NURS 623 Exam 4 Study Questions
with Elaborate Answers | Latest
Edition
1. Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral
spine is within normal limits. Which of the following diagnoses do you
explore further?
a. Scoliosis
b. Osteoarthritis
c. Spinal stenosis
d. Herniated nucleus pulposus - ANSWER Herniated nucleus pulposus
A plain x-ray will not show a herniated nucleus pulposus or a muscle strain. It
will show spondylolisthesis, scoliosis, osteoarthritis, and spinal stenosis. Note
that x-rays of the spine are not indicated in low back pain unless the cause of
the pain is thought to be bony in origin or traumatic in nature or there is a need
to rule out systemic disease.
2. What are the typical demographics of a patient with MS (what type of
person does this disease normally effect) - ANSWER Young, caucasion
female of eastern European desent
3. At the onset of alzheimers, what category of medications should be initiated
- ANSWER Cholinesterase inhibitors
4. What factors contribute to a patient being high risk for falls - ANSWER
History of falls, medications, vision impairment, heat rate/rhythm
abnormalities, footwear issues, home environment, gait/mobility issues, poor
reflexes.
,5. What classes of antibiotics would need to be renally dosed with a patient
with impaired renal function - ANSWER Vanc, floroquinolones, and
aminoglycosides
6. What are the s/s of Parkinsons? - ANSWER Age >60, tremor at rest (pill
rolling), rigidity, bradykinesia, masked face, stopped posture, shuffling gait,
arching (limbs, neck, back), decrease facial dexterity, dysphagia, orthostatic
hypotension, anosmia, depression, cognitive impairment, freezing
phenomenon, cogwheeling, postural instability (advanced disease)
7. What are the s/s of GB? - ANSWER Prickling, pins and needles sensations
in your fingers, toes, ankles or wrists. Weakness in your legs that spreads to
your upper body. Unsteady walking or inability to walk or climb stairs.
Difficulty with eye or facial movements, including speaking, chewing or
swallowing. Severe pain that may feel achy or cramplike and may be worse
at night. Difficulty with bladder control or bowel function. Rapid heart rate.
Low or high blood pressure. Difficulty breathing.
8. What are s/s of temporal arteritis? - ANSWER Jaw claudication (pain with
chewing that is relieved when stops chewing), unilateral pain, temporal area
with scalp tenderness; skin over artery is indurated, tender, warm, and
reddened. Amaurosis fugaz (temporary blindness), may occur. Low-grade
fever and fatigue, occurs sometimes. ESR/sed rate (often reaches 100 mm/hr
or more). CRP elevated >50. Medical Urgency: polymyalgia rheumatica
common in these patients, older adults and elder are more common.
9. What are articular bone structures? - ANSWER Includes structures like the
synovium, synovial fluid, articular cartilage, joint capsules, and juxta-
articular bone. Articular disorders may be characterized by deep or diffuse
pain, pain or limited ROM on active and passive movement, swelling,
crepitus.
,10.What are non-articular bone structures? - ANSWER Supportive structures
such as tendons, bursae, muscles, fascia, bone, nerve, overlying skin. Tend
to be painful on active but not passive (assisted) ROM. Seldom demonstrate
swelling, crepitus, instability, or deformity by itself.
11.In a patient who is elderly and falls, but there is no clear cause of falls, what
should your workup center around? - ANSWER Cardiac and neurologic
causes
12.If a patient is alert and oriented and refuses to give consent for a procedure,
how do you move forward as a provider? - ANSWER Discuss risks of not
having procedure, abort procedure, document refusal.
13.In elderly patients, what factors can contribute to loss of appetite and
malnourishment? - ANSWER Diminished taste/smell/vision, dry mouth,
poor dentation, chronic illness, meds, pain, depression, loneliness, etc.
14.What are the benefits of NSAIDS? - ANSWER Used frequently to help
reduce pain and inflammation for patients with low back pain, spondylosis,
headaches, stenosis, bursitis, arthritis, and other musculoskeletal
injuries/pain.
15.What are side effects of NSAIDS? - ANSWER May cause gastritis, n/v,
PUD (high risk for H. pylori), increased risk of GI bleeding, ulceration, and
perforation.
16.What are complications of long term use of NSAIDS? - ANSWER Black
box warning of increased risk of serious and potentially fatal cardiovascular
thrombotic events such as MI/stroke; risk increases with long term use.
, 17.How would you assess for a suspected meniscal tear with a physical exam? -
ANSWER McMurray test: External rotation of foot = medial meniscus.
Internal rotation of foot = lateral meniscus
18.What are some diff dx for patient with fatigue and SOB? - ANSWER
Pulmonary: pneumonia, pulmonary embolism, COPD exacerbation, asthma
exacerbation, pleural effusion, severe kyphoscoliosis, interstitial lung
disease, pulmonary HTN. Cardiac: MI, CHF, mitral stenosis/regurgitation.
Hematological: anemia. Psychogenic: anxiety/panic disorders.
19.Marilyn is a 59-year-old female who has experienced neck pain off and on
for several years. She has never had an acute injury, but she has been
evaluated for this and reports that she really has been compliant with
performing the neck exercises that have been prescribed. Her symptoms
have gradually progressed, and today upon physical examination the nurse
practitioner (NP) suspects spondylotic myelopathy when she finds all of the
following on physical examination except which?
1.Unsteady gait
2.Fine motor deficit
3.Diminished dexterity
4.Weakness to adduction - ANSWER Weakness to adduction
20.Greg, age 26, runs marathons and frequently complains of painful
contractions of his calf muscles after running. What do you attribute this to?
1.Hypercalcemia
2.Hyponatremia
3.Heat exhaustion
4.Dehydration - ANSWER Hyponatremia
with Elaborate Answers | Latest
Edition
1. Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral
spine is within normal limits. Which of the following diagnoses do you
explore further?
a. Scoliosis
b. Osteoarthritis
c. Spinal stenosis
d. Herniated nucleus pulposus - ANSWER Herniated nucleus pulposus
A plain x-ray will not show a herniated nucleus pulposus or a muscle strain. It
will show spondylolisthesis, scoliosis, osteoarthritis, and spinal stenosis. Note
that x-rays of the spine are not indicated in low back pain unless the cause of
the pain is thought to be bony in origin or traumatic in nature or there is a need
to rule out systemic disease.
2. What are the typical demographics of a patient with MS (what type of
person does this disease normally effect) - ANSWER Young, caucasion
female of eastern European desent
3. At the onset of alzheimers, what category of medications should be initiated
- ANSWER Cholinesterase inhibitors
4. What factors contribute to a patient being high risk for falls - ANSWER
History of falls, medications, vision impairment, heat rate/rhythm
abnormalities, footwear issues, home environment, gait/mobility issues, poor
reflexes.
,5. What classes of antibiotics would need to be renally dosed with a patient
with impaired renal function - ANSWER Vanc, floroquinolones, and
aminoglycosides
6. What are the s/s of Parkinsons? - ANSWER Age >60, tremor at rest (pill
rolling), rigidity, bradykinesia, masked face, stopped posture, shuffling gait,
arching (limbs, neck, back), decrease facial dexterity, dysphagia, orthostatic
hypotension, anosmia, depression, cognitive impairment, freezing
phenomenon, cogwheeling, postural instability (advanced disease)
7. What are the s/s of GB? - ANSWER Prickling, pins and needles sensations
in your fingers, toes, ankles or wrists. Weakness in your legs that spreads to
your upper body. Unsteady walking or inability to walk or climb stairs.
Difficulty with eye or facial movements, including speaking, chewing or
swallowing. Severe pain that may feel achy or cramplike and may be worse
at night. Difficulty with bladder control or bowel function. Rapid heart rate.
Low or high blood pressure. Difficulty breathing.
8. What are s/s of temporal arteritis? - ANSWER Jaw claudication (pain with
chewing that is relieved when stops chewing), unilateral pain, temporal area
with scalp tenderness; skin over artery is indurated, tender, warm, and
reddened. Amaurosis fugaz (temporary blindness), may occur. Low-grade
fever and fatigue, occurs sometimes. ESR/sed rate (often reaches 100 mm/hr
or more). CRP elevated >50. Medical Urgency: polymyalgia rheumatica
common in these patients, older adults and elder are more common.
9. What are articular bone structures? - ANSWER Includes structures like the
synovium, synovial fluid, articular cartilage, joint capsules, and juxta-
articular bone. Articular disorders may be characterized by deep or diffuse
pain, pain or limited ROM on active and passive movement, swelling,
crepitus.
,10.What are non-articular bone structures? - ANSWER Supportive structures
such as tendons, bursae, muscles, fascia, bone, nerve, overlying skin. Tend
to be painful on active but not passive (assisted) ROM. Seldom demonstrate
swelling, crepitus, instability, or deformity by itself.
11.In a patient who is elderly and falls, but there is no clear cause of falls, what
should your workup center around? - ANSWER Cardiac and neurologic
causes
12.If a patient is alert and oriented and refuses to give consent for a procedure,
how do you move forward as a provider? - ANSWER Discuss risks of not
having procedure, abort procedure, document refusal.
13.In elderly patients, what factors can contribute to loss of appetite and
malnourishment? - ANSWER Diminished taste/smell/vision, dry mouth,
poor dentation, chronic illness, meds, pain, depression, loneliness, etc.
14.What are the benefits of NSAIDS? - ANSWER Used frequently to help
reduce pain and inflammation for patients with low back pain, spondylosis,
headaches, stenosis, bursitis, arthritis, and other musculoskeletal
injuries/pain.
15.What are side effects of NSAIDS? - ANSWER May cause gastritis, n/v,
PUD (high risk for H. pylori), increased risk of GI bleeding, ulceration, and
perforation.
16.What are complications of long term use of NSAIDS? - ANSWER Black
box warning of increased risk of serious and potentially fatal cardiovascular
thrombotic events such as MI/stroke; risk increases with long term use.
, 17.How would you assess for a suspected meniscal tear with a physical exam? -
ANSWER McMurray test: External rotation of foot = medial meniscus.
Internal rotation of foot = lateral meniscus
18.What are some diff dx for patient with fatigue and SOB? - ANSWER
Pulmonary: pneumonia, pulmonary embolism, COPD exacerbation, asthma
exacerbation, pleural effusion, severe kyphoscoliosis, interstitial lung
disease, pulmonary HTN. Cardiac: MI, CHF, mitral stenosis/regurgitation.
Hematological: anemia. Psychogenic: anxiety/panic disorders.
19.Marilyn is a 59-year-old female who has experienced neck pain off and on
for several years. She has never had an acute injury, but she has been
evaluated for this and reports that she really has been compliant with
performing the neck exercises that have been prescribed. Her symptoms
have gradually progressed, and today upon physical examination the nurse
practitioner (NP) suspects spondylotic myelopathy when she finds all of the
following on physical examination except which?
1.Unsteady gait
2.Fine motor deficit
3.Diminished dexterity
4.Weakness to adduction - ANSWER Weakness to adduction
20.Greg, age 26, runs marathons and frequently complains of painful
contractions of his calf muscles after running. What do you attribute this to?
1.Hypercalcemia
2.Hyponatremia
3.Heat exhaustion
4.Dehydration - ANSWER Hyponatremia
