PSI APEA FNP Practice Exam Updated 2023-2024 New Latest Version with All Questions, Exams of Nursing

Download PSI APEA FNP Practice Exam Updated 2023-2024 New Latest Version with All Questions and more Exams Nursing in PDF only on Docsity! PSI APEA FNP Practice Exam Updated 2023-2024 New Latest Version with All Questions from Actual Past Exam and 100% Correct Answers Which of the following criteria differentiates a TIA from a stroke? A. focal symptoms B. Amnesia of incident C. Slowness of onset D. Absence of residual symptoms ------- Correct Answer -------- D. absence of residual symptoms Which of the following best describes psoriatic lesions in an elderly patient? A. Shiny, purple, smooth lesions B. Localized erythematous vesicles C. Erythematous plagues with central clearing D. Red, sharply defined plaques with silvery scales ------- Correct Answer -------- D. Red, sharply defined plaques with silvery scales A 68-yo female presents with a new onset of left-sided throbbing headache. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. Sedimentation rate is elevated, but all other lab values are WNL. The headache is most likely due to: A. TIA B. NSAID induced headache C. Temporal arteritis D. Glaucoma ------- Correct Answer -------- C. Temporal arteritis A patient with macular degeneration has difficulty seeing objects: A. from a distance B. In the center of the visual field C. At reading distance D. In the peripheral fields ------- Correct Answer -------- B. In the center of the visual fields. Trigeminal neuralgia manifests itself primarily with: A. electric-shock-like unilateral facial pain B. Unilateral facial asymmetry C. Burning bilateral facial pain D. jaw pain extending to the neck ------- Correct Answer -------- A. Electric-shock-like unilateral facial pain A 65-yo male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical exam, the patient is tachycardic, positive for jugular venous distension, and positive for S3, with a systolic murmur. Chest xray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: A. mycardial infarction B. pneumonia C. Heart failure D. pleural effusion ------- Correct Answer -------- C. Heart failure An 88-yo patients has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: A. lateralize to the left B. lateralize to the right C. Be inconclusive D. Not lateralize ------- Correct Answer -------- A. Lateralize to the left. A 38-yo male experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Examination reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: A. Testicluar cancer B. Testicular torsion C. Appendicitis D. Epididymitis ------- Correct Answer -------- B. Testicular Torsion Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: A. oxygen B. Anticholinergic drugs C. Systemic steroids D. Exercise ------- Correct Answer -------- A. Oxygen A 15 year old patients returns for contraceptive services 2 weeks after a diagnosis of trichomonas vaginitis and treatment with 2gm of metronidazole (Flagyl). She reports that discharge and itching are gone, but she is urinating frequently, accompanied with alot of burning. The patient has not resumed sexual activity and has menstrated since her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which diagnostic test should be performed immediately? A. Urine pregnancy test B. Microscopic exam of urine C. Herpes simplex virus culture D. Repeat chlamydia test. ------- Correct Answer -------- B. Microscopic exam of urine. 14 year old patient who fell on a outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on xray. The most likely working diagnosis is: A. Urticaria B. No remarkable clinical symptoms C. A green mucoid penile discharge D. A penile ulcer ------- Correct Answer -------- B. No remarkable clinical symptoms To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: A. The meaning of a common proverb B. What action the patient would take if their was a fire in the house C. To count backwards from 100 by 7s D. To spell a word backward. ------- Correct Answer -------- A. The meaning of a common proverb A common rule to follow when prescribing many medications for the elderly is to: A. Give most medications in the morning to allow slowed body functions to have time to adjust to the drug. B. Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. C. Perform a creatinine clearance test for baseline data on all person over age 70 before starting on new medications. D. Give medication with a full glass of water to promote absorption and limit harm to the kidneys. ------- Correct Answer -------- B. Start at a low dose than what is commonly prescribed for adults, and increase the dose slowly. A 72 year old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3am, is reluctant to go out although she has family member living nearby, and feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include: A. Stroke, depression, and hyperthyroidism B. Depression, Unresolved grief, and hypothyroidism C. Migraine, anxiety disorder, and hypertension D. Dementia, delirium, and pna ------- Correct Answer -------- B. Depression, Unresolved grief, and hypothyroidism The parent of a 13-year old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The nurse practitioner should advise the parent that development of fever may: A. make the seizure medication less effective B. Lower the seizure threshold C. Increase the seizure threshold D. Have no effect on the seizure threshold ------- Correct Answer -------- B. Lower the seizure threshold After a 3-week camping trip, an 11-year old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: A. trimethoprim-sulamethoxazole (Bactrim) B. Azithromycin (Zithromax) C. Metronidazole (Flagyl) D. Doxycycline (Doryx) ------- Correct Answer -------- D. Doxycycline An 88 year old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? A. Folstein Mini-Mental State examination B. Geriatric Depression Scale C. Minnesota Multiphasic Personality Inventory Myers-Briggs Test ------- Correct Answer -------- A. Folstein Mini-mental state examination During development of a treatment plan for an 84 year old patient with hypothyroidism, the nurse practitioner has to keep in mind the worsening of: A. renal insufficiency B. Osteoporosis C. Dementia D. Anemia ------- Correct Answer -------- B. Osteoporosis A 16 year old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She hasn't missed any doses and uses no other medication. Which of the following is appropriate? A. Modifying use B. Double dosing for 2 days C. Changing to Ortho-Novum 1/35 D. Providing reassurance ------- Correct Answer -------- D. Providing reassurance The management of choice for polymyalgia rheumatica includes: A. whirlpool B. Prednisone C. Anelgesics D. Celebrex ------- Correct Answer -------- B. Prednisone A 50 year old male presents with a chief complaint of malaise. Further questioning reveals that his primary concern is delayed ejaculation. He is currently taking the following medications: atenolol (Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and hydrochlorthoriazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be: A. loratadine B. hydrochlorthoriazide (HCTZ) C. lisinopril (Zestril) D. paroxetine (Paxil) ------- Correct Answer -------- D. Paroxetine (Paxil) A 3 year old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? A. throat culture B. sputum culture C. Mantoux (PPD) skin test D. Cold agglutinin test ------- Correct Answer -------- B. Sputum culture A 25-year old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated with movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? A. Palpate structures around the shoulder B. Obtain an MRI to evaluate the shoulder C. Order an Xray of the shoulder D. Request an EMG ------- Correct Answer -------- A. Palpate the structures around the shoulder A 17 year old femlae has never had her menses. She is at Tanner stage III of sexual development. Her physical exam in completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? A. Ovarian dysgenesis B. Dysmenorrhea C. Primary amenorrhea D. Secondary amenorrhea ------- Correct Answer -------- C. Primary amenorrhea An 18-month old child presents with a bulging, immobile tympanic membrane; T- 103F(39.4C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: A. Obtain an EKG B. Obtain an Echocardiogram C. Reevaluate the patient in 10 days D. Refer the patient to a cardiologist ------- Correct Answer -------- C. Reevaluate the patient in 10 days Which of the following is NOT an indication of preeclampsia? A. visual disturbances B. Glucosuria C. Edema of the face and hands C. Palpitations D. Sweating ------- Correct Answer -------- D. Sweating A 67-year old with type 2 diabetes mellitus, congestive heart failure, and mild coronary artery disease is currently taking Digoxin, 0.25mg daily; HCTZ, 25mg daily; Metformin 500mg daily; glipizide 10mg daily; and Atorvastatin (Lipitor) 20mg HS. Which of the following is an accurate statement regarding the regimen? A. The glipizide will increase the risk of potassium depletion. B. The digoxin will increase the risk of hypoglycemia C. The HCTZ will predispose the patient to Digoxin toxicity D. The atorvastatin will worsen the diabetes. ------- Correct Answer -------- C. The HCTZ will predispose the patient to Digoxin toxicity The initial therapy for a 3 week old infant with uncomplicated symptoms of gastroesophageal reflux disease includes of the following positions and change in diet? A. Prone position and rotate formulas in order to find one that causes less reflux B. Smaller, more frequent feedings while holding infant C. Semisupine position and offer more ounces of formula less frequently D. Lateral position and start small amounts of solid food with formula ------- Correct Answer -------- Smaller, more