NSG6420 Final Exam Study Guide
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South University, Tampa *
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Course
6420
Subject
Health Science
Date
Dec 6, 2023
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docx
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12
Uploaded by bwells91
Study Guide for the mid-term exam – NSG6420 70 Questions Total—All multiple choice
1.
Definition of endemic and pandemic
1.
2 questions - definition
2.
Usefulness of clinical guidelines
1.
Why do we use them
3.
Practice guidelines-why designed
4.
Bell’s palsy recovery
1.
Progression of disease
2.
How long does it last
5.
Confusion
1.
Causes
1.
UTI, stoke, TBI, Alzheimer’s, Delirium, drugs
6.
Alzheimer’s disease—drug at time of diagnosis
1.
Medications for ALZ
1.
Class of medications
7.
Signs and symptoms of rosacea
1.
8.
Contact dermatitis--questions to ask patient
1.
Signs and Symptoms
9.
Scabies transmission
1.
S/S
2.
How transmitted
3.
Basic Facts on transmission
10. Conjunctivitis—diagnosis of different types
1.
Bacterial
2.
Allergic
3.
Viral
11. Chronic open angle glaucoma
1.
12. Diabetes and diabetic retinopathy
1.
Patients must be screened every year
2.
Common complication of DM
13. Otitis externa vs media
1.
OE
1.
Swimmers ear, tragal pain
2.
Pain produced by manipulation of external ear
2.
OM Medications (First line)
1.
Amoxicillin
2.
Azithromycin 14. Treatment of acute otitis media with PCN allergy
15. Signs and symptoms of mono
1.
Kissing Disease
2.
Epstin Barr
3.
Posterior Cervical Lymphadenopathy
4.
Photosensitivity
5.
Splenomegaly
1.
Rest
2.
No contact sports x6 weeks
16. Next steps when rapid strep negative
1.
Criteria for dx strep
2.
CENTOR Criteria
3.
FLEE
1.
Fever
2.
Lack of something
3.
Enlarged Tonsils
4.
Erythema
4.
Culture is a gold standard for dx strep
1.
Swab is 60% correct
2.
Strep A&B
17. Positive rapid strep and co-infection
1.
Can have Strep and Mono at the same time
1.
Strep Positive
1.
Tx and not improving
2.
Run a mono test
18. Meds not to take when driving
1.
Muscle relaxers
2.
Narcotics (opioids)
19. Captopril adverse effects
1.
Cough 20. Anxiety-related dyspnea
1.
Anxiety attack
2.
SOB, palpitation, restlessness, CP, nervousness,
21. Smoking cessation education, including when to start Chantix
1.
Chronic problem – Never stop asking – Even if pt aggressive
2.
22. TST reading 1.
TB
2.
Measure the induration
3.
Positive test
23. OSA contributing factors
1.
Obese
2.
Large neck size…. What size? 17in?
3.
Deviated Septum
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4.
HTN
5.
Male
6.
Age
7.
Snore/Stop breathing
8.
Tiredness
24. HDL cardioprotective level
1.
LDL = Bad
2.
HDL = Good >60
1.
Cardioprotective
25. Endocarditis prophylaxis—when? 1.
ABX
26. Common presenting complaint with CHF
1.
Cough?
27. NTG—how to give
1.
EKG
2.
Nitro
28. Test for suspected pulmonary embolism
1.
VQ (Ventilation perfusion scan)
29. Doses of statin to decrease LDL by up to 50% on average
1.
Atorvastatin
1.
What dose decrease LDL by 50%
30. JNC8 recommendation—when to add 2
nd
drug or increase initial drug
1.
1 month follow up
31. Female patient with complaints abdominal pain—exam
1.
Pregnancy (HCG Test)
2.
Bladder (UA)
3.
Bowels
4.
Ovaries
5.
Uterus
32. GERD
1.
Heartburn
2.
Cough
3.
Globulous sensation
4.
Omeprazole (PPI)
33. HPI first - 34. Lower UTI diagnosis
1.
Throw off a UA
1.
Medications
2.
AZO
1.
Send for C&S
2.
Leuko and Nitrate in urine = UTI
35. Upper UTI diagnosis
1.
CVA Tenderness, Fever
1.
Pyelonephritis
36. Macrobid dose to treat lower UTI
1.
Dosing for UTI
1.
100MG PO BID x 7 days
37. Contraindications for Detrol LA
1.
Medications for Urinary incontinence 38. Causes of Hematuria
1.
3 questions
2.
Causes
39. Proteinuria
40. Risk factors for bladder cancer
41. When to start prostate screening
1.
Screening for BPH guidelines
1.
Initial evaluation with American Urological Association Symptom (AUA) Index, a self-administered tool that asks seven questions about symptoms of BPH: incomplete emptying, frequency, intermittency, urgency, a weak stream, hesitancy, and nocturia. The index is scored from 0-35 depending on symptoms:
1.
