Zerwekh Review- Health Promotion & Maintenance
A mother states that the iron-fortified formula her 3mos old is on has been causing the infant constipation. The FNP recommends:
Adding 1-2 tsp of dark corn syrup to the formula ~ The American Academy of Pediatrics does not recommend low-iron formulas but does recommend, if stools are hard, to treat for constipation. Typical treatment includes giving 1-2 tsp of dark corn syrup, including fruit juices (prune, pineapple, apricot), nonstarchy vegetables, and water, and avoiding rice cereal. Mineral oil is not recommended at this age
The FNP is performing an annual Medcare exam on a 77yr old patient. Whicih of the following recommendations would be of greatest benefit in maintaining optimal health?
"Exercise your arms and legs as much as you can each day" ~ Maintaining muscle strength reduces the ridk of immobility. immobility is a predictor of loss of independence, depression, reduced quality of life, falling, institutionalization, and death. Sleeping long hours is not associated with improved energy. Less-than-optimal nutrition and urinary incontinence are not as great a threat to loss of independence as is immobility. Preventing falls is a Healthy People 2020 goal
At which patient age should the FNP recommend routine use of the dingle-dose pneumovax 23 (PPSV23) vaccine?
65yrs or older ~ The pneumococcal polysaccharide vaccine Pneumovax 23 (PPSV23) is recommended in patients without risk factors starting at age 65. PPSV23 vaccination is indicated only for those ages 2-64yrs if additional risk factors or co-morbidities are present, including smoking, immunosuppression, or serious disease
When screening for intimate partner violence (IPV), it is important for the FNP to understand that the following statement is true:
1/4 of all women experience IPV ~ 1/4 of all women experience IPV. IPV can occur in any adult-gerontolog primary care setting. Most abused women report that their partner was the first person to abuse them. Many batterers are successful professional, including politicians, ministers, physicians, and lawyers
According to the American Academy of Pediatrics, infants may be fed whole cow's milk once they reach:
12mos of age ~ At 1yr of age, infants may be fed whole cow's milk. the purpose for waiting is that it has ben shown that cow's milk is low in iron, linoleic aced, and vitamin # and high in protein, sodium, and potassium
Teaching testicular self-examination should be targeted to which age group?
15-25yrs ~ The 15-25yr old group is most often affected by testicular cancer
The mother of a 15yr old child who has not had chickenpox is concerned and wats her daughter to be vaccinated. The recommendations are:
2 doses at least 28days apart ~ Children over the age of 13yrs who have not had chickenpox and have not been previously immunized are recommended to have 2 doses at least 28days apart for effective immunity
A person is concerned about travel to a hepatitis A virus (HAV) endemic area. What are the preexposure recommendations before travel?
2 doses at least 28days apart ~ Persons planning to depart to an area with high or intermediate endemic HAV in less than 2 weeks should receive the initial dose of HAV caving, and also simultaneously be administered IG at a separate anatomic injection site. The IG will prove immediate protection and the HAV vaccine will provide lifelong immunity. Twinrix provides immunization for both HAV and HBV and should be administered before travel
The American Diabetes Association recommends screening adults starting at age 45 with a fasting plasma glucose (FPG) test every:
3 years ~ The American Diabetes Association recommends screening adults starting at least by age 45 and repeating the FPG every 3yrs. This is for all patients, and screening is indicated at 3yr intervals for patients with >25 bmi or other risk factors at any age for an adult. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40-70yrs who are overweight or obese
Before giving a child the measles, mumps, and rubella (MMR) trivalent vaccine, it is recommended to wait how long after cancer chemotherapy has stopped?
3mos ~ The MMR is a live-virus vaccine. Children severely immunosuppressed because of cancer therapy should not receive live-virus vaccines for 3mos after chemotherapy has been stopped
A child is 6yr old. How many doses of inactivated poliovirus vaccine (IPV) will he have received?
4 doses ~ It is recommended that the child receive the IPV at 2mos, 4mos, the 3rd dose between 6-18mos, and the 4th dose between 4-6yrs of age
The recommended time for the introduction of solid foods into an infant's diet is:
4-6mos ~ Solid food does not need to be introduced before 4-6mos of age. The first foods introduced are cereals. New foods are introduced one at a time at weekly intervals. In this way, the infant's digestive system can adapt to the food, and any reaction can be easily detected
In the preparation of educational materials for patients an parents, the FNP is aware that the reading level of most adults is at the:
6th grade level ~ The reading level of most American adults is from 6-8th grade
Which person should not receive the Shingrix vaccine:
A 30yr old patient who is pregnant ~ A person should not receive Shingrix if they have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix, tested negative for immunity to varicella zoster virus, currently have shingles, or currently are pregnant or breast-feeding. Women who are pregnant or breast-feeding should wait to get Shingrix. Healthy adults 50yrs+ should get 2 doses of Shingrix, separated by 2-6mos. Patients should get Shingrix even if they already have had shingles, received Zostavax, or are not sure if they had chickenpox. There is no maximum age for getting Shingrix. If a patient has Zostavax recently, then the patient should wait at least 8wks before getting Shingrix
A 65yr old woman inquires about her vaccination requirements regarding the pneumococcal vaccine. She received a single PPSV23 vaccination at age 57 because of the presence of risk factors. She had never received any other pneumococcal vaccinations. Which of the following should the FNP recommend?
Administer PPSV23 ~ PCV13 vaccination is no longer routinely recommended for all adults 65yrs+. ACIP continues to recommend that all adults 65yrs+ receive 1 dose of PPSV23. A single dose of PPSV23 is recommended for routine use among all adult 65yrs+
Consultation with the mother of an 18mos old who has received no immunizations reveals that the child was exposed to measles 48hrs before the visit. At this time the FNP would:
Administer the live attenuated measles vaccine ~ If given within 72hrs of exposure, the live attenuated measles vaccine will provide protection in most cases. The os of IgG would be 0.25mL/kg, given within 6days of exposure
At what age should a routine screeing mammography begin for women who have average risk of breast cancer, according to the U.S. Preventive Services Task Force (USPSTF) 2016 recommendations?
