AG-ACNP DRT Exam 2 Questions and Answers Graded A

AG-ACNP DRT Exam 2 Questions and Answers Graded A Pt demonstrating AMS and free water restriction with euvolemia. Urine osmolality 270, BUN 14/0.6, urine Na 30. You suspect hyponatremia. What is the most likely cause? SIADH 45 yo. F s/p double mastectomy 2 months ago. Now complaining of pain at the incision site. What type of pain is she experiencing? Neuropathic pain caused by nerve damage during the double mastectomy. 31 M presents with blowing murmur occurring during S1 and a galloping additional heart sound. Murmur is heard best at the base of the heart. What is most likely? Mitral Regurgitation 25 yo. F with no significant PMH asks you as the ACNP how often she should come in for a physical examination. You would tell her? q5-6 years 65 yo. M presents with complaints of nausea, vomiting, and constipation x several days and a 6 lb weight loss. Pt is s/p total knee replacement several weeks ago and reports not really getting off the couch. What electrolyte abnormality is most likley? Hypercalcemia related to immobility s/p TKR 34 yo. M presents to ED with mother who reports that patient "downed an entire bottle of Tylenol". PMH significant for schizophrenia. What is the initial management in this patient? OGT and GI lavage r/t AMS and ARF aspiration. Then followed by N-Acetyclcystine (Mucomyst) 140 mg loading dose. 53 yo. M presents with complaints of dribbling and nocturia. You suspect BPH. PSA level is elevated. What confirms this diagnosis? Transrectal ultrasound is confirmation of BPH in presence of elevated PSA level. Your 52 yo. F patient expresses concerns for side effects associated with hormonal replacement therapy (HRT). What are the associated side effects? Gallstones Blood clots CVA Hormonal replacement therapy (HRT) has been shown to improve what dx? Osteoporosis What diagnostic is used to distinguish intrarenal or postrenal etiology of acute renal failure? Urinary sediment Intrarenal - urinary sediment has granular white casts Postrenal - urinary sediment is normal 25 yo. M presents with mid-diastolic, apical "crescendo" murmur. You know this murmur occurs during which heart sound? Mitral Stenosis. S1. AV valves close 32 yo. M presents to ED with GSW to forearm. Injuries are negligible and patient is hemodynamically stable. Pt reports he was hunting with friends and the gunshot was an accident and there was no foul play. You as the ACNP would do what next? Report the GSW to the Health Department. ALL GSW must be reported. When is the greatest risk for a mechanically ventilated patient to contract VAP? 48-72 hrs What is the DIC confirmatory diagnostic? Increased fibrin degradation product What signs are clinically significant for distal SBO? High pitched, tinkling bowel sounds Episodic vomiting Profuse vomiting and variable epigastric pain are two symptoms that are clinically significant for? PROXIMAL SBO Ionized calcium is 11.5 mg/dL. What is not an etiology? Pancreatitis. Pancreatitis is associated with HYPOcalcemia. In addition to a positive serum ANA, what diagnostic is supportive of diagnosing a patient with SLE? Leukopenia What is the confirmatory test for diagnosing syphillis? Fluorescent treponemal antibody absorption (FTA-ABS) What two herbs are associated with relieving premenstrual symptoms in women? Evening Primrose Black cohash 28 yo. F presents to ED with fever, malaise, rash across back, and splinter hemorrhages. Hgb 10 mg/dL, positive ANA, UA revealed proteinuria and elevated ESR. What is the suspected diagnosis? SLE ENDOCARDITIS does not have proteinuria. 49 yo. M presents with complaints of abdominal swelling that continues to progress for the past two days. Patient also reports multiple episodes of mucous-filled diarrhea and abdominal pain. Physical exam significant for profound abdominal distention. You suspect distal SBO. What type of bowel sounds are associated with distal SBO? High pitched, tinkling bowel sounds Patient is s/p AMI and EKG in ED reveals ST segment elevation in leads II, III and aVF. As the ACNP, what is the most important question when considering to administer tPA to a patient s/p AMI? How long ago was the AMI? Initial action in a patient with new onset seizures CT scan Lymphoma present in R axilla and R neck. What stage? Stage II - same side of the diaphragm How often should a woman between the ages of 20-39 yo. receive a PAP smear and HPV testing? q5 years How often should a F between the ages 20-39 yo. receive PAP smear and cytology? q3 yrs What is the pathology of Parkinson's Disease? An imbalance between ACH and dopamine in the corpus striatum. A bedside parasternal ultrasound reveals fluid in the pericardial sac. What is the initial action in managing this patient? Emergent pericardiocentesis When treating a patient diagnosed with syphillis, what drug allergy is most important to consider before initiating treatment? PCN allergy Syphillis is treated with PCN G A patient is receiving chemotherapy for treatment of TB. What serum test is most important in determining if chemotherapy is appropriate in this patient? alanine transaminase ABG reads high HCO3 and pCO2 55 mmHg. What electrolyte abnormality is most likely associated with these values? Hypokalemia related to metabolic alkalosis with concurrent respiratory acidosis What is the leading cause of death in AA M ages 40-59 years old? Coronary artery disease What is the leading cause of intrinsic acute renal failure? Nephrotoxic drugs True or False: Restraining an unwilling patient is grounds for malpractice. False A patient presents to the ED with complaints of chest pain and SOB. The ACNP misinterprets the EKG and admits the patient to the floor for further monitoring without consulting cardiology. Later in the shift, the patient decompensates and goes into cardiac arrest. The patient was successfully resuscitated but sustained permanent brain damage. What grounds of malpractice is the ACNP accountable for? Lack of skill Which of the following medications is not indicated in the management of bacterial meningitis: a. third generation cephalosporin b. vancomycin c. Phenytoin (Dilantin) d. Fluroquinolone Phenytoin (Dilantin) 23 yo. F presents in DKA. ABG reveal pH 7.3, glucose 520 mg/dL, BP 90/65, HR 120, and confused. Which of the following are not included in initial management of this patient in DKA: a. Isotonic fluids b. Insulin infusion c. sodium bicarbonate IV d. Supportive care C. sodium bicarbonate IV is only indicated in DKA if pH <7.1 What is the hemodynamic parameter that distinguishes cardiogenic shock from obstructive shock? Pulmonary capillary wedge pressure PCWP > 18 mmHg in cardiogenic PCWP <6 mmHg in obstructive On physical examination, you note a moderately loud murmur but no palpable thrill. What grade murmur is this? III/VI 60 yo. M presents to ED and children report that he passed out in the car while driving, regained consciousness and was drooling and "out of it". Patient's heart rate and blood pressure are decreased. You give Nimodipine. What is the rationale for administering Nimodipine to this patient? To counter vasospasm s/p CVA If born in or after what year is it indicated to receive 2 doses of mumps vaccine? 1957 What age does an individual receive Zostavax? Age 50; one time 18 yo. M presents to ED with mother and is noted to be crying and anxious. Mother reports that patient drank a bottle of fabric softener while playing truth or dare. What initial action is indicated by the ACNP? Activated Charcoal 1 gm/kg q4hrs What symptom is associated with hepatotoxicity s/p acetaminophen toxicity? Delirium What CSF values are characteristic of bacterial meningitis? elevated opening pressure elevated protein decreased glucose WBC Mike, 35 yo. Asian-American is in good health and is worried about life-prolonging measures. What is the most likely cause of death for a man like Mike? Homicide is the most common cause of death in males <40 yo. What pathological finding can cause both cardiogenic shock and obstructive shock? Cardiac tamponade When should PSA levels be initiated and how often? PSA levels qYear for M >40 yo. Annual PSA levels and annual DRE are indicated in what group? African-American M, >40 yo, Family history of prostate cancer 57 yo. M with PMH significant for cardiovascular disease presents with complaints of pain in both knees that is progressive throughout the day. You suspect osteoarthritis. What medication is contraindicated in this patient? Celebrex r/t ARF heart attack and patient's PMH positive for cardiovascular disease