ANCC FNP BOARD EXAM ACTUAL EXAM | 300 QUESTIONS AND DETAILED ANSWERS | PROFESSOR VERIFIED, Exams of Nursing

Download ANCC FNP BOARD EXAM ACTUAL EXAM | 300 QUESTIONS AND DETAILED ANSWERS | PROFESSOR VERIFIED and more Exams Nursing in PDF only on Docsity! ANCC FNP BOARD EXAM ACTUAL EXAM | 300 QUESTIONS AND DETAILED ANSWERS | PROFESSOR VERIFIED | GRADED A+ | LATEST VERSION (JUST RELEASED!) Christina is a 30-year-old female patient who comes to the clinic complaining of a cheesy white discharge from the vagina. Upon examination you see that the vulva and the vagina are red and irritated. The diagnosis for this patient is which of the following? - -----CORRECT ANSWER-----------candidal vaginitis Candidal vaginitis is caused by an overgrowth of Candida albicans yeast in the vulva/vagina. It results in a large amount of inflammation with symptoms of pruritus, swelling, and redness. If your patient with Meniere's disease is experiencing acute vertigo, which of the following drugs is the drug of choice? ------CORRECT ANSWER-----------Valium Valium (diazepam) is used as a vestibular suppressant. It is the drug of choice for acute vertigo. Antivert is used for vertigo but it has a slower onset. Your patient has AIDS. He is in the hospital suffering from an infection. He presented with severe watery diarrhea, abdominal cramps, nausea, malaise and has an electrolyte imbalance. Which of the following opportunistic infections do these symptoms best describe? ------CORRECT ANSWER-----------cryptosporidiosis Cryptosporidiosis presents with severe watery diarrhea - sometimes as many as 30-40 stools per day. The patient also has abdominal cramps, nausea, malaise and tests will show an electrolyte balance. A patient with sensitive skin had a TB skin test but has no symptoms. He returns with redness and swelling that appears positive. What is the next step? ------CORRECT ANSWER-----------Schedule a CXR The nurse practitioner should not cross certain boundaries with patients. Which of the following would not be considered crossing one of these boundaries? ------CORRECT ANSWER-----------Not sharing personal information with the patient The United States Preventive Services Task Force recommends screening older patients for depression: ------CORRECT ANSWER-----------at each primary care visit Which of the following types of hepatitis is transmitted by fecal and oral route from contaminated food? ------CORRECT ANSWER-----------Hep A Which of the following is a normal physiologic change during pregnancy? ------ CORRECT ANSWER------------Cardiac output increases by 1/3 by the last two trimesters. -Decreased systolic and diastolic pressure occurs in the first trimester. -There is decreased peristalsis from progesterone effects. If a patient is diagnosed with left-heart failure, which of the following medications would the nurse practitioner more than likely use for treatment? ------CORRECT ANSWER------ -----Lasix When counseling patients who smoke cigarettes, which of the following is NOT good management advice? ------CORRECT ANSWER-----------For asymptomatic adults, instruct the patient on how it is easier to stop now than when symptomatic. According to Prochaska and DiClemente, the 5 stages of preparation for patient change would include which of the following? ------CORRECT ANSWER-----------Action Paul is a 67-year-old male patient with type 2 diabetes. In managing this patient's care which of the following lab tests would you have done for Paul every 3 - 6 months? ------ CORRECT ANSWER-----------A1c Which of the following statements about the legal process is incorrect? ------CORRECT ANSWER-----------A statute is a law written by a state or federal agency in accordance with a regulation. Traditionally, the American Indian culture values a holistic approach to health care integrating the person, lifestyle, environment, family, and religion. Patients adhering to these traditional cultural practices often feel that illness is due to a lack of harmony with the physical body, mind, spirit, and emotions. Patients may seek care from western medicine for specific ailments while also consulting with traditional healers for spiritual guidance. Healthcare providers should seek to understand relevant cultural factors and assess each individual's healthcare literacy in order to provide culturally competent care. The nurse practitioner sees an older adult patient in the clinic with the primary report of hearing loss and a sensation of fullness in the right ear. The nurse practitioner suspects conductive hearing loss. Which could contribute to this? ------CORRECT ANSWER------- ----Cerumen, commonly called earwax, is a combination of secretions and sloughed epithelial cells that protects the ears from infection, water, and insects. It is normally expelled from the ear canal through natural jaw movement. When this self-cleaning process fails, cerumen can become impacted. Cerumen impaction occludes the ear canal and can press against the tympanic membrane, resulting in conductive hearing loss. _________________________________________ Conductive hearing is the