Comprehensive AANP Review (LEIK/Barkley/Fitzgerald) pt. 3 (printed from TiffenyWade)

Administering a pneumococcal vaccination in a pt with COPD is an example of what type of prevention?

primary

A TST is an example of ________ prevention or health screening.

secondary

What is the treatment for rosacea

Topical metronidazole gel

Do living wills include a healthcare DPA?

Usually but not necessarily

The right act is the one that produces the greatest good for the greatest number of individuals

Utilitarianism

How is BMI calculated

Weight divided by height

Goofy is a healthy 18 y/o who presents for primary care. according to his immunization record, he received two doses of HBV vaccine 1 month apart at age 14 yrs. which of the following best describes his HBV vaccination needs: a. he should receive a single dose of HBV now b. a three-dose HBV vaccine series should be started during today's visit c. he has completed the recommended HBV vaccine series d. he should be test for HBsAB and further immunization recommendations should be made according to the test results

a. he should receive a single dose of HBV now

a 30 y/o man with HIV lives with his two pre-schooled aged children. which of the following statements best represents advice you should give him about immunizing his children? a. immunizations should take place without regard for his health status b. the children should not receive influenza vaccine c. MMR vaccine should not be given d. the children should not receive poliovirus immunization

a. immunizations should take place without regard for his health status

classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD I is Mild at FEV1>=________%

>=80% predicted

which of the following is inconsistent with the presentation of asthma that is not well controlled? a. troublesome nocturnal cough at least 2 nights per week b. need for albuterol to relieve SOB at least twice a week c. morning sputum production d. two or more exacerbations/year requiring oral corticosteroids

c. morning sputum production

smallpox vaccine contains: a. live vaccinia virus b. a virus fragment c. dead smallpox virus d. an antigenic protein

a. live vaccinia virus

In counseling a patient who experience migraines, you recommend all of the following lifestyle changes to minimize the risk of triggering a headache except: A. avoiding eating within 1-2 hours of AM awakening. B. limiting exposure to cigarette smoke. C. avoiding trigger physical activities. D. implementing strategies to reduce stress.

A. avoiding eating within 1-2 hours of AM awakening

What is experimental research?

experimental manipulation of variables utilizing randomization and control group

Lipid Disorders

■ Total lipid profile after a 9-HOUR (MINIMUM) FAST.

S/S of? - "Paroxysms" of dry & severe cough that "interrupts sleep" - Cough dry to productive - Light colored sputum - Lung sounds ranges from clear to severe wheezing, rhonchi - CXR: Normal - Can last up to "4-6 weeks"

Acute Bronchitis:

What is active immunity?

Antibody formation stimulated with a antigen

Tuskegee Syphilis Experiment

An infamous study of 600 African American sharecroppers (1932 to 1972) from Alabama. The men were all tested for syphilis infection and those with positive results were never informed or treated. Due to this study, laws were passed that protect human subjects' rights and mandate informed consent.

75. Which form of urinary incontinence is most common in older adults? A. stress B. urge C. iatrogenic D. overflow

B. urge

When evaluating a patient with a MCV greater than 100 what 2 labs are ordered

B12 and folate

what does a large amount of epithelial cells in the urine specimen mean

Contamination

Which of the following describes prescriptions for antidepressant medications written by primary care providers? A. Dose too high B. Dose too low C. Excessive length of therapy D. Appropriate length of therapy

B. Dose too low

Priapism is a potential adverse effect of which of the following psychotropic medications? A. Bupropion B. Sertraline C. Trazodone D. Amitriptyline

C. Trazodone

Which of the following food-based allergies is likely to be found in adults and children? A. Milk B. Egg C. Soy D. Peanut

D. Peanut

Chronic amenorrhea and hypermetabolism can result in what

Osteoporosis

Common symptoms of a patient with sarcoidosis include all of the following except: A. Arthralgia B. Dyspnea upon exertion C. Blurred vision D. Cardiac palpitations

D. Cardiac palpitations

Which of the following is found in tertiary syphilis? A. Arthralgia B. Lymphadenopathy C. Maculopapular lesions involving the palms and soles D. Gumma

D. Gumma granulomatous lesions involving the skin, mucous membranes and bone aortic aneurysm, aortic insufficency, Argyll Robertson pupil and seizures

In providing primary care for a patient with post traumatic stress disorder (PTSD), you consider that all of the following are likely to be reported except: A. Agoraphobia B. Feeling of detachment C. Hyperarousal D. Poor recall of the precipitating event

D. Poor recall of the precipitating event

Which of the following is the most accurate information in caring for a 40-year-old man with cystitis? A. This is a common condition in men of this age B. A gram-negative organism is the likely causative pathogen C. A urological evaluation should be considered D. Pyuria is rarely found

C. A urological evaluation should be considered

Of the following medications, which is least likely to be implicated as a trigger for anaphylaxis? A. Ibuprofen B. Amoxicillin C. Acetaminophen D. Aspirin

C. Acetaminophen

Tom is a 19-year-old man who presents with sudden onset of edema of the lips and face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical examination reveals inspiratory and expiratory wheezing. Blood pressure is 78/44 mmHg, heart rate 102 bpm, and respiratory rate is 24/min. His clinical presentation is most consistent with the diagnosis of: A. Urticaria B. Angioedema C. Anaphylaxis D. Reactive airway disease

C. Anaphylaxis

An increase in the normal variation of RBC size is known as: A. Poikilocytosis B. Granulation C. Anisocytosis D. Basophilic stippling

C. Anisocytosis

A pre-participation physical screening examination should include: A. CBC B. Urinalysis C. Blood pressure measurement D. Radiograph of the spine

C. Blood pressure measurement

All of the following are typical findings for a patient with chancroid except: A. Multiple lesions B. Spontaneous rupture of affected nodes C. Blood-tinged penile discharge D. Dense, matted lymphadenopathy on the ipsilateral side of the lesion

C. Blood-tinged penile discharge

When prescribing a benzodiazepine, the NP should consider that: A. The ingestion of 3 to 4 days of therapeutic dose can be life-threatening B. The medication must be taken at the same hour every day C. Concomitant use of alcohol should be avoided D. Onset of therapeutic effect takes many days

C. Concomitant use of alcohol should be avoided

When discontinuing benzodiazepine treatment after prolonged use, you recommend: A. Terminating treatment immediately B. Decreasing the dose 20% per day C. Decreasing the dose 25% per week D. Decreasing the dose 50% per week

C. Decreasing the dose 25% per week

In a person diagnosed with superficial bladder cancer without evidence of metastasis, you realize that: A. The prognosis for 2-year survival is poor B. A cystectomy is indicated C. Despite successful initial therapy, local recurrence is common D. Systemic chemotherapy is the treatment of choice

C. Despite successful initial therapy, local recurrence is common

Syphilis is most contagious at which of the following times? A. Before onset of signs and symptoms B. During the primary stage C. During the secondary stage D. During the tertiary stage

C. During the secondary stage

You see a 63-year-old man with suspected upper gastrointestinal bleed. Expected laboratory findings would include: A. Elevated BUN; elevated serum creatinine B. Normal BUN; elevated serum creatinine C. elevated BUN; normal serum creatinine D. Lowered BUN; elevated serum creatinine

C. Elevated BUN; normal serum creatinine

Which of the following is not representative of the presentation of primary syphilis? A. A painless ulcer B. Localized lymphadenopathy C. Flulike symptoms D. A spontaneously healing lesion

C. Flulike symptoms

Which of the following SSRIs is most likely to significantly interact with warfarin? A. Citalopram B. Paroxetine C. Fluoxetine D. Sertraline

C. Fluoxetine

A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus? A. Iron B. Niacin C. Folic acid D. Vitamin C

C. Folic Acide

Neisseria gonorrhoeae are best described as: A. Gram-positive cocci B. Gram-negative rods C. Gram-negative diplococci D. Gram-negative bacilli

C. Gram-negative diplococci

Which of the following is not consistent with anemia of chronic disease (ACD)? A. NL RDW B. NL MCHC C. Hct less than 24% D. NL to slightly elevated serum ferritin

C. Hct less than 24%

Risk of benzodiazepine misuse is minimized by use of: A. Agents with a shorter T 1/2 B. The drug as an as-needed rescue medication for acute anxiety C. More lipophilic products D. Products with long duration of action

D. Products with long duration of action

Risk of benzodiazepine misuse can be minimized by use of: A. Agents with a shorter half-life B. The drug as an "as needed" rescue medication for acute anxiety C. More lipophilic products D. Products with longer duration of action

D. Products with longer duration of action

All of the following can cause an elevated PSA level except: A. Prostate infection B. Cystoscopy C. BPH D. Prostatectomy

D. Prostatectomy

Characteristics of binge eating disorder include all of the following except: A. Lack of control over the amount and type of food eaten B. Behavior present for at least 6 months C. Marked distress, self-anger, shame, and frustration as a result of binging D. Purging activity after an eating binge

D. Purging activity after an eating binge

All of the following are likely reported in a man with an initial episode of genital HSV-2 (HHV-2) infection except: A. painful ulcer B. Inguinal lymphadenopathy C. Fever and body aches D. Pustular lesions

D. Pustular lesions

Which of the following hemograms would be expected for a 75-year-old woman with anemia and chronic renal failure? A. Hg = 9.7 g/dL (12 to 14 g/dL); MCV = 69 fL (80 to 96 fL); reticulocytes = 0.8% (1%-2%) B. Hg = 10.2 g/dL (12 to 14 g/dL); MCV = 104 fL (80 to 96 fL); reticulocytes = 1.2% (1%-2%) C. Hg = 9.4 g/dL (12 to 14 g/dL); MCV = 83 fL (80 to 96 fL); reticulocytes = 0.7% (1%-2%) D. Hg = 10.4 g/dL (12 to 14 g/dL); MCV = 94 fL (80 to 96 fL); reticulocytes = 2.6% (1%-2%)

C. Hg = 9.4 g/dL (12 to 14 g/dL); MCV = 83 fL (80 to 96 fL); reticulocytes = 0.7% (1%-2%)

Common causes of chronic renal failure include all of the following except: A. Type 2 diabetes B. Recurrent pyelonephritis C. Hypotension D. Polycystic kidney disease

C. Hypotension

All of the following are common signs of osteoporosis except: A. Gradual loss of height with stooped posture B. Hip or wrist fracture C. Increase in waist circumference D. Patient report of back pain

C. Increase in waist circumference

The most common sites for lumbar disk herniation are: A. L1 to L2 and L2 to L3 B. L2 to L3 and L4 to L5 C. L4 to L5 and L5 to S1 D. L5 to S1 and S1 to S2

C. L4 to L5 and L5 to S1

Loss of Achilles tendon reflex most likely indicates a lesion at: A. L1 to L2 B. L3 to L4 C. L5 to S1 D. S2 to S3

C. L5 to S1

In assessing a man with testicular torsion, the NP is most likely to note: A. Elevated PSA level B. Whit blood cells reported in urinalysis C. Left testicle most often affected D. Increased testicular blood flow by color-flow Doppler ultrasound

C. Left testicle most often affected

Appropriate treatment of acute epididymitis for a 32-year-old man who has sex with other men is: A. Ceftriaxone B. Azithromycin C. Levofloxacin D. TMP-SMX

C. Levofloxacin

Symptoms in chronic bacterial prostatitis often include: A. Fever B. Gastrointestinal upset C. Low back pain D. Penile discharge

C. Low back pain

Which of the following tests yields the greatest amount of clinical information in a patient with acute lumbar radiculopathy? A. Lumbosacral radiograph series B. ESR measurement C. MRI D. Bone scan

C. MRI

Cyclooxygenase-1 (COX-1) contributes to: A. Inflammatory response B. Pain transmission C. Maintenance of gastric protective mucosal layer D. Renal arteriole function

C. Maintenance of gastric protective mucosal layer

Cyclooxygenase-2 (COX-2) contributes to all of the following except: A. Inflammatory response B. Pain transmission C. Maintenance of gastric protective mucosal layer D. Renal arteriole constriction

C. Maintenance of gastric protective mucosal layer

The use of calcitonin to treat osteoporosis has been associated with an increased risk of: A. Type 2 diabetes B. Rheumatoid arthritis C. Malignancy D. Systemic lupus erythematosus

C. Malignancy

Common symptoms of renal stones include all of the following except: A. Pink, red, brown urine B. Sharp pain in the back or lower abdomen C. Marked febrile response D. Pain while urinating

C. Marked febrile response

Which of the following therapeutic agents id commonly used to help with sleep difficulties such as insomnia associated with PTSD? A. Duloxetine B. Bupropion C. Mirtazapine D. Zolpidem

C. Mirtazapine

In treatment-resistant patients with panic disorder, which drug class is occasionally used? A. Atypical antipsychotic B. Selective dopamine reuptake inhibitor C. Monoamine oxidase inhibitor D. Neuroleptic

C. Monoamine oxidase inhibitor

Radiographic findings of osteoarthritis of the knee often reveal: A. Micro fractures B. Decreased density of subchondral bone C. Osteophytes D. No apparent changes to the joint structure

C. Osteophytes

Depression often manifests with all of the following except: A. Psychomotor retardation B. Irritability C. Palpitations D. Increased feelings of guilt

C. Palpitations

A person with latex allergy also often has a cross-allergy to all of the following except: A. Banana B. Avocado C. Kiwi D. Romaine lettuce

D. Romaine lettuce

Poikilocytosis refers to alterations in a red blood cells: A. Thickness B. Color C. Shape D. Size

C. Shape

When providing primary care for a middle-aged woman with a history of prescription benzodiazepine dependence, you consider that: A.she is unlikely to have a problem with misuse of other drugs or alcohol B. Rapid detoxification is the preferred method of treatment for this problem C. She likely has an underlying untreated or under-treated mood disorder D. She is at significant risk for drug-induced hepatitis

C. She likely has an underlying untreated or under-treated mood disorder

A 52-year-old woman has RA. She now presents with decreased tearing, "gritty" - feeling eyes, and a dry mouth. You consider a diagnosis of: A. Systemic lupus erythematosus B. Vasculitis C. Sjogren syndrome D. Scleroderma

C. Sjogren syndrome

Loss of corneal reflex is in part seen in dysfunction of CN: A. III B. IV C. V D. VI

C. V

85. When evaluating illness symptoms in the older patients, the disease often presents in a manner different from younger adults due to: A. polypharmacy. B. increased physiological responses to illness C. normal age-related decline D. increased compensatory mechanisms.

C. normal age-related decline

Title I of HIPPA is also known as ____ and specifies ____

COBRA, Offers protection of health insurance after job loss

Any patient with a positive TST or QuantiFERON-TB test result should have a ____________ to help exclude the diagnosis of active pulmonary tuberculosis.

CXR

What establishes that a person has met certain standards in a particular profession which signify mastery of specialized knowledge and skills?

Certification

All of the following are common sites of fracture in patients with osteoporosis except: A. The proximal femur B. The distal forearm C. The vertebrae D. The clavicle

D. The clavicle

The most common locations for tophi include all of the following except: A. The auricle B. The elbows C. The extensor surfaces of the hands D. The shoulders

D. The shoulders

Common locations for Pressure Ulcers

Common locations: hips (trochanter), the back (sacrum, ischium), shoulders, elbows, knees, ankles (malleolus), heels, back of the head (occiput). Risk factors: immobility, disabilities, spinal cord injuries, older age (especially greater than 75 years), malnutrition, incontinence, and so on.

What ethical principle? Psychiatric and mental health medical records are protected information and require separate consent.

Confidentiality

When considering depression and thoughts about death, rank the following from the most common (1) to the least common (3): Thinking it would be fine to just die

1

Without treatment, individuals with LTBI have a ____% lifetime risk of reactivation of the disease,

10

When can the Tdap be used as a booster in adolescents and adults?

2) What is done if a patient has a tetanus-prone wound and vaccination status is unknown? Administer immediate dose of Td vaccine and the tetanus immunoglobulin (TIG) injection. 3) Which wounds are considered as highest risk for tetanus infection? Puncture wounds, wounds with devitalized tissue, soil-contaminated wounds, crush injuries, others.

How long is the course of treatment for healthy women with uncomplicated UTI's

3 days

TB skin test: Positive - Recent immigrants - Child < 4 or child/adol exposed to high-risk adult - IV drug user, health care worker, homeless - Employees or residents from high risk congregate setting (jails, nursing homes)

>= 10 mm

TB skin test: Positive________ - HIV - Recent contact w/ TB cases - CXR w/ fibrotic changes consistent w/ previous TB - Any child who had close contact or TB symptoms (< 5 yo) - Immunocompromised (organ transplant, BMT, RF, pts on biologic drugs, etc)

>=5 mm

High doses of what vitamin can be teratogenic

A

Who grants certification?

A non-governmental agency

A small confidence interval implies what?

A very precise range of values

Which of the following agents has the longest T1/2? A. Fluoxetine B. Paroxetine C. Citalopram D. Sertraline

A. Fluoxetine

A 25-year-old woman presents with sinus arrhythmia. Which of the following statements is correct concerning sports participation? A. Full activity should be encouraged B. Weight lifting is contraindicated C. An exercise tolerance test is advisable D. A calcium channel antagonist should be perscribed

A. Full activity should be encouraged

Which of the following plays an essential role in type 1 hypersensitivity? A. Immunoglobulin E B. Immunoglobulin A C. Immunoglobulin G D. Immunoglobulin F

A. Immunoglobulin E

Concomitant health problems found in a patient with panic disorder often include: A. Irritable bowel syndrome B. Thought disorders C. Hypothyroidism D. Inflammatory bowel disease

A. Irritable bowel syndrome

Which of the following is a common finding in a man with varicocele? A. Lower sperm count with increased number of abnormal forms B. Increased rate of testicular cancer C. Recurrent scrotal pain D. BPH

A. Lower sperm count with increased number of abnormal forms

Which of the following best describes the presentation of a patient with OA? A. Worst symptoms in weight-bearing joints later in the day B. Symmetrical early morning stiffness C. Sausage-shaped digits with associated skin lesions D. Back pain with rest and anterior uveitis

A. Worst symptoms in weight-bearing joints later in the day

A patient taking phenytoin can exhibit a drug interaction when concurrently taking: A. cyclosporine. B. famotidine. C. acetaminophen. D. aspirin

A. cyclosporine

A 24-year-old man who presents in the ED following a motor vehicle accident. He exhibits confusion and falls in and out of consciousness. What is the appropriate course of action? A. head CT scan B. head MRI C. neither

A. head CT scan

Concomitant disease seen with giant cell arteritis includes: A. polymyalgia rheumatica. B. acute pancreatitis. C. psoriatic arthritis. D. reactive arthritis.

A. polymyalgia rheumatica.

The mechanism of action of triptans is as a(n): A. selective serotonin receptor agonist. B. dopamine antagonist. C. vasoconstrictor. D. inhibitor of leukotriene synthesis.

A. selective serotonin receptor agonist.

What is the criteria for metabolic syndrome

Abdominal obesity, hypertension, hyperlipidemia OR Elevated triglycerides and low HDL, elevated fasting glucose greater than 100

When a patient is asked to interpret a pro verb what is this testing

Abstract thinking

When a patient is experiencing acute grief or is in a crisis, what 2 key therapeutic communication principles must you demonstrate?

Acknowledge feelings and show empathy

When AST level is double the level of ALT what is associated with

Alcohol abuse

Use of flunitrazepam (Rohypnol) has been associated with: A. Agitation B. Amnesia C. Increased appetite D. Hallucination

B. Amnesia

When prescribing antihypertensive therapy for a man with BPH and hypertension, the NP considers that: A. Loop diuretics are the treatment of choice B. An alpha 1 antagonist should not be used as a solo or first-line therapeutic agent C. Angiotensin receptor antagonist use is contraindicated D. Beta-adrenergic antagonist use often enhances urinary flow

B. An alpha 1 antagonist should not be used as a solo or first-line therapeutic agent

The most common causative organism of lymphogranuloma venereum is: A. Ureaplasma genitalia B. C. trachomatis types 1 to 3 C. Neisseria gonorrhoeae D. H. ducreyi

B. C. trachomatis types 1 to 3

Initial treatment of lateral epicondylitis includes all of the following except: A. Rest and activity modifications B. Corticosteroid injections C. Topical or oral NSAIDS D. Counterface bracing

B. Corticosteroid injections

You perform an extraocular movement test on a middle-aged patient. He is unable to move his eyes upward and inward. This indicates a possibility of paralysis of CN: A. II B. III C. V D. VI

B. III

Medications known to increase the risk of renal stones include all of the following except: A. Hydrochlorothiazide B. Moxifloxacin C. Topiramate D. Indinavir

B. Moxifloxacin

Which of the following is often reported by anxious patients? A. Constipation B. Muscle tension C. Hive-form skin lesions D. Somnolence

B. Muscle tension

Which of the following organisms is a gram-negative diplococcus? A. Streptococcus pneumoniae B. Neisseria meningitidis C. Staphylococcus aureus D. Haemophilus influenzae

B. Neisseria meningitidis

What grants a nurse practitioner permission to practice in an inpatient setting?

Credentialing and privileging

What condition increases the risk of testicular cancer

Cryptoorchidism (undescended testes)

Approximately what percent of patients experiencing low back pain will have the symptoms resolve within 1 month without specific therapy? A. 33% B. 57% C. 78% D. 90%

D. 90%

Up to what percent of patients with medial epicondylitis recover without surgery? A. 35% B. 50% C. 70% D. 95%

D. 95%

88. Complications of pressure ulcers include all of the following except: A. squamous cell carcinoma B. osteoporosis C. bone and joint infections. D. cellulitis.

B. osteoporosis

70. Factors that contribute to stress incontinence include: A. detrusor overactivity B. pelvic floor weakness C. urethral stricture D. urinary tract infection (UTI)

B. pelvic floor weakness

DSM-5 criteria for anorexia nervosa include all of the following except: A. Refusal to maintain body weight at or above the minimum normal weight for age and height B. Intense fear of gaining weight or becoming fat despite being underweight C. Distorted experience and significance of body weight and shape D. Absence of at least three consecutive menstrual cycles

D. Absence of at least three consecutive menstrual cycles

Treatment with venlafaxine (Effexor) can lead to dose-dependent increases in: A. Heart rate B. Serum glucose C. AST/ALT D. Blood pressure

D. Blood pressure

112. Dementia syndrome or cognitive impairment that is associated with severe depression is called: A. delirium B. pseudodementia C. Alzheimer's disease D. bipolar disorder

B. pseudodementia

In prescribing prednisone for a patient with Bell's palsy,the nurse practitioner (NP) considers that its use: A. has not been shown to be helpful in improving outcomes in this condition. B. should be initiated as soon as possible after the onset of facial paralysis. C. is likely to help minimize ocular symptoms. D. may prolong the course of the disease

B. should be initiated as soon as possible after the onset of facial paralysis.

What is a precursor for esophageal camcer

Barrett's esophagitis

All headaches are unilateral with the exception of a tension headache, which feels like what

Been like had pain that last for days

Avoid high tyramine foods with MAOI, such as what

Beer, aged cheese, wine, beans

The duty to prevent harm and promote good

Beneficence

The obligation to help the patient. Remove harm, prevent harm, promote good. ("do no harm"). Acting in the patient's best interest. Compassionate patient care.

Beneficence

What ethical principle Calling the surgeon to get a prescription for stronger pain med

Beneficence

What ethical principle? Educating an obese patient on the harmful effects of obesity and recommending weight loss.

Beneficence

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "anxiety"

Benzodiazepines: Confusion, dizziness, ataxia resulting in falls, other accidents.

What drugs are used for prophylactics for migraine headaches

Beta blockers (propanalol), tricyclic antidepressants (elavil), anticonvulsants (gabapentin)

What medications can be given to help with the symptoms of hyperthyroidism

Beta blockers (propranolol, atenolol)

Tanner stages

Boys- 1- prepubertal 2- testes begin to enlarge in an increase in scrotum size 3- penis elongates, scrotal growth continues 4- penis thickens and increases in size. Larger testes 5- adult pattern Girls- 1- prepubertal 2- breast bud 3- breast tissue and Areola and 1 mound 4- secondary mound 5- adult

Identify if the following characteristic is noted in anorexia nervosa, bulimia nervosa or both disorders: Esophageal tears

Bulimia nervosa, possible with anorexia nervosa if binge-purging type present

Identify if the following characteristic is noted in anorexia nervosa, bulimia nervosa or both disorders: Parotid gland enlargement

Bulimia nervosa, possible with anorexia nervosa if binge-purging type present

Which HPV types are most likely to cause anorectal carcinoma? A. 1 and 3 B. 6 and 11 C. 16 and 18 D. 72 and 81

C. 16 and 18

In health, the ratio of hemoglobin to hematocrit is usually: A. 1:1 B. 1:2 C. 1:3 D. 1:4

C. 1:3

How long after contact does the onset of clinical manifestations of syphilis typically occur? A. Less than 1 week B. 1 to 3 weeks C. 2 to 4 weeks D. 4 to 6 weeks

C. 2 to 4 weeks

A 44-year-old woman presents with pyelonephritis. The report of her urinalysis is least likely to include: A. WBC casts B. Positive nitrites C. 3+ protein D. Rare RBCs

C. 3+ protein

A study that manipulate variables but lacks a comparison group or randomization is called what?

Quasi-experimental study

What two key elements are required for a study design to be truly experimental?

Randomization and a control group

What is nonmaleficence ?

The duty to do no harm

True/False: Access to a firearm increases the risk for a completed suicide.

True

What ethical principle? The outcome of the action is what matters with utilitarianism. It also means to use a resource for the benefit of most (e.g., tax money). It may resemble justice, but it is not the same concept (see below).

Utilitarianism

Vision

VISION Visual processing involves the brain, the optic nerve (CN II), and the structures of the eyes. The retina is the neural tissue that first encounters the light. Vision is fully developed (to 20/20) by the age of 6 years. Sudden visual loss is always an emergency. Refer to the ED.

Which medication is contraindicated in bulimia/anorexia pts bc it increases the seizure threshold

Wellbutrin

What drug category is Proscar

X

40. (Y/N) Urinary retention is associated with the use of anticholinergic agents in older adults

Y

41. (Y/N) Constipation is associated with the use of anticholinergic agents in the older adults

Y

the components of brief intervention for txing tobacco use include: a. ask, advise, assess, assist, arrange b. advise, intervene, counsel, followup, prescribe c. document, counsel, caution, describe, demonstrate d. advise, describe, confer, prescribe, document

a. ask, advise, assess, assist, arrange

how is the varicella virus most commonly transmitted? a. droplet transmission b. contact with inanimate reservoirs c. contact transmission d. water-borne transmission

a. droplet transmission

during an office visit, a 48 y/o man who smokes two packs of cigarettes per day states, my kids are begging me to quit. my dad smoked and died when he was 80, so i am not sure what all the fuss is about. according to the stages of change transtheorectical model, his statement is most consistent with a person at the stage of: a. precontemplation b. contemplation c. preparation d. action

a. precontemplation

HAV vaccine, does not contain live virus a. true b. false

a. true

CLASSIC CASE & FINDINGS [Clinical Presentation] Hx of recent URI, albuterol inhaler use increased, SOB, wheezing, chest tightness, dry cough in night and early AM that awakens from sleep

asthma

when answering questions about HAV vaccine, the NP considers that it: a. contains live virus b. should be offered to adults who frequently travel to developing countries c. is contraindicated for use in children younger than age 6 yrs d. usually confers lifelong protection after a single injection

b. should be offered to adults who frequently travel to developing countries

Roflumilast (Daliresp) is a phosphodiesterase-4 inhibitor indicated for the reduction of exacerbations in severe and very severe chronic ____________.

bronchitis

identify whether the item has the characteristics of 23-valent pneumococcal polysaccharide vaccine (PPSV23) or 13-valent pneumococcal conjugate vaccine (PCV13) c. routinely used in all well adults age 65 yrs or older____

c. PPSV23

If the chemistry profile shows marked elevations in the serum calcium and/or alkaline phosphatase, it is usually indicative of

cancerous metastasis of the bone.

an abnormal ________ and clinical findings are required to confirm the diagnosis of pneumonia.

chest radiograph

Type of research study design.... study that evaluates for interrelationships between two or more groups.

correlational

clinical presentation of progressive primary TB most commonly includes all of the following EXCEPT: a.malaise b. fever c. dry cough d. frank hemoptysis

d. frank hemoptysis

the cornerstone of moderate persistent asthma drug therapy is the use of: a. oral theophylline b. mast cell stabilizers c. short-acting beta2 agonist (SABA) d. inhaled corticosteroids

d. inhaled corticosteroids

smallpox disease includes which of the following characteristics? a. usually mild disease b. lesions that erupt over several days c. loss of contagiousness when vesicles form d. lesions all at the same stage during the eruptive phase of the illness

d. lesions all at the same stage during the eruptive phase of the illness

What is standard 6 in CLAS standards?

family and friends should NOT be used as translators, except by request of patient.

respiratory fluoroquinolones are:

levofloxacin (levaquin) gemifloxacin (factive) moxifloxacin (avelox)

Does Augmentin cover the atypical organisms causing CAP?

no

Does this patient have a reactive TST A 21 y/o man with no identifiable TB risk factors and a 10mm induration.

no

What is level of significance?

statistical differences between groups <0.05= 95% of people saw benefit

Does this patient have a reactive TST? a 42 y/o woman with RA who is taking etanercept (Enbrel) who has a 7mm induration

yes

Skin Cancer Counseling

■ Recommended for Children, Adolescents, and Young adults (ages 10 to 24 YEARS) with FAIR. ■ Education includes AVOIDance of SUNlight from 10 A.M. to 4 P.M., use of SPF 15 or higher SUNBLOCK, protective clothing, wide-brim hats.

Prostate Cancer: RISK factors

■ USPSTF AGAINST ROUTINE PSA-based screening REGARDLESS of age. ■ EXCEPTIONS are men DIAGNOSED or undergoing TREATMENT for prostate cancer.

Common secondary headache causes include all of the following except: A. brain tumor. B. intracranial bleeding. C. intracranial inflammation. D. cluster headache.

D. cluster headache.

79. The diagnosis of _______ should be considered in an older adult with new-onset urinary incontinence coupled with an acute change in mental status. A. dementia B. spinal cord compression C. bladder stone D. delirium

D. delirium

Persons eligible for Medicare include all of the following except: A. individuals age 65 and older. B. individuals younger than 65 years of age with certain permanent disabilities C. certain individuals concurrently receiving Medicaid. D. healthy individuals younger than 65 years with income below 150% of the federal poverty line

D. healthy individuals younger than 65 years with income below 150% of the federal poverty line

Screening test for HIV Confirmatory test

ELISA Western blot

If a patient under the age of 40 has arcus senilis, what needs to be checked on them

Fasting lipid profile

At the ferritin levels look low the patient has what

Iron deficiency anemia

What are the two first-line drugs for TB

Isoniazid and rifampicin

What ethical principle Low-income individuals do not pay some types of taxes to the government, but they still have equal access to the postal service and other public services that are supported by taxes.

Justice

A communication the causes someone to suffer a damaged reputation

Libel

What will a chest x-ray show with a person with pneumonia

Lobar infiltrates

A study that involves taking multiple measures of a group over an extended period of time to find relationships between variables

Longitudinal study

Leading cause of death in adolescence

MVA

Major cause of death in Young adult? 20-39

MVA Homicide Suicide Injury Heart disease AIDS

What murmur radiates to the axilla

Mitral regurgitation

What drugs are used to treat acute bronchitis

Mucolytic's, antitussives, guaifeneson, possible albuterol inhaler, if severe wheezing a short-term oral steroid SYMPTOMATIC TREATMENT!!

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "musculoskeletal"

Muscle relaxants (Soma, Skelaxin, Norflex): Drowsiness, confusion, delirium. High anticholinergic effects (antihistamines, antipsychotics, atropine, Ditropan, etc.).

The symbol to indicate the total size of the sample.

N

What antibiotic is use to tx UTI in oregnacy

Nitrofurantoin

What ethical principle? Making decisions for a patient (or for others) because you "believe" that it is for their best interest. The opinion (or desires) of the patient is minimized or ignored. The patient is "powerless."

Paternalism

What is the Rhomberg test

Patient stand with arms straight out to each side with feet together and instructed to close both eyes while standing in that position. Observe for steadiness

What is non-experimental research?

Post-facto correlational research

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "cardiac meds"

Propranolol, others (beta-blockers): Depression, fatigue, slowing, hypotension. Digoxin (warfarin sodium): High doses cause visual changes, fatigue, depression.

What is an example of of 5-alpha reductase inhibitor

Proscar

Prospective Versus Retrospective Studies

Prospective Studies that are done in the present (to the future) time frame. Retrospective Studies done on events that have already occurred (e.g., chart reviews, recall of events). Another name for this study design is "Ex post facto."

Where is a split 2 best heard

Pulmonic area

Type of research study design.. The researcher uses observation and detailed interviews to gather data. Qualitative research is inductive. Identifies phenomena and concepts. Asks broad questions. The study's data are gathered as "words" and not numerical data.

Qualitative

Special "Skin" considerations in geriatrics... Affects primarily lower legs and ankles secondary to chronic edema (from PVD).

Stasis Dermatitis

To qualify as a Medicare provider, a nurse practitioner must hold what?

State license, national certification and a Masters degree

Molluscum is caused by what

Poxvirus

What is one of the most important goals of a care map or critical path?

Monitoring outcomes of care

Presentstion of ankylosing spondilytis

More common in males in their early 20s Chronic back pain for more than three months that is worse in the upper back Joint pain keeps patient awake at night

FLU Vaccine

November: Start giving flu vaccines (FALL to WINTER seasons).

There is no significant relation between the variables of the study. If the null hypothesis is rejected, it means that the results of the study are not due to chance.

Null hypotheses

What are anorexic patients at higher risk for developing

Osteopenia/osteoporosis

What is the T score for osteoporosis and Osteopenia

Osteoporosis T (-2.5- lower) Osteopenia T (-1.5 to -2.5)

Chronic use of pie does inhaled steroids can result in what conditions

Osteoporosis, glaucoma, cataracts, mild growth retardation in children

3 positive signs of pregnancy

Palpation of fetus by provider Ultrasound FHT by Doppler

Definitions of primary and secondary amenorrhea

Primary-absence of menses by the age of 15 with or without development of secondary sex characteristics Secondary-absence of menses the three cycles for six months previously had menses.

Treatment for trichomonas

Flagyl

What is phalen sign

Flexion of wrist for 60 seconds Positive if tingling sensation felt

Patient visits you and requests a note from his employer requesting information about a condition and or diagnosis, must you provide the note?

Give a note saying the patient was under your medical care on certain dates, but HIPPA prevents you from specifying any other details like conditions or diagnoses

What diabetic drugs are contraindicated in patients with severe heart disease or heart failure

Glitizone (actos,avandia) They can cause water retention which can precipitate CHF

The Thayer Martin culture is for what STD

Gonorrhea

To test the reflex center of L2 to L4 what do you do

Patellar tendon briskly

What ethical principle ? Example: A 92-year-old male does not want to be on a ventilator if he codes. The son disagrees and quietly tells the NP and physician that he wants this father to be aggressively treated with life support, if it is necessary.

Paternalism

Abnormal vision problems - Complains of a yellowish to green tint to everything

(adverse effect digoxin).

Life Expectancy

*Life Expectancy AVERAGE life EXPECTANCY is 78.5 years.

Over the age of 65

1) What vaccine is recommended for persons who are "65" YEARS of age? ■ Give ONE dose of Pneumovax (LIFETIME). No booster is needed. 2) If a person is vaccinated BEFORE the age of "65", what is recommended? ■ Give a BOOSTER dose of Pneumovax "5" YEARS AFTER the INITIAL dose.

Which Medicare parts require a premium?

B, C and D

Which HPV types are most likely to cause condyloma acuminatum? A. 1, 2 and 3 B. 6 and 11 C. 16 and 19 D. 22 and 24

B. 6 and 11

97. The most common etiology of dementia is: A. vascular disease B. Alzheimer's disease C. traumatic head injury. D. drug-drug interaction induced.

B. Alzheimer's disease

A laboratory finding commonly observed in patients with sarcoidosis is: A. Hyponatremia B. Hypercalcemia C. Hypokalemia D. Hyperkalemia

B. Hypercalcemia

Assessing vision and visual fields involves testing cranial nerve (CN): A. I B. II C. III D. IV

B. II

The most common cause of acute bursitis is: A. Inactivity B. Joint overuse C. Fibromyalgia D. Bacterial infection

B. Joint overuse

Hyperthermia and a racing heart rate is a potentially life-threatening presentation for a person using: A. Cannabis B. MDMA (e.g., Molly) C. LSD D. Barbiturates

B. MDMA (e.g., Molly)

Mrs. Sanchez is a 42-year-old mother of three who reports pain and stiffness in multiple joints that have lasted for more than 6 months. She is diagnosed with rheumatoid arthritis. She has no other clinical conditions of significance. You recommend which of the following treatments for first-line therapy? A. Topical analgesics and oral NSAIDS B. Methotrexate plus oral NSAIDS C. Acetaminophen plus leflunomide D. Anakinra and systemic corticosteroids

B. Methotrexate plus oral NSAIDS

What ethical principle Example: An elderly woman is recently diagnosed with advanced pancreatic cancer. The patient thinks that she has a very good chance of being cured. The oncologist explains to the patient her poor prognosis. The oncologist is being truthful and honest to the patient about her prognosis.

Veracity

103. When assess a 76 year old man with new-onset mental status change, all of the following diagnostic tests are essential except: A. serum glucose B. PET scan C. CBC with white blood cell differential D. ECG.

B. PET scan

Dietary recommendations for a person with gouty arthritis include avoiding foods high in: A. Artificial flavors and colors B. Purine C. Vitamin C D. Protein

B. Purine

A middle-aged woman who has taken therapeutic dose of lorazepam for the past 6 years wishes to stop taking the medication. You advise her that: A. She can discontinue the drug immediately if she believes it no longer helps with her symptoms B. Rapid withdrawal in this situation can lead to tremors and hallucinations C. She should taper down the dose of the medication over the next week D. Gastrointestinal upset is typically reported during the first week of benzodiazepine withdrawal

B. Rapid withdrawal in this situation can lead to tremors and hallucinations

A positive ANA test is a sensitive marker for the presence of: A. Hyperparathyroidism B. Systemic lupus erythematosus (SLE) C. Kawasaki disease D. Leukocytosis

B. Systemic lupus erythematosus (SLE)

Pharmacological intervention for patients with urge incontinence includes: A. Doxazosin (Cardura) B. Tolterodine (Detrol) C. Finasteride (Proscar) D. Pseudoephedrine

B. Tolterodine (Detrol)

Which of the following best describes patient presentation during a simple partial seizure? A. blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness B. awake state with abnormal motor behavior lasting seconds C. rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness D. abrupt muscle contraction with autonomic signs

B. awake state with abnormal motor behavior lasting seconds

A 57-year-old woman with a prior history of a brain tumor that was removed 8 years ago. She complains of headaches that have been increasing in frequency and intensity over the past month. What is the appropriate course of action? A. head CT scan B. head MRI C. neither

B. head MRI

What ethical principle Encouraging a patient to stop smoking and enroll in smoking cessation programs.

Beneficence

When using trazodone to aid sleep, the drug should be optimally taken ______ prior to sleep. A. Immediately B. 15 minutes C. 1 hour D. 2 hours

C. 1 hour

Of the following individuals in need of an antidepressant, who is the best candidate for fluoxetine (Prozac) therapy? A. An 80-year-old woman with depressed mood 1 year after the death of her husband B. A 45-year-old man with mild hepatic dysfunction C. A 28-year-old man who occasionally "skips a dose" of his prescribed medication D. A 44-year-old man with decreased appetite

C. A 28-year-old man who occasionally "skips a dose" of his prescribed medication

Treatment of pseudogout can include all of the following except: A. NSAIDS B. Colchicine C. Allopurinol D. Oral corticosteroids

C. Allopurinol

The most helpful diagnostic test to perform during acute gouty arthritis is: A. Measurement of erythrocyte sedimentation rate (ESR) B. Measurement of serum uric acid C. Analysis of aspirate from the affected joint D. Joint radiography

C. Analysis of aspirate from the affected joint

Which of the following dietary supplements is associated with increased risk for gout? A. Vitamin A B. Gingko biloba C. Brewer's yeast D. Glucosamine

C. Brewer's yeast

All of the following pharmacological interventions are used in the treatment of patients with bulimia nervosa except: A. Fluoxetine (Prozac) B. Desipramine (Norpramin) C. Bupropion (Wellbutrin) D. Paroxetine (Paxil)

C. Bupropion (Wellbutrin)

All of the following are likely to be reported by patients with acute bacterial prostatitis except: A. Perineal pain B. Irritative voiding symptoms C. Penile discharge D. Fever

C. Penile discharge

In addition to dopamine agonists, other drug classes used to treat Parkinson disease include all of the following except: A. MAO B inhibitors. B. catechol O-methyltransferase (COMT) inhibitors. C. SSRIs. D. anticholinergics

C. SSRIs.

Treatment options for patients with condyloma acuminata include all of the following except: A. Imiquimod B. Podofilox C. Topical acyclovir D. Cryotherapy

C. Topical acyclovir

Which of the following statements is false regarding giant cell arteritis? A. results in inflammation of temporal and other arteries B. normal sections of arteries can be found in between affected sections C. primarily impacts smaller-sized vessels D. results in a tender or nodular, pulseless vesse

C. primarily impacts smaller-sized vessels

_________The subjects in an experiment who do not receive treatment.

Control group:

A 35-year-old man presents with edema of the face, hands, and ankles along with hypertension (175/115 mmHg). He reports urine that is darkly colored and foamy. You suspect acute glomerulonephritis and would expect urinalysis results to include all of the following findings except: A. Elevated level of protein B. Presence of red blood cells C. Presence of renal casts D. Abnormally high glucose levels

D. Abnormally high glucose levels

DSM-5 criteria for a substance abuse include all of the following except: A. Desire to cut down and/or has tried unsuccessfully in the past B. Inability to maintain major role obligations C. Excessive time spent obtaining substance, using substance, or recovering from its effects D. Involved in at least one incarceration related to substance use in the past 6 months

D. Involved in at least one incarceration related to substance use in the past 6 months

The mechanism of action of glucosamine and chondroitin is: A. Via increased production of synovial fluid B. Through improved cartilage repair C. Via inhibition of the inflammatory response in the joint D. Largely unknown

D. Largely unknown

Risk factors for CTS include all of the following except: A. Pregnancy B. Untreated hypothyroidism C. Repetitive motion D. Multiple sclerosis

D. Multiple sclerosis

37. Which of the following medications has little anticholinergic effect? A. diphenhydramine B. amitriptyline C. chlorpheniramine D. loratadine

D. loratadine

Who is the deciding body in Native American culture?

Elders, >50 y.o.

How do Japanese patients view pharmacology use?

Esteem safety over efficacy

What is the screen scoliosis

Forward bend test

Top four leading causes of death in the US

Heart disease Cancer Lung diseases Cva

WHAT RACE - father's mother is decision maker - balance of hot and cold, wet dry - mal de ojo - illness = punishment... wellness = reward - worry about meds being addictive.. noncompliance - LOVE INJECTIONS! not PO meds. may consider a visit shitty and not effective unless get a shot - touch a mexican baby if complimenting or talking about them

Hispanics

The numerical value separating the higher half from the lower half. The middle value in a list of numbers. The numbers are sorted from the lowest to the highest value.

Median

Medicare Part? does not pay for: - Most eyeglasses and eye exams (except following cataract surgery that implants an intraocular lens). - Hearing aids. - Most dentures and dental care. - Cosmetic plastic surgery (unless it is medically necessary). - Over-the-counter drugs and most prescription drugs.

Medicare Part B (Outpatient Insurance)

Medicare see is now known as what?

Medicare advantage

The duty to do no harm

Nonmaleficence

Describe a stye (hordeolum)

Painful acute bacterial infection of the hair follicle on the eyelid Complains of itchy eyelid and acute onset of a pustule on the upper or lower eyelid that becomes painful

Which SSRI has to be weaned slowly

Paxil

Most common cancer in men

Prostate

What 2 signs are positive in acute appendicitis

Psoas and obturators

Type of research study design.... The design is similar to an experimental study except there is no randomization of the research subjects. Instead, recruitment of subjects is by convenience sample.

Quasiexperimental

______________ Asthma FEV1/PEF <60%, symptoms most of day. SABA, high dose ICS, LABA, oral steroid daily

Severe Persistent Asthma

What diabetic medication do you not want to use in heart failure patients

TZD's (actos, avandia)

Aspirin given after a stroke or an MI is considered what type of prevention

Tertiary

To test reflex center at L5 to S2 what do you do

Test the Achilles reflex

Special considerations in geriatrics "Sex hormones"

Testes active for the entire life cycle of males. Produce less dehydroepiandrosterone (DHEA) and testosterone. Females: estrogen and progesterone production decrease significantly due to ovarian failure (menopause). Adipose tissue is able to synthesize very small amounts of estrogen.

What four elements are required to establish a patient's competence?

The ability to reason, differentiate good from bad, understand, and communicate

Veracity

The duty to be truthful

What is Veracity?

The duty to be truthful

What is Beneficence?

The duty to prevent harm Promote good

Beneficence

The duty to prevent harm and promote good

What is the duty to warn?

The duty to protect a patient from harming him/herself supersedes the right to confidentiality

T/F: according to CURB-65 A score of one or less indicates that the patient can be treated as an outpatient, whereas a score greater than 1 indicates hospitalization is needed

True

What is the diagnostic test for testicular torsion

US

Chest x-ray and CBC findings in Atypical PNA

Usually diffuse rather than consolidated infiltrates; CBC may be normal

which of the following best describes how the variola virus that causes smallpox is transmitted? a. direct deposit of infective droplets b. surface contact c. blood and body fluids d. vertical transmission

a. direct deposit of infective droplets

PPSV23 is not licensed for use in children younger than age 2 years a. true b. false

a. true

two MMR immunizations one month apart are recommended for adults born after 1957 a. true b. false

a. true

primary prevention measures are:

activities to prevent the onset of acquisition of a given disease, such as, health protecting education/counseling, encouraging the use of car restraints and bicycle helmets, safer sexual practices, providing info on accident and fall prevention, immunizations and chemoprophylaxis

in which of the following grps is routine HBsAg screening recommended? a. hospital lab workers b. recipients of hepatitis B vaccine series c. pregnant women d. college students

c. pregnant women

Special "Cardiac" considerations in geriatrics heart sound a "normal finding" in the elderly if not associated with heart disease. The left ventricle hypertrophies with aging (up to 10% of thickness).

s4

which asthma pharmacologic therapies are considered Relievers? short-acting beta2-agonists (SABA) short-acting muscarinic agents (SAMA) oral corticosteroids (OCS)

short-acting beta2-agonists (SABA) short-acting muscarinic agents (SAMA) oral corticosteroids (OCS)

Leukotriene Inhibitors (Montelukast, Zileuton) side effect

side effects Neuropsychological effects (agitation, aggression, depression); monitor LFTs

Males

■ Age 35 YEARS or older: Screen for LIPID disorder. ■ Age 20 to 35 YEARS: Screen if at INCREASED RISK of HEART disease.

BREAST Cancer

■ BASELINE mammogram: START at age 50 YEARS then every 2 YEARS (biennially) until the age of 74 YEARS.

Female cancer

■ BREAST cancer

Asthma Green zone on PEFR 80-100% expected volume, maintain or reduce meds

80-100% expected volume, maintain or reduce meds

The most common renal stones are composed of: A. Calcium B. Uric acid C. Sodium D. Iron

A. Calcium

QT prolongation is a concern with higher doses of: A. Citalopram B. Sertraline C. Venlafaxine D. Fluoxetine

A. Citalopram

Patients with olecranon bursitis typically present with: A. Swelling and redness over the affected area B. Limited elbow range of motion (ROM) C. Nerve impingement D. Destruction of the joint space

A. Swelling an redness over the affected area

If an APN is practicing outside the legal scope of practice for the state, does malpractice insurance cover this?

Absolutely not!!

What is the drug of choice for diabetics with hypertension

Ace inhibitor

What is a classic case of pyelonephritis

Acute onset of high fever, chills, nausea/vomiting, one sided flank pain. Also symptoms associated with cystitis

What is a normal rinne test

Air conduction is twice as long as bone conduction

Influenza

All health care personnel should have an ANNUAL flu shot during the fall/winter. NOVEMBER.

Most common cancer

■ SKIN cancer.

Advise all patients with hypertension to lower their dietary intake of what

Salt

TERTIARY Prevention

(REHABILITATION, SUPPORT Groups, EDUCATION on Equipment) ■ SUPPORT GROUPS: Alcoholics Anonymous (AA), breast cancer support groups, HIV support groups. ■ EDUCATION for patients with preexisting disease (i.e., diabetes, hypertension): Avoidance of drug interactions, proper use of wheelchair or medical equipment, and so on. ■ REHABILITATION: Cardiac rehab, physical therapy (PT), occupational therapy (OT). ■ EXERCISE PROGRAMS for obese children and adults.

Abnormal vision problems -C/o excessive glare of lights that interferes with driving

(glaucoma).

Rashes that are very pruritic at night and located on the interdigital webs are what

Scabies

CLASSIC CASE & FINDINGS [Clinical Presentation] Fever, anorexia, fatigue, night sweats, mild non-productive cough (early phase), in later stages productive cough with hemotypsis and weight loss. Cavitations and adenopathy and granulomas in hila of lungs

TB

TB: Chemoprophylaxis

TB: Chemoprophylaxis - W/ isoniazid and other agents to prevent the dev of active TB should be considred for pts w/ latent TB (+ TB skin test, but neg CXR, and no suspicion of dz by hx or PE). - duration of isoniazid tx is 6-9 mons. - Alternative: rifampin (if izoniazid cannot be taken or poorly tolerated).

Osgoodd Schlatter disease presentation

Tender bony mass over the anterior tubercle of the knee. It is worse with the activities.

peak infectivity of persons with hepatitis a usually occur: a. before onset of jaundice b. at the time of maximum elevation of liver enzymes c. during the recovery period d. at the time of maximum disease-associated sxs

a. before onset of jaundice (approximately two weeks prior to jaundice)

Name the 12 cranial nerves

1. Olfactory (s) 2. Optic (s) 3. Oculomotor (m) 4. Trochlear (m) 5. Trigeminal (b) 6. Abducens (m) 7. Facial (b) 8. Acoustic (s) 9. Glossopharyngeal (b) 10. Vagus (b) 11. Spinal accessory (m) 12. Hypoglosa (m)

When you start screening for colon cancer

50

Longitudinal Studies

A long-term study follows the same group of subjects (or a subpopulation) over many years to observe and measure the same variables over time. It is an observational study (there is no manipulation or intervention). For example, the Framingham Heart Study has tracked the same research subjects (N = 5,029) from the town of Framingham, MA. The goal is to study the development and identify the factors that are associated with the development of cerebrovascular disease.

Every asthma patient needs what medication

A short acting beta two agonist such as albuterol

Significance level of p value is indicated by

A significance level of p <.05 means that there is a 5% probability that the data from the study are due to chance.

X-rays will fail to show changes in affected joints in approximately what percent of patients with RA at disease onset? A. 30% B. 50% C. 75% D. 95%

A. 30%

Treatment options for lymphogranuloma venereum include: A. Doxycycline B. Penicillin C. Ceftriaxone D. Dapsone

A. Doxycycline

Common adverse effects of musculotropic relaxants used in the treatment of urinary incontinence include: A. Dry mouth and constipation B. Nausea C. Headaches D. Syncope

A. Dry mouth and constipation

A 68-year-old woman with heart failure presents with tachycardia, S3 heart sound, and basilar crackles bilaterally. Blood pressure is 90/68 mmHg; BUN is 58 mg/dL (20.7 mmol/L); creatinine is 2.4 mg/dL (212.1 μmol/L). This clinical presentation is most consistent with: A. Prerenal azotemia B Acute glomerulonephritis C. Tubular necrosis D. Postrenal azotemia

A. Prerenal azotemia

Evaluation for disease progression is a patient with sarcoidosis can involve: A. Pulmonary function test and carbon monoxide capacity test B. Skin biopsy C. Check for WBCs in the urine D. The Phalen test

A. Pulmonary function test and carbon monoxide capacity test

The use of which of the following drugs often mimics generalized anxiety disorder? A. Sympathomimetics B. Antipsychotics C. Anticholinergics D. Alpha-beta antagonists

A. Sympathomimetics

The presentation of acute epididymitis in an otherwise-well 22-year-old man includes: A. The presence of a positive Prehn sign B. Low back pain C. Absent cremasteric reflex D. Diffuse abdominal pain

A. The presence of a positive Prehn sign

The most common type of injury causing a sport-related meniscus tear involves: A. Twisting of the knee B. Hyperextension of the knee C. Repetitive hard impact on the knee (i.e., running on hard surface) D. An unknown origin in most cases

A. Twisting of the knee

Changes to the joint during osteoarthritis can typically include all of the following except: A. Widening of the joint space B. Articular cartilage wears away C. Formation of bone spurs D. Synovial membrane thickens

A. Widening of the joint space

Prophylactic treatment for migraine headaches includes the use of: A. amitriptyline. B. ergot derivative. C. naproxen sodium. D. clonidine.

A. amitriptyline.

All of the following are consistent with GOLD COPD recommendation for pulmonary rehabilitation except: A. reserved for very severe COPD. B. goals include improvement in overall well-being C. an underused therapeutic option D. components aimed at reducing the deconditioning common in COPD

A. reserved for very severe COPD.

ALT or AST, which is more sensitive to the liver

ALT

Symptoms of lymphogranuloma venereum typically occur how long after contact with an infected host? A. 5-7 days B. 1-4 weeks C. 4-6 weeks D. 2-3 months

B. 1-4 weeks

Approximately what percentage of sexually active adults has serological evidence of human herpesvirus 2 (HHV-2 or herpes simplex type 2)? A. 5 B. 15 C. 25 D. 40

B. 15

56. Orthostatic hypotension is present in about ____% of older adults A. 10 B. 20 C. 30 D. 40

B. 20

Anticipated organ survival exceeds 85% with testicular decompression within how many hours of torsion? A. 1 B. 6 C. 16 D. 24

B. 6

You examine a 32-year-old man with chancroid and anticipate finding: A. a verruciform lesion B. A painful ulcer C. A painless, crater-like lesion D. A plaque like lesion

B. A painful ulcer

Which of the following agents offer an intervention for the control of tremor and tachycardia associated with alcohol withdrawal? A. Phenobarbital B. Clonidine C. Verapamil D. Naltrexone

B. Clonidine

A significant adverse effect of biologic therapy for treating RA is: A. Myopathy B. Infections C. Renal impairment D. Elevated liver enzymes

B. Infections

The use of a systemic corticosteroid in the treatment of anaphylaxis is primarily helpful for: A. Treatment of the most acute symptoms B. Minimization of a protracted allergic response C. Prevention of future episodes D. Reducing the risk of fatality associated with the event

B. Minimization of a protracted allergic response

To help prevent meniscal tear, you advise: A. Limiting participation in sports B. Quadriceps-strengthening exercises C. Using a knee brace D. Applying ice to the knee before exercise

B. Quadriceps-strengthening exercises

Most of the body's iron is obtained from: A. Animal-based food sources B. Recycled iron content from aged red blood cells (RBCs) C. Endoplasmic reticulum production D. Vegetable-based food sources

B. Recycled iron content from aged red blood cells (RBCs)

A 63-year-old man presents with abdominal pain, pain during urination, and red urine. Imaging reveals a renal stone in the ureter. An appropriate treatment option would be: A. Percutaneous nephrolithotomy B. Shock wave lithotripsy C. Insertion of a nephrostomy tube D. Insertion of a catheter

B. Shock wave lithotripsy

Intervention in anemia of chronic disease most often includes: A. Oral vitamin B12 B. Treatment of the underlying cause C. Transfusion D. Parenteral iron

B. Treatment of the underlying cause

Which antihistamine should be avoided in the elderly

Benadryl

Treatment for syphilis

Benzathine PCN IM

In treating a person with panic disorder using an SSRI, the NP should consider that there is: A. Considerable abuse potential with these medications B. No significant therapeutic advantages over TCAs C. A reduction in number and severity of panic attacks D. Significant toxicity in overdose

C. A reduction in number and severity of panic attacks

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb = 9.1 g (normal 12 to 14 g) Hct = 28% (normal 36% to 42%) RBC = 5 million mm3 (normal 3.2 to 4.3 million mm3) MCV = 68 fL (normal 80-96 fL) MCHC = 33.2 g/dL (normal 32 to 36 g/dL) RBC distribution width (RDW) = 13% (normal < or equal to 15%). Reticulocytes = 1.5% This is most consistent with the laboratory assessment of: A. Iron-deficiency anemia B. Cooley anemia C. Alpha-thalassemia minor D. Hemoglobin Bart's

C. Alpha-thalassemia minor

When choosing an antimicrobial agent for the treatment of chronic bacterial prostatitis, the NP considers that: A. Gram-positive organisms are the most likely cause of infection B. Cephalosporins are the first-line choice of therapy C. Choosing an antibiotic with gram-negative coverage is critical D. Length of antimicrobial therapy is typically 5 days

C. Choosing an antibiotic with gram-negative coverage is critical

Risks factors for acute glomerulonephritis include all of the following except: A. Bacterial endocarditis B. Goodpasture's syndrome C. Crohn's disease D. Polyarteritis

C. Crohn's disease

Which of the following is not characteristic of rheumatoid arthritis (RA)? A. It is common in women at a 3:1 ratio B. Family history of autoimmune conditions often is reported C. Peak age for disease onset in individuals is age 50 to 70 years D. Wrists, ankles, and toes often are involved

C. Peak age for disease onset in individuals is age 50 to 70 years

14. This age related change that results in near vision blurriness is a change in the senses sometimes reported by the older adult. A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

C. Presbyopia

A 22-year-old woman wants to know whether she can start a walking program. She has a diagnosis of MVP, with echocardiogram revealing trace mitral regurgitation. You respond that: A. She should have an exercise tolerance test B. An ECG should be obtained C. She may proceed in the absence of symptoms of activity intolerance D. Running should be avoided.

C. She may proceed in the absence of symptoms of activity intolerance

Common symptoms of MS include all of the following except: A. numbness or weakness in one or more limbs. B. double vision or blurring vision. C. facial weakness or numbness. D. cold sensitivity.

C. facial weakness or numbness.

What is the desired therapeutic action of inhaled corticosteroids when used to treat COPD? A. reversal of fixed airway obstruction B. improvement of central respiratory drive. C. reduction of airway inflammation D. mucolytic activity

C. reduction of airway inflammation

60. Most falls in older adults occur in: A. a healthcare institution. B. a public place C. the patient's home D. an outdoor setting

C. the patient's home

Conductive hearing loss

Conductive Hearing Loss Involves the external ear (external canal, pinna, tragus) and/or the middle ear (eustachian tube, tympanic membrane [TM], and the ossicles). Example: Cerumenosis (earwax impaction). Otitis Externa

Stages of Pertussis _____________ Stage: cough less severe and less frequent

Convalescent

What is Medicare Part B

Covers physician services, outpatient hospital services, laboratory and diagnostic testing, medical equipment, some home health services. REQUIRES a preium!

Which urine culture result is needed to confirm a UTI in an asymptomatic woman who has not had recent use of a urinary catheter? A. 10^2 cfu/mL or more B. 10^3 cfu/mL or more C. 10^4 cfu/mL or more D. 10^5 cfu/mL or more

D. 10^5 cfu/mL or more

Risk factors for lateral epicondylitis include all of the following except: A. Repetitive lifting B. Playing tennis C. Hammering D. Gout

D. Gout

A 24-year-old woman has a new onset of panic disorder. As part of her clinical presentation, you expect to find all of the following except: A. Peak symptoms at 10 minutes into the panic attack B. History of agoraphobia C. Report of chest pain during panic attack D. History of thought disorder

D. History of thought disorder

All of the following electrolyte disorders are commonly found in a person with chronic renal failure except: A. Hypernatremia B. Hypercalcemia C. Hyperkalemia D. Hypophosphatemia

D. Hypophosphatemia

Objective findings in patients with glomerulonephritis include all of the following except: A. Edema B. Urinary red blood cell (RBC) casts C. Proteinuria D. Hypotension

D. Hypotension

First-line treatment options for bursitis usually include: A. Corticosteroid bursal injection B. Heat to area C. Weight-bearing exercises D. Nonsteroidal anti-inflammatory

D. Nonsteroidal anti-inflammatory

Tophi are best described as: A. Ulcerations originating on swollen joints B. Swollen lymph nodes C. Abscesses with one or more openings draining pus onto the skin D. Nontender, firm nodules located in soft tissue

D. Nontender, firm nodules located in soft tissue

A 78-year-old man presents with fatigue and difficulty with bladder emptying. Examination reveals a distended bladder but is otherwise unremarkable. The blood urea nitrogen (BUN) is 88 mg/dL (31.4 mmol/L); the creatinine is 2.8 mg/dL (247.5 μmol/L). This clinical assessment is most consistent with: A. Prerenal azotemia B. Acute glomerulonephritis C. Acute tubular necrosis D. Postrenal azotemia

D. Postrenal azotemia

Which of the following is not a common risk factor for erectile dysfunction (ED)? A. Diabetes mellitus B. Hypertension C. Cigarette smoking D. Testosterone deficiency

D. Testosterone deficiency

96. The most common trigger for delirium is: A. alcohol withdrawal B. fecal empaction C. head trauma D. acute infection

D. acute infection

Treatment options in cluster headache include the use of: A. nonsteroidal anti-inflammatory drugs (NSAIDs). B. oxygen. C. the triptans. D. all of the above therapies.

D. all of the above therapies.

Diagnostic confirmation of glomerulonephritis typically requires: A. Urinalysis plus a CBC with differential B. Abdominal CT scan C. Kidney ultrasound D. Kidney biopsy

D. kidney biopsy

Who developed quality assurance/quality improvement/continuous process improvement?

Deming, and tested in Japan

True or False: A 52 y/o immunocompetent patient with COPD who receives the pneumococcal vaccine should get re-vaccinated in 5 years.

False

Dedication and loyalty to one's patients. Keeping one's promise.

Fidelity

GERD tx

First line is lifestyle changes Next step is H2 blockers or PPI

Special considerations in geriatrics "Immunizations" "Influenza Vaccine"

Given annually starting in oct/nor of each year. Vaccine strains changes every year due to the viral mutations. Immunity from the flu vaccine lasts only a few months.

Shots needed at 11-12 yrs

HPV, MCV4, Tdap

Side effects of thiazide diuretics

Hyperglycemia, hypertriglyceridemia, hyperuricemia

What findings are seen on a wet mount slide in Candida vaginitis

Hyphae and spores and a large number of white blood cells

What ethical principle? The lack of bias. The right to fair and equitable treatment. The fair and equitable distribution of societal resources.

Justice

_________ TB Intact immune system causes macrophages to sequester bacteria in the lymph nodes (mediastinum) in the form of granulomas

Latent

What is abnormal weber test

Lateralization to an ear

Who sets the standard for reimbursement and cutting costs?

Medicare

Population of cluster headaches are they seen most in

Men

Do life insurance or employers or workers comp carriers have to observe HIPPA?

No

Is wheezing required for a diagnosis of asthma?

No

Who can perform the initial service under "incident to" billing for Medicare?

Only the physician

When can patient records be shared with the patient's family, relatives, friends, or others?

Only when the patient specifies them as being involved with their healthcare or bill payment.

How does Temporel arteritis present

Pain behind the eye and on the scalp

Collaborative practice exists to enhance ____

Quality of care and improve patient outcomes

Medicare part C allows patients to do what?

Receive their care from an HMO

What is tertiary prevention?

Rehabilitation and restoration of health,

What is a positive Prehn's sign

Relief of pain with scrotal elevation

albuterol (Proventil, Ventolin, ProAir), levalbuterol (Xopenex), and pirbuterol (Maxair) are what kind of medications?

SABAs

What lab is elevated in Temporel arteritis (giant cell arteritis) How is this treated

Sed rate Steriods x several weeks

"Skin" considerations in geriatrics Secondary to sun exposure; potential for malignancy.

Senile Actinic Keratosis

What do you labs are preferred when checking renal function

Serum creatinine and GFR

If the patient has a rash at the tip of the nose and the temple area what do you need to rule out

Shingles infection of the trigeminal nerve

What is the only drug class that is used as a rescue medication and asthmatics and C0PD patients

Short acting Beta two agonist such as albuterol and Xopenex

Avoid high oxalate foods such as what

Spinach, Brubar, beats, chocolate, tea, meats

Staging Ulcers Damage to epidermis. Blisters form, which erupt into red shiny skin or shallow superficial ulcers. The wound bed is pink to red in color

Stage II:

Staging Ulcers Deep ulcers with visible muscle, tendon, fascia, and/or bone. Undermining on wound edges or tunneling is common. Higher risk of osteomyelitis

Stage IV:

What criteria is used to establish negligence?

Standards of care

Obesity

Start at age 6 YEARS; ADOLEscents to ADULTS

Sexually transmitted infections (STIs)

Start at the ONSET of sexual activity High-intensity behavioral COUNSELING

What is papilledema

Swollen optic disc with blurred edges due to ICP

If the patient has an elevated TSH what labs need to be drawn next

TSH, T4,t3

Instructions for those that have missed two consecutive days of the pill

Take two pills the next two days to finish cycle and use condoms as a back up

Temporal arthritis

Temporal Arteritis (Giant Cell Arteritis) Temporal headache (one sided) with tenderness or induration over temporal artery; may be accompanied by sudden visual loss in one eye (amaurasis fugax). Scalp tenderness of affected side. Screening test is the sedimentation rate, which will be elevated. Considered a medical emergency (can cause blindness).

To test reflect center of L4 to S2 what do you do

Test the plantar reflex

What does informed consent imply?

That the patient understands, can reason, differentiate good and bad, and communicate

Autonomy

The duty to respect an individual's thoughts and actions

What rule specifies patients being allowed to receive a copy of their records, corrections, reports on how when and why info you shared, or file complaints?

The privacy rule

How to Caucasians view a successful visit to the doctor/NP?

They leave with a prescription

What hypertensive medication should be given to women with osteopenia or osteoporosis

Thiazides - help bone loss by slowing down calcium loss from the bone and stimulating osteoclasts

Hepatitis B Vaccine

Total of THREE doses. If series NOT completed, CATCH UP until THREE-dose series is COMPLETED. The CDC does NOT recommend a RESTART of the hepatitis B series.

How is personal spaced often viewed with African-Americans?

Touch is essential, personal space may be limited

Which type of healthcare providers will Japanese women most often communicate with ?

Women NOT MEN

What is a living will?

Written statement documenting which life-prolonging measures one does and does not want if incapacitated

What is an advanced directive?

Written statement of a patient's intent regarding medical treatment if they should become incapacitated

38. (yes/no) Confusion is associated with the use of anticholinergic agents in older adults

Y

the MMR vaccine contains live but weakened (attenuated) virus a. true b. false

a. true

What medication must be stopped during an acute gout attack

allopurinol, restart 4 to 6 weeks after resolved

L. is a 52 y/o woman who presents for a followup visit for HTN, type 2 DM, and dyslipidemia. she has a 50 pack yr cigarette smoking hx, quit smoking 6 months ago, and now reports smoking about 10 cigarettes per day for the past 2 wks while being particularly stressed during her 78 y.o mother's recent serious illness. L. states, I give up, I guess I cannot quit. which of the following is the most appropriate response to L's statement? a. do you think your mother's illness was a trigger for your smoking? b. can we work on a plan to help you to get back to being smoking-free? c. once your mom is well again, you should try quitting again d. you sound really discouraged about this

b. can we work on a plan to help you to get back to being smoking-free?

current limitations of screening smokers with CT scan include all of the following EXCEPT: a. a high false-positive rate b. low sensitivity c. radiation exposure from multiple CT scans d. patient anxiety

b. low sensitivity

compared with albuterol, levalbuterol (Xopenex) has: a. a different mechanism of action b. the ability potentially to provide greater bronchodilation at a lower dose c. an anti-inflammatory effect similar to that of an inhaled corticosteroid d. a contraindication to use in elderly patients

b. the ability potentially to provide greater bronchodilation with a lower dose

What two ethical principles are often in conflict? For example, a patient wishes to cease chemotherapy?

beneficence (not maleficence) and autonomy

in the US, universal childhood HBV began in what year? a. 1962 b. 1972 c. 1982 d. 1992

c. 1982

a 50 y/o man with HTN and dyslipidemia presents for a primary care visit. he states, it has been at least 10 yrs since my last tetanus shot. he should be immunized with: a. Td b. tetanus IG c. Tdap d. none of the above, owing to his concomitant health problems

c. Tdap

Symptoms of lung cancer caused by a primary tumor include all of the following EXCEPT: a. chest discomfort b. dyspnea c. hoarseness d. hemoptysis

c. hoarseness

a middle aged man with COPD who is about to receive injectable influenza vaccine should be advised that: a. it is more than 90% effective in preventing influenza b. its use is contraindicated int he presence of psoriasis vulgaris c. localized reactions such as soreness and redness at the site of the immunization are fairly common d. a short, intense, flulike syndrome typically occurs after immunization

c. localized reactions such as soreness and redness at the site of the immunization are fairly common

What is qualitative research?

case studies, open-ended questions, field studies, observation

Any patient with unexplained iron-deficiency anemia who is older, male, or postmenopausal should be referred for a

colonoscopy.

a dx of pneumonia is confirmed by: a. sputum culture b. sputum gram stain c. bronchoalveolar lavage d. chest x-ray

d. chest x-ray

a woman who has been advised to receive varicella-zoster immune globulin (VZIG) asks about its risks. you respond that IG is a: a. synthetic product that is well tolerated b. pooled blood product that often transmits infectious disease c. blood product obtained from a single donor d. pooled blood product with an excellent safety profile

d. pooled blood product with an excellent safety profile

approximately ___ of healthcare providers receive influenza immunization annually a. one quarter b. one half c. two thirds d. three quarters or more

d. three quarters or more

Females

■ Age 45 YEARS or older: Screen for LIPID disorder. ■ Age 20 to 45 YEARS: Screen if at INCREASED RISK of heart disease (i.e., hypertensive, strong family history of MI, or stroke).

Is shaking a fist in the air, in the direction of another person an example of assault?

Yes

What is a precursor for skin cancer

Actinic keratosis

Written statement of medical treatment intention

Advanced directive

LABAs increase the risk of what?

Asthma deaths

Is a nurse practitioner allowed to bill for an assistance work?

Yes

First line for raynauds

CCB

What is libel?

Defaming via written material

Who determines how to meet the goals of healthy people 2020?

Individuals, communities and organizations

Foods high in folate

Leafy green vegetables, grains, beans, liver

What is rovsing sign

Pushing on LLQ, referred pain in RRQ

What color phlegm will a person produced with a streptococcus Pneumoniae infection

Rust colored or blood tinged

During a crisis, should you call security or 911?

Security

Who enforces HIPPA?

The office for civil rights

Korsakoff syndrome is caused by what chronic deficiency

Thiamine - cheonic ETOH abuse

Is acute bronchitis most commonly bacterial or viral?

Viral (90%)

Staging Ulcers Reddened area on intact skin that does not go away. Non-blanchable. The affected area may feel warm and firm (induration). Darker color of skin,

Staging Stage I:

What are 3 important risk factors for death from asthma and should influence decisions regarding asthma management?

1. A poor perception of symptoms 2. use of two or more short-acting beta2-agonist canisters/month 3. prior severe exacerbations

The ANA's social policy statement defines collaboration as a ____ in which all players ____

"true partnership", Have and desire power, share common goals, recognize and accept separate areas of responsibility and activity

Abnormal vision problems -Acute onset of severe eye pain, tearing, redness, blurred vision, nausea, and vomiting

(acute glaucoma is emergent; refer to the ED).

Abnormal vision problems -Male complains of bluish tinge to vision

(check if taking sildenafil/Viagra).

When can count milk be introduced to a child

12 months

What are the four distinct roles for the nurse practitioner?

1. clinician 2. consultant/collaborator 3. educator 4. researcher

What hours should send might be avoided

10-4

What is NP reimbursement when billed under "incident to" a physician service?

100%

At what age does abstract thinking start

11

Which HPV strands are considered carcinogenic

16,18

How long is the first episode of herpes simplex treated versus flare up treatment

1st- 7-10 days Flare ups- 5 days

INR goal for prosthetic valve

2.5-3.5

Under Medicare, the patient pays what percentage of the total bill for services?

20%

When does the Moro reflex dissappear

3-4 months If still in a 6 month old this is abnormal

TB skin test: Positive - Person w/ no RF for TB

> 15 mm

A 34 year old non-smoker (who is otherwise healthy) has been diagnosed with acute bronchitis. His symptoms have persisted for the past 4 days. What's an appropriate treatment for him? 1. Prescribe azithromycin 2. Prescribe doxycycline 3. Prescribe amox/clavulate 4. Treat symptomatically

4. Treat symptomatically

Antitussives should not be used in children younger than ____ years because of a lack of effectiveness and risk of adverse effects.

8

How much do NPs get paid for a *procedure* under Medicare?

80% of the 85% of the physician fee schedule

What must informed consent include?

A discussion of all the benefits and risks to the patient.

What is Medicaid?

A federally supported and state administered program for low income individuals and families.

How do African-Americans view health?

A gift from God, folk healing common, allopathic care, voodoo,

What establishes that a person is qualified?

A license

What does 20/40 vision mean

A patient can see it 20 feet what a person with normal vision can see at 40 feet

What does Medicare part C cover?

A+B=C Inpatient and physician

In children and the elderly, which of the following conditions can contribute to bladder instability and increase the risk of a UTI? A. Constipation B. Upper respiratory tract infection C. Chronic diarrhea D. Efficient bladder emptying

A. Constipation

59. In assessing a person with or at risk for orthostatic hypotension, the BP should be measured after 5 minutes in the supine position and then ___ and ___ minutes after standing. A. 1, 3 B. 2, 4 C. 3, 5 D. 5, 10

A. 1, 3

Treatment for reactive arthritis (also known as Reiter syndrome) in a sexually active man usually includes: A. Antimicrobial therapy B. Corticosteroid therapy C. Anti rheumatic medications D. Immunosuppressive drugs

A. Antimicrobial therapy

Anxiety in response to a challenging life event is a natural response by the body to: A. Help a person focus on the issue at hand B. Diminish the fight-or-flight response C. Impair decision-making under duress D. Provide transient improvement in physical capabilities

A. Help a person focus on the issue at hand

Use of laxatives and diuretics by persons with bulimia nervosa will most commonly result in: A. Hypokalemia B. Hypercalcemia C. Proteinuria D. Hypernatremia

A. Hypokalemia

Risk factors for acute gouty arthritis include: A. Obesity B. Female gender C. Rheumatoid arthritis D. Joint trauma

A. Obesity

Conditions that commonly mimic or can worsen anxiety include all of the following except: A. Opioid use B. Thyrotoxicosis C. Alcohol withdrawal D. Overuse of caffeine

A. Opioid use

The Phalen test is described as: A. Reproduction of symptoms with forced flexion of the wrists B. Abnormal tingling when the median nerve is tapped C. Pain on internal rotation D. Palmar atrophy

A. Reproduction of symptoms with forced flexion of the wrists

Which of the following best describes the lesions associated with condyloma acuminata? A. Verruciform B. Plaquelike C. Vesicular D. Bullous

A. Verruciform

A first-line prophylactic treatment option for the prevention of tension-type headache is: A. nortriptyline. B. verapamil. C. carbamazepine. D. valproate

A. nortriptyline

Risk factors for MS include all of the following except: A. older than 50 years of age. B. female gender. C. northern European ancestry. D. autoimmune disease.

A. older than 50 years of age

Post streptococcal glomerulonephritis typically occurs how long following a bacterial pharyngitis infection? A. 4 to 6 days B. 1 to 2 weeks C. 3 to 4 weeks D. 2 months

B. 1 to 2 weeks

With fluoroquinolone use, length of antimicrobial therapy during uncomplicated pyelonephritis is typically: A. 5 days B. 1 week C. 2 weeks D. 3 weeks

B. 1 week

Is an Essential tremors an action tremor or resting tremor? What's the first line treatment

Action Beta blockers (propranolol)

What ethical principle ? Health care providers are responsible for their own choices and actions and do not blame others for their mistakes.

Accountability

nongovernmental association evaluates and certifies that an organization (e.g., hospital, clinic, nursing program) has met the requirements and excels in its class. For example, the American Nurses Credentialing Center and the National League for Nursing Accrediting Commission, Inc.,

Accredidation

Tx of Alzheimer's

Adjunct Treatment Physical activity and exercise have been shown to decrease the risk of dementia. Gingko biloba: May help with memory (do not mix with aspirin or warfarin). Omega-3 fatty acids, vitamin B supplementation Treatment Plan Most patients with dementia are taken care of at home by a family member or caregiver during the early stages of the disease. As disease progresses, many patients are placed in skilled nursing facilities, or assisted-living dementia units. In later stages of the disease, families may consider hospice care.

Persistent microscopic hematuria would be the primary finding in about ______% of individuals with bladder cancer. A. 10 B. 20 C. 30 D. 40

B. 20%

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "psych meds"

Atypical antipsychotics: Black Box Warning of the high risk of mortality in elderly (from long-term care facilities) with dementia who are treated with atypical antipsychotics (Seroquel, etc.).

Depression

Adolescents (12-18 YEARS) Start screening for depression. Look for signs/symptoms. BECK Depression Inventory GERIATRIC Depression Scale

What is the first line treatment for a severe asthmatic exacerbation or respiratory distress

Adrenaline injection such as epinephrine

Multiple myeloma has the highest incidence rate in what racial background

African dissent

Foods high in B 12

All foods of animal origin meat, poultry, eggs, milk, cheese

Assault requires a threat coupled with what?

An apparent, present ability to cause the harm

What is confidence interval?

An interval with limits with a specified probabilty of including the parameter being estimated : A small confidence interval implies a very precise range of values.

Identify if the following characteristic is noted in anorexia nervosa, bulimia nervosa or both disorders: Lanugo

Anorexia Nervosa

The average incubation period for the organism N. meningitidis is: A. 24 hours. B. 3 to 4 days. C. 12 to 14 days. D. 21 days

B. 3 to 4 days.

Osteoporosis is more common in individuals: A. With type 2 diabetes mellitus B. On long term systemic corticosteroid therapy C. Who are obese D. Of African ancestry

B. On long term systemic corticosteroid therapy

How is eye-contact interpretted with Asians?

As a sign of disrespect

The use of all of the following medications can trigger gout except: A. Aspirin B. Statins C. Diuretics D. Niacin

B. Statins

An intentional act that creates an apprehension of an imminent harmful or offensive contact

Assault

Flu Vaccine: What is the YOUNGEST age at which flu vaccine (injection) can be given?

At the age of "6" MONTHS. The LIVE flu vaccine (FLUMIST) can be given at AGE "2 to 49" YEARS.

What is the youngest age at which flu vaccine (injection) can be given?

At the age of "6" MONTHS. The LIVE flu vaccine (FLUMIST) can be given at age "2 to 49" YEARS.

Preferred abx for dog, cat, human bitea

Augmentin

The duty to respect an individual's thoughts and actions

Autonomy

What ethical principle Examples: An alert elderly female with periods of forgetfulness and who has breast cancer decides to have a mastectomy after discussing the treatment options with her oncologist. The woman's daughter tells the NP that she does not want her mother to have a mastectomy because she thinks her mother is too old and confused. The NP has the duty to respect the patient's forgetfulness and who has breast cancer decides to have a mastectomy after discussing the treatment options with her oncologist.

Autonomy

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "antihistamines" concerning disease-drug

Avoid using diphenhydramine (Benadryl) in elderly, especially those with dementia. glaucoma

What anabiotic is used for pregnant patients who have chlamydia

Azithromycin

Treatment for Pertussis

Azithromycin or Clarithromycin (7 days); chemoprophylaxis for close contacts, respiratory droplet precautions

Treatment for chlamydia

Azithromycin or a doxycycline Must tx sexual partners

Common physical examination findings in patients with pernicious anemia include: A. Hypoactive bowel sounds B. Stocking-glove neuropathy C. Thin, spoon-shaped nails D. Retinal hemorrhages

B. Stocking-glove neuropathy

[Auscultation:] Rhonchi, crackles, wheezing [Percussion:] Dullness over affected lobe [Tactile fremitus & egophony:] Increased [Whispered Pectoriloquy:] Abnormal (whispered words louder) What pulmonary diagnosis?

CAP PNA

What medications can be given for patients with Raynauds phenomenon

Calcium channel blocker's (nifedipine, amlodipine)

What part of the brain does the the Rhomberg test

Cerebellar

45. When prescribing a medication, the clinician considers that half-life is the amount of time needed to decrease the serum concentration of a drug by: A. 25% B. 50% C. 75% D. 100%

B. 50%

5-HT1D

B. Antimigraine effect

Acute cerebral hemorrhage is best identified with which of the following imaging techniques? A. transesophageal echocardiogram B. CT scan C. cerebral angiogram D. MR angiography

B. CT scan

Risk factors for the development of low back pain include all of the following except: A. Older age B. Carpal tunnel syndrome C. Scoliosis D. Spinal stenosis

B. Carpal tunnel syndrome

Risk factors for folate-deficiency anemia include: A. Menorrhagia B. Chronic ingestion of overcooked foods C. Use of nonsteroidal antiinflammatory drugs D. Gastric atrophy

B. Chronic ingestion of overcooked foods

Risk factors for prostate cancer include all of the following except: A. African Ancestry B. History of genital trauma C. Family history of prostate cancer D. High-fat diet

B. History of genital trauma

Factors that contribute to stress incontinence include: A. Detrusor overactivity B. Pelvic floor weakness C. Urethral stricture D. Urinary tract infection (UTI)

B. Pelvic floor weakness

Describe the presentation of bacterial pneumonia versus atypical pneumonia

Bacterial pneumonia: Sudden onset High fever Productive cough with purulent sputum Chest pain eith coughing Atypical: Gradual onset Several weeks of the fatigue Severe paroxysmal coughing that is nonproductive Patient usually start it with cold like symptoms

Treatment for chronic prostatitis

Bactrim or quinolone 4-6 weeks

What is scope of practice?

Based on legal allowances in each states according to NPA Provides guidelines for nursing practice

Can one commit assault or battery on an unconscious person?

Battery

What is grey turner sign

Blue discoloration around flanks

If a patient has conductive hearing loss what with the Rhine tests show

Bone conduction will be greater than air conduction

Most common cancer in women

Breast

How do Filipinos believe health is determined?

By good, supernatural forces and Yin and Yang

2. The age range referred to as "young old" is A. 60 to 65 years B. 66 to 70 years C. 65 to 74 years D. 70 to 80 years

C. 65 to 74 years

RA disease progression is typically evaluated using all of the following approaches except: A. X-ray B. MRI C. Echosonography D. ultrasound

C. Echosonography

Loss of posterior tibial reflex often indicates a lesion at: A. L3 B. L4 C. L5 D. S1

C. L5

What is S 3 indicate

CHF

What did the Weber or Rhine test what netve

CN 8

What condition is Edema of the scalp that crosses midline and becomes molded and cone shaped in a newborn infant

Caput succedaneum

___________ are usually experienced RNs who act as coordinators for the outpatient management of patients with certain diagnoses (usually chronic diseases). mainly done by telephone. Examples: COPD, chronic heart failure, diabetes.

Case Managers The process is called "case management."

Chronic steroid use can cause what in the eyes

Cataracts

What process ensures mastery? Who issues this?

Certification, NGO

What is the gold standard test for diagnosing CAP

Chest X-ray

What headache is treated with high dose oxygen

Cluster headache

Four distinct roles of the NP:

Clinician Consultant/collaborator Educator Researcher

Type of research study design.... A study of a group of individuals with one or more common characteristics. For example, the Framingham study has a subpopulation of nurses whose health habits have been tracked for many years.

Cohort study

Type of study comparing an outcome amongst groups who are similar but different by a specific characteristic

Cohort study

Surgical intervention in BPH should be considered with all of the following except: A. Recurrent urinary tract infection B. Bladder stones C. Persistent obstruction despite medical therapy D. Acute tubular necrosis

D. Acute tubular necrosis

What process to the steps implement? Quality planning, delineate scope, identify indicators and thresholds, collect and organize data, evaluate, take action, assess, communicate results

Continuous quality improvement or quality assurance steps

Eye findings in hypertensive retinopathy

Copper and silver wire arterials and AV nicking

13. Painless vision change that includes central vision distortion is an age-related change in the senses reported by the older adult. It is known as: A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

D. Age-related maculopathy

Routine anal Pap tests can be considered for all of the following patient populations except: A. Men with HIV B. Men who have sex with men (MSM) C. Women with a history of anogenital HPV infection D. All males under age 25 years

D. All males under age 25 years

Treatment options for chancroid include all of the following except: A. Azithromycin B. Ciprofloxacin C. Ceftriaxone D. Amoxicillin

D. Amoxicillin

salmeterol (Serevent) and formoterol (Foradil) are what kind of drugs?

Long-acting beta2-agonists

What is the most common cancer in men?

Prostate

Type of research study design.... Describes and measures relationships between two or more variables (or interrelationships). Data are measurable and are numerical. Data are subjected to statistical testing. Example: "Is there a relationship between HIV knowledge and safe sex behaviors of college students?"

Correlational

Whta is good samaritan statute?

Protects HC providers from lawsuits who aid at the scene of an accident.

Which patient presentation is most consistent with the diagnosis of depression? A. Recurrent diarrhea and cramping B. Difficulty initiating sleep C. Diminished cognitive ability D. Consistent early morning wakening

D. Consistent early morning wakening

Patients with medial epicondylitis typically present with: A. Forearm numbness B. Reduction in ROM C. Pain on elbow flexion D. Decreased grip strength

D. Decreased grip strength

Among the preferred first-line pharmacological treatment options for patients with PTSD include the use of: A. Methylphenidate (Ritalin) B. Oxazepam (Serax) C. Lithium carbonate D. Sertraline

D. Sertraline

Common causes of sciatica include all of the following except: A. Herniated disk B. Spinal stenosis C. Compression fracture D. Soft tissue abnormality

D. Soft tissue abnormality

Where are heberdens nodes

DIP joint

Question If a patient had ONLY had ONE dose of HEPAtitis B vaccine, what is recommended?

DO NOT RESTART the HEPATITIS B series again. If only one dose, give the second dose. CATCH UP until the THREE-dose series is completed.

Inductive reasoning or deductive reasoning? reasoning is figuring out a problem after evaluating some broad generalization(s).

Deductive reasoning

Type of research study design.... Describes and measures the characteristics of a group or a phenomenon. Data are measurable, numerical, and are evaluated by statistical testing. No correlations are measured between the variables. Also known as surveys. Example: "HIV knowledge of college students."

Descriptive

What are the two types of nonexperimental research designs?

Descriptive, and ex facto

What can be billed under medicare B by an NP?

Diagnosis Therapy Surgery consult Care plan

Treatment for candida albicans

Diflucan

What ethical principle? Hospital gowns should be secured correctly so that when patients get up to walk with their backs not visible

Dignity

What is a classic case of a UTI

Dysuria, frequency, urgency, nocturia, suprapubic discomfort. Urine dipstick will show moderate to large amount of leukocytes and will be positive for nitrites

15.This age related change can result in peripheral vision loss. It is a change in the senses sometimes reported by the older adult. A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

E. Chronic glaucoma

If suspect elder abuse ask what "3" questions?

Do you feel safe where you live? Who handles your checkbook and finances? Who prepares your meals?

What does a fib look like

Doesn't have discrete P waves

The patient designates a person (family member or a close friend) who has the legal authority to make future health care decisions for the patient in the event that the patient becomes mentally incompetent or incapacitated (i.e., comatose).

Durable power of attorney

5-HT3

E. nausea, diarrhea

How is a Fib diagnosed

ECG

- Permanent alveolar damage and loss of elastic recoil in chronic hyperinflation of the lungs. - Expiratory respiratory phase is markedly prolonged

Emphysema

Special considerations in geriatrics "Endocrine"

Endocrine Minor atrophy of the pancreas. Increased levels of insulin along with mild peripheral insulin resistance. Changes or disorders of the circadian rhythm hormonal secretion (growth hormone, melatonin, and other hormones) can cause changes in sleep patterns.

Manipulation of variables utilizing randomization and a control group

Experimental study

T\F: Macrolides do not cover h. flu or atypicals

F

classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD II is Very Severe at FEV1<_____% predicted

FEV1<30% predicted

What is malpractice?

Failure of a professional to render services with the degree of care, diligence and precaution that another NP would render to prevent injury

What should be increased in a pts diet who has IBS

Fiber

How do Chinese often use traditional medicine? Western Medicine?

For long-term conditions For emergencies and acute care

First NP? Specialty? Where?

Ford Pediatric Colorado

What herb can help with memory

Ginko biloba

______A court-appointed guardian who is assigned by a court (and has the legal authority) to act in the best interest of the "ward." The ward is usually a person who is a child, frail, or vulnerable.

Guardian ad litem

Eye findings in those with diabetic retinopathy

Hard exudates, cotton wool spots, microaneurysms

What is the goal HDL and LDL for DM OR CHD pts

Hdl >40 Ldl <100

What headache is treated with high dose anticonvulsants

Headache related to trigeminal neuralgia

A systematic organizational process to identify risky practices to minimize adverse patient outcomes and corporate liability. For example, high-risk areas that are usually checked by risk managers are medication errors, hospital-acquired infections, patient identification problems, and falls.

Health Risk Management

The diagnostic test without thalassemia and sickle cell anemia is what

Hemoglobin electrophoresis

Hepatitis B

Hepatitis B TITERS should be CHECKED WITHIN "60" DAYS of the THIRD dose. If INcomplete hepatitis B series (FEWER than THREE doses), COMPLETE the series (DO NO RESTART) and check the titer as recommended.

What is first to be lost when there is hearing loss, high frequency or low-frequency

High

Betamethasone, 0.6-0.75 mg Dexamethasone, 0.75 mg are high, medium, or low potency corticosteroids?

Higher potency corticosteroids (equipotent doses)

High risk populations for TB

Immigrants, migrant farm workers, illegal drug users, homeless, inmates of jails and nursing homes, HIV-infected, immunocompromised

The nurse practitioner role was developed when and under what circumstances?

In the early 1960s as a result of physician shortages in the area of pediatrics

Where is incident to billing not allowed?

In the hospital setting

What does "ex post facto" mean?

In the past

How can you increase HDL

Increase aerobic type exercises and take niacin

What are the goals of Healthy People 2020?

Increase quality of life Eliminate health care disparities

List the goals of healthy people 2020

Increase the quality and years of healthy life, eliminate health disparities

What is the most sensitive sign of CAP in elderly?

Increased RR and HR

To lower triglycerides advise patients to do what

Reduce intake of simple carbohydrates, John foods, and fried foods

The variable that is not affected by the other variables. It is the variable that is manipulated.

Independent Variable

Falls

Injuries from falls include head injuries, pelvic injuries, lacerations, and others. About 90% of hip fractures are due to falls. White women are at higher risk for hip fractures than Black women. During 2008, the majority of deaths (82%) from falls were among people aged 65 years or older.

How do Caucasians view pain?

Intolerant to pain,

What is Longitudinal research?

Involves taking multiple measurements of the group over an extended period of time

What is Combivent?

Ipratropium and albuterol

The duty to be fair

Justice

Integration of care, collaboration and coordination of care, research-based clinical practice, clinical leadership, family assessment and discharge planning

Key elements of the NP role

Cancer Mortality

Leading cause of cancer DEATHs: ■ LUNG cancer Leading cause of cancer deaths in MEN: ■ LUNG cancer Leading cause of cancer deaths in WOMEN: ■ LUNG cancer

Are Peak expiratory flow meters more or less accurate than spirometry?

Less

Drugs such as montelukast (Singulair) and zafirlukast (Accolate) are what kind of drugs?

Leukotriene modifiers (LTM)

__________________, are used to control asthma by inhibiting the inflammatory actions of leukotrienes

Leukotriene modifiers (LTM)

The probability level of which the results of statistical analysis are judged to indicate a statistically significant difference between groups

Level of significance

The legal responsibility that a nurse practitioner has for actions that fail to meet the standard of care

Liability

What does Medicare part D cover?

Limited RX coverage

Medicare part D provides what?

Limited drug prescription coverage

What is Medicare Part D

Limited prescription drug coverage, monthly premium required, co-pay on each prescription is required. Plans are offered by insurance and other private companies that are approved by Medicare.

INH is high risk for what?

Liver disorder especially >age 35.

A maculopapular butterfly shaped rash on the middle of the face (malar rash) is associated with what disease

Lupus

What is the gold standard test processing joint damage

MRI

Pertussis: 1st line tx

Macrolides

Which third-party payer sets the standard for reimbursement?

Medicare

When to start screening lipids

Males: age 35 < OR age 20 to 35 IF increased risk of heart disease Females: age 45 years or older OR age 20 to 45 if increased risk of heart disease

Failure of a professional to render services with the degree of care, diligence, and precaution that another member of the same profession under similar circumstances would render to prevent injury to someone else

Malpractice

Early bacterial PNA chest x-ray findings

May be normal

How do Hispanics take/follow medication regimens?

May dc once symptoms subside

________________Asthma FEV1/PEF >80%, symptoms <2 days/week. SABA only

Mild Intermittent

Who is the family leader in Hispanic cultures?

Mother/Grandmother

Name all the systolic murmur's and where they are best heard

Mr. Peyton Manning as MVP Mitral regurgitation-apex Physiologic murmur Aortic stenosis- 2ICS Right Mitral valve prolapse "click"- apex

The NP's prescription pad should contain the following: (6)

NP's name, designation, and license number. Clinic's name, address, and phone number. If the practice has several clinics, the other clinics where the NP practices should also be listed on the pad.

Lifestyle favors to teach gerd pts

No mints, avoid caffeine, don't eat 3-4 hrs before bed

If a nurse practitioner is providing home visits under Medicare part A, do they need a physicians order?

No, unless they are providing nursing services exclusively.

What type of research is descriptive, or ex post facto correlational research?

Nonexperimental

Are NPs required to report domestic violence?

Not in most states

What are Bouchard and heberdens nodes associated with

OA

What is the treatment for a 10° curve in scoliosis

Observation

This type of malpractice policy is not affected by job changes or retirement. When a claim is filed against the NP in the future, it is covered if he or she had an occurrence-based policy at the time the incident occurred.

Occurrence

________________ A person who acts as an intermediary (or as a liaison) between the patient and an organization (long-term care or nursing homes, hospitals, governmental agencies, courts). The ombudsman represents the patient and works in the best interests of the patient.

Ombudsman

When are Medicaid payments made?

Only after other insurance and third-party payments have been made (i.e. Medicare)

Where are Bouchard nodes

PIP joint

What does Medicare part B cover?

Physician services

What is a "herald" patch or Christmas tree pattern rash found in

Pityriasis rosea

What is the most common bacterial pathogens that causes otitis externa

Pseudomonas

Know the difference between RA and OA

RA: Joint stiffness last longer Involves multiple joints Symmetrical distribution Accompanied by systemic symptoms like fatigue, fever, anemia OA: Early-morning joint stiffness with short duration Absence of systemic symptoms

Other

ROUTINE creening is NOT recommended by the USPSTF for the following conditions: ■ LUNG cancer ■ OVARIAN cancer ■ ORAL cancer ■ PROSTATE ■ TESTICULAR

What are the screening test for syphilis

RPR/VDRL

What services are not considered physician services by Medicare?

Regular physical exams, health maintenance screening, counseling, and others

What is the most problematic bias with qualitative studies?

Researcher bias

Why do you want to avoid using aspirin and children with viral infections that are under the age of 16

Reye's syndrome

What is standard 4 in CLAS standards?

Right to language assistance

Sig E Caps For depression, must have >2 but less than 5 for minor and more than 5 for major

S- sleeping slot I- loss of interest G- guilt E- loss of energy C- difficulty concentrating A- decreased appetite P- psychomotor agitation S- suicidal

What is secondary prevention?

S=Screening: focus on early identification and treatment of existing problems: Pap, prostate screening, cholesterol

Ist line tx for COPD

SABA/ SAAC

Who is not required to follow HIPAA laws?

School CPS Life insurance Law enforcement Employer Workers comp

State nurse practice act allow states to establish statutory authority for what 4 key areas of advanced practice nursing?

Scope of practice, disciplinary grounds, certification, and prescriptive authority

What is the screening test for temporal arteritis

Sed rate

How does acute pancreatitis pain present

Severe epigastric pain radiates to mid back

What is certification?

Shows mastery in a specialization

SABAs work by binding to the beta2 adrenergic receptor, causing _________ muscle relaxation and ____________. This effect occurs within _____ to _____ minutes.

Smooth muscle, bronchodilation, 3 to 5

What is the number one causing bacteria of community acquired pneumonia

Streptococcus pneumoniae

Kegel exercises and pelvic floor rehabilitation with biofeedback

Stress Incontinence

What is uveitis

Swelling of the uvea, the middle layer of the eye that supplies blood to the retina Referred these patients to ophthalmology

What is tinel sign

Tapping wrist briskly Positive if pins and needles are felt over the median nerve

Cluster headaches are the only headaches that are accompanied by what two symptoms

Tearing the nasal congestion

Who delineates nurse practitioner scope of practice?

The State Board of nursing within each state

Justice

The duty to be fair

What is justice?

The duty to be fair

Fidelity

The duty to be faithful

What is prevalence?

The proportion of a population that is affected by a disease

What is hypospadias? What do you do with a pt with this?

The urethral opening is located on the ventral aspect of the glands of the penis. Refer to urologist

What is a pro and a con of qualitative studies?

They provide very rich data that no other research type can provide, however the findings may not be generalizable to a larger population

Who gets referred to Occupational Med?

Those struggling with fine motor skills

When and under what circumstances can restraints be used?

To prevent the patient from harming himself or others.

What technique is used to assess for a hydrocele and scrotal masses

Transillumination

Asthma is a lower airway obstructive disease that can have clinical findings that are consistent with air _____________.

Trapping

What medications are used for post herpetic neuralgia

Tricyclic antidepressants (elavil) Gabapentin Anticonvulsants

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "antidepressant"

Tricyclic antidepressants: Amitriptyline (Elavil) is the most sedating. Also causes confusion, delirium, hallucinations. All tricyclic antidepressants (TCAs) cause sedation. Given at bedtime.

The duty to be truthful

Veracity

Describe herpetic whitlow

Viral skin infection of the finger that is caused by herpes simplex. Complains of painful red bumps and small blisters on the sides of fingers.

Women who breast-feed need to supplement the babies with what

Vit D

Validity

We are testing what we are supposed to test

How may Hispanics maintain good health?

Wearing religious metals, eating proper foods, and working the proper amount of time.

How much are women allowed to drink/day? Men?

Women 1/day Men 2/day A person who drinks one glass or one beer a day is not considered alcoholic

a peak flow meter is used for a. monitoring asthma b. diagnosing asthma

a. monitoring asthma

active immunity is defined as: a. resistance developed in response to an antigen b. immunity conferred by an antibody produced in another host c. the resistance of a group to an infectious agent d. defense against disease acquired naturally by the infant from the mother

a. resistance developed in response to an antigen

secondary prevention measures are:

activities provided to identify and tx Asymptomatic person who have risk factors for a given disease or in preclinical disease. examples include mammogram, cervical exam with Pap test, blood pressure measurement to detect hypertension and lipid profile to detect hyperlipidemia

in an immunocompetent adult, the length of incubation for the influenza virus is on average: a. less than 24 hrs b. 1 to 4 days c. 4 to 7 days d. more than a week

b. 1 to 4 days

According to ACCP guidelines, annual screening for lung cancer should occur in 55-74 y/o smokers with a smoking hx of at least ___pack-years: a. 15 b. 30 c. 50 d. 70

b. 30

tetanus infection is caused by the

clostridium tetani, an anaerobid, gram positive spore-forming rod and found in soil

How are hot illnesses treated in Chinese culture?

cold herbs and food

92. Is acute onset of change in mental status most likely associated?

delirium

The cough in TB is typically (productive or dry?)

dry

Identify the following organisms as a gram +, gram -, or a atypical pathogen: -Haemophilus influenzae

gram negative

which asthma pharmacologic therapies are considered Controllers?

inhaled corticosteroids (ICS) leukotriene modifiers (LTM) inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA)

What does Medicare part A cover?

inpatient hospitalization

__________ = golfer's elbow -pt c/o of pain over the inner aspect of lower humerus. -tenderness, elbow pain, FA weakness, wrist flexion worsens -"decreased grip strength"

medial epicondylitis

Rank the following causes of stroke from the most common (1) to least common (3): Cerebral hemorrhage Cerebral ischemia Subarachnoid hemorrhage

most common (1) to least common (3): 1- Cerebral ischemia 2- Cerebral hemorrhage 3- Subarachnoid hemorrhage

Minorities in general...

often d/c meds with SS resolve so noncompliance is an issue... METFORMIN

___________ is an alternative choice if isoniazid cannot be taken or is poorly tolerated.

rifampin

a primary series of ____ tetanus vaccine injections sets the stage for long-term immunity and a booster tetanus dose every ___ yrs is recommended

three, ten

Nonmaleficence

the duty to do no harm

the forced expiratory volume in the first second of expiration (FEV1): forced vital capacity (FVC) ratio is considered to be:

the most sensitive indicator of early airflow limitations - the presence of a post-bronchodilator FEV1:FVC <70% confirms airflow obstruction.

True or False: A 66 y/o woman is an acceptable candidate for the high-dose inactivated influenza vaccine shot.

true

use of the inactivated polio virus (IPV) is used in the US to prevent a rare risk of

vaccine-associated paralytic poliomyelitis (VAPP)

Ipratropium bromide (Atrovent) an anticholinergic inhaled agent that inhibits muscarinic cholinergic receptors, reducing ________ tone in the airway, decreasing mucus secretion and blocking reflex bronchoconstriction because of reflex esophagitis.

vagal

AGAINST ROUTINE screening (Insufficient Evidence)

■ LUNG cancer ■ SKIN cancer ■ OVARIAN/TESTIcular cancer ■ PANCREATIC cancer

is the second most common cause of dementia in the United States. It is caused by brain deposits of Lewy bodies. Patient symptoms of this type of dementia are visual hallucinations, cognitive fluctuations, and parkinsonism.

"Dementia with Lewy bodies" Stroke or CVA or vascular dementia. Parkinson's disease (up to 40% develop dementia). Management Important to obtain a thorough health/medical/drug history. Patient should be accompanied by family during the interview. Family members (and friends) will report patient's signs and symptoms. Refer to neurologist for further assessment.

Mild Intermittent Asthma FEV1/PEF ______%, symptoms __________days/week. Treatment=

>80% <2 days/week SABA only

71. Factors that contribute to urge incontinence include: A. detrusor overactivity B. pelvic floor weakness C. urethral stricture D. UTI

A. detrusor overactivity

Among individuals younger than 35 years, the most common cause of sudden cardiac death is: A. Non-ST-segment myocardial infarction B. ST-segment myocardial infarction C. A congenital cardiac malformation D. Aortic stenosis

C. A congenital cardiac malformation

Pseudogout has been linked with abnormal activity of the: A. Liver B. Kidneys C. Parathyroid D. Adrenal gland

C. Parathyroid

Which SSRI has the least amount of drug interactions with other drugs

Celexa

What test is used to evaluate macular degeneration

Amsler grid

Describe erysipelas

Cellulitis involving the upper dermis and superficial lymphatics that is caused by group A strep. Sudden onset of large hot and indurated red skin lesion that has clear margins. Usually located on shins or on cheeks. Accompanied by fever and chills

What is swelling up and then said that does not cross the midline or suture lines

Cephalohematoma

What feeling does a varicocele present with

Feels like a "bag of worms"

How is psoas performed

Flex hip 90 degrees, ask or to push against resistance and straighten leg

Major cause of death in adolescents? 12-19

MVA Suicide Accidents Homicide Malignancy Cardiovascular/Congenital disease

The most common value in a list of numbers.

Mode:

__________________ Asthma FEV1/PEF 60-80%, daily symptoms. SABA, daily moderate dose ICS, or low dose ICS and LABA

Moderate Persistent Asthma

Patients with ___________ usually present with cough (more than 90%), dyspnea (66%), sputum production (66%), and pleuritic chest pain (50%), although nonrespiratory symptoms, including fatigue and gastrointestinal upset, are also commonly reported.

PNA

Senile Actinic Keratosis potential for?

POTENTIAL FOR MALIGNANCY

Varicella

PROOF of immunity necessary (POSITIVE varicella TITER, documentation of "TWO" doses of varicella vaccine or DIAGNOSIS of varicella by PHYSICIAN/health care provider).

MMR

PROOF of immunity necessary (born BEFORE 1957, LABoratory confirmation such as POSITIVE TITERS). If NOT vaccinated for MMR, need "TWO" doses (at least "4" WEEKS apart).

What is the treatment for plantar fasciitis

NSAIDs such as naproxen or Aleve bid Use orthotic foot appliance at night and ice pack to affected foot Stretching and massaging the foot, rolling a golf ball with the soul of the foot

Treatment for osteoarthritis

NSAIDs, steroid injections, surgery

Niacin and fibrates are best lowering what

Triglycerides

T/F: Although the risk of liver toxicity with anti-TB drug use increases with age, age alone is not a contraindication to its use

True

T/F: Bilateral interstitial infiltrates on chest x Ray means viral or atypical

True

T/F: Combination inhaled orticosteroid/long-acting bronchodilator is more effective in improving symptoms and lung function, and reducing exacerbations in patients with moderate to very severe COPD than either individual component.

True

If the patient has a DVT what test will be positive

Positive Homans sign

#1 organism to kill HIV pts

Pneumocystic jerovecii pneumonia

In a patient with CAP and DRSP risk ?

Respiratory fluoroquinolone Advanced Macrolides (azithro or clarithro) !~PLUS~! = a beta-lactam (augmentin, ceftriaxone, cefpodoxime, cefuroxime) Alternative to Macrolides = Doxycycline

Local adverse effects of ICSs (3)

Sore throat Oral candidiasis Hoarseness.

What is Slander?

Spoken defamation

Atypical Presentation in Elderly "Hypothyroidism"

Subtle and insidious symptoms such as slowing and depression. Problems with memory. If severe, may mimic dementia. Slower movements. Appears apathetic.

A. Genital secretions, B. Oral secretions and C. Intact skin In the person with HSV-2 infection, the virus can spread via contact through which of the following methods? More than one can apply. A. Genital secretions B. Oral secretions C. Intact skin

all

Who dictates the level of prescriptive authority allowed for NPs?

States DEA has ruled that APNPs may obtain registration numbers

Describe the step approach for asthma treatment

Step 1- SABA STEP 2- ICS (low dose) STEP 3- ICS (med dose) Step 4- LABA Oral prednisone Step 5- Add leukotriene inhibitors, theophylline, or mast cell stabilizer

In Chinese culture how is traditional medicine viewed?

one can remove the cause of symptoms, the underlying disorder and the permanent disease state.

tertiary prevention measures are:

part of the management of an established disease. the goal is to minimize disease associated complication. examples include meds and lifestyle modification to normalize blood glucose levels in diabetes and in conjunction with the txment of heart failure, aimed at improving or minimizing disease related sxs

Asthma __________zone on PEFR 80-100% expected volume, maintain or reduce meds

green

Special "Cardiac" considerations in geriatrics Baroreceptors

less sensitive to changes in position. Decreased sensitivity of the autonomic nervous system. Blunted BP response. Decrease in maximum heart rate. Higher risk of orthostatic hypotension.

Would the following finding normally be present in gonorrheal urethritis in an otherwise well 28-year-old man (yes/no)? Dysuria Milky penile discharge Scrotal swelling Fever

yes yes no no

Special considerations in geriatrics "Pharm"

. Pharmacologic Issues Drug clearance is affected by: renal impairment, less efficient liver CYP 450 system, malabsorption, and relatively higher fat:muscle tissue (extends fat-soluble drugs. Older adults have an increased sensitivity to benzodiazepines, hypnotics, tricyclic antidepressants (TCAs), and antipsychotics. The American Geriatric Society's has made a list of inappropriate medications for the elderly (Updated Beers Criteria, 2012)

Are the following physical exam finding in asthma/copd exacerbations? 1. Hyperresonance on thoracic percussion 2. Increased tactile fremitus wheeze (expiratory first, inspiratory later) 3. Prolonged expiratory phase of forced exhalation 4. Low diaphragms decreased anterior-posterior diameter 5. Reduction in forced expiratory volume at 1 second (FEV1 ) or peak expiratory flow rate (early finding) 6. Reduction in arterial oxygen saturation (SaO2 ) (later finding)

1. Yes 2. No, Decreased tactile fremitus wheeze (expiratory first, inspiratory later) 3. Yes 4. No, Low diaphragms Increased anterior-posterior diameter 5. Yes 6. Yes

Omalizumab (Xolair) is a humanized monoclonal antibody and is indicated for those _____years or older with ____(type of asthma)___ that is _____ induced and is uncontrolled with the use of _____(drug)__________

12 years or older moderate-severe persistent allergy ICS.

INR goal for a fib

2-3

classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD II is Moderate at __________%<=FEV1______% predicted

50%<=FEV1<80% predicted

At what age does a baby usually get their first tooth? What age does the first permanent tooth usually come in?

6-10 months 6 years

How often is the TSH checked

6-8 weeks

Normal blood pressure Stage 1 Stage 2

<120/80 140-159/80-89 >160/100

Severe Persistent Asthma FEV1/PEF ________%, symptoms ___________ Treatment (5)

<60%, symptoms most of day SABA, high dose ICS, LABA, oral steroid daily

Who grants hospital privileges?

A Hospital Credentialing Committee made up of physicians who hold privileges at a specific hospital

What does the patient safety and quality improvement act establish?

A voluntary reporting system for patient safety events, whistleblower protection

Which of the following tests is most specific to the diagnosis of RA? A. Elevated levels of rheumatoid factor B. Abnormally high ESR C. Leukopenia D. Positive ANA titer

A. Elevated levels of rheumatoid factor

A likely causative pathogens in a 25-year-old man with acute epididymitis who has sex with men is: A. Escherichia coli B. Mycoplasma spp. C. Chlamydia trachomatis D. Acinetobacter baumannii

A. Escherichia coli

Which of the following statements is most accurate concerning RA? A. Joint erosions are often evident on radiographs B. RA is seldom associated with other autoimmune diseases C. A butterfly-shaped facial rash is common D. Parvovirus B19 infection can contribute to its development

A. Joint erosions are often evident on radiographs

113. When managing depression in older adults, all of the following should be considered except: A. start at the highest dose possible of antidepressant and then titrate down once symptoms resolve B. encourage psychotherapy in addition to pharmacotherapy. C. utilize electroconvulsive therapy for severe depression D. conduct a medication review to minimize potential drug-drug interactions.

A. start at the highest dose possible of antidepressant and then titrate down once symptoms resolve

Appendicitis presentation

Acute onset peri umbilical pain that goes to McBurney's point, no appetite

What do you high triglycerides increase the risk of

Acute pancreatitis It marked high triglycerides 500 or greater, lower triglycerides levels first before treating cholesterol

What murmur radiates to the neck

Aortic stenosis

According to recent epidemiologic studies, prostate cancer is the number _______ cause of cancer death in men residing within the United States? A. 1 B. 2 C. 3 D. 4

B. 2

67. An older adult who has recently fallen as a(n)_____ times increased risk of falling again within the next year. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5

B. 2 to 3

The maximum recommended dose of citalopram for patients older than 60 years of age is: A. 10 mg/day B. 20 mg/day C. 30 mg/day D. 40 mg/day

B. 20 mg/day

Initial therapy for patients with CTS includes: A. Intra-articular injection B. Joint splinting C. Systemic corticosteroids D. Referral for surgery

B. Joint splinting

A complication of glomerulonephritis is: A. Type 2 diabetes B. Nephrotic syndrome C. Pyelonephritis D. Bladder cancer

B. Nephrotic syndrome

76. Medications used to treat urge incontinence and overactive bladder usually have anticholinergic and antimuscarinic effects that can lead to problems in older adults including: A. tachycardia and hypertension B. sedation and dry mouth C. agitation and excessive saliva production D. loose stools and loss of appetite

B. sedation and dry mouth

73. Pharmacological intervention for patients with urge incontinence includes the use of: A. doxazosin (Cardura). B. tolterodine (Detrol). C. finasteride (Proscar). D. psuedoephedrine (Sudafed).

B. tolterodine (Detrol).

Which of the following statements is false regarding patients with depression and hypochondriasis? A. About 30% of patients with depression also have hypochondriasis B. These patients are less likely to see a healthcare provider compared to those with depression alone C. These patients are unable to process objective information that they have no particular health problem D. They perceive that an existing health problem is far more serious than it is in reality

B.These patients are less likely to see a healthcare provider compared to those with depression alone

What do the turbinates look like in allergic rhnitis

Blue tinged pale boggy swollen

Identify if the following characteristic is noted in anorexia nervosa, bulimia nervosa or both disorders: Dysrhythmias

Both

You are examining a 65-year-old man who has a history of acute coronary syndrome and migraine. Which of the following agents represents the best choice of acute headache (abortive) therapy for this patient? A. verapamil B. ergotamine C. timolol D. sumatriptan

C. timolol

Type of research study design.. An intensive and in-depth study of one person.

Case study

Stages of Pertussis ______________ Stage: mild cough, low fever, rhinorrhea

Catarrhal Stage

Ethambutol S/E

Causes optic neuritis; avoid if pt has abnormal vision (blindness, retinal vein occlusion)

What is the screening test for all anemias

Cbc

Treatment for gonorrhea

Ceftriaxone IM PLUS treat for chlamydia Azrithomycon

Cerebrovascular Accident

Cerebrovascular Accident (CVA) Sudden onset of neurological dysfunction that worsens within hours. Also called a "brain attack." Deficits can include changes such as blurred vision, slurred speech, one-sided upper and/or lower extremity weakness, confusion. Signs and symptoms dependent on location of infarct. In comparison, a transient ischemic attack (TIA) is a temporary episodes that generally lasts less than 24 hours.

What is passive immunity?

Conferred by the introduction of antibody proteins via Igg or maternal tranfer

AAOS strongly recommends all of the following therapeutic agents for the management of symptomatic OA of the knee except: A. Oral NSAIDS B. Topical NSAIDS C. Tramadol D. Opoids

D. Opoids

53. The most commonly reported form of elder maltreatment is: A. physical abuse B. sexual exploitation C. financial exploitation D. neglect

D. neglect

17. An 81 year old woman has early bilateral senile cataracts. Which of the following situations would likely pose the greatest difficulty for her? A. reading the newspaper B. distinguishing between primary colors C. following extraocular movements D. reading road signs while driving

D. reading road signs while driving

Dementia An irreversible disorder with gradual and insidious onset. Global intellectual decline. Terminal stage is about 10 years in Alzheimer's disease (most common cause). Patient is usually incoherent to nonverbal; unable to ambulate, eat, or perform self-care as disease progresses. Duration: lifetime. Etiology Alzheimer's disease (most common cause of dementia in the United States). Caused by neurofibrillary plaques and tangles, which can be detected if the brain is biopsied. IBS, irritable bowel syndrome; PEG, polyethylene glycol.

Dementia

the variable(s) that is the result of the manipulation of the independent variable.

Dependent Variable

Meningococcal conjugate vaccine quadrivalent (MCV4)

Depends: For ADULTS, give ONE to TWO doses (at least "2" MONTHS apart) First-year COLLEGE students through age "21" YEARS who will be living in residence halls (give ONE dose) DORMS.

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "allergy meds"

Diphenhydramine (Benadryl) is the most sedating antihistamine. Avoid antihistamines, if possible. Claritin less likely to cause sedation.

What is required when restraints are used?

Documentation of the exact reason or rationale for the restraint order, and charting of safety checks of the restraints.

Parkinson's is caused by a decrease in what neurotransmitter

Dopamine

Special considerations in geriatrics "Elder abuse" signs

Elder Abuse Presence of bruising, skin tears, lacerations, and fractures that are poorly explained. Presence of sexually transmitted disease, vaginal, and/or rectal bleeding, bruises on breasts are indicators of possible sexual abuse. Malnutrition, poor hygiene, and pressure ulcers. Screen for abuse and financial exploitation.

Atypical Presentation in Elderly "Bacterial PNA"

Fever and chills may be missing or mild. Coughing may not be a prominent symptom. The cough may be mild and produce little to no sputum (especially if the patient is dehydrated). May stop eating and drinking water and start and weak with loss of appetite. May become incontinent of bladder and bowel. Tachycardia usually present. Increases the risk of falls. The WBC count may be normal or mildly elevated. Streptococccal pneumonia causes the most deaths from pneumonia in the elderly.

The duty to be faithful

Fidelity

What are the preferred antibiotics for DRSP for CAP?

Flouroquinolones High dose amox

Having a assistant who is aware of voiding cues and helps with toileting activities

Functional Incontinence

What is the most common side effect of the Digoxin overdose

G.I. affects such as nausea and abdominal discomfort

An elevation in what lab value is sensitive to possible alcoholism

GGT

Classic presentation of carpal tunnel syndrome

Gradual onset of numbness and tingling to the thumb and fingers

What is peak expiratory flow based on

Height Age Gender (HAG)

A new development in the exam is questions about genetic symbols. The symbol for a healthy male is an empty square; for a diseased/affected male, it is a filled square. The symbol for a healthy female is an empty circle; for a diseased/affected female, it is a filled circle. A diagonal dash across a symbol means that the person is dead.

Human Genetic Symbols

What is assault?

Intentional act by a person that creates an apprehension in another of imminent or harmful or offensive contact (causes fear)

Mortality Statistics

Leading cause of death (all ages/genders): ■ HEART disease (or diseases of the heart) ■ CANCER (or malignant neoplasms) ■ Chronic LUNG diseases (or chronic lower respiratory diseases)

document that contains the patient's instructions and preferences regarding health care if the patient becomes seriously ill or is dying. It contains the patient's preferences (or not) for aggressive life-support measures. Health care providers should have a copy of the document in the patient's chart.

Living Will

Signs/sympts of secondary syphilis

Maculopapular rash on the palms and soles

How much does the patient pay for physician services under Medicare?

Medicare pays 80% Patient pays 20%

What labs would make you suspect fatty liver disease

Mild elevation of ALT & AST that is not associated with alcohol, medications, drugs, or hepatitis in an overweight to obese patient

Classic Case Typical patient is an older to elderly adult who complains of bone pain with generalized weakness. The bone pain is usually located on the chest and/or the back and usually does not occur at night. The majority have anemia (73%).

Multiple Myeloma Myeloma is a cancer of the bone marrow that affects the plasma cells of the immune system (production of monoclonal immunoglobulins). The racial background with the highest incidence are people of African descent (doubled or tripled compared with Whites). Multiple myeloma is a cancer found mostly in older adults. Classic Case Typical patient is an older to elderly adult who complains of bone pain with generalized weakness. The bone pain is usually located on the chest and/or the back and usually does not occur at night. The majority have anemia (73%). Management Baseline labs include CBC, FBOT, chemistry panel, and urinalysis. Refer to hematologist

What ethical principle A new nurse practitioner (NP) is told to suture a laceration on a patient's face. The NP tells the physician that she has not been trained to suture facial area lacerations and therefore is unable to do it.

Nonmaleficence

What ethical principle The obligation to avoid harm. Protecting a patient from harm.

Nonmaleficence

What ethical principle? The NP discusses a new anticancer drug that may be more effective in treating a patient's cancer. The NP discusses the known risk versus the benefits of the new drug. The patient declines the treatment

Nonmaleficence

COPD Exacerbations

Oral Steroids for Exacerbations • Shorten recovery time • Improve lung function (FEV1) and arterial hypoxemia (PaO2) • Reduce the risk of early relapse, treatment failure, and length of hospital stay • A dose of 40 mg prednisone per day for 5 days is recommended

Inhaled corticosteroids side effects (4)

Oral thrush, HPA axis suppression, glaucoma, cataracts

What are the symptoms of trigeminal neuralgia

Pain on one side of the face or cheek that is precipitated by talking, chewing, cold food, or cold air

A measure of the interdependence of two random variables that range in value from -1 to +1

Perfect correlation

Abnormal vision problems -caused by stiffening of the lens of the eye (not as flexible).

Presbyopia It makes it harder to focus on close objects (such as reading). Reading glasses or prescription glasses are used to "correct" vision.

How may illnesses be diagnosed in Chinese culture?

Pulses and texture of the tongue

"problem" is identified (diabetic complications such as peripheral neuropathy, retinopathy, etc.). Then outcome measures are identified (such as an A1c of less than 6.5 %, etc.).

Quality improvement programs Be familiar about what a good outcome is for a disease (for diabetics, a good outcome is A1c less than 6.5%) and what a poor outcome is (A1c greater than 8%).

Type of research study design.. Systematic gathering of data. The study's data are measurable and numerical. Data are evaluated by using statistical methods. Quantitative research is deductive.

Quantitative

What labs would be abnormal in patients with RA

Sed rate: elevated Cbc: mild microcytic or normocytic anemia RF: positive

What drugs are used for abortive treatment for migraine headaches

Sumatripan (Imitrex)

T/F: a person with LTBI does not have active disease but is contagiousn

T

The standards of advanced practice are defined by who?

The ANA (American nurses Association)

What is utilitarianism?

The right act is the one that produces the greatest good for the greatest number

True/False: During pregnancy, folic-acid requirements increase twofold to fourfold

True

Why may MMR vaccine not show immunity?

Vaccination gives lower antibody than infection

What is Genu valgum And Genu varum

Valgum- knock knees Varum- bowlegs

The degree to which a variable measures what is intended to be measured

Validity

A characteristic, an object, or an event that is being measured.

Variable

What ethical principle ? The duty to present information honestly and truthfully.

Veracity

Visual aids

Visual Aids Prescription eye glasses. Adequate light? Magnifying glass and electronic magnifiers. Large-print watches, books, or telephones with large keys. Computer magnifiers: digital magnification of text and objects (special software). Talking watches or alarm clocks

What is patient safety and quality improvement Act? (PSQIA)

Voluntary reporting system to enhance the data available to assess and resolve patient safety and health care issues

Services that are not billed under physician services?

Wellness PE

What is "tail" insurance or "tail coverage"?

When an NP with claims-based malpractice insurance retires or changes to a new job, it is advisable to buy "tail" coverage insurance. The tail coverage insurance will cover the NP for malpractice claims that may be filed against him or her in the future.

List the HIPPA protected information

Written medical records, conversations about care, computer records, billing information

Chinese view health as a result of what?

Yin (cold) and Yang (hot)

What encompasses the required education, licensure and certification to practice as a nurse practitioner?

Your credentials

According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a 42 y/o male with no comorbidity, no reported drug allergy, and no recent antimicrobial use? a. azithromycin b. cefpodoxime c. trimethoprim-sulfamethoxazole d.ciprofloxacin

a. azithromycin

secondary prevention measures for a 78 y/o man with COPD include: a. screening for mood d/o b. administering influenza vaccine c. obtaining a serum theophylline level d. advising about appropriate use of car passenger restraints

a. screening for mood d/o

which of the following is consistent with the NAEPP comment on the use of inhaled corticosteroids (ICS) for a child with asthma? a. the potential but small risk of delayed growth with ICS is well balanced by their effectiveness b. ICS should be used only if leukotriene modifiers fail to control asthma c. permanent growth stunting is consistently noted in children using ICS d. leukotriene modifiers are equal in therapeutic effect to the use of a long-acting beta2-agonist

a. the potential but small risk of delayed growth with ICS is well balanced by their effectiveness

Essential tremor is classified as an

an action or an intentional tremor (postural tremor). It is not curable, but the symptoms can be controlled by treatment with beta-blockers. Treatment Plan Propranolol 60 to 320 mg per day. Long-acting propranolol (Inderal LA) is also effective but it provides the same response as "regular" propranolol. Alternative treatment is primidone 50 to 1,000 mg per day.

Identify the following organisms as a gram +, gram -, or a atypical pathogen: -Legionella species

atypical

Identify the following organisms as a gram +, gram -, or a atypical pathogen: -chlamydophila pneumoniae

atypical

Identify the following organisms as a gram +, gram -, or a atypical pathogen: -mycoplasma pneumoniae

atypical

Maria is a 28 y/o healthy woman who is 6 weeks pregnant. her routine prenatal lab testing reveals she is not immune to varicella. she voices her intent to breastfeed her infant for at least 6 months. which of the following represents the best advise for Maria? a. she should receive VZV vaccine once she is in her second trimester of pregnancy b. Maria should be advised to receive two doses of VZV vaccine after giving birth c. once Maria is no longer breastfeeding, she should receive one dose of VZV vaccine d. a dose of VZIG should be administered now

b. Maria should be advised to receive two doses of VZV vaccine after giving birth

for which of the following pts should an NP order varicella antibody titers? a. 14 y/o with an uncertain immunization hx b. a healthcare worker who reports having had varicella as a child c. a 22 y/o woman who received two varicella immunizations 6 weeks apart d. a 72 y/o with shinles

b. a healthcare worker who reports having had varicella as a child

you see Harold, a 25 y/o man who recently had multiple sexual encounters without condom use with a male partner who has chronic hepatitis B. Harold provides documentation of receiving a properly times hepatitis B immunization series. in addition to counseling about safer sexual practices, you also advise that Harold: a. needs to repeat his hepatitis B immunization series b. receive a single dose of HBV vaccine c. be tested for hepatitis B surface antibody (HBsAb) d. should receive hepatitis B immune globulin (HBIG) and a single dose of hepatitis B immunization series

b. receive a single dose of HBV vaccine

You examine Jane, a 24 y/o female who has an acute asthma flare following a 3 day hx of UPR sxs (clear nasal discharge, dry cough, no fever). She has a hx of moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PEF). She is using budesonide (Pulmicort) and albuterol as directed and continues to have difficulty with coughing and wheezing. At home her PEF is 55% of personal best. In the office, her forced expiratory volume at 1 sec (FEV1) is 65% of predicted. Her medication regime should be adjusted to include: a. theophylline b. salmeterol (Serevent) c. prednisone d. montelukast (Singulair)

c. prednisone

risk factors for death resulting from pneumonia include: a. viral origin b. hx of allergic rx to multiple antimicrobials c. renal insufficiency d. polycythemia

c. renal insufficiency

a 44 y/o man has a long-standing hx of moderate persistent asthma that is normally well controlled by fluticasone with salmeterol (Advair) via metered-dose inhaler, one puff bid, nad the use of albuterol 1-2 times a week prn for wheezing. Three days ago, he developed a sorethroat, clear nasal discharge, body aches, and a dry cough. In the past 24 hrs, he has had intermittent wheezing that necessitated the use of albuterol, two puffs every 3 hrs, which produced partial relief. Your next most appropriate action is to obtain a: a. chest x-ray b. measurement of oxygen saturation (SaO2) c. spirometry measurement d. sputum smear for WBCs

c. spirometry measurement

_____________ and _____________, both are potent cytochrome P450 3A4 inhibitors, concomitantly with select calcium channel blockers have been associated with an increased risk for profound hypotension.

clarithromycin or erythromycin

What is cohort research?

compares a particular outcome (lung cancer) in groups who are alike but different by a certain characteristic (female nurses who smoke compared with those that don't)

CURB-65 allocates one point for each of the following five criteria: . confusion BUN greater than _______ respiratory rate > _______ blood pressure < _______ _______years of age and older

confusion BUN greater than 19 respiratory rate > 30 blood pressure < 90/60 65 years of age and older

identify whether the item has the characteristics of 23-valent pneumococcal polysaccharide vaccine (PPSV23) or 13-valent pneumococcal conjugate vaccine (PCV13) d. not licensed for use in children younger than 2 yrs of age

d. PPSV23

which of the following statements is correct about the varicella vaccine? a. it contains killed varicella-zoster virus b. the use of the vaccine is associated with an increase in reported cases of shingles c. varicella vaccine should be offered to adults who were US born prior to 1980 and report a childhood hx of chickenpox d. although highly protective against invasive varicella disease, mild cases of chickenpox have been reported in immunized individuals

d. although highly protective against invasive varicella disease, mild cases of chickenpox have been reported in immunized individuals

when a critical portion of a community is immunized against a contagious disease, most members of the community, even the unimmunized, are protected against that disease because thee is little opportunity for an outbreak. this is know as __________ immunity a. passive b. humoral c. epidemiologic d. community

d. community

the patient you are evaluating is having a severe asthma flare. You have assessed that his condition is appropriate for office tx. You expect to find the following on physical examination: a. tripod posture b. inspiratory crackles c. increased vocal fremitus d. hyperresonance on thoracic percussion

d. hyperresonance on thoracic percussion

when advising a pt about injectable influenza immunization, the NP considers the following about the use of this vaccine: a. its use is not recommended in sickle cell anemia b. its use is limited to children older than 2 yrs c. its use is limited due to containing live virus d. its use is recommended for virtually all members of the population

d. its use is recommended for virtually all members of the population

risk factors for development of infection reactivation in patients with latent TB infection include all of the following EXCEPT: a. diabetes mellitus b. immunocompromise c. long-term oral corticosteroid therapy d. male gender

d. male gender

According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a: 47 y/o female who was recently tx within the past 2 months with a beta-lactam for acute bacterial sinusitis? a. amoxicillin-clavulanate b. high-dose amoxicillin c. clarithromycin d. moxifloxacin

d. moxifloxacin

usual txment for an adult with acute hepatitis A includes: a. interferon-alfa therapy b. high-dose ribavirin c. parenteral acyclovir d. supportive care

d. supportive care

which of the following is true about the MMR vaccine? a. it contains inactivated virus b. its use is contraindicated in pts with a hx of egg allergy c. revaccination of an immune person is associated with risk of significant systemic allergic reaction d. two doses at least 1 month apart are recommended for young adults who have not been previously immunized

d. two doses at least 1 month apart are recommended for young adults who have not been previously immunized

risk factors for infection with DRSP include all of the following EXCEPT: a. systemic antimicrobial therapy in the previous 3 months b. exposure to children in day care c. age older than 65 years d. use of inhaled corticosteroids

d. use of inhaled corticosteroids

94. Is it more likely that mental status will potentially return to pre-illness baseline with delirium or dementia?

delirium

91. Is insidious onset over months to years is more likely associated with delirium or dementia?

dementia

95. In a person with no perceptual disturbances (i.e. hallucinations) until later disease most likely experiencing delirium or dementia?

dementia

in the past, a hx of egg allergy was considered a contraindication to receiving MMR vaccine, however now it is considered safe in people with egg allergy, however, pts with a hx of anaphylactic reaction to

neomycin or gelatin should not receive MMR

When considering the diagnosis of acute stroke,which of the following can be part of the presentation? (Answer yes or no.) partial loss of visual field unilateral hearing loss facial muscle paralysis vertigo diplopia headache ataxia

partial loss of visual field- YES unilateral hearing loss- YES facial muscle paralysis- YES vertigo- YES diplopia- YES headache-YES ataxia- YES

What are usual clinical symptoms for a pt w/ __________ • Cough (> 90%) • Sputum production (purulent) • Fever (> 80%) • Chills (> 40-50%) • SOB (≥ 24 bpm) • Pleuritic chest pain (> 30%) • Increased RR + HR (most sensitive sign in older patients) • Leukocytosis: 15-30,000/mm3 What are usual clinical symptoms in a patient who has pneumonia?

pneumonia

Ipratropium bromide (Atrovent) is a _________________ agent indicated for the treatment of moderate or severe asthma exacerbations to provide additional bronchodilation to albuterol. What disorder is it used primarily for?

short-acting muscarinic (anticholinergic) COPD

WHAT RACE view pain as INTOLERANT whereas all else view pain as a PART OF LIFE

white pp

Does this patient have a reactive TST? a 45 y/o female from a country in which TB is endemic who has an 11mm induration

yes

Indicate (yes or no)if each of the following is eligible for Medicare A 67-year old man with multiple comorbidities and high income

yes

Sensitivity

■ These screening tests detect individuals who HAVE the disease. ■ Highly sensitive tests have HIGHER risk of "FALSE positives." ■ For example, the HIV ELISA has a 99% sensitivity for HIV antibodies, but it is TOO SENSITIVE and can be "FALSE positive" (especially in LOW-risks populations). ■ The next step is the WESTERN BLOT test, which is very SPECIFIC for HIV (the CONFIRMATORY test).

Describe a pterygium

A yellow triangular wedge shaped thickening of the conjunctiva that extends to the cornea on the nasal or the Temporel cornea. Usually asymptomatic

Drug treatment options for a patient with bipolar disorder often include all of the following except: A. Atomoxetine (Strattera) B. Lithium carbonate C. Risperidone (Risperdal) D. Valproic acid (Depakote)

A. Atomoxetine (Strattera)

Which of the following agents should be avoided in Harvey alcohol users due to a potential risk for hepatotoxicity? A. Duloxetine B. Desvenlafaxine C. Escitalopram D. Bupropion

A. Duloxetine

The time to highest blood concentration (Cmax) of epinephrine is shorter when the medication is given: A. Intramuscularly in the vastus lateralis B. Subcutaneously in the abdominal wall C. Intramuscularly in the deltoid D. Intramuscularly in the gluteus

A. Intramuscularly in the vastus lateralis

Your priority in caring for Tom, the aforementioned patient, is to: A. Administer a rapidly acting oral antihistamine B. Administer parenteral epinephrine C. Initiate vasopressor therapy D. Administer a parenteral systemic corticosteroid

B. Administer parenteral epinephrine

A 44-year-old man who admits to drinking "a few beers now and then" presents for examination. After obtaining a health history and performing a physical examination, you suspect he is a heavy alcohol user. Your next best action is to: A. Obtain liver enzymes B. Administer the CAGE questionnaire C. Confront the patient with your observations D. Advise him about the hazards of excessive alcohol use.

B. Administer the CAGE questionnaire

Risk factors for lumbar radiculopathy include all of the following except: A. Male gender B. Age <50 years C. Overweight D. Cigarette smoking

B. Age <50 years

Diagnostic criteria for generalized anxiety disorder include all of the following except: A. Difficulty concentrating B. Consistent early morning awakening C. Apprehension D. Irritability

B. Consistent early morning awakening

During an office visit, a 38-year-old woman states, "I drink way too much but do not know what to do to stop." According to Prochaska's change framework, her statement is most consistent with a person at the stage of: A. Precontemplation B. Contemplation C. Preparation D. Action

B. Contemplation

The preferred screening test for osteoporosis is: A. Quantitative ultrasound measurement B. Dual-energy x-ray absorptiometry C. Qualitative CT D. Wrist, spine, and hip radiographs

B. Dual-energy x-ray absorptiometry

One month into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a: A. Schilling test B. Hemoglobin measurement C. Reticulocyte count D. Serum cobalamin

B. Hemoglobin measurement

High doses or prolonged use of kava kava has been associated with cases of: A. Renal impairment B. Hepatotoxicity C. Iron-deficiency anemia D. Hyperthyroidism

B. Hepatotoxicity

When considering characteristics of the domestic violence perpetrator, one of the best predictors of a subsequent homicide of victims of domestic violence is which of the following? A. History of perpetrator striking victim on the face with an open hand B. History of perpetrator attempting to strangle the victim C. Perpetrator's access to kitchen knives D. Alcohol abuse history in the victim

B. History of perpetrator attempting to strangle the victim

First-line treatment of SLE in a patient with mild symptoms is: A. Systemic corticosteroids B. Hydroxychloroquine plus NSAIDS C. Anakinra D. Methotrexate

B. Hydroxychloroquine plus NSAIDS

When assessing a person with acute opioid withdrawal, you expect to find: A. Constipation B. Hypertension C. Hypothermia D. Somnolence

B. Hypertension

Pernicious anemia is usually caused by: A. Dietary deficiency of vitamin B12 B. Lack of production of intrinsic factor by the gastric mucosa C. RBC enzyme deficiency D. A combination of micronutrient deficiencies caused by malabsorption

B. Lack of production of intrinsic factor by the gastric mucosa

Which form of urinary incontinence is most common in elderly persons? A. Stress B. Urge C. Iatrogenic D. Overflow

B. Urge

What is the first line drug for treating osteoporosis

Bisphosphonates (fosamax, actobel)

What herbs are commonly used for improving menstrual/menopausal symptoms?

Black Cohosh Evening Primrose

Signs and symptoms of cauda equina

Bladder incontinence bladder incontinence, saddle anesthesia Refer to the ED

Antiepileptic drugs useful for preventing migraine headaches include all of the following except: A. divalproex. B. valproate. C. lamotrigine. D. topiramate.

C. lamotrigine.

Which of the following is most consistent with findings in patients with Parkinson disease? A. rigid posture with poor muscle tone B. masklike facies and continued cognitive function C. tremor at rest and bradykinesia D. excessive arm swinging with ambulation and flexed posture

C. tremor at rest and bradykinesia

Classic Case Most patients with colorectal cancer present with abdominal pain and a change in bowel habits with hematochezia or melena. The patient may report anorexia and unintentional weight loss. Iron-deficiency anemia is present in a few cases (11%). Management Baseline labs include:

Colon Cancer Also known as colorectal cancer. It is the second most common cause of cancer deaths in the United States. It is staged using the TNM staging system (Stage I to Stage IIIC). Risk factor: Advancing age (most common), inflammatory bowel disease, or a family history of colorectal cancer, colonic polyps. Lifestyle risk factors: Lack of regular physical activity, high-fat diet, low-fiber diet, obesity, and so on. Screening: Start at age 50 years with baseline colonoscopy (every 10 years), sigmoidoscopy (every 5 years), or a high-sensitivity fecal occult blood test (annually). CBC, FBOT, chemistry panel, and urine. Check occult fecal blood in stool (guaiac-based, stool DNA, others).

