D115 - OA readiness
Which of the following characteristics applies to type 2 diabetes mellitus? A) Major risk factors are heredity and obesity B) Pear-shaped body type is commonly found C) Exogenous insulin is needed for control of the disease D) Physical activity increases insulin resistance
A) Major risk factors are heredity and obesity Risk factors of type 2 DM include increasing age, obesity, race, and genetics.
pancytopenia
deficiency of all types of blood cells
azotemia or uremia
A condition where there is abnormally high levels of waste products in the blood due to kidney failure. This causes cramping of legs, headache, extreme tiredness, and vomiting.
glomerulonephritis
A disease that causes damage to the kidneys and interferes with their ability to remove waste. Symptoms include hematuria, rash, joint pain, and difficulty breathing. The exact cause of glomerulonephritis is not always known, but an inciting event triggers an immune response in the body that sets off a chain of responses, causing inflammation of the glomeruli. Some of the known inciting events include infections such as strep throat, impetigo, or bacterial endocarditis. Other infections that may cause glomerulonephritis include HIV, hepatitis B, and hepatitis C. Autoimmune diseases such as lupus, Goodpasture's syndrome, and IgA nephropathy may also cause inflammation of the glomeruli.
serum albumin
Albumin helps move many small molecules through the blood, including bilirubin, calcium, progesterone, and medicines.Abnormal low amounts may suggest a problem with the liver or kidneys. Abnormal high amounts may indicate dehydration or severe diarrhea. The normal range is 3.4 to 5.4 g/dL
CRP (C-reactive protein)
A substance produced by the liver that increases in the presence of inflammation in the body. normal results less than 3-10 mg/L
intrinsic factor
A substance produced by the mucosa of the stomach and intestines that is essential for the absorption of vitamin B12.
The FNP is seeing a 10 year old child with complaints of otalgia and muffled hearing. The mother states the child recently recovered from an upper respiratory infection. The FNP suspects that this child has: A) Acute otitis media B) Acute otitis externa C) Cholesteatoma D) Chronic otitis media
A) Acute otitis media The classic presentation of otitis media is otalgia, muffled hearing, popping sensation, and a recent history of a cold or flare up of allergic rhinitis.
When explaining the types of adaptive immunity, the FNP student is aware that: A) Adaptive immunity is a cell-mediated immune response which is B) Adaptive immunity is the level of immunity that all persons are born with. C) Adaptive immunity occurs when antibodies are passed from the mother to the fetus. D) Adaptive immunity occurs through immunization.
A) Adaptive immunity is a cell-mediated immune response which is carried out by T cells and B cells. There are two types of adaptive immunity responses: the cell-mediated immune response, which is carried out by T cells, and the humoral immune response, which is controlled by activated B cells and antibodies.
A 45-year-old male patient with altered testosterone levels needs treatment. An advanced practice registered nurse (APRN) is aware that three factors affect hormone target cell responses when determining a treatment approach. Which factor should be considered by the APRN? A) Affinity of receptor for the hormones B) Limited number of target cell receptors C) Change of target cell sensitivity D) Limited concentration of organs
A) Affinity of receptor for the hormones
In the most commonly seen form of Turner Syndrome, how is the X chromosome affected? A) Each cell has only one X chromosome? B) Some cells have two X chromsomes, while the other cells have only one. C) Each cell has two X chromsomes, but part of the chromosome is missing. D) Each cell has an extra X chromosome
A) Each cell has only one X chromsome 45% of persons with Turner Syndrome have monosomy X meaning there is only one copy of the X chromosome in each cell.
A 36-year-old patient is being seen by an advanced practice registered nurse (APRN) in a primary care clinic for the first time. The patient reports feeling depressed due to a major life change. Additional symptoms include weight gain, sedentary activity, and insomnia. The APRN plans on providing the patient with several exercises to reduce the physiological effect of stress. Why is the APRN concerned about relieving this emotional response? A) It decreases glucose uptake. B) It increases protein synthesis. C) It increases smooth muscle contraction.
A) It decreases glucose uptake.
An adult patient with pernicious anemia may present with which signs and symptoms? A) Peripheral neuropathy, ataxia, lethargy, and fatigue B) Hepatomegaly, jaundice, and RUQ pain C) Hypertension, angina, and peripheral edema D) Blurred vision, diplopia, and decreased vibratory sensation
A) Peripheral neuropathy, ataxia, lethargy, and fatigue Vitamin B12 deficiency may result in neurologic signs and symptoms including peripheral neuropathy, paresthesias, unsteady gait, loss of proprioception, decreased vibratory sensation, lethargy and fatigue. In later stage, spasticity, hyperactive reflexes and the presence of Romberg's sign are noted because of the formation of a demyelinating lesion of the neurons of the spinal cord and cerebral cortex and the presence of a beefy red tongue. These findings are specific to pernicious anemia and must be assessed in all patient who present with anemia.
An advanced practice registered nurse (APRN) is examining an adolescent patient who describes hearing voices telling her to gather weapons because the government is trying to control her. The patient also describes feelings of happiness related to a tragic personal event. What is the probable diagnosis? A) Schizophrenia B) Obsessive compulsive disorder C) Panic attack D) Bipolar disorder
A) Schizophrenia
Which of the following characteristics applies to type 1 diabetes mellitus? A) Significant hyperglycemia and ketoacidosis result from a lack of insulin. B) This condition is commonly diagnoses on routine examination or work-up for other health problems. C) Initial response to oral sulfonylureas is usually favorable. D) Insulin resistance is a significant part of the diease.
A) Significant hyperglycemia and ketoacidosis result from a lack of insulin. Type 1 DM is associated with beta cell destruction leading to absolute insulin deficiency resulting in significant hyperglycemia and potential for ketoacidosis.
During an evaluation of a patient with prediabetes, the FNP identifies which finding in the patient's objective data that is associated with the increasing insulin resistance? A) Triglycerides > 150mg/dL B) HDL > 40 mg/dL in men and >50 mg/dL in women C) BP < 130/85 mm Hg D) FBS < 110 mg/dL
A) Triglycerides > 150mg/dL Improper use of glucose increases the release of free fatty acids which elevates triglycerides.
The FNP understands the the most accurate explanation for the diagnosis of mixed precocious puberty is: A) When a child develops some secondary sex characteristics of the opposite sex. B) When a child does not develop any identifiable external sex organs. C) When early puberty occurs due to multiple, integrated causative effects. D) When early puberty has signs of physical and hormonal abnormalities.
A) When a child develops some secondary sex characteristics of the opposite sex. Mixed precocious puberty cases the child to develop some secondary characteristics of the opposite sex, such as the feminization of a boy.
Typically, the earliest sign of lower-extremity venous insufficiency is: A) edema The earliest signs of venous insufficiency are lower extremity edema, especially after extended periods of standing. B) altered pigmentation C) skin atrophy D) shiny skin
A) edema The earliest signs of venous insufficiency are lower extremity edema, especially after extended periods of standing.
What is the most common indication for genetic counseling? A) maternal age B) drug exposure during the first trimester? C) Increased maternal alpha-fetoprotein D) history of previous still birth
A) maternal age The largest group of women who benefit from genetic counseling are those over the age of 35
A 68-year-old female with heart failure presents with tachycardia, S3 heart sound, and basilar crackles bilaterally. blood pressure is 90/68, BUN is 58 mg/dL, creatinine is 2.4 mg/dL. This clinical presentation is most consistent with: A) prerenal azotemia B) acute glomerulonephritis C) tubular necrosis D) postrenal azotemia
A) prerenal azotemia Prerenal azotemia refers to elevations in BUN and creatinine levels resulting from problems in the systemic circulation that decrease flow to the kidneys.
Which of the following is most likely to be found in a 50-year-old woman with new-onset reflux esophagitis? A) recent initiation of estrogen-progestin hormonal therapy B) recent weight loss C) report of melena D) evidence of h. pylori infection
A) recent initiation of estrogen-progestin hormonal therapy The use of certain medications including estrogen, progestin, theophylline, calcium channel blockers, and nicotine can results in a decrease in lower esophageal sphincter pressure and worsen GERD.
Changes to the joint during osteoarthritis can typically include all of the following except: A) widening of the joint space B) wearing of articular cartilage C) formation of bone spurs D) thickening of synovial membrane
A) widening of the joint space In patients with OA, the articular cartilage becomes rough and wears away. Bone spurs often form, and synovial membrane thickens. Consequently the joint space narrows.
Anemia of chronic disease
Anemia of chronic disease happens when you have an autoimmune disease or other illness lasts longer than three months and that causes inflammation.
Which of the following three statements are accurate about the sickle cell trait? (choose 3) A) If an individual has the trait, they do not pass the gene to their off spring. B) Acquiring two abnormal sickle genes from both parents leads to sickle cell disease. C) Sickle cell trait is a common genetic mutation of WBCs. D) In areas in which malaria occurs frequently, sickle cell trait offers some protection against infection caused by malaria parasites. E) Life expectancy is poor with sickle cell trait. F) Sickle cell trait is a heterozygous carrier state and not a disease.
B) Acquiring two abnormal sickle genes from both parents leads to sickle cell disease D) In areas in which malaria occurs frequently, sickle cell trait offers some protection against infection caused by malaria parasites. F) Sickle cell trait is a heterozygous carrier state and not a disease. Sickle cell trait is the most common genetic mutation of the hemoglobin. An individual with sickle cell trait inherits one mutated gene from the mother or the father, with a non-mutated gene from the other parent. Sickle cell trait is a heterozygous carrier state and not a disease. Individuals with sickle cell trait are often from W. Africa, the Middle East, and the Mediterranean region, and India. These are areas in which malaria occurs frequently, and sickle cell trait offers some protection against malaria. Carrier states increases the risk of having an offspring with sickle cell trait, and if the partner also has sickle cell trait, then sickle cell disease is possible. The life expectancy of persons with sickle cell trait is similar to that of the general population.
An advanced practice registered nurse (APRN) is performing an assessment on a newborn in a nursery. The infant's head is atraumatic with an open, flat, and soft anterior fontanel. The pupils are equal, round, and reactive to light with normal light reflex. Upon occlusion of the left nare, the infant startles, becomes irritable, and is unable to breathe. The APRN is unable to pass a small catheter into the right nare. What is the probable diagnosis? A) Macroglossia B) Choanal atresia C) Cleft palate D) Epstein pearls
B) Choanal atresia
An older adult patient is diagnosed with leukemia and has constitutional symptoms of night sweats, unintentional weight loss, and fatigue with painless lymphadenopathy. What type of leukemia does this patient have? A) Acute lymphocytic leukemia B) Chronic lymphocytic leukemia C) Acute myelogenous leukemia D) Chronic myelogenous leukemia
B) Chronic lymphocytic leukemia Chronic lymphocytic leukemia is the most common leukemia in older adults caused by proliferation of immature lymphocytes. Patients can have variable presentations of night sweats, unintentional weight loss, fever, and severe fatigue. Patients typically have painless lymphadenopathy and abnormal lab analysis with lymphocytosis, although neutropenia, anemia, and thrombocytopenia can be observed.
The FNP is assessing a newborn who is demonstrating a high-pitched cry, microcephaly, hypertelorism, hypotonia, and a low birth weight. The FNP would suspect which of the following genetic conditions? A) Down Syndrome B) Cri du chat C) Charge syndrome D) Duncan disease
B) Cri du chat The clinical symptoms of cri du chat syndrome usually include a high-pitched cat-like cry, mental retardation, delayed development, distinctive facial features, small head size (microcephaly), widely-spaced eyes (hypertelorism), low birth weight and weak muscle tone (hypotonia) in infancy.
The FNP is performing an assessment on a patient who is having difficulty controlling his left-sided heart failure. The FNP understands that the primary symptoms associated with this type of HF are: A) Systemic venous congestion B) Dyspnea and pulmonary congestion C) Increased peripheral edema and anorexia D) Atrial fibrillation with a heart rate around 110 bpm
B) Dyspnea and pulmonary congestion Respiratory symptoms are predominant in patients with left-sided HF.
An 80-year-old patient brings her grandchildren with her to a routine medical appointment. The patient has moderate chronic obstructive pulmonary disease (COPD) and is concerned about developing pneumonia because of its increased incidence at the senior center. What should the nurse practitioner recommend for this patient? A) Increasing inhaler use to four times daily B) Getting an annual influenza vaccine C) Avoiding her grandchildren this winter D) Undergoing prophylactic anticoagulation
B) Getting an annual influenza vaccine
A young adult female patient presents to the clinic with complaints of nervousness, tremulousness, palpitations, heat intolerance, fatigue, weight loss, and polyphagia. After a complete history and physical, along with thyroid function tests, the FNP makes the diagnosis of hyperthyroidism, recognizing that the most common cause of this condition is: A) Thyroid cancer B) Graves' disease C) Pituitary adenoma D) Postpartum thyroiditis
B) Graves' disease Graves' disease, an autoimmune condition also known as "diffuse toxic goiter" is the most common cause of hyperthyroidism in this age group.
An older adult woman has an area of vesicles in clusters with an erythematous base that extend from her spine, around and under her arm and breast, to the sternum on her left side. She states that the area was very tender last week and that the vesicles started erupting yesterday. She is complaining of severe pain in the area. What is the probable diagnosis? A) Psoriasis B) Herpes Zoster C) Contact dermatitis D) Cellulitis
B) Herpes Zoster Herpes zoster typically presents with a history of tenderness followed by eruptions and vesicles that follow a dermatome on one side of the body. The condition is very painful. Other symptoms may include fever, headaches, and malaise.
When cardiac output falls in heart failure, the body attempts to compensate. What electrolyte imbalances result from this response? A) Hypernatremia and hyperkalemia B) Hyponatremia and hypokalemia C) Hypophosphatemia and hypercalcemia D) Hyperphosphatemia and hypocalcemia
B) Hyponatremia and hypokalemia The compensatory mechanism causes excess secretion of aldosterone that predisposes to potassium excretion. total body sodium content will be greater than normal, but the excessive secretion of ADH causes greater retention of water, diluting the serum level. ADH is continually secreted because of the presence of low pressure at the carotid sinus baroreceptors, directly related to low cardiac output.
Which immunoglobulin may contribute to the pathophysiologic characteristics of asthma? A) IgA B) IgE C) IgG D) IgM
B) IgE Immunoglobulin E-mediated airway inflammation is active in most patients with asthma.
Which of the following is NOT a risk factor for endometrial cancer? A) Obesity B) Oral contraceptive use C) Unopposed estrogen use D) Advancing age, greater than 50 years
B) Oral contraceptive use Oral contraceptives have been shown to reduce the incidence of endometrial cancer.
