APN1 Final Prep Flashcards
1
Q
What defines chronic cough?
A
A cough that has lasted longer than 8 weeks.
2
Q
What medications has a side effect of chronic cough?
A
ACE inhibitors (lisinopril, captopril…)
3
Q
What is assessed in the CURB 65 screening tool?
A
Evidence for severity of pneumonia: Confusion, BUN >19, RR >30, SBP <90/DBP <60, >65 yo
4
Q
When should a patient be educated to stop smoking after starting chantix?
A
At least 1 week but up to 1 month
5
Q
FEV between 30-50 is considered what stage of COPD?
A
Severe
6
Q
FEV between 50-80 is considered what stage of COPD?
A
Moderate
7
Q
Very Severe COPD is definded as FEV less than____?
A
30
8
Q
Mild COPD is found with FEV at what level?
A
> /= 80
9
Q
What is the most common pathogen for CAP?
A
Streptococcus pneumoniae (70% cases) followed by pneumoccolal pneumonia (25-35%) and mycoplasma pneumoniae
10
Q
What is chest pain in the anterior chest related to muscle strain with cough and other strenuous activities?
A
Costochondritis
11
Q
According to JNC8, what defines hypertension in those under the age of 60 without DM/CKD?
A
150/90
12
Q
According to JNC8, for those over 60 or who have DM/CKD, what defines hypertension?
A
140/90
13
Q
For pt’s with HF, what antihypertensives according to JNC8 are recommended?
A
ACEI/ARB + BB + diuretic
14
Q
For pts with DM, what antihypertensives are first line according to JNC8?
A
ACEI/ARB
15
Q
According to JNC8, what antihypertensives are recommended for those with CKD?
A
ACEI/ARB
16
Q
According to JNC8, what is the first line antihypertensive agent for pregnant women?
A
Labetolol (nifedipine and methyldopa as alternative agents)
17
Q
According to ACC/AHA, stage 1 HTN in those who are considered low risk (ASCVD Score <10) is defined as?
A
130-139 SBP
80-89 DBP
18
Q
According to ACC/AHA, what defines stage 2 HTN?
A
> /=140 SBP
>/= 90 DBP
19
Q
What is Variant or prinzemetal’s angina?
A
Pts without atherosclerotic plaques who experience intermittent coronary artery vasospasm usually occurs at rest, often during the night and is unrelated to exertion. May be relieved by exercise.
20
Q
How is stable and unstable angina differentiated?
A
Stable angina is predictible and is relieved with rest and NTG- generally lasting 3-15 minutes. Whereas unstable (ACS) is more intense and last longer. It is also unpredictible and does not relieve with rest. Unstable angina may often present w/ N/V and diaphoresis.
21
Q
What is the theraputic INR range for coumadin dosing?
A
2.0-3.0 (higher for those w/ mechanical valves)
22
Q
Patients with orthopnea, dyspea at rest, presence of S3, downward shift of PMI, bilateral rales, and dependent edema would be suggestive of what condition?
A
L. Side heart failure
23
Q
Patients with JVD, RUQ abd pain, hepatosplenomegaly and peripheral edema are suggestive of what cardiac disorder?
A
R. Sided heart failure
24
Q
MCV of less than 80 is found in what type of anemia classification?
A
Microcytic
25
What are common types of microcytic anemias?
IDA
Thalassemia
Sideroblastic anemia
ACD can be micro or normocytic
26
What are the typical laboratory findings in IDA?
Low HGB, low iron, low Ferratin, low MCV/MCHC, and high TIBC
27
In ACD, what are the common lab findings?
RBC low, Iron low, Ferritin, and MCV/MCHC normal to mildly low. TIBC is normal to increased.
28
What is the most common causative agent in mono?
EBV (although can be CMV)
29
Patient with fever, sore throat, adenopathy and fatigue should be suspected to have___?
Mono
30
Patients with mono may exhibit what additional signs?
Morbilliform viral rash, N/V, anorexia, hepatosplenomegaly and headache
31
Herberden and Bourchard’s nodes are indicative of what disease?
Osteoarthritis
32
RF factor is helpful in determining the prognosis of RA in what manner?
The degree of elevation positively correlates with severity of disease.
33
Is a positive RF alone diagnostic of RA?
No, anti-CCP antibodies is more sensitive-however, it does not correlate with severity. Both RF and Anti-CCP antibodies are useful in diagnosis.
34
How do CRP and ESR aide in the diagnosis and managment of RA?
Since they are markers of inflammation, they both support the Dx and indicate response to treatment.
35
Why is ANA ordered in the RA workup?
It can differentiate between lupus and RA- which have similar presentation
36
Malar rash also known as “butterfly” rash is associated with what disorder?
Lupus
37
With non-inflammatory muscle pain syndrome fibromyalgia, pain is often found to present?
Pain extensively on one side of the body, or regionally such as above or below the waist or axial skeletal (c-spine, anterior chest, thoracic spine and lower back). Dx criteria includes pain in 11/18 tender points
38
Compression of the medial nerve is found in what disorder?
Carpal tunnel syndrome
39
What are the risk factors for carpal tunnel syndrome?
Occupations that produce prolonged extention or flexion of the wrist/hands as well as use of highly vibratory tools.
Hormone imbalance found with pregnancy, menopause, DM, and myxedematous hypothyroidism.
Underlying MS disorders or prior fractures incread the risk.
40
What are some red flags when assessing low back pain?
- new onset bowel/bladder incontinence (cauda equina)
- saddle numbness (cauda equina)
- Fever/ systemic sx (infection)
- Sudden onset in those <20 >55 w/o prior hx
- unrelenting w/ rest or inability to find comfortable position (AAA, renal calculi)
- elevated WBC/ESR (infection/abscess)
- tearing sensation (AAA)
- worse while supine, weightloss (cancer)
- IV drug user (infection)
- Loss of anal spincter tone (Cauda equina
41
What is the gold standard diagnostic test for osteoporosis?
Dexascan (densitometry)
42
How are hordeolum and chalazion differentiated?
Hordeolum is acute, erythematous, and painful eyelid lump (follicular or meibomian gland)
Chalazion is a chronic and painless swelling of the eyelid (meibomian gland affected)
43
Diabetic patient found to have microaneurysms, cotton wool spots (microvascular infarcts), hard exudates (lipid deposits), intraretinal hemorrhages, and macular edema is suggestive of what disorder?
Diabtetic retinopathy
44
What are common migraine triggers?
```
Tyramine or phylethylamine foods
Dehydration
Exercise
Vasoactive substances
-vasodialtors: alcohol, sodium nitrate
-vasoconstrictors: caffeine
MSG
Hormones: Low estrogen increased prostaglandin
Environmental: weather, excessive sun, strong odors, visual displays and high pitched noises
Sleep disturbances
```
45
For pt’s with MS, lesions in which areas present what symptoms?
Optic nerve- blindness
Corticospinal tract-weakness
Posterior column of spinal cord-unusual sensation and numbness
Medial longitudinal fasciculus- double vision
Vestibular pathways-dizziness
46
What are the most common presenting sx of MS?
Fatigue, LE weakness, dizziness, and bladder & bowel dysfunction.
ataxic gait, paresthesias, and optic neuritis (unilateral blurring to blindness) also are frequently reported
47
What can delay the progressive symptoms in MS?
Regular exercise
48
What is the first line treatment for alzheimers disease?
Cholinesterase inhibitors
- donepezil (aricpet)
- alantamine (reminyl)
- rivastigime (exelone)
N-methyl-D-asprate RA memtantine (namenda) also helps improve cognitive functioning and has additive affects to cholinesterase inhibitors
49
This type of headache usually presents with mild to moderate bilateral nonpulsating tightening pain. Generally there is no n/v and is not worsened by physical activity.
Tension headache
50
A headache that is unilateral & pulsating with N/V, photophobia and may or may not have an aura is most likely _____ headache?
Migraine
51
Cluster headaches usually present as?
Severe , nonthrobbing and unilateral pain to the head/face and around or in the eye. More common in men.
52
What population has the highest risk of MS?
Women, caucasian of european ancestry
53
Although the exact cause of MS is not know, what is considered to be the factors that leads to MS?
Epigenetics- interaction between genetic risk and environemental exposures that promote the disorder such as viral illness in childhood.
54
Adult with unilateral stabbing, sharp pain that is described as tingling in a unilateral location following a dermatome often accompanied by vesicular rash eruption within a few days is likely to be?
Herpes zoster (shingles)
55
The goal of nursing research is to?
Conduct studies to develop a body of nrusing knowledge.
56
What are examples of Level 1 evidence in research?
systemic reviews or meta-analysis of RCTS or guidelines developed from RCTs. Or 3 or more RCTs of good quality that have produced similar results.
57
What is the goal of management in hypothyroidism?
To normalize (not supress) TSH
58
What is a risk of over-treatment of hypothyroidism?
Decreased bone mineral density leading to osteoporosis
59
What is the usual starting dose of levothyroid?
