Nr 661 Vise Exam Questions With Correct Answers.

NR 661 VISE EXAM QUESTIONS WITH
CORRECT ANSWERS
hypertension - presentation - CORRECT ANSWER-✔✔✅Most are not symptomatic, Occipital
Headaches, headache on awakening in am, blurry vision



hypertension - assessment - CORRECT ANSWER-✔✔✅· Asymptomatic

· Occipital headache

· Blurry vision

· Headache upon wakening

· Look for AV nicking

· LVH (left vent hypertrophy - sob, fatigue, cp, dizzy)



Hypertension - Diagnostic Studies - CORRECT ANSWER-✔✔✅to look for secondary causes of HTN like
target organ damage and establish ASCVD risk: EKG, fasting lipid profile, fasting blood glucose, CBC,
CMP (electrolyte, creatinine, & calcium levels), and urinalysis (checking for proteinuria).



hypertension - diagnosis - CORRECT ANSWER-✔✔✅Measure BP 5 minutes apart. Average of 2 or
more BP readings on two different visits at > 140/90 mm Hg start then can be diagnosed with HTN.



Hypertension - staging - CORRECT ANSWER-✔✔✅Stage 1 (ASCVD <10%) then non-pharmacologic
management only:

· First: Lifestyle modifications: diet and exercise 30 minutes aerobic exercise 5 days per week.

· Limit alcohol

· stop smoking

· stress management.

· DASH

· Medication compliance

· Reduce sodium intake

,· Measure BP daily

If Stage 2 (ASCVD >10% and known CAD) initiate lifestyle + Pharmacologic



Hypertension pharmacological management - CORRECT ANSWER-✔✔✅· Alone: hydrochlorothiazide
(HCTZ) 25 mg/day (chlorthalidone is preferred over HCTZ)

· Alone: lisinopril 10mg/day complicated HTN first line

· Combo: thiazide + ACE or ARB

· Alternative CB (especially in isolated HTN seen mainly in older adults)

· Black population: thiazide + CCB is recommended first line



hypertension f/u - CORRECT ANSWER-✔✔✅2-4 weeks



hypertension referral - CORRECT ANSWER-✔✔✅cardiology if ekg abnormal



hypertension differential - CORRECT ANSWER-✔✔✅· Secondary hypertension

· Pregnant

· Pregnancy induced hypertension



acute maxillary sinusitis - etiology - CORRECT ANSWER-✔✔✅inflammation of the maxillary sinus due
to viral, bacterial, or fungal infection or allergic reaction



acute sinusitis - CORRECT ANSWER-✔✔✅symptoms last < 12 weeks

· Common bacterial causes: strep pneumoniae, haemophilus influenzae, Moraxella catarrhalis

· Common viral causes: rhonovirus, coronavirus, flu A and B, parainfluenza, RSV



recurrent acute sinusitis - CORRECT ANSWER-✔✔✅at least 3 episodes of acute bacterial sinusitis in a
year



chronic sinusitis - CORRECT ANSWER-✔✔✅symptoms of varying severity > 12 weeks; further
classified with or without nasal polyps, abnormal findings on CT scan or nasal endoscopy

,· Gram negative is more likely

· Staph aureus

· Pseudomonas aeruginosa

· Anaerobic organisms



sinusitis - presentations - CORRECT ANSWER-✔✔✅· Fever may or may not be present

· Persistent symptoms of URI (> 10-14 days)

· Congestion, purulent nasal discharge

· headache, sore throat,

· Pain and pressure over cheeks and upper teeth suggest maxillary

· Pain and pressure over eyebrows suggest frontal

· Pain and pressure/tenderness behind and between eyes suggests ethmoid

· cough, anosmia, halitosis, postnasal discharge, periorbital edema

Symptoms > 10 days that worsen after initial improvement, persistent purulent nasal discharge, fever,
unilateral face or tooth pain is more likely a bacterial infection



sinusitis - diagnostics - CORRECT ANSWER-✔✔✅CBC (elevated WBC),

sinus x-rays for recurrent disease

transillumination: opacification with air-fluid levels if sinus cavity is infected

CT scan for recurrent disease

Consider c and s for treatment resistant infections



sinusitis -- nonpharmacological - CORRECT ANSWER-✔✔✅Avoid environmental irritants,

Humidified air

treat otitis media,

sleep with HOB elevated to aid with drainage,

Good hand hygiene

blowing nose, not sniffing.

, sinusitis -- pharmacological - CORRECT ANSWER-✔✔✅First line- Augmentin 875 mg/125 mg PO BID
for 5 days,

Allergic to Penicillin then Doxycycline 100mg BID for 5-7 days OR 200mg PO daily for 5-7 days
Levofloxacin 500mg PO daily for 10-14 days Monifloxacin 400mg PO daily for 5-7 days

Macrolides no longer recommended due to high resistance

Analgesics for headache and fever

Saline irrigation



sinusitis - f/u, referral - CORRECT ANSWER-✔✔✅Follow up:

1 week or until clinically free of infection

Referral:

May refer to ENT for recurrent infections or resistance to tx

Consider immediate referral if periorbital cellulitis

ER if meningitis suspected



hyperlipidemia - etilogy - CORRECT ANSWER-✔✔✅may be familial, dietary, obesity, hypothyroid,
renal disorders, thiazide or beta blocker use, alcohol and/or caffeine intake



hyperlipidemia - presentation - CORRECT ANSWER-✔✔✅· Xanthomata (lipid deposits around the
eyes)

· Corneal Arcus prior to age 50 years (white iris), normal

· Angina

· Bruits

· MI

· Stroke



hyperlipidemia - diagnositics - CORRECT ANSWER-✔✔✅· Fasting/nonfasting lipid profile (total
cholesterol, LDL, and HDL minimally affected by eating)

· Glucose,

· UA and creatinine (for detection of nephrotic syndrome which can induce dyslipidemia),