NR 603 Week 4 APEA Predictor Exam TestBank Updated2022/2023 Accurate Summer, Exams of Nursing

Download NR 603 Week 4 APEA Predictor Exam TestBank Updated2022/2023 Accurate Summer and more Exams Nursing in PDF only on Docsity! NR 603 Week 4 APEA Predictor Exam TestBank Updated A patient with iron deficiency anemia takes iron supplementation daily. What should he be advised to avoid within a couple of hours of taking iron? An antacid Leukemia may have varied clinical presentations. Which characteristic would be unusual to find in a patient with leukemia? Sickle shaped cells A 66 year-old African American male complains of pain in his trunk, especially his ribs. Cardiovascular disease is ruled out. He has a normocytic, normochromic anemia with hypercalcemia. The differential diagnosis should include: multiple myeloma. What hallmark finding is associated with both B12 and folate deficiencies? Macrocytosis A patient demonstrates leukocytosis. This means: he has an infection of unknown origin. What statement is true about anemia in older adults? Anemia may have more than one origin and co-exist in older adults. A patient has been treated for HIV infection with anti-retroviral therapy. He is stable. How often should CD4 counts be repeated? Every 3-6 months A patient presents with hematuria, RBC casts, and proteinuria. What is a likely explanation? Glomerulonephritis A patient demonstrates leukocytosis. This means: he has an infection of unknown origin. A patient is having an allergic reaction to seafood. Which white cell will probably be increased? Eosinophils A female patient has been diagnosed with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this patient? Avoid aspirin and sulfa drugs A 75 year-old patient who has multiple chronic diseases has been in very poor health for a decade. What type of anemias is he most likely to exhibit? Folic acid and pernicious A patient has been diagnosed with HIV. The patient’s viral load was ordered. What other test may be ordered to assess the status of the patient’s immune system? CD4 cell count A 70 year-old male has lymph nodes in his axillary and inguinal areas that are palpable but non-tender. He states that he feels well today. What should be included in a Lymphoma NR 603 Week 4 APEA Predictor Exam TestBank Updated Lead toxicity can be associated with: sideroblastic anemia. differential diagnosis for this patient? A two year-old with sickle cell anemia (SCA) should receive which immunizations? All routine childhood immunizations at the usual time A three year-old child presents with hematuria, petechiae, and a platelet count of 50,000 (Normal = 150,000-450,000/ml). The rest of his CBC is normal. He had an upper respiratory infection about 2 weeks ago. On exam today, he is found to have petechiae and bruises. The most likely diagnosis is: idiopathic thrombocytopenia purpura (ITP). A child and father live in an old house. They both are found to be lead toxic. What type anemia is typically observed in patients who are lead toxic? Iron deficiency anemia A patient with diarrhea has a stool specimen positive for WBCs. What does this indicate? A viral infection A 26 year-old female has thalassemia minor. What should be limited in her diet to avoid hepatotoxicity? Multi-vitamin with iron A patient is found to have eosinophilia. An expected finding is: asthma exacerbation. An African American male complains of pain in his back and trunk. He is diagnosed with multiple myeloma. He is probably: about 65 years old. . A patient has heavy menses. Which lab value below reflects an iron deficiency anemia? Increased TIBC An obese 78 year-old male with poorly controlled hypertension and diabetes has a normocytic, normochromic anemia. This anemia is likely: associated with chronic disease. . An elderly male diagnosed with a microcytic, hypochromic anemia: may have a GI bleed. Which suggestion below is the standard for Iron supplementation in treating iron deficiency anemia in infants divided doses between meals and children? with orange juice A patient with pernicious anemia may be observed to have: glossitis. NR 603 Week 4 APEA Predictor Exam TestBank Updated may increase the likelihood of photosensitivity? A 60 year-old patient is noted to have rounding of the distal Hepatic cirrhosis phalanx of the fingers. What might have caused this? A patient exhibits petechiae on both lower legs but has no other Order a CBC complaints. How should the NP proceed? When can a child with chickenpox After all lesions have crusted over return to daycare? Hand-foot-and-mouth disease and are viral infections caused by herpangina: Coxsackie viruses. What is the proper technique to safely remove a tick from a Pull it off with tweezers human? Most cases of atopic dermatitis topical steroids. exacerbation are treated with: The primary therapeutic intervention for patients who anti-histamines. present with hives is: A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the hyphae. infected area would likely demonstrate: A patient has been diagnosed with scabies. What is the medication of Permethrin choice to treat this? An adolescent has acne. The nurse practitioner prescribed a benzoyl peroxide product for him. What Photosensitivity of the skin can important teaching point should occur be given to this adolescent regarding the benzoyl peroxide? A patient presents with plaques on the extensor surface of the elbows, knees, and back. The plaques are plaque psoriasis. erythematous and there are thick, silvery scales. This is likely: An infant is diagnosed with diaper topical anti-fungal agent. dermatitis. Satellite lesions are NR 603 Week 4 APEA Predictor Exam TestBank Updated visible. This should be treated with a: A key component of the approach to a patient who has atopic dermatitis is hydration. Which agent should be avoided? Patients with atopic dermatitis are likely to exhibit: A 16 year-old has been diagnosed with Lyme disease. Which drug should be used to treat him? A 28 year-old has thick, demarcated plaques on her elbows. Which features are suggestive of psoriasis? A 71 year-old female presents Lotions Itching. Doxycycline Silvery scales that are not pruritic with a vesicular rash that burns and itches. Shingles is diagnosed. An oral antiviral: A patient was burned with hot water. He has several large fluid filled lesions. What are these termed? A patient with a primary case of scabies was probably infected: A patient has a lower leg wound that appears infected. It is red, should be started within 72 hours of the onset of symptoms. Bullae 3-4 weeks ago. warm to touch and edematous. He had an acute onset of pain, symptoms, and low grade fever. What is this? A 15 year-old male has worked this summer as a lifeguard at a local swimming pool. He complains of itching in the groin area. He is diagnosed with tinea cruris. The nurse practitioner is likely to identify: A patient has been diagnosed with MRSA. She is sulfa allergic. Which medication could be used to treat her? well marginated half moon macules on the inner thigh. Doxycycline A skin lesion which is a solid mass papule. Erysipelas NR 603 Week 4 APEA Predictor Exam TestBank Updated is described as a: Impetigo is characterized by: honey-colored crusts. A 10 year-old has thick, demarcated plaques on her elbows. Which features are suggestive of psoriasis? The agent commonly used to treat patients with scabies is permethrin. How often is it applied to eradicate scabies? Which test is NOT suitable to diagnose shingles if the clinical presentation is questionable? A 74 year-old is diagnosed with Silvery scales that are not pruritic Once Complete blood count (CBC) shingles. The NP is deciding how to best manage her care. What should be prescribed? The term caput succedaneum refers to: A pregnant mother in her first An oral antiviral agent scalp edema. trimester has a 5 year-old who has There is a risk of fetal death if she Fifth Disease. What implication does this have for the mother? A topical treatment for basal cell carcinoma is: The most common form of skin cancer is: A skin disorder has a hallmark finding of silvery scales. What word below describes this common condition? The most common place for basal cell carcinoma to be found is the: A low potency topical hydrocortisone cream would be most appropriate in a patient who has been diagnosed with: A patient with a positive history of a tick bite about 2 weeks ago and erythema migrans has a positive ELISA for Borrelia. The Western blot is positive. How should he be managed? becomes infected. 5-fluorouracil. basal cell carcinoma. Chronic face. atopic dermatitis. He should receive doxycycline for Lyme disease. NR 603 Week 4 APEA Predictor Exam TestBank Updated parent who has a child with Fifth Disease? What finding characterizes shingles? A 70 year-old is diagnosed with multiple cherry angiomas. The nurse practitioner knows that: A patient with diabetes has a right lower leg that has recently become edematous, erythematous, and tender to touch over the anterior shin. There is no evidence of pus, but the leg is warm to touch. What is the most likely diagnosis to consider? The American Cancer Society uses an ABCDE pneumonic to help patients develop awareness of suspicious skin lesions. What does the “B” represent? A 9 year-old has been diagnosed with chickenpox. A drug that should be avoided in him is: Mr. Johnson is a 74 year old who presents with a pearly-domed nodular looking lesion on the back aches and pains. Unilateral dermatomal rash these may bleed profusely if ruptured. Cellulitis Border aspirin. Basal cell carcinoma of the neck. It does not hurt or itch. What is a likely etiology? A 3 year-old female had a fever of 102 degrees F for 3 days. Today she woke up from a nap and is afebrile. She has a maculopapular rash. Which statement is true? The lesions seen in a patient with folliculitis might be filled with: A child has 8-10 medium brown café au lait spots > 1 cm in diameter. The differential diagnosis should include: A patient presents with small vesicles on the lateral edges of his fingers and intense itching. On close inspection, there are small The rash will blanch. pus. neurofibromatosis. Dyshidrotic dermatitis NR 603 Week 4 APEA Predictor Exam TestBank Updated vesicles on the palmar surface of the hand. What is this called? The nurse practitioner examines a patient who has had poison ivy for “no, transmission does not occur 3 days. She asks if she can spread it from the blister’s contents.” to her family members. The nurse practitioner replies: A patient who is at high risk for skin cancer should: A patient has used a high potency topical steroid cream for years to treat psoriasis exacerbations when they occur. She presents today and states that this cream “just doesn’t work anymore.” What word describes this? Topical 5-fluorouracil (5-FU) is used to treat: A “herald patch” is a hallmark finding in which condition? The nurse practitioner identifies satellite lesions in a 6 month-old infant. These are: The nurse practitioner is examining a 3-month old infant who has normal development. She has identified an alopecic area at the occiput. What should be done? A 6 year-old has been diagnosed with Lyme disease. Which drug should be used to treat him? A child with a sandpaper textured rash probably has: An adolescent takes isotretinoin for nodulocystic acne. She is on oral contraceptives. Both were prescribed by the dermatologist. The adolescent arrives in your clinic with a sinus infection. Her temperature is 99.5 degrees F and her blood pressure is 160/100. How should this be managed? examine his skin monthly for changes. Tachyphylaxis basal cell carcinoma. Pityriasis rosea indicative of candidal infection. Encourage the caregiver to change the infant’s head position Amoxicillin strept infection. Call the dermatologist to report the elevated BP Which of the following skin lesions Actinic keratosis NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A 40 year-old female patient presents to the clinic with multiple, painful reddened nodules on the anterior surface of both legs. She is concerned. These are probably associated with her history of: deep vein thrombosis.phlebitis. Incorrectulcerative colitis. Correctalcoholism. Explanation: These nodules describe erythema nodosum. These are most common in women aged 15-40 years old. They are typically found in pretibial locations and can be associated with infectious agents, drugs, or systemic inflammatory disease like ulcerative colitis. They probably occur as a result of a delayed hypersensitivity reaction to antigens. It is not unusual to find polyarthralgia, fever, and or malaise that precede or accompany the skin nodules. Question: A patient reports that he found a tick on himself about one month ago. He reports that there is a red circle and a white center near where he remembers the tick bite. He did not seek treatment at the time. Today he complains of myalgias and arthralgias. What laboratory test can be used to help diagnose Lyme disease? CBCLyme titerELISA CorrectSkin scraping Explanation: A detailed history should always precede testing for Lyme Disease. The red circle with the white center is likely erythema migrans (EM). EM is the characteristic skin lesion of Lyme Disease (and other illnesses) and usually occurs within one month following the tick bite. Many learned authorities including the Infectious Diseases Society of America conclude that individuals should not be screened/tested for Lyme disease unless they have a high probability of having Lyme disease. In this case, historical features coupled in the elderly is a premalignant condition? A patient has suspected scarlet fever. He likely has a sandpaper rash and: a positive rapid strept test. A 6 year-old patient with sore throat has coryza, hoarseness, and Viral etiology diarrhea. What is the likely etiology? A 74 year-old male patient has sustained a laceration to his foot. His last tetanus shot was more Tetanus, diphtheria, and acellular than 10 years ago. He has pertussis (Tdap) completed the primary series. What should be recommended? The best way to evaluate jaundice associated with liver disease is to the sclera, skin, and lips. observe: NR 603 Week 4 APEA Predictor Exam TestBank Updated Liver function testsComplete blood count CorrectHepatitis B surface antigenArterial blood gases Explanation: Koilonychia is the term that describes spoon shaped nails. Spoon shaped nails may be present in patients with long-standing iron deficiency anemia. A CBC should be performed to assess for anemia. The most common symptoms of iron deficiency anemia are weakness, headache, irritability, fatigue, and exercise intolerance. Question: A 60 year-old patient is noted to have rounding of the distal phalanx of the fingers. What might have caused this? Coronary artery diseaseHepatic cirrhosis CorrectLead toxicityIron deficiency anemia Explanation: Rounding of the distal phalanx describes clubbing. Clubbing of fingers is most often associated with chronic hypoxia as seen in cigarette smokers and patients with COPD or lung cancer. Other causes are cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic heart disease. Question: Impetigo is characterized by: honey-colored crusts. Correctsilvery scales.marble-like lesions.wheals with pus. Explanation: Impetigo is a superficial bacterial infection of the skin characterized by honey-colored crusts. Another form of impetigo is characterized by the presence of bullae. These infections are treated with topical antibiotics, good hygiene, and frequent hand washing. It is usually caused by Staphylococcus or Group A Streptococcus. Question: A skin lesion fluoresces under a Wood’s lamp. What microscopic finding is consistent with this? Clue cellsHerpes simplexHyphae CorrectLeukocytes Explanation: A Wood’s lamp emits ultraviolet light when turned on. If an area fluoresces under Wood’s lamp illumination, a fungal (and sometimes bacterial) infection should be suspected. The test is most effectively performed in a darkened room so the fluorescence can be more easily identified. Deodorant, soap, and make-up may also fluoresce. About one-third of hyphae fluoresce. Question: A skin disorder has a hallmark finding of silvery scales. What word below describes this common condition? Chronic CorrectInfectiousContagiousAcute Explanation: “Silvery scales” describes the hallmark finding in psoriasis. This is a chronic condition. It is not infectious, contagious, or acute. There are several variants, but “silvery scales” is the most common form. Question: A patient will be taking oral terbinafine for fingernail fungus. The NP knows that: This will cure her infection 95% of the time. Incorrecta topical antifungal will work just as well when the nail matrix is involved.Terbinafine is a potent inhibitor of the CYP 3A4 enzymes. Correcttoenail fungus resolves faster than fingernail fungus after treatment. Explanation: NR 603 Week 4 APEA Predictor Exam TestBank Updated Most oral antifungal agents inhibit the 3A4 enzymes in the cytochrome P450 system. This is why they must be used with extreme caution (or not used) in patients who consume medications that need 3A4 enzymes for metabolism. And, liver enzymes must be monitored in patients who take oral antifungal medications and discontinued if elevations are >2.5 times the upper limits of normal. There is no oral agent that has a 95% cure rate for fingernail fungus (tinea unguium). This can be a difficult infection to clear even if oral antifungal agents are utilized. A topical antifungal agent typically will not clear the infection if the nail matrix is involved. There is anecdotal evidence that menthol ointments or bleach may cause resolution when used topically. Generally, resolution of fingernail fungus occurs more rapidly than toenail fungus because toenails grow at slower rates than fingernails. Question: Which of the following areas of the body has the greatest percutaneous absorption? Sole of the footScalp IncorrectForeheadGenitalia Correct Explanation: Genitalia have the highest percutaneous absorption across the entire body. This is important because low potency creams will act with greater potency in this area. Always start with low potency creams in the genitalia. The sole of the foot has the lowest percutaneous absorption followed by the scalp, forehead, and genitalia. Therefore, the sole of the foot will require more potent vehicles to enhance absorption. Question: A patient who has been in the sun for the past few weeks is very tanned. He has numerous 3-6 mm light colored flat lesions on his trunk. What is the likely etiology? Tinea corporisTinea unguiumTinea versicolor CorrectHuman papilloma virus Explanation: Tinea versicolor is typically visualized during the spring and summer months when a patient has become tanned. The areas that are infected do not tan and so become very noticeable. The chest and back are common areas to observe tinea versicolor. There can be 100 or more in some infections. This can be treated with topical selenium sulfide or an oral antifungal agent. Question: The nurse practitioner is examining a 3-month old infant who has normal development. She has identified an alopecic area at the occiput. What should be done? Order a TSHOrder a hydrocortisone creamSuspect child abuseEncourage the caregiver to change the infant’s head position Correct Explanation: In a normally developing infant, an alopecic area at the occipital area is generally because the infant has been placed in the supine position during sleeping and waking hours. Prolonged pressure on the occipital area can restrict hair growth. This is normal and will resolve when the infant begins to have better head control and movement; and he begins to have less pressure on the occipital area. Sometimes coarse, dry hair can be indicative of hypothyroidism; not necessarily alopec Question: A patient calls your office. He states that he just came in from the woods and discovered a tick on his upper arm. He states that he has removed the tick and the area is slightly red. What should he be advised? No treatment is needed. CorrectHe should be prescribed doxycycline. IncorrectHe needs a topical scrub to prevent Lyme Disease.He should come to the office for a ceftriaxone injection. Explanation: Many factors must be present for a patient to develop Lyme Disease from a tick bite. First, the tick must belong to Ixodes species. The tick must have been attached for at least 48-72 hours before disease can be spread. Time of year, stage of organism's development, and others all affect transmission. There is no need for prophylactic treatment in this case because the tick has not been present long enough, though, many patients will feel antibiotics are necessary. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: An example of a first generation cephalosporin used to treat a skin infection is: cephalexin. Correctcefuroxime.cefdinir.ceflamore. Explanation: Two common first generation cephalosporins used to treat skin and skin structure infections are cephalexin and cefadroxil. These are taken 2-4 times daily and are generally well tolerated. These antibiotics provide coverage against Staphylococcus and Streptococcus, common skin pathogens Question: Which of the following skin lesions in the elderly is a premalignant condition? XanthelasmaChalazionHordeolumActinic keratosis Correct Explanation: Actinic keratosis is a premalignant condition of the skin and is considered an evolving carcinoma in situ. It is a precursor of squamous cell carcinoma. The lesions are usually multiple in occurrence and sit on an erythematous base. They appear dry, scaly, and flat and are usually secondary to sun damaged skin so can be found on sun exposed areas. The most common sites are the face, ears, lateral forearms, and tops of hands. Question: A 74 year-old is diagnosed with shingles. The NP is deciding how to best manage her care. What should be prescribed? An oral antiviral agent CorrectAn oral antiviral agent plus an oral steroidAn oral antiviral agent plus a topical steroidA topical steroid only Explanation: An oral antiviral agent such as acyclovir, famciclovir, valacyclovir should be prescribed, especially if it can be initiated within 72 hours after the onset of symptoms. The addition of oral corticosteroids to oral antiviral therapy demonstrates only modest benefit. Adverse events to therapy are more commonly reported in patients receiving oral corticosteroids. There is no evidence that corticosteroid therapy decreased the incidence or duration of post-herpetic neuralgia or improved quality of life. Corticosteroids should be limited to use in patients with acute neuritis who have not derived benefit from opioid analgesics. Question: A child with a sandpaper textured rash probably has: rubeola.strept infection. Correctvaricella.roseola. Incorrect Explanation: Streptococcal infections can present as a sandpaper textured rash that initially is felt on the trunk. Rubeola, measles, produces a blanching erythematous “brick-red” maculopapular rash that begins on the back of the neck and spreads around the trunk and then extremities. Varicella infection produces the classic crops of eruptions on the trunk that spread to the face. The rash is maculopapular initially and then crusts. Roseola produces a generalized maculopapular rash preceded by 3 days of high fever. Question: Patients with atopic dermatitis are likely to exhibit: Itching. Correctasthma and allergic bronchitis.nasal polyps and asthma.allergic conjunctivitis and wheezing. Explanation: Atopic dermatitis is diagnosed on clinical presentation and includes evidence of pruritic skin. It is recurrent and often begins in childhood. For decades the "atopic triad" has been used to refer to patients with atopic NR 603 Week 4 APEA Predictor Exam TestBank Updated He should receive doxycycline for Lyme disease. CorrectHe should receive penicillin for Rocky Mountain spotted fever (RMSF).He does not have Lyme disease or RMSF.He needs additional testing to confirm Lyme disease. Explanation: The first serologic test for Lyme disease is the ELISA. If this is positive, it should be confirmed. In this case, it was confirmed by a Western blot and it is positive. This patient can be diagnosed with Lyme disease. The appropriate treatment for treatment of erythema migrans is doxycycline, amoxicillin, or cefuroxime for 21 days. All three medications were found to be of equal efficacy. Question: A pregnant mother in her first trimester has a 5 year-old who has Fifth Disease. What implication does this have for the mother? She does not have to worry about transmission to the fetus.She may get a mild case of Fifth disease.There is a risk of fetal death if she becomes infected. CorrectThe mother should have a fetal ultrasound today. Explanation: Pregnant mother should avoid exposure to patients with known Fifth disease. However, the risk of transmission is very low. She should avoid exposure to aplastic patients who are infected because they are highly contagious. Infection during pregnancy is associated with 10% fetal death. There is no need for an ultrasound today. This pregnant patient does not have evidence of disease. She should be monitored for a rash which could indicate infection. Question: A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate: hyphae. Correctyeasts.rods or cocci.a combination of hyphae and spores. Explanation: Under microscopic exam, hyphae are long, thin and branching, and indicate dermatophytic infections. Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis. Yeasts are usually seen in candidal infections. Cocci and rods are specific to bacterial infections. Question: A topical treatment for basal cell carcinoma is: sulfacetamide lotion.5-fluorouracil. Correcttetracycline lotion.trichloroacetic acid. Incorrect Explanation: Several treatments exist for basal and squamous cell carcinoma. The majority are simple procedures like cryotherapy, electrodessication, surgical excision, and a topical treatment like 5-fluorouracil (5-FU). The other agents listed are not used to treat basal or squamous cell carcinoma. 5-FU works by inhibiting DNA synthesis. It is effective if used for superficial basal cell carcinomas. It is available in cream and solution and is usually applied twice daily for 3-6 weeks. Question: The best way to evaluate jaundice associated with liver disease is to observe: blanching of the hands, feet, and nails.the sclera, skin, and lips. Correctthe lips, oral mucosa, and tongue.tympanic membrane and skin only. Explanation: Looking at the sclera allows the examiner to see jaundice most easily and reliably. Jaundice may also appear in the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin. Jaundice in adults is a result of liver disease usually, but can be due to excessive hemolysis of red blood cells. In infants the usual cause is hemolysis of red blood cells as is seen in physiologic jaundice. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A patient has been diagnosed with MRSA. She is sulfa allergic. Which medication could be used to treat her? AugmentinTrimethoprim-sulfamethoxazole (TMPS)CeftriaxoneDoxycycline Correct Explanation: MRSA is methicillin resistant Staph aureus. This is very common in the community and is typically treated with sulfa medications like TMPS (Bactrim DS and Septra DS). If the patient is sulfa allergic, this could not be used. A narrow spectrum antibiotic that can be used is doxycycline or minocycline. It is given twice daily and is generally well tolerated. MRSA is resistant to the antibiotics mentioned and so they should NOT be used to treat it. Question: An adolescent has acne. The nurse practitioner prescribed a benzoyl peroxide product for him. What important teaching point should be given to this adolescent regarding the benzoyl peroxide? Don’t apply this product more than once dailyThis often causes peeling of the skinPhotosensitivity of the skin can occur CorrectHypersensitivity can occur with repeated use Explanation: Benzoyl peroxide can produce sensitivity to the sun and so adolescents should be informed of this. This product can be used twice daily. It can cause peeling of the skin, but this is not a frequent occurrence. Hypersensitivity can occur with any topical product and is not specific to benzoyl peroxide. Question: Which of the following lesions never blanches when pressure is applied? Spider angiomaSpider veinPurpura or petechiae CorrectCherry angioma Explanation: Blanching with pressure over spider angiomas always occurs. Spider veins and cherry angiomas usually blanch with pressure. Purpura and petechiae never blanch with pressure. Purpura and petechiae represent an extravasation of blood under the skin. This will not blanch. This is usually observed in patients with thrombocytopenia or trauma. Question: A patient with a primary case of scabies was probably infected: 1-3 days ago.1 week ago.2 weeks ago.3-4 weeks ago. Correct Explanation: The incubation period for scabies is about 3-4 weeks after primary infection. Patients with subsequent infections with scabies will develop symptoms in 1-3 days. The classic symptom is itching that is worse at night coupled with a rash that appears in new areas over time. Question: The lesions seen in a patient with folliculitis might be filled with: blood.pus. Correctfluid.serous fluid. Incorrect Explanation: Folliculitis is a superficial inflammation of hair follicles usually caused by bacteria. As a superficial infection, it involves only the epidermis. When this occurs, there are usually numerous pustular lesions. The composition of pus is dead white cells and other cellular debris. Question: The term caput succedaneum refers to: cradle cap. Incorrectatopic dermatitis.scalp edema. Correctasymmetric head shape. NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: Caput succedaneum is a common finding in newborns. It is a result of pressure over the presenting part. This results in some ecchymosis of the scalp. While this may be disturbing to new parents who observe this in their newborn, it will resolve in a few days and is harmless. Question: The primary therapeutic intervention for patients who present with hives is: steroids.anti-histamines. Correctcalcium channel blockers.topical steroid cream. Explanation: The primary cause of pruritis associated with hives is histamine. Histamine is released from mast cells with other substances of anaphylaxis. Anti-histamines are the primary therapeutic intervention. Since both H1 and H2 receptors participate in allergic inflammation, both H1 and H2 blockers are helpful in relieving symptoms in these patients. Topical steroid is not helpful. Calcium channel blockers (nifedipine) are used as a “last resort” for refractory cases of urticaria. Steroids do not inhibit mast cell degradation and so are less helpful than thought. Steroids can be used for persistent attacks of acute urticaria if antihistamines are not helpful. Question: A patient has a lower leg wound that appears infected. It is red, warm to touch and edematous. He had an acute onset of pain, symptoms, and low grade fever. What is this? CellulitisErysipelas CorrectImpetigoAn allergic reaction Explanation: Erysipelas is characterized by an acute onset of symptoms as described in this scenario. Fever and chills are common. Patients with cellulitis tend to have a more gradual course with development of symptoms over several days. The erythema noted in erysipelas is well demarcated and raised above the level of the skin. This elevation reflects that the more superficial dermis is involved. Question: The main difference between cellulitis and erysipelas is the: infecting organism.length of time that infection lasts.treatment.layer of skin involvement. Correct Explanation: Erysipelas and cellulitis both cause skin erythema, edema, warmth. However, erysipelas involves the upper dermis and superficial lymphatics; cellulitis involves the deeper dermis and subcutaneous fat. Erysipelas is usually caused by Streptococcus; cellulitis may be caused by Staphylococcus and less commonly by Streptococcus. Question: A “herald patch” is a hallmark finding in which condition? Erythema infectiosumPityriasis rosea CorrectSeborrheic keratosisAtopic dermatitis Explanation: Pityriasis rosea (PR) is a self-limiting exanthematous skin disorder characterized by several unique findings. It is more common in young adults. A characteristic finding is the “herald” or “mother” patch found on trunk. This looks like a ringworm and precedes the generalized “Christmas tree” pattern rash. The lesions associated with the rash are salmon-colored and oval in shape. Most cases clear in 4-6 weeks, but the plaques may last for several months. Question: Most cases of atopic dermatitis exacerbation are treated with: : emollients.topical steroids. Correctantihistamines.antibiotics. NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: This constellation of symptoms is typical of a viral infection. Group A Streptococcus is usually not accompanied by coryza. H. parainfluenzae is not a common cause of pharyngitis. Mycoplasma usually is associated with lower respiratory tract infections. Question: A 9 year-old has been diagnosed with chickenpox. A drug that should be avoided in him is: penicillin.aspirin. Correctibuprofen.sulfa. Explanation: Aspirin is always avoided in the case of viral infections in children and adolescents. The incidence of Reye syndrome is increased if aspirin is given. This is especially true with varicella and influenza infections. The typical constellation of symptoms occurs during a bout of chickenpox and includes nausea, vomiting, headache, excitability, delirium, and combativeness with progression to coma. Since aspirin use has declined sharply, Reye syndrome has too. Question: Which of the following antibiotics may increase the likelihood of photosensitivity? AmoxicillinCephalosporins IncorrectFluoroquinolones CorrectMacrolides Explanation: Many medications can produce a phototoxic reaction when a patient is exposed to sunlight. Antibiotics are especially notable for this. Common antibiotics associated with photosensitivity are tetracyclines, sulfa drugs, and fluoroquinolones. Other common medications that increase photosensitivity are hydrochlorothiazide, diltiazem, selective serotonin reuptake inhibitors, antihistamines, ibuprofen, and naproxen. Question: A patient with diabetes has a right lower leg that has recently become edematous, erythematous, and tender to touch over the anterior shin. There is no evidence of pus, but the leg is warm to touch. What is the most likely diagnosis to consider? Deep vein thrombosis (DVT)Buerger’s diseaseCellulitis CorrectVenous disease Explanation: This description is one of cellulitis. Cellulitis involves an infection of the subcutaneous layers of the skin. It must be treated with an oral antibiotic. This is particularly important to identify early, and aggressively treat in a diabetic because elevated blood sugar levels will make eradication more difficult. Buerger’s disease involves inflammation of the medium sized arteries and does not present on the anterior shin only. DVT seldom presents on the anterior shin. Venous disease does not present acutely as in this situation. Question: A 70 year-old is diagnosed with multiple cherry angiomas. The nurse practitioner knows that: this is a mature capillary proliferation more common in young adults.an angioma occurs as a single lesion.these may bleed profusely if ruptured. Correctthese are precursors of skin malignancies. Explanation: Cherry angiomas are mature capillary proliferations that are more common in middle and older adults. They blanch with pressure and are usually 0.1-0.4 cm in diameter. They are commonly found on the trunk as multiple lesions. Because they are a proliferation of capillaries, they will bleed significantly if they rupture. The bleed is not life threatening, but, in older adults who take aspirin, the bleeding will be worse. Pressure should be held over the ruptured area until bleeding stops. These are not precursors of skin malignancies. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A 15 year-old male has worked this summer as a lifeguard at a local swimming pool. He complains of itching in the groin area. He is diagnosed with tinea cruris. The nurse practitioner is likely to identify: swelling of the scrotum.macular lesions on the penis.well marginated half moon macules on the inner thigh. Correctmaceration of the scrotal folds with erythema of the penis. Explanation: Tinea cruris, “jock itch” is common during warm months and in humid areas. It is a fungal infection that affects the scrotum and inner thighs, but never affects the penis and is never evidenced by scrotal swelling. He is probably at increased risk because he is working as a lifeguard and may wear damp or wet swim trunks during work. He should be treated with a topical antifungal cream, advised to dry off after swimming and put on dry swim trunks. Question: Which chronic skin disorder primarily affects hairy areas of the body? Seborrheic dermatitis CorrectAtopic dermatitisContact dermatitisHydradenitis suppurativa Explanation: Seborrheic dermatitis causes flaking of the skin, usually the scalp. In adolescents and adults, when it affects the scalp, it is termed dandruff. When this occurs in young children or infants, it is termed “cradle cap”. The exact cause is unknown; however it has a propensity for hairy areas of the body such as the scalp, face, chest, and legs. It appears greasy and flaky. This may be seen in patients with Parkinson’s disease. Question: Topical 5-fluorouracil (5-FU) is used to treat: atopic dermatitis.hepatitis.thalassemia.basal cell carcinoma. Correct Explanation: 5-FU is a topical agent that can be used to treat basal cell carcinoma (BCC). It is most effective on rapidly proliferating cells. This treatment should only be used on superficial BCCs. If it is used on more invasive BCC, the cure rate is significantly lower. Therefore, 5-FU should be used only on superficial BCCs in non- critical locations. It is used as a 5% formulation twice daily for 3-6 weeks. Question: A patient reports to the minor care area of the emergency department after being bitten by a dog. The patient states that the dog had a tag around his neck and had been seen roaming around the neighborhood. The dog did not exhibit any odd behavior. How should this be managed? If the bites are only minor, do not mention rabies prophylaxis to the patient.Give the patient tetanus immunization only. Don’t call animal control.Clean the wounds, provide tetanus and rabies prophylaxis. IncorrectReport the bite to animal control and administer appropriate medical care. Correct Explanation: All 50 states require reporting of animal bites to animal control or the state’s appropriate authority for reporting animal bites. It sounds unlikely that the dog could be infected with rabies, but rabies prophylaxis must be considered after all history and information has been taken. Question: A 3 year-old female had a fever of 102 degrees F for 3 days. Today she woke up from a nap and is afebrile. She has a maculopapular rash. Which statement is true? NR 603 Week 4 APEA Predictor Exam TestBank Updated This child probably has measles.The rash will blanch. CorrectThis is a streptococcal rash.This could be Kawasaki disease. Explanation: This describes a patient with roseola or exanthem subitum. This is a common viral exanthem found in young children caused by the Human Herpes Virus 6B. It is characterized by high fever for 3 days followed by the abrupt cessation of fever and the appearance of a maculopapular rash. This usually resolves in a few days. The child may return to school or daycare when he has been fever free for 24 hours. Question: A patient has a “herald patch” and is diagnosed with pityriasis rosea. Where is the “herald patch” found? On the affected limbOn the chest CorrectClose to the scalpBehind one of the ears Explanation: The herald patch associated with pityriasis rosea is typically found on the trunk. It precedes the generalized Christmas tree pattern rash that is easily noted on the rest of the body. Because it appears round and has a darkened center, it looks like a ringworm. In fact, it is commonly mistaken for ringworm until the Christmas tree pattern rash appears. It would be unusual to identify the herald patch on a body part other than the trunk, but there are case reports of this. Question: Which test is NOT suitable to diagnose shingles if the clinical presentation is questionable? Tzanck preparationPolymerase chain reaction (PCR) IncorrectDirect fluorescent antibody (DFA)Complete blood count (CBC) Correct Explanation: Herpes viruses are the causative agents in shingles, chickenpox, genital herpes, and oral fever blisters. Diagnosis is usually made on clinical presentation. However, in questionable cases, lab tests may be employed. A Tzanck preparation is a rapid test used to diagnose infections due to herpes viruses. Cells taken from a blister’s fluid are smeared on a slide and stained with a Wright’s stain or the fluid can be used for other methods of testing. DFA is the most common test employed for shingles diagnosis because it can be rapidly performed and offers results in about 90 minutes. PCR may be performed on skin scrapings, serum or blood for herpetic diagnosis. CBC may indicate a patient with a viral infection, but is non-specific for herpetic infections. Question: A 4 year-old has been diagnosed with measles. The nurse practitioner identifies Koplik’s spots. These are: spots on the skin that are pathognomonic for measles.red rings