Leik 2021/ExamEdge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice

Which of the following GI changes in associated with normal aging? A. Decreased production of gastric acid B. Decreased incidence of gallstones C. Increased salivation D. Increased esophageal emptying

A. Decreased production of gastric acid.

Trigeminal neuralgia manifests itself primarily with: A. electric-shock-like unilateral facial pain B. Unilateral facial asymmetry C. Burning bilateral facial pain D. jaw pain extending to the neck

A. Electric-shock-like unilateral facial pain

Which of the following is the most serious outcome of Barrett's esophagus? A. Esophageal adenocarcinoma B. Biliary atresia C. Liver hemangioma D. Esophageal varices

A. Esophageal adenocarcinoma

In the majority of children, the first permanent teeth start to erupt at the age of 6 years. Which of the following are the first permanent teeth to erupt in this time period? A. First Molars B. Second Molars C. Lower or upper incisors D. Canines

A. First Molars

An 88 year old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? A. Folstein Mini-Mental State examination B. Geriatric Depression Scale C. Minnesota Multiphasic Personality Inventory Myers-Briggs Test

A. Folstein Mini-mental state examination

A 66- yo patient presents with bilateral otis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 x 4. The patient should be evaluated for: A. HIV infection B. Myelodysplastic syndrome C. Congenital lymphoproliferative disease D. non-Hodgkin's lymphoma

A. HIV infection

An 88-yo patients has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: A. lateralize to the left B. lateralize to the right C. Be inconclusive D. Not lateralize

A. Lateralize to the left.

Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: A. oxygen B. Anticholinergic drugs C. Systemic steroids D. Exercise

A. Oxygen

Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? A. Pain worse in supine position; focal neurological signs B. Hyperreflexia; personality changes C. Acute onset; increasing pain over hours to days D. Pupillary constriction; stupor

A. Pain worse in supine position; focal neurological signs

A 25-year old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated with movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? A. Palpate structures around the shoulder B. Obtain an MRI to evaluate the shoulder C. Order an Xray of the shoulder D. Request an EMG

A. Palpate the structures around the shoulder

A test called the visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central vision C. Visual acuity D. Accomodation

A. Peripheral vision

Cranial Nerve VIII

Acoustic (Hearing and balance)

What is the most common cause of Cushing's syndrome?

Administration of a glucocorticoid or ACTH. Iatrogenic Cushing's syndrome is the most common type. Exogenous glucocorticoid administration produces a Cushing's Syndrome that is reversible by discontinuation of the medication.

If the asthma patient has to use high-dose inhaled steroids, it can cause which of the following? Immune suppression Mild growth retardation in children Cataracts All of the above

All of the above The patient that uses high-dose inhaled steroids has the potential to experience: Immune suppression Mild growth retardation in children Cataracts Osteoporosis Glaucoma Hypothalamic pituitary-adrenal suppression Others

Which activities are NOT characteristic of preschool children?

Always follow rules during playground games. Since preschoolers are just beginning to learn moral behaviors, they often cheat to win. While most preschoolers toilet independently, accidents occasionally occur and bed-wetting is not unusual. The use of a security item such as a blanket is common.

You are providing care to a patient who has experienced an MI. The results of his treadmill stress test are poor, and treatment with aspirin and heparin have been ineffective. What is likely to be the next intervention for this patient? Coronary bypass surgery. Angioplasty. Repeat stress test. Heart transplant.

Angioplasty. Angioplasty, the insertion of a catheter with a balloon on the end into an artery or vein to remove an obstruction, is the preferred nonsurgical intervention. For patients with poor stress test results and who have not responded to anticoagulant therapy, angioplasty is likely to be a next step. Coronary bypass may follow if angioplasty proves unsuccessful.

Deep tendon reflex

Ankle- S1 primarily Knee- Lumbar 2,3,4 Supinator(brachioradialis)-C5,6 BicepTriceps-C6,7

Evaluation of Anterior Cruciate Ligament (ACL) injury

Anterior Drawer sign and Lachman test

A child has just scalded her index finger with hot water at home. The mother calls the NP within 5 minutes of the injury. All of the following are appropiate instructions for the mother regarding the care of the patient with a 2nd degree burn EXCEPT:

Applying butter, cooking oil, or lanolin for pain relief. Flushing first or second degree burn with cool water is appropriate to prevent further thermal injury and to provide pain relief. Oil should NEVER be applied to a burn injury. Consider consultation for burns in patients who are under 10 years of age and over 50 years of age. Physician referral is recommended for all 3rd degree burns, for 2nd and 3rd degree burns involving more than 10% of the body surface area, any deep thickness burns involving more than 2% of the body surface area, and burns involving the face.

Appendicitis is a common cause of acute abdominal pain.

Assess for positive McBurney's point tenderness, Rovsing's sign, the psoas sign, and obturator sign.

According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a vlaue equal to or greater than: A. 100 mg/dl B. 126 mg/dl C. 140 mg/dl D. 180 mg/dl

B. 126 mg/dl

The management of choice for polymyalgia rheumatica includes: A. whirlpool B. Prednisone C. Anelgesics D. Celebrex

B. Prednisone

The common bacteria responsible for pneumonia in older adults residing in the community is: A. Staphylococcus aureus B. Streptococcus pneumoniae C. Pseudomonas Aeruginosa D. Moraxelle catarrhalis

B. Strep Pneumo

Stroke risk scale

CHADS2 C-Congestive heart failure H-Hypertension A-Age >75 years D- Diabetes S-prior Stroke/TIA

Education of women with fibrocystic breast disease should include which of the following statements?

Caffeine may trigger breast pain. Avoidance of all methylxanthines (eg coffee, tea, chocolate) has been shown to reduce breast pain in women with fibrocystic breast disease. It is usually a benign condition, not a precursor of malignancy. Mammography is recommended once at age 35 years, at least every 1-2 years after age 40, and then annually beginning at age 50 years. Oral contraceptives may help reduce cyclical pain and swelling.

Category X FDA classification drugs would be used for studies in humans or animals to help demonstrate fetal abnormalities. Which of the following medications would not be considered a Category X drug? Accutane Cocaine Cytotec Coumadin

Cocaine The list of Category X FDA drugs would include: Accutane Cytotec Coumadin Proscar Propecia Birth-control pills HRT Testosterone Live virus vaccines such as rubella, measles, and mumpsT halidomides such as methimazoleOthers

A PPD is considered positive at 5 millimeters or more for which population?

Confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with a chest X-ray suggestive of TB A PPD greater than or equal to 10 mm is considered positive for injecting drug users known to be HIV negative, occupants of long-term care facilities, age less than 4 years, groups with a high prevalance for TB, the medically underserved, and healthcare workers. A PPD is considered positive at 15mm or more in those with no known risk factors.

You are conducting an assessment with a patient who presents with a severe sore throat. Upon examination, you see that her tonsils touch her uvula. How would you rate this patient's tonsils? 2+ 3+ 5+ 2

Correct Answer: 3+ Tonsils which touch the uvula are rated 3+. Further tests will be necessary to diagnose the cause of the patient's tonsilar swelling.

According to the ANA, the role of the NP who provides primary health care is the:

Direct nursing care role. The NP with a traditional nursing care role is a primary health care provider. Increasing numbers of nurse practitioners are assuming indirect roles such as educator, administrator, researcher, and consultant.

Correct Answer: noise trauma Noise trauma is the second most common cause of hearing loss. Also termed acoustic trauma, it can be related to a single, very loud noise or by exposure to a noise at a lower decibel over a long period of time. Sounds louder the 85 dB are potentially damaging to the cochlea, especially with prolonged exposure such as having worked in a factory for over 20 years.

Elmer is a client who comes to you complaining of difficulty hearing. He works in an automotive plant with loud machinery in use at all times. He has been exposed to this environment for 25 years. This supports a diagnosis of which of the following? noise trauma otosclerosis presbycusis ototoxicity

The nurse practitioner knows that all of the following are nonpharmacologic treatments for a patient with acute glomerulonephritis EXCEPT: Avoid high-potassium foods. Treat them as inpatient until edema and hypertension are under control. Restrict protein in presence of azotemia and metabolic acidosis. Encourage increased fluid intake.

Encourage increased fluid intake The patient's fluid intake should be restricted to only the amount the patient requires to replace lost fluids. The remaining answer choices are included in the treatment of acute glomerulonephritis.

The ANP is prescribing a pseudoephedrine/phenylephrine preparation for his patient. Of the following, which would the ANP prescribe? Entex. Rhinocort. Muro 128. Bacitracin 500 u/g.

Entex. Entex = Pseudoephedrine/Phenylephrine preparation Rhinocort = Inhaled Nasal Steroid Muro 128 = Lubricating Ophthalmic Drop Bacitracin 500 u/g = Anti-staphylococcal

Abduction (Valgus) stress test

Evaluate for Medial Collateral Ligament (MCL) injury

Cranial nerve III, IV, VI

Eye movement

Heberdens nodes

Found at the distal interphalangeal joint (DIP). Seen in osteoarthritis.

Finkelstein's Test

If positive, Indicates de Quervain's tenosynovitis. Grasp the thumb against the palm and then move the wrist toward the midline in the ulnar deviation

Evaluation of a meniscal tear using

McMurray Sign and a locking on full knee extension

The nurs practitioner is caring for a 19 year old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate INITIAL treatment for this patient is:

Oral ferrous sulfate. With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed, but may be required in the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron.

All of the following interventions with pediatric patients are appropriate EXCEPT:

Pre-medicate the patient prior to all painful interventions. Pre-medication is not warranted prior to all painful interventions. For example, premedication is not warranted prior to routine immunizations but it certainly is prior to suturing. Pain management should be an integral part of patient management.

Which of the following pathogens is the most common cause of fatal community-acquired pneumonia? M. pneumoniae H. influenzae Legionella spp. S. pneumoniae

S. pneumoniae S. pneumoniae is the most common cause of fatal community-acquired pneumonia. It is a Gram-positive diplococci.

Which laboratory test is useful in the diagnosis of spontaneous abortion?

Serial quantitative beta-huma chorionic gonadotropin levels. Serial quantitative beta-human chorionic gonadotropin levels are the most useful for diagnosing spontaneous abortion. The levels progressively decline.

Cranial Nerve I

Smell (1 nose)

In terms of newborn vision, which of the following statements is accurate? Newborns have 20/100 vision. They can focus best at distances of 24 inches. The preferred colors are black, red, and white. Lacrimal ducts are mature at birth.

The preferred colors are black, red, and white. This is the accurate statement. Newborns have 20/200 vision that becomes 20/20 by age 6. They can focus best at distances of 8-12 inches. Lacrimal ducts mature by age 2 to 3 months; newborns do not have tears when crying.

Correct Answer: Both B and C The above image would be considered an example of an MRI of the human kidney. Some of the types of benign masses could include: Hemangioma Hematoma Cysts Angiomyolipoma Oncocytoma Renal adenoma

This question showed a CT image of a kidney. Which of the following might be considered a form of benign mass that could potentially be diagnosed by the procedure above? Diabetes mellitus Hemangioma Hematoma Both B and C

Cranial Nerve II

Vision (2 eyes)

Cranial Nerve V,VII,X,XII

Voice and speech

An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure?

Weight gain. Early signs of heart failure include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension.

lazy eye

What is Amblyopia -

Correct answer: amenorrhea This is a presumptive sign of pregnancy, along with fatigue, nausea, breast changes, urinary frequency, and a slight increase in body temperature. The other choices are probable signs of pregnancy.

Which of the following would be considered a presumptive sign of pregnancy? amenorrhea Goodell's sign Hegar's sign ballottement

Correct answer: presbyopia Presbyopia is the natural loss of accommodation that is caused by aging. Hyperopia is the inability to see near objects clearly because of failure to accommodate. Myopia is the inability to see distant objects. Glaucoma is a disease of the eye.

You have a 60-year-old male patient who has some vision loss. You tell him that there is a certain amount of normal vision loss associated with aging. This type of vision loss is known as which of the following? hyperopia presbyopia glaucoma myopia

Varicella is a systemic disease commonly known as chickenpox. Which of the following age groups has the greatest varicella mortality rate? neonates infants 6 - 12 months old adults 30 - 49 years old adults over 65 years old

adults 30 - 49 years old Most cases of varicella are seen in children younger than 18 years. The highest mortality rate from varicella, however, is found in persons 30 - 49 years of age.

What test is used to assess peripheral arterial disease (PAD)?

ankle-brachial index.

A 21 yo college student presents to the sudent health center with copious, markedly purulent discharge from her left eye. The nurse practitioner should suspect:

gonococcal conjunctivitis. A purulent and copious discharge should alert the nurse practitioner to the likely possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic treatment and immediate referral to an opthalmologist for evaluation.

The FNP calculates a patient's BMI to be 23. Which category would this patient fall into? normal weight underweight overweight obese

normal weight This patient would fall into the normal weight category. Persons with a BMI of 18.5 to 24.9 are considered of normal weight.

Oburator Sign

right hypogastric pain constitiutes a positive obturator sign. Ask patient to flex right thigh at the hip, with the knee bent, and rotate the leg internally at the hip.

Of the diagnostic tests for hearing, which of the following tests evaluates the clarity of hearing? audiometric study speech discrimination testing audiogram tympanogram

speech discrimination testing Speech discrimination testing is used to evaluate the clarity of hearing. Results are reported as percentage correct.

An elderly male has a diagnosis of left-sided congestive heart failure (CHF). The nurse practitioner would identify which of the following as a common condition associated with CHF? ventricular dysrhythmias peripheral vascular disease untreated hypertension chronic obstructive pulmonary disease

untreated hypertension Untreated hypertension causes significant increased work of the left ventricle. Further, the years of untreated high blood pressure eventually causes congestive heart failure (CHF).

Your patient has had a gradual onset of paresthesias that have been progressing. Her CBC reveals a macrocytic anemia and peripheral smear shows multisegmented neutrophils. The diagnosis is most likely: acute leukemia non-Hodgkin's lymphoma Hodgkin's lymphoma vitamin B12 deficiency

vitamin B12 deficiency This patient most likely has a vitamin B12 deficiency. The normal vitamin B12 level is> 250 pg/mL.

How long would it typically take for a patient who is taking Parcopa (carbidopa-levodopa) orally to help control his symptoms? 1 - 2 months 1 - 2 weeks 3 - 4 months the effect is immediate

1 - 2 months It takes at least 1 to 2 months for this medication to be effective. Sometimes it takes as much as 6 months. The patient is not likely to see any improvement in symptoms in 10 days.

How many doses of the MCV4 (Meningococcal conjugate vaccine quadrivalent) should be administered to an adult? 3 doses 1 dose 4 doses 1-2 doses

1-2 doses This will depend on the patient, but typically 1-2 doses should be administered. These should be given at least 1 months apart.

Mary is concerned because her 12-year-old son shows no signs of puberty. You would tell her that the average age of onset for males is which of the following? 10 - 12 years 13 - 16 years 10.5 - 16 years 10.5- 13 years

10.5 - 16 years You can reassure this mother that her son is not behind schedule in reaching puberty. The average age of onset for males is 10.5 - 16 years.

You have a patient who has Osgood-Schlatter disease. Your patient wants to know how long it will be until there is a complete recovery. You would tell him that complete resolution of physiologic symptoms takes how long? 12 - 24 months 6 - 12 months 3 - 6 months 2 - 4 weeks

12 - 24 months Complete resolution of symptoms of Osgood-Schlatter disease through physiologic healing takes 12 - 24 months. You should work with the client in the meantime to help determine the degree of stress or athletic participation that may be undertaken without significant pain.

An adult female patient is seeking information about her ideal weight. She is 5 feet 7 inches tall. Using the "height-weight formula" what is her ideal body weight?

135 lbs The height-weight formula is a quick method of determining ideal weight. Females allow 100 lbs for the first 5 feet of height plus 5 lbs for each additional inch. Males allow 106 lbs for the first 5 feet plus 6 lbs for each additional inch. This method can only be used as an estimate because it does not account for body composition or age.

A patient comes to the clinic with a burn on his leg that is about 2 times the palmar surface of his hand. The body surface area (BSA) of the burn can be estimated at: 4% 6% 2% 12%

2% A person's palmar surface represents a BSA of 1% throughout his life span. Therefore, a burn that is 2 times the palmar surface represents a BSA of 2%.

You have a patient who you are examining after he suffered a TIA. You would consider the diagnosis of stroke if signs and symptoms do not resolve within what maximum time frame? 24 hours 12 hours one week 36 hours

24 hours All signs and symptoms of a TIA, including numbness, weakness and flaccidity, visual changes, ataxia or dysarthria resolve usually within minutes but certainly by 24 hours after onset. If changes persist beyond 24 hours, the diagnosis of stroke should be considered

Of the following screening tests, which would confirm hypertension due to pheochromocytoma? CT angiography. 24-hour urinary metanephrine and normetanephrine. Doppler flow study; magnetic resonance angiography. Estimated GFR.

24-hour urinary metanephrine and normetanephrine The preceding screening tests are used to confirm or refute hypertension due to the following: CT angiography - Coarctation of the aorta 24-hour urinary mentanephrine and normetanephrine - Pheochromocytoma Doppler flow study; magnetic resonance angiography - Renovascular hypertension Estimated GFR - Chronic kidney disease

You have a patient who has developed meningitis in the course of being treated for Lyme disease. You would expect treatment for this individual to last how long? 14 - 21 days 21 - 28 days 30 - 60 days 3 - 6 months

30 - 60 days For the patient who develops meningitis or encephalitis, the treatment phase will last 30 - 60 days. For early Lyme disease, treatment lasts for 14 - 21 days; and for late disease, 21 - 28 days.

You have a pregnant patient who asks you if her iron intake should increase while she is pregnant. What is the typical iron requirement for a pregnant woman with no iron deficiency? 325 mg/d 30 mg/d 65 mg/d 200 mg/d

30 mg/d In the absence of an iron deficiency, 30 mg/d is the recommended amount of iron for a pregnant woman. If there is an iron deficiency or a multiple-gestation pregnancy, the recommended amount would be 60 - 100 mg/d. With iron deficiency anemia, 200mg/d would be required.

After taking a job with a professional organization, you are a practicing nurse practitioner in a rural community. You are involved in work-related surveillance and know that the records related to this must be held for how many years after employment? 10 years 20 years 30 years They can be destroyed only after the employee's death.

30 years The Occupational Safety Health Act (OSHA) was formed to protect employees from hazardous work environments. The requirements of OSHA are to keep these records for 30 years after the termination of employment.

The FNP is calculating the BMI for a female patient who wants to lose weight. If the patient is 5 feet 6 inches and weighs 200 lbs. what is her BMI to the nearest tenth? 23.2 33.2 32.3 30.3

32.3 The BMI is calculated by dividing the weight in pounds by the height in inches squared and multiplying that by 703.200÷ 662 = 200 ÷ 4,356 = 0.045913 * 703 = 32.2768, or 32.3 rounded to the nearest tenthThis puts the woman in the obese category.

Your patient has been treated for warts by using laser therapy. How long after treatment will this therapy become effective? immediately within 48 hours within 10 days 4 - 6 weeks

4 - 6 weeks Laser therapy needs 4 - 6 weeks to granulate the tissue and is best reserved for treatment-resistant warts. It is used to dissect lesions.

Babies should begin oral iron supplementation:

4-6 months of age. Generally, full term infants who are breadt-fed have sufficient stores of iron to last through the first 4-6 months of life. Earlier supplementation may be m=necessary for premature infants, infants who are breastyfed exclusively beyond the first 6 months of age, and infants who begin drinking cow's milk prior to 1 year of age.

For patients with fibromyalgia, the maximum dose of Lyrica is which of the following? 100 mg/day. 450 mg/day. 1000 mg/day. 150 mg/day.

450 mg/day The maximum dose of Lyrica for neuropathic pain associated with fibromyalgia is 300-450 mg/day. It is given in two or three doses during the day. Patients typically start on a lower dose of 150 mg/day and build up to 300-450 mg/day over the course of a week.

Therapy for acute otitis media with azithromycin would last for how many days? 7 days 10 days 5 days 3 days

5 days Antibiotic therapy for acute otitis media generally is for 7 - 10 days. There are exceptions, however; and Zithromax (azithromycin) has a treatment period of 5 days.

