NUR 630 EXAM 2 QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026

NUR 630 EXAM 2 QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026 Ideal obesity tx - Answers RD, behaviorist, Exercise specialist interventions can be applied in a systematic way in office obestity tx in office visits - Answers 1. Self Weighing 2. Alteration of Env. cues 3. Meal Replacements 4. Physical Activity typical pt - Answers gains weight each year Your job as provider - Answers 1. start the conversation - is it ok to discuss weight - their thoughts on weight/health - how important it is to them Body weight discuss - Answers discuss in context of health risks. - sm amts of weight loss/inc. physical activity can have significant effect on health body weight intervention - Answers 5-7% weight loss, calc. for them Target maintence for 3 months - if weight stable, target 3% loss DAILY SELF WEIGHING - min. of wkly - inc dietary restraint - correlated w weight loss maintence -establishes habit Visual cues influence intake - Answers pt tend to eat bc its there - underestimate calories - same satiety Environmental cues - Answers Proximity of food - closer/eat more Visibility of food - see it/eat it Larger container/larger serving size Dieting-Environmental Interventions - Answers create natural stopping point smaller plates/bowl Serve from stove, except veg/salad Use foil to cover food dark containers High risk foods in back Put all food away Restaurant interventions - Answers Decide what to order before going 1/2 serving or package 1/2 immediately Split entree order app and salad for entree Meal Replacements - Answers portion controlled nutrient defined data to support greater weight loss with them than reduced cal. diet, remains at 1 yr(34% vs 72% lost 5% body weight) Meal Replacement Rationale - Answers structure narrow stimuli decrease decision fatigue simplify choices calorie/portion control adequate nutrition Meal Replacement stats - Answers 1-3 as meal/snack 150c-300cals protein 10/snack-30g carbs 15-40g fat 3-10g fiber 3+ Physcial activity - Answers little evidence for weight loss w mod. increases in activity benefits weight losss (cardio etc) 150 mins/mod- (prevent diabetes)- 200mins National weight control registry - Answers weight themselves daily 90% daily physical activity for 60mins at moderate intense walk 11000steps/day 80% eat breakfast Intervention of physical activity - Answers explane role of small inc. of activity explore lifestyle poss. health benefits of sm. changes encourage achievable goals Physical activity aides - Answers - pedometers= acountability/feedback phone apps Dr. mike evans Tricks of weight loss - Answers music power poses breakfast journaling smart phone apps alt. activities- not alt. foods. (now you can...) music and nutrition - Answers engages reward system in brain (same as food) feel good songs for when they want to eat - can inc. physical activity power poses - Answers -superman INC testosterone 20% Dec. Cortisol 25% bring strongest self to situation Body language is giving you a msg, changing your mind, changes your beh, changes your outcome Breakfast research - Answers no effect overall of eating/skipping journaling/phone apps - Answers shown to make diff not sustainable- short term/episodic nutrition key points - Answers Regular self weighing- necessary to maintain lost weight Better to alter env. than change ones mind to control food intake - MR have been shown effective weight loss/maintence -Inc physical activity is necessary for maintence of lost weight obesity demo - Answers 30% population more obese worldwide than starving epidemiology of obesity - Answers genetic homone imbalance /stress physical activity diet oxidative stress/hypoxia inflammation,infx,toxins insulin resistance and hyperglycemia epigentic factors adipocyte - Answers metabolically active endocrine organ obesity bias - Answers most amongst family members more than gays/race etc cope by eat more food, refuse to diet, bingeing, avoid exercise, less preventative care judged=less likely to lose weight obesity pharmacotherapy - Answers 27 w comorbidity 30+ comorbidity=htn, hld, pre/diabetes, sleep apnea Bariatric SX - Answers 35 w comorbid 40 comorbid= htn, hld, pre/dm, sleep apnea obesity major points - Answers Assess NEED - 25 w RF -BMI 30 Readiness to make lifestyle, ID barriers Set weight loss and health GOALS Intervention Strategies - 5-10% of baseline weight in 6 months - sustained loss 3-5% of body weight Key Behaviors in Weight management - Answers Inc Physical actvity- 30mins/5x limit sit time improve sleep 7-9hrs reduce stress healthier food healthier meds diabetic meds weight gain - Answers insulin sulfony. thz diabetic meds - Answers metformin dd4 inhib glp 1 agonist sglts inhib anthypertensives weight gain - Answers bblockers weight loss ACEARB diuretic ca channel block new bb antihistamine weight gain - Answers diphenhydramine cyproheptadine antihistamine weight loss - Answers inhaled 2nd gen- loratadine, cetirizine, fexofenadine antileptic weight loss - Answers topomax zonisamide antipsych weight loss - Answers ziprasidone ariprazole antidepressant weight loss - Answers wellbutrin snris stimulants nefazadone contraceptive weight loss - Answers combo pills iud barrier change meds - Answers atenolol- linsinopril/hctz paroxetine- wellbutrin valproic acid- topamax Depot-provera-- desogestrel/ethinyl estodiol diphenhydramine-- evaluate sleep apnea, behavior therapies- stimulus control, cbt weight loss med general principals - Answers Goal- 5-10% in 3-6months Maintain 3-5% combo w lifestyle change only work while on it combos may work better eval monthly for 3 months, then q3mn not while pregs Lorcaserin/Belviq - Answers weight loss drug selective 5ht2c agonist 3% loss at 1 yr Schedule 4 cse- h/a dizzy fatigue, n constipation, priapism lorcaserin/belviq Cautions - Answers caution w drugs that affect serotonin, severe liver disease, crcl50, diabetes, inhibs cyp2d6 Risk of serotonin syndrome, nms Avoid CrCl 30 Qsymia=phentermine/topamax - Answers inc dosing after 2 wks 9% weight loss at 1 yr Schedule 4 REMS- risk evaluation and mitigation strategy qysmia/phentermine/topamax CSE - Answers memory loss, paresthesia, dizzy, insomnia, nephrotox, met. acidosis low dose w mod-severe ckd/liver disease Contraindicated- pregs, glaucoma, hyperthyroid, maoi therapy, alcoholism, severe liver disease Obesity - Answers chronic frequently progressing rarely remitting triggers 65+ conditions - arthritis, sleep apnea, cancer fooD and energy - Answers regulation of food/energy complex afferent signals molecules from adipose, pancreas, gi system, hypothalamus, pns,cns altering just one wouldnt be long term soln Contrave: Naltrexone/wellbutrin - Answers dose 8/90 weight loss 5% at 1 yr CSE- n/v, constipation, h/a, dizzy Contra: uncontrolled htn, sz, anorexia/bulimia, w/d, mao inhibs Liraglutide( Saxenda) - Answers GLP 1 agonist enhances glucose-stimulated insulin realease by pancreatic b cells and acts on satiety paths -delays gastric emptying inc. dosing 5% weight loss 1 yr Liraglutide= saxenda cse - Answers n/v, ha, pancreatitis Contra: medullary thyroid ca hx, mult endocrine neoplasia type 2 Orlistat ( xenica- rx) (alli otc) - Answers TID w meals blocks fat absorption 3% weight loss 1 yr NONcompliance GAS, Fecal urgency, Steatorrhea, abd pain, n, -dec. absorption of fat-soluble vitamins. interfere w absorption of certain drugs. Phentermine (adipex, suprenza) - Answers in AM inc. bp, hr, nervous, insomnia, dry mouth, constipation sympathomimetic amines Sympathomimetic amines - Answers weight loss drugs diethylpropion benzphetamine phendimetrazine Phentermine off label use - Answers most prescribed weight loss med NOT approved for LT use- no data Contra: Cardio disease, psych disease, subst abuse - know other meds have documented data - no inc in hr, bp - has weight loss dose 7.5, 15mg 1qid f/u monthly q3 months on stable dose lisdexamphetamine- vyvanse - Answers Binge Eating DO amphetamine/stimulant SE- inc. bp/hr, nervous, insomnia, dry mouth, constipation best drug for weight loss 1 yr - Answers phentermine/topamax phentermine lutide Roux en Y Gastric Bypass - Answers Restrictive Malabsorptive Metabolic "bypass most of stomach" by attaching to small intestine Sleeve Gastrectomy - Answers excise stomach Lap Band- adjustable - Answers dec in popularity band around top of stomach - High complications- 1/2 need removal Efficacy of bariatric sx - Answers most with gastric bypass then sleeve Risks of gastric sx- sleeve and bypass - Answers #1 REoperative risk- gallstones, leak PE staple line leak death hernia, bleeding infx- 1% Bypass: Internal hernia, ulcer (not w sleeve) Gastric sx nutrition - Answers Multivitamin plus mineral bid ----iron, folic acid, thiamine CA mg Vit D 3000u, keep d30 B12 po/im iron- 60mg multivitamin and addition sup protein 60-90mg no conc. sweets no liquids at meals Dumping syndrome - Answers bypass cse early- 30 mins late 1-3 hrs. hair loss - Answers gastric bypass effect telogen effluvium/hair loss after stress vs rapid nutritional changes peaks at 6months grows back Bariatric sx cse - Answers hair loss depression- new image, not all probs solved, change in social identity Fertility- improvement of hormonal balance, pcos ----new self image E abuse- tx addiction , tolerance Loose skin- age, weight, nutrition musculoskeletal pain weight regain Gastric balloon - Answers bmi 30 AND comorbidity inserted endo. filled w saline, methyl blue removed afer 6 months Vbloc - Answers communication btwn vagus nerve and brain about hunger, digestive enzymes -delivers intermittent 5000hz pulses lap vagal lead placement, subq rechargeable neuroregulator back pain stats - Answers 80% in lifetime #1 cause time off, disability COST nicotine- damages vascualar system/joints- more fx/djd spine anatomy - Answers 7 12 5 sacrum degenerative conditions of lumbar spine - Answers lumbar stenosis=narrowing (arthritis/bone spurs).elderly disc herniation= tear in fibrous ring. young ppl degenerative spondylolisthesis/scoliosis= slippage Pain assoc w lumbar djd - Answers low back pain leg pain/radiculopathy=nerve symptoms butt pain (considered leg pain) leg numbness/tingling leg weakness lumbar disc herniation - Answers tear in fibrous ring young 30s/40s "sciatica"= nerve compression more pain w sitting, flexion acute pain pt prefers to stand lumbar disc herniation tx - Answers conservative - improves 4-6wks time PT NSAIDS injections weight loss smoking cessation medrol dose pack- careful w diabetes RARE sx mech of back pain - Answers mechanical- loss of disc structure and biomechanical properties chemical- release of mediators that sensitize nerve endings. RED FLAGS back pain - Answers bowel/bladder incontinence(cauda equina) saddle paresthesias progressive neuro deficit fever/chills=infx/discitis unexplained weight loss intractable pain/night pain foot drop= refer low back pain dx - Answers h and p xrays mri only if s/s 4-6wks of red flags (most ppl over 60yo have asymptomatic degeneration/bulging disc) Indications for lumbar disectomy - Answers cauda equina progressive/significant neuro deficit intractable pain failure of conservative tx --( pt, nsaids, medrol dose, epidural injects) microdiscectomy - Answers If disc is pressing on nerve very sucessful sx 30 mins oupt minimally invasive lumbar stenosis - Answers narrowing spinal canal disc bulge and collapse facet hypertrophy- enlarge as we age ligamentum flavum hypertrophy degenerative affects older pts. spondylolisthesis - Answers degenerative- instability/slippage requires laminectomy and fusion (screws/rods/bonegraft) painful w only micromotion cervical herniated discs - Answers neck pain arm/shoulder pain/back of head=radiculopathy myleopathy= cord compression=red flag Degenerative cervical spine conditions - Answers disc herniation cervical spondylosis=degeneration/arthritis cervical stenosis Referred Symptoms/Radiculopathy - Answers arm/hand pain, weakness, numbness, tingling LOWER MOTOR NEURON Cervical pain RED FLAGS - Answers disabling weakness bowel/bladder incont intractable pain myleopathy- signs of spinal cord compression. Cervical Myelopathy/Cord Compression - Answers Decrease in fine motor skills hand numbness/tingling balance changes/dec wide based gait UPPER MOTOR NEURON Neck pain/radiculopathy tx - Answers nsaids traction- 10-20lbs, bid ----not in cord compression PT Collar No MRI until 4-6wks unless red flags cervical disc degeneration in asymptomatics - Answers 40 yo- 60% had degeneration or bulge Cervical myelopathy RED FLAGS - Answers Spinal cord compression Balance/coordination issues loss of fine motor skills In hands Can be combined with weakness/numbness/tingling in arms Bowel/Bladder dysfunction If need sx= Operate ASAP DDX of cervical myelopathy - Answers MS AIDS