NURS 6614 Final
Terms in this set (108)
You have a 33-year-old patient with diabetes type 2. Your patient has a fasting plasma glucose of 280 mg/dl and A1C of 10%. You want to assess your patient for diabetic nephropathy. What is the best way to assess your patient?
Serial random urinalysis for microalbuminuria
A 33-year-old female patient presents to your clinic with a 2 day history of dysuria, urinary frequency, and incontinence. She has been afebrile and denies sexual intercourse in the past two months. This is the first such episode and she has no history of previous hospitalization or antibiotic use for any reason in the past 3 months. She has no known allergies to any medications. What is most likely to be the best option for your initial diagnostic work-up today?
Clean-catch, mid-stream urine for urinalysis
A 33-year-old female patient presents to your clinic with a 2 day history of dysuria, urinary frequency, and incontinence. She has been afebrile and denies sexual intercourse in the past two months. This is the first such episode and she has no history of previous hospitalization or antibiotic use for any reason in the past 3 months. She has no known allergies to any medications. She has no pertinent positive exam findings. The urinalysis is positive for RBCs, protein, and nitrites. What is your diagnosis for this patient?
Lower urinary tract infection
A 33-year-old female patient presents to your clinic with a 2 day history of dysuria, urinary frequency, and incontinence. She has been afebrile and denies sexual intercourse in the past two months. This is the first such episode and she has no history of previous hospitalization or antibiotic use for any reason in the past 3 months. She has no known allergies to any medications. The urinalysis is positive for blood and pyuria. Your patient does not have insurance and has financial constraints. There is no known antibiotic resistance in your area. What do you decide to order for your patient today?
Which of the following statements are true about uncomplicated cystitis in women? Please SELECT ALL THAT APPLY
Treatment can be with short-term antimicrobial therapy, which consists of single-dose therapy or 1-3 days of therapy.
Trimethoprim-sulfamethoxazole can be ineffective because of the emergence of resistant organisms.
In elderly patients, altered mental status may be the sole manifestation and should create a high level of suspicion.
Approximately 80%-90% of the uncomplicated cases are a result of the gram-negative rod bacterium, Escherichia coli.
Which of the following are true regarding microalbuminuria? Please SELECT ALL THAT APPLY.
At least 2 of 3 spot urine collections over a 3 to 6 month period should be abnormal before a diagnosis of Chronic Kidney Disease is justified.
Subsequent end-stage chronic kidney disease can be predicted by persistent urinary albumin excretion rates exceeding 30 mcg./min.
Minimal but persistent amounts of albumin in the urine are associated with diabetic nephropathy and with hypertensive renal damage.
An ACE inhibitor in normotensive diabetics impedes progression to proteinuria and prevents the increase in albumin excretion rate.
A urine specimen that is positive for protein (in the absence of infection) negates the need for microalbumin testing.
You are reviewing a patient's labwork from a clinic visit. You note that serum creatinine is elevated for the second lab draw in a row. What are you thinking about the patient's glomerular filtration rate (GFR)?
The patient's GFR is probably going down.
Chronic renal failure (CRF) is defined as a deterioration in renal function that persists for more than three months. All of the following are possible etiologies of CRF except:
Lower urinary tract infections
You are ordering lab work to monitor your diabetic patient. You include all of the following lab orders except:
Which of the following is the most important risk factor for nephrolithiasis in the general population?
Women with frequent UTI
The major factor that prevents development of urinary tract infection is:
Maintaining sterility of the urinary tract
The organism responsible for approximately 80% of urinary tract infections is:
A notation of alkaline urine in a patient with a UTI may point to infection caused by:
A 44-year-old woman presents with pyelonephritis. The report of her urinalysis is least likely to include:
A 36-year-old afebrile woman without health problems presents with dysuria and frequency of urination. Her urinalysis findings include results positive for leukocyte esterase. Nitrites are negative. You understand that possible reasons for these findings include all of the following except:
Her differential diagnosis excludes UTI
Nephritic syndrome is synonymous with:
Risk factors for glomerulonephritis include all of the following except:
Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) are significant public health problems in the US and a major source of suffering and poor quality of life for those affected. Which of the following ethnic group is least likely to develop CKD?
