Nursing > Solutions Guide > Frances Guide Qbank to Pass Your Adult-Gerontology Acute Care (AGACNP) Certification Exam Updated 20 (All)
Everyone who passed the Adult-Gerontology Acute Care (AGACNP) Certification Exam knows that one of the best resources is the Frances Guide. AGACNP - Based on Frances Guide Review Answered. You wa... nt to get more funding for your hospital's Rapid Response Team. How should you present this issue to the committee? a. Stress importance of the team (look up evidence about how team affects outcomes) b. Describe how to improve and expand the team 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 your local congressman d. review literature and give more in-services 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 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 What is the best way to advocate for gay and lesbian population? a. participate in a high state or national level b. join a non-profit advocacy group c. consider lobbying the government d. start at your facility Which of the following is most important to evaluate statistical significance when reviewing the literature? a. consider the sample size b. make sure the confidence interval is tight c. see if the p-value is less than the alpha-coefficient d. determine the error rate When closing a practice, the NP is required to do all of the following except a. give the patient adequate time to find another provder 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 Which of the following components of an evidenced based research process is the most important for NP to participate in? a. specifying methods of data collection b. formulating the hypothesis c. carefully reviewing the literature d. formulating the research problem A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander Can you tell the patient's wife, for her protection, that her husband has HIV? How can the ANCP prepare to get involved in future mass casualty event? 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? Your patient is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: 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 workds. What ethical principles does this challenge? Health literacy Quality assurance CPI Answer- A root 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: Which clinical scenario does the NP evaluate for a quality improvement process change? Goals set forth in healthy people 2020 by the US department of Health and Human services include: Based on the individual's culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership with the patient by: A 70 year old patient with a history of DM, HTN, OAs, and a new diagnosis of CAD, is being discharged. The adult-gerontology acute care NP teaches the patient that the first point of contact for health care needs is the: 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? What legislation allowed NPs to be recognized Medicare providers in all geographical areas with their own provider number? True/false: restraining an unwilling patient is grounds for malpractice? Patient presents to the clinic for routine f/u and passes out. You revive the patient and admit overnight. Which of the following would qualify as incident to billing? The NP program initiated, primarily, because of what issue in healthcare at the time? Elderly 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? Patient calls to complain about bills and states he has Medicare, which should cover all costs. You explain: Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient... Patient in ER not doing well, primary MD calls: NP working on ESRD research project. A colleague renal specialist asks for patient info on your patients: Who enforces HIPAA? Who isn't covered by HIPAA? Insurance company calling to verify some patient appointments? Benchmarking Managed care Peer review Sensitivity vs specificity There was a question where a patient had a multinodular goiter and wanted to know why the NP was not going to do periodic US and fine needle biopsy in monitoring for some kind of cancer or complication. The answer I picked was that these tests were not very specific to detect the cancer Reliability Validity of results in an article Statistical significance Privileging Who determines scope of practice? Case management 50-60 year old patient ith a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? a. consult CM b. Consult SW c. refer to Oncology d. refer to Hospice Nondisclosure Negligence 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? Living will NP sees a patient for HF and performs an H&P. What % is expected to be paid? Focus of palliative care asic improvement in QOL of anyone with an illness at any stage Hospice Scope of practice: integration of care across the acute illness continuum with: a. collaboration b. coordination of care c. research based clinical practice Collaboration Patient is getting d/c'd and need wound care, pulmonary, and follow up. NP's role is to: oordinate services Government is moving towards being cost effective. What is the best way? Protected health information: discussion between the NP and consultant on case onsidered clinical relevance How should the ACNP stay up to date with current information? Which medicare is Hospice covered under? A patient presents to the Er with c/o CP and SOB. The NP misinterprets the EKG and admits the patient fro further monitoring without consulting cardio. 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? Healthcare exchange You notice there have been less favorable outcomes and satisfaction surveys in 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 tx plan for all patients that can be used by all healthcare staff d. form individualized tx plans that can be used by all healthcare staff You have transferred a patient to the SNF. The MD in charge at that 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 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 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 Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserves 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 A patient visits 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 appt c. perform the pap today d. do a vaginal exam only, and refer the PAP to a gyno A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: a. refer her to gynecologist b. schedule her to come back c. perform the PAP today d. do a vaginal exam only, and refer the PAP to a gyno Discharge planning is udnerway for a patient who has been very dehabilitated 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 Your patient presents to ED w/ R wrist pain. She states, "it's my fault; I should have had dinner