APEA 3p Final Exam (Questions and Answers) Latest update 2024 Rated 100%, Exams of Nursing

Download APEA 3p Final Exam (Questions and Answers) Latest update 2024 Rated 100% and more Exams Nursing in PDF only on Docsity! APEA 3p Final Exam-2024 APEA 3p Final Exam (Questions and Answers) Latest update 2024 Rated 100% What would cause decrease in Digoxin levels Antacids Taking Pyridium for UTI, what can Pyridium cause? Hemolytic Anemia What can PCOS result in? increased insulin levels, Androgens, hirsutism What is a hypertensive used in pregnancy Methyldopa What is a characteristic of Placenta Previa? painless red bleeding What is a characteristic of Rheumatoid arthritis ? Red hot joints APEA 3p Final Exam-2024 Medications that cause ototoxicity Aminoglycosides, nasal decongestants, antihistamines Treatment period for enterobiasis 2 weeks CBC Interpretation MCV - mean corpuscular volume help diagnose different types of anemia (High=macrocytic like B12, Low=microcytic like Fe anemia) Rhogham given at how many weeks gestation? 27 weeks Janesway lesions Happen with endocarditis, non painful lesions seen on hands and feet, Osler same but painful Warfarin management - forgot a dose? If under 12 hours take missed dose, if over skip and need INR redraw APEA 3p Final Exam-2024 Topical Permethrin massaged from head to soles of feet and wach off with shower or bath after 8-14 hours. Treat again in 1 week Names of skin findings Macule; freckle <1 cm, Papule Macule >1 cm chloasma, Papule <0.5cm elevated nevi (molluscum wart), Plaque (psoriasis, lichen planus), Nodule 0.5-2 cm lipoma, vesicle (herpes simplex contact derm, Keloid hypertrophic scar that is invasive beyond point of original injury Skin continued Bulla-second degree burn, friction burn Wheal- raised, mosquito bite, hive Scales;dandruff Crusts-scab from abrasian, impetigo Tinea Fungal infections; Tinea capitis-round patchy scales on scalp (cradle cap) treatment Grisefulvin take with high fat meal 4-6 weeks 500 mg tinea corporis -red and scaly plaque on trunk (ring worm) Treatment is an azole for 2 weeks Melanoma How do you assess APEA 3p Final Exam-2024 ABCDE Asymmetry, border, color, diameter >6 mm, elevation Psoriasis silvery white scales, nails are pitted; positive Auspitz sign- pinpoint bleeding occurs when lesions are scraped Shingles (Herpes Zoster) Unilateral dermatomal rash- painful as it progresses to vesicles, Acyclovir within 48-72 hours or symptoms. May only transmit chickenpox virus to susceptible patients that have not gotten exposed or vaccinated yet. Post herpetic neuralgia pain is longer than 1 month after rash has resolved. Contact dermatitis papules or vesicles 5mm or less, scaling, crusting, oozing. Tx corticosteroids/antihistamines Acne Vulgaris Inflamm disorder where androgen-dependent sebaceous glands produce excess sebum. Areas most commonly affected are face, anterior and posterior chest, arms and shoulders. Treatment: Erythromycin/Benzyl peroxide=limit exposure to sunlight peroxide can decrease resistance to erythromycin Atopic dermatitis APEA 3p Final Exam-2024 Patchy plaque like rash with inflammation. common in people with other atopic illnesses (asthma, allergic rhinitis) Eye Findings in HTN and DM AV nicking-arteries indent and displace veins, cotton wool spots-gradual vision loss, flame hemorrhages- blot and dot hemorrhages Tx of acute sinusitis in adults and pediatrics Viral symptomatic tx only, is bacterial- amoxicillin first line symptoms>10 days purulent nasal discharge, fever, unilateral face or tooth pain Snellen test Test for visual acuity; CN II What medications can cause ototoxicity Aminoglycosides (tx otitis externa) , loop diuretics, quinine, ASA Rhinitis Eosinophils due to WORMS, wheezes, weird diseases. Most effective tx for allergic rhinitis- Fluticasone Flonase APEA 3p Final Exam-2024 found in patients with hypothyroid, hypothermia, thickening of the tongue, and disorientation Assessment findings PCOS Hirsutism, hyperinsulinemia, elevated lipids, abnormal hair, acne Assessment finding and RX for hyperthyroidism M/C cause is Graves' disease, finding include tachyC, Afib, weight loss, hyperactivity, warm, moist skin, flushed Hyperprolactinemia Menstrual dysfunction, ED, pain in breast, loss of libido, lactation, vaginal dryness, infertility Hyperandrogenism High levels