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Nurse Practitioner Certification Exam
actual solution
primary lesion - ans-lesion that develops on previously unaltered skin lesion - ans-a region in an organ or tissue that has suffered damage thru injury or disease secondary lesion - ans-lesion that either changes impression over time or occurs when a primary lesion is scratched it may be infected macule - ans-circumscribed flat area; different color and texture from surrounding tissue, <1cm ex.) ephelides (freckles), petechia, flat nevi (moles) patch - ans-a large macule; >1cm ex.) mongolian spot, Cafe, au lair spot papule - ans-Small solid elevated lesion; <1cm ex.) bug bite, elevated nevus (mole) or verruca (wart) plaque - ans-elevation of skin; >1cm; example psoriasis lesion pustule - ans-a visible accumulation of purulent fluid under skin; <1cm; examples acne and impetigo
vesicle - ans-a circumscribed elevation of skin contains "SEROUS FLUID: <1cm; examples, herpes simples, varicella, shingles nodule - ans-solid mass of skin, is elevated or palpated >1cm; often extends deeper into dermis: examples xanthoma and fibroma bulla - ans-blister, circumscribed elevation containing fluid >1cm , extends only into epidermis, examples burns, superficial blister, contact dermatitis wheal - ans-elevated white or pink compressible papule or plaque, a red, axon-mediated flare often surround it, commonly associated with allergic reaction, examples PPD test and mosquito bites cyst - ans-any closed cavity or sac; contains fluid or semisolid material, normal or abnormal epithelium. example sebaceous cyst Abscess - ans-a localized collection of purulent fluid in a cavity formed by disintegration or necrosis of tissues >1cm tumor - ans-"MASS: > few cm in diameter; firm or soft; benign or malignant configuration: annular - ans-circular, begins in center and spreads to periphery configuration: confluent - ans-lesions run together configuration: grouped - ans-lesion cluster configuration: gyrate - ans-twisted, coiled, spiral and snake like configuration: linear - ans-scratch, streak, line stripe configuration: polycyclic - ans-annular lesions merge
group a strep - ans-bactrim + beta lactam (PCN, amoxicillin , keflex) or doxy/inocycline +beta lactam or clindamycin erysipelas - ans-usually caused by strep, rapid progression of an erythematous, warm indurated area (looks like sunburn,) hidradenitis supparativa - ans-staph infection common in groin or axilla ; abscess formation common impetigo - ans-usually caused by staph, primary lesion is thin walled vesicle that breaks easily and honey colored crust at edge; satelite lesions appear and spread to remote areas of skin paronychia - ans-staph around nail fold candida balanitis - ans-inflammation of superficial tissues of penile head caused by candida albicans : managed by steroids, miconazole, clotrimazole or fluconazole candida intertrigo - ans-irruption of the fold of skin in warm, moist body areas; use drying agents like talc, cornstarch, topical antifungals, oral antifungals tinea capitus - ans-dermatophyte infection of scalp caused by trichophyton; managed with selenium shampoo, oral terbinafine, fluconanzole tinea corporis - ans-dermatophyte infection caused by trichomphyton or microsporum; managed with topical antifungals, severe axes systemic therapy ketoconazole tinea curis - ans-jock itch. dermatophyte infection in groin (used topical agents or oral antifungals) tinea pedis - ans-athletes foot treat with miconazole or clotrimazole (pedis) or aluminum sub acetate soaks tinea unguium - ans-onychomycosis ( persistent fungal infection affecting the toe nails and fingernails caused by dermatophytes. treated with oral antifungals
tinea vesicolor - ans-fungal infection of skin caused by yeast, treated with topical selenium sulfide, topical antifungals herpes zoster - ans-pain along dermatomal distribution, usually on trunk, may be life threatening in immunocomprised individuals. grouped vesicles eruption of erythema and exudate along the dermatomal pathway, regional lymphadenoapathy may be present. zostavax - ans-approved 50> for prevention of shingles management of shingles pharmacological - ans-acyclovir, famciclovir, valacyclovir actinic keratosis - ans-small patches occurring on sun-exposed parts of the body. Pre-malignant (1:1000) lesions progress to squamous cell carcinoma. systematic, small patches may be tender, fought, flesh colored, pink and hyperpigmented squamous cell carcinoma - ans-arise out of actinic keratoses; firm , irregular papule or nodule, develop over few months 3-7% metastasize, prolonged sun-exposed areas in fair skin people, keratitic, scaly bleeding treatment of squamous cell carcinoma - ans-biopsy and surgical excision (MOHS) seborrheic keratoses - ans-benign, not painful lesion, beigh, brown, or black plaques, stuck on appearance, 3-20cm basal cell carcinoma - ans-MOST common skin cancer; slow growing; grows 1-2 cm in years; waxy, pearly appearance (may be shiny red), central depression or rolled edge; may have telangiectatic vessels treatment of basal cell carcinoma - ans-shave/punch biopsy and surgical excision malignant melanoma - ans-mortality rate highest of all skin cancers; mediate age of diagnoses 40, may spread to any organ ABCDE
