Leik study plans FNP

Trough (minimum concentration):

The lowest concentration of a drug after a dose.

Molluscum contagiosum is caused by: A. Herpesvirus B. Poxvirus C. Staphylococcus aureus D. Haemophilus influenzae

B. Poxvirus

Mortality from illicit drug use is more common among A. Adults B Adolescents

A. Adults

What is the preferred treatment for RMSF:

Doxycycline is the preferred agent for both children and adults.

Minimum inhibitory concentration (MIC):

The lowest concentration of an antibiotic that will inhibit the growth of organisms (after overnight incubation).

Example of Quinolones with gram-positive coverage

Levofloxacin (Levaquin), moxifloxacin (Avelox), gatifloxacin (Tequin)

meniscus cartilage damage

MRI

example of Tetracyclines:

Tetracycline, doxycycline, minocycline (Minocin)

Maximum concentration:

The highest concentration of a drug after a dose.

The sigmoid colon, is the most common site for the development of?

diverticula.

Spinach is a good dietary source of?

potassium, magnesium, and calcium. PMC

Example An NP working in a school health clinic is evaluating a new student who has been referred by a teacher. The student is a 16-year-old boy with a history of attention deficit disorder (ADD). He complains that his parents are always fighting, and he thinks that they are getting divorced. He reports that he is failing two classes. During the interview, he stares at the floor and avoids eye contact. He reports that he is having problems falling asleep at night and has stopped seeing friends, including his girlfriend. Which of the following statements is the best choice to ask this teen? "Do you want me to call your parents after we talk?" "Do you have any plans for killing or hurting yourself or other people?" "Do you have any close male or female friends?" "Do you want to wait to tell me about your plans until you feel better?"

"Do you have any plans for killing or hurting yourself or other people?" Best Clues Classic behavioral cues (avoidance of eye contact, insomnia, social isolation) Parents fighting and getting divorced Teenagers are separating from their parents emotionally and value their privacy highly. When interviewing a teen, do it privately (without parents) and also with the parent(s) present.

If the question is asking for the initial or screening lab test, it will probably be a

"cheap" and readily available test such as the complete blood count (CBC) to screen for anemia.

Maculopapular rash in a lace-like pattern (fifth disease)

(fifth disease)

Vesicular rashes on an erythematous base (herpes simplex, genital herpes)

(herpes simplex, genital herpes)

Maculopapular rashes that are oval shaped with a herald patch (pityriasis rosea)

(pityriasis rosea)

Maculopapular rashes with papules, vesicles, and crusts (varicella zoster, herpes simplex)

(varicella zoster, herpes simplex)

Left sided heart failure symptoms

-Left = lungs (and heart) -Crackles, increased HR, SOB, palpitations, dizzy, lightheaded, confused, restless, cough, dyspnea

After antihypertensive therapy is initiated, when should a patient's BP be rechecked? A.1 month B.2 months C.3 months D.4 months

1 month The 2017 ACC/AHA guidelines recommend follow-up in 1 month after initiating (or titrating) an antihypertensive. When it is under control, the follow-up visit can be in 3 months.

1. Elderly patients are divided into two age categories on the AANPCB exam. Those between the ages of 65 and 84 years are the? 2. Those from the age of 85 years and older are the

1. "young gerontologicals." 2. "frail elderly."

Rank the following cancers according to mortality rate (highest to lowest) in adults (all ages/genders) A. Colorectal cancer B. Pancreatic cancer C. Lung cancer D. Breast cancer

1. C) Lung cancer 2. A) Colorectal cancer 3. B) Pancreatic cancer 4. D) Breast cancer

The nurse practitioner is reviewing evidence regarding the use of a drug used to treat Parkinson's disease. Rank the strength of evidence from strongest (1) to weakest (3). A. An editorial that discusses how the drug may impact the advancement of Parkinson's treatment, published in the official journal of the American Academy of Neurology B. An experimental study of 300 patients with Parkinson's disease who were randomly assigned to receive either a placebo or the drug daily for 12 months C. A meta-analysis that evaluates the effectiveness of the drug, using 25 randomized controlled trials found on MEDLINE and the Cochrane database

1. C, 2. B, 3. A

E: Evaluate Response to the Treatment/Intervention or Evaluate the Situation; 1, 2

1. Decide where there is poor or no response to treatment (or worsens). 2. Decide whether a situation is emergent.

P: Treatment Plan

1. Initiate or prescribe medications and symptomatic treatment (if applicable). 2. Educate the patient. 3. Recommend a follow-up visit to assess response to treatment and so on.

S: Look for Subjective Evidence Ex 1, 2, 3, 4

1. Interview the patient and/or family member about the history of the present illness. 2. Ask about the presentation of the illness (e.g., timing, signs and symptoms). 3. Ask whether the patient is on any medication; inquire about the past medical history, diet, and so forth. 4. Be alert for the historical findings because they provide important clues that help point to the correct diagnosis (or differential diagnosis).

O: Look for Objective Evidence 1. 2. 3. 4.

1. Perform a physical exam (general or targeted to the present complaints; examine associated systems in the differential, e.g., diabetic foot exams). 2. If applicable, perform a physical maneuver (e.g., Tinel's, Kernig's, drawer). 3. Order laboratory/other tests to "rule in" (or "rule out") the differential diagnosis. 4. If the laboratory test result is abnormal, you may be asked about the next step (such as a follow-up lab test that is more sensitive or specific).

1. Pharmacology: 2. Pharmacokinetics: Figure 1). 3. Pharmacodynamics: 4. Pharmacogenomics: The study of how a person's genes affect response to medications.

1. The study of the interaction between the body and drugs. 2. The movement of drugs through the body (absorption, bioavailability, distribution, metabolism, and excretion; 3. The study of the physiologic and biochemical effects of drugs (what a drug does to the body). 4. The study of how a person's genes affect response to medications.

A: Diagnosis or Assessment 1, 2, 3,

1. What is the most likely diagnosis based on the history, disease presentation, and physical exam findings? 2. If applicable, figure out whether the lab or other testing results point to a more specific diagnosis (or rule out a diagnosis). 3. Decide whether the condition is emergent or not (if applicable).

Magnesium (decreases 1. ____________, 2.dilates_______________):

1. decreases BP, 2. dilates blood vessels: Some nuts (almonds, peanuts, cashews), some beans, whole wheat; also found in laxatives, antacids, milk of magnesia

Idiopathic thrombocytopenic purpura (ITP), severity ranges from mild to severe (platelet count <30,000/μL). Platelets are broken down by the spleen, causing thrombocytopenia. 1. The NP should assess for? 2. what is the initial treatment

1. easy bruising, petechiae, purpura, epistaxis, and gingival bleeding (combined with low platelet count). 2. Initial treatment for ITP is glucocorticoids (i.e., prednisone) based on platelet response.

Some diseases and conditions are known by two different names that are used interchangeably in both the clinical area and the literature 1. Degenerative joint disease (DJD), or 2. Atopic dermatitis, or 3. Senile arcus, or 4. Lupus, or 5. Otitis media with effusion (OME), or

1. osteoarthritis 2. eczema 3. arcus senilis (see image) 4. systemic lupus erythematosus (SLE) 5. middle ear effusion (MEE)

The normal range is between

1.0 and 1.5 ng/ml. An abnormal rise: A PSA score may also be considered abnormal if it rises a certain amount in a single year. For example, if your score rises more than 0.35 ng/ml in a single year, your doctor may recommend further testing.

Some diseases and conditions are known by two different names that are used interchangeably in both the clinical area and the literature 11. Scarlet fever, or 12. Otitis externa, or 13. Condyloma acuminata, or 14. Tic douloureux, or 15. Tinea cruris, or

11. scarlatina 12. swimmer's ear 13. genital warts 14. trigeminal neuralgia 15. jock itch

Some diseases and conditions are known by two different names that are used interchangeably in both the clinical area and the literature 16. Thalassemia minor, or 17. Giant cell arteritis, or 18. Psoas sign, or 19Tinea capitis, or 20. Light reflex, or the Hirschberg (corneal reflex) test

16. thalassemia trait (either alpha or beta) 17. temporal arteritis 18. iliopsoas muscle sign 19. ringworm of the scalp 20. Hirschberg (corneal reflex) test

laboratory monitoring is anticoagulation therapy and the international normalized ratio (INR) values. For patients with A/FIb, the goal is to keep the INR between _____and ______. for patients with prosthetic heart valves, the INR goal is usually from ___to___

2 and 3 2.5 to 3.5.

USPSTF Screening Guidelines Cervical cancer (2018) Baseline Pap smear/cytology at age should begin at age?

21 years (do not screen younger) Screen every 3 years until age 65 years; at age 30-65 years, another option is to screen every 5 years using hrHPV testing alone or in combination with cytology (cotesting).

Some diseases and conditions are known by two different names that are used interchangeably in both the clinical area and the literature 21. Sentinel nodes, or 22. Mantoux test, or 23. Erythema migrans, or 24. Sinusitis, or 25. Major depression, or

21. Virchow's nodes 22. TB skin test 23. early Lyme disease 24. rhinosinusitis 25. unipolar depression

Some diseases and conditions are known by two different names that are used interchangeably in both the clinical area and the literature 6. Group A beta Streptococcus, or 7. Tinea corporis, or 8. Enterobiasis, or 9. Vitamin B12, or 10 Vitamin B1, or

6. S. pyogenes 7. ringworm 8. pinworms 9. cobalamin or cyanocobalamin 10. thiamine

Biphasic anaphylaxis occurs in up to 23% of cases, symptoms recur within

8-10 hours after initial episode. This is the reason why these patients are prescribed a Medrol Dose Pack and a long-acting antihistamine after being discharged from the ED.

A sentinel event is defined as

A sentinel event is defined as "a patient safety event (not primarily related to the natural course of patient's illness or underlying condition) that reaches a patient and results in any of the following: death, permanent harm, or severe temporary harm"

Maculopapular: A skin rash that has both color (macular) and texture (small papules or raised skin lesions—the color ranges from red [erythematous] to bright pink)

A skin rash that has both color (macular) and texture (small papules or raised skin lesions—the color ranges from red [erythematous] to bright pink)

the "gold standard" preferred diagnostic test for a melanoma

A biopsy

Some commonly used drugs have rare (but potentially life-threatening) adverse effects. Example: A rare but serious adverse effect of angiotensin-converting enzyme inhibitors (ACEIs) is angioedema.

A common side effect of ACEIs is a dry cough (up to 10%).

Example A 10-year-old female student complains of pain and decreased hearing in her left ear that is getting steadily worse. She has a history of allergic rhinitis and is allergic to dust mites. On physical exam, the left tympanic membrane is bulging and red with displaced landmarks. The tympanogram exam reveals a flat line. The student denies frequent ear infections, and the last antibiotic she took was 8 months ago for a urinary tract infection. She is allergic to sulfa and tells the NP that she will not take any erythromycin because it makes her very nauseated. Which of the following is the best choice of treatment for this patient? A. Amoxicillin 500 mg PO three times a day for 7 days B. Pseudoephedrine (Sudafed) 20 mg PO as needed every 4 to 6 hours C. Fluticasone (Flonase) nasal inhaler 1 to 2 sprays each nostril every 12 hours D. Clarithromycin (Biaxin) 500 mg PO two times a day for 10 days

A. Amoxicillin 500 mg PO three times a day for 7 days Best Clues Red bulging tympanic membrane with cloudy fluid inside and displaced landmarks are a clue. Last antibiotic taken was 8 months ago and ear infections were infrequent (lack of risk factors for beta-lactamase-resistant bacteria). A nasal steroid spray BID is a good adjunct treatment for this patient because of allergic rhinitis, which causes the eustachian tube to swell and become blocked.

A chest radiograph shows an area of consolidation on the lower lobe of the lung. Which of the following conditions is most likely? A. Bacterial pneumonia B. Acute bronchitis C. Chronic obstructive pulmonary disease (COPD) D. Atypical pneumonia

A. Bacterial pneumonia

A 2-day-old full-term infant presents with jaundice symptoms. Which of the following interventions should be implemented first? A. Check bilirubin level B. Schedule a follow-up visit C. Advise parent to feed infant 5 to 6 times per day D. Prescribe phototherapy

A. Check bilirubin level

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 elderly adult complains that his central vision appears to be blurred and he cannot see when driving. Which condition is most likely? A. Macular degeneration B. Central vision inflammation C. Blepharitis D. Conjunctival hemorrhage

A. Macular degeneration

A second triple screen on a 35-year-old primigravida reveals abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin. Which of the following interventions is the best choice for this patient? A. Order an ultrasound B. Order a CT scan of the abdomen C. Order a 24-hour urine for protein clearance D. Assess for a history of illicit drug or alcohol use

A. Order an ultrasound

Which of the following selective serotonin reuptake inhibitors (SSRIs) is most likely to cause erectile dysfunction? A. Paroxetine (Paxil) B. Escitalopram (Lexapro) C. Venlafaxine (Effexor) D. Amitriptyline (Elavil)

A. Paroxetine (Paxil)

Example Which of the following is most likely to be found in patients with a long-standing case of iron-deficiency anemia? A. Pica B. Fatigue C. Pallor D. Irritability

A. Pica Best Clues The diagnosis (iron-deficiency anemia) Knowledge that pica is also associated with iron-deficiency anemia Notes If you are guessing, use common sense. Fatigue and irritability are found in many conditions. Pallor is also seen in many disorders such as shock, illness, and anemia. By the process of elimination, you are left with option A, the correct choice. Another specific clinical finding in iron-deficiency anemia is spoon-shaped nails (or koilonychia). Do not confuse this finding with pitted nails (psoriasis).

Part Two Which of the following is the best treatment plan to follow? A. Refer the patient to the hospital ED. B. Refer the patient to an infectious disease specialist. C. Initiate a prescription of oral glucocorticoids. D. Collect a blood specimen for culture and sensitivity.

A. Refer the patient to the hospital ED. Knowledge of the emergent nature of RMSF (can cause death if not treated within the first 8 days of symptoms)

Example Which of the following drug classes is considered as first-line treatment for unipolar depression in the elderly? A. SSRIs B. SNRIs C. Tricyclic antidepressants (TCAs) D. MAOIs

A. SSRIs

Example Which of the following drug classes is indicated as first-line treatment of both major depression and OCD? A. SSRIs B. TCAs C. Mood stabilizers D. Benzodiazepines

A. SSRIs Rule out benzodiazepines, which are used to treat anxiety or insomnia (process of elimination). Mood stabilizers, such as lithium salts, are used to treat bipolar disorder (process of elimination). The stem is asking for the "first-line treatment" for depression, which is the SSRIs.

Example Which of the following is the second highest cause of mortality among adolescents and young adults in this country? A. Suicide B. Smoking C. Homicide D. Illicit drug use

A. Suicide Best Clues Rote memory (suicide is the second highest cause of mortality among adolescents)

Example A middle-aged male nurse is having his Mantoux test result checked. A reddened area of 10.5 mm is present. It is smooth and soft and does not appear to be indurated. During the interview, the patient denies fever, cough, and weight loss. Which of the following is a true statement? A. The Mantoux test result is negative. B. The Mantoux test result is borderline. C. The Mantoux test should be repeated in 2 weeks. D. A chest x-ray and sputum culture are indicated.

A. The Mantoux test result is negative. Best Clues Knowledge that skin induration, not the red color, is the best indicator of a positive reaction Lack of signs or symptoms of TB; The Mantoux test (TB skin test [TST]) result is negative because of the description of the soft and smooth skin (it is not indurated)

The nurse practitioner is reviewing the laboratory results of a female patient who states that she has had one menstrual period over the last year and is experiencing problems sleeping. The patient's lab results include an estradiol level of 200 pg/mL, follicle-stimulating hormone (FSH) of 35 IU/L, and an anti-müllerian hormone (AMH) level of 0.2 ng/mL. What do the findings indicate? A. The patient is perimenopausal B. The patient is menopausal C. The patient is fertile D. The patient should be tested for ovarian cancer

A. The patient is perimenopausal

A benign variant is a physiologic abnormality that does not interfere with bodily processes or functions. There are very few questions on benign variants. Some examples of the benign variants that have been seen on the exams include the geographic tongue, torus palatinus, and a split or fishtail uvula. Benign variants are listed under the appropriate organ system. II. Example A 45-year-old female patient complains of a sore throat. Upon examination, the NP notices a bony growth midline at the hard palate of the mouth. The patient denies any changes or pain. It is not red, tender, or swollen. She reports a history of the same growth for many years without any change. Which of the following conditions is most likely? A. Torus palatinus B. Geographic tongue C. Acute glossitis D. Leukoplakia

A. Torus palatinus The description of a chronic bony growth located midline in the hard palate indicates torus palatinus. Rule out glossitis, geographic tongue, and hairy leukoplakia because they are all located on the tongue and not on the hard palate (roof of the mouth).

AAABCD ( Drug Names) Examples ACE inhibitors ARBs Alpha Blockers Beta Blockers Calcium channel blockers Diuretics

ACE inhibitors = pril enalapril, lisinopril ARBs = sartan Losartan, Valsartan Alpha Blockers = Osin Doxazosin, . Terazosin Beta Blockers = Lol Metoprolol, Labetalol Calcium channel blockers = dipine Amlodipine, Nicardipine Diuretics = ide Thiazide, Hydrochlorothiazide

Discussion During life-threatening situations, managing the airway, breathing, and circulation (the ABCs) is always the top priority. If the question does not describe conditions requiring the ABCs, then the next level of priority is?

Acute or sudden change in the mental status and the level of consciousness (LOC). One of the most important clues in such problems is the acute timing of onset of symptoms or the sudden change of the LOC from the patient's "baseline."

ED treatment medications for Anaphylaxis?

Administer epinephrine IM, 100% oxygen by face mask, an antihistamine (H1 antagonist) such as diphenhydramine (Benadryl), an H2 antagonist such as ranitidine, a bronchodilator such as albuterol (short-acting beta-2 agonist), and systemic glucocorticosteroids such as prednisone.

USPSTF Screening Guidelines: Fall prevention in community-dwelling older adults

Adults aged ≥65 years, exercise interventions to prevent falls in adults at increased risk; against vitamin D supplementation.

Anomia is defined as a language specific disturbance arising after

After brain damage whose main symptom is the inability of retrieving known words.

Note: Pick Out the Most Specific Sign/Symptom

Always pick out the most specific answer to a question when it is asking about the signs and/or symptoms of a disease. Learn the unique or the most specific signs/symptoms associated with the disease

What is the is the preferred first-line antibiotic for both AOM and acute sinusitis in children (for patients with no risk factors for resistant organisms).

Amoxicillin The ideal patient is someone who has not been on any antibiotics in the past 3 months and/or does not live in an area with high rates of beta-lactam-resistant bacteria If the patient is a treatment failure or was on an antibiotic in the previous 3 months, then a second-line antibiotic, such as amoxicillin-clavulanate (Augmentin) BID or cefdinir (Omnicef) BID, should be given.

Test tip remember

Assume that all the questions on the exams contain enough information to answer them correctly. Do not read too much into a question or assume that it is missing some vital information. As far as the ANCC and AANPCB exams are concerned, all questions contain enough information to allow you to solve them correctly. Consider a patient is in good health unless a disease or other health condition is mentioned in the test question.

