ANP 650 Final Exam: Questions and Answers with Rationales, Exams of Nursing

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ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Qualifying factors for acute rehab - correct answer - ability to tolerate 3 hours of therapy per day

• do not need to be able to shower themselves Which patient population do best in acute rehab? - correct answer - stroke
• total joint
• hip fractures
• head injuries Tertiary prevention: - correct answer treating the complications of a disease HMO: - correct answer A group plan offering prepaid medical care to its members. Negotiated fees, paid by diagnosis LTAC Medicare reimbursement criteria: - correct answer Patients who have been in the ICU at least 3 days and will be on the vent at the LTAC for 96 hours Hospice medicare reimbursement - correct answer Most people only qualify for home hospice, but medicare will only cover intermittent care, comfort related medications Respite care - correct answer a type of care provided for caregivers of homebound ill, disabled, or elderly patients. 1 week per benefit period. Red flag for spinal injury - correct answer - Incontinence
• Altered sensation to extremities compartment syndrome - correct answer 4 P's
• pain
• pallor
• pulselessness
• paresthesia Example of pathological fracture - correct answer CA - tumor causing bone to break Frailty fracture - correct answer osteoporosis What chronic comorbidity is very common and often associated with bone demineralization and frailty fractures? - correct answer CKD
• hyperparathyroidism causes bone demineralization and frailty fracture
• Hypercalcemia = calcification of vascular system (coronaries, valves)

ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Should geriatric patients with fractured hip wait to see ortho? - correct answer NO, hip fractures are urgent. Early stabilizations improves outcomes Fibromyalgia - correct answer diffuse pain Fibromyalgia comorbidities - correct answer psych / depression Fibromyalgia treatment - correct answer antidepressants, NSAIDs, physical therapy, trigger point injections (Opiates contraindicated) How does spinal stenosis present? - correct answer Neurogenic claudication (legs hurt on ambulation/ worsening pain when standing = compression) Symptom management for osteoarthritis medication: - correct answer - Acetaminophen: safest in elderly adults with HTN, GI bleed, or CKD

• NSAIDs: works better but higher risks When do you consider joint replacement for osteoarthritis? - correct answer After failed conservative management Would you promote someone with severe COPD to have a hip replacement? - correct answer No, they wouldn't have improved mobilization or quality of life How do you tell the difference btw osteoarthritis and inflammatory arthritis: - correct answer - Bilateral significant inflammation in inflammatory arthritis _ Inflammatory is worse in the morning, whereas worse in the night for osteoarthritis Term for boney abnormalities associated with osteoarthritis: - correct answer Herberden: most distal Bouchard: pip joints What medicine can cause musculoskeletal disease? - correct answer - Steroids: demineralization of bone
• ABX: tendon rupture (quinolones)
• Statin: myopathy Allopurinol v Colchicine - correct answer Allopurinol criteria: 2 gout flares per year Colchicine: acute gout flare Example of adjuvant therapy: - correct answer Tricyclic antidepressants (TCAs) for pain management Differential list for shoulder pain: - correct answer - Cardiac (MI)

ANSWERS WITH RATIONALES (VERIFIED ANSWERS)

• GI (gallbladder)
• Cervical spine (radiating cervical spine stenosis)
• Rotator cuff injury What musculoskeletal complication is associated with Crohn's disease: - correct answer Ankylosing Spondylitis (spinal fusion) Different classes of urinary incontinence: - correct answer - Urge: just used the bathroom and have to go immediately after but cannot make it in time
• Overflow: bed bound post void residual of >
• Stress: while working out
• Functional: patient has all 4 rails up and cannot go to the bathroom Workup for patient with urinary frequency: - correct answer - Symptoms
• Assessment
• U/A: r/o infection (-)
• Post void residual (-)
• Anticholinergic? Avoid in elderly (BEERs criteria) bc it causes urinary retention, confusion, altered mentation, orthostatic hypotension, & falls Is it ever normal for older adults to have bacteria in their urine? - correct answer Yes, only treat symptomatic bacteria in the urine Causes of proteinuria - correct answer - Renal failure
• Hypertension
• Rhabdo
• Nephrotic syndrome (threshold: >3g) Hematuria workup - correct answer - check ua with c/s
• ask about exercise, meds, foods, trauma
• if no history, CBC and 24 hour urine
• CT
• Sono
• Pt, PTT possibly

ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Hyponaremia workup - correct answer - Serum osmolarity

• Urine osmolarity
• Serum sodium
• Urine sodium Mechanism of anemia in ESRD - correct answer - ALL OF THE ABOVE
• Erythropoietin deficient
• Iron deficient
• Dialysis Calciphylaxis - correct answer Calcium accumulated when ESRD patients don't receive full dialysis (Medication that increases risk: warfarin) Pre-renal - correct answer - HTN
• HF
• Shock
• Hemorrhage Cause for post-renal/obstructive renal failure: anywhere after the kidneys - correct answer - Kidney stone
• Urinary retention Intra-renal failure: - correct answer - Toxins to filtration
• Infection
• Systemic reaction from ABX Patient compliant with 4 BP meds, SBP is still 180. What should be evaluated: - correct answer Renal artery stenosis (most common cause: atherosclerosis) Living will v Medical Power of Attorney - correct answer - Living will: you write your wishes
• Advanced directive: power of attorney speaks on your behalf when you cannot Palliative tx vs curative tx (regarding CA): - correct answer Palliative decreases symptoms of CA but does not cure A patient has a Cr of 4.0, is on MS Contin 90 mg 3x/day - correct answer Causes muscle spasms, toxic neurological issues, respiratory depression

ANSWERS WITH RATIONALES (VERIFIED ANSWERS) Tx for intractable nausea: - correct answer - Ondansetron (Zofran)

• Haldol and Ativan
• Dexamethasone
• Compazine (Prochlorperazine)
• Metoclopramide (Reglan) Tx for secretions: - correct answer - Glyco
• Atropine True or false: palliative care and hospice are the same - correct answer FALSE
• Palliative: complex life limiting disease (even with curative tx)
• Hospice: end of life care (<6 months) Difference btw capacity and competence (regarding state of mind): - correct answer - Capacity: ability to make decisions at a specific moment in time and they understand the consequences
• Competence: made in a legal arena by a judge to see if the person can manage their own affairs Biomarkers for prognosis: - correct answer albumin, hgb, and cholesterol (if low = poor prognosis) or high Cr What are some examples of anticholinergics: - correct answer - Oxybutynin
• Benadryl When is long-term feeding a good idea: - correct answer - Dementia? No benefit, just complications
• Appetite stimulants aren't a good idea at end of life
• Hand feeding with real food > ensure all day long Liver function tests (LFTs) - correct answer AST, ALT, Alk Phos and bilirubin (least specific: alk phos) Red flags that indicate an EGD: - correct answer - Bleeding
• Anemia
• Hematemesis/Melena

ANSWERS WITH RATIONALES (VERIFIED ANSWERS)

• Symptoms: dysphasia, unintentional weight loss Major risk factor for C. Diff: - correct answer Prolonged wide spectrum ABX Why do you give beta blockers for esophageal varices? - correct answer Dilate portal circulation