frequent feedings while holding infant. A patient with Type 1 diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of an at-home glucose test reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: A. Insulin resistance B. Cortisol deficiency C. the Somogyi effect D. pawn phenomenon ------- Correct Answer -------- C. the Somogyi effect An 18 yo college student presents for an athletic physical. When asked about current medications, she mentions that she takes "some hearb" she bought at a health food store for migrains and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? A. Ephedra B. Echinacea C. Feverfew D. Ginko Biloba ------- Correct Answer -------- C. Feverfew Which of the following GI changes in associated with normal aging? A. Decreased production of gastric acid B. Decreased incidence of gallstones C. Increased salivation D. Increased esophageal emptying ------- Correct Answer -------- A. Decreased production of gastric acid. A 32 year old patient reports a 6-month history of intermittant symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Gouty arthritis D. Reiter's syndrome ------- Correct Answer -------- A. Rheumatoid Arthritis An 85 year old patient related that on the way to an annual physical exam, the patient suffered a sudden loss of vision in the right eye characterized by a "bunch of lights" and a feeling that " a curtain came down" The most likely diagnosis is: A. Vitreal hemorrhage B. Optic nerve lesion C. Central retinal nerve occlusion D. Retinal Detachment ------- Correct Answer -------- D. Retinal detachment Assessment findings that would support a diagnosis of mitral regurgitation include: A. atrial fibrillation with summation gallop B. Loud, high-pitched pansystolic murmur C. Diastolic murmur with split S1 D. Early diastolic murmur with an S3 wave. ------- Correct Answer -------- B. Loud, high- pitched pansystolic murmur During an employment physical exam of a 21-year old female, bruising around the areola on the breasts is noted. An appropriate health history for these findings should include all of the following EXCEPT: A. Current social relatonships B. History of present or past traumas C. Mental health status D. Socioeconomic status. ------- Correct Answer -------- D. Socioeconomic status. According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a vlaue equal to or greater than: A. 100 mg/dl B. 126 mg/dl C. 140 mg/dl D. 180 mg/dl ------- Correct Answer -------- B. 126 mg/dl A nurse practitioner orders pulmonary rehabilitation for a 75 yo patient with COPD. Expected outcomes of this program include all the following EXCEPT: A. enhanced quality of life B. Increased lung capacity C. Decreased in-patient hospitalizations D. Improved exercise capacity ------- Correct Answer -------- B. Increased lung capacity A 2month old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (not beet red) macular rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted . The infant's rash is most likely caused by. A. Candida albicans infections. B. Eczema C. Seborrheic dermatitis D. Contact dermatitis ------- Correct Answer -------- D. Contact dermatitis A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T=100F (37.8C). The patient does not apear toxic and can tolerate fluids. An appropriate plan should include: A. barium enema and nothing by mouth B. Clear liquids and antibiotics C. low-fiber diet and referral to gastroenterologist D. hospital admission for IV antibiotics ------- Correct Answer -------- B. Clear liquids and antibiotics. Which class of antihypertensive agents has been associated with acute renal failure and is contraindicated in patients with bilateral renal artery stenosis? A. Calcium channel blockers B. Thiazide diuretics C. Potassium-sparing diuretics D. Angiotensin-converting enzyme (ACE) inhibitors. ------- Correct Answer -------- D. ACE inhibitors A 70 yo male presents with parathesia of the lower extremities. On exam, the patient appears pale and shows a decreased vibratory sense. Lab tests reveal elevated indirect bilirubin; Hct=30%; Mean corpuscular volume(MCV)=120 (norm 87-103). The most likely diagnosis is: A. pernicious anemia B. Anemia of chronic disease C. folic acid deficiency D. Iron deficiency anemia ------- Correct Answer -------- A. Pernicious anemia Which of the following findings is typically a sign of acute appendicitis? A. Positive Murphy's sign B. Rebound tenderness at McBurney's point C. A negative Rovsing's sign D. Positive Prehn's sign ------- Correct Answer -------- Rebound tenderness at McBurney's point Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? A. Pain worse in supine position; focal neurological signs Cremasteric Reflex ------- Correct Answer -------- a superficial (i.e., close to the skin's surface) reflex observed in human males. This reflex is elicited by lightly stroking the superior and medial (inner) part of