Download Exam 2: NU664B/ NU 664B (NEW 2025/ 2026 Update) Complete Guide | 100% Correct- Regis and more Exams Nursing in PDF only on Docsity!
Exam l 2 : l NU664B/ l NU l 664B l (NEW l 2025/ l
2026 l Update) l Primary l Care l of l Family l I l
Complete l Guide| l Questions l & l Answers| l
Grade l A| l 100% l Correct l (Verified l
Solutions)- l Regis
QUESTION
irritablel bowell syndrome Answer:
- Functionall bowell disorderl ofl motilityl (meaningl nol structurall orl biochemicall etiologiesl tol explainl it) al dxl byl exclusion,l oncel otherl causesl arel ruledl outl dxl by:l ROMEl IIIl criterial
- recurrentl abdominall painl onl averagel atl leastl onel dayl perl weekl inl thel lastl 3 l months,l associatedl withl twol orl morel ofl thel followingl *relatedl tol defecation *associatedl withl al changel inl stooll frequency *associatedl withl al changel inl stooll forml (appearance)
QUESTION
IBSl presentation Answer: usuallyl latel teens/20s 80%l arel women co-morbidl deoression/l anxietyl common usuallyl non-radiating,l cramoy,l lowerl abdominall pain: ***oftenl worsel afterl meals,l exacerbatedl byl stress,l relievedl byl BM,l doesl notl interuptl sleep c/ol abdominall bloating,l diarrhea,l constipation,l orl alternatingl patternl IBS-D,l IBS-C mayl c/ol mucusl inl stool ***bel surel tol establish:
- nol blood,l nol weightl loss,l nol fever,l nol nocturnall symptoms 0askl aboutl familyl hxl ofl colonl CA,l inflammatoryl bowell disease
- meds,l dietaryl review
- stressl management
QUESTION
IBSl alarml features Answer: agel ofl onsetl afterl agel 50 l rectall bleedingl orl melena nocturnall diarrhea progressivel abdominall pain unexplaiendl weightl loss laboratoryl abnormalitiesl (ironl deficiencyl anemia,l elevatedl CRP,l orl fecall calprotectin/l lactoferrin) familyl hxl ofl IBDl orl colorectall cancer
QUESTION
IBSl PEl andl dx Answer: carefull abdl exam,l pelvicl exam,l rectall exam dx:
- CBCl (bewarel leukocytosisl orl ironl deficeicnyl anemia)
- ESR
- BSl (r/ol diabeticl gastroenteropathy)
- TSH
- IgAl antil tissuel transglutaminasel TTGl (celiacl sprue) stool:
- fecall calprotectinl orl fecall lactoferrin +/-l stooll tests/l giardial dependingl onl hx +/-l hydrogenl breathl testl (orl 3 l weekl triall ofl lactosel freel diet) considerl GIl referrall forl scopel ifl dxl isl unclearl orl ifl poorl responsel tol therapy agel appropriatel colorectall screen,l pelvicl USl ifl pelvicl causesl al concern
QUESTION
IBSl management Answer:
- education,l reassurance
- dietaryl modifcation-l dietaryl hx/l journal,l fodmap,l gluten,l lactose
- physicall activity
- possiblel foodl allergyl testingl unclear
QUESTION
constipation Answer: mostl commonl digestivel complaintl inl thel generall populationl andl isl associatedl withl substantiall economicl costs acute:l recentl surgery,l immobility,l pain,l medication,l opiods chronic:l variedl infrequenlyl constipationl inl thel firstl manifestationl ofl metabolicl (DM,l hypothyroid,l hypecalcemia,l neuroloic,l obstructivel intestinall disease) morel commonl inl women,l nonwhitesl andl thosel > lowerl activity,l lowl income,l lowerl education
QUESTION
ROMEl IVl criterial forl constipation Answer: 1 l orl morel ofl thel following 1
- strainingl duringl morel thanl 25%l ofl defecations
- lumpyl orl hardl stoolsl inl morel thanl 25%l
- sensationl ofl incompletel evacuationl forl morel thanl 25%
- sensationl ofl anorectall obstruction/l blockagel forl morel thanl 25%
- manuall maneuversl tol faciliatel morel thanl 25%l ofl defecationl (digitall evacuation,l supportl pelvicl floor) 2 l loosel stoolsl arel rarelyl presentl withl thel usel ofl laxatives 3 l insufficentl criterial forl iBS
QUESTION
evaluationl withl constipation Answer: al recentl al persistentl changel inl bowell habits,l ifl notl associatedl withl al readilyl definablel causel ofl constipationl shouldl promptl anl evaluationl tol excludel structurall bowell changesl orl organicl disease thisl isl particularlyl importantl inl olderl adultsl whol complainl ofl excessivel strainingl orl al sensel ofl incompletel evacuationl orl whol alsol exhibitl anemial orl occultl GIl bleeding al dxl ofl functionall constipationl shouldl bel consideredl onlyl afterl thesel diseasesl havel beenl excluded
QUESTION
PEl withl constipation
Answer: generall PEl notl helpful,l rectall examl oftenl helpful canl identifyl hemorrhoids abnormall anall opening canl evaluatel sphincterl musclel tone laboratoryl data:l CBC,l glucose,l creatinine,l calcium,l thyroid-stimulatingl hormonel shouldl bel performedl inl ptsl withl hematochezia,l weightl lossl ofl >10l lbs,l familyl hxl ofl colonl cancerl ofl inflammatoryl bowell disease,l anemia,l orl positivel fecall occultl bloodl tests flexiblyl sigmoid
QUESTION
dxl constipation Answer: flexiblyl sigmoidl orl colonscopyl if:
- ptsl agedl >50l yol presentl withl constipationl whol havel notl previouslyl hadl colonl cancerl screening.l thisl agel isl youngerl inl ptsl withl familyl hxl ofl colorectall cancer
- ptsl withl constipationl andl alarml featuresl (rectall bleeding,l hemel positivel stool,l ironl deficiencyl anemia,l weightl lossl >10l lbs,l obstructivel symptoms.l familyl hxl ofl colorectll cancerl orl inflammatoryl bowell disease)
QUESTION
managementl ofl constipation Answer: initall managementl ofl ideopathicl chronicl constipationl includesl ptl education,l dietaryl changes,l bulkl formingl laxatives,l and/orl thel usel ofl nonl bulkl formingl laxativesl orl enemas surfactant-l ducosatel sodium,l lessl effecgivel thanl other osmoticl laxatives:l polyethylenel glycoll (PE)-l mirlax...l carefull ofl electroyltes stimulantl laxatives:l disacodyll orl senna....cautionl longl term
QUESTION
managementl ofl severel constipation Answer: suppositories,l disimpaction,l enema,l maybel contrastl enemal withl fluoroscopyl tol ensurel nol obstructionl (avoidl sodiuml phophatel enemasl inl thosel >70)-l electrolytel freel PEGl solution guanylatel cylasel Cl receptorl agonistl stimulatesl intestinall fluidl secretionl andl transit
stooll forl cl diff
QUESTION
cl diff Answer: graml +l anaerobicl bacterium mostl commonl healthcarel associatedl pathogen.l riskl factors:l abxl usel quinolones,l clindamycin,l increasedl age,l hospitalization,l severel illness,l gastricl acidl suppression,l GIl surgery symptomsl mildl tol fulminantl diseasel withl toxicl megacolon cardinall signsl :l wateryl diarrhea,l abdl pain,l cramping,l lowl gradel temp,l nausea,l leukocytosis suspectl cl diffl withl significantl diarrheal >3l loosel unformedl stoolsl inl 24 l hrsl orl ileusl withl riskl facotrsl (abxl use,l hospitalization,l advacingl age) ifl asymptomatic,l nol needl tol testl orl treat
QUESTION
cl diffl differnentialsl andl guidelines Answer: dx-l molecylarl NAATsl canl misdiagnose imagingl warrentedl forl severel illnessl ofl fulminantl colitisl (severel abdmoninall pain,l abdominall distentionl withl ilius,l fever,l hypovolemnia,l lacticl acidosis,l hypoalbuminemia,l leukocytosis) differentiall dx:
- acutel abdomen,l shock,l infectiousl diarrhea,l nonl infectiousl dirrhea txl guidelines
- initiall presentationl mild/moderatel =l 10 l dayl coursel ofl vancol orl fidaxomicin recurrance-l ifl atl leastl 3 l occurrancesl ofl CDIl thenl considerl fecall transplant
QUESTION
loperamidel abuse Answer: immodiuml isl approvedl tol helpl thel managmetl ofl diarrheal includingl travelsl diarrhea worksl onl opiodl receptorl inl thel stomachl tol slowl downl thel movementl inl thel intestines canl causel seriousl cardiacl eventsl atl highl doses-l QTl prolongation,l torsades,l ventricularl arrythmia,l syncoe limitingl thel numberl ofl dosesl perl pack
QUESTION
dyspepsia Answer: chronicl orl recurrentl painl centeredl inl upperl abdomenl atl leastl 20%l ofl populationl effected diff/;l GERD,l PUD,l biliaryl pain,l IBS,l drugl inducedl dyspepsial (NSAIDs,l bisphosphonates,l erthyrmycin),l gastricl pain,l cardiacl pain
QUESTION
managmentl ofl dyspepsia Answer: CBC,l LFT,l lytes,l amylase,l lipase
60:l endol forl definitivel dx <l 60 l withl nol alarml sx:
- testl forl Hl pylori:l ifl +l treatl andl confirml eredication.l ifl sxl persisitl triall PPIl 4 - 8 l weeks.l ifl persistl d/cl andl triall TCAl 8 - 12 l weeks.l ifl persistl triall prokineticl forl 4 l weeks ifl negl triall 4 - 8 l weeksl ofl PPIl ifl persistentl d/cl andl triall TCAl 8 - 12 l weeks.l ifl sxl persistl triall prokineticl (metoclopramide )
QUESTION
PUD
Answer: ***Majorl riskl factors:l hl pyloril andl NSAIDl use duodenall ulcer:l 80%,l hl pyloril enhancesl mucosall susceptibilityl tol injuryl byl acidl andl pepsinl (testingl inl stool) gastricl ulcers:l peakl incidencel 55 - 64 l yo,l associatedl withl NSAIDl usel (blockl prostaglandins/l directl irriation),l ETOH,l smokingl
- 15%l ofl thosel onl longl terml NSAIDsl developl ulceration/riskl higherl inl elderly
- 90%l ofl thosel notl causedl byl NSAIDl arel relatedl tol Hl pylori
QUESTION
ulcerl presentation Answer: gastric
- epigastric,l upperl abdomen,l knife-like,l burning,l gnawing,l mayl radiatel tol back,l substerum,l mayl bel provokedl byl food,l mayl bel relievedl byl antcids
QUESTION
hl pyloril tx Answer: +l ulcers
- abx/PPIl txl asl perl priorl slidel withl avoideancel ofl NSAIDS
- concurrentl PPIl therapyl reducesl riskl ofl ulceration,l considerl asl prophylaxisl
- f/ul breathl testl orl endoscopyl tol documentl eradication
- fourl tol sixl weeksl afterl txl completed
- avoidl ETOH,l smoking,l coffee,l corticosteroids
- l ulcers
- acidl suppressionl therapyl 6 - 12 l weeks,l H2l blocker,l PPIl preferred,l endol tol confirml healing
QUESTION
GERD
Answer: symptomsl ofl mucosall damagel producedl byl thel abnomrall refluxl ofl gastricl contentsl intol esopagus symptoms
- hearburn:l worsel afterl eating,l lyingl down,l bendingl forward,l nighttimel symptomsl common,l chestl painl thatl mimicsl angina reguritation
- sourl taste,l metallic,l sorel throat,l cough/asthma/hoarseness/sorel throat dysphagia/odynophagia:l withl severel erosion,l maligancy,l infection,l alarml symptom dentall erosion/l gingivitis nausea waterl brashl (hypersalivation)
QUESTION
alarml featuresl ofl GERD Answer: newl onsetl dyspepsial inl ptsl > evidencel ofl gastrointestinall bleedingl (hematemesis,l melena,l hematochezia,l occultl bloodl inl stool) ironl deficiencyl anemia anorexia unexplainedl weightl loss dysphagis
odynophagia persisentl vomiting GIl cancerl inl firstl degreel relative
QUESTION
GERDl aggrevatingl facors Answer: largel meals coffee,l tea,l chocolate,l peppermint,l fattyl foods,l citrs,l spicy,l concentratedl sweets,l tomatol basedl foods,l variousl meds,l ETOH,l soda beingl overweight,l tightl closes.l lyingl downl soonl afterl eating,l smokimg importantl tol categorizel thel severity
- mild:l lessl thanl twicel perl week
- severe:l morel thanl twicel perl week
QUESTION
GERDl managment Answer: smokingl cessation,l decreasel ETOH,l reducel meall size,l reducel fatl intake weightl reductionl ifl overweight,l elevatel headl ofl bedl 6 l inches avoidl beingl supinel forl 2 l hoursl afterl eatingl mildl symptoms: usel lowl dosel H2l blocketsl withl concommitantl antacidsl ifl lessl thanl oncel al weeks canl addl H2RAl (famotidine0l twicel dailyl forl 2 l weeksl - >l PPIl (omeprazole,l pantoprazole)l forl atl leastl 8 l weeksl tol assessl forl efficacyl severe:l
- PPIl dailyl forl 8 l weeksl
- thenl H2RAl
- ultimatelyl d/cl accl acidl suppressionl inl asymptomaticl ptsl exceptl ifl theyl havel Barrett'sl esophagusl (needl PPI)
- willl needl endoscopyl ifl nol identifiedl barrettsl andl sxl persist
QUESTION
barrett'sl esophagus Answer: metaplasticl columnarl epitheliuml hasl bothl gastricl andl intestinall featuresl replacesl thel stratifiedl squamousl epitheliuml thatl normallyl linesl thel distall esophagus.l developsl asl al
thyroidl nodules Answer: mostl commonl endocrinel probleml inl thel US,l 1 - 10 l people,l <10%l arel malignant usuallyl nol symptoms=l incidental ifl itl producesl itsl ownl hormone,l canl causel hyperthyroidism canl causel al neck,l jawl orl earl pain obstructivel sxl ifl largel dysphagia,l SOB,l 'ticklel inl throat' ifl largel enoughl canl causel hoarsness
QUESTION
thyroidl nodulel concernigl forl cancer Answer: hardl andl fixed dysphagia,l dyspnea,l swellingl ofl lymphl nodesl inl neckl andl jaw hoarnessl (suggestsl laryngeall compression)
QUESTION
thyroidl nodulel workl up Answer: firstl assessl TSHl andl T4,l mostl patientsl wl nodulesl havel normall thyroidl function lowl TSHl mayl indicatel nodulesl arel likelyl producingl thyroidl hormone highl TSHl suggestsl autoimmunel inflammationl ofl thel thyroidl (Hashimoto)
QUESTION
USl ofl thyroidl nodules Answer: canl assessl nodulel #l andl location,l sizel andl canl identifyl featuresl ofl cancer canl telll ifl itsl cysticl orl solidl (l concern) can'tl accessl ifl itsl functioningl orl notl andl ifl itsl cancenl orl not
QUESTION
thyroidl scan Answer: usesl radioactivel substancesl tol determinel ifl nodulel isl fucntionall andl helpsl tol determinel ifl biopsyl isl needed
canl determinel liklihoodl ofl cancerl butl can'tl determinl typel ofl type
QUESTION
thyroidl scanl results Answer: 'cold'=l nonl functioing,l notl takingl upl radioactivel dye,l needsl bxl (suspeicious) 'functioning'=l radioactivel uptakel similarl tol normall thyroidl tissue,l liklihoodl ofl cancerl low,l bxl notl needed 'hot'=l uptakel greaterl thanl normall thyroidl cells,l cancerl extremelyl rare,l bxl notl needed.l usuallyl indicatesl hyperthyroidl state
QUESTION
thyroidl finel needlel aspirationl biopsy Answer: inl office locall anesthetic nol speciall prep quickl <30l min ptsl canl returnl tol usuall activitiesl immediatelyl after 5 - 6 l samplesl takenl froml mostl suspiciousl nodulesl canl takel 2 - 3 l weeksl tol comel backl notl alwaysl diagnostic
QUESTION
FNAl reportl f/u Answer: benign:l 50 - 60%l arel anl overgrowthl ofl normaltl thyroidl tissue,l generallyl dol notl requirel surgicall removal,l butl mayl needl tol bel re-biopsiedl ifl theyl growl (missedl cal <3%) maligant:l 5%,l mostlyl papillaryl ca,l needsl surgicall removal suspicious-l 10%l canl bel eitherl follicularl adeneomal (benign)l orl follicularl cal (needsl surgicall removall forl definitivel dx) nondiagnositc:l 20%,l notl enoughl tol makel dx,l typicallyl al cyst
QUESTION
riskl factorsl forl thyroidl cancer Answer: Childhoodl irradiationl tol headl andl neck
- HCGl ifl indicated
- U/A
- seruml chemistryl (includingl LFTl andl BS) ***amylasel (risesl 6 - 12 l hoursl afterl onsetl ofl symptoms)l butl doens'tl alwaysl becomel elevatedl especiallyl inl drinkers)l andl mayl returnl tol normall afterl 2 - 3 l days ***lipasel (risesl 4 - 8 l hoursl afterl onsetl ofl sxl speaksl atl 24 l hrsl andl returnsl tol NLl inl 8 - 14 l days)l elevatedl inl drinksl andl non-drinkersl alike
QUESTION
dxl withl pancreatitis Answer: diagnosisl ofl acutel pancreatitisl requiresl thel presencel ofl twol ofl thel following:
- acutel onsetl ofl persistent,l severe,l epigastricl painl oftenl radiatingl tol thel back
- elevationl inl seruml lipasel orl amylasel orl threel timesl orl greaterl thanl thel ULN
- characteristicl findingsl ofl acutel pancreatitisl onl imagingl (CT,l MRIl orl transabdominall US)
QUESTION
mortalityl r/tl pancreatitis Answer: remember...l initiall clinicall picturel isl notl al reliablel indicatorl ofl whatl isl tol come...l mildl presensationl mayl deterioratel rapidly,l particularlyl withl thosel >55....l Ransonl criteria treatmentsl varyl dependingl onl severity
- fluidl replacement,l nutritionl eitherl entrall orl parental,l painl managment,l abxl neededl inl aprox.l 20%l duel extraparcreaticl infection
QUESTION
etiologyl ofl acutel pancreatitis Answer: mechanical:l gallstones,l biliaryl studge,l duodinall structurel orl obstructionl etc toxic:l ethanol,l methanoll etc metabolic:l hyperlipidemia,l hypercalcemia drugs:l antifungal,l furosimide,l thiazide,l valproicl acid infection:l viral trauma:l bluntl orl pentratingl abdominall injury
QUESTION
ulcerativel colitis
Answer: chronicl inflammatoryl bowell diseasel characterizedl byl recurringl episodesl ofl inflammationl limitedl tol thel mucosall layerl ofl thel colon.l itl commonlyl involvesl thel rectuml andl mayl extendl tol otherl partsl ofl thel colon clinicall presentation:l usuallyl presentl withl diarrhea...l possiblyl bloodl andl mucusl associatedl symptoms:
- colickyl adbominall pain
- urgency
- tenesmus
- incontinence
- erythemal nodosuml (redl nodulesl onl shins)
- pryodermal gangrenosuml (earlyl lesionl inl pydermal gangrenosuml presentsl asl al pustularl plaque)
- potentiall forl extral intestinall manifestations
QUESTION
ulcerativel colitis Answer: chronicl inflammaotryl bowell diseasel characterizedl byl recurringl episodesl ofl inflammationl limitedl tol thel mucosall layerl ofl thel colon.l commonlyl invovlesl thel rectuml andl mayl entendl tol otherl partsl ofl colon usuallyl presentl withl diarrheal andl orl mucus associatedl symptoms
- colickyl abdominall pain
- urgency
- tenesmus
- incontinence
- potentiall forl extraintesitnall manifestations
QUESTION
extraintestinall manifestations Answer: aproxl 10%l havel thesel atl dx,l althoughl 25%l willl havel atl somel pointl inl theirl lifetime musculoskeletal:l arthritis eye:l uveitis,l episcleritis derm:l erythemal nodosuml andl pyodermal gangrenosum heptaobiliary:l NAFLD hematology:l increasedl riskl ofl venousl andl arteriall thromboemolism
QUESTION
ulcerativel colitisl endoscopyl andl colonscopyl results Answer: endoscopicl findingsl inl thel ptl withl ucl arel nonl specific biopsiesl ofl thel colonl arel necessaryl tol establishl chronicityl ofl inflammationl tol r/ol otherl cuasesl ofl colitis findingsl include:l lossl ofl vascularl markingsl duel tol mucosal engorgement.l mucosal mayl exhibitl peteachiae,l edema,l exudates,l erosions,l spontagneousl bleeding
QUESTION
treatmentl forl ulcerativel colitis Answer: initall approachl mild-moderatel disease
- topicall 5 - ASAl isl firstl linel forl thosel tol usel rectall therapy.l remissionl 90%
- topicall steriodsl canl bel usedl butl notl preferred severe:
- orall steriodsl inl combinationl withl orall dosel 5 - ASAl orl steriodl supp
QUESTION
chrohn'sl disease Answer: inflammatoryl conditionl ofl unknownl etiologyl thatl causesl transmurall inflammationl ofl GIl tract,l itl canl affectl anyl portionl ofl thel GIl tractl froml mouthl tol anusl (80%l smalll bowell involvement)l clinicall manifestations:l morel variedl thanl ucl andl oftenl havel symptomsl forl yearsl priorl tol dx s/s
- prolongedl diarrheal withl abdominall painl **
- fatigue,l weightl loss**
- anemia,l B12l deficiency,l vitl Dl deficiency
- steatorrhea
- fever
- mayl orl mayl notl havel grossl bleeding
- fistulasl orl abcesses
- extreintestinall involvement
- increasedl riskl cancerl hasl beenl reported,l findingsl arel controversial
QUESTION
extraintestionall manifestationsl ofl UC Answer: typicallyl relatedl tol inflammatoryl diseasel activity similarl tol UC:l arthritis,l episcleritis,l dermatologic morel specificl findingsl tol CD:l cholangitis,l renall stonesl (duel tol steatorrheal andl diarrhea),l bonel lossl (duel tol malabsorption),l pulmonaryl manifestations
QUESTION
chrohn'sl diseasel PE/l andl dx Answer: diagnosisl establishedl withl endoscopicl findingsl orl imagingl studiesl inl al ptl withl compatiblel hx PE:
- maybel normal
- abnormall tenderness
- pallor
- weightl loss
- perianall skinl tags
- sinusl tracts labs:
- l CBC,l lytes,l BG,l renall function,l ESR,l CRPl (usuallyl higherl inl CDl thanl UC),l seruml iron,l B12l andl Vitl D
- ifl diarrheal present,l stooll cxl forl c-diff,l Ol &P,l maybel fecall calprotectinl otherl serologyl markers:
- aidl inl thel dxl andl severityl designationl ofl CD,l althoughl accuracyl andl predictivel valuel arel undetermined egl pANCA-antineutrophill cytoplasmicl antibodies,l ASCAl anti-saccharomycesl cervisiasel antibodies,l anti-OmpCl antibody
QUESTION
chronsl dx Answer: ileocolonoscopy-l colonscopyl withl intubationl ofl terminall illeusl inl usedl tol establishl al dxl ofl CD featuresl include:l focall ulcerationsl adjacentl tol areasl tol normall appearingl mucosal alongl withl polypoidl mucosall changesl thatl givesl al cobblestonel appearance
- wirelessl capsulel endoscopy
