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What material does the program include?

Information covered in this course:

1. Core concentration areas pertaining to specialty area:

2. Taking the Certification Examination, FNP Professional Role

3. Health Promotion/ Disease Prevention

4. Head, Eyes, Ears, Nose and Throat Disorders

5. Respiratory Disorders

6. Cardiovascular System Disorders

7. Endocrine Disorders

8. Psychiatric/ Mental Health Conditions

9. Renal and Urologic Conditions

10. Infectious Diseases

11. Hematological Disorders

12. Sexually Transmitted Diseases

13. Dermatological Disorders

14. Musculoskeletal Disorders

15. Neurologic System Disorders

16. Gastrointestinal System Disorders

17. Male and Female Reproductive Disorders

18. Content slide handouts can be accessed and printed with registration.

19. Contact hours are awarded with completion and processing of verification documentation.

20. No contact hour credit will be awarded after 8/31/2013.

A maximum of 19.43 contact hours may be earned by learners who successfully complete this continuing nursing education activity.

ANA’s Center for Continuing Education and Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

ANCC Provider Number 0023

ANA’s Center for Continuing Education and Professional Development is approved by the California Board of Registered Nursing, Provider Number CEP6178 for 23.32 contact hours (50 minute contact hour).

ANA’s Center for Continuing Education & Professional Development includes ANCC’s Credentialing Knowledge Center.

How much does it cost? $400 allows unlimited use for ninety days from the date of purchase.

What technical capabilities do I need? All you need to get going is an e-mail address and access to the Internet (with Flash Player.) However, in order to access all content and materials available with the course, a sound card with speakers (or headphones) and printer are also required. Click here for minimum technical requirements.

When can I take this course? The Web-based course is available for enrollment at your convenience. You can review the material in the course as many times as you like during this ninety-day period.

How do I access the course? Simply click on the enrollment link at the top right of this page. You will be asked to register and submit your credit card information. Once you are done you will receive a confirmation e-mail which will give you login information and a direct link to the Web course.

Note: You will use the log-in and password that you create during the purchase process to log in to the course. After this, you can to access all materials at anytime through the Web.

Family Practice Board Exam Topics:

•Atopic Dermatitis

•Eczema

•Human Immunodeficiency Virus

•Paget's Disease

•Systemic Lupus Erythematosus

•Hyperlipidemia

•Congestive Heart Failure

•Aortic Stenosis

•Myocardial Infarction

•Lichen Planus

•Treatment of Psoriasis

•Impetigo

•Acute Appendicitis

•Management of Hypothermia

•Type 2 Diabetes Mellitus

•Hyperthyroidism

•Hypocalcemia

•Cushing's Disease

•Peptic Ulcer Disease

•Esophageal Dysphagia

•Lactose Intolerance

•Cirrhosis of The Liver

•Epigastric Hernias

•Dementia

•Parkinson's Disease

•Osteoporosis

•Sideroblastic Anemia

•Sickle Cell Disease

•Thalassemia

•Von Willebrand's Disease

•Multiple Myeloma

•Polycythemia Vera

•Chronic Leukemia

•Hodgkin's Lymphoma

•Bacterial Meningitis

•Conjunctivitis

•Hepatitis B (HBV)

•Methicillin-Resistant S Aureus

•Nephrotic Syndrome

•Addison's Disease

•Hypernatremia

•Metabolic Acidosis

•Nephrolithiasis

•Temporal Arteritis

•Friedreich's Ataxia

•Horner's Syndrome

•Crohn's Disease

•Hyperemesis Gravidarum

•Macrosomia

•Sarcoidosis

Quiz 1 annc

1. Which of the following foods would NOT be a dietary trigger influencing the onset or severity of migraine symptoms? 

A. Stilton cheeses 

B. Pickled herring 

C. Broad beans 

D. Kale 

------

Explanation: 

Correct answer: Kale

There are many foods that are potential dietary triggers influencing the onset or severity of migraine symptoms. Kale and other fresh green vegetables are not one of these types of foods. Other triggers include: bananas, citrus foods, pizza, chicken liver and freshly baked yeast products.

  

2. A nurse practitioner (NP) has worked at a large hospital as an RN and now, as a new NP. She has developed an NP-managed clinic for hospital employees and is employed by the hospital. The NP is described as a(n): 

A. Risk taker 

B. Nurse specialist 

C. Intrapreneur 

D. Entrepreneur 

The Correct answer is: Intrapreneur

An intrapreneur is someone who is able to carve out a specialty role within an existing organization, healthcare setting, or business setting. An entrepreneur is someone who assumes the financial and personal risks of owning their own business, which they also operate. 

3. When evaluating the carotids, with correct procedure for auscultating is: 

A. Use the bell of the stethoscope. 

B. Position the client at a 30-degree angle, and press firmly with bell of the stethoscope. 

C. Use the diaphragm of the stethoscope. 

D. Place the stethoscope 1 inch off the area above the sternocleidomastoid muscle. 

Explanation:  The correct answer is to use the bell of the stethoscope.  The correct procedure is to listen for carotid bruits with the bell of the stethoscope, which brings out low-frequency sounds and filters out high-frequency sound. The bell should be placed very lightly on the neck with just enough pressure to seal the edge. 

11. Which of the following is a typical sign in a person who develops type 2 diabetes? 

A. polyuria 

B. polydipsia 

C. polyphagia 

D. all of the above 

----------------------------------------------------------------

Explanation:  Correct answer: all of the above

 

All of the first three choices are signs/symptoms experienced by a person with type 2 diabetes. Other associated symptoms include: parasthesia, dysesthesias, blurred vision, vaginal candidiasis, or fungal skin infections.

12. Which of the following is the most common cause of stasis ulcers? 

A. diabetes mellitus 

B. fungal infections 

C. venous insufficiency 

D. arterial insufficiency 

 

Correct answer: venous insufficiency

 

Stasis ulcers are most commonly caused by venous insufficiency. They are far less commonly caused by arterial insufficiency, diabetes mellitus and fungal infections.

13. A 66-year-old African-American male with Type II Diabetes is in the office for a check up and medication refills. You conduct a diabetic foot screen for evaluation. Which question is not part of the Carville Diabetic Foot Screen? 

A. Does the foot have an abnormal shape? 

B. Are the nails thick, too long, or overgrown? 

C. Has there been a change in the foot since the last evaluation? 

D. Does the foot hurt when walking? 

 

The correct answer is: "Does the foot hurt when walking?"

The Carville Diabetic Foot Screen does not include the question, “Does the foot hurt when walking?” The Diabetic Foot Screen helps practitioners to determine if a patient with diabetes mellitus has a current and severe foot issue or has risk factors for acute foot issues. The five questions of the Carville Diabetic Foot Screen include:

 

Does the foot have an abnormal shape?

Are the nails thick, too long, or overgrown?

Has there been a change in the foot since the last evaluation?

Is there weakness in the ankle or foot?

Is there a foot ulcer now or a history of foot ulcer?

 

14. You are examining a 12 month old infant at a well-baby checkup. You would expect his heart rate to be in which of the following ranges?

A. 55 – 95 beats per min. 

B. 80 – 160 beats per min. 

C. 65 – 105 beats per min. 

D. 70 – 190 beats per min. 

 

Correct answer: 80 – 160 beats per min.

 

The normal range for heart rate for a 12 month old infant is 80 – 160 beats per min. This is a resting measurement.

15. Marketing refers to determining the needs and desires of the prospective consumer and designing NP services to meet those needs. The key elements of marketing include the four Ps which are: 

A. product, price, place, and prescription 

B. profession, place, price and production 

C. product, price, place and promotion 

D. profession, price, place and prescription 

 

Correct answer: product, price, place and promotion

 

The key elements of marketing include the four Ps. These are: product (the unique role of the NP); price (cost advantage in the NP-delivered care); place (competitive advantage of a practice site or after-hours services); and promotion (processes devoted to negotiating a position in practice).

16. You have a patient whom you suspect has rubella. You would expect to see which of the following types of rash on this patient?

A. pinpoint to 1 cm oval or round pink macules and/or papules

B. bright red to purple macules and papules 

C. bright red confluent lacy rash 

D. sandpaper-like red papules 

 

Correct answer: pinpoint to 1 cm oval or round pink macules and/or papules

 

Rubella is marked by pinpoint to 1 cm oval or round pink macules and/or papules. The rash begins on the face and neck and spreads rapidly to the trunk and extremities.

17. When screening for tuberculosis (TB) which of the following is least likely to be used?

A. sputum culture 

B. PPD 

C. Mantoux test 

D. none of the above 

 

Correct answer: sputum culture

 

When screening for TB, the purified protein derivative (PPD) test or the Mantoux test are used. Sputum cultures or chest X-rays are not used for screening.

18. In terms of the scope of practice for an NP, which of the following statements is incorrect? 

A. The scope of practice defines a specific legal scope determined by state statutes, boards of nursing, educational preparation and common practice within a community. 

B. General scope of practice is specified in many published professional documents. 

C. Prescriptive authority is recognized as within the scope of practice for nurse practitioners in all 50 states. 

D. Scope of practice is always defined by state statutes enacted by the state legislature. 

 

Correct answer: Scope of practice is always defined by state statutes enacted by the state legislature.

 

Some states define scope of practice by state statutes enacted by the state legislature. In other states, the legislature gives the board of nursing the authority to define the scope of NP practice. Either way is enforceable.

19. The most common cause of Cushing’s disease in children is which of the following? 

A. hypersecretion of ACTH

B. adrenal adenomas 

C. long-term corticotropic or glucocorticoid use 

D. nonpituitary neoplasms

 

 

Correct answer: long-term corticotropic or glucocorticoid use

 

All of the choices are causes of Cushing’s disease. However, the most common cause in children is long-term corticotropic or glucocorticoid use.

20. Which of the following does not play a significant role in the development of varicose veins? 

A. diabetes mellitus 

B. wearing constricting garments 

C. weakness of the walls of the vein 

D. pregnancy 

 

Correct answer: diabetes mellitus

 

Diabetes does not play a significant role in the development of varicose veins. An inherited venous defect of either a valvular incompetence or a weakness in the walls of the vessel likely plays a significant role. In addition, situations that cause high venous pressure, such as wearing constricting garments and pregnancy, contribute to their development.

21. Lead poisoning remains a serious public health problem. Which of the following is the least likely to present a lead hazard? 

A. lead-glazed pottery

B. lead-soldered vessels used for cooking

C. fumes from burnt casings of batteries 

D. paint in a home built in 1995 

 

Correct answer: paint in a home built in 1995

 

This is the least likely source to present a lead hazard. Lead-based paint has not been available in the USA for more than 30 years. Therefore, a home built in 1995 would not contain lead-based paint

22. An acute viral illness caused by the Herpes viride family, that presents as an erythematosus, maculopapular rash appearing on the trunk is which of the following? 

23. rubella 

24. rosacea 

25. rubeola 

26. roseola 

 

 Correct answer: roseola

 

Roseola is an acute viral illness caused by an infection of the Herpes viride family, with most cases caused by human herpes virus. Infection occurs throughout the year and as often in males as in females.

23. For a healthcare professional to obtain blood at the request of law enforcement officials without a patient’s consent which of the following must be present? 

A. The suspect must be under arrest. 

B. A delay in drawing blood would lead to destruction of evidence. 

C. The test is performed in a reasonable manner. 

D. all of the above 

Correct answer: all of the above

 

All of the first three choices are factors that must be present. Two other conditions must also be present: the likelihood that the blood drawn will produce evidence for criminal prosecution; and the test is reasonable and not medically contraindicated.

 

24. White papules found on the gum line resembling an erupting tooth are which of the following? 

A. Epstein’s pearls 

B. epispadias 

C. hypospadias 

D. Moro lesions 

 

Correct answer: Epstein’s pearls

 

Epstein's pearls are small white or yellow cystic vesicles (1 to 3 mm in size) often seen in the mouth of newborn infants. They do not require treatment because they resolve spontaneously over the first few weeks of life.

25. Which of the following parts of Medicare pays 80% of durable medical equipment such as wheelchairs and walkers? 

A. Part D 

B. Part A 

C. Part B 

D. Medicare does not pay for durable medical equipment. 

 

Correct answer: Part B

 

Medicare Part B pays for medically necessary services or supplies (outpatient). This includes durable medical equipment such as wheelchairs and walkers.

 

26. Which of the following statements about tendonitis and its treatment is false? 

A. With rotator cuff involvement, the likelihood of concurrent bursitis is low. 

B. When the hand or wrist is affected, splinting and NSAIDs are reasonable first-line therapies. 

C. Achilles tendonitis may necessitate treatment with a posterior splint. 

D. There is a 10% risk of tendon rupture with recurrent Achilles tendonitis. 

 

Correct answer: With rotator cuff involvement, the likelihood of concurrent bursitis is low.

 

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

 

27. A female patient has a history of vaginal itching and heavy white discharge. She reports no recent sexual activity and upon examination the nurse practitioner (NP) discovers a red edematous vulva and white patches on the vaginal walls. The NP expects what factor to be in the patient's history? 

A. early menopause 

B. recent antibiotic use 

C. vegetarian diet 

D. recent diarrhea 

The Correct answer is: Recent antibiotic use

These findings are consistent with candidiasis and the majority of women, almost half, develop a vaginal infection due to candidiasis, after completing antibiotics. Further, candidiasis is not a sexually transmitted disease. 

 

Question 28 

You are counseling a mother who has her 7-month-old infant in the office with the complaint of "spitting up his formula." The nurse practitioner (NP) knows this to be a common thing for infants but the mother conveys she has "put him on goat's milk." The NP is concerned because she knows that goat's milk places the infant at risk of developing: 

  scurvy 

  rickets 

   megaloblastic anemia 

  botulism 

-

The Correct answer is:

Megaloblastic anemia

This condition can develop secondary to folic acid deficiency. Goat's milk does not contain the appropriate level of folic acid needed for the infant. Scurvy is caused by a lack of ascorbic acid and rickets is a result of a diet lacking in Vitamin D. Botulism is food poisoning due to an endotoxin produced by the bacillus Clostridium botulinum. 

 

Question 29 

You are treating a patient for a knee sprain. The nurse practitioner understands that initial management includes: 

  anti-anxiety medications 

   rest, ice, compression, and elevation 

   activity as tolerated 

  X-rays 

 

The Correct answer is:

Rest, ice, compression and elevation

Rest, ice, compression, and elevation, which is often abbreviated as RICE, is a standard initial management for a knee sprain, along with anti-inflammatory medications. X- rays are not necessary for a sprain. Further, activity is usually withheld for 48 hours. 

 

Question 30 

Your elderly patient has tan-colored macules on the dorsum of the forearms. You understand that these are which of the following? 

  seborrheic keratoses 

  senile purpura 

   lentigines 

  actinic keratoses 

 

Correct answer:

lentigines

 

Lentigines are also known as “liver spots.” They are tan-to-brown colored macules on the dorsum of the hands and forearms from sun damage. They are more common in light skin and are benign.

 

Question 31 

The FNP has a 70-year-old female patient who has come in because she began to feel weak and dizzy. After examination the FNP suspects atrial fibrillation. The FNP’s plan of diagnosis and treatment for this woman would include which of the following? 

  doing a 12-lead electrocardiogram (EKG) 

  prescribing an anticoagulant 

   monitoring response to anticoagulation with the INR 

   all of the above 

 

Correct answer:

all of the above

 

The diagnosis and treatment for this woman would include all of the first three choices. The anticoagulation guidelines are atrial fibrillation: INR 2.0 – 3.0; synthetic valves: INR 2.5 to 3.5.

 

Question 32 

Which of the following is NOT an absolute contraindication to postmenopausal estrogen therapy? 

   seizure disorder 

  unexplained vaginal bleeding 

   acute liver disease 

  neruo-ophthalmologic vascular disease 

 

Correct answer:

seizure disorder

 

All of the choices are absolute contraindications to postmenopausal estrogen therapy except seizure disorders. In the case of seizure disorders, estrogen therapy can be used with caution, considering if the benefit outweighs the risk.

 

Question 33 

The FNP has a 67-year-old male patient with type 2 diabetes. In managing this patient’s care which of the following lab tests should be done every 3 – 6 months? 

  thyroid assessment 

  urine microalbumin/creatinine 

   serum creatinine 

   A1c 

 

Correct answer:

A1c

 

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

 

Question 34 

The first-line treatment for osteoarthritis in European nations that is a nutritional supplement here in the United States is which of the following? 

  timed antacid use 

  scralfate 

   glucosamine 

  misoprostol 

 

Correct answer:

glucosamine

 

In many European nations glucosamine is a first-line treatment of OA. In the United States it is an over-the-counter nutritional supplement. The results of research studies have differed on the effectiveness of its use, with many reporting no improvement in arthritis symptoms.

 

Question 35 

You are seeing a teenage girl who comes to the clinic and tells you she was raped late last night by her date. The immediate action taken by the nurse practitioner is: 

   Send patient to emergency room for examination 

  Call her parents so they can be with her. 

   Perfom a pelvic examination to determine her injuries. 

  Send her immediately for counseling to help her deal with this situation. 

 

The Correct answer is:

Send patient to emergency room for examination

This patient should be examined by emergency room personnel who are specifically trained to collect appropriate evidence needed to testify in court regarding rape. The exam cannot be done in the office unless the nurse practitioner has protocol and training in this area. The patient decides whom to call, and should be offered rape crisis resources. 

 

Question 36 

You are doing a complete physical exam on a 25-year-old female patient with sleep apnea. Which of the following are you most likely to find in this patient?

 

  bruit 

  paroxysms of sweating 

   increased blood pressure 

  atrial fibrillation 

 

Correct answer:

increased blood pressure

 

Increased blood pressure is the only choice that might be found in a patient with sleep apnea. Bruit might be found in renal artery stenosis. Paroxysms of sweating may be found in a person with pheochromocytoma. Atrial fibrillation might be found in a person with hyperthyroidism.

 

Question 37 

Which of the following is NOT classified as a generalized seizure? 

  absence seizures 

  myoclonic seizures 

   status epilepticus 

  tonic seizures

 

Correct answer:

status epilepticus

 

Status epilepticus is considered an unclassified epileptic seizure. Other generalized seizures (convulsive or nonconvulsive) include petit mal, clonic, tonic-clonic, atonic seizures and infantile spasms.

 

Question 38 

Of the following hormones, which one stimulates the ovaries to ovulate? 

  TSH 

  GH 

   ACTH 

   LH 

 

Correct answer:LH

LH (luteinizing hormone) stimulates the ovaries to ovulate. It is also responsible for the production of progesterone by the corpus lutea

Question 39 

In males, puberty is considered precocious if it occurs before: 

  12 years of age 

   9 years of age 

   14 years of age 

  10 years of age 

 

Correct answer:

9 years of age

 

In boys, puberty starts at 9 years of age. It is considered precocious puberty if it begins before 9 years of age. In girls puberty starts at 8 years of age and is considered precocious if it begins before 8 years of age.

 

 Question 40 

You are treating a 38-year-old mildly obese female with peptic ulcer disease symptoms. The most cost effective, sensitive and specific test for Helicobacter pylori infection is: 

  fecal DNA testing 

   organism-specific stool antigen testing 

   serological testing for antigen related to the infection 

  stool Gram stain, looking for the offending organism 

 

The Correct answer is:

Organism-specific stool antigen testing

The most cost-effective method of diagnosing H. pylori infection is the organism-specific stool antigen testing. Serological testing is also available but has limitations. H. pylori is transmitted via the oral-fecal and oral-oral route. It is a gram-negative, spiral shaped organism that is seen in duodenal ulcer and gastric ulcer disease. 

 

Question 41 

The most common cause of acute diarrhea in children is which of the following? 

  Escheria coli 

   rotavirus 

   salmonella 

  shigella 

Correct answer:

rotavirus

The most common cause of acute diarrhea in children is rotavirus. it causes 25% of cases. Other pathogens include Norwalk-like viruses, enteric adenoviruses, astroviruses, and caliciviruses. Bacterial pathogens include salmonella, shigella, yersinia, campylobacter, and more.

 

 Question 42 

The process by which a voluntary, non-governmental agency or organization appraises and grants status to institutions and programs or services which meet predetermined structure, process and outcome criteria is which of the following? 

   accreditation 

  certification 

   licensure 

  scope of practice 

Correct answer:

accreditation

 

Accreditation is the process by which a voluntary, non-governmental agency or organization appraises and grants status to institutions and programs or services which meet predetermined structure, process and outcome criteria. The purpose is to assure that the organization has met specific standards.

 

Question 43 

The FNP has a patient who is hypertensive. The FNP is making some suggestions of lifestyle modifications as recommended by the JNC-7 report. Which of the following recommendations is likely to produce the best average systolic blood pressure reduction rate? 

  moderation of alcohol consumption 

  aerobic physical activity 

   dietary sodium reduction 

   weight reduction 

 

Correct answer:

weight reduction

 

Weight reduction will give the patient a 5 – 20 mm Hg reduction for every 10 kg of weight lost. Moderation of alcohol consumption will give a 2 – 4 mm Hg reduction; aerobic physical activity will give a 4 – 9 mm Hg reduction; and dietary sodium reduction will give a 2 – 8 mm Hg reduction.

 

Question 44 

The FNP has a pregnant patient who is Rh negative and whose baby is Rh positive. The treatment for the infant antepartum includes which of the following? 

   transfusion with Rh negative blood 

  phototherapy 

   transfusion of packed red blood cells 

  administration of gamma globulin 

 

Correct answer:

transfusion with Rh negative blood

 

Once a diagnosis has been established, antenatal treatment includes transfusion of the fetus with Rh negative blood. All of the other choices are parts of postpartum interventions.

 

Question 45 

Communication theory emphasizes all of the following EXCEPT: 

  interaction of individuals that includes both verbal and nonverbal communication 

  emotional support, shared information, and instruction 

   that messages are not time-bound 

  that communication conveys values and beliefs between members and the external environment 

 

Correct answer:

that messages are not time-bound

 

On the contrary, communication theory emphasizes that messages are time-bound. They must be appreciated within the context of the sender.

 

Question 46 

Your patient has been diagnosed with Bell’s palsy. The cranial nerve involved in this disease is which of the following? 

  CN V 

  CN VI 

   CN VII 

  CN VIII 

 

Correct answer:

CN VII

 

CN VII is the facial nerve. Dysfunction of this nerve gives the characteristic findings of Bell’s palsy (facial asymmetry, droop of mouth, absent nasolabial fold, impaired eyelid movement).

 

Question 47 

All of the following are factors that would protect a person from the possibility of gastroenteritis EXCEPT: 

  normal bacterial flora of the intestine 

  acidity of the stomach 

   normal motility of the GI tract 

   taking antacids 

 

Correct answer:

taking antacids

 

Loss of normal gastric acidity, such as in those taking antacids or H2-receptor antagonists, is a factor that increases susceptibility to gastroenteritis. Gastric surgery, increased age, and poor physical condition are also factors contributing to susceptibility.

 

 Question 48 

A nurse practitioner (NP) has been infected with the HIV virus during her emergency department working days in the early 1980s. She is now employee in a private clinic and performs wellness exams. Which of the following is an ethical statement? 

   The NP is under no obligation to inform anyone. 

  The NP is under obligation to inform the patient if she performs invasive procedures. 

   The NP is obligated to inform her patients of her HIV status. 

  The NP is obligated to inform her employer of her HIV status. 

 

The Correct answer is:

The NP is under no obligation to inform anyone 

The nurse practitioner's health information is protected, therefore, she is not obligated to inform her patients, employer, or the state board of nursing as long as she is able to perform her job without imposing a risk to anyone

 

Question 49 

Which of the following statements about Managed Care Organizations (MCOs) is false? 

  MCO is an umbrella term that may include HMOs and other forms of health plans. 

  MCOs reimburse primary care providers on a fee-for-service basis, a capitated basis or a combination of both. 

   MCOs do not credential providers; that is done by the federal government. 

  MCOs sell a priced package of health services to their clients. 

 

Correct answer:

MCOs do not credential providers; that is done by the federal government.

 

This is the false statement. MCOs do credential providers. They collect educational, license, malpractice, employment and certification data on each provider and make a judgment that a provider is or is not adequately prepared to care for the MCO’s patients.

 

Question 50 

Which statement is TRUE regarding the professional role in reading evidence-based medicine articles? 

   Nurse practitioners should have sufficient research skills to be able to critically evaluate and participate in outcome studies that will relate to their clinical practice. 

  The trend is to base decisions on intuition and tradition, not research. 

   Clinical trials have yet to gain acceptance as valid foundations on which care can be provided. 

  The use of evidence-based research in clinical practice is not common. 

 

The Correct answer is:

Nurse practitioners should have sufficient research skills to be able to critically evaluate and participate in outcome studies that will relate to their clinical practice 

To reduce the number of conflicting or varying recommendations for the diagnosis and treatment of common problems, the trend is going to evidence-based research from randomized controlled research trials and meta-analyses of these trials. Outcome studies are replacing tradition, intuition and preference for how problems should be treated. The use of research in clinical practice is now commonplace.

 

Question 51 

A nurse practitioner wants to make a change in the state's law concerning the dispensing of prescription medications by nurse practitioners. Who would this case need to be taken to? 

  state board of nursing 

  state board of pharmacy 

   nursing specialty organization 

   state legislature 

 

The Correct answer is:

State legislature

Healthcare policy within the states is codified or enacted into law by the respective state legislature. The boards should have significant input in the process, such as providing the research data and expert "testimony" that the legislature needs to make informed decisions. However, boards, such as the state nursing boards, do not have the governing power to pass state laws. 

 

Question 52 

You are conducting a Mini-Mental exam (MME) on a patient. You ask the patient to spell “world” backward. Which of the following MME activities is being used? 

  recall 

  orientation 

   attention and calculation 

  copying 

 

Correct answer:

attention and calculation

 

Attention and calculation activities of the MME include asking the patient to spell a work backwards. It also includes serial 7s (asking a patient to subtract 7 from 1000 and on down).

Question 53 

An adult female comes to your clinic complaining of a rash on her hands. You ask her if there have been any changes in detergent, lotion, etc. that come in contact with her hands. She tells you that she changed her brand of dish detergent recently and that she washes all her dishes by hand. Which of the following would you diagnose for this patient?

 

   contact dermatitis 

  atopic dermatitis

 

   scabies 

  psoriasis 

 

Correct answer:

contact dermatitis

 

Contact dermatitis is a cutaneous reaction to an external substance such as an irritant or allergen. It appears as an asymmetric distribution of red, raised, and/or inflamed rash, or rash only on exposed areas. 80% of cases are due to universal irritants such as soap and detergent.

 

 Question 54 

In terms of practice environment, what would a CAM treatment be? 

  a treatment used in mass casualty situations

  a treatment used when patients ask for a specific treatment 

   a complementary and alternative medicine treatment 

   none of the above 

 

Correct answer:

a complementary and alternative medicine treatment

 

These days there is a greater recognition of the use by patients of complementary and alternative modalities and medicines. FNPs as providers need to learn about common CAM treatments.

 

Question 55 

Which of the following is least likely to exacerbate edema in your patient? 

  laxative abuse 

  corticosteroids 

   calcium agonists 

   diuretics 

 

Correct answer:

diuretics

 

Diuretics are indicated for marked peripheral edema, pulmonary edema, CHG, and inadequate dietary salt restriction. Abuse of diuretics, however, can lead to edema.

 Question 56 

Attachment, in terms of infant psychosocial development, is the enduring and specific affective bond that develops over the first year of life. In an insecure-disorganized attachment the underlying process/emotion is which of the following? 

  anger 

  anxiety 

   confusion/dysfunction 

   ambivalence 

 

Correct answer:

confusion/dysfunction

 

In an insecure-disorganized attachment the underlying process is confusion and dysfunction. In a secure attachment, the underlying emotion is love. In an insecure-avoidant attachment, the underlying emotion is anger. In an insecure-anxious attachment the underlying emotion is anxiety/ambivalence.

 

Question 57 

A 35-year-old Caucasian female is in the office with rosacea. She is asking about treatment options. What is the recommended treatment for her? 

  topical 5-fluorouracil 

   low-dose tetracycline 

  oral ketoconazole 

   Dilantin 

 

The Correct answer is:

Low-dose tetracycline

Treatment with systemic low-dose tetracycline is a very effective measure for rosacea. Further, topical treatment with metronidazole or a low-dose steroid cream may also be helpful. In some cases, ketoconazole, the antifungal cream and not an oral form, is used to treat rosacea. Topical 5-fluorouracil is used to treat actinic keratosis.

 

 Question 58 

Which of the following specifically addresses the need to promote consistent access to quality advanced practice nursing care within states and across state lines?

 

  The Joint Commission 

   The Advanced Practice Registered Nurse Compact 

   ANA 

  HHS 

 

Correct answer:

The Advanced Practice Registered Nurse Compact

 

Beginning in 1999, the National Council of State boards of Nursing (NCSBN) began implementation of an interstate compact for nursing practice to reduce state-to-state discrepancies in nursing requirements to practice. The Advanced Practice Registered Nurse Compact addresses the need to promote consistent access to quality advanced practice nursing care within states and across state lines.

Question 59 

A diabetic patient with proteinuria has been placed on an ACE inhibitor. How soon can the anti-proteinuric effect of the ACE inhibitor be realized in this patient? 

   6 to 8 weeks 

  3 months 

   6 months 

  3 to 5 years 

 

The Correct answer is:

6 to 8 weeks

The effect can be realized as early as 6 to 8 weeks after starting an ACE inhibitor or ARB. A second agent can be added if the ACE or ARB reaches maximum dosage and the goal of proteinuria, which is less than 500 mg/dL, has not been achieved. 

 Question 60 

Which of the following would NOT be a common reason for developing a scope of practice in state law for an NP? 

  to allow NPs to perform at their level of education and training 

   to assure safe and appropriate care with an outcome as good as expected 

   to avoid any charges of practicing medicine without a license 

  to place accountability for benefits or harm to a patient squarely on the NP 

 

Correct answer:

to assure safe and appropriate care with an outcome as good as expected

 

This is a reason for developing a standard of care rather than scope of practice. Other reasons for developing a scope of practice in state law for an NP include: to get reimbursement for physician services, when provided by an NP; to avoid imputation of liability for medical malpractice to someone other than the NP, usually a physician, and to establish that the NP is a professional entity, not just a “nonphysician.”

Question 61 

A patient in the clinic is found to have 2 palpable, tender, left pre-auricular nodes that are about 0.5 cm in diameter. You expect to find what in this patient? 

  ulceration on the tongue 

  ear infection 

   sore throat 

   conjunctivitis 

 

The correct answer is conjunctiviitis.  The eyes are drained by the pre-auricular lymph nodes and they can be palpated near the ear. These swell in response to eye infections, allergies, or foreign bodies in the eye. 

 

Question 62 

A patient you diagnosed with hypothyroidism was started on levothyroxine. At what interval should the nurse practitioner reassess her TSH? 

  1 to 2 weeks 

  2 to 4 weeks 

   4 to 6 weeks 

   6 to 8 weeks 

 

The Correct answer is:

6 to 8 weeks

In the treatment of hypothyroidism, T4 replacement is needed in the form of levothyroxine (Synthroid or Levoxyl). The initial dosage for an adult is 75 to 125 mcg. For an elderly person, the dose is 75% less than the adult dosage. Because of the long half-life of levothyroxine, the effects of a dosage adjustment or initiation would not cause a change in TSH for approximately five to six drug half-lives, or about 6 to 8 weeks.

Question 63 

There are issues that the nurse practitioner must address in negotiation with managed care organizations, health systems, or professional practice groups. Which of the following is NOT one of these issues? 

  clinical privileges 

  participation in bonus payment plans 

   malpractice insurance 

   patients' bill of rights 

 

The Correct answer is:

Patients' bill of rights

The patients' bill of rights has nothing to do with negotiation with managed care organizations, health systems or professional groups. The remaining answer choices are all included as important issues as well as percentage of payment to collaborating physician, contracts between the nurse practitioner, employer and payer, and risk sharing. 

 

 Question 64 

The ability of a patient and family to understand and act on health information is known as which of the following? 

  family systems theory 

  complementary medicines 

   collaborative education 

   health literacy 

 

Correct answer:

health literacy

 

Health literacy is recognized as one of the largest contributors to health outcome. It is the ability of a patient and family to understand and act on health information.

 

 Question 65 

Which of the following statements about heart murmurs is least accurate? 

  Midsystolic murmurs usually originate in semilunar valves. 

  Pansystolic murmurs are usually associated with regurgitation. 

   Murmurs originating in the left side of the heart change more with respiration.

