AANP FNP Certification Final Exam Questions and Answers, Exams of Nursing

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AANP FNP CERTIFICATION FINAL EXAM

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All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM - Correct Answer III first time audible, IV first time thrill Fundal height 12 weeks - Correct Answer Fundal Height 12 weeks above symphysis pubis. EXAM Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US 3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - Correct Answer Iron, TIBC

3 months of synthroid, TSH increased, T4 normal, what do you do? - Correct Answer Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - Correct Answer Mini mental exam 4 month old with strabismus, mom is worried...... - Correct Answer tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - Correct Answer Growth chart 6 month old closed anterior fontanel. - Correct Answer XRAY Abnormal cells on PAP, what do you do next? - Correct Answer Refer for Colposcopy CAGE ACRONYM - Correct Answer Cut down Annoyed by criticism Guilty about drinking Eye opener drink

Causes of tachycardia - Correct Answer Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - Correct Answer CN 3,4, Definition of metabolic syndrome - Correct Answer cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - Correct Answer wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - Correct Answer Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - Correct Answer Anterior septum Definitive diagnosis of acute bacterial prostatitis - Correct Answer urinalysis and culture

GERD treatment - Correct Answer H2 is first line, give hs Grade 3 cells on Pap, treatment? - Correct Answer LEEP excision Fingernail hematoma treatment? - Correct Answer drill hole and drain blood? Increased risk of ectopic pregnancy - Correct Answer Salpingitis, or history of abortion, PID, Koplick spots - Correct Answer Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots - Correct Answer Measles (rubeola). Grains of salt lesions inside mouth in Measles Legg-Calve-Perthes Disease - Correct Answer Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - Correct Answer Pancreatitis

Low HGB, Low HCT, High MCV indicates what? - Correct Answer Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - Correct Answer Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - Correct Answer Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - Correct Answer Meniscus tears Lachman's Test - Correct Answer pivot shift test (ACL tear) Newborn with foot turned in, what do you do? - Correct Answer refer to orthopedist Osgood-Schlatter disease - Correct Answer Knee pain.

inflammation or irritation of the tibia at its point of attachment with the patellar tendon Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? - Correct Answer Alzheimer's Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - Correct Answer Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - Correct Answer Tinea Corporis Pt presents with "bag of worms:, indicates? - Correct Answer Varicocele Pt with atopic dermatitis, look for what other diseases? - Correct Answer Asthma Pt with bleeding after menopause - Correct Answer endometrial biopsy, need to screen for cancer

Pt with hx of PID, increased rick for? - Correct Answer Infertility Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? - Correct Answer This is good. Want higher than 350 Pt with hx of htn and stroke, now having memory loss. What does this indicate? - Correct Answer Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - Correct Answer slap cheek, PVB19, rash hands / feet Fetal death and birth defects Quick assessment of patients fall risk? Timed Get up and Go - Correct Answer Timed Get up and Go Red beefy tongue? - Correct Answer pernicious anemia Rotator cuff injury presentation - Correct Answer disturbs sleep, arm weakness, dull ache Shingles near eye - Correct Answer immediate referral to ophthalmology

Signs and symptoms of Roseola (6ths disease)? - Correct Answer Viral infection Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage

• Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash
• Seizures may occur during this period.
• On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs.
• High fever, pink flat or raised rash Treatment for chronic alcoholism: - Correct Answer 12 step program Treatment for Gonorrhea? - Correct Answer Rocephin 250mg IMx1 plus Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Report to health department Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - Correct Answer IUD

Basal cell cancer - Correct Answer Waxy, pearly, telangiectasia, ulcer center lesion

• most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - Correct Answer Scaly red to yellow located in sun exposed area
• a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - Correct Answer Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area
• a pre squamous cell carcinoma occurs on sun-damaged skin biopsy cryo or 5fu cream subungual hematoma tx - Correct Answer Make a hole and drain the blood Moderate acne treatment - Correct Answer Without inflammation: Topical retinoid

Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered) PLUS ADD Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne) Minocycline- long term use has been linked with pseudotumor cerebri Oral contraceptives for hormone related Spironolactone heart murmur with holosystolic or pan systolic Heart mumur with mid systolic - Correct Answer MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH

Coarctation of Aorta - Correct Answer COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs.

• congenital cardiac condition characterized by a narrowing of the aorta

Murmur Grade III - VI - Correct Answer Loud murmur easily heard JVD caused by - Correct Answer - tension pneumothorax,

• Rt. sided heart failure,
• cardiac tamponade,
• traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - Correct Answer endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles.

Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - Correct Answer PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI<0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment - Correct Answer Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - Correct Answer >5 mm in an immunocompromised patient or close contact

10 mm in immigrant, health care workers, drug user 15 mm in a patient who lives in an area where TB is very rare. what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - Correct Answer Croup/Epiglottitis

AV nicking (Arterioles pressing on vein of the eye) - Correct Answer HTN retinopathy intraocular pressure (IOP) - Correct Answer Fluid pressure inside the eye; measured with tonometry Rovsing sign - Correct Answer pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - Correct Answer Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma - Correct Answer SDH migraine headache - Correct Answer - paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4 - 12 hours,

abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate Vitamin B12 - Correct Answer Folate shares a close relationship with this other B Vitamin. Vitamin B12 - Correct Answer Cognitive deficits, glossitis, pernicious anemia, Folate shares a close relationship with this other B Vitamin. 88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. - Correct Answer be changed to NSAID, SED rate is a sign of inflammation Which medication causes low sperm count for a patient - Correct Answer SSRI grandiosity - Correct Answer Exaggerated belief in or claims about one's importance or identity. Bipolor