After age 50 ~ According to the USPSTF 2016 recommendations, screening mammography in women before age 50 yrs should be and individual decision. Women may choose to begin biennial screening between the ages of 40-49yrs. Biennial screening mammography is recommended for women aged 50-74yrs with average risk. the American Cancer Society's current recommendations are that women aged 40-44yrs should have the choice to start annual breast cancer screening with mammograms if they wish to do so, and women aged 45-54yrs should get mammograms every year ans switch to every 2yrs at age 55.
The FNP is assessing an 8mos old infant inn immunization clinic. By this time, the infant should have received which immunizations/
All 3 Hep B injections, all rotavirus series, 3 doses of the pneumococcal conjugate series, and at least 2 doses of inactivated poliovirus ~ Hep B 1st dose should be given at birth. By 8mos, all 3 doses of the Hep B series should have been given. RN should be given at 2, 4, and 6mos. IPV should be given at 2 & 4mos, and the 3rd dose anytime from 6-18mos. MMR 1st dose is at 12mos and again at 4-6yrs. Tetanus toxoid, diphtheria toxoid and Tdap are given to children who are 11yrs+; however, if children who are age 7yrs+ are not fully immunized with the DTaP vaccine, they should receive the Tdap vaccine as 1 dose (preferably the 1st) in the catch-up series
In caring for school-aged children, the FNP should be aware that the #1 reason for school absenteeism is:
Asthma ~ The CDC has identified that asthma is 1 of the leading causes of school absenteeism
What is an example of a secondary level of prevention measure for an older adult patient?
Assessment of vitamin D level ~ Secondary prevention measure focus on detection and management of potential disease states through diagnostic testing and scheduled examinations; thus detection of vitamin D levels helps to establish a baseline. Dietary counseling and identifying smoking are examples of primary level of prevention measures because they focus on preventing the occurrence of disease and identifying relevant risk behaviors. Focusing on preventing complications related to disease is an example of tertiary level of prevention because the disease process is already established
The family nurse practitioner is preparing to provide an education class on medication compliance to a group of alder adult individuals. Which strategies could lead to potential barriers that would affect the group's ability to receive the information?
Assume that mental deficits exist in the group; therefore, repetition of information should be strongly encouraged ~ With the older population, normal changes associated with aging may lead to potential sensory deficits that can prove to be a barrier in providing and receiving information. Although information may have to be repeated, the assumption that this is caused by mental deficits associated with aging is a form of implicit bias. Handouts that contain easily understood language, providing examples to use in demonstration of content, and ensuring that the room in which teaching/learning occurs has good lighting will help promote educational learning
In preparing a patient for a colorectal screening, the FNP should instruct the patient to:
Avoid aspirin, iron, and anti-inflammatory medications ~ Screening for colorectal cancer includes annual fecal occult blood screening for individuals over age 50. Avoiding medication that can cause gastrointestinal irritation and bleeding can help avoid false-positive results. Rare meats and vegetables that are high in peroxidase will cause false-positive results, whereas vitamin C can cause false-negative results.
An Hispanic child presents with symptoms of weakness, irritability, weight loss, constipation, and mild ataxia, and a history of elevated lead levels. Which of the following homeopathic substance would the FNP suspect had been used?
Azarcon and greta ~ Azarcon and greta are traditional Hispanic remedies that contain lead, which can result in increased lead levels and eventual poisoning. The other substances wil not cause the symptoms described. Arnica root is used as a topical preparation to reduce inflammation, muscle pain, and bruising. The Mexican yam root is used for menopausal symptoms and is source of natural progesterone. White willow bark action is similar to ASA and is used for the relief of pain.
Which of the following describes how cultural diversity may affect a client's health?
Caucasian and other ethnic groups may self-treat their depression with OTC alternative remedies, such as St. John's wort ~ Many cultural factors affect a client's approach to health and health care. Alternative remedies, such as St. John's wort, are used for self-treatment of depression. For most cancers, certain racial and ethnic groups have lower survival rates that Caucasians. Hypertension has a high rate of occurrence in African Americans, who are at greater risk of developing heart disease, end-stage renal disease, and stroke than the general population. Asian American have a higher incidence of stomach and liver cancers. Ethnic groups respond differently to medications. Caucasians are more sensitive to the effects of beta-adrenergic blockers, such as propranolol, whereas African Americans are less responsive to this drug group.
According to ChooseMyPlate, which 2 foods are included the vegetable group?
Chickpeas Beans ~ Beans and peas are legumes, which are included in the vegetable group and are excellent sources of plant proteins. Quinoa, popcorn, and wild rice belong to the grains group
A FNP is prescribing a narcotic analgesic for pain relief to an 82yr old patient who lives alone. Which 3 actions should the FNP take to promote safety?
Conduct an assessment of the patient's cognitive and motor abilities Start with a low dose of analgesic and increase slowly if needed Evaluate for polypharmacy before ordering the analgesic ~ The FNP should identify specific methods to improve safe use of medications in older adults by conducting a thorough assessment of the patient's cognitive and motor abilities and presence of polypharmacy. Although many analgesics can contribute to constipation, it is the assessment of kidney function that is most important because the older adult is less able to eliminate drugs, owing to the GFR gradually declining by about 40% from ages 20-80 yrs. The golden rule in prescribing to the older adult is to start with the lowest dose possible and titrate the medication dose slowly on the basis of the renal and hepatic function of the patient. Determining sleeping patterns doesn't focus on promoting drug safety in the older adult
A father (height 74", onset of puberty at age 16) is concerned that his 15yr old son is going to be short. In a physical examination, the FNP finds the son is Tanner stage II, height 62", and the result of the rest of the exam are essentially normal for a well-nourished adolescent. After reviewing his growth records, which indicate a growth pattern of height at the 5%, the most likely diagnosis is:
Constitutional growth delay ~ Familial short stature is not indicated in this case, because the father is of normal height. Hypopituitarism would be associated with other findings (micropenis, small testes, immature facies, and olfactory defects). Gonadotropin deficiency might be a possibility but considering all findings in th the situation and based on the father having a pubertal onset at age 16 and achieving an average height, the more likely diagnosis is constitutional growth delay
Anticipatory guidance for the family with a 6yr old child includes:
Continue to use a belt-positioning booster seat until the child has reached 4'9" tall and is between 8-12 yrs of age ~ Car safety and use of a forward-facing care seat continue to be a priority for the 6yr old child. Belt positioning booster seats are used until the chil is 4'9" tall and is between 8-12 yrs of age. Bttled drinking water is not necesary when traveling, unless it is outside of the United States. A fluoridated dentifice should be usedn in a small amount (pea size), and children under age 6 should be supervided so that they do not swallow too much toohtpaste, which would put them at risk for fluorosis. Three regular meals and 2 snacks are recommended for the busy 6yr old child. Dnacks should be rich in complex carbohydrates and low in fat, such as in yogurt; children should avoid candy, chips, and soft drinks
The FNP is discussing making lifestyle changes that will decrease the older adult's risk for cardiovascular disease. Which o fat following is most important to include in this discussion?