found on the tongue that have a white granular area inside the ring.found on the inside of the cheek and are granular. Correctblanchable areas on the trunk and extremities. Explanation: Koplik’s spots are found in the oral cavity, especially on the buccal mucosa opposite the first and second molars. The spots are white and granular and are circled by an erythematous ring. The spots are pathognomonic for measles. There is an exanthem associated with measles. It typically is described as cranial to caudal in progression. The lesions become confluent and last for approximately 4 days before fading begins. Question: A 74 year-old male patient has sustained a laceration to his foot. His last tetanus shot was more than 10 years ago. He has completed the primary series. What should be recommended? NR 603 Week 4 APEA Predictor Exam TestBank Updated A 20 year old student has an MMR titer that demonstrates an unprotective titer for rubella. She is HIV positive. Which statement is true? She should not receive the MMR immunization because she is low risk for the disease. IncorrectMMR is safe to give but she does not need this.She is at risk for MMR but should not be immunized. CorrectShe should receive this. The immunization is not alive. Explanation: This patient is at risk for rubella because she does not have a sufficient titer. The MMR immunization is an attenuated virus. Though an attenuated immunization is weakened, it is still considered live and so is contraindicated in anyone who is immunocompromised. She should be advised not to get pregnant. Question: Two common causes of weight loss in the elderly are: anorexia and depression.depression and malignancy. Correctmalignancy and social isolation.financial limitations. Explanation: Malignancy is the most common cause of weight loss in the elderly. Depression is the second most common reason. Other reasons that contribute to weight loss are social isolation. Many elders live alone and consequently eat alone. Many elderly patients have financial and mobility limitations that make eating and acquiring foods more difficult. Anorexia is not unusual in the elderly, but there are a number of reasons for this. Some are physical, social, and psychosocial. Question: An older adult has osteopenia. Her healthcare provider has recommended calcium 500 mg three times daily. What is the most common side effect of calcium supplementation? Stomach upset IncorrectDiarrheaConstipation CorrectMild nausea initially Explanation: Constipation is the most common side effect of calcium supplementation. To improve tolerance, the nurse practitioner can suggest 500 mg daily for a week, then 500 mg twice daily for a week, then three times daily. The patient should be encouraged to increase the intake of fruits, vegetables, fluid, and fiber. Weight bearing exercise and Vitamin D should be encouraged to improve bone density. Question: A contraindication to giving MMR is: family history of any adverse event after a dose.fever of 104 F within 72 hours of immunization. Incorrectseizures within 7 days of immunization.encephalopathy within 7 days after immunization. Correct Explanation: Encephalopathy within 7 days after MMR is an absolute contraindication. Fever of 105F or greater within 48 hours and seizures within 3 days after immunization are not a specific contraindication, but benefits should outweigh risks before giving a second dose. A family history of any adverse event after an MMR immunization does not contraindicate any immunization. Question: MMR immunization is safe in children: who are allergic to eggs. Correctless than one year of age.when given every 5 years.if they are at least 5 years of age. NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: Egg allergy is no longer considered a contraindication for the MMR vaccine. The measles vaccine is grown in a chick embryo medium but several large studies have demonstrated efficacy and safety. The immunization is attenuated and considered safe if given at 12 months of age. It is repeated once at age 4-6 years. Question: The Framingham study of cardiovascular disease initiated in the early 1970s is an example of a: randomized clinical trial.cohort study. Correctcase control study.sequential control study. Explanation: The Framingham study was initiated in Framingham, Massachusetts in the early 1970s. The participants agreed to follow-up study (interviews and physical exam) every 2 years in a long-term study. This cohort study has examined what happens to disease over time. These are termed prospective studies because the events of interest occur after the study has begun. Question: What should the nurse practitioner recommend to any elder taking medications? Have someone check your medications prior to taking themNever take your medicine on an empty stomachKeep a list of all of your medications with you CorrectHave a pharmacist review your list once a year Explanation: A list of current medications should be kept with each patient and carried with him especially when healthcare visits are scheduled. Many older adults are capable of taking medications without supervision and so choice one is not correct. Many medications should be taken without food (thyroid supplementation for example). A pharmacist can evaluate the list of medications for drug-drug interactions, but the pharmacist will not know the diagnoses and other reasons for choosing the medications. Question: What pharmacokinetic factor is influenced by a decrease in liver mass in an elderly adult? AbsorptionDistributionMetabolism CorrectElimination Explanation: As the liver decreases in mass and potentially has a decrease in blood flow, drug metabolism is decreased. Consequently, lower doses of medications in older adults may be as efficacious as higher doses in their younger counterparts. Question: In elderly females, which screening test has demonstrated greatest reduction in mortality from cancer? Breast CorrectCervicalOvarianLung Explanation: There are no recommendations for screening for ovarian or lung cancer in elderly women. Cervical cancer is primarily a disease found in younger women, though, when it is identified in elderly patients, there is usually a higher mortality rate than in younger women. However, the incidence of cervical cancer is much lower in the elderly. Screening for breast cancer has demonstrated the highest reduction in mortality and it is recommended that women who have a life expectancy of >4 years have screening for breast cancer with mammography. Mammography should be performed every 1-2 years according to the American Geriatrics Society. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A seven year-old entered the clinic one month ago. There was no evidence that he had any immunizations. He was given hepatitis B, DTaP, IPV, varicella, and MMR. If he returns today, which immunizations can he receive? Hepatitis B, Td, Hib, polio, MMRHepatitis B, Td, IPV, MMR, varicella IncorrectIPV onlyHepatitis B, DTaP, IPV, MMR Correct Explanation: The minimum length of time between Hepatitis B, DTaP, IPV, and MMR is one month. Therefore, he can receive all of these today. He should not receive another varicella today. The minimum length of time between immunizations is 3 months if he is less than 13 years of age. Question: A patient who is 62 years old asks if she can get the shingles vaccine. She has never had shingles but states that she wants to make sure she doesn’t get it. What should the nurse practitioner advise? The immunization will protect you from acquiring shingles.You are not old enough to receive the immunization.The immunization is offered only to those who have had shingles.You are eligible to receive it but you still may get shingles. Correct Explanation: Patients must be at least 50 years old to receive the shingles immunization. It is generally well tolerated but provides protection from shingles in 50-64% of patients. The incidence of post-herpetic neuralgia is decreased up to 65% after immunization. The patient still may develop shingles after receiving the immunization. The vaccine may be offered regardless of whether the patient has history of shingles. However, since it is a live vaccine, it may be contraindicated because of steroid use or immune status. Question: A 58 year-old patient has an annual exam. A fecal occult blood test was used to screen for colon cancer. Three were ordered on separate days. The first test was positive; the last two were negative. How should the nurse practitioner proceed? Re-screen in one year.Perform a fourth exam.Refer him for a colonoscopy. CorrectExamine him for hemorrhoids. Incorrect Explanation: A fecal occult blood test is performed multiple times on different days because tumors don’t consistently excrete blood. The reason multiple are performed is to increase the likelihood of identifying blood. The patient needs to have a colonoscopy performed for examination of the colon. The standard of practice is to refer all positive colon cancer screens for colonoscopy. Question: A pregnant patient is concerned because her 12 month-old needs an MMR immunization. What should the NP advise this patient? The MMR is a dead virus; therefore, there is no risk to the mother.Have the child wait until Mom delivers.Have the child wait until Mom is in her 28th week or later before immunization.MMR immunization presents no risk to the child’s mother. Immunize now. Correct Explanation: MMR immunization in the child presents no risk to the pregnant mother. MMR is actually attenuated, also thought of as an inactivated form of the virus. Therefore, there is no risk to her. If the mother were pregnant, she should not be vaccinated. If she is contemplating pregnancy, she should avoid MMR for 4 weeks following immunization. Question: NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: Non-stop crying for 3 hours or more (and) occurring within 48 hours of the immunization is not a specific contraindication, but careful consideration must be given to the benefits and risks of the vaccine under these circumstances. The temperature that should cause concern, but is not a contraindication to a subsequent dose of MMR is 105F within 48 hours of immunization. Vomiting and injection site soreness are not contraindications or concerns after MMR. Question: The incidence of osteoporosis in the elderly is high. Which characteristics below would increase the risk of osteoporosis in an elderly male patient? Low body weight, age 60 yearsSmoker, age 65 yearsChronic glucocorticoid therapy, age 70 years CorrectFamily history of hypothyroidism, age 65 years Explanation: Women should be screened for osteoporosis starting at age 65 years; sooner if risk factors are present. Males greater than age 65 years should be screened with DEXA scanning if they exhibit risk factors. Those with the greatest impact on bone density include primary hyperparathyroidism, chronic glucocorticoid therapy and hypogonadism. Question: A 76 year-old patient who is very active has elevated cholesterol and LDLs. He had been treated for hypertension for > 10 years with near normal blood pressures. What is the current recommendation for managing his lipids? No treatment should take place since his age exceeds 75 years.He should be treated with an aspirin only.He should be treated with a statin. CorrectThe benefits of treating this patient do not exceed the risk of using a statin or aspirin. Explanation: Numerous studies (PROSPER, 2006) and learned authorities (including the USPSTF) have found that lipid lowering drug therapy decreases the incidence of coronary heart disease and vascular events in middle aged and older adults. The current recommendation is to screen and treat lipid abnormalities in patients who are at risk for a cardiac event. It is unclear whether treatment of middle aged and older adults at low risk for cardiac events is beneficial. Question: Which finding below is considered “within normal limits”? A diastolic murmur in an 18 year-oldAn INR of 2.0 in a patient taking warfarin CorrectCholesterol level of 205 in a 15 year-oldBlood pressure of 160/70 in a 75 year-old Explanation: An INR (International Normalized Ratio) is considered the best measure of clotting status in outpatients. Depending on the reason for anticoagulation, a common target is 2.0 – 3.0. Diastolic murmurs are always considered abnormal regardless of age. Cholesterol levels in adolescents should be less than 170 mg/dL (according to National Heart, Lung and Blood institute, NHLBI). Blood pressure of 160/75 constitutes isolated systolic hypertension, and, so this is abnormal. Question: A patient who has been treated for hypothyroidism presents for her annual exam. Her TSH is 4.1 (normal = 0.4- 3.8). She feels well. How should she be managed? Continue her current dosage of thyroid replacement.Increase her replacement.Decrease her replacement.Repeat the TSH in 2-3 weeks. Correct Explanation: NR 603 Week 4 APEA Predictor Exam TestBank Updated When an abnormal TSH is received, especially when a patient is not symptomatic, it should be repeated. Sometimes there are periods of transient hypothyroidism, lab error, and missed doses that can cause changes in TSH levels. Question: A 6-month old child comes into the clinic for immunizations. Which item below allows a delay in his getting immunizations today? Child is on antibiotics IncorrectChild has otitis media with temperature of 103F CorrectMom is pregnantChild has a family member on chemotherapy Explanation: A 6 month old with acute otitis media and temperature of 103F is considered moderately ill. Persons with moderate or severe illnesses, with or without fever, can be vaccinated as soon as they are recovering and not considered acutely ill. Antibiotics would not be considered a contraindication for any routine immunizations today. Pregnancy in the mother would not contraindicate any immunizations today. Live vaccines would be contraindicated if a family member was on chemotherapy, however, a 6 month old will not be receiving any live viruses. Question: What is the recommendation from American Cancer Society for assessment of the prostate gland in a man who is 45 years old and of average risk for development of prostate cancer? He should have: screening starting at 50 years of age. Correctprostate specific antigen (PSA) now.PSA and digital rectal exam now.digital rectal exam only. Explanation: At age 50 years, males of average prostate cancer risk should have PSA measurement with or without digital rectal exam (DRE). If they are deemed to be of high risk because of a family history (first degree relative with prostate cancer before age 65 years) or race (African American), screening discussions should take place at age 40-45 years. If initial PSA is > 2.5 ng/mL; annual testing should take place. If the initial PSA is < 2.5 ng/mL; test every 2 years. Question: A patient who wrote a living will has changed his mind about the initiation of life-sustaining measures. What statement is true about this? He cannot change his mind regarding the content of the living will.He can only change the content if he is of sound mind. CorrectA healthcare provider is exempt from liability if they provide care outside the living will.An attorney must be consulted if the living will is changed at any time. Explanation: A living will is intended to allow a patient to provide instructions for his family and health care providers about how he would like his care directed if he is unable to make these decisions. He can change the content at any time. If however, he is determined not to be of sound mind, any changes that he attempts to make should not be followed. A healthcare provider is bound to carry out the living will provided it does not violate any laws or the ethics of the provider. In this case, the provider would be exempt from liability for not carrying these out. In the case of an ethical dilemma, the healthcare provider should identify another healthcare provider who is willing to carry them out. An attorney is not required to be consulted to change the content of a living will. Question: What is the recommendation for daily multivitamin supplementation in older adults? Supplementation reduces morbidity. IncorrectSupplementation reduces mortality.It decreases the relative risk of dementia.It has no proven benefit. Correct Explanation: NR 603 Week 4 APEA Predictor Exam TestBank Updated No studies have demonstrated specific benefit to daily consumption of multivitamins in older adults. However, a daily multivitamin supplement ensures adequate intake of essential vitamins and so should be considered for older adults. Question: A 7 year-old enters the nurse practitioner clinic. There is no evidence that he has received any immunizations. What should be administered today? Hepatitis B, Tdap, Hib, IPV, MMRTd, Hib, IPV, varicellaHepatitis B, Tdap, IPV, varicella, MMR CorrectHepatitis B, IPV, varicella, MMR Explanation: This child will be placed on CDC's catch-up schedule (a copy can be downloaded from CDC's website). Because of his age, he does not need a Hib immunization. He does need all of the immunizations listed in choice C. Question: An octogenarian asks the nurse practitioner if it is OK for him to have an alcoholic beverage in the evenings. There is no obvious contraindication. How should the nurse practitioner respond? Yes, but not more that 4 days per week.Yes, but not more than 1-2 drinks per day. CorrectNo, you will increase your risk of falling and injury.It depends on the type of alcohol you would like to consume. Explanation: A good rule of thumb for alcohol consumption in older adults is no more than 1-2 drinks/day after age 65 years. If the patient is cognitively impaired, abstinence is recommended. The type of alcohol is not of great importance. Beer, wine, and hard liquor all contain alcohol with the potential to impair older adults. The reason alcohol should be limited or avoided is because of decreased lean body mass and decreased total body water in aging bodies. Question: A nurse practitioner examined a patient who had been bitten by her husband during an assault. There were numerous bite marks and lacerations on the patient’s forearms. The nurse practitioner sutured the lacerations, though this was contraindicated because of the highly infectious nature of human bites. The patient suffered no ill effects after suturing. How can this be described? This is negligence. CorrectThis was a fortunate situation for the patient.This is malpractice.This is poor judgment and malpractice. Explanation: This is not malpractice. This is negligence. Negligence occurs when one fails to exercise the care that a reasonable person would exercise. Injury does not have to occur for negligence to occur. Human bites, known to be dirty bites with high probability of infection should not be sutured. Malpractice is usually described as having multiple elements that all must be satisfied for malpractice to occur. There must be a duty, a breach of the duty, and a subsequent injury due to the breach. Comparison of performance is based on the standard of care delivered by nurse practitioners. Question: A nurse practitioner is working in a minor care area of an emergency department. An illegal immigrant has a puncture wound caused by an unknown sharp object in a trash container. A dirty needle is suspected. The nurse practitioner: should administer a tetanus injection only since the patient has no medical insurance. Incorrectshould prescribe appropriate medications for HIV exposure even though the nurse practitioner knows the patient can’t afford them. Correctshould not mention the possibility of HIV exposure from a dirty needle to the patient.can offer to buy the HIV medications for $50 with the professional discount at the pharmacy next door. Explanation: NR 603 Week 4 APEA Predictor Exam TestBank Updated The most important aspect of the initial visit is to establish trust. Many patients will not be willing to disclose a complete history to the examiner; especially one regarding alcohol or illegal drugs. A complete head to toe exam might be important, but most homeless patients are driven to care based on episodic illness. They will be interested in care for the problem that brought them in on the day of the exam. Additionally, resources may be limited which would not allow for a complete head to toe exam on each patient, but instead, a focused visit. Question: The legal authority to practice as a nurse practitioner in any state is determined by: state boards of nursing.state legislatures. Correctfederal guidelines.certification boards. Explanation: The authority to practice as a nurse practitioner is determined by each state’s legislature. Rules and regulations may be promulgated by state boards of nursing that reflect scope of practice of nurse practitioners specific