Acute Pancreatitis: Diagnosis and Management, Exams of Nursing

Download Acute Pancreatitis: Diagnosis and Management and more Exams Nursing in PDF only on Docsity! AANP BOARD CERTIFICATION Exam Questions From Past Exams With Detailed Correct Answers And Rationales (Verified Answers)| Already Graded A+ You are seeing a 34-year old woman in the office today. She has a long-standing history of alcohol abuse and presents with a 4-day history of mid-abdominal pain that radiates through to the back and remains relatively constant. This has been accompanied by nausea and three episodes of vomiting. Antacids have not helped her pain and symptoms. Her abdominal examination reveals slightly hyperactive bowel sound with upper abdominal tenderness. There is no localization or rebound. Her skin is moist and cool, blood pressure is 92/54 and pulse rate is elevated at 122 bpm. The most likely diagnosis is: acute gastroenteritis acute viral hepatitis acute pancreatitis acute alcohol toxicity Correct Answer: acute pancreatitis The most common risk factors for pancreatitis include gallstones and excessive alcohol use. Significant pain and volume constriction are common in patients with this condition. Mary Jane, a 50-year-old female tripped on a curb and fell. She suffered a Colles' fracture. You understand that a Colles' fracture is associated with a fall on which of the following? finger outstretched hand elbow thumb Correct Answer: outstretched hand Loss in continuity in the substance of a bone is called a fracture. A Colles' fracture is associated with a fall on an outstretched hand such as when a person tries to break a fall. A 16-year-old female adolescent is brought to the nurse practitioner's office by her mother, who is concerned about her daughter's recent weight loss. History reveals that the daughter was consistently in the 50th percentile for weight, but is now in the 10th percentile. The mother states that she is concerned that her daughter is purging herself after meals since she often goes to the restroom after eating and remains there for a long period of time. The daughter denies any self-induced vomiting, starvation or excessive activity. She does state that she jogs five miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment? 1. Electrolytes, fasting blood sugar 4. Streptococcus pneumoniae and Pseudomonas aeruginosa Correct Answer strep pneumo and haemophilus influenzae A child is being treated with methylphenidate (Ritalin) for attention-deficit disorder. The following are all side effects of Ritalin EXCEPT: 1. muscle cramps 2. mild irritability. 3. increased heart rate. 4. slight increase in growth velocity. Correct Answer slight increase in growth velocity A geriatric female presents for her annual examination. She has been on antihypertensive medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse practitioner is concerned about the patient's cardiac health risks, due her to weight and her waist circumference. According to the AHA guidelines, which of the following goals is expected for this patient? 1. Physical activity for 60 minutes daily, for a minimum of 6 days a week 2. Physical activity for 30 minutes daily, 7 days a week 3. Physical activity for 30 minutes daily, for a minimum of 5 days a week 4. Physical activity for 60 minutes daily, 7 days a week Correct Answer physical activity for 30 minutes daily, for a minimum of 5 days a week The management of COPD in the elderly is best guided by: 1. spirometry. 2. arterial blood gases. 3. radiologic imaging. 4. symptomatology. Correct Answer symptomatology A young, athletic adult presents with shoulder pain and inability to raise the arm above the shoulder. The most likely diagnosis is: 1. frozen shoulder syndrome. 2. cervical radiculopathy. 3. rotator cuff tear. 4. polymyositis. Correct Answer rotator cuff tear A 50-year-old male presents with bruises and abrasions on the left leg and forearm, claiming to have had a number of minor accidents at home and at work. The patient reports general feelings of depression, forgetfulness, and, despite the fact that he is regularly employed, a mounting collection of unpaid and overdue bills. In taking the patient's history, a significant pattern of parental alcohol abuse, stroke, TIA, and MI emerges. During questioning to elicit a more thorough diagnosis, the patient becomes hostile and leaves the clinic without further treatment. The most likely explanation for this behavior is: 1. Alzheimer's disease. 2. chronic alcoholism. 3. cancer. 4. carotid artery stenosis. Correct Answer chronic alcoholism A 28-year-old patient presents with profuse yellow vaginal discharge, odor, and local irritation. She reports completing a 7-day course of oral metronidazole (Flagyl), 500 mg b.i.d. 4 weeks ago. She has had multiple recurrences over the last 18 months. Microscopic examination reveals presence of clue cells. What is the most appropriate treatment intervention? 1. Oral metronidazole (Flagyl), 500 mg b.i.d., plus metronidazole vaginal gel (MetroGel), for 5 days 2. Treat both patient and partner(s) with oral metronidazole (Flagyl), 500 mg b.i.d., for 7 days 3. Metronidazole vaginal gel (MetroGel) twice weekly for 4 to 6 months 4. Treat patient with metronidazole vaginal gel (MetroGel) b.i.d. and partner(s) with tetracycline, 250 mg q.i.d., for 7 days Correct Answer Treat both patient and partner(s) with oral metronidazole (Flagyl), 500 mg b.i.d., for 7 days Which of the following is NOT an appropriate serving size of vegetables for a person on the ADA diet? 1 c romaine lettuce. ½ c steamed broccoli. 1 c cooked baby spinach. 1 c raw baby spinach. Correct Answer Correct Answer 1 c cooked baby spinach A serving of vegetables on the Mrs. Layden is a 56-year-old female patient who is complaining of facial pain that she says begins on the side of her mouth and then shoots up toward her ear. You suspect which of the following? cluster headaches facial migraine herpes zoster trigeminal neuralgia Correct Answer Correct Answer: trigeminal neuralgia Trigeminal neuralgia is a recurrent unilateral facial pain syndrome. It most often affects the maxillary division of the trigeminal nerve. Patients complain of pain on one side of the face and may have a small degree of numbness. What is the recommended level for LDL for healthy adults? <100 mg/dL. <130 mg/dL. >40 mg/dL. <200 mg/dL. Correct Answer Correct Answer: <100 mg/dL Expert panels have established several limits for lipid levels. For low density lipoprotein (LDL), the level is <100 mg/dL for adults. More that this amount places the individual at risk for cardiovascular disease. Your patient complains of constipation. Your examination reveals no flatus, abdominal distention, and an absence of bowel sounds. Which of the following is the most likely cause? bowel ischemia volvulus diverticular disease bowel obstruction Correct Answer Correct Answer: bowel obstruction Of the choices given, the most likely cause would be bowel obstruction. The client may also be experiencing vomiting. An abdominal radiograph would show free air. What is the purpose of certification for the Adult Nurse Practitioner? The purpose is to define a specific legal scope of practice determined by state statutes, boards of nursing, educational requirements, and common practice. The purpose is to protect the public by ensuring a minimum level of professional competence. The purpose is to assure the public that an individual has mastery of a body of knowledge and has acquired the necessary skills to function in a particular specialty. none of the above Correct Answer Correct Answer: The purpose is to assure the public that an individual has mastery of a body of knowledge and has acquired the necessary skills to function in a particular specialty. The purpose of scope of practice for ANPs is to define a specific legal scope of practice determined by state statues, boards of nursing, educational requirements, and common practice. The purpose of licensure for ANPs is to protect the public by ensuring a minimum level of professional competence. All of the following are true of informed consent except: It must be documented in the medical records that the patient has been informed of his or her healthcare options. This is the right of all competent adults who are over the age of 18 and the right of emancipated minors. The clinician has the duty to explain relevant information to the patient so that the patient can make an appropriate decision regarding the care to be provided. This consent will absolve the ANP from allegations of malpractice should it occur. Correct Answer Correct Answer: This consent will absolve the ANP from allegations of malpractice should it occur. The information of informed consent includes diagnosis, nature and purpose of proposed treatment or procedure, risks and benefits, prognosis, alternative methods of treatment or care with their risks and benefits, and the remote possibility of serious harm or complications. In myopia distance vision is poor and items can be seen better the closer they are. Upper airway disorders that mimic asthma include which of the following? vocal fold paralysis conversion disorder bronchiectasis eosinophilic pneumonia Correct Answer Correct Answer: vocal fold paralysis Patients who have atypical symptoms or poor response to asthma therapy may have a condition that mimics asthma. Of the choices given, vocal fold paralysis is an upper airway disorder. Conversion disorder is a psychiatric cause; bronchiectasis and eosinophilic pneumonia are lower airway disorders. Your elderly patient is bedridden and has developed pressure ulcers. There has been damage to the epidermis with blisters forming. The wound bed is pink in color. This would be a pressure ulcer of which of the following stages? stage II stage III stage IV unstageable Correct Answer Correct Answer: stage II Pressure ulcer staging ranges from I to IV plus unstageable or unclassified. This patient has a stage II pressure ulcer which is characterized by damage to the epidermis where blisters form and erupt into red shiny skin or shallow superficial ulcers. The wound be is pink to red in color. Hemoptysis may be the presenting symptom for many different diseases. If your 65-year-old male patient also has dyspnea and pleuritic chest pain along with the hemoptysis this is indicative of which of the following? pulmonary embolism bronchitis bronchogenic carcinoma alveolar hemorrhage syndrome Correct Answer Correct Answer: pulmonary embolism Hemoptysis along with dyspnea and pleuritic chest pain are indicative of pulmonary embolism. Bronchitis symptoms may include fever, cough, and bloody sputum. Bronchogenic carcinoma may present with chronic weight loss and a change in cough. Alveolar hemorrhage syndrome may be indicated by chronic dyspnea and minor hemoptysis. Glaucoma is primarily a condition in older adults. All of the following statements about glaucoma are true except: Glaucoma involves gradual, painless vision loss. Glaucoma can be cured with the proper treatment. Glaucoma is generally asymptomatic, especially in early stages. Glaucoma may lead to blindness if untreated. Correct Answer Correct Answer: Glaucoma can be cured with the proper treatment. This statement is not true. Glaucoma cannot be cured, but it can be treated with success pharmacologically and surgically. Subclinical hypothyroidism is characterized by all but which of the following? profound symptoms increased serum TSH concentrations normal free T4 normal free T3 levels Correct Answer Correct Answer: profound symptoms Subclinical hypothyroidism is characterized by increased serum TSH concentrations with normal free T4 and free T3 levels. It occurs in 10% to 15% of the general population. The presentation is nonspecific, and symptoms are usually subtle (not profound). Pulmonary angiograms are one of the most sensitive tools for diagnosis of pulmonary emboli. Through a catheter advanced into the pulmonary artery, contrast material is injected during rapid filming. Emboli appear as filling defect, or dark circumscribed areas, within the white vascular images of the artery. An older adult complains of sudden onset of dyspnea and coughing. Cough produces pink-tinged frothy sputum. tachycardia, pallor, and feelings of impending doom are also present. Of the following which is the most likely diagnosis? tuberculosis pulmonary embolus bronchitis COPD Correct Answer Correct Answer: pulmonary embolus Pulmonary embolus is characterized by all of the symptoms set forth in the question. Any condition that increases risk of blood clots will increase risk of PE. These patients have a history of atrial fibrillation, estrogens, surgery, pregnancy, long bone fractures, and prolonged inactivity. In terms of blood pressure