APEA PRE-PREDICTOR ACTUAL EXAM TEST BANK 850+ QUESTIONS AND CORRECT DETAILED ANSWERS WIT, Exams of Nursing

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APEA PRE-PREDICTOR ACTUAL EXAM TEST BANK

850+ QUESTIONS AND CORRECT DETAILED

ANSWERS WITH RATIONALES (VERIFIED

ANSWERS) |ALREADY GRADED A+

A 38-yo pregnant patient at 18 weeks gestation, complains of feeling light-headed when standing. Which of the following is an appropriate response by the NP? - CORRECT ANSWER>>Blood pressure normally decreases during pregnancy and can cause this symptom. Blood pressure normally decreases during pregnancy, reaching the lowest point during the second or third trimesters and rising there after. Patient education to rise slowly from sitting or lying is important. Low blood glucose may be the etiology, but an oral glucose tolerance test at this point is not indicated. A fasting blood glucose could be ordered, however, an electrocardiogram is not indicated. An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure? - CORRECT ANSWER>>Weight gain. Early signs of heart failure include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension. A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the most likely diagnosis and the most appropriate action? - CORRECT ANSWER>>Scarlet fever; treat with antibiotics. This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia lines. A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? - CORRECT ANSWER>>6 weeks.

The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of 4-6 weeks before checking the patient's TSH. A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about: - CORRECT ANSWER>>testicular self-examination. Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. The treatment of choice for chronic bacterial prostatitis (CBP) is: - CORRECT ANSWER>>a flouroquinolone twice daily for 3 weeks to 4 months. The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with Bactrim-DS is only about 30-40%. A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the most likely underlying conidition predisposing her to recurring candidal vaginitis? - CORRECT ANSWER>>Diabetes. A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this patient. Which of the following is NOT a characteristic of the S3 heart sound? - CORRECT ANSWER>>The sound is high-pitched and occurs just prior to the S1 heart sound. The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is produced by rapid ventricular filling and is best auscultated in the mitral area. It is a common finding with right-sided heart failure, rapid growth, and the last trimester of pregnancy. Following the finding of prostate gland abnormalities on DRE, the NP orders the appropriate labs. Whem preparing to review lab reports with the patient, the nurse practitioner knows all of the following are true EXCEPT: - CORRECT ANSWER>>normal PSA is 10ng/ml or less. Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated with BPH. A 10 or greater PSA level suggests prostate cancer. Positive serum acid phosphatase is associated with malignancy of the prostate gland with bone metasasis. A 66 yo female presents to your clinic. She states that yesterday evening she had chest pain for 20 - 30 minutes. Which finding most strongly correlates with myocardial infarction? - CORRECT ANSWER>>Elevated Troponin I levels

An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK may be elevated from an IM injection, surgery, ot any type of extensive skeletal muscle trauma or prolonged, strenuous physical exertion. ST segment depression on EKG usually indicates an ischemic myocardium, but, not necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB bands are specific for myocardial smooth muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most accurate marker of cardiac damage, because it is more specific and sensitive than CK MB, is a troponin measurement. What is a secondary cause of hyperlipidemia? - CORRECT ANSWER>>hypothyroidism Hypothyroidism is a common secondary cause of hyperlipidemia. In the evaluation of a patient with hyperlipidemia, a TSH should always be checked and corrected before attempting treatment for hyperlipidemia. Other possible causes of seconday hyperlipidemia include pregnancy, excessive weight gain, excessive alcohol intake, insulin resistance or deficiency, obstructive liver disease, and uremia. Some medications can produce secondary hypothyroidism too: thiazide diuretics, some beta-blockers, oral contraceptives, and corticosteroids. A 35-yo male presents with a complaint of low pelvic pain, dysuria, hesitancy, urgency, and reduced for of stream. The nurse practitioner suspects acute bacterial prostatitis. The NP would appropriately collect all of the following specimens EXCEPT a: sterile in-and-out catheter urine specimen. - CORRECT ANSWER>>A sterile in-and-out catheter specimen would identify only organisms in the bladder and would not differentiate between bladder, kidney, or prostate site infection. The sequence for obtaining specimens when prostat infection is suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder urine, and 3. voided post-prostate massage urine. A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should the nurse practitioner advise her to do to minimize her risk of pregnancy? - CORRECT ANSWER>>Double today's dose and tomorrow's dose and use a barrier method for the rest of the month. If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled and a barrier method recommended for the remainder of the cycle. Cranial Nerve VIII - CORRECT ANSWER>>Acoustic (Hearing and balance) Cranial nerve IX - CORRECT ANSWER>>Glossopharyngeal- swallowing and rise of the palate, gag reflex Cranial Nerve XI - CORRECT ANSWER>>Spinal Accessory (upper trapezius)

Deep tendon reflex - CORRECT ANSWER>>Ankle- S1 primarily Knee- Lumbar 2,3, Supinator(brachioradialis)-C5, BicepTriceps-C6, Stroke risk scale - CORRECT ANSWER>>CHADS C-Congestive heart failure H-Hypertension A-Age >75 years D- Diabetes S-prior Stroke/TIA In the majority of children, the first permanent teeth start to erupt at the age of 6 years. Which of the following are the first permanent teeth to erupt in this time period? A. First Molars B. Second Molars C. Lower or upper incisors D. Canines - CORRECT ANSWER>>A. First Molars All of the following are classified as activities of daily living (ADLs) except: A. ability to feed self B. Ability to manage bladder and bowel elimination C. Personal hygiene and grooming D. Grocery Shopping - CORRECT ANSWER>>D. Grocery shopping You note the following result on a routine urinalysis of a 37-year old primigravida who is at 30 weeks gestation. Leukocyte=trace, nitrite=negative, protein=2+, blood=negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A.HELLP syndrome B. Pregnancy-induced hypertension (pre-eclampsia) C. Eclampsia of pregnancy D. Primary hypertension - CORRECT ANSWER>>B. Pregnancy-induced hypertension (preeclampsia). Classic triad of symptoms of preeclampsia include hypertension, edema (weight gain), and proteinuria.