 

  Middiastolic/presystolic murmurs are associated with atrioventricular valves. 

 

Correct answer:

Murmurs originating in the left side of the heart change more with respiration.

 

This is not accurate. Murmurs originating in the right side of the heart change more with respiration. Examples of this type of murmur are pulmonic or tricuspid murmurs.

Question 66 

 You are examining a 4-year-old child who attends daycare when his mother and father are working. He has a rash with a “slapped cheek” appearance. Your most likely diagnosis for this child will be which of the following?

 

  roseola 

  chicken pox 

   Fifth disease 

  scabies 

 

Correct answer:

Fifth disease

 

Fifth disease is a mild, self-limiting viral disease characterized by erythematous, macular rash first appearing on the cheeks and ears, leading to a “slapped cheek” appearance. One of the factors contributing to this disease is institutional style day care.

 

Question 67 

Although nurse practitioners and physician’s assistants may function similarly, there are differences between NPs and PAs. Which of the following statements about NPs in relation to PAs is incorrect? 

  A PA has a job description, while an NP has a scope of practice. 

  PAs practice medicine under the license of a physician, never independently. 

   NPs are always primary care providers. 

  NPs practice under their own licenses. 

Correct answer:

NPs are always primary care providers.

 

Some state’s laws specifically authorize nurse practitioners to be primary care providers (PCPs). Other states do not prohibit a nurse practitioner from being designated as a PCP. State law governs whether the NP can be a primary care provider. Physician’s assistants are never primary care providers.

Question 68 

A pulse oximetry of less than what percent indicates the need for supplemental oxygen therapy? 

  98% 

  95% 

   94% 

   90% 

 

Correct answer:

90%

 

Pulse oximetry determines oxygen saturation. Less than 90% indicates the need for supplemental oxygen therapy.

 

Question 69 

What do you expect to find in the cerebral spinal fluid (CSF) when evaluating a patient who has aseptic or viral meningitis? 

  low opening pressure 

  glucose at about 30% serum levels 

   low protein level 

   predominance of lymphocytes 

 

The Correct answer is:

Predominance of lymphocytes

To eliminate or support a diagnosis of meningitis, a lumbar puncture to evaluate cerebral spinal fluid is often done. Pleocytosis, defined as a white blood cell (WBC) count of more than 5 cells/mm of CSF, is an expected finding in meningitis caused by bacterial, viral, tubercular, fungal, or protozoan infection. An elevated CSF opening pressure is also a nearly universal finding, not a low one. Normal glucose levels and normal or high protein levels are also noted findings with meningitis. 

 

Question 70 

Which test is the most important diagnostic lab value to diagnose iron deficiency anemia? 

  serum folate level 

   serum ferritin level 

   red blood cell (RBC) count 

  direct Coombs 

 

The Correct answer is:

Serum ferritin level

Serum ferritin levels correlate with the total body iron stores because it is the major iron storage protein. Its value is reduced in iron deficiency anemia. Serum folate measures the folic acid level. Direct Coombs measures in vivo RBC coating by immunoglobulins.

 

Question 71 

You have a patient who has hypertension which has been controlled by medication. You believe that this patient has the right and responsibility for selecting self-care behaviors that will be consistent with keeping her blood pressure under control. You believe in which of the following theories? 

  compliance perspective 

  fulfillment perspective 

   transtheoretical perspective 

   empowerment perspective 

 

Correct answer:

empowerment perspective

 

The empowerment perspective assumes that the informed client is the “expert” in his or her own disease and, as such, has the right and responsibility for selecting self-care behaviors consistent with good or better health within the context of daily lifestyle. Efforts to understand the client’s perspective, acknowledge feelings, and educate for optimal decision making are cornerstones of this model.

Question 72 

You have a patient who is 26 weeks pregnant. She presents with what you diagnose as Fifth Disease. You understand that all of the following are special considerations for this patient EXCEPT:

 

  Infections during pregnancy may cause fetal hydrops and death. 

  The risks associated with Fifth Disease are lower in this patient since she was exposed after 20 weeks of pregnancy. 

   The risk of fetal hydrops and death is relatively high in pregnant women. 

  B19 infected fetuses may be treated with intrauterine blood transfusions.

 

Correct answer:

The risk of fetal hydrops and death is relatively high in pregnant women.

 

The risk of fetal hydrops and death is relatively low. The highest risk is if the mother is exposed during the first 20 weeks of pregnancy

 

Question 73 

Your patient brings her 6-year-old female child to you. The child is complaining of abdominal pain and swelling of her hands and feet. She tells you that the child had a “strep throat” a couple of weeks ago. She has been running a fever and acts very tired. Which of the following diseases/disorders is most consistent with these symptoms? 

  systemic lupus 

   acute glomerulonephritis 

   congestive heart failure 

  bacterial endocarditis 

 

Correct answer:

acute glomerulonephritis

 

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

Question 74 

The FNP has an African-American female patient who is 75 years old. She complains of a gradual loss of her peripheral vision. Examination indicates increased IOP. Which of the following is the most likely cause of her symptoms? 

  subconjunctival hemorrhage 

  primary closed-angle glaucoma 

   primary open-angle glaucoma 

  macular degeneration 

 

Correct answer:

primary open-angle glaucoma

 

Primary open-angle glaucoma has a gradual onset of increased IOP due to blockage of drainage of the aqueous humor. The optic nerve undergoes ischemic damage resulting in permanent visual loss. It is the most common type of glaucoma and is most commonly seen in elderly patients, especially those of African background or diabetics.

 

Question 75 

A patient receives another person's medication in error. This was done by an LPN in the office and did not result in a life-threatening situation for the patient. What is an appropriate way for the nurse practitioner to document this? 

  Patient received wrong medication. Incident report was filed. LPN was disciplined. 

   X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified. 

   LPN inadvertently administered Y drug to the wrong patient. Supervisor notified. Family threatening litigation. 

  Patient was given X mg of Y drug in error. 

 

The Correct answer is:

X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified 

Documenting, "X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified," is the most accurate note because it is factual. Also, with this noted documentation, the writer is avoiding blame or assuming liability. The other notes, identified in the remaining answer choices, would be "red flags" mentioning error, litigation, and incident report. 

 

Question 76 

You are testing a 5-year-old child for visual acuity. You use the Snellen chart. The child should be standing at what distance from the chart? 

  5 feet 

  10 feet 

   15 feet 

   20 feet 

 

Correct answer:

20 feet

 

You should obtain visual acuity (V/A) and binocular vision by age 4 to 5 years. The child using the Snellen chart should be at 20 feet when reading it. A failed test is V/A 20/40 or greater in either eye, or if there is a two-line discrepancy between the eyes.

Question 77 

The FNP has recommended isometric exercises for a patient who is recovering from a joint injury. All of the following statements about isometric exercises are true EXCEPT: 

  They are controlled and sustained contraction and relaxation of a muscle group. 

   They are helpful for those with osteoporosis. 

   They are less stressful on joints than regular exercise. 

  They are usually done first before active exercise post injury. 

 

Correct answer:

They are helpful for those with osteoporosis.

 

Isometric exercises are non-weight-bearing exercises. Only weight-bearing exercises work for osteoporosis (for instance, walking or biking).

Question 78 

In terms of physiologic changes during pregnancy, which of the following is the least accurate statement? 

   There is increased peristalsis from progesterone effects. 

  Plasma volume increases 50% by the end of the third trimester.

 

   Decreased systolic and diastolic pressure occurs in the first trimester. 

  Cardiac output increases by 1/3 by the last two trimesters. 

 

Correct answer:

There is increased peristalsis from progesterone effects.

 

This is not accurate. There is decreased peristalsis from progesterone effects. This results in things like heartburn and constipation

 

Question 79 

A 16-year-old mildly obese adolescent presents requesting a letter stating she should not participate in gym class because of her asthma. The most appropriate response is to: 

  Excuse her from outdoor activities only as to avoid pollen exposure. 

  Write the note to excuse her from indoor activities only to avoid dust mite exposure. 

   Write the note because gym class participation could trigger asthma symptoms. 

   Remind her that with appropriate asthma care, she can participate in gym class and that exercise is part of a healthy lifestyle. 

 

The Correct answer is:

Remind her that with appropriate asthma care, she can participate in gym class and that exercise is part of a healthy lifestyle

Asthma is a common chronic disorder that is complex but treatable. Exercise is a necessary part of a healthy lifestyle, especially for a developing teen that is overweight. With the use of a short-acting beta2 agonist inhaler, this condition can be controlled and managed during activity. 

 

 Question 80 

In terms of newborn vision, which of the following statements is correct? 

  Newborns are farsighted. 

   Newborns can focus best at a distance of about 24 inches. 

   Preferred colors are yellow and blue. 

  Newborns have excessive tears when crying. 

 

Correct answer:

Newborns can focus best at a distance of about 24 inches.

 

This is the correct statement. Newborns are nearsighted. Their preferred colors are black, white and red; and they have no tears when crying since lacrimal ducts mature by age 2 – 3 months.

 

Question 81 

A young male is in the clinic and he mentions suicidal thoughts. All of the following are part of the suicidal risk assessment EXCEPT:

 

  Approach with a declaration such as: "It sounds as if you are having a really hard time." 

  Always ask "Do you have a plan?" 

   There is no need for intervention if the patient is not tearful and distraught. 

  Pay attention to affect and mood. 

 

The Correct answer is:

There is no need for intervention if the patient is not tearful and distraught

The patient does not have to be distraught and tearful to be suicidal. Often, they present with a soft low voice and have downcast eyes with poor eye contact

 

Question 82 

For the patient with mild ulcerative colitis, the nurse practitioner knows the primary therapy is: 

  amoxicillin 

  metronidazole 

   sulfasalazine 

  cephalexin 

 

The Correct answer is:

Sulfasalazine

Sulfasalazine is the treatment recommended for patients with mild ulcerative colitis. Additionally, it results in symptomatic improvement in 50-75% of patients diagnosed with mild ulcerative colitis. If no response is seen after 2-4 weeks, the addition of prednisone is recommended. The remaining answer choices are not first line initial therapy. 

Question 83 

Which of the following is NOT a violation of the Stark Acts? 

  referring a patient covered by Medicare to a clinical laboratory where the physician or an immediate family member of the physician has a financial relationship 

  referring a patient to certain designated health services when the physician has a financial relationship with the facility offering the services 

   referring a patient to another physician in the same group practice 

  none of the above 

 

Correct answer:

referring a patient to another physician in the same group practice

 

Under the Stark Acts, a physician cannot refer a patient covered by Medicare to a clinical laboratory where the physician or an immediate family member of the physician has a financial relationship. Nor may a physician refer a patient to certain designated health services when the physician has a financial relationship with the facility offering the services. He can, however, refer a patient to another physician in the same group practice.

 

Question 84 

Which of the following changes are you least likely to see in a menopausal woman? 

   larger nipples that protrude more 

  atrophy of the vulva

 

   sleep disorder 

  increased incidence of cystocele and rectocele 

 

Correct answer:

larger nipples that protrude more

 

You are not likely to see that a menopausal woman’s nipples enlarge and protrude more. Changes related to the breast include nipples that become flatter and smaller. Also there is size and shape change in the breasts and atrophy of glandular tissue.

 

Question 85 

A 23-year-old thin Caucasian female presents in the clinic with a new diagnosis of Crohn's disease. She has recently started medication prescribed by her gastroenterologist and asks you to tell her what else to do. You know that proper nonpharmacological management of this condition includes all of the following EXCEPT:

 

  Avoid dairy products that contain lactose if they exacerbate symptoms. 

   A  low protein is recommended. 

   Stress management is important, including relaxation techniques. 

  A low-roughage diet is recommended during acute exacerbations. 

 

Correct answer:

A low protein diet is recommended.

 

A diet high in protein and vitamins, particularly B12, is recommended for the patient with Crohn's disease.

Question 86 

The FNP has a patient with a gradual onset of numbness starting in the hands and feet. The CBC on this patient reveals a macrocytic anemia and a peripheral smear shows multisegmented neutrophils. This patient most likely has which of the following conditions/diseases? 

  neutropenia 

   vitamin B12 deficiency 

   thrombocytopenia 

  non-Hodgkin’s lymphoma 

 

Correct answer:

vitamin B12 deficiency

 

Vitamin B12 deficiency is indicated since the patient has a gradual onset of paresthesias (numbness, tingling or pricking) starting in the hands and feet with a CBC that reveals a macrocytic anemia and a peripheral smear that shows multisegmented neutrophils. Pernicious anemia is the most common cause of vitamin B12 deficiency.

 Question 87 

The state boards of nursing do all but which of the following? 

   do audits of NP practice 

  carry out the statutes of the state 

   write and administer rules and regulations for nursing practice, based on statute 

  ensure that NP qualifications are up to date 

 

Correct answer:

do audits of NP practice

 

State boards of nursing do not do audits of NP practices. They also do not test NPs. 

 

Question 88 

Which of the following would NOT be a common cause of epilepsy in older adults? 

  cerebrovascular disease 

   premature birth

 

   neoplasms 

  head trauma 

 

Correct answer:

premature birth

 

Premature birth is a factor that would increase susceptibility to seizures, but is not a common cause in the elderly population. In addition to the other three choices, metabolic derangements are also a common cause.

Question 89 

Which of the following measures would be directed particularly against the reservoirs of infection? 

   insect spraying 

  water purification 

   immunization 

  improved nutrition 

 

Correct answer:

insect spraying

 

Measures directed against the reservoirs of infection include: insect spraying, isolation and quarantine. Water purification is a measure to interrupt the transmission of organisms. Immunization and improved nutrition are measures that reduce host susceptibility. 

 

Question 90 

When a patient is receiving antithyroid medication, the nurse practitioner has knowledge that: 

  The drugs are somewhat expensive and have serious cardiac and hematologic side effects. 

   Patients remain on drug therapy for 1-2 years and then the medication is gradually withdrawn. 

   Lifelong daily treatment is necessary to keep TSH levels within the normal range. 

  Antithyroid medications do not cross the placebo membrane structure. 

 

The Correct answer is:

Patients remain on drug therapy for 1-2 years and then the medication is gradually withdrawn

Antithyroid medications are relatively inexpensive. The client remains on the medications for 1-2 years with the hope of a permanent remission of symptoms when they are withdrawn.

 

Question 91 

A patient is having a seizure with rigid extension of her arms and legs and sudden jerking movements with loss of consciousness. She is having which of the following types of seizure? 

  myoclonic 

   tonic-clonic 

  simple partial 

  complex partial 

 

Correct answer:

tonic-clonic

 

A tonic-clonic (grand mal) seizure is characterized by rigid extension of her arms and legs and sudden jerking movements with loss of consciousness. The onset of this type of seizure can happen at any age. In adults, a new onset may be found in patients with a brain tumor, post head injury or alcohol withdrawal

 

 Question 92 

If a clinician is doing a research study that measures the impact of a fall prevention program on the number of falls among older adults it would be which of the following types of research? 

   experimental research 

  descriptive research 

   historical research 

  correlational research 

 

Correct answer:

experimental research

 

Experimental research is research aimed at determining the effect of one or more variables. The fall prevention research falls into this category. For a true experimental design to exist, the sample must be randomly selected; there must be manipulation of the independent variable by the researcher as is usually seen in intervention studies; and there must be a control group.

 

Question 93 

Researchers try to substantiate causality so that the patient outcomes can be more consistently predicted. For the nurse practitioner, the ability to predict the outcomes for every patient would mean: 

  no further studies would need to be conducted about treatments 

  the patient's individual qualities would not need to be considered 

   treatments would not need to be individualized for each patient 

   the appropriate treatment would be prescribed for patients 

 

The Correct answer is:

The appropriate treatment would be prescribed for patients

The ability to always predict patient outcomes would mean that everyone would receive the exact same treatment. Treatments would still have to be individualized, and individual qualities would need to be considered

 

Question 94 

You are treating a patient with acute sinusitis. You understand that the “gold standard” first line medication for this condition is which of the following? 

  cephalosporins 

  trimethoprim sulfamethoxazole 

   Ceftin 

   amoxicillin 

 

Correct answer:

amoxicillin

 

Acute sinusitis is an infection of the sinuses by Gram-positive and Gram-negative bacteria. For treating acute sinusitis, amoxicillin is the “gold standard” for any age group.

 

Question 95 

Which of the following statements about dysphagia is least accurate? 

   It can be attributed to normal aging. 

  It may be a structural or neuromuscular problem. 

   It may present as difficulty swallowing solids or liquids. 

  It may present as chest pain. 

 

Correct answer:

It can be attributed to normal aging.

 

This is the least accurate statement. Dysphagia is not attributed to normal aging. It is a difficulty in swallowing and having food pass from the mouth down the esophagus to the stomach.

 

 Question 96 

A 11-year-old girl is brought into the office with clinical symptoms and a diagnostic history for scabies. The nurse practitioner knows that she was probably infected: 

  1-3 days ago 

  1 week ago 

   2 weeks ago 

   3-4 weeks ago 

 

The Correct answer is:

3-4 weeks ago

The incubation period for scabies is about 3-4 weeks after primary infection. Further, the patient with scabies will develop symptoms in 1-3 days. The classic complaint from patients with scabies is nocturnal pruritus. 

 

Question 97 

Persons who are allergic to latex products are often allergic to all of the following EXCEPT: 

   apples 

  kiwi 

   bananas 

  avocado 

 

The Correct answer is:

Apples

It has been noted that those persons with latex allergy also often have a cross-allergy to kiwi, bananas and avocado. Apples pose no cross-allergy threat, making this the right answer in this case. 

 

Question 98 

A 65-year-old female has come to the clinic complaining of a scaly red rash on one of her nipples that will not go away. She tells the FNP that it has become crusty and sometimes bleeds. Examination shows a discharge from the nipple and a small lump. Which of the following diseases/conditions is likely to be diagnosed? 

  breast cancer 

  fibrocystic breast 

   Lymphogranuloma Venereum 

   Paget’s disease of the breast 

 

Correct answer:

Paget’s disease of the breast

 

Paget’s disease of the breast is often reported by older females. The disease presents as a scaly rash resembling eczema on the nipple or the nipple and areola that does not heal. It can eventually have crusting, ulceration and/or bleeding and is sometimes itchy. 

 

Question 99 

Which of the following is least likely to precipitate an attack of pancreatitis? 

   a high protein diet 

  high fat diet 

   heavy meal 

  alcohol ingestion 

Correct answer:

a high protein diet

 

A high fat diet, heavy meal, or alcohol ingestion may precipitate an attack of pancreatitis. A high protein diet will not. Alcohol abstinence should be stressed to any patient with pancreatitis.

 

Question 100 

A patient is diagnosed today with pregnancy and her last pregnancy was 3 years ago. At that time she had a protective rubella titer. What should be done about evaluating a rubella titer today? 

  It should be evaluated to make sure it is still protective. 

  She should be vaccinated now to insure protection. 

   She does not need one because it was protective 3 years ago. 

   There is no need to get one since she has been pregnant before. 

 

The Correct answer is:

She does not need one because it was protective 3 years ago

Standard practice across the U.S. is to insure that a protective rubella titer exists in women who are pregnant. Re-evaluation is not necessary if the pregnant patient had a protective rubella titer.  

Test 1

Question 1

You are treating a patient with asthma in the clinic. They tell you they received a new medication in an emergency room when they were out of town visiting family. Which of the following should be avoided in a patient with asthma?

naproxen

topical hydrocortisone

amlodipine

timolol ophthalmic drops

The Correct answer is:

Timolol ophthalmic drops

Timolol ophthalmic solution drop is a beta blocker which is known to precipitate asthma exacerbation in patients. Even though it is administered in the eye, there is considerable absorption through the mucous membranes, resulting in systemic effects. The remaining answer choices have no specific contraindications for patients with asthma.

Question 2

In terms of informed consent, the patient is informed of all of the following EXCEPT:

the insurance coverage for the procedure or treatment

the purpose of the procedure or treatment

the success rate or failure for the suggested treatment or procedure

the prognosis and success rate

Correct answer:

the insurance coverage for the procedure or treatment

Insurance coverage, although important in any case, is not a part of informed consent. In addition to the other choices, informed consent addresses the risk vs. benefits of the procedure and alternatives to the procedure or treatment.

Question 3

Nurse practitioners are at risk for which of the following professional mishaps?

business

clinical

both business and clinical

none of the above

Correct answer:

both business and clinical

Nurse practitioners are at risk for two categories of professional mishap: clinical and business mishap. There can, however, be an overlap between clinical and business problems.

Question 4

Which of the following drugs for treating anxiety has the most rapid onset of action?

diazepam

clonazepam

alprazolam

oxazepam

Correct answer:

diazepam

Diazepam (Valium) has a rapid onset of action and a relatively sustained effect. The other choices all have a slow onset of action and a relatively or highly sustained effect.

Question 5

The nurse practitioner (NP) understands that the research process is similar to the processes that the NP use to provide patient care in that both are decision-making processes. The steps of these processes in the correct order are:

Notification, subject selection, consent verification and study implementation

Study scope, literature review, study protocol and study design

Research construction, research compilation, research conclusion, research implementation

Assessing, planning, implementing and evaluating

The Correct answer is:

Assessing, planning, implementing and evaluating

When conducting research, the nurse uses the process steps of assessing, planning, implementing and evaluating. During the assessing stage of the research, the nurse identifies the problem and performs a literature review. The nurse practitioner also identifies any variables that may need to be later measured in the study. With planning, the nurse performs research to create a hypothesis, determine measurements for the variables of the study and then decide how the sample for the study is selected. The nurse practitioner then collects the data. During the evaluation or evaluating stage, the nurse practitioner analyzes or evaluates the data, makes a conclusion about the findings and determines how to communicate the findings.

Question 6

Which of the following is NOT one of the ethical concepts for nurses?

beneficence

human dignity

confidentiality

risk

Correct answer:

risk

Risk is not one of the six ethical concepts for nurses. The six ethical concepts are: beneficence, non-malfeasance, confidentiality, accountability, human dignity, and compassion.

Question 7

A 42-year-old non-smoker is diagnosed with mild community-acquired pneumonia. He is otherwise healthy and does not need hospitalization at this time. Which antibiotic can be used for empirical treatment according to the 2007 Infectious Disease Society of America?

azithromycin

baclofen

oxybutynin

Zoloft

The Correct answer is:

Azithromycin

These guidelines promote doxycycline or macrolide use, such as azithromycin, clarithromycin and erythromycin, for the initial treatment of uncomplicated pneumonia in patients who are otherwise healthy and have not had recent antibiotic therapy. The remaining answer choices, oxybutynin and baclofen, are not antibiotics but are drugs used for treating symptoms associated with other conditions such as multiple sclerosis. For example, in patients with multiple sclerosis, baclofen is often prescribed for muscle spasms. Then, oxybutynin helps control the urinary incontinence. Further, Zoloft is an antidepressant medication.

Question 8

Which of the following parts of the eye are used for color perception?

cones

rods

fundus

macula

Correct answer:

cones

The cones are for color perception. The fundus is the interior surface of the eye opposite the lens. The rods are for detecting light and for depth perception. The macula is for central vision

Question 9

The most cost-effective method of diagnosing H. pylori infection is which of the following?

stool antigen testing

UGI endoscopy

serological testing

biopsy

Correct answer:

stool antigen testing

Stool antigen testing is the most cost-effective way to diagnose H. pylori infection. It is particularly effective when it is coupled with a clinical presentation consistent with peptic ulcer disease

Question 10

When counseling a patient with benign prostatic hypertrophy, the nurse practitioner knows to advise:

The patient to limit intake of fluids in the evening, and avoid large quantities in a short time frame.

The patient that there are no surgical options available.

The patient to void at least twice a day.

The patient to avoid certain bladder irritants such as cranberry juice, clear sodas, and blood pressure pills.

The Correct answer is:

The patient to limit intake of fluids in the evening, and avoid large quantities in a short time frame

It is important to tell the patient that if severe symptoms persist, surgical options such as transurethral resection of the prostate (TURP) are available. Also, the nurse practitioner should encourage the patient to void frequently. Further, the nurse practitioner should advise the patient to avoid certain bladder irritants like antihistamines, anticholinergics, coffee, alcohol, decongestants, and tricyclic antidepressants.

Question 11

A 68-year-old female patient has been under your care for years. She is a heavy smoker and has frequent episodes of pneumonia. The nurse practitioner realizes that age-associated changes that increase the risk of pneumonia in the elderly include an increase in:

diameter of the trachea and bronchi

lung parenchyma

cough forcefulness

compliance of the chest wall

Correct answer:

diameter of the trachea and bronchi

This is an age-associated physiologic change that occurs in the elderly. Other changes include less elastic lung parenchyma, less forceful cough, and decreased compliance of the chest wall.

Question 12

You are seeing a 2-year-old male child in the clinic with community acquired pneumonia (CAP). When managing this patient, you know that what percentage of children have an episode of pneumonia by age 5?

less than 10%

10%

20%

30%

The correct answer is:

20%

Pneumonia is considered to be a disease that primarily affects older adults and the chronically ill. However, about 20% of children develop pneumonia by age five

Question 13

According to guidelines, which of the following might be considered least important in determining the level of visit to bill for evaluation and management of a patient (not counseling)?

examination

time

history taking

medical decision making

Correct answer:

time

Time is a minor consideration in determining the level of visit to bill, according to guidelines, if a clinician is billing an office visit for evaluation and management. If a visit is primarily counseling, however, time matters and should be documented.

Question 14

When communicating with Hispanic Americans, the nurse practitioner understands that:

Avoiding eye contact with a person of authority indicates disrespect.

Dramatic body language is avoided.

Direct confrontation is expected.

Members tend to be verbally expressive yet value confidentiality.

The Correct answer is:

Members tend to be verbally expressive yet value confidentiality

Avoiding eye contact with a person in authority indicates respect and attentiveness with the Hispanic American patient population. Dramatic body language, such as gestures and facial expression, are often used to express emotion or pain. Direct confrontation is disrespectful and not expected with the members.

Question 15

When treating an adult male with alcoholic cirrhosis diagnosed by liver biopsy, the nurse practitioner has to counsel on the progression of the disease and its management. It is important that the nurse practitioner inform him that the disease is irreversible at this point and that the following will generally halt the progression of the disease:

long-term, low dose corticosteroids

abstinence from alcohol

vitamin B supplements

maintenance of a nutritious diet

The Correct answer is:

Abstinence from alcohol

Refraining from alcohol is the most important measure for the patient with alcoholic cirrhosis to undertake. The client's diet should be full of adequate protein and calories and salt should be restricted if fluid retention occurs. Vitamin supplementation is necessary. Long-term corticosteroids should be avoided.

Question 16

A 22-year-old female suspects she is pregnant. In order to establish pregnancy, a test of the urine or blood is routinely performed. The nurse practitioner understands that this can be done with predictable results at what time?

within 3 days after conception

within 7 days after conception

1-2 weeks after conception

35 days after last menses

Correct answer:

1-2 weeks after conception

Whether performed on urine or blood, the presence of hCG is evaluated to identify pregnancy and can be found in high quantities in the first morning urine or at any time in a serum sample. Both tests are highly sensitive, but if the pregnancy is early, the serum test is more specific.

Question 17

Which of the following are elements of a broad-based risk management program?

System of contract review that helps to avoid assuming liabilities that should be borne by others.

Hazardous materials compliance program as part of a comprehensive safety and security system.

Early-warning/incident reporting program to identify elements of risk.

All of the above.

The Correct answer is:

All of the above

These and other elements combine to produce a program of systematic risk identification, analysis, treatment, and evaluation, with the overall goal of loss prevention.

Question 18

When evaluating a patient for the need for a bone density screening test, it is important for the nurse practitioner to understand that:

All patients over the age of 40 need to be screened.

A risk factor for osteoporosis is being of African American descent.

This condition is common in individuals with estrogen deficiency.

The patient must be NPO for the exam.

The correct answer is:

This condition is common in individuals with estrogen deficiency

Osteoporosis is more common in people on chronic steroids, those with an androgen or estrogen deficiency, and individuals with hypogonadism. It is more common in Caucasian and Asian women and not all patients over the age of 40 need to be screened. The patient does not need to be NPO for the exam. However, some testing equipment analyzes the lumbar spine. Further, no calcium pills three days prior to the test are recommended.

Question 19

In which of the following cases would the FNP refer a patient to a specialist for low back pain? A patient with:

acute neck pain

bladder dysfunction

reduced range of movement

stiffness

Correct answer:

bladder dysfunction

If the patient has a bladder dysfunction, or a limb or bowel dysfunction, prompt referral to a specialist is needed. Surgery is usually considered only if severe symptoms persist beyond 3 months.

Question 20

Konrad Lorenz is best known for the theory that:

there are biologically-programmed periods (sensitive periods) predisposed for particular learning.

maternal separation and social isolation resulted in dramatic impairment of social-emotional development.

promoted rooming-in and father participation in the birth of a child.

neutral stimulus associated with a meaningful one over time leads to a “conditioned” response that can be elicited by neutral stimulus alone as though it were the meaningful one.

Correct answer:

there are biologically-programmed periods (sensitive periods) predisposed for particular learning.

Konrad Lorenz is best known for the theory that there are biologically-programmed periods (sensitive periods) predisposed for particular learning. It is one of the many ethologic theories developed in the 20th century.

Question 21

A 52-year-old male patient presents in the office and you notice a yellowish plaque on his upper eyelid that is painless. What should the nurse practitioner look for?

liver function studies

lipid levels

sedimentation rate

vision in the affected eye

The Correct answer is:

Lipid levels

The yellowish painless plaque on the patient's upper eyelid is descriptive of xanthelasma. Additionally with xanthelasma, the plaque is slightly raised and well-circumscribed on the upper eyelid. Further, one or both eyelids may be affected. Xanthelasma is often associated with lipid disorders but may occur independent of any systemic or local disease. However, xanthelasma does not affect vision

Question 22

A 45-year-old woman complains to the FNP that her 80-year-old mother is too demanding and that it has created a great stress in her life. According to Havighurst’s developmental tasks, this complaint reflects which of the following?

a need for independence

a need to adjust to an aging parent

establishing an explicit affiliation with one’s own age group

a need to achieve emotional independence

Correct answer:

a need to adjust to an aging parent

One of Havighurst’s developmental tasks for 30 – 60 year old persons is adjusting to an aging parent. Other tasks in this age group include: achieving adult social and civic responsibility, developing adult leisure time activities and relating oneself to one’s spouse as a person

Question 23

The FNP has a patient who desires to quit smoking. She asks the FNP if there is anything that can help her in trying to quit. The FNP understands that all of the following are true in regard to smoking cessation EXCEPT:

Bupropion, an atypical antidepressant, is used for smoking cessation.

Bupropion can be used with nicotine products such as gum or nasal sprays.

Bupropion is safe to use for persons with hypertension or seizures.

Nicotine patches should not be used with other nicotine products.

Correct answer:

Bupropion is safe to use for persons with hypertension or seizures.

This is incorrect. Bupropion (Zyban) is contraindicated in persons with hypertension or a history of seizures

Question 22

A 45-year-old woman complains to the FNP that her 80-year-old mother is too demanding and that it has created a great stress in her life. According to Havighurst’s developmental tasks, this complaint reflects which of the following?

a need for independence

a need to adjust to an aging parent

establishing an explicit affiliation with one’s own age group

a need to achieve emotional independence

One of Havighurst’s developmental tasks for 30 – 60 year old persons is adjusting to an aging parent. Other tasks in this age group include: achieving adult social and civic responsibility, developing adult leisure time activities and relating oneself to one’s spouse as a person.

Question 23

The FNP has a patient who desires to quit smoking. She asks the FNP if there is anything that can help her in trying to quit. The FNP understands that all of the following are true in regard to smoking cessation EXCEPT:

Bupropion, an atypical antidepressant, is used for smoking cessation.

Bupropion can be used with nicotine products such as gum or nasal sprays.

Bupropion is safe to use for persons with hypertension or seizures.

Nicotine patches should not be used with other nicotine products.

This is incorrect. Bupropion (Zyban) is contraindicated in persons with hypertension or a history of seizures

Question 24

The FNP has a patient with a H. Pylori-Negative ulcer. Which of the following therapies would not be prescribed for this patient?

H2 blockers

antibiotics

proton pump inhibitor if necessary

lifestyle changes

Antibiotics would not be prescribed because there is no infection in H. Pylori-Negative ulcers. After encouraging lifestyle changes, the FNP would prescribe an H2 blocker as first line therapy. If this does not give relief or gives a poor result, the FNP may switch to a proton pump inhibitor.

