Health Promotions and Screening

Name an online resource tool that you intend to try:

ASCVD risk calculator, American Heart Association's Heart 360 or National Heart, Lung, and Blood Institute's online publications.

Key features of delirium include:

Acute onset with a fluctuating course

Your patient, an asymptomatic 80-year-old receiving treatment for HTN (and reporting no adverse effects ) consistently presents with BPs > 140/80 but less than 150/90. According to the Joint National Committee (JNC) 8 recommendations, what approach to her HTN management would you have (in addition to reviewing compliance and diet)?

Add no antihypertensives at this time.

Your patient, Mr. Smith, is a 56-year-old moderately overweight African American hospital administrator with HTN. He has a FHx of DM but has had consistently negative screening labs for DM. He has been exercising regularly, is a nonsmoker, and has lost 10 lb over the past 6 months. Until recently, he has maintained a BP < 140/90 on HCTZ 25 mg daily. The past 3 months his BP has been creeping upward and at his current visit is 160/94. In addition to checking labs and discussing his diet and stress, you decide to alter his medication regimen by:

Adding an angiotensin converting enzyme inhibitor OR Adding a calcium channel blocker

All of the following are considered secondary disorders of lipid metabolism, except:

Familial combined hyperlipidemia

The age range referred to as "young old" is:

65 to 74 years

When documenting Paula's mental status, which of these choices is the best description of her mood?

"Despondent. It feels like this misery will never go away." Mood should be described in the patient's own words.

Ms. Jones frequently visits the emergency department with complaints of chest pain, shortness of breath, dizziness, sweating, and nausea. Her EKG, imaging studies, cardiac enzymes, lipids, and metabolic panel results have all been normal. She presents to a primary care follow-up appointment requesting a cardiology referral. What actions do you perform to assess the appropriateness of a referral?

(all o the above) - Obtain a detailed history of symptoms including precipitating factors, duration, and factors that relieve or exacerbate symptoms. - Administer a Generalized Anxiety Disorder scale (GAD-7). - Administer a Generalized Anxiety Disorder scale (GAD-7). - Assess for thyroid dysfunction and substance use

Lung cancer ranks number ____ as the cause of cancer related deaths in men and women.

1

The prevalence of children with developmental and behavioral problems in the United States is estimated at:

12-16%

What is the incidence/prevalence of smoking in the general population?

18.1 %

Fill in the blank. According to recent epidemiological studies, prostate cancer is the number ______ cause of cancer death in men in the U.S.

2

According to current American Cancer Society data, colorectal cancer is the number ___ cause of cancer death in men and women.

3

The onset of perimenopause is between the ages of:

40 to 45 years

Guidelines from the National Comprehensive Cancer Network (NCCN) recommend screening high-risk smokers beginning at age _____.

50 years

Long term calcium supplementation is recommended to post-menopausal women as it reduces fracture risk by:

50%

The APN is reviewing the recommended ages for performing developmental surveillance using the ASQ-3. The AAP recommends children under 5 years of age be screened with the ASQ at:

9, 18, 30 months

The Ages and Stages Questionnaire, Third Edition (ASQ-3) has a sensitivity of 0.70 to 0.90. This means that different studies found the sensitivity to range from 0.70 to 0.90. The interpretation of a sensitivity of 0.90 is that:

90% of the children who receive positive screening results truly have a developmental problem

A 45-year-old otherwise healthy Latina woman patient has had four BP readings in the past 6 months ranging from 145-155/79-82. What treatment do you recommend at this time?

Advise on lifestyle modifications and start a low dose of an antihypertensive such as an ACEI or diuretic.

Presbycusis is defined as

Age-related hearing loss

Which of the following statements regarding non-pharmacologic management for the prevention and treatment of postmenopausal osteoporosis and/or fracture is true?

