Differential Diagnosis and Clinical Decision-Making in Primary Care, Exams of Nursing

Download Differential Diagnosis and Clinical Decision-Making in Primary Care and more Exams Nursing in PDF only on Docsity! Leik ExamEdge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice 2024-2025. Questions and Correct, Verified Answers. Graded A+ 1. Poor hygiene 2. The use of razors on the skin 3. Break in the skin tissue 4. Diabetes mellitus - ANSWhat are the 4 most common predisposing factors for the bacterial infection folliculitis? 14 year old patient who fell on a outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on xray. The most likely working diagnosis is: A. upper arm sprain B. lateral epicondylitis C. Radial head fracture D. Olecranon bursitis - ANSC. Radial head fracture. 2 year old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After closed manipulation, the best indication of successful treatment is that: A. Swelling dissipates immediately B. Pulse and sensation are restored C. The child quickly begins to use the affected arm D. A click is felt while the child is extending and rotating the arm - ANSC. The child quickly begins to use the affected arm. A "port wine" stain that is located on half the facial area may be a sign of which of the following? Sturge-Weber Syndrome Von Recklinghausen's Disease trachoma chlamydial pneumonia - ANSSturge-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). Cafe au last is associated with Von Recklinghausesn's Disease. This disease is a genetic disorder characterized by the growth of tumors on the nerves. The disease can also affect the skin and cause bone deformities. There are three forms of VRD: neurofibromatosis type 1 (NF1) neurofibromatosis type 2 (NF2) schwannomatosis, which is a variant of NF2 A 10-month old presents with a rash, runny nose, and cough. Examination reveals a cluster of tiny white papuls with an erythematous base on the buccal mucosa. What does this suggest? A. Scarlet fever B. Rubella C. Erythema infectiosum D. Measles - ANSD. Measles A 14yo male with bronchitis is being treated with fluids and expectorants. He returns to the clinic with a fever of 103F, right pleuritic chest pain, and green sputum. Which of the following examination results would be expected? A. Right lower lobe crackles B. Decreased Fremitus C. Bilateral Wheezing D. Normal Percussion - ANSA. Right lower lobe crackles. 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? - ANSAppendicitis. 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. A 22 year old female patient expresses interest in taking Accutane for severe acne. The patient is required to do all but which of the following in order to be prescribed Accutane? Sign a document pledging to use two specific forms of birth control while on Accutane. Agree to take a pregnancy test before starting the medication. Have a total hysterectomy. Agree to take a pregnancy test within 30 days of her last dose of Accutane. - ANSHave a total hysterectomy Accutane poses a risk of serious birth defects. Patients who wish to be put on Accutane must sign a pledge that they will use two specific forms of birth control while on the drug. They must also have a negative pregnancy test within 30 days of stopping and starting the drug. They are not required to undergo hysterectomy. 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? - ANSDouble 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. 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? - ANSDiabetes. A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this patient. A 25-year old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated with movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? A. Palpate structures around the shoulder B. Obtain an MRI to evaluate the shoulder C. Order an Xray of the shoulder D. Request an EMG - ANSA. Palpate the structures around the shoulder 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? - ANSItraductal 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 non-tender, may present with pain. Chest wall syndrome may present in some women as breast pain. Fibrocystic breast disease often presents with bilateral breast pain. A 29-year old male with noncomplicated Chlamidia infection may exhibit: A. Urticaria B. No remarkable clinical symptoms C. A green mucoid penile discharge D. A penile ulcer - ANSB. No remarkable clinical symptoms A 2month old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (not beet red) macular rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted . The infant's rash is most likely caused by. A. Candida albicans infections. B. Eczema C. Seborrheic dermatitis D. Contact dermatitis - ANSD. Contact dermatitis A 3 year old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? A. throat culture B. sputum culture C. Mantoux (PPD) skin test D. Cold agglutinin test - ANSB. Sputum culture A 30 year old female patient presents with abdominal pain as her chief complaint. She also mentions alternating between constipation and diarrhea. There is no fever. What do you need to pay close attention to in the assessment? Diet and exercise. Diet. Exercise. Depression. - ANSDiet and exercise. The patient's lifestyle can affect digestion. A diet that is low in fiber can contribute to IBS and other problems. A sedentary lifestyle will also negatively affect digestion. A 32 year old patient reports a 6-month history of intermittant symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Gouty arthritis D. Reiter's syndrome - ANSA. Rheumatoid Arthritis 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: B. Schedule a colonoscopy to rule out colon cancer C. Repeat the guaiac test three times and obtain complete blood count D. Prescribe bulk forming agents and hydrocortisone suppositories. - ANSD. Prescribe bulk forming agents and hydrocortisone suppositories. A 45-year-old male patient presents with the acute onset of diffused pink-to-red skin on the site of a skin trauma. He tells the FNP that the area has enlarged over the last few days. The skin is indurated, swollen and tender. Which of the following is the most likely diagnosis? allergic dermatitis acute cellulitis actinic keratoses contact dermatitis - ANSacute cellulitis Acute cellulitis is a skin infection caused by Gram-positive bacteria. Points of entry are skin breaks such as abrasions or surgical wounds. The classic case has an acute onset. A 47-yo patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. The patient is not currently taking any medications. The most likely differential diagnoses would include: A. colitis and peptic ulcer disease B. Colitis and small bowel disease C. Gastritis and Crohn's disease D. Gastritis and peptic ulcer disease - ANSD. Gastritis and peptic ulcer disease. A 50 year old male presents with a chief complaint of malaise. Further questioning reveals that his primary concern is delayed ejaculation. He is currently taking the following medications: atenolol (Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and hydrochlorthoriazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be: A. loratadine B. hydrochlorthoriazide (HCTZ) C. lisinopril (Zestril) D. paroxetine (Paxil) - ANSD. Paroxetine (Paxil) 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? - ANSStart 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 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for Type II diabetes mellitus. What should be done to manage him FIRST? Start insulin Start metformin plus pioglitazone Have him return tomorrow to recheck his blood glucose Start metformin - ANSStart insulin Most oral agents will have little effect on his glucose and it should be lowered immediately. Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a chance to work. He should return to the clinic the next day for a recheck of the blood glucose and medication adjustment. 