MN 566 MIDTERM EXAM 2023 ANSWERED V5, Exams of Nursing

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MN 566 Midterm Review

1. Polypharmacy is a major contributor to confusion in older adults
2. One of the indicator of diagnosing dementia is having a hard time finding words, continual problem having a hard time finding words.
3. If a patient has a history of dementia, you might also see chronic kidney disease (something you might notice)
4. Migraines can be trigger by wine(especially red wine)
5. What else trigger migraines: stress, smells, caffeine (it can help and trigger migraines), bright lights, flashing lights
6. If you have vertigo, in the vestibular area, you may need something to decrease that edema: Acetazolamide (Diamox) is a diuretic side note: Meclizine (antivert) do not decrease edema
7. An absent seizure can also be describe as someone having a blank stare
8. If you look at epidemiology and pick out a person based on age and sex on MS, you may pick out a male in their 40’s or late 40’s, if it’s a female you may pick out a young female (25 yr old female).
9. There is no specific test for MS. You can confirm the probability by MRI, and you can see lesions
10. MS can cause relapse and remitting. This is where pt has episodes blindness one day and the next day the blindness is better, double vision or numbness and tingling one day and better the next day. They can have optic neuritis (side note: they would need heavy dose of steroid)
11. A pt with MS has a new onset of tingling in their arms, a shot of Methylprednisolone (solu-medrol) will help
12. One of the risk factor of Alzheimer’s disease is down syndrome
13. One of the first type of drug for Alzheimer’s disease is cholinesterase inhibitors (Aricept) to treat the cognitive sx (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer’s disease.
14. If someone was hit in the head with a frying pan, where do you think the hematoma may occur: Subdural

15. What if a person have a hematoma occurring in the temporal cranial wall from tears of artery: temporal arteritis (they would need long-term steroids). What type of hematoma would you be concern about? Epidural. You would want to get a head CT prior to administering what drug? Blood thinner drug TPA
16. Cranial nerve 5, what is it associated with/what movement you are going to check/what are you going to ask them to do? It’s the jaw area so chewing.
17. A link in delay for stroke treatment could be: FAST
18. A pt with a carotid bruit may also have a hx of peripheral vascular occlusive disease
19. A cluster headache might be more likely in a 45 yr old male who wakes up at night, he wakes up with that cluster headache at night
20. Myasthenia Gravis (MG), thinking about epidemiology, and the risk that might be given to you as an option for the characteristic and demographic of a pt: perhaps a 31 yr old Hispanic women, is at risk for women with MG
21. A sleep wake cycle disturbance can certainly be a hallmark symptoms of delirium (people with delirium, their days and nights are mixed up often)
22. Aseptic meningitis is more benign, is self-limiting type of meningitis , and is cause by a virus, but sometimes medicine can cause aseptic meningitis.
23. Cefotaxime (good choice for strep pneumonia) is a cephalosporin, is associated with tx strep pneumonia. Strep pneumonia and strep in general, you should think cephalosporin treatment.
24. Viral encephalitis tx with IV acyclovir
25. With herpes, a person would have vesicular lesion on one side of the body
26. Epidemiology question: a 72 yr old female is more likely to be dx with Gillian-Barre syndrome
27. If someone has bell’s palsy, most people will have full recovery in 3-6 months
28. Dance like movement, what disease is that? Huntington’s chorea
29. If someone has Parkinson plus disorder, they will have posture instability
30. Light sensitivity with migraine
31. A carotid endarterectomy, if someone has symptomatic, with a greater than 50% stenosis that is symptomatic, then you would consider a carotid endarterectomy.

32. On a functional activity questionnaire ask a patient about a news event from the current week.
33. Almost 90% of all headaches are without pathological cause
34. Each state does have different laws regarding driving for seizure disorders (some laws, have to be seizure free for 3 yrs)
35. Need to know about relapsing and remitting tx for MS: “mab” are good for that, so Natalizumab, it is a once a month injection
36. Freezing phenomena is associated with Parkinson disease
37. Cogwheeling: in Parkinson’s disease, is jerky feeling in your arm or leg that you can sense when rotating that limb or joint. It is an early sign of Parkinson’s.
38. Inability to learn new information and cognitive problem is associated/description of Alzheimer.
39. Mini-mental status examine: assess cognition. Know the levels (example: 12 to 24 means?) a. Is a 30-point test used to measure thinking ability (or “cognitive impairment”). Mini-Mental State Exam Scoring Chart Score Level of Dementia 24 and higher Normal cognition; no dementia 19 – 23 Mild dementia 10 – 18 Moderate dementia 9 and lower Severe dementia
40. If you are going to do a thrombolytic therapy with a stroke, it should be within 3 hrs of symptoms onset
41. Oxygen can help with cluster headaches
42. A cough that last longer than 8 weeks is chronic
43. Arnold reflex: a cough stimulated by the auricular branch of the vagus nerve (in our book: check the ears for cerumen or hairs impinging on the tympanic membrane, which may cause cough=>Arnold reflex)
44. If you are going to do a fungal serology on a chronic cough, you might be checking a patient with a history of AIDs (so if you have a pt with AIDs and have a cough, you will want to do a fungal serology).

45. If you are going to give a pt a decongestant, typically they may have allergic rhinitis
46. Liquorice should be use with caution in hypertension
47. Captopril (ACE inhibitor)v “pril” may cause people to cough
48. Anxiety related dyspnea, can lead to a panic attack
49. BORG scale (dyspnea scale): is useful for assessing the degree of dyspnea, 6 to 20, 6 = no exertion, 20 = very, very hard exertion.
50. Mitral stenosis: if you have a 30 yr old AA woman that might be coughing up blood, you will want to check for mitral stenosis
51. Long term beta agonist (bronchodilator) might not be the best choice in the AA population, they could have a negative reaction to this.
52. Someone with a decrease PA2, on assessment you find crackles, they could have a chronic bronchitis. Decrease oxygen, increase CO2 = chronic bronchitits
53. You will need to use a Curve 65 clinical prediction tool to assess community acquire pneumonia. One of the risk factors would be DM
54. If you are going to look for the smallest diameter of induration of a positive TB, it would be 5
55. If a pt has a decrease response to a TB skin test, may be they have been on long term corticosteroids therapy.
56. Vitamin B6 (pyridoxine) for TB regime to prevent numbing and tingling of the hands or feet caused by other TB medicines.
57. Squamous cell carcinoma in a 65 yr old male with a 20 yr history of smoking is more likely
58. Horner’s syndrome: a disrupted nerve pathway on one side from the brain to the face and eye. Horner’s syndrome is the result of another medical condition, such as stroke, tumor, or SCI. (ptosis of upper eyelid, slight elevation of lower lid, constriction of pupil, anhidrosis).
59. Know what TNM is (tumor node metastasis): is the most widely used cancer staging system. The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor. a. Cancer size is less than 3 cm, there’s no lymph nodes = N0, metastasis is zero, there is no metastasis.

b. In the TNM system: i. The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor. ii. The N refers to the number of nearby lymph nodes that have cancer. iii. The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.

60. If a person is not ready to quit smoking, always address it at every visit. Motivational discussion helps. Aske “what are your barriers” “what do you think you will gain from quitting smoking?”
61. Patient decided to quit smoking with Chantix, you will want to discuss quit date “your quit date will begin in a week”
62. When people are using gum to quit smoking, they need to chew and park it on their buccal mucosa
63. Sputum stain for viral respiratory culture should be a florescent antibody stain
64. Treating group A strep throat: tx with penicillin
65. Moderate persistent asthma: how would you know that? (know if asthma is mild, moderate, serve) moderate asthma: they have continuous sx greater than once a week, sx at night time, they constantly use their inhaler
66. Inhaled corticosteroid is the corner stone for asthma tx

67. If someone is on the Theophylline, you would want their theophylline serum level to be 5 to 15
68. Stages of COPD a. Stage 1mild: FEV1>80% predicted b. Stage 2 moderate: FEV1 <50% to <80% predicted c. Stage 3 severe: FEV1 >30% to <50% predicted d. Stage 4 very severe: FEV1 <30% predicted
69. Nosocomial pneumonia are typically gram negative bacteria
70. The size of TB skin test, has nothing to do with the erythema, it’s the induration you are checking. (induration = firmness or nodule feeling)
71. Asthmas is an obstructive lung disease that is technically classify as reversible, people can grow out of asthma.
72. The most prevalent carcinoma is adenocarcinoma of the lungs in both sex, even in non- smoker, 35-
73. If someone has a large neck 17 inches = prone to sleep apnea
74. CPAP, want to look at 15 to 20 scans of pressure
75. Sometime laser assisted = uvuloplasty for OSA
76. If you have a 3 week old baby, who has influenza you can give liquid Oseltamivir (Tamiflu)
77. Force vital capacity is decrease in restricted disease
78. Common cause of community acquire pneumonia is streptococcus pneumoniae
79. If somebody recently survive a fire, maybe 40% of their body is cover in burn, they might not have an appropriate response to a TB skin test.
80. Insulin resistant is a possible consequence of sleep apnea.
81. Bladder cancer/all renal cancer is associated with cigarette smoking
82. TB medications should be taken on an empty stomach to facilitate absorption
83. Cigarette smoking do increase the risk of pneumothorax
84. How much of nicotine in cigarette? 15-20 mg
85. There are steps to quitting (pre-contemplation, contemplation) a. If somebody is preparing to quit, they bought the gum, asking you question about Chantix, that means they are in preparation to quit

86. One of the benefit to quitting smoking is = enhance taste and smell
87. A barrel chest characteristic of emphysema is a result of the hyperinflation
88. Supplemental oxygen will help improve mortality of COPD (15 hrs a day is acceptable, statistically it has been shown to improve mortality)
89. Alpha 1 is a genetic deficiency, their alpha 1 antitrypsin level will need to be check a. alpha 1 antitrypsin: an inherited disorder that cause lung disease and liver disease b. If you have a pt that is young and smoke like a 43 yrs old and they already have COPD, you will want to check their alpha 1 antitrypsin level
90. In ethnic group, the highest lung cancer incident and mortality rate are AA men
91. Statin use example: 65 yr old female with an MI
92. If you have someone that has chest wall pain that is not cardiac related, it could be costochrondritis
93. Why would you order a holter monitor?
94. A BP of 150/90 = normal in healthy older adults (JCN8 guideline)
95. One good thing to reduce HTN is limiting beer to 24 oz per day
96. Chlorthalidone (thiazide) helps reduce the incident of stroke
97. If your HDL is greater than 60, that is cardioprotective. You want your LDL to be low, and your HDL to be high. Brand food makes a difference
98. Metabolic syndrome, one of the parameter for Sigred metabolic syndrome is a waist is over 36 inches.
99. Prinzmetal Angina: often triggered by exertion or emotional stress. Almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful.
100. Labetalol can give a false reading on a cardiac stress test (betablockers)
101. Deep vein thrombosis, someone at risk of a DVT is someone having surgery
102. Peripheral artery disease, the left leg is cold, pale, smaller, thick toe nail
103. Second degree mobitz1vs type 2: The difference between Type 1 and Type 2 second degree heart block: Type 1 has increasing PR intervals, increasing until the QRS is "dropped" or missing. Type 2 has constant PR intervals, with randomly dropped QRS complexes.

104. presyncope = light headed, feel faint, feel like you are going to past out and need to sit down.
105. Wolff-Parkinson-White disease: A syndrome in which an extra electrical pathway in the heart causes a rapid heartbeat.
106. Delta waves: is a type of high amplitude brain wave found in humans. Delta waves have a frequency from one to four hertz and are measured using an electroencephalogram (EEG).
107. S4 heart sound and how it relates to left ventricular hypertrophy
108. Somebody who has a prosthetic heart valve and they are going to the dentist, they will need antibiotic prophylaxis to prevent endocarditis
109. Framingham heart study: a person who is normal tensive, 55 yr old, they still have a 95% risk developing hypertension
110. Angina can be describe as diffuse (ex: describe pain characteristic “it kind of here in my chest and it goes over here, and I feel like it’s up underneath here” = diffuse)
111. Proper way to measure BP: cuff bladder 80% and the width 40% of arm circumference, and pt resting 5 minutes.
112. About 30% of pt with angina will have dyspnea
113. If someone has palpitation due to catecholamine, they may say “I feel like my heart is beating real strong like I just work out” its catecholamine production
114. Most common complaint of CHF is = SOB/dyspnea
115. When it involves the lower extermities, we know that peripheral edema can be possibly cardiac condition
116. 911 should be call after 3 doses of nitroglycerine
117. You can still have thrombolytic benefit for an MI given up to 12 hours
118. How long is Nitroglycerine good in a bottle once its open = 6 months
119. Heart failure level/classification: 1 thru 4 new York, classification ABCD

i. D class level would be hospice level, nothing that can be done

120. Good diagnostic test for HF lab wise = BNP
121. PE = chest CT/VQ scan
122. Torvastin 80 mg is shown to decrease your LDL by 50%
123. Cilostazol (pletal) causes platelets aggregation
124. High dose diuretic can be a problem with hyperlipidemia
125. Hawthorn is herbal and can be used as a complementary therapy that can helpful with orthostatic hypotension
126. CHADS2 index for stroke, what does the A stand for: age (C= congestive heart failure, H = hypertension, A = age, D = diabetes, S = prior stroke or transient ischemic attach).
127. a 50/50 murmur, where would that murmur be? aortic sclerosis
128. dabigatran (pradaxa) is a blood thinner = it can not be immediately reverse, you have to give an antidote
129. ankle brachial index of less than 0.9 could indicate peripheral artery disease
130. apixaban is an alternative med, it does not necessitate dose titration (don’t need dose titration)
131. JCN8, looking at a BP goal, you are not going to add two drugs at once typically, you want to particularly add one drug and then wait one month and then add another drug. JNC8 guideline is wait about a month before adding a second HTN medication.
132. Hydrochlorothiazide is a good first line of choice
133. Non-medical to reduce HTN = Weight lost
134. Lisinopril good for post MI with HTN

135. We want to look at right access deviation , it comes from lead 1
136. Distended neck veins = seen in a male pt with HTN
137. A 25 yr old with PVCs = they don’t need to be treated
138. Ordinary artery disease associated with HF is a very common disease that you see in A-Fib
139. Digitalis can compete with potassium
140. Calculating PR interval will help you understand if it is SVT or V-tach, so PR- interval is an indicator
141. DM, diet and exercise, and metformin
142. TSH and a T 143. Review endocrine