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Common Prob Acute
ANCC Board review
| Question | Answer |
|---|---|
| Define Acute | Usually Shorter than 6 months |
| Define Chronic | Continual or episodic pain of longer duration >6 months |
| Cutaneous | Localized on the skin or surface of the body |
| Visceral | Poorly localized as such with internal organs |
| Somatic | Non localized; originates in muscle, bone, nerve pathway injury or supporting tissue (SOFT TISSUE) |
| Neuropathic | Frequently cause by a tumor, involves nerve pathway injury or compression |
| Step 1 of the pain MGMT Ladder includes | Asprin Acetaminophen NSAIDS plus or minus adjuvants such as: Gabapentin Pregablin Tricyclic antidepressants |
| Step 2 of Pain Ladder includes | Continue Step 1 plus: choose 1 Codeine Hydrocodone Oxycodone Tramadol |
| Step 3 of Pain Ladder | Nonopioid analgesics and adjuvants plus Morphine Dilaudid Methadone Fentanyl |
| What should the NP use for break through cancer pain | Fentanyl patches for sustained release |
| what is the body normal temperature in Celsius | 37C |
| What temperature is considered to be a fever | 38.3C |
| Should all patients with a fever get ABx therapy? | NO! antimicrobials are used only when a microbe is present |
| What are some common causes of Fever that do not require Abx Tx? | CV Dz such as MI, phlebitis, and PE CNS disease such as cerebral Hemorrhage, brain tumor-> which interferes with thermoregulatory process |
| What is the leading causes of Post-operative fever | Post-OP Atelectasis |
| What is the 2nd leading cause of fever in the Post-operative patient | Dehydration |
| True or false, Increased metabolic rate can be contributory to fever in the post-operative patient | True |
| What is the other cause of post-operative fever | Drug reactions |
| What would you expect to see in a patient with an Infectious cause of fever in the post op pt | WBC production with a shift to the left which represents bandemia |
| Your patient has a WBC count of >30,000 how likely is this due to infection? | Unlikely at this level; more likely to be leukemia |
| What should the NPs first response be to Post-operative fever? | Hydration and measures to expand lung inflation |
| What is the treatment for Post-op fever | Supportive with fluids and APAP treat underlying source Grain stain and C&S all invasive lines or catheters as indicated |
| What is the cost important component to a Headache | Chronology |
| The patient has a headache and the NP is suspicious of a tension headache. What S/S would confirm this Dx | Vise-like or tight in quality, generalized, with no focal neurological symptoms lasting for several hours |
| What is the approach to managing a tension headache | OTC analgesia |
| The pt comes to the NPs office with complaints unilateral throbbing Headache with sensitivity to both photo and photophobia that started gradually and has persisted now for nearly two days. The most likely Dx is | Migraine Headache |
| What are common triggers for Migraine headaches | Emotional or physical stress, lack of or excess sleep, ETHOH, contraceptives Nitrate containing foods (pickles, lunch meats) |
| What are the roles of Lab and Diagnostics in Migraine HA | Ruling out organic causes |
| Treatment of Miagaine | Trigger avoidance rest and relaxation stress mgmt techniques |
| What are two common Medications that can be used for Migraine prophylaxis | Amitryptyline (Eval) and Propranolol (Inderal) |
| The Acute care NP had a pt who is experiencing an Acute Migraine. The NP knows that which medication is the standard of care for the acute Migraine attack. | Sumatriptan (Imitrex) 6mg SQ at onset, may repeat in 1hr (total 3x daily) |
| What are some other therapies for MGMT of the acute Migraine | Rest in dark, quiet room |
| The NP is evaluating a patient with severe, unilateral, periorbial pain that occurs daily now for several weeks. The pain usually occurs during the night or after awakening from sleeping and lasts for <2hours. The NP is most suspicious of | Cluster HA |
| What is the first line therapy for cluster HA | inhalation of 100% O2 |
| The NP knows that which lab best represents malnutrition | Prealbumin |
| The NP knows that 1 unit of packed red blood cells will raise the hemoglobin and Hematocrit by? | 1:3 Eg: H&H is 7.0 and 19 you give 1 unit PRBCs the follow on H& H should be 8 & 22 |
| The NP needs to provided nutrition support for an ICU patient for >6 weeks. He or she would choose the following to provided nutrition | Enterostomal tube |
| The NP needs to provide nutritional support for the patient however, they cannot use the GI tract. It is anticipated that the need for be less that 2 weeks. What is the preferred method for treatment | Peripheral IV |
| The NP will need to provided nutrition for the patient for less than 6 weeks and the GI tract is useable and there is no risk for aspiration. Which therapy is most ideal? | NG tube |
| In the patient who cannot receive nutrition via GI tract and will receive D10 the NP knows a ________________ is needed | Central line |
| When is a NasoDuodenal tube used? | Supplemental nutrition needed for <6weeks in the setting of, or risk for, aspiration |
| What are some complications of Parental Nutritional support | Pnemothorax Hemothorax Air emboli HHNK Hyperglycemia catheter thrombiois |
| What Lab is required when the patient is receiving TPN | Daily BMP |
| What other risk occur from TPN | Bacteremia and CLABSI |
| What is a normal serum osmolality | 280 or 2x NA (140) |
| What is the purpose of obtaining a urine sodium | Aids in distinguishing between renal and non renal causes of Hyponatremia |
| What does a urine NA >20 mEq/L suggest | renal salt wasting (problem with kidneys) |
| What does a urine NA <10 mEq/L suggest | renal retention of NA to compensate for extra renal fluid losses (problem other than kidneys) |
| The NP realizes that Isotonic Hyponatermia often a ___________ | Laboratory artifact |
| What is the serum osmolality in Isotonic Hypo NA | 284-295 |
| What are some causes for Isotonic hypo NA | extreme hyperlipidemia or hyperprotienemia |
| Tx for Isotonic hypo NA | cut down fat- NO FLUID RESTRICTON |
| What is the Serum Osmolality in Hypotonic Hyponatremia | <280 |
| What do you need to assess in Hypotonic hyponatremia | need to determine if the patient is hypovolemic or hypervolemic |
| The patient has hypovolemic hypernatremia what do assess to determine the cause | urine sodium |
| Cause of hypovolemic hypernatremia w/urine NA+ <10 mEq/L | Dehydration Diarrhea (think CDIFF) Vomiting |
| Causes of hypervolemic hypernatremia w/ urine NA+ >10 mEq/L | Diuretics (Most Common) ACE inhibitors Mineralocorticoid deficiency |
| What is the treatment for hypervolemic hypotonic hyponatremia | Restriction of fluids |
| Causes fo hypervolemic hypotonic hyponatremia | Edematous states CHF Liver Dz Advanced renal failure |
| The patient has a serum Osmolality >290 the NP knows this finding correlates with | Hypertonic Hyponatremia |
| Cause of hypertonic Hyponatremia | hyperglycemia (HHNK) |
| The patient arrives to the NP office and complains of weakness, fatigue and muscle cramping The NP would be most suspicious of what electrolyte imbalance | Hypokalemia |
| The ICU patient has EKG changes with broad T waves and prominent U waves. The NP is most concerned with what electrolyte abnormality | Hypokalemia |
| The following signs and symptoms can occur in severe hypokalemia (<2.5) | flaccid paralysis, tetany, hyporeflexia and rhabdomylosis |
| Your pt has a serum K+ of 2.2 what other laboratory studies are warrented | serum CK and urine myoglobin to R/O rhabdomyolosis |
| You are walking down past a patients room and notice there are multifocal PVCs wit short runs of Vtach as an NP you are most concerned with what electrolyte abnormality | Hypokalemia |
| You have been replacing your pts potassium and despite replacement it is not correcting. What electrolyte deficiency frequently impairs K+ correction | Mg++ |
| Your patient is complaining of weakness has abdominal distention and of note has a history of chronic NSAID usage. You would suspect what electrolyte abnormality | Hyperkalemia |
| What EKG findings would the NP see when the patient has hyperkalemia | tall peaked T-waves are the class findings |
| When would you want to to measure an ionized calcium | in the setting of abnormal serum albumin |
| How does acidemia affect ionized calcium | It will cause an increase |
| How does alkalemia affect ionized calcium | it will cause a decrease |
| Your patient has had multiple blood transfusion. As the NP you would be most concerned with which electrolyte abnormality | hypocalcemia |
| What does a normal calcium level in the setting of low albumin suggest | the patient is hypercalcemic |
| the pt presents with muscle and abdominal cramps accompanied by frequent spasms of the hand and feet. This finding is most suggestive of | hypocalcemia. Spasms of hands and feet also known as carpopedal spasms (Trousseau's sign) |
| Tapping the branches of the facial nerve in front of the ear with the finger tip causes twitching of the muscles of the face. This is known as | Chvostek's sign which is an indication of of hypocalcemia |
| A prolonged QT interval on EDK would suggest the following electrolyte abnormality | hypocalcemia |
| The acute treatment of hypocalcemia is | IV calcium gluconate |
| Chronic treatment of hypocalcemia | oral supplements, Vitamin D, and hydroxide |
| your patient presents with fatiguability, muscle weakness, and constipation and has a history of hyperthyroidism. You suspect the following electrolyte abnormality | hypercalcemia |
| A Ca++ level of >12 is considered a | medical emergency |
| What can result from serve hypercalcemia | coma and death |
| The NP knows that prolonged immobilization can lead to | hypercalcemia |
| Define Respiratory acidosis | ph , 7.35 with PCO2 >45 |
| Complications from Respiratory acidosis | somnolence, confusion, coma myoclonus with asterisks increased cerebral blood flow causes increased CSF pressure which leads t increased ICP |
| S/S Respiratory Alkalosis | stocking glove tingling anxiety (PE) Paraesthesia if severe tetany |
| Define Respiratory Alkalosis | pH >7.45 pCO2 <35 if chronic low serum Bi Carb |
| Tx for Resp Alkalosis | decrease vent rate if needed may need to be sedated for hyperventilation Breathe into paper bag if acute hyperventilation |
| Causes of Increased anion Gap | DKA Lactic acidosis Alcoholic KA Drug or chemical anion |
| Causes or Normal Anion Gat acidosis | Diarrhea Ileostomy Renal tubular acidosis Recovery from DKA |
| Tx for Met Acidosis | Tx underlying cause Fluid resuscitation |
| First degree Burn | No blistering, Dry red epidermis only |
| 2nd Degree Burn | Blistering, extends beyond epidermis |
| 3rd Degree | Muscle and/or bone involvement |
| What is the Parkland formula | 4 x KG (pt weight) x % Burn |
| When fluid resuscitating a burn patient, how much of fluid do you give how much fluid in the first 8 hours? | 1/2 then the rest over 16hrs |
| Causes of Met Alkalosis | Ng suction Vomiting Diuretics |
| Tx of Met alkalosis | Deficit correction with NaCL and KCL Discontinue diuretics H2 blockers in patients with GI losses ACETAZOLAMIDE (DIAMOX) 250-500 mg IV every 4-6 h if volume replacement is contraindicated |
| Emergent Bur MGMT Pearls | submerse injured area in clean water ASAP Keep the patients temperature normal (37-37.5) Sterile NS is used in initial treatment |
| Most common cause of cellulitis in the outpatient are | Prep. pygenes - usual cause S. aureus- less common |