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? - ANSScarlet 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 62 year old female patient has signs of Stage 2 hypertension and several risk factors in her health history. Upon auscultation, the patient also has carotid bruits. Further diagnostic tests should include a(n): Electrocardiogram. Magnetic resonance imaging. Endoscopy. Doppler imaging. - ANSDoppler imaging Doppler imaging is used in patients who have hypertension. A chest x-ray may be necessary for further diagnosis. Additionally, the GNP should also consider carotid Doppler for patients who have carotid bruits present. A 65 yo female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical exam, there is pain on ROM, with no weakness noted. Lab studies show a low hemoglobin and elevated SED rate. Which of the following is the most likely diagnosis? A. Polymyositis B. Osteoarthrits C. Polymyagia Rheumatica D. Fibromyalgia - ANSPolymyalgia Rheumatica A 65-yo male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical exam, the patient is tachycardic, positive for jugular venous distension, and positive for S3, with a systolic murmur. Chest xray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: A. mycardial infarction B. pneumonia C. Heart failure D. pleural effusion - ANSC. Heart failure 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? - ANSElevated 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 Nervous. Urinary. - ANSGastrointestinal. While high cholesterol is an indicator of heart disease, low cholesterol can be a sign of gastrointestinal problems. Cholesterol below 160 indicates the need for a GI exam. Cholesterol over 240 is too high. 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: - ANSApplying 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. A common rule to follow when prescribing many medications for the elderly is to: A. Give most medications in the morning to allow slowed body functions to have time to adjust to the drug. B. Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. C. Perform a creatinine clearance test for baseline data on all person over age 70 before starting on new medications. D. Give medication with a full glass of water to promote absorption and limit harm to the kidneys. - ANSB. Start at a low dose than what is commonly prescribed for adults, and increase the dose slowly. A common rule to follow when prescribing many medications for the elderly is to: - ANSStart at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. A family member brings her elderly mother into the office with a new onset of fecal incontinence. The nurse practitioner knows that the most common cause is: poor fluid consumption constipation medication related inactivity - ANSconstipation The most common cause of fecal incontinence in elderly adults is underlying constipation. Risk factors include age greater than 80 years, impaired mobility, and neurologic disorders including dementia. While inactivity and poor fluid consumption may contribute to constipation, they are not the cause of fecal incontinence. 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: - ANSone 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 3-7 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. A mother brings her 8-year-old female child to you. The child is complaining of abdominal pain and swelling of her hands and feet. She tells you that the child had a "strep throat" a couple of weeks ago. She has been running a fever and appears very tired. Which of the following diseases/disorders is most consistent with these symptoms? systemic lupus bacterial endocarditis congestive heart failure acute glomerulonephritis - ANSacute glomerulonephritis Acute glomerulonephritis is the result of an immune response, usually a streptococcal infection. It is common in children with the peak ages being 2 - 6 years. A mother brings in her 7-year-old female child saying that she thinks the child is "running a fever." You take the child's oral temperature and find that it is 101.5° F. You understand that this temperature would be classified as which of the following? low fever severe fever moderate fever none of the above - ANSlow fever A low fever is an oral reading of 100.4° to 102.2° F. A high fever is an oral reading of more than102.2° F. A fever higher than 108° F produces unconsciousness and brain damage if sustained. A mother brings in her child reporting that the child's eyes are crossed. You perform a test in which you stand about 20 inches from the child in a darkened room and look at both eyes through an ophthalmoscope. This is known as which of the following? Hirschberg test Bruckner's test EOMs cover-uncover test - ANSBruckner's test Bruckner's test is one of the four tests used to assess ocular alignment. During this test you would note symmetry of red reflexes bilaterally. Hirschberg test- also Hirschberg corneal reflex test, is a screening test that can be used to assess whether a person has strabismus (ocular misalignment). A cover test or cover-uncover test is an objective determination of the presence and amount of ocular deviation. A mother comes into the office with her 2-year-old child who attends daycare. The child is pulling at her ears, running a fever, and has bright red bulging tympanic membranes bilaterally. The nurse practitioner knows that with acute otitis media (AOM) the risk factors include: Chinese race, previous otitis media, many siblings Education on using barriers during sexual activity (e.g., condom/dental dams) is important. Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is not appropriate ethically or legally to contact the partner; however, it would be appropriate for the patient to encourage his partner to get tested. A patient being treated for dehydration may be given all but which of the following? Gatorade. Clear chicken broth. Popsicles. Ice cream. - ANSIce cream Full liquids should be avoided when treating dehydration. Clear fluids given by mouth are the first line of treatment and prevention for dehydration. If clear fluids are not tolerated, IV fluids may be necessary. A patient comes to the clinic with a burn on his leg that is about 2 times the palmar surface of his hand. The body surface area (BSA) of the burn can be estimated at: 4% 6% 2% 12% - ANS2% A person's palmar surface represents a BSA of 1% throughout his life span. Therefore, a burn that is 2 times the palmar surface represents a BSA of 2%. A patient has a history of anorexia. She presents with a sudden weight loss of five pounds and no physical sign of illness. What assessment will help determine if treatment for anorexia is effective? Social. Medical. Family history. Review of systems. - ANSSocial. A social history includes relationships and habits. Dietary habits and support have a profound impact on recovery. A family interview will also shed light on the social assessment. A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? - ANS6 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 patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient? A. edema B. Tachycardia C. Palpitations D. Sweating - ANSD. Sweating A patient presents in the office 3 weeks post-myocardial infarction (MI) complaining of pericardial pain and elevated temperature. Physical examination reveals a pericardial friction rub. The nurse practitioner determines which of the following diagnostic studies would be ordered first? cardiac enzymes with myoglobin complete blood count (CBC) with differential echocardiogram 24-hour holter monitoring - ANScomplete blood count (CBC) with differential Post-myocardial infarction syndrome, also known as Dressler's syndrome, may develop 1 to 4 weeks after a myocardial infarction (MI). A post-myocardial infarction syndrome is characterized by pericarditis with effusion and fever. Also, post-myocardial infarction syndrome is due to antigen-antibody reactions. Laboratory findings for this condition include elevated white blood cell count and erythrocyte sedimentation rate. A patient who has been prescribed Adderall should be educated to notify his healthcare provider if he experiences which of the following side effects? Nausea. Headache. Teeth grinding. Difficulty sleeping. - ANSTeeth grinding. The patient should notify his healthcare practitioner if he experiences teeth grinding. Difficulty sleeping, nausea, and headache may occur with Adderall, but are not typically a cause for concern. If these increase or worsen, the patient should notify his healthcare provider. A patient who has been prescribed betamethasone for psoriasis should be advised to contact her healthcare provider immediately if she experiences which of the following? Weight gain. Stomach upset. Vomit that looks like coffee grounds. Changes in her menstrual period. - ANSVomit that looks like coffee grounds This is potentially a sign of internal bleeding, which is a serious complication. The patient should seek immediate medical attention. Weight gain, stomach upset, and changes in menstruation are common side effects of betamethasone, and are usually not serious. A patient who has been prescribed Imodium for symptoms of IBS should be advised to seek immediate medical attention if he experiences which of the following? D. hospital admission for IV antibiotics - ANSB. Clear liquids and antibiotics. A patient with a history of which of the following has a high risk of developing colon cancer? Polyps. Auras. Ulcers. GERD. - ANSPolyps A history of polyps places a patient at a higher risk of developing colon cancer. Ulcers and GERD are not related to colon cancer. Auras accompany migraines. A patient with hypertension is in the office and you have prescribed Losartan. Losartan, if taken with which of the following other drugs, can put a patient at risk for developing a renal calculi? Cimetidine Ketoconazole Fluconazole Oxypurinol - ANSOxypurinol Losartan is an angiotensin II Receptor Antagonist prescribed for the treatment of hypertension. This drug blocks the material in the body that constricts or narrows the blood vessels, then relaxes the blood vessels, allowing the blood to flow more freely and results in a lowered blood pressure. The common side effects of Losartan are dizziness, diarrhea, muscle cramps, heartburn, stuffy nose, pain in the leg, knee or the back. Some serious side effects include chest pain, difficulty breathing and swelling in the face, throat or tongue. Losartan, if taken with certain other drugs, can cause a potential drug interaction. For example, when Losartan is taken with Cimetidine, Losartan increases the serum level of Cimetidine. Then, if Losartan is taken with Fluconazole, Fluconazole reduces the efficacy of Losartan. When Losartan is taken with Oxypurinol, the patient has an increased risk of developing renal calculi. Further, if the patient drinks grapefruit juice with Losartan, grapefruit juice causes a delay in the absorption and decreases the serum levels of the Losartan. A patient with macular degeneration has difficulty seeing objects: A. from a distance B. In the center of the visual field C. At reading distance D. In the peripheral fields - ANSB. In the center of the visual fields. A patient with moderate persistent asthma will probably be most effectively managed with daily: - ANSinhaled 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 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: - ANSElevate 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 patient with Type 1 diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of an at-home glucose test reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: A. Insulin resistance B. Cortisol deficiency C. the Somogyi effect D. pawn phenomenon - ANSC. the Somogyi effect A physical assessment of Jerry, your 15-year-old male patient with acne will help to establish the grade of his acne. His acne appears to be pure comedonal acne. This is which of the following grades? Grade I Grade II Grade III Grade IV - ANSGrade IGrade I is pure comedonal acne. It may be treated with tretinoin. To avoid overdrying the skin, the treatment should be initiated on an every-other-day basis. Grade 1: Comedones, occasional papules. Grade 2: Papules, comedones, few pustules. Grade 3: Predominant pustules, nodules, abscesses. Grade 4: Mainly cysts, abscesses, widespread scarring. A PPD is considered positive at 5 millimeters or more for which population? - ANSConfirmed 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. A routine laboratory assessment of a 12 year old patient with a family history of thalassemia and anemia reveals Tanner II presentation and Hct=355. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? A. serum folic acid B. Vitamin B12 level C. Hemoglobin Electrophoresis D. 24-hour urine creatinine - ANSC. Hemoglobin electrophoresis A test called the visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central vision C. Visual acuity looking at the laboratory report, which of the following values would you expect to see in a patient with acute appendicitis? total WBCs 1200 mm³ neutrophils 4% bands 1% lymphocytes 44% total WBCs of 500mm³ neutrophils 10% bands 2% lymphocytes 39% total WBCs 16,000 mm³ neutrophils 67% bands 8% lymphocytes 23% None of the above would indicate acute appendicitis. - ANStotal WBCs 16,000 mm³ neutrophils 67% bands 8% lymphocytes 23% You would expect a "left shift." This includes leukocytosis (elevated WBCs), neutrophilia (an absolute neutrophil count (ANC) of greater than 7000 neutrophils/mm. ANC is calculated by multiplying the percentage of neutrophils by the total WBC in mm. Therefore, the following answer choice is correct, as the absolute neutrophil count is greater than 7000 mm³ if you multiplied 0.67 by 16,000. This would be 10,720 neutrophils/mm³. After taking a job with a professional organization, you are a practicing nurse practitioner in a rural community. You are involved in work-related surveillance and know that the records related to this must be held for how many years after employment? 10 years 20 years 30 years They can be destroyed only after the employee's death. - ANS30 years The Occupational Safety Health Act (OSHA) was formed to protect employees from hazardous work environments. The requirements of OSHA are to keep these records for 30 years after the termination of employment. After thorough testing of your elderly patient, you diagnose her as being positive for Suberosis. Of the following, which was she MOST likely exposed to that caused this illness? Rotting maple tree bark. Moldy compost. Moldy cork dust. Contaminated humidifier. - ANSMoldy cork dust. Maple bark stripper's disease is typically caused by rotting maple tree logs or bark, and Mushroom picker's disease, moldy compost. Suberosis is caused by moldy cork dust. "Humidifier" lung is caused by contaminated humidifiers, air conditioners, or heating systems. After thorough testing, the ANP decided it is best to treat his patient with a SERM. Which of these is an example of a SERM? ASA. Rofecoxib. Raloxifene. Baclofen. - ANSRaloxifene ASA - NSAID Rofecoxib - COX-2 Raloxifene - SERM Baclofen - Skeletal Muscle Relaxant Selective estrogen receptor modulators, called SERMs for short, block the effects of estrogen in the breast tissue. SERMs work by sitting in the estrogen receptors in breast cells. If a SERM is in the estrogen receptor, there is no room for estrogen and it can't attach to the cell. Aileen is an adult patient of Scottish descent who reports a red, acne-like area around her nose and mouth. She tells you that it comes and goes. Your most likely diagnosis of the following choices would be: cheilosis tinea barbae cystic acne rosacea - ANSrosacea Rosacea is seen more in adults of Celtic background with pale skin, blue eyes, and red-to-blond hair. The patient usually complains of chronic, small acne-like papules and pustules that erupt around the nose, mouth, and chin, which become exacerbated episodically. Alfred is a 54-year-old male patient with high cholesterol. You are going to prescribe a bile acid sequestrants for him. Which of the following drugs is a bile acid sequestrant? Zocor Colestid TriCor Pravachol - ANSColestid Colestid is a bile acid sequestrants. TriCor (fenofibrate) is a fibrate drug. Pravachol and Zocor are HMG CoA Reductase Inhibitors (statins). C. Feverfew D. Ginko Biloba - ANSC. Feverfew An 18-month old child presents with a bulging, immobile tympanic membrane; T-103F(39.4C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: A. Obtain an EKG B. Obtain an Echocardiogram C. Reevaluate the patient in 10 days D. Refer the patient to a cardiologist - ANSC. Reevaluate the patient in 10 days An 18yr old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? A. Amoxicillin-Clavulanate (Augmentin) B. Ceftriaxone (Rocephin) C. Levofloxacin (Levaquin) D. Erythromycin - ANSA. Amoxicillin-Clavulanate (Augmentin) 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: - ANSA 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. An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure? - ANSWeight 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. An 85 year old patient related that on the way to an annual physical exam, the patient suffered a sudden loss of vision in the right eye characterized by a "bunch of lights" and a feeling that " a curtain came down" The most likely diagnosis is: A. Vitreal hemorrhage B. Optic nerve lesion C. Central retinal nerve occlusion D. Retinal Detachment - ANSD. Retinal detachment An 88 year old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? A. Folstein Mini-Mental State examination B. Geriatric Depression Scale C. Minnesota Multiphasic Personality Inventory Myers-Briggs Test - ANSA. Folstein Mini-mental state examination An 88 year old patient presents with right-sided weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis? A. Seizure B. Right-sided Stroke C. Left-sided stroke D. Trans ischemic attack - ANSC. Left-sided Stroke An 88-yo patients has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: A. lateralize to the left B. lateralize to the right C. Be inconclusive D. Not lateralize - ANSA. Lateralize to the left. 