Over the past decade, several studies have shown that proteinuria predicts faster progression of kidney disease to ESRD. Studies have shown that drugs that reduce proteinuria can also slow the progression of established kidney disease. These drugs include which of the following:
Angiotensin-Converting Enzyme (ACE) Inhibitors
A 56 year old patient is seen in your office for follow-up of results of routine lab work. You decide, based on his lipid profile that a statin medication is indicated and believe that atorvastatin is the best option for this patient. You note that the patient's estimated glomerular filtration rate is 56ml/min/1.732 . According to the 2012 KDOQI Clinical Practice Guideline, which of the following would be the appropriate rationale in deciding the appropriate dosage of atorvastatin based on his current kidney function?
The patient has Stage III CKD, no dosage adjustment is indicated for atorvastatin
When assessing and establishing a diagnosis in a patient with a psychiatric or mental health disorder, the single most important tool in establishing a diagnosis is
The DSM-IV is all of the following except
Uses a four-axis system that evaluates patients along several dimensions
A 48 year old female patient presents to clinic with the following history: "Feeling blue" "No desire to attend sewing group these days" "I go to sleep at night but I wake up at 3 am and cannot go back to sleep." "I just have trouble getting out of bed in the morning and I feel tired all day." "I'm just not a good wife any more." When asked how long she has been feeling this way she recalls at least 3 weeks, maybe more. Based on the following history, your patient
Meets the DSM-IV diagnostic criteria for major depression in adults
The DSM-IV criteria for PTSD includes all of the following except
The patient meets the criterion for intensity of symptoms
You diagnose a patient with PTSD and will make a referral for group therapy or individual counseling. You want to start pharmotherapy in the meantime. What is the first-line pharmotherapy for a patient with PTSD?
SSRI drugs such as fluoxetine
The CAGE questionnaire is used to screen for
Recurrent episodes of binge eating and inappropriate compensatory behaviors to prevent weight gain for at least three months is best described as
You have a patient age 50 years with an existing diagnosis of cardiovascular disease and today you make a new diagnosis of depression. Which of the following best describes your treatment plan today?
Administer a depression screening assessment tool such as the Beck Depression Inventory and begin Citalopram 20 mg. a day
A 85 year old nursing home patient is "seeing children in the corner of her room". She has no previous history of hallucinations and staff reports that she has had no significant changes in physical or mental status in the last several days. What is the most likely cause of her hallucinations?
Dementia with psychotic features
For the patient in the previous question, what would be your best course of action to address the hallucinations?
Rule out physical causes for the hallucinations and start Aricept and Namenda.
Sarah, who is postmenopausal, has well-controlled asthma and hypertension. Sarah is a current smoker and has a 10 pack year smoking history. Her LDL (low-density lipoprotein) cholesterol is 170 mg/dl, and a HDL (high-density lipoprotein) cholesterol of 40 mg/dl. To reduce Sarah's chance of a cardiovascular event, the primary focus of her treatment plan would be:
Encourage smoking cessation efforts.
the classic change seen on a 12-lead ECG during an acute myocardial infarction is:
To determine target organ damage in a patient with hypertension and other risk factors in a client with hypertension, basic diagnostics should include which of the following?
Chest x-ray, electrocardiogram, urinalysis, complete blood count, chemistry profile, lipid profile, and thyroid-stimulating hormone level.
Marvin, age 56, is a smoker with diabetes mellitus. He has just been diagnosed with hypertension. Which of the following drugs includes the potential for causing the development of bronchial asthma and inhibiting gluconeogensis?
Mrs. Jones presents to your office with a BP of 138/92 in her right arm and 130/80 in her left arm. She is concerned about her BP because of recurrent headaches and swelling of her feet. She has kept a record of her BP for you. She has been taking her BP up to 10 times each day. It averages about 140/90, but sometimes goes as high as 180/100. She has no comorbid conditions. You determine she has:
Prehypertension and encourage lifestyle modifications with a return visit in one month
Which of the following is not a cause of secondary hypertension?
Pharmacologic therapy should be started in any patient who is diagnosed with hypertension and has end organ damage. Considering JNC VII compelling indications for anti-hypertensive therapy, pharmacologic therapy in most cases should begin with:
Angiotensin converting enzyme inhibitors
You examine a 46 year old smoker with hypertension. His lipid profile is as follows: HDL level is 48 mg/dL, LDL level is 192 mg/dL, and triglyceride level is 110 mg/dL. He has been on a low cholesterol diet for 6 months when these test results were taken. Which of the following represents the next best step?
