FAMILY NURSE PRACTITIONER EXAM QUESTIONS AND COMPLETE ANSWERS 2024/2025 UPDATED (ACTUAL EX, Exams of Nursing

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FAMILY NURSE PRACTITIONER EXAM

QUESTIONS AND COMPLETE ANSWERS

2024/2025 UPDATED (ACTUAL EXAM)

GRADED A+.

Trauma to Kiesselbachs plexus: - Solution Will result in an anterior nosebleed The diagnostic or gold standard test for sickle cell anemia, G6PD anemia, and alpha or beta thalassemia: - Solution Hemoglobin electrophoresis Erythromycin "allergy" vs adverse reaction: - Solution Adverse reaction- symptoms of nausea or GI upset allergy -hives, angioedema Acute mononucleosis: - Solution Pt will most likely be a teen presenting w classic triad of sore throat, prolonged fatigue, and enlarged cervical nodes. Alpha thalassemia: - Solution More common among Southeast Asians such as, Indian, Chinese, or Filipino descent Lupus - Solution Malar rash(butterfly rash)Pts need to avoid or to minimize sunlight exposure(photosensitivity) Tx polymyalgic rheumatica(PMR) - Solution 1st line tx for PMR includes long-term steroids. Long term steroids are commonly used to control symptoms(pain, stiffness on shoulders, and hip girdle). PMR pts have higher risk for temporal arteritis. Gold standard exam for temporal arteritis: - Solution Biopsy of the temporal artery. refer pt to opthalmologist for mgt Finkelstein's test: - Solution Positive in De Quervains tenosynovitis

Anterior Drawer maneuver and Lachman maneuver: - Solution Positive if anterior cruciate ligament (ACL) of knee damaged. The knee may also be unstable McMurray's sign: - Solution Positive in meniscus injuries of the knee Damaged Joints: - Solution Order X-ray first, but MRI is the Gold Standard Diabetic retinopathy: - Solution Neovascularization, hard exudates, cotton wool spots, and micoaneurysms Hypertensive retinopathy: - Solution AV nicking, silver and or copper wire arterioles Checking deep tendon reflexes: - Solution absent(0), hypoactive (1) normal (2) hyperactive (3) clonus (4) Clonus: - Solution Clonus is typically seen in patients with stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy. Clonus has also appeared after ingesting potent serotonergic drugs, where ingestion strongly predicts imminent serotonin toxicity (serotonin syndrome). Clonus is a series of involuntary, rhythmic, muscular contractions and relaxations. Clonus is a sign of certain neurological conditions, particularly associated with upper motor neuron lesions involving descending motor pathways, and in many cases is, accompanied by spasticity (another form of hyper excitability). Unlike small, spontaneous twitches known as fasciculation’s (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex. A rare but serious adverse effect of ACE inhibitors is: - Solution Angioedema A common side effect of ACE inhibitors is a - Solution Dry cough (10%)

1st line drug to tx htn in DM & pts w mild renal dz bc of their renal protective properties: - Solution ACE inhibitors or ARBS Penicillin: - Solution Amoxicillin(broad-spectrum PCN) Penicillin VK Macrolide: - Solution Erythromycin, azithromycin(Z-Pack), or clarithromycin(Biaxin) Cephalosporins: - Solution 1st generation(Keflex), 2nd generation(Cefaclor, Ceftin, Cefzil)3rd generation(Rocephin, Suprax, Omnicef) Quinolones w gram positive coverage: - Solution Levofloxacin(Levaquin), moxifloxacin(Avelox), gatifloxacin(Tequin) Quinolones: - Solution Ciprofloxacin(Cipro), ofloxacin(Floxin) Sulfa: - Solution Trimethoprim/sulfamethazole(Bactrim, Septra), nitrofurantoin(Macrobid), Tetracyclines: - Solution Tetracycline, doxycycline, minocycline(Minocin) NSAID: - Solution Ibuprofen, naproxen(aleve, Anaprox) Cox-2 inhibitors: - Solution Celecoxib (celebrex) Antitussives: - Solution Dextromorphan(Robitussin), benzonate(Tessalon Perles) Drugs allowed for pregnant or lactating women: - Solution Category B Pregnancy in pain: - Solution Tylenol instead of Ibuprofen Avoid nitrofurantoin & sulfa drugs during 3rd trimester: - Solution Increase the risk of hyperbilirubinemia Best way method of spreading viruses or bacteria: - Solution Making them airborne or nebulized