ready on time." What do you do? a. Tell her not to go home bc it's not safe b. XR the wrist c. call the police d. consult psych Now the husband presents to the ED with drug overdose. What is your action? a. Hand him off to anothe rpractitioner b. call the police c. consult psych d. treat him without prejudice The medical resident obtained 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 Your HIV positive patient is preparing to discharge when he tells you not only that he has passed 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 Your clinical student breaks the sterile field. HOw do you handle this situation? a. discuss it with the student b. report it to the charge nurse c. report it to the unit manager d. inform the faculty in charge of the student 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 unit currently d. the attending MD who is at home A code you are in does not go well, and staff members afterwards are 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 Your patient is not doing well and family/wife is at bedside crying. Yo are preparing to talk to the family. What do you do first? a. place a social work consult b. explicitly explain the situation, the outcomes and 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 Your patient is not conscious. HIs advance directive states he wants to be a DNR, but his family says 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 directive A patient comes to the ED at a community hospital who is 29 weeks pregnant. She says her water has broken. Her VS are stable. What do you do? a. transfer her to a tertiary facility b. contact her OB/GYN for treatment advice c. admit to l/d d. consult the nurse midwife Your 51F patient is getting ready to discharge when she tells you she hasn't had a mammogram in 3 years. What do you do? Your patient's 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? 35yo F presents with c/o bilateral wrist pain. You suspect spouse abuse. You notice a handgun in her purse. What would be your next action? Adult child of a patient reports that her father has expressed desire to commit suicide and has a hx of ETOH and depression. The best response would be to? You notice that another NP in your group is frequently contact by pharmacy for prescription errors. How do you handle the situation? Your patient voices concerns because he has lost his insurance and worries his children will no longer have coverage for medical expenses. What do you do? 80yo patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the NP: A 40yo female patient with no PMH is admitted with bilateral PE. W/u reveals a psoitive result for lupus anticoagulant, and anticoagulant therapy is planned. The patient verbalizes concern about her ability to manage the appointments and the follow up care. The NP's most effective intervention si to: rrange follow up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge What procedure does the AGACNP perform to evaluate cytology, only, in the tumor? A patient has fully recovered from septic shock due to bacteremia and has been accepted to a LTC facility for continuation of abx. ID has not seen the patient in two days. The NP: ontacts the ID MD to determine the appropriate abx duration 32yo M presented with a gunshot wound (GSW) to the FA. Injuries are negligible and pt is stable. Pt reports the shot was an accident during hunting. What should the NP do? What is the most important when assessing status? A woman of child bearing age c/o abdominal pain. What level of exam do you document? A diabetic patient complains of abd pain. Which type of exam do you conduct? What qualifies patient for HHC Patient is refusing care? Guy in ER needs refill on ritalin Knowledge deficit in ICU, what would you do for nurses? A patient has advanced dementia, ESRD, and HF, what do you do for him? Your 24m patient has been out hiking on vacation. He shows you the following rash, and thinks he has Rocky Mountain Spotted Fever. What is his diagnoses? 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 the illness is her fault b. embarrassment from the examination c. a sign of respect d. a normal response Your patient speaks only spanish and you need to evaluate his pain. What do you do? a. ask a family member to translate for you b. utilize the hospital's interpreter service c. call over the Hispanic housekeeper and ask her to translate d. Use a visual pain scale 58yo Japanese male with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the Ed warrant admission? a. age b. gender c. pain level d. ethnicity A 77yo male patient's wife cares for him at home .Which statement by the wife indicates a need for a 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 Which psychiatric disorder is most commonly diagnosed, yet least commonly treated? a. bipolar disorder b. alzheimer disease c. depression d. dementia Your patient with PNA is noted to have a heavy drinking habit. 2 days post admit he becomes combative/agitated. What is tx? a. IV valium b. IV ativan c. PO librium d. lasix Your patient 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 How long will it take to begin to see healing in a pressure ulcer that has a clean, well-vascularized bed? a. 7 days b. 2-4 weeks c. 2 days d. 4-6 weeks 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 Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication? a. compartment syndrome b. decrease in ROM ability c. septic shock d. osteomyelitis What is the strongest predictor of functional impairment prior to discharge of the elderly patient? a. advanced age b. incontinence c. cognitive impairment d. poor balance Your patient has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.2) a. give IVF b. antipyretic c. abx d. ice packs to groin and axilla 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 Your patient has a fever 3 days post op, WBC are 15k, blood cultures negative, and Eos 9%. What is the diagnosis? a. viral infection b. bacterial infection c. malignant hyperthermia d. drug fever (eos=allergic reaction, normal is 1-4%) What are protein supplements best used for? a. eliminate the need for lipids b. prevent anasarca (peripheral edema) c. aid in post op healing Which macronutrient of TPN significantly increases the osmolality of the solution? a. lipids b. dextrose c. mutivitamin d. potassium Protein in nutrition for what reason? Which electrolyte are you most concerned about monitoring in cachexic patient? a. mag b. ca c. na d. k . refeeding syndrome, hypokalemia and hypophosphatemia Which electrolyte do you monitor in refeeding syndrome? Which lab do you monitor daily in a patient on nutritional supplements? a. BMP b. cbc c. abg d. blood culture (LFTs weekly) What alternative therapy can you order to relax the patient prior to procedure? a. massage b. aromatherapy c. music d. muscle relaxant What alternative therapy can you use to help/distract them from their pain during the procedure? Answer- Guided imagery Which alternative therapy helps Parkinson's patients with coordination? a. acupuncture b. tai chi c. relaxation techniques d. hypnotherapy (also helps prevent falls in elderly) Which 2 headaches are treated with triptans? What kind of dressing do you use on a decubitus ulcer with necrotic tissue? 