The FNP understands the following about pyelonephritis: A) Young adults with severe illness may present with altered mental state and absence of fever. B) Patients complain of localized flank/back pain combined with systemic symptoms, such as fever, chills, and nauses. C) Requires hospitalization for most cases including parenteral antibiotic therapy. D) Requires no follow-up.
B) Patients complain of localized flank/back pain combined with systemic symptoms, such as fever, chills, and nauses. Pyelonephritis is characterized by localized flank/back pain, CVA tenderness, combined with systemic symptoms such as fever, chills, and nausea.
A 30-day-old infant presents to the emergency room with decreased oral intake, decreased urine output, and a fever of 101.8. The infant is admitted for further evaluation with a workup to include a blood culture, a urine culture, a spinal tap, and a chest X-ray. Which issue of innate immunity, as it relates to neonates, is of concern? A) High levels of mannose-binding lectin B) Relative deficiency of factor B C) Excess collectin and collectin-like protein D) Dysfunctional chemotactic factor response
B) Relative deficiency of factor B
An advanced practice registered nurse (APRN) is consulting with a teen patient who has recently learned that she is pregnant. The APRN knows that a certain medication taken by the patient can contribute to the development of congenital malformations in the fetus. The APRN reviews the patient's current medication list and finds one medication that is a concern. Which medication is the APRN concerned about? A) Bisphenol A B) Retinoic Acid C) Benzoyl peroxide D) Clindamycin
B) Retinoic Acid
What directly causes ovulation during the menstrual cycle? A) Gradual decrease in estrogen levels. B) Sudden increase of LH. C) Sharp rise in progesterone levels. D) Gradual increase in estrogen levels.
B) Sudden increase of LH. Ovulation generally occurs 1-2 hours before the final progesterone surge, or about 12-36 hours after the onset of the FSH and LH surge.
When providing patient education regarding asthma. The FNP states that control of symptoms is necessary due to which pathophysiologic process? A) Norepinephrine causes bronchial smooth muscle contraction and mucus secretion but it also causes high blood pressure. B) Uncontrolled inflammation leads to increased bronchial hyperresponsiveness and eventual scarring. C) The release of epinephrine leads to development of cardiac dysrhythmias. D) Immunoglobulin G causes smooth muscle contraction which will eventually weaken the respiratory muscles.
B) Uncontrolled inflammation leads to increased bronchial hyperresponsiveness and eventual scarring. Untreated inflammation can lead to long-term airway damage that is irreversible, known as airway remodeling.
An older adult patient has a diagnosis of left-sided heart failure. The FNP would identify what common condition associated with heart failure? A) Peripheral vascular disease B) Untreated hypertension C) Ventricular dysrhythmias D) COPD
B) Untreated hypertension Untreated HTN causes significant increased work of the the LV, eventually causing left-sided HF.
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 A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint.
A newborn's screening for cystic fibrosis is positive. An advanced practice registered nurse (APRN) is reviewing screening results and taking a comprehensive genetic screening of the parents. The APRN asks the parents questions to help determine the transmission of this disease. Which question should the APRN ask? A) "Do you wish to have maternal genetic testing done?" B) "Are either of you showing symptoms of cystic fibrosis?" C) "Are you both the genetic donor parents?" D) "Do any of your siblings have cystic fibrosis?"
C) "Are you both the genetic donor parents?"
A patient presents to the hospital complaining of blurred vision, muscle weaknesses, impaired gait, and fatigue lasting more than 24 hours. The patient has a history of smoking and vitamin D deficiency. Extensive diagnostic testing and a comprehensive neurological assessment reveals a diagnosis of multiple sclerosis. Which pathological mechanism will support this diagnosis? A) Demyelination caused by antibody and cell-mediated immunologic reaction of the peripheral nerves B) Degeneration of the neuromuscular junction and the upper and lower motor neurons C) A loss of myelin sheaths, causing a disruption of nerve conduction D) A defect in nerve impulse transmission at the neuromuscular junction
C) A loss of myelin sheaths, causing a disruption of nerve conduction
Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? A) Increased norepinephrine B) Adducin C) Angiotensin II D) Insulin resistance
C) Angiotensin II Hypertension causes an increased cardiovascular mechanical load that can deleteriously affect heart function. An early myocardial response is an increase in cardiac Angiotensin II (Ang II) protein levels, which is intimately associated with the pathogenesis of cardiac hypertrophy and heart failure.
The FNP is assessing an older patient diagnosed with shingles in the prodromal stage. What would the practitioner expect to find on the assessment of this patient? A) Erythematous lesions present over four different parts of the body. .B) Red, pin point, painless rash. C) Burning pain in a line on only half the patient's chest that does not cross the midline. D) Painless purulent lesions for 2 days followed by complaints of itching, burning, and nausea.