Results of a nerve conduction study in a person with carpal tunnel syndrome (CTS) would reveal: A. Erratic nerve impulses during forearm muscle contraction B. A lack of nerve impulses in the carpal tunnel C. Continued firing of the median nerve while the forearm muscles are at rest D. A slowing of nerve impulses in the carpal tunnel

D. A slowing of nerve impulses in the carpal tunnel

All of the following are risk factors for relapse except: A. Current episode lasts more than 2 years B. onset of depression occurs at younger than 20 years of age C. Poor recovery between episodes D. Absence of dysthymia preceding the episode

D. Absence of dysthymia preceding the episode

Patients with urethral stricture often report urine loss: A. With exercise B. During the day C. Associated with urgency D. As dribbling after voiding

D. As dribbling after voiding

The most common site for cervical radiculopathy is: A. C3 to C4 B. C4 to C5 C. C5 to C6 D. C6 to C7

D. C6 to C7

Appropriate antimicrobial treatment for a 65-year-old man with acute bacterial prostatitis is: A. Erythromycin B. Cefepime C. TMP-SMX D. Ciprofloxacin

D. Ciprofloxacin

Which of the following is not a component of the CAGE questionnaire? A. Have you ever felt you should cut down on your drinking? B. Have you been annoyed by people criticizing your drinking? C. Have you ever felt guilty about your drinking? D. Have you ever engaged in a violent act while drinking?

D. Have you ever engaged in a violent act while drinking?

Which of the following is true regarding panic disorder and agoraphobia? A. More men than women experience panic disorder without agoraphobia B. More women than men experience panic disorder without agoraphobia C. More men than women experience panic disorder with agoraphobia D. More women than men experience panic disorder with agoraphobia

D. More women than men experience panic disorder with agoraphobia

Evidence supports the use of all of the following vitamins and supplements for migraine prevention except: A. butterbur. B. riboflavin. C. feverfew. D. ginkgo biloba

D. ginkgo biloba

A 19-year-old college sophomore has documented meningococcal meningitis. You speak to the school health officers about the risk to the other students on campus. You inform them that: A. the patient does not have a contagious disease. B. all students are at significant risk regardless of their degree of contact with the infected person. C. only intimate partners are at risk. D. individuals with household-type or more intimate contact are considered to be at risk

D. individuals with household-type or more intimate contact are considered to be at risk

Macrolides (erythromycin, azithromycin [Zithromax, Zmax], clarithromycin [Biaxin]) and tetracyclines (tetracycline, minocycline [Minocin], doxycycline) do not exhibit activity against __________.

DRSP

Leading Causes of Death in ADOLESCENTS

Death rate for teen MALES is HIGHER than for females. ■ ACCIDENTS/INJURIES(48%). The most COMMON cause is CAR accidents. ■ Homicide (13%). ■ Suicide (11%). Watch teens for signs of DEPRESSION, excess STRESS, and SUICIDAL behavior. OPEN COMMUNICATION between the adolescent and the parents/caretakers (or persons they trust) is extremely important in preventing teenage suicide. ■ Unintentional injuries (ACCIDENTS) are the LEADING cause of death in the United States for persons aged 1 to 19 years.

Complications Alzheimer's death due to? common cause?

Death usually due to an overwhelming infection such as pneumonia and sepsis. Hip fractures are also a common cause of death (from complications).

Indicates a patient is able to make personal decisions about his or her care, implying the ability to understand, reason, and differentiate good and bad, and communicate

Decisional capability, or competence

Atypical Presentation in Elderly "Acute abdomen"

Elderly patients may have more subtle symptoms such as the absence of abdominal guarding and other signs of acute abdomen. The abdominal pain may be milder. The WBC count may be only slightly elevated. Patient will have anorexia and weakness.

Benefits of credentialing?

Establish minimum performance level Ensure public safety Comply with federal/state laws Acknowledges the scope of practice Mandates accountability Enforces professional standards

If a smoker or a patient with COPD has pneumonia, what is the likely pathogen

H. Influenzae

Major cause of death in elderly? >60 y.o.

Heart disease CVA COPD Pneumonia/Flu Lung/colorectal cancer

LABAs must be paired with____________ concerning asthma control.

ICS

Asthma controllers consist of what types of medications? (3)

Inhaled corticosteroids (ICS) Leukotriene modifiers (LTM) Inhaled corticosteroids combined with long-acting beta2-agonist (ICS/LABA).

Classic Case An older male smoker (or ex-smoker) presents with a new onset of cough that is productive of large amounts of thin mucoid phlegm (bronchorrhea). Some patients have blood-tinged phlegm. The patient complains of worsening shortness of breath or dyspnea. Some will report persistent and dull achy chest pain that does not go away. If the tumor is obstructing a bronchus, it can result in recurrent pneumonia of the same lobe. Some may have weight loss. Mgmt? Gold Standard Diagnostic?

Lung Cancer * The cancer with the highest mortality for older adults (both genders). Lung cancer is also the most common cancer in the world. Most patients with lung cancer are older adults. The 5-year survival rate for lung cancer is low (16%) compared with colon cancer (65%). Most common risk factor: Smoking (causes 90% of cases), history of radiation therapy. Most common type of lung cancer: Small cell (80%) and non-small cell (90%) carcinoma. Screening: There is no screening test for lung cancer Management Order chest radiograph (nodules, lesions with irregular borders). The next imaging exam is a computed tomography (CT) scan. Gold standard is a positive lung biopsy. Baseline labs include the CBC, FOBT, chemistry panel, and urinalysis. Refer patient to a pulmonologist for bronchoscopy and tumor biopsy.

Emancipated Minor Criteria

Minors Any person who is under 18 years of age. Emancipated Minor Criteria Legal court document declaring that the minor is an "emancipated minor." Active duty in the U.S. military. Legally binding marriage (or divorced from a legally binding marriage).

What is an antibody?

Molecules synthesized in reaction to an antigen

Sensorineural hearing loss

Perforation of the tympanic membrane. Sensorineural Hearing Loss Involves the inner ear (cochlear hair cells and vestibulocochlear nerve). Examples Presbycusis (or age-related hearing loss) is a type of sensorineural hearing loss. Most common cause of hearing loss in the world. Progressive and symmetric (both ears) hearing loss. High-frequency hearing lost first (e.g., human speech).

Plan for vision

Perform visual exam. Check distance vision using the Snellen chart. Check near vision by asking patient to read a paragraph from a book or magazine. Eye problems are more common in older adults (glaucoma, diabetic or hypertensive retinopathy, macular degeneration). Older adults should have an eye exam at least once a year. Older diabetics usually get eye exams twice a year. .

__________: Labs - Swab for culture, PCR - antibodies by ELISA - Elevated WBCs and marked lymphocytosis up to 80% in WBC diff - CXR: Negative (if +, d/t secondary bacterial infection).

Pertussis

What is Title 1 of HIPAA?

Protects health insurance coverage for workers when they change jobs--offering COBRA

What is the most common bacteria that causes pneumonia and patient with cystic fibrosis

Pseudomonas aeruginosa

What is used to treat psoriasis

Psoralens (tar derived topicals), antimetabolite (methotrexate)

[CLASSIC PRESENTATION] Sudden onset dyspnea & coughing with thick pink-tinged frothy sputum, tachycardia, pallor, feelings of impending doom

Pulmonary Emboli

"Skin" considerations in geriatrics Soft wart-like skin lesions that appear "pasted on." Mostly seen on the back/trunk. Benign.

Seborrheic Keratoses

____________Asthma FEV1/PEF <60%, symptoms most of day. SABA, high dose ICS, LABA, oral steroid daily

Severe Persistent Asthma FEV1/PEF <60%, symptoms most of day. SABA, high dose ICS, LABA, oral steroid daily (required)

___________Also known as the "α" or a "p-value." It is the probability that the study results are due to chance. The p value is usually set at either p <.05 or p <.0.1

Significance level:

When to Suspect DRSP (drug resistant Strept pneumo) if:

Suspect DRSP (drug resistant Strept pneumo) if: • Age > 65 years • Beta-lactam, macrolide, or respiratory quinolone therapy in the 3 months • Alcoholism • Medical co-morbids • Immunosuppressive illness or therapy • Exposure to child in daycare

___________ contains "the goals, values and ethical precepts that direct the profession of nursing." According to the ANA, the Code "is nonnegotiable." Each nurse "has an obligation to uphold and adhere to the code of ethics."

The ANA Code of Ethics for Nurses with Interpretive Statements (2001)

T/F: The use of expectorants and inhaler medications are not recommended for routine use in patients with acute bronchitis.

True

Bacterial pathogens implicated in causing acute bronchitis include all of the following EXCEPT: a. S. pneumoniae b. M. pneumoniae c. C. pneumoniae d. B. pertussis

a. S. pneumoniae

risks associated with chronic hepatitis B include all of the following except: a. hepatocellular carcinoma b. cirrhosis c. continued infectivity d. systemic hypertension

d. systemic hypertension

Highest risk (of fatal pneumococcal infection)

■ Highest risk (of fatal pneumococcal infection): - CHRONIC diseases (alcoholism, diabetes, CSF leaks, asthma, chronic hepatitis). - Anatomic or functional ASPLENIA (including sickle cell disease). - IMMUNOCOMPROMISED or on medications causing immunocompromised state. - Generalized MALIGNANCY or CANCERS of the blood (leukemia, lymphoma, multiple myeloma). - RENAL diseases (i.e., chronic renal failure, nephrotic syndrome). - HISTORY of organ or bone marrow TRANSPLANT.

Male cancer

■ PROSTATE cancer

What is the "concern" with Herbal agents that start with "G"? Which ones?

"INCREASED" Bleeding Ginger Ginseng Gingko Garlic

Sundowning

"Sundowning" Seen in both delirium and dementia. Starting at dusk/sundown, the patient becomes very agitated, confused, and combative. Symptoms resolve in the morning. Seen more with dementia. Recurs commonly. Treatment Plan Avoid quiet and dark rooms. Well-lighted room with a radio, TV, or clock. Familiar surroundings important. Do not move furniture or change decor. Avoid drugs that affect cognition (antihistamines, sedatives, hypnotics, narcotics).

Delirium

(Acute Confusional State) A reversible process that is temporary. Acute and dramatic onset. Duration is usually brief (hours to days). May be excitable, irritable, and combative. Short attention span, memory loss, and disorientation. Secondary to medical condition, drug, intoxication, adverse reaction to medicine. Etiology Polypharmacy (drug-drug interactions, adverse reaction). Abrupt drug withdrawal (alcohol, benzodiazepines, drugs). Preexisting medical conditions, intensive care unit patients. Infections (UTIs and pneumonia most common infections), sepsis. GI distress (constipation, diarrhea). Treatment Plan Remove and/or treat illness, infection, or metabolic derangement and delirium will resolve.

SECONDARY Prevention

(EARLY DETECTION of a Disease to Minimize Bodily Damage) ■ SCREENING tests (Pap smears, mammograms, CBC for anemia, etc.). ■ SCREENING for depression (interviewing a patient about feelings of sadness, hopelessness). ■ SCREENING for sexually transmitted infections (STIs; sexual history, partners, signs and symptoms). ■ SCREENING for alcohol abuse (interview a patient using the CAGE questionnaire).

PRIMARY Prevention

(PREVENTION of Disease/Injury) ■ INDIVIDUAL ACTION (healthy individuals): Eat a nutritious diet, exercise, use seatbelts, helmets. ■ GUN SAFETY: Safety locks for guns, keep guns out of reach of children/teens. ■ National programs: IMMUNIZATIONS, OSHA job safety LAWS, EPA environmental laws. ■ Other: Building a YOUTH CENTER in an urban high-crime area, Habitat for Humanity (shelter).

Abnormal vision problems -Consistently leaves foods/drinks untouched on one area of the food tray

(hemianopsia).

Abnormal vision problems -Reports that light poles and wall edges appear bent or crooked

(hemianopsia, retinal pathology).

Abnormal vision problems -Complains of acute onset of floaters with blurred vision

(retinal detachment; refer to ED).

Abnormal vision problems -Tilts head slightly to the side and scans when reading street signs

(visual field defect).

Zoster vaccine (Zostavax): Contraindications

- PREGNANCY and BREASTFEEDING. - Leukemia, lymphomas, or other MALIGNANCIES of the BONE/bone MARROW. - IMMUNOCOMPROMISED (high-dosed steroids greater than 2 weeks, anti-TNF meds such as etanercept).

Certain patient characteristics increase the likelihood of death from pneumonia and should alert the NP to consider hospitalization and aggressive therapy. These include (3)

-Age older than 65 years - severe electrolyte [serum sodium < than 130 mEq/L] -hematological [HCT <30% or absolute neutrophil count of <1000/mm3]

To qualify to be a medicare provider an NP must provide 3 documents:

1. A state license as an NP 2. Certification by a certifying body 3. An MSN or above degree

What are reportable acts to police? (2)

1. Criminal acts, 2. Injury from a dangerous weapon

Concern with St. John's Wort? Which meds should not be used with it?

1. Increased clotting and cataract formation 2. Not for use with SSRI, OCP

IDSA and ATS 2007 Guidelines for Treatment of Pneumonia Summary of Treatment Options:

1. Macrolide or doxy for most patients If DRSP is suspected: 2. Resp quinolone 3. Beta lactam (PCN or Ceph) plus macrolide or doxy

Prescribing Strategy for COPD (4)

1. Short acting anticholinergic PRN or SA Beta2 PRN, then 2. Long acting anticholinergic or LABA; plus rescue med, then 3. ICS + LABA or LA anticholinergic; plus rescue med, then 4. ICS + LABA and/or LA anticholinergic; plus rescue med

Reduction of impairment is achieved by the prevention of symptoms, & use of a short-acting beta2-agonist limited to ____ or fewer days/week

2

When considering depression and thoughts about death, rank the following from the most common (1) to the least common (3): Having suicidal thoughts

2

When do you start Pap smears

21 then x3 years until 65

What is the starting dose of Synthroid

25 mcg

When considering depression and thoughts about death, rank the following from the most common (1) to the least common (3): Making a plan to commit suicide

3

the onset of action for a SAMA is _____ min and the duration ____ hrs

30 min and the duration is 4-6 hrs

classification of severity of airflow limitation in COPD based on post-bronchodilator FEV1 (in pts with FEV1/FVC<0.70: GOLD II is Severe at __________%<=FEV1<______% predicted

30%<=FEV1<50% predicted

What is the treatment for H. pylori positive ulcers

3x therapy: Clarithromycin BID + Amox BID + PPI BID 4x therapy: Bismuth QID + Metronidazole QID + Tetracycline QID + PPI DAILY

What patient is most likely to harbor an atypical pathogen? 1. A 19 year old type 1 diabetic 2. A 27 year old with asthma, recent sinus infection treated with amox/clav 3. A 39 year old smoker of 1 PPD 4. A 48 year old who has teenagers in the household

4. A 48 year old who has teenagers in the household

What characteristic best distinguishes asthma from COPD? 1. Severity of shortness of breath 2. Need for rescue medicine 3. Use of steroids for exacerbations 4. Presence of inflammation

4. Presence of inflammation

PCV13 or Prevnar 13 is a pneumococcal conjugate vaccine that is approved for adults ____ years and older and protects against 13 serotypes.

50

What's the youngest age a flu vaccine can be given

6 months

What should the weight of a baby be at six months? 12 months?

6 mos- doubled birth weight 12- tripled birth weight

At what age is the shingles vaccine given

60

Moderate Persistent Asthma FEV1/PEF ________%, symptoms ___________ Treatment (3)

60-80%, daily SABA, daily moderate dose ICS, or low dose ICS and LABA

Pneumovax is a 23-valent polysaccharide vaccine that protects against 23 pneumococcal serotypes and is recommended for adults ______ years and older, as well as younger adults at high risk for disease.

65

What is the recommended dose for chronic use of aspirin

81 mg a day

NPs are reimbursed at what % of physician reimbursement under Medicare part B?

85%

Youngest age that Gardasil can be given

9

The goal of therapy is to ensure adequate oxygen delivery to the vital organs by increasing the baseline PaO2 at rest to 60 mm Hg or greater at sea level, or producing SaO2 equal to or greater than ____%, or both.

90

Describe the symptoms of a cataract

A gradual onset of decreased night vision, sensitivity to car lights, hazy vision and the disappearance of the red reflex on exam

Consent Versus Assent

A minor (who is not emancipated) as young as the age of 7 years up to age 17 years can give assent to participate in a research study, but cannot give consent legally. The parent or legal guardian must first consent to the minor's participation in the study. In addition, the researcher needs parental permission to speak with the minor in order to obtain assent (the child signs a separate assent form).

Consent Versus Assent

A minor (who is not emancipated) as young as the age of 7 years up to age 17 years can give assent to participate in a research study, but cannot give consent legally. The parent or legal guardian must first consent to the minor's participation in the study. In addition, the researcher needs parental permission to speak with the minor in order to obtain assent (the child signs a separate assent form).

What out-of-pocket expenses to patients pay in Medicare part D?

A monthly premium plus a co-pay with each medication ordered

Belmont Report

A paper that outlines the important ethical principles that should be followed when doing research involving human subjects. It was issued by a national commission of experts in the United States in 1978.

It bands form in a blood sample what does this indicate

A serious infection

What is cross sectional research?

A study that looks at a population with a similar attribute except one specific variable (age for example)

Describe a pinguecula

A yellow triangular thickening of the bulbar conjunctiva, which is the skin covering the eyeball. Located on the inner and outer margins of the cornea

During asymptomatic HSV-2 infection, genital shedding of the virus occurs during approximately ___________ of days. A. 10% B. 25% C. 50% D. 100%

A. 10%

Which of the following patients with acute gouty arthritis is the best candidate for local corticosteroid injection? A. A 66-year-old patient with gastric ulcer B. A 44-year-old patient taking a thiazide diuretic C. A 68-year-old patient with type 2 diabetes mellitus D. A 32-year-old patient who is a binge drinker

A. A 66-year-old patient with gastric ulcer

The best diagnostic test to identify the offending organism in acute bacterial prostatitis is: A. A urine culture B. A urethral culture C. Antibody testing D. A urine Gram stain

A. A urine culture

107. Potential noncognitive reasons for behavioral issues observed in older adults include all of the following except: A. ADHD B. pain C. infection D. depression

A. ADHD

First-line pharmacological intervention for milder OA should be a trial of: A. Acetaminophen B. Tramadol C. Celecoxib D. Intraarticular corticosteroid injection

A. Acetaminophen

5-HT2

A. Agitation, anxiety, panic

Benzodiazepines taken concomitantly with which of the following can lead to enhanced sedation and increased risk of death? A. Alcohol B. Acetaminophen C. Ibuprofen D. Statins

A. Alcohol

Which of the following medications can contribute to the development of acute urinary retention in an older man with BPH? A. Amitriptyline B. Loratadine C. Enalapril D. Lorazepam

A. Amitriptyline avoid 1st generation antihistamines and tricyclic antidepressants (anticholinergic effect)

One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is: A. An increase in RBC distribution width (RDW) B. A reduction in measurable hemoglobin C. A low MCH level D. An increased platelet count

A. An increase in RBC distribution width (RDW)

Taking a high dose of aspirin or ibuprofen causes: A. An increase in the drug's half-life B. Enhanced renal excretion of the drug C. A change in the drug's mechanism of action D. A reduction of antiprostaglandin effect

A. An increase in the drug's half-life

During a pre-participation sports examination, you hear a grade 2/6 early- to mid-systolic ejection murmur, heard best at the second intercostal space of the left sternal border, in an asymptomatic young adult. The murmur disappears with position change from supine to stand position change. This most likely represents: A. An innocent flow murmur B. Mitral valve incompetency C. Aortic regurgitation D. Mitral valve prolapse (MVP)

A. An innocent flow murmur

Sequelae of genital human papillomavirus (HPV) infection in a man can include: A. Anorectal carcinoma B. Low sperm count C. Paraphimosis D. Reiter syndrome

A. Anorectal carcinoma

Creatinine clearance usually: A. Approximates the glomerular filtration rate (GFR) B. Does not change as part of normative aging C. Is greater in women compared with men D. Increases with hypotension

A. Approximates the glomerular filtration rate (GFR)

Long-term bisphosphonate treatment (i.e., >5 years) has been associated with: A. Atypical fractures B. Hyperprolactinemia C. Osteoarthritis D. Bone marrow suppression

A. Atypical fractures

A. Boggy During acute bacterial prostatitis, the digital rectal examination usually reveals a gland described as: A. Boggy B. Smooth C. Irregular D. Cystic

A. Boggy

SSRI withdrawal syndrome is best characterized as: A. Bothersome but not life-threatening B. Potentially life-threatening C. Most often seen with discontinuation of agents with a long half-life D. Associated with seizure risk

A. Bothersome but not life-threatening

A 64-year-old woman presents with urge incontinence and has not been able to tolerate treatment with anticholinergic agents. You recommend the use of which of the following? More than one can apply A. Botulinum toxin injections B. Fesoterodine fumarate (Toviaz) C. Mirabegron (Myrbetriq) D. Finasteride (Proscar)

A. Botulinum toxin injections and C. Mirabegron (Myrbetriq)

You see a 28-year-old man who has been diagnosed with moderate depression and has not responded well to SSRI therapy over the past 3 months. He was involved in a motor vehicle accident 2 years ago that resulted in head trauma an now occasionally experiences occasional tonic clonic seizures. When considering alternative antidepressant therapy, which of the following should be avoided? A. Bupropion B. Trazodone C. Citalopram D. Duloxetine

A. Bupropion

First-line therapy for prepatellar bursitis should include: A. Bursal aspiration B. Intrabursal corticosteroid injection C. Acetaminophen D. Knee splinting

A. Bursal aspiration

You see a 48-year-old woman who reports low back pain. During the evaluation, she mentions new-onset loss of bowel and bladder control. This most likely indicates: A. Cauda equina syndrome B. Muscular spasm C. Vertebral fracture D. Sciatic nerve entrapment

A. Cauda equine syndrome

Which of the following is recommended by the Centers for Disease Control and Prevention as single-dose therapy for uncomplicated urethritis caused by N. gonorrhoeae when an oral product is the most appropriate option? A. Cefixime B. Metronidazole C. Azithromycin D. Amoxicillin

A. Cefixime

The preferred treatment for uncomplicated gonococcal proctitis is: A. Ceftriaxone 250 mg IM as a single dose plus a single dose of azithromycin 1 g po B. Oral erythromycin 500 mg bid for 7 days C. Oral norfloxacin 400 mg bid with metronidazole 500 mg bid for 3 days D. Azithromycin 1 g po as a single dose plus single dose of injectable doxycycline 100 mg.

A. Ceftriaxone 250 mg IM as a single dose plus a single dose of azithromycin 1 g po

When ordering laboratory tests to confirm chancroid, the NP considers that: A. Concomitant infection with herpes simplex is often found B. A disease-specific serum test is available C. A white blood cell count with differential is indicated D. Dark-field examination is needed

A. Concomitant infection with herpes simplex is often found

Factors that contributed to urge incontinence include: A. Detrusor overactivity B. Pelvic floor weakness C. Urethral stricture D. UTI

A. Detrusor overactivity

Which of the following special examinations should be periodically obtained during hydroxychloroquine sulfate use? A. Dilated eye retinal examination B. Bone marrow biopsy C. Pulmonary function tests D. Exercise tolerance test

A. Dilated eye retinal examination

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for substance use tolerance includes: A. Diminished effect with the same amount of substance used B. Desiring to get an amplified effect with higher doses C. Ability to decrease the frequency of substance use D. Absence of withdrawal symptoms when substance is not used for a prolonged period.

A. Diminished effect with the same amount of substance used

Which of the following is a reasonable treatment option for a 30-year-old man with acute epididymitis who presents without gastrointestinal upset and will be treated as an outpatient? A. Doxycycline with ceftriaxone B. Amoxicillin with clavulanate C. Metronidazole with linezolid D. Clindamycin with cefixime

A. Doxycycline with ceftriaxone

5. During a routine assessment of a 73 year old man with back pain, he reveals that he has become increasingly concerned about the physical changes related to aging. He misses the ability to do physical and recreational activities that he once enjoyed. He feels that this realization has made him "cranky," which his children have mentioned to him on several occasions. You realize that this patient may be having difficulty accepting the inevitability of physical decline and death as described by: A. Erickson. B. Peck C. Butler. D. Levinson

A. Erickson

Which is most consistent with the diagnosis of COPD? A. FEV1 /FVC ratio equal to or less than 0.70 after properly timed SABA use B. dyspnea on exhalation C. elevated diaphragms noted on x-ray D. polycythemia noted on complete blood cell count

A. FEV1 /FVC ratio equal to or less than 0.70 after properly timed SABA use

A 23-year-old woman presents with mild mitral stenosis and is without symptoms. Which of the following is correct concerning sports participation? A. Full activity is likely acceptable B. Prolonged aerobic exercise is discouraged C. An ACE inhibitor should be prescribed prior to participation D. Sports participation should be limited to noncontact sports

A. Full activity is likely acceptable

A 19-year-old man presents with Stage 1 hypertension. Which of the following statements is correct concerning sports participation? A. Full activity should be encouraged B. Weight lifting is contraindicated C. An exercise tolerance test is advisable D. A beta-adrenergic antagonist should be prescribed

A. Full activity should be encouraged

Which of the following is representative of the presentation of secondary syphilis? A. Generalized rash B. Chancre C. Pupillary alterations D. Aortic regurgitation

A. Generalized rash

John is a 47-year-old man who reports constant sadness following the death of his wife in a motor vehicle accident 2 weeks ago. He has not been able to function at work and avoids socializing with friends and family. You recommend: A. Giving him time and support during this period of acute grief B. Weekly psychotherapy sessions C. Prescribing an anxiolytic to help with grief symptoms D. Psychotherapy plus a prescription for an antidepressant

A. Giving him time and support during this period of acute grief

The most common causative organisms in chronic bacterial prostatitis include: A. Gram-negative rods B. Gram-positive cocci C. Gram-negative cocci D. Gram-positive coccobacilli

A. Gram-negative rods

12. Decline in the sense of smell is an age related change in the senses reported by the older adult. It is known as: A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

A. Hyposmia

Patients with gluteus medius or deep trochanteric bursitis typically present with: A. Increased pain from resisted hip abduction B. Limited hip ROM C. Sciatic nerve pain D. Heat over the affected area

A. Increased pain with resisted hip abduction

Hemorrhagic cystitis is characterized by: A. Irritative voiding symptoms B. Persistent microscopic hematuria C. The presence of hypertension D. Elevated creatinine and BUN levels

A. Irritative voiding symptoms

Which of the following characteristics about atrial septic defect is false? A. It is more common in boys than in girls B. Child presentation can range from entirely well to heart failure C. Full sports participation is typically acceptable with correction D. Easy fatigability is a sign of atrial septic defect

A. It is more common in boys than girls

Which of the following statements is false regarding the use of omalizumab (Xolair)? A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares. B. The medication selectively binds to IgE to reduce exacerbations. C. Labeled indication is for patients with poorly controlled asthma with frequent exacerbations. D. Special evaluation is required prior to its use and ongoing monitoring is needed during use.

A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares.

Which of the following statements is false regarding the use of omalizumab (Xolair)? A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares. B. The medication selectively binds to IgE to reduce exacerbations. C. Labeled indication is for patients with poorly controlled asthma with frequent exacerbations. D. Special evaluation is required prior to its use and ongoing monitoring is needed during use.

A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares.

Early neurological changes in patients with lumbar radiculopathy include: A. Loss of deep tendon reflexes B. Poor two-point discrimination C. Reduced muscle strength D. Footdrop

A. Loss of deep tendon reflexes

According to DSM-5, a diagnosis of depression must include either depressed mood or which of the following? A. Loss of interest or pleasure B. Recurrent thoughts of death C. Feelings of worthlessness D. Weight change (either increase or decrease)

A. Loss of interest or pleasure

The drug buspirone (BuSpar) has: A. Low abuse potential B. Significant antidepressant action C. A withdrawal syndrome when discontinued, similar to benzodiazepines D. Rapid onset of action

A. Low abuse potential

Second-line drug intervention in the presence of anaphylaxis should be: A. Oral diphenhydramine B. Nebulized albuterol C. Nebulized epinephrine D. Oral prednisone

A. Oral diphenhydramine

Which of the following statements concerning panic disorder is false? A. Panic disorder rarely occurs with depression B. Up to 4% of the general population suffers from panic disorder C. New onset panic disorder rarely occurs after 45 years of age D. family history of panic disorder is a risk factor for the condition

A. Panic disorder rarely occurs with depression

First-line treatment options for primary syphilis include: A. Penicillin B. Ciprofloxacin C. Erythromycin D. Ceftriaxone

A. Penicillin

Which of the following is found early in the development of chronic renal failure? A. Persistent proteinuria B. Elevated creatinine level C. Acute uremia D. Hyperkalemia

A. Persistent proteinuria

Long-term use of which medication has been possibly associated with increased risk for bladder cancer? A. Pioglitazone B. Saxagliptin C. rosuvastatin D. Clopidogrel

A. Pioglitazone

When assessing a 78-year-old man with suspected BPH, the NP considers that: A. Prostate size does not correlate well with severity of symptoms B. BPH affects less than 50% of men of this age C. He is at increased risk for prostate cancer D. Limiting fluids is a helpful method of relieving severe symptoms

A. Prostate size does not correlate well with severity of symptoms

Clinical conditions with a presentation similar to acute bursitis include: (More than one option can apply.) A. Rheumatoid arthritis B. Septic arthritis C. Joint trauma D. Pseudogout

A. Rheumatoid arthritis B. Septic arthritis C. Joint trauma D. Pseudogout

In gonococcal infection, which of the following statements is true? A. Risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act B. Most men have symptomatic infection C. The incubation period is about 2 to 3 weeks D. The organism rarely produces beta-lactamase

A. Risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act

3. Which of the following is most commonly reported as the largest single source of income for elderly people? A. Social Security B. public/private pension earnings C asset income D. family financial support

A. Social Security

Which test is demonstrated when the examiner applies pressure to the top of the head with the neck bending forward, producing pain or numbness in the upper extremities? A. Spurling B. McMurray C. Lachman D. Newman

A. Spurling

To confirm the results of a McMurray test, you ask the patient to: A. Squat B. Walk C. Flex the knee D. Rotate the ankle

A. Squat

Recommended exercises for patients with OA of the knee include all of the following except: A. Squatting with light weights B. Straight-leg raises without weights C. Quadriceps sets D. Limited weight-bearing aerobic exercises

A. Squatting with light weights

Concomitant use of an SSRI with which of the following herbal products can potentially lead to serotonin syndrome? A. St. John's wort B. Kava kava C. Gingko biloba D. Valerian root

A. St. John's wort

One week into sertraline (Zoloft) therapy, a patient complains of a new onset recurrent dull frontal headache that is relieved promptly with acetaminophen. Which of the following is true in this situation? A. This is common, transient side effect of selective serotonin reuptake inhibitor (SSRI) therapy B. She should discontinue the medication C. Fluoxetine should be substituted D. Desipramine should be added

A. This is common, transient side effect of selective serotonin reuptake inhibitor (SSRI) therapy

Which of the following is most likely to be part of the clinical presentation of an otherwise healthy 27-year-old woman with uncomplicated lower urinary tract infection (UTI)? A. Urinary frequency B. Fever C. Supra public tenderness D. Lower gastrointestinal (GI) upset

A. Urinary frequency

Common physical findings of SLE include all of the following except: A. Weight gain B. Joint pain and swelling C. Fatigue D. Facial rash

A. Weight gain

Patients with stress incontinence often report urine loss: A. With lifting B. At night C. Associated with a strong sensation of needing to void D. As dribbling after voiding

A. With lifting

Which of the following is least likely to be reported by patients with CTS? A. Worst symptoms during the day B. Burning sensation in the affected hand C. Tingling pain that radiates to the forearm D. Nocturnal numbness

A. Worst symptoms during the day

The cause of multiple sclerosis is best described as: A. a destructive process of the nerve fiber protecting myelin. B. an intracranial viral infection. C. inflammation of the brain and/or spinal cord. D. an autoimmune disorder that destroys muscle fibers

A. a destructive process of the nerve fiber protecting myelin.

24. A person with cerumen impaction experiences: A. a general diminution of hearing B. unhampered ability in hearing low-pitched sounds C. pain when exposed to high-pitched sounds D. an ability to hear but cannot understand a conversation in a noisy environment

A. a general diminution of hearing

36. When dosing warfarin in older adults it is important to consider: A. a lower dose is needed due to lower serum albumin B. a lower dose is needed due to higher serum albumin C. a higher dose is needed due to lower serum albumin D. a higher dose is needed due to lower serum albumin

A. a lower dose is needed due to lower serum albumin

Which of the following signs and symptoms most likely suggests meningitis caused by N. meningitidis? A. a purpura or a petechial rash B. absence of fever C. development of encephalitis D. absence of nuchal rigidity

A. a purpura or a petechial rash

Among the following beta blockers, which is the least effective in preventing migraine headache? A. acebutolol B. metoprolol C. atenolol D. propranolol

A. acebutolol

18. Part C Match the Medicare part with it's appropriate benefit. A. allows beneficiaries to enroll in a private plan as an alternative to the traditional fee-for-service plan B. covers inpatient and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, nurse practitioner, outpatient, home health, and preventive services.

A. allows beneficiaries to enroll in a private plan as an alternative to the traditional fee-for-service plan

66. A 68 year old man is taking multiple medications for various chronic conditions. Discontinuing or finding an alternative for which of the following medications will have the greatest impact in decreasing the potential for fall risk? A. amitriptyline B. sitagliptin C. atorvastatin D. aspirin

A. amitriptyline

Which of the following best describes patient presentation during an absence (petit mal) seizure? A. blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness B. awake state with abnormal motor behavior lasting seconds C. rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness D. abrupt muscle contraction with autonomic signs

A. blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness

35. In an older adult with advanced impaired renal function, the clinician anticipates that there is usually no need to adjust the antimicrobial dose with the use of: A. ceftriaxone B. tobramycin C. levofloxacin D. vancomycin

A. ceftriaxone

The diagnosis of Parkinson disease relies on findings of: A. clinical evaluation of six cardinal features. B. head MRI or CT scan. C. pleocytosis in the CSF. D. a visual evoked potential test

A. clinical evaluation of six cardinal features.

9. Match Cross-link theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

A. collagen molecules bind to each other to produce stiffness and rigidity

Of the following, which is the least likely bacterial source to cause meningitis? A. colonization of the skin B. colonization of the nose and throat C. extension of acute otitis media D. extension of bacterial rhinosinusitis

A. colonization of the skin

Which of the following statements about ergotamines is false? A. extrapyramidal movement risk. B. act as 5-HT1A and 5-HT1D receptor agonists C. have potential vasoconstrictor effect D. should be avoided in the presence of coronary artery disease

A. extrapyramidal movement risk.

110. Define Agnosia A. failure to recognize objects despite intact sensory function B. language disturbance C. impairment of motor activities despite intact motor function.

A. failure to recognize objects despite intact sensory function

29. When prescribing a diuretic, the NP considers that the older adult: A. has diminished ability to conserve sodium B. has increased ability to excrete potassium C. has continued response to a thiazide despite increasing creatinine D. often develops allergic reaction to these products

A. has diminished ability to conserve sodium

A 45-year-old man who presents with a sudden, abrupt headache. Upon questioning, he appears somewhat confused with decreased alertness to his surroundings. What is the appropriate course of action? A. head CT scan B. head MRI C. neither

A. head CT scan

Indicators that a headache can be the presenting symptom of a serious illness and may require neuroimaging include all of the following except: A. headaches that occur periodically in clusters. B. increasing frequency and severity of headaches. C. headache causing confusion, dizziness, and/or lack of coordination. D. headache causing awakening from sleep.

A. headaches that occur periodically in clusters.

99. Which of the following electrolyte disorders is commonly associated with delirium A. hyponatremia B. hypernatremia C. hyperkalemia D. hypophosphatemia

A. hyponatremia

77. Poorly controlled diabetes mellitus is a potential cause of reversible urinary incontinence primarily caused by which of the following mechanisms? A. increased urinary volume B. increased UTI risk C. irritating effect of increased glucose in the urine D. decreased ability to perceive need to void

A. increased urinary volume

Treatment options in MS to attenuate disease progression include: A. interferon beta-1b. B. methylprednisolone. C. ribavirin. D. phenytoin.

A. interferon beta-1b

When caring for a patient with a recent TIA, you consider that: A. long-term antiplatelet therapy is likely indicated. B. this person has a relatively low risk of future stroke. C. women present with this disorder more often than men. D. rehabilitation will be needed to minimize the effects of the resulting neurological insult

A. long-term antiplatelet therapy is likely indicated

28. Anticipated age-related changes that can result in less drug effect include: A. loss of beta-2 receptor sites B. lower gastrointestinal (GI) pH. C. increased renin-angiotensin production D. increased GI motility.

A. loss of beta-2 receptor sites

86. In older adults, heart failure can be precipitated by: A. mild hypothyroidism B. hyperparathyroidism C. mild hyperkalemia D. mild hyponatremia

A. mild hypothyroidism

When evaluating a patient with acute headache, all ofthe following observations would indicate the absence of a more serious underlying condition except: A. onset of headache with exertion, coughing, or sneezing. B. history of previous identical headache. C. supple neck. D. normal neurological examination results.

A. onset of headache with exertion, coughing, or sneezing.

Risk factors for bacterial meningitis include all of thefollowing except: A. over 25 years of age. B. living in a community setting. C. cigarette smoker. D. use of immunosuppressant drugs

A. over 25 years of age.

Risk factors for cluster headaches include all of the following except: A. over 65 years of age. B. heavy alcohol use. C. heavy tobacco use. D. male gender.

A. over 65 years of age

43. The study of biochemical and physiological effects of drugs on the body or disease is called: A. phamacodynamics B. pharmacokinetics C. biotrasformation D. bioavailability

A. phamacodynamics

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD guidelines, which of the following medications is indicated for use in all COPD stages? A. short-acting inhaled beta2-agonist B. inhaled corticosteroid C. long-acting anticholinergic D. long-acting beta2-agonist

A. short-acting inhaled beta2-agonist

111. The use of antipsychotic medications in older adults is associated with an increased risk for: A. stroke and cardiovascular events B. hypoglycemia C. delirium D. hypertension

A. stroke and cardiovascular events

Therapeutic interventions for Mrs. Lewis should include: A. systemic corticosteroid therapy. B. addition of an angiotensin-converting enzyme inhibitor (ACEI) to her antihypertensive regimen. C. warfarin therapy. D. initiation of topiramate (Topamax) therapy.

A. systemic corticosteroid therapy.

27. When evaluating serum creatinine in an elderly adult, the clinician considers that: A. this value is influenced by glomerular filtration rate B. age-related physiological changes do not influence this laboratory value C. male and female norms are equivalent D. an increase is an expected age-related change.

A. this value is influenced by glomerular filtration rate

Medications with narrow therapeutic indexes (NTIs)include all of the following except: A. topiramate. B. phenytoin. C. carbamazepine. D. valproate

A. topiramate

WHAT RACE - be close (w/in touching distance when speaking to them - eldest kids make decisions - pastor/religion esp at end of life - health = gift from god - cod liver old for colds; copper/silver bracelets for protection - not into preventive health or homeopathics - voodoo - jamaican male highest prostate ca rate

AA

What is done if a patient has a tetanus-prone wound and vaccination STATUS is UNKNOWN?

ADMINISTER immediate dose of TD vaccine and the TETANUS IMMUNOGLOBULIN (TIG) injection.

HYSTERectomy with removal of the CERVIX

AGAINST ROUTINE SCREENING (if NO past HISTORY of high-grade preCANCER or CANCER of the cervix).

Safety Issues

AVOID giving to PREGNANT patients; patients with IMMUNOSUPPRESSION or on drugs that affect the IMMUNE system (steroids, BIOLOGICS such as HUMIRA for autoimmune diseases to DECREASE INFLAMMATION, Enbrel); patients having RADIATION treatment or with any type of CANCER.

A pulsatile abdominal mass is felt, what do you order

Abdominal ultrasound and CT

Is lateralization on the weber test normal or abnormal

Abnormal

What are the signs and symptoms of paroxysmal atrial tachycardia

Abrupt onset of palpitations and lightheadedness shortness of breath and anxiety HR of 150-250 EKG- tachycardia with Peaked QRS complexes and P waves present

The law was passed by the U.S. Congress and enacted in August, 1996. The law provides protections for: "the use and disclosure of individuals' health information"—called "protected health information" by organizations subject to the Privacy Rule—called "covered entities."

Accountability Act (HIPAA) * Also known as the "HIPAA Privacy Rule"

AK

Actinic Keratosis (Precursor of Squamous Cell Carcinoma) Small rough pink to reddish lesions that do not heal. Located in sun-exposed areas such as the cheeks, nose, back of neck, arms, chest, and so on. More common in light-skinned individuals. Squamous cell precancer skin lesions. Diagnostic method of choice is biopsy. Small number of lesions can be treated with cryo. Larger numbers with wider distribution treated with 5-fluorouracil cream.

CLASSIC CASE & FINDINGS: Cough mainly dry, productive later with small amount of sputum, frequent paroxysms of coughing, low grade fever, mild wheezing, chest pain with cough, headache Lungs: from clear to severe wheezing Percussion: resonant Chest x-ray: Normal Afebrile to low-grade fever

Acute Bronchitis

S/S of? - "Acute onset" - High fever, chills - Cough, large amount of "green - rust-colored" sputum - Pleuritic chest pain w/ cough - Crackles, decreased breath sounds, dull - CBC: leukocytosis; elevated neutrophils, bands form ("shift to the left") - CXR: "Lobar infiltrates"

Acute CAP (#1 Strept pneumoniae): S/S

Acute Closure Glaucoma

Acute Closure Glaucoma Older adult with acute onset of severe eye pain, severe headache, and nausea and vomiting. The eye(s) is reddened with profuse tearing. Complains of blurred vision and halos around lights. Call 911. Do not delay treatment. Tonometry is done in the emergency room to quickly measure the intra-ocular pressure.

Atypical Presentation in Elderly "Acute MI"

Acute Myocardial Infarction May be asymptomatic. Symptoms may consist of back pain or mild chest pain.

What information is needed to calculate peak expiratory flow (PEF)

Age Gender Height

Notes: Cervical Cancer

Age 21 YEARS or younger: AGAINST ROUTINE screening (cervical cancer rare BEFORE age 21 years). Note: These recommendations do NOT apply to women who are IMMUNOCOMPROMISED (i.e., HIV infection), had in-utero exposure to diethylstilbestrol (DES), or have a diagnosis of high-grade preCANCERous cervical lesion or cervical CANCER.*

Notes: BREAST Cancer

Age 40 to 49 YEARS (individualize based on risk factors, BIENNIAL schedule if done). The American Cancer Society recommends STARTING ROUTINE screening at age 40 YEARS*

Treatment for acute prostatitis

Age <35: Treat with ceftriaxone IM and doxycycline 100 mg for 10 days (Treat like a gonococcal infection) Age >35: Treat with ciprofloxacin twice a day OR Levaquin for 4 to 6 weeks

What is a normal rinne test

Air conduction that is twice as long as bone conduction

Elevated during the teenage years due to rapid growth spurt's

Alkaline phosphate

- Rare condition - Severe lung damage at earlier ages - Check if pt is young w/ S/S of COPD - protects lung from oxidative environmental damage

Alpha-1 trypsin deficiency

Classic case of ______________ Mild (from 2 to 4 years): Getting lost on familiar routes. Problems managing personal finances and money. Forgets important dates. Repeats same questions. Poor judgment. Becomes withdrawn, anxious, and/or depressed. Easily upset. Moderate (from 2 to 10 years): Wanders and gets lost. Problems with speech and following instructions. Stops paying bills. May start a conversation and forget to complete sentences. Loses ability to read and write. Problems recognizing familiar people (agnosia). Severe/Stage 3 (from 1 to 3 years): Needs total care. Unable to feed self. Incontinent of bowel and bladder. Stops walking. Uses wheelchair or bedridden. Incoherent or mute. Apathetic.

Alzheimer's

Accumulation of neurofibrillary plaques/tangles cause permanent damage to brain. The median survival time after diagnosis is 10 years. Three As: aphasia, apraxia, agnosia. - Aphasia (difficulty verbalizing). - Apraxia (difficulty with gross motor movements such as walking). - Agnosia (inability to recognize familiar people or objects).

Alzheimer's Disease

Ototoxic meds

Aminoglycosides (e.g., gentamycin, vancomycin) Aspirin/salicylic acid Furosemide Some chemotherapeutic drugs

They do not participate in Medicare or Social Security. The community pays for health care. Traditional roles for women. Prefer large families with several children. Prefer giving birth (using midwives) and dying at home.

Amish/Mennonites They do not participate in Medicare or Social Security. The community pays for health care. Traditional roles for women. Prefer large families with several children. Prefer giving birth (using midwives) and dying at home.

How can you treat protracted problematic cough in acute bronchitis? (3)

Anticholinergic bronchodilator (i.e atriovent/ipatropium bromide) Inhaled beta agonist (albuterol) Prednisone 40mg po daily 3-5 days

Any health care provider, health insurance company, health care plans, and third-party administrators (TPAs) who "electronically transmit health information" must follow the HIPAA regulations.

Any health care provider, health insurance company, health care plans, and third-party administrators (TPAs) who "electronically transmit health information" must follow the HIPAA regulations.

Name the diastolic murmur's and where they are best heard

Aortic regurgitation - 2nd ICS Right Mitral stenosis- apex/apical

WHAT RACE - herbals (drug interactions a worry) - eye contact is a sign of disrespect. thai ppl look at floor - decisions made by elders. include in all HC decisions. - DM less prevelant; HTN bc soy sauce sodium? - lowest uninsured rate of all minorities in US - don't like to go to doc. tx LT stuff with chinese med. acute with western med. - females want female providers - don't believe in HC as first line. homeopathic. - think they need lower doses because "I'm Asian" - lowest death rate, highest life exp - chinese - yin and yang. hot and cold. treat w/opposite - philipino - yin and yang also

Asians

Atypical Presentation in Elderly

Atypical disease presentations are more common in this age group. The immune system is less robust as we age and is less likely to become stimulated by bacterial and viral infections. Vaccines in the elderly may not be as effective compared with the young because of decreased immune response (result is lower antibody production). Older adults and the elderly are more likely to be asymptomatic or to present with subtle symptoms. The elderly are less likely to have high fever during an infection. Instead, they are more likely to suffer acute cognitive dysfunction such as confusion, agitation, and delirium. One of the reasons for cognitive dysfunction may be that many have multiple comorbid conditions, resulting in many prescriptions. Polypharmacy increases the chances of adverse drugs reactions and drug-drug interactions. Examples The management of these diseases is covered in the respective organ system. For example, the management and treatment of pneumonia is in the "pulmonary" chapter.

What ethical principle ? Mentally competent adult patients have the right to make their own health decisions and express treatment preferences. If the patient is mentally incapacitated (dementia, coma), the designated surrogate's choices are respected. A patient can decline or refuse treatment.

Autonomy

What anemia has neurologic symptoms such as tingling and numbness

B 12 deficiency

Which of the following best describes the presentation of a person with RA? A. Worse symptoms in weight-bearing joints later in the day B. Symmetrical early-morning stiffness C. Sausage-shaped digits with characteristic skin lesions D. Back pain with rest and anterior uveitis

B Symmetrical early-morning stiffness

22-year-old Muslim woman is seen for a complaint of recurrent abdominal pain. The NP gives the patient a paper gown with instructions and leaves the room. When the NP returns, the patient is still clothed and refuses to undress. The nurse practitioner's best action is to: A) Ask the patient if she prefers to be seen by a male physician.. B) Tell the patient what to expect and perform a modified physical exam. C) Instruct the patient to go to the closest ED for an abdominal sonogram. D) Lecture the patient about the importance of performing an abdominal exam without clothing on the skin.

B) Tell the patient what to expect and perform a modified physical exam. b

An increase in creatinine from 1 to 2 mg/dL is typically seen with a _________ loss in renal function. A. 25% B. 50% C. 75% D. 100%

B. 50%

Approximately what percent of patients with radiological findings of osteoarthritis of the knee will report having symptoms? A. 25% B. 50% C. 70% D. 95%

B. 50%

Which of the following drugs is likely to be the most dangerous when taken in overdose? A. A 4-week supply of fluoxetine B. A 2-week supply of Nortriptyline C. A 3-week supply of venlafaxine D. A 3-day supply of diazepam

B. A 2-week supply of Nortriptyline

Demographic data indicated which of the following persons is most likely to misuse prescription medications? A. A 14-year-old male B. A 24-year-old female C. A 33-year-old male D. A 38-year-old male

B. A 24-year-old female

Which of the following is the most likely candidate to initiate dialysis due to chronic kidney disease (CKD)? A. A 46-year-old man with hypertension and GFR = 42 mL/min B. A 64-year-old woman with type 2 diabetes and GFR = 28 mL/min C. A 76-year-old man with anemia and GFR=55 mL/min D. A 58-year-old woman with heart disease and GFR=46 mL/min

B. A 64-year-old woman with type 2 diabetes and GFR = 28 mL/min

A 36-year-old afebrile woman with no health problems presents with dysuria and frequency of urination. Her urinalysis findings include results positive for nitrites and leukocytosis esterase. You evaluate these results and consider that she likely has: A. Purulent vulvovaginitis B. A gram-negative UTI C. Cystitis caused by Staphylococcus saprophyticus D. Urethral syndrome

B. A gram-negative UTI

Creatinine is best described as: A. A substance produced by the kidney B. A product related to skeletal muscle metabolism C. Produced by the liver and filtered by the kidney D. A by-product of protein metabolism

B. A product related to skeletal muscle metabolism

The Tinel test is best described as: A. Reproduction of symptoms with forced flexion of the wrists B. Abnormal tingling when the median nerve is tapped C. Pain on internal rotation D. Palmar atrophy

B. Abnormal tingling when the median nerve is tapped

The most effective strategy for preventing renal stones is: A. Daily exercise B. Adequate hydration C. Limiting coffee consumption D. Smoking cessation

B. Adequate hydration

A risk factor for sarcoidosis is: A. Male gender B. African American race C. Age older than 60 years D. Type 2 diabetes mellitus

B. African American race

You examine a 47-yer-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram: Hemoglobin (Hgb) = 15 g HCT = 45% RBC = 4.2 million mm3 MCV = 108 fL MCHC = 33.2 g/dL These values are most consistent with: A. Pernicious anemia B. Alcohol abuse C. Thalassemia minor D. Fanconi disease

B. Alcohol abuse

Which of the following statements regarding "on" and"off" periods of Parkinson disease is false? A. A person can move with relative ease during an "on" period. B. An "off" period typically occurs at the C max following levodopa dosing. C. Medication adjustment can usually minimize "off"periods. D. Surgical treatment may be needed to manage dyskinesia during "off" periods

B. An "off" period typically occurs at the C max following levodopa dosing.

You perform a digital rectal examination (DRE) on a 72-year-old man and find a lesion suspicious for prostate cancer. The findings are described as: A. A rubbery, enlarged prostatic lobe B. An area of prostatic induration C. An indurated gland D. Prostatic tenderness

B. An area of prostatic induration

A 40-year-old woman with pyelonephritis is taking two medications: ciprofloxacin and ferrous sulfate (for iron-deficiency anemia). She asks about taking both medications. You advise that: A. She should take the medications with a large glass of water B. An inactive drug compound is potentially formed if the two medications are taken together C. She can take the medications together to enhance adherence to therapy D. The ferrous sulfate potentially slows gastrointestinal motility and results in enhanced ciprofloxacin absorption

B. An inactive drug compound is potentially formed if the two medications are taken together

You examine a 57-year-old woman with rheumatoid arthritis who is on disease-modifying antirheumatic disease but continues to have poor disease control and find the following results on hemogram: Hgb = 10.5 g Hct = 33% RBC = 3.1 million mm3 MCV = 88 fL MCHC = 32.8 g/dL RDW = 12.2% Reticulocytes = 0.8% The laboratory findings are most consistent with: A. Pernicious anemia B. Anemia of chronic disease C. Beta-thalassemia minor D. Folate-deficiency anemia

B. Anemia of chronic disease

The use of which of the following medications can precipitate acute renal failure in a patient with bilateral renal artery stenosis? A. Corticosteroids B. Angiotensin II receptor antagonists C. Beta-adrenergic antagonists D. Cephalosporins

B. Angiotensin II receptor antagonist

Treatment for anorexia nervosa usually includes: A. Referral for parenteral nutrition evaluation B. Antidepressant therapy C. Use of psychostimulants D. Psychoanalysis

B. Antidepressant therapy

You see a 67-year-old woman who has been treated for pain due to OA of the hip for the past 6 months and who asks about hip replacement surgery. She complains of pain even at night when sleeping and avoids walking even moderate distances unless absolutely necessary. In counseling the patient, you mention all of the following except: A. Arthroplasty can be considered when pain is not adequately controlled B. Arthroplasty is not needed if the patient can walk even short distances C. Arthroplasty candidates must be able to tolerate a long surgical procedure D. Rehabilitation following surgery is essential to achieve maximal function of the joint

B. Arthroplasty is not needed if the patient can walk even short distances

You see a 54-year-old man complaining of low back pain and is diagnosed with acute lumbosacral strain. Which of the following is the best advice to give about exercising? A. You should not exercise until you are free of pain B. Back-strengthening exercises can cause mild muscle soreness C. Electric-like pain in response to exercise is to be expected D. Conditioning exercises should be started immediately

B. Back-strengthening exercises can cause mild muscle soreness

Deformity of the proximal interphalangeal joints found ina an elderly patient with OA is known as: A. Heberden nodes B. Bouchard nodes C. Halle's valgus D. Dupuytren contracture

B. Bouchard nodes

An adverse effect associated with the use of glucosamine is: A. Elevated ALT and AST B. Bronchospasm C. Increased bleeding risk D. QT prolongation

B. Bronchospasm

An alternative to methadone that can be used to curb opioid withdrawal symptoms is the use of: A. Gabapentin B. Buprenorphine plus naloxone C. Methylnaltrexone D. Topiramate

B. Buprenorphine plus naloxone

Symptoms commonly associated with reactive arthritis include all of the following except: A. Dactylitis B. Bursitis C. Enthesitis D. Cervicitis

B. Bursitis

The NP can consider presenting treatment options and support for change after the patient has moved into which of Prochaska's stages? A. Precontemplation B. Contemplation C. Preparation D. Action

B. Contemplation

In general, pharmacological intervention for patients with depression should: A. Be given for about 4 months on average B. Continue for a minimum of 6 months after remission is achieved C. Be continued indefinitely with a first episode of depression D. Be titrated to a lower dose after symptoms relief is achieved

B. Continue for a minimum of 6 months after remission is achieved

Pharmacological intervention in an anxiety disorder should be: A. Generally given for about 4 to 6 months B. Continued for at least 6 months after remission is achieved C. Continued indefinitely with a first diagnosis of the condition D. Titrated to a highest dose recommended after symptom relief is achieved

B. Continued for at least 6 months after remission is achieved

Which of the following is the most helpful approach in the care of a patient with alcoholism? A. Advise the patient to stop drinking in a straightforward manner B. Counsel the patient that alcohol abuse is a treatable disease C. Inform the patient of the long-term health consequences of alcohol abuse D. Refer the patient to Alcoholics Anonymous

B. Counsel the patient that alcohol abuse is a treatable disease

80. Which of the following is a true statement with regard to driving and the elderly? A. The number of elderly drivers will decrease over the next decade. B. Crashes with elderly drivers tend to involve diminished speed of visual processing C. There is a greater incidence of accidents involving right-hand turns compared with left-hand turns D. There is no evidence to suggest, if the elder's health is preserved, that the skills needed for safe driving deteriorate with age.

B. Crashes with elderly drivers tend to involve diminished speed of visual processing

Physical examination findings in patients with bulimia nervosa often include: A. Body mass index (BMI) less than 75% of anticipated B. Dental surface erosion C. Tachycardia D. Hair that is easily plucked

B. Dental surface erosion

Which of the following is most consistent with the diagnosis of generalize anxiety disorder? A. Gastrointestinal upset B. Difficulty initiating sleep C. Diminished cognitive ability D. Consistent early morning wakening

B. Difficulty initiating sleep

You see a 33-year-old man diagnosed with reactive arthritis and urethritis. You recommend antimicrobial treatment with: A. Amoxicillin B. Doxycycline C. TMP-SMX D. Nitrofurantoin

B. Doxycycline

Use of St. John's wort is known to impact the effectiveness of all of the following medications except: A. Oral contraceptive B. Fluoroquinolones C. Cyclosporine D. Select antiretrovirals

B. Fluoroquinolones

Which of the following medications is most likely to cause sexual dysfunction? A. Vilazodone (Viibryd) B. Fluoxetine (Prozac) C. Nortriptyline (Pamelor) D. Bupropion (Wellbutrin)

B. Fluoxetine (Prozac)

Risk factors for medial epicondylitis include playing: A. Tennis B. Golf C. Baseball D. Volleyball

B. Golf

The clinical presentation of acute gouty arthritis affecting the base of the great toe includes: A. Slow onset of discomfort over many days B. Greatest swelling and pain along the median aspect of the joint C. Improvement of symptoms with joint rest D. Fever

B. Greatest swelling and pain along the median aspect of the joint

In men with reactive arthritis and associated urethritis, a common finding is: A. ANA positive B. HLA-B27 positive C. RF positive D. ACPA positive

B. HLA-B27 positive

A Still murmur: A. Is an indication to restrict sports participation selectively B. Has a buzzing quality C. Is usually heard in patients who experience dizziness when exercising D. Is a sign of cardiac structural abnormality

B. Has a buzzing quality

You are examining an 18-year-old man who is seeking a sports clearance physical examination. You note a mid-systolic murmur that gets louder when he stands. This most likely represents: A. Aortic stenosis B. Hypertrophic cardiomyopathy C. A physiologic murmur D. A still murmur

B. Hypertrophic cardiomyopathy -sudden cardiac death

Appropriate antimicrobial treatment for a 25-year-old man with acute bacterial prostatitis is: A. Oral azithromycin B. IM ceftriaxone followed by oral doxycycline C. Oral ofloxacin D. Oral amoxicillin-clavulanate

B. IM ceftriaxone followed by oral doxycycline

When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that: A. These usually resolve within days with appropriate therapy B. If present for longer than 6 months, these changes are occasionally permanent C. The use of parenteral vitamin B12 therapy is needed to ensure symptom resolution D. Cognitive changes associated with vitamin b12 deficiency are seldom reversible even with appropriate therapy

B. If present for longer than 6 months, these changes are occasionally permanent

Which of the following is most consistent with the presentation of a patient with bipolar I disorder? A. Increased need for sleep B. Impulsive behavior C. Fatigue D. Anhedonia

B. Impulsive behavior

Physical examination findings in lymphogranuloma venereum include: A. Verruciform lesions B. Lesions that fuse and create multiple draining sinuses C. A painless crater D. Plaquelike lesions

B. Lesions that fuse and create multiple draining sinuses

Which of the following is most consistent with iron-deficiency anemia? A. Low mean corpuscular volume (MCV), normal mean corpuscular hemoglobin (MCH) B. Low MCV, low MCH C. Low MCV, elevated MCH D. Normal MCV, normal MCH

B. Low MCV, low MCH

Which represents the most appropriate diagnostic test for the patient in the previous question? A. complete blood cell count with white blood cell(WBC) differential B. Lyme disease antibody titer C. computed tomography (CT) scan of the head with contrast medium D. blood urea nitrogen and creatinine levels

B. Lyme disease antibody titer

The most common causative organisms of acute bacterial prostatitis in men <35 years are: A. E. coli and K. pneumoniae B. N. gonorrhoeae and C. trachomatis C. Pseudomonas and Acinetobacter species D. Enterococci

B. N. gonorrhoeae and C. trachomatis

First-line therapy for treating patients with acute gouty arthritis usually includes: A. Aspirin B. Naproxen sodium C. Allopurinol D. Probenecid

B. Naproxen sodium

You hear a fixed split second heart sound (S2) in a 28-year-old woman who wants to start an exercise program and consider that it is: A. A normal finding in a younger adult B. Occasionally found in uncorrected atrial septal defect C. The result of valvular sclerosis D. Often found in patients with right bundle branch block

B. Occasionally found in uncorrected atrial septal defect

A 68-year-old man who is usually healthy presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical examination reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows: Hgb = 7.6 g Hct = 20.5% RBC = 2.1 million mm3 MCV = 76 fL MCHC = 28 g/dL RDW = 18.4% Reticulocytes = 1.8% The most likely cause of these finding is: A. Poor nutrition B. Occult blood loss C. Malabsorption D. Chronic inflammation

B. Occult blood loss

The notation of alkaline urine in a patient with a UTI may point to infection caused by: A. Klebsiella species B. P. mirabilis C. E. coli D. S. saprophyticus

B. P. mirabilis

Which of the following is most consistent with the diagnosis of bulimia nervosa? A. Patients with bulimia nervosa usually present asking for treatment B. Periods of anorexia often occur C. Hyperkalemia often results from laxative abuse D. Most patients with bulimia nervosa are significantly obese

B. Periods of anorexia often occur

Which of the following conditions is unlikely to result in anemia of chronic disease? A. Rheumatoid arthritis B. Peripheral vascular disease C. Chronic renal insufficiency D. Osteomyelitis

B. Peripheral vascular disease

When initiating SSRI therapy for a patient with panic disorder, the NP should consider all of the following except: A. Start with a low dose and slowly escalate doses as necessary B. Preferable to use agents that are more energizing than less energizing C. Select agents with a low rate of insomnia and akathisia D. SSRI therapy can precipitate panic attacks with early use

B. Preferable to use agents that are more energizing than less energizing

11. Difficulty with appreciating the content of the conversation in a noisy environment is an age-related change in the senses reported by the older adult. It is known as: A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

B. Presbycusis

Finasteride (Proscar, Propecia) and dutasteride (Avodart) are helpful in the treatment of BPH because of their effect on: A. Bladder contractility B. Prostate size C. Activity at select bladder receptor sites D. Bladder pressure

B. Prostate size

Patient presentation possibly common to anxiety and depression includes: A. Feeling of worthlessness B. Psychomotor agitation C. Dry mouth D. Appetite disturbances

B. Psychomotor agitation

Angiotensin-converting enzyme inhibitors can limit the progression of some forms of renal disease by: A. Increasing intraglomerular pressure B. Reducing efferent arteriolar resistance C. Enhancing afferent arteriolar tone D. Increasing urinary protein excretion

B. Reducing efferent arteriolar resistance

A 54-year-old white man with not obvious risk for prostate cancer opted to undergo PSA screening and DRE testing. The DRE findings are normal and his PSA is 3.7 ng/mL. You recommend: A. Repeating the PSA test immediately B. Repeat screening in 1 year C. Repeat screening in 2 years D. Repeat screening in 5 years

B. Repeat screening in 1 year

Risk factors for mitral regurgitation include a prior diagnosis of all of the following except: A. Rheumatic heart disease B. Scarlet fever C. Endocarditis D. Calcific annulus

B. Scarlet fever

A patient with a lumbosacral strain will typically report: A. numbness in the extremities B. Stiffness, spasm and reduced ROM C. "Electric" sensation running down one or both legs D. Pain at its worst when in sitting position

B. Stiffness, spasm and reduced ROM

DSM-5 criteria for a substance use disorder include all of the following except: A. Substance use in larger amounts or over longer period than intended B. Substance overuse resulting in hospitalization C. Craving or strong desire to use D. Substance use in potentially hazardous positions

B. Substance overuse resulting in hospitalization

A 47-year-old woman with lupus erythematosus is diagnosed with acute glomerulonephritis. Treatment options include all of the following except: A. Systemic corticosteroids B. Systemic antimicrobials C. Immune suppressor D. Plasmapheresis

B. Systemic antimicrobials

The primary treatment option for sarcoidosis is the use of: A. Parenteral methotrexate B. Systemic corticosteroids C. Oral acetaminophen D. Oral hydroxychloroquine

B. Systemic corticosteroids

Which of the following medications for ED treatment has the longest half-life? A. Sildenafil (Viagra) B. Tadalafil (Cialis) C. Vardenafil (Levitra) D. Avanafil (Stendra)

B. Tadalafil (Cialis)

When prescribing erythropoietin supplementation, the NP considers that: A. The adrenal glands are its endogenous source B. The addition of micronutrient supplementation needed for erythropoiesis is advisable C. Its use is as an adjunct in treating thrombocytopenia D. With its use, the RBC life span is prolonged

B. The addition of micronutrient supplementation needed for erythropoiesis is advisable

While counseling an adolescent about the risks of marijuana use, the NP considers that: A. Symptoms of physical and psychological dependency are rarely reported by regular users B. The development of chronic obstructive airway disease is often associated with regular use C. Use on a daily basis among teens is significantly less common than that of alcohol D. Driving ability is minimally impaired with it use

B. The development of chronic obstructive airway disease is often associated with regular use

When prescribing a benzodiazepine, the NP considers that: A. The drugs are virtually interchangeable, with similar durations of action and therapeutic effect B. The onset of therapeutic effect is usually rapid C. These drugs have a low abuse potential in substance abusers D. Elderly adults will likely require doses similar to those needed by younger adults

B. The onset of therapeutic effect is usually rapid

In tension-type headache, which of the following is true? A. Photophobia is seldom reported. B. The pain is typically described as "pressing" in quality. C. The headache is usually unilateral. D. Physical activity usually makes the discomfort worse

B. The pain is typically described as "pressing" in quality.

Concerning BPH, which of the following statements is true? A. Digital rectal examination is accurate in diagnosing the condition B. The use of a validated patient symptom tool is an important part of diagnosing the condition C. Prostate size directly correlates with symptoms and bladder emptying D. Bladder distention is usually present in early disease

B. The use of a validated patient symptom tool is an important part of diagnosing the condition

You see a 42-year-old woman recently diagnosed with sarcoidosis. She is reluctant to use any first-line medications for the condition because of severe adverse effects experienced previously. You consider prescribing all of the following alternatives except: A. Hydroxychloroquine B. Tofacitinib C. Infliximab D. Azathioprine

B. Tofacitinib 1st line- corticosteroids 2nd line Hydroxychloroquine (antimalarial drug) or Azathioprine and methotrexate (immune suppressing agent) or Infliximab is a TNFI (tumor necrosis factor inhibitor)

Risk factors for renal stones include all of the following except: A. Male gender B. Vegetarian diet C. Family history of renal stones D. Obesity

B. Vegetarian diet

A 30-year-old man with prostatitis presents with a fever of 102.3 degrees F (39.1 degrees C). What would be the expected CBC findings from this patient? A. WBC = 15,000/mm3; neutrophils = 4000/mm3 B. WBC = 18,000/mm3; neutrophils = 11,500/mm3 C. WBC = 7200/mm3; neutrophils = 3200/mm3 D. WBC = 4000/mm3; neutrophils = 1200/mm3

B. WBC = 18,000/mm3; neutrophils = 11,500/mm3

Medicare is best defined as: A. an entitlement program to provide healthcare coveage for low income elderly persons. B. a publicly supported health insurance program for elderly persons and younger persons with permanent disabilities. C. a health insurance program for persons ineligible for private insurance. D. the nation's insurance program for long-term care coverage in elderly persons.

B. a publicly supported health insurance program for elderly persons and younger persons with permanent disabilities.

8. Match Programmed theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

B. a senescence factor accumulates in the cell

19. A risk factor for primary open-angle glaucoma is: A. postural hypotension B. age more than 40 years C. history of fungal conjunctivitis D. white race

B. age more than 40 years

16. A 76 year old woman is being treated for senile cataracts. The granddaughter who is accompanying the patient expresses concern that one day she may also develop cataracts. You explain that she can reduce the risk of senile cataracts by avoiding all of the following except: A. tobacco use. B. alcohol abuse C. ocular corticosteroid therapy D. sunlight exposure

B. alcohol abuse

Parkinson disease is primarily caused by: A. degradation of myelin surrounding nerve fibers. B. alteration in dopamine-containing neurons within the midbrain. C. deterioration of neurons in the brainstem. D. excessive production of acetylcholinesterase in the CSF

B. alteration in dopamine-containing neurons within the midbrain.

48.when considering pharmacological options to treat neuropathic pain in a 72 year old man, which of the following is the least appropriate option due to its anticholinergic effect? A. nortriptyline B. amitriptyline C. duloxetine D. venlafaxine

B. amitriptyline

65. With the use of insulin, fall risk in an older adult is most likely to occur _____ of the medication. A. at the onset of action B. at the peak of action C. at the middle point of duration of action D. toward the end of anticipated duration of action

B. at the peak of action

69. With the use of a benzodiazepine in an older adult, the risk of fall is most likely to occur ____ of the medication. A. at the onset of action B. at the peak of action C. at the middle point of duration of action D. toward the end of anticipated duration of action.

B. at the peak of action

An 18-year-old college freshman is brought to the student health center with a chief complaint of a 3-day history of progressive headache and intermittent fever. On physical examination, he has positive Kernig and Brudzinski signs. The most likely diagnosis is: A. viral encephalitis. B. bacterial meningitis. C. acute subarachnoid hemorrhage. D. epidural hematoma.

B. bacterial meningitis.

Mrs. Lewis is a 74-year-old woman with well-controlled hypertension. She is taking hydrochlorothiazide and presents with a 3-day history of unilateral throbbing headache with difficulty chewing because of pain. On physical examination, you find a tender, non compressible temporal artery. Blood pressure (BP) is160/88 mm Hg, apical pulse is 98 bpm, and respiratory rate is 22/min; the patient is visibly uncomfortable. The optimal technique to confirm a diagnosis of giant cell arteritis is: A. check serum ALT/AST levels. B. biopsy of temporal artery. C. CT scan of the head. D. transesophageal echocardiogram

B. biopsy of temporal artery.

98. Medications that commonly contribute to delirium include all of the following except: A. first-generation antihistamines B. cardioselective beta-adrenergic antagonists. C. opiods D. benzodiazepines.

B. cardioselective beta-adrenergic antagonists.

Dopamine or dopamine agonists used to treat Parkinson disease include all of the following except: A. levodopa. B. chlorpromazine. C. ropinirole. D. pramipexole.

B. chlorpromazine.

106. The NMDA receptor antagonist memantine works via: A. slowing the death of neurons in the brain. B. creating an environment that allows for storage and retrieval of information C. promoting more rapid transduction of nerve signals. D. a largely unknown mehanism

B. creating an environment that allows for storage and retrieval of information

34. An expected age-related change in the older adult with intact renal function is decreased muscle mass and an associated: A. increase in serum creatinine B. decreased serum creatinine C. minimal impact on serum creatinine D. increase in creatinine clearance

B. decreased serum creatinine

23. A common complaint for a person with presbycusis is: A. general diminution of hearing B. diminution of high-frequency hearing C. worsening hearing at night D. unable to hear low-pitched sounds

B. diminution of high-frequency hearing

The use of neuroleptics such as prochlorperazine (Compazine) and promethazine (Phenergan) in migraine therapy should be limited to less than three times per week because of their: A. addictive potential. B. extrapyramidal movement risk. C. ability to cause rebound headache. D. sedative effect

B. extrapyramidal movement risk.

A 48-year-old woman with a history of breast cancer who presents with 3 month history of progressively severe headache, and bulging optic disk. What is the appropriate course of action? A. head CT scan B. head MRI C. neither

B. head MRI

4. The poverty rate among elderly people residing in the United States can best be described as: A. at approximately the same level across ethnic and age groups B. highest among the old old C. greatest among married couples D. highest among older adults depending on investment income as a substantial part of their finances.

B. highest among the old old

61. Which of the following are identifiable risk factors for fall in the older adult? Choose all that apply A. negative prior history of fall B. history of a stroke C. current diagnosis of osteoporosis D. osteoarthritis of the hips

B. history of a stroke C. current diagnosis of osteoporosis D. osteoarthritis of the hips

Surgical intervention such as deep brain stimulationcan be helpful in the management of Parkinson disease-related symptoms: A. in early disease as a first-line therapy. B. in patients with advanced disease who have unstable medication responses. C. related to memory loss. D. only as a last resort when all other options have been exhausted

B. in patients with advanced disease who have unstable medication responses.

A 68-year-old man presents with new onset of headaches. He describes the pain as bilateral frontal to occipital and most severe when he arises in the morning and when coughing. He feels much better by mid-afternoon. The history is most consistent with headache caused by: A. vascular compromise. B. increased intracranial pressure (ICP) C. brain tumor. D. tension-type with atypical geriatric presentation.

B. increased intracranial pressure (ICP)

108. Define Aphasia A. failure to recognize objects despite intact sensory function B. language disturbance C. impairment of motor activities despite intact motor function.

B. language disturbance

Which of the following oral agents has the most rapid analgesic onset? A. naproxen (Naprosyn) B. liquid ibuprofen (Motrin, Advil) C. diclofenac (Voltaren) D. enteric-coated naproxen (Naproxen EC)

B. liquid ibuprofen (Motrin, Advil)

For a patient receiving standard therapy for giant cell arteritis, the use of all of the following concomitant therapies should be considered except: A. aspirin. B. nitrate. C. bisphosphonate and calcium/vitamin D. D. proton-pump inhibitor

B. nitrate.

A 48-year-old woman presents with a monthly 4-day premenstrual migraine headache, poorly responsive to triptans and analgesics, and accompanied by vasomotor symptoms (hot flashes). The clinician considers prescribing all of the following except: A. continuous monophasic oral contraceptive. B. phasic combined oral contraceptive with a 7-day-per-month withdrawal period. C. low-dose estrogen patch use during the premenstrual week. D. triptan prophylaxis

B. phasic combined oral contraceptive with a 7-day-per-month withdrawal period.

When evaluating a patient who has aseptic or viral meningitis, the NP expects to find CSF results of: A. low protein. B. predominance of lymphocytes. C. glucose at about 30% of serum levels. D. low opening pressure

B. predominance of lymphocytes.

All of the following are not typically covered by Medicare except: A. long term care services. B. preventive care. C. hearing exams and hearing aids D. routine vision care and eyeglasses

B. preventive care. FYI: Medicare is divided into four parts that each provides different healthcare benefits: * Part A (Hospital Insurance Program): Covers inpatient hospital services, skilled nursing facilities, home health, and hospital care. This is funded by a tax of 2.9% of earnings paid by employers and workers. *Part B (Supplemental Medical Insurance Program): Helps pay the outpatient, home health, and preventive services of the healthcare provider. This is funded by general revenues and beneficiary programs. *Part C (Medicare Advantage Program): Allows beneficiaries to enroll in a private plan, such as a health maintenance organization, preferred provider organization, or private fee-for-service plan. These plans receive payments from Medicare to provide Medicare-covered benefits, such as hospital and physician services. *Part D: Provides prescription drug benefits delivered through private plans that contract with Medicare. A monthly premium is typically paid by beneficiaries who enroll in these plans.

26. A general principle of drug absorption in an elderly adult is best described as: A. amount of absorption is decreased B. rate of absorption is changed C. drug absorption is altered but predictable. D. bioavailability is altered

B. rate of absorption is changed

100. Older adults are at greater risk of subdural hematoma, even with minor head trauma due to: A. lower bone density in the skull B. relatively fragile blood vessels. C. decreased adipose tissue reserves. D. age-related reduction in circulating clotting factors

B. relatively fragile blood vessels.

54. The daughter of a 76 year old woman expresses concern regarding her mother's refusal for assistance in everyday living activities. The mother lives by herself and is often found with poor hygiene and reports eating one small meal a day. She also has poor adherence to her current medication regimen. This represents an example of: A. abandonment B. self-neglect C. early-onset dementia D. psychological abuse

B. self-neglect

Headache associated with giant cell arteritis is least likely to occur in the: A. frontal area. B. temporal area. C. vertex. D. occipital area

B. temporal area.

83. When counseling an older driver, you recommend all of the following except: A. reviewing current medications for potential adverse effects. B. that having the radio on to an enjoyable talk show enhances driving skills C. predetermining the route before driving D. driving during the day and in good weather.

B. that having the radio on to an enjoyable talk show enhances driving skills

104. An 81 year old man who was recently diagnosed with Alzheimer's type dementia is accompanied by his granddaughter for an office visit. The granddaughter reports that her grandfather often acts erratic with angry outbursts that can soon be followed by a more "normal" demeanor. She reports that the grandfather recently moved in with her, and she would like for this to continue as long as possible. In counselling the granddaughter, you consider all of the following except: A. behavioral difficulties often arise in patients with AD if their usual routine is disrupted. B. treatment with a cholinesterase inhibitor will likely improve his mental status to a point similar to his pre-dementia baseline. C. a home safety evaluation should be conducted and appropriate modification performed. D. any sudden change in mental status should be reported to the healthcare provider as soon as possible.

B. treatment with a cholinesterase inhibitor will likely improve his mental status to a point similar to his pre-dementia baseline.

72. An 82 year old man presents with his caretaker who reports new-onset urinary incontinence occurring in the past 3 days. Diagnostic evaluation should include: A. PSA testing B. urine culture with susceptibility testing C. ultrasound of the bladder D. urine stream flow assessment

B. urine culture with susceptibility testing

Which of the following best describes the role of theophylline in COPD treatment? A. indicated in moderate to very severe COPD B. use limited by narrow therapeutic profile and drug-drug interaction potential C. a potent bronchodilator D. available only in parental for

B. use limited by narrow therapeutic profile and drug drug interaction potential

22. An effective method to prevent presbycusis is: A. avoid using cotton swabs in the ear canal. B. use of ear protection when exposed to loud noises. C. avoid using hearing aids for a prolonged period of time. D. regular cerumen removal

B. use of ear protection when exposed to loud noises.

105. Which of the following supplements is used to potentially slow cognitive decline in AD? A. Vitamin B-12 B. vitamin E C. ginkgo biloba D. St. John's wort

B. vitamin E

68. Which of the following is not part of the "Get Up and Go" criteria when evaluating gait and balance for a 72 year old woman who normally uses a walker? A. rising from a straight-backed chair B. walking 10 feet without the use of a walking aid C. turning around after walking 10 feet D. returning to the chair and sitting down

B. walking 10 feet without the use of a walking aid

With a COPD exacerbation, a chest x-ray should be obtained: A. routinely in all patients B. when attempting to rule out a concomitant pneumonia C. if sputum volume is increased D. when work of breathing is increased

B. when attempting to rule out a concomitant pneumonia

115. The use of physical restraints in older adults is appropriate: A. as a form of discipline B. when needed to meet a healthcare need. C. to prevent wandering outside an institution D. under no circumstances.

B. when needed to meet a healthcare need.

What does pernicious anemia result in

B12 deficiency anemia Macrocytic megaloblastic anemia Neurologic symptoms

Differential Diagnosis dementia Rule out correctable causes such as? Drugs commonly used to slow down cognitive decline in Alzheimer's disease are:

B12 deficiency, hypothyroidism, major depression, infection, adverse/drug interactions, heavy metal poisoning, others. Aricept, Namenda, Exelon, and Cerefolin (folate, B12, and acetylcysteine). There is no cure.

Bacille-Calmette-Guerin

BACILE-CALMETTE-GUERIN (BCG) is a vaccine against TUBERCULOSIS (TB) infection. BCG is made from LIVE attenuated (or weakened) tuberculosis mycobacterium. BCG vaccine is used in some countries (i.e., Asia, Africa) where TB disease is common. ■ What is the follow-up if a person with a history of BCG immunization has a positive PPD? EVALUATE the person for signs and symptoms of TB. Rule out LATENT infection. Order a CHEST X-RAY and check for signs and symptoms of TB such as a "CHRONIC COUGH, weight LOSS, and NIGHT sweats. Do NOT assume the reaction is from the BCG vaccine since the EFFECT of the vaccine DECLINES over time.

What medication is given to HIV pts as first line for prophylaxis against opportunistic infections

Bactrim

How does a Baker's cyst present

Ball like mass behind one knee that is soft and smooth, patient may be asymptomatic

And illegal, willful, angry, violent, or negligent striking of a person, his clothes, or anything with which he is in contact

Battery

A paper that outlines the important ethical principles that should be followed when doing research involving human subjects. It was issued by a national commission of experts in the United States in 1978.

Belmont Report

What is the treatment for syphilis

Benzathine PCN IM

What patients do you not want to use Ace inhibitors in

Bilateral renal stenosis - Will precipitate acute renal failure

What is Cullen's sign

Blue discoloration around umbilicus

Identify if the following characteristic is noted in anorexia nervosa, bulimia nervosa or both disorders: Hypokalemia

Both

A 42-year-old man who has a long-standing history of alcohol abuse presents for primary care. He admits to drinking 12 to 16 beers daily for 10 years. He states, "I really do not feel like the booze is a problem. I get to work every day. " Your most appropriate response is: A. "Work is usually the last thing to go in alcohol abuse." B. "Your family has suffered by your drinking." C. "I am concerned about your health and safety." D. " Participating in a support group can help you understand why you drink."

C. "I am concerned about your health and safety."

You note that a 25-year-old woman has bruises on her right shoulder. She states: "I fell up against the wall." The bruises appear finger-shaped. She denies that another person injured her. What is your best choice of statement in response to this? A. "Your bruises really look as if they were caused by someone grabbing you." B. "Was this really an accident?" C. "I notice the bruises are in the shape of a hand." D. "How did you fall?"

C. "I notice the bruises are in the shape of a hand."

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption? A. "Take with other medications." B. " Take on a full stomach." C. "Take on an empty stomach." D. "Do not take with vitamin C."

C. "Take on an empty stomach."

How much daily calcium is recommended for women older than 50 years of age? A. 800 mg B. 1000 mg C. 1200 mg D. 1500 mg

C. 1200 mg

Osteoporosis is defined as having a bone density more than ______ standard deviation(s) below average bone mass for women younger than 35 years old. A. 1 B. 1.5 C. 2.5 D. 4

C. 2.5

55. Orthostatic (postural) hypotension is defined as an excessive decrease in blood presure with position, usually greater than ____ m Hg systolic and _____ mm Hg diastolic A. 10, 5 B. 15, 7 C. 20, 10 D. 30, 15

C. 20, 10

Peak symptoms of alcohol withdrawal are usually observed how long after alcohol intake is discontinued? A. Less than 12 hours B. 12 to 24 hours C. 24 to 36 hours D. More than 36 hours

C. 24 to 36 hours

46. Under ordinary circumstances, the presence of a medication in the body is needed for how many half-lives to reach steady state? A. 0.5 to 1 B. 1 to 3 C. 3 to 5 D. 5 to 7

C. 3 to 5

47. Compared with a healthy 40 year old, CYP 450 isoenzyme levels can decrease by _____% in elderly adults after age 70. A. 10 B. 20 C. 30 D. 40

C. 30

The average American man has an approximately _____% lifetime risk of prostate cancer and an approximately _____% likelihood of clinical disease. A. 15, 5 B. 25, 8 C. 40, 10 D. 60, 15

C. 40, 10

Which of the following is most consistent with the diagnosis of dysthymia? A. A 23-year-old man with a 2-month episode of depressed mood after a job loss B. A 45-year-old woman with "jitteriness" and difficulty initiating sleep for the past 6 months C. A 38-year-old woman with fatigue and anhedonia for the past 2 years D. A 15-year-old boy with a school adjustment problem and weekend marijuana use for the past year

C. A 38-year-old woman with fatigue and anhedonia for the past 2 years

In reference to reactive arthritis (also known as Reiter syndrome), which of the following statements is false? A. When the disease is associated with urethritis, the male:female ratio is about 9:1 B. When the disease is associated with infectious diarrhea, the male and female incidences are approximately equal C. ANA analysis reveals a speckled pattern D. Results of joint aspirate culture are usually unremarkable

C. ANA analysis reveals a speckled patterrn

The American Academy of Orthopaedic Surgeons (AAOS) favors all of the following in the management of symptomatic OA of the knee except: A. Low-impact aerobic exercises B. Weight loss for those with a BMI > or = 25 kg/m2 C. Acupuncture D. Strengthening exerises

C. Acupuncture

You see a 37-year-old man with rheumatoid arthritis who has been treated with hydroxychloroquine and oral NSAIDS for the past 3 months with little improvement in symptoms. Radiography indicates slight progression of RA in several major joints. You recommend: A. Maintaining the current regimen B. Increasing the dose of NSAIDS C. Adding methotrexate to his regimen D. Switching from hydroxychloroquine to a biological agent

C. Adding methotrexate to his regimen

116. When considering end-of-life decisions, which of the following statements is false? A. Advanced directives include living wills and do not resuscitate (DNR) orders. B. A video or audiotaped discussion may include advanced directives C. Advanced directives are legally binding in all states D. Advanced directives are only recognized when the patient is hopelessly and terminally ill.

C. Advanced directives are legally binding in all states FYI: It is important to note that advanced directives are not legally binding and not all states recognize them in a legal sense. States that do recognize advanced directives only do so when the patient is, in the opinion of the healthcare provider, hopelessly and terminally ill.

5-HT1A

C. Antidepressant

Patients with urge incontinence often report urine loss: A. With exercise B. At night C. Associated with a strong sensation of needing to void D. As dribbling after voiding

C. Associated with a strong sensation of needing to void

You see a 42-year-old man with uncomplicated urogenital gonorrhea. His medical records indicate a severe allergic reaction to penicillin that includes difficulty breathing and diffuse urticaria. You recommend treatment with: A. Cefixime B. Levofloxacin C. Azithromycin D. Tigecycline

C. Azithromycin

Secondary gout can be caused by all of the following conditions except: A. Psoriasis B. Hemolytic anemia C. Bacterial cellulitis D. Renal failure

C. Bacterial cellulitis

DSM-5 criteria for bulimia nervosa include all of the following except: A. Eating an excessively large amount of food within a discrete amount of time B. A sense of lack of control during binge eating episode. C. Binge eating and compensatory behavior occurring at least three times per week D. Self-worth heavily influenced by body shape and weight

C. Binge eating and compensatory behavior occurring at least three times per week

Which of the following diagnostic approaches is used for confirmation of sarcoidosis? A. Chest x-ray B. High-resolution CT scan C. Biopsy ANA fluorescent staining

C. Biopsy

Nondairy sources of calcium include all of the following except: A. Tofu B. Spinach C. Brown rice D. Sardines

C. Brown rice

The most likely causative pathogens in a 26-year-old man with acute epididymitis include: A. Escherichia coli B. Enterbacteriace C. C. trachomatis D. Pseudomonas species

C. C. trachomatis

The preferred method to identify the location of small renal stones is: A. X-ray B. Abdominal ultrasound C. CT scan D. Radionuclide scan

C. CT scan

When providing care for a middle-aged man with acute cocaine intoxication, you inquire about: A. Feelings of anxiety B. Difficulty maintaining sleep C. Chest pain D. Abdominal pain

C. Chest pain

An example of a first-line therapeutic agent for the treatment of pyelonephritis is: A. Amoxicillin with clavulanate B. Trimethoprim-sulfamethoxazole C. Ciprofloxacin D. Nitrofurantoin

C. Ciprofloxacin

You see a 70-year-old woman in a walk-in center with a chief complaint of increased urinary frequency and dysuria. Urinalysis reveals pyuria and positive nitrites. She mentions she has a "bit of kidney trouble, not too bad." Recent evaluation of renal status is unavailable. In considering antimicrobial therapy for this patient, you prescribe: A. Nitrofurantoin B. Fosfomycin C. Ciprofloxacin D. Doxycycline

C. Ciprofloxacin

As you develop the initial treatment plan for a woman with panic disorder, you consider prescribing: A. Carbamazepine (Tegretol) B. Risperidone (Risperdal) C. Citalopram (Celexa) D. Bupropion (Wellbutrin)

C. Citalopram (Celexa)

Sally is a 34-year-old married woman who is diagnosed with major depressive disorder. She feels that it is likely associated with stress resulting from her troubled marriage. She is initiated on an SSRI and reports initial improvement in symptoms. However, over the following months, the medication loses its effectiveness despite her insistence that she is being adherent with the dosing regimen. This is likely a result of: A. An inadequate dose of medication B. Development of tolerance to the SSRI C. Continued or escalated stress from the troubled marriage D. Missed doses despite her insistence on compliance

C. Continued or escalated stress from the troubled marriage

Which of the following conditions is least likely to contribute to an increased risk of stroke? A. hyperlipidemia B. diabetes mellitus C. Crohn's disease D. hypertension

C. Crohn's disease

You see an 82-year-old woman with early onset dementia and urge incontinence. Which of the following medications is least likely to contribute to worsening mental status? A. Oxybutynin (Ditropan) B. Tolterodine (Detrol) C. Darifenacin (Enablex) D. Solifenacin (VESIcare)

C. Darifenacin (Enablex)

Which of the following statements is true concerning anorexia nervosa? A. The disease affects men and women equally B. Onset is usually in the mid-20s for men and women C. Depression is often found concomitantly D. Individuals with anorexia nervosa are aware of the extreme thinness associated with the disease

C. Depression is often found concomitantly

Which of the following describes the Kernig sign? A. Neck pain occurs with passive flexion of one hip and knee, which causes flexion of the contralateral leg. B. Passive neck flexion in a supine patient results inflexion of the knees and hips. C. Elicited with the patient lying supine and the hip flexed 90 degrees, it is present when extension of the knee from this position elicits resistance or pain in the lower back or posterior thigh. D. Headache worsens when the patient is supine.

C. Elicited with the patient lying supine and the hip flexed 90 degrees, it is present when extension of the knee from this position elicits resistance or pain in the lower back or posterior thigh.

The most likely causative organism in community-acquired UTI in women during the reproductive years is: A. Klebsiella species B. Proteus mirabilis C. Escherichia coli D. Staphylococcus saprophyticus

C. Escherichia coli

Treatment options for HSV-2 genital infection include: A. Ribavirin B. Indinavir C. Famciclovir D. Cyclosporine

C. Famciclovir

114. Which of the following statements is true with regard to decision making for the impaired patient? A. Only a court or close family member can declare a person incompetent. B. Impaired judgment can be used to declare a person incompetent C. Healthcare providers have the ability to determine whether a patient can provide informed consent. D. Informed consent does not necessarily require disclosing the diagnosis to the patient.

C. Healthcare providers have the ability to determine whether a patient can provide informed consent.

Which of the following is the anticipated clinical effect of acamprosate (Campral) in the treatment of alcohol dependence? A. Modifies intoxicating effects of alcohol B. Causes unpleasant adverse effects of alcohol C. Helps to reduce the urge to drink D. Minimizes alcohol withdrawal symptoms

C. Helps to reduce the urge to drink

Which of the following hemograms would be expected for a 46-year-old woman with poorly controlled RA? A. Hg = 11.1 g/dL (12-14 g/dL); MCV - 66 fL (80-96 fL); reticulocytes = 0.8% (1%-2%) B. Hg = 10.1 g/dL (12-14 g/dL); MCV = 103 fL (80-96 fL); reticulocytes = 1.2% (1%-2%). C. Hg = 9.7 g/dL (12-14 g/dL); MCV = 87 fL (80-96 fL); reticulocytes = 0.8% (1%-2%). D. Hg = 11.4 g/dL (12-14 g/dL); MCV = 84 fL (80-96 fL); reticulocytes = 2.3% (1%-2%).

C. Hg = 9.7 g/dL (12-14 g/dL); MCV = 87 fL (80-96 fL); reticulocytes = 0.8% (1%-2%).

Clinical disorders that increase the risk for osteoporosis include all of the following except: A. Rheumatoid arthritis B. Celiac disease C. Hyperlipidemia D. Hyperprolactinemia

C. Hyperlipidemia

In the first weeks of anemia therapy with parenteral vitamin B12 in a 68-year-old woman with hypertension who is taking a thiazide diuretic, the patient should be carefully monitored for: A. Hypernatremia B. Dehydration C. Hypokalemia D. Acidemia

C. Hypokalemia

Which of the following best describes the presentation of patient with complete medial meniscus tear? A. Joint effusion B. Heat over the knee C. Inability to kneel D. Loss of smooth joint movement

C. Inability to kneel

For patients with erectile dysfunction who fail therapy with a PDE-5 inhibitor, alternative approaches include all of the following except: A. Alprostadil injection into the penis B. Mechanical vacuum devices C. Insertion of a nitroglycerin pellet in the urethra D. Implantation of a prosthetic device

C. Insertion of a nitroglycerin pellet in the urethra

With the straight-leg-raising test, the NP is evaluating tension on which of the following nerve roots? A. L1 and L2 B. L3 and L4 C. L5 and S1 D. S2 and S3

C. L5 and S1

Guidelines recommend considering initiating treatment with an erythropoiesis-stimulating agent (ESA) for patients with chronic renal failure and a hemoglobin (Hg) level: A. Less than 8.5 mg/dL B. Less than 9.0 mg/dL C. Less than 10 mg/dL D. Less than 11.5 mg/dL

C. Less than 10 mg/dL

Patients with subscapular bursitis typically present with: A. Limited shoulder ROM B. Heat over affected area C. Localized tenderness under the superomedial angle of the scapula D. Cervical nerve root irritation

C. Localized tenderness under the superomedial angle of the scapula

When the cause of a macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following? A. Haptoglobin and reticulocyte count B. Schilling test and gastric biopsy C. Methylmalonic acid and homocysteine D. Transferrin and prealbumin

C. Methylmalonic acid and homocysteine

Most episodes of low back pain are caused by: A. An acute precipitating event B. Disk herniation C. Muscle or ligamentous strain D. Nerve impingemen

C. Muscle or ligamentous strain

All of the following diagnostic findings are expected in a patient with SLE except: A. Elevated ESR B. Anemia C. Negative ANA test D. Proteinuria

C. Negative ANA test

As part of the evaluation of patient with OA, the NP anticipates finding: A. Anemia of chronic disease B. Elevated CRP level C. No disease-specific laboratory abnormalities D. Elevated antinuclear antibody (ANA) titer

C. No disease-specific laboratory abnormalities

Which of the following is the best choice of therapy in chronic bacterial prostatitis? A. Oral trimethoprim-sulfamethoxazole for 2 weeks B. Parenteral ampicillin for 4 weeks C. Oral ciprofloxacin for 4 weeks D. Injectable gentamicin for 2 weeks

C. Oral ciprofloxacin for 4 weeks

To prevent a recurrence of testicular torsion, which of the following is recommended? A. Use of scrotal support B. Avoidance of testicular trauma C. Orchiopexy D. Limiting the number of sexual partners

C. Orchiopexy

A 68-year-old man presents with suspected bladder cancer. You consider that its most common presenting sign or symptom is: A. Painful urination B. Fever and flank pain C. Painless gross hematuria D. Palpable abdominal mass

C. Painless gross hematuria

Diagnostic testing of a person with primary HSV-2 infection would likely show: A. Negative virologic and serologic test results B. Negative virologic test result and positive serologic test results C. Positive virologic test result and negative serologic test results D. Positive virologic and serologic test results

C. Positive virologic test result and negative serologic test results -virologic testing is present (ex. viral culture swab) -serologic testing (serum blood) looking for evidence of exposure

You see a 58-year-old man diagnosed with a kidney stone who reports pain primarily during urination. You consider all of the following except: A. Improved hydration B. Alpha blocker use C. Prescribing a diuretic D. Analgesia use

C. Prescribing a diuretic

Extracorporeal shock-wave therapy can be used in the treatment of epicondylitis as a means to: A. Improve ROM B. Build forearm strength C. Promote the natural healing process D. Stretch the extensor tendon

C. Promote the natural healing process

Treatment of dysthymia typically involves: A. Psychotherapy alone B. Antidepressants alone C. Psychotherapy plus antidepressants D. Electroconvulsive therapy (ECT)

C. Psychotherapy plus antidepressants

In caring for a patient with OA of the knee, upon advise that: A. Straight-leg raising should be avoided B. Heat should be applied to painful joints after exercise C. Quadriceps-strengthening exercises should be performed D. Physical activity should be avoided

C. Quadriceps-strengthening exercises should be performed

Which of the following pathogens is often implicated in a COPD exacerbation caused by respiratory tract infection? A. Legionella species B. Streptococcus pyogenes C. Respiratory tract viruses D. Staphylococcus aureus

C. Respiratory tract viruses

Results of hemogram in a person with anemia of chronic disease include: A. Microcytosis B. Anisocytosis C. Reticulocytopenia D. Macrocytosis

C. Reticulocytopenia

A 48-year-old woman developed iron-deficiency anemia after excessive perimenopausal bleeding, successfully treated by endometrial ablation. Her hematocrit (HCT) level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible observed change in laboratory parameters would include: A. A correction of mean cell volume B. An 8% increase in HCT level C. Reticulocytosis D. A correction in ferritin level

C. Reticulocytosis

All of the following agents can be considered for the treatment of severe cases of SLE except: A. Leflunomide B. Azathioprine C. Rituximab D. Belimumab

C. Rituximab

50. Which of the following statements is true concerning elder maltreatment? A. This problem is found mainly in families of lower socioeconomic status. B. An elderly adult who is being mistreated usually seeks help C. Routine screening is indicated as part of the care of an older adult D. In most instances of elder maltreatment, a predictable cycle of physical violence directed at the older adult followed by a period of remorse on the part of the perpetrator is the norm.

C. Routine screening is indicated as part of the care of an older adult

Which of the following statements is true concerning domestic violence? A. It is found largely among people of lower socioeconomic status B. The person in an abusive relationship usually seeks help C. Routine screening is indicated during pregnancy D. A predictable cycle of violent activity followed by a period of calm is the norm.

C. Routine screening is indicated during pregnancy

You see a 26-year-old woman who has been recently diagnosed with SLE and has initiated therapy to control moderate symptoms of the disease, including fatigue and joint pain. She mentions that she and her husband are hoping to start a family soon. In counseling her about pregnancy, you consider that: A. There is a low probability of conception during symptomatic flares of SLE B. Most treatments for SLE must be discontinued once a woman becomes pregnant C. SLE is associated with a high risk of pregnancy loss D. There is a higher risk of gestational diabetes in women with SLE

C. SLE is associated with a high risk of pregnancy loss

Common signs of high-grade aortic stenosis in an individual during exercise include all of the following except: A. Dyspnea B. Angina C. Seizure D. Syncope

C. Seizure

A patient with sciatica will typically report: A. Loss of bladder control B. Stiffness, spasm, and reduced ROM C. Shooting pain that starts at the hip and radiates to the foot D. Pain at its worst when lying down

C. Shooting pain that starts at the hip and radiates to the foot

Primary prevention of CTS includes: A. Screening for thyroid dysfunction B. Treatment of concomitant arthritis forms C. Stretching and toning exercises D. Wrist splinting

C. Stretching and toning exercises

Patients whose CTS fails to respond to conservative treatment measures should be considered for: A. Systemic corticosteroid use B. Low-dose opioids C. Surgery D. Vitamin B6 injections in the carpal tunnel

C. Surgery

Which of the following statements is true regarding depression and relapse? A. Without maintenance therapy, the relapse rate is typically less than 50% in the first year B. The risk of relapse is less for those who have experienced multiple episodes of major depressive disorder C. The risk of relapse is greatest in the first 2 months after discontinuation of therapy D. Relapse rarely occurs if there is an absence of symptoms after 9 months of treatment discontinuation

C. The risk of relapse is greatest in the first 2 months after discontinuation of therapy

NSAIDS cause gastric injury primarily by: A. Direct irritative effect B. Slowing gastrointestinal motility C. Thinning of the protective gastrointestinal mucosa D. Enhancing prostaglandin synthesis

C. Thinning of the protective gastrointestinal mucosa

A 44-year-old man has been taking an SSRI for the past 4 months and complains of new onset of sexual dysfunction and difficulty achieving orgasm. You advise him that: A. This is a transient side effect often seen in the first weeks of therapy B. Switching to another SSRI would likely be helpful C. This is a common adverse effect of SSRI therapy that is unlikely to resolve without adjustment in his therapy D. He should see an urologist for further evaluation

C. This is a common adverse effect of SSRI therapy that is unlikely to resolve without adjustment in his therapy

Evidence-based factors that prevent or minimize the risk of UTIs include all of the following except: A. Male gender B. Longer urethra-to-anus length in women C. Timed voiding schedule D. Zinc-rich prostatic secretions

C. Timed voiding schedule

Preferred therapy for nonmuscle-invasive bladder cancer without evidence of metastasis is: A. Cystectomy B. Intravesical chemotherapy only C. Transurethral resection with intravesical chemotherapy D. Systemic chemotherapy

C. Transurethral resection with intravesical chemotherapy

Treatment options for varicocele repair include all of the following except: A. Open surgery B. Laparoscopic surgery C. Treatment with a thrombolytic agent D. Percutaneous embolization

C. Treatment with a thrombolytic agent

The most common clinical manifestation of systemic anaphylaxis typically is: A. Dizziness B. Airway obstruction C. Urticaria D. Gastrointestinal upset

C. Urticaria

A healthy 34-year-old man asks whether he should take an iron supplement. You respond that: A. This is a prudent measure to ensure health B. Iron-deficiency anemia is a common problem in men of his age C. Use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload D. Excess iron is easily excreted

C. Use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload

You examine a 29-year-old woman who has a sudden onset of right-sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. Her examination is otherwise unremarkable. This presentation likely represents paralysis of CN: A. III B. IV C. VII D. VIII

C. VII

Osteoporosis prevention measures include all of the following except: A. Calcium supplementation B. Selective estrogen receptor modulator use C. Vitamin B6 supplementation D. Weight-bearing and muscle-strengthening exercises

C. Vitamin B6 supplementation

Acroparesthesia, frequently reported in patients with CTS, is best described as: A. Constant pain radiating from the elbow B. A transient inability to move the fingers C. Waking up at night with numbness and burning pain in the fingers D. Muscle spasms that cause fist clenching

C. Waking up at night with numbness and burning pain in the fingers

Clinical findings of the knee in a patient with OA include all of the following except: A. Coarse crepitus B. Joint effusion C. Warm joint D. Knee often locks or a pop is heard

C. Warm joint

In caring for elderly patients, the NP considers that all of the following is true except: A. Many older patients with dementia have a component of depression B. Dementia signs and symptoms usually evolve over months, but depression usually has a more rapid onset C. With dementia, a patient is aware of difficulties with cognitive ability D. Treating concurrent depression can help improve symptoms of dementia

C. With dementia, a patient is aware of difficulties with cognitive ability

Patient education about the use of sildenafil (Viagra) includes the following: A. A spontaneous erection occurs about 1 hour after taking the medication B. This medication helps regain erectile function in nearly all men who use it C. With the use of the medication, sexual stimulation also is needed to achieve an erection D. Nitrates can be safely used concurrently

C. With the use of the medication, sexual stimulation also is needed to achieve an erection

Differentiation between gout and pseudogout can involve all of the following diagnostic approaches except: A. Analysis of minerals in the blood B. Analysis of joint fluid C. X-ray of the affected joint D. Measuring thyroid function

C. X-ray of the affected joint

Tamsulosin (Flomax) is helpful in the treatment of BPH because of its effect on: A. Bladder contractility B. Prostate size C. Activity at select bladder receptor site D. Bladder pressure

C. activity at select bladder receptor site

With appropriately prescribed headache prophylactictherapy, the patient should be informed to expect: A. virtual resolution of headaches. B. no fewer but less severe headaches. C. approximately 50% reduction in the number of headaches. D. that lifelong therapy is advised

C. approximately 50% reduction in the number of headaches.

51. Risk factors for becoming a perpetrator of elder maltreatment include all of the following except: A. a high level of hostility about the caregiver role B. poor coping skills C. assumption of caregiving responsibilities at a later stage of life D. maltreatment as a child.

C. assumption of caregiving responsibilities at a later stage of life

One of the most serious complications of giant cell arteritis is: A. hemiparesis B. arthritis C. blindness D. uveitis

C. blindness

When used in treating COPD, ipratropium bromide (Atrovent) is prescribed to achieve which of the followiapeutic effects? A. increase mucocillary clearance B. reduce alveolar volume C. bronchodilation D. mucolytic action

C. bronchodilation

The diagnosis of MS can typically involve all of the following approaches except: A. MRI B. analysis of CSF. C. check for presence of Kernig sign. D. evoked potential test.

C. check for presence of Kernig sign

A 40-year-old man presents with a 5-week history of recurrent headaches that awaken him during the night.The pain is severe, lasts about 1 hour, and is located behind his left eye. Additional symptoms include lacrimation and nasal discharge. His physical examination is within normal limits. This clinical presentation is most consistent with: A. migraine without aura. B. migraine with aura. C. cluster headache. D. increased intracranial pressure (ICP)

C. cluster headache.

90. Appropriate treatment of stage 1 pressure ulcer can include all of the following except: A. ensuring proper nutrition and hydration of the patient. B. regular repositioning of the patient C. debridement of non-vital skin D. special padding for vulnerable skin areas.

C. debridement of non-vital skin

52. Elder maltreatment is considered to be underreported, with an estimated _____ cases going unreported to each one that is reported. A. three B. four C. five D. six

C. five

58. Lifestyle interventions for an older adult with orthostatic hypotension should include counseling about: A. avoiding the use of compression stockings B. minimizing salt intake C. flexing the feet multiple times before changes position D. restricting fluids

C. flexing the feet multiple times before changes position

78. A 78 year old woman who has osteoarthritis affecting both knees but no current problems with urinary incontinence is placed on a loop diuretic. She is now at increased risk for _______ urinary incontinence. A. overflow B. urge C. functional D. idiopathic

C. functional

When evaluating the person who has bacterial meningitis, the NP expects to find cerebrospinal fluid (CSF) results of: A. low protein. B. predominance of lymphocytes. C. glucose at about 30% of serum levels. D. low opening pressure

C. glucose at about 30% of serum levels

Limitations of use of butalbital with acetaminophen and caffeine (Fioricet) include its: A. energizing effect. B. gastrointestinal (GI) upset profile. C. high rate of rebound headache if used frequently. D. excessive cost.

C. high rate of rebound headache if used frequently.

109. Define Apraxia A. failure to recognize objects despite intact sensory function B. language disturbance C. impairment of motor activities despite intact motor function.

C. impairment of motor activities despite intact motor function.

102. When managing dementia, cholinesterase inhibitors offer the greatest benefit: A. for prevention of Alzheimer's-type dementia B. in patients with mild cognitive impairment. C. in patients with mild-to-moderate AD D. in patient with severe AD

C. in patients with mild-to-moderate AD

25. Age related changes in an elderly adult include all of the following except: A. total body water decreases by 10% to 15% between ages 20 and 80 years. B. body weight as fat increases from 18% to 36% in men and from 33% to 45% in women C. increase in serum albumin D. increase in gastric pH

C. increase in serum albumin

30. Age-related changes in the gastrointestinal system include all of the following except: A. decreased gastric acid production B. decreased GI motility C. increased GI surface area D. decreased gastric emptying

C. increased GI surface area

Systemic corticosteroid therapy would be most appropriate in treating: A. tension-type headache. B. migraines occurring on a weekly basis. C. intractable or severe migraines and cluster headaches. D. migraines occurring during pregnancy

C. intractable or severe migraines and cluster headaches

A 22-year-old woman presents with a 3-year history of recurrent, unilateral, pulsating headaches with vomiting and photophobia. The headaches, which generally last 3 hours, can be aborted by resting in a dark room. She can usually tell that she is going to get a headache. She explains, "I see little 'squiggles' before my eyes for about 15 minutes." Her physical examination is unremarkable. This presentation is most consistent with: A. tension-type headache. B. migraine without aura. C. migraine with aura. D. cluster headache

C. migraine with aura.

During an outbreak of meningococcal meningitis, all ofthe following can be used as chemoprophylaxis except: A. a single dose of ceftriaxone. B. multiple doses of rifampin. C. multiple doses of amoxicillin. D. a single dose of meningococcal conjugate vaccine(MCV4 or Menactra).

C. multiple doses of amoxicillin.

A 47-year-old woman experiences occasional migraine with aura and reports partial relief with zolmitriptan. You decide to add which of the following to augment the pain control by the triptan? A. lamotrigine B. gabapentin C. naproxen sodium D. magnesium

C. naproxen sodium

A 37-year-old man diagnosed with cluster-type headache that is alleviated with high-dose NSAIDs. What is the appropriate course of action? A. head CT scan B. head MRI C. neither

C. neither

6. Match Gene theory with it's key aspect. A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

C. one or more latent harmful genes become activated

Physical examination findings in papilledema include: A. arteriovenous nicking. B. macular hyperpigmentation. C. optic disk bulging. D. pupillary constriction

C. optic disk bulging.

A 45-year-old man experiences rapidly progressing migraine headaches that are accompanied by significant GI upset. Appropriate acute headache (abortive) treatment includes all of the following except: A. injectable sumatriptan. B. dihydroergotamine nasal spray. C. oral naproxen sodium. D. zolmitriptan nasal spray.

C. oral naproxen sodium.

Risk factors for giant cell arteritis include all of the following except: A. older age. B. female gender. C. osteoarthritis. D. Northern European descent.

C. osteoarthritis.

74. Intervention for patients with stress incontinence includes: A. establishing a voiding schedule B. gentle bladder-stretching exercises C. periurethral bulking agent injection D. restricting fluid intake.

C. periurethral bulking agent injection

44. When considering the properties of a drug in the body, which of the following does not change as a person ages? A. excretion B. biotransformation C. pharmacodynamics D. absorption

C. pharmacodynamics

42. The process of absorption, distribution, metabolism, and elimination of a drug is known as: A. pharmacodynamics B. drug interactions study. C. pharmacokinetics D. therapeutic trasformation

C. pharmacokinetics

Which of the following systemic corticosteroid doses is most potent? A. methylprednisolone 8 mg B. triamcinolone 10 mg C. prednisone 15 mg D. hydrocortisone 18 mg

C. prednisone 15 mg

Part D Match the Medicare part with it's appropriate benefit. A. allows beneficiaries to enroll in a private plan as an alternative to the traditional fee-for-service plan B. covers inpatient and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, nurse practitioner, outpatient, home health, and preventive services.

C. provides outpatient prescription drug benefits

When discussing immunizations with a 67 y/o woman with COPD, you advise that she: A. receive live attenuated influenza virus vaccine. B. avoid immunization against influenza because of the risk associated with the vaccine. C. receive inactivated influenza virus vaccine. D. take an antiviral for the duration of the influenza season.

C. receive inactivated influenza virus vaccine.

49. When making a home visit to a bedridden 89 year old man, you note that he is cachectic and dehydrated but cognitively intact. He states he is not receiving his medications regularly and that his granddaughter is supposed to take care of him but mentions, "She seems more interested in my Social Security check." The patient is unhappy but asks that you not "tell anybody" because he wants to remain in his home. The most appropriate action would be to: A. talk with he patient's granddaughter and evaluate her ability to care for the patient B. visit the patient more frequently to ensure that his condition dies not deteriorate C. report the situation to the appropriate state agency D. honor the patient's wishes because a competent patient has the right to determine care.

C. report the situation to the appropriate state agency

Which of the following best describes patient presentation during a tonic-clonic (grand mal) seizure? A. blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness B. awake state with abnormal motor behavior lasting seconds C. rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness D. abrupt muscle contraction with autonomic signs

C. rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness

Funding for Medicare include all of the following sources except: A. payroll taxes. B. monthly premiums for beneficiaries. C. sales taxes on alcohol and tobacco products. D. taxes from Social Security benefits.

C. sales taxes on alcohol and tobacco products. In addition to funding from payroll taxes and Medicare premiums, other sources of funding include taxation of Social Security benefits, payments from states, and interest.

89. A pressure ulcer that exhibits full-thickness skin loss with a crater-like appearance can be categorized as: A. stage 1 B. stage 2 C. stage 3 D. stage 4

C. stage 3

101. When discussing the use of a cholinesterase inhibitor with a 72-year-old woman with a recent diagnosis of Alzheimer's type dementia and her family, you report that A. this medication will help return memory to her pre-illness baseline B. this risk associated with the use of this medication outweighs its benefits C. this medication will likely afford clear, although minor and time-limited benefits. D. the medication should have been started earlier to help prevent any change in cognition.

C. this medication will likely afford clear, although minor and time-limited benefits.

21. Besides aging, a risk factor for age-related macular degeneration is: A. hypertension B. hyperlipidemia C. tobacco use. D. alcohol abuse.

C. tobacco use.

Match the CN with the appropriate function or test. A. Tongue and throat, swallowing B. Sense of smell C. Facial asymmetry, drop of mouth (Bell's palsy)

CN I- B. Sense of smell CN VII- C. Facial asymmetry, drop of mouth (Bell's palsy) CN IX- A. Tongue and throat, swallowing

H. influenzae is a predominant pathogen in CAP patients with _________

COPD

____________a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gase

COPD

What are the majority of kidney stones made up of

Calcium oxalate

Special considerations in geriatrics "CA in older adults" Cancer with highest mortality: Cancer with second highest mortality: most common risk factors of cancer: Cancers among older adults may be caused by:

Cancer with highest mortality: lung cancer (both genders). Cancer with second highest mortality: colon cancer. Aging and advancing age are the most common risk factors of cancer. Up to 60% of newly diagnosed malignancies occur in older adults (age 65 years or older). Cancers among older adults may be caused by gene-related DNA damage, familial genetics, decrease in immunity, decreased healing rates, and hormonal influences.

Special "Cardiac" considerations in geriatrics Thickened intimal layer of arteries and arteriosclerosis resulting in increased systolic blood pressure (BP) due to increased vascular resistance (isolated systolic hypertension). Thicker mitral and aortic valves, which may contain calcium deposits.

Cardiac Elongation and tortuosity (twisting) of the arteries.

When can the 'right to refuse care' be used?

Care may be refused as long as the patient has decision making capability or competence

What mobilizes, monitors and controls the resources that a patient uses during the course of an illness while balancing quality and cost?

Case management

Coughing w/ excessive mucus production for at least "3 or more months" for a minimum of "2 or more" consecutive years

Chronic bronchitis

Symptoms of chronic prostatitis vs acute

Chronic- Usually older males Several weeks of perineal discomfort Irritated voiding symptoms such as dysuria, nocturia, frequency Prostate May feel normal or slightly boggy but will be nontender Acute- Usually younger males Sudden onset High fever and chills Perineal pain that may radiate to the back Urinary sympts Prostate will feel warm and boggy and be extremely tender

A claim is filed in court against an NP in January 2011 for an incident that occurred in January 2009. The NP remains enrolled with the same malpractice insurance company. Therefore, the claim will be covered. But if the NP has changed jobs or is retired (and does not carry tail coverage), the claim will not be covered even if the NP was insured at that time.

Claim based policy

_______________ use with select statins (lova-, simva-and atorvastatin, all CYP3A4 substrates) can dramatically increase the risk of myositis and rhabdomyolysis.

Clarithromycin

NYHA Functional capacity rating od heart disease ***know #2***

Class I - no limitations with physical activity Class II - ordinary physical activity result in for tea and exertional dyspnea Class III - Marked limitation in physical activity Class IV - symptoms are present at rest with or without physical activity

Match the female:male ratio for each type of primary headache listed: Tension-type headache 1:3 to 1:8 Migraine without aura 5:4 Cluster headache 3:1

Cluster- 1:3 to 1:8 Migraine- 3:1 Tension- 5:4

What ethical principle? This "right" is also protected by the Health Insurance Portability and Accountability Act (HIPAA) (release of patient information for electronic billing purposes).

Confidentiality

What ethical principle? The obligation to protect the patient's identity, personal information, test results, and medical records.

Confidentiality

In COPD, routine use recommended with FEV1 <60% predicted and/or with recurrent exacerbations. Inhaled corticosteroids mometasone (Asmanex) fluticasone (Flovent) budesonide (Pulmicort) beclomethasone (Qvar), ciclesonide (Alvesco) Are indicated when?

Controller drug, preferred treatment for persistent asthma to prevent and control inflammation

Herpes zoster infection a cranial nerve five can result in what

Corneal blindness

What is the treatment for otitis externa

Cortisporin drops

What is Medicare Part A

Covers inpatient/hospitalization, SNF services, home health services, hospice associated with inpatient event. Most individuals qualify to receive benefits at age 65.

What is a health care provider required to report?

Criminal acts and injury from a dangerous weapon (police), gonorrhea chlamydia and syphilis, HIV and TB (PHD), animal bites (animal control), suspected or actual child or elder abuse (social services, who then report to the police, not you)

____ contains key patient care activities and time frames that are needed for specific case type

Critical path

What is a common statistical measure of the reliability of an instrument?

Cronbach's alpha

Type of study examining a population with similar attributes but with one specific variable, designed to find relationships between variables at a specific point in time. Provide an example of this type of study.

Cross-sectional study, for example a survey

What is CLAS?

Culturally and linguistically appropriate services

A TIA is characterized as an episode of reversible neurological symptoms that can last: A. 1 hour B. 6 hours C. 12 hours D. 24 hours

D. 24 hours

Which of the following contains the greatest amount of alcohol? A. 12 oz (360mL) beer (9 proof) B. 4 oz (120 mL) wine (22 proof) C. 3.5 oz (105 mL) mixed drink (30 proof) D. 3 oz (90 mL) liquor (80 proof)

D. 3oz (90mL) liquor (80 proof)

Suppressive therapy reduces the frequency of genital herpes recurrences by: A. 5%-10% B. 20%-25% C. 40%-50% D. 70%-80%

D. 70%-80%

1. In the elderly population, the current fastest growing group is the age range: A. 71 to 75 years B. 76 to 80 years C. 81 to 84 years D. 85 years and older

D. 85 years and older

Of the following individuals, who is at highest risk for NSAID-induced gastropathy? A. A 28-year-old man with an ankle sprain who has taken ibuprofen for the past week and who drinks four to six beers every weekend B. A 40-year-old woman who smokes and takes about six doses of naproxen sodium per month to control dysmenorrhea C. A 43-year-old man with dilated cardiomyopathy who uses ketoprofen one to two times per week for low back pain D. A 72-year-old man who takes aspirin four times a day for pain control of osteoarthritis

D. A 72-year-old man who takes aspirin four times a day for pain control of osteoarthritis

In children younger than age 6 years, accidental overdose of iron-containing products is: A. Easily treated B. A source of significant GI upset C. Worrisome but rarely causes significant harm D. A leading cause of fatal poisoning in the age group

D. A leading cause of fatal poisoning in the age group

Which of the following is most likely to be noted in a 45-year-old woman with laboratory evidence of chronic excessive alcohol ingestion? A. Alanine aminotransferase (ALT) 202 U/L (0 to 31 U/L), mean corpuscular volume (MCV) 70 fL (80 to 96 fL) B. Asparatate transaminase (AST) 149 U/L (0 to 31 U/L), MCV 81 fL (80 to 96 fL) C. ALT 88 U/L (0 to 31 U/L), MCV 140 fL (80 to 96 fL) D. AST 80 U/L (0 to 31 U/L), MCV 103 fL (80 to 96 fL)

D. AST 80 U/L (0 to 31 U/L), MCV 103 fL (80 to 96 fL)

Risk factors for acute bacterial prostatitis include all of the following except: A. Having unprotected sex B. Use of a urinary catheter C. Prior bladder infection D. Age >70 years

D. Age >70 years

Which is the most appropriate choice of therapy in the treatment of a mild acute COPD exacerbation in a 42 y/o man? A. a 5-day course of levofloxacin B. a 7-day course of amoxicillin C. A 10-day course of doxycycline D. Antimicrobial therapy is usually no indicated.

D. Antimicrobial therapy is usually no indicated.

You see a 37-year-old man complaining of low back pain consisting of stiffness and spasms but without an sign of neurologic involvement. You recommend all of the following interventions except: A. Application of cold packs for 20 minutes 3-4 times a day B. Use of NSAIDS or acetaminophen for pain control C. Initiation of aerobic and toning exercises D. Bed rest for at least 5 days

D. Bed rest for at least 5 days

You see a 28-year-old Italian-American man who participates in recreational basketball and has mild hypertension. In considering treatment, you consider all of the following as viable options except: A. Calcium channel blockers B. Angiotensin converting enzyme inhibitors C. Angiotensin receptor antagonist D. Beta-adrenergic antagonists

D. Beta-adrenergic antagonists

Which of the following is inconsistent with the description of benign prostatic hyperplasia (BPH)? A. Obliterated median sulcus B. Size larger than 2.5 cm x 3 cm C. Sensation of incomplete emptying D. Boggy gland

D. Boggy gland

Pseudogout is caused by the formation of what type of crystals in joints? A. Uric acid B. Calcium oxalate C. Struvite D. Calcium pyrophosphate dihydrate

D. Calcium pyrophosphate dehydrate

Regarding the current scientific evidence on the use of glucosamine and chondroitin for the management of symptomatic OA of the knee, AAOS: A. Strongly favors their use B. Provides a moderate-strength recommendation for their use C. Cannot recommend for or against the use of these supplements (limited evidence) D. Cannot recommend the use of these supplements

D. Cannot recommend the use of these supplements

5-HT1C, 5-HT2C

D. Cerebral spinal fluid production

Clinical studies have consistently shown benefit of long-term use of glucosamine and chondroitin for treating OA in the knee A 72-year-old man presents at an early stage of osteoarthritis in his left knee. He mentions that he heard about the benefits of using glucosamine and chondroitin for treating joint problems. In consulting the patient, you mention all of the following except: A. Any benefit can take at least 3 months of consistent use before observed B. Glucosamine is not associated with any drug interactions C. Clinical studies have consistently shown benefit of long- term use of glucosamine and chondroitin for treating OA of the knee D. Chondroitin should be used with caution because of its anti platelet effects

D. Chondroitin should be used with caution because of its anti platelet effects

You see a 34-year-old woman with an uncomplicated UTI. She is otherwise healthy but reports having a sulfa allergy. Appropriate therapy would include: A. TMP-SMX B. Amoxicillin C. Azithromycin D. Ciprofloxacin

D. Ciprofloxacin

Patients with lateral epicondylitis typically present with: A. Electric-like pain elicited by tapping over the median nerve B. Reduced joint ROM C. Pain that is worst with elbow flexion D. Decreased hand grip strength

D. Decreased hand grip strength

Increased risks for fatal reactions from anaphylaxis include all of the following except: A. Personal history of asthma B. Delay in administering epinephrine C. Age in the teen years D. Delay in administering antihistamines

D. Delay in administering antihistamines

Among young adults with an implantable cardioverter defibrillator (ICD), participation in sports should be: A. Generally cautioned against B. Limited to noncontact sports C. Limited to anaerobic activities D. Determined on an individual basis

D. Determined on an individual basis

84. Which of the following is a true statement with regard to disease presentation in older adults? A. Normal age-related changes do not alter the way an illness presents. B. Diseases in the elderly are usually more difficult to treat because they present at later stages C. A mild decline in memory an information processing is not a normal age-related change. D. Diseases usually present at earlier stages due to impaired compensatory systems

D. Diseases usually present at earlier stages due to impaired compensatory systems

Which of the following joints is most likely to be affected by osteoarthritis (OA)? A. Wrists B. Elbows C. Metacarpophalangeal joint D. Distal interphalangeal joint

D. Distal interphalangeal joint

All of the following statements about electromyography (EMG) are true except: A. EMG measures electrical impulses caused by muscles B. Diagnosis of carpal tunnel syndrome involves comparing EMG results of the muscles at rest versus contraction C. EMG can detect muscle damage D. EMG involves sending a small electrical impulse through the muscle tissue

D. EMG involves sending a small electrical impulse through the muscle tissue -impulse will be slowed down

Successful treatment of a patient with reactive depression associated with a loss (e.g., death of a loved one) would expect all of the following results except: A. Elevated mood B. Restored function C. Improved decision-making ability D. Elimination of sadness

D. Elimination of sadness

The causative organism of chancroid is: A. Ureaplasma species B. Chlamydia trachomatis C. Mycoplasma hominis D. Haemophilus ducreyi

D. Haemophilus ducreyi

A patient has been taking fluoxetine for 1 week and complains of mild nausea and diarrhea. You advise that: A. This is a common, long lasting side effect of SRRI therapy B. He should discontinue the medication C. Another antidepressant should be substituted D. He should be taking the medication with food

D. He should be taking the medication with food

Compared to younger women, uncomplicated UTI in an elderly woman is more likely to be associated with each of the following signs and symptoms except: A. New onset urinary incontinence B. Delirium C. Weakness D. Hematuria

D. Hematuria

Lorazepam or oxazepam is the preferred benzodiazepine for treating alcohol withdrawal symptoms when there is a concomitant history of: A. Seizure disorder B. Folate deficiency anemia C. Multiple substance abuse D. Hepatic dysfunction

D. Hepatic dysfunction

You see a 58-year-old woman who is being treated for a renal stone. Analysis of a stone passed in the urine reveals that it is composed of calcium oxalate. In counseling the patient about preventing future stones, you consider all of the following except: A. Reducing sodium in her diet B. Limiting consumption of beets, rhubarb, nuts, and chocolate C. Encouraging getting her daily calcium requirements from food D. If calcium supplements are needed, this medication should be taken on an empty stomach

D. If calcium supplements are needed, this medication should be taken on an empty stomach

Worldwide, which of the following is the most common type of anemia? A. Pernicious anemia B. Folate-deficiency anemia C. Anemia of chronic disease D. Iron-deficiency anemia

D. Iron-deficiency anemia

Initial treatment for meniscal tear includes all of the following except: A. NSAID use B. Applying ice to the affected area C. Elevation of the affected limb D. Joint aspiration of the affected knee

D. Joint aspiration of the affected knee

Which of the following is not a risk factor for bladder cancer? A. Occupational exposure to textile dyes B. Cigarette smoking C. Occupational exposure to heavy metals D. Long-term aspirin use

D. Long-term aspirin use

Dysthymia is characterized by: A. Suicidal thoughts B. Multiple incidents of harming oneself C. Social isolation D. low level depression

D. Low level depression

Folate-deficiency anemia causes which of the following changes in the RBC indices? A. Microcytic, normochromic B. Normocytic, normochromic C. Microcytic, hypochromic D. Macrocytic, normochromic

D. Macrocytic, normochromic

Pernicious anemia causes which of the following changes in the RBC indices? A. Microcytic, normochromic B. Normocytic, normochromic C. Microcytic, hypochromic D. Macrocytic, normochromic

D. Macrocytic, normochromic

Which of the following is the preferred method of preventing NSAID-induced gastric ulcer? A. A high-dose histamine 2 receptor antagonist B. Timed antacid use C. Sucralfate (Carafate) D. Misoprostol (Cytotec)

D. Misoprostol (Cytotec)

Initial preparticipation screening of athletes should include: A. A resting 12-lead ECG B. Echocardiogram C. Both resting 12-lead ECG and echocardiogram D. Neither a resting 12-lead ECG nor echocardiogram

D. Neither a resting 12-lead ECG nor echocardiogram

When taking a PDE-5 inhibitor, concomitant use of which medication must be avoided? A. Statins B. Sulfonylurea C. ACE inhibitors D. Nitrates

D. Nitrates

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb = 10.1 g Hct = 32% RBC = 2.9 million mm3 MCV = 72 fL MCHC = 28.2 g/dL RDW = 18.9% Physical examination is likely to include: A. Conjunctiva pallor B. Hemic murmur C. Tachycardia D. No specific anemia-related findings

D. No specific anemia-related findings

A 23-year-old man has a non tender "bag of worms" mass within the left scrotum that disappears when he is in the supine position. He is diagnosed with a varicocele. What is a risk factor that may have contributed to this condition? A. Younger age B. Current cigarette smoker C. Multiple sexual partners D. None of the above

D. None of the above

Among surgical and procedural interventions, AAOS strongly recommends the use of which of the following for the management of symptomatic OA of the knee? A. Intraarticular corticosteroid use B. Hyaluronic acid injections C. Arthroscopy with lavage and/or debridement D. None of the above

D. None of the above

Which of the following SSRIs is associated with the greatest anticholinergic effect? A. Fluvoxamine B. Sertraline C. Fluoxetine D. Paroxetine

D. Paroxetine

You are examining a 19-year-old man who is diagnosed with a murmur of mitral regurgitation. When he asks about participation in sports activities, you counsel that: A. Participation in sports activities should not be affected by his condition B. He should refrain from any activities requiring physical exertion C. Participation will depend on the degree of atrial atrophy D. Participation will depend on the degree of ventricular enlargement

D. Participation will depend on the degree of ventricular enlargement

All of the following can negatively impact perivaginal lactobacilli colonization except: A. Recent antimicrobial use B. Exposure to the spermicide nonoxynol-9 C. Estrogen deficiency D. Postcoital voiding

D. Postcoital deficiency

Which part of the prostate is readily palpable during a DRE? A. Anterior lobe B. Median lobe C. Lateral lobes D. Posterior lobe

D. Posterior lobe

A 78-year-old man presents with a 3-day history of new onset fatigue and difficulty with bladder emptying. Examination reveals a distended bladder but is otherwise unremarkable. Blood urea nitrogen level is 88 mg/dL (31.4 mmol/L); creatinine level is 2.8 mg/dL (247.5 μmol/L). The most likely diagnosis is: A. Prerenal azotemia B. Acute glomerulonephritis C. Tubular necrosis D. Postrenal azotemia

D. Postrenal azotemia start w/prolonged obstruction leading to hydronephrosis potentially life-threatening causes 5% of all renal failure

Immediate diagnostic imaging for low back pain should be reserved for all of the following except: A. Presence of signs of the cauda equina syndrome B. Presence of severe neurologic deficits C. Presence of risk factors for cancer D. Presence of moderate pain lasting at least 2 weeks

D. Presence of moderate pain last at least 2 weeks

During a pre-participation cardiovascular history, all of the following questions should be included except: A. Past detection of a heart murmur B. Excessive, unexplained, and unexpected shortness of breath C. Prior occurrence of exertional chest pain/discomfort D. Prior use of NSAID

D. Prior use of NSAID

Erythropoietin is a glycoproteins that influences a stem cell to become a: A. Lymphocyte B. Platelet C. Neutrophil D. Red blood cell

D. Red blood cell

A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having intermittent unilateral testicular pain in the past but not as severe this current episode. Confirmation of testicular torsion would include all of the following findings except: A. Unilateral loss of the cremasteric reflex B. The affected testicle held higher in the scrotum C. Testicular swelling D. Relief of pain with scrotal elevation

D. Relief of pain with scrotal elevation

Which of the following is not a gram-negative organism? A. E. coli B. K. pneumoniae C. P. mirabilis D. S. saprophyticus

D. S. saprophyticus

Likely sequelae of intrabursal corticosteroid injection include: A. Irreversible skins atrophy B. Infection C. Inflammatory reaction D. Soreness at the site of injection

D. Soreness at the site of injection

Which of the following is an over-the-counter herbal preparation used to relieve symptoms of depression? A. Valerian root B. Melatonin C. Kava kava D. St. John's wort

D. St. John's wort

81. Which of the following is a false statement with regard to driving and Alzheimer's-type dementia (AD)? A. Patients with AD typically continue to drive for at least 3 years following the diagnosis. B. Those with mild-to-moderate AD have an eight-fold increase in the number of accidents. C. Those at early stages of AD can continue to drive safely, though driving should be monitored regularly D. The National Transportation and Safety Board recommends surrendering the driver's license for all individuals with an AD diagnosis.

D. The National Transportation and Safety Board recommends surrendering the driver's license for all individuals with an AD diagnosis.

With migraine, which of the following statements is true?A. Migraine with aura is the most common form. B. Most migraineurs are in ongoing healthcare for the condition. C. The condition is equally common in men and women. D. The pain is typically described as pulsating.

D. The pain is typically described as pulsating

Which is the most appropriate statement about therapy for a severe COPD exacerbation in a 52 year-old man? A. A 5-day course azithromycin should be prescribed. B. A 10 day course of amoxicillin/clavulanate is advisable C. A 7-day course of trimethoprim-sulfamethoxazole is recommended. D. The role of antimicrobial therapy is debated, even for severe disease.

D. The role of antimicrobial therapy is debated, even for severe disease.

Concerning herbal and nutritional therapies for BPH treatment, which of the following statements is false? A. The mechanism of action of the most effective and best studied products is similar to prescription medications for this condition B. These therapies are currently considered emerging therapy by the American Urological Association C. Major areas of concern with use of these therapies include issues of product purity and quality control D. These therapies are safest and most effective when used with prescription medications.

D. These therapies are safest and most effective when used with prescription medications.

Which of the following is the best answer regarding anaphylaxis? A. Adults usually do not develop new anaphylaxis triggers such as food allergies B. Peanuts are the primary food that can cause a severe allergic reaction C. Future anaphylactic reactions will become increasingly more severe D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction

D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction

All of the following are common precipitating factors in acute renal failure except: A. Anaphylaxis B. Infection C. Myocardial infarction D. Type 1 diabetes

D. Type 1 diabetes

A 22-year-old man presents with new onset of pain and swelling in his feet and ankles, conjunctivitis, oral lesions, and dysuria. To help confirm a diagnosis of reactive arthritis, the most important test to obtain is: A. ANA analysis B. ESR measurement C. Rubella titer measurement D. Urethral cultures

D. Urethral cultures

Recommended exercises for patients with OA of the hip include all of the following except: A. Stretching exercises of the gluteus muscles B. Straight-leg raises without weights C. Isometric exercises of the iliopsoas and gluteus muscles D. Weight-bearing aerobic exercises

D. Weight-bearing aerobic exercises

Which of the following statements about potential drug interactions with phenytoin is false? A. Phenytoin increases theophylline clearance by increasing cytochrome P-450 (CYP 450) enzyme activity. B. When taken with other highly protein-bound drugs,the free phenytoin concentration can increase to toxic levels. C. Phenytoin can increase the metabolic capacity of hepatic enzymes, thus leading to reduced drug levels. D. When phenytoin and theophylline are given together, the result is a higher concentration of both drugs than when given separately

D. When phenytoin and theophylline are given together, the result is a higher concentration of both drugs than when given separately

Struvite stones are typically found in people: A. With type 2 diabetes B. Who live in colder climates C. Who abuse alcohol D. With a history of kidney infections

D. With a history of kidney infections

All of the following persons should receive a dose of the meningococcal vaccine except: A. a 19-year-old who received a first dose at 12 years of age. B. a 22-year-old who has not received the vaccine and will be moving to a college dormitory. C. a 35-year-old who will be traveling to a country where meningococcal disease is hyperendemic. D. a 14-year-old who received a first dose at 11 years of age

D. a 14-year-old who received a first dose at 11 years of age

62. The NP is asked to evaluate a 77 year old woman who recently had an unexpected fall. The patient is normally healthy and has no mobility limitations or other obvious risk factors. During the history, the NP learns that the patient did not attempt to break the fall, "I just suddenly found myself on the floor." This statement suggests: A. a previously undiagnosed cognitive impairment that requires further evaluation. B. that the underlying sensory deficits (visual, hearing) are the most likely cause of the fall and require physical assessment. C. that a history of alcohol use or abuse should be explored D. a syncopal episode requiring a cardiovascular and neurological evaluation.

D. a syncopal episode requiring a cardiovascular and neurological evaluation.

10. Match Somatic mutation theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

D. an essential gene is destroyed and causes the cell to stop dividing

The most effective nonpharmacologic method to prevent exacerbations in patients with COPD is: A. weight loss for those with a BMI greater than 25 B. avoid exposure to children or day-care centers. C. brisk walking for at least 5 minutes 3-5 times a day as tolerated. D. avoid exposure to pulmonary irritants, such as cigarette smoking.

D. avoid exposure to pulmonary irritants, such as cigarette smoking.

32. To avoid rebound gastric hyperacidity following discontinuation of long-term PPI use, all of the following methods can be used except: A. gradually tapering the PPI dose B. switch to every-other-day dosing of PPI C. switch to a low-dose H2RA therapy D. avoiding antacid therapy when symptoms flare.

D. avoiding antacid therapy when symptoms flare.

A 37-year-old woman complains of migraine headaches that typically occur after eating out in restaurants. Potential triggers that can influence the onset and severity of migraine symptoms include all of the following except: A. cheese pizza. B. pickled or fermented foods. C. freshly baked yeast products. D. baked whitefish

D. baked whitefish

Which of the following best describes patient presentation during a myoclonic seizure? A. blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness B. awake state with abnormal motor behavior lasting seconds C. rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness D. brief, jerking contractions of arms, legs, trunk, or all of these

D. brief, jerking contractions of arms, legs, trunk, or all of these

You see a 67-year old man with stage IV (very severe) COPD who asks, "When should I use my home oxygen?" You respond: A. as needed when short of breath B. primarily during sleep hours. C. preferably during waking hours. D. for at least 15 hours a day.

D. for at least 15 hours a day.

18. All of the following are consistent with normal age related vision changes except: A. need for increased illumination. B. increasing sensitivity to glare. C. washing out of colors D. gradual loss of peripheral vision

D. gradual loss of peripheral vision

Part B Match the Medicare part with it's appropriate benefit. A. allows beneficiaries to enroll in a private plan as an alternative to the traditional fee-for-service plan B. covers inpatient and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, nurse practitioner, outpatient, home health, and preventive services.

D. helps pay for physician, nurse practitioner, outpatient, home health, and preventive services.

63. In an older adult, the greatest risk of long-term complication is associated with fracture of the : A. forearm. B. spine. C. ankle. D. hip

D. hip

31. Long-term proton pump inhibitor (PPI) is associated with all of the following except: A. increased risk of pneumonia in hospitalized patients B. increased risk of C. difficile colitis in hospitalized patients C. reduced absorption of calcium and magnesium D. increased absorption of iron and copper

D. increased absorption of iron and copper

33. Age-related renal changes in older adults potentially include all of the following except: A. decreased glomerular filtration rate (GFR) B. diminished renal blood flow C. loss of functional nephrons D. increased renal mass to compensate for decreased function

D. increased renal mass to compensate for decreased function

57. The use of which of the following medications is associated with the least risk of postural hypotension in the older adult? A. nifedipine B. furosemide C. clonidine D. lisinopiril

D. lisinopiril

20. All of the following are risk factors for angle-closure glaucoma except: A. Asian ethnicity B. female gender C. far-sightedness D. long-term use of contact lenses

D. long-term use of contact lenses

Risk factors for transient ischemic attack (TIA) include all of the following except: A. atrial fibrillation. B. carotid artery disease. C. combined oral contraceptive use. D. pernicious anemia

D. pernicious anemia

Antiplatelet agents commonly used in secondary prevention of stroke include all of the following except: A. aspirin B. clopidogrel C. aspirin plus extended-release dipyridamole D. rivaroxaban

D. rivaroxaban

64. Fall risk in an older adult is decreased with the use of which of the following footwear? A. sandal B. jogging shoe C. slipper D. semi-rigid sole shoe

D. semi-rigid sole shoe

Compared with short-acting beta2-agonists, long acting beta2-agonists: A. are recommended as a first-line therapy in mild intermittent asthma. B. have a significantly different pharmacodynamic profile. C. have a rapid onset of action across the drug class. D. should be added to therapy only when ICS use does not provide adequate asthma control.

D. should be added to therapy only when ICS use does not provide adequate asthma control.

82. Common driving errors observed with older drivers include all of the following except: A. difficulty backing up and making turns B. delayed glare recovery when driving at night C. bumping into curbs and objects D. tailgating

D. tailgating

Treatment options for an adult with seizures include all of the following agents except: A. carbamazepine. B. phenytoin. C. gabapentin. D. tamsulosin

D. tamsulosin

87. Risk factors for pressure ulcers include all of the following except: A. malnutrition B. dehydration C. smoking D. weight gain.

D. weight gain.

Descriptive Versus Correlational Studies

Descriptive Describes and measures the characteristics of a group or a phenomenon. Data are measurable, numerical, and are evaluated by statistical testing. No correlations are measured between the variables. Also known as surveys. Example: "HIV knowledge of college students." Correlational Describes and measures relationships between two or more variables (or interrelationships). Data are measurable and are numerical. Data are subjected to statistical testing. Example: "Is there a relationship between HIV knowledge and safe sex behaviors of college students?" Cross-Sectional A correlational study that evaluates for interrelationships between two or more groups.

7. Match Error theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

E. proteins produced in the cell accumulate more errors during aging.

Who are the authority figures in the Asian population?

Elders

Describe subclinical hypothyroidism

Elevated TSH with a normal free T4

Billing and coding: which codes identify the level of care provided?

Evaluation and management (E&M) codes

What is Mal de Ojo

Evil eye, HC workers can inadvertently give it.

What is a Shinto belief?

Evil is caused by outside spirits, if you please them you will have good health

Reviewing past charts is an example of what kind of research design?

Ex post facto or correlational

Evaluation of hearing

Examine external ear and TM. Remove cerumen if unable to view TM. Look at TM landmarks such as the "cone of light," retraction or bulging of TM, erythema. Check history of tinnitus, ototoxic meds, signs/symptoms of otitis media, ear infections, chronic exposure to loud noises, diabetes, and so on.

Type of research study design.... considered the "gold standard" in research design. An important criterion is the use of random sampling to recruit research subjects. There is an intervention (or treatment) group and a control group. Pretest (before intervention) and posttest data are measured. Data are numerical and evaluated using rigorous statistical testing.

Experimental Design

Experimental Versus Quasiexperimental Studies

Experimental Design Considered the "gold standard" in research design. An important criterion is the use of random sampling to recruit research subjects. There is an intervention (or treatment) group and a control group. For example, a simple two-group experimental design will contain a control group and an intervention group that are "matched." Pretest (before intervention) and posttest data are measured. Data are numerical and evaluated using rigorous statistical testing. Quasiexperimental Design The design is similar to an experimental study except there is no randomization of the research subjects. Instead, recruitment of subjects is by convenience sample. Case Study An intensive and in-depth study of one person. Cohort Study A study of a group of individuals with one or more common characteristics. For example, the Framingham study has a subpopulation of nurses (a cohort of nurses) whose health habits have been tracked for many years.

What is negligence?

Failure of an individual to do what a reasonable person would do, resulting in injury

Negligence

Failure to do what a reasonable person would do

T/F: Sputum characteristics (e.g., clear, yellow, or green color) are reliable indicators to differentiate between a viral or bacterial infection.

False

True or False: Cigarette smokers should not receive the pneumococcal vaccine until 65 years of age.

False

True/False: Access to a firearm by a male perpetrator is associated with increased risk of abuse toward women only in lower socioeconomic income households

False

True/False: Interpersonal violence is uncommon in same- sex relationships

False

True/False: The NP is in an ideal position to provide counseling to both members of a couple involved in domestic violence, particularly if both members of the couple are members of the NP's practice panel.

False

True/False: The body's normative response to anemia is reticulocytopenia

False

True/False: Women's violence against male partners is as likely to result in serious injury as men's violence toward women.

False

True or False approximately 80% of the dose of an ICS is systemically absorbed

False <1%

T/F: Ciprofloxacin has reliable strep pneumoniae coverage

False!

T/F: In TB The chest examination is usually abnormal, with dyspnea typically reported even when the disease is not extensive.

False. The chest examination is usually normal, with dyspnea seldom reported unless disease is extensive.

______________All parts of a system are interrelated and dependent on each other. If one part of the system is damaged or dysfunctional, the rest of the system is also affected. Families develop at different rates. If one family member becomes dysfunctional, it will affect the whole family. Another family member may compensate and take over some of the duties or the role of the dysfunctional family member.

Family Systems Theory

Signs and Symptoms of Hearing Loss

Family or friends complain that patient sets the TV volume or radio "too loud." Problems hearing or understanding speech in noisy areas (e.g., restaurant). May look puzzled or will ask person to repeat at question several times. Complains of difficulty hearing phone conversations. Complaints of tinnitus.

What ethical principle? Example: A woman with terminal breast cancer does not want the NP to reveal her poor prognosis to her mother. The patient explains to the NP that her mother is very term-23anxious and she wants to wait until the next week before she tells her mother news. If the NP keeps the prognosis in confidence from the patient's mother, she is exercising the concept________

Fidelity

Screening for dementia MMSE Folstein mini mental status exam

Folstein Mini-Mental Status Examination (MMSE) A brief screening exam to assess for cognitive impairment. Sensitivity of 87% and specificity of 82%. Maximum score is 30 points (range 0-30). A score of less than 24 points suggestive of dementia or delirium. Low scores are seen in dementia, delirium, and schizophrenia. Six subject areas are tested: Orientation - Date, day of the week, state, country, home address, and so on. Attention and calculation -Serial 7s (ask patient to subtract 7 from 100 and so on). Stop after 5 correct answers. - -Spell "world" (or another word) backward. Recall - Name three objects. Ask patient to repeat names after 5 minutes (short-term memory). Write a sentence - Instruct the patient to write a sentence. Do not give hints. The sentence must be a full sentence. Three-stage command - Tell patient to "take a paper in your right hand," then "fold it in half and put it down on the floor." Copy a design - Examiner uses a handout that is designed for the Mini-Mental State Examination (MME). It is pre-drawn with intersecting lines, such as two pentagons. - Examiner draws a square or a triangle and tells the patient to copy the design. ".

How long should a person with mono avoid contact sports

Four weeks

Special considerations in geriatrics "Fractures"

Fractures of the Hip Acute onset of limping, guarding, body). History of osteoporosis or osteopenia. Fractures of the hip are a major cause of morbidity and mortality in the elderly. Up to 20% of elderly with hip fractures die from complications (e.g., pneumonia).and/or inability/difficulty with bearing weight on the affected side. New onset of hip pain; may be referred to the knee or groin. Unequal leg length. Affected leg is abducted (turned away from the

Geriatric assessment Assessment team: ADLs: Cognition and mood disorders: Polypharmacy education: Fall assessment and prevention:

GERIATRIC ASSESSMENT Assessment team: Physician/nurse practitioner, nurse, social worker, dietician, physical therapist, others. ADLs: Dressing, feeding self, grooming, bathing. Instrumental ADLs: Driving, grocery shopping, laundry, cooking. Cognition and mood disorders: Depression, geriatric bipolar disorder. Risk of falls: Assess History of falls, gait and balance, vision, hypotension, postural hypotension, arrythymias, osteoporosis, type of shoes, assistive devices. Polypharmacy (including herbs, alternative therapy): Advise patient to bring all meds, vitamins, and other alternative medicines in a brown bag

What other lab beside ALT/AST is associated with alcoholism

GGT

Special considerations in geriatrics "Gastro"

Gastrointestinal System Receding gums and dry common. Large bowel (colon) transit time is slower. Constipation more common. Increased risk of colon cancer (age greater than 50 years is strongest risk factor). Fecal incontinence common due to drug side effects, underlying disease, and/or neurogenic disorders. Fecal impaction may lead to small amount of runny soft stool. Laxative abuse more common.

What test is used to diagnose gonorrhea and chlamydia

Gen-Probe

What do Hispanics get concerned with in terms of taking medications?

Getting addicted

Td or Tdap

Give ONE-time dose of "Tdap" for all health care personnel who have NOT received the Tdap when DUE for a Tetanus booster. Continue giving Td BOOSTERS every "10" YEARS for a LIFETIME.

Varicella Vaccine

Give TWO doses at least "4" WEEKS apart Healthy teenagers to adults with NO history of chickenpox; health care workers

What is recommended if the patient received the pneumonia vaccine prior to the age of 65

Give a booster five years from the last vaccination

What diagnoses must NPs report to the DHHS?

Gonorrhea Chlamydia Syphilis HIV TB Lyme disease Animal bites

What protects healthcare providers from lawsuits when they help someone at the scene of an accident and render reasonable, emergency care within the NP scope of practice?

Good Samaritan statutes

How are religion and health connected for Hispanics?

Good health is a gift from God, and a reward for good behavior.

Symptoms/presentation of Parkinson's

Gradual onset of motor symptoms Pill rolling tremors of the hands Cogwheel rigidity With difficulty initiating voluntary movement Slow shuffling gait and poor balance Masked facies

What is a durable power of attorney?

Grants a significant other to act as a proxy, who is responsible for articulating the patients advanced directive

What constitutes a diagnosis of UTI

Greater than 100,000 ML of one organism

Presentation of trichomonas

Green to yellow frothy vaginal discharge, itching, redness, complaints of dysuria, strawbery cervix

Gynecomastia versus pseudogynecomastia

Gynecomastia-excessive growth of breast tissue in males, more common during infancy and adolescence, resolve spontaneously Pseudo gynecomastia-more common in obese boys, bilateral enlargement of the breast tissue due to fatty tissue. Feel soft to the touch is nontender. There's no breast but our disc like breast tissue

What is a common respiratory pathogen with tobacco related lung disease?

H. Influenzae

________is a predominant pathogen in CAP patients w/ COPD.

H. influenzae

What is standard 5 in CLAS standards?

HC organizations must provide patient in preferred language verbal and written notice to inform them they are eligable for language assistance

Health providers are required to provide each patient with a copy of their office's _______ policy form must be reviewed and signed annually by the patient. Patients have the right to review their medical files. A mental health provider has the right to refuse patients' requests to view their psychiatric and mental health records. When patients request to review their medical records, the health provider has up to 30 days to comply. Patients are allowed to correct errors in their medical records. Must keep identifying information (name, DOB, address, Social Security number) and any diagnosis/disease or health concerns private except with allowed exceptions (see list below).

HIPPA Accountability Act (HIPAA) * Also known as the "HIPAA Privacy Rule"

The office for civil rights enforces which HIPAA?

HIPPA Title ll: Privacy of individually accountable health information Protection of electronic health info Prevention of identifiable info being used for patient safety events

Where is HSV 1 and HSV 2 most commonly found

HSV 1- oral HSV2- genital

A model that attempts to explain why people engage in health behavior(s). According to the__________, a person is more likely to engage in healthier behavior if he or she feels threatened by the condition (perceived susceptibility), and believes that he or she can overcome the barriers (perceived barriers), will benefit, and can successfully perform the action (self-efficacy) (Rosenstock, Stretcher, & Becker, 1988). Example: Who is more likely to perform healthier behavior—a 50-year-old smoker who recently had a myocardial infarction (MI), or 16-year-old girl who is obese? In this case, it is probably the 50-year-old smoker who is more likely to quit smoking due to the seriousness of a MI and his older age, rather than the teenager who has to lose weight.

Health Belief Model (HBM) A model that attempts to explain why people engage in health behavior(s). According to the HBM, a person is more likely to engage in healthier behavior if he or she feels threatened by the condition (perceived susceptibility), and believes that he or she can overcome the barriers (perceived barriers), will benefit, and can successfully perform the action (self-efficacy) (Rosenstock, Stretcher, & Becker, 1988).

Who is required to follow HIPAA?

Health care providers, clearinghouses, and health plans

What covered entities must follow HIPPA?

Health plans (government and private), providers, and healthcare cleaning houses

Type of advanced directive that may or may not include a living will, and or DPA

Healthcare directive

Major cause of death in Middle Adult? 40-59

Heart disease Accident Lung Cancer CVA Breast/Colorectal Cancer COPD

Special considerations in geriatrics "Hematologic"

Hematologic System There are no changes in the red blood cell (RBC) lifespan, the blood volume, or the total number of circulating leukocytes. Higher risk of thrombi and emboli due to increased platelet responsiveness. Increased risk of iron and folate-deficiency anemia due to decreased efficiency of the GI tract to absorb Vitamin B12 and folate.

Which hepatitis has the highest risk of cirrhosis and liver cancer

Hep c

Do not combine the triptan in medications with SSRIs because of what

Higher risk of serotonin syndrome

What a respecter's for thyroid cancer

History of neck radiation and childhood or a painless nodule larger than 2.5 cm

Who is in charge of hospital credentialing?

Hospital credentialing committee

How are cold illnesses treated in Chinese culture?

Hot herbs and food

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "sleep"

Hypnotics: Avoid long-acting (e.g., Halcion). Prefer shorter duration (e.g., Ambien).

The proposed explanation for a phenomena

Hypothesis

When the TSH is elevated, the pt has what? If it's decreased?

Hypothyroidism Hyperthyroidism

What does an answer of YES often mean coming from the Asian population?

I heard you. Not necessarily affirmative

Preferred test for those w/ a hx of BCG vaccination

IGRA test- Interferon Gamma Release Assay (blood tes

Prophylaxis for TB if positive PPD

INH 300mg/day x 9 months, x 12 months if HIV

Initial treatment regimen for TB

INH, Rifampin, Ethambutol, Pyrazidamide

The first time a thrill is palpated is what grade murmur

IV

What is Battery?

Illegal, willful, angry, violent or negligent striking of a person (physically hurting)

What is the balance of hot/cold?

Illness may be hot or cold, Medication may be hot or cold For example, may not want to take PCN for hot illness b/c PCN is a hot medication

What do Native American cultures believe can cause illness?

Imbalance of spiritual, mental, physical and social interactions of individual/family/clan

How should Bisphosphonates be taken

Immediately upon wakening in the morning with a full glass of water Do not crush or chew tablets Never take with other medications, juice, coffee, antacids, vitamins

Special considerations in geriatrics "Immune system"

Immune System Less likely to present with fever during infections. Typical body temperature is slightly lower. Decreased antibody response to vaccines. Immune system is less active. Higher risk of infection. Cellular immunity is affected more by aging than humoral immunity. Humoral immunity is associated with B-lymphocytes and antibody (immunoglobulins or IgG) production. Cell-mediated or cellular immunity involves the activity of T-lymphocytes, macrophages, and the cytokines.

a DPA must usually be ____ before it will be honored

In writing

Special considerations in geriatrics Immunizations "Zoster Vaccine" (Zostavax)

Indicated for adults aged 60 years or older (regardless if they report a prior episode of shingles). Person must have a history of chickenpox or varicella titer before giving vaccine

What medicine is given to treat gout

Indomethacin or naproxen

Inductive reasoning or deductive reasoning? is the process of developing a generalization after studying specific information.

Inductive reasoning

Beta-lactams (cephalosporins and penicillins) are effective or ineffective against M. pneumoniae and C. pneumoniae and Legionella?

Ineffective

ICSs have proved to be most effective in preventing airway ______________ and are the preferred controller treatment for all levels of persistent asthma.

Inflammation

Describe a chalazion

Inflammation of the me meibomian gland of the eyelids Gradual onset of a small superficial nodule that is discrete and movable on the upper eyelid that feels like a bead. It is painless and benign

A statement indicating that the patient has received adequate information to make a prudent personal choice regarding treatment

Informed consent

What is first-line treatment for COPD

Inhaled anti-cholinergic such as ipratropium (atrovent) AND/OR Long acting beta two agonist such as salmetrol or formoterol

How does a patient with pertussis present

Initial sympts: Low-grade fever, rhinorrhea with a mild cough (catarrhal stage) Cough become severe with is a inspiratory whooping sound, the patient may vomit afterwards (paroxysmal stage) Cough becomes less severe and less frequent and finally resolves (convalescent stage)

Medicare A covers

Inpatient hospitalization, plus skilled nursing facility, hospice, home health services associated with an inpatient event

What ethical principle A homeless alcoholic male without health insurance presents to the ED for abdominal pain. The patient is triaged and treated in the same manner as the other patients who have health insurance.

Justice

What herbs are used to treat anxiety/insomnia

Kava kava, passion flower, valerian root

What does S4 indicate

LVH

What will the result of the Weber test be with conductive hearing loss

Lateralization to the bad ear

"Susto" is a cultural illness (susto means "fright"). "Mal ojo" or the "evil eye" is a folk illness (usually of a baby/child). It is caused by an adult who stares with envy at the child. The evil eye is also practiced in some Muslim and Mediterranean cultures. Family ties are important and several generations may live in the same household.

Latinos/Hispanics

What is liability?

Legal responsibility of the nurse

"Skin" considerations in geriatrics Also known as "liver spots." Tan-to brown-colored macules on the dorsum of the hands and forearms. Due to sun damage. More common in light skinned individuals. Benign.

Lentigines

What process ensures qualification? Who issues this?

Licensure. The state.

Special "Liver" considerations in geriatrics

Liver size and mass decreases due to atrophy (20%-40%). Liver blood flow and perfusion decreases (up to 50% in some elders). Fat (lipofuscin) deposition in the liver is more common. The liver function test (aspartate aminotransferase [ALT], alanine aminotransferase [AST], alkaline phosphatase) result is not significantly changed. Metabolic clearance of drugs is slowed by 20% to 40% because the cytochrome P450 (CYP 450) enzyme system is less efficient. The low-density lipoprotein (LDL) and cholesterol levels increase with aging.

Written statement of desired life prolonging measures during incapacitation

Living will

Risk factors for UTI in women include: A. Postvoid wiping back to front B. Low perivaginal lactobacilli colonization C. Hot tube use D. Wearing snug-fitting pantyhose

Low perivaginal lactobacilli colonization

Hydrocortisone, 20 mg Cortisone, 25 mg are high, medium, or low potency corticosteroids?

Low potency corticosteroids (equipotent doses)

Leading cause of cancer deaths in men and women

Lung

Special "Lung" considerations in geriatrics

Lungs Total lung capacity remains relatively the same as we age. Both the residual volume and the forced expiratory volume in 1 second (FEV1) increase due to the decrease in lung and chest wall compliance. The chest wall becomes stiffer and the diaphragm is flatter and less efficient. Mucociliary clearance (less cilia) and coughing are less efficient. The airways collapse sooner during expiration. Responses to hypoxia and hypercapnia decreases. Decreased breath sounds and crackles are commonly found in the lung bases of elderly patients without presence of disease. Instruct the patient to "cough" several times to inflate the lung bases (the benign crackles will disappear). Increased anterior-posterior (AP) diameter related to normal body changes.

What is the first line treatment for pertussis

Macrolides

Treatment for Atypical PNA 1st line and alternative?

Macrolides Okay to give antitussives as cough is mostly non-productive Doxycycline 100mg BID x10days

What is recommended therapy for CAP if healthy and low DRSP and H. Flu risk?

Macrolides (Azithromycin, erythromycin etc). Or Doxycycline (Bc cover Non-DRSP and atypicals)

What anabiotic's are used in penicillin allergic patients

Macrolides, sulfas Do not you cephalosporins especially a class one reaction or anaphylaxis

What is the most common cause of blindness in the United States

Macular degeneration

When a patient has loss of central vision what do they have?

Macular degeneration

How may African-Americans take medications?

May dc once symptoms subside

How to assess orthostatic hypotension

Measure blood pressure in the sitting and standing position

Authorized by Title XIX of the Social Security Act. A federal and state matching program. Provides health insurance coverage for low-income individuals and their families who meet the federal poverty level criteria. Provides health insurance for children, pregnant women, parents, seniors, and individuals with disabilities (i.e., blindness). Pays for health care and prescription drugs.

Medicaid

Medicare Part? will not pay for custodial care (nursing homes, retirement homes).Also covers persons with end-stage renal diseases at any age. Certain religious groups (e.g., Amish Mennonites) do not participate in Medicare. will pay for the following "medically necessary" services: Inpatient hospitalization (including inpatient psychiatric hospitalization). Hospice care. Home health care. Skilled nursing facility.

Medicare Part A

Medicare Part? Also covers persons with end-stage renal diseases at any age. Certain religious groups (e.g., Amish Mennonites) do not participate in Medicare. Medicare Part A will pay for the following "medically necessary" services: Inpatient hospitalization (including inpatient psychiatric hospitalization). Hospice care. Home health care. Skilled nursing facility. will not pay for custodial care (nursing homes, retirement homes).Also covers persons with end-stage renal diseases at any age. Certain religious groups (e.g., Amish Mennonites) do not participate in Medicare. will pay for the following "medically necessary" services: Inpatient hospitalization (including inpatient psychiatric hospitalization). Hospice care. Home health care. Skilled nursing facility. will not pay for custodial care (nursing homes, retirement homes).

Medicare Part A (Inpatient Hospitalization)

Medicare Part? "Automatic" at age 65 if the person paid the premiums (automatically deducted from paycheck by the employer). If the person never paid the premiums (e.g., full-time housewife), the person is not eligible for Medicare coverage.

Medicare Part A (Inpatient Hospitalization) "Automatic" at age 65 if the person paid the premiums (automatically deducted from paycheck by the employer). If the person never paid the premiums (e.g., full-time housewife), the person is not eligible for Medicare coverage.

Medicare Part? pays health prevention services: - Flu shots once a year. Pneumovax (once in a lifetime). - Screening mammogram (once every 12 months for women age 40+). - Screening colonoscopy or flexible sigmoidoscopy (aged 50 years or older) every 10 years if low risk. - Routine Pap smears (once every 2 years, or once every 12 months for women at high risk). - Prostate cancer screening (once a year after age 50). - Lipid profile (cardiovascular screening every 5 years). - Bone density testing. - HIV screening. - Physical exams (once a year). - Smoking cessation.

Medicare Part B (Outpatient Insurance)

Medicare Part? will pay for the following "medically necessary" services: - Outpatient visits (including walk-in clinics, urgent care clinics, emergency room visits). - Laboratory and other types of tests (electrocardiogram, x-rays, computed tomography scans). - Durable medical equipment. - "Second opinions" with another physician (surgery). - Kidney dialysis, organ transplants, and many others.

Medicare Part B (Outpatient Insurance)

Medicare Part? is a voluntary program with monthly premiums. Must enroll during the "general enrollment period" (happens once a year).

Medicare Part B (Outpatient Insurance) will pay for the following "medically necessary" services: - Outpatient visits (including walk-in clinics, urgent care clinics, emergency room visits). - Laboratory and other types of tests (electrocardiogram, x-rays, computed tomography scans). - Durable medical equipment. - "Second opinions" with another physician (surgery). - Kidney dialysis, organ transplants, and many others. does not pay for: - Most eyeglasses and eye exams (except following cataract surgery that implants an intraocular lens). - Hearing aids. - Most dentures and dental care. - Cosmetic plastic surgery (unless it is medically necessary). - Over-the-counter drugs and most prescription drugs. pays health prevention services: - Flu shots once a year. Pneumovax (once in a lifetime). - Screening mammogram (once every 12 months for women age 40+). - Screening colonoscopy or flexible sigmoidoscopy (aged 50 years or older) every 10 years if low risk. - Routine Pap smears (once every 2 years, or once every 12 months for women at high risk). - Prostate cancer screening (once a year after age 50). - Lipid profile (cardiovascular screening every 5 years). - Bone density testing. - HIV screening. - Physical exams (once a year). - Smoking cessation.

Medicare Part? Also known as the Medicare prescription drug benefit. Only individuals who are enrolled (or eligible) for Medicare Part A and/or Part B are eligible. One type of Part__________ coverage is called the Medicare Advantage plan (MA). All prescription drug plans have a list of preferred drugs (the formulary). If a non-formulary drug is used, it may not be covered and the patient has to pay for it "out-of-pocket."

Medicare Part D Also known as the Medicare prescription drug benefit. Only individuals who are enrolled (or eligible) for Medicare Part A and/or Part B are eligible. One type of Part D coverage is called the Medicare Advantage plan (MA). All prescription drug plans have a list of preferred drugs (the formulary). If a non-formulary drug is used, it may not be covered and the patient has to pay for it "out-of-pocket."

Medications for Alzheimer's

Medications Cholinesterase inhibitor (increases acetylcholine synthesis): moderate to severe cases. Memantine (Namenda) by mouth (po) daily to twice a day (BID), donepezil (Aricept) po once a day. Improvement within 3 to 6 months. Stop if not effective anymore.

What ethnic groups is thalassemia common in

Mediterranean North American middle eastern and Southeast Asia

Methylprednisolone, 4 mg Triamcinolone, 4 mg Prednisolone, 5 mg Prednisone, 5 mg are high, medium, or low potency corticosteroids?

Medium potency corticosteroids (equipotent doses)

________________Asthma FEV1/PEF >80%, symptoms >2 days/week. SABA & daily low dose ICS

Mild Persistent Asthma

Describe the four different stages of asthma

Mild intermittent- FEV >80 Symptoms <2 days/week Mild persistent- FEV >80 Symptoms >2 days/week Moderate persistent- FEV 60-80 Symptoms daily (but now all day long) Severe persistent- FEV <60 Symptoms all day

How is mild acne treated? How is moderate acne treated?

Mild- Retin A, benzoyl peroxide, clindamycin Start low dose Moderate- Topicals as above Oral tetracycline Minoxycline

___________ TB Disseminated TB disease infecting multiple organ systems, milia seed pattern on x-ray, more common in younger children & elderly

Military

Screening for dementia Mini cog

Mini-Cog" Test Quick method for assessing dementia. If abnormal, screen further with MMSE. Use these two methods: the clock drawing test with word recall test (three unrelated words). Instruct patient to draw a clock and mark it with the hands showing a certain time. Example: Instruct patient to "Draw a clock that shows 20 minutes past 4." -Scoring clock test: Hands point to the correct time and numbers on clock are in correct sequence question will ask you to identify the MMSE "activity" that is being performed.

Part A Match the Medicare part with it's appropriate benefit. A. allows beneficiaries to enroll in a private plan as an alternative to the traditional fee-for-service plan B. covers inpatient and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, nurse practitioner, outpatient, home health, and preventive services.

Most beneficiaries of Part A do not pay a monthly premium but may be responsible for a deductible before Medicare coverage begins. Some individuals who are not entitled to Part A coverage (such as those who did not pay enough Medicare taxes during their working years) have the option to pay a monthly premium for part A benefits. There are several limitations to medicare coverage that are commonly needed by the elderly or those with permanent disabilities. These include coverage for custodial long-term care services either at home or in an institution (such as a nursing home or assisted living facility), routine dental care and dentures, routine vision care and eyeglasses, or hearing exams and hearing aids. Medicare also has significant deductibles and cost-sharing requirements for covered benefits.B. covers inpatient and hospital services

Special "Musculoskeletal" considerations in geriatrics

Musculoskeletal System Kyphosis: Compression fractures of vertebrae (a sign of osteoporosis). Deterioration of articular cartilages common after age of 40. Stiffness in the morning. Osteoarthritis (degenerative joint disease [DJD]) very common. Muscle mass and muscle strength markedly decrease, with more muscle loss on the legs compared with the arms. Osteoporosis and osteopenia common. Slower healing of fractures due to decrease in the number of osteoblasts. Bone resorption is more rapid than bone deposition in women compared with men (4:1)

What is the number one bacteria causing organism in atypical pneumonia

Mycoplasma Pneumoniae

39. (Y/N) Hypertension is associated with the use of anticholinergic agents in older adults

N

Special considerations in geriatrics... "Nails"

Nails Growth slows and become brittle, yellow, and thicker. Longitudinal ridges develop.

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "pain"

Narcotics: Start at lower doses; lasts longer in the elderly.

Atrovent & Spiriva (Anticholinergics): Avoid in pts w/ the following conditions (3)

Narrow-angle glaucoma, BPH, or bladder neck obstruction

Title II for HIPPA establishes what?

National standards for EMR transactions; and national identifiers for providers, insurance companies and employers.

WHAT RACE - leadership and comm service - elders (50+) are the decision makers - illness is an IMBALANCE in life. often w/ family issues - healing is "sacred" - treat white man dz (DM) with white man med and NA dz with NA meds (psych, pain, ETOH) - spiritual

Native american

Failure to do what a reasonable person would do, and resulting in injury to the patient

Negligence

Special considerations in geriatrics "Neuro"

Neurologic System Cranial nerve testing may show differences in ability to differentiate color, papillary response, and decreased corneal reflex. Decreased gag reflex. Deep tendon reflexes may be brisk or absent. Neurological testing may be impaired by medications causing slower reaction times. Benign essential tremor more common

Can assault be committed on an unconscious person?

No

Do law-enforcement agencies, municipal offices or child protective service agencies have to follow HIPPA?

No

Is the scope of practice for nurse practitioners the same across all states?

No

Is a healthcare provider required to report domestic violence?

No (not in most states, but you should offer support)

Normal vision

Normal Difficulty reading or unable to see small print, holds magazine at arm's length in order to read print. This is normal at this age, and it starts during the early 40s (refer to optometrist for prescription glasses).

What ethical principle The Women, Infants, and Children food (WIC) program

Not only for pregnancy and children. It is not open to adults and elderly males. The reason may be that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (affects the brain growth, etc.).

How do you determine the effectiveness of proscar

Obtain PSA and multiple by 2. This value should be under baseline (4).

What type of malpractice An NP who has been retired for 2 years has a claim filed against her for an incident that occurred while she was employed. Since she carried an ______ -based policy, the claim will be covered.

Occurrence

Medicare part B coverage

Outpatient physician services, labs, diagnostic tests, medical equipment and some home health services

What is the only treatment known to prolong life in patients with COPD

Oxygen therapy Should be wore at least 15 hrs a day

What is primary prevention?

P=Promote health before onset of illness: healthy diet, vaccine, avoid tobacco, seatbelts, helmets,

Stages of Pertussis _____________ Stage: severe cough with "whooping" sound, posttussive emesis common

Paroxysmal

What is Medicare Part C

Patients with medicare A and B are eligible to receive all of their health care services through one of the provider organizations under part C (HMO, PPO)

Which SSRI has the highest incidence of ED

Paxil (paroxetine)

CLASSIC CASE & FINDINGS [Clinical Presentation] Coughing illness at least 14 days PLUS paroxysmal coughing, inspiratory whooping (or posttussive vomiting) without apparent cause [Diagnostic testing] Nasopharyngeal swab & PCR for culture Pertussis antibodies by ELISA CBC: elevated WBCs with marked lymphocytosis (>80%) Chest x-ray: Clear

Pertussis

Patient reports sharp localized pain worse with deep breath and movement and cough with CAP symptoms this is likely a _______.

Pleural rub

A person who is designated by the patient, and who has the legal authority to make decisions for the patient. This role is broader and encompasses not only health care decisions but also other areas of the patient's life, such as financial affairs.

Power of attorney

What is the most common cause of hearing loss in the world

Presbycusis

"Ear" considerations in older adults/ geriatrics High-frequency hearing lost first (e.g., speaking voice is high-frequency). Degenerative changes of the ossicles, fewer auditory neurons, and atrophy of the hair cells resulting in sensorineural hearing loss.

Presbycusis (Sensorineural Hearing Loss)

Prolonged pressure and shearing forces over areas of tissue located over bony prominences cause ischemic damage to the skin and underlying tissue. Treatment depends on the stage.

Pressure Ulcers

____________data are the preferred source in research (original study that produced the data). _________studies use randomization. A ____________study describes and measures the interrelationships among the study's variables. A ______________study describes and measures the interrelationships among the study's variables between two groups (or more).

Primary Experimental Correlational Cross-correlational

SOURCES OF DATA

Primary Sources (Preferred) In research, primary sources are preferred. It is the original research where the data came from. Secondary Sources Secondary sources are created when the original data (primary data) are interpreted or analyzed by another person (not the original researcher). Institutional Review Boards (IRBs) An important duty of the IRB is to ensure the rights of human subjects who are participating in research studies in their hospital or clinic. IRBs have the right and responsibility to approve or reject research proposals that are submitted to their institution or hospital. IRB Committee Members The members of the IRB committee are the staff members and others who are affiliated with the institution. The members usually consists of staff members (registered nurses, nurse practitioners, physician assistants, physicians), staff pharmacist and/or affiliated consultants, and research faculty members. The size of the IRB and its members depend on the type of institution. Therefore physicians, clinicians, providers, or retail pharmacists who are not affi liated with the institution are generally not included in an IRB committee. Vulnerable Populations Almost all types of biomedical and behavioral research in the United States require informed consent. Groups considered "vulnerable populations" have additional paperwork and consent requirements. The following groups have special protections and have additional informed consent requirements: ■ Infants and children under the age of 18 years. ■ Pregnant women. ■ Prisoners. ■ Persons at risk for suicide. ■ Persons with impaired decision capacity (e.g., mental retardation, Down's syndrome, etc.).

Factors that decrease risk for falls in eldery

Proper lighting, especially in bathrooms and hallways. Grab bars by the toilet and by the tub/shower, higher level of toilet seat. Regular weight-bearing exercises. Leg strength exercises. Gait training PRN. Tai Chi programs. Exercises to improve balance. Adequate calcium and vitamin D intake. Annual eye exams. Take all meds and vitamins in a "brown bag" to health provider to check.

TYPES OF RESEARCH

Prospective Studies that are done in the present (to the future) time frame. Retrospective Studies done on events that have already occurred (e.g., chart reviews, recall of events). Another name for this study design is "Ex post facto." Longitudinal Studies A long-term study follows the same group of subjects (or a subpopulation) over many years to observe and measure the same variables over time. It is an observational study (there is no manipulation or intervention). For example, the Framingham Heart Study has tracked the same research subjects (N = 5,029) from the town of Framingham, MA. The goal is to study the development and identify the factors that are associated with the development of cerebrovascular disease. Variable A characteristic, an object, or an event that is being measured. Independent Variable The variable that is not affected by the other variables. It is the variable that is manipulated. The result from the manipulation is called the dependent variable. Dependent Variable The variable(s) that is the result of the manipulation of the independent variable.

Most common pneumonia pathogen in patient with Cystic Fibrosis

Pseudomonas Aeruginosa

Macrolide is is associated with and CV risk? (2)

QT prolongation increased risk for Cardiovascular death

Case studies, questions, field studies, observation and ethnographic studies, mostly using interviews and detailed descriptions

Qualitative study

_________________________ Patient outcomes are important indicators of a health system's quality. The goal of these programs is to improve the quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, and increase patient satisfaction.

Quality improvement programs

TYPES OF STUDIES

Quantitative Systematic gathering of data. The study's data are measurable and numerical. Data are evaluated by using statistical methods. Quantitative research is deductive. Qualitative The researcher uses observation and detailed interviews to gather data. Qualitative research is inductive. Identifies phenomena and concepts. Asks broad questions. The study's data are gathered as "words" and not numerical data. Inductive Versus Deductive Reasoning Inductive reasoning is the process of developing a generalization after studying specific information. Deductive reasoning is figuring out a problem after evaluating some broad generalization(s).

__________ zone on PEFR <50% expected, if still in distress after treatment give epinephrine and call 911

Red

Special "Renal" considerations in geriatrics

Renal size and mass decreased by 25% to 30%. The steepest decline in renal mass occurs after the age of 50. Starting at the age of 40 years, the glomerular filtration rate (GFR) starts to decrease. By age 70, up to 30% of renal function is lost. Renal clearance of drugs is less efficient. The serum creatinine is a less reliable indicator of renal function in the elderly due to the decrease in muscle mass, creatine production, and creatinine clearance. Serum creatinine can be in the normal range even if renal function is markedly reduced. The risk of kidney damage from nonsteroidal anti-inflammatory drugs (NSAIDs) is much higher. The renin-angiotensin levels are lower in the elderly.

Informed Consent of Human Subjects

Research subjects must be informed that they have the right to withdraw from the research study at any time without adverse consequences or penalty. There are additional requirements for minors and vulnerable subjects. ■ Description of the study. Inform the subject of what he/she is expected to do (e.g., questionnaires, labs). ■ Describe the risk or the discomforts of participating in the study in the present and the future (if applicable). ■ Describe the benefi ts of participating in the study in the present and the future (if applicable). ■ Discuss the alternatives to the study. ■ Discuss if there is any compensation or reward for participation. ■ Discuss how confidentiality and data will be secured to protect the subject's identity. ■ Give the number and/or email address of the contact for the study so that the subject can contact that person if there are any concerns or problems with the study.

What is a positive kerning sign

Resistance to Lake straightening because a painful hamstrings. Indicates meningitis or inflammation on the lumbar nerve roots

How do Caucasians view eye contact?

Respect, honesty

Perform screening testing (Rinne). Rinne Test Normal if: How is it done:

Rinne Test Normal: AC (air conduction) > than BC (bone conduction). Place handle of tuning fork over the mastoid bone behind the ear, then move the tuning fork to the front of the ear. Instruct patient to indicate when the sound stops on each side. Example: If BC > AC, it is highly suggestive of conductive hearing loss (e.g., cerumenosis, otitis media). Rule out conductive hearing loss. Weber test will also show lateralization (hears better in the affected/bad ear if it is conductive hearing loss).

Factors that increase risk for falls in eldery

Risk Frailness and older age (more common after age 75 years). Postural hypotension. Adverse or side effects from certain medications. Polypharmacy (4 or more drugs). Dementia and cognitive impairment. Neurologic deficits. Chronic illness. Poor eyesight, decreased hearing, decrease in night vision. Balance problems. Use of area rugs, poor fit to shoes/slippers Poor lighting. Lives alone. History of previous falls. UTIs.

Treatment for rheumatoid arthritis

Same treatment as osteoarthritis PLUS systemic steroids, antimalarial (plaquenil) antimetabolics (methotrexate), biologics (humira, embrel)

Screening test

Screening test: Visual field by confrontation.

"Skin" considerations in geriatrics purple-colored patches with well-demarcated edges. Located on the dorsum of the forearms and hands. Lesions eventually resolved over several weeks. Benign.

Senile Purpura

Describe sensitivity and specificity

Sensitivity- screening test that the text individuals who have the disease Specificity- screening test that to text individuals who do not have the disease

Special considerations in geriatrics "Severe Bacterial Infections"

Severe Bacterial Infections Atypical presentation is common. Older adults/elderly with bacteremia or sepsis may be afebrile. About one-third to one-half of people with severe bacterial infections do not develop fever and/or chills. Some present with slightly lower than normal body temperature (less than 37°C or 98.6°F). The white blood count (WBC) can be normal. Atypical presentations also include a sudden decline in mental status (confusion, dementia), the new onset of urine/bowel incontinence, falling, worsening inability to perform activities of daily living (ADLs), and/or loss of appetite. Serious infections include pneumonia, pyelonephritis, bacterial endocarditis, sepsis, and others. The most common infection in older adults (greater than 65 years) is urinary tract infection (UTI).

Drugs With Adverse Effects on Vision

Sildenafil (Viagra): Causes bluish tinge to vision and ischemic optic neuropathy, which causes blindness (permanent). Avoid prescribing if eye problems. If older diabetic, refer for eye examination with ophthalmologist first to find out severity of retinopathy. Consider referring to physician. Anticholinergics (decongestants, antihistamines, etc.): Can precipitate acute-angle glaucoma.

Describe psoriasis

Silvery fine scales

Most common cancer

Skin (Basal cell most common type)

"Skin" considerations in geriatrics

Skin Findings Skin atrophy. Thinner epidermis, dermis, and subdermal fat. Less collagen (less elasticity). Fragile skin and slower healing. Slower nail growth. Lower oil production and drier skin (xerosis) due to decrease in sebaceous and sweat gland activity. Fewer melanocytes leading to graying of hair and vitamin D synthesis. Decrease in the skin's sensory ability.

Who does an NP report abuse either suspected or actual to?

Social services

Flu Vaccine: What types of medications are avoided after receiving the LAIV flu vaccine (intranasalform)

Some ANTIVIRALs (amantadine, rimantadine, zanamivir, or osletamivir) should be AVOIDED "48" HOURS before and "14" DAYS AFTER vaccination because they interfere with antibody production.

What is the most common lung function test used to diagnose and monitor asthma and provides a rapid method to evaluate lungs and airways.

Spirometry

What herb is used to tx depression

St Johns wort

Staging Ulcers Damage to epidermis and dermis. Ulcers are deeper and involve subcutaneous tissue. Base may be red, pink, or yellowish. Ulcer borders are obvious and firm. Fat may be visible. Tendon, bone, or muscle is not visible.

Stage III

The average amount of deviation of values from the mean

Standard deviation

Liability

Standard of care

Special considerations in geriatrics Immunizations "Pneumovax Vaccine" (Pneumococcal Polysaccharide Vaccine)

Start vaccinating healthy older adults at the age of 65 years. The patient needs only one dose per lifetime if healthy. If patient received first vaccine before age 65 years, another dose of the vaccine may be given. .

What law makes scope of practice possible question

State nurse practice act

Normal tactile fremitus ....describe vibrations

Stronger vibrations palpable on the upper lobes and softer on lower lobes

What is an antigen?

Substance capable of inducing an immune response

Mixing warfarin with what other drugs can increase bleeding risk and increase INR

Sulfa drugs

A statistical test to evaluate the differences in means between two groups

T-test

Special considerations in geriatrics Immunizations "Tetanus Vaccine (Td and Tdap) "

Tetanus Vaccine (Td and Tdap) Booster every 10 years. Adults 50 years or older should receive one dose of Tdap regardless of time since last immunization. This is particularly important for adults caring for infants and young children. "pertussis" Tdap can replace one of the regular Td boosters. For contaminated wounds, give a booster if the last one was given 5 years or more before the incident.

If the ferritin level is normal to high the patient has what

Thalassemia

Title II of HIPPA is known as

The administrative simplification (AS) provisions

What varies from state to state with regard to Medicaid?

The benefits offered

What is fidelity?

The duty to be faithful

What is autonomy?

The duty to respect an individuals thoughts and actions

What is incidence?

The frequency with which a disease apears

When is consent not needed

The health plan/insurance company that is paying for the medical care. A third party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor's office hires to assist in payment of their services (e.g., medical billing services). Health care operations (medical services review, sale of health care plan, audits). Collection agency for unpaid bills. Victims of abuse/neglect or domestic violence. No separate consent is needed to consult with other health care providers.

What is required for patient to refuse care?

The patient must have decisional capability (competence)

Hearing

The process of hearing is complex . It involves the brain, cranial nerve VIII (vestibulocochlear nerve), the cochlea, the ossicles, the tympanic membrane, and a patent external ear canal. The area of the brain that is responsible for hearing, memory, and language comprehension is located in the temporal lobes.

Reliability

The results are the same over time

Utilitarianism

The right to act is the one that produces the greatest good for the greatest number

What is the Danforth amendment of 1991?

The right to refuse care

Patients must be advised at the time of their admission to federally funded hospital, nursing home, hospice, HMO etc. that they have what?

The right to refuse care, including any, some, or all care, as long as the patient has decisional capability, or competence

Health Care Personnel Vaccination Recommendations

These recommendations also apply to students who are in training.

Specificity

These screening tests detect individuals who DO NOT have the disease. ■ For example, a POSITIVE HIV ELISA result is ALWAYS "CONFIRMED" with the WESTERN BLOT test, which is very SPECIFIC for HIV antibodies. ■ The WESTERN BLOT is the "CONFIRMATORY test" for HIV. It is better at ruling out a person who does NOT have the disease.

Notes: Colerectal Cancer

These three methods are all acceptable. The screening intervals of each method differ: ■ High-sensitivity FECAL OCCULT blood test (FOBT) × 3 CONSECUTIVE stool samples ANNUALLY. ■ Flexible SIGMOIDoscopy every 5 YEARS. ■ COLONOscopy every 10 YEARS.*

Who gets referred to Hospice?

Those with a terminal dx, will die in next 6 mo.

What patients are at high risk for developing temporal arteritis

Those with polymyalgia rheumatica

Special considerations in geriatrics "leading causes of death" (3)

Three Leading Causes of Death (Greater Than Age 65 Years) 1. Heart disease (myocardial infarction [MI], heart failure, arrythymias). 2. Cancers (lung and colorectal). 3 chronic lower resp infections (COPD)

What are the symptoms associated with a migraine

Throbbing, nausea, photophobia, phonophobia

If the patient has possible aspirin toxicity what might they complain of

Tinnitus

What is Title 2 of HIPAA?

Title II of HIPAA defines policies, procedures and guidelines for *maintaining the privacy and security of individually identifiable health information* as well as outlining numerous offenses relating to health care and sets civil and criminal penalties for violations. It also creates several programs to *control fraud and abuse within the health care system*

What are curanderas?

