ANCC AGPCNP Practice Qs

If a known sulfa allergy is present, which cross-sensitivity should the nurse practitioner be aware of when prescribing medications? (Select all that apply.) a. Thiazides b. Loop diuretics c. Silver sulfadiazine d. Atenolol e. Protease inhibitors

A, B, C, E Patients with sulfa allergies may be sensitive to thiazides, loop diuretics, silver sulfadiazine (used in treating burns), and some protease inhibitors (e.g., darunavair, fosamprenavir), which are used in the treatment of HIV. Atenolol has not been proven to have any contraindications or cross-sensitivity when prescribed with sulfa-containing medications.

A 19-year-old woman has recently been diagnosed with acute hepatitis B. She is sexually active and is monogamous. She reports that her partner uses condoms inconsistently. What would you recommend for her male sexual partner who was also tested for hepatitis with the following results: HBsAg (−), anti-HBc (−), anti-HBs (−), anti-HCV (−), anti-HAV (+)? A.Hepatitis B vaccination B.Hepatitis B immunoglobulin C.Hepatitis B vaccination and hepatitis B immunoglobulin D.No vaccination is needed at this time

C.Hepatitis B vaccination and hepatitis B immunoglobulin HBsAg is a marker of infectivity. If positive, it indicates either an acute or chronic hepatitis B infection, so the partner does not have acute or chronic hepatitis B infection. Anti-HBs is a marker of immunity and because this is negative, it indicates that the partner is not immune to hepatitis B. Antibody to hepatitis B core antigen (anti-HBc) is a marker of acute, chronic, or resolved hepatitis B virus (HBV) infection; it may be used in pre-vaccination testing to determine previous exposure to HBV. The hepatitis B panel results for the individual in this question (negative HBsAg, anti-HBc, and anti-HBs) indicate the partner is susceptible (not immune), has not been infected, and is still at risk of future infection—and thus needs vaccine. Hepatitis B immunoglobulin contains antibodies that provide "instant" immunity against hepatitis B, but its action lasts for several days only. It is not a vaccine. It is given to infants and others who are at high risk of becoming infected and are not immune. The hepatitis B vaccine stimulates the body to make its own antibodies, which are permanent. A total of three doses are needed to gain full immunity against hepatitis B. Interpretation of the negative anti-HCV screening test indicates that the partner is not infected with Hepatitis C. The positive anti-HAV indicates that the individual is immune (either from previous disease or from vaccination) to Hepatitis A.

All of the following findings are associated with labyrinthitis or vestibular neuritis, except: a. Acoustic nerve damage b. Symptoms provoked by changes in head position c. Vertigo with nausea and vomiting d. Nystagmus

a. Acoustic nerve damage Labyrinthitis is also known as vestibular neuritis. It is caused by viral or postviral inflammation that affects the vestibular portion of cranial nerve VIII (acoustic nerve). It is usually a self-limiting disorder. The other symptoms listed are common with labyrinthitis and are made worse with moving the head, sitting up, rolling over, or looking upward. Treatment is corticosteroids (methylprednisone), antivirals (valacyclovir), and antihistamines such as meclizine (Antivert) or dimenhydrinate (Dramamine).

Which debridement method works best for wounds with minimal to no discharge? a. Autolytic debridement b. Sharp debridement c. Jet lavage debridement d. Enzymatic debridement

a. Autolytic debridement In autolytic debridement, the wound is covered with hydrogel sheet, alginate sheet, or semiocclusive transparent film, which retains the enzymes produced by the wound. It works best in wounds with minimal to no discharge. In sharp debridement, the necrotic tissue is cut with a scalpel or sharp scissors. Water is used to clean and debride in jet lavage debridement, and proteolytic enzymes are applied to the wound in enzymatic debridement.

A patient presents to the primary care clinic with complaints of headache, nonproductive cough, and fatigue for the past 2 weeks. The nurse practitioner auscultates crackles and wheezing. A chest x-ray shows patchy infiltrates. The patient does not have comorbidities or recent use of antibiotics. What is the most appropriate treatment for this patient? a. Azithromycin (Z-Pak) daily × 5 days b. Levofloxacin (Levaquin) 750 mg PO × 5-7 days c. Amoxicillin-clavulanate (Augmentin) 1,000/62.5 mg PO BID × 5-7 days d. Moxi.oxacin (Avelox) 400 mg PO daily × 5-7 days

a. Azithromycin (Z-Pak) daily × 5 days The patient presents with signs and symptoms of Mycoplasma pneumoniae (atypical pneumonia). Because this patient does not have any comorbidities or antibiotic resistance, the most appropriate treatment would be azithromycin (Z-Pak) daily × 5 days. Patients with risk of possible comorbidity (e.g., chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia) and/or those at risk for antibiotic resistance should receive monotherapy with a fluoroquinolone (e.g., levofloxacin or moxifloxacin) or combination therapy of amoxicillin-clavulanate plus a macrolide or doxycycline. Monotherapy with amoxicillin-clavulanate would not be appropriate.

A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week. The patient's forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner upgrades the patient to the next stage of treatment, which includes: a. Budesonide with formoterol b. Budesonide with montelukast c. Cromolyn or nedocromil d. Fluticasone with salmeterol

a. Budesonide with formoterol. The patient has moved from step 2 to step 3 on the asthma classification scale. Therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been discontinued in the United States.

All of the following findings are associated with the secondary stage of an infection by the organism Treponema pallidum, except: a. Condyloma acuminata b. Maculopapular rash of the palms and soles c. Lymphadenopathy d. Condyloma lata

a. Condyloma acuminata Findings consistent with the diagnosis of syphilis, caused by the T. pallidum organism, include painless chancre, maculopapular rash of the palms and soles, lymphadenopathy, and condyloma lata. Condyloma acuminate (genital warts) are caused by the human papillomavirus (HPV) and spread to others by skin-to-skin contact.

An adult presents to the health center with a fever of 104.2°F, vomiting, and petechiae on the hands and feet progressing to the trunk over the past 3 days. Which medication will the nurse practitioner prescribe? a. Ceftriaxone 2 grams IV every 12 hours b. Doxycycline BID × 10 days c. Rifampin PO every 12 hours × 2 days d.Cephalexin (Keflex) QID × 10 days

a. Doxycycline BID x 10 days The patient likely has Rocky Mountain spotted fever. Doxycycline is the first-line treatment for Rocky Mountain spotted fever, a vector-borne (commonly by ticks) disease caused by the bacterium Rickettsia rickettsii. The treatment is based on empirical diagnosis. To avoid possible complications, treat within 5 days; do not wait for lab results. Rifampin is indicated for treating close contacts of a patient with meningococcemia. If confirmed with meningococcemia, patient will be admitted to the hospital and started on ceftriaxone 2 grams IV every 12 hours and vancomycin IV every 8 to 12 hours. Cephalexin (Keflex) is the preferred medication of choice for severe cases of impetigo.

All of the following are true statements regarding the tetanus and diphtheria vaccine, except: a. Fever occurs in up to 80% of the patients b. A possible side effect is induration on the injection site c. A tetanus and diphtheria toxoid vaccine is given every 10 years d. The DPT and DT should not be given beyond the seventh birthday

a. Fever occurs in up to 80% of the patients Side effects of the Td vaccine include induration at the injection site. Td or Tdap is given in adults every 10 years. The DPT and DT should not be given beyond 7 years of age. Fever may occur, but studies do not support 80% of patients having fever.