C) Burning pain in a line on only half the patient's chest that does not cross the midline. Shingles is a vesicular dermatomal eruption related to a reactivation of latent varicella virus. It increases with advanced age and is characterized by burning pain and paresthesia along one or two dermatomes, not crossing the midline, and may be accompanied by fever, malaise, or headache
A 12-year-old African American patient presents with unilateral eye swelling and lower lip swelling. The patient's parent reports that the swelling is spontaneous and resolves over several days. The patient does not have complaints of fever, hives, or vomiting. Serum lab results show hyperactivation of three plasma protein systems. The APRN suspects hereditary angioedema. What is the cause of the genetic defect suspected in this situation? A) Hageman factor B) Plasminogen C) C1 esterase inhibitor D) Bradykinin
C) C1 esterase inhibitor
Pulmonary edema in ARDS is the result of an increase in what? A) Levels of serum sodium and water B) Capillary permeability C) Capillary hydrostatic pressure D) Oncotic pressure
C) Capillary hydrostatic pressure The most common cause of pulmonary edema is left-sided heart disease which leads to increasing pressure on the left side of the heart which can cause a concomitant increase in pulmonary capillary hydrostatic pressure.
A patient is seen in the clinic after being a restrained passenger in a car accident the previous week. The patient continues to have intermittent headaches and has noticed periods of forgetfulness. Assessment findings include a BP of 130/82 mm Hg and an apical pulse rate of 72 bpm. An advanced practice registered nurse (APRN) is concerned that the symptoms might stem from a specific process. Which process should the APRN be concerned about? A) Subarachnoid hemorrhage B) Skull fracture C) Cerebral concussion D) Decreased cerebral perfusion
C) Cerebral concussion
Priapism has been associated with the abuse of which substance? A) Marijuana B) Alcohol C) Cocaine D) Heroin
C) Cocaine Priapism is an uncommon condition of prolonged penile erection. In 60% of cases the cause is idiopathic. The remaining 40% are associated with spinal cord trauma, sickle cell disease, leukemia, pelvic tumors, or infections. It has also been associated with cocaine use.
A patient is being admitted to an ICU after a traumatic brain injury. During the first few hours, the patient develops polydipsia, and his urinary catheter is draining large volumes of dilute urine. An advanced practice registered nurse (APRN) runs some tests, and the serum lab values show hypernatremia and hyperosmolarity. Which diagnosis should the APRN identify for this patient? A) Hyperpituitarism B) Syndrome of inappropriate antidiuretic hormone C) Diabetes insipidus D) Hypopituitarism
C) Diabetes insipidus
The parent of a child diagnosed with Down syndrome expresses concerns about the child's recurrent respiratory tract infections to an advanced practice registered nurse (APRN). The infections have occurred regularly since birth. What should the APRN tell the parent is the underlying cause of this illness? A) Hypertonia causes airway restriction. B) Hyperthyroidism causes an increased risk of infection. C) Gastroesophageal reflux disease causes aspiration of thin fluids. D) Short stature causes poor lung development.
C) Gastroesophageal reflux disease causes aspiration of thin fluids.
During an intake interview with a 26-year-old man diagnosed with generalized anxiety disorder, the FNP might observe what type of behavior? A) An inflated sense of self B) Constant relation to future events C) Inability to concentrate and irritability when questioned Impaired concentration and irritability are major characteristics of GAD. D) Nervousness and fear of the FNP during the interview
C) Inability to concentrate and irritability when questioned Impaired concentration and irritability are major characteristics of GAD.
The FNP is seeing a patient for a routine health maintenance visit. The patient's initial blood pressure, taken by the RN is 156/102 mm Hg. A repeat BP by the FNP is 148/92. The remainder of the patient's physical exam in unremarkable. The FNP understands that the plan of care for this patient should include all of the following except: A) Assessment of lifestyle and risk factors B) CBC, BMP, and UA C) Initiation of anti-hypertensive medications D) Follow up visit to re-assess blood pressure.
C) Initiation of anti-hypertensive medications Evaluation and management of blood pressure should by highly individualized. The diagnosis of hypertension is based upon the measurement of blood pressure on AT LEAST two separate occasions averaging at least 2 mins apart. Evaluation should also include a comprehensive assessment of lifestyle and risk factors, CBC, BMP, and UA. Initiation of anti-hypertensive medication would not occur until the diagnosis of hypertension is confirmed, and is dependent upon the stage of hypertension.
A woman has sustained a traumatic brain injury. She is able to follow simple commands and can manipulate objects. Which term describes this state? A) Coma B) Persistent vegetative state C) Minimally conscious D) Locked-in syndrome
C) Minimally conscious When responses to the environment are seen, the patient is said to be in a minimally conscious state
A child presents to a clinic with a white pupillary reflex noted in the right eye. The child is constantly crying and rubbing her eyes. An advanced practice registered nurse (APRN) performs a complete ophthalmologic examination and orders several diagnostic tests. Based on the findings, a diagnosis of retinoblastoma is confirmed. What is the pathological mechanism of this disorder? A) Deficiency of hexosaminidase causes accumulation enzymes that damage the brain B) Invasion of astrocytomas of the brain structure destroys normal defenses C) Mutations of a gene on chromosome 13q14 lead to neoplastic proliferation of cells D) Autosomal dominant linked to genes results in mutations on chromosome 21
C) Mutations of a gene on chromosome 13q14 lead to neoplastic proliferation of cells
Which term describes recurrent, intrusive thoughts or impulses? A) Hallucinations B) Compulsions C) Obsessions Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. D) Delusions
C) Obsessions Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust.
