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Flashcards in The night before test questions Deck (60):
1

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

diuretics

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

2

Stage A B C D of heart failure

(this is NOT the NYHA classification)

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 

3

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

calcium channel blocker because they can be a negative inotrope

4

3 Drugs for HF

ACE I

thiazide diuretics

beta blockers (despite negative inotrope, improve outcomes)

5

Diastolic HF

signs/symptoms HF but normal EF and normal valves

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

6

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

What is indicated?

beta blocker (improves survivial among pts with HF)

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

*all three of them

7

CXR with kerly B lines, cephalization is indicative of:

HF (cephalization is increase prominence of vessels)

8

Syncopal patient presents with a harsh III/VI systolic murmur that radiates to the carotids 

MR ASS

Aortic stenosis

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

9

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

MS ARD

mitral stenosis

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

10

A systolic murmur that radiates to the axillla

MR ASS

mitral regurg

11

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

myocarditis

*myocarditis is thought to have some autoimmune component

12

What medications are CONRAindicated in the INITIAL treatment of pericarditis?

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

13

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

equalization of hemodynamic pressures during diastole

pulsus paradoxis

decreased ECG voltage

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. 

effusion

*get an echo to see tamponade/effusion!

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?

ACE-I

*first line HTN for heart transplant

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?

doBUTamine

because their index is low

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

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.

low dose statin and therapeutic lifestyle changes

18

Contraindicatoins for fibrinolytics in STEMI include

ischemic CVA less than 3 months ago

19

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

CHF

HTN

Age >= 75

DM

Stroke/TIA/TE gets TWO points

 

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

20

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

<130/80

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

21

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

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

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.

pletal/cilostazol

23

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

4-5 weeks

24

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

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

 

25

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

VQ mismatch because they responsd quickly to O2

26

Dead space example is PE.  There IS ventilation, but there is no_____.

perfusion

27

Enteral feeding recommendations for a patient with resp failure is:

calorie dense formula because this may help avoid fluid overload

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:

PRESSURE control ventilation

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?

interstitial lung disease is obstructive with a restrictive ventilitory pattern so:

Low FEV1

low FVC

high fev1/fvc ratio

low DLCO

30

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

lateral decubitis

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?

left lingula

32

The best view for a CXR is the _____ view?

PA view 

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

33

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

clinical judgment

34

Sytems thinking is driven by

strengths of families

strengths/weaknesses of staff

navigates the whole system

35

Clinical inquiry

(blends with clinical judgement)

adapts standards of care to specific patients

questions current practice

maintains knowledge and skills

36

The focus of the ACNP practice is

providing restorative care

37

ACNP scope of practice

resorative

curative

palliative

rehabiliative

maintanable

determined by the area of focus and identified needs of the patient

38

An important leadership activity of the ACNP is

interpreting the ACNP role to providers and the public

39

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

falls

central line infections

air embolism

blood incombatilibililty

foreign body after surgery

stage 3-4 pressurre ulcers obtained in hospital

DVT after ortho surgery

40

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

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

41

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

year

42

UPSTF recommendation for colorectal cancer begins at what age?

start 50-75 end

can use fecal occult, sigmoidoscopy, colonoscopy

a high hiber diet helps prevent colorectal cancer

 

43

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

"TELL ME..."

44

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

get a third party involved (get the ethics committee)

45

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

nonprescription use of pain medicaiton

46

To determine the patients cr cl based on COCKFOFT GAULT eqaution

age

wt

sex

plasma cr

47

what is normal creatinine clearance?

100-150

48

cockroft gault equation to eval renal function

((140-age)xkg)/(plasma cr x72)

*if a girl x by 0.85

49

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

kayexalate bc prevents absorption in the gut and patient not symptomatic 

50

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

calcium acetate

51

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

4 to 12 weeks

52

UPSTF recommendation for PSA screening for prostate screening?

never at any age to risks outweight benefits

 

53

flomax is what drug class?

alpha blocker

54

The most common cause of vaginal bleeding in postmenopausal women is

endometrial cancer

it is ruled out with endometrial biopsy

55

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

cancer of the vulva

high incidence in women 80+ years old

56

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

check bleeding time or platelet function assay

*extended pump time messes up the platelet function

57

What abnormal labs are found in tumor lysis syndrome?

hyPERPHosphotemia

and 

hypocalcemia

58

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

steroids

59

HIV positive results

ELISA +

Western blot + with p24 and gp120

60