NSG 6420 WEEK 3 QUIZ

NSG 6420 WEEK 3 QUIZ

Week 3 Return to deck 1. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis 2. The pulmonary component includes an abnormal inflammatory response to noxious stimuli, principally tobacco, but also occupational and environmental pollutants. The hallmark of chronic bronchitis is a daily chronic cough with increased sputum production lasting for at least 3 consecutive months in at least 2 consecutive years, usually worse on awakening; this may or may not be associated with COPD (GOLD, 2011). Emphysema is characterized by obstruction to airflow caused by abnormal airspace enlargement distal to terminal bronchioles. Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 206) 3. A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal. Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be? Observation and reassurance Treatment with an antibiotic such as amoxicillin Treatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanate Combination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler. 4. A previously healthy 24 year old man presents at a clinic in Southern New England ten days after a weekend camping trip. He reports the appearance of a painless skin lesion on his right thigh five days previously. He now notes malaise, low-grade fever, and migrating joint pain of 48 hours duration. Careful questioning fails to elicit any recent history of an insect bite. The lesion on the thigh had begun to fade, but you recognize an area of central clearing with an erythematous margin. Further examination reveals a second, similar lesion near the right axilla. Question: The patient referred to in the scenario returns three days later complaining of worsening weakness and lightheadedness. His pulse is 42 and his pressure in the supine position is 90/40. You quickly obtain an EKG, which reveals third degree heart block. The best management at this point would include: A) Add oral cefuroxime 500mg po bid to his antibiotic regimen. B) Stop all antibiotics immediately and administer Benadryl 50mg intramuscularly stat. C) Administer atropine 1mg intravenously, observe the patient for 4 hours and discharge if he remains stable. D) Admit the patient for cardiac monitoring and begin intravenous ceftriaxone 2g per day. E) Stop all antibiotics immediately and admit the patient for electrophysiological studies. The correct answer is: D About 8% of patients with Lyme disease will develop cardiac involvement, usually some form of atrioventricular block. Patients with third degree heart block should be treated with intravenous ceftriaxone until the heart block resolves and then complete a 30-day course of oral antibiotics. The development of neurological symptoms also requires treatment with intravenous antibiotics. Ref: ID/ Harrison's 16, p. 996, 998/ RAL 5. . When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: No palpable vibration is felt Decreased fremitus is felt Increased fremitus is felt Vibration is referred to the non-obstructed lobe Instructor Explanation: Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. Conversely, areas of decreased fremitus raise the suspicion of abnormal fluid- or air-filled spaces, such as occurs with pleural effusion, pneumothorax, or emphysema. In the instance of an extensive bronchial obstruction, no palpable vibration is felt in the related field. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 209) & Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file. (page 193) 6. Your patient presents with complaint of persistent cough. After you have finished obtaining the History of Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The most common cause of cough with wheezing is asthma. What of the following physical exam findings will support your tentative diagnosis of asthma? Clear, watery nasal drainage with nasal turbinate swelling Pharyngeal exudate and lymphadenopathy Clubbing, cyanosis and edema. Diminished lung sounds with rales in both bases