N314 2026 Midterm 1 Study Guide

What are the goals of medicine?

to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress.

Determinants of Health

Biology and genetics

Individual behavior

Social environment

Health services

Physical environment

BI-SHP

Mammogram and Papsmear are examples of what type of test?

Screening test

What is an example of preventive medication?

Birth Control

At what age do we start cervical screening?

21 years old

At what age do we start colon cancer screening?

45 years old

What is included in clinical preventive services?

1. Screening tests

2. Behavior change counseling

3. Preventive medications

4. Information/education

What does the USPSTF Recommendation grade A mean?

Recommended by USPSTF

Substantial benefit

What does the USPSTF Recommendation grade B mean?

Recommended by USPSTF

Moderate to substantial benefit

What does the USPSTF Recommendation grade C mean?

Selective / Depends on circumstances

Small benefit

What does the USPSTF Recommendation grade D mean?

D - Don't do it

No net benefit or the harms outweigh the benefits

What does the USPSTF Recommendation grade I mean?

I - Insufficient evidence

Lacking evidence, cannot determine benefit

Colorectal screening is an example of what grade for ages 45-49?

Grade B

Colorectal screening is an example of what grade for age 50-75?

Grade A

Cervical screening is an example of what grade?

Grade A

Starts at Age 21

30-65 y/o > Rec. Screening Q3yrs. Q5yrs for hrHPV

HTN screening for 18+ w/o hx of HTN is an example of what grade?

Grade A

Unhealthy drug use screening 18+ is an example of what grade?

Grade B

Depression and Suicide Risk is an example of what grade?

Grade B

Prostate cancer is an en example of what grade for men aged 55-69?

Grade C

Prostate cancer is an example of what grade for men 70+

Grade D

Aspirin use for adults aged 40-59 years old with > 10% CVD risk is an example of what grade?

Grade C

Skin cancer screening is an example of what grade?

Grade I

What grade are companies that try to advertise benefits on their product?

Grade I

- Needs clinical trial

EKG screening for Adults at low risk of CVD events is an example of what grade?

Grade D

What is primary prevention?

1. Health promotion

2. Specific protection

Stage: Pre-disease

What is secondary prevention?

1. Pre-symptomatic diagnosis

2. Treatment

Stage: Pre-symptomatic disease

What is tertiary prevention?

1. Disability limitation for early symptomatic disease

2. Rehabilitation for late symptomatic disease

Stage: Symptomatic disease

What is an EXAMPLE of primary interventions?

Health promotion, action before disease onset

Ex: Immunizations, Hand Hygiene, Exercise, safety of drugs/foods

What is an EXAMPLE of secondary interventions?

Restore health before irreversible damages

Ex: Screening tests, regular exams, low-dose meds

What is an EXAMPLE of tertiary interventions?

Disease has advanced, goal is to reduce/limit disease progression

Ex: Wound care, support groups, rehab, chronic disease management, pharmacological interventions

What is the CA Nurse Practice Act?

Defines the scope of practice, standards for education programs, licensure requirements, and grounds for disciplinary actions. The law provides a framework for establishing nursing actions in the care of clients.

TLDR: decision-making authority, set laws, standards, requirements, and regulations for nurses in CA

What are the 3 types of nurse practice functions?

Independent

Dependent

Interdependent

What are the Independent Functions of Nurses?

Basic care, safety, protection, personal hygiene, and protection of Pt

comfort, disease prevention, and restorative measures. Skin tests, immunization, blood draws, and monitoring the patient

What are the Dependent Functions of Nurses?

Administer meds/treatment by order of the Physician

What are the Interdependent Functions of Nurses?

Collaborative decision among nurses & healthcare professionals to decide the best care of Pt.

What grade?

Substantial benefit and is recommended

A

What grade?

Moderate to substantial benefit and is recommended

B

What grade?

Selective / Depends on circumstances

Small benefit

C

What grade?

No net benefit or the harms outweigh the benefits

D

What grade?

Insufficient evidence

Lacking evidence, cannot determine benefit

I

What are the data entry points to use the ASCVD Risk Estimator?

SAR - THL - DS - SBP - AS

- Sex, Age, Race

- Total Cholesterol, HDL Cholesterol. LDL Cholesterol

- Diabetes, Smoker: Yes or No, Former

- Systolic BP, Treatment for High BP

- On Aspirin Therapy or Statins

10-year risk of ASCVD for what age range?

40 to 75 y/o | Routinely

Lifetime / 30-year ASCVD risk for what age range?

20 to 39 y/o

40-59 y/o who have less than 7.5% 10yr ASCVD risk

What is the formula to calculate LDL?

- On midterm

3/4 (TC-HDL)

What are the primary / top 4 known risk factors for ASCVD?

HTN, Smoking, High Cholesterol, Diabetes

How do you obtain an accurate BP?

Patient positioning

- Seated, arm heart level, legs uncrossed

Cuff size

- Width 40% of arm circumference

- Bladder encloses at least 2/3 of the adult, or all for peds

Palpate, align cuff, palpate until pulsation stops, inflate cuff to 30mmhG above where it stopped, slowly deflate

What are the major lifestyle interventions to reduce CVD risk?

