NURS 642 Exam 4 with correct answers |\ |\ |\ |\ |\ |\
pulmonary tuberculosis phases - CORRECT ANSWERS ✔✔Intensive phase
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(< 8wks)• Continuation Phase (4mo after)•
|\ |\ |\ |\ |\ |\
Latent Phase (6-9mo)
|\ |\
pulmonary tuberculosis 4 medications of treatment during the intensive
|\ |\ |\ |\ |\ |\ |\ |\ |\
phase - CORRECT ANSWERS ✔✔•Pyrazinamide, Rifampin,
|\ |\ |\ |\ |\ |\
Isoniazid, |\
Ethambutol
Medications during the continuation phase of TB - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔INH AND RIFAMPIN |\ |\
LATENT PHASE TB MEDICATIONS - CORRECT ANSWERS ✔✔•INH x
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9mo: daily or twice weekly
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•INH x 6mo: daily or twice weekly
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•INH + RIF x 3mo once weekly
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•RIF x 4 months daily
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Active Infection must be R/O BY - CORRECT ANSWERS ✔✔Negative
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Sputum cx q8h x 3• |\ |\ |\ |\
,IF acid-fast bacillus(AFB)/Mycobacterium TB (Mtb) - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\
✔✔Limit high risk visitors |\ |\ |\
TB Symptoms: - CORRECT ANSWERS ✔✔Cough > 3wks (hemoptysis),
|\ |\ |\ |\ |\ |\ |\ |\ |\
Night sweats, Fever, Pleuritic CP
|\ |\ |\ |\
Elderly: Most likely non-specific
|\ |\ |\
TB DAIGNOSIS - CORRECT ANSWERS ✔✔•Rapid Diagnosis: MTB/RIF
|\ |\ |\ |\ |\ |\ |\ |\
Assay (Checks Mtb and rifampin resistance)
|\ |\ |\ |\ |\
•CXR (Mainstay) |\
Findings (Rarely Normal): Active lesions vs. scarring of past infection
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
•PPD (Assesses does NOT diagnose): Often negative <8-10 wks
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PPD SKIN TEST - CORRECT ANSWERS ✔✔Often negative <8-10 wks
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•Cut-Offs: 48 - 72 hr after administration (Induration)
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•15 mm: those without risk factors
|\ |\ |\ |\ |\ |\
•10 mm: "healthy" with risk factors (such as healthcare workers, foreign-born
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
persons)
|\ |\
•5 mm: household contact, CXR suspicious, and immunocompromised
|\ |\ |\ |\ |\ |\ |\
,pleural effusion - CORRECT ANSWERS ✔✔abnormal accumulation of fluid
|\ |\ |\ |\ |\ |\ |\ |\ |\
in the pleural space
|\ |\ |\
Breast and lung cancer: 50% may develop pleural effusions (poor prognosis)
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
TRANSUDATIVE PLEURAL EFFUSION - CORRECT ANSWERS |\ |\ |\ |\ |\ |\
✔✔Systemic causes: CHF, nephrotic sx, cirrhosis: |\ |\ |\ |\ |\ |\
No pulm dz (HF ~90%)
|\ |\ |\ |\
Aspiration fluid: Similar glucose to serum and low WBC (<1000)
|\ |\ |\ |\ |\ |\ |\ |\ |\
HF = Diuretics
|\ |\
Exudative pleural effusion - CORRECT ANSWERS ✔✔Pulm dz, infection
|\ |\ |\ |\ |\ |\ |\ |\ |\
(Malignancy ~50%) |\
Aspiration fluid: High Protein & LDH on (exudes proteins)
|\ |\ |\ |\ |\ |\ |\ |\
PLEURAL EFFUSION DIAGNOSIS - CORRECT ANSWERS ✔✔Once|\ |\ |\ |\ |\ |\ |\
*blunting of the costovertebral angles* (which requires at least 250cc) is seen
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the diagnosis is made.
|\ |\ |\ |\ |\
|\
CXR (Upright PA & Lateral - 175mL to visualize)
|\ |\ |\ |\ |\ |\ |\ |\
High Suspicion and <175mL = Lateral Decubitus (75mL)
|\ |\ |\ |\ |\ |\ |\
HUMAN INFLUENZA - CORRECT ANSWERS ✔✔PRIMARILY B AND C -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
START ANTIVIRALS ASAP |\ |\
, STATIN INITIATION - CORRECT ANSWERS ✔✔•Do not: initiate if K >
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
5.5, combine with ARB, pregnant
|\ |\ |\ |\ |\
•ACC/AHA Guidelines: |\
1. Patients with any form of clinical ASCVD
|\ |\ |\ |\ |\ |\ |\
2. Patients with primary LDL >/= 190 (ASCVD)
|\ |\ |\ |\ |\ |\ |\
3. Patients with DM, 40-7yo w/ LDL 70 to 189
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
4. Patients w/o DM, 40-75yo w/ estimated 10-year ASCVD risk ≥ 7.5%
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
HTN, PRIMARY - CORRECT ANSWERS ✔✔(95%): No one identifiable
|\ |\ |\ |\ |\ |\ |\ |\ |\
cause (Genetic or lifestyle)
|\ |\ |\
OSA, High Na diet, ETOH, Smoking, NSAIDs
|\ |\ |\ |\ |\ |\
HTN, SECONDARY - CORRECT ANSWERS ✔✔Something is Causing
|\ |\ |\ |\ |\ |\ |\ |\
(Cushings) |\
•High Suspicion Age < 50
|\ |\ |\ |\
HTN TREATMENT - CORRECT ANSWERS ✔✔< 55Y/O
|\ |\ |\ |\ |\ |\ |\
GOAL SPB <140/90 |\ |\ |\
1st line: Lifestyle modification
|\ |\ |\
Look for secondary cause in young patients
|\ |\ |\ |\ |\ |\
pulmonary tuberculosis phases - CORRECT ANSWERS ✔✔Intensive phase
|\ |\ |\ |\ |\ |\ |\ |\
(< 8wks)• Continuation Phase (4mo after)•
|\ |\ |\ |\ |\ |\
Latent Phase (6-9mo)
|\ |\
pulmonary tuberculosis 4 medications of treatment during the intensive
|\ |\ |\ |\ |\ |\ |\ |\ |\
phase - CORRECT ANSWERS ✔✔•Pyrazinamide, Rifampin,
|\ |\ |\ |\ |\ |\
Isoniazid, |\
Ethambutol
Medications during the continuation phase of TB - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔INH AND RIFAMPIN |\ |\
LATENT PHASE TB MEDICATIONS - CORRECT ANSWERS ✔✔•INH x
|\ |\ |\ |\ |\ |\ |\ |\ |\
9mo: daily or twice weekly
|\ |\ |\ |\ |\
•INH x 6mo: daily or twice weekly
|\ |\ |\ |\ |\ |\ |\
•INH + RIF x 3mo once weekly
|\ |\ |\ |\ |\ |\ |\
•RIF x 4 months daily
|\ |\ |\ |\
Active Infection must be R/O BY - CORRECT ANSWERS ✔✔Negative
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Sputum cx q8h x 3• |\ |\ |\ |\
,IF acid-fast bacillus(AFB)/Mycobacterium TB (Mtb) - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\
✔✔Limit high risk visitors |\ |\ |\
TB Symptoms: - CORRECT ANSWERS ✔✔Cough > 3wks (hemoptysis),
|\ |\ |\ |\ |\ |\ |\ |\ |\
Night sweats, Fever, Pleuritic CP
|\ |\ |\ |\
Elderly: Most likely non-specific
|\ |\ |\
TB DAIGNOSIS - CORRECT ANSWERS ✔✔•Rapid Diagnosis: MTB/RIF
|\ |\ |\ |\ |\ |\ |\ |\
Assay (Checks Mtb and rifampin resistance)
|\ |\ |\ |\ |\
•CXR (Mainstay) |\
Findings (Rarely Normal): Active lesions vs. scarring of past infection
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
