NSG555 / NSG 555 Exam 1 (Latest 2024 / 2025 Update): Nurse Practitioners in Primary Care I | Complete Guide with Questions and Verified Answers | All Modules Covered | 100% Correct | Grade A - Wilkes

Exam 1: NSG555 / NSG 555 (Latest 2024 / 2025 Update) - Nurse Practitioners in Primary Care II Exam Review | Complete Guide with Questions and Verified Answers | All Modules Covered |100% Correct | Grade A - Wilkes Q: nasal tumors and polyps--most common Answer: inverted papilloma between nose and maxillary sinus Highly vascular benign tumor Common in boys of adolescent age Q: nasal polyps Answer: inflammatory disorder of nose and paranasal sinuses that can result in chronic nasal obstruction and a diminished sense of smell common in 1/3 of patients/children with CF Q: pathophys of nasopharynx tumors Answer: dx difficult because varied pathophys. more common in men, assoc. with smoking, etoh, sunlight exposure Q: clinical presentation/PE of nasal tumors Answer: mimic rhinitis or sinusitis unilateral nasal obstruction + pain, hemorrhage, HA, visual/olfactory changes nasal obstruction, d/c, facial swelling, recurrent epistaxis (these are usually benign and can be seen) Q: nasal polyps presentation and PE Answer: nasal obstruction, hyposmia/anosmia, recurrent sinusitis, HA, post-nasal drip, intrinsic asthma . teardrop or grap shaped. use pen light to look at nares, assess lymph nodes, Q: diagnostics nasal polyps Answer: endoscopic eval and biopsy is gold standard CBC sinus x-ray, may need CT/MRI to assess bone involvement Q: priority differential dx for nasal tumors/polyps Answer: benign/malignant polyps, granulomatosis with polyangiitis (wegeners), mucoceles, granulomas without systemic improvement wegeners granulomatosis: systemic vasculitis by glomerulonephritis+granulomas of nose and lungs. destruction of bone, cartilage, soft tissue of nose found on biopsy to be malignant neoplasms. Often first s/s is resp. tract symptoms Q: pharm management of nasal polyps Answer: glucocorticoids: nasal topical, if not helpful then use short course of oral corticosteroids antihistamines may help s/s but not polyps themselves CAM: intranasal capsaicin may help reduce size of polyp surgery, they frequently return consult rheumatology: IF GPA is suspected consult ENT: if unrelieved by nasal corticosteroids see ENT. all suspected tumors refer to ENT Q: acute bronchitis def/epidemiology Answer: acute, self limited inflammation of trachea and major bronchi cough of 1-3 weeks WITHOUT bronchial consolidation (simila rot pna or underlying c/p disease usually viral (influenza a and b, RSV, paravirus) and part of spectrum of URI (includes acute otitis, pharyngitis, tonsillitis, acute sinusitis) but by definition bronchitis is inflam of lower resp tract Bacterial cause more common in pts with chronic health problems, same diseases as those that cause CAP: bordatella p, m. pna, etc Q: acute bronchitis pathophys Answer: cause is rarely identified. cough due to increased edema in tracheobronchial tree, epithelial cell dammage, proinflamm mediators and inc in secretions Q: presentation/PE acute bronchitis Answer: cough is most common sign, slow to resolve, characteristics vary from dry/nonproductive to productive. * clear or mucoid or purulent sputum (this does not mean bacterial). *burning substernal pain with inspiration. * low-grade fever, wheezes, rhonchi . VS normal Q: dx test of acute bronchitis Answer: no tests needed cough+normal VS (no tachypnea, tachycardia, rales, egophony)=acute bronchitis, minimal likelihood of pna If lab testing is done -inc in leuk can mean bacterial -inc CRP associated with pna (if less than 10 and no dyspnea or fever this rules pna out) rapid dx tests and sputum cultures not recommended unless community outbreak -CXR--only if suspicious of CAP (older adults)--only get if tachypnea, tachycardia or fever and chest exam suggests consolidation (egophony or fremitus) IF cough lasts longer than 3 weeks return to clinic. Q: differential dx acute bronchitis common cold, GERD, asthma, COPD, PNA. VERY important to rule out pna Chronic bronchitis if cough+sputum most days of the month for a minimum of 3 mos/year X2 years in a row Q: pharm mgt acute bronchitis