NRNP 6531 Final Exam part two (180 Questions) and Answers with Rationale 2022/2023

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A patient has symptoms of carpal tunnel syndrome. Which diagnostic tests will help confirm this disorder? (Select all that apply.) a. Anti-nuclear antibody (ANA) b. Electromyography c. Erythrocyte ... sedimentation rate (ESR) d. Nerve conduction studies e. Plain radiographs - ANS: B, D While diagnosis may be made on history and physical findings, electromyography and nerve conduction studies can be helpful to confirm or exclude carpal tunnel syndrome. ANA and ESR testing are useful when rheumatoid arthritis is suspected. Plain radiographs are not useful. A patient is diagnosed with polymyalgia rheumatica (PMR) with giant cell arteritis. Which dose of prednisolone will be given initially? a. 15 mg daily b. 20 mg daily c. 30 mg daily d. 60 mg daily - ANS: D Although the usual starting dose to treat PMR is 15 to 20 mg daily, a higher dose of 60 mg daily is used when there is evidence of concomitant giant cell arteritis. A patient who is taking prednisolone 20 mg daily to treat polymyalgia rheumatica reports blurred vision. What will the provider do? a. Discontinue the medication b. Increase the prednisolone dose to 60 mg daily c. Prescribe NSAIDs to treat the inflammation d. Refer to a rheumatologist immediately - ANS: D Sudden vision loss, diplopia, and other visual disturbances may indicate giant cell arteritis (GCA) and requires immediate referral to rheumatology. The primary provider should not change the medication regimen without a consult A 60-year-old patient reports new onset of bilateral shoulder pain with morning stiffness lasting approximately 1 hour. Which will be included in initial diagnostic testing for this patient? (Select all that apply.) a. Antinuclear antibodies b. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) c. Liver function tests (LFTs) d. Protein electrophoresis e. Serum calcitonin - ANS: B, C, D ESR, CRP, and protein electrophoresis are included in the initial diagnostic workup when polymyalgia rheumatica is suspected. ANA testing is not specific for this disorder. Serum calcitonin is not indicated. A provider performs a nail fold capillaroscopy on a patient who reports marked color changes of both hands with cold exposure and notes tortuous and dilated capillary loops. This finding is consistent with what condition? a. Polymyositis b. Primary Raynaud's phenomena c. Scleroderma d. Secondary Raynaud's phenomena - ANS: D Microvascular abnormalities like tortuous of dilated capillary loops are observed in secondary Raynaud's phenomena and capillaroscopy is used to differentiate primary from secondary Raynaud's. These findings are not present with polymyositis or scleroderma. A patient has secondary Raynaud's phenomena with severe digital ischemia. Which treatment is indicated for this patient? a. Ginkgo biloba b. Intravenous prostaglandin E1 c. Oral nifedipine d. Sildenafil as needed - ANS: B Intravenous prostaglandin E1 is reserved for patients with secondary Raynaud's phenomenon who have severe digital ischemia. Ginkgo biloba is associated with adverse effects and has not been shown to be effective. Nifedipine is used to prevent vasospasm in milder cases. Sildenafil may be used as a vasodilator in milder cases. A patient has swelling and tenderness in the small joints of both hands and reports several weeks of malaise and fatigue. A rheumatoid factor (RF) test is negative. What will the primary care provider do next? a. Begin treatment with a biologic disease-modifying anti-rheumatic (DMARD) drug b. Order radiographic tests, a CBC, and acute-phase reactant levels c. Reassure the patient that the likelihood of rheumatoid arthritis is low d. Refer the patient to an orthopedic specialist for evaluation and treatment - ANS: B The patient has signs of rheumatoid arthritis (RA); the RF test may be negative initially but will become positive in 70% to 80% of patients. The provider's next step is to order tests to confirm the diagnosis and to provide a baseline to monitor disease progress and response to treatment. DMARDs may be ordered when the disease is confirmed. The PCP may treat in consultation with a rheumatologist who will order medications and will refer the patient for physical therapy, occupational therapy, and psychotherapy. A patient is diagnosed with rheumatoid arthritis (RA) after a review of systems, confirmatory lab tests, and synovial fluid analysis. What will the provider order initially to treat this patient? a. Disease-modifying anti- rheumatic (DMARDs) drugs b. Long-term glucocorticoid therapy c. Non-pharmacological treatments d. Nonsteroidal anti-inflammatory drugs (NSAIDs) - ANS: A Treatment with DMARDs should be initiated as soon as the diagnosis of RA is established to achieve disease modification. Long-term glucocorticoid therapy is not recommended because of adverse effects. NSAIDs are not first-line drugs and increase the risk of cardiac and renal complications. NSAIDs are used as adjunctive and not first-line therapy. Which are symptoms of rheumatoid arthritis (RA) that distinguish it from osteoarthritis (OA)? (Select all that apply.) a. Extra-articular inflammatory signs b. History of injury to affected joints c. Morning stiffness of at least 1 hour d. Symmetric tender, swollen joints e. Unilateral joint involvement - ANS: A, C, D The clinical presentation of RA includes extra-articular symptoms, morning stiffness lasting at least 1 hour, and symmetric, bilateral joint involvement. OA often has a history of previous injury and is usually asymmetric and may be unilateral. [Show More]

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