rocky mountain spotted fever - ans- small pox definition - ans-infectious disease unique to humans, caused by virus variants, localizes in blood vessels of the skin mouth and throat signs and symptoms of small pox - ans-Sudden onset flu like symptoms, rash appears as flat , red spots/lesions that turn into blisters within 2 days filled with clear fluid and later with pus*pain is excruciating what is the hallmark distribution of small pox, which is the primary way of diagnosing - ans-1st lesions appear in oral mucosa/face or forearms 2nd. centrifugal distribution (trunk and spreads out) with greatest concentration on face, distal extremities 3rd on any one part of body, all lesions are in the same stage of development 4th scabs lead to pitted scars. how to treat small pox - ans-1. small pox vaccine before infection 2. no cure once infected 3. supportive therapy and antibiotics to treat secondary bacterial infections 4. isolation of infected person to prevent spreading to others Antrax definition - ans-acute disease caused b the bacterium "bacillus anthraces" (referred to as spores) but are not fungal spores. 2. anthrax spores can be produced in vitro and used as biological weapon 3. disease is mostly lethal; affects humans and animals 4. spores are transported by clothing, shoes, body of dead animals that die of anthrax what are the signs and symptoms of anthrax? Cutaneous form - ans-1. cutaneous (95% cases) a. occurs on exposed areas on arms and hands, followed by face and neck b. pruritic papule leading to ulcer surround vesicles. c. develops into black necrotic central eschar with edema d. after 1-2 weeks, eschar dries, loosens and separates, leaving a permanent scar e. regional lymphadenopathy signs of symptoms of anthrax inhalation form - ans-5% of cases. follows deposition of spore-bearing particles into alveolar spaces, clinical presentation shows a biphasic pattern. (A) prodromal phase: non- specific flu-like symptoms, dyspnea, malaise, myalgia (B) Fulminant phase: fever, diaphoresis and septic shock
lab testing and treatment for anthrax - ans-gram stain of specimen. vaccine exist for those at risk such military. Antibiotics: penicillin, cipro, doxycycline and report to health deparment Warts definition - ans-1. benign epidural neoplasm caused by HPV 2. transmitted by direct contact 3. several types Common wart : verruca vulgaris - ans-flesh-colored papule with rough surface treated with salicylic acid, liquid nitrogen, electrocautery filiform warts (digitate) - ans-finger-like appearances with various projections. Treated with tretinoin cream, liquid nitrogen and electrocautery flat warts - ans-pink or light yellow. Treated with tretinoin cream, liquid nitrogen and electrocautery plantar warts - ans-roughened surface, slightly raised and may be painful. Treated with salicylic acid c, compound W freeze off (OTC-cyro) blunt dissection, laser therapy genital warts - ans-pale pink with several projections and broad base (think cauliflower) treated with 20% podophyllin resin (pododerm) podofilox (condylox) cryosurgery, trichloroacetic acide What is an allergic reaction and treatment - ans-hypersensitivity reaction to a particular allergen; symptoms can vary from mild to severe. Treated with withdrawal of any medication that is causing reaction, antipruritic agent and antihistamine frost bite - ans-tissue damage resulting from exposure to cold. Assess for hypothermia, soak in water 100F, treat for pain insect stings or bites - ans-may cause a toxic reaction that range from local to mild to life threatening; remove stinger, topical or intra-lesional corticosteroids, topic anesthetics Oral contraceptives categories - ans-1. combined pills alter dosage of estrogen and progestin throughout the cycle and progestin only pills (not as effective) in which mechanism of action affects the cervical mucus and endometrium, most likely changes tubal transport of oocyte and sperm
EXCEssive androgenic effects of oral contraceptives - ans-hirsutism, acne, oily skin, edema, increased libido, What are some EXCESS estrogen/deficient progesterone combination effects? - ans-dysmenorrhea, menorrhagia (heavy bleeding), nausea, vomiting, headache, irritability, bloating, syncope what are some absolute contradictions in prescribing oral contraceptives - ans-history of thromboembolic disorders, CVA, CAD, known or suspected breast ca, or estrogen dependent neoplasia, pregnancy, benign or malignant liver tumor, impaired liver function, previous cholelithiasis during pregnancy, undiagnosed abnormal uterine bleeding, what are some prescriptive guideline for oral contraceptives - ans-1 begin low lose combo or multi phasic pill (35mcg or less), progestin only pills may be used in women with history of migraines, who are breast feeding or who have contraindication with combo pill what pregnancy category for Oral contraceptives/ - ans-X, stop immediately NuvaRing - ans-flexible, ring , 2 inches in diameter to prevent pregnancy; failure