NR511 MIDTERM EXAM STUDY GUIDE GRADED A

NR 511 Midterm Study Guide (75 questions over week 1-4) General Study Tips and Recommendations Topics and content on guides are intended to focus student attention when reading/studying and some topics may be repeated in multiple chapters. Multiple test items are derived from the same topic areas to encourage deeper comprehension. Students must have a broad understanding of content and not simply memorize passages in textbooks or articles. Information contained in the chapters as well as boxes and table within the chapters may include test items. Exam questions represent various levels of cognitive learning. You are expected to analyze, synthesis, and evaluate patient scenarios in order to answer the questions. Students are expected to use clinical decision making to prioritize treatment actions based on the information provided in the exam question. Read all of the answers BEFORE reading the stem of the question. This will help you focus on the key content and not get distracted by extraneous information. Once you have selected your answer, read the question one more time to ensure that the best answer has been chosen. Utilize your time well by not rushing. You will have plenty of time to read each question for understanding before you select your final answer. Chapter 4 The Art and Diagnosis of Treatment • Specificity and sensitivity of a diagnostic study (see course lesson) o Specificity: if it is high= high % of results normal, if low then a high number of false (+) o Sensitivity: is the % of true (+), if high= (+) with patients with disease • What is the patient history in terms of documentation? subjective • Where in the chart is OLD CARTS used? Pain under subjective Chapter 5 Evidence-based Practice • Sources that NPs use to help with clinical decision-making (i.e. evidence-based research, clinical practice guidelines) Chapter 10 Infectious and Inflammatory Neurological Disorders (p. 131-134) • Assessment and diagnosis of herpes zoster o Caused by varicella-zoster characterized by painful rash with blisters o Characterized by a unilateral vesicular rash along a dermatome, most commonly a thoracic or lumbar dermatome. The rash begins as erythema, then changes to popular lesions that rapidly form vesicles. The vesicles rupture, releasing infectious fluid, and then form scabs o Unexplained pain may be tingling/stabbing, along a dermatome, unilateral vesicular rash o Diagnosis with H&P if unsure then can-do PCR assay and antibody titer Chapter 11 Common Skin Complaints • Dry skin: older adults at risk o Teachable moment: encourage the use of tepid water and mild cleansing cream or soap • Assessment and diagnosis of common skin complaints o Rash, alopecia= baldness, vitiligo= loss of color, chloasma= mask of pregnancy • Health teaching for patients with pruritus (itching sensation with urge) • Treatment of urticaria (inflammation) find the cause and stop exposure o Look at the location of the rash; the first step is to determine the need for epinephrine; look for respiratory symptoms, difficulty breathing, hoarseness; look at location of rash; is it on the neck, around the face, etc.; if it is, epinephrine must be administered o Sometimes all choices may seem correct; in that case, the question is prompting you to prioritize your NP actions. Look for what should be done first. o Give 2nd Gen H1 Antihistamines, usually hydroxyzine o Avoid ASA, ACE inhibitors, and NSAIDs o Cholinergic urticaria are hives or wheals that are pruritic and occur on the trunk and arms following exercise, anxiety, elevated body temperature, hot baths, and showers ▪ Treated with antihistamines ▪ History taking is important in determining rash development Chapter 12 Parasitic Skin Infections • Assessment and diagnosis of common parasitic skin infections o scabies (mite called sarcoptes scabie) goes in web spaces, folds, ankles o intense itch worse at night o diagnose with history and assessment o can last several days or weeks o transmitted through direct contact • Pharmacological management of common parasitic skin infections o treatment is to treat the surroundings, use a lotion with scabicides like permethrin cream leave on 8-12 hours and repeat in 1 week • Health promotion and teaching for patients with common parasitic skin infections o Trim nails, do not overuse scabicides, may itch up to 1 week after treatment o Treat home with hot soapy water • Characteristics of scabies o Intraepidermal burrows, small 1-2mm, red papules, intense itching o Diagnosis of scabies is almost never made until hypersensitivity has occured • Differential diagnoses for scabies o Atopic dermatitis (Eczema), contact dermatitis, folliculitis (page 160) • Systemic treatment of scabies o Systemic gets corticosteroids for severe pruritus and ivermectin (stromectol) 200mcg/kg • Pediculosis-differentiating between lice and dandruff o Nits hallmark is that they are firmly cemented in place and therefore, do not slide easily on the hair shaft, compared to dandruff scales. Sebaceous plugs result from plugged oil glands on the scalp and (unlike nits) do not originate on the hair shaft o Pt education is essential when treating pediculosis: ▪ Itching may continue for up to a week after successful treatment because of the slow resolution of the inflammatory reaction caused by the lice infestation Chapter 13 Fungal Skin Infections • Assess: Papular rash, satellite lesions • Diagnosis is based on presentation; common type is candida albicans • Treatment is antifungal cream and pill • Tinea infections are classified by the location in the body: Type Assess Tinea vesicolor Flat to slightly elevated brown papules and plaques that scale when they are rubbed along with areas of hypopigmentation; pruritic; most commonly found on trunk and shoulders Balanitis Candidiasis in the glans of the penis Tinea Corporis Annual lesions with scaly borders and central clearing on the trunk; has ring-shaped lesions (ring worm) with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk.