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NRNP 6550 Exam Questions with Correct Answers
1. Vaccinations and immunosuppression. 2 keypoints: - give inactive agents instead of live agents
- might not work as effectively
2. live virus vaccine types: Virus:
- measles
- mumps
- polio (oral)
- rubella
- varicella
- yellow fever
- herpes zoster
Bacteria:
- typhoid
3. inactive vaccine virus: Virus:
- Hep A and B
- HPV
- influenza
- polio (subq)
- rabies Bacteria:
- anthrax
- cholera
- diphteria
- Lyme
- meningococcus
- pertussis
- plague
- pneumococcus
- tetanus
4. Immunization recommendation influenza: all ages, all types (pregnant, dia- betes, immunocompromised, etc)
5. Immunization recommendation pregnancy and weakened immune system: - 1 dose Tdap
- no varicella, zoster, MMR
6. HIV and vaccinations: Give inactive agents when CD4 count is greater than 200 cells/ mm
- Inflammation of conjuctiva (outer layer of eye)
11. Conjunctivitis: causes: Chemical, bacterial, viral, allergic, herpetic. Aden- ovirus is the most common cause, but
bacteria (Haemophilus influenzae and Strep- tococcus pneumoniae) are also common causes in children.
12. Conjunctivitis: findings: - redness
- itching
- discharge
- edema eyelid
- may find gonorrhea or chlamydia in eye discharge
13. Conjunctivitis: management: - cooling
- rule out corneal abrasion
- bacteria: antibiotic solution (gentamicin, neomycin)
- chlamydia: oral tetracycline or erythromycin
- gonorrhea: single dose ceftriaxone
- herpes: refer to opthalmologist
14. Corneal abrasion: definition, cause, findings, treatment: - disruption of cornea (clear covering of eye)
- foreign body/ trauma
- pain, redness, photophobia, decreased visual acuity
- ab ointment: gentamicin, sulfacetamide, eye-patch, ophthalmologist
15. diabetic retinopathy: definition, cause, findings, treatment: - ocular retinal disease due to DM
- DM, exac by smoking and HTN (macular edema)
- flashing lights in vision, blurred vision, black spots, loss of vision, sustained glucose greater than 130
- Laser therapy for macular edema, smoking cessation, glucose control, BP control
16. retinal detachment: definition, cause, findings, treatment: - separation of retina and choroid
- trauma, intraocular mass, iris inflammation, cataract surgery, DM, sickle cell
- painless vision changes, blurred vision, light flashes, "curtain" over visual field, bullous elevation without tears
- ophthalmologist for cryotherapy, laser therapy, vitrectomy. If from trauma: eye patch
17. Central & Branch Retinal Artery Occlusion: definition, cause, findings, treatment: - abrupt blockage of
retinal artery causing sudden vision loss> will become permanent without intervention
- thrombosis/ embolism, arteritis (migraine, older age, afib, DM, HTN, coagu- lopathies)
- sudden, painless vision loss, sluggish pupil, cherry-red spot at fovea
- EMERGENCY. Put pressure on eyelid, heparin, immediate consult opthalmolo- hgist. check coagulopathies, check labs for artherosclerotic disease, blood cultures (endocarditis?),
18. Glaucoma: definition, cause, findings, treatment: - progressive visual loss, first peripherally then centrally:
membrane with rupture
- ab's (amoxi - 10 days), analgesic for pain, ENT for recurrent
22. vertigo: definition, cause, findings, treatment: - dizziness
- vestibular neuronitis, meniere disease, damage to CN 8 (meningitis, trauma), damage to brain stem nuclei, syphilis, drugs, dm, TIA/ CVA
- dizziness, tinitis, N/V, "full" ear, Romberg sign (sways/ falls with eyes closed)
- TSH (to rule out hypothyroidism), CT/ MRI, glucose, treat symptoms/ bedrest, vestibular suppressants (meclizine, diazepam, scopalamine), antiemetics. low salt and diuretic with meniere
23. epistaxis: definition, cause, findings, treatment: - nosebleed
- forceful expiration, winter, trauma, sinusitis, HTN, coagulopathies
- bleeding from nose
- head erect and elevated, cotton ball with Afrin, topical lidocaine, nasal packing
24. sinusitis: definition, cause, findings, treatment: - inflammation of the sinuses
- upper respiratory infections, neoplasms
- pain, headache, congestion
- ab's (amoxi, doxycycl), analgesics
25. pharyngitis: definition, cause, findings, treatment: - inflammation of pharynx, often with tonsillitis
- viral (influenza A & B, Adeno) (most common), bacterial (streptococcus), fungal
- pain, fever. Viral: ulcers in oral cavity, edema of lymphoid tissue. Bacterial: white/ yellow exudate, swollen tonsils, bright red mucosa, high fever. Fungal: white spots
- rapid strep test, throat culture, mono spot, chlamydia testing, pain relief. Strep: AB's (Bicillin, Cephalxein, azithromycin. Candida/ fungal: Nystatin, fluconazole
26. Epiglottitis (Supraglottitis): definition, cause, findings, treatment: - inflam- mation of mucous membrane
resulting in airway obstruction because of swelling
- bacterial (H. influenza, streptococcus, S. aureus)
- voice change, dyspnea, anxiety, hoarse voice, drooling, don't examine pharync till x-ray done
- xr-neck, CT neck, xr chest, CBC, bld cult, monitor vitals, ER, protect airway (nasotracheal intubation), ab's (3rd cephalo: ceftriaxone or vanco, or clinda)
27. temporomandibular joint (TMJ) disorder: definition, cause, findings, treat- ment: - pain in joint
- rheumatoid arthritis, trauma, dentures, dental work
- pain, jaw clicking, earache
- NSAIDS, local heat, soft diet
Meds: take 6 - 8 wks to go into effect SSRI: citalopram, setraline, fluoxetine. Lower overdose or side effect potential.May add: effexor, cymbalta, buproprion or mirtazapine Tricyclic antidepressants and MAOI: overdose potential
33. bipolar disorder, 3 types: type 1: mania
type 2: depressive type 3: fluctuating between mania and depression
34. Bipolar treatment: Lithium and depakote. Antidepressants can cause mania.
35. Alcohol withdrawal treatment: - rehydration
- Thiamine
- Hypoglycemia prevention
- Benzodiazepines: diazepam and lorazepam
36. Anxiety treatment: - rule out physical cause
- meds:
- benzodiazepines: lorazepam
- buspirone (slow onset of action: 2 wks)
37. Delirium treatment: - identify and address the underlying cause
- optimize brain condition (O2, hydration, pain, etc.
- antipsychotics: haldol (im), lorazepam and zyprexa (po) for dementia. Lorazepam may worsen delirium in elderly.
38. SSRIs, which and side effects: - Fluoxetine, paroxetine, sertraline, citalopram
- takes 3 weeks to work
- safer than other antidepressants
- side effect: serotonin syndrome (shivering/ seizures)
39. MAOIs, which and side effects: - phenelzine
- postural hypotension, weight gain, sexual dysfunction
- avoid sauerkraut, wine, aged cheese, soy products: may cause hypertensive crisis
40. tricyclic antidepressants, which and side effects: - Amitriptyline, nortripty- line, imipramine, desipramine,
clomipramine, doxepin, amoxapine
- dry mouth, constipation, blurred vision, urinary retention, dizziness, tachycardia, delirium, orthostatic hypotension, weight gain, seizures, sexual dysfunction, arrhyth- mia
41. Antidepressants and Bipolar: Antidepressants and bipolar may cause mania
42. Systole: - contraction
- AV valves (tricuspid and mitral) close, semilunar (aortic and pulmonic) valves open
43. Diastole: - filling
- AV valves (tricuspid and mitral) open, semilunar (aortic and pulmonic) close
53. S4 heart sound: - atrial gallop
- heard at apex (with bell), before S
- atrial contraction filling noncompliant ventricle
- caused by myocardial infarction, hypertension, left ventricular hypertrophy, heart failure
- Ten-ne-see
54. early diastolic murmur: sounds as, heard best at, means: - decrescendo, high pitch
- patient sits forward and holds breath
- Aortic or pulmonic regurgitation (incompetent semilunar valves)
55. diastolic rumbling murmur: sounds as, heard best at, means: - sounds as: decrescendo - crescendo, low
pitched
- at apex
- mitral stenosis and tricuspid stenosis (rheumatic heart disease)
56. Midsystolic Ejection Murmurs: sounds as, heard best at, means: - crescen- do - decrescendo
- aortic area
- aortic or pulmonic stenosis
57. Pansystolic Regurgitant Murmurs: - blowing sound
- apex
- backward flow of blood. endocarditis
58. midsystolic click: mitral valve prolapse
59. Aortic ejection click: heard at apex, related to stenosis
60. pulmonic ejection click: heard at base
61. friction rub: sounds as, related to, heard best at: - scratchy
62. ECG Change with Hyperkalemia: - Tall and peaked T waves
- Prolonged PR Intervals
- Widened QRS
63. ECG Change with Hypokalemia: - U waves (following t wave)
64. ECG change with hypercalcemia: - AV block, BBB, bradycardia
65. ECG change with hypocalcemia: - bradycardia, ventricular ectopy, asystole
72. LDL - ATP III: <100 optimal
100 - 129 near optimal 130 - 159 borderline 160 - 189 high <190 very high
73. HDL: low: <40mg/dl high:
60mg/dl
74. Cholesterol goals for pt's with dm or CAD: LDL less than 70 HDL greater than 40
TG less than 150
75. Management of high cholesterol: - identify LDL, HDL, TGs (fasting lipid pro- file), clinical artherosclerotic
disease, and risk factors for CHD
76. Indications for statin therapy: - clinical evidence of ASCVD, age <
- LDL >
- DM age 40-75 with LDL between 70 - 189 (moderate to high)
- High intensity: adults >21 with LDL >
- Moderate intensity: adults 40 - 75 with DM
77. Statins: high/ moderate/ low dose: - High: Atorvastatin 20-40mg or rosuvas- tatin 20 - 40mg. Lowers LDL by
- Moderate: Atorvastatin 10 - 20mg, Rosuvastatin 5 - 10mg, Simvastatin 20- 40mg. Lowers LDL by 30 - 50%.