Which initial treatment will the nurse practitioner include in the plan of care for a patient with a positive Finkelstein's test? a. Ibuprofen b. Oral prednisone c. Lidocaine injection d. Corticosteroid injection

a. Ibuprofen Finkelstein's test is used to diagnose de Quervain's tenosynovitis. De Quervain's tenosynovitis occurs from repetitive movement or overuse of the wrist and thumb. The symptoms associated with de Quervain's tenosynovitis result from infl ammation of the tendons and sheaths located on the thumb side of the wrist, causing pain traveling up the arm and swelling over the thumb and wrist. The patient will be instructed to apply ice packs for a prescribed amount of time daily and take a nonsteroidal anti-infl ammatory drug such as ibuprofen for discomfort. Oral prednisone is not used in the treatment of de Quervain's tenosynovitis. Doses of 0.5% plain lidocaine and 0.5 mL of a long-acting corticosteroid are injected either simultaneously or subsequentially into the sheath of the fi rst dorsal compartment to reduce tendon infl ammation. They are not used singularly for treatment of the condition. Furthermore, the treatments are invasive and increase the risk for complications; therefore they are not the first line of treatment.

What is the mechanism of action of probenecid? a. Increases uric acid excretion b. Increased uric acid metabolism c. Decreases formation of uric acid d. Decreases metabolism of uric acid

a. Increases uric acid excretion Probenecid is a uricosuric agent used to increase the excretion of uric acid through the renal system in patients with gout. Probenecid does not affect the formation of uric acid. Uric acid is not metabolized; it is excreted.

Which of the following is true regarding a screening test with high sensitivity? a. It is the ability of the test to correctly identify an individual who has the disease b. It is the ability of the test to correctly identify an individual who does not have the disease c. It is the probability that subjects with a positive screening test truly have the disease d. It is the probability that subjects who have a negative screening test truly do not have the disease

a. It is the ability of the test to correctly identify an individual who has the disease A test with high sensitivity is very good at identifying individuals who have the disease; therefore, fewer cases of the disease are missed. Option B is the definition of a test with high specificity; it is the ability of the test to correctly identify an individual who does not have the disease. Option C is the definition of a test with a high positive predictive value (PPV); it is the probability that subjects with a positive screening test truly have the disease. Option D is the definition of negative predictive value (NPV); it is the probability that subjects who have a negative screening test truly do not have the disease.

A 20-year-old woman reports that for several years, she has had random episodes of palpitations and shortness of breath that resolve spontaneously. She denies chest pain, arm pain, and syncope. Her past medical and family histories are negative for coronary artery disease, stroke, or lung disease. During the cardiac exam, the nurse practitioner notices a grade 3/6 murmur that is accompanied by a midsystolic click, which is best heard at the apical area. The apical pulse is 78 beats/min, blood pressure is 120/60 mmHg, and temperature is 98.6°F. The cardiac exam is highly suggestive of which of the following conditions? a. Mitral valve prolapse (MVP) b. Aortic stenosis c. Atrial septal defect d. Pulmonary regurgitation

a. Mitral valve prolapse A systolic murmur that is accompanied by a midsystolic click located at the apical area is a classic finding of MVP. Most cases of MVP are asymptomatic. To detect MVP, order an echocardiogram with Doppler imaging.

An 84-year-old female presented to the clinic 2 weeks ago with vague reports of fatigue, red maculopapular rash, and low-grade fever. Upon further examination, there was no lymphadenopathy, sore throat, atypical white blood cells (WBC), or splenomegaly. During the follow-up exam 2 weeks later, the patient is diagnosed with Guillain-Barré syndrome. What was the original diagnosis? a. Mononucleosis b. Influenza c. Meningitis d. Measles

a. Mononucleosis In older adults, reactive infectious mononucleosis presents atypically, not with the classic triad of fever, pharyngitis, and lymphadenopathy. Influenza (virus) presents with a sore throat, fever, chills, and runny nose. Meningitis presents with high fever, severe headache, photophobia, and neck stiffness. Measles presents with a fever, reddish-brown rash, lethargy, cough, and photophobia. Measles may occur in unvaccinated infants, but it may also affect older adults.

Which of the following is a first-line medication for tinea unguium? a. Oral terbinafine (Lamisil) b. Efinaconazole 10% solution (Jublia) c. Azelaic acid (Azelex) d. Metronidazole topical gel (Metrogel)

a. Oral terbinafine (Lamisil). Tinea unguium (onychomycosis) is a fungal infection of the nails, usually the great toe. The toenail becomes yellowed and thickened and may even separate from the nail bed. The first-line medication is oral terbinafine (Lamisil) for 12 weeks. For mild-to-moderate infections, efinaconazole 10% solution (Jublia) can be used. Azelaic acid (Azelex) and metronidazole gel (Metrogel) are treatments for rosacea (acne rosacea).

The nurse practitioner is assessing a 56-year-old patient and notes diffuse reddish-brown, pigmented lesions on the back, trunk, abdomen, chest, and arms. A sample of the skin scrapings on a potassium hydroxide (KOH) wet mount reveals short hyphae and budding cells. Which medication will the nurse practitioner prescribe? a. Oral fluconazole (Diflucan) b. Oral ketoconazole (Nizoral) c. Topical tacrolimus (Protopic) d. Topical selenium sulfide

a. PO fluconazole Pityriasis versicolor, formerly known as tinea versicolor, is a fungal infection caused by a type of yeast that is normally present on the skin but has grown out of control. Pityriasis versicolor is diagnosed by clinical appearance and a sample of the skin scrapings placed on a potassium hydroxide (KOH) wet mount, which reveal short hyphae and budding cells. Due to the extent of the patient's fungal infection, oral fluconazole is the primary prescribed treatment for tinea versicolor. Oral ketoconazole is contraindicated in the treatment of pityriasis versicolor due to the risk of adrenal problems, liver damage, and harmful drug interactions. Tacrolimus is an immunosuppressant that demonstrates antimycotic action but is not the most effective in reducing the appearance of hypopigmentation associated with pityriasis versicolor. Topical selenium sulfide for a widespread case of pityriasis versicolor can be expensive and difficult to cover large surface areas of the infected skin.

An adult patient was walking on the beach when a nail punctured through their shoe. The patient has a swollen, diffuse pinkish-red, warm foot. Which gram-negative pathogen is the most likely the cause of this infection? A.Pseudomonas aeruginosa B.Vibrio vulnificus C.Pasteurella multocida D.Staphylococcus aureus

a. Pseudomonas Aeruginosa Puncture wounds of the foot may become infected with Pseudomonas aeruginosa (gram negative) by the foam material from sneakers, ultimately causing cellulitis. Vibrio vulnificus is a gram-negative bacterium that causes infections from consuming raw oysters or clams. Pasteurella multocida is a gram-negative pathogen that is present in dog and cat bites. Staphylococcus aureus is a gram-positive bacterium that causes a purulent form of cellulitis such as methicillin-resistant Staphylococcus aureus (MRSA), especially in the lower leg (85%).

