Improving and Expanding Healthcare Teams: AGACNP Roles and Advocacy, Exams of Nursing

Download Improving and Expanding Healthcare Teams: AGACNP Roles and Advocacy and more Exams Nursing in PDF only on Docsity! ANCC AGACNP - Frances Guide Review Questions and Answers You want to get more funding for your hospital's Rapid Response Team. How should you present this issue to the committee? a. Stress importance of the team (look up evidence about how team affects outcomes) b. Describe how to improve and expand the team - Correct answer a. stress importance of team" "What is the best way for the AGACNP to get involved in policy making? a. attend legislative days at the state capitol b. join a hospital committee c. write your local congressman d. review literature and give more in-services - Correct answer b. join a hospital committee" "What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? a. join a hospital committee b. petition the government c. bill for independent services d. start your own practice - Correct answer c. bill for independent services" "Which of the following is considered a high acuity role for the AGACNP? a. primary care clinic b. cardiology office c. community health department d. minute clinic - Correct answer b. cardiology office" "What is the best way to advocate for gay and lesbian population? a. participate in a high state or national level b. join a non-profit advocacy group c. consider lobbying the government d. start at your facility - Correct answer d. start at your facility Answers are worded differently. "decrease bias in healthcare" "create in-servises in healthcare" "obtain funding to increase access"" "Which of the following is most important to evaluate statistical significance when reviewing the literature? a. consider the sample size b. make sure the confidence interval is tight c. see if the p-value is less than the alpha-coefficient d. determine the error rate - Correct answer a. consider the sample size" "When closing a practice, the NP is required to do all of the following except a. give the patient adequate time to find another provder b. keep all of the patient's records for a minimum of five years 1 c. send a certified letter with a return receipt requested d. provide names of other providers for future care - Correct answer c. send a certified letter with a return receipt requested" "Which of the following components of an evidenced based research process is the most important for NP to participate in? a. specifying methods of data collection b. formulating the hypothesis c. carefully reviewing the literature d. formulating the research problem - Correct answer d. formulating the research problem" "A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander - Correct answer a. libel" "Can you tell the patient's wife, for her protection, that her husband has HIV? - Correct answer No, not without his permission" "How can the ANCP prepare to get involved in future mass casualty event? - Correct answer Pre enroll in disaster volunteer program" "An 80 year old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? - Correct answer Medicaid" "Your patient is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: - Correct answer Pays after insurance and 3rd party payers have paid" "You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that workds. What ethical principles does this challenge? - Correct answer Veracity and fidelity" "Health literacy - Correct answer Average american: 8th grade level" "Quality assurance - Correct answer A process for evaluating the care of patients using established standards of care to ensure quality" "CPI - Correct answer Measures structure, processes, and outcomes" "A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based policies to establish clinician-family communication standards in the unit. These policies should include: - Correct answer Guidelines for having discussions with family members that are geared toward establishing treatment goals" "Which clinical scenario does the NP evaluate for a quality improvement process change? - Correct answer An increased incidence of postoperative sternal wound infections" 2 "Nondisclosure - Correct answer Not disclosing patient PHI without permission" "Negligence - Correct answer Failure of individual to do what any reasonable person would do, resulting in injury to the patient" "When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? - Correct answer Nonmaleficence" "Living will - Correct answer Health care proxy/POA" "NP sees a patient for HF and performs an H&P. What % is expected to be paid? - Correct answer Medicare pays 80% of the total bill, pt pays 20%, NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure 80% of that 85%" "Focus of palliative care - Correct answer Basic improvement in QOL of anyone with an illness at any stage" "Hospice - Correct answer <6m to live" "Scope of practice: integration of care across the acute illness continuum with: a. collaboration b. coordination of care c. research based clinical practice - Correct answer a. collaboration" "Collaboration - Correct answer True partnership in which all players have the desire power, share common goals, and recognize/accept separate areas of responsibility/activity" "Patient is getting d/c'd and need wound care, pulmonary, and follow up. NP's role is to: - Correct answer Coordinate services" "Government is moving towards being cost effective. What is the best way? - Correct answer Allow NP to treat a wider variety of patients" "Protected health information: discussion between the NP and consultant on case - Correct answer Considered clinical relevance" "How should the ACNP stay up to date with current information? - Correct answer Evidence based guidelines" "Which medicare is Hospice covered under? - Correct answer Medicare A" "A patient presents to the Er with c/o CP and SOB. The NP misinterprets the EKG and admits the patient fro further monitoring without consulting cardio. Later in the shift, the patient decompensates and goes into cardiac arrest. The patient was resuscitated but sustained permanent brain damage. What grounds of malpractice is the NP accountable for? - Correct answer Lack of skill" "Healthcare exchange - Correct answer Health insurance marketplaces, organizations in each state through which people can purchase health