WGU D027 OBJECTIVE ASSESSMENT FINAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS WITH STUDY GUIDE AND ACTUAL EXAM ||ALREADY GRADED A +|| Latest Version

WGU D027 OBJECTIVE ASSESSMENT FINAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS WITH STUDY GUIDE AND ACTUAL EXAM ||ALREADY GRADED A +|| Latest Version Autosomal Dominant - ANSWER 1 parent has, 50% change of child having Autosomal Recessive - ANSWER Both parents are carriers, 25% change of child having, 50% chance child is a carrier. Cystic Fibrosis - ANSWER affects pancreas causing secretions in lungs 21st Trisomy - ANSWER Down Syndrome Klinefelter Syndrome (XXY) - ANSWER male has extra X, female like qualities Turner Syndrome - ANSWER Missing X in females Alpha Thalassemia - ANSWER inherited blood disorder; mild to severe anemia Beta Thallasemia - ANSWER low hemoglobin; contraindicated medication ferrous sulfate Prevalence Risk - ANSWER proportion of the population affected at a certain time Incidence rate - ANSWER number of new cases divided by population Innate immunity - ANSWER inflammation; increased vascular permeability B&T lymphocytes - ANSWER immune response primary malignant tumor - ANSWER lack of organization of cells glucocorticoids - ANSWER used in combination with other agent to treat lymphoid tissue (leukemia). glucocorticoids are directly toxic to lymphoid tissues. Selective estrogen receptor modulators (SERM) - ANSWER for hormone receptor positive and advanced breast cancer. (Tamoxifin reduces risk and recurrence risk) Heart failure - ANSWER impairment of the ventricle to fill with or eject blood; heart cannot meet metabolic need of the body. CHF - ANSWER heart cannot keep up with metabolic needs; volume overload in pulmonary area Left Ventricular Dysfunction - ANSWER reduced ejection fraction; ventricle having issue ejecting blood. normal ejection fraction - ANSWER 55 - 60 % (blood pumped out with each heartbeat) Ejection fraction of 50% - reduced or preserved? - ANSWER preserved Diastolic CHF - ANSWER preserved ejection fraction, problem is with filling Systolic CHF - ANSWER reduced ejection fraction, problem is with ejecting Left sided CHF - ANSWER pulmonary (JVD, fluid volume overload, rails, S-3 murmurs) ** #1 cause of Right sided CHF BNP - ANSWER gold standard lab test to diagnose CHF Echocardiogram - ANSWER Diagnostic tool, evaluates heart structure and function At Risk for HF - Stage A - ANSWER no structural heart disease or symptoms of heart failure Stage A HF co-morbidities - ANSWER htn, atherosclerotic disease, diabetes, metabolic syndrome, patients using cardiotoxins with family history Therapy goals of stage A HF - ANSWER treat htn, encourage smoking cessation, encourage regular exercise, treat lipid disorders, discourage alcohol intake/drug use, control metabolic syndrome Meds: ACEI or Angiotensin II RB for vascular disease or diabetes (avapro, losartan, benicar, diovan, etc) At Risk for HF - Stage B - ANSWER structural heart disease but no symptoms of heart failure Stage B HF co-morbidities - ANSWER previous MI, LV remodeling with LV hypertrophy and low EF, asymptomatic valvular disease Therapy goals of Stage B HF - ANSWER Meds: ACEI or ARB, Beta-blockers, inplantable defibrillators Stage C heart failure - ANSWER structural heart disease with prior or current symptoms of HF Presentation of Stage C HF - ANSWER known structural heart disease and shortness of breath and fatigue, reduced exercise tolerance Therapy for Stage C HF - ANSWER dietary salt restriction, MEDS: diuretic, ACEI, beta blockers. Some patients: aldosterone antagonist, ARBs, digitalis, hydralazine/nitrates, biventricular pacing, inplantable defibrillators Stage D heart failure - ANSWER refractory HF requiring specialized interventions Presentation of Stage D HF - ANSWER marked symptoms at rest despite maximal medical therapy (recurrently hospitalized or cannot be safely discharged without specialized interventions) Therapy goals for Stage D HF - ANSWER compassionate end-of-life care/hospice, extraordinary measures ,heart transplant, chronic inotropes, permanent mechanical support, experimental drugs or surgery Ischemic heart Disease (CAD, MI) presentation - ANSWER chest discomfort, pain in neck/jaw/chest (crushing, squeezing, sharp), pain worse with exertion (demand requirement is higher), abnormal heart sounds, hypoxia, arrhythmias (afib, ST elevation) Stable angina goal - ANSWER decrease cardiac oxygen demand Meds for stable angina - ANSWER nitro first choice, then beta blockers (beta blockers if angina occurs with effort) nitroglycerine dose - ANSWER sublingual, acts within 5 minutes, max of 3 doses Cardiac glycosides (Digoxin) - ANSWER Increased myocardial contractile force (increases output), used in ED, exerts positive inotropic action, can cause severe dysrhythmias Digoxin Dosing - ANSWER therapeutic - 0.5-0.8 ng/ml. ASSESS apical pulse before administering, If lethargic and not acting right, see patient FIRST Goal of Anticoagulant and Antiplatelet Drugs - ANSWER inactivate and suppress formation of thrombin Warfarin (coumadin) - ANSWER PO to prevent blood clots; start with half a dose Anticoagulants - ANSWER Warfarin, heparin, lovenox; Caution about hemorrhage, any patients with risks for bleeding Pneumonia Patho - ANSWER pathogen reaches airway and overwhelms defenses causing inflammatory cascade; fluid forms, blocking diffusion (gas exchange) causing hypoxia, ultimately leads to respiratory failure Diagnosing pneumonia - ANSWER Chest X-ray: viral - diffuse widespread whitening; bacterial - patchy, consolidated, lobar Emphysema - ANSWER destruction of alveolar walls; air goes into lungs, can't get out; leads to hyperinflation Bronchitis - ANSWER excess mucus production, smooth muscle hypertrophy asthma - ANSWER chronic inflammatory obstruction of bronchi; trigger causing mucus clogging bronchial tubes; is reversable, give beta antagonists and steroids Foundation meds of asthma and COPD - ANSWER glucocorticosteroids: Pulmicort and Flovent; taken daily for long term control to suppress inflammation. Oral glucocorticoids - methylprednisone, prednisone; gradually decrease dose Bronchodilators (Beta 2-Adrenergic Agonists) - ANSWER provide symptomatic relief, do not effect inflammation of disease process; taken PRN during attack (Albuterol), long actinb Beta2 can be used in combo with glucocorticoids Back pain treatment - ANSWER first 4-6 weeks no imaging needed unless neurologic involved; give NSAIDS and rest, is the #1/2 reason for visits to PCP Types of Endocrine Disorders - ANSWER Diabetes Acromegaly - overproduction of growth hormone, have overbite and buffalo hump Addison's - decreased production of hormones by adrenal gland Cushing - high cortisol levels Graves - hyperthyroidism (excessive) Stage 1 Kidney Disease (CKD) - ANSWER kidney damage with normal or increased GFR, treat comorbid conditions to slow disease progression, CVD risk reduction Stage 2 CKD - ANSWER kidney damage with mild decreased GFR (60-89), Estimation of progression Stage 3 CKD - ANSWER moderate decreased GFR (30-59), treat complications Stage 4 CKD - ANSWER Severely decreased GFR (15-29), prepare for kidney replacement therapy Stage 5 CKD - ANSWER Kidney failure GFR 15 or dialysis, replacement if uremia present How do you start first dose of antihypertensives/heart failure medications? - ANSWER start first dose at night; do slow position changes, lay down if hypotension occurs Ace Inhibiters (ACEI) *pril - ANSWER reduce angiotensin II, increase bradykinin, hyperkalemia, dry cough, angioedema; contraindicated in pregnancy (fetal death), first dose causes severe hypotension, can cause renal failure Beta Blockers - ANSWER prevent chemical messengers; slow HR, relax vessels, lower BP, Class II antidysrhythmic drug nonselective beta blockers - ANSWER use with caution in people with lung conditions; do not use with asthma Cardio selective beta blockers - ANSWER metoprolol - only beta-1 receptors affected Third generation beta blockers - ANSWER labetalol - blocks alpha and beta receptors Calcium Channel Blockers - ANSWER vasodilation of arterioles and heart, class IV antidysrhythmic drug Verapamil - ANSWER calcium channel blocker, first choice dihydropyridines CCB - ANSWER *ine, vasodilators used to treat htn and angina non-dihydropyridines CCB - ANSWER *dilt, used for arrhythmias Statins - ANSWER lipid lowering agents (LDL), can increase good HDL, muscle pain can lead to rhabdo, kidney failure, and death Diuretics - ANSWER 2 hours after oral intake, peaks at 4-6 hours, lasts 12 hours Thiazide Diuretics - ANSWER block reabsorption (10%) in distal convoluted tubule; not used in kidney failure, can cause hypokalemia, not used in sickle cell disease Loop diuretics - ANSWER Furosemide; blocks reabsorption (20%) in loop of Henle Potassium-sparing diuretics - ANSWER Spironolactone (Aldactone); distal nephron, holds K, excretes sodium, takes 48 hours to work Angiotensin II - ANSWER vasocontraction; increased bp by acting on adrenal cortex secreting aldosterone Antiotensin II Receptor Blockers (ARBS) - ANSWER Sartan; blocks action of angiotensin II, second choice if cannot tolerate ACE for htn and HF Diabetes diagnosis - ANSWER Hgb A1C is most reliable assessment of blood glucose over 3 month period. Poor control is 9%, goal is 6.5% in healthy people Short acting insulin - ANSWER lispro (Humalog)/Aspart (NovoLog)/glulisine (aspirdra) Long acting insulin - ANSWER glargine (Lantus) - most painful; detemir (levemir) Metformin - ANSWER first drug of choice with new Type 2 Diabetes; inhibits glucose in liver, slightly reduces glycose absorption in gut, increases glucose uptake; DOES NOT drive insulin down, very low risk for hypoglycemia TSH levels - ANSWER normal range is 0.4 to 4.0 mu/L. If you are being treated for a thyroid disorder, the normal range is 0.5 to 3.0 mu/L. A value above the normal range indicates that the thyroid is underactive. This indicates hypothyroidism. Hypothyroidism Presentation - ANSWER inadequate amounts of hormone; slows body function and processes, cold, pale puffy face, skin cool and dry, low HR, low temp, lethargy, fatigue Hypothyroidism in pregnancy - ANSWER must be treated to prevent a child's neurological problems Hypothyroidism in newborns - ANSWER require replacement within a few days, lasts for 3 years, prevents mental development changes and growth patters, dwarfish How do you take Levothyroxine (t4) - ANSWER on an empty stomach for increased absorption Hashimoto disease presentation - ANSWER weight gain and fatigue; autoimmune disease Hyperthyroidism (thyrotoxicosis) presentation - ANSWER elevations in T4 and T3, tachyarrhythmias, anxiety, insomnia, rapid speech, hot Graves Disease - ANSWER women 20-40 most susceptible, remove or destroy thyroid tissue or suppress with drugs (methimazole or propylthiouracil), treat with Iodine - I31, beta blockers also used to suppress release of thyroid hormones Plummer disease (toxic nodular goiter) - ANSWER result of thyroid adenoma (tumor), same as Graves disease, but absence of exophthalmos (bulging eyes) Thyroid storm - ANSWER caused by major surgery or severe illness such as sepsis, 105 F, severe tachycardia, restlessness, tremor, heart failure, coma. Treat with Propylthiouracil (PTU), symptom management Histamine - 1 antihistamines - ANSWER cause vasodilation, bronchoconstriction, help with memory and sleep. Relieve itching, pain, secretion, and mucus (allergies). Side effects: sedative, dry mouth, urinary hesitancy,, constipation. Second generation (-ine) are non-sedating Histamine 2 Receptor Antagonists - ANSWER secretion of gastric acid; treat gastric and duodenal ulcers Stage I HTN - ANSWER 130-139/80-89 Stage 2 HTN - ANSWER 140/90 Med used after heart attack - ANSWER Beta blocker - use for 6 months Meds for ischemic vascular disease - ANSWER aspirin or antithrombotic Cervical cancer screening - ANSWER 21 - 64 cytology every 3 years, 30-64 cytology and HPV every 5 years Pneumonia CURB - ANSWER Confusion, Urea 7, RR 30, BP 90 or 60, Age 65 0-1 = home treatment, 2 = short stay hospital, 3+ = severe pneumonia (ICU) End of Life care - ANSWER optimize patient's comfort and function while avoiding unnecessary side effects First line of depression treatment - ANSWER SSRIs - low side effects with good effectiveness Stress - ANSWER exacerbates many serious health issues, stress cannot cause cancer broken heart syndrome - ANSWER mimics MI, no coronary obstruction SDOH - ANSWER social determinants of health Types of SDOHs - ANSWER access to healthy foods, health literacy, housing stability, socioeconomic status, rural vs. urban healthcare access Amoxicillin - ANSWER first line of treatment for uncomplicated otitis media in pediatric patient without comorbidities POTS - ANSWER Postural Orthostatic Tachycardia Syndrome Treatment of POTS - ANSWER stand slowly, lay back down if needed, add extra salt increase fluids, MEDS: Florinef Symptoms/Diagnosing POTS - ANSWER Tilt Test - HR increases by 30 bpm when standing up or over 120 in first 10 minutes, symptoms are related to reduced blood volume when standing up, can cause lightheadedness, fainting Florinef - ANSWER Used to treat conditions which glucocorticoids are low. These conditions include Addison's disease, adrenocortical insufficiency. *Also treats orthostatic hypotension; Side effects: nausea, headache, sleep problems, mood changes Off label use for prazosin/minipress - ANSWER sleep aid for patients diagnosed with PTSD Myasthenia Gravis - ANSWER a neuromuscular disorder characterized by muscle weakness and rapid fatigue, drooping eyelids, difficulty swallowing, generalized weakness Meds used to treat myasthenia gravis - ANSWER corticosteroids - treat diplopia and suppress adrenal function; take 4-6 weeks then taper Cholinesterase inhibitors - neostigmine Side effects of cholinesterase inhibitors - ANSWER excessive salivation, urinary incontinence/urgency, sweating, muscle spasm, bradycardia Med: neostigmine therapeutic levels produce mild stimulation Toxic levels depress CNS (BBB) - treat with respiratory support and atropine thyrotoxicosis - ANSWER condition caused by the exposure of body tissue to excessive levels of thyroid hormone first line treatment for uncomplicated HTN - ANSWER hydrochlorothiazide, oral with lifestyle changes Ataxia in pediatric patient - ANSWER genetic predisposition, Fragile X syndrome, Prader-Willie Syndrome Prader-Willie Syndrome - ANSWER deletion of chromosome from father