of Androgens in females, sx include acne, seborrhea, hair loss on scalp, increased body or facial hair, infrequent or absent menstruation, Can be caused by PCOS DM A1c over 6.5 or fasting glucose over 126, initiate Metformin at initial diagnosis Assessment of neuropathy APEA 3p Final Exam-2024 In distal lower extremities, long effect of hyperglycemia, paresthesias and burning Treatment and Presentation of Giardiasis Foul smelling stools, abdominal pain, flatulence spread fecal-oral route. Tx is Metronidazole 250 mg TID Presentation and assessment of Cirrhosis Coagulopathy, variceal bleed, hepatic encephalopathy, extrahepatic sx- neuro, psychiatric, arthralgia, autoimmune disorders, glucose intolerance. Pt early stage of cirrhosis likely to have thrombocytopenia Assessment of Hepatitis Malaise, fever, jaundice, fatigue, weight loss, joint pain, dark urine, RUQ pain, liver enlargement, pancytopenia. Elevated ALT/AST, bili, alk phos GERD Pyrosis (heartburn), burning beneath sternum, regurgitation, postnasal drip, throat clearing, chronic cough, chronic sore throat, hoarseness. Tx 8 week course of PPI H Pylori Algorithm Amoxicillin BID, Clarithromycin BID, PPI BID x 14 days. If PCN allergy tx would change to Metronidazole BID, Clarithromycin BID, PPI BID x 14 days APEA 3p Final Exam-2024 Which of the following symptoms associated with GERD is considered an alarm symptom? Odynophagia (Pain with swallowing, maybe w/wo difficult swallowing) Crohn's Disease Chronic bloody diarrhea- fatigue, abdominal pain, prolonged diarrhea, with/without bleeding, weight loss and fever. Skip lesions, cobblestone appearance and fistulas common. Slow progressive inflammation small intestine and or large intestine or TI. TX- Budesonide 5-aminosalicylates Common pathogens that cause Gastroenteritis Common pathogen gastroeneritis <1 y.o., adults (norovirus, enteric adenovirus, astrovirus), campylobacter jejuni in children, Salmonella most common foodborne illness, Giardia Lambia most common parasitic Pyloric Stenosis Presentation narrowing of the pyloric sphincter due to hypertrophy of pyloric muscle- forceful vomiting usually 2-3 weeks of age Hepatitis B Bloodborne/body fluids highly infectious, patients who test positive for HBV and HCV should also be screened for HIV due to common transmission routes Pinworm infection APEA 3p Final Exam-2024 vitamin B12 absorption. S/S:cog impairment, fatigue, ataxia, weakness, neuropathy, glossitis, mouth ulcers When and how long to take iron supplementation for? Take 1-2 hour before meal, empty stomach, with Vitamin C. Take for 4-6 months, after iron was replaced continue to take for 12 weeks. Repeat CBC Rh incompatibility hemolutic disease of the fetus and newborn desctruction of RBC's by maternal IgG antibodies. Can lead to jaundice, anemia, fetal hydrops. Rhogam shot at 28 weeks and 72 hours of delivery to prevent Sickle Cell Repeated episodes of sickling can cause the cells to become irreversibly sickled. Hemoglobin electroparesis confirms dx. it is autosomal recessive characterized by ischemic tissue injury and chronic severe hemolytic anemia. BPH Enlargement of the prostate that narrows the urethral lumen. Risk factors Elevated PSA increased age, genetics, black and Asian. Firm smooth prostate enlarged- usually nontender, hesitancy, dribbling, incomplete bladder emptying. Avoid caffeine, ETOH, diuretics. Alpa 1 adrenergic antagonist - immediate relief, relaxes smooth muscle in the prostate (tamsulosin). 5 alphs reductase inhibitor (finasteride)- long term therapy takes 6-12 months. inhibits conversion of testosterone to DHT. Hydrocele APEA 3p Final Exam-2024 peritoneal fluid collection in scrotum. Painless swelling in scrotum, feels heavy, transillumination of scrotum (will light up brightly) Penile Cancer Squamous cell carcinoma; risk factors: HPV, AIDS, uncircumcised, smoking, psoriasis, cryptochordism. Thick white plaques, large scaly growths. Bleeding is late sign Erectile Dysfunction Treatment PDE-5 inhibitor, usual reason HTN meds, antidepressants, antiandrogens, recreastional drugs High risk of penile and testicular cancer development Cryptochordism Prostatitis Inflammation of the prostate usually bacterial origin. S/S: frequency, urgency, fever, enlarged boggy warm prostate. Tx Chronic prostatitis: Ciprofloxacin or Fluoroquinolones for 4-12 wk tx or Bactrim. 