NR 507 FINAL EXAM 1 – QUESTION AND ANSWERS

NR 507 FINAL EXAM 1- QUESTIONS AND ANSWERS 1. What term is used to describe a hernial protrusion of a saclike cyst that contains meninges, spinal fluid, and a portion of the spinal cord through a defect in a posterior arch of a vertebra? a. Myelomeningocele 2. What provides the best estimate of the functioning of renal tissue? a. Glomerular filtration rate 3. Where are Langerhans cells found? a. skin 4. Where in the lung does gas exchange occur? a. Alveolocapillary membrane 5. The tonic neck reflex observed in a newborn should no longer be obtainable by: a. 5 months 6. When renin is released, it is capable of which action? a. Formation of Angiotensin I 7. The portion of the antigen that is configured for recognition and binding is referred to as what type of determinant? a. Epitope 8. Which sexually transmitted infection frequently coexists with gonorrhea? a. Chlamydia 9. How is the effectiveness of vitamin B12 therapy measured? a. Reticulocyte count 10. Carcinoma refers to abnormal cell proliferation originating from which tissue origin? a. Epithelial cells 11. Which type of microorganism reproduces on the skin? a. Bacteria and fungi 12. An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. A wide fixed splitting of the second heart sound is also found. These clinical findings are consistent with which congenital heart defect? a. Atrial Symptom defect (ASD) 13. An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom? a. Lack of symptoms 14. What is the function of erythrocytes? a. Tissue oxygenation 15. Which terms represent the correct nomenclature for benign and malignant tumors of adipose tissue, respectively? a. Lipoma, liposarcoma 16. What is the chance with each pregnancy that a child born to two parents with the sickle trait will have sickle cell disease (SCD)? a. 25% 17. What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx? a. Cillias 18. The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by which gland? a. Posterior pituitary 19. Why is the herpes virus inaccessible to antibodies after the initial infection? a. The virus does not circulate in the blood 20. Which renal change is found in older adults? a. Decrease in the number of nephrons 21. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? a. IG A 22. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a. Norepinephrine 23. Which statement is true regarding maternal antibodies provided to the neonate? a. The antibodies enter circulation by means of active transport 24. The function of the tumor cell marker is to: a. Screen individuals for high risk of cancer 25. Which statement is true concerning a fungal infection? a. Phagocytes and T lymphocytes control fungal infections 26. Which change is a result of puberty and defends the vagina from infection? a. Vaginal PH becomes more acidic 27. The number of persons living with a specific disease at a specific point in time is referred to by which term? a. Prevalence 28. Which risk factor for hypertension is influenced by genetic factors and lifestyle? a. Obesity 29. Having ejected a mature ovum, the ovarian follicle develops into a(n): a. Corpus luteum 30. The failure of bones to ossify, resulting in soft bones and skeletal deformity, characterizes which disorder? a. Rickets 31. What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding? a. Tolerance 32. Aldosterone directly increases the reabsorption of: a. Sodium 33. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? a. Embolic 34. Which clinical manifestations are associated with fibromyalgia? a. Sensitivity at the tender points and profound fatigue 35. Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation? a. Heat exhaustion 36. What is the leading cause of infertility in women? a. Polycistic ovary syndrome 37. Which substance is a water-soluble protein hormone? a. Insulin 38. What is the target tissue for prolactin-releasing factor? a. Anterior pituitary 39. What is the cause of familial hypercholesterolemia (FH)? a. REduction in the number of low density lipoprotein receptors on cell surfaces 40. Regarding type 2 diabetes, obesity is considered to be what type of risk? a. Modifiable 41. Which four-step process correctly describes muscle contraction? a. Excitation, coupling, contraction, relaxation 42. Adoption studies have shown that the offspring of an alcoholic parent when raised by nonalcoholic parents have what amount of an increased risk of developing alcoholism? a. fourfold 43. Which hormone stimulates gonads to produce both male and female hormones? a. LH 44. A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome? a. Klinefelter 45. Which would be considered