SARAH MICHELLE LIVE REVIEW STUDY
GUIDE
A new graduate nurse practitioner has a patient presented 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 - ANS -4. The tuning fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? - ANS -Vertigo, tinnitus, ear
pressure, nystagmus
What is our biggest worry for a Meniere's Disease patient? - ANS -There is a possibility for a
potential, permanent hearing loss.
What is rhinitis meidcamentosa? - ANS -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? - ANS -This is an infection of the cornea due to herpes simplex virus
How is herpes keratitis diagnosed? - ANS -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? - ANS -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? - ANS -Patient with chronic lung
diseases: asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? - ANS -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? - ANS
-Around 8 week mark
What is COPD? - ANS -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? - ANS -Chronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? - ANS -Neurological
symptoms, paresthesia (numbness and tingling in hands and feet), unsteady gait, memory
issues
Beefy red tongue
What diet can result in B12 deficiency? - ANS -Vegan- oral supplements can be used for
treatment
What surgery can result in B12 deficiency? - ANS -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? - ANS -Women of childbearing age- ages
15-45, African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? - ANS -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? - ANS -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? - ANS -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? - ANS -Viral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? - ANS -Pituitary gland
What is the function of TSH? - ANS -Tells your thyroid when to produce and release those
critical thyroid hormones- T3 and T4.
What disorders include hypothyroidism? - ANS -Iodine deficiency, Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? - ANS -Hypothyroidism is caused
by an autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? - ANS -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? - ANS -Must be
taken on an empty stomach before other medications
What are signs and symptoms of a myxedema coma? - ANS -Low body temperature, edema,
confusion, lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? - ANS -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? -
ANS -Assess how the patient is taking their Synthroid
What signs and symptoms are common in hyperthyroidism? - ANS -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? - ANS -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? - ANS -Radioactive iodine therapy
, Hyperthyroidism left untreated may lead to what conditions? - ANS -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? - ANS -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? - ANS -Biguanides
(Metformin)
DPP-4 inhibitors
GLP-1 Agonists
SGLT-2 inhibitors
Insulin
Sulfonylureas
TZDs
Alpha-glycosides inhibitors
Why are type 1 diabetics insulin dependent? - ANS -They have an autoimmune destruction of
their beta cells
What are some examples of rapid acting insulin? - ANS -Humalog, Novalog, Apidra
What is the onset, peak, and duration of rapid acting insulin? - ANS -Onset: 15 minutes
Peak: 1 hour
Duration: 2-4 hours
What are some examples of short acting insulin? - ANS -Regular insulin (Humulin R, Novolin R)
What is the onset, peak and duration of short acting insulin? - ANS -Onset: 30 min- 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
What are some examples of intermediate insulin? - ANS -NPH (Humulin N, Novolin N)
What is the onset, peak, and duration of intermediate insulin? - ANS -Onset: 1-2 hours
Peak: 6-12 hours
Duration: 24 hours
GUIDE
A new graduate nurse practitioner has a patient presented 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 - ANS -4. The tuning fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? - ANS -Vertigo, tinnitus, ear
pressure, nystagmus
What is our biggest worry for a Meniere's Disease patient? - ANS -There is a possibility for a
potential, permanent hearing loss.
What is rhinitis meidcamentosa? - ANS -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? - ANS -This is an infection of the cornea due to herpes simplex virus
How is herpes keratitis diagnosed? - ANS -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? - ANS -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? - ANS -Patient with chronic lung
diseases: asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? - ANS -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? - ANS
-Around 8 week mark
What is COPD? - ANS -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? - ANS -Chronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? - ANS -Neurological
symptoms, paresthesia (numbness and tingling in hands and feet), unsteady gait, memory
issues
Beefy red tongue
What diet can result in B12 deficiency? - ANS -Vegan- oral supplements can be used for
treatment
What surgery can result in B12 deficiency? - ANS -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? - ANS -Women of childbearing age- ages
15-45, African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? - ANS -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? - ANS -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? - ANS -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? - ANS -Viral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? - ANS -Pituitary gland
What is the function of TSH? - ANS -Tells your thyroid when to produce and release those
critical thyroid hormones- T3 and T4.
What disorders include hypothyroidism? - ANS -Iodine deficiency, Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? - ANS -Hypothyroidism is caused
by an autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? - ANS -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? - ANS -Must be
taken on an empty stomach before other medications
What are signs and symptoms of a myxedema coma? - ANS -Low body temperature, edema,
confusion, lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? - ANS -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? -
ANS -Assess how the patient is taking their Synthroid
What signs and symptoms are common in hyperthyroidism? - ANS -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? - ANS -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? - ANS -Radioactive iodine therapy
, Hyperthyroidism left untreated may lead to what conditions? - ANS -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? - ANS -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? - ANS -Biguanides
(Metformin)
DPP-4 inhibitors
GLP-1 Agonists
SGLT-2 inhibitors
Insulin
Sulfonylureas
TZDs
Alpha-glycosides inhibitors
Why are type 1 diabetics insulin dependent? - ANS -They have an autoimmune destruction of
their beta cells
What are some examples of rapid acting insulin? - ANS -Humalog, Novalog, Apidra
What is the onset, peak, and duration of rapid acting insulin? - ANS -Onset: 15 minutes
Peak: 1 hour
Duration: 2-4 hours
What are some examples of short acting insulin? - ANS -Regular insulin (Humulin R, Novolin R)
What is the onset, peak and duration of short acting insulin? - ANS -Onset: 30 min- 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
What are some examples of intermediate insulin? - ANS -NPH (Humulin N, Novolin N)
What is the onset, peak, and duration of intermediate insulin? - ANS -Onset: 1-2 hours
Peak: 6-12 hours
Duration: 24 hours
