NSG 554 Exam 3 (Latest
Update) Nurse Practitioners in Primary
Care I Questions and Verified Answers
100% Correct {Grade A} – Wilkes
Signs and symptoms of a MI - Correct answer -substernal chest pain or discomfort
that radiates to the jaw, left shoulder or arm
-Dyspnea, nausea, diaphoresis, syncope
Diagnostics to confirm MI - Correct answer -Cardiac myocyte necrosis (myoglobin,
CK-MB and troponin I and T)
-without ST-elevation, abnormal CK-MB or troponin=MI
-ECG changes (new Q waves, ST elevation/depression, T-wave flattening/inversion
Gouty arthritis - Correct answer Sudden onset and frequently nocturnal
Common precipitants are alcohol (beer)
Gouty arthritis diagnostics - Correct answer -Serial measurements of serum uric acid
-Increased WBC
,Sodium urate crystals in joint fluid aspirated from tophus
-xray later in dx=punched-out erosions with an overhanging rim of cortical bone
develop "rat bite" adjacent to soft tissue tophus
-Smaller tophi imaged by US
Acute gout tx - Correct answer 1. NSAIDS- full dose of naproxen 500 mg BID or
indomethacin 25-50 mg Q8 until symptoms resolve (contraindicated in PUD, decreased
kidney function)
2. Colchicine-Good if duration of attach is less than 36 hours
-Loading dose=1.2mg then 0.6 mg 1 hour later for prophylaxis
-0.6mg BID
3. Corticosteroids- IV or PO, 5-10 days with taper
4. Interleukin-1 inhibitors- anakinram canakinumab, and rilonacept not FDA approved
Rheumatoid arthritis: Signs and Symptoms-
Joints - Correct answer -joint symptoms: symmetric swelling of multiple joints with
tenderness and pain
-stiffness longer than 30 mins in the morning
,-may reoccur after daytime inactivity or be more severe after strenuous activity
-fingers, wrists, knees, ankles, MTP joints
Rheumatoid arthritis: Signs and Symptoms-
Rheumatoid nodules - Correct answer - subcutaneous nodules most common over
bony prominences
-can also occur in the bursae and tendon sheaths
-lungs, sclerae, other tissue
Rheumatoid arthritis: Signs and Symptoms-Ocular symptoms - Correct answer -
dryness of eyes, mouth, mucus membranes especially in advanced disease
-episcleritits, scleritis, scleromalacia d/t nodule
Rheumatoid arthritis: Signs and Symptoms-
Other symptoms - Correct answer -interstitial lung disease
-pericarditits
-pleural disease
-palmar erythema
, -felty syndrome=splenomegaly, neutropenia
Rheumatoid arthritis: lab tests - Correct answer -Anti-CCP antibodies= most specific
-rheumatoid factor (IgM)= can occur in other autoimmune disease
-ESR and CRP usually elevated based on disease activity
Rheumatoid arthritis: imaging - Correct answer -radiographic changes most specific
-1st 6 months of symptoms usually normal
Rheumatoid arthritis: treatment categories - Correct answer -Corticosteroids
-DMARDs:
-Synthetic
-Biologic DMARDs
-Combination DMARDs
RA: tx corticosteriods - Correct answer -low-dose for anti-inflammatory (5-7.5 mg)
-"bridge" to reduce disease activity
Update) Nurse Practitioners in Primary
Care I Questions and Verified Answers
100% Correct {Grade A} – Wilkes
Signs and symptoms of a MI - Correct answer -substernal chest pain or discomfort
that radiates to the jaw, left shoulder or arm
-Dyspnea, nausea, diaphoresis, syncope
Diagnostics to confirm MI - Correct answer -Cardiac myocyte necrosis (myoglobin,
CK-MB and troponin I and T)
-without ST-elevation, abnormal CK-MB or troponin=MI
-ECG changes (new Q waves, ST elevation/depression, T-wave flattening/inversion
Gouty arthritis - Correct answer Sudden onset and frequently nocturnal
Common precipitants are alcohol (beer)
Gouty arthritis diagnostics - Correct answer -Serial measurements of serum uric acid
-Increased WBC
,Sodium urate crystals in joint fluid aspirated from tophus
-xray later in dx=punched-out erosions with an overhanging rim of cortical bone
develop "rat bite" adjacent to soft tissue tophus
-Smaller tophi imaged by US
Acute gout tx - Correct answer 1. NSAIDS- full dose of naproxen 500 mg BID or
indomethacin 25-50 mg Q8 until symptoms resolve (contraindicated in PUD, decreased
kidney function)
2. Colchicine-Good if duration of attach is less than 36 hours
-Loading dose=1.2mg then 0.6 mg 1 hour later for prophylaxis
-0.6mg BID
3. Corticosteroids- IV or PO, 5-10 days with taper
4. Interleukin-1 inhibitors- anakinram canakinumab, and rilonacept not FDA approved
Rheumatoid arthritis: Signs and Symptoms-
Joints - Correct answer -joint symptoms: symmetric swelling of multiple joints with
tenderness and pain
-stiffness longer than 30 mins in the morning
,-may reoccur after daytime inactivity or be more severe after strenuous activity
-fingers, wrists, knees, ankles, MTP joints
Rheumatoid arthritis: Signs and Symptoms-
Rheumatoid nodules - Correct answer - subcutaneous nodules most common over
bony prominences
-can also occur in the bursae and tendon sheaths
-lungs, sclerae, other tissue
Rheumatoid arthritis: Signs and Symptoms-Ocular symptoms - Correct answer -
dryness of eyes, mouth, mucus membranes especially in advanced disease
-episcleritits, scleritis, scleromalacia d/t nodule
Rheumatoid arthritis: Signs and Symptoms-
Other symptoms - Correct answer -interstitial lung disease
-pericarditits
-pleural disease
-palmar erythema
, -felty syndrome=splenomegaly, neutropenia
Rheumatoid arthritis: lab tests - Correct answer -Anti-CCP antibodies= most specific
-rheumatoid factor (IgM)= can occur in other autoimmune disease
-ESR and CRP usually elevated based on disease activity
Rheumatoid arthritis: imaging - Correct answer -radiographic changes most specific
-1st 6 months of symptoms usually normal
Rheumatoid arthritis: treatment categories - Correct answer -Corticosteroids
-DMARDs:
-Synthetic
-Biologic DMARDs
-Combination DMARDs
RA: tx corticosteriods - Correct answer -low-dose for anti-inflammatory (5-7.5 mg)
-"bridge" to reduce disease activity