Tx cutaneous anthrax: - Solution Ciprofloxacin 500mg orally BID for 60 days or 8 weeks. If pt allergic to ciprofloxacin , use doxycycline 100mg BID Good communication rules: - Solution Ask open ended questions, do not reassure patients, avoid angering the patient, and respect the patients culture. Primary vs secondary: - Solution "Will performing this action prevent the disease or the social condition from happening? If it does, then it is considered as primary prevention(if it doesn, then it is secondary) Breast self exam and genital self exam: - Solution Considered secondary prevention Tertiary prevention: - Solution Involves not only rehabilitation, but also includes actiivities that will help to prevent complications from disease treatment, such as patient education about medication side effects or the proper use of equipment such as cane. Support groups for a disease /condition are all considered as part of a tertiary prevention activity. Primary prevention: - Solution (Prevent disease.injury/condition)-youth violence prevention, bullying prevention, presonal safety promotion, disease prevention-immunization, using suncreen, healthy lifestyle promotion, promotion of OSHA lawas-workplace safety, EPA laws-clean water, anipollution laws Secondary prevention: - Solution (Detect disease.condition as Early as Possible) any lab test to screen disease, US preventive Services Task Force- screening rec-mammograms, PSA, PPD, screening for high risk behaviour- suicide, depression, personal action to detect cancer Tertiary prevention: - Solution (Limiting Further harm and disability) All types of rehabilitation-cardiac, pt/ot, speech therapy, addition/drug rehab, support groups, exercise for an obese person Clue cells: - Solution Mature squamous epithelial cells with numerous bacteria noted on the cell borders(bacterial vaginosis)

Bacterial Vaginosis: - Solution Has a alkaline pH(vagina normally has an acidic pH of 4.0) BV is the only vaginal condition with the only alkaline pH for the exam. BV is not considered an STD(it is imbalance of vaginal bacteria-sex partner does not need to be treated. The microscopy slide will have very few WBC and large number clue cells. Candida vaginal discharge: - Solution White in color with a thick and curd like consistency. it frequently causes redness and itching in the vulvovagina due to inflammation Microscopy in candidiasis: - Solution Will show a large number of WBC, pseudohyphae, and spores(saghetti and meatballs) Candida yeast: - Solution Normal flora of gastrointestinal tract and in some womens vaginas Trichomonas infection: - Solution Vaginal discharge is copious, bubbly, and green in color. It causes a lot of inflammation resulting in itching and redness of the vulvvagina. It is considered a sexually transmitted infection. The sex partner needs treatment. Gold standard of diagnosis for BV, candida vaginitis, and trichomoniasis for the exam: - Solution Microscopy is the gold standard. Tx for strep throat: - Solution Penicillin VK PO for 10 days. If pt is PCN allergy, macrolides can be used instead. Mortality: - Solution Most common cause of death Prevalence: - Solution Most common cause of a certain disease in a population Torus palatinus: - Solution Is a benign growth of bone(an exostosis) located midline on the hard palate and covered with normal oral skin. It is painless and does not interfere with function. Geographic tongue: - Solution Has multiple fissures and irrecgular smoother areas on its surface that makes it look like a topographic map. The paitent may complain of soreness on the tongue after eating or drinking acidic or hot foods

Leukoplakia: - Solution Benign variant. It appears as a slow growing white plaque that has a firm to hard surface that is slightly raised on the tongue or inside the mouth. It is considered a precancerous lesion. It is due to chrnoic irritation of the skin or to precancerous changes on the tongue and inside the cheeks. It causes include poorly fitting dentures, chewing tobacco, and using other types of tobacco. refer for biopsy Oral hairy leukoplakia(OHL): - Solution Tongue is a painless white patch that appears corrugated. It is located on the lateral aspects of the tongue and is associated with HIV and AIDS infection. It is caused by Epstein-Barr virus infection of the tongue. It is considered a premalignant lesion. Initial workup for ovarian cancer: - Solution Is the intravaginal ultrasound and the CA 125 Risk factor for ovarian cancer: - Solution Early menarch or late menarche, nulliparity, endometriosis, PCOS, and family history of ovarian cancer. Women with BRCA 1 and 2 mutations are also at higher risk for both brest and ovarian cancer. Tanner Stages Girls: - Solution Stage I-Prepubertal pattern Stage II-Breast bud and areola starts to develop Stage III-Breast continues to grow with nipples/areola(one mound/no separation) Stage IV- Nipples and areoola become elevated from the breast (a secondary mound) Stage V-Adult pattern Tanner stage Boys: - Solution Stage I - Prepubertalpattern StageII-Testeswith scrotum starts to enlarge(scrotal skin starts to get darker/more ruggae) Stage III-Penis grows longer(length) and testes/scrotum continues to become larger Stage IV-Penis become wider and continues growing in length(testes are larger with darker scrotal skin nd more ruggae) Stage V-Adult pattern Scabies: - Solution Classic location of the rashes (finger webs, waist, penis)

High risk groups are health care givers, or any erson working with large populations such as schools, nursing homes, group homes, or prisons. Spread skin to skin Rash of Scarletina: - Solution Has sandpaper like texture and is accompanied by a sore throat, strawberry tongue, and skin desquamination(peeling) of the palms and soles. It is not pruritic. Impetigo rashes: - Solution Initially appear as papules that develop into bullae that rupture easily, becoming superficial, bright red weeping rashes with honey-colored exudate that becomes crusted as it dries. The rashes are very pruritic and are located on areas that are easily traumatized, such as the face, arms or legs. Insect bites, acne lesions, and varicella lesion scan also become secondarily infected, resulting in impetigo. Cutaneous larva migrans(creepin eruption): - Solution Rashes are shaped like red raised wavy lines(serpinginous or snakelike) that are alone of=r few. appears maculopapular Larva migrans: - Solution The areas of body that are commonly exposed directly to contaminated soil and sand such as soles of the feet, extremities or buttocks. are most common location Tx for larva migrans: - Solution Systemic treatment with either ivermectin once a day for 1-2 days or albendazole for 3 days 1st line tx for AOM and sinusitis: - Solution Amoxicillin 500mg po TID( for 10 days. Second line of abx is Augmentin BID or cefdinir(omnicef)BID S3 heart sounds: - Solution Indication of heart failure. The best place to listen for the S3 heart sound is the pulmonic area(the pulmonic area is near the ventricles). Pulmonary TB: - Solution A sputum culture is the gold standard. In Correct answer s: - Solution are statements that are judgmental, ressuring to the patient, vague, disrespectful, or do not address the issue of suicide(or homicide) in a direct manner.

1st line tx for depression: - Solution SSRI. Second line tx TCAs. TCAs are also used as prophylactic treatment of migraine headaches, chronic pain, and neuropathic pain such as post herpatic neuralgia. Ex: amitriptyline(elavil), nortriptyline(Pamelor) do not give suicidal pt TCAs because of high risk of hoarding and overdosing. Overdose of TCAs can be fatal(cardiac and CNS toxicity) SSRI: - Solution SSRI are firrst line treatment for OCD, generalized anxiety discorder, panic disorder, social anxiety disorder(extreme shyness) and premenstrual mood disorder(fluoxetine or Prozac) Examples of SSRI: citalopram(Celexa), ecitalopram(lexapro), fluoxetine(Prozac, sertraline (Zoloft), paroxetine (Paxil) CAGE mnemonic: - Solution A screening tool used to screen patients for possible alcohol abuse. Scoring two out of 4 is highly suggestive of alcohol abuse. Thizide diuretics: - Solution Prefered for hypertension patients with osteopenia or osteoporosis. The mechanism of action of thiazide on the bone is that it decreases calcium excretion by the kidneys and it stimulates osteoclast activity that helps with bone formation Beta blockers: - Solution Are contraindicated in asthmatics or patients with chronic lung diseases such as astma , COPD, emphysema, or chonic bronchitis. Acute diverticulitis: - Solution Tx outpt w ciprofloxacin 500mg PO BID plus metronidazole PO TID for 10 to 14 days Rocky Mountain Spotted fever: - Solution South central US, classsic rash (red rash on both wrists and ankles that spread centrally with involvement of the palms and the soles) systemic symptoms-high fever, headache, myalgia, nausea. can cause death if not treated with the first 8 days of symptoms Rocky Mountain spotted fever (RMSF) - Solution Dog/wood tick bite, spirochete called Rickettsia rickettsia. Treatment with doxycycline 100mg PO/IV for minimum of 7 days

Early lyme disease (erythema migrans rash stage): - Solution Oxodes(deer) tick bite, spirochete called Borrelia burgdorferi of the cases are in the Mid Atri. treatment with doxycycline x 21 days. Majority of the cases are in theMid Atlantic and New England states(CT, MA, NY, NJ, PA) ITP(Idiopathic thrombocytopenic purpura - Solution Severity ranges from mild to severe(platelet count less than 30,000/) Platelets are broken down by the spleen, causing thrombocytopenia. Look for easy bruising, petechiae, purpura, epistxis, and gingival bleeding. Initial treatment for ITP is glucocorticoids(prednisone) based on platelet response. Estimated GFR: - Solution Better test of renal function compared with the serum creatinine concentration. A GFR value fo 60 or less is a sign of kidney damage(refer to nephrologist) The GFR is an estimated alue, it is not measured directly and is computed using the serum creatinine value in the Cockcroft-Gault(or MDRD study) equations. Serum creatinine: - Solution Is affected by age(less sensitive in elderly) gender (higher in males), ethnicity (higher with African American background) and other factors. BUN: - Solution Is a waste product of the protein from foods that you have eaten. If you eat more protein before the test, it will increase(or decrease with low protein intake) Dehydration will elevate the BUN value. Liver(cytochrome P450 enzyme system): - Solution Most active organ. Drug excretion: - Solution Almost all drugs chemicals are broken down by the liver and excreted from the body in the bile, urine, feces, respiratory gas(Co2) and as sweat. Trough: - Solution The lowest concentration fo a drug after a dose Potent inhibitors of the cytochrome P450 system: - Solution These drugs are respnsible for a large number of drug -drug interactions Macrolides(erythromycin, clarithromycin, pediazole) Antifungals(ketoconazole, fluconazole) Cisapride(Proulsid) Cimetidine(Tagament)

