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The night before test questions Flashcards

1
Q

You have a patient with severe aortic stenosis. What medication should be avoided or used with caution?

A

diuretics

because the patient with aortic stenosis is sensitive to preload since their ability to augment their SVR is limited

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2
Q

Stage A B C D of heart failure

(this is NOT the NYHA classification)

A

A: risk factrors for HF but NO signs or symptoms

B: no symptoms (asymptomatic), but signs (LVH, S4)

C: symptoms

D: patients with refractory symptoms. require therapy like IABP

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3
Q

A patient with stage C of systolic HF, which medications would you avoid?

A

calcium channel blocker because they can be a negative inotrope

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4
Q

3 Drugs for HF

A

ACE I

thiazide diuretics

beta blockers (despite negative inotrope, improve outcomes)

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5
Q

Diastolic HF

A

signs/symptoms HF but normal EF and normal valves

lower extremity edema and weight gain are common in D HF patients

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6
Q

A patient with HF, EF 35%, unable to tolerate ACE I & ARB.

What is indicated?

A

beta blocker (improves survivial among pts with HF)

hydralazine and isosorbide dinitrate (replaces the ACE I/ARB)

*all three of them

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7
Q

CXR with kerly B lines, cephalization is indicative of:

A

HF (cephalization is increase prominence of vessels)

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8
Q

Syncopal patient presents with a harsh III/VI systolic murmur that r_adiates to the carotids_

A

MR ASS

Aortic stenosis

*aortic stenosis is r/t syncope, mitral is not

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9
Q

A patient has a-fib, DIASTOLIC low pitched murmur that radiates to the AXILLA, m-shaped p-waves. What is the murmur?

A

MS ARD

mitral stenosis

*the messed up AV valve leads to the a-fib and

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10
Q

A systolic murmur that radiates to the axillla

A

MR ASS

mitral regurg

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11
Q

An HIV patient has signs/symptoms of HF, global hypokonesis, elevated cardiac enzymes, no valvular defects. What is the diagnosis?

A

myocarditis

*myocarditis is thought to have some autoimmune component

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12
Q

What medications are CONRAindicated in the INITIAL treatment of pericarditis?

A

steroids are INITIALLY avoided because they are thought to increase the chance of reoccurance AND increase risk of infection

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13
Q

An xray with a water bagged shaped heart is consistant with pericardial tamponade. Signs of tampondade are

A

equalization of hemodynamic pressures during diastole

pulsus paradoxis

decreased ECG voltage

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14
Q

A patient with metastatic cancer is at increased risk for pericardial ______ which can lead to cardiac tamponade. This patient may have distant heart sounds and JVD.

A

effusion

*get an echo to see tamponade/effusion!

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15
Q

You have established a dx of HTN in a patient with a heart transplant. What is the first drug of choice for this patient?

A

ACE-I

*first line HTN for heart transplant

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16
Q

Patient with large anterior lateral MI who doesn’t respond to fluid and levo with BP 80/40, CI of 1.8, what med do you give next?

A

doBUTamine

because their index is low

*not epi bc it increases myocardial 02 demand in MI and you don’t want to do that

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17
Q

The AHA guideline for STEMI says ALL patients with STEMI should go home on _____ and have therapeutic lifestyle changes regardless of their lipid panel.

A

low dose statin and therapeutic lifestyle changes

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18
Q

Contraindicatoins for fibrinolytics in STEMI include

A

ischemic CVA less than 3 months ago

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19
Q

CHADS2 for patients with AFIB takes into account what and how many points do you need to get started on coumadin?

A

CHF

HTN

Age >= 75

DM

Stroke/TIA/TE gets TWO points

*If you have CHADS2 score 2 or greater you start coumadin

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20
Q

According to JNC 7 guidelines, what is the goal BP for a patient with DM?

A

<130/80

(normal pt <140/80 but bc JNC 7 with DM <130/80)

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21
Q

A patient with normal lipid panel EXCEPT elevated triglycerides, what medication would you give?

A

niacin (nicotinic acid) and fibrates are the drug of choice for high triglycerides

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22
Q

What medication is giving for peripheral arterial disease if claudication is treated medically?

This medication must be taken for weeks before results are scene.

A

pletal/cilostazol

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23
Q

How long should a post-op hip patient who is 85 with renal insufficiency be on DVT prophylaxis post op?

A

4-5 weeks

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24
Q

A shunt is perfusion without adequate ventilation. Blood is passing through the lungs, but isn’t exposed to the alvioi. Examples are:

A

PNA

pneumothorax

When there is a true shunt, no matter how much FIO2 you give them they won’t respond because there isn’t alvioli connecting to the blood

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25
Q

If the patient responds quickly to supplemental o2 is it a shunt or a ventilation-perfusion mismatch?

A

VQ mismatch because they responsd quickly to O2

26
Q

Dead space example is PE. There IS ventilation, but there is no_____.

A

perfusion

27
Q

Enteral feeding recommendations for a patient with resp failure is:

A

calorie dense formula because this may help avoid fluid overload

28
Q

On the test, if you are concerned about the risk of ventilator induced lung injury in a patient who is not assisting with breathing is:

A

PRESSURE control ventilation

29
Q

A patient with interstitial lung disease (the area surrounding the alveoli is a problem so it is obstructive). What would you guess their PFTs to be?

A

interstitial lung disease is obstructive with a restrictive ventilitory pattern so:

Low FEV1

low FVC

high fev1/fvc ratio

low DLCO

30
Q

Prior to performing a thoracentesis, what film should be obtained?

A

lateral decubitis

31
Q

A patient with a positive silhoette sign at the L heart border. You are concerned that the patient has a infiltrate in which lobe?

A

left lingula

32
Q

The best view for a CXR is the _____ view?

A

PA view

this is with your chest toward the plate, radiation is coming from behind so the exposure goes from posterior to anterior

33
Q

The NP using knowledge and expertise to integrate evidence based guidlines into formulating a plan of care is

A

clinical judgment

34
Q

Sytems thinking is driven by

A

strengths of families

strengths/weaknesses of staff

navigates the whole system

35
Q

Clinical inquiry

A

(blends with clinical judgement)

adapts standards of care to specific patients

questions current practice

maintains knowledge and skills

36
Q

The focus of the ACNP practice is

A

providing restorative care

37
Q

ACNP scope of practice

A

resorative

curative

palliative

rehabiliative

maintanable

determined by the area of focus and identified needs of the patient

38
Q

An important leadership activity of the ACNP is

A

interpreting the ACNP role to providers and the public

39
Q

What is a nonreimbursable condition in the hospital according to medicare and medicaid?

A

falls

central line infections

air embolism

blood incombatilibililty

foreign body after surgery

stage 3-4 pressurre ulcers obtained in hospital

DVT after ortho surgery

40
Q

On this test, based on UPSTF recommendations mamograms for women LESS than age 50

A

screening for women under age 50 depends on personal risk factors and personal choice

41
Q

On this test a mamogram should be done from age 50-75 every other

A

year

42
Q

UPSTF recommendation for colorectal cancer begins at what age?

A

start 50-75 end

can use fecal occult, sigmoidoscopy, colonoscopy

a high hiber diet helps prevent colorectal cancer

43
Q

If you have a choice of interviewing the patient choose the question that starts with

A

“TELL ME…”

44
Q

When the patients written directive and the family don’t agree what do you do?

A

get a third party involved (get the ethics committee)

45
Q

Current evidence based practice states the most common gateway drug to subsequent illicit drug use is

A

nonprescription use of pain medicaiton

46
Q

To determine the patients cr cl based on COCKFOFT GAULT eqaution

A

age

wt

sex

plasma cr

47
Q

what is normal creatinine clearance?

A

100-150

48
Q

cockroft gault equation to eval renal function

A

((140-age)xkg)/(plasma cr x72)

*if a girl x by 0.85

49
Q

Patient with PO KCL overdose, not symptomatic, what is the treatment?

A

kayexalate bc prevents absorption in the gut and patient not symptomatic

50
Q

Renal failure patient with elevated phos level. What is the drug of choice as a phos binder?

A

calcium acetate

51
Q

REpeated (chronic with repeated events = treatment failure) prostatitis/urosepsis. How long for abx?

A

4 to 12 weeks

52
Q

UPSTF recommendation for PSA screening for prostate screening?

A

never at any age to risks outweight benefits

53
Q

flomax is what drug class?

A

alpha blocker

54
Q

The most common cause of vaginal bleeding in postmenopausal women is

A

endometrial cancer

it is ruled out with endometrial biopsy

55
Q

Pain, prutitis, palpable lesion on labia minora, and hyperpigmentation

A

cancer of the vulva

high incidence in women 80+ years old

56
Q

A patient with a CABG and a surgical prolonged pump time who is bleeding with normal PT PTT and platelet counts.

A

check bleeding time or platelet function assay

*extended pump time messes up the platelet function

57
Q

What abnormal labs are found in tumor lysis syndrome?

A

hyPERPHosphotemia

and

hypocalcemia

58
Q

What type of transplant meds cause severe insomnia and mood swings?

A

steroids

59
Q

HIV positive results

A

ELISA +

Western blot + with p24 and gp120

60
Q
A

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