Migraine headaches and MAOIs (Marplan, Nardil, and Parnate)

Avoid high amounts of High-tyramine foods: Aged cheeses/meats, red wine, fava beans, draft beer, fermented foods

Example Which of the following individuals is least likely to have an alcohol abuse problem? A. A woman who gets annoyed if her best friend talks to her about her drinking habit B. A carpenter who drinks two cans of beer when playing cards with friends C. A nurse who feels shaky when she wakes up and drinks one glass of wine to feel better D. A college student who tells his friend that he drinks only on weekends but feels that he should be drinking less

B. A carpenter who drinks two cans of beer when playing cards with friends Best Clues Lack of risk factor (two cans of beer at night is considered normal consumption for males); for females, the limit is one drink per day (one 12 oz beer, 5 oz wine). There is no description of any negative effects on the carpenter's daily functioning, social environment, or mental state.

Example A 13-year-old girl complains of an irregular menstrual cycle. She started menarche 6 months ago. Her last menstrual period was 2 months ago. She denies being sexually active. Her urine pregnancy test is negative. Which of the following would you tell the child's mother? A. Consult with a pediatric endocrinologist to rule out problems with the hypothalamic-pituitary-adrenal (HPA) axis. B. Advise the mother that irregular menstrual cycles are common during the first year after menarche. C. Advise the mother that her child is starting menarche early and has precocious puberty. D. Ask the medical assistant to get labs drawn for TSH, follicle-stimulating hormone (FSH), and estradiol

B. Advise the mother that irregular menstrual cycles are common during the first year after menarche. Best Clues Patient recently started menarche 6 months ago (knowledge of pubertal changes); the ovaries may not ovulate monthly (resulting in irregular periods) when starting menarche. The teen is not sexually active (rule out pertinent negative, such as the negative pregnancy test). Notes This question describes normal growth and development in adolescents. When girls start menarche, their periods may be very irregular for several months up to 2 years.

A 40-year-old man complains to the nurse practitioner of severe stabbing pains behind his left eye for the past 2 days. They are accompanied by some nasal congestion and rhinorrhea, which is clear in color. The patient denies pharyngitis and fever. Which of the following conditions is most likely? A. Migraine headache with aura B. Cluster headache C. Tic douloureux D. Cranial neuralgia

B. Cluster headache

An elderly patient is diagnosed with herpes zoster opthalmicus. Which cranial nerve is infected with this disorder? A. Cranial nerve VII B. Cranial nerve V C. Cranial nerve III D. Cranial nerve IV

B. Cranial nerve V

An adult visits the urgent care clinic with a fever of 104.2°F, vomiting, and petechiae on the hands and feet progressing to the trunk over the past 3 days. The nurse practitioner will prescribe? A. Ceftriaxone (Rocephin) 2 g IV every 12 hours B. Doxycycline BID × 10 days C. Rifampin PO every 12 hours × 2 days D. Cephalexin (Keflex) QID × 10 days

B. Doxycycline BID × 10 days

An elderly diabetic female with peripheral neuropathy and coronary artery disease is recently diagnosed with major depression. The patient refuses psychotherapy and wants medication. She denies suicidal and homicidal ideation. Which of the following pharmacologic agents is the best choice for this patient? A. Quetiapine (Seroquel) B. Duloxetine (Cymbalta) C. Escitalopram (Lexapro) D. Amitriptyline (Elavil)

B. Duloxetine (Cymbalta)

What does a potassium hydroxide (KOH) prep help the nurse practitioner diagnose? A. Herpes zoster infections B. Fungal infections C. Herpes simplex infections D. Viral infections

B. Fungal infections

Which HPV strains are oncogenic and cause the majority of cervical cancer cases? A. HPV 6 and HPV 11 B. HPV 16 and HPV 18 C. HPV 2 and HPV 4 D. HPV 40 and HPV 51

B. HPV 16 and HPV 18

An 8-year-old child is seen as a walk-in appointment by the nurse practitioner. The mother reports that her child has been febrile for 2 days and is not eating well because of painful sores inside the mouth. The child's temperature is 101°F, pulse is 88 beats/min, and respirations are 14 breaths/min. During the physical exam, the nurse practitioner notices several small blisters and shallow ulcers on the child's pharynx and oral mucosa. The child has small, round red rashes on both palms and soles. Which of the following conditions is most likely? A. Herpes simplex infection B. Hand, foot, and mouth disease (HFMD) C. Varicella infection D. Secondary syphilis infection

B. Hand, foot, and mouth disease (HFMD)

The nurse practitioner is examining a 4-year-old child who is experiencing nausea, lethargy, fever, and loss of appetite. The child attends day care, and several other children in the facility have experienced similar symptoms. Blood tests reveal the child is positive for IgM antibodies and negative for IgG antibodies. Which diagnosis is most likely? A. Hand-foot-mouth disease B. Hepatitis A C. Kawasaki disease D. Influenza

B. Hepatitis A

A patient with Pick's disease fell out of bed and hit her head on the table. The patient is not on anticoagulant therapy and is alert and oriented upon arrival to the clinic. The patient's vital signs are blood pressure of 188/90 mmHg, pulse of 43 beats/minute, and respirations of 7 breaths/minute. Which diagnosis is most likely? A. Hypovolemic shock B. Increased intracranial pressure (ICP) C. Cerebrovascular accident (CVA) D. Subdural hematoma

B. Increased intracranial pressure (ICP)

What does a positive posterior drawer sign signify? A. Normal knee B. Instability of the knee C. Swelling on the knee D. Injury to the meniscus

B. Instability of the knee

Part One An adolescent male reports the new onset of symptoms 2 weeks after returning from a hiking trip in North Carolina. He presents with complaints of high fever, severe headache, muscle aches, lack of appetite, and nausea. The symptoms are accompanied by a generalized red rash that is not pruritic. The rash initially appeared on both ankles and wrists and then spread toward the patient's trunk. The rash involves both the palms and the soles. Which of the following conditions is most likely? A. Meningococcemia B. RMSF C. Idiopathic thrombocytopenic purpura (ITP) D. Lyme disease

B. RMSF Location and activity (south-central United States, outdoor activity) Classic rash (red rash on both wrists and ankles that spreads centrally with involvement of the palms and the soles) Systemic symptoms (high fever, headache, myalgia, nausea)

A 65-year-old woman is complaining of generalized morning stiffness, especially in both her wrist and hands. It is much worse in the morning and lasts for a few hours. She also complains of fatigue and generalized body aches that have been present for the past few months. Which of the following is most likely? A. Osteoporosis B. Rheumatoid arthritis C. Osteoarthritis D. Gout

B. Rheumatoid arthritis

Which of the following is a true statement regarding pes planus in an infant? A. It should be evaluated by a pediatric orthopedist if spontaneous correction does not occur by age 12 months B. The fat pads on an infant's feet can mimic pes planus C. It is always corrected by wearing special orthotic shoes D. It is also called talipes equinovarus

B. The fat pads on an infant's feet can mimic pes planus Flatfoot (pes planus) is common in infants and children and often resolves by adolescence. Thus, flatfoot is described as physiologic because it is usually flexible, painless, and of no functional consequence.

Normal Values BNP Elevated Potassium

BNP Elevated = (elevated in heart failure) Potassium = <3.5 or >5.5 mEq/L (critical values <2.5 or >8 mEq/L)

Potassium (helps decrease 1. _________): 2. Potassium containing foods include?

BP; Most fruits (especially apricot, banana, orange, prune juice), some vegetables

Dehydration will elevate the ________value.

BUN

Iron (treats iron-deficiency anemia): Food containing Iron?

Beef, liver, black beans, black-eyed peas

A patient has a past medical history of chickenpox (childhood), which provided what type of immunity? A. Herd immunity B. Passive immunity C. Active immunity D. No immunity

C. Active immunity

Folate (decreases homocysteine levels and fetal neural tube defects) what are some foods containing?

Breakfast cereals fortified with folate, green leafy vegetables (i.e., spinach), liver

The nurse practitioner diagnoses an adult patient with heart failure. Which of the following will be included in the treatment plan to relieve symptoms of volume overload? A. Sodium restricted to 4 g/day B. Fluids restricted to 3 L/day C. Atenolol (Tenormin) D. Furosemide (Lasix)

D. Furosemide (Lasix)

A middle-aged adult male smoker with COPD presents to the clinic complaining of several days of fever, loss of appetite, coughing, and chest pain. The cough is productive of purulent sputum. Physical examination reveals a temperature of 102.0°F (39.0°C), pulse of 88, and respiratory rate of 24. The lung exam reveals crackles on the lower right lobe and wheezing on the upper airways. Question What is the preferred treatment for the above patient's condition? A. Amoxicillin B. Doxycyline C. Amoxicillin-clavulanate (Augmentin) plus a macrolide D. Azithromycin (Z-Pak) plus a fluoroquinolone

C. Amoxicillin-clavulanate (Augmentin) plus a macrolide

The nurse practitioner is examining a middle-aged patient with complaints of numbness and tingling in her fingers. She has a history of rheumatoid arthritis and smoking. Upon examination, the nurse practitioner notices her fingertips are slightly cyanotic. The nurse practitioner will recommend all of the following, except: A. Avoid caffeine B. Avoid touching cold objects C. Avoid direct sun D. Begin a smoking cessation program

C. Avoid direct sun

A 36-year-old woman is seen by the nurse practitioner for a Pap smear and gynecologic exam. The patient is of Ashkenazi Jewish ethnicity. Her mother died of breast cancer at age 50 years. Her 57-year-old sister has recently been diagnosed with breast cancer. The breast exam is negative for a dominant mass, and the axillae do not contain any masses. All of the following are appropriate measures for this patient, except: A. Mammogram and MRI of the breast B. Referral to a breast specialist C. Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels D. Genetic counseling and BRCA testing

C. Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels

Example A 13-year-old girl with a history of mild persistent asthma and allergic rhinitis complains of a cough that has been waking her up very early in the morning. She reports that she is wheezing more than usual. She is accompanied by her mother. Her last office visit was 8 months ago. Which of the following is the best initial course of action? A. Initiate a prescription of a short-acting beta-2 agonist QID PRN and a low-dose steroid inhaler BID. B. Refer the patient to an allergist for a scratch test. C. Discuss her symptoms and other factors associated with the asthmatic exacerbation. D. Perform a thorough physical exam and obtain blood work.

C. Discuss her symptoms and other factors associated with the asthmatic exacerbation. Best Clues The patient's asthma appears to be getting worse (wheezing more than usual, early-morning cough). There is a need to find out about precipitating factors, medication compliance, comorbid conditions, and so on. Always obtain a history (subjective) before performing a physical exam and labs. The adolescent age group starts at age 13 years (ANCC).

Example Which of the following laboratory tests is a sensitive indicator of renal function in people of African descent? A. Serum blood urea nitrogen (BUN) B. Serum creatinine concentration C. Estimated glomerular filtration rate (eGFR) D. Serum BUN-to-creatinine ratio

C. Estimated glomerular filtration rate (eGFR) Knowledge that the eGFR is a better test of renal function compared with the serum creatinine concentration

II. Example An asthmatic male patient complains of a sudden onset of itching and coughing after taking two aspirin tablets for a headache in the waiting room. The patient's lips and eyelids are becoming swollen. The patient complains of feeling hot. Bright-red wheals are noted on his chest and arms and legs. Which of the following is the best initial intervention to follow? A. Call 911. B. Check the patient's BP, pulse, and temperature. C. Give an injection of aqueous epinephrine 1:1,000 (1 mg/mL) 0.5 mg IM into the vastus lateralis muscle immediately. D. Initiate a prescription of a potent topical steroid and a Medrol Dose Pack.

C. Give an injection of aqueous epinephrine 1:1,000 dilution (1 mg/mL) 0.5 mg IM into the vastus lateralis muscle immediately. Best Clues The quick onset of symptoms, such as angioedema, after taking aspirin is a clue. The classic signs and symptoms of anaphylaxis described in this case should be noted. Severe anaphylactic episodes occur almost immediately or within 1 hour after exposure.

A 18-year-old college freshman presents at the campus clinic with reports of severe night sweats, lymphadenopathy, and severe pain over gland areas after drinking alcohol. Further assessment indicates that the patient has a positive Pel-Ebstein sign. Blood work reveals several Reed-Sternberg cells. Which diagnosis is most likely? A. Leukemia B. Acute lymphocytic leukemia (ALL) C. Hodgkin's lymphoma D. Acute myelogenous leukemia (AML)

C. Hodgkin's lymphoma

A middle-aged female patient is seen by the nurse practitioner for a hypertension management follow-up. The patient has been taking chlorthalidone (Hygroton) 12.5 mg daily for 30 days and has a history of smoking, emphysema, and breast cancer. The patient's current blood pressure is 168/92 mmHg. What adjustment will the nurse practitioner make to the treatment plan? A. Add propranolol (Inderal) B. Decrease chlorthalidone (Hygroton) C. Increase chlorthalidone (Hygroton) D. Add captopril (Capoten)

C. Increase chlorthalidone (Hygroton)

The nurse practitioner is performing a vision screening on a newborn. Which finding would prompt a referral to a pediatric ophthalmologist? A. Inability to produce tears B. Fixation on mother's face C. One eye turned inward D. Bluish-gray eyes

C. One eye turned inward

Upon examination of a 26-year-old patient, the nurse practitioner finds elongated papilla of the lateral aspects on the patient's tongue. How will the nurse practitioner document this finding? A. Koplik's spots B. Geographic tongue C. Oral hairy leukoplakia D. Cheilosis

C. Oral hairy leukoplakia

A 15-year-old basketball player who is 6 ft (1.83 m) tall is seen for complaints of painful lumps on his knees. Upon inspection, the nurse practitioner notes a bonelike growth on the upper tibia midline below the kneecap on both knees. The patient has full range of motion with no joint tenderness, redness, or swelling. Which of the following conditions is best described? A. Osteosarcoma of the tibia B. Juvenile rheumatoid arthritis C. Osgood-Schlatter disease D. Paget's disease of the bone

C. Osgood-Schlatter disease

A mother brings her 4-year-old daughter, who just started attending preschool, to the health clinic. She tells the nurse practitioner that her child is complaining of burning and itching that started in the left eye. Within 2 days it involved both eyes, and the child developed a runny nose and sore throat. During the physical exam, the child's eyes appear injected bilaterally with no purulent discharge. The throat is red, the inferior nasal turbinates are swollen, and lymph nodes are palpable in front of each ear. Which diagnosis is most likely? A. Herpes keratitis B. Corneal ulcer C. Viral conjunctivitis D. Bacterial conjunctivitis

C. Viral conjunctivitis

Which diagnostic test is used to confirm a diagnosis of vaginal candida infection? A. pH B. Whiff test C. Wet mount D. Tzanck smear

C. Wet mount

An elderly patient with a history of severe mitral regurgitation has surgery for placement of a prosthetic mitral valve. Which of the following is the correct INR value? A.INR 1.5 to 2.5 B.INR 2.0 to 3.0 C.INR 2.5 to 3.5 D.INR 3.0 to 4.0

C.INR 2.5 to 3.5

Where is Kiesselbach's plexus located? A.The posterior area of the pharynx B.The superior lateral area of the maxillary sinus C.The anterior inferior area of the nasal septum D.The submandibular area of the mouth

C.The anterior inferior area of the nasal septum

All of the following drug classes are approved for treating hypertension. Which of the following antihypertensive drug classes is associated with the largest number of research studies? A.Angiotensin-converting enzyme (ACE) inhibitors B.Angiotensin-receptor blockers (ARBs) C.Thiazide diuretics D.Calcium channel blockers (CCBs)

C.Thiazide diuretics

CAGE Screening Tool (Two or More Positive Answers Is Suggestive of Alcoholism) C: Do you feel the need to cut down? A: Are you annoyed when your friends/spouse comment about your drinking? G: Do you feel guilty about your drinking? E: Do you need to drink early in the morning (eye-opener)?

C: Do you feel the need to Cut down? A: Are you Annoyed when your friends/spouse comment about your drinking? G: Do you feel Guilty about your drinking? E: Do you need to drink Early in the morning (eye-opener)?

Calcium helps with 1.________osteopenia and 2.______________osteoporosis, and helps decrease 3._________BP): 4. foods containing Ca

Calcium helps with 1. osteopenia and 2. osteoporosis, helps decrease 3. BP: 4. Low-fat dairy, low-fat milk, low-fat yogurt, cheeses

Example of Quinolones:

Ciprofloxacin (Cipro), ofloxacin (Floxin)

Normal values are as follows: PH SG Glucose Ketones Nitrites Leukocyte esterase

Color - Yellow (light/pale to dark/deep amber) Clarity/turbidity - Clear or cloudy. pH - 4.5-8. Specific gravity - 1.005-1.025. Glucose - ≤130 mg/d. Ketones - None. Nitrites - Negative. Leukocyte esterase - Negative.

Gluten (avoid with celiac disease/celiac sprue): Wheat (including spelt and kamut), rye, barley (breads, cereals, pasta, cookies, cakes) Gluten free (safe carbohydrates):

Corn, rice, potatoes, quinoa, tapioca, soybeans

USPSTF Screening Guidelines: Skin cancer (2016) Current evidence insufficient to assess benefits/harms of visual skin exam. Educate fair-skinned persons to avoid sunlight (10 a.m.-3 p.m.) and use sunblock ≥SPF 15.

Current evidence insufficient to assess benefits/harms of visual skin exam. Educate fair-skinned persons to avoid sunlight (10 a.m.-3 p.m.) and use sunblock ≥SPF 15.

Example A 67-year-old man walks into an urgent care center. The patient complains of episodes of chest pain in his upper sternum when he is climbing up stairs in his apartment building. When he stops the activity, the pain goes away. He reports that once when he was eating a steak dinner, he also experienced the chest pain. A fasting total lipid profile is ordered. The result reveals total cholesterol of 250 mg/dL, LDL of 180 mg/dL, and HDL of 25 mg/dL. Which of the following is most likely? A. Acute esophagitis B. MI C. GERD D. Angina

D. Angina Best Clues Classic presentation (chest pain that is precipitated by exertion and is relieved by rest) History (several episodes of the same chest pain) Positive risk factors (low HDL, elevated lipid levels, age, and gender) Pain is relieved by rest (angina). If pain is not relieved by rest, consider unstable angina. Other signs include angina that occurs at rest, unpredictable episodes, increased frequency episodes, or no response to medications (e.g., nitroglycerin) that previously worked.

Example A 16-year-old teenager with a history of ADHD is brought in to the ED by his mother. She does not want her son to be alone in the room. The NP doing the intake notes several burns on the teen's trunk. Some of the burns appear infected. The NP documents the burns as mostly round in shape and about 0.5 cm (centimeter) in size. Which of the following questions is most appropriate to ask the child's mother? A. Your son's back looks terrible. What happened to him?" B. Does your son have more friends outside of school?" C. Did you burn his back with a cigarette?" D. Can you please tell me what happened to your son?"

D. Can you please tell me what happened to your son?" Best Clues Option D is the only open-ended question in the group. In addition, it is not a judgmental statement.

A 14-year-old boy is brought in by his mother who reports that her son has been complaining for several months of recurrent bloating, stomach upset, and occasional loose stools. She reports that he has difficulty gaining weight and is short for his age. She has noticed that his symptoms are worse after eating large amounts of crackers, cookies, and breads. She denies seeing blood in the boy's stool. Which of the following conditions is most likely? A. Amebiasis B. Malabsorption C. Crohn's colitis D. Celiac disease

D. Celiac disease

The nurse practitioner sees a patient for a skin assessment and finds a small number of rough, scaly patches on the patient's face, lips, ears, and neck. What is the most appropriate treatment for this condition? A. Cryopexy B. Radiation C. 5-fluorouracil cream D. Cryotherapy

D. Cryotherapy

A 70-year-old patient presents to the urgent care clinic with complaints of a "blinding headache." Vital signs reveal a blood pressure of 200/110 mmHg. The patient notes a 10-year history of taking atenolol (Tenormin) and occasional use of fluticasone (Flovent) over the past 3 years. Which of the following questions should the nurse practitioner ask the patient? A. Do you have a family history of hypertension? B. Do you have a family history of hypercholesterolemia? C. Are you currently using Flovent? D. Do you have a history of migraine headaches?

