Healthcare Concepts and Terminology, Exams of Gerontology

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AGACNP (Adult Gerontology Acute Care Nurse Practitioner) EXAM COMPILATION 2024/ACTUAL EXAMS WITH CORRECT DETAILED ANSWERS/BRAND NEW 2024/ALREADY GRADED A+ Contents AGACNP CERTIFICATION EXAM 1 .............................................................................................. 1 AGACNP EXAM- RISK ASSESSMENT, HERBAL AGENTS .......................................................... 84 NURS 642 /AGACNP EXAM 1 ...................................................................................................... 95 AGACNP EXAM 3 ...................................................................................................................... 126 AGACNP NT TEST PREP EXAM ................................................................................................ 163 AGACNP 106 FINAL EXAM ....................................................................................................... 179 AGACNP FINAL EXAM REVIEW .............................................................................................. 213 ANCC AGACNP CERTIFICATION FINAL EXAM VERSION 1 .................................................... 272 ANCC AGACNP FINAL EXAM VERSION 2 ................................................................................ 330 AGACNP CERTIFICATION EXAM 1 At what grade level would health literature be written at - Correct Answer-6th-8th grade Accreditation guidelines are laid out by - Correct Answer-the joint commission QI is the management process of - Correct Answer-Monitoring Evaluating Continuously reviewing Improving the quality of healthcare delivery and safety of the system If patient has a 0 on the RASS, then the patient is - Correct Answer-alert and calm If the patient has a +4 on the RASS, then the patient is - Correct Answer-combative What is used as pain assessment for pain in intubated patients? - Correct Answer- CPOT Using the MMSE, when does the patient have cognitive disfunction - Correct Answer- <24 Nursing informatics role - Correct Answer-Practice Education Government Industry This is the comparison and measurement of a healthcare organization's services against other national healthcare organizations - Correct Answer-Benchmarking Process by which practiced RNs systematically access, monitor, and make judgements about the quality of nursing care provided by peers measured against professional standards of practiced - Correct Answer-Peer review Written statement of patient's intent regarding medical treatment - Correct Answer- Advance directive This Act requires that all patients entering a hospital should be advised of their right to execute an advance directive - Correct Answer-Patient Self-Determination Act of 1990 Written compilation of statements in document format that specifies which life- Patients must pay for which two types of Medicare - Correct Answer-Part B and D New patient always requires what kind of assessment - Correct Answer-Comprehensive Covers physician services, outpatient hospital services, lab and diagnostics - Correct Answer-Medicare part B NPs receive what percentage of physician reimbursement? - Correct Answer-85% Which things are not covered as physician services under Medicare? - Correct Answer- Regular physical exams, health maintenance screenings, counseling for well patients What is the purpose of case managers? - Correct Answer-Mobilize, monitor, and control resources that a patient uses during a course of an illness while balancing quality and cost A process for evaluating the care of patients using established standards of care to ensure quality - Correct Answer-Quality assurance A tool for identifying prevention strategies to ensure safety - Correct Answer-Root cause analysis What is the purpose of RCA? - Correct Answer-Build a culture of safety Unexpected occurrences involving death or serious physical or psychological injury or risk thereof - Correct Answer-Sentinel event Based on legal allowances in each state, according to and delineated by individual state nurse practice acts - Correct Answer-Scope of practice Encompasses required education, licensure and certification to practice as a nurse practitioner - Correct Answer-Credentials Establishes that a person is qualified to perform in a particular professional role and is set forth by a governmental agency - Correct Answer-Licensure Establishes that a person has met certain standards in a particular profession which signify mastery of specialized knowledge and skills - Correct Answer-Certification Admitting privileges were given to NPs in 1983 by which organization - Correct Answer- The joint commission Process by which an NP is granted permission to practice in an inpatient setting - Correct Answer-Privileges Refers to interventions that are unlikely to produce any significant benefit for the patient - Correct Answer-Medical futility A state indicating that a patient has received adequate instruction or information regarding aspects of care to make a prudent, persona choice regarding such treatment - Correct Answer-Informed consent Danforth Amendment of 1991 states that - Correct Answer-patient can refuse care Study of moral conduct and behavior which serves to govern conduct, thereby protecting the rights of an individual - Correct Answer-ethics The duty to do no harm - Correct Answer-Nonmaleficience The right act is the one that produces the greatest good for the greatest number - Correct Answer-Utilitarianism The duty to prevent harm and promote good - Correct Answer-Beneficence The duty to be fair - Correct Answer-Justice The duty to be faithful - Correct Answer-Fidelity The duty to be truthful - Correct Answer-Veracity The duty to respect an individual's thoughts and actions - Correct Answer-Autonomy Who developed the first NP program - Correct Answer-Silver and Ford Where was the first NP program - Correct Answer-University of Colorado When was the first NP program developed - Correct Answer-1960s Why was the first NP program developed - Correct Answer-Hospital restructuring and decrease in medical residency programs Used as criteria to measure whether negligence has