NR511 QUESTIONS AND VERIFIED SOLUTIONS 2
In the table above, what is the sensitivity of the Prostate Specific Antigen (PSA) for
detecting prostate cancer? - ✔✔ Sensitivity is the proportion of client with the
disease that have a positive result; it is the number of true positives divided by the total
number of clients who have the disease. A diagnostic test is used in a sample of 1000
clients. 500 of these clients have the disease, while 500 do not. Of those 500 clients
without the disease, 30 tests positive, and 470 tests negative. What is the specificity of the
test? - ✔✔ Specificity: proportion of 'test negative' of total without the disease;
the number of true negatives over all negatives. In this example, 500/1000 clients have the
disease; 30 test positive, and 470 test negative. The Positive Predictive Value (PPV) of a test
refers to which of the following? - ✔✔Test PPV refers to the proportion of clients with a
positive test who have the disease Which of the following depends on the prevalence of the
disease? - ✔✔Predictive values depend on the prevalence of disease in the population
whereas sensitivity and specificity are intrinsic properties of the test. Reliability refers to
the consistency or stability of a measure. A low pretest probability of disease may lead to
which of the following? - ✔✔Low positive predictive value and more false-positive results
Positive predictive value increases with prevalence; thus, low prevalence value yields a
low positive predictive value and implies a high false-positive rate. Negative predictive
value decreases with prevalence, and sensitivity/specificity do not vary. If you strongly
suspect that a client is positive for a specific condition but tests negative, the negative
result may be: - ✔✔False-negative test results due to a low negative predictive value. Your
clinical suspicion is equivalent to pre-test probability and high prevalence of a population.
Negative predictive value is inversely correlated with prevalence. Your clinical suspicion is
a low negative predictive value, suggesting a false-negative. A client has a positive rapid
strep test. Knowing nothing else, how likely is it that the client has strep pharyngitis? -
✔✔Cannot be determined from this information. Without a pre-test probability the test
result cannot be interpreted accurately. Which test(s) provide data relevant to the chief
complaint: Fever - ✔✔CBC Which test(s) provide data relevant to the chief complaint:
Unexplained bruising - ✔✔CBC hich test(s) provide data relevant to the chief complaint:
Fatigue - ✔✔CBC, CMP Which test(s) provide data relevant to the chief complaint: Cardiac
dysrhythmias - ✔✔CMP, electrolyte abnormalities Which test(s) provide data relevant to
the chief complaint: Unexplained weight loss - ✔✔CBC, CMP Check WBC for inflammation
or possible cancer, CMP for glucose, liver or kidney abnormalities Which test(s) provide
data relevant to the chief complaint: Edema - ✔✔CMP SNAPPS - ✔✔Summarize the history
and findings Narrow the differential diagnosis to two or three possibilities Analyze the
,differential by comparing and contrasting the possibilities Probe the preceptor by asking
questions about alternative approaches or uncertainties Plan the management of the
client's health issues Select an issue from the case for self-directed learning Pruritis - ✔✔-
Pruritus is the sensation of itching accompanied by the urge to scratch and can be
considered as acute or chronic. It can be a symptom of an actual dermatological issue or it
can be a symptom of another disease or drug reaction. In persons older than 65, pruritis is
the most common skin complaint encountered in primary care. -Pruritis is caused from a
localized reaction, as in the case of an insect bite or it can be caused from a systemic
response. A systemic cause of pruritis is in hyperbilirubinemia where bile salts deposit in
the skin creating the discomfort. Pruritis can exist with or without a rash. rash - ✔✔A rash
is a clinical manifestation of inflammation that can have multiple etiologies, including
autoimmune, parasitic, viral, and bacterial origins. A thorough and careful history is an
important step in the evaluation of pruritis and rashes Third-party payers - ✔✔7 categories:
Medicare/ Medicaid, VA, workman's comp, indemnity insurance, managed care corp, auto
liability Payment of NPs by Centers for Medicare and Medicaid Services (CMS): - ✔✔85% of
physicians fee Medicare Part A and B (what each pays): - ✔✔o A: Inpatient hospital stay,
skilled nursing care, hospice, home care o B: Outpatient services, provider visits, surgery,
lab, medical equipment, preventative exams. The purpose of Medicare Advantage Plans -
✔✔Benefits of Medicare and additional with lower copays Assessment and diagnosis of
herpes zoster - ✔✔-Painful rash with blisters (unilateral vesicular rash along dermatome)
most commonly a thoracic or lumbar dermatome - May present with unexplained pain
Assessment and diagnosis of common skin complaints - ✔✔Sexual history (STD), social
history (Occupational exposure, travel, hobbies, pets, drugs), Medications, Medical history
(recent illness) Health teaching for patients with pruritus - ✔✔-Patients should be
educated to avoid scratching, to use cool compresses and apply pressure to itchy areas,
and to keep fingernails trimmed -avoidance of strong soaps; taking shorter, tepid showers
(10 to 20 minutes) instead of hot baths; and the use of effective emollients Treatment of
urticaria - ✔✔antihistamines Characteristics of scabies - ✔✔-Intensely itchy rash, can last
several days or weeks -interdigital web spaces, wrists, anterior axillary folds, periumbilical
skin, pelvic girdle, penis, and ankles. The palms, soles, face, neck, and scalp are more
frequently involved in small children. differential diagnosis for scabies - ✔✔atopic
dermatitis, contact dermatitis, folliculitis Systemic tx for scabies - ✔✔ivermectin ·
Pediculosis-differentiating between lice and dandruff - ✔✔does not slide easily on the hair
shaft · Risk factors for developing a fungal skin infection: - ✔✔Older, younger (Diaper rash),
diabetic, antibiotic therapy, altered immunity (corticosteroids, BM transplant) ·
Assessment findings of fungal skin infections: - ✔✔o papular rash with satellite lesions ·
, Pharmacological management of common fungal skin infections: - ✔✔o antifungal cream;
pill · Treatment onychomycosis: - ✔✔Topical antifungal (Nystatin, clotrimazole,
miconazole, terbinafine, naftifine, ciclopirox · Characteristics of cellulitis: - ✔✔o red,
warm, painful without sharply demarcated borders o Spreading of infection of epidermis
and subq tissue · Causes and characteristics of folliculitis - ✔✔o Bacterial infection of hair
follicle o "Bumpy rash", small pustules surrounded by 1 to 2 mm of erythema located over
the pilosebaceous orifice or the ostium of the hair follicle · Diagnosing a cyst - ✔✔o
Epidermal inclusions cyst is chronic- cheesy white discharge with a strong odor o Furuncle
is acute · Hidradenitis suppurativa and Furuncle - ✔✔o HS is a long term condition of
painful pumps under the skin usually in the armpits, groin, buttock, breast o If a furuncle is
on the axilla you should DD HS -· Differential diagnosis of swollen lymph nodes under the
arm Assessment findings for impetigo - ✔✔ Simon presents with alopecia areata with well-
circumscribed patches of hair loss on the crown of his head. How do you respond when he
asks you the cause? - ✔✔"The cause is unknown, but we suspect it is due to an
immunologic mechanism." Which of the following is "a linear crack extending from the
epidermis to the dermis?" - ✔✔A fissure What should the nurse do when the child arrives
on the floor with the diagnosis of bacterial meningitis? - ✔✔Place the child in respiratory
isolation A bulla is: - ✔✔A vesicle larger than 1 cm in diameter An example of ecchymosis
is: - ✔✔A bruise When looking under the microscope to diagnose an intravaginal infection,
you see a cluster of small and oval to round shapes. What do you suspect they are? -
✔✔Spores Your patient is in her second trimester of pregnancy and has a yeast infection.
Which of the following is a treatment that you usually recommend/order in nonpregnant
patients, but is listed as a Pregnancy category D? - ✔✔Diflucan, 150 mg Tinea unguium is
also known as: - ✔✔Onychomycosis Sally, age 25, presents with impetigo that has been
diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red
vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has
not been adequate. Which type of impetigo is this? - ✔✔Ecthyma Mark has necrotizing
fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas
production by which anaerobic bacteria? - ✔✔Clostridium perfringens When using the
microscope for an intravaginal infection, you see something translucent and colorless.
What do you suspect? - ✔✔Hyphae Marci has a wart on her hand. She says she heard
something about "silver duct tape therapy." What do you tell her about his? - ✔✔It is a
simple treatment that should be tried first. Which is the most potent and irritating dose of
tretinoin? - ✔✔0.05% liquid formulation Of the following types of cellulitis, which is a
streptococcal infection of the superficial layers of the skin that does not involve the
In the table above, what is the sensitivity of the Prostate Specific Antigen (PSA) for
detecting prostate cancer? - ✔✔ Sensitivity is the proportion of client with the
disease that have a positive result; it is the number of true positives divided by the total
number of clients who have the disease. A diagnostic test is used in a sample of 1000
clients. 500 of these clients have the disease, while 500 do not. Of those 500 clients
without the disease, 30 tests positive, and 470 tests negative. What is the specificity of the
test? - ✔✔ Specificity: proportion of 'test negative' of total without the disease;
the number of true negatives over all negatives. In this example, 500/1000 clients have the
disease; 30 test positive, and 470 test negative. The Positive Predictive Value (PPV) of a test
refers to which of the following? - ✔✔Test PPV refers to the proportion of clients with a
positive test who have the disease Which of the following depends on the prevalence of the
disease? - ✔✔Predictive values depend on the prevalence of disease in the population
whereas sensitivity and specificity are intrinsic properties of the test. Reliability refers to
the consistency or stability of a measure. A low pretest probability of disease may lead to
which of the following? - ✔✔Low positive predictive value and more false-positive results
Positive predictive value increases with prevalence; thus, low prevalence value yields a
low positive predictive value and implies a high false-positive rate. Negative predictive
value decreases with prevalence, and sensitivity/specificity do not vary. If you strongly
suspect that a client is positive for a specific condition but tests negative, the negative
result may be: - ✔✔False-negative test results due to a low negative predictive value. Your
clinical suspicion is equivalent to pre-test probability and high prevalence of a population.
Negative predictive value is inversely correlated with prevalence. Your clinical suspicion is
a low negative predictive value, suggesting a false-negative. A client has a positive rapid
strep test. Knowing nothing else, how likely is it that the client has strep pharyngitis? -
✔✔Cannot be determined from this information. Without a pre-test probability the test
result cannot be interpreted accurately. Which test(s) provide data relevant to the chief
complaint: Fever - ✔✔CBC Which test(s) provide data relevant to the chief complaint:
Unexplained bruising - ✔✔CBC hich test(s) provide data relevant to the chief complaint:
Fatigue - ✔✔CBC, CMP Which test(s) provide data relevant to the chief complaint: Cardiac
dysrhythmias - ✔✔CMP, electrolyte abnormalities Which test(s) provide data relevant to
the chief complaint: Unexplained weight loss - ✔✔CBC, CMP Check WBC for inflammation
or possible cancer, CMP for glucose, liver or kidney abnormalities Which test(s) provide
data relevant to the chief complaint: Edema - ✔✔CMP SNAPPS - ✔✔Summarize the history
and findings Narrow the differential diagnosis to two or three possibilities Analyze the
,differential by comparing and contrasting the possibilities Probe the preceptor by asking
questions about alternative approaches or uncertainties Plan the management of the
client's health issues Select an issue from the case for self-directed learning Pruritis - ✔✔-
Pruritus is the sensation of itching accompanied by the urge to scratch and can be
considered as acute or chronic. It can be a symptom of an actual dermatological issue or it
can be a symptom of another disease or drug reaction. In persons older than 65, pruritis is
the most common skin complaint encountered in primary care. -Pruritis is caused from a
localized reaction, as in the case of an insect bite or it can be caused from a systemic
response. A systemic cause of pruritis is in hyperbilirubinemia where bile salts deposit in
the skin creating the discomfort. Pruritis can exist with or without a rash. rash - ✔✔A rash
is a clinical manifestation of inflammation that can have multiple etiologies, including
autoimmune, parasitic, viral, and bacterial origins. A thorough and careful history is an
important step in the evaluation of pruritis and rashes Third-party payers - ✔✔7 categories:
Medicare/ Medicaid, VA, workman's comp, indemnity insurance, managed care corp, auto
liability Payment of NPs by Centers for Medicare and Medicaid Services (CMS): - ✔✔85% of
