random practice test questions Flashcards
What medication class is metformin/glucophage?
biguanides
What is the mechanism of action of the biguinides? (metformin)
limits the conversion of glycogen to glucose by the liver and reduces insulin receptors resistance
Risk factors for a person to develop HHS include?
infection
people who are dehydrated (dependent elderly who can’t get their own drinks despite feeling thirsty)
In HHS is the problem an insulin deficit or a fluid deficit?
a fluid volume deficit
Is the main treatment of HHS fluid replacment or insulin?
fluid replacement
Which thyroid hormone is responsible for calcium and phosphate regulation?
Calcitonin
The INITIAL intervention in the symptomatic patient with hyperthyroidism is:
beta blocker
An intubated ventilated PNA patient with Na 130, euvolemia, adequate UOP, and urine sodium 50. What is the cause of the hyponatremia?
SIADH
*SIADH is caused by head trauma AND lung problems, ventilator therapy
For stroke patients who are NOT a candidate for tPA, what is the appropriate BP?
SBP<220 or DBP<110
*permissive HTN if they mount a HTN response
Per ACCN exam, what is the target glucose level in acute stroke?
<145
An acute inflammatory polyneuropathy is a characteristic of
Gullian barre syndrome
Relapsing/remitting MS is characterized by what clinical course?
relapse over 1-2 weeks, lasts 4-8 weeks, returns to baseline
Accurate dilantin levels may be affected by:
low albumin levels
*free dilantin levels measure unbound dilantin
*serum dilantin measued by bound to albumin
The incomplete spinal cord injury syndrome that results in arms motor loss but spares the legs is
central cord syndrome
What clinical finding in SCI is a poor prognostic sign because it is a hallmark of complete spinal cord injury?
priapism
What is the timeframe for Subacute SDH ?
48 hours - 2 weeks
Gnawing epigastric pain that is worse at night and relieved by vomiting, worse one hour after eating. Whats the dx?
duodenal ulcer
What patients are at greatest risk for acalculous cholecystitis?
critical illness and sepsis
*they die because they are too sick for OR
Central vision loss is caused in old people by
macular degeneration
A patient with a history of heart failure arrives at the emergency department exhibiting shortness of breath and lower extremity swelling. Both of the patient’s symptoms are a result of:
a decrease in plasma oncotic pressure.
an increase in capillary hydrostatic pressure.
an increase in capillary membrane permeability.
an obstruction of lymphatic drainage.
an increase in capillary hydrostatic pressure
When discharging an 85-year-old patient who has a diagnosis of stasis dermatitis, an adult-gerontology acute care nurse practitioner includes instructions to:
keep legs elevated while seated.
maintain systolic blood pressure greater than 120 mm Hg.
soak legs in warm water daily.
wear compression stockings of 65 mm Hg below the knee.
keep legs elevated while seated
A 70-year-old patient with acute systolic heart failure 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?
Amlodipine (Norvasc)
Digoxin (Lanoxin)
Furosemide (Lasix)
Lisinopril (Zestril)
ACE-I is 1st line therapy for HF
Lisinopril (Zestril)
A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace) is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is parenteral:
cefoxitin (Mefoxin).
ceftriaxone (Rocephin).
ciprofloxacin (Proquin).
levofloxacin (Levaquin).
ceftriaxone (rocephin)
*cipro and levaquin are fluoroquinolones and can cause QT prolongation
*sotalol (beta blocker) can also cause QT prolongation
. What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?
The Affordable Care Act
The Balanced Budget Act
The Civilian Health and Medical Program of the Uniformed Services
The Omnibus Budget and Reconciliation Act
The nonphysician practitioner (NPP) component of the Balanced Budget Act of 1997
the act also standardized NPP reimbursement at 85% of the physician’s Medicare fee schedule regardless of where that service was provided
a patient is at increased risk for acalculous cholecystitis if they have:
biliary stasis
(NPO, surgery, trauma, critical illness/sepsis because not using GI track)
A patient with malobsorption related weight loss, mucoid diarrhea, vitamin B12 deficiency, and right lower quadrant abd pain might have:
Crohn’s disease
A patient with bloody stools which may lead to iron deficiency anemia (from bleeding), uses a nicotiene patch to limit disease symptoms, has a disease that is limited to the colon, may lead to perianal fissures, increases risk for adenocarcinoma of the bowel:
ulcerative colitis
A rash with an annular shape, scales, erythematous base, raised borders with clearing in the center, found in the groin, fungus, is:
tinea cruris
Bulls eye rash characteristic of Lyme disease is called:
(it can also be seen without lyme disease)
erythema migrans
Which skin condition is often seen with Steven Johnsons syndrome, has a positive Nikolsky’s sign, and taget like lesions?
erythema multiforme MAJOR
*can be caused in response to medications
Stevens-johnsons syndrome AKA erythema multiforme major
A patient has a dark brown lesion that is one cm across and has a stuck on appearance. It is raised, has a warty texture, and well defined boarders. What is it and is it an emergency?
