BARKELY 3P EXAM WITH RATIONALE

BARKELY 3P EXAM WITH RATIONALE

Which of the following statements is true regarding contraceptives?

a. Because oral contraceptives may cause harm to the fetus, they are pregnancy category X drugs in pregnancy.

b. Oral contraceptives are linked to the promotion of ovarian, endometrial, and breast cancer.

c. By increasing angiotensin and aldosterone, oral contraceptives may increase blood pressure.

 d. Oral contraceptives may reduce the effects of theophylline, benzodiazepines, and tricyclic antidepressants - answer-c. By increasing angiotensin and aldosterone, oral contraceptives may increase blood pressure.

estrogen promotes aldosterone production= sodium retention & HTN. Also believed stimulates hepatic production of angiotensinogen, affecting renal system via elevated angiotensin & BP. OCP are category X, but because serve no use, decrease incidence of ovarian and endometrial ca and don't increase risk of breast ca. OCP containing progestin may enhance effects of theophylline, benzos, and tricyclic antidepressants by decreasing clearance.

Upon percussion of the chest, you notice hyperresonance. Of the following choices which would most likely be the cause?

a. Atelectasis

b. Normal Lung

c. Pneumothorax

d. Pulmonary embolism - answer-c. Pneumothorax

What is the proper order of steps to accurately perform the Ortolani maneuver?

a. Extend the legs, adduct the legs, and abduct the knees

b. Flex the knees, abduct the knees, and adduct the legs

c. Flex the knees, adduct the legs, and abduct the legs

d. Extend the knees, abduct the legs, and adduct the knees - answer-b. Flex the knees, abduct the knees, and adduct the legs

 done on supine infant, flex knees while holding thighs. Adduct legs until thumbs touch, follow with abduct knees until lateral part of knee touch table.

You have four patients who all have a family history of developing coronary heart disease at an early age. According to their blood test results, which patient would most likely develop coronary heart disease first?

a. Cholesterol: 170; LDL: 120; Triglycerides: 120; HDL: 45

b. Cholesterol: 195; LDL: 110; Triglycerides: 135; HDL: 30

c. Cholesterol: 170; LDL: 100; Triglycerides: 140; HDL: 20

d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 - answer-d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50

3 of the 4 measurements are above what should be; HDL <40 in men & 50 in women increase risk, LDL aim is <130, Chol > 200 & trig >150 attributed to increase risk heart disease.

This low-molecular-weight heparin is indicated for use with warfarin for the treatment of acute symptomatic deep vein thrombosis, either with or without pulmonary embolism:

a. Nadroparin

b. Dalteparin

c. Tinzaparin

d. Fondaparinux - answer-c. Tinzaparin-

can be combined with warfarin for DVT, aids warfarin in inhibiting clotting of blood. Nadroparin & Dalteparin don't use w/ warfarin, use independently. Fondaparinux is a Xa inhibitor NOT LMWH.

he main reason for discontinuance of implanted etonogestrel (Nexplanon) is:

a. Weight gain

b. Pregnancy

c. Breast tenderness

d. Irregular bleeding - answer-d. Irregular bleeding

For the treatment of relapsing-remitting multiple sclerosis, the nurse practitioner knows that:

a. First-line therapy typically involves an immunomodulator

b. Natalizumab is one of the safest drugs to use as initial therapy

c. A patient using interferon-beta products would have to have renal function monitored.

d. Fingolimod is given intravenously for patients with resistant remitting-relapsing multiple sclerosis. - answer-a. First-line therapy typically involves an immune modulator

 therapy begins with interferon-beta products (fingolimod, glatiramer, natalizumab) which are immune modulator. Natalizumab limited (assoc w/ infections in brain) are used if others don't work. Meds are hepatotoxic and need liver function monitoring. Fingolimod is 1st ORAL disease modifying med approved for MS.

You are auscultating Jon's chest. When he sits up and leans forward, you can hear a high pitched, blowing murmur at S2. What does this type of murmur most likely indicate?

a. Mitral stenosis

b. Aortic Stenosis

c. Mitral regurgitation

d. Aortic regurgitation - answer-d. Aortic regurgitation

Aortic regurg is soft, high pitched, blowing diastolic decrescendo that best heard at the 3rd left interspace at base. Murmur initiated w/ S2 and heard when Pt sits up and leans forward. Mitral Stenosis= low pitched diastolic rumble & doesn't radiate. Best heard in apex when in left lateral position. Aortic stenosis= loud, harsh murmur midsystole, radiated down the side of neck and down apex. Mitral regurg= loud blowing murmur heard at apex and is pansystolic.

Which of the following is the most common clinical manifestation of osteoporosis?

a. Bone deformity

b. Bone pain

c. Pathologic fracture

d. Fat embolism - answer-a. Bone deformity

most common metabolic bone disease, is chronic, progressive, & systemic; Low bone mass and deterioration of bone tissue, = leads to increased skeletal fragility & deformity. Osteoporosis usually not apparent until AFTER a fracture; 2/3 of vertebral fractures are painless. Fat embolism from fat obstruction d/t injury or trauma & not common in osteoporosis.

A male patient requests a phosphodiesterase inhibitor to treat erectile dysfunction. Which of the following is appropriate?

 a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week.

b. Vardenafil (Levitra), 5 mg, may be taken with a high-fat meal four hours before sexual activity

c. Sildenafil (Viagra), 50 mg, may be taken one hour before sexual activity as long as the patient has a resting blood pressure below 170/110 mm Hg

d. Avanafil (Stendra) is recommended at 50 mg for all patients, and may be taken 30 minutes before sexual activity. - answer-a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week.