The FNP would expect which symptoms in a patient with a diagnosis of schizophrenia? A) High energy with varying sleep patterns and non stop conversation. B) Extreme and frequent mood swings with hyperactivity and difficulty concentrating. C) Paranoia, delusions, hallucinations, and diminished self-care. D) Anti-social behavior, manipulative behavior, charisma, and ability to lie convincingly.
C) Paranoia, delusions, hallucinations, and diminished self-care. The characteristics of schizophrenia are paranoia, delusions, tangential thoughts, suspiciousness, disorganized behavior, and hallucinations.
An advanced practice registered nurse (APRN) is caring for a patient complaining of pelvic pain. Assessment findings include a fever of 39°C (102.2° F), vaginal discharge, low bilateral abdominal pain that is dull and steady that developed during menstruation and worsens with walking, and dysuria. Lab studies include a positive finding for chlamydia. Which diagnosis should the APRN assign to this patient based on these findings? A) Vulvodynia B) Bartholinitis C) Pelvic inflammatory disease D) Vaginitis
C) Pelvic inflammatory disease
The FNP schedules a 38-year-old primigravida (first time pregnancy) for an amniocentesis at 16 weeks gestation. The FNP would explain that the purpose of this procedure is to: A) Assess for the possibility of twins B) Deterime the biliruben level C) Perform genetic studies D) Assess L/S ratio
C) Perform genetic studies This womans age puts her at risk for Down Syndrome
The FNP is educating the mother of a child with sickle cell anemia regarding immunization schedules. Due to the high risk of infection, septicemia, and risk for meningitis, the mother should be educated that the child should receive which of the following immunizations before age 2? A) MMR B) IPV C) Pneumococcal D) Varicella
C) Pneumococcal Fatality is high and the risk of infection is greatest among children who are not vaccinated against pneumococcal serotype.
Early signs of renal damage in patients with diabetes mellitus and hypertension include which two of the following? (choose 2) A) Increased BUN B) Increase in serum creatinine C) Presence of proteinuria D) Decrease in GFR E) Hematuria F) Elevated A1c
C) Presence of proteinuria D) Decrease in GFR The earliest indication of renal damage from diabetes is the presence of microalbuminuria; because of this all patients with diabetes should have this tested annually. A decrease in GFR is also noted. Diabetic nephropathy is characterized by proteinuria, hypertension, edema, and renal insufficiency.
The FNP is evaluating a 65-year-old patient with diabetes and hypertension, who has known kidney disease. the patient's blood pressure at today's visit is 142/88. The patient's GFR is 42 and the serum albumin level is 3.9g/dL. A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 E) Stage 5
C) Stage 3 A GFR of 42 indicates stage 3 chronic kidney disease. A serum albumin level of 4.1 g/dL or lower is associated with an increased risk of end stage renal disease.
An adolescent male is suffering from severe, sudden pain in his genital region during football practice. He is embarrassed to seek emergency treatment. However, he is finding the pain unbearable. His coach appropriately recommends he seek emergency treatment. What is a plausible cause of the pain? A) Prostate hyperplasia B) Hydrocele C) Testicular torsion D) Cryptorchidism
C) Testicular torsion
The most helpful diagnostic test to perform during acute gouty arthritis is: A) measurement of 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 A synovial fluid test evaluates the presence of urate crystals in the joint fluid. This the most accurate test for diagnosing gout.
A 24-year-old man presents with a 3-month history of upper abdominal pain. He describes it as an intermittent, centrally located burning feeling in his upper abdomen, most often occuring 2-3 hours after meals. His presentation is most consistent with the clinical presentation of: A) acute gastritis B) gastric ulcer C) duodenal ulcer D) cholecystitis
C) duodenal ulcer The pain associated with duodenal ulcers typically improves immediately following meals and returns several hours after a meal.
As a part of the evaluation of patients with OA, the FNP anticipates which laboratory finding? A) anemia of chronic disease B) elevated CRP C) no disease specific laboratory abnormalities D) elevated ANA
C) no disease specific laboratory abnormalities Because OA is typically a non-inflammatory disease, laboratory abnormalities are usually not seen.
Disseminated Intravascular Coagulation (DIC)
Complex, acquired disorder in which clotting and hemorrhage simultaneously occur. The underlying cause is usually due to inflammation, infection (sepsis), or cancer.
