Rationales did not know Flashcards
most common side effect of celexa is
nausea, loss of appetite, sweating and dizziness
Celexe does not cause
weight gain
Piroxicam is a
NSAID not good with muscle disorders
normal cardiac output is usually
4-6 L
Dysthymia is a
chronic form of depression, continuous long term depression - sx for years
max dose of cymbalta for treating depression si
120 day
what drug do you not give with Multiple sclerosis
tysabri
Hep A has incubation period of how long
15-50 days
Myerson’s sign is a
clinical test used in the neurological examination of patients suspected to have Parkinson’s disease
Constructional apraxia is the
inability to reproduce geometric figures and designs
Participants in a research study who do not have the disease or condition that is being studied, but who are included for comparison are:
controls
A 13-year-old female has been diagnosed with scoliosis. You are concerned that the curve may increase. How often would you evaluate the curve as a follow-up for your patient?
4-6 months
The recommended frequency for evaluating the curvature in a child with scoliosis who is at risk of curve progression is every 4 to 6 months. This timeframe allows for close monitoring during the critical growth spurts seen in adolescence. Scoliosis can progress quickly during these periods of rapid growth, and early detection of changes in the curvature is essential for timely intervention.
You are caring for a newborn infant boy who was preterm and has respiratory distress syndrome (RDS). To maximize the infant’s respiratory process, you would advise placing the newborn in which of the following positions?
In a prone position:** The prone position (lying on the stomach) is often recommended for infants with RDS. This position can improve oxygenation by enhancing the distribution of air within the lungs and reducing the compression of lung tissue by the heart and abdominal contents. In prone, the lung regions receive more even ventilation, and it can help in opening up collapsed alveoli (air sacs in the lungs), improving the overall functional residual capacity. Furthermore, the prone position can help in draining secretions, which might be beneficial for certain infants. However, it is crucial to monitor infants closely when in this position to ensure there are no issues with airway obstruction or undue pressure on the face.
RBC in males normal is
37 -49
lexapro ( escitalopram) target dosage is
10-20
Exceeding 20 mg per day is generally not recommended due to the increased risk of side effects without a proportional increase in therapeutic benefits.
The FNP has a patient who was a premature baby. The FNP knows that prematurity increase the risk of the child developing which of the following diseased/conditions?
myopia
nonfluent aphasia is also known as
brocas aphasia
You understand that the complete resolution of symptoms of Osgood-Schlatter disease through physiologic healing takes:
can take 6 - 12 montns
How long would it typically take for a patient who is taking Parcopa (carbidopa-levodopa) orally to help control his symptoms?
1 - 2 months
normal resp rate in newborn is
30-60
In a child with bacterial meningitis, the typical CSF response includes a median WBC count of:
Correct Answer: 1200 cells/mm3 with 90 – 95% neutrophils
In cases of bacterial meningitis, the cerebrospinal fluid (CSF) typically shows a distinct response that aids in the diagnosis of this severe infection. The CSF is the fluid that circulates in the spinal cord and around the brain, providing mechanical protection, as well as nutrient transport and waste removal. When an infection such as bacterial meningitis occurs, the body’s immune response alters the composition of the CSF, which can be detected through a lumbar puncture.
common cause of SJS is
lamotrigine, sulfomanimides allopurinol
salicyclic acid paints is
compound W good for children warts
Impetigo is caused by
staph and group a strep
The most common medications for H. influenzae coverage are
amoxicillin-clavulanate (Augmentin) and Ceftriaxone (Rocephin).
to get the ABI you divide the SBP of
right ankle with highest SBP of right or left arm whch ever is higher
Nexium generic name is
esomperazole PPI
what are the serious side effects of nexium
liver impairment
Your patient is complaining of hair loss. Your assessment finds that there are many hairs with white tips that come out when combing the hair. You understand that this is a condition known as which of the following?
alopecia areata androgenetic alopecia telogen effluvium cicatricial alopecia
Telogen effluvium Telogen effluvium is a form of alopecia that involves diffuse hair shedding. It typically occurs as a response to a significant stressor on the body, which can be physiological or psychological. Common triggers include severe illness, major surgical procedures, significant psychological stress, extreme weight loss, or changes in hormone levels, such as those occurring post-pregnancy or during menopause.
Diagnosis of telogen effluvium typically involves
clinical examination and might include a hair pull test, where gentle traction is applied to a bunch of hairs to see how many come out. Additionally, a detailed history to identify potential triggering events is crucial. Treatment generally focuses on addressing the underlying cause, and in many cases, once the stressor is managed, hair growth returns to normal over time.
our middle-aged female patient has been diagnosed with viral hepatitis. Since you know that adequate fluid intake is important for patients with viral hepatitis, which of the following is the best schedule for adequate fluid intake for this patient?
200 to 500 mL fluid per day 600 to 1,000 mL fluid per day 1,000 to 2,000 mL fluid per day 3,000 to 4,000 mL fluid per day
3,000 to 4,000 mL fluid per day
Fontaine classification for PVD
stage 1 is characterized as being asymptomatic, which means there are no outward symptoms, although there might be some blockages or narrowing in the peripheral arteries detectable through diagnostic testing.
Stage 2 is known as intermittent claudication. This stage is marked by muscle pain, cramping, or fatigue in the legs that occurs during exercise such as walking and typically subsides with rest. The pain is generally reproducible and is due to insufficient blood flow during increased demand.
Stage 3, which is directly relevant to the question, involves rest pain. This stage indicates a more severe progression of PAD. Patients experience pain even while at rest, typically because the blood flow is so reduced that it cannot keep up with the normal metabolic needs of the limb, even in its resting state. The pain often worsens at night when lying flat, as gravity no longer helps blood circulation to the extremities. Patients might find some relief by hanging their legs over the edge of the bed or sleeping in a chair to allow gravity to assist in blood flow.
Finally, Stage 4 includes ulceration or gangrene of the limb. At this stage, the lack of adequate blood flow leads to tissue death, which can manifest as ulcers or gangrene. This is the most severe stage and often requires urgent medical and possibly surgical intervention to prevent further complications, including potential amputation.
Part of the job of an FNP is educating parents on safety measures for children. Which type of car seat or restraint is recommended for toddlers less than 2 years old?
seat belt booster rear-facing forward-facing convertible, combination
Rear facing
Should remian in two until reach max height
In terms of liver function tests, which of the following test has a normal reference range of 5 – 50 u/L?
Alkaline Phosphatase Serum GGT Serum ALT Serum AST
Serum AST
first sign of puberty in males is
testicular enlargement
Which of the following would be a standard UTI treatment for children?
Cipro 250 – 500 mg po q 12 h Macrodantin 100 mg po q 12 h Keflex 500 mg bid Floxin 200 mg q 12
keflex
anisocoria is
is defined as a condition where the pupils of the eyes are of unequal sizes
is categorized as a short-acting oral antidiabetic agent. It belongs to a class of medications known as meglitinides,
Prandin (repaglinide) stimulates the pancreatic to release insulin
The Stark Acts, also known simply as “Stark Law,” are
set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services (“DHS”) if the physician (or an immediate family member) has a financial relationship with that entity.
The optimal daily intake of calcium for a postmenopausal female patient who is 65 years of age is
1200
Sequoiosis is a
type of hypersensitivity pneumonitis, also known as extrinsic allergic alveolitis. This condition is an inflammatory response of the lungs caused by inhaling organic dusts and other substances. Each type of hypersensitivity pneumonitis is typically associated with exposure to a specific type of antigen.
what is the most noticeable sign of parkinsons
tremors
The correct reference range for carbon dioxide in the serum or plasma of an adult, when assessing acid/base balance, is
24 to 30
-Henry is a patient who has had a TIA . He has been prescribed Ticlopidine. You understand that this is because the patient has an intolerance to which of the following?
eggs and egg products aspirin dairy products warfarin
ASA
Ticlopidine belongs to a class of medications known as thienopyridines. It acts by inhibiting platelet aggregation, thus preventing the formation of new blood clots. This action is crucial for patients like Henry, who are at an increased risk of stroke following a TIA. The drug is particularly reserved for those who cannot use aspirin, providing a vital option for ongoing stroke prevention.
How would you test the glabella reflex in a patient?
Tap above or below mouth at midline. Touch lips with a blunt object. Stimulate the palm of the hand. Tap the forehead.
Tap the forehead.
The optimal calcium intake from birth to 6 months is what
200 mg
For patients with fibromyalgia, the maximum dose of Lyrica is which of the following?
100 mg/day. 450 mg/day. 1000 mg/day. 150 mg/day.
450 mg a day
An adult patient with a skin condition is being prescribed a topical steroid from Group 1 (according to potency) of the most common topical steroids. Of the following, which is in Group 1?
Betamethasone dipropionate ointment 0.25%. Triamcinolone acetonide ointment 0.5%. Desoximetasone 0.25% Desonide cream 0.05%
Correct Answer: Betamethasone dipropionate ointment 0.25%.
The question asks to identify a topical steroid from Group 1 of potency among a list of several options. It’s important to understand that topical steroids are categorized into groups based on their potency, with Group 1 being the most potent. Let’s break down the options given: 1. Betamethasone dipropionate ointment 0.25% - This is a high-potency corticosteroid. According to standard classifications, betamethasone dipropionate 0.25% in an optimized vehicle (such as an ointment) is indeed classified as a Group 1 topical steroid. This group includes the most potent steroids available for topical use. 2. Triamcinolone acetonide ointment 0.5% - This is mentioned in the question as a Group 3 topical steroid. Group 3 steroids are considered medium potency, which is less potent than those in Group 1. 3. Desoximetasone 0.25% - This option is identified in the question as a Group 2 steroid. Group 2 steroids are potent but not as potent as those in Group 1. 4. Desonide cream 0.05% - This is listed as a Group 6 steroid, indicating that it belongs to the least potent category of topical steroids. Given these classifications and the potency ranking, Betamethasone dipropionate ointment 0.25% is the correct answer as it is the only steroid from Group 1 listed in the options. This steroid is typically used for treating severe inflammatory skin conditions due to its high potency, which is effective in reducing inflammation and suppressing immune responses in the skin.
One developmental milestone is the ability to draw a stick figure “person” with six separate body parts. What is the age group that this finding is associated with?
A.2 years old
B.3 years old
C.4 years old
D.5 years old
Answer: D. 5 years old
By 5 years of age, a child can draw a stick person with six body parts and copy a square. Children should be able to copy a straight line or circle at ages 2 and 3, respectively. A 4-year-old child can copy a cross and draw a stick person with three body parts.
A 19-year-old patient is referred to the nurse practitioner by a counselor after disclosing symptoms consistent with bulimia nervosa, including frequent episodes of binge eating followed by self-induced vomiting. The patient expresses distress over their eating behavior and a desire for help. Their physical examination is unremarkable, and their laboratory tests, including electrolytes, are within normal limits. What is the most appropriate initial treatment for this patient’s bulimia nervosa?
A.Prescribe a selective serotonin reuptake inhibitor (SSRI)
B.Refer the patient for cognitive behavioral therapy (CBT) specialized to eating disorders
C.Recommend a group support session for weight management
D.Begin a nutritional supplementation program to address possible deficiencies
Answer: B. Refer the patient for cognitive behavioral therapy (CBT) specialized to eating disorders
Bulimia nervosa requires a multifaceted approach, focusing on psychological, nutritional, and medical aspects. Among these, the psychological aspect is often addressed initially, and referral for specialized CBT is considered the first-line treatment. SSRIs may be part of the treatment plan; however, SSRIs alone are not the initial treatment of choice. A group support session for weight management does not target the specific psychological complexities of bulimia nervosa and is not an initial treatment approach. Beginning a nutritional supplementation program and addressing potential nutritional deficiencies does not directly address the core psychological component of bulimia nervosa and may be unwarranted given the patient’s normal laboratory tests.
Which of the following smoking cessation options is the most appropriate first-line management for a patient with several unsuccessful prior attempts to quit cold turkey?
A.Refer to a smoking cessation support group
B.Prescribe nicotine replacement therapy (NRT)
C.Start the patient on varenicline
D.Advise reduction in number of cigarettes per day
Answer: B. Prescribe nicotine replacement therapy (NRT)
NRT is a first-line treatment for smoking cessation. It can help to reduce withdrawal symptoms and cravings associated with quitting smoking, increasing the likelihood of successful cessation. While referral to a smoking cessation support group could be beneficial as an adjunct to pharmacological treatment, it would not typically be the primary method of treatment, especially for patients with prior unsuccessful cessation attempts. Varenicline is a medication that is sometimes used to aid in smoking cessation, but it is usually considered after NRT has been tried, due to its potential side effects. While gradually reducing the number of cigarettes smoked per day might work for some patients, NRT is a more proven and effective method and would generally be the recommended first-line approach.
