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NURS 8024 EXAMS SET 2025 QUESTIONS AND ANSWERS
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✔✔Treatment for UTI in non-pregnant patient - ✔✔1* Nitrofurantoin (macrobid) 100mg BID x5 days 2 - Fosfomycin (monurol) 3g x 3 - Bactrim (TMP/SMX) 160/800 BID x3 days (IF resistance is <20%) ✔✔Treatment for UTI in a PREGNANT patient - ✔✔PCN (amoxicillin) - 500mg Q8H for 5 - 7 days OR 875mg Q12H for 5-7 days Augmentin (amoxicillin-clavunate) Cephalosporin (Keflex/Cephalexin)- 250 - 500mg Q6H for 5-7 days ✔✔what medication for UTI is avoided at end of pregnancy and in patients with glucose- 6 - phosphate dehydrogenase deficiency d/t risk of hemolytic anemia in the newborn? - ✔✔nitrofurantoin ✔✔what medication for UTI is avoided in the FIRST and THIRD trimester b/c it is a folate antagonist (1st trimester) and in those with g6pd (third trimester; hemolytic anemia) and in those with sulfa allergy? - ✔✔Bactrim (TMP/SMX) ✔✔This type of diabetes typically begins in childhood, and is d/t beta cell destruction...there is a genetic component (especially w/ 1st degree relatives)...requires insulin - ✔✔type I DM ✔✔this type of diabetes is d/t insulin deficiency/secretory effect & increased hepatic glucose production...lifestyle modification (exercise/diet), oral anti-DM's, sometimes insulin - ✔✔Type II DM ✔✔what is the prevalence of type I DM in the US - ✔✔10% of those diagnosed w/ DM have type I ✔✔what is the prevalence of type II DM in the US - ✔✔1 in 10 Americans; >14 million cases ✔✔risk factors for type II DM include: - ✔✔obesity sedentary lifestyle family h/o certain races (native Americans, Hispanics, blacks, Asians) high cholesterol ✔✔what is the prevalence of obesity in the US - ✔✔68.8% of the US population 80% AA's, 78% Hispanics (compared to 60.3% of non-Hispanic White women)
✔✔what are the risks associated with being obese? - ✔✔heart disease, HTN, type II DM, stroke, cancer, cholecystitis, OSA, disability, OA ✔✔who is most at risk for developing osteoarthritis? - ✔✔older females (also repetitive joint stress/overuse) ✔✔what is the patho behind ostearthritis? - ✔✔degeneration of articular cartilage and subchondral bone causing synovial inflammation (bone ends thicken and form bone spurs) ✔✔osteoarthritis causes what type of joint pain... - ✔✔unilateral (one sided), asymmetrical joint pain ✔✔what type of nodes are common with osteoarthritis - ✔✔herberdens, bouchards ✔✔in osteoarthritis, pain worsens with movement and subsides with rest, and causes AM joint stiffness t or f - ✔✔TRUE ✔✔most common sites affected by osteoarthritis - ✔✔knees, hips, hands, cervical/lumbar spine ✔✔what is the first line management for osteoarthritis? - ✔✔NSAID's ✔✔the exact etiology of rheumatoid arthritis is unknown; t or f *thought to be an autoimmune component/chronic inflammation - ✔✔true (there may be a genetic predisposition or environmental factors like bacterial infections or asbestos) ✔✔rheumatoid occurs in men more than women; t or f - ✔✔FALSE women > men ✔✔rheumatoid arthritis occurs bilaterally or unilaterally & asymmetrical or symmetrical in wrists/fingers, hips, knees? - ✔✔BILATERALLY, SYMETRICALLY ✔✔in RA the joints are tender, warm, swollen, t or f - ✔✔true ✔✔pain with RA causes AM pain and stiffness, and stiffness is worse after a long rest (vs. with OA where rest relieves pain) t or f - ✔✔TRUE ✔✔what is the treatment for RA? - ✔✔- DMARDs (disease-modifying anti-rheumatic drugs)
✔✔this is chronic autoimmune hyperthyroidism; is the most COMMON type of hyperthyroidism antibodies cause thyroid to secrete thyroid hormones in excess - ✔✔graves ✔✔if a patient gets an MMR vaccine, how long should they wait before trying to conceive? - ✔✔4 weeks ✔✔do you have to wait after stopping OCP before trying to get pregnant? - ✔✔medically, NO, but it might be easier to track cycles if you've had a few off of the pill ✔✔education regarding pre-conception...women should start... - ✔✔taking a PNV that contains folic acid** ✔✔When is the most fertile period? - ✔✔ 3 - 5 days prior to ovulation** ACOG: Patients desiring pregnancy should be counseled that the fertile window is having sexual intercourse in the 3-4 days before ovulation and that intercourse every 1- 2 days yields the highest pregnancy rates ✔✔explain tracking BBT... - ✔✔The BBT is your body's temperature when you are fully at rest. increases slightly during ovulation (0.5-1°F) and remains high until the end of the menstrual cycle. The most fertile days are the 2-3 days before this increase in temperature. To monitor your BBT, take your temperature every morning after waking up, before any activity, getting out of bed, or having anything to eat or drink. Record these temperatures daily. BBT by itself is not a good way to prevent or promote pregnancy. It shows only when ovulation has already occurred, not when it is going to occur. ✔✔What is the life course perspective? - ✔✔health of a person over their life, and how it determines overall health status mental, physical, and social health of an individual that determines their health trajectory ✔✔Foods that contain folic acid... - ✔✔Green leafy vegetables, legumes, lentils, oranges (citrus), bananas, eggs, nuts/seeds, grains & organ meats, fortified grains (cereals) ✔✔common risk factors for major depression - ✔✔life stressors (job/finances) lack of support
IPV
unintended pregnancy low SES limited education smoking ✔✔how will the WHNP screen women for depression in a primary care setting? - ✔✔PHQ-2 (the easiest tool in primary care setting) ✔✔what questions does the PHQ-2 ask? - ✔✔ 1 - do you find enjoyment in activities she usually enjoys? 2 - do you feel down, depressed, or hopeless? ✔✔scores for PHQ-2 range from 0-6...what is considered a "positive" score? - ✔✔3 or higher (if +, do the PHQ- 9 ) ✔✔in order to assess for suicidal ideation, the WHNP can... - ✔✔ask the following:
- have you ever thought of hurting yourself?
- have you had any thoughts recently? ✔✔what does the acronym SIGECAPS stand for - ✔✔Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide ✔✔what is the first line treatment for a 42-year old woman diagnosed with major depression? - ✔✔SSRI's*** (fluoxetine, paroxetine, escitalopram, sertraline) ✔✔how will the WHNP diagnose a generalized anxiety disorder? - ✔✔using the GAD- 7*** 1 - nervous/anxious/on edge 2 - not sleeping, can't control worrying 3 - worrying too much 4 - trouble relaxing 5 - being restless/can't sit still 6 - becoming easily annoyed/irritable 7 - feeling afraid something bad will happen score of 5 = mild score of 10= moderate score of 15= severe
✔✔causes "sickled" cells, HgbS, results in a decreased lifespan of RBC's resulting in chronic anemia and hypoxemia (will have a + hgb electrophoresis) - ✔✔sickle cell anemia ✔✔what type of disorder is sickle cell anemia? - ✔✔autosomal recessive ✔✔this type of disorder results in lack of protection of oxidizing effects on RBC's- hemolysis occurs d/t illness, stress, and exposure to sulfa drugs or fava beans - ✔✔G6PD ✔✔what type of disorder is G6PD? - ✔✔x-linked ✔✔d/t a low level of von willebrand substance, or improperly functioning VWD substance, that results in the inability to clot or a prolonged clotting time - ✔✔Von Willebrand's Disease ✔✔what is the most common bleeding disorder? - ✔✔von Willebrand disease ✔✔this is the SIZE of rbc's; 80- 100 - ✔✔MCV (mean corpuscular volume) ✔✔this is the amount of hgb present on a rbc; 27- 32 - ✔✔MCH (mean corpuscular hemoglobin) ✔✔this is the avg concentration of hgb in a VOLUME of RBC's; 32- 35 - ✔✔MCHC (mean corpuscular hgb concentration) ✔✔this measures the body's ability to BIND IRON to transferrine; 250- 450 - ✔✔TIBC (total iron binding capacity) ✔✔this is the storage form of iron; 30- 250 - ✔✔ferritin level ✔✔patient has abdominal pain in the RUQ, N/V x 3 hours, no diarrhea. exam reveals normal bowel sounds, + murphy's sign whats the most likely diagnosis - ✔✔cholecystitis ✔✔what test needs done to diagnose cholecystitis? - ✔✔US (has a 95% sensitivity rate) ✔✔labs for gallbladder workup - ✔✔CBC, AST/ALT, amylase/lipase, US ✔✔conservative management for cholecystitis... - ✔✔IV hydration, bowel rest, ATB's, pain meds
✔✔what is the only definitive treatment for cholecystitis... - ✔✔surgery ✔✔what are the risk factors for GERD? - ✔✔any condition that increases pressure on the stomach and promotes retrograde flow... ie. straining, obesity, pregnancy ✔✔what are the s/s of GERD? - ✔✔heart burn, regurgitation, dysphagia, chronic cough, laryngitis, asthma, dental erosion. s/s usually occur after eating. ✔✔what is the 1st line treatment of GERD? - ✔✔PPI's (proton pump inhibitors)
- azole's ✔✔what is the 2nd line treatment of GERD? - ✔✔h2 receptor antagonists
- tidine's ✔✔this is a functional disorder of the GI tract with no cause that can be identified; is more common in women, <age 50, poor SES - ✔✔irritable bowel syndrome (IBS) ✔✔what are the s/s of IBS? - ✔✔constipation, diarrhea, pain, bloating, abdominal distention, incomplete evacuation, straining, gas, urgency ✔✔what is the treatment of IBS? - ✔✔stress mgmt probiotics increase fiber antispasmodics (i.e. bentyl- for cramping) tricyclic antidepressants ✔✔does pain usually dissipate after a bowel movement in someone with IBS? - ✔✔yes... ✔✔this type of hepatitis is:
- spread via fecal-oral route d/t poor hygiene or sanitation
- incubation: 28 days
- there IS a vaccine
- treatment = mgmt of GI symptoms - ✔✔Hepatitis A ✔✔this type of hepatitis is:
- spread via blood/sexual contact
- incubation: 90 days
- there IS a vaccine
- treatment- if exposed give IG, chronic can use antiretroviral therapy - ✔✔Hepatitis B ✔✔this type of hepatitis is:
rash has been there for the past 4 years the rash comes/goes, periods where skin is clear rash is reddened with several silver-white patches that are thick, scaly, and flaky...what is the diagnosis - ✔✔psoriasis ✔✔what is thought to be the cause of psoriasis? - ✔✔auto-immune mediated; genetic component w/ environmental triggers, can be triggered by stress, trauma, infections, medications. ✔✔How is psoriasis managed? - ✔✔needs referral topical Vitamin D analogues corticosteroids phototherapy methotrexate ✔✔A 30-year-old presents with CC of dry, scaly lesion rash on her right arm (anterior elbow area), sometimes with intense itching and burning for the last 2 years; sometimes this rash oozes. What is the diagnosis - ✔✔eczema (atopic dermatitis) because of vesiculation/weeping of lesions, and itching ✔✔what is the treatment for eczema? - ✔✔cool wet compresses topical steroid creams oral antihistamines (although watch for sedative ones) oral vit D supplementation 2x weekly diluted bleach baths ✔✔what is thought to be the cause of eczema? - ✔✔genetics/environment- inherited predisposition towards skin hypersensitivities, these patients usually have dry skin that makes them vulnerable to irritants, have a lower itch threshold, and can be triggered by sweat, clothing, and season changes. ✔✔macrocytic anemia - ✔✔MCV > 100, caused by vitamin B12 or folate deficiency or both. Other causes (alcoholism, poor nutrition, GI disorders and pregnancy. Vitamin B12 deficiency can result in serious neurological dysfunction. Folic acid deficiency causes ulcerations of the tongue and oral mucosa, and changes to skin, hair and fingernail pigmentation TX: Vitamin B12 (Cyanocobalamin) injections (1st line), folic acid (folate vitamin B9) ✔✔microcytic anemia - ✔✔MCV < 80 iron deficiency thalassemia ✔✔Hypochromic, microcytic anemia - ✔✔iron deficiency
✔✔itch-scratch cycle - ✔✔Lichen simplex chronicus ✔✔a 14 year old and her mother present to the office inquiring about HPV vaccine...what does the education entail? - ✔✔ 1 - the vaccine helps prevent against new HPV strains; it does NOT treat already existing ones. 2 - recommended age for HPV vaccine is 11-12, and prior to sex 3 - the vaccine has dropped HPV cancers/warts by 81% 4 - most common SE's = injection site reactions (red/swell), sore arm ✔✔if the HPV vaccine is given prior to age 15... - ✔✔it is given in 2 dose series- second dose given 6-12 months after the first ✔✔if the HPV vaccine is given after age 15... - ✔✔it is given in a 3 dose series- second dose given 1-2 months after the first, 3rd dose given 6 months after that. (older patient, more shots) ✔✔HPV-6 and HPV- 11 - ✔✔genital warts ✔✔HPV-16 and HPV- 18 - ✔✔cervical cancer ✔✔what phase goes with the follicular phase? - ✔✔proliferative (both have F's in them) ✔✔what phase goes with the luteal phase? - ✔✔secretory phase ✔✔ovarian cycle consists of: - ✔✔follicular phase, ovulation, luteal phase ✔✔the uterine cycle consists of - ✔✔menses, proliferative phase, secretory phase ✔✔the......phase of the ovarian cycle VARIES in length... - ✔✔follicular ✔✔the.......phase of the ovarian cycle is CONSISTENT in length... - ✔✔luteal (you gotta be consistent to get the lute) ✔✔what hormone is dominant during the follicular/proliferative phases? - ✔✔estrogen ✔✔what hormone is dominant during the luteal/secretory phases? - ✔✔progesterone ✔✔Step 1 of Menstrual Cycle - ✔✔menses (when estrogen and progesterone are both low...think nothing is controlling that lining...so its shedding) ✔✔Step 2 of Menstrual Cycle - ✔✔Follicular/Proliferative (estrogen dominant) the follicle is produced to be ready for ovulation again the endometrium thickens
✔✔the ovaries react to... - ✔✔FSH/LH ✔✔the uterus reacts to... - ✔✔estrogen/progesterone ✔✔order of fertilization... - ✔✔oocyte zygote morula blastocyst gastrula embryo fetus ✔✔What is the preembryonic period? - ✔✔ 0 - 2 weeks ✔✔What is the embryonic period? - ✔✔weeks 3-8 (organogenesis) ✔✔what is the fetal period? - ✔✔9 weeks to birth ✔✔When does the heart start beating? - ✔✔day 22 ✔✔the predominate site of biosynthesis of the sex hormones (estrogen, progesterone, and androgen) in a healthy, ovulating woman is the.... however, these hormones can be produced in lesser degree in the... - ✔✔ovaries adrenal gland ✔✔proliferation of endometrium (what hormone is dominant?) - ✔✔estrogen ✔✔Secretory phase of endometrium (what hormone is dominant?) - ✔✔progesterone ✔✔secreted by the ovarian theca cells... - ✔✔LH ✔✔secreted by the ovarian granulosa cells... - ✔✔responds to FSH, produces estrogen ✔✔high levels of estrogen stimulate this hormone... - ✔✔LH ✔✔this hormone influences the growth of the follicle... - ✔✔FSH ✔✔What is primary infertility? - ✔✔never been pregnant ✔✔What is secondary infertility? - ✔✔Difficulty conceiving after having had a pregnancy, regardless of outcome. ✔✔5 basic factors to consider in clients with infertility: what are they? - ✔✔ 1 - ovulatory 2 - uterine/tubal
3 - male factor 4 - cervical 5 - peritoneal (i.e. endometriosis) ✔✔32 year old, G1P1 and 33 yr old husband have hx of infertility for the past 2 years- has been tracking BBT, no STI hx, tubes patent, normal uterus, semen analysis normal...whats the most likely diagnosis? - ✔✔secondary infertility unexplained infertility ✔✔What is the postcoital test? - ✔✔- after sex, checks cervical mucous for abundance and spinnbarkheit
- looks at the sperm in the mucous for number and motility ✔✔What is spinnbarkeit? - ✔✔the stretching characteristics of mucus
- stringy, elastic, stretchy
- can be stretched b/t thumb and index finger ✔✔what is the mechanism of action for IUD's (mirena, liletta, kyleena, skyla) - ✔✔thickening of cervical mucus preventing passage of sperm into the uterus, inhibition of sperm capacitation or survival, and alteration of the endometrium ✔✔Benefits of an IUD (progesterone only) - ✔✔decreased menses/pain or amenorrhea reversible used for those that can't take CHC's can be used in breastfeeding and immediately PP ✔✔contraindications of an IUD/ParaGard - ✔✔Pregnancy. distorted uterine anatomy. Unexplained vaginal bleeding concerning for pregnancy or pelvic malignancy. Gestational trophoblastic disease Ongoing pelvic infection (PID) ✔✔side effects of an IUD - ✔✔irregular bleeding/spotting (in first few months) Headache. Acne. Breast tenderness. Irregular bleeding, which can improve after six months of use. Mood changes. Cramping or pelvic pain ✔✔how effective are IUD's/ParaGard's - ✔✔99% ✔✔if pregnancy occurs with IUD in place...what is done? - ✔✔IUD needs removed promptly
✔✔what is the most important education for someone taking the mini pill/progesterone only pill - ✔✔**THEY MUST TAKE IT AT THE SAME TIME EVERY DAY ✔✔MOST COMMON side effect of progesterone only pill - ✔✔breakthrough bleeding/irregular menses ✔✔if a patient is > 3 hours late taking the mini pill...what do they need to do - ✔✔use a back up method for 48 hours ✔✔mechanism of action for the Depo shot - ✔✔prevents follicular maturation and ovulation and causes thickening of cervical mucus (suppresses HPO axis) ✔✔sickle cell disease/seizure disorders and depo - ✔✔may reduce sickling may reduce seizures ✔✔most common side effects of depo - ✔✔irregular/amenorrhea/breakthrough bleeding weight gain can decrease bone density in long-term user ✔✔education for someone who is starting depo and wants to know how it can affect fertility? - ✔✔can take anywhere from 15-49 weeks for fertility to return ✔✔who should not use a diaphragm? - ✔✔HIV- diaphragm can disrupt vaginal epithelium and make infection easier to pass on/get ✔✔education about a diaphragm - ✔✔insert just prior to or up to 2 hours before sex leave in place for 6 hours after sex ✔✔mechanism of action of subdermal implant birth control (nexplanon) - ✔✔inhibits ovulation ✔✔does nexplanon contain estrogen? - ✔✔NO remember, only COC's, patch, ring do! ✔✔side effects of nexplanon - ✔✔irregular menstrual bleeding pain/bruising/infection at insertion site ✔✔EDUCATION for a patient using the transdermal patch for birth control... - ✔✔skin irritation can occur at application site rotate site (butt, belly, back, upper arm) apply new patch on same day each week for 3 weeks, then no patch for 4th week for bleed
✔✔education for a patient using the nuvaring for birth control... - ✔✔insert ring for 3 weeks, remove for bleed, insert new ring 7 days later ✔✔fertility awareness-based methods - ✔✔contraceptive or family planning method that involves identifying a fertile period in a woman's cycle and either avoiding intercourse or using contraception during this time - 24% failure rate ✔✔what is meant by monophasic oral contraceptive? - ✔✔Each pill is designed to deliver the same level of hormone throughout the entire pill pack. That's why it's called "monophasic," or single phase Junel, Yaz ✔✔what is meant by multiphasic oral contraceptive? - ✔✔alter the ratio of progestin to estrogen and the doses during the 21-day cycle OrthoTriCyclen (triphasic) ✔✔what is meant by extended-cycle oral contraceptive? - ✔✔taking a pill for longer than the typical 21 days - and not taking the placebo pills, constant hormone (usually results in a period every 3 months or so) Seasonique, Seasonale ✔✔what is the CDC first line treatment for gonorrhea? - ✔✔Ceftriaxone 500mg IM x 1 if cant r/o coinfection- doxy 100mg PO BID x7 days ✔✔Symptoms of Gonorrhea - ✔✔discharge and painful urination (often asymptomatic or mistaken for a UTI) ✔✔education for patient with gonorrhea - ✔✔both partners need treated! TOC 7-14 days ONLY if throat infection untreated can cause PID (infertility, ectopic's, pain) ✔✔incubation period for gonorrhea - ✔✔ 1 - 14 days ✔✔what is the CDC's first line treatment for chlamydia? - ✔✔doxycycline 100mg BID x 7 days azithromycin 1g PO x1 dose ✔✔what are the symptoms of chlamydia? - ✔✔dysuria, itching, irritation of the genital area, discharge ✔✔education for a patient with chlamydia: - ✔✔BOTH partners need treated!
✔✔Symptoms of Trichomoniasis - ✔✔Green, yellow, gray, frothy, vaginal discharge strawberry spots on cervix ✔✔education for a patient with trichomoniasis? - ✔✔DO NOT DRINK ALCOHOL DURING TREATMENT (can experience a disulfiram-like reaction- abd pain, N/V, HA) sex partners need treated too! TOC is rec 3 months after completion of tx ✔✔incubation period of trichomoniasis - ✔✔ 5 - 28 days ✔✔CDC first line treatment of condyloma acuminata? - ✔✔Patient-applied: Imiquimod 3.75% or 5% cream† Provider-administered: Cryotherapy with liquid nitrogen OR Surgical removal OR Trichloroacetic acid (TCA) ✔✔what are the symptoms of condyloma accuminata? - ✔✔Small, skin-colored or gray spots in your genital area that are raised or flat. Several warts close together that are shaped like a cauliflower** HPV 6/ ✔✔incubation period of condyloma acuminata - ✔✔2 weeks-8 months (avg 2-3 mos) ✔✔CDC's first line treatment for herpes (HSV)? - ✔✔Acyclovir† 400 mg orally 3 times/day for 7-10 days OR Famciclovir 250 mg orally 3 times/day for 7-10 days OR Valacyclovir 1 gm orally 2 times/day for 7-10 days suppressive therapy is available to prevent breakouts ✔✔HSV- 1 - ✔✔cold sores (1 mouth) ✔✔HSV- 2 - ✔✔genital herpes (2 lips) ✔✔incubation period of herpes - ✔✔ 2 - 12 days ✔✔first line treatment for HPV? - ✔✔THERE IS NO TREATMENT - prevention is key (Gardasil vaccine)
✔✔is the HPV vaccine recommended for those >26 years old? - ✔✔NO ✔✔what is the incubation period for HPV? - ✔✔ 2 - 3 months (can range from 1- 20 months for warts, and up to TEN YEARS for high-risk HPV to become cancer) ✔✔what is the CDC's first line treatment for HIV? - ✔✔there is NO cure **antiretroviral treatment (to suppress viral load) want to keep tcell count >400- 500 ✔✔what are the options for prevention of HIV? - ✔✔PrEP (pre exposure prophylaxis) PEP (post exposure prophylaxis) ✔✔incubation period of HIV - ✔✔2wks-6mos after contact w/ virus ✔✔CDC first line treatment of pelvic inflammatory disease - ✔✔Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours ✔✔Symptoms of PID include: - ✔✔· Lower abdominal pain · Pelvic organ tenderness · Inflammation of the genital tract · Fever · Abnormal uterine bleeding ✔✔what is the most likely causative organisms of PID? - ✔✔N. gonorrhoeae and C. trachomatis ✔✔education for PID: - ✔✔test partners from the last 60 days for STI and treat presumptively for N. gonorrhoeae and C. trachomatis ✔✔when should you note clinical improvement of PID? - ✔✔within the first 3 days after treatment initiation ✔✔what is the incubation period for PID? - ✔✔unknown (depends on causative agent usually) ✔✔Define menopause - ✔✔cessation of menstruation for 12 months ✔✔Define perimenopause - ✔✔period b/t beginning of menopausal sxs/changes until 12 months after LMP (irregular menstrual cycles are common during this time)
