Term
A nurse practitioner's scope of practice is influenced by a number of factors.
Which one does not influence scope of practice.
B. |
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Definition
Select one:
a. State and federal laws governing practice.
b. Reimbursement rate for visits/procedures.
c. Nurse practice act.
d. Code of ethics. |
|
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Term
A mother brings her school age child in with concerns that her son is the shortest child
in the class. She is worried that something is wrong. Initial differentiation of cause
by the FNP of the child s short stature would include: C |
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Definition
Select one:
a. Immediate referral to an endocrinologist.
b. History, PE and trial treatment with growth hormone.
c. History, PE including Tanner stage with possible skeletal maturation assessed by radiography, if indicated.
d. PE and complete blood count, thyroid function panel, urinalysis, karyotyping,
chemistry profile, and insulin sensitivity tests. |
|
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Term
| The NP finds Heberden's nodes on the PE of a patient. The nodes are a cardinal sign of: |
|
Definition
Osteoarthritis
OA of the hands is manifested as Heberden's nodes (deformities of the interphalangeal joints) and Bouchard's nodes (deformities of the proximal interphalangeal joints). |
|
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Term
Upon examining a 2-week-old infant, the FNP notes that the infant's left eye is
watering and there is crusted material on the eyelids. No edema or erythema is noted.
The NP makes a diagnosis of: |
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Definition
| Nasolacrimal duct obstruction is fairly common in neonates (up to 6% of live births). Resolves spontaneously in 96% of infants by 12 months of age. Clinical findings include continuous or intermittent tearing and blepharitis in lids and lashes." |
|
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Term
|
Definition
validates competence
Not all 50 states require national certification, but all 50 states recognize national certification
Reimbursement depends on setting, not certification |
|
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Term
| A patient has several lesions with an erythematous base and silvery scales on his elbows and knees. What is the MOST likely diagnosis? |
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Definition
| In psoriasis, scaly papules and plaques form and collect on skin surfaces in well-demarcated lesions. The lesions have an erythematous base with silvery white plaques that are adherent |
|
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Term
| Cause(s) of delayed puberty are: D |
|
Definition
Select one:
a. Infection.
b. Turner syndrome.
c. Deficiency of growth hormone.
d. All of the above. |
|
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Term
| Risk factors for gout include which of the following? B. |
|
Definition
Select one:
a. Joint trauma
b. Thiazide use Correct
Buttaro page 917
"Use of diuretics may also increase gout flares."
c. Female gender
d. Rheumatoid arthritis |
|
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Term
| In the evaluation of a patient with low back pain, loss of bowel and bladder control most likely indicates which of the following? |
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Definition
Cauda Equina Syndrome
It is important to ask if there are symptoms of saddle anesthesia, bowel or bladder changes such as urinary retention or incontinence, or recent onset erectile dysfunction. These symptoms are associated with cauda equina syndrome, which is a serious neurological disorder involving the lumbosacral nerve roots." |
|
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Term
| Which of the following "triggers" may inflame acne rosacea? |
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Definition
| Alcohol, Sun Exposure, Spicy Foods |
|
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Term
| A 28 year old female is seen for a complete baseline health assessment. She is a new patient in the practice. She tells you she is "wonderfully healthy". She has had no weight loss or gain, no sweating, no tremors, no diarrhea or constipation, no anxiety or depression, no irritability or other symptoms. On PE she is found to have a 3 cm nodule in the left lobe of the thyroid gland. B/P is 130/70, pulse is 96 and regular. The MOST important investigation to be done next is: |
|
Definition
Serum FT4, Thyroid Ultrasound
"Thyroid function tests are necessary to exclude hypothyroidism or hyperthyroidism"
"Thyroid ultrasound evaluationshould be performed for all patients with a suspected abnormality....High resolution sonography can clearly distinguish between solid and cystic components |
|
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Term
| A 28 year old man with a long standing history of injection drug use presents with malaise, nausea, fatigue, and "yellow eyes" for the past week. After ordering diagnostic tests, you confirm the diagnosis of acute hepatitis B. Anticipated laboratory results include: |
|
Definition
HBsAg +
For acute hepatitis B, findings would include HBsAg +, anti-HBc +, IgM anti HBc +, anti-HBs |
|
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Term
| A 42 year old presents with obesity (gained 40 pounds in last 6 months), elevated B/P at her last walk-in visit, increased body hair, purple streaks on her abdomen, a "fat face" (her description), and pains in her joints and bones. She takes no medications nor has she been on any medications in the past year. On PE her BMI is 35, B/P is 160/110, has obvious hirsutism over her entire body, abdomen is obese with purple stria. Based on this information, the MOST likely diagnosis is: |
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Definition
|
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Term
| A 17 year old male presents with scrotal pain. A suspected diagnosis that requires immediate referral is: |
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Definition
Testicular Torsion
"Immediate emergency department referral or physician consultation is indicated for patients with sudden onset unilateral scrotal pain or testicular torsion." |
|
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Term
| A common complication of viral gastroenteritis in children is: |
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Definition
Dehydration
Gastroenteritis...can lead to dehydration, electrolyte imbalance and in severe cases death in those who are malnourished." |
|
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Term
| A 24-year-old woman patient develops wheezing and shortness of breath when exposed to cold air or when exercising. These symptoms are getting worse. Which of the following is the prophylactic agent of choice for the treatment of asthma in these circumstances? |
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Definition
| Inhaled short acting Beta 2 agonists |
|
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Term
| A 12 year old obese AA male has complained of right anterior thigh pain intermittently for the past 6 weeks. His mom reports no history of trauma but notes "he is limping more and more." You note reluctance to walk at all, positioning of the right hip in an extreme rotation and limited hip flexion on exam. He is afebrile. You suspect: |
|
Definition
| Slipped capital femoral epiphysis |
|
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Term
| In contrast to dementia, patients with depression often: |
|
Definition
complain about their cognitive deficits
Impaired concentration, difficulty with decision making and mild memory impairment are possible and must not be confused with cognitive changes in dementia. Patients with dementia do not typically worry about what is wrong with them." |
|
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Term
| Diagnostic testing for a patient with newly detected hypertension should include the following EXCEPT: D. |
|
Definition
Select one:
a. Hematocrit.
b. Creatinine.
c. Potassium.
d. Thyroid stimulating hormone.
Routine evaluation of hypertension includes urinalysis, CBC, determination of serum potasium, BUN, serum creatinine, fasting blood glucose, plasma lipoprotein, serum uric acid and calcium concentration." |
|
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Term
| A 36 year-old presents with episodic attacks of severe vertigo, usually with associated ear fullness. Her attacks usually last several hours and she is well before and after the attacks. You might attribute this to: |
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Definition
Menieres Disease
"Early in the disease, patients have intermittent attacks of vertigo that last from minutes to hours, often associated with nausea and vomiting. These episodes are commonly accompanied by pressure in the ear, low pitched tinnitus fluctuating in intensity, and hearing loss, usually in one ear. There can be long periods of remission." |
|
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Term
| A potassium hydroxide (KOH) preparation: |
|
Definition
| Is prepared from skin/scale scrapings. |
|
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Term
A 21 year old is taking an oral contraceptive (OC). She complains of acne.
How should you adjust the estrogen in the OC? |
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Definition
| Increase it...remember it can take 6 months on OCP to see a difference in acne |
|
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Term
A 20 month old has been brought to the clinic after having a simple febrile seizure.
The appropriate intervention is: |
|
Definition
Educate the parents on febrile seizures and first aid
Anticonvulsants are not recommended
No indication for a lumbar puncture
Parents should receive information about febrile seizures, their risks and their management |
|
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Term
| A 64 year old male who had an MI 2 years ago has HTN and DM. His fasting lipid profile was obtained after an appropriate diet x 8 months. High-density lipoprotein (HDL) = 38 mg/dL; low-density lipoprotein (LDL) = 140 mg/dL; triglycerides =180 mg/dL. Which of the following is the MOST appropriate advice? |
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Definition
| The LDL Goal should be lower than 100 |
|
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Term
| A 6 year-old has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect: |
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Definition
|
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Term
A 54 year old female presents with complaints of morning stiffness in the neck and back,pelvic and shoulder pain, and fatigue. Lab studies reveal an elevated ESR, a normal
rheumatoid factor, a normal creatine phosphokinase, and normochromic, normocytic
anemia. PE reveals an elevated temperature, bilateral pain and stiffness of the pectoral
and pelvic muscles. Based on this information,the MOST LIKELY diagnosis is: |
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Definition
|
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Term
| A 74-year-old client with herpes zoster has a vesicle on the top of the nose. The FNP knows that this may indicate: |
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Definition
Opthalmic Zoster
Herpes zoster on the tip of the nose, around the eyes and on the forehead requires immediate opthamology consultation and evaluation. These findings signal possible involvement of the branch of the trigeminal nerve that innervates the cornea, which may cause ulceration on the cornea and result inpermanent damage. |
|
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Term
|
Definition
Begins at age 2-3 weeks of age, may palpate a distinct "olive mass" in RUQ
Projectile vomiting after feeding |
|
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Term
| All of the following are common sites of fracture in patients with osteoporosis |
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Definition
| In patients with osteoporosis, hip, wrist and spinal fractures are most common |
|
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Term
|
Definition
A hordeolum or chalizion may present at any age as a gradually enlarging nodule. A hordeolum is usually painful, whereas a chalazion does not normally cause pain."
Hard tender nodules on the eyelid or border |
|
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Term
An adolescent complains of right knee pain immediately after running in a track meet.
PE findings include: knee is warm to touch, and a tender, swollen tuberosity is noted. The FNP suspects: |
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Definition
Osgood-Schlatters Disease
Recent physical activity such as playing track, soccer, or football or surfboarding commonly produces the condition.
Pain increases during and immediately after the activity and decreases when the activity is stopped for awhile.
On physical exam there may be focal swelling, heat and point tenderness at the tubal tuberosity. |
|
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Term
| An example of an active strategy of health promotion is: |
|
Definition
Enacting a stress management program
With active strategies of health promotion, individuals are motivated to adopt specific health programs.
Passive strategies of health promotion benefit indoviduals without any actionsby the individuals themselves. |
|
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Term
| If a screening test was used on 100 individuals known to be free of breast cancer and identified 80 individuals who did not have breast cancer while missing 20 of the individuals, the specificity would be: |
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Definition
Specificity measures the proportion of negatives that are correctly identified as such
80 identified as negative, 100 actually negative
80/100 = .8 = 80% |
|
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Term
| In a young child, unilateral purulent rhinitis is MOST often caused by: |
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Definition
Foreign Body
A persistent or recurrent unilateral, purulent nasal discharge is often reported.
Foul odor, epistaxis, nasal obstruction and mouth breathing are less commonly reported symptoms. |
|
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Term
| Increased tactile fremitus occurs with: |
|
Definition
Lobar Pneumonia
Physical examiniation may reveal signs of consolidation (egophony, increased fremitus, dullness to percussion, rales and rhonchi)..." |
|
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Term
| JL is a 32 year old female, here today at 22 weeks estimated gestational age based on her LNMP. At her previous visit at 16 weeks, her assessment showed IUP 16 weeks, Size = Date. Today you measure her fundal height to be 30 centimeters. Your preceptor rechecks your measurement and concurs that 30cms is the correct measurement. Based on this information what is the size/date discrepancy reflected by these measurements? |
|
Definition
8cm
At 22 weeks gestation fundal height (in cms) should equal date (in weeks)
Therefore at 22 weeks gestation the fundal height should be 22 cm, instead of the measured 30 cm
30-22=8 for the size date discrepancy |
|
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Term
| During a mental status exam, which question might you ask to assess abstraction ability? |
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Definition
What does a rolling stone gathers no moss mean
Abstract reasoning involves the interpretation of complex ideas, such as proverbs.
Serial 7's measures the ability to perform calculations
The other options measure judgement |
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Term
| John, age 26, has a cast on his right arm after a rollerblading accident. Twelve hours after the cast was applied, he complains of severe pain even though he recently took his pain medication. His fingers are pink, yet he states that they are tingling and feel slightly numb. What do you suspect? |
|
Definition
Compartment syndrome is a complication of increased pressure in an enclosed tissue space
Providers should use the 6 P's to identify...pain, pallor, parethesias, pulselessness, paralysis and poikilothermia |
|
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Term
The pictured lesion, typically found around the mouth and nose, is characteristic of:
[image] |
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Definition
|
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Term
| Mrs. White is seen in the office by the FNP. She has recently been getting short of breath going up the stairs with increasing attacks of angina that are unresolved with rest. She now requires two sublingual nitroglycerine tablets to get relief. She is experiencing: |
|
Definition
| Symptoms of unstable angina are similar to those of MI and include chest pain or pressure, sweating, dyspnea, nausea, vomiting, dizziness or sudden weakness, fatigue. Symptoms may often be at rest, become suddenly more frequent or prolonged or are a change from the usual pattern of angina and may not respond to NTG |
|
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Term
| A tympanogram provides direct information on |
|
Definition
| Tympanometry evaluates the function of the middle ear by assessing the movement of the tympanic membrane |
|
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Term
| When prescribing pulse dosing with itraconazole (Sporonox) for the treatment of fingernail fungus, the NP realizes that: |
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Definition
Itraconazole (Sporonox) may be used to treat onychomycosis, however, there is a risk of side effects
LFTs should be performed before treatment and after 6 weeks of treatment |
|
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Term
| A 10 year old male presents with hematuria, periorbital edema, and elevated blood pressure. He has a history of streptococcal pharyngitis 2 weeks earlier. The MOST likely diagnosis is: |
|
Definition
| Post streptococcal glomerulonephritis is the classic form of glomerulonephritis and is characterized by a history of strep pharyngitis withing the prior two weeks and an acute onset of edema, oliguria, HTN and gross hematuria |
|
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Term
Match the following:
Genu valgum
Pes panus
Talipes equinovarus |
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Definition
Genu valgum: knock knees
Pes Panus: Flat Foot
Talipes equinovarus: Club Foot |
|
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Term
| The definitive test for cystic fibrosis is: |
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Definition
|
|
Term
| The primary purpose of professional licensure is to: |
|
Definition
| Protect the public by ensuring a minimal standard for competency |
|
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Term
| The viral exanthem seen here, known as Koplik spots, are present in: |
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Definition
| In rubeola (measles) an exanthema can be found on the oral mucosa opposite the lower molars. These Koplik spots last 12-15 hours. They are small, irregular, bluish white granules on an erythematous background and are pathognomonic of measles infection. |
|
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Term
| Which of the following are absolute contraindications for prescribing oral contraceptives? |
|
Definition
| hx of CVA, estrogen dependent neoplasia, pregnancy |
|
|
Term
| Which of the following is NOT included in the AHCPR's recommendations for clinicians to help clients quit smoking? |
|
Definition
| recommend alternative therapy such as hypnosis |
|
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Term
| You are assessing Mike, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: |
|
Definition
ACL and PCL injuries are evaluated using the anterior and posterior drawer tests
Meniscus injuries are typically evaluated using the McMurray test |
|
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Term
| Urinalysis on an adolescent reveals 2+ protein. The next step in the evaluation would be: |
|
Definition
| Evaluate for orthostatic proteinuria |
|
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Term
| A 24-year-old woman patient develops wheezing and shortness of breath when exposed to cold air or when exercising. These symptoms are getting worse. Which of the following is the prophylactic agent of choice for the treatment of asthma in these circumstances? |
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Definition
|
|
Term
| In epidemiology, prevalence is defined as: |
|
Definition
| The proportion of persons in a population with a particular disease |
|
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Term
| A 3 year old is brought to the clinic with noisy respirations. Which of the following signs or symptoms would be an indication for immediate referral and hospitalization? |
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Definition
|
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Term
| A 5 year old is seen by the FNP. The mother states that for the last week or so, her child has been scratching the back of her head. On examination of the head, small grey-white oval spots are seen that seem to be attached to the hair shafts. Along the nape of her neck and behind her left ear, small black specks and excoriations are noted. No rash is noted on the upper trunk, arms, or face. There are some slightly enlarged superficial nodes along the occipital border of the scalp. Based on this information, which of the following should be considered as a likely diagnosis? |
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Definition
|
|
Term
| The rash associated with scarlet fever is usually described as: |
|
Definition
|
|
Term
| Thin, spoon shaped nails are seen in: |
|
Definition
|
|
Term
| You suspect that Sharon has hypoparathyroidism because, in addition to her other signs and symptoms, she has |
|
Definition
| elevated serum phosphate levels |
|
|
Term
| Symptoms of digitalis toxicity include which of the following? Choose all that apply. |
|
Definition
headache, nausea and vomiting
Symptoms of digitalis toxicity may include confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhea, palpitations, vision changes, decreased consciousness, decreased urinary output, difficulty breathing while lying down, overall swelling, and excessive nighttime urination |
|
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Term
A 14-year-old adolescent is brought to the office because of an asthma exacerbation.
The PEFRs over the past 2 days have measured 50%-80% of personal best. This measurement of maximal flow represents which zone on a peak flow meter? |
|
Definition
|
|
Term
A 78-year-old male presents with the complaint of pain and pressure in his calves (R>L) when he walks 3 miles to the post office to get his mail. On PE the FNP notes the following:
calves are equal in size, no apparent edema or areas of specific tenderness, hair loss on the toes, callous formation and trophic changes of the toenails and a small area of ulceration over the right heel. His chief complaint and these findings suggest: |
|
Definition
Arterial Insufficiency : Patients over the age of 70 are at risk for PAD
Classic symptom is claudication- a tightening or cramping pain in calf muscles that is precipitated by exercise and relieved by rest |
|
|
Term
| Concomitant disease seen with giant cell arteritis includes |
|
Definition
| Giant cell arteritis (GCA) is a systemic large-vessel vasculitis commonly affecting the branches of the proximal aorta that supply the neck and the extracranial structures of the head. Approximately 40% to 50% of pateints with GCA have symptoms of polymyalgia rheumatica, and conversely, 15% to 20% of patients with polymyalgia rheumatica have GCA |
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Term
| A 6 year-old appears with abdominal distention and pain, an abdominal mass on the right side, fever, and slight hematuria. There is no precipitating event. What do you suspect? |
|
Definition
Clinical findings of Wilm's tumor include:
Most frequent finding is increasing abdominal size or an actual palpable mass
Pain is reported if the mass has undergone rapid growth or hemorrhage
Fever, dyspnea, diarrhea, vomiting, weight loss or malaise may also be reported |
|
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Term
| A child is being worked-up for rheumatic fever. PE findings include: T 103.60 F, migratory joint pain, and elevated erythrocyte sedimentation rate (ESR). Using the Jones criteria, what other finding is essential for the diagnosis of rheumatic fever? |
|
Definition
| Hx of group A streptococcal infection |
|
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Term
| A father calls the NP at the private practice where she works. He tells the NP that his two-year-old has just splashed turpentine in his eyes. The father is alone with the child and the NP can hear the child screaming in the background. The BEST advice to the father is: |
|
Definition
Any eye irritant should be flushed as soon as possible with water to remove as much irritant as possible and minimize damage
The child should then be transported to the ED for evaluation
Patching should be avoided as it may cause additional damage |
|
|
Term
| A patient with actinic keratosis should be told: |
|
Definition
| These lesions can develop into squamous cell carcinoma |
|
|
Term
| After instillation of fluorescein, a corneal abrasion or ulcer stains |
|
Definition
| One drop of fluoroscein can be applied and viewed under a cobalt blue light or Woods lamp. A corneal abrasion should appear as a bright green area, often polygonal. |
|
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Term
| Which is most consistent with the diagnosis of COPD |
|
Definition
|
|
Term
| For which of the following pateints shoulf a nurse practitioner order varicella antibody titers? |
|
Definition
| Because of the increased risk for exposure and potential transmission of the varicella virus, all healthcare workers should have confirmed immunity |
|
|
Term
| During a pelvic exam, if the client strains and a pouching is seen on the anterior wall of the vagina, what would you suspect? |
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Definition
| A cystocele occurs when the supportive tissue between the vagina and the bladder weakens and stretches allowing the bladder to bulge into the vagina. Recall that when a female is in the lithotomy position, the bladder is anterior to the vaginal vault and the rectum is posterior. |
|
|
Term
| Which of the following best describes the presentation in a patient with osteoarthritis? |
|
Definition
| Worse symptoms in weight bearing joints later in the day |
|
|
Term
| Which of the following is true about inactivated poliovirus vaccine (IPV) |
|
Definition
| It is the preferred method of immunization |
|
|
Term
| John, age 50, has a chronic, episodic headache. He states that it can wake him up at night, lasts 15 minutes to 3 hours, and has occurred daily over a period of 4-8 weeks. You suspect a: |
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Definition
| The patient with cluster headache, acute or chronic, is usually awakened during the night with severe, unilateral, retro-orbital pain. A cluster headache reaches maximum intensity in 15 minutes and usually lasts about 90 minutes, although some can last 3 hours. |
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Term
| Jane, who has diabetes, is complaining of a "rash" under her breasts. On examination you see the following. The most likely diagnosis is: |
|
Definition
| Predisposing factors to candidal infection include obesity, medications such as antibiotics and corticosteroids, malnutrition, diabetes and other endocrine diseases and immunosuppressed conditions including HIV/AIDS. |
|
|
Term
| In which age group is testicular self-examination teaching most important due to a higher risk for testicular cancer? |
|
Definition
| Testicular cancer occurs most often between the ages of 20 and 39 years and is the most common form of cancer in men between the ages of 15 and 34 years, although these tumors have been reported in infants and in older men. |
|
|
Term
Marie states that she has a maternal history of rheumatoid disease but she has never been affected. Today she presents with complaints of dryness of the eyes and mouth.
What do you suspect? |
|
Definition
| Sjorgrens syndrome, associated with connective tissue diseases such as rheumatoid arthritis, polyarteritis nodisa, and systematic lupus erythematosus, is manifested with classic xerostomia, abnormal taste, keratoconjunctivitis sicca, dry tongue, and intermittent unilateral or bilateral swelling of the salivary gland. |
|
|
Term
| Mary, age 72, presents complaining of a new onset lateral headache, weakness, and blurred vision. She denies any precipitating event. Her erythrocyte sedimentation rate is 90 mm/min. What do you suspect? |
|
Definition
|
|
Term
| Mrs. Jackson's two pre-schoolers are diagnosed with scabies. Which of the following would the FNP include in her management plan? |
|
Definition
| Treatment with 5% premetherin Elimite cream |
|
|
Term
| A 29 year old woman has a sudden onset of a right-sided facial assymetry. She is unable to tightly close her right eyelid or frown or smile on the affected side. Her examination is otherwise unremarkable. This represents paralysis of cranial nerve: |
|
Definition
|
|
Term
| he diagnosis of Metabolic Syndrome includes the notation of which of the following? Choose all that apply. |
|
Definition
Abdominal Obesity
Triglyceride level greater than 150mg/dl
HDL cholesterol of less than 40 mg/dL for men and 50 mg/dL in women
BP greater than 150/90 |
|
|
Term
A 40 year old female's blood test results include: T4 = 8.0mg/dl (normal 5.0-11.5); T3
uptake 22.8% (normal 14-37%); TSH = 1.4mu/l (normal 0.4-4.2). The patient is taking
synthroid 100mcg daily. Based on the laboratory values, the NP should: |
|
Definition
Continue synthroid at 100mcg/day
Hypothyroidism is treated with levothyroxine orally in amounts that return TSH to normal levels. The desired amount is determined by measurements of TSH and by subjective clinical criteria. |
|
|
Term
A 36 year old presents with a 3-month history of sweating, palpitations, weight loss,
nervousness, irritability, hand tremors and diarrhea. There are no significant past personal
illnesses. As a teacher, she is finding it hard to concentrate and perform her job due to
profound fatigue. On PE, B/P is 160/77, P - 120 and regular. She demonstrates mild proptosis. A smooth, diffusely enlarged and nontender thyroid gland is felt. No other abnormalities are noted. What is the MOST likely diagnosis? |
|
Definition
|
|
Term
| A 61 year-old man has been diagnosed with postrenal renal failure. Which of the following would be the most likely precipitating cause? |
|
Definition
| Advanced Prostate Hypertrophy with hematuria |
|
|
Term
| According the World Health Organization, obesity is defined as a body mass index equal to or exceeding ______ kg/m2? |
|
Definition
|
|
Term
| Anti-HBs (hepatitis B surface antibody) is an indication of: |
|
Definition
The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B
virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against
hepatitis B. |
|
|
Term
| As a nurse practitioner you are researching the clinical practice therapies for one of your patients with anemia, which of the following would be the best choice to make practice decisions? |
|
Definition
A systematic review is a critical assessment and evaluation of all research studies that address a particular clinical issue. The researchers use an organized method of locating, assembling, and evaluating a body of literature on a particular topic using a set of specific criteria. A systematic review typically includes a description of the findings of the collection of research studies. The systematic review may also include a quantitative pooling of data, called a meta-analysis.
Of the options presented in this question, the systematic review offers the most rigor |
|
|
Term
| As part of the evaluation of a 3 cm, round, mobile thyroid mass, the NP obtains a thyroid ultrasound revealing a fluid-filled structure. The MOST likely diagnosis is: |
|
Definition
| Thyroid Cyst-Fluid filled structures discovered on ultrasound are typicallly indiciative of cysts |
|
|
Term
| Chvostek's sign assesses for: |
|
Definition
| Chvostek’s sign is elicited by tapping on the face at a point just anterior to the ear and just below the zygomatic bone. A postitive response involves twitching of the ipsilateral facial muscles, suggestive of neuromuscular excitability. This is caused by hypocalcemia |
|
|
Term
| Corneal reflex is controlled through which cranial nerve? |
|
Definition
| The corneal reflex that is dependent on the integrity of the Vth and the VIIth cranial nerves |
|
|
Term
| Pernicious anemia is usually caused by: |
|
Definition
| Lack of production of intrinsic factor by the gastric mucosa. |
|
|
Term
| Pharmacotherapy for treatment of obesity may be used as an adjunctive therapy in patients with a: |
|
Definition
| BMI > 30 or > 27 with other risk factors or diseases |
|
|
Term
Which ethical approach focuses on the consequences that actions or policies have on
the well-being of all persons directly or indirectly affected by the action of the policy. |
|
Definition
|
|
Term
| The most common cause of hepatitis A infection is: |
|
Definition
| Contaminated Water supplies |
|
|
Term
| A 25 year old schoolteacher presents with nausea, vomiting, anorexia, aversion to her usual 2 packs a day tobacco habit, and right upper quadrant abdominal pain. She has been sick for the past 3 days. Two of the students in her class have come down with similar symptoms. She has had not exposure to blood products and has no significant risk factors for sexually transmitted disease. On examination, she looks acutely ill. Her pulse is 100/min, B/P 110/70, respirations 18, temperature 101 degrees F. Her sclera are icteric, and her liver is tender. What is the most likely diagnosis: |
|
Definition
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Term
| The most sensitive test for patients with a history of heavy and chronic alcohol use is |
|
Definition
GGT is elevated in about 75% of chronic drinkers
Elevations in AST may also be seen |
|
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Term
| When counseling about bariatric surgery, the FNP provides the following information: |
|
Definition
The average weight loss following gastric bypass surgery is approximately 5-15 pounds per week for the first 2 or 3 months with a gradual tapering off to about 1-2 pounds per week after the first 6 months or so. The rate of weight loss varies greatly between individuals. It is very important not to compare your rate of weight loss with others.
Mortality after bariatric surgery is a rare event. It is influenced by different risk factors including type of surgery, open surgery, prolonged operative time, comorbidities, and volume of activity. |
|
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Term
| A patient presents to your clinic after falling about 8 feet off of his porch onto a railing below. He hit his left lateral chest. Which of the following would indicate respiratory complications due to the injury? |
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Definition
| Decreased breath sounds on the same side as the injury may be indicative of a collapsed lung and should be evaluated immediately |
|
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Term
| Alkaline phosphatase levels are often elevated in the following conditions: |
|
Definition
Higher-than-normal ALP levels can be found in the following conditions:
Bone conditions Hepatitis Liver disease Eating a fatty meal if you have blood type O or B Leukemia Lymphoma Sarcoidosis Biliary obstruction Osteoblastic bone tumors Osteomalacia Healing bone fracture Hyperparathyroidism Paget’s disease Rickets
Biliary obstruction.
b. Pregnancy.
c. Normal growing bones.
d. Primary cirrhosis. |
|
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Term
| The FNP examines an elderly woman with long-standing, poorly controlled hypertension. When evaluating her for hypertensive target organ damage the FNP looks for evidence of which of the following? Choose all that apply |
|
Definition
Retinopathy
Microalbuminuria
Left Ventricular Hypertrophy |
|
|
Term
| The Genetic Information Nondiscrimination Act (GINA) does which of the following? Choose all that apply |
|
Definition
a. Protects against the use of genetic information to discriminate in health insurance and employment.
Correct
b.
Prohibits using a person’s genetic information in setting eligibility or premium or contribution amounts.
Correct
c.
Prohibits health insurers from requesting or requiring that a person undergo a genetic test. |
|
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Term
| In a patient with severe liver disease you would expect the albumin level to be elevated. |
|
Definition
| False: Albumin levels are typically decreased in severe kidney or liver disease. |
|
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Term
| A 54-yr-old woman comes to see the FNP for her annual gynecologic exam. She experienced menopause about 3 years ago. She mentions that she has noted occasional spotting over the last 6-8 months. She is not taking HRT. What do you recommend to the patient at this time? |
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Definition
| Any postmenopausal woman with onset of vaginal spotting needs to be immediately evaluated for uterine cancer via an endometrial biopsy |
|
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Term
| What is the preferred treatment for trichomoniasis? |
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Definition
|
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Term
| A 34-year-old man with a normal CBC and family history of Thalassemia asks whether he should take an iron supplement. You respond that: |
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Definition
| This may cause iatrogenic iron overload |
|
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Term
| A 50 year old female is concerned that she is "menopausal". She complains of "hot flashes" and has not had a period in 12 months. Which of the following diagnostic test results may be helpful for consideration of menopause? |
|
Definition
According to the North American Menopause Society, sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.
However, a single FSH level can be misleading in perimenopause since estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels can vary greatly during perimenopause. One elevated FSH level is not enough to confirm menopause. More importantly, a low FSH level in a woman who is having hot flashes and changing periods does not eliminate the likelihood that she is still in perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid. |
|
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Term
| A criterion suggestive of erythromelalgia includes: |
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Definition
| Erythromelalgia is a clinical syndrome characterized by intermittent (though constant in some patients) heat, redness, and pain affecting the extremities (usually the lower extremities, and usually bilaterally and symmetrically) |
|
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Term
| A liability policy which pays claims only during the period that the policy is active is termed: |
|
Definition
|
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Term
| A patient has heavy menses. Which lab value below reflects an iron deficiency anemia |
|
Definition
Serum iron. This test measures the amount of iron in your blood. The level of iron in your blood may be normal even if the total amount of iron in your body is low. For this reason, other iron tests also are done.
Serum ferritin. Ferritin is a protein that helps store iron in your body. A measure of this protein helps your doctor find out how much of your body's stored iron has been used.
Transferrin level, or total iron-binding capacity. Transferrin is a protein that carries iron in your blood. Total iron-binding capacity measures how much of the transferrin in your blood isn't carrying iron. If you have iron-deficiency anemia, you'll have a high level of transferrin that has no iron.
RDW may potentially increase as an early indicator of iron deficiency anemia |
|
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Term
| All of the following are common causes of secondary hypertriglyceridemia except: |
|
Definition
a. Hypothyroidism.
b. Niacin use. Correct
Niacin can be used to lower triglycerides
c. Poorly controlled DM.
d. Excessive alcohol use. |
|
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Term
| All of the following are risks for lactic acidosis in metformin users except: |
|
Definition
Metformin may interact with the dye used for an X-ray or CT scan, and patients should advise to stop taking it before any medical exams or diagnostic tests that might cause less urine output than usual.
Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure. |
|
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Term
| All of the following are considered extraarticular manifestations of rheumatoid arthritis, EXCEPT: |
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Definition
|
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Term
An 8 year old male present to the pediatric clinic with the following symptoms: nasal
stuffiness, congested cough, clear rhinorrhea and itching of throat for 3 weeks. On exam,
the FNP notes pale blue nasal turbinates, Dennie lines around the eyelids and a cobblestone appearance to the posterior pharynx. Lungs are clear to auscultation. Family history reveals that his brother has asthma. The most likely diagnosis is: |
|
Definition
|
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Term
| Identifiable, secondary, cause(s) of hypertension is(are): |
|
Definition
. Pheochromocytoma.
b. Steroid therapy.
c. Thyroid disease.
d. Sleep apnea.
e. All of the above. Correct |
|
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Term
| Clinical findings that should raise the nurse practitioners suspicion regarding possible alcohol abuse include all of the following EXCEPT: |
|
Definition
|
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Term
| Excessive menstrual bleeding (>80 cc per cycle) that occurs at irregular intervals is referred to as: |
|
Definition
Menorrhagia is defined as excessive uterine bleeding occurring at regular intervals or prolonged uterine bleeding lasting more than seven days. The classic definition of menorrhagia (i.e., greater than 80 mL of blood loss per cycle) is rarely used clinically.
Metrorrhagia is the type of abnormal uterine bleeding diagnosed when menstruation occurs at irregular intervals. The amount of blood loss during menstruation and the number of days vaginal bleeding occurs are not excessive.
Menometrorrhagia is excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals.
Oligomenorrhea is infrequent or very light menstruation.. With oligomenorrhea, menstrual periods occur at intervals of greater than 35 days, with only four to nine periods in a year. |
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Term
| Testing for sexually transmitted infection should be initially obtained: |
|
Definition
| STIs can cause pregnancy complications and should be identified as soon as possible in pregnancy. If the mom-to-be is at high risk of contracting STIs then screening later in the pregnancy can be considered as well. |
|
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Term
| The majority of peritonsillar abscesses are associated with the following organism(s): |
|
Definition
| . Mixed profile, aerobic and anaerobic |
|
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Term
You examine an elderly woman with long-standing, poorly controlled hypertension.
When evaluating her for hypertensive target organ you look for evidence of: |
|
Definition
| Left ventricular hypertrophy |
|
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Term
| Several factors have been associated with reducing SIDS deaths and are recommended by the American Academy of Pediatrics. They include which of the following? Choose all that apply. |
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Definition
|
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Term
| Included in the differential diagnosis for a child with a painful limp would be which of the following? Choose all that apply. |
|
Definition
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Term
A patient presents with a sore throat. On examination the patient has a muffled voice and his oropharynx is shown here. The most likely diagnosis would be which of the following?
[image] |
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Definition
|
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Term
| Which of the following is an example of a qualitative research study? |
|
Definition
A study evaluating the lived experience of mothers with disabled children. Correct
Qualitative Research is collecting, analyzing, and interpreting data by observing what people do and say. Whereas, quantitative research refers to counts and measures of things, qualitative research refers to the meanings, concepts, definitions, characteristics, metaphors, symbols, and descriptions of things. |
|
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Term
| Criteria for a major depressive episode include all of the following EXCEPT: B. |
|
Definition
Select one:
a. Diminished ability to think or concentrate.
b. Insomnia or hypersomnia.
c. Grandiose delusions. Correct
Buttaro page 1331
Section on Clinical Presentation
d. Weight loss or gain. |
|
|
Term
| Deborah, age 61, has enlarged, bony proximal interphalangeal joints. You describe these as: |
|
Definition
| Bouchards-Bony bumps on the middle joint of the finger (proximal interphalangeal joint) are Bouchard's nodes. Heberden's nodules are located on the joint closest to the fingernail (distal interphalangeal joint). Both are indicative of osteoarthritis. |
|
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Term
Deficiency of which nutritional source usually presents with an insidious onset of
paresthesias of the hands and feet that are usually painful? |
|
Definition
|
|
Term
| In terms of the etiology of acute diarrhea in children, which organism is associated with contaminated,improperly prepared poultry, eggs, and dairy products? |
|
Definition
|
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Term
| A 9 year-old child is bitten by a raccoon at summer day camp. After cleaning the wound, the NPs next action is to: |
|
Definition
c. Administer rabies immune globulin (RIG) and human diploid cell vaccine (HDCV) Correct
Racoons, foxes, bats and skunks are the primary carriers of rabies in the United States. Treatment with immunoglobin should commence as soon as possible to prevent transmission of rabies to humans through bites. |
|
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Term
Maura had less than 7% value on her Schilling test. What medication do you anticipate
that Maura might need? |
|
Definition
| Vitamin B 12- The Schilling test has been the classic method to verify the diagnosis of pernicious anemia |
|
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Term
| The FNP examines a 38 year old obese woman who has presented for an initial examination PAP test. She has no complaints. Her B/P is 144/98 mm Hg bilaterally. The rest of the PE is unremarkable. The next BEST action is to: |
|
Definition
Arrange for 2 additional B/P measurements during the next 2 weeks. Correct
Buttaro page 561
Diagnosis is based on measurements from 3 seperate office visits since many external factors may influence blood pressure |
|
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Term
| The most accepted recommendation regarding prevention of skin cancer is: |
|
Definition
| Avoidance of excessive sun exposure. |
|
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Term
| The parent of a 5 month old bring him to the office as they have noted that his scrotum is enlarged. On PE, the NP finds a non-tender, smooth,firm mass. The NP utilizes a penlight to assess for trans-illumination and sees the following result. The MOST likely diagnosis is which of the following? |
|
Definition
|
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Term
| Which class of medications is known to worsen symptoms or GERD? |
|
Definition
Calcium Channel Blockers Correct
Estrogens, progesterones, calcium channel blockers, theophylline and nicotine can decrease lower esophogeal sphinctor pressure |
|
|
Term
| Unexplained nocturnal cough in an older adult should suggest: |
|
Definition
|
|
Term
| Which of the following can typically be found in a young woman using Depo-Provera (DMPA) for over a year? |
|
Definition
. Weight gain Correct
Weight gain has been noted with use of DMPA. Return to fertility is often delayed 6 - 12 months after discontinuation. Heavy menses is not typically seen, but spotting may be an issue. |
|
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Term
| You suspect that the patient has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? |
|
Definition
| a. Bismuth Subsalicylate (Pepto-Bismol), Tetracycline (Achromycin) or Amoxicillin (Amoxil), and Metronidazole (Flagyl). Correct |
|
|
Term
| When prescribing niacin, patient education should include which of the following? |
|
Definition
b. Post dosing flushing is common Correct
flushing is a common concern voiced by pateints taking niacin. To minimize the effects of this phenomenon pateints should be instructed to take the niacin with aspirin at bedtime. |
|
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Term
| A 23 year old male with a known history of HIV infection presents with fatigue, night sweats and anorexia. The NP suspects tuberculosis and administers a PPD skin test. In this individual, the size of a positive reaction would be: |
|
Definition
|
|
Term
A 8 year old girl has been diagnosed with juvenile rheumatoid arthritis. Which of the
following historical data is consistent with this diagnosis? |
|
Definition
| c. Complains of joint stiffness in the morning when she wakes up. Correct |
|
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Term
| A patient presents with jaundice and you ordered liver function studies and bilirubin levels. The total bilirubin is elevated, the unconjugated (indirect) bilirubin is elevated, and the conjugated (direct) bilirubin level is normal. These finding are most consistent with: |
|
Definition
|
|
Term
| All of the following clinical findings are associated with emphysema EXCEPT: |
|
Definition
. Increased anterioposterior chest diameter.
b. Usually thin in appearance with muscle wasting.
c. Persistent cough with copious sputum production. Correct
Buttaro page 445-454
d. Barrel shaped chest with diminished breath sounds. |
|
|
Term
| Postmenopausal women tend to have more recurrent uriinary tract infections and vaginal bacterial infections due to which of the following? Choose all that apply. |
|
Definition
Select one or more:
a. Postvoid residual urine Correct
b. A decrease in lactobacilli Correct
e. Thinning vaginal mucosa Correct
f. Estrogen depletion related changes Correct |
|
|
Term
| Macrocytic normochromic anemias are primarily caused by which of the following? Choose all that apply. |
|
Definition
| malabsorption of B12 and folic acid deficiency |
|
|
Term
| An 18 year-old college student comes into Student Health complaining of sudden onset severe flank and lower abdominal pain that radiates into his groin and bloody urine. He denies fever or chills but complains of nausea. Which of the would be best to evaluate this complaint? |
|
Definition
| CT abdomen and pelvis without contrast |
|
|
Term
| You have started your patient on ezetimbe (Zetia), which of the following labs should you monitor? |
|
Definition
| No special labwork or monitoring is required |
|
|
Term
| A 25-year-old male presents with erythematous, ovoid, itching lesions of the trunk for 10 days.The patient noted that the largest patch developed on the abdominal wall, then spread all over the trunk. See the photo for presentation. The MOST likely diagnosis is: |
|
Definition
| Pityriasis Rosacea: A herald spot or patch (in 70% of presentations) is a 2-5 cm solitary, ovoid, slightly erythematous lesion with a finely scaled, slightly elevated border which enlarges quickly with central clearing. Typical locations for the herald patch include trunk, upper arm, neck or thigh. Secondary lesions occur 2-21 days later and in a Christmas tree pattern. The rash is especially prevelent on the back and follows dermatome skin lines with oval lesions running parrallel and wrapping around the trunk horizontally |
|
|
Term
| Wood's light is especially useful in diagnosing: |
|
Definition
| Tinea versicolor: Tinea versicolor is a superficial fungal infection and scapings from the skin fluorese yellow-orange under a Woods lamp if the skin has not been cleaned recently |
|
|
Term
A young adult just returned from Central America with traveler's diarrhea.
Which antibiotic do you order? |
|
Definition
| Ciprofloxacin:Travelers diarrhea may occur during the trip or up to 10 days after return. Symptoms generally last 3-5 days and are self-limiting. Treatment includes fluid replacement, loperamide, and 3 days of ciprofloxacin or 1 gm of azithromycin |
|
|
Term
| Cathy has her asthma well controlled by using only a beta-adrenergic metered-dose inhaler. Lately, she has had difficulty breathing during the night and her sleep has been interrupted about 3 times a week. What do you do? |
|
Definition
| Prescribe and inhaled steroid |
|
|
Term
| Most health maintenance organizations (HMOs) use a reimbursement mechanism called capitation. This means that: |
|
Definition
d. HMO reimburses the provider a set fee per client, per month, based on the client's age and sex. Correct
Capitation occurs when an HMO pays providers a set amount of money for each enrolled person over a stipulated time frame, regardless of how many times the patent is seen.
Reimbursement by a pateint of their family is considered private pay
Fee for Service is just what the name implies...an seperate fee is paind for each service that is provided. The disadvantage of this type of coverage is that some providers abuse the system by performing excessive services. |
|
|
Term
| A positive Babinski's sign: D |
|
Definition
Select one:
a. Is expected in children.
b. Is dorsiflexion of the big toe with fanning of all the toes.
c. Occurs with upper motor neuron disease of the pyramidal tract.
d. All of the above. Correct |
|
|
Term
| The first symptom seen in the majority of clients with Parkinson's disease is: |
|
Definition
| Rest tremor of the hands, described as "pill rolling" increases with walking and may be an early sign when others are not yet present |
|
|
Term
| The client's two children have intense pruritis of the hands and face. The FNP learns that the children were taken on a recent school trip that involved a hike in the woods. Other students in the class have similar symptoms. The MOST likely diagnosis is: |
|
Definition
Contact dermatitis is acute or chronic inflammation resulting from hypersensitive reaction to a substance.
The fact that this occured simultaneously, with multiple people who were recently hiking increases the liklihood that this is contact dermatitis and not contagious |
|
|
Term
Which of the following factors created an opportunity for the development of the
nurse practitioner movement? |
|
Definition
| A primary care physician shortage |
|
|
Term
You examine as 57-year-old woman with rheumatoid arthritis and find the following
results on hemogram:
Hgb = 10.5
Hct = 33%
MCV = 88fL
The most likely diagnosis is: |
|
Definition
| Anemia of chronic disease |
|
|
Term
| You see a woman who has been sexually involved with a man newly diagnosed with acute hepatitis B. You advise her to: |
|
Definition
Receive hepatitis B immune globulin and hepatitis B immunization series. Correct
Buttaro page 675
To prevent transmission, therapy should be initiated immediately after exposure to HBV
The recommendations for prophylaxis after sexual exposure to HBV include Hepatitis B immune globulin within 14 days of exposure and simultaneous Hepatitis B vaccination, with second and third injections at 1 and 6 months respectively |
|
|
Term
| Which statement is true of HMG-CoA reductase inhibitors (statins)? |
|
Definition
c. They may cause myopathies, especially at higher doses or in combination with certain drugs. Correct
Buttaro page 1109
A rare but serious adverse reaction to high dose statins, particularly simvastatin, is drug-induced myopathy, which can range from mild myalgias to severe muscle breakdown of rhabdomyolisis with the potential for subsequent acute renal failure. Additionally, there is an increased risk of myopathy when simvastatin is used in combination with certain other medications. |
|
|
Term
| Which type of hematuria in an older adult is an ominous sign? |
|
Definition
b. Painless, gross hematuria. Correct
Buttaro page 762
Assymptomatic, gross hematuria denotes a significant risk of malignant disease |
|
|
Term
You examine a 64 year old man with hypertension and type 2 diabetes. Results are as follows:
HDL level is 38 mg/dl; LDL level is 135 mg/dl; and triglyceride level is 180mg/dl. His current medications include a sulfonylurea, biguanide, ACE inhibitor, thiazide diuretic, and he has acceptable glycemic and blood pressure control. He states " I really watch fats and sugars in my diet." Which of the following is the most appropriate advice? |
|
Definition
c. Lipid lowering drug therapy should be initiated. Correct
Buttaro page 1080
Dyslipidemia in Type 2 diabetes is characterized by hypertriglyceridemia, low HDL levels, and high LDL levels. A low fat, low cholesterol diet and aerobic exercise are essential in the treatment of dydlipidemia. However, most patients will also require medications. Statins are the first line therapy to decrease LDL cholesterol |
|
|
Term
| Which of the following is most consistent with subclinical hypothyroidism? |
|
Definition
b. Normal T4 and elevated TSH levels. Correct
Buttaro page 1134
Subclinical hypothyroidism is defined as an elevated TSH level in the presence of normal thyroid hormone levels |
|
|
Term
| Which of the following is true concerning hepatitis C infection? |
|
Definition
c. More than 50% of those with hepatitis C infection go on to develop chronic infection. Correct
Buttaro page 670
The Third National Health and Nutrition Examination Survey found that approximately 75% of patients with HVC develop chronic infection |
|
|
Term
| Which of the following statements regarding childhood asthma are true? Choose all that apply. |
|
Definition
a. There is a very significant hereditary component to the probability of a child acquiring asthma.
Correct
b. Asthma in children often is associated with parental smoking. |
|
|
Term
A nurse practitioner examined a patient who had been attacked by a cat. There was a 4
centimeter laceration on the patient's forearm. The NP sutured the laceration, though this
was contraindicated because of the nature of the bite. The patient subsequently became
infected, needed hospital admission, and required IV antibiotics with incision and drainage. How can this situation be characterized? |
|
Definition
This is malpractice: Negligence is the provision of care that does not meet standards of care
Once harm has occured then malpractice exists |
|
|
Term
| A patient presents with jaundice and you ordered liver function studies and bilirubin levels.The total bilirubin is elevated, the unconjugated (indirect) bilirubin is elevated, and the conjugated (direct) bilirubin level is normal. These finding are most consistent with: |
|
Definition
| Hemolytic Anemia: Unconjugated (indirect) hyperbilirubinemia suggests a hemolytic disorder, such as autoimmune or microangiopathic hemolytic anemia |
|
|
Term
| An 18 year old female you saw for a urinary tract infection last week comes to your office with severe fatigue and lightheadedness. She states that her last menstrual period was 3 weeks ago and that her flow was light, as usual. Her hemoglobin is 8.7g/L, and her MCV s 84mm. Last year her CBC was normal. |
|
Definition
. This is hemolytic anemia secondary to Macrodantin. Correct
Buttaro page 1156
Drugs associated with hemolysis in GGPD efficient patients include aspirin and phenacetin, sulfonimides, nitrofurantoin, and primaquin. Ingestion of an offending drug can result in denaturation of hemoglobin, leading to an acute hemolytic event. |
|
|
Term
| An elevated alanine aminotransferase (ALT) greater than 10,000 U/L is most likely associated with: |
|
Definition
| Acute Acetaminophen toxicity |
|
|
Term
| Causes of secondary amenorrhea include each of the following except: C. |
|
Definition
Select one:
a. Pregnancy.
b. Thyroid dysfunction.
c. Turner's syndrome. Correct
Buttaro page 797
See differential diagnosis box in upper left corner
Turner Syndrome would be a cause of primary amenorrhea
d. Hyperprolactinemia. |
|
|
Term
| Pregnant women with hypertension should be followed carefully due to risks to the fetus and mother. All of the following are preferred medications during pregnancy, EXCEPT: C. |
|
Definition
Select one:
a. Beta blockers (BBI)
b. Methyldopa
c. Angiotensin converting enzyme inhibitors (ACE-I) Correct
ACE inhibitors have been associated with many complications during pregnancy including fetal renal damage in the second and third trimester. Use in the first trimester is still controversial
d. Vasodilators, for example hydralazine |
|
|
Term
MS is a four-year old established patient with a history of asthma, who presents to you for general follow-up on her asthma with her mother. Her last asthma exacerbation was 6
months ago when she was treated with oral corticosteroids. Since that time she has maintained asthma control with symptoms occurring 1-2 days per week, and associated use of her beta2 agonist during these episodes with relief. She experiences 1 nighttime awakening per month and has minor limitations in her day to day activities. How would you classify MS's asthma? |
|
Definition
|
|
Term
| Metformin's (Glucophage's) mechanism of action is as: |
|
Definition
| c. A drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production |
|
|
Term
| Laws related to emancipated minors are determined by the federal government. |
|
Definition
| False: Determined at the state level |
|
|
Term
| Folate-deficiency anemia causes which of the following changes in the RBC indices? |
|
Definition
Macrocytic, normochromic. Correct
Butarro page 1148
Vitamin B 12 deficiency and folate deficiency are the primary causes of macrocytic anemia |
|
|
Term
| What is the most important investigation for patients suspected for having delirium? |
|
Definition
CBC: A CBC should be performed to determine if infection is the underlying cause of the delirium.
Scanning of the head and brain should only be performed if focal neuro deficits are detected. |
|
|
Term
| What is the importance of the A1C measurement? |
|
Definition
| Diagnosis of Diabetes, and standard marker of success in treatment of patients with diabetes |
|
|
Term
| Which of the following is true concerning hepatitis C infection? |
|
Definition
| More than 50% go on to develop chronic hep c |
|
|
Term
| You ordered a CBC on a 38 year old health female patient as part of a pre-operative work up, the blood work returns with a decrease MCV and decreased MCHC. What should the FNP do next? |
|
Definition
Order a TIBC, iron level and ferritin level. Correct
Buttaro page 140
Evaluation of the body's iron stores includes serum ferritin, serum iron, total iron binding capacity (TIBC), and the transferritin saturation percentage.
These tests are essential for differentiating the etiology of microcytic anemia caused by impaired hemoglobin synthesis |
|
|
Term
You are caring for a 68 year old male patient who is a school bus driver. On initial
presentation his blood pressure was 152/92 and you therapeutically counseled the patient
regarding lifestyle modifications and begin Norvasc (amlodipine) 5mg daily. The next week the patient presents to your office, he lost 2 pounds and stated that he had made some positive lifestyle changes, he is concerned because he is experiencing some flushing, peripheral edema and headache. His follow up blood pressure is 150/90. Now, you: |
|
Definition
b. discontinue the Norvasc and add a different agent. Correct
The patient is experiencing side effects common to calcium channel blockers including headache and edema of the lowere extremities, therefore changing to a different class of medications is recommended to ensure pateint compliance
The patient remains hypertensive and is a school bus driver, therefore it is important to encourage lifestyle changes, but to also treat with medication. |
|
|
Term
| A 2 year old girl presents with pustular, ulcerating lesions on the hands and feet, as well as oral ulcers that appear like the attached picture. The child is cranky, well hydrated, and afebrile. The most likely diagnosis is: |
|
Definition
a. Hand-foot -and-mouth disease Correct
Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth (herpangina), and a skin rash. |
|
|
Term
| Which of the following is active against Chlamydia trachomatis? |
|
Definition
|
|
Term
| Atopic disorders are characterized by which of the following? Choose all that apply. |
|
Definition
Select one or more:
a. High levels of circulating blood glucose
b. A hereditary component Correct
c. A link to Fragile X syndrome
d. Elevated levels of total and allergen specific IgE Correct
e. Allergic hypersensitivity Correct
f. A link to environmental factors Correct |
|
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Term
| The mother of a 5 year old daughter, Emma, who has just completed chemotherapy, asks when Emma could get the 2nd dose of measles-mumps-rubella (MMR) vaccine. The NP tells the mother: |
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Definition
. Since the MMR is a live virus, Emma should not get the vaccine for at least 3 months as it will take that long for the immunoglobulin levels to increase adequately. Correct
Burns pages 438-439
MMR is a live vaccine
If an individual is unable to produce antibodies, they are unlikely to respond to a veccine
An individual with cellular immunodeficiency can be seriously compromised if given a LAIV |
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Term
| In 2012 the United States Preventative Task Force released a statement regarding Prostate Specific Antigen (PSA) screening for prostate cancer. A key message from this statement is: |
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Definition
d. The USPSTF gave the screening a grade of D and therefore recommended against PSA-based screening for prostate cancer.
Correct
Buttaro page 756
A meta-analysis of randomized trials for the USPSTF did not determine significant benefits of prostate cancer screening |
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Term
| The straight-leg raising maneuver can be used in the diagnosis of: |
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Definition
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Term
| Which of the following helps differentiate between otitis media (OM) and otitis externa (OE)? |
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Definition
. With otitis externa, movement or pressure on the pinna is extremely painful. Correct
Burns page 659
OE findings on physical examination can include pain, often quite severe, with movement of tragus or on attempts to examine the ear with an otoscope |
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Term
| One of the more common sites for atopic dermatitis in the infant is: |
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Definition
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Term
A 50 year old has type 1 diabetes that is well controlled with insulin. Recently she has
experienced several personal difficulties that have her emotionally upset. As a result of
this stress, it is possible that she will: |
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Definition
| Have an increased blood glucose level |
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Term
| A 2 year-old boy is brought in by his father and is presenting with vague symptoms and a capillary serum lead level of 30 µg/dL the NP knows that the CDC recommendations are to: |
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Definition
Confirm the lead level with a venous sample within 7-30 days Correct
Burns page 1066
A capillary sample can be used for initial screening, but venous blood should be drawn to confirm a diagnosis of elevated lead |
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Term
| A patient reports that he has been unable to see clearly since yesterday. He reports that his vision is like "looking through a veil." He also sees floaters and flashing lights but does not have any pain. The NP suspects: |
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Definition
d. Retinal detachment. Correct
Buttaro page 318
Photopsia (light flashes) from retinal problems may be another indication of an impending or actual retinal tear or detachment
Retinal detachment may also produce a persistent symptom described as a curtain, shadow or veil falling over part of the visual field |
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Term
A nurse practitioner examined a patient who had been attacked by a cat. There was a 4
centimeter laceration on the patient's forearm. The NP sutured the laceration, though this
was contraindicated because of the nature of the bite. The patient subsequently became
infected, needed hospital admission, and required IV antibiotics with incision and drainage. How can this situation be characterized? |
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Definition
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Term
| The reticulocyte count is an: |
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Definition
a. evaluation of bone marrow production of red blood cells Correct
A reticulocyte count is a blood test that measures how fast red blood cells called reticulocytes are made by the bone marrow and released into the blood. Reticulocytes are in the blood for about 2 days before developing into mature red blood cells. Normally, about 1% to 2% of the red blood cells in the blood are reticulocytes.
The reticulocyte count rises when there is a lot of blood loss or in certain diseases in which red blood cells are destroyed prematurely, such as hemolytic anemia. Also, being at high altitudes may cause reticulocyte counts to rise, to help you adjust to the lower oxygen levels at high altitudes. |
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Term
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Definition
c. The volume of air exhaled during the first second of forced vital capacity. Correct
FEV1 is the maximal amount of air you can forcefully exhale in one second. It is then converted to a percentage of normal. For example, an FEV1 may be 80% of predicted based on height, weight, and race. FEV1 is a marker for the degree of obstruction with asthma or COPD |
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Term
| You are caring for a 54 year old patient with chronic kidney disease who receives hemodialysis three days a week. The patient's blood pressure is 128/78, you would consider this blood pressure to be: |
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Definition
a. Prehypertension, continue to monitor and initiate therapeutic lifestyle changes. Correct
Hypertension for a patient with chronic kidney disease is defined as >130/80
In this example the patient would be considered pre-hypertensive since the 130/80 threshold is not exceeded
At the pre-hypertensive stage no medication is recommended but therapeutic lifestyle changes should be encouraged |
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Term
| Which of the following is NOT characteristic of innocent heart murmurs in children? |
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Definition
| Usually transmitted to the neck |
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Term
| Increased folic acid intake prior to conception will likely reduce the risk of which of the following birth defects? |
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Definition
d. Open neural tube defect Correct
If women of childbearing age take 400 micrograms of folic acid every day before and during early pregnancy, it may help reduce their baby’s risk for birth defects of the brain and spine called neural tube defects (NTDs). The neural tube is the part of a developing baby that becomes the brain and spinal cord. An NTD can happen when the neural tube doesn’t close completely. |
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Term
| Which of the following characteristics apply to type 2 diabetes mellitus? |
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Definition
| Major risk factors are heriditary and obesity |
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Term
| Which of the following cardiac conditions is associated with cyanosis? |
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Definition
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Term
| What is the most important risk factor for a patient acquiring Alzheimer's disease? |
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Definition
d. A family history of dementia. Correct
Scientists know genes are involved in Alzheimer’s. There are two types of genes that can play a role in affecting whether a person develops a disease—risk genes and deterministic genes. Alzheimer's genes have been found in both categories.
Risk genes increase the likelihood of developing a disease, but do not guarantee it will happen. Scientists have so far identified several risk genes implicated in Alzheimer's disease. The risk gene with the strongest influence is called apolipoprotein E-e4 (APOE-e4). Scientists estimate that APOE-e4 may be a factor in 20 to 25 percent of Alzheimer's cases.
APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOE-e3. Everyone inherits a copy of some form of APOE from each parent. Those who inherit APOE-e4 from one parent have an increased risk of Alzheimer’s. Those who inherit APOE-e4 from both parents have an even higher risk, but not a certainty. Scientists are not yet certain how APOE-e4 increases risk. In addition to raising risk, APOE-e4 may tend to make Alzheimer's symptoms appear at a younger age than usual.
Deterministic genes directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder. Scientists have discovered variations that directly cause Alzheimer’s disease in the genes coding three proteins: amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2).
When Alzheimer’s disease is caused by these deterministic variations, it is called “autosomal dominant Alzheimer’s disease (ADAD)” or “familial Alzheimer’s disease,” and many family members in multiple generations are affected. Symptoms nearly always develop before age 60, and may appear as early as a person's 30s or 40s. Deterministic Alzheimer's variations have been found in only a few hundred extended families worldwide. True familial Alzheimer’s accounts for less than 5 percent of cases. |
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Term
| A woman presents with concerns of vaginal discharge that has a foul odor. On vaginal exam you see the following. What is the most likely diagnosis? |
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Definition
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Term
| A family brings in a 32 year-old man with a history of psychiatric illness. He has not been taking his medications. He is shouting that he is a messenger from the planet Orion and he knows what happened in Roswell. This is an example of: |
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Definition
a. A delusion. Correct
A delusion is an unshakable belief in something untrue. These irrational beliefs defy normal reasoning, and remain firm even when overwhelming proof is presented to dispute them
Hallucinations are false or distorted sensory experiences that appear to be real perceptions. These sensory impressions are generated by the mind rather than by any external stimuli, and may be seen, heard, felt, and even smelled or tasted.
Magical thinking is the irrational belief that one can bring about a circumstance or event by thinking about it or wishing for it
An illusion is a false visual perception of an object that others perceive correctly. |
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Term
Which of the following is (are) nationally reportable dieases? Choose all that apply.
ABCDE |
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Definition
Select one or more:
a. Gonorrhea Correct
b. Chlamydia Correct
c. Hepatitas A, B and C Correct
d. HIV Correct
e. Measles, mumps and rubella Correct
f. Fifths disease |
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