45yo s/p double mastectomy 2 months ago. Now is c/o pain at the incision site What does the leg/foot look like in a hip fracture Pt has a post op fever... WHO pain ladder... Best pain indicator... Best alternative therapy to decrease pain in clavicle fracture: Answer- Therapeutic touch/reiki (hand or palm healing that transfers 'universal energy' has been used for cancer, emotional, or physical healing) Picture of gunshot wound to the R lung area Cocaine induced psychosis Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms with dilated pupils Answer- Sympathomimetic (cocaine or meth) Antidepressant OD Answer- s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension (can't see, can't pee, can't spit, can't shit) Antidepressant OD treatment Answer- ICU if CNS or cardio toxic, activated charcoal NaHCO3 for dysrhythmias and maintain pH, benzos (valium) for seizure (if serotonin syndrome: dantrium/dantrolene sodium) ASA overdose ASA overdose treatment ctivated charcoal, NaHCO3 for severe acidosis of <7.1, monitor ABGs How do you treat group A strep on skin Pt has cellulitis of lower extremity with a wound, what do you treat with? as Mallampati grades for visualization of oral cavity: 4. none Osteomalacia Hospice vs palliative care Venous stasis ulcer Indication for tetanus shot irty wound and haven't had a tetanus shot in five years Tdap vaccine is an example of what type of immunity ctive immunity How often should a woman between the ages of 20-39 have a PAP with HPV If born on or after what year is it indicated to receive 2 doses of mumps vaccine? What age does an individual receive zostavax? When should PSA levels be initiated and how often? Annual PSA and DRE are indicated in what group? Pt has normal PAP smear and reports that she has not had an abnormal PAP for past 10 years. What is the appropriate age to DC? 35yo 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? What is the leading cause of death in African american males ages 40-59? AD What is the leading cause of deaths in hispanics in the US? The most common cause of hyponatremic hyperosmolality a. hyperglycemia b. hyperthyroidism c. adrenal insufficiency d. k sparing diuretics What method should you use to treat hyponatremia related to SIADH? a. bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200ml/hr d. 3% hypertonic saline ,calculated What is a potential cause of hyperkalemia? a. carafate b. NSAIDs c. centrally acting HTN meds Your patient has a Na of 128 and was treated with colloids 3 days ago. What is a treatment? A 68yo patient had sx three days ago to repair a AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFT's are normal, no s/s CHF, the patient's laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0.8 mg/dL, PaCO2 of 37mmHg. Which 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 Your patient has a serum osmolality of 268 mOsm/kg and a 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 (Na<10 is nonrenal cause. Diuretics are associated with renal cause, urine na >20) A 61 year old female c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating 'abnormally' and she has been experiencing muscle spasms on occasion. You order and EKG and find decreased amplitude and broad T waves. Occasionally you also note prominent U waves. Of the following, which is the most likely diagnosis? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypermagnesemia Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except: a. hypernatremia b. pneumothorax c. HHNK d. GI bleed 65yo male with c/o n/v/constipation x several days and a six pound weight loss. Pt s/p TKR severral weeks ago and reports not getting off the couch. What electrolyte is altered? Pt with s/s of abd distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the patient has a fluid and electorlyte problem. Which of the following is he most likely experiencing? ABG reads high HCO3 and pCO2 55mmHg. What electrolyte abnormality is most likely associated with these values? Pt has a fever and tachycardia, and hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status Low serum Na and high serum osmolality A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give: Low protein = Low BUN = A patient who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lbs (59.9kg), is intubated and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2o. Clinical signs include tachycardia and hypotension. The initial treatment is to: Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse patient? What electrolyte should be monitored prior to administering succinylcholine? Answer- K ASA overdose, which electrolyte do you monitor? What sx is associated with hepatotoxicity s/p acetaminophen toxicity? elirium Patient at high risk for hyperkalemia? Tube feeding side effects iarrhea: decrease the osmolality of the tube feeding What patient requires labs to be monitored closely after intiating Tf? lcoholic with decreased intake over the past 2-3 weeks What disorder can be ruled out using the Cosyntropin stimulation test? a. Cushing's b. DI c. Adrenal insufficiency d. SIADH What side effect of levothyroxine is most likely to lead to non-compliance when first initiated? a. alopecia b. dyspepsia c. weight loss d. nevousness 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 What method should you use to treat hyponatremia related to SIADH? a. Bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200mL/hr d. 3% hypertonic saline, calculated For the past few months, 29yo Janine has been gaining weight while experiencing amenorrhea and increasingly severe acnes. She has gained more than 20 pounds, and you note that she is carrying her weight around her midline, with bilateral purple-ish striae across both flanks. You suspect CUshing's 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 In cushing's, pituitary does not respond to dexamethasone. Which of the following is NOT a criteria of metabolic syndrome? a. BP>140/90 b. waist >40 in c. TG>150 d. HDL <40 (it's 130/85) What are Cushing's labs/symptoms? Answer- Increased BG, increased Na, decreased Central obesity, moon face with buffalo hump, purple