Chronic Conditions and Disease Management, Exams of Nursing

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ANCC FNP Board Questions And Correct Answers

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A middle-age female patient presents to the clinic with a recurrence of mild hidradenitis suppurativa after topical therapies failed. Which first- line treatment is recommended? - ANSWER>>Tetracycline Twelve weeks of oral tetracycline (Sumycin) is the recommended first- line treatment for hidradenitis suppurativa.

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Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing skin. It is a chronic, disabling disorder that progresses, often causing keloids, contractures, and immobility. It is characterized by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent discharge, and progressive scarring. Arthropathy associated with hidradenitis may be present. Typical presentation includes nodules and sinus tracts (inflamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area, perineum, gluteal area, and inframammary area in women.

Recommended treatments include antibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor agents. A dermatology consultation should also be considered. First-line treatment is a 12-week course of an oral tetracycline (Sumycin) such as doxycycline. For patients who do not respond to doxycycline, the next recommended step is a combination of twice- daily clindamycin (Cleocin) and rifampicin (Rifadin) for 10- 12 weeks. If treatment fails, acitretin (Soriatane, for males and nonfertile females) or dapsone (Aczone) may be considered by a dermatologist. In patients with moderate to severe hidradenitis suppurativa, adalimumab (Humira) may possibly be considered. When providing culturally competent health care services to an American Indian elder, the nurse practitioner understands which is traditionally true? - ANSWER>>The "Medicine Wheel" is used by many for the purpose of health and healing The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west. Traditionally each tribe has different meanings for each direction and they may represent the season of the year or stage of life. It is aimed at providing a holistic view of life.

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An understanding of different cultural preferences leads to cultural competence in healthcare. Some patients may value traditional culture and preferences as it relates to healthcare. These individual preferences should be included in the interview and treatment plan for patients. 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? - 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.

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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? - ANSWER>>Amoxicillin High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults without comorbidities.

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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? - 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? - 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? - 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? - 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: - ANSWER>>have an HDL level of < 35 mg/dL Which of the following found on an ECG would confirm atrial fibrillation? - 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: - 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? - 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? - 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 - ANSWER>>enteric nervous system Aplastic anemia would be classified as which of the following? - ANSWER>>normocytic anemia Charles Darwin wrote On the Origin of Species about human evolution. He also is known for which of the following? - ANSWER>>developing

the "baby journal" as a systematic method to document observed behavioral development 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? - 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? - 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? - ANSWER>>Not sharing personal information with the patient

The United States Preventive Services Task Force recommends screening older patients for depression: - ANSWER>>at each primary care visit Which of the following types of hepatitis is transmitted by fecal and oral route from contaminated food? - ANSWER>>Hep A Which of the following is a normal physiologic change during pregnancy? - 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? - ANSWER>>Lasix When counseling patients who smoke cigarettes, which of the following is NOT good management advice? - 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? - 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? - ANSWER>>A1c Which of the following would be considered one of the stages of Pertussis? - ANSWER>>Convalescent You are testing a 35-year-old male patient for Addison's disease. You perform the test for ACTH stimulation. If this patient has primary adrenal insufficiency he will have which of the following responses to this test? - ANSWER>>no response You want to prescribe a drug with a rapid onset for a patient who is being treated for anxiety. Which of the following drugs for treating anxiety has the most rapid onset of action? - ANSWER>>diazepam - Diazepam has a rapid onset of action and a relatively sustained effect.

You have a patient with a "port wine" stain that is located on half of her facial area. You understand that this can be a sign of which of the following? - ANSWER>>Sturge-Weber Syndrome- The flat, large, dark ink to purple stain-like lesions occurring in irregular shapes and sizes are nevus flammeus or "port wine" stains. A large lesion located on half the facial area may be a sign of trigeminal nerve involvement and Sturge-Weber Syndrome (a neurological disorder). A patient with stable angina would exhibit which of the following? - ANSWER>>no change in duration of symptoms during the preceding 6 weeks Which of the following is most likely when there is no p wave present on an electrocardiogram? - ANSWER>>A.Fib Lispro insulin has an onset which starts at which of the following? - ANSWER>>15 minutes Which of the following would be considered correct for a fungal infection which is a common skin tissue issue that is typically seen on the extremities, trunk or face? - ANSWER>>ringworm

