NRNP 6560 Midterm exam Questions and Correct

NRNP 6560 Midterm exam Questions and Correct Answers Updated Version 2023 Guaranteed Success Acute Fractures Management - Correct Answer- ABC care (Airway, breathing, circulation), musculoskeletal second survey

• fluid resuscitation
• early reduction of fracture
• cover open wounds
• surgical irrigation and debridement for open fracture

- Ab's: Cefazolin for gram pos. Clindamycin for tetani infection

- pain: opioids

• tetanus shot of unknown
• calcium upon discharge for osteoporosis
• cement injection in bone with vertrebroplasty

Acute liver failure: findings, management - Correct AnswerWeakness, fatigue

weightloss, n/v, abd pain Change in bowel pattern

• Check BMP, ABG, lactate, toxicology screen, acetaminophen screen, Hep panel, PT/

INR

- Treat specific etiology:

charcoal for acetaminophen and N-acetylcysteine) Supportive for Hep A and E Antiviral for Hep B Test for Wilson

• ICU management: watch for cerebral edema, hyperventilate if present, mannitol. CT

head for encephalopathy

Acute pancreatitis findings/ diagnostics - Correct Answer- Epigastric abd pain, abrupt, worse with walking or supine, better with knee to chest, leaning forward

• N/V
• hypoactive bowelsounds
• tachycardia, hypotension
• jaundice
• ascites

• Elevated lipase and amylase
• elevated urine amylase
• elevated trypsin levels
• leukocytosis
• Bili elevated
• Hypocalcemia if severe disease
• Low albumin 1 / 4

- xr abdomen: ileus, pancreatic calcifications, gallstones

• CT abdomen preferred over US, and MRI over CT

Acute pancreatitis management - Correct Answer- IV hydration - Fluid therapy to

prevent hypovolemia and shock: LR or NS with 20 K at 75- 100 ml/hr

• May need plasma, RBC, albumin
• Pain control - Morphine, Fentanyl
• AB's, not prophylactically, only when septic or biliary stones.
• NPO, then supplements, small frequent meals
• NG for ileus or vomiting
• replace electrolytes
• enteral feeding

acute pancreatitis: what and etiology - Correct Answerinflammation of pancreas

Alcoholism Gallstones Smoking Traumatic or hereditary Infectious (CMV) Meds: Sulfa drugs, thiazide diuretics, Lasix, Corticosteroids, Depakote, Opioids

Advanced HIV infection: definition, symptoms, prognosis - Correct AnswerCD4 below 50

Wasting, fevers, fatigue

Poor

AIDS, definition and diagnosis - Correct Answeracquired immune deficiency syndrome

CD4 low, below 500 and infection with opportunistic organism

Or:

CD4 below 200

Alcoholic liver disease: etiology, findings, management - Correct AnswerMost common cause of cirrhosis Women twice as sensitive to alcohol toxicity then men Binge drinking High mortality rate

Diagnosis on report of alcohol intake, evidence of liver disease, lab abnormalities AST and ALT often high than 2

Score for mortality: Maddreys' score

• Abstinence 2 / 4

- MDF score greater than 32: prednisone for 4 wks

• May require liver transplant

ANA. Tests in rheumatic disease: what, normal level, abnormal with. - Correct

AnswerAntinuclear antibody (ANA).

Normal: Titer 1.32

POsitive with: Sjogren's (SS), SLE (lupus),

Antiretroviral therapy (ART) - Correct Answer- Combination therapy, 3 or more from different drug classes

• Follow up with HIV viral load determination at 4 - 6 wks after initiation and then every 3
• 6 mo.
• Adherence is vital
• always assess drug- drug interactions/ medication reconciliation
• May make changes when CD4 exceeds evidence level
• check GFR/ creat/ BUN monthly for elderly on Tenofovir
• If deteriorating on ART (decline in CD4) then perform drug resistance testing and

revision of ART

Appendicitis findings and diagnostics - Correct AnswerAbd pain: periumbilical first, then right lower quadrant pain (McBurney's point)

Rovsing's sign: pain rlq when touched llq

Psoas sign: pain with extension of right hip

Obturator sign: pain with internal rotation right hip

Anorexia n/v constipation low grade fever motionless, right thigh up guarding rlq

Moderate leukocytosis

UA: elevated spec gravity, hematuria, pyuria, albuminuria

Ultra sound: very sensitive

CT to detect: perforation, periappendiceal abscess

Appendicitis Treatment - Correct AnswerMainstay treatment: surgery

IV fluids/ correct electrolytes

AB: Cefoxitin 1 - 2 gr

Tx for gangrenous/ perforated appendicitis:

• mild/ moderate severity: one AB or Cefazolin/ Ceftraixone/ Cipro/ Levaquin with Flagyl
• high risk/ severity (immunocompromised, old): Meropenem, Zosyn or Cefepime/ Cipro/

Levaquin with Flagyl.Narrow AB once culture results available

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Pain tx:

Dilaudid Morphine

Appendicitis: what and etiology - Correct AnswerAcute inflammation of the appendix.Caused by: fecalith (fecal stone), inflammation, intestinal worms, strictures, tumors.Gangrene and perforation if not treated within 36hrs.

Assessment of surgical risk - Correct Answer- Unstable cardiac condition (recent MI, active angina, active HF, uncontrolled HTN, severe valvular disease), concern with CAD, CHF. arrhythmia, CVD

• patient stable or unstable?
• urgency of the procedure (oncology will be time sensitive)
• risk of procedure
• nutritional status
• immune competence
• determine functional capacity (need to be more than 4 METS, more than 10 METs

makes low risk)

Autoimmune hepatitis: what, etiology, findings, management - Correct

Answerunresolving inflammation of liver with unknown cause

More women than men

• Abnormal serum globulins and presence of autoantibodies
• Abnormal serum aminotransferases

Prednisone monotherapy, induction and maintenance Prednisone with azathioprine, induction and maintenance May need liver transplant

C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with. -

Correct AnswerDetermines hemolytic activity which speaks to level of inflammatory response Normal: men: 12-72. Women: 13-75 mg/dl

Increased with: inflammatory disease

Decreased with: RA, lupus, SS

Calcineurin inhibitors: which, indication, adverse effects - Correct AnswerTacrolimus Cyclosporine

Prophylaxis of rejection

T: tremor, renal dysfunction, hyperglycemia

C: tremor, renal dysfunction, htn, hirsutism, gingival hyperplasia

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