The night before test questions

Question 1

You have a patient with severe aortic stenosis. What medication should be avoided or used with caution?

Answer 1

diuretics

because the patient with aortic stenosis is sensitive to preload since their ability to augment their SVR is limited

Question 2

Stage A B C D of heart failure

(this is NOT the NYHA classification)

Answer 2

A: risk factrors for HF but NO signs or symptoms

B: no symptoms (asymptomatic), but signs (LVH, S4)

C: symptoms

D: patients with refractory symptoms. require therapy like IABP

Question 3

A patient with stage C of systolic HF, which medications would you avoid?

Answer 3

calcium channel blocker because they can be a negative inotrope

Question 4

3 Drugs for HF

Answer 4

ACE I

thiazide diuretics

beta blockers (despite negative inotrope, improve outcomes)

Question 5

Diastolic HF

Answer 5

signs/symptoms HF but normal EF and normal valves

lower extremity edema and weight gain are common in D HF patients

Question 6

A patient with HF, EF 35%, unable to tolerate ACE I & ARB.

What is indicated?

Answer 6

beta blocker (improves survivial among pts with HF)

hydralazine and isosorbide dinitrate (replaces the ACE I/ARB)

*all three of them

Question 7

CXR with kerly B lines, cephalization is indicative of:

Answer 7

HF (cephalization is increase prominence of vessels)

Question 8

Syncopal patient presents with a harsh III/VI systolic murmur that r_adiates to the carotids_

Answer 8

MR ASS

Aortic stenosis

*aortic stenosis is r/t syncope, mitral is not

Question 9

A patient has a-fib, DIASTOLIC low pitched murmur that radiates to the AXILLA, m-shaped p-waves. What is the murmur?

Answer 9

MS ARD

mitral stenosis

*the messed up AV valve leads to the a-fib and

Question 10

A systolic murmur that radiates to the axillla

Answer 10

MR ASS

mitral regurg

Question 11

An HIV patient has signs/symptoms of HF, global hypokonesis, elevated cardiac enzymes, no valvular defects. What is the diagnosis?

Answer 11

myocarditis

*myocarditis is thought to have some autoimmune component

Question 12

What medications are CONRAindicated in the INITIAL treatment of pericarditis?

Answer 12

steroids are INITIALLY avoided because they are thought to increase the chance of reoccurance AND increase risk of infection

Question 13

An xray with a water bagged shaped heart is consistant with pericardial tamponade. Signs of tampondade are

Answer 13

equalization of hemodynamic pressures during diastole

pulsus paradoxis

decreased ECG voltage

Question 14

A patient with metastatic cancer is at increased risk for pericardial ______ which can lead to cardiac tamponade. This patient may have distant heart sounds and JVD.

Answer 14

effusion

*get an echo to see tamponade/effusion!

Question 15

You have established a dx of HTN in a patient with a heart transplant. What is the first drug of choice for this patient?

Answer 15

ACE-I

*first line HTN for heart transplant

Question 16

Patient with large anterior lateral MI who doesn’t respond to fluid and levo with BP 80/40, CI of 1.8, what med do you give next?

Answer 16

doBUTamine

because their index is low

*not epi bc it increases myocardial 02 demand in MI and you don’t want to do that

Question 17

The AHA guideline for STEMI says ALL patients with STEMI should go home on _____ and have therapeutic lifestyle changes regardless of their lipid panel.

Answer 17

low dose statin and therapeutic lifestyle changes

Question 18

Contraindicatoins for fibrinolytics in STEMI include

Answer 18

ischemic CVA less than 3 months ago

Question 19

CHADS2 for patients with AFIB takes into account what and how many points do you need to get started on coumadin?

Answer 19

CHF

HTN

Age >= 75

DM

Stroke/TIA/TE gets TWO points

*If you have CHADS2 score 2 or greater you start coumadin

Question 20

According to JNC 7 guidelines, what is the goal BP for a patient with DM?

Answer 20

<130/80

(normal pt <140/80 but bc JNC 7 with DM <130/80)

Question 21

A patient with normal lipid panel EXCEPT elevated triglycerides, what medication would you give?

Answer 21

niacin (nicotinic acid) and fibrates are the drug of choice for high triglycerides

Question 22

What medication is giving for peripheral arterial disease if claudication is treated medically?

This medication must be taken for weeks before results are scene.

Answer 22

pletal/cilostazol

Question 23

How long should a post-op hip patient who is 85 with renal insufficiency be on DVT prophylaxis post op?

Answer 23

4-5 weeks

Question 24

A shunt is perfusion without adequate ventilation. Blood is passing through the lungs, but isn’t exposed to the alvioi. Examples are:

Answer 24

PNA

pneumothorax

When there is a true shunt, no matter how much FIO2 you give them they won’t respond because there isn’t alvioli connecting to the blood

Question 25

If the patient responds quickly to supplemental o2 is it a shunt or a ventilation-perfusion mismatch?

