AGACNP Review
PAD/PVD: patient with PVD needs to quit smoking. What do you tell them?
"Tell me how I can help you, what do you need? "
Pernicious anemia
+Babinski sign
24-year-old male presents with DKA. Now confused and irritable. ABG pH 7.29/33/22. Received isotonic fluids x1 hour, BP 110/70, HR 90, Blood glucose 550. What is the best IV fluid indicated?
1/2 NS (d/t BG >500)
If born on or after what year is it indicated to receive two doses of mumps vaccine?
1957
Pt was burned in explosion. Burns feature moisture on the skin w/ blisters and redness (2nd degree burns). He was burned on each arm, his face, and his neck. The pt wants to know how much of his body was burned. The NP states?
28% (each arm 9%= 18%, head 9%, neck 1%)
On physical exam, you know what a moderate loud MM with no thrill. What grade?
3
Opiate naive, how long do you monitor?
3 hours
Your patient has a gunshot chest wound. What kind of dressing does he need?
3-sided dressing. Allows air to escape, but not enter and us be trapped in the lungs, so as to not cause tension pneumothorax. When the patient exhales, air tries to enter the hole. This is why we have the patient take a deep breath and hold it when we pull a chest tube. Air won't enter chest cavity when the lungs are full of air
What grade murmur do you first hear a thrill?
4 (IV)
When is the greatest risk for mechanically ventilated patient to contract VAP?
48-72 hours
BPH to string medication?
5 alpha-reductase inhibitors: Finasteride (Proscar) and Dutasteride (Avodart)
At what age do males start colonoscopy every 10 years?
50
At what age is the PSA screening indicated in non-African american male with no family hx?
50
What age does an individual receive Zostavax?
50, one time dose
Example of a patient most likely to have emphysema?
59 y/o with increased AP diameter
Patient has normal PAP smear and reports that she has not had an abnormal PAP for past 10 years. What is the appropriate age to discontinue?
65-70
Normal anion gap?
7-17
Health literacy education level
8th grade
What should the dietary protein requirement be with chronic renal insufficiency?
<40g/day
The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource provides the strongest level of evidence?
A systemic review
Your patient has swallowed a foreign object (coin) end it is lodged in the C-spine area according to x-ray. How to get it out? A. A bronchoscope B. Surgery with forceps
A. A bronchoscope
Patient presents with RLQ pain, 1-2 episodes of vomiting, and + psoas sign. What diagnosis are confirmatory of appendicitis? A. ABD US and WBC 10-20 B. CT ABD and elevated amylase C. ABD US and elevated amylase D. CT ABD and elevated amylase and lipase
A. ABD US and WBC 10-20 (key WBC. A CT would work)
Older man who had been a smoker for years and had shiny hairless legs (PAD). Which diagnostic test do you order? A. ABI B. Arterial Doppler C. Venous Doppler D. D-Dimer
A. ABI
Your 33F patient tells you she does not use protection during sexual intercourse. Cervical motion tenderness in addition to what other finding indicates PID? A. Adnexal tenderness B. Vaginal itching C. UTI D. No other symptoms
A. Adnexal tenderness
Which lab do you monitor daily and a patient on nutritional supplements? A. BMP B. CBC C. ABG D. Blood culture
A. BMP
Following is not a criteria of metabolic syndrome? A. BP >140/90 B. Waist >40 inches C. TG >150 D. HDL <40
A. BP >140/90 (it's 130/85)
Your patient is S/P liver transplant. He develops fever and his bile production decreases to 20 from 300. What should you do next? A. Consider liver biopsy B. Run a C&S on the bile C. Call the surgeon to recommend an operation D. Consult GI to rule out pancreatitis
A. Consider liver biopsy
Which of the following is most important to evaluate statistical significance when reviewing the literature? A. Consider the sample size B. Make sure the confident and interval is tight C. See if the p-value is less than the a-coefficient D. Determine the error rate
A. Consider the sample size
What is s/p craniotomy and is about to discharge home. You notice ataxic gait and holding the wall while walking. What is your action? A. Consult PT B. Discharge home C. Make outpatient PT appt D. 2nd guess the RN assessment
A. Consult PT
The nurse calls you to report low BP and a CHF patient on the unit. You have IVF ordered, and the cardiologist has ordered Lasix. A. D/C the Lasix B. Leave the orders as they are C. Call the cardiologist to discuss D. Call the Ethics Committee
A. D/C the Lasix
A student breaks the sterile field. How do you handle the situation? A. Discuss it with a student B. Report it to the charge nurse C. Report it to the unit manager D. Inform the faculty in charge of the student
A. Discuss it with a student
Patient was diagnosed with caudal equina syndrome and neurosurgery has been consulted. What is the NP responsibility in anticipation of surgery? A. Discuss the MRI results and how the nerves are affected B. Discuss rehab after surgery C. Order small frequent meals to prevent nausea D. Explain the surgery to the patient
A. Discuss the MRI results and how the nerves are affected
Which of the following is not an early sign of HIV/AIDS? A. Fatigue/vag abdominal pain B. Fever C. Weight loss D. Night sweats
A. Fatigue/vag abdominal pain
Patient has been taking Thorazine and now has a fever, sweating, lethargy, and a temp of 39.4 (102.92): A. Give IVF B, Antipyretic C. Abx D. Ice packs to groin and axilla
A. Give IVF
It has overdosed on Lopressor. It has been 5-6 hours. What do you order? A. Glucagon and Atropine B. Narcan C. Activated charcoal D. Flumazenil
A. Glucagon and Atropine
What is GI angioplasty used to diagnose? A. Hemorrhage of unknown cause B. Uncontrolled bleeding C. Cholelithiasis D. Bleeding due to PVD
A. Hemorrhage of unknown cause
The most common cause of hyponatremic hyperosmolality? A. Hyperglycemia B. Hyperthyroidism C. Adrenal insufficiency D. K-sparing diuretics
A. Hyperglycemia
A 61 year old female complaining of fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating "abnormal" and she has been experiencing muscle spasms on occasion. You order an EKG and find decreased amplitude and broad T waves. Occasionally you also know prominent you waves. Of the following, which is the most likely diagnosis? A. Hypokalemia B. Hyperkalemia C. Hypocalcemia D. Hypermagnesemia
A. Hypokalemia
Your patient has suffered a spinal cord injury. What sign indicate recovery has begun? A. Increase in DTRs B. Bradycardia C. Edema D. Moderating respiratory rate
A. Increase in DTRs (deep tendon reflex)
A former patient of an NP is writing blog post, sending emails, distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? A. Libel B. Slander
A. Libel- written (slander- oral)
Your patient is a 30 greek female with microcytic anemia who has just returned from the middle eat. What lab is not expected in her anemia? A. Low serum ferritin B. Low HGB C. TIBC 300 D. MCHC <32%
A. Low serum ferritin (<15)
A 77 year old male patient wife cares for him at home. Which statement by the wife indicates a need for SNF? A. My husband needs more help with his ADLs B. I can't lift him out of bed anymore C. He has lost 20 pounds D. He has trouble swallowing and I'm worried he will choke on his food
A. My husband needs more help with his ADLs
A patient presents to the ED with intense abdominal pain that worsens when she coughs. A physical exam indicates abdominal tenderness, abdominal guarding. During the PE, the NP elicits RLQ pain when pressure is applied to LLQ. Her labs are: HR 140, SV 70 mL/min, CVP 8 mmHg, PCWP 4 mm Hg, SVR 600 dyn sec/cm3. Which of the following should be initiated for this patient? A. Norepinephrine B. Hydrocortisone suppositories C. Epinephrine D. PRBC transfusion
A. Norepinephrine
Your patient has had a CVA and is now having trouble feeding himself. Who do you consult? A. OT B. PT C. Social work D. Case management
A. OT
The patient has been in a bar fight and has a human bite on his hand. What should you do next? A. Order PO abx B. Order wound culture C. Order IV abx D. Measure the wound depth and width
A. Order PO abx
Your patient complains of tarry stools, change in stool caliper, and constipation. What intervention is appropriate? A. Order more testing B. Consult surgery for possible colon cancer C. Give PRBCs D. Consult oncology for chemotherapy
A. Order more testing
What is the most important assessment finding and determining patient's mental status? A. Orientation level B. Attention C. Memory D. Affect
A. Orientation level
You're a 32-year-old male patient has a history of MVR and complaining of wheezing with exercise. What is your order? A. PFTs B. Pulmonary consult C. PO steroids D. SABA
A. PFTs
A patient visit your cardiology clinic. She requests a Pap smear she said she has not done one in years. You: A. Refer her to a gynecologist B. Schedule her to come back next week for the pap at another appointment C. Perform the pap today D. do a vaginal exam only, and refer the pap to gyro
A. Refer her to a gynecologist
Your asthmatic patient is Anna SABA and ICS. She has no secretions but her symptoms are still not well controlled. What do you order next? A. Salmeterol (LABA) B. Ipratropium bromide C. Montelukast D. Metaproterernol
A. Salmeterol (LABA)
Trent is an obese 38F with the following fasting lipid panel: TC 270, LDL 168, HDL 28. What is your action? A. Start a statin B. Teach lifestyle changes C. Prescribe Metformin D. Prescribe Niacin
A. Start a statin (key word obese)
You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention? A. Stop the TPN, remove the line, and place a new line for TPN B. Start abx C. Send Cx D. Change the guidewire
A. Stop the TPN, remove the line, and place a new line for TPN
You want to get more funding for your hospital's Rapid Response Team. How should you present this issues to the committee? A. Stress the importance of a team B. Describe how to improve and expand the team
A. Stress the importance of a team
Your patient presents to the ED with ischemic stroke-like symptoms. Her BP is 160/90 and she is on Norvasc. Symptom onset was 4 hours ago. Which of the following is contraindication to fibrinolytic therapy? A. Time B. PMH C. Age D. BP
A. Time
A patient comes to the ED at a community hospital who is 29 weeks pregnant. She states her water has broken. Her vital signs are stable. What do you do? A. Transfer her to a tertiary facility B. Contact her OB/GYN for treatment advice C. Admit to labor and delivery D. Consult the nurse midwife
A. Transfer her to a tertiary facility
Affect of level thyroxine is most likely to lead to noncompliance when first initiated? A.Alopecia B. Dyspepsia C. Weight loss D. Nervousness
A.Alopecia
Which of the following does not cause hypoxemia? A.Hyperventilation B. Hypoventilation C. Decreased in atmospheric O2 D. Right to left shunt
A.Hyperventilation
First priority in a septic shock hypotensive patient?
ABC, then IVF
Which drug prevents cardiac remodeling?
ACEI -possible BB as well
HTN + DM what else do they need?
ACEi
Patient is post MI, on a beta blocker and statin what do they need?
ACEi
Patient with a 50% right sided carotid artery occlusion and right sided weakness that went away (TIA), what medication should be ordered?
ASA or Plavix
OA treatment?
ASA, APAP (1st line), NSAIDS, Cox2 inhibitors (Celebrex-except heart disease). Swimming for non-charm. Cane goes on opposite side.
Trauma hypotensive patient. Distractor is blood transfusion. What is answer?
ATN (causes: ischemia- decreased perfusion, sepsis, nephrotoxins-drug, IV contrast)
Aspirin Overdose Treatment
Activated charcoal, NaHCO3 for severe acidosis of <7.1 monitor ABGs
Tdap vaccine is an example of what type of immunity?
Active immunity
Elderly women who has a hx of lung dysfunction comes to our office. She presents with a number of respiratory symptoms. Most severe c/o HA. Which is the most likely respiratory dx based on HA?
Acute bronchitis
Cardiogenic shock causes?
Acute pump failures, MI, dysrhythmia, pulmonary edema, tamponade
You noticed that another NP in your group is frequently contacted by pharmacy for a prescription errors. How do you handle the situation?
Address it directly with the NP
Your patient had an appendectomy + chemo for symptomatic relief of cancer. Is this curative or adjuvant treatment?
Adjuvant
Patient was stung by a bee and is in respiratory distress what do you do first?
Administer Epinephrine
Annual PSA and DRE are indicated in what group?
African American >40 and family hx of prostate CA
Anaphylactic shock (Distributive) Treatment?
Airway, epi IM, benadryl IV/IM, IVF, consider ranitidine (H2 antagonist), inhaled beta agonist
What patient requires labs to be monitored closely after initiating TF?
Alcoholic with decreased intake over the past 2 to 3 days
What is collaboration?
All players have and desire power, share common goals, and recognize/accept separate areas of responsibility/activity
Government is moving towards being cost-effective. What is the best way?
Allow NP to treat a wider variety of patients
Picture of gunshot wound to the right lung area. Purpose of the dressing?
Allow the dressing to be sucked to the chest wall during the negative pressure of expiration.
Which of the following meds is not indicated in the management of closed angle glaucoma?
Alpha 2 adrenergic agonist
Most important HPI questions in patients with hemoptysis?
Amount of blood, previous episodes, dyspnea
What is quantitive research?
Amount/numbers
UTI during pregnancy treatment?
Amoxicillin, Macrobid, Keflex, for 7 days
Which clinical scenario does the NP evaluate for a quality improvement process change?
An increased incidence of postoperative sternal wound infections
Pt presents with GI bleeding what diagnostic do you use?
Angioplasty
Detrol LA side effects
Anticholinergic effects: drying- xerostomia, constipation, dyspepsia, dry eyes, dysuria, headache
What defect will the patient have if the left middle cerebral artery has an infarct?
Aphasia
A 40-year-old patient with no past medical history is admitted with bilateral pulmonary emboli. Work up reveals a positive result for lupus anticoagulant, and anticoagulant therapy as planned. The patient verbalizes concerns about her ability to manage the appointments and the follow up care. The NP's most effective intervention is to:
Arrange follow-up appointments for the patient at the Warfarin (Coumadin) clinic and PCP after discharge
Elderly female patient takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do?
Ask for advance directives
Your patient imaging reveals he has metastatic cancer. The family, in accordance with their culture, request that you not share the test results to spare him distress. How do you respond?
Ask the patient what he wants to know about his prognosis
Males with gonorrhea s/s & treatment?
Asymptomatic, white/yellow-green discharge Tx: Ceftriaxone 125 mg IM x1, cervical culture with Thayer Martin media, gram - diplococci. TX Ceftriaxone IM x1, Zithromax 1 gm PO x1, report to health department
Treatment for chlamydia?
Azithromycin
Your 45Y male patient has new onset atrial fibrillation, but no other past medical history. What should you prescribe? A. Tylenol B. ASA C. Coumadin D. Plavix
B. ASA (young with no risk factors/history)
Which of the following displays a current or recent hepatitis A infection? A. Antibody-specific to IgG B. Antibody-specific to IgM C. Hepatitis A core antibody D. Hepatitis A surface antigen
B. Antibody-specific to IgM
Is paradoxical abdominal and diaphragmatic movement? A. Symptoms of anxiety disorder B. Asthma ominous sign C. Respiratory bacterial infection
B. Asthma ominous sign
The NP correctly identifies the expected hemodynamic profile of a patient in hypovolemic shock as being most closely represented by which of the following? A. CO 3.5 L/min, CVP 1 mmHg, PCWP 4 mmHg, SVR 700 B. CO 3.0 L/min, CVP 1 mmHg, PCWP 3 mmHg, SVR 1400 C. CO 3.5 L/min, CVP 1 mmHg, PCWP 14 mmHg, SVR 1300 D. CO 8.5 L/min, CVP 9 mmHg, PCWP 4 mmHg, SVR 700
B. CO 3.0 L/min, CVP 1 mmHg, PCWP 3 mmHg, SVR 1400
Which of the following is not associated with anemia of chronic disease? A. HIV B. COPD C. SLE D. Ulcerative colitis
B. COPD
Which of the following is considered a high acuity role for the AGACNP? A. Primary care clinic B. Cardiology office C. Community health department D. Minute Clinic
B. Cardiology office
HIV positive patient is preparing to discharge when he tells you not only that he has pass the virus to his wife, but also that he plans to kill her when he gets home. How do you respond? A. Call the police B. Consult psych C. Consult social work D. Document his statements
B. Consult psych
Which macronutrient of TPN significantly increases the osmolality of the solution? A. Lipids B. Dextrose C. MV's D. Potassium
B. Dextrose
You're a patient has a serum osmolality of 268 mOsm/kg serum sodium of 134 mEq/L. His urine has Na+ less than 10 mEq/L. You know that all of the following are possible explanations except: A. Diarrhea B. Diuretics C. Dehydration D. Vomiting
B. Diuretics (Na <10 is non renal cause. Diuretics are associated with renal cause, urine Na >20)
Which lab value is expected in iron deficiency anemia? A. Elevated MCHC B. Elevated TIBC C. Elevated MCV D. None of the above
B. Elevated TIBC (>450)
A 51-year-old male is admitted to the ED with severe dyspnea. The patient's history indicates emphysema. The NP orders 02, since the patients SaO2 dropped from 96% to 90%. However, the NP also advises the attending RN to continue monitoring the patient because? A. He has lost his hypoxemic respiratory drive B. He has lost his hypercapnic respiratory drive
B. He has lost his hypercapnic respiratory drive
It was pneumonia is noted to have a heavy drinking habit. Two days p admit he becomes combative/agitated. What is treatment? A. IV Valium B. IV Ativan C. PO Librium D. Lasix
B. IV Ativan
What is the best way for the AGACNP to get involved in policy making? A. Attend legislative days at the state capitol B. Join a hospital committee C. Write to your local congressman D. Review literature and give more in-services
B. Join a hospital committee
What is a potential cause of hyperkalemia? A. Carafate B. NSAIDS C. Centrally acting HTN meds
B. NSAIDS
Your patient is pre-operative for an elective surgery. You notice a pulsating mass in the mid abdomen (AAA). What is next action? A. Cancel the surgery B. Order abdominal U/S C. Order abdominal CT D. Document the mass carefully and send to surgery
B. Order abdominal U/S
Where are Bouchard's located? A. DIPs B. PIPs C. MCP D. Wrists
B. PIPs
Is post-op after an aneurysm clipping. What intervention is used? A. Maintain SBP 140-160 B. Place patient in a quiet room C. Encourage visitors D. Start Decadron
B. Place patient in a quiet room
Your patient has a severe closed head injury. VS are listed. Which value is it crucial in evaluating him for brain death? A. Pt had a gag & cough reflex B. Pt is not normothermic C. Pt is not normotensive D. Documenting family opinion on whether pt is brain dead
B. Pt is not normothermic
What is the initial finding in a pulmonary embolism? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
B. Respiratory alkalosis
Most critical symptom for diagnosing peritonitis/bowel perforation? A. Guarding B. Rigidity C. Distention D. Rebound tenderness
B. Rigidity
A patient visit your clinic for sinusitis. She requests a Pap smear since she has not had one in years. You: A. Refer her to a gynecologist B. Schedule her to come back next week for the pap at another appointment C. Perform the pap today D. Do a vaginal exam only, and refer the pap to a gyro
B. Schedule her to come back next week for the pap at another appointment
A 34 year old female presents to the ED with severe flank pain, nausea, and vomiting. The pt states she had trouble urinating before the onset of her other s/s. A CT scan reveals a 2.5 mm stone in the left kidney just above the upper ureter. Which course of action is most appropriate? A. Give IVF and discharge home B. Strain the urine immediately C. Schedule laser lithotripsy
B. Strain the urine immediately (she may pass it on her own)
What is the earliest sign of PNA in the elderly patient? A. Dyspnea/SOB B. Tachycardia C. Fever D. Hypoxia
B. Tachycardia
What helps a Parkinson's patient with coordination? A. Acupuncture B. Tai Chi C. Relaxation techniques D. Hypnotherapy
B. Tai Chi
Your patient is ventilated and becomes confused with arm edema. What low cost test do you order? A. D-Dimer B. Ultrasound C. VQ scan
B. Ultrasound
Which of the following demonstrates the appearance of normal veins on a funduscopic examination? A. Pale gray compared to arteries B. Wider than arteries C. Brighter red than arteries D. Thinner than arteries
B. Wider than arteries (arteries are brighter red and narrower than veins)
Your patient presents to ED with right wrist pain. She states, "it's my fault; I should have had dinner ready on time. "What are you do? A. Tell her not to go home because it's not safe B. X-ray of the wrist C. Call the police D. Consult psych
B. X-ray of the wrist
What is the best non-pharmacologic treatment in a patient with end stage COPD?