ADHD - Correct Answer A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity. pt. pap's smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? - Correct Answer HPV test if not done. Refer for colposcopy Chlamydia trachomatis - Correct Answer Doxycycline (+ ceftriaxone for gonorrhea coinfection) Genital warts treatment - Correct Answer Cryotherapy OR Podophyllotoxin cream - OR Imiquimod (Aldara cream) HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. - Correct Answer tell the pt. that he is qualified to be diagnosed with AIDS according to CDC

Most common cause of death in children - Correct Answer motor vehicle Tanner 2 - Correct Answer Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 - Correct Answer Tanner 4- female nipples and areola become elevated from breast, secondary mound Male penis grows wider grows in length, darker scrotum pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. - Correct Answer vascular dementia presbycusis - Correct Answer a gradual loss of sensorineural hearing that occurs as the body ages a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - Correct Answer Ultrasound Romberg test - Correct Answer cerebellar

• ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed

• expected finding: client should be able to stand with minimal swaying for at least 5 seconds Direct Coombs test - Correct Answer r/o bilirubin preeclampsia treatment - Correct Answer bed rest, laying on her side Molluscum contagiosum treatment - Correct Answer Currettage, liquid nitrogen pyloric stenosis - Correct Answer non bilious vomiting, olive like firm mass palpated on right upper quadrant horizontal nystagmus that stops when eye is close to midline in a college student - Correct Answer Meniere's disease? Nystagmus test - Correct Answer the involuntary jerking of the eyes as a person gazes to the side eating, painful lump noted on the jaw that comes and go. - Correct Answer sialolithiasis).

Etopic Pregnancy: Risk Factors - Correct Answer Previous ectopic pregnancy Prior fallopian tube surgery Previous pelvic or abdominal surgery Certain sexually transmitted infections (STIs) Pelvic inflammatory disease Endometriosis cigarette smoking age older than 35 years history of infertility use of assisted reproductive technology, such as in vitro fertilization (IVF) Which among the list can cause increase in respiration - Correct Answer Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration - Correct Answer hypercapnia Osteoporosis Risk Factors (ACCESS) - Correct Answer A-lcohol Use

C-orticosteroid Use C-alcium low E-strogen low S-moking S-edentary lifestyle/s ACCESS leads to OSTEOPOROSIS to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct - Correct Answer VITAMIN D 600-800, CALCIUM 1000-1200. OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION. LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH Carotid bruit - Correct Answer abnormal flow of blood through the carotid artery Carotid bruit - Correct Answer abnormal flow of blood through the carotid artery due to atherosclerotic disease

Common causes of GERD - Correct Answer risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil Common causes of GERD - Correct Answer risk factors- alcohol, anticholinergic, CCB, BB chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline Zeprexa. What lab and intervention to put in place - Correct Answer CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose

Weber test - Correct Answer Sensorineural loss Weber test(top of head) no laterization, normal finding, does not lateralize to either ear, bilateral hearing loss, if hear better in left ear, right sensorineural loss Weber test - Correct Answer Sensorineural loss Weber test (top of head) no laterization- normal, does not lateralize to either ear- bilateral hearing loss, if hear better in left ear, right sensorineural loss. SUN- sensorial lateralize unaffected ear CAFFE- Conductive lateralize to affected ear Assessment on patient with ascites - Correct Answer Dullness Assessment on patient with ascites - Correct Answer Dullness to percussion Varus Stress Test - Correct Answer application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL Varus Stress Test - Correct Answer TEST LCL (lateral-vaRus)

McMurrays- Meniscus CLICK application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL German Measles (Rubella) - Correct Answer Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots. patient with IOP of 32mmHg, what do you expect during fundoscopic exam - Correct Answer patient with IOP of 32mmHg, what do you expect during fundoscopic exam - Correct Answer increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence - Correct Answer anticholinergics/oxybutynin, impamine/tricyclic/antidepressant

Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH BPH and urge incontinence - Correct Answer TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - Correct Answer a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - Correct Answer telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS intussusception - Correct Answer telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS CURRENT JELLY STOOL IBS (irritable bowel syndrome) - Correct Answer An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation.

due to Small intestinal bacterial overgrowth, or SIBO IBS (irritable bowel syndrome) - Correct Answer SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool. Caused by: Small intestinal bacterial overgrowth, or SIBO TX fiber, avoid gas foods, antispasmodics, decrease life stress Osteoporosis treatment - Correct Answer TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth Statins increase bone mineral density Osteoporosis treatment - Correct Answer TX BIOPHOSPHATES alendronate, Fosamax, CALCIUM 500 mg, vitamin D food and supplementation, testosterone, WT BEARING EXERCISE

CAUCASIAN and ASIAN affected most RISK PPI, STATIN, STEROIDS, THYROID, Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth BONE DENSITY >2.5 Retinoblastoma - Correct Answer white reflection in child's pupil for staph aureus infection (skin) with pus - Correct Answer MRSA- TX Bactrim or tetracyclines? hyperparathyroidism - Correct Answer high calcium Hyperthyroidism treatment - Correct Answer methimazole, PTU- propylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers