NURS 623 Exam 4 (2022/2023) test-bank complete solutions

What are the typical demographics of a patient with MS (what type of person does this disease normally effect) - correct answer Young, caucasion female of eastern European desent At the onset of alzheimers, what category of medications should be initiated - correct answer Cholinesterase inhibitors What factors contribute to a patient being high risk for falls - correct answer History of falls, medications, vision impairment, heat rate/rhythm abnormalities, footwear issues, home environment, gait/mobility issues, poor reflexes. What classes of antibiotics would need to be renally dosed with a patient with impaired renal function - correct answer Vanc, floroquinolones, and aminoglycosides What does FAST mean when assessing for s/s of stroke - correct answer Face, Arms, Speech, Time How does an absence seizure present (symptoms) - correct answer Sudden onset, blank stare (upward rotation of eye), activity stops and appears transfixed, few seconds to 1 min What is the difference between delirium and dementia - correct answer First involves underlying acute cause, abrupt onset, hours to days, reversible, hallucination, incoherent speech, and confusion. The second can have various causes, gradual change with mental status, months to years, progressive to irreversible (speech, memory, mood, and judgment). What are the risk factors for development of a pressure ulcer? - correct answer Elderly are most at risk population. Thin skin and less subcutaneous fat along with less movement create and environment for pressure ulcers. What are the red flag signs of a patient with low back pain. - correct answer Hx trauma, fever, unexplained weight loss, hx cancer, incontinence, long term steroid use, parental drug abuse, intense localized pain, inability to find comfortable position, Cadua Equina Syndrome. Always assess radiation of pain, bowel, bladder. What are the common bacterial organisms associated with bacterial meningitis. - correct answer Neisseria meningitides (high mortality), haemophilus influenza type B, streptococcus pneumoniae most common What are the s/s of alzheimers? - correct answer Presence of dementia by clinical exam and MMSE (mini-mental state exam) deficit in 2 or more areas of cognition, progressive worsening of memory and cognitive function without disturbed consciousness and absence of systemic illness/other brain disease. Impaired ability to learn new info along with disturbance in language, function, or perception. What are the s/s of Parkinsons? - correct answer Age 60, tremor at rest (pill rolling), rigidity, bradykinesia, masked face, stopped posture, shuffling gait, arching (limbs, neck, back), decrease facial dexterity, dysphagia, orthostatic hypotension, anosmia, depression, cognitive impairment, freezing phenomenon, cogwheeling, postural instability (advanced disease) What are the s/s of GB? - correct answer Prickling, pins and needles sensations in your fingers, toes, ankles or wrists. Weakness in your legs that spreads to your upper body. Unsteady walking or inability to walk or climb stairs. Difficulty with eye or facial movements, including speaking, chewing or swallowing. Severe pain that may feel achy or cramplike and may be worse at night. Difficulty with bladder control or bowel function. Rapid heart rate. Low or high blood pressure. Difficulty breathing. What are s/s of temporal arteritis? - correct answer Jaw claudication (pain with chewing that is relieved when stops chewing), unilateral pain, temporal area with scalp tenderness; skin over artery is indurated, tender, warm, and reddened. Amaurosis fugaz (temporary blindness), may occur. Low-grade fever and fatigue, occurs sometimes. ESR/sed rate (often reaches 100 mm/hr or more). CRP elevated 50. Medical Urgency: polymyalgia rheumatica common in these patients, older adults and elder are more common. What are articular bone structures? - correct answer Includes structures like the synovium, synovial fluid, articular cartilage, joint capsules, and juxta-articular bone. Articular disorders may be characterized by deep or diffuse pain, pain or limited ROM on active and passive movement, swelling, crepitus. What are non-articular bone structures? - correct answer Supportive structures such as tendons, bursae, muscles, fascia, bone, nerve, overlying skin. Tend to be painful on active but not passive (assisted) ROM. Seldom demonstrate swelling, crepitus, instability, or deformity by itself. What dx test is most useful in patient who presents with lumbar radiculopathy? - correct answer The straight leg raise (assesses L5-S1). This is best initial diagnostic because the most common disc herniation is at L5-S1. Straight leg raise will cause sciatica and radicular pain. In older adults, how can you increase physical activity-things you can encourage or are there certain underlying factors that would enable a patient to be more successful? - correct answer Ensure the patient is motivated What are s/s of bells palsy? (cranial nerve VII) - correct answer Facial paralysis with normal ocular movement and sensation. Loss of taste (dysgeusia). Postauricular pain. Sound sensitivity (hyperacusis). Heavy feeling in face. What are the demographics/people effected by bells palsy? - correct answer Anyone at any age. It occurs most often in pregnant women, and people who have diabetes, influenza, a cold, or another upper respiratory ailment. Bell's palsy affects men and women equally. It is less common before age 15 or after age 60. What is the testing for bells palsy? - correct answer There's no specific test for it. Your doctor will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow showing your teeth and frowning, among other movements. What is the treatment for Bells palsy? - correct answer Prevent eye injury, acyclovir, Prednisone, NSAIDs for pain, rest decreased auditory stimulation. Self limiting, recovery in a few weeks or months. What are the s/s of Migraine? - correct answer Often but not always unilateral and tends to have a throbbing or pulsatile quality. Accompanying features may include nausea, vomiting, photophobia, or phonophobia during attacks. Can be precipitated by an aura. Triggered by things like stress, caffeine, weather changes, or food. What are the s/s of cluster headaches? - correct answer Unilateral, often severe headache attacks and typical accompanying autonomic symptoms. Characterized by attacks of severe unilateral orbital, supraorbital, or temporal pain accompanied by autonomic phenomena. Unilateral autonomic symptoms are ipsilateral to the pain and may include ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, and nasal congestion. Attacks usually last 15 to 180 minutes. Can last 2-3 months. What is a potential complication of steroid use in a patient with impaired integrity of bone structure? - correct answer Increased risk of fx Where do the cervical nerves innervate? - correct answer C1-4: head, neck, diaphragm C5-8: neck, shoulders, arms, wrists, hands What are the s/s of carpal tunnel? - correct answer Related to compression of the median nerve, which results in pain, paresthesia, numbness and tingling, and associated weakness in the hand and wrist that radiate to the thumb, index finger, middle finger, and radial half of the ring finger. What are the s/s of Gout? - correct answer Form of arthritis characterized by painful flare-ups in joints of distal extremities. What are s/s of medial epicondylitis? - correct answer Pain on the inside of elbow. Elbow stiffness, hand and wrist weakness. Tingling sensation or numbness in the fingers, especially the ring and little fingers. Difficulty moving the elbow, will be pain with wrist flexion. What are s/s of ruptured cervical disc? - correct answer Can cause neck pain, radiating arm pain, shoulder pain, and numbness or tingling in the arm or hand. The quality and type of pain can very from dull, aching, and difficult to localized to sharp, burning, and easy to pinpoint. Can cause weakness in arm(s). In a patient with a new herniated lumbar disc and no red flag symptoms, how do you manage? - correct answer May resolve in 3-6 weeks, NSAIDS, short course of oral steroids, pain management or Epidural steroid injection (ESI). Surgical option if no improvement in 3 months, intolerable dysfunctional pain, neurologic deterioration, or Cauda Equina syndrome (emergent surgery). In elderly patients, fracture of what body part would lead to potentially fatal outcomes or problematic long term sequaelea? - correct answer Hip fracture What are some early symptoms of Parkinsons? - correct answer Bradykinesia (moving slow), tremor at rest to hand/finger (pill rolling), masking or hypomimia (reduced degree of facial expression), shuffling gait. What are late symptoms of Parkinsons? - correct answer Flexed posture involving the entire body; causes abnormal accumulation of the substantia migra - may lead to dementia; overall worsening of symptoms with gait, tremor, depression, sleep disturbances, anxiety. What is the gold standard test for dx osteoporosis? - correct answer DEXA or DXA: Dual energy X-ray absorptiometry What are the demographics of a patient who is at risk for the development of osteoporosis? - correct answer Lifestyle (Low body weight, smoking, calcium deficit, vit d deficit), Diseases (thyrotoxicosis, hyperparathyroidism, cushing's, hypogonadism, RA, IBS), Medications (glucocorticoids, excessive thyroxine, long-term phenytoin), Other (65, family history, menopause, genetics). In a patient who is elderly and falls, but there is no clear cause of falls, what should your workup center around? - correct answer Cardiac and neurologic causes If a patient is alert and oriented and refuses to give consent for a procedure, how do you move forward as a provider? - correct answer Discuss risks of not having procedure, abort procedure, document refusal. In elderly patients, what factors can contribute to loss of appetite and malnourishment? - correct answer Diminished taste/smell/vision, dry mouth, poor dentation, chronic illness, meds, pain, depression, loneliness, etc. What are the benefits of NSAIDS? - correct answer Used frequently to help reduce pain and inflammation for patients with low back pain, spondylosis, headaches, stenosis, bursitis, arthritis, and other musculoskeletal injuries/pain. What are side effects of NSAIDS? - correct answer May cause gastritis, n/v, PUD (high risk for H. pylori), increased risk of GI bleeding, ulceration, and perforation. What are complications of long term use of NSAIDS? - correct answer Black box warning of increased risk of serious and potentially fatal cardiovascular thrombotic events such as MI/stroke; risk increases with long term use. How would you assess for a suspected meniscal tear with a physical exam? - correct answer McMurray test: External rotation of foot = medial meniscus. Internal rotation of foot = lateral meniscus