D. Do you have a history of migraine headaches?

All of the following clinical signs are seen in patients with Parkinson's disease, except: A. Pill-rolling tremor B. Difficulty initiating voluntary movement C. Shuffling gait with cogwheel rigidity D. Increased facial movements due to tics

D. Increased facial movements due to tics

Which of the following is the best location to auscultate for the S3 heart sound? A. Aortic area B. Pulmonic area C. Tricuspid area D. Mitral area

D. Mitral area Memorization of the S3 heart sound facts Notes The mitral area, sometimes called the cardiac apex, is the optimal location to hear the S3. This area is located at the left fifth intervertebral space, along the midclavicular line. The left lateral recumbent position brings the apex closer to the wall and improves the practitioner's ability to hear the left ventricular S3.

All of the following are considered sentinel events, except: A. Unanticipated death of a full-term infant B. Abduction of any patient who is receiving treatment or services C. Suicide of a patient who is receiving around-the-clock care D. Nausea and vomiting caused by a prescription of oral erythromycin

D. Nausea and vomiting caused by a prescription of oral erythromycin. If you are not sure of the answer, one way to guess is to look for a pattern or for contextual clues. Notice that options A, B, and C all have something in common; they are all serious patient safety events.

Which of the following conditions is associated with a positive Auspitz sign? A. Contact dermatitis B. Seborrheic dermatitis C. Systemic lupus erythematosus D. Psoriasis

D. Psoriasis

A 35-year-old patient is being worked up for microscopic hematuria. All of the following are differential diagnoses of microscopic hematuria, except: A. Kidney stones B. Bladder cancer C. Acute pyelonephritis D. Renal artery stenosis

D. Renal artery stenosis

Example A male nursing assistant who works in a nursing home is complaining of multiple pruritic rashes that have been disturbing his sleep at night for the past few weeks. He reports that several of the residents are starting to complain of pruritic rashes. On physical exam, the NP notices multiple small papules, some vesicles, and maculopapular excoriated rashes on the sides and the webs of the fingers, on the waist, and on the penis. Which of the following is the most likely diagnosis? A. Scarlatina B. Impetigo C. Erythema migrans D. Scabies

D. Scabies Best Clues History (pruritic rashes disturb sleep at night, and individual works in a higher risk area [nursing home]) Classic location of the rashes (finger webs, waist, penis) Notes Assume that a patient has scabies if excoriated pruritic rashes are located in the finger webs and the penis until proven otherwise. Higher risk groups are healthcare providers or people who work with large populations such as those in schools, nursing homes, group homes, or prisons

Example An older woman complains of a new onset of severe pain in her right ear after taking swimming classes for 2 weeks. On physical exam, the right ear canal is red and swollen. Purulent green exudate is seen inside. Which of the following is an incorrect statement? A. Pulling on the tragus is painful B. The tympanic membrane is translucent with intact landmarks C. The external ear canal is swollen and painful D. Tenderness of the mastoid area during palpation

D. Tenderness of the mastoid area during palpation Best Clues Positive risk factor (history of swimming) Classic signs (reddened and swollen ear canal with green exudate)

Example A 16-year-old boy presents to a community clinic accompanied by his grandmother, who reports that he fell off his bike this morning. The patient now complains of a headache with mild nausea. The patient's grandmother reports that he was not wearing a helmet. The health history is uneventful. Which of the following statements is indicative of an emergent condition? A. The patient complains of multiple painful abrasions that are bleeding on his arms and legs. B. The patient complains of a headache that is relieved by acetaminophen (Tylenol). C. The patient makes eye contact occasionally and answers with brief statements. D. The patient is having difficulty with following normal conversation and answering questions.

D. The patient is having difficulty with following normal conversation and answering questions. History of recent trauma that is followed by a headache with nausea. The patient did not wear a bicycle helmet. Even though the patient is bleeding, note that he has "abrasions," which are superficial. The behavior described in option C is considered "normal" for an adolescent male (or female).

The abnormal eye findings in diabetes (diabetic retinopathy) and hypertension (hypertensive retinopathy) should be memorized. Learn to distinguish each one. Diabetic retinopathy: Hypertensive retinopathy:

Diabetic retinopathy: neovascularization, cotton wool spots, and microaneurysms. Hypertensive retinopathy: atrioventricular (AV) nicking, silver and/or copper wire arterioles. Another nickel silver or copper

Diastolic murmurs: Early Diastolic Another Regular Player Record At the FInish Mid/late Diastolic murmur: Mi Stepsister Tride Stepdancing Other = Public Display of Attention

Diastolic murmurs: Early Diastolic Aortic regurgitation Pulmonic Regurgitation Austin Flint Mid/late Diastolic murmur: Mitral Stenosis Tricuspid Stenosis Other: PDA (Patent Ductus Arteriosus)

The risk factors for asthma fatality include a history of ?

ED visits, frequent use of short-acting beta-agonist use (i.e., albuterol), nocturnal awakenings, increased dyspnea and wheezing, respiratory viral infection, and so on.

Normal Values ESR; sed rate Men_____ mm/hr Women _____mm/hr Elevated may indicate? CRP Elevated? cTnT Elevated in?

ESR = Men 0-22 mm/hr Women 0-29 mm/hr Elevated (giant cell arteritis, rheumatoid arthritis [RA], lupus, inflammation) CRP Elevated (inflammation, autoimmune diseases, a risk factor for heart disease) cTnT Elevated in myocardial infarction, heart damage, heart failure Sensitive test for myocardial cell damage (myocardial infarction, unstable angina)

Tay-Sachs, a rare and fatal genetic disorder, is most common among individuals of what Ethnic background?

Eastern European (Ashkenazi) Jews. A warning about ethnic background: It can also be used as a distractor. In most medical conditions, the patient's ethnic background does not affect the treatment plan or the patient's response to treatment.

Example of Macrolide

Erythromycin, azithromycin (Z-Pack), or clarithromycin (Biaxin)

Expect to see at least one or two questions regarding Tanner stages in girls and boys. Because Tanner stage I is prepuberty and Tanner stage V is the adult pattern for both boys and girls, the only stages to memorize for the exams are Tanner stage II to Tanner stage IV. For girls, memorize the pattern of breast development, and for boys, the genital development (testes and penis). It is not as important to memorize pubic hair development for both.

For girls, memorize the pattern of breast development, and for boys, the genital development (testes and penis). It is not as important to memorize pubic hair development for both.

Category B drugs are allowed for pregnant or lactating women. Example:

For pain relief, pick acetaminophen (Tylenol) instead of NSAIDs such as ibuprofen (Advil) or naproxen (Aleve, Anaprox). Avoid nitrofurantoin and sulfa drugs during the third trimester (these increase risk of hyperbilirubinemia).

example of Cephalosporins

First-generation (Keflex), second-generation (Cefaclor, Ceftin, Cefzil), third-generation (Rocephin, Suprax, Omnicef)

Notes Treatment of anaphylaxis (in primary care): If only one clinician is present: Give an injection of

Give an injection of epinephrine 1:1,000 dilution 0.3 to 0.5 mg intramuscularly stat, and then call 911. May repeat dose within 5 minutes in case of poor response.

A rating of Grade D means?

Grade D means that the harm outweighs the benefits (or there is no benefit) to the service and the use of the service is discouraged.

Vitamin K (should control intake if on anticoagulants): Foods ?

Green leafy vegetables (kale, collard greens, spinach), broccoli, cabbage

Your HDL ("good" cholesterol) is the one number you want to be high ideally above ____. Your LDL ("bad" cholesterol) should be below _____. Your total should be below 200. Normal fasting blood triglyceride levels are: for adults is ________. and ________ for children ages 10 to 19

HDL > 60 LDL < 100 Total Cholesterol should be < 200 Triglycerides <150 mg/dL for adults. Lower than 90 mg/dL for children ages 10 to 19

Normal Values Hemoglobin Males Females Hematocrit Males Females

Hemoglobin Males = 13.0-17.5 g/dL Females = 12.0-16 g/dL Hematocrit Males = 40%-50% Females = 36%-45%

Pel-Ebstein fever is a rare condition reported in patients with _______________

Hodgkin's lymphoma, characterized by cyclic fevers that rise and fall every one or two weeks.

Anaphylaxis is classified as a type

I IgE-dependent reaction.

Example of Nonsteroidal anti-inflammatory drug (NSAID):

Ibuprofen, naproxen (Aleve, Anaprox) COX-2 inhibitor: Celecoxib (Celebrex)

Isoniazid preventive therapy is used to treat

Isoniazid is used to treat tuberculosis (TB) or prevent its return (reactivation). It may be given alone, or in combination with other medicines, to treat TB or to prevent its return (reactivation)

Pulmonary fibrosis is a lung disease where lung tissue becomes scarred (fibrosis). It is diagnosed and managed by

It is diagnosed and managed by pulmonologist.

Early Lyme disease (erythema migrans rash stage):

Ixodes (deer) tick bite; spirochete called Borrelia burgdorferi (Lyme disease) Treat with doxycycline × 21 days. Majority of the cases are in the mid-Atlantic and New England states (i.e., Connecticut, Massachusetts, New York, New Jersey, Pennsylvania).

Saturated fats or trans fats ↑↑↑ (increase risk of heart disease):

Lard, beef fat (fatty steak), deep-fried fast foods

Celiac disease

Lifetime avoidance of gluten-containing cereals such as wheat, rye, and barley is necessary. May eat: Gluten free: Rice, corn, potatoes, peanuts, soybeans, meat, dairy, all fruits/vegetables; most people with celiac disease can eat oats.

A new patient who is a 40-year-old female postal worker is being evaluated for complaints of a new-onset erythematous rash on both cheeks and the bridge of the nose, accompanied by fatigue. She reports a history of Hashimoto's thyroiditis and is currently being treated with levothyroxine (Synthroid) 1.25 mg daily. Which of the following conditions is most likely? A. Atopic dermatitis B. Thyroid disease C. Lupus erythematosus D. Rosacea

Lupus erythematosus Classic symptoms of lupus erythematosus are butterfly rash across both cheeks and the bridge of the nose and fatigue. Risk factors include being female and 40 years old. Rosacea also has a similar rash but usually not associated with fatigue.

Normal Values MCV RDW> Platelet count

MCV = 80-100 fL RDW = >14.5% Platelet count = <150,000/mm3 (increased risk of bleeding, disseminated intravascular coagulation)

MR. ASS. is the mnemonic for a systolic murmur. It stands for MS. ARD is the mnemonic for

MR> ASS. Mitral Regurgitation/Aortic Stenosis = Systolic. MS. ARD (mitral stenosis/aortic regurgitation = diastolic) is the mnemonic for a diastolic murmur.

According to the IDSA and the ATS treatment guidelines, outpatient treatment of CAP in healthy patients (no comorbidities) involves the which ATB

Macrolides (azithromycin, clarithromycin, or erythromycin).

Ethnic background may give a clue for some diseases. Example: Alpha thalassemia is more common among Southeast Asians (such as Filipinos). Beta thalassemia is more common in

Mediterranean people

SSRIs are also first-line treatment for ?

OCD, generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (extreme shyness), PTSD, and premenstrual mood disorder (fl uoxetine or Prozac). Examples of SSRIs are citalopram (Celexa), escitalopram (Lexapro), fl uoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

Normal Values Neutrophils Band forms Eosinophils>3% (↑ allergies, parasitic diseases, cancer)

Neutrophils = (or segs)55%-70% (↑ bacterial infections) Band forms = (immature WBCs)>5% (↑ severe bacterial infections)Also called "shift to the left" Eosinophils = >3% (↑ allergies, parasitic diseases, cancer)

What is a tonometry normal range?

Normal eye pressure ranges from 10-21 mm Hg (millimeters of mercury.

You will need to be familiar with the drug's indications and the duration of treatment. Become familiar with a "first-line drug" and the alternative drug (if applicable). For example, the first-line (or preferred) drug for treating "strep" throat is?

Penicillin V PO × 10 days. If the patient has a penicillin allergy, macrolides and clindamycin can be used instead.

The most common bacterial pathogen in Acute otitis externa (Swimmers ear) is?

Pseudomonas (bright-green pus).

These women are considered low risk. The U.S. Preventive Services Task Force (USPSTF) recommends that women aged 21 to 29 years be screened every 3 years with cervical cytology alone, and that women aged 30 to 65 years be screened every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology.

REVIEW

Cutaneous larva migrans (creeping eruption) rashes are shaped like

Red raised wavy lines (serpiginous or snake-like) that are alone or a few may be grouped. They are red and very pruritic, and they become excoriated from scratching (appears maculopapular). Zoonotic hookworm infections usually result in a skin condition called cutaneous larva migrans, or CLM. When people walk or sit on beach sand or soil where infected dogs or cats have defecated, the dog or cat hookworm larva can penetrate the skin of the foot or body and migrate in the top layers of the skin.

Righ sided heart failure

Rest of the body/peripheral Fatigue, ↑Venous Pressure, Ascites, Enlarged liver and spleen (Hepatosplenomegaly) Distended Jugular vein, Anorexia, GI distress, Weight gain, dependent Edema

Normal Values Reticulocytes =

Reticulocytes = 0.5%-1.5% of red cells (↑ acute bleeding), starting treatment for vitamin deficiencies (iron, B12, folate), acute hemolytic episodes

The drugs that are included in the examinations are usually the "older" drugs that have been in use for several years to several decades (e.g., azithromycin, doxycycline, omeprazole, prednisone, amoxicillin).

Review the class and uses

Kawasaki syndrome, the nurse practitioner monitors for the serious complication of: Aortic dissection Still's murmur Infective endocarditis Heart failure

Solution: A Aortic dissection. Kawasaki syndrome results in systemic vasculitis that can cause widening of the coronary arteries and aorta, resulting in possible aneurysms and dissection. Seventy-five percent (75%) of all cases occur in children aged 5 years or younger. Still's murmur is a benign murmur that would not develop as a result of the vascular inflammation. Because Kawasaki syndrome is inflammatory in nature, infective endocarditis would not be a primary concern. Heart failure can be a long-term complication of an acquired cardiac condition but would not be a direct complication of Kawasaki syndrome: Aortic dissection. K a uses w idening of a rteries & a orta due to vasculitis can lead to aaa.

Visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central distance vision C. Narrow-angle glaucoma D. Accommodation

Solution: A Peripheral vision The visual fields by confrontation test is used to evaluate peripheral vision. The Snellen chart is used to measure central distance vision. A tonometer is used to assess for glaucoma. The ophthalmoscope is used to assess for cataracts.

. A 4-year-old presents with a fever of 103.4°F and earache. Upon learning the child has a history of Kawasaki syndrome, the nurse practitioner monitors for the serious complication of: Aortic dissection Still's murmur Infective endocarditis Heart failure

Solution Solution: A Aortic dissection. Kawasaki syndrome results in systemic vasculitis that can cause widening of the coronary arteries and aorta, resulting in possible aneurysms and dissection K auses w idening of of arteries & aorta due to vasculitis can lead to aaa

A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) related to 45-pack-year smoking history presents with lower back ache, frequency of urination, and "sometimes pink-tinged" urine. The urine dipstick test is heme positive. The nurse practitioner will order: A. Microscopic urinalysis (UA) B. Urine culture and sensitivity (C&S) C. Urine for cytology D. A 24-hour urine collection for protein

Solution Solution: C Urine for cytology The patient presents with common risk factors for urothelial or renal malignancy: age, tobacco use, and gross hematuria. Testing of urine for cytology should be ordered. A urine C&S would be ordered if infection were suspected. A microscopic UA would be the next step if the other symptoms were not evident. A 24-hour urine for protein would be ordered to detect conditions or diseases that cause renal inflammation.

A 55-year-old female patient presents with symptoms of a urinary tract infection. A clean catch midstream urine specimen is obtained and sent to the laboratory for culture and sensitivity testing. Which of the following results is indicative of an uncomplicated urinary tract infection? A. 105 CFU/mL of one organism B. 105 CFU/mL of one or more organisms C. 103 CFU/mL of Enterobacteriaceae D. 103 CFU/mL of gram-negative Enterobacteriaceae

Solution: A 105 CFU/mL of one organism A urinary tract infection (UTI) is diagnosed with a urine culture and sensitivity result of 105 CFU/mL of one organism and accompanied by symptoms such as dysuria, urgency, frequency, nocturia, and suprapubic discomfort. Do not let the word uncomplicated distract you; the numbers are the same with complicated and uncomplicated UTIs.

What is the most common type of cancer in young children? A. Acute lymphoblastic leukemia B. Multiple myeloma C. Aplastic anemia D. Non-Hodgkin's lymphoma

Solution: A Acute lymphoblastic leukemia Acute lymphoblastic leukemia, a malignancy of the bone marrow, is the most common type of cancer in children. t is more common in boys and in children between the ages of 2 and 4 years. Aplastic anemia is bone marrow suppression (not cancer) usually caused by medications or a viral infection (A virus or infection turns bone marrow into plastic). Multiple myeloma and non-Hodgkin's lymphoma are more common in older adults.

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

Solution: A Budesonide with formoterol The patient has moved from step 2 to step 3 on the asthma classification scale; therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been discontinued in the United States. SABA then ICS and LABA= budesonide with formoterol If SABA doesnt work then ICS and LABA the two buds form a great team for Stage 3 Asthma defense ********

A sexually active 16-year-old with cervicitis is tested for gonorrhea and chlamydia. The NAAT test result shows that the patient is positive for gonorrhea. Which of the following is appropriate treatment for this patient? A. Cephalosporin B. Cephalosporin and macrolide C. Tetracycline D. Tetracycline and sulfonamide

Solution: A Cephalosporin As of December 2020, the CDC recommends that patients with gonorrhea-positive testing be treated with a higher dose of cephalosporin than previously recommended. Additionally, the recommendation for cotreatment of chlamydia with positive gonorrhea has been removed, provided chlamydia status is confirmed negative. The first-line treatment for gonorrhea-positive culture is ceftriaxone 500 mg IM for patients who weigh ≤150 kg and 1 gram IM for patients who weigh ≥150 kg. If the patient has a cephalosporin allergy, the recommended alternative is 240 mg IM plus azithromycin 2 g PO. Screening for gonorrhea again in 3 months is recommended due to the high rates of reinfection.

Which chronic illness disproportionately affects the Hispanic population? A. Diabetes mellitus B. Hypertension C. Alcohol abuse D. Skin cancer

Solution: A Diabetes mellitus. The risk of diabetes mellitus is two to three times higher in Mexican Americans than in non-Hispanic Americans.

Which lab results suggest a diagnosis of hypothyroidism? A. Elevated thyroid-stimulating hormone (TSH), low free T4 B. Elevated TSH, normal free T4 C. High free T4 D. Normal free T4

Solution: A Elevated thyroid-stimulating hormone (TSH), low free T4 In hypothyroidism, TSH is >5.0 mU/L, free T4 is low, and T3 is low. In subclinical hypothyroidism, TSH is >5.0 mU/L, free T4 is normal, and T3 is normal. In hyperthyroidism, TSH is <0.5 mU/L, and free T4 and T3 are high. Subclinical hyperthyroidism presents with a TSH <0.5 mU/L and normal free T4 and T3.