| Organisms that cause cellulitis in the inpatient setting | 1.Gram negative E. coli, Klebsiella, Pseudomonas, Enterobacter 2. S aureus 3. Strep |
| What is the most serious cause of cellulitis | osteomylitis |
| What is the treatment of a skin and soft tissue infection with no fever or systemic S?S | No antibiotics, I&D and Culture |
| Why is Clindamycin a good choice in the treatment of Cellulitis | It has coverage for both staph and strep |
| What are the S/S of Acetaminophen intoxication | usually asymptomatic for the first 24-48 hours RUQ Pain (liver) Jaundice, increased LFTs, prolonged PT, AMS, Delirium |
| Treatment for Acetaminophen? | N-Acetlcysteine (Mucomyst) |
| Salicylate intoxication S/S | TINNITUS NV Elevated LFTs |
| MGMT of Salicylate intoxication | Emesis for recent ingestions, gastric lavage/activated charcoal HCO3 IV in severe acidosis ph <7.1 |
| Organophosphate Intoxication S/S | NVD and cramping Excessive salivation HA BLURRED VISION AND MIOSIS BRDYCARDIA |
| MGMT of Organophosphate intoxification | Wash the skin throughly ATROPINE IS THE DRUG OF CHOICE |
| Antidepressant toxicity S/S | Confusion hallucination, blurred vision Hypotension |
| MGMT of Antidepressant toxicity | ICU admission if CNS or cardiac toxicity event Benzo IV for seizure control (Valium) Serotonin syndrome treated with Tantrum; clonazepam (Klonopin) used to treat Rigor, following blanket to control temperature |
| S/S of Acute rejection of Transplant | Immediate failure of the organ Flu-like symptoms (fever, chills, malaise) |
| You suspect your Kidney transplant patient is having acute rejection of the organ. As an NP you know what should be done | Immediate Biopsy of the organ |
| What is the standard anti-rejection induction agents therapy | Calcineurin inhibitor (Tacrolimus (Prograft) or Cyclosporine)+ Antimetabolite ( Azathiprine (Imuran) or Mycophenolate (Cellcept) + Steroid |
| Can you give someone with HIV the varicella-zoster vaccine | NO. It is a live vaccine |
| You are examining your pt and you notice group vesicle eruption with erythema and exudate along the dermatomal pathway on the trunk. You know this to likely be _______ | herpes Zoster |
| The patient with herpes zoster and suspected ocular involvement warrants | An immediate referral to opthalmologist |
| Treatment for Post-herpetic neuralgia | Gabapentin, Pregabalin |
| SEs of Gabapentin and Pregabalin | sedation and weight gain |
| Actinic Kratoses | Asymptomatic, small patches, occurring on sun exposed parts of the body; Premalignant |
| The patient comes in for a routine visit you notice a firm regular papule on his cheek. When examining the nodule you determine it to be Keratotic. You are know this to be the folloing | Squamous Cell Carcinoma |
| Treatment for Squamous Cell Carcinoma | Biopsy and surgical excision (Mohs) |
| You notice your patient has a Beige, brown plague like lesion on this for arm approximately 12mm in diameter that is non painful. It presents with a stuck on appearance. You suspect this is a | Seborrheic Kreatoses |
| The Tx for Seborrheic Keratoses is | NONE or liquid nitrogen |
| Your pt comes to pt comes to the office with complaints of a lesion that is 1 year old. On closer exam you find the lesion to have a waxy appearance with central depression and telangiectatic vessels. You suspect_______ and order ______ | Basal Cell carcinoma Shave punch biopsy and surgical excision |
| Your patient comes in with concerns of a skin lesion on her upper back that was pointed out to her by a friend. On examination the lesion is asymmetric with color variation, elevated and 9mm in diameter. Th NP knows this to be | Malignant melanoma |
| Criteria for brain death | Apnea, No corneal reflex, no Gag reflex, Labile BP, Normal temperature |
Created by:
EL92578
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