Leik bank Flashcards
The NP is managing a stable middle-aged adult with emphysema. In addition to reinforcing smoking cessation and med schedules, which annual intervention will the NP recommend?
Quadrivalent inactivated influenza vaccine (QIV)
An older adult with chronic respiratory disease should receive this
Who can receive the Live Attenuated Influenza vaccine?
2 years - 49 years
administered via nasal spray
PPSV23 is recommended for people that are….
65+
aged 19 to 64 who smoke
PCV13 is recommended for
children <2 years
What is the Murphy’s sign?
deeply press RUQ during inspiration. Mid inspiratory arrest = cholecystitis
What is rovsing’s sign
Deep palpation of the LLQ of the abdomen.
What is the Markle test
patient raises their heels and drops them suddenly
What is the psoas test?
When patient experiences abdominal pain while flexing the hip and knee
what causes PSA testing to be falsely elevated?
urinary retention
UTI
DRE
Ejaculation within 48 hours
A young adult with myasthenia gravis is diagnosed with pertussis. Which antibiotic is contraindicated in a patient with this condition?
Why?
What would you give instead?
Erythromycin
Telithromycin
Potential for respiratory collapse.
Give Azithromycin
or Clarithromycin
The NP who is evaluating a patient with polycystic kidney disease wil pay close attention to which area of the kidney?
A 29-year-old female patient presents to the clinic with complaints of painful sexual intercourse and pain when urinating. The patient’s temperature is 100.1F. Upon physical examination, the nurse practitioner notes a healthy appearance of the internal and external genitalia. The patient has lower abdominal and cervical motion tenderness in response to palpation. What will the NP order to confirm the diagnosis and determine the appropriate treatment?
Cervical culture
Patient findings associated with endometritis. blood cultures only when signs of sepsis. US if post partum for retained products
The NP is reviewing the chart of an 8 month old infant scheduled to receive immunizations. Which vaccine woudl the NP question if noted in teh infant’s chart?
MMR?
Hep B?
Hib?
Rotavirus
MMR because it is not given until 12 months of age
What is the first line treatment for osteoporosis?
Bisphosphonates
EX: alendronate, risedronate, “-ronate”
What are the 1st and 2nd line treatment for acne?
1st: OTC topical antibiotic gels and medicated soap
2nd Tetracycline
What hemopoietic disorder will the NP assess for in a 3 y/o with lead poisoning?
iron deficiency anemia
irone defiency has been shown to increase in lead retention
What is pernicious anemia?
inability to absorb vitamin B12
What is the cause of normocytic anemia? who does it normally effect?
long-term chronic disease
Elderly
A male patient presents with urethritis, migratory arthritis in the large joints, and ulcers on the glans penis secondary to chlamydial infection. The NP will implement all of the following interventions except?
a. Tx w/ NSAID
b. antibiotics to tx infection
c. treat with alpha-linolenic acid
This is Reiter’s syndrome
immune mediated reaction 2ndary to chlamydia infection.
EXCEPT!!! alpha-linolenic acid (treats ankylosing spondylosis)
What are the ACS guidelines for screening for colon cancer?
Annual colonoscopy and/or fecal occult blood testing starting at 50 years old
hat is Bowen’s disease?
SCC of epidermis that has not invaded the dermis.
well defined, primary lesions <20 mm over trunk and extremities
Tx: Curettage and electrodessication
What is the mnemonic for high risk hearing loss ?
HEARS
Hyperbilirubinemia
ear infection frequency
low Apgar scores
Exposure to rubella
CMV
Seizures
For women that are not high risk, what should we start mammograms for breast cancer screening? How often should we repeat?
Start at age 50
Repeat every 2 years
What is the screening for congenital heart defects for a newborn?
O2 saturation measure greater than/equal to 95% and no more than a 3% difference between the hand and feet
What are common signs of pregnancy induced hypertension?
edema of face and upper extremities
Weight gain
Blurred vision
Elevated BP
proteinuria
Headaches
What would you prescribe for urinary incontinence for a women?
Oxybutynin (Ditropan)
What drug class is Chlorthalidone (Hygroton)?
thiazide
What diuretics are contraindicated in patients who are allergic to sulfa poducts?
thiazides
Loop diuretics
what does a 24 hr urine collection measure?
creatinine clearance to assess for proteinuria, albuminuria, and GFR
What are hematologic findings with beta thalassemia?
decreased hemoglobin a
hypochromic RBCs
MCV decreased
MCHC decreased
What would you prescribe to treat HTN and BPH
Terazosin (Hytrin)
What type of tear would produce a positive McMurray?
meniscus
What can cause a false positive ovulation test?
PCOS
menopause
endometriosis
ovarian insufficiency
What do you prescribe to treat an 18 months old with a symptomatic UTI?
Augmentin and Bactrim
At 12 weeks gestation, the fundus of the uterus should be located approximately at ____
symphysis pubis
a patient with Grave’s disease for 2 years is found to have afib….what do you prescribe?
Warfarin (Coumadin)
People with hyperthyroid are at higher risk of osteoporosis and afib.