50-100mcg/day titrating every 3-6 weeks increasing by 0.025mg. Max dose is 0.3mg/day.
60
Diabetic patient with decreased vibratory sense in foot and LE pain, what would be the first-line treatment?
TCAs
61
How is the effectiveness of levothyroxine therapy assessed?
TSH within target of 0.3-2.4, checking 4-8 weeks after initiating therapy, then once or twice a year once stable unless symptoms present of over/under correction.
62
Decreased TSH level, elevated FT4 and T3, firm and painless goiter, menstrual irregularities, heat intolerance, anxiety, tachycardia and weightloss indicates what disorder?
Graves Disease (Hyperthyroidism)
63
What are the normal levels of TSH?
0.45-4.5
64
What medication is preventative for those with gout and what are the CI for those drugs?
Uric acid reducing agents such as
Allopurinol (best for hypersecretors, CI renal or hepatic disease)
Probenecid (best for hyposecretors and should be avoided in anyone with blood dyscrasias. Should not be started for at least 4 weeks after an attack
65
What is the gold standard treatment for gouty flare?
NSAIDs/colchicine
66
Name examples of inflammatory musculoskeletal disorders:
Infectious
Crystal induced (gout)
Immune related (RA, SLE)
Idiopathic
67
What are some noninflammatory musculoskeletal disorders?
Ineffective repair (osteoarthritis0
Pain amplification (Fibromyalgia)
Trauma
Neoplasm
68
Uric acid level >7 in a male with painful, swollen and red toe would be indicative of what disorder?
Gout
69
What would likely be found in the synovial apsirate of a person w/ gout?
Urate crystals
70
What other health conditions are associated with gout?
Obesity, HTN, and hyperlipidemia
71
What are Tophi?
Nodular deposits of monosodium urate monohydrate crystals which initiate the inflammatory process in gout.
72
Imbalance between androgen and estrogren or elevated prolactin can cause what disorder in men?
Gynecomastia
73
Growth hormones, estrogen and corticosteriods stimulate what aspect of breast growth?
Ductal
74
Alveolar lobular growth of the breast tissue is stimulated by what hormones?
Progesterone and prolactin
75
Promoting safe sports participation by identifying high risk situations requires sports physicals to be performed how often?
Annually
76
Hemoptysis and shortness of breath, with or without cough in a swimmer is suggestive of what emergency condition?
Swimming induced pulmonary edema
77
What are the recommended treatments for scabies?
Topical:Permethrin cream 5% (emlite) or Lindane 19%
Systemic: Ivermectin
Symptom management: Topical and oral steriods, as well as antihistamines
78
What should a clinician educate a patient with sickle cell to help avoid a crisis?
Avoiding anything that causes dehyration, excessive sun exposure, physical or emotional stress, and loss of sleep are essential to help prevent crisis. Additionally, folic acid supplementation is essential
79
The ANA code of ethics helped advanced the profession by what means?
It gave nursing legitimacy as a profession
80
Essentially, what is the Code of ethics?
A contract between society and nursing profession in which the values and ethical principals that guieds decsions. Additionally, it created the framework for APRN practice.
The purpose is to promote high-quality nursing and protect the public from incompetent or unethical nursing practice.
81
What is the most common cause of malpractice in clincial practice?
incorrect diagnosis
82
The APRN scope of practice does what?
Defines the rules, regulations and boundaries within which the APRN can practice
83
According to JNC8, what is the recommended first line treatment for HTN in a non-black person without DM/CKC?
Thiazide or ACEI/ACE
84
What is the first-line, second-line, and third-line treatment for AOM?
1st: Amoxicillin
2nd: Augmentin
2nd: Cephlosporins (Cefuroxime/Cefdinir)
3rd: Macrolides
85
What drug(s) should be avoided in a patient with gout?
Thiazide diuretics (increase uric acid secretion)
86
A claims-made policy covers what?
Only situations in which the incident occured and while the policy was in effect.
87
What is a tail-policy and when should it be carried?
It covers claims made after policy is terminted and should be carried with claims-made type of policy.
88
Which policy provides the most protection?
Occurance policy, it covers all acts or omissions during the period the policy is in effect- no matter when the claim was made.
89
What are examples of inflammatory musculoskeletal disorders?
```
Infectious
Crystal induced (gout)
Immune related (RA/SLE)
```
90
What are examples of non-inflammaroty musculoskeletal disorders?
Ineffective repair (OA)
Pain amplification (Fibromyalgia)
Trauma
Cancer