•PPD (Assesses does NOT diagnose): Often negative <8-10 wks
|\ |\ |\ |\ |\ |\ |\ |\
PPD SKIN TEST - CORRECT ANSWERS ✔✔Often negative <8-10 wks
|\ |\ |\ |\ |\ |\ |\ |\ |\
•Cut-Offs: 48 - 72 hr after administration (Induration)
|\ |\ |\ |\ |\ |\ |\ |\
•15 mm: those without risk factors
|\ |\ |\ |\ |\ |\
•10 mm: "healthy" with risk factors (such as healthcare workers, foreign-born
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
persons)
|\ |\
•5 mm: household contact, CXR suspicious, and immunocompromised
|\ |\ |\ |\ |\ |\ |\
,pleural effusion - CORRECT ANSWERS ✔✔abnormal accumulation of fluid
|\ |\ |\ |\ |\ |\ |\ |\ |\
in the pleural space
|\ |\ |\
Breast and lung cancer: 50% may develop pleural effusions (poor prognosis)
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
TRANSUDATIVE PLEURAL EFFUSION - CORRECT ANSWERS |\ |\ |\ |\ |\ |\
✔✔Systemic causes: CHF, nephrotic sx, cirrhosis: |\ |\ |\ |\ |\ |\
No pulm dz (HF ~90%)
|\ |\ |\ |\
Aspiration fluid: Similar glucose to serum and low WBC (<1000)
|\ |\ |\ |\ |\ |\ |\ |\ |\
HF = Diuretics
|\ |\
Exudative pleural effusion - CORRECT ANSWERS ✔✔Pulm dz, infection
|\ |\ |\ |\ |\ |\ |\ |\ |\
(Malignancy ~50%) |\
Aspiration fluid: High Protein & LDH on (exudes proteins)
|\ |\ |\ |\ |\ |\ |\ |\
PLEURAL EFFUSION DIAGNOSIS - CORRECT ANSWERS ✔✔Once|\ |\ |\ |\ |\ |\ |\
*blunting of the costovertebral angles* (which requires at least 250cc) is seen
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the diagnosis is made.
|\ |\ |\ |\ |\
|\
CXR (Upright PA & Lateral - 175mL to visualize)
|\ |\ |\ |\ |\ |\ |\ |\
High Suspicion and <175mL = Lateral Decubitus (75mL)
|\ |\ |\ |\ |\ |\ |\
HUMAN INFLUENZA - CORRECT ANSWERS ✔✔PRIMARILY B AND C -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
START ANTIVIRALS ASAP |\ |\
, STATIN INITIATION - CORRECT ANSWERS ✔✔•Do not: initiate if K >
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
5.5, combine with ARB, pregnant
|\ |\ |\ |\ |\
•ACC/AHA Guidelines: |\
1. Patients with any form of clinical ASCVD
|\ |\ |\ |\ |\ |\ |\
2. Patients with primary LDL >/= 190 (ASCVD)
|\ |\ |\ |\ |\ |\ |\
3. Patients with DM, 40-7yo w/ LDL 70 to 189
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
4. Patients w/o DM, 40-75yo w/ estimated 10-year ASCVD risk ≥ 7.5%
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
HTN, PRIMARY - CORRECT ANSWERS ✔✔(95%): No one identifiable
|\ |\ |\ |\ |\ |\ |\ |\ |\
cause (Genetic or lifestyle)
|\ |\ |\
OSA, High Na diet, ETOH, Smoking, NSAIDs
|\ |\ |\ |\ |\ |\
HTN, SECONDARY - CORRECT ANSWERS ✔✔Something is Causing
|\ |\ |\ |\ |\ |\ |\ |\
(Cushings) |\
•High Suspicion Age < 50
|\ |\ |\ |\
HTN TREATMENT - CORRECT ANSWERS ✔✔< 55Y/O
|\ |\ |\ |\ |\ |\ |\
GOAL SPB <140/90 |\ |\ |\
1st line: Lifestyle modification
|\ |\ |\
Look for secondary cause in young patients
|\ |\ |\ |\ |\ |\