4-6 weeks tx guided by results of C&S. NOT KEFLEX. Levofloxacin yes Determining testicular torsion from Epididiymitis Testicular torsion- acute onset testicular pain and loss of cremasteric reflex on affected side. Most common acute ain in prepubertal boys- epididymitis, but testicular torsion must be ruled out. Symptoms onset testicular torsion- few hours vs epididiymitis- few days and pain with cremasteric reflex APEA 3p Final Exam-2024 Gonorrhea/Chlamydia tx Doxycycline 100 mg BID x 14 days, and Ceftriaxone x1 IM Migraine Treatment Rescue- Triptans, prophylactic- Beta Blockers, antidepressants, anticonvulsants. (Topamax, Propranolol, Inderal) Migraines presentation Mostly inulateral, crescendo, cool, quiet dark rooms usually lasts 4-72 hours. Tension Headaches Bilateral pressure, tightness, band like, waxes and wanes. Fiorcet can help pain, Butalbital Cluster Headaches ALWAYS unilateral, begins around the temple or eye. excruciating/explosive, sudden onset. Lasts 30-90 min can be up to 180 mins associated symptoms includes red eye, tears rhinorrhea. Most common at night. Secondary headache underlying causes Person with VP shunt - headache upon awakening, Meningitis accompanied with stiff neck/fever, brain tumor- frequent headaches worsens when coughing or sneezing. APEA 3p Final Exam-2024 RA vs OA RA=Worn cartilage, bone loss, thickened synovial membrane. joints are hot, swollen, Autoimmune, eats away bone OA=extremely worn cartilage and bone spurs, Positive Heberden and Bouchards nodes, bony and hard Treatment OA Exercise, Weight loss, and RICE, Tylenol NOT recommended. SHort acting NSAIds ok. Cymbalta (multiple joints affected), duloxetine, and Tramadol longer acting. Refer to ortho for injections Sprain vs Strain Ligaments are fibrous tissue that attach to bones, A sprain is a stretch or tear in a LIGAMENT. A train is a stretch or tear in a muscle or tendon. Tx is RICE for both. Ortolani's click a "click" is heard or felt as dislocation is reduced (good until one year) Barlows Maneuver Feeling of a slip of the femoral head slips away from the Acetabulum (toward the butt) Meningitis signs Positive Kernig (flex hips 90 degreed pain with extension of leg), Brudzinski (involuntary flexion of legs when neck is flexed) APEA 3p Final Exam-2024 Adams sign examiner stands behind pt looks for spinal curvature, pt bends over and touches toes (-) functional scoliosis if curve straightens out (+) structural scoliosis if curve remains *if no scoliosis present = no Adam's Sign indicated Fat pad sign test for elbow fracture McMurray Test Audible palpable click when knee is raised with tibia externally rotated and then straightened, medial meniscus tear assessment Gout and treatment Acute joint pain with swelling, warmth, and erythema begins abruptly and involves single joint. Normal uric acid levels are common during acute attack. Colchicine for acute gout long term is Allopurinol (urate lowering agents dosed 2 or more attacks/year renal stones. decreases production of uric acid. for preventative attacks. GTPAL APEA 3p Final Exam-2024 Gravida # of times women has been pregnant, multiples=1 Term=number of children >37 weeks or more Preterm=20-37 weeks Abortion or miscarriages L=living children, twins./multiples count individually Fundal Height Distance from the pubic bone to the top of the uterus measure in centimeters. After 24 weeks fundal height should match the number of weeks youve been pregnant Preeclampsia BP >140/90 and proteinuria (300 mg/24 hour) or edema, pulmonary edema, visual impairments, renal or hepatic function. Tx: magnesium sulfate, antihypertensives, corticosteroids for long development Naegeles Rule First day of LMP-3 months+7 days+add one year Placenta previa Bright red, painless bleeding in a woman>20 weeks gestation. Abnormal placement of the placenta near or covering the internal cervical os First line treatment of UTI in pregnancy APEA 3p Final Exam-2024 Munchausen by proxy caregiver makes up or causes an illness or injury in a person under his or her care Suicide screening 3 questions: Are you thinking of hurting yourself, whats your plan, do you have means or a gun? At risk, prior attempt, adolescents, males, elderly white males highest risk. Asthma Mild intermittent- symptoms 2 or less days per week or 2 less nights per month