seborrheic keratosis
not an emergency at all, benign lesion
removal is cosmetic
Actinic keratosis is found in sun exposed areas and needs to be treated because it can turn into
squamous cell carcinoma
A common skin finding in a patient with insulin resistance and hyperinsulinemia, an area of darker thickened skin found in folds of obese patients is:
acanthosis nigricans
Who is more at risk for malignant skin lesions?
young or old
smoker or non smoker
HIV or not HIV
pale/fair or dark skin
more at risk for malignant skin lesions
old
smoker
HIV
pale/fair skin
What is the triad of symptoms associated with necrotizing fasciitis?
pain out of proportion to exam
erythema
swelling
*may also have weaping
On the test, the most effective evidence based treatment that has shown to improve outcomes for necrotizing fasciitis is:
surgical debridement
A pearly white or waxy bump, often with visible blood vessels, on your face, ears or neck. The bump may bleed and develop a crust. In darker skinned people, this type of cancer may be brown or black.
*slow growing CA
basal cell carcinoma
What is the diagnostic criteria for SIRS?
temp >38 c or <36 c
HR>90
RR>20 (or paCO2<32 indicating hyperventilating)
WBC <4 or >12 or total bandemia >10% of WBC
*must meet two or more criteria to dx SIRS*
What is the diagnostic criteria for sepsis?
temp >38 c or
HR>90
RR>20 (or paCO2
WBC 12 or total bandemia >10% of WBC
suspected or present source of infection
*SIRS + source of infection*
Septic Shock Criteria
Severe Sepsis with Hypotension, despite adequate fluid resuscitation
What is the diagnostic criteria for SEVERE sepsis?
temp >38 c or
HR>90
RR>20 (or paCO2
WBC 12 or total bandemia >10% of WBC
suspected or present source of infection
sepsis + Organ Dysfunction, Hypotension, or Hypoperfusion*
*SBP<90 or <40 of baseline, lactic acidosis*
What is the most likely causative organism for subacute bacterial endocarditis is:
staphylococcus aureus
If a patient lost 750ml of blood post-op. According to the american college of surgeons, if you are going to replace with crystalloid how much do you give to replace 750ml loss of blood?
2250ml LR/NS because you replace 3:1
When is surgery or vascular procedure indicated for patient with AAA due to increased risk for rupture?
if your aneurysm is causing symptoms, or is larger than about 2 inches (roughly 5.0 to 5.5 centimeters), or is enlarging under observation of serial CT q 6-12 months
Dysfunction of which of the following organs is key to the development of MODS?
kidney
liver
GI tract
endothelium
endothelium
because vascular endothelium connects multiple organs
What is a common reason for organ dysfunction in MODS?
microvascular thrombi
If a patient is hypoperfused (that is the insult) and then has microvascular thrombi which leads to MODS, what is the standard progression of organ dysfunction?
pulmonary failure 4-6 days post insult
hepatic failure 6-10 days post insult
renal failure 10-14 days post insult
Name two reasons to start TPN
the patient will not be able to get any other form of nutrition for greater than 7 days
the patient has mandatory bowel rest (SBO, abd surgery etc)
The hallmark feature of RA
prolonged early morning stiffness that takes > 30 minutes to go away
Gram negative cocci include_____ and can be treated with_______.
gonorrhea
rocephin
You have a patient with a tylenol overdose. How many hours after ingestion of tylenol would you expect to see changes in LFTs?
12-24 hours after ingestion
What is the drug of choice in a patient with amphetamine or cocaine overdose?
benzodiazepine
What medication class is CONTRAINDICATED in amphetamine overdose?
beta blockers
because you will leave the patient with an unopposed alpha response which will increase HTN and increase risk for MI.CVA.CV collapse
To establish malpractice four things must be established:
you must have a duty to the patient
you must have violated a standard of care
that violation has to be the cause of damages
there have to be damages
Normal neutrophil count is what percentage of total WBC?
60%
You have WBC with high neutrophil count. Neutrophils fight what?
Neutrophils fight bacteria
Your patient has an elevated WBC. On the differential the lymphocytes are elevated. What is your differential?
lymphocytes fight virus
CLL
You have a patient with elevated WBC and increase in monocytes. What is the differential?
monocytes like to debride non-infectious junk
so if you have MI with dead tissue monocytes will get it
if you have cancer monocytes will get it
You have a patient with elevated WBC and elevated eosinophils. What is your differential?
hypersensitivity reaction
drug reaction
allergic reaction
Neutrophelia is any neutrophil >70% of total WBC
indicates bacterial infection
The concept of the WBC Left shift is used to describe a differential that represented a
bacterial infection
Bands are immature_____. They are immature. They shouldn’t be out
4% of total WBC are normally bands
if you have bandemia you have excess immature WBC that are getting out to fight infection