A HMG-CoA reductase inhibitor should be prescribed
Diagnostic testing for a patient with newly diagnosed hypertension should include all of the following except:
In the person with hypertension, which of the following yields the greatest potential reduction in blood pressure in a patient with a BMI (body mass index) of 35?
10 kg weight loss
When prescribing niacin, or niacin-containing medications, the NP expects to see the following changes in lipid profile:
Increase in HDL cholesterol
All of the following are common causes of secondary hypertriglyceridemia except:
familial genetic factors
Jim, age 72, has a history of non-insulin-dependent diabetes mellitus (Type 2) that has been controlled by diet. He has come for a routine examination and reports feeling more tired than usual. Otherwise his ROS is negative. On his electrocardiogram (ECG), you notice Q wave changes in leads II, III, and atrial fibrillation that were not present on his previous ECGs. What would you do?
Initiate aspirin therapy and refer Jim to a cardiologist for evaluation of occult ischemic heart disease and left ventricular function as soon as possible.
Jamie, age 49, who has a history of hyprlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be?
Hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, an thrombosis as appropriate.
Martin, age 56, has hypertension and has been taking antihypertensive medication for about 10 years. He has been very stable. You have not seen him in about 6 months. His examination today should specifically include:
Include a funduscopic examination.
Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Her microalbumin is 24 mg/ day. Other than her diabetes medications, what would you prescribe today during her routine office visit?
Terry, a 42-year-old Black male, who just moved into the area, comes into the clinic for a new-client visit. He brings his medical records from his previous health-care provider; the records show a blood pressure of 140/104 mm Hg on two separate occasions. Recent laboratory tests (complete blood count, chemistry profile, urinalysis, and thyroid-stimulating hormone) are normal. A recent electrocardiogram shows normal sinus rhythm with left ventricular hypertrophy. He denies any medical problems and tells you he has never been diagnosed with hypertension. He is not taking any medications, does not smoke, and drinks about two beers a day. He is currently unemployed. His blood pressure today is 150/110 mm Hg. Your next step would be to?
Begin drug therapy with hydrochlorothiazide (hydorodiuril), 25 mg once a day.
Which of the following drugs should be considered as first-line therapy for a client with hypertension and heart failure?
Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles (rales) that do not clear with coughing, and peripheral edema. What do you suspect?
Congestive heart failure
A 36 year old male presents with acute onset of unilateral inflammation, pain, and erythema of the first metatarsophanlangeal (MTP) joint. Differential diagnoses that should be considered include:
Cellulitis, arthritis, and gout
36 year old male presents with complaints of pain and swelling in his left knee with associated knee instability and occasional "locking" when walking. He reports playing tennis last week and felt a tearing, popping sensation that caused him to fall to the ground. He denies any bruising. He has self treated with Ibuprofen and wearing a knee brace with partial resolution. Based on this history your differentials should include all of the following except:
You suspect a medial meniscus injury in your client. In performing a McMurray's test, the client complains of sharp pain and you palpate a popping sensation at 45 degree flexion. Your next diagnostic plan of action would be:
Refer to Orthopedics
You've conservatively treated a client for carpel tunnel syndrome for six weeks with cock-up splints, avoidance of repetitive activities, and NSAIDS without significant improvement. Your patient education should include which of the following:
Carpel Tunnel Syndrome patients should be referred to a specialist for injection of corticosteroid into the carpal tunnel or for operation when they do not improve.
In accurately assessing a client who reports back injury, it is critical to first question:
Mechanism of injury
A 28 year old female presents with complaints of chronic aching pain and stiffness, frequently involving the entire body but with prominence of pain around the neck, shoulders, low back, and hips. She reports frequent headaches and trouble sleeping at least three nights per week and reports that even minor exertion aggravates pain and increases fatigue. Physical examination is normal except for "trigger points" of pain produced by palpation of various areas such as the trapezius, the medial fat pad of the knee, and the lateral epicondyle of the elbow. Your most likely diagnosis would be:
In teaching a client about fibromyalgia, the NP includes what information?
Try medications such as alprazolam and ibuprofen at bedtime for relief.
A 55 year old female presents as a new patient with complaints of a several year history of worsening joint pain that is worse in the morning. On examination, the NP notices Heberden's nodes and understands that this is a sign of:
A 25 year old male presents with complaints of daily back pain localized to his lower back after lifting a heavy box at work 3 days ago. The symptoms interfere with his ability to participate in his bowling league. He denies incontinence, gait instability or radicular symptoms. On examination, you note normal musculature, FROM of the spine with moderate paravertibral tenderness throughout the lubrosacaral spine without spasm. The client complains of posterior thigh pain when his right leg is elevated 75 degrees. His remaining examination is unremarkable. Your diagnosis is:
A 60 year old female patient in your clinic reports the recent onset of lancinating, cutting pain (pain scale: 8) on the right side of her face that lasts for approximately 5-10 seconds. The pain commenced after brushing her teeth and there has been no pain between the two recent episodes. You suspect trigeminal neuralgia (tic douloureux). Which of the following best describes your plan of care today?
Schedule MRI and start Carbamazepine (Tegretol) at 100 mg. BID. Plan to monitor Tegretol blood levels and liver function
A 69-year-old client asks the nurse practitioner what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is most appropriate?
OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.
Because type 2 diabetes mellitus is the leading cause of end-stage renal disease and some complications can be prevented, what test is recommended by the American Diabetic Association when patients are first diagnosed with type 2 DM and then annually?
Urine for microalbumin
Your patient has no past history of diabetes, heart disease, nor endocrine disorders. Today your patient presents with a recent onset of polyuria, polydipsia, weight loss and fatigue. What will your plan of care include today?
Random plasma glucose level and glycosylated hemoglobin (A1C)
The American Diabetic Association (ADA), European Associateion fo the Study of Diabetes, and the American Association of Clinical Endocrinologists (AACE) recommends what first-line oral medication for the treatment of type 2 DM?
Obesity is a known risk factor for type 2 diabetes mellitus. Which BMI below begins the index obesity in your patient?
You are seeing a 54 year old Asian-american patient with Type II DM. In review of his lab work, his HgbA1c is 10.6. His calculated eGFR is 52ml/min/1.732 . He is 68 inches tall and weighs 210 pounds today. You determine he needs to begin insulin therapy. You calculate his total daily dosage of insulin to be (round to the nearest whole number):
Weight is 210/2.2= 95.45 kg. Using 0.5u/kg/24 hours = 47.72 units TDD
Certain medications is to treat Type II DM are recognized for causing negative clinical outcomes such as mortality, morbidity, What category of medications used to treat type 2 DM is most associated with adverse cardiac events such as MIs?
Thiazolidinedione (such as Rosiglitazone)
Your patient had a vitamin D [25(OH)D] level below 20 ng/ml. You prescribed Cholecalciferol 50,000 iu weekly for 8 weeks. The patient assures you that she has been compliant with her regimen but her levels have not responded to treatment as expected. What laboratory test would you now consider in your plan of care to further evaluate the poor response?
Parathyroid hormone (PTH)
The diagnosis of hypothyroidism is made by measuring
TSH and Free T4
All of the following are considerations in treating a patient with hypothyroidism except:
Practitioners are encouraged to write prescriptions that allow substitution so the patient may obtain a less expensive generic form of the medication.
Blood sugar is considered well controlled in an older adult with comorbid conditions when Hemoglobin A1C is:
You see a patient one week after initiating insulin therapy. He brings in glucose log to his visit as you instructed. You note that the past four mornings his FSBG readings range from 186-203. Using the Treat-To-Target criteria, you make what changes in treatment plan?
Increase his TDD insulin dosage by 8 units daily
The total iron for a 56 year old female patient is 40 mcg/dl, TIBC 401 mcg/dl, Transferrin Saturation 8%, Ferritin 150 ng/ml, MCV is 82, Hgb is 10.6, Hct 30.3 and WBC is 8.5. These lab results indicate
Anemia of chronic disease
Folate deficiency, as seen in alcoholics, is most likely related to:
Inadequate dietary intake.
Stu, age 59, has slightly reduced hemoglobin and hematocrit readings. What is your next priorty action after you ask him about his diet?
Perform a fecal occult blood test
Pernicious anemia is due to a(n):
intrinsic factor deficiency.
