NRNP 6560 Midterm exam Questions With Complete
Solutions
Acute Fractures Management Correct Answers - ABC care
(Airway, breathing, circulation), musculoskeletal second survey
- fluid resuscitation
- early reduction of fracture
- cover open wounds
- surgical irrigation and debridement for open fracture
- Ab's: Cefazolin for gram pos. Clindamycin for tetani infection
- pain: opioids
- tetanus shot of unknown
- calcium upon discharge for osteoporosis
- cement injection in bone with vertrebroplasty
Acute liver failure: findings, management Correct Answers
Weakness, fatigue
weightloss, n/v, abd pain
Change in bowel pattern
- Check BMP, ABG, lactate, toxicology screen, acetaminophen
screen, Hep panel, PT/ INR
- Treat specific etiology:
charcoal for acetaminophen and N-acetylcysteine)
Supportive for Hep A and E
Antiviral for Hep B
Test for Wilson
- ICU management: watch for cerebral edema, hyperventilate if
present, mannitol. CT head for encephalopathy
,Acute pancreatitis findings/ diagnostics Correct Answers -
Epigastric abd pain, abrupt, worse with walking or supine, better
with knee to chest, leaning forward
- N/V
- hypoactive bowelsounds
- tachycardia, hypotension
- jaundice
- ascites
- Elevated lipase and amylase
- elevated urine amylase
- elevated trypsin levels
- leukocytosis
- Bili elevated
- Hypocalcemia if severe disease
- Low albumin
- xr abdomen: ileus, pancreatic calcifications, gallstones
- CT abdomen preferred over US, and MRI over CT
Acute pancreatitis management Correct Answers - IV
hydration - Fluid therapy to prevent hypovolemia and shock: LR
or NS with 20 K at 75- 100 ml/hr
- May need plasma, RBC, albumin
- Pain control - Morphine, Fentanyl
- AB's, not prophylactically, only when septic or biliary stones.
- NPO, then supplements, small frequent meals
- NG for ileus or vomiting
- replace electrolytes
- enteral feeding
,acute pancreatitis: what and etiology Correct Answers
inflammation of pancreas
Alcoholism
Gallstones
Smoking
Traumatic or hereditary
Infectious (CMV)
Meds: Sulfa drugs, thiazide diuretics, Lasix, Corticosteroids,
Depakote, Opioids
Advanced HIV infection: definition, symptoms, prognosis
Correct Answers CD4 below 50
Wasting, fevers, fatigue
Poor
AIDS, definition and diagnosis Correct Answers acquired
immune deficiency syndrome
CD4 low, below 500 and infection with opportunistic organism
Or:
CD4 below 200
Alcoholic liver disease: etiology, findings, management Correct
Answers Most common cause of cirrhosis
Women twice as sensitive to alcohol toxicity then men
Binge drinking
High mortality rate
, Diagnosis on report of alcohol intake, evidence of liver disease,
lab abnormalities
AST and ALT often high than 2
Score for mortality: Maddreys' score
- Abstinence
- MDF score greater than 32: prednisone for 4 wks
- May require liver transplant
ANA. Tests in rheumatic disease: what, normal level, abnormal
with. Correct Answers Antinuclear antibody (ANA).
Normal: Titer 1.32
POsitive with: Sjogren's (SS), SLE (lupus),
Antiretroviral therapy (ART) Correct Answers - Combination
therapy, 3 or more from different drug classes
- Follow up with HIV viral load determination at 4 - 6 wks after
initiation and then every 3 - 6 mo.
- Adherence is vital
- always assess drug- drug interactions/ medication
reconciliation
- May make changes when CD4 exceeds evidence level
- check GFR/ creat/ BUN monthly for elderly on Tenofovir
- If deteriorating on ART (decline in CD4) then perform drug
resistance testing and revision of ART
Appendicitis findings and diagnostics Correct Answers Abd
pain: periumbilical first, then right lower quadrant pain
(McBurney's point)
Rovsing's sign: pain rlq when touched llq
Psoas sign: pain with extension of right hip
Solutions
Acute Fractures Management Correct Answers - ABC care
(Airway, breathing, circulation), musculoskeletal second survey
- fluid resuscitation
- early reduction of fracture
- cover open wounds
- surgical irrigation and debridement for open fracture
- Ab's: Cefazolin for gram pos. Clindamycin for tetani infection
- pain: opioids
- tetanus shot of unknown
- calcium upon discharge for osteoporosis
- cement injection in bone with vertrebroplasty
Acute liver failure: findings, management Correct Answers
Weakness, fatigue
weightloss, n/v, abd pain
Change in bowel pattern
- Check BMP, ABG, lactate, toxicology screen, acetaminophen
screen, Hep panel, PT/ INR
- Treat specific etiology:
charcoal for acetaminophen and N-acetylcysteine)
Supportive for Hep A and E
Antiviral for Hep B
Test for Wilson
- ICU management: watch for cerebral edema, hyperventilate if
present, mannitol. CT head for encephalopathy
,Acute pancreatitis findings/ diagnostics Correct Answers -
Epigastric abd pain, abrupt, worse with walking or supine, better
with knee to chest, leaning forward
- N/V
- hypoactive bowelsounds
- tachycardia, hypotension
- jaundice
- ascites
- Elevated lipase and amylase
- elevated urine amylase
- elevated trypsin levels
- leukocytosis
- Bili elevated
- Hypocalcemia if severe disease
- Low albumin
- xr abdomen: ileus, pancreatic calcifications, gallstones
- CT abdomen preferred over US, and MRI over CT
Acute pancreatitis management Correct Answers - IV
hydration - Fluid therapy to prevent hypovolemia and shock: LR
or NS with 20 K at 75- 100 ml/hr
- May need plasma, RBC, albumin
- Pain control - Morphine, Fentanyl
- AB's, not prophylactically, only when septic or biliary stones.
- NPO, then supplements, small frequent meals
- NG for ileus or vomiting
- replace electrolytes
- enteral feeding
,acute pancreatitis: what and etiology Correct Answers
inflammation of pancreas
Alcoholism
Gallstones
Smoking
Traumatic or hereditary
Infectious (CMV)
Meds: Sulfa drugs, thiazide diuretics, Lasix, Corticosteroids,
Depakote, Opioids
Advanced HIV infection: definition, symptoms, prognosis
Correct Answers CD4 below 50
Wasting, fevers, fatigue
Poor
AIDS, definition and diagnosis Correct Answers acquired
immune deficiency syndrome
CD4 low, below 500 and infection with opportunistic organism
Or:
CD4 below 200
Alcoholic liver disease: etiology, findings, management Correct
Answers Most common cause of cirrhosis
Women twice as sensitive to alcohol toxicity then men
Binge drinking
High mortality rate
, Diagnosis on report of alcohol intake, evidence of liver disease,
lab abnormalities
AST and ALT often high than 2
Score for mortality: Maddreys' score
- Abstinence
- MDF score greater than 32: prednisone for 4 wks
- May require liver transplant
ANA. Tests in rheumatic disease: what, normal level, abnormal
with. Correct Answers Antinuclear antibody (ANA).
Normal: Titer 1.32
POsitive with: Sjogren's (SS), SLE (lupus),
Antiretroviral therapy (ART) Correct Answers - Combination
therapy, 3 or more from different drug classes
- Follow up with HIV viral load determination at 4 - 6 wks after
initiation and then every 3 - 6 mo.
- Adherence is vital
- always assess drug- drug interactions/ medication
reconciliation
- May make changes when CD4 exceeds evidence level
- check GFR/ creat/ BUN monthly for elderly on Tenofovir
- If deteriorating on ART (decline in CD4) then perform drug
resistance testing and revision of ART
Appendicitis findings and diagnostics Correct Answers Abd
pain: periumbilical first, then right lower quadrant pain
(McBurney's point)
Rovsing's sign: pain rlq when touched llq
Psoas sign: pain with extension of right hip
