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1

What medication class is metformin/glucophage?

biguanides

2

What is the mechanism of action of the biguinides? (metformin)

limits the conversion of glycogen to glucose by the liver and reduces insulin receptors resistance

3

Risk factors for a person to develop HHS include?

infection

people who are dehydrated (dependent elderly who can't get their own drinks despite feeling thirsty)

 

 

4

In HHS is the problem an insulin deficit or a fluid deficit?

a fluid volume deficit

5

Is the main treatment of HHS fluid replacment or insulin?

fluid replacement

6

Which thyroid hormone is responsible for calcium and phosphate regulation?

Calcitonin

7

The INITIAL intervention in the symptomatic patient with hyperthyroidism is:

beta blocker

8

An intubated ventilated PNA patient with Na 130, euvolemia, adequate UOP, and urine sodium 50.  What is the cause of the hyponatremia?

SIADH

*SIADH is caused by head trauma AND lung problems, ventilator therapy

9

For stroke patients who are NOT a candidate for tPA, what is the appropriate BP?  

SBP<220 or DBP<110

*permissive HTN if they mount a HTN response

10

Per ACCN exam, what is the target glucose level in acute stroke? 

<145

11

An acute inflammatory polyneuropathy is a characteristic of 

Gullian barre syndrome

12

Relapsing/remitting MS is characterized by what clinical course?

relapse over 1-2 weeks, lasts 4-8 weeks, returns to baseline

13

Accurate dilantin levels may be affected by:

low albumin levels

*free dilantin levels measure unbound dilantin

*serum dilantin measued by bound to albumin

14

The incomplete spinal cord injury syndrome that results in arms motor loss but spares the legs is 

central cord syndrome

15

What clinical finding in SCI is a poor prognostic sign because it is a hallmark of complete spinal cord injury?

priapism

16

What is the timeframe for Subacute SDH ?

48 hours - 2 weeks

17

Gnawing epigastric pain that is worse at night and relieved by vomiting, worse one hour after eating.  Whats the dx?

duodenal ulcer

18

What patients are at greatest risk for acalculous cholecystitis?

critical illness and sepsis

 

*they die because they are too sick for OR

19

Central vision loss is caused in old people by

macular degeneration

20

A patient with a history of heart failure arrives at the emergency department exhibiting shortness of breath and lower extremity swelling. Both of the patient’s symptoms are a result of:

 a decrease in plasma oncotic pressure.
 an increase in capillary hydrostatic pressure.
 an increase in capillary membrane permeability.
 an obstruction of lymphatic drainage.

an increase in capillary hydrostatic pressure

21

When discharging an 85-year-old patient who has a diagnosis of stasis dermatitis, an adult-gerontology acute care nurse practitioner includes instructions to:

 keep legs elevated while seated.
 maintain systolic blood pressure greater than 120 mm Hg.
 soak legs in warm water daily.
 wear compression stockings of 65 mm Hg below the knee.

keep legs elevated while seated

22

A 70-year-old patient with acute systolic heart failure denies any functional limitations, is able to walk five blocks before tiring, and is euvolemic. Which medication is the first-line therapy for this patient?

 Amlodipine (Norvasc)
 Digoxin (Lanoxin)
 Furosemide (Lasix)
 Lisinopril (Zestril)

ACE-I is 1st line therapy for HF
 Lisinopril (Zestril)

23

A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace) is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is parenteral:

 cefoxitin (Mefoxin).
 ceftriaxone (Rocephin).
 ciprofloxacin (Proquin).
 levofloxacin (Levaquin).

ceftriaxone (rocephin)

*cipro and levaquin are fluoroquinolones and can cause QT prolongation

*sotalol (beta blocker) can also cause QT prolongation

 

24

. What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?

 The Affordable Care Act
 The Balanced Budget Act
 The Civilian Health and Medical Program of the Uniformed Services
 The Omnibus Budget and Reconciliation Act

The nonphysician practitioner (NPP) component of the Balanced Budget Act of 1997

the act also standardized NPP reimbursement at 85% of the physician's Medicare fee schedule regardless of where that service was provided

 

25

a patient is at increased risk for acalculous cholecystitis if they have: 

biliary stasis

(NPO, surgery, trauma, critical illness/sepsis because not using GI track)

26

A patient with malobsorption related weight loss, mucoid diarrhea, vitamin B12 deficiency, and right lower quadrant abd pain might have:

Crohn's disease

27

A patient with bloody stools which may lead to iron deficiency anemia (from bleeding), uses a nicotiene patch to limit disease symptoms, has a disease that is limited to the colon, may lead to perianal fissures, increases risk for adenocarcinoma of the bowel: 

ulcerative colitis

28

A rash with an annular shape, scales, erythematous base, raised borders with clearing in the center, found in the groin, fungus, is:

tinea cruris

29

Bulls eye rash characteristic of Lyme disease is called:

(it can also be seen without lyme disease)

erythema migrans

30

Which skin condition is often seen with Steven Johnsons syndrome, has a positive Nikolsky's sign, and taget like lesions? 