All of these answers are true. - People should take an adequate intake of calcium (1200 mg/day in divided doses) - People should take adequate intake of vitamin D (800 - 1200 IU/day) - Complete a fall risk assessment

Your patient Mrs. P, is a 55-year-old, Japanese-American postmenopausal woman who presents with a chief complaint of ongoing but "mild" hot flashes and difficulty sleeping. You inquire as to whether she may have other symptoms related to menopause and she says, "I don't think so." To better understand the extent of Mrs. P's condition, which of the following strategies would be most effective?

Ask her a direct question, such as "A lot of women who having hot flashes are also noticing that they are having vaginal dryness or discomfort with sexual activity. Is this something that we need to talk about?

The NP teaching a female person about bladder health would include all of the following guidelines EXCEPT:

Avoid doing Kegel's exercises

According to the WHO osteoporosis is defined as:

BMD less than 2.5 SD below the mean for your normal adults (T Score)

In order for the offspring to be affected with an autosomal recessive disorder:

Both the father and mother must carry the genetic mutation

According to evidence- based studies what works best for smoking cessation?

Bupropion or varenicline with NRT

E-cigarettes are a new tool to aid in smoking cessation especially for adolescents

False

The Amsterdam Criteria is:

Criteria that measures the risk for colon cancer

The International Hap Map is a website that:

Describes variations in human genes across and within populations

At her first visit with you, Ms. Ryan, a 55-year-old school teacher, is checked in by the medical assistant with a blood pressure of 155/92. Ms. Ryan reports no history of HTN or CVR disease and is asymptomatic. Repeat BP performed by you gives a reading of 148/85. In addition to ordering labwork and an ECG, you :

Discuss lifestyle modifications and schedule Ms. Ryan back for repeat BP readings in 2-4 weeks

Elevated diastolic BP is a stronger risk factor for cardiovascular disease than elevated systolic BP

False

What is a key point to be included in patient education when starting a patient on a SSRI?

Early side effects of SSRI treatment such as decreased appetite, nausea, and headache are usually time limited and do not indicate a need to discontinue the medication.

A 68-year-old man comes into your primary care clinic for a routine visit. He complains of increased difficulty reading the morning newspaper. He notes the problem has been occurring now for a few months and seems better when he borrows his wife's reading glasses. As a provider you should:

Educate regarding presbyopia and notify him this is a normal process of aging

Which of the following are possible consequences of obesity? Select all that apply.

Endometrial cancer Obstructive apnea Female infertility Steatohepatitis

APNs incorporate standardized developmental screening instruments into primary care visits to:

Enhance the precision of developmental surveillance

Which of the following medications are appropriate first-line treatments for an anxiety disorder?

Escitalopram, venlafaxine, sertraline

When assessing Paula's risk of suicide, which of these behaviors would be a particular cause for concern?

Excessive alcohol consumption

Despite few existing studies, experts report it is safe to use nicotine replacement therapy with patients who have cardiovascular disease

FALSE

Dually diagnosed patients should not receive treatment for anxiety disorders until they achieve abstinence.

FALSE

Elevated diastolic BP is a stronger risk factor for cardiovascular disease than elevated systolic BP.

FALSE

Patients should be educated that it takes approximately 2 years to transition. However, increasing the dosage of hormones will hasten the transitioning process.

FALSE

Since 2009 with the passage of the Tobacco Control Act, the tobacco industry has been actively helpful in educating the public about the risks of smoking and reducing rates of smoking.

FALSE

The best way to determine if a health maintenance intervention is appropriate for an older adult is to adhere strictly to age cutoffs in guidelines.

FALSE

The most common event that in turn causes loss of independence in older adults is:

Falls

Benzodiazepines are appropriate to use as monotherapy for all anxiety disorders.

False

In an 8-year-old and older the examiner expects the patient to verbalize:

Family relationships Peer relationships Body concerns School progress

According to the American Cancer Society recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51 year old male?

Fecal occult blood test

Leading factors for urinary incontinence include:

Female gender, Cognitive impairment , Impaired mobility

A pelvic exam is indicated for:

Females at 21 years of age regardless of reported sexual activity

In the family history for an x-linked recessive condition you will see:

Females most often have a normal phenotype

Which of the following is most likely to be noted in a person with colorectal cancer?