Age and the admission of the Glasgow Coma Scale (GCS) are important diagnostic factors in TBI. Which GCS score describes a severe TBI? A) 13-15 B) 12-13 C) 9-12 D) 3-8
D) 3-8 The GCS is scored between 3 and 15, 3 being the worst and 15 the best.
The FNP understands that which of the following patients would be at the highest risk for developing disseminated intravascular coagulation (DIC)? A) A 35-year-old pregnant patient with placenta previa B) A 42-year-old client with a pulmonary embolus C) A 60-year-old client receiving hemodialysis 3 days a week D) A 78-year-old patient diagnosed with septicemia
D) A 78-year-old patient diagnosed with septicemia DIC is a clinical syndrome that develops as a complication of a wide variety of other disorders, with sepsis being the most common cause.
Which of the following changes occurs in the RBC indices for pernicious anemia? A) microcytic, normochromic B) microcytic, hypochromic C) normocytic, normochromic D) macrocytic, normochromic A macrocytic, normochromic anemia resulting from atrophic gastric mucosa not secreting intrinsic factor is the definition of pernicious anemia. These indices could also include folic-acid deficiency.
D) macrocytic, normochromic A macrocytic, normochromic anemia resulting from atrophic gastric mucosa not secreting intrinsic factor is the definition of pernicious anemia. These indices could also include folic-acid deficiency.
A patient is seeing an advanced practice registered nurse (APRN) in an occupational health setting. The patient has been referred by employee assistance for reckless and self-destructive behaviors and a violent incident at work regarding a fellow employee. The APRN suspects post-traumatic stress disorder (PTSD). Which diagnostic cluster of PTSD is the patient exhibiting? A) Reexperiencing B) Negative cognitions C) Avoidance D) Arousal
D) Arousal
What type of ovarian cyst develops when an ovarian follicle is stimulated but no dominant follicle develops and completes the maturity process? A) Follicular B) Corpus luteum C) Corpus albicans D) Benign ovarian
D) Benign ovarian Benign ovarian, or functional cysts, are variations of normal physiologic events. Benign cysts of the ovary are produced when a follicle is stimulated but does not complete the maturity process.
When prescribing a meal plan for the patient with type 2 diabetes, the FNP tells the patient that the macronutrient with the most influence on the postprandial glucose level is: A) Fiber B) Fat C) Protein D) Carbohydrate
D) Carbohydrate Carbohydrate is a macronutrient with the greatest impact on the postprandial glucose levels.
A patient is seen by an advanced practice registered nurse (APRN) at a primary care clinic for follow-up to discuss abnormal results of testing for peripheral nervous system impairment. Which diagnosis should the APRN suspect? A) Spinal cord injury B) Autonomic hyperreflexia C) Diffuse axonal injury D) Demyelinating polyneuropathy
D) Demyelinating polyneuropathy
___ occurs when the blood vessels become overcrowded with immature blast cells in patients with AML who have high WBC counts, which can lead to ischemia and infarcts in the pulmonary and cranial blood vessels.
Leukostasis
Which are common sites for atopic dermatitis in adults? A) Cheeks, forehead, and scalp. B) Wrists, ankles, and antecubital fossae. C) Antecubital fossae, face, neck, and back. D) Hands and face
D) Hands and face Atopic dermatitis is a chronic, pruritic inflammatory skin disease that occurs most frequently in children, but can also affect adults. Atopic dermatitis in adults may be generalized, however it frequently appears in the creases of the elbows or knees, dorsa of the feet, and nape of the neck. In adults, the hands and face are more commonly involved.
When assessing for the signs and symptoms of acute respiratory distress syndrome, the absence of which condition is considered characteristic? A) Progressive respiratory distress B) Bilateral infiltrates C) Decreased pulmonary compliance D) Heart failure
D) Heart failure ARDS is the most severe form of acute lung inflammation and is defined by acute onset of bilateral infiltrates not explained by cardiac failure or fluid overload, and a low ratio of the partial pressure of arterial oxygen to the fraction of inhaled oxygen.
An advanced practice nurse (APRN) is working with a patient who is choosing to undergo breast removal due to family history of breast cancer. The patient's genetic testing revealed an abnormal BRCA1. The patient shares with the APRN that she is relieved that she will not need to worry about cancer once the breast tissue is removed. The APRN proceeds to educate the patient about additional risks. Which other type of cancer is the patient at risk for developing? A) Liver B) Brain C) Bladder D) Ovarian
D) Ovarian
The FNP understands that a potential complication of tonsillar infections, which is characterized by severe sore throat, difficulty swallowing, odynophagia, trismus, and a "hot potato" voice; accompanied by fever, chills and malaise is indicative of: A) Retropharyngeal abscess B) Epiglotitis C) Peritonsillar cellulitis D) Peritonsillar abscess
D) Peritonsillar abscess Peritonsillar abscess is characterized by severe sore throat, pain or difficulty swallowing, jaw muscle spasms, and a hot potato voice.
