AGACNP Barkley Review: Combined TEST | 628 questions with Complete Solutions
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Course
Barkley
Institution
Barkley
What is the management for a migraine headache? - Ans 1. Avoidance of trigger factors
(very impt)
2. relaxation/stress mgt
3. PPX daily if attacks occure >2-
3x/month -amitryptyline(Elavil) -
divalproex(Depakote) -
propanolol(Inderal) -Imipramine(Tofranil)
-clonodine(Catapres)
AGACNP Barkley Review: Combined
TEST | 628 questions with Complete
Solutions
What is the management for a migraine headache? - Ans 1. Avoidance of trigger factors
(very impt)
2. relaxation/stress mgt
-topiramate(Topamax)
-gabapentin(Neurontin)
-methysergide(Sansert)
-magnesium
***not an inclusive list**
What is the management for an acute attack of migraine headache? - Ans 1. rest in dark, quiet
room
2. simple analgesic (ASA) taken right away may provide some relief
3. Sumatriptan(Imitrex) 6mg SQ at onset, may repeat in 1hr (total of 3x/day)
4. Sumatriptan 25mg PO at onset of headache
Cluster headaches affect mostly __________? - Ans middle-aged men, very painful syndromes
What are the causes/incidence of cluster headaches? - Ans - *middle-aged men*
,- often no FMHx of headache or migraine
- may be *precipitated by alcohol ingestion*
- characterized by *severe, unilateral, periorbital pain* occurring daily for several weeks
- usu *occurs at night, awakening the pt from sleep*
- usu *lasts <2 hours*
- usu pain free for weeks or months b/w attacks
- *ipsilateral nasal congestion, rhinorrhea, & eye redness may occur*
What are the physical exam findings in cluster headache? - Ans - usually normal exam, may see
*eye redness, rhinorrhea, ipsilateral nasal congestion*
What is the management for cluster headache? - Ans - *100% of O2*
- *sumatriptan (Imitrex) 6mg SQ*
- *ergotamine* tartrate aerosol inh (Ergostat)
- tx of indiv attacks w/ oral drugs are usu unsatisfactory
What does albumin level of <3.5 indicate? - Ans Protein malnutrition
Albumin normal - 3.5 to 5
How low does the albumin level when you can expect to see edema? - Ans albumin level of
<2.7g/dL
A hgb of <12g/dL for women & <13.5g/dL for men can indicate lack of iron or protein resulting
in _____________? - Ans inadequate oxygen perfusion
What is the H/H ratio & threshold to transfuse? - Ans H/H 1:3 ratio
,Hgb of 8, HCT of 24 - transfuse, don't discharge without giving 2 units of PRBC
What is the earliest indication of malnutrition? - Ans Pre-albumin
Why do women have lower H/H than men? - Ans Testosterone promotes erythropoiesis
which is why women have lower Hgb
If a patient has an ashened skin color, what could this indicate? - Ans Folic acid deficiency
Describe the nutritional support decision tree? - Ans **Can you use the GI tract?
*NO* => need total parenteral nutrition (TPN) => need support for >2 weeks?
- Yes => use central vein (esp dextrose >10%)
- No => use peripheral vein (<10% dextrose)
*YES* => need supplements for >6 weeks?
- Yes => use enterostomal tube (Peg, J-tube)
- No => use nasoenteric tube
=> is the patient at risk for aspiration?
-Yes => use duodenal tube (DHT) or nasoduodenal tube (NDT)
-No => use nasogastric tube
What the are complications of ENTERAL nutritional support? - Ans *Enteral = Solution*
Aspiration
Diarrhea (dumping or refeeding syndrome)
, Dehydration
Emesis
GIB
Hypernatremia
Mechanical obstruction of the tube
What the are complications of PARENTERAL nutritional support? - Ans *Parenteral = Mode
of Delivery*
PTX
Hemothorax
Arterial laceration
Air emboli
Catheter thrombosis
Catheter sepsis
Hyperglycemia
HHNK
Hyponatremia is the most common electrolyte abnormality. What are the steps in evaluation
of hyponatremia? - Ans 1. I&O (Hypervolemic, hypovolemic, euvolemic) = if I&O is equal,
euvolemic
Urine sodium >20 mEq/L suggests what? - Ans Urine Na >20 suggests renal salt wasting
(i.e., problem with the kidneys)
Urine sodium <10 mEq/L suggests what? - Ans Urine Na <10 suggests renal retention of sodium
to compensate for extrarenal fluid losses (i.e., a problem other than the kidneys)
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