Leik Review 2 Flashcards
When starting an elderly patient on a new prescription of levothyroxine (Synthroid), the nurse practitioner should keep in mind that the rationale for beginning with a lower dose in such patients relates to the drug’s:
Cardiac effects - palpitations, tachycardia, anxiety, irritability, elevated BP, flushing, and insomnia
What is the total burn surface area percent of the left arm and hand?
9%
What is the total burn surface area percent of the anterior thorax?
18%
What is a partial thickness burn? Superficial? Full-thickness?
partial
superficial
full:
A 13-year-old girl has a throat culture that is positive for strep throat. She reports that her younger brother was recently diagnosed with strep throat and treated. The patient has a severe allergy to penicillin and reports that erythromycin makes her very nauseated. What antibiotic is the best choice?
Macrolide - Azithromycin, patient will have a 10% cross-reactivity to cephalosporins (first generation). Nausea is a common reaction to Erythromycin. Azithromycin has fewer drug interactions
What treatments do NOT require parental consent?
STDs
pregnancy testing
contraception counseling and treatment
An ophthalmoscope assesses for:
cataracts
Damage to the cochlea, vestibule, and/or auditory nerve pathways causes what type of hearing loss?
sensorineural
Condylomata lata is associated with?
spyhillis - painless chancre, maculopapular rash of palms and soles, lymphadenopathy, and condylomata lata
Condylomata acuminata is associated with?
human papillomavirus - genital warts
Causes of pulsus paradoxus is associated with?
status asthmaticus, tamponade, pericarditis, and cardiac effusion
systolic pressure drops with inspiration because of increased pressure/positive pressure
A patient newly diagnosed with diabetes reports severe hives and swollen lips after taking Bactrim for a bladder infection 2 months ago. What is true about taking medications in the sulfonylurea class for this patient?
They can take ANY of the pills in the sulfonylurea class - no cross reactivity between antimicrobials and nonantimicrobials (furosemide, thiazide, sulfonylurea hypoglycemics, protease inhibitors, carbonic anhydrase inhibitors)
lab values of normal ferritin level, high serum iron, elevated TIBC, normal red blood cell color, and abnormal electrophoresis. What should be suspected?
thalassemia
can be normocytic/normochromic or microcytic/hypochromic (minor vs major)
lab values of low ferritin levels, decrease serum iron, elevated TIBC, decreased MCH concentration, and normal hemoglobin electrophroesis. What should be suspected?
IDA
Sickle cell anemia includes what?
abnormal hemoglobin electrophoresis findings
diagnostic testing does not include ferritin, iron, TIBC, or MCH concentration of this anemia.
A 28-year-old male is evaluated by the nurse practitioner for frequent episodes of psychotic delusions and paranoia. He has taken risperidone (Risperdal) in the past but states that the drug was not effective. Which medication will the nurse practitioner prescribe?
Clozapine (Versacloz) - decreases psychotic symptoms and episodes in patients with resistance to first line antipsychotics
Sudden onset of unilateral scrotal pain, nausea, vomiting, and abdominal pain. What do you suspect? What sign should be assessed?
testicular torsion
cremasteric reflex (negative = bad)
A sexually active man with fever, chills, nausea, and unilateral pain. What should be suspected?
acute epididymitis
A recent mumps infection (parotitis) is associated with what?
acute orchitis with testicular edema
The anti-hepatitis C virus (HCV) test of a 60-year-old female patient is positive. What test is appropriate for follow-up?
HCV RNA - anti-HCV detects the presence of antibodies to hepatitis C virus = exposure. RNA is qualitative and can distinguish current and past infection
An infant will regain its weight by ______.
Double weight by ______.
Triple weight by _______.
regain by 2 weeks
double by 6 months
triple by 12 months
A 55-year-old male presents with a swollen, painful right testicle and burning on urination. Examination reveals edematous scrotum with tenderness and a positive Prehn’s sign. The patient states he is heterosexual and has been in a monogamous relationship for the past 5 years. He denies practicing anal intercourse. The nucleic acid amplification test (NAAT) is negative. What medication will the nurse practitioner prescribe?
NAAT negative = no chlamydia or gonorrhea
older male = acute epididymitis (E. Coli) is probable with negative STD test results
Levofloxacin/Levaquin is the best treatment
Signs and symptoms of viral keratoconjunctivitis
redness unilateral spreads bilateral
watery and crusted in the morning
cobblestone appearance of lower eyelid
ipsilateral preauricular adenopathy
What are the treatment options for viral keratoconjunctivitis?
Topical ophthalmic vasoconstrictor for redness
Excuse from school - this is transmitted easily (pools, hands, contagious for 10-12 days after onset)
Cold compresses
Artificial tears for itching
No towel sharing, avoid touching eyes
What are risk factors for UTIs?
female pregnancy spermicide use mother with a hx of UTIs new sex partner urinary incontinence cystolcele hyperglycemia/diabetes steroids
CN that helps to shrug shoulders?
CN XI - spinal accessory, trapezius and sternocleidomastiod (turn to each side against resistance) muscle strength
Hypersegmented granulocytes,
MCV >100,
serum cobalamin level decreased <200, and
MCH concentration elevation. What do you suspect? Will RDW be elevated or normal?
Pernicious anemia - megaloblatic RBCs are associated with pernicious anemia
RDW is elevated > 15%
In the majority of children, the first permanent teeth start to erupt at the age of 6 years. What are the first permanent teeth to erupt in this time period?
first molars around 6 years of age
What lab values should be ordered for a person at risk for bone fractures?
bone density test
calcium (normal 8.6-10.2)
estrogen levels
vitamin D (normal 20-40)
The nurse practitioner notes a high-pitched, blowing pansystolic murmur while assessing a 70-year-old male patient. It is grade 2/6 and is best heard at the apical area. What murmur is this?
mitral regurgitation - heard best at the APICAL area. Usually HIGHPITCHED, BLOWING PANSYSTOLIC murmur.