Control hypertension, stop smoking, maintain normal weight, and exercise regularly ~ Hypertension, smoking, and hyperlipidemia are the major risk factors in the development of cardiovascular disease. Controlling hyperglycemia, increasing high dietary fiber intake, and taking vitamin supplements assist in maintaining a healthy lifestyle, but they are not as important in preventing cardiovascular disease
A client of Latina heritage is refusing treatment at the clinic and wants a curandero called. What should the FNP understand about the practices of a curandero?
Curanderos are fold healers who use holistic healing practices ~ Latino clients may use home remedies and consult fol healers known as curanderos or curanderas rather than traditional Western health care providers. Curanderos provide a holistic form of healing, which combines prayer, herbal remedies, rituals, psychic healing, spiritualism, and massage. Curanderos believe in the hot and cold theory of disease
Smallpox vaccine is offered to certain members of the military in anticipation os possible exposure caused by bioterrorism. What are 2 common side effects of smallpox vaccination?
Dime-sized blister lesions at the injection site that forma a scab and leaves a scar Fatigue ~ The smallpox vaccination has the following common side effects: itching, swollen lymph nodes, sore arm resulting from the injection, fever, headache, body ache, mild rash, and fatigue. The injection site lesion starts as a red and itchy bump forming at the vaccination site within 2-5days, then the next few days, the bump becomes a blister and fills with pus. During the 2nd wk, the blister dries up, and a scab forms. The fluid from the lesion and the crust are contagious until a scab forms.
The ACIP recommends that healthy older adults receive the Td or tetanus booster vaccination:
Every 10yrs ~ Td is usually given as a booster dose every 10 years but it can also be given earlier after a swerve and dirty would or burn. For adults 19-64yrs who previously have not received a dose of Tdap, a single dose of Tdap should replace a single decennial Td booster dose. Persons 65yrs+ who have or who anticipate having close contact with an infant aged less than 12 months and who previously have not received Tdap should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission. For other adults 65yrs+, a single dose of Tdap vaccine may be administered instead of Td vaccine in persons who previously have not received Tdap. Boostrix should be used for adults 65yrs+; however, the ACIP concluded that either vaccine administered to a person 65yrs+ is immunogenic and would provide protection
The FMP is developing a plan of care for an Asian American client. Which 2 measures should be included the client's plan of care?
Explain responses carefully fo questions asked by the client Avoid the use of hand gestures to communicate ~ It is important to check for understanding of what issuing said about the plan of care for all clients, not just Asian Americans. Consider those periods of silence by the client are indicative of reflection on what has been said. Avoiding physical closeness, limiting eye contact, avoiding hand gestures, and clarifying the responses to questions are all components of the plan of care fo and Asian American client
In teaching a new mother about fevers, the FNP knows that:
Fevers may precipitate convulsions in children between 6mos-5yrs of age ~ Febrile seizures are benign and do not lead to brain damage. Most febrile illnesses in children result from a virus rather than bacteria and are associated with a high fever
According to the CDC, which 2 immunization are recommended as primary prevention for adults ages 60+?
Flu and Shingles ~ The CDC recommends that adults ages 60+ should receive immunizations for seasonal flu and herpes zoster. Yearly tetanus prophylaxis is not indicated, because the required time interval for a booster is every 10 yrs and/or in response to an injury. An adult who has had a previous allergic reaction to immunization should be further evaluated to determine potential adverse reactions to specific components before any immunization schedule is started
What would be an appropriate post exposure immunization for hepatitis A virus (HAV) for an adult over age 40 who has not been previously immunized?
GamaSTAN S/D ~ GamaSTAN S/D is the only IM preparation for immune globulin (IG). IG is administered to persons aged >40yrs; however, a vaccine may be used if IG cannot be obtained. Post-exposure prophylaxis with IG or HepA vaccine prevents infection with HAV when administered within 2wks of exposure. Twinrix provides immunization for both HAV and HepB virus. Shingrix is an immunization for herpes zoster. IgM, which is found mainly in the blood and lymph fluid, is the first antibody to be made by the body to fight a new infection
The HPV vaccine should be recommended to:
Girls age 11-12 ~ All boys and girls 11-12yrs should get vaccinated. Catch-up vaccines are recommended for males through age 21 and females through 26yrs. It is recommended for men and women with compromised immune systems through age 26yrs if they were not fully vaccinated when they were pinger. The vaccine is also recommended for gay and bisexual men through age 26yrs. ACOP does not recommend the vaccine for patients >26yrs but rather promotes shared decision making
Which of these health promotion screenings should be completed annually for the patient who is over age 50?
Guaiac-based fecal occult blood test (gFOBT) ~ The gFOBT will assist in identifying any problems with intestinal bleeding, polyps, and cancer and is recommended to be started at age 50. Pneumococcal vaccination is not a screening test. A colonoscopy is recommended at age 50 and then every 10yrs thereafter, not annually. Annual chest xrays are recommended for adults ages 55-80yrs who have a 30 pack-yr smoking history and currently smoke or have quit within the past 15yrs
Which of the following is recommended as an annual screening test for colorectal cancer in a patient who is 51 yrs old?