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? - ANS135 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. 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? His friend tell him he drinks too much. He wants to cut out drinking on the weekends to reduce calories. He drinks one beer a night. He does not drink to alleviate stress. - ANSHis friend tell him he drinks too much A patient who feels guilty about drinking and is told to cut down by his friends or family may be an alcoholic. Using the CAGE strategy will help determine the risk of alcoholism. CAGE Alcohol Questionnaire (CAGE) Have you ever felt you needed to Cut down on your drinking? ... Have people Annoyed you by criticizing your drinking? ... Have you ever felt Guilty about drinking? ... Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? An elderly male has a diagnosis of left-sided congestive heart failure (CHF). The nurse practitioner would identify which of the following as a common condition associated with CHF? ventricular dysrhythmias peripheral vascular disease untreated hypertension Accutane Cytotec Coumadin Proscar Propecia Birth-control pills HRT Testosterone Live virus vaccines such as rubella, measles, and mumpsT halidomides such as methimazoleOthers Causes of weight loss include - ANSGI deases; endocrine disorders (diabetes, hyperthyroidism, adrenal insufficiency); chronic infections, HIV/AIDS; malignancy; chronic cardiac, pulmonary, or renal failure; depression; and anorexia nervosa or bulimia; Congenital heart disorders present with symptoms at: - ANSbirth, 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. Considering mortality statistics for the adolescent age group. education targeted toward this group should first focus on: - ANSalcohol 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. Correct answer: regular exercise Prevention of hemorrhoidal engorgement and inflammation is the best treatment for hemorrhoids. This includes such strategies as weight control, high-fiber diet, regular exercise and increased fluid intake. Treatment for acute hemorrhoid flare-ups includes the use of astringents and topical corticosteroids, sitz baths, and analgesics. - ANSWhich of the following would be the least likely treatment to be used for an acute hemorrhoid flare-up? regular exercise astringents sitz baths analgesics Correct Answer: The NP must respect confidentiality but it does not have to be formally discussed with the patient. Confidentiality requires that the provider discuss confidentiality issues with patients. They must establish consent, and clarify any questions about disclosure of information. - ANSThe patient and his family have a right to assume that information given to the NP will not be disclosed. This means all of the following EXCEPT: Verbal information is covered by confidentiality. Written information is covered by confidentiality. The individual's right to privacy is respected when responding to a request for a patient's medical record. The NP must respect confidentiality but it does not have to be formally discussed with the patient. Correct Answer: 1200 cells/mm3 with 90 - 95% neutrophils Lumbar puncture should be part of the valuation of a febrile younger child who has an altered neurological examination. Typical CSF response in bacterial meningitis includes a median WBC of 1200 cells/mm3 with 90 - 95% neutrophils. - ANSYou have a 4-year-old child patient with bacterial meningitis. The typical CSF response in bacterial meningitis includes a median WBC count of which of the following? 1500 cells/mm3 with 85 - 95% neutrophils 500 cells/mm3 with 80 - 85% neutrophils 1200 cells/mm3 with 90 - 95% neutrophils 1800 cells/mm3 with 80 - 85% neutrophils Correct answer: 50% At least 50% of persons with Epstein-Barr virus mononucleosis develop splenomegaly. Hepatomegaly develops in about 10% of cases. - ANSIn a person with Epstein-Barr virus mononucleosis what are the chances that this person will develop splenomegaly? 10% 25% 50% 85% Correct Answer: age history of STDs Braces Physical/occupational therapy Surgery - ANSWhich of the following treatments would be considered correct for the osteoarthritis on the left in the x-ray image above? check all answers that apply Anti-inflammatory drugs Braces Corticosteroid injections Amputation Correct answer: asking the patient to clench his or her teeth Part of inspecting the face and head of a patient is testing the masseter muscle. During an extra-oral examination, stand near the patient and visually inspect and bilaterally palpate the muscle. Place the fingers of each hand over the muscle and ask the patient to clench his or her teeth several times. - ANSYou would test a patient's masseter muscle by doing which of the following? palpating the scalp tapping on the forehead asking the patient to stand quickly asking the patient to clench his or her teeth Correct Answer: Both B and C Cephalosporins and penicillins would be considered the first most frequent cause of allergic reactions. Sulfonamides would be considered the second most frequent cause of allergic reactions. - ANSCorrect answer: unintentional injuries The leading cause of death in children 12 months to 9 years is unintentional injuries. The leading cause of death in infants younger than 12 months is congenital anomalies. Correct Answer: Both B and C The above image would be considered an example of an MRI of the human kidney. Some of the types of benign masses could include: Hemangioma Hematoma Cysts Angiomyolipoma Oncocytoma Renal adenoma - ANSThis question showed a CT image of a kidney. Which of the following might be considered a form of benign mass that could potentially be diagnosed by the procedure above? Diabetes mellitus Hemangioma Hematoma Both B and C Correct answer: Bowen's family systems theory Bowen's family systems theory explains current family situations in terms of past relationships and family histories. It connects one's past family experiences with current behaviors and suggests that multiple factors interacting across time influence family functioning. - ANSThe theory that explains current family situations in terms of past relationships and family histories is which of the following? Maslow's hierarchy of needs Piaget's cognitive development theory Erikson's stages of psychosocial development Bowen's family systems theory Correct Answer: Consent. Procedures and tests require patient consent before they can take place. Since the patient is a conscious adult, the patient gives consent. This is the first step. - ANSA 23 year old patient is conscious and requires an x-ray for a differential diagnosis of a broken arm. What is the first step to the process? Prepare the machine. Position the patient. Consent. Inform radiology. Correct Answer: decreased mental competence objects by an EGD. - ANSwhich would be the typical procedure that would more than likely be used to remove the screws from the patient with screws found in the esophagus during an x-ray image? Laparoscopy Abdominal surgery Colonoscopy Esophagogastroduodenoscopy (EGD) Correct Answer: Facial features continue to develop Digestive tract/sensory organs begin to develop Weighs about 1/30 of an ounce The above image would be considered a 3D rendered human fetus at 2 months that should be seen on the ultrasound. By or during month 2, the embryo