premeium required
-Co-pay on each prescription is required

209
Q

Medicaid: What is covered and who gets medicaid?

A

Federally supported, state administered program for low-income families and individuals

Benefits vary from state to state
Medicaid payments are made after other insurance or third party payments have been made

210
Q

In terms of quality improvement, define:
Structures
Processes of Care
Outcomes

A

Structures: Inputs into care such as resources, equipment or numbers and qualifications of staff

Processes of Care: Include assessments, planning, performing treatments and managing complications

Outcomes: Include complications, adverse events, short term results of treatment and long-term results of patient health and functioning

211
Q

What are the 6 key competencies that are supported by the Quality and Safety Education for Nurses initiative?

A

PETS IQ

Patient-centered care
Evidence-based practice
Teamwork and collaboration
Safety
Informatics
Quality Improvement

212
Q

What is a root cause analysis

A

A tool for identifying prevention strategies to ensure safety
A process that is part of the effort to build a culture of safety and move beyond the culture of blame

213
Q

What is a cross sectional study?

A

A type of observational study that examines a population with a very similar attribute but differs in one specific variable (such as age); designed to find relationships between variables at a specific point in time or “surveys”

214
Q

What is a cohort study?

A

A type of nonexperimental or observational study
Retrospective or prospective
Compares a particular outcomes (such as lung cancer) in groups of individuals who are alike in many ways but differ by a certain characteristic (i.e. female nurses who smoke compared with those who do not smoke)

215
Q

What is a longitudinal study?

A

A study that involves taking multiple measures of a group/population over an extended period of time to find relationships between variables

216
Q

What is a quasi-experimental study?

A

Research that involves manipulation of variables but lacks a comparison group or randomization

217
Q

What is a qualitative study?

A

Includes case studies, open-ended questions, field studies, participant observation and ethnographic studies where observations and interview techniques are used to explore phenomena through detailed descriptions of people, events, situations or observed behavior

218
Q

What is the difference between a type 1 and type 2 error

A

Type 1 error: False Positive - incorrectly rejecting the true null hypothesis

Type 2 error: False Negative - failing to reject a null hypothesis which is false

219
Q

How many percentage points fall within each standard deviation from the mean?

A

68% fall within one standard deviation
95% fall within two standard deviations

220
Q

What is the difference between sensitivity and specificity

A

Sensitivity: Positive
True Positives: The degree to which those who have a disease screen/test positive

Specificity: Negative
True negatives: The degree to which those who do not have a disease screen/test negative

221
Q

As far as herbal remedies go, if it starts with a G it increased the risk for…..

A

bleeding.

222
Q

St. John’s Wort: Hazards and Precations/Interactions

A

Increases risk of blood clotting
Should not be taken with ASA
Many drug interactions (SSRI - serotonin syndrome, decrease oral contraceptive efficacy, digoxin)
Can cause HIV medications not to work
May increase the potency of narcotics

223
Q

Why do people take St. John’s Wort?

A

Depression and anxiety

224
Q

What is Ginko Biloba used for

A

Memory and concentration
Improves sxs of Alzheimer’s Disease, intermittent claudication and glaucoma

225
Q

Top 5 causes of death

A

CAD
Cancer
Unintentional injury
Lower respiratory disease (asthma, COPD)
CVA

226
Q

What cancer in women is responsible for the highest mortality

A

Lung cancer

227
Q

Leading GYN associated cancer

A

Ovarian - no screening exam available

228
Q

Highest incidence of cancer other than skin cancer in women

A

Breast Cancer

229
Q

What cancer in men is responsible for the highest mortality

A

Lung Cancer

230
Q

Other than skin cancer, what is the 2nd most common cancer in men

A

Prostate Cancer

231
Q

Who should get the pneumococcal vaccine?

A

Ages 65 and older
Those 19-64 who smoke or have asthma
People with lung, heart or kidney disease
Those with weakened immune systems
Those living in a nursing home or long term care facility

232
Q

Who gets the mumps vaccine

A

If born before 1957: should get one dose unless immunity because of previous mumps infection

If born after 1957: should get 2 doses of the vaccine

233
Q

Meningococcal vaccine: When is it recommended and how often

A

Recommended for ages 2-55. Should get booster x1 if high risk (military, dorm livers) usually at age 11-15

234
Q

How often should a female have a pap smear done? Breast self exam?

A

Pap: 3 years

Breast exam: Starting at age 21, every 3 years, annually after age 40

235
Q

How often should a woman get a mammogram

A

From ages 45-54, annually
After age 55, every 2 years
Continue as long as the pt is expected to live 10+ years

236
Q

How often should a man get a prostate exam

A

For men with a family hx of prostate cancer, should get a prostate exam and PSA checked annually starting at age 40.