The mother of a 12 month old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A. Fifth Disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes - CORRECT ANSWER>>B. Roseola Infantum (Exanthema subitum) A 70-year old male patient complains of a bright red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on Bayer aspirin, 1 tablet a day. Which of the following is most likely? A. Corneal abrasion B. Acute bacterial conjunctivitis C. Acute uveitis D. Subconjunctival hemorrhage - CORRECT ANSWER>>D. Subconjunctival hemorrhage. Bright red blood in a sharply defined area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage. A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH is 4.0. There are very few leukocytes and no RBCs are seen on the wet smear. Which of the following is most likely? A. Atrophic vaginitis B. Bacterial Vaginosis C. Trichomoniasis D. This is a normal finding. - CORRECT ANSWER>>A. Atrophic vaginitis. Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0- 5.0 (acidic) The most common type of skin malignancy is: A. Squamous cell cancer B. Basal skin cancer C. Melanoma D. Dysplastic nevi - CORRECT ANSWER>>B. Basal skin cancer. It is several times more common that squamous cell skin cancer according to the NIH.

Koplik's spots are associated with: A. Poxvirius infections B. Measles C. Kawasaki's disease D. Reye's syndrome - CORRECT ANSWER>>B. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and koplik's spots on buccal mucosa At what level of prevention would you classify for lung cancer? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Primordial prevention - CORRECT ANSWER>>D. primordial prevention. Screening for lung cancer is not currently recommended in the general population, but it is secondary prevention. A test called the visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central vision C. Visual acuity D. Accomodation - CORRECT ANSWER>>A. Peripheral vision What is the most common cause of Cushing's syndrome? - CORRECT ANSWER>>Administration of a glucocorticoid or ACTH. Iatrogenic Cushing's syndrome is the most common type. Exogenous glucocorticoid administration produces a Cushing's Syndrome that is reversible by discontinuation of the medication. A patient with no significant medical history has vericose veins. She complains of '"aching legs". The intervention that will provide the greatest relief for her complaint is to: - CORRECT ANSWER>>Elevate her legs periodically. The intervention that will provide the greatest relief for this patient is elevating her legs periodically. This will facilitate venous return. Use of support stockings will prolong the length of time she is able to stand in place, but will not provide relief after her legs begin aching. Support stockings should be applied prior to getting out of bed. A 25-yo female patient presents for a routine well-women exam. On physical exam, the NP notes a scant nipple discharge, absence of palpable mass, and absence of lymph node enlargement. What is the most likely diagnosis? - CORRECT ANSWER>>Itraductal papilloma.

Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple discharge located in the ductal system near the areola. Breast cancer, although usually nontender, may present with pain. Chest wall syndrome may present in some women as breast pain. Fibrocystic breast disease often presents with bilateral breast pain. According to the ANA, the role of the NP who provides primary health care is the: - CORRECT ANSWER>>Direct nursing care role. The NP with a traditional nursing care role is a primary health care provider. Increasing numbers of nurse practitioners are assuming indirect roles such as educator, administrator, researcher, and consultant. An 8-mo male presents with hemarthrosis of both knees and hematuria. The parents give no history of trauma, but say " he has always bruised easily" The most likely diagnosis is: - CORRECT ANSWER>>A type of hemophilia. Hemophilia is usually diagnosed within the first year of life. It commonly presents with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding times. The nurse practitioner is following a child with juvemile rheumatoid arthritis (JRA) who has been previously diagnosed and is being managed for the disease by a pediatric rheumatologist. The mother asks for information about the child's long-term prognosis. The appropriate reply is that: - CORRECT ANSWER>>most children with JRA achieve complete remission by adulthood, but its effects might cause lifelong limitations. Although the active disease does not continue into adulthood, the contractures, growth retardation, bone deformities, and visual impairment associated with JRA may lead to lifelong functional impairments. A comprehensive treatment program involving physical therapy, occupational therapy, nutrition, education, and regular opthalmologic care can limit residual functional limitations. Approximately 70% of the organisms found in canine oral and nasal fluids, and consequently in fresh dog bite wounds, are: - CORRECT ANSWER>>Staphylococcus and Pasteurella multocida. All of these organisms are found in canine oral and nasal fluids, and cultured from fresh dog bite wounds, but the most common (70%) are Staph and Pasteurella multocida. Education of women with fibrocystic breast disease should include which of the following statements? - CORRECT ANSWER>>Caffeine may trigger breast pain. Avoidance of all methylxanthines (eg coffee, tea, chocolate) has been shown to reduce breast pain in women with fibrocystic breast disease. It is usually a benign condition, not a precursor of malignancy. Mammography is recommended once at age 35 years, at least every 1-2 years