Question 25

The theory that maternal separation and social isolation results in dramatic impairment of social-emotional development was developed by which of the following persons?

Konrad Lorenz

John Bowlby

Harry Harlow

Marshall Klaus and John Kennel

Correct answer:

Harry Harlow

Harry Harlow was part of the Wisconsin primate laboratory’s classic rhesus monkey experiments on maternal deprivation. He found that maternal separation and social isolation results in dramatic impairment of social-emotional development. Physical contact and comfort are necessary for normal social and emotional

Question 26

In terms of a migraine headache without aura which of the following is NOT true?

It is usually bilateral, although occasionally unilateral.

The female to male ratio with this type of headache is 3:1.

During the headache nausea or vomiting may occur.

Photophobia occurs with this type of headache.

Correct answer:

It is usually bilateral, although occasionally unilateral.

This is not true. The opposite is true. Migraine headaches without aura are usually unilateral, although occasionally they are bilateral.

Question 27

A mother is asking questions regarding giving her 4-month-old infant fruit juice. The nurse practitioner understands that the following statements are accurate concerning fruit juice EXCEPT:

Fruit juice is an excellent replacement for infant formula if an infant is allergic to cow's milk.

Juice should not be given before 6 months of age and intake should be limited to 1 to 2 ounces.

Pureed fruit should be given instead of juice if possible.

Fruit juice should not replace breast milk or infant formula in the diet because it is high in carbohydrate and low in the other nutrients.

The Correct answer is:

Fruit juice is an excellent replacement for infant formula if an infant is allergic to cow's milk

Fruit juice is not an excellent alternative to infant formula. If an infant is allergic to cow’s milk, the nurse practitioner can suggest to the mother other acceptable alternatives, such as feeding the infant soy-milk formula. Further, fruit juice should only be given to infants who are 6 months old and older. Therefore, the nurse practitioner should inform the mother that the 4-month-old is not at an appropriate age to drink fruit juice.

Question 28

What type of insurance coverage does the clinic need that is purchased by an organization to address employee job-related injuries?

business interruption insurance

directors and officers insurance

workers' compensation insurance

professional liability insurance

The Correct answer is:

Workers' compensation insurance

Professional liability insurance is acquired to protect the organization from lawsuits by clients arising from negligent acts of employees. Business interruption coverage is usually purchased in tandem with fire insurance and it will reimburse an organization for losses sustained from a catastrophic event. Workers' compensation is the line of coverage that protects employees after on-the-job injuries.

Question 29

Part of health promotion for the adult patient is to recommend an exercise regimen. Which of the following is a good recommendation for the adult patient?

The intensity or component of the program should be increased to build stamina if the patient is unable to talk while exercising.

Contraindications for exercise include asthma, obesity, and hypertension.

The goal of exercise for the adult is to sustain target heart rate for 50 minutes for maximum cardiopulmonary conditioning.

The focus should be on fundamental fitness, not sport-specific skills.

The Correct answer is:

The focus should be on fundamental fitness, not sport-specific skills

The intensity should be decreased if the patient is unable to talk while exercising and increased as the patient develops tolerance. A person can exercise with asthma, obesity, and hypertension. It is highly recommended. The goal of exercise is to get the heart rate up at the target range for 30 minutes during a session.

Question 30

Several research studies based on the transactional model of development emerged in the 1980s. One of these models was the Kauai longitudinal study from birth to adulthood to explore perinatal risk and environmental factors on subsequent developmental outcomes and resiliency. Which of the following researchers conducted this study?

Alan Sroufe

Michael Rutter

Lawrence Kohlberg

Emmy Werner

Correct answer:

Emmy Werner

The transaction model was first described in 1975 as a “continuum of reproductive risk and caretaking casualties” by Arnold Dameroff and Michael Chandler. Emmy Werner produced the Kauai longitudinal study from birth to adulthood to explore perinatal risk and environmental factors on subsequent developmental outcomes and resiliency based on the transactional model.

Question 31

Which of the following statements about structural functional theory of families is the least accurate?

Rank order within families is not a component of structure.

Families are social systems.

In optimally functioning families, members take on predictable roles.

Disease or ill health can interfere with the family’s ability to carry out its internal functions.

Correct answer:

Rank order within families is not a component of structure.

All of the statements are accurate except this one. Internal family subsystems function as a microcosm of society, reflecting the larger sphere of human needs. Rank order within families is a component of structure, such as the ordering of children by birth in the family.

Question 32

Which of the family theories of assessment and intervention outlines eight consecutive stages in the family life cycle?

general systems theory

structural functional theory

communication theory

developmental theory

Correct answer:

developmental theory

Developmental theory explains human growth and development according to theorists such as Erikson, Piaget and Havinghurst. The model outlines the eight consecutive states in the family life cycle that offers a predictive overview of the activities that occur in families over time and serves as a basis for anticipatory guidance when assessing and teaching families. They are: beginning family, childbearing family, family with preschool children, families with schoolchildren, family with teenagers, launching center family, family with middle-aged parents and family with old age and retirement.

Question 33

A mother comes into the office with her 2-year-old child who attends daycare. The child is pulling at her ears, running a fever, and has bright red bulging tympanic membranes bilaterally. The nurse practitioner knows that with acute otitis media (AOM) the risk factors include:

Chinese race, previous otitis media, many siblings

Summer season, full-time day care, premature at birth

higher socioeconomic level, full-time day care, allergies

second-hand smoke, attending day care, American Indians and Eskimos

The Correct answer is:

Second-hand smoke, attending day care, American Indians and Eskimos

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

Question 34

Margaret Mahler developed the neo-Freudian theory of psychological birth of the infant. Which of the following phases of Mahler’s “psychological birth” takes place at about 24 – 36 months?

consolidation

rapprochement

differentiation and practicing

symbiosis

Correct answer:

consolidation

According to Mahler consolidation is part of the separation-individuation phase that takes place from 6 to 36 months of age. Consolidation takes place from 24 – 36 months of age. It is defined by the increased ability to cope with separations through symbolic play.

Which of the following tests is a diagnostic test?

hemoglobin test

Mantoux test

MRI scan

fasting blood glucose test

Correct answer:

MRI scan

Diagnostic tests are more specific and/or sensitive than screening tests. They give objective proof that a disease process or abnormal condition is present. Other diagnostic tests include: tissue biopsies, cultures and CT scans.

Question 36

You are treating a patient with a persistent cough. Which of the following is NOT an accurate statement regarding when to consult or refer this patient?

Refer if patient is at high risk for malignancy.

Refer if patient refuses to stop smoking.

Refer to a pulmonologist if bronchoscopy is indicated.

Refer if cough is accompanied by blood for at least 2-3 days after there has been treatment initiated for a respiratory infection.

The Correct answer is:

Refer if patient refuses to stop smoking

The patient's refusal to stop tobacco use is not a reason for referral or consultation, but a reason to counsel.

Question 37

The U.S. Department of Agriculture (USDA) food pyramid and other research suggests all of the following EXCEPT:

diet should have substantial fiber

use sweets, fats, and oils sparingly

vegetables: 6-8 servings daily

fruits: 2-4 servings daily

The Correct answer is:

Vegetables: 6-8 servings daily

The current USDA recommendation for vegetables is 2-3 servings daily. The remaining answer choices are all current recommendations.

Question 38

In terms of the course of disease development, the subclinical stage is which of the following?

stage of disability

stage of susceptibility

stage of presymptomatic disease

stage of clinical disease

Correct answer:

stage of presymptomatic disease

The subclinical stage of disease is also known as the stage of presymptomatic disease. It is the early stage of disease when physiologic changes have begun but no signs or symptoms are observed.

Question 39

Which of the following medications is contraindicated as a treatment for acute gouty arthritis?

aspirin

naproxen

indomethacin

naproxen sodium

Correct answer:

aspirin

Aspirin is contraindicated as a treatment for gout because it can precipitate gout. A loading dose of an NSAID, such as naproxen, 750 mg or indomethacin, 50 mg, followed by lower doses, can be helpful.

Question 40

Documentation is part of the health care process. The nurse practitioner understands that the following are all types of procedures that may trigger a signed consent requirement except for:

HIV tests

a minor surgical procedure

an abortion

a DEXA scan

The Correct answer is:

A DEXA scan

The DEXA scan does not require additional consent. However, the remaining answer choices are all invasive and sensitive tests and procedures requiring documented consent.

Question 41

In which of the following situations might there be an exception to guaranteed confidentiality of a patient?

in cases of suspected child abuse

when next of kin requests a patient’s records

when discussing the patient with another medical professional not involved in the care of the patient

none of the above

Correct answer:

in cases of suspected child abuse

There are exceptions to guaranteed confidentiality when society determines that the need for information outweighs the principle of confidentiality. These situations include: when records are released to insurance companies; to attorneys involved in litigation; in answering court orders, subpoenas or summonses; in meeting state requirements for mandatory reporting of diseases or conditions; in cases of suspected child abuse; or if a patient reveals an intent to harm someone.

Question 42

Certain medications have been known to cause drug-induced macrocytosis without existing anemia. All of the following are in this category EXCEPT:

Altace (ACE inhibitor)

carbamazepine (Tegretol)

valproic acid (Depakote)

zidovudine (AZT)

The Correct answer is:

Altace (ACE inhibitor)

Abnormally large or macrocytic cells due to an altered RNA:DNA ratio results in macrocytosis without anemia. Valproic acid (Depakote), zidovudine (AZT) and carbamazepine (Tegretol) can cause macrocytosis as well as alcohol and phenytoin (Dilantin).

Risk factors for oral cancer include all of the following EXCEPT:

recent trauma to the mouth

smoking

alcohol abuse

human papillomavirus type 16

Correct answer:

recent trauma to the mouth

This is not a risk factor for oral cancer. The risk factors include advancing age, tobacco and alcohol abuse and most recently, they include chronic infection with human papillomavirus type 16.

Question 44

The nurse practitioner knows that certain persons may require additional immunizations. The following are all in this category EXCEPT:

food handlers

animal workers

factory workers

travelers

The Correct answer is:

Factory workers

Many persons with special circumstances require additional immunizations that the general public does not. Factory workers are not in this category. However, the other remaining answer choices all have special needs due to increased risks.

Question 45

You are volunteering at a homeless clinic to gain clinical experience. The nurse practitioner knows that which statement is true regarding this?

Volunteerism negates susceptibility to lawsuits.

Malpractice insurance will be needed.

Malpractice coverage will be provided by the state where the clinic is located.

Malpractice insurance is not necessary when working volunteer status.

The Correct answer is:

Malpractice insurance will be needed

The nurse practitioner should always have malpractice insurance. The "good Samaritan" law protects professional volunteers in some states, but in the event of being sued, professional liability should be carried.

Question 46

A 25-year-old female patient comes to the clinic with a “rash” on the inner wrist area. She tells the FNP that it is extremely itchy, especially at night. The FNP tells her that she has scabies. The FNP understands that all of the following are true in regard to this disease EXCEPT:

Kwell (lindane) is the preferred treatment.

Permethrin 5% can be used as a treatment by applying to the entire body and head and washing off after 8 to 14 hours.

The entire household must be treated.

Linens and clothes must be washed in very hot water.

Correct answer:

Kwell (lindane) is the preferred treatment.

All of the choices are true except this one. Kwell may be used as an alternative treatment but it is out of favor as a treatment due to neurotoxicity.

Question 47

A 57-year-old Asian female is in the office inquiring about the symptoms and treatment options for menopause. She describes "hot flashes" that are occurring frequently throughout the day. The nurse practitioner knows to tell her that these are related to:

fluctuating estrogen levels

low estrogen levels

fluctuating progesterone levels

low progesterone levels

The Correct answer is:

Fluctuating estrogen levels

Low levels of estrogen alone do not produce these hot flashes. A rapid change in estrogen levels produce the vasomotor symptoms that are referred to as hot flashes.

Question 48

You are seeing a patient in the clinic with gastric ulcer. The nurse practitioner has knowledge that which of the following is least likely to be found in this patient?

The patient is younger than 50 years of age.

The patient has previously used H2RA or antacids.

The patient has a history of long-term naproxen use.

The patient smokes cigarettes.

The Correct answer is:

The patient is younger than 50 years of age

Contributing factors and risks of gastric ulcers are nonsteroidal anti-inflammatory drug (NSAID) and corticosteroid use, cigarette smoking, and peak incidence in the fifth and sixth decades of life. The presenting signs and symptoms are pain with meals or immediately afterwards, nausea, vomiting, and weight loss.

Question 49

Which of the following is a TRUE statement about the Healthy People 2010?

This model applies only to people of the United States of America.

This model is developed and formulated by a special committee formed by an alliance of all the state health departments of the United States of America.

This model's objectives are not only applicable nationally, but also internationally.

This model has an objective to help people internationally achieve only physical health.

The Correct answer is:

This document applies only to people of the United States of America

The Healthy People model provides science-based, 10-year national objective for improving the health of citizens in the United States. The Healthy People model assesses progress to: (1) promotes collaborations across sectors; (2) help individuals make better and knowledgeable health decisions; and (3) evaluate the effects of health prevention strategies. Healthy People 2010 is not developed by a committee formed by state health departments, but by the U.S. Department of Health and Human Services. Also, this model does not apply to people internationally, only individuals living within the United States.

Question 50

Which of the following SSRIs has the shortest half-life?

Prozac

Fontex

Lexapro

Paxil

Correct answer:

Paxil

Paxil has the shortest half-life of the SSRIs (selective serotonin reuptake inhibitors) in the choices. Prozac has the longest.

Question 51

The theory of aging that holds that after repeated use and damage, body structures and functions wear out because of stress is which of the following?

wear-and-tear theory

free-radical theory

immune theory

activity theory

Correct answer:

wear-and-tear theory

There are a number of theories of aging. They can be sociologic theories, biologic theories or psychologic theories. The wear-and-tear theory is a biologic theory that holds that after repeated use and damage, body structures and functions wear out because of stress.

Question 52

You are seeing a 3-year-old female child in the office. Her mother is concerned about her not being able to elevate her left arm without crying out. A clavicular fracture is suspected. Which of the following is NOT true regarding a fracture of the clavicle?

This is one of the most common fractures that occur in childhood.

The patient may avoid moving the arm on the injured side or may angle the head toward the injured side to relax the trapezius muscle.

There is usually no visible or palpable deformity upon examination and it is rarely seen on an x-ray.

The mechanisms of injury is usually a fall on the outstretched hand or direct blow to the shoulder area.

The Correct answer is:

There is usually no visible or palpable deformity upon examination and it is rarely seen on an x-ray

There is most always a visible and a palpable deformity seen and the x-ray findings will show a visible separation of the clavicular bone. Further, the remaining answer choices are all true of this type of fracture.

Question 53

Which of the following is NOT one of the basic requirements/allowances of the HIPAA privacy rule?

Providers releasing patient information for marketing purposes must explain to the patient how the information will be used, to whom it will be disclosed, and the time frame.

Providers and their staff are restricted to conveying the “minimum necessary information” about patients.

Providers may disclose health information to oversight agencies.

In general, providers may disclose psychotherapy notes without patient consent.

Correct answer:

In general, providers may disclose psychotherapy notes without patient consent.

There are special rules for psychotherapy notes. In general, patient authorization is required in order to disclose psychotherapy notes to carry out treatment, payment or healthcare operations.

Question 54

Which of the following is least likely to be considered a risk factor for heart disease?

BMI 4.5 alkaline.

Question 77

The FNP has a 35-year-old male patient who has been smoking since he was 15 years old. She wants to make a brief intervention using the “5 As.” The “5 As” are which of the following?

ask, advise, assess, assist, arrange

ask, advocate, assess, assist, arrange

ask, advise, assess, aid, arrange

ask, advise, assist, arrange, advocate

Correct answer:

ask, advise, assess, assist, arrange

The “5 As” should be employed with all tobacco users, including individuals with no current desire to quit because this can serve as a motivating factor in future attempts to quit tobacco use. The “5 As” are: Ask about tobacco use; Advise to quit; Assess willingness to make an attempt to quit; Assist in quit attempt; Arrange follow-up.

Question 78

When discussing dependency with a patient in the clinic, the nurse practitioner understands that:

Treatment is usually simple and requires short-term therapy.

Dependency becomes addiction when there is loss of control (compulsivity) and obsession or preoccupation with the activity.

The action began involuntary and remains so.

Dependency and addiction are easy to treat with medications.

The Correct answer is:

Dependency becomes addiction when there is loss of control (compulsivity) and obsession or preoccupation with the activity

Treatment is complex and require long-term therapy. The action is begun voluntarily but, through repetition, becomes involuntary. Dependency and addiction are difficult to treat and usually medications alone do not help.

Question 79

Which of the following treatments is recommended for mild persistent asthma?

albuterol metered dose inhaler

albuterol metered dose inhaler plus low-dose steroid metered dose inhaler

albuterol metered dose inhaler plus low-to-medium-dose steroid metered-dose inhaler mixed with salmeterol plus leukotriene inhibitor.

none of the above

Correct answer:

albuterol metered dose inhaler plus low-dose steroid metered dose inhaler

This would be the recommended treatment for a person with mild persistent asthma. For mild intermittent asthma, the albuterol metered dose inhaler is all that is recommended, and for moderate persistent asthma, albuterol metered does inhaler plus low-to-medium-dose steroid metered-dose inhaler mixed with salmeterol plus leukotriene inhibitor is indicated.

Question 80

Which of the following statements about breach of privacy is true?

It is an intentional tort.

It cannot be the basis of a malpractice suit.

It is not a violation of state law.

It is not a violation of federal law.

Correct answer:

It is an intentional tort.

Breach of privacy is an intentional tort. There are many ways to breach a patient’s privacy. It can amount to malpractice in some cases.

Question 81

Medicaid is a federal program administered by the states. All of the following statements regarding Medicaid are true EXCEPT:

Medicaid pays NPs 70% to 100% of the fee-for-service rates set for physicians by state Medicaid agencies.

Federal law controls the rates paid by Medicaid.

Medicaid reimbursement generally is lower than the rate paid by commercial insurers.

Many states have applied to the federal government for a Medicaid waiver in order to administer Medicaid in ways that differ from federal laws and regulations.

Correct answer:

Federal law controls the rates paid by Medicaid.

This is incorrect. Federal law does not control the rates paid by Medicaid. State law controls the rates paid by Medicaid.

Question 82

A 45-year-old man comes to the FNP wanting to have an evaluation for disability under the Medicare program. What should the FNP tell this patient?

I can do an evaluation and determine whether you have a disability under Medicare

The physician must do the evaluation but I can handle the determination of disability under Medicare.

I can do an evaluation but I cannot legally determine whether you have a disability under Medicare.

You must see a physician. I can do nothing for you.

Correct answer:

I can do an evaluation but I cannot legally determine whether you have a disability under Medicare.

The FNP can do a disability evaluation. The FNP does not have the legal authority to determine disability under the Medicare program.

Question 83

The ecological model of growth and development that is a person-place-process model with microsystems, mesosystems, exosystems and macrosystems was developed by which of the following theorists?

Arnold Sameroff

Michael Rutter

Emmy Werner

Urie Bronfenbrenner

Correct answer:

Urie Bronfenbrenner

Urie Bronfenbrenner published this theory in a 1979 publication – Ecology of Human Development: Experiments by Nature and Design. Among other things it holds that understanding how and why a child changes or stays the same over time requires examination, not only of the child’s emerging capabilities, but also of the quality of the settings where the child spends time.

Question 84

The nurse practitioner (NP), who has practiced for many years, has decided to open her own clinic. She has purchased equipment and signed a lease on a building. This NP is a(n):

intrapreneur

networker

independent nurse practitioner

entrepreneur

The Correct answer is:

Entrepreneur

Someone who assumes the financial and personal risks of owning and operating their own business is an entrepreneur. An intrapreneur is someone who is able to carve out a specialty role within an existing organization.

Question 85

In terms of business organization types for nurse practitioner practice, which of the following has its own identity and is a separate legal entity?

corporation

partnership

LLC

sole proprietorship

Correct answer:

corporation

A corporation is a business entity with its own identity. Although one individual may be the sole stockholder, director and officer, the corporation is nevertheless a separate legal entity.

Question 86

Which of the following is NOT true in regard to DEA registration for a nurse practitioner?

The DEA oversees NPs’ prescribing of controlled substances.

An NP must register with the DEA to prescribe controlled substances.

The NP must use the DEA number obtained from the DEA on prescriptions for scheduled drugs.

The NP does not need a state controlled substances license.

Correct answer:

The NP does not need a state controlled substances license.

This is not true. Federal registration is based on the applicant’s complying with state and local laws. If a state requires a separate controlled substances license, an NP must obtain that license and submit a copy with the application for a DEA number.

Question 87

In treating a person with multiple sclerosis, which of the following drugs would be the LEAST likely to be used because it carries a warning about progressive multifocal leukoencephalopathy, a destructive brain infection?

Betaseron

Tysabri

Avonex

Novantrone

Correct answer:

Tysabri

Natalizumab (Tysabri) is a monoclonal antibody with considerable clinical efficacy in treating MS. However, it carries a warning about progressive multifocal leukoencephalopathy, a destructive brain infection that is associated with its use.

Question 88

The American Academy of Pediatrics recommends infants to be fed whole cow's milk at what age?

6 months of age

8 months of age

12 months of age

18 months of age

The Correct answer is:

12 months of age

Since cow's milk has a low iron content, it is recommended that infants are not started on it until around age one. Additionally, formula and breast milk is fortified with protein, linoleic acid, and vitamin E whereas whole cow's milk does not contain adequate amounts of these substances.

Question 89

A 16-year-old female patient inquires about douching. You are counseling on birth control, safe sexual practices and hygiene. What instruction regarding douching should the nurse practitioner include?

Hypoallergenic douches include flavored or perfumed types.

Douching during menstruation is a safe effective practice.

Douching removes natural mucus and upset normal vaginal flora.

Daily douching is important if the patient has copious vaginal discharge.

The Correct answer is:

Douching removes natural mucus and upsets normal vaginal flora

Douching is never necessary because it upsets the normal vaginal flora and disrupts pH. Douching is contraindicated during menstruation due to "retrograde menstruation," a potential precursor to endometriosis. Further, a patient with copious vaginal discharge needs to be evaluated for an infection.

Question 90

Medical records must be kept safe. It is essential that each healthcare organization establish an effective procedure for safeguarding them. The following are all true statements regarding medical records EXCEPT:

Medical records should be stored in a secure, restricted-access location.

Competent medical records personnel should review every record before it is examined by the patient or patient representative.

An original medical record should be sent with the patient to specialist appointments and for their attorney to review as necessary.

Anyone who is not an authorized employee or staff member should not be allowed to examine a medical record.

The Correct answer is:

An original medical record should be sent with the patient to specialist appointments and for their attorney to review as necessary

An original medical record should never be sent with the patient to a specialist’s appointment. The original medical record remains on the facility’s premises unless the organization has received a Subpoena Duces Tecum, court order or a subpoena and a court order to bring the medical record to a court of law. Alternatively, if the medical record has reached the state and federal law’s identified retention period, the original medical record can be stored offsite or destroyed.

If the patient needs information from the medical record to take to the specialist, the nurse practitioner’s office can make a copy of what is needed for the referral and send the photocopies of the medical. This process holds true for an attorney. The attorney will only receive copies of the original medical record. Or, if the patient signs appropriate consent forms, the attorney can come to the medical office and review the original medical record.

Also, the healthcare provider, nurses or any other staff cannot take original medical records home or to another facility to complete charting or other documentation in the medical record. All charting has to be completed in the facility where the original medical exists. By removing the original medical record from the facility, it can be lost, accidentally destroyed or even stolen, for instance. This can lead to breaches of confidentiality and privacy laws, not to mention it is hard to reproduce an original medical record if it is lost.

In the case of office space restrictions, some physician offices and hospitals may not have sufficient amounts of space to store all of their medical records. Therefore, storage or retention of the original medical records becomes an issue. There are many options to storing medical records including storing them offsite, microfilming, scanning the medical records and storing them on CD ROM’s, disks and more. In this case, the nurse practitioner will need to review state and federal laws, as the laws govern how medical records can be retained and the compliance guidelines required if the physical, original medical record has to be stored offsite. Certain medical record documents are permanently kept, such as records of surgical procedures and master patient indexes. Then, depending on state laws, diagnostic images, for instance x-ray films, can be kept for 5 years before the images are archived or destroyed. Destruction of medical records are also dictated by federal and state laws. Some destruction methods include shredding the medical record, for example.

Question 91

You are assessing a 2 week old infant for reflexes. Which of the following is NOT an expected reflex in this age infant?

Moro reflex

Stepping reflex

Tonic Neck reflex

Vertical reflex

The Correct answer is:

Vertical Reflex

The moro reflex (startle reflex) results when a sudden loud noise causes symmetric abduction and extension of the arms followed by adduction and flexion of the arms over the body. The stepping reflex occurs when the baby is upright and the dorsal foot is placed on the table causing a simulated stepping motion. The tonic neck reflex (fencing reflex) results when the infant turns the head to one side with the jaw over the shoulder causing the arm and leg on the side where the head is turned to extend. There is no vertical reflex.

Question 92

What act states individuals can make decisions about medical care, including the right to accept or refuse any type of medical or surgical interventions?

The Americans With Disabilities Act

The Patient Self-Determination Act

The Omnibus Budget Reconciliation Act

The Veterans Readjustment Assistance Act

The Correct answer is:

The Patient Self-Determination Act

On December 1, 1991, federal legislation known as the Patient Self-Determination Act (PSDA) took effect in healthcare organizations. It requires these institutions to develop and maintain written policy and procedures to provide written information to adults for who care is provided.

Question 93

A 29-year-old Caucasian male calls your office. He tells you he just came in from the woods and discovered a tick on his upper right thigh. He reports self-removal of the tick and now the area is slightly red. What should you advise him to do?

He should come to the office for a ceftriaxone (Rocephin) injection.

He should be prescribed doxycycline.

He needs no treatment.

He needs a topical scrub to prevent Lyme Disease.

The Correct answer is:

He needs no treatment

To develop Lyme Disease from a tick bite, many factors must be present. The tick must belong to Ixodes species and must have been attached for at least 48 hours before the disease can spread. There is no need for prophylactic treatment in this case because the tick has not been present long enough.

Question 94

You are caring for an elderly patient who has had a cerebrovascular accident (CVA) and has urinary incontinence. The family should be taught to:

insert a Foley catheter

establish a scheduled voiding pattern

restrict fluid intake

reposition the patient often to reduce the discomfort of urgency

The Correct answer is:

Establish a scheduled voiding pattern

The patient needs a reestablished pattern for regularity to assist in maintaining bladder control. A Foley catheter would expose the patient to infection and fluids should not be restricted.

Question 95

The majority of breast cancers occur in which area of the breast?

beneath the nipple and areola

upper outer quadrant

lower outer quadrant

upper inner quadrant

The Correct answer is:

Upper outer quadrant

The upper outer quadrant is the most common site for breast cancer. The second most common site for breast cancer is beneath the nipple and areola.

Question 96

The theory that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior is which of the following?

Systems Theory

Self-Efficacy Theory

Health Belief Model

Family Systems Theory

Correct answer:

Self-Efficacy Theory

The Self-Efficacy Theory holds that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior. This concept was put forth by Albert Bandura in the 1970s.

Question 97

The nurse practitioner is treating a 42-year-old obese Caucasian male who has an allergy to sulfa. She understands that which of the following medications is contraindicated in this patient?

ramipril

hydrochlorothiazide

verapamil

trimethoprim

The Correct answer is:

Hydrochlorothiazide

Hydrochlorothiazide has a sulfonamide ring in its chemical structure, generally referred to as "sulfa." This can initiate an allergic reaction in a patient with a sulfa allergy. The other answer choices, verapamil, ramipril and trimethoprim, are medications that can be used without concern because they have no sulfonamide component.

Question 98

Which of the following best describes a "co-payment"?

A flexible dollar amount that a person chooses to pay the provider.

A proportion of the total charges for medical services that an insured person must pay the provider.

A fixed dollar amount that a person insured through a health maintenance organization (HMO) or preferred provider organization (PPO) must pay the provider.

The amount the provider must pay to be allowed to participate with HMOs and PPOs.

The Correct answer is:

A fixed dollar amount that a person insured through an health maintenance organization (HMO) or preferred provider organization (PPO) must pay the provider

A proportion of the total charges for medical services billed to a patient or paid by them is "co-insurance." The co-payment, for example $5, $10, or $20, must be paid at the time of the clinic visit in order to receive care.

Question 99

Which of the following ethical concepts for Professional Nurses is the duty to help others?

non-malfeasance

accountability

human dignity

beneficence

The Correct answer is:

Beneficence

Beneficence is the duty to help others. Non-malfeasance is the duty to avoid harm to others. Accountability is being responsible for one's own actions. Human dignity is respect for the patient.

Question 100

According to the American Cancer Society Guidelines for the Early Detection of Cancer, yearly mammograms are recommended for women who are:

in good health and are 35 years of age or over

in good heath and are 40 years of age or over and continuing for as long as a woman is in good health

in good heath and are 35 years of age or over and continuing every 2 or 3 years if the mammogram is negative

in good heath and are 40 years of age or over and continuing every 2 or 3 years if the mammogram is negative

Correct answer:

in good heath and are 40 years of age or over and continuing for as long as a woman is in good health

The American Cancer Society recommends yearly mammograms starting at age 40 and continuing for as long as a woman is in good health. The American Cancer Society also recommends that some women -- because of their family history, a genetic tendency, or certain other factors -- be screened with MRI in addition to mammograms. (The number of women who fall into this category is small: less than 2% of all the women in the US.)

Test 3 ancc

Question 1

Head circumference should be measured until a child has attained what age?

12 months

18 months

24 months

36 months

The Correct answer is:

24 months

A child's head is usually measured at each well child visit until he or she is 2 years old. During the first three years of life, the head grows and its growth should be monitored for adequacy. These measurements are recorded on a growth chart so that changes can be followed and the percentile for age and rate of growth can be determined.

Question 2

A patient is in the office who was bitten by her husband during an assault. There are several bite marks and lacerations on the forearms. You treat her by suturing the lacerations although it is contraindicated because of the highly infectious nature of human bites. What is this described as?

This is malpractice.

This is poor judgment and malpractice.

This is negligence.

This is an unfortunate situation.

The Correct answer is:

This is negligence

The suturing of the patient's lacerations is negligence, not malpractice. Since human bites are highly infectious, they should not be sutured. Negligence occurs when you fail to exercise the care that is reasonable. Injury does not have to occur for negligence.

Question 3

In a 74-year-old Caucasian male who has had Type II Diabetes for ten years, a hypoglycemic episode is more likely to exhibit:

dizziness and weakness

contusions

symptoms of compulsive reactions

delusional hyperactivity

The Correct answer is:

Dizziness and weakness

Older adults are more likely to have deleterious consequences than younger adults. Younger adults present with tremors, sweating and adrenergic symptoms. Then, older adults tend to have neurological symptoms, like dizziness and weakness.

Question 4

A patient receives another person's medication in error. This was done by an LPN in the office and did not result in a life-threatening situation for the patient. What is an appropriate way for the nurse practitioner to document this?

Patient received wrong medication. Incident report was filed. LPN was disciplined.

X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified.

LPN inadvertently administered Y drug to the wrong patient. Supervisor notified. Family threatening litigation.

Patient was given X mg of Y drug in error.

The Correct answer is:

X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified

Documenting, "X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified," is the most accurate note because it is factual. Also, with this noted documentation, the writer is avoiding blame or assuming liability. The other notes, identified in the remaining answer choices, would be "red flags" mentioning error, litigation, and incident report.

Question 5

When treating a patient with a topical agent, you anticipate the greatest rate of absorption when it is applied to:

face

ankles

palms of the hands

soles of the feet

The Correct answer is:

face

Certain parts of the body, notably the face, axillae, and genital area, are quite permeable, allowing for greater absorption of medication. Less permeable areas are the extremities and trunk. The palms of the hands and soles of the feet create a barrier so little absorption occurs there.

Question 6

You are working in a rural health clinic and have a hunter come into the office. A 26-year-old man reports that while walking in the woods he was bitten on the leg by a raccoon. Upon examination, you find a 1 cm deep wound on his left lower posterior leg and the wound is oozing bright red blood. Your next best action is to:

Give rabies immune globulin and rabies vaccine.

Suture wound after proper cleansing.

Administer high-dose parental penicillin.

Initiate antibacterial prophylaxis with amoxicillin.

