HEENT NUR 3165 FNP TEST 1 QUESTIONS AND ANSWERS TESTED AND VERIFIED,ANSWERS ARE 100% CORR, Exams of Nursing

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HEENT NUR 3165 FNP TEST 1 QUESTIONS AND ANSWERS TESTED AND

VERIFIED,ANSWERS ARE 100% CORRECT WITH A+ GRADING

1. A thin patient presents in office with hyperpigmentation and salt cravings. What lab do you want to do? ADDISON - Cortisol
2. Which diabetic oral medication would you not want to use in a patient with HF?
   • ACTOS (Pioglitazone) (THIAZOLIDINEDIONES)
3. Elderly patient presents with acute eye pain, blurred vision, headache, and n/v? What would you do? - Acute angle closure glaucoma, Refer to ED
4. You perform a fundoscopic exam on a patient and see a swollen optic disc with blurred edges. What is this indicative of? - Papilledema, ICP
5. Geriatric patient with progressive loss of vision and probable open-angle glaucoma can have notching of optic disc and changes in cup-to-disc ratio. 1. AV nicking = HTN (arterioles pressing on veins, arteries are smaller than veins, its hypertensive retinopathy , copper wire arterioles, flamed shaped hemorrhages. - Cotton wool spots = diabetes and/or HTN - Papilledema = ICP/ Meningitis - Optic disc cupping = IOP/Glaucoma 22 or higher - *WILL GET 2 or 4 questions on this
6. What are some causes of ICP?
   • Bleeding, tumor, abscess
7. What eye complaint is associated with sudden onset of floaters and complaints of a curtain closing?

• Retinal detachment, refer to ED

13. On fundoscopic exam, you observe an artery crosses a vein and indents it. What is this associated with?
    • AV nicking, HTN
14. A pediatric patient has small, red papules with a white center on the inside of their mouth. What are they called? What are they associated with?
    • Koplik’s spots, Measles (Rubeola)
15. A patient has a cerumen impaction of the left ear. What would you see when performed a Rinne test? On Weber?
    • BC>AC (Rinne test)
    • lateralization to the left ear (Weber test)
16. In a patient with left ear infection, test should lateralize to the left ear.
17. Presbycusis is sensorineural hearing loss, especially at higher frequencies.
18. A carpenter comes in with complaints of a splinter (Astilla)in his eye. What would you do first?
    • Visual acuity 19. Patient was struck(golpeado) in the eye and c/o irritation and foreign body. Initial assessment is visual acuity.
19. A yellow, triangular thickening on the nasal side of the eye called?
    • Pterygium

21. What is the vascular area that anterior nosebleeds originate from?
    • Kiesselbach’s plexus
22. A 21-year-old female presents with complaints of nasal congestion for three weeks. She takes Afrin daily and NSAIDs, as needed, for migraines. What is the cause? - Afrin, or other nasal decongestant, use >3 days results in rebound congestion. This is called rhinitis medicamentosa
23. What is the most common organism in acute otitis media? What is first line treatment? - S. Pneumoniae (Streptococcus pneumoniae): TTO: Amoxicillin What if the patient had an abx in the last three months? Augmentin (Amoxicillin / Clavulanic
    • Patient has hives(ronchas) with penicillin and Ceftin (cephalosporin) and complains of n/v with erythromycin. What do you give? Azithromycin (Macrolide) erythromycin, roxithromycin, azithromycin and clarithromycin. - First-line indications for macrolides include the treatment of atypical community acquired pneumonia , H. Pylori (as part of triple therapy), chlamydia and acute non-specific urethritis.
24. Patient was treated for Acute otitis media two weeks ago, but still complains of inner ear fullness. You educate him on middle ear effusion and tell him that it can last up to?
    • 8 weeks
25. Which patient is not at risk for H. Influenzae infection?
    • or a patient with Otitis externa?
26. What is the most common pathogen of Otitis externa?
    • Pseudomonas aeruginosa
    • Treat with? Corticosporin/hydrocortisone drops

31. Patient with EBV(Mononucleosis) 3 months ago comes to clinic requesting clearance for sports. He has no abdominal pain or organomegaly. Patient may return to sports immediately. Not 100% positive on this one. Other answers included “in 3 months” and “in 6 months.” 4 weeks until USG show completely resolution. (Codina pg132) Flash card say immediately 33- A middle-aged man presents with high fever, chills, myalgia, and a rash on his palms and soles. He was recently hiking (excursionismo)in Tennessee. What is your leading diagnosis?
    • Rocky Mountain Spotted Fever
    • Treat with? Doxycycline (Tetracycline)
32. An elderly patient has an asymmetrical, black, brown, and red lesion with irregular borders on his back. Based on this description, what do you think this is? FYI- my question said blue/purple/pink lesion.
    • Malignant melanoma
33. A pediatric patient presents with a bulls-eye rash with myalgias and fever. He was recently camping with his dad. You diagnose him with Lyme Disease. What do you call his rash? Erythema migrans. TTO: in <8 years children- TX azithromycin, clarithromycin, ceftriaxone, TX with doxycycline or amoxicillin, or azithromycin Dx the most frequently used test is the enzyme immunoassay (EIA) or enzyme-linked immunosorbent assay (ELISA). Confirmatory Western blot testing is recommended
34. A fair skinned ( Piel clara ) female presents with a pearly, waxy skin lesion on her right cheek that has not healed despite topical treatment. What is your leading diagnosis?
    • Basal Cell Carcinoma
35. A male patient has a rash over the large part of his back. It appears to be a Christmas tree pattern. What is it?
    • Pityriasis rosacea 36. A patient presents in office and you note linear burrows in between his phalanges. He complains of itching. What do you diagnose him with?
    • Scabies - Treat with? Permetherin Once time

37. A middle-aged man presents with vesicular lesions on the right side of his abdomen. What is the cheapest (barato)treatment?
    • Oral acyclovir
38. An elderly patient complains of a slow growing lesion on her neck that is dry, red, and scaly. (Actinic keratosis). What is this a precursor to?
    • Squamous cell carcinoma Actinic keratosis can lead to squamous cell carcinoma. Dx biopsy, refer to dermatology, TX topical 5 fluoracil 5-FU, cryotherapy. 39. Actinic keratosis can lead to Basal Cell Cancer : ( Hints: Waxy, pearly, telangiectasia
39. How do you treat a subungual hematoma?
    • Trephination- drill a hole in the finger and release the blood
40. An elderly man has brown lesions that appear “ pasted on .” What do you advise him about these?
    • Seborrheic keratosis, benign
41. A 35-year-old appears with a yellow colored plaque on his upper eyelid. What labs would you draw?
    • Lipid panel (xanthelasma, can be normal in over 40)

• Molluscum contagiosum No lleva TTO. 45.Erythematous, scaly, pruritic, annular lesion with central clearing should be treated with a topical azole antifungal. (Tinea Corporis)

46. You diagnose a pediatric patient with atopic dermatitis. What other conditions would you look for?

• Asthma and allergic rhinitis

47. An obese patient complains of red, shiny lesions in her intertriginous folds. How do you treat this?

• Nystatin

48. An elderly patient was diagnosed with cellulitis. You prescribe him Keflex. He returns with complaints of continued redness and swelling. What do you suspect?

• DVT

49. A patient has superficial skin swelling and redness on his cheek. What is your diagnosis?
    • Erysipelas Erysipelas of the face presents as painful, sharply demarcated erythema and edema. Erysipelas A subtype of cellulitis involving the upper dermis and superficial lymphatics that is usually caused by group A Streptococcus o (KEY WORD IS DEMARCATION) o TX: PCN or Macrolide o Caused by Strep infection 50. An adolescent patient has an erythematous, annular shape rash with raised borders on his arm. What is your diagnosis?
    • Tinea corporis, antifungal cream
50. Pruritic, angular , reddish-purple lesions with white lines in the center is - lichen planus.
51. A patient has been treated for acne with Retin-A daily. He reports improvement, but states his skin is irritated. What do you do?
    • Decrease his dose to three times a week

60. Patient with Barrett’s esophagus has a cancelled GI consult and needs PPI refills what should the NP do?
    • Refill RX for PPI’s
61. A patient has JVD , what does this give your insight into?
    • Left (for lungs) or right-side functioning of the heart?
62. An elderly patient has uncontrolled hypertension. Which heart sound would you hear? - S4, (HTN) (Hyhpertrophy del ventrículo izquierdo) -think S 3 for heart and heart failure
63. A patient has a systolic murmur that radiates to the neck. What is it? Aortic stenosis (systolic) 2do ICS a la right of sternum)(High Pitch) SE VE EN HOMBRE REUMATIC FEVER AND SYFILIS LATENT 64. An III/VI murmur is described as having moderate intensity or loud murmur easily heard. (NO THRILL PALPABLE)
64. A patient has an EKG showing no P waves. What do you diagnose him with? - A. Fib, TTO: WARFARIN -What condition can initiate A.fib? Hyperthyroidism 66. A patient with hyperthyroidism and a “ hot spot” on imaging has toxic nodular goiter. 67. A patient with hyperthyroidism should be treated with: antithyroid drugs, beta blockers, and NSAIDS. -methimazole -propylthiouracil 72-A patient has an INR of 1.4 or 1.2. What do you do with the Coumadin dose?
    • Increase dosage Therapeutic range: 2.0-3.
65. You diagnose a patient with Coarction of Aorta, what are your expected findings on exam? -Weak femoral pulse and upper extremity BP higher than lower extremity BP, caused by congenital heart disease.
66. You see a prolonged PR interval on an EKG. What do you suspect this patient has?
    • 1 st^ degree heart block

70. Geriatric arrhythmias can be caused by sinoatrial fibrosis.
71. A 30-year-old male presents with a BP of 200/100. You hear an abdominal bruit on exam. What do you expect?
    • Renovascular hypertension /renal artery stenosis, Not use ACEI (pril) in stenosis of renal artery 72.Carotid bruits can be caused by carotid narrowing.
72. A patient has stable angina. What test do you order for him?
    • Stress test
73. An African American man presents to your clinic for follow up. He was previously placed on Losartan. His BP is still elevated. What do you do?
    • Change to CCB 75. What is the cause of isolated systolic hypertension? TTO: Calcium Chanel Blocker
    • Decreased elasticity of the arteries
74. A patient complains of lower extremity pain with walking. The pain subsides when he sits down. What do you suspect?
    • PAD What test would you use? Ankle brachial index PVD has swelling, darkening of skin of lower extremities 77. Name a few medications that interact with grapefruit juice. - Statin, CCB 78.Before initiating statin therapy , you should check AST/ALT. Liver enzymes)
75. An overweight male presents with total cholesterol: 200, HDL: 35, LDL: 130 and Triglycerides: 350. What is your first line treatment?
    • Diet and exercise -If the triglycerides were 650 , what would you do? Niacin -What are patients at risk for with high tri’s? Pancreatitis Cholesterol<200, HDL >40, LDL <100, Triglycerides < TX first line : life modifications, niacin, fenofibrate, statins. Always treat Triglycerides first.

CD4 count less than 200 after antiviral treatment

• diagnosis of AIDS should be made
• start prophylaxis against Pneumocystis Carinii with Bactrim or Dapsone.
• normal CD4 is 500-
• CD4 count increases as HIV virus is controlled with treatment 94. HIV patient was started on HAART (combined antiretroviral therapy). Repeat testing shows CD4+ below 200. The patient should be told treatment failed and you now have AIDS.

95. You diagnose a patient with mild intermittent asthma. What is your treatment plan? ▪ SABA 101-1-First-line treatment Mild persistent asthma? SABA + ICS low-dose inhaled corticosteroid. 102-A woman presents with amenorrhea and galactorrhea. What lab would you draw?

• Prolactin level Primary amenorrhea is defined as lack of menses at age 16 with other secondary sex characteristics.

96. A patient has an elevated calcium level and a low potassium. What diagnosis do you suspect?

• Hyperparathyroidism
• High calcium, low phosphorus and potassium (opposite)

97. A woman with hypothyroidism presents three weeks after starting Synthroid with complaints of continued symptoms. What do you do?

• Continue dose and reassess at 6 weeks What if her TSH was 1.4, her (0.5-5.0)?