For men without a family hx of prostate cancer, should get a prostate exam and PSA annually starting at age 50

237
Q

How often should one get a colonoscopy and when should they start?

A

Should start ages 45-75

Should get annual stool based testing
Colonoscopy every 10 years

238
Q

Who should be considered for prophylactic antibiotics before a dental procedure?

A

Those with:
Prosthetic cardiac material
Hx of endocarditis
Hx of congenital cardiac illness
Hx of cardiac transplant

239
Q

In a patient with hypocalcemia s/p thyroidectomy (hypoparathyroidism), what medication should be started if the patient is demonstrating sxs of hypocalcemia

A

Should administer calcium gluconate immediately

Then the patient should be started on calictriol to help with the absorption of calcium

240
Q

If a patient is cardioverted for A-fib, how long before and after cardioversion should the patient be treated with anticoagulants?

A

3 weeks prior to cardioversion and 4 weeks after

241
Q

What are the triad of features of Marfan’s Syndrome?

A

Long, thin extremities, often associated with other skeletal changes
Reduced vision due to dislocation of the lenses (ectopia lentis)
Aortic aneurysm that starts at the base of the aorta

Other skeletal deformities include chest deformities, scoliosis, kyphosis, and pes planus

242
Q

What is the pathophysiology behind migraines

A

Vasodilation and excessive pulsation of the branches of the carotid arteries

243
Q

What are electrolyte abnormalities found in acute pancreatitis

A

Hyperglycemia
Hypocalcemia
Elevated LFTs

244
Q

In terms of capacity and compliance, how do the lungs change in the elderly?

A

Total lung capacity remains the same throughout old age
Residual volume increases
Vital capacity decreases
Functional residual capacity increases

245
Q

What is a typical lab finding associated with isotonic hyponatremia?

A

HLD

246
Q

What are two herbal remedies to alleviate premenstrual discomfort for women

A

Black Cohosh and Evening Primrose

247
Q

With regards to potassium, would we suspect potassium to be high or low in alkalotic states? Acidotic states?

A

Hypokalcemia is associated with alkalosis

Hyperkalcemia is associated with acidosis

Sodium is not associated with acid-base abnormalities

248
Q

How often should women receive a physical exam in their 20s

A

Every 5-6 years

249
Q

How often are clinical breast exams recommended inpatients in their 20s

A

Every 3 years

250
Q

What is the leading cause of death among patients 40-59 years old

A

Coronary artery disease

251
Q

What bowel sounds would be expected in patients with a small bowel obstruction?
Partial bowel obstruction?

A

In a partial small bowel obstruction, the pt will complain of abd distention but not constipation, rather watery stool
—High pitched, tinkling bowel sounds will be presents

In complete small bowel obstruction, there will be constipation
—Hypoactive bowel sounds or absent bowel sounds

252
Q

Describe Kernig’s Sign

A

Maneuver used to diagnose meningitis
Patient will lay supine with knees and hips flexed at 90 degrees
If straightening the knee, while the hip is flexed at 90 degrees causes increase headache or neck pain, this is a positive Kernig’s Sign and suggests meningitis

253
Q

A patient presents with a murmur that is low pitched, mid-diastolic and has an apical crescendo rumble. The murmur would most likely occur during which heart sound? What type of murmur is this?

A

This is mitral stenosis
It would occur during S1

254
Q

How do you calculate creatinine clearance

A

[(140-age) x weight in kg]/ 72xCr = Creatinine clearance

Multiple by 0.85 for women

255
Q

What medication would give to a patient that has a NSAID induced peptic ulcer but needs to continue to take NSAIDs

A

Misoprostol

256
Q

What test would you use in order to differentiate between instrisic renal failure and post renal failure

A

Urine Sediment would show granular white casts in intrinsic renal failure. In postrenal, it would be normal.
BUN/Cr and FENa would differentiate prerenal from intrinsic

257
Q

What test could you perform to help make the diagnosis of DIC?

A

Elevated fibrin degradation product is a typical finding of DIC

Fibrinogen levels would be normal
PT and PTT would be elevated
D-Dimer would be elevated

258
Q

What is a symptom of Acetaminophen poisoning?

A

RUQ pain
Delirium

259
Q

What is the drug of choice for organophosphate toxicity that is absorbed through the skin

A

Atropine

Activated charcoal would be used if he were to have ingested in orally

260
Q

How often should a Pap Smear with HPV co-test be conducted in a woman between the ages of 20-39

A

Every 5 years

A Pap smear with cytology should be done every 3 years

261
Q

First line treatment for acetaminophen intoxication?
What about if the patient has AMS?

A

First line treatment should include emesis or gastric lavage
If AMS, gastric lavage is recommended
N-acetylcysteine is indicated at 140mg/kg

262
Q

What can cause both cardiogenic and obstructive shock

A

Cardiac tamponade

Acute Care NP Exam (22 decks)

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