with short exac Mild persistent- symptoms greater than 2/week but less than once per day Moderate persistant- daily symptoms or more than 3-4 nights per month Severe persistant- continual symptoms or frequents symptoms >1 night per month Asthma Diagnostic Spirometry, pulmonary function tests, allergy testing, peak flow TX: Mild int- SABA COPD Progressive pathological changes to the airway and/or alveoli due to increased inflammatory response to pollutants or inhaled irritants. Gold standard dx: spirometry with bronchodilation. Progressive APEA 3p Final Exam-2024 dyspnea, cough with or without sputum, prolonged expiratory phase, wheezing on forced exhalation, barrel chest tripod position late phase Empyema Presence of pus in the pleural space. Develops when pulmonary lymphatics become blocked leading to an outpouring of contaminated lymph flui into pleural space. Fever, cyanosis, tachyC, pleural pain. Pleural Effusion Presence of fluid in the pleural space from blood or lymphatic vessels. Dyspnea, atelactasis, pleural pain. Dullness on percussion. , mediastinal shift Treatment of CAP Mycoplasma- walking pna, Strep pna- will kill your patient. TX Macrolide i.e. Azithromycin. Infant Amoxicillin, school age amox or macrolide. Outpatient previously healthy- Macrolide OR Doxycycline Outpatient recent ABs- Resp flouroquinolone OR advanced macrolide (azithromycin) plus high dose amoxicillin Outpatient comorbidities no recent AB-Advanced macrolide OR resp fluoroquinolone Outpatient comorbidities recent AB- resp fluoroquinolone or advanced macrolide plus beta-lactam APEA 3p Final Exam-2024 Pertussis Lasts six weeks to two months. Caused by Bordatella Pertussis, tx macrolide (Azithromycin) or sulfonamide (Bactrim), everyone in household treated, Pregnant women get Dtap shot 27/28 weeks. TB Dx Quantiferon gold, T spot, TB skin test. Tx is very liver toxic: Isoniazid, Rifampin. DO TREAT LATENT but not infectious. Sx: Fever cough >3 weeks, hemoptysis, weight loss, night sweats. Croup Acute viral illness barking cough, stridor, cough, hoarseness subglottal swelling. No tongue depressors can spasm. Racemic epi? Chlamydia Most common STI in US, genital ulceration, lymphadenopathy, ocular trachoma, proctitis. Often asymptomatic, cervical motion tenderness, Nucleic acid amplification test (NAAT) and Gen probe gold standard. Tx azithromycin if pregnant Amoxicillin. Can cause PID Gonorrhea Common with Chlamydia. Ceftriaxone 500 mg x1, highsuspension for chlamydia give doxycycline. Purulent discharge , blood tinged, prostatitis Bacterial Vaginosis APEA 3p Final Exam-2024 Assessment of Breast cancer Painless, firm fixed mass, skin or nipple changes, nipple discharge, swelling, lymph enlargement, Pagets disease scaly nipple lesion.Peau d orange, nipple retraction, redness, persistent itching, warm skin. Who does and doesnt get combined oral contraceptive and contraindications Do not give COC to a women of child bearing age that also has migraines with an aura How to assess and tx dysmenorrhea Painful cramping with menstruation pelvic exam has to be normal tx with heating pad non pharmacological, NSAIDs, oral contraceptives. Assessment and tx of PMS symptoms depression, anger, anxiety, confusion, soacial withdrawal, irritability, breast tenderness, bloating, HA, swelling. estrogen replacement CONTRAindicated in women with breast cancer, undiagnosed vaginal bleeding, pregnancy, clots, and active liver disease PEDS: Medication Sinusitis- Augmentin, DDAVP desmopressin acetate for enuresis, succimer for lead APEA 3p Final Exam-2024 PEDS ESRD Erythropoeitin is safe for use in children Surbstance abuse and assessment PEDS Risk factor-ADD tx is atomoxetine Contraindications to decongestants in Peds FDA discourages the use of OTC decongestants to under 2 years old Acromegaly presentation Gigantism is peds, giantism is adults. Presents with bone overgrowth big hands, face, and feet. Overproduction of pituitary gland. Patients with aortic regurgitation present with dyspnea and angina endocarditis tx zosyn/vanco APEA 3p Final Exam-2024 mechanism of action of prostaglandin with transposition of the great vessels provide vasodilation and adequate oxygenation HTN and CAT acronym CCB-amlodipine ACE/ARB- "pril" Thiazide or chlorthalidone nephropathy or diabetic start with ACE/ARB black- thiazide first