after age 40, and then annually beginning at age 50 years. Oral contraceptives may help reduce cyclical pain and swelling. Congenital heart disorders present with symptoms at: - CORRECT ANSWER>>birth, infancy, or in childhood. A common misconception is that congenital disorders always present symptomatically at birth. They can present at various times throughout childhood and are classified as cyanotic or acyanotic. Cardiac disorders in infants and children may be acquired from rheumatic fever or kawasaki syndrome. A 21-yo patient presents with abdominal guarding, rigid abdominal musculature, rebound tenderness at McBurney's point, and leukocytosis. What is the most likely diagnosis? - CORRECT ANSWER>>Appendicitis. McBurney's point is the RLQ abdominal landmark for the appendix. Rigid abdominal musculature, rebound tenderness, and positive psoas sign (inflamed psoas muscle), indicates inflammation of the peritoneum. Cholecystitis presents with RUQ pain and positive Murphy's inspriatory arrest. Ilcerative colitis presents with LLQ pain. Pain associated with pancreatitis is typically in the epigastric region. Atenolol (Tenormin) should be avoided in: - CORRECT ANSWER>>a 43-yo female with asthma. Atenolol is a beta blocker. It should be avoided in pateints with asthma or other bronchospastic conditions. These patients often require beta stimulation, not beta blockade. Although atenolol is a beta 1-selective agent, at higher doses beta 2 receptors (bronchial and vascular) are blocked. Beta blockers, specifically atenolol, are beneficial post-myocardial infarction because they have demonstrated a reduction in morbidity and mortality. All of the following interventions with pediatric patients are appropriate EXCEPT: - CORRECT ANSWER>>Pre-medicate the patient prior to all painful interventions. Pre-medication is not warranted prior to all painful interventions. For example, premedication is not warranted prior to routine immunizations but it certainly is prior to suturing. Pain management should be an integral part of patient management. Infants with veliac disease (gluten eneteropathy) are at risk for multiple complications. The most urgen complication of this disease is: - CORRECT ANSWER>>Intususseption or volvulus. Intuseusseption and volvulus are surgical emergencies. Delay releasing the invaginated or "telescoped" bowel (intususseption), or releasing the twisted bowel (volvulus) may result in tissue death and gangrene, perforation, peritonitis, and/or sepsis, and fatality. There is also a high rate of intususseption and volvulus among infants with cistic fibrosis.

Which activities are NOT characteristic of preschool children? - CORRECT ANSWER>>Always follow rules during playground games. Since preschoolers are just beginning to learn moral behaviors, they often cheat to win. While most preschoolers toilet independently, accidents occasionally occur and bed-wetting is not unusual. The use of a security item such as a blanket is common. A 50yo, non-smoker, with no co-morbidity presents to the clinica and is diagnosed with pna. His vital signs are normal except for temperature of 101.6 degrees. A sputum specimen is collected and sent for culture and sensitivity. What action should the nurse practitioner take today? - CORRECT ANSWER>>Start Clarithromycin (Biaxin) 500mg 2 times a day for 10 to 14 days. Most treatment guidelines for outpatient pna in non-smokers without co-morbidity and 60 years of age or younger, recommend erythromycin or another macrolide like Biaxin. Pcn s indicated for patient swith pneumococcal pna and ciprofloxacin is recommended for Legionella species. A 38 year old patient is being treated the by the NP for heavy vaginal bleeding secondary to multiple uterine leiomyomas. Her uterus is greater than 12 weeks gestational size, her hematocrit is 28%, and she has not responded to hormonal therapy. Which of the following would be the most appropriate intervention at this time? - CORRECT ANSWER>>Obtain a gynecological consultation Gynecological consultation is recommended for a patient with a uterus greater that 12 weeks gestational size, significant anemia (hct <30),. o a normal endometrial biopsy with failure to respond to hormonal therapy. What maternal situation is considered an absolute contraindication to breastfeeding? - CORRECT ANSWER>>Early HIV detection There are few absolute contraindications to breastfeeding. HIV infection and IV drug abuse are 2 contraindications. A 21 yo college student presents to the sudent health center with copious, markedly purulent discharge from her left eye. The nurse practitioner should suspect: - CORRECT ANSWER>>gonococcal conjunctivitis. A purulent and copious discharge should alert the nurse practitioner to the likely possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic treatment and immediate referral to an opthalmologist for evaluation.