A patient with a past medical history of chronic obstructive pulmonary disease (COPD) asks for recommendations on managing his lower urinary tract symptoms secondary to his new diagnosis, benign prostatic hyperplasia (BPH). Which of the following is the most appropriate treatment strategy?
A.Recommend the use of saw palmetto to treat symptoms of BPH
B.Increase intake of mild diuretics (e.g., caffeine) to ensure adequate urine output
C.Trial the use of a timed voiding regimen
D.Reduce fluid intake in the morning
Answer: C. Trial the use of a timed voiding regimen
The use of a timed voiding regimen can be helpful in patients who exhibit obstructive complaints or carry a high post-void residual. This technique prompts the patient to empty their bladder based on a time interval (e.g., every 90 to 120 minutes) rather than by the usual sensations, which can be helpful to reduce lower urinary tract symptoms. While herbal remedies may appeal to many patients, there is little data to support their safety and efficacy, and they are not recommended for this patient. Additional lifestyle recommendations include limiting fluid intake before bedtime or prior to travel, limiting intake of mild diuretics (e.g., coffee, alcohol), limiting intake of bladder irritants (e.g., highly seasoned or irritative foods), avoiding constipation, increasing physical activity, practicing Kegel exercises at the time of urinary urgency, and using double-voiding techniques.
what virus is associated with URI with GI complaints
adenovirus, roatvirus, norwalk
Which of the following hormones stimulates testosterone release by the Leydig cells of the testes?
A.Growth hormone
B.Follicle-stimulating hormone
C.Prolactin
D.Luteinizing hormone
Answer: D. Luteinizing hormone
The luteinizing hormone stimulates testosterone release by the Leydig cells of the testes. It also stimulates steroid release from the ovaries, ovulation, and the release of progesterone after ovulation by the corpus luteum. The growth hormone is responsible for growth regulation during childhood, as well as metabolic functions such as production of insulin-like growth factor-1 and increase in gluconeogenesis. Follicle-stimulating hormone plays a role in estrogen production and follicular development as well as in initiation and maintenance of spermatogenesis. Prolactin has many functions but most notably is responsible for milk production and the development of mammary glands within breast tissues.
Which medication is most commonly used as a short-term treatment for Cushing’s syndrome?
A.Mifepristone
B.Ketoconazole
C.Spironolactone
D.Fludrocortisone
Answer: B. Ketoconazole
Ketoconazole is most commonly used as a short-term treatment for Cushing’s syndrome. Mifepristone is used for Cushing’s syndrome treatment, but only in certain cases. Spironolactone is not a primary treatment for Cushing’s syndrome, and fludrocortisone is used for conditions such as adrenal insufficiency.
Which medication is a first-line treatment for acromegaly?
A.Octreotide
B.Bromocriptine
C.Cabergoline
D.Pegvisomant
Answer: A. Octreotide
Octreotide is a first-line treatment for acromegaly, a condition characterized by excessive growth hormone production. Bromocriptine and cabergoline are used for the treatment of prolactinomas, and pegvisomant is used as a second-line treatment for acromegaly.
A patient presents with reports of increasing central obesity, resistant hypertension, facial plethora, striae, menstrual irregularities, and hyperglycemia. A high index of suspicion for hypercortisolism is made based on the multiple clinical features. Initial testing for Cushing’s syndrome includes which of the following?
A.Early-morning salivary cortisol
B.48-hour urinary free cortisol excretion
C.Overnight 1 mg dexamethasone suppression test
D.Late-serum cortisol
Answer: C. Overnight 1 mg dexamethasone suppression test
Cushing’s syndrome includes multiple progressive features, including striae, decreased libido, central obesity/weight gain, menstrual changes, facial plethora/round face, hirsutism, hypertension, ecchymoses, lethargy, dorsal fat pad, and abnormal glucose tolerance. Initial testing includes two or three of the following: late-night salivary cortisol (two measurements), 24-hour urinary free cortisol excretion (two measurements), or the overnight 1 mg dexamethasone suppression test. The low-dose dexamethasone test is a standard screening test used to differentiate patients with Cushing’s syndrome of any cause from those who do not have Cushing’s syndrome. The late-night serum cortisol relies on the fact that the normal evening nadir in serum cortisol is preserved in patients with central obesity and depression but not in patients with Cushing’s syndrome. Because this test is less convenient than the late-night salivary cortisol, it is not routinely used in practice.