Guaiac-based fecal occult blood test (gFOBT) at-home test ~ The U.S. Preventive Services Task Force recommends screening for colorectal cancer using high-sensitivity gFOBT, sigmoidoscopy, or colonoscopy beginning at age 50yrs and continuing until age 75 yrs. Of course, a colonoscopy is the best test and it is okay to have a stand-alone screening of gFOBT, as long as colonoscopy is recommended first. The multiple gFOBY stool take-home test should be used. One gFOBY test obtained by the FNP in the office is not adequate for testing. A colonoscopy should be scheduled if the gFOBT test result is positive
A female college students develops symptoms of HAV about 5wks after receiving a vaccination for HAV. The FNP explains to the patient: (Select 3 responses)
HAV infections in the United States are most often acquired during travel to HAV endemic countries Symptoms occur primarily after consuming food or water contaminated with HAV or via direct contact with a person with HAV infection with poor hygiene A prevaccine exposure to HAV could be the reason for the patient's symptoms ~ The primary transmission is fecal-oral; bloodborne transmission is rare. Men having sex with men is a risk factor. The incubation period is 2-6wks. Infection occur primarily after consuming food or water contaminated with HAV or via direct contact with a person with HAV infection with poor hygiene. The Advisory Committee on Immunization Practices recommends that one dose of single-antigen HAV vaccine administered within 2wks before travel departure may provide adequate protection for most healthy persons, along with passive immunization with IG. The first dose should be followed by the second immunization within 6-12mos, if using Havrix. In this patient situation, prevaccine exposure to HAV was present
Based on 2020 recommendations for immunizations for individual who are over 65yrs,which schedule may be recommended on the basis of individual risk assessment?
HBV ~Hep B series may be recommended for adults who are 65yrs+ on the basis of clinical risk assessment, i.e., having chronic liver disease, HIV infection, incarcerated persons, travel in high risk countries, IV drug use, sexual exposure risk. MMR vaccinations would bot be required for recommended for this age group. Chickenpox (varicella-zoster virus) and pneumococcal immunizations would be recommended for this age group
Which of the following immunizations decreases the possibility of epiglottis?
Haemophilus influenza type B (Hib) ~ His makes inflectionless likely. His vaccine successfully decreases the possibility of epiglottis. A wide variety of viruses, bacteria, and even fungi can cause epiglottis. There are no vaccines for Epstein-Barr virus, coxsackievirus, or S. pyrogenes
And adult who works as a veterinarian has been administered a rabies vaccination. What are 4possible side effects and risks of receiving the vaccination?
Hives, fever, and joint pain Soreness and redness at the injection site Headache and dizziness Abdominal pain and gastric distress ~ The risk of the rabies vaccine causing serious harm or death is extremely small. Serious problems arising from the rabies vaccine are very rare, according to the CDC. the CNP recognizes the following as a mild problem after immunization: soreness, redness, swelling, or itching where the shot was given; headache, nausea, abdominal pain, muscles aches and dizziness.
A new mother asks about the differences between human milk and cow's milk, The FNP explains that:
Human milk has more lipase and linoleic acid ~ Human milk has more lipase and linoleic acid. Cow's milk is not as good of a nutritional source as human milk because cow's milk has more mineral content (calcium, phosphorus, sodium, potassium), which causes a larger renal solute load. In addition, cows milk is high in protein, casein, and saturated fat, and is lower in carbohydrates than human milk
Which of the following best describes the benefit of sports screening physicals?
Identification of risk for an adverse cardiovascular event ~ the primary goal and benefit of a sports screening physical exam is to identify athletes at risk for an adverse cardiovascular event. The physical exam also screens for athletes at risk for orthopedic injuries secondary to previously unresolved injuries; however, this is not the primary benefit. Even with a thorough history obtained from the screening exam, performing the exam is unlikely to completely eliminate injuries or be able to identify all underlying health problems. The other options (assessing drug and alcohol use, estimating aerobic capacity, and assessing for undiagnosed musculoskeletal deformities) are not the benefit of the sports screening physical.
Which of the following patient situations requires the use of inactivated vaccines?
Immunocompromised adult ~ The live vaccine can produce serious disseminated disease in patients with immunocompromised status and in those undergoing cancer chemotherapy. Mild acute illness, concurrent antimicrobial therapy, and history of nonspecific allergies are not contraindications for use of a live vaccine
Which of the following is found in the LGBTQ young adult, compared with a heterosexual young adult? (Select 2 responses)
Increased rate of substance abuse Increase rate of smoking tobacco ~ LGBTQ is a common acronym that typically refers to lesbian, gay, bisexual, transgender, and queer or questioning individuals. LGBTQ young adults hav increased rates of smoking, drinking alcohol, and substance abuse compared with their heterosexual peers. In addition, they also have increased rates of eating disorders, anxiety, depression, and suicidal thoughts
Immunizations recommended for a healthy 40yrs old adult who has had his childhood series include:
Influenza, Hep A, Hep B, varicella, MMR, and tetanus ~ It would be important to start the Hep Ab series consider his age because this was not included as part of his childhood vaccination series. Hep A is also recommended, especially if the person travels to foreign countries, along with varicella because these immunizations were not available during his childhood. An MMR immunization is required for adults born in 1957 or later who have no laboratory proof of immunity or documentation of either previous vaccination or a physician-documented case of measles. Tetanus vaccination is recommended every 10yrs, especially in high-risk situations. PPSV23 is indicated for an adult who has a chronic disease, such as diabetes, COPD, or chronic CVD, and it is also indicated for adults who are immunocompromised. If the adult did not receive the OPV series as a child, it is recommended to vaccinate the adult with injectable enhanced-potency inactivated poliovirus vaccine because the risk of vaccine-associated poliomyelitis is lower
Immunizations recommended for healthy young adults include:
Influenza, Hep B, rubella, measles, and tetanus ~ A percentage of young adults are susceptible to measles and/or rubella. Influenza and Hep B vaccinations are recommended for young adults who have exposure to a large number of people. Tetanus is recommended every 10yrs; especially in high-risk situations. PPSV23 is indicated in a young adult who has a chronic disease and is also indicated for young adults who are immunocompromised
The FNP answers a phone call from an Asian american client who is experiencing a fever. the client wants to self-treat first before taking an antipyretic medication. What would the FNP suggest to the client?
