NRNP 6560 Midterm exam questions with verified
answers
Acute Fractures Management Ans✓✓✓ - ABC care (Airway, breathing,
circulation), musculoskeletal second survey
- fluid resuscitation
- early reduction of fracture
- cover open wounds
- surgical irrigation and debridement for open fracture
- Ab's: Cefazolin for gram pos. Clindamycin for tetani infection
- pain: opioids
- tetanus shot of unknown
- calcium upon discharge for osteoporosis
- cement injection in bone with vertrebroplasty
Acute liver failure: findings, management Ans✓✓✓ Weakness, fatigue
weightloss, n/v, abd pain
Change in bowel pattern
- Check BMP, ABG, lactate, toxicology screen, acetaminophen screen, Hep panel,
PT/ INR
- Treat specific etiology:
charcoal for acetaminophen and N-acetylcysteine)
Supportive for Hep A and E
Antiviral for Hep B
Test for Wilson
,- ICU management: watch for cerebral edema, hyperventilate if present,
mannitol. CT head for encephalopathy
Acute pancreatitis findings/ diagnostics Ans✓✓✓ - Epigastric abd pain, abrupt,
worse with walking or supine, better with knee to chest, leaning forward
- N/V
- hypoactive bowelsounds
- tachycardia, hypotension
- jaundice
- ascites
- Elevated lipase and amylase
- elevated urine amylase
- elevated trypsin levels
- leukocytosis
- Bili elevated
- Hypocalcemia if severe disease
- Low albumin
- xr abdomen: ileus, pancreatic calcifications, gallstones
- CT abdomen preferred over US, and MRI over CT
Acute pancreatitis management Ans✓✓✓ - IV hydration - Fluid therapy to
prevent hypovolemia and shock: LR or NS with 20 K at 75- 100 ml/hr
- May need plasma, RBC, albumin
- Pain control - Morphine, Fentanyl
,- AB's, not prophylactically, only when septic or biliary stones.
- NPO, then supplements, small frequent meals
- NG for ileus or vomiting
- replace electrolytes
- enteral feeding
acute pancreatitis: what and etiology Ans✓✓✓ inflammation of pancreas
Alcoholism
Gallstones
Smoking
Traumatic or hereditary
Infectious (CMV)
Meds: Sulfa drugs, thiazide diuretics, Lasix, Corticosteroids, Depakote, Opioids
Advanced HIV infection: definition, symptoms, prognosis Ans✓✓✓ CD4 below 50
Wasting, fevers, fatigue
Poor
AIDS, definition and diagnosis Ans✓✓✓ acquired immune deficiency syndrome
CD4 low, below 500 and infection with opportunistic organism
, Or:
CD4 below 200
Alcoholic liver disease: etiology, findings, management Ans✓✓✓ Most common
cause of cirrhosis
Women twice as sensitive to alcohol toxicity then men
Binge drinking
High mortality rate
Diagnosis on report of alcohol intake, evidence of liver disease, lab abnormalities
AST and ALT often high than 2
Score for mortality: Maddreys' score
- Abstinence
- MDF score greater than 32: prednisone for 4 wks
- May require liver transplant
ANA. Tests in rheumatic disease: what, normal level, abnormal with. Ans✓✓✓
Antinuclear antibody (ANA).
Normal: Titer 1.32
POsitive with: Sjogren's (SS), SLE (lupus),
Antiretroviral therapy (ART) Ans✓✓✓ - Combination therapy, 3 or more from
different drug classes
- Follow up with HIV viral load determination at 4 - 6 wks after initiation and then
every 3 - 6 mo.
answers
Acute Fractures Management Ans✓✓✓ - ABC care (Airway, breathing,
circulation), musculoskeletal second survey
- fluid resuscitation
- early reduction of fracture
- cover open wounds
- surgical irrigation and debridement for open fracture
- Ab's: Cefazolin for gram pos. Clindamycin for tetani infection
- pain: opioids
- tetanus shot of unknown
- calcium upon discharge for osteoporosis
- cement injection in bone with vertrebroplasty
Acute liver failure: findings, management Ans✓✓✓ Weakness, fatigue
weightloss, n/v, abd pain
Change in bowel pattern
- Check BMP, ABG, lactate, toxicology screen, acetaminophen screen, Hep panel,
PT/ INR
- Treat specific etiology:
charcoal for acetaminophen and N-acetylcysteine)
Supportive for Hep A and E
Antiviral for Hep B
Test for Wilson
,- ICU management: watch for cerebral edema, hyperventilate if present,
mannitol. CT head for encephalopathy
Acute pancreatitis findings/ diagnostics Ans✓✓✓ - Epigastric abd pain, abrupt,
worse with walking or supine, better with knee to chest, leaning forward
- N/V
- hypoactive bowelsounds
- tachycardia, hypotension
- jaundice
- ascites
- Elevated lipase and amylase
- elevated urine amylase
- elevated trypsin levels
- leukocytosis
- Bili elevated
- Hypocalcemia if severe disease
- Low albumin
- xr abdomen: ileus, pancreatic calcifications, gallstones
- CT abdomen preferred over US, and MRI over CT
Acute pancreatitis management Ans✓✓✓ - IV hydration - Fluid therapy to
prevent hypovolemia and shock: LR or NS with 20 K at 75- 100 ml/hr
- May need plasma, RBC, albumin
- Pain control - Morphine, Fentanyl
,- AB's, not prophylactically, only when septic or biliary stones.
- NPO, then supplements, small frequent meals
- NG for ileus or vomiting
- replace electrolytes
- enteral feeding
acute pancreatitis: what and etiology Ans✓✓✓ inflammation of pancreas
Alcoholism
Gallstones
Smoking
Traumatic or hereditary
Infectious (CMV)
Meds: Sulfa drugs, thiazide diuretics, Lasix, Corticosteroids, Depakote, Opioids
Advanced HIV infection: definition, symptoms, prognosis Ans✓✓✓ CD4 below 50
Wasting, fevers, fatigue
Poor
AIDS, definition and diagnosis Ans✓✓✓ acquired immune deficiency syndrome
CD4 low, below 500 and infection with opportunistic organism
, Or:
CD4 below 200
Alcoholic liver disease: etiology, findings, management Ans✓✓✓ Most common
cause of cirrhosis
Women twice as sensitive to alcohol toxicity then men
Binge drinking
High mortality rate
Diagnosis on report of alcohol intake, evidence of liver disease, lab abnormalities
AST and ALT often high than 2
Score for mortality: Maddreys' score
- Abstinence
- MDF score greater than 32: prednisone for 4 wks
- May require liver transplant
ANA. Tests in rheumatic disease: what, normal level, abnormal with. Ans✓✓✓
Antinuclear antibody (ANA).
Normal: Titer 1.32
POsitive with: Sjogren's (SS), SLE (lupus),
Antiretroviral therapy (ART) Ans✓✓✓ - Combination therapy, 3 or more from
different drug classes
- Follow up with HIV viral load determination at 4 - 6 wks after initiation and then
every 3 - 6 mo.
