Diabetes and Musculoskeletal Disorders, Exams of Nursing

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FNP BOARD REVIEW EXAM QUESTIONS

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Approximately % of all clinically recognized pregnancies end in spontaneous abortion A) 10 B) 20 C) 30 D) 40 - correct answer ✅B) 20% Approximately % of spontaneous abortions are associated with chromosomal defects. A) 20 B) 40 C) 60 D) 80 - correct answer ✅C) 60% In the first few weeks of a viable intrauterine pregnancy, serum hCG levels usually double every hours until approximately 10,000-20,000 mIU/mL

A) 24

B) 48

C) 72

D) 96 - correct answer ✅B) 48 hours A) Uterine contents include a nonviable pregnancy that is in the process of being expelled. B) Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable. C) The products of conception have been completely expelled. D) Vaginal bleeding is present, but ultrasound evaluation shows a viable pregnancy. - correct answer ✅1. Complete abortion = C) The products of conception have been completely expelled.

2. Inevitable abortion = A) Uterine contents include a nonviable pregnancy that is in the process of being expelled.
3. Threatened abortion = D) Vaginal bleeding is present, but ultrasound evaluation shows a viable pregnancy.
4. Incomplete abortion = B) Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable. What is Naegele's Rule to estimate the due date? - correct answer ✅LMP subtract 3 months + 7 days +1 year ACOG and AMA recommend routing screening of all pregnant women for domestic violence at every prenatal visit. Which characteristic below is not suggestive of domestic violence? A) improbable injury B) missed prenatal visits C) unsupportive partner

D) seeking prenatal care late (after 14 weeks) - correct answer ✅C) unsupportive partner ...as opposed to an overprotective partner A pregnant mother is Rh negative. When should she receive RhoGam (anti- D immune globulin)? Select all that apply. A) At diagnosis of pregnancy B) At 12-14 weeks gestation C) At about 28 weeks gestation D) Once in each trimester E) Within 72 hours of delivery - correct answer ✅C, E C) At about 28 weeks gestation E) Within 72 hours of delivery A pregnant mother who is Rh negative had a suspected miscarriage early this morning. Her LMP was 8 weeks ago. Which of the following statements about administration of Rhogam (anti-D immune globulin) is correct? A) She does not need Rhogam

B) She should receive Rhogam now C) She only needs Rhogam if miscarriage occurs in the 2nd trimester D) She only needs Rhogam if miscarriage occurs in the 3rd trimester - correct answer ✅B) She should receive Rhogam now Which statements are true about placenta previa? Select all that apply. A) Painless vaginal bleeding is typical. B) This usually occurs in the 2nd trimester. C) No referral is needed unless it worsens. D) This may progress to placenta abruptio. - correct answer ✅A, B, D A) Painless vaginal bleeding is typical. B) This usually occurs in the 2nd trimester. D) This may progress to placenta abruptio. Also, a vaginal exam should NOT be performed if placenta previa is suspected. When is a patient with an ectopic pregnancy most likely to present for evaluation?

A) 2-4 weeks after conception B) 4-6 weeks after conception C) 6-8 weeks after LMP D) 8 or more weeks after LMP - correct answer ✅C) 6-8 weeks after LMP A patient has a fundal height measurement of 24 cm. She is probably about A) 14-18 weeks gestational age B) 18-22 weeks gestational age C) 22-26 weeks gestational age D) In her 3rd trimester - correct answer ✅C) 22-26 weeks gestational age The uterine fundus should be palpable at 16 weeks A) at the level of the umbilicus B) just above the level of the symphysis pubis C) midway between the symphysis pubis and umbilicus D) below the symphysis pubis - correct answer ✅C) midway between the symphysis pubis and umbilicus

The fundus should be at the level of the umbilicus at 20 weeks What drugs could you use to manage hypertension in women who are pregnant or contemplating pregnancy? Select all that apply. A) Lisinopil B) Methyldopa C) Nifedipine D) Labetolol E) Losartan F) Verapamil G) Hydralazine H) Diltiazem - correct answer ✅B, C, D, F, G, & H B) Methyldopa C) Nifedipine D) Labetolol F) Verapamil G) Hydralazine

H) Diltiazem CCBs (nifedipine, diltiazem, and verapamil), beta blockers, Methyldopa, Hydralazine are safe in pregnancy AVOID ACEIs and ARBs in pregnancy - they affect the developing kidneys and lead to miscarriage. A 24-year old, otherwise healthy college student presents with c/o cough x 6 weeks. She has tried several OTC cough meds with no improvement. What is the most important information to consider when building your differential diagnoses? A) Her age B) Family hx C) Ineffectiveness of OTC cough medicines D) Length of time she has been coughing - correct answer ✅D) Length of time she has been coughing Why? This information helps you build your ddx

Acute cough < 3 weeks: bronchitis, sinusitis, PND, exacerbation of COPD/asthma, pneumonia, pulmonary embolism Chronic cough (>8 weeks) GERD and Asthma are most common causes, also consider infection (e.g. pertussis, atypical pneumonia), ACE inhibitors, chronic bronchitis, bronchiectasis, lung ca) According to the CDC, what drug class is considered first-line treatment for pertussis? A) Sulfonamide B) Tetracycline C) Macrolide D) Beta-lactam - correct answer ✅C) Macrolide antiobitic (e.g. Azithromycin, clarithromycin Sulfonamides are second-line Match the antibiotics with the correct drug class:

1. Sulfonamide

2. Tetracycline
3. Macrolide
4. Beta-lactam A. Doxycyline B. Azithromycin C. Penicillins D. Trimethoprim-Sulfamethoxazole E. Cephalosporin F. Clarithromycin - correct answer ✅1. Sulfonamide - D.Trimethoprim- Sulfamethoxazole (Bactrim)
5. Tetracycline - A. Doxycycline
6. Macrolide - B & F, Azithromycin and Clarithromycin
7. Beta-lactam - C & E, PCN and cephalosporins What are the three most common bugs in community-acquired pneumonia? - correct answer ✅Streptococcus pneumoniae Mycoplasma pneuomiae (atypical pathogen)

Chlamydophila pneumoniae (atypical pathogen) What is the treatment for CAP caused by Strep pneumo? - correct answer ✅Respiratory quinolone (e.g. Levofloxacin, moxifloxacin, gemifloxacin) OR high- dose amoxicillin OR amoxicillin with clavulanate What antibiotics are avoided in CAP caused by Strep pneumo due to high rates of resistance? - correct answer ✅Macrolides What is the treatment for CAP caused by Mycoplasma pneumoniae? - correct answer ✅Macrolide OR doxycycline What antibiotics are avoided in CAP caused by atypical pathogens? - correct answer ✅Beta-lactams (ineffective) A 38-year old mother of two teenagers recently recovered from Mycoplasma pneumonia a couple of weeks ago. She asks if she should get the "pneumonia shot." She takes levothyroxine 88 mcg daily for hypothyroidism, but is otherwise healthy. How do you respond? A) No, it's too soon after your infection B) No, it's not indicated

C) Yes, you can get it in about a month D) Yes you can get it today - correct answer ✅B) No, it's not indicated An otherwise healthy adult without immunocompromise or multiple comorbid conditions is not a "vulnerable population" The pneumonia vaccine does not prevent mycoplasma pneumonia According to GOLD, what is required to establish the diagnosis of COPD? - correct answer ✅Spirometry (FEV1/FVC ratio < 70%) A 70-year old house painter reports a 4-week history of exertional dyspnea, chest tightness, and cough for the past 3 months. He has never smoked. What diagnoses are included in your differential? Select 4. A) Asthma B) Angina C) COPD D) GERD E) Pneumonia

F) Tuberculosis G) Heart Failure - correct answer ✅B) Angina C) COPD F) Tuberculosis G) Heart failure How do inhaled anticholinergics work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction

• correct answer ✅B) They block the action of acetylcholine and prevent bronchconstriction Name a short-acting inhaled anticholinergic: - correct answer ✅Ipratropium (Atrovent) Name a long-acting inhaled anticholinergic: - correct answer ✅Tiotropium (Spiriva) How do inhaled betá-agonists work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs

B) They block the action of acetylcholine and prevent bronchoconstriction - correct answer ✅A) They cause bronchodilation in the lungs What are the only 2 inhaled short-acting beta agonists (SABAs): - correct answer ✅Albuterol and levalbuterol Name an inhaled long-acting beta agonists (LABAs): - correct answer ✅Salmeterol (Serevent) What are the side effects associated with anticholinergic medications? - correct answer ✅Cognitive impairment, confusion, hallucinations, dry mouth, blurry vision, urinary retention, constipation, tachycardia, acute angle glaucoma "Can't see, can't pee, can't spit, can't shit." Name a inhaled combined short-acting anticholinergic/short-acting beta agonist: - correct answer ✅Ipratropium/albuterol (Combivent) Name a inhaled combined long-acting beta-agonist/corticosteroid - correct answer ✅Fluticasone/salmeterol (Advair) Fluticasone/vilanterol (Breo)

Budesonide/formoterol (Symbicort) Mometasone/frmoterol (Dulera) Name an inhaled steroid: - correct answer ✅Fluticasone (Flovent) Budesonide (Pulmicort) Mometasone (Asmanex) Put the following in the correct order for COPD prescribing strategy: A) Long-acting anticholinergic or LABA, plus rescue med B) Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med C) Short-acting anticholinergic or SABA PRN D) Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med - correct answer ✅C, A, B, D

1. Short-acting anticholinergic or SABA PRN THEN
2. Long-acting anticholinergic or LABA, plus rescue med THEN
3. Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med

THEN

4. Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med There is good evidence in support of oral steroids for COPD exacerbations to shorten recovery time and improve lung function. What is the correct recommended dose? A) Medrol dose-pack B) 10-day course of Prednisone 20 mg, followed by a taper C) 5-day course of Prednisone 40 mg - correct answer ✅C) 5-day course of Prednisone 40 mg Chronic use should be avoided - associated with an unfavorable risk-to-benefit ratio A patient with asthma symptoms daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma

D) Severe persistent asthma - correct answer ✅C) Moderate persistent asthma A patient with asthma symptoms more than twice a week, but not daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - correct answer ✅B) Mild persistent asthma A patient with asthma symptoms less than twice a week has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - correct answer ✅A) Intermittent asthma A patient with asthma symptoms multiple times throughout the day and nighttime awakenings on most nights of the week has

A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - correct answer ✅D) Severe persistent asthma What are the most common side effects of long-term inhaled steroid use? A) Osteoporosis and GERD B) Cataracts and osteopenia C) Hyperkalemia and diabetes D) Hypertension and diabetes - correct answer ✅B) Cataracts and osteopenia What medication combination is considered unsafe in a patient with asthma? A) Fluticasone and albuterol B) Mometasone, formoterol, albuterol C) Budesonide and levalbuterol D) Salmeterol and levalbuterol

Why? - correct answer ✅D) Salmeterol and levalbuterol Salmeterol is a long-acting beta agonist. LABAs MUST be combined with an inhaled corticosteroid (e.g. Advair, Breo, Symbicort) A 30-year old male has persistent asthma. What daily medication regimen would be appropriate? A) Albuterol B) Low-dose fluticasone, albuterol C) Medium-dose fluticasone D) Budseonide, salmeterol, albuterol - correct answer ✅C) Medium-dose fluticasone Albuterol alone is used for intermittent asthma Albuterol should not be used daily (if the patient is using their rescue inhaler more than twice a week --> call the PCM!) Mr. Jones, a 45-year old drug and alcohol counselor, smokes 1 PPD and c/o cough, low-grade fever, and night sweats for the last week. His CXR show bilateral hilar nodes. What should you do next?