to that state. Certification boards like ANCC and AANP “certify” that a nurse practitioner has met the requirements set by the certifying body. Question: Mr. Bowers, a 97 year old, is not able to make an informed decision due to mental incapacity. He does not have advanced directives but only a durable power of attorney (DPA). How should the nurse practitioner proceed? Allow the family to make a decision regarding medical care.Allow the DPA to make a decision based on the patient’s known values. CorrectAllow the nurse practitioner to make a decision if there is disagreement between the family and DPA.Have the family and DPA come to an agreement regarding care. Explanation: An informed decision is determined by whether a patient is able to make and express personal preferences, comprehend risks, benefits, and implications, able to give reasons for alternatives, and has rational reasons for his choices. When an older adult is not able to make an informed decision, if a durable power of attorney is available, this makes the decision for direction of treatment. Question: How would you create a therapeutic relationship with a patient? Tell the patient that he can trust you.At the end of the visit, tell the patient you enjoyed taking care of him.Ask open-ended questions. CorrectTouch the patient during the interview. Explanation: A therapeutic relationship with a patient can be established in many different ways. One way is to ask open- ended questions. This allows the patient to discuss what is most important to him; personal concerns may be vocalized by the patient. Telling the patient that he can trust you probably does little to establish trust. Actions that establish trust are more therapeutic than this statement. Touching the patient during the interview may be perceived as inappropriate by many patients. In contrast, touching the patient during the exam is different. Finally, telling the patient that you enjoyed taking care of him (if this was true) does little to establish trust. Question: A nurse practitioner knows that she is HIV positive. She is employed in a private clinic and performs wellness exams on ambulatory adults. The nurse practitioner: is obligated to inform her employer of her HIV status.is obligated to inform her patients of her HIV status.is under no obligation to inform anyone. Correctis under obligation to inform the patient if she performs invasive procedures. Incorrect Explanation: The nurse practitioner’s health information is protected health information. She is not obligated to inform NR 603 Week 4 APEA Predictor Exam TestBank Updated her employer, patient, or state board of nursing as long as the performance of her job does not impose unnecessary risk to anyone. Question: A nurse practitioner’s scope of practice is influenced by a number of factors. Which one does not influence scope of practice? Code of ethicsState and federal laws governing practiceCourt of law CorrectEducational preparation Incorrect Explanation: The scope of practice for nurse practitioners is established legally, ethically, and by boards of nursing and professional organizations. Scope of practice sets the boundaries and indicates what is permitted legally, etc. Scope of practice is not influenced by court of law. Scope of practice is determined by state statutes, state nursing boards, common practice in a locale, educational preparation, and others. Scope of practice can vary from state to state. Question: A nurse practitioner is working in a minor care clinic. She realizes that a patient with a minor laceration does not have insurance and is using his brother’s insurance information today so that his visit will be covered. How should she proceed? She should let him know that she knows what he is doing.She should ignore this and proceed to suture his wound.She should let the clinic's business office know what is happening. CorrectShe should not suture his wound and ask him to leave. Explanation: The nurse practitioner cannot ignore the fact that this patient is attempting to defraud the clinic and insurance company in order to receive free care. If she does not let the business office know, she is a party to the fraud. She should let the business office know what is happening and have the patient present documents verifying that he is who he states that he is. If he cannot, he can still receive care if he is willing to pay for it. An alternative site to receive care should be offered to him. Question: What would be the study of choice to determine the cause of a cluster of adult leukemia cases found in an isolated area of a rural state? Randomized clinical trialCohort studyCase series IncorrectCase control Correct Explanation: A case control study would be ideal for discovering the cause of this situation. Case control looks at “what happened”? It would identify those subjects who have leukemia and would identify a control group of adults from the area who did not have leukemia. Both groups would be analyzed for characteristics or risk factors that were present in the “case” group but not the “control” group. This is an observational study. Question: Standards of practice are established to: regulate and control nurse practitioner practice. Correctlimit liability of nurse practitioners.protect nurse practitioners from frivolous law suits.promote autonomous practice. Explanation: Standards of practice for all professionals (nurses, physicians, dentists, etc.) are established to regulate and NR 603 Week 4 APEA Predictor Exam TestBank Updated control practice. They are intended to provide accountability for professionals and to help protect the public from unethical behavior and unsafe practice. Question: The nurse practitioner decides to study a group of patients who are trying to quit smoking. They all will be taking the same type of medication for 42 days to help them stop smoking. The patients have agreed to return to the clinic once weekly for the study’s duration. This type of study design is termed: experimental study.cohort study. Correctcase control study.controlled trial. Explanation: A cohort study describes an observational study that is prospective in nature, such as the case with this group of smokers. Cohort studies usually ask the question, “what will happen?” A case control study looks backward in time (retrospective). Case control studies usually ask the question, “what happened?” A controlled trial is an experimental study, not observational. Question: The nurse practitioner is examining an elderly patient with dementia. She is noted to have bruises on her arms and on her posterior thoracic area. The nurse practitioner suspects elder abuse, but cannot be certain. The daughter of this elderly patient is her caregiver. The daughter is a patient of the nurse practitioner. What should the nurse practitioner do? Do not report the abuse until the NP is certain of it.Rule out elder abuse since her daughter is the caregiver.Report it to the appropriate authorities. CorrectAsk the daughter if she is abusing her mother. Explanation: Actual or suspected elder abuse is reportable in all 50 states and healthcare providers are all mandatory reporters. Most elders are abused by their caregivers; particularly when the elder is demented. If the nurse practitioner asks the patient’s daughter if she is abusing her mother it will likely result in a negative response by the daughter. Additionally, the daughter is not likely to seek this nurse practitioner’s help in the future because of fear of retribution. Question: The Medicaid funded health program is: funded with premiums from participants.unlimited on the number of adult visits.funded by both state and federal governments. Correctbasically the same from state to state. Explanation: Medicaid is state run and specific to each state. The state programs are funded by a combination of state and federal funds. Most states have limits on the number of adult visits. Some states have no limits on visits for children. Participants generally do not pay premiums like Medicare recipients pay. Question: A nurse practitioner has worked for a large hospital as an RN. As a new nurse practitioner, she has developed a nurse practitioner managed clinic for hospital employees and is employed by the hospital. This nurse practitioner is described as a(n): intrapreneur. Correctentrepreneur.risk taker.nurse specialist. Explanation: An intrapreneur is someone who is able to carve out a specialty role within an existing organization, healthcare setting, or business/industrial setting. An entrepreneur is someone who assumes the financial and personal risks of owning and operating a business. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A liability policy which pays claims even after the policy is no longer active is termed: claims made policy.tail coverage. Correctliability protection.“all-protect”. Explanation: This is termed tail coverage because it extends beyond the time that the policy is active. This type insurance is important for protection against claims that may come in after the healthcare provider has left the practice or retired. These are generally more expensive than claims made policies. Question: A nurse practitioner is volunteering in a homeless clinic to gain clinical experience. Which statement is true about this? Malpractice insurance is not needed because this is volunteer work.Volunteerism negates susceptibility to lawsuits.Malpractice insurance is needed by the nurse practitioner. CorrectCoverage will be provided by the state where the clinic is located. Explanation: Malpractice insurance is needed in any situation where patients are treated by a nurse practitioner. Some states have a “good Samaritan” law which protects professional volunteers from being sued. Unless this is specifically provided by state law, a nurse practitioner should have professional liability insurance in the event the NP is sued. Question: A nurse practitioner is taking care of a patient with health insurance and allergic complaints. The NP is aware that the patient is not using the prescribed allergy medication for her. Instead, the patient is giving the medication to her husband because he does not have insurance. What should the NP do? Continue to prescribe the medicationStop prescribing the medication for the patient IncorrectOnly prescribe the medication if the patient promises to use it CorrectPrescribe the medication only once more Explanation: If the NP knowingly prescribes a medication for a patient other than the intended patient, the NP incurs medical liability and is deliberately diverting medications. This is illegal and constitutes theft in most states. The NP cannot legally continue to prescribe the medication if she knows that the intended patient is not the recipient of the medication. Question: In a research study, the difference between the smallest and largest observation is the: standard deviation.first degree of freedom.range. Correctabsolute value. Explanation: The range is the difference between the smallest and the largest observation in a group of values. Question: The research design that provides the strongest evidence for concluding causation is: randomized controlled trials. Correctcohort studies.case control studies.prospective studies. Explanation: A randomized clinical trial (RCT) is the epitome of all research designs. Subjects are randomly assigned to treatment groups. This type study provides the best evidence that the results were due to the intervention and not something else. A RCT is an experimental design, not an observational one. Question: A nurse practitioner (NP) works in an HIV exclusive practice. In talking with a patient, the NP learns that the patient’s sister lives next door to the NP. When the NP sees her neighbor (the patient’s sister), the NP NR 603 Week 4 APEA Predictor Exam TestBank Updated states that she met her sister in the clinic today. The neighbor replies, “Don’t you work in an HIV clinic?” How can this situation be characterized? This is negligence.This is a breach of confidentiality. CorrectThis is not a breach of confidentiality.The NP has no liability. Explanation: This is a breach of the patient’s confidentiality. The neighbor’s sister is the NP’s patient. The NP is bound to confidentiality regarding protected health information for any of her patients. Even though the NP did not acknowledge that her sister was a patient, she breached patient confidentiality by telling the patient’s sister that she had met her in the clinic. This is different than telling her sister she met her at the grocery store. Question: What is the usual age for vision screening in young children? 2 years3 years Correct4 years5 years Explanation: Initial vision screening should take place at 3 years of age. If the child is not cooperative, screening should be attempted 6 months later. If the child is still not cooperative at 3.5 years, it should be attempted at 4 years. Generally, children are cooperative at 4 years of age. The usual vision of a 3 year-old is 20/50. Question: A patient has nasal septal erosion with minor, continuous bleeding. There is macerated tissue. What is a likely etiology? Improper use of a nasal steroidChronic sinusitisSevere allergic rhinitisCocaine abuse Correct Explanation: The nasal septum separates the right from left nostrils. It is made of thick cartilage and is covered with mucous membrane. It can be injured from foreign substances that contact it, like cocaine. A nasal septal erosion or perforation should always be assumed to have been from sniffing toxic substances in the nose, not nasal steroids. Question: The nurse practitioner performs a fundoscopic exam on a patient who has recently been diagnosed with hypertension. What is the significance of AV nicking? This is an incidental finding.This is indicative of long standing hypertension. CorrectThe patient should be screened for diabetes. IncorrectThe patient should be referred to ophthalmology. Explanation: Normally, veins are larger than arteries in the eyes. The vessels in the eyes are particularly susceptible to increased blood pressure. AV (arterio-venous) nicking can be observed as arteries cross veins when the arteries have narrowed secondary to hypertension. Generally, AV nicking takes time to develop and would be expected in patients with long standing hypertension; especially when it is poorly controlled. Cotton wool exudates should prompt the examiner to screen for diabetes. An ophthalmology referral is not required at this point for AV nicking. In severe hypertension, the retina can become detached. Question: Which statement about serous otitis media is correct? This usually needs treatment with antibiotics. IncorrectThis can be diagnosed with pneumatic otoscopy. CorrectSerous otitis media can produce a sensorineural hearing loss.Otitis media and serous otitis are frequently associated with fever. Explanation: NR 603 Week 4 APEA Predictor Exam TestBank Updated Serous otitis media (SOM) is also called otitis media with effusion (OME) or "glue ear". OME occurs when there is fluid (non-infectious) in the middle ear. This prevents normal mobility of the tympanic membrane and creates a conductive hearing loss. Pneumatic otoscopy is the primary non-invasive diagnostic method because it has a high sensitivity and specificity. It may be present before otitis media develops, or it may follow resolution of otitis media. OME is far more common than otitis media and is not associated with systemic symptoms like fever. Acute otitis media (AOM) describes infected fluid in the middle ear. Question: A medication considered first line for a patient with allergic rhinitis is a: decongestant.non-sedating antihistamine.leukotriene blocker.topical nasal steroid. Correct Explanation: Allergy and asthma guidelines in the US recommend topical nasal steroids first line for management of symptoms of allergic rhinitis. A non-sedating antihistamine can be added to manage unresolved symptoms after a nasal steroid has been initiated. Antihistamines work well when the predominant symptoms are thin, clear nasal discharge. These can be safely used in combination for management. Decongestants are not recommended as lone agents because they have no effect on the underlying allergic mechanisms. They work well in combination with antihistamines and nasal steroids for congestion. Sedating antihistamines are usually avoided for allergic rhinitis because of safety concerns. Question: What clinical finding necessitates an urgent referral of the patient to an emergency department? A fiery red epiglottis CorrectSudden onset of hoarsenessPurulent drainage from the external canalTragal tenderness Explanation: A finding of a fiery red epiglottis signals epiglottitis. Since airway obstruction can be rapid with epiglottitis, immediate referral to an emergency department is warranted. Sudden onset of hoarseness does not signal a specific emergency situation. Purulent drainage from the external canal may signify a ruptured tympanic membrane or otitis externa. Tragal pain is significant of otitis externa. Question: A patient stated that his ears felt stopped up. He pinched his nose and blew through it forcefully. The nurse practitioner diagnosed a ruptured left tympanic membrane. What would indicate this? Bright red blood in the left external canal CorrectPain in the left and right earsClear fluid in the left external canalAbsence of hearing in the left ear Explanation: This patient ruptured his tympanic membrane (TM) traumatically from excessive pressure when he pinched his nose and blew out through it at the same time. It is common to find bright red blood (not clear fluid), but not active bleeding, in the external canal of the affected ear. He may experience pain in the affected ear, but this alone would not be indicative of a ruptured TM. Hearing may be diminished in the affected ear but should not be absent. Patients usually describe hearing as muffled. Question: A 70 year-old patient in good health is found to have a large, white plaque on the oral mucosa of the inner cheek. There is no pain associated with this. What is a likely diagnosis? CheilitisAphthous ulcerSjögren's syndromeLeukoplakia Correct Explanation: The etiology of this white plaque is unclear from the given information, but it cannot be cheilitis. This affects the lips. It cannot be an aphthous ulcer because this is painful. Sjögren's syndrome does involve the mucous membranes but manifests itself as dry mouth, not a plaque or lesion. The differential diagnosis for a white oral plaque should include oral leukoplakia, a premalignant lesion. This is often related to HPV, human papilloma virus. Risk factors include smokeless tobacco. Others in the differential include oral hairy leukoplakia (seen almost exclusively in patients with HIV), squamous cell carcinoma, and malignant melanoma. It may also be a completely benign growth, but this can only be established after biopsy. NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: A white, chalky mark on the surface of the TM reflects scarring of the tympanic membrane (TM). This can occur secondary to TM rupture or tympanostomy tube placement. The normal color of the TM is pink or pearly gray so this is not a variant of normal. A cholesteatoma is an abnormal growth found in the middle ear or mastoid, not on the surface of the TM. Foreign bodies typically reside in the external canal. Question: Papilledema is noted in a patient with a headache. What is the importance of papilledema in this patient? It is not related to this patient’s headache.It is an incidental finding in patients with migraines.It could be an important finding in this patient. CorrectThis is a common finding in patients with headaches. Explanation: Papilledema represents swelling of the optic nerve head and disc secondary to increased intracranial pressure (ICP). It is not a common finding in patients with headaches; only those with headache secondary to ICP. The pressure disrupts fluid flow within the nerve and swelling results. The cardinal symptom of ICP is a headache; papilledema is a secondary finding. Question: A patient diagnosed with Strept throat received a prescription for azithromycin. She has not improved in 48 hours. What course of action is acceptable? The patient should wait another 24 hours for improvement.The antibiotic should be changed to a first generation cephalosporin.A different macrolide antibiotic should be prescribed.A penicillin or cephalosporin with beta lactamase coverage should be considered. Correct Explanation: The patient should demonstrate improvement after 48 hours if an antibiotic with the appropriate antimicrobial spectra was prescribed. A macrolide would be a poor choice because there are high rates of Strept resistance to macrolide antibiotics. In light of this, strong consideration should be given to an antibiotic with different antimicrobial spectra. Since Strept was diagnosed and azithromycin was ineffective, the prescriber should consider that the causative agent has macrolide resistance and could be beta lactamase producing. An antibiotic with beta lactamase coverage should be considered. Choice d provides this coverage. Question: A teenager with fever and pharyngitis has a negative rapid strept test. After 24 hours, the throat culture reveals “normal flora". Which conclusion can be made? The pharyngitis is not secondary to Strept.The pharyngitis is secondary to a bacterial pathogen but not Strept. IncorrectThe pharyngitis is of undetermined etiology. CorrectThe patient has mononucleosis. Explanation: The patient has a preliminary culture that indicates the presence of normal flora, i.e. no finding of pathogenic organisms like beta hemolytic Strept. A final culture result generally takes longer than 24 hours to complete. It is premature to make a diagnosis at 24 hours with this culture report. The only conclusion that can be made at this time is "pharyngitis of undetermined etiology". He should be treated symptomatically with antipyretics and analgesics until a final culture is available to help with formulation of a diagnosis. Question: A 4 year-old child with otitis media with effusion: NR 603 Week 4 APEA Predictor Exam TestBank Updated needs an antibiotic.probably has a viral infection.probably has just had acute otitis media. Correcthas cloudy fluid in the middle ear. Incorrect Explanation: Otitis media with effusion (OME) frequently precedes or follows an episode of acute otitis media. This condition should not be treated with an antibiotic since the middle ear fluid is not infected. However, the fluid acts as a medium for bacterial growth. Question: A patient with environmental allergies presents to your clinic. She takes an oral antihistamine every 24 hours. What is the most effective single maintenance medication for allergic rhinitis? AntihistamineDecongestantIntranasal glucocorticoids CorrectLeukotriene blockers Incorrect Explanation: These agents are particularly effective in the treatment of nasal congestion and would be a good choice for the patient in this scenario. Intranasal glucocorticoids are effective in relieving nasal congestion, discharge, itching, and sneezing. A trial of stopping the oral antihistamine could be tried in this patient. Symptoms would determine whether the antihistamine should be resumed. Question: A patient describes a sensation that "there is a lump in his throat". He denies throat pain. On exam of the throat and neck, there are no abnormalities identified. What is the most likely reason this occurs? Factitious sore throatLymphadenitisGlobus CorrectEsophageal motility disorder Incorrect Explanation: The term used to describe the sensation of "a lump in my throat", or the feeling that there is a foreign body in the throat, is globus. It is not associated with sore throat or pain. The most common cause of globus is GERD or other disorders of the upper esophageal tract. If there is no actual foreign body or abnormality, then other etiologies may be psychologic or psychiatric disorders. Question: The most common complication of influenza is: cough.bacterial pneumonia. Correctviral pneumonia. Incorrectbronchitis. Explanation: Pneumonia is the most common complication of influenza; bacterial pneumonia is the most common form. Streptococcus pneumoniae is the most common bacterial pathogen. 25% of deaths associated with influenza are related to pneumonia. Clinical presentation of pneumonia as a complication of influenza is characterized by worsening of symptoms after an initial period of improvement for 1-3 days. Fever, cough, purulent sputum predominate. Cough is a symptom of influenza, not a complication. Bronchitis might be part of the differential of influenza, however, fever is uncommon in bronchitis. Question: Which of the following is most likely observed in a patient with allergic rhinitis? Exacerbation of symptoms after exposure to an allergen CorrectNasal congestion and sneezing IncorrectPost nasal drip and sore throatWorsening of symptoms during a sinus infection Explanation: Allergic rhinitis is usually diagnosed on clinical presentation and history. The diagnosis is appropriately made when allergic rhinitis symptoms are reproducible after exposure to the suspected allergen, like pollen. NR 603 Week 4 APEA Predictor Exam TestBank Updated Nasal congestion, sneezing, post-nasal drip and sore throat are not exclusive to allergic rhinitis. Finally, sinusitis does exacerbate allergic rhinitis symptoms. Question: A nurse practitioner performs a fundoscopic exam. He identifies small areas of dull, yellowish-white coloration in the retina. What might these be? Cotton wool spots CorrectMicroaneurysmsHemorrhagesExudates Explanation: These are cotton wool spots. They are due to swelling of the surface layer of the retina. Swelling occurs because of impaired blood flow to the retina. The most common causes of cotton wool spots are diabetes and high blood pressure. A microaneurysm is the earliest manifestation of a diabetic retinopathy. These appear as small round dark red dots on the retinal surface. Exudates are an accumulation of lipid and protein. These are typically bright, reflective white or cream colored lesions seen on the retina. Question: The throat swab done to identify Streptococcal infection was negative in a 12 year-old female with tonsillar exudate, fever, and sore throat. What statement is true regarding this? A second swab should be done to repeat the test.The patient does not have Strept throat.The patient probably has mononucleosis.A second swab should be collected and sent to microbiology. Correct Explanation: A second swab is collected, but it is not used to repeat the test. The second swab is sent to microbiology for culture. The sensitivity varies in office Strept tests. Some are as low as 50% and a second swab should be collected. If beta-hemolytic Strept organisms are grown out, then the patient can be diagnosed with Streptococcal infection. Question: A 6 month-old infant has a disconjugate gaze. The nurse practitioner observes that the 6 month old tilts his head when looking at objects in the room. Which statement is true? Nystagmus will be present.The infant will have an abnormal cover/uncover test. CorrectThe patient’s vision is 20/200. IncorrectHe needs a CT to rule out an ocular tumor. Explanation: The cover/uncover test is used to assess strabismus, a common cause of disconjugate gaze. Strabismus represents a nonparallelism of the visual axis of the eyes. This results in the inability of both eyes to focus on the same object at the same time. At 6 months of age, a disconjugate gaze and tilting of the child’s head is a red flag. This child needs referral to ophthalmology. While an ocular tumor could be present, this is unlikely and not the action that should be taken today Question: Group A Strept pharyngitis: is characterized by a single symptom.can be accompanied by abdominal pain. Correctusually does not have exudative symptoms.is commonly accompanied by an inflamed uvula. Incorrect Explanation: Group A Streptococcus is usually characterized by multiple symptoms with an abrupt onset. Sore throat is usually accompanied by fever, headache. GI symptoms are common too; nausea, vomiting and abdominal pain are usual. Even without treatment, symptoms usually resolve in 3-5 days. NR 603 Week 4 APEA Predictor Exam TestBank Updated Amoxicillin with clavulanateDecongestant and analgesic CorrectAzithromycin and decongestantLevofloxacin Explanation: The vast majority of patients who have acute rhinosinusitis have a viral infection. In fact, 2% or fewer cases of acute rhinosinusitis are due to bacteria. When bacteria are the causative agents, Streptococcus and Staphylococcus are common pathogens. Since the most likely pathogen is a virus, symptomatic treatment should occur unless a red flag such as fever, facial pain, purulent drainage, etc. is present. Typically, conservative measures should be used for 7-10 days prior to antibiotic use. In clinical practice, patients typically request antibiotics sooner than 7-10 days. Question: A patient has been diagnosed with mononucleosis. Which statement is correct? He is likely an adolescent male.Splenomegaly is more likely than not.He cannot be co-infected with Strept.Cervical lymphadenopathy may be prominent. Correct Explanation: Mononucleosis is a common viral infection in adolescents and early twenty year olds. Splenomegaly occurs in about 50% of patients with mononucleosis. While it is not common, it is possible to be co-infected with Streptococcus in the throat. If this is the case, treatment with penicillin should be avoided because of the possibility of an “ampicillin” rash. The most prominent symptoms are fever, fatigue, pharyngitis, and lymphadenopathy. Question: An older adult has a cold. She calls your office to ask for advice for an agent to help her runny nose and congestion. She has hypertension, COPD, and glaucoma. What agent is safe to use? PseudoephedrineOxymetazoline nasal sprayGuaifenesin CorrectDiphenhydramine Explanation: Pseudoephedrine will increase her blood pressure. Oxymetazoline can be absorbed across mucus membranes and elevate blood pressure too. Diphenhydramine is a sedating antihistamine with anti- cholinergic properties. This would be contraindicated with glaucoma. Guaifenesin would be the safest agent to use. Question: A patient reports a penicillin allergy. What question regarding the allergy should the nurse practitioner ask to determine whether a cephalosporin can be safely prescribed? Have you ever taken a cephalosporin?How long ago was the reaction?What kind of reaction did you have? CorrectWhat form of penicillin did you take? Explanation: The most important question to ask the patient is “what kind of reaction did you have?" Unfortunately, many patients who report penicillin allergy are not actually penicillin allergic. About 2-10% of patients who are penicillin allergic have cephalosporin allergy too. Cephalosporins should never be prescribed for penicillin allergic patients if the patient reports hives or an anaphylaxis after having taken penicillin. Question: A 6 day-old has a mucopurulent eye discharge bilaterally. What historical finding explains the etiology of the discharge? Infant is Hepatitis B positive.Infant received silver nitrate drops.Mother has chlamydia. CorrectDelivery was by C-section. Explanation: Infants born vaginally to mothers who have chlamydia have a 60-70% risk of acquiring C. trachomatis. NR 603 Week 4 APEA Predictor Exam TestBank Updated Newborns may present with pneumonia and/or conjunctivitis. The most common clinical feature is conjunctivitis that occurs 5 to 14 days after delivery. It is characterized by swelling of the lids and a watery discharge that becomes mucopurulent. The conjunctivae are erythematous. This must be treated orally because topical treatment is not effective. The drug of choice in infants is oral erythromycin 50 mg/kg/day in divided doses for 14 days whether treating pneumonia or conjunctivitis. Question: A 4 month-old infant has thrush. The mother is breastfeeding. She reports that her nipples have become red, irritated, and sensitive. What should the nurse practitioner advise the mother of this baby to treat thrush? Have the mother exercise good hygiene of her nipplesAdminister an oral anti-fungal suspension to the motherAdminister an oral anti-fungal suspension to the infant IncorrectTreat the infant with an oral anti- fungal suspension and the mother’s nipples with a topical anti-fungal agent Correct Explanation: If the infant has thrush, he should be treated with an oral anti-fungal suspension like nystatin. This is given 4 times daily after feedings. Since the mouth of the infant is in contact with the mother’s nipples during breastfeeding, and they sound infected too, the mother and infant should be treated simultaneously. Care should be given so that the mother gently washes her nipples and dries them before breastfeeding. This will minimize or eliminate ingestion of the topical anti-fungal in the infant. Question: How should the class effect of the nasal steroids be described? There is a lot of variation among agents within the class. IncorrectThere are no significant systemic effects with these. CorrectThere are high rates of nasal bleeding.It is generally not well-tolerated. Explanation: One reason these are preferred agents in older adults (and young children) is that there are very few systemic effects. The steroids are absorbed across the mucous membranes and are deposited in the area where they need to work. There is absolutely no sedation associated with their use. They are generally well- tolerated. The class is predictable. There is very little variation between agents. Question: A 70 year-old male has a yellowish, triangular nodule on the side of the iris. This is probably: a stye.a chalazion.a pinguecula. Correctsubconjunctival hemorrhage. Explanation: Pinguecula are common as patients age. They usually appear on the nasal side first and then on the temporal side. This is a completely benign finding. A stye is also called a hordeolum. It is a tender, painful infection of a gland at the eyelid margin. These are self-limiting. A chalazion is a non-tender enlargement of a meibomian gland. A subconjunctival hemorrhage is a blood red looking area on the sclera that does not affect vision. It occurs and resolves spontaneously. Question: A patient with allergic rhinitis developed a sinus infection 10 days ago. He takes fexofenadine daily. What should be done with the fexofenadine? Stop the fexofenadine. Stop the fexofenadine and add a nasal steroid. IncorrectContinue the fexofenadine and prescribe an antibiotic. CorrectContinue the fexofenadine and add a decongestant. Explanation: This patient should continue his fexofenadine. This treats his allergies and although he has a sinus infection, he still needs treatment for his allergies. A topical nasal steroid can be added if poor control of NR 603 Week 4 APEA Predictor Exam TestBank Updated allergies exists, otherwise, this probably just increases the cost of treatment of during this sinus infection. If his sinus infection has been present for 10 days, an antibiotic seems prudent at this point. Question: A patient who is 65 years old states that she has “hayfever” and has had this since childhood. What agent could be safely used to help with rhinitis, sneezing, pruritis, and congestion? Nasal steroid CorrectIpratropiumAntihistamine IncorrectDecongestant Explanation: A nasal steroid is considered the gold standard for improvement of all symptoms associated with allergic rhinitis (hay fever). Ipratropium helps with rhinitis only. An antihistamine helps will all symptoms listed but is not as effective at relieving symptoms of congestion as a nasal steroid. A decongestant is extremely effective at relieving congestion, but no other symptoms listed. Question: A patient presents to your clinic with a painless red eye. Her vision is normal, but her sclera has a blood red area. What is this termed? ConjunctivitisAcute iritisGlaucomaSubconjunctival hemorrhage Correct Explanation: This represents leakage of blood out of the ophthalmic vasculature. It is usually painless and can be the result of coughing, sneezing, hypertension, or trauma. This will resolve without treatment, but, aspirin or other agents that can produce bleeding should be discontinued until the etiology is determined. Question: A 30 year old male has been diagnosed with non-allergic rhinitis. What finding is more likely in non- allergic rhinitis than allergic rhinitis? Older age of symptom onset CorrectMale genderPost nasal drip IncorrectSneezing Explanation: Non-allergic rhinitis, often called vasomotor rhinitis, is very common in the US. It is typically diagnosed and differentiated from allergic rhinitis by history. Although both conditions may co-exist in patients, non- allergic rhinitis typically has onset after age 20 years. Allergic rhinitis typically presents prior to age 20 years. The most common symptoms associated with non-allergenic rhinitis are nasal congestion and post- nasal drip. It is predominantly reported in females. Common precipitants of non-allergic rhinitis symptoms can occur with exposure to spicy foods, cigarette smoke, strong odors, perfumes, and alcohol consumption. This is frequently treated with topical azelastine. Question: An elderly patient who has a red eye with tearing was diagnosed with conjunctivitis. What characteristics below indicate viral conjunctivitis? Moderate tearingProfuse tearing CorrectModerate exudate IncorrectProfuse exudate Explanation: A patient with viral conjunctivitis typically has profuse tearing and minimal exudate. Patients with bacterial conjunctivitis have moderate tearing and exudate. Both are considered highly contagious. Patients should refrain from work or group activities for 48 hours until symptoms have subsided. Question: An NP examines a screaming 2 year-old. A common finding is: NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A 70 year-old patient is concerned and comes into the clinic with complaints of headache, slurred speech, and onset of symptoms within the last 60 minutes. When the patient is examined, her complaints are confirmed by the examiner. What is the likely etiology of this event? Migraine headache IncorrectAlcohol intoxicationStroke CorrectBell’s palsy Explanation: Migraine headache can produce headache and numbness of the face. However, migraine risk decreases as age increases and is unlikely of new onset in this 70 year-old patient. Stroke increases as age increases. Bell’s palsy is accompanied by facial numbness and sometimes slurred speech occurs if the upper lip is affected, but, headache does not accompany Bell’s palsy. Alcohol intoxication might be considered, but, stroke must be ruled out. When headache accompanies stroke, it is often hemorrhagic stroke, but ischemic stroke can cause headache too. Question: A 2 month-old infant has an asymmetric Moro reflex. What statement is true? This is normal. It develops bilaterally later.This indicates a side of dominance.The infant could have a hearing problem.The infant could have a birth injury. Correct Explanation: The Moro reflex is a startle reflex. Observation of the reflex is confirmed if the infant symmetrically flings his arms away from his body followed by an immediate flexion of both arms in response to simulating falling. If this is asymmetrical, it could indicate an injury during or after birth (more likely during birth) such as a brachial plexus palsy, hemiplegia, or even a fractured clavicle. The Moro reflex usually disappears between 3-6 months. The significance of this reflex is for evaluation of integration of the central nervous system. Question: The classic description of transient ischemic attack is “ a sudden onset of focal neurological symptoms that lasts less than”: one minute.five minutes.one hour. Incorrect24 hours. Correct Explanation: Most learned authorities agree on the above definition but realize that it is inadequate. Infarction usually begins once an area has been ischemic for an hour. Therefore, a TIA is not benign and even brief ischemia can produce irreversible brain damage. Question: Which reflexes might a one month-old infant be expected to exhibit? Moro, stepping, rooting CorrectStepping, rooting, tonic neckBabinski, Moro onlyFencing, stepping, rooting Incorrect Explanation: A one month old infant would be expected to exhibit the Moro, stepping, rooting, and Babinski reflexes. The tonic neck, or “fencing” reflex isn’t exhibited until about 2-3 months of age. This is assessed by lying the baby on his back and turning his head to one side. If the reflex is present, he should extend his arm on the side that his head is turned. The opposite arm assumes a flexed position. This pose mimics a fencer and thus, the name. Question: The "get up and go" test in an elderly patient is used to evaluate: risk for falls. Correctlower extremity strength.mental acuity.driving safety. NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: The “get up and go” test is used to evaluate musculoskeletal function. The patient is asked to rise from a seated position in an armchair, walk across the room, turn around, and return to the chair. This test evaluates the patient’s gait, balance, leg strength, and vestibular function. It should be assessed in patients who report a fall or who present after a fall but who appear without injury. Question: A patient complains of right leg numbness and tingling following a back injury. He has a diminished right patellar reflex and his symptoms are progressing to both legs. What test should be performed? Lumbar x-rays IncorrectLumbar CT scanLumbar MRI CorrectLumbar MRI with contrast Explanation: This patient has symptoms that could indicate an urgent neurological situation. Acute radiculopathy could indicate the need for intervention by a neurosurgeon. An MRI is a superior study because it provides excellent information about the soft tissues, like the lumbar discs. Contrast might be used in this patient if he had a history of previous back surgery. Then, contrast would be helpful to distinguish scar tissue from discs. Question: An elderly patient is at increased risk of stroke and takes an aspirin daily. Aspirin use in this patient is an example of: primary prevention. Correctsecondary prevention.tertiary prevention. Incorrectprimary or secondary. Explanation: Primary prevention refers to an action that has the potential to prevent an event prior to its occurrence. Secondary prevention refers to an intervention demonstrated to help prevent a second occurrence of a deleterious event; or may refer to an intervention designed for early detection. Tertiary prevention is an action designed to prevent additional deleterious events from occurring. Question: A patient presents to the NP clinic with a complaint of nocturnal paresthesias. What is the likely underlying etiology? De Quervain’s tenosynovitisCarpal tunnel syndrome CorrectUlnar radiculopathy IncorrectMedial epicondylitis Explanation: Nocturnal paresthesias are typical in patients who have carpal tunnel syndrome. A patient will complain of nighttime numbness, tingling, or “sleeping” hands and arms. This is a result of compression of the median nerve that traverses through the carpal tunnel. If the nerve is compressed, the symptoms (nocturnal paresthesias) usually result. With surgical decompression, symptoms usually abate. Question: Mrs. Jopson is unable to name a familiar object. How is this described? Anomia CorrectAnosmiaAcanthosisIncompetent Explanation: Anomia is the difficulty in the naming of familiar objects. This is an example of mild impairment. Other evidence of mild impairment is recent recall problems, decreased insight, and difficulty managing finances. Many mildly impaired adults are not able to state today’s date. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: Mrs. Johnson is an 89 year-old resident at a long-term care facility. Her state of health has declined rapidly over the past 2 months, and she can no longer make her own decisions. Her daughter requests a family conference with the nurse practitioner. Some important principles that need discussion at this time, if not previously documented, are: bereavement support for the family, quality of life for the resident, and living will. Explanation: American Geriatrics Society stresses not only care of the patient, but care of the family as well. Choice A includes meeting the current and future needs of the patient, family needs, and end of life issues with the living will. The living will is recognized as a valid advanced directive. Choice A includes developmental landmarks for the patient and family. Question: A patient diagnosed with cluster headaches: usually has scotomas.can be diagnosed with an imaging study.should eliminate triggers like nicotine and alcohol. Correctmay exhibit nuchal rigidity. Explanation: Cluster headaches are extremely painful headaches but are not as common as migraine or tension headaches. The headaches occur in cyclical patterns, hence the name “cluster”. The cycle lasts about 2-12 weeks. A single attack may last 30-90 minutes, but can last up to 3 hours. Patients do not exhibit fever or nuchal rigidity. These symptoms may characterize meningitis. Lifestyle measures like avoiding alcohol, nicotine, and high altitudes may help prevent a headache . Avoiding afternoon naps, bright lights, and glare during a headache cycle, may prevent a subsequent headache from occurring. Scotoma refers to an area of diminished vision in the visual field. Question: A patient who had a stroke has recovered and is performing all of her activities of daily living. Taking aspirin for stroke prevention is an example of: primary prevention.secondary prevention. Correcttertiary prevention. Incorrectquaternary prevention. Explanation: The patient is taking aspirin to prevent recurrent stroke. Research demonstrates that taking an aspirin daily can prevent subsequent strokes and MI significantly. Secondary prevention means that the intervention is performed to prevent another occurrence of the deleterious event. If she had never had a stroke but took an aspirin daily for prevention of stroke, that would be primary prevention. Taking an aspirin at home during the course of having an MI is an example of tertiary prevention. There is no reference in the literature to quaternary prevention. Question: An elderly patient with organic brain syndrome is at increased risk of elder abuse because she: lives in a nursing home.has multiple caregivers.is incontinent of stool and urine.has declining cognitive function. Correct Explanation: Elders are at increased risk of abuse because of their decline in cognitive function. Caregiver strain, stress, and depression occur at higher rates than in the general population. According to the National Center of Elder Abuse, family members are likely to be abusers of the infirmed elderly. Healthcare providers should remain alert to signs of elder abuse and caregiver stress. Question: When should medications be started in a patient diagnosed with Parkinson’s disease? As soon as the disease is diagnosedWhen symptoms interfere with life’s activities CorrectWhen non- pharmacologic measures have been exhaustedAfter MRI and CT have ruled out stroke or tumor NR 603 Week 4 APEA Predictor Exam TestBank Updated hypertension. An episode of severe hypertension can result. Triptans may be used in patients with well- controlled hypertension, but a hypertensive episode can always occur. Question: A patient who is 60 years old complains of low back pain for the last 5-6 weeks. She states that the severity is about 4/10 and that she gets no relief from sitting, standing, or lying. The NP should consider: sciatica.ankylosing spondylitis. Incorrectdisc disease.systemic illness. Correct Explanation: Systemic illness, like cancer or infection is a serious consideration when patients report no relief of pain with lying down. Additionally, this patient is female, older, and has pain more than 4 weeks. These are three risk factors for systemic cause of low back pain. Sciatica presents with pain down the leg. Ankylosing spondylitis is typical in males in their 40s. Disk disease is a consideration, but, an absence of relief with lying down is unusual. Question: Most patients with migraine headache symptoms do not need imaging for diagnosis. Which finding in a patient with migraine headache symptoms would compel the examiner to order an imaging study? First occurrence with typical migraine symptomsNausea and photophobiaRapidly increasing frequency of headache CorrectFully reversible speech disturbance Explanation: Fully reversible speech disturbance in conjunction with migraine type symptoms likely represents a typical aura. Nausea and photophobia are typical with migraine headaches. A normal neurological exam in conjunction with typical migraine symptoms, even on first occurrence, does not compel the examiner to order an imaging study. A headache with rapidly increasing frequency, history of lack of coordination, localized neurologic symptoms, headache that awakens the patient from sleep all increase the likelihood that a neurologic abnormality exists. Any of these findings should compel the examiner to order an imaging study. The study most likely to be ordered is a CT scan or MRI with and without contrast. However, an MRA maybe ordered depending on the suspected underlying abnormality. Question: A patient reports a history of transient ischemic attack (TIA) 6 months ago. His daily medications are lisinopril, pravastatin, and metformin. After advising him to quit smoking, what intervention is most important in helping to prevent stroke in him? Auscultation of carotid arteries at each visitTaking a baby aspirin daily CorrectAssessing hemoglobin A1C every 3-6 monthsEncouraging smoking cessation at each visit Incorrect Explanation: Antiplatelet therapy, usually aspirin, inhibits the enzyme cyclooxygenase and reduces thromboxane A2 production, which stimulates platelet aggregation. Risk of ischemic stroke is reduced. The dosage of aspirin needed to prevent an event is debatable. Most studies found that 75- 150 mg daily was as effective in preventing stroke as was higher doses. Lower doses of aspirin are associated with less GI toxicity and subsequent side effects. Question: A patient who is 82 years old is brought into the clinic. His wife states that he was working in his garden today and became disoriented and had slurred speech. She helped him back into the house, gave him cool fluids, and within 15 minutes his symptoms resolved. He appears in his usual state of health when he is examined. He states that although he was scared by the event, he feels fine now. How should the nurse practitioner proceed? Prescribe an aspirin daily.Re-examine him tomorrow.Send him to the emergency department. CorrectOrder an EKG. Incorrect NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: This patient likely suffered a transient ischemic attack. He needs urgent evaluation with head CT and/or MRI, ECG, lab work (CBC, PTT, lytes, creatinine, glucose, lipids and sedimentation rate); possible magnetic resonance angiography, carotid ultrasound, and/or transcranial Doppler ultrasonography. He is at increased risk of stroke within the first 48 hours after an event like this one. On initial evaluation, the most important determination to be made is whether the etiology of the stroke or TIA is ischemic or hemorrhagic. After this determination, treatment can begin. Unfortunately, this determination cannot be made in the clinic. The patient needs urgent referral to a center where this evaluation and possible treatment can be performed. Question: A 72 year-old patient with a relatively benign medical history complains of new onset headache associated with abrupt onset of visual disturbances. Her sedimentation rate is elevated. Her neuro exam is otherwise normal. What is the most likely reason for her symptoms? StrokeMigraine headache IncorrectBrain tumorTemporal arteritis Correct Explanation: Giant cell arteritis, also known as temporal arteritis, is most likely in this patient based on the results of the exam and lab. This is best diagnosed by temporal artery biopsy. Temporal arteritis is a chronic vasculitis of the medium and large vessels. A biopsy can be performed on the same day as it is suspected. Generally, patients have complaints of new onset headaches, abrupt onset of visual disturbances, jaw claudication, unexplained fever or anemia, and an elevated sedimentation rate. The average age of diagnosis is 72 years. She should be referred to neurology for evaluation today. Question: A nurse practitioner is assessing a 3 day old infant’s head. What would be a normal observation in a healthy 3 day old infant who is crying? There are pounding pulsations over the anterior fontanel.There are palpable pulsations over the anterior fontanel. CorrectThere is a palpable nodule near the posterior fontanel.The fontanel is depressed. Explanation: Palpable or visible pulsations are common if the infant is crying or is agitated. Normally, the anterior fontanel is slightly depressed, but a depressed fontanel is indicative of a dehydrated or malnourished infant. Pounding pulsations are indicative of increased intracranial pressure. A palpable nodule near the posterior fontanel is an abnormal finding possibly indicative of a calcium deposition or bony abnormality. Question: What is the earliest age that an average child would appropriately receive construction paper and a pair of scissors with rounded points? 3 years4 years Correct5 years6 years Incorrect Explanation: A 4 year-old should have the dexterity to cut and paste. Therefore, this is the most appropriate age. A 5 or 6 year-old may also use these items, but these would be appropriate as early as 4 years. Pointed tips represent hazards especially in a classroom with multiple children moving simultaneously. Question: Which reflex may be present at 9 months of age during sleep? Moro reflexRooting CorrectStepping IncorrectTonic neck NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: The rooting reflex disappears about 2-3 months of age but may be present during sleep up to 12 months. The Moro reflex disappears somewhere between 3 and 6 months, usually 4-5 months. The tonic neck, or “fencing” response, generally disappears about 6 months of age. The stepping response disappears about 9 months. Interestingly, this is usually when infants are beginning to take the first steps with assistance. Question: A 68 year-old smoker with a history of well controlled hypertension, describes a syncopal episode which occurred yesterday while mowing his lawn. Today, he has no complaints. Initially, the NP should: perform a complete neurological and cardiac exam with auscultation of the carotid arteries. Correctorder a 12 lead ECG, carotid ultrasound, and perform a physical exam.order a CT of the brain, blood clotting studies, and cardiac enzymes.check blood pressure in 3 positions, order a 12 lead ECG, and schedule an exercise stress test. Incorrect Explanation: The event described is syncope. Syncope is a brief and sudden loss of consciousness that occurs with spontaneous recovery. This is a significant event but especially in a smoker with hypertension. The initial assessment of this patient must start with an examination of the patient’s cardiac and neurological systems. Based on the findings and tentative diagnosis of syncope, coupled with the patient’s history of the event, other tests might be ordered to evaluate arrhythmias, stroke, transient ischemic attack, myocardial infarct, carotid stenosis, etc. A referral to specialty care is indicated after initial workup by the nurse practitioner. Question: The most common polyneuropathy in the elderly is: Charcot-Marie-Tooth disease.diabetes mellitus. Correcturinary incontinence.Guillain-Barre syndrome. Explanation: A polyneuropathy is a term that refers to a process that affects multiple nerves, usually peripheral. The distal nerves are more commonly affected. Symptoms described by patients are burning, weakness, or loss of sensation. Charcot-Marie-Tooth disease is a rare, hereditary primary motor sensory neuropathy. Guillain- Barre is an acute autoimmune neuropathy that is primarily demyelinating. Urinary incontinence does not represent a common polyneuropathy in the elderly. Question: Restless legs syndrome is part of the differential diagnosis for Mr. Wheaton. What should be part of the laboratory workup? BUN/CrSerum ferritin CorrectALT/AST IncorrectUrinalysis Explanation: Restless legs syndrome (RLS) is the unrelenting urge to move the legs. This rarely affects the upper extremities. The symptoms are relieved by movement of the affected limbs and only occurs if the affected limbs are at rest. Iron deficiency has been considered as a cause of RLS. The exact mechanism of iron deficiency is not known, but many patients who exhibit symptoms of restless legs syndrome have low serum ferritin levels and have relief of symptoms when supplemented with iron. Even in patients with normal serum levels, a month long trial of iron may be helpful. Question: A 70 year-old male who is diabetic presents with gait difficulty, cognitive disturbance, and urinary incontinence. What is part of the nurse practitioner’s differential diagnosis? Diabetic neuropathyNormal pressure hydrocephalus CorrectParkinson’s DiseaseMultiple sclerosis Incorrect NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: This scenario is typical of an infant with pyloric stenosis. It is more common in males (88%) and usually is diagnosed before the child is 12 weeks old. The classic presentation is an infant who vomits immediately after eating. The “knot” in the abdomen is the typical “olive-shaped mass” palpable at the lateral edge of the rectus abdominus muscle in the right upper quadrant of the abdomen. The mass is best palpated immediately after vomiting. The differential should include GER, but no mass is palpable. Munchausen syndrome by proxy is the fabrication or induction of an illness in a child in order for the caregiver to receive attention. Question: A mother of a 4 week-old infant visits your office. She states that her baby is vomiting after feeding and then cries as if he is hungry again. What should the nurse practitioner assess? His abdomen for an olive shaped mass CorrectHis rectum for patencyHis swallowing abilityThe position his mother uses when she feeds him Explanation: The symptoms sound like pyloric stenosis. The most common time for this to occur is 3-6 weeks. It rarely occurs after 12 weeks of age. Babies who have episodes of projectile vomiting and who demand to be re- fed are called “hungry vomiters” and a diagnosis of pyloric stenosis should be considered. The olive shaped mass, if found, probably represents hypertrophy of the lateral edge of the rectus abdominus muscle. It is most easily felt immediately after vomiting. This diagnosis is made much earlier now than it used to be, so problems with dehydration are not as common as decades ago. Question: The relationship between colon polyps and colon cancer is: polyps eventually all become malignant.polyps have a slow progression to colon cancer. Correctpolyps have a rapid progression to colon cancer.polyps have no relationship to colon cancer. Explanation: Colon polyps are usually very slow growing and take a long time to progress to cancer. This is the reason that a colonoscopy does not need to be repeated annually. While not all polyps grow slowly, this is the usual progression. Question: Which of the following is appropriate for initiation of an 8 week-old with gastroesophageal reflux? Small, frequent thickened feedings CorrectCimetidine every 6 hoursChange formula to soy based IncorrectPlace infant on left side after eating Explanation: Two strategies should be tried initially. First, avoidance of overfeeding is recommended. Hence, small, frequent feedings. Second, milk thickening agents appear to improve symptoms in infants who experience gastroesophageal reflux (GER). Thickened feedings significantly decrease frequency of reflux in most infants. Also, caloric content is increased and this may be helpful for patients who are underweight because of persistent GER. Generally, when medications are used, proton pump inhibitors are preferred over an H2 blocker like cimetidine. Changing formula generally does not help, however, a milk-free diet may help since 40% of infants with GER are sensitive to cow’s milk protein. Thus, soy would not help. Positioning seems to be ineffective in relieving symptoms in infants. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A patient has a positive hepatitis B surface antibody. This means: he has acute hepatitis B.he has chronic hepatitis B.he is immune to hepatitis B. Correcthe needs immunization to hepatitis B. Explanation: The hepatitis B surface antibody indicates immunity to hepatitis B virus. Specifically, if this patient comes in contact with hepatitis B virus, he will not become infected with hepatitis B. The presence of hepatitis B surface antibody indicates immunity from immunization or actual infection. It also indicates recovery if the patient was infected. Question: An elderly adult has chronic constipation. How should this be managed initially? Avoid all constipating medications/foods when possible CorrectAdd dietary fiber and increase fluidsAdd sorbitol solution dailyUse an oil retention enema Explanation: Initially, all medications known to cause constipation should be stopped when possible. Symptoms should be re-assessed. It is always preferable to stop a medication to correct a condition BEFORE adding a medication to correct a condition. If symptoms persist, 6-25 grams of dietary fiber should be added along with increasing fluid intake. Physical activity should be increased as tolerated. Choice 3 and 4 would be initiated if other options mentioned were not helpful. Question: GERD (gastroesophageal reflux disease) and physiologic reflux have similar characteristics. However, physiologic reflux: can produce mucosal injury. Incorrectrarely occurs at nighttime. Correctoccurs only postprandial.is always asymptomatic. Explanation: GERD is usually associated with symptoms that produce injury to the mucosa. This rarely occurs in physiologic reflux. Characteristics typical of physiologic reflux are that it occurs primarily post-prandial (like GERD), are usually asymptomatic, rarely occur nocturnally, and are usually short-lived. In contrast, GERD usually occurs nocturnally, especially when there is lower esophageal sphincter disease. Question: Children with an inguinal hernia: have a history of an intermittent bulge in the groin. Correctare usually symptomatic.have a mass that is always present on exam.are usually irritable and often constipated. Incorrect Explanation: Inguinal hernias are usually asymptomatic and absent on exam but can sometimes be elicited by increasing intraabdominal pressure such as occurs with straining or crying. The “silk sign” is infrequently appreciated but represents a silky thickening of the cord. If it is able to be palpated, it is done by placing a single finger next to the inguinal canal at the level of the pubic tubercle and gently moving the finger from side to side. Children with an incarcerated mass are often irritable but not constipated. Question: Which of the following would be usual in a patient with biliary colic? NR 603 Week 4 APEA Predictor Exam TestBank Updated Presence of gallstones on imaging studies Presence of gallstones and unpredictable abdominal painPositive Murphy’s sign only Pain in upper abdomen in response to eating fatty foods Correct Explanation: Biliary colic refers to discomfort produced by contraction of the gallbladder. This occurs in response to eating. Typically, pain occurs in the upper right quadrant or chest, peaks in an hour after eating, and then remains constant and finally subsides over the next several hours. A positive Murphy’s sign is elicited when the gallbladder wall is inflamed. It can be elicited by palpating the gallbladder just beneath the liver as the patient takes a deep breath. Question: A 40 year-old patient has the following laboratory values. How should they be interpreted? HBsAg (-), HBsAb (+), HBcAb (-) The patient had hepatitis.The patient has hepatitis. IncorrectThe patient should consider immunization.The patient has been immunized. Correct Explanation: This patient has a negative hepatitis B surface antigen (HBsAg). Therefore, he does not have hepatitis B. The patient has a negative hepatitis B core antibody (HBcAb). Therefore, he has never had hepatitis B. The patient has a positive hepatitis B surface antibody (HBsAb). Therefore, he is considered immune. The patient is immune from immunization because his hepatitis B core antibody is negative. If the core antibody had been positive, he would be considered immune from the disease. The correct answer is choice D. Question: A 95 year-old male has lost muscle mass as he has aged. He does not have any underlying disease that has caused this loss. What is this termed? HypoproteinemiaSarcopenia CorrectCachexia IncorrectDithering Explanation: Sarcopenia is the term used to describe loss of muscle mass related to aging. The actual definition is a decrease in appendicular muscle mass that is measured as a two standard deviation decrease. It is associated with increased falls, disability, and impairment. In males, this is due to decreased production of testosterone. Question: Hirschsprung's disease is characterized by: intermittent constipation in the first year of life.inability to absorb carbohydrates.failure to pass meconium in the first 48-hours of life. Correctchronic fecal incontinence. Explanation: Another name for this condition is aganglionic megacolon. The affected segment of colon is absent of ganglia that are responsible for producing peristalsis. The diagnosis cannot be made in the first 48-hours of life, but a suggestion of the diagnosis can be made because meconium is not passed in a timely manner. Consequently, most children are diagnosed in the neonatal period. Patients usually present with emesis, abdominal distention, and failure to pass stool. An abdominal x-ray will demonstrate distal intestinal obstruction with dilated bowel loops. The patient should be referred for surgery to remove the diseased segment of colon. NR 603 Week 4 APEA Predictor Exam TestBank Updated diagnostic accuracy of 93% for acute groin problems. The definitive treatment for inguinal hernia is surgical repair. Question: The most common place for indirect inguinal hernias to develop is: the internal inguinal ring. Correctthe external inguinal ring.Hesselbach’s triangle.femoral ring. Incorrect Explanation: The internal inguinal ring is the most common site for development of an indirect inguinal hernia. These can occur in men and women. Though most are probably congenital, symptoms may not be obvious until later in life. Indirect hernias are more common on the right side. Direct inguinal hernias occur through Hesselbach’s triangle. Question: A patient has a positive anti-HCV test. This means: he has hepatitis C. Incorrecthe has immunity to hepatitis C.he does not have hepatitis C.more data is needed. Correct Explanation: The anti-HCV test is a screening test. A patient who has a positive screen for hepatitis C may have the disease, but more data is needed to determine this. Once the screen is positive, a confirmatory test should be performed. The confirmatory test is the RIBA (recombinant immunoblot assay). If it is positive, it indicates past or current infection with hepatitis C. If negative, the RIBA indicates that the screen was a false positive. Question: A 5 year-old has been diagnosed with pinworms. He lives with his mother. There are no other members of the household. How should his mother be managed? Reassure the mother that if she develops symptoms, she will need to be treated.Visually assess the mother’s rectum for redness or presence of worms.Have the mother collect a stool specimen and send it to the laboratory. IncorrectPerform the “scotch tape” test and look at the collection under the microscope. Correct Explanation: The diagnosis of pinworms (Enterobiasis) is made by using a piece of scotch tape on a tongue depressor. It is touched against the patient’s rectum. The greatest yield of eggs will occur during the nighttime or early AM. Eggs will be found here if they are present. Worms and eggs are rarely found in stool specimens, so this is not a good plan. When the scotch tape is examined under a low power microscope, the eggs will be easily visualized since they are large and bean shaped. The finding of an adult worm would confirm the diagnosis. These are large enough to be seen with the naked eye. If the mother is symptomatic, she should be treated with or without a rectal exam. It is very likely she is infected. Question: Older adults frequently complain of constipation. Which medication listed below does NOT increase chance of constipation in an older adult? Diltiazem IncorrectHydrochlorothiazideCalcium supplementsMetformin Correct NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: Constipation is a common complaint in older adults because of mediations they routinely consume and many diseases they often have. Some other examples of medications that can cause constipation are opiate analgesics, NSAIDs, and antacids. Some diseases and conditions that can produce constipation are hypothyroidism, colon cancer, electrolyte abnormalities, immobility, change in diet due to inability to chew food properly. Question: What medication used to treat patients who have GERD provides the fastest relief of heartburn symptoms? Calcium carbonate CorrectRanitidine IncorrectAmantadinePantoprazole Explanation: Calcium carbonate is an antacid. It provides rapid changes in gastric pH. This provides relief that can be noticed immediately. The increase in pH lasts for about 30 minutes. Ranitidine is an H2 blocker. It provides relief in 1-2 hours. This usually lasts for about 6-12 hours. Amantadine is an antiviral not used to treat GERD. Pantoprazole is a proton pump inhibitor. This provides relief after several hours or days of daily consumption. Question: The most common cause of diarrhea in adults is: E. coli.salmonella.C. difficile.viral gastroenteritis. Correct Explanation: Most cases of acute gastroenteritis are viral in origin. Severe diarrhea is usually caused by bacteria. This typically lasts longer than 3 days. Question: A patient has hepatitis B. He probably has a predominance of: leukocytes.lymphocytes. Correctneutrophils.eosinophils. Explanation: Lymphocytes tend to be the predominant white cell present during viral infections. Hepatitis B is a viral infection. The total white count will likely be decreased. This happens very often in the presence of viral infections. A bacterial infection is frequently evidenced by an elevated leukocyte count, a increased neutrophil count, and a decreased lymphocyte count. Question: A 19 year-old female presents with lower abdominal pain that began about 12 hours ago. She is febrile. She denies vaginal discharge. Which choice below is the least likely cause of her symptoms? AppendicitisUrinary tract infectionRenal stone CorrectOvarian cyst Incorrect Explanation: A renal stone can produce lower abdominal pain, but is unlikely to produce fever. Fever can be associated with the presence of a stone if pyelonephritis also accompanies this. However, this is not nearly as likely as the other diagnoses listed. Another diagnosis that must be considered because of her age, is pelvic inflammatory disease. In this case, a pelvic exam should be performed. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: What medication may be used to treat GERD if a patient has tried over the counter ranitidine without benefit? Calcium carbonatePrescription strength ranitidineCimetidinePantoprazole Correct Explanation: If a patient has been diagnosed with GERD and he is symptomatic on an H2 blocker like ranitidine, a proton pump inhibitor (PPI) should be considered. An example of a proton pump inhibitor is pantoprazole. Relief of symptoms after using a PPI does not indicate a benign condition. This patient could have esophageal erosions, Barrett’s esophagitis, or esophageal cancer. He should be screened for risk factors for these conditions and then a decision to refer this patient to gastroenterology can be made. Question: A 56 year-old male patient has been diagnosed with an inguinal hernia. What symptom would make the nurse practitioner suspect an incarcerated hernia? Swelling Change in skin colorConstipationPain Correct Explanation: A hernia is a weakened area in the muscle where loop of bowel protrudes through the abdominal wall. Normally, hernias are not frankly painful, though they may be tender. A painful hernia should be suspected as one that has become incarcerated or strangulated. Incarceration means that the hernia cannot be reduced; it is trapped. A strangulated hernia means that it is incarcerated and ischemia is present. A strangulated hernia is a surgical emergency. Emergency surgery should be performed within 4-6 hours to prevent loss of bowel. Question: The two tests which can indicate with certainty that a patient has hepatitis B at present are: hepatitis B surface antigen and antibody. Incorrecthepatitis B surface antigen and IgM. Correcthepatitis B surface antibody and core antibody.positive IgG and positive core antibody. Explanation: The earliest serologic marker that indicates acute hepatitis B infection is the hepatitis B surface antigen. It becomes positive about 2-6 weeks after infection, but before symptom onset. A positive IgM indicates acute infection at this time. The finding of a positive hepatitis B core antibody identifies with certainty, hepatitis B infection (either at present or in the past). It does not indicate timing of infection. Question: Many older adults have cachexia. What characterizes this? Anorexia and weight lossWeakness and fatigueIllness and loss of muscle mass CorrectStarvation and weight loss Explanation: Cachexia is common in older adults and is associated with increased mortality. It is described as a syndrome of underlying illness that is accompanied by loss of muscle mass. Illnesses associated with cachexia are malignancies, renal disease, COPD, and chronic heart failure. Other matters are associated with cachexia and may contribute to loss of muscle mass. These include loss of appetite, insulin resistance, and increased catabolism of bodily proteins. NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A 45 year-old patient has the following laboratory values. How should they be interpreted? HBsAg (+), HBsAb (-), HBcAb (+) The patient has hepatitis. CorrectThe patient had hepatitis. IncorrectThe patient should consider immunization.The results are indeterminate. Explanation: This patient has a positive hepatitis B surface antigen (HBsAg). Therefore, he has hepatitis B. A positive HBcAb is found in patients who either have hepatitis now or who have had it. The surface antibody (HBsAb) would be expected to be negative in a patient with positive surface antigen (HBsAg) because these 2 markers will not be positive at the same time. Question: Which medication listed below can exacerbate the symptoms of GERD? Verapamil CorrectMetforminFerrous sulfateCeftriaxone Explanation: Verapamil is a calcium channel blocker. Calcium is needed for muscle contraction. Since the lower esophageal sphincter is opened and closed by muscles, the contraction of these muscles will be less forceful. GERD can be exacerbated in this case. Calcium channel blockers should be avoided in patients with severe GERD or in patients in whom calcium channel blockers exacerbate GERD symptoms. Question: A patient has been prescribed metronidazole for treatment of C. difficile. What should be avoided in this patient? Excess fluidsVitamin B12Grapefruit juiceAlcohol Correct Question: A 50 year-old with a history of consumption of 3-4 alcoholic drinks daily and weekend binges has elevated liver enzymes. Which set of enzymes is most representative of this patient? AST= 200, ALT= 75 CorrectAST= 100, ALT = 90AST=100, ALT=200AST= 30, ALT= 300 Explanation: The normal AST/ALT ratio in healthy subjects is 0.8. In patients with alcoholic hepatitis, the usual ratio (AST:ALT) is 2:1. When the ALT is very elevated, infectious hepatitis must be considered. Normally, both AST and ALT are less than 40 IU/L. The level of elevation does not correlate with the degree of damage in the liver and has no prognostic value in patients with non-acute liver disease. Question: The most common risk factor for developing hepatitis B is: homosexual activity.injecting drug use. Incorrectheterosexual activity. Correctbody piercings. NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: Hepatitis B can be contracted by any of the choices listed. However, the one with the highest likelihood of disease transmission, and the one that is most common, is heterosexual activity. Question: An inguinal hernia is palpated on a male patient by an examiner. Which word below best describes what the hernia feels like when touched by the examiner? NodularSilky CorrectFirm IncorrectBumpy Explanation: Patients should be in the standing position when examined for a hernia. They are asked to strain, cough, or bear down after the examiner has inserted his fingertip within the external ring. The word used to describe the impulse of the hernia bumping into the finger is “silky”. Nodular might be the word used to describe a prostate gland. Bumpy implies an irregular surface on some object. This is not the case with a hernia. Question: The most common symptoms associated with gastroesophageal reflux disease (GERD) are heartburn and: cough.regurgitation and dysphagia. Correctcough and hoarseness. Incorrectbelching and sore throat. Explanation: The three most commonly associated symptoms of GERD are heartburn, especially post-prandial, regurgitation, and dysphagia, especially after long-standing heartburn. Other common symptoms are chest pain, nausea, and odynophagia (painful swallowing). Question: Which patient has NO indication for further evaluation of his diarrhea? One with: bloody diarrhea.temperature > 101.3F.duration of illness >48 hours. Incorrectwatery diarrhea and fever. Correct Explanation: Diarrhea is extremely common. Evaluation of diarrhea should take place when specific criteria suggest severe illness. In addition to those listed, some conditions which indicate further work-up are: profuse watery diarrhea with signs of hypovolemia, passage of >6 unformed stools per 24 hours or a duration of illness > 48 hours, recent antibiotic use or recent hospitalization, and diarrhea in a patient > 70 years old. Question: A patient has elevated liver enzymes. ALT = 642 U/L; AST= 150 U/L. What is the likely etiology of the elevation? Acetaminophen toxicity IncorrectAlcohol abuseHepatitis CorrectDrug overdose Explanation: These liver enzymes are elevated. In looking at the numbers, the ALT is grossly elevated compared to the NR 603 Week 4 APEA Predictor Exam TestBank Updated AST. A diagnosis of hepatitis is far more common when the ALT is elevated. AST becomes the dominant liver enzyme when the patient has consumed a substance that causes the liver to be damaged. Examples of this are found in the choices suggesting acetaminophen, alcohol, and drug abuse. Question: Which of the following symptoms is typical of GERD? Chest painCoughSore throat IncorrectPyrosis Correct Explanation: Typical symptoms of GERD include pyrosis (heartburn). The other symptoms listed are considered atypical symptoms of GERD. Patients who present with atypical symptoms of GERD, especially if older than 50 years, should be considered for endoscopy. Question: An 83 year-old patient is diagnosed with diverticulitis. Where is her pain typically located? Epigastric areaRight or left lower quadrantLeft lower quadrant CorrectRight lower quadrant Incorrect Explanation: Diverticular disease is more common in older adults. About 70% of patients diagnosed with diverticulitis have left lower quadrant pain. Pain may be present for several days prior to the acute episode. In addition to left lower quadrant pain, bloating and cramping are commonly described by these patients. Diverticulitis occurs secondary to perforations of a diverticulum. Question: A 10 year-old female presents with a three-month history of abdominal pain. She has been diagnosed with recurrent abdominal pain. During the interview the nurse practitioner is likely to elicit a finding of: nocturnal pain.change in bowel habits.school absenteeism. Correctpain relief with ibuprofen. Explanation: Recurrent abdominal pain can be diagnosed after three episodes of abdominal pain that severely affects the child’s usual activities and occurs over at least a three month period. No acute cause can be identified. Fewer than one in 10 children with recurrent abdominal pain attends school regularly. The goal in treating these children is a return to normal function and activities, not necessarily relief of pain. Caregivers must be coached to avoid reinforcement of pain behaviors with the child. Question: The most common reason that older adults develop peptic ulcer disease is: chronic NSAID use. IncorrectH. pylori infection. Correctacetaminophen abuse.polypharmacy. Explanation: The most common reason that older adults have peptic ulcer disease is infection with H. pylori. There are many regimens approved to treat H. pylori and most are well tolerated. NSAID use is the second most common reason older patients have PUD. NR 603 Week 4 APEA Predictor Exam TestBank Updated Explanation: A positive hepatitis B surface antigen means that this patient has acute hepatitis B. The first serologic marker to be positive is the surface antigen. It can become positive as soon as 3-4 weeks after exposure to hepatitis B. Question: The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and: E. coli. IncorrectEnterovirus.Yersinia.Shigella. Correct Explanation: Shigella will be shed continuously in the stool and should be easily identified on stool culture. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. Generally, these three pathogens are easily identified if they are present. Question: Most patients who have acute hepatitis B infection: are females.are acutely ill.have varied clinical presentations. Correctdevelop subsequent cirrhosis. Explanation: Most patients with Hepatitis B (70%) have sub-clinical hepatitis. Development of cirrhosis is rare following Hepatitis B infection unless other systemic factors are present, such as ethanol abuse, HIV infection, Hepatitis C infection, etc. There is no predilection for this disease by gender. When patients are symptomatic, they typically develop nausea, jaundice, and flu-like symptoms with fever, body aches, and fatigue. Question: A patient has been diagnosed with viral gastroenteritis. He has nausea, vomiting, and has started having lower abdominal cramps. What is the most effective intervention for him? An anti-diarrhealAn anti-emeticAn anti-spasmodicOral rehydration Correct Explanation: Patients with viral gastroenteritis should be treated symptomatically. The goal of therapy is to prevent dehydration and replace electrolyte losses. Loperamide can decrease abdominal cramping and symptoms of diarrhea but should only be used in adults. Careful use or avoidance is suggested in older adults and children less than age 5 years. Question: The initial step in the management of encopresis is: client and family education. Correctbowel cleansing.dietary changes.psychosocial evaluation. Explanation: Encopresis is repetitive soiling of stool by a child who is 4 years of age or older who should be potty NR 603 Week 4 APEA Predictor Exam TestBank Updated trained. The patient and caregivers of a child with encopresis need education about the underlying cause, usually chronic constipation. The initial step is to remove negative attributions regarding soiling. The caregivers should be educated about changing the child’s chronic behavior patterns. The child should not be scolded. The next step after education is to relieve the constipation with a goal of one soft bowel movement daily. Question: A patient has been diagnosed with Hepatitis A. The most common reported risk factor is: drinking contaminated water.homosexual activity. Incorrectinternational travel. Correcteating contaminated food. Explanation: Traveling internationally is the most common risk factor. Hepatitis A (HAV) is spread via the fecal-oral route (and is highly contagious), though most people have no recollection of eating or drinking contaminated food/drink. Mexico, Central and South America are countries with the highest reported rates of HAV. Other risk factors are contact with infected family or close contacts and homosexual activity among men. Hepatitis A has declined since vaccination in the US has become widespread. Question: A healthcare provider (“the HCP”) was stuck with a needle from a patient suspected to be infected with HIV (“the patient”). A rapid HIV test was performed and was found to be positive. This means that the: healthcare provider has been infected with HIV.the patient is infected with HIV.the HIV status of the patient requires further testing. Correctthe HIV status of the healthcare provider requires further testing. Incorrect Explanation: The rapid HIV is always performed on the source patient (“the patient”). It is known as an ELISA (enzyme linked immunosorbent assay). In the patient suspected of being HIV positive, it is performed to establish whether or not he was positive at the time of the needle stick. In this case, it was found to be positive, but, this is a screening test, and false positives can occur. Therefore, a confirmatory test, the western blot, is routinely performed on the patient’s specimen to confirm the findings of the ELISA. The healthcare provider will usually be tested with a rapid HIV but it is done to establish HIV status at the time of the needlestick. It is not used to establish infection in the healthcare provider. The results of a rapid test can be reported in 20-40 minutes. Question: A 70 year-old presents to the nurse practitioner’s office for a well exam today. What medication probably has no affect on screening for occult blood in the stool? AspirinClopidogrelAcetaminophen CorrectIbuprofen Explanation: The exam for occult blood is a screen for colorectal cancer. Aspirin, clopidogrel, NSAIDs, warfarin all decrease the positive predictive value of the test because they all can exacerbate bleeding if it is occurring in the colon secondary to a polyp or tumor. Ideally, the medications mentioned (except acetaminophen) would be stopped prior to the exam to increase the likelihood of test sensitivity, but this is not always possible. Question: NR 603 Week 4 APEA Predictor Exam TestBank Updated A patient with eczema asks for a recommendation for a skin preparation to help with xerosis. What should the NP respond? Use a petroleum based product CorrectUse a hypoallergenic lotionUse any hypoallergenic productNo particular product is better than another Explanation: Xerosis is dry skin. It is common in patients who have eczema. Using thick creams or ointments can prevent xerosis. Lotions should be avoided because they have high water content that promotes evaporation of water from the skin. Hypoallergenic refers to the allergenicity of a product. This is not related to the water content of products. Question: The early signs and symptoms of appendicitis in an adult: are subtle. Correctproduce marked pain in the lower right abdominal quadrant.produce symptoms in the periumbilical region only.include fever, nausea and vomiting. Incorrect Explanation: The most consistent findings in adults with early presentation of acute appendicitis are very subtle and difficult to identify. Symptoms may be as vague as indigestion, flatulence, a feeling of ill-being. Initially, pain can be in the general abdomen, then become periumbilical, and finally localize to the lower right quadrant. Early symptoms are difficult to identify, especially in older adults Question: An elderly adult has constipation. A supplement known to cause constipation is: Vitamin A.calcium. Correctmagnesium.Vitamin B-12. Explanation: Calcium does produce constipation in many patients. If this is taken as a supplement for osteoporosis or osteopenia, the patient should be encouraged to increase fluids and fiber Question: Which imaging study of the abdomen would be LEAST helpful in diagnosing an acute appendicitis? UltrasoundCT scanMRIX-ray Correct Explanation: X-rays are usually not helpful in diagnosing appendicitis, however, some findings on radiograph can be associated with appendicitis: ileus, free air, right lower quadrant appendicolith or soft tissue density, or a deformity of the cecal outline. A CT scan is considered more accurate than an ultrasound, but ultrasound and CT are the most commonly used tests. The sensitivity and specificity with CT scan are 94 and 95% respectively. With an ultrasound, the sensitivity and specificity are 86 and 81% respectively. MRI is generally not used because it is more expensive, takes more time to complete, and is not as readily available. Question: Which of the following is NOT part of the prescription for management of weight loss in older adults? Increase carbohydrate intake CorrectIncrease the calories at each mealIncrease the frequency of mealsConsider liquid supplements Explanation: NR 603 Week 4 APEA Predictor Exam TestBank Updated Question: A 26 year-old female with low-grade fever and nausea has pain at McBurney’s point. The most appropriate action by the NP is to: order a CBC and pregnancy test. Correctorder an abdominal ultrasound.refer her to the emergency department.order an abdominal CT. Explanation: Patients with appendicitis usually have pain at McBurney’s point, the painful area in the lower right quadrant of the abdomen. However, because this patient is of child bearing age, pregnancy is part of the differential and must be ruled out. Once pregnancy status is determined, patient disposition can be managed. If pregnancy is ruled out, then workup for appendicitis can proceed. CT scan of abdomen has very high sensitivity and specificity for appendicitis (95 and 94% respectively) and so it is the gold standard for diagnosis of appendicitis. Question: What is the simplest screen for nutritional adequacy in elderly patients? Measure their weight CorrectMeasure their BMIAsk about food preferences IncorrectObtain a 72 hour food recall diary Explanation: In older adults, serial weight is the simplest screen for assessment of nutritional adequacy. Weight loss in elderly patients is associated with greater mortality than weight maintenance. Question: A 44 year-old non-smoker is diagnosed with pneumonia. He is otherwise healthy and does not need hospitalization at this time. Which antibiotic can be used for empirical treatment according to the 2007 Infectious Diseases Society of America/American Thoracic Society? ErythromycinLevofloxacinAzithromycin CorrectAmoxicillin Explanation: The guidelines recommend macrolide use or doxycycline for initial treatment of uncomplicated pneumonia in outpatients who are otherwise healthy and have not had recent antibiotic exposure. The initial choices can be any of these: azithromycin, clarithromycin, or doxycycline. These agents are chosen because they cover atypical pathogens, the most likely pathogen in this population. Fluoroquinolones are commonly used first line in these patients; however, the guidelines strongly recommend using fluoroquinolones for patients with co-morbidities or those who have recent antibiotic exposure. Question: An independent 82 year-old male patient is very active but retired last year. His total cholesterol and LDLs are moderately elevated. How should the NP approach his lipid elevation? He has reached an age where treatment holds little benefit. IncorrectTreatment is not age dependent; he should receive niacin today.Treatment is based on expected length of life. CorrectHe should receive a statin today until he is 85 years. Explanation: Older adults have higher rates of coronary events than younger adults do. Treatment of elevated lipids in older adults has been shown to decrease overall mortality, decrease major coronary events, and is associated with relative risk reduction for subsequent coronary events. United States Preventive Services NR 603 Week 4 APEA Predictor Exam TestBank Updated Task Force and American Heart Association recommend lipid-lowering therapy because it clearly benefits older adults. This patient should have a statin started if lifestyle modifications do not allow him to reach goal lipid values. Niacin is poorly tolerated and wouldn't be a first choice in older adults because of hypotension and flushing. Question: A characteristic of an ACE inhibitor induced cough is that it: is mildly productive.is worse at nighttime.usually begins within a week of starting therapy. Correctis more common in men. Explanation: The cough associated with use of an ACE inhibitor is typically dry and non-productive. It is more common in women than men and is thought to be due to the buildup of bradykinin. Bradykinin is partly degraded by ACE (angiotensin converting enzyme). When degradation is impaired, bradykinin can accumulate and cough can ensue. Question: A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure? It is dry and non-productive.It is wet and worse with recumbence. CorrectIt is purulent and tachycardia accompanies it.Shortness of breath always results after coughing. Explanation: The cough associated with fosinopril, an ACE inhibitor, is dry, non-productive and may be described as annoying. Its severity does not change with position or time of day. A cough associated with heart failure is wet, worse when lying down, and is usually described by patients as "worse at night". Choice c is often associated with fever and probably reflects an infectious process like pneumonia. Question: A 28 year-old has a Grade 3 murmur. Which characteristic indicates a need for referral? A fixed split CorrectAn increase in splitting with inspirationA split S2 with inspirationChanges in intensity with position change Incorrect Explanation: A split is created because of closure of valves. For example, an S2 is created by closure of the aortic and pulmonic valves. Normally these split with inspiration and almost never with expiration. Splits should never be fixed. This indicates some pathology like an atrial septal defect, pulmonic stenosis, or possibly mitral regurgitation. In any event, this patient needs initial evaluation with an echocardiogram because fixed splits are always considered abnormal. Question: You are managing the warfarin dose for an older adult with a prosthetic heart valve. Which situation listed requires that warfarin be discontinued now? NR 603 Week 4 APEA Predictor Exam TestBank Updated INR of 3, no bleedingINR of 4, no bleedingINR of 6, no significant bleeding CorrectINR of 2 with no significant bleeding Explanation: INR is a good measure of the clotting status in an outpatient who takes an oral anticoagulant like warfarin. When warfarin is overdosed and INR climbs, or when warfarin is overdosed because of food or medication that produces deleterious side effects, warfarin doses may be omitted or discontinued until the INR is in a more acceptable range. Generally, one or 2 doses may be omitted before rechecking INR and resuming warfarin. Question: According to the National Heart, Lung and Blood Institute, which characteristic listed below is a coronary heart disease (CHD) risk equivalent; that is, which risk factor places the patient at similar risk for CHD as a history of CHD? HypertensionCigarette smokingMale age > 45 yearsDiabetes mellitus Correct Explanation: In determining whether a patient should be treated for hyperlipidemia, a patient's risk factors must be determined. After assessing fasting lipids, specifically LDLs, CHD equivalents must be identified. These are diabetes, symptomatic carotid artery disease, peripheral artery disease, abdominal aortic aneurysm, and multiple risk factors that confer a 10 year risk of CHD > 20 percent. Major CHD risk factors are elevated LDL cholesterol, cigarette smoking, hypertension, low HDL cholesterol, family history of premature CHD [in male first degree relatives (FDR) < 55 years; female FDR, 65 years], and age (men > 45 years, women > 55 years). Patients with 2 or more risk factors should have a 10 risk assessment performed and treated accordingly. Question: A 40 year-old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The nurse practitioner replies: palpitations and weakness.ventricular arrhythmias.shortness of breath and syncope. Correctfatigue and exercise intolerance. Explanation: The three most common symptoms associated with aortic stenosis are angina, syncope, and heart failure evidenced by dyspnea. Syncope is usually exertional. Angina may be due to aortic stenosis, but, underlying coronary artery disease accounts for half of anginal symptoms in these patients. There is usually a prolonged asymptomatic phase, but the presence of symptoms usually indicates a need for valve replacement. Without replacement, there is a rapid decline in the patient's status and death will ensue. Question: How often should lipids be screened in patients who are 65 years and older if they have lipid disorders or cardiovascular risk factors? Annually CorrectEvery other yearEvery 3 yearsEvery 5 years Explanation: Screening should take place annually for patients who have coronary artery disease and other risk factors like diabetes, peripheral artery disease, or prior stroke. These patients are at very high risk and annual NR 603 Week 4 APEA Predictor Exam TestBank Updated Just know all your lab values, screening guidelunes. Derm n what they look like plus treatment, management and propitiation, levels of research Fitzgerald has a good hierarchy that was helpful. • 53 questions on clinical management • 7 questions on professional role and policy • 16 questions on nurse practitioner and patient relationship • 39 questions on assessment of acute and chronic illness • 4 questions on research • 31 questions on health promotion and disease prevention The questions cover a range of life stages from birth to aging adult (including pregnant women), although some questions may not be precise about the stage of life. Family Nurse Practitioner Certification Exam Practice Questions 1. The nurse practitioner should order which diagnostic study to confirm a suspected diagnosis of colorectal cancer? a. Stool Hematest b. Carcinoembryonic antigen (CEA) c. Colonoscopy d. Abdominal computed tomography (CT) scan 2. The nurse practitioner is determining if a client's lesions are indicative of herpes zoster. The best way to determine this is that herpes zoster lesions are typically: a. grouped vesicles occurring on lips and oral mucous membranes. b. grouped vesicles occurring on the genitalia. c. rough, fresh, or gray skin protrusions. d. grouped vesicles in linear patches along a dermatome. 3. A client with left-sided heart failure comes into the clinic complaining of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse practitioner recognizes these findings as signs and symptoms of: a. right-sided heart failure. b. acute pulmonary edema. c. pneumonia. d. cardiogenic shock. 4. A nurse practitioner is assessing a client with suspected pneumothorax. To confirm the diagnosis, the nurse practitioner should order: NR 603 Week 4 APEA Predictor Exam TestBank Updated a. arterial oxygen saturation (SaO20) monitoring. b. arterial blood gas (ABG) studies. c. hourly chest auscultation. d. a chest X-ray. 5. What diagnostic study finding helps make a diagnosis of multiple myeloma? a. Decreased serum creatinine level b. Hypocalcemia c. Bence Jones protein in the urine d. Low serum protein level 6. A nurse practitioner suspects neglect in a 3-year-old child seen in the office. What assessment findings should the nurse practitioner look for? a. Slapping, kicking, and punching others b. Poor hygiene and weight loss c. Loud crying and screaming d. Pulling hair and hitting 7. A 2-year-old child is brought clinic with a history of upper airway infection that has worsened over the past 2 days. The nurse practitioner suspects the child has croup. Signs of croup include a hoarse voice, inspiratory stridor, and a. a barking cough. b. a high fever. c. sudden onset. d. dysphagia. 8. A mother brings her 5-year-old son who is complaining of a fever and sore throat to the clinic. A nurse practitioner documents the client's tonsils as 3+. This rating means the tonsils are: a. barely visible outside the tonsillar pillar. b. halfway between the tonsillar pillar and the uvula. c. touching the uvula. d. touching each other. 9. A nurse practitioner is conducting a well-baby examination of an 8-month-old infant. Which reflex does the nurse practitioner anticipate to be present? a. Stepping b. Moro c. Plantar grasp d. Palmar grasp NR 603 Week 4 APEA Predictor Exam TestBank Updated 10. An obese 14-year-old adolescent says that he wants to lose weight. Besides dietary intake and physical activity, what's the most important factor to assess? a. The adolescent's metabolic rate b. Who prepares the adolescent's meals c. How food is used in his home d. His educational interests NP Family Certification Risk Factors of Infection View our NP Family Review on YouTube | Nurse Practitioner Test Secrets Family Nurse Practitioner Certification Exam Answer Key 1. C: Used to visualize the entire colon, colonoscopy aids in the detection of colorectal cancers. A stool Hematest detects the presence of blood in the stool; it doesn't confirm a diagnosis of colorectal cancer. CEA may be elevated in colorectal cancer but isn't considered a confirming test. Abdominal CT scan is used to stage the presence of colorectal cancer. 2. D: Herpes zoster, or shingles, is an acute inflammation of the dorsal root ganglia, causing localized, vesicular skin lesions that follow a dermatome. Herpes simplex type 1 is a viral infection affecting the skin and mucous membranes, usually producing cold sores or fever blisters. Herpes simplex type 2 primarily affects the genital area, causing painful clusters of small ulcerations. Warts appear as rough, fresh, or gray skin protrusions. 3. B: Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid may be driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema characterized by shortness of breath, agitation, and pink-tinged, foamy sputum. In right-sided heart failure, the client exhibits hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client should have a temperature spike, and sputum that varies in color. Cardiogenic shock involves signs of hypotension and tachycardia. 4. D: A chest X-ray confirms the diagnosis of pneumothorax by revealing air or fluid in the pleural space. SaO2 values may initially decrease with a pneumothorax, but they typically return to normal in 24 hours. ABG levels may show hypoxemia, possibly with respiratory acidosis and hypercapnia not related to a pneumothorax. Chest auscultation determines overall lung status, but it's difficult to determine if the chest is reexpanded sufficiently. 5. C: Presence of Bence Jones protein in the urine almost always confirms multiple myeloma; however absence doesn't rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased. 6. B: Neglect can involve failure to provide food, bed, shelter, health care, or hygiene. Slapping, kicking, punching, pulling hair, and hitting are signs of physical abuse. Loud crying and screaming aren't abnormal findings for a 3-year-old child. 7. A: Croup is an acute viral respiratory illness characterized by a barking cough. Fever is usually low- grade. Croup has a gradual onset, and dysphagia isn't a symptom.