BIPAP (NIPPV)
What is azotemia?
BUN >100, treatment is dialysis
Lower UTI treatment?
Bactrim, cipro, augmentin for 3 day course
What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?
Balanced budget act
Patient has cellulitis of lower extremity with a wound, what do you treat with?
Based on the hospital sensitivity
What is palliative care?
Basic improvement in quality of life of anyone with an illness at any stage
Patient had an EF of 20 and bronchospasm what med caused it?
Beta blocker
What race is at highest risk for cancer?
Black men (per CDC website)
What does temporal arteritis require immediate treatment in order to prevent?
Blindness in the affected eye
Septic Shock Treatment?
Blood cultures, IVF, vasopressors: NE, dopamine, dobutamine; abx within 1 hour
Your patient is a 79-year-old male Japanese immigrant. What TB induration measurement is diagnostic? A. 3 mm B. 7 mm C. 11 mm
C. 11 mm
How long will it take to begin to see healing in a pressure ulcer that has a clean, well vascularized bad? A. 7 days B. 2-4 weeks C. 2 days D. 4-6 weeks
C. 2 days
Which of the following is least likely to experience a DVT? A. 24Y F on OCP B. 74 M post hip replacement C. 58Y M liver patient D. Paraplegic
C. 58Y M liver patient
Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to? A. Shame because she feels that illness is her fault B. Embarrassment from the examination C. A sign of respect D. A normal response
C. A sign of respect
What disorder can be ruled out using the Cosyntropin stimulation test? A. Cushings B. Diabetes insipidus C. Adrenal insufficiency D. SIADH
C. Adrenal insufficiency
What are protein supplements best used for? A. Eliminate the need for lipids B. Prevent anasarca C. Aid in post-op healing
C. Aid in post-op healing
Your patient is not doing well and family/wife is at bedside crying. You are preparing to talk to the family. What are you do first? A. Place a social work consult B. Explicitly explain the situation, the outcomes, in the care involved C. Ask if the patient has an advanced directive D. Set up a family meeting in a room with a specific time and date
C. Ask if the patient has an advanced directive
Which vitamin is appropriate for post-operative patient with alcoholism? A. D B. K C. B1 D. A
C. B1n (thiamine)
What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? A. Join a hospital committee B. Petition the government C. Bill for independent services D. Start your own practice
C. Bill for independent services
The medical resident obtain consent for an operative procedure. On your visit, the patient is confused/refusing the procedure. A. Cancel the surgery B. Have the wife sign another consent C. Call the resident to clarify the patient was not confused when he signed the first consent D. Consult neurology
C. Call the resident to clarify the patient was not confused when he signed the first consent
Strongest predictor of functional impairment prior discharge of the elderly patient? A. Advanced age B. Incontinence C. Cognitive impairment D. Poor balance
C. Cognitive impairment
Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do? A. Administer PRBCs as needed B. Call the ethics committee C. Continue to research alternative treatments D. Ask the family to give permission now that he's unconscious
C. Continue to research alternative treatments
Your patient has been on peritoneal dialysis long-term, and develops a fever and cloudy peritoneal fluid. What do you order first? A. Blood culture B. Antibiotics C. Culture of dialysis tube
C. Culture of dialysis tube
Which psychiatric disorder is most commonly diagnosed, yet least commonly treated? A. Bipolar disorder B. Alzheimer disease C. Depression D. Dementia
C. Depression
It has developed a fever of unknown origin. What is the next step? A. Po abx B. IV abx C. Do nothing until diagnosis is confirmed D. Tylenol
C. Do nothing until diagnosis is confirmed
You noticed there have been less favorable outcomes satisfaction surveys and patients treated for sickle cell anemia. How do you approach this problem? A. Ask the patients treated how care can be improved B. Look back at prior treatment given to see how outcomes can be improved C. Form a standardized treatment plans for all patients that can be used by all healthcare staff D. form individualized treatment plans that can be used by all healthcare staff
C. Form a standardized treatment plans for all patients that can be used by all healthcare staff
Which of the following patient is most likely to get HIV? A. Sex worker who doesn't use condoms B. MSM who doesn't use condoms C. IVDU
C. IVDU
Six year old with history of Crohn's disease arrives in the ER with complaints of abdominal pain, frequent vomiting and water bowel movements. You notice high-pitched, tinkling bowel sounds and transabdominal ultrasound reveals partial SBO. Which is not necessary? A. NPO and IVFs B. NG tube for LWS C. Immediate surgical consult D. Monitor for spontaneous resolution
C. Immediate surgical consult
Six year old patient who has a history of asthma comes to the ED in a fatigue state. She has difficulty speaking due to respiratory distress, but able to explain that she is recovering from a cold, but her signs and symptoms are so severe that she came to the ED. HR is 118, FVCWDL, FEV1 45% of expected value. You order Metaproterenol (albuterol) 0.3 mL in 5% solution, but the pt does not respond. Now what? A. Aqueous epinephrine B. Albuterol C. Methylprednisolone D. Montelukast
C. Methylprednisolone
What alternative therapy can you order to relax the patient prior to a procedure? A. Massage B. Aromatherapy C. Music D. Muscle relaxant
C. Music
Your patient is on 5 FU for chemotherapy. What symptoms are most likely to cause discontinuation of treatment? A. Alopecia B. Mouth sores C. Nausea/vomiting and mucosal irritation
C. Nausea/vomiting and mucosal irritation
32 year old female is brought to the ED after spilling a pot of boiling water on her arms and chest. On exam you see that burned skin is broken, swollen with edema, and covered with blisters. She rates pain as "extremely painful. " You determine that the patient has burns over 20% of her TBSA. Which of the following most accurately describes the patient's burn? A. 1st degree burn B. Full thickness burn C. Partial thickness burn D. 3rd degree burn
C. Partial thickness burn
Your patient with sickle cell anemia is complaining of nausea and lack of sleep. What med is best? A. Reglan B. Zofran C. Phenergan D, Ativan
C. Phenergan
Which of the following anti-epileptic drugs is the LT drug of choice for treating patients diagnosed with convulsive status epileptics? A. Phosyfentoin B. Diazepam C. Phenytoin D. Phenobarbital
C. Phenytoin
Discharge planning is underway for a patient who has been very debilitated after treatment for end stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? A. Hospice B. Home health care C. SNF D. Private Duty RN
C. SNF
When closing a practice, the NP is required to do all of the following except: A. Give the patient adequate time to find another provider B. Keep all of the patient's records for a minimum of five years C. Send a certified letter with a return receipt requested D. Provide names of other providers for future care
C. Send a certified letter with a return receipt requested
You are treating a patient for hypothyroidism. Which lab value is monitored for treatment/Synthroid effectiveness? A.T3 B. T4 C. TSH D. Thyroxin index
C. TSH
You're 67 year old patient has a blood pressure of 168/92. On her second visit her BP is 158/88. What is your initial treatment plan? A. Prescribe an ACEi B. Prescribe a mild diuretic C. Teach lifestyle changes D. Schedule a stress test
C. Teach lifestyle changes
What is the leading cause of death in African-American males ages 40-59?
CAD
Lab for rhabdomyolysis?
CK
HIV pt with petechiae on legs (bone marrow suppression) and leg weakness (malaise) What should you test for?:
CMV
Cranial nerve sensory only?
CN I, II, VIII
Cranial nerve: hands on the side of patient's face and ask them to chew?
CN V, trigeminal nerve
Pain scale to use in ventilated or unconscious patient?
CPOT
What test do you use to confirm pheochromocytoma?
CT
Gold standard for dx nephrolithiasis?
CT scan
Initial action in a patient with new onset seizures?
CT scan
What imaging do you order for a patient who has a change in LOC?
CT w/o contrast
To check for other sources of bleeding in a pelvic fracture?
CXR and Fast scan
Most common types of stones?
Calcium 80%, gout = uric acid, women = struvite
60 year old male presents to the ER and his child reports he passed out in the car while driving, regained consciousness and was drooling and out of it. Patient's HR and BP are decreased. You give Nimodipine. What is the rationale for administering Nimodipine to this patient?
Calcium channel blocker, counters vasospasm s/p CVA
35 year old female presents with complaints of bilateral wrist pain. You suspect spouse abuse. You notice a hand gun in her purse. What would be your next action?
Call security to ensure safety
Your female pt presents with mucopurulent cervical drainage, fever >102 F, adnexal tenderness, & distended, rigid abdomen. What is the appropriate measure?
Call surgery and arrange for an exploratory laparotomy & pelvic abscess drainage (key is rigid abdomen)
What meds are used to treat ulcerative colitis?
Canada (Mesalamine) suppositories or enemas for 3-12 weeks, hydrocortisone suppositories and enemas
What pathological finding can cause both cardiogenic and obstructive shock?
Cardiac tamponade
Gerontology and cardiac?
Cardiomegaly
Patient has a hip fracture, carotid bruit, weakness, and confusion. What are you order?
Carotid US
37 year old s/p endotracheal intubation 2 days ago has fever, chills and purulent sputum. CXR= lung infiltrates. Which of the following is the best regiment for the patients condition?
Cefepime and Cipro (pseudomonas for VAP)
57 y/o male with PMH of cardiovascular disease presents with c/o of pain in both knees that is progressively worse throughout the day. You suspect OA. What medication is contraindicated?
Celebrex r/t ARF, MI, and CV disease
57 y/o male with PMH of cardiovascular disease presents with c/o pain in both knees that is progressively worse throughout the day. You suspect OA. What medication is contraindicated?
Celebrex r/t ARF, MI, and pts PMH + for cardiac disease
A young female pt in ED w/ vaginal d/c. After a pelvic exam, the NP documents which finding?
Cervical motion tenderness
What do you check in atrial fibrillation and then what do you treat it with?
Check TSH. Treat with beta blocker.
A 78-year-old male pt w/ CHF developed a bacterial UTI secondary to an indwelling f/c. Pt has a known allergy to PCN and sulfonamides. The appropriate choice for antimicrobial therapy is?
Ciprofloxacin
What antibiotics do you use for ulcerative colitis?
Ciprofloxacin and metronidazole in severe colitis and high-grade fever, leukocytosis with extreme numbers of immature neutrophils (bands >700/microL), and peritoneal signs or megacolon.
What disorder worsens with epistaxis?
Cirrhosis, HIV
What is scope of practice?
Collaboration, coordination of care, researched based clinical practice, clinical leadership, family assessment, discharge planning
Diabetic patient complains abdominal pain. Which type of exam do you conduct?
Comprehensive
What do patients with chronic venous insufficiency and a venous stasis ulcer need to use?
Compression stockings
Protected health information: conversation between the ACNP in a consultant on the case
Consider clinical relevance
What is reliability?
Consistency of a measurement, or the degree to which an instrument measures the same way over time
What confirms the diagnosis of pneumonia?
Consolidation in the lungs on CXR
Your patient voices concerned because he has lost his insurance and worries his children will no longer have coverage for medical expenses. What are you do?
Consult case management
A patient has fully recovered from septic shock due to bacteremia and has been excepted to a LTC facility for continuation of the anabiotic's. ID has not seen the patient in two days. The NP:
Contacts the ID MD to determine the appropriate anabiotic duration
Patient is getting discharged and needs wound care, pulmonary, and follow up. What is the NPs role?
Coordinate services
What do you test do you use to test for Addison's?
Cosyntropin + if serum cortisol <18 mcg/dL in the morning
What to monitor with NSAIDS?
Creatinine, Hyperkalemia
What is at risk for toxic megacolon?
Crohn's and ulcerative colitis
Fibrinogen what to give?
Cryoprecipitate
A patient who has HIV or some comorbidity tests positive for TB. Which of the following is diagnostic?
Culture x3 (sputum)
Which is best used to diagnose pulmonary HTN? A. Bubble Study B. Presence of peripheral edema C. Cardiac catherization D. 2D ECHO
D. 2D ECHO (confirmed by cath)
What message should you use to treat hyponatremia related to SIADH? A. Bolus 500 mL NS B. Bolus 3% hypertonic saline C. NS at 200 mL/hr D. 3% hypertonic saline, calculated
D. 3% hypertonic saline, calculated
What method should you use to treat hyponatremia related to SIADH? A. Bolus 500 mL NS B. Bolus 3% hypertonic saline C. NS at 200 mL/hr D. 3% hypertonic saline, calculated
D. 3% hypertonic saline, calculated
Which of the following is contra indicated for a patient receiving a renal angiogram? A. Beta blocker B. Alpha blocker C. Calcium channel blocker D. Ace Inhibitor
D. Ace Inhibitor (may cause renal impairment)
For the past three months, 29-year-old Janine has been gaining weight while experiencing amenorrhea and increasingly severe acne. She has gained more than 20 pounds, and you know that she is caring her way around the midline, w/BL, purplish stray across both blanks. You suspect Cushing syndrome. Which of the following findings would not contribute to a diagnosis? A. Urine free cortisol= 360 ug/day (>50 abnormal) B. Glycosuria C. WBC 19 D. After a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol
D. After a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol (In Cushings, pituitary does not respond to dexamethasone)
Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserve life, but states that the patient would not want to be on a ventilator. What should you do? A. Consult neurology to come interview the family B. Document the situation carefully in the chart C. Call a clergy member to offer support D. Call the ethics committee
D. Call the ethics committee
Which of the following is a reason to enter be in an asthmatic patient? A. RR in the 30s B. Bad ABGs C. SaO2 in the 80s D. Change in behavior
D. Change in behavior
What among the following is a common cause of pancreatitis? A. Moderate ETOH use B. Medications C. Abdominal trauma D. Cholelithiasis
D. Cholelithiasis
Has a fever three days postop, WBC are 15,000, blood cultures negative and EOS 9%. What is the diagnosis? A. Viral infection B. Bacterial infection C. Malignant hyperthermia D. Drug fever
D. Drug fever
You are assessing heart sound pre-operatively and hear a classic "aortic stenosis" type murmur, as well as a carotid bruit. There are no neurological symptoms. What should you order first? A. Carotid ultrasound B. Consultation to cardiology C. Cancellation of surgery until next week D. Echocardiogram
D. Echocardiogram
A 68-year-old patient has sx three days I'll go to repair and AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFTS are normal, no signs and symptoms CHF. The patient's laboratory values are: blood urea nitrogen of 12 mg/dLI'll go to repair and AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFTS are normal, no signs and symptoms CHF. The patient's laboratory values are: blood urea nitrogen of 12 mg/dL, PaCO2 of 37 mmHg. What is the most appropriate method to deliver nutrition? A. Central line B. PIV C. G tube D. Enteral feeding to the duodenum via a nasogastric small-bore tube (NG tube)
D. Enteral feeding to the duodenum via a nasogastric small-bore tube (NG tube)
58 year old Japanese male with chest pain 4/10 for 3 hours, reluctant to answer questions. Which of the following in the ED weren't admission? A. Age B. Gender C. Pain level D. Ethnicity
D. Ethnicity
Which of the following components of an evidence based research process is the most important for the NP to participate in? A. Specifying methods of data collection B. Formulating the hypothesis C. Carefully reviewing the literature D. Formulating the research problem
D. Formulating the research problem
Your patient has complications from parenteral nutrition all support. All of the following are possible explanations except: A. Hypernatremia B. Pneumothorax C. HHNK D. GI bleed
D. GI bleed
Your HIV patient has CMV. What is the appropriate treatment? A. Cefazolin B. Ciprofloxacin C. Fluconazole D. Gemcyclovir
D. Gemcyclovir (vir)
Patient with asthma has decreased breath sounds on presentation. You gave her nebulizer treatment. Now the SaO2 is decreased to 86% and there are no with breath sounds. What do you do? A. Stat nebulizer B. ABGs C. Epinephrine D. Intubate
D. Intubate
Which electrolyte are you most concerned about monitoring in a cachexia patient? A. Mag B. Ca C. Na D. K
D. K (syndrome hypokalemia also hypophosphatemia)
Has a closed head injury and is ventilated. His ABGs are: pH 7.48, PC02 35, FiO2 40%, P02 60. What is the recommended action? A. Increase the FiO2 to 60% B. Decrease the tidal volume C. Decrease the respiratory rate D. Leave the setting as it is
D. Leave the setting as it is (CO2 in head trauma=35 goal. Permissive hypocapnea)
How do you were and does not go well, and the staff members afterwards or criticizing each other. How do you deal with the situation? A. Schedule an in-service to discuss common code mistakes B. Meet with each team member individually C. Set up exercises to increase collaboration during a code D. Meet with all who participated in the code and have a one time briefing
D. Meet with all who participated in the code and have a one time briefing
What history do you ask about before you prescribe a sleep aid to your 69-year-old patient? A. Seizure B. Depression C. Heart disease D. OSA
D. OSA
Your patient has had treatment for a hematoma. He is confused and combative. It is necessary that he lie still for several hours. What do you do? A. Order paralytic B. Order bedside sitter C. Insist the family remain at bedside D. Order sedation with holidays for neuro checks
D. Order sedation with holidays for neuro checks
Your patient has a chronic, nonhealing decubitus ulcer. He complains of pain when he moves his leg. What is a potential complication? A. Compartment syndrome B. Decrease in ROM stability C. Septic shock D. Osteomyelitis
D. Osteomyelitis
Your patient has a history of coagulopathy and is about to go to surgery. Which order is appropriate for DVT/bleeding prophylaxis? A. Heparin gtt B. Lovenox C. Coumadin D. Pneumatic stockings
D. Pneumatic stockings
What is the best way to make sure a patient will follow up as instructed? A. instruct the patient to schedule the appointment B. Ask the patient the best time they can go to an appointment C. Have the office manager to schedule the appointment D. Schedule the appointment for the patient both PCP and cardiology
D. Schedule the appointment for the patient both PCP and cardiology
You have transferred a patient to the skilled nursing facility. The MD in charge at the facility calls for info about the patient's medical care. What do you do? A. Direct him to look it up in the EMR B. Refuse to share protected health information C. Instruct him to call the department head D. Share the information he requests
D. Share the information he requests
What is the best way to advocate for gay and lesbian population in your area? A. Participate at a high state or national level B. Join a nonprofit advocacy group C. Consider lobbying the government D. Start at your facility
D. Start at your facility
Which of the following lipid panels shows three out of four abnormal values? A. TC 205, LDL 150, HDL 30, TG 300 B. TC 150, LDL 99, HDL 35, TG 145 C. TC 102, LDL 50, HDL 60, TG 102 D. TC 180, LDL 136, HDL 25, TG 160
D. TC 180, LDL 136, HDL 25, TG 160 Cholesterol <200 Triglycerides <150 (30-175) LDL 60-130 HDL 35-85
Your patient is not conscious. His advanced directive states he wants to be a DNR, but his family states that they want him to be a full code. How do you respond? A. Tell her the decision goes to the next of kin B. Call the ethics committee C. Comply with her wishes and make him a full code D. Tell her you can't go against the advance directives
D. Tell her you can't go against the advance directives
You are the NP on call for the night. The nurse calls you to report the patient is decompensating. Who do you direct her to call? A. The ER physician B. Anesthesia C. An NP present on another unity currently D. The attending MD who is at home
D. The attending MD who is at home
Now the husband presents to the ED with a drug overdose. What is your action? A. Hand him off to another practitioner B. Call the police C. Consult psych D. Treat him without prejudice
D. Treat him without prejudice
What does allopurinol prevent in Non-Hodkin Lymphoma? A. Gout B. Hypokalemia C. Nausea and vomiting D. Tumor lysis syndrome
D. Tumor lysis syndrome
Which of the following is not an indicator of pre-renal failure? A. BUN/Cr ration >10:1 B. FeNA <1 C. Specific Gravity >1.015 D. Urine Na >40
D. Urine Na >40
Your patient speaks only Spanish and you need to evaluate his pain. What are you do? A. Ask a family member to translate for you B. Utilize the hospitals interpreter service C. Call over the Hispanic housekeeper and ask her to translate D. Use of visual pain scale
D. Use of visual pain scale
Von Willenbrand disease lack of factor VIII. Give what?
