NRCME Study Sheet Exam 2023-2024 Solution, Exams of Nursing

Download NRCME Study Sheet Exam 2023-2024 Solution and more Exams Nursing in PDF only on Docsity! NRCME Study Sheet Exam 2023-2024 Solution vision requirements Distant vision 20/40 each eye and 20/40 both eyes, Peripheral vision at least 70 degrees, Ability to recognize and distinguish betwen the colors of traffic signals and devices. If the driver presents a valid vision exemption, how long can he be certified? 1 year The driver with a vision exemption must present what 2 things before receiving the medical examiner's certificate. Valid vision exemption and copy of the specialist eye examination report. When applying for a vision exemption, the driver should include a copy of the Medical Examination Report form and the medical examiner's certification with what marked? The "accompanied by" exemption checkbox and write "vision" to identify the type of exemption. If the driver is qualified by operation of 49 CFR 391.64 due to participation in the vision study program, what must the driver present to qualify for certification? Letter identifying the driver as a participant and copy of the specialist eye examination. How long can a driver who is qualified by operation of 49 CFR 391.64 be certified. 1 year hearing requirements Whisper at not less than 5 feet in 1 ear, or average hearing loss no greater than 40 dB at 500Hz, 1000Hz, 2000 Hz in 1 ear. What is the waiting period for vertigo caused by benign positional vertigo or acute/chronic peripheral vestibulopathy? 3 months Name 4 otic conditions that are automatic disqualification Meniere's, uncontrolled vertigo, labyrinthine fistula, nonfunctioning labyrinth Apnea-hypopnea index of [blank] or more episodes per hour is diagnostic of OSA 30 3 requirements for a passing ETT 1. increased SBP of at least 20 without angina 2. workload capacity >6 METs 3. no significant ST depression Examiners must retain records for how many years? 3 Regulation that describes the physical qualifications of drivers. 49 CFR 391.41 Regulation that describes the responsibilities of the medical examiner. 49 CFR 391.43 Regulation that describes the process for conflict resolution when there is a disagreement between the primary care provider for the driver and the medical examiner for the motor carrier concerning driving qualifications. 49 CFR 391.47 What is the waiting period and maximum certification period for driver on anticoagulants for cardiovascular cause? 1 month stabilized and 1 year with monthly INRs What is the waiting period and maximum certification period for driver on anticoagulants for neurlogical condition? None, driver is disqualified. 5 reasons to disqualify a driver with AAA 1. Symptomatic 2. AAA >5cm 3. AAA 4-5 cm and does not have clearance from a cardiologist 4. AAA increased in size 0.5cm in 6 months 5. Surgical repair was recommended but not done Maximum certification period for driver with AAA that is asymptomatic or <4cm, >4cm and <5cm but has clearance from cardiologist 1 year Maximum certification period for Acute DVT 1 year Maximum certification period for Chronic DVT 2 years Waiting period and maximum certification period for intermittent claudication if driver has no resting pain. 3 months for post-surgical repair and 1 year Waiting period and maximum certification for aneurysms of visceral, peripheral arteries or venous vessels 3 months post-surgical repair and 1 year with clearance from cardiologist Waiting period and maximum certification for peripheral vascular disease 3 months post-surgical repair and 1 year without resting pain Waiting period and maximum certification for pulmonary emboli 3 months with no pulmonary embolism and 1 year if asymptomatic Maximum certification period for superficial phlebitis 2 years Waiting period and maximum certification for thoracic aneurysm <3.5cm 3 months post surgical repair and 1 year True or false: having an ICD is automatic disqualification true Min waiting period for pacemaker implantation for sinus node dysfunction or AV block 1 month Min waiting period for pacemaker implantation for neurocardiogenic syncope or hypersensitive carotid sinus with syncope 3 months In order for a driver to receive maximum