The highest incidence of AOM (acute otitis media) is in which of the following age groups? 10 - 12 years 7 - 8 years 4 - 6 years 6 months to 3 years

6 months to 3 years Acute otitis media is an infection of the middle ear cavity with bacterial pathogens secondary to temporary Eustachian tube dysfunction. The highest incidence of AOM is from ages 6 months to 3 years.

A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH?

6 weeks. The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of 4-6 weeks before checking the patient's TSH.

According to the American Burn Association Burn Classification ratings, a minor full thickness burn in adults and children involves how much body surface area? 3 - 10% 10 - 15% >2% <2%

<2% According to the American Burn Association burn Classification a minor full thickness burn in adults and children involves <2% of body surface area. This does not include burns to special areas, such as eyes, ears, face, hands, feet, or perineum; nor does it include people at high risk.

Correct Answer: Consent. Procedures and tests require patient consent before they can take place. Since the patient is a conscious adult, the patient gives consent. This is the first step.

A 23 year old patient is conscious and requires an x-ray for a differential diagnosis of a broken arm. What is the first step to the process? Prepare the machine. Position the patient. Consent. Inform radiology.

The Correct answer is: Water intoxication Desmopressin acetate (DDAVP) promotes reabsorption of water in the renal tubules, which can lead to water intoxication. Other signs of this are behavioral changes and disorientation.

A 6-year-old patient has been discharged from the hospital to home on DDAVP (desmopressin acetate) for diabetes insipidus after removal of a pituitary tumor. The nurse practitioner (NP) notices that the child is lethargic and has 4+ deep tendon reflexes on examination. The NP suspects: interaction with OTC cough medicine water intoxication increased vasopressor effect noncompliance with therapy

A 35-yo male presents with a complaint of low pelvic pain, dysuria, hesitancy, urgency, and reduced for of stream. The nurse practitioner suspects acute bacterial prostatitis. The NP would appropriately collect all of the following specimens EXCEPT a: sterile in-and-out catheter urine specimen.

A sterile in-and-out catheter specimen would identify only organisms in the bladder and would not differentiate between bladder, kidney, or prostate site infection. The sequence for obtaining specimens when prostat infection is suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder urine, and 3. voided post-prostate massage urine.

An 8-mo male presents with hemarthrosis of both knees and hematuria. The parents give no history of trauma, but say " he has always bruised easily" The most likely diagnosis is:

A type of hemophilia. Hemophilia is usually diagnosed within the first year of life. It commonly presents with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding times.

An 18yr old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? A. Amoxicillin-Clavulanate (Augmentin) B. Ceftriaxone (Rocephin) C. Levofloxacin (Levaquin) D. Erythromycin

A. Amoxicillin-Clavulanate (Augmentin)

A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH is 4.0. There are very few leukocytes and no RBCs are seen on the wet smear. Which of the following is most likely? A. Atrophic vaginitis B. Bacterial Vaginosis C. Trichomoniasis D. This is a normal finding.

A. Atrophic vaginitis. Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0 (acidic)

Which of the following would be an appropriate alternative to erythromycin therapy in an 18 year old patient with Mycoplasma pneumoniae infection? A. Azithromycin (Zithromax) B. Cephalexin (Keflex) C. Amoxicillin D. Clindamycin (Cleocin)

A. Azithromycin

A 20 yo male presents with a 1 month history of a " bump on my testicle" He reports being sexually active, frequent episodes of unprotected intercourse with multiple partners. Which condition should be suspected? A. Cancer of the testicles B. Torsion of the testicles C. Acute epididymitis D. Gonorrhea

A. Cancer of the testicles

A 70 yo male presents with parathesia of the lower extremities. On exam, the patient appears pale and shows a decreased vibratory sense. Lab tests reveal elevated indirect bilirubin; Hct=30%; Mean corpuscular volume(MCV)=120 (norm 87-103). The most likely diagnosis is: A. pernicious anemia B. Anemia of chronic disease C. folic acid deficiency D. Iron deficiency anemia

A. Pernicious anemia

A 32 year old patient reports a 6-month history of intermittant symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Gouty arthritis D. Reiter's syndrome

A. Rheumatoid Arthritis

A 14yo male with bronchitis is being treated with fluids and expectorants. He returns to the clinic with a fever of 103F, right pleuritic chest pain, and green sputum. Which of the following examination results would be expected? A. Right lower lobe crackles B. Decreased Fremitus C. Bilateral Wheezing D. Normal Percussion

A. Right lower lobe crackles.

A nurse practitioner is suturing a simple laceration on an 11-yo patient. The use of lidocaine with epinephrine is contraindicated in all of the following areas EXCEPT the: A. Scalp B. Nose C. Fingers D. Earlobe

A. Scalp

The best lab test to distinguish iron deficiency anemia from other anemias is: A. Serum ferritin level B. Mean corpuscular hemoglobin concentration C. Mean corpuscular volume D. Transferrin saturation

A. Serum ferritin level

To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: A. The meaning of a common proverb B. What action the patient would take if their was a fire in the house C. To count backwards from 100 by 7s D. To spell a word backward.

A. The meaning of a common proverb

Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? A. Urinalysis and urine culture B. Scrotal palpation and urine culture C. Prostate-specific antigen (PSA) D. Complete blood count with differential (CBC with Diff)

A. Urinalysis and urine culture

When would Aldactone be contraindicated? When the patient has hyperkalemia (serum potassium of greater than 5.5 mEq/L. When the patient has renal insufficiency (serum creatinine greater than 2.0 mg/dL. If the patient has type 2 diabetes mellitus with microalbuminuria. All of the above

All of the above The nurse practitioner would need to evaluate the patient prior to ordering Aldactone.The following would be considered contraindications for ordering Aldactone:When the patient has hyperkalemia (serum potassium of greater than 5.5 mEq/L.When the patient has renal insufficiency (serum creatinine greater than 2.0 mg/dL.If the patient has type 2 diabetes mellitus with microalbuminuria.

Correct answer: deficient intake of calcium The FRAX algorithm does not take into account certain other risk factors such as deficient intake of calcium. The algorithm includes age, gender, smoking, three or more alcoholic drinks per day, rheumatoid arthritis, low BMI, prolonged corticosteroid use, secondary osteoporosis, parent with a hip fracture, and BMD. Risk factors that are not considered include deficient intake of calcium, activity level, risk for falling, intake of vitamin D, and caffeine.

All of the following are risk factors in the FRAX algorithm for fracture risk assessment EXCEPT: deficient intake of calcium prolonged corticosteroid use parent with a hip fracture low BMI

Rimantadine and which of the following would be recommended for the patient that is suspected of having influenza? Lisinopril Percocet Furosemide Amantadine

Amantadine Rimantadine and amantadine would be recommended for use for the patient that has the influenza or is suspected of having influenza. The other medications would not be recommended for a patient that is suspected of having influenza.

Amblyopia is a secondary vision loss related to disease of the visual pathways. Which of the following statements about the complications of amblyopia is least accurate? Amblyopia causes impairment of depth perception. Amblyopia causes impairment of peripheral vision. Amblyopia causes monocular vision loss. Amblyopia has no effect on childhood development.

Amblyopia has no effect on childhood development. This statement is not accurate. Amblyopia is detrimental to childhood development. It is also detrimental to education achievement and self-esteem. Lazy eye (amblyopia) is reduced vision in one eye caused by abnormal visual development early in life. The weaker — or lazy — eye often wanders inward or outward. Amblyopia generally develops from birth up to age 7 years. It is the leading cause of decreased vision among children. Rarely, lazy eye affects both eyes.

Which of the following statements about management of GERD is least accurate? Antacids can increase absorption of some medications. Pharmacological treatment in children under the age of 2 years is discouraged. If nonpharmacologic treatment is not effective, acid-neutralizing drugs may be initiated. Lifestyle modification is the first step in therapy.

Antacids can increase absorption of some medications. This is not accurate. Actually, antacids can decrease absorption of some medications. These include: fluoroquinolones, tetracycline, and ferrous sulfate. Doses should be separated by at least 2 hours.

A 21-yo patient presents with abdominal guarding, rigid abdominal musculature, rebound tenderness at McBurney's point, and leukocytosis. What is the most likely diagnosis?

Appendicitis. McBurney's point is the RLQ abdominal landmark for the appendix. Rigid abdominal musculature, rebound tenderness, and positive psoas sign (inflamed psoas muscle), indicates inflammation of the peritoneum. Cholecystitis presents with RUQ pain and positive Murphy's inspriatory arrest. Ilcerative colitis presents with LLQ pain. Pain associated with pancreatitis is typically in the epigastric region.

Which of the following medications would be temporarily contraindicated for the pediatric patient that has received an influenza vaccine? Aspirin Tylenol Steroids Calcium-channel blockers

Aspirin If a child receives the vaccine, they should not take aspirin for at least 4 weeks following the vaccination.There are also some antivirals such as osletamivir, zanamivir, rimantadine, and amantadine that should not be administered for 48 hours prior to the administration of the vaccine and for at least 14 days afterwards for any patient. If it is administered, it could interfere with the antibody production.

Correct Answer: Peak expiratory flow rate (PEFR) triggers that are affecting the asthma effectiveness of medications These are important determinations for each follow-up visit. You should also determine that the client is taking the medication properly and discuss an action plan.

At each follow-up visit with your patient who has asthma you should determine which of the following? check all answers that apply Peak expiratory flow rate (PEFR) diet triggers that are affecting the asthma blood count effectiveness of medications

The most common type of skin malignancy is: A. Squamous cell cancer B. Basal skin cancer C. Melanoma D. Dysplastic nevi

B. Basal skin cancer. It is several times more common that squamous cell skin cancer according to the NIH.

Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection: A. WBC count and viral load B. CD4 count and viral load. C. CD4 count and Western blot test D. CD4 count and enzyme-linked immunosorbent assay (ELISA)

B. CD4 count and viral load

A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T=100F (37.8C). The patient does not apear toxic and can tolerate fluids. An appropriate plan should include: A. barium enema and nothing by mouth B. Clear liquids and antibiotics C. low-fiber diet and referral to gastroenterologist D. hospital admission for IV antibiotics

B. Clear liquids and antibiotics.

A 72 year old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3am, is reluctant to go out although she has family member living nearby, and feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include: A. Stroke, depression, and hyperthyroidism B. Depression, Unresolved grief, and hypothyroidism C. Migraine, anxiety disorder, and hypertension D. Dementia, delirium, and pna

B. Depression, Unresolved grief, and hypothyroidism

Which of the following is NOT an indication of preeclampsia? A. visual disturbances B. Glucosuria C. Edema of the face and hands D. Headaches

B. Glucosuria

A patient with macular degeneration has difficulty seeing objects: A. from a distance B. In the center of the visual field C. At reading distance D. In the peripheral fields

B. In the center of the visual fields.

A nurse practitioner orders pulmonary rehabilitation for a 75 yo patient with COPD. Expected outcomes of this program include all the following EXCEPT: A. enhanced quality of life B. Increased lung capacity C. Decreased in-patient hospitalizations D. Improved exercise capacity

B. Increased lung capacity

Assessment findings that would support a diagnosis of mitral regurgitation include: A. atrial fibrillation with summation gallop B. Loud, high-pitched pansystolic murmur C. Diastolic murmur with split S1 D. Early diastolic murmur with an S3 wave.

B. Loud, high-pitched pansystolic murmur

The parent of a 13-year old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The nurse practitioner should advise the parent that development of fever may: A. make the seizure medication less effective B. Lower the seizure threshold C. Increase the seizure threshold D. Have no effect on the seizure threshold

B. Lower the seizure threshold

Koplik's spots are associated with: A. Poxvirius infections B. Measles C. Kawasaki's disease D. Reye's syndrome

B. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and koplik's spots on buccal mucosa

A 15 year old patients returns for contraceptive services 2 weeks after a diagnosis of trichomonas vaginitis and treatment with 2gm of metronidazole (Flagyl). She reports that discharge and itching are gone, but she is urinating frequently, accompanied with alot of burning. The patient has not resumed sexual activity and has menstrated since her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which diagnostic test should be performed immediately? A. Urine pregnancy test B. Microscopic exam of urine C. Herpes simplex virus culture D. Repeat chlamydia test.

B. Microscopic exam of urine.

A 29-year old male with noncomplicated Chlamidia infection may exhibit: A. Urticaria B. No remarkable clinical symptoms C. A green mucoid penile discharge D. A penile ulcer

B. No remarkable clinical symptoms

During development of a treatment plan for an 84 year old patient with hypothyroidism, the nurse practitioner has to keep in mind the worsening of: A. renal insufficiency B. Osteoporosis C. Dementia D. Anemia

B. Osteoporosis

You note the following result on a routine urinalysis of a 37-year old primigravida who is at 30 weeks gestation. Leukocyte=trace, nitrite=negative, protein=2+, blood=negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A.HELLP syndrome B. Pregnancy-induced hypertension (pre-eclampsia) C. Eclampsia of pregnancy D. Primary hypertension

B. Pregnancy-induced hypertension (pre-eclampsia). Classic triad of symptoms of preeclampsia include hypertension, edema (weight gain), and proteinuria.

A 4-yo girl with a history of recurrent urinary tract infections returns for follow-up after diagnosis of the most recent infection. During the physical exam, the 4 yo tells the nurse practitioner that her brother (age 9) lies on top of her and rubs his penis in her pubic area. After completing the physical exam, the nurse practitioner must: A. Discuss the child's report with the mother B. Report suspicion's to the appropriate child protective services agency C. Refer the case to a physician D. Suggest psychological counseling.

B. Report suspicions to the appropriate child protective services agency.

The mother of a 12 month old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A. Fifth Disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes

B. Roseola Infantum (Exanthema subitum)

A 3 year old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? A. throat culture B. sputum culture C. Mantoux (PPD) skin test D. Cold agglutinin test

B. Sputum culture

A common rule to follow when prescribing many medications for the elderly is to: A. Give most medications in the morning to allow slowed body functions to have time to adjust to the drug. B. Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. C. Perform a creatinine clearance test for baseline data on all person over age 70 before starting on new medications. D. Give medication with a full glass of water to promote absorption and limit harm to the kidneys.

B. Start at a low dose than what is commonly prescribed for adults, and increase the dose slowly.

A 38-yo male experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Examination reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: A. Testicluar cancer B. Testicular torsion C. Appendicitis D. Epididymitis

B. Testicular Torsion

Which of the following assessments or tests is most likely to provide valuable information about the state of renal perfusion? creatinine level osmolality urine volume BUN level

BUN level The BUN level provides valuable information about the state of renal perfusion. The creatinine level is more precise in evaluating actual tubular function. Urine volume and osmolality, along with specific gravity, are useful in identifying the kidney's ability to excrete and concentrate fluid.

You are planning the pharmacological management for your 12-year-old male patient with Tourette syndrome. You understand that all of the following statements about the pharmacological management of this condition are accurate EXCEPT: Consult with a pediatric neurologist. Begin a dose of pimozide 1 mg with gradual increases until symptoms subside. Begin clonidine which is the most effective drug with the fewest side effects. Begin a dose of haloperidol 0.25 mg to 0.5 mg at bedtime with gradual increases until symptoms subside.

Begin clonidine which is the most effective drug with the fewest side effects. This statement is not true. Clonidine may be used because it has fewer side effects but it is the least effective pharmacological intervention.

A 38-yo pregnant patient at 18 weeks gestation, complains of feeling light-headed when standing. Which of the following is an appropriate response by the NP?

Blood pressure normally decreases during pregnancy and can cause this symptom. Blood pressure normally decreases during pregnancy, reaching the lowest point during the second or third trimesters and rising there after. Patient education to rise slowly from sitting or lying is important. Low blood glucose may be the etiology, but an oral glucose tolerance test at this point is not indicated. A fasting blood glucose could be ordered, however, an electrocardiogram is not indicated.

You are conducting an assessment with a patient who has presented at the ED with severe, painful gas and bloating. The patient says she has been vomiting since early this morning. Her temperature is 102.7F. On auscultation, you hear tinkling and splashing. Which of the following conditions is this patient displaying signs and symptoms of? Perforated bowel. Gallstones. Bowel obstruction Inflammatory bowel disease.

Bowel obstruction The patient's symptoms indicate a bowel obstruction. The tinkling and splashing bowel sounds are especially revealing. The nature of the sounds will indicate whether the blockage is complete or partial.

A mother brings in her child reporting that the child's eyes are crossed. You perform a test in which you stand about 20 inches from the child in a darkened room and look at both eyes through an ophthalmoscope. This is known as which of the following? Hirschberg test Bruckner's test EOMs cover-uncover test

Bruckner's test Bruckner's test is one of the four tests used to assess ocular alignment. During this test you would note symmetry of red reflexes bilaterally. Hirschberg test- also Hirschberg corneal reflex test, is a screening test that can be used to assess whether a person has strabismus (ocular misalignment). A cover test or cover-uncover test is an objective determination of the presence and amount of ocular deviation.

The FNP has a patient who desires to quit smoking. She asks the FNP if there is anything that can help her in trying to quit. The FNP understands that all of the following are true in regard to smoking cessation EXCEPT: Bupropion, an atypical antidepressant, is used for smoking cessation. Bupropion can be used with nicotine products such as gum or nasal sprays. Bupropion is safe to use for persons with a history of seizures. Nicotine patches should not be used with other nicotine products.

Bupropion is safe to use for persons with a history of seizures. Bupropion (Zyban) is contraindicated in persons with a history of seizures.

To assess spinal function at the S1 level, which deep tendon reflex should be tested? A. Patellar B. Cremasteric C. Achilles D. Anal wink

C. Achilles

Which of the following lab test should a nurse practitioner order when the suspected diagnosis is temporal arteritis? A. Antinuclear antibody B. Electrolyte profile C. Erythrocyte sedimentation rate (ESR) D. Complete Blood Count (CBC)

C. Erythrocyte Sedimentation Rate (ESR)

An 18 yo college student presents for an athletic physical. When asked about current medications, she mentions that she takes "some hearb" she bought at a health food store for migrains and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? A. Ephedra B. Echinacea C. Feverfew D. Ginko Biloba

C. Feverfew

The follow-up exam of a 12 month old treated 2 weeks ago for bilateral otitis media reveals a normal left tympanic membrane and a right tympanic membrane with visible serous fluid levels and decreased mobility. An appropriate plan should include: A. Consultation with an audiologist B. Prescription for an oral decongestant C. Follow-up evaluation of the ears in 2 months D. Referral to an ENT specialist for surgical consultation

C. Follow-up evaluation of the ears in 2 months.

A 65-yo male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical exam, the patient is tachycardic, positive for jugular venous distension, and positive for S3, with a systolic murmur. Chest xray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: A. mycardial infarction B. pneumonia C. Heart failure D. pleural effusion

C. Heart failure

A routine laboratory assessment of a 12 year old patient with a family history of thalassemia and anemia reveals Tanner II presentation and Hct=355. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? A. serum folic acid B. Vitamin B12 level C. Hemoglobin Electrophoresis D. 24-hour urine creatinine

C. Hemoglobin electrophoresis

An 88 year old patient presents with right-sided weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis? A. Seizure B. Right-sided Stroke C. Left-sided stroke D. Trans ischemic attack

C. Left-sided Stroke

A 17 year old femlae has never had her menses. She is at Tanner stage III of sexual development. Her physical exam in completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? A. Ovarian dysgenesis B. Dysmenorrhea C. Primary amenorrhea D. Secondary amenorrhea

C. Primary amenorrhea

14 year old patient who fell on a outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on xray. The most likely working diagnosis is: A. upper arm sprain B. lateral epicondylitis C. Radial head fracture D. Olecranon bursitis

C. Radial head fracture.

An 18-month old child presents with a bulging, immobile tympanic membrane; T-103F(39.4C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: A. Obtain an EKG B. Obtain an Echocardiogram C. Reevaluate the patient in 10 days D. Refer the patient to a cardiologist

C. Reevaluate the patient in 10 days

A 68-yo female presents with a new onset of left-sided throbbing headache. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. Sedimentation rate is elevated, but all other lab values are WNL. The headache is most likely due to: A. TIA B. NSAID induced headache C. Temporal arteritis D. Glaucoma

C. Temporal arteritis

A 67-year old with type 2 diabetes mellitus, congestive heart failure, and mild coronary artery disease is currently taking Digoxin, 0.25mg daily; HCTZ, 25mg daily; Metformin 500mg daily; glipizide 10mg daily; and Atorvastatin (Lipitor) 20mg HS. Which of the following is an accurate statement regarding the regimen? A. The glipizide will increase the risk of potassium depletion. B. The digoxin will increase the risk of hypoglycemia C. The HCTZ will predispose the patient to Digoxin toxicity D. The atorvastatin will worsen the diabetes.