occurred - Correct Answer- Standards of care Failure of an individual to do what a reasonable person would do, resulting in injury to the patient - Correct Answer-Negligence Failure of a professional to render services with the degree of care, diligence and precaution that another member of the same profession under similar circumstances would render to prevent injury - Correct Answer-Malpractice This may involve: professional misconduct, unreasonable lack of skill, illegal/immoral conduct, other allegations resulting in harm to a patient - Correct Answer-Malpractice Intentional act by one person that creates an apprehension in another or an imminent harmful or offensive contact - Correct Answer-Assault Illegal, willful, angry, violent or negligent striking or a person, his clothes or anything with which he has in contact - Correct Answer-Battery Defaming, distributed written material - Correct Answer-Libel Spoken defamation - Correct Answer-Slander The degree to which those who have a disease screen/test positive - Correct Answer- Sensitivity The degree to which those who have a disease screen/test negative - Correct Answer- Specificity The frequency with which a disease or disorder appears in a particular population or area at a given time - Correct Answer-Incidence The proportion of a population that is affected by a disease or disorder at a particular time - Correct Answer-Prevalence Healthy diet, exercise, avoiding tobacco, wearing seat belts and immunizations are examples of - Correct Answer-Primary prevention Pap smear screening, prostate cancer screening and cholesterol screening are examples of - Correct Answer-Secondary prevention Cardiac rehabilitation, kidney screening after a diagnosis of DM is an example of - Correct Answer-Tertiary prevention Pain that is localized on the skin or surface of the body - Correct Answer-Cutaneous Poor localized pain such as with internal organs - Correct Answer-Visceral Non-localized pain that originates in muscle, bone, nerves, blood vessels and supporting tissue - Correct Answer-Somatic Pain that is frequently caused by a tumor and involves nerve pathway injury or compression - Correct Answer-Neuropathic What is recommended for breakthrough cancer pain - Correct Answer-Fentanyl patches What is considered a fever - Correct Answer-Temp greater than 37 C oral or rectal temp greater than 99.5 Most important history item for a headache - Correct Answer-Chronology Vice-like or tight in quality headache, that is generalized with no focal symptoms - Correct Answer-Tension headache What is treatment for tension headache - Correct Answer-OTC analgesics Unilateral, throbbing headache that occurs episodically. It is dull and throbbing with neurological deficits - Correct Answer-Migraine Treatment for migraines? - Correct Answer-ASA right away Sumatriptan Precipitated by alcohol ingestion and characterized by severe, unilateral periorbital pain occurring daily for serval weeks - Correct Answer-Cluster headache This headache may include ipsilateral nasal congestion, rhinorrhea and eye redness - Correct Answer-Cluster headache Treatment for cluster headache - Correct Answer-Inhalation of O2 Sumatriptan What are causes of hypovolemic hyponatremia and a urine Na >20? - Correct Answer- Diuretics Ace inhibitors Mineralcorticoid deficiency What are the causes of hypervolemic, hypotonic, hyponatemia? - Correct Answer- Edematous states CHF Liver disease What is the treatment of hypervolemic, hypotonic, hyponatremia? - Correct Answer- Restrict water Patient has a serum osmo of 300 and sodium of 125. What is cause? - Correct Answer- Hyperglycemia If the patient is hyponatremic with a urine Na >20, then how do you treat? - Correct Answer-Treat the cause If the patient is hypervolemic, how do you treat? - Correct Answer-Water restriction If the patient has a sodium of 115 and has neuro signs and symptoms, then how do you treat? - Correct Answer-3% NS with loop diuretics Electrolyte imbalance due to excess water loss - Correct Answer-Hypernatremia How do you treat hypovolemic hypernatremia? - Correct Answer-NS followed by ½ normal saline How do you treat euvolemic hypernatremia? - Correct Answer-D5W How do you treat hypervolemic hypernatremia? - Correct Answer-D5W and loop diuretics What are some causes of hypokalemia - Correct Answer-Diuretics GI loss Excess renal loss Alkalosis Muscular weakness, fatigue, muscle cramps, constipation signifies which electrolyte imbalance - Correct Answer-Hypokalemia What EKG changes would you expect to see in hypokalemia? - Correct Answer-Broad T waves Prominent U waves What electrolyte deficiency frequency impairs K correction - Correct Answer-Magnesium What are some causes of hyperkalemia - Correct Answer-Excess intake Renal failure Hypoaldosternoism NSAIDs Heparin Acidosis Weakness, flaccid paralysis, abdominal distention and diarrhea are signs of which electrolyte imbalance - Correct Answer-Hyperkalemia Which EKG changes would you expect to find with hyperkalemia - Correct Answer-Tall, peaked T waves Major cellular ion and important as a mediator of neuromuscular and cardiac function - Correct Answer-Calcium What is normal total calcium? - Correct Answer-2.2-2.6 mmol/L OR 8.5-10.5 mg/dl What is normal ionized calcium? - Correct Answer-1.1-1.4 mmol/L Why would you get ionized calcium over total calcium? - Correct Answer-Ionized calcium does not vary with albumin If there is a normal calcium level in the presence of a low albumin level, it suggest - Renal failure If the patient has an increased anion gap, how do you treat? - Correct Answer-Treat the cause Fluid HCO3 indicated if severe hyperkaemia If the patient has a normal anion gap, how do you treat? - Correct Answer-Bicitra 10-30 cc Ng suction and vomiting can cause which acid base imbalance - Correct Answer- Metabolic alkalosis With metabolic alkalosis, which electrolyte imbalance will you see - Correct Answer- Hypokalemia What is acetazolamide? - Correct Answer-Diamox; diuretic Burn that is dry, red, no blisters and involves the epidermis only - Correct Answer-First degree Burn that is partial thickness, moist, has blisters, and extends beyond the epidermis - Correct Answer-Second degree Burn that is