Your patient has "swimmer's ear." She has no other associated conditions. Your management of this patient will include which of the following? - ANSWER>>application of local heat to outer ear for pain relief A mother brings in her 7-year-old child with a red rash on his cheeks and ears. You diagnose Fifth disease. You might recommend all of the following for this child EXCEPT: - ANSWER>>isolation A patient has recently been diagnosed with Addison's disease. How often should this patient's electrolytes be monitored? - ANSWER>>every 3-4 months for the first year of therapy You are doing a gynecologic assessment of your 25-year-old female patient. Which of the following specimens would you collect last during this examination? - ANSWER>>Papanicolaou testing A patient is diagnosed as dehydrated, anxious, and isolated. What should you give the highest priority? - ANSWER>>Dehydration. According to the structural functional theory of assessment and intervention, which of the following statements is false? -

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? - ANSWER>>tinea corporis Bactrim should NOT be prescribed to which of the following patients? - 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? - ANSWER>>Burow's solution During the process of implantation, the fetus in the above picture ( 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? - 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? - ANSWER>> 12 weeks The most common cause of secondary hypertension is which of the following? - ANSWER>>renal conditions The effect of a goitrogen could likely be: - ANSWER>>hyperthyroidism An injury to one of the ligamentous structures of the body is termed a(n): - 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: - ANSWER>>Corticosteroids are often used for maintenance. Which of the following statements about endometriosis is least accurate? - 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? - 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? - 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? - 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? - 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? - 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? - 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? - 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? -

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? - 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? - ANSWER>>corporation If a nurse practitioner is providing care for pediatric patients, why is it especially important to have adequate professional liability insurance coverage? - ANSWER>>The statute of limitations is often put on hold (or tolled) until the minor reaches legal age status. Then, the timeframe within which the child or parent can file a lawsuit is extended. Piaget's cognitive development theory includes which of the following?

• ANSWER>>sensorimotor

A mother brings her 3-year-old son to the clinic where the FNP diagnoses impetigo. The FNP understands that which of the following statements about treatment for this disease is least accurate? - ANSWER>>Mupirocin and oral erythromycin are not as effective as penicillin. Which of the following factors would most likely be associated with blepharitis? - ANSWER>>-rosacea

• seborrhea
• contact lens use The FNP understands that in terms of physiological adaptations during pregnancy, which of the following is the least likely to happen? - ANSWER>>Insulin levels decrease by 2 to 10-fold. The FNP calculates a patient's BMI to be 23. Which category would this patient fall into? - ANSWER>>normal weight
• a BMI of 18.5 to 24.9 are considered of normal weight. Blank staring lasting 3 - 50 seconds accompanied by impaired level of consciousness is an indication of which of the following types of seizures? - ANSWER>>absence

You are monitoring a patient for signs of heart failure. You understand that a sign of left-sided heart failure is which of the following? - ANSWER>>orthopnea Upon examination you find that your patient has unequal pupil size and the pupils are reactive to light and accommodation. This indicates which of the following? - ANSWER>>anisocoria All of the following are drugs used for Cushing's disease EXCEPT: - ANSWER>>digoxin Which of the following bronchodilator categories would include ipratropium bromide and glycopyrrolate? - ANSWER>>anticholinergics The FNP has a menopausal woman patient who is troubled by hot flashes. The FNP tells her that they can often be reduced in number and minimized in severity with simple lifestyle changes. All of the following would be a hot flash trigger EXCEPT: - ANSWER>>chocolate consumption alcohol usetight restrictive clothing

*****cold baths or showers According to the Health Insurance Portability and Accountability Act (HIPAA), which of the following circumstances would require a patient consent? - ANSWER>>surgical treatment Melba is a 38-year-old sexually active female who comes to you complaining of lower abdominal pain and cramping. She tells you that she has not had a period for about 7 weeks. The pain worsens when she is lying down on her back. You might suspect which of the following? - ANSWER>>ectopic pregnancy Which of the following cranial nerves would be responsible for the sense of smell? - ANSWER>>CN I Which of the following rash-producing febrile illnesses is caused by the human parvovirus B19? - ANSWER>>Fifth disease Which of the following parts of the eye is for color perception? - ANSWER>>cones

Which of the following tests would you most likely order for a patient whom you suspect has iron deficiency anemia? - 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? - 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? - ANSWER>>Allopurinol Which of the following is NOT an incomplete spinal cord injury syndrome? - 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? - 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? - 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? - 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? - 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? - 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? - ANSWER>>every 3 years

How often must hospitals check the National Practitioner Data Bank before granting clinical privileges to nurse practitioners? - 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: - 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? - 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? - ANSWER>>peptic ulcer disease

A urine pregnancy test is considered which of the following signs of pregnancy? - ANSWER>>probable sign of pregnancy Where does the pancreas lie in the human body? - 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? - 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? - 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?" - ANSWER>>The spacer will help increase the delivery of the aerosolized drug to the lungs.