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

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

A child diagnosed with eczema was treated with over-the-counter 1% hydrocortisone ointment. During a follow-up visit, the mother reports that the rash does not seem to be improving. What level steroid should the nurse practitioner prescribe next? A. Group 6 B. Group 5 C. Group 4 D. Group 3

Solution: A Group 6 The patient is currently using a potency Group 7 (over-the-counter topical hydrocortisone, 0.5%-1.0%) for eczema. The nurse practitioner should prescribe the next level of topical steroids, a Group 6, such as desonide cream or lotion (0.05%) and then reevaluate for effectiveness. The topical steroid strengths range from 7 (least potent) to 1 (very potent). For example, a Group 5 is fl uticasone propionate cream (0.05%), a Group 4 is triamcinolone acetonide cream (0.1%), and a Group 3 is amcinonide (0.1%). Children should not be prescribed topical steroids for more than 2 weeks.

A 44-year-old woman who is undergoing treatment for infertility complains of not having had a menstrual period for a few months. The night before, she started spotting and is now having cramp-like pains in her pelvic area. Her blood pressure (BP) is 160/80 mmHg, pulse is 110 beats/min, and she is afebrile. Her labs reveal mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely? A. Inevitable abortion B. Threatened abortion C. Incomplete abortion D. Acute pelvic inflammatory disease

Solution: A Inevitable abortion Inevitable abortion is defined as vaginal bleeding with pain, cervical dilation, and/or cervical effacement. Threatened abortion is defined as vaginal bleeding with absent or minimal pain and a closed, long, and thick cervix. Incomplete abortion involves moderate to diffuse vaginal bleeding, with the passage of tissue and painful uterine cramping or contractions. Acute pelvic inflammatory disease is a sudden onset of inflammation and pain that affects the pelvic area, cervix, uterus, and ovaries, and is caused by infection.

Which type of hypertension is caused by loss of recoil in the arteries resulting in an increased peripheral vascular resistance (PVR)? A. Isolated systolic hypertension in the elderly. B. Hypertensive emergency in a pediatric patient C. Orthostatic hypertension in a newborn child D. "White Coat" hypertension in a school-aged child

Solution: A Isolated systolic hypertension in the elderly. Isolated systolic hypertension is caused by loss of recoil in the arteries of elderly patients

In the United States, the most common cause of cancer deaths in men is: A. Lung cancer B. Prostate cancer C. Colon cancer D. Skin cancer

Solution: A Lung cancer is the most common cause of cancer deaths in men. Prostate cancer and colon cancer are the second and third causes of cancer death in men.

The nurse practitioner is reviewing the chart of an 8-month-old infant scheduled to receive immunizations. Which vaccination would the nurse practitioner question if noted in the infant's chart? Measles, mumps, and rubella (MMR) vaccine, 0.5 mL subcutaneous Hepatitis B (Hep B) vaccine, 0.5 mL intramuscular Haemophilus influenzae type B (Hib) vaccine, 0.5 mL intramuscular Rotavirus (PRV, RV5) vaccine, 1 mL oral Solution

Solution: A Measles, mumps, and rubella (MMR) vaccine, 0.5 mL subcutaneous. The nurse practitioner would question the MMR vaccine because it is not given until 12 months of age. Hepatitis B (Hep B), Haemophilus influenzae type B (Hib), and rotavirus (PRV, RV5) vaccines are given at 6 months of age.

A 10-year-old girl who plays on an intramural soccer team has a history of exercise-induced asthma. She wants to know when she should use her albuterol inhaler. The nurse practitioner advises the patient to: A. Premedicate 10 to 15 minutes before starting exercise B. Wait until she starts to exercise before using the inhaler C. Premedicate 30 minutes before starting exercise D. Wait until she finishes her exercise before using the inhaler

Solution: A Premedicate 10 to 15 minutes before starting exercise Exercise-induced asthma is best controlled by using the Proventil inhaler (bronchodilator) approximately 10 to 15 minutes before exercise to prevent vasospasm of the bronchioles and shortness of breath with exercise. The effects of these bronchodilators usually last approximately 4 hours. They also work quickly to open up the bronchioles if an acute attack/shortness of breath occurs.

A charitable foundation plans to build a community youth center in a large urban area with a history of gang violence. What type of health prevention activity is being done in this area? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Quaternary prevention

Solution: A Primary prevention A community youth center with good staffing can be an effective method of drawing youth out of the streets into a safer environment. It can reduce the risk of youth becoming victims of gang violence. In addition, staff members can serve as role models or mentors for adolescents.

An elderly patient with chronic obstructive pulmonary disease (COPD) is diagnosed with an essential tremor of the left hand. Which medication is contraindicated? A. Propranolol (Inderal) B. Primidone (Mysoline) C. Nimodipine (Nymalize) D. Gabapentin (Neurontin)

Solution: A Propranolol (Inderal) Because this patient has COPD, beta-blockers such as propranolol (Inderal) are contraindicated. Primidone (Mysoline) is an antiepileptic medication that is effective for the management of an essential tremor. Nimodipine (Nymalize; third-line treatment) is a calcium channel blocker that has been successful in managing limb tremors associated with essential tremors. Gabapentin (Neurontin) is a safe alternative to essential tremors, especially in the elderly. It is an anticonvulsant that is also prescribed for neuropathic pain.

An elderly male visits the nurse practitioner in November for an annual physical exam and laboratory tests. The CBC results are hemoglobin of 12 g/dL, hematocrit of 36%, and MCV of 76 fL. The patient has a history of benign prostatic hyperplasia (BPH), hypertension, and hyperlipidemia. Which of the following laboratory tests is the next step in this patient's evaluation? A. TIBC, ferritin level, iron B. Homocysteine, folate level C. Vitamin B12 level, folate level D. Hemoglobin electrophoresis

Solution: A TIBC, ferritin level, iron A male with a hemoglobin of 12 g/dL and hematocrit of 36% has anemia. The MCV of 76 fL means that he has microcytic anemia. The most common type of microcytic anemia is iron-deficiency anemia, which is evaluated by checking the TIBC, ferritin level, and iron. The source of the blood loss should be investigated, since IDA is a symptom of blood loss.

A 30-year-old woman complains of having had no period for the past 12 weeks. She is sexually active, and her partner has been using condoms inconsistently. The urine pregnancy test result is positive. Which of the following is a true statement regarding this pregnancy? A. The fundus of the uterus should be at the level of the symphysis pubis B. The cervix should be dilated about 0.5 inches at this time of gestation C. "Quickening" starts during this period D. Hegar's sign is present during this period of pregnancy

Solution: A The fundus of the uterus should be at the level of the symphysis pubis At 12 weeks' gestation, the fundus of the uterus should be located approximately at the symphysis pubis.

Nurse practitioners and clinical nurse specialists derive their legal right to practice from: A. The nurse practice act in the state where they practice B. The laws of the state where they practice C. The Medicare statute D. The board of nursing in the state where they practice

Solution: A The nurse practice act in the state where they practice The nurse practice act is a statute enacted by the legislature of each state. The act delineates the legal scope of the practice of nursing within the geographic boundaries of the jurisdiction. The purpose of the act is to protect the public. The SBON is the agency that enforces the nurse practice act. The Medicare statute provides the funds for paying for health services at the age of 65 years and older.

A suspected diagnosis of aorTic valve sTEnosis would be confirmed by: Transthoracic echocardiogram (TTE) Electrocardiogram (ECG) Chest radiographs Cardiac catheterization Solution Solution: A Transthoracic echocardiogram (TTE).

Solution: A Transthoracic echocardiogram (TTE).

What is the most common sign or symptom of allergic rhinitis? A. Transverse nasal crease B. Yellow nasal discharge C. Under-eye circles D. Inability to sleep through the night

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

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

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

Which of the following is a cause of primary amenorrhea? A. Turner syndrome B. Hypothyroidism C. Menopause D. Obesity

Solution: A Turner syndrome Turner syndrome is a cause of primary amenorrhea. Menopause, hypothyroidism, and obesity (or extreme weight loss) can cause secondary amenorrhea, which is defined as the cessation of regular menses for 3 months or cessation of irregular menses for 6 months.

Which of the following statements is true regarding a threatened abortion? A. Vaginal bleeding and cramping are present, but the cervix remains closed B. Vaginal bleeding and cramping are present along with a dilated cervix C. The fetus and placenta are both expelled D. The products of conception and the placenta remain inside the uterus along with a dilated cervix

Solution: A Vaginal bleeding and cramping are present, but the cervix remains closed Threatened abortion is defined as vaginal bleeding and cramping without the presence of cervical dilation.

The nurse practitioner discovers that a patient received an inappropriate medication due to a lab error. The nurse practitioner immediately informs the patient of the error. Which ethical principle is reflected in the nurse practitioner's behavior? Veracity Autonomy Confidentiality Fidelity Solution

Solution: A Veracity By presenting the information honestly and truthfully, the nurse practitioner is following the ethical principle of veracity. Autonomy is the obligation to ensure that patients have the right to make their own healthcare choices. Confidentiality is the obligation of the nurse practitioner to protect all medical and personal information of the patient. Fidelity is the process of following through with promises and maintaining trust within relationships.

A patient presents with angina, blood pressure of 196/102 mmHg, pulse of 154 beats/minutes, dilated pupils, midline nasal septum perforation, and confusion. What will the nurse include in the initial treatment plan for this patient? Select all that apply. Perform an EKG Administer a beta-blocker Draw troponin levels Place nasogastric (NG) tube Administer naltrexone

Solution: A and C Perform an EKG and Draw troponin levels. The patient is presenting with signs and symptoms of a cocaine overdose (OD), which includes dilated pupils (mydriasis), tachycardia, hypertension, confusion, and angina

A patient with a cholesterol level of 245 mg/dL is refusing to take a statin medication because they are concerned about the potential side effects. The patient has a calcium level of 8.5 mg/dL and a vitamin D level of 48 ng/mL. Which lipid-lowering medication(s) would be appropriate for the nurse practitioner to prescribe? Select all that apply. A. Nicotinic acid B. Fenofibrate C. Cholestyramine D. Simvastatin E. Ezetimibe

Solution: A, B and E Nicotinic acid, Fenofibrate and Ezetimibe (used together with lifestyle changes (diet, weight-loss, exercise) to reduce the amount of cholesterol. Nicotinic acid, fibrates, fish oil omega 3, and ezetimibe would be appropriate lipid-lowering medication options to prescribe. Bile acid sequestrants, such as cholestyramine, should not be prescribed because they interfere with fat absorption, as well as fat soluble vitamins (A, D, E, K). Currently, the patient's vitamin D level is 48 ng/mL, whereas an optimal range is 50 to 70 ng/mL. The patient's desire not to be prescribed a statin (simvastatin) should be respected.

The cytology (Pap smear) results for a 35-year-old woman reveal a high-grade squamous intraepithelial lesion (HSIL) of the cervix. The human papillomavirus (HPV) test is positive for the type 16 strain. Place each action in chronological order by dragging it to the correct location. A. Colposcopy B. Loop electrosurgical excision procedure (LEEP) C. Cervical biopsy

Solution: A1, C2, B3 HPV strains 16 and 18 are highly oncogenic. This patient has cervical cancer and requires immediate biopsy, excisional treatment, and staging for cervical cancer. The correct order of these actions is as follows: (1) Refer the patient for a colposcopy, (2) obtain cervical biopsy specimens for pathologic evaluation, and (3) perform LEEP for removal of cancerous cervical tissue.

A bulla is defined as: A.A solid nodule <1 cm in size B.A superficial vesicle filled with serous fluid >1 cm in size C.A maculopapular lesion D.A shallow ulcer

Solution: B A superficial vesicle filled with serous fluid >1 cm in size This is a blister—a circumscribed, fluid-containing, elevated lesion of the skin, usually >5 mm in d

A high-school wrestler is recovering from infectious mononucleosis. Which intervention must be completed to inform whether it is safe for the patient to return to play? MRI Abdominal ultrasound Complete blood count Strep culture Solution

Solution: B Abdominal ultrasound An athlete who plays a contact sport such as wrestling should have an abdominal ultrasound before returning to play to determine risk of splenic rupture. An MRI is not required. Atypical lymphocytes would not necessarily prevent an athlete from returning to play but should be monitored until within normal limits. A strep culture would not be necessary unless the athlete had symptoms.

Which medication will the nurse practitioner include in the treatment plan for a 7-year-old child with acute otitis media? A. Cefaclor B. Amoxicillin C.E rythromycin D. Azithromycin

Solution: B Amoxicillin Amoxicillin is the first line of therapy for the treatment of acute otitis media. Cefaclor is a second-generation cephalosporin and is not the first line of treatment for acute otitis media unless the infection is caused by gram-positive cocci and gram-negative rods. Erythromycin is not prescribed as the fi rst line of treatment for acute otitis media. Azithromycin can be administered as the first line of treatment for acute otitis media if amoxicillin is contraindicated.

The nurse practitioner is performing a pre-operative assessment on a patient who is scheduled for a wisdom tooth removal. The patient has a history of infective endocarditis. Which prophylactic antibiotic should be prescribed? Azithromycin (Zithromax) Amoxicillin (Amoxil) Doxycycline (Vibramycin) Cefdinir (Omnicef)

Solution: B Amoxicillin (Amoxil). Amoxicillin is the preferred antibiotic for prophylaxis in patients who have a history of infective endocarditis. Clindamycin, clarithromycin, and cephalexin are acceptable options if a penicillin allergy is present. Azithromycin, doxycycline, and cefdinir are not recommended. infective endoc a rd i ti s = a mox i c i ll i n

Q. The presence of the S4 heart sound may be absent in which of the following conditions? A. Aortic stenosis B. Atrial fibrillation C. Myocardial infarction D. Hypertensive heart disease

Solution: B Atrial fibrillation. Because effective atrial contraction is required for production of the S4 heart sound, patients with atrial fibrillation may not demonstrate this sound. Aortic stenosis, myocardial infarction, and hypertensive heart disease are all associated with the S4 heart sound

Which of the following best describes Cullen's sign? A. Cessation of inspiration upon deep palpation of the RUQ of the abdomen B. Bruising around the periumbilical area of the abdomen C. Deep palpation of the LLQ of the abdomen that causes pain to radiate to the RLQ D. Blue-black discoloration that is located on the right flank of the trunk

Solution: B Bruising around the periumbilical area of the abdomen Cullen's sign is bruising around the periumbilical area of the abdomen that is associated with pancreatitis. The color can range from blue-black to purple, and then the color changes as the bruise resolves. It is caused by retroperitoneal bleeding, when the blood migrates to the subcutaneous tissue in the periumbilical area (Cullen's sign) or flank (Grey Turner's sign). It is also seen in conditions such as splenic rupture, ruptured aortic aneurysm, rectus sheath hematoma, perforated duodenal ulcer, ruptured ectopic pregnancy, and hepatocellular cancer. It occurs in only 1% of patients with acute pancreatitis, but it is associated with 37% death rate.

All of the following describe normal behavior for a 3-year-old child, except: A. Speaks in three- to five-word sentences that are understood by most strangers B. Can draw a cross C. Can draw a circle D. Can ride a tricycle

Solution: B Can draw a cross. Developmental stages in children include the following: 1 year—walk; 2 years—walks up steps with the same foot; 3 years—pedals a tricycle and copies a circle; 4 years—copies a cross and draws a person with three parts.

When starting an elderly patient on a new prescription of levothyroxine (Synthroid), the nurse practitioner should keep in mind that the rationale for beginning with a lower dose in such patients relates to the drug's: A. Central nervous system effects B. Cardiac effects C. Renal effects D. Hepatic effects

Solution: B Cardiac effects Levothyroxine (Synthroid) should be started on the lowest dose in elderly patients because of the severe side effects that can occur. These include palpitations, tachycardia, anxiety, irritability, elevated blood pressure, flushing, and insomnia.

When assessing an infant during a well-baby visit, the nurse practitioner notes pale and damp skin, fussiness, and shortness of breath. There is a delay of the femoral pulse when compared with the brachial pulse. To confirm diagnosis, all of the following should be ordered, except: A. Echocardiogram B. Complete blood count C. EKG D. Chest x-ray

Solution: B Complete blood count Based on exam findings, the nurse practitioner suspects coarctation of the aorta. An absence or delay of the femoral pulse compared with the brachial pulse is considered diagnostic. To further confirm diagnosis, an echocardiogram, EKG, and chest x-ray should be ordered. A complete blood count is not diagnostic for coarctation of the aorta.

An older adult male with alcohol use disorder is scheduled for a physical exam and laboratory testing. The patient's laboratory blood test results may show: A. Increased serum creatinine levels and eGFR B. Decreased number of platelets and increased MCV C. Increased serum potassium and increased triglycerides D. Decreased AST and ALT levels

Solution: B Decreased number of platelets and increased MCV Chronic alcohol use affects the MCV because of reduction of folate levels from dietary deficiency and/or impaired absorption due to excess use of alcohol. Alcohol also interferes with the production and function of white blood cells. Alcohol interferes with platelet production with diminished fibrinolysis resulting in thrombocytopenia. Alcoholics are at higher risk for bleeding. It can increase aspartate aminotransferase and alanine aminotransferase because of liver inflammation. Alcohol affects lipid metabolism in the liver, resulting in hypertriglyceridemia.

Which finding will the nurse practitioner expect to see in a 13-year-old male patient with Cushing's syndrome? A. Excess estrogen B. Delayed puberty C. Pseudogynecomastia D. Accelerated growth in height

Solution: B Delayed puberty Cushing's syndrome is associated with delayed puberty and growth failure in children and adolescents. Patients with Cushing's syndrome have an excess of androgens, not estrogen. Gynecomastia, not pseudogynecomastia, occurs with Cushing's disease. Pseudogynecomastia is caused by the deposition of fat, whereas gynecomastia is caused by excess cortisol.

A 25-year-old patient with a history of diabetes is positive for serum ketones and has a serum glucose level >300 mg/dL. Which diagnosis is most likely? A. Diabetes insipidus B. Diabetic ketoacidosis C. Hypoglycemia D. Somogyi phenomenon

Solution: B Diabetic ketoacidosis A patient with serum ketones and serum glucose levels >300 mg/dL is likely experiencing diabetic ketoacidosis. Diabetes insipidus is an overproduction of antidiuretic hormone; it does not create ketones in the blood. Hypoglycemia causes low blood glucose levels. The Somogyi phenomenon is rebound hyperglycemia following an episode of hypoglycemia.

A 45-year-old patient presents to the primary care office with leg redness. Vital signs: temperature 98.7°F, pulse 72 bpm, respirations 16 breaths/min, blood pressure 124/76 mmHg. The examination reveals a localized area of redness and tenderness to the right calf, and a cord-like vein is also noted. The nurse practitioner will: Diagnose a deep vein thrombosis and order an ultrasound Diagnose superficial thrombophlebitis and prescribe ibuprofen Diagnose peripheral artery disease and measure ankle-brachial index (ABI) score Diagnose Raynaud phenomenon and doppler the distal pulses

Solution: B Diagnose superficial thrombophlebitis and prescribe ibuprofen.

Which of the following viral infections is associated with occasional abnormal forms of lymphocytes during an acute infection? A. Cytomegalovirus (CMV) B. Epstein-Barr virus (EBV) C. Human papillomavirus (HPV) D. Coxsackievirus

Solution: B Epstein—Barr virus (EBV). EBV is a member of the herpesvirus family and one of the most common viruses. During adolescence, EBV causes infectious mononucleosis. In most cases of infectious mononucleosis, the clinical diagnosis can be made from the triad of fever, pharyngitis, and lymphadenopathy lasting 1 to 4 weeks. Serology tests show normal to moderately elevated white blood cells and increased numbers of lymphocytes, >10% atypical lymphocytes, and a positive reaction to a mono spot test. The antibody response in primary EBV infection appears to be quite rapid.