rate <1-2% what is mechanism of action of NuvaRing - ans-releases synthetic estrogen and progestin (etonogestrel) , 1 month protection, release of hormone activated by vaginal contact, prevents ovulation, thickens cervical mucus, inhibits sperm penetration what are some of advantages of Nuva Ring - ans-discreet, can not be felt by partner, once a month insertion, shorter and lighter periods, improves acne, depression and cramps what are some disadvantages of Nuva Ring - ans-similar to O.C.; also diaphragms, cervical caps or shields can not be used as back up methods while using rings, may worsen depression if previously diagnosed, no protection STDS, can't be used in pt >35 or uncontrolled HTN, or smoke >15 cigarettes daily how long is a NovaRing left in place for - ans-21 days, if ring slips out, must be re-inserted within three hours or must use back up
the patch - ans-a transdermal contraceptive patch that releases synthetic estrogen and progesterone ; failure rate <1-2%; prevents ovulation What are advantages of the patch - ans-administered once a week, can be worn for three weeks, easily reversible, sexual activity not interrupted what are disadvantages of the patch - ans-site reactions, similar to OC's, reduced effectiveness in woman >90Kg or 198 lbs, reduce effectiveness with concurrent use of antibiotics, antifungals, anticonvulsants, St John's wart, Seriously increased cardiovascular risks b/c it releases 60% more estrogen then O.C's, do not use woman> how should you use patch - ans-patch applied on first day of cycle or on first sunday after, patch removed seven days later and then add new patch, after the third week, you wait 7 days (patch free) before re-applying patch, if patch stays off for more than 24 horus, you must restart a 4 week cycle along with using back up what is repo-provera (DMPA)? - ans-long-acting progestin by IM injection, failure rate <1%, how does DMPA work (Depo) - ans-supresses follicle stimulating hormone (FSH) and luteining hormone (LH), thus blocking LH surge which inhibits ovulation, thickens mucus and thins endometrium lining what are advantages of DePO - ans-highly effective, prolonged amenorrhea, reduces pain associated with endometriosis, no estrogen side effects, reduction risk of PID, endometrial and ovarian cancers what are disadvantages of Depo? - ans-amenorrhea, delayed return of fertility of (up to one year) and must have injection every three months what are some undesirable effects of depo - ans-lipid changes, decreases HDL , reduction in bone density with long term use, anaphylactic reactions may occur what are some prescriptive guidelines for Depo - ans-pregnancy test if longer than 2 weeks since three month period ended, there is a two week grace period when injection is given every three months, do no massage injection site, use back up methods for first two weeks unless administer by doc 5
what are some absolute contraindications for using IUD - ans-active, recent or recurrent pelvic infection, pregnancy, risk of PID, undiagnosed irregular uterine bleeding what are some prescriptive guidelines for IUD - ans-requires informed consent, may be inserted at anytime of cycle, but expulsion is greater during menses, may insert 4-8 weeks postpartum, make sure patients know to check strings, monitor for bleeding, fever, chills diaphragm /cervical cap - ans-flexible dome shape cup constructed of latex rubber that prevents pregnancy by blocking the transport of sperm through cervical os; typical first year failure rate ***18% not. when used with spermicidal gel or cream destroys the cell membrane of sperm - ans-diaphragm/cervical cap what are advantages of diaphragm/cervical cup - ans-may provide protection against some STD's when used with spermicidal gel (nonoxynol-9), safe and easy to use, inserted before inters coarse, provides immediate protection what are some undesirable effects of diaphragm/cervical cap - ans-skin irritation may occur secondary to latex or spermicide, increased risk of UTIs and vulvovaginitis; allergic reaction, or inability to insert product what are some management and prescriptive guidelines for diaphragm/cervical cap use? - ans-check for holes and tears, should be re-fitted with weight gain or loss of 20 pounds or more, avoid oil-based lubricants because it destroys latex, must be left in vagina for at least 6 hours following intercourse, must instill spermicide in vagina (not removing diaphragm) for repeated intercourse. spermacides - ans-preparations which contain chemicals, nonoxynol-9 or octoxynol, that destroys sperm. typical first year failure rates 21% advantages of spermicides - ans-OTC product, immediate protection, also agains some STD,s, enhances effectiveness of barrier methods
disadvantages of spermacides - ans-vaginal or penile irritation, suppositories may completely dissolve, unpleasant taste , (what? lol), allergy, sponge - ans-disposable, round barrier of soft polyurethane which fits over the cervix, similar to diaphragm, that contains spermacide; failure rate 10%, brand names are today or protectAID IN CANADA Advantages of sponge - ans-no felt, inserted up to 6 hours before intercourse, may provide protection against gonorrhea and chlaymdia what are disadvantages of sponge - ans-risk of toxic shock syndrome if you leave in too long, contraindicated if allergic to spermacides, what are management /prescriptive guidelines for sponge - ans-inserted into vagina using cord loop attachment, can be inserted up to 6 hours before, should be left in place 6 hours after intercourse, provides protection for up to 12 hours, should not be left in vagina for more than 30 hours condoms - ans-sheath-like covering usually made of latex, inserted over penis or into vagina, may have spermacide, failure fate male 12% and female 21% advantages of condom - ans-OTC, safe to use, immediate protection against pregnancy and most STDs disadvantages of condom - ans-produce less sexual sensation, they break or slip, foreplay is interrupted, if they are 'NATURAL skin" condoms, they DO NOT protect against STD's, also, do not use if allergic to spermicide or rubber how to use condoms - ans-avoid oil based lubricants, lubrications with increase sensation, to reduce breakage, leave half inch of empty space at end of condom, effectiveness increase if spermicide used emergency contraception - ans-mechanism used to either prevent fertilization or implantation of a fertilized egg in uterus
lactational method of contraception - ans-relies on breastfeeding for family planning, which often delays the onset of ovulation and menstruation for about 6 months intrauterine pregnancy - ans-40 week process in which an embryo grows and develops into infant in uterus, first trimester to 12 weeks, second trimester to 13-27 weeks and last trimester 28-40 weeks symptoms of first trimester - ans-amenorrhea, nausea, vomiting, fatigue, breast tenderness, urinary frequence symptoms of second trimester - ans-fetal movement, abdominal discomfort, changes in skin pigmentation, syncopal episodes symptoms of third trimester - ans-abdominal growth, braxton hicks , return of urine frequency with discount of presenting part, increased respiratory effort until decent physical examination of first trimester - ans-breast enlargement, Goodell's sign (softening of cervix), chadwick sign (cervix cyanosis), Hegar's sign (softening of cervicouterine junction, fetal heart tones 10- 12 weeks physical examination of second trimester - ans-striae may appear, funds palpable at umbilicus at 20 weeks and grows 1cm per week after, leopold maneuvers after 20 weeks (four steps to determine fetal position) physical exam of third trimester - ans-lightening may occur up to 3-4 weeks prior to labor, loss of mucus plug, bloody show prior to labor by one week, increased braxton hicks/rupture of membranes pregnancy tests - ans-urine or serum; quantitative titiers or serum Hcg, ultrasound what trimester is Chorionic villus sampling done (CVS) - ans-first trimester what semester do you perform an amniocentesis and when? - ans-15-20 weeks if family history of chromosomal abnormalities or advanced material age
what other screening test are done in second trimester - ans-triple or quad screen (multiple marker test) and ultrasound for fetal survey at 18-20 weeks; and one hour GTT at 20 weeks if family history of diabetes or pt weighs more than 200 pounds third trimester screening - ans-RhoGam for un-sensitized Rh-negative mothers at 28 weeks, Hgb/Hct at 28-36 weeks; non stress test (NST) biophysical profile (BPP) as needed for assessment of fetal well being scheduling for prenatal visits - ans-0-28 weeks: every four weeks 28-36 weeks: every two weeks 36 weeks to delivery: every week Naegele's rule - ans-establishment of estimated date of confinement (EDC) based on last normal menstrual period (LNMP)= 1 year-3 months+7 days labs done on return OB visits - ans-routine, plus urine for protein, glucose, ketones at each visit (looking for preeclampsia) 95% of ectopic pregnancies occur in - ans-fallopian tubes symptoms of ectopic pregnancies - ans-abnormal uterine bleeding, abdominal or pelvic pain, lower back or shoulder p win, hemodynamic changes in vital signs (shock-rupture) physical exam of ectopic pregnancy - ans-tender adenexa ( appendages of uterus= ovaries, fallopian tubes, and ligaments that hold uterus in place); positive cervical motion tenseness, uterine enlargement with hegar's sign (softening and consistency of cervix), positive peritoneal signs if rupture abortion - ans-pregnancy termination at any time prior to viability (20 weeks) either through spontaneous or expulsion or medical/surgical removal approximately what percentage of pregnancies are abortions - ans-15% what causes abortion in first trimester - ans-chromosomal abnormalities
headaches, visual disturbances; reflexes WNL progress to 3-4+ with worsening condition; lagging fundal height management of preeclampsia - ans-strict bed rest with worsening condition in left lateral recumbent position, fetal surveillance, referral, kick counts at home, weekly steroid injections (B-methasone) for fetal lung maturity if <34 weeks and hospitalization with MgSo4 therapy if severe condition, then delivery if >34 weeks or 2 doses of B-methasone
