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MIDTERM NR 511 EXAM
DIAGNOSTIC REASONING AND DIFFERENTIAL DIAGNOSIS - CORRECT ANSWER - Taking a client history OLDCARTS Specificity and Sensitivity Reimbursement Clinical Decision-Making OLDCARTS - CORRECT ANSWER - Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity True or False: the history of the present illness is a breakdown of the client's chief complaint
- CORRECT ANSWER - True Specificity: Low - CORRECT ANSWER - Getting a positive result when it is not present- a high number of false positives- meaning a healthy person has a disease when they actually do not Specificity: High - CORRECT ANSWER - A high percentage of healthy individuals will show a normal result Test with High Specificity - CORRECT ANSWER - A high percentage of healthy individuals will show a normal result Sensitivity - CORRECT ANSWER - the proportion of true positives out of all patients with a designated condition
High Sensitivity - CORRECT ANSWER - will lead to positive findings for patients with a disease Medicare Part A - CORRECT ANSWER - Inpatient hospital stat, skilled nursing care, hospice, home care Medicare Part B - CORRECT ANSWER - Outpatient care, provider visits, surgery, lab tests, medical equipment, preventative exams Medicare Part C - CORRECT ANSWER - Wellness services, vision exams, hearing exams, eyeglasses, hearing aids Medicare Part D - CORRECT ANSWER - Prescription drugs Reimbursement for NPs - CORRECT ANSWER - Reimbursed 85% of the physician's fee Fungal Skin Infections - CORRECT ANSWER - Papular Rash, SATELLITE LESIONS (classic symptom) Treatment of fungal skin infections - CORRECT ANSWER - Antifungal cream, pill, keep area as dry as possible Location of fungal skin infections - CORRECT ANSWER - Can be under the breast, in between skin folds, or in the groin area Who is at risk for fungal skin infections - CORRECT ANSWER - Immunocompromised, diabetics, antibiotic therapy, cellular immunity (chemo, AIDS, corticosteroid treatment, bone marrow transplant), invasive parenteral catheterization, invasive monitoring devices Tinea Vessicolor - CORRECT ANSWER - Most commonly found on trunk and shoulders.
Foliculitis - CORRECT ANSWER - Bacterial infection of the hair follicle, papules are characteristic of follicles. Impetigo - CORRECT ANSWER - Highly contagious bacterial skin infection and most commonly EFFECTS YOUNG CHILDREN Treatment of Impetigo - CORRECT ANSWER - Non-pharmacologic management involves the use of solutions or substances to debride the lesions and to expose the skin surfaces where the bacteria are present Two types of impetigo - CORRECT ANSWER - Bullous and non-bullous Bullous and non-bullous impetigo (Face) - CORRECT ANSWER - The cervical lymph nodes are enlarged Bullous and non-bullous impetigo (Upper Extremeties) - CORRECT ANSWER - The axillary nodes are enlarged Inclusion cyst - CORRECT ANSWER - Cheesy white discharge with a strong odor Epidermal inclusion cyst - CORRECT ANSWER - History of the cyst on the SAME SITE FOR MONTHS TO YEARS Furuncles - CORRECT ANSWER - Acute process, taking only several days to form Hives - CORRECT ANSWER - Type 1 hypersensitivity reaction, look at the location of the rash First step for hives - CORRECT ANSWER - Determine the need for epinephrine What is important in determining rash development - CORRECT ANSWER - History taking
Atopic Dermatitis - CORRECT ANSWER - Classic sign severe pruritus Primary locations of atopic dermatitis in children - CORRECT ANSWER - Antecubital fossae and popliteal fossae Herpes Simplex common symptoms - CORRECT ANSWER - Blistering sores, itching, pain during urination (genital herpes), fever, headache, tiredness, lack of appetite Treatment for herpes simplex in immunocompromised patients - CORRECT ANSWER - Famciclovir or Valacyclovir Goal of treatment for herpes - CORRECT ANSWER - To suppress Characteristics of herpes zoster - CORRECT ANSWER - Unilateral vesicular rash along a dermatome Common dermatomes that shingles follow - CORRECT ANSWER - Thoracic or lumbar Characteristic of shingles rash - CORRECT ANSWER - Begins as erythema, then changes to papular lesions that rapidly form vesicles Acne first line treatment - CORRECT ANSWER - Benzoyl peroxide Teaching for acne - CORRECT ANSWER - Sunscreen should be used Key information for acne - CORRECT ANSWER - Wash face gently at least twice a day with an antibacterial soap
Scabies - CORRECT ANSWER - An intensely itchy rash caused by a mite known as Sarcoptes scabies can last several days or weeks Differential diagnosis for scabies - CORRECT ANSWER - Atopic dermatitis, contact dermatitis, and folliculitis Furuncle (Boil) - CORRECT ANSWER - Painful red bumps under the skin due to infection of hair follicles or in oil glands Starts as red, tender lump at the infection area and may grow to form pus-filled lumps - CORRECT ANSWER - Furuncle (Boil) Differential diagnosis of furuncle when located in the axilla - CORRECT ANSWER - Hidradenitis suppurativa- long-term skin condition characterized by painful bumps under the skin, usually in the armpits, groin, buttocks or breasts Warts - CORRECT ANSWER - Caused by human papillomavirus, RECUR DESPITE TREATMENT Causative organism of viral conjunctivitis - CORRECT ANSWER - Adenovirus Signs and symptoms of viral conjunctivitis - CORRECT ANSWER - Can present with or without cold symptoms, itchy, red eyes, and may have clear to no discharge Hallmark sign of viral conjunctivitis - CORRECT ANSWER - Preauricular lymph node swelling and tenderness Treatment for viral conjunctivitis - CORRECT ANSWER - Lubrication for comfort, artificial tears (Refresh, Celluvisc, Murine) HSV-1 OR HSV-2 conjunctivitis hallmark characteristics - CORRECT ANSWER - Skin vesicles and corneal infection with a "dendrite"
Treatment for HSV-1 or HSV-2 conjunctiviits - CORRECT ANSWER - Pyrimidine (thymidine) or Oral antivirals acyclovir (Zovirax) start therapy within 72 hours Treat or Refer HSV-1 or HSV-2 conjunctivitis - CORRECT ANSWER - Treat and then refer to an ophthalmologist Characteristics of bacterial conjunctivitis - CORRECT ANSWER - Red eye with crusted eye lid Bacterial conjunctivitis - CORRECT ANSWER - Visual acuity will be normal First-line treatment of bacterial conjunctivitis - CORRECT ANSWER - Sodium sulfacetamide (Bleph 10, Cetamide, Ak-sulf) Erythromycin ointment (E-Mycin) Azithromycin (AzaSite) Bacitracin (AK-Tracin, Baciguent) Ciprofloxacin (Ciloxan) Cataracts - CORRECT ANSWER - Produce a gradual, painless, and progressive loss of vision although many clients are unaware of any vision problems due to the gradual nature of onset Age-Related cataracts - CORRECT ANSWER - Tend to be bilateral in nature and may manifest as blurred or distorted vision, with complaints of a glare when driving at night or in bright light Blepharitis - CORRECT ANSWER - Inflammation around the eyelid margins Blepharitis caused by - CORRECT ANSWER - Staphylococcal infection at the lash base and dysfunctional Meibomian glands
When to get help for subconjunctival hemorrhage - CORRECT ANSWER - Visual changes or with more extensive hemorrhage Herpes Zoster ophthalmicus first line defense - CORRECT ANSWER - Prevention through vaccination Standard treatment for Herpes Zoster Ophthalmicus - CORRECT ANSWER - Antiviral medication (Acyclovir) Hordeolum (Stye) - CORRECT ANSWER - Small red, painful lump in the edge of the eyelid Cause of hordeolum - CORRECT ANSWER - Bacterial infection Treatment for hordeolum - CORRECT ANSWER - Most cases get better on their own and do not require treatment Sinusitis - CORRECT ANSWER - The maxillary sinus is the largest of the paranasal sinuses and is the most commonly affected sinus Diagnosis of sinusitis - CORRECT ANSWER - If a pt has a URI for at least 7 days, the presence of 2 or more of the following signs and symptoms will confirm the diagnoses of sinusitis: colored nasal drainage, a poor response to decongestants, facial or sinus pain (especially if aggravated by postural change) and headache Sinusitis as a virus - CORRECT ANSWER - Viruses may produce all of the clinical manifestations described, however, patients who meet the 7-day criteria are more likely to have bacterial rather than a viral URI Otitis Externa - CORRECT ANSWER - Classic sign is tenderness on traction of the pinna and/or pain on applying pressure over the tragus
Acute Otitis Media diagnosis - CORRECT ANSWER - Made by otoscopic examination, TM will appear red and bulging with or without visible effusion, light reflex is usually diminished or absent, mobility is decreased, external auditory canal is red and erythematous Treatment for acute otitis media - CORRECT ANSWER - Amoxicillin 40-45mg/kg/day PO in two divided doses for 10 days Follow up for otitis media - CORRECT ANSWER - Should be seen for follow-up in 48 to 72 hours if symptoms have not resolved Acute Angle-Closure Glaucoma - CORRECT ANSWER - Results in increased intraocular pressure, is an EMERGENCY when left untreated, can cause blindness Symptoms of acute angle closure glaucoma - CORRECT ANSWER - Occurs suddenly with a dramatic onset of symptoms, including blurred vision, red eye, unilateral pain, pressure, headache, seeing halos around lights and photophobia followed by loss of peripheral vision, then central vision loss What can cause severe damage to the optic nerve? - CORRECT ANSWER - Sudden and severe intraocular pressure elevation Barotrauma of the auditory canal - CORRECT ANSWER - May be relieved by the use of nasal steroids and oral decongestants Sensorineural hearing loss - CORRECT ANSWER - Hearing loss caused by exposure to loud noises, inner ear infections, congenital or familial disorders, Menier's disease, ototoxic drugs, trauma Conductive Hearing Loss (Presbycusis) - CORRECT ANSWER - Bone conduction is greater than air conduction
Symptoms of pharyngitis - CORRECT ANSWER - Fatigue, fever, scratchy throat, pain, and difficulty swallowing Treatment of pharyngitis - CORRECT ANSWER - 10 - day course of PCN 500mg PO BID or 250mg PO 4 times a day Benzathine PCN Hoarseness (Dysphonia) - CORRECT ANSWER - Changes in the pitch or quality of the voice, which may sound weak, scratchy or husky Differential Diagnosis of Hoarseness - CORRECT ANSWER - Papillomatosis Papillomatosis - CORRECT ANSWER - Wart-like growth or tumor on the surface of the larynx Peritonsillar Abscess - CORRECT ANSWER - Infection is virtually always unilateral and is located between the tonsil and the superior pharyngeal constrictor muscle Rhinitis (Hayfever) - CORRECT ANSWER - Type 1 hypersensitivity to airborne irritants affecting eyes, nose, sinuses, throat, and bronchi Allergic Rhinitis - CORRECT ANSWER - Overuse of decongestant nasal sprays can cause rebound rhinitis Characteristics of rebound rhinitis - CORRECT ANSWER - Nasal congestion w/out rhinorrhea following the short-term use of topical vasoconstrictive medications. Remedy of rebound rhinitis - CORRECT ANSWER - Immediately stopping all topical decongestant use, usually resolves after 2-3 weeks
Atopic triad - CORRECT ANSWER - Genetic predisposition toward allergic reactivity may be the most important etiological factor Atopic triad-personal or family history - CORRECT ANSWER - Asthma, allergic rhinitis, and eczema