98. A diabetic patient has a A1c of 9.0%. He is on Metformin 500mg BID and Glipizide 40mg daily. What do you do next?

• Max out metformin
• What if his metformin was maxed out? Add basal insulin *** KNOW THE NAME OF A BASAL INSULIN***, ( Lantus or Levemir ) 99. Patients on Metformin should be monitored for lactic acidosis. 100. Old women complaining of fatigue, who is on multiple medications that contain sulfonylureas and ACEI, could have hypotension, hypoglycemia, and polypharmacy, but not hypocalcemia.

101. A female patient complains of RUQ pain, nausea, and aversion to smoking. What is your diagnosis?
     • Hepatitis
     • What lab/labs is elevated in chronic hepatitis? ALT (central to liver)alanina transferasa
     • RUQ pain with radiation to shoulder after a heavy meal? Chole
102. A patient has periumbilical pain. Which would NOT be in the list of differentials? - Appendicitis, hernia, gastroenteritis, or hepatitis
103. An elderly patient presents with reports of weight loss and pencil like stools. What area of the colon would be considered?
     • Descending
104. An elderly woman complains of intermittent diarrhea and weight loss. What would you do next?
     • Colonoscopy 120. Most-specific test for an inflammatory intestinal condition is C.diff. 121 Person most likely to get C. diff is a patient who has taken abx recently for cellulitis. 122 What would you expect to see in a stool sample of a patient with an **inflammatory bowel disease?

• WBCs 123** An adult patient has complaints of acid reflux. He has been taking OTC tums. What is your first line treatment for him?
• H2 blockers 124 -A young woman complains of intermittent episodes of diarrhea and constipation. She complains of bloating , but it resolves with bowel movements. What do you suspect?
• IBS 125 The CHF is present in patient with: S3 heart sound, orthopnea, and paroxysmal nocturnal dyspnea. 126 An elderly woman is on a diuretic for CHF. Her creatinine level has gone from 0.8 to 1.2. What would you expect to see in her GFR? A geriatric patient with creatinine increasing from 0.8-1.2 on digoxin shows substantial decrease of GFR.

- NSAIDs/Triptans Prophy? BBs/TCAs 138 -The most effective medication for migraines in the prodromal period is . The answers are triptans or ergotamine. I know triptans are more effective once the migraine starts, but I don't know about the prodromal period.

• Triptans ( Imitrex)(sumatriptan ) 139 -What is your first line treatment for trigeminal neuralgia?
• Anticonvulsants Treatment – high doses of anticonvulsants ( carbamazepine or phenytoin ); MRI/CT if patient is young , bilateral involvement, or numbness 140 -A patient is taking kava kava(sedantes) for anxiety. What medications would you want to avoid?
• Benzos and other CNS depressants 141 -A patient presents with glossitis. What do you suspect?
• Pernicious anemia (B12) , may see neuro complaints 142 -Orthostatic hypotension in a Diabetic is most likely caused by autonomic neuropathy. 143 -Correct screening test for anemia is H/H. MCV<80 fl.(microcytic): R/O: iron-deficiency anemia vs. thalassemia trait. MCV 80-100 fl.(normocytic): Anemia of chronic disease. MCV > 100 fl. (macrocytic/megaloblastic): R/O: B12 deficiency vs. folate deficiency anemia. Iron-deficiency Anemia lab follow-up 144 -What are the chances that sickle cell disease will be passed on to two carriers’ children? - 25% My question was what the percentage of two Heterozyte Parents of is passing the disease to child. I believe it is 50%.( Trait)

145 -What immunizations should a sickle cell patient have?

• All 146 -A patient comes in after falling with an outstretched hand. The XR is normal. What do you suspect? What kind of splint do you use? Thumb Spica splint Scaphoid fracture still having pain( Hand)
• repeat x-ray, splint wrist, refer to surgeon
• scaphoid fractures may not show on initial x-ray
• patient usually has history of falling forward on outstretched hand
• common complaint is deep, dull wrist pain that worsens with gripping or squeezing
• high risk of avascular necrosis and nonunion

A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone. It is thus a form of child bone fracture. It is a common injury found in children , occurring in 15% of childhood long bone fractures. 147 -A patient has lateral epicondylitis. What is your treatment? Rest, Ice, Compression, and Elevation (RICE) Any soft tissue injuries, use RICE 148 -What orthopedic maneuver tests for meniscal tear?

• Mc’Murrays Test