a positive symptom of schizophrenia? a. Auditory hallucinations 46. What term describes the loss of the comprehension or production of language? a. Aphasia 47. Consanguinity refers to the mating of persons: a. Having common family relations 48. The major sleep center is located in which section of the brain? a. Hypothalamus 49. Which type of ion directly controls the contraction of muscles? a. Calcium 50. Bacteria gain access to the female urinary tract by which means? a. Bacteria ascending the urethra into the bladder 51. A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive worrying that lasts for at least how many months? a. 6 months 52. What is the first indication of nephrotic syndrome in children? a. Periorbital edema 53. An amniocentesis indicates a neural tube defect when an increase in which protein is evident? a. Alpha fetoprotein 54. What is the risk for the recurrence of autosomal dominant diseases? a. 50% 55. Which term is used to identify the temporary displacement of two bones causing the bone surfaces to partially lose contact? a. Subluxation 56. The tear in a ligament is referred to as a: a. Sprain 57. Why is prolonged diarrhea more severe in children than it is in adults? a. Fluid reserves are smaller in children 58. The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? a. Ovarian 59. Insulin transports which electrolyte in the cell? a. Potassium 60. What term is used to identify an interlacing bundle of dense, white fibrous tissue that is richly supplied with nerves, blood vessels, and lymphatic vessels? a. Joint capsue 61. Which of the following is a lipid-soluble hormone? a. Cortisol 62. The mucosal secretions of the cervix secrete which immunoglobulin? a. IG A 63. The sudden apparent arousal in which a child expresses intense fear or another strong emotion while still in a sleep state characterizes which sleep disorder? a. Night terrors 64. What is the basic structural unit in compact bone? a. Haversian system 65. Parkinson disease is a degenerative disorder of the brain’s: a. Basal ganglia 66. Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain? a. GCT 67. Saliva contains which immunoglobulin (Ig)? a. IG A 68. What type of fracture occurs at a site of a preexisting bone abnormality and is a result of a force that would not normally cause a fracture? a. Pathologic 69. An infant suddenly develops abdominal pain, becomes irritable (colicky), and draws up the knees. Vomiting occurs soon afterward. The mother reports that the infant passed a normal stool, followed by one that looked like currant jelly. Based on these data, which disorder does the nurse suspect? a. Intussception 70. In 95% of children of delayed puberty, the problem is caused by: a. Physiologic hormonal delays 71. Which characteristic is true of type II (white fast-motor) muscle fibers? a. Fast conduction velocities 72. Neurofibrillary tangles characterize which neurologic disorder? a. Alzheimer disease 73. Which hormone triggers uterine contractions? a. Oxytocin 74. How does the release (increase) of epinephrine raise body temperature? a. It raises the metabolic rate 75. Which hormone is linked to an increase in appetite during puberty? a. Leptin 76. Chvostek and Trousseau signs indicate which electrolyte imbalance? a. Hypocalcemia 77. How An adult’s chest wall compliance is lower than an infant’ chest wall compliance in an infant differ from that of an adult? a. An adult’s chest wall compliance is lower than an infant’s. 78. What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated? a. Refractory 79. What is the suggested mean blood pressure for an 8- to 9-year-old child? a. 106/58 80. Which is an example of an endogenous antigen? a. Cancer cells 81. What is the most commonly reported symptom of cancer treatment? a. Fatigue 82. At birth, which statement is true? a. Gas exchange shifts from the placenta to the lung. 84. What is the treatment of choice for pernicious anemia (PA)? a. Vit B12 by injection 85. Which disease is an example of a rickettsial infection? a. Rocky Mountain spotted fever 86. Which statement is true regarding maternal antibodies provided to the neonate? a. The antibodies enter into the fetal circulation by means of active transport 87. Which statement is true regarding pain and cancer? a. Pain is generally associated with late-stage cancer. 88. During an infection, why do lymph nodes enlarge and become tender? a. B lymphocytes proliferate. 89. What is a significant cause of morbidity and mortality worldwide? a. Infectious Disease 90. After sexual transmission of HIV, a person can be infected yet seronegative for how many months? a . 6-14 91. Which organism is responsible for the development of syphilis? a. Treponema pallidum 92. The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins? a. IgE 93. Blood cells that differentiate into macrophages are known as: a. monocytes 94. In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells? a. Bone marrow 95. Hemophilia B is caused by a deficiency of which clotting factor? a. IX 96. Which of the following causes condylomata acuminata or genital warts? a. HPV 97. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a. Adaptation 98. Which chamber of the heart endures the highest pressures? a. Left ventricle 99. Which glycoprotein protects against urolithiasis and is a ligand for lymphokines? a. Urodilatin 100. Having ejected a mature ovum, the ovarian follicle develops into a(n): a. Corpus luteum 101. The most critical aspect in correctly diagnosing a seizure disorder and establishing its cause is: a. Health history 102. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta? a. Alkaline phosphatase 103. Clinical manifestations that include irregular or heavy bleeding, the passage of large clots, and the depletion of iron stores support which diagnosis? a. Dysfunctional uterine bleeding 104. What happens to the vagina’s lining at puberty? a. It becomes thicker 105. The two most important risk factors for type 2 diabetes are: a. Obesity and positive family history 106. What is the leading cause of infertility in women? a. Polycystic ovary syndrome 107. Which structure attaches skeletal muscle to bone? a. Tendon 108. Which term is used to describe an intestinal obstruction caused by the invagination of the ileum into the cecum and part of the ascending colon by collapsing through the ileocecal valve? a. Intussusception 108. Which dyskinesia involves involuntary movements of the face, trunk, and extremities? a. Tardive 109. It is true that myasthenia gravis: a. Causes muscle weakness 110. What effect does hyperphosphatemia have on other electrolytes? a. Decreases serum calcium. 111. Which pancreatic enzyme is responsible for the breakdown of carbohydrates? A amylase 112. What part of the brain provides the emotional response to pain? a. limbic 113. The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone? a. Cortisol 114. Which clinical manifestations would be expected for a child who has complete trisomy of the twenty-first chromosome? a. An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears 115. Which assessment finding characterizes Osgood-Schlatter disease? a. Tendinitis of the anterior patellar tendon 116. Dilation of the ipsilateral pupil, following uncal herniation, is the result of pressure on which cranial nerve (CN)? a. Oculomotor CN III 117. What directly causes ovulation during the menstrual cycle? a. Sudden increase of LH 118. Which clinical manifestations are associated with fibromyalgia? a. Fasciculations of the upper and lower extremity muscles 119. What anchors articular cartilage to the underlying bone? a. Collagen fibers 120. At 2 or 3 weeks of age, an infant who has been well fed and has gained weight begins to vomit for no apparent reason. The vomiting gradually becomes more forceful. These symptoms may be indicative of which disorder? a. Pyloric stenosis 121. The common property among the three types of medications used to treat depression is that they: a. Increase neurotransmitter levels within the synapse. 122. The presence of a zygote having one chromosome with the normal complement of genes and one with a missing gene is characteristic of which genetic disorder? a. Cri du chat 123. Alterations in which part of the brain are linked to hallucinations, delusions, and thought disorders associated with schizophrenia? a. Temporal lobe 124. Which person is at the greatest risk for developing delirium? a. An individual on the second day after hip replacement 125. What term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis? a. hypospadius 83. Acute and prophylactic therapies, including herbal, for migraine headaches (see lecture with narration attached) and chapter 44 84. What monitoring is necessary for migraine prophylactic medications? 85. Recommended prophylactic therapies for migraine headaches (be sure to view/listen to the migraine lecture) 86. serotonin syndrome? (Ch 47 pg 523-526) (epocrates) 87. drugs are associated with serotonin syndrome? (epocrates) 88. Which prophylactic antihypertensive medication should … avoided in patients with asthma due to risk of bronchospasm? 89. Pharmacologic management of Gout including side effects of medication 90. Pharmacologic management of OA including side effects of the medications 91. Side effects of NSAIDs 92. Uses of aspirin and adverse effects- 93. If a patient is to have surgery, does aspirin need to be stopped, if so, how soon before? What about NSAIDs such as naproxen or ibuprofen? 94. Medication that may increase uric acid levels 1. A pt who has osteoarthritis is … to have knee surgery. The pt takes asparin for MI prophylaxis and naproxen (Naprosyn) for pain and inflammation. Which statement by the pt to the primary care NP indicates a need for further teaching? 2. A pt who is obese and has hypertension is taking a thiazide diuretic and develops gouty arthritis, which is treated with probenecid. At a follow-up visit, the pts serum uric acid level is 7mg/dl, and the pt denies any current symptoms. The primary care NP should discontinue the probenecid and : 3. A pt who has HTN is taking a thiazide diuretic. The pt has a serum uric acid level of 8 mg/dl. The primary care NP caring for this pt should: 4. A patient with a history of gouty arthritis comes to the clinic with acute pain and swelling of the great toe. The patient is not currently taking any medications. The primary care NP should prescribe: 5. A patient having recurring migraine headaches and you plan to initiate prophylactic therapy. Which class of anti-hypertensive medications has … shown to have the greatest efficacy in preventing migraine headache? 1. Question: A patient who has disabling intermittent claudication is not a candidate for surgery. Which of the following medications should the primary care NP prescribe to treat this patient? 2. Question: A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDs) daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should: 3. Question: A patient in the clinic reports heartburn 30 minutes after meals, a feeling of fullness, frequent belching, and a constant sour taste. The patient has a normal weight and reports having a high-stress job. The primary care NP should recommend: 4. Question: A patient who has gastroesophageal reflux disease (GERD) undergoes an endoscopy, which shows a hiatal hernia. The patient is mildly obese. The patient asks the primary care nurse practitioner (NP) about treatment options. The NP should tell this patient that: 5. Question: A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to: 6. Question: A patient comes to the clinic with a 4-day history of 10 to 12 liquid stools each day. The patient reports seeing blood and mucus in the stools. The patient has had nausea but no vomiting. The primary care NP notes a temperature of 37.9° C, a heart rate of 96 beats per minute, and a blood pressure of 90/60 mm Hg. A physical examination reveals dry oral mucous membranes and capillary refill of 4 seconds. The NP’s priority should be to: 7. Question: A patient is in the clinic for an annual physical examination. The primary care NP obtains a medication history and learns that the patient is taking a β-blocker and nitroglycerin. The NP orders laboratory tests, performs a physical examination, and performs a review of systems. Which finding may warrant discontinuation of the β-blocker in this patient? 8. Question: The primary care NP sees a patient who has a history of hypertension and alcoholism. The patient is not taking any medications. The NP auscultates crackles in both lungs and palpates the liver 2 cm below the costal margin. Laboratory tests show an elevated creatinine level. The NP will refer this patient to a cardiologist and should prescribe: 9. Question: The primary care NP is considering prescribing captopril (Capoten) for a patient. The NP learns that the patient has decreased renal function and has renal artery stenosis in the right kidney. The NP should: 10. Question: A patient who has had four to five liquid stools per day for 4 days is seen by the primary care NP. The patient asks about medications to stop the diarrhea. The NP tells the patient that antidiarrheal medications are: 11. Question: A patient has been taking antibiotics to treat recurrent pneumonia. The patient is in the clinic after having diarrhea for 5 days with six to seven liquid stools each day. The primary care NP should: 12. Question: A primary care NP sees a patient who is about to take a cruise and reports having had motion sickness with nausea on a previous cruise. The NP prescribes the scopolamine transdermal patch and should instruct the patient to apply the patch: 13. Question: A patient who has been taking propranolol for 6 months reports having nocturnal cough and shortness of breath. The primary care NP should: 14. Question: A patient who has GERD with erosive esophagitis has been taking a PPI for 4 weeks and reports a decrease in symptoms. The patient asks the primary care NP if the medication may be discontinued. The