A 75-year-old patient with a history of diabetes for 25 years is at the primary care clinic for a yearly exam. Which finding would prompt the nurse practitioner to refer the patient to the ED? a. Tonometer reading of 28 mmHg b. Retinal hemorrhages c. Cotton-wool spots on the retina d. Reports of difficulty driving at night

a. Tonometer reading of 28 mmHg A tonometer is used to measure intraocular pressure (IOP). A normal range for IOP is 8 to 21 mmHg. A reading of 28 mmHg could be indicative of primary open-angle glaucoma. Retinal hemorrhages in a 75-year-old patient with a 25-year history of diabetes would likely be the result of systemic vascular conditions such as hypertension and carotid artery stenosis. They represent a long-standing disease and are not a medical emergency; however, if the patient presented with sudden black spots or floaters in the vision, the retinal hemorrhage could represent a more emergent issue such as retinal tear/retinal detachment. Cotton-wool spots on the retina indicate diabetic retinopathy, which is not a medical emergency. Cataract symptoms include difficulty driving at night due to glare, halos around lights, and blurred vision.

What is the most common sign or symptom of allergic rhinitis? a. Transverse nasal crease b. Yellow nasal discharge c. Under-eye circles d. Inability to sleep through the night

a. Transverse nasal crease The classic sign of allergic rhinitis is a transverse nasal crease (allergic salute) from frequent rubbing and wiping away of nasal discharge. Allergic rhinitis generally produces clear nasal discharge unless there is also sinusitis. It may also cause under-eye circles from vasodilation or lack of sleep from sneezing and itchiness.

Which of the following drugs can increase the risk of bleeding in patients who are receiving anticoagulation therapy with warfarin sodium (Coumadin)? a. Trimethoprim-sulfamethoxazole (Bactrim DS) b. Carafate (Sucralfate) c. Losartan (Cozaar) d. Furosemide (Lasix)

a. Trimethoprim-sulfamethoxazole (Bactrim DS). Warfarin sodium (Coumadin) interacts with Bactrim and will increase the risk of bleeding; therefore, concurrent use is contraindicated.

Which of the following antigens is a component of the HIV 1/2 combination antibody/antigen testing? a. p24 b. p20 c. P18 d. P14

a. p24 The p24 antigen appears early in HIV infection and enables earlier detection. The preferred test for HIV screening is the fourth-generation HIV 1/2 combination antibody with p24 antigen test. If strong suspicion of HIV infection, also order the HIV RNA PCR test, which detects the HIV virus directly.

An elderly fair-skinned male presents to the clinic for a routine examination. The nurse practitioner notices a lesion on his nose. The lesion is a small, translucent papule with a central ulceration, telangiectasis, and rolled borders. Which diagnosis is most likely? a. Acral lentiginous melanoma b. Basal cell carcinoma c. Actinic keratosis d. Seborrheic keratosis

b. Basal cell carcinoma This is a classic appearance of a basal cell carcinoma. Lesions are small, translucent papules with a central ulceration, telangiectasis, and rolled borders. They appear as pearly white, light pink, brownish, or flesh colored. Basal cell carcinoma is more common in fair-skinned persons with long-term sun exposure. Acral lentiginous melanoma is a common type in African Americans and Asians. These are dark brown or black lesions located on nail beds. Actinic keratosis is a rough, scaly patch on the skin that develops from years of exposure to the sun. It is most commonly found on the face, lips, and ears; back of the hands; forearms; scalp; or neck. Seborrheic keratoses are soft, wartlike benign lesions that frequently appear on the back and trunk of older adults.

What is the most common cause of balanitis? a. Pseudomonas b. Candida albicans c. Bacteria d. Virus

b. Candida albicans Balanitis is inflammation of the glans penis. It can be caused by an infection, allergic reaction to a soap, or poor hygiene. The most common infectious organism is the yeast Candida albicans. The glans penis will develop redness, shallow ulcers with white base, and curd-like discharge. Risk factors include diabetes, obesity, and uncircumcised penises. Pseudomonas is not associated with balanitis.

The nurse practitioner is assessing a new 55-year-old male patient. The patient has smoked cigarettes for 30 years and is now occasionally coughing up blood-tinged sputum and experiencing increased dyspnea and dull, achy chest pain that does not resolve. Which initial screening test will the nurse practitioner order? a. Lung/tumor biopsy b. Chest radiograph c. CT scan d. Bronchoscopy

b. Chest radiograph Chest radiograph to detect nodules, lesions, or irregular borders would be ordered first. If lesions are noted, a CT scan is ordered, and the patient is referred to a pulmonologist for additional assessment to include a bronchoscopy and lung biopsy.

Which of the following is considered an objective finding in patients who have a case of suppurative otitis media? a. Erythema of the tympanic membrane b. Decreased mobility of the tympanic membrane as measured by tympanogram c. Displacement of the light reflex d. Bulging of the tympanic membrane

b. Decreased mobility of the tympanic membrane as measured by tympanogram Acute suppurative otitis media is an acute infection affecting the mucosal lining of the middle ear and the mastoid air system. Suppurative stage: The tympanic membrane bulges and ruptures spontaneously through a small perforation in the pars tensa. Ear discharge is usually present. Diagnosis is usually made simply by looking at the eardrum through an otoscope. The eardrum will appear red and swollen, and may appear either abnormally drawn inward or bulging outward. Using the tympanogram with the otoscope allows a puff of air to be blown lightly into the ear. Normally, this should cause movement of the eardrum. In an infection, or when there is fl uid behind the eardrum, this movement may be decreased or absent.

A sexually active 17-year-old female patient visits a community health clinic to obtain birth control. Her body mass index (BMI) is 18.3, albumin level is 2.7 g/dL, blood sugar is 96 mg/dL, and she has +1 pedal edema. Which contraception method should be avoided with this patient? a. Monophasic pills b. Depo provera c. Biphasic pills d. Triphasic pills

b. Depo provera The patient is underweight with a low albumin level and +1 pedal edema, which suggests that the patient may have anorexia nervosa. Medroxyprogesterone (Depo Provera) is a progesterone-based injection with a higher risk for osteoporosis or osteopenia, so it should be avoided in patients with anorexia nervosa. Monophasic, biphasic, and triphasic birth control pills are combination medications with progesterone and estrogen and are preferred in this patient.

Which medication will the nurse practitioner select for a frail elderly patient with systolic blood pressures between 152 and 158 mmHg? a. Furosemide (Lasix) 40 mg/day b. Hydrochlorothiazide (Microzide) 12.5 mg/day c. Bumetanide (Bumex) 1 mg BID d. Propranolol (Inderal) 40 mg BID

b. Hydrochlorothiazide (Microzide) 12.5 mg/day It is acceptable for an elderly adult without chronic kidney disease (CKD) or diabetes mellitus to have a systolic blood pressure up to 150 mmHg. A low-dose thiazide diuretic should be the first-line medication for frail elderly patients with isolated systolic hypertension. Take caution with thiazides if the patient has a sulfa allergy. Bumetanide and furosemide can increase the risk for severe hypotension, as well as electrolyte imbalance, in elderly patients. Propranolol should not be used to treat hypertension because of a shorter half-life.

