NR 667 VISE (Actual) Exam Latest Updated Graded A+

a 4 mos. old is suspected of having developmental dysplasia of the hip. what test would best assess for this? - ANS Galeazzi and Klisic: limited abduction and apparent thigh length discrepency is a better indicator of DDH than is instability after 3 months of age, Barlow and Ortolani maneuvers are tests used to test hip instability in newborns until approx. 3 months old. Trendelenburg pelvic test is to test for walking age children to test for hip weakness and is characterized by unilateral hip dyspleasia. which mitral disorder results from redundancy of the mitral valve leaflet? - ANS mitral valve prolapse. Most common . adult murmur. Valves annulus becomes enlarged in conjunction with elongated chordae tendonae (this is degeneration of the mitral tissue. serum ferritin - ANS demonstrates the amount of iron in storage. helpful in evaluating pts being treated for iron deficiency anemia. a patient with aortic stenosis has been asymptomatic for decades and begins c/o some dizziness c activity w/o chest pain or sob. - ANS refer to cardiology; be alert for s/s that precede syncope. dizziness precedes syncompe, and the patient is now presenting with symptoms of aortic stenosis. A patient taking candesartan should avoid - ANS K+ supplements. Candesartan can produce hyperkalemia because the MOA spares K+. A patient taking long actin basal insulin has elevated blood glucose. What blood sugars are important to evaluae and base insulin changes on - ANS AM fasting. . basal insulin mimics steady stream of insulin produced by the pancrease throughout day. Should be based off of fastin AM glucose check. The other blood sugars reflect blood sugar in reflection to meals. hyperthyroidism may affect bp by increase SBP and DBP. It is also a common cause of secondary HTN other Endocrine disorders that do the same are: - ANS Pheochromocytoma, Cushings syndrome, neuroblastoma. all of these are causes of secondary HTN. An immune response to Strep A infection of the hear are - ANS rheumatic fever. Can also affect CNS and joints. most common age group affected is 5-15 yo. Residual affects not felt until decades later. At what age should hearing screening be performed on older adults according to Assessing Care in Vulnerable Elders - ANS 75 yo. completed at initial evaluation, if fails needs referral to audiology. Correlation with compliance with heawring aids. An adult has UR sx and cough x 14 days. what should be considered? - ANS Pertussis should be considered any time there is an acute cough for greater than 5 days. incubation period is about 7-10 days. Classic paroxysmal sign is a cough that starts in the seond week of illness. The duration of the cough is about 3 months even after treated with abx. HIGHLY INFECTIOUS AND A REPORTABLE DISEASE. What are current tx guidelines for treaing Pneumonia - ANS Amoxcillin, 1g tid Doxy and azithro are conditional first line tx for patient fluoroquinolones are commonly used in patients with comorbidities and recent abx exposure OR recent contact with the healthcare system. WHat side effect does Lisinopril cause in 5-20 % of the population - ANS cough. ACE inhibitors as a whole class can induce a cough. This is because ACE is thought to metabolize bradykinin in the lungs, Bradykinin is thought to be responsisble for the cough because it induces the production of arachidonic acid and nitric oxide; both substances promote cough. what is a unique presentation of strep pna - ANS rust colored sputum is unique to strep pna also known and pneumococcal pna scant or watery sputum is associated with an atypical pathogen like mycoplasma and Chlamydophilia pna. thick, discolored sputum may be associated with bacterial pna. The relationship b/w colon polyps anc ca. - ANS polyps have a slow progression to colon ca. A 3 day old infant has a bilirubin level of 16mg/dl. what should be done? - ANS Initiate phototherapy. This level is considered high intermediate; because it is expected the bilirubin level will rise in the next few days, phototherapy is most appropriate. Leukemia may have varied clinical presentation. What presentation would be unusual to have in a leukemia patient? - ANS sickle shaped cells; Leukemia is characterized by failure in the bone marrow. Sickle cell anemia would not be observed unless they also had SCA what patient is at highest risk for suicide? - ANS 87 yo male with chronic pain; older adults and men are successful with death. suicide is more likely in patients with : hopelessness, insomnia, alcohol abuse, unremitting pain, restlessness, impaired concentration. the most likely time to spread hiv is? - ANS during times of high viral load periods; The highest viral load may occur at the earliest stages of infection, before there are any symptoms. A pregnant patient is likely to have what heart sounds? - ANS A venous hum and an s3; Usually due to increased fluid. What medication listed below is NOT associated with weight gain: a) insulin 2)metoprolol 3)esciltalopram - ANS 2)metoprolol; most diabetes treating medication can cause weight gain; many diabetic patients are overweight so this is frustrating. A 50 yo M c/o scrotal heaviness, Reports sensation is worst at the end of the day., denies pain, what is the likely etiology? a)epididymitis b)hydrocele c)inguininal hernia d)testicular torsion - ANS Inguinal hernia; these are common in males and the common symtom is scrotal heaviness, especially tpwards teh end of the day. It can usually be relieved by lying down; excessive pain may indicate strangulation of the hernia. what medication is recommended by the American College of Cardiology as a first line agent for a patient who has been unsuccessful with nonpharmacological interventions for OA - ANS ibuprofen which statement about HIV and CD4 count is correct? - ANS There are few conditions that cause a depletion of CD4 cells other than HIV a 38 yo m presents to the clinic for prmary care. BG is 242, second check is 288. which is least helpful in initial evaluation of the patient? A) BP B) nonfasting lipids c)albumin d) all of the above - ANS non- fasting lipids are of no help in initial evaluation. Triglycerides are especially sensitive to nonfasting states; A patient states that her knee "locks" and feels as though it will "give out" . She denies injury, She has no complaints of her other knee, What is her likely problem? - ANS Meniscal tear; Knee locking is a classic complaint of a Meniscal tear; sometimes loss of ROM secondary to pain is observed. Clinical exam and MRI are usual diagnosing methods. The McMurray test is commonly used to assess joint movement and meniscal injuiry. A positive sign is a painful "click" during early or mid extension of the knee. pain felt along the midline of the knee. what disease is associated with lymphocytosis? - ANS mononucleosis.; Lymphocytosis is an increase in number of circulating lymphocytes. These are usually predominant in a viral infection, but are not increased in patients with anemia. Bacterial infections will usually show a decrease in lymphocytes. what AM glucose range is appropriate for a 78 yo diabetic? - ANS a good range is 80-100. BG 130 is desirable, but no less than 80 as hypoglycemia causes seizures in this age group. The post prandial glucose should be no higher than 180. what reflex would NOT be observed in a 1 month old infant? - ANS parachute reflex How soon would an enzyme immunoessay yield C. Dif. results - ANS 24 hours What is the most common nutritional syndrome in older adults? - ANS undernutrition an 80 yo patient asks if he can have a an alcoholic beverage in the evening. there are no obvious contraindications, how should the nurse practitioner respond? - ANS Yes, but not more than 1-2 day. This is due to body mass decrease with age. If the patient is cognitively impaired, alcohol should be avoided altogether. Metformin is a good choice for many older adults with T2DM. What should be monitored while on this med? - ANS as renal dysfunction diclines with age, lactic acidosis can build up, though its uncommon. Everyone should have kidney values monitored, but especially in the elderly. a 60 yo patient has anosmia, which cranial nerve must be assessed? - ANS CN I is responsible for anosmia (olfactory nerve). A common scent like peppermint is used, and the patient is asked to ID a M patient takes HCTZ for HTN. He develops severe pain in his great toe yesterday, what medication would be contraindicated at this time? - ANS Allopurinol. It has no role in the treatmen of gout because it plays no role in inflammation. It is a BP medicaiton. if a patient on BP medication develops gout, their meds should not be stopped. Which study is considered an experimental study? - ANS meta-analysis is the correct answer. It takes the results of many studies and combines them to arrive at a conclusion. observational study: participants are observed with no intervention,