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NGR6202 Final Exam M9-13 Questions With Complete Solutions
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NGR6202 Final Exam M9-13 Questions With Complete Solutions -Chromic Correct Answers COLOR Hypo - low Hyper - rich Normo - normal MCH 26- Think hemoglobin! -Cytic Correct Answers SIZE Micro Normo Macro MCV 80- Think LOKI VARIANTS!!! A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices muscular
stiffness; brittle nails, coarse, dry hair; and a delay in relation in deep tendon reflexes. Which test should be ordered next? A. Electrolytes B. Thyroid-stimulating hormone C. Serum calcium D. Urine specific gravity Correct Answers B. Thyroid- stimulating hormone This patient likely has hypothyroidism A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of "my feet feel like they are on fire." He has a loss of vibratory sense and +1 Achilles reflex. Which of the following would be an appropriate treatment? A. Aspirin B. Angiotensin-converting enzyme inhibitors C. Tricyclic antidepressants D. Insulin Correct Answers C. Tricyclic antidepressants A 70 year-old female fell 2 weeks ago and developed immediate pain in her left elbow on the lateral epicondyle. She thought she just bruised it, but is now worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. During your examination, you find she has moderate swelling and ecchymosis, but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?
D. Administering glucagon subcutaneously Correct Answers B. Have him drink 4 ounces of juice. A non cancerous lump, often on the tendons or joints of the wrists and hands. A. Ganglion cyst B. Bursitis C. Trigger wrist D. Contracture Correct Answers A. Ganglion cyst A painful condition affecting the tendons on the thumb side of the wrist. A. Bursitis B. De Quervain's tenosynovitis C. Rheumatoid arthritis D. Tendinitis Correct Answers B. De Quervain's tensynovitis A painful condition that affects the small, fluid-filled sacs. The most common locations are in the shoulder, elbow and hip. A. Bursitis B. Tendinitis C. Tensosynovitis D. Carpal tunnel syndrome Correct Answers A. Bursitis A patient is 66 inches in height, weighing 200 lbs, and newly diagnosed with type 2 diabetes mellitus (DM). The A1c is 7.1%. What is the best initial treatment?
A. No treatment at this time B. Diet and exercise C. Diet, exercise, and metformin D. Diet, exercise, and exogenous insulin Correct Answers C. Diet, exercise, and metformin A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve? A. CN II B. CN III C. CN IV D. CN V Correct Answers C. CN IV A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which condition that the patient also has would be a contraindication to taking metformin? A. Inflammatory bowel disease B. Chronic obstructive pulmonary disease C. Renal disease D. Ulcerative colitis Correct Answers C. Renal disease A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? A. Urine dipstick for glucose B. Oral glucose tolerance test
Acute Diarrhea Correct Answers Acute diarrhea is the passage of six or more stools daily without improvement for 3 or more days Most causes of acute diarrhea in adults are self-limiting and of infectious etiology. After removing a tack from a type 2 diabetic's heel and evaluation the site for infection, what is the best plan for this patient? A. Refer to a podiatrist for a foot-care treatment plan B. Recommend increased intake of vitamin B C. Suggest the patient use a heating pad to improve circulation D. Send the patient for acupuncture treatments. Correct Answers A. Refer to a podiatrist for a foot-care treatment plan. Allen test Correct Answers Determines the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery Anaplastic tumors are the fastest-growing of all thyroid neoplasms- associated with a high mortality rate True or False Correct Answers True Anorexia Nervosa Correct Answers An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being overweight
