FNP Adult Health Final Study Guide: Questions and Answers, Exams of Advanced Education

Download FNP Adult Health Final Study Guide: Questions and Answers and more Exams Advanced Education in PDF only on Docsity! FNP ADULT HEALTH FINAL STUDY GUIDE What is the recommended antibiotic therapy for previously healthy patients with no risk factors for drug-resistant S. pneumonia infection that have community acquired pneumonia (CAP)? - Macrolide (Azithromycin, clarithomycin, or erythromycin) OR Doxycycline What is the recommended antibiotic therapy for patients with chronic comorbidites, such as chronic disease of heart, liver, lungs, or kidneys; diabetes, alcoholism, malignancies, immunospression, antimicrobial use within the last 3 months that have community acquired pneumonia? - Respiratory fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin {750 mg}) OR beta lactam plus macrolide (preferably high-dose amoxicillin (1 to 3 times daily) or amoxicillin-clavulanate (2 tabs twice daily). Alternatives include ceftriaxone, cefpodoxime, and cefuroxime (500 mg, twice daily); with doxycycline as an alternative to the macrolide) What is the recommended antibiotic therapy for suspected pseudomonas aeruginosa infection? - Antipneumococcal antipseudomonoal beta lactam (pipercillin-tazobactam, cefepime, meropenem, or imipenem-cilastatin) plus either ciprofloxacin or levofloxacin (750 mg dose) OR Antipneumococal antipseudomonoal beta-lactam plus an amino glycoside and azithromycin OR Antipneumonoccal antipseudomonal beta-lactam plus an amino glycoside and an antipneumococcal fluoroquinolone. Aztreonam plus an amino glycoside and an antipneumococcal fluoroquinolone for patients allergic to penicillin What is the recommended antibiotic therapy for suspected community acquired MRSA infection with community acquired pneumonia? - Addition of vancomycin or linezolid When should you obtain a chest X ray on COPD patient? - During a COPD exacerbation when attempting to rule out a concomitant pneumonia. What Pathogen is most commonly seen in COPD caused by bacteria? - Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae What is the preferred meds for Persistent asthma treatment? - Low dose ICS; Low dose ICS plus LABA, or Medium dose ICS; Medium dose ICS plus LABA. What are examples of inhaled corticosteroids? - Fluticasone (Flovent HFA) Budesonide (Pulmicort) Mometasone (Asmanex Twisthaler) Beclomethasone (Qvar) Ciclesonide (Alvesco) Flunisolide (Aerospan HFA) What are examples of long acting beta agonists? - Advair, Dulera, and Symbicort (a combination of a long-acting beta-agonist bronchodilator and an inhaled steroid) Serevent (salmeterol) Foradil (formoterol) Perforomist (formoterol solution for nebulizers) What are x-ray findings of acute asthma attack? - Hyperinflation, focal atelectasis, and bronchial thickening are clinical findings on chest X-ray of exacerbated asthma. How is asthma managed without medication? - Peak flow monitoring Avoidance of asthma triggers Extensive, ongoing asthma education for the patient and family regarding disease, treatment, avoidance of triggers, asthma managed plan, and emergency actions. Use of an asthma action plan can reduce the number of ED visits as well as hospitalizations. What screening is appropriate for diabetic neuropathy? - Urinalysis for urine protein and a Blod test to check for GFR (kidney function). The most appropriate screen for diabetic nephropathy is? - Microalbuminuria a 26 y/o pt with long hx of chronic sinusitis presents today with temperature of 103.2F, headache, and stiff neck. Which finding below should make the NP suspect meningitis? - A positive Kernig's and Brudzinski's sign What two tests demonstrate nuchal ridgidity? - Kernig's and Brudzinski's sign A common presentation of an inguinal hernia is: - Groin or abdominal pain with a scrotal mass Hesselbach's triangle forms the landmark for: - inguinal hernia The most common place for indirect inguinal hernias to develop is: - The internal inguinal ring A 25 y/o male pt with subacute bacterial epididymitis should be txed initially with: - Doxycycline A pt with testicular torsion will have a: - Negative cremasteric reflex on the affected side A 50 y/o male pt reports that he has a sensation of scrotal heaviness. he reports that the sensation is worse at the end of the day. he denies pain. what is the likely etiology of these sxs? - Inguinal Hernia An inguinal hernia is palpated on a male pt by an examiner. which word below best describes what the hernia feels like when touched by the examiner? - Silky An example of primary prevention is: - using a condom to prevent infection with an STD A pt was exposed to HIV through sexual intercourse. he should be followed with screening tests to identify seroconversion for: - One year An elderly male pt is taking finasteride, a 5-alpha-reductase inhibitor. what affect might this have on his PSA level? - It will decrease The risk of HIV transmission is increased: - When other STDs are present A 26 y/o male pt has been dx with gonorrhea. how should he be managed? - Ceftriaxone and azithromycin Which of the following results in a clinically insignificant increase in the prostate specific antigen (PSA)? - Digital Rectal Exam Testicular