Answer 25

VQ mismatch because they responsd quickly to O2

Question 26

Dead space example is PE. There IS ventilation, but there is no\_\_\_\_\_.

Answer 26

perfusion

Question 27

Enteral feeding recommendations for a patient with resp failure is:

Answer 27

calorie dense formula because this may help avoid fluid overload

Question 28

On the test, if you are concerned about the risk of ventilator induced lung injury in a patient who is not assisting with breathing is:

Answer 28

PRESSURE control ventilation

Question 29

A patient with interstitial lung disease (the area surrounding the alveoli is a problem so it is obstructive). What would you guess their PFTs to be?

Answer 29

interstitial lung disease is obstructive with a restrictive ventilitory pattern so: Low FEV1 low FVC high fev1/fvc ratio low DLCO

Question 30

Prior to performing a thoracentesis, what film should be obtained?

Answer 30

lateral decubitis

Question 31

A patient with a positive silhoette sign at the L heart border. You are concerned that the patient has a infiltrate in which lobe?

Answer 31

left lingula

Question 32

The best view for a CXR is the _____ view?

Answer 32

**PA view** this is with your chest toward the plate, radiation is coming from behind so the exposure goes from posterior to anterior

Question 33

The NP using knowledge and expertise to integrate evidence based guidlines into formulating a plan of care is

Answer 33

clinical judgment

Question 34

Sytems thinking is driven by

Answer 34

strengths of families strengths/weaknesses of staff navigates the whole system

Question 35

Clinical inquiry

Answer 35

(blends with clinical judgement) adapts standards of care to specific patients questions current practice maintains knowledge and skills

Question 36

The focus of the ACNP practice is

Answer 36

providing restorative care

Question 37

ACNP scope of practice

Answer 37

resorative curative palliative rehabiliative maintanable determined by the area of focus and identified needs of the patient

Question 38

An important leadership activity of the ACNP is

Answer 38

interpreting the ACNP role to providers and the public

Question 39

What is a nonreimbursable condition in the hospital according to medicare and medicaid?

Answer 39

falls central line infections air embolism blood incombatilibililty foreign body after surgery stage 3-4 pressurre ulcers obtained in hospital DVT after ortho surgery

Question 40

On this test, based on UPSTF recommendations mamograms for women LESS than age 50

Answer 40

screening for women under age 50 depends on personal risk factors and personal choice

Question 41

On this test a mamogram should be done from age 50-75 every other

Answer 41

year

Question 42

UPSTF recommendation for colorectal cancer begins at what age?

Answer 42

start 50-75 end can use fecal occult, sigmoidoscopy, colonoscopy a high hiber diet helps prevent colorectal cancer

Question 43

If you have a choice of interviewing the patient choose the question that starts with

Answer 43

"TELL ME..."

Question 44

When the patients written directive and the family don't agree what do you do?

Answer 44

get a third party involved (get the ethics committee)

Question 45

Current evidence based practice states the most common gateway drug to subsequent illicit drug use is

Answer 45

nonprescription use of pain medicaiton

Question 46

To determine the patients cr cl based on COCKFOFT GAULT eqaution

Answer 46

age wt sex plasma cr

Question 47

what is normal creatinine clearance?

Answer 47

100-150

Question 48

cockroft gault equation to eval renal function

Answer 48

((140-age)xkg)/(plasma cr x72) \*if a girl x by 0.85

Question 49

Patient with PO KCL overdose, not symptomatic, what is the treatment?

Answer 49

kayexalate bc prevents absorption in the gut and patient not symptomatic

Question 50

Renal failure patient with elevated phos level. What is the drug of choice as a phos binder?

Answer 50

calcium acetate

Question 51

REpeated (chronic with repeated events = treatment failure) prostatitis/urosepsis. How long for abx?

Answer 51

4 to 12 weeks

Question 52

UPSTF recommendation for PSA screening for prostate screening?

Answer 52

never at any age to risks outweight benefits

Question 53

flomax is what drug class?

Answer 53

alpha blocker

Question 54

The most common cause of vaginal bleeding in postmenopausal women is

Answer 54

endometrial cancer it is ruled out with endometrial biopsy

Question 55

Pain, prutitis, *palpable lesion* on labia minora, and hyperpigmentation

Answer 55

cancer of the vulva high incidence in women 80+ years old

Question 56

A patient with a CABG and a surgical prolonged pump time who is bleeding with normal PT PTT and platelet counts.

Answer 56

check bleeding time or platelet function assay \*extended pump time messes up the platelet function

Question 57

What abnormal labs are found in tumor lysis syndrome?

Answer 57

hyPERPHosphotemia and hypocalcemia

Question 58

What type of transplant meds cause severe *insomnia* and mood swings?

Answer 58

steroids

Question 59

HIV positive results

Answer 59

ELISA + Western blot + with p24 and gp120