hesi primary 2 Flashcards

Question

preferred first-line therapy for children with impetigo

Answer 1

Mupirocin is the preferred first-line therapy for children with impetigo.

Answer 2

anticoagulants, tricyclic antidepressants, antacids and calcium, iron, multivitamins, proton pump inhibitors, estrogens, statins, metformin. Certain foods interfere with absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid taking them together and should space these foods and drugs several hours apart. Levothyroxine is a synthetic form of T4.

Answer 3

The current treatment for hypothyroidism is levothyroxine T4. Replacement therapy with levothyroxine T3 alone is not recommended. Much of the conversion of T3 comes from T4. T3 has a very short life span in the body, which would require a patient to take the medication several times a day and may result in imbalanced levels resulting in unpleasant symptoms. Too high of a level can result in injury to the heart and bones. Combined levothyroxine T3 and T4 can be prescribed, but this does not offer any advantage over prescribing T4 alone.

Answer 4

Diphenhydramine (Benadryl) is an antihistamine that causes sedation and is used as a hypnotic. Older patients have increased sensitivity to the drug’s effects. Diphenhydramine use places the patient at risk for confusion, urinary retention and incontinence, and sedation.

Answer 5

Serum potassium should be monitored upon initiation of an ACE inhibitor or angiotensin-receptor blocker (ARB) in a patient with kidney disease. Potassium may rise initially and begin to taper off 2 to 3 months later, so continued monitoring of serum potassium is recommended.

Answer 6

The diagnosis of the bacteria can be made with a gram-stain culture; however, a broad-spectrum antibiotic that targets Pasteurella, as well as other gram-positive and gram-negative bacteria, is preferred for prophylaxis. Amoxicillin–clavulanate is a recommended antibiotic for prophylactic treatment.

Answer 7

The outbreak that occurs with shingles lasts about 3 to 5 weeks. A patient prescribed gabapentin 3 months after an outbreak of shingles is being treated for postherpetic neuralgia. Therefore, the nurse practitioner will inquire about pain, which is generally confined to the area in which dermatomal involvement occurred. Symptoms associated with postherpetic neuralgia include a sensation of burning, throbbing, sharp pain, and aching at the site of the outbreak.

Answer 8

symptoms of liver damage, including fatigue, anorexia, jaundice, and dark-colored urine. The statin should be discontinued, and a liver function profile is indicated. This patient is taking high-dose atorvastatin (60 mg) plus a high-dose B-complex vitamin (which contains niacin or vitamin B3). The combination of a statin with niacin raises the risk of drug-induced hepatitis and rhabdomyolysis.

Answer 9

The first-line antibiotic treatment for an infant with pertussis are macrolides (azithromycin, erythromycin, or clarithromycin).

Answer 10

Penicillins are indicated for strep throat and otitis media.

Answer 11

Cephalosporins are appropriate for gram-positive cocci bacteria.

Answer 12

Quinolones are effective against gram-negative and atypical bacteria.

Answer 13

The chronic effect of using finasteride to treat prostate cancer is the stabilization or gradual decline of the patient’s PSA. An acute effect of the finasteride on PSA is a reduction, rather than an increase, of approximately 50%. Any increase in PSA is a concern, even if the value is within a normal range.

Answer 14

The use of aspirin affects platelet function by irreversibly inactivating platelet COX-1 enzyme, ultimately affecting platelet aggregation due to lowered levels of thromboxane A2. While the ½ life of aspirin is only 15 to 20 minutes, the antiplatelet effect lasts the entire lifespan of the platelet, which is approximately 10 days. Although it may take 10 days for the total platelet population to be renewed, platelets are renewed at a rate of 10% per day, and partial platelet function can be seen when about 1/3 of the platelets have COX function (~33% or almost 4 days).

Answer 15

It is important to monitor serum concentration when administering theophylline (Theo-Dur). Theophylline can cause adverse effects due to the plasma concentration, especially when it exceeds 20 mg/L.

Answer 16

Liver function testing is appropriate for medications that affect the liver such as antibiotics, antipsychotics, and statins.

Answer 17

Complete metabolic panel lab testing is instrumental in diagnosing disorders such as diabetes, hypertension, and coronary artery disease.

Answer 18

Acyclovir (Zovirax) 400 mg PO TID x 7 to 10 days is the recommended treatment for the first episode of primary genital herpes.

Answer 19

Benzathine penicillin G 2.4 mU IM in a single dose.

Answer 20

Podofilox (Condylox) 0.5% gel or cream BID x 3 consecutive days i

Answer 21

may appear on the vagina, external genitals, urethra, anus, penis, nasal mucosa, oropharynx, or conjunctivae.