Citaprolam(Celexa) Coumadin: - Solution For A fib the target INR is from 2.0 to 3.0. INR values below 2.0 increase stroke risk sixfold Vitamin K: - Solution Mayonnaise, canola oil, and soybean oil has Vitamin K Adverse effects of thiazide dieuretics: - Solution Hyperglycemia, elevated triglycerides and LDL, elevattes uric acid, hypokalemia. Thiazide diuretics: - Solution Pt with both htn and osteoporosis have an extra benefit from thiazides. thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoclasts formation. Patients with serious sulfa allergies should avoid thiazide diuretics. Potassium sparing diuretics can be used as alternative. Potassium sparing diuretics: - Solution Hypertension alternative dieuretics with severe sulfa allergy. Loop diuretics: - Solution Edema from heart failure, cirrhosis , renal disease, hypertension. Loop diuretics are excreted via loop of Henle of the kidneys and are more motent than Hctz. Ex: Lasix, Gumetanide. Loop diuretics are more potent tha thiazides , but shorter duration of action Adverse effect of loop diuretics: - Solution Electrolytes imblance, hypocolemia, pancreatitis, juandice, rash. ototoxicity. Aldosterone Antagonists: - Solution Hirsuitism, htn, sever heart failure. exp spironolactone. Adverse effects are galactorrhea and hyperkalemia. Spironolactone is rarely used to treat htn in primary care due to adverse effects and higher risk of certain cancer. Beta Blockers: - Solution HTN, post myocardial infarction(first line), angina, arrhythmias, migraine prophylaxis. Adjunct tretment-hyperthyroidism/thyrotoxicosis (decrease HR, anxiety). Migrain prophylaxis-non-cardioselective(blocks beta 1 and beta 2). Cardio selective(blocks beta 1 only)-atenolol(tenormin), metoprolol (lopressor)

Adverse effects of beta blockers: - Solution Bronchospasm, bradycardia, depression, fatigue, erectile dysfunction, blunts hypoglycemic resonse Contraindications of beta blockers: - Solution Asthma (causes bronchospasm) COPD (causes bronchospasm) Chronic bronchitis (causes bronchoconstriction) Emphysema (casues bronchoconstriction) Bradycardia and AV block (second to third degree block) Ace inhibitors: - Solution Lisinopril(Zestril) Captopril(Capoten) Benazepril(lotensin) Combination: lisinopril and HCTZ (Zestoretic) ENalapril(Vasotec) Angiotensin II Receptor Blockers (ARBs) - Solution Valsartan(Diovan) Losartan(Cozar) Irbesartan(Avapro) Potassium sparing diuretics: - Solution Triamterene(Dyrenium) Triamterne + HCTZ(Dyazide) Amiloride(Midamor) Beta blockers: - Solution Propranolol(Inderal) atenolol(Tenormin) metoprolol(Lopressor) pindolol(Visken) Due not discontinue beta blockers a Ace inhibitors and ARBS: - Solution Cat C (first trimestor) cat D (second and third trimestor) ACEI blocks conversion of angiotensin I to angiotensin II(potent vasocontrictor). ARBs blocks angiotensin II(less aldonsteron). ACEI suffix "pril" ARBS suffix sartan" Calcium Channel Blockers: - Solution HTN, Raynauds phenomenon(first line) Amlodipine(Nirvasc) Diltiazem(Cardizem)

Nifedipine(Procardia) Verapamil(Calan. Do not mix with erythromycin and clarithromycin(drug interaction) Contraindications:AV-block(second to third degree), bradycardia, CHF Adverse effects of CCB: - Solution Headache Periperhal edema(not due to fluid overload) Bradycardia HF, heart block Hypotension, QT prologation Constipation is the most commonly reported side effect Alpha blockers: - Solution HTN with coexisting BPH Terazosin(Hytrin) at bedtime-potent vasodilator Macrolides(cat B): - Solution Erythromycin PO QID Azithromycin (Z-pack) Clarithromycin PO BID Many side effects: careful with myasthenia gravis, coumadin, QT prolongation/bradyarrhythmias GI distress(especially erythromyicin) Ototoxicity, cholestatic juandice QTCprolongation(risk of torsades de pointes) Cephalosporins (CAT B): - Solution Cephalosporins and penicillins belong to the beta-lactam family of ABX. FIRST GENERATION Cephalosporins -Activity against gram-positive bacteria. Used to treat infections caused mainly by gram positive bacteria(cellulitis, mastitis) Exp: Cephalaxin(Keflex) PO QID Pregnancy: UTI(if sensitive)pregnancy Skin:Cellulitis (not caused by MRSA) impetigo Second generation Cephalosporins: - Solution Considered as "broad spectrum" antibiotics. Used to tx infections caused by gram positive bacteria. (sinusitis, otitis media) Cefuroxime axetil(Ceftin) PO BID ENT:Sinusitis, OM Cefprozil(Cefzil) PO BID Resp: CAP, exac chronic Bronchitis Cefaclor (Ceclor) PO BID others: AOM, sinusitis, skin infections

Third generation Cephalosporins: - Solution Less activity against gram positive infections compared to the first generation cephalosporins. Better covereage for gram negative bacteria(Neisseria gonorrheae infections) and against enteric bacteria 3rd gen Ceph Ceftriaxone (Rocephine)IM STD:Gonorrhea cervicitis, urethritis, PID Cefixime (Suprax) daily to BID ENT: AOM in children, acute sinusitis, OM Cefdinir(Omnicef) daily to BID GU: pyelonephritis, CAP Penicillins (CAT B): - Solution There is a chance of cross reactivity, especially with firrst gen cephalosporins. Amoxicillin and ampicillin are extended spectrum penicillins. They are effective against gram positive bacteria andsome gram negative bacteria(Haemophilius influenza, Escherichia coli, Proteus mirabilis) Examples: Penicillin V PO QID Amoxicillin PO BID to TID Amoxicillin plus clavulanic acid (Augmentin) PO BID Benzathine PCN G IM Dicloxacillin PO QID Adverse reactions of PCNs: - Solution Diarrhea, c difficile, vaginitis(usualy candida) First line tx for gonorrheal infection: - Solution Rocephine(ceftriaxone) IM First line tx for MRSA skin infections (boils , abscesses): - Solution Do not use cephalosporins. First line tx is either trimethoprim-sulfa(Bactrim DS) BID r clindamycin TID treat for 5 to 10 days. If pt have true allergy to PCN: - Solution They are more likely to have allergic reaction to cephalosporins(esecially 1st gen) Use PCN VK: - Solution Mononucleosis, not amoxicillin(causes generalized rash not related to allergy)

Dicloxacillin: - Solution Is for pencilinase-producing staph skin infections(mastitis and impetigo) Fluoroquinolones (Quinolones): - Solution Effective against gram negative bacteria and some atypical bacteria(chlamydia, Mycoplasma, Legionella) Newer generation quinolones (levofloxacin , moxifloxacin, gatifloxacin) are also active against gram positve bacteria. Respiratory quinolones: - Solution Levoflaxacin and moxifloxacin -due to their excellent activity against strep pneumonia Quinolones: - Solution Norfloxacin(Noroxin) BID Ciprofloxacin (Cipro) BID Ofloxacin (Floxin) BID Broad spectrum quinolones Moxifloxacin (Levaquin) daily Gemifloxacin (Factive ) daily Black box warning-increased risk of achilles tendon rupture. Avoid strenuous activity while onthe drug) Stop if develops tendon pain/swelling Adverse effects of quinolones: - Solution QT prolongation, CNS(dizziness, headache, insomnia, mood changes) do not use quinolones on children under 18 due to adverse effects on growing cartilage. Anthrax TX: - Solution Bioterrorism related inhalation of anthrax is treated with ciprofloxacin 500mg BID x 60 days Pseudomonas aeruoginosa (gram negative): - Solution 1st line tx is ciprofloxacin Per cdc - Solution Stop using quinolones to tx gonorrheal infection Sulfonamides (Cat B): - Solution Active against gram negative bacteria(E.Coli, Klebsiella, H. Influenzae) Bacteriostatic- Timethoprim-Sulfamethoxazole(TMP-SMX)Bactrim DS BID Other sulfa-type drugs: -Dieuretics(furosemide, HCTZ)

-Sulfonylureas(glyburide, glipizide) -COX-2 inhibito(celecoxib or Celebrex) -Dapsone(for HIV) Contraindications of sulfonamides: - Solution G6PD anemia(a genetic hemolytic anemia) causes hemolysis Newborns and infants less thn 2 months Pregnancy in late third trimester(increased risk of hyperbilirubinemia/kernicterus) Hypersensstivity to sulfa drugs drug interations -coumadin(increases INR) Adverse effects: skin rash, Steven Johnson syndrome Quinolones uses: - Solution Ciprofloxacin(ipro) BID -Anthrax infection and prophylaxis Travelers diarrhea (Cipro) Ofloxacin(Floxin)BID-UTI, pyelonephritis, epididumitis, prostatitis. Black box warning : risk of tendinitis and achilles tendinopathy/rupture. Broad-spectrum quinlones- Levofloxacin has increased risk of hypoglycemia Levofloxacin(Levaquin) daily- CAP, acute exac of chronic bronchitis, pyelonephritis, epididymitis, prostatitis, Moxifloxacin(Avelox) daily-Osteomyelitis, sinusitis, AOM Gemiflxacin (Factive) Topical Floxin Otic gts-OM with perforated TM, otitis Externa Ocuflox opthalmic gtts-bacterial conjunctivitis Topical Nasal Decongestants: - Solution Oxymetazoline Nasal Spray(Afrin), Phenylephrine(Neo-Synephrine) short term use i considered safe (BID PRN x 3), rhinitis medicamentosa is due to chronic use(greater than 3 days) of nasal decongestants) Antihistamines: - Solution Diphenhydramine(Benadryl)

Loratadine(cclaritin) Cetrizine(Zyrtec)-more potent and long acting. Sulfonamides: - Solution Trimethoprim-sulfamethoxazole (TMP-SMX) Bactrim DS BID- prophylaxis treatment of PCP, MRSA cellulitis, UTIs, pyelonephritis Aspirin toxicity: - Solution If pt c/o tinnitus(possible asa toxicity), asa given post MI or after stroke is considered tertiary prevention. Tylenol: - Solution max dose up to 4 gm, considered 1st line drug for pain from osteoarthritis, the antidote for tylenol overdose is acetylcysteine Oral steroids: - Solution Prednisone 40 to 60 for 3-4 days , does not need to be weaned. Methylprednisolone(Medrol Dose Pack) x 7 days. Does not need to be weaned Topical steroids: - Solution Classification (class 1 (superpotent) to class 7(least potent) -superpotent(class 1)-clobetasol(Temovate) -Potent-halocinonide (Halog) -Moderate-triamcinolone(Kenalog) -Least potent (Class 7)-hydrocortisone Acutely inflamed joints (knee/hip/shoulders/elbows): - Solution Can be tx w intra-articular triamcinolone(Kenolog) injections up to 3 times per year. Poison ivy or poison oak: - Solution Severe case of poison ivy case or poison oak rash may require 14 to 21 days of an oral steroid to clear Tapering weaning drugs: - Solution Beta-clockers (rebound htn, or htn crisis) Benzodiazepines (severe anxiety, insomnia, seizures, tremors) Oral Steroids Anticonvulstants Antipsychotics Antiarrythmics Paroxetine or Paxil

Controled substance act-US FDA DEA: - Solution Schedule I drugs(heroin, ecstasy/MDMA, PCP, -illegal to prescribe Schedule 2(Demerol, Dilaudid, Oxycontin, cocaine, amphetamines)-only the original prescription with the physicians signature acceptable Schedule 3(Tylenol with codein, Vicodin, nabolic steroids, testosterone, ) Schedule4(benzodiazepines, ambien, lunesta, Soma) Schedule 5(cough medicine with less than 200mg codeine, Lomotil,Lyrica) Schedule 4,5 acn be mailed to the matient. some states allow NPs to prescribe lower level controlled substance For all controlled substance: Must have the prescribers and the supervising physicians name/DEA number with the clinic address on the pad. Some states do not require supervising physician. List of Category X drugs: - Solution Finasteride(proscar, propecia)- reproductive aged or pregnant women should not handle crushed finasteride tablets Isotretinoin(Accutane) Warfarin sodium(coumadin) Misoprostol(Cytotec) Androgenic hormones: birth control pills, HRT, testosterone Live virus vaccines(measles, mumps, rubella, varicella, rotavirus, flumist) Thalidomide, DES, methimazole FDA category classification: - Solution Category A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Category B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Category C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Category X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Category N FDA has not classified the drug. Prescription pads: - Solution the NPs prescription pads should contain the following information: NPs name/designation/license number Supervising physician name. clinic address(if multiple sites, the sites where the NP works should be listed on the pad) Mortality statistics: - Solution Leading cause of death(all ages/genders) -Heart disease(or diseases of heart) -Cancer -Chronic lung diseases Cancer mortality: - Solution Leading cause of cancer death -Lung cancer MC cancer-Skin cancer MC type of skin cancer:-Basal cell cancer (but melanoma causes 75% of deaths from skin cancers) What conditions must be met for NP to bill 'incident to' the physician, receiving 100% reimbursement from Medicare? - Solution If certain conditions are met, services provided by NPs may be reimbursed by billing "incident to" a physician's services, that is, as if the physician had provided the service directly. This method of billing allows slightly higher reimbursement of the service provided, 100% of the physician fee scale, compared with direct billing, which is paid out at 85% of the physician fee

scale; however, incident to billing identifies the physician as the servicing provider and not the NP, leading to a lost opportunity to track quality and outcome data. MUST BE ON-SITE AND ENGAGED IN CLIENT CARE Legal authority for APRN practice is granted by: - Solution a. federal law b. regulations from the department of health and human services c. state law and regulations d. the board of medicine in most states c. state law and regulations Primary prevention: - Solution Prevention of Disease.Injury nutrition, exercise, gun safety, Secondary Prevention: - Solution Early detection of a disease to minimize bodily damage -screening test (pap, mamogram, cbc for anemia) -screening for depression -screening for STD -screening for alcohol abuse Tertiary prevention: - Solution rehabilitation, support groups, education on equipment -support groups education with preexisting disease(DM, HTN -PT, OT, exercise prgrams for obese children Acute angle glaucoma: - Solution Elderly pt with onset of severe eye pain accompanied by headache, nausea/vomiting, halos around lights, and decreased vision examination reveals:mid dilated pupil that is oval shaped, cornea is cloudy, fundoscopics exam reveals cupping of optic nerve. Cholesteatoma: - Solution "Cauliflowerlike" groWth accompanied by foul smelling ear discharge. Hearing loss on affected ear. refer to ENT MD, can cause face and damage to facial nerve VII

Battle sign: - Solution Acute onset of bruise behind the ear over the mastoid area after recent hx of trauma. Indicated fracture of the basilar skull Clear golden fluid discharge from the nose/ear: - Solution Indicative of basilar skull fx. CSF slowly leaking through fx Peritonsillar abscess: - Solution Severe sore throat and difficulty swallowing, odonophagia, trsmus, and a "hot potato" voice. refer to ED for incision and drainiage Diptheria: - Solution Sore throat, fever, and swollen neck"bull neck". Eyes normal finding: - Solution Fundi: the veins are larger than arteries Cones: for color perception, 20/20 vision Rods: for detecting light and shadow, depth perception, night vision Macula: the macula is the area responsible for central vision. The fovea which contains large number of cones is set in the middle. This area of the eye determines 20/20 vision. Cobblestoning: inner conjunctiva with mildly elevated lymphoid tissue resembling "cobblestone" may be seen in atopic pt, allergic rhinitis, allergic conjunctivitis Presbyopia: age realted visual change due to a decreaswe ability of the eye to accommodat3e and stiffening of the lense. Usually start at age 40, Normal finding ears: - Solution Tympanic membrame (TM) translucent off white to gray color with the "cone of light" intact Tympanogram: most objects measure for presence of fluid inside middle ear(results in a straight line vs a peaked shape) External portion of ear: has large amount of cartilage. Cartilage: des not regenerate Leukoplakia: - Solution Appear on the surface and under the tongue. may be cancerous. pt with hx of chewing tobacco are high risk of oral cancer Aphthous stomatitis(canker sores): - Solution Painful and look like shallow ulcers of soft tissue. Torus palatinus: - Solution Painless bony protuberance midline of the hard palate(roof of mouth). May be asymmetrical.

Papilledema: - Solution Optic disc swollen with blurred edges due to ICP HTN retinopathy: - Solution Microaneurysm cause by neovascularization Cataract: - Solution Opacity of the corneas. Chronic steroid use can cause cataract Allergic rhinitis; - Solution Blue tinged or pale and swollen nasal turbinates kopliks spots; - Solution Small sized red paples with blue white centers inside the cheeks by the lower molars Hairy leukoplakia: - Solution Elongated pailla on the lateral aspects of the tongue that are pathognomic for HIV infection. Caused by epstein barr virus hyperopia: - Solution Farsightedness Nystagmus: - Solution Abnormal For color blindness: - Solution Ishihara chart Fluorescein dye strips: - Solution Herpes keratitis appears as fernlike lines. cornial abrasion usually appear more linear Hordeolum (stye): - Solution Painful acute bacterial infection of a hair follicle on the eyelid tx: abx drops(sulfa, erythromycin gtts) warm packs BID to TID until pustules drains Chlazion: - Solution Chronic inflammation fo the meibomian gland(specialized sweat gland)of the eyelid-t c/o gradual onset of a small superficial nodule that is discrete and movable on the upper eyelid that feels like a bead. i fnodule enlarges or does not resolve in a few weeks. biopsy to r/o SCC. Primary open angle glaucoma: - Solution Gradual onset of increased intraocular pressure grater than 22mmdue to blockage of the drainage of aqueos humor inside the eye. If untreated permanent damage. Most common type of glaucoma (60-70%)

CHeck IOP+normal 1- to 22 Primary angle closure glaucoma: - Solution Sudden blockage of aqueous humor causes marked increas of the IOP, causing ischemic and permanent damage to optic nerv (II) Case: older pt co/o acute onset of a severe frontal headache or sever eye pain with blurred vision and tearing. Seeing halos around lights. May c/o nausea vomiting Anterior Uveitis(Iritis): - Solution Higher risk autoimmune disorders (RA, lupus, ankylosing spondylitis) syphilis. C/o red sore eyes. Appears like red eye but with increased tearing Age related macular degeneration: - Solution Age realted macular degenerationcan either be atrophic (dry form) or exudative(wet form). The dry form is more common(85-90%) and is less severe. case:elerly smoker c/o gradual or sudden and painless central vision loss. Sjogrens Syndrome: - Solution Chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands. case:the classic symptoms are daily symptoms of dry eyes and dry mouth for several months (greater than 3 mo) c/o of chronic dry eyes and that both eyes have sandy or gritty sensation. tx:otc tear substitue. Blepharitis: - Solution Chronic condition of the base of the eyelashes cause by inflammation. c/o itching or irritation in the eyelash area, eye redness and crusting tx:johnsons baby shampoo with warm water. gently scrub eyelid margin s Allergic rhinitis: - Solution Tx nasal sterid sprays daily, decongeestants, zyrtec 10 mg daily Strep throat: - Solution 1st line tx: PCN QID x10 days PCN allergy z-pack x 5 days Levaquin x 10 days (contraindicated under 18years) Acute otitis media: - Solution An acute infection of the middle ear with bacterial pathogenes due to mucus that is trapped in the middle ear.

