Points to focus on Flashcards
Management of chronic diverticulosis
1 - Diet high in fiber
2 - Daily supplement of psyllium (Metamucil) or bran
Spironolactone is what type of antihypertensive medication?
Potassium sparing diuretic.
Heberden’s nodes are found in what arthritis?
Rheumatoid
Bouchard nodes are found in what arthritis?
Osteo and Rheumatoid
A diabetic patient is taking low-dose enalapril (Vasotec®) for hypertension. A record of the patient’s blood pressure over 4 weeks ranges from 130 to 142 mmHg systolic and 75 to 85 mmHg diastolic. How should the nurse practitioner respond?
Increase ACEI dose
Question
Which of the following physical modalities recommended for treatment of rheumatoid arthritis provides the most effective long-term pain relief? - Heat, cold, increase exercise, TENS therapy
Exercise
The nurse practitioner teaches the parents of a 2-month-old infant with gastroesophageal reflux (GER) that treatment typically includes all of the following interventions:
1 - Providing smaller, more frequent feedings
2 - Thickening the formula with rice cereal
3 - Frequent burping during feedings
4 - Positioning the infant at 45 degrees
All of this reduces the risk of GER by decreasing gastric content volume and pressure on the lower esophageal sphincter (LES).
Herniated nucleus pulposus typically presents clinically by all of the following:
When the nucleus pulposus (located in the center of the intervertebral disc) ruptures and herniates into the spinal canal, the following happens:
1 - it causes pressure on the spinal root, with consequent numbness and paresthesia along the distribution of the involved dermatome.
2 - Mobility and motor function may be impaired.
3 - There is usually local tenderness to palpation.
4 - On standing, the patient typically lists away from the affected side toward the unaffected side.
This injury occurs most often in men between the ages of 20 and 45 and most frequently due to lifting and/or twisting. Lumbar herniation most often affects L4-L5 and L5-S1 and causes sciatic pain producible with straight leg raising (LaSegue’s test).
A 50 year old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis?
Endometrial Cancer
Typically, endometrial cancer presents in women over 40 years-of-age who are post-menopausal, but 20% of women develop the disease while still menstruating. Bleeding is characterized by heavy menstrual periods and inter-menstrual watery discharge with small amounts of blood, especially early in the disease process.
The most appropriate medication for treatment of exercise-induced asthma is a(n):
inhaled Beta 2-agonist.
Cromolyn sodium (A mast cell stabilizer) or an inhaled beta-2 agonist administered 20 to 30 minutes before exercise is the treatment of choice for exercise-induced asthma.
A physical examination of the patient presenting with acute cholecystitis will be positive for
Murphy’s inspiratory arrest.
McBurney’s point is the anatomical landmark in the RLQ of the abdomen for locating the vermiform appendix. Pain associated with pancreatitis and duodenal ulcer commonly radiates to the anterior aspect of the RUQ and pain associated with cholecystitis commonly radiates to both the anterior and posterior aspects of the RUQ. Pain radiating to the right shoulder is typically caused by inflammatory liver disease. While the examiner presses over the gallbladder at the upper rib margin of the RUQ, the patient is asked to inhale fully. When the gallbladder is inflamed, as with acute cholecystitis, the patient suddenly ceases the inhalation as the gallbladder is pressed against the examiners fingers (hence, “Murphy’s inspiratory arrest”).
Given appropriate patient education by the primary care provider, poor compliance with medical recommendations is most often due to:
Limited cognitive ability
In the National Adult Literacy Survey, 75% of Americans with chronic physical or mental health problems scored in the lowest 2 out of 5 skill levels. This translates to marginal functional literacy. Among the elderly, minorities, and low income groups, 2/5 cannot read the simplest brochure. Most patients are not likely to volunteer this information.
An elderly patient presents with a gray-white ring around the periphery of the iris. This is probably:
A normal variant of aging.
This is a description of arcus senilis, commonly associated with the aging process. It should be considered a possible indicator of atherosclerotic disease when it presents in individuals less than 40 years-of-age. There is no epidemiological data to support an association with atherosclerotic disease after 40 years-of-age.
A 3-year-old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient?
Sputum Cultures - This would be preferable to PPD because waiting the 48 - 72 hours is too long. This is a confirmatory test.
To assess a patient’s ability to think abstractly, an appropriate question to ask would be?
The meaning of a common proverb.
Thinking about what to do in a fire would be more concrete, as there is a specific reaction. Thinking about a proverb asks for a patient to ponder the meaning of the proverb. This is abstract thinking.
