NR 511 FINAL EXAM
QUESTIONS AND
VERIFIED ANSWERS
, NR 511 FINAL EXAM QUESTIONS AND VERIFIED ANSWERS
2 Coding Classification systems that are currently used in the US healthcare system - - Answer
--CPT-recognized universally and provide logical means to be able to track healthcare data,
trends, and outcomes.
ICD-10-shorthand for the patient's diagnosis, which are used to provide the payer information
on the necessity of the visit or procedures performed.
31. Describe how to perform a
Tinnel test - - Answer --Purpose: Assess for compression neuropathy
Procedure: Percuss the median nerve at the wrist. If the patient complains of tingling in the
digits (POSITIVE TINEL SIGN), compression at the site of percussion is likely.
5ths disease - - Answer --o 3 Stages:
1. Classic "slapped cheek" rash bright red bilateral cheeks which spare the forehead, nasal
bridge, and perioral area
2. Pink lacy (or reticulated) erythematous macules on all extremities and trunk spare the palms
and sole surfaces.
• The rash may be itchy at this stage.
3. 2-3 weeks of the body rash.
This rash may come and can last for up to 3 weeks.
8. Discuss common characteristics (objective findings) of patients with lumbar spinal stenosis - -
Answer --- Muscle weakness
- Impaired proprioception
- Diminished reflexes
- Sensory changes (numbness/tingling)
- Bowel or bladder symptoms
o Sphincter tone decreased
o Don't confuse w/ prostate problems in older men
Accurately document why every procedure code must have a corresponding diagnosis code - -
Answer --every procedure code needs a diagnosis to explain the necessity whether the code
represents an actual procedure performed or a nonprocedural encounter like an office visit
Acute appendicitis - - Answer --Inflammation of the vermiform appendix; due to obstruction or
infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
, Acute appendicitis diagnostics - - Answer --Diagnosis is made clinically and based on history
and physical
Elevated WBC
Mild Fever, 99-100
RLQ pain/McBurneys point
CT abd may help rule out other diagnostic possibilities
ABD ultrasound helps to visualize the inflamed appendix
Acute appendicitis treatment - - Answer --• Appendectomy
• Antibiotic
• Drain abscesses
• Can be removed prophylactically
Acute cholecystitis - - Answer --Inflammation of gallbladder (GB)
Usually due to gallstone in cystic duct
1. Cystic duct - leaves gall bladder & connects to common bile duct
Symptoms
Patient will have mid-epigastric pain
Because GB is still squeezing, increasing pressure w/ nowhere for bile to go
Can lead to nausea/vomting
Stone can get more stuck w/ more squeezing
Bile starts to irritate mucosa
Mucosa starts to produce mucous and inflamm enzymes
Leads to inflammation, distention, pressure build up
Bacterial growth (E. coli, enterococci, bacteroides fragilis, colstriduim)
As GB "balloons", pain shifts to RUQ, R scapula/shoulder
Bacteria invades in & through GB wall, into peritoneum, causing peritonitis
Rebound tenderness
Murphy's Sign = Put pressure on right side under ribs. This will hold GB in place. Have patient
take a deep breath. The diaphragm will push on the GB & a painful response = Cholecystitis
Immune response
Neutrophilic leukocytosis
Fever
Acute cholecystitis diagnostics - - Answer --US confirmed
Detects stones
Sonographic murphy sign
Tenderness when sonogram is over gallbladder
GB wall thickening
Sludge
Distention of GB or common bile duct
Cholescintigraphy (HIDA scan)
Radiolabeled marker used to visualize the biliary system
Acute cholecys - ducts are blocked, GB can't be seen
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscope down to pancreas
Dye injected & viewed via fluoro
Magnetic Resonance Cholangiopancreatography (MRCP)
1. Visualizes bili system with MRI
Acute cholecystitis treatment - - Answer --o Supportive measures
QUESTIONS AND
VERIFIED ANSWERS
, NR 511 FINAL EXAM QUESTIONS AND VERIFIED ANSWERS
2 Coding Classification systems that are currently used in the US healthcare system - - Answer
--CPT-recognized universally and provide logical means to be able to track healthcare data,
trends, and outcomes.
ICD-10-shorthand for the patient's diagnosis, which are used to provide the payer information
on the necessity of the visit or procedures performed.
31. Describe how to perform a
Tinnel test - - Answer --Purpose: Assess for compression neuropathy
Procedure: Percuss the median nerve at the wrist. If the patient complains of tingling in the
digits (POSITIVE TINEL SIGN), compression at the site of percussion is likely.
5ths disease - - Answer --o 3 Stages:
1. Classic "slapped cheek" rash bright red bilateral cheeks which spare the forehead, nasal
bridge, and perioral area
2. Pink lacy (or reticulated) erythematous macules on all extremities and trunk spare the palms
and sole surfaces.
• The rash may be itchy at this stage.
3. 2-3 weeks of the body rash.
This rash may come and can last for up to 3 weeks.
8. Discuss common characteristics (objective findings) of patients with lumbar spinal stenosis - -
Answer --- Muscle weakness
- Impaired proprioception
- Diminished reflexes
- Sensory changes (numbness/tingling)
- Bowel or bladder symptoms
o Sphincter tone decreased
o Don't confuse w/ prostate problems in older men
Accurately document why every procedure code must have a corresponding diagnosis code - -
Answer --every procedure code needs a diagnosis to explain the necessity whether the code
represents an actual procedure performed or a nonprocedural encounter like an office visit
Acute appendicitis - - Answer --Inflammation of the vermiform appendix; due to obstruction or
infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
, Acute appendicitis diagnostics - - Answer --Diagnosis is made clinically and based on history
and physical
Elevated WBC
Mild Fever, 99-100
RLQ pain/McBurneys point
CT abd may help rule out other diagnostic possibilities
ABD ultrasound helps to visualize the inflamed appendix
Acute appendicitis treatment - - Answer --• Appendectomy
• Antibiotic
• Drain abscesses
• Can be removed prophylactically
Acute cholecystitis - - Answer --Inflammation of gallbladder (GB)
Usually due to gallstone in cystic duct
1. Cystic duct - leaves gall bladder & connects to common bile duct
Symptoms
Patient will have mid-epigastric pain
Because GB is still squeezing, increasing pressure w/ nowhere for bile to go
Can lead to nausea/vomting
Stone can get more stuck w/ more squeezing
Bile starts to irritate mucosa
Mucosa starts to produce mucous and inflamm enzymes
Leads to inflammation, distention, pressure build up
Bacterial growth (E. coli, enterococci, bacteroides fragilis, colstriduim)
As GB "balloons", pain shifts to RUQ, R scapula/shoulder
Bacteria invades in & through GB wall, into peritoneum, causing peritonitis
Rebound tenderness
Murphy's Sign = Put pressure on right side under ribs. This will hold GB in place. Have patient
take a deep breath. The diaphragm will push on the GB & a painful response = Cholecystitis
Immune response
Neutrophilic leukocytosis
Fever
Acute cholecystitis diagnostics - - Answer --US confirmed
Detects stones
Sonographic murphy sign
Tenderness when sonogram is over gallbladder
GB wall thickening
Sludge
Distention of GB or common bile duct
Cholescintigraphy (HIDA scan)
Radiolabeled marker used to visualize the biliary system
Acute cholecys - ducts are blocked, GB can't be seen
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscope down to pancreas
Dye injected & viewed via fluoro
Magnetic Resonance Cholangiopancreatography (MRCP)
1. Visualizes bili system with MRI
Acute cholecystitis treatment - - Answer --o Supportive measures
