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 ANS: - III first time audible, IV first time thrill Fundal height 12 weeks - CORRECT ANS: - 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 ANS : - Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - CORRECT ANS : - Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - CORRECT ANS : - Mini mental exam 4 month old with strabismus, mom is worried .. - CORRECT ANS: - tell her it is

normal. 4 month old wont keep anything down, what is the main thing you look at? - CORRECT ANS: - Growth chart 6 month old closed anterior fontanel. - CORRECT ANS : - XRAY Abnormal cells on PAP, what do you do next? - CORRECT ANS : - Refer for Colposcopy CAGE ACRONYM - CORRECT ANS : - Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia - CORRECT ANS: - Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - CORRECT ANS : - CN 3,4, Definition of metabolic syndrome - CORRECT ANS : - cluster of conditions that increase risk of heart disease, stroke, diabetes.

diagnose trichomoniasis - CORRECT ANS: - wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - CORRECT ANS : - Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - CORRECT ANS: - Anterior septum Definitive diagnosis of acute bacterial prostatitis - CORRECT ANS : - urinalysis and culture GERD treatment - CORRECT ANS : - H2 is first line, give hs Grade 3 cells on Pap, treatment? - CORRECT ANS: - LEEP excision Fingernail hematoma treatment? - CORRECT ANS : - drill hole and drain blood? Increased risk of ectopic pregnancy - CORRECT ANS : - Salpingitis, or history of abortion, PID, Koplick spots - CORRECT ANS : - Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots - CORRECT ANS: - Measles (rubeola). Grains of salt lesions

inside mouth in Measles Legg-Calve-Perthes Disease - CORRECT ANS : - Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - CORRECT ANS : - Pancreatitis Low HGB, Low HCT, High MCV indicates what? - CORRECT ANS : - Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - CORRECT ANS: - Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - CORRECT ANS: - Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - CORRECT ANS : - Meniscus tears Lachman's Test - CORRECT ANS : - pivot shift test (ACL tear) Newborn with foot turned in, what do you do? - CORRECT ANS: - refer to orthopedist

Osgood-Schlatter disease - CORRECT ANS : - 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 ANS: - 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 ANS: - Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - CORRECT ANS: - Tinea Corporis Pt presents with "bag of worms:, indicates? - CORRECT ANS: - Varicocele Pt with atopic dermatitis, look for what other diseases? - CORRECT ANS: - Asthma Pt with bleeding after menopause - CORRECT ANS: - endometrial biopsy, need to screen for cancer Pt with hx of PID, increased rick for? - CORRECT ANS: - Infertility Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? - CORRECT ANS: - This is good. Want higher than 350

Pt with hx of htn and stroke, now having memory loss. What does this indicate? - CORRECT ANS: - Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - CORRECT ANS: - slap cheek, PVB19, rash hands / feet Fetal death and birth defects Quick assessment of patients fall risk? Timed Get up and Go - CORRECT ANS: - Timed Get up and Go Red beefy tongue? - CORRECT ANS: - pernicious anemia Rotator cuff injury presentation - CORRECT ANS: - disturbs sleep, arm weakness, dull ache Shingles near eye - CORRECT ANS: - immediate referral to ophthalmology Signs and symptoms of Roseola (6ths disease)? - CORRECT ANS: - 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 ANS: - 12 step program Treatment for Gonorrhea? - CORRECT ANS: - 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 ANS: - IUD Basal cell cancer - CORRECT ANS: - Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - CORRECT ANS: - Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - CORRECT ANS: - 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 ANS: - Make a hole and drain the blood Moderate acne treatment - CORRECT ANS: - 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 ANS: - MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH Coarctation of Aorta - CORRECT ANS: - 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 ANS: - Loud murmur easily heard JVD caused by - CORRECT ANS: - -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 ANS: - 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 ANS: - 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 ANS: - Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - CORRECT ANS: - >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 ANS: - Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) - CORRECT ANS: - HTN retinopathy

intraocular pressure (IOP) - CORRECT ANS: - Fluid pressure inside the eye; measured with tonometry Rovsing sign - CORRECT ANS: - pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - CORRECT ANS: - 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 ANS: - SDH migraine headache - CORRECT ANS: - -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 ANS: - Folate shares a close relationship with this other B Vitamin.