MR is the most common form of valvular heart disease.
A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Describe a threatened abortion.
vaginal bleeding and cramping
cervix is CLOSED.
A patient with intermittent claudication, what should be ordered first?
Ankle and brachial blood pressures before and after exercise
A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) related to 45-pack-year smoking history presents with lower back ache, frequency of urination, and “sometimes pink-tinged” urine. The urine dipstick test is heme positive. The nurse practitioner will order:
urine for cytology - pt has risk factors for urothelial or renal malignancy. Age, tobacco use, and gross hematuria.
Why would a provider order a 24-hour urine for protein?
to detect conditions/disease that cause renal inflammation
What are classical symptoms of Meniere’s disease?
episodic vertigo, tinnitus, sensorineural hearing loss, ear fullness
What viral infection is associated with occasional abnormal forms of lymphocytes during an acute infection?
Epstein-Barr virus - triad of fever, pharyngitis, lympadenopathy 1-4 weeks. Serology - normal to elevated WBCs and lymphocytes. Mostly atypical lymphocytes = + mono spot test
Classical barking cough
Croup - viral, runny nose and cough, no fever
What medications inhibit the CYP450 system?
Erythromycin
Theophylline
Warfarin
Diazepam
A 3-year-old male toddler was seen in the office 8 days ago and prescribed amoxicillin 200 mg PO (suspension) TID × 10 days for strep throat. He presents for a follow-up visit with fatigue, reduced appetite, and dark-colored urine. A urine dipstick test reveals protein, albumin, and blood in the urine. What should be ordered next?
24-hour urine collection for blood, protein, and creatinine clearance
assess overall renal function first before moving to CT or BMP with CBC diff
What medication treats vertigo?
Meclizine
What is the three of four Amsel criteria for diagnosis of Bacterial Vaginosis?
white, thick adherent discharge
pH >4.5
positive whiff test (KOH)
Clue cells on wet mount (epithelial cells with large numbers of bacteria that obscure borders)
A kindergarten teacher is diagnosed with acute streptococcal pharyngitis. On exam, her throat is a bright-red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The urinalysis shows a large amount of white blood cells and is positive for nitrites. The patient has a sulfa allergy and thinks she is also allergic to penicillins. What would be the treatment of choice?
Levofloxacin/Levaquin - treats strep pharyngitis and UTIs.
Which area of the breast is the most common site for female breast cancer?
the tail of Spence - upper outer quadrant of the breast
A patient with a syncopal or near-syncopal episode should be evaluated for?
hypoglycemia, cardiac arrhythmia, orthostatic hypotension, seizure, accidental fall, triggers (stress, prolonged standing, heat exposure)
The span of the normal adult liver is
6 to 15 cm
Detecting disease at an early stage to halt or slow progress is considered what form of health prevention?
Secondary prevention - all screening tests, lab tests, asking questions/screening
A normal laboratory finding in relation to skeletal growth spurts?
alkaline phosphatase
The ELISA and Western blot tests are used to detect what?
HIV antibodies
A red, raised serpiginous-shaped rash is noted by the nurse practitioner on the right foot of a 4-year-old child brought in for a preschool physical by the mother. The child complains of severe itch and keeps scratching the lesion. The mother reports that the child frequently plays in the yard without wearing shoes or sandals. What do you suspect
lava migrans - parasites found in dogs and cats that can be found in contaminated dirt
While examining the genitalia of a male patient, the nurse practitioner observes distended scrotal veins. What should you instruct the patient to do?
Perform the valsalva maneuver - helps to evaluate for possible scrotal abnormalities such as varicocele
Swim therapy (aqua therapy) for a 13-year-old with cerebral palsy is an example of what kind of prevention?
tertiary prevention - any type of rehabilitation (physical, cardia, speech)
carotid stenosis increases the risk of
stroke and coronary artery disease
a bruit indicates narrowing/atherosclerosis, increasing CV disease
What is koilonychia? What is it associated with?
spoon-shaped nails, thin and concave shape of fingernails
associated with IDA
What chronic illness disproportionately affects the Hispanic population?
diabetes mellitus
When a domestic dog is suspected of being infected with the rabies virus, it can either be killed for a brain biopsy or be quarantined. What is the minimum number of days a dog suspected of rabies must be quarantined?
10 days
What heart sound is considered a normal finding when heard in children?
S3 - normal in children, pregnant women, and some athletes
What heart sound is considered a normal finding when heard in older adults?
S4
What lab should be ordered if you have an elevated liver function panel and suspect alcohol abuse?
serum GGT (gamma glutamyl transferase)
What symptoms are indicative of ulcerative colitis?
bloody stools covered in mucus and pus with systemic symptoms (fatigue, low grade fever, weight loss)
A 72-year-old female presents with complaints of a nonproductive cough, fatigue, shortness of breath, and weight gain. An S3 heart gallop is noted. What side of the heart is affected?
Left-sided HF - DOE, fatigue at rest, weak, orthopnea, PND, cough, edema
A 17-year-old boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like a “bag of worms” are noted underneath the scrotal skin. The testicle is not swollen or reddened. What do you suspect?
Varicocele - varicose veins in the scrotum is an abnormal tortuosity and dilation of the veins within the spermatic cord. Most common on the left side, may cause pain. Associated with reduced fertility. Visible when standing.
