NSG 6420 WEEK 3 QUIZ
1.
Susan P., a 60-year-old woman with a 30 pack year history, presents to your
primary care practice for evaluation of a persistent, daily cough with increased
sputum production, worse in the morning, occurring over the past three months.
She tells you, “I have the same thing, year after year.” Which of the following
choices would you consider strongly in your critical thinking process?
Seasonal allergies
Acute bronchitis
Bronchial asthma
Chronic bronchitis
2.
The pulmonary component includes an abnormal inflammatory response to
noxious stimuli, principally tobacco, but also occupational and environmental
pollutants. The hallmark of chronic bronchitis is a daily chronic cough with
increased sputum production lasting for at least 3 consecutive months in at least 2
consecutive years, usually worse on awakening; this may or may not be
associated with COPD (GOLD, 2011). Emphysema is characterized by
obstruction to airflow caused by abnormal airspace enlargement distal to
terminal bronchioles.A
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced
Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14.
VitalBook file. (page 206)
3.
A patient presents complaining of a 5 day history of upper respiratory symptoms
including nasal congestion and drainage. On the day the symptoms began he had a
low-grade fever that has now resolved. His nasal congestion persisted and he has
had yellow nasal drainage for three days associated with mild headaches. On exam
he is afebrile and in no distress. Examination of his tympanic membranes and
throat are normal. Examination of his nose is unremarkable although a slight
yellowish-clear drainage is noted. There is tenderness when you lightly percuss his
maxillary sinus. What would your treatment plan for this patient be?
Observation and reassurance
Treatment with an antibiotic such as amoxicillin
Treatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanate
, Combination of a low dose inhaled corticosteroid and a long acting beta2 agonist
inhaler.
4.
A previously healthy 24 year old man presents at a clinic in Southern New England
ten days after a weekend camping trip. He reports the appearance of a painless skin
lesion on his right thigh five days previously. He now notes malaise, low-grade
fever, and migrating joint pain of 48 hours duration. Careful questioning fails to
elicit any recent history of an insect bite. The lesion on the thigh had begun to fade,
but you recognize an area of central clearing with an erythematous margin. Further
examination reveals a second, similar lesion near the right axilla. Question: The
patient referred to in the scenario returns three days later complaining of worsening
weakness and lightheadedness. His pulse is 42 and his pressure in the supine
position is 90/40. You quickly obtain an EKG, which reveals third degree heart
block. The best management at this point would include: A) Add oral cefuroxime
500mg po bid to his antibiotic regimen. B) Stop all antibiotics immediately and
administer Benadryl 50mg intramuscularly stat. C) Administer atropine 1mg
intravenously, observe the patient for 4 hours and discharge if he remains stable.
D) Admit the patient for cardiac monitoring and begin intravenous ceftriaxone 2g
per day. E) Stop all antibiotics immediately and admit the patient for
electrophysiological studies.
The correct answer is: D About 8% of patients with Lyme disease will develop
cardiac involvement, usually some form of atrioventricular block. Patients with
third degree heart block should be treated with intravenous ceftriaxone until the
heart block resolves and then complete a 30-day course of oral antibiotics. The
development of neurological symptoms also requires treatment with intravenous
antibiotics. Ref: ID/ Harrison's 16, p. 996, 998/ RAL
5.
. When palpating the posterior chest, the clinician notes increased tactile fremitus
over the left lower lobe. This can be indicative of pneumonia. Areas of increased
fremitus should raise the suspicion of conditions resulting in increased solidity or
consolidation in the underlying lung tissue, such as in pneumonia, tumor, or
pulmonary fibrosis. In the instance of an extensive bronchial obstruction:
No palpable vibration is felt
Decreased fremitus is felt
Increased fremitus is felt
Vibration is referred to the non-obstructed lobe
Instructor Explanation: Areas of increased fremitus should raise the suspicion of
conditions resulting in increased solidity or consolidation in the underlying lung
tissue, such as in pneumonia, tumor, or pulmonary fibrosis. Conversely, areas of
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