transition of sound from the external and middle ear to the inner ear. Conductive hearing loss is caused by problems in the external and middle ear that interfere with the transmission of sound and its conversion to mechanical vibration. Causes of conductive hearing loss include obstruction of the external auditory canal by cerumen, foreign bodies, debris from otitis externa, and large exocytosis and osteomas. Sensorineural hearing loss involves difficulty converting mechanical vibrations to electrical potential in the cochlea or in auditory nerve transmission to the brain. It is mostly caused by permanent damage in the organ of Corti. It can be caused by age-related hearing loss, noise trauma, medications, autoimmune diseases, mechanical trauma, Meniere disease, infection, and neoplasm (acoustic neuroma). Approximately one-third of older adults between the ages of 61 and 70 years have hearing loss. More than 90% of adults older than 85 years of age have hearing loss. The most common type of hearing loss is age-related and sensorineural. All adults older than 60 years of age should be screened for hearing loss at periodic health examinations. An otherwise healthy adult patient presents to the clinic with a diagnosis of community- acquired pneumonia and no recent antibiotic therapy. Which is the best option for treatment? ------CORRECT ANSWER-----------Amoxicillin High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults without comorbidities. _____________________________________________ Community-acquired pneumonia (CAP) is pneumonia not acquired in a hospital or long-term care facility. Patients with suspected CAP should receive a chest X- ray for diagnosis. The Pneumonia Severity Index should be used to assist in decisions regarding the need for hospitalization in patients with CAP. According to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) 2019 guidelines, the initial treatment of CAP for most patients is amoxicillin or doxycycline. Macrolides are an option for treatment, but are no longer recommended routinely as first-line treatment, given increased macrolide resistance. This is a change from the 2007 ATS/IDSA guidelines. Respiratory fluoroquinolones and amoxicillin/clavulanate should be used in patients who fail first-line medications, have significant comorbidities, have had recent antibiotic therapy, are allergic to alternative agents, or have a documented infection with highly drug-resistant pneumococci. A patient presents to the clinic for conception counseling. She recently stopped taking oral contraceptives and would like to become pregnant. Which statement about conception safety after stopping oral contraceptives is correct? ------CORRECT ANSWER----------- You have a 35-year-old female patient who is complaining of wrist pain. She is an administrative assistant who does a great deal of computer work in her job. You will test her for carpal tunnel syndrome. When you tap at the volar surface of the wrist you are performing which of the following tests? ------CORRECT ANSWER-----------Tinel's sign A gastrinoma located on the pancreas or the stomach which secretes gastrin, stimulating high levels of acid production in the stomach is which of the following? ------ CORRECT ANSWER-----------Zollinger-Ellison syndrome A 16-year-old male is in the office. He has a insect bite on his left forearm and you suspect a brown recluse spider bite. What medical management would you provide? ---- --CORRECT ANSWER-----------ice pack and elevation of the area In addition to being overweight, the American Diabetes Association recommends type 2 diabetes mellitus testing in adults who: ------CORRECT ANSWER-----------have an HDL level of < 35 mg/dL Which of the following found on an ECG would confirm atrial fibrillation? ------CORRECT ANSWER------------absent P waves -irregular ventricular rate As an FNP you understand that all of the following statements about chronic heart failure are accurate EXCEPT: ------CORRECT ANSWER------------The preponderance is in females until the age of 75, then there is equal occurrence in males and females. -Patients who are underweight have a greater risk of CHF. The FNP has a 45-year-old male patient with BPH who has poison ivy. The FNP plans to prescribe Benadryl for this. What is a possible adverse effect with the use of Benadryl for this patient? ------CORRECT ANSWER-----------urinary retention You are testing a client suspected of having Parkinson's disease. You support the client's elbow with his forearm extended in your hand and grasp his wrist, flexing the forearm. You find rigid resistance to this motion. This is considered which of the following? ------CORRECT ANSWER-----------cogwheeling The complex network of nerve fibers that innervate the organs within the abdomen like the gastrointestinal tract, pancreas, and gall bladder is the ------CORRECT ANSWER---- -------enteric nervous system According to the structural functional theory of assessment and intervention, which of the following statements is false? ------CORRECT ANSWER-----------Suprasystems form within the family to reflect