C. The HCTZ will predispose the patient to Digoxin toxicity

2 year old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After closed manipulation, the best indication of successful treatment is that: A. Swelling dissipates immediately B. Pulse and sensation are restored C. The child quickly begins to use the affected arm D. A click is felt while the child is extending and rotating the arm

C. The child quickly begins to use the affected arm.

A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate intervention to aid in the diagnosis of this case? A. Nitrazine test B. Non-Stress test C. Ultrasound D. Bimanual cervical exam

C. Ultrasound

A patient with Type 1 diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of an at-home glucose test reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: A. Insulin resistance B. Cortisol deficiency C. the Somogyi effect D. pawn phenomenon

C. the Somogyi effect

You have a patient who admits to having several drinks every night after work. He often misses work because of the effects of his drinking the night before. Which of the following tools would you use for determining alcohol abuse in this patient? mini-mental examination SNOOP test CAGE test Snellen chart

CAGE test An effective screening tool for alcohol abuse is the CAGE test or questionnaire. This questionnaire can be modified for use with other forms of substance abuse. SNOOP test - headache warning signs (Systemic Symptoms, Nuerological Signs and Symptoms, Onset, Older age of onset, Prior headache history. Have you ever felt you needed to Cut down on your drinking? ... Have people Annoyed you by criticizing your drinking? ... Have you ever felt Guilty about drinking? ... Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

The classification system for reporting procedures and services recognized by third-party payers is which of the following? medical procedural classification diagnostic procedural classification ICD CPT

CPT Current procedural terminology (CPT) is a classification system for reporting procedures and services recognized by third-party payers. It is a series of codes used to bill for a visit. The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. The CPT code describes what was done to the patient during the consultation, including diagnostic, laboratory, radiology, and surgical procedures while the ICD code identifies a diagnosis and describes a disease or medical condition.

Which of the following is NOT a typical physiologic change during pregnancy? Cardiac output decreases by one-third by the last two trimesters. The heart is displaced upward and to the left in the late second to third trimester. Decreased systolic and diastolic pressure occurs in the first trimester. The thyroid can enlarge by as much as 15%.

Cardiac output decreases by one-third by the last two trimesters. All of the choices are typical physiologic changes during pregnancy except this one. Cardiac output increases by one-third by the last two trimesters.

You are evaluating a patient who has had a potential stroke. The nurse practitioner knows that which of the following is the most common cause of a stroke? cerebral ischemia cerebral hemorrhage venous insufficiency subdural hemorrhage

Cerebral ischemia About 80% of strokes are due to cerebral ischemia, which makes cerebral ischemia the most common cause of strokes. Further, about 15% of strokes are due to cerebral hemorrhage. Then, about 5% of strokes are due to subarachnoid hemorrhage. Venous insufficiency is not a cause.

You have calculated the BMI of your patient as 39.8. You understand that this means that this patient is in which of the following classes? overweight Class I obesity Class II obesity Class III obesity

Class II obesity Class II obesity is when BMI is 35 - 39.9. Normal BMI is 18.5 - 25. Subdivisions of Obesity: Class 1: BMI of 30 to < 35. Class 2: BMI of 35 to < 40. Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as "severe" obesity.

Alfred is a 54-year-old male patient with high cholesterol. You are going to prescribe a bile acid sequestrants for him. Which of the following drugs is a bile acid sequestrant? Zocor Colestid TriCor Pravachol

Colestid Colestid is a bile acid sequestrants. TriCor (fenofibrate) is a fibrate drug. Pravachol and Zocor are HMG CoA Reductase Inhibitors (statins).

Correct Answer: Both B and C Cephalosporins and penicillins would be considered the first most frequent cause of allergic reactions. Sulfonamides would be considered the second most frequent cause of allergic reactions.

Correct answer: unintentional injuries The leading cause of death in children 12 months to 9 years is unintentional injuries. The leading cause of death in infants younger than 12 months is congenital anomalies.

A 34-year-old female with multiple sclerosis (MS) is in the office. She is now under your care after relocating from another state to live with relatives who can help her. The nurse practitioner understands that which of the following is NOT part of her management plan: Physical and occupational therapy. Complex treatment regimen must be coordinated with a neurologist. Acute exacerbations should be treated with prednisone 60-80 mg/day for 1 week, taper over 2-3 weeks. Corticosteroids are often used for maintenance.

Corticosteroids are often used for maintenance Corticosteroids are only for acute exacerbations, not for maintenance. The remaining answer choices are treatment options for this condition.

A 39 yo patient was diagnosed with acute bronchitis in the emergency department and treated with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a smoking habit of 1 pack per day. The patient now presents to a nurse practitioner's office with a fever of 101.2 and a cough productive of thick, yellow-green, foul-smelling sputum. The nurse practitioner should encourage smoking cessation and prescribe: A. theolphylline B. A PCN antibiotic C. an inhalable corticosteroid D. a macrolide antibiotic

D. A macrolide antibiotic

Which class of antihypertensive agents has been associated with acute renal failure and is contraindicated in patients with bilateral renal artery stenosis? A. Calcium channel blockers B. Thiazide diuretics C. Potassium-sparing diuretics D. Angiotensin-converting enzyme (ACE) inhibitors.

D. ACE inhibitors

A 2month old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (not beet red) macular rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted . The infant's rash is most likely caused by. A. Candida albicans infections. B. Eczema C. Seborrheic dermatitis D. Contact dermatitis

D. Contact dermatitis

After a 3-week camping trip, an 11-year old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: A. trimethoprim-sulamethoxazole (Bactrim) B. Azithromycin (Zithromax) C. Metronidazole (Flagyl) D. Doxycycline (Doryx)

D. Doxycycline

A 17 year old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the most appropriate diagnostic tests to order would be: A. BUN, creatinine, electrolytes, and dehydroepiandrosterone(DHEA) B. CBC, BUN, creatinine, and estrone C. Fasting blood sugar (FBS), complete blood count (CBC), BUN, and sex hormone binding globulin D. Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH)

D. FSH, LH, TSH

A 47-yo patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. The patient is not currently taking any medications. The most likely differential diagnoses would include: A. colitis and peptic ulcer disease B. Colitis and small bowel disease C. Gastritis and Crohn's disease D. Gastritis and peptic ulcer disease

D. Gastritis and peptic ulcer disease.

Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? A. Olopatadine (Patanol) B. Cromolyn opthalmic (Crolom) C. Timolol (Timoptic) D. Gentamycin Opthalmic (Genoptic)

D. Gentamycin Opthalmic (Genoptic)

All of the following are classified as activities of daily living (ADLs) except: A. ability to feed self B. Ability to manage bladder and bowel elimination C. Personal hygiene and grooming D. Grocery Shopping

D. Grocery shopping

A nurse pracitioner is evaluating a 40 year old patient suspected of having a pulmonary embolus. The patient complains of anxiety and cough. A stat chest x-ray is normal. Which of the following tests should the nurse practitioner perform next? A. Spirometry B. MRI C. Contrast venography D. Helical CT pulmonary angiography

D. Helical CT pulmonary angiography

Which of the following is the leading cause of cancer-related deaths in the majority of women? A. cervical Cancer B. Ovarian Cancer C. Breat Cancer D. Lung Cancer

D. Lung Cancer

A 10-month old presents with a rash, runny nose, and cough. Examination reveals a cluster of tiny white papuls with an erythematous base on the buccal mucosa. What does this suggest? A. Scarlet fever B. Rubella C. Erythema infectiosum D. Measles

D. Measles

A 50 year old male presents with a chief complaint of malaise. Further questioning reveals that his primary concern is delayed ejaculation. He is currently taking the following medications: atenolol (Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and hydrochlorthoriazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be: A. loratadine B. hydrochlorthoriazide (HCTZ) C. lisinopril (Zestril) D. paroxetine (Paxil)

D. Paroxetine (Paxil)

A 40 year old male patient presents with a 2 week history of rectal pain and itching. He reports a past history of constipation, and finding spots of bright red blood on toilet paper several times a week. Rectal exam reveals a tender, swollen, bluish, ovoid mass. The stool guaiac test is negative. Which of the following actions should the nurse practitioner take? A. Prescribe diphenoxylate/atropine( Lomotil) B. Schedule a colonoscopy to rule out colon cancer C. Repeat the guaiac test three times and obtain complete blood count D. Prescribe bulk forming agents and hydrocortisone suppositories.

D. Prescribe bulk forming agents and hydrocortisone suppositories.

A 16 year old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She hasn't missed any doses and uses no other medication. Which of the following is appropriate? A. Modifying use B. Double dosing for 2 days C. Changing to Ortho-Novum 1/35 D. Providing reassurance

D. Providing reassurance

Which of the following best describes psoriatic lesions in an elderly patient? A. Shiny, purple, smooth lesions B. Localized erythematous vesicles C. Erythematous plagues with central clearing D. Red, sharply defined plaques with silvery scales

D. Red, sharply defined plaques with silvery scales

An 85 year old patient related that on the way to an annual physical exam, the patient suffered a sudden loss of vision in the right eye characterized by a "bunch of lights" and a feeling that " a curtain came down" The most likely diagnosis is: A. Vitreal hemorrhage B. Optic nerve lesion C. Central retinal nerve occlusion D. Retinal Detachment

D. Retinal detachment

During an employment physical exam of a 21-year old female, bruising around the areola on the breasts is noted. An appropriate health history for these findings should include all of the following EXCEPT: A. Current social relatonships B. History of present or past traumas C. Mental health status D. Socioeconomic status.

D. Socioeconomic status.

A 70-year old male patient complains of a bright red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on Bayer aspirin, 1 tablet a day. Which of the following is most likely? A. Corneal abrasion B. Acute bacterial conjunctivitis C. Acute uveitis D. Subconjunctival hemorrhage

D. Subconjunctival hemorrhage. Bright red blood in a sharply defined area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage.

A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient? A. edema B. Tachycardia C. Palpitations D. Sweating

D. Sweating

Office Spriometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: A. Oxygen saturation B. Whether airway obstruction is from pulmonary fibrosis C. Chronic carbon dioxide retention D. Whether a patient has reversible airway obstruction

D. Whether a patient has reversible airway obstruction

Which of the following criteria differentiates a TIA from a stroke? A. focal symptoms B. Amnesia of incident C. Slowness of onset D. Absence of residual symptoms

D. absence of residual symptoms

At what level of prevention would you classify for lung cancer? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Primordial prevention

D. primordial prevention. Screening for lung cancer is not currently recommended in the general population, but it is secondary prevention.

You are examining a 32-year-old obese man who complains of indigestion and heartburn with a strong acid taste in the mouth about an hour after meals. His history is negative for chronic illnesses. You make the diagnosis of GERD. What is the best initial treatment? Eat five small meals daily and lie down after meals. Take propantheline (Pro-Banthine) 15 mg tid 30 minutes before eating. Take omeprazole (Prilosec). Decrease weight and take ranitidine (Zantac).

Decrease weight and take ranitidine (Zantac). Changes in diet, weight reduction and H2 blockers are first line treatments for gastrointestinal reflux disease (GERD). It is recommended that the patient with GERD does not lie down after meals. Omeprazole is not recommended for the first phase of treatment but with failure on an H2 blocker. Anticholinergics like propantheline may increase the problem by lowering the LES pressure.

A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the most likely underlying conidition predisposing her to recurring candidal vaginitis?

Diabetes. A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this patient.

A 30 year old female patient presents with abdominal pain as her chief complaint. She also mentions alternating between constipation and diarrhea. There is no fever. What do you need to pay close attention to in the assessment? Diet and exercise. Diet. Exercise. Depression.

Diet and exercise. The patient's lifestyle can affect digestion. A diet that is low in fiber can contribute to IBS and other problems. A sedentary lifestyle will also negatively affect digestion.

Of the following, which is a Class IA antidysrhythmic drug you can prescribe to help treat your patient's ventricular tachycardia? Disopyramide. Lidocaine. Encainide. Bretylium.

Disopyramide (Norpace). Disopyramide - Class IA Lidocaine - Class IB Encainide - Class IC Bretylium - Class III

An older adult male presents with complaints of sharp flank and back pain. The patient has difficulty answering questions because of severity of pain. Blood pressure is 90/60 mmHg. The patient has a 20-pack-year smoking history. Abdomen is distended upon palpitation. Which diagnosis is most likely? Congestive heart failure Infective endocarditis Dissecting abdominal aortic aneurysm Acute myocardial infarction

Dissecting abdominal aortic aneurysm. Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp, excruciating pain located in the abdomen, back, or flank area, accompanied by a distended abdomen and hypotension. Older male adults with a smoking history and hypertension are at higher risk. Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and swollen feet and ankles. Patients with infective endocarditis present with fever, chills, and malaise, along with the presence of a new murmur. Acute myocardial infarction generally presents with a gradual onset of intense and heavy chest discomfort that feels like a squeezing, tightness, and heavy pressure in the chest.

A 62 year old female patient has signs of Stage 2 hypertension and several risk factors in her health history. Upon auscultation, the patient also has carotid bruits. Further diagnostic tests should include a(n): Electrocardiogram. Magnetic resonance imaging. Endoscopy. Doppler imaging.

Doppler imaging Doppler imaging is used in patients who have hypertension. A chest x-ray may be necessary for further diagnosis. Additionally, the GNP should also consider carotid Doppler for patients who have carotid bruits present.

A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should the nurse practitioner advise her to do to minimize her risk of pregnancy?

Double today's dose and tomorrow's dose and use a barrier method for the rest of the month. If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled and a barrier method recommended for the remainder of the cycle.

When the nurse practitioner is treating the depressed patient that has peripheral neuropathy, which of the following medications might be considered appropriate? Duloxetine Bupropion Citalopram Escitalopram

Duloxetine If the patient that has depression also has peripheral neuropathy, the nurse practitioner might consider prescribing duloxetine (Cymbalta) for them. This medication is also indicated for treatment of neuropathic pain.

What maternal situation is considered an absolute contraindication to breastfeeding?

Early HIV detection There are few absolute contraindications to breastfeeding. HIV infection and IV drug abuse are 2 contraindications.

Correct Answer: TMJ dysfunction TMJ dysfunction is not an early sign of acceleration/deceleration injuries of the cervical spine. It is a late symptom along with anxiety, limited tolerance to ADLs, depression, and disequilibrium.

Early signs and symptoms of acceleration/deceleration injuries of the cervical spine (whiplash) include all but which of the following? headache neck stiffness TMJ dysfunction vertigo

A nurse practitioner working in a community health clinic sees a male patient who expresses concern about starting a homosexual relationship with a new partner. Which of the following is the best plan to follow during this visit? (Select all that apply.) Contact the patient's partner to schedule HIV testing Educate the patient about using barrier devices during sex Prescribe daily oral PrEP Draw a blood sample for a combination HIV antigen/antibody test Schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP

Educate the patient about using barrier devices during sex; draw a blood sample for a combination HIV antigen/antibody test; schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP Education on using barriers during sexual activity (e.g., condom/dental dams) is important. Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is not appropriate ethically or legally to contact the partner; however, it would be appropriate for the patient to encourage his partner to get tested.

Which of the following is an incorrect statement regarding the expected course and follow-up of a person with acute otitis media? Simple cases are resolved in 2 - 3 days. Middle ear effusion commonly persists after the course of treatment. Recheck can be made in 2 - 8 weeks depending on the reliability of the patient or parent. Effusion is present in 10% of cases at 2 weeks.

Effusion is present in 10% of cases at 2 weeks. This is incorrect. Effusion is present in 60% of cases at 2 weeks. It decreases to 40% at 4 weeks, 20% at 2 months, and 10% at 3 months.

The nurse practitioner should order a TSH, Lanoxin level, and which of the following if a patient that has been on Lanoxin for a few years develops a new onset of atrial fibrillation? CBC Electrolyte level Liver panel Lipid profile

Electrolyte level It is considered important to have baseline blood work, especially if there is a new-onset of atrial fibrillation. The TSH is ordered because thyroid disease can be a common cause for a new-onset of atrial fibrillation.With this patient, the nurse practitioner would more than likely order: TSH Lanoxin level Electrolyte level The therapeutic range of Lanoxin (Digoxin) is 0.6 to 1.2 ng/mL. Levels of 4.0 ng/mL and above may be potentially life-threatening.

A patient with no significant medical history has vericose veins. She complains of '"aching legs". The intervention that will provide the greatest relief for her complaint is to:

Elevate her legs periodically. The intervention that will provide the greatest relief for this patient is elevating her legs periodically. This will facilitate venous return. Use of support stockings will prolong the length of time she is able to stand in place, but will not provide relief after her legs begin aching. Support stockings should be applied prior to getting out of bed.

A 66 yo female presents to your clinic. She states that yesterday evening she had chest pain for 20-30 minutes. Which finding most strongly correlates with myocardial infarction?

Elevated Troponin I levels An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK may be elevated from an IM injection, surgery, ot any type of extensive skeletal muscle trauma or prolonged, strenuous physical exertion. ST segment depression on EKG usually indicates an ischemic myocardium, but, not necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB bands are specific for myocardial smooth muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most accurate marker of cardiac damage, because it is more specific and sensitive than CK MB, is a troponin measurement.

A patient who has been prescribed tamsulosin should be advised to seek immediate medical attention if he experiences which of the following? Light-headedness. Runny nose. Weakness. Erection lasting more than 4 hours

Erection lasting more than 4 hours Erection lasting more than 4 hours is a potentially serious side effect of tamsulosin. Patients experiencing this should seek immediate medical attention. Less serious side effects include runny nose, drowsiness, weakness, problems ejaculating, and light-headedness. Tamsulosin (Flomax) alpha blocker similar medicines such as alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), or terazosin (Hytrin)

Your patient is a 9-year-old female child who is 4 feet 4 inches and weighs 110 lb. This child has a body mass index over the 95th percentile and is therefore overweight. You understand that all of the following are true in regard to the management and treatment of obesity in children EXCEPT: Promote prevention in infancy through parent education regarding nutritional needs and feeding strategies. Discuss moderate modification of diet while increasing exercise. Establish a goal for younger children to include weight reduction. Use behavior modification strategies.

Establish a goal for younger children to include weight reduction. The goal for younger children is weight maintenance rather than weight reduction while linear growth catches up. For adolescents treated after their growth spurt, the goal may include weight reduction.

Adduction (Varus) Stress test

Evaluate for lateral collateral ligament (LCL) injury

You are providing patient education about breast self exam. Which of the following should be the first step in any self exam? Examine the breasts in a mirror with the arms in several different positions. Examine the breasts while lying down. Press the surface of the breasts with the pads of the fingers, in a wedge pattern. Closely examine the skin of the breasts for any bumps.

Examine the breasts in a mirror with the arms in several different positions. The patient should examine her breasts with her arms at her side, her hands on her hips, and her arms raised. This helps to spot any dimpling or other changes in the surface of the breasts. The patient should also carefully examine the breasts for any changes or unusual bumps, lumps, or marks.

In terms of Fee-for-service Medicare, which of the following statements about CPT codes and related items is incorrect? Fees for CPT codes are the same in every location and for every provider. All reimbursable services have a CPT code. CPT codes were developed by the AMA. All CPT codes have a corresponding Medicare fee.

Fees for CPT codes are the same in every location and for every provider. This is incorrect. Fees for CPT codes may vary in different locations and for different providers depending upon a complex variety of factors. These include: geographic area of service and certain office, malpractice and training expenses of the provider.

Your 55-year-old male patient has been diagnosed with BPH. You might prescribe an alpha-1 adrenergic blocker for this disease. Which of the following drugs is NOT an alpha-1 adrenergic blocker? Terazosin Finasteride Tamsulosin Doxazosin

Finasteride Finasteride is a 5-alpha-reductase inhibitor. It blocks conversion of testosterone to DHT. As a consequence the gland shrinks. F in Finasteride is the same with Five in 5-alpha-reductase inhibitor.

Causes of weight loss include

GI deases; endocrine disorders (diabetes, hyperthyroidism, adrenal insufficiency); chronic infections, HIV/AIDS; malignancy; chronic cardiac, pulmonary, or renal failure; depression; and anorexia nervosa or bulimia;

A 75 year old patient has a serum cholesterol of 140. What system will you want to examine? Gastrointestinal. Cardiovascular. Nervous. Urinary.

Gastrointestinal. While high cholesterol is an indicator of heart disease, low cholesterol can be a sign of gastrointestinal problems. Cholesterol below 160 indicates the need for a GI exam. Cholesterol over 240 is too high.

Cranial nerve IX

Glossopharyngeal- swallowing and rise of the palate, gag reflex

A physical assessment of Jerry, your 15-year-old male patient with acne will help to establish the grade of his acne. His acne appears to be pure comedonal acne. This is which of the following grades? Grade I Grade II Grade III Grade IV

Grade IGrade I is pure comedonal acne. It may be treated with tretinoin. To avoid overdrying the skin, the treatment should be initiated on an every-other-day basis. Grade 1: Comedones, occasional papules. Grade 2: Papules, comedones, few pustules. Grade 3: Predominant pustules, nodules, abscesses. Grade 4: Mainly cysts, abscesses, widespread scarring.

Which of the following would be considered the correct term for a court-appointed guardian that is assigned to act in the best interest of the ward? Power of attorney Guardian Ad Litem Ombudsman Health Care Power of Attorney

Guardian Ad Litem The Guardian Ad Litem is a court-appointed guardian that is assigned to act in the best interest of the ward. A "ward" is typically an individual that is a child, vulnerable or frail.

Which of the following topical steroids would be categorized as potent? Halocinonide Hydrocortisone Clobetasol Triamcinolone

Halocinonide Hydrocortisone would be considered a least potent Class 7 topical steroid. Clobetasol would be considered a superpotent Class I topical steroid. Triamcinolone would be considered a moderately potent topical steroid. Halocinonide would be considered a potent topical steroid.

A 22 year old female patient expresses interest in taking Accutane for severe acne. The patient is required to do all but which of the following in order to be prescribed Accutane? Sign a document pledging to use two specific forms of birth control while on Accutane. Agree to take a pregnancy test before starting the medication. Have a total hysterectomy. Agree to take a pregnancy test within 30 days of her last dose of Accutane.

Have a total hysterectomy Accutane poses a risk of serious birth defects. Patients who wish to be put on Accutane must sign a pledge that they will use two specific forms of birth control while on the drug. They must also have a negative pregnancy test within 30 days of stopping and starting the drug. They are not required to undergo hysterectomy.

You have an African-American male patient who is 42 years old. His older brother has been diagnosed with prostate cancer recently, and he asks when he should begin prostate cancer screening. You would tell him which of the following? He is too young to begin screening. He should not worry about screening because being of the African-American race reduces his risk. He should have begun screening when he was 21 years old. He should begin immediately because he has a higher risk of prostate cancer.

He should begin immediately because he has a higher risk of prostate cancer. Normally a man should begin prostate cancer screening at age 50. But since this patient has a brother who has prostate cancer and he is also of the African-American race he has a higher risk and should begin yearly screening immediately. Age 40 is the recommended age for high risk patients.

An adult patient admits to drinking alcohol on the weekends. He does, however, say in the interview that he is thinking about cutting back on his drinking. What other statement would indicate that the patient is possibly an alcoholic? His friend tell him he drinks too much. He wants to cut out drinking on the weekends to reduce calories. He drinks one beer a night. He does not drink to alleviate stress.

His friend tell him he drinks too much A patient who feels guilty about drinking and is told to cut down by his friends or family may be an alcoholic. Using the CAGE strategy will help determine the risk of alcoholism. CAGE Alcohol Questionnaire (CAGE) Have you ever felt you needed to Cut down on your drinking? ... Have people Annoyed you by criticizing your drinking? ... Have you ever felt Guilty about drinking? ... Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

The nurse practitioner (NP) is examining a child for a sore throat. Which of the following statements is true regarding tonsils? Most cases of tonsillitis are caused by beta-hemolytic streptococcal infection. Hypertrophied tonsils in children usually represent a normal finding. Tonsils enlarge as the child grows older. Children with large tonsils are more prone to tonsillitis than those with small tonsils.

Hypertrophied tonsils in children usually represent a normal finding Enlarged tonsils are common in young children and as the child grows older, the tonsils will recede in size. Only about 25% of tonsillitis is caused by streptococcal infection. Further, children with large tonsils are more prone to tonsillitis than those with small tonsils is a false statement.

A patient being treated for dehydration may be given all but which of the following? Gatorade. Clear chicken broth. Popsicles. Ice cream.

Ice cream Full liquids should be avoided when treating dehydration. Clear fluids given by mouth are the first line of treatment and prevention for dehydration. If clear fluids are not tolerated, IV fluids may be necessary.

Which of the following statements about Medicaid is incorrect? The federal government has given most of the rule-making and administrative duties for Medicaid to the individual states. If NPs are not included as providers in the language of a state waiver to enroll all Medicaid patients in managed care, they may not care for Medicaid patients covered by traditional Medicaid either. In most cases state law controls Medicaid activities. States must follow CMS rules and regulation regarding administration of Medicaid.

If NPs are not included as providers in the language of a state waiver to enroll all Medicaid patients in managed care, they may not care for Medicaid patients covered by traditional Medicaid either. This statement is incorrect. If NPs are not included as providers in the language of a state waiver to enroll all Medicaid patients in managed care, they may care for Medicaid patients covered by traditional Medicaid. They may not care for patients covered by managed care.

The patient that has been treated for a bite (either human or animal) should have a 24-48 hour follow-up to check for improvement and/or any complications. Which of the following wounds would not require a referral of wounds? If there is a compromised host If there is a crush injury If there is no closed-fist injury If there is cartilage damage

If there is no closed-fist injury If the patient that has experienced a bite has any of the following, there should be a referral of the wound: If there is close-fist injury If there is a compromised host If there is a crush injury If there is cartilage damage If the wound needs cosmetic effects, refer to a plastic surgeon

Mrs. Worley is a 78-year-old patient who has diverticulitis. Which of the following medications are you least likely to prescribe for Mrs. Worley? trimethoprim/sulfamethoxazole Imitrex metronidazole Cipro

Imitrex Imitrex is not a medication for diverticulitis. It is a medication used for migraine headaches. All of the other medications might be used to treat diverticulitis. For severe cases the patient may have to be hospitalized.

Correct answer: 50% At least 50% of persons with Epstein-Barr virus mononucleosis develop splenomegaly. Hepatomegaly develops in about 10% of cases.

In a person with Epstein-Barr virus mononucleosis what are the chances that this person will develop splenomegaly? 10% 25% 50% 85%

Psoas Sign

Increased abdominal pain when patient attempts to raise thigh against your hand or when asking the patient to extend their right leg at the hip. Indicates Appendicits

Expected spriometry readings when the patient has chronic emphysema include:

Increased total lung capacity (TLC). Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and total lung capacity is increased with emphysema. RV, VC, and FEV-1 spirometry readings are the same whether COPD is due to chronic emphysema or chronic bronchitis, however, TLC is normal or only slightly increased with chronic bronchitis.

Infants with veliac disease (gluten eneteropathy) are at risk for multiple complications. The most urgen complication of this disease is:

Intususseption or volvulus. Intuseusseption and volvulus are surgical emergencies. Delay releasing the invaginated or "telescoped" bowel (intususseption), or releasing the twisted bowel (volvulus) may result in tissue death and gangrene, perforation, peritonitis, and/or sepsis, and fatality. There is also a high rate of intususseption and volvulus among infants with cistic fibrosis.

Grace is a 17 year-old female patient with anorexia nervosa. You are educating her parents about this condition. Which of the following statements would you NOT make to these parents? Approximately 90% of patients are female. It is associated with OCD in 86% of cases. It is associated with depression in 65% of cases. The maximum frequency of occurrence is 12 - 25 years of age.

It is associated with OCD in 86% of cases. Anorexia nervosa is associated with OCD in 26% of cases.

Which of the following statements about Fifth disease is NOT accurate? The peak incidence is in the spring. Approximately 60% of cases occur in children between the ages of 5 and 15. It can result in significant anemia in clients who are immunocompromised. It is spread via fecal contamination.

It is spread via fecal contamination. Fifth disease is spread by respiratory and blood routes. Humans are the only known host. The virus is a single-strand DNA that replicates in erythroid progenitor cells and causes lysis of the cell with transient anemia.

A 25-yo female patient presents for a routine well-women exam. On physical exam, the NP notes a scant nipple discharge, absence of palpable mass, and absence of lymph node enlargement. What is the most likely diagnosis?

Itraductal papilloma. Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple discharge located in the ductal system near the areola. Breast cancer, although usually non-tender, may present with pain. Chest wall syndrome may present in some women as breast pain. Fibrocystic breast disease often presents with bilateral breast pain.

All but which of the following would be considered a side effect of the receptor antagonist "Aldosterone?" Vomiting Gynecomastia Stomach cramps Joint pain

Joint pain Some of the side effects of Aldosterone would include: Nausea/vomiting Gynecomastia Stomach cramps Hyperkalemia Diarrhea Postmenopausal bleeding Erectile dysfunction

With knowledge of the alternative dispute resolution (ADR), which of the following is NOT a form of this? binding and nonbinding arbitration settlement conference jury trial mediation

Jury trial A jury trial is what the alternative dispute resolution (ADR) seeks to avoid. Some jurisdictions use the settlement conference as a technique to attempt settlement after a lawsuit has been filed but before a trial begins. Mediation and arbitration are the most well-known forms of ADR.

You are conducting an assessment with a 40 year old female patient who reports extreme urinary urgency and pain that radiates from her flank to her genitals. She has passed blood in her urine and finds that she is often sweaty and nauseous. Which of the following is the most likely diagnosis for this patient? Bladder infection. Gonorrhea. Kidney stones. Ovarian cyst.

Kidney stones This patient displays the classic signs of kidney stones, including renal colic (the radiating pain). Further diagnostic tests such as ultrasound should be performed to confirm the diagnosis.

Which of the following medications or treatments is least likely to be prescribed for head lice? permethrin 1% cream rinse nit removal with a fine tooth comb Lindane 1% shampoo soaking brushes and combs in Nix shampoo

Lindane 1% shampoo This is least likely to be prescribed because of neurotoxic effects. It is definitely contraindicated in infants, toddlers, or any patient with neuro or seizure disorder.

Which of the following statements about pharmacologic maintenance treatment for a patient with Meniere's disease is least accurate? The aim is to attempt to modify the endolymphatic hydrops by lowering endolymphatic pressure. Long-term maintenance therapy is always recommended. Maintenance therapy usually includes diet modifications combined with pharmacologic interventions. Medical options include intratympanic aminoglycosides to control vertigo.

Long-term maintenance therapy is always recommended. This is the least accurate statement. Long-term maintenance therapy is usually not recommended because of the fluctuant nature of the disease.

The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may:

Mask symptoms of hypoglycemia. Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on betablockers should be taught to look for this specific symptom as a possible indication of hypoglycemia.

Which of the following medication or medication class that does NOT have dizziness or vertigo as potential adverse side effects?

Meclizine (Antivert) Dizziness is associated with a sensation of body movement when there is no body movement occurring. (The person is spinning and the room is not). Vertigo is the sensation that the person is still and the room is spinning. There is no associated muscle weakeness or visual disturbance with either of these conditions. The most common causes are related to drug ingestion, hypotension, inner or middle ear pathology, and positional vertigo. Dizziness is an adverse reaction associated with certain antibiotics (gentomycin and strptomycin) and high-dose salicylates. Vertigo is associated with certain inner ear pathology such as labyrinthitis and Meniere's disease. Meclizine is a long-acting antihistamine which is used to treat chronic vertigo.

After thorough testing of your elderly patient, you diagnose her as being positive for Suberosis. Of the following, which was she MOST likely exposed to that caused this illness? Rotting maple tree bark. Moldy compost. Moldy cork dust. Contaminated humidifier.

Moldy cork dust. Maple bark stripper's disease is typically caused by rotting maple tree logs or bark, and Mushroom picker's disease, moldy compost. Suberosis is caused by moldy cork dust. "Humidifier" lung is caused by contaminated humidifiers, air conditioners, or heating systems.

Louis is a 67-year-old male patient with open-angle glaucoma. Your follow-up for Louis should include which of the following? Caution the person to avoid exercise. Monitor a high-protein, low-fat diet. Monitor for side effects of beta blocker use. Follow up IOP and visual field changes every six weeks.

Monitor for side effects of beta blocker use. Monitor for side effects of drugs, especially with non-cardioselective beta blocker use. Even with topical use, bronchoconstriction may be a side effect of these drugs.

Of the following illnesses, which would be caused by the paramyxovirus? Rubella Chicken pox Malaria Mumps

Mumps Mumps is caused by the paramyxovirus.Mumps is transmitted by the respiratory route and has an incubation period of 16-18 days.

You are crafting a plan of care for a 32 year old female patient who has large uterine fibroids. These are causing her intense discomfort and anemia from heavy periods. She says she hopes to have children within the next several years. Which of the following procedures is the best choice for this patient? Partial hysterectomy. Myomectomy. Fibroid embolization. Uterine ablation.

Myomectomy. A myomectomy removes fibroids but leaves the uterus intact. For patients who have child bearing plans, this is often the best choice. Healthy pregnancies are common after myomectomy. However, fibroids may return.

Humulin insulin 70/30 would be considered a mixture of? Regular insulin 70% and NPH insulin 30% Lantus insulin 70% and regular insulin 30% Lispro insulin 70% and NPH insulin 30% NPH insulin 70% and regular insulin 30%

NPH insulin 70% and regular insulin 30% This mixture usually has an onset of 30 minutes, peak of 4.4 hours, and duration of 24 hours.Humulin insulin 70/30 would consist of a mixture of: NPH insulin 70%Regular insulin 30%

A 17-year-old female patient is being managed with Depo-Provera for the purpose of birth control. The nurse practitioner understands that the recommended length of use is usually: no more than 2 years as determined by her lipid response to the medication as long as the patient desires this form of contraception less than 1 year

No more than 2 years Depo-Provera is a highly reliable form of contraception and a good choice for young women and adolescents who do not wish to become pregnant for at least 18 months after discontinuing usage. Due to the U.S. Food and Drug Administration warning, prolonged use of Depo-Provera can result in loss of bone density. Therefore, it is not recommended that individuals take Depo-Provera for more than 2 years.

A 38 year old patient is being treated the by the NP for heavy vaginal bleeding secondary to multiple uterine leiomyomas. Her uterus is greater than 12 weeks gestational size, her hematocrit is 28%, and she has not responded to hormonal therapy. Which of the following would be the most appropriate intervention at this time?

Obtain a gynecological consultation Gynecological consultation is recommended for a patient with a uterus greater that 12 weeks gestational size, significant anemia (hct <30),. o a normal endometrial biopsy with failure to respond to hormonal therapy.

Correct Answer: miliaria Miliaria or milia (also known as "prickly heat") involves multiple yellow or white 1-2 mm papules located mainly on the forehead, cheeks, and nose. It is most common in neonates and with overheating. Resolution is spontaneous.

Of the following pediatric skin lesions, which one is most common in neonates with overheating? erythema toxicum seborrheic dermatitis nevus flammeus miliaria

Correct Answer: MRI The "gold standard" test for joint damage would be considered the MRI. Some of the other maneuvers which might be used when the nurse practitioner is assessing the patient could include: Drawer Sign Finklestein's Test McMurray's Test Lachman's Sign

Of the following, which would be considered the "gold standard" test for joint damage? X-ray Ultrasound CT-scan MRI

You are prescribing Estropipate as the Hormone Replacement Therapy for your elderly patient. Which of the following is a brand name for this drug? Menest. Ogen. Provera. Aygestin.

Ogen. Menest is the brand name for Esterified estrogen and Ogen, Estropipate. Provera is the brand name for Medroxyprogesterone acetate and Aygestin, Norethisterone.

Which of the following statements about evaluation and follow-up of a patient with IBD is least accurate? Most patients follow a cyclic course of remission and flare-up. An estimated 50% to 65% of patients with Crohn's disease undergo surgery at some point in their lives for intestinal resection or colectomy. Overall mortality for ulcerative colitis is between 35% and 40%. Ulcerative colitis patients have a risk for serious complications such as hemorrhage and perforation.

Overall mortality for ulcerative colitis is between 35% and 40%. This is not accurate. The overall mortality for ulcerative colitis is much lower - between 12% and 15%. This is because of risk for serious complications such as hemorrhage, perforation, and toxic megacolon.

Your 59-year-old female patient suffers from urge incontinence. You will prescribe which of the following as a first-line drug for her urge incontinence? pseudoephedrine Tolterodine Oxybutynin Imipramine

Oxybutynin Oxybutynin is a first-line drug for treatment of urge incontinence. Pseudoephedrine is used for stress incontinence. Tolterodine and imipramine are also used for treatment of urge incontinence.

A patient with hypertension is in the office and you have prescribed Losartan. Losartan, if taken with which of the following other drugs, can put a patient at risk for developing a renal calculi? Cimetidine Ketoconazole Fluconazole Oxypurinol

Oxypurinol Losartan is an angiotensin II Receptor Antagonist prescribed for the treatment of hypertension. This drug blocks the material in the body that constricts or narrows the blood vessels, then relaxes the blood vessels, allowing the blood to flow more freely and results in a lowered blood pressure. The common side effects of Losartan are dizziness, diarrhea, muscle cramps, heartburn, stuffy nose, pain in the leg, knee or the back. Some serious side effects include chest pain, difficulty breathing and swelling in the face, throat or tongue. Losartan, if taken with certain other drugs, can cause a potential drug interaction. For example, when Losartan is taken with Cimetidine, Losartan increases the serum level of Cimetidine. Then, if Losartan is taken with Fluconazole, Fluconazole reduces the efficacy of Losartan. When Losartan is taken with Oxypurinol, the patient has an increased risk of developing renal calculi. Further, if the patient drinks grapefruit juice with Losartan, grapefruit juice causes a delay in the absorption and decreases the serum levels of the Losartan.

Rovsing's sign

Pain in the RIGHT lower quadrant during LEFT-sided pressure is a positive Rovsing's sign. Indicates appendicitis

What is Not part of the test for pronator drift? Patient can be sitting or standing for the test. Patient's eyes are closed. Patient's arms are extended and palms upward. Patient's arms are tapped down.

Patient's arms are tapped down. When testing for pronator drift, the patient is asked to hold both arms fully extended at shoulder level in front of them with palms upwards, and to hold the position. Closing the eyes accentuates the effect, because the brain is deprived of visual information about the position of the body and must rely on proprioception. If the patient is unable to maintain the position the result is positive.

When a patient is receiving antithyroid medication, the nurse practitioner has knowledge that: The drugs are somewhat expensive and have serious cardiac and hematologic side effects. Patients remain on drug therapy for 1-2 years and then the medication is gradually withdrawn. Lifelong daily treatment is necessary to keep TSH levels within the normal range. Antithyroid medications do not cross the plasma membrane structure.

Patients remain on drug therapy for 1-2 years and then the medication is gradually withdrawn. Antithyroid medications are relatively inexpensive. The client remains on the medications for 1-2 years with the hope of a permanent remission of symptoms when they are withdrawn.

Of the following, which is an antipsychotic that can be used to treat neurological disorders? Hydantoin. Pimozide. Flurazepam. Bromocriptine.

Pimozide. All of the medications listed can be used in the treatment of neurological disorders, however, they are different classes of drugs. Hydantoin - Anticonvulsant; Pimozide - Antipsychotic; Flurazepam - Benzodiazepine; Bromocriptine - Dopamine Agonist.