should: Facial features continue to develop Digestive tract/sensory organs begin to develop The embryo would be approximately 1 inch long and weigh about 1/30 of an ounce. The neural tube which contains the brain, spinal cord, and other neural tissues is well developed. The cartilage is starting to be replaced by bone. The heart beat can be detected by about 6 weeks. By 2 months, the embryo is now referred to as a fetus. - ANSWhich of the following would be considered correct for the development of the embryo at 2 months? check all answers that apply Facial features continue to develop Digestive tract/sensory organs begin to develop Weighs about 1/30 of an ounce Is approximately 6 inches in length Correct Answer: fecal occult blood test at home with collection of two samples from three consecutive specimens The American Cancer Society colorectal cancer screening guidelines recommend a fecal occult blood test at home with collection of two samples from three consecutive specimens. If there is an initial positive finding then a colonoscopy should be done. - ANSThe American Cancer Society colorectal cancer screening guidelines recommend which of the following as a screening test for colorectal cancer? fecal occult blood test at home with collection of two samples from three consecutive specimens fecal occult blood test obtained via the digital rectal examination in the provider's office toilet bowl fecal occult blood test digital rectal examination Correct Answer: gabapentin Of the medications listed, phenytoin, primidone, and carbamazepine are all known increase the failure of hormonal contraceptives. Only gabapentin is not known to reduce efficacy of hormonal contraceptives. - ANSThe FNP has a 21-year-old female patient with a history of seizures. She is married and taking oral contraceptives until she is ready to start a family. Which of the following medications is not known to reduce the efficacy of hormonal contraceptives? phenytoin primidone carbamazepine gabapentin Correct Answer: hearing via bone conduction impaired malfunction is in the cochlea, the cochlear portion of the eighth cranial nerve, or both These are two characteristics of sensorineural hearing loss. The other three choices are related to conductive hearing loss. - ANSWhich of the following are associated with sensorineural hearing loss? check all answers that apply decreased hearing via air conduction interference of transmission of sound through the external auditory canal interference of transmission of vibrations from the tympanic membrane through the ossicular chain to the oval window hearing via bone conduction impaired malfunction is in the cochlea, the cochlear portion of the eighth cranial nerve, or both Correct Answer: Inspection of the eye, sclera, and conjunctiva for the presence of any foreign bodies. Patient's temperature The picture above would be considered chalazion, which is a chronic lipogranulomatous inflammation of a meibomian gland. When performing a physical examination on this patient, the following should be done: Inspection of the eye, sclera, and conjunctiva for the presence of any foreign bodies. Patient's temperature Check the eyelid for any masses or tenderness seborrheic dermatitis nevus flammeus miliaria Correct Answer: MRI The "gold standard" test for joint damage would be considered the MRI. Some of the other maneuvers which might be used when the nurse practitioner is assessing the patient could include: Drawer Sign Finklestein's Test McMurray's Test Lachman's Sign - ANSOf the following, which would be considered the "gold standard" test for joint damage? X-ray Ultrasound CT-scan MRI Correct Answer: noise trauma Noise trauma is the second most common cause of hearing loss. Also termed acoustic trauma, it can be related to a single, very loud noise or by exposure to a noise at a lower decibel over a long period of time. Sounds louder the 85 dB are potentially damaging to the cochlea, especially with prolonged exposure such as having worked in a factory for over 20 years. - ANSElmer is a client who comes to you complaining of difficulty hearing. He works in an automotive plant with loud machinery in use at all times. He has been exposed to this environment for 25 years. This supports a diagnosis of which of the following? noise trauma otosclerosis presbycusis ototoxicity Correct Answer: oral corticosteroid Pramoxine, topical anesthetics, topical steroids, and oral antihistamines are normal treatment for pruritus. However, if the pruritus is more severe and there is swelling in the area, an oral corticosteroid would be most effective. - ANSYou have a patient whose pruritic skin condition is manifesting with severe pruritus and swelling. Which of the following treatments would be most effective for this patient? Pramoxine oral corticosteroid oral antihistamine any topical anesthetic Correct Answer: Peak expiratory flow rate (PEFR) triggers that are affecting the asthma effectiveness of medications These are important determinations for each follow-up visit. You should also determine that the client is taking the medication properly and discuss an action plan. - ANSAt each follow-up visit with your patient who has asthma you should determine which of the following? check all answers that apply Peak expiratory flow rate (PEFR) diet triggers that are affecting the asthma blood count effectiveness of medications Correct Answer: Pericarditis Some of the complications of rheumatoid arthritis would be considered: Pericarditis Uveitis Scleritis Vasculitis Increased risk of certain malignancies - ANSRheumatoid arthritis would be considered a systemic autoimmune disorder that is more common in the female patients. Of the following, which might be considered a complication of this disorder? Pericarditis Nausea/vomiting Severe headaches Rash over the torso bonus formula termination clause none of the above Correct Answer: rubella The pathogenicity of the rubella organism is considered intermediate. The other three choices are highly pathogenic. They have the greatest ability to produce disease. - ANSWhich of the following diseases is caused by an organism with the least pathogenicity of the choices given? rubella rabies rhinovirus varicella Correct answer: salmon macular rash polyserositis splenomegaly leukocytosis The acute febrile form of JRA presents with all of these symptoms. It is one of the three forms of JRA. The other two forms are polyarticular pattern JRA and pauciarticular disease. - ANSThe acute febrile form of juvenile rheumatoid arthritis (JRA) presents with which of the following symptoms? check all answers that apply salmon macular rash polyserositis splenomegaly chronic pain and swelling of joints five or more joints are involved leukocytosis Correct Answer: self-actualization Maslow developed a hierarchy of needs in which some needs are more important than others and must be met before other needs can be considered. The most basic needs in Maslow's hierarchy of needs are survival needs: water, food, sleep. The highest is achieving potential which is known as self-actualization. - ANSThe highest level of Maslow's hierarchy of needs is which of the following? self-actualization self-esteem love and belonging safety and security Correct Answer: The patient is 80-years-old or older and unable to comprehend the complex medical facts. All patients are entitled to medical information regardless of age. The nurse practitioner may treat in any of the other circumstances listed in the remaining answer choices. - ANSThe Family Nurse Practitioner has the duty to disclose certain information to the patient as part of the informed consent process. Exceptions to this duty would include all of the following EXCEPT: It is a definite emergency situation. The healthcare provider believes that the information would be harmful to the patient and invokes the therapeutic privilege. The patient has waived the right to receive informed consent. The patient is 80-years-old or older and unable to comprehend the complex medical facts. Correct Answer: TMJ dysfunction TMJ dysfunction is not an early sign of acceleration/deceleration injuries of the cervical spine. It is a late symptom along with anxiety, limited tolerance to ADLs, depression, and disequilibrium. - ANSEarly signs and symptoms of acceleration/deceleration injuries of the cervical