Babies should begin oral iron supplementation: - CORRECT ANSWER>>4-6 months of age. Generally, full term infants who are breadt-fed have sufficient stores of iron to last through the first 4-6 months of life. Earlier supplementation may be m=necessary for premature infants, infants who are breastyfed exclusively beyond the first 6 months of age, and infants who begin drinking cow's milk prior to 1 year of age. Which item is NOT implicated in erectile dysfunction (ED)? - CORRECT ANSWER>>Urinary tract infection (UTI) Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can result in ED> Many medications can cause ED, particularly the antihypertensives (Vasotec) and the antidepressants (Paxil). Other activities like heavy smoking, drug abuse, and alcoholism can also lead to ED. Expected spriometry readings when the patient has chronic emphysema include: - CORRECT ANSWER>>Increased total lung capacity (TLC). Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and total lung capacity is increased with emphysema. RV, VC, and FEV-1 spirometry readings are the same whether COPD is due to chronic emphysema or chronic bronchitis, however, TLC is normal or only slightly increased with chronic bronchitis. Physical exam findings consistent with emphysema include all of the following EXCEPT: - CORRECT ANSWER>>pallor and cyanosis of the mucosa and nailbeds. Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_. Emphysema (Type A COPD, the "pink puffer") is not associated with pallor or cyanosis. Increased AP dianeter produces a "barrel chest". The normal chest is elliptical whereas the barrel chest is round. The muscles of the thorax appear thin and wasted while the accessory muscles of respiration are hypertrophied. Breath sounds are minished and cough is weak and ineffective. Which laboratory test is useful in the diagnosis of spontaneous abortion? - CORRECT ANSWER>>Serial quantitative beta-huma chorionic gonadotropin levels. Serial quantitative beta-human chorionic gonadotropin levels are the most useful for diagnosing spontaneous abortion. The levels progressively decline. The most acceoted recommendation regarding skin cancer prevention is: - CORRECT ANSWER>>avoidance of excessive sun exposure. Avoidance of excessive sun exposure is the most accepted recommendation for prevention of skin cancer. All the other items are recommended by particular groups, but are not as widely

accepted. Clinicians should remain alert for suspicious lesions in fair-skinned men and women

65 years, those with atypical moles, those with > 50 moles. These groups have a substantially increased risk for melanoma. What prophylaxis medication is recommended for the patient under 35 years of age with a positive ppd? - CORRECT ANSWER>>isoniazid (INH) The CDC recommends administration of isoniazid to persons under 35 years of age with a positive PPD. The goal of this treatment is to prevent progression from latent infection to active infection. The other medications are used to treat active TB, but not for prophylaxis. The diagnosis of Meniere's disease is based on: - CORRECT ANSWER>>The exclusion of other pathologies. Most cases of Meniere's disease are idiopathic and the diagnosis is based on the exclusion of other pathologies. Central vertigo is present with many vestibular problems. Low frequency hearing loss is more commonly associated with Meniere's disease. MRI is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease. The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may: - CORRECT ANSWER>>Mask symptoms of hypoglycemia. Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on betablockers should be taught to look for this specific symptom as a possible indication of hypoglycemia. An adult female patient is seeking information about her ideal weight. She is 5 feet 7 inches tall. Using the "height-weight formula" what is her ideal body weight? - CORRECT ANSWER>> lbs The height-weight formula is a quick method of determining ideal weight. Females allow 100 lbs for the first 5 feet of height plus 5 lbs for each additional inch. Males allow 106 lbs for the first 5 feet plus 6 lbs for each additional inch. This method can only be used as an estimate because it does not account for body composition or age. The nurs practitioner is caring for a 19 year old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate INITIAL treatment for this patient is: - CORRECT ANSWER>>Oral ferrous sulfate. With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed, but may be required in the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron.

A male patient with chronic atrial fibrillation takes a generic brand of Coumadin (warfarin). He should report all of these to his health care provider EXCEPT: - CORRECT ANSWER>>one missed dose of warfarin. This patient takes warfarin for prevention of emboli secondary to chronic atrial fibrillation. According to the NHLBI and ACCP, warfarin is the standard of care when anticoagulation is required for this condition. Warfarin is a drug with a narrow therapeutic index. This means that fluctuation in its level (increased or decreased) can potentiall cause big changes in its therapeutic effect. Consequently, warfarin levels are checked frequently to maintain therapeutic levels. If changes such as medication substitutions occur, warfarin levels should be checked in 37 days. Levels should be checked minimally every 4-6 weeks once regulation has occurred. While it is important NOT to omit doses of warfarin, this is the least important of all the choices because the effect of warfarin lasts beyond 24 hours. Which of the following medication or medication class that does NOT have dizziness or vertigo as potential adverse side effects? - CORRECT ANSWER>>Meclizine (Antivert) Dizziness is associated with a sensation of body movement when there is no body movement occurring. (The person is spinning and the room is not). Vertigo is the sensation that the person is still and the room is spinning. There is no associated muscle weakeness or visual disturbance with either of these conditions. The most common causes are related to drug ingestion, hypotension, inner or middle ear pathology, and positional vertigo. Dizziness is an adverse reaction associated with certain antibiotics (gentomycin and strptomycin) and high-dose salicylates. Vertigo is associated with certain inner ear pathology such as labyrinthitis and Meniere's disease. Meclizine is a long-acting antihistamine which is used to treat chronic vertigo. A PPD is considered positive at 5 millimeters or more for which population? - CORRECT ANSWER>>Confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with a chest X-ray suggestive of TB A PPD greater than or equal to 10 mm is considered positive for injecting drug users known to be HIV negative, occupants of long-term care facilities, age less than 4 years, groups with a high prevalance for TB, the medically underserved, and healthcare workers. A PPD is considered positive at 15mm or more in those with no known risk factors. Considering mortality statistics for the adolescent age group. education targeted toward this group should first focus on: - CORRECT ANSWER>>alcohol abuse. Alcohol is the most commonly used psychoactive substance in the United States today. It has been used by about 90% of adolescents by 16 years of age. Motor vehicle accidents related to