A 65 yo female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical exam, there is pain on ROM, with no weakness noted. Lab studies show a low hemoglobin and elevated SED rate. Which of the following is the most likely diagnosis? A. Polymyositis B. Osteoarthrits C. Polymyagia Rheumatica D. Fibromyalgia

Polymyalgia Rheumatica

A patient with a history of which of the following has a high risk of developing colon cancer? Polyps. Auras. Ulcers. GERD.

Polyps A history of polyps places a patient at a higher risk of developing colon cancer. Ulcers and GERD are not related to colon cancer. Auras accompany migraines.

Evaluating Posterior Cruciate Ligament (PCL) injury

Posterior drawer sign

You are treating your patient with a cough suppressant for her pulmonary disorder. Of the following, which would you prescribe? Promethazine with codeine. Guaifenesin. Flunisolide. Zafirlukast.

Promethazine with codeine. Promethazine with codeine - cough suppressant; Mucinex - expectorant; Flunisolide - inhaled steroid; Zafirlukast - leukotriene receptor antagonist

After thorough testing, the ANP decided it is best to treat his patient with a SERM. Which of these is an example of a SERM? ASA. Rofecoxib. Raloxifene. Baclofen.

Raloxifene ASA - NSAID Rofecoxib - COX-2 Raloxifene - SERM Baclofen - Skeletal Muscle Relaxant Selective estrogen receptor modulators, called SERMs for short, block the effects of estrogen in the breast tissue. SERMs work by sitting in the estrogen receptors in breast cells. If a SERM is in the estrogen receptor, there is no room for estrogen and it can't attach to the cell.

Which of the following findings is typically a sign of acute appendicitis? A. Positive Murphy's sign B. Rebound tenderness at McBurney's point C. A negative Rovsing's sign D. Positive Prehn's sign

Rebound tenderness at McBurney's point

Isaac is a 50-year-old male patient with a history of urethritis. He complains of red, swollen joints that he says, comes and goes. He also has an ulcer on the skin of the glans penis. Which of the following is your most likely diagnosis? Jarisch-Herxheimer reaction Reiter's syndrome perihepatitis Fitz-Hugh-Curtis syndrome

Reiter's syndrome Reiter's syndrome is an immune-mediated reaction secondary to infection with certain bacteria that spontaneously resolves. It is more common in males. Treatment is supportive.

Correct Answer: Pericarditis Some of the complications of rheumatoid arthritis would be considered: Pericarditis Uveitis Scleritis Vasculitis Increased risk of certain malignancies

Rheumatoid arthritis would be considered a systemic autoimmune disorder that is more common in the female patients. Of the following, which might be considered a complication of this disorder? Pericarditis Nausea/vomiting Severe headaches Rash over the torso

The diagnostic standard in streptococcal pharyngitis is a positive throat culture for which of the following? M. pneumoniae S. pneumoniae S. pyogenes Chlamydophila pneumoniae

S. pyogenes A positive throat culture for Streptococcus pyogenes (S. pyogenes) is considered the diagnostic standard in streptococcal pharyngitis. A potential drawback, however, is that a positive result does not distinguish between acute viral pharyngitis with group A streptococcus carriage and acute streptococcal pharyngitis.

A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the most likely diagnosis and the most appropriate action?

Scarlet fever; treat with antibiotics. This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia lines.

A mother comes into the office with her 2-year-old child who attends daycare. The child is pulling at her ears, running a fever, and has bright red bulging tympanic membranes bilaterally. The nurse practitioner knows that with acute otitis media (AOM) the risk factors include: Chinese race, previous otitis media, many siblings Summer season, full-time day care, premature at birth higher socioeconomic level, full-time day care, allergies second-hand smoke, attending day care, American Indians and Eskimos

Second-hand smoke, attending day care, American Indians and Eskimos The key factor that contributes to acute otitis media (AOM) is a dysfunctional eustachian tube that allow bacteria from the nasopharynx into the middle ear. American Indians and Eskimos have more repetitive and severe otitis media than members of other races. Further, this condition occurs more often during the fall, winter, and spring months than summer. Children who attend day care centers have a greater risk of acquiring acute otitis media as do members of lower socioeconomic levels. Other risks for the development of acute otitis media are second-hand smoke, having a large number of siblings, male gender, and developmental abnormalities.

Which of the following types of hearing loss results from deterioration of the cochlea? conductive hearing loss sensorineural hearing loss auditory neuropathy spectrum disorder all of the above

Sensorineural hearing loss Sensorineural hearing loss results from deterioration of the cochlea. This is usually because of the loss of hair cells from the organ of Corti. Examples of causes include noise trauma, aging, and ototoxicity.

You have diagnosed a 35-year-old female patient with dysthymia. Which of the following is most likely to support this diagnosis? She has gained a significant amount of weight without having increased her caloric intake. She has a number of phobias. She recently has had difficulty making decisions. She has been depressed more often than not for at least the last two years.

She has been depressed more often than not for at least the last two years. A patient diagnosed with dysthymia has chronic depression that has lasted for at least two years. This depression is not severe which makes it hard to distinguish from a person's normal functioning.

Which of the following tests would you use to assess intellectual impairment in the elderly? Mini-Mental State Examination Yesavage GDS Short Portable Mental Status Questionnaire Index of Independence in ADL

Short Portable Mental Status Questionnaire The Short Portable Mental Status Questionnaire (SPMSQ) is used to screen older adults for dementia signs and other neurologically based deficits and to determine the degree of impairment.

The initial therapy for a 3 week old infant with uncomplicated symptoms of gastroesophageal reflux disease includes of the following positions and change in diet? A. Prone position and rotate formulas in order to find one that causes less reflux B. Smaller, more frequent feedings while holding infant C. Semisupine position and offer more ounces of formula less frequently D. Lateral position and start small amounts of solid food with formula

Smaller, more frequent feedings while holding infant.

You are treating a male patient with a history of bronchial asthma and he is seen in the office complaining of episodes of difficulty breathing. You have prescribed theophylline 100 mg PO tid. This 40-year-old obese patient has an 18-year history of cigarette smoking and excessive intake of coffee. He eats a low-carbohydrate, high-protein diet. The nurse practitioner knows that which factors decrease the therapeutic effects of theophylline? age and weight smoking history and diet coffee intake and weight age and gender

Smoking history and diet A higher dosage of theophylline may be required for smokers because tobacco increases metabolism of theophylline. A high-protein, low-carbohydrate diet increases the metabolism of theophylline and decreases serum concentrations.

Which of the following is classified under Love and Belonging in Maslow's Hierarchy of needs? Social isolation. Communication impaired. Chronic sorrow. Deficient knowledge.

Social isolation Love and belonging is a classification of Maslow's Hierarchy that is used to diagnose and prioritize. The Social isolation falls under Love and Belonging. The other answers fall under safety and security.

A patient has a history of anorexia. She presents with a sudden weight loss of five pounds and no physical sign of illness. What assessment will help determine if treatment for anorexia is effective? Social. Medical. Family history. Review of systems.

Social. A social history includes relationships and habits. Dietary habits and support have a profound impact on recovery. A family interview will also shed light on the social assessment.

Cranial Nerve XI

Spinal Accessory (upper trapezius)

The available screening tests for osteoporosis include all but which of the following? dual-energy x-ray absorptiometry ultrasound peripheral quantitative computed tomography Spurling test

Spurling test Available screening tests for osteoporosis include: dual-energy x-ray absorptiometry (DXA), ultrasound, radiographic absorptiometry, single-energy x-ray, absorptiometry, peripheral DXA and peripheral quantitative computed tomography. The Spurling test is a very specific, but not sensitive physical examination maneuver in diagnosing cervical spondylosis or acute cervical (neck) radiculopathy.

Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? A. Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells B. Squamous epithelial cells with clear cytoplasm and distinct borders, many lactobacillus rods, and occasional WBC C. Organisms about the size of white blood cells with undulating flagellum, occasional lactobacillus rods, and many WBC D. Hyphae and spores, few lactobacillus rods, and occasional WBC

Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells.

Approximately 70% of the organisms found in canine oral and nasal fluids, and consequently in fresh dog bite wounds, are:

Staphylococcus and Pasteurella multocida. All of these organisms are found in canine oral and nasal fluids, and cultured from fresh dog bite wounds, but the most common (70%) are Staph and Pasteurella multocida.

A 50yo, non-smoker, with no co-morbidity presents to the clinica and is diagnosed with pna. His vital signs are normal except for temperature of 101.6 degrees. A sputum specimen is collected and sent for culture and sensitivity. What action should the nurse practitioner take today?

Start Clarithromycin (Biaxin) 500mg 2 times a day for 10 to 14 days. Most treatment guidelines for outpatient pna in non-smokers without co-morbidity and 60 years of age or younger, recommend erythromycin or another macrolide like Biaxin. Pcn s indicated for patient swith pneumococcal pna and ciprofloxacin is recommended for Legionella species.

A common rule to follow when prescribing many medications for the elderly is to:

Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly.

A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for Type II diabetes mellitus. What should be done to manage him FIRST? Start insulin Start metformin plus pioglitazone Have him return tomorrow to recheck his blood glucose Start metformin

Start insulin Most oral agents will have little effect on his glucose and it should be lowered immediately. Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a chance to work. He should return to the clinic the next day for a recheck of the blood glucose and medication adjustment.

You are conducting an assessment with a 31 year old male patient who complains of gas, bloating, and diarrhea. He says that he has been having these symptoms nearly daily for two months. They are sometimes aggravated by eating dairy. He occasionally has blood in his stool as well. His temperature is 98.5F. All but which of the following are potential diagnoses for this patient? Irritable bowel syndrome. Lactose intolerance. Bacterial infection. Stomach cancer.

Stomach cancer. This patient's symptoms are consistent with a number of potential conditions, including IBS and a bacterial infection. Stomach cancer does not present these symptoms, though colon cancer may be a potential diagnosis. The patient's report that dairy sometimes worsens his symptoms means that lactose intolerance may also need to be investigated.

When counseling a mother on her newborn that presents with a concerning skin lesion, the nurse practitioner has knowledge that: Erythema toxicum or infant acne is extremely rare and should be referred to a specialist. Milia or prickly heat rash only occurs in warm regions of the world. A Mongolian spot is a blue to black-colored patch or stain that is commonly located on the face of Caucasian children. Strawberry hemangiomas are raised vascular lesions with a bright red color and up to 95% involute spontaneously.

Strawberry hemangiomas are raised vascular lesions with a bright red color and up to 95% involute spontaneously. Erythema toxicum is common and there is no need for referral as it resolves spontaneously. Milia rash occurs with overheating of the infant in all regions of the world. Mongolian spots are common in African American, Asian, Hispanic, and Native American infants and are usually in the lumbosacral area.

A "port wine" stain that is located on half the facial area may be a sign of which of the following? Sturge-Weber Syndrome Von Recklinghausen's Disease trachoma chlamydial pneumonia

Sturge-Weber Syndrome The flat, large, dark ink to purple stain-like lesions occurring in irregular shapes and sizes are nevus flammeus or "port wine" stains. A large lesion located on half the facial area may be a sign of trigeminal nerve involvement and Sturge-Weber Syndrome (a neurological disorder). Cafe au last is associated with Von Recklinghausesn's Disease. This disease is a genetic disorder characterized by the growth of tumors on the nerves. The disease can also affect the skin and cause bone deformities. There are three forms of VRD: neurofibromatosis type 1 (NF1) neurofibromatosis type 2 (NF2) schwannomatosis, which is a variant of NF2

SAH stands for which of the following? System and History Subdural Hematoma System Assessment Health Subarachnoid Hemorrhage

Subarachnoid Hemorrhage SAH stands for Subarachnoid Hemorrhage. Typically, the patient will complain of the worse headache they have ever had. This headache can be accompanied by such symptoms as meningeal irritation, nausea/vomiting, photophobia, and a rapid decline in consciousness.

A new mother is unable to breast feed. The FNP's advice about bottle feeding would include all but which of the following? The amount of formula the infant needs at 0 to 1 month is about 2 - 4 oz. every 3 to 4 hours. The amount of formula the infant needs at 2 - 4 months is about 5 - 7 oz. every 4 to 5 hours. Iron-fortified formulas are best. Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies.

Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies. The FNP would not tell the bottle-feeding mother this information. It is incorrect. The FNP would only suggest partial hydrolysate formula if the infant is at risk for atopic diseases, for instance a strong family history of atopic disease.

The FNP has a patient who has been diagnosed with Bell's palsy. The FNP knows that all of the following are true about treatment of the disease EXCEPT: Systemic corticosteroid therapy has been shown to limit the length and severity of the paralysis. Systemic corticosteroid therapy is effective no matter when it is started during the progression of the disease. Acyclovir is associated with some controversy as a treatment for Bell's palsy. Supportive care to help avoid ocular and oral injury is needed.

Systemic corticosteroid therapy is effective no matter when it is started during the progression of the disease. Systemic corticosteroid therapy is most effective when started early in the disease. It is of no use if begun more than 10 days after the onset of symptoms.

In diagnosing a toothache (pulpitis), the nurse practitioner has knowledge that all of the following are correct except: Systemic manifestations do not occur from dental caries and pulpitis. You should inquire about fever and chills. Dental caries are the most frequent type of injury that causes pulpitis. There is diverse flora involved in the infectious process, including gram-positive anaerobes and bacteroides.

Systemic manifestations do not occur from dental caries and pulpitis. Many patients present in the clinic setting with a toothache or related symptoms. Systemic manifestations often occur and they include lymphadenopathy, malaise, fever, and pain. The remaining answer choices are true regarding this condition.

You are explaining to a patient some facts about toxic shock syndrome (TSS) as well as how to avoid TSS. Which of the following statements would you include in your explanation? Toxins causing TSS are always symptomatic. Women should change tampons every 8 hours to decrease potential for TSS. TSS usually begins within 5 days of menstrual period in women who use tampons. Women diagnosed with TSS should use diaphragms for contraception.

TSS usually begins within 5 days of menstrual period in women who use tampons.

A patient who has been prescribed Oracea (doxycycline) for gonorrhea should be advised to do which of the following? Take the medication with a full meal. Take the medication with milk. Take the medication on an empty stomach with a full glass of water. Take the medication on an empty stomach with only a small amount of water.

Take the medication on an empty stomach with a full glass of water. Oracea is best taken on an empty stomach but with a full glass of water. Other forms of doxycycline should be taken with food, so proper patient education is key when prescribing this medication.

A patient who has been prescribed Adderall should be educated to notify his healthcare provider if he experiences which of the following side effects? Nausea. Headache. Teeth grinding. Difficulty sleeping.

Teeth grinding. The patient should notify his healthcare practitioner if he experiences teeth grinding. Difficulty sleeping, nausea, and headache may occur with Adderall, but are not typically a cause for concern. If these increase or worsen, the patient should notify his healthcare provider.

Correct Answer: fecal occult blood test at home with collection of two samples from three consecutive specimens The American Cancer Society colorectal cancer screening guidelines recommend a fecal occult blood test at home with collection of two samples from three consecutive specimens. If there is an initial positive finding then a colonoscopy should be done.

The American Cancer Society colorectal cancer screening guidelines recommend which of the following as a screening test for colorectal cancer? fecal occult blood test at home with collection of two samples from three consecutive specimens fecal occult blood test obtained via the digital rectal examination in the provider's office toilet bowl fecal occult blood test digital rectal examination

Correct Answer: gabapentin Of the medications listed, phenytoin, primidone, and carbamazepine are all known increase the failure of hormonal contraceptives. Only gabapentin is not known to reduce efficacy of hormonal contraceptives.

The FNP has a 21-year-old female patient with a history of seizures. She is married and taking oral contraceptives until she is ready to start a family. Which of the following medications is not known to reduce the efficacy of hormonal contraceptives? phenytoin primidone carbamazepine gabapentin

Correct Answer: The patient is 80-years-old or older and unable to comprehend the complex medical facts. All patients are entitled to medical information regardless of age. The nurse practitioner may treat in any of the other circumstances listed in the remaining answer choices.

The Family Nurse Practitioner has the duty to disclose certain information to the patient as part of the informed consent process. Exceptions to this duty would include all of the following EXCEPT: It is a definite emergency situation. The healthcare provider believes that the information would be harmful to the patient and invokes the therapeutic privilege. The patient has waived the right to receive informed consent. The patient is 80-years-old or older and unable to comprehend the complex medical facts.

Reimbursement for services provided by nurse practitioners (NPs) to patients occurs through several mechanisms. Which of the following is NOT an accurate statement regarding this? The NP's services are covered at 100% in the Medicare Part B structure of payment without billing "incident-to." In managed care plans, NPs may receive payment as an identified provider for a panel of patients. NPs who are not identified as the primary provider of care but are employed by a professional practice group may receive payment through their employer's managed care arrangement. Salaries can be based on revenues generated by NPs.

The NP's services are covered at 100% in the Medicare Part B structure of payment The NP's services are covered at 85% of the prevailing physician rate. "Incident to" services allow the NP services to be billed at 100%, but specific requirements are necessary for this.

Correct answer: salmon macular rash polyserositis splenomegaly leukocytosis The acute febrile form of JRA presents with all of these symptoms. It is one of the three forms of JRA. The other two forms are polyarticular pattern JRA and pauciarticular disease.

The acute febrile form of juvenile rheumatoid arthritis (JRA) presents with which of the following symptoms? check all answers that apply salmon macular rash polyserositis splenomegaly chronic pain and swelling of joints five or more joints are involved leukocytosis

Correct answer: restrictive covenant A restrictive covenant is a promise not to compete. Specifically, a restrictive covenant is a clause that restricts an employee from practicing within a set number of miles from an employer's business for a set period of time after the employee leaves the employer's business.

The clause in an employment contract for nurse practitioners that limits an employee from practicing within a set number of miles from an employer's business for a set period of time after leaving the employer's business is which of the following? restrictive covenant bonus formula termination clause none of the above

Correct Answer: decreased mental competence The elderly are vulnerable to disease for reasons mentioned in all of the choices except this one. Just because a person is older does not mean that they have decreased mental competence. Mental competence has nothing to do with physiological vulnerability to disease.

The elderly are more physiologically vulnerable to disease for all but which of the following reasons? decreased physiologic reserve decreased mental competence less flexible homeostatic processes less effective body defenses

The diagnosis of Meniere's disease is based on:

The exclusion of other pathologies. Most cases of Meniere's disease are idiopathic and the diagnosis is based on the exclusion of other pathologies. Central vertigo is present with many vestibular problems. Low frequency hearing loss is more commonly associated with Meniere's disease. MRI is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease.

Correct Answer: self-actualization Maslow developed a hierarchy of needs in which some needs are more important than others and must be met before other needs can be considered. The most basic needs in Maslow's hierarchy of needs are survival needs: water, food, sleep. The highest is achieving potential which is known as self-actualization.

The highest level of Maslow's hierarchy of needs is which of the following? self-actualization self-esteem love and belonging safety and security

Correct answer: unintentional injuries The leading cause of death in children 12 months to 9 years is unintentional injuries. The leading cause of death in infants younger than 12 months is congenital anomalies.

The leading cause of death in children 12 months to 9 years is: heart disease unintentional injuries congenital anomalies cancer

Which of the following statements would be considered correct regarding the normal parameter of an infants head growth? The newborn's head should be the same size as the chest. The newborns' head should be approximately 6 cm smaller than the chest. The newborn's chest should be approximately 4 cm larger than the head. The newborn's head should be approximately 2 cm larger than the chest.

The newborn's head should be approximately 2 cm larger than the chest. The newborn's head should be approximately 2 cm larger than the chest. The normal head circumference of a newborn should be 32-33 cm.

The Correct answer is: Decrease in systemic vascular resistance Calcium channel blockers depress the rate of discharge from the sinoatrial node and conduction velocity through the atrioventricular node, causing a decrease in heart rate. In addition, they relax the coronary and systemic arteries, producing vasodilatation and decreased myocardial contractility.

The nurse practitioner has a patient on verapamil (Calan SR) and is monitoring the patient for therapeutic effects. He understands that with verapamil you should assess for: decrease in systemic vascular resistance increase in heart rate decrease in ventricular premature beats increase in blood pressure

Correct Answer: The NP must respect confidentiality but it does not have to be formally discussed with the patient. Confidentiality requires that the provider discuss confidentiality issues with patients. They must establish consent, and clarify any questions about disclosure of information.