control, in patients aged 60 years and older, treatment for hypertension should be started when SBP ≥ 150 and DBP ≥ 90 SBP ≥ 120 and DBP ≥ 90 SBP ≥ 110 and DBP ≥ 80 SBP ≥ 150 and DBP ≥ 80 Correct Answer Correct Answer: SBP ≥ 150 and DBP ≥ 90 In patients aged 60 years and older, treatment for hypertension should be started when SBP ≥ 150 and DBP ≥ 90. After initiation of pharmacological treatment, the patient should be reevaluated within a month. A patient has lost weight but swears she has been eating regularly. Which type of assessment would you use before making a definitive diagnosis? Nutrition. NGASR. Sleep. Psychosocial. Correct Answer Correct Answer: Nutrition. Poor body image may be related to a nutrition imbalance. There may also be other factors that affect the imbalance. A nutrition assessment will help determine the patient's attitude towards food. You are treating a patient with acute anxiety and she is having an acute attack in the office. The ANP has knowledge that the fastest relief of symptoms is: a TCA a beta-blocker a benzodizepine an SSRI Correct Answer Correct Answer: benzodiazepine The fastest relief of anxiety symptoms will occur with a benzodiazepine. The other choices list agents that will require multiple doses for results. With daily continued use of benzodiazepines, the anti-anxiety effect may become diminished. A geriatric patient with cardiovascular disease is in the office being counseled on lifestyle changes. The ANP knows that which of the following is the most important to include in this discussion? "Control your hypertension, stop smoking, maintain a normal weight, and exercise regularly." "Have a yearly physical examination, increase fiber in your diet, and exercise regularly." "Maintain a normal level of serum blood sugar and decrease cholesterol intake." Review of systems. Symptom assessment. Functional assessment. Objective assessment. Correct Answer Correct Answer: Review of systems In the review of systems, the patient tells the nurse in his or her own words what signs or symptoms he or she has experienced in various body systems. It is important that these be in a patient's own words to perform the most complete and accurate assessment. All of the following are typical changes to the gastrointestinal system that come with aging EXCEPT: decreased liver size decreased muscle tone in bowel increased absorption of calcium atrophy of salivary glands Correct Answer Correct Answer: increased absorption of calcium Decreased absorption of calcium is a common change that comes with aging, not increased absorption. Other gastrointestinal changes include: less efficient cholesterol stabilization and absorption, atrophy of taste buds, and slowing in esophageal emptying, among others. A 28-year-old female patient is in the office and is to undergo radioactive iodine treatment for Graves disease. The ANP is counseling her and understands that the mechanism of action of this treatment therapy is: alter the thyroid metabolic rate relieve distress caused by increased thyroid size destroy the overactive thyroid tissue reduce production of TSH Correct Answer Correct Answer: destroy the overactive thyroid tissue Graves disease is the most common form of thyrotoxicosis. Radioactive iodine is used for thyroid ablation to destroy the overactive thyroid tissue that causes the thyroid hormone dysfunction. Which of the following statements about falls in the elderly is least accurate? Black women are at higher risk for hip fractures than white women. The majority of deaths from falls are among people aged 65 years or older. Injuries from falls include head injuries, pelvic injuries, lacerations, and more. About 90% of hip fractures are due to falls. Correct Answer Correct Answer: Black women are at higher risk for hip fractures than white women. It is white women, not black women, who are at higher risk for hip fractures. Falls are one of the most common adverse events that threaten the quality of life of older adults. Falls among older adults are not a normal consequence of aging. Normal age-related changes of the skin may be confused with which of the following clinical abnormalities? dehydration vitiligo scabies shingles Correct Answer Correct Answer: dehydration Normal age-related changes of the skin may be confused with dehydration. Sebaceous gland activity tends to decrease with age, and the skin's natural hydrators decline over the years. The skin's ability to regenerate lipids compromising the protective lipid barrier layer of the Stratum Corneum also declines with age, as does blood flow to the skin, which may cause a drop in sebum production. A 29-year old woman who is 6 weeks postpartum reports she is having rectal bleeding that she believes is related to hemorrhoids. The Adult Nurse Practitioner knows that this type of rectal bleeding is usually described as: a recurrent spasmodic cough that is worse at night Correct Answer The Correct Answer is: a congested cough worse during the day Choice B is the right answer. The asthmatic patient complains of a cough that is worse at night and has little congestion or sputum production. There is a history of wheezing and chest tightness, shortness of breath with exercise, and symptoms that worsen after airborne allergen exposure. Which of the following is an example of objective data used for diagnosis? Patient reports being more tired than usual. Patient reports having difficulty breathing. Patient reports productive cough. Patient's cough produces yellow sputum. Correct Answer Correct Answer: Patient's cough produces yellow sputum Objective data must be measurable and verifiable. It is key to collect both objective and subjective data to form correct differential diagnoses and then to determine the correct diagnosis and course of further testing or treatment for a patient. The ability to synthesize both objective and subjective data is a key skill for NPs. A 68-year-old woman has been admitted to the hospital suffering from peripheral vascular disease (PVD). You check her medical records for predisposing factors. You recognize that all of the following are predisposing factors EXCEPT: arteriosclerosis advanced age a history of renal problems valvular incompetence Correct Answer Correct Answer: a history of renal problems A predisposing factor for PVD is a history of deep vein thrombosis (DVT). All of the other choices are valid predisposing factors. Which of the following is NOT an indication of impaired skin integrity? A mole with irregular borders. Bruises in various stages of healing. Cuts in various stages of healing. A navel piercing more than a year old. Correct Answer Correct Answer: A navel piercing more than a year old. Unless the piercing is marked by scabbing or other evidence of trauma, it is not evidence of impaired skin integrity. Tattoos and other body modifications should be noted in the patient's assessment, but they are not in themselves cause for concern. You are determining the peak expiratory flow (PEF) for a 67-year-old female patient who suffers from asthma. Which of the following is NOT a factor in determining peak expiratory flow (PEF) for this patient? age height weight gender Correct Answer Correct Answer: weight Weight is not a factor in determining PEF. The PEF is based on height (H), age, (A), and gender (G) - HAG. Upon examination of a patient with a heart murmur, you hear a grade 1-3/6 late systolic crescendo murmur with a honking quality. This is most likely indicative of which of the following? pulmonary hypertension mitral regurgitation mitral valve prolapse aortic sclerosis Correct Answer Correct Answer: mitral valve prolapse In a patient with mitral valve prolapse, you would hear a grade 1-3/6 late systolic crescendo murmur with a honking quality. This is best heard at the apex of the heart. The murmur follows a mid-systolic click. Anxiety. Disturbed personal identity. Infection risk. Correct Answer Correct Answer: Anxiety The patient wringing his or her hands is an objective system. This signals anxiety even if the patient does not mention feeling anxious. The diagnosis should be considered with other symptoms. Insensible fluid loss from fever in older adults is often associated with all but which of the following? dry oral mucosa dry furrowed tongue hyponatremia serum sodium less than 150 mEq/L Correct Answer Correct Answer: hyponatremia Insensible fluid loss from fever is associated with hypernatremia which presents with thirst. Disorientation, seizures, and coma occur in severe hypernatremia. Nurse Terri is assessing a female patient with red, itchy spots on various parts of the body. Her chart shows she isn't allergic to anything but the patient admits to changing her laundry detergent recently. Terri believes it is an allergic reaction due to what? An external irritant. A new medicine. A interaction of current medicines. Outdoor allergy. Correct Answer Correct Answer: An external irritant When a patient present with an itchy rash or skin disorder, one of the first things to consider is an allergy to a medicine or food. When no allergy is detected, one of the most common forms of dermatitis happens when a patient tries a new cosmetic or laundry detergent. These types of disorders is often resolved once the product is discontinued.. The type of shock associated with impaired tissue perfusion caused by damage to or dysfunction of the sympathetic nervous system is which of the following? obstructive shock septic shock neurogenic shock hypovolemic shock Correct Answer Correct Answer: neurogenic shock Neurogenic shock is rare and may be associated with trauma, anesthesia, or spinal shock. In neurogenic shock, impaired tissue perfusion is caused by damage to or dysfunction of the sympathetic nervous system. Almost all lung cancers fall within one of four histologic categories. Which of the following is NOT one of these categories? malignant mesothelioma small cell carcinoma squamous cell carcinoma adenocarcinoma Correct Answer Correct Answer: malignant mesothelioma Malignant mesothelioma is not one of the four histologic categories for neoplastic lung disease. Besides the other three choices, large cell carcinoma is also one of the four categories. A 65-year-old Caucasian female is in the office with rosacea. She is asking about treatment options. What is the recommended treatment for her? topical 5-fluorouracil low-dose tetracycline oral ketoconazole oral hydrocortisone Correct Answer Correct Answer: low-dose tetracycline Treatment with systemic low-dose tetracycline is a very effective measure for rosacea; topical treatment with metronidazole or a low-dose steroid cream may also be beef bread eggs coffee Correct Answer Correct Answer: beef Meat and fish contribute significantly to the risk of developing gout in susceptible individual as does tea and alcohol. Bread, coffee and dairy products are low in purine. Which of the following is NOT a sleep pattern change you would expect to see in an otherwise healthy geriatric patient? Difficulty falling asleep. Sleeping fewer hours than in earlier years. Difficulty remaining asleep. Sleeping many more hours than in earlier years. Correct Answer Correct Answer Sleeping many more hours than in earlier years A number of sleep related changes can accompany aging in otherwise healthy adults. Sleeping fewer hours, trouble falling asleep, and trouble staying asleep are all common. A 66-year-old male patient has been diagnosed with Parkinson's disease. You understand that the disease varies from person to person but that the signs and symptoms include all but which of the following? pill-rolling tremor akathisia muscular rigidity with masked facies cog-wheel rigidity Correct Answer Correct Answer: akathisia Akathisia is a movement disorder that is characterized by a feeling of inner restlessness and a need to be in constant motion. Bradykinesia, on the other hand, is a reduction in the ability to initiate voluntary movement which is typical in Parkinson's patients. Cog-wheel rigidity and muscular rigidity with masked facies as well as pill rolling tremors are all symptoms of Parkinson disease. After thorough testing of your elderly patient, you diagnose him as being positive for Farmer's lung. Of the following, which was he MOST likely exposed to that caused this illness? Moldy hay. Bird serum and excreta. Moldy sugar cane fiber. Moldy redwood sawdust. Correct Answer Correct Answer: Moldy hay Farmer's lung is typically caused by moldy hay, and Bird fancier's lung, bird serum and excreta. Bagassosis is caused by moldy sugar cane fiber and Sequoiosis, moldy redwood sawdust. Nurse Cherri's patient has recently been diagnosed with Ulcerative Colitis (UC). Cherri refers the patient to have routine colorectal exams, since patients with UC are more susceptible to what? Hemorrhoids. Colorectal cancer. Unusual polyps in the colon. Increased constipation. Correct Answer Correct Answer: Colorectal cancer. Colorectal screenings and tests are great tools for prevention of various diseases of the colon. Patients diagnosed with ulcerative colitis or Crohn's Disease are encouraged to receive these tests along with regular treatment, since the patient's sensitive system can be more susceptible to other colon diseases, including cancer. You are treating your elderly patient with Ativan. Which of the following correctly identifies the starting dose and target dose of this medication? 