insurance" 5 "You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do you approach this problem? a. ask the patients treated how care can be improved b. look back at prior treatment given to see how outcomes can be improved c. form a standardized tx plan for all patients that can be used by all healthcare staff d. form individualized tx plans that can be used by all healthcare staff - Correct answer c. form a standardized tx plan for all patients that can be used by all healthcare staff" "You have transferred a patient to the SNF. The MD in charge at that facility calls for info about the patient's medical care, what do you do? a. direct him to look it up in the EMR b. refuse to share protected health information c. instruct him to call the department head d. share the information he requests - Correct answer d. share the information he requests" "Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do? a. administer PRBCs as needed b. call the ethics committee c. continue to research alternative treatments d. ask the family to give permission now that he's unconscious - Correct answer c. continue to research alternative treatments" "What is the best way to make sure a patient will follow up as instructed? a. instruct the patient to schedule the appointment b. ask the patient the best time they can go to an appointment c. have the office manager to schedule the appointment d. schedule the appointment for the patient - Correct answer d. schedule the appointment for the patient" "Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserves life, but states that the patient would not want to be on a ventilator. What should you do? a. consult neurology to come interview the family b. document the situation carefully in the chart c. call a clergy member to offer support d. call the ethics committee - Correct answer d. call the ethics committee" "A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in "years". You: a. refer her to a gynecologist b. schedule her to come back next week for the PAP at another appt c. perform the pap today d. do a vaginal exam only, and refer the PAP to a gyno - Correct answer b. schedule her to come back next week for the PAP at another appt" 6 "A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: a. refer her to gynecologist b. schedule her to come back c. perform the PAP today d. do a vaginal exam only, and refer the PAP to a gyno - Correct answer a. refer to gynecologist" "Discharge planning is udnerway for a patient who has been very dehabilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? a. hospice b. home health care c. SNF d. private duty RN - Correct answer c. SNF" "Your patient presents to ED w/ R wrist pain. She states, "it's my fault; I should have had dinner ready on time." What do you do? a. Tell her not to go home bc it's not safe b. XR the wrist c. call the police d. consult psych - Correct answer b. XR the wrist" "Now the husband presents to the ED with drug overdose. What is your action? a. Hand him off to anothe rpractitioner b. call the police c. consult psych d. treat him without prejudice - Correct answer d. treat him without prejudice" "The medical resident obtained consent for an operative procedure. on your visit, the patient is confused/ refusing the procedure a. cancel the surgery b. have the wife sign another consent c. call the resident to clarify the patient was not confused when he signed the first consent d. consult neurology - Correct answer c. call the resident to clarify the patient was not confused when he signed the first consent" "Your HIV positive patient is preparing to discharge when he tells you not only that he has passed the virus to his wife, but also that he plans to kill her when he gets home. How do you respond? a. call the police b. consult psych c. consult social work d. document his statements - Correct answer b. consult psych" "Your clinical student breaks the sterile field. HOw do you handle this situation? a. discuss it with the student b. report it to the charge nurse c. report it to the unit manager d. inform the faculty in charge of the student - Correct answer a. discuss it with the student" 7 "Knowledge deficit in ICU, what would you do for nurses? - Correct answer In services" "A patient has advanced dementia, ESRD, and HF, what do you do for him? - Correct answer Transfer from acute to palliative care" "Your 24m patient has been out hiking on vacation. He shows you the following rash, and thinks he has Rocky Mountain Spotted Fever. What is his diagnoses? - Correct answer Lyme disease (Erythema migrans/bullseye rash), both are treated with doxycycline" "Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to? a. shame because she feels the illness is her fault b. embarrassment from the examination c. a sign of respect d. a normal response - Correct answer c. a sign of respect" "Your patient speaks only spanish and you need to evaluate his pain. What do you do? a. ask a family member to translate for you b. utilize the hospital's interpreter service c. call over the Hispanic housekeeper and ask her to translate d. Use a visual pain scale - Correct answer D. use a visual pain scale" "58yo Japanese male with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the Ed warrant admission? a. age b. gender c. pain level d. ethnicity - Correct answer d. ethnicity (underestimates pain, taught to be stoic, pain is probably much more severe)" "A 77yo male patient's wife cares for him at home .Which statement by the wife indicates a need for a SNF? a. my husband needs more help with his ADLs b. I can't lift him out of bed anymore c. he has lost 20 pounds d. he has trouble swallowing and I'm worried he will choke on his food - Correct answer a. my husband needs more help with his ADLs" "Which psychiatric disorder is most commonly diagnosed, yet least commonly treated? a. bipolar disorder b. alzheimer disease c. depression d. dementia - Correct answer c. depression" "Your patient with PNA is noted to have a heavy drinking habit. 2 days post admit he becomes combative/agitated. What is tx? a. IV valium 10 b. IV ativan c. PO librium d. lasix - Correct answer c. PO librium" "Your patient has developed a fever of unknown origin. What is the next step? a. PO abx b. IV abx c. do nothing until diagnosis is confirmed d. tylenol - Correct answer c. do nothing until diagnosis is confirmed" "How long will it take to begin to see healing in a pressure ulcer that has a clean, well-vascularized bed? a. 7 days b. 2-4 weeks c. 2 days d. 4-6 weeks - Correct answer c. 2 days" "The patient has been in a bar fight and has a human bite on his hand. What should you do next? a. order PO abx b. order wound culture c. order IV abx d. measure the wound depth and width - Correct answer a. Order PO abx" "Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication? a. compartment syndrome b. decrease in ROM ability c. septic shock d. osteomyelitis - Correct answer d. osteomyelitis" "What is the strongest predictor of functional impairment prior to discharge of the elderly patient? a. advanced age b. incontinence c. cognitive impairment d. poor balance - Correct answer c. cognitive impairment" "Your patient has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.2) a. give IVF b. antipyretic c. abx d. ice packs to groin and axilla - Correct answer a. give IVF (Flush it out, this is neuroleptic malignant sydnrome)" "You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention? a. stop the TPN, remove the line, and place a new line for TPN b. start abx c. send cx 11 d. change the guidewire - Correct answer a. stop the TPN, remove the line, and place a new line for TPN" "Your patient has a fever 3 days post op, WBC are 15k, blood cultures negative, and Eos 9%. What is the diagnosis? a. viral infection b. bacterial infection c. malignant hyperthermia d. drug fever - Correct answer d. drug fever (eos=allergic reaction, normal is 1-4%)" "What are protein supplements best used for? a. eliminate the need for lipids b. prevent anasarca (peripheral edema) c. aid in post op healing - Correct answer c. aid in post op healing" "Which macronutrient of TPN significantly increases the osmolality of the solution? a. lipids b. dextrose c. mutivitamin d. potassium - Correct answer b. dextrose" "Protein in nutrition for what reason? - Correct answer maintain nitrogen balance along with metabolic needs, adjust protein weekly by measuring urinary urea nitrogen" "Which electrolyte are you most concerned about monitoring in cachexic patient? a. mag b. ca c. na d. k - Correct answer d. k refeeding syndrome, hypokalemia and hypophosphatemia" "Which electrolyte do you monitor in refeeding syndrome? - Correct answer Phosphorous (or potassium)" "Which lab do you monitor daily in a patient on nutritional supplements? a. BMP b. cbc c. abg d. blood culture - Correct answer a. BMP (and monitor LFT's weekly)" "What alternative therapy can you order to relax the patient prior to procedure? a. massage b. aromatherapy c. music d. muscle relaxant - Correct answer c. music" 12 "35yo Asian american is in good health. He is worried about life prolonging measures. What is the most likely cause of death for a man like him? - Correct answer Unintentional injury (if he's African american, it's homicide <35 and heart disease at 35)" "What is the leading cause of death in African american males ages 40-59? - Correct answer CAD" "What is the leading cause of deaths in hispanics in the US? - Correct answer Heart disease" "The most common cause of hyponatremic hyperosmolality a. hyperglycemia b. hyperthyroidism c. adrenal insufficiency d. k sparing diuretics - Correct answer a. hyperglycemia" "What method should you use to treat hyponatremia related to SIADH? a. bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200ml/hr d. 3% hypertonic saline ,calculated - Correct answer d. 3% hypertonic saline, calculated" "What is a potential cause of hyperkalemia? a. carafate b. NSAIDs c. centrally acting HTN meds - Correct answer b. NSAIDs" "Your patient has a Na of 128 and was treated with colloids 3 days ago. What is a treatment? - Correct answer Restrict free water" "A 68yo patient had sx three days ago to repair a AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFT's are normal, no s/s CHF, the patient's laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0.8 mg/dL, PaCO2 of 37mmHg. Which is the most appropriate method to deliver nutrition? a. central line b. PIV c. G tube d. enteral feeding to the duodenum via a nasogastric small-bore tube - Correct answer d. enteral feeding to the duodenum via a nasogastric small bore tube" "Your patient has a serum osmolality of 268 mOsm/kg and a serum sodium of 134 mEq/L. His urine has Na less than 10 mEq/L. You know that all of the following are possible explanations except: a. diarrhea b. diuretics c. dehydration d. vomiting - Correct answer b. diuretics (Na<10 is nonrenal cause. Diuretics are associated with renal cause, urine na >20)" "A 61 year old female c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating 'abnormally' and she has been experiencing muscle spasms on occasion. You order and 15 EKG and find decreased amplitude and broad T waves. Occasionally you also note prominent U waves. Of the following, which is the most likely diagnosis? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypermagnesemia - Correct answer a. hypokalemia" "Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except: a. hypernatremia b. pneumothorax c. HHNK d. GI bleed - Correct answer d. GI bleed" "65yo male with c/o n/v/constipation x several days and a six pound weight loss. Pt s/p TKR severral weeks ago and reports not getting off the couch. What electrolyte is altered? - Correct answer Hypercalcemia secondary to immoblity" "Pt with s/s of abd distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the patient has a fluid and electorlyte problem. Which of the following is he most likely experiencing? - Correct answer Hyperkalemia" "ABG reads high HCO3 and pCO2 55mmHg. What electrolyte abnormality is most likely associated with these values? - Correct answer Hypokalemia r/t metabolic alkalosis" "Pt has a fever and tachycardia, and hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status - Correct answer Extracellular dehydration deficit" "Low serum Na and high serum osmolality - Correct answer Hyperglycemia (Probably HHNK)" "A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give: - Correct answer NS" "Low protein = Low BUN = - Correct answer hypoosmolar hyponatremia (probably edematous, expect edema in Albumin <2.7)" "A patient who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lbs (59.9kg), is intubated and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2o. Clinical signs include tachycardia and hypotension. The initial treatment is to: - Correct answer Replenish the volume by infusing a 0.9% sodium chloride solution" "Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse patient? - Correct answer Hyponatremia" "What electrolyte should be monitored prior to administering succinylcholine? - Correct answer K" "ASA overdose, which electrolyte do you monitor? - Correct answer K (if low will prevent hte alkalinization of urine, which is the mainstay of treatment)" 16 "What sx is associated with hepatotoxicity s/p acetaminophen toxicity? - Correct answer Delirium" "Patient at high risk for hyperkalemia? - Correct answer NSAIDs then ACEi" "Tube feeding side effects - Correct answer Diarrhea: decrease the osmolality of the tube feeding" "What patient requires labs to be monitored closely after intiating Tf? - Correct answer Alcoholic with decreased intake over the past 2-3 weeks" "What disorder can be ruled out using the Cosyntropin stimulation test? a. Cushing's b. DI c. Adrenal insufficiency d. SIADH - Correct answer c. Adrenal insufficiency" "What side effect of levothyroxine is most likely to lead to non-compliance when first initiated? a. alopecia b. dyspepsia c. weight loss d. nevousness - Correct answer a. alopecia" "You are treating a patient for hypothyroidism. Which lab value is monitored for treatment/synthroid effectiveness? a. T3 b. T4 c. TSH d. thyroxin index - Correct answer c. TSH" "What method should you use to treat hyponatremia related to SIADH? a. Bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200mL/hr d. 3% hypertonic saline, calculated - Correct answer d. 3% hypertonic saline, calculated" "For the past few months, 29yo Janine has been gaining weight while experiencing amenorrhea and increasingly severe acnes. She has gained more than 20 pounds, and you note that she is carrying her weight around her midline, with bilateral purple-ish striae across both flanks. You suspect CUshing's syndrome. Which of the following findings would not contribute to a diagnosis? a. urine free cortisol=360 ug/day (>50 abnormal) b. glycosuria c. wbc 19 d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol - Correct answer d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol In cushing's, pituitary does not respond to dexamethasone." "Which of the following is NOT a criteria of metabolic syndrome? a. BP>140/90 17 c. cancellation of surgery until next week d. echocardiogram - Correct answer d. echocardiogram" "Which of the following is contraindicated for a patient receiving a renal angiogram? a. beta blocker b. alpha blocker c. calcium channel blocker d. ace inhibitor - Correct answer d. ace inhibitor" "Your 45 yo male patient has new onset atrial fibrillation, but no other past medical history. What should you prescribe? a. tylenol b. ASA c. coumadin d. plavix - Correct answer b. ASA - he is young with no risk factors/history Coumadin would be used in 65y+ or with positive risk factors/history" "Which is best used to diagnose pulmonary HTN? a. bubble study b. presence of peripheral edema c. cardiac catheterization d. 2D echo - Correct answer d. 2D echo used for diagnosis, cardiac cath used for confirmation" "Your patient has overdosed on Lopressor. It has been 5-6 hours, what do you order? a. glucagon and atropine b. narcan c. activated charcoal d. flumazenil - Correct answer a. glucagon and atropine" "Your patient is preoperative for an elective surgery. You notice a pulsating mass in the mid abdomen (AAA). What is next action? a. cancel the surgery b. order abdominal ultrasoud c. order abdominal CT d. document the mass carefully and send to surgery - Correct answer b. order abdominal ultrasound" "Your patient is postoperative after an aneurysm clipping. Which intervention is used? a. maintain SBP 140-160 b. place patient in a quiet room c. encourage visitors d. start decadron - Correct answer b. place patient in a quiet room" "Your 67yo patient has a BP of 168/92. On her second visit her BP is 158/88. What is your initial treatment plan? a. prescribe an AceI b. prescribe a mild diuretic c. teach lifestyle changes 20 d. schedule a stress test - Correct answer c. teach lifestyle changes" "Which of the following lipid panels shows 3 out of 4 abnormal values? a. TC 205, LDL 150, HDL 30, TG 300 b. TC 150, LDL 99, HDL 35, TG 145 c. TC 102, LDL 50, HDL 60, TG 102 d. TC 180, LDL 136, HDL 25, TG 160 - Correct answer d. TC 180, LDL 136, HDL 25, TG 160" "Your patient is an obese 38 yo female wiht the following fasting lipid panel: TC 270, LDL 168, HDL 28. What is your action? a. start a statin b. teach lifestyle changes c. prescribe metformin d. prescribe niacin - Correct answer a. start a statin (key word, obese)" "Which med must be on the d/c list of a patient admitted for CHF? a. sotalol b. norvasc c. lisinopril d. losartan - Correct answer c. lisinopril You have to pick out the CHF fro mthe stem distractors, and the answer is an ACE inhibitor" "31 yo male with a blowing murmur occurring during S1 and galloping addition heart sound. Mumur is heard best at the base of the heart. What is MM? - Correct answer Mitral regurgitation" "When d/c'ing an 85 yo female patient with stasis dermatitis, the NP includes instructions to: - Correct answer Keep legs elevated while seated" "An older man is a smoker and has been for years. He has shiny hairless legs. Which diagnostic test would you order? a. ankle-brachial index b. arterial doppler c. venous doppler d. d-dimer - Correct answer a. ankle brachial index PAD" "A 70 yo patient with acute systolic HF denies any functional limitations, is able to walk five blocks before tiring, and is euvolemic. Which medication is the first line therapy for this patient? - Correct answer Lisinopril" "A patient with HF has dyspnea on exertion and sleeps all night while using 3 pillows. What is her NYHA HF stage? - Correct answer Stage III" "Treatment of heart block? - Correct answer Identify type, trancutaneous pacing, venous if can't capture, atropine if very symptomatic, plan for pacemaker, d/c all AV nodal blocking drugs" 21 "Patient has an EF of 20% and a bronchospasm, what med caused it? - Correct answer Beta blocker" "What BP is hypertensive emergency? - Correct answer 220/110" "What BP is hypertensive