Answer 22

acquired neutropenia. Hydrochlorothiazide can cause bone marrow suppression, leading to neutropenia. Nifedipine (and other calcium channel blockers) suppress cytokine-induced activation of neutrophils.

Answer 23

a descriptive term for macrocytes that are larger than normal. It can occur in the presence of anemia, alcoholism, and sickle cell disease.

Answer 24

acquired or inherited genetic mutations. It causes abnormally high levels of red blood cell precursors.

Answer 25

Excess platelets in the blood cause thrombocythemia.

Answer 26

Secondary thrombocythemia can be caused by infection, inflammatory states, hemorrhage, trauma, or splenectomy.

Answer 27

The infant’s blood–brain barrier is not fully developed for several months; therefore, the infant has an increased risk of central nervous system toxicity and sensitivity to pharmacologic agents that act on the brain. Renal excretion is decreased in an infant. Gastric emptying time in infants is prolonged and irregular. Therefore, enhanced absorption of a pharmacologic agent may occur as a result of delayed gastric emptying. Because of the low level of serum albumin, protein-binding drugs are less able to bind in infants, and endogenous compounds that compete with drugs for binding sites result in a higher concentration of free drug level

Answer 28

Sensorineural hearing loss involves difficulty converting mechanical vibrations to electrical potential in the cochlea or in auditory nerve transmission to the brain. It is mostly caused by permanent damage in the organ of Corti. It can be caused by age-related hearing loss, noise trauma, medications, autoimmune diseases, mechanical trauma, Meniere disease, infection, and neoplasm (acoustic neuroma).

Answer 29

Approximately one-third of older adults between the ages of 61 and 70 years have hearing loss. More than 90% of adults older than 85 years of age have hearing loss. The most common type of hearing loss is age-related and sensorineural. All adults older than 60 years of age should be screened for hearing loss at periodic health examinations.

Answer 30

Conductive hearing is the transition of sound from the external and middle ear to the inner ear. Conductive hearing loss is caused by problems in the external and middle ear that interfere with the transmission of sound and its conversion to mechanical vibration. Causes of conductive hearing loss include obstruction of the external auditory canal by cerumen, foreign bodies, debris from otitis externa, and large exocytosis and osteomas.

Answer 31

key to remember, conductive hearing loss is what you can see on physical assessment and sensorineural is what you can't see.

Answer 32

Menses return in 30 days for most women after stopping oral contraception. Although it is safe to conceive immediately after taking oral contraceptives for any length of time, it may take the patient up to a year to return to fertility.

Answer 33

Community-acquired pneumonia (CAP) is pneumonia not acquired in a hospital or long-term care facility. Patients with suspected CAP should receive a chest X-ray for diagnosis. The Pneumonia Severity Index should be used to assist in decisions regarding the need for hospitalization in patients with CAP.

Answer 34

the initial treatment of CAP for most patients is amoxicillin or doxycycline.

Answer 35

Respiratory fluoroquinolones and amoxicillin/clavulanate should be used in patients who fail first-line medications, have significant comorbidities, have had recent antibiotic therapy, are allergic to alternative agents, or have a documented infection with highly drug-resistant pneumococci.

Answer 36

This is correct because in the treatment of CAP the choices are Macrolides, Amoxicillin and Doxycycline or in the presence of complications use Levaquin (acronym M-A-D-Lung). The Amoxicillin was the only viable choice provided in the list of selections.

Answer 37

Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing skin. It is a chronic, disabling disorder that progresses, often causing keloids, contractures, and possible immobility. It is characterized by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent discharge, and progressive scarring.

Answer 38

First-line treatment is a 12‑week course of doxycycline (Vibramycin).

Answer 39

Thyroid storm is an extreme form of severe thyrotoxicosis that is life-threatening and should be managed in the hospital setting. Its symptoms include marked agitation or delirium, a high fever, severe tachycardia, vomiting, diarrhea, and dehydration. Cardiac arrhythmias, heart failure, and myocardial infarctions are possible complications.

Answer 40

After the crisis is stabilized, it is necessary to follow the patient closely in the clinical setting. Strict attention must be paid to TSH and T4 levels, adherence to medication, and appropriately prescribed dosages of medication. The patient should have frequent follow-ups and laboratory studies, because hypercalcemia, osteoporosis, and nephrocalcinosis may occur in hyperthyroidism. They will likely be comanaged with an endocrinologist.

Answer 41

Male patients should be questioned regarding sexual function, because decreased libido, erectile dysfunction, diminished sperm motility, and gynecomastia may occur.