The patient and his family have a right to assume that information given to the NP will not be disclosed. This means all of the following EXCEPT: Verbal information is covered by confidentiality. Written information is covered by confidentiality. The individual's right to privacy is respected when responding to a request for a patient's medical record. The NP must respect confidentiality but it does not have to be formally discussed with the patient.

Which of the following is NOT true of the treatment plan for a pregnant patient with a vaginal yeast infection? The patient should avoid topical treatments such as Monistat. The patient should not take oral medication for the infection. The patient can use topic medications such as Monistat. It may take longer to cure a yeast infection during pregnancy.

The patient should avoid topical treatments such as Monistat. During pregnancy, patients should treat yeast infections only with topic medications. Oral medications are not recommended during pregnancy. Pregnant patients may need to treat a yeast infection for a longer time than do patients who are not pregnant.

A patient who has been prescribed miconazole for athlete's foot asks how long he should use the medication. Which of the following is an appropriate response to this patient? The patient should use the medication for 3 days. The patient should use the medication for 1 month. The patient should use the medication until symptoms are gone. The patient should use the medication for 2 weeks.

The patient should use the medication for 1 month Patients who are using miconazole for athlete's foot should apply the medication once or twice a day for 1 month. Patients should not exceed the recommended amount or duration of miconazole.

Which of the following statements about bronchiolitis is least accurate? The majority of cases are caused by the respiratory syncytial virus. The peak incidence in children is between 3 and 6 years of age. Small airways become obstructed. Risk factors include low socioeconomic status.

The peak incidence in children is between 3 and 6 years of age. The peak incidence in children is between 3 and 6 years of age is the least accurate statement. Bronchiolitis is an acute inflammation of the bronchioles resulting in obstruction of the small airways. The peak incidence in children is between 3 and 6 months of age.

Correct Answer: Inspection of the eye, sclera, and conjunctiva for the presence of any foreign bodies. Patient's temperature The picture above would be considered chalazion, which is a chronic lipogranulomatous inflammation of a meibomian gland. When performing a physical examination on this patient, the following should be done: Inspection of the eye, sclera, and conjunctiva for the presence of any foreign bodies. Patient's temperature Check the eyelid for any masses or tenderness Check the patient for any preauricular adenopathy

The physical examination for the eye condition in the picture above would include which of the following? check all answers that apply Inspection of the eye, sclera, and conjunctiva for the presence of any foreign bodies. Patient's temperature Draw a CBC CT scan of the head

Which of the following statements about the MMR vaccine is false? The MMR vaccine is safe to use during lactation. The MMR vaccine is a live, attenuated vaccine. The recommended schedule for early childhood immunization is two immunizations one month apart. Systemic reaction to the MMR vaccine is rare.

The recommended schedule for early childhood immunization is two immunizations one month apart. This statement is false. The recommended schedule for early childhood immunization is two doses of MMR vaccine given between 12 and 15 months and between 4 and 6 years. Two immunizations one month apart are recommended for older children who were not immunized earlier in life.

Which of the following is NOT a characteristic of the S3 heart sound?

The sound is high-pitched and occurs just prior to the S1 heart sound. The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is produced by rapid ventricular filling and is best auscultated in the mitral area. It is a common finding with right-sided heart failure, rapid growth, and the last trimester of pregnancy.

Correct answer: Bowen's family systems theory Bowen's family systems theory explains current family situations in terms of past relationships and family histories. It connects one's past family experiences with current behaviors and suggests that multiple factors interacting across time influence family functioning.

The theory that explains current family situations in terms of past relationships and family histories is which of the following? Maslow's hierarchy of needs Piaget's cognitive development theory Erikson's stages of psychosocial development Bowen's family systems theory

Which of the following statements about evaluation and follow-up of a child with failure to thrive (FTT) is least accurate? There is a low rate of relapse with FTT. The child should be followed weekly and then monthly for several months. Parents may not be able to carry out efforts to help the child over time. Follow until the child returns to a normal growth curve.

There is a low rate of relapse with FTT.This is the least accurate statement. There is a high rate of relapse in FTT. FTT in the first year of life is ominous. Most brain growth occurs in the first 6 months.

Melanie is a 25-year-old patient with an inflammation of the eyelid margin that is red, scaling and crusting. You suspect blepharitis. Which of the following is true concerning this condition? It is more common in dark-skinned people. There is an equal incidence in males and females. The non-ulcerative form is considered an acute condition. Symptoms include pain and excessive tearing.

There is an equal incidence in males and females. This is the only true statement of the choices. Blepharitis is more common in fair-skinned people. The non-ulcerative form is considered a chronic condition with acute flare-ups. Symptoms include irritation, burning, and itching of the eyes.

For which of the following reasons would quinolones not be prescribed to children less than 18 years of age? They could cause the patient to experience severe joint pain. They could cause the patient to experience bi-polar disease. They could cause an adverse effect on the patient's sight. They could cause an adverse effect on the growing cartilage.

They could cause an adverse effect on the growing cartilage. With the adult patient, the side effects of quinolones could include CNS symptoms such as insomnia, mood changes, headaches or dizziness, in addition to potential QT prolongation. This classification is not prescribed for patients 18 years or younger because they have the potential to have an adverse effect on the patient's growing cartilage.

Carpal Tunnel maneuvers

Tinnel's and Phalen's

Which of the following statements about the "incident to (a physician's professional service)" Medicare phrase is incorrect? Services must be furnished during a course of treatment where a physician performs and initial service and frequent subsequent services. To qualify under this definition, the services of non-physicians must be rendered under a physician's direct personal supervision. To bill an "incident to a physician's service," the physician need not be in the same suite in an office as the nurse practitioner at the time the nurse practitioner is performing the service to be billed. If an NP and physician who work for the same employer both see a patient on the same day, their services may be billed to Medicare under the physician's name.

To bill an incident to a physician's service, the physician need not be in the same suite in an office as the nurse practitioner at the time the nurse practitioner is performing the service to be billed. This is the incorrect statement. To bill an incident to a physician's service, the physician must be in the same suite in an office as the nurse practitioner at the time the nurse practitioner is performing the service to be billed.

One of the complications of epistaxis would be considered posterior nasal bleeds. If this complication occurs, which of the following interventions would be considered appropriate? To instruct the patient to lie supine with head down for 1 hour. To instruct the patient to schedule an appointment to see their general practitioner as soon as possible (within the week). To instruct the patient to go to an emergency room. To instruct the patient that the bleed should eventually stop with no treatment needed.

To instruct the patient to go to an emergency room. Epistaxis (nosebleeds) can be caused by trauma or laceration to the nasal passages. If a posterior nasal bleed occurs, it can result in severe hemorrhaging. The patient should be instructed to go to an emergency room immediately.

Drugs associated with weight gain include

Tricyclic antidepressants, insulin and sulfonulurea, contraceptives, glucocorticoids, progestational steroids, mirtazapine and paroxetine, gabapentin and valproate and propanolol

The NP notices on her patient's leg, a solid, elevated mass about 2.5 cm in size. What type of lesion is this? Bulla. Tumor. Pustule. Macule.

Tumor Bulla: fluid-filled, elevated, circumscribed lesion larger than 5 mm Tumor: solid, elevated mass larger than 1 cm Pustule: pus-filled, elevated, circumscribed lesion up to 5 mm in size Macule: flat, nonpalpable colored spot up to 5 mm in size

Frank has a skin condition that requires a super-high potency topical corticosteroid. In light of this which of the following topical corticosteroids would you prescribe? Diprolene AF cream Elocon ointment Synalar-HP Ultravate 0.05%.

Ultravate 0.05%. Ultravate 0.05%. is the super-high potency topical corticosteroid, along with Diprolene gel or ointment, and Temovate. The other choices are lower potency.

Which item is NOT implicated in erectile dysfunction (ED)?

Urinary tract infection (UTI) Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can result in ED> Many medications can cause ED, particularly the antihypertensives (Vasotec) and the antidepressants (Paxil). Other activities like heavy smoking, drug abuse, and alcoholism can also lead to ED.

When listening to your 86-year-old patient's heart murmur, you note that it is so loud that it can be heard with the stethoscope completely off the chest. How do you grade the murmur? IV/VI. I/VI. V/VI. VI/VI.

VI/VI. Grading heart murmurs follows this system: I/VI: Heart murmur makes faint sound and may not be heard when patient changes position. II/VI: Heart murmur is quiet but can be heard as soon as the stethoscope is placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI: Heart murmur is loud and accompanied by a palpable thrill. V/VI: Heart murmur is very loud and can be heard with the stethoscope partially off the chest. VI/VI: Heart murmur is very loud and can be heard with the stethoscope completely off the patient's chest.

When assessing the patient with unstable angina, the nurse practitioner knows that the causes include all of the following EXCEPT: vasoconstriction nonocclusive thrombus inflammation or infection ventricular hypertrophy

Ventricular hypertrophy Acute unstable angina, most often caused by atherosclerosis, results from an imbalance in the ability to supply the myocardium with sufficient oxygen to meet its metabolic demands. Causes of unstable angina include vasoconstriction, nonocclusive thrombus and inflammation or infection.

You are seeing a 7-year-old patient with diarrhea, sore throat, coryza and hoarseness. What is the most likely etiology? viral etiology H. parainfluenzae group A Streptococcus mycoplasma

Viral etiology This group of symptoms is typical of a viral infection. Group A Streptococcus is usually not accompanied by coryza and H. Further, parainfluenzae is not a common cause of pharyngitis. Mycoplasma is not associated with upper respiratory tract infections, but seen in lower respiratory infections.

A patient who has been prescribed betamethasone for psoriasis should be advised to contact her healthcare provider immediately if she experiences which of the following? Weight gain. Stomach upset. Vomit that looks like coffee grounds. Changes in her menstrual period.

Vomit that looks like coffee grounds This is potentially a sign of internal bleeding, which is a serious complication. The patient should seek immediate medical attention. Weight gain, stomach upset, and changes in menstruation are common side effects of betamethasone, and are usually not serious.

A patient who has been prescribed Imodium for symptoms of IBS should be advised to seek immediate medical attention if he experiences which of the following? Constipation. Dizziness. Vomiting. Tiredness.

Vomiting If the patient experiences vomiting, he should stop taking the medication and seek immediate medical attention. Mild constipation may accompany Imodium; if it becomes severe, medical attention should be sought. Dizziness and tiredness are common side effects of Imodium

1. Poor hygiene 2. The use of razors on the skin 3. Break in the skin tissue 4. Diabetes mellitus

What are the 4 most common predisposing factors for the bacterial infection folliculitis?

Otosclerosis - an inherited hearing disorder that causes hearing loss due to ears inability to amplify sound Presbycusis - age related hearing loss Ototoxicity - ingesting chemicals or certain medications that can adversely affect the way the inner ear functions. Some drugs can specifically effect the cochlea nerve, impairing hearing and affecting balance

What does otosclerosis mean? What is presbycusis mean? What does ototoxicity mean?

Correct Answer: hearing via bone conduction impaired malfunction is in the cochlea, the cochlear portion of the eighth cranial nerve, or both These are two characteristics of sensorineural hearing loss. The other three choices are related to conductive hearing loss.

Which of the following are associated with sensorineural hearing loss? check all answers that apply decreased hearing via air conduction interference of transmission of sound through the external auditory canal interference of transmission of vibrations from the tympanic membrane through the ossicular chain to the oval window hearing via bone conduction impaired malfunction is in the cochlea, the cochlear portion of the eighth cranial nerve, or both

Correct Answer: rubella The pathogenicity of the rubella organism is considered intermediate. The other three choices are highly pathogenic. They have the greatest ability to produce disease.

Which of the following diseases is caused by an organism with the least pathogenicity of the choices given? rubella rabies rhinovirus varicella

Correct answer: dicloxacillin Dicloxacillin is used for impetigo. It is not used for killing lice. All of the other choices are pediculicides.

Which of the following drugs is NOT a pediculicide? pyrethrin with piperonyl butoxide 0.3% dicloxacillin permethrin 1% cream rinse lindane

Correct Answer: age history of STDs Age is a factor since, as a woman ages, her fertility decreases. The tendency to delay pregnancy until a woman is in her 30s and 40s means that fertility is naturally declining when pregnancy is first attempted. Increasing rates of STDs may also affect a woman's ability to become pregnant.

Which of the following factors are most likely to be associated with infertility? check all answers that apply age history of STDs heredity menarche at an early age

hyperopia

Which of the following is NOT considered a risk factor for primary open-angle glaucoma (POAG)? African descent advancing age diabetes mellitus hyperopia

The Correct answer is: The ethical behavior of nurses has been defined for professional nursing in an American Practice Act policy statement The ethical behavior of nurses was defined by the American Nurses Association and not the American Practice Act. The remaining answer choices are part of ethical decision-making process of a nurse practitioner.

Which of the following is NOT part of the ethical decision making process for the nurse practitioner? Moral concepts such as advocacy, accountability, loyalty, caring, compassion, and human dignity are the foundations of ethical behavior. Duty to help others, beneficence, is a foundational component of ethical behavior. Ethical behavior incorporates respect for the individual and his or her autonomy. The ethical behavior of nurses has been defined for professional nursing in an American Practice Act policy statement.

Correct answer: intense itching Intense itching is a symptom of pediculosis pubis which is a parasitic infection of the genital region caused by the crab louse. Other symptoms include difficulty sleeping and irritability or distraction related to itching.

Which of the following is most consistent with a diagnosis of pediculosis pubis infestation? diarrhea moderate fever intense itching constipation

Correct Answer: Relapse is highest after the second month after discontinuation of treatment. Relapse is highest in the first 2 months after discontinuation of treatment. Maintenance therapy should be considered as with any chronic illness.

Which of the following statements about depression therapy is incorrect in regard to the length of pharmacological intervention in depression? Therapy should be a minimum of 9 - 12 months. The acute phase of treatment to bring symptoms under control and into remission lasts up to 3 months. Relapse is highest after the second month after discontinuation of treatment. Medication should be continued for a minimum of 6 months after depression remission is achieved.

Correct answer: Amblyopia has no effect on childhood development. This statement is not accurate. Amblyopia is detrimental to childhood development. It is also detrimental to education achievement and self-esteem.

Which of the following statements about the complications of amblyopia is not accurate? check all answers that apply It is currently believed that the sensitive period for amblyopia is younger than 10 years of age. The most common reason for failure of amblyopia therapy is non-compliance. Amblyopia has no effect on childhood development. Amblyopia causes monocular vision loss.

Correct Answer: Anti-inflammatory drugs Braces Corticosteroid injections The x-ray image above would be considered an example of one knee with a knee replacement and the other with osteoarthritis. The treatments for osteoarthritis would include: Anti-inflammatory drugs Pain relievers Weight loss Exercise Corticosteroid injections Acupuncture Supplements such as glucosamine Braces Physical/occupational therapy Surgery

Which of the following treatments would be considered correct for the osteoarthritis on the left in the x-ray image above? check all answers that apply Anti-inflammatory drugs Braces Corticosteroid injections Amputation

Correct Answer: PSA test lipid profile to detect hyperlipidemia Secondary prevention measures include activities provided to identify and treat asymptomatic persons who have risk factors for a given disease. Examples include screening for pre-clinical evidence of cancer, blood pressure measurement to detect hypertension and lipid profile to detect hyperlipidemia.

Which of the following would be a secondary prevention measure for a 56-year-old male who has type 2 diabetes? check all answers that apply lifestyle modification education PSA test lipid profile to detect hyperlipidemia prescribing glucophage to control his diabetes

Correct Answer: Facial features continue to develop Digestive tract/sensory organs begin to develop Weighs about 1/30 of an ounce The above image would be considered a 3D rendered human fetus at 2 months that should be seen on the ultrasound. By or during month 2, the embryo should: Facial features continue to develop Digestive tract/sensory organs begin to develop The embryo would be approximately 1 inch long and weigh about 1/30 of an ounce. The neural tube which contains the brain, spinal cord, and other neural tissues is well developed. The cartilage is starting to be replaced by bone. The heart beat can be detected by about 6 weeks. By 2 months, the embryo is now referred to as a fetus.

Which of the following would be considered correct for the development of the embryo at 2 months? check all answers that apply Facial features continue to develop Digestive tract/sensory organs begin to develop Weighs about 1/30 of an ounce Is approximately 6 inches in length

Correct answer: regular exercise Prevention of hemorrhoidal engorgement and inflammation is the best treatment for hemorrhoids. This includes such strategies as weight control, high-fiber diet, regular exercise and increased fluid intake. Treatment for acute hemorrhoid flare-ups includes the use of astringents and topical corticosteroids, sitz baths, and analgesics.

Which of the following would be the least likely treatment to be used for an acute hemorrhoid flare-up? regular exercise astringents sitz baths analgesics

Correct Answer: Isoflavones The herbal supplements which are derived from soy beans would be Isoflavones. This supplement has Estrogen-like effects.

Which of the herbal supplements would be derived from soy beans and can have Estrogen-like effects? St. John's wort Isoflavones Glucosamine Kava Kava

Which of the following statements about tendonitis and its treatment is false? With rotator cuff involvement, the likelihood of concurrent bursitis is low. When the hand or wrist is affected, splinting and NSAIDs are reasonable first-line therapies. Achilles tendonitis may necessitate treatment with a posterior splint. There is a 10% risk of tendon rupture with recurrent Achilles tendonitis.

With rotator cuff involvement, the likelihood of concurrent bursitis is low. This statement is false. With rotator cuff involvement, the likelihood of concurrent bursitis is high. Treatment includes limiting overhead movement and intrabursal corticosteroid injection.

The FNP has a 25-year-old male patient who is a jogger. He presents with a ball-like mass behind one knee. The FNP tells him that he has a Baker's cyst. The treatment for this condition may include all but which of the following? X-ray of knee RICE drainage of bursa if large C&S to rule out infection

X-ray of knee There would be no need for an X-ray of the knee. The FNP would recommend RICE (rest, ice, compression and elevation), and if the bursa is large, drainage with syringe. If the synovial fluid is cloudy, the FNP may order C&S to rule out infection.

Correct Answer: 1200 cells/mm3 with 90 - 95% neutrophils Lumbar puncture should be part of the valuation of a febrile younger child who has an altered neurological examination. Typical CSF response in bacterial meningitis includes a median WBC of 1200 cells/mm3 with 90 - 95% neutrophils.

You have a 4-year-old child patient with bacterial meningitis. The typical CSF response in bacterial meningitis includes a median WBC count of which of the following? 1500 cells/mm3 with 85 - 95% neutrophils 500 cells/mm3 with 80 - 85% neutrophils 1200 cells/mm3 with 90 - 95% neutrophils 1800 cells/mm3 with 80 - 85% neutrophils

Correct Answer: Ellis III An Ellis III fracture is a full-thickness fracture of the tooth. It involves the enamel, dentin, and pulp. Pink tissue or blood is seen in the fracture. This patient would need a referral to an oral surgeon for probable tooth extraction or root canal.

You have a patient who has tripped and fallen on her face and has a tooth fracture. Upon examination you observe a full fracture of the tooth involving the enamel, dentin, and pulp. Pink tissue is seen in the fracture. This fracture would be classified as which of the following? check all answers that apply avulsion Ellis I Ellis II Ellis III Type I fracture

Correct Answer: oral corticosteroid Pramoxine, topical anesthetics, topical steroids, and oral antihistamines are normal treatment for pruritus. However, if the pruritus is more severe and there is swelling in the area, an oral corticosteroid would be most effective.

You have a patient whose pruritic skin condition is manifesting with severe pruritus and swelling. Which of the following treatments would be most effective for this patient? Pramoxine oral corticosteroid oral antihistamine any topical anesthetic

Correct answer: wax impaction This is something that you might find during the examination of a person with conductive hearing loss. The person usually speaks softly and the Weber lateralizes to the poor ear.