driving under the influence of alcohol are the leading cause of death in the 15 - 24 year old age group. A patient with moderate persistent asthma will probably be most effectively managed with daily: - CORRECT ANSWER>>inhaled steroids and long acting bronchodilators. A patient with moderate persistent asthma has symptoms daily. He is best managed with daily medications of inhaled corticosteroids and long acting bronchdilators. Oral leukotriene blockers may be added to this regimen. A child has just scalded her index finger with hot water at home. The mother calls the NP within 5 minutes of the injury. All of the following are appropiate instructions for the mother regarding the care of the patient with a 2nd degree burn EXCEPT: - CORRECT ANSWER>>Applying butter, cooking oil, or lanolin for pain relief. Flushing first or second degree burn with cool water is appropriate to prevent further thermal injury and to provide pain relief. Oil should NEVER be applied to a burn injury. Consider consultation for burns in patients who are under 10 years of age and over 50 years of age. Physician referral is recommended for all 3rd degree burns, for 2nd and 3rd degree burns involving more than 10% of the body surface area, any deep thickness burns involving more than 2% of the body surface area, and burns involving the face. What is the recommended treatment for cat scratch disease? - CORRECT ANSWER>>usually self-limiting and presents with lymphadenopathy that goes away on it's own; severe cases may benefit from azithromycin What is the most common cause of traveler's diarrhea? - CORRECT ANSWER>>e coli What bacteria is responsible for causing cat scratch disease? - CORRECT ANSWER>>bartonella henselae What are the 4 different components of tetralogy of fallot? - CORRECT ANSWER>>overriding aorta, pulmonary stenosis, right ventricular hypertrophy, and a ventricular septal defect What does the murmur auscultated in tetralogy of fallot sound like? - CORRECT ANSWER>>systolic murmur best heard at the left upper sternal border What does the murmur auscultated in a ventricular septal defect sound like? - CORRECT ANSWER>>systolic murmur best heard at the left lower sternal border

Where is the aorta best auscultated? - CORRECT ANSWER>>at the second ICS to to the right of the sternum Where is the pulmonary artery best auscultated? - CORRECT ANSWER>>at the second ICS to the left of the sternum What is a scotoma? - CORRECT ANSWER>>a blind spot or aura that obstructs part of your vision Is presbyopia nearsightedness or farsightedness? - CORRECT ANSWER>>farsightedness meaning it can be harder to see things up close, such as reading a newspaper and may need to hold it farther away or use reading glasses Is myopia nearsightedness or farsightedness? - CORRECT ANSWER>>nearsightedness meaning it is hard to see things far away Do cataracts cause myopia or presbyopia? - CORRECT ANSWER>>myopia; meaning nearsightedness and they make things blurry that are farther away which is why driving at night becomes difficult What is the USPSTF's recommendation on scoliosis screening for adolescents? - CORRECT ANSWER>>insufficient When should adolescent girls be screened for scoliosis? - CORRECT ANSWER>>as early as 10 years old and then again at age 12 When should adolescent boys be screening for scoliosis? - CORRECT ANSWER>>between age 12 - 13 What is Auspitz sign? - CORRECT ANSWER>>the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques A positive Auspitz sign is indicative of what? - CORRECT ANSWER>>psoriasis When are pregnant women screening for gestational diabetes? - CORRECT ANSWER>>week 2428

What is round ligament pain? - CORRECT ANSWER>>a deep, sharp, stabbing or stretching sensation that begins or worsens with movement and can be unilateral or bilateral. This is a normal and benign part of pregnancy What are the components of the fetal biophysical profile? - CORRECT ANSWER>>nonstress test (heart rate monitoring), amniotic fluid analysis, fetal movements, fetal tone, and fetal breathing How is the fetal biophysical profile performed? - CORRECT ANSWER>>via ultrasound and fetal heart rate monitoring When is the fetal biophysical profile often performed? - CORRECT ANSWER>>in the third trimester, often after week 28- 32 What is a normal kick count in pregnancy? - CORRECT ANSWER>>at least 10 kicks in a consecutive two hour period How much weight should an underweight woman gain in pregnancy? - CORRECT ANSWER>>2840 pounds How much weight should a normal weight woman gain in pregnancy? - CORRECT ANSWER>>25-35 pounds How much weight should an overweight woman gain in pregnancy? - CORRECT ANSWER>>1525 pounds How much weight should an obese woman gain in pregnancy? - CORRECT ANSWER>>11- 20 pounds Underweight and normal weight woman should be gaining how much weight per week in their second and third trimesters? - CORRECT ANSWER>>1 pound Overweight and obese women should be gaining how much weight per week in their second and third trimesters? - CORRECT ANSWER>>0.5 pounds What is the biggest risk associated with scabies? - CORRECT ANSWER>>secondary infection due to itching

What do scabies look like on the skin? - CORRECT ANSWER>>red papular bumps that have s shaped burrows on them; may have fluid coming from them Sickle cell anemia is what type of anemia? - CORRECT ANSWER>>normocytic How is sickle cell anemia diagnosed? - CORRECT ANSWER>>hemoglobin electrophoresis Which age group is rheumatic fever most common in? - CORRECT ANSWER>>children ages 5- 15 What are the major symptoms of rheumatic fever? - CORRECT ANSWER>>carditis, arthritis, chorea, erythema marginatum (rash), subcutaneous nodules What are the minor symptoms of rheumatic fever? - CORRECT ANSWER>>fever, elevated ESR, prolonged PR interval How do we treat rheumatic fever? - CORRECT ANSWER>>refer to the hospital What is chorea? - CORRECT ANSWER>>abnormal involuntary movements What are the main s/s of rubeiola (measles) - CORRECT ANSWER>>Koplick spots + the 3 c's - cough, coryza, conjunctivitis GABHS infection puts individuals at the highest risk of developing what sequelae? - CORRECT ANSWER>>peritonsillar abscess, glomerulonephritis, rheumatic fever What is the diagnostic criteria for acute rheumatic fever? - CORRECT ANSWER>>2 major criteria OR 1 major + 2 minor criteria PLUS evidence of a recent strep infection When can a breastfeeding mother breast feed again after drinking alcohol? - CORRECT ANSWER>>wait 2-3 hours per drink consumed before breastfeeding again Can a mother take methadone while pregnant and breastfeeding? - CORRECT ANSWER>>yes Does subsequent mean before or after? - CORRECT ANSWER>>after What is the recommended treatment for Kawasaki disease? - CORRECT ANSWER>>refer to the ED, will likely need IVIG and high dose aspirin

What are the s/s of Kawasaki disease? - CORRECT ANSWER>>fever + CREAM (conjunctivitis, rash, erythema of palms and soles, adenopathy cervical, mucous membranes) Kawasaki disease is caused by what? - CORRECT ANSWER>>an acute vasculitis of the small and medium blood vessels What is the main difference between Kawasaki disease and scarlet fever? - CORRECT ANSWER>>KD has conjunctivitis and scarlet fever does not The rash associated with acute rheumatic fever - CORRECT ANSWER>>erythema marginatum The rash associated with parvovirus aka slapped cheek aka fifth disease - CORRECT ANSWER>>erythema infectiosum What does erythema marginatum of rheumatic fever look like? - CORRECT ANSWER>>erythematous with a central clearing, not itchy The medical term for tennis elbow - CORRECT ANSWER>>lateral epicondylitis What is the leading cause of death in anorexia? - CORRECT ANSWER>>suicide Erikson stage from birth to 18 months - CORRECT ANSWER>>trust vs mistrust Erikson stage from 18 months to 3 years - CORRECT ANSWER>>autonomy vs shame and doubt Erikson stage from 3-5 years - CORRECT ANSWER>>initiative vs guilt Erikson stage from 5-13 years - CORRECT ANSWER>>industry vs inferiority Erikson stage from 13-21 years - CORRECT ANSWER>>identity vs role confusion Erikson stage from 21-39 years - CORRECT ANSWER>>intimacy vs isolation Erikson stage from 40-65 years - CORRECT ANSWER>>generativity vs stagnation Erikson stage for 65 and older - CORRECT ANSWER>>ego integrity vs despair

Macrobid/nitrofurantoin is contraindicated in which patients? - CORRECT ANSWER>>those with renal insufficiency Treatment options for complicated UTI - CORRECT ANSWER>>cipro or levo x 5-7 days Treatment options for uncomplicated UTI - CORRECT ANSWER>>bactrim x 3 days, macrobid x 5 days, fosfamycin 1g one time dose Olecranon bursitis is pain in which region of the elbow? - CORRECT ANSWER>>the posterior elbow; will also have swelling and warmth Lateral epicondylitis manifests as what type of elbow pain? - CORRECT ANSWER>>weak grip and pain with gripping, pain with rotation of the wrist and forearm The medical term for golfer's elbow - CORRECT ANSWER>>medial epicondylitis How does the pain in lateral vs. medial epicondylitis differ? - CORRECT ANSWER>>lateral epicondylitis is worse with supination of the hand and medial epicondylitis is worse with pronation of the hand involves tapping a finger along the problem nerve - CORRECT ANSWER>>tinel sign asking the patient to place both elbows on a table while keeping both forearms vertical and flexing both wrists - CORRECT ANSWER>>phalen sign Which nerve runs on the side of the thumb - CORRECT ANSWER>>median nerve Which nerve runs on the side of the pinky finger - CORRECT ANSWER>>ulnar nerve What is ankylosing spondylitis? - CORRECT ANSWER>>an inflammatory condition affecting the spine causing chronic back pain and stiffness that improves with exercise and enthesitis What is the treatment for ankylosing spondylitis? - CORRECT ANSWER>>refer to rheumatology for possible DMARDs What are the s/s of polymyalgia rheumatica? - CORRECT ANSWER>>chronic pain in the proximal joints (shoulders and hips) bilaterally with stiffness lasting for more than 45 minutes

What is the recommended treatment for polymyalgia rheumatica? - CORRECT ANSWER>>PO steroids and refer to Rheumatology to confirm the diagnosis Where are the biggest food sources of vitamin B12? - CORRECT ANSWER>>fish, meat, poultry, eggs, and dairy products, also fortified breakfast cereals and fortified nutritional yeasts What is the gold standard for the diagnosis of herpes? - CORRECT ANSWER>>nucleic acid amplification test Most cases of acute sinusitis are viral and how can we treat them? - CORRECT ANSWER>>treat the symptoms with intranasal steroids and saline rinses What is the difference between chronic vs gestational hypertension? - CORRECT ANSWER>>chronic htn is present before 20 weeks gestation or 12 weeks after delivery; gestational hypertension is after 20 weeks gestation Which is the recommended diagnostic when a patient has a breast lump? - CORRECT ANSWER>>if less than 45, do an ultrasound. if older than 45, do a diagnostic mammogram. An overactive bladder is what type of incontinence? - CORRECT ANSWER>>urge incontinence What is the recommended treatment for urge incontinence? - CORRECT ANSWER>>anticholinergics like oxybutynin What is the recommended treatment for stress incontinence? - CORRECT ANSWER>>alpha agonists like sudafed, TCAs What is the recommended treatment for BPH? - CORRECT ANSWER>>alpha blockers like terazosin, doxazosin, tamsulosin Alcohol and marijuana worsen which type of incontinence? - CORRECT ANSWER>>urge Which SSRI is safest in pregnancy? Which poses the most risk? - CORRECT ANSWER>>sertraline; paroxetine Infants born to women who smoke are at increased risk for what? - CORRECT ANSWER>>low birth weight and preterm delivery What is the best marker of an acute MI? - CORRECT ANSWER>>troponin

When do troponins peak after a MI? - CORRECT ANSWER>>12 hours When should an infant be able to display a conjugate gaze (track you all the way across the room)? - CORRECT ANSWER>>6 months Which medication is approved in Peds for the prevention of febrile seizures? - CORRECT ANSWER>>diazepam Folic acid is which vitamin? - CORRECT ANSWER>>vitamin B What is the dosage preferred for folic acid deficiency? - CORRECT ANSWER>>1-5mg daily Dosage of folic acid in pregnancy to prevent neural tube defects - CORRECT ANSWER>>400mcg daily What are ECG changes you may see on a patient with hypokalemia? - CORRECT ANSWER>>tachyarrhythmas, ST depression, prolonged QT, and U wave present What are ECG changes you may see on a patient with hyperkalemia? - CORRECT ANSWER>>peaked T waves A U wave present on EKG is thought to represent what? - CORRECT ANSWER>>repolarization of the purkinje fibers What is considered legal blindness? - CORRECT ANSWER>>20/200 or worse What is the pain of temporal arteritis like? - CORRECT ANSWER>>new onset headache, jaw pain with chewing Are nexplanon and norplant (levonorgestrol) combined contraceptives or progesterone only? - CORRECT ANSWER>>progesterone only Breastfeeding women cannot have which type of anti-contraceptive? - CORRECT ANSWER>>anything with estrogen in it; this includes things like cocps What is the treatment of choice for community acquired, uncomplicated pneumonia? - CORRECT ANSWER>>amoxicillin

Vitamin B12 deficiency anemia is a type of ____________ anemia. - CORRECT ANSWER>>pernicious; macrocytic Prostate infection or inflammation can cause a sharp rise in PSA values. When should this value go back down to normal levels and be checked after an acute infection? - CORRECT ANSWER>>4 weeks The most common cause of atypical pneumonia in adults - CORRECT ANSWER>>mycoplasma pneumoniae An herbal supplement thought to help BPH - CORRECT ANSWER>>saw palmetto A male patient presents to your clinic with a lump in his breast. How should we work this up? - CORRECT ANSWER>>clinical breast exam, mammogram, AND ultrasound If a patient with strep comes back after 48 hours with no improvement on antibiotics, what should you then prescribe? - CORRECT ANSWER>>a penicillin or cephalosporin with beta lactamase coverage How long must a tick be attached to the skin in order for Lyme disease to be transferred? - CORRECT ANSWER>>48 hours When should kids be treated for hypertension? - CORRECT ANSWER>>if they also have diabetes, are symptomatic, have hypertension > 95th percentile, or when end organ damage is present ACEIs can cause what electrolyte abnormality? - CORRECT ANSWER>>hyperkalemia A positive "drop arm" test is a sign of what? - CORRECT ANSWER>>torn rotator cuff The medical term for spoon shaped nails - CORRECT ANSWER>>koilonychia Koilonychia is a sign of what? - CORRECT ANSWER>>iron deficiency anemia How is influenza diagnosed? - CORRECT ANSWER>>a nasal swab What finding would be most likely to differentiate gout from septic arthritis? - CORRECT ANSWER>>fever would be indicative of septic arthritis

Diphenhydramine has __________ properties and is contraindicated in which patient populations? - CORRECT ANSWER>>anticholinergic; elderly and those with glaucoma The medical term for flat feet - CORRECT ANSWER>>pes planus How does plantar fasciitis usually present? - CORRECT ANSWER>>as pain in the morning with resolution after several steps, but as it worsens the patient will start to complain of heel pain throughout the day and with walking Scope of practice for NPs is not influenced by which entity? - CORRECT ANSWER>>a court of law Used to establish a designated level of professional competence - CORRECT ANSWER>>licensure Treatment of subclinical hypothyroidism is generally not indicated unless the TSH is ___________. - CORRECT ANSWER>>greater than 10 In the presence of an elevated serum TSH, what is the next step in management? - CORRECT ANSWER>>repeat TSH plus free T4 Patients with a history of UC or Crohn's should have a colonoscopy how often? - CORRECT ANSWER>>every 1-5 years due to the increased risk of colorectal cancer What is the first line treatment for community acquired atypical pneumonia? - CORRECT ANSWER>>macrolides such azithromycin. If the pt cannot take a macrolide, then they can do levofloxacin or doxycycline What is metatarsus adductus? - CORRECT ANSWER>>the medical term for in-toeing What is true regarding older adults who are overweight? - CORRECT ANSWER>>mortality in older adults related to overweight states declines over time How do we manage rubella immunity in pregnant women? - CORRECT ANSWER>>we screen all pregnant women with a rubella titer. If they had a protective rubella titer in a previous pregnancy, then they do not need to be checked again. If they are found to not be immune when pregnant, then she should be vaccinated AFTER delivery