A) Refer to Pulmonology B) Order a chest CT with contrast C) Order a TB skin test D) Repeat the CXR in 2 weeks - correct answer ✅C) Order a TB skin test A patient who takes fosinopril for HTN has been diagnosed with ACE-inhibitor cough. Which of the following statements is true? A) He could switch to lisinopril B) This cough is more likely in patients with lower airway disease C) His cough should improve over time D) The cough is related to an inability to break down bradykinin - correct answer ✅D) The cough is related to an inability to break down bradykinin A 19-year old college student (otherwise healthy, nonsmoker) was diagnosed with community-acquired pneumonia by CXR a couple days ago. She has been taking amoxillin with clavulanate 875 mg BID for the past 48 hours. She returns today for a follow-up appointment.

Her vitals 2 days ago: BP 120/72, HR 96, T 103F, RR 24/min, Ó2 sats 92%. Her vitals today: BP 130/80, HR 100, T 102.2, RR 24/min, Ó2 sats 94%. How would you manager her today? A) Repeat CXR, CBC, and start levofloxacin B) Start azithromycin 5-day pack C) Continue with amoxicillin-clavulanate for another 24 hours D) Stop amoxicillin-clavulanate and start doxcycline 100 mg BID x 7 days - correct answer ✅D) Stop amoxicillin-clavulanate and start doxycycline 100 mg BID x 7 days She most likely has an atypical pathogen (mycoplasma pneumoniae or chlamydophila pneumoniae), which should be treated with a macrolide or doxycycline If a 19-year old college female diagnosed with community acquired pneumonia was pregnant in her first trimester, how could she be managed? A) Levofloxacin 750 mg PO daily x 5 days

B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID C) Cephalexin 500 mg PO BID x 5 days D) Doxycyline 100 mg PO BID x 5 days - correct answer ✅B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID Quinolones (e.g. levofloxacin) and tetracyclines (e.g. doxycycline) are teratogenic and should not be given during pregnancy A 63-year old patient w/ COPD c/o a pounding heart after using his inhaler. Which of the following is the least likely culprit? A) Fluticasone B) Albuterol C) Iptratropium D) Salmeterol - correct answer ✅A) Fluticasone Mr. Smith, an 80-year old smoker, has stage II COPD. Based on his medications, what is the most predictable drug-disease interaction?

Losartan 50 mg, HCTZ 12.5 mg, Amlodipine 5 mg daily, Tamsulosin (Flomax) 0.8 mg daily, Atorvastatin (Lipitor) 10 mg daily, Albuterol inhaler 2 puffs PRN for SOB, tiotropium (Spiriva) once daily A) Glaucoma B) Frequent urination C) Anxiety D) Pruritis E) Hyperglycemia F) Fatigue G) Constipation - correct answer ✅G) Constipation Amlodipine (CCB) and tiotropium (short-acting anti-cholinergic) An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. How should she be managed today? A) Treat with azithromycin daily for 5 days

B) Treat with ciprofloxacin, nebulized albuterol q4-6 hours PRN for wheezing C) Treat with oral steroid and nebulized levalbuterol q8 hours PRN D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing - correct answer ✅D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing She is more likely to have Strep pneumoniae and should be treated with a quinolone. Ciprofloxacin is not a respiratory quinolone An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. She is being treated for pneumonia with levofloxacin and nebulized albuterol q4-6 PRN for wheezing. She develops white plaques on the buccal mucosa, palate, and tongue (thrush). What medications are the most likely cause of this? A) Levofloxacin and metformin B) Albuterol and levofloxacin C) Metformin and fluticasone D) Fluticasone and levofloxacin - correct answer ✅D) Fluticasone and levofloxacin

Anemia is a reduction in one or more of what RBC measurements? - correct answer ✅RBC count (4.2-4.9 mil/microL), hemoglobin (12-15 g/dl), or hematocrit (37-51%) The patient has the following CBC results: Is the patient anemic? RBC 4.0 HGB 11.5 HCT 35.6% MCV 90 MCH 25.7 MCHC 33.4 RDW 14.6 PLT 265 MPV 7.1 - correct answer ✅Yes Name 3 causes of anemia. Which is the most common reason in the US? - correct answer ✅Blood loss (most common), sick bone marrow, increased RBC destruction