What would an EKG show for someone that took too much TCA (Elavil (Amitriptyline)
Sinus tachycardia
What is the recommended care for a women with preeclampsia?
bedrest with bathroom privileges
weight & BP monitoring
Urine protein & serum protein, creatinine
Platelet counts
MEDS ARE NOT FIRST LINE
What is HBsAg a marker of?
positive = acute or chronic Hep B infection
What is anti-HBs a marker of?
marker of immunity
what is anti-HBc a marker of?
antibody to hep B core antigen
acute, chronic, or resolved Hep B infection
What are contraindications to Timolol (Betimol) opthalmic drops?
Bronchial asthma
Asthma
severe COPD
uncompensated HF
heart block
sinus bradycardia
shock
A patient presents with epigastric pain and intermittent diarrhea that worsens with food. She has a history of multiple ulcers. The NP reviews the results of the serum fasting gastrin level and finds there is no inhibition of gastrin levels. Whats your diagnosis?
Zollinger-Ellison
Neuroendocrine tumor that causes gastrin hypersecretion and peptic ulcer formation
What are the signs and symptoms of tennis elbow?
Lateral epicondylitis
-lateral tenderness at insertion site
-pain is worse with grasping or twisting movements
What symptoms are associated with golfers elbow?
medial epicondylitis
-pulling pain
What is the MOA of probenecid (Probalan)?
Increases uric acid excretion
exreted through kidneys
An adult visits the UC with a fever of 104.2F, vomiting, and petechiae on hands and feet progressing to the trunk over the past 3 days.
Dx?
Tx?
Rocky Mountain spotted fever
Tx: doxy
In the US the most common cause of cancer deaths in men is?
lung cancer
A patient presents with c/o acute epigastric pain that is relieved by taking OTC antacids. The NP discovers the patient takes NSAID TID for joint pain. All of the following diagnostic tests should be ordered to verify the suspected diagnosis, except:
a. fecal occult
b CBC
c. HbA1c
d. urea breath test
A1c
Define Inevitable abortion
vaginal bleeding with pain
cervical dilation AND/OR
cervical effacement
Define threatened abortion
vaginal bleeding with absent or minimal pain
closed, long, and thick cervix
Define incomplete abortion
moderate to diffuse vaginal bleeding, with the passage of tissue and painful uterine cramping/contractions
What should patients taking HCTZ and nifedipine be monitored for?
Acquired neutropenia
In an adolescent with scoliosis, what degree of spinal curvature requires a referral for surgical correction?
When is bracing necessary?
> 40 degrees
20 to 40 degrees
What are symptoms of Vit B12 deficiency
-Paresthesia
-Hyperreflexia
-Balance disorders (Romberg)
First-line therapy for an elderly patient diagnosed with isolated systolic htn?
HCTZ
What age should healthy full-term infants be screened for anemia?
9 to 12 months
(at birth hemoglobin is elevated from maternal RBCs mixed with fetal RBCs)
Signs of a syphilis infection
dx
wartlike lesions
rash on palms and soles of feet
dx RPR or VDRL »_space; if reactive order confirmatory test
What are the triad of symptoms for preeclampsia?
hypertension
edema (weight gain)
proteinuria
What is the first line treatment for an unvaccinated infant diagnosed with pertussis?
Macrolides
-azithromycin
-erythromycin
-clarithromycin
what should you test for before treating hep c?
hepB
it can reactivate during treatment and cause serious liver problems
How do you calculate ABI
right/left ankle/ highest sbp of both arms
What is the most common cause of dementia in the elderly
alzheimer’s
What is CN5
how is it tested?
trigeminal nerve
chewing and clenching teeth
elderly adult c/o centra vision blurred and cannot see when driving…dx?
macular degeneration
What tanner stage do the areola, nipple, and breast tissue develop and become elevated as one mound?
Tanner III
What tanner stage do the areola and nipple separate to form a distinct secondary mound?
Tanner IV
The NP sees an adult patient who reports frequent headaches over the past few months. The patient has tried acetaminophen and ibuprofen without relief. The patient has a history of MI, bradycardia, and kidney stones. What meds are most appropriate? why are the others not?
a. topiramate (topamax)
b. sumatriptan (imitrex)
c. imipramine (elavil)
d. atenolol (tenormin)
Imipramine (Elevil) is most appropriate
Topiramate contraindicated d/t kidney stones
Atenolol contraindicated d/t bradycardia
sumatriptan contraindicated d/t MI
What is a positive Kernig sign?
Resistance to leg straightening from back pain
this causes painful hamstrings from lumbar nerve root inflammation
Is it ulcerative colitis or CD that has mucosal inflammation throughout the colon?
UC
is it CD or UC that has skip lesions
CD
What meds help with IBS with diarrhea?
Amtriptyaline (Elavil) anticholinergic effects
Dicyclomine (Bentyl) anticholinergic
Alosetron
What is recommended to treat COPD
category A
B
C
A: SABA
B: LABA
C: LAMA
Pioglitazone is contra indicated in what disease?
This is a diabetic medication that causes water retention
- CHF
-Bladder Cancer
Who should not take Biguanides
Renal disease
alcoholism
hypoxia
How do you treat a cluster headache?
100% oxygen at 12L via mask
Intranasal 4% lidocaine
How do you treat trigeminal neuralgia?
Phenytoin (Dilantin)
What is first line med for tinea unguium?
Oral terbinafine (Lamisil)
(fungal infection of big toe nail)
What is first line med for tinea unguium?
Oral terbinafine (Lamisil)
(fungal infection of big toe nail)