A 55-year-old male presents with a swollen, painful right testicle and burning on urination. Examination reveals edematous scrotum with tenderness and a positive Prehn's sign. The patient states he is heterosexual and has been in a monogamous relationship for the past 5 years. He denies practicing anal intercourse. The nucleic acid amplification test (NAAT) is negative. Which medication will the nurse practitioner prescribe? a. Ceftriaxone 250 mg IM b. Levofloxacin 500 mg PO × 10 days c. Doxycycline 100 mg PO BID × 10 days d. Ceftriaxone 250 mg IM and ofloxacin 300 mg PO BID × 10 days

b. Levofloxacin 500 mg PO × 10 days. The results of the NAAT indicate the patient is negative for chlamydia and gonorrhea. In an older male, acute epididymitis, caused by enteric organisms (generally gram-negative Escherichia coli ), is the probable diagnosis. Levofloxacin 500 mg orally once a day for 10 days is the treatment of choice. Epididymitis is diagnosis for most commonly gram-negative E. coli. Ceftriaxone 250 mg IM in addition to Doxycycline 100 mg orally twice a day for 10 days is recommended for patients with epididymitis caused by chlamydia and gonorrhea. Ceftriaxone 250 mg IM in addition to ofloxacin 300 mg orally twice a day for 10 days is indicated for patients with acute epididymitis most likely caused by sexually transmitted chlamydia and gonorrhea, as well of the probability of enteric organisms obtained by men who practice anal sex.

Which medication will the nurse practitioner prescribe to a 28-year-old female newly diagnosed with hypothyroidism? a. Levothyroxine T3 b. Levothyroxine T4 c. Thyroid-stimulating hormone d. Combined levothyroxine T3 and T4

b. Levothyroxine T4 The current treatment for hypothyroidism is levothyroxine T4. Replacement therapy with levothyroxine T3 alone is not recommended. Much of the conversion of T3 comes from T4. T3 has a very short life span in the body, which would require a patient to take the medication several times a day and may result in imbalanced levels resulting in unpleasant symptoms. Too high of a level can result in injury to the heart and bones. Thyroid-stimulating hormone stimulates the release of T3 and T4 from the thyroid gland, which in hypothyroidism is not reacting to producing the hormones in response to stimulation of thyroid stimulating hormone from the anterior pituitary gland. Combined levothyroxine T3 and T4 can be prescribed, but this does not offer any advantage over prescribing T4 alone.

An 80-year-old woman complains about her "thin" and dry skin. Which of the following is the best explanation for her complaint? a. Genetic predisposition b. Loss of subcutaneous fat and lower collagen content c. Atrophy of sebaceous glands d. Damage from severe sun exposure

b. Loss of subcutaneous fat and lower collagen content

A patient diagnosed with irritable bowel syndrome (IBS) tells the nurse practitioner that over the past few months, she has been experiencing frequent bouts of constipation. Which prescription will the nurse practitioner add to the treatment plan? a. Amitriptyline (Elavil) 50 mg PO once daily b. Lubiprostone (Amitiza) 8 mcg PO BID c. Alosetron (Lotronex) 0.5 mg PO BID × 4 weeks d. Dicyclomine (Bentyl) 20 mg PO every 6 hours, 30 to 60 minutes before meals

b. Lubiprostone 8 mcg orally twice daily. Lubiprostone is a chloride channel activator that is approved by the Food and Drug Administration (FDA) for the treatment of irritable bowel syndrome with constipation in adults. Amitriptyline is a tricyclic antidepressant that can be used to treat abdominal pain, mucorrhea, and stool frequency. Dicyclomine hydrochloride is an anticholinergic and antispasmodic that decreases fecal urgency and pain associated with diarrhea. Alosetron is administered for irritable bowel syndrome associated with diarrhea. It is associated with gastrointestinal toxicity resulting in ischemic colitis and should not be prescribed for patients with constipation.

A 55-year-old patient who is on a prescription of clindamycin for a dental infection presents to the nurse practitioner with complaints of watery diarrhea for the past 4 days. She complains of abdominal cramping and bloating with diarrheal stools up to 10 times a day. She denies seeing blood or pus in her stool. There is no history of recent travel. The patient has been taking over-the-counter medicine with no relief. Which of the following antibiotics is indicated for this infection? a. Ciprofloxacin (Cipro) 400 mg PO BID × 7 days b. Metronidazole (Flagyl) 500 mg PO TID × 10 days c. Levofloxacin (Levaquin) 750 mg PO daily × 7 days d. Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet PO BID × 10 days

b. Metronidazole (Flagyl) 500 mg PO TID × 10 days First-line treatment for a mild case of Clostridium difficile colitis is metronidazole (Flagyl) 500 mg PO TID for 10 days. Discontinuation of the offending antibiotic (if possible) or switching to another antibiotic class is recommended. The role of probiotic supplementation is controversial. Complications are pseudomembranous colitis, toxic megacolon, and fulminant colitis.

Which treatment will the nurse practitioner prescribe for a 20-year-old female patient who presents with frothy, malodorous vaginal discharge? a. Azithromycin 1 g PO × 1 dose b. Metronidazole 2 g PO × 1 dose c. Acyclovir 400 mg PO TID × 10 days d. Doxycycline 100 mg PO BID × 7 days

b. Metronidazole 2 g PO × 1 dose The patient's clinical findings are associated with trichomoniasis caused by a protozoan parasite for which the treatment is metronidazole 2 g PO × 1 dose. Metronidazole belongs to the classification of drugs known as nitroimidazoles, which are used to treat parasitic infections. The clinical findings are not associated with vaginal bacterial infections, chlamydia, gonorrhea, or syphilis. Azithromycin and doxycycline are antibiotics used to treat bacterial infections. Acyclovir is an antiviral medication used to treat conditions such as genital herpes simplex infections.

A college student is brought to the primary care clinic with a stiff neck, photophobia, severe headache, and changes in mental status. The nurse practitioner suspects meningitis and evaluates for which additional data to confirm this diagnosis? a. Cerebrospinal fluid with high levels of glucose b. Positive Kernig sign c. Negative Brudzinski sign d. Negative Babinski reflex

b. Positive Kernig sign Acute bacterial meningitis presents with nuchal rigidity, light sensitivity, petechiae, severe headache, mental status changes, and, in some cases, nausea and vomiting. Meningitis is highly contagious, and droplet precautions should be implemented. A lumbar puncture with large numbers of white blood cells (WBCs), elevated levels of protein, and low glucose levels are indicative of meningitis. A positive Kernig sign (resistance to leg strengthening due to inflammation of lumbar nerve roots) is a test to assess for meningeal irritation. The Brudzinski sign would also be positive, not negative. A Babinski reflex (plantar reflex) should be negative in adults.

A 22-year-old presents for her annual gynecological exam and testing. The Pap smear result shows ASC-US. Which of the following is the best management for this patient? a. Check for high-risk HPV b. Repeat Pap in 12 months c. Refer patient for colposcopy d. Refer patient for endometrial biopsy

b. Repeat pap in 12 months The appropriate follow-up for a 22-year-old with a Pap smear result of ASC-US is to perform a repeat Pap smear in 12 months. HPV testing is not recommended for this age group with ASC-US. A colposcopy is not recommended for ASC-US, as most cases clear spontaneously in young women. An endometrial biopsy is not appropriate follow-up for ASC-US, since it does not involve the endometrium.

The nurse practitioner is evaluating a middle-aged woman who has experienced gradual weight gain, lack of energy, dry hair, and an irregular period for the past 8 months. Routine annual laboratory testing showed a thyroid-stimulating hormone (TSH) level of 10 mU/L. The nurse practitioner decides to order a thyroid profile. Results show that TSH is 8.50 mU/L and serum free T4 is decreased. During the physical exam, the patient's body mass index (BMI) is 28. The heart and lung exams are both normal. Which of the following is the best treatment plan for this patient? a. Advise the patient that the decreased TSH level means her thyroid problem has resolved b. Start patient on levothyroxine (Synthroid) 25 mcg PO daily c. Start patient on Armour thyroid d. Refer the patient to an endocrinologist

b. Start patient on levothyroxine (Synthroid) 25 mcg PO daily The patient is symptomatic (weight gain, lack of energy, and irregular periods) with low free T4. Even though the TSH level decreased slightly, the free T4 remains low. An elevated TSH and low free T4 are indicative of hypothyroidism. The next step is to start the patient on levothyroxine (Synthroid) 25 mcg daily and recheck the TSH in 6 weeks. The goal is to normalize the TSH (between 1.0 and 3.5) and ameliorate the patient's symptoms (e.g., increased energy, feels better). Armour thyroid (desiccated thyroid) is a natural supplement composed of dried (desiccated) pork thyroid glands. It is used in alternative medicine as an alternative to synthetic levothyroxine (Synthroid).

When an adolescent male's penis grows more in length than width, in which of the following Tanner stages is he classified? a. Tanner stage II b. Tanner stage III c. Tanner stage IV d. Tanner stage V

b. Tanner stage III In Tanner stage III in males, the testicular volume increases, the scrotum enlarges, and the penis begins to lengthen. Tanner stages are I: Prepubertal small penis; II: The penis length remains unchanged; III: Penis begins to lengthen; IV: Penis increases in length and circumference; and V: Scrotum and penis are mature size.

An 18-year-old female patient is being followed up for acne by the nurse practitioner. During the facial exam, papules and pustules are noted mostly on the forehead and the chin areas. The patient has been using over-the-counter topical antibiotic gels and medicated soap daily for 6 months without much improvement. The nurse practitioner will recommend: a. Isotretinoin (Accutane) b. Tetracycline (Sumycin) c. Clindamycin topical solution (Cleocin- T) d. Minoxidil (Rogaine)

b. Tetracycline (Sumycin) First-line treatment for acne vulgaris includes over-the-counter medicated soap and water with topical antibiotic gels. The next step in treatment would be the initiation of oral tetracycline.

What effect does finasteride have on prostate-specific antigen (PSA) levels in patients with prostate cancer? a. Finasteride does not have an acute effect on the PSA b. The chronic effect of finasteride is the stabilization of the PSA c. When using finasteride for long-term management, the PSA will be doubled d. An increase in PSA within the normal range may occur with the use of finasteride

b. The chronic effect of finasteride is the stabilization of the PSA. The chronic effect of using finasteride to treat prostate cancer is the stabilization or gradual decline of the patient's PSA. An acute effect of the finasteride on PSA is a reduction, rather than an increase, of approximately 50%. Any increase in PSA should be of concern, even if the value is within a normal range.

A patient has been managed for Graves' disease for 2 years. During a recent office visit, the patient is found to also have atrial fibrillation. Which new medication will the nurse practitioner add to the treatment regimen? a. Furosemide [Lasix] b. Warfarin [Coumadin] c. Cholestyramine [Prevalite] d. Atenolol [Tenormin]

b. Warfarin [Coumadin] Patients with (Graves' disease) hyperthyroidism are at higher risk for osteoporosis and atrial fibrillation. The most appropriate medication to add to the treatment regimen is Coumadin, which treats atrial fibrillation. Furosemide (Lasix) is prescribed for heart failure, which is not a risk factor for a patient with hyperthyroidism. Cholestyramine (Prevalite) is used for hyperlipidemia. A beta-blocker such as atenolol is normally prescribed when a patient is first diagnosed with Graves' disease, to lessen hyperstimulation.

A nurse practitioner assesses a patient who is experiencing severe otalgia and has a temperature of 100.7°F. The Rinne test result shows that BC < AC, and the Weber exam shows lateralization in the affected ear. The nurse practitioner notes blisters on an erythematic tympanic membrane (TM). Which of the following conditions is most likely? a. Acute otitis media (AOM) b. Otitis media with effusion c. Bullous myringitis d. Otitis externa

c. Bullous myringitis Bullous myringitis is a severe type of AOM with painful blisters (bullae) on a reddened TM. The patient may exhibit conductive hearing loss, otalgia, muffled hearing, and a low-grade fever. With otitis media with effusion, the TM may bulge or retract, but it is not red. It may follow AOM and be caused by chronic allergic rhinitis. Otitis externa (swimmer's ear) is more common in the warm and humid seasons. There is external otalgia, swelling, discharge, pruritus, and hearing loss if the canal is blocked with pus.

A 35-year-old woman smokes approximately 10 cigarettes per day. She started smoking at the age of 18 years. She has a new male sexual partner and is interested in contraception. She was recently treated for gonorrhea and chlamydia. She is using condoms inconsistently. The urine pregnancy test is negative. She denies a history of hypertension, blood clots, liver disease, heart disease, and diabetes. Her last menstrual period was 5 days ago. Which of the following contraceptive methods is recommended? a. Oral contraceptive pills b. Copper IUD c. Etonogestrel implant (Nexplanon) d. Vaginal ring (NuvaRing)

c. Etonogestrel implant (Nexplanon) An etonogestrel implant (Nexplanon) is the best option for this patient. It is a progesterone-only method. The 35-year-old patient is a smoker, so she cannot take oral contraceptives, which contain estrogen/progesterone. An IUD (copper or progestin) is contraindicated until the patient is retested (4-6 weeks after treatment) to ensure that her gonorrhea and chlamydia infections are gone. The vaginal ring (NuvaRing) contains estrogen and progesterone; it is contraindicated for this patient.

The ELISA and Western blot tests are used to detect which of the following? a. HIV RNA b. HIV DNA c. HIV antibodies d. HIV antigens

c. HIV antibodies The ELISA (enzyme-linked immunosorbent assay) and Western blot tests detect only HIV antibodies. That is why there is a "window period" with HIV infection. If the test is performed too early in the infection, it will be falsely negative because there may not yet be enough antibodies against HIV to trigger a positive result.

Which statement made by a 24-year-old patient with diabetes mellitus indicates that education about disease management was effective? a. will check my blood sugars at the same time I do now b. Eating small meals every 2 hours will keep my blood sugars stable c. If I feel really tired or cannot concentrate, I will call you d. I will stop taking my oral medications and just take insulin

c. If I feel really tired or cannot concentrate, I will call you A patient with diabetes should eat small meals every 3 to 4 hours to keep blood sugars as normal as possible. Patients who have a blood sugar higher than 300 mg/dL, level of consciousness changes, or dehydration should contact the provider for advice. Blood sugars should be checked more frequently when a patient is sick, and they should not stop taking oral medications or insulin unless their fasting blood glucose (FBG) is lower than expected and as per provider's orders.

