NSG555 / NSG 555 Exam 2 (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 2: 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: anal fissure painful linear cracks common in kids and middle age adults. if present <6 weeks it's acut if >6 weeks it's chronic caused by trauma from constipationor diarrhea which causes a chemical burn or anal stenosis Q: anal fissure that is NOT posterior midline Answer: suspect STI, TB, HIV, infection, UC, crohns, malignant neoplasm, etc REFER THESE PTS Q: s/s and PE of anal fissure Answer: tearing with passing stool, pain, small amounts of blood on TP. Q: differential dx anal fissure Answer: anal cancer, perianal abscess, thrombosed hemorrhoid RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody diarrhea, wt loss Q: management of anal fissures Answer: usually resolve without tx. Inc fiber, stool softeners, sitz baths, supps or foam antiinflammatory agents lidocaine gel before BMs topical nitrates or oral CCBs (diltiazem) helps healing of fissures Q: Gold standard treatment of CHRONIC anal fissure Answer: lateral internal sphincerotomy: reduces internal sphincter tone allowing fissure to heal Q: Pruritis ani Answer: RED FLAG IF wieght loss or refractory s/s to rule on cancer Itching. very common. caused by hundreds of things. dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivite. rule out STI, may need biopsy if no relief, assess if food alergy or detergent allergy, pin worms, yest, etc. Q: management of pruritis ani Answer: hygien. increase fiber if there are loos stools. Use a hair dryer on cool setting to dry anus. avoid perfumes. 1% hydrocortisone cream (d/c after 2 weeks to avoid skin atrophy) antihistamine with antipruritic (Atarax/hydroxyzine) Witch hazel relief in 4-6 weeks Q: anorectal abscess or fistula Answer: common in crohns patients. pus from internal opening of fistual tract, purulent drainage or a sinus. dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy Mgt: incision and drainage is first line treatment pharm mgt: abx usually not needed unless infection. if infection with cellullitis or immunosuppression cipro or metronidazole Q: cirrhosis Answer: end stage consequence of hepatic fibrosis. Irreversible commonly from BV or HCV, ETOH liver disease, NAFLD, and NASH apap, amiodarone, methotrexate, isoniazid, abx, arbon tetrachloride can also cause. Q: portal hypertension Answer: the elevation of blood pressure within the portal venous system due to shunting of portal/arterial blood supplies Q: fibrosis in the liver causes Answer: portal HTN, obstructive biliary channels, destruction of liver cells, liver cancer, liver failure As increased portal pressure occurs new collateral circulation/vascular channels created in peritoneum, retroperitoneum, thorax, esophagus, etc. This can cause ascites, splenomegay, esophageal varices and can rupture-->death Q: primary biliary cirrhosis Answer: autoimmune destruction of bild ducts Q: pathophys cirrhosis Answer: hepatocellular injury-->inflammation-->new liver cells generated by fibrotic scar tissue00>nodules which deform normal hepatic dissue-->increased resistance to circulation, decreased blood flow, obstruction to portal vein and decreased liver function Q: early symtoms of primary biliary cirrhosis Answer: itching, weight loss, fatigue Q: general cirrhosis s/s Answer: weakness, malaise, dark urine, pale stools, anorexia, n/v, hematemesis, abdominal pain because of stretching of muscled d/t enlarged liver, chest pain d/t cardiomegalyk Q: physical exam cirrhosis jaundice, spider