Ingest yin foods ~ Yin foods are cold foods and yang foods are hot foods. With the client experiencing a fever, they will want to eat yin foods or cold foods. Having a massage and meditating and praying are not part of the yin and yang approach to address symptoms of illness
A FNP is examining a 78yrs old man in an assisted-living facility who has exhibit decreased food intake for 1 day bt is still taking fluids. Which priority assessment should the FNP perform?
Inspect the patient's oral cavity to determine whether there are any structural or infectious processes ~ Because the patient is experiencing a decrease in food intake but still taking fluids, there is no immediate need to prescribe enteral nutritional support or switching of diet. Best practice would be to inspect the oral cavity to see if there is any structural or infection process that is preventing ingestions of food. Reviewing the medication profile of the patient may be needed but would not be the priority assessment at this time.
A 1yr old child who had a normal physical exam has a lead level of 15ug/dL. Which of the following actions should the FNP take?
Investigate possible sources of lead and repeat in 3-4mos ~ Although 15ug/dL is an elevated lead level (normal is <10), chelation therapy in children with a normal exam is not usually conducted until the lead level is >25ug/dL. It is important at this level to identify the source of the elevation and to monitor thr child frequently.
Which statement about the polyvalent pneumococcal vaccine is true?
It is recommended for children older than 2yrs of age with chronic diseases, including diabetes ~Polyvalent pneumococcal vaccine is recommended for children with chronic diseases. It is not recommended for use to prevent OM and other pneumococcal disease. It can be given concurrently with other vaccines, and it doesn't not cause severe systemic reactions. It will occasionally cause mild local reactions
An elderly patient comes fo your office 2days after receiving the PCV13. He complains of pain in the injection site, difficulty raising his arm without pain, and has a fever of 100.4F. What shout the FNP suspect?
It is somewhat common to get a fever and localized reaction to this vaccine ~ According to the CDC, 1 of 3 patients develop a mild fever and localized pain at the injection site. There is no indication that this patient requires hospitalization at this time. The fever is likely related to the vaccination. There is no contraindication about receiving this vaccine with an allergy to egg
In the presence of dyslipidemia and diabetes, the National Cholesterol Education Program guidelines set the goals for lipid levels as follows:
LDL <100 mg/dL and triglyceride levels <150 mg/dL ~ The recommendation is LDL <100mg/dL and triglyceride levels <200mg/dL for individuals with risk factors for coronary heart disease. Although 150mg/dL is the ideal goal for triglyceride levels, treatment is started at >200mg/dL in the diabetic and almost all other patients with risk factors. In a diabetic patient, the LD goal is independently <100mg/dL. If the patient has triglycerides >200mg/dL, then the goal is <130mg/dL non-LDL cholesterol. All other choices have an inaccurate goals
What is the most common occupationally related health problem?
Lung disease ~ All these disorders can be associated with work-place exposure, but lunch disease is currently still the most common occupationally related disease. Representing approximately 10% of the chronic occupational diseases, lung disease has been named as 1 of 10 leading work-related disease and injury categories by the National Institute for Occupational Safety and Health. Musculoskeletal injuries are on the rise.
A healthy 4mo old infant weighting 13lb 3oz has started waking up at night after previously sleeping for periods of 9-11hrs. The infant takes 32oz of formula in a 24hr period. The FNP recommends:
Maintain current formula intake and introduce small amounts of rice cereal ~ If the infant has been satisfied up to this point (by sleeping for long intervals), the infant probably needs additional calories in the forma of rice cereal. Adding increased amounts of formula can lead to IDA
Which liefstyle modifications are most effective in controlling hypertension in the older adult patient?
Maintain normal weight, decrease sodium in diet, and exercise regularly ~ Maintaining normal weight, decreasing sodium in the diet, and exercising regularly are three modifications that are most effective in maintaining normal blood pressure in the older adult
What are the current American Cancer Society (ACS) dietary recommendations for cancer prevention?
Maintaining a desirable body weight and eating a variety of foods, including fruits and vegetables and foods that are high in fiber ~ The ACS recommends maintenance of a desirable body weight; research has shown an association between increased mortality resulting from various cancers and varying degrees of being overweight. Another recommendation is to eat a wide variety of foods, consistent with the ChooseMyPlate guide of the U.S. Department of Agriculture and U.S Department of Health and Human Services. A variety of fruits and vegetables should be included in the daily diet (make half your plate fruits and vegetables) because research has shown an association between lower cancer rates and high fruit and vegetable consumption. High-fiber foods are also recommended; a lower risk of colon cancer is seen in those who consume a high-fiber diet. Currently, there are no recommendations to increase the amount of protein in the diet. Because of the high consumption of red meat in the American diet, many people are already receiving large quantities in their current diets. It is recommended that red meat and processed foods should be limited. The ACS recommends limiting the daily consumption of alcohol to 2 drinks for males, one drink for females, and no drinks for pregnant females. They also state that, ideally, no alcohol should be consumed; regular alcohol consumption has been shown to increase the risk of various cancers
According to U.S. Department of Health and Human Services guidelines, which test is considered an important screening test to be done every 2yrs for women between the ages of 50-64?
Mammogram ~ Starting at age 50, a screening mammogram should be performed every 2yrs through age 74. At ages 75 and older, the patient needs to check with her doctor or FNP to see if screening is required because of previous findings and current risk factors. Patients should be tested for chlamydia or HIV if they are sexually active and at increased risk. Starting at age 50, a patient should be screened for colorectal cancer every 10 yrs unless there are incrased risk factors or polyps are present
The FNP has been asked by a local high school to provide an education program on teaching adolescents about social networking and texting on phones. The FNP identifies what 4 findings as being important?