In the majority of children experiencing delayed puberty, the problem is caused by: A) Disruption of the hypothalamus. B) Disruption of the pituitary. C) Deficiencies in estrogen or testosterone. D) Physiologic delays in maturation.
D) Physiologic delays in maturation. In 95% of cases, delayed puberty is physiologic in nature.
Diagnostic confirmation of glomerulonephritis typically requires: A) UA plus a CBC with differential B) Abdominal CT C) Renal US D) Renal biopsy
D) Renal biopsy Diagnosis of glomerular disease is confirmed by abnormal UA and renal biopsy to confirm specific renal injury and type of pathologic condition.
A patient presents to the emergency department complaining of difficulty swallowing, drooling, and pain radiating to the left ear. During the assessment, an advanced practice registered nurse (APRN) notes unilateral redness, left swollen tonsil, and a displaced uvula. Which diagnosis should the APRN make for this patient? A) Pharyngitis B) Periodontitis C) Bartholin's abscess D) Retropharyngeal abscess
D) Retropharyngeal abscess
An advanced practice registered nurse (APRN) examines a patient and notes the following findings: -adipose tissue in the trunk, facial, and cervical areas -striae of skin -easy bruising -thin extremities -hypertension -cardiac hypertrophy -increased facial hair -hypercortisolism Which pathological mechanism of the disease process is associated with these symptoms of Cushings Disease? A) Insufficient ADH activity, excretion of large volumes of dilute urine, and increased plasma osmolality B) Excessive autonomous secretion of aldosterone due to lack of its principal regulator, angiotensin II C) Hypomagnesemia inhibits PTH secretion, impairment of resorption of calcium from bone, and regulation of calcium reabsorption from the renal tubules D) Secretion of both cortisol and adrenal androgens is increased and inhibition of corticotropin-releasing hormone (CRH) secretion
D) Secretion of both cortisol and adrenal androgens is increased and inhibition of corticotropin-releasing hormone (CRH) secretion
An older adult who has acute myelogenous leukemia is undergoing cytotoxic chemotherapy treatment and has the following laboratory reports: elevated serum uric acid, serum potassium, and serum phosphate and a low serum calcium level. The WBC count is extremely elevated, and on physical exam, there is noted lymphadenopathy and splenomegaly. What is the most likely cause? A) DIC B) Leukostasis C) Pancytopenia D) Tumor lysis syndrome
D) Tumor lysis syndrome Tumor lysis syndrome occurs when a patient has a high WBC count and is undergoing cytotoxic chemotherapy for the treatment of AML. It is characterized by the development of acute hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
A 78-year-old man presents with fatigue and difficulty with bladder emptying. Examination reveals a distended bladder but is otherwise unremarkable. The BUN is 88mg/dL; the creatinine is 2.8 mg/dL. This clinical assessment is most consistent with: A) prerenal azotemia B) acute glomerulonephritis C) acute tubular necrosis D) postrenal azotemia
D) postrenal azotemia Postrenal azotemia refers to elevations in BUN and creatinine levels resulting from obstruction in the collecting system
antinuclear antibody (ANA)
Detects antinuclear antibodies in the blood to check for autoimmune disease
S3 heart sound
Results from increased atrial pressure leading to increased flow rates, as seen in congestive heart failure, which is the most common cause of a S3.
Epstein pearls
Small white cysts found on the gums and at the junction of the soft and hard palates
S4 heart sound
The characteristic sound of an S4 is created by the movement of blood during diastole from the atria flowing against a stiff ventricular wall caused by hypertension, pulmonary hypertension, ventricular outflow obstruction, or ischemic heart disease.
ESR (erythrocyte sedimentation rate)
The rate in which it takes for RBC's to settle off in an unclotted tube. Tests for nonspecific inflammation. Normal rate is 1 ml in 5 min.
Cushing's syndrome
a condition caused by prolonged exposure to high levels of cortisol
atresia
absence of a normal body opening; occlusion; closure
Capillary hydrostatic pressure (CHP) versus capillary permeability
accumulation of excess interstitial fluid, which results from elevated capillary hydrostatic pressure while permeability edema results from disruption of the physical structure of the pores in the microvascular membrane such that the barrier is less able to restrict the movement
diabetes insipidus (DI)
antidiuretic hormone (ADH) is not secreted, or there is a resistance of the kidney to ADH; symptoms are excretion of large volumes of dilute urine, hypernatremia and hyperosmolarity of the blood.+
pernicious anemia (PA)
autoimmune; anemia resulting when digestive system absorbs insufficient amount of vitamin B12; vitamin B12 is necessary for erythrocyte production
pyelonephritis
inflammation of the renal pelvis and the kidney due to bacteria (ex. E. Coli); usually begins as a UTI
Addison's disease
occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone
proteinuria
protein in the urine; results form increased blood sugar in people with diabetes, as well as high blood pressure, which is a common co-occurring condition in people with diabetes.
prodromal stage
the period between the appearance of initial symptoms and the full development of a rash or fever.