spine (whiplash) include all but which of the following? headache neck stiffness TMJ dysfunction vertigo Correct answer: unintentional injuries The leading cause of death in children 12 months to 9 years is unintentional injuries. The leading cause of death in infants younger than 12 months is congenital anomalies. - ANSThe leading cause of death in children 12 months to 9 years is: heart disease unintentional injuries During development of a treatment plan for an 84 year old patient with hypothyroidism, the nurse practitioner has to keep in mind the worsening of: A. renal insufficiency B. Osteoporosis C. Dementia D. Anemia - ANSB. Osteoporosis Edema from extravascular fluid retention is visible in conditions like - ANSheart failure, nephrotic syndrome and liver failure. Education of women with fibrocystic breast disease should include which of the following statements? - ANSCaffeine 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. Enuresis is involuntary urination after a child has reached the age when bladder control is usually attained. Management of primary nocturnal enuresis includes all of the following EXCEPT: limiting fluid intake before bedtime double voiding before bedtime avoiding punishment withholding verbal praise so as not to call attention to the problem - ANSwithholding verbal praise so as not to call attention to the problem Verbal praise is an excellent means of motivational therapy for a child with primary nocturnal enuresis. Other means of motivational therapy include a reward system and keeping a dryness calendar. Evaluating Posterior Cruciate Ligament (PCL) injury - ANSPosterior drawer sign Evaluation of a meniscal tear using - ANSMcMurray Sign and a locking on full knee extension Evaluation of Anterior Cruciate Ligament (ACL) injury - ANSAnterior Drawer sign and Lachman test Examining a male with suspicion of testicular cancer, the nurse practitioner understands that what test is a useful tumor marker for this disease? prostate-specific antigen (PSA) alpha-fetoprotein (AFP) prostatic acid phosphatase (PAP) alkaline phosphatase (ALP) - ANSalpha-fetoprotein (AFP) AFP increases in testicular and primary hepatocellular cancer. Prostate-specific antigen (PSA) increases in prostate cancer. Prostatic acid phosphatase (PAP) is used to monitor therapy with antineoplastic drugs and bone cancers. Then, alkaline phosphatase (ALP) increases in osteosarcoma, liver carcinoma, and bone tumors. Expected spriometry readings when the patient has chronic emphysema include: - ANSIncreased 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. Finkelstein's Test - ANSIf positive, Indicates de Quervain's tenosynovitis. Grasp the thumb against the palm and then move the wrist toward the midline in the ulnar deviation 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: - ANSnormal 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. For a 41-year-old male patient who has had a normal baseline blood glucose level measurement done several years ago, you would advise that it be measured how often from now on? every 2 years every 5 years every 10 years every 6 months - ANSevery 2 years Blood glucose level baseline measurement should be obtained at 18 to 39 years. After that blood glucose should be measured every 2 years. For patients with fibromyalgia, the maximum dose of Lyrica is which of the following? 100 mg/day. 450 mg/day. 1000 mg/day. 150 mg/day. - ANS450 mg/day The maximum dose of Lyrica for neuropathic pain associated with fibromyalgia is 300-450 mg/day. It is given in two or three doses during the day. Patients typically start on a lower dose of 150 mg/day and build up to 300-450 mg/day over the course of a week. For which of the following reasons would quinolones not be prescribed to children less than 18 years of age? 4 doses 1-2 doses - ANS1-2 doses This will depend on the patient, but typically 1-2 doses should be administered. These should be given at least 1 months apart. Humulin insulin 70/30 would be considered a mixture of? Regular insulin 70% and NPH insulin 30% Lantus insulin 70% and regular insulin 30% Lispro insulin 70% and NPH insulin 30% NPH insulin 70% and regular insulin 30% - ANSNPH insulin 70% and regular insulin 30% This mixture usually has an onset of 30 minutes, peak of 4.4 hours, and duration of 24 hours.Humulin insulin 70/30 would consist of a mixture of: NPH insulin 70%Regular insulin 30% Hydrocephalus is an abnormal expansion of cavities within the brain caused by the accumulation of cerebrospinal fluid. The management/treatment for your infant patient with hydrocephalus may include which of the following? extracranial shunts treatment of the underlying cause anticipatory guidance for families and caregivers throughout the child's life all of the above - ANSall of the above The management/treatment of hydrocephalus in an infant would include all of the choices. Most cases will require: extracranial shunts, particularly ventriculoperitoneal types; treatment of the underlying cause such as a mass or lesion; and anticipatory guidance for the families and caregivers, such as referral to support groups and daily head circumference measurements. hyperopia - ANSWhich of the following is NOT considered a risk factor for primary open-angle glaucoma (POAG)? African descent advancing age diabetes mellitus hyperopia If the asthma patient has to use high-dose inhaled steroids, it can cause which of the following? Immune suppression Mild growth retardation in children Cataracts All of the above - ANSAll of the above The patient that uses high-dose inhaled steroids has the potential to experience: Immune suppression Mild growth retardation in children Cataracts Osteoporosis Glaucoma Hypothalamic pituitary-adrenal suppression Others If, upon examination of a child you find tufts of hair overlying the spinal column this may be a sign of spina bifida occulta. This is known as which of the following? nevus flammeus milia faun tail nevus hirsutism - ANSfaun tail nevus Faun tail nevus occurs when there are tufts of hair overlying the spinal column usually at the lumbosacral area. This may be a sign of spina bifida occulta. An ultrasound of the lesion should be done to rule out spina bifida. Nevus flammeus or port-wine stain is a capillary malformation presenting as a pink or red patch on a newborn's skin. It is a congenital skin condition that can affect any part of the body and persists throughout life. In diagnosing a toothache (pulpitis), the nurse practitioner has knowledge that all of the following are correct except: Systemic manifestations do not occur from dental caries and pulpitis. You should inquire about fever and chills. Dental caries are the most frequent type of injury that causes pulpitis. There is diverse flora involved in the infectious process, including gram-positive anaerobes and bacteroides. - ANSSystemic manifestations do not occur from dental caries and pulpitis. Many patients present in the clinic setting with a toothache or related symptoms. Systemic manifestations often occur and they include lymphadenopathy, malaise, fever, and pain. The remaining answer choices are true regarding this condition. In terms of Fee-for-service Medicare, which of the following statements about CPT codes and related items is incorrect? Fees for CPT codes are the same in every location and for every provider. All reimbursable services have a CPT code. CPT codes were developed by the AMA. Isaac is a 50-year-old male patient with a history of urethritis. He complains of red, swollen joints that he says, comes and goes. He also has an ulcer on the skin of the glans penis. Which of the following is your most likely diagnosis? Jarisch-Herxheimer reaction Reiter's syndrome perihepatitis Fitz-Hugh-Curtis syndrome - ANSReiter's syndrome Reiter's syndrome is an immune-mediated reaction secondary to infection with certain bacteria that spontaneously resolves. It is more common in males. Treatment is supportive. Jake is a 25-year-old male patient who has been experiencing diarrhea for several days. He tells you that he has not felt much like eating or drinking anything since this started. Your assessment shows mottled, very dry mucous membranes, prolonged skin tenting, and deeply sunken eyes. These are all indications of which level of dehydration? mild moderate chronic severe - ANSsevere This patient has severe dehydration. This patient will likely have no urine output, low blood pressure, and tachycardia, as well. John is a patient with acute renal failure. His inability to regulate electrolytes might be evidenced by all but which of the following conditions? hyperkalemia hyperlipidemia hypocalcemia hypernatremia - ANShyperlipidemia This patient's inability to regulate electrolytes might be evidenced by hyperkalemia, hypernatremia, hyponatremia, hypokalemia, hypermagnesemia, hyperphosphatemia, and hypocalcemia. Hyperlipidemia is abnormally elevated levels of any or all lipids and/or lipoproteins in the blood. Koplik's spots are associated with: A. Poxvirius infections B. Measles C. Kawasaki's disease D. Reye's syndrome - ANSB. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and koplik's spots on buccal mucosa lazy eye - ANSWhat is Amblyopia - Lead poisoning in children is often caused by lead-based paints found in older homes. If a child is exposed to lead, develops symptoms and has a lead level of 55 mcg/dL which of the following is the best course of action? removal from the source of lead, improved nutrition and iron therapy hospital admission no intervention is required at this level chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy - ANSchelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy. Most children with lead levels of 10 - 45 mcg/dL are treated with removal from the source, improved nutrition and iron therapy. With lead levels of 46 - 69 mcg/dL, chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy is indicated. With lead levels above 70 mcg/dL hospital admission with expert evaluation is the most prudent course. Louis is a 67-year-old male patient with open-angle glaucoma. Your follow-up for Louis should include which of the following? Caution the person to avoid exercise. Monitor a high-protein, low-fat diet. Monitor for side effects of beta blocker use. Follow up IOP and visual field changes every six weeks. - ANSMonitor for side effects of beta blocker use. Monitor for side effects of drugs, especially with non-cardioselective beta blocker use. Even with topical use, bronchoconstriction may be a side effect of these drugs. Mary Beth is a32-year-old female who complains of excessive facial and body hair, infrequent periods, and acne. You suspect polycystic ovary syndrome. If this is true you would find which of the following in this patient? atrophied ovaries FSH levels elevated serum testosterone low androstenedione elevated - ANSandrostenedione elevated You might find this in a client with polycystic ovary syndrome. The ovaries would not be atrophied; they would be enlarged. Serum testosterone would be elevated and FSH levels normal or low. Mary is concerned because her 12-year-old son shows no signs of puberty. You would tell her that the average age of onset for males is which of the following? 10 - 12 years 13 - 16 years 10.5 - 16 years 10.5- 13 years - ANS10.5 - 16 years You can reassure this mother that her son is not behind schedule in reaching puberty. The average age of onset for males is 10.5 - 16 years. Mrs. Worley is a 78-year-old patient who has diverticulitis. Which of the following medications are you least likely to prescribe for Mrs. Worley? trimethoprim/sulfamethoxazole Imitrex metronidazole Cipro - ANSImitrex Imitrex is not a medication for diverticulitis. It is a medication used for migraine headaches. All of the other medications might be used to treat diverticulitis. For severe cases the patient may have to be hospitalized. Multiple sclerosis (MS) is usually classified into different forms. Your patient has the type of MS in which episodes resolve with good neurologic function between exacerbations. This type of MS is which of the following? primary progressive MS secondary regressive MS secondary progressive MS relapsing, remitting MS - ANSrelapsing, remitting MSRRMS (relapsing, remitting MS) is the type in which episodes resolve with good neurologic function between exacerbations and it has minimal to no cumulative defects. This type of MS accounts for approximately 85% of patients with the condition. Oburator Sign - ANSright hypogastric pain constitiutes a positive obturator sign. Ask patient to flex right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. Of the diagnostic tests for hearing, which of the following tests evaluates the clarity of hearing? audiometric study speech discrimination testing audiogram tympanogram - ANSspeech discrimination testing Speech discrimination testing is used to evaluate the clarity of hearing. Results are reported as percentage correct. Of the following illnesses, which would be caused by the paramyxovirus? Rubella Chicken pox Malaria Mumps - ANSMumps Mumps is caused by the paramyxovirus.Mumps is transmitted by the respiratory route and has an incubation period of 16-18 days. Of the following qualitative designs which one uses interviews and inductive analysis to seek understanding of lived experience? historical grounded theory phenomenologic experimental - ANSphenomenologic There are six common qualitative designs for research: phenomenologic, ethnographic, grounded theory, historical, random sample, and non-random sample. Phenomenologic research uses interviews and inductive analysis to seek understanding of lived experience. Of the following screening tests, which would confirm hypertension due to pheochromocytoma? CT angiography. 24-hour urinary metanephrine and normetanephrine. Doppler flow study; magnetic resonance angiography. Estimated GFR. - ANS24-hour urinary metanephrine and normetanephrine The preceding screening tests are used to confirm or refute hypertension due to the following: CT angiography - Coarctation of the aorta 24-hour urinary mentanephrine and normetanephrine - Pheochromocytoma Doppler flow study; magnetic resonance angiography - Renovascular hypertension Estimated GFR - Chronic kidney disease Of the following, which is a Class IA antidysrhythmic drug you can prescribe to help treat your patient's ventricular tachycardia? Disopyramide. Lidocaine. Encainide. Bretylium. - ANSDisopyramide (Norpace). Disopyramide - Class IA Lidocaine - Class IB Encainide - Class IC Bretylium - Class III Ototoxicity - ingesting chemicals or certain medications that can adversely affect the way the inner ear functions. Some drugs can specifically effect the cochlea nerve, impairing hearing and affecting balance - ANSWhat does otosclerosis mean? What is presbycusis mean? What does ototoxicity mean? Physical exam findings consistent with emphysema include all of the following EXCEPT: - ANSpallor 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. Positive Murphy's sign - ANSindicates Acute Cholecystitis. Right upper Quadrant Psoas Sign - ANSIncreased abdominal pain when patient attempts to raise thigh against your hand or when asking the patient to extend their right leg at the hip. Indicates Appendicits Reimbursement for services provided by nurse practitioners (NPs) to patients occurs through several mechanisms. Which of the following is NOT an accurate statement regarding this? The NP's services are covered at 100% in the Medicare Part B structure of payment without billing "incident-to." In managed care plans, NPs may receive payment as an identified provider for a panel of patients. NPs who are not identified as the primary provider of care but are employed by a professional practice group may receive payment through their employer's managed care arrangement. Salaries can be based on revenues generated by NPs. - ANSThe NP's services are covered at 100% in the Medicare Part B structure of payment The NP's services are covered at 85% of the prevailing physician rate. "Incident to" services allow the NP services to be billed at 100%, but specific requirements are necessary for this. Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: A. oxygen B. Anticholinergic drugs C. Systemic steroids D. Exercise - ANSA. Oxygen Rimantadine and which of the following would be recommended for the patient that is suspected of having influenza? Lisinopril Percocet Furosemide Amantadine - ANSAmantadine Rimantadine and amantadine would be recommended for use for the patient that has the influenza or is suspected of having influenza. The other medications would not be recommended for a patient that is suspected of having influenza. Rovsing's sign - ANSPain in the RIGHT lower quadrant during LEFT-sided pressure is a positive Rovsing's sign. Indicates appendicitis SAH stands for which of the following? System and History Subdural Hematoma System Assessment Health Subarachnoid Hemorrhage - ANSSubarachnoid Hemorrhage SAH stands for Subarachnoid Hemorrhage. Typically, the patient will complain of the worse headache they have ever had. This headache can be accompanied by such symptoms as meningeal irritation, nausea/vomiting, photophobia, and a rapid decline in consciousness. Stroke risk scale - ANSCHADS2 C-Congestive heart failure H-Hypertension A-Age >75 years D- Diabetes S-prior Stroke/TIA The ANP is prescribing a pseudoephedrine/phenylephrine preparation for his patient. Of the following, which would the ANP prescribe? Entex. Rhinocort. Muro 128. Bacitracin 500 u/g. - ANSEntex. Entex = Pseudoephedrine/Phenylephrine preparation Rhinocort = Inhaled Nasal Steroid Muro 128 = Lubricating Ophthalmic Drop Bacitracin 500 u/g = Anti-staphylococcal The available screening tests for osteoporosis include all but which of the following? Colorectal cancer is the second leading cause of cancer in the United States. A person with this disease is usually asymptomatic until the disease is quite advanced. In advanced colorectal cancer, the patient will have iron deficiency anemia and vague abdominal complaints. The mass is most often beyond the examiners digit during the rectal exam. - ANSou are treating a 66-year-old woman who you suspect has colorectal cancer. The nurse practitioner knows that which of the following is TRUE concerning this disease? Most colorectal cancers are found during rectal examination. Early manifestations of this disease include maladaptive deficiency anemia. Later disease presentation often includes iron deficiency anemia. Early manifestations of this disease include severe abdominal pain. The Correct answer is: The ethical behavior of nurses has been defined for professional nursing in an American Practice Act policy statement The ethical behavior of nurses was defined by the American Nurses Association and not the American Practice Act. The remaining answer choices are part of ethical decision-making process of a nurse practitioner. - ANSWhich of the following is NOT part of the ethical decision making process for the nurse practitioner? Moral concepts such as advocacy, accountability, loyalty, caring, compassion, and human dignity are the foundations of ethical behavior. Duty to help others, beneficence, is a foundational component of ethical behavior. Ethical behavior incorporates respect for the individual and his or her autonomy. The ethical behavior of nurses has been defined for professional nursing in an American Practice Act policy statement. The Correct answer is: Water intoxication Desmopressin acetate (DDAVP) promotes reabsorption of water in the renal tubules, which can lead to water intoxication. Other signs of this are behavioral changes and disorientation. - ANSA 6-year-old patient has been discharged from the hospital to home on DDAVP (desmopressin acetate) for diabetes insipidus after removal of a pituitary tumor. The nurse practitioner (NP) notices that the child is lethargic and has 4+ deep tendon reflexes on examination. The NP suspects: interaction with OTC cough medicine water intoxication increased vasopressor effect noncompliance with therapy The diagnosis of Meniere's disease is based on: - ANSThe 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 diagnostic standard in streptococcal pharyngitis is a positive throat culture for which of the following? M. pneumoniae S. pneumoniae S. pyogenes Chlamydophila pneumoniae - ANSS. pyogenes A positive throat culture for Streptococcus pyogenes (S. pyogenes) is considered the diagnostic standard in streptococcal pharyngitis. A potential drawback, however, is that a positive result does not distinguish between acute viral pharyngitis with group A streptococcus carriage and acute streptococcal pharyngitis. The diagnostic test which combines fluoroscopy and radiography to evaluate the spinal subarachnoid space is which of the following? venography myelography electromyography electroencephalography - ANSmyelography Myelography utilizes a contrast medium that is injected into the epidural space by spinal puncture. Myelography is used to identify bone displacement, disk herniation, spinal cord compression, or tumors. The fact that a systemic viral infection such as measles produces lasting immunity means that this disease has a high degree of which of the following? communicability incubation virulence immunogenicity - ANSimmunogenicity Immunogenicity refers to the ability to produce a lasting and effective immunity. Systemic viral infections, such as measles, produce lasting immunity. Rhinovirus, on the other hand primarily acts locally, and results in a poor systemic immune response. The FNP calculates a patient's BMI to be 23. Which category would this patient fall into? normal weight underweight overweight obese - ANSnormal weight The highest incidence of AOM (acute otitis media) is in which of the following age groups? 10 - 12 years 7 - 8 years 4 - 6 years 6 months to 3 years - ANS6 months to 3 years Acute otitis media is an infection of the middle ear cavity with bacterial pathogens secondary to temporary Eustachian tube dysfunction. The highest incidence of AOM is from ages 6 months to 3 years. The initial therapy for a 3 week old infant with uncomplicated symptoms of gastroesophageal reflux disease includes of the following positions and change in diet? A. Prone position and rotate formulas in order to find one that causes less reflux B. Smaller, more frequent feedings while holding infant C. Semisupine position and offer more ounces of formula less frequently D. Lateral position and start small amounts of solid food with formula - ANSSmaller, more frequent feedings while holding infant. The Jones criteria are the major criteria for acute rheumatic fever, ARF. Which of the following is NOT part of these criteria? breast tenderness carditis polyarthritis erythema marginatum - ANSbreast tenderness Breast tenderness is not part of the Jones criteria for ARF. The other three choices are part of the Jones criteria. The management of choice for polymyalgia rheumatica includes: A. whirlpool B. Prednisone C. Anelgesics D. Celebrex - ANSB. Prednisone The most acceoted recommendation regarding skin cancer prevention is: - ANSavoidance 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. The most common type of skin malignancy is: A. Squamous cell cancer B. Basal skin cancer C. Melanoma D. Dysplastic nevi - ANSB. Basal skin cancer. It is several times more common that squamous cell skin cancer according to the NIH. 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 - ANSB. Roseola Infantum (Exanthema subitum) The National Committee for Quality Assurance (NCQA) is a consumer-oriented group directed by which of the following? physicians representatives of major employers, insurers and government representatives of hospitals and physician groups none of the above - ANSrepresentatives of major employers, insurers and government The National Committee for Quality Assurance (NCQA) is a consumer-oriented group directed by representatives of major employers, insurers and government. NCQA accredits MCOs and health plans. The National Practitioner Data Bank is a repository for which of the following types of information? personal information professional credentials licensure information malpractice payments - ANSmalpractice payments The National Practitioner Data Bank is a repository for damage award data. It is a data bank that keeps track of payments and judgments from professional liability insurance companies on behalf of the clients to injured parties for successful malpractice claims. It also retains adverse peer review actions of physicians and other health care practitioners. The NP notices on her patient's leg, a solid, elevated mass about 2.5 cm in size. What type of lesion is this? Bulla. Tumor. Pustule. Macule. - ANSTumor Bulla: fluid-filled, elevated, circumscribed lesion larger than 5 mm Tumor: solid, elevated mass larger than 1 cm Pustule: pus-filled, elevated, circumscribed lesion up to 5 mm in size Macule: flat, nonpalpable colored spot up to 5 mm in size