Mobile access to the internet has become widespread among adolescents Multitasking and using multiple media types at the same time have been associated with late nights and sleep deprivation in adolescents Adolescent "sexting" as been linked to risky sexual behaviors in a few research studies Adolescents texting on the phone while driving is outlawed in many states ~ The use of social media an access to the internet are very prominent and widespread among adolescents. This promotes opportunities for developing interpersonal skills and in some environments (rural areas, adolescents with rare health conditions or shyness) provides an avenue for the adolescent to interact with others like themselves. Many states have outlawed the use of handheld mobile devices while an adolescent is actively driving a car. Sexting is the sending of sexually explicit or suggestive pictures or messages online and has been linked to risky sexual behaviors. Adolescents actually do use the online social environment to interact with the same peer they send their day with at school and in extracurricular activities. The online environment can create opportunities for cyberbullying. Cyberbullying is the communication of insults, harassment, and publicly humiliating statements via social media, that is, email, online chat rooms, or texting on cell phones.
The FNP understands that children who should not receive the measles vaccine are children who have severe allergic reactions to:
Neomycin ~ Children who have a severe allergy to neomycin are at increased risk for the development of an allergic reaction to the measles vaccine
Which group is at greatest risk for alteration in immune functions related to nutritional status?
Older adults ~ The older adult is at greatest risk for altered immune function related to nutrition. The older adult often does not receive enough nutrition for a variety of reasons, including altered taste, eating alone, ability to prepare meals, and malabsorption. Adequate nutrition in the older adult has been shown to improve immune status and antibody response to influenza vaccine
Which of the following components should be included when taking a history from a patient who is new to the clinic?
Past medical and surgical history of patient and family, psychosocial history, diet and exercise habits, chemical use, sexual practices, and review of systems ~ All areas are important to probe in the initial interview of a new patient. The history will help determine the necessary components of the physical exam and laboratory or radiologic studies that are ordered and the counseling that is done during the appointment
A FNP is reveiwing a 72yr old patient's history in the clinical setting. Which finding, if noted, requires a priority action in term of health promotion and maintenance?
Patient is not current for flu vaccination ~ When reviewing an older patient's history in the clinical setting, it is important to assess whether the patient is current with immunizations. Older patients are especially susceptible to seasonal flu, which may end up compromising their health. Past smoking history, even with a recorded PPD, is not a priority assessment if it has been 30 yrs since active smoking. The fact that a patient wear reading glasses does not require a priority action. Similarly, a history of osteoarthritis does not require a priority action, unless there are known deficits related to ambulation and/or increases in pain
The FNP performs a physical exam on a 75yrs old patient who is healthy. The patient remembers having chickenpox as a child and reports remembering a mild case of shingles on her back that occurred when she was in her 40"s, with no postherpetic neuralgia. She has had no further episodes of shingles. What should the FNP do?
People 60yrs+ should get a shingles vaccine. They should get the vaccine regardless of whether they recall having had chickenpox. there is no maximum age for getting a shingles vaccine. Twinrix is a combined Hep A & Hep B vaccine that can be given to adults. There is no reason to order a varicella titer
A 48yr old man presents to the clinic after having his cholesterol checked at a health fair. He states that his results were over 300 mg/dL and that he needs to see his PCP for further testing. An appropriate intervention for the FNP to include is:
Performing a thorough history and physical and drawing a lipid profile ~ The patient's history and physical exam will reveal the presence of any coronary heart disease (CHD) risk factors (age, family, history of CHD, diabetes, current cigarette smoking, blood pressure, height/weight, cardiovascular exam). A lipid profile is also recommended to asses the level of risk and consists of total cholesterol, high-density lipidprotein, low-density lipidprotein, and triglyceride levels. It would be prudent to have a precise cholesterol measurement done because the previous measurement was done at a screening health fair, ad no written record was taken. These parameters should be assessed first, before a cholesterol-lowering agent, ECG, or stress test is ordered. An exercise program is also important but should be done only after a history is taken and a physical exam is done and after lipid profile results are known. If the lipid profile or the history and physical exam results are abnormal, stress testing may be appropriate before undertaking a new exercise program.
The FNP is scheduled to provide health promotion teaching on oral health for a group of older patients who reside in an assisted-living community. Which 4 content areas should be included in the discussion?
Perodontal irritation Tooth loss Decreased taste perception Maintaining hydration ~ The older patient is at risk for oral health problems, and health promotion teaching should be focused on periodontal irritation, tooth loss, decreased taste perception, and maintaining hydration. Excessive salivation typically not seen in the older patient; rather, dry mouth occurs because of decreased salivation
A 2mos old infant received his immunizations, and 12hrs later, the mother calls and says the infant has a fever of 101F. What is the most likely cause of the fever?
Pertussis immunization ~ the most common cause of fever at the 2mos immunization series is the pertussis. This vaccine causes reactions in about 75% of infants. The MMR vaccine is not given until 12-15mos
What are teriary prevention activities for an older adult woman who has had a stroke?
Physical therapy program ~ Tertiary prevention refers to reducing the impact of an ongoing illness or injury. The physical therapy program will assist the older adult woman in restoring her optimum level of functioning after a stroke. An annual influenza vaccination is a primary prevention activity nonspecific to the care of a patient with a stroke. An annual mammogram and ophthalmologic examination to evaluate for glaucoma are examples of secondary prevention activities nonspecific to the care of a patient with a stroke
Primary prevention of Neonatal Abstinence Syndrome (NAS) includes:
Prescribing a reliable form of birth control for a patient being treated for chronic pain wit opioids ~ Pregnancy prevention is the primary prevention for NAS. Universal screening and referrals to treatment are recommended, but they do not prevent NAS. There will be times when women of child-bearing age must be prescribed opioids. Although consulting th drug-monitoring program does help decrease doctor shopping, it does not prevent NAS
The FNP understands that the only contraindication to HB vaccination is:
Prior anaphylaxis or severe hypersensitivity ~ Prior anaphylaxis and severe hypersensitivity reaction would be considered a contraindication; mild viral illness would not. The patient who is pregnant or lactating may be immunized
Which of the following management plans demonstrates an understanding of primary prevention of falls among older adults?
Provide information about medications, side effects, and interactions ~The information about side effects and interactions of medication will prevent complications that may result in a fall. Evaluating for assistive devices following a fall and providing resources to correct hazards in the home are appropriate tertiary prevention. Reinforcing the need to wear prescribed eyeglasses is appropriate for secondary prevention, which is intended to prevent the patient from experiencing another fall
While teaching a class to a group of senior citizens, which would be most important for the FNP to consider during the presentation?
Recognize that past life experiences are beneficial in learning new information ~ Using past life experiences applies the concept of adult educational principles. Overhead lighting may produce an increase in the glare, which can decrease visualization. There is an alteration of color perception (e.g. blue appears green-blue) as an individual ages. As individuals age, the ability to hear women's and children's voices decreases because these are generally at a high pitch. The video would not enhance the program because the patients frequently have presbycusis as a result of the normal aging process
The FNP is seeing an 86yr old patient diagnosed with postural hypotension. Which intervention would be recommended to reduce the patient's fall risk?
Recommend wearing support stockings ~ Support stockings improve blood retune to the central circulation, improving cardiac output and cerebral perfusion. Dorsiflexion of the feet and leg movement help improve cardiac output. Exercise should be postponed until later in the afternoon or evening, when blood pressure is higher. Waiting fo r20 mins or longer to stand from the table helps reduce orthostatic hypotension following meals.
A child presenting with vague symptoms and a serum lead level of 28ug/dL would be managed by:
Rescreening and referral to a physician ~ Recommendations of the CDC for a serum lead level greater than 10ug/dL are for rescreening and referral to a physician. Rescreening is done before the removal of the child/family from the hazard, although a thorough environmental assessment is essential at rescreening
The influenza vaccination is recommended annually for high-risk groups. The FNPknows that the greatest need for the vaccinations is for:
Residents of long-term care facilities ~ Influenza outbreaks may affect 60% of those in long-term care,. and mortality rates are high. All the other groups listed are appropriate for the influenza vaccine but are not an as high priority. Poliomyelitis is a contraindication
Which of the following is most important for the FNP to do each time a child comes in for a health maintenance clinic visit?
Review immunization record ~ It is essential that the immunization record be viewed. The other options are important but not essential fo a health maintenance visit
The FNP understands that the following is considered an attenuated live-virus vaccination:
Rubella and measles ~ Attenuated live-virus vaccines are available for the following communicable diseases: measles, mumps, rubella, poliomyelitis, yellow fever, and smallpox. The rabies vaccine is a killed virus, and hepatitis B is a purified viral antigen obtained for the blood of an infected patient and then inactivated when manufactured into a vaccination.
Which of the following should be included when discussing primary injury prevention with the parents of a 2mos old child?
Set water heater thermostat at <120 F ~ The water heater should bot be set of 120F to prevent scald burns. Crib rails should be no more than 2 3/8" apart. The rear-facing infant seat is applicable to 20lbs of weight or 1yr of age. Sunscreen should be applied whenever there is sun exposure
The National Childhood Vaccine Injury Act requires standardized consent form for the administration of. vaccines to children. The content on the form for the medical record included the vaccine lot number, nurse signature, injection/inoculation site, and:
Signature of parent or legal guardian ~ The law calls for the parental signature to be maintained in the clinical record
For an older adult patient who has an alteration in the sensory-perceptual function of hearing, which plan would be most appropriate for the FNP to implement during a health promotion session?
Speak in a tone that does not include shouting ~ Shouting increases the pitch of the voice. In presbycusis, or hearing loss in older adults, high-pitched consonant sounds are the first to be affected, and the change may occur gradually, The FNP should face the patient when speaking. If the FNP needs to stand behind the patient, touch is used to get the patient's attention. simple sentences should be used to facilitate understanding
In taking a history of a healthy 50yr old man, the FNP determines the patient is an avid gardener and spends much of his times enjoying outdoor activities. A health maintenance recommendation for this patient is to obtain a:
Tdap/Td vaccine ~ All adults should have a Tdap/Td booster once, as recommended by the ACIP. As part of standard wound management care to prevent tetanus, a tetanus toxoid-containing vaccine might be recommended for for wound management in adults 19yrs+ if 5yrs or more have elapsed since last receiving a Td vaccine. If a tetanus booster is indicated Tdap is preferred over Td for wound management in adults 19yrs+ who have not received Tdap previously. A pneumococcal vaccine is recommended for adults 65yrs+ for those with a chronic illness or in an immunocompromised state. Most older adults had chickenpox as a child and do not require the vaccine
Immunizations and chemoprophylaxis offered routinely to patients 65yrs+ are:
Tdap/Td, influenza, shingles, and pneumococcal vaccine ~ACIP continues to recommend that all adults aged 65yrs+ receive 1 dose of PPSV23. A single dose of PPXV23 is recommended for routine use among all adults 65yrs+. Annual influenza immunizations are recommended for those who are older than 65yrs. Shingles vaccination is recommended as a 2dose series 2-6mos apart. Tdap for all adults 65yrs+ is recommended for those who never received a Tdap as an adult because then they would just get a Td booster every 10 yrs as this is recommended for all ages 19+. Boostrix should be used for adults 65+yrs; however, the ACIP concluded that either vaccine (Adacel or Boostrix) administered to a person 65yrs+ is immunogenic and provides protection. The shingles vaccine is contraindicated in women who are pregnant and in individuals who have a weakened immune system
Recommendations fo the ACIP and the CDC for the Hep A vaccine include: (Select 2 responses)
Testing for HAV immunity is not necessary before HAV vaccinations If the interval between the 1st and 2nd doses of HAV vaccine extends beyond 18mos, it is not necessary to repeat a dose ~ It is not necessary to test for HAV immunity before vaccinating. HAV vaccine is recommended for pregnant women with additional medical conditions or other indications for receiving the HAV vaccine. The vaccination schedule is 2 doses given 6mos apart, which is the minimum interval between the 1st and 2nd doses. the antibody test for total anti-HAV measures both IgG anti-HAVIfM anti-HAV. The presence of IgM anti-HAV is found in the blood during an acute Hep A infection. Persons who are total anti-HAV positive and IgM anti-HAV negative have serologic markers indicating immunity consistent with either past infection or vaccination. IgG anti-HAV appears in the convalescent phase of HAV infection, remains present in serum for the lifetime of the person, and confers lifelong protection against disease. ACIP recommends that all children in the United States receive the Hep A vaccine at 1yr of age to avoid interference by passive maternal anti0HaV that may be present during the 1st year of life.
Which statement most correctly describes tetanus toxoid?
Tetanus toxoid is a bacterial toxins that has been changed to a nontoxic form ~ Tetanus toxoid is a bacterial toxin that has been changed to nontoxic for am and produces persistent antitoxin antibody titters because the patient immune system is stimulated to manufacture antitoxins. C. Diphtherae is the organism that causes diphtheria, not tetanus. DTaP and DT are for use in children under 7yrs and should NOT be used in adults. DT does not contain peruses and is given as a substitute for children who cannot tolerate the DTaP vaccine, which contains pertussis, The recommended dose of tetanus toxoid alone For an adult is 0.5mL IM. To help you remember, look closely at the letters and keep the following in mind: Upper case T means there is about the same amount of tetanus in DTaP, Tdap, and Td Upper case D and P means there is more diphtheria and pertussis in DTaP than in Tdap and Td; lower case letters mean there is less.
The FNP understands that the infant mortality rate is:
The number o infant deaths per 1000 live births ~ This is the frequently used ratio
The FNP is assessing an older adult patient using the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative algorithm call the Algorithm for Fall Risk Assessments & Interventions. Which documentation is representative of moderate risk?
The patient has fallen once in the past year without injury, gait and balance deficits present ~ Any patient with gait, balance, or sensory deficits is considered moderate or high risk, regardless of fall history. A patient with gait, balance or sensory deficits who has not fallen, or a patient who has fallen one time without injury is classified as moderate risk. A patient who has fallen once with injury or fallen 2+ times is considered at high risk. Only patients without gait and balance issues without a history of falls are classified as low risk and may need further evaluation with other assessment tools. A patient who had concerns about falling but did not exhibit any balance or ambulation problem would be considered at low risk
An older adult patient reports being forgetful. The FNP is planning a possible drug regimen. Which of the following would promote adherence to the drug regimen? (Select 3 responses)
Time doses of mediations to mealtime Prescribe the smallest number of mediations Older medication that are dosed once daily whenever possible ~To promote patient adherence in prescribing medications, the following are effective measures: prescribe the lowest dose and the smallest number of medications with the simplest dose regimens, providing simple verbal and written instruction for each medication and what it is for. The scheduling of medications that is best for the patient who is forgetful is a once-a-day dose and timing the doses to mealtimes to support the older adult in remembering to take the medication. If side effects occur, the patient should be told to call the FNP. The patient should not be taught to reduce or alter the dose of the medication without guidance from the FNP. Medications that are similar in size and color can be difficult for the older adult to discriminate because of reduced vision or being forgetful
The FNP is conducting an admission assessment interview with an adult Native American client. Which therapeutic approach would be most effective?
Use a soft voice with open-ended statements and reflective technique; avoid direct constant eye contact ~ Indigenous cultures, such as the Native American culture, place special significance on the place of humans in the natural world. That culture emphasizes the importance of holistic body-mind-spirit and living in harmony with nature. Using a soft voice with open-ended statements that reflect a cooperative, sharing style rather than competitive or intrusive approaches would be the preferred therapeutic approach (i.e. a passive style would be best received). Also, some Native American cultures use silence to a far greater degree, which should bot be mistaken for belligerence of sullenness, but likened more to a common response in dealing with strangers or noted as a sign of wisdom. The other options would be more effective to use with clients of a Western culture orientation.
The FNP is developing a plan of care fo ra group of adolescents who have a history of being unsupervised after school. Which 3 factors of adolescence should the FNP consider when planning care?
Use alcohol and smoke marijuana Be involved in risky behavior Are more likely to smoke tobacco ~ Adolescents most likely to smoke, abuse substances, perform poorly in school, be depressed, and engage in risky behavior are those who have history of being unsupervised after school
The FNP who volunteers at a senior citizens center is planning activities for the members who attend the center. Whcih activity would best promote and maintain health for theese senior citizens?
Walking 3-5 times per week for 30" ~ Exercise and activity are essential for health promotion and maintenance in the older adult and to achieve an optimal level of functioning. About half of the physical deterioration of the older patient is caused by disuse rather than by the aging process or disease. One of the best exercises for an older adult is walking, progressing to 30" sessions, 3-5 times per week. Swimming and dancing are also beneficial
The FNP is preparing to conduct an interview with a non-English-speaking client. An interpreter is scheduled. Which of the following actions are appropriate?
Watch the client's verbal and nonverbal communication ~ Watch and listen to the client's nonverbal communication, when the client is talking. During the interview, look and speak with the client, not the interpreter. Pace a conversation so there is time fo rthe client's response to be interpreted. Do not ask the interpreter to paraphrase or insert their meaning into the client's words. Ask the client for feedback and clarification at regular intervals. Use brief, concise sentences and simple language- avoid technical terms and slang language
In explaining the purpose of primary prevention programs to a group of nursing students, the FNP states that primary prevention programs:
Work to lower the incidence of birth defect ~ Primary prevention programs exist to prevent disease, malfunctioning, or maladaptation from occurring (for example, work to lower the incidence of birth defects). Examples of these types of programs include the promotion of a healthy diet, practice of safe sex, and avoidance of alcohol and tobacco. Secondary prevention is early diagnosis and treatment (for example, screening for tuberculosis or sickle cell disease, breast and testicular self-examination). Tertiary prevention is the prevention of complications and rehabilitation after the disease or condition has occurred (for example, cardiac rehabilitation, CBC done before chemotherapy)