A 45-year-old patient presents with symptoms including central obesity, facial rounding, thin skin with easy bruising, and muscle weakness. The individual also reports increased urination and has a medical history of hypertension and type 2 diabetes. The patient has not taken steroid therapy or any related medication. What would be the most appropriate next step in confirming the diagnosis for this patient?
A.Order a dexamethasone suppression test
B.Order a 24-hour urinary free cortisol test
C.Measure serum adrenocorticotropic hormone (ACTH) levels
D.Evaluate the patient’s midnight salivary cortisol level
Answer: A. Order a dexamethasone suppression test
The appropriate next step in confirming the diagnosis for this patient is to perform a dexamethasone suppression test. This test helps to diagnose or exclude Cushing’s syndrome by evaluating how the cortisol levels respond to dexamethasone, a synthetic glucocorticoid. Ordering a 24-hour urinary free cortisol test is a valid test for Cushing’s syndrome but is not as specific as the dexamethasone suppression test. Measuring serum ACTH levels could be part of the diagnostic process for Cushing’s syndrome but would typically come after initial testing to suppress or confirm elevated cortisol levels. Evaluating the patient’s midnight salivary cortisol level is another method to screen for Cushing’s syndrome but is not the most common initial step in diagnosis.
A male patient presents with a waist circumference of 100 cm (about 39 inches), neck circumference of 38 cm (15 inches), blood pressure of 150/90 mmHg, fasting blood glucose of 140 mg/dL, and triglyceride level of 160 mg/dL. The patient has a past medical history of type 2 diabetes, obstructive sleep apnea, chronic kidney disease, and hypertension. The patient meets criteria for metabolic syndrome based on what diagnostic parameters?
A.Neck circumference, blood pressure, fasting blood glucose
B.History of type 2 diabetes, blood pressure, triglyceride level
C.Fasting blood glucose, waist circumference, history of obstructive sleep apnea
D.Blood pressure, fasting blood glucose, triglyceride level
Answer: D. Blood pressure, fasting blood glucose, triglyceride level
Diagnostic criteria for metabolic syndrome include three or more of the following: fasting blood glucose ≥100 mg/dL or drug treatment for elevated glucose; high-density lipoprotein (HDL) cholesterol <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL cholesterol; triglycerides ≥150 mg/dL or drug treatment for elevated triglycerides; a waist circumference ≥102 cm (about 40 inches) in men or ≥88 cm (about 35 inches) in women; and hypertension as defined by blood pressure ≥130/85 mmHg or drug treatment for hypertension. Metabolic syndrome is not defined by neck circumference, history of type 2 diabetes, or obstructive sleep apnea.
T4 normal range is
0.8 - 1.8
normal TSH is
0.4-4.0
what is the most common finding in primary adrenal insufficiency
hyperpigmentation
Best test to order to dx cushings is
dexamethsone suppresion test
what is a rare but potentially serious complicatio of type 2 DM
Hyperosmolar Hyperglcyemic state
The condition is characterized by very high blood sugar levels without significant ketones, and early symptoms of the disorder can include extreme thirst, dry mouth, confusion, and lethargy.
Diabetes can be diagnosed based on American Diabetes Association criteria. These include
hemoglobin A1C ≥6.5%; fasting plasma glucose ≥126 mg/dL; 2-hour plasma glucose ≥200 mg/dL during an oral glucose tolerance test; and random plasma glucose ≥200 mg/dL in a patient with classic symptoms of hyperglycemia.
Which of the following hormones stimulates testosterone release by the Leydig cells of the testes?
A.Growth hormone
B.Follicle-stimulating hormone
C.Prolactin
D.Luteinizing hormone
Answer: D. Luteinizing hormone
The luteinizing hormone stimulates testosterone release by the Leydig cells of the testes. It also stimulates steroid release from the ovaries, ovulation, and the release of progesterone after ovulation by the corpus luteum.