Few symptoms

Mrs. Taylor is a 79-year-old widowed white woman who lives alone and whom you have been treating for HTN, knee degenerative joint disease, and depression for 5 years. She is taking a diuretic, an ACEI, and a low dose of a beta blocker, all started by her former primary care physician before she transferred care to you. At this visit her BP has risen to 170/80, checked twice by you during the visit. Which of the following is not necessary to include in the history portion of the exam today:

Inquire about social support and spirituality.

Adam is at his pediatric clinic visit, is a 16-year-old male, reports one lifetime sexual partner who is female, denies any symptoms, and requests "to be tested for everything." He has never been screened for any sexually transmitted infection (STI). Following STI screening recommendations by the CDC and/or the U.S. Preventive Services Task Force (USPSTF), Adam should be offered which of the following:

HIV Screening

Medical problems associated with Down syndrome include:

Hearing impairment, hypothyroidism, and early Alzheimer disease

Diane is a well-nourished, well-developed 17-year-old female who reports regular menses every 30 days, moderate flow for 3-5 days, who presents for a well adolescent visit. Routine adolescent primary care visits should include:

Hemoglobin/hematocrit every 5-10 years starting in adolescence

Studies have shown that __________ is most effective at reducing the frequency of hot flashes associated with menopause.

Hormone therapy (HT)

Which of the following is not a sign of vaginal/vulvo atrophy?

Hot flashes

An 86-year-old female presents to the emergency department with acute onset of worsening confusion. She appears more agitated and anxious to caregivers. She has been physically aggressive with one caregiver and this is reported to be an abrupt change from her baseline mental status. This is most consistent with:

Hyperactive delirium

The APN reviewed the Parental Evaluation of Developmental Status (PEDS) screening tool before seeing a 4-year old for her primary care visit. The screening identified a delay in the child's fine motor development and normal gross motor and speech and language skills. How should the APN prepare for the visit?

Identify if there was a previous history of abnormal neurologic examination or fine motor delay noted in previous developmental screenings.

Passive immunization with immune globulin is indicated:

In certain acquired or congenital immunodeficiencies

Ms. S is a 55-year-old woman with diabetes and an estimated 10- year risk < 7.5%. At her last visit, she was started on simvastatin 10 mg and her LDL has reduced from 110 mg/dl to 90 mg/dl. How do you proceed?

Increase simvastatin to 20 mg daily.

A major cause of health disparities in people with developmental disabilities (DDs) is:

Lack of access to health-related, long-term care services and supports

Which of the following is true concerning colorectal cancer?

Later disease presentations often include iron deficiency anemia

Which of the following over-the-counter products (taken regularly) should be considered as a possible factor in elevating BP ?

Licorice tea

A patient hypertriglyceridemia requests education about how to prevent pancreatitis. How do you counsel?

Limit excessive alcohol intake

Which of the following does not increase a patient's risk of developing colorectal cancer?

Long-term aspirin therapy

Which of the following is not an established major risk factor for osteoporosis?

Low calcium intake ????????????? OR chronic use or steroids

Which of the following gene mutations is most likely to result in the development of a tumor?

Mutations in genes that promote cell division

Mrs. P does acknowledge symptoms of Vulvo Vaginal Atrophy when directly questioned, but when you bring up the option of local ET, she becomes resistant because her sister is a breast cancer survivor and she read the HT causes breast cancer. To best put her anxiety at ease, you offer what explanation?

Non hormonal treatments, such as lubricants and moisturizers, can be helpful but the low doses of locally administered Estrogens have little systemic effect

Which of the following screening tests provides the highest detection rates for Down syndrome?

Noninvasive prenatal testing

Which of the following is not an associated risk factor for osteoporosis?

Obesity

Individuals with developmental disabilities are at high risk for osteoporosis at ages younger than in the general population. The following statements are all true except:

Once screening has begun, dexa scans should be done on an annual basis. Risk factors for osteoporosis in patients with developmental disabilities include mobility impairments, long-term use of antiepileptic and antipsychotic medications, nutritional issues, and oral-motor problems. The age to begin screening for osteoporosis is unclear. Some sources recommend beginning at age 40-45 for those with high risk. The screening interval is unclear.

M.S. is currently 26 weeks pregnant. She is seeing you today for a prenatal visit. She has had an uncomplicated pregnancy. Which of the following would be a part of your management plan at today's visit?

Order a glucose load test and a CBC

The risk factors for Breast/Ovarian Cancer Syndrome includes:

Ovarian cancer, male breast cancer, breast cancer before 40

After age 70 years, the American Cancer Society recommends discontinuing routine.

PSA

The next step in the management of the 24-year-oldwith an ASC-US Pap is

Perform repeat Pap test in 12 months

Which of the following symptoms differentiate panic disorder from a panic attack?

Prolonged worry about having another panic attack

Delusions and hallucinations are an aspect of which perinatal mood and anxiety disorder?

Psychosis

A woman and her 6-year-old son present to your urgent care clinic after the boy sustains a bite on his forearm from another child on the school playground. The boy's skin was broken and he reports that the wound bled slightly after the bite. The boy denies any trauma to the biter's mouth prior to the bite and says the biter's saliva and teeth were not bloody. To address the mother's concern about HIV transmission you:

Reassure the patient and his mother that this was not a potential exposure to HIV and therefore PEP is not indicated

Mr. Smith has a diagnosis of generalized anxiety disorder. He responded well to increasing doses of citalopram, yet begins to complain of difficulty controlling his symptoms. He specifically endorses difficulty controlling anxious behaviors. Which is the best intervention to address his concerns?

Recommend that he receive cognitive-behavioral therapy (CBT).

Matt is a 20-year-old, nonverbal, autistic man. Presuming competence means:

Referring Matt to a speech therapist for an augmentative communication evaluation Clinicians should presume competence, which means to assume that all people communicate and all people have the capacity to learn and grow and improve skills. It is important not to make assumptions about people's intellect when it cannot be accurately assessed due to limitations in expressive communication. People with profound expressive communication problems can have normal receptive language.

A 55 year old white man with no obvious risk for prostate cancer chose to have PSA screening and DRE testing. The DRE findings are normal, and his PSA test is 3.7. You recommend:

Repeat screening in one year

A 20-year-old transgender patient presents to the office with multiple bruises and periorbital hematoma. You notice in the chart that there were three other reported injuries during the past 6 months. Universal steps in all 50 U.S. states for assessing possible IPV include all the following except:

Report the alleged incident and past history to law enforcement

Paula has remained on SSRI treatment for 15 months and has now been symptom free for 6 months. She wants to get pregnant and would like to discontinue medication. What would be your treatment recommendation to Paula?

She should continue to be monitored for several months after discontinuing her medication because risk of relapse is highest in the first 2 months after discontinuing treatment.

Your patient is a 75-year-old woman with hypertension, diabetes, renal insufficiency, and a history of a stroke. She is unable to walk farther than half of a city block and needs assistance with bathing, cleaning, and shopping. Her daughter helps manage her finances and her medication. What is your estimate of her current life expectancy?

Shorter than the average 75-year-old woman

Which family history would require additional screening?

Sibling still birth Pulmonary disease in a first-degree relative Premature cardiovascular disease in first-degree relative Type I diabetes in sibling

Which of the following is FALSE regarding complex genetic disorders?

Sickle cell anemia and cystic fibrosis are examples of this type of disorder

A 25-year-old patient presents for annual blood tests. His A1C is 4.9%. His LDL is 195 mg/dl. He is a nonsmoker and has no personal history of CAD. What should be the next step in terms of clinical management? Select the best answer.

Start atorvastatin 40 mg daily.

Despite the overall decrease in rates of smoking since 1965, smoking remains the leading cause of preventable death

TRUE

The AAP recommends that infants with visible jaundice noted prior to 24 hours of age be screened with a serologic or transcutaneous bilirubin test.

TRUE

There are more than 65 cancer-causing chemicals found in cigarette smoke.

TRUE

Six months ago you diagnosis your patient with osteoporosis. You started her on a bisphosphonate. She has also been taking Calcium with vitamin D and exercising. She wants to know if the therapy is working. You would:

Tell her there is no test that will reflect treatment efficacy at this time.

The psychometric properties of a developmental screening tool include assessing specificity. Specificity is defined as:

The ability of a screening tool to be accurate and identify children who do not have a developmental delay

Frailty tends to be more prevalent in the presence of any stressors in the body.

True

Geriatric Syndromes are defined as common conditions seen in older adults that cannot be classified into a single disease but have a significant impact on well-being and quality of life.

True

Some common medications that contribute to worsening of urinary incontinence include alpha blockers, loop diuretics, and narcotics.

True

Adults with disabilities have an increased risk for abuse and neglect. They should be screened yearly with a complete history and physical exam. Some signs and symptoms of abuse/neglect include:

Unexplained bruising, behavior changes, depression There are many signs and symptoms of abuse and neglect. One of the most common seen in adults with developmental disabilities, particularly those who have difficulty with verbal communication, is unexplained behavioral changes. Behavior is always a form of communication.

A 75-year-old female complains that she awakens 3-4 times each night sensing bladder fullness, but is unable to "hold it" until she can get seated on the bathroom toilet. This type of urinary incontinence is termed:

Urge incontinence

According to the American Geriatric Society, a person must have three or more specific characteristics in order to be classified with frailty. The three characteristics include:

Weight loss, low activity level, weakness

Treatment for anxiety disorders is indicated

When symptoms interfere with a patient's ability to function

A young couple presents for pre-conceptual counseling. Both carry the sickle cell trait. The NP would be accurate to tell them that the baby:

Will either have the disease or carry the sickle cell trait

Providers at a primary care clinic that serves all ages and genders adhere to the recommendations from the U.S. Preventive Services Task Force when screening which of these patients:

Women of childbearing age

Your patient is an 80-year-old woman who lives independently, manages her own financial and household affairs well, and swims 4 days a week. Her only medication is amlodipine for hypertension. She has had regular medical care all her life and has had routine screenings up to now. The average life expectancy for 80-year-old women is 9.1 years. Colon cancer screening is expected to benefit those who have at least 10 years of life expectancy. Would you recommend a colonoscopy?

Yes

The "timing hypothesis" of hormone therapy (HT, when applied to findings int the Women's Health Initiative, suggests that HT does not increase coronary heart disease (CHD) risk when initiated in which types of patients?

Younger and more recently postmenopausal women

Early disease presentation in osteoporosis often includes:

patient report of back pain

Intervention for patients with stress incontinence includes:

periurethral bulking agent injection

Post-menopausal hormone therapy can result in:

a reduction in frequency and severity of vaso motor symptoms

A risk factor for primary open-angle glaucoma is:

age more than 40 years

In counseling a postmenopausal woman, you advise her that hormone therapy users may experience:

an increase in breast cancer rates with long-term use

To avoid rebound gastric hyperacidity following discontinuation of long-term PPI use, all of the following methods can be used except:

avoiding antacid therapy when symptoms flare

Risk factors for prostate cancer include all of the follow EXCEPT:

history of genital trauma

The progestin component of HT is given to:

minimize endometrial hyperplasia

All of the following are common sites of fracture in patients with osteoporosis except:

the clavicle

Osteoporosis prevention measures include all of the following except:

vitamin B6 supplementation

When advising a person who will be using orlistat (Xenical*, Alli*) as part of a weight loss program, the NP provides the following information about when to take the medication:

within an hour of each meal that contains fat.