The nurse practitioner notes a high-pitched, blowing pansystolic murmur while assessing a 70-year-old male patient. It is grade 2/6 and is best heard at the apical area. Which of the following is most likely? a. Ventricular septal defect b. Tricuspid regurgitation c. Mitral regurgitation d. Mitral stenosis

c. Mitral regurgitation. Mitral regurgitation is best heard at the apical area and manifests as a high-pitched, blowing pansystolic murmur. It occurs when the mitral valve does not close properly. It is the abnormal leaking of blood from the left ventricle, through the mitral valve, and into the left atrium. When the ventricle contracts, there is backflow (regurgitation) of blood into the left atrium. Mitral regurgitation is the most common form of valvular heart disease. Murmurs are graded (classified) depending on how loud they sound with a stethoscope. The scale is 1 to 6 on loudness. A grade 2/6 is a grade 2 on the 6-point scale.

Which initial treatment will the nurse practitioner prescribe to a 23-year-old female allergic to sulfa drugs who is diagnosed with acute cystitis? a. Cephalexin (Keflex) 500 mg BID × 5 days b. Ciprofloxacin (Cipro) 250 mg BID × 3 days c. Nitrofurantoin (Macrobid) 100 mg BID × 5 days d. Amoxicillin 500 mg BID × 5 days

c. Nitrofurantoin (Macrobid) 100 mg BID × 5 days Nitrofurantoin can be safely administered to a patient with a sulfa allergy to treat acute cystitis and is the first line of treatment. Cephalexin and amoxicillin are beta-lactam antibiotics that can be prescribed for a patient who has an allergy to sulfa and nitrofurantoin. A fluoroquinolone, such as ciprofloxacin, is recommended for a patient who is allergic to sulfa and beta-lactam drugs or has a sulfa allergy and a known resistance to beta-lactam antibiotics.

A patient presents with proptosis and abnormal extraocular movement with pain. Which diagnosis is most likely? a. Hordeolum b. Anterior uveitis c. Orbital cellulitis d. Corneal abraision

c. Orbital cellulitis. Orbital cellulitis has an acute onset with a swollen eyelid and bulging eyeballs (proptosis). There is pain upon movement and an inability to perform smooth pursuit movements upon examination. Assess for a history of an upper respiratory infection. A corneal abrasion has an acute onset of eye pain and tearing; patients often report that it "feels like there is something in the eye." Anterior uveitis (iritis) causes eye pain with conjunctival redness; there is no purulent discharge, and it may cause blindness if not treated. A hordeolum (common stye) is a contagious external infection of a hair follicle in the upper or lower eyelid.

A 73-year-old male who is a smoker has a BMI of 28 and is newly diagnosed with primary HTN. He has a history of emphysema and second-degree AV block. His BP from the previous visit is 145/80 mmHg. During the current visit, his BP is 155/80 mmHg. What is the next step? a. Start patient on atenolol (Ternomin) 50 mg once a day and reassess in 3 months b. Start patient on felodipine (Cabren) 2.5 mg once a day and reassess in 2 months c. Start patient on chlorthalidone 12.5 mg daily and reassess in 1 month d. No medication is needed at this time

c. Start patient on chlorthalidone 12.5 mg daily and reassess in 1 month For patients newly diagnosed with HTN, the guidelines recommend follow-up visits every month (4 weeks) to reassess BP. When BP is at goal (<130/80 mmHg), the visits can be done every 3 to 6 months. The patient has emphysema, so beta-blockers are not allowed (rule out option A). He also has a second-degree AV block, which is a contraindication to CCBs (rule out option B).

Swim therapy (aqua therapy) for a 13-year-old with cerebral palsy is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health prevention

c. Tertiary prevention Tertiary prevention is any type of rehabilitation for a particular condition. Examples include physical rehab (swimming), cardiac rehab, and/or speech therapy.

A patient newly diagnosed with diabetes reports severe hives and swollen lips after taking Bactrim for a bladder infection 2 months ago. Which of the following statements is correct? a. The patient cannot take any pills in the sulfonylurea class b. The patient can take some of the pills in the sulfonylurea class c. The patient can take any of the pills in the sulfonylurea class d. None of the above

c. The patient can take any of the pills in the sulfonylurea class The patient can take any of the pills in the sulfonylurea class. Available evidence does not support existence of cross-reactivity between the sulfonamide antimicrobials (e.g., sulfamethoxazole) and the nonantimicrobial sulfonamides (e.g., furosemide, thiazide diuretics, sulfonylurea hypoglycemics, protease inhibitors, and carbonic anhydrase inhibitors). This is due to the differences in their sulfa metabolites. The exception is sulfasalazine, a disease-modifying antirheumatic drug (DMARD), which can cause a cross-reaction.

The Jarisch-Herxheimer reaction is a response to treatment of which of the following organisms? a. Neisseria gonorrhoeae b. Chlamydia trachomatis c. Treponema pallidum d. Rickettsia rickettsii

c. Treponema pallidum The Jarisch-Herxheimer reaction is an immune reaction caused by treatment of the spirochete Treponema pallidum (syphilis) with benzathine penicillin G, given by IM injection. When large amounts of treponema are killed, it releases foreign antigens that the body responds to with symptoms such as fever, chills, headache, myalgia, tachycardia, and increased respiratory rate that occurs in the first few hours after treatment and peaks in 6 to 8 hours. It is a self-limited reaction. Treatment is corticosteroids, antipyretics, and general supportive measures. Other spirochete bacteria that may elicit this reaction are Borrelia burgdorferi (Lyme disease) and Leptospira (leptospirosis, also known as Weil's disease or swamp fever).

A nurse practitioner is discussing urinary incontinence with a 78-year-old female patient and her caregiver. Which treatment would be most helpful for this patient? a. Kegel exercises b. PT c. Trial of oxybutynin d. Terazosin

c. Trial of oxybutynin Oxybutynin is an appropriate medication to trial for older women with urinary incontinence. The other option is imipramine, a tricyclic antidepressant (TCA). Kegel exercises are recommended for women who have stress incontinence; the highest incidence is in women between 45 and 49 years. Physical therapy for gait training and strengthening is for functional incontinence. Terazosin or tamsulosin would be prescribed for men with benign prostatic hyperplasia (BPH).

Which recommendation on mammogram examination would the nurse practitioner provide to a new middle-aged female patient? a. Women should begin receiving a mammogram at age 35 if they don't have risk factors b. Women aged 40 to 49 years should receive a mammogram every year; at age 50, they should receive a mammogram every 2 years c. Women aged 50 to 74 years should receive a mammogram every 2 years d. Women aged 40 to 75 years should receive a mammogram every 2 years

c. Women aged 50 to 74 years should receive a mammogram every 2 years According to the U.S. Preventive Services Task Force guidelines, women between 50 and 74 years of age should have a mammogram every 2 years. There is no clinical evidence that a woman should receive a mammogram starting at 35 if she does not have any risk factors. Between ages 40 and 49 years, mammograms are done on an individual basis based on history. There is no clinical benefit to a mammogram after the age of 75 and can yield a false-positive result.

An elderly patient has a positive polymerase chain reaction (PCR) for varicella zoster virus and has a recent history of breast cancer. All of the following interventions should be included in the treatment plan, except: a. Acyclovir five times daily × 10 days b. Lidocaine 5% patch c. Zostavax vaccine d. Gabapentin TID

c. Zostavax vaccine The treatment plan for an elderly patient who is immunocompromised and diagnosed with shingles is acyclovir × 10 days, a lidocaine patch, and gabapentin TID for postherpetic neuralgia (PHN). Because the patient is immunocompromised, she should not receive Zostavax (live virus vaccine).

