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AANP-FNP TEST exam new latest version 2024-2025 best studying material, Exams of Nursing

AANP-FNP TEST exam new latest version 2024-2025 best studying material withWITH RATIONALES AND verified answers graded A WITH 100+ QUESTIONS

Typology: Exams

2024/2025

Available from 09/04/2024

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AANP-FNP TEST exam new latest

version 2024-2025 best studying

material with WITH RATIONALES AND

verified answers graded A WITH 100+

QUESTIONS

What is the recommended daily folic acid supplementation during a normal pregnancy? A. 1,000 mcg B. 250 mcg C. 400 mcg D. 500 mcg

  • ANSWER C. 400 mcg For normal pregnancies, the daily recommendation of folic acid is 400 mcg (C). Folic acid is an important supplement during pregnancy to ensure the fetus develops normally neurologically. Folic acid is found in prenatal vitamins and should ideally be started 1 month before conception. Folic acid is necessary to prevent defects in the closure of the neural tube during development

of the central nervous system that occurs in the third and fourth weeks of fetal gestation. It is difficult to ingest the recommended dosage via diet alone, so supplementation must occur via vitamins. A 25-year-old patient presents to the clinic for contraceptive counseling. She asks the nurse practitioner if combined oral contraceptives increase the risk of cancer. Which of the following is the most appropriate response by the nurse practitioner? A. "Combined oral contraceptives increase the risk of developing colorectal cancer" B. "Patients who take combined oral contraceptives may have a slightly higher risk of cervical and breast cancer" C. "There is no increased risk of cancer associated with combined oral contraceptives" D. "Use of combined oral contraceptives may increase your risk of endometrial and ovarian cancer"

  • ANSWER B. "Patients who take combined oral contraceptives may have a slightly higher risk of cervical and breast cancer" The most appropriate response by the nurse practitioner is that patients who take combined oral contraceptives (COCs) may have a slightly higher risk of cervical and breast cancer (B). The link between these medications and cancer risk has been researched with large observational studies. Although an increased risk of cervical and breast cancer is associated with COCs, research demonstrates this risk decreases over time after a patient stops taking the medication.A COC is a medication used to prevent pregnancy that contains estrogen and

progesterone. These medications suppress gonadotropin-releasing hormone, follicle-stimulating hormone, and luteinizing hormone to prevent ovulation. COCs are also associated with an increased risk of venous thromboembolism and hypertension. Rare risks of severe cardiovascular disease, including myocardial infarction and stroke, are associated with this contraceptive medication class. Which medication would be appropriate for symptom relief for hyperthyroidism?

  • ANSWER Atenolol (tenormin) What finding is consistent with benign prostatic hyperplasia during a digital rectal exam? - ANSWER An enlarged, smooth, and rubbery prostate Viral PNA caused by?
  • ANSWER influenza viruses Bacterial PNA caused by?
    • ANSWER Atypical - Mycoplasma pneumonia "walking pneumonia" Typical - Streptococcus pneumonia (classic symptoms) When should a CXR be followed up after being treated for PNA with ABX?
  • ANSWER 8 weeks fasting blood glucose (FBG)
    • ANSWER 100-125 pre dm

125 DM oral glucose tolerance test - ANSWER 140 - 149 pre dm

200 DM

random BG test

  • ANSWER > 200 with symptoms A 78-year-old man presents to the clinic for a follow-up after an emergency department visit for acute bronchitis. He reports he did not fill his discharge prescriptions because he could not pay for them. The man states, "My grandson borrowed my debit card last month for an emergency and hasn't returned it." Which of the following types of elder mistreatment might this indicate? A. Emotional abuse B. Exploitation C. Neglect D. Self-neglect
  • ANSWER B. Exploitation Exploitation (B) is the illegal or improper use of an older adult's funds, property, or assets. In cases of confirmed sexually transmitted infections, which of the following diseases does not require co-treatment for the sexual partner?

A.