The nurse practitioner understands that most adult clients with Hodgkin's disease present with:
Painless, movable mass in the neck, axilla, or groin
Anemia of chronic disease is most commonly associated with which of the following conditions:
Inflammation, infection, neoplasms
Which statement is true concerning thalessemia?
Thalessemia minor does not typically require pharmacologic treatment
Which of the following statements is true concerning the leukemias?
Initial white blood cell (WBC) count is the most important predictor of prognosis.
An elderly male presents to the office with complaints of fatigue, dizziness, decreased activity tolerance, and occasional bounding heart rate. Physical examination reveals pallor (including mucous membranes), tachycardia, and general appearance of lethargy. The nurse practitioner orders CBC with differential, peripheral smear, serum iron, TIBC, and serum ferritin because there is a high index of suspicion for:
Iron deficiency anemia
A macrocytic, normochromic anemia is diagnosed in an elderly male client. What should be the next test(s) ordered?
Vitamin B12 and RBC/folate levels
Sue has sickle cell anemia. In regulating her and monitoring her hemoglobin and hematocrit levels, you want to maintain them at:
Slightly below normal
Frank, a 66-year-old white male who is on diuretic therapy, presents with an elevated hematocrit. He also has splenomegaly on examination, as well as subjective complaints of blurred vision, fatigue, headache, and tinnitus. You suspect:
Sherri's blood work returns with a decreased mean cell volume (MCV) and decreased mean cellular hemoglobin concentration (MCHC). What should you do next?
Order a serum iron, TIBC, and serum ferritin level
A person with sickle cell trait, one S allele and one normal, will be resistant to malaria and will eventually develop sickle cell disease.
In terms of immune response as discussed within our Centra session, a mantoux skin reaction is an example of:
T cell immunity
responsible for immunity obtained from vaccinations
eliminates pathogens in the early stages of B cell mediated (humoral) immunity
Found in mucosal areas; prevents colonization of pathogens
Binds to allergens and triggers release from histamine receptors, basophils, and mast cells
A 52 year old patient presents in your office for complaints of fatigue, weight loss, blurred vision, and abdominal fullness. On exam, you note that he complains that your stethoscope hurts him when auscultating his heart sounds with minimal pressure, his skin is warm and dry, and his spleen is enlarged. Upon examination of his CBC, which of the following would you expect to find?
WBC count >500,000
you begin ferrous sulfate 325mg daily for your patient who was recently diagnosed with iron deficiency anemia with corrected source of iron loss. Based on the life span of RBCs, when would you expect to see a maximum response to your treatment plan?
The first step in diagnosing a fever of unknown origin is:
Stop all nonessential medications
Cat and human bites have higher rates of infection than dog bites. A patient comes to your clinic with a human or animal (cat or dog) bite. It does not require sutures & does not apprear infected but you want to cover the patient with antibiotic prophylaxis. The patient has no history of allergies (NKA). Which antibiotic below is the regimen of choice?
Marcie just returned from Central America with severe nausea and diarrhea. You suspect traveler's diarrhea. Which antibiotic do you order?
You know that Streptococcus pneumoniae (gram-positive bacteria) is the cause of approximately 70% of all bacterial community acquired pneumonia (CAP). You diagnose your patient with CAP and know that your community has penicillin-resistant strains of S pneumoniae. For this reason, you decide not to order amoxicillin. What medication below will you order today?
A 76-yr-old man comes into the office because he recently read about the "shingles shot" and wants to know if he should have it. He had an isolated case of herpes zoster in the past and does not want a recurrence. Which of the following is true regarding the herpes zoster vaccination?
It is contraindicated for patients who are immunosuppressed, have a history of TB, or who have recently taken oral steroids or chemotherapy.
Amy, a 34-year-old patient receives an influenza vaccination in your office today. Understanding how humoral immunity develops, you expect which of the following:
She will have immunity from the virus in 2 weeks when her body produces IgG antibodies.
In general, what is the relationship between the number of helper T cells and the viral concentration in the blood?
As the number of HIV increase, the number of helper T cells decreases.
Which of the following statements is true regarding the human immunodeficiency virus?
It must reproduce inside another cell.
What are the two main targets currently used in anti-HIV therapy?
Reverse transcriptase and protease
Factors that promote the progression of HCV to liver fibrosis include:
increased alcohol intake, age greater than 40 years at time of infection, male gender
Cat Scratch Fever