You have assessed your patient who complains of hearing loss. You have determined that it is a conductive hearing loss which involves which of the following? person speaks loudly wax impaction Weber lateralizes to the better ear non-specific Rinne findings

Correct answer: asking the patient to clench his or her teeth Part of inspecting the face and head of a patient is testing the masseter muscle. During an extra-oral examination, stand near the patient and visually inspect and bilaterally palpate the muscle. Place the fingers of each hand over the muscle and ask the patient to clench his or her teeth several times.

You would test a patient's masseter muscle by doing which of the following? palpating the scalp tapping on the forehead asking the patient to stand quickly asking the patient to clench his or her teeth

Correct answer: MAO inhibitors MAO inhibitors should be avoided for those with bulimia. They have a potential for severe food interactions and hypertensive crisis.

Your 20-year-old female patient has bulimia. You might manage her condition by all of the following EXCEPT: MAO inhibitors SSRIs TCAs Cognitive behavioral therapy

Atenolol (Tenormin) should be avoided in:

a 43-yo female with asthma. Atenolol is a beta blocker. It should be avoided in pateints with asthma or other bronchospastic conditions. These patients often require beta stimulation, not beta blockade. Although atenolol is a beta 1-selective agent, at higher doses beta 2 receptors (bronchial and vascular) are blocked. Beta blockers, specifically atenolol, are beneficial post-myocardial infarction because they have demonstrated a reduction in morbidity and mortality.

Which of the following persons would not be a candidate for the antipneumococcal vaccine? a 65-year-old healthy female living with her family a 35-year-old patient with HIV infection a 58-year-old male resident of a nursing home a 55-year-old female living alone

a 55-year-old female living alone The antipneumococcal vaccine is not indicated for an otherwise healthy person who is under the age of 65 unless there are other health factors involved. Living alone has no bearing on the need for the vaccine. The vaccine is indicated for persons with HIV infection, persons living in nursing homes, and all adults 65 years or older regardless of health status.

The treatment of choice for chronic bacterial prostatitis (CBP) is:

a flouroquinolone twice daily for 3 weeks to 4 months. The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with Bactrim-DS is only about 30-40%.

In which of the following patients would blepharitis be more common? an African-American male a light-skinned Irish female an olive-skinned Greek male a Filipina female

a light-skinned Irish female Blepharitis is inflammation of the eyelid margin, resulting in redness, scaling and crusting. It is more common in fair-skinned people. There is equal incidence in males and females.

Cremasteric Reflex

a superficial (i.e., close to the skin's surface) reflex observed in human males. This reflex is elicited by lightly stroking the superior and medial (inner) part of the thigh-regardless of the direction of stroke. The normal response is an immediate contraction of the cremaster muscle that pulls up the ipsilateral testis.

When doing an ophthalmologic assessment of a patient all of the following would be normal findings EXCEPT: yellow-white disc well-defined disc margins arteries enter at optic disc absent cup

absent cup This would be an abnormal finding most likely associated with optic atrophy. All of the other choices are normal along with veins leaving at the optic disc.

You have prescribed Danazol to suppress menses in your patient who has endometriosis. The common side effects of this drug include which of the following? loss of weight increased breast size loss of hair acne

acne Loss of weight and increased breast size are not usual side effects of Danazol. Weight gain is more likely as is decreased breast size. Danazol produces a hyperandrogenic state and shrinks endometrial implants.

A 45-year-old male patient presents with the acute onset of diffused pink-to-red skin on the site of a skin trauma. He tells the FNP that the area has enlarged over the last few days. The skin is indurated, swollen and tender. Which of the following is the most likely diagnosis? allergic dermatitis acute cellulitis actinic keratoses contact dermatitis

acute cellulitis Acute cellulitis is a skin infection caused by Gram-positive bacteria. Points of entry are skin breaks such as abrasions or surgical wounds. The classic case has an acute onset.

A mother brings her 8-year-old female child to you. The child is complaining of abdominal pain and swelling of her hands and feet. She tells you that the child had a "strep throat" a couple of weeks ago. She has been running a fever and appears very tired. Which of the following diseases/disorders is most consistent with these symptoms? systemic lupus bacterial endocarditis congestive heart failure acute glomerulonephritis

acute glomerulonephritis Acute glomerulonephritis is the result of an immune response, usually a streptococcal infection. It is common in children with the peak ages being 2 - 6 years.

Considering mortality statistics for the adolescent age group. education targeted toward this group should first focus on:

alcohol abuse. Alcohol is the most commonly used psychoactive substance in the United States today. It has been used by about 90% of adolescents by 16 years of age. Motor vehicle accidents related to driving under the influence of alcohol are the leading cause of death in the 15-24 year old age group.

Which of the following NSAIDs has the FDA approved for primary dysmenorrhea? ibuprofen indomethacin naproxen sodium all of the above

all of the above All of the first three choices are NSAIDs that have been approved by the FDA for primary dysmenorrhea. NSAIDs are effective in 75% to 90% of cases.

The U.S. Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS) have regulations governing research activities on human subjects. The principal investigator is responsible for: securing a signed research consent form from each participant appearing before the Institutional Review Board to present the study and secure approval to proceed with the subject recruitment at the facility report back to the Institutional Review Board if a subject is injured during the course of the study all of the above

all of the above Each of the answer choices are all basic requirements for conducting research at healthcare facilities.

Hydrocephalus is an abnormal expansion of cavities within the brain caused by the accumulation of cerebrospinal fluid. The management/treatment for your infant patient with hydrocephalus may include which of the following? extracranial shunts treatment of the underlying cause anticipatory guidance for families and caregivers throughout the child's life all of the above

all of the above The management/treatment of hydrocephalus in an infant would include all of the choices. Most cases will require: extracranial shunts, particularly ventriculoperitoneal types; treatment of the underlying cause such as a mass or lesion; and anticipatory guidance for the families and caregivers, such as referral to support groups and daily head circumference measurements.

Mrs. Fielder brings in her 4-year-old child who has itching in both eyes. Upon examination you find that the conjunctiva is edematous and moderately inflamed and that the discharge from the eye is watery. This is most likely which of the following types of conjunctivitis? bacterial chemical viral allergic

allergic Allergic conjunctivitis is characterized by watery or stringy mucoid discharge and bilateral itching. It occurs in both eyes simultaneously. The conjunctiva appear edematous or moderately inflamed. Infection should respond to treatment in 2 - 3 days.

Examining a male with suspicion of testicular cancer, the nurse practitioner understands that what test is a useful tumor marker for this disease? prostate-specific antigen (PSA) alpha-fetoprotein (AFP) prostatic acid phosphatase (PAP) alkaline phosphatase (ALP)

alpha-fetoprotein (AFP) AFP increases in testicular and primary hepatocellular cancer. Prostate-specific antigen (PSA) increases in prostate cancer. Prostatic acid phosphatase (PAP) is used to monitor therapy with antineoplastic drugs and bone cancers. Then, alkaline phosphatase (ALP) increases in osteosarcoma, liver carcinoma, and bone tumors.

Which of the following drugs is a drug that is injected directly into the penis for correction of erectile dysfunction? alprostadil Muse taldalafil vardenafil

alprostadil Alprostadil (Caverject) causes vasodilation and is highly effective as a treatment for erectile dysfunction. Muse is a pellet inserted into the urethra and can achieve the same effect. Taldalafil (Cialis) and vardenafil (Levitra) are oral treatments.

Mary Beth is a32-year-old female who complains of excessive facial and body hair, infrequent periods, and acne. You suspect polycystic ovary syndrome. If this is true you would find which of the following in this patient? atrophied ovaries FSH levels elevated serum testosterone low androstenedione elevated

androstenedione elevated You might find this in a client with polycystic ovary syndrome. The ovaries would not be atrophied; they would be enlarged. Serum testosterone would be elevated and FSH levels normal or low.

You are treating a child with croup. Your treatment plan for this child would include all but which of the following? humidified air by cool mist vaporizer keeping the child quiet oxygen as needed antibiotics

antibiotics Antibiotics are not indicated. A subsequent bacterial infection is possible, but uncommon. Mild cases can be managed at home. Croup is usually caused by a viral infection, most often a parainfluenza virus.

You have treated a 1-month-old infant who had blocked tear ducts (nasolacrimal duct obstruction). When should you reevaluate the patient? at 12 months every month at 6 months every week until 3 months

at 12 monthsThis disease is characterized by tear drainage being cut off between the lacrimal sac and the nose. You would reevaluate this patient at 12 months and if the infant is still symptomatic, refer to an ophthalmologist.

You are testing a patient for dementia and ask her to spell "world" and then to spell it backward. You are testing for what area in particular? orientation recall attention and calculation copying

attention and calculation The five subject areas of the Mini-Mental Exam (MME) are: orientation; attention and calculation; recall; writing a sentence; and copying a design. Attention and calculation include: serial 7's (subtracting 7 from 100 and so on); and spelling a word forward and backward.

You would advise the parents of a child who has mumps to do which of the following? avoid acidic food and drink for the child suck on peppermint candies for relief avoid giving too many fluids no isolation is necessary

avoid acidic food and drink for the child The only proper advice of the choices is to avoid acidic food and drink for the child as well as tart or sour food or drink. Peppermint should be avoided as it irritates the mucous membranes. Fluids should be pushed, as well as bed rest and warm or cold compresses to the affected area (whichever is more soothing) and the child should be isolated until the swelling disappears.

The most acceoted recommendation regarding skin cancer prevention is:

avoidance of excessive sun exposure. Avoidance of excessive sun exposure is the most accepted recommendation for prevention of skin cancer. All the other items are recommended by particular groups, but are not as widely accepted. Clinicians should remain alert for suspicious lesions in fair-skinned men and women >65 years, those with atypical moles, those with > 50 moles. These groups have a substantially increased risk for melanoma.

Which of the following best describes the presentation of a patient during a myoclonic seizure? blank stare lasting 3 - 50 seconds with impaired level of consciousness awake state or momentary loss of consciousness with abnormal motor behavior lasting seconds to minutes rigid extension of arms and legs followed by sudden jerking movements aura characterized by unusual sense of smell or taste, visual or auditory hallucinations and stomach upset

awake state or momentary loss of consciousness with abnormal motor behavior lasting seconds to minutes A myoclonic seizure is characterized by an awake state or momentary loss of consciousness with abnormal motor behavior lasting seconds to minutes. One or more muscle groups cause brief jerking contractions of the limbs and trunk, occasionally flinging the patient.

Congenital heart disorders present with symptoms at:

birth, infancy, or in childhood. A common misconception is that congenital disorders always present symptomatically at birth. They can present at various times throughout childhood and are classified as cyanotic or acyanotic. Cardiac disorders in infants and children may be acquired from rheumatic fever or kawasaki syndrome.

The Jones criteria are the major criteria for acute rheumatic fever, ARF. Which of the following is NOT part of these criteria? breast tenderness carditis polyarthritis erythema marginatum

breast tenderness Breast tenderness is not part of the Jones criteria for ARF. The other three choices are part of the Jones criteria.

Lead poisoning in children is often caused by lead-based paints found in older homes. If a child is exposed to lead, develops symptoms and has a lead level of 55 mcg/dL which of the following is the best course of action? removal from the source of lead, improved nutrition and iron therapy hospital admission no intervention is required at this level chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy

chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy. Most children with lead levels of 10 - 45 mcg/dL are treated with removal from the source, improved nutrition and iron therapy. With lead levels of 46 - 69 mcg/dL, chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy is indicated. With lead levels above 70 mcg/dL hospital admission with expert evaluation is the most prudent course.

Mrs. Harris a 67-year-old woman who is in the early stages of Alzheimer disease. She suffers from mild dementia. In this type of Alzheimer dementia which of the following would you use as the mainstay treatment? Vitamin E 1000 IU twice daily cholinesterase inhibitors NSAIDS Selgiline 5 mg twice daily

cholinesterase inhibitors The mainstay treatment for mild to moderate stage Alzheimer-type dementia is the use of cholinesterase inhibitors. These include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They have a clear, although minor and time-limited benefit.

Which of the following is a prenatal diagnostic test rather than a prenatal screening test? ultrasound NIPT maternal serum chorionic villus sampling

chorionic villus sampling Chorionic villus sampling is a diagnostic test. The other choices are screening tests that separate those who "might" from those who "probably don't" have the specific condition being tested for. Screening tests are NOT diagnostic.

A patient presents in the office 3 weeks post-myocardial infarction (MI) complaining of pericardial pain and elevated temperature. Physical examination reveals a pericardial friction rub. The nurse practitioner determines which of the following diagnostic studies would be ordered first? cardiac enzymes with myoglobin complete blood count (CBC) with differential echocardiogram 24-hour holter monitoring

complete blood count (CBC) with differential Post-myocardial infarction syndrome, also known as Dressler's syndrome, may develop 1 to 4 weeks after a myocardial infarction (MI). A post-myocardial infarction syndrome is characterized by pericarditis with effusion and fever. Also, post-myocardial infarction syndrome is due to antigen-antibody reactions. Laboratory findings for this condition include elevated white blood cell count and erythrocyte sedimentation rate.

A family member brings her elderly mother into the office with a new onset of fecal incontinence. The nurse practitioner knows that the most common cause is: poor fluid consumption constipation medication related inactivity

constipation The most common cause of fecal incontinence in elderly adults is underlying constipation. Risk factors include age greater than 80 years, impaired mobility, and neurologic disorders including dementia. While inactivity and poor fluid consumption may contribute to constipation, they are not the cause of fecal incontinence.

Which of the following factors would increase the susceptibility of a person for glaucoma? corticosteroid therapy mental illness history of pneumonia history of heart disease

corticosteroid therapy There are many factors that increase a patient's susceptibility to glaucoma. Corticosteroid therapy is one of them. Others include: eye inflammation or trauma; neoplasm; neovascularization; and increasing age.

Which of the following pharmacological treatments for allergic rhinitis is not an intranasal corticosteroid? beclomethasone cromolyn sodium budesonide fluticasone

cromolyn sodium Intranasal cromolyn sodium is not an intranasal corticosteroid. It is a topical antiinflammatory agent.

In which layer of the skin are blood vessels, sebaceous glands, and hair follicles located? topmost layer of epidermis bottom layer of epidermis dermis subcutaneous layer

dermis There are three layers of the skin: the epidermis, dermis, and the subcutaneous layer. Blood vessels, sebaceous glands, and hair follicles are located in the dermis.

When you examine a young child you find that one phase of his development is out of synchrony with others. This is known as which of the following? delay dissociation deviance disorder

dissociation Diagnosis of developmental delays includes three levels: delay, dissociation, and deviance. Dissociation occurs when one phase of development is out of synchrony with others.

You are examining Manuel, a patient who is having bouts of coughing and pain when he breathes. In terms of pulmonary function, which of the following findings would be abnormal? lower lobes: vesicular breath sounds (soft and low) dull tone on percussion upper lobes: bronchial breath sounds (louder) voice louder and easy to understand in the upper lobes

dull tone on percussion A dull tone on percussion might indicate bacterial pneumonia with lobar consolidation. It may also indicate pleural effusion (fluid or tumor).

Your patient is an adolescent with moderate acne vulgaris. In the treatment of acne vulgaris, and you are prescribing an antimicrobial agent which is also anti-inflammatory and is indicated in treatment of mild to moderate inflammatory acne vulgaris. Which of the following drugs would fall into this classification? tretinoin azelaic acid 20% cream Accutane erythromycin (topical antibiotic)

erythromycin (topical antibiotic) Erythromycin (topical antibiotic) is an antimicrobial against P. acnes and is also an anti-inflammatory. As a topical antibiotic it is indicated in treatment of mild to moderate inflammatory acne vulgaris; however it is less effective than oral antibiotics. Other topical antibiotics in this class are clindamycin and tetracycline.

For a 41-year-old male patient who has had a normal baseline blood glucose level measurement done several years ago, you would advise that it be measured how often from now on? every 2 years every 5 years every 10 years every 6 months

every 2 years Blood glucose level baseline measurement should be obtained at 18 to 39 years. After that blood glucose should be measured every 2 years.

You have a 65-year-old female patient with type 2 diabetes. In managing this patient's care how often should you do the A1c test? every month every 1 - 2 months every 3 - 6 months every year

every 3 - 6 months The A1c test should be done every 3 - 6 months. The goal for this test is a result of ≤ 6.9% (ADA) or ≤ 6.5% (AACE).

When discussing prenatal visits with a pregnant patient, the Family Nurse Practitioner knows that the recommended frequency of prenatal visits in the patient's 5th week of pregnancy is: every week every 4 weeks every 3 weeks every 2 weeks

every 4 weeks The patient is in her 5th week of pregnancy. Therefore, she will see the provider every 4 weeks until she reaches her 28th week of pregnancy. Then, she will start seeing the provider every 2 weeks. The frequency for prenatal visits, after the patient has had her initial examination, is as follows: Time of Pregnancy Frequency of Visits up to 28 weeks every 4 weeks 28 to 36 weeks every 2 weeks > 36 weeks every week

Which of the following is NOT considered a contraindication to DTP/DTaP vaccination? anaphylaxis family history of SIDS fever equal or > 105° F within 48 hours of a dose encephalopathy

family history of SIDS A family history of SIDS is not considered a contraindication to DTP/DTaP vaccination. Also not considered a contraindication is a family history of seizures and a fever of less than 105° F from prior DTaP vaccination.

If, upon examination of a child you find tufts of hair overlying the spinal column this may be a sign of spina bifida occulta. This is known as which of the following? nevus flammeus milia faun tail nevus hirsutism

faun tail nevus Faun tail nevus occurs when there are tufts of hair overlying the spinal column usually at the lumbosacral area. This may be a sign of spina bifida occulta. An ultrasound of the lesion should be done to rule out spina bifida. Nevus flammeus or port-wine stain is a capillary malformation presenting as a pink or red patch on a newborn's skin. It is a congenital skin condition that can affect any part of the body and persists throughout life.

Your management of a patient with acute pyelonephritis on an outpatient basis might include all but which of the following? Ciprofloxacin Sulfamethoxazole/trimethoprim follow-up in 2 weeks Ofloxacin

follow-up in 2 weeks You might prescribe any of the drugs mentioned. You would treat adults as outpatient if not toxic and follow up in 12 to 24 hours. You would hospitalize children and pregnant women for IV antibiotics.

According to the National Asthma Education and Prevention Program Expert Panel Report 3 (NAEPP EPR-3) all of the following are goals of asthma care EXCEPT: minimal or no chronic symptoms such as cough and wheeze no limitations on activities no or minimal side effects while optimal medications are given fully reverse impaired lung function

fully reverse impaired lung function This is incorrect. The formerly held concept in asthma was that no matter how severe the airway obstruction, the process was fully reversible. The newer disease model acknowledges that continued airway inflammation contributes to significant and potentially permanent airway remodeling and fixed obstruction. The NAEPP EPR-3 goal therefore is to prevent progressive loss of lung function, not fully reverse impaired lung function.

Edema from extravascular fluid retention is visible in conditions like

heart failure, nephrotic syndrome and liver failure.

John is a patient with acute renal failure. His inability to regulate electrolytes might be evidenced by all but which of the following conditions? hyperkalemia hyperlipidemia hypocalcemia hypernatremia

hyperlipidemia This patient's inability to regulate electrolytes might be evidenced by hyperkalemia, hypernatremia, hyponatremia, hypokalemia, hypermagnesemia, hyperphosphatemia, and hypocalcemia. Hyperlipidemia is abnormally elevated levels of any or all lipids and/or lipoproteins in the blood.

What is a secondary cause of hyperlipidemia?

hypothyroidism Hypothyroidism is a common secondary cause of hyperlipidemia. In the evaluation of a patient with hyperlipidemia, a TSH should always be checked and corrected before attempting treatment for hyperlipidemia. Other possible causes of seconday hyperlipidemia include pregnancy, excessive weight gain, excessive alcohol intake, insulin resistance or deficiency, obstructive liver disease, and uremia. Some medications can produce secondary hypothyroidism too: thiazide diuretics, some beta-blockers, oral contraceptives, and corticosteroids.

In which of the following cases would referral for lymphadenopathy be least likely? if no resolution in symptoms 48 - 72 hours after treatment is initiated if difficulty swallowing or breathing suspected malignancy if cervical adenitis is primary site of infection

if cervical adenitis is primary site of infection This is not a situation for referral as are all of the other choices. The expected course for benign lymphadenitis is that it will resolve over time, some within days of treatment, others over the course of 2 - 3 weeks with or without treatment.

