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SARAH MICHELLE LIVE REVIEW EXAM
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SARAH MICHELLE LIVE REVIEW EXAM
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SARAH MICHELLE LIVE REVIEW EXAMA new graduate nurse practitioner has a patient presents with a hearing complaint.
The patient states that they have had decreased hearing on the right side for the last
month that is continuing to get worse. The NP completes both the Rinne and Weber
tests. If the patient has Ménière's disease, what would be the expected finding on the
Weber test?
1. AC is 2 times longer than BC
2. BC is 2 times longer than AC
3. The tuning fork lateralizes to the right ear
4. The tuning fork lateralizes to the left ear - ANSWER 4. The tuning fork lateralizes
to the left ear
What are common signs and symptoms of Meniere's Disease? - ANSWER Vertigo,
tinnitus, ear pressure, nystagmus
What is our biggest worry for a Meniere's Disease patient? - ANSWER There is a
possibility for a potential, permanent hearing loss.
What is rhinitis meidcamentosa? - ANSWER Drug-induced rebound nasal
congestion, this can happen after use of nasal decongestants like Afrin. These nasal
decongestants should ideally not be used for greater than 3-5 days because of this
risk.
What is herpes keratitis? - ANSWER This is an infection of the cornea due to herpes
simplex virus
How is herpes keratitis diagnosed? - ANSWER By examining the eye under a black
lamp and visualized the cornea, in herpes keratitis, fern like lines will be seen on the
cornea
A child that has a history of mononucleosis is at increased risk for development for
what cancer later in life? And why? - ANSWER Hodgkin's Lymphoma and Burkitt's
Lymphoma, this is due to the exposure of the Epstein-Barr virus
What types of patients will be at a higher risk of pneumonia? - ANSWER Patient with
chronic lung diseases: asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? - ANSWER
Because we WANT them to get that gunk out, we do not want them to hold it in their
lungs, an expectorant would be a better option for these patients.
When should a follow up chest X-Ray be completed after treatment of pneumonia? -
ANSWER Around 8 week mark
What is COPD? - ANSWER Chronic Obstructive Pulmonary Disease. This is a
chronic condition that is made up of chronic bronchitis and emphysema. It is a
progressive inflammatory lung disease that makes it hard for the patients to breathe,
,because the chronic bronchitis leads to mucous build up and the emphysema portion
destroys areas of the lungs.
What signs and symptoms are common in COPD patients? - ANSWER Chronic
cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? - ANSWER
Neurological symptoms, paresthesia (numbness and tingling in hands and feet),
unsteady gait, memory issues
Beefy red tongue
What diet can result in B12 deficiency? - ANSWER Vegan- oral supplements can be
used for treatment
What surgery can result in B12 deficiency? - ANSWER Gastric surgery- patient will
lose intrinsic factor that is required to absorb B12- these patients will require life long
IM B12 injections
What patient population is lupus commonly seen? - ANSWER Women of
childbearing age- ages 15-45, African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? - ANSWER Must have 4/11 diagnostic
criteria:
Malar rash
Discoid rash
Photosensitivity
Oral/nasal ulcers
Non-erosive arthritis
Cardio-pulmonary complaints
Renal complaints
Neurological concerns
Immunological disorders
+ ANA test
Hematologic disorders
What is Sjogren's Syndrome and what is the treatment? - ANSWER Dry eyes and
dry mouth- treatment revolves around symptom management- artificial tears, hard
candies, etc.
Common in lupus patients
What is a major concern for lupus patients? How do we monitor this? - ANSWER
Impact on the kidneys- Lupus nephritis
Be on the look out for glomerularnephritis as well as proteinuria
These patients will require routine UA for assessment of their kidneys and protect
them
What is the function of the thyroid? - ANSWER Viral hormone gland
,Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? - ANSWER Pituitary gland
What is the function of TSH? - ANSWER Tells your thyroid when to produce and
release those critical thyroid hormones- T3 and T4.
What disorders include hypothyroidism? - ANSWER Iodine deficiency, Hashimoto's,
or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? - ANSWER
Hypothyroidism is caused by an autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? - ANSWER Weight gain,
constipation, dry skin, cold intolerance, fatigue, course hair, facial puffiness, thick
tongue, and maybe some cardiac side effects
What patient education must be included regarding Synthroid administration? -
ANSWER Must be taken on an empty stomach before other medications
What are signs and symptoms of a myxedema coma? - ANSWER Low body
temperature, edema, confusion, lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? - ANSWER Lithium or
amiodarone
Your patient who is on 75 mcg Synthroid PO daily comes in for a 6 week follow up to
check their TSH level. When you get the results, their TSH is 0.1. What should you
do next as the NP? - ANSWER Assess how the patient is taking their Synthroid
What signs and symptoms are common in hyperthyroidism? - ANSWER Anxiety,
palpitations, cardiac abnormalities, tachycardia, diaphoresis, weight loss, and
increased appetite, menstrual irregularities, amenorrhea, tremors, lid lag,
exophthalmos
What needs to be considered with PTU medication administration? - ANSWER Need
frequent lab work: CBC, and Thyroid panel
Required to take PTU multiple times a day
What is the most common treatment for Grave's Disease? - ANSWER Radioactive
iodine therapy
Hyperthyroidism left untreated may lead to what conditions? - ANSWER Heart
disease- patient's heart is in a constant high-output state, your heart can't keep up
with that all of the time, may lead to heart failure
Osteoporosis
Infertility
, What is worst case scenario in hyperthyroid patients? - ANSWER Thyroid storm-
Temperature, HR, and BP- dangerously HIGH levels
Puts body into compromised state, especially impacting your heart. Heart starts to go
into Letha dysrhythmias and even heart failure.
What are the 8 most common drug classes for diabetes medications? - ANSWER
Biguanides (Metformin)
DPP-4 inhibitors
GLP-1 Agonists
SGLT-2 inhibitors
Insulin
Sulfonylureas
TZDs
Alpha-glycosides inhibitors
Why are type 1 diabetics insulin dependent? - ANSWER They have an autoimmune
destruction of their beta cells
What are some examples of rapid acting insulin? - ANSWER Humalog, Novalog,
Apidra
What is the onset, peak, and duration of rapid acting insulin? - ANSWER Onset: 15
minutes
Peak: 1 hour
Duration: 2-4 hours
What are some examples of short acting insulin? - ANSWER Regular insulin
(Humulin R, Novolin R)
What is the onset, peak and duration of short acting insulin? - ANSWER Onset: 30
min- 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
What are some examples of intermediate insulin? - ANSWER NPH (Humulin N,
Novolin N)
What is the onset, peak, and duration of intermediate insulin? - ANSWER Onset: 1-2
hours
Peak: 6-12 hours
Duration: 24 hours
What are some examples of long acting insulin? - ANSWER Lantus, Levemir
What is the onset, peak and duration of long acting insulin? - ANSWER Onset: 2
hours
Peak: NONE
Duration: 24 hours
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