certification period of 1 year for pacemaker the driver must: Comply with pacemaker center scheduled function checks and provide documentation of pacemaker function checks at examination. Minimum waiting period for atrial fibrillation 1 month with adequate anticoagulation Minimum waiting period for atrial flutter 1 month post-isthmus ablation Minimum waiting period for AV nodal reentrant tachycardia, AV reentrant tachycardia and Wolff-Parkinson-White syndrome, Atrial tachycardia, Junctional tachycardia 1 month without symptoms Maximum certification period for SVT with adequate rate control, anticoagulation if indicated, and clearance from a cardiologist. 1 year Minimum waiting period for VT caused by coronary heart disease, right ventricular outflow VT, Idiopathic LV VT. 1 month after drug or other therapy Maximum certification for VT if patient is asymptomatic, NSVT with LVEF >40% and has clearance from a cardiologist 1 year Driver is to be disqualified if VT and the following: symptomatic, sustained VT, NSVT with LVEF <40% or diagnosis of hypertrophic cardiomyopathy, long QT interval syndrome or Brugada syndrome Waiting period and maximum certification for Acute MI is Waiting period 2 months post MI and maximum certification is 1 year What is required for initial certification following MI? In-patient post-MI echocardiogram showing LVEF 40% What are the requirements for certifying driver with history of MI? Maximum certification for syncope in driver who has been treated as is now asymptomatic, is at low risk for recurrence and has cardiac clearance. 1 year Follow up evaluation for drivers with syncope Annual evaluation by cardiologist Maximum certification for aortic regurgitation if the driver has mild aortic regurgitation that is asymptomatic or moderate aortic regurgitation that is asymptomatic with normal LV function, normal or mild LV enlargement 1 year Follow up evaluation for drivers with mild or moderate aortic regurgitation Echocardiogram every 2 to 3 years Waiting period and maximum certification for severe aortic regurgitation if the driver is asymptomatic, normal LV function, minimal LV dilation (LVEDD </60mm and LVESD </50mm) 3 months if post-aortic valve repair and 6 months if not surgically repaired or 1 year if repaired What disqualifies a driver with severe aortic regurgitation Symptomatic, unable to achieve workload > 6MET on Bruce protocol, LVEF <50%, LVEDD >70mm or LVES >55mm Follow up evaluation for drivers with severe aortic regurgitation Echocardiogram every 6 to 12 months if LVEDD <60mm or LVESD <50mm or every 4-6 months if LVEDD =60mm or LVESD =50mm Waiting period and maximum certification of aortic stenosis in driver with mild aortic stenosis and is asymptomatic, moderate aortic stenosis that is asymptomatic or severe aortic stenosis that has been surgically repaired 3 months post-surgical repair and 1 year What disqualifies a driver with aortic stenosis If moderate aortic stenosis and angina, heart failure, atrial fibrillation, LV dysfunction with EF<50% or thromboembolism. If severe aortic stenosis regardless of symptoms. Follow up evaluation for drivers with aortic stenosis Echocardiogram every 5 years if mild aortic stenosis and every 1 to 2 years if moderate aortic stenosis Follow up evaluation for drivers following aortic valve repair Two-dimensional echocardiogram with Doppler prior to discharge and follow up based on aortic regurgitation severity Waiting period and maximum certification for mitral regurgitation if driver has mild or moderate mitral regurgitation if asymptomatic, normal LF size and function and normal pulmonary artery pressure; severe mitral regurgitation that is asymptomatic; or surgical mitral valve repair, is asymptomatic and has cardiac clearance 3 months if post-surgical commissurotomy and 1 year Disqualification for mitral regurgitation Symptoms, less than 6 METs on Bruce protocol, ruptured chordae or flail leaflet, atrial fibrillation, LV dysfunction, thromboembolism and pulmonary hypertension Follow up evaluation for drivers with mitral regurgitation Annual echocardiogram if moderate mitral regurgitation. ETT and echocardiogram every 6 to 12 months if severe mitral regurgitation. Waiting periods and maximum certification period for mitral stenosis in driver with mild mitral stenosis that is asymptomatic, moderate stenosis that is asymptomatic, or severe mitral stenosis and cardiac clearance 4 weeks if post-percutaneous balloon mitral valvotomy or 3 months if post-surgical commissurotomy and 1 year Follow up evaluation for drivers with mitral stenosis Annual cardiac clearance with chest x-ray, electrocardiogram and two-dimensional echocardiogram with doppler Waiting period and maximum certification period for mitral valve prolapse 3 months if post-surgical repair 1 year Follow up evaluation for drivers with mitral valve prolapse Echocardiogram annually and cardiac clearance Disqualification of drivers with mitral valve prolapse Symptomatic, ruptured chordae or flail leaflet, systemic emboli, atrial fibrillation, syncope or documented VT or severe mitral regurgitation or LV dysfunction Waiting period and maximum certification for pulmonary valve stenosis if driver has mild or moderate pulmonary valve stenosis or pulmonary valve stenosis corrected by surgical valvotomy or balloon valvuloplasty 1 month if post-balloon valvulopasty or 3 months if post-surgical valvotomy and 1 year Disqualification of drivers with pulmonary valve stenosis syndrome, idiopathic central nervous system hypersomnolence, restless leg syndrome associated with EDS Follow up evaluation for drivers with chronic sleep disorders Continue uninterrupted therapy Undergo yearly objective testing (multiple sleep latency test of maintenance of wakefulness test) Maximum certification for acute infectious diseases 2 years How long should drivers avoid driving after taking sedating medications 12 hours Maximum certification for atypical tuberculosis if driver has normal lung function and tolerates the medical regimen 2 years Maximum certification for pulmonary tuberculosis in driver determined not to be contagious and treatment has been shown to be adequate/effective, safe and stable 2 years Disqualification for pulmonary tuberculosis Advanced TB with respiratory insufficiency not meeting PFT criteria Chronic TB Noncompliance with antitubercular therapy Not completed streptomycin therapy Residual 8th cranial nerve damage that affects balance and/or hearing to an extent that interferes with safe driving Follow up evaluation of drivers with tuberculosis Positive PPD with normal CXR requires no further testing If conversion occurred within the last year, prophylactic therapy should take place Maximum certification of drivers with chest wall deformity (kyphosis, kyphoscoliosis, pectus excavatum, ankylosing spondylitis, massive obesity and recent thoracic/upper abdominal surgery or injury) 2 years Maximum certification for cystic fibrosis 2 years Disqualification of cystic fibrosis Hypoxemia at rest, chronic respiratory failure, history of cough syncope, not met spirometry parameters, unstable condition or treatment regimen Follow up evaluation of cystic fibrosis PFTs if resting dyspnea and annual specialist exam Maximum certification of interstitial lung disease 2 years Waiting period for pneumothorax Following complete recovery using CXR Maximum certification for pneumothorax in driver who is asymptomatic without chest pain or shortness of air, no disqualifying underlying lung disease, confirmed resolution or successful pleurodesis and meets pulmonary parameters 2 years Disqualification for pneumothorax Not met certification parameters History of 2 or more spontaneous pneumothoraces on same side without successful surgical procedure to prevent recurrence Hypoxemia at rest Chronic respiratory failure History of cough syncope Maximum certification for cor pulmonale 2 years Disqualification for cor pulmonale Dyspnea at rest, dizziness or hypotension PaO2 <65mmhg Maximum certification for pulmonary hypertension 1 year Disqualification for pulmonary hypertension Dyspnea at rest, dizziness or hypotension PaO2 <65mmhg Disqualifying neurological diagnoses Epilepsy Severe TBI AV malformation not surgically treated Dementia Parkinson's Iatrogenic parkinsonism Maximum certification for autonomic neuropathy 2 years Disqualification for autonomic neuropathy Cardiovascular autonomic neuropathy that causes resting tachycardia or orthostatic blood pressure Other autonomic neuropathy that interferes with driving Maximum certification for conditions associated with abnormal muscle activity 2 years Disqualification for conditions associated with abnormal muscle activity Myotonia Isaac's syndrome Stiff-man syndrome What are examples of congenital myopathies Central core disease Centronuclear myopathy Congenital muscular dystrophy Rod myopathy What are examples of inflammatory myopathies Dermatomyositis Inclusion body myositis Polymyositis Maximum certification of congenital or inflammatory myopathies None, this is disqualifying Maximum certification of metabolic muscle disease None, this is disqualifying Examples of motor neuron diseases Hereditary spinal muscular atrophy ALS Maximum certification of motor neuron diseases None, this is disqualifying Examples of neuromuscular junction disorders Myasthenia gravis Myasthenic syndrome Maximum certification of motor neuron diseases None, this is disqualifying Maximum certification of peripheral neuropathy None, this is disqualifying Waiting period for CNS tumors 1 year post-surgical removal of infratentorial meningiomas, acoustic neuromas, pituitary adenomas, spinal benign tumors or benign extra-axial tumors 2 years post-surgical removal of benign supratentorial tumors and spinal tumors Maximum certification for CNS tumors in driver who completed waiting period, has stable nonprogressive deficit or no neurological deficit and imaging shows no tumors 1 year Maximum certification for dementia None, this is disqualifying Waiting period for embolic stroke 1 year if not at risk for seizures (cerebellum or brainstem lesions) 5 years if at risk for seizures (cortical or subcortical deficits) Maximum certification for embolic stroke in driver who completed waiting period; nml neuro-opthalmological evaluation and neuropsychological testing; no neuro residuals or does not affect driving; clearance from neurology 1 year Waiting period for intracerebral or subarachnoid hemorrhages 1 year if not at risk for seizures (cerebellum or brainstem lesions) 5 years if at risk for seizures (cortical or subcortical deficits) Maximum certification for intracerebral or subarachnoid hemorrhages in driver who completed waiting period; nml neuro-opthalmological evaluation and neuropsychological testing; no neuro residuals or does not affect driving; clearance from neurology 1 year Waiting period for TIA 1 year Maximum certification for TIA in driver who completed waiting period seizure free and off anticonvulsants; nml neuro-opthalmological evaluation and neuropsychological testing; no neuro residuals or does not affect driving; clearance from neurology 1 year Classification of TBI Severe-penetrates the dura and causes a loss of consciousness lasting >24hrs Moderate-does not penetrate the dura but causes loss of consciousness >30min but Some drivers with diabetes who use insulin may be medically certified if the driver: has or is eligible to apply for a Federal diabetes exemption Has a FMCSA-issued letter that states the driver may be qualified by operation of 49 CFR 391.64(a) Waiting period for diabetic on insulin therapy 1 month if previously treated that did not include the use of insulin 2 months if newly diagnosed and not on prior treatment Maximum certification for diabetes 1 year What is included in the annual diabetes assessment package for patients with Federal diabetes exemption Endocrinologist annual evaluation Opthalmologist or optometrist annual evaluation What is required for the driver with diabetes who is grandfathered Copy of the endocrinologist report addressing the requirements listed in 49 CFR 391.64(a) Maximum certification for hernia 2 years Maximum certification for nephropathy 2 years Follow up evaluation for nephropathy Abnormal urinalysis may indicate need for further evaluation Maximum certification for antidepressant therapy that does not affect the ability to drive (1st generation antidepressant is disqualifying) 1 year Maximum certification for antipsychotic therapy that does not affect the ability to drive 1 year Maximum certification for anxiolytic/sedative therapy in driver that uses short acting hypnotic at the lowest effective dose and is used for <2 weeks or non-sedating anxiolytic 2 years Disqualification for anxiolytic/sedative therapy Use of a sedating anxiolytic Maximum certification for CNS stimulant therapy in driver with Adult ADHD 1 year Evaluation for CNS stimulant therapy Evaluation from the treating provider confirming the diagnosis of Adult ADHD Comprehensive evaluation from appropriate mental health professional Waiting period for ECT 6 months symptom free following a coarse of ECT Maximum certification for ECT in driver who completes waiting period, has comprehensive evaluation from an appopriate mental health professional, is not undergoing maintenace ECT and tolerates treatment without disqualifying side effects 1 year Maximum certification for lithium therapy in driver whi is asymptomtic, lithium levels are maintained in the therapeutic range and ha sno impairment that interferes with safe driving 1 year Disqualifications for ADHD Active psychosis Prominent negative symptoms: compromised judgment, attentional difficulties, suicidal behavior or ideation, personality disorder that is repeatedly manifested by overt, inappropriate acts Waiting period for bipolar disorder or major depression 6 months symptom free following a nonpsychotic major depression unaccompanied by suicidal behavior 1 year symtpom free following a severe depressive episode, suicide attempt or manic episode Maximum certification for bipolar disorder, major depression or personality disorder in driver who completes appropriate waiting period, complies with treatment program, tolerates treatment and has comprehensive evaluation from appropriate mental health professional 1 year Disqualifications for bipolar disorder, major depression or personality disorder Active psychosis Prominent negative symptoms: compromised judgment, attentional difficulties, suicidal < 65 mm Hg less than 5k feet, < 60 mmHg above 5k, or CO2 > 45mm at any altitude Severe Traumatic Brain Injury - Automatic __ DQ Moderate TBI - What happens? Case by case basis, but must be seizure free for 2-5 years post injury Epilepsy - DQ if patient has how many or more unprovoked seizures? To requalify, pt must have 10 years of no ___ and ___ unprovoked seizures. 2 or more. 10 years of no meds and no unprovoked seizures Stage 1 Hypertension is defined as __/__ to ___/___. If a driver has these readings, then he gets a one year certificate and recertify in 1 year. If at the next recertification the BP is still > 140/90, a one-time certification for ___ months is given. If the BP is still over after 3 months, the patient is __ until the BP is brought under 140/90. THEN ___ ___ from the date of the ORIGINAL EXAM. 140/90 to 159/99. 3 months. DQ. One year from the date of the original exam once its brought below 140/90. Stage 2 Hypertension is defined as __/__ to ___/___. The driver gets a one time certification for ___ months. The driver must get the BP < __/__ or he is DQ'ed. 160/100 to 179/109. 3 months. < 140/90 Stage 3 Hypertension is defined as > __/__. How long does the certificate last? > 180/110. Pt is DQ until BP under 140/90 then may be certified for 6 month periods as long as BP remains at or below 140/90. If the patient is taking BP meds and their BP is under 140/90, they get a certificate for how long? 1 year So, to recap, the 3 month med card is granted in 2 cases specific to BP: When a driver has stage 2 HTN, or when a driver with stage 1 hasn't reduced BP to less than 140/90 at recertification time The 6 month expiration and recertification dates apply to (in cases of BP): Driver has stage 3 HTN, has an acceptable BO at the time of the exam, and tolerates treatment with no side effects affecting safe CMV operation. A driver has Cor Pulmonale, RVH, Dyspnea at rest, Dizziness, and Hypotension. Whats the plan for him DQ Unstable Angina (Pain at rest, Poor Response to Medications) DQ What is the scoring system for the heart, based on correctable vs. noncorrectable conditions? Framingham If a driver has stable angina, it must be static with the 4 E's or without meds for 1 year. What are the 4 E's? Emotion, Extremes in weather, Exertion, Ecstasy There are guidelines for drivers who have had an MI. They include a __ month wait, EF of > __ %, A ___ ETT, They are able to tolerate _____, and they must pass the ___ physical. 2 month wait, EF > 40%, Exercise tolerance test normal, Tolerate Medications, and pass the CMV physical A driver with SUSTAINED V TACH and an EF of < 40% will be DQ The definition of non sustained Vtach is > ___ and less than __. > 40 and < 50. I have no idea what this means. What 4 conditions calls for an ETT? MI, Angioplasty, Static Angina, CABG If a patient has an ICD, what is the ruling? DQ, no exceptions If a driver has a pacemaker, when can they return to driving? One month post implant, and then do a one year routine check What is the most common form of heart failure? Idiopathic Dilated Cardiomyopathy There are 6 criteria for a driver to return to work post CABG. 1. Driver can return to work __ months post procedure. 2. The driver must be ______. 3. The driver must have an EF of > __ %. 4. The certification period is __. 5. The driver must be able to tolerate _____. 6. The driver must have a __ year __ due to likliehood of reocclusion. Then a yearly ETT. 3 months post procedure, Asymptomatic, EF of > 40%, certification period is yearly, tolerate medications, 5 year post CABG ETT, then yearly afterwards Afib risks include embolus or stroke. How long can the certificate be for? 1 year if rate controlled via meds If a patient has significant pulmonary htn, what immediately happens? DQ Prescription If a driver has a mood disorder, he can be certified if he has been symptom free for how long? 1 year, if suicide has been attempted. Certify if symptom free for 6 months if no hx of suicide. In either case, certification is for 1 year. If a driver has progressive dementia, what happens to him? Metabolic dementia may be treated how? DQ, case by case If a driver is taking anxiolytics, he can take what kind? Non-sedative only A driver can take hypnotics if: the half life is less than __ hours, it is a __ dose, and if the driver is taking it __ term, meaning less than __ weeks. less than 5 hours, low dose, short term (less than 2 weeks) If a driver is taking 1st gen antidepressants, such as Elavil, what is the policy? DQ If a driver is taking 2nd gen antidepressants, such as Zoloft, Welbutrin, or Prozac, what is the policy? OK If a driver has had ECT, he must wait how long before getting a certification? 6 months, then it is a 1 year certification If a driver has insulin dependent DM, he must be disqualified. UNLESS he has a diabetes waiver If a driver has insulin dependent diabetes, he must have a new exam __ with exemption Annually... The driver must have been on Insulin at least one __ if on previous NIDDM meds, and two __ if first time taking insulin for any DM treatment. Insulin 1 month if previous meds or 2 months if a first timer If a driver has Diabetic Neuropathy/Paresthesis (loss of positional awareness) they are automatically DQ DO NOT CERTIFY IF: a driver has, in the previous __ months, experienced a hypoglycemic reaction that resulted in a seizure, LOC, Needed assistance from another person, or had a period of __ cognitive function that occurred without warning. 12 Do not certify a driver if he has had in the past __ years, 2 or more (recurring) hypoglycemic reactions , loss of __ sensation, loss of sensation in the feet, resting __, orthostatic ___, or a dx of peripheral neuropathy or proliferative retinopathy. 5: position, tachycardia, hypotension, To pass the audiometric test, you must average the __ frequencies for each ear (__ Hz, 1000Hz, and 2000Hz) 3 - 500, 1k, 2k To convert from ISO standards to ANSI, subtract what number from 500 Hz? 14 dB To convert from ISO standards to ANSI, subtract what number from 1000 Hz? 10 dB To convert from ISO standards to ANSI, subtract what number from 2000 Hz? 8.5 To pass the audiometric portion of the hearing test, one ear must show an average hearing loss that is less than or equal to what dB? 40 If this is the first exam at which the driver has a BP Between 140-159/90-100, driver has no HX of HTN, and doesn't take medications, he is certified for how long? 1 Year... If a driver has a 1 yr certification for untreated stage I HTN, and doesn't take meds (ie HTN driver wants recert after 1 year, no meds) certify for how long? 3 months