Heart Healthy Diet: Replace saturated fats w/ dietary monounsat. & polyunsat fats, avoid trans fat

Reduce cholesterol & sodium

Reduce processed meats and refined products

Total Exercise (150 moderate or 75 min rigorous)

+ Weight loss

Low in sodium is how many mg/day?

1000-1500

After eating, walking for 5-10 minutes does what to your insulin sensitivity?

Increases insulin sensitivity

Clinically meaningful weight loss is __% of initial weight?

5%

What does stomach fat do to our insulin resistance?

Increases insulin resistance

What are the key recommendations to manage overweight & obesity in adults?

- weight loss (≥ 5% initial weight)

- calorie restriction

- diet & nutrition

What is the difference between overweight and obese?

> EXPAND

BMI, waist circumference

Underweight BMI?

< 18.5

Normal BMI?

18.5-24.9

Overweight BMI? Risk level?

25-29.9

If waist circumference:

M < 40 & F < 35in | Increased risk

M > 40 & F > 35 | High Risk

Obesity (Class 1) BMI? Risk level?

30-34.9

Waist circumference:

M < 40 & F < 35in | High

M > 40 & F > 35 | Very High

Obesity (Class 2) BMI? Risk level?

35-39.9

Waist circumference:

M < 40 & F < 35in | Very High

M > 40 & F > 35 | Very High

Extreme Obesity (Class 3) BMI? Risk level?

40+

Waist circumference:

M < 40 & F < 35in | Extremely High

M > 40 & F > 35 | Extremely High

What are the 'at risk' numbers in male waist circumference?

≥ 40 inches in males

What are the 'at risk' numbers in female waist circumference?

≥ 35 inches in females

Less than 200 mg/dL total cholesterol?

Desirable

200-239 mg/dL total cholesterol?

Borderline High cholesterol

240+ mg/dL total cholesterol?

High cholesterol

What is LDL?

low-density lipoprotein (bad cholesterol)

The higher the value, the worse

What is HDL?

high-density lipoprotein (good cholesterol)

The higher the value, the better

Less than 100mg/dL LDL?

Optimal LDL

What is less than < 70 mg/dL LDL considered?

Desirable

Unless you are at a young age, because that will cause hormone issues.

100-129 mg/dL LDL is?

Near optimal/above optimal

130-159 mg/dL LDL is?

Borderline High LDL

160-189 mg/dL LDL is?

High LDL

190+ mg/dL LDL is?

Very High LDL

Less than 40mg/dL HDL is?

A major risk factor for heart disease | HDL

40-59 mg/dL HDL is?

Near optimal

60+ mg/dL HDL is?

Considered protective against heart disease

How to improve BP readings?

No talking, BP cuff on bare skin, empty bladder, support arm at heart level, support back, keep legs uncrossed, and support feet.

Small Adult arm circumference?

22-26 cm

Adult arm circumference?

27-34 cm

Large Adult arm circumference?

35-44 cm

Adult Thigh circumference?

45-52

Trick to remember arm circumference

8-10-8

Remember: starting value 22 and end value 52.

Add one at the ending values to start next category then just add 8, 10, 8 for ending values

22 to 26

+8 = 34

27-34

+10 = 44

35-44

+8 = 52

45-52

If you have a small PT with a big cuff, what happens to BP?

Decrease BP

If you have a big PT with a small cuff, what happens to BP?

Increase BP

What is systolic pressure?

Max pressure in the arteries during ventricular contraction

What is diastolic pressure?

Pressure in the arteries during cardiac relaxation

What is a normal BP?

Both Less than 120/80 mmHg

What is an elevated BP?

Sys: 120-129

AND

Dia: Less than 80

What is High Blood Pressure (HTN Stage 1)?

S: 130-139

OR

D: 80-89

What is HTN Stage 2?

S: 140+

OR

D: 90+

What is a hypertensive crisis?

S: 180+

and/or

D: 120+

Describe the DASH diet

Dietary Approaches to Stop Hypertension

- rich in potassium, magnesium, & calcium.

- high in whole grains, fruits, veggies,

- low fat dairy, nuts, seeds

Non-pharmacological interventions to reduce BP

Weight loss, heart health diet, sodium reduction, dietary potassium supplements, exercise, and limit alcohol

What are the recommended non-pharmacological interventions to reduce BP?

Heart-healthy diet

Reduce sodium intake

Limit alcohol

Statin benefit groups

1. Clinical Atherosclerotic Cardiovascular Disease (ASCVD)

2. LDL-C ≥ 190 mg/dL, Age ≥ 21 years

3. Statin use for primary prevention

Risk factors for CVD

Diabetes, HTN, smoking, and Dyslipidemia

- Dyslip: LDL-C > 130 mg/dL or HDL-C < 40 mg/dL

Are statins indicated for 76+ y/o with no history of CVD? (USPSTF)

No, grade I

What is a Grade B example for statin use?

Low to moderate dose statin for:

Adults 40-75 yrs w/ no hx of CVD

Calculated 10-yr CVD event risk ≥10% and ≥ 1 CVD risk factor

How do statins work?

inhibit HMG-CoA reductase, which controls cholesterol production in the liver

> Statins replace the HMG-CoA in the liver, which SLOWS DOWN THE CHOLESTEROL PRODUCTION PROCESS

What is an example of a statin?

Lipitor (Atorvastatin)

How many intensity levels for statins?

Low, Moderate and High intensity