striae, amenorrhea What are Addison's disease labs/diagnosis/tx? ecreased BG, decreased Na, increased Cosyntropin test, positive if serum cortison <18mcg/dL in the morning Patient is hypotensive with Addison's disease. What is the treatment? What is SIADH, lab values, and treatment? Hypothermia, hyponatremia, decreased serum Osm, increased urine Osm, urine sodium >20 mEq (kidney's trying to excrete water via salt) Tx: 3% hypertonic saline calculated Urine Na 28, serum Osm 250, urine Osm 115. What is suspected dx? 23 yo female presents with DKA. Abg pH 7.3, glucose 520, BP 90/65, HR 120, and she is confused. Which of the following are not included in the initial management of DKA? a. isotonic fluids b. insulin infusion c. sodium bicarbonate d. supportive care (Only indicated for DKA if pH <7.1) 24 yo male presents with DKA. He is now confused and irritable. AbgL 7.29/33/22. Received isotonic fluids x 1 hour, BP 110/70, HR 90. Blood glucose is 550. What is the best IV fluid indicated? HHNK: what fluids should you use? Answer- NS for massive fluid volume deficit, then 1/2 NS to hydrate the cell, then D51/2NS if on insulin gtt What are Hyperthyroidism labs? Answer- High T3, high T4, resin uptake TSH >5, low TSH What are Hypothyroidsim labs? What are the s/s of thyroid storm/crisis? What is the treatment for myxedema coma? Patient with BP 210/110, headache, then BP decreases below 160s, what is 1st treatment? lpha blockers preoperatively, regitine/phentolamine, likely pheochromocytoma What is the first test you run when you see s/s of pheochromocytoma? What diagnostic test confirms pheochromocytoma? DKA fluids? What is the Somogyi effect? 15 year old patient with DMI reports increased BG in AM. The ACNP determines hyperglycemia is d/t dawn phenomenon? What should you do to his tx regimen? 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 Which of the following is least likely to experience a DVT? a. 24yo Female on oral contraceptives b. 74 yo male post hip replacement c. 58 yo male liver patient d. paraplegic The nurse calls you to report low BP in 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 You are assessing heart sounds preoperatively 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 US b. consultation to cardiology c. cancellation of surgery until next week d. echocardiogram Which of the following is contraindicated for a patient receiving a renal angiogram? a. beta blocker b. alpha blocker c. calcium channel blocker d. ace inhibitor Your 45 yo 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 (coumadin would be used in 65y+ or with positive risk factors/history) Which is best used to diagnose pulmonary HTN? a. bubble study b. presence of peripheral edema c. cardiac catheterization d. 2D echo (cardiac cath used for confirmation) Your patient 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 Your patient is preoperative 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 ultrasoud c. order abdominal CT d. document the mass carefully and send to surgery Your patient is postoperative after an aneurysm clipping. Which intervention is used? a. maintain SBP 140-160 b. place patient in a quiet room c. encourage visitors d. start decadron Your 67yo patient has a BP 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 Which of the following lipid panels shows 3 out of 4 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 Your patient is an obese 38 yo female wiht 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 (key word, obese) Which med must be on the d/c list of a patient admitted for CHF? a. sotalol b. norvasc c. lisinopril d. losartan (You have to pick out the CHF from the stem distractors, and the 31 yo male with a blowing murmur occurring during S1 and galloping addition heart sound. Mumur is heard best at the base of the heart. What is MM? When d/c'ing an 85 yo female patient with stasis dermatitis, the NP includes instructions to: An older man is a smoker and has been for years. He has shiny hairless legs. Which diagnostic test would you order? a. ankle-brachial index b. arterial doppler c. venous doppler d. d-dimer (PAD) A 70 yo patient with acute systolic HF 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? A patient with HF has dyspnea on exertion and sleeps all night while using 3 pillows. What is her NYHA HF stage? Treatment of heart block? Patient has an EF of 20% and a bronchospasm, what med caused it? What BP is hypertensive emergency? What BP is hypertensive urgency? What lab should you check with new onset Afib and what is the treatment? What grade murmur do you first hear a thrill? On physical exam, you note a moderately loud MM with no thrill. What grade? Pt has low diastolic rumble murmur in the left lateral position with no radiation? Patient presents with suspected mitral regurgitation. What physical findings would confirm? Tricuspid regurgitation occurs in... Stages of heart failure? Patient with history of HF, wet lung sounds, lower extremity edema, dyspnea, what is the cause of edema? What is the purpose of cardiac stress testing? STEMI guidelines, "door to needle"? STEMI guidelines, "door to balloon"? Patient is post MI, on a beta blocker and statin. What do they need? Which drug prevents cardiac remodeling? Patient with 14 hours of chest pain presents to ED, next step of action? Pericarditis s/s Best diagnostic test for Pericarditis Pericarditis treatment A patient post CABG with abdominal distention, diagnosis? Patient with PVD need to quit smoking, how would you address this using therapeutic communication? Venous stasis ulcer tx? How patient with DM and heart disease can decrease LDL non-pharmacologically? iet and exercise, lifestyle changes Temporal arteritis requires immediate treatment to prevent? lindness in the affected eye Patient in the ER with sudden LOC and motor function. The ER diagnosis is TIA. The patient has right-handed weakness and numbness. Carotid studies are completed and reveal 92-95% occlusion bilaterally. What is the next step? 62yo 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? What among the following is a common cause of pancreatitis? a. moderate ETOH use b. medications c. abdominal trauma d. cholelithiasis 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 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 Your patient is post op cardiothoracic surgery. She devlops nausea, periumbilical abdominal pain, moderate lipase, LDH, ALT, decreased Bs. What is the diagnosis? Your patient complains of tarry stools, change in stool caliber, and constipation. What intervention is appropriate? a. order more testing b. consult surgery for posible colon cancer c. give PRBCs d. consult oncology for chemotherapy 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 the dialysis tube Most critical symptom for diagnosing peritonitis/bowel perforation? a. guarding b. rigidity c. distention d. rebound tenderness What is GI angioplasty used to diagnose? a. hemorrhage of unknown cause b. uncontrolled bleeding c. cholelithiasis d. bleeding due to PVD 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 Patient presents with RLQ pain, 1-2 episodes of vomiting, and positive Psoas sign. What diagnostics are confirmatory for 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 (key is WBC, a CT would also work) 36yo with history of Crohn's disease arrives in the ER with c/o abd pain, frequent vomiting and water bowel movements. You notice high-pitched, tinkling bowel sounds and a transabdominal US reveals a partial SBO. Which is not necessary? a. NPO and IVF b. NGT for LIS c. immediate surgical consult d. monitor for spontaneous resolution 42 yo male with epigastric pain that is better after he eats? 65 yo ETOH use with 25y smoking history has dysphagia and epigastric pain. What is diagnosis? Answer- GERD On CXR notes air under diaphragm? Diverticulitis flare ups can be caused by? What is the treatment of diverticulitis? True/false: barium enema is indicated in the conservative management of diverticulitis? Answer- False Lab values of acute pancreatitis? 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 Which disorder worsens epistaxis? Bowel obstruction antibiotic? 49 yo male presents with c/o abdominal swelling that progressed over 2 days. Patient also reports mucous-filled diarrhea and abdominal pain. Exam is significant for profound abd distention. You suspect SBO. What type of bowel sounds are associated? Profuse vomiting and variable epigastric pain are 2 symptoms of what diagnosis? What is the presentation and treatment of crohn's? 48yo with fever, abdominal pain and bloody diarrhea with h/o chronic sinusitis, arthritis, and recent DVT. Which represents the most likely diagnosis and test to order? Young male with ulcerative colitis, what would be probable finding? Ulcerative colitis medications? What abx do you use for ulcerative colitis? Treatment for fulminant ulcerative colitis without s/s of systemic toxicity? WHen would you find "thumb printing sign" on abdominal xray? Radiologic sign of bowel wall thickening Both husband and wife abuse ETOH. Woman has liver disease but husband does not? Answer- Women are likely to get liver disease while drinking less than men What causes GI bleed in elderly? RF: Nsaid/asa/anticoagulant use Do not use protonix long term due to? Why would you pick a PPI over phenergan for treatment? Patient on PD dialysis has an infected dialysis catheter. What is the first thing you do? 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? Answer- Have the student review the clinical symptoms and query differential diagnosis What are the s/s of the icteric phase of hepatitis? What are the s/s of the pre-icteric phase of hepatitis? Answer- Fatigue, malaise, anorexia, n/v, headache, aversion to smoking and alcohol What is the most important assessment findin in determining a patient's mental status? a. orientation level b. attention c. memory d. affect 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 Pt is not normotensive d. documenting family opinion on whether patient is brain dead A nurse experiences a needle stick fro ma patient who has Non-a, non-b hepatitis. She has already had the HepB vaccine series. What is the next step? Answer- Obtain blood samples from the patient and the RN Your patient has a closed head injury and is ventilated. His abg's are: pH 7.48, pCO2 35, FiO2 40%, pO2 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 (CO2 in head trauma, 35 is the goal) Your patient has suffered a spinal cord injury. What sign indicates recovery has begun? a. increase in DTRs b. bradycardia c. edema d. moderating respiratory rate Your patient presents to 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 a contraindication to fibrinolytic therapy? a. time b. PMH c. age d. BP Your patient is s/p craniotomy and is about to d/c 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 appointment d. 2nd guess the RN assessment Patient has a hip fracture, carotid bruit, weakness, and confusion. What do you order? arotid us A patient was diagnosed with cauda 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 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 (includes SLP) A patient has hyper active reflexes of the lower extremities. The adult-gerontology acute care nurse practitioner assesses for ankle clonus by: Answer- Sharply dorsiflexing and maintaining the foot in this position, while supporting the knee Which muscle moves the eye from center to side and back? There is a patient with a TBI and increasing hypercapneia/lethargy. The NP is worried about ICP, what should she consider? What is the treatment for flare up of multiple sclerosis? What is the pathology of multiple sclerosis? What is the pathology of myasthenia gravis? What are the s/s of myasthenia gravis? What meds/tx of myasthenia gravis? How to conduct MMSE? Is the MMSe a reliable test? Dementia vs delirium? What is the number one cause of death in dementia patients? Patient with a 50% right sided carotid artery occlusion and right sided weakness that went away (TIA), what medication should be ordered? SA or plavix CVA tPA contraindication VA two months ago Chronic subdural hematoma presents with... Chronic subdural hematoma managmeent Latest sign that you have missed herniation? Homonymous hemaniopia Left middle cerebral artery infarct symptom phasia Sensory cranial nerves Cranial nerves that are both motor and sensory Which cranial nerve is involved when you place hands on either side of the patient's face and ask them to chew? In Status epilepticus when the medications are not working, the patient is desaturating, and the family cannot decide on code status, what do you do? What is Cauda equina syndrome? S/s include pain, numbness, tingling, low back pain radiating to legs S1-s2: weak plantar flexion with loss 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, cancer, infection, inflammation What i the pathology of Parkinson's disease? You are examining a patient with a PMH of seizures. Pt sustains a seizure lasting around 1 minute. What is the most appropriate intervention? Initial action taken in a patient with new onset seizures? 60 yo male presents to ER and his child reports he passed out on the care while driving, regained consciousness and was drooling and out of it. Patient's HR and BP are decreased. You give Nimodipine. What is the rational for administering Nimodipine to this patient? What CSF values are characteristic of bacterial meningitis? Answer- Increased opening pressure, increased protein, increased WBC, decreased glucose Your patient has swallowed a foreign object (coin) and it is lodged in the Cspine area according to XR. How do you get it out? a. a surgery with forceps b. bronchoscopy c. tracheostomy d. allow the coin to pass Your patient has a gunshot chest wound. What kind of dressing does he need? Allows air to escape, but not enter (and thus can be trapped) in the lungs, so as not to cause a tension pneumothorax when the patient exhales and 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 the chest cavity when the lungs are full of air. Your patient is 3 days post appendectomy and develops dysphagia, drooling ,and expiratory stridor. What is going on? Your patient is ventilated and becomes confused with arm edema. What low cost test do you order? a. d-dimer b. us c. VQ scan d. ankle brachial index Your patient with VAP is on broad spectrum coverage including levaquin, cefepime, and vancomycin. Your culture comes back growing pseudomonas. What do you do now? Answer- Narrow the spectrum (d/c vanc) Which of the following does not cause hypoxemia? a. hyperventilation b. hypoventilation c. decrease in atmospheric O2 d. right to left shunt What is the initial finding in pulmonary embolism? a. respiratory acidosis b. respiratory alkalosis c. metabolic acidosis d. metabolic alkalosis Your 32 yo male patient has a history of MVR and c/o wheezing with exercise. What is your order? a. pulmonary consult b. PO steroids c. PFTs d. SABA 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, is not working. Which of the following should the mother administer to treat the asthma attack? a. metaproterenol b. albuterol c. aqueous epinephrine d. ipratroprium bromide (anticholinergic) Alupent is albuterol, metaproterenol acts the same way and aqueous epinephrine should only be used if the patient won't cooperate A 36yo patient who has a history of asthma comes to the Ed in a fatigued state. She has difficulty speaking d/t respiratory distress but is able to explain that she is recovering from a cold, but her s/s are so severe that she came into the ED. HR is 118, FVC WDL, FEV 1 45% of expected value. You order metaproterenol 0.3 mL in 5% solution, but the patient does not respond. Now what? a. aqueous epinephrine b. albuterol c. methylprednisolone d. montelukast Your patient with asthma has decreased breath sounds on presentation. You give a nebulizer treatment. Now the SaO2 is decreased to 86% and there are no breath sounds. What do you do? a. stat nebulizer b. abg's c. epinephrine d. intubate A 51 year old male is admitted to the ED with severe dyspnea. The patient's history indicates emphysema. The NP orders O2, since the patient 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 What is the earliest sign of Pna in the elderly patient? a. dyspnea/SOB b. tachypnea c. fever d. hypoxia Your patient is a 79 yo male japanese immigrant. What TB induration measurement is diagnostic? a. 3mm b. 7mm c. 11 mm Your asthmatic patient is on a SABA and ICS. She has no secretions but her symptoms are still not well controlled. What do you order next? a. salmeterol b. ipratroprium bromide c. montelukast d. metaproterenol (LABA) Your patient on albuterol has had multiple trips to the ER in the past three months. what should you add? n ICS, flovent What is paradoxical abdominal and diaphragmatic movement? a. symptoms of anxiety disorder b. asthma ominous sign c. respiratory bacterial infection Which of the following is reason to intubate in an asthmatic patient? a. RR in the 30s b. bad ABGs c. SaO2 in the 80s d. change in behavior What history do you ask about before you prescribe a sleep aid to your 69 yo patient? a. seizure b. depression c. heart disease d. OSA Your patient is an RN with a positive PPD. Her CXR comes back negative. What do you do now? Which national measure is most important to prevent VAP? Patient with SOB and dry cough. CXR reveals generalized inflammation throughout, numerous poorly defined small (<5mm) opacities throughout both lungs, sometimes sparing the apices and bases What do you see on CXR with airspace disease? A pattern of fine reticulation may also occur What is the diagnosis and treatment when XR reveals blunting of costophrenic angles? What is the diagnosis when CXR reveals Kerley B lines? Answer- Pulmonary edema What are the lab values in exudative effusion? When is the greatest risk for mechanically ventilated patient to contract VAP? Common bacteria in VAP? Treatment of Pseudomonous pneumonia? 37 yo s/p ET intubation 2 days ago has fever, chills, and purulent sputum. CXR shows lung infiltrates. Which of the following regimen for the patient's condition? Spontaneous pneumothorax is common in what disorder? Most important HPI questions in patient with hemoptysis? Pathophysiology of PE? What is the best non-pharmacologic treatment in a patient with end stage COPD? i Which med decreases mortality in COPD? (salmeterol/fluticasone) Example of a patient most likely to have emphysema? Maintstay of COPD treatment? Answer- Symphathomimetics (albuterol) What PFTs show asthma? Most important in a status asthmatic patient who was extubated? A patient has TB and lives with 6 other people. Do you treat the 6 other people or test them? A patient who has HIV tests positive for TB, what is the treatment? Pt presents with night sweats and dry cough with weight loss. You suspect TB. What is diagnostic? 38 yo 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? What confirms the diagnosis of pneumonia? Is the pneumonia vaccine recommended for asthmatics or smokers ages 19-64? An elderly woman who has a history of lung dysfunction comes to your office. She presents with a number of respiratory symptoms. Most severe c/o head ache. What is the most likely respiratory diagnosis based on headache? cute bronchitis Your patient needs to start treatment with a DMARD for RA. Which is the least expensive? a. hydroxychloroquine b. sulfasalazine c. methotrexate d. leflunomide Where are bouchard's nodes located? a. DIPs b. PIPs c. MCP d. wrists Which of the following is NOT an early sign of HIV/AIDS? a. fatigue/vague abdominal pain b. fever c. weight loss d. night sweats Which of the following patients is most likely to get HIV? a. sex worker who doesn't use condoms b. MSM who doesn't use condoms c. IV drug user 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 Your HIV patient has CMV. What is the appropriate treatment? a. cefazolin b. ciprfloxacin c. fluconazole d. gemcyclovir (CMV is a virus) Your patient has RA and her corticosteroids are not working. What is your next step? Your patient stepped on a nail and does not know his last tetanus status. Do you give Td or Tdap? In which patient would sarcopenia be the most expected finding? Answer- Elderly patient Why are so many HIV patients noncompliant? HIV patient with petechiae on legs (bone marrow suppression) and leg weakness (malaise). What should you test for? HIV med side effects ESR elevated ,what should you suspect? In addition to positive serum ANA, what diagnostic is supportive of diagnosis of SLE? 28 yo female presents with fever, malaise, rash across the back and splinter hemorrhages, Hgb 10, positive ANA, UA, proteinuria, and elevated ESR. What is the suspected diagnosis? Which of the following drugs can cause lupus-like symptoms? What should you monitor while on methotrexate? What is Felty's sydnrome? Pt is c/o wrist/hand pain, swollen, and redness that is worse in AM and resolves as the day goes on. What diagnosis do you suspect and what diagnostic test would support it? How should you use a cane? 57 yo male with PMH of CV disease presents with c/o pain in both knees that is progressively worse throughout the day. What diagnosis do you suspect and what medication is contraindicated? What is associated with headache, fever, and elevated ESR? Answer- Temporal arteritis Best way to verify your treatment is working for open angle glaucoma? Which med is not indicated in the management of closed angle glaucoma? l 47 yo male comes in complaining of intense right eye pain which has worsened since he woke up. Eye exam: copious tearing/redness. What do you do to confirm the suspected diagnosis? What are elderly persons at risk for skin tears? Older lady with iron deficiency anemia is opening a jar and sustains a spiral fracture of her arm. Your patient's abgs come back as follows: pH 7.37, HcO3 19, pCO2 24. What is the diagnosis? 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 Your patient has tachycardia, anxiety, urticaria in recovery from a cardiac catheterization. What is the treatment? Answer- IV methylprednisolone, H2 blocker, and IV benadryl What kind of shock is exhibited by the following values? PCWP 18, CI 2, SVR 1800 a. distributive b. cardiogenic c. obstructive d. hypovolemic (Only shock with high PCWP) 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. bedside sitter c. insist the family stay at the bedside d. order sedation with holidays for neuro checks 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 (Shunting is due to atelectasis) 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 (air leak) 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, CVP 1, PCWP 4, SVR 700 b. CO 3, CVP 1, PCWP 3, SVR 1400 c. CO 3.5, CVP 1, PCWP 14, SVR 1300 d. CO 8.5, CVP 9, PCWP 14, SVR 1300 (Everything is low except SVR) 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 physical exam, the NP elicits RLQ pain when pressure is applied to LLQ. Her labs are: HR 140, SV 70, CVP 8, PCWP 4, SVR 600. Which of the following should be initiated for this patient? a. norepinephrine b. hydrocortisone suppositories c. epinephrine d. PRBC transfusion A 42 yo 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 in blisters. She rates pain as "extremely painful". You determine that he patient has burns over 20% of her TBSA, Which of the following most accurately describes the patient's burns? a. 1st degree burn b. Full thickness burn c. Partial thickness burn d. 3rd degree burn Indicative of early septic shock? First priority in a septic shock hypotensive patient? How would you know cardiogenic shock? Pt was stung by a bee and is in respiratory distress, what do you do first? 54 yo male s/p acute MI on levophed, epi, vasopressin and nitro. BP 160/75, now 81/50. Which med would you decrease? What pathological finding can cause both cardiogenic and obstructive shock? Hypovolemic shock treatment? Cardiogenic shock treatment? Obstructive shock causes and treatment? Neurogenic shock cause and treatment? Septic shock treatment? Basic vent settings? Lung protective ventilation Patient is 2 days post extubation, is now stable but failed swallow eval in ICU. Can you transfer to step down? Patient is decompensating and family isn't sure what they want to do. What do you do? What acid base imbalance indicates CRRT? What do you do to the vent in respiratory acidosis? Central line is placed, pain develops, in respiratory distress, absent breath sounds: Which valve condition is a CI for intra-arterial balloon pump? Lab for rhabdo? When to transfer burns? Patient was burned in explosion. Burns feature moisture on the skin with blisters and redness. He was burned on each arm, his face, and his neck. The patient wants to know what kind and how much of his body was burned. The NP states? Answer- 2nd degree burn to 28% of body Each arm is 9%, head is 9%, neck is 1% At bedside parasternal US reveals fluid in the pericardial sac. What is the initial action in managing this patient? Cervical spine xr of guy who hung himself is inconclusive? Testicular torsion treatment? A patient diagnosed with compartment syndrome should immediately receive what? Patient with tibia/fibula fracture started having s/s of compartment syndrome. What do you do next? To check for other sources of bleeding in a pelvic fracture? XR and FAST scan There is a trauma patient who is hypotensive and blood transfusion is needed. What does this place the patient at risk for? LeFort criteria determined by? Tx: trauma referral, stabilize and ship to tertiary hospital Which antiemetic blocks the 5-HTS serotoniin receptor and can cause extrapyramidal symptoms? a. ondanestron b. metoclopramide What can contribute to Dilantin toxicity in patient with DM? Answer- Hypoalbuminemia Which of the following anti epileptic drugs is the long term drug of choice for treating patients with convulsive status epilepticus? a. phosfenytoin b. diazepam c. phenytoin d. phenobarbitol Which of the following factors puts the patient at risk for drug toxicity? 