0.25 mg q.d. - b.i.d. / 0.5 to 3 mg / day. 0.25 mg q.h.s. / 0.5 mg q.d. - t.i.d. 0.25 mg q.d. - b.i.d. / 1 - 2 mg / day. 5 mg q.d. / 15 - 30 mg divided t.i.d. Correct Answer Correct Answer: 0.25 mg q.h.s. / 0.5 mg q.d. - t.i.d. The other options are starting / target dosages for other medications used to treat anxiety disorders. For example, BuSpar = 5 mg q.d. / 15 - 30 mg divided t.i.d. Xanax = moderate intensity exercise steam inhalation and salt water gargles steam inhalation and salt water gargles acetaminophen or ibuprofen and topical decongestants low indoor humidity and antihistamines Correct Answer Hide Explanation Correct Answer: steam inhalation and salt water gargles acetaminophen or ibuprofen and topical decongestants A patient has nasopharyngitis- a minor, self-limiting viral infection of the upper respiratory tract. Acetaminophen or ibuprofen treats fever and headache. Topical decongestants used for nasal congestion; use 3-4 days to avoid "rebound congestion." Use first-generation antihistamines/decongestant combination for cough. You have a 25-year-old female patient whose cystic acne has not responded to the treatments prescribed for her. You consider the use of isotretinoin for this patient. You understand that all of the following are true statements about this medication EXCEPT: Isotretinoin is not teratogenic. The usual course of treatment is 4 - 6 months. It likely inhibits sebaceous gland function. Women must use two types of highly effective contraception while on this drug. Correct Answer Correct Answer: Isotretinoin is not teratogenic. This is incorrect. Isotretinoin (Accutane) has a potent teratogenicity. The patient must be educated in the use of this drug and fully aware of adverse reactions and its teratogenicity. Which of the following is NOT a sign of depression in an older adult? Unexplained aches or pains. A sense of hopelessness. Difficulty with short-term memory. Intense feelings of guilt. Hide Explanation Correct Answer: Difficulty with short-term memory. Difficulties with short-term memory are more consistent with dementia in older adults. Depression may be marked by difficulty concentrating or brief lapses in memory. Intense feelings of guilt and hopelessness are also common.Which of the following is NOT a sign of depression in an older adult? Unexplained aches or pains. A sense of hopelessness. Difficulty with short-term memory. Intense feelings of guilt. Correct Answer Correct Answer: Difficulty with short-term memory. Difficulties with short-term memory are more consistent with dementia in older adults. Depression may be marked by difficulty concentrating or brief lapses in memory. Intense feelings of guilt and hopelessness are also common. An elderly patient is diagnosed with hyperlipidemia. The NP is prescribing a medication that may have the following effects on her LDL, HDL and Triglyceride levels: LDL-5 to 15% decrease, HDL - 14 to 20% increase and Triglyceride - 20 to 50% decrease. Which of the following drugs is the NP MOST likely prescribing? Atorvastatin Gemfibrozil. Nicotinic acid. Colestipol. Correct Answer Correct Answer: Gemfibrozil The expected outcomes of the preceding medications are as follows: Atorvastatin: LDL: 20-60% decrease HDL: 5- 15% increase Triglyceride: 10-40% decrease Gemfibrozil: LDL: 5-15% decrease HDL: 14-20% increase Triglyceride: 20-50% decrease Nicotinic acid: LDL: 10-25% decrease HDL: 15-35% increase Triglyceride: 20-50% decrease You prescribe a medication for your elderly patient and note it should be p.o. What does this mean? Three times a day. As directed. In each eye. Taken by mouth. Correct Answer Correct Answer: Taken by mouth O.U. - In each eye; p.o. - Taken by mouth; t.i.d. - Three times a day; ut dict. - As directed. The Geriatric Nurse Practitioner is seeing an older female with pendulous breasts. She complains of a "burning" under her breast and the GNP smells a yeasty odor and sees a reddened area. What is this? impetigo tinea corporis pityriasis rosea intertrigo Correct Answer The Correct Answer is: intertrigo Choice D is the right answer. This is common in females of any age. The areas affected are any between skin folds, under the breasts, between the scrotum and inner thigh, or between the toes. You prescribe nasal corticosteroid spray for a patient with allergic rhinitis. What is the anticipated onset of symptom relief with its use? immediately with the first spray within 1 to 2 days after a few days 2 or more weeks Correct Answer Correct Answer:after a few days The mechanism of action of corticosteroid nasal spray in allergic rhinitis therapy is prevention of production of inflammatory substances; therefore, corticosteroid and mast cell stabilizers are effective at preventing symptoms of allergic rhinitis, not giving instant relief. Symptoms improvement will be seen after a few days to one week. Which of the following is an ideal candidate for joint replacement surgery? An 88-year old man in excellent healthy with 75% of the articular cartilage of his knee worn away. A 68-year old woman in good health with 90% of the articular cartilage of her knee worn away. A 67-year old woman with severe COPD, CHF, and 70% of the cartilage of her knee worn away. A 74-year old man with hypertension, profound kyphosis, dementia,and 65% of the articular cartilage of his knee worn away. . Correct Answer The Correct Answer is:A 68-year old woman in good health with 90% of the articular cartilage of her knee worn away. Choice B is the right answer. For joint replacement, there must be 80% or more of the articular cartilage worn away. The ideal candidate is able to tolerate a surgical procedure that last for several hours, followed by an aggressive postoperative course of rehabilitation Which of the following drugs is a cholinesterase inhibitor that comes in the form of a pill, syrup or drug-releasing skin patch? Galantamine. Hydrocodone. Rivastigmine. Donepezil. Correct Answer Correct Answer: Rivastigmine There are three cholinesterase inhibitors commonly prescribed by doctors. These are Donepezil, Galantamine and Rivastigmine. Hydrocodone is a type of medication that treats moderate to severe pain as well as cough. Your 89-year-old patient presents with dyspepsia and nausea. After testing, you determine she is positive for Peptic Ulcer Disease. Of the following, which would LEAST likely be a differential diagnosis for Peptic Ulcer Disease? Cholecystitis. 