Answer 42

The patient's history of sun exposure after exposure to limes points to a diagnosis of phytophotodermatitis. Phytophotodermatitis is an inflammatory skin eruption caused by a combination of contact with ultraviolet rays and light-sensitizing botanical substances. Examples of these botanicals include parsley, celery, carrots, Queen Anne's lace, and lime. When exposure to these plants is associated with exposure to ultraviolet rays, skin eruptions may occur. The skin eruption occurs approximately 24 hours after exposure and the eruption may be more severe when the skin is wet, sweating, and with heat at the time of exposure. With this condition, the skin may blister with burning erythema which progresses to peeling and, in some cases, permanent hyper- or hypopigmentation.

Answer 43

Skin eruptions commonly occur in areas of the body exposed to plants and sunlight, such as the arms and legs. This condition is self-limited with the removal of the offending agent. Some drug agents may be used to relieve the discomfort and lessen the inflammatory response. These include topical corticosteroids and nonsteroidal anti-inflammatory drugs. The patient should be reassured that the condition is self-limited and should be instructed to use sunscreens which may prevent further phototoxic reactions.

Answer 44

Alcohol use during pregnancy increases the risk of Fetal Alcohol Syndrome, which can cause intellectual disabilities and physical abnormalities.

Answer 45

Endometriosis may increase the risk of miscarriage, preterm birth, and placental abnormalities. It is not known to increase the risk of aneuploidy.

Answer 46

Being of Ashkenazi Jewish descent increases the risk of certain inherited genetic disorders such as Tay-Sachs and Cystic Fibrosis. Carrier screening is recommended for this population. It is not known to increase the risk of aneuploidy.

Answer 47

Aneuploidy occurs when there is an extra or missing chromosome. Most commonly, this is seen as an extra chromosome, referred to as trisomy. Down syndrome is the most common type of trisomy. It occurs when there is extra genetic material that affects chromosome 21. Down syndrome can cause a spectrum of intellectual disabilities and physical abnormalities. The biggest risk factor for Down syndrome is advanced maternal age. At 25 years old the risk of having a child with Down syndrome is 1 in 1200; at 35 years old the risk increases to 1 in 350. When a woman reaches 45 years old, the risk increases substantially to 1 in 30.

Answer 48

Age-related macular degeneration (AMD) is the most prevalent cause of blindness in adults. It is a degenerative disease that affects the macula and results in central field vision loss. It may be present in one or both eyes and is classified as dry (atrophic) or wet (exudative) AMD.

Answer 49

a diagnostic tool that aids in the detection of visual disturbances caused by changes in the retina, such as macular degeneration.

Answer 50

Starting in 2021, antibiotics are no longer the cornerstone of outpatient therapy for acute uncomplicated diverticulitis; outpatient management includes pain control and a liquid or modified diet for 2-3 days until symptoms improve then advance diet as tolerated.

Answer 51

Antibiotics are still indicated for patients with complicated diverticulitis being managed in the inpatient setting. The selection of antibiotics in low-risk regions for community-acquired infections should generally provide coverage for streptococci, Enterobacteriaceae, and Escherichia coli

Answer 52

Phytoestrogens are plant-based compounds that have a similar effect to estrogen in the body. Many types of phytoestrogens are found naturally in food. Examples of foods containing phytoestrogens include soy and soy products, soybeans and other types of beans, certain seeds (flaxseed, sesame seeds), some fruits, and whole grains. Because of how phytoestrogens imitate natural estrogen in the body, some theories suggest that it may decrease certain types of estrogen-dependent cancers, like breast cancer, as well as help reduce symptoms of hot flashes during menopause when estrogen levels are low.

Answer 53

includes relaxation of the bronchioles, prevention of bronchoconstriction, decreased inflammation, and enhanced gas exchange. The stimulation of beta receptors in the lungs causes relaxation, therefore, beta-agonists are used. Examples of these include short-acting albuterol and long-acting salmeterol. Stimulation of muscarinic receptors in the lungs causes bronchoconstriction. Muscarinic antagonists, such as ipratropium which is short-acting, and tiotropium which is long-acting are used to decrease this bronchoconstriction. Inflammation of the lung tissue is another component of COPD. Inhaled corticosteroids such as fluticasone and budesonide are used to decrease the inflammatory process. These medications all improve symptoms of COPD, however, have not been shown to improve survival rates.

Answer 54

When the SaO2 is < 89%, low O2 supplementation should be initiated. Of all the treatments available for COPD, only oxygen supplementation and stopping smoking has been shown to improve survival rates. When stopping cigarette smoking, although the lung function will never return to normal, the FEV1 decline stops, thereby improving survival rates.