Vitamin B12 - CORRECT ANS: - 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 ANS: - be changed to NSAID, SED rate is a sign of inflammation Which medication causes low sperm count for a patient - CORRECT ANS: - SSRI grandiosity - CORRECT ANS: - Exaggerated belief in or claims about one's importance or identity. Bipolor ADHD - CORRECT ANS: - 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 ANS: - HPV test if not done. Refer for colposcopy

Chlamydia trachomatis - CORRECT ANS: - Doxycycline (+ ceftriaxone for gonorrhea coinfection) Genital warts treatment - CORRECT ANS: - 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 ANS: - tell the pt. that he is qualified to be diagnosed with AIDS according to CDC Most common cause of death in children - CORRECT ANS: - motor vehicle Tanner 2 - CORRECT ANS: - Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 - CORRECT ANS: - 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 ANS: - vascular dementia presbycusis - CORRECT ANS: - 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 ANS: - Ultrasound Romberg test - CORRECT ANS: - 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 ANS: - r/o bilirubin preeclampsia treatment - CORRECT ANS: - bed rest, laying on her side Molluscum contagiosum treatment - CORRECT ANS: - Currettage, liquid nitrogen pyloric stenosis - CORRECT ANS: - 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 ANS: - Ménière's disease?

Nystagmus test - CORRECT ANS: - 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 ANS: - sialolithiasis). Etopic Pregnancy: Risk Factors - CORRECT ANS: - 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 ANS: - Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration - CORRECT ANS: - hypercapnia Osteoporosis Risk Factors (ACCESS) - CORRECT ANS: -

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 ANS: - 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 ANS: - abnormal flow of blood through the carotid artery Carotid bruit - CORRECT ANS: - abnormal flow of blood through the carotid artery due to atherosclerotic disease Common causes of GERD - CORRECT ANS: - 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 ANS: - 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 ANS: - CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose Weber test - CORRECT ANS: - 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 ANS: - 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 ANS: - Dullness Assessment on patient with ascites - CORRECT ANS: - Dullness to percussion Varus Stress Test - CORRECT ANS: - 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 ANS: - 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 ANS: - 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 ANS: - patient with IOP of 32mmHg, what do you expect during fundoscopic exam - CORRECT ANS: - increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence - CORRECT ANS: - 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 ANS: - TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - CORRECT ANS: - a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - CORRECT ANS: - 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 ANS: - 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 ANS: - 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 ANS: - 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 ANS: - 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 ANS: - 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 ANS: - white reflection in child's pupil for staph aureus infection (skin) with pus - CORRECT ANS: - MRSA- TX Bactrim or tetracyclines? hyperparathyroidism - CORRECT ANS: - high calcium Hyperthyroidism treatment - CORRECT ANS: - methimazole, PTU-

propylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers Mammography Screening - CORRECT ANS: - -Age 45 - 54 yearly mammogram -55 and older every 2 years Fifth's Disease (Erythema Infectiosum) - CORRECT ANS: - B19: lytic infection, respiratory transmission Sx: flushed rash/fever in kids Px: fever, get better in a week pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - CORRECT ANS: - TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. chlamydia in pregnancy - CORRECT ANS: - Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM papilledema - CORRECT ANS: - optic disc swollen w/ blurred edges due to increased ICP EXAM

actinic keratoses - CORRECT ANS: - Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM Allergic Conjunctivitis - CORRECT ANS: - "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD - CORRECT ANS: - COPD- Gold 1-2- SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN CN IX Glossopharyngeal - CORRECT ANS: - - Shoulder shrug/ ROMBERG test EXAM

CN V Trigeminal - CORRECT ANS: - Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear - CORRECT ANS: - ears 8 EXAM CN VII Facial - CORRECT ANS: - BELLS EXAM ACEI contraindicated - CORRECT ANS: - pregnancy Safe to give varicella/MMR - CORRECT ANS: - Do not give <12 mo. EXAM QUESTION Acne Vulgaris - CORRECT ANS: - common acne. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide. Acne Rosacea - CORRECT ANS: - - chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM Cataracts - CORRECT ANS: - is on EXAM in elderly night vision issues. Opaque Kawasaki disease - CORRECT ANS: - - acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin.