AANP REVIEW Questions 1
pain-management strategies that can occasionally alleviate pain after a herpes zoster outbreak occurs.
Capsaicin and amitriptyline
aggressive form of squamous cell carcinoma characterized by a well-defined, circumscribed, erythematous scaly patch.
Bowen's disease
Iron therapy used to treat iron deficiency anemia should last how long once the underlying cause has been successfully addressed?
2 months
A 64-year-old man presents with an eruption of painful lesions on his trunk and he is concerned that he has shingles. When considering a possible diagnosis, which of the following is most consistent with herpes zoster?
A 1-2-day prodrome of pain prior to lesions erupting
Person most likely to develop folate-deficiency anemia?
A 24-year-old woman with celiac disease
Which of the following is most at risk of beta thalassemia minor
A 26-year-old man of Middle Eastern ancestry and generally healthy
You are involved in the care of a 72-year-old patient who is terminally ill and can no longer communicate his healthcare decisions. Which of the following provides legal authorization of another person to make healthcare decisions for the patient?
A durable power of attorney for health care
patients would be an appropriate recipient of the high-dose influenza vaccine (Fluzone®) or adjuvanted influenza vaccine (Fluad®)?
A healthy 68-year-old man who receives the seasonal influenza vaccine annually.
melanoma is generally found on the nails, soles, and palms.
Acral lentiginous
Increase in number of WBCs
Leukocytosis
a reduction in the number of WBCs.
Leukopenia
Type of anemia that can be confirmed with hemoglobin electrophoresis
Thalessemia
genetic disorder resulting in a stable anemia of long duration and is associated with normal RDW
Thalessemia anemia
also known as athlete's foot
Tinea Pedis
Which of the following statements is false regarding basal cell carcinoma (BCC)
BCC has a high rate of metastasis
our ethical duty to help those in need—to do the greatest good.
beneficence
You see a 54-year-old truck driver who has been treating a small (2 mm) actinic keratosis lesion on his left hand with topical 5-fluorouracil for 4 weeks, with his last dose of medication approximately 3 months ago. You notice that the lesion has increased slightly in size since 2 weeks ago and shows signs of ulceration. You recommend
biopsy of the lesion
pearly, painless presentation, though it can take other forms. and occurs most often on areas of the skin that are often exposed to sunlight, such as the head, neck, and back.
Basal Cell carcinoma
available by prescription or over-the-counter and is the standard baseline ingredient in products to treat mild-to-moderate acne.
Benzoyl peroxide
You see a 34-year-old woman of Middle Eastern ancestry who is being evaluated during her initial visit as a new patient in your practice. She does not report any health issues and appears generally well. Her hemogram reveals Hb 11.4 g/dL (114 g/L) (12-14 g/dL [120-140 g/L]), MCV 72 fL (81-96 fL), MCHC 26.6 g/dL (266 g/L) (31-37 g/dL (310-370 g/L)), RBC 6.8 million/mm3 (4.7-6.1 million/mm3), and RDW 12.8% (0.128 proportion) (11.5-15% [0.115-0.15 proportion]).
Beta thalassemia minor
A viral infection typically results in an elevation of
lymphocytes
A bacterial infection typically results in an elevation of
neutrophils
unlikely to be noted in a person with psoriasis vulgaris?
the face is invloved
When counseling a 16-year-old on the use of topical antimicrobial therapy for the treatment of acne present on his face and upper back, the NP realizes that additional education is needed when the patient states:
"I should see improvement in 7 to 10 days." and "I should only put the medicine on just the pimples I have now."
Hb 10.2 g/dL (102 g/L) (12-14 g/dL [120-140 g/L]); MCV 85 fL (81-96 fL); MCHC 33.8 g/dL (338 g/L) (31-37 g/dL [310-370 g/L]); RDW 13.2% (0.132 proportion) (11.5-15% [0.115-0.15 proportion]); RBC 3.1 million/mm3 (4.2-5.4 million/mm3)
Fecal occult blood test
loyalty, fairness, truthfulness, advocacy, and dedication to the patient, and refers to the concept of keeping this commitment and is based upon the virtue of caring.
Fidelity
macrocytic, normochromic anemia
Folic acid or Vitamin B12 deficiency
Which of the following hemograms is most consistent with anemia of chronic disease? Hb 8.2 g/dL (82 g/L) (12-14 g/dL [120-140 g/L]); MCV 110 fL (81-96 fL); MCHC 35.8 g/dL (358 g/L) (31-37 g/dL [310-370 g/L]); RDW 17.2% (0.172 proportion) (11.5-15% [0.115-0.15 proportion]); Reticulocytes 2.4% (0.024 proportion) (1-2% [0.01-0.02 proportion]) Hb 9.2 g/dL (92 g/L) (12-14 g/dL [120-140 g/L]); MCV 105 fL (81-96 fL); MCHC 36.4 g/dL (364 g/L) (31-37 g/dL [310-370 g/L]); RDW 13.2% (0.132 proportion) (11.5-15% [0.115-0.15 proportion); Reticulocytes 4.0% (0.04 proportion) (1-2% [0.01-0.02 proportion]) Hb 10.0 g/dL (100 g/L) (12-14 g/dL[120-140 g/L]); MCV 84 fL (81-96 fL); MCHC 32.4 g/dL (324 g/L) (31-37 g/dL [310-370 g/L]); RDW 12.6% (0.126 proportion) (11.5-15% [0.115-0.15 proportion]); Reticulocytes 0.8% (0.008 proportion) (1-2% [0.01-0.02 proportion]) Hb 10.4 g/dL (104 g/L) (12-14 g/dL [120-140 g/L]); MCV 75 fL (81-96 fL)
Hb 10.0 g/dL (100g/L) (12-14 g/dL [120-140 g/L]); MCV 84 fL (81-96 fL); MCHC 32.4 g/dL (324 g/L) (31-37 g/dL [310-370 g/L]); RDW 12.6% (0.126 proportion) (11.5-15% [0.115-0.15 proportion]); Reticulocytes 0.8% (0.008 proportion) (1-2% [0.01-0.02 proportion]).
most consistent with anemia of chronic disease (ACD)
Hct >24% (>0.24 proportion)
Hb 11.6 g/dL (116 g/L) (12-14 g/dL [120-140 g/L]); MCV 76 fL (81-96 fL); MCHC 29.2 g/dL (292 g/L) (31-37 g/dL [310-370 g/L]); RDW 14.0% (0.14 proportion) (11.5-15% [0.115-0.15 proportion]); RBC 5.8 million/mm3 (4.2-5.4 million/mm3)
Hemoglobin electrophoresis
Passive immunity via administration of immune globulin is NOT available for
Hepatitis C
occurs in areas populated by apocrine glands (axilla, buttocks, and groin) and seborrheic dermatitis is a scalp, not facial, disorder.
Hidradenitis suppurativa
two most common microcytic anemias (low MCV)
Iron deficiency anemia and thalassemia
ensures that all patients are treated fairly and are offered the care they deserve.
Justice
ocalized melanoma that typically occurs on sun-damaged skin of the face and neck.
Lentigo melanoma
Which of the following CBC with differential reports is most likely due to a bacterial infection?
Leukocytes 16,000/mm3 (4,500-11,000/mm3); neutrophils 72% (40-60%); lymphocytes 20% (20-40%); bands 8% (0-5%)
Which of the following is the most consistent finding for a 28-year-old man with suspected acute appendicitis? a) Leukocytes 2,500/mm3 (4,500-11,000/mm3); neutrophils 68% (40-60%); lymphocytes 24% (20-40%); Bands 3% (0-5%) b) Leukocytes 14,000/mm3 (4,500-11,000/mm3); neutrophils 40% (40-60%); lymphocytes 50% (20-40%); Bands 4% (0-5%) c) Leukocytes 24,000/mm3 (4,500-11,000/mm3); neutrophils 65% (40-60%); lymphocytes 25% (20-40%); Bands 7% (0-5%) d) Leukocytes 10,000/mm3 (4,500-11,000/mm3); neutrophils 50% (40-60%); lymphocytes 35% (20-40%); Bands 6% (0-5%)
Leukocytes 24,000/mm3 (4,500-11,000/mm3); neutrophils 65% (40-60%); lymphocytes 25% (20-40%); Bands 7% (0-5%)
The most important treatment option for a person with a current outbreak of herpes zoster to minimize the risk of post-herpetic neuralgia is a(n)
Oral valacyclovir
Which of the following is not a criterion for a level 4 office visit?
Patient must be seen by a physician at some point in visit
Medical Orders for Life-Sustaining Treatment (MOLST) are appropriate in guiding treatment decisions for:
Patients toward the end of life
According to the U.S. Preventative Services Task Force (USPSTF), which of the following statements is true regarding screening adolescent and adult males for testicular cancer?
Screening is not recommended due to no net benefit when balancing the potential benefits and harms.
An actinic keratosis is on the histologic continuum towards a?
Squamous cell carcinoma
can vary by jurisdiction, but it generally refers to the care that a reasonable, similarly situated professional would have provided for an individual.
Standard of Care
A physician employs an NP to provide services at a satellite office. If the physician is not present at the satellite office, which of the following statements is true?
The NP services should be billed under the NP's provider number.
biopsy that contains both cells types is most valuable for examination. As a result, the best specimen for evaluation includes
The border between lesion and unaffected skin
characterized by similar morphologies and distributions and are both frequently on the same list of differential diagnoses.
acne and rosacea
The process of acquiring resistance to a disease upon exposure to an antigen and characterized by antibody production by the host is best referred to as:
active immunity
normocytic, normochromic anemia with normal limit RDW
acute blood loss ( commonly GI bleeding)
Increase in variation of RBC size
anisocytosis
The most common cause of pernicious anemia is:
autoimmune
the competent patient's right to direct his or her care with a personal plan of life and action.
autonomy
Potassium hydroxide (KOH) facilitates microscopic visualization of
fungus
Serum ferritin should be evaluated when what type of anemia is suspected
iron deficiency
microcytic, hypochromic anemia of an evolving etiology (demonstrated by the elevated RDW).
iron deficiency
most commonly a consequence of slow, steady blood loss and resulting depletion of iron, resulting in low MCHC, elevated RDW
iron deficiency anemia
defined as <1 cm, flat, nonpalpable discolorations
macule
You see a 22-year-old woman with a chief complaint of eczema on both arms. She is otherwise healthy. The most important aspect of skin care for this person is
maintaining skin lubrication
reatment of iron deficiency anemia .
oral or parenteral iron.
conferred by an antibody produced in another host, acquired naturally by an infant from the mother, or artificially by administration of an antibody-containing preparation (antiserum or immune globulin).
passive immunity
>1 cm, flat, nonpalpable discolorations
patch
an inability to absorb vitamin B12 from food due to reduced production of intrinsic factor in the stomach, but has also been attributed to long-term metformin use in a dose-dependent manner.
pernicious anemia
most common cause of vitamin B12 deficiency
pernicious anemia
U.S. Food and Drug Administration (FDA) NOT approved for the treatment of basal cell carcinoma
phototherapy
Efforts to prevent a health problem from occurring are called
primary prevention
The high-dose influenza vaccine (Fluzone®) is indicated for
pts 65 yrs and older
efforts focus on detecting disease in an early, asymptomatic or preclinical state to minimize its impact
secondary prevention
Eosinophilia is often seen in infections caused by
Eosinophils
When billing services to Medicare, "incident to" services
Are defined as those services that are furnished incident to physician professional services in the office or in a patient's home.
a hemogram finding of a 54-year-old man with a history of peptic ulcers; chronic, low volume, upper GI bleed; and iron deficiency anemia
Low MCV, low MCHC, elevated RDW
When considering topical medications, a key benefit of an ointment over a gel is that the ointment
Allows greater absorption of medication
Anemia demonstrated by a microcytic, hypochromic anemia of stable etiology (RDW WNL) and can be confirmed with hemoglobin electrophoresis
Alpha or beta thalassemia minor
You see a healthy 65-year-old man for a routine physical examination. He has not received any pneumococcal vaccination in the past. Likely optimal immunization includes
Administering PCV13 now and a second vaccination with PPSV23 in one year
Certain ethnic groups are at higher risk of beta-thalassemia minor
African, Mediterranean, and Middle Eastern ancestry.
You see a 26-year-old woman who states that she has an allergy to eggs. She reports development of mild hives after eating cooked eggs, but can consume baked goods that contain eggs with no ill effects. She has never experienced any respiratory distress due to her allergy. When considering administering the flu vaccine, the NP realizes
Any age-appropriate flu vaccine can be used
Therapies for the treatment of rosacea in an otherwise healthy 54-year-old woman would NOT include topical administration
Cortisone cream
legal obligation of a provider to adhere to a standard of care when providing medical services. established when there is a provider-patient relationship.
Duty of care
Which of the following is most consistent with a hemogram finding in vitamin B12 deficiency that can occasionally be found with long-term metformin use? Low MCV, elevated MCHC, normal RDW Elevated MCV, normal MCHC, elevated RDW Low MCV, low MCHC, low RDW Normal MCV, elevated MCHC, elevated RDW
Elevated MCV, normal MCHC, elevated RDW.
refers to selecting treatment (e.g., antimicrobial therapy) based on practical experience and observation in the absence of a firm diagnosis
Empiric therapy
According to USPSTF recommendations, asymptomatic adults 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit smoking within the past 15 years should be screened
Every 3 years
defined as those services that are furnished incident to professional services in the office (whether located in a separate office suite or within an institution) or in a patient's home.
Incident to
Which of the following represents the highest level of scientific evidence when evaluating clinical research?
Meta-analysis of randomized controlled trials
the presence of abnormally-shaped red blood cells.
Poikilocytosis
initiating treatment for a disease prior to the presentation of signs or symptoms, usually based on the presence of biomarkers.
Preemptive therapy
designed to protect information held by a covered entity in any form or media, including paper, electronic, or oral.
Privacy Rule
You see a 44-year-old well man who presents for his initial visit at the clinic. When asked about his immunization status, he mentions that he is unsure about any vaccines in the past 20 years. He knows that he received vaccines as a child but is unclear about where he received them. The best option for this patient is to:
Proceed with age-appropriate immunization administration
Which of the following would be a violation of HIPAA standards by a covered entity?
Providing an employer protected health information in relation to a patient's workers compensation claim.
requirement for malpractice and refers to a breach in the standard of care that causes an injury.
Proximal cause
information can be shared to the appropriate authorities with cases of abuse or if there is an imminent threat to a person or the public.
Prtected health information
One week into treatment for iron deficiency anemia, you anticipate?
Reticulocytosis
occurs soon after initiation of therapy with the reticulocyte count peaking around 7 to 10 days after starting treatment.
Reticulocytosis
All of the following are required Medicare terms and conditions for paying NP services except
Separate charges are billed for NP services and facility charges
Hb 9.6 g/dL (96 g/L) (12-14 g/dL [120-140 g/L]); MCV 73 fL (81-96 fL); MCHC 27.6 g/dL (276 g/L) (31-37 g/dL [310-370 g/L]); RDW 19.2% (0.192 proportion) (11.5-15% [0.115-0.15 proportion]); RBC 3.4 million/mm3 (4.2-5.4 million/mm3)
Serum ferritin
Hb 8.4 g/dL (84 g/L) (12-14 g/dL [120-140 g/L]); MCV 118 fL (81-96 fL); MCHC 33.4 g/dL (334 g/L) (31-37 g/dL [310-370 g/L]); RDW 18.6% (0.186 proportion) (11.5-15% [0.115-0.15 proportion); RBC 2.9 million/mm3 (4.2-5.4 million/mm3)
Serum vitamin B12 or folate
Which of the following can qualify as "incident to" services?
Services rendered in a patient's home in collaboration with a physician.
Typically involves scaly soles and fissures between the toes
Tinea Pedis
When counseling for melanoma risk assessment and reduction, the nurse practitioner advises the patient:
To avoid the sun between 9:00 a.m. and 3:00 p.m
You see a 64-year-old man with poorly-controlled rheumatoid arthritis with a chief complaint of fatigue. A hemogram reveals a hemoglobin level of 8.6 g/dL (86 g/L), hematocrit of 28% (0.28 proportion), and RBC indices within normal limits. The most appropriate intervention for this patient includes: Vitamin B12 injection. Treatment of the underlying cause Transfusion. Oral iron.
Treatment of the underlying cause
The use of which of the following medications is a common cause of drug-induced thrombocytopenia? Warfarin Aspirin Ibuprofen Unfractionated heparin
Unfractionated heparin
Which of the following statements about epoetin alpha use is false? Induces the release of reticulocytes from bone marrow Has the same biological activity as the endogenous hormone Induces erythropoiesis
Use is routinely advised with iron deficiency.
The healthcare principle that promotes actions that lead to achieving the greatest good for the greatest number is known as
Utilitarianism