1000 mg. 500 mg. 750 mg. 100 mg. Correct Answer Correct Answer 100 mg The maximum recommended daily dose for Celebrex in older patients is 100 mg. This drug may require aspirin supplementation in those patients requiring cardioprotection. This may also lead to need for gastrointestinal protection, especially in geriatric patients. The ANP is consulting with her pregnant patient who was recently diagnosed with gestational diabetes. What is the best method of treatment she can put the patient on that is safe for her and her fetus? Regular insulin. Oral salt tablets. Controlled diet. Nothing at all. Correct Answer Correct Answer: Controlled diet. Insulin or oral medicines are not recommended for a patient with gestational diabetes because they can affect the growing fetus and interfere with glucose absorption, so controlled diet and exercise is usually the best way to treat it. You have a 62-year-old male patient who has just recovered from an acute attack of gout. You want to prescribe a maintenance medication for this patient. Which of the following gout medications would you prescribe? Indometacin Colchicine Naproxen Allopurinol Correct Answer Correct Answer: Allopurinol Allopurinol is a maintenance medication for gout sufferers. Maintenance drugs are prescribed to be used at least 4 to 6 weeks after the acute phase is over. They may be used daily for years to lifetime. Older adults often get B12 anemia. What is true concerning vitamin B12 therapy? Anemia can resolve within 2 weeks of treatment. Vitamin B12 is available only in parenteral and oral form. Reversal of neurological abnormalities takes longer than 2 months once therapy is started. Oral B12 is just as beneficial as parenteral B12. Correct Answer Correct Answer: Reversal of neurological abnormalities takes longer than 2 months once therapy is started. Anemia does not resolve until around 2 months of treatment and reversal of neurological abnormalities is generally slower than this. B12 is available in parenteral, oral and nasal gel forms. Oral B12 is not as beneficial as parenteral B12. You are assessing a 67-year old woman with complaints of right knee pain when she goes up the stairs or walks long distances. You are examining the knee and note crepitus. What does the Geriatric Nurse Practitioner believe to be the likely cause? femoral tendinitis patellar tendinitis arthritis of the knee patellar bursitis Correct Answer The Correct Answer is: arthritis of the knee Choice C is the right answer. Typical symptoms of arthritis include the ones mentioned in the scenario and also pain with standing up after sitting. She will report stiffness after sitting for long periods and after awakening in the morning. Mrs. Hanson is an 80-year-old woman for whom you must prescribe a pain-killing drug. When prescribing drugs for the elderly, such as Mrs. Hanson which of the following would NOT be in your plan? Begin with more than the usual adult dose since absorption may take longer. Make changes infrequently. Allow an adequate trial period before discontinuing the drug. You have a patient who has just had a diagnostic arthroscopy. You are instructing him about what to do when he gets home. Which of the following would you NOT instruct him to do? report severe pain to the physician immediately elevate the extremity for 24 - 48 hours resume normal activities within 12 hours so as to help reduce the swelling apply ice to the area involved intermittently Correct Answer Correct Answer: resume normal activities within 12 hours so as to help reduce the swelling You would not tell this patient to resume normal activities within 12 hours since activity is initially limited and will slowly progress. He should elevate the extremity for 24-48 hours, report severe pain immediately and treat pain with a mild analgesic. In terms of evaluating heart murmurs, the characteristics of regurgitant murmurs can best be described as which of the following? usually rough usually more pure and uniform sound heard from S1 through S2 turbulent Correct Answer Correct Answer: usually more pure and uniform sound Regurgitant murmurs are usually a more pure, uniform sound (e.g., mitral regurgitation). Ejection murmurs are usually rough; and pansystolic murmurs are heard from S1 through S2. Which of the following supplements would you recommend for a woman who is trying to get pregnant that has the ability to reduce birth defects by about 50%? vitamin C vitamin K magnesium folic acid Correct Answer Correct Answer: folic acid Folic acid taken as a supplement has been recognized as reducing the occurrence of neural tube defects. All women of childbearing years, whether pregnant or not, should take 0.4 mg daily of folic acid either alone or as part of a multivitamin supplement. The dose is increased with pregnancy. In which of the following cases would you refer a patient to a specialist for low back pain? A patient with: acute neck pain bladder dysfunction reduced range of movement stiffness Correct Answer Correct Answer: bladder dysfunction If the patient has a bladder dysfunction, or a limb or bowel dysfunction, prompt referral to a specialist is needed. Surgery is usually considered only if severe symptoms persist beyond 3 months. A 65-year-old woman presents for a follow-up examination after a new patient visit. She has not seen a healthcare provider for several years. She is a smoker and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the nurse practitioner should start the patient on: 1.bile acid sequestrant. 2. a statin drug. 3. a cholesterol absorption inhibitor. 4. low-dose aspirin. Correct Answer A statin drug The most commonly prescribed medication for mild systemic lupus erythematosus (SLE) is: 1. azathioprine (AZA). 2. belimumab (Benlysta). 3. ibuprofen (Advil). 4. cyclophosphamide (Cytoxan). Correct Answer ibuprofen (advil) 3. Document the data and report the information to risk management. 4. Call the patient's family and inquire about the concerns. Correct Answer report the case to proper authorities In most cases, the first manifestation of Alzheimer's disease is: 1. impaired judgment. 2. decrease in short-term memory. 3. disorientation in time and place. 4. decrease in long-term memory. Correct Answer decrease in short-term memory The optimal treatment for latent tuberculosis is: 1. rifampin (Rifadin) for 5 months. 2. isoniazid (Nydrazid) for 9 months. 3. pyrazinamide for 6 months. 4. ethambutol for 6 months. Correct Answer osioniazid (nydrazid) for 9 months Unilateral spontaneous serous or serosanguineous discharge from a single duct of a breast is most often caused by: 1. intraductal papilloma. 2. mucinous breast lesions. 3. Paget's disease. 4. ductal carcinoma in situ. Correct Answer intraductal papilloma A young child with asthma presents for follow-up evaluation. After numerous changes in medications and doses, the parents report that the child continues to have difficulty with coughing, especially during the night. Which of the following conditions would be the most likely cause of the continued asthma symptoms? 1. Vocal cord dysfunction 2. Cystic fibrosis 3. Gastroesophageal reflux 4. Allergic rhinitis Correct Answer gastroesophageal reflux A pregnant woman with known HIV infection can reduce the risk of perinatal transmission through zidovudine (Retrovir) therapy. Based on current research, optimal therapy is to start daily dosing: 1. post amniocentesis. 2. after 14 weeks of gestation. 3. if premature rupture of membranes occurs. 4. if maternal viral loads are greater than 10,000. Correct Answer after 14 weeks gestation T-wave inversion with a normal ST segment on a 12-lead EKG may represent: 1. acute coronary ischemia. 2. right ventricular hypertrophy. 3. atrial hypertrophy. 4. hyperkalemia. Correct Answer acute coronary ischemia The 16-year-old mother of a 2-month-old presents the infant, reporting that the child is very irritable and does not feed well. During physical examination, the child's head drops back and the child exhibits sudden flexing of the extremities. As the flexing stops, the child cries uncontrollably. Funduscopic examination reveals retinal hemorrhages. Which of the following diagnostic tests should be ordered? 1. Skull X-rays 2. MRI 3. CT scan 4. Pet scan Correct Answer CT scan The most important diagnostic factor in evaluating angina pectoris is the patient's: 1. King of Heart's monitor. 2. physical examination. 3. history. 4. echocardiogram. Correct Answer history There are three reasons for latex allergies. Which of the following does NOT cause the problem? 1. Immediate hypersensitivity 2. Irritant contact of dermatitis 3. Cytotoxic hypersensitivity 4. Immune complex reaction Correct Answer cytotoxic hypersensitivity 1. hemolytic anemia. 2. weight loss. 3. depression. 4. hypothyroidism. Correct Answer hemolytic anemia An 86-year-old patient presents with pinguecula, a yellow triangular degenerative tissue thickening of the bulbar conjunctiva. This condition is: 1. cured by eye drops. 2. a genetic process. 3. a malignant growth. 4. a solar-induced lesion Correct Answer a solar-induced lesion During a well-child examination of an 18-month-old, premature tooth decay and inflamed gums, particularly of the maxillary incisors, are noted. The approach to this problem includes: 1. referring the child to a dentist, assessing for bottle feeding and fluoride in local water. 2. teaching the mother to brush the child's teeth, encouraging vitamin supplements. 3. recommending fluoride mouthwash and toothpaste, suggesting celery sticks for snacks. 4. providing fluoride treatment, teaching dental hygiene, and eating foods high in calcium. Correct Answer referring the child to a dentist, assessing for bottle feeding and fluoride in local water Which of the following is typically observed in the GI system upon stimulation of the parasympathetic nervous system? 1. No overall effect 2. Increased sphincter tone 3. Increased peristalsis 4. Decreased secretions Correct Answer increased peristalsis Type 2 diabetes mellitus is characterized by which of the following? 1. Decreased production of exogenous glucagon-like peptide 2. Autoimmune beta-cell destruction 3. Relative deficiency of dipeptidyl peptidase-4 4. Decreased reabsorption of sodium-glucose transporters Correct Answer decreased reabsorption of sodium- glucose transporters In pulmonary function testing, forced vital capacity represents the: 1. maximum volume of air that can be forcefully exhaled after maximum inspiration. 2. total volume of air that is exhaled after normal inspiration. 3. total volume of air that the lungs can hold, minus the expiratory reserve volume. 4. volume of air that can be forcefully exhaled in 1 second. Correct Answer maximum volume of air that can be forcefully exhaled after maximum inspiration An adult male presents as first patient of the day after awaking about 5:00 AM with indigestion and chest pressure. On checking his pulse, he found no change from previous measurements. He states that, while waiting for the nurse practitioner to arrive, he began to feel a little clammy. A 12-lead EKG records the following patterns. On the basis of these EKG readings, the diagnosis is: 1. anterior-septal acute myocardial infarction. 2. lateral acute myocardial infarction. 3. inferior acute myocardial infarction. 4. anterior acute myocardial infarction. Correct Answer inferior acute myocardial infarction During the past 24 hours, a 62-year-old has experienced abdominal pain that radiates to the back. The patient also reports several episodes of nausea and vomiting, a low- grade temperature, and a history of excessive drinking. Physical examination reveals a distended abdomen. Laboratory serum values indicate elevated alkaline phosphatase, amylase, and serum lipase. The most likely diagnosis is: 1. alcoholic liver disease. 2. acute mesenteric ischemia. 3. viral hepatitis. 4. acute pancreatitis. Correct Answer acute pancreatitis dry palms with no nail involvement. The most likely diagnosis is: 1. contact dermatitis. 2. scabies infestation. 3. psoriasis. 4. eczema. Correct Answer contact dermatitis Anorexia nervosa occurs most commonly in which of the following? 