DDAVP preoperatively
15-year-old patient with DM1 reports ^ BS in a.m. The ACNP determines hyperglycemia is due to?
Dawn Phenomenon
What is the cause of anemia in renal failure?
Decrease in erythropoietin production
Are Addison's disease labs?
Decreased BS, Decreased Na+, Increased K+
Why are so many HIV patients noncompliant?
Decreased access to care
What signs and symptoms are associated with hepatotoxicity s/p acetaminophen toxicity?
Delirium
Picture of an elderly persons arm with a skin tear
Dermis thins in old age
What is qualitative research?
Descriptive, like case study
A woman of childbearing age complaining of abdominal pain. What level of exam do you document?
Detailed
What is the treatment and presentation of Crohn's?
Diarrhea, abdominal pain, abscess/fistula's, TX: antibiotics Flagyl/Cipro
Tube Feeding side effects?
Diarrhea- decrease the osmolality of the tube feeding
How patients with DM and heart disease decrease LDL non-pharmacologically?
Diet and exercise, lifestyle changes
What is the purpose of cardiac stress testing?
Differentiate ischemia versus infarction
STEMI guidelines?
Door to needle 30 min Door to balloon 90 min
Patient is hypotensive and has Addison's what do you treat this with?
Dopamine/Pressors if they don't work, choose IVF DSNS
Hypoalbuminemia risk of
Drug toxicity (decreased binding --> more free substance in blood)
Why should you not use Protonix PPIs long-term?
Due to increased risk of hip fracture. Increase vitamin D
42-year-old male with epigastric pain that is better after he eats?
Duodenal ulcer
Most common UTI etiology in women?
E. Coli Men= proteus
HIV testing?
ELISA and Western Blot (western blot confirms)
Elderly pt takes an herbal root to help fight colds, however has a history of renal insufficiency. Which medication could exacerbate his diagnosis?
Echinacea causing nephrotoxicity
Pt sexually active with gonorrhea who is not practicing safe sex?
Educate
What are the four roles of nurse practitioners?
Education, research, clinician, consultant/collaborator
St. John's wort decreases what?
Effectiveness of digoxin, ^ risk of SSRI syndrome
Goals set forth and healthy people 2020 by the united states department of health and human services include:
Elimination of health disparities
A bedside parasternal ultrasound reveals fluid in the pericardial sac. What is the initial action in managing this patient?
Emergency percicardicentesis
Testicular torsion treatment?
Emergency surgery
Your patient is three days post appendectomy and develops dysphasia, drooling, and expiratory straighter. What is going on?
Epiglottitis
Jehovah's witness needs transfusion but is refusing blood products. What alternative can you give?
Epogen or colony
What is informed consent?
Estate indicating patient has received adequate instruction/information regarding aspects of care to make a prudent, personal choice regarding such treatment. Includes benefits and risks. Includes competence: patient ability to CURD: communicate, understand, reason, differentiate good and bad
What 2 herbs are associated with relieving premenstrual symptoms?
Evening primrose and black cohosh
How should the ACNP stay up-to-date with current information?
Evidence based guidelines
What does the leg/foot look like in a hip fracture? Is it internally rotated or externally rotated?
Externally rotated
Has a fever and tachycardia, and history of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status?
Extra cellular dehydration deficit
Clotting factors give?
FFP
When to transfer burns?
Facial involvement
What is negligence?
Failure of an individual to do what any responsible person would do, resulting in injury to the patient
Pathophysiology of PE?
Failure of right ventricle
True/False: Barium enema is indicated in the conservative management of diverticulitis?
False
True/False: restraining an unwilling patient is grounds for malpractice?
False, if they are a danger you can restrain
Iron Deficiency Anemia?
Ferritin <15, TIBC >450
What do you use for breakthrough cancer pain according to the WHO pain ladder?
Fetanyl Patch
What are signs and symptoms of thyroid storm/crisis?
Fever, goiter, tachycardia, low TSH Hyperthyroidism
What procedure does the AGACNP perform to evaluate cytology, only, and the tumor?
Fine needle biopsy
How often should a woman between the ages of 20-39 have a PAP with HPV?
Five years, PAP with cytology every three years
Difference between upper UTI and lower UTI?
Flank pain
What do you treat Addison's with?
Florinef, Hydrocortisone, Steroid bolus
What do you give in postop fever?
Fluids
What is the confirmatory test for diagnosing sypillis?
Fluorescent treponema antibody absorption (FTA-ABS)
Most important in status asthmatic patient who was extubated?
Follow up with asthma specialist in 3-5 days
A 32 y/o patient who underwent an open splenectomy for a ruptured spleen is preparing for discharge. An adult-gerontology acute care nurse practitioner reviews the potential complications with the patient. The nurse practitioner emphasizes which instruction to the patient?
Follow up with primary care provider for vaccinations
65 year old EtOH use +25 years of smoking. Signs and symptoms dysphasia and epigastric pain. What is the diagnosis?
GERD
HIV meds side effects
GI problems, N/V, skin rash, anemia
Lab values of acute pancreatitis?
GWGLA HBCABE Prognostic signs on admission Greater than 55yo WBC>16 Glucose >200 LDH>350 AST>250 Prognostic signs during first 48h Hct drop of >10 BUN increases >5 Calcium <8 Arterial O2 <60 Base deficit >4 Estimated fluid sequestration >6k nL
52 y/o female is concerned with hormonal replacement therapy. What are the associated SE?
Gall stones, blood clots, and CVA
Coumadin, how do you know patients understands instructions?
Getting INR checked
Patient in the ER not doing well, primary doctor calls:
Give him information
25 y/o female presents with green vaginal discharge, what is the diagnosis?
Gonorrhea (females s/s dysuria, urinary freq, abd pain, fever, N/V)
What is dementia?
Gradual, permanent memory/intellectual
But cause analysis of a crisis situation in the ICU identified a lack of clinician family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based policies to establish clinician family communication standards in the unit. These policies should include:
Guidelines for having discussions with family members that are geared toward establishing treatment goals
NP working on ESRD research project. A colleague renal specialist asked for patient info on your patients:
HIPPA breach
Doctor calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient?
HIPPA. Tell to consult other Dr at SNF
Antidepressant overdose signs and symptoms?
Hallucinations, confusion, Tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension (Can't see, can't pee, can't spit, can't shit)
Leukemia with low WBC. What to avoid infection?
Hand washing
Minor with STI what to do with parent?
Have parent step out of room
Patient not doing well and family at bedside who do you talk to?
Healthcare proxy
What is the leading cause of death in Hispanics in the US?
Heart disease
49-year-old male presents with complaints of abdominal swelling that progressed over two days. Patient also reports mucus filled diarrhea and abdominal pain. Exam is significant for profound abdominal distention. You suspect a SPO. What type of bowel sounds are associated?
High pitched, tinkling bowel sounds
Exudative effusion
Higher ratio of pleural protein and LDH to serum levels Protein -Pleural fluid:serum ratio >0.5 -LDH: pleural fluid: serum >0.6 -Pleural fluid LDH >2/3 upper limit of serum LDH
PPI r/o what?
Hip fractures, Increased Vitamin D
32 y/o presents with c/o fever, night sweats, and unexplained weight loss. Upon exam you note a swollen cervical lymph node. A subsequent CXR reveals mediastinal adenopathy. Which of the following is the dx?
Hodgkin's Lymphoma
Adult child of a patient reports that her father has expressed desire to commit suicide and has a history of EOTH and depression. The best response would be to?
Hospitalize the patient and start psychotherapy
Tamoxifen side effects
Hot flashes, menopausal symptoms, vag dryness, hair thinning/loss, menstrual irregularities, pancytopenia, ^ risk of DVT/CVA
You are a preceptor who is mentoring a student. The patient's s/s are broad and variable and include mild icteric symptoms. How should you educate your student?
How did the student review the clinical symptoms and query differential diagnosis Icteric= phase of hepatitis after pre-icteric Pre-Icteric= WL, jaundice, RUQ pain, clay stool, dark urine
What is benchmarking?
How institution compares with similar organizations
What kind of dressing do you use on a decubitus ulcer with necrotic tissue?
Hydrocolloid
Chronic renal insufficiency results in what calcium imbalance?
Hypercalcemia (d/t 2nd hyperparathyroidism, renal osteodystrophy)
65-year-old male with complaints of nausea vomiting constipation for several days and a 6 pound weight loss. Patient status post TKR several weeks ago and reports not getting off the couch what electrolyte is altered?
Hypercalcemia secondary to immobility
Low serum Na and high serum osmolality
Hyperglycemia (Probably HHNK)
What is the Dawn phenomenon? How is it treated?
Hyperglycemia upon awakening in the morning. Caused by RELEASE OF GH OR CORTISOL (more common in adolescence) Treatment: Can't confirm this unless BS is checked 0200-0400 and on awakening (if both are high, then increase nighttime insulin
Patient with signs and symptoms of abdominal distention, weakness, and occasional diarrhea. History indicates renal failure. You conclude that the patient has a fluid and electrolyte problem. Which of the following is he most likely experiencing?
Hyperkalemia
What is the blood pressure for hypertensive emergency and hypertensive urgency?
Hypertensive Emergency- 220/120 Hypertensive Urgency- 180/110
What can contribute to Dilantin toxicity in patient with DM?
Hypoalbuminemia
ABG reads high HCO3 and PaCO2 55 mmHg. What electrolyte abnormality is most likely associated with these values?
Hypokalemia r/t metabolic acidosis
What electrolyte in balance leads to confusion and lethargy in the EtOH abuse patient?
Hyponatremia
Low protein equals= low BUN
Hypoosmolar hyponatremia
Mallampati grades for a visual of oral cavity
I- complete soft palate II- complete uvula III- uvula base only IV- none
CAM-ICU measures what?
ICU delirium
Antidepressant Overdose Treatment
ICU if CNS or cardio toxic, activated charcoal, NaHCO3 for dysrhythmias, and maintain pH, benzos (valium) for seizures, if serotonin syndrome: dantrium/dantrolene sodium)
Pt with hx of A-fib has maintained NSF w/ Sotalol (Betapace), is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is?
IV Ceftriaxone (Rocephin)
Your patient has tachycardia, anxiety, urticaria in recovery from cardiac catheterization. What is the treatment?
IV methlprednisolone, H2 Blocker, and IV Benadryl
Treatment for fulminant ulcerative colitis?
IV steroids
What do you do first in a DKA patient?
IVF first (1L in 1st hr, then 500 mL/hr, use 1/2 NS if BS >500)
Sickle cell anemia crisis treatment?
IVF for hydration (most important) Analgesics for pain Oxygen for hypoxemia
Cardiogenic shock treatment
IVF then vasopressors: NE, dopamine, dobutamine, nitro IV if ischemia
Hypovolemic shock treatment?
IVF, tranfuse PRBC's as needed
What is the pathology of Parkinson's disease?
Imbalance between ACH and dopamine in the corpus striatum
Passive immunity what to give?
Immunoglobin injections
Knowledge deficit in I see you, what would you do for nurses?
In-service
Respiratory Acidosis what do you do if on vent?
Increase RR on vent to blow off acids
What are Cushing's labs and symptoms?
Increased BG, increased Na, decreased K S/S: Central obesity, moon face with buffalo hump, purple striae, amenorrhea
What is Metabolic Syndrome?
Increased BP, Increased BS, Obese, Increased Triglycerides, Decreased HDL
Early Septic Shock
Increased CO/CI (>8/4)
Pt c/o wrist/hand, swollen, redness & pain worse in A.M. resolves as the day goes on. What dx test would support RA?
Increased ESR
Ginseng side effects
Increased bleeding
Patient with history of HF or PRBCs, what LS, LE edema, dyspnea-cause of edema?
Increased hydrostatic capillary pressure
Pt decompensating and family not sure if they want to intubate right now what do you do?
Intubate
Status epilepticus and meds not working, lol SaO2/desating, family can't decide what do you do?
Intubate
There is a patient with a TBI and increasing hypercapnia/lethargy. The NP is worried about ICP, what should she consider?
Intubation to control CO2
What qualifies patient for HHC?
Is homebound, has a prescription, requires care services, wound care, select care
ATN causes?
Ischemia (prerenal/perfusion related), sepsis, and nephrotoxins (IV contrast)
Aspirin overdose what electrolyte to monitor?
K+
What electrolyte should be monitored prior to administering succinylcholine?
K+
When discharging an 85-year-old female patient with stasis dermatitis, the NP includes instructions to?
Keep legs elevated while seated
Which medication decreases mortality in COPD?
LABA-ICS combo
What to monitor for when taking Methotrexate?
LFTs
Patient presents to the ER with complaints of chest pain and shortness of breath. The NP misinterprets the EKG and admits the patient for further monitoring without consulting cardiology. Later in the shift, the patient decompensates and goes into cardiac arrest. The patient was resuscitated but sustained permanent brain damage. What grounds of malpractice is the NP accountable for?
Lack of skill
Metformin causes?
Lactic acidosis
Who isn't covered by HIPPA?
Law enforcement/municipal offices/ CPS/schools, employers/Workmen's Comp., life insurance
Cervical spine X-ray of a guy who hung himself what do you do?
Leave collar on
A male patient you have placed on an alpha blocker for BPH comes in complaining of increased urinary frequency. What do you do?
Leave it alone, the med is working
What is hospice?
Less than six months to live
Patient is refusing care what do you do?
Let them refuse, educate, and search for alternatives
In addition to positive serum ANA, what diagnostic is supportive of diagnosis of SLE?
Leukopenia
Male pt w/UTI on 3 day regimen of abx, comes in requesting stronger abx:
Levaquin (another version narrow the spectrum)
What is the most important when assessing status?
Level of alertness or hx of symptoms
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?
Lisinopril
What is the treatment for myexedema coma?
Loading dose Synthroid followed by maintenance dose Hypothyroidism
Lung protective vent settings: for ARDS?
Low tidal volume ventilation 4-8 ml/kg predicted BW. Can also adjust Vt to goal inspiratory plateau pressure </= 30 cm H2O. Decreased Vt= decreased risk of alveolar distention, VALI (ventilatory-associated lung injury)
You're a 24-year-old male patient has been out hiking on vacation. He shows you the following garage, and thinks he has Rocky Mountain spotted fever. What is his diagnosis?
Lymes disease treated with Doxycycline
Hodgkins?
Lymphadema in cervical chain
Synthroid risk of?
MI risk. Ensure adequate treatment by checking TSH. S/E: Alopecia
LeForte Criteria?
Malocclusion and xray: trauma referral, stabilize and ship if community hospital
Spontaneous pneumothorax common in what disorder?
Marphan syndrome
What are institutional bylaws?
May further restrict practice
What is privileging?
Maybe granted in full or part by the hospital. Credentialing committee is made of physicians
An 80 year old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify?
Medicaid
What is cauda equina signs and symptoms and causes?
Medical emergency. 18 nerve roots of the cauda equine at base of spine. S/S: pain, numbness, tingling and low back pain radiating into legs, S1-S2: weak plantar flexion with lots of ankle jerks, foot drop. S3-S5: loss of bowel/bladder. Muscle weakness, sensory loss in the dermatomal distribution of the affected nerve roots. Cause: tumor, spinal stenosis, herniated disc, CA, infection, inflammation
NP sees a patient for heart failure and performs at H&P. What percent is expected to be paid?
Medicare pays 80% of the total bill, patient pays 20%. NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure is paid 80% of that 85%
Your patient is post-op cardiothoracic surgery. She develops nausea, periumbilical abdominal pain, moderate lipase, LDH, ALT, decreased BS. What is the diagnosis?
Mesenteric Infarct
A patient post CABG with abdominal distention, labs provided equals what?
Mesenteric Infarct (one RF is cardiac surgery)
When would you find "thumb printing sign" on the abdominal x-ray?
Mesenteric ischemia (ischemic colitis), pseudomembranous colitis, and IBD (ulcerative colitis)= radiologic sign of thickening of the bowel wall.
What acid-base imbalance indication for CRRT?
Metabolic acidosis
Your patient ABG's come back as follows: pH 7.37 HCO3: 19 pCO2: 24 What is the diagnosis?
Metabolic acidosis with resulting respiratory alkalosis
Renal disease gives what metabolic abnormality?
Metabolic acidosis, treat with IVF of NS and sodium bicarbonate as needed
Your patient has RA and her corticosteroids are not working. What is your next step?
Methotrexate
RA: Methotrexate, DMARDS, Corticosteroids, Hydrochloroquine, Gold salts. Which is most cost effective?
Methotrexate (monitor LFTs)
Which two headaches can be treated with Triptan's?
Migraines and cluster
31 y/o male with a blowing murmur occurring during S1 and galloping addition heart sound. Murmur is heard best at the base of the heart. What is the MM?
Mitral regurgitation
Patient has low diastolic rumble murmur in the left lateral position with no radiation?
Mitral stenosis
What is case management?
Mobilize, monitor, and control resources that a patient uses during course of an illness while balancing quality and cost. Moves patients through the system appropriately
What is the treatment for diverticulitis?
NPO depending upon condition, IVF, IV antibiotics (Flagyl, Ciprofloxacin, Ceftazidime, Clindamycin, Ampicillin), Tx GI bleed
A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give?
NS
What fluids do you use for HHNK?
NS for massive fluid volume deficit, then 1/2 NS to hydrate cell, then D5 1/2 NS if on insulin gtt
Patient at highest risk for hyperkalemia?
NSAIDs then ACEi
You're a patient with VAP is on broad-spectrum coverage including Levaquin, cefepime, and vancomycin. Your culture comes back growing Pseudomonas. What do you do now?
Narrow the spectrum (you don't need the Vanc)
What would you monitor post-op with serotonin HT3?
Nausea
Central line is placed, pain develops, in respiratory distress, absent breath sounds:
Needle decompression
Pt is 2 days post extubation, is now stable but failed a swallow eval in ICU what do they need?
Needs step down unit
What is specificity?
Negative r/o disease
What is the leading cause of intrinsic acute renal failures?
Nephrotoxic drug
45-year-old status post double mastectomy two months ago. Now he's complaining of pain at the incision site. What kind of pain is this?
Neuropathic pain
62 year old male presents with angina after his daily walk. Lipid panel reveals LDL 250, HDL 25, cholesterol 350, and triglycerides 250. You prescribe niacin. How would you explain the mechanism of action to the patient?
Niacin lowers LDL and increased HDL
54 y/o male s/p acute MI on Levophed, EPI, Vasopression, and Nitro. BP 160/75, now 81/50, which medication would you decrease?
Nitro
Renal angiogram no what?
No ACEi
Tell the patient's wife, for her protection, that her husband has HIV?
No, not without his permission
When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation?
Nonmaleficence
What is non-disclosure?
Not disclosing patient PHI without their permission
Patient with shortness of breath and dry cough chest x-ray reveals generalized inflammation throughout= pneumonitis. What does X-ray show?
Numerous poorly defined small <5 mm opacities throughout both lungs, sometimes with sparing of the apices and bases Airspace dz: usually seen as ground-glass opacities (patchy or diffuse, resemble pulmonary edema) or rarely, as consolidation.
What PFTs show asthma?
Obstructive: decreases in FEV1, FEV 25-75, PEFR, FVC
A nurse experiences a needle stick from a patient who has Non-A, Non-B hepatitis. She has already had the HepB vaccine series. What is the next step?
Obtain blood samples from the patient in the RN
Your patient is an RN with a positive PPD. Her CXR comes back negative WDL. What do you do now?
Offer 6 months INH
What enforces HIPPA?
Office of Civil Rights/ Department of Health and Human Services
How would you know cardiogenic shock?
Only shock with high wedge PCWP
Hormonal replacement therapy has been shown to improve what dx?
Osteoporosis
Older lady with iron deficiency anemia is opening a jar and sustains a spiral fracture of her arm. Why?
Osteoporosis
When treating a pt diagnosed with syphillis, what drug allergy is most important to consider before initiating tx?
PCN allergy, syphillis tx with PCN G
Which of the following is recommended for asthmatics or smokers age 19-64?
PNA vaccine
What does the Living Will provide?
POA/health care proxy
When should PSA levels be initiated and how often?
PSA levels every year >50 and DRE
Most common complication of ERCP?
Pancreatitis
Cocaine induced psychosis signs and symptoms?
Paranoia, delusions, hallucinations, bugs under skin, mydriasis
What is MS pathophysiology and treatment?
Pathophysiology: auto immune disease, immune system attacking myelin TX: Flare-ups= steroids
Myasthenia gravis pathophysiology, s/s, Tx?
Pathophysiology: reduction of the number of a acetylcholine receptor sites at neuromuscular junction. S/S: ptosis, diplopia, extremity weakness worse with exercise, respiratory difficulty. TX: Anticholinesterase drugs like Prostigmin, Plasmapheresis, and Immunosuppressives. Vent may be needed in crisis.
The patient has had a dog bite and three doses of Tetanus in the past. The NP knows the recommendation for tetanus is that the?
Patient gets a booster if they have a dirty wound and haven't had a tetanus shot in five years
Best paint indicator is:
Patient self report
Patient in the ER with sudden LOC and motor function. The ER diagnosis TIA. The patient has a right handed weakness and numbness. Carotid studies are completed and revealed 92-95% occlusion bilaterally. What is the next step
Patient to have left carotid explored first followed by the right one at a later date
Pericarditis and best diagnostic test and what do you send them home with?
Patient with normal chest x-ray, low-grade temp, elevation and all leads. Best diagnostic echo. Send home with NSAIDS.
Your patient is worried about insurance coverage and asks for advice on Medicaid. You instruct the patient that Medicaid:
Pays after insurance and third-party payers have paid
The NP program initiated, primarily, because of what issue in healthcare at the time?
Pediatric physician shortage
Homonymous hemianopsia definition?
Person only sees on one side
Patient with BP 210/110, headache, then BP decreases below 160s, what is 1st treatment?
Pheochromocytoma: Alpha blockers prep Regitine/Phenotolamine Adrenal Medulla
Platlets 150-400 K what to give?
Platelets
Blunting of costophrenic angles on CXR & treatment
Pleural effusion TX: Thoracentesis
What is the number one cause of death in dementia patients?
Pneumonia (think aspiration)
32-year-old male presented with a gunshot wound to the FAA. Injuries are negligible and patient is stable. Patient reports the shot was an accident during hunting. What should the NP do?
Port to the police. All GSW must be reported
Why would you pick a PPI over Phenergan for treatment?
Ppi can be used in combo with other drugs to control symptoms
How can the ANCP prepare to get involved in future mass casualty event?
Pre-enroll in disaster volunteer program
What does chronic subdural hematoma present with? & how do you manage it?
Presents with insidious onset of headache, lightheadedness, cognitive impairment, apathy, somnolence, and occasional seizure Management: surgical evaluation of patients with potential for recovery if there is evidence of moderate to severe cognitive impairment, if progressive neurological deterioration, or if clot thickness >10 mm or midline shift >5 mm
A 70 year old patient with a history of DM, HTN, OAs, and a new diagnosis of coronary artery disease, is being discharged. The adult gerontology acute care nurse practitioner teaches the patient at the first point of contact for health care needs is the
Primary care provider and cardiologist
Validity of results: P-value
Probability of falsely rejecting the null hypothesis (want it to be low)
Which of the following drugs can cause lupus-like sympotms?
Procainamide (flushing/rash)
TCA overdose expected finding?
Prolonged QT
80-year-old patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of hip fracture. To prepare the patient for discharge the NP:
Provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery
Profuse vomiting and variable epigastric pain or two symptoms of what diagnosis?
Proximal SBO (upper)
What bacteria is for VAP? & Treatment?
Pseudomonas Tx: Zosyn, Cefepime, or imipenem/meropenem) + fluoroquinolone or azithromycin) +/_ getamycin
38 y/o female immobilized for 4 months. Examining her before releasing you not dyspnea and tachycardia. You suspect PE, but VQ scan does not confirm. What is the next diagnostic test?
Pulmonary angiography
Kerley B lines on x-ray
Pulmonary edema
Latest sign that you missed a herniation?
Pupil change and positive babinski (toes fan UP/out)
What is managed care?
Putting caps on payments
How to avoid diverticulitis flare ups?
Quit smoking (also increased risk for perf/abcess)
Succinylcholine
R/o malignant hyperthermia, C.I.: ^ K. intubation for Methamphetamine OD
What is Felty's syndrome?
RA + joint swelling + enlarged spleen + leukopenia
ESR elevated ,what should you suspect?
RA, SLE, temporal arteritis, inflammation
Basic vent settings?
RR 12, PEEP 5-8, Vt 6-8mL/kg
Young male with ulcerative colitis, what would be a probable finding?
Rectosigmoid stricture
Which muscle moves the eye from the center, to the side, and back?
Rectus
You're 51-year-old female patient is getting ready to discharge when she tells you she hasn't had a mammogram in three years what do you do?
Refer to PCP for outpatient discharge
A patient has TB and lives with 6 other people. Do you treat the 6 other people or test them?
Refer to health department/Test them
A patient diagnosed with compartment syndrome should immediately received what?
Referral for surgery
Is a MSE (mental status examination) on an older patient reliable?
Reliable
Patient on PD dialysis has an infected dialysis catheter what do you do?
Remove the catheter
A patient who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lbs (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypertension the initial treatment is to?
Replenish volume by infusing a 0.9% sodium chloride solution
Guy in the ER needs a refill on Ritalin. What do you do?
Research alternatives
What acid/base imbalance do PE's cause?
Respiratory alkalosis (breathing off acids)
Your patient has a Na of 128 and was treated with colloids 3 days ago. What is the treatment?
Restrict free water
Patient presents with suspected mitral regurgitation. What physical findings would confirm?
S3 systolic MM
Urine Na 128, serum osmolality 250, urine osmolality 115. What is the suspected cause?
SIADH
28 y/o female with fever, malaise, rash across the back and splinter hemorrhages. HBG 10, positive ANA, UA proteinuria and elevated ESR. What is the suspected diagnosis?
SLE
What should you look at in statistical significance?
Sample size & p-value
In which patient would sarcopenia be the most expected finding?
Sarcopenia
Dantroline Soidum/Dantrium Treatment?
Serotonin syndrome, Malignant hyperthermia, Neuroleptic malignant syndrome
A patient has hyperactive reflexes of the lower extremities. The adult gerontology acute care nurse practitioner assess for ankle clonus by?
Sharply dorsiflexing and maintaining the foot in this position, while supporting the knee
Which valve condition is a contraindication for intra-arterial balloon pump?
Significant aortic regurgitation (regurgitation ^'ed by counter-pulsation. Also: aortic dissection & big aortic aneurysm)
Patient calls to complain about bills and states he has Medicare, which should cover all costs. You explain:
Since you're healthy, exams are not covered.
23-year-old female presents with DKA. ABD pH 7.3, glucose 520, blood pressure 90/65, HR 120, and confused. Which of the following are not included in the initial management of DKA? Isotonic fluids, insulin infusion, sodium bicarb, or supportive care?
Sodium bicarb is only indicated for DKA if pH is <7.1
47 y/o male comes in complaining of intense right eye pain which has worsened since he woke up. Eye exam: copious tearing/redness. Which of the following do you complete to confirm suspected dx?
Sodium fluorescein stain for corneal abrasion
What is Osteomalacia?
Softening of bones; PEDS equals Rickets. Most common cause= deficient Vit D ( also pos, Ca, UV-B light)
Neurogenic Shock cause?
Spinal cord injury, regional anesthesia
Leforte: your patient has mx facial fractures, malocclusion, broken palate & teeth. What do you do?
Stabilize and ship
Lymphoma present in right axilla and right neck. What stage?
Stage II- same side of diaphragm
A patient with heart failure has DOE and sleeps all night while using three pillows. What is her NYHA HF stage?
Stage III
ITP TX?
Steroids
CPI measures what three measures to improve nursing?
Structure, processes, and outcomes
What is delirium?
Sudden transient clouded sensorium
Patient comes in tachycardic, hallucinating, all kinds of other crazy symptoms with dilated pupils?
Sympathomimetic- cocaine/meth
Mainstay COPD treatment
Sympathomimetics (albuterol)
UTI pt allergic to PCN Tx:
TMP-SMX (Bactrim)
How do you treat group A strep on the skin?
TMP/SMX or Doxy/mino + beta lactam (1st generation cephalosporin, PCN, or amoxil)
First test do you run when you see signs and symptoms of phenochromocytoma?
TSH
Based on the individuals culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership with the patient by:
Tailoring his or her communication style to the patient's preference
Patient with 14 hours of chest pain presents to the ED. What is your next step of action?
Take to cath lab (fibrinolytic therapy 6 window closed)
After CVA who continued to have fear of falls even after therapy. What dance?
Tango Dance therapy
Metoclopramide side effects?
Tardive dyskinesia, EPS
Your patient stepped on a nail and does not know his tetanus status. Do you give Td or Tdap?
Tdap
Patient presents to the clinic for routine follow-up and passes out. You revive the patient and admit overnight. Which of the following would qualify as incident-to-billing?
Temperature and weight recording
What is assocaited with HA, fever, and elevated ESR?
Temporal arteritis
Best alternative therapy to decrease pain in clavicle fracture?
Therapeutic touch/ reiki
What causes G.I. bleed an elderly?
Thin gastric membranes. PUDNUGIB. Diverticulosis and colitis and LGIB. Both exacerbated by NSAID/ASA/anticoagulant use).
Best way to verify your treatment is working for open angle glaucoma?
Tonometry (IOP 10-20 normal)
17 year old with ulcerative colitis, what is the worst complication?
Toxic megacolon
A patient has advanced dementia, ESRD, and HF, what do you do for him?
Transfer from acute to palliative care
53 y/o male c/o dribbling and nocturne. You suspect BPH. PSA is 3.2. What confirms the diagnosis?
Transrectal ultrasound
Sepsis quality measure
Treat with antibiotics within 1 hour
Blow flow through the heart
Tricuspid regurgitation occurs in RA
When doing a MMSE (mini-mental state examination) have visitors leave room? True/False
True
First test to order with a male presenting with BPH?
UA
48 year old with fever, abdominal pain, and bloody diarrhea with history of chronic sinusitis, arthritis, and recent DVT. Which presents the most likely diagnosis and test order?
Ulcerative colitis, Sigmoidoscopy
35 year old Asian American is in good health. He is worried about life-prolonging measures. What is the most likely cause of death for a man like him?
Unintentional injury. If he is African-American is homicide. <35 and heart disease at 35
What are normal urine osmolality levels, serum osmolality, and urine Na+ levels?
Urine osmolality- 300-900 Serum osmolality- 275-295 Urine Na+- 20-30
What do you do for a Venous stasis ulcer?
Use compression stockings
CN both motor and sensory?
V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus)
You are examining a patient with past medical history of seizures. Patient sustained a seizure lasting around one minute. What is the most appropriate intervention?
Valium 5-10 mg IV
Leukemia + COPD: low WBC, CXR and ABG pretty normal, lungs diminished and you give steroid:
Ventilate
You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that works. What ethical principles does this challenge?
Veracity and Fidelity
What is the Somogyi effect?
When blood glucose levels drop too low in the middle of the night, the body tries to compensate by rebounding into hyperglycemia
Women ETOH has liver disease but husband does not. Who is more likely to get liver disease?
Women are likely to get liver disease while drinking less than men
If I insurance company calls to verify some patients appointments what do you do?
You assume there's already a medical release signed by the patient and give the requested information to them
What antibiotic do you use for bowel obstruction?
Zosyn
What is the DIC confirmatory test?
^ FDPs
Which national measure is more important to prevent VAP ^ HOB or frequent oral care?
^ HOB 30 degrees
45 y/o male s/p ABD Sx has now developed ARF: BUN 100/Cr 4.5, indications for dialysis?
^ K, metabolic acidosis, & encephalopathy
What CSF values are characteristic of bacterial meningitis?
^ opening pressures, ^ protein, ^ WBC, decreased glucose
Your ventilated patient has these settings: SIMV, FiO2 60%, PEEP 5. You notice pulmonary shunting. What is your best action? a. Increase PEEP to 10 b. Order a beta agonist inhaler c. Increase FiO2 to 70% d. Add +5 pressure support
a. Increase PEEP to 10
The mother of a 19 yo female calls you with concerns about her daughter's asthma attack. She tells you that she is SOB and has difficulty speaking in sentences. She adds that her usual medicine, alupent (Albuterol), is not working. Which of the following should the mother administer to treat the asthma attack? a. Ipratroprium bromide (anticholinergic) b. Aqueous epinephrine c. Albuterol d. Metaproterenol
a. Ipratroprium bromide (anticholinergic)
Neurogenic Shock Treatment?
airway, IVF, vasopressors (dopamine, norepi, ephedrine)
What kind of shock is exhibited by the following values? PCWP 18, CI 2, SVR 1800 a. Distributive b. Cardiogenic c. Obstructive d. Hypovolemic
b. Cardiogenic (only one with high wedge)
Which antiemetic blocks the 5-HTS serotoniin receptor and can cause extrapyramidal symptoms? a. Ondanestron b. Metoclopramide
b. Metoclopramide
Your anaphylactic patient is wheezing and states she feels like her throat is closing. What is the priority action? a. IV steroids b. Give epinephrine c. Intubate d. IV benadryl
c. Intubate
Which med must be on the d/c list of a patient admitted for CHF? a. Sotalol b. Norvasc c. Lisinopril d. Losartan
c. Lisinopril
Your patient needs to start treatment with a DMARD for RA. Which is the least expensive? a. Hydroxychloroquine b. Sulfasalazine c. Methotrexate d. Leflunomide
c. Methotrexate
Your intubated patient has sounds coming out from around the tube. What is the cause? a. Mucous plug b. Bronchospasm c. Tracheoesophageal fistula d. Cuff insufficiency
d. Cuff insufficiency (air leak)
What is healthcare exchange?
health insurance marketplaces= orgs. in each state thru which people can purchase health insurance
What are abnormal labs in hyperthyroid?
high T3, T4, resin uptake TSH >5
What is SIADH?
inappropriate water retention, CNS d/o, retain water, hypothermia, hyponatremia, Decreased sOS, ^ urine osmolality (concentrated), urine sodium >20 mEq (kidneys trying to excrete water via salt) Need 3% hypertonic fluids calculated
AIDS CD4 count
less than 200
What are abnormal labs in hypothyroid?
low T4, low resin uptake (T3 not reliable test)
What is quality assurance?
process for evaluating the care of patients using established stands of care to ensure quality
What is sensitivity?
the ability of a test to detect disease (POSITIVE)
What is peer review?
timely, no anonymous & NP nows how peer review will impact early evaluation
Aspirin overdose signs and symptoms?
tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis