NURS 6501 FINAL EXAM WITH QUESTIONS AND CORRECT
ANSWERS GRADED A+
What is your responsibility as a health care provider to do when a patient informs
you that they have recently been sexually assaulted? (IF WITHIN 72H) - ANS... --
PCP should defer a PE and refer the pt to the ER if the sexual assault occured
within the last 5 day, preferably within 72h
- Ensures proper measures are taken and comply with standardized protocols
- Support the patient's current or future desire for legal pursuits
- PCP doesn't need to request specific info about the assault → this will be done in
the ED
what's the role of the PCP if sexual assault happened > 5 days? - ANS... -- Medical
care can be managed in the outpatient setting
- Get a detailed hx and perform a full PE and gyn exam
- 40% of rape victims sustain a collateral injury; 5% sustain a severe injury
- Injuries most common in >30yrs old
- Gyn injuries: vaginal or anal tearing, rectal bleeding, bruising, soreness
- Use face of a clock for documenting locations
- Other SS: GI irritability, dysmenorrhea, pelvic pain, UTIs
- Get a gonorrhea, chlamydia, HepB/C, HIV, and pregnancy tests
Does your responsibility change for sexual assault if the patient is under the age of
18? - ANS... -Children and adolescents would need collaboration with agencies
that are specific to this age group to prevent lifelong complications of the abuse
what are the variables worth 1 point each in the CAD clinical decision rule -
ANS... -Men > 55 yrs, women > 65 yrs
Known CAD aor CVA
Pain not reproducible by palpation
Pain worse during exercise
Patient assumes pain is cardiogenic
what would you do for low risk of CAD using the clinical decision rule (0-1 score)
- ANS... -Evaluate for noncardiac causes unless pt has other reasons for concern
(murmur, dyspnea, arrhythmia)
,what would you do for moderate risk of CAD using the clinical decision rule (2-3
score) - ANS... -- Findings consistent with ischemic heart disease (new ST ▲, new
LBBB, Q wave, or T wave hyperacuity
- ^^ yes or no would determine if they go to the ER vs checking troponins vs
determining a nonischemic cause
what would you do for high risk of CAD using the clinical decision rule (4-5 score)
- ANS... -Order EKG; give O2 and ASA; arrange EMS to ER
anaphylaxis ss - ANS... -Occurs within 5-30 minutes of exposure to:
Generalized itching with or without hives
Swollen lips, throat, body part
Difficulty breathing, cough
Chest tightness
Abdominal cramping
NVD
Feeling of impending doom
What is the role of the primary care provider in mental health? - ANS... -- Screen
for mental health issues
- Improve outcomes and reduce health care costs
- Assess and give care to mild-moderate disorders or patients with stable severe
mental disorders
- From strong links with mental health specialty care for complex cases
Sharing patient info (ex: meds used)
about PHQ2
- what does it screen for, what are the questions, scoring - ANS... -- Screens for
MDD
- It is the first two questions of the PHQ9
- In the last two week, have you been feeling these (not at all, several days, more
than half the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Scoring:
A single yes or score >3 (out of 0-6) = possible clinical depression ⇒ due the
PHQ9
, If the pt screens (+) ⇒ continue to eval with the PHQ9
about PHQ9
- what its used for, questions, scoring - ANS... -Used for screening, diagnosing,
and treating
- It asks about functioning impairments which is needed for the DSM-based
diagnosis
Includes asking about suicide or hurting self
Scoring:
0-27 available
0-4: Minimal/none
Monitor; may not require treatment
5-9: Mild
Use clinical judgment; follow-up in one month
10-14: Moderate
Use clinical judgment; may need meds if functionally impaired
15-19: Moderately Severe
Warrants active treatment with psychotherapy, meds, or combo
20-27: Severe
Warrants active treatment with psychotherapy, meds, or combo
What is the appropriate initiation dose for fluoxetine for adults and geriatric
adults? - ANS... -20mg PO once daily in the AM
- May ↑ daily dose after several weeks if inadequate response
- Full therapeutic effect may be delayed 4 weeks or longer
- Max dose: 80mg/day
What labs would be appropriate to draw if you initiate fluoxetine in a geriatric
patient? - ANS... -Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs, previous hx
of antidepressant-induced hyponatremia, low body weight, concomitant use of
thiazides or other hyponatremia-inducing agents)
- monitor regularly in the elderly
What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE - ANS... -Common
SSRIs:
Lexapro, celexa, paxil, zoloft, prozac
ANSWERS GRADED A+
What is your responsibility as a health care provider to do when a patient informs
you that they have recently been sexually assaulted? (IF WITHIN 72H) - ANS... --
PCP should defer a PE and refer the pt to the ER if the sexual assault occured
within the last 5 day, preferably within 72h
- Ensures proper measures are taken and comply with standardized protocols
- Support the patient's current or future desire for legal pursuits
- PCP doesn't need to request specific info about the assault → this will be done in
the ED
what's the role of the PCP if sexual assault happened > 5 days? - ANS... -- Medical
care can be managed in the outpatient setting
- Get a detailed hx and perform a full PE and gyn exam
- 40% of rape victims sustain a collateral injury; 5% sustain a severe injury
- Injuries most common in >30yrs old
- Gyn injuries: vaginal or anal tearing, rectal bleeding, bruising, soreness
- Use face of a clock for documenting locations
- Other SS: GI irritability, dysmenorrhea, pelvic pain, UTIs
- Get a gonorrhea, chlamydia, HepB/C, HIV, and pregnancy tests
Does your responsibility change for sexual assault if the patient is under the age of
18? - ANS... -Children and adolescents would need collaboration with agencies
that are specific to this age group to prevent lifelong complications of the abuse
what are the variables worth 1 point each in the CAD clinical decision rule -
ANS... -Men > 55 yrs, women > 65 yrs
Known CAD aor CVA
Pain not reproducible by palpation
Pain worse during exercise
Patient assumes pain is cardiogenic
what would you do for low risk of CAD using the clinical decision rule (0-1 score)
- ANS... -Evaluate for noncardiac causes unless pt has other reasons for concern
(murmur, dyspnea, arrhythmia)
,what would you do for moderate risk of CAD using the clinical decision rule (2-3
score) - ANS... -- Findings consistent with ischemic heart disease (new ST ▲, new
LBBB, Q wave, or T wave hyperacuity
- ^^ yes or no would determine if they go to the ER vs checking troponins vs
determining a nonischemic cause
what would you do for high risk of CAD using the clinical decision rule (4-5 score)
- ANS... -Order EKG; give O2 and ASA; arrange EMS to ER
anaphylaxis ss - ANS... -Occurs within 5-30 minutes of exposure to:
Generalized itching with or without hives
Swollen lips, throat, body part
Difficulty breathing, cough
Chest tightness
Abdominal cramping
NVD
Feeling of impending doom
What is the role of the primary care provider in mental health? - ANS... -- Screen
for mental health issues
- Improve outcomes and reduce health care costs
- Assess and give care to mild-moderate disorders or patients with stable severe
mental disorders
- From strong links with mental health specialty care for complex cases
Sharing patient info (ex: meds used)
about PHQ2
- what does it screen for, what are the questions, scoring - ANS... -- Screens for
MDD
- It is the first two questions of the PHQ9
- In the last two week, have you been feeling these (not at all, several days, more
than half the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Scoring:
A single yes or score >3 (out of 0-6) = possible clinical depression ⇒ due the
PHQ9
, If the pt screens (+) ⇒ continue to eval with the PHQ9
about PHQ9
- what its used for, questions, scoring - ANS... -Used for screening, diagnosing,
and treating
- It asks about functioning impairments which is needed for the DSM-based
diagnosis
Includes asking about suicide or hurting self
Scoring:
0-27 available
0-4: Minimal/none
Monitor; may not require treatment
5-9: Mild
Use clinical judgment; follow-up in one month
10-14: Moderate
Use clinical judgment; may need meds if functionally impaired
15-19: Moderately Severe
Warrants active treatment with psychotherapy, meds, or combo
20-27: Severe
Warrants active treatment with psychotherapy, meds, or combo
What is the appropriate initiation dose for fluoxetine for adults and geriatric
adults? - ANS... -20mg PO once daily in the AM
- May ↑ daily dose after several weeks if inadequate response
- Full therapeutic effect may be delayed 4 weeks or longer
- Max dose: 80mg/day
What labs would be appropriate to draw if you initiate fluoxetine in a geriatric
patient? - ANS... -Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs, previous hx
of antidepressant-induced hyponatremia, low body weight, concomitant use of
thiazides or other hyponatremia-inducing agents)
- monitor regularly in the elderly
What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE - ANS... -Common
SSRIs:
Lexapro, celexa, paxil, zoloft, prozac