full thickness, dry, leathery, black, pearly, waxy and tends from epidermis to dermis to underlying tissues, fat, muscle, and/or bone - Correct Answer-Third degree What is the rule of 9's? - Correct Answer-Each arm: 9% Each leg: 18% Thorax: 18% front and 18% back Head: 9% Perineum/genitals: 1% What is the parkland formula? - Correct Answer-4mL/kg x TBSA What % of fluid requirements do you give during the first 8 hours of injury - Correct Answer-½ What electrolyte imbalance do you initially see with burns? - Correct Answer- Hyperkalemia Which acid base imbalance do you see during the resuscitation phase of a burn injury? - Correct Answer-Metabolic acidosis What electrolyte imbalance do you see three days post burn? - Correct Answer- Hypokalemia Which burns are automatically intubated? - Correct Answer-Burns to face Singled nares or eyebrows Dark soot/mucous in nares and/or mouth Common topical antibacterial/antifungal used to treat second and third degree burns - Correct Answer-Silver sulfadiazine How do you treat bites? - Correct Answer-Offer TDAP Augmentin Common gram negative agents that cause cellulitis? - Correct Answer-E coli Kelbsiella Pseudomonas Enterobacter Common treatment for CA-MRSA with cellulitis? - Correct Answer-Bactrim Doxy/minocycline Famciclovir Valacyclovir For post-herpetic neuralgia, what do you give for treatment? - Correct Answer- Gabapentin Lyrica At what age do you give herpes zoster vaccine? - Correct Answer-50 Rough, flesh colored, pink, hyper pigmented areas that occur on sun-exposed parts of the body - Correct Answer-Actinic keratoses Firm, irregular papules or nodules that are on sun exposed areas - Correct Answer- Squamous cell carcinoma Benign, not painful lesions that have a stuck on appearance. They are beige, brown or black plaques - Correct Answer-Seborrheic keratosis The most common skin cancer that has a waxy, pearly appearance and spider veins with a central depression or rolled edges - Correct Answer-Basal cell carcinoma Highest mortality rate of all skin cancers - Correct Answer-melanoma Metabolic syndrome - Correct Answer-Waist circumference > 40 inches in men and >35 inches in women; BP >130/85; triglycerides > 150; FBG > 100; HDL < 40 in men and <50 in women Normal A1C - Correct Answer-5.5-7 Recurrent vaginitis is often first sign of this type of disease in women - Correct Answer- Diabetes type 2 Total carbohydrate intake - Correct Answer-55-60% Total fat intake - Correct Answer-20-30% Total fiber intake - Correct Answer-25g/1000 calories Total protein intake - Correct Answer-10-20% total calcories Side effect of Metformin - Correct Answer-lactic acidosis Nocturnal hypoglycemia but patient has a rebound elevated blood sugar at 0700 - Correct Answer-Somogyi effect How do you treat somogyi effect? - Correct Answer-Reduce or omit bed time insulin Results when tissue becomes desensitized to insulin nocturnally and blood glucose becomes progressively elevated throughout the night resulting in elevated glucose levels at 0700 - Correct Answer-Dawn phenomenon What is the treatment for dawn phenomenon - Correct Answer-add bed time insulin Patient presents with increased sweating, exopthalmos, anxiety, and weight loss. What is diagnosis? - Correct Answer-Hyperthyroidism What is the most common presentation of hyperthyroidism? - Correct Answer-Gaves disease What is the most sensitive test for hyperthyroidism? - Correct Answer-TSH What labs would you expect to see in hyperthyroidism? - Correct Answer-Decreased TSH Increased T3, T4 Normal T3 - Correct Answer-80-230 A high iodine uptake during a thyroid radioactive iodine uptake and scan is indicative of - Correct Answer-graves disease This is due to pituitary deficiency of TSH - Correct Answer-Hypothyroidism Patient presents with extreme weakness, muscle fatigue, hair loss and edema of hands How do you treat Addisons? - Correct Answer-Glucocorticoid, mineralcorticoid Vasopressors are ineffective; treat the cause Labs associated with SIADH - Correct Answer-Decreased serum osmo Increased urine osmo Urine Na > 20 Hyponatremia Related to pituitary or hypothalamus damage resulting in ADH deficiency - Correct Answer-Central DI Due to a defect in the renal tubules resulting in renal insensitivity to ADH - Correct Answer-Nephrogenic DI What labs can you expect with DI - Correct Answer-Hypernatremia Increased serum osmo Decreased urine osmo If the desmopressin challenge test is positive, then it would signify - Correct Answer- central DI How do you treat SIADH? - Correct Answer-If Na >120, restrict fluids If Na < 120 with no s/s, restrict fluids If Na < 120 with s/s give 3% NS with diuretic How do you treat DI? - Correct Answer-If Na > 150, give D5W If Na <150, give ½ NS or 0.9% DDAVP Rare, but serious disease resulting from excess catecholamine release characterized by paroxysmal or sustained hypertension - Correct Answer-Pheochromocytoma What causes a pheochromocytoma? - Correct Answer-Adrenal medulla Patient presents with labile hypertension, diaphoresis, hyperglycemia, palpitations, severe headaches, and tachycardia. What does patient have? - Correct Answer- Pheochromocytoma What lab work can you expect with pheochromocytoma? - Correct Answer-Normal TSH Metanephrine levels >1.4 VMA What test should you run for pheochromocytoma? - Correct Answer-CT to find tumor How do you treat pheochromocytoma? - Correct Answer-Tumor removal Phentolamine IV then Phenooxybenzamine PO During S1, what is happening - Correct Answer-AV nodes closed; semi-lunar valves open What are AV nodes? - Correct Answer-Mitral Tricuspid What are semilunar valves? - Correct Answer-Pulmonic Aortic What causes S3? - Correct Answer-Increased fluid states What causes S4? - Correct Answer-Stiff ventricular wall LVH Murmur that is loud, associated with a thrill - Correct Answer-4/6 This diagnostic test will show contractile/relaxation, valve function, and ejection fraction - Correct Answer-Echocardiogram Patient has wheezing during exercising, then what tests would you run? - Correct Answer-PFTs What is hypertension? - Correct Answer-SBP >140 OR DBP >90 Subaccipital pulsating headache that happens early in the AM and resolves throughout the day - Correct Answer-severe HTN