functional needs. A mother brings her 5-year-old child to the clinic with a ringlike pruritic rash with some central clearing on the arms and legs. The FNP knows that this is which of the following conditions? ------CORRECT ANSWER-----------tinea corporis Bactrim should NOT be prescribed to which of the following patients? ------CORRECT ANSWER-----------1 month old child In treating a patient with eczema, which of the following would you use if the patient has acute, weeping lesions? ------CORRECT ANSWER-----------Burow's solution During the process of implantation, the fetus in the above picture (4 weeks) would have finger-shaped growths that grow to help anchor the embryo to the uterine lining. Which of the following would be considered the correct name for these growths? ------ CORRECT ANSWER-----------Chorionic villi The FNP has a pregnant patient whose uterus is grapefruit size. At what stage of pregnancy is this patient most likely to be? ------CORRECT ANSWER-----------12 weeks The most common cause of secondary hypertension is which of the following? ------ CORRECT ANSWER-----------renal conditions The effect of a goitrogen could likely be: ------CORRECT ANSWER----------- hyperthyroidism An injury to one of the ligamentous structures of the body is termed a(n): ------ CORRECT ANSWER-----------sprain - A sprain is an injury to one of the ligamentous structures of the body. A 34-year-old female with multiple sclerosis (MS) is in the office. She is now under your care after relocating from another state to live with relatives who can help her. The nurse practitioner understands that which of the following is NOT part of her management plan: ------CORRECT ANSWER-----------Corticosteroids are often used for maintenance. Which of the following statements about endometriosis is least accurate? ------ CORRECT ANSWER-----------The FNP can manage the patient with endometriosis independently. For a healthcare professional to obtain blood at the request of law enforcement officials without a patient's consent which of the following must be present? ------CORRECT ANSWER------------The suspect must be under arrest. -A delay in drawing blood would lead to destruction of evidence. -The test is performed in a reasonable manner. ***all of the above A CT would allow for a better diagnosis (with "slices") of the patient by which of the following ways? ------CORRECT ANSWER------------Forms a full three-dimensional computer model of the inside of the patient. -It is easier for the physician to pinpoint a problem because of the narrow "slices" that the scanner uses. The Romberg test is used to evaluate which of the following? ------CORRECT ANSWER-----------cerebellar system- Tandem gait is also used for testing the cerebellar system. Your patient has a superficial skin lesion that is elevated. It is less than 1 cm in diameter and it is filled with serous fluid. Which of the following skin lesions is this? ------ CORRECT ANSWER-----------vesicle The nurse practitioner will need to be aware of infectious diseases and the concerns regarding the recognition and management of them. Which of the following is important regarding the professional role related to infectious disease recognition and management? ------CORRECT ANSWER-----------Be alert to endemic diseases. Be alert to diseases that may be the result of bioterrorism. Know the local health department guidelines for reporting communicable diseases. ****All of the above In which quadrant of the abdomen would you find the body of the pancreas? ------ CORRECT ANSWER-----------Left Upper Quad A 35-year-old female patient tells you that she has not had a period in over 3 months. She tells you that until now she has been quite regular with her periods. This condition is which of the following? ------CORRECT ANSWER-----------secondary amenorrhea The Family Nurse Practitioner has the duty to disclose certain information to the patient as part of the informed consent process. Which of the following is not an exception to this duty? ------CORRECT ANSWER-----------The patient is 80-years-old or older and unable to comprehend the complex medical facts. Holly is a30-year-old female client with systemic lupus erythematosus. You are telling Holly what to do to improve symptoms. In the course of this education you would include all but which of the following statements? ------CORRECT ANSWER-----------get plenty of sunlight - You would tell her to protect against sunlight. In terms of business organization types for nurse practitioner practice, which of the following has its own identity and is a separate legal entity? ------CORRECT ANSWER-- ---------corporation If a nurse practitioner is providing care for pediatric patients, why is it especially important to have adequate professional liability insurance coverage? ------CORRECT Which of the following rash-producing febrile illnesses is caused by the human parvovirus B19? ------CORRECT ANSWER-----------Fifth disease Which of the following parts of the eye is for color perception? ------CORRECT ANSWER-----------cones Which of the following tests would