Organism: Strep pneumoniae(gram positive) Haemophilus influenza(gram negative) Moraxella catarralis(gram negative) Bullous Myringitis: - Solution A type of acute OM infection c/o unilateral facial pressure that worsens when bending down along with pain in the upper molar teeth(max sinusitis) or frontal headache(frontal sinisitis)self tx with OTC cold and sinus remedies procide no relief. Tx for AOM and acute sinusitis 10-14 days - Solution 1st line: Amoxicillin is the gold standard for any age group 2nd line abx tx criteria: hx of abx use in the past 3 months, no response to amoxicilin, or severe case of AOM- Amoxicilllin/clavulante(Augmentin)po BID or 3rd generation cephalosporins: Cefdinir(Omnicef) Cefpodoxime(Vantin) PO BID Ceftriaxone(Rocephine) 3gm IM x 1 or Cefuroxime(Ceftin) PO bID-second generation cephalosporins PCN allergic Pt Zpack or clarithromycin(Biaxin) levoflaxacin(levaquin) or moxifloxacinif 18 years or older Trimethoprim/sulfamethazole(bactrim ds Otitis Media with effusion: - Solution TM may bulge or retract. tx: oral decongestants, steroid nasal spray, oral antihistamine Organism: Pseudomonas aeruginosa(gram negative) Staph aureus(gram positive) Infectious Mononuleosis: - Solution peak ages 15 to 24 classic triad:fatigue, acute pharyngitis, lymphadenopathy Objective:cbc, heterophile antibody test(Monospot)Positive order abd u/s if splenomegaly/hepatomegaly

Cheilosis: - Solution Skin fissures and maceration at the corners of the mouth. Multiple etiologies-iron def anemia, secondary bact infection, vitamin def Tx for Otitis Externa: - Solution Cortisporin Otic gtts most common pathogen:pseudomonas Rocky mountain spotted fever: - Solution Classic rash look like small red spots (petechiae) and starts to erupt on both the hands and feet. Rapidly progressing toward the trunk until it becomes generalized. the rash appears on 3rd day after the abrupt onset of high fever. Erythema Migrans(early lyme disease): - Solution The classic lesion is an expanding red rash with central clearing that resembles a target. (bulls eye) rash usually appears within 7 to 14 days. after deer tick bite. between 3 to 30 days. Melanomawith a diameter of 6 mm or larger: - Solution Dark colored moles with eneven texture, variegated colors, and irregular borders Basal cell carcinoma - Solution Suerficial form of BCC looks like a pearly white waxy skin lesion with an atropic or ulcerated center that does not heal. Steven johnsons syndrome (erythema multiforme major): - Solution The classic lesions appear target like or (bulls eye). the drug classes associated with SJS are the PCN, sulfas, barbiturates and Dilantin. Anatomy of skin: - Solution Epidermis-no blood vessels, gets nourished from the dermis, consists of : Top layer:consists of keratinized cells (dead squamous epitheal cells) Bottom level-is where melanocytes reside and vitmin D synthesis occurs Dermis-blood vessels, sebaceous glnds, and hair follicles subcutaneous layer-fat , sweat glands, and hair follicles Screening for melanoma: - Solution A-asymmetry B-border irregular C-color varies in the same region D-diameter>6mm

E-enlargment or change in size Skin lesion review: what is a bulla vesicle pustule macule papule plaque - Solution Bulla-elevated superficial blister filled with serous fluid and >1 cm in size exp:impetigo, second degree burn, SJS Vesicle-elevated superficial skin lesion <1 cm in diameter and filled with serous fluid. exp: herpetic lesion Pustule:elevated superficial skin lsion <1 cm diameter dilled with purulent fluid Exp: acne pustules Macule:flat nonpalapable lesion <1cm in diameterEx freckles, lentigenes, small cherry angiomoas Papule:palpable solid lesion up to 0.5 cm ex: nevi(moles), acne Plaque: flattened elavated lesion with variable shape that is >1 cm in diameter ex: psoriatic lesion Vitiligo: - Solution Hypopigmented patches of skin with irregular shapes. Acanthosis Nigricans: - Solution Diffuse velvety thickening of the skin that is usually located behind the neck and on axilla. It is associated with DM, metabolic syndrome, obesity, and cancer of the GI tract Xerosis: - Solution Inherited skin disorder that results in extremely dry skin and may involve mucosal surfaces and conjuctiva Psoriasis: - Solution Inherited skin disorder in which squamous epitheal cells undergo rapid mitotic division and abnormal maturation Koebner phenomenon- new psoriatic plaques form over areas of skin trauma Auspitz sign-pinpoint aras of bleeding reamin in the skin when a plaqu is removed. Tinea versicolor: - Solution Superficial skin infection caused by yeasts labs-potassium hydroxide(Koh) slide-hyphae and spores (Spaghetti and meatballs)