Bacterial vaginosis B. Chlamydia C. Gonorrhea D. Trichomoniasis

  • ANSWER A. Bacterial vaginosis Partners of those with bacterial vaginosis (A) do not need treatment as it is not a sexually transmitted infection. Bacterial vaginosis, or BV, is a condition in which the pH of the vagina changes due to external factors, thus allowing for the overgrowth of anaerobic vaginal bacteria. Bacterial vaginosis can present with a white, fishy-smelling vaginal fluid, and patients should be educated about its true source. Rocky Mountain Spotted Fever
  • ANSWER Treat with Doxycycline regardless of age or pregnant What test is considered the gold standard for the diagnosis of HIV? A. Antinuclear antibody test

B.

Enzyme-linked immunosorbent assay test C. Nucleic acid test D. Rapid plasma reagin test

  • ANSWER C. Nucleic acid test The nucleic acid test (C) is the preferred confirmatory test for clients with suspected HIV. Mini-cog tool - ANSWER Used to assess patients for dementia. A negative screen is 3 to 5, while a positive screen is 0 to 2. A 63-year-old man with a medical history of Lyme disease presents to the clinic for left leg pain that has been going on for the last few weeks. He states the pain feels like an electric shock down his left leg and into his foot. He also notes a burning, numb, and tingly sensation in the left foot intermittently. Which of the following is the most appropriate therapy? A. Amitriptyline B. Methotrexate C.

Naproxen D. Phenelzine

  • ANSWER A. Amitriptyline Amitriptyline (A) is a tricyclic antidepressant that is used to treat a variety of psychiatric and neurological diseases. It is a first-line agent to treat neuropathic pain because of its analgesic properties. Treatment is often multi-disciplinary and should target the root cause of neuropathy. Physical and occupational therapy are commonly recommended for people with neuropathic pain to help with functional goals. Antihistamine medications are contraindicated for use as a first-line treatment for older adults due to an increased risk of side effects. Consider a situation where an older adult reports no therapeutic effect from a recommended first-line treatment option for allergic rhinitis and the nurse practitioner is now considering an antihistamine trial. Which of the following antihistamines is most appropriate for this patient? A. Azelastine (Astelin) B. Cetirizine (Zyrtec) C. Diphenhydramine (Benadryl) D. Loratadine (Claritin)
    • ANSWER A.

Azelastine (Astelin) Azelastine (A) is an antihistamine nasal spray for allergic rhinitis that is an appropriate choice for an older adult who reports lack of a therapeutic effect from a first-line agent. Antihistamine nasal sprays are preferred over oral formulations in older adults due to lower risk of systemic side effects A 12-year-old boy in sixth grade has a history of attention-deficit/hyperactivity disorder. His inattention and hyperactivity have improved on long-acting methylphenidate (Ritalin), but his parent reports that he has been persistently irritable for the entire school year. His reactions to disagreements with his classmates and teachers are out of proportion and usually proceed to meltdowns. At home, his mood is labile, ranging from being content to screaming over the slightest provocation. Recently, his parent noted that he has had a lot of difficulty sleeping, which she suspects might be contributing to his irritability. The school psychologist has suggested that the boy be evaluated for possible bipolar disorder. What additional detail of the boy's clinical history would most support a diagnosis of bipolar disorder? A. He forgets to take his medication, talks excessively, and shifts from one topic to another B. Ov - ANSWER B. Over the past few weeks, he has slept about 4 hours per night without being drowsy during the day A persistent decreased need for sleep (B) would be the symptom most suggestive of bipolar disorder. Bipolar disorder is a mental disorder that is characterized by unusual shifts in mood, energy, and activity levels that are severe enough to cause overall dysfunction. A decreased need for sleep for several nights should raise suspicion for bipolar disorder. A 24-year-old woman presents for her routine Pap smear. Her last Pap smear was performed 3 years ago and resulted with normal findings. Upon cervical exam, you notice an erythematous cervix with some purulent discharge around the cervical os. She states she has been having unprotected sex with more than one partner and was last tested for sexually transmitted