- Low: Simvastatin 10mg, Pravastatin 10-20mg. Lowers LDL by less than 30%.
78. Side effects of statins: - myopathy, hepatic dysfunction (monitor liver en- zymes!), abd pain, rhabdo, n/v
- many drug - drug interactions
79. metabolic syndrome: - 3 of these signs:
abdominal obesity triglycerides > 150mg/dl HDL <40 (men), <50 (women) BP >130 syst or >85 diast fasting glucose >
80. Treatment of metabolic syndrome: Treat underlying causes Treat HTN
Aspirin for pt's with CHD Treat elevated triglycerides or low HDL
81. Treatment of elevated triglycerides: - weight management, physical activity, avoid alcohol
- treatment DM
- reach LDL goal first. If still elevated triglycerides, then condider adding LDL lowering drug
- if triglyceride level greater than 500mg/dl, avoid pancreatitis! By: low fat diet, weight management, start omega-3- fatty acids or niacin
82. Risk factors for a myocardial infarction: CAD HTN
Metabolic syndrome obesity smoking DM 1 & 2
88. Emergency management of ACS: First 10min:
Aspirin 162-325 PO (plavix for allergy to aspirin) Nitro 0.4mg subli q5min (morphine 2-4mg q5-15min if unrelieved by nitro) O2 at 2-4ltr/min monitor vitals IV (cardiac enzymes and other labs drawn) pain assessment ECG within 10min xr chest For STEMI: start reperfusion therapy (PCI/ fibrinolysis) After admit: trend cardiac enzymes start betablocker for hemodynamically stable patients (25-50mg PO, end with 50-100mg PO BID) Optional for unastable angina/ high risk ischemia/ NSTEMI: hep. drip, to maintain PTT between 1.5 - 2 nitro drip to control pain consider need for PCI/ PTCA or CABG
89. Outpatient management of stable angina: - Nitrates before exertion and ex- tended nitro q8h
- Isosorbide TID
- B-blockers (contra-indication: brady, bronchospastic disease, HF)
- Ca-channel blockers: Diltiazem/ Verapamil (if B-blocker not tolerated)
90. Fibrinolytic therapy: indication, contraindications, which, aftercare: STEMI if PCI unavailable within 90min,
unrelieved chest pain longer than 30min, shorter than 6hrs, ECG changes (ST elevation) prior stroke (ICH or ischemic within 3mo), head trauma, brain tumor, TPA in last 6mo, aortic dissection, acute bleed, uncontrolled HTN, spinal surgery last 2mo, (dementia, pregnancy, peptic ulcer) t-PA, r-PA monitor for bleeds, treat with aspirin, heparin (PTT 1.5-2)
91. PCI: indications: MI when available in 90min, ST changes, new LBBB, angina
92. cardiac tamponade: findings, management: Beck's triad: jugular venous dis- tention, narrowing pulse pressure,
distant heart tones, tachy, shock state, echo confirms diagnosis, xr chest (widened mediastinum) Pericardiocentesis, shock treatment
93. PVD peripheral vascular disease: peripheral arterial disease and chronic ve- nous insufficiency
94. PVD risk factors: smoking, dm
95. PVD Findings: Six P's:
pain-intermittent claudication pallor pulse absent/ diminished paresthesias paralysis poikilothermic Peripheral edema
96. PVD Diagnostic Testing: Ankle-brachial index US doppler
Treadmill testing