Patient with HTN may have S4 heart sound related to - Correct Answer-LVH If patient has HTN, what tests would you run? - Correct Answer-Reno vascular disease studies CXR Plasma aldosterone level AM/PM cortisol to r/o Cushings ECG PA/Lateral CXR SBP 155 and DBP 92 is what stage of HTN? - Correct Answer-Stage 1 Normal blood pressure for patients >60 - Correct Answer-150/90 Normal blood pressure for patients <60 - Correct Answer-140/90 Treatment options for african american with HTN - Correct Answer-Thiazide CCB Treatment options for non-african americans with HTN - Correct Answer-CCB ACE/ARB These drugs may cause hypokalemia, hypomagnesemia, hyperglycemia, hyponatremia, hypercalcemia. Screen for sulfa allergy before administering. First line drug for HTN - Correct Answer-Thiazide diuretic Do not initiate this HTN drug if potassium is greater than 5.5. Contraindicated in pregnancy. May cause hyperkalemia, cough, renal impairment - Correct Answer-ACE Reserved for patients intolerant of ACE, contraindicated in pregnancy, may cause cough, hyperkalemia and renal impairment - Correct Answer-ARB Hypertensive agent that may be used for angina, arrhythmias and migraines. May cause headache, flushing, and bradycardia - Correct Answer-CCB Drug that may be used for BPH. Could cause first dose syncope, dry mouth, orthostasis - Correct Answer-Peripheral alpha-1 antagonist Ex: Terazosin, Doxazosin Characterized by severe elevations in blood pressure of >180/110 without progressive target organ dysfunction - Correct Answer-Hypertensive urgencies How do you treat hypertensive urgency? - Correct Answer-Clonidine Captopril Nifedipine What fundoscopic changes will you see in hypertensive urgency? - Correct Answer- Papilledema, flame-shaped retinal hemorrhages and soft exudates What is papilledema - Correct Answer-Swelling of optic disk with blurred margins What is considered a hypertensive emergency - Correct Answer->180/120 How do you treat hypertensive emergency? - Correct Answer-Nicardipine Sodium nitroprusside Decreased blood flow through the vessel that causes tissue ischemia - Correct Answer- Angina Exertional angina - Correct Answer-Stable angina Elevation in I, aVL - Correct Answer-Lateral MI Elevation in II, III, aVF - Correct Answer-Inferior MI Normal INR on Coumadin - Correct Answer-2-3 Normal PTT - Correct Answer-60-90 Normal PT - Correct Answer-11-16 Heparin antidote - Correct Answer-Protamine Why should you not give pharmacologic revascularization? - Correct Answer-Prior ICH Ischemic stroke within 3 months Aortic dissection Severe uncontrolled HTN Active bleeding Calf claudication, shiny/hairless skin, dependent rubber and pallor - Correct Answer- PVD Which tests would you do for PVD - Correct Answer-ABI Doppler Arteriography is the most definitive More common in women, aching of lower extremities relieved by elevation, edema after prolonged standing, discoloration - Correct Answer-CVI How do you treat CVI - Correct Answer-Keep legs elevated TED hose Inflammation of the pericardium - Correct Answer-Pericarditis Most common cause of pericarditis - Correct Answer-Virus Patient presents with localized retrosternal chest pain that is increased by deep inspiration and coughing but relieved by sitting forward - Correct Answer-Pericarditis How do you treat pericarditis? - Correct Answer-NSAIDs What EKG changes would you see in pericarditis? - Correct Answer-ST elevation in all leads Depression of PR segment Infection of the endothelial surface of the heart - Correct Answer-Endocarditis What is the cause of endocarditis - Correct Answer-Bacteria Patient presents with night sweats, weight loss, general sick feeling with petechiae, osler nodes - Correct Answer-Endocarditis How do you treat endocarditis? - Correct Answer-Nafcillin Vanc Penicillin G Most common cause of PUD - Correct Answer-H. pylori Signs and symptoms of perforation of gastric ulcer - Correct Answer-Severe epigastric pain Board like abdomen Quiet bowel sounds When do you get an endoscopy on patient with PUD? - Correct Answer-After 8-12 weeks of treatment Patient serology shows HBsAG, HBeAg, Anti-HBc, IgM. What do they have? - Correct Answer-Active Hep B What are treatment options for hepatitis? - Correct Answer-Supportive Increase fluids No/low protein diet Avoid alcohol or drugs detoxified by the liver Vitamin K for prolonged PT Inflammation or localized perforation of one or more diverticula with abscess formation - Correct Answer-Diverticulitis Mild to moderate aching abdominal pain in LLQ, constipation or diarrhea may be present, N/V - Correct Answer-Diverticulitis In diverticulitis, a sigmoidoscopy will show - Correct Answer-free air When you obtain plain abdominal films for diverticulitis, what will you see? - Correct Answer-Free air (pneumoperitoneum) How do you treat diverticulitis? - Correct Answer-NPO IVF Flagyl, Cipro, Clinda, Ampicillin Inflammation of the gallbladder, associated with gallstones - Correct Answer- Cholecystitis What lab work do you expect to see with cholecystitis? - Correct Answer-WBC 12- 15000 Bilirubin elevated ALT, AST, LDH, Alk phos elevated Amylase elevated What is the gold standard of treatment for cholecystitis? - Correct Answer-Ultrasound Inflammation of the pancreas due to escape of pancreatic enzymes into surrounding tissue - Correct Answer-Pancreatitis What electrolyte imbalance can cause pancreatitis - Correct Answer-Hypercalcemia Severe epigastric pain worsened by walking and lying supine and it radiates to the back wit absent bowel sounds - Correct Answer-Pancreatitis What labs do you expect to see with pancreatitis? - Correct Answer-WBC elvation Hyperglycemia LDH, AST elevation Amylase (50-180) and Lipase (14-280) elevated Hypocalcemia (<7) What kind of diagnostic test should you get for pancreatitis? - Correct Answer-CT Cramping umbilical pain initially that later becomes constant and diffuse with high pitched tinkling bowel sounds - Correct Answer-Bowel obstruction When you obtain plain films for bowel obstruction, what may you see? - Correct Answer- Dilated loops of bowel Idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon - Correct Answer-Ulcerative colitis What does ulcerative colitis involve? - Correct Answer-Rectum