NP should tell the patient that: 15. Question: A patient reports having episodes of dizziness, nausea, and lightheadedness and describes a sensation of the room spinning when these occur. The primary care NP will refer the patient to a specialist who, after diagnostic testing, is likely to prescribe: 16. Question: A patient comes to the clinic with a complaint of gradual onset of left-sided weakness. The primary care NP notes slurring of the patient’s speech. A family member accompanying the patient tells the NP that these symptoms began 4 or 5 hours ago. The NP will activate the emergency medical system and expect to administer: 17. Question: A patient who is taking an oral anticoagulant is in the clinic in the late afternoon and reports having missed the morning dose of the medication because the prescription was not refilled. The primary care NP should counsel this patient to: 18. Question: A patient who has congestive heart failure and arthritis has been taking chlorthalidone (Zaroxolyn) 25 mg daily for 6 months. The primary care NP notes a persistent blood pressure of 145/90 mm Hg. The NP should: 19. Question: An 80-year-old patient who has persistent AF takes warfarin (Coumadin) for anticoagulation therapy. The patient has an INR of 3.5. The primary care NP should consider: 20. Question: A 2-year-old child has chronic “toddler’s” diarrhea, which has an unknown but benign etiology. The child’s parent asks the primary care NP if a medication can be used to treat the child’s symptoms. The NP should recommend giving: 21. Question: The primary care NP refers a patient to a cardiologist who diagnoses long QT syndrome. The cardiologist has prescribed propranolol (Inderal). The patient exercises regularly and is not obese. The patient asks the NP what else can be done to minimize risk of sudden cardiac arrest. The NP should counsel the patient to: 22. Question: A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS. The patient comes to the clinic and reports having dry mouth, difficulty urinating, and more frequent constipation. The primary care NP notes a heart rate of 92 beats per minute. The NP should: 23. Question: A patient who has been taking quinidine for several years reports lightheadedness, fatigue, and weakness. The primary care NP notes a heart rate of 110 beats per minute. The serum quinidine level is 6 μg/mL. The NP should: 24. Question: An 80-year-old patient with chronic stable angina has begun taking nadolol (Corgard) 20 mg once daily in addition to taking nitroglycerin as needed. After 1 week, the patient reports no change in frequency of nitroglycerin use. The primary care nurse practitioner (NP) should change the dose of nadolol to _____ mg _____ daily. 25. Question: A woman has severe IBS and takes hyoscyamine sulfate (Levsin), simethicone (Phazyme), and a TCA. She reports having continued severe diarrhea. The primary care NP should: 26. ________________________________________ 27. 28. A primary care NP prescribes a nonselective NSAID for a patient who has osteoarthritis. The patient expresses concerns about possible side effects of this medication. When counseling the patient about the medication, the NP should tell this patient: to take each dose of the NSAID with a full glass of water. 29. A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four times each month. The NP should: prescribe an anticonvulsant such as topiramate. 30. A patient who has osteoarthritis is scheduled to have knee surgery. Pt takes Aspirin and Naproxen for pain and inflammation. Which statement indicates a need for further teaching? I will need to stop both meds 1 week before I have surgery. 31. A patient reports having an acute onset of low back pain associated with lifting a heavy object the day before.Besides advising the patient to rest and apply ice, the primary care NP should prescribe a nonsteroidal antiinflammatory drug (NSAID) 1. What is the first line drug of choice for osteoarthritis? - Acetaminophen 2. What are the two main reasons that long term NSAID use is usually unadvisable? GI bleeding, Renal impairment 3. What are some interventions that would decrease preventable adverse drug events? Should not take with alcohol, should not take more than recommended dose 4. What are the main goals of treatment for osteoarthritis? Reduce of pain, improved joint function, decreased joint destruction, increased quality of live 5. What lifestyle modifications should be suggested to decrease the pain and stress related to osteoarthritis? Aerobic and strength training, weight loss to keep BMI at 20 - 25, cognitive behavioral therapy Hello , Despite of your challenges of using Kaltura, you did an