Mild symptoms: score of 0-7
2.
Moderate symptoms: score of 8-19
3.
Severe symptoms: score of 20-35
2.
May also use International Prostate Symptoms Score (IPSS)
3.
Urinalysis: pyuria if residual urine present
4.
Renal panel to assess renal function
5.
Postvoid residual urine measurement (>100 mL)
6.
Prostate-specific antigen (PSA): may be elevated, but <10 ng/mL
7.
If obstruction suspected, obtain ultrasound and assess renal function
8.
Needle biopsy
9.
Ultrasound, CT, or MRI (not necessary for routine evaluation of the prostate)
10. Optional testing: maximal urinary flow rate, postvoid residual urine volume, urine cytology
42. Prostate Cancer
1.
Prostate-specific antigen (PSA): usually >4 ng/mL, however, PSA can be normal. Evaluate velocity of change in PSA and use in conjunction with digital rectal exam (DRE)
2.
Prostate cancer antigen 3, TMPRSS2-ERG gene fusion, and prostate health index are infrequently used by clinicians, but are adjunct tests to use with PSA
3.
Alkaline phosphatase: elevated with metastasis
4.
Testosterone and liver function tests if provider suspects androgen deprivation
5.
Transrectal biopsy with transrectal ultrasound (TRUS) guidance prostate biopsy
6.
CT, primarily to evaluate the size of prostate and assess for pelvic lymph node involvement in the preoperative period for staging purposes or evaluation of metastasis
7.
MRI and bone scan if evidence of nodal involvement, PSA >20 ng/mL or Gleason
score >8; Gleason score >8 indicates cancer more likely to spread rapidly
8.
Bone scan: positive if metastasis (always indicated if PSA >20)
1.
A PSA value >10 ng/mL generally necessitates biopsy. A PSA value >4-
9.9 ng/mL usually is biopsied, but only 20% of these patients have prostate cancer.
43. Nocturia in middle aged men, diagnosis, treatment, possible side effects
1.
BPH
44. Testicular torsion—what to do
1.
Testicular pain
2.
Rub thigh test for reflex
1.
If absent positive for TT
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45. Loss of libido—tests
1.
Tests
1.
Testosterone level (First)
2.
ED can be caused by certain medications
1.
SSRI, SNRI, BB
46. Common cause epididymitis
1.
Causative organisms
2.
Age of the patient
1.
Younger (STD) - 2.
Older (Infection) - 47. Shoulder dislocation—what to monitor for
1.
Check Neuro and vascular
48. Carpal tunnel syndrome—risk
1.
Repetitive flexion, pronation, and supination of the wrist (high hand/wrist repetition)
2.
Obesity
3.
Perimenopause
4.
Rheumatoid arthritis
5.
Osteoarthritis
6.
Distal upper extremity tendinopathies
7.
Tendinitis
8.
Workplace factors (gardening, computer work, assembly line, vibration, forceful grip/exertion)
9.
Diabetes
10. Fibromyalgia
11. Female sex
12. Hypothyroidism/thyroid dysfunction
13. Fractures/local trauma
14. Pregnancy or premenstrual edema
15. Space-occupying lesions
16. Tumors
17. Pregnancy is a risk factor due to edema
18.
49. Cauda equina syndrome
1.
Lower back injury
1.
Saddle anesthesia
2.
Loss of B&B
50. OA
1.
NONPHARMACOLOGIC MANAGEMENT
1.
Emphasis must be given to nonpharmacologic management to delay or minimize use of medications that have adverse effects
2.
Weight loss, if indicated: loss of 10% of body weight can lead to improvement in reported symptoms
3.
OA is a chronic disorder requiring muscle strengthening to provide joint support
4.
Educate patient about OA etiology, risk factors, and expected prognosis
5.
Organized program of supervised exercise strongly recommended, to include balance and strength training
6.
Rest
7.
Cognitive behavioral therapy is conditionally recommended
8.
Knee or elbow braces to stabilize joints during exercise
9.
Kinesio tape application for joint support
10. Assistive devices for ambulation: cane, sling
11. Orthotic shoes and wedged insoles (not recommended for knee or hip OA)
12. Apply heat and/or cold or paraffin to affected joints
13. Wedge osteotomy, arthroplasty
14. Acupuncture may be beneficial
15. Topical creams or liniments for counterirritant effect
16. Tai chi, acupuncture and yoga are alternative therapies that may be considered for management of symptoms
2.
PHARMACOLOGIC MANAGEMENT
1.
Pharmacologic therapy should only be used when symptoms are present; routine use has not been shown to modify the disease
2.
Medication therapy is usually needed long term; use is associated with many possible side effects
3.
Careful consideration should be given to existing comorbid conditions when selecting therapy (e.g., diabetes, poorly controlled hypertension, cardiovascular disease, peptic ulcer disease, chronic kidney disease, advanced age)
4.
The use of acetaminophen as a first-line agent for OA is no longer recommended due to safety concerns and lack of efficacy for musculoskeletal pain
5.
Short-acting NSAIDs are associated with fewer side effects than long-
acting forms
6.
Concomitant use of misoprostol (Cytotec) to prevent gastric ulcer development caused by NSAIDs
7.
Consider COX-2 inhibitors for GI protection (risk of GI bleeds decreased but still present)
8.
Topical NSAIDs may be an excellent alternative for older adults and patients who tolerate NSAIDs poorly
9.
Duloxetine (Cymbalta) can be used for patients with OA in multiple joints and those with comorbid conditions in which NSAIDs are contraindicated;
FDA indication for chronic musculoskeletal pain
10. Topical capsaicin can be used if one or a few joints are involved (not recommended for hand OA)
11. Tramadol (Ultram) is recommended by the American College of Rheumatology(ACR) as add-on therapy for patients with OA involving the
hands, knees and/or hips who have not responded to other treatment modalities. Narcotic analgesics indicated only briefly for severe exacerbation
12. Intra-articular corticosteroid injections, limited to four times a year, recommended for knee, shoulder and hip and conditionally recommended for hand OA
13. Current ACR guidelines recommend against vitamin D, bisphosphonates, fish oil, non-tramadol opioids, methotrexate, glucosamine, chondroitin sulfate, and hydroxychloroquine in OA treatment
51. Bisphosphonates education
1.
Contraindications
52. Diagnosis of lateral epicondylitis
1.
Lateral epicondylitis
2.
Tennis elbow
1.
Is an inflammation of the common tendinous origin of the extensor muscles of the forearm on the lateral humeral epicondyle, primarily at the extensor carpi radialis brevis tendon origin. It evolves to a degenerative condition (tendinosis) due to micro tears of tissue with poor healing. Lateral epicondylitis is 10 times more common than medial epicondylitis
1.
Gradual onset of dull, aching pain over a period of weeks or months on the lateral aspect of the elbow; may be present at rest, but usually worsens with activity
2.
Pain may radiate down the back of the forearm
3.
Shaking hands, lifting a cup, or turning a doorknob causes sharp pain
4.
Point tenderness over and just distal to the lateral epicondyle
5.
Full range of motion; no swelling or erythema
6.
Pain to the lateral aspect of the elbow with resisted wrist extension when fist clenched and elbow extended (positive Cozen test)
7.
Pain with resisted extension of the middle finger (positive Maudsley’s test)
53. Tests for median nerve compression
1.
Carpal Tunnel
1.
Tests
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54. Treatment for newly diagnosed person with T2DM
1.
?? Didn’t hear her..
55. When to order TSH
1.
S/S Hypo and Hyper thyroid
2.
What tests to order
56. T2DM with feet on fire treatment
1.
Diabetic Neuropathy
2.
Tricyclic Antidepressants
57. DM Dietary
58. Idiopathic hypoglycemia
59. Treatment for anaphylaxis
1.
EPI
1.
Administration
1.
Thigh
60. HIV PEP for healthcare workers
1.
Prophylaxis
2.
When to start
3.
How long for
1.
Post-exposure prophylaxis (PEP) can reduce your chance of getting HIV infection. It must be started within 72 hours (3 days) after you may have
been exposed to HIV. But the sooner you start PEP, the better. Every hour counts!
61. Hematocrit: Hemoglobin ratio
1.
Ratio what is it
62. Lyme disease
63.
Borrelia burgdorferi
spirochete transmitted by the Ixodid tick
1.
S/S
2.
First symptoms
1.
HPI
64. Common psychiatric condition in US
1.
Right now, nearly 10 million Americans are living with a serious mental disorder. The most common are
1.
anxiety disorders 2.
major depression 3.
bipolar disorder
65. Suicide risk evaluation
1.
What screening tool do you use to assess.
1.
PHQ-9?
66. Opioid abuse
1.
Addiction
2.
Abuse
3.
Elderly fall (impairment)
67. Age-related lab changes
1.
ESR changes with age
1.
ESR and CRP levels significantly increased with age (β-ESR = 0.017,
p
< 0.001 and β-CRP = 0.009,
p
= 0.006), 2.
independent of the number of tender and swollen joints, general health, and sex. 1.
For each decade of aging, ESR and CRP levels became 1.19 and 1.09 times higher, respectively.
1.
Furthermore, women demonstrated average ESR levels that
were 1.22 times higher than that of men (β = 0.198,
p
= 0.007), whereas men had 1.20 times higher CRP levels (β = -0.182,
p
= 0.048).
68. Fall risk
1.
Generalized question
1.
Fall risk assessment
1.
Have you fallen in the past year?
2.
Do you feel unsteady when standing or walking?
3.
Are you worried about falling?
69. Vaccines for 65+ adults
1.
Shingles
2.
TDAP (10 years)
3.
Prevnar
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