Argo is a 13 yo male who fell off his bike. He comes to the clinic with c/o sharp shoulder pain and he is reluctant to move the upper extremity. He denies neck pain and any paresthesias. Which of the following education will the FNP likely provide? A. These fractures usually best heal spontaneously after proper immobilization; they rarely require surgery B. He will need to wear a neck brace x 2 weeks C. He will need to have a cast placed by Ortho D. These fractures are uncommon and he will likely need surgical repair. Correct Answers A. These fractures usually best heal spontaneously after proper immobilization; they rarely require surgery. Arthropod Bites Correct Answers In the case of airway edema, bronchospasm, and/or cardiovascular instability (with or without cutaneous manifestations of urticaria or angioedema), the clinician should immediately administer aqueous epinephrine 1: 1,000 IM into the upper outer thigh, which provides the most rapid entry into the systemic circulation. The dose is 0.3 to 0. mg every 10 to 20 minutes as indicated. Injection of 0.1 to 0. mg of the epinephrine dose can be made directly into the sting or bite, causing vasoconstriction and reduction of swelling Articular musculoskeletal structures Correct Answers Articular structures include the synovium, synovial fluid, articular cartilage, intra-articular ligaments, joint capsule, and juxta- articular bone. Disorders of these structures are characterized by deep or diffuse pain, limited range of motion (ROM) on active and passive movement, swelling (caused by synovial
constitutional symptoms, or abrasions are present, aspiration and culture are warranted with possible referral to an orthopedic specialist. If none of these symptoms are present, the bursitis is likely caused by inflammation and can be treated with NSAIDS, ice for 15 to 20 minutes several times a day, and rest. Chris is a 28-year-old male who complains of lower back pain that began 3 days ago. The pain is worse when he stands or bends, and it is somewhat relieved when he sits. The clinician performs the straight-leg raise test and it is negative. Plain film x-ray is positive. Which diagnosis is most likely? A. Osteoarthritis B. Spinal stenosis C. Scoliosis D. Muscle strain Correct Answers D. Muscle strain Common symptoms include high fever, chills, myalgias, and malaise. A. Cough B. Influenza C. Strep throat D. Sinus infection Correct Answers B. Influenza Concussion Symptoms Correct Answers • Headaches
Finkelstein's test is positive Debbie is a 43-year-old female being evaluated for a wrist injury. The clinician is assessing for median nerve compression by having Debbie maintain forced flexion of her wrist for 1 minute with the dorsal surface of each hand pressed together. Which of these tests did the clinician just perform? A. Allen's test B. Phalen's test C. Tinel's sign D. Finkelstein's test Correct Answers B. Phalen's test Depression is common and treatable, yet many Americans do no seek treatment True or False Correct Answers True Diagnosing Diabetes Mellitus Correct Answers There are four laboratory-based criteria to confirm DM:
Dietary iron sources Correct Answers Animal proteins, legumes, dark leafy greens, veggies Dopamine Correct Answers a neurotransmitter that regulates motor behavior, motivation, pleasure, and emotional arousal Drawer Test Correct Answers tests knee stability, ACL and PCL; pt supine, flex knee and grasp lower leg firmly with both hands; attempt to push knee back and firth while sitting on the foot to stabilize it; test to show torn ligament abnormal: forward motion=ACL tear; backward motion=PCL tear Dupuytren's contracture (Viking's Disease) Correct Answers Thickening and shrinking of the fascia of the palm with the 4th and 5th fingers primarily being drawn into a flexed position If contracture develops, send the patient to ortho surgeon If there is no contracture or pain, have the patient try antiinflammatory precautions, including the Mediterranean diet. E. Coli is the second most common cause of UTIs True or False Correct Answers False, it is the MOST common cause End of Life Care is focused on controlling.... Correct Answers pain, respiratory distress, and confusional states Falls are the leading cause of head injury
points on digital palpation with an applied pressure of 4 kg/cm (enough force to whiten the examiner's nailbed). The 18 tender points are bilateral sites at nine key locations Laboratory testing for FMS should include the same screening tests as for CFS, as well as muscle enzymes (creatine kinase, aldolase). Antinuclear antibody testing is typically not helpful unless an autoimmune disorder such as SLE is strongly suspected because it may generate a false-positive result that incorrectly labels these patients as having lupus Ultimately, the goal of therapy is to enable the patient to have the best quality of life possible within the limitations of chronic disability related to pain cognitive behavior therapy, which changes beliefs and behaviors that are barriers to recovery, and graded exercise Foreign Body Obstructions Correct Answers The pathophysiology of a foreign body obstruction depends on the orifice that is obstructed. Otic (ear canal) occlusion may contribute to otitis externa or otitis media, especially if the tympanic membrane is ruptured. Nasal occlusion may predispose to rhinitis, sinusitis, malodorous discharge, or epistaxis (nosebleed). Moreover, nasal, pharyngeal, tracheal, or even esophageal occlusion may all result in varying degrees of respiratory compromise, if the respiratory tract is at all obstructed either internally or via external compression on the airway. A vaginal occlusion, if unattended, can lead to toxic shock syndrome (mediated by infection with Staphylococcus aureus or
Streptococcus pyogenes) or pelvic inflammatory disease. A bowel obstruction may result from a foreign body occluding the rectum if the object inserted is high enough in the GI tract Because children are usually involved in foreign body incidents, prevention is essential. Parents should be encouraged to buy age-appropriate toys and to keep small objects out of the reach of children. Also, children should be taught not to put objects in the various orifices of their bodies. It should also not be assumed that foreign body obstructions in adults always occur accidentally, and an open and frank discussion of the risks of certain sexual practices or self-care (hygiene) behaviors may be needed, if it becomes apparent that the insertion of foreign bodies into the vagina or rectum was voluntary. Moreover, a domestic violence assessment with appropriate social service and police referrals should be completed on any patient presenting with a genitourinary or gastrointestinal foreign body obstruction, as a nonaccidental insertion may nonetheless be involuntary for the patient Fractures in the humerus, clavicle and acromion are treated by: Correct Answers These fractures usually best heal spontaneously after proper immobilization; they rarely require surgery. Fractures of the humerus, clavicle and acromion are not common True or False Correct Answers False; these are some of the most common fractures.
underlying conditions related to frozen shoulder include hypothyroidism, Dupuytren disease, cervical disc herniation, Parkinson's disease, stroke, and tumors. In a short period of time, immobility will result in a tight, painful shoulder joint that has limited active ROM (a "freezing" phase of pain) and then typically progresses to a "thawing" phase of decreasing discomfort associated with a steady improvement in function. This process may take anywhere from 6 months to 2 years. Physical examination typically reveals a loss in both active and passive ROM. Pain and tenderness are common with motion and at the deltoid insertion. Diffuse tenderness about the shoulder may also be present. AP and axillary radiographs of the shoulder are indicated to ensure that smooth, concentric joint surfaces with an intact cartilage space are present and to rule out other pathology such as osteophytes, loose bodies, calcium deposits, or tumors. Other studies, such as arthrography, CT, or MRI, are rarely indicated if radiographs are normal. Adhesive capsulitis is differentiated from chronic posterior shoulder dislocation, tumor, and OA on radiograph. Posttraumatic shoulder stiffness is, obviously, related to a history of trauma. Rotator cuff tear is differentiated because of the presence of normal passive ROM. Treatment consists of the application of moist heat and use of analgesics (NSAIDs and nonnarcotic analgesics. Physical therapy is recommended to restore
Functional dyspepsia is most commonly caused by GERD, which is caused by a relaxed LES True or False Correct Answers True GERD treatment Correct Answers Proton pump inhibitors or H2 blockers may be ordered. Common triggers of GERD by affecting the LES include smoking, alcohol, citrus foods, spicy foods, caffeine, chocolate, and mints. Patients must be recommended to avoid all of these. A blood test for Helicobacter pylori to detect an ulcer may be performed if the empiric therapy does not improve the heartburn. Eat small frequent meals Head elevated at night Geriatric Syndromes (SPICES) Correct Answers S: Sleep disorders. P: Problems with eating or feeding. I: Incontinence. C: Confusion E: Evidence of falls. S: Skin breakdown. Glasgow Coma Scale (GCS) Correct Answers The GCS establishes baseline neurologic status in each of three areas: eye opening (rated 1 to 4), motor response (rated 1 to 6), and verbal response (rated 1 to 5). Function in each of the three areas is rated on a progressive scale as noted, with a maximum score of 15 representing normal neurological function. A score of 7