The fact that a systemic viral infection such as measles produces lasting immunity means that this disease has a high degree of which of the following? communicability incubation virulence immunogenicity

immunogenicity Immunogenicity refers to the ability to produce a lasting and effective immunity. Systemic viral infections, such as measles, produce lasting immunity. Rhinovirus, on the other hand primarily acts locally, and results in a poor systemic immune response.

When can a patient with hyphema expect the bleeding to resorb? in 5 - 10 days in 2 - 3 days in 2 weeks in 24 hours

in 5 - 10 days Hyphema is hemorrhage into the anterior chamber of the eye. It can be caused by blunt trauma to the eye. The blood usually resorbs in 5 - 10 days as long as there is no further bleeding.

All of the following are typical changes to the gastrointestinal system that come with aging EXCEPT: decreased liver size decreased muscle tone in bowel increased absorption of calcium atrophy of salivary glands

increased absorption of calcium Decreased absorption of calcium is a common change that comes with aging, not increased absorption. Other gastrointestinal changes include: less efficient cholesterol stabilization and absorption, atrophy of taste buds, and slowing in esophageal emptying, among others.

Positive Murphy's sign

indicates Acute Cholecystitis. Right upper Quadrant

A patient with moderate persistent asthma will probably be most effectively managed with daily:

inhaled steroids and long acting bronchodilators. A patient with moderate persistent asthma has symptoms daily. He is best managed with daily medications of inhaled corticosteroids and long acting bronchdilators. Oral leukotriene blockers may be added to this regimen.

Which of the following diseases is more likely to cause chronic pelvic pain rather than acute pelvic pain? ectopic pregnancy PID ovarian cysts interstitial cystitis

interstitial cystitisInterstitial cystitis is more likely to cause chronic pelvic pain rather than acute pelvic pain as in the other choices. Other causes of chronic pelvic pain include: endometriosis, leiomyomas, and malignancy.

What prophylaxis medication is recommended for the patient under 35 years of age with a positive ppd?

isoniazid (INH) The CDC recommends administration of isoniazid to persons under 35 years of age with a positive PPD. The goal of this treatment is to prevent progression from latent infection to active infection. The other medications are used to treat active TB, but not for prophylaxis.

You are examining a 6-week-old female in a well-baby checkup. You understand that which of the following would be a developmental warning sign for a 6 week old infant? persistent fisting failure to follow 180° (for both near and far objects) lack of visual fixation (focusing) preference of one hand

lack of visual fixation (focusing) The developmental warning signs for a 6 week old infant would include: lack of visual fixation (focusing); absence of auditory alertness; and excessive head lag on pulling-to-sitting position. The other choices would be developmental warning signs for a 6 month old infant.

Which of the following is considered the gold standard for diagnosis of endometriosis? laparoscopy CA 125 MRI pelvic ultrasound

laparoscopy Laparoscopy is considered the gold standard for diagnosis by enabling direct visualization of endometrial implants. They may appear as: classic brown "powder burn" lesions; reddish-blue lesions on pelvic viscera; or endometrioma "chocolate cysts" on the ovary.

A mother brings in her 7-year-old female child saying that she thinks the child is "running a fever." You take the child's oral temperature and find that it is 101.5° F. You understand that this temperature would be classified as which of the following? low fever severe fever moderate fever none of the above

low fever A low fever is an oral reading of 100.4° to 102.2° F. A high fever is an oral reading of more than102.2° F. A fever higher than 108° F produces unconsciousness and brain damage if sustained.

The National Practitioner Data Bank is a repository for which of the following types of information? personal information professional credentials licensure information malpractice payments

malpractice payments The National Practitioner Data Bank is a repository for damage award data. It is a data bank that keeps track of payments and judgments from professional liability insurance companies on behalf of the clients to injured parties for successful malpractice claims. It also retains adverse peer review actions of physicians and other health care practitioners.

Wilson's disease and hypoparathyroidism can lead to which of the following type of cataracts? congenital cataracts metabolic cataracts secondary cataracts traumatic cataracts

metabolic cataracts Cataracts are the leading cause of preventable blindness in adults in the United States. Diseases leading to metabolic cataracts include diabetes mellitus, Wilson's disease, and hypoparathyroidism.

The nurse practitioner is following a child with juvemile rheumatoid arthritis (JRA) who has been previously diagnosed and is being managed for the disease by a pediatric rheumatologist. The mother asks for information about the child's long-term prognosis. The appropriate reply is that:

most children with JRA achieve complete remission by adulthood, but its effects might cause lifelong limitations. Although the active disease does not continue into adulthood, the contractures, growth retardation, bone deformities, and visual impairment associated with JRA may lead to lifelong functional impairments. A comprehensive treatment program involving physical therapy, occupational therapy, nutrition, education, and regular opthalmologic care can limit residual functional limitations.

The diagnostic test which combines fluoroscopy and radiography to evaluate the spinal subarachnoid space is which of the following? venography myelography electromyography electroencephalography

myelography Myelography utilizes a contrast medium that is injected into the epidural space by spinal puncture. Myelography is used to identify bone displacement, disk herniation, spinal cord compression, or tumors.

You have a patient who would benefit greatly from cessation of smoking. You understand that which of the following doubles the probability that this patient will be successful? nicotine replacement therapy behavioral strategies nicotine replacement therapy along with bupropion nicotine replacement therapy along with behavioral strategies

nicotine replacement therapy along with bupropion When a smoker is ready to quit, combination therapies seem to be more effective than any method alone. Nicotine replacement therapy and bupropion double the probability of success.

Following the finding of prostate gland abnormalities on DRE, the NP orders the appropriate labs. Whem preparing to review lab reports with the patient, the nurse practitioner knows all of the following are true EXCEPT:

normal PSA is 10ng/ml or less. Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated with BPH. A 10 or greater PSA level suggests prostate cancer. Positive serum acid phosphatase is associated with malignancy of the prostate gland with bone metasasis.

Function of cranial nerve XII is tested by which of the following? Rinne test noting movement and protrusion of the tongue evaluating shoulder shrug evaluating lateral neck rotation

noting movement and protrusion of the tongue Function of cranial nerve XII is tested by noting movement and protrusion of the tongue. CN XII is the hypoglossal nerve.

Mrs. Woo is a 55-year-old female patient who has a leiomyoma (fibroid tumor). She is of Asian ethnicity, smokes, is obese, and has had 5 children. Which of these factors increases her susceptibility to fibroid tumors? Asian ethnicity smoker obesity multiparity

obesity Factors that increase a person's susceptibility to leiomyomas include: obesity and being a nonsmoker, black ethnicity, sedentary lifestyle, nulliparity, age older than 35 years, family history, a history of infertility, oral contraceptive use, and intrauterine device use.

You have a patient who is complaining that her menstrual period now occurs every 45 days instead of the usual 28 days. Your notation in the records of this woman will be which of the following? oligomenorrhea metrorrhagia dysmenorrhea hypermenorrhea

oligomenorrhea Oligomenorrhea is a decrease in the number of bleeding episodes. It is defined as a menstrual interval greater than every 35 days.

A male patient with chronic atrial fibrillation takes a generic brand of Coumadin (warfarin). He should report all of these to his health care provider EXCEPT:

one missed dose of warfarin. This patient takes warfarin for prevention of emboli secondary to chronic atrial fibrillation. According to the NHLBI and ACCP, warfarin is the standard of care when anticoagulation is required for this condition. Warfarin is a drug with a narrow therapeutic index. This means that fluctuation in its level (increased or decreased) can potentiall cause big changes in its therapeutic effect. Consequently, warfarin levels are checked frequently to maintain therapeutic levels. If changes such as medication substitutions occur, warfarin levels should be checked in 3-7 days. Levels should be checked minimally every 4-6 weeks once regulation has occurred. While it is important NOT to omit doses of warfarin, this is the least important of all the choices because the effect of warfarin lasts beyond 24 hours.

The Correct answer is: Later disease presentation often includes iron deficiency anemia. Colorectal cancer is the second leading cause of cancer in the United States. A person with this disease is usually asymptomatic until the disease is quite advanced. In advanced colorectal cancer, the patient will have iron deficiency anemia and vague abdominal complaints. The mass is most often beyond the examiners digit during the rectal exam.

ou are treating a 66-year-old woman who you suspect has colorectal cancer. The nurse practitioner knows that which of the following is TRUE concerning this disease? Most colorectal cancers are found during rectal examination. Early manifestations of this disease include maladaptive deficiency anemia. Later disease presentation often includes iron deficiency anemia. Early manifestations of this disease include severe abdominal pain.

Physical exam findings consistent with emphysema include all of the following EXCEPT:

pallor and cyanosis of the mucosa and nailbeds. Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_. Emphysema (Type A COPD, the "pink puffer") is not associated with pallor or cyanosis. Increased AP dianeter produces a "barrel chest". The normal chest is elliptical whereas the barrel chest is round. The muscles of the thorax appear thin and wasted while the accessory muscles of respiration are hypertrophied. Breath sounds are minished and cough is weak and ineffective.

Of the following qualitative designs which one uses interviews and inductive analysis to seek understanding of lived experience? historical grounded theory phenomenologic experimental

phenomenologic There are six common qualitative designs for research: phenomenologic, ethnographic, grounded theory, historical, random sample, and non-random sample. Phenomenologic research uses interviews and inductive analysis to seek understanding of lived experience.

You are treating a 24-year-old man with infectious mononucleosis for tonsillar hypertrophy, exudative pharyngitis, difficulty swallowing, and a patent airway. For this case, you know that you should prescribe: prednisone acyclovir amoxicillin ibuprofen

prednisone Infectious mononucleosis is an acute systemic viral illness usually caused by Epstein-Barr virus, a DNA herpes virus that typically enters the body via oropharyngeal secretions and infects B lymphocytes. While antibiotics are not used to treat infectious mononucleosis, they are prescribed to treat accompanying infections of the throat, sinuses, and tonsils. In this case, the treatment would include a corticosteroid, such as prednisone 40 to 60 mg/day for 3 days.

You have a 60-year-old male patient who has some vision loss. You tell him that there is a certain amount of normal vision loss associated with aging. This type of vision loss is known as which of the following? hyperopia presbyopia glaucoma myopia

presbyopia Presbyopia is the natural loss of accommodation that is caused by aging. Hyperopia is the inability to see near objects clearly because of failure to accommodate. Myopia is the inability to see distant objects. Glaucoma is a disease of the eye.

You are assessing a patient whom you suspect is suffering from cellulitis. Which of the following notations in the patient's past medical history is least likely to support this diagnosis? saphenous venectomy previous STDs diabetes PVD

previous STDs A past medical history of diabetes or peripheral vascular disease (PVD) or saphenous venectomy support a diagnosis of cellulitis. Previous STD is less likely to support the diagnosis. A history of recurrent cellulitis is also supportive of the diagnosis of cellulitis.

Mr. Sellers has prostatitis that is causing painful urination. He tells you that he finds it hard to urinate and has a decreased urinary flow with hesitancy. He admits to having some back pain. Which type of prostatitis does Mr. Sellers most likely have? prostatodynia chronic bacterial prostatitis nonbacterial prostatitis acute bacterial prostatitis

prostatodynia Prostatodynia, also called chronic pelvic pain syndrome, presents with no fever and all of the other symptoms listed in the question. There are no other physical findings as there might be in other types of prostatitis.

There are a number of theories that are associated with anxiety disorders. The theory which holds that a person has a severe conflict between the id and the superego that is causing the anxiety is which of the following? behavioral theory existential theory psychodynamic theory biologic theory

psychodynamic theory The psychodynamic theory holds that anxiety comes from a severe conflict between the id and the superego. It holds that anxiety also comes from irrational guilt and shame.

Multiple sclerosis (MS) is usually classified into different forms. Your patient has the type of MS in which episodes resolve with good neurologic function between exacerbations. This type of MS is which of the following? primary progressive MS secondary regressive MS secondary progressive MS relapsing, remitting MS

relapsing, remitting MSRRMS (relapsing, remitting MS) is the type in which episodes resolve with good neurologic function between exacerbations and it has minimal to no cumulative defects. This type of MS accounts for approximately 85% of patients with the condition.

The National Committee for Quality Assurance (NCQA) is a consumer-oriented group directed by which of the following? physicians representatives of major employers, insurers and government representatives of hospitals and physician groups none of the above

representatives of major employers, insurers and government The National Committee for Quality Assurance (NCQA) is a consumer-oriented group directed by representatives of major employers, insurers and government. NCQA accredits MCOs and health plans.

Aileen is an adult patient of Scottish descent who reports a red, acne-like area around her nose and mouth. She tells you that it comes and goes. Your most likely diagnosis of the following choices would be: cheilosis tinea barbae cystic acne rosacea

rosacea Rosacea is seen more in adults of Celtic background with pale skin, blue eyes, and red-to-blond hair. The patient usually complains of chronic, small acne-like papules and pustules that erupt around the nose, mouth, and chin, which become exacerbated episodically.

Which of the following skin conditions affects individuals 50 years of age and older? psoriasis melanoma plantar warts seborrheic keratosis

seborrheic keratosis Seborrheic keratosis affects individuals 50 years of age and older. It is the proliferation of immature keratinocytes and melanocytes. They are beige, brown, or black plaques with a velvety or warty surface.

Jake is a 25-year-old male patient who has been experiencing diarrhea for several days. He tells you that he has not felt much like eating or drinking anything since this started. Your assessment shows mottled, very dry mucous membranes, prolonged skin tenting, and deeply sunken eyes. These are all indications of which level of dehydration? mild moderate chronic severe

severe This patient has severe dehydration. This patient will likely have no urine output, low blood pressure, and tachycardia, as well.

Danielle is a 20-year-old female patient with mononucleosis. Upon examination of this patient you would expect to see all but which of the following symptoms? severe jaundice fever fatigue sore throat

severe jaundice This is not a common symptoms of mononucleosis. Besides, fever, fatigue, and sore throat the patient may also have dysphagia and swelling of the lymph nodes, especially posterior cervical lymph nodes. Less common are anorexia, headache, and abdominal pain.

On the Borg dyspnea scale, a score of 4 would indicate which of the following? somewhat severe breathlessness very slight breathlessness severe breathlessness moderate breathlessness

somewhat severe breathlessness The Borg dyspnea scale ranges from 0 (no breathlessness at all) to 10 (maximal breathlessness). A score of 4 indicates somewhat severe breathlessness. The Borg scale is just one of many used to rate dyspnea. 0 No exertion at all 0.5 Very, very slight (just noticeable) 1 Very slight 2 Slight 3 Moderate 4 Somewhat severe 5 Severe 6 7 Very severe 8 9 Very, very severe (almost maximal) 10 Maximal

Which of the following drugs is a Category C drug that is contraindicated in the third trimester of pregnancy because it shows adverse effects in animal studies but no human data is available? penicillins sulfa drugs analgesics ACE inhibitors

sulfa drugs Sulfa drugs are Category C drugs that have shown adverse effects in animal studies, but no human data is available. They are Category C in the third trimester because of increased risk of hyperbilirubinemia. Penicillins and analgesics are Category B drugs. ACE inhibitors are Category D drugs.

You have a patient whom you suspect has Meniere's disease. You order an RPR test. This test will help you to rule out which of the following diseases? otosclerosis leukemia syphilis cerumen impaction

syphilis An RPR test should be done to rule out syphilis. Syphilis is a known cause of Meniere's disease, which is an idiopathic disease characterized by hearing loss, tinnitus, and episodic vertigo.

You have an elderly patient with a zinc deficiency. You would expect that this would affect which of the following? hearing depth perception taste tactile sensation

taste If a patient has a zinc deficiency this may result in altered taste sensation. Medications may also affect taste.

Which of the following injuries to a patient will show no specific radiographic findings? tennis elbow finger fractures Jones fracture Boxer's fractures

tennis elbow Tennis elbow will show no specific radiographic findings. Finger fractures may reveal crush injures. Jones fractures reveal a fracture to the fifth metatarsal. Boxer's fractures reveal a fracture of the fifth metacarpal, which frequently is medially angulated. A boxer's fracture is a break in the neck of the 5th metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers. The metacarpal bones are the intermediate bones of the hand found inside the flat part of the hand. A Jones fracture is a fracture of the bone on the pinky toe side of your foot, the fifth metatarsal bone.

A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about:

testicular self-examination. Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer.

To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient:

the meaning of a common proverb

You have a 58-year-old male patient with possible pancreatic cancer. You will not order an abdominal ultrasound for diagnosis because it is limited by which of the following? previous history of pancreatic disease patient's age the presence of intestinal gas size of tumor

the presence of intestinal gas The usefulness of abdominal ultrasound is limited by the presence of intestinal gas. Abdominal CT scan is more helpful in identifying pancreatic cancer.

Utilization review can best be described as which of the following? a system of monitoring and assessing for high-risk areas and procedures the process of evaluating the appropriateness of inpatient hospitalization the process used for accreditation the process used for case management

the process of evaluating the appropriateness of inpatient hospitalization A utilization review is the process of evaluating the appropriateness of inpatient hospitalization. Proof of the medical necessity for the patient's hospitalization is done mainly through chart reviews. If the reviewer and payor do not agree, the claim can be denied, resulting in denial of payment to the health facility.

Your patient has a burn on his right thigh that has a white and leathery skin texture. This is consistent with which of the following types of burn? third degree second degree first degree partial thickness

third degree The pain of a third degree burn may be minimal but the burns are usually surrounded by areas of painful first- and second-degree burns. The skin is usually white and leathery.

After completing a physical examination, you suspect that a 16-year old girl has acute appendicitis. She presents with acute abdominal pain and you order a white blood cell (WBC) count with differential and an x-ray of the abdomen. You receive the laboratory report back first and are still waiting on the x-ray. By looking at the laboratory report, which of the following values would you expect to see in a patient with acute appendicitis? total WBCs 1200 mm³ neutrophils 4% bands 1% lymphocytes 44% total WBCs of 500mm³ neutrophils 10% bands 2% lymphocytes 39% total WBCs 16,000 mm³ neutrophils 67% bands 8% lymphocytes 23% None of the above would indicate acute appendicitis.

total WBCs 16,000 mm³ neutrophils 67% bands 8% lymphocytes 23% You would expect a "left shift." This includes leukocytosis (elevated WBCs), neutrophilia (an absolute neutrophil count (ANC) of greater than 7000 neutrophils/mm. ANC is calculated by multiplying the percentage of neutrophils by the total WBC in mm. Therefore, the following answer choice is correct, as the absolute neutrophil count is greater than 7000 mm³ if you multiplied 0.67 by 16,000. This would be 10,720 neutrophils/mm³.

Your patient has been diagnosed with blepharitis. Your nonpharmacologic treatment for this disease would include which of the following? cold compresses q.i.d. for 15 minutes using tear-free shampoo for daily cleansing of the eyelid with warm, damp cotton tip meibomian gland massage eye patch

using tear-free shampoo for daily cleansing of the eyelid with warm, damp cotton tip Of the four choices this is the only one that would be recommended for blepharitis. In addition, warm, moist compresses would help to soften encrustation. Contact lenses and eye makeup should be discontinued during treatment.

Correct Answer: Esophagogastroduodenoscopy (EGD) The image above would be considered an example of screws in a patient's esophagus. Infants and children are more prone to this type problem. If an object actually reaches the gastrointestinal tract, it may pass spontaneously. Only about 10-20 percent of these cases actually required removal of the objects by an EGD.

which would be the typical procedure that would more than likely be used to remove the screws from the patient with screws found in the esophagus during an x-ray image? Laparoscopy Abdominal surgery Colonoscopy Esophagogastroduodenoscopy (EGD)

Enuresis is involuntary urination after a child has reached the age when bladder control is usually attained. Management of primary nocturnal enuresis includes all of the following EXCEPT: limiting fluid intake before bedtime double voiding before bedtime avoiding punishment withholding verbal praise so as not to call attention to the problem

withholding verbal praise so as not to call attention to the problem Verbal praise is an excellent means of motivational therapy for a child with primary nocturnal enuresis. Other means of motivational therapy include a reward system and keeping a dryness calendar.