NURS 620 Adult 1 Exam 2 Maryville questions and answers 2022

Claudication is the classic presenting symptom associated with which of the following? arterial insufficiency Risk factors for chronic arterial insufficiency?- tobacco use You are using the CURB 65 clinical tool, for determining which patient dx with CAP should be hospitalized or treated at home. Mabel's score is 2- what should we do? Short inpatient stay; if she is relatively healthy, she could be closely supervised outpatient S/S of COPD correlate with which of the following?- Chronic bronchitis with airway obstruction Presents with history of asthma without treatment for a while. She reports daily but not continual symptoms that last longer than 1 week and present at night. She has been using her rescue inhaler. Her FEV1 is 60-80% predicted- how would you classify her asthma? moderate persistent What is the most common bacterial pathogen in CAP? Streptococcus PNA Which obstructive lung disease is reversible asthma George has COPD and a 40% FEV1. How would you classify the severity of his COPD Stage 3 Jason age 62 has Obstructive Sleep Apnea (OSA). Which of these is a contributing factor? his collar size is 17 inches A patient with CAD should be placed on which of the following as antiplatelet tx (first line) Aspirin What is the desired therapeutic action of inhaled corticosteroids? reduction in airway inflammation What is the appropriate tx for a pt dx with chronic venous insufficiency use of elastic stockings What is the most important measurement in a pulmonary function in a patient with asthma? FEV forced expiratory volume Healthy 27 yo man, dx with CAP, which one of these is the best choice of tx? azithromycin- macrolide Salmeterol (Serevent) is an example of which of the following? long acting beta agonist(LABA) fluticasone & budesonide (pulmocort) are examples of what? ICS Inhaled Corticosteroid Ipratropium (Atrovent) is an example of what? Short-acting muscarinic-antagonist (SAMA) montelukast (Singulair) is an example of what? NON STEROIDAL PREVENTERS Salbutamol (Ventolin) and Albuterol is an example of what? Short acting beta-2 andrenergic (SABA) tiotropium (Spiriva) is an example of what? (LAMA) Long-acting muscarinic-antagonist What is the most important goal of treating HTN Avoiding disease targeted organ damage indicates severe asthma attack, requiring emergent treatment? inaudible breath sounds When should a rescue course of prednisolone be issued for a asthma attack anytime its needed for symptoms What intervention would indicate a patient needs more education for her asthma? opening a window at night what is usually the earliest sign of coronary artery disease (CAD) intermittent claudication what characteristic is a risk factor for PVD? male gender An asthmatic patient comes in for a follow up, as you assess his asthma control. He uses albuterol for wheezing, cough, SOB 1 x week. He has been to the ER once for asthma symptoms and coughs 3x a month at night. He is only prescribed albuterol. What would you add? Inhaled low dose corticosteroid A patient presents with a dry cough, causing chest discomfort x 10 days. He has a runny nose and fatigue. Nurse notes late expiratory wheeze in the lower lobes and rhinitis in the nasal passages. Denies smoking, fever, wheezing. What do we expect? Acute bronchitis According to JNC 8, a 40 yo with 168/88 with CKD should have treatment with? Lisinopril (ACE inhibitors) a new 58yo pt has a BP 152/90, first time seeing this patient, what should you do? Come back for 3 more BP checks What HDL level is considered cardioprotective? 60 which of the following is the drug of choice for a African American pt with HTN and DM? HCTZ (diuretic) There are 4 stages of heart failure, classified as A-D- Describe the evolution and progression of the disease A -Asymptomatic; B -structural change; C-Fatigue, DOE, -Pulmonary congestion on CXR, Cardiomegaly; D-nocturnal dyspnea, edema, JVD, S3, crackles, Pleural effusion Patients who have symptoms of HF at rest despite medical therapy and are hospitalized or require special interventions.. which stage would it be? D Risk factors for HTN age, race (AA), gender (male), obesity, FH, ETOH, sedentary, smoking, stress, diet BP goals per JNC 8 ≤ 60 y/o or DM, CKD 140/90; ≥ 60 y/o 150/90 what are Cozaar (losartan), Benicar (olmesartan), Micardis (telmisartan), and Avapro (Irbesartan) examples of? angiotensin receptor blockers (ARBs) What would you see on EKG with ischemia? T-wave inversion Which of the following is in the heart and rapidly rises in the blood stream in heart failure? BNP James is in your office for annual exam. His cholesterol screening is 198. Which action would you take? initiate drug therapy with a statin Which diagnostic test would be used for dx of a venous embolism (gold standard)? Ascending venogram Sam age 78 presents to the clinic with respiratory symptoms. His PFT- normal, total lung capacity, decreased PaO2, increased PaCO2, on assessment crackles and forced expiratory wheezes. What is our DX? Chronic Bronchitis At what LDL level would you start a person on a statin with no risk factors regardless of comorbidities? 190 What does this CXR Show? infiltrates; pneumonia Heart Failure Classification System I - Asymptomatic; II - Symptoms only with marked exertion; III - Symptoms with moderate exertion; IV - Symptoms at rest What would a diagnosis of HTN w/o further confirmation be based on? Initial screening BP of ≥180/110 mmHg or who presents with hypertensive emergency What is the first lifestyle modification to address for someone diagnosed with HTN Weight reduction African Americans dx with HTN without chronic kidney disease should use CCBs and thiazides what 2 classes of HTN medication should not be used together? ACEIs and ARBs What should be used instead of ACEIs and ARBs in patients over age 75 with impaired kidney function CCBs and thiazides If goal not reached within a month of treatment for HTN what is the next step? increase the initial dose of drug or add a 2nd agent & reinforce lifestyle changes What level of BUN will increase the CURB 65 score by 1? greater than 19 What factors are considered to calculate CURB 65 score? age ≥65, BUN 19, Systolic 90/Diastolic ≤ 60, RR 30, confusion sleep apnea education weight loss and exercise; elevate head of bed; avoid alcohol What is the cause of CAD and PAD/PVD? atherosclerosis (hardening of the arteries) Contributing factors of CAD DM, Obesity, Stress What medication are used to manage CAD? Beta blocker, aspirin, statin, nitrates Risk factors for CAD Age, male, AA, FH, HTN, Hyperlipids, smoking, sedentary, Women: menopause uses estrogen/Bcp & smoking When should cholesterol screening begin for high risk? 25 for women, 35 for men, every 3 yrs Risk factors for hyperlipids? diabetic, HTN, smoking, FH When should cholesterol screening begin for low risk? males 35, females 45, every 5 yrs Desirable lipid levels? Total 200; Trigly 150; LDL 100; HDL F 45 M 40 cardioprotective 60 What tests and labs are use to dx PVD? Ankle-Brachial Index (ABI) & lipid panel Treatment of PVD/PAD consists of what? drugs to lower lipids, control HTN, antiplatelet agent Risk factors for DVT genetic clotting issues, immobility, smoking, obesity, age, FH, hormone/BCPs Symptoms of DVT unilateral LE swelling, pain in calf, leg cramps, erythema, pallor What is a common technique to elicit pain associated with DVT Homan's sign (dorsiflexion of foot) Common treatment for DVT anticoagulants, compression stockings, "clot busters"-tPA Treatment goals for DVT Resolve clot, prevent PE, prevent post phlebitis syndrome or reoccurrence Cardinal Symptoms of asthma? Cough, wheeze, SOB Differential dx for asthma COPD, GERD, Esinophilic bronchitis What is the main trigger to asthma? exposure to agent pt is sensitized to. What is Baylor's Rules of Two with asthma? More than 2 uses of rescue inhaler/wk, more than 2 night awakenings/month, more than 2 rescue canisters/ year most common finding with mild to moderate persistent asthma? expiratory wheezing what physical finding may be seen with severe-persistent asthma? hyperinflation of the chest with an increase in the AP diameter What would be considered Intermittent asthma symptoms 2 D/WK, Awakening 2x/MTH, no interference with daily life, Nml FEV1 between episodes, predicted FEV 80% What would be considered Mild-Persistent asthma Symptoms 2 D/Wk but not daily, Awakening 3-4x/MTH, minor interference with daily life, FEV1 ≥ 80% What would be considered Moderate Persistent Asthma? Symptoms daily, Awakening 1x weekly but not nightly, some limitation in daily life, FEV1 60% What would be considered Severe Persistent Asthma? Symptoms throughout day, Awakening 7x/