lupus demylenating disease b12 deficiency Chiari malformation foramen magnum tumors syringomelia Indications for cervical SX - Answers Recalcitrant symptoms (4-6wks) Neuro deficit/correlative imaging Signs of spinal cord compression Types of Cervical SX - Answers Anterior cervical discectomy and fusion Posterior cerv. dissect. and fusion Post Cervical decompression Anterior Cervical Sx - Answers Relieved pressure on spinal cord and/or nerve root all from the front Treats radiculopathy(arm pain) and/or myelopathy (constellation of symptoms seen w spinal cord compression Myelopathy success of surgical decompression - Answers length of symptoms age medical status Hoffman sign - Answers should be NEGATIVE/thumb NOT move tells if problems in corticalspinal tract tap nail, flick terminal phalanx of middle/ring finger positive = flexion of the terminal phalanx of the thumb. abnormal. ankle clonus - Answers series of abnormal reflex movements of the foot, induced by sudden dorsiflexion, Damage to nerve pathways in spine/brain UPPER motor neuron issue sign of spinal cord compression abnormal- 2-3 beats Babinski reflex - Answers abnormal- upgoing toes what big toe does when sole of foot stimulated problem with cns Scoliosis types - Answers congenital infantile 3yo Juvenile 3-10yo Idiopathic adolescent scoliosis 10 Adult - degenerative Progression of idiopathic adolescent Scoliosis - Answers curvature of spine 10degrees in coronal plane - can compromise pulmonary and cardiac function only if severe 100 degree curve Cosmetic Scoliosis tx - Answers observation Brace in child/adol PT SX if -documented curve progression - curve 50 deg. Significant coronal or sagittal imbalance no longer one big rod down center/herrington Metastatic spine disease - Answers 60-70% of pts with mets have spinal involve. #1 breast 2- lung myeloma prostate lymphoma kidney Goal of mets disease of spine - Answers decrease pain preserve/improve neural function maintain mobility prevent/improve deformity hepatitis - Answers inflammation of liver acute hepatitis vs chronic - Answers acute 6mnths of clinical or biochemical evidence of liver disease chronic 6months fulminant hepatitis - Answers onset of liver failure - encephalopathy -synthetic dysfunction within 8 wks of recognition of liver disease. Abnormal liver tests - Answers common 20% of pple have high ALT-measures inflammation of liver LFTs do NOT represent synthetic function Prothrombin time, bilirubin, platelets, albumin are descriptive r/t synthetic function evaluating abnormal liver tests - Answers enzyme elevation does NOT correlate w presence of significant liver disease or its severity Early dx= prompt therapy life ins/stigma of liver disease can have cirrhosis and normal ast/alt Steps of treating liver disease - Answers 1. Repeat blood tests. confirm 2. H & P-most important 3. categorize 4. dx 5. tx Liver disease h&P - Answers meds -otc, statins, anti-epileptics, anti-tb, abx RF- etoh,iv drugs, occupation-healthcare, comorbids-hd, travel Fam HX - hemochromatosis, alpha 1 antitrypsin, wilsons Extrahepatic s/s -rashes, sjogrens, RF, psych Categorizing liver disease - Answers Hepatocellular vs cholestatic(high bili and alk phosp - acute/chronic hepatocellular - intrahepatic vs extrahepatic cholestatic Symptomatic vs asymptomatic Isolated hyperbilirubinemia Intrahepatic cholestasis - Answers interruption in excretion of bile by obstruction within liver causes- blockage of small ducts - hepatitis - medications Extrahepatic cholestasis - Answers caused by obstruction outside the liver. - caused- stone, pancreatic ca d.o of pancreas stricture s/s- pain in gallbladder or pancrease intra/extra cholestasis s/s - Answers jaundice dark urine pale stools itching bone pain xanthoma- yellow fat deposits beneath skin dx cholestasis - Answers alk phosph 3x greater than normal. dx hepatocellular - Answers high ast/alt isolated hyperbilirubinemia dx - Answers high bili others normal alcoholic hepatitis dx - Answers ast x2 to alt Ast/alt not usually 300 Acute causes of hepatitis - Answers a,b,c,d,e alcohol Epstein barr virus cmv wilsons disease toxins autoimmune ischemia (shock liver) icu-just coded Hep D - Answers need hep b infx superinfx likely to be chronic hep E - Answers fecal-oral mexico/n Africa/asia