Answer 55

Beta-blockers reduce circulating catecholamines and prevent some of the damage caused by long-term exposure to these neurotransmitters. These effects can include cardiac remodeling, myocyte hypertrophy, increased heart rate, and increased demand for energy by the myocardium. Treatment with beta-blockers can help prevent these problems and reduce the morbidity and mortality of HFrEF.

Answer 56

Shoulder impingement syndrome is a condition that causes pain and impaired mobility in the shoulder. Shoulder impingement is not an injury to a specific glenohumeral structure, but rather a spectrum of clinical findings. Impingement happens when a glenohumeral structure is compressed between the underside of the acromion, acromioclavicular joint, or coracoacromial arch, and the humeral head. The compressed structure may be part of the rotator cuff, subacromial bursa, or other soft tissues of the joint.

Answer 57

The Neer test (passive painful arc maneuver) is used to gauge the severity of the impingement based on the angle at which the arc elicits pain. The maneuver is conducted by the provider passively flexing the glenohumeral joint while preventing the shoulder from shrugging. Shoulder shrugging by the patient is guarding, which the provider should aim to prevent.

Answer 58

Bone mineral density testing is an important screening step, especially for older adult females. Identifying reduced bone density early can prevent complications such as fractures and slow progression to osteoporosis. One of the most common imaging options for bone density screening is the dual-energy x-ray absorptiometry (DEXA) scan. This imaging can provide the patient with a T-score to identify their level of bone density. A normal result is between +1 and -1, -1 to -2.5 is osteopenia, and -2.5 is osteoporosis.

Answer 59

Lifestyle interventions are typically the first step in the management of osteopenia and osteoporosis, including dietary supplements, a healthy diet, exercise, and smoking cessation. Repeating DEXA scanning at appropriate intervals can identify further loss of bone density and the need for additional treatment such as medication implementation. If normal Q 3-5 years

Answer 60

The diaphragm is a nonhormonal contraception method that provides barrier protection. It is not as commonly used because of the development of newer contraceptive methods but is still available.

Answer 61

Good candidates for diaphragm use are those who cannot take hormonal contraception, such as older women, smokers, and those with other comorbid conditions. Diaphragms are usually not ideal for an adolescent because of reduced compliance rates and spontaneity reduction. The ideal candidate is an older woman who is willing to comply with the correct usage and who exhibits skill in proper placement. Education is important before diaphragm use because a diaphragm’s effective insertion and removal require some skill.

Answer 62

The diaphragm should be refitted if one experiences a weight gain or loss of greater than 10 pounds. Proper fit is important for effective usage. Diaphragms should be inserted within an hour of sexual intercourse with spermicide, which may cause pH changes and increase urinary tract infection frequency and vaginal irritation.

Answer 63

estrogen and progestin.

Answer 64

GI discomfort is a common side effect, especially when starting the medication or after a dose change. Metformin may disturb vitamin B12 absorption in the GI tract. Patients with vitamin B12 deficiency often present with peripheral neuropathy, and a serum level should be drawn. The addition of a multivitamin and routine serum B12 monitoring is indicated for many patients taking metformin daily.

Answer 65

lactic acidosis. This condition is rare but has a high risk of fatality. Signs of lactic acidosis may include nausea, vomiting, changes in mental status, and hypotension.

Answer 66

long term use of metformin has been associated with vitamin B12 deficiency and anemia.

Answer 67

Hepatitis A virus is an infection transmitted primarily through the fecal-oral route. It is often self-limiting and does not progress to a chronic infection. This infection is vaccine-preventable.

Answer 68

IgM= IMMediate “M’s” IgG= Gone “G’s” IgG = Gone IgM = Miserable

Answer 69

During an acute HAV infection, IgM is elevated in the serum and detectable at the time of symptom onset. This antibody can be detected several months after recovery. IgM elevation without symptoms may be caused by an infection in the past, asymptomatic infection, or incorrect result. During the convalescent phase, IgG may be elevated and can persist in the serum for many years after infection. If the patient has IgG but not IgM, it may indicate past infection or immunity via vaccination. IgM is elevated in the serum and detectable at the time of symptom onset. This antibody can be detected several months after recovery. IgM elevation without symptoms may be caused by an infection in the past, asymptomatic infection, or incorrect result. During the convalescent phase, IgG may be elevated and can persist in the serum for many years after infection. If the patient has IgG but not IgM, it may indicate past infection or immunity via vaccination.