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SARAH MICHELLE LIVE REVIEW STUDY GUIDE questions and answers rated A+ 2024/2025
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SARAH MICHELLE LIVE REVIEW STUDYGUIDE
A new graduate nurse practitioner has a patient presents with a hearing complaint. The patient
states that they have had decreased hearing on the right side for the last month that is
continuing to get worse. The NP completes both the Rinne and Weber tests. If the patient has
Ménière's disease, what would be the expected finding on the Weber test?
1. AC is 2 times longer than BC
2. BC is 2 times longer than AC
3. The tuning fork lateralizes to the right ear
4. The tuning fork lateralizes to the left ear - ANS4. The tuning fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? - ANSVertigo, tinnitus, ear
pressure, nystagmus
What is our biggest worry for a Meniere's Disease patient? - ANSThere is a possibility for a
potential, permanent hearing loss.
What is rhinitis meidcamentosa? - ANSDrug-induced rebound nasal congestion, this can
happen after use of nasal decongestants like Afrin. These nasal decongestants should ideally
not be used for greater than 3-5 days because of this risk.
What is herpes keratitis? - ANSThis is an infection of the cornea due to herpes simplex virus
How is herpes keratitis diagnosed? - ANSBy examining the eye under a black lamp and
visualized the cornea, in herpes keratitis, fern like lines will be seen on the cornea
A child that has a history of mononucleosis is at increased risk for development for what cancer
later in life? And why? - ANSHodgkin's Lymphoma and Burkitt's Lymphoma, this is due to the
exposure of the Epstein-Barr virus
What types of patients will be at a higher risk of pneumonia? - ANSPatient with chronic lung
diseases: asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? - ANSBecause we WANT them
to get that gunk out, we do not want them to hold it in their lungs, an expectorant would be a
better option for these patients.
,When should a follow up chest X-Ray be completed after treatment of pneumonia? -
ANSAround 8 week mark
What is COPD? - ANSChronic Obstructive Pulmonary Disease. This is a chronic condition that
is made up of chronic bronchitis and emphysema. It is a progressive inflammatory lung disease
that makes it hard for the patients to breathe, because the chronic bronchitis leads to mucous
build up and the emphysema portion destroys areas of the lungs.
What signs and symptoms are common in COPD patients? - ANSChronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? - ANSNeurological
symptoms, paresthesia (numbness and tingling in hands and feet), unsteady gait, memory
issues
Beefy red tongue
What diet can result in B12 deficiency? - ANSVegan- oral supplements can be used for
treatment
What surgery can result in B12 deficiency? - ANSGastric surgery- patient will lose intrinsic factor
that is required to absorb B12- these patients will require life long IM B12 injections
What patient population is lupus commonly seen? - ANSWomen of childbearing age- ages
15-45, African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? - ANSMust have 4/11 diagnostic criteria:
Malar rash
Discoid rash
Photosensitivity
Oral/nasal ulcers
Non-erosive arthritis
Cardio-pulmonary complaints
Renal complaints
Neurological concerns
Immunological disorders
+ ANA test
Hematologic disorders
What is Sjogren's Syndrome and what is the treatment? - ANSDry eyes and dry mouth-
treatment revolves around symptom management- artificial tears, hard candies, etc.
Common in lupus patients
,What is a major concern for lupus patients? How do we monitor this? - ANSImpact on the
kidneys- Lupus nephritis
Be on the look out for glomerularnephritis as well as proteinuria
These patients will require routine UA for assessment of their kidneys and protect them
What is the function of the thyroid? - ANSViral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? - ANSPituitary gland
What is the function of TSH? - ANSTells your thyroid when to produce and release those critical
thyroid hormones- T3 and T4.
What disorders include hypothyroidism? - ANSIodine deficiency, Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? - ANSHypothyroidism is caused by
an autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? - ANSWeight gain, constipation, dry
skin, cold intolerance, fatigue, course hair, facial puffiness, thick tongue, and maybe some
cardiac side effects
What patient education must be included regarding Synthroid administration? - ANSMust be
taken on an empty stomach before other medications
What are signs and symptoms of a myxedema coma? - ANSLow body temperature, edema,
confusion, lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? - ANSLithium or amiodarone
Your patient who is on 75 mcg Synthroid PO daily comes in for a 6 week follow up to check their
TSH level. When you get the results, their TSH is 0.1. What should you do next as the NP? -
ANSAssess how the patient is taking their Synthroid
What signs and symptoms are common in hyperthyroidism? - ANSAnxiety, palpitations, cardiac
abnormalities, tachycardia, diaphoresis, weight loss, and increased appetite, menstrual
irregularities, amenorrhea, tremors, lid lag, exophthalmos
What needs to be considered with PTU medication administration? - ANSNeed frequent lab
work: CBC, and Thyroid panel
Required to take PTU multiple times a day
What is the most common treatment for Grave's Disease? - ANSRadioactive iodine therapy
, Hyperthyroidism left untreated may lead to what conditions? - ANSHeart disease- patient's heart
is in a constant high-output state, your heart can't keep up with that all of the time, may lead to
heart failure
Osteoporosis
Infertility
What is worst case scenario in hyperthyroid patients? - ANSThyroid storm- Temperature, HR,
and BP- dangerously HIGH levels
Puts body into compromised state, especially impacting your heart. Heart starts to go into Letha
dysrhythmias and even heart failure.
What are the 8 most common drug classes for diabetes medications? - ANSBiguanides
(Metformin)
DPP-4 inhibitors
GLP-1 Agonists
SGLT-2 inhibitors
Insulin
Sulfonylureas
TZDs
Alpha-glycosides inhibitors
Why are type 1 diabetics insulin dependent? - ANSThey have an autoimmune destruction of
their beta cells
What are some examples of rapid acting insulin? - ANSHumalog, Novalog, Apidra
What is the onset, peak, and duration of rapid acting insulin? - ANSOnset: 15 minutes
Peak: 1 hour
Duration: 2-4 hours
What are some examples of short acting insulin? - ANSRegular insulin (Humulin R, Novolin R)
What is the onset, peak and duration of short acting insulin? - ANSOnset: 30 min- 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
What are some examples of intermediate insulin? - ANSNPH (Humulin N, Novolin N)
What is the onset, peak, and duration of intermediate insulin? - ANSOnset: 1-2 hours
Peak: 6-12 hours
Duration: 24 hours
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