The Correct answer is:

Give rabies immune globulin and rabies vaccine

All bites should be considered to carry certain infectious risk. Nocturnal wild animals are know to carry rabies. These include raccoons, foxes, squirrels, skunks, bats, and woodchucks.

Question 7

In diagnosing a toothache (pulpitis), the nurse practitioner has knowledge that all of the following are necessary except:

Systemic manifestations do not occur from dental caries and pulpitis.

You should inquire about fever and chills.

Dental caries are the most frequent type of injury that causes pulpitis.

There is diverse flora involved in the infectious process, including gram-positive anaerobes and bacteroides.

The Correct answer is:

Systemic manifestations do not occur from dental caries and pulpitis

Many patients present in the clinic setting with a toothache or related symptoms. Systemic manifestations often occur and they include lymphadenopathy, malaise, fever, and pain. The remaining answer choices are true regarding this condition.

Question 8

In terms of cranial nerve testing, which cranial nerve (CN) is associated with facial movements?

CN 1

CN 3

CN 7

CN 11

Correct answer:CN 7

Cranial nerve 7 is associated with facial movements. This includes puffing cheeks, raising eyebrows and smiling

Question 9

In terms of the scope of practice for an NP, which of the following statements is incorrect?

The scope of practice defines a specific legal scope determined by state statutes, boards of nursing, educational preparation and common practice within a community.

General scope of practice is specified in many published professional documents.

Prescriptive authority is recognized as within the scope of practice for nurse practitioners in all 50 states.

Scope of practice is always defined by state statutes enacted by the state legislature.

Correct answer:

Scope of practice is always defined by state statutes enacted by the state legislature.

Some states define scope of practice by state statutes enacted by the state legislature. In other states, the legislature gives the board of nursing the authority to define the scope of NP practice. Either way is enforceable.

Question 10

Which of the following is an accurate statement regarding the Medicaid health program?

This program is funded with premiums from the participants.

This program is basically the same in every state.

This program offers unlimited number of adult visits to the healthcare provider.

This program is funded by both the state and federal governments.

The Correct answer is:

This program is funded by both the state and federal governments

The Medicaid program is state operated and varies from state to state. Participants generally do not have to pay premiums. Also, most states have limits on the number of adult visits allowed.

Question 11

Which stage in Erikson's Model of Psychosocial Development is where failure leads to feelings of shame and doubt?

Stage I Trust

Stage II Autonomy

Stage III Initiative

Stage IV Industry

The Correct answer is:

Stage II Autonomy

With Stage I Trust, failure causes mistrust. With Stage II Autonomy, failure leads to feelings of shame and doubt. With Stage III Initiative, failure leads to feelings of guilt. With Stage IV Industry, failure leads to feelings of inferiority. With Stage V Identity, failure leads to role confusion. With Stage VI Intimacy, failure leads to additional role confusion.

Question 12

In documenting a patient’s history, which of the following elements is a chronological description of illness from the first sign and/or symptom?

CC

HPI

ROS

PFSH

Correct answer:

HPI

HPI represents “history of present illness.” It is a chronological description of illness from the first sign and/or symptom or from the previous encounter to the present. It includes the following elements: location, quality, severity, duration, timing, context, modifying factors and associated signs and symptoms. A brief HPI consists of one to three of the elements of the HPI.

Question 13

The most common cancer for all ages and genders (not considering mortality) is which of the following?

lung cancer

leukemia

skin cancers

colon cancer

Correct answer:

skin cancers

Skin cancers are the most common cancer for all ages and genders. Squamous cell cancer is the most common skin cancer. Lung cancer is the leading cause of cancer deaths. Leukemia is the most common cancer and cancer death in children ages 0 – 19 years.

Question 14

Office laboratories are subject to federal oversight under the Clinical Laboratory Improvement Amendments (CLIA). These laboratories are subject to state and federal inspection and approval; however, office labs may obtain exemption from inspection if they do a limited number of specific laboratory tests. Which of the following is NOT one of the tests that an office laboratory with an exemption may do?

fecal occult blood (hemoccult)

HIV test

urine pregnancy test

blood glucose

Correct answer:

HIV test

Office laboratories are subject to state and federal inspection and approval. In offices where laboratory tests are limited to fecal occult blood, urine pregnancy test, blood glucose, urinalysis and office microscopy, practices may obtain exemption from inspection. HIV testing is not included in the list.

Question 15

A 23-year-old thin Caucasian female presents in the clinic with a new diagnosis of Crohn's disease. She has recently started medication prescribed by her gastroenterologist and asks you to tell her what else to do. You know that proper nonpharmacological management of this condition includes all of the following EXCEPT:

Avoid dairy products that contain lactose if they exacerbate symptoms.

A low protein is recommended.

Stress management is important, including relaxation techniques.

A low-roughage diet is recommended during acute exacerbations.

Correct answer:

A low protein diet is recommended.

A diet high in protein and vitamins, particularly B12, is recommended for the patient with Crohn's disease.

Question 16

When lymph nodes are referred to as shotty, the nurse practitioner understands that they are:

small and pellet-like

discrete and cystic

tender, mobile, and >5 mm

irregular, soft, and fixed to surrounding tissue

The correct answer is:

Small and pellet-like

Shotty lymph nodes are small, pellet-like nodes that are movable, cool, nontender and discrete. These lymph nodes range in size up to 3 mm in diameter.

Question 17

Which of the following questions is NOT related to assessing the psychosocial aspect of a female patient?

When was your last menstrual period?

How frequently do you consume alcohol?

Are you sexually active?

Have you ever smoked?

Correct answer:

When was your last menstrual period?

This is not related to psychosocial development or needs. It is a physiological question. The other question relate to the psychosocial history of the patient.

Question 18

When discussing advance directives with a family member of a terminal patient, it is important to include:

Their provisions go into effect when the patient has become conscious.

Living wills are verbal agreements between the patient and healthcare provider.

Only the patient can make decisions about their care, even when they are incompetent.

The patient can create a healthcare durable power of attorney when he or she is still competent.

The Correct answer is:

The patient can create a healthcare durable power of attorney when he or she is still competent

A competent individual establishes a written advance directive to identify his or her instructions and preferences for medical care. When the patient is unable to make decisions regarding medical care, such as when the patient has become incompetent or unconscious, the designated representative or family member and healthcare provider makes decisions based on the advance directive’s provisions. Types of advance directives are durable power of attorney, a living will or a healthcare proxy. With a durable power of attorney, the patient identifies the person or representative, a healthcare proxy, who will make medical decisions on his or her behalf. With a living will, the patient has identified specific instructions for the family or representative and the medical professional to carry out when he or she is unable to make decisions regarding medical care

Question 19

Which of the following hormone therapy agents provides the LEAST hot flash relief for menopausal women?

oral conjugated equine estrogen: 0.625 mg

oral estradiol - 17β: 2 mg

transdermal estradiol - 17β: 0.05 mg

oral estradiol - 17β: 0.25 mg

Correct answer:

oral estradiol - 17β: 0.25 mg

The three most commonly used prescription hormone therapy agents include oral conjugated equine estrogen and oral and transdermal estradiol - 17β. The amount of hot flash relief that women get from each form and dose differs. Oral estradiol - 17β: 0.25 mg gives the least hot flash relief.

Question 20

Which of the following does not play a significant role in the development of varicose veins?

diabetes mellitus

wearing constricting garments

weakness of the walls of the vein

pregnancy

Correct answer:

diabetes mellitus

Diabetes does not play a significant role in the development of varicose veins. An inherited venous defect of either a valvular incompetence or a weakness in the walls of the vessel likely plays a significant role. In addition, situations that cause high venous pressure, such as wearing constricting garments and pregnancy, contribute to their development.

Question 21

With the geriatric client, which assessment tool should the nurse practitioner use to evaluate balance and gait problems?

Index of Independence of Activities of Daily Living Scale

Tinetti Balance and Gait Evaluation

Lawton & Brody Balance and Coordination Scale

Instrumental Activities of Daily Living Scale

The Correct answer is:

Tinetti Balance and Gait Evaluation

The Tinetti scale and gait evaluation is an activity-based test that asks the patient to perform tasks, such as sitting and rising from a chair, turning, and bending. The Index of Independence o Activities of Daily Living helps to identify daily activities with which the patient needs assistance. The Instrumental Activities of Daily Living Scale assesses complex tasks.

Question 22

The FNP has been asked to prepare a talk for elementary school teachers about playground and classroom safety. Which of the following methods of presenting this information would be most effective?

videos and lecture

lecture only

presentation of case studies

presentation of information followed by small group discussion

Correct answer:

presentation of information followed by small group discussion

Studies show and theories hold that the older the learner, the more increased is the need for self-direction. Therefore sessions in which the teachers can actively take part would be the most effective way to deal with the issues in question. Adults like to see themselves as doers.

Question 23

The nurse practitioner has a patient on verapamil (Calan SR) and is monitoring the patient for therapeutic effects. He understands that with verapamil you should assess for:

decrease in systemic vascular resistance

increase in heart rate

decrease in ventricular premature beats

increase in blood pressure

The Correct answer is:

Decrease in systemic vascular resistance

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

Question 24

A mother brings her infant into the office and you diagnose oral candidiasis. Which of the following is a pharmacological treatment option for thrush in the infant:

nystatin oral suspension

clotrimazole troches

systemic ketoconazole

oral Diflucan x 1 dose

The Correct answer is:

Nystatin oral suspension

This is the only recommended treatment option for infants. Clotrimazole troches are used in children 3 and older. Systemic ketoconazole is not recommended for use in children. Oral Diflucan x 1 dose has been used to treat vaginal candidiasis in teens and adults.

Question 25

Which of the following statements about Pap smears is incorrect?

If endometrial cells are present a referral for biopsy is indicated.

If endocervical cells are missing the Pap smear is incomplete.

There is a high false-negative rate for Pap smears of 15 – 40%.

The Pap smear is the preferred diagnostic test for cervical cancer.

Correct answer:

The Pap smear is the preferred diagnostic test for cervical cancer.

A pap smear is a screening test only. The diagnostic test is the cervical biopsy, done during a colposcopy.

Question 26

The FNP has a female adult patient who tells him that she has lost a large amount of weight in a short amount of time, has become irritable and anxious and often experiences insomnia. Upon examination the FNP finds a diffusely enlarged thyroid gland without nodules, and tachycardia. Of the following which is the most likely diagnosis for these symptoms?

Grave’s disease

thyroid cancer

hyperprolactinemia

pheochromocytoma

Correct answer:

Grave’s disease

Grave’s disease is an autoimmune disorder of the thyroid gland causing hyperfunction and production of excess thyroid hormones. There is a higher incidence in females (8:1 ratio). In later stages of Grave’s disease there can also be exophthalmos (protruding eyeballs).

Question 27

There are theories of how and why a person changes or stays the same over time. One debate on theory involves nature vs. nurture. Which of the following theorists is part of the nature position on human growth and development?

John Locke

Arnold Gesell

John B. Watson

B.F. Skinner

Correct answer:

Arnold Gesell

Arnold Gesell promoted the maturational-organismic theory that is a nature position (emphasis on heredity and maturational process). This theory has a biological basis and the organizing principle of the theory is structure (closed system of transformational rules governing thought).

Question 28

You are treating a pregnant female and she inquires about HIV testing. The nurse practitioner has the understanding that:

It is better performed in the third trimester

It is an "opt-in" approach.

It produces many false positives.

It is recommended by the ACOG.

The Correct answer is:

It is recommended by the ACOG

The American College of Obstetrics and Gynecology (ACOG) recommends an "opt-out" approach to HIV screening in pregnant patients. This means that HIV will be routinely preformed unless the patient refuses.

Question 29

In terms of Medicaid, which of the following statements is incorrect?

Medicaid pays for health care.

Medicaid pays for nursing home.

Medicaid pays for prescription drugs.

Providers may collect 10% of the charges for services from the patient.

r:

Providers may collect 10% of the charges for services from the patient.

This statement is incorrect. Providers must agree to accept Medicaid payment in full and not collect from the patient or beneficiaries

Question 30

Which theorist whose theory of human growth and development puts emphasis on learning and environment (nurture) saw a child as a “tabula rasa” or “blank slate?”

John B. Watson

B.F. Skinner

Albert Bandura

John Locke

Correct answer:

John Locke

John Locke was a proponent of the nurture position of human growth and development that puts an emphasis on learning and environment. He saw a child as a blank slate upon which the effects of learning and environment would be written.

Question 31

There are many barriers to the electronic medical record. The NP understands that which of the following is NOT one of these issues?

technical matters: uncertain quality, ease of use, lack of integration

potential for streamlining and automating workflow

financial matters: maintenance, upgrades, replacement

doubts of clinical usefulness

The correct answer is potential for streamlining and automating workflow. Streamlining and automating the workflow is considered a benefit of the electronic medical record, not a barrier. Other barriers include resource issues (training and re-training), certification, security, and ethical matters.

Question 32

Your friend, a nurse practitioner (NP), has been diverting medications from patients. You and the friend work together at a clinic, both as NPs. What is your professional responsibility?

Report this to the state board of nursing.

Report this to her husband to get her help.

Report this to the police and clinic owner.

You have no professional responsibility regarding others' actions.

The Correct answer is:

Report this to the state board of nursing

You should report unsafe practice to the state board of nursing. The clinic owner should be made aware of this as well. You are not obligated to notify the police or her family.

Question 33

A 44-year-old Caucasian female is taking lovastatin for hyperlipidemia and complains of muscle aches in her thighs and right calf for three days without improvement. She has been on the medication for 3 months. What should the nurse practitioner do first?

Check bilirubin enzymes.

Order a CPK.

Ask about nighttime muscle cramps.

Stop lovastatin immediately.

The Correct answer is:

Order a CPK

This patient has a complaint of myalgias that could be associated with statin use. This patient should be assessed for rhabdomyolysis by measuring the creatine phosphokinase (CPK) level. If the CPK value is elevated, lovastatin should be stopped immediately. Nighttime cramps are not associated with statin usage

Question 34

The FNP faces the task of educating a Native American Navajo female about her newly diagnosed type 2 diabetes. The FNP understands that which of the following is true in regard to discussing this with the patient?

The FNP should avoid direct eye contact with the patient while educating the patient.

The FNP should include the woman’s husband in the education for the reason that the husband makes all of the decisions in Native American Navajo families.

Native American Navajo families are not accepting of outside health-care practitioners.

none of the above

Correct answer:

The FNP should avoid direct eye contact with the patient while educating the patient.

This is the true statement. Native Americans often avoid direct eye contact and consider it disrespectful or aggressive.

Question 35

The purpose of an OSHA 200 log is to record:

only work-related deaths

dangerous workplace situations

lost work days

occupational injuries and illnesses

The Correct answer is:

Occupational injuries and illnesses

The purpose of an OSHA 200 log is to record occupational injuries and illnesses, including mortality reports and lost workdays, which could also reveal dangerous working conditions.

Question 36

All pregnant women should undergo screening for HBsAg at the first prenatal visit, regardless of HBV vaccine history. This is because infants who have been infected perinatally with HBV have what percentage chance of developing hepatocellular carcinoma or cirrhosis in their lifetime?

25%

20%

10%

5%

Correct answer:

25%

Infants who have been infected perinatally with HBV have an estimated 25% lifetime chance of developing hepatocellular carcinoma or cirrhosis. The HBV vaccine is not 100% effective and a woman could have carried HBsAg since before pregnancy.

Question 37

Which of the following should be considered for the first-line therapy for prepatellar bursitis to afford significant pain relief?

intrabursal corticosteroid injection

bursal aspiration

NSAIDs

applying ice to the affected area

Correct answer:

bursal aspiration

With prepatellar bursitis, bursal aspiration should be considered as a first-line therapy because this procedure affords significant pain relief and allows the bursa to reapproximate. In other sites, first-line therapy includes minimizing or eliminating the offending activity, applying ice to the affected area for 15 minutes at least four times per day, and the use of NSAIDs. Intrabursal corticosteroid injections are used if conservative measures have not worked after approximately 4 to 8 weeks.

Question 38

The nurse practitioner understands that there are three groups of behaviors that would improve population health. All of the following are included EXCEPT:

preventative health services (infant care, immunizations, sexually transmitted disease services

health protection activities (toxic agent control, occupational safety, injury prevention)

health promotion behaviors (smoking cessation, stress reduction, improved fitness)

cost means prevention ( avoiding unnecessary testing, eliminating screenings for malignancy)

The Correct answer is:

Cost means prevention ( avoiding unnecessary testing, eliminating screenings for malignancy)

Health promotion includes cost means prevention with an emphasis on containing costs with early detection through testing and screenings before the disease occurs. The other answers are important behaviors to improve population health.

Question 39

A woman brings her elderly mother to the office for a check-up. When counseling her, you find a need to discuss falls prevention. The following are all necessary interventions EXCEPT:

Provide an obstacle free, well-lit environment.

Raise chair heights and seat heights as necessary.

The use of rugs.

Avoid soft sole shoes without proper tread.

The Correct answer is:

Use of rugs

"Throw rugs" have been known to cause falls and slips in the elderly. Therefore, rugs should be avoided.

Question 40

What medication and dose can be used for abortive therapy in an adult client with symptoms of migraine headache?

ergotamine (Ergostat) 2 mg SL

ketorolac (Toradol) 100 mg IM

sumatriptan (Imitrex) 1 mg IM

amitriptyline (Elavil) 100 mg PO

The Correct answer is:

Ergotamine (Ergostat) 2 mg SL

The dosing guideline for ergotamine (Ergostat) is 2 mg by mouth, sublingually. Further, additional treatment options for a migraine headache can also include Ketorolac and Sumatriptan, as well as other medications. Depending on the patient's severity of symptoms and medical history, the following are dosing guidelines providers can use to administer Ketorolac and sumatriptan. For Ketorolac, the provider can administer the drug intravenously or intramuscularly before administering orally as a tablet. When taking Ketorolac orally, the dosing guidelines are 30-60 mg. The patient is given an initial first dose of two 20 mg tablets. After the first dose, the patient is given one 10 mg tablet every 4-6 hours for up to 5 days. The dosing for Ketorolac should not exceed 40 mg per day. Therefore, the answer choice stating "ketorolac (Toradol) 100 mg IM" is incorrect, as 100 mg is too high of a dosage. Next, Sumatriptan (Imitrex) dosing guidelines include oral (25-200 mg daily) and subcutaneous injections (6-12 mg) administration, as well as administration of the medication by a nasal spray (5-20 mg as 1 spray in each nostril and then up to 40 mg a day.) Therefore, the answer choice with the dosing of 1 mg IM for sumatriptan (Imitrex) is incorrect. Then, amitriptyline is not used for abortive therapy.

Question 41

You have a 2-year-old Caucasian child that attends daycare in the clinic. Her mother tells you she has been rubbing her eye. You notice that the right eye has reddened ejected conjunctiva and yellow discharge. When treating suppurative conjunctivitis, the nurse practitioner has knowledge that all of the following are causative organisms for bacterial conjunctivitis except:

Haemophilus influenzae

Pseudomonas aeruginosa

Streptococcus pneumoniae

Staphylococcus aureus

The correct answer is:

Pseudomonas aeruginosa

Therapy in conjunctivitis is aimed at eradicating or eliminating the underlying causes. Therefore, accurate diagnosis is critical. Further, it is important to understand the causative agents for this condition. Pseudomonas aeruginosa does not cause conjunctivitis. However, the remaining answer choices are all causative organisms.

Question 42

School age children begin to develop permanent teeth. At what age would the first premolar be likely to erupt?

8 - 9 years

7 - 8 years

11 - 12 years

10 - 11 years

Correct answer:

10 – 11 years

The first premolars are most likely to erupt between 10 and 11 years. Central incisors erupt between 7 and 8 years; lateral incisors between 8 and 9 years; and cuspids between 11 and 12 years.

Question 43

An elderly client with a recent history of a left hemisphere stroke returns to the clinic for a follow-up. The nurse practitioner expects to see what symptoms?

bilateral weakness of lower extremities

difficulty with speech

left visual field deficit

left sided weakness

The Correct answer is:

Difficulty with speech

The Broca's area, or speech center, is most often located in the left hemisphere. The patient would probably experience weakness of the right side of the body and not left sided weakness. Then, the patient will experience right-sided visual deficit, and not left visual field deficit.

Question 44

A middle aged postmenopausal woman is in the office with questions regarding hormone therapy. You explain to her that hormone therapy users may experience:

an increase in breast cancer rates with long-term use

a 10% increase in bone mass

no change in the occurrence of osteoporosis

reduction in high-density lipoprotein cholesterol

answer is:

An increase in breast cancer rates with long-term use

Postmenopausal hormone therapy can help reduce the risk of postmenopausal fracture by 50% by minimizing further bone loss. The benefits must be balanced against the noted increased risk of breast cancer and other problems.

Question 45

Principles of structural functional theory adapted from Friedman and others include all of the following EXCEPT:

Families are social systems with instrumental and expressive functions.

In optimally functioning families, members take on predictable roles that meet the needs of its members.

Families are composed of small numbers with characteristics of small-group behavior.

Individuals adopt norms and values solely from outside the family system.

er:

Individuals adopt norms and values solely from outside the family system.

This is incorrect. Individuals adopt norms and values, as well as cultural traditions as part of the process of family socialization.

Question 46

Which of the following suggests that a patient may be abusing alcohol?

rhinophyma, hypotension, peripheral neuropathy

telangiectasias, flat affect, thyroid dysfunction

hepatosplenomegaly, murmur, osteoarthritis

macrocytosis, tremulousness, hypertension

The Correct answer is:

Macrocytosis, tremulousness, hypertension

Findings that would cue the nurse practitioner that a patient was abusing alcohol are tremors, hypertension, rhinophyma, peripheral neuropathy, telangiectasias or hepatosplenomegaly. The patient may not exhibit all of these symptoms at one time however. Further, the patient will have macrocytosis because there is a high rate of B12 and folate deficiency among these patients

Question 47

Which group has the greatest risk for immune system dysfunction with poor nutritional status?

Frail older adults, aged 65 and over

healthy adults, aged 25-49

healthy adolescents and young adults

thriving infants

The Correct answer is:

Frail older adults, aged 65 and over

Frail geriatric patients are at the greatest risk for altered immune function related to nutrition due to multiple factors such as altered taste and loss of appetite due to chronic disease. Adequate nutrition has been proven through research to improve immune status.

Question 48

In terms of provider credentialing by an MCO, all of the following may be part of the credentialing process EXCEPT:

collecting data that includes educational, license, malpractice, employment and certification data on each provider

formal issuance of a certification document to the provider

making a site visit

investigating systems for admitting patients

Correct answer:

formally issuing a certification document to the provider

Provider credentialing by an MCO does not include formally certifying the provider. It does include all of the other choices, however.

Question 49

The ability of a patient and family to understand and act on health information is called:

complementary modality

alternative modality

health literacy

health disparity

Correct answer:

health literacy

Health literacy is the ability of a patient and family to understand and act on health information. It is now recognized as one of the largest contributors to health outcome.

Question 50

Upon seeing a patient in the office that had a recent cervical whiplash injury, the nurse practitioner knows that which of the following is NOT true regarding this:

It is identifiable on MRI or CT, but not X-ray.

This occurs after a traumatic event.

Occipital pain and headache can occur.

It may be accompanied by severe pain and spasm.

The Correct answer is:

It is identifiable on MRI or CT, but not x-ray

Diagnostic tests, such as a MRI, CT scan or x-ray, do not show signs of a cervical whiplash injury. This type of injury commonly follows a car accident when a rear collision is involved. Loss of range of motion and delayed pain sensation are common.

Question 51

Elizabeth Kübler-Ross has identified five stages of grief. In which stage of grief is the person who tells the FNP that if she could just live to see her granddaughter’s wedding, she would be ready to die?

denial

bargaining

acceptance

depression

Correct answer:

bargaining

This patient is in the bargaining stage of grief. The five stages are: denial, anger, bargaining, depression and acceptance.

Question 52

You are doing a well-child exam on a male immigrant child and make some concerning findings. He has pectus excavatum and associated scoliosis. You understand that the nurse practitioner should evaluate for:

cardiac compromise

Marfan syndrome

joint deformities

pulmonary dysfunction

The Correct answer is:

Marfan syndrome

If pectus excavatum is associated with scoliosis, the nurse practitioner should evaluate for Marfan syndrome. Marfan syndrome is a heritable condition that affects the connective tissue. The primary purpose of connective tissue is to hold the body together and provide a framework for growth and development. In Marfan syndrome, the connective tissue is defective and does not act as it should. Because connective tissue is found throughout the body, Marfan syndrome can affect many body systems, including the skeleton, eyes, heart and blood vessels, nervous system, skin and lungs.

Question 53

An option to the injectable influenza vaccination is the nasal spray vaccine. It is important that the nurse practitioner understands to advise a patient:

Its use is limited to children younger than 6 years.

This is the preferred method of immunization for persons who are allergic to eggs or egg products.

It contains a live, attenuated virus.

It is acceptable to use during pregnancy.

The Correct answer is:

It contains live, attenuated virus

The nasal influenza virus contains influenza viruses that are sufficiently weakened as to be incapable of causing disease. However, the virus is strong enough to stimulate a protective immune response. The influenza virus vaccine is indicated for individuals aged 2 to 49 years, if the individual is healthy. The vaccine is contradicted in persons with egg allergy and pregnant women.

Question 54

When assessing color perception with the preschooler, which test should be given?

Bruckner's test

Hirschberg's test

Ishihara's test

Jaeger's test

The Correct answer is:

Ishihara's test

The Ishihara's test is a test for color perception. The Bruckner's test is used to evaluate for the red reflex presence. The Hirschberg's test is used for the corneal light reflex. The Jaeger's test assesses near vision.

Question 55

Which of the following organizations is not obligated to reimburse nurse practitioners as primary care providers?

Medicare

MCOs

TRICARE

federally funded school-based clinics

Correct answer:

MCOs

NPs are reimbursed for their services as primary care providers under Medicare, Medicaid, Federal Employees Health Benefits Program, TRICARE (formerly CHAMPUS), veterans’ and military programs and federally funded school-based clinics. MCOs have frequently excluded NPs from being designated as primary care providers.

Question 56

When treating the patient with COPD exacerbations, the nurse practitioner is aware that certain organisms are often associated with this process with advanced disease. Of the following, which is one?

Haemophilus influenzae

Staphylococcus aureus

Pseudomonas aeruginosa

Streptococcus pneumoniae

The Correct answer is:

Pseudomonas aeruginosa

Common pathogens usually found in the presence of advanced disease and repeated exacerbations are Enterobacteriaceae spp. and Pseudomonas spp. Other organisms, such as Haemophilus influenzae and Streptococcus pneumoniae, are seen in the disease, but not in advanced cases. Staphylococcus aureus is not commonly seen in COPD cases.

Question 57

An adult patient presents with painful red nodules and pustules under his arm. He tells the FNP that some of the lumps have started to drain pus. The FNP is most likely to diagnose which of the following?

Hidradenitis Suppurativa

impetigo

meningococcemia

herpes zoster

Correct answer:

Hidradenitis Suppurativa

Hidradenitis Suppurativa is a bacterial infection of the sebaceous glands of the axilla (or groin) by Gram-positive Staphylococcus aureus. It is marked by flare-ups and resolution. It can be confirmed by a C&S of the purulent discharge.

Question 58

The FNP has a patient with a gradual onset of numbness starting in the hands and feet. The CBC on this patient reveals a macrocytic anemia and a peripheral smear shows multisegmented neutrophils. This patient most likely has which of the following conditions/diseases?

neutropenia

vitamin B12 deficiency

thrombocytopenia

non-Hodgkin’s lymphoma

Correct answer:

vitamin B12 deficiency

Vitamin B12 deficiency is indicated since the patient has a gradual onset of paresthesias (numbness, tingling or pricking) starting in the hands and feet with a CBC that reveals a macrocytic anemia and a peripheral smear that shows multisegmented neutrophils. Pernicious anemia is the most common cause of vitamin B12 deficiency.

Question 59

Which of the following patients does the nurse practitioner need to refer?

a patient who has had persistent low back pain and does not respond to conservative treatment after a week

a patient with a viral upper respiratory infection you have started on symptomatic care

a patient with an anal fissure that has not responded well to treatment after 10 days

a patient with dysphagia without obvious treatable cause

The Correct answer is :

A patient with dysphagia without obvious treatable cause

Low back pain should be evaluated further with diagnostic testing and treatment should be tried longer before referral. A viral upper respiratory infection does not warrant referral and a patient with an anal fissure should be given time to heal, such as 30-60 days before referring the patient.

Question 60

The nurse practitioner understands that in the workplace, sexual harassment may occur. Which of the following is NOT true concerning sexual harassment?

A hostile environment is a form of sexual harassment.

Sexual harassment must be pervasive and does not need to be longstanding to be considered.

The participants do not have to find the actions objectionable and have work performance be affected.

Sexual harassment is difficult to prove.

The Correct answer is:

The participants do not have to find the actions objectionable and have work performance be affected

Sexual harassment results in a hostile environment where the participants find the actions objectionable and work performance is affected. It is difficult to prove when there are no witnesses

Question 61

You are treating a patient for sinusitis who has no insurance. The patient's adolescent daughter does have health insurance so you write a prescription in her name for her mother's sinusitis. This is considered:

adequate care

fraud and abuse

good Samaritan care

none of the above

The Correct answer is:

Fraud and abuse

Using one patient's insurance to fill medications for another person is illegal and considered fraud and abuse. The appropriate thing to do, if the mother does not have money to buy medications, is offer samples or refer her to social services or a local agency that helps the uninsured.

Question 62

For which of the following diseases/conditions should the FNP refer the patient to an ophthalmologist stat?

cluster headache

temporal arteritis

trigeminal neuralgia

migraine headache (with aura)

Correct answer:

temporal arteritis

Temporal arteritis is a systemic inflammatory process of the medium and large arteries of the body. A patient with temporal arteritis should be referred to an ophthalmologist stat. Permanent blindness can result if the person is not diagnosed and treated early.

Question 63

Which of the following findings is often found in a person with stage 2 Lyme disease?

macrocytic anemia

conductive hearing loss

atrioventricular heart block

peripheral neuropathic symptoms

The Correct answer is:

Atrioventricular heart block

Lyme disease has three stages, which are stage 1, stage 2 and stage 3. In stage 2 Lyme disease, also known as early disseminated infection, the infectious organism spreads or disseminates into the blood. A potential complication for stage 2 Lyme disease is Lyme carditis, which is exhibited by the presence of abnormal heart rhythms, or an atrioventricular block. Further, in stage 2 Lyme disease, a classic rash may reappear with multiple lesions and arthralgias. Additionally, fatigue, myalgia, and headaches may occur.

Question 64

The National Practitioner Data Bank is a repository for which of the following types of information?

personal information

professional credentials

licensure information

malpractice payments

Correct answer:

malpractice payments

The National Practitioner Data Bank is a repository for damage award data. It is a data bank that keeps track of payments form professional liability insurance companies on behalf of the clients to injured parties for successful malpractice claims.

Question 65

Which of the following would NOT be recommended by the FNP as a measure to prevent colonic diverticulosis and diverticulitis?

regular aerobic exercise

foods low in uric acid

adequate hydration

a high-fiber diet

Correct answer:

foods low in uric acid

Foods low in uric acid are what is recommended for those suffering from gout. The other three choices are recommendations for preventing colonic diverticulosis and diverticulitis. They help to increase bowel motility and tone.

Question 66

The nurse practitioner knows that the following are all developmental warning signs EXCEPT:

At 6 weeks, the infant has an absence of auditory alertness.

At 18 months, the child does not have a pincher grasp.

At 10 months, the infant does not wave bye.

A 2 years, the child does not walk.

The Correct answer is:

At 10 months, the infant does not wave bye

An infant may not wave bye until age 14 months. The remaining answer choices are all warning signs regarding development. Other warning signs for a 6-week-old infant include lack of visual fixation (focusing) and the infant's head lag when going from pulling to sitting position. At 18 months, the child does not have a pincer grasp or exhibits the inability to stand without support.

Question 67

When evaluating the carotids, with correct procedure for auscultating is:

Use the bell of the stethoscope.

Position the client at a 30-degree angle, and press firmly with bell of the stethoscope.

Use the diaphragm of the stethoscope.

Place the stethoscope 1 inch off the area above the sternocleidomastoid muscle.

The correct answer is to use the bell of the stethoscope. The correct procedure is to listen for carotid bruits with the bell of the stethoscope, which brings out low-frequency sounds and filters out high-frequency sound. The bell should be placed very lightly on the neck with just enough pressure to seal the edge.

Question 68

A 55-year-old male comes to the clinic complaining of swelling of his left calf which he says is painful to touch. He tells the FNP that he has just returned from a business trip in Hong Kong. The FNP’s examination reveals a warm, red area that is painful when palpated and a positive Homan sign. The likely diagnosis for this patient is which of the following?

superficial thrombophlebitis

deep vein thrombosis (DVT)

peripheral vascular disease (PVD)

Raynaud’s phenomenon

Correct answer:

deep vein thrombosis (DVT)

Thrombi develop in the deep venous system of the legs or pelvis secondary to stasis, trauma to vessel walls, inflammation or increased coagulation. Complications of DVT include pulmonary emboli and stroke.

Question 69

When the FNP examines a patient with suspected hypothyroidism, he would NOT expect to find:

weight gain

coarse, dry skin

tachycardia

intolerance of cold

Correct answer:

tachycardia

The FNP would not expect to find tachycardia in a patient with suspected hypothyroidism; he would be more likely to find bradycardia, especially in severe cases. He may also find that the person is lethargic and has memory problems, that the person has thick, coarse hair with a tendency to break, and thick, dry nails.

Question 70

The nurse practitioner (NP) has been asked to resolve a conflict between two medical assistants. One is observed as pleasant and helpful, while the other is abrasive and angry. What guideline must the NP observe in the resolution of this conflict?

Deal with issues, not personalities.

Weigh the consequences of each possible solution.

Require the medical assistants to reach a compromise.

Encourage ventilation of anger and use humor to minimize the conflict.

The Correct answer is:

Deal with issues, not personalities

The conflict must be addressed directly by the nurse practitioner. The personal characteristics of the assistants must not enter into the conflict resolution process. Compromise is only one method of conflict resolution.

Question 71

A 45-year-old female comes to the clinic reporting that she has had several episodes of a blue color in her fingertips accompanied by a tingling and numbness of these fingertips. The FNP diagnoses Raynaud’s phenomenon. Which of the following would the FNP NOT do for the patient suffering from this condition?

Tell her to stop smoking.

Tell her to avoid cold weather.

Prescribe Norvasc.

Prescribe Imitrex.

Correct answer:

Prescribe Imitrex

Imitrex is a vasoconstricting drug. This is why it would not be prescribed for a person with Raynaud’s phenomenon.

Question 72

The descriptors for the levels of evaluation and management (E/M) services recognize seven components that are used in defining the levels of E/M services. Which of the following is NOT one of these components?

history

counseling

time

expense

Correct answer:

expense

Expense is not one of the seven components used in defining the levels of E/M services. The seven components are: history, examination, medical decision making, counseling, coordination of care, nature of presenting problem and time.

Question 73

A mother brings a 21-month-old Asian-American female child into the office. The chief complaint is abdominal pain with flatulence and diarrhea after eating. Up until 3 months ago, she was being breast-fed twice a day. The nurse practitioner suspects:

lactose intolerance

food allergy

irritable bowel syndrome

Hirschsprung's disease

The Correct answer is:

Lactose intolerance

This condition is common among the Asian population. Primary symptoms include bloating, flatulence, abdominal cramps and diarrhea after eating foods with lactose. Food allergies are common in children under the age of 3 and they develop angioedema, flushing, hives and throat itching. Irritable bowel syndrome symptoms are constipation alternating with diarrhea and more common during late adolescence. Hirschsprung's disease is more common in boys than girls.

Question 74

A female patient is in the office with scoliosis. The nurse practitioner knows that the following are all true regarding the management of this condition EXCEPT:

The goal of management is to prevent further deformity.

Curves >40° in growing children require surgical rod insertion or spinal fusion.

Curvature of less than 20° is of no concern.

Bracing is required if curves are >25° in growing children.

The Correct answer is:

Curvature of less than 20° are of no concern

Curves < 14° should be observed, documented and evaluated on follow-up in 6 months in children with a Tanner V or less. If the curvature is 15°, they should be referred to an orthopedist to monitor for progression.

Question 75

In the course of educating a patient who suffers from migraine headaches, the FNP would advise the patient to avoid all but which of the following foods?

chocolate

pickled beets

lima beans

fish

Correct answer:

fish

Certain foods should be avoided by persons who suffer from migraines. Fish is not one of these foods. Foods to be avoided include: chocolate, broad beans, any pickled, fermented or marinated food, sour cream, ripened cheeses, sausages, pizza, MSG, nuts, figs, citrus foods, bananas, caffeinated beverages and alcoholic beverages.

Question 76

Which of the following theorists wrote the book Adolescence that first described adolescence as a critical developmental period?

G. Stanley Hall

Arnold Gesell

Alfred Binet

Theophile Simon

Correct answer:

G. Stanley Hall

G. Stanley Hall wrote the book Adolescence that first described adolescence as a critical developmental period of “storm and stress” or “Sturm und Drang.” Its three key aspects are conflict with parents, mood disruptions, and risky behavior.

Question 77

Teratogens are agents that can cause structural abnormalities during pregnancy. Which of the following is NOT a teratogen?

Ciprofloxacin

cocaine

aminoglycosides

lithium

Correct answer:

Cipro

Cipro is a Category C drug -- there may be a risk of fetal harm, and the drug should only be used if the potential benefits outweigh the potential risk. All of the other choices, along with alcohol, cigarettes, Accutane, lithium, and other substances, are teratogens, meaning they are suspected or known to cause fetal abnormailities.

Question 78

Which of the following statements about revocation of an NPs license is true?

Both the state board of nursing and a court of law can revoke or suspend an NP’s license.

A court can only revoke or suspend an NP’s license if the judge believes the NP to be grossly negligent.

Only the state board of nursing can revoke or suspend an NP’s license.

Only a court can revoke or suspend an NP’s license.

Correct answer:

Only the state board of nursing can revoke or suspend an NP’s license.

A state board of nursing approves an NP’s right to practice in a state and this same board of nursing can suspend or revoke an NP’s license. A court cannot revoke an NP’s license. If a judge believes an NP to be grossly negligent, the judge may report the nurse to the state board of nursing.

Question 79

Which of the following is only a presumptive sign of pregnancy?

Goodell’s sign

enlarged uterus

amenorrhea

urine tests

Correct answer:

amenorrhea

Amenorrhea is only a presumptive sign of pregnancy. It could be the result of other factors. Presumptive signs are the softest and least objective signs. The other choices are all probable signs of pregnancy.

Question 80

A sudden and rapid drop in the hemoglobin (< 6 g/dL) along with pallor, clammy skin, tachycardia and hypotension may indicate:

acute hemorrhage

neutropenia

thrombocytopenia

vitamin B12 deficiency

Correct answer:

acute hemorrhage

Acute hemorrhage is indicated by a sudden and rapid drop in the hemoglobin. Signs and symptoms of shock such as pallor, clammy skin, tachycardia and hypotension may also be present.

Question 81

Which of the following statements about the Nurse Practice Act of the state is correct?

Only some states have a Nurse Practice Act.

The Nurse Practice Act has no statutory authority.

The Nurse Practice Act is not legally enforceable.

The Nurse Practice Act gives nurses the legal right to practice.

Correct answer:

The Nurse Practice Act gives nurses the legal right to practice.

This is the correct statement. The Nurse Practice Act gives nurses the legal right to practice. All states have a Nurse Practice Act. It has statutory authority and is legally enforceable.

Question 82

Which of the following terms is used for the process by which an agency of state government grants permission to individuals (such as FNPs) for the practice of a profession to engage in the practice of that profession and prohibits all others from legally doing so?

accreditation

certification

endorsement

licensure

Correct answer:

licensure

Licensure is the process by which an agency of state government grants permission to individuals (such as FNPs) for the practice of a profession to engage in the practice of that profession and prohibits all others from legally doing so. Certification is the process by which a non-governmental agency or association certifies that an individual licensed to practice as a professional has met certain predetermined standards specified by that profession for specialty practice.

Question 83

The nurse practitioner must carry professional liability insurance. An occurrence-form type is preferred because:

The carrier will be notified of a potential claim during the policy period.

The coverage is limited and time based.

The amount of insurance money available to pay a claim increases with each renewal of the policy.

The policy proceeds are available to pay claims regardless of when the claim is reported to the carrier.

The Correct answer is:

The policy proceeds are available to pay claims regardless of when the claim is reported to the carrier

The types of professional liability, as well as general liability, insurances include occurrence form and claims-made. With the occurrence form, the liability insurance plan pays the claim based on when the loss happens and according to the timeframe the policy was in place. For instance, the nurse practitioner has professional liability insurance, which is occurrence form based. The nurse practitioner purchased the insurance coverage in 2007. The nurse practitioner has paid the premiums to keep the coverage up to date with the XYZ Corporation. A patient files a lawsuit against the nurse practitioner in July 2010 for an incident that occurred in May of 2008. If the patient wins the lawsuit, the XYZ Corporation will pay the claim, under the occurrence form plan, because the incident occurred during the timeframe when the policy was in effect (May 2008). With a claims-made policy, this policy pays claims also when the coverage is in effect. However, the claims made coverage policy will pay the claim based on the terms identified in the policy at the current time. Therefore, if an incident occurred in 2008 and a claim is filed in 2011, the incident has to be covered in the current 2011 and not the 2008 policy coverage terms, before the insurance company pays the claim. Additionally, the answer choice “the carrier will be notified of a potential claim during the policy period” is incorrect, as the carrier does not need to be informed during the policy period. This is a requirement with the claims-made type coverage. Further, the limits do not automatically increase with the occurrence form type of coverage, which makes the answer choice “amount of insurance money available to pay a claim increases with each renewal of the policy” incorrect.

Question 84

The most highly infectious stage of pertussis is during which of the following?

convalescent stage

incubation stage

paroxysmal stage

catarrhal stage

Correct answer:

catarrhal stage

The person who has pertussis is most highly infectious during the catarrhal stage of the illness. At this stage, that usually lasts from one to two weeks, the illness is characterized by complaints related to upper respiratory tract infection.

Question 85

The FNP overhears a staff member talking about a patient who “had a senior moment” because she could not remember something. The FNP knows that this statement:

could be interpreted as stereotyping older adults and considered ageism

is innocent and has no negative connotation

is a generally accepted comical statement about older adults

none of the above

Correct answer:

could be interpreted as stereotyping older adults and considered ageism

This statement shows a bias against older adults. It can be considered a form of ageism. It is prejudicial and perpetuates stereotypes of older adults.

Question 86

There is a shortage of pneumococcal vaccine for adults. The nurse practitioner understands that of all of the following, who is at greatest risk for invasive pneumococcal infection and should be priority?

a 36-year-old woman who underwent a splenectomy recently

a 52-year-old man with a 15-year history of type 2 diabetes

a 78-year-old woman with decreased mobility due to chronic rheumatoid arthritis

a 64-year-old man with chronic obstructive pulmonary disease

The Correct answer is:

A 36-year-old woman who underwent a splenectomy recently

Medical indications for this vaccine include chronic lung disease, chronic renal disease, chronic cardiovascular disease, chronic liver diseases, diabetes, immunocompromising conditions, and anatomic asplenia (splenectomy). Without the spleen, the patient's resistance to fight infection is greatly reduced.

Question 87

In terms of liver function tests, which of the following tests has a normal reference range of 5 – 50 u/L?

Alkaline Phosphatase

Serum GGT

Serum AST

Serum ALT

Correct answer:

Serum AST

Serum AST is normal at 5 to 50 u/L. It is present in the liver, heart muscle, skeletal muscle, kidney and lung. It is not specific for liver injury because it is also elevated in other conditions such as acute MI.

Question 88

A patient with a vitamin D deficiency can be helped by all but which of the following?

increased sun exposure

a dose of 50,000 IU once a week for 8 weeks

low-dose (400 – 800 IU) vitamin D supplementation alone

eating a diet rich in vitamin D

Correct answer:

low-dose (400 – 800 IU) vitamin D supplementation alone

This is not enough to correct a vitamin D deficiency. Vitamin D does not have the ability to be stored in fat nor does it have a long half-life. Daily low-dose supplementation to a high dose once a week for 8 weeks is the norm.

Question 89

A pregnant woman voices her concern with you over the side effects she is having with supplemental iron therapy. The nurse practitioner knows that maternal iron requirements are the greatest during what part of her pregnancy?

first trimester

second and third trimester

first and second trimester

preconception

The Correct answer is:

Second and third trimester

Maternal iron requirements increase in the second and third trimesters of pregnancy, in part because of the fetus's need to build iron stores. Iron deficiency anemia is common during pregnancy and the patient should be counseled on ways to tolerate the side effects of the supplementation.

Question 90

In interacting with a patient, which of the following phrases should NOT be used?

“Tell me about . . .”

“What are your thoughts . . .?”

“What are you feeling?”

“If it were me I would . . .”

Correct answer:

“If it were me I would . . .”

Some phrases should not be used in communicating with patients. “If it were me I would . . .” is one of them. Useful phrases are those that promote therapeutic interaction and keep it open, genuine and patient-centered.

Question 91

The first-line intervention for anterior epistaxis is which of the following?

nasal packing

simple pressure to the area superior to the nasal alar cartilage

cautery

topical thrombin

Correct answer:

simple pressure to the area superior to the nasal alar cartilage

Anterior epistaxis is usually the result of localized nasal mucosa dryness and trauma. Most episodes can be easily managed with simple pressure – with firm pressure to the area superior to the nasal alar cartilage. If this action is ineffective, then other secondary measures such as those mentioned in the other choices may be used.

Question 92

A standard being developed under managed care is credentialing. Which of the following statements about credentialing is false?

Credentialing for most health plans is being conducted largely by the Council for Affordable Quality Health Care.

There are emerging standards regarding patient satisfaction.

Under managed care, all standards for clinicians are related to the quality of patient care.

none of the above

Correct answer:

Under managed care, all standards for clinicians are related to the quality of patient care.

This is false. Under managed care, not all standards for clinicians are related to the quality of patient care. Some standards look at quantity of care delivered.

Question 93

A mother brings her 3-year-old son into the clinic for a routine checkup. The mother tells the FNP that her child “acts out” a lot and that she needs help in addressing this behavior. The FNP suggests a “time out” for the child when he misbehaves. Which statement in regard to a “time out” for children is most accurate?

The “time out” should last for as many minutes as the child has misbehaved.

The child should sit still in the “time out” for as many minutes as his age in years.

The child should be allowed to read or draw during the “time out.”

“Time outs” should not be used until a child is at least old enough to have started school.

Correct answer:

The child should sit still in the “time out” for as many minutes as his age in years.

A “time out” for a child should not last longer than his age in years. Since this child is three years old, his “time out” should be three minutes. He should sit still during this time, not read, draw or do any other activity.

Question 94

The FNP has a patient who has suffered a cat bite. The FNP knows that the rate of infection from cat bites is:

negligible

5%

50%

80%

Correct answer:

80%

All bites should be considered to carry significant infectious risk. This risk can vary from the relatively low rate of infection from dog bites (about 5%) to the very high rate from cat bites (about 80%). Initial therapy for all bite wounds should include vigorous wound cleansing with antimicrobial agents as appropriate and debridement if necessary

Question 95

In the management of Parkinson Disease (PD), surgical intervention such as deep brain stimulation surgery can be helpful to manage disease-related symptoms:

that are related to memory loss

to ease the tremors and bradykinesia

when medication therapy is not tolerated or helpful

as a last resort when all other options have been exhausted

The Correct answer is:

When medication therapy is not tolerated or helpful

Deep brain stimulation surgery for Parkinson Disease is helpful in making the "off" state more like movement in the "on" state, and is helpful in the reduction of levodopa-induced dyskinesias. As with other therapies, expert consolation should be sought, and all options should be thoroughly discussed with the patient before pursuing surgical intervention.

Question 96

The FNP has a 70-year-old female patient who has been diagnosed with giant cell arteritis. The FNP understands that all of the following are true about this disease and its treatment EXCEPT:

Her symptoms may be accompanied by respiratory tract symptoms.

Approximately 50% of patients with giant cell arteritis experience visual symptoms.

Transient repeated episodes of blurred vision are usually reversible.

Sudden loss of vision is almost always reversible.

Correct answer:

Sudden loss of vision is almost always reversible.

Sudden loss of vision is almost always permanent. Treatment for giant cell arteritis helps minimize the risk of blindness.

Question 97

Health disparities have gained much attention in research and media. The following is NOT a true statement concerning health disparities:

Nurse practitioners struggle with defining their professional response to the plight of uninsured and underinsured.

Remedies to the gaps in healthcare by nurse practitioners include lobbying for incremental increases in coverage to include services by APNs.

The new economic environment will not affect insurance premiums or the cost of healthcare.

Some of those who suffer health disparities are rural and urban low-income groups, African-Americans and Hispanic people.

The Correct answer is:

The new economic environment will not affect insurance premiums or the cost of healthcare

The new economic environment will affect premiums and healthcare costs.

Question 98

An example of a secondary prevention measure for a 55-year-old healthy and physically active female is which of the following?

yearly flu shot

recommending the use of bicycle helmets

educating her about skin cancer from sun exposure

doing a mammogram and Pap smear

Correct answer:

doing a mammogram and Pap smear

Secondary prevention measures include activities provided to identify and treat asymptomatic persons who might be at risk for a particular disease or condition. Doing a mammogram and Pap smear is a secondary prevention measure. All of the other choices are primary prevention measures.

Question 99

Which of the following treatments would be considered a long-term control medication for asthma sufferers?

Albuterol HFA

Xopenex

Accolate

Ventolin HFA

Correct answer:

Accolate

Accolate (zafirlukast) is a leukotriene receptor antagonist that is used for long-term control of asthma in adults and children 5 – 11 years old. The other choices are all quick-relief (rescue) medications.

Question 100

A 34-year-old female with multiple sclerosis (MS) is in the office. She is now under your care after relocating from another state to live with relatives who can help her. The nurse practitioner understands that which of the following is NOT part of her management plan:

Physical and occupational therapy.

Complex treatment regimen must be coordinated with a neurologist.

Acute exacerbations should be treated with prednisone 60-80 mg/day for 1 week, taper over 2-3 weeks.

Corticosteroids are often used for maintenance.

The Correct answer is:

Corticosteroids are often used for maintenance

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

test 4 ancc

Question 1

You are counseling a patient with a new diagnosis of GERD or gastroesophageal reflux disease. Which of the following is accurate nonpharmacologic management?

lying down and resting after meals and weight reduction.

weight reduction and sleep with the head of the bed elevated on blocks

avoid mint, orange juice, and milk

drink large amounts of fluids with meals and avoid alcohol

Correct answer:

Weight reduction and sleep with the head of the bed elevated on blocks

This is the accurate non-pharmacological management. One of the main education interventions is to advise the patient not to lie down within 3 hours after meals to avoid reflux. Large amounts of fluids encourage GERD, and alcohol, mint, and orange juice all relax the esophageal sphincter allowing reflux to occur.

Question 2

A patient has anosmia. What is this condition and which cranial nerve is involved?

cranial nerve I - inability to smell

cranial nerve II - inability to taste

cranial nerve III - inability to blink

cranial nerve IV - inability to hear

The Correct answer is:

Cranial nerve I - inability to smell

The cranial nerve I involves the olfactory nerve and it is rarely tested. However, cranial nerve lesions do occur. Anosmia would be a clinical manifestation of this.

Question 3

What type of headache is typically described as "pressing" in quality?

migraine headache

tension-type headache

cluster headache

simple stress headache

The Correct answer is:

Tension-type headache

Tension-type headache is pressing, nonpulsatile pain, mild to moderate in intensity and usually bilateral in location. Migraine headache is described as pulsating quality, usually unilateral, with associated nausea and photophobia. Cluster headache is often behind one eye, steady and intense. Simple stress headache is a fictitious term, which makes it an incorrect answer choice.

Question 4

You are counseling a young female patient who is trying to get pregnant. She wants to take a home pregnancy test and inquires about how early she can take this test and see predictable results. Your response is:

within 3 days after conception

within 5 days after conception

1-2 weeks after conception

35 days after the last menses

The Correct answer is:

1-2 weeks after conception

The office urine pregnancy tests and home pregnancy tests are the same and they detect the presence of the beta subunit of human chorionic gonadotropin (hCG). This is found in the highest quantities in first morning urine.

Question 5

A 28-year-old female patient is in the office and is to undergo radioactive iodine treatment for Graves' disease. The nurse practitioner is counseling her and understands that the mechanism of action of this treatment therapy is:

alter the thyroid metabolic rate

relieve distress caused by increased thyroid size

destroy the overactive thyroid tissue

reduce production of TSH

The Correct answer is:

Destroy the overactive thyroid tissue

Graves' disease is the most common form of thyrotoxicosis. Radioactive iodine is used for thyroid ablation to destroy the overactive thyroid tissue that causes the thyroid hormone dysfunction.

Question 6

Bronchiolitis is a common illness in early childhood. Treatment of bronchiolitis in children usually consists of treatment with:

supportive therapy

corticosteroids

ribavirin

bronchodilators

Correct answer:

supportive therapy

In most children, bronchiolitis runs a course of 2 to 3 weeks of mild upper respiratory symptoms. Supportive therapy is usually sufficient. The use of corticosteroids, ribavirin and bronchodilators remains controversial with little evidence of efficacy.

Question 7

The nurse practitioner knows that the influenza vaccination is recommended annually for certain high risk groups. Which of the following would have the GREATEST need for this vaccine?

dialysis patients

healthcare employees

adults with chronic disease

residents of long-term care facilities

The Correct answer is:

Residents of long-term care facilities

The outbreak of influenza may affect 60% of those in long-term care and the mortality rates related to this are high. All of the other groups are in need of the vaccine, but not the priority or greatest risk

Question 8

You are treating a 24-year-old man with infectious mononucleosis with tonsillar hypertrophy, exudative pharyngitis, difficulty swallowing, and a patent airway. You know that you should prescribe:

prednisone

acyclovir

amoxicillin

ibuprofen

The Correct answer is:

Prednisone

Infectious mononucleosis is an acute systemic viral illness usually caused by Epstein-Barr virus, a DNA herpes virus that typically enters the body via oropharyngeal secretions and infects B lymphocytes. Treatment includes a corticosteroid, such as prednisone 40 to 60 mg/day for 3 days.

Question 9

You are working in an urgent care clinic within a hospital emergency department. A patient without insurance arrives who has a puncture wound caused by an unknown sharp object in a trash container. A dirty needle is suspected. The nurse practitioner should:

administer a tetanus injection only since the patient has no insurance

prescribe appropriate mediations for HIV exposure even though the patient has no resources to buy them

not mention the possibility of HIV from a contaminated needle

offer to buy the HIV medications for the patient and use your employee discount at the pharmacy

The Correct answer is:

Prescribe appropriate mediations for HIV exposure even though the patient has no resources to buy them

The standard of patient care should be followed by the nurse practitioner. This measure should not be altered depending on the patient's insurance and financial status. It is unethical to not properly inform this patient of the risks involved for being exposed to a contaminated needle. You should prescribe the medications and refer them to social services or a community resource agency for assistance. Buying the medications for the patient with an employee discount is unethical and should not be done.

Question 10

Which of the following factors is least likely to put a woman at a higher for breast cancer?

first degree relative who had breast cancer

shorter exposure to estrogen (as in late menarche with early menopause)

obesity

high-dosed radiation

Correct answer:

shorter exposure to estrogen (as in late menarche with early menopause)

Mammography is a secondary prevention measure. It is recommended at age 40 and older. Women at higher risk for breast cancer include all of the choices except this one. Longer exposure to estrogen (as in early menarche with late menopause) puts a woman at higher risk.

Question 11

Multiple sclerosis (MS) is usually classified into different forms. The type of MS in which episodes resolve with good neurologic function between exacerbations would be which of the following?

RRMS

primary progressive MS

secondary progressive MS

none of the above

Correct answer:

RRMS

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

Question 12

A 20-year-old college student is in the clinic with complaints of weakness. She is 15% below ideal body weight. She reports doing well in her classes, drinking alcohol every night and coffee throughout the day. She is bradycardic and gets dizzy when she stands up. What other findings may be seen in this patient?

sleep apnea

amenorrhea

hypertension

mitral regurgitation

The Correct answer is:

Amenorrhea

This patient has anorexia nervosa and is far below ideal body weight. She exhibits evidence of poor nutrition and health. More than 90% of patients with anorexia are amenorrheic. Hypotension is more common than hypertension and many patients with anorexia also exhibit mitral valve prolapse, not regurgitation.

Question 13

The nurse practitioner may put her license in jeopardy if:

The practitioner delegates patient assessment tasks to a licensed practical nurse who is working in the clinic.

The practitioner provides care with the established standards of practice in this jurisdiction.

The practitioner appropriately delegates medication administration to a trusted registered nurse who administers a fatal dose.

A medical assistant in the office exceeds the scope of her authority and the nurse practitioner takes prompt action to correct the problem.

The Correct answer is:

If the nurse practitioner delegates patient assessment tasks to a licensed practical nurse who is working in the clinic

The licensed practical nurse should not be doing assessments. Assessments are presumed to be within the purview of the professional nurse, not those with fewer years of nursing education.

Question 14

Certain medications have a direct effect on urinary continence. Which of the following drugs would cause urinary retention as well as fecal impaction?

diuretics

opioids

alcohol

alpha-adrenergic antagonists

Correct answer:

opioids

Opioids will have the effect of urinary retention, overflow, alteration in sensorium and fecal impaction. Drugs with anticholinergic activity such as first generation antihistamines, tricyclic antidepressants and antipsychotics have the same effect.

Question 15

A 65-year-old woman has been diagnosed with terminal stomach cancer. She complains to the nurse that her family keeps telling her to fight and not give up. She gets angry every time that they refuse to acknowledge the prognosis. What is the best thing that the FNP could say to her?

Your family loves you. You can’t expect them to accept a terminal diagnosis.

You shouldn’t be angry with them. They don’t know any better.

Would you like me to talk to them so that they understand how you feel?

You’re angry because your family won’t acknowledge your prognosis?

Correct answer:

You’re angry because your family won’t acknowledge your prognosis?

This is the best response. It restates what the client has said to ensure understanding. This is part of therapeutic communication.

Question 16

At what stage of pregnancy is the uterine fundus at the level of the umbilicus?

8 weeks

12 weeks

16 weeks

20 weeks

Correct answer:

20 weeks

At 20 weeks (5 months) of pregnancy the uterine fundus is at the level of the umbilicus. Also the fetal heart tones are heard with a fetoscope or stethoscope.

Question 17

Which of the following statements about prostate cancer detection is incorrect?

Men at high risk for prostate cancer should begin testing at age 45.

The American Cancer Society recommends routine testing for prostate cancer.

Discussion with a clinician about prostate cancer screening should include an offer for testing with the PSA test.

African-American men are at high-risk for prostate cancer and should begin testing at age 45.

Correct answer:

The American Cancer Society recommends routine testing for prostate cancer.

At this time the American Cancer Society does not recommend routine testing for prostate cancer. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment.

Question 18

The following are true regarding the pathogenesis of adult abuse and neglect EXCEPT:

The etiology is unclear, but there are a number of recurrent theories emerging.

Financial conditions appear to play a role in the occurrence of abuse.

Very few incidences of abuse to elderly and disabled persons occur.

Alcoholism and drug dependency in a caregiver enhance the likelihood of abuse.

The Correct answer is:

Very few incidences of abuse to elderly and disabled persons occur

It is estimated that almost 2 million older adults and disabled persons are abused annually. The victim is usually a woman and the perpetrator is most often the spouse or an adult child. The remaining answer choices are true regarding abuse.

Question 19

The FNP sees a patient who has recently completed antibiotic treatment with sulfa drugs. He presents with severe vesicular lesions all over his body. There is mucosal involvement with blisters on his mouth and nose. What should the FNP suspect with this history and these symptoms?

Stevens-Johnson syndrome

shingles

meningococcemia

erythema multiforme

Correct answer:

Stevens-Johnson syndrome

Stevens-Johnson syndrome is the acute onset of severe vesicular to bullous lesions all over the body. They range from hives to blisters and hemorrhagic lesions. There is also mucosal involvement with blisters. A history of recent antibiotic treatment with sulfas, penicillins, phentoin and other drugs can precede the onset. Erythema multiforme is a milder form of Stevens-Johnson syndrome with no mucosal involvement.

Question 20

In terms of the gastrointestinal system which of the following statements about ulcers is false?

Duodenal ulcers are five times more prevalent than gastric ulcers.

Chronic NSAID use can result in ulcers.

Abdominal exam of a person with an ulcer will reveal normal or mildly tender epigastric area during flare-ups.

Gastric ulcers have a lower risk for malignancy compared to duodenal ulcers which are often malignant.

Correct answer:

Gastric ulcers have a lower risk for malignancy compared to duodenal ulcers which are often malignant.

This statement is false. Gastric ulcers have a higher risk for malignancy compared to duodenal ulcers which are mostly benign. Duodenal ulcers are seen more in the elderly population.

Question 21

In terms of malpractice insurance, which of the following statements is correct?

NPs should choose a company that is located in the USA and has a stable financial rating.

Individual insurance policies are necessary if an NP works outside of the work setting.

Under a “claims made” policy, an NP is covered only when the insurance policy is active, no matter when the incident occurred.

All of the above are correct.

Correct answer:

All of the above are correct.

All of the choices are correct statements in terms of malpractice insurance. Also, “occurrence” insurance covers any incident that occurred while the NP was insured.

Question 22

When counseling the mother of a toddler on lead toxicity and poisoning, what should the nurse practitioner understand that is most likely to lead to this condition?

If the toddler lives near an electric generating plant, he or she is at risk.

If the toddler is developmentally disabled, he or she is at risk.

If the toddler lives in a 15-year old home with copper plumbing, he or she is at risk.

If the toddler lives in a 100-year old home that is being remodeled, he or she is at risk.

The Correct answer is:

If the toddler lives in a 100-year old home that is being remodeled, he or she is at risk

The toddler is at risk if he or she is exposed to lead-based paint. This paint has not been available in the United States in 30 years. Also, copper pipes are not a risk to the toddler as lead-lined pipes are. A toddler living near a lead factory would be at risk, not one living near a electric generating plant. A developmental disability does not increase lead toxicity risk.

Question 23

You are educating a patient with Type II diabetes mellitus. The nurse practitioner understands that secondary causes of hyperglycemia include the use of all of the following medications EXCEPT:

niacin

thiazide diuretics

angiotensin receptor blockers

corticosteroids

The Correct answer is:

Angiotensin receptor blockers

Angiotensin receptor blockers are recommended for use in individuals with concomitant type II diabetes and hypertension. They do not affect glucose levels. The remaining answer choices are all medications that can cause elevated glucose levels and should be avoided with a diabetic patient.

Question 24

Which of the following statements about tuberculosis is incorrect?

Tuberculosis occurs only in the lungs.

Transmission of tuberculosis is by respiratory droplets.

The majority of cases in the United States are reactivated infections.

A TB infection is controlled by an intact immune system.

Correct answer:

Tuberculosis occurs only in the lungs.

This statement is incorrect. The most common site of infection is the lungs (85%), but infection can also occur in the kidneys, brain, lymph nodes, adrenals, bone and more.

Question 25

In general, family theory serves as a basis for assessing and coming to understand the structure, development and function of families through the process of family assessment. There are several family theories including the communication theory. Which of the following is NOT a part of the communication theory?

The content of messages is time-bound and must be appreciated within context.

Families share common developmental processes with other families.

Lack of clarity in communication may lead to family dysfunction.

Communication conveys values and beliefs between members and the external environment.

Correct answer:

Families share common developmental processes with other families.

Although this statement is true, it is not a part of the communication theory. It is a part of the developmental theory promoted by Erikson, Piaget and Havinghurst.

Question 26

A patient is in the office with keratosis pilaris. The nurse practitioner knows that all of the following are ways to manage this EXCEPT:

The use products containing alpha hydroxy acids on the affected areas.

Lactic acid 12% to control this condition.

Continued use of lubricants to the affected areas as needed.

Avoiding moisturizing soaps, which worsen this condition

The Correct answer is to:

Avoiding moisturizing soaps, which worsen this condition

The use of moisturizing soaps, and not avoiding them, are recommended for the treatment of keratosis pilaris. The remaining answer choices are all adequate management techniques.

Question 27

The nurse practitioner must use critical thinking and decision-making in her practice. The following statements are true regarding this EXCEPT:

Critical thinking cannot be learned, but is a skill of intelligence.

Critical thinking involves acquisition of knowledge with an attitude of deliberate inquiry.

Decision-making involves making decisions based on an understanding of the different options, and the possible desirability of the outcomes of each option.

Pattern recognition and common-sense understanding are important aspects that influence decision-making.

The Correct answer is:

Critical thinking cannot be learned, but is a skill of intelligence

Part of critical thinking may be innate, but most people can be taught to think critically. Therefore, this statement is not accurate.

Question 28

You are treating a 32-year-old female who is in the office with varicose veins. As part of her management, the nurse practitioner understands that which of the following does not directly contribute to the development of varicose veins?

pregnancy

heredity

leg crossing

Raynaud's disease

The Correct answer is:

Raynaud's disease

Varicose veins are seen in 15% of the adult population and are most often found in the lower extremities. Raynaud's disease is not connected to varicosities. However, pregnancy, heredity and leg crossing are associated with this condition.

Question 29

The most common joint disease in North America is which of the following?

osteoarthritis

bursitis

rheumatoid arthritis

meniscal tear

Correct answer:

osteoarthritis

Osteoarthritis is the most common joint disease in North America. It is a degenerative condition that manifests without systemic manifestations or acute inflammation. The most problematic joint involvement is in the hip and knee.

Question 30

The FNP has a 67-year-old male patient with type 2 diabetes. In managing this patient’s care which of the following lab tests should be done every 3 – 6 months?

thyroid assessment

urine microalbumin/creatinine

serum creatinine

A1c

Correct answer:

A1c

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

Question 31

A law enacted by a state legislature or Congress is known as which of the following?

regulation

policy

statute

standard

Correct answer:

statute

A statute is a law enacted by a state legislature or Congress. A regulation is law written by a state or federal agency in accordance with a statute. A policy is a rule made by companies or government agencies, that does not have the force of law but that dictates day-to-day decisions. A standard is a rule or a principle used as a basis for judgment.

Question 32

Which of the following concepts is NOT a part of the legal theory of negligence?

failure to stop to help victims of an auto accident

failure to follow up

failure to refer when necessary

failure to disclose necessary information to a patient

Correct answer:

failure to stop to help victims of an auto accident

This is not a part of the legal theory of negligence. Negligence involves a duty of care. A duty is established when there is a provider-patient relationship. There is no legal obligation for an NP to stop at the scene of an accident to help victims. However, if the NP does stop and help, then negligence can come into play.

Question 33

While doing a 12-month well-child examination, the mother has some questions regarding her child's development. The nurse practitioner knows that for this age all of the following are expected EXCEPT:

plays social games like peek-a-boo

pulls to a stand

waves bye-bye

The child has at least a 25 word vocabulary

The Correct answer is:

The child has at least a 25 word vocabulary

The 12-month-old does not have an advanced vocabulary. A 12-month-old usually speaks 1-5 words, including "mama" and "dada".

Question 34

There are certain fundamental domains in human growth and development. Temperament and personality would fall into which domain?

psychological and social domain

cognitive domain

physical domain

maturational domain

Correct answer:

psychological and social domain

Temperament and personality are processes of human development that are part of the psychological and social domain. Other processes in the psychological and social domain include: interpersonal relationships; moral development; and home environment and other social contexts.

Question 35

Your 72-year old male patient has many signs and symptoms that are worrisome. You suspect bladder cancer. What sign or symptoms are most common with this disease process?

gross painless hematuria

fever, worse at night

microscopic proteinuria

nausea and vomiting

The Correct answer is:

Hematuria

Bladder cancer is the second most common urologic malignancy in men, after prostrate cancer. It is usually a disease that occurs later in life. Gross painless hematuria is the most common presenting sign of bladder cancer. An abdominal mass may be palpable in advanced disease. Fever, proteinuria, nausea, and vomiting are not indicators of this disease.

Question 36

You are treating a 39-year-old female with an anal fissure. The nurse practitioner knows that all of the following are true regarding the management of this except:

A stool softener is necessary to prevent stool withholding.

Topical anesthetics are good for comfort measures.

Hydrocortisone cream should be prescribed bid to tid.

There is no need for topical antibiotic ointment.

The Correct answer is:

There is no need for topical antibiotic ointment

A stool softener, topical anesthetics and hydrocortisone cream are used to treat an anal fissure. Additional treatment options for an anal fissure may include the use of botulinum toxin, nitroglycerin therapy and topical antibiotic ointment.

Question 37

A 35-year-old male is in the clinic after receiving blunt trauma to the chest. He reports that a large piece of wood hit him in the chest. Which assessment finding would indicate that he may have respiratory complications?

He has an oximetry reading of about 97% consistently.

He has a fever of 102°F and increased sputum production.

He complains of increased pain over the affected area.

He has decreased breath sounds on the affected side.

Correct answer:

He has decreased breath sounds on the affected side

These symptoms are indicative of a pneumothorax, the most common respiratory complication after a traumatic injury to the chest. Increased pain at the injury site is expected.

Question 38

The FNP is treating a patient with recurring severe migraine headaches that progress rapidly and are accompanied by significant GI upset. This patient also has coronary artery disease. For relief of these headaches the FNP would first prescribe a(n):

oral product

injectable product

triptan

ergotamine

Correct answer:

oral product

Although injectable products like Imitrex and Migranal have a rapid onset of action, and are best suited for patients with rapidly progressing migraines accompanied by significant GI upset, they are generally contraindicated in patients with coronary artery disease and should only be used with great caution and under close supervision. Triptan and ergotamine are not recommended for patients with coronary artery disease.

Question 39

When should an infant be able to lift his head and hold his head erect?

1 – 2 months

3 - 4 months

5 - 6 months

6 - 8 months

Correct answer:

1 – 2 months

At 1 – 2 months an infant should be able to lift his head and hold it erect. He should also be regarding faces, following objects through a visual field, smiling spontaneously and recognizing his parents.

Question 40

Professional Standards of Practice exist in the nurse practitioner's workplace. Which of the following best describes these Standards of Practice?

They focus on the maximum levels of performance.

They are not necessary to legally describe standard of care, but necessary for licensure.

They are authoritative statements by which the quality of practice, service, or education can be judged.

The standards are exact for all levels of nursing.

The Correct answer is:

They are authoritative statements by which the quality of practice, service, or education can be judged

Standards of Practice focus on the minimum levels of acceptable performance as a way of providing consumers with a means of measuring the quality of care they receive. They may be generic and general, as well as precise and specific. They are used to legally describe the standard of care that must be met by a provider.

Question 41

The FNP has a patient who she suspects has macular degeneration. The FNP may use which of the following tests to check the central vision of the patient?

Snellen chart

Amsler grid

amplitude of accommodation

slit lamp examination

Correct answer:

Amsler grid

Macular degeneration is a gradual change in the pigment in the macula (area of central vision) resulting in blindness. The FNP will check central vision with the Amsler Grid test. If macular degeneration is present, the lines in the center of the grid are distorted.

Question 42

All of the following are recommended pediatric screening EXCEPT:

hearing screening

anemia screening

metabolic screening

glucose screening

The Correct answer is:

Glucose screening

While type II diabetes mellitus in children is on the rise, the Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) does not recommend periodic glucose screening in children. However, the nurse practitioner can further evaluate a child who exhibits symptoms of diabetes mellitus. Also, the urinalysis, which is part of the routine pediatric screening, detects evaluated glucose levels. The remaining answer choices are routine types of screenings for the pediatric population, along with screening of neonatal, genetic, lead, cholesterol and lipid, tuberculin, vision and blood pressure.

Question 43

When counseling a patient with the human herpes virus 2 (HHV-2), the nurse practitioner knows that what percentage of sexually active adults has serological evidence of this disease?

5%

10%

15%

25%

The Correct answer is:

25%

The human herpes virus 2 (HHV-2) causes painful ulcerated lesions and lymphadenopathy. Approximately 25% of adults who are sexually active have serological evidence of this disease, although only a small percentage of these persons have symptoms.

Question 44

In assessing the vision of a toddler which of the following tests might be done?

Snellen test

determine ability to follow an object

Jaeger test

blink reflex

Correct answer:

determine ability to follow an object

The FNP should determine the toddler’s ability to follow an object as part of a vision screening for a toddler or older infant. The FNP might also perform a corneal light reflex test, perform a cover/uncover test and assess red reflex.

Question 45

A 16-year-old male patient presents in the clinic with abdominal pain, worse with ambulation, nausea, and fever. Next, the nurse practitioner would test the obturator and iliopsoas muscle to evaluate for which of the following?

cholecystitis

acute appendicitis

inguinal hernia

gastric ulcer

The Correct answer is:

Acute appendicitis

Acute appendicitis is common in this age group and the symptoms are indicative of the condition. The obturator and iliopsoas muscles are sensitive when the appendix is diseased.

Question 46

Systematically developed statements to assist practitioner and patient about appropriate care for specific clinical outcomes are termed:

clinical practice guidelines or protocols

standards of practice

scope of practice

advanced practice

Correct answer:

clinical practice guidelines or protocols

Systematically developed statements to assist practitioner and patient about appropriate care for specific clinical outcomes are termed clinical practice guidelines or protocols. They are variable requirements depending on individual state nurse practice acts and standards of practice.

Question 47

Treatment options for adult seizure patients include al of the following medications EXCEPT:

gabapentin

phenytoin

carbamazepine

aminophylline

The Correct answer is:

Aminophylline

Numerous standard seizure therapies exist including gabapentin, phenytoin, carbamazepine, ethosuximide, lamotrigine, topiramate, valproic acid and clonazepam. However, aminophylline is not used to treat seizures.

Question 48

Maslow's Hierarchy of Needs includes all of the following EXCEPT:

Narcissistic needs

Safety and security

Self-esteem

Self-actualization

The Correct answer is:

Narcissistic needs

Abraham H. Maslow created a hierarchy that identified the basic needs a human requires for survival. The hierarchy levels include physiological needs, safety needs, love and belonging needs, esteem or self-esteem needs and self-actualization needs. The physiological needs are the basic elements a human requires to survive, such as food, shelter and water. Then, safety needs focuses on security. Love and belonging needs addresses an individual’s desire for relationships with other people and a need for acceptance by others. Then, esteem needs focuses on self-esteem and an individual’s view of other people. Self-actualization deals with an individual recognizing and achieving his or her potential.

Question 49

Which of the following is NOT a managed care plan?

Health Maintenance Organization

Preferred Provider Organization

Physician Group

Point of Service Plan

Correct answer:

Physician Group

A Physician Group is not a managed care plan. It is defined as two or more physicians legally organized as a partnership, professional corporation, foundation, not-for-profit-corporation, faculty practice plan, or similar association. All of the other choices are tpes of managed care plans.

Question 50

Any condition or substance such as hyperthyroidism or caffeine that irritates or overstimulates the heart can cause which of the following conditions?

hypertension

atrial fibrillation

PVD

DVT

Correct answer:

atrial fibrillation

Atrial fibrillation is caused by any condition or substance that irritates or overstimulates the heart. Examples are hyperthyroidism, cocaine, caffeine, or alcohol.

Question 51

Which of the following statements about Medicare Part B is incorrect?

It covers all medically necessary services.

It is financed by general federal revenues and by Part B monthly premiums.

It covers 80% of the approved amount after the annual deductible.

Services covered include hospitalization costs.

Correct answer:

Services covered include hospitalization costs.

This is incorrect. Hospital costs are covered in Medicare Part A. Payment for hospitalization is based on projected costs of caring for a patient with a given problem

Question 52

The nurse practitioner has examined a patient who has suffered a bite wound on the chest region from her boyfriend during an assault. There were numerous lacerations to the patient's forearms as well. The clinician sutured the lacerations even though this was contraindicated due to the highly infectious nature of human bite wounds. The patient did not suffer ill effects or complications from this. How can this be described?

This is malpractice.

This is a deviation from standard of care that is appropriate.

This is negligence as well as poor judgment.

This is only poor judgment.

The Correct answer is:

This is negligence as well as poor judgment

This is not malpractice since no ill effects were sustained. This is, however, negligence and poor judgment. Negligence occurs when one fails to exercise care that a reasonable person would exercise and injury does not have to occur with negligence. Human bites have a high probability of infection and should not be sutured.

Question 53

According to the Trans-theoretical Model of Change, the stages are:

precontemplation, contemplation, preparation, action, maintenance, and termination

survival needs, safety and security, love and belonging, self-esteem, and self-actualization

primary, secondary, and tertiary

none of the above

The Correct answer is:

Precontemplation, contemplation, preparation, action, maintenance and termination

Prochaska and DiClemente (1984) proposed these six terms, precontemplation, contemplation, preparation, action, maintenance and termination, as the six predictable stages of change. Survival needs, safety and security, love and belonging, self-esteem, and self-actualization are the stages of Maslow's hierarchy of needs, proposed in 1954.

Question 54

Which of the following conditions/diseases is a contraindication to bariatric surgery for overweight patients?

untreated or unstable mental health conditions

gastroesophageal reflux

degenerative joint disease

fatty liver

Correct answer:

untreated or unstable mental health conditions

Contraindications to bariatric surgery include untreated or unstable mental health conditions, active drug or alcohol abuse, poor adherence to advised health regimens and concomitant health conditions that would pose significant operative risk. The other choices are reasons why bariatric surgery might be recommended for obese persons.

Question 55

A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for Type II diabetes mellitus. What should be done to manage him FIRST?

Start insulin

Start metformin plus pioglitazone

Have him return tomorrow to recheck his blood glucose

Start metformin

The Correct answer is:

Start insulin

The patient can be diagnosed with diabetes if his glucose exceeds 200 mg/dL and he is symptomatic. Most oral agents will have little effect on his glucose and it should be lowered immediately. Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a chance to work. He should return to the clinic the next day for a recheck of the blood glucose and medication adjustment.

Question 56

The nurse practitioner recognizes tobacco use and abuse as a major public health concern. All of the following are true concerning smoking cessation EXCEPT:

Combination therapy with education, support, medications, and nicotine replacement is more effective than one method alone.

Nicotine replacement therapy and bupropion double the probability of success.

Smoking cessation therapies such as acupuncture and hypnosis are recommended.

Cessation without pharmacologic interventions should be attempted first.

The Correct answer is:

Smoking cessation therapies such as acupuncture and hypnosis are recommended

Alternative therapies do not have the clinical evidence-based research data to be recommended at this time.

Question 57

Which of the following exercise regimens would you prescribe for a person with osteoarthritis of the knee?

isometric exercise of iliopsoas

quadriceps sets

isometric exercise of the gluteus muscles

stretching exercises of adductors, rotator and gluteus muscles

Correct answer:

quadriceps sets

This is the only exercise regimen of the choices given that would help a person with osteoarthritis of the knee. The other choices are all exercise regimens for osteoarthritis of the hip.

Question 58

Nursing theory is of two types: nursing grand theories and middle range nursing theories. Which of the following persons promoted the nursing grand theory of enhancing the body’s reparative processes by manipulation of noise, nutrition, hygiene, light, comfort and hope?

Nightingale

Benner and Wrubel

Orem

King

Correct answer:

Nightingale

Nursing grand theories are abstract, connect and relate the concepts of person, environment, nursing and health. Nightingale’s concept was that of enhancing the body’s reparative processes by manipulation of noise, nutrition, hygiene, light, comfort and hope.

Question 59

The FNP is treating a patient with primary open angle glaucoma (POAG). Which of the following medications is the FNP least likely to use to treat this patient?

pilocarpine

timolol

dorzolamide

latanoprost

Correct answer:

pilocarpine

Pilocarpine is the least likely medication to be used to treat POAG. Because of its ability to cause pupillary constriction, pilocarpine and similar medications are now seldom used.

Question 60

A 70-year-old male comes to the FNP with a raised, red lesion in his oral cavity. He tells the FNP that he is afraid that it is cancer. Besides evaluating the lesion the FNP evaluates the man’s risk for oral cancer. These risks include all of the following EXCEPT:

poor diet

alcohol abuse

tobacco abuse

advanced age

Correct answer:

poor diet

Poor diet is not a risk factor for oral cancer. Alcohol and tobacco use and advanced age are risks.

Question 61

Which of the following classic developmental theorists saw the child as an “untamed savage”?

Charles Darwin

Jacque Rousseau

Arnold Gesell

Alfred Binet

Correct answer:

Jacque Rousseau

Jacque Rousseau saw the child as an “untamed savage.” He wrote Emile – Treatise on Education which served as the inspiration for what became a new national system of education during the French Revolution.

Question 62

According to the American Diabetes Association, adults, beginning at age 45, should be tested for fasting plasma glucose every:

3 years

2 years

1 year

none of the above

Correct answer:

3 years

The American Diabetes Association recommends screening adults, beginning at age 45, for diabetes by testing the fasting plasma glucose every 3 years. There are 79 million people in the United States who have prediabetes. Screening can identify these people so providers can take action before type 2 diabetes develops

Question 63

Patients have a right to confidentiality and privacy. Which of the following statements about breach of privacy is incorrect?

Breach of privacy is not an intentional tort.

Breach of privacy can be the basis for a lawsuit by a patient.

Breach of privacy can be malpractice.

Breach of privacy can be a violation of both state and federal law.

Correct answer:

Breach of privacy is not an intentional tort.

This statement is incorrect. Breach of privacy is an intentional tort and so, can be the basis of a lawsuit by a patient. Breach of privacy can also be malpractice, the basis for a disciplinary action by a state’s board of nursing and a violation of state and federal law.

Question 64

In terms of patient confidentiality, which of the following statements is incorrect?

Healthcare providers must not discuss any information given to them during the healthcare encounter with anyone not directly involved in providing this care without the patient’s or family’s permission.

Confidentiality of the healthcare encounter is protected under HIPAA.

The individual’s right to privacy does not apply to requests for a patient’s medical records.

Exceptions to guaranteed confidentiality occur when society determines that the need for information outweighs the principle of confidentiality.

Correct answer:

The individual’s right to privacy does not apply to requests for a patient’s medical records.

This is incorrect. The individual’s right to privacy is respected when requesting or responding to a request for a patient’s medical record.

Question 65

The theoretical concept that sets forth the idea that the person who feels susceptible to disease and believes that he will benefit from changing his behavior is more likely to perform the healthier behavior is which of the following?

Health Belief Model

Family Systems Theory

Systems Theory

Self-Efficacy Theory

er:

Health Belief Model

The Health Belief Model sets forth the idea that the person who feels susceptible to disease and believes that he will benefit from changing his behavior is more likely to perform the healthier behavior. It was first developed by social scientists in the 1950s.

Question 66

The average U.S. female gains how about much weight and height between the ages of 10 and 14 years?

38 pounds and 9.5 inches

42 pounds and 9.5 inches

32 pounds and 8.5 inches

35 pounds and 9 inches

Correct answer:

38 pounds and 9.5 inches

The average U.S. female gains about 38 pounds and 9.5 inches between the ages of 10 and 14. The average U.S. male gains about 42 pounds and 9.5 inches between the ages of 12 and 16.

Question 67

Which of the following physiological changes would NOT be seen during pregnancy?

Plasma volume will increase 50% by the end of the third trimester.

Hemoglobin and hematocrit are decreased.

Cardiac output decreases by 1/3 by the last two trimesters.

The thyroid becomes diffusely enlarged by up to 15%.

Correct answer:

Cardiac output decreases by 1/3 by the last two trimesters.

This is not a physiological change seen during pregnancy. In actuality, cardiac output increases by 1/3 by the last two trimesters.

Question 68

Most of the drugs used in pregnancy are Category B drugs. The FNP has a patient in the third trimester of pregnancy. Which of the following drugs is a category C drug that should not be prescribed for this patient?

insulin

Colace

Sulfa drugs

thyroid hormone

Correct answer:

Sulfa drugs

Sulfa drugs are considered Category C drugs in the third trimester because of increased risk of hyperbilirubinemia. NSAIDs are also contraindicated in the third trimester because they block prostaglandins.

Question 69

You are counseling a 23-year-old with an abnormal pap smear. It is important you discuss the risks of cervical cancer. Which of the following is NOT a risk factor for cervical cancer?

virginal status

previous high-grade squamous intraepithelial lesion

human papillomavirus

multiple sexual partners

The correct answer is:

Virginal status

A female who has not had sexual intercourse is not at risk for developing cervical cancer. However, the remaining answer choices are risk factors for cervical cancer.

Question 70

Which of the following gout medications is used for maintenance?

Indocin

Zyloprim

Anaprox

colchicine

Correct answer:

Zyloprim

Zyloprim (allopurinol) is a maintenance medication for gout sufferers. Maintenance drugs are prescribed to be used at least 4 to 6 weeks after the acute phase is over. They may be used daily for years to lifetime

Question 71

The following are all accurate statements regarding The National Practitioner Data Bank (NPDB) with the exception of:

The number of NPs who have had a malpractice claim filed against them is decreasing and therefore, they are not in the NPDB.

Currently, very few NPs are listed in the NPDB.

The Health Care Quality Improvement Act of 1986 established the NPDB.

The purpose of the NPDB is to scrutinize members of the healthcare profession and list those practitioners who have had a malpractice claim against them.

The correct answer is the number of NPs who have had a malpractice claim filed against them is decreasing and therefore, they are not in the NPDB. The number of NPs who have had claims against them is increasing as the number of NPs in practice increases.

Question 72

Which of the following identifies six types of conduct that are considered felonies and may result in fines of up to $25,000 and/or up to 5 years in prison?

The Federal False Claims Act

Stark I Federal Law

The Medicare and Medicaid Patient Protection Act

The Anti-Kickback statute

The Correct answer is:

The Medicare and Medicaid Patient Protection Act

The Medicare and Medicaid Patient Protection Act was enacted in 1987 and prohibits the billing for services that were not provided. Further, this act prohibits other false statements with regard to billing.

Question 73

Nurse practitioner education is continuous and ongoing. Which of the following statement is NOT accurate regarding a nurse practitioner's education?

Nurse practitioner programs are evaluated by the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN).

The AACN has developed a practice doctorate in nursing.

The National Organization of Nurse Practitioner Faculties regards the practice doctorate of nursing as an important evolutionary step for the preparation of nurse practitioners.

The criteria set by the National Organization of Nurse Practitioner Faculties and American Association of Colleges of Nursing establishes a basis for evaluating medical programs as well as practitioner programs.

The Correct answer is:

The criteria set by the National Organization of Nurse Practitioner Faculties and American Association of Colleges of Nursing establishes a basis for evaluating medical programs as well as practitioner programs

The criteria set by the National Organization of Nurse Practitioner Faculties and American Association of Colleges of Nursing are only established to evaluate nurse practitioner programs. The organizations do not establish criteria for the evaluation of medical programs.

Question 74

You are evaluating a 32-year-old sexually active man in the clinic. You suspect he has a urethral infection due to urethral discharge and complaints of dysuria. When you obtain testing, you find gram-negative cocci. The nurse practitioner knows that this gram-negative cocci is more specifically identified as:

N. gonorrhoeae

E. coli

Staphylococcus aureus

U. genitalium

The Correct answer is:

N. gonorrhoeae

Gonorrhea, caused by the gram-negative diplococcus N. gonorrhoeae, is one of the most common sexually transmitted diseases. This pathogen has a short incubation period, 1 to 5 days. Also, this pathogen is likely to cause infection in 20-30% of men who come in contact with an infected female partner and up to 80% of men who have sex with a male partner

Question 75

In terms of having a laboratory, the NP’s practice must:

get approval by the state

get approval by the federal government

comply with the State Laboratory Administration and the CLIA requirements

all of the above

Correct answer:

all of the above

The laboratory must obtain and fill out the necessary paperwork needed to comply with state (State Laboratory Administration) and federal (CLIA) requirements. This is done to get the approval of the state and federal government for the laboratory.

Question 76

You are managing a patient who has irritable bowel syndrome (IBS). Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of:

amitriptyline (Elavil)

loperamide (Imodium)

dicyclomine (Bentyl)

Metronidazole (Flagyl)

The Correct answer is:

Amitriptyline (Elavil)

A low dose tricyclic antidepressant or a selective serotonin reuptake inhibitor can be helpful in altering the gut pain threshold, resulting in less abdominal pain. Imodium and Bentyl are prescribed to treat diarrhea. Flagyl is not used as treatment for irritable bowel syndrome, but is used to treat certain types of infectious colitis.

Question 77

The part of the joint anatomy that acts as padding and is filled with synovial fluid is which of the following?

articular cartilage

bursae

ligaments

synovial space

Correct answer:

bursae

The bursae are present on the anterior and posterior areas of a joint. They act as padding and are filled with synovial fluid.

Question 78

To eliminate or support the diagnosis of meningitis, lumbar puncture with CSF evaluation is necessary. In a person who has bacterial meningitis, the FNP might find all of the following EXCEPT:

pleocytosis

elevated CSF opening pressure

increased CSF glucose amount below the normal level of about 40% of the plasma level

elevated CSF protein level

Correct answer:

increased CSF glucose amount below the normal level of about 40% of the plasma level

This is not a typical finding for bacterial meningitis. Evaluation of CSF would show reduced CSF glucose amount below the normal level of about 40% of the plasma level.

Question 79

The theory of development that sets forth a hierarchy of needs for healthy, creative individuals was put forth by which of the following?

Abraham Maslow

Carl Rogers

Carol Gilligan

L.S. Vygotsky

Correct answer:

Abraham Maslow

Abraham Maslow put forth a theory of basic needs and human potential derived from study of healthy, creative individuals. These needs include: physiologic; safety, security and stability; affiliation, acceptance and love; ego, self-worth, confidence, competence and success; and self-actualization.

Question 80

Which of the following types of headache has a higher risk of suicide in males?

cluster headaches

migraine headaches

muscle tension headaches

temporal arteritis

Correct answer:

cluster headache

A cluster headache is a sudden onset of severe “ice-pick” headaches behind one eye that occurs several times a day. The attacks happen at the same times daily and the cause is unknown. There is a higher risk of suicide in males who have this type of headache as compared with the other types of chronic headaches.

Question 81

In terms of risk management, which of the following would NOT be a high-risk patient?

a 45-year-old disabled male with multi-system failure

a low-functioning 23-year-old female with Down syndrome

a 65-year-old female who takes two drugs for hypertension

a 19-year-old cocaine addict

Correct answer:

a 65-year-old female who takes two drugs for hypertension

Certain patient characteristics should alert the FNP to be aware of risk management strategies. High-risk patients include those with the following characteristics: multisystem failure, low intelligence, polypharmacy, noncompliant behavior, positive review of systems, substance abuse and litigiousness. A 65-year old female who takes only two drugs would not be considered high risk.

Question 82

Which of the following is not true in regard to a durable power of attorney for health care?

It is limited to the circumstances of terminal illness.

It is legally binding.

It is often accompanied by a power of attorney over financial issues as well.

It is flexible enough to carry out the patient’s wishes throughout the course of an illness.

Correct answer:

It is limited to the circumstances of terminal illness.

This is not true. A durable power of attorney for health care is not limited to the circumstances of terminal illness. A living will is an advance directive concerning terminal illness only.

Question 83

In regards to hypothyroidism, the nurse practitioner knows that periodic monitoring for this condition is indicated in the presence of which of the following conditions?

Down syndrome

male gender

alcoholism

antihypertensive use

The Correct answer is:

Down syndrome

Thyroid disease exists in less than 7% of the population but is seen commonly in patients with Down syndrome. Other risk factors associated with this condition include advancing age, use of certain medications that alter thyroid hormone synthesis, female gender, postpartum, strong family history of autoimmune diseases, and history of radiation or surgery to the head and neck.

Question 84

When assessing for an urinary tract infection in a geriatric patient, it is important for the nurse practitioner to know:

There is always a fever present.

It is an uncommon finding in catheterized patients.

Elderly people may or may not demonstrate symptoms other than mental status change with this type of infection.

Dysfunctional voiding pattern or infrequent voiding are not contributing factors to the development of a urinary tract infection.

The Correct answer is:

Elderly people may or may not demonstrate symptoms other than mental status change with this type of infection

Geriatric patients with a urinary tract infection usually do not have a fever. It is common in patients with catheters and dysfunctional voiding pattern and infrequent voiding are contributing factors in the development of a urinary tract infection.

Question 85

What is the name of the agreement between a physician and a nurse practitioner (NP) outlining the NPs role and responsibility to the clinical practice?

a clinical guideline

a collaborative agreement

a standard of practice contract

a consultation contract

The Correct answer is:

A collaborative agreement

A collaborative agreement must be signed by both the nurse practitioner and the physician who supervises him or her and is usually submitted to the board of nursing. Agreements must be reviewed periodically. Criteria on how the collaborative agreement should be written are provided by each state's board.

Question 86

The FNP has a 45-year-old male patient who is disabled due to a work-related injury. He has become withdrawn, does little else than nap and watch television all day. Which of Erikson’s developmental stages is this patient not meeting?

trust vs. mistrust

generativity vs. stagnation

initiative vs. guilt

industry vs. inferiority

Correct answer:

generativity vs. stagnation

The central task of middle age (40 to 65 years) is “generativity vs. stagnation.” The primary developmental task is one of contributing to society and helping to guide future generations. This patient has signs of not meeting this stage of development.

Question 87

Which of the following statements are NOT true concerning entries in the medical record?

Maintaining a complete medical record is important to comply with licensing and accreditation requirements.

Medical record entries should be made in clear and concise language that can be understood by healthcare professionals who treat the patient.

Allegations of improper care can always be defended without documentation in a medical record if staff witnessed the care.

Maintaining a complete medical record enables the healthcare provider to establish that a patient has received adequate care.

The Correct answer is:

Allegations of improper care can always be defended without documentation in a medical record if staff witnessed the care

Some courts have dismissed claims involving incomplete records. However, some cases have been decided without documentation of the allegation in the medical record.

Question 88

At which stage of development would a child engage in parallel play?

school age

infant

preschool

toddler

Correct answer:

toddler

Parallel play is a common occurrence in the toddler years. When interacting with other toddlers, the child engages in similar play activity but with minimal interaction.

Question 89

In terms of hazardous waste, which of the following statements is incorrect?

Red plastic containers specially made for sharp instruments and needles are required by law.

Diapers and bloody materials are deposited in red bags in trash cans.

Clinics may dispose of their own hazardous waste.

Personnel who pick up the hazardous waste must be certified in that area.

Correct answer:

Clinics may dispose of their own hazardous waste.

This statement is incorrect. Personnel who pick up the hazardous waste must be certified in that area; a staff person cannot do the job. Therefore, clinics must hire waste disposal services.

Question 90

You are treating a patient with the diagnosis of bulimia nervosa. The nurse practitioner understands that the following is most consistent with this diagnosis:

Patients with bulimia nervosa develop hyperkalemia from laxative abuse.

Most patients with bulimia nervosa are significantly obese.

Patients with bulimia nervosa usually present asking for treatment.

Patients with bulimia nervosa have periods of anorexia.

The Correct answer is:

Patients with bulimia nervosa have periods of anorexia

Bulimia nervosa is a secretive disease with relatively few easily noted clinical findings. It is more common in women and typically is present for many years before the patient presents for treatment or before the disorder is noted by a healthcare provider. It is estimated that approximately 30-50% of individuals with anorexia will exhibit characteristics of bulimia nervosa, by eating large amounts of food and then getting rid of the food from the body by using laxatives or even vomiting. Because of laxative usage, patients with bulimia nervosa are at risk of hypokalemia, and not hyperkalemia. Also, patients with bulimia nervosa are typically of average weight.

Question 91

Type 2 diabetes mellitus testing should be considered in all adults who are overweight and have additional risk factors. All of the following are additional risk factors to consider EXCEPT:

history of cardiovascular disease

women with polycystic ovarian syndrome

member of a high risk population

history of hypotension

Correct answer:

history of hypotension

This is not one of the additional risk factors for type II diabetes. All of the other choices are additional risk factors along with: physical inactivity, first-degree relative with diabetes, women who delivered an infant weighing over 9 pounds, women who have had gestational diabetes, hypertension, HDL cholesterol level of < 35 mg/dL, triglyceride level > 250 mg/dL, impaired glucose tolerance and other clinical conditions associated with insulin resistance.

Question 92

A nurse practitioner wants to make a change in the state's law concerning the dispensing of prescription medications by nurse practitioners. Who would this case need to be taken to?

state board of nursing

state board of pharmacy

nursing specialty organization

state legislature

The Correct answer is:

State legislature

Healthcare policy within the states is codified or enacted into law by the respective state legislature. The boards should have significant input in the process, such as providing the research data and expert "testimony" that the legislature needs to make informed decisions. However, boards, such as the state nursing boards, do not have the governing power to pass state laws.

Question 93

A 72-year-old woman is diagnosed with giant cell arteritis. Due to the severity of this diagnosis, the nurse practitioner understands that concomitant disease seen with this condition includes:

acute pancreatitis

psoriatic arthritis

Reiter syndrome

polymyalgia rheumatica

The Correct answer is:

Polymyalgia rheumatica

These two conditions, giant cell arteritis and polymyalgia rheumatica, are autoimmune vasculitis and are often seen together. Also, polymyalgia rheumatica is a systemic disease affecting medium-sized and large-sized vessels that causes inflammation of the temporal artery.

Question 94

One of the theories of development is Piaget's (1969) Cognitive Development Theory. This theory focuses on intellectual changes and the way they relate to the environment. Which of the following is NOT a stage of this continuous interaction sequential manner?

Abstract Operations

Concrete Operations

Preoperational Thinking

Formal Operations

The Correct answer is:

Abstract Operations

The stages are listed in this order:

1-Sensorimotor (infancy)

2-Preoperational Thinking

3-Concrete Operations

4-Formal Operations

There is no Abstract Operations stage in this theory model.

Question 95

The following component should be included in a history of a patient who is new to your clinic:

interval history, past medical history, family medical history, dietary habits, substance use, sexual practices

past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices

general history on the physical examination for is sufficient; there is no need of interview

past medical and surgical history, family medical and surgical histories, psychosocial history, diet and exercise habits, chemical use, sexual practices, review of systems

The Correct answer is:

Past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices

Past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices are all areas that are necessary to investigate a new patient's health.

Question 96

Which of the following is NOT a preventative measure for avoiding the ticks associated with Lyme disease?

using insect repellents

wearing long-sleeved shirts and long pants

taking a single 200 mg dose of doxycycline orally

avoiding areas with known or potential tick infestation

This is not a preventative measure. After a tick bite occurs, a single 200 mg dose of doxycycline taken orally seems to be effective in reducing the Lyme disease risk.

Question 97

The following are all reasons to keep a child out of school or daycare EXCEPT for which of the following?

diarrhea with blood or mucus

purulent conjunctivitis

streptococcal pharyngitis, until 3 days after initiation of treatment

impetigo, until 24 hours after initiation of treatment

The child may go back to school 24 hours after initiation of treatment for streptococcal pharyngitis. The remaining answer choices are all correct. Other childcare exclusions are: (1) pediculosis, until after the first treatment is given, (2) scabies, until after treatment is given, (3) varicella, until all lesions are crusted over, (4) pertussis, until after 5 days of antibiotics therapy, (5) hepatitis A, until 1 week after illness began and (6) tuberculosis, until no longer infectious.

Question 98

Which of the following does NOT correctly relate to end-of-life care?

From an insurance and hospice point of view, the end-of-life state begins six months before death.

Pain management is a priority in end-of-life care.

Medical care often shifts from supportive intervention to invasive intervention.

Support for family caregivers is important.

This is not true. Medical care often shifts from invasive intervention aimed at prolonging life to supportive intervention that focuses on control of symptoms.

Question 99

There is a greater recognition of the use by patients of complementary and alternative modalities and medicines (CAM) today than ever before. Which of the following is an inaccurate statement regarding the practice environment involving CAM?

Research suggests that 40-50% of patients are currently utilizing some form of complementary or alternative therapy.

There is a wealth of evidenced based research that supports CAM.

Nurse practitioners, as providers, need to learn about common CAM treatments and about how some herbal products interact with prescription medications.

The National Center for Complementary and Alternative Medicine is a federal government's lead agency for scientific research on CAM.

The Correct answer is:

There is a wealth of evidenced based research that supports CAM

There is a dearth of research supporting such treatment modalities.

Question 100

You are evaluating a patient who is having an asthma flare. What would you expect to find upon physical examination?

inspiratory crackles

a tripod posture

hyperresonance on thoracic percussion

increased vocal fremitus

Physical findings upon examination include hyperresonance on thoracic percussion, decreased tactile fremitus, wheezing, prolonged expiratory phase, and low diaphragms. Individuals asthma can try to avoid the things that triggers the asthma attack, if known, in order to help prevent future asthma flare-ups.

test 5 aanp

Question 1

When evaluating a 56-year-old Caucasian female for menopause, the nurse practitioner has knowledge that the primary function of FSH is:

triggering infiltration

stimulation of maturation of ovarian follicles

inhibiting the release of LH from the pituitary gland

milk secretion

The Correct answer is:

Stimulation of maturation of ovarian follicles

The FSH stimulates the maturation of ovarian follicles and results in a dominant follicle. The production and release of LH is regulated by estrogen. Milk secretion depends on prolactin

Question 2

In terms of cranial nerves, which CN is facial nerve?

CN 7

CN 1

CN 5

CN 4

Correct answer:

CN 7

CN 7 is the facial nerve. It is associated with being able to puff the cheeks, raise eyebrows, and smile.

Question 3

A mother brings her 5-year-old daughter into the office with complaints that she is "acting funny." She states that she has brief periods when she does not respond to her. Then, she suddenly responds and acts as if nothing has happened. The nurse practitioner would need to evaluate the child further for:

Horner's syndrome

Avoidance disorder of childhood

Simple partial seizure activity

Petit mal or absence seizures

The Correct answer is:

Petit mal or absence seizures

The description of the patient’s symptoms indicates a petit mal or absence seizure. With petit mal or absence seizure, the patient does not show symptoms, such as convulsions. Instead, the patient will stare for a short period and fail to response to anyone or anything around him or her. Although the etiology of the majority of seizures is unclear, the client should be referred for neurologic evaluation to determine if an underlying abnormality is present.

Question 4

Which of the following effects on urinary continence would be found in a person using opioids?

urinary retention

increase in frequency of voiding

relaxing internal urethral sphincter

none of the above

Correct answer:

urinary retention

For those taking an opioid medication the effect on urinary continence would include urinary retention. Other effects include: overflow incontinence, alteration in sensorium and fecal impaction.

Question 5

At about what age can the FNP expect to see an infant keep his back straight when pulled to sitting?

1 – 2 months

3 – 4 months

5 months

9 – 11 months

Correct answer:

5 months

At 5 months an infant will typically keep his back straight when he is pulled to a sitting position. At this age infants also bear weight on their legs when standing, play with their feet and sit with support.

Question 6

When assessing an 80 year old patient, you note that she is less active from chronic pain, she is low income, and she has little support. What does this place her at risk for?

Hepatitis.

Diabetes.

Carcinoma.

Obesity.

Correct answer: Obesity Obesity is linked to a number of illnesses. Even though she may not have as much money for food, the food is probably empty calories. This increases the risk of obesity.

Question 7

With a giardia lamblia diagnosis, the NP would MOST likely prescribe what medication?

Metronidazole.

Erythromycin.

Ampicillin.

Trimethoprim-sulfamethoxazole.

Correct answer: Metronidazole The preceding drugs are typically used in treating the following: - Campylobacter jejuni: Erythromycin - Salmonella: Ampicillin - Shigella: Trimethoprim-sulfamethoxazole - Giardia lamblia: Metronidazole

Question 8

Some states require a written protocol for NP practice. Which of the following statements about a protocol is incorrect?

A protocol need not be written; it may be oral.

It is considered a standard.

It consists of mutually agreed-upon medical guidelines between physician and NP.

It defines the individual and shared responsibilities of the physician and NP.

Correct answer:

A protocol need not be written; it may be oral.

A protocol is a written instrument that guides the NP in collecting data from the patient and recommends specific action based upon the collected data. The protocol provides a guideline for a minimum level of safe practice

Question 9

Which of the following tests would you most likely order for a patient whom you suspect has iron deficiency anemia?

CBC with differential or smear

TIBC

ferritin

all of the above

Correct answer:

all of the above

You might order all of the tests. You might also order a serum iron or special tests to determine underlying bleed, if suspected.

Question 10

Simvastatin is the generic form of which of the following drugs?

Lipitor

Zocor

Tricor

Questran

Correct answer:

Zocor

Zocor (Simvastatin) is a recommended drug therapy for hyperlipidemia. The daily dose range for this drug is 5 – 80 mg.

Question 11

The most common cause of anemia is which of the following?

obesity

iron deficiency

alcohol abuse

drug abuse

Correct answer:

iron deficiency

The most common cause of anemia is iron deficiency. The prevalence of iron deficiency is currently estimated to be approximately 3% for children 1 to 5 years old.

Question 12

When assessing a patient with suspected appendicitis, the nurse practitioner knows that the peak ages for occurrence of this is:

1 to 15 years

10 to 30 years

25 to 55 years

30 to 50 years

The Correct answer is:

10 to 30 years

Acute appendicitis is an inflammatory disease of the vermiform appendix that is caused by an infection or an obstruction. The peak age of patients is 10 to 30 years. Further, this condition is uncommon in infants and the elderly.

Question 13

You are educating a group of adults about depression. You are NOT likely to include which of the following statements in your talk?

When adults live in long-term care facilities they are less likely to suffer from depression.

No significant relationship has been found between race and mood disorders.

Once a person has experienced a depressive episode, the incidence of depression increases.

Depression is more common in young women.

Correct answer:

When adults live in long-term care facilities they are less likely to suffer from depression.

This is incorrect. You would tell the group that when adults live in long-term care facilities they are more likely to suffer from depression. Older adults are at a high risk for depression because of the multiple losses and health problems that frequently occur at this stage of life.

Question 14

A patient with folliculitis has been prescribed Mupirocin ointment to treat the area. What is the dosage?

Apply tid before antibiotic ointment.

2%, apply bid X 10 days and cover with DSD.

Apply to area bid-tid.

0.5 to 1 mg/kg/day PO in divided doses.

Correct answer: 2%, apply bid X 10 days and cover with DSD The preceding medications should be administered at the following dosages: Mupirocin ointment - 2%, apply bid X 10 days and cover with DSD. Gentamicin Sulfate cream or ointment - Apply to area bid-tid. Isoretinoin - 0.5 to 1 mg/kg/day PO in divided doses. Anhydrous ethyl alcohol with 6.25% aluminum chloride - Apply tid before antibiotic ointment.

Question 15

The nurse practitioner knows that when assessing a burn, the type that results in the surface being raw and moist is:

a first-degree burn

a second-degree burn

a third-degree burn

a fourth-degree burn

The Correct answer is:

A second-degree burn

A first degree burn results in affected skin that blanches with ease. A third-degree burn results in the affected area being white and leathery. There is no degree level of fourth-degree burn.

Question 16

A patient who has diarrhea as the main symptom of IBS may be prescribed all but which of the following?

Lomotil.

Imodium.

Lotronex.

Amitiza.

:

Correct Answer: Amitiza This medication is actually recommended for relief of long-term constipation and may make diarrhea worse. The other choices are all anti-diarrheals and may be used to help treat IBS. Lotronex is usually prescribed only when other treatments have not been successful.

Question 17

The following component should be included in a history of a patient who is new to your clinic:

interval history, past medical history, family medical history, dietary habits, substance use, sexual practices

past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices

general history on the physical examination for is sufficient; there is no need of interview

past medical and surgical history, family medical and surgical histories, psychosocial history, diet and exercise habits, chemical use, sexual practices, review of systems

The Correct answer is:

Past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices

Past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices are all areas that are necessary to investigate a new patient's health.

Question 18

You use the learning theory that appreciates that learners are unique and learn best when treated with positive regard. This learning theory is which of the following?

cognitive theory

behaviorist theory

humanistic theory

andragogy

Correct answer:

humanistic theory

The humanistic theory appreciates that learners are unique persons. It recognizes that they learn optimally when treated with positive regard, when their uniqueness is considered, and when they are involved in decision making.

Question 19

The FNP has a 55-year-old male patient who has recently been diagnosed with bladder cancer. The FNP understands that all of the following are true statements in regard to bladder cancer EXCEPT:

Most patients with newly diagnosed bladder cancer have superficial disease which allows for effective treatment.

Follow-up of bladder cancer patients is crucial because recurrence is often seen.

Long-term survival is rare with the invasive and non-invasive form of the disease.

Treatment is dictated in invasive bladder cancer by the type of tumor and degree of invasion among other things.

Correct answer:

Long-term survival is rare with the invasive and non-invasive form of the disease.

Long-term survival is the norm with the non-invasive form of the disease. With invasive disease, treatment is dictated by the type of tumor, degree of invasion and presence of metastatic disease, so long-term survival is based on numerous factors.

Question 20

Lead poisoning remains a serious public health problem. Which of the following is the least likely to present a lead hazard?

lead-glazed pottery

lead-soldered vessels used for cooking

fumes from burnt casings of batteries

paint in a home built in 1995

paint in a home built in 1995

This is the least likely source to present a lead hazard. Lead-based paint has not been available in the USA for more than 30 years. Therefore, a home built in 1995 would not contain lead-based paint.

Question 21

Alzheimer’s disease involves what is known as the three A’s. All of the following are one of the components of the three A’s EXCEPT:

aphasia

apraxia

angina

agnosia

Correct answer:

angina

Angina is not one of the three A’s associated with Alzheimer’s disease. The three A’s include: aphasia (difficulty verbalizing); apraxia (difficulty with gross motor movements such as walking); and agnosia (inability to recognize familiar objects and people).

Question 22

You are treating a patient with a large red, tender burn to one arm. What is the estimated involved body surface area?

1%

9%

30%

55%

The Correct answer is:

9%

A person's palmar surface represents a body surface area (BSA) of 1% of the total body surface area (TBSA) and is a good guide in the estimation of BSA involvement. The entire total surface area for one arm is 9%, according the rule of nines.

Question 23

The Occupational and Safety Health Act requires certain situations to be reported. Which of the following would need to be reported?

a minor closed head injury where no loss of consciousness occurred

a twisted ankle that improved with ice therapy and an Ace wrap

a back strain while lifting a box that resulted in reassignment to office work for a week

a 3 cm abrasion on the forearm

The Correct answer is:

A back strain while lifting a box that resulted in reassignment to office work for a week

The Occupational and Safety Health Act (OSHA) requires the reporting of any injury or illness that requires more than first-aid. Also, the injury has to result in lost work time, limited work status, death, or loss of consciousness.

Question 24

When assessing a patient for dietary habits, what will NOT factor into poor eating habits?

Gender.

Income.

Education.

Medical conditions.

Correct answer: Gender Women typically eat better than men, but that does not always factor into poor eating habits. The other answers can lead to poor eating habits. This can mean poor nutrition.

Question 25

You are volunteering at a homeless clinic to gain clinical experience. The nurse practitioner knows that which statement is true regarding this?

Volunteerism negates susceptibility to lawsuits.

Malpractice insurance will be needed.

Malpractice coverage will be provided by the state where the clinic is located.

Malpractice insurance is not necessary when working volunteer status.

The Correct answer is:

Malpractice insurance will be needed

The nurse practitioner should always have malpractice insurance. The "good Samaritan" law protects professional volunteers in some states, but in the event of being sued, professional liability should be carried.

Question 26

The ecological model developed and described by Urie Bronfenbrenner that is a person-place-process model includes all of the following systems EXCEPT:

Microsystems

Mesosystem

Endosystem

Exosystem

Correct answer:

Endosystem

This is not part of the person-place-process model of Bronfenbrenner. The person-place-process model includes: microsystems, mesosystem, exosystem and macrosystem. Understanding how and why a child changes or stays the same over time requires examination, not only of the child’s emerging capabilities but the quality of the settings where children spend time.

Question 27

Which of the following medications provides the greatest analgesic effect in the shortest amount of time for a tension-type or migraine headache?

Naprosyn

Aleve

Anaprox

Both Aleve and Anaprox

Correct answer:

Both Aleve and Anaprox

The National Health Foundation Guidelines advise the use of rapid-onset NSAIDs such as ibuprofen in high doses with booster doses for tension-type and migraine headaches. Plain naproxen (Naprosyn) has a relatively slow onset of analgesic activity, whereas naproxen sodium (Aleve or Anaprox) use is associated with a significantly more rapid onset of pain relief.

Question 28

You have a child in the office that has had a severe anaphylactic reaction to eggs in the past. The nurse practitioner understands that she cannot administer the following immunization:

hepatitis B

IPV

varicella

influenza

The Correct answer is:

Influenza

The influenza vaccine is contraindicated for any person who has had anaphylactic reaction to eggs because the vaccine is made from eggs.

Question 29

Which of the following is federally mandated testing for infants?

hemoglobin

hematocrit

PKU test

lead screening

Correct answer:

PKU test

The PKU test is federally mandated. Severe mental retardation can occur if PKU is not treated early. PKU is the inability to metabolize phenylalanine to tyrosine because of a defect in the production of the enzyme phenylalanine hydroxylase.

Question 30

You are examining a male infant, age 9 months, and notice an undescended testicle on the right side. When counseling the mother, the nurse practitioner understands the following to be true of cryptorchidism EXCEPT:

This is where the testis does not descend with massage of the inguinal area.

You cannot exam the infant in a warm room.

Increased risk of testicular cancer occurs if testicles are not removed from the abdomen.

Surgical correction within the first year of life is necessary if it does not spontaneously descend.

The Correct answer is:

You cannot exam the child in a warm room

In order to see if the muscle will relax and the testicle will descend, the infant should be sitting and the exam room should be warm to relax the muscles when massaging the inguinal canal. Another option is to examine the infant during or after a warm bath.

Question 31

You are discussing Depo-Provera therapy with a 17-year-old adolescent who cannot remember to take her birth control pills. You must warn her of side effects and long term effects. The Family Nurse Practitioner knows that which of the following is commonly found after a year of using this agent?

hypermenorrhea

weight gain

cystic acne

insomnia

The Correct answer is:

Weight gain

Depo-Provera is given every 90 days in the form of an intramuscular injection. An unfortunate side effect to this agent is weight gain. While some patients enjoy the loss of menses (amenorrhea or hypomenorrhea), some find this occurrence worrisome. Acne is improved with Depo usage and insomnia is not a known side effect.

Question 32

You are treating a patient who presents with a painful, blistering thermal burn on his right hand and digits. What is the best way to treat this?

Wrap the burn loosely with a nonadherent dressing and prescribe anti-inflammatory agents.

Apply silver sulfadiazine cream to the burn and apply a thick dressing.

Apply topical antibiotic ointment and leave open to air.

Refer to a burn care specialist.

The Correct answer is:

Refer to a burn care specialist

Patients with any burn involving areas of high function such as the hands and feet or ones that have significant cosmetic consequence such as the face should be referred promptly to specialty care.

Question 33

Which of the following statements about tinnitus is least accurate?

Most people suffer from occasional intermittent tinnitus.

Continuing tinnitus usually means that the person has suffered sensory hearing loss.

The overall prevalence of unexplained tinnitus is 11%.

Approximately 10% of the population in the Untied States suffers from chronic tinnitus that causes severe distress.

Correct answer:

Approximately 10% of the population in the Untied States suffers from chronic tinnitus that causes severe distress.

This is the least accurate statement. Approximately 1% of the population in the United States suffers from chronic tinnitus that causes severe distress. This type of tinnitus requires some kind of management intervention.

Question 34

You are evaluating a 35-year-old pregnant female who has an indication for genetic counseling. What might this be?

maternal age

increased maternal alpha-fetoprotein

drug exposure during the first trimester

history of previous stillbirth

The Correct answer is:

Maternal age

Women 35 years of age and older are at high risk for pregnancies involving congenital abnormalities. The remaining answer choices are all reasons for genentic counseling, but to a much lesser degree.

Question 35

A 70-year-old male comes to the FNP with a raised, red lesion in his oral cavity. He tells the FNP that he is afraid that it is cancer. Besides evaluating the lesion the FNP evaluates the man’s risk for oral cancer. These risks include all of the following EXCEPT:

poor diet

alcohol abuse

tobacco abuse

advanced age

Correct answer:

poor diet

Poor diet is not a risk factor for oral cancer. Alcohol and tobacco use and advanced age are risks.

Question 36

The stethoscope is placed slightly off the chest of an elderly patient who is suspected of having a murmur. The sound produced is very loud and accompanied by palpable thrill. Which of the following murmur grades does this describe?

III/VI.

IV/VI.

V/VI.

II/VI.

Correct answer: V/VI Each of the preceding murmur grades is defined below: III/VI - Moderately loud IV/VI - Loud with palpable thrill V/VI - Very loud and heard with the stethoscope partially off the chest; palpable thrill II/VI - Quiet but heard as soon as the stethoscope is placed on the chest

Question 37

Which of the following is an absolute contraindication for fibrinolysis in ST segment elevation myocardial infarction?

any prior intracranial hemorrhage

history of chronic, severe, poorly controlled hypertension

pregnancy

active peptic ulcer

Correct answer:

any prior intracranial hemorrhage

Any prior intracranial hemorrhage is an absolute contraindication for fibrinolysis in ST segment elevation myocardial infarction. The other choices are relative contraindications.

Question 38

When assessing a child during a well-child exam, the nurse practitioner (NP) notices that genu valgum is present. The NP knows that this is normal from:

1-2 years old

3-5 years old

8-10 years old

12-16 years old

The Correct answer is:

3-5 years old

Knock knees or genu valgum is a condition that affects the knees in some children. With knock knees, the knees angle in and touch one another when the legs are straightened. Genu valgum can be seen in children from ages 3 to 5. Genu valgum is corrected naturally, without treatment interventions, by the time the child reaches 10 years of age.

Question 39

Which of the following is the correct laboratory norm for Mean Corpuscular Hemoglobin Concentration (MCHC)?

100 – 200 g/dL

50 – 100 g/dL

31.0 – 37.0 g/dL

21.0 – 27.0 g/dL

Correct answer:

31.0 – 37.0 g/dL

MCHC is a measure of the average color of the RBCs in a sample of blood. It is decreased in iron deficiency anemia and thalassemia and normal in the macrocytic anemias. The normal is 31.0 – 37.0 g/dL.

Question 40

Which of the following is NOT one of the Jones criteria for pelvic inflammatory disease (PID)?

lower back pain

cervical motion tenderness

adnexal tenderness

lower abdominal tenderness

Correct answer:

lower back pain

The Jones criteria are the major criteria for PID. Only one of the criteria is necessary to diagnose and treat for PID. All of the choices are one of the Jones criteria except lower back pain.

Question 41

The program that provides health insurance for uninsured children who qualify is which of the following?

COBRA

SCHIP

OBRA

Medicare

Correct answer:

SCHIP

The State Children’s Health Insurance Program (SCHIP) provides health insurance for uninsured children who qualify. It is important for the NP to know that a child may be eligible for SCHIP even if the family is not eligible for Medicaid.

Question 42

Of the following laboratory procedures, which one is used as an adjunct for evaluating herpetic infections?

Pap smear

Tzanck smear

Gram stain

KOH slide

Correct answer:

Tzanck smear

The Tzanck smear is used as an adjunct for evaluating herpetic infections (oral, genital or skin). A positive smear will show large abnormal nuclei on the squamous epithelial cells.

Question 43

An adult male patient reports fatigue and nausea. In the last 30 days, he has travelled extensively in Latin America. He also reports clay-colored stools and a nearly-constant itching sensation. The patient should be further evaluated for which of the following?

Hepatitis A.

Intestinal parasites.

Hodgkin' disease.

Lyme disease.

Correct Answer: Hepatitis A This patient's symptoms are consistent with Hepatitis A. The fact that he has recently traveled to a developing area of the world also puts him at higher risk. His liver functions should be monitored and tests for Hepatitis A performed.

Question 44

Fraud and abuse by healthcare providers have increased during the last several years. Which of the following is correct concerning fraud and abuse?

The federal Health Insurance Portability and Accountability Act (HIPAA) allow for broad penalties for defrauding a health plan.

The Health Insurance Portability and Accountability Act (HIPAA) prohibits knowingly and willfully offering, paying, soliciting, or receiving anything of value in order to induce furnishing of services under federal and state programs.

The federal False Claims Act maintains a list of "safe harbors," which are arrangements that will not be considered a violation of the anti-kickback law.

There are no laws that limit physicians from directing patients to their privately owned laboratories or diagnostic centers.

The Correct answer is:

The federal Health Insurance Portability and Accountability Act (HIPAA) allow for broad penalties for defrauding a health plan

The Health Insurance Portability and Accountability Act (HIPAA) provides required guidelines a health plan, provider and healthcare organization must adhere to in regards to fraud and abuse. Also, HIPAA has privacy rules that outlines protective measures that healthcare organizations must follow in order to keep patient health information private. Or, in the case of health insurance plans, HIPAA has mandates the health plans must follow in order to keep member health information private. Further, the federal anti-kickback statute prohibits knowingly and willfully offering, paying, soliciting, or receiving anything of value in order to induce furnishing of services under federal and state programs. The federal False Claims Act imposes civil liability on anyone who submits a false claim. The Stark I and II federal laws prohibit physicians from self-referring patients and then receiving payment for the referral.

Question 45

The tendency of an individual to expend less effort when working collectively than when working individually is known as which of the following?

informal behavior

social loafing

cognitive regress

none of the above

Correct answer:

social loafing

Social loafing is the tendency for individuals to expend less effort when working collectively than when working individually. It directly challenges the logic that the productivity of the group as a whole should at least equal the sum of the productivity of each individual in that group.

Question 46

When would you expect the uterine fundus in a pregnant woman to be at the level of the umbilicus?

12 weeks

16 weeks

20 weeks

28 weeks

Correct answer:

20 weeks

At 20 weeks (5th month) you would expect the uterine fundus to be at the level of the umbilicus. At this stage fetal heart tones are heard with the fetoscope or stethoscope.

Question 47

A physician cannot refer a patient covered by Medicare to a clinical laboratory where the physician or an immediate family member of the physician has a financial relationship. This is part of which of the following laws?

Stark Acts

HIPAA

ADA

Clinical Laboratory Improvement Amendments

Stark Acts

The Stark Acts establish rules regarding “Physicians’ Referrals to Health Care Entities With Which They Have Financial Relationships.” In addition to clinical laboratories, a physician cannot refer a patient to certain designated health services when the physician has a financial relationship with the facility offering the services. Even though the Stark Acts are aimed at physicians, a nurse practitioner can become involved in an activity that violates the Stark Acts.

Question 48

You are doing a complete physical exam on a 25-year-old female patient with sleep apnea. Which of the following are you most likely to find in this patient?

bruit

paroxysms of sweating

increased blood pressure

atrial fibrillation

Correct answer:

increased blood pressure

Increased blood pressure is the only choice that might be found in a patient with sleep apnea. Bruit might be found in renal artery stenosis. Paroxysms of sweating may be found in a person with pheochromocytoma. Atrial fibrillation might be found in a person with hyperthyroidism.

Question 49

An insurance company that pays for the medical care of its insured but does not deliver health care is called:

Medicaid

Indemnity Insurer

Managed Care Organization

Private Payer

Correct answer:

Indemnity Insurer

An Indemnity Insurer is an insurance company that pays for the medical care of its insured but does not deliver health care. Indemnity insurers pay healthcare providers on a per-visit, per-procedure basis.

Question 50

Which of the following statements about characteristics of a theory is least accurate?

Theories interrelate concepts to create more useful ways of looking at particular phenomena.

Theories must be logical in nature.

Theories must differ from other validated theories, laws, and principles.

Theories must be relatively simple.

Correct answer:

Theories must differ from other validated theories, laws, and principles.

This is the least accurate statement. Theories must be consistent with other validated theories, laws, and principles, but they will leave unanswered questions that need to be investigated.

Question 51

The sudden massive destruction of spirochetes after a Penicillin G injection that causes an immune-mediated reaction is which of the following?

Reiter’s syndrome

Fitz-Hugh-Curtis syndrome

Jarisch-Herxheimer reaction

Neisseria gonorrhea

Correct answer:

Jarisch-Herxheimer reaction

The Jarisch-Herxheimer reaction is an immune-mediated reaction caused by the sudden massive destruction of spirochetes after a Penicillin G injection. It usually resolves spontaneously. Treatment is supportive.

Question 52

An asthmatic child is brought in with an attack. The medical history shows that the attacks have become more frequent in the last few months. What will you want to assess in the family interview?

Exercise.

Diet.

Environment.

Heart disease.

Correct answer: Environment The environment of asthmatics is important to maintaining their health. Exposure to secondhand smoke, chemicals, and pollutants can cause asthma attacks. Determine whether something in the environment is causing the attacks.

Question 53

Urinary incontinence is defined as “involuntary loss of urine which is sufficient to be a problem.” The type of urinary incontinence that accounts for 80% in women younger than 60 years is which of the following?

urge incontinence

stress incontinence

overflow incontinence

functional incontinence

Correct answer:

stress incontinence

Stress incontinence is associated with activities that result in increased intraabdominal pressure, such as coughing, sneezing, laughing, or lifting. It accounts for 80% of urinary incontinence in women younger than 60 years.

Question 54

You are teaching a group of student nurses about gynecological problems. You tell them all of the following about pelvic inflammatory disease (PID) EXCEPT:

Consistent use of barrier contraceptives increases a woman’s susceptibility to the disease.

Up to 60% of cases are caused by Chlamydia trachomatis or Neisseria gonorrhea.

Bacterial vaginosis and trichomoniasis may also be present.

A new sex partner within 30 days of symptoms is a factor increasing susceptibility.

Correct answer:

Consistent use of barrier contraceptives increases a woman’s susceptibility to the disease.

This is not true. Consistent use of barrier contraceptives decreases a woman’s susceptibility to the disease. It is a protective factor.

Question 55

Which cranial nerve is the acoustic nerve?

CN 1

CN 4

CN 7

CN 10

Correct answer:

CN 7

Cranial nerve 7 is the facial nerve. It is involved in such things as puffing cheeks, raising eyebrows, and smiling.

Question 56

The domain of learning that relates to values, attitude, feelings, and emotions is which of the following?

affective

psychomotor

cognitive

behaviorist

Correct answer:

affective

The affective domain relates to values, attitude, feelings, and emotions. It begins with an awareness, willing response, commitment, prioritization, and finally integration into one’s lifestyle. Appropriate teaching methods include role play, role modeling, discussions, audiovisuals, and printed materials.

Question 57

In terms of human growth and development there are certain fundamental domains. Under which of the following domains would receptive and expressive language fall?

cognitive

physical

psychological

 test 6 aanp

Question 1

Olecranon bursitis is located in which of the following places?

shoulder

knee

elbow

heel

Explanation:

Correct answer:

elbow

Olecranon bursitis is located in the elbow. There is pain and swelling behind the elbow. It is often described as a ball or sac hanging from the elbow. Risk factors include prolonged pressure or trauma to the elbow.

Question 2

Which of the following are you most likely to do to treat a patient who has temporal arteritis?

ice pack on forehead

100% oxygen

administer Tegretol

refer to ER or ophthalmologist

Correct answer:

refer to ER or ophthalmologist

Arteritis is a systemic inflammatory process of the medium and large arteries of the body. If the temporal artery is involved, it is called temporal arteritis. Permanent blindness may occur if it is not diagnosed and treated early.

Question 3

A 64-year-old Caucasian male has the following lipid level results:

Total cholesterol 240 mg/dL

LDL 140 mg/dL

HDL 35 mg/dL

Triglycerides 201 mg/dL

What class of medications will normalize his lipid elevations and decrease his risk of a cardiac event?

fibric acids

bile acid sequestrants

niacin

statins

The Correct answer is:

Statins

The only medication class that lowers elevated lipid levels and has proven efficacy in lowering the risk of cardiac events, even for primary prevention, is statin medications. Further, statin therapy has been shown to reduce overall mortality due to cardiovascular deaths

Question 4

Which of the following statements about herpes zoster (shingles) is least accurate?

More than 66% of those affected are older than 50 years.

Only 5% of cases occur in children younger than 15 years.

Herpes zoster occurs equally in males and females.

Radiotherapy is a protective factor for the disease.

Correct answer:

Radiotherapy is a protective factor for the disease.

All of the statements are accurate except this one. Radiotherapy is a factor increasing susceptibility for the disease.

Question 5

The nurse practitioner (NP) understands that the following is NOT true regarding the care of minors:

In most jurisdictions, minors under the age of 18 cannot receive healthcare services without permission of an adult who is a parent or legal guardian.

If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian.

In case of emergency, when no parent or guardian is available, care may be rendered.

If a 15-year-old becomes pregnant, she is an emancipated minor.

The Correct answer is:

If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian

A teen with a STD is considered an emancipated minor, and the parent or legal guardian should not be contacted. The remaining answer choices are true regarding the care of minors.