Treat with herbs, teas, visits to shrines, medals and promises to god,

Treatment for constipation

Treatment Plan Education and behavior modification. Teach "toilet" hygiene such as going to the bathroom at the same time each day; advise not to ignore the urge to defecate. Dietary changes such as eating dried prunes and/or drinking prune juice. Bulk-forming fibers (25-35 g/day) once to twice a day. Take with full glass of water (can cause intestinal obstruction). Increase physical activity. Increase fluid intake from 8 to 10 glasses/day (if no contraindication). Consider laxative treatment ( Table 25.1 ). Avoid using laxatives daily (except for fiber supplements) and chronic treatment with laxatives.

T/F: Inhaled bronchodilators (beta2-agonists or anticholinergics or both) are effective for the treatment of COPD exacerbation.

True

T/F: No taper needed if use is short-term (<10 days) and at lower dose (prednisone, 40-60 mg/d or less)

True

T/F: Pleural inflammation or a pleural friction rub occurs on both inspiration and expiration.

True

T/F: SABAs are the drug of choice for all age groups to relieve acute asthma symptoms including bronchoconstriction and to prevent exercise-induced bronchoconstriction.

True

T/F: The Duration of oral corticosteroids for asthma is usually 5 to 10 days. There is no need to taper the dose for a 7 day course and usually no need to taper for a 10-day course, particularly if a patient is on an inhaled corticosteroid

True

True or False: Seasonal influenza vaccination is generally recommended for all persons over the age of 6 months.

True

True/False: Anemia in children is potentially associated with poorer school performance.

True

True/False: Approximately 90% of the body's erythropoietin is produced by the kideny

True

True/False: Child abuse is present in about half of all homes where partner mistreatment occurs.

True

True/False: The red blood cell content is approximately 90% hemoglobin

True

What is specificity?

True negatives the degree to which those who have a disease screen or test negative

What is sensitivty?

True positives: The degree to which those who have a disease screen or test positive

Drugs: Higher Risk of Adverse Effects (Avoid With Frail/Elderly) "Clinical tip for benzos"

Try to prescribe shorter-acting drugs. For example, for benzodiazepines, Xanax has a shorter effect (half-life of 4 hours) versus that of Valium (can last 12 hours).

An infamous study of 600 African American sharecroppers (1932 to 1972) from Alabama. The men were all tested for syphilis infection and those with positive results were never informed or treated. Due to this study, laws were passed that protect human subjects' rights and mandate informed consent

Tuskegee Syphilis Experiment

Perform screening testing (Tympanogram testing)

Tympanogram If fluid/pus inside middle ear (e.g., otitis media) or cerumen is present, the TM will have little to no mobility. The result will be abnormal (flat line, small peak to no peak on printout result). Diagnostic test: audiometry using soundproof booth (refer to audiologist for testing and hearing aid fitting).

Staging Ulcers Damaged skin with eschar or sloughing that cannot be staged (until the base is visible).

Unstageable/Unclassified:

Establishing a voiding schedule and gentle bladder stretching

Urge Incontinence

Atypical Presentation in Elderly "UTI"

Urinary Tract Infections The most common infection in elderly nursing home residents. Patients usually have no fever or can be asymptomatic. May become acutely confused or agitated. May become septic with mild symptoms. At higher risk of falls. Acute Myocardial Infarction May be asymptomatic. Symptoms may consist of back pain or mild chest pain. Hypothyroidism

Instructions to give females who take accutane

Use 2 forms of BC

How can nurse practitioners bill at 100% of physician rates under Medicare?

Via "incident-to" billing, under the direct personal supervision of a physician who must be present in the same office suite and immediately available.

Homonymous Hemianopsia Plan?

Visual field loss involving either the two left halves (or the two right halves) of the visual field. Most common cause is stroke. There are many types of hemianopsia. Refer to ophthalmologist for evaluation. When placing food or drinks in front of the patient, position on the right side of the tray. Tell patient what is on the tray. Vision training, such as scanning training, compensates for missing visual field.

__________ __________ Almost all types of biomedical and behavioral research in the United States require informed consent. Groups considered __________ have additional paperwork and consent requirements. The following groups have special protections and have additional informed consent requirements: Infants and children under the age of 18 years. Pregnant women. Prisoners. Persons at risk for suicide. Persons with impaired decision capacity (e.g., mental retardation, Down's syndrome, etc.).

Vulnerable Populations

Perform screening testing (Weber) Weber Test Normal if: How is it done:

Weber Test Normal: Sound is heard in both ears. If sound is heard only in one ear, abnormal (lateralization). Place handle of tuning fork between the brows on the forehead. Ask patient if sound is heard on both sides or if the sound is heard in one ear (called lateralization). Example: With cerumenosis, the sound will be lateralized on the "bad" ear (will hear sound better in plugged ear).

Fast Facts

What age group should receive the vaccine? ■ Give a one-time dose at the age of "60" YEARS or older (even if patient already had shingles). ■ The YOUNGEST age that Zostavax can be given is "50" YEARS of age. ■ Varicella vaccine: - Varicella LIVE attenuated virus (Varivax): Given by SC route. Need TWO doses ("4 to 8" WEEKS apart). - Exposure to chickenpox: Give WITHIN "5" DAYS AFTER incident for postexposure prophylaxis. - Acceptable evidence for varicella infection. - WRITTEN documentation of TWO doses of varicella vaccine (at least 28 days apart). - WRITTEN diagnosis of chickenpox or shingles based on health care provider diagnosis. - POSITIVE laboratory varicella TITER. - If born in the United States BEFORE 1980, DO NOT give the vaccine.

Give an example of when the patients right to confidentiality may be overridden

When the patient's condition may endanger others, or when you need to protect the patient from harming themselves or others

What is a positive brudzinski sign

When the patient's neck is bent towards the chest, the patient reflexively flexes the hips and knees to relieve pressure

Perform screening testing (Whisper Test) How is it done:

Whisper Test Stand about 2 feet behind. Occlude one ear (press tragus toward ear). Whisper the alphabet or count numbers. Another option is to rub patient's hair together in front of each ear.

What is required to disclose patient information to an employer, for marketing or advertising, or sharing private notes?

Written permission from the patient

Can patients request a report outlining when and why their health information was shared?

Yes

Does this patient have a reactive TST? A 31 y/o male with HIV and a 6mm induration?

Yes

Does this patient have a reactive TST? A 45 y/o woman with type 2 diabetes mellitus and chest x-ray consistent with previous TB and a 7mm.

Yes

Is a nurse practitioner potentially reliable if a patient is discharged while in the danger of hurting himself or others?

Yes

Are the following a reactive TST: 1.] A 45-year-old woman with type 2 diabetes mellitus and chest radiograph finding consistent with previous TB and a 7-mm induration 2.] A 21-year-old man with no identifiable TB risk factors and a 10-mm induration 3.] A 31-year-old man with HIV and a 6-mm induration 4.] A 45-year-old woman from a country in which TB is endemic who has an 11-mm induration 5.] A 42-year-old woman with rheumatoid arthritis who is taking etanercept (Enbrel) who has a 7-mm induration

Yes No Yes Yes Yes

Is a S4 heart sounds normal in the elderly

Yes, if not associatred with heart issues

Are there any circumstances where informed consent can be assumed?

Yes, in a life-threatening emergency

Can a patient's health information be used or shared without written permission?

Yes, when HIPPA allows

Based on the CURB-65 criteria, indicate which patients should be treated as an inpatient or outpatient? a 56 y/o female with no confusion, BUN=22mg/dL, respiratory rate = 27/min, and blood pressure = 88/56 a. Inpatient b. Outpatient What triggered?

a. Inpatient = score is 2 Trigger(s):BUN=22mg/dl & blood pressure = 88/56 *Score >1 indicates need for hospitalization

based on the CURB-65 criteria, indicate which patients should be treated as an inpatient or outpatient? a 72 y/o male with confusion, BUN=18mg/dL, respiratory rate = 35/min, and blood pressure = 102/66 a. Inpatient b. Outpatient What triggered?

a. Inpatient = score is 3 Trigger(s):confusion, respiratory rate = 35/min, 72 y/o *Score >1 indicates need for hospitalization

identify whether the item has the characteristics of 23-valent pneumococcal polysaccharide vaccine (PPSV23) or 13-valent pneumococcal conjugate vaccine (PCV13) a. routinely used in early childhood ______

a. PCV13

which pneumococcal vaccine offers protection against the greatest number of serotypes? a. Pneumovax b. Prevnar c. PCV7 d. LSIV a. Pneumovax

a. Pneumovax 23 prevnar 13

which of the following is a quality of respiratory fluoroquinolones? a. activity against drug-resistant S. pneumoniae (DRSP) b. poor activity against atypical pathogens c. predominatly hepatic route of elimination d. poor activity against beta-lactamase producing organisms

a. activity against drug-resistant S. pneumoniae (DRSP)

Signs that a patient being treated for CAP is stable and not worsening include: Select all that apply a. afebrile for 48-72hrs b. does not have more than one CAP associated sign clinical instability (^HR, ^RR, hypotension) c. absence of cough d. CXR absence of pneumonia indications

a. afebrile for 48-72hrs b. does not have more than one CAP associated sign clinical instability (^HR, ^RR, hypotension)

a 34 y/o female presents with a 7day hx of cough with no fever or difficulty breathing. She is otherwise healthy. she is producing small amts of yellow-tinged sputum. As part of her tx, you recommend: a. an antitussive, e.g. dextromethorphan b. an antihistamine c. a macrolide antimicrobial d. a beta-lactam antimicrobial

a. an antitussive, e.g. dextromethorphan ACCP guidelines suggest that they are reasonable to use CI in children <8

the primary mechanism of antimicrobial resistance of H. influenzae is through the organism's: a. beta-lactamase production b. hypertrophy of cell membrane c. alteration in protein-binding sites d. failure of DNA gyrase reversal

a. beta-lactamase production

According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a: 28 y/o female with a severe beta-lactam allergy who has a dry cough, headache, malaise, no recent antimicrobial use, and no comorbidity who takes no medication? a. clarithromycin b. amoxicillin c. levofloxacin d. ceftriaxone

a. clarithromycin

which of the following products provides passive immunity? a. hepatitis B immune globulin (HBIG) b. measles, mumps, and rubella (MMR) vaccine c. pneumococcal conjugate vaccine d. live attenuated influenza vaccine (LAIV)

a. hepatitis B immune globulin (HBIG)

you are caring for a 52 y/o male who is currently smoking 1.5ppd, has a 40 year cigarette smoking hx, and has CAP. It is the 3rd day of his antimicrobial therapy, and he is without fever, is well hydrated, and is feeling less SOB. His initial chest x-ray revealed a rt lower lobe infiltrate. Physical exam today reveals peak inspiratory crackles with increased tactile fremitus in the rt posterior thorax. Which of the following represents the most appropriate next step in this pt's care? a. his current plan of care should continue because he is improving by clinical assessment b. a chest x-ray should be taken today to confirm resolution of pneumonia c. given the persistence of abnormal thoracic findings, his antimicrobial therapy should be changed d. a CT scan of the thorax is needed today to image better any potential thoracic abnormalities

a. his current plan of care should continue because he is improving by clinical assessment

which of the following is most likely to appear on a chest x-ray of a person during an acute severe asthma attack? a. hyperinflation b. atelectasis c. consolidation d. Kerley B signs

a. hyperinflation

which of the following statements best describes zanamivir (Relenza) or oselamivir (Tamiflu) use in the care of pts with or at risk for influenza? a. initiation of txment early in acute influenza illness can help minimize the severity of disease when the illness is caused by nonresistant viral strain b. the primary indication is in preventing influenza A during outbreaks c. the drugs are active only against influenza B d. the use of these meds is an acceptable alternative to influenza vaccine

a. initiation of txment early in acute influenza illness can help minimize the severity of disease when the illness is caused by nonresistant viral strain

which of the following statements is true about poliovirus infection? a. it is transmitted via the fecal-oral route b. rates of infection among household contacts are about 30% c. sporadic outbreaks continue to occur in North America d. it is transmitted via aerosol and droplets

a. it is transmitted via the fecal-oral route

when compared with screening for breast cancer, screening for lung cancer results in: a. lower number needed to screen to prevent one death b. approximately the same number needed to screen to prevent one death c. a higher number needed to screen to prevent one death d. a higher percentage of pts identified where cancer can be prevented a. lower number needed to screen to prevent one death

a. lower number needed to screen to prevent one death Screening of high-risk smokers with LDCT is predicted to prevent 1 death from lung ca for every 320 screenings Breast cancer screening with mammogram prevents 1 death for every 780 screened.

which of the following is usually viewed as the most cost-effective form of healthcare? a. primary prevention b. secondary prevention c. tertiary prevention d. cancer-reduction measures

a. primary prevention

when considering an adult's risk for MMR, the NP considers the following: a. pts born before 1957 have a high likelihood of immunity against these disease because of a hx of natural infection b. considerable mortality and morbidity occur with all three diseases c. most cases in the US occur in infants d. the use of the MMR vaccine is often associated with protracted arthralgia

a. pts born before 1957 have a high likelihood of immunity against these disease because of a hx of natural infection

which wound presents the greatest risk for tetanus infection? a. puncture wound obtained while gardening b. laceration obtained while trimming beef c. human bite d. abrasion obtained by falling on a sidewalked

a. puncture wound obtained while gardening

According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a: 69 y/o male with heart failure, prior MI, and type 2 diabetes? a. respiratory fluoroquinolone b. amoxicillin with a beta-lactamase inhibitor c. cephalosporin d. beta-lactam plus macrolide

a. respiratory fluoroquinolone

a 33 y/o female works in a small office with a man recently dx with active pulmonary TB. Which of the following would be the best plan of care for this woman? a. she should receive TB chemoprophylaxis if her TST result is 5mm or more in induration b. because of her age, TB chemoprophylaxis is CI even in the presence of a positive TST result c. if the TST result is positive but the chest X-ray is normal, no further evaluation or tx is needed d. further evaluation is needed only if the TST results is 15mm or more in induration

a. she should receive TB chemoprophylaxis if her TST result is 5mm or more in induration

which of the following statements best describes amantadine or rimantadine use in the care of pts with or at risk for influenza? a. significant resistance to select strains of influenza limits the usefulness of these meds b. the primary action of these txments is in preventing influenza A during outbreaks c. these txments are active against influenza A and B d. the use of these products is an acceptable alternative to influenza vaccine

a. significant resistance to select strains of influenza limits the usefulness of these meds

brief intervention that provides motivation to quit tobacco use should be: a. used at every clinical visit that the tobacco user has, regardless of reason for the visit b. offered when the tobacco user voices concern about the health effects of smoking c. applied primarily during visits for conditions that are clearly related to or exacerbated by tobacco use, such as respiratory tract disease d. when the clinician is conducting a comprehensive health assessment, such as with the annual physical examination

a. used at every clinical visit that the tobacco user has, regardless of reason for the visit

Exam tips When a person is asked to interpret a proverb (given by the NP), it is a test of

abstract thinking. Abstract thinking starts at about age 11 years (early abstract thinking stage). Sample Question A nurse practitioner instructs a patient to copy a square (or spell world backwards, subtract 7 from 100, etc.). Which of the following tests is being performed? A) Minnesota Multiphasic Personality Inventory for personality testing B) CAGE (for alcohol abuse screening in primary care) C) MMSE (correct answer) D) Beck's Inventory (a depression screening tool) The correct answer is Option C, the MMSE

What is the NPs repayment percentage?

at 85% of physician schedule

Choosing an antimicrobial with activity against __________________(M. pneumoniae, C. pneumoniae, Legionella species) and gram-positive and gram-negative organisms (S. pneumoniae, H. influenzaeif patient risk is present) helps ensure optimal outcome.

atypical organisms

a healthy 6 y/o girl presents for care. her parents request that she receive vaccination for influenza and report that she has not received this vaccine in the past. how many doses of influenza vaccine should she receive this flu season? a. 1 b. 2 c. 3 d. 4

b. 2 and spaced four weeks apart

according to the ATS/IDSA guidelines, what is the usual length of antimicrobial tx for the tx of CAP for outpatients? a. less than 5 days b. 5-7 days c. 7-10 days d. 10-14 days

b. 5-7 days

Based on the CURB-65 criteria, indicate which patients should be treated as an inpatient or outpatient? a 47 y/o male with no confusion, BUN=17mg/dL, respiratory rate = 32/min, and blood pressure = 110/72 a. Inpatient b. Outpatient What triggered?

b. Outpatient = score is 1 Trigger: respiratory rate = 32/min *Score >1 indicates need for hospitalization

identify whether the item has the characteristics of 23-valent pneumococcal polysaccharide vaccine (PPSV23) or 13-valent pneumococcal conjugate vaccine (PCV13) b. use is associated with greater immunogenicity_____

b. PCV13

which of the following is not recommended to receive the MMR vaccination? a. a 1 yr old boy with a hx of hive-form reaction egg ingestion b. a 24 y/o woman who is 20 weeks pregnant c. a 4 yr old girl who was born at 32 weeks of gestation d. a 32 y/o woman who is breastfeeding a 2 week old

b. a 24 y/o woman who is 20 weeks pregnant

of the following, who is at greatest risk for invasive pneumococcal infection? a. a 68 y/o man with chronic obstructive pulmonary disease b. a 34 y/o woman who underwent splenectomy after a motor vehicle accident c. a 50 y/o man with a 15 yr hx of type 2 diabetes d. a 75 y/o woman with decreased mobility as a result of severe osteoporosis

b. a 34 y/o woman who underwent splenectomy after a motor vehicle accident

all of the following pts received pneumococcal vaccine 5 yrs ago. who is a candidate for receiving a second dose of antipneumococcal immunization at this time? a. 45 y/o man who is a cigarette smoker b. a 66 y/o woman with COPD c. a 35 y/o man with moderate persistent asthma d. a 72 y.o woman with no chronic health problems

b. a 66 y/o woman with COPD

tertiary prevention measures for a 69 y/o woman with heart failure include: a. administering antipneumococcal vaccine b. adjusting txment to minimize dyspnea c. surveying skin for precancerous lesions d. reviewing safe handling of food

b. adjusting txment to minimize dyspnea

common sxs of CAP in otherwise well adults include all of the following EXCEPT: a. cough b. altered mental status c. dyspnea d. pleuritic chest pain

b. altered mental status

when working with a middle aged- man with a body mass index of 33 kg/m2 on wt reduction, an NP considers that one of the first actions should be to: a. add an exercise program while minimizing the need for dietary changes b. ask the pt about what he believes contributes to his wt issues c. refer the pt to a nutritionist for diet counseling d. ask for a commitment to lose wt

b. ask the pt about what he believes contributes to his wt issues

hepatitis B vaccine should not be given to a person with a hx of anaphylactic reaction to: a. egg b. baker's yeast c. neomycin d. streptomycin

b. baker's yeast

which of the following represents the food or beverage that is least likely to be contaminated with the hepatitis A virus? a. lettuce salad b. bowl of hot soup c. plate of peeled mango d. glass of ice tea

b. bowl of hot soup

an example of a primary prevention measure for a 78 y/o man with COPD is: a. reviewing the use of prescribed meds b. conducting a home survey to minimize fall risk c. checking FEV1 (forced expired volume at 1 second) to FVC (forced vital capacity) ratio d. ordering fecal occult blood test (FOBT)

b. conducting a home survey to minimize fall risk

during an office visit, a 38 y/o woman states, I drink way too much but do not know what to do to stop. according to the stages of change transtheorectical model, her statement is most consistent with a person at the stage of: a. precontemplation b. contemplation c. preparation d. action

b. contemplation

in the tx of asthma, leukotriene receptor antagonist should be used as: a. controllers to prevent bronchospasm b. controllers to inhibit inflammatory responses c. relievers to tx acute bronchospasm d. relievers to tx bronchospasm and inflammation

b. controllers to inhibit inflammatory responses

an 18 y/o woman with allergic rhinitis presents for primary care. she is sexually active with a male partner and is 1 yr post-coitarche; during this time she had had two sex partners. an example of a primary prevention activity for this pt is: a. screening for sexually transmitted infection b. counseling about safer sexual practices c. prescribing therapies for minimizing allergy d. obtaining a liquid-based Pat test

b. counseling about safer sexual practices

Shirley is a 29 y/o with moderate persistent asthma. She is not using prescribed inhaled corticosteroids, but is using albuterol PRN to relieve her cough and wheeze with reported satisfactory clinical effect. Currently she uses about 2 albuterol metered-dose inhalers per month and is requesting a prescription refill. You consider: a. her asthma is well controlled and albuterol use can continue b. excessive albuterol use is a risk factor for asthma death c. her asthma is not well controlled and salmeterol should be added to relieve bronchospasm and reduce her albuterol use d. her asthma has better control with albuterol than inhaled corticosteroids

b. excessive albuterol use is a risk factor for asthma death

a 22 y/o man is starting a job in a college health center and needs proof of German measles. measles, and mumps immunity. he received childhood immunizations and supplies documentation of MMR vaccination at age 1.5 yrs. your best response is to: a. obtain rubella, measles (rubeola) and mumps titers b. give MMR immunization now c. advise him to obtain IG if he has been exposed to measles or rubella d. advise him to avoid individuals with skin rashes

b. give MMR immunization now

According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a: 78 y/o female with a hx of COPD, hypertension, and dyslipidemia who is taking lovastatin and a dihydroppyridine calcium channel blocker? a. clindamycin b. high-dose amoxicillin with doxycycline c. clarithromycin d. ceftriaxone

b. high-dose amoxicillin with doxycycline

a 36- y/o male with asthma also need antihypertensive therapy. Which of the following products should you try to avoid? a. hydrochlorothiazide (thiazide) b. propranolol (beta-blocker) c. amlodipine (calcium channel blocker) d. enalapril (ACEi)

b. propranolol (beta-blocker)

Peak expiratory flow meters: a. should only be used in the presence of a medical professional b. provide a convenient method to check lung function at home c. are as accurate as spirometry d. should not be used more than once daily

b. provide a convenient method to check lung function at home

the use of FDA approved pharmacologic intervention in tobacco use: a. makes little difference in smoking cessation rates b. reliably increases long-term smoking abstinence rates c. is helpful but generally poorly tolerated d. poses a greater risk to health than continued tobacco use

b. reliably increases long-term smoking abstinence rates

the most common mode of influenza virus transmission is via: a. contact with a contaminated surface b. respiratory droplet c. saliva contact d. skin-to-skin contact

b. respiratory droplet

which of the following best describes the mechanism of transmission in an atypical pneumonia pathogen? a. microaspiration b. respiratory droplet c. surface contamination d. aerosolized contaminated water

b. respiratory droplet

concerning the MMR vaccine, which of the following is true? a. the link between use of MMR vaccine and childhood autism has been firmly established. b. there is no credible scientific evidence that MMR use increases the risk of autism c. the use of the combined vaccine is associated with increased autism risk, but giving the vaccine's three components as separate vaccines minimizes this risk d. the vaccine contains thimerosal, a mercury derivative

b. there is no credible scientific evidence that MMR use increases the risk of autism

subcutaneous immunotherapy is recommended for use in pts: a. w/well-controlled asthma and infrequent exacerbations b. with allergic-based asthma c. w/ moderate persistent asthma who are intolerant of ICS d. w/ poorly-controlled asthma who fail therapy w/ omalizumab

b. with allergic-based asthma

after inhaled corticosteroid is initiated, improvement in control is usually seen: a. on the first day b. within 2-8 days c. in about 3-4 weeks d. in about 1-2 months

b. within 2-8 days

a sedentary, obese 52 y/o woman is dx with HTN and states, it is going to be too hard to diet, exercise, and take these pills. what is the LEAST helpful response to her statement? a. try taking your medications when you brush your teeth b. you really need to try to improve your health c. tell me what you feel will get in your way of improving your health d. could you start with reducing the amt of salty foods in your diet?

b. you really need to try to improve your health

guidelines from the National Comprehensive Cancer Network (NCCN) recommend screening high risk smokers beginning at age: a. 40 yrs b. 45 yrs c. 50 yrs d. 55 yrs

c. 50 yr

which of the following should not receive vaccination against influenza? a. 19 y/o with a hx of hive-form reaction to eating eggs b. a 24 y/o woman who is 8 wks pregnant c. a 4 months old infant who was born at 32 weeks of gestation d. a 28 y/o woman who is breastfeeding a 2 week old

c. a 4 months old infant who was born at 32 weeks of gestation

you examine a 28 y/o female who has emigrated from a country where TB is endemic. She has documentation of receiving Bacille CalmetteGuerin (BCG) vaccine as a child. with this information, you consider that: a. she will always have a positive TB skin test (TST) result b. biannual chest x-rays are needed to assess her health status accurately c. a TST finding of 10mm or more induration should be considered a positive result d. isoniazid therapy should be given for 6 months before TSTS is undertaken

c. a TST finding of 10mm or more induration shuld be considered a positive result

the mechanism of resistance of DRSP is through the cell's a. beta-lactamase production b. hypertrophy of cell membrane c. alteration in protein-binding sites d. failure of DNA gyrase reversal

c. alteration in protein-binding sites

in the US, what proportion of all reported hepatitis A cases have no specific risk factor identified? a. approximately 25% b. approximately 50% c. approximately 75% d. nearly 100%

c. approximately 75%

an 18 y/o high school senior presents, asking for a letter stating that he should not participate in gym class because he has asthma. the most appropriate action is to: a. write the note because gym class participation could trigger asthma sxs b. excuse him from outdoor activities only to avoid pollen exposure c. assess his level of asthma control and make changes in his tx plan if needed so he can participate d. write a note excusing him from gym until his f/u exam in 2 months

c. assess his level of asthma control and make changes in his tx plan if needed so he can participate

which of the following is a recommended method of annual colorectal cancer screening for a 62 y/o man? a. digital rectal examination b. in-office fecal occult blood test (FOBT) c. at home FOBT d. sigmoidoscopy

c. at home FOBT

The NAEPP EPR 3 guidelines recommend achieving and maintaing controll for how long before trying to step down? a. one month b. two months c. at least three months d. six months

c. at least three months

a 44 y/o woman with asthma presents asking for a flue shot. she is seen today for an urgent care visit, is dx with a lower urinary tract infection and is prescribed trimethroprim-sulfamethoxazole. she is without fever or GI upset with stable respiratory status. you inform her that she: a. should return for the immunization after completing her antibiotic txment b. would likely develop a significant reaction if immunized today c. can receive the immunization today d. is not a candidate for any form of influenza vaccine

c. can receive the immunization today

which of the following best describes asthma? a. intermittent airway inflammation with occasional bronchospasm b. a disease of bronchospasm that leads to airway inflammation c. chronic airway inflammation with superimposed bronchospasm d. relatively fixed airway constriction

c. chronic airway inflammation with superimposed bronchospasm

risk factors for pneumonia caused by P. aeruginosa include all of the following EXCEPT: a. mechanical ventilation b. cystic fibrosis c. community residence d. chronic tracheostomy

c. community residence

clinical findings characteristic of asthma include all of the following except: a. recurrent spasmodic cough that is worse at night b. recurrent SOB and chest tightness with exercise c. congested cough that is worse during the day d. wheezing with and without associated respiratory infections

c. congested cough that is worse during the day

findings of increased tactile fremitus and dullness to percussion at the rt lung base in the person with CAP likely indicate an area of: a. atelectasis b. pneumothorax c. consolidation d. cavitation

c. consolidation

According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for tx of CAP in a: 46 y/o well female with a hx of a bilateral tubal ligation who is macrolide intolerant? a. clarithromycin b. amoxicillin c. doxycyline d. fosfomycin

c. doxycyline

which of the following characteristics applies to macrolides? a. consistent activity against DRSP b. contraindicated in pregnancy c. effective against atypical pathogens d. unstable in the presence of beta-lactamase

c. effective against atypical pathogens Legionella species chlamydophila pneumoniae mycoplasma pneumoniae

which of the following types of cancer screening is not routinely recommended in a 55 y/o woman? a. breast b. skin c. endometrial d. colorectal

c. endometrial

which of the following is an example of a primary prevention activity in a 76 y/o woman with osteoporosis? a. bisphosphonate tx b. calcium supplementation c. ensuring adequate illumination in the home d. use of a back brace

c. ensuring adequate illumination in the home

you see a 48 y/o pt who started taking varenicline (chantix) 4 wks ago to aid in smoking cessation. which of the following is most important question to ask during today's visit? a. how many cigarettes a day are you currently smoking? b. on a scale of 0-10 how strong is your desire to smoke? c. have you noticed any changes in your mood? d. are you having any trouble sleeping?

c. have you noticed any changes in your mood?

all of the following antimicrobial strategies help facilitate the development of resistant pathogens EXCEPT: a. longer course of therapy b. lower antimicrobial dosage c. higher antimicrobial dosage d. prescribing a broader spectrum agent

c. higher antimicrobial dosage

of the following, the most common route of hepatitis A virus (HAV) transmission is: a. needle sharing b. raw shellfish ingestion c. ingestion of contaminated food or water d. exposure to blood and body fluids

c. ingestion of contaminated food or water

which of the following is the therapeutic objective of using inhaled Ipratropium bromide? a. as an intiinflammatory b. an increase in vagal tone in the airway c. inhibition of muscarinic cholinergic receptors d. an increase in salivary and mucous secreation

c. inhibition of muscarinic cholinergic receptors

when advising a pt about the influenza nasal spray vaccine,t he NP considers the following: a. its use is acceptable during pregnancy b. its use is limited to children younger than 6 yrs c. it contains live, attenuated virus d. this is the preferred method of influenza protection in the presence of airway disease

c. it contains live, attenuated virus

criteria to distinguish if pneumonia is CAP include all of the following EXCEPT: a. lives in the community b. not a resident of a long-term care facility c. no prior antimicrobial use in the previous 3 months d. no recent hospitalization

c. no prior antimicrobial use in the previous 3 months

which of the following most accurately describes sputum analysis in the evaluation of the person with CAP? a. gram stain is routinely advised b. antimicrobial therapy should not be initiated until sputum specimen for culture has been obtained c. sputum analysis is not recommended in the majority of pts with CAP d. if required, chest physical therapy can be used to facilitate sputum production

c. sputum analysis is not recommended in the majority of pts with CAP

an 18 y/o man has no primary tetanus immunization series documented. which of the following represents the immunization needed? a. 3 doses of diphtheria, tetanus, and acellular pertussis (DTaP)vaccine 2 months apart b. tetanus IG now and two doses of tetanus-diphtheria (Td) vaccine 1 month apart c. tetanus, diphtheria, and acellular pertussis (tdap) vaccine now with a dose of Td vaccine in 1 and 6 months d. Td vaccine as a single dose

c. tetanus, diphtheria, and acellular pertussis (tdap) vaccine now with a dose of Td vaccine in 1 and 6 months

concerning hepatitis B virus (HBV) vaccine, which of the following is true? a. the vaccine contains live, whole HBV b. adults should routinely have anti-hepatitis B surface antibody titers measured after three doses of vaccine c. the vaccine should be offered during txment for sexually transmitted diseases in unimmunized adults d. serologic testing for hepatitis B surface antigen (HBsAg) should be done before hepatitis B vaccination is initiated in adults

c. the vaccine should be offered during txment for sexually transmitted diseases in unimmunized adults

influenza protection options for a 62 y/o man with HTN, dyslipidemia, and type 2 diabetes include receiving: a. live attenuated influenza vaccine via nasal spray b. high-dose trivalent inactivated vaccine (TIV) via intramuscular injection c. trivalent inactivated vaccine (TIV) in standard dose via intramuscular injection d. appropriate antiviral medication as the initial onset of influenza-like illness

c. trivalent inactivated vaccine (TIV) in standard dose via intramuscular injection

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD guidelines, the goal of inhaled corticosteroid use in stage III or severe COPD is to: A. minimize the risk of repeated exacerbation. B. improve cardiac function. C. reverse alveolar hypertrophy D. help mobilize secretions

corticosteroid use in stage III or severe COPD is to: A. minimize the risk of repeated exacerbation.

diphteria is caused by the

corynebacterium diphtheriae, a gram negative bacillus and transmitted typically via person to person via respiratory droplets

which of the following women should have screening for cervical cancer? a. 18 y/o who has a hx of genital warts b. 17 y.o with coitarche 3 yrs ago and four male sexual partners c. an 80 y/o with heart failure and a remote hx of normal Pap test results d. a 21 y/o who has had one male sexual partner and consistent condom use

d. a 21 y/o who has had one male sexual partner and consistent condom use

all of the following individuals have not received vaccination against HBV. the vaccine should not be given in which of the following pts? a. 35 y/o man with multiple sclerosis b. 25 y/o woman with a past hx of Guillain-Barre syndrome c. a 48 y/o woman with systemic lupus d. a 28 y/o man who is acutely ill with bacterial meningitis

d. a 28 y/o man who is acutely ill with bacterial meningitis

while seeing a 62 y/o who is hospitalized with CAP, the NP considers that: a. pneumococcal vaccine should be given when antimicrobial therapy has been completed b. pneumococcal vaccine can be given today, and influenza vaccine can be given in 2 wks c. influenza vaccine can be given today, and pneumococcal vaccine can be given in 2 wks d. influenza and pneumococcal vaccines should be given today

d. influenza and pneumococcal vaccines should be given today

when advising an adult pt about pneumococcal immunization, the NP considers the following about the vaccine: a. the vaccine contains inactivated bacteria b. its use is contraindicated in individuals with asthma c. it protects against community-acquired pneumonia caused by atypical pathogens d. its use is seldom associated with significant adverse reactions

d. its use is seldom associated with significant adverse reactions

Compared with TST, potential advantages of the QuantiFERON-TB Gold test (QTF-G) include all of the following EXCEPT: a. ability to have entire testing process complete with one clinical visit b. results are available within 24 hrs c. interpretation of test is not subject to reader bias d. provides a prediction as to who is at greatest risk for active disease development

d. provides a prediction as to who is at greatest risk for active disease development

you see a woman who has been sexually active with a man newly dx with acute hepatitis B. she has not received hepatitis B vaccine in the past. you advise her that she should: a. start a hepatitis b immunization series b. limit the number of sexual partners she has c be tested for hepatitis B surface antibody (HBsAb) d. receive hepatitis B immune globulin (HBIG) and hepatitis B immunization series

d. receive hepatitis B immune globulin (HBIG) and hepatitis B immunization series

According to the National Asthma Education and Prevention Program Expert Panel Report-3 guidelines, which of the following is NOT a risk for asthma death? a. hospitalization or an emergency department visit for asthma in the past month b. current use of systemic corticosteroids or recent withdrawal from systemic corticosteroids c. difficulty perceiving airflow obstruction or its severity

d. rural residence

93. Is delirium or dementia most likely associated with the use of medications with anticholinergic effects

delirium

the FDA has added a warning regarding the use of varenicline (chantix), specifically for those with

depressed mood, agitation, changes in behavior, suicidal ideation and suicide

What ethical principle? Respect for human dignity is an important aspect of medical ethics. A person's religious, personal, and cultural beliefs can influence greatly what a person considers "dignified" treatment.

dignity

MMR vaccine is safe to due during lactation but its use during pregnancy is

discouraged

A decrease in ___________predicted best or peak expiratory flow rate (PEFR) is usually noted before the onset of clinical obstructive findings.

forced expiratory volume at 1 second (FEV1 )

Identify the following organisms as a gram +, gram -, or a atypical pathogen: -Streptococcus pneumoniae

gram positive

ROM is preserved in bursitis, instead..

just limited by pain

_______ tuberculosis—that is, positive tuberculin test results, but negative chest radiograph results and no suspicion of disease revealed by health history or physical examination.

latent

__________=tennis elbow -pt c/o pain over outer aspects of lower humerus - pain worsens w/wrist and "elbow" extension -weak "hand grip" of affected side

lateral epicondylitis

When considering the use of _________ for CAP, it is important to note that these agents are associated with QTc interval prolongation and risk for torsades de pointes. This is a result of a metabolic interaction potential (drug-drug interactions) as well as an intrinsic arrhythmogenic capability of these agents.

macrolides

The symbol to indicate the number of subjects in the group.

n

Indicate (yes or no)if each of the following is eligible for Medicare A 68 year old undocumented resident.

no Individuals aged 65 and over are eligible for Medicare if they are a US citizen or permanent legal resident regardless of prior medical history, comorbidities, income, or assets. Persons younger than 65 years with permanent disabilities are eligible for Medicare after receiving Social Security Disability Income payments for 24 months. Some conditions, such as end stage renal disease or Lou Gehrig's disease, allow immediate eligibility for Medicare without waiting through 24 months of SSDI payments.

Omalizumab (Xolair) is delivered by ___________ and acts by selectively binding to_____, reducing _____, _____ and ______. **this medication requires specialized evaluation prior to initiation and ongoing monitoring during its use.

subcutaneous injection IgE exacerbations, symptoms, and corticosteroid use

Adjusting as pt with COPD medication is a example of what type of prevention?

tertiary

Why are M. pneumoniae, C. pneumoniae, and Legionella species referred to as atypical?

they are not detectable via gram stain, cannot be cultured on standard bacterial media, and clinically do not present with a classic pneumonia presentation

the organization that does the processing of claims and administrative work for another company (health insurer, health plans, retirement plans).

third-party administrator (TPA)

the onset of action for a SABA is within_____ minutes and the duration is ______hrs

within 15 minutes and the duration is 4-6 hrs

_________ zone on PEFR 50-80% expected volume, increase therapy or in acute exacerbation

yellow

Are the lungs hyperinflated on a chest radiograph due to significant air trapping in asthma?

yes

Indicate (yes or no)if each of the following is eligible for Medicare A 72 year old permanent legal resident (non-US citizen)

yes

Would the following be present in acute epididymitis (Yes/no)? Irritative voiding symptoms Penile discharge Ulcerative lesion Scrotal swelling Boggy prostate Epididymoorchitis in later stages of the disease

yes yes no yes no yes

Risk Factors for Death from Asthma (many)

• Infants <1 year old • Previous severe exacerbations • ≥2 hospitalizations in past year • ≥3 ED visits in past year • Hospitalization/ED visit in past month • > 2 canisters SABA use per month • Poor patient perception of symptoms • Lack of written asthma care plan • Sensitivity to Alternaria • Low socioeconomic status • Illicit drug use • Major psychosocial problems • Comorbidities (CV disease, Other chronic lung disease) • Major psychological disease

* 2007 IDSA/ATS Guidelines for Tx of Pneumonia Previously health NO antibiotic exposure in the last 3 months:

• Macrolide x 5 days (azithromycin or clarithromycin) unless macrolide resistant S. pneumo is > 25% • Or Doxycycline BID daily • Discourage quinolone use initially!

2007 Guidelines for Treatment of Pneumonia If DRSP is suspected:

• Respiratory Quinolone x 5 days OR • Beta-lactam (any PCN or ceph) plus macrolide • Beta-lactam plus doxycycline

NO Routine Screening

■ Age GREATER than 65 years: NO ROUTINE PAP screening (if history of PRIOR screening and NO RISK FACTOR for cervical CANCER).

Most common type of SKIN cancer

■ BASAL CELL cancer (but melanoma causes 75% of deaths from skin cancers)

CERVICAL Cancer

■ BASELINE Pap smear/liquid cytology: START at age 21 YEARS THEN every 3 YEARS until age 65 YEARS

Colorectal Cancer

■ BASELINE: START at age 50 YEARS until the age of 75 YEARS (OLDER age is the most COMMON risk factor). ■ Age 76 to 85 YEARS: AGAINST routine screening but "there may be considerations." INDIVIDUALIZE. ■ OLDER than age 85 years: AGAINST screening for colorectal cancer.

MAMMOGRAM

■ DO NOT perform ROUTINE MAMMOGRAM 75 YEARS or older. Insufficient evidence.

LAIV Safety Issues

■ Do NOT give ASPIRIN to children within the "4" WEEKS FOLLOWING vaccination.

Tetanus Vaccine

■ Give every "10" YEARS for LIFETIME. ■ BOOSTERS: For "dirty"/contaminated WOUNDS, give a booster if the LAST dose was MORE than "5" YEARS prior. ■ Age "7" YEARS and OLDER: Use only tetanus and diphtheria (TD) and tetanus, diphtheria, and acellular pertussis (TDAP) forms of the vaccine. ■ Td: Given by IM route. Start using this form at the age of "7" YEARS. ■ Tdap: Given by IM route. Safety Issue AVOID if EGG allergy or history of GUILLIAN-Barré syndrome.

Colorectal Cancer: RISK factors

■ History of FAMILIAL polyposis (multiple POLYPS on colon). ■ FIRST-degree RELATIVE with colon cancer. ■ CROHN's disease (ULCERATIVE colitis).

Emancipated Minor Criteria

■ Legal court document declaring that the minor is an "emancipated minor." ■ Active duty in the U.S. military. ■ Legally binding marriage (or divorced from a legally binding marriage).

Cervical Cancer: RISK factors

■ MULTIPLE sex partners (defined as GREATER than FOUR lifetime partners). ■ YOUNGER age ONSET of sex (IMMATURE cervix easier to INFECT). ■ IMMUNOsupression and SMOKING.

Sexually Transmitted Infections or STDs: RISK factors

■ MULTIPLE sexual partners. ■ EARLIER age ONSET of sex. ■ NEW partners (defined as less than 3 months). ■ History of STD. ■ HOMELESSNESS.

Breast Cancer: RISK factors

■ Older AGE: Greater than 50 YEARS (MOST COMMON risk factor). ■ Previous HISTORY of breast cancer. ■ TWO or MORE FIRST-degree RELATIVES with breast cancer. ■ EARLY menarche, LATE menopause, NULLIPARITY (LONGER exposure to ESTROGEN). ■ OBESITY (ADIPOSE tissue can synthesize SMALL amounts of ESTROGEN).

LAIV Contraindictions

■ PREGNANCY ■ CHRONIC DISEASES (i.e., asthma, COPD, renal failure, diabetes, immunosuppression). ■ CONTRAindicated in children on ASPIRIN therapy (age "2" to "17" YEARS.

Which wounds are considered as HIGHEST RISK for TETANUS infection?

■ PUNCTURE wounds wounds with DEVITALIZED tissue ■ SOIL-contaminated wounds ■ CRUSH injuries and others

Pneumococcal Vaccine

■ Pneumococcal vaccine polyvalent (Pneumovax-23): Given by IM route. ■ Age "65" YEARS or OLDER and persons at HIGH risk: Give ONE dose for a lifetime.

Exam Tips

■ Primary data are the preferred source in research (original study that produced the data). ■ Experimental studies use randomization. ■ A correlational study describes and measures the interrelationships among the study's variables. ■ A cross-correlational study describes and measures the interrelationships among the study's variables between two groups (or more). ■ Definition of a cohort study, case study. ■ What is a dependent or independent variable? ■ Which groups are considered vulnerable populations? ■ Definition of an IRB's role. ■ Any staff or consultant of the hospital can become a member of the IRB. Community-based health professionals (e.g., retail pharmacist) cannot be part of an IRB (unless they are hired as consultants). ■ Define a longitudinal study, descriptive study. ■ The IRB's most important role is to protect the rights of the human subjects enrolled in the study. ■ Definition of assent. Assent refers to minors because they legally cannot give consent (unless an emancipated minor). ■ Definition of an emancipated minor. ■ What is the significance level (the α or the p-value)? It is usually set at either p <.05 or p <.01. A significance level of p <.05 means that there is a 5% probability that the data from the study are due to chance. ■ Learn defi nition of "median."

Zoster vaccine (Zostavax) for SHINGLES

■ The SHINGLES vaccine can be administered to persons EVEN IF they NEVER had a CHICKENPOX infection. However, if a person had SHINGLES BEFORE, the vaccine CAN STILL be administered. Certain ANTIVIRALS (acyclovir, famciclovir, valacyclovir) can DECREASE IMMUNOLOGIC response if taken "24" HOURS BEFORE or "14" DAYS AFTER vaccination. May cause EXACERBATION of ASTHMA and polymyalgia rheumatica (PMR).

Prostate Cancer* PSA= SURVEILLANCE testing

■ The USPSTF does NOT recommend prostate-specific antigen (PSA) screening for PROSTATE cancer. The new recommendation "applies to men in the general U.S. population, regardless of age." ■ EXCEPTION: Males DIAGNOSED or undergoing TREATMENT for prostate cancer (PSA test for SURVEILLANCE.

Flu Vaccines (Injection Forms)

■ Trivalent INactivated influenza vaccine (TIV form): give by intramuscular (IM) injection. ■ FLUZONE intradermal formulation: Give by INTRADERMAL route. Safety Issues AVOID if severe EGG ALLERGY, GENTAmicin or GELATIN allergy, or in children or adolescents receiving concomitant ASPIRINor ASPIRIN-containing therapy.

SHINGLES/Zoster vaccine (Zostavax)

■ Zoster vaccine (Zostavax) is a LIVE attenuated virus vaccine (LAIV). ■ Age "60" YEARS: give ONE-time dose SC.

Statistical Terms

■ α: Also known as the signifi cance level or the "p-value." It is usually set as either p <.05 or p <.01. A significance level of p <.05 means that there is a 5% probability that the data from the study are due to chance. A significance level of p <.01 means that there is only a 1% probability that the data from the study are due to chance. Therefore, an α of p <.01 is "better" than an α of p <.05. ■ Control group: The subjects in an experiment who do not receive treatment. ■ Hypothesis: The proposed explanation for (or prediction of ) a phenomenon. ■ Median: The numerical value separating the higher half from the lower half. The middle value in a list of numbers. The numbers are sorted from the lowest to the highest value. ■ Mode: The most common value in a list of numbers. ■ N: The symbol to indicate the total size of the sample. ■ n: The symbol to indicate the number of subjects in the group. ■ Significance level: Also known as the "α" or a "p-value." It is the probability that the study results are due to chance. The p-value is usually set at either p <.05 or p <.01. ■ Null hypothesis: There is no significant relation between the variables of the study. If the null hypothesis is rejected, it means that the results of the study are not due to chance.