In an adolescent with scoliosis, what degree of spinal curvature requires a referral for surgical correction? a. 10 to 20 degrees b. 20 to 30 degrees c. 30 to 40 degrees d. >40 degrees

d. >40 degrees A spinal curvature of 40 degrees or greater will require surgical intervention with a Harrington rod. Curvatures between 5 and 20 degrees should be monitored for changes. Bracing is necessary for curvatures between 20 and 40 degrees.

All of the following patients should be screened for diabetes mellitus, except: a. An obese man of Hispanic descent b. An overweight middle-aged Black woman whose mother has type 2 diabetes c. A woman who delivered an infant weighing 9.5 lb d. A 30-year-old White man with hypertension

d. A 30-year-old White man with hypertension The 30-year-old White man with hypertension would be the last patient to be screened for diabetes. Not having any information about him also puts him lower on the list. Obesity, ethnicity (Hispanic/Latino Americans, African Americans, Native Americans, Asian Americans, Pacific Islanders, and Alaska natives), family history of diabetes, and gestational diabetes (mother of the infant weighing 9.5 lb) are all risk factors. These were present in all of the other selections. Other risk factors for diabetes include impaired glucose tolerance test, sedentary lifestyle, polycystic ovary syndrome (PCOS), and hypertension.

A patient recently returned from a trip to Africa and is experiencing 10 to 12 loose stools every day. The patient takes metformin every morning and otherwise is in good health. Which medication will the nurse practitioner prescribe to treat the diarrhea? a. Levofloxacin daily b. Ofloxacin BID c. Trimethoprim-sulfamethoxazole BID d. Ciprofloxacin in a single dose

d. Ciprofloxacin in a single dose The patient most likely has traveler's diarrhea, given the history of a recent return from another country. The patient's treatment should be based on functional impact of symptoms and not frequency of symptoms, which is not indicated in the question. The patient likely has moderate acute traveler's diarrhea, which can be treated with loperamide as monotherapy or with adjunctive antibiotic therapy. The patient is taking metformin daily for diabetes, so risk of precipitating hypoglycemia is lower than with other oral antidiabetic agents. Because it can be given in a single dose, ciprofloxacin would be the appropriate choice for reducing exposure and microbiome colonization disruption. Levofloxacin and ofloxacin require one to three doses. Trimethoprim-sulfamethoxazole is a sulfonamide and would be appropriate treatment for cyclosporiasis but not giardiasis, which is the most common parasitic cause of traveler's diarrhea.

A nurse practitioner sees a patient for a skin assessment and finds a small number of rough, scaly patches on the patient's face, lips, ears, and neck. Which is the most appropriate treatment for this condition? a. Cryopexy b. Radiation c. 5-Fluorouracil cream d. Cryotherapy

d. Cryotherapy The patient has a small number of actinic keratosis lesions on their head, so cryotherapy is the best plan. If the patient had larger numbers of lesions all over their body, 5-fluorouracil cream would be the most appropriate intervention. Cryopexy is the treatment for a retinal detachment. There is no need for radiation, because actinic keratosis is a precursor to squamous cell carcinoma but is not cancerous.

The nurse practitioner is completing a health assessment on a 15-year-old female patient who is in the office for her annual physical. The patient reports feelings of hopelessness and sadness for several months, no history of suicidal ideations, and a struggle with anorexia. The patient scores an 11 on Beck's Depression Inventory. Which antidepressant will the nurse practitioner prescribe? a. Sertraline (Zoloft) b. Lithium carbonate (Eskalith) c. Bupropion (Wellbutrin) d. Escitalopram (Lexapro)

d. Escitalopram [Lexapro] Escitalopram is a safe antidepressant for an adolescent who has severe depression and no history of suicidal ideations. Sertraline is not a safe option for patients younger than 24 years of age because of increased risk of suicidal ideation. Bupropion is an atypical antidepressant and is not a first-line therapy for depression. It is contraindicated in patients with anorexia nervosa. Lithium is indicated for patients with bipolar disorder.

A sexually active young adult is diagnosed with Chlamydia trachomatis and treated with doxycycline 100 mg BID × 7 days. During a follow-up visit, the patient reports new onset of right upper quadrant pain and tenderness on palpation. Alanine aminotransferase (ALT) is 43 U/L, and aspartate aminotransferase (AST) is 24 U/L. Which complication does the nurse practitioner suspect? a. Jarisch-Herxheimer reaction b. Reiter's syndrome c. Stevens-Johnson syndrome d. Fitz-Hugh-Curtis syndrome

d. Fitz-Hugh-Curtis Syndrome The patient is most likely presenting with a complication from a pelvic inflammatory disease called Fitz-Hugh-Curtis syndrome. Signs and symptoms include right upper quadrant pain and pain on palpation, normal liver function, and "violin string" adhesions revealed on laparoscopy exam. Reiter's syndrome is more common in men and is a secondary reaction to certain bacteria such as chlamydia. Treatment is supportive, and the syndrome spontaneously resolves. Stevens-Johnson syndrome is an adverse reaction to an antibiotic that produces a severe rash and flu-like symptoms. A Jarisch-Herxheimer reaction is an acute response from syphilis or other spirochete treatment in the first 24 hours and produces acute fever, chills, headache, and myalgia.

All of the following medications have drug interactions with levothyroxine (Synthroid), except: a. Antacids b. Tricyclic antidepressants c. Anticoagulants d. Penicillins

d. Penicillins Levothyroxine does not interact with penicillins, but it does have numerous drugs it interacts with, such as anticoagulants, tricyclic antidepressants, antacids and calcium, iron, multivitamins, proton pump inhibitors, estrogens, statins, metformin, and others. Certain foods interfere with absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid taking them together and should space these foods and drugs several hours apart. Levothyroxine (Synthroid) is a synthetic form of T4.

A 68-year-old patient recently prescribed caridopa-levodopa (Sinemet) tells the nurse practitioner that he has been bloated and experiencing difficulty with bowel movements. Which medication will the nurse practitioner consider incorporating into the treatment plan? a. Senna b. Methylnaltrexone c. Magnesium citrate d. Polyethylene glycol

d. Polyethylene glycol Levodopa, an antiparkinsonian drug, can cause constipation in an older patient. The first-line treatment for the patient's constipation is osmotic laxatives such as polyethylene glycol. Senna is a stimulant laxative that is a second-line treatment for constipation in an older adult. Methylnaltrexone is a peripherally acting mu-opioid antagonist that acts on the gastrointestinal tract to decrease opioid-induced constipation. Magnesium-based laxatives (e.g., magnesium citrate) taken over the long term should be avoided because of the potential of toxicity.

A patient presents with a wedge-shaped, superficial, yellow, triangular mass on the nasal side of the left eye. The patient denies pain or vision changes. PERRLA is normal. Which diagnosis is most likely? a. Pinguecula b. Chalazion c. Hordeolum d. Pterygium

d. Pterygium The patient has a pterygium, which is a yellow, triangular thickening of the conjunctiva that extends across the cornea on the nasal side. Pinguecula is a yellowish, raised growth on the conjunctiva next to the cornea. A chalazion is a chronic inflammation of the meibomian gland. A hordeolum, or stye, is an abscess of a hair follicle and sebaceous gland on the eyelid.