infections a couple of years ago. Based on this information and these clinical findings, what would be the priority test to order today? A. HIV-1/2 antibody/antigen assay test B. Nucleic acid amplification test C. Rapid plasma reagin D. Venereal disease research laboratory - ANSWER B. Nucleic acid amplification test Nucleic acid amplification testing (B) on vaginal swabs (preferred for female patients) or urine (preferred for male patients) is the recommended screening test for chlamydia, gonorrhea, and trichomoniasis. These sexually transmitted infections (STIs) commonly present with no symptoms, which is why cervical exams are so valuable. Female patients may experience vaginal discharge, intermenstrual bleeding, and postcoital bleeding. Male patients sometimes experience urethritis but can also transmit infection with no symptoms. On cervical exam, the practitioner may see classic findings of cervicitis, including mucopurulent endocervical discharge, friability, and ectropion. Which DM med is cardioprotective? - ANSWER (SGLT2) inhibitor - e.g. Canagliflozin (A) is a sodium-glucose cotransporter 2 that is used in the treatment of diabetes mellitus. It has cardioprotective features and is recommended for patients with type 2 diabetes mellitus and atherosclerotic heart disease or heart failure because they hinder progressive cardiovascular and kidney disease. SGLT2 inhibitors include medications such as empagliflozin and dapagliflozin. These are oral medications taken once daily that increase the excretion of

glucose in the urine, which reduces serum glucose concentration and may increase weight loss. This class of medications needs to be avoided in patients prone to urinary tract infections and genital infections, as they can be exacerbated or become more frequent. A 74-year-old woman presents to the office for an annual physical exam. She is accompanied by her children who voice concerns about their mother's memory. A Mini-Cog test is administered, and the results show possible Alzheimer disease. The nurse practitioner understands that Alzheimer disease is associated with which of the following neurologic pathologies? A. Deposits of beta-amyloid plaques and neurofibrillary tau protein tangles B. Ischemic damage due to atherosclerotic plaques, bleeding, or blood clots C. Loss of dopamine receptors in the basal ganglia D. Widespread demyelination of nerve fibers in the gray matter - ANSWER A. Deposits of beta-amyloid plaques and neurofibrillary tau protein tangles Alzheimer disease (AD) is characterized by deposits of beta-amyloid plaques and neurofibrillary tau protein tangles (A) in the brain. The true cause of AD is unknown, but a genetic predisposition is suspected. AD makes up for 60-80% of all forms of dementia. It should be distinguished from age-related cognitive impairment and other causes of dementia, including Lewy body disease and vascular dementia. AD should also be distinguished from delirium and other reversible causes of cognitive decline, such as infection, autoimmune disease, metabolic imbalances, substance use, or depression.AD is most common in older women. Risk factors include smoking, hypertension, hyperlipidemia, tobacco use, and stroke. Other modifiable risk factors include excessive alcohol consumption, poor quality sleep, less than eighth grade

education, later life depression, and lack of social engagement. Imaging and testing for biomarkers (beta-amyloid plaques and tau protein) can be helpful for diagnosis. A 75-year-old man presents to the clinic for a follow-up on his recently diagnosed Parkinson disease. He reports that he is having difficulty zipping his winter coat. Which of the following terms best describes this symptom? A. Bradykinesia B. Postural instability C. Rigidity D. Tremor - ANSWER A. Bradykinesia Bradykinesia (A) is the slowing of movement that is present early in the onset of Parkinson disease. It may sometimes be described as incoordination, weakness, and tiredness in movement. Bradykinesia impacts the patient's ability to perform basic daily tasks, such as zipping a zipper, double-clicking a computer mouse, buttoning clothes, tying shoelaces, or picking up coins from a pocket. A patient who uses intravenous drugs presents to the clinic today with a new murmur that was not noted on his last two visits. The nurse practitioner suspects a possible diagnosis of infective endocarditis, as the patient is also presenting with chills and a low grade fever. The nurse practitioner knows which of the following heart valves is the most likely to be affected by intravenous drug use?

A.

Aortic B. Mitral C. Pulmonic D. Tricuspid - ANSWER D. Tricuspid Infective endocarditis usually refers to infection of one or more heart valves or it could indicate infection at a surgically placed intracardiac device. Among intravenous drug users, approximately 50-70% of infective endocarditis cases affect the tricuspid (D) heart valve, making it the most commonly affected valve. Infective endocarditis infecting the tricuspid or pulmonic valves is best classified as right-sided native valve infection. Up to 90% of patients with right- sided infective endocarditis use intravenous drugs. Which of the following pharmacologic data are incorrect with regard to the antiviral medication acyclovir (Zovirax)? A. Black, tarry stools are a possible adverse reaction B. Laboratory evaluation of kidney function should be assessed prior to prescribing this medication

C.

Medication dose adjustments are not needed for hepatic impairment D. Oral, topical, and intravenous formulations are available - ANSWER A. Black, tarry stools are a possible adverse reaction Black tarry stools are not an identified adverse reaction of acyclovir (A). Acyclovir is generally well tolerated, but systemic formulations may cause mild gastrointestinal side effects such as nausea, vomiting, or diarrhea.Acyclovir is considered the first-line treatment for herpes simplex virus, herpes zoster, and varicella. It is also commonly used as an adjunct therapy to corticosteroids in new-onset, severe cases of Bell palsy. Other possible side effects of acyclovir include headache, dizziness, and malaise. Neurotoxicity is a rare but severe adverse effect and may manifest as confusion, altered level of consciousness, or agitation. Oral acyclovir may be administered without regard to food. Patients should be advised to ensure adequate hydration and monitor for a decrease in urinary output. Treatment for H. Plyori - ANSWER Triple therapy CAP - Clarithromycin, Amoxicillin, and PPI Quad therapy PP,I tetracycline, Flagyl, and Bismuth cholesteatoma can affect what crania nerve? - ANSWER CN VII HPV-6 and HPV- 11 - ANSWER genital warts HPV 16 and 18 - ANSWER cervical cancer

Pap smear start at what age? - ANSWER 25 and every 5 years What if you receive a LSIL and HSIL (low and high grade lesions) result on pap smear? - ANSWER Refer out for colposcopy Postiive HPV? - ANSWER Refer out for colposcopy Gardisil vaccine recommended at what age?q - ANSWER age 11 Treatment for genital warts - ANSWER TCA acid or cyrotherapy What is non-hormonal contraception? - ANSWER Copper IUD, IUD, Depo-Provera, progestin- only pill (mini pill) What birth control increases risk of osteoporosis? - ANSWER Depo-provera injection (do not use for > 5 years) Which birth control cannot be used for patients with migraines with aura? - ANSWER Combined contraceptives (the estrogen puts pt at risk for increase risk of clot and stroke) Contraindications for combined contraceptives? - ANSWER Age > 35 hx of clot liver disease smoker current cancer uncontrolled HTN migraines with aura not ideal for breast feeding women

What if women calls and has missed two pills? What education do you give them? - ANSWER take the most recent pill asap, and get rid of any other missed pills and use a back up method. CIN 2 and 3 - ANSWER Receive HPV co-testing regardless of age ASCUS (atypical squamous cells of undetermined significance) - ANSWER Receive HPV co-testing regardless of age Which SSRI helps with menopausal symptoms e.g. hot flashes and night sweats? - ANSWER Paroxetine (Paxil) What herbal supplement helps with menopause? - ANSWER Black cohosh maybe even gingko (remember gingko makes you more likely to bleed) Soy isoflavones Evening primrose oil hormone replacement therapy (HRT) increases what kind of cancer? - ANSWER Ovarian cancer Topical estrogen can help with? - ANSWER Improves dryness, UTI protection, and does not carry same cancer risk) With PCOS what kind of cancers are at increased risk? - ANSWER Ovarian and endometrial cancers What type of psych meds increase risk of galactorrhea? - ANSWER Atypical antipsychotics, e.g olanzapine (zyprexa)

what lab do you draw for galactorrhea? - ANSWER Prolactin (because a prolactinoma may be cause of galactorrhea, if it is this- you refer) Presumptive pregnancy signs - ANSWER Felt by patient = amenorrhea, N & V, breast sensitivity, fatigue, urinary frequency Probable signs of pregnancy - ANSWER blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign Positive signs of pregnancy - ANSWER audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of fetus Fundal height during pregnancy - ANSWER Weeks Pregnant 12 - Barely palpable above pubic symphysis 15 - Midpoint between pubic symphysis and umbilicus 20 - At the umbilicus 28 - 6 cm above the umbilicus 32 - 6 cm below the xyphoid process 36 - 2 cm below xyphoid process 40 - 4 cm below xiphoid process When do you screen for gestational diabetes? - ANSWER 24-28 weeks

200 = gestational DM When do you screen for group b step in pregnancy? and what happens if you are positive? - ANSWER 36-37 weeks (vaginal/rectal swab), if positive you receive IV penicillin during labor If the baby is Rh+ and the mother is Rh- when does mother receive RhoGAM? - ANSWER Mother will receive RhoGAM 72 hrs postpartum

When do we do AFP (alpha feta protein) testing? - ANSWER Around 16 weeks (15-20 weeks) What does it mean when AFP is high or low? - ANSWER High = possible spina bifida Low = downs syndrome down syndrome has increased risk for what diseases? - ANSWER hypothyroidism, alzheimers disease, cervical spine instability Placenta abruption - ANSWER premature separation of the placenta from the wall of the uterus happens in the third trimester Emergency! Painful and uterus hard to touch placenta previa - ANSWER implantation of the placenta over the cervical opening less serious light and painless vaginal bleeding pelvic rest monitoring with ultrasound typically resolves Complications of endometriosis - ANSWER ovarian cancer and infertility Rotterdam criteria - ANSWER PCOS What hormones are no longer produced in the ovaries in menopause? - ANSWER Estrogen and progesterone

Complications of menopause? - ANSWER Increase cardiovascular risk and osteoporosis mammograms - ANSWER ages 50-74 twice per year for prevention/early detection recommended folic acid intake for pregnant women - ANSWER 400 mcg/daily recommended folic acid intake for pregnant women with hx of neural tube defect? - ANSWER 4,000 mcg/day Category X meds - ANSWER Accutane, methotrexate, statins, fluoroquinolones, ACE inhibitors Naegele's Rule - ANSWER add 9 months and 7 days to LMP preterm labor - ANSWER labor before 37 weeks Preeclampsia: what is it? how do we treat? - ANSWER abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, visual changes, epigastric pain, and headache Tx: Delivery of baby Listeria - ANSWER foodborne bacterial infection that can lead to preterm delivery and stillbirth in pregnant women. Screening for postpartum? - ANSWER Edinburg Postnatal Depression Scale Xulane patch has highest risk of what? - ANSWER blood clot

Menopause NO UTERUS - ANSWER estrogen only Menopause with UTERUS - ANSWER estrogen and progestin combo - to prevent endometrial hyperplasia and cancer Fibromyalgia "treat your CELF" - ANSWER cymbalta elavil lyrica flexiril When on allopurinol what lab do you want to make sure you monitor? - ANSWER CBC d/t it can cause bone marrow supression DEXA SCAN VALUES - ANSWER Normal > - 1. Osteopenia - 1.0 to - 2. Osteoporosis < - 2.5 (e.g. - 3.5, - .4, etc.) DMARDS can lead to what anemia? - ANSWER Folate def. anemia e.g. meds - methotrexate and plaquenil The American Cancer Society's cervical cancer screening guidelines are relied upon by nurse practitioners. Which of the following statements is incorrect regarding human papillomavirus (HPV) screening and Pap smears? A. Due to the fact that HPV tests are so reliable, they do not have to be repeated as often as Pap smears B.

