NRNP Finals 6560 Question And Answers 2023, Exams of Nursing

Download NRNP Finals 6560 Question And Answers 2023 and more Exams Nursing in PDF only on Docsity! NRNP Finals 6560 Question And Answers 2023 coup-contrecoup injury - Correct Answer ✅Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds. Scalp laceration: what, effect, management - Correct Answer ✅Primary head injury profuse bleeding - signs of hypovolemia Apply direct pressure Suture/ staple laceration Lidocaine 1% with epi to control bleeding, not close to nose/ ears Skull fracture: types, effect, management - Correct Answer ✅Primary head injury Simple: no displacement of bone. Observe and protect spine Depressed: bone fragment depressing thickness of scull Surgery for debridement. Give tetanus and seizure precautions Basilar: fracture at floor of skull Raccoon eye - periorbital bruising battle's sign: mastoid bruising otorrhea/ rhinorrhea - halo sign: do not obstruct flow Give Ab's Oral intubation and oral gastric instead of nasal Brain injury: types, effect, management - Correct Answer ✅Primary head injury Concussion: reversible change in brain functioning NRNP Finals 6560 Question And Answers 2023 loss of consciousness, amnesia Do not give opioids, admit for unconsciousness greater than 2min Contusion: bruising to surface of brain with edema Frontal and temporal region Brainstem contusion: posturing, variable temp, variable vital signs N/V, dizziness, visual changes seizure precautions Hematoma - neuro: types, effect, management - Correct Answer ✅Epidural hematoma: commonly temporal/ parietal region with skull fracture, causing bleeding into epidural space Loss of consciousness Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation CT scan (non contrast) Treatment based on Brain trauma foundation. Surgical if greater than 30cm Subdural hematoma most common type of intracranial bleed Acute (hours): drowsy, agitated, confused, headache, pupil dilation, CT scan (noncontrast) surgery for 10mm thickness or 5mm midline shift or for worsening GCS Chronic (days): headache, memory loss, incontinence CT scan (noncontrast) Surgery: burr holes/ crani Cerebral edema/ ICP elevated/ herniation: symptoms, management - Correct Answer ✅decreased level of consciousness Blown pupil NRNP Finals 6560 Question And Answers 2023 - pathologic fractures (osteoporosis/ cancer) mainly cervical spine. High mortality. More common in men more common in young than old Fractures and vertebrae - Correct Answer ✅Cervical: C1-C7. Flexible and small diameter so many fractures Thoracic (T1-T12): connected to ribs. Not common in fractures Lumbar: L1-L5: Very mobile, requires great force to fracture Sacral Spinal cord trauma assessment - Correct Answer ✅- History: mechanism of injury, pt's complaints, pre- hospital tx - Physical assessment: treat airway, breathing, circulation (ABC) first. Pulm complication common in quadriplegia. Assess respiratory status: injury above C3 is resp arrest. C5 - C6 spares diaphragm so breathing exists. - grade strengthening (0= no muscle contraction, 5 = full strength) - complete lesion: pt lacks all function below level of spinal cord damage. Poor prognosis. - incomplete lesion: parts of spinal cord intact - sensory function: start at no feeling then go to feeling - evaluate back (log-roll) Motor assessment in spinal cord trauma - Correct Answer ✅If unable to do, # above: Deltoids (C4): shrug shoulder NRNP Finals 6560 Question And Answers 2023 Biceps (C5): flex arm and push arms away Wrist (C6): try to straighten wrist while pt tries to flex Triceps (C7): extend arm and try to bend while pt prevents that Intrinsic (C8): fan fingers and push together Hip flexion (L2 - L4): bend knee and apply pressure Knee extension (L2-L4): extend knee with hip/ knee flexed key signs of spinal cord injury - various levels - Correct Answer ✅C2-C3: resp paralysis, flaccid paralysis, deep tendon reflexes loss C5-C6: diaphragmatic brething, paralysis of intercostal muscles, quadriplegia, anaesthesie below clavicle, areflexia, fecal/ urinary retention, priaprism T12-L1: paraplegia, anesthesia legs, areflexia legs, fecal/ urinary retention, priaprism L1-L5: flaccid paralysis, ankle/ plantar areflexia Multisystem impact of spinal cord injury - Correct Answer ✅Cardiovascular: - hypotension/ spinal shock. Fluid resuscitation (LR) - bradycardia; oxygenate well, normothermia, atropine - vasovagal reflex: limit suctioning length - Poikilothermy - venous thrombosis: dvt prophylaxis - orthostatic hypotension GI: - abdominal injuries: assess for abd distention - curling's ulcer: stress ulcer. Give ranitidine NRNP Finals 6560 Question And Answers 2023 - gastric atony and ileus: NG to LIS - loss of bowel function: initiate bowel program GU: - autonomic dysreflexia: HTN crisis from distended bladder or other noxious stimulu. Decompress bladder. - UTI Musculoskeletal: - paralysis - wounds Psychological: - ineffective coping, powerlessness, denial/ anger/ depression. Be honest with positivity, include pt, interdisciplinary approach Spinal cord lesions/ syndrome - Correct Answer ✅Anterior cord syndrome: weakness/ paralysis with loss of sense of pain and temp Posterior cord syndrome: can't feel touch and vibration Central cord syndrome: greater loss in upper extremities than lower Brown sequard syndrome: one side of spinal cord is damaghed by stab/ gun wound. Ipsilateral motor loss and contralateral loss of pain and temp sense. Extremities that can move have no feeling and that have feeling can not move. Spinal cord injury: diagnostics - Correct Answer ✅Cervical vertrebrea: lateral xr, then AP (swimmer view) NRNP Finals 6560 Question And Answers 2023 Dementia labs/ diagnostics - Correct Answer ✅- History: family/ spouse report - Physical: neuro, cognitive examz: Mini mental State exam (score 23 or less is cognitive impairment), document in 3-6mo intervals - Labs: glucose, electrolytes, magnesium, calcium, liver tests, BUN/ creat, thyroid, Vit B12, HIV, CBC, ABG, cultures, drug screen - CT head/ MRI: for tumor/ infarction - PET scan: differentiate dementia type - EEG - Lumbar: rule out meningitis, neurosyphilis - XR chest: rule out CHF, COPD - ECG - Identify treatable cause DSM-V criteria for dementia - Correct Answer ✅1. Memory impaired 2. At least two of these: aphasia, apraxia, agnosia, disturbance in executive functioning 3. Disturbance of one or two of these disrupts functioning 4. Disturbance not only during delirium Dementia management - Correct Answer ✅- supportive: living situation - treat underlying illness - stop nonessential meds - maintain nutrition - avoid restraints, except for safety - address safety issues - cholinesterase inhibitors can improve symptoms mildly (because of cholinergic deficiency) - Alzheimer's related: meds very mild and temporary effect NRNP Finals 6560 Question And Answers 2023 Medication for dementia - Correct Answer ✅Mild to moderate Alzheimer's: - Donezepil 5mg, then 10mg after 4-6 wks. Can cause syncope, brady, AV-block, N/V, weightloss - Rivastigmine. With food, can cause hypotension, syncope - Galantimine, 4mg for 4 wks, then 8mg 4 wks, then 12mg. Avoid in renal and liver failure Moderate to severe dementia: - Memantine (N-methyl-d-aspartate rec anatgonist), prevents progression. May be paired with donezepil. May cause Stevens-Johnson's For aggression: - Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone, Ziprasidone. Short term. May cause tardive dyskinesia - Haldol may help too for unmanageable aggression. - Benzo's: Clonazepam. May cause paradoxical aggression. Lorazepam For emotional lability: - Imipramine - Setraline - Zoloft - Citalopram multiple sclerosis - Correct Answer ✅Disease with myelin sheath destruction causing disruptions in nerve impulse conduction. Acquired, immune-mediated. Relapses/ attacks/ exacerbations and remissions NRNP Finals 6560 Question And Answers 2023 Etiology of MS - Correct Answer ✅More women than men Caucasians, more northern European Early onset, 20-40ies Measles, Herpes, Chlamydia, Epstein-Barr Classification of MS - Correct Answer ✅Relapsing - Remitting: Clear/ defined episodes of relapse and recovery. No progression between episodes and return to baseline. Most often initial presentation. Secondary progressive: As Relapsing- Remitting, but then progression between episodes. No return to baseline. Primary progressive: Continued disease progression. Minor improvements. Usually after 40yrs. Progressive relapsing. Progressive disease with relapses, and progression in between. Malignant MS: rapid onset, rapid deterioration Benign MS: No deterioration after 10 yrs MS symptoms - Correct Answer ✅Subjective: - Motor weakness, stiffness - Numbness, tingling, burning, pain - double vision, dysarthria, dysphasia, vertigo (brain stem) - visual deficits NRNP Finals 6560 Question And Answers 2023 - Exercise Dopaminergic agents and Parkinson's - Correct Answer ✅Carbidopa-levodopa. Most effective drug. Use with rasagiline. May cause on/ off phenomena, dyskinesia, confusion, headache, hallucinatinos. Dopamine agonists and Parkinson's - Correct Answer ✅Pramipexole and Ropinirole May reduce risk for complications and alleviate symptoms. Mono or dual theraoy with levodopa. May cause N/V, dyskinesia, confusion. MAO-B inhibitors and Parkinson's - Correct Answer ✅Rasagiline Adjunct therapy May cause serotonin syndrome, dyskniesia, arthralgia, ataxia Amyotrophic lateral sclerosis (ALS): what and etiology - Correct Answer ✅Disease of motor neurons causing asymmetric weakness, in upper or lower extremity. Less likely to present with resp weakness, dysarthria or dysphagia Onset age: 50 Men more likely Familial is 10% of cases unknown Average survival: 2-5 yrs NRNP Finals 6560 Question And Answers 2023 Symptoms and diagnostics ALS - Correct Answer ✅Classified by number of upper and lower motor neurons in regions of brain Progressive weakness over weeks/ months Sensation intact Muscle atrophy Small muscle fasciculations Hyperreflexia Spasticity Serum CK elevated EMG: denervation Muscle biopsy: atrophic muscle fibers MRI: no abnormality Management of ALS - Correct Answer ✅Supportive and palliative: - Immobilty - Altered resp function: ventilation/ suction - Dysphagia/ poor nutrition - pain: pain management - Anxiety - Meds: riluzole. Can extend life by months but not cure. Low back pain - major syndromes - Correct Answer ✅1. Back strain 2. Disk herniation 3. Osteoarthritis/ disk degenration; osteophyte (bone spur) 4. Spinal stenosis: narrowing spinal foramen leading to spinal nerve entrapment Specific findings for back pain - Correct Answer ✅- numbness NRNP Finals 6560 Question And Answers 2023 - saddle anesthesia (CA, mass) - bowel, bladder dysfunction (emergency surgery)- pain worse at rest (CA, tumor, infection) - Discitis, epidural abcess (IV drug use) - Decreased rom - Radiculopathy (pain down leg), not with OA - Crossover straight leg test: herniated disk - back, buttock, leg pain when ambulating (neurogenic claudication with spinal stenosis). Also positive straight leg raise test with spinal stenosis xr anteroposterior, to rule out scoliosis, bone spur MRI for soft tissue structure, bulging disk CT for bony imaging Transient Ischemic Attack (TIA): what, etiology - Correct Answer ✅Rapid onset of neurological deficit caused by focal brain, spinal cord, or retinal ischemia, resolves in 24hours. - atherosclerotic disease - cardiac emboli, from afib, mi, valvular disease - vasculitis, from lupus - hematologic causes (sickle cell, oral contraceptive) - high risk: older than 45, hx of thrombolytic event, history of spontaneous abortion, autoimmune, family hx - intracranial causes (brain tumor, seizures) - cocaine abuse - migraines TIA risk factors - Correct Answer ✅Important risk factor for stroke, especially in first week after NRNP Finals 6560 Question And Answers 2023 weakness speech difficulty visual loss dizziness severe headache ischemic stroke: what, etiology - Correct Answer ✅Thrombus in blood vessel in head or neck Predisposing: - atherosclerosis/ hyperlipidemia - HTN - DM - hypotension - smoking - trauma - afib, endocarditis, mitral stenosis (embolism) Ischemic stroke symptoms, based on location - Correct Answer ✅Middle cerebral artery: - Hemiplegia (upper and face mostly), hemianesthesia, heminopia - aphasia - neglect Anterior cerebral artery: - hemiplegia (lower mostly), primitive reflexes, confusion, behavioral changes if bilateral anterior Vertebral and basilar arteries: - LOC NRNP Finals 6560 Question And Answers 2023 - vertigo - dyshpagia, diplopia - ipsilateral CN findings - Contralateral sensory deficiency Deep penetrating branches of major cerebral infarction (lacunar infarction): - associated with poorly controlled HTN and DM - contralateral pure motor and sensory deficits - ipsilateral ataxia - dysarthria ischemic stroke diagnostics - Correct Answer ✅- CT head without contrast initially, preferable to MRI to rule out hemorrhage. Appears as area of density. - xr chest: possible cardiomegaly, neoplasm (metastasis brain suspicion) - Labs: CBC, Pt, PTT? INR, lipid profile, drug screen, alcohol level - ECG/ holter - MRI/ MRA (diffusion weighted more sensitive to detect cerebral ischemia) - CTA: vascular anatomy. Combine with CT perfusion which can show old infarct and salvageable areas. Ischemic stroke treatment - Correct Answer ✅- appropriate time goals - BP control: Only treat if higher than 220 syst and 120 diast., aortic dissection, or receiving t-PA. For t-PA goal goal is less than 185 syst/ 110 diast, before t-PA and less than 180 syst/ 105 diast. after. Use repeat labetolol or nicardipine drip. - Anticoagulation: IV Heparin, bridge to Warfarin (PTT 1.5-2.5 baseline). But newer meds better: Dabigatran, Apixaban (Eliquis - for stroke prevention in afib), Rivaroxaban (stroke prevention afib). No routine labs necessary for those. Not for hemorrhage, cautino after GI bleed - Antiplatelet: Aspirin or Clopidogrel - Mannitol and hypertonic saline for cerebral edema, on second on third day. Monitor serum osmolality. - Corticosteroids to reduce cerebral edema from tumor burden. NRNP Finals 6560 Question And Answers 2023 - surgery for high grade extracranial carotid artery disease (greater than 70%) Time goals of stroke - Correct Answer ✅- ED eval within 10min - notify stroke team within 15min - CT scan within 25min - CT scan interpretation within 45min - Thrombolytic (if appropriate) within 60min - Transfer to bed within 3 hrs t-PA - Correct Answer ✅- Pt needs to be in 3 - 4.5 hr window - Prior CT to assess for hemorrhage - need to have "last well known" - older than 18 - ischemic stroke - neurochecks q15min for 2hrs, q30min for 6 hrs, q1h till 24hrs Contraindications: - age greater than 80 - previous hemorrhage - previous stroke within 3mo - major surgery last 14 days - Urinary/ GI hemorrhage within 24 days - seizure - PTT and PT elevated - oral anticoag/ heparin with elevated PTT/ PT - glucose less than 50/ greater than 400 - SBP greater than 185 or DBP greater than 110 NRNP Finals 6560 Question And Answers 2023 - dysarthria SAH diagnostics - Correct Answer ✅- CT head: ischemia or hemorrhage. Sensitive in first 3 days, after that consider LP. hard to see if smaller than 3mm. - LP is strong suspicion bit negative CT. - CSF: bloody ( 103 - 106 RBC), xantochromia (yellow, breakdown of blood) - CTA, prior to clot removal ICH diagnostics - Correct Answer ✅- CT without contrast, to confirm bleed and determine size/ site. May reveal structural abnormalities. - Cerebral angio: determine source as aneurysm or an AVM. - MRI/ MRA: structural abnormalities - CBC, PT/ PTT, electrolytes, liver enzymes, kidney function SAH management - Correct Answer ✅- ABC's - may place external ventricular drain if hydrocephelus - bedrest strict - cardiac monitoring - treat ha, no NSAIDS (bleeding risk) - no straining/ exertion - stool softener - seizure prophylaxis (Phenytoine or Levetiracetam) - maintain SBP less than 160, may use nicardipine drip, labetolol push, hydralazine of brady - cerebral edema: mannitol or hypertonic saline. - surgical cliiping or coil asap - treat cerebral vasospasm - rebleeding: between day 2 - 19. Repeat CT. NRNP Finals 6560 Question And Answers 2023 - cerebral salt wasting: hyponatremia. Crystalloid fluid replacement when euvolemia: 3% saline for hyponatremia - manage fever ICH management - Correct Answer ✅- ABC, intubate/ give O2 - Control HTN. SBP: 140 - 150. Nicardipine, labetolol - CPP: keep at 50 - 70 - pressors if SBP less than 90: Dopamine, epi, levo - maintain ICP less than 20 - mannitol for cerebral edema. For 5 days or less. check serum osmolality. Or 3% saline. - ventricular drain for hydrocephalus - keep euvolemia - seizure precautions (phenytoine, levetiracetam) - control fever - surgery if hemorrhage greater than 3cm cerebral vasospasm - Correct Answer ✅- cerebral vasospasms: between day 7 - 10 after aneurysm lasting till day 21 - symptoms: confusion, ams, neuro deficits, ha, increased icp. May cause infarction. - treat: calcium channel blocker: nimodipine. Symptomatic: tripe H. Hypervolemia, hypertension, hemodilution. Meningitis, what and etiology - Correct Answer ✅inflammation of arachnoid, dura mater, pia mater or spinal cord due to viral, bacterial, or fungal infection - predisposing: sinusitis, otitis, pneumonia, trauma, congenital malformation Bacterial meningitis - Correct Answer ✅Bacterial: - may be fatal in hours NRNP Finals 6560 Question And Answers 2023 - exudate in subarachnoid space, thus thickened CSF and decreased flow Most commonly caused by: - streptococcus pneumoniae (infants) - neisseria meningitidis (school, college, spread of drainage/ blood) - haemophilus influenzae (daycare children - vaccine) - Escherichia coli/ emterobacter/ klebsiella (infants, elderly, immunocompromised) - Atypical: mycobacterium, listeria viral meningitis, what and etiology - Correct Answer ✅Pia and arachnoid space filled with lymphocytes but not with exudate. benign and self-limited. In late summer/ early fall. Transmission via cough, saliva, fecal matter Caused by: enterovirus, mumps, varicella, herpes, rubella, cmv, epstein barr, HIV Fungal meningitis, what and etiology - Correct Answer ✅Most common in immunocompromised Causes: candida cryptococcus histoplasma aspergillus Meningitis findings and diagnostics - Correct Answer ✅- severe ha - stiff neck/ nuchal rigidity - phtophobia - fever NRNP Finals 6560 Question And Answers 2023 - surgery and debridement when abscess is greater than 2.5cm Encephalitis, what and etiology - Correct Answer ✅Acute inflammation of the brain - most commonly caused by herpes simplex virus - tick infestation - west nile virus - toxoplasmosis (AIDS pt's) - CMV - rabies Encephalitis findings and diagnostics - Correct Answer ✅- lethargy - unstable vitals - nystagmus, photophobia - n/v - nuchal rigidity - ha - pos babinski - Lab: CBC, liver, BMP, fluid cultures - LP: elevated WBC, normal or slightly elevated protein, normal or slightly elevated glucose - EEG - IgM meausring in serum and CSF, pos in CSF - CT - MRI Encephalitis treatment - Correct Answer ✅- IV fluids NRNP Finals 6560 Question And Answers 2023 - resp and circulatory support - anticonvulsants - monitor for SIADH - for HSV: acyclovir - report to CDC encephalopathy, what and etiology - Correct Answer ✅Dysfunction of brain caused by disease (process) Hepatic, hypertensive, metabolic, hypercapnic cause Thiamine deficiency (wernicke) encephalopathy, findings and diagnostics - Correct Answer ✅- ha - ams - confusion - ammonia may be elevated - CSF analysis - EEG - MRI encephalopathy treatment - Correct Answer ✅- ABC's - correction underlying cause - anticonvulsant therapy Seizure/ epilepsy, what and etiology - Correct Answer ✅Seizure: abnormal neuronal discharge within brain Epilepsy: recurrent, unprovoked seizures NRNP Finals 6560 Question And Answers 2023 - unknown cause - metabolic disorders (acidosis, hypoglycemia, hypoxia, alcohol withdrawal) - CNS infection - tumor - noncompliance with epilepsy meds Focal seizures - Correct Answer ✅one cerebral hemipshere: - without dyscognitive features (aware). May have sensory changes, autonoic (sweating, flushing), sppech arrest, aura, psychic symptoms - with dyscognitive features (unaware). most common seizure. Simple partial seizure followed by loss of awareness. Automatisms. Begins with aura often. Generalized seizures - Correct Answer ✅- typical absence seizures: sudden loss of consciousness (5- 30sec), mild clonic/ tonic movements, several times/ day - atypical absence seizures: longer loss of consciousness, obvious motor signs - generalized tonic-clonic seizures: discharge throughout cerebral cortex. Abrupt start with outcry, loss of consciousness/ falling, resp arrest, tonic and clonic movement, urinary incont, 2-5min, postictal state status epilepticus - Correct Answer ✅a prolonged seizure (longer than 5min) or situation when a person suffers two or more convulsive seizures without regaining full consciousness Requires aggressive tx medical emergency Seizure diagnosis - Correct Answer ✅-EEG/ 24 hrs: focal abnormalities: partial seizure, generalized abnormalities: generalized seizures - CT head - LP if CT or MRI did not show anything NRNP Finals 6560 Question And Answers 2023 - possible: sob, wheezing, hypotension - if urticaria and angioedema present, then mast cell degranulation, so repeat reaction is likely. - maculopapular rash, most often on trunk - ecxematoid rash - photodermatitis - may have: hemolytic anemia, liver/ kidney dysfunction, serum sickness (rash, fever, malaise) - clinical diagnosis - blood work no value - eosinophil count greater than 1000 - skin biopsy - challenge dosing - if anaphylactic reaction not likely - serum renal/ liver if indicated Dermatitis medicamentosa, management - Correct Answer ✅- Withdraw drug - may be only thing necessary - Epi0.5-1ml IV or SQ relief from urticaria and angioedema. Repeat after 20min up to three doses - Oral/ IV antihistamine: benadryl or Ranitidine - Severe cases: Prednisone, taper slowly - Bronchodilators for wheezing Cellulitis: what - Correct Answer ✅Infection of dermis and subcutaneous tissue. Caused by gram Pos cocci and staph. aureus (for dm) as well as gram neg. E.coli. Fungi for neutropenic patients. H. influenza for facial and upper extremities. Cellulitis, general comments - Correct Answer ✅- break in skin precedes cellulitis, NRNP Finals 6560 Question And Answers 2023 - Risk factors: trauma, underlying skin lesion, diabetes, pedal edema, venous/ lymphatic compromise, IV drug use - may be next to necrosis or abscess - often lower extremities - complicated by DVT Cellulitis findings - Correct Answer ✅- tenderness, pain, swelling, erythema, warmth - rapid increase intensity and spread - fever, chills, malaise - sepsis possible - erythema with indistinct margins; warmth and tenderness - enalargement and tenderness of regional lymphnodes - red streaks from site (lymphatic spread: lymphangitis) - erythema and tenderness few cm from site - Lymphnode enlargement and lymphangitis: cellulitis. - Blood culture and wound culture - Rule out: DVT and necrotizing fasciitis, which should be suspected in very sick pt with bullae, crepitus, anesthesia of involved skin, skin necrosis, rhabdo, DIC Cellulitis treatment - Correct Answer ✅- AB: cover streptococci and staphylococci, with penicillin, Cephalexin, Dicloxacillin. If allergy to pcn: erythromycin or clindamycin. - Inpt AB: nafcillin, Cefazolin, Vanco for MRSA suspicion, - Hospitalize very sick or immunocompromised and treat with vanc. - Immobilization and elevation of limb - moist heat - low dose, long-term pcn for recurrent cellulitis NRNP Finals 6560 Question And Answers 2023 Herpes Zoster (shingles): what, etiology - Correct Answer ✅Reactivation of latent varicella-zoster virus, characterized by unilateral pain present 48hrs before rash. Rash: single dermatome: vesicular or bullous erruption - older than 50 - impaired immune system, lymphoma, fatigue - can have postherpic pain for up to 1mo Herpes Zoster findings and diagnostics - Correct Answer ✅- Prodormal pain symptoms (sharp), burning, itching in affected spot - malaise, low grade fever, headache - allodynia - lymphadenopathy, 1 -2 days prior - grouped vesicles on erythematous tender base along nerve group - papules appear within 24hrs and progress to vesicles and bullae within 48hrs, then pustules with cloudy fluid. Crusts for 7-10days. - ECG during prodormal: rule out cardiac disease - VZV antigen detection - positive Tzanck test - viral culture Herpes Zoster management - Correct Answer ✅- consult ophthalmology for HZ on tip of nose - antiviral therapy for 50-50-50: 50hrs or less since onset, 50yrs or older, more than 50 lesions - Acyclovir 5/ day. Adjust for renal impairment. - pain control with opioids - Moist dressing: water, saline 15min qid NRNP Finals 6560 Question And Answers 2023 - bleeding/ ulceration bad sign - scaling - texture change, irregular border - bigger than 6mm - color change - itching ABCDEE changes: Assymetric shape Border irregularity Color change Diameter greater than 6mm Elevation Enlargement/ increase in size Surgical biopsy: full thickness total excisinoal biopsy. Do not shave, curette, or electrodesiccate melanoma Melanoma staging - Correct Answer ✅Clark staging: Level 1: epidermis - in situ Level 2: invasion of papillary dermis Level 3: invasion of interface of papillary, reticular dermis Level 4: invasion of reticular dermis Level 5: invasion subcutaneous fat Breslow staging: Thin: less than 0.75m depth Intermediate: 0.76 - 3.99mm depth NRNP Finals 6560 Question And Answers 2023 Thick: greater than 4mm depth Melanoma Management - Correct Answer ✅- dermatologist - follow up q3-6mo - Based on stage: Less than 1mm: wide excision 1mm. No lymphnode dissection 1-4mm thick: wide excision 2mm. Nodal biopsy recommended. Lymphatic mapping. 4mm thick: wide excision more than 4mm - Adjuvant therapy: hem/ onc. Alpha-interferon Types of wounds - Correct Answer ✅Acute: Acute surgical: clean/ contaminated Traumatic wound: clean/ contaminated Chronic: Arterial: ischemia from arterial occlusive disease Venous: venous return disorder Diabetic: from hyperglycemia and per neuropathy Pressure: prolonged pressure Factors that delay wound healing - Correct Answer ✅- pressure - decreased tissue perfusion/ oxygenation - incontinence - infection - dm - poor nutrition - steroids NRNP Finals 6560 Question And Answers 2023 - immunusuppression - aging Wound findings, specifics - Correct Answer ✅- Pain - Arterial: claudication - Venous: lower extremities heavy and sore - Neuropathy: numbness, tingling - Arterial, venous, diabetic: poor healing Wound depth, levels - Correct Answer ✅- Superficial - Partial thickness: through epidermis, partially into dermis - Full thickness: through epidermis and dermis and some subcut layer. Muscle/ bone may be involved. - Undermining and tunneling Wound colors - Correct Answer ✅Red: healthy Yellow: debridement/ cleaning needed Black: necrotic Findings arterial and diabetic ulcers - Correct Answer ✅- On toes and below ankles (arterial) - plantar surfaces of feet (diabetic) - diminished pulse - shiny, cool le skin - no leg hair - thick toe nails - deep ulcer with smooth wound margins, small amount of drainage/ necrosis Findings venous ulcers - Correct Answer ✅- lower legs, above ankle NRNP Finals 6560 Question And Answers 2023 - enzymatic debridement: collagenese - AB's: mild: cephalexin, amoxicillin, for MRSA: doxycillin or bactrim moderate: levofloxacin and severe MRSA: vanco. severe: vanco - analgesic - wet to moist dressing qid Management of pressure ulcers - Correct Answer ✅- positioning - support surfaces - skin barrier products - hydrocolloids - debridement - cleansing: NS. Irrigation for dirty. - keep ulcer moist - topical AB's PRN - diet: increased protein/ high caloric diet - analgesics PRN Types of burns - Correct Answer ✅- Thermal; flames, hot objects. Most common type of burn - Chemical; necrotizing agents - electrical; causes damage to nerves and tissues - inhalation injury; smoke/ hot air. Incl Carbon monoxide - cold thermal; frostbite Categories of burns - Correct Answer ✅- First: painful, dry, red, no blisters, epidermis only - Second: severly painful, moist blisters, beyond epidermis, infection barrier destroyed - Third: not painful/ nerve destroyed, leathery, black/white, pearly, from epidermis to dermis to underlying tissue/ fat/ muscle/ bone NRNP Finals 6560 Question And Answers 2023 Extent of burns measurement - Correct Answer ✅Rule of nines: - each arm: 9% - each leg: 18% - thorax: 18% front, 18% back - head: genitals 9% - perineum/ genitals: 1% Fluid resuscitation in burns - Correct Answer ✅- 2-4ml/kg x total body surface area in first 24/hrs - Asap. Even before hospital. - Half of all fluids within first 8 hrs. - Give crystalloids (NS/ LR), no colloids (albumin, plasma) - Urine output should be 30-50ml/hr - Monitor for hyperkalemia first 24-48 hrs, after that hypokalemia. General burn management rules - Correct Answer ✅- rinse chemical injuries in water, no other products - wrap area in clean, dry towel (not wet, to keep body temp) - dressing before treatment: wrap in ns and sterile towels - maintain normothermia (warming blankets, etc) - analgesics (morphine), only iv - topical ab options: silvadene, sulfamylon, collagenase - intubate for one of these: burn to face, singed nares/ eyebrows, dark soot from nares, hoarseness, drooling, difficulty swallowing. AND bronchoscopic laryngeal edema Transport to burn center for - Correct Answer ✅- 2nd degree, more than 10% TBSA - 3rd degree - electrical burn - chemical burn NRNP Finals 6560 Question And Answers 2023 - inhalation injury - burned children - burn injury is big risk for mortality carbonmonoxide poisoning - Correct Answer ✅- CO replaces Hgb - Cause: home furnace/ gas and car exhaust - signs: ha, dyspnea, confusion, n/v, tachy, seizures, coma, death - Give 100% O2 - potential hyperbaric oxygen chamber Laceration treatment - Correct Answer ✅Cleanse (NS) Debridement (for contaminated wound) (potential excision) Control of hemorrhage - pressure, elevation, ligation, tourniquet Closure (do not close contaminated wound) Suturing - Correct Answer ✅- not too tight - choose smallest suture size - remove after 5-7 days or 10 days on trunk and extremities Nerve block for laceration - Correct Answer ✅- 1% lidocaine with epinephrine, do not exceed 7mg/kg or 4mg/kg without epi - or Procaine - choose small needle (30gauge) Aneurysm: what and types - Correct Answer ✅Dilation of arterial wall because of abnormal weakening, often from sudden increase in bp Types: NRNP Finals 6560 Question And Answers 2023 Hydrocephalus - may require shunt placement, ext ventricular drain, lumbar drain Seizures Increased intracranial pressure arteriovenous malformation (AVM) - Correct Answer ✅a vascular malformation that is a tangle of abnormal blood vessels connecting arteries and veins in the brain; has increased risk of bleeding and decreases normal oxygen flow to local tissues (no capillary bed for gas exchange) Treat with: embolization, surgical excision Dural arteriovenous fistula - Correct Answer ✅Fistula between artery and vein in dura matter. Signs: tinnitus, headache Treat with: embolization, surgical excision Chiari malformation - Correct Answer ✅part of cerbellum herniates down through foramen magnum Treat: surgery Hydrocephalus: what, etiology - Correct Answer ✅Excessive amount of CSF in cerebral ventricles. Can be acute or normopressure - oversecretion CSF - obstruction of CSF (tumor/ lesion) - impaired absorption NRNP Finals 6560 Question And Answers 2023 - head injury Hydrocephalus classification - Correct Answer ✅Communicating: - from impaired absorption or overproduction - after aneurysmal rupture Noncommunicating: - obstruction in ventricle, thus no communication with subarachnoid space - from lesions or tumors hydrocephalus signs - Correct Answer ✅Acute: - papilledema - ha - n/v - gait change - upward gaze Normopressure: Triad: dementia, gait disturbance, urinary incontinence hydrocephalus management - Correct Answer ✅Acute: ext ventricular drain Chronic: ventricular shunt Ventriculostomy- surgical Brain tumor - Correct Answer ✅Primary: originating in brain NRNP Finals 6560 Question And Answers 2023 Secondary: metastases Most common: gliobastoma multiforme Most common brain tumors - Correct Answer ✅Gliobastoma multiforme - nonspecific symptoms, focal deficits as tumor grows - rapid course, poor prognosis Astrocytoma - longer course - variable prognosis - might do total surgical removal Meningioma - compresses instead of invading neural structure - common with advancing age - surgical treatment, potentially with radiation Brain tumor signs and diagnostics - Correct Answer ✅- progressive neuro deficit - ha - seizures - MRI, procedure of choice - CT to also look at other body parts - EEG for seizures - CT angio to asses vessels - barin biopsy for definite diagnosis NRNP Finals 6560 Question And Answers 2023 more women early adulthood, equal later in life Myastenia Gravis symptoms and diagnostics - Correct Answer ✅- Ptosis - Diplopia - facial weakness - fatigue from chewing - neck weakness - more upper than lower limb weakness - resp weakness - may cause severe quadriparesis - Antibody testing: ACHR and MUSK pos - increased jitter on electromyography - Edrophonium test (Tensilon): in MG will have brief improvement when given Edrophonium. No improvement if cholinergic crisis - MRI/ C - Thyroid function tests: may have thyroid disease - Vit B 12 low, pernicious anemia - ANA, RA factor pos - normal LP Myastenic crisis - Correct Answer ✅Defined by resp failure, requiring mechanical ventilation, following increasing muscle weakness and diplopia. More likely in MUSK positive. This often follows an infection, stress, steroid change, drug exposure myastenia gravis treatment - Correct Answer ✅- neuro -Symptom mamagement with: NRNP Finals 6560 Question And Answers 2023 Pyrodostigmine bromide - slows down degradation. Monitor for cholinergic adverse effect: n/v, diarrhea, bronchial secretions, cramps. - Immunomodulating therapy: Prednisone, taper to low maintenance. Azathriopine. - Management of impending crisis: intubate. And give rapid immunomodulating therapy: IVIG. Can also do plasmapharesis. Removes antibodies. GCS measures - Correct Answer ✅The GCS measures the following functions: Eye Opening (E) 4 = spontaneous 3 = to sound 2 = to pressure 1 = none NT = not testable Verbal Response (V) 5 = orientated 4 = confused 3 = words, but not coherent 2 = sounds, but no words 1 = none NT = not testable Motor Response (M) 6 = obeys command 5 = localizing 4 = normal flexion 3 = abnormal flexion 2 = extension 1 = none NRNP Finals 6560 Question And Answers 2023 NT = not testable GCS outcomes - Correct Answer ✅Severe: GCS 8 or less Moderate: GCS 9-12 Mild: GCS 13-15 Ectopic pregnancy: what, etiology - Correct Answer ✅Implantation of fertilized ovum in other place than endometrium, often fallopian tube Could be caused by: PID, especially gonorrhea and chlamydia endometriosis IUD tubal tumors On Clomid smoking Most common cause for maternal mortality Ectopic pregnancy findings and diagnostics - Correct Answer ✅- missed period, then continued intermittent bleeding - sudden, sharp abdominal pain, diffuse pelvic pain, and radiation to shoulders/ neck - fainting, vertigo - n/v - right or left pelvic pain - hypovolemic shock signs - cullen sign NRNP Finals 6560 Question And Answers 2023 - STI hx - contraception use - sexual hx - pregnancy test - drug allergy - CDC criteria CDC PID/ salpingitis criteria - Correct Answer ✅Needs to have one of these: - uterine/ adnexal tenderness - cervical motion tenderness And potentially: - fever - purulent vaginal discharge - elevated ESR - gonorrhea or chlamydia - WBC up Definite: - evidence from endometrial biopsy - tuboovarian abscess on US - lap.scopic abnormalities consistent with PID PID/ salpingitis management - Correct Answer ✅- Early and aggressive tx of STIs will prevent PID - Admit for: surgical emergencies, coexisting pregnancy, failure to respond to tx - notify sexual partners - test for cure after 7days - rescreen for gonorrhea and chlamydia after 4-6 wks - remove IUD NRNP Finals 6560 Question And Answers 2023 - test for HIV - no douching - no sex - bed-rest semi-fowlers - Tylenol Inpatient: - Cefotetan