The results of a Pap test performed on a 21-year-old woman state, "Atypical squamous epithelial cells present. No endocervical cells present." What will the nurse practitioner advise? a. Test for human papillomavirus (HPV) b.Endometrial biopsy c. Refer for colposcopy d. Repeat the test as soon as possible

d. Repeat the test as soon as possible. A specimen is satisfactory only if both squamous epithelial cells and endocervical cells are present. If lacking either type of cell, the specimen is incomplete, and the test needs to be repeated. Atypical squamous cells are a cause for concern in a complete specimen. When atypical squamous cells of undetermined significance are found in women aged 25 to 29, an HPV test should be performed. An endometrial biopsy is indicated if there are atypical glandular cells in the presence of endometrial cells. A referral for colposcopy is only needed if atypical cells are found in an acceptable specimen in women aged 30 years or older. A colposcopy would be recommended for a 21-year-old woman only if high-grade squamous intraepithelial lesions were found.

A 22-year-old woman is going on a 5-day cruise for her honeymoon. She reports a history of severe motion sickness. Which of the following medicines can be prescribed for motion sickness? a. Dimenhydrinate (Dramamine) b. Metoclopramide (Reglan) c. Ondansetron (Zofran) d. Scopolamine patch (Transderm Scop)

d. Scopolamine patch (Transderm Scop) Scopolamine patch (Transderm Scop) is a prescription medicine that is used for motion/sea sickness. It is a small, circular patch that is placed behind the ear and is effective for 3 days. Advise the patient to apply it 4 hours before the trip to be effective. Because the question is asking about a "prescribed" medication, an over-the-counter (OTC) medicine, such as Dramamine, is an incorrect response. Zofran is indicated for cancer-related nausea and vomiting (chemotherapy, radiation, surgery).

A 45-year-old gardener is seen as a walk-in patient in a private clinic. He reports stepping on a nail that morning. He received a Td vaccine 9 years ago. Which of the following vaccines is recommended? a. Diphtheria, tetanus, acellular pertussis (DTaP) b. Diphtheria and tetanus (DT) c. Tetanus diphtheria (Td) d. Tetanus, diphtheria, acellular pertussis (Tdap)

d. Tetanus, diphtheria, acellular pertussis (Tdap) The Centers for Disease Control and Prevention (CDC) recommends that one of the tetanus boosters be replaced with the Tdap (once in a lifetime). Thereafter, the Td form of the vaccine is indicated every 10 years. The DTaP and DT forms of the tetanus vaccine are not given after the age of 7 years. Puncture wounds are at higher risk for tetanus because Clostridium tetani bacteria are anaerobes (deep puncture wounds are not exposed to air compared with superficial wounds).

Which of the following is a true statement about the effect of aspirin on a platelet's function? a. The effect on platelets is reversible b. The effect on platelets is reversible and lasts only 1 week c. The effect on platelet function is minimal d. The effect on platelet function is irreversible and lasts 10 days

d. The effect on platelet function is irreversible and lasts 10 days The use of aspirin affects platelet function by irreversibly inactivating platelet COX-1 enzyme, ultimately affecting platelet aggregation due to lowered levels of thromboxane A2. While the ½ life of aspirin is only 15 to 20 minutes, the antiplatelet effect lasts the entire lifespan of the platelet, which is approximately 10 days. Although it may take 10 days for the total platelet population to be renewed, platelets are renewed at a rate of 10% per day, and partial platelet function can be seen when about 1/3 of the platelets have COX function (~33% or almost 4 days).

An elderly patient is brought to the primary clinic clutching a spoon. Her caregiver states, "I'm worried about her. She uses that spoon to eat, then combs her hair with it, and she even tries to write with it." Which of the following is a true statement regarding this possible dementia diagnosis? a. A CT scan is the best imaging test for dementia b. The most common cause of dementia is Lewy bodies c. A high score on the Mini-Cog indicates severe dementia d. This is one of the few types of dementia that has a possible genetic component

d. This is one of the few types of dementia that has a possible genetic component The patient is demonstrating utilization behavior commonly seen in frontotemporal dementia (FTD). Most dementias do not have a known genetic component; however, 10% to 15% of people with FTD, formally called Pick's disease, have a family history. The best brain imaging test to use for screening dementia and cognitive impairment is an MRI scan of the brain. The most common cause of dementia is Alzheimer's disease (60%-80%). Lewy bodies are the second most common cause of dementia. The lower the score on the Mini-Cog or Folstein's Mini-Mental State Examination (MMSE), the greater the level of dementia.

An 18-year-old patient who wears contact lenses presents to the clinic with eye pain, redness, and excessive tearing in the right eye. The patient tells the nurse practitioner she frequently sleeps with her contact lenses on because she forgets to take them out. During slit-lamp testing, the nurse practitioner notes there is an oval-shaped lesion in the right cornea. Which medication will the nurse practitioner prescribe? a. Oral steroid b. Oral antibiotic c. Topical steroid d. Topical antibiotic

d. Topical antibiotic Sleeping with contact lenses on is an unhygienic practice that may result in contact lens keratitis. Symptoms include eye pain, redness, excessive tearing, and a lesion on the cornea. Topical antibiotics are the first line of treatment for the condition. Oral steroids, antibiotics, and topical steroids are not used as the first line of treatment for contact lens keratitis.

Which initial treatment will the nurse practitioner prescribe to a patient experiencing mild allergic conjunctivitis? a. NSAID b. PO antihistamine c. Topical corticosteroid d. Topical antihistamine/mast cell stabilizer

d. Topical antihistamine/mast cell stabilizer Mild allergic conjunctivitis occurs because of a mast cell response to an allergen. An over-the-counter topical antihistamine/mast cell stabilizer can be used to treat the initial symptoms of mild allergic conjunctivitis. NSAIDs are not the first line of treatment for mild allergic conjunctivitis. Patients with allergic conjunctivitis often produce an inadequate amount of tears, which results in dryness of the eyes. Although oral antihistamines can be used for mild allergic conjunctivitis, they may induce dry eye syndrome, which impairs the protective barrier of tears and worsens allergic conjunctivitis. Artificial tears may be needed if oral antihistamines are prescribed. Topical corticosteroids are not the first line of treatment for mild allergic conjunctivitis.

An elderly patient was burned when a large pot of boiling water fell off the stove. According to the Lund-Browder chart, the patient has reddened skin and several bullae on approximately 4% of the abdominal area. The patient is allergic to sulfa products. Which intervention will the nurse practitioner implement? a. Treat with benzocaine spray b. Gently rupture blisters c. Treat with silver sulfadiazine d. Treat with bacitracin zinc

d. Treat with bacitracin zinc The patient has a partial-thickness (second-degree) burn because the patient is older than 50 years old and the total body surface area (TBSA) burned was less than 5%. The treatment is bacitracin zinc and nonadherent dressings. Silver sulfadiazine cream should be avoided because of the patient's allergy to sulfa products. Treating with benzocaine spray or aloe vera gel is the treatment for superficial-thickness (first-degree) burns. Blisters should not be ruptured, because it may increase the risk of infection, especially in elderly patients.