Abrupt loss of consciousness accompanied by generalized tonic-clonic seizures followed by a postictal period characterizes what type of seizure disorder? A. Absence seizure B. Grand mal seizure C. Atonic seizure D. Myoclonic seizure

Solution: B Grand mal seizure Grand mal seizure is the older term for generalized tonic-clonic seizure. It starts with abrupt loss of consciousness and stiffening of the muscles (tonic phase). After about a minute, the muscles start to jerk for 1 to 2 minutes (clonic phase). Cessation of muscle twitching signals the start of the postictal period. During this period, the person may be asleep (and gradually wake up) or may become agitated or confused. Do not insert anything in the mouth such as tongue blades. Help the person lie on the floor on his or her side.

A 55-year-old woman with rheumatoid arthritis sees the nurse practitioner for an episodic visit. She has been taking ibuprofen twice daily for many years. All of the following organ systems are at risk for damage from chronic nonsteroidal anti-inflammatory drug (NSAID) use, except: Cardiovascular system Musculoskeletal system Hematopoietic system Integumentary system

Solution: B Musculoskeletal system The musculoskeletal system is not damaged by NSAIDs. In fact, NSAIDs are used to treat muscle and/or joint pain and inflammation. Systems adversely affected by NSAIDs include the cardiovascular, hematopoietic (because aspirin affects platelets), and integumentary (e.g., Stevens-Johnson syndrome).

The nurse practitioner is examining a 4-year-old child who is experiencing nausea, lethargy, fever, and loss of appetite. The child attends day care, and several other children in the facility have experienced similar symptoms. Blood tests reveal the child is positive for IgM antibodies and negative for IgG antibodies. Which diagnosis is most likely? Hand-foot-mouth disease Hepatitis A Kawasaki disease Influenza Solution

Solution: B Hepatitis A The hepatitis A virus is transmitted primarily via the fecal-oral route—i.e., when an uninfected person ingests food or water that has been contaminated with the feces of an infected person. Transmission can occur when an infected person, or someone caring for an infected person, does not use proper hand hygiene while preparing food. Children who attend day care are at risk of hepatitis A infection because of poor hand hygiene and sanitation practices. Labs that are positive for IgM antibodies and negative for IgG antibodies confirm hepatitis A. Hand-foot-mouth disease is a common, acute viral illness caused by the coxsackievirus. Kawasaki disease presents with high fever, enlarged neck lymph nodes, conjunctivitis, peeling skin on hands and feet, and a swollen, red tongue. Influenza, also called "the flu," is a highly contagious viral infection of the respiratory system. It causes a high fever, body aches, cough, and other symptoms. Most children are ill with the flu for less than a week.

Which diagnosis describes a chronic disease of the apocrine follicles and glands, characterized by clusters of abscesses and pustules in the axilla, groin, and perianal area? A. Mulloscum contagiosum B. Hidradenitis suppurativa C. Folliculitis D. Furuncle

Solution: B Hidradenitis suppurativa Hidradenitis suppurativa is a chronic disease and recurrent inflammatory disorder of the apocrine glands that results in painful pustules, nodules, and abscesses in areas such as the axilla, groin, perianal, and mammary areas. It is more common in women; risk factors include obesity and a history of smoking. Mulloscum contagiosum is a relatively common viral infection of the skin that results in round, firm, painless bumps ranging in size from a pinhead to a pencil eraser. Folliculitis is a common skin condition in which hair follicles become inflamed. It is usually caused by a bacterial or fungal infection. At first, it may look like small red bumps or white headed pimples around hair follicles. It is not a chronic condition. A furuncle, also known as a boil, is a painful infection that forms around a hair follicle and contains pus. It is not a chronic condition.

A 68-year-old male of Hispanic descent has recently been discharged from the hospital with a diagnosis of stroke secondary to venous thromboemboli, DVT, and type 2 diabetes. His medications are listed on the discharge note as warfarin 5 mg every Monday, Wednesday, Friday, and Sunday; metformin 1 g twice a day and aspirin 325 mg daily. Which of the following is the correct INR value for this patient? A. INR 1.5 to 2.5 B. INR 2.0 to 3.0 C. INR 2.5 to 3.5 D. INR 3.0 to 4.0

Solution: B INR 2.0 to 3.0 The goal INR of a patient who has had a stroke is an INR of 2.0 to 3.0. This is the most common INR value and is also true for atrial fibrilla

A 48-year-old patient presents to the primary care office with a fever, chills, and malaise. Upon auscultating the heart, the nurse practitioner hears a cardiac murmur and notes there is no documented history. Further examination reveals painful, violet-colored nodes on the patient's fingers and toes. Red spots are also noted on the palms of the hands, but the patient does not complain of pain. The most likely diagnosis is: A. Congestive heart failure B. Infective endocarditis C. Dissecting abdominal aortic aneurysm D. Acute myocardial infarction

Solution: B Infective endocarditis. Symptoms of infective endocarditis include fever, chills, anorexia, and weight loss; a new onset of a cardiac murmur develops in up to 85% of patients. There may also be subungual hemorrhages (splinter hemorrhages on the nail bed), petechiae on the palate, painful violet-colored nodes on the fingers and toes (Osler nodes), and nontender red spots on the palms/soles (Janeway lesions). Congestive heart failure symptoms include dyspnea, fatigue, and dry cough.

The nurse practitioner is performing a vision assessment on a 10-week-old infant. All of the following assessment findings require a referral to a pediatric ophthalmologist, except: A. Pseudostrabismus B Intermittent esotropia C. White reflex D. Positive Hirschberg test

Solution: B Intermittent esotropia Abnormal vision screenings that require a referral to a pediatric ophthalmologist include pseudostrabismus (epicanthal folds appear "crossed-eyed"); white reflex, which could indicate cataracts, leukocoria, or retinoblastoma; and a positive Hirschberg test. Intermittent esotropia is common in infants younger than 20 weeks and usually resolves spontaneously. Refer if esotropia is still present after age 20 weeks

A 72-year-old female patient has a complicated urinary tract infection. Which regimen will the nurse practitioner prescribe? A. Medication treatment for a minimum of 3 days B. Medication treatment for a minimum of 7 days C. Medication treatment for a minimum of 10 days D. Medication treatment for a minimum of 14 days

Solution: B Medication treatment for a minimum of 7 days Complicated urinary tract infections in males, uncontrolled diabetic patients, pregnant or elderly women, and patients who are immunocompromised require medication treatment for a minimum of 7 days. Three days of treatment is not long enough to remediate any bacteria, and 10 or 14 days would be too long and may cause various other complications, such as antibiotic-related infections (e.g., Clostridium difficile )

he nurse practitioner is reviewing the results of an echocardiogram that was ordered for a patient with infective endocarditis; valve vegetation is noted. Which of the following heart murmurs would be present on physical exam? A. Aortic stenosis B. Mitral regurgitation C. S4 late diastole D. Wide splitting of S1

Solution: B Mitral regurgitation. Infective endocarditis can result in leaflet destruction and the presence of a valve vegetation, which causes mitral regurgitation. Splitting of the S2, not S1, can also occur. Aortic stenosis and S4 are not associated murmurs.

A 76-year-old male patient with a history of atherosclerotic cardiovascular disease presents with hyperlipidemia. Which intensity statin will the nurse practitioner prescribe? A. Low-intensity statin B. Moderate-intensity statin C. Moderate- to high-intensity statin D. High-intensity statin

Solution: B Moderate-intensity statin Current guidelines on the management of blood cholesterol recommend moderate-intensity statins for patients >75 years with atherosclerotic cardiovascular disease (ASCVD). If a patient presents with ASCVD and is aged 21 to 75 years, the guidelines recommend a high-intensity statin such as atorvastatin (Lipitor) or rosuvastatin (Crestor).

he research term/symbol that is used to indicate the "total population" in a research study is: A .n B. N C. p D. α

Solution: B N The correct symbol to indicate total number of subjects in a study (total population) is N. For example, a research study has a total number of subjects or total population of 100 (N = 100). The small letter n is used to indicate a subpopulation. For example, a study uses a total population of N = 100 that is divided into two groups of 50 subjects (n = 50). The letter p is used to indicate p -value. The symbol α denotes the significance level.

An older adult patient presents to the nurse practitioner with dysuria, frequency, and hesitancy. The patient has been taking warfarin for several years and has an international normalized ratio (INR) of 3.1. Based on these assessment findings, the safest treatment option would be: Metronidazole (Flagyl) Nitrofurantoin (Macrobid) Moxifloxacin (Avelox) Sulfamethoxazole-trimethoprim (Bactrim)

Solution: B Nitrofurantoin (Macrobid). Nitrofurantoin should be prescribed for a patient taking warfarin who has a urinary tract infection because nitrofurantoin will not increase the patient's international normalized ratio (INR) level. Metronidazole, moxifloxacin, and sulfamethoxazole-trimethoprim can all increase the INR level. Also, metronidazole is not an appropriate treatment for a UTI and moxifloxacin is not FDA approved for UTI treatment.

Isoniazid therapy is associated with some possible adverse events. Which of the following events can be minimized or prevented with simultaneous intake of pyridoxine? A. Hepatic toxicity B. Peripheral neuropathy C. Urticaria D. Nausea and vomiting

Solution: B Peripheral neuropathy Isoniazid (INH) competes with pyridoxine (vitamin B6) as a cofactor for synthesis of synaptic neurotransmitters, resulting in neurologic adverse effects such as peripheral neuropathy, paresthesias, and ataxia.

Hegar's sign is considered a: A. Positive sign of pregnancy B. Probable sign of pregnancy C. Presumptive sign of pregnancy D. Problem in pregnancy

Solution: B Probable sign of pregnancy Hegar's sign is softening of the lower portion of the uterus and is considered a probable sign of pregnancy.

The most important job of an institutional review board (IRB) is: A. Protecting the interests of the hospital or the research institution B. Protecting the rights of the human subjects who participate in research done at the institution C. Protecting the researcher and research team from lawsuits D. Evaluating research protocols and methodology for appropriateness and safety

Solution: B Protecting the rights of the human subjects who participate in research done at the institution Every research institution has an IRB whose job is to review all the research that is conducted in that institution. The IRB's most important role is to protect the rights of the human subjects who participate in research done at the institution of which the IRB is a part (e.g., research hospitals, universities).

A middle-aged patient newly diagnosed with type 2 diabetes wants to start an exercise program. All of the following statements are true, except: A. If the patient is unable to eat due to illness, antidiabetic agents can be continued with frequent glucose monitoring B. Strenuous exercise is contraindicated for most patients with type 2 diabetes because of a higher risk of hypoglycemic episodes C. Exercise increases the body's ability to metabolize glucose D. Patients who exercise vigorously in the afternoon may have hypoglycemic episodes in the evening or at night if they do not eat

Solution: B Strenuous exercise is contraindicated for most patients with type 2 diabetes because of a higher risk of hypoglycemic episodes Exercise is recommended because exercise helps to use the glucose stores and reduce blood sugar. When exercising, the patient should monitor blood sugar closely, especially if using insulin, to avoid hypoglycemia.

A 30-year-old male with a history of HIV infection has been on antiretroviral therapy (ART) since diagnosis at age 28 years. Which of the following indicates that the patient's immune system is responding to ART? A. The HIV viral load is higher compared with the previous test B. The CD4 count is higher than the previous test C. The CBC shows an increase in the leukocyte count D. HIV genetic testing of the patient's HIV strain shows that it is sensitive to current HIV regimen

Solution: B The CD4 count is higher than the previous test. One of the best indicators that the patient is responding to ART regimen is an increase in the CD4 count. Another indicator is a decrease in the viral load. The leukocyte count in the CBC indicates neutrophils; it does not indicate CD4 status.

A 37-year-old male high school teacher complains of an acute onset of pain and redness of his leftwrist. He denies trauma to the wrist. He reports that the condition occurred on the same wristbefore. The symptoms started that morning after he went to a birthday party the previous evening.He reports that he drank a few glasses of white wine. During the physical exam, the left wrist is red,swollen, and tender to palpation. The skin is intact but feels warm to the touch. Question Regarding the previous case, all of the following can be used to treat his condition, except: A. Oral glucocorticoids B. Topical glucocorticoids C. NSAIDs D. Colchicine

Solution: B Topical glucocorticoids Topical glucocorticoids are not used to treat gout, but oral glucocorticosteroids (prednisone, prednisolone, and methylprednisolone) are useful to treat inflammation caused by the uric acid crystals inside the joint. The other drugs used to treat an acute exacerbation of gout are NSAIDs and colchicine.

. The nurse practitioner determines that a patient with Marfan syndrome needs a cardiac evaluation. What initial imaging study will the nurse practitioner order for this patient? A. Standard chest x-ray B. Two-dimensional echocardiogram (ECHO) C. Transesophageal echocardiography (TEE) D. Magnetic resonance angiography (MRA)

Solution: B Two-dimensional echocardiogram (ECHO). The initial cardiac evaluation for a patient with Marfan syndrome should include a two-dimensional echocardiogram (ECHO) to assess the aortic root and ascending aorta. This study should be repeated in 6 months to assess the stability of the aortic dimensions. A standard chest x-ray is not adequate to detect aortic root enlargement. Transesophageal echocardiography (TEE) and magnetic resonance angiography (MRA) are more advanced, secondary imaging studies to evaluate the aortic root, the descending aorta, and cardiac valves

Which assessment finding is expected in a 3-year-old male with penopubic epispadias? A. Fused pelvic bones B. Urine leakage with stress C. Narrow penis that curves down D. Urinary meatus found along shaft of penis

Solution: B Urine leakage with stress In penopubic epispadias, the urethral meatus is found near the pubic bone. The position of the meatus helps predict how well the bladder stores urine. When the bladder sphincter is shaped more like a horseshoe than a ring, it does not close all the way. Because of this, urine leaks out. Most boys with penopubic epispadias and about two of three with penile epispadias leak urine with stress. In most cases of penopubic epispadias, the bones of the pelvis do not come together in the front. In boys with epispadias, the penis tends to be broad, short, and curved up. In penile epispadias, the urinary meatus is found along the shaft. In penopubic epispadias, it is found on or near the pubic bone.

A left-hand-dominant high-school tennis player presents with a concern of left elbow pain. Which signs and symptoms suggest that the patient is suffering from tennis elbow? (Select all that apply.) Elbow pain that worsens with pulling activity Lateral elbow pain with tenderness at the lateral epicondyle Elbow pain with grasping movement Medial elbow pain with tenderness at the medial epicondyle Elbow pain that worsens with extension

Solution: B and C Lateral elbow pain with tenderness at the lateral epicondyle and Elbow pain with grasping movement. Tennis elbow, or lateral epicondylitis, is inflammation of the tendon insertion of the extensor carpiradialis brevis muscle. It is associated with lateral tenderness at the insertion site. Pain worsens with grasping or twisting movements. Pulling is associated with medial epicondylitis, or golfer's elbow. Elbow pain with extension is indicative of hyperextension.

Displacement of the point of maximal impulse (PMI) may be noted in which of the following conditions? Select all that apply. Infancy (younger than 2 years of age) Pregnancy (third trimester) Hypertrophic cardiomyopathy Ischemic heart disease Idiopathic scoliosis

Solution: B and C Pregnancy (third trimester) and Hypertrophic cardiomyopathy.

Which hematologic findings on a peripheral smear support a diagnosis of sickle cell anemia? (Select all that apply.) A. Burr cells B. Target cells C. Schistocytes D. Howell-Jolly bodies E. Anisopoikilocytosis

Solution: B and D Target cells and Howell-Jolly bodies Target cells and Howell-Jolly bodies are found on a peripheral smear in patients with sickle cell anemia. Burr cells and schistocytes are cell shapes categorized as poikilocytosis. Anisopoikilocytosis is associated with beta thalassemia major, not sickle cell anemia.

A patient is seen in the primary care clinic with an edematous and painful lower extremity. The physical examination reveals intermittent claudication with walking and a dry, shiny lower calf with two small ulcers near the ankle. The patient is diagnosed with peripheral artery disease (PAD). What lab test(s) would confirm this diagnosis? Select all that apply. A. Positive d-dimer B. Lipoprotein A = 33 mg/dL C. Homocysteine level = 21 µml/L D. C-reactive protein = 3.8 mg/L E. TC:HDL = 2.6 mg/dL

Solution: B, C and D Lipoprotein A = 33 mg/dL, Homocysteine level = 21 µml/L and C-reactive protein = 3.8 mg/L. A patient diagnosed with peripheral arterial disease (PAD) will have an elevated lipoprotein A level (<30 mg/dL is normal), which is a possible indicator for atherosclerosis, coronary artery disease, or stroke. Homocysteine is an amino acid and a breakdown product of protein metabolism. When present in high concentrations, homocysteine has been linked to an increased risk of heart attack and stroke. A normal homocysteine level is 4 to 15 µmol/L. C-reactive protein (CRP) levels measure the amount of inflammation circulating in the blood system. A normal CRP level should be <3 mg/L. A d-dimer level would be positive if the patient had a deep vein thrombosis (DVT). The total cholesterol to high-density lipoprotein (TC:HDL) ratio is within normal range. The TC:HDL ratio should be <4.5 mg/dL for men and <4.0 mg/dL for women.

An African-American infant is brought into the primary care center with a temperature of 101.0°F and swelling of the hands and feet. Blood work reveals hemoglobin S cells. The nurse practitioner will prescribe (select all that apply): A. Ketorolac (Toradol) B. Oral hydroxyurea (Hydrea) C. Daily folic acid supplements D. Aspirin (Bayer) E. Penicillin (Pen VK)

Solution: B, C and E Oral hydroxyurea (Hydrea), Daily folic acid supplements and Penicillin (Pen VK). Sickle cell disease or sickle cell anemia is more prevalent in patients of African American heritage and typically worsens over time. An infant 4 to 6 months of age who has sickle cell disease will present with hand-foot syndrome (edema) and a fever. Blood tests can identify four types of abnormal hemoglobin: F, S, A, and C. Children with sickle cell disease should receive oral hydroxyurea to increase hemoglobin levels, a folic acid supplement to help with anemia, and penicillin until the age of 5 to prevent pneumonia. Ketorolac is generally not recommended due to a number of potential toxicities, black box warnings, and limited evidence of effectiveness. Aspirin is not indicated for children with pain or fever because it carries the risk of Reye syndrome.

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.) A. Contact the patient's partner to schedule HIV testing B. Educate the patient about using barrier devices during sex C. Prescribe daily oral PrEP D. Draw a blood sample for a combination HIV antigen/antibody test E. Schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP

Solution: B, D and E Educate the patient about using barrier devices during sex, draw a blood sample for a combination HIV antigen/antibody test and 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.

A patient arrives at the primary care clinic with a temperature of 101°F, rigor, and malaise. For which additional signs or symptoms would the nurse practitioner assess to confirm a diagnosis of bacterial endocarditis? Select all that apply. A. Sedimentation rate of 11 mm/hour B. Splinter hemorrhages of nail beds C. Bouchard nodes D. Roth spots on retina E. A new heart murmur

Solution: B, D and E Splinter hemorrhages of nail beds, Roth spots on retina and A new heart murmur. A patient with bacterial endocarditis may present with fever, chills, malaise, splinter hemorrhages of the nail beds, Roth spots on retina, and a new heart murmur. Additional findings include Osler nodes on the fingers and toes and Janeway lesions on the palms and soles. The patient's sedimentation rate (ESR) will be elevated (>20 mm per hour). Bouchard nodes occur with degenerative joint disease. SRM

One of the developmental milestones for this age group is the ability to draw a stick figure "person" with six separate body parts. What is the age group that this finding is associated with? A. 3-year-olds B. 4-year-olds C. 5-year-olds D. 6-year-olds

Solution: C 5-year-olds. By 5 years of age, a child can draw a stick person with six body parts, copy a square, print some letters and numbers, and count to 10 or more.

What cranial nerve (CN) is measured with a "clicking" stimuli? A. CN I B. CN II C. CN VIII D. CN V

Solution: C CN VIII CN VIII is responsible for the auditory function and is tested by using a "clicking" stimuli to test the auditory brainstem response (ABR). CN I is the olfactory system (mnemonic: one nose). CN II is the optic nerve (mnemonic: two eyes). CN V is the trigeminal nerve for chewing and clenching teeth and is the largest cranial nerve.

Among patients with nephrolithiasis, what is the most common type of kidney stone? A. Struvite B. Cystine C. Calcium oxalate D. Uric acid

Solution: C Calcium oxalate The majority of kidney stones are made up of calcium oxalate (60%-70%). The other types of stones are struvite (7%), uric acid (7%), and cystine (1%).

When the nurse practitioner is evaluating a patient for intermittent claudication, they would first: A. Order a venogram B. Order TED antiembolism stockings C. Check the ankle and brachial blood pressures before and after exercise D. Check the pedal and posterior tibial pulses

Solution: C Check the ankle and brachial blood pressures before and after exercise Initial evaluation for intermittent claudication would include checking the ankle and brachial blood pressures before and after exercise.

A multigravida who is at 34 weeks' gestation wants to know at what level her uterine fundus should be. The best answer is to advise the mother that her fundus is: A. Midway between the umbilicus and the lower ribs B. At the level of the umbilicus C. From 33 to 35 cm D. From 32 to 34 cm

Solution: C From 33 to 35 cm After 20 weeks' gestation, fundal height in centimeters should measure approximately the same as the number of weeks of gestation.

All of the following are true about strawberry hemangiomas found in infants, except: A. Most will involute spontaneously by the age of 18 to 24 months B. Watchful waiting is the most useful strategy C. Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months D. Strawberry hemangiomas are benign

Solution: C Hemangiomas should be treated with laser therapy if they have not resolved by the age of 12 months True strawberry hemangiomas will eventually resolve by the time the child goes to kindergarten. Most will reduce or disappear in the first 2 years. Laser treatment is rarely needed.

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

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

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

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

An elderly patient with a history of severe mitral regurgitation has surgery for placement of a prosthetic mitral valve. Which of the following is the correct INR value? INR 1.5 to 2.5 INR 2.0 to 3.0 INR 2.5 to 3.5 INR 3.0 to 4.0

Solution: C INR 2.5 to 3.5 The ACC/AHA guidelines for anticoagulation of patients with prosthetic valves suggest an INR of 2.5 to 3.5. They are at higher risk of blood clots because of the prosthetic valves.

While examining the genitalia of a male patient, the nurse practitioner observes distended scrotal veins. The nurse practitioner: A. Examine the patient in a supine position B. Examine the patient in a sitting position C. Instruct the patient to perform a Valsalva maneuver D. Assess the testicular size with an orchidometer

Solution: C Instruct the patient to perform a Valsalva maneuver The nurse practitioner will instruct the patient to perform a Valsalva maneuver, generally in a standing position. This action will cause the distention of the veins of the pampiniform plexus and assist in evaluation for possible scrotal abnormalities such as varicocele. The patient sitting or laying supine may not yield accurate assessment findings. An orchidometer is used to measure the size of the testes, not to evaluate for scrotal abnormalities.

A middle-aged male patient with a history of cluster headaches arrives at the primary care clinic for treatment. Which of the following interventions is included in the acute treatment plan? Ice pack on forehead Acetaminophen Intranasal 4% lidocaine Phenytoin (Dilantin)

Solution: C Intranasal 4% lidocaine A patient with a cluster headache should be initially treated with 100% oxygen at 12 L/min via mask and intranasal 4% lidocaine. These headaches are most prevalent in middle-aged men between 30 and 40 years of age. An ice pack to the forehead and a dark room are effective for a migraine headache. Phenytoin (Dilantin) would be administered for trigeminal neuralgia. Acetaminophen or nonsteroidal anti-infl ammatory drugs (NSAIDs) are helpful for muscle tension headaches.

A 65-year-old woman's bone density result shows severe demineralization of cortical bone. All of the following pharmacologic agents are useful in treating this condition, except: A. Raloxifene (Evista) B. Calcitonin (Miacalcin) C. Medroxyprogesterone (Depo-Provera) D. Calcium with vitamin D

Solution: C Medroxyprogesterone (Depo-Provera) Long-term use (>3 years) of medroxyprogesterone (Depo-Provera) increases risk of bone loss. Avoid with osteopenia, osteoporosis, and long-term amenorrhea and in underweight women with anorexia. First-line treatment of osteoporosis is the bisphosphonates. Lifestyle measures are weight-bearing exercises and adequate calcium and vitamin D intake.

Upon auscultation of a 6-year-old patient, the nurse practitioner hears a systolic murmur that sounds like a musical vibration and becomes louder in the supine position. The murmur is a Grade I/II in intensity with minimal radiation. The nurse practitioner will: A. Refer the patient to a pediatric cardiovascular surgeon B. Refer the patient to a pediatric cardiologist C. Note on the record to monitor on annual physical exam D. Schedule an echocardiogram

Solution: C Note on the record to monitor on annual physical exam The findings are indicative of a Still's murmur. It is a benign murmur that is common in school-age children and usually resolves by adolescence. The murmur sound is of musical quality with minimal radiation. Because the condition is benign and usually self-resolves, the most appropriate action is to monitor on annual physical exam.

Kyphosis is a late sign of: A. Rheumatoid arthritis B. Osteopenia C. Osteoporosis D. Osteoarthritis

Solution: C Osteoporosis Kyphosis is a curvature of the spine that causes a rounding of the back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis) contributes to this curvature in the spine. Symptoms that may occur with severe cases of kyphosis include difficulty breathing, fatigue, and back pain.

All of the following are risk factors that could lead to hearing loss in an infant who was premature at birth, except: A. Hyperbilirubinemia B. Low Apgar scores C Rubeola D. Seizures

Solution: C Rubeola Use the HEARS mnemonic for risk factors that may lead to hearing loss: Hyperbilirubinemia; Ear infections that are frequent; low Apgar scores; Rubella/cytomegalovirus (CMV), not rubeola; and Seizures. Sickle cell disease is not a risk factor for hearing loss.

Which lab values will the nurse practitioner monitor in a patient taking theophylline? A. Liver function test B. Complete blood count C. Serum concentration D. Complete metabolic panel

Solution: C Serum concentration It is important to monitor serum concentration when administering theophylline. Theophylline can cause adverse effects due to the plasma concentration, especially when it exceeds 20 mg/L. Liver function testing is appropriate for medications that affect the liver such as antibiotics, antipsychotics, and statins. Theophylline does not affect white or red blood cells, so there is no reason for a complete blood count. Complete metabolic panel lab testing is instrumental in diagnosing disorders such as diabetes, hypertension, and coronary artery disease, but it is not indicated in cases of theophylline use.

Pulsus paradoxus is more likely to be associated with: A. Sarcoidosis B. Acute bronchitis C. Status asthmaticus D. Bacterial pneumonia

Solution: C Status asthmaticus Pulsus paradoxus is most likely to be seen with status asthmaticus. With inspiration, systolic pressure drops because of the increased pressure (positive pressure). Some pulmonary risks of having increased pressure include asthma and emphysema. Cardiac causes for pulsus paradoxus include tamponade, pericarditis, and cardiac effusion.

An asthmatic adult presents to the clinic for a routine physical. Upon examination, the nurse practitioner notes a paradoxical pulse. Which diagnostic criteria is used to determine this diagnosis? The radial pulse varies by more than 10 beats during a respiratory cycle. The apical pulse decreases by at least 10 beats during inspiration. The systolic blood pressure drops more than 10 mmHg upon inspiration. The diastolic blood pressure rises more than 10 mmHg when the patient exhales.

Solution: C The systolic blood pressure drops more than 10 mmHg upon inspiration. Pulsus paradoxus, or the paradoxical pulse, is measured by using a sphygmomanometer (blood pressure cuff) and a stethoscope. A drop in systolic BP (SBP) of more than 10 mmHg during the inspiratory phase is diagnostic. The patient's history of asthma is a contributing pulmonary factor. While the pulse and diastolic blood pressure are both measured when obtaining vital signs, they are not part of the pulsus paradoxus diagnosis criteria.

The primary function of all of the following pharmacologic agents is to treat inflammation in the lungs, except: A. Nedocromil sodium inhaler (Tilade) B. Cromolyn sodium inhaler (Intal) C. Theophylline oral (Theo-24) D. Fluticasone inhaler (Flovent)

Solution: C Theophylline oral (Theo-24) The primary function of nedocromil sodium inhaler (Tilade), cromolyn sodium inhaler (Intal), and fluticasone inhaler (Flovent) is to treat inflammation in the lungs. Nedocromil sodium and cromolyn sodium are mast cell stabilizers, which inhibit the degranulation of mast cells, preventing the release of inflammatory mediators. Fluticasone is a corticosteroid. Theophylline oral (Theo-24), a methylxanthine, primarily functions as a bronchodilator, widening the airways and relaxing the bronchial muscles.

An adult of African American heritage with type II diabetes is diagnosed with heart failure. The patient has a potassium level of 5.4 mEq/L and a serum creatinine of 2.6 mg/dL. What first-line drug class will the nurse practitioner prescribe? Calcium channel blockers (CCBs) Angiotensin-converting enzyme inhibitors (ACEIs) Thiazides Angiotensin-receptor blockers (ARBs)

Solution: C Thiazides. An appropriate first-line drug class for an African American patient with diabetes, hyperkalemia, and elevated creatinine level is thiazides (e.g., hydrochlorothiazide). Calcium channel blockers (CCBs) are contraindicated in patients with heart failure, bradycardia, and a second or third heart block. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) are contraindicated in patients with hyperkalemia.

During a sports participation exam of a 14-year-old high school athlete, the nurse practitioner notices a split of the S2 component of the heart sound during deep inspiration. She notes that it disappears upon expiration. The heart rate is regular, and no murmurs are auscultated. Which of the following is correct? A. This is an abnormal finding and should be evaluated further by a cardiologist B. A stress test should be ordered C. This is a normal finding in some young athletes D. An echocardiogram should be ordered

Solution: C This is a normal finding in some young athletes. It is common to hear a split S2 heart sound over the pulmonic area of the heart with inspiration. As long as it disappears with expiration, with no other abnormal symptoms, this is a normal finding. The sound is caused by the splitting of the aortic and pulmonic components.

An adult Black male presents with blood under the nail of the great toe that involves approximately 50% of the nail area. He reports dropping a hammer accidentally on his toe about 5 hours ago. Which of the following is the recommended treatment? A. Biopsy to rule out melanoma B. No treatment is needed C. Trephination D. Nail removal

Solution: C Trephination Trephination is the name of a procedure in which a small hole is drilled on top of the nail so that the blood can drain. An 18-gauge needle or a large paperclip (straighten one end) is used and heated with a flame from a lighter. If the blood is not drained, it will result in permanent ischemic damage to the nail bed, which can lead to permanent loss of the toenail

The Jarisch-Herxheimer reaction is a response to treatment of which of the following organisms? A. Neisseria gonorrhoeae B. Chlamydia trachomatis C. Treponema pallidum D. Rickettsia rickettsii

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

Which of the following benzodiazepines has the shortest half-life? A. Lorazepam (Ativan) B. Alprazolam (Xanax) C. Triazolam (Halcion) D. Clonazepam (Klonopin) Solution

Solution: C Triazolam (Halcion) Triazolam (Halcion) has an average half-life of about 2 hours. Alprazolam (Xanax) has a half-life of 12 hours. Lorazepam (Ativan) has a half-life of 15 hours. Clonazepam (Klonopin) has a half-life of 34 hours.

Which lab result would confirm a diagnosis of hyperlipidemia? LDL = 90 mg/dL Total cholesterol = 186 mg/dL Triglycerides = 185 mg/dL HDL = 56 mg/dL

Solution: C Triglycerides = 185 mg/dL. A normal triglyceride level is less than 150 mg/dL. An optimal low-density lipoprotein (LDL) level is less than 100 mg/dL. Total cholesterol levels should be less than 200 mg/dL. High-density lipoprotein (HDL) levels should greater than 40 mg/dL in men and greater than 50 mg/dL in women.

The nurse practitioner is conducting a health assessment on a 21-year-old patient with pheochromocytoma. During the assessment, the nurse practitioner is likely to detect all of the following signs and symptoms, except: A. Headaches B. Tachycardia C. Weight gain D. Sweaty palms

Solution: C Weight gain Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive catecholamine. It causes hypertension, diaphoresis (including sweaty palms), headaches, tachycardia, hyperglycemia, hypermetabolism, and weight loss (not weight gain).

At what age should healthy full-term infants be screened for anemia? 0 to 3 months 3 to 6 months 6 to 9 months 9 to 12 months

Solution: D 9 to 12 months Hemoglobin and hematocrit are not routinely screened at birth, because hemoglobin is elevated from maternal red blood cells (RBCs) that are mixed with fetal RBCs. Healthy infants have enough iron stores to last 4 to 6 months after birth. Complementary foods are typically rich in iron, so they should not be screened until 9 to 12 months

In an adolescent with scoliosis, what degree of spinal curvature requires a referral for surgical correction? A. 10 to 20 degrees B. 20 to 30 degrees C. 30 to 40 degrees D. >40 degrees

Solution: D >40 degrees A spinal curvature of >40 degrees requires surgical intervention with a Harrington rod. Curvatures between 5 and 20 degrees should be monitored for changes. Bracing is necessary for curvatures between 20 and 40 degrees

All of the following patients are at higher risk of suicide, except: A. A 66-year-old White man whose wife of 40 years recently died B. A high school student with a history of bipolar disorder C. A depressed 45-year-old woman with a family history of suicide D. A 17-year-old teen who has only one close friend in school

Solution: D A 17-year-old teen who has only one close friend in school Risk factors for suicide include (a) elderly White men (especially after the death of a spouse); (b) past history of suicide; (c) family history of suicide; (d) plans for use of a lethal weapon such as a gun or knife; (e) gender (higher attempt rate in females, but higher success rate in males); and (f) personal history of bipolar disorder or depression.

An elderly patient has been taking digoxin, metformin, atenolol, and aspirin for several months. During an office visit, the patient reports dark areas in the central vision fields. The patient's digoxin level is 1.3 ng/mL. Which of the following is the most likely cause? Acute angle-closure glaucoma Herpes keratitis Retinal detachment Age-related macular degeneration

Solution: D Age-related macular degeneration The patient is experiencing symptoms of macular degeneration (changes in central vision), which can be attributed to atenolol use. The patient's digoxin level is within normal range (0.7 to 1.5 ng/mL). Additionally, the patient's vision changes are not typical of digoxin toxicity, which include yellowish-green halos. Metformin and aspirin do not cause macular degeneration.

When examining a preschool child, the nurse practitioner notes wheezing and diffused crackles upon auscultation of the lungs. Throat examination appears erythematous without pus or exudate. Respirations are 24 and temperature is 99.2°F. The mother states the child has been coughing for several weeks. Chest x-ray shows diffuse interstitial infiltrates. The nurse practitioner orders all of the following, except: A. Azithromycin × 5 days B. Increased fluids C. Antitussives PRN D. Albuterol nebulizer

Solution: D Albuterol nebulizer The patient likely has atypical pneumonia (walking pneumonia), which is an infection of the lungs more common in children and young adults. It is highly contagious and should be treated with an antibiotic. The nurse practitioner will also recommend increased fluids and rest, as well as an antitussive as needed. Albuterol nebulizer is not routinely ordered for atypical pneumonia.

While reviewing the lab results for a patient being evaluated for possible heart failure, the nurse practitioner notes the B-type natriuretic peptide (BNP) level is elevated. In addition to heart failure, which of the following can also elevate the BNP? A. Deep vein thrombosis B. Endocrine dysfunction C. Morbid obesity D. Chronic kidney disease

Solution: D Chronic kidney disease. B-type natriuretic peptide (BNP) is elevated with chronic kidney disease. A pulmonary embolism can increase the BNP; a deep vein thrombosis (DVT) cannot. Endocrine dysfunction can cause cardiac changes such as hypertension but does not directly impact BNP. Obesity is associated with a lower BNP result.

Which medication would NOT be initially prescribed for an elderly patient diagnosed with nonvalvular atrial fibrillation? A. Rivaroxaban (Xarelto) B. Apixaban (Eliquis) C. Dabigatran (Pradaxa) D. Clopidogrel (Plavix)

Solution: D Clopidogrel (Plavix). Direct-acting anticoagulants (DOACs) are now the first-line agents for nonvalvular atrial fibrillation.

Which of the following is an adverse effect from nondihydropyridine CCBs? Hyperkalemia Hypertriglyceridemia Hyperuricemia Constipation Solution

Solution: D Constipation Constipation affects up to 25% of patients who are on nondihydropyridine CCBs (verapamil, diltiazem). It can be severe in the elderly. It is important that the patient take a soluble fiber daily (e.g., Benefiber), increase fiber intake, walk daily, and ensure adequate fluid intake. Prunes or prune juice daily is also effective. Polyethylene glycol (Miralax) can be mixed with the fiber if the fiber alone is not effective. It takes 12 to 24 hours for Miralax to be effective

Which of the following BEST describes a Grade 4 heart murmur? Audible with stethoscope placed off of the chest Detectable but not associated with a palpable thrill Audible with stethoscope placed lightly on chest Easily detectable with a palpable precordial thrill Solution Solution: D Easily detectable with a palpable precordial thrill. A Grade 4 heart murmur is easily detectable and associated with a palpable precordial thrill.

Solution: D Easily detectable with a palpable precordial thrill. A Grade 4 heart murmur is easily detectable and associated with a palpable precordial thrill.

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

Solution: D Escitalopram (Lexapro) Escitalopram (Lexapro) is a safe antidepressant for an adolescent who has severe depression and no history of suicidal ideations. Sertraline (Zoloft) is not a safe option for patients <24 years of age due to increased risk of suicidal ideation. Bupropion (Wellbutrin) is an atypical antidepressant and is not a first-line therapy for depression. It is contraindicated in patients with anorexia nervosa. Lithium carbonate (Eskalith) is indicated for patients with bipolar disorder.

A patient with a low-density lipoprotein (LDL) level of 202 mg/dL and an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 22%. What medication will the nurse practitioner prescribe? Fluvastatin 30 mg/day Simvastatin 10 mg/day Atorvastatin 60 mg/day Lovastatin 40 mg/day

Solution: D Lovastatin 40 mg/day. The patient has an elevated LDL (low-density lipoprotein) level of 202 mg/dL, and the optimal level for LDL is <130 mg/dL. The patient also has an elevated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 22%, for which the ideal risk level is <5.0%. Therefore, a moderate-intensity statin such as lovastatin would be an appropriate medication to prescribe. The purpose of moderate-intensity statins is to lower LDL levels by 30% to 50%. Fluvastatin and simvastatin are low-intensity statins that can lower LDL levels by 30%, which may not be effective. Atorvastatin is a high-intensity statin that would be prescribed if the moderate-intensity statin is unsuccessful.

A 70-year-old man with open-angle glaucoma is prescribed timolol (Betimol) ophthalmic drops. All of the following are contraindications to Betimol ophthalmic drops, except: A. Overt heart failure or sinus bradycardia B. History of asthma C. Second- or third-degree atrioventricular (AV) block D. Migraine headaches

Solution: D Migraine headaches Migraines are not a contraindication to Betimol (timolol). Contraindications include bronchial asthma, asthma history, severe chronic obstructive pulmonary disorder (COPD), uncompensated heart failure, second- or third-degree AV block, sinus bradycardia, and cardiogenic shock. Caution should be used if the following conditions are present: closed-angle glaucoma, peripheral vascular disease, bronchospastic disease, diabetes, hyperthyroidism, and myasthenia gravis.

Upon cardiac examination, the nurse practitioner hears a loud, high-pitched, blowing murmur at the apex of the heart, which radiates to the axillary area. The murmur is indicative of: A. Aortic regurgitation B. Mitral stenosis C. Aortic stenosis D. Mitral regurgitation E. Solution

Solution: D Mitral regurgitation. A loud, high-pitched, blowing murmur is indicative of mitral regurgitation, a pansystolic murmur.

Which of the following is a true statement regarding the beliefs of many patients who are Hindu? A. Blood loss worsens illness B. Life energy (chi or qi) imbalance or blockage is the cause of disease C. "Temple garments" should be worn under hospital gown D. Pain is a means of progressing spiritually

Solution: D Pain is a means of progressing spiritually Hinduism encourages the acceptance of pain and suffering as part of the consequences of karma. Hindu patients may not be forthcoming about pain and may prefer to accept it as a means of progressing spiritually. Vietnamese patients may fear blood tests and surgery because of a belief that blood loss worsens illness. Mormons may wear "temple garments" under their clothes or hospital gown as a symbol of covenant they made in the temple. Practitioners of traditional Chinese medicine believe that life energy (chi or qi) imbalance or blockage is the cause of disease.

A 68-year-old patient recently prescribed caridopa-levodopa (Sinemet) tells the nurse practitioner that he has been bloated and is experiencing difficulty with bowel movements. Which of the following will the nurse practitioner incorporate into the treatment plan? A. Senna B. Methylnaltrexone (Relistor) C. Magnesium citrate D. Polyethylene glyco

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

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

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

A patient's 2-month blood pressure log shows an average pulse of 88 BPM and average blood pressure of 148/88 mmHg based on eight separate readings. The nurse practitioner reports the patient's blood pressure as: Normal Elevated Stage 1 hypertension Stage 2 hypertension Solution

Solution: D Stage 2 hypertension. Normal <120 mmHg systole and <80 mmHg.Pre HTN 120 to 129 mmHg diastole <80 mmHg.Stage 1 HTN 130 to 139 mmHg systole or 80 to 89 mmHg diastole.Stage 2 HTN 140 mmHg or a diastole of at least 90 mmHg

Auscultation of normal breath sounds of the chest will reveal: A. Bronchial breath sounds heard at the lower bases B. High-pitched vesicular breath sounds heard over the upper lobes C. Vesicular breath sounds heard over the trachea D. Vesicular breath sounds in the lower lobe

Solution: D Vesicular breath sounds in the lower lobe Normal sounds of the chest wall include vesicular breath sounds in the lower lobes. Bronchial breath sounds are heard best at the second and third intercostal spaces. Tracheal breath sounds are heard over the trachea.

Tanner Stages Girls

Stage I: Prepubertal pattern (Same for Both) Stage II: Breast bud and areola start to develop. Stage III: Breast continues to grow with nipples/areola (one mound/no separation). Stage IV: Nipples and areola become elevated from the breast (a secondary mound). Stage V: Adult pattern (Same for bothe)

What does SOAPE mean?

Subjective, Objective, Assessment, Planning, and Evaluation

What is the preferred therapy for larva migrans.

Systemic treatment with either ivermectin once a day (for 1-2 days) or albendazole (for 3 days) is the preferred therapy for larva migrans

Systolic Murmurs: midsystolic Another Store Profitable Sale (of) Antique Season Dressers HO ray CM all Systolic: Holosystolic murmurs My Regular Tricycle Regularly Violates Set Destinations Late Systolic murmer: Mi Vagina Prolapled

Systolic Murmurs: midsystolic Aortic Stenosis Pulmonic Stenosis Atrial Septal defect HOCM (Hypertrophic Cardiomyopathy) Systolic: Holosystolic murmurs Mitral valve regurgitation Tricuspid regurgitation Ventricular Septal defect Late Systolic murmur: Mitral Valve prolapse

Cavitations on the upper lobes of the lung are one of the classic signs of active or past TB disease.

TB disease.

Is TB is a reportable disease

TB is a reportable disease. Noncompliant patients who refuse treatment can be quarantined to protect the public. A baseline LFT level and follow-up testing are recommended for patients on isoniazid (INH).

Normal Values TSH>5.0 mU/L (hypothyroidism)<0.4 mU/L (hyperthyroidism) PSA<4.0 ng/mL (benign prostatic hyperplasia [BPH], prostate cancer) Ferritin<15 mcg/L (iron-deficiency anemia)

TSH = >5.0 mU/L (hypothyroidism)<0.4 mU/L (hyperthyroidism) PSA = <4.0 ng/mL (benign prostatic hyperplasia [BPH], prostate cancer) Ferritin = <15 mcg/L (iron-deficiency anemia)

The usual recommendation for scabies include

That all family members and close contacts be treated at the same time as the patient (spread by skin-to-skin contact). Used clothes/sheets should be washed in hot water and then dried or ironed with high heat.

Half-life (t½): Means

The amount of time in which drug concentration decreases by 50%.

What area of the bodies are common locations for Cutaneous larva migrans (creeping eruption)

The areas of the body that are commonly exposed directly to contaminated soil and sand, such as the soles of the feet, extremities, or buttocks, are the most common locations for larva migrans

Area under the curve (AUC):

The average amount of a drug in the blood after a dose is given. It is a measure of the bioavailability of a drug after it is administered.

U.S. Preventive Services Task Force (USPSTF) screening guidelines are graded as A, B, C, D, or I (insufficient evidence or evidence is lacking or of poor quality). The highest rating is a Grade

The highest rating is a Grade A (routine screening is advised—high certainty that the net benefit is substantial).

What is the first line of treatment for uncomplicated GERD

The first-line treatment of mild, uncomplicated GERD is lifestyle changes (e.g., avoid eating 3-4 hours before bedtime, dietary changes, weight loss if overweight).

Maximum concentration (Cmax):

The peak serum concentration of a drug

The BUN is a waste product of the protein from ________________

The protein from foods that you have eaten. If you eat more protein before the test, it will increase (or decrease with low protein intake).

Side effects of thiazide diuretics

Thiazide diuretics are associated with ↑hyperuricemia, ↑hyperglycemia, ↑hyperlipidemia, ↑hypercalcemia. ↓ K+, ↓ NA, ↓hypomagnesemia

What is the preferred treatment for Dog/wood tick bite; spirochete called Rickettsia rickettsii

Treat with doxycycline 100 mg orally or by IV for a minimum of 7 days or longer.

example of Sulfa drug

Trimethoprim-sulfamethoxazole (Bactrim, Septra), nitrofurantoin (Macrobid)

PLETAL is a ________________ It can treat intermittent problems with blood flow in the legs (claudication) by enabling people to walk longer distances with less pain.

Vasodilator It can treat intermittent problems with blood flow in the legs (claudication) by enabling people to walk longer distances with less pain.

foods to avoid with celiac disease/celiac sprue

Wheat (including spelt and kamut), rye, barley (breads, cereals, pasta, cookies, cakes) Gluten free (safe carbohydrates): Corn, rice, potatoes, quinoa, tapioca, soybeans

A 4-year-old child presents with a red, swollen, painful blister-type lesion on his lower back, fever of 101°F, and vomiting for 24 hours. His mother reports that the child was playing with a box of toys that were brought down from the attic the day before. The nurse practitioner will: A. Wash the lesion and apply antibiotic cream B. Prescribe tazarotene 0.1% cream C. Apply hydrocolloid and silver-impregnated dressings D. Prescribe doxycycline 100 mg BID × 10 days

Wash the lesion and apply antibiotic cream The history indicates the probability that the child was bitten by a brown recluse spider living in the box from the attic, as spiders prefer dark places to hide. The bite should be washed with soap and water and then treated with an antibiotic cream. A poisonous spider bite generally will form a blister (eschar) and then ulcerate. It can take several weeks to heal. Tazarotene cream is a retinoid prescribed for psoriasis. Hydrocolloid and silver-impregnated dressings are used to treat burns. Doxycycline is first-line treatment for the tick-borne diseases Rocky Mountain spotted fever and Lyme disease, which are generally contracted outside the house.

The gold-standard exam for temporal arteritis is

a biopsy of the temporal artery. Refer the patient to an ophthalmologist for management.

If a patient is at high risk for esophageal cancer (aged 50 years or older, smoker, chronic GERD for decades), consider referral to

a gastroenterologist for an upper endoscopy.

A karyotype is an individual's complete set of chromosomes; A karyotype may be used to look for? think Turner syndrome.

abnormalities in chromosome number or structure

Example: A patient with chronic obstructive pulmonary disease (COPD) is prescribed ipratropium bromide (Atrovent) for dyspnea. On follow-up, the patient complains that the symptoms are not relieved. The next step would be to prescribe

an albuterol inhaler (Ventolin) or a combination inhaler.

Patients diagnosed with Barrett's esophagus typically have endoscopic examinations with biopsy by a gastroenterologist how frequently?

annually (or every 6 months for high-grade lesions).

Patients with an atopic history (asthma, eczema, allergic rhinitis) with nasal polyps are at higher risk for

aspirin and nonsteroidal anti-inflammatory drug (NSAID) allergies.

the differential diagnoses to consider for chronic cough (a cough lasting more than 8 weeks) are asthma, GERD, ACE inhibitors, chronic bronchitis, lung cancer, and lung infections such as TB (and many more).

asthma, GERD, ACE inhibitors, chronic bronchitis, lung cancer, and lung infections such as TB (and many more).

Diseases that are selected for case management are usually chronic conditions, such as

asthma, congestive heart failure (CHF), HIV infection, and chronic psychiatric conditions. A good outcome will show good symptom control and no exacerbations or hospitalizations.

Become familiar with lupus or systemic lupus erythematosus (SLE). Example: A malar rash (butterfly rash) is present in most patients with lupus. These patients should be advised to

avoid or minimize sunlight exposure (photosensitivity).

USPSTF Screening Guidelines Breast cancer (2018) Baseline mammogram should begin at age?

at age 50 years Screen every 2 years until age 74 years (biennial) After age 75 years (insufficient evidence)

If Patient with AOM If penicillin allergic, an alternative is azithromycin (Z-Pack) and clarithromycin (Biaxin) BID.

azithromycin (Z-Pack) and clarithromycin (Biaxin) BID. Pseudoephedrine (Sudafed) is for symptoms only. Do not use for infants, young children, or patients with hypertension

Become knowledgeable about physical exam "normal" and "abnormal" findings. Example: When checking deep tendon reflexes (DTRs) in a patient with severe sciatica or diabetic peripheral neuropathy, the ankle jerk reflex (Achilles reflex) may be?

be absent or hypoactive. Scoring: absent (0), hypoactive (1), normal (2), hyperactive (3), and clonus (4).

Septicemia (sepsis)

blood culture

the Food and Drug Administration (FDA) recommended genotyping all Asians (for HLA-B*1502) before starting ________Therapy

carbamazepine (Tegretol) therapy (Anticonvulsant). This allele is highly associated with severe to fatal carbamezapine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (mortality as high as 30%). It is most common among Chinese, but it is also present in other Asian groups (e.g., Malays, Thai, Filipino, Indian

The chest radiograph of a person with active pulmonary TB or a history of pulmonary TB (lung scarring) may show ___________ that are usually located on the ______________.

cavitations upper lobes.

Anticonvulsants, such as carbamazepine (Tegretol), are also used for

chronic pain and trigeminal neuralgia.

Some drugs that have extensive first-pass metabolism effects cannot be given by the oral route, simply because there is not enough of the active drug left. A good example is insulin, which, if given by the oral route, would be?

completely broken down in the gastrointestinal (GI) tract (by enzymes). To bypass first-pass metabolism, insulin must be given by the parenteral route.

Learn about the preferred and/or first-line drug used to treat some diseases. Example: ACEIs or angiotensin receptor blockers (ARBs) are the preferred drugs to treat hypertension in

diabetics and patients with renal disease because of their renal-protective properties.

Changes in LOC on the test are usually subtle changes. Signs to watch for include?

difficulty answering questions, slurred speech, apparent confusion, inability to understand instructions/conversation, being sleepy/lethargic, and so forth.

Do not pick answers that "reassure" patients about their issues, because this discourages them from verbalizing more about it

discourages them from verbalizing more about it

Acute otitis externa is a superficial infection of the skin in the ear canal. It is more common during warm and humid conditions such as swimming and summertime.

during warm and humid conditions such as swimming and summertime.

Barrett's esophagus is the "precancerous" lesion of_________ cancer. It is best managed by a _______________________________not an oncologist

esophageal cancer. gastroenterologist

Nicotinic acid (Niacin) can treat high cholesterol and triglyceride levels as well as niacin deficiency. It can also reduce the risk of heart attack and slow narrowing of the arteries

heart attack and slow narrowing of the arteries

Oral Drugs: First-Pass Hepatic Metabolism (First-Pass Effect) All oral drugs except __________ must go through "first-pass metabolism" before they can be released and used by the body.

except sublingual drugs

Legionella pneumonia (Legionnaire's disease) is uncommon in primary care. Look for a history of exposure to

exposure to "nebulized" water sources (e.g., air conditioners, fountains). Presents with pneumonia signs/symptoms that are accompanied by gastrointestinal (GI) symptoms (diarrhea, nausea/vomiting).

Screening for depression in all adolescents is recommended. Signs of a depressed teen include?

falling grades, acting out, avoiding socializing, moodiness, and so forth.

The signs and symptoms of CAP include?

fever and cough productive of green sputum with a small amount of blood (or rust-colored sputum). Rust-colored sputum is associated with Streptococcus pneumoniae infection.

Nonpharmacologic interventions such as alternative and herbal medicines are also included. For example, the herb feverfew is used for

feverfew used for migraine, irregular menstrual periods, tinnitus, and other conditions.

The most common triggers for anaphylaxis in children are

foods. Medications and insect stings are the most common triggers in adults.

All oral drugs must go through "first-pass metabolism" before they can be released and used by the body. When a drug is swallowed, it goes down the esophagus, reaches the stomach, and passes to the small intestine. When it is in the small intestine, it enters the portal circulation and reaches the liver. Inside the liver, the cytochrome P450 (CYP450) system is responsible?

for the biotransformation (metabolism) of the drug. When it is completed, the active drug is released to the body where it can be used.

The serum creatinine is affected by age (less sensitive in elderly), and what other factors?

gender (higher in males), ethnicity (higher with African background), and other factors.

The strongest risk factor for ovarian cancer (or breast cancer) is ?

genetic predisposition, such as BRCA1 or BRCA2 mutations and positive family; The absolute risk of developing ovarian cancer is 35% to 45% in women with BRCA1 mutation other risk factors are age, obesity, clomiphene (Clomid) use, and early-age menarche or late-onset menopause.

The rash of scarlatina is described as?

has a sandpaper-like texture and is accompanied by a sore throat, strawberry tongue, and skin desquamation (peeling) of the palms and soles. It is not pruritic. The red rash of scarlet fever usually begins on the face or neck, later spreading to the chest, trunk, arms and legs. Scarlet fever is a bacterial illness that develops in some people who have strep throat.

A "geographic tongue"

has multiple fissures and irregular smoother areas on its surface that make it look like a topographic map. The patient may complain of soreness on the tongue after eating or drinking acidic or hot foods.

the "gold-standard test" or the diagnostic test for a condition. Example: The diagnostic or gold-standard test for sickle cell anemia, glucose-6-phosphate dehydrogenase (G6PD) anemia, and alpha or beta thalassemia is the

hemoglobin electrophoresis.

Patients with Barrett's esophagus are treated with a

high-dose PPIs for a "lifetime."

An adult (21-75 years) with any type of ASCVD (e.g., CAD, PAD, stroke, TIA) is given ___________-intensity statins such as __________ 40 to 80 mg or _____________ 20 to 40 mg.

high-intensity statins such as atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg. An adult with LDL >190 mg/dL (without ASCVD or DM) is a candidate for high-intensity statin dosing. If patient has markedly high triglycerides (500 mg/dL or higher), lower triglycerides first (niacin or fibrate) before treating the high cholesterol and LDL levels. Very high triglycerides increase risk of acute pancreatitis.

Do not give suicidal patients a prescription for TCAs, because of the high risk of?

hoarding the drug and overdosing. Overdose of TCAs can be fatal (cardiac and central nervous system [CNS]

Foods and supplements containing stimulants, such as caffeine and ephedra, are best avoided by patients with

hypertension, arrhythmias, high risk for MI, hyperthyroid disease, albuterol use, amphetamine use, and so on.

A good outcome for children with asthma is their ability to attend school full time and to play normally every day. What is a poor case management outcome.

if the child misses school and/or is unable to play because of poor control of asthma symptoms

High sodium containing foods increases 1. ___________, and can increase 2.________ 3. Foods containing high sodium

increases 1. water retention, can increase 2. BP 3. Cold cuts, pickles, preserved foods, canned foods, hot dogs, chips

Abuse Questions: If a history is being taken, pick the open-ended question first. Interview both the patient and possible "abuser" together, and then?

interview the patient separately.

What are Drug formulations that bypass first-pass metabolism are intravenous (IV) and other parenteral drugs, vaginal gels/creams, and drugs absorbed by the skin (transdermal patches).

intravenous (IV) and other parenteral drugs, vaginal gels/creams, and drugs absorbed by the skin (transdermal patches).

elevated RDW is one of the earliest indicators of

iron-deficiency anemia.

Example: The American Academy of Pediatrics (AAP) recommends that breastfed infants should be started on vitamin D during the first few days of life; then at age 4 months,

iron-supplementation is recommended (formula contains vitamins/minerals so no need to supplement).

The preferred treatment for cutaneous anthrax

is ciprofloxacin 500 mg orally twice a day for 60 days or 8 weeks. If the patient is allergic to ciprofloxacin, use doxycycline 100 mg twice a day. Cutaneous anthrax is not contagious; it comes from touching fur or animal skins that are contaminated with anthrax spores.

An example of a sentinel event involving medications is when a patient who is allergic to a drug (e.g., macrolides) is prescribed erythromycin, resulting in death of the patient due to anaphylaxis.

is when a patient who is allergic to a drug (e.g., macrolides) is prescribed erythromycin, resulting in death of the patient due to anaphylaxis.

A GFR value of 60 mL/min/1.73 m2 or less is a sign of?

kidney damage (refer to a nephrologist).

Anticoagulation therapy (e.g., warfarin sodium or Coumadin) Avoid eating large amounts of?

leafy green vegetables (kale/collard greens, spinach, cabbage, broccoli) and cooking with canola oil (high in vitamin K); use other oils instead. High levels of vitamin K decrease the effects of warfarin sodium.

The main organ of biotransformation of drugs is the ?_____________

liver. The CYP450 enzyme system is the most active. It can either be induced (increase drug metabolism) or be inhibited (slow down drug metabolism).

unipolar depression is the same disease entity as?

major/minor depression. Depression in bipolar patients is called bipolar depression.

TCAs are also used as prophylactic treatment for?

migraine headaches, chronic pain, and neuropathic pain (i.e., tingling, burning) such as postherpetic neuralgia. Examples of TCAs are amitriptyline (Elavil), nortriptyline (Pamelor), doxepin (Sinequan), desipramine (Norpramin).

Renal filtration accounts for

most of drug excretion. The kidney is the principle organ for drug elimination. As people age, renal drug excretion is decreased because of physiologic decline in glomerular filtration. Chronic kidney disease alters renal drug metabolism and increases the risk of adverse drug reactions. See Table 1 for drugs affected by kidney disease.

Adolescents; According to the CDC, the number one cause of mortality in this age group is motor vehicle crashes

motor vehicle crashes

In a case scenario about a patient with symptoms of gout and a new diagnosis or a history of hypertension, it is best?

not to pick a thiazide diuretic as the treatment, because they are contraindicated in gout.

Other health theorists who have been included on the exams in the past are (not inclusive) Alfred Bandura (self-efficacy), Erik Erikson, Sigmund Freud, Elisabeth Kübler-Ross (grieving), and others. Example: If a small child expresses a desire to marry a parent of the opposite sex, the child is in which stage

oedipal stage (Freud). The child's age is about 5 to 6 years (preschool to kindergarten).

Tenderness of the mastoid area is not a complication of otitis externa (swimmers ear)

otitis externa.

The USPSTF (2018) is against routine screening for

ovarian cancer in asymptomatic women who are not known to have a high risk of hereditary cancer syndrome.

The rash of impetigo initially appears as _________________________

papules that develop into bullae. These rupture easily, becoming superficial, bright-red "weeping" rashes with honey-colored exudate that becomes crusted as it dries. The rashes are very pruritic and are located on areas that are easily traumatized, such as the face, arms, or legs. Insect bites, acne lesions, and varicella lesions can also become secondarily infected, resulting in impetigo.

USPSTF Screening Guidelines: Tobacco smoking (2020) Ask all adults about tobacco use, advise them to stop smoking, and_________

provide behavioral interventions/pharmacotherapy (if not pregnant) for smoking cessation.

Choosing the Correct Drug I. Discussion Test-takers are expected to know not only a drug's generic and/or brand name, but also its drug class. If you are familiar only with the drug's brand name or generic form, you will still be able to recognize the drug on the test because both names will be listed. In addition, the drug's action, indication(s), common side effects, drug interactions, and contraindications are important to learn. Drugs may only be listed as a drug class.

refresh medication knowledge

If Chest pain is not related to meals (rule out GERD).

rule out GERD

regarding angiotensin-converting enzyme inhibitors (ACEIs) (e.g., enalapril, lisinopril, captopril) and angiotensin receptor blockers (ARBs; e.g., losartan, valsartan, irbesartan), what levels should be monitored at baseline, within the first month, and periodically, especially in the elderly, diabetics, and those with chronic kidney disease (CKD).

serum potassium and serum creatinine

At the age of 6 months, infants can

sit without support; roll over front to back, then from back to front; transfer objects from one hand to the other; use a raking grasp; and babble.

For pulmonary TB, a ______________culture is the gold standard

sputum culture is the gold standard. Treatment is started with at least three antitubercular drugs because of high rates of resistance. When the sputum culture and sensitivity result are available, the antitubercular antibiotic treatment can be narrowed down or changed. Another drug can be added.

A 7-year-old child with acute otitis media (AOM) who is treated with amoxicillin returns in 48 hours without improvement (complains of ear pain, bulging tympanic membrane). The next step is to discontinue the amoxicillin and

start the child on a second-line antibiotic such as amoxicillin-clavulanate (Augmentin) twice a day × 10 days.

Disease states are usually presented in their full-blown "classic" textbook presentations. Example: In a case of acute mononucleosis, the patient will most likely be a teen presenting with the classic triad of sore throat, prolonged fatigue, and enlarged cervical nodes. If the patient is older, but has the same signs and symptoms, it is

still mononucleosis (reactivated type).

The second most common cause of mortality in adolescents in the United States is

suicide, and the third is homicide.

An indurated cord-like vein would be present in a patient with?

superficial thrombophlebitis.

Erysipelas is a type of cellulitis caused by?

strep

Become familiar with polymyalgia rheumatica (PMR). Example: First-line treatment for PMR includes long-term steroids. Long-term, low-dosed steroids are commonly used to control symptoms (pain, severe stiffness in shoulders and hip girdle). PMR patients are also at higher risk for

temporal arteritis.

The other organ systems that are involved in drug metabolism are?

the kidneys, the GI tract (breakdown by gut bacteria), lungs, plasma, and skin.

Patients with asthmatic exacerbations whose PEF is <50% of predicted value after being given nebulized albuterol/saline treatments should

the patient should not be discharged. Consider calling 911. The differential diagnosis for an early-morning cough includes postnasal drip, allergic rhinitis, sinusitis, GERD, and so forth.

If a patient has an infection that responds well to macrolides, but they think they are "allergic" to erythromycin (symptoms of nausea or gastrointestinal [GI] upset), inform them that

they had an adverse reaction, not a true allergic reaction (hives, angioedema).

Otitis externa does not involve the middle ear or the tympanic membrane and you should expect what finding on assessment.

translucent tympanic membrane with intact landmarks, no redness, no bulging.

Niacin and fibrates are best agents for lowering? A. LDL B. HDL C. triglycerides

triglycerides

Lobar pneumonia does not include cavitations. It will show a?

white-colored patchy area on one of the lobes of the lungs.

Oral hairy leukoplakia (OHL) of the tongue is?

(OHL) of the tongue is a painless white patch (or patches) that appears corrugated. It is usually located on the lateral aspects of the tongue (or other areas inside the mouth) and is associated with HIV and AIDS infection. It is caused by Epstein-Barr virus (EBV) infection of the tongue. It is not considered a premalignant lesion.

Plant sterols and stanols are known to reduce

(reduce cholesterol, LDL, triglycerides): Sterol-fortified spreads (Benecol spread), sterol-fortified foods, wheat germ, sesame oil

pH (vagina normally has an acidic pH of?

(vagina normally has an acidic pH of 3.5-4.5)

USPSTF Screening Guidelines: Abdominal aortic aneurysm (2019) One-time screening in men

One-time screening (men aged 65-75 years) for cigarette smokers or those who have quit. Screening test is ultrasound of abdomen

1. Most common cancer in females: 2. Most common cancer in males: 3. Most common type of cancer overall (males/females): 4. Most common type of skin cancer (males/females): 5. Skin cancer with the highest mortality: 6. Gynecological cancer 7. Most common gynecological cancer 8. Second most common gynecological cancer)

1. Breast cancer 2. Prostate cancer 3. Skin cancer 4. Basal cell cancer 5. Melanoma 6. (vulva, vagina, cervix, uterus, ovary): 7. Uterine/endometrial cancer 8. Ovarian cancer

1. Disease-causing the most deaths overall: Heart disease 2. Cancer with the highest mortality: 3. Cancer with the highest mortality in males and females: 4. Most common cause of death in adolescents: Motor vehicle crashes

1. Heart disease 2. Lung cancer 3. Lung cancer 4. Motor vehicle crashes

Sometimes, a question will ask about a gender-specific cause. For example, the most common cancer in females is 1.___________r, and the most common cancer in males is 2.__________ (prevalence). But the cancer causing the most deaths overall for both males and females is still 3.______________(mortality).

1. breast cancer 2. prostate cancer 3. lung cancer

Determine whether a question is asking about the most common cause of death (mortality) or whether it is asking about the most common cause of a certain disease in a population (prevalence). For example, the most common cause of cancer death overall is lung 1.___________ (mortality), but the most common cancer overall (prevalence) is 2._________ The most common type of skin cancer is 3.___________basal cell skin cancer.

1. lung cancer 2. skin cancer 3. basal cell skin cancer

I. Discussion There are basically three kinds of food-related questions on the exam. You may be asked to pick the foods that have high levels of certain minerals, such as potassium, calcium, or magnesium. Other questions will address food interactions, example tetracycline and 1. __________, drug interactions (monoamine oxidase inhibitor [MAOI] and 2. ____________________________________, or foods that should be avoided for a particular disease e.g., in the case of celiac disease you should avoid? 3._________

1. tetracycline and dairy: 2. high-tyramine-containing foods such as fermented foods), 3. wheat products If one of the food choices in an answer option is incorrect, rule out this option because all of the foods on the list have to be correlated.

USPSTF Screening Guidelines: Colorectal cancer (2016) Baseline screening at age?

50 years Use high-sensitivity fecal occult blood test (yearly) or sigmoidoscopy (every 5 years) or colonoscopy (every 10 years) from age 50 to 75 years; aged 76-85 years, individualize.

Regarding breast cancer screening, the USPSTF (2018) currently recommends that a screening baseline mammogram (with or without clinical breast exam) start at age of_____________

50 years and then every 2 years until the age of 74 years. For women aged 40 to 49 years, mammograms should be based on individual factors (such as risk factors, preferences, risk vs. benefits of mammograms).

Which of the following antibiotics is the preferred treatment for healthy adults diagnosed with uncomplicated CAP? Azithromycin (Zithromax Z-Pak 250 mg) 500 mg on day 1, then 250 mg daily for 4 days Dextromethorphan with guaifenesin (Robitussin DM) 1 to 2 teaspoons PO QID as needed Cephalexin (Keflex) 500 mg PO QID × 10 days Levofloxacin (Levaquin) 500 mg PO daily × 7 days

A. Azithromycin (Zithromax Z-Pak 250 mg) 500 mg on day 1, then 250 mg daily for 4 days

Using the drug class as the answer option: A previously healthy 30-year-old complains of an acute onset of fever and chills accompanied by a productive cough with purulent sputum and a loss of appetite. The patient denies receiving an antibiotic in the previous 3 months. The NP diagnoses CAP. The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) treatment guidelines recommend which of the following as the preferred first-line treatment for this patient? Macrolides Antitussives Cephalosporins Fluoroquinolones with gram-positive bacteria activity

A. Macrolides

What is the most common type of gynecological cancer? A. Uterine cancer B. Cervical cancer C. Breast cancer D. Ovarian cancer

A. Uterine cancer There may be a question about the gynecological cancers. These types of cancers are located in the pelvis (labia, vagina, uterus, fallopian tubes, ovaries). Breast cancer is not classified as a gynecological cancer.

USPSTF Screening Guidelines: Prostate cancer Screening age is?

Aged 55-69 years, PSA-based screening should be individualized; ≥70 years, against prostate cancer screening.

A 65-year-old female smoker presents with a history of Barrett's esophagus and gastroesophageal reflux disease (GERD). The patient reports that her gastroenterologist's prescription for esomeprazole (Nexium) 40 mg daily ran out a few days ago. She is complaining of severe heartburn and a sore throat. During the physical exam, the NP notes an erythematous posterior pharynx without tonsillar discharge and mild dental enamel loss on the rear molars. What is the best initial action for the NP to follow? A. Refer the patient to an oncologist for a biopsy to rule out esophageal cancer. B. Give the patient a refill of her proton-pump inhibitor (PPI) prescription and advise her to schedule an appointment with her gastroenterologist. C. Recommend that the patient take over-the-counter (OTC) ranitidine (Zantac) twice a day until she can be seen by her gastroenterologist. D. Switch the patient's prescription to another brand of PPI because her symptoms are not improving.

B. Give the patient a refill of her proton-pump inhibitor (PPI) prescription and advise her to schedule an appointment with her gastroenterologist. Best Clues Rule out option A because the patient is already under the care of a gastroenterologist. OTC ranitidine (Zantac) is not potent enough to control the symptoms of erosive esophagitis. A PPI is the preferred treatment for erosive esophagitis. Do not switch the patient to another brand of PPI. Her worsening symptoms are due to rebound caused by abrupt cessation of PPI. The best initial action in this case is to refill the PPI prescription because the patient is fully symptomatic (erosive esophagitis) until she can see her gastroenterologist.

Which of the following foods are known to have high potassium content? A. Low-fat yogurt, soft cheeses, and collard greens B. Aged cheese, red wine, and chocolate C. Potatoes, apricots, and Brussels sprouts D. Black beans, red meat, and citrus juice

C. Potatoes, apricots, and Brussels sprouts Best Clues First, look at the answer options for inconsistencies in the list of foods. Rule out option A because it is inconsistent and these foods do not contain high levels of potassium: low-fat yogurt and soft cheeses (calcium) with collard greens (vitamin K). B Aged cheese, red wine, and chocolate have a high tyramine, not potassium, content. D because it is inconsistent. Although citrus juices are high in potassium, both black beans and red meat are not (iron). If options A, B, and D are incorrect, then the only one left is option C (potatoes, apricots, and Brussels sprouts). A large number of fruits and vegetables are rich in potassium and vitamins.

II. Example A 14-year-old boy is brought in by his mother for a physical exam. Both are concerned about his breast enlargement. The teen denies breast tenderness. On physical exam, the NP palpates soft breast tissue that is not tender. No dominant mass is noted. The skin is smooth, and there is no nipple discharge with massage. The teen has a body mass index (BMI) of 29. Which of the following statements is correct? A. Advise the mother that the patient has physiologic gynecomastia and should return for a follow-up exam. B. Order an ultrasound of both breasts to further assess the patient's breast tissue development. C. Reassure the mother that the patient's breast development is within normal limits. D. Educate the mother that her son has pseudogynecomastia.

D. Educate the mother that her son has pseudogynecomastia. \Best Clues The boy is very overweight (BMI 29) and is almost obese. The clinical breast exam does not show palpable breast tissue. Instead, the breast palpation reveals soft fatty tissue. It is wrong to "reassure" a patient or family member in the exam (poor therapeutic communication technique). Notes Physiologic gynecomastia physical exam findings will show disklike breast tissue that is mobile under each nipple/areola; the breast may be tender, and the breast can be asymmetrical (one breast larger than the other). A BMI of 25 to 29.9 is considered overweight. Obesity is a BMI of 30 or higher. Overweight to obese males are at highest risk for pseudogynecomastia.

II. Example What is the USPSTF screening recommendation for ovarian cancer? A. Annual bimanual pelvic exam with pelvic ultrasound B. Pelvic and intravaginal ultrasound C. Intravaginal ultrasound with CA-125 tumor marker D. The USPSTF does not recommend routine screening of women for ovarian cancer (Grade D)

D. The USPSTF does not recommend routine screening of women for ovarian cancer (Grade D) Transvaginal ultrasound and CA-125 are not used for routine screening. Although the bimanual pelvic exam is "low tech," it is being used as a distractor.

USPSTF Screening Guidelines; Hysterectomy (no cervix)

Do not screen (if no history of precancer or cervical cancer).

Omega-3 or fish oils (decrease risk of heart disease): what are some examples fish and foods?

Fatty cold-water marine fish (salmon), fish oils, flaxseed oil, and krill oil

Example C The following is an example of a question about a common side effect: Which of the following are possible side effects that may be seen in a patient who is being treated with hydrochlorothiazide for hypertension? A. Dry cough and angioedema B. Swollen ankles and headache C. Hyperuricemia and hyperglycemia D. Fatigue and depression

Hyperuricemia and hyperglycemia Example A is caused by angiotensin-converting enzyme (ACE) inhibitors. Look for a sudden or new onset of a dry cough in a patient with hypertension (without signs of the common cold). Angioedema is a rare adverse effect and can be life-threatening. Example B is caused by calcium channel blockers (CCBs). Look for a hypertensive patient with swollen ankles (not associated with heart failure) and headache. Example C is caused by thiazide diuretics (hyperuricemia and hyperglycemia). Example D is caused by beta-blockers. Look for a patient with a history of myocardial infarction (MI), heart failure, and/or hypertension who complains of increased fatigue and depression (avoid if possible in depressed patients, pulse <50 beats/min, second- or third-degree heart block).

Foods with a high tyramine content can cause dangerous food-drug interactions with?

MAOI inhibitors (e.g., isocarboxazid [Marplan], phenelzine [Nardil], and tranylcypromine [Parnate]). Tyramine (TIE-ruh-meen) is an amino acid that helps regulate blood pressure. It occurs naturally in the body, and it's found in certain foods. Medications called monoamine oxidase inhibitors (MAOIs) block monoamine oxidase, which is an enzyme that breaks down excess tyramine in the body. Blocking this enzyme helps relieve depression. If you take an MAOI and you eat high-tyramine foods, tyramine can quickly reach dangerous levels. This can cause a serious spike in blood pressure and require emergency treatment.

Neutrophil values

Neutrophils: 40% to 60% Lymphocytes: 20% to 40% Monocytes: 2% to 8% Eosinophils: 1% to 4%

Monounsaturated fats/fatty acids ↓↓↓ (decrease risk of heart disease): what are some examples?

Olive oil, canola oil, some nuts (almonds, walnuts), sunflower oil/seeds Mediterranean diet, which is high in monounsaturated fats

Tanner Stages Boys

Stage I: Prepubertal pattern (Same for both) Stage II: Testes and scrotum start to enlarge (scrotal skin starts to get darker/more rugae). Stage III: Penis grows longer (length) and testes/scrotum continues to become larger. Stage IV: Penis become wider and continues growing in length (testes are larger with darker scrotal skin and more rugae). Stage V: Adult pattern (same for both) Scrotal skin has small elevations (rugae) on the surface and is more pigmented than the remainder of the body,

Starting at the age of about 11 years, most children can understand abstract concepts (early abstract thinking) and are better at logical thinking. Example: When performing the Mini-Mental State Exam, when the NP is asking about "proverbs," the nurse is assessing the patient's ability to understand

abstract concepts.

Leukoplakia

is not a benign variant. It appears as a slow-growing white plaque that has a firm to hard surface that is slightly raised on the tongue or inside the mouth. It is considered a precancerous lesion. It is due to chronic irritation of the skin or precancerous changes on the tongue and inside the cheeks. Its causes include poorly fitting dentures, chewing tobacco (snuff), and using other types of tobacco. Refer the patient for a biopsy because it can sometimes become malignant.

The majority of the medicines seen on the exam are the well-known drugs that have been in use for a few years to many decades (e.g., doxycycline, penicillin, amoxicillin). Memorize drug class and some representative drugs from that class. For example, in the quinolone drug class are drugs such as

ofloxacin (Floxin), moxifloxacin (Avelox), and levofloxacin (Levaquin).

Always rule out ovarian cancer in a postmenopausal woman who has a palpable

ovary. The next step is to order a pelvic and intravaginal ultrasound with CA-125. Refer to an oncologist

A navicular stress fracture is an injury is often seen in athletes due to

overuse or trauma. Navicular fractures tend to worsen over time and feel most painful during or after periods of exercise; Navicular fractures can occur in the middle of the foot. They also occur in the wrist, as one of the eight carpal bones at the base of the hand is also known as the scaphoid or navicular bone

There are some questions on theories and conceptual models. Example: Stages of change or "decision" theory (Prochaska) include concepts such as?

precontemplation, contemplation, preparation, action, and maintenance.

Physical exam findings in children that are abnormal with serious consequences might be included. Example: Leukocoria (white color) is noted on one eye while checking for the red reflex. Rule out

retinoblastoma of the eye, which is a malignant tumor of the retina.

If there is a case scenario of an older woman who complains of vague abdominal/pelvic symptoms (stomach bloating, low-back ache, constipation) and is found to have a palpable ovary during the bimanual exam, you should

rule out ovarian cancer.

torus palatinus

s a benign growth of bone (an exostosis) located midline on the hard palate and covered with normal oral skin. It is painless and does not interfere with function.

USPSTF Screening Guidelines: Ovarian cancer (2018) Routine screening is not recommended. High-risk (BRCA mutation, family history of breast/ovarian cancer) are screened by ?

specialist; refer for genetic counseling.

Category X: The risk of use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are, or may become pregnant. Examples:

thalidomide, oral contraceptives, statins (e.g. Lipitor) What are some Category X drugs? Category X Drugs Valproate. Methotrexate. Ribavirin. Triazolam. Bosentan. Aliskiren. Emergency contraception: Levonorgestrel, Ulipristal. Griseofulvin.

injury to the Kiesselbach's plexus

will result in an anterior nosebleed.