but may extend upward involving the whole colon What is the hallmark symptom of ulcerative colitis? - Correct Answer-Bloody diarrhea What establishes the diagnosis of ulcerative colitis? - Correct Answer-Sigmoidoscopy What is the treatment for ulcerative colitis? - Correct Answer-Mesalamine suppositories or enemas Syndrome as a result of inadequate blood flow through the mesenteric circulation leading to ischemia and gangrene of the bowel - Correct Answer-Mesenteric infarct TIA that is due to carotid stenosis - Correct Answer-Carotid What is aphasia - Correct Answer-unable to speak What is dysarthria - Correct Answer-cannot articulate What is hemiplegia - Correct Answer-paralysis of one side of the body What is paresthesia? - Correct Answer-Tingling, numbness What is the best diagnostic test in distinguishing between ischemia, hemorrhage, and tumor - Correct Answer-CT When should you do a MRI in patients who may have CVA vs TIA - Correct Answer- when you think it may be due to ischemia Treatment for TIA - Correct Answer-ASA Plavix When do you do a endartectomy - Correct Answer-When there is >70% stenosis and patient is symptomatic CVA that produces subtle, progressive or sudden neurologic deficits - Correct Answer- CVA infarct CVA that usually presents with acute onset of focal neurologic deficits. Sudden fallout - Correct Answer-hemorrhagic How fast should you do fibrinolytic therapy? - Correct Answer-3-4.5 hours How do you prevent ICP increases? - Correct Answer-Bed rest with HOB elevated to promote venous drainage Sedation Adequate oxygenation Analgesics What would you like to keep CO2 at in a patient with a CVA who has increased ICP? - Correct Answer-35 S/S of increased ICP - Correct Answer-Hypotension Hypercapnia Hypoxemia What would you like to keep MAP at to treat cerebral vasospasm? - Correct Answer- 110-130 What drug helps to counter vasospasm by preventing calcium to enter smooth muscle cells and cause contraction? - Correct Answer-Nimodipine Seizure that lasts less than 1 minute, no LOC, motor symptoms start in a single muscle group and spread to entire side of the body - Correct Answer-Simple partial Seizure that is like a simple partial but has an impaired LOC. May have automatisms like lip smacking or picking at clothing - Correct Answer-Complex partial This is the most important test in determining seizure classification - Correct Answer- EEG What drug do you give for status epileptics? - Correct Answer-Phenytoin What drug do you give for seizures? - Correct Answer-Benzo Long acting anticonvulsant example - Correct Answer-Carbamazepine (Tegretol) Phenobarbital If patient has a C-spine injury, you can expect what kind of paralysis - Correct Answer- quadreplegic If patient has a thoracic spine injury, you can expect what kind of paralysis? - Correct Answer-paraplegic 3/5 muscle strength - Correct Answer-Full ROM against gravity, not against resistance 2/5 muscle strength - Correct Answer-extremity can move, but not against gravity Treatment of spinal cord injury - Correct Answer-Methylpredinosine Patient has diaphoresis and flushing above the level of injury and chills and severe vasoconstriction below the level of injury - Correct Answer-autonomic dysreflexia What is the usual cause of autonomic dysreflexia - Correct Answer-bowel/bladder distention restrictive clothing with brown sequard syndrome, what kind of symptoms can you expect - Correct Answer-Same side motor paralysis Opposite side pain and temperature Caused by compression of nerve roots at the end of the spinal cord - Correct Answer- Cauda Equina Neurogenic shock is caused by - Correct Answer-massive vasodilation Degenerative disorder as a result of insufficient amounts of dopamine in the body - Correct Answer-Parkinsons Anticholinergics are given in Parkinson's disease to help with - Correct Answer- alleviating tremor and rigidity Lewy bodies dementia is like - Correct Answer-Parkinsons What is agnosia - Correct Answer-inability to recognize an object What is apraxia - Correct Answer-inability to perform a previously learned tasks What is the normal breath sound? - Correct Answer-Resonance What does hyper-resonance indicate? - Correct Answer-air trapping (COPD/asthma) What will you see on x-ray with a pleural effusion? - Correct Answer-blunting/shunting of costaphrenic angle Obstructive disorder characterized by an increased responsiveness of the trachea and bronchi to various stimuli manifested by widespread narrowing of the airways - Correct Answer-Asthma Ominuous signs of asthma - Correct Answer-Fatigue Absent breath sounds Paradoxical chest movement Cyanosis FEV1 will be in asthma - Correct Answer-reduced If an asthma patient has a CO2 level of 35, then what does this indicate - Correct Answer-A very sick patient If an asthma patient has a CO2 of 45, than what does this indicate - Correct Answer- Emergency What are some examples of short acting beta adrenergic agonists? - Correct Answer- Albuterol What do you prescribe before exercise? - Correct Answer-Albuterol What are some examples of inhaled corticosteroids? - Correct Answer-Budesonide (Pulmicort) What is a side effect of inhaled corticosteroid? - Correct Answer-Candida infection bromide (Atrovent) Sympathomimetics (Ventolin, Preventil) What is inpatient management for COPD? - Correct Answer-Ampicillin/Amoxicillin Doxycycline Bactrim Where would you see TB on CXR - Correct Answer-upper lobes that looks like a honeycomb What is a positive PPD test for HIV infected persons, contacts of a known case, or persons with chest film typical for TB - Correct Answer-5 mm What is positive PPD test for immigrants from high prevalence areas, those in high risk groups, health care workers? - Correct Answer-10 mm What is positive PPD in all others not in high prevalence groups? - Correct Answer-15 mm If a family member has TB, then what do you do for the rest of the family? - Correct Answer-Set them up for TB testing What is the most common etiological agent of CAP? - Correct Answer-S. Pneumoniae What will you see on CXR with someone who has PNA? - Correct Answer-Infiltrates What would you treat someone with CAP with who is otherwise healthy? - Correct Answer-Macrolide (azithromycin) What