the thigh-regardless of the direction of stroke. The normal response is an immediate contraction of the cremaster muscle that pulls up the ipsilateral testis. Edema from extravascular fluid retention is visible in conditions like ------- Correct Answer -------- heart failure, nephrotic syndrome and liver failure. Drugs associated with weight gain include ------- Correct Answer -------- Tricyclic antidepressants, insulin and sulfonulurea, contraceptives, glucocorticoids, progestational steroids, mirtazapine and paroxetine, gabapentin and valproate and propanolol Causes of weight loss include ------- Correct Answer -------- GI deases; endocrine disorders (diabetes, hyperthyroidism, adrenal insufficiency); chronic infections, HIV/AIDS; malignancy; chronic cardiac, pulmonary, or renal failure; depression; and anorexia nervosa or bulimia; Appendicitis is a common cause of acute abdominal pain. ------- Correct Answer -------- Assess for positive McBurney's point tenderness, Rovsing's sign, the psoas sign, and obturator sign. Rovsing's sign ------- Correct Answer -------- Pain in the RIGHT lower quadrant during LEFT-sided pressure is a positive Rovsing's sign. Indicates appendicitis Psoas Sign ------- Correct Answer -------- Increased abdominal pain when patient attempts to raise thigh against your hand or when asking the patient to extend their right leg at the hip. Indicates Appendicits Oburator Sign ------- Correct Answer -------- right hypogastric pain constitiutes a positive obturator sign. Ask patient to flex right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. Positive Murphy's sign ------- Correct Answer -------- indicates Acute Cholecystitis. Right upper Quadrant What test is used to assess peripheral arterial disease (PAD)? ------- Correct Answer ---- ---- ankle-brachial index. Heberdens nodes ------- Correct Answer -------- Found at the distal interphalangeal joint (DIP). Seen in osteoarthritis. Finkelstein's Test ------- Correct Answer -------- If positive, Indicates de Quervain's tenosynovitis. Grasp the thumb against the palm and then move the wrist toward the midline in the ulnar deviation Carpal Tunnel maneuvers ------- Correct Answer -------- Tinnel's and Phalen's Evaluation of a meniscal tear using ------- Correct Answer -------- McMurray Sign and a locking on full knee extension Abduction (Valgus) stress test ------- Correct Answer -------- Evaluate for Medial Collateral Ligament (MCL) injury Adduction (Varus) Stress test ------- Correct Answer -------- Evaluate for lateral collateral ligament (LCL) injury Evaluation of Anterior Cruciate Ligament (ACL) injury ------- Correct Answer -------- Anterior Drawer sign and Lachman test Evaluating Posterior Cruciate Ligament (PCL) injury ------- Correct Answer -------- Posterior drawer sign Cranial Nerve I ------- Correct Answer -------- Smell (1 nose) Cranial Nerve II ------- Correct Answer -------- Vision (2 eyes) Cranial nerve III, IV, VI ------- Correct Answer -------- Eye movement Cranial Nerve V,VII,X,XII ------- Correct Answer -------- Voice and speech Cranial Nerve VIII ------- Correct Answer -------- Acoustic (Hearing and balance) Cranial nerve IX ------- Correct Answer -------- Glossopharyngeal- swallowing and rise of the palate, gag reflex Cranial Nerve XI ------- Correct Answer -------- Spinal Accessory (upper trapezius) Deep tendon reflex ------- Correct Answer -------- Ankle- S1 primarily Knee- Lumbar 2,3,4 Supinator(brachioradialis)-C5,6 BicepTriceps-C6,7 Stroke risk scale ------- Correct Answer -------- CHADS2 C-Congestive heart failure H-Hypertension A-Age >75 years D- Diabetes S-prior Stroke/TIA In the majority of children, the first permanent teeth start to erupt at the age of 6 years. Which of the following are the first permanent teeth to erupt in this time period? A. First Molars B. Second Molars C. Lower or upper incisors D. Canines ------- Correct Answer -------- A. First Molars All of the following are classified as activities of daily living (ADLs) except: A. ability to feed self B. Ability to manage bladder and bowel elimination C. Personal hygiene and grooming D. Grocery Shopping ------- Correct Answer -------- D. Grocery shopping You note the following result on a routine urinalysis of a 37-year old primigravida who is at 30 weeks gestation. Leukocyte=trace, nitrite=negative, protein=2+, blood=negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A.HELLP syndrome B. Pregnancy-induced hypertension (pre-eclampsia) C. Eclampsia of pregnancy D. Primary hypertension ------- Correct Answer -------- B. Pregnancy-induced hypertension (pre-eclampsia). Classic triad of symptoms of preeclampsia include hypertension, edema (weight gain), and proteinuria. The mother of a 12 month old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A. Fifth Disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes ------- Correct Answer -------- B. Roseola Infantum (Exanthema subitum) A 70-year old male patient complains of a bright red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on Bayer aspirin, 1 tablet a day. Which of the following is most likely? A. Corneal abrasion B. Acute bacterial conjunctivitis C. Acute uveitis D. Subconjunctival hemorrhage ------- Correct Answer -------- D. Subconjunctival hemorrhage. Bright red blood in a sharply defined area surrounded by normal- appearing conjunctiva indicates subconjunctival hemorrhage. Education of women with fibrocystic breast disease should include which of the following statements? ------- Correct Answer -------- Caffeine may trigger breast pain. Avoidance of all methylxanthines (eg coffee, tea, chocolate) has been shown to reduce breast pain in women with fibrocystic breast disease. It is usually a benign condition, not a precursor of malignancy. Mammography is recommended once at age 35 years, at least every 1-2 years after age 40, and then annually beginning at age 50 years. Oral contraceptives may help reduce cyclical pain and swelling. Congenital heart disorders present with symptoms at: ------- Correct Answer -------- birth, infancy, or in childhood. A common misconception is that congenital disorders always present symptomatically at birth. They can present at various times throughout childhood and are classified as cyanotic or acyanotic. Cardiac disorders in infants and children may be acquired from rheumatic fever or kawasaki syndrome. A 21-yo patient presents with abdominal guarding, rigid abdominal musculature, rebound tenderness at McBurney's point, and leukocytosis. What is the most likely diagnosis? ------- Correct Answer -------- Appendicitis. McBurney's point is the RLQ abdominal landmark for the appendix. Rigid abdominal musculature, rebound tenderness, and positive psoas sign (inflamed psoas muscle), indicates inflammation of the peritoneum. Cholecystitis presents with RUQ pain and positive Murphy's inspriatory arrest. Ilcerative colitis presents with LLQ pain. Pain associated with pancreatitis is typically in the epigastric region. Atenolol (Tenormin) should be avoided in: ------- Correct Answer -------- a 43-yo female with asthma. Atenolol is a beta blocker. It should be avoided in pateints with asthma or other bronchospastic conditions. These patients often require beta stimulation, not beta blockade. Although atenolol is a beta 1-selective agent, at higher doses beta 2 receptors (bronchial and vascular) are blocked. Beta blockers, specifically atenolol, are beneficial post-myocardial infarction because they have demonstrated a reduction in morbidity and mortality. All of the following interventions with pediatric patients are appropriate EXCEPT: ------- Correct Answer -------- Pre-medicate the patient prior to all painful interventions. Pre-medication is not warranted prior to all painful interventions. For example, premedication is not warranted prior to routine immunizations but it certainly is prior to suturing. Pain management should be an integral part of patient management. Infants with veliac disease (gluten eneteropathy) are at risk for multiple complications. The most urgen complication of this disease is: ------- Correct Answer -------- Intususseption or volvulus. Intuseusseption and volvulus are surgical emergencies. Delay releasing the invaginated or "telescoped" bowel (intususseption), or releasing the twisted bowel (volvulus) may result in tissue death and gangrene, perforation, peritonitis, and/or sepsis, and fatality. There is also a high rate of intususseption and volvulus among infants with cistic fibrosis. Which activities are NOT characteristic of preschool children? ------- Correct Answer ----- --- Always follow rules during playground games. Since preschoolers are just beginning to learn moral behaviors, they often cheat to win. While most preschoolers toilet independently, accidents occasionally occur and bed- wetting is not unusual. The use of a security item such as a blanket is common. A 38-yo pregnant patient at 18 weeks gestation, complains of feeling light-headed when standing. Which of the following is an appropriate response by the NP? ------- Correct Answer -------- Blood pressure normally decreases during pregnancy and can cause this symptom. Blood pressure normally decreases during pregnancy, reaching the lowest point during the second or third trimesters and rising there after. Patient education to rise slowly from sitting or lying is important. Low blood glucose may be the etiology, but an oral glucose tolerance test at this point is not indicated. A fasting blood glucose could be ordered, however, an electrocardiogram is not indicated. An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure? ------- Correct Answer -------- Weight gain. Early signs of heart failure include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension. A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the most likely diagnosis and the most appropriate action? ------- Correct Answer -------- Scarlet fever; treat with antibiotics. This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia lines. A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? ------ - Correct Answer -------- 6 weeks. The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of 4-6 weeks before checking the patient's TSH. A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about: ------- Correct Answer -------- testicular self-examination. Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. The treatment of choice for chronic bacterial prostatitis (CBP) is: ------- Correct Answer - ------- a flouroquinolone twice daily for 3 weeks to 4 months. The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with Bactrim-DS is only about 30-40%. A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the most likely underlying conidition predisposing her to recurring candidal vaginitis? ------- Correct Answer -------- Diabetes. A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this patient. Which of the following is NOT a characteristic of the S3 heart sound? ------- Correct Answer -------- The sound is high-pitched and occurs just prior to the S1 heart sound. The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is produced by rapid ventricular filling and is best auscultated in the mitral area. It is a common finding with right-sided heart failure, rapid growth, and the last trimester of pregnancy. Following the finding of prostate gland abnormalities on DRE, the NP orders the appropriate labs. Whem preparing to review lab reports with the patient, the nurse practitioner knows all of the following are true EXCEPT: ------- Correct Answer -------- normal PSA is 10ng/ml or less. Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated with BPH. A 10 or greater PSA level suggests prostate cancer. Positive serum acid phosphatase is associated with malignancy of the prostate gland with bone metasasis. A 66 yo female presents to your clinic. She states that yesterday evening she had chest pain for 20-30 minutes. Which finding most strongly correlates with myocardial infarction? ------- Correct Answer -------- Elevated Troponin I levels An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK may be elevated from an IM injection, surgery, ot any type of extensive skeletal muscle trauma or prolonged, strenuous physical exertion. ST segment depression on EKG usually indicates an ischemic myocardium, but, not necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB bands are specific for myocardial smooth muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most accurate marker of cardiac damage, because it is more specific and sensitive than CK MB, is a troponin measurement. What is a secondary cause of hyperlipidemia? ------- Correct Answer -------- hypothyroidism The most acceoted recommendation regarding skin cancer prevention is: ------- Correct Answer -------- avoidance of excessive sun exposure. Avoidance of excessive sun exposure is the most accepted recommendation for prevention of skin cancer. All the other items are recommended by particular groups, but are not as widely accepted. Clinicians should remain alert for suspicious lesions in fair-skinned men and women >65 years, those with atypical moles, those with > 50 moles. These groups have a substantially increased risk for melanoma. What prophylaxis medication is recommended for the patient under 35 years of age with a positive ppd? ------- Correct Answer -------- isoniazid (INH) The CDC recommends administration of isoniazid to persons under 35 years of age with a positive PPD. The goal of this treatment is to prevent progression from latent infection to active infection. The other medications are used to treat active TB, but not for prophylaxis. The diagnosis of Meniere's disease is based on: ------- Correct Answer -------- The exclusion of other pathologies. Most cases of Meniere's disease are idiopathic and the diagnosis is based on the exclusion of other pathologies. Central vertigo is present with many vestibular problems. Low frequency hearing loss is more commonly associated with Meniere's disease. MRI is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease. The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may: ------- Correct Answer -------- Mask symptoms of hypoglycemia. Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on betablockers should be taught to look for this specific symptom as a possible indication of hypoglycemia. An adult female patient is seeking information about her ideal weight. She is 5 feet 7 inches tall. Using the "height-weight formula" what is her ideal body weight? ------- Correct Answer -------- 135 lbs The height-weight formula is a quick method of determining ideal weight. Females allow 100 lbs for the first 5 feet of height plus 5 lbs for each additional inch. Males allow 106 lbs for the first 5 feet plus 6 lbs for each additional inch. This method can only be used as an estimate because it does not account for body composition or age. The nurs practitioner is caring for a 19 year old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate INITIAL treatment for this patient is: ------- Correct Answer -------- Oral ferrous sulfate. With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed, but may be required in the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron. A male patient with chronic atrial fibrillation takes a generic brand of Coumadin (warfarin). He should report all of these to his health care provider EXCEPT: ------- Correct Answer -------- one missed dose of warfarin. This patient takes warfarin for prevention of emboli secondary to chronic atrial fibrillation. According to the NHLBI and ACCP, warfarin is the standard of care when anticoagulation is required for this condition. Warfarin is a drug with a narrow therapeutic index. This means that fluctuation in its level (increased or decreased) can potentiall cause big changes in its therapeutic effect. Consequently, warfarin levels are checked frequently to maintain therapeutic levels. If changes such as medication substitutions occur, warfarin levels should be checked in 3-7 days. Levels should be checked minimally every 4-6 weeks once regulation has occurred. While it is important NOT to omit doses of warfarin, this is the least important of all the choices because the effect of warfarin lasts beyond 24 hours. Which of the following medication or medication class that does NOT have dizziness or vertigo as potential adverse side effects? ------- Correct Answer -------- Meclizine (Antivert) Dizziness is associated with a sensation of body movement when there is no body movement occurring. (The person is spinning and the room is not). Vertigo is the sensation that the person is still and the room is spinning. There is no associated muscle weakeness or visual disturbance with either of these conditions. The most common causes are related to drug ingestion, hypotension, inner or middle ear pathology, and positional vertigo. Dizziness is an adverse reaction associated with certain antibiotics (gentomycin and strptomycin) and high-dose salicylates. Vertigo is associated with certain inner ear pathology such as labyrinthitis and Meniere's disease. Meclizine is a long-acting antihistamine which is used to treat chronic vertigo. A PPD is considered positive at 5 millimeters or more for which population? ------- Correct Answer -------- Confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with a chest X-ray suggestive of TB A PPD greater than or equal to 10 mm is considered positive for injecting drug users known to be HIV negative, occupants of long-term care facilities, age less than 4 years, groups with a high prevalance for TB, the medically underserved, and healthcare workers. A PPD is considered positive at 15mm or more in those with no known risk factors. Considering mortality statistics for the adolescent age group. education targeted toward this group should first focus on: ------- Correct Answer -------- alcohol abuse. Alcohol is the most commonly used psychoactive substance in the United States today. It has been used by about 90% of adolescents by 16 years of age. Motor vehicle accidents related to driving under the influence of alcohol are the leading cause of death in the 15-24 year old age group. A patient with moderate persistent asthma will probably be most effectively managed with daily: ------- Correct Answer -------- inhaled steroids and long acting bronchodilators. A patient with moderate persistent asthma has symptoms daily. He is best managed with daily medications of inhaled corticosteroids and long acting bronchdilators. Oral leukotriene blockers may be added to this regimen. A child has just scalded her index finger with hot water at home. The mother calls the NP within 5 minutes of the injury. All of the following are appropiate instructions for the mother regarding the care of the patient with a 2nd degree burn EXCEPT: ------- Correct Answer -------- Applying butter, cooking oil, or lanolin for pain relief. Flushing first or second degree burn with cool water is appropriate to prevent further thermal injury and to provide pain relief. Oil should NEVER be applied to a burn injury. Consider consultation for burns in patients who are under 10 years of age and over 50 years of age. Physician referral is recommended for all 3rd degree burns, for 2nd and 3rd degree burns involving more than 10% of the body surface area, any deep thickness burns involving more than 2% of the body surface area, and burns involving the face. ------- Correct Answer -------- Pra