erythema multiforme MAJOR

*can be caused in response to medications

Stevens-johnsons syndrome AKA erythema multiforme major

31

A patient has a dark brown lesion that is one cm across and has a stuck on appearance.  It is raised, has a warty texture, and well defined boarders.  What is it and is it an emergency?

seborrheic keratosis

not an emergency at all, benign lesion

removal is cosmetic

32

Actinic keratosis is found in sun exposed areas and needs to be treated because it can turn into 

squamous cell carcinoma

33

A common skin finding in a patient with insulin resistance and hyperinsulinemia, an area of darker thickened skin found in folds of obese patients is:

acanthosis nigricans

34

Who is more at risk for malignant skin lesions?

young or old
smoker or non smoker

HIV or not HIV

pale/fair or dark skin

more at risk for malignant skin lesions

old

smoker

HIV

pale/fair skin

35

What is the triad of symptoms associated with necrotizing fasciitis?

pain out of proportion to exam

erythema

swelling

*may also have weaping 

36

On the test, the most effective evidence based treatment that has shown to improve outcomes for necrotizing fasciitis is:

surgical debridement

37

A pearly white or waxy bump, often with visible blood vessels, on your face, ears or neck. The bump may bleed and develop a crust. In darker skinned people, this type of cancer may be brown or black.

*slow growing CA

 

basal cell carcinoma

 

38

What is the diagnostic criteria for SIRS?

temp >38 c or <36 c

HR>90

RR>20 (or paCO2<32 indicating hyperventilating)

WBC <4 or >12 or total bandemia >10% of WBC

*must meet two or more criteria to dx SIRS*

 

39

What is the diagnostic criteria for sepsis?

temp >38 c or

HR>90

RR>20 (or paCO2

WBC 12 or total bandemia >10% of WBC

suspected or present source of infection

*SIRS + source of infection*

 

40

Septic Shock Criteria

Severe Sepsis with Hypotension, despite adequate fluid resuscitation

41

What is the diagnostic criteria for SEVERE sepsis?

temp >38 c or

HR>90

RR>20 (or paCO2

WBC 12 or total bandemia >10% of WBC

suspected or present source of infection

sepsis + Organ Dysfunction, Hypotension, or Hypoperfusion*

*SBP<90 or <40 of baseline, lactic acidosis*

42

What is the most likely causative organism for subacute bacterial endocarditis is:

staphylococcus aureus

43

If a patient lost 750ml of blood post-op.  According to the american college of surgeons, if you are going to replace with crystalloid how much do you give to replace 750ml loss of blood?

2250ml LR/NS because you replace 3:1

44

When is surgery or vascular procedure indicated for patient with AAA due to increased risk for rupture?

 if your aneurysm is causing symptoms, or is larger than about 2 inches (roughly 5.0 to 5.5 centimeters), or is enlarging under observation of serial CT q 6-12 months

45

Dysfunction of which of the following organs is key to the development of MODS?

kidney

liver 

GI tract

endothelium

endothelium 

because vascular endothelium connects multiple organs

46

What is a common reason for organ dysfunction in MODS?

microvascular thrombi

47

If a patient is hypoperfused (that is the insult) and then has microvascular thrombi which leads to MODS, what is the standard progression of organ dysfunction? 

pulmonary failure 4-6 days post insult

hepatic failure 6-10 days post insult

renal failure 10-14 days post insult

 

 

48

Name two reasons to start TPN

the patient will not be able to get any other form of nutrition for greater than 7 days

 

the patient has mandatory bowel rest (SBO, abd surgery etc)

 

 

49

The hallmark feature of RA

prolonged early morning stiffness that takes > 30 minutes to go away

50

Gram negative cocci include_____ and can be treated with_______.

 

gonorrhea

rocephin

51

You have a patient with a tylenol overdose.  How many hours after ingestion of tylenol would you expect to see changes in LFTs?

12-24 hours after ingestion

52

What is the drug of choice in a patient with amphetamine or cocaine overdose?

benzodiazepine

53

What medication class is CONTRAINDICATED in amphetamine overdose?

beta blockers

because you will leave the patient with an unopposed alpha response which will increase HTN and increase risk for MI.CVA.CV collapse

54

To establish malpractice four things must be established:

you must have a duty to the patient

you must have violated a standard of care

that violation has to be the cause of damages

there have to be damages

55

Normal neutrophil count is what percentage of total WBC?

60%

56

You have WBC with high neutrophil count.  Neutrophils fight what?

Neutrophils fight bacteria

57

Your patient has an elevated WBC.  On the differential the lymphocytes are elevated.  What is your differential?

lymphocytes fight virus

CLL

 

58

You have a patient with elevated WBC and increase in monocytes.  What is the differential?

monocytes like to debride non-infectious junk

so if you have MI with dead tissue monocytes will get it

if you have cancer monocytes will get it

59

You have a patient with elevated WBC and elevated eosinophils.  What is your differential?

hypersensitivity reaction

drug reaction 

allergic reaction

60

Neutrophelia is any neutrophil >70% of total WBC

indicates bacterial infection

61

The concept of the WBC Left shift is used to describe a differential that represented a 

bacterial infection

62

Bands are immature_____.  They are immature.  They shouldn't be out

4% of total WBC are normally bands

if you have bandemia you have excess immature WBC that are getting out to fight infection

63