physicians fee Medicare Part A and B (what each pays): - ✔✔o A: Inpatient hospital stay,
skilled nursing care, hospice, home care o B: Outpatient services, provider visits, surgery,
lab, medical equipment, preventative exams. The purpose of Medicare Advantage Plans -
✔✔Benefits of Medicare and additional with lower copays Assessment and diagnosis of
herpes zoster - ✔✔-Painful rash with blisters (unilateral vesicular rash along dermatome)
most commonly a thoracic or lumbar dermatome - May present with unexplained pain
Assessment and diagnosis of common skin complaints - ✔✔Sexual history (STD), social
history (Occupational exposure, travel, hobbies, pets, drugs), Medications, Medical history
(recent illness) Health teaching for patients with pruritus - ✔✔-Patients should be
educated to avoid scratching, to use cool compresses and apply pressure to itchy areas,
and to keep fingernails trimmed -avoidance of strong soaps; taking shorter, tepid showers
(10 to 20 minutes) instead of hot baths; and the use of effective emollients Treatment of
urticaria - ✔✔antihistamines Characteristics of scabies - ✔✔-Intensely itchy rash, can last
several days or weeks -interdigital web spaces, wrists, anterior axillary folds, periumbilical
skin, pelvic girdle, penis, and ankles. The palms, soles, face, neck, and scalp are more
frequently involved in small children. differential diagnosis for scabies - ✔✔atopic
dermatitis, contact dermatitis, folliculitis Systemic tx for scabies - ✔✔ivermectin ·
Pediculosis-differentiating between lice and dandruff - ✔✔does not slide easily on the hair
shaft · Risk factors for developing a fungal skin infection: - ✔✔Older, younger (Diaper rash),
diabetic, antibiotic therapy, altered immunity (corticosteroids, BM transplant) ·
Assessment findings of fungal skin infections: - ✔✔o papular rash with satellite lesions ·
, Pharmacological management of common fungal skin infections: - ✔✔o antifungal cream;
pill · Treatment onychomycosis: - ✔✔Topical antifungal (Nystatin, clotrimazole,
miconazole, terbinafine, naftifine, ciclopirox · Characteristics of cellulitis: - ✔✔o red,
warm, painful without sharply demarcated borders o Spreading of infection of epidermis
and subq tissue · Causes and characteristics of folliculitis - ✔✔o Bacterial infection of hair
follicle o "Bumpy rash", small pustules surrounded by 1 to 2 mm of erythema located over
the pilosebaceous orifice or the ostium of the hair follicle · Diagnosing a cyst - ✔✔o
Epidermal inclusions cyst is chronic- cheesy white discharge with a strong odor o Furuncle
is acute · Hidradenitis suppurativa and Furuncle - ✔✔o HS is a long term condition of
painful pumps under the skin usually in the armpits, groin, buttock, breast o If a furuncle is
on the axilla you should DD HS -· Differential diagnosis of swollen lymph nodes under the
arm Assessment findings for impetigo - ✔✔ Simon presents with alopecia areata with well-
circumscribed patches of hair loss on the crown of his head. How do you respond when he
asks you the cause? - ✔✔"The cause is unknown, but we suspect it is due to an
immunologic mechanism." Which of the following is "a linear crack extending from the
epidermis to the dermis?" - ✔✔A fissure What should the nurse do when the child arrives
on the floor with the diagnosis of bacterial meningitis? - ✔✔Place the child in respiratory
isolation A bulla is: - ✔✔A vesicle larger than 1 cm in diameter An example of ecchymosis
is: - ✔✔A bruise When looking under the microscope to diagnose an intravaginal infection,
you see a cluster of small and oval to round shapes. What do you suspect they are? -
✔✔Spores Your patient is in her second trimester of pregnancy and has a yeast infection.
Which of the following is a treatment that you usually recommend/order in nonpregnant
patients, but is listed as a Pregnancy category D? - ✔✔Diflucan, 150 mg Tinea unguium is
also known as: - ✔✔Onychomycosis Sally, age 25, presents with impetigo that has been
diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red
vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has
not been adequate. Which type of impetigo is this? - ✔✔Ecthyma Mark has necrotizing
fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas
production by which anaerobic bacteria? - ✔✔Clostridium perfringens When using the
microscope for an intravaginal infection, you see something translucent and colorless.
What do you suspect? - ✔✔Hyphae Marci has a wart on her hand. She says she heard
something about "silver duct tape therapy." What do you tell her about his? - ✔✔It is a
simple treatment that should be tried first. Which is the most potent and irritating dose of
tretinoin? - ✔✔0.05% liquid formulation Of the following types of cellulitis, which is a
streptococcal infection of the superficial layers of the skin that does not involve the
