SARAH MICHELLE LIVE REVIEW STUDY
GUIDE (COMPLETE) QUESTION & ANSWERS
GUARANTEE PASS!!!
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 - CORRECT ANSWER -- 4. The tuning
fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? - CORRECT
ANSWER -- Vertigo, tinnitus, ear pressure, nystagmus
What is our biggest worry for a Meniere's Disease patient? - CORRECT ANSWER --
There is a possibility for a potential, permanent hearing loss.
What is rhinitis meidcamentosa? - CORRECT ANSWER -- Drug-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? - CORRECT ANSWER -- This is an infection of the cornea
due to herpes simplex virus
How is herpes keratitis diagnosed? - CORRECT ANSWER -- By 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? - CORRECT ANSWER -- Hodgkin'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? - CORRECT ANSWER
-- Patient with chronic lung diseases: asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? - CORRECT
ANSWER -- Because 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? -
CORRECT ANSWER -- Around 8 week mark
What is COPD? - CORRECT ANSWER -- Chronic 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? - CORRECT ANSWER --
Chronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? - CORRECT
ANSWER -- Neurological symptoms, paresthesia (numbness and tingling in hands
and feet), unsteady gait, memory issues
Beefy red tongue
What diet can result in B12 deficiency? - CORRECT ANSWER -- Vegan- oral
supplements can be used for treatment
What surgery can result in B12 deficiency? - CORRECT ANSWER -- Gastric
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? - CORRECT ANSWER -- Women
of childbearing age- ages 15-45, African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? - CORRECT ANSWER -- Must 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? - CORRECT ANSWER --
Dry 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? - CORRECT
ANSWER -- Impact 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? - CORRECT ANSWER -- Viral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? - CORRECT ANSWER -- Pituitary gland
What is the function of TSH? - CORRECT ANSWER -- Tells your thyroid when to
produce and release those critical thyroid hormones- T3 and T4.
What disorders include hypothyroidism? - CORRECT ANSWER -- Iodine deficiency,
Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? - CORRECT ANSWER -
- Hypothyroidism is caused by an autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? - CORRECT ANSWER --
Weight 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? -
CORRECT ANSWER -- Must be taken on an empty stomach before other
medications
What are signs and symptoms of a myxedema coma? - CORRECT ANSWER -- Low
body temperature, edema, confusion, lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? - CORRECT ANSWER --
Lithium 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? - CORRECT ANSWER -- Assess how the patient is taking their
Synthroid
What signs and symptoms are common in hyperthyroidism? - CORRECT ANSWER
-- Anxiety, 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? - CORRECT
ANSWER -- Need 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? - CORRECT ANSWER --
Radioactive iodine therapy
Hyperthyroidism left untreated may lead to what conditions? - CORRECT ANSWER
-- Heart 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? - CORRECT ANSWER --
Thyroid 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? - CORRECT
ANSWER -- Biguanides (Metformin)
DPP-4 inhibitors
GLP-1 Agonists
SGLT-2 inhibitors
Insulin
Sulfonylureas
TZDs
Alpha-glycosides inhibitors
Why are type 1 diabetics insulin dependent? - CORRECT ANSWER -- They have an
autoimmune destruction of their beta cells
What are some examples of rapid acting insulin? - CORRECT ANSWER -- Humalog,
Novalog, Apidra
What is the onset, peak, and duration of rapid acting insulin? - CORRECT ANSWER
-- Onset: 15 minutes
Peak: 1 hour
Duration: 2-4 hours
What are some examples of short acting insulin? - CORRECT ANSWER -- Regular
insulin (Humulin R, Novolin R)
What is the onset, peak and duration of short acting insulin? - CORRECT ANSWER
-- Onset: 30 min- 1 hour
Peak: 2-4 hours
Duration: 6-8 hours
What are some examples of intermediate insulin? - CORRECT ANSWER -- NPH
(Humulin N, Novolin N)
What is the onset, peak, and duration of intermediate insulin? - CORRECT
ANSWER -- Onset: 1-2 hours
Peak: 6-12 hours