excellent job in your narrative powerpoint about osteoarthritis. I really enjoyed listening to it and reviewing its informative content. I noted you mentioned Tylenol as first line drug of choice, which I agree with you. You also listed Celebrex and Ultram treatments as options as well. All of those drug of choices are geared towards the main goal of treating the osteoarthritis as you articulated in your powerpoint initial slides suc has reducing the pain, improving joint function, decreasing joint destruction, and increasing quality live. Those drug choices serve for pain as well as inflammation management purposes. During my literature search about osteoarthritis, I came along with a useful information about Duloxetine (Cymbalta) being used more widely to help reduce the pain caused by osteoarthritis. This drug can be a choice for treatment if the patient is allergic to the drugs listed by you in your presentation or have contradictions to take them. Cymbalta, which is a selective serotonin and norepinephrine reuptake inhibitor, is an FDA approved drug of choice for the chronic musculoskeletal pain caused by conditions such as osteoarthritis (Brown & Boulary, 2013). Initial treatment dose is recommended at 30 mg once daily for 1 week, then 60 mg once daily with potential maximum dose of 120mg per day (Wang et al., 2015). Although this drug is not one of the agents from the Walmart or Target $4 RX list, it will only cost$ 17 at Walmart, which might be an expensive prescription to obtain. Furthermore, to complement to your non-pharmacological implications listed in the powerpoint, I would educate my patients to avoid placing any extra stress to the affected joints such. These measures may include engaging in gentle exercises such as aquatic ones versus vigorous ones, avoiding weight gain, using special equipment if necessary such as cante, walker, neck color, elastic knee support to protect joints from overuse. Acupuncture or massage done by a professional therapist to relieve pain at the affected joints are also therapeutic measures to consider. Overall, you did a great job presenting on the osteoarthritis management. Respectfully, Armine References Brown, P. J. and Boulay, J. L. (2013). Clinical experience with duloxetine in the management of chronic musculoskeletal pain. A focus on osteoarthritis of the knee. Therapeutic Advances of Musculoskeletal Disease, 5(6), 291-304. Wang ZY, Shi SY, Li SJ, et al. (2015). Efficacy and Safety of Duloxetine on Osteoarthritis Knee Pain: A Meta-Analysis of Randomized Controlled Trials. Pain Med, 6(7), . In summary, this week through our Grand Rounds presentations, we demonstrated proficiency in using evidence based research in treating our case study patients. The discussions led to searching for other treatment options that have been known to be effective. With the pharmacotherapy agents recommended each participant was prompted to discuss therapeutic actions and adverse response. If the medication was ineffective or the side-effects too great, other options were provided through discussion. In addition to the Grand Rounds presentation, we studied pulmonary disorders. With cigarette smoking and pollution continuing to be problematic, chronic obstructive pulmonary disease is treated frequently. This is a debilitating disease and the symptoms must be managed effectively. Learning the stepwise approach to disease treatment will be imperative for best, evidence based outcomes. Dear Emily, Great Presentation, lots of good information was covered! I agree with you as well as Dr. McMahon, that hypothyroidism can be complex when it comes to its treatment because of the alternative nature at which the provider should routinely monitor and adjust synthroid. Otherwise, there are so few, limited treatment agents to choose from. Like you indicated, there is not any alternative treatments for this particular disease but hormone replacement of one of those: synthetic or natural. As I stated above, the list narrows when discussing medications for Hypothyroidism. The only $4 thyroid replacement therapy is Levothyroxine (Synthroid) which you discussed in your presentation. I will point out that the $4 prescription is a 30-day supply while there is also a $10 90 supply available as well if the practitioner writes the order as such which will save the patient $2 overall in filling a 90-day supply. To reemphasize, Levothyroxine is a synthetic T4 hormone which is indistinguishable from the natural one by its biochemical and physiological features with the main mechanism of action of creating a negative feedback loop by inhibiting thyrotropin releasing hormone (TRH) and thyroid stimulating hormone (TSH) secretion, whereby decreasing further thyroid hormone synthesis and secretion (Woo & Robinson, 2016). I will give a clinical scenario where a patient was previously prescribed Levothyroxine but now her practitioner is switching her to a non-synthetic form, Armour Thyroid, due to some adverse reactions to the synthetic form. You did a great job reviewing this medication in your presentation. I’d like to add more to the content shared by you. This is a desiccated thyroid extract that is made from animal (pigs) thyroid glands. In an article written by McAninch & Bianco (2016) they noted a study showing a patient preference to desiccated thyroid extract over L-Thyroxine monotherapy, and patients happened to experience weight loss in conjunction with therapy. Usual starting dose of Armour Thyroid is 30mg with incremental dosing of 15mg every 2-4 weeks depending on lab values. If patient has a history of cardiac disorders or angina, then an initial starting dose of 15mg is recommended. Maintenance dosing is between 60-120 mg/day. Drug interactions may occur with anticoagulants as thyroid hormone appears to intensification catabolism of vitamin K (Woo & Robinson, 2016). Cordially, Armine Test Questions 1. What lab tests determine hypothyroidism – TSH, T3, T4 2. What is the standard pharmacological treatment for hypothyroidism – Synthroid 3. How long will the patient be expected to take the medication? lifetime 4. When does the patient need to take the medication? Before breakfast 5. Can the patient switch the brands of the medication, why or why not? No, because they are not equivalent References McAninch E.A and Bianco A.C (2016). The History and Future of Treatment of Hypothyroidism. Annals of Internal Medicine, 164(1), 50-6. Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advanced Practice Nurse prescribers (4th ed.). Retrieved from 29. 30. What term is used to describe a hernial protrusion of a saclike cyst that contains meninges, spinal fluid, and a portion of the spinal cord through a defect in a posterior arch of a vertebra? 31. Question 2. What provides the best estimate of the functioning of renal tissue? 32. Question 3. Where are Langerhans cells found? 33. Question 4. Where in the lung does gas exchange occur? 34. Question 5. The tonic neck reflex observed in a newborn should no longer be obtainable by: 35. Question 6. When renin is released, it is capable of which action? 36. Question 7. The portion of the antigen that is configured for recognition and binding is referred to as what type of determinant? 37. Question 8. Which sexually transmitted infection frequently coexists with gonorrhea? 38. Question 9. How is the effectiveness of vitamin B12 therapy measured? 39. Question 10. Carcinoma refers to abnormal cell proliferation originating from which tissue origin? 40. Question 11. Which type of microorganism reproduces on the skin? 41. Question 12. An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. A wide fixed splitting of the second heart sound is also found. These clinical findings are consistent with which congenital heart defect? 42. Atrial Symptom defect (ASD) 43. Question 13. An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom? 44. Question 14. What is the function of erythrocytes? 45. Question 15. Which terms represent the correct nomenclature for benign and malignant tumors of adipose tissue, respectively? 46. Question 16. What is the chance with each pregnancy that a child born to two parents with the sickle trait will have sickle cell disease (SCD)? 47. Question 17. What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx? 48. Question 18. The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by which gland? 49. Question 19. Why is the herpes virus inaccessible to antibodies after the initial infection? 50. Question 20. Which renal change is found in older adults? 51. Question 21. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? 52. Question 22. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? 53. Question 23. Which statement is true regarding maternal antibodies provided to the neonate? 54. Question 24. The function of the tumor cell marker is to: 55. Question 25. Which statement is true concerning a fungal infection? 56. Question 26. Which change is a result of puberty and defends the vagina from infection? 57. Question 27. The number of persons living with a specific disease at a specific point in time is referred to by which term? 58. Question 28. Which risk factor for hypertension is influenced by genetic factors and lifestyle? 