would you treat someone with CAP with who has DM, heart/lung/renal disease? - Correct Answer-FQ/Beta lactam + Macrolide Ex: Levaquin + azithromycin How would you treat someone who has pseudomonas infection? - Correct Answer- Zosyn/Cefepime + Cipro/Levaquin or Vancomycin What is HAP? - Correct Answer-48 hours after admission to the hospital What is VAP? - Correct Answer-48-72 hours after intubation Hyper-resonance on affected side, diminished breath sounds and diminished fremitus on affected side. Mediastinal shift toward the unaffected side in tension. - Correct Answer-Pneumo Where do you do a needle thoracotomy (always first for tension pneumo) - Correct Answer-2nd ICS, MCL Where do you place a chest tube? - Correct Answer-4th or 5th ICS, MAL What are the four things S. Pneumoniae causes - Correct Answer-Otitis Meningitis CAP Sinusitis What is the main cause of death in those who have a PE? - Correct Answer-Right ventricular failure Prolonged bedrest/immobility, oral contraceptives, surgery to long bones, venous statin, cardiac thrombi are all risk factors for - Correct Answer-PE Before starting thrombolytic therapy in someone with a PE, the PT/PTT must ve - Correct Answer-<2 x normal Normal PT (11-19) Normal PTT (60-90) Symmetrical disease that is more common in women that affects the PIP, MCPs and has swelling and edema with redness and head complaints to the joints - Correct Answer-RA RA pain is - Correct Answer-Worse in the morning and better as the day progresses What labs will you see in RA? - Correct Answer-Elevated ESR What will you see on X-ray in RA? - Correct Answer-Joint swelling Osteopenia Joint space narrowing What is treatment for RA? - Correct Answer-High dose salicylate NSAIDs Corticosterioids MTX What are three types of fractures - Correct Answer-Closed Open Avulsion Disruption between normal relationships of joint surfaces - Correct Answer-Dislocation This is an incomplete dislocation - Correct Answer-Subluxation Inflammatory condition primarily affecting patients over the age of 50 - Correct Answer- Giant Cell Arteritis (temporal arteritis) This condition can lead to permanent blindness and accounts for 15% of FUO in patients 65 and older - Correct Answer-Giant cell arteritis Patient presents with HA, jaw claudication, enlarged temporal artery, fever of 103 and scalp tenderness - Correct Answer-Giant cell arteritis What labs can you expect to see with giant cell arteritis - Correct Answer-Very high ESR Normal WBC Positive temporal artery biopsy What is treatment options for giant cell arteritis - Correct Answer-Prednisone If the cup/disc ratio is greater than ½ the size of the diameter than the patient has - Correct Answer-glaucoma In a fundoscopic exam, the arteries are - Correct Answer-bright red and narrow What is the A:V ratio in a fundoscopic exam - Correct Answer-2:3 or 4:5 Micro aneurysms are the earliest detectable sign of this disease process - Correct Answer-Diabetic retinopathy Sign of chronic hypertension - Correct Answer-AV nicking Trauma to the eye resulting in interruption in the epithelial surface - Correct Answer- Corneal abrasion Patient presents with intense pain in affected eye, worsening in time along with tearing and redness - Correct Answer-Corneal abrasion What test do you do to detect corneal abrasion? - Correct Answer-Sodium fluorsecein stain How do you treat corneal abrasion? - Correct Answer-Topical antibiotics or sulfonamide drops Pressure patch for 24 hours This type of glaucoma is chronic - Correct Answer-open angle This type of glaucoma is an emergency - Correct Answer-close angle Patient is asymptomatic, but has an elevated IOP and fundoscopic exam shows cupping of the disc and constriction of visual fields - Correct Answer-Open angle (chronic) glaucoma What hemodynamic values can you expect to see in cardiogenic shock? - Correct Answer-Low CO High CVP High PCWP High SVR If there is a decreased SVR, then what is most likely the type of shock? - Correct Answer-Distributive How do you treat cardiogenic shock? - Correct Answer-IVF Vasopressor Nitro (vasodilator) What is the most common cause of obstructive shock? - Correct Answer-PE What is the most common cause of cardiogenic shock? - Correct Answer-MI What is the most common causative organism in women for UTI? - Correct Answer-E. coli What will urinalysis with UTI show - Correct Answer-WBC >10 If something is 99% sensitive then - Correct Answer-there is a 99% chance it will work What is diminished renal reserve - Correct Answer-50% nephron loss, creatinine doubles What is renal insufficiency - Correct Answer-75% nephron loss, mild azotemia What is end stage renal disease - Correct Answer-90% nephron damage, azotemia, metobolic alterations Criteria for dialysis - Correct Answer-Acidosis Electrolyte imbalance (hypercalcemia) Intoxication Oligura (<400/24 hrs) Uremia How do you treat acute renal failure? - Correct Answer-Determine cause and treat How do you treat chronic renal failure? - Correct Answer-Control HTN and DM Reduce protein to 40 g/day Caused by conditions that impair renal perfusion such as shock, dehydration, cardiac failure, burns, diarrhea, vasodilation and sepsis - Correct Answer-Pre-renal Caused by disorders that directly affect the renal cortex or medulla such as hypersensivitiy, embolism, nephrotoxic agents, mismatched blood - Correct Answer- Intra-renal Results in nephron damage. Damage to the tumbler portion of the nephron is the most common cause - Correct Answer-ATN Results from urine flow obstruction - Correct Answer-Post renal What is serum: BUN ration in pre-renal - Correct Answer->10:1 What is urine Na in pre-renal - Correct Answer-<20 What is urine specific gravity in pre-renal - Correct Answer-> 1.015 What do you see in the urinary sediment in pre-renal? - Correct Answer-normal/few hyaline casts Saw Palmetto What medications can make BPH worse? - Correct Answer-SSRIs Anticholinergics Antihistamines Normal CrCl in men < 40 - Correct Answer-107-139 Normal CrCl in women <40 - Correct Answer-87-107 What are some gram negative agents that cause UTI in elderly? - Correct Answer-E Coli P. aeruginosa What are some gram positive agents that cause UTI in elderly? - Correct Answer-S. aureus