52 yo female is concerned with hormonal replacement therapy. What are the associated SE? Hormonal replacement therapy has been shown to improve what dx? What is dantroline sodium/dantrium treatment used for? Detrol LA side effects nticholinergic effects: drying- xerostomia, constipation, dyspepsia, dry eyes, dysuria, headache Ginseng SE Metformin SE What should you monitor for when taking NSAIDs? How long should you monitor the opiate niave? How do you know a patient understands his coumadin instructions? Tamoxifen side effects St John's wort side effects ecreases effectiveness of digoxin, increased risk of serotonin syndrome Succinylcholine precautions Synthroid increases risk of what? How to ensure adequate synthroid use? What is an expected finding in TCA overdose? What would you monitor postop with serotonin HT3? What 2 herbs are associated with relieving menstrual symptoms? Elderly patient takes an herbal root t o help fight colds, however has a history of renal insuficiency. Which herb could exacerbate his diagnosis? Which of the following is not an indicator of prerenal failure? a. BUN/Cr ratio >10:1 b. FeNa <1 c. specific gravity > 1.015 d. urine na >40 A 34 year old female presents to the ED with severe flank pain, nausea, and vomiting. The patient states she had trouble urinating before the onset of her other s/s. A CT scan reveals a 2.5 mm stone in the L kidney just above the upper ureter. Which course of action is most appropriate? a. give IVF b. strain the urine immediately c. schedule lithotripsy (She may past stone on her own) Your 33 yo female 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 53 yo male c/o dribbling and nocturia. You suspect BPH, PSA 3.2. What confirms the diagnosis? A male patietn you have placed on an alpha blocker for BPH comes in complaining of increased urinary frequency. What do you do? Answer- Leave it alone, the med is working A 78yo male patient with CHF develops a bacterial UTI secondary to indwelling foley catheter. Pt has known allergy to PCN and sulfonamides. The appropriate choice for antimicrobial therapy is? Patient with history of Afib has maintained NSR with sotalol, is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is? A young female patient is in ED with vaginal discharge. After pelvic exam, the NP documents which finding? Your female patient presents with mucopurulent cervical drainage, fever 102F, adnexal tenderness, and distended/rigid abdomen. What is the appropriate measure? Lower UTI treatment actrim, cipro, augmentin for 3d course Male patient with UTI on 3 day regimen of abx comes in requestion stronger abx, you order? UTI patient is allergic to PCN, you order? UTI during pregnancy, you order? Most common UTI etiology in women/men? Difference between upper and lower UTI? First test to order with a male presenting with BPH? Treatment of BPH At what age is the PSA screening indicated in non-African american male with no family hx? ATN causes? What is the leading cause of intrinsic acute renal failure? Renal disease gives what metabolic abnormality? What is the cause of anemia in renal failure? What is azotemia? UN >100, treatment is dialysis What should the dietary protein requirment be with chronic renal insufficiency? Chronic renal insufficiency results in what calcium imbalance? Gold standard for diagnosis of nephrolithiasis? Most common types of stones alcium 80%, gout = uric acid, women = struvite 45yo M s/p abd surgery has now developed ARF: BUN 100/cr 4.5, what are indications for dialysis? Treatment for chlamydia? 25yo female presents with green vaginal discharg,e what is the diagnosis? What are the s/s of gonorrhea in males and females? Females: dysuria, urinary frequency, abdominal pain, fever, n/v, yellow-green discharge Treatment for gonorrhea eftriaxone 125mg IM x 1, cervical culture with Thayer martin media, also give zithromax 1 gm PO x 1 to treat for chlamydia which is often a coinfection Report to health department Patient is sexually active with gonorrhea who is not practicing safe sex, what do you do? Minor with STI, what do you do? What is the confirmatory test for diagnosing syphilis? When treating a patient diagnosed with syphilis, what drug allergy is most important to consider before initiating? Which lab value is expected in iron deficiency anemia? a. elevated MCHC b. elevated TIBC c. elevated MCV d. none of the above (>450) Which vitamin is appropriate for a postoperative patient with alcoholism? a. D b. K c. B1 d. A (thiamine) Your patient is a 30 yo greek female with microcytic anemia who has just returned from the middle east. What lab is not expected in her anemia? a. low serum ferritin b. low hgb c. tibc 300 d. MCHC <32% (<15) What does allopurinol prevent in non-hodgkin's lymphoma? a. gout b. hypokalemia c. n/v d. tumor lysis syndrome Your patient is on 5FU for chemotherapy. What symptoms are most likely to cause discontinuation of treatment? a. alopecia b. mouth sores c. n/v with mucosal irritation Which of the following is not associated with anemia of chronic disease? a. HIV b. COPD c. SLE d. ulceratie colitis A 32 yo patient who underwent an open splenectomy for a ruptured spleen is preparing for discharge. An ACNp review the potential complications with the patient. The NP emphasizes which instruction to the patient? 32 yo 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. What is the diagnosis? Your patient had an appendectomy and chemo for symptomatic relief of cancer. Is this curative or adjuvant treatment? Another name for macrocytic anemia? Iron deficiency anemia labs? What race is at highest risk for cancer? Pernicious anemia, odd neuro sign? Coagulation labs and what to give Hodgkin's lymphoma signs Lymphoma present in R axilla and R neck. What stage? Leukemia with low WBC, what to avoid infection? Leukemia + COPD, low WBC, CXR and abg normal, lungs diminished? What is DIC confirmatory tests? Passive immunity? ITP treatment? Sickle cell anemia crisis treatment Jehovah's witness needs transfusion but is refusing blood products. What alternative can you give? What is deficient in Von Willebrand disease? What is treatment of Von Willebrand disease? What does cosyntropin help to rule out? What is drug of choice for rate control with a fib? What do you order if you need to assess the galbladder? What do NSAIDs place patient at risk for? What increases risk of toxicity for diabetic patient? What are the three CPI measures to improve nursing? Medical futility What does living will indicate that an advanced directive does not? What are the 4 roles of a NP? What do you use to treat a venous stasis ulcer? Most likely age for AIDS related death? What has lucid interval? Daily med for AIDs patients to prevent leading cause of death? What stage NYHA has symptoms at rest? What is the sound with the R wave? What is least likely RA joint? Is fulminante hepatitis with liver failure common with Hep A? What herbal is commonly used for S&S of enlarged prostate? What can cause cardiogenic or obstructive shock? What is treatment for insecticide ingestion? Patient has an NSAID induced GI ulcer but has to continue taking NSAIDs what is the best medication to give? What age should the herpes zoster vaccine be given? How often should a women have HPV smear test between 20-39? [Show More]
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