1. Painters 2. Only children 3. High-level athletes 4. Individuals from large families Correct Answer high level athletes A frail elderly patient presents with constipation. Which of the following normal physiologic changes seen with aging is the most likely cause? 1. Decreased bowel muscle tone 2. Increased bile secretion 3. Increased absorption of calcium 4. Decreased pancreatic secretions Correct Answer decreased bowel muscle tone A patient reports to your office, having been struck on the right cheek with a baseball bat. On examination, you notice tenderness and swelling over the cheek. The patient is unable to gaze laterally with his left eye, and he complains of double vision when he attempts to do so. This is most likely associated with: 1. retinal hemorrhage. 2. orbital rim fracture. 3. subarachnoid hemorrhage. 4. periorbital cellulitis. Correct Answer orbital rim fractures A 7-year-old child presents with group A streptococcal infection confirmed by throat culture. Past history includes treatment for positive streptococcal infection with erythromycin (EryPed oral suspension) 3 weeks ago. What is the most appropriate next intervention? 1. Treat with amoxicillin for 10 days. 2. Obtain culture for all household members. 3. Treat with azithromycin (Zithromax) for 10 days. 4. Intramuscular Penicillin. Correct Answer treat with amoxicillin for 10 days An adult female who recently returned from a business trip to Japan presents for a recheck appointment. The only remarkable laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 0.4-6 microunits/mL). The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following laboratory tests should the nurse practitioner order now? 1. Triiodothyronine (T3) and free thyroxine (FT4) 2. Triiodothyronine (T3) only 3. Triiodothyronine (T3) resin uptake assay 4. Triiodothyronine (T3) and free triiodothyronine (FT3) Correct Answer Triiodothyronine (T3) and free thyroxine (FT4) In treating a pregnant female with migraine headaches, which of the following drugs is in Category X? 1. Ergotamine tartrate (Ergomar) 2. Sumitriptan succinate (Imitrex) 3. Frovatriptan (Frova) 4. Amitriptyline (Elavil) Correct Answer ergotamine tartate (ergomar) A nurse practitioner is evaluating an infant for possible colic. Which of the following could indicate the need for a more extensive evaluation? 1. 3-oz (85 g) weight gain over the past 2 weeks 2. Stool negative for occult blood 3. Moist mucus membranes and flat fontanels 4. Onset at 4 weeks of age Correct Answer 3-oz (85 g) weight gain over the past 2 weeks Which of the following is a hallmark of lumbar spinal stenosis? 1. Incontinence of bowel and/or bladder 2. Point tenderness of the lumbar spine 3. Leg, buttock or back pain precipitated by walking. A mother has just noticed that her 15-month-old, 15-kg child has recently ingested an unknown quantity of iron tablets. The mother has ipecac syrup and activated charcoal on hand. The mother should be advised to: 1. take the child to the primary care provider. 2. give ipecac per recommendation on the bottle label. 3. take the child to the emergency room. 4. give the child 30 g of activated charcoal diluted with water Correct Answer take child to emergency room A 13-year-old is concerned because she has not yet begun to menstruate. Physical examination indicates that the patient is at Tanner stage IV and is of average height and weight. Which of the following would be the most appropriate response to this patient? 1. "We'll need to refer you to an endocrinologist for a complete workup." 2. "We'll need to do some tests to find out why you are not having periods." 3. "I'll give you some pills that will make your periods start." 4. "Your development is exactly as expected for your age; you'll probably begin to have periods within a year." Correct Answer "Your development is exactly as expected for your age; you'll probably begin to have periods within a year." The most common bacterial cause of cellulitis in patients with diabetes mellitus is: 1. Pseudomonas aeruginosa. 2. group B beta-hemolytic Streptococcus. 3. Staphylococcus aureus. 4. Staphylococcus saprophyticus. Correct Answer Staphylococcus aureus A 46-year-old female found a lump in her breast this morning. History includes: no prior breast disease; G2P2 (first birth, age 22); maternal aunt diagnosed with breast cancer at age 72; last menstrual period was 2.5 weeks ago. On examination, a nurse practitioner palpates a 2-cm round, soft, mobile, tender lesion in the upper outer quadrant of the right breast. Mammogram is negative. Which of the following actions is most appropriate? 1. Reassure the patient that no further action is necessary. 2. Repeat unilateral right mammogram in 3 months. 3. Schedule a right-breast ultrasound. 4. Refer for genetic testing if the lump increases in size. Correct Answer schedule a right breast ultrasound Risk factors for genital herpes include: 1. multiple sexual partners and years of sexual activity. 2. genetic transmission. 3. infection with other sexually transmitted diseases before the age of 12. 4. multiple sexual partners and frequent use of public spas. Correct Answer multiple sexual partners and years of sexual activity On physically assessing a newborn's head, you note an enlarged, fluid-filled area that is subperiosteal and does not cross suture lines. This finding indicates the presence of: 1. macrocephaly. 2. subgaleal hemorrhage. 3. congenital hypothyroidism. 4. cephalohematoma. Correct Answer cephalohematoma A 65-year-old patient being treated with digoxin (Lanoxin) for chronic heart failure (HF) presents with complaints of palpitations. Three days ago, the patient was placed on clarithromycin (Biaxin) by another provider for community- acquired pneumonia. The appropriate course of action at this point would be to: 1. increase the digoxin dosage by 25%. 2. obtain a digoxin level and change the antibiotic to azithromycin (Zithromax). 3. obtain a chest X-ray. 4. obtain a serum potassium level and perform a 12-lead EKG. Correct Answer obtain a digoxin level and change the antibiotic to azithromycin (zithromax) A 54-year-old male who is 30 pounds overweight states that he awakens at night with heartburn and the taste of hot acid in his mouth. Stress makes his condition worse, yet baking soda seems to provide some relief. Findings on