or Cefoxitin - Doxycycline - Clindamycin or Metronidazole with Doxy for abscess Or: - Clindamycin - Gentamicin Continue till 24-48hrs after improvement Outpt: - Ceftriaxone - single dose - Doxycycline - Metronidazole Or: - Cefoxitin - Doxycycline with Metronidazole Vaginitis - what - Correct Answer ✅Most commonly: bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis Vaginitis, findings - Correct Answer ✅- vaginal discharge - vulvar itching/ irritation NRNP Finals 6560 Question And Answers 2023 - vaginal odor - asymptomatic On speculum exam: - Bacterial vaginosis: adherent, thin, milky foul/ fishy smelling discharge - Candidiasis: thick, clumpy, white cottage cheese discharge. Inflammation, erythema - Thrichomoniasis: frothy, gray/ yellow/ green discharge. Cervical petechiae: strawberry cervix. Vaginitis, diagnostics - Correct Answer ✅Bacterial vaginosis: Amsel criteria: - vaginal PH greater than 4.5 - clue cells on wet mount - whiff/ fishy odor test - milky- white discharge, adherent to vaginal wall Candidiasis: wet mount: pseudohyphae and or budding yeast Thrichomoniasis: - wet mount: motile trichomonads seen - vaginal PH greater than 4.5 - culture - nucleic acid amplification test Vaginitis treatment - Correct Answer ✅- Enclose to partner and treat - no sex NRNP Finals 6560 Question And Answers 2023 - wet mount: polymorphonuclear cells - test for syphillis and gonorrhea - HIV testing - Hep B testing Chlamydia management - Correct Answer ✅- Azithromcyin or Doxycycline - May give Erythromycin or Ofloxacin Pregnant: - Azithromycin or Amoxicillin - Or Erythromcyin - treat partner and evaluate last sexual partners - test of cure after 3 wks - no sex - use condom - report to health department Gonorrhea, what and etiology - Correct Answer ✅Bacterial STI, can be symptomatic or asymptomatic. Most commonly in cervix for women. Caused by N. Gonorrhoeae, gram negative, from GI tract, oropharynx, anorectum. Incubation period: 3-7 days - more male to female exposure than other way around Can cause: - PID - ectopic pregnancy - infertility NRNP Finals 6560 Question And Answers 2023 - Perihepatits (Fitz-Hugh and Curtis syndrome) - Epididymitis Gonorrhea findings - Correct Answer ✅Female: - asymptomatic 80% Early: - dysuria/ frequency - purulent discharge - labial pain/ swelling - lower abd pain - pharyngitis Late: - fever - abnormal periods - n/v - joint pain/ swelling Male: - asymptomatic usually Early: - dysuria/ frequency - white discharge - pharyngitis Late: - yellow/ green discharge - epididymitis - lower abd pain NRNP Finals 6560 Question And Answers 2023 - fever - Abd pain: guarding, referred, rebound - Hyperperistalsis - Painful, enlarged Bartholin and Skene glands - urethral discharge - red vaginal wall -purulent drainage from cervix - adnexal pain and masses - cervical motion tenderness - red and swollen penile shaft Gonorrhea diagnostics - Correct Answer ✅- Corner stone diagnosis: perform throat and endocervical culture for oral/ vaginal sex - rectal exam for anal sex - check for Chlamydia and syphilis and HIV - leukocytosis - ESR up - males: one hour after voiding Gonorrhea management - Correct Answer ✅- Ceftriaxone single - Azithromycin or Doxy 7 days Pregnant: - Azithromycin - Tell sexual partners and treat, and screen also for chlamydia - no sex NRNP Finals 6560 Question And Answers 2023 Teaching on sexual transmission Human Papillomavirus (HPV), what and etiology - Correct Answer ✅Infection at basal cell layer that causes genital warts, cervical abnormalities, and cancer Low risk for ca: HPV 6 and 11 and low grade cervical changes High risk for ca: HPV 16 and 18 Incubation: week to months for warts, years for cancer Most common STD HPV findings and diagnostics - Correct Answer ✅- no findings often - genital warts: cauliflower like, smooth/ flat papules, warts in areas of coital friction - visual inspection of genital warts - biopsy for: uncertain diagnosis, immunocompromised, worsening lesions despite tx, persistent ulceration HPV management - Correct Answer ✅- Pap smear for all sexually active women - tx will treat infectivity but not cure - sinecatechins ointment or imiquimod on warts until gone - Cryotherapy - Partner exam not necessary - all women age 9-26 should get vaccine Syphilis, what and etiology - Correct Answer ✅Systemic STI with 4 stages: primary, secondary, latent, tertiary. caused by treponema pallidum. Incubation period: 21 days. Infection at site of inoculation: small sore. NRNP Finals 6560 Question And Answers 2023 Syphilis findings - Correct Answer ✅Primary: - Chancre (painless, indurated ulcer). heals in 1-5 days. - regional lymphadenopathy Secondary: - Flulike symptoms - maculopapular rash on palms and soles of feet 2-6 wks after infection - patchy alopecia - wartlike lesions in mouth, throat, cervix - resolves in 12 wks Latent: - infectious for one year then noninfectious - blood test still pos for T pallidum Tertiary: - gummatous syphilis (soft granulomatous tumor) - cardiovascular syphilis - neurosyphilis Syphilis diagnostics - Correct Answer ✅- Dark field microscopic exam and direct fluorescent antibody test - VDRL and RPR test, 1 - 2 wks till results - Treponemal specific test Syphilis management - Correct Answer ✅Early, primary, secondary, latent: - benzathine penicillin NRNP Finals 6560 Question And Answers 2023 Tertiary, exl neurosyphilis: - benzathine penicillin Neurosyphilis: - aqueous crystalline penicillin or procane penicillin - If allergic to pcn. Desensitize first. - Follow up after 3 and 6mo - Treat sexual partners presumptively - Report to health department Acetaminophen toxicity findings and diagnostics - Correct Answer ✅- N/V at 24-48 hrs - RUQ pain - Hypotension - Hypothermia - Hepatotoxicity; jaundice, prolonged bleeding time, hepatic encephalopathy - Draw labs after 4 hrs of ingestion - Toxicity/ liver injury at more than 7.5gr, but at lower doses for preexisting liver injury - monitor q24hrs: ALT, AST, BUN, creat, PT, bili, metabolic acidosis, lactic, alk phos, phosphate, PH Acetaminophen toxicity management - Correct Answer ✅- Activated charchoal, within 4 hrs after ingestion (10grams per 1 gr acetaminophen) - Remove charcoal with gastric lavage before Acetylcysteine - Acetylcysteine, within 8-10hrs of ingestion. PO or IV Alcohol toxicity findings and diagnostics - Correct Answer ✅- N/V NRNP Finals 6560 Question And Answers 2023 - Resp depression - absent reflexes - miosis (pupil constriction) Barbiturate overdose management - Correct Answer ✅- airway/ ventilation - charcoal for cooperative/ stable pt's - hemodynamic support/ vasopressors Benzodiazepine overdose: what, findings, diagnostics - Correct Answer ✅Clonazepam, Diazepam - Drowsiness - confusion - slurred speech - unsteady gait - resp depression - hypoactive reflexes Benzodiazepine overdose management - Correct Answer ✅- monitor BP and respiration - Flumazenil - gastric lavage Betablocker and calcium overose: what, findings, treatment - Correct Answer ✅Labetolol, metoprolol Amlodipine, Nicardipine, Diltiazem Bradycardia, hypotension, rhythm changes NRNP Finals 6560 Question And Answers 2023 - Give Gluconate/ Glucagon and calcium chloride - Atropine for bradycardia - Monitor and treat electrolyes (K) - charcoal - ECG and possible pacing carbon monoxide poisoning findings - Correct Answer ✅- SOB - HA - confusion/ ams - n/v - weakness - blurred vision - parkinsonism - dysrythmia's - cardiac arrest - HF - resp depression - hypoxia - elevated carboxyhemoglobin level - Sinus tach - ST depression and PVC's - metabolic acidosis carbon monoxide poisoning management - Correct Answer ✅- 100% O2 with mask or intubation - may require hyperbaric O2 if carboxyhemoglobin levels are greater than 25%, or pregnant, or ams NRNP Finals 6560 Question And Answers 2023 Opioid toxicity: what, findings, treatment - Correct Answer ✅Codeine, heroin, methadone, opium, morphine, oxycodone - hypothermia - ams/ drowsiness/ coma - resp depression - miosis - ECG - ventilatory support - Narcan 0.4-2mg q2-3min Lithium toxicity findings - Correct Answer ✅- n/v - muscle weakness/ tremor/ rigidity - ataxia - dementia/ delirium - lithium level greater than 1.5 - hyperglycemia - AV-block/ prolonged QT - DI - seizures - leukocytosis - stupor/ coma Lithium toxicity management - Correct Answer ✅- bolus NS - charcoal ineffective NRNP Finals 6560 Question And Answers 2023 - shock - seizures - coma - death Brown spider bite management - Correct Answer ✅- Ice site - daily, local wound care - tetanus prophylaxis Scorpion sting findings - Correct Answer ✅- no allergic reaction - immediate, intense pain - swelling/ bruising Systemic signs: - hypersalivation - dysphagia - visual changes/ rolling eyes - resp distress - htn - muscle spasms/ paralysis Scorpion sting management - Correct Answer ✅- ice site - analgesics - tetanus prophylaxis - ABC's - may give b-blocker for svt - may give antivenin for severe symptoms NRNP Finals 6560 Question And Answers 2023 Dog, cat, human bites treatment/ facts - Correct Answer ✅- may cause infection, may rinse out with NS or LR to prevent infection - give prophylactic AB, augmentin - determine rabies status for animal bites - leave wounds to hands and le open - wound older than 6hrs, leave open Palliative extubation, management - Correct Answer ✅- remove unnecessary treatment - treat pain (HR, RR, expression): morphine, fentanyl, versed - remove mechanical ventilation in stepwise fashion, while assessing and treating pain ANA Code of Ethics for Nurses - Correct Answer ✅-In all professional relationships, practices with compassion & respect -Primary commitment is to patient, family, group, community -Promotes, advocates, protects health, safety, & rights of patients -Responsible & accountable for his/her own patient care practice -Owes same duty to self as to others, with integrity, competence, growth -Participates in improving ethical and safe, high quality health care environments -Participates in advancement of profession with research -Collaborates with other health professionals & public to protect human rights, reduce health disparities -Profession of nursing, as represented by associations/members...responsible for values & integrity & shaping social policy Autonomy - Correct Answer ✅the right to make their own decisions based on their own beliefs and values, for the patient Veracity - Correct Answer ✅being completely truthful with patients; nurses must not withhold the whole truth from clients even when it may lead to patient distress NRNP Finals 6560 Question And Answers 2023 Beneficence - Correct Answer ✅Action should promote good Non-malfeasance - Correct Answer ✅Ethical concept requiring that an action do no harm, or do less harm than good Justice - Correct Answer ✅All patients have a right to be treated fair and equally by others. AACN Clinical Standards for Acute Care Nurse Practitioners - Correct Answer ✅• perform comprehensive advanced health assessments • order and interpret the full spectrum of diagnostic tests and procedures • formulate a differential diagnosis to reach a diagnosis, and • order, provide, and evaluate the outcomes of interventions. The ACNP provides comprehensive advanced nursing care across the continuum of health care services to meet the individualized needs of patients with acute, critical, and/or complex chronic health conditions. ACNPs do not require physician supervision or oversight as may be defined in collaborative practice arrangements to fulfill their role. - The ACNP elicits relevant data and information concerning patients with acute, critical, and/or complex chronic illnesses or injury - The ACNP analyzes and synthesizes the assessment data in determining differential diagnoses for patients with acute, critical, and/or complex chronic illnesses or injury. - The ACNP identifies individualized goals and outcomes for patients with acute, critical, and/or complex chronic illness or injury - The ACNP develops an outcomes-focused plan of care. - The ACNP implements the interventions identified in the interprofessional plan of care for patients with acute, critical, and/or complex chronic illness or injury.