APEA Pre-Predictor Test EXAM NEWEST 2024 ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWER, Exams of Nursing

Download APEA Pre-Predictor Test EXAM NEWEST 2024 ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWER and more Exams Nursing in PDF only on Docsity! pg. 1 APEA Pre-Predictor Test EXAM NEWEST 2024 ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS. What is the biggest side effect of colchicine? - ANSWER - diarrhea How would you describe the appearance of molluscum contagiosum? - ANSWER - papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant? - ANSWER - no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSWER - week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSWER - week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSWER - week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSWER - week 28 At what week of pregnancy is the fundus just below the xiphoid process? - ANSWER - week 34 Increased sweat production is a sign of what endocrine disorder? - ANSWER - hyperthyroidism What is Paget's disease? - ANSWER - there is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures pg. 2 How do we treat Paget's diseease? - ANSWER - bisphosphonates How should pregnant women wear their seatbelt? - ANSWER - with the shoulder strap like a normal person and then the groin strap below the belly and across the hips What is another name for fifth disease? - ANSWER - parvovirus aka slapped cheek disease aka erythema infectiosum Which type of prevention are vaccinations? - ANSWER - primary When should patients begin antiretroviral therapy for HIV infection? - ANSWER - as soon as it is detected, even if in the acute phase What are the first generation antihistamines? - ANSWER - diphenhydramine (benadryl) and chlorpeniramine (actifed) What are s/s of the secondary stage of syphilis? - ANSWER - rash on hands and feet, lymphadenopathy, fever What is the recommended treatment for chronic bacterial prostatitis? - ANSWER - a fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for acute prostatitis? - ANSWER - cipro (if not STI related) or ceftriaxone What are s/s of an intraductal breast papilloma? - ANSWER - clear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSWER - first generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin pg. 5 Preeclampsia most commonly shows up at what time in pregnancy? - ANSWER - around week 20 How do we treat UTIs in a pregnant woman? - ANSWER - can either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSWER - about 10 days before menses What can be a sequelae of an ectopic pregnancy? - ANSWER - pelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What is the Coomb's test and when is this completed? - ANSWER - test given 8 weeks in to pregnancy to determine a woman's RH compatibility If a patient's Coomb's test is positive, what do we do? - ANSWER - nothing, she is RH positive so we do not need to treat If a patient's Coomb's test is negative, what do we do? - ANSWER - give rhogam at 28 weeks and 72 hours after birth What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSWER - IUD The vaginal ring for contraception must be taken out how often? - ANSWER - every 3 weeks If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSWER - increase the progesterone How do we treat temporal arteritis? - ANSWER - steroids If a patient is on birth control and they miss one pill, what should they do? - ANSWER - double up pg. 6 If a patient is on birth control and they miss two pills, what should they do? - ANSWER - double up for 2 days If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSWER - do a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSWER - mammogram; ultrasound When do we screen for group B strep in pregnancy? - ANSWER - weeks 35-37 When do we perform alpha fetoprotein screening in pregnancy? - ANSWER - 15-20 weeks Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSWER - spina bifida and anencephaly What is placenta previa? - ANSWER - when the placenta blocks the cervical opening of the uterus What is placenta abruptio? - ANSWER - when the placenta either fully or partially detaches from the uterine wall When does placental abruption most commonly occur? - ANSWER - in the third trimester What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSWER - a placental abruption is painful whereas placenta previa is painless If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSWER - placenta previa What is the recommended treatment for polymyalgia rheumatica? - ANSWER - steroids pg. 7 Patients with SLE are going to have what abnormal labwork? - ANSWER - elevated ESR and CRP How do we treat lupus flares? - ANSWER - steroids What are common sequelae of fibromyalgia? - ANSWER - insomnia and depression What is a great treatment option for fibromyalgia? - ANSWER - amitriptyline (a TCA) because it helps with chronic pain, sleep, and depression How is fibromyalgia diagnosed? - ANSWER - when at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months What is slipped capital femoral epiphysis? - ANSWER - when the femoral head of the hip is out of place What is the trendelenburg sign and when is it positive? - ANSWER - when the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What is the main characteristic of a slipped capital femoral epiphysis? - ANSWER - walking with a limp SCFE is most common in which patient population? - ANSWER - adolescents What is legg-calve-perthe disease? - ANSWER - avascular necrosis of the femoral head due to a lack of blood supply Legg-calve-perthes disease is most common in which patient population? - ANSWER - young children What is the radiographic study of choice for the knee? - ANSWER - MRI What is the radiographic study of choice for the back? - ANSWER - x ray pg. 10 What is the first line treatment for trigeminal neuralgia? - ANSWER - carbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the recommended treatment for Bell's palsy? - ANSWER - steroids and anti-virals How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSWER - in trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache What are the preventative treatment options for migraines? - ANSWER - beta blockers, amitriptyline, venlafaxine, topamax, valproate What is Addison's disease? - ANSWER - adrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What are s/s of Addison's disease? - ANSWER - bronze or discolored skin, salt cravings a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSWER - molar pregnancy What bacteria is the leading cause of urethritis? - ANSWER - neisseria gonorrhea What is the most common cause of hypercortisolism? - ANSWER - excessive ACTH production How do we treat developmental hip dysplasia in a child under 6 months? - ANSWER - Pavlik harness; if older than 6 months may need surgery It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANSWER - 5 years old; penicillin When can cervical cancer screening stop if no abnormal screening history is present? - ANSWER - age 65 pg. 11 When should breast cancer screening begin and end with a biannual mammogram? - ANSWER - age 50- 74 When should colorectal cancer screening stop? - ANSWER - age 85 Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSWER - age 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSWER - Do HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. Which pap smear result is considered to be HPV positive? - ANSWER - LSIL If a patient has LSIL with a negative HPV test, what would you do? - ANSWER - repeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSWER - refer for colposcopy If a patient's pap results show NILM, what should you do? - ANSWER - repeat in 3 years If a patient's pap results show ASC-H or HSIL what should you do? - ANSWER - refer for colposcopy The valgus stress test assesses what? - ANSWER - the medial collateral ligament The varus stress test assesses what? - ANSWER - the lateral collateral ligament The Lachman's test assesses what? - ANSWER - the ACL The McMurray's test assesses for what? - ANSWER - a torn meniscus pg. 12 The anterior drawer test assesses what? - ANSWER - the acl The posterior drawer test assesses what? - ANSWER - the posterior cruciate ligament (pcl) a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSWER - dawn phenomenon How can you tell between the dawn and somogyi effect? - ANSWER - If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. A 15 years old high school student with a mild sore throat and low-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the following is the LEAST appropriate intervention? Palpate the lymph nodes and spleen Examine the posterior oropharynx for petechiae Obtain a CBC, throat culture, and heterophil antibody test. Obtain an urinalyses and serum for LFTs and amylase - ANSWER - Obtain an urinalyses and serum for LFTs and amylase Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus. Common is people 15-24 years of age. Common signs and symptoms following incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally a petechial rash occurs in less than 15% of patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and lymphocytosis are usually detected in the CBC pg. 15 Failure of diligence Professional liability Negligence Malpractice - ANSWER - Malpractice Explanation: malpractice, a negligence tort, occurs when a health care professional's actions fall bellow the appropriate standard of care and hurts the patient. In this case the patient came with sings and symptoms indicating appendicitis and the NP failed to refer the patient. A NP has recently been hired to work in a fast track facility. The NP employer asked if she has "a problem prescribing medications for emergency contraception." The NP replies affirmatively. This is: a. Grounds for dismissal An ethical dilemma for the NP Illegal according to the standards of nursing Patient abandonment. - ANSWER - An ethical dilemma for the NP Explanation: in this instance, the NP has a difference of opinion with her employer based on her religious or moral belief about providing emergency contraception. This situation is an example of an ethical dilemma. Failure to participate in the provision of care to the patient based on the NP's beliefs is neither against the law nor a violation of the standards of practice A patient presents with pruritic lesions on both knees. There are visible silver scales. How Should this condition be managed? . Topical antifungal cream or ointment Oral antibiotics Topical corticosteroids cream . Topical anti-fungal/ steroid cream - ANSWER - Topical corticosteroids cream pg. 16 Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely defined plaques with silvery scales. Auspitz sings is another common finding. Topical agents containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also be ordered. Antidepressant discontinuation syndrome is less likely if the patient Is male Is less than 35 y/o Has taken an SSRI with a short half life Gradually tapers SSRI use - ANSWER - Gradually tapers SSRI use Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care office in association with SSRI discontinuation, because SSRIs are the most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti-depressant medication is sometimes associated with an antidepressant discontinuation syndrome; in early reports it was referred to as a "withdrawal reaction. Symptoms of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Tapering is recommended by experts. Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one of the following drug classes? . Alpha adrenergic antagonist Anti-androgen agents Tricyclic antidepressant (TCA) Sulfonamides - ANSWER - Tricyclic antidepressant (TCA) Explanation: tricyclic antidepressant should not be used by men with benign prostatic hyperplasia because of the increased risk of urinary retention secondary to the anticholigergic effects of TCAs. Which of the following is the best response to a woman who has just admitted she is a victim of spousal abuse? What was it that you did to make him angry? pg. 17 You must seek refuge immediately I am concerned about your safety I am going to call a shelter for you - ANSWER - I am concerned about your safety Explanation: The first step is to establish trust in the therapeutic relationship. without trust future collaboration, intervention and client outcome cannot be accomplished to facilitate appropriate and safe behavior. The experience of abuse is a traumatic psychological crisis that must be addressed as such. The healthcare providers must emphasize the fact that the victim has not done anything wrong and they must also emphasize the fact that the victim's life and the lives of their children can be in danger if the abuse is not addressed. It will not disappear with a lack of action. An order of protection against the perpetrator is often recommended. For which patient group does the US Preventive Services Task Force recommend routine screening for asymptomatic bacteriuria pregnant woman . Children Patients with diabetes patients over the age of 70 - ANSWER - pregnant woman Explanation: an increased incidence of bacteriuria is found in all the population listed. However, bacteriuria in pregnant women increases the mother.....Also increased is the risk of a pre-term delivery, which then increases perinatal and fetal morbidity and mortality. The recommended it What diabetic complications result from hyperglycemia? select all that apply Retinopathy Hypertension resistant to treatment Peripheral neuropathy Accelerated atherosclerosis - ANSWER - Retinopathy Hypertension resistant to treatment Accelerated atherosclerosis pg. 20 A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing up of the legs followed by periods of lethargy. On physical examination, a "sausage-like" mass in the upper right quadrant of the distended abdomen. Which of the following is the most likely diagnosis? Volvulus Crohn's disease Foreign body in the GI tract Intussusception - ANSWER - Intussusception explanation: Intussusception is one of the most common causes of abdominal obstruction in children prior 2 years of age; is best described as a portion of the intestine which telescopes into a more distal intestinal segment. The classic triad of intussusception include crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools. The patient may pull up his knees with crying. The patient may develop vomiting with bilious emesis. Progressive lethargy/altered level of consciousness and pallor is common. The etiology of this lethargic presentation is not known, but it tends to occur in younger infants. As intussusception progresses, a palpable, sausage-shape mass may develop. Some hypothesize that this is due to release of endogenous opioids or endotoxins released from ischemic bowel. Intussusception in a child presenting with lethargy is often difficult to diagnose since other causes of lethargy such as dehydration, hypoglycemia, sepsis, toxic ingestion, post-ictal state, etc., must also be considered. Ultrasound is the preferred diagnostic test. Enemas is considered the first line of treatment prior surgery. Volvulus occurs more frequently in middle-aged and elderly men. Crohn's is most often diagnosed between 13 - 30 years of age. A middle-aged female complains of insomnia, night sweats, feeling intensely hot, emotional lability, extreme nervousness and impatience. The LEAST likely cause of her symptoms is a. Thyrotoxicosis .Menopausal vasomotor instability Alcohol or another drug withdrawal New onset type 2 diabetes mellitus - ANSWER - New onset type 2 diabetes mellitus Explanation: New onset diabetes produces elevated serum glucose levels less than 200 mg/dL (7.0 mmol/L) and usually no clinical signs or symptoms. At higher levels, the patient may report lethargy, fatigue, weakness, weight loss, and polydipsia, polyuria, and/or polyphagia. Complaints of insomnia, night sweats, feeling intensely hot, emotional lability, and extreme nervousness may be caused by thyroxine excess, menopausal instability, or withdrawal from alcohol or other drugs of addiction. pg. 21 Which of the following indicated need for further evaluation? . A 7 y/o girl with vaginal bleeding A 7 years old girl with no true pubic hair A 12 years old boy with sparse, slightly pigmented pubic hair A 12-year-old girl with breast buds - ANSWER - A 7 y/o girl with vaginal bleeding explanation: In newborn girls, withdrawal bleeding may occur as a normal response to maternal estrogen leaving the infant's uterine lining. Vaginal bleeding after the first few weeks of life and before puberty is considered abnormal. Early vaginal bleeding can indicate trauma, foreign bodies (toilet paper is the most common), vulvovaginitis, hemangiomas, benign polyps, precocious puberty, or sexual abuse. A young couple is being seen by the NP for preconception counseling. They express a wish for pregnancy within the next 3 month and are very eager to know what they can do now to "make the baby as healthy as possible". Which of the following should the NP encourage to decrease the chance of neural tube defect in the fetus? Folic acid 0.4 mg daily Maternal alpha-fetoprotein level . Rubella vaccine today Vitamin E 400 IU daily - ANSWER - Folic acid 0.4 mg daily Explanation: Supplementation with folic acid decreases the development of neural tube defects, such as spina bifida and anencephaly. Folic acid plays an essential role in neural tube closure. Neural tube development/closure takes place in the fist 4 weeks of embryonic life (6 weeks' gestation). U.S. Public Health Service and the CDC recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent tube defects. A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several time p.... which is relived with nitroglycerin. Which is the most appropriate initial action for the NP? . Refer to a cardiologist as soon as possible Prescribe long-acting nitroglycerin Order treadmill stress test pg. 22 Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours - ANSWER - Refer to a cardiologist as soon as possible Explanation: The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery). A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: Infection proximal to the nodes . A possible cancer diagnosis Shorty nodes, a common normal variant in children An infectious process distal to the nodes - ANSWER - Infection proximal to the nodes explanation: size of lymph nodes is important. Nodes > 1 cm are significant and should be asses carefully. Nodes > 5 cm are almost always neoplastic. Tenderness of a node usually suggest inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection. The NP examines a 2-month-old with unequal gluteal and thigh skin folds. What should the NP do next? Send the infant for x-ray of the hips Send the infant for ultrasound of the hips . Perform Ortolani and Barlow test . Examine the infant for unequal arm length - ANSWER - Perform Ortolani and Barlow test Explanation: Gluteal and thigh skin fold asymmetry may indicate congenital hip dysplasia. Xray studies are not useful before 3 months-of-age because the femoral head has not completely ossified