Sarah Michelle Live Review Exam – Comprehensive Study
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
A new graduate nurse practitioner has a patient presents with a hearing complaint. The
patient states that they have had decreased hearing on the right side for the last month that is
continuing to get worse. The NP completes both the Rinne and Weber tests. If the patient has
Ménière's disease, what would be the expected finding on the Weber test?
1. AC is 2 times longer than BC
2. BC is 2 times longer than AC
3. The tuning fork lateralizes to the right ear
4. The tuning fork lateralizes to the left ear - ans4. The tuning fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? - ansVertigo, tinnitus, ear
pressure, nystagmus
What is our biggest worry for a Meniere's Disease patient? - ansThere is a possibility for a
potential, permanent hearing loss.
What is rhinitis meidcamentosa? - ansDrug-induced rebound nasal congestion, this can
happen after use of nasal decongestants like Afrin. These nasal decongestants should ideally
not be used for greater than 3-5 days because of this risk.
What is herpes keratitis? - ansThis is an infection of the cornea due to herpes simplex virus
How is herpes keratitis diagnosed? - ansBy examining the eye under a black lamp and
visualized the cornea, in herpes keratitis, fern like lines will be seen on the cornea
A child that has a history of mononucleosis is at increased risk for development for what
cancer later in life? And why? - ansHodgkin's Lymphoma and Burkitt's Lymphoma, this is
due to the exposure of the Epstein-Barr virus
What types of patients will be at a higher risk of pneumonia? - ansPatient with chronic lung
diseases: asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? - ansBecause we WANT
them to get that gunk out, we do not want them to hold it in their lungs, an expectorant would
be a better option for these patients.
When should a follow up chest X-Ray be completed after treatment of pneumonia? -
ansAround 8 week mark
What is COPD? - ansChronic Obstructive Pulmonary Disease. This is a chronic condition
that is made up of chronic bronchitis and emphysema. It is a progressive inflammatory lung
disease that makes it hard for the patients to breathe, because the chronic bronchitis leads to
mucous build up and the emphysema portion destroys areas of the lungs.
What signs and symptoms are common in COPD patients? - ansChronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? - ansNeurological
symptoms, paresthesia (numbness and tingling in hands and feet), unsteady gait, memory
issues
Beefy red tongue
What diet can result in B12 deficiency? - ansVegan- oral supplements can be used for
treatment
,Sarah Michelle Live Review Exam – Comprehensive Study
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
What surgery can result in B12 deficiency? - ansGastric surgery- patient will lose intrinsic
factor that is required to absorb B12- these patients will require life long IM B12 injections
What patient population is lupus commonly seen? - ansWomen of childbearing age- ages 15-
45, African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? - ansMust have 4/11 diagnostic criteria:
Malar rash
Discoid rash
Photosensitivity
Oral/nasal ulcers
Non-erosive arthritis
Cardio-pulmonary complaints
Renal complaints
Neurological concerns
Immunological disorders
+ ANA test
Hematologic disorders
What is Sjogren's Syndrome and what is the treatment? - ansDry eyes and dry mouth-
treatment revolves around symptom management- artificial tears, hard candies, etc.
Common in lupus patients
What is a major concern for lupus patients? How do we monitor this? - ansImpact on the
kidneys- Lupus nephritis
Be on the look out for glomerularnephritis as well as proteinuria
These patients will require routine UA for assessment of their kidneys and protect them
What is the function of the thyroid? - ansViral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? - ansPituitary gland
What is the function of TSH? - ansTells your thyroid when to produce and release those
critical thyroid hormones- T3 and T4.
What disorders include hypothyroidism? - ansIodine deficiency, Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? - ansHypothyroidism is caused by
an autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? - ansWeight gain, constipation, dry
skin, cold intolerance, fatigue, course hair, facial puffiness, thick tongue, and maybe some
cardiac side effects
What patient education must be included regarding Synthroid administration? - ansMust be
taken on an empty stomach before other medications
What are signs and symptoms of a myxedema coma? - ansLow body temperature, edema,
confusion, lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? - ansLithium or amiodarone
,Sarah Michelle Live Review Exam – Comprehensive Study
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
Your patient who is on 75 mcg Synthroid PO daily comes in for a 6 week follow up to check
their TSH level. When you get the results, their TSH is 0.1. What should you do next as the
NP? - ansAssess how the patient is taking their Synthroid
What signs and symptoms are common in hyperthyroidism? - ansAnxiety, palpitations,
cardiac abnormalities, tachycardia, diaphoresis, weight loss, and increased appetite, menstrual
irregularities, amenorrhea, tremors, lid lag, exophthalmos
What needs to be considered with PTU medication administration? - ansNeed frequent lab
work: CBC, and Thyroid panel
Required to take PTU multiple times a day
What is the most common treatment for Grave's Disease? - ansRadioactive iodine therapy
Hyperthyroidism left untreated may lead to what conditions? - ansHeart disease- patient's
heart is in a constant high-output state, your heart can't keep up with that all of the time, may
lead to heart failure
Osteoporosis
Infertility
What is worst case scenario in hyperthyroid patients? - ansThyroid storm- Temperature, HR,
and BP- dangerously HIGH levels
Puts body into compromised state, especially impacting your heart. Heart starts to go into
Letha dysrhythmias and even heart failure.
What are the 8 most common drug classes for diabetes medications? - ansBiguanides
(Metformin)
DPP-4 inhibitors
GLP-1 Agonists
SGLT-2 inhibitors
Insulin
Sulfonylureas
TZDs
Alpha-glycosides inhibitors
Why are type 1 diabetics insulin dependent? - ansThey have an autoimmune destruction of
their beta cells
What are some examples of rapid acting insulin? - ansHumalog, Novalog, Apidra
What is the onset, peak, and duration of rapid acting insulin? - ansOnset: 15 minutes
Peak: 1 hour
Duration: 2-4 hours
What are some examples of short acting insulin? - ansRegular insulin (Humulin R, Novolin
R)
What is the onset, peak and duration of short acting insulin? - ansOnset: 30 min- 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
What are some examples of intermediate insulin? - ansNPH (Humulin N, Novolin N)
What is the onset, peak, and duration of intermediate insulin? - ansOnset: 1-2 hours
Peak: 6-12 hours
, Sarah Michelle Live Review Exam – Comprehensive Study
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
Duration: 24 hours
What are some examples of long acting insulin? - ansLantus, Levemir
What is the onset, peak and duration of long acting insulin? - ansOnset: 2 hours
Peak: NONE
Duration: 24 hours
What is truly our GO TO oral diabetes medication? - ansMetformin (Biguanides)
What is the maximum daily dosage of Metformin? - ans2,550 mg in a day
What labs do we need to monitor when a patient is on Metformin? - ansMonitor renal
function, if GFR drop to less than 30- have to discontinue Metformin
Why does Metformin need to be stopped prior to having any procedure with contrast? -
ansContrast dye is harsh on the kidneys, need to be sure that there is pause with that
Metformin so that their kidneys are not seriously injured.
Long term usage of Metformin can lead to what deficiency? - ansB12 deficiency anemia
How does Metformin impact weight? - ansMetformin is weight NEUTRAL, some patient
even will have weight loss with this drug
Does Metformin cause hypoglycemia? - ansNO, Metformin works in the body by inhibiting
glucose production in the liver. Due to that there are no issues with hypoglycemia
What are some examples of SGLT-2 inhibitors? - ansAll the -flozin's
Empagiflozin
What is the MOA for SGLT-2 inhibitors? - ansReduce absorption of glucose in the renal
tubules, the patient will urinate out the extra glucose
What lab should be assessed prior to prescribing SGLT-2 inhibitors? - ansRenal function
Does SGLT-2 inhibitors cause hypoglycemia? - ansSGLT-2 inhibitors have a LOW risk for
hypoglycemia
What education is required for patients who are on SGLT-2 inhibitors? - ansStaying hydrated
and reporting any new urinary issues
What patients are NOT good candidates for SGLT-2 inhibitors? - ansPatients who cannot
make it to the bathroom in time
Patients with frequent UTIs or yeast infections already
What is a major perk to SGLT-2 inhibitors? - ansThey are cardio-protective- they have shown
to reduce overall risk of mortality associated with coexisting cardiac conditions, and they
may even prevent future cardiac issues.
What diabetes medication classes are cardioprotective? - ansSGLT-2 inhibitors and GLP-1
agonists
What are examples of DPP-4 inhibitors? - ansAlt he -gliptins
Sitagliptin
What is the MOA of DPP-4 inhibitors? - ansIncrease insulin production/decrease glucagon
secretion
Impacts fasting and postprandial glucose levels
DPP-4 inhibitors are contraindicated in patients with a history of what condition? -
ansPancreatitis
What are examples of sulfonylureas? - ansAll the ide's
glipizide, glyburide, glimepiride
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
A new graduate nurse practitioner has a patient presents with a hearing complaint. The
patient states that they have had decreased hearing on the right side for the last month that is
continuing to get worse. The NP completes both the Rinne and Weber tests. If the patient has
Ménière's disease, what would be the expected finding on the Weber test?
1. AC is 2 times longer than BC
2. BC is 2 times longer than AC
3. The tuning fork lateralizes to the right ear
4. The tuning fork lateralizes to the left ear - ans4. The tuning fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? - ansVertigo, tinnitus, ear
pressure, nystagmus
What is our biggest worry for a Meniere's Disease patient? - ansThere is a possibility for a
potential, permanent hearing loss.
What is rhinitis meidcamentosa? - ansDrug-induced rebound nasal congestion, this can
happen after use of nasal decongestants like Afrin. These nasal decongestants should ideally
not be used for greater than 3-5 days because of this risk.
What is herpes keratitis? - ansThis is an infection of the cornea due to herpes simplex virus
How is herpes keratitis diagnosed? - ansBy examining the eye under a black lamp and
visualized the cornea, in herpes keratitis, fern like lines will be seen on the cornea
A child that has a history of mononucleosis is at increased risk for development for what
cancer later in life? And why? - ansHodgkin's Lymphoma and Burkitt's Lymphoma, this is
due to the exposure of the Epstein-Barr virus
What types of patients will be at a higher risk of pneumonia? - ansPatient with chronic lung
diseases: asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? - ansBecause we WANT
them to get that gunk out, we do not want them to hold it in their lungs, an expectorant would
be a better option for these patients.
When should a follow up chest X-Ray be completed after treatment of pneumonia? -
ansAround 8 week mark
What is COPD? - ansChronic Obstructive Pulmonary Disease. This is a chronic condition
that is made up of chronic bronchitis and emphysema. It is a progressive inflammatory lung
disease that makes it hard for the patients to breathe, because the chronic bronchitis leads to
mucous build up and the emphysema portion destroys areas of the lungs.
What signs and symptoms are common in COPD patients? - ansChronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? - ansNeurological
symptoms, paresthesia (numbness and tingling in hands and feet), unsteady gait, memory
issues
Beefy red tongue
What diet can result in B12 deficiency? - ansVegan- oral supplements can be used for
treatment
,Sarah Michelle Live Review Exam – Comprehensive Study
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
What surgery can result in B12 deficiency? - ansGastric surgery- patient will lose intrinsic
factor that is required to absorb B12- these patients will require life long IM B12 injections
What patient population is lupus commonly seen? - ansWomen of childbearing age- ages 15-
45, African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? - ansMust have 4/11 diagnostic criteria:
Malar rash
Discoid rash
Photosensitivity
Oral/nasal ulcers
Non-erosive arthritis
Cardio-pulmonary complaints
Renal complaints
Neurological concerns
Immunological disorders
+ ANA test
Hematologic disorders
What is Sjogren's Syndrome and what is the treatment? - ansDry eyes and dry mouth-
treatment revolves around symptom management- artificial tears, hard candies, etc.
Common in lupus patients
What is a major concern for lupus patients? How do we monitor this? - ansImpact on the
kidneys- Lupus nephritis
Be on the look out for glomerularnephritis as well as proteinuria
These patients will require routine UA for assessment of their kidneys and protect them
What is the function of the thyroid? - ansViral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? - ansPituitary gland
What is the function of TSH? - ansTells your thyroid when to produce and release those
critical thyroid hormones- T3 and T4.
What disorders include hypothyroidism? - ansIodine deficiency, Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? - ansHypothyroidism is caused by
an autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? - ansWeight gain, constipation, dry
skin, cold intolerance, fatigue, course hair, facial puffiness, thick tongue, and maybe some
cardiac side effects
What patient education must be included regarding Synthroid administration? - ansMust be
taken on an empty stomach before other medications
What are signs and symptoms of a myxedema coma? - ansLow body temperature, edema,
confusion, lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? - ansLithium or amiodarone
,Sarah Michelle Live Review Exam – Comprehensive Study
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
Your patient who is on 75 mcg Synthroid PO daily comes in for a 6 week follow up to check
their TSH level. When you get the results, their TSH is 0.1. What should you do next as the
NP? - ansAssess how the patient is taking their Synthroid
What signs and symptoms are common in hyperthyroidism? - ansAnxiety, palpitations,
cardiac abnormalities, tachycardia, diaphoresis, weight loss, and increased appetite, menstrual
irregularities, amenorrhea, tremors, lid lag, exophthalmos
What needs to be considered with PTU medication administration? - ansNeed frequent lab
work: CBC, and Thyroid panel
Required to take PTU multiple times a day
What is the most common treatment for Grave's Disease? - ansRadioactive iodine therapy
Hyperthyroidism left untreated may lead to what conditions? - ansHeart disease- patient's
heart is in a constant high-output state, your heart can't keep up with that all of the time, may
lead to heart failure
Osteoporosis
Infertility
What is worst case scenario in hyperthyroid patients? - ansThyroid storm- Temperature, HR,
and BP- dangerously HIGH levels
Puts body into compromised state, especially impacting your heart. Heart starts to go into
Letha dysrhythmias and even heart failure.
What are the 8 most common drug classes for diabetes medications? - ansBiguanides
(Metformin)
DPP-4 inhibitors
GLP-1 Agonists
SGLT-2 inhibitors
Insulin
Sulfonylureas
TZDs
Alpha-glycosides inhibitors
Why are type 1 diabetics insulin dependent? - ansThey have an autoimmune destruction of
their beta cells
What are some examples of rapid acting insulin? - ansHumalog, Novalog, Apidra
What is the onset, peak, and duration of rapid acting insulin? - ansOnset: 15 minutes
Peak: 1 hour
Duration: 2-4 hours
What are some examples of short acting insulin? - ansRegular insulin (Humulin R, Novolin
R)
What is the onset, peak and duration of short acting insulin? - ansOnset: 30 min- 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
What are some examples of intermediate insulin? - ansNPH (Humulin N, Novolin N)
What is the onset, peak, and duration of intermediate insulin? - ansOnset: 1-2 hours
Peak: 6-12 hours
, Sarah Michelle Live Review Exam – Comprehensive Study
Guide
Detailed study notes from the Sarah Michelle Live Review
Exam covering key concepts, clinical topics, and exam
strategies for advanced nursing practice.
Latest Updated Exam Study Guide 2025/2026
Duration: 24 hours
What are some examples of long acting insulin? - ansLantus, Levemir
What is the onset, peak and duration of long acting insulin? - ansOnset: 2 hours
Peak: NONE
Duration: 24 hours
What is truly our GO TO oral diabetes medication? - ansMetformin (Biguanides)
What is the maximum daily dosage of Metformin? - ans2,550 mg in a day
What labs do we need to monitor when a patient is on Metformin? - ansMonitor renal
function, if GFR drop to less than 30- have to discontinue Metformin
Why does Metformin need to be stopped prior to having any procedure with contrast? -
ansContrast dye is harsh on the kidneys, need to be sure that there is pause with that
Metformin so that their kidneys are not seriously injured.
Long term usage of Metformin can lead to what deficiency? - ansB12 deficiency anemia
How does Metformin impact weight? - ansMetformin is weight NEUTRAL, some patient
even will have weight loss with this drug
Does Metformin cause hypoglycemia? - ansNO, Metformin works in the body by inhibiting
glucose production in the liver. Due to that there are no issues with hypoglycemia
What are some examples of SGLT-2 inhibitors? - ansAll the -flozin's
Empagiflozin
What is the MOA for SGLT-2 inhibitors? - ansReduce absorption of glucose in the renal
tubules, the patient will urinate out the extra glucose
What lab should be assessed prior to prescribing SGLT-2 inhibitors? - ansRenal function
Does SGLT-2 inhibitors cause hypoglycemia? - ansSGLT-2 inhibitors have a LOW risk for
hypoglycemia
What education is required for patients who are on SGLT-2 inhibitors? - ansStaying hydrated
and reporting any new urinary issues
What patients are NOT good candidates for SGLT-2 inhibitors? - ansPatients who cannot
make it to the bathroom in time
Patients with frequent UTIs or yeast infections already
What is a major perk to SGLT-2 inhibitors? - ansThey are cardio-protective- they have shown
to reduce overall risk of mortality associated with coexisting cardiac conditions, and they
may even prevent future cardiac issues.
What diabetes medication classes are cardioprotective? - ansSGLT-2 inhibitors and GLP-1
agonists
What are examples of DPP-4 inhibitors? - ansAlt he -gliptins
Sitagliptin
What is the MOA of DPP-4 inhibitors? - ansIncrease insulin production/decrease glucagon
secretion
Impacts fasting and postprandial glucose levels
DPP-4 inhibitors are contraindicated in patients with a history of what condition? -
ansPancreatitis
What are examples of sulfonylureas? - ansAll the ide's
glipizide, glyburide, glimepiride