Enterococci If patient has negative cremastueric reflex then they have - Correct Answer-Torsion What is normal TIBC - Correct Answer-250-450 What is normal MCV - Correct Answer-80-100 What is normal iron - Correct Answer-50-150 What labs will you see with iron deficiency anemia? - Correct Answer-Decreased MCV Decreased ferritin High TIBC What is normal ferritin - Correct Answer-20-200/500 What labs will you expect to see in thalassemia - Correct Answer-Decreased MCV TIBC and Ferritin will be normal What labs will you see in folic acid deficiency? - Correct Answer-Increased MCV Decreased folate What labs will you see in pernicious/B12 anemia? - Correct Answer-Increased MCV Decreased B12 What labs will you see with anemia of chronic disease? - Correct Answer-Normal MCV Decreased TIBC Increased ferritin What kind of anemia would you expect to see in alcoholics? - Correct Answer-Folic acid This test may help determine the cause of B12 anemia - Correct Answer-Schillings What are some foods high in folic acid? - Correct Answer-Bananas PB Fish Green leafy vegetables Number one priority for sickle cell anemia? - Correct Answer-Fluids Genetic disorder that results in reduced ability to create blood clots - Correct Answer- Von Willebrand Disease What is treatment for von villebrand? - Correct Answer-DDAVP Constitutes 80% of acute leukemia in adults with remission rates from 50-85% - Correct Answer-AML More difficult to cure in adults than children and has a hallmark of pancytopenia with circulating blasts - Correct Answer-ALL Most common leukemia in adults that has a median survival rate of 10 years. Lymphocytosis is the hallmark of the disease - Correct Answer-CLL This leukemia has the philadelphia chromosome - Correct Answer-CML What confirms diagnosis of leukemia? - Correct Answer-bone marrow patches on cervix and vagina - Correct Answer-Trichomonas Fishy smelling discharge which is watery and grey, vaginal spotting - Correct Answer- Bacterial vaginosis Thick, white curd like discharge - Correct Answer-Candidiasis Normal saline mixture shows motile trichomonads - Correct Answer-Trichomonas Normal saline mixture shows clue cells - Correct Answer-BV KOH mixture shows pseudo hyphae - Correct Answer-candidiasis How do you treat trichomonas? - Correct Answer-Flagyl BID x 7 days How do you treat BV? - Correct Answer-Flagyl BID x 7 days How do you treat candida? - Correct Answer-Miconazole x 7 days How do you treat genital herpes? - Correct Answer-Valacyclovir How do you treat genital warts? - Correct Answer-Azithromycin/Rocephin/Cipro How often do you get a Pap smear ages 20-39 - Correct Answer-every 3 years How often do you get Pap smear ages 20-39 with HPV screen - Correct Answer-every 5 years When do you start total cholesterol checks - Correct Answer-20 (every 5 years) Woman who is 47 needs a mammogram. How often should she get one? - Correct Answer-Every year until 55; then every 2 years When should patients have their first EKG - Correct Answer-40 When should you start colorectal screening? - Correct Answer-Age 50 Sigmoid every 5 Colon every 10 When should you give herpes zoster vaccine? - Correct Answer-Age 60 When should you give Pneumococcal - Correct Answer-Age 65 What pneumo vaccines do those 65 and older need? - Correct Answer-PPSV23 and PCV13 Top causes of death in adolescents? - Correct Answer-MVCs Suicides Top causes of death in young adults - Correct Answer-MVCs Homicide Top cause of death in middle aged adults - Correct Answer-Heart disease Accidents My plate nutrition guidelines include: - Correct Answer-½ plate fruit and veggies Switch to skim of 1% milk Make at least half your grains whole Vary protein food choices Patients over 35 years old who have never had a program of exercise should have the following before instituting an exercise program - Correct Answer-Complete history Physical exam Exercise stress test Which vaccines are indicated for female adolescents for HPV and associated ages? - Correct Answer-Gardasil 11-26 Cerverix 10-25 What is the most common cancer killer for boys in adolescent period? 2nd most common? - Correct Answer-Testicular cancer HIV depending on drug use/sexual activity When is the last meningiococcal vaccine given? When is revaccination indicated? - Correct Answer-Late adolescent period Person who will go to college and live in a dorm. Meningioccal vaccine is not a routine vaccine in the adult. At what age is the influenza vaccine given? - Correct Answer-Every year for persons 6 months of age and older. Should PPD screening be done in adolescents? - Correct Answer-Yes, one time. 20-39 age, when should a complete physical be done? When should it start? - Correct Answer-Start at 20, repeat complete physical every 5-6 years. PAP smears should begin at what age? - Correct Answer-21 years old. Conventional/liquid based cytology is recommended. Repeated every 3 years. At age 30. HPV Co-test, repeated every 5 years. Full fasting lipid panel? - Correct Answer-Start at age 20 unless significant family history. If pt. not fasting, total and HDL are reasonable. Self skin exam? Dental cleaning and checkups? - every 6 to 12 months. - Correct Answer-TD vs. TDAP How often should a woman have mammography? - Correct Answer -Every 1 to 2 years until woman is 50 years old to 74 years old. Digital rectal exam? PSA? - Correct Answer -Age 40 Age 50 African-Americans or prostate CA hx- PSA done 40 years old or earlier. HIV, BP, cholesterol, ECG ? Colorectal cancer screening? - Correct Answer -Done by 40 years old. Starts by age 50 years old. Top killers of adults - Correct Answer- 1. Heart Disease (CAD, HF, cardiomyopathy) 2. Colorectal cancer 3. Lower respiratory disease (PNA, asthma, COPD) 4. CVA (stroke) Cancers responsible for highest mortality? – Correct Answer- 1. Lung 2. Colorectal Leading GYN associated killer cancer? Highest incidence of cancer in women? - Correct Answer-Ovarian Breast Highest incidence of cancer in men? - Correct Answer- 1. Lung 2. Prostate Leading killer of African Americans in US? – Correct Answer -Heart Disease Tinometry (glaucoma screening) - Correct Answer-Have a baseline by age 40. Herpes zoster vaccine (Zosyvax), what age should it be given? - Correct Answer-50 years old. Discontinue PAP smear at what age? Tertiary Prevention? - Correct Answer-Rehabilitation, restoration of health, Cardiac rehab after MI, physical therapy after car accident. Food plate divisions? - Correct Answer-55-60% of daily intake should be carbs, 0.8-1 g/kg/day protein intake half of plate should be fruits and vegetables. Exercise and health promotion, what does it do? How long/day - Correct Answer-Increases LDL, increases basal metabolic rate, reduces stress, helps to decrease signs of aging, improves cardiovascular health. 