you most likely order for a patient whom you suspect has iron deficiency anemia? ------CORRECT ANSWER------------CBC with differential or smear -TIBC -ferritin ****all of the above If heat is applied to the site of an insulin injection, which of the following can happen? --- ---CORRECT ANSWER-----------hypoglycemia 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? ------CORRECT ANSWER----------- Allopurinol Which of the following is NOT an incomplete spinal cord injury syndrome? ------ CORRECT ANSWER-----------Miller Fisher syndrome You have a patient diagnosed with acute bronchitis. Which of the following types of drugs are you NOT likely to prescribe? ------CORRECT ANSWER-----------Antibiotics The reasonable and ordinary care, skill and diligence that would be given by practitioners in good standing, in the same geographic area and in the same general type of practice in similar cases is which of the following? ------CORRECT ANSWER----- ------standard of care Clotting factors are proteins and other substances numbered I to XIII, that form a fibrin matrix at sites of blood vessel or tissue injuries. Which of the following is also known as the Hageman factor? ------CORRECT ANSWER-----------Factor XII A patient of yours has a "Christmas tree" pattern of rash on his trunk. He tells you that he started having some lesions about two weeks ago but now they have spread. You would suspect which of the following conditions/diseases? ------CORRECT ANSWER---- -------Pityriasis rosea A patient who has been prescribed Zestril for hypertension should be advised that all but which of the following are potential side effects? ------CORRECT ANSWER----------- Wet cough. For a 40-year-old female patient who has had a baseline blood glucose level measurement done several years ago, you would advise that it be measured how often from now on? ------CORRECT ANSWER-----------every 3 years How often must hospitals check the National Practitioner Data Bank before granting clinical privileges to nurse practitioners? ------CORRECT ANSWER-----------every two years If you are working OB and managing a patient after an amniocentesis, the nurse practitioner understands that she must assess for which high priority occurrence first: --- ---CORRECT ANSWER-----------spontaneous rupture of the membranes Jorge is an 18 month-old Hispanic male who presents with bluish black patches in the lumbosacral area. Bruising and child abuse have been ruled out. The diagnosis for this child would most likely be which of the following? ------CORRECT ANSWER----------- Mongolian Spots Louise, an 85-year-old female patient, comes to you with a gnawing stomach pain. She tells you that she has been using NSAIDs for her arthritis for the last several months. She also reports that her stools appear dark. After a thorough assessment you diagnose which of the following for this patient? ------CORRECT ANSWER----------- peptic ulcer disease A urine pregnancy test is considered which of the following signs of pregnancy? ------ CORRECT ANSWER-----------probable sign of pregnancy Where does the pancreas lie in the human body? ------CORRECT ANSWER-----------in front of the spine and behind the stomach Blood clots are treated differently depending on the location of the clot and a patient's health. The treatment which involves medicine that dissolve blood clots is which of the following? ------CORRECT ANSWER-----------thrombolytics An adult patient admits to drinking alcohol on the weekends. He does, however, say in the interview that he is thinking about cutting back on his drinking. What other statement would indicate that the patient is possibly an alcoholic? ------CORRECT ANSWER-------- ---his friend tells him he drinks too much When ordering an inhaler for a patient, the nurse practitioner might also order a "spacer." Which of the following would be considered a purpose for the "spacer?" ------ CORRECT ANSWER-----------The spacer will help increase the delivery of the aerosolized drug to the lungs. Which of the following statements about epistaxis (nosebleeds) is not accurate? ------ CORRECT ANSWER-----------The incidence of nosebleeds increases during the summer months. The incidence of nosebleeds increases during the winter months. Which of the following is considered a complication associated with giant cell arteritis? -- ----CORRECT ANSWER-----------higher incidence of thoracic aortic aneurysm - Giant cell arteritis is a systemic panarteritis affecting medium to large size vessels. Complications of giant cell arteritis include higher incidence of thoracic aortic aneurysm and blindness. Arcus senilis in a patient aged 40 years old may be a sign of which of the following? ----- -CORRECT ANSWER-----------hypercholesterolemia. -Arcus senilis is common in the elderly; but it can also appear earlier in life as the result of hypercholesterolemia. It is a white, gray, or blue opaque ring in the corneal margin, or white ring in front of the periphery of the iris. Knowledge of the cranial nerves (CNs) is critical for accurate neurologic assessment. Which of the following is the facial nerve? ------CORRECT ANSWER-----------CN VII CN VII is the facial nerve. It provides motor innervation to the muscles of facial expression. Which of the following injuries to a patient will show no specific radiographic findings? -- ----CORRECT ANSWER-----------tennis elbow Mr. Barlow is a 50-year-old patient who has epididymitis. Which of the following findings would NOT be consistent with this diagnosis? ------CORRECT ANSWER-----------The scrotum is not normal; it would be swollen You are assessing the lab work for a patient who is pregnant. You notice that AFP is high. Which of the following might this indicate? ------CORRECT ANSWER----------- neural tube defect Part of the job of an FNP is educating parents on safety measures for children. Which type of car seat or restraint is recommended for toddlers and preschoolers? ------ CORRECT ANSWER-----------forward-facing convertible, combination Which of the following NSAIDs has the FDA approved for primary dysmenorrhea? ------ CORRECT ANSWER-----------ibuprofen indomethacin naproxen sodium ****all of the above A 42-year-old non-smoker is diagnosed with mild community-acquired pneumonia. He is otherwise healthy and does not need hospitalization at this time. Which antibiotic can be used for empirical treatment according to the 2007 Infectious Disease Society of America? ------CORRECT ANSWER-----------azithromycin - macrolide ATB You are doing a complete physical exam on a 25-year-old female patient with sleep apnea. Which of the following are you most likely to find in this patient? ------CORRECT ANSWER-----------increased blood pressure Medicare Part A would cover all but which of the following? ------CORRECT ANSWER--- --------Nursing home care (custodial care) Mr. Findlay is a patient who has no risk factors for tuberculosis. You administer a TB test. Which of the following indurations would indicate a positive test for TB in this patient? ------CORRECT ANSWER----------->15mm An induration of >15 mm in a person who has no risk factors for TB is considered a positive result. In an HIV-positive person, an induration of >5mm is considered positive. In persons who have recently arrived from a high-prevalence country an induration of > 10 mm is considered positive. Which of the following tests is used to identify the specific source bacteria of pneumonia and which antibiotics they are sensitive to? ------CORRECT ANSWER-----------sputum Cx- Sputum culture is used to identify the specific source bacteria of pneumonia and which antibiotics they are sensitive to; that is, to determine which antibiotics will work and which will not. Which of the following skin lesions is normally greater than 1 cm in size? ------ CORRECT ANSWER-----------bulla- A bulla is an elevated superficial blister filled with serous fluid and greater than 1 cm in size. An example of a bulla is a second degree burn blister. A 70-year-old female presents with a one-sided headache in the temple and tenderness over the temporal artery. She complains of vision loss in one eye. Which of the following diseases is this patient most likely to have? ------CORRECT ANSWER-----------temporal arteritis Patients with which of the following conditions should not be prescribed Cipro? ------ CORRECT ANSWER-----------Myasthenia gravis Your patient is a pregnant woman who is in her first trimester of pregnancy. She has been exposed to fifth disease. You have tested her for IgM and IgG antibodies and found a positive infection. You would do weekly fetal ultrasounds for how long after infection to detect fetal hydrops? ------CORRECT ANSWER-----------2 - 4 weeksPregnant women exposed to fifth disease in the first trimester should be serologically tested for IgM and IgG antibodies. If susceptibility or a positive infection is found, weekly fetal ultrasounds are indicated for 4 - 8 weeks after exposure or 2 - 4 weeks after infection to detect fetal hydrops. Of the following statements about herpes zoster infection (shingles) which one is false? ------CORRECT ANSWER-----------During an acute attack the varicella-zoster virus is not shed. Which of the following are consistent with a diagnosis of cystic fibrosis in an infant? ------ CORRECT ANSWER-----------chronic cough abdominal distention salty taste when kissed ****All of the above PSA is influenced by ----CORRECT ANSWER--------race, age and volume what common side effect can occur in older adults with the use of diphenhydramine ---- CORRECT ANSWER--------next day sleepiness serotonin is thought to play a role in the etiology of ----CORRECT ANSWER-------- depression the major advantage of the CAGE questionnaire is ----CORRECT ANSWER-------- brevity of questions what medication used to treat patients who have GERD has the fastest relief of heartburn symptoms ----CORRECT ANSWER--------calcium carbonate a 62 year old woman who wants the shingles vaccine says she has never had shingles but wants to make sure she does not get it should be told ----CORRECT ANSWER------- -she can get the vaccine but she could still get shingles an example of a first gen cephlasporin that is used to treat skin infections ----CORRECT ANSWER--------cephlexin (keflex) which symtpom can be used to rule out a fracture ----CORRECT ANSWER--------no symptom can be used to rule out a fracture a pregnant patient is likely to have a ----CORRECT ANSWER--------venous humm murmur and an S3 Dose of Tetanus Immune Globulin (TIG) ------CORRECT ANSWER---------250 units IM How many doses of Tdap or Td IM needed for protection after clean minor wounds. ----- -CORRECT ANSWER---------Three doses needed. If <3, unknown, or >10 years since last dose give dose of Tdap or Td for clean minor wounds. No need to give TIG. Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses of Tdap/Td. ------CORRECT ANSWER---------Tdap or Td IM & TIG Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles, burns, frostbite) ------CORRECT ANSWER---------If <3 doses Tdap or Td give both Tdap and TIG 250 units. If 3 doses in past, but none in the last 5 years then given Tdap or Td. No need to give TIG If 3 or > doses in the past When to switch from DTap to Tdap in children ------CORRECT ANSWER---------Age 7 or > given Tdap A woman becomes pregnant and received Tdap during her last pregnancy 1 year ago. When should she receive her next dose. ------CORRECT ANSWER---------Tdap is recommended for each pregnancy. "Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at preventing whooping cough in babies younger than 2 months old (CDC)". A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? - -----CORRECT ANSWER---------IPV, MMR, varicella A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? - -----CORRECT ANSWER---------IPV, vaccinia (smallpox) A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations (IZ)? ------CORRECT ANSWER---------Hepatitis B A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? ----- -CORRECT ANSWER---------varicella zoster (zostavax) and MMR Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn. What other interventions/meds should be considered during anaphylaxis? ------CORRECT ANSWER---------Supine, 911, give epinephrine: 7.5-15kg: give 0.1 mg IM x1 15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1 >30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min H1/H2 blocker po (diphenhydramine, ranitidine) IV access for fluids, Oxygen. Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids, bronchodilators s/s anaphylaxis ------CORRECT ANSWER---------Skin: pruritus, urticaria, angioedema Resp: dyspnea, wheezing (bronchospasm), stridor End-organ dysfunction: hypotension, collapse, syncope, incontinence PCV-13 ------CORRECT ANSWER---------Prevnar. Greater protection, Narrower coverage. Pneumococcal conjugate. PCV23 ------CORRECT ANSWER---------lesser protection, broader coverage In suspected leukemia, what lab work other than CBC should you obtain? ------ CORRECT ANSWER---------Serum electrolyte and creatinine levels, LFTs, and coagulation studies. If the patient appears ill or is febrile, the physician should evaluate for infection with urinalysis, urine culture, blood cultures, and chest radiography. The next step in diagnosis involves a peripheral blood smear and usually a bone marrow specimen (an aspirate or core biopsy). Normal results for TIBC are... ------CORRECT ANSWER---------250 to 450 mcg/dL for men and women. A normal platelet count ranges ------CORRECT ANSWER---------150,000 to 450,000 platelets per microliter of blood. Non-Hodgkin's Lymphoma (NHL) s/s ------CORRECT ANSWER---------enlarged lymph nodes, fatigue, weight loss and fever More than 67 types of non-Hodgkin lymphoma; more common than Hodgkins. Impacts lymphocytes. Most cases present >/= 55 y/o, can present in children. typically diagnosed at a later stage than non-hodgkins, NO Reed-Sternberg cells are identified. Hodgkin's Lymphoma s/s ------CORRECT ANSWER---------enlarged lymph nodes, fatigue, weight loss , fever, night sweats Impacts lymphocytes. Median age 39y/o, often diagnosed in early stage, arise in upper body (neck, chest, armpits, groin). Reed-Sternberg cells are present. The main difference between leukemia and lymphoma ------CORRECT ANSWER--------- In leukemia, the cancer cells are mainly in the bone marrow and blood. In lymphoma they tend to be in lymph nodes and other tissues. NT-proBNP (N-Terminal-ProBNP) normal ranges ------CORRECT ANSWER---------No diagnosis of HF: Less than 125 pg/mL for patients aged 0-74 years Less than 450 pg/mL for patients aged 75-99 years In heart failure, the following NT-proBNP levels could mean your heart function is unstable: Higher than 450 pg/mL for patients under age 50 Higher than 900 pg/mL for patients age 50 and older what level of serum lead is indicative for lead poisoning? ------CORRECT ANSWER------ ---↑ lead level (> 5 μg/dL) on venous blood sample. chelation at 40-45mcg/dL. peripheral blood smear: microcytic hypochromic anemia. basophilic stippling of RBCs. high iron, high ferritin, low TIBC Normal ESR ------CORRECT ANSWER---------men 10-22, women 10-29 Classification of QTc prolongation ------CORRECT ANSWER---------normal men ≤430 ms; women ≤450 ms; borderline men 431-450 ms; women 451-470 ms; abnormal men ≥451 ms; women ≥471 ms. What intraoccular pressure correlates with glaucoma? ------CORRECT ANSWER--------- Tonometry measuring 22mmHg or greater. Normal range 10-21mmHg When does the anterior fontanel close ------CORRECT ANSWER---------12-15 months When does the posterior fontanel close ------CORRECT ANSWER---------3 months What snellen chart result requires a referral to an ophthalmologist? When is the soonest one can test with the snellen chart? ------CORRECT ANSWER---------20/40, 6 y/o Myesthenia gravis- pathophysiology & 1st s/s ------CORRECT ANSWER--------- antibodies (immune proteins produced by the body's immune system) block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents the muscle from contracting. This is most often caused by antibodies to the acetylcholine receptor itself, but antibodies to other proteins, such as MuSK (Muscle- Specific Kinase) protein, also can impair transmission at the neuromuscular junction. 1st s/s might be ptosis weakness after exercise, better after rest. typically 20-40 y/o women dip percentages of white blood cell types from most to least. ------CORRECT ANSWER------ ---Neutrophils - (40-60%) Lymphocytes - (20-40%) Monocytes - (2-8%) Eosinophils - (1-4%) Basophils - (0.5-1%) Parkinson's disease --path and typical meds. ------CORRECT ANSWER---------Problem: lack of dopamine Motor symptoms (rocks a lots to get out of chair): tx is to increase dopamine with Levodopa. Amantadine, Pramipexole Non-motor symptoms: treat with anticholinergics to alleviate tremor (resting) and rigidity. trihexyphenidyl, benztropine Myerson sign (Glabella tap reflex) Common in which Dz? ------CORRECT ANSWER---------Parkinson's dz. They will blink every time you tap over the bridge of the nose. Where are bouchard's nodes and what are they associated with? ------CORRECT ANSWER---------PIP; noted in both OA and RA Polycythemia vera might present with tenderness in which location? ------CORRECT ANSWER---------burning pain hands/feet. It's considered a myeloproliferative neoplasm. Increased erythrocytes (erythrocytosis) and might precent with increased WBCs and platelets as well. When to consider an MRI ------CORRECT ANSWER---------visualization of soft tissues (Cancer, brain, cartilage, muscles, inflammation), tissues with high water content. stress fx Can someone with a cochlear implant have an MRI? ------CORRECT ANSWER---------It depends. Plan ahead and get info from the manufacturer so that patient is prepared. Bacillus anthracis prophylaxis ------CORRECT ANSWER---------Ciprofloxacin or Levofloxacin for 60 days and anthrax vaccine adsorbed (BioThrax) gram + rod after spore contact r/t infected animals or contaminated animal products (hide, wool, hair) or raw animal products. ------CORRECT ANSWER---------Cutaneous anthrax: GI anthrax Respiratory anthrax Injection anthrax Bell's palsy pain ------CORRECT ANSWER---------may present with ipsilateral eye, jaw, ear or post auricular pain. increased sensitivity to sound on the affected side is possible. HA and decreased taste may accompany the condition. valacyclovir and prednisone for 1 week. s/s pregnancy induced HTN ------CORRECT ANSWER---------facial, UE edema, blurred vision, proteinuria and HAs mean age to ride a bike with training wheels ------CORRECT ANSWER---------5 to 6 y/o Hegar's sign ------CORRECT ANSWER---------softening of the lower portion of uterus; probable sign of pregnancy What is contraindicated in placenta previa? ------CORRECT ANSWER---------pelvic exams, rectal exams or TVUS. avoiding activities that might cause contractions, including having sex, douching, using tampons, or engaging in activities that can increase your risk of bleeding, such as running, squatting, and jumping. symptoms of placenta previa ------CORRECT ANSWER---------bright red blood in the 2nd trimester or later WITHOUT pain Atypical PNA radiological pattern includes... Atypical PNA etiologies include... ------CORRECT ANSWER---------Patchy inflammatory changes, often confined to the pulmonary interstitium. Atypical bacterial etiologies such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophilia. Viral and fungal pathogens may also create the radiological and clinical picture of atypical pneumonia. Vitamin supplementation of ____________ should be recommended for all breastfed infants on their 1st PCP visit ------CORRECT ANSWER---------400 IU/day of Vitamin D; decreases the risk of rickets. recommend OTC multivitamin supplement or vitamin D supplement. after TIA (resolution of symptoms within minutes to 2 hrs) what is the approximate risk of stroke? ------CORRECT ANSWER---------10-20% of patients will have a stroke in 90 days. cluster HA ocular symptoms. also list the typical length of HA. ------CORRECT ANSWER---------miosis (constriction), ptosis, tearing. 15-180 minutes. What risk is associated with MAOIs and aged/fermented foods (high in tyramine) ------ CORRECT ANSWER---------HTN crisis Metformin Contraindications/Precautions ------CORRECT ANSWER---------renal, hepatic, ETOH, conditions r/t hypoxia (cardiac/pulmonary), sepsis/dehydration (r/t risk of lactic acidosis), advanced age. What is myxedema? ------CORRECT ANSWER---------"Myxedema is a term generally used to denote severe hypothyroidism. Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism. In this setting, myxedema refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area. When skin changes occur in hyperthyroidism, mostly Graves disease, it's called pretibial myxedema"- Medscape What tool should be utilized to diagnose fibromyalgia? ------CORRECT ANSWER--------- Widespread Pain Index (American College of Rheumatology) What WPI score and SS scale score is diagnostic for fibromyalgia? ------CORRECT ANSWER---------A patient is diagnosed with fibromyalgia if the following three conditions are met: The WPI score is 7 or higher and the SS scale score is 5 or higher or the WPI is 3-6 and the SS scale score is 9 or higher The symptoms have been present at a similar level for at least 3 months The patient does not have another disorder that would otherwise explain his or her pain treatment for polymyalgia rheumatic ------CORRECT ANSWER---------low dose prednisone for 3 month to 3 years as this is a self-limiting illness Name 2 other med classes associated with CDAD (diarrhea up to 10 weeks without fever). r/o pseudomembranous colitis ------CORRECT ANSWER---------cephalosporins and fluroquinolones What populations are fluroquinolones contraindicated? ------CORRECT ANSWER-------- -Children and pregnancy. What to give an elderly patient who was incidentally placed on cimetidine (beers list) and had subsequent neuropsychiatric changes? ------CORRECT ANSWER--------- Physostigmine Name additional rationales for avoiding benadryl in the elderly besides risk of confusion. ------CORRECT ANSWER---------It may worsen glaucoma, increase HTN and thickened secretions may be another precaution in the the patient with lung dz. Is an allergy to SULFA drugs a contraindication for sulfonylureas? (glipizide, glyburide, glimepiride) ------CORRECT ANSWER---------NO Prior to starting atypical antipsychotics what lab tests should be obtained? What AE will you monitor for? ------CORRECT ANSWER---------fasting blood glucose, fasting lipid profile, weight. These meds will increase lipid profile and increase risk of obesity, hyperglycemia and DMII. Watch for hypotension and sedation. 1st line drug class for OCD (obsessive-compulsive disorder) ------CORRECT ANSWER- --------SSRI Benzodiazepine with the shortest ½ life ------CORRECT ANSWER---------Triazolam RhoGam (Rh (D) Immune Globulin) prevents... ------CORRECT ANSWER---------rhesus disease (hemolytic disease of the newborn). It's a solution of IgG anti-D antibodies that suppresses the mother's immune system from attacking Rh-positive blood cells 1st line gout therapy ------CORRECT ANSWER---------Indomethacin 50mg TID prn and colchicine (anti-inflammatory) 1.2 mg at onset of symptoms and 0.6mg 1 hr later on day one, 0.6mg BID until symptoms resolve. Colchicine can be taken daily for prophylaxis. SE of colchicine ------CORRECT ANSWER---------GI upset: abd pain, nausea, diarrhea CCB side effects ------CORRECT ANSWER---------HA, peripheral edema, dizziness, flushing, weakness Meds contraindicated in G6PD deficiency anemia (name 7 meds/classes) ------ CORRECT ANSWER---------Risk of hemolysis with the following: nitrofurantoin, sulfa, NSAIDs, anti-malarials. Contraindications to loop diuretics (name 3) ------CORRECT ANSWER---------Low B/P <90mmHg, severe hyponatremia/hypokalemia, acidosis What 3 agents are used for prophylaxis of Pneumocystis Jirovecii PNA ------CORRECT ANSWER---------Bactrim, dapsone, aerosolized pentamidine Meds for migraine prophylaxis ------CORRECT ANSWER---------propranolol, timolol, amitriptyline, divalproex, sodium valproate, topiramate How long is a full therapeutic trial for migraine prophylaxis? ------CORRECT ANSWER-- -------2-6 months Moderate dose statins that can be ramped up to high dose. ------CORRECT ANSWER-- -------Rosuvastatin 5-10mg Atorvastatin 10-20mg High dose statin therapy ------CORRECT ANSWER---------Rosuvastatin 20-40mg Atorvastatin 40-80mg Symptoms of acute drug-induced hepatitis (statin therapy) ------CORRECT ANSWER---- -----dark colored urine, fatigue. absence of generalized muscle soreness. obtain LFTs muscle soreness in new statin user (isolated or generalized) ------CORRECT ANSWER- --------CK to r/o rhabdomyolosis anticholinergic drug overdose symptoms ------CORRECT ANSWER---------flushing, fever/tachycardia, urinary retention, delirium/hallucinations, mydriasis MAOIs (monoamine oxidase inhibitors) ------CORRECT ANSWER---------Phenelzine (Nardil) is an example. Hypertensive crisis may occur with tyramine food ingestion, so care must be taken to avoid these substances. Educate the client to avoid all medications until discussed with provider. physiologic galactorrhea of the newborn onset and duration ------CORRECT ANSWER-- -------onset 3-4 days of life; breast engorement should resolve within the first 2 months of life neonatal ocular chemosis, mucoid eye discharge, eyelid edema around 2 weeks old ---- --CORRECT ANSWER---------suspect chlamydial conjunctivitis