Pap smears are responsible for drastic decreases in cervical cancer rates C. Pap smears have a higher sensitivity than HPV tests when it comes to accuracy D. There have been studies that prove HPV testing is more reliable than Pap smears - ANSWER C. Pap smears have a higher sensitivity than HPV tests when it comes to accuracy According to the American Cancer Society, HPV testing is more sensitive and specific compared to the Pap smear (C). The HPV test is a screening measure that detects infection by high-risk types of HPV. It can be conducted alone or with the Pap test, which is also known as a cotest. A 43-year-old Black patient with a history of osteoporosis and peripheral arterial disease presents to the clinic for a follow-up on elevated blood pressure readings. At the previous visit 3 months ago, the nurse practitioner discussed lifestyle modifications and implementation of a blood pressure log. Home blood pressure readings from the last 4 days are 135/92 mm Hg, 136/86 mm Hg, 140/84 mm Hg, and 139/88 mm Hg. Which of the following plans would be most beneficial for this patient? A. Continue lifestyle modification B. Initiate chlorthalidone (Thalitone) C. Initiate lisinopril (Prinivil)

D.

Initiate metoprolol (Lopressor) - ANSWER B. Initiate chlorthalidone (Thalitone) Since the patient has a history of peripheral arterial disease and has already attempted 3 months of lifestyle interventions, medication initiation is warranted. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), thiazide diuretics, and calcium channel blockers are all recommended therapies in the treatment of hypertension. The American Heart Association (AHA) and the American College of Cardiology (ACC) offer race- specific recommendations only for Black patients. Patients without heart failure or chronic kidney disease and who do not require two-drug therapy should be prescribed a thiazide diuretic, such as chlorthalidone (B), or a calcium antagonist. Black patients with heart failure or chronic kidney disease should be prescribed an angiotensin receptor blocker.Determining the blood pressure threshold for the initiation of antihypertensive therapy is complicated. Clinicians must consider the patient's age, comorbidities, atherosclerotic cardiovascular disease risk, and presence or absence of confirmed cardiovascular disease (CVD). Blood pressure reduction goals are based on protection against pressure-related CVD events. A normal blood pressure is < 120/80 mm Hg. An elevated blood pressure is 120-129 mm Hg systolic and < 80 mm Hg diastolic. Stage 1 hypertension is defined as 130-139 mm Hg systolic or 80-89 mm Hg diastolic. Stage 2 hypertension is defined as ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic. This patient requires drug initiation since her blood pressure is consistently > 130/80 mm Hg. Which test offers the highest sensitivity for the evaluation of an anterior cruciate ligament tear? A. Anterior drawer test B. Lachman test C. McMurray test

D.

Valgus stress test - ANSWER B. Lachman test When a patient presents with an acute knee injury it is important to assess the stability of the four major ligaments of the knee (anterior cruciate ligament [ACL], posterior cruciate ligament [PCL], medial collateral ligament [MCL], and lateral collateral ligament [LCL]). The ACL is the most frequently injured knee ligament, and the Lachman test (B) is the most sensitive test to assess for ACL damage. A 32-year-old woman presents to the clinic with a persistent, worsening cough for 2 weeks. She reports coughing spells and states that it is difficult to stop coughing once it starts. The nurse practitioner suspects acute bronchitis due to pertussis because of a local outbreak. Which of the following is the most appropriate plan of care? A. Educate the patient about symptomatic relief B. Follow up in 1 week if the cough persists C. Prescribe azithromycin (Zithromax) D. Prescribe cephalexin (Keflex) - ANSWER C. Prescribe azithromycin (Zithromax)

Most cases of acute bronchitis are viral in nature and only require symptomatic relief. When patients have prolonged symptoms or the bronchitis is caused by Bordetella pertussis, antibiotics are necessary. Macrolides are the antibiotics of choice in the treatment of pertussis, so prescribing azithromycin (Zithromax) (C) is the most appropriate plan of care for this patient. She should be educated that while this will limit the spread of infection, it will not likely decrease the length of symptoms. The whooping cough will persist until the lungs are fully healed. Acute bronchitis is defined as inflammation of the trachea and major bronchi characterized by a cough that lasts 1-3 weeks without evidence of consolidation (e.g., pneumonia) or underlying cardiopulmonary disease. It is a self-limiting condition and is most often viral in origin. It is diagnosed based on the presence of an acute cough that can either be dry or productive. Patients may have dyspnea and wheezing. Cigarette smoking often causes more severe disease, and clinicians may consider undiagnosed asthma or COPD. A common myth among patients is that sputum that has color (e.g., green) requires antibiotics due to bacteria, but purulent sputum production is often a result of sloughing of the tracheal bronchial epithelium. Patients with a paroxysmal cough that lasts > 2 weeks should be suspected to have B. pertussis, especially in the presence of a community outbreak. This is rarely life-threatening, but diagnosis is important to reduce spread. A common symptom of acute bronchitis due to B. pertussis is post-tussive vomiting. If macrolides cannot be used in the treatment of pertussis, trimethoprim- sulfamethoxazole (Bactrim) can also be used. A nurse practitioner student is reviewing causes of community-acquired pneumonia with the preceptor. The preceptor notes that which of the following pathogens leads to the most overall deaths in patients with community-acquired pneumonia? A. Legionella pneumophila B. Mycoplasma pneumoniae C. Staphylococcus aureus

D.

Streptococcus pneumoniae - ANSWER D. Streptococcus pneumoniae Community-acquired pneumonia (CAP) is an infection of the lung tissue, which is responsible for gas exchange. CAP is acquired outside of the hospital setting. The most common pathogen of CAP is Streptococcus pneumoniae (D), which is also responsible for the most overall deaths in patients with CAP. A 26-year-old man presents with a left ankle sprain after sustaining a fall. He states that he rolled his ankle as he fell during a basketball game. The patient is unable to bear any weight on the ankle. Which of the following is the most appropriate management plan for this patient? A. Educate the patient to compress the ankle and tell him it will heal with rest, as this is likely a grade 1 sprain B. Instruct the patient to rest, ice, compress, and elevate the ankle and educate him about using NSAIDs as needed, as this is likely a grade 2 sprain C. Refer the patient to an orthopedic specialist, as this is likely a grade 3 sprain D. Refer the patient to the emergency department, as you are concerned for a grade 4 sprain - ANSWER C. Refer the patient to an orthopedic specialist, as this is likely a grade 3 sprain

Ankle sprains are the most common cause of ankle injury. There are three locations of ankle sprains: lateral, medial, and syndesmotic. Ankle sprains are graded based on the degree of ligament disruption. Grade 1 mild sprains involve stretching of a ligament with potential microscopic ligamentous tears. Grade 2 moderate sprains involve an incomplete tear of a ligament. Grade 3 severe sprains involve the complete ligament tear of a ligament. Inability to bear weight on the affected extremity is a sign of a grade 3 injury. Patients with grade 3 tears should be referred to an orthopedic specialist (C) for consideration of conservative versus surgical management. An otherwise healthy 6-month-old girl is brought to the clinic by a parent, who states the patient has been extremely fussy for the past 2 days and developed a fever of 100.4°F today. On physical exam, the nurse practitioner observes a well-appearing infant. A screening urinalysis and urine culture are obtained. Urinalysis results indicate a urinary tract infection. Urine culture results are pending. This is the infant's first urinary tract infection. What plan of care is most appropriate for this patient? A. Order a repeat urine culture in 48 hours B. Order a voiding cystourethrogram C. Prescribe antibiotics empirically and order a kidney and bladder ultrasound D. Refer the patient to the emergency department for evaluation - ANSWER C. Prescribe antibiotics empirically and order a kidney and bladder ultrasound Management of febrile urinary tract infection (UTI) in infants consists of prescribing antibiotics to empirically treat the infection and ordering a kidney and bladder ultrasound (C). Given that this infant otherwise appears well and has no named kidney anomalies or preexisting kidney