59. Question 29. Having ejected a mature ovum, the ovarian follicle develops into a(n): 60. Question 30. The failure of bones to ossify, resulting in soft bones and skeletal deformity, characterizes which disorder? 61. Question 31. What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding? 62. Question 32. Aldosterone directly increases the reabsorption of: 63. Question 33. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? 64. Question 34. Which clinical manifestations are associated with fibromyalgia? 65. Question 35. Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation? 66. Question 36. What is the leading cause of infertility in women? 67. Question 37. Which substance is a water-soluble protein hormone? 68. Question 38. What is the target tissue for prolactin-releasing factor? 69. Question 39. What is the cause of familial hypercholesterolemia (FH)? 70. Question 40. Regarding type 2 diabetes, obesity is considered to be what type of risk? 71. Question 41. Which four-step process correctly describes muscle contraction? 72. Question 42. Adoption studies have shown that the offspring of an alcoholic parent when raised by nonalcoholic parents have what amount of an increased risk of developing alcoholism? 73. Question 43. Which hormone stimulates gonads to produce both male and female hormones? 74. Question 44. A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome? 75. Question 45. Which would be considered a positive symptom of schizophrenia? 76. Question 46. What term describes the loss of the comprehension or production of language? 77. Question 47. Consanguinity refers to the mating of persons: 78. Question 48. The major sleep center is located in which section of the brain? 79. Question 49. Which type of ion directly controls the contraction of muscles? 80. Question 50. Bacteria gain access to the female urinary tract by which means? 81. Question 51. A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive worrying that lasts for at least how many months? 82. Question 52. What is the first indication of nephrotic syndrome in children? 83. Question 53. An amniocentesis indicates a neural tube defect when an increase in which protein is evident? 84. Question 54. What is the risk for the recurrence of autosomal dominant diseases? 85. Question 55. Which term is used to identify the temporary displacement of two bones causing the bone surfaces to partially lose contact? 86. Question 56. The tear in a ligament is referred to as a: 87. Question 57. Why is prolonged diarrhea more severe in children than it is in adults? 88. Question 58. The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? 89. Question 59. Insulin transports which electrolyte in the cell? 90. Question 60. What term is used to identify an interlacing bundle of dense, white fibrous tissue that is richly supplied with nerves, blood vessels, and lymphatic vessels? 91. Question 61. Which of the following is a lipid-soluble hormone? 92. Question 62. The mucosal secretions of the cervix secrete which immunoglobulin? 93. Question 63. The sudden apparent arousal in which a child expresses intense fear or another strong emotion while still in a sleep state characterizes which sleep disorder? 94. Question 64. What is the basic structural unit in compact bone? 95. Question 65. Parkinson disease is a degenerative disorder of the brain’s: 96. Question 66. Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain? 97. Question 67. Saliva contains which immunoglobulin (Ig)? 98. Question 68. What type of fracture occurs at a site of a preexisting bone abnormality and is a result of a force that would not normally cause a fracture? 99. Question 69. An infant suddenly develops abdominal pain, becomes irritable (colicky), and draws up the knees. Vomiting occurs soon afterward. The mother reports that the infant passed a normal stool, followed by one that looked like currant jelly. Based on these data, which disorder does the nurse suspect? 100. Question 70. In 95% of children of delayed puberty, the problem is caused by: 101. Question 71. Which characteristic is true of type II (white fast-motor) muscle fibers? 102. Question 72. Neurofibrillary tangles characterize which neurologic disorder? 103. Question 73. Which hormone triggers uterine contractions? 104. Question 74. How does the release (increase) of epinephrine raise body temperature? 105. Question 75. Which hormone is linked to an increase in appetite during puberty? 106. 76. Chvostek and Trousseau signs indicate which electrolyte imbalance? 107. 77. How An adult’s chest wall compliance is lower than an infant’ chest wall compliance in an infant differ from that of an adult? 108. An adult’s chest wall compliance is lower than an infant’s. 109. 110. 111. 112. Hypocalcemia 113. 114.