30 minutes per day For patients >35 who never exercised but want to start? - Correct Answer-They should have a physical exam, exercise stress test. What is the substance that the bad guy? - Correct Answer-Antigen What is made by the body to fight antigens? - Correct Answer-Antibodies This immunity comes from say receiving a tetanus toxoid? - Correct Answer-Active Immunity Conferred by antibody formation that is stimulated with a specific antigen- like toxoids. Conferred by introduction of antibody protein such as gammaglobuin injections or maternal immunity that is transferred to fetus? - Correct Answer-Passive immunity Gammaglobulin injection- HBIG - given for known exposure to hep B in a patient that is not previously vaccinated. Pneumococcal vaccine indications. - Correct Answer-65+ 19 to 64 who smoke or have asthma People with lung, heart, liver, or kidney disease. People with weakened immune systems. People with chronic term condition. Hep A vaccine? Hep B vaccine? - Correct Answer-Military, men who have sex with men, travelers to endemic areas All health care workers and high risk patients including sexually active adults. Mumps vaccine? - Correct Answer-Born before 1957, take one dose of vaccine After 1957- take 2 doses of vaccine. Meningiococcal vaccine age? - Correct Answer-2-55 years old. Military, immunocompromised, travelers to Africa, college students. Expensive, not that effective. Which herb is used to increase overall physical and mental well being, lowers cholesterol, reduces fatigue, and enhances libido? - Correct Answer-Ginseng The side effects of this herb are insomnia, nausea, diarrhea, headaches, nervousness, and nose bleeds. - Correct Answer-Ginseng What is used for nausea, dyspepsia, constipation, colic? - Correct Answer-Ginger This herb can cause blood pressure changes (high or low), mania in depressed patients taking MAOIs, may inhibit the effects of opioids. - Correct Answer-Ginseng This herb is used to treat depression, anxiety, sleep disorders, improve BPH symptoms - Correct Answer-St. John's wort The side effects of this herb are increased sensitivity to sunlight, anxiety, dry mouth, dizziness, GI symptoms, fatigue, HA, sexual dysfunction. - Correct Answer-St. John's Wort Which herb causes an increased risk of clotting? - Correct Answer-St. John's Wort Which herb has many drug interactions namely serotonin syndrome when combined with SSRIs, decreased effectiveness of oral contraceptives, digoxin, alprazolam, requiring anesthesia for sx. - Correct Answer-Evening Primrose This herb improves relaxation without disrupting mental clarity. - Correct Answer-Kava Kava The side effects of this herb are eye irritation and rash. - Correct Answer-Kava Kava Higher doses and long term use of this herb can lead to htn, liver damage, visual impairment and dry skin. ETOH increases toxic effects, may worsen Parkinson's and may impair reaction time when driving an automobile - Correct Answer-Kava Kava Herb that improves indigestion and respiratory complaints, increases energy levelss - Correct Answer-Garlic Which herbs increases risk of bleeding (5)? - Correct Answer-Ginger, ginseng, Gingo Biloba, Black Cohosh (vag bleeding), Garlic NURS 642 /AGACNP EXAM 1 Pneumothorax - Correct Answer-occurs when air is allowed into the pleural space Caused by trauma, medical procedures, or spontaneously - Correct Answer- penumothorax perforation of chest wall or pleura: trauma (sucking chest), blunt (air enters form lung to pleura), iatrogenic, - Correct Answer-causes of penumothorax Pneumothorax risk factors - Correct Answer-trauma, iatrogenic, intrinsic lung disease, young, thin males, smoking, HIV with penumocystis jiroveci penumonia Iatrogenic causes - Correct Answer-Central line , bronchoscopy(with needle bx) needle insertion (bx liver, lung, thoracentesis) surgery (chest,neck abdominal) Mechanical ventilation Tension Pneumothorax - Correct Answer-air pressure builds within the pleura space (unable to exit) pressure rises lung collapses causing shifting of the mediastinum and impairment of venous blood return to the heart - Correct Answer-tension pneumothorax Pneumothorax HPI - Correct Answer-acute onset of dyspnea and pain. agitation or apprehension may cause tachypnea, tachycardia developing a tension pneumothorax - Correct Answer-hemodynamic instability (hypotension, CV collapse with distended neck veins, tracheal shift) and mediastinal shift may be noted. reduced breath sounds, splinting, reduced respiratory expansion, tracheal/mediastinal shift, subcutaneous empheysema, hemodynamic instability with impaired venous return - Correct Answer-tension pneumothorax mainstay for diagnosing pneumothorax - Correct Answer-CXR what is the preferred position of CXR for penumothorax - Correct Answer-upright position increased translucency, visible lining collapse demarcation, mediastinal shift. (looks like lung pushed inwards) - Correct Answer-findings on CXR for pneumothorax Diff. diagnosis for penumothorx include (think of causes for acute sob) - Correct Answer-PE and Pneumonia pneumothorax diagnostic criteria - Correct Answer-significant history and exam findings may be sufficient to proceed with treatment without CXR. pneumothorax in a stable patient - Correct Answer-CXR is diagnostic criteria Pneumothorax goals of care - Correct Answer-stabilization and intervention in the unstable pt pneumothorax goals of care for the stable patient - Correct Answer-decision made to intervene or monitor based on the amount of lung volume lost. tension pneumothorax Acute management - Correct Answer-emergent intervention : needle decompression, 14-16G needed, 2nd ICS, anterior at MCL and chest tube