torsion can produce: - Scrotal edema A sexually active male pt presents with epididymitis. what finding is likely? - Recent hx of heavy physical exercise An adolescent has suspected varicocele. he has dull scrotal pain that is relieved by: - Recumbency What is the effect of digital rectal examination on a males's PSA level if it is measured on the same day as DRE? - The change is insignificant A male with gonorrhea might c/o: - Dysuria A dx of osteoporosis can be made when: - Bone mineral density is 2/5 standard deviations below the mean A localized tumor in the prostate gland associated with early stage prostate cancer is likely to produce: - An absence of signs and symptoms Hematuria is not a common clinical manifestation in: - Early prostate cancer Digital rectal exam may be performed to assess the prostate gland. which term does NOT describe a prostate gland that may have a tumor? - Boggy A patient presents with sudden onset of "crushing chest pressure," diaphoresis, pallor, and extreme weakness. Electrocardiogram and serum enzyme changes support a diagnosis of acute myocardial infarction (AMI). The nurse practitioner would expect: - ST changes, prominent Q wave, elevated CPK- MB and LDH, and cardiac troponin I. A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several times per day (while at rest) which is relieved with nitroglycerin. What is the most appropriate initial action for the nurse practitioner? - Refer to a cardiologist as soon as possible. A patient presents to the rural health clinic with severe chest pain. The nurse practitioner places the patient on a cardiac monitor and observes a normal sinus rhythm with elevated ST segments. His blood pressure is 130 75 mmHg. What is the likely cause of this patient's chest pain? - Cardiac Ischemia Harry comes to your office with waxing and waning ischemic symptoms over a period of days and weeks, an increase in angina while at rest, and transient ST changes on his electrocardiogram. This presentation leads you to believe that he is experiencing??? - Unstable Angina Jamie, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to ??? - Hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, and thrombosis as appropriate. Pt w a positive hx of a tick bite about 2 wks ago and erythema migrans has a positive ELISA for borrelia. The Western blot is positive. What medication is appropriate and what is the diagnosis? - Receive doxycycline for Lyme disease LYME DISEASE History? (Hollier 1/17) Screening test? (Hollier 1/17) Confirmatory test? (Hollier 1/17) Treatment? (Hollier 1/17) - HISTORY of positive tick bite SCREENING TEST: ELISA CONFIRMATORY TEST: Western Blot TREATMENT: Doxycycline = Amoxicillin = or cefurixime x21 days What are some health promotion tips for smokers? - Get pneumonia vaccine 43 year old woman has a 12 hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is: - acute cholecystitis. What tool is used to examine diabetic feet? - 10g monofilament What are risk factors for breast cancer? - white greater than 50 early menarche (under 12) late menopause (after 50) nulliparity or late first pregnancy Principles of treating patients with RA include: - early use of disease-modifying antirheumatic drugs (DMARDs) to slow or halt joint damage. First line therapy for acne vulgaris with closed comedones? - benzoyl peroxide What is the most common symptoms of GERD? - Dyspepsia (heartburn) What is first-line medical treatment for GERD? - Proton Pump inhibitors What are the signs/symptoms of GERD? - 1. Retrosternal burning 2. Bitter taste in mouth 3. Belching, hiccups, dysphagia 4. excessive salivation 5. Frequently occurs at night &/or in recumbent position 6. May be relieved by sitting up, antacids, water or food When prescribing antihypertensive therapy for a man with BPH and hypertension, the NP considers that: - an alpha, antagonist should not be used as a solo or first-line therapeutic agent. Which of the following is recommended by the Centers for Disease Control and Prevention as single- dose therapy for uncomplicated urethritis caused by N. gonorrhoeae when an oral product is the most appropriate option? - cefixime A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? - Transdermal nitroglycerin Rationale: Taking drugs like sildenafil with nitrates may lead to dangerous hypotensive episodes. Patients prescribed sildenafil (Viagra) should be instructed regarding the potential fatal drug interaction with which medication(s)? - nitroglycerin When taken in conjunction with nitroglycerin, sildenafil can cause severe hypotension unresponsive to treatment. The mechanism of action of metformin (Glucophage) is as: - a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. What is Lantus? - basal/long acting insulin A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) - Ketosis-prone Younger than 30 years of age Little endogenous insulin What are the different classifications of obesity? - Obesity Class I: BMI 30-34.9 Obesity Class II: BMI 35-39.0 Severe Obesity Class III: >40.0 Acute otitis media findings include? - Reddened, inflamed tympanic membrane Tympanic membrane may appear to be dull and bulging What is treatment for strep throat? - penicillin VK PO for 10 days. If pt is PCN allergy, macrolides (-mycin drugs) can be used instead. What is the most common cause of dementia? - alzheimer-type which of the following therapeutic modalities is useful for severe uncontrollable atopic dermatitis? - Ultraviolet light ATOPIC DERMATITIS Def? (Hollier 11/19) Tx goal? (Hollier 9/19) Tx: Least appropriate vehicle? (Hollier 9/19) Tx: Most appropriate vehicle? (Hollier 9/19) Rx? (Hollier 11/19) - Def: chronic inflammatory skin disorder involving a genetic defect in proteins supporting the epidermal layer. Tx goal: needs continuous skin hydration Tx: Least appropriate: lotions. Lotions worsen xerosis due to evaporation of water on skin. Lotions have high water content and low oil content. creams have lower water content. Tx: Most appropriate: Ointments have no water and are excellent agents to use on dry skin as well as to prevent dry skin. which criterion below is a criterion for Alzheimer's Disease? - Impairment of executive function a pt cannot stick his tongue out of his mouth and move his tongue from side to side. What CN is responsible for this movement? - XII which class of medications is NOT used for migraine prophylaxis? - Triptans the class of medications known as triptans, which includes sumatriptan is used for - abortive agents for migraine headaches which recommendation below reflects CDCs recommendation for administration of the zoster vaccine? - it should be given to immunocompetent adults age 60 and older all of the following characteristics may be found in an odler adult with dementia. Which one is common in a pt with Alzheimer's disease, but uncommon in a pt with another type of dementia? - Indifference Acute coronary syndrome ECG change is what? - ST segment elevation a male pt has a family hx of bipolar disorder in two first degree relatives. Bipolar disorder: - Often affects multiple family members a 38 y/o pt dx with bipolar disease has taken lithium for many months. his mood has stabilized he was told to report frequent urination while taking lithium. what might be the underlying cause of his frequent urination? - Diabetes insipidus what is the usual age of onset of sxs for pts with bipolar disorder? - Between 15 and 30 years a 34 y/o bipolar pt has been placed on a fluoxetine and valproate for manic depressive sxs. he has had great improvement in his sxs and has returned to work. the psychiatrist has released him to your care. what must be monitored in this pt? - Valproate levels Platelet count Liver function studies carbamazepine is used in pts with bipolar disorder for mood stabilization. prescribers who have pts taking carbamazepine should be alert to: - Drug-Drug interactions a newly dx pregnant teenager has suspected depression. before a dx is made, she should have a CBC, TSH, renal and liver function tests and: - Urine toxicology which statement about bulimia nervosa is accurate? - High dose SSRIs are used to treat this. a pt with anorexia nervosa had sxs that began about 6 months ago. she presents today and is dxed with anorexia nervosa. she has a lab evaluation. what might be expected? - Normal lab values a pt presents to your clinic numerous times with vague complaints. she seems to respond poorly to medical tx that is given to her. what should be considered when obtaining a hx from her? - Physical abuse or depression what sx listed below is typical of depression? - Early morning wakening a pt reports that she takes kava kava regularly for anxiety with good results. what should the NP evaluate? - Liver function studies a good first choice of antidepressants in an older adult is: - An SSRI the preferred medication class to tx pts with an initial episode of depression is: - SSRIs serotonin syndrome may result from taking an SSRI and: - dextromethorphan a depressed pt is started on an SSRI. when should another antidepressant be tried if there is no response? - 8-12 weeks a pt may derive benefit from a tricyclic antidepressant if he experiences depression and: - Chronic pain a pt with bipolar disease has purchased a $10,000 baby grand piano. he does not play the piano. this behavior is typical during: - mania a pt presents to the NP's clinic and states that she feels sad and thinks she is depressed. what info is important to elicit in order to dx her with depression? - How long have you felt like this? depression is dx on clinical presentation. what time frame is important for distinguishing between depressed mood and clinical depression? - 2 weeks serotonin is thought to play a role in the etiology of: - Depression a pt with bulimia nervosa probably has concurrent: - Anxiety impaired blood flow to the extremities is caused by which of the following common disorders? - Peripheral vascular disease When the PVD disease is arterial, it is usually the result of - accumulated fatty streaks and fibrous plaques (high levels of LDH) when the PVD disease is venous, it is usually related to - venous incompetence secondary to valve obstruction, leading to chronic venous insufficiency and varicose veins JNC-8 recommends what four classification of medication for the initial tx of hypertension? - thiazide type diuretics ACEi ARBs CCBs the most expedient way to slow the progress of peripheral arterial occlusive disease is: - Stop tobacco use