How is permethrin applied to the skin for scabies? - CORRECT ANSWER>>a one time application to all skin below the neck and then left on for 8-12 hours is sufficient After exposure to HIV, when will the patient seroconvert and become positive? - CORRECT ANSWER>>3 months Is age less than 18 years a risk factor for an ectopic pregnancy? - CORRECT ANSWER>>no; but personal history of PID, an IUD, previous ectopic pregnancy, previous tubal surgery, pathology, or ligation all are risk factors What is Tanner stage 5 of breast development in females? - CORRECT ANSWER>>projection of the nipple only What are two common classes of drugs that interact with grapefruit juice? - CORRECT ANSWER>>statins and CCBs Ankle inversion is a common complaint from a patient with what? - CORRECT ANSWER>>a lateral ankle sprain How can we best diagnose coarctation of the aorta? - CORRECT ANSWER>>by comparing the upper and lower extremity blood pressures What is the most important risk factor for developing breast cancer in women of average risk? - CORRECT ANSWER>>age hey - CORRECT ANSWER>>stopped at top of page 7 What is the recommended treatment for blepharitis? - CORRECT ANSWER>>erythromycin 1cm ribbon 5x daily for 7 days What is the recommended treatment for severe anorexia with delusions? - CORRECT ANSWER>>2nd atypical antipsychotics What lab values need to be monitored in a patient on Tizanidine? - CORRECT ANSWER>>LFTs and BP at baseline and 1 month after the max dose is achieved (can cause hepatotoxicity and hypotension) What class of drug is dabigatran (pradaxa)? - CORRECT ANSWER>>direct thrombin inhibitor

The most effective treatments for acne related to increased sebum production are what? - CORRECT ANSWER>>oral contraceptives and isotretinoin Oral contraceptive regimen in which both the estrogen and progesterone concentrations vary throughout the cycle - CORRECT ANSWER>>quadriphasic Oral contraceptive regimen in which the estrogen and progestin doses are fixed throughout the cycle - CORRECT ANSWER>>monophasic Oral contraceptive regimen in which in the estrogen dose remains the same for the first 21 days of the cycle, while progestin is lower in the first half and higher in the second half - CORRECT ANSWER>>biphasic Oral contraceptive regimen in which the estrogen remains consistent and the progestin dose varies - CORRECT ANSWER>>triphasic Patients who are receiving beta blockers may find what treatment for allergies ineffective? - CORRECT ANSWER>>treatments containing epinephrine For a patient on warfarin who needs to receive a tetracycline antibiotic, how will we adjust their warfarin? - CORRECT ANSWER>>tetracyclines depress prothrombin activity, same as warfarin, so we need to decrease the warfarin to avoid an increase in INR and significant bleeding What is the herbal, valerian root often used for? - CORRECT ANSWER>>insomnia/sleep, ADHD, anxiety, depression What is the herbal, saw palmetto, often used for? - CORRECT ANSWER>>BPH What is the herbal, black kohosh, often used for? - CORRECT ANSWER>>symptoms of menopause - hot flashes What is the herbal, St. John's wart, often used for? - CORRECT ANSWER>>depression What are the intrauterine transplacental infections that can be passed from mother to infant? - CORRECT ANSWER>>think TORCH; toxoplasmosis, Other (syphilis, varicella zoster, parvovirus) Rubella, Cytomegalovirus and Herpes simplex, as well as tuberculosis. Note that chlamydia is NOT transplacental, but rather transvaginal during childbirth

The antibiotic of choice for a dog bite - CORRECT ANSWER>>augmentin; doxy if there is a penicillin allergy Obese women should gain how much weight during pregnancy? - CORRECT ANSWER>>11- 20 pounds Overweight women should gain how much weight during pregnancy? - CORRECT ANSWER>>1525 pounds Normal weight people should gain how much weight during pregnancy? - CORRECT ANSWER>>25-35 pounds Underweight people should gain how much weight during pregnancy? - CORRECT ANSWER>>28-40 pounds Pregnant women should increase their daily caloric intake by how many calories per day? - CORRECT ANSWER>>300 Immunizations are considered to be what level of prevention? - CORRECT ANSWER>>primary Children can start to ride a tricycle around age _____ - CORRECT ANSWER>>3 A gray or white ring present around the peripheral iris - CORRECT ANSWER>>arcus senilis What causes arcus senilis? - CORRECT ANSWER>>it is a normal, benign condition with aging, but can also occur in younger people as a result of high cholesterol and triglycerides How is a diagnosis of neuroblastoma confirmed? - CORRECT ANSWER>>via serum catecholamine testing and a biopsy Are saturated or unsaturated fatty acids better for you? - CORRECT ANSWER>>unsaturated Which patient populations are thalassemias most common in? - CORRECT ANSWER>>mediterranean countries (greece and turkey), asia, africa Is Meniere's disease most often unilateral or bilateral? - CORRECT ANSWER>>unilateral