urgency? - Correct answer 180/110" "What lab should you check with new onset Afib and what is the treatment? - Correct answer TSH, beta blocker" "What grade murmur do you first hear a thrill? - Correct answer 4" "On physical exam, you note a moderately loud MM with no thrill. What grade? - Correct answer 3" "Pt has low diastolic rumble murmur in the left lateral position with no radiation? - Correct answer Mitral stenosis" "Patient presents with suspected mitral regurgitation. What physical findings would confirm? - Correct answer S3 systolic MM" "Tricuspid regurgitation occurs in... - Correct answer Right atrium" "Stages of heart failure? - Correct answer NYHA" "Patient with history of HF, wet lung sounds, lower extremity edema, dyspnea, what is the cause of edema? - Correct answer Increased hydrostatic capillary pressure" "What is the purpose of cardiac stress testing? - Correct answer Differentiate ischemia vs infarction" "STEMI guidelines, "door to needle"? - Correct answer 30 minutes" "STEMI guidelines, "door to balloon"? - Correct answer 90 minutes" "Patient is post MI, on a beta blocker and statin. What do they need? - Correct answer AceI" "Which drug prevents cardiac remodeling? - Correct answer AceI" "Patient with 14 hours of chest pain presents to ED, next step of action? - Correct answer Take to cath lab, fibrinolytic therapy 6 hour window has closed" "Pericarditis s/s - Correct answer normal CXR, low grade temp, elevation of ST segment in ALL leads" "Best diagnostic test for Pericarditis - Correct answer ECHO, at risk for tamponade" "Pericarditis treatment - Correct answer NSAIDs" "A patient post CABG with abdominal distention, diagnosis? - Correct answer Mesenteric infarct (risk factor cardiac surgery)" 22 "65 yo ETOH use with 25y smoking history has dysphagia and epigastric pain. What is diagnosis? - Correct answer GERD" "On CXR notes air under diaphragm? - Correct answer Pneumoperitoneum" "Diverticulitis flare ups can be caused by? - Correct answer Smoking" "What is the treatment of diverticulitis? - Correct answer NPO dependent upon condition, IVF, IV abx (flagyl, cipro, ceftazidime, clinda, ampicillin)" "True/false: barium enema is indicated in the conservative management of diverticulitis? - Correct answer False" "Lab values of acute pancreatitis? - Correct answer GWGLA HBCABE Prognostic signs on admission Greater than 55yo WBC>16 Glucose >200 LDH>350 AST>250 Prognostic signs during first 48h Hct drop of >10 BUN increases >5 Calcium <8 Arterial O2 <60 Base deficit >4 Estimated fluid sequestration >6k nL" "Which disorder worsens epistaxis? - Correct answer Cirrhosis, HIV" "Bowel obstruction antibiotic? - Correct answer Zosyn" "49 yo male presents with c/o abdominal swelling that progressed over 2 days. Patient also reports mucous-filled diarrhea and abdominal pain. Exam is significant for profound abd distention. You suspect SBO. What type of bowel sounds are associated? - Correct answer High pitched, tinkling bowel sounds" "Profuse vomiting and variable epigastric pain are 2 symptoms of what diagnosis? - Correct answer Proximal SBO" "What is the presentation and treatment of crohn's? - Correct answer diarrhea, abdominal pain, abscess/fistulas Ts: flagyl/cipro" 25 "Who is at risk of toxic megacolon? - Correct answer Both crohn's and ulcerative colitis" "48yo with fever, abdominal pain and bloody diarrhea with h/o chronic sinusitis, arthritis, and recent DVT. Which represents the most likely diagnosis and test to order? - Correct answer Ulcerative colitis, sigmoidoscopy" "Young male with ulcerative colitis, what would be probable finding? - Correct answer Rectosigmoid stricture" "Ulcerative colitis medications? - Correct answer Canasa (mesalamine) suppositories or enemas for 3-12 weeks, hydrocortisone suppositories and enemas" "What abx do you use for ulcerative colitis? - Correct answer Cipro/flagyl in severe colitis and high grade fever, leukocytosis with extreme numbers of immature neutrophils (bands >700/microL), and peritoneal signs or megacolon There is no role of abx in patients with severe colitis without signs/symptoms of systemic toxicity" "Treatment for fulminant ulcerative colitis without s/s of systemic toxicity? - Correct answer IV steroids" "WHen would you find "thumb printing sign" on abdominal xray? - Correct answer Mesenteric ischemia (ischemic colitis), pseudomembraneous colitis, and IBD Radiologic sign of bowel wall thickening" "Both husband and wife abuse ETOH. Woman has liver disease but husband does not? - Correct answer Women are likely to get liver disease while drinking less than men" "What causes GI bleed in elderly? - Correct answer Thin gastric membranes RF: Nsaid/asa/anticoagulant use" "Do not use protonix long term due to? - Correct answer Increased risk of hip fracture" "Why would you pick a PPI over phenergan for treatment? - Correct answer PPI can be used in combo with other dugs to control symptoms" "Patient on PD dialysis has an infected dialysis catheter. What is the first thing you do? - Correct answer Remove the catheter" "You are a preceptor who is mentoring a student. The patient's s/s are broad and variable and include mild icteric symptoms. How should you educate your student? - Correct answer Have the student review the clinical symptoms and query differential diagnosis" "What are the s/s of the icteric phase of hepatitis? - Correct answer Jaundice, RUQ pain, clay stool, dark urine, weight loss, low grade fever, hepatosplenomegaly" 26 "What are the s/s of the pre-icteric phase of hepatitis? - Correct answer Fatigue, malaise, anorexia, n/v, headache, aversion to smoking and alcohol" "What is the most important assessment findin in determining a patient's mental status? a. orientation level b. attention c. memory d. affect - Correct answer a. orientation level" "Your patient has a severe closed head injury. VS are listed. Which value is it crucial in evaluating him for brain death? a. pt had a gag/cough reflex b. pt is not normothermic Pt is not normotensive d. documenting family opinion on whether patient is brain dead - Correct answer b. pt is not normothermic" "A nurse experiences a needle stick fro ma patient who has Non-a, non-b hepatitis. She has already had the HepB vaccine series. What is the next step? - Correct answer Obtain blood samples from the patient and the RN" "Your patient has a closed head injury and is ventilated. His abg's are: pH 7.48, pCO2 35, FiO2 40%, pO2 60. What is the recommended action? a. increase the FiO2 to 60% b. decrease the tidal volume c. decrease the respiratory rate d. leave the setting as it is - Correct answer d. leave the setting as it is (CO2 in head trauma, 35 is the goal)" "Your patient has suffered a spinal cord injury. What sign indicates recovery has begun? a. increase in DTRs b. bradycardia c. edema d. moderating respiratory rate - Correct answer a. increase in DTRs" "Your patient presents to ED with ischemic stroke-like symptoms. Her BP is 160/90 and she is on norvasc. Symptom onset was 4 hours ago. Which of the following is a contraindication to fibrinolytic therapy? a. time b. PMH c. age d. BP - Correct answer a. time" "Your patient is s/p craniotomy and is about to d/c home. You notice ataxic gait and holding the wall while walking. What is your action? a. consult PT b. discharge home 27 "You are examining a patient with a PMH of seizures. Pt sustains a seizure lasting around 1 minute. What is the most appropriate intervention? - Correct answer Valium 5-10 mg IV" "Initial action taken in a patient with new onset seizures? - Correct answer CT scan" "60 yo male presents to ER and his child reports he passed out on the care while driving, regained consciousness and was drooling and out of it. Patient's HR and BP are decreased. You give Nimodipine. What is the rational for administering Nimodipine to this patient? - Correct answer Calcium channel blocker that counters vasospasm s/p CVA" "What CSF values are characteristic of bacterial meningitis? - Correct answer Increased opening pressure, increased protein, increased WBC, decreased glucose" "Your patient has swallowed a foreign object (coin) and it is lodged in the Cspine area according to XR. How do you get it out? a. a surgery with forceps b. bronchoscopy c. tracheostomy d. allow the coin to pass - Correct answer b. bronchoscopy" "Your patient has a gunshot chest wound. What kind of dressing does he need? - Correct answer 3 sided dressing Allows air to escape, but not enter (and thus can be trapped) in the lungs, so as not to cause a tension pneumothorax when the patient exhales and air tries to enter the hole. This is why we have the patient take a deep breath and hold it when we pull a chest tube. Air won't enter the chest cavity when the lungs are full of air." "Your patient is 3 days post appendectomy and develops dysphagia, drooling ,and expiratory stridor. What is going on? - Correct answer Epiglottitis" "Your patient is ventilated and becomes confused with arm edema. What low cost test do you order? a. d-dimer b. us c. VQ scan d. ankle brachial index - Correct answer b. us" "Your patient with VAP is on broad spectrum coverage including levaquin, cefepime, and vancomycin. Your culture comes back growing pseudomonas. What do you do now? - Correct answer Narrow the spectrum (d/c vanc)" "Which of the following does not cause hypoxemia? a. hyperventilation b. hypoventilation c. decrease in atmospheric O2 d. right to left shunt - Correct answer a. hyperventilation" 30 "What is the initial finding in pulmonary embolism? a. respiratory acidosis b. respiratory alkalosis c. metabolic acidosis d. metabolic alkalosis - Correct answer b. respiratory alkalosis" "Your 32 yo male patient has a history of MVR and c/o wheezing with exercise. What is your order? a. pulmonary consult b. PO steroids c. PFTs d. SABA - Correct answer c. PFTs" "The mother of a 19 yo female calls you with concerns about her daughter's asthma attack. She tells you that she is SOB and has difficulty speaking in sentences. She adds that her usual medicine, alupent, is not working. Which of the following should the mother administer to treat the asthma attack? a. metaproterenol b. albuterol c. aqueous epinephrine d. ipratroprium bromide - Correct answer d. ipratroprium bromide (anticholinergic) Alupent is albuterol, metaproterenol acts the same way and aqueous epinephrine should only be used if the patient won't cooperate" "A 36yo patient who has a history of asthma comes to the Ed in a fatigued state. She has difficulty speaking d/t respiratory distress but is able to explain that she is recovering from a cold, but her s/s are so severe that she came into the ED. HR is 118, FVC WDL, FEV 1 45% of expected value. You order metaproterenol 0.3 mL in 5% solution, but the patient does not respond. Now what? a. aqueous epinephrine b. albuterol c. methylprednisolone d. montelukast - Correct answer c. methylprednisolone" "Your patient with asthma has decreased breath sounds on presentation. You give a nebulizer treatment. Now the SaO2 is decreased to 86% and there are no breath sounds. What do you do? a. stat nebulizer b. abg's c. epinephrine d. intubate - Correct answer d. intubate" "A 51 year old male is admitted to the ED with severe dyspnea. The patient's history indicates emphysema. The NP orders O2, since the patient SaO2 dropped from 96% to 90%. However the NP also advises the attending RN to continue monitoring the patient because a. He has lost his hypoxemic respiratory drive b. He has lost his hypercapnic respiratory drive - Correct answer b. he has lost his hypercapnic respiratory drive" "What is the earliest sign of Pna in the elderly patient? 31 a. dyspnea/SOB b. tachypnea c. fever d. hypoxia - Correct answer b. tachypnea" "Your patient is a 79 yo male japanese immigrant. What TB induration measurement is diagnostic? a. 3mm b. 7mm c. 11 mm - Correct answer c. 11 mm" "Your asthmatic patient is on a SABA and ICS. She has no secretions but her symptoms are still not well controlled. What do you order next? a. salmeterol b. ipratroprium bromide c. montelukast d. metaproterenol - Correct answer a. salmeterol (LABA)" "Your patient on albuterol has had multiple trips to the ER in the past three months. what should you add? - Correct answer An ICS, flovent" "What is paradoxical abdominal and diaphragmatic movement? a. symptoms of anxiety disorder b. asthma ominous sign c. respiratory bacterial infection - Correct answer b. asthma ominous sign" "Which of the following is reason to intubate in an asthmatic patient? a. RR in the 30s b. bad ABGs c. SaO2 in the 80s d. change in behavior - Correct answer d. change in behavior" "What history do you ask about before you prescribe a sleep aid to your 69 yo patient? a. seizure b. depression c. heart disease d. OSA - Correct answer d. OSA" "Your patient is an RN with a positive PPD. Her CXR comes back negative. What do you do now? - Correct answer Offer 6 months INH" "Which national measure is most important to prevent VAP? - Correct answer Increased HOB 30 degrees" "Patient with SOB and dry cough. CXR reveals generalized inflammation throughout, numerous poorly defined small (<5mm) opacities throughout both lungs, sometimes sparing the apices and bases - Correct answer Pneumonitis" 32 "Which of the following demonstrates the appearance of normal veins on a funduscopic examination? a. pale gray compared to arteries b. wider than arteries c. brighter red than arteries d. thinner than arteries - Correct answer b. wider than arteries" "Your HIV patient has CMV. What is the appropriate treatment? a. cefazolin b. ciprfloxacin c. fluconazole d. gemcyclovir - Correct answer d. gemcyclovir (CMV is a virus)" "Your patient has RA and her corticosteroids are not working. What is your next step? - Correct answer Methotrexate" "Your patient stepped on a nail and does not know his last tetanus status. Do you give Td or Tdap? - Correct answer Tdap" "In which patient would sarcopenia be the most expected finding? - Correct answer Elderly patient" "Why are so many HIV patients noncompliant? - Correct answer Decreased access to care" "Know HIV testing - Correct answer Initial ELISA, confirmed with Western blot" "What is criteria for AIDS - Correct answer CD4 <200 (800 is WDL) or <20%. Ideal virus load <5000" "HIV patient with petechiae on legs (bone marrow suppression) and leg weakness (malaise). What should you test for? - Correct answer CMV" "HIV med side effects - Correct answer GI problems: n/v Skin rash, anemia" "ESR elevated ,what should you suspect? - Correct answer RA, SLE, temporal arteritis, inflammation" "In addition to positive serum ANA, what diagnostic is supportive of diagnosis of SLE? - Correct answer Leukopenia" "28 yo female presents with fever, malaise, rash across the back and splinter hemorrhages, Hgb 10, positive ANA, UA, proteinuria, and elevated ESR. What is the suspected diagnosis? - Correct answer SLE" "Which of the following drugs can cause lupus-like symptoms? - Correct answer Procainamide" "RA treatment - Correct answer methotrexate, DMARDs, corticosteroids, hydrochloroquine, gold salts" 35 "What should you monitor while on methotrexate? - Correct answer LFTs" "What is Felty's sydnrome? - Correct answer RA + joint swelling + enlarged spleen + leukopenia Complication of RA" "Pt is c/o wrist/hand pain, swollen, and redness that is worse in AM and resolves as the day goes on. What diagnosis do you suspect and what diagnostic test would support it? - Correct answer RA, increased ESR" "Pharmacologic treatment for OA - Correct answer ASA, APAP (1st line), NSAIDs, Cox2 inhibitors (celebrex)" "Nonpharmacologic treatment for OA - Correct answer Swimming" "How should you use a cane? - Correct answer Opposite side" "57 yo male with PMH of CV disease presents with c/o pain in both knees that is progressively worse throughout the day. What diagnosis do you suspect and what medication is contraindicated? - Correct answer OA, celebrex is CI in patients with ARF, MI, and hx of cardiac disease" "What is associated with headache, fever, and elevated ESR? - Correct answer Temporal arteritis" "Best way to verify your treatment is working for open angle glaucoma? - Correct answer Tonometry (normal is 10-20 mmHg)" "Which med is not indicated in the management of closed angle glaucoma? - Correct answer Alpha 2 adrenergic agonist (for open angle)" "47 yo male comes in complaining of intense right eye pain which has worsened since he woke up. Eye exam: copious tearing/redness. What do you do to confirm the suspected diagnosis? - Correct answer Sodium fluorescein stain for corneal abrasion" "What are elderly persons at risk for skin tears? - Correct answer dermis thins with age" "Older lady with iron deficiency anemia is opening a jar and sustains a spiral fracture of her arm. Why? - Correct answer Osteoporosis" "Your patient's abgs come back as follows: pH 7.37, HcO3 19, pCO2 24. What is the diagnosis? - Correct answer Metabolic acidosis with resulting respiratory alkalosis" "Your anaphylactic patient is wheezing and states she feels like her throat is closing. What is the priority action? a. IV steroids b. give epinephrine c. intubate d. IV benadryl - Correct answer c. intubate" 36 "Your patient has tachycardia, anxiety, urticaria in recovery from a cardiac catheterization. What is the treatment? - Correct answer IV methylprednisolone, H2 blocker, and IV benadryl" "What kind of shock is exhibited by the following values? PCWP 18, CI 2, SVR 1800 a. distributive b. cardiogenic c. obstructive d. hypovolemic - Correct answer b. cardiogenic Only shock with high PCWP" "Your patient has had treatment for a hematoma. He is confused and combative. It is necessary that he lie still for several hours. What do you do? a. order paralytic b. bedside sitter c. insist the family stay at the bedside d. order sedation with holidays for neuro checks - Correct answer d. order sedation with holidays for neuro checks" "Your ventilated patient has these settings: SIMV, FiO2 60%, PEEP 5. You notice pulmonary shunting. What is your best action? a. increase PEEP to 10 b. order a beta agonist inhaler c. increase FiO2 to 70% d. add +5 pressure support - Correct answer a. increase PEEP to 10 Shunting is due to atelectasis" "Your intubated patient has sounds coming out from around the tube. What is the cause? a. mucous plug b. bronchospasm c. tracheoesophageal fistula d. cuff insufficiency - Correct answer d. cuff insufficiency (air leak)" "The NP correctly identifies the expected hemodynamic profile of a patient in hypovolemic shock as being most closely represented by which of the following? a. CO 3.5, CVP 1, PCWP 4, SVR 700 b. CO 3, CVP 1, PCWP 3, SVR 1400 c. CO 3.5, CVP 1, PCWP 14, SVR 1300 d. CO 8.5, CVP 9, PCWP 14, SVR 1300 - Correct answer b. CO 3, CVP 1, PCWP 3, SVR 1400 Everything is low except SVR" "A patient presents to the ED with intense abdominal pain that worsens when she coughs. A physical exam indicates abdominal tenderness, abdominal guarding. During the physical exam, the NP elicits RLQ pain when pressure is applied to LLQ. Her labs are: HR 140, SV 70, CVP 8, PCWP 4, SVR 600. Which of the following should be initiated for this patient? a. norepinephrine 37 "Patient with tibia/fibula fracture started having s/s of compartment syndrome. What do you do next? - Correct answer Measure intracompartmental pressure" "To check for other sources of bleeding in a pelvic fracture? - Correct answer CXR and FAST scan" "There is a trauma patient who is hypotensive and blood transfusion is needed. What does this place the patient at risk for? - Correct answer ischemic ATN" "LeFort criteria determined by? - Correct answer malocclusion and XR showing broken palate and teeth Tx: trauma referral, stabilize and ship to tertiary hospital" "Which antiemetic blocks the 5-HTS serotoniin receptor and can cause extrapyramidal symptoms? a. ondanestron b. metoclopramide - Correct answer b. metoclopramide" "What can contribute to Dilantin toxicity in patient with DM? - Correct answer Hypoalbuminemia" "Which of the following anti epileptic drugs is the long term drug of choice for treating patients with convulsive status epilepticus? a. phosfenytoin b. diazepam c. phenytoin d. phenobarbitol - Correct answer c. phenytoin" "Which of the following factors puts the patient at risk for drug toxicity? - Correct answer CrCL <30" "52 yo female is concerned with hormonal replacement therapy. What are the associated SE? - Correct answer Gallstones, blood clots, and CVA" "Hormonal replacement therapy has been shown to improve what dx? - Correct answer Osteoporosis" "What is dantroline sodium/dantrium treatment used for? - Correct answer Serotonin syndrome, malignant hyperthermia, neuroleptic malignant syndrome" "Detrol LA side effects - Correct answer Anticholinergic effects: drying- xerostomia, constipation, dyspepsia, dry eyes, dysuria, headache" "Ginseng SE - Correct answer increases risk of bleeding" "Metformin SE - Correct answer Lactic acidosis" "What should you monitor for when taking NSAIDs? - Correct answer creatinine, hyperkalemia" "How long should you monitor the opiate niave? - Correct answer 3 hours" 40 "How do you know a patient understands his coumadin instructions? - Correct answer They are getting their INR checked" "Tamoxifen side effects - Correct answer Estrogen modulator: hot flashes, menopausal symptoms, vaginal dryness, hair thinning/loss, menstrual irregularities, pancytopenia, increased risk of DVT/CVA" "St John's wort side effects - Correct answer decreases effectiveness of digoxin, increased risk of serotonin syndrome" "Succinylcholine precautions - Correct answer Risk of malignant hyperthermia, increases K," "Synthroid increases risk of what? - Correct answer MI" "How to ensure adequate synthroid use? - Correct answer Check TSH" "What is an expected finding in TCA overdose? - Correct answer Prolonged QT" "What would you monitor postop with serotonin HT3? - Correct answer Nausea (zofran is serotonin 5HT3 antagonist)" "What 2 herbs are associated with relieving menstrual symptoms? - Correct answer Evening primrose and black cohosh" "Elderly patient takes an herbal root t o help fight colds, however has a history of renal insuficiency. Which herb could exacerbate his diagnosis? - Correct answer Echinacea causes nephrotoxicity" "Which of the following is not an indicator of prerenal failure? a. BUN/Cr ratio >10:1 b. FeNa <1 c. specific gravity > 1.015 d. urine na >40 - Correct answer d. urine na >40" "A 34 year old female presents to the ED with severe flank pain, nausea, and vomiting. The patient states she had trouble urinating before the onset of her other s/s. A CT scan reveals a 2.5 mm stone in the L kidney just above the upper ureter. Which course of action is most appropriate? a. give IVF b. strain the urine immediately c. schedule lithotripsy - Correct answer b. strain the urine immediately She may past stone on her own" "Your 33 yo female patient tells you she does not use protection during sexual intercourse. Cervical motion tenderness in addition to what other finding indicates PID? a. adnexal tenderness b. vaginal itching c. UTI 41 d. no other symptoms - Correct answer a. adnexal tenderness" "53 yo male c/o dribbling and nocturia. You suspect BPH, PSA 3.2. What confirms the diagnosis? - Correct answer Transrectal ultrasound" "A male patietn you have placed on an alpha blocker for BPH comes in complaining of increased urinary frequency. What do you do? - Correct answer Leave it alone, the med is working" "A 78yo male patient with CHF develops a bacterial UTI secondary to indwelling foley catheter. Pt has known allergy to PCN and sulfonamides. The appropriate choice for antimicrobial therapy is? - Correct answer Ciprofoxacin" "Patient with history of Afib has maintained NSR with sotalol, is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is? - Correct answer IV Ceftriaxone" "A young female patient is in ED with vaginal discharge. After pelvic exam, the NP documents which finding? - Correct answer Cervical motion tenderness" "Your female patient presents with mucopurulent cervical drainage, fever 102F, adnexal tenderness, and distended/rigid abdomen. What is the appropriate measure? - Correct answer Call surgery and arrange for an ex lap and pelvic abscess drainage" "Lower UTI treatment - Correct answer Bactrim, cipro, augmentin for 3d course" "Male patient with UTI on 3 day regimen of abx comes in requestion stronger abx, you order? - Correct answer Levaquin (narrow the spectrum)" "UTI patient is allergic to PCN, you order? - Correct answer Bactrim" "UTI during pregnancy, you order? - Correct answer Amoxicillin, macrobid, keflex for 7 days" "Most common UTI etiology in women/men? - Correct answer Ecoli in women/ proteus in men" "Difference between upper and lower UTI? - Correct answer flank pain" "First test to order with a male presenting with BPH? - Correct answer UA" "Treatment of BPH - Correct answer 5 alpha reuctase inhibitors: finasteride (proscar) and dutaseride (avodart)" "At what age is the PSA screening indicated in non-African american male with no family hx? - Correct answer 50" "ATN causes? - Correct answer Ischemia (prerenal/perfusion related), sepsis, and nephrotoxins (IV contrast)" "Wht is the leading cause of intrinsic acute renal failure? - Correct answer Nephrotoxic drugs" 42