Question 6

While examining a patient you hear a high-pitched diastolic murmur at the second ICS at the right side of the sternum. You know that this indicates which of the following?

aortic regurgitation

aortic stenosis

mitral stenosis

mitral regurgitation

Correct answer:

aortic regurgitation

A high-pitched diastolic murmur which is best heard at the second ICS at the right side of the sternum indicates aortic regurgitation. Aortic stenosis produces a harsh and noisy murmur and radiates to the neck.

Question 7

Which of the following statements about end-of-life care is least accurate?

Withholding or withdrawing artificial nutrition or hydration from terminally ill or permanently unconscious patients is illegal.

Oral statements made by a patient may be legally valid advance directives.

Only a few states require “clear and convincing evidence” of a patient without decision-making capabilities that it is his or her wish to forego life-sustaining treatment.

There is no legal requirement to notify risk management personnel before life-sustaining medical treatment can be stopped.

Correct answer:

Withholding or withdrawing artificial nutrition or hydration from terminally ill or permanently unconscious patients is illegal.

This is the least accurate statement. Just like any other therapy, fluids and nutrition may be withheld if it is the patient’s or surrogate’s wish.

Question 8

In the latent stage of syphilis which of the following is the most common sign?

painless chancre

maculopapular rash on palms and soles that is not pruritic

no symptoms

valvular damage

Correct answer:

no symptoms

Syphilis has four stages: primary, secondary, latent, and tertiary. The latent stage is characterized by being asymptomatic

Question 9

You are seeing an uncircumcised client that presents with a complaint of not being able to retract the foreskin over the glans penis. What is the likely diagnosis?

phimosis

paraphimosis

lateral phimosis

Peyronie's disease

The Correct answer is:

Phimosis

Phimosis results in the patient's inability to retract the foreskin from behind the glans penis. This condition occurs at any age and is the result of poor hygiene and chronic infection.

Question 10

When counseling a patient with the human herpes virus 2 (HHV-2), the nurse practitioner knows that what percentage of sexually active adults has serological evidence of this disease?

5%

10%

15%

25%

The Correct answer is:

25%

The human herpes virus 2 (HHV-2) causes painful ulcerated lesions and lymphadenopathy. Approximately 25% of adults who are sexually active have serological evidence of this disease, although only a small percentage of these persons have symptoms.

Question 11

Which of the following is NOT a live attenuated virus vaccine?

MMR

Varicella Zoster

injectable tri-valent influenza vaccine

FluMist

Correct answer:

injectable tri-valent influenza vaccine

The injectable trivalent influenza vaccine (TIV) does not contain live virus and is not shed. There is no risk of transmitting an infectious agent to household contacts. The other choices are vaccines with live attenuated viruses.

Question 12

Kurt Lewin’s model of change management can best be described as which of the following?

preparation, change and continuity

grounding, amending and permanence

training, exchanging and connection

unfreezing, moving and refreezing

Correct answer:

unfreezing, moving and refreezing

The unfreezing stage involves getting to a point of understanding that change is necessary and getting ready to move away from the current comfort zone. Moving is moving towards a new way of being. Refreezing is about establishing stability once the changes have been made.

Question 13

Nurse practitioners are always reimbursed for their services as primary care providers under all but which of the following?

Medicare

Federal Employees Health Benefits Program

Managed Care Organizations

TRICARE

Correct answer:

Managed Care Organizations

Managed Care Organizations frequently have excluded NPs from being designated as primary care providers carrying their own caseloads. Thus, in many MCOs, the only option for NPs is that of being a salaried employee.

Question 14

The knee joint includes four bones. Which of the following is NOT one of these bones?

distal femur

distal tibia

patella

proximal fibula

Correct answer:

distal tibia

The distal tibia is not one of the bones of the knee. The knee joint includes the distal femur, the patella, the proximal fibula, and the proximal tibia.

Question 15

In terms of etiology of disease, incidence rates can best be described as which of the following?

a group at a certain point in time and the number within a group that has a particular disease or problem

interventions at the clinical stage of disease, directed at treatment and rehabilitation

the rate of involvement of causative agents

the rate of development of a disease in a group over a period of time

Correct answer:

the rate of development of a disease in a group over a period of time

Incidence rates describe the rate of development of a disease in a group over a period of time. They also describe the continuing occurrence of new cases of disease.

Question 16

Your patient has an extensive infection of several adjacent hair follicles that form a mass with multiple drainage points. You understand that this patient has which of the following?

folliculitis

carbuncle

furuncle

none of the above

Correct answer:

carbuncle

A carbuncle occurs when there is an extensive infection of several adjacent hair follicles that form a mass with multiple drainage points. Folliculitis is a minor inflammation of hair follicles with or without pustules. A furuncle (abscess or boil) is a more extensive infection of a hair follicle.

Question 17

A 23-year-old female who is breastfeeding is inquiring about alcohol use during lactation. The nurse practitioner understands that:

Because of its high molecular weight, relatively little alcohol is passed into breast milk.

Infant intoxication may be seen with as little as one to two maternal drinks.

Drinking a glass of wine or beer will enhance the let-down reflex.

Maternal alcohol use causes a reduction in the amount of milk ingested by the infant.

The Correct answer is:

Maternal alcohol use causes a reduction in the amount of milk ingested by the infant

Alcohol has a low molecular weight and is highly lipid soluble. These characteristics allow it to have easy passage into breast milk. Even in small amounts, alcohol ingestion by a nursing mother can cause a smaller amount of milk produced, reduction in the let-down reflex and less rhythmic and frequent sucking by the infant, resulting in a smaller volume of milk ingested.

Question 18

A 42-year-old Caucasian male has newly diagnosed hypertension and has received a prescription for ramipril. He is otherwise healthy and on no other medications. Which laboratory test would be important to monitor him?

PT with INR

potassium level

ALT/AST

calcium level

The Correct answer is:

Potassium level

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. Further, this medication causes retention of potassium. Therefore, the patient's potassium level should be measured about one month after initiating therapy and again after dosage changes. The remaining answer choices, PT with INR, ALT/AST and calcium level, are not specific laboratory tests for ACE inhibitor therapy.

Question 19

Which of the following is the gold standard diagnostic test for thalassemia minor?

blood smear

serum ferritin

hemoglobin electrophoresis

none of the above

Correct answer:

hemoglobin electrophoresis

Hemoglobin electrophoresis is the gold standard diagnostic test for thalassemia minor. in beta thalassemia it is abnormal. There is an elevated Hgb.A2, and Hgb F.

Question 20

What dietary regimen would be appropriate for an elderly client with chronic obstructive pulmonary disease?

high caloric, low protein, high carbohydrate

low caloric, low protein, high carbohydrate

high caloric, high protein, low carbohydrate

low caloric, high protein, low carbohydrate

The Correct answer is:

High caloric, high protein, low carbohydrate

By eating a high protein, high caloric and low carbohydrate diet, the patient with chronic obstructive pulmonary disease is able to meet his or her nutritional needs. Additionally, a patient with chronic obstructive pulmonary disease, who retains carbon dioxide, should avoid high carbohydrate foods because carbohydrates metabolize into carbon dioxide (CO2) as a waste product.

Question 21

The type of nursing research that examines events of the past to enhance self-understanding is called:

phenomenology

historical research

grounded theory

ethnographic research

Correct answer:

historical research

Historical research examines events of the past to enhance self-understanding. It is a type of qualitative research that focuses on the collection of data through interviews, observations and focus groups to enhance understanding about a particular area of interest in nursing.

Question 22

Which of the following conditions is most likely to be found in a person with acute cholecystitis?

fever

jaundice

vomiting

palpable internal joint

The Correct answer is:

Vomiting

Acute cholecystitis symptoms include vomiting, right upper abdomen pain, and nausea. Fever, jaundice and a palpable internal joint are not seen in patients with cholelithiasis. Cholelithiasis is defined as a condition in which there is the formation of calculi or gallstones.

Question 23

A 8-year-old male child is called back into the office because his stool specimen for ova and parasites (O & P) came back positive. The nurse practitioner knows what regarding enterobiasis?

The parasite causes pruritus around the anus because the females exit at night to lay eggs on the skin.

This parasite is a protozoan and the source is usually contaminated water and it is spread by fecal-oral contamination.

The parasite is in the soil and enters the body through the feet.

Eggs of this parasite enter the body by ingestion of dirt or from unwashed vegetables that contain the eggs in the dirt.

The correct answer is:

The parasite causes pruritus around the anus because the females exit at night to lay eggs on the skin

This infestation is also known as "pinworms" which reside in the intestine. Hookworm larvae reside in the soil and enter the body through the feet. When dirt is ingested, there is a risk of contacting roundworm. Giardiasis from Giardia lamblia results from ingesting this organism through contaminated water or fecal-oral transmission.

Question 24

In terms of Medicare, which of the following statements about hospital privileges is incorrect?

Every hospitalized patient covered by Medicare must be under the care of a physician.

The federal government includes licensed doctors of medicine, osteopathy, podiatry and chiropractic in its definition of physician.

Hospitalized patients may be under the care of a clinical psychologist.

Doctors of medicine or osteopathy may not delegate tasks for hospitalized patients to other qualified health care personnel.

Correct answer:

Doctors of medicine or osteopathy may not delegate tasks for hospitalized patients to other qualified health care personnel.

This is the incorrect statement. Doctors of medicine or osteopathy may delegate tasks for hospitalized patients to other qualified health care personnel “to the extent recognized under State law or a State’s regulatory mechanism.” NPs who deliver care to hospitalized patients presumably fall under the delegation rule.

Question 25

The FNP calculates a patient’s BMI to be 23. Which category would this patient fall into?

normal weight

underweight

overweight

obese

Correct answer:

normal weight

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

Question 26

Which of the following is NOT a risk factor for osteoporosis?

alcohol abuse

active lifestyle

advancing age

history of bone fracture

Correct answer:

active lifestyle

An inactive lifestyle, not an active lifestyle would be a risk factor for osteoporosis. All of the other choices are risk factors along with: female gender, family history, and low estrogen levels in women, among other things.

Question 27

Which of the following is a system of controlled oversight and authorization of services and benefits provided to patients?

clinical ladder

case management

triage

clinical guidelines

The Correct answer is:

Case management

Case management is a special type of communication that is a necessity for healthcare providers. It is the process of interviewing and teaching patients and for sharing or clarifying information with others involved in the patient's care

Question 28

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

Tagament

Nizoral

Diflucan

Oxipurinol

Correct answer:

Oxipurinol

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

Question 29

You are treating a 48-year-old male who is suffering with alcoholism. The first most helpful approach for him is:

Inform the patient of the long-term health consequences of alcohol abuse.

Tell the patient to stop drinking.

Refer the patient to Alcoholics Anonymous.

Counsel the patient that alcohol abuse is a treatable disease.

The correct answer is:

Counsel the patient that alcohol abuse is a treatable disease

The first approach for the nurse practitioner is to counsel the patient and family that alcoholism is a lifelong but treatable disease. In addition, asking about current drinking habits and associated consequences to health with each visit is important and are appropriate next steps. Then, the remaining answer choices are also important interventions after the nurse practitioner counsels the patient and the family regarding alcoholism as a treatable disease.

Question 30

You are discussing medication therapy in a 39-year-old man who has just been diagnosed with gastroesophageal reflux disease (GERD). Which medication on his medication list do you know exacerbates the symptoms of GERD?

metformin

ferrous sulfate

verapamil

viagra

The Correct answer is:

Verapamil

The lower esophageal sphincter is opened and closed by muscles. Verapamil is a calcium channel blocker and calcium is needed for muscle contractions. Gastroesophageal reflux disease can be exacerbated in this case so verapamil should be avoided in this patient.

Question 31

You suspect anemia in an 88-year-old female patient, particularly vitamin B12 deficiency. Which of the following lab indices is more indicative of a B12 deficiency?

macrocytosis

leukocytosis

thrombocytosis

microcytosis

The Correct answer is:

Macrocytosis

A vitamin B12 deficiency produces a form of anemia known as pernicious anemia. It is more common in older adults and characterized by macrocytosis, where red blood cells are larger than expected. Leukocytosis describes large numbers of white blood cells. Thrombocytosis refers to an increased number of platelets. Microcytosis, small red blood cells, is seen in iron deficiency anemia or thalassemia.

Question 32

A 36-year-old mentally challenged and disabled man has been diagnosed with prostate cancer and it is determined he needs surgery. Consent for this surgery should be obtained from:

the patient's court-appointed guardian

the administrator of the group home where the patient lives

the patient himself

the client's mental health physician

The Correct answer is:

The patient's court-appointed guardian

Since this patient's mental capacity to consent is questionable, alternatives must be sought. If this patient has a court-appointed guardian, that person is the decision maker. If no guardian exists, the nurse practitioner would have to evaluate the patient's family dynamics and state and federal laws to determine if a close relative is appropriate to consent for this surgical procedure. Also, a group home employee cannot consent for this as they have no legal authority.

Question 33

NSAID and corticosteroid use are potent risk factors in which of the following types of peptic ulcer disease?

gastric ulcer

duodenal ulcer

nonerosive gastritis

chronic type B gastritis

Correct answer:

gastric ulcer

NSAID and corticosteroid use are a potent risk factors for gastric ulcers. Cigarette smoking is also a risk factor. Nearly all gastric ulcers found in patients without H. Pylori infection are caused by NSAID use.

Question 34

When a patient tells you that she has no family anymore since her sister and her husband died last year and you reply, “That must make you very sad,” you are using which of the following types of therapeutic communication?

trust

honesty

validation

empathy

Correct answer:

empathy

Empathy is an emotional linkage between two or more people through which feelings are communicated. It involves trying to imagine what it must be like to be in another person’s situation.

Question 35

The amount of cream or ointment needed to treat a dermatologic condition on one leg for one time is which of the following?

6 g

3 g

10 g

12 g

Correct answer:

6 g

The amount of cream or ointment needed to treat a dermatologic condition on one leg for one time is 6 g. Prescribers often write prescriptions for an inadequate amount of topical medication creating a situation in which treatment fails because of an inadequate length of therapy.

Question 36

As part of a nonpharmacologic treatment for a second-degree burn, you would do all of the following EXCEPT:

Remove all rings to avoid a tourniquet effect.

Apply ice to the site.

Gently cleanse with a mild detergent.

Cover the burn area with a thin layer of silver sulfadiazine cream.

Correct answer:

Apply ice to the site.

Do NOT apply ice to the site. In addition to the other three choices you may flush a chemical burn copiously with water and debride any broken blisters and dead skin.

Question 37

Which of the following injuries shows no specific radiographic findings?

tennis elbow

finger fractures

Jones fracture

Boxer’s fractures

Correct answer:

tennis elbow

Tennis elbow as well as nursemaid’s elbow show no specific radiographic findings. Finger fractures may reveal crush injuries. Jones fractures reveal a fracture to the fifth metatarsal. Boxer’s fractures reveal a fracture of the fifth metacarpal, which frequently is medially angulated.

Question 38

A 67-year-old man is in the clinic with frequent dizziness while standing. Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases:

more than 20 points any time after rising

more than 20 points within one minute after rising

any degree drop if the patient becomes weak or dizzy

more than 20 points within three minutes after rising

The Correct answer is:

More than 20 points within three minutes after rising

Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving to an upright position. It can be evaluated from lying to sitting or from sitting to standing. Also, if the systolic reading does not drop but the diastolic drops by 10 mm Hg or more, postural hypotension can be diagnosed.

Question 39

You have a 50-year-old male patient complaining of hearing loss. One of the tests you do involves placing the tuning fork on the forehead and asking the patient where it is heard best. This is known as which of the following?

Rinne test

Weber test

tympanogram

audiogram

Correct answer:

Weber test

The Weber test involves placing the tuning fork on the forehead or front teeth. The patient then indicates where it is heard best. The Rinne test involves placing the tuning fork alternately on the mastoid bone and in front of the ear canal. The other choices are tests that do not involve a tuning fork.

Question 40

Which of the following would NOT be considered one of the general principles of medical record documentation?

The rationale for ordering diagnostic and other ancillary services should be documented or easily inferred.

The patient’s progress, response to and changes in treatment, and revision of diagnosis should be documented.

Health risk factors do not appear in documentation, only in practice.

The medical record should be complete and legible.

Correct answer:

Health risk factors do not appear in documentation, only in practice.

Appropriate health risk factors should be identified in documentation. Past and present diagnoses should also be accessible to the treating and/or consulting physician

Question 41

A physician or nurse practitioner who specializes in the care of hospitalized patients is called a(n):

specialist

primary care provider

hospitalist

adjunct provider

Correct answer:

hospitalist

Traditionally, a patient who needed to be admitted to a hospital was admitted through the patient’s primary care provider, who coordinated the care of the patient. This tradition has been challenged by the realization that this model is not too efficient. More hospitalists (physicians and nurse practitioners who specialize in the care of hospitalized patients) are taking over this aspect of practice.

Question 42

An 18-year-old female comes to the clinic complaining of a sore throat and fatigue that has persisted for several months. She also has some upper abdominal pain. The FNP’s examination reveals enlarged cervical nodes, erythema of the pharynx and red tonsils. The most likely diagnosis is:

rhinitis medicamentosa

acute mononucleosis

acute sinusitis

allergic rhinitis

Correct answer:

acute mononucleosis

Mononucleosis is an infection by the Epstein-Barr virus that is transmitted through saliva by intimate oral contact. The classic triad to look for is pharyngitis, cervical lymphadenopathy and fatigue.

Question 43

You are examining a male infant, age 9 months, and notice an undescended testicle on the right side. When counseling the mother, the nurse practitioner understands the following to be true of cryptorchidism EXCEPT:

This is where the testis does not descend with massage of the inguinal area.

You cannot exam the infant in a warm room.

Increased risk of testicular cancer occurs if testicles are not removed from the abdomen.

Surgical correction within the first year of life is necessary if it does not spontaneously descend.

The Correct answer is:

You cannot exam the child in a warm room

In order to see if the muscle will relax and the testicle will descend, the infant should be sitting and the exam room should be warm to relax the muscles when massaging the inguinal canal. Another option is to examine the infant during or after a warm bath.

Question 44

Which of the following is NOT one of the Jones criteria for pelvic inflammatory disease (PID)?

lower back pain

cervical motion tenderness

adnexal tenderness

lower abdominal tenderness

Correct answer:

lower back pain

The Jones criteria are the major criteria for PID. Only one of the criteria is necessary to diagnose and treat for PID. All of the choices are one of the Jones criteria except lower back pain

Question 45

Which of the following would NOT be a breach of patient confidentiality?

discussing a patient’s condition with the nurse assistant assigned to the patient

discussing a patient’s condition with family members

giving a patient’s name and address to a vendor

talking about a patient within earshot of others

Correct answer:

discussing a patient’s condition with the nurse assistant assigned to the patient

All of the choices would be a breach of patient confidentiality except this one. Other breaches include: releasing medical information about a patient without prior written permission, leaving a telephone message on a patient’s answering machine, leaving patient records within view of others, and discarding unshredded duplicate records.

Question 46

Osteoporosis is indicated by a bone density score of which of the following?

less than -2.5

between -1 and -2.5

greater than -1

none of the above

Correct answer:

less than -2.5

Interpretation of bone density testing is based on a T score, which refers to the number of standard deviations above or below the average value in young adults of the same gender. Osteoporosis is a bone density indicated by a T score less than -2.5. It is also indicated by the presence of fragility fractures, irrespective of the bone density test results.

Question 47

A 16-year-old male is in the office. He has a insect bite on his left forearm and you suspect a brown recluse spider bite. What medical management would you provide?

ice pack and elevation of the area

active and passive range of motion (ROM) to the area

avoidance of antihistamines

warm moist soaks to the affected area

The Correct answer is:

Ice pack and elevation of the area

Ice packs are preferred to heat to decrease the edema. The area should be immobilized and tetanus toxoid given. Antihistamines may reduce the swelling and relieve site itching

Question 48

You have a 58-year-old female patient who is post-menopausal and whom you have diagnosed as having an ovarian cyst. The cyst is 3 cm and the client has no other risk factors. Which of the following actions would you take for this patient?

Refer for emergency care.

Recheck her at 6 weeks.

Refer to a surgeon.

Do nothing.

Correct answer:

Recheck her at 6 weeks.

If the patient is post-menopausal, the cyst is smaller than 5 cm, and the patient does not have any other risk factors, you would recheck her in 6 weeks, and then again at 3 months, and then 6 months. Refer the patient if there is any increase in size of the mass.

Question 49

A 70-year-old male comes to the FNP with a raised, red lesion in his oral cavity. He tells the FNP that he is afraid that it is cancer. Besides evaluating the lesion the FNP evaluates the man’s risk for oral cancer. These risks include all of the following EXCEPT:

poor diet

alcohol abuse

tobacco abuse

advanced age

Correct answer:

poor diet

Poor diet is not a risk factor for oral cancer. Alcohol and tobacco use and advanced age are risks.

Question 50

The Health Insurance Portability and Accountability Act of 1996 (HIPPA) protects the privacy of patients and their health care records. All of the following are basic requirements of the privacy rule EXCEPT:

Providers and their staff are restricted to conveying the minimum necessary information about patients.

If a provider wants to release patient information for marketing purposes, the patient must authorize the use of the information in writing.

Providers may not disclose health information to oversight agencies, such as CMS without patient authorization.

Individuals have no right to psychotherapy notes, information compiled in anticipation of civil or criminal litigation and certain clinical laboratory information.

Correct answer:

Providers may not disclose health information to oversight agencies, such as CMS without patient authorization.

This is not a requirement of the privacy rule. Providers may disclose health information to oversight agencies, such as CMS without patient authorization.

Question 51

A 38-year-old male patient complains of a sudden onset of severe “ice pick” pains behind one eye. The headache is accompanied by tearing, a clear runny nasal discharge and a drooping eyelid. What type of headache does he have?

muscle tension headache

migraine headache

cluster headache

temporal arteritis

Correct answer:

cluster headache

Cluster headaches are severe headaches with lancinating pain behind one eye that occurs several times a day, usually at the same times every day. Their cause is unknown and they are more common in adult males in their 30s and 40s.

Question 52

Human papillomavirus (HPV) is considered the causal agent in what percentage of cervical cancers worldwide?

75.5%

89.2%

90.9%

99.8%

Correct answer:

99.8%

Human papillomavirus (HPV) is now considered the causal agent in 99.8% of cervical cancers worldwide. HPV strains 16, 18, 31, 33, 39, and 42 are strongly associated with cervical cancer.

Question 53

Psoriasis is an inherited skin disorder. All of the following are typical treatments for psoriasis EXCEPT:

Psoralen drugs

methotrexate

Goeckerman regimen

systemic penicillin

Correct answer:

systemic penicillin

Topical steroids and tar preparations (Psoralen drugs) are used for psoriasis. Systemic drugs such as methotrexate are used for severe forms of the disease as is the Goeckerman regimen. Systemic penicillin would not be used as this is a drug that is used for infections, not for psoriasis, a condition where the squamous epithelial cells undergo rapid mitotic division producing psoriatic plaque.

Question 54

When assessing a rash near the eye and side of the temple, the nurse practitioner understands that herpes keratitis has what signs and/or symptoms?

blindness, painful swollen hair follicle

small nodule that moves under the skin of the eyelid

acute onset of eye pain, photophobia and blurred vision in the affected eye

a yellow triangular thickening of the conjunctiva

The Correct answer is:

Acute onset of eye pain, photophobia and blurred vision in the affected eye

Herpes keratitis is caused by a herpes virus infection, usually shingles, and it causes these signs and symptoms. A stye or hordeolum is a painful acute bacterial infection of a hair follicle on the eyelid that does not result in blindness. A chalazion results in a movable nodule. Then, pterygium presents with a yellow triangular thickening of the conjunctiva.

Question 55

Medications may produce anxiety as a side effect. Of the following, which medication is least likely to have this effect?

corticosteroids

bronchodilators

antihistamines

antibiotics

Correct answer:

antibiotics

Antibiotics are the least likely of the choices to produce anxiety as a side effect. Besides the other three choices, anticholinergics, antihypertensives, antipsychotics, antidepressants, amphetamines, and anesthetics may also produce anxiety.

Question 56

Which of the following best defines a hospitalist?

a physician or nurse practitioner who specializes in the care of hospitalized patients

a member of a hospital accreditation board

any physician or nurse practitioner who has hospital privileges

none of the above

Correct answer:

a physician or nurse practitioner who specializes in the care of hospitalized patients

To increase efficiency, physicians and nurse practitioners can specialize in the care of hospitalized patients. These clinicians are called hospitalists.

Question 57

A 45-year-old African-American male reports chest pain that is sudden and severe. Also, the male patient describes the pain as "tearing." You notice that the pain is accompanied by a decrease in peripheral pulses. You understand that this may indicate a diagnosis of:

pericarditis

aortic dissection

acute MI

angina

The Correct answer is:

Aortic dissection

Aortic dissection almost invariably begins with sudden onset of severe chest pain that is tearing or ripping in quality and is accompanied by absent or decreased peripheral pulses and neurologic deficits. The pain of angina and acute myocardial infarction (MI) is usually described as "pressure" by the patient. Pericarditis produces pain that is more gradual in its onset.

Question 58

A woman who has been on hormone replacement therapy (HRT) is likely to have some possible improvement. Which of the following is one of these?

A decrease in the symptoms associated with menopause.

A reduction in the risk of dementia.

A reduction in the risk of osteoarthritis.

A reduction in the risk of endometrial cancer risk.

The Correct answer is:

A decrease in the symptoms associated with menopause

As with all medication, the use of HRT comes with the possibility of adverse effects. There is no decrease in the risk of dementia or osteoarthritis. There is a reduction of osteoporosis risk. Endometrial cancer risk, and not a reduction in the risk, with unopposed estrogen exists.

Question 59

Which of the following vaccines is NOT a live attenuated vaccine?

MMR

varicella

Salk polio

varicella zoster

Correct answer:

Salk polio

An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable (or "live"). Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent. The Salk polio vaccine is not a live attenuated vaccine.

Question 60

A positive Homan’s sign is associated with which of the following?

deep vein thrombosis

superficial thrombophlebitis

peripheral vascular disease

Raynaud’s phenomenon

Correct answer:

deep vein thrombosis

Deep vein thrombosis (DVT) occurs when a thrombus develops in the deep venous system of the legs or pelvis. On physical exam of a patient with DVT, a positive Homan’s sign (lower leg pain on dorsiflexion of the foot) is noted

Question 61

You are advising your patient with diabetes about exercise and diet. You would tell this patient all of the following EXCEPT:

Exercising heavily will decrease the risk of hypoglycemia in the evening and at bedtime.

Skipping a meal will increase the risk of hypoglycemia in the evening and at bedtime.

Eat simple carbohydrates before or during exercise and complex carbohydrates after exercise.

Exercise increases glucose utilization.

Correct answer:

Exercising heavily will decrease the risk of hypoglycemia in the evening and at bedtime.

This is not correct. Exercising heavily will increase the risk of hypoglycemia in the evening and at bedtime and should be avoided. In older diabetics preexisting CHD should be ruled out before starting an exercise program by administering a stress test.

Question 62

Some employers offer the NP the opportunity for bonuses. If a bonus is based on the number of patient visits per year it is which of the following types of bonus formulas?

quality-based

profit-based

patient satisfaction-based

productivity-based

Correct answer:

productivity-based

A formula based on the number of patient visits per year is a productivity-based formula. This type of formula makes good business sense under a fee-for-service arrangement.

Question 63

What type of headache is typically described as "pressing" in quality?

migraine headache

tension-type headache

cluster headache

simple stress headache

The Correct answer is:

Tension-type headache

Tension-type headache is pressing, nonpulsatile pain, mild to moderate in intensity and usually bilateral in location. Migraine headache is described as pulsating quality, usually unilateral, with associated nausea and photophobia. Cluster headache is often behind one eye, steady and intense. Simple stress headache is a fictitious term, which makes it an incorrect answer choice

Question 64

Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option. The four levels of evaluation and management services include all of the following EXCEPT:

high complexity

low complexity

straightforward

up-front

Correct answer:

up-front

There is no up-front level of E/M services. The four types of medical decision making are: straightforward, low complexity, moderate complexity and high complexity

Question 65

Which of the following is NOT one of the basic requirements/allowances of the HIPAA privacy rule?

Providers releasing patient information for marketing purposes must explain to the patient how the information will be used, to whom it will be disclosed, and the time frame.

Providers and their staff are restricted to conveying the “minimum necessary information” about patients.

Providers may disclose health information to oversight agencies.

In general, providers may disclose psychotherapy notes without patient consent.

Correct answer:

In general, providers may disclose psychotherapy notes without patient consent.

There are special rules for psychotherapy notes. In general, patient authorization is required in order to disclose psychotherapy notes to carry out treatment, payment or healthcare operations.

Question 66

Lead is primarily absorbed through which of the following body systems?

neurologic

integumentary

respiratory and gastrointestinal

integumentary and lymphatic

Correct answer:

respiratory and gastrointestinal

Lead is absorbed primarily through the respiratory and gastrointestinal systems. After lead is absorbed into the bloodstream most of it is bound to red blood cells.

Question 67

Which of the following statements about collaborative agreements is incorrect?

It is a written document between a physician and a nurse practitioner.

It is never submitted to the board of nursing.

It outlines the nurse practitioner’s role and responsibility to the clinical practice.

It must be signed by both the physician and the nurse practitioner.

Correct answer:

It is never submitted to the board of nursing.

All of the choices are true statements except this one. The collaborative agreement is usually submitted to the board of nursing.

Question 68

A 16-year-old female patient inquires about douching. You are counseling on birth control, safe sexual practices and hygiene. What instruction regarding douching should the nurse practitioner include?

Hypoallergenic douches include flavored or perfumed types.

Douching during menstruation is a safe effective practice.

Douching removes natural mucus and upset normal vaginal flora.

Daily douching is important if the patient has copious vaginal discharge.

The Correct answer is:

Douching removes natural mucus and upsets normal vaginal flora

Douching is never necessary because it upsets the normal vaginal flora and disrupts pH. Douching is contraindicated during menstruation due to "retrograde menstruation," a potential precursor to endometriosis. Further, a patient with copious vaginal discharge needs to be evaluated for an infection.

Question 69

The ability to conduct a cultural assessment to collect relevant cultural data regarding the patient’s presenting problem as well as accurately conducting a culturally-based physical assessment is called:

cultural diversity

cultural awareness

cultural skill

cultural desire

Correct answer:

cultural skill

Cultural skill is the ability to conduct a cultural assessment to collect relevant cultural data regarding the patient’s presenting problem as well as accurately conducting a culturally-based physical assessment. It is part of the “ASKED” mnemonic to promote becoming culturally competent.

Question 70

You have a patient complaining of severe pain in the great toe in which you observe erythema. He tells you that this happened quite quickly and got to the point of being severe in just a few hours. You suspect acute gout. Which of the following tests is the only confirmatory test for acute gout?

joint aspiration

serum uric acid

creatinine, BUN

24-hour urine for urate and creatinine

Correct answer:

joint aspiration

Joint aspiration is the only confirmatory test for acute gout. It can find MSU crystal in phagocytes or free in tophi, seen under a polarized microscope. The other tests are of limited value in acute gout.

Question 71

Of the following prostaglandin inhibitors, which one is a proprionic acid?

Naproxen

Mefenamic acid

Indomethacin

Diflunisal

Correct answer:

Naproxen

Naproxen is a proprionic acid along with Ibuprofen and naproxen sodium. Mefenamic acid is a fenamate and the other two choices are acetic acid/salicylic acids.

Question 72

Which of the following types of research is most likely to be considered a philosophy as well as a research method?

phenomenology

quasi experimental research

longitudinal research

cross-sectional research

Correct answer:

phenomenology

Phenomenology is both a philosophy and a research method. The purpose is to describe experiences as they are lived and to capture the “lived experience” of study participants

Question 73

Which of the following is a secondary prevention measure?

educating a diabetic about exercise and diet

immunizations

bicycle helmets

mammogram

Correct answer:

mammogram

All screening tests are secondary prevention measures. A mammogram and breast exam are secondary prevention measures.

Question 74

A mother brings her 8-year-old son to your office. She tells you that he has had no immunizations but she would like him to have all of the necessary immunizations now. Which of the following immunizations would NOT be necessary for this child?

PCV (3 doses)

Td (3 doses primary, then every 10 years)

IPV (3 doses)

MMR (2 doses)

Correct answer:

PCV (3 doses)

PCV (pneumococcal conjugate vaccine) is not given after age 7 years. All of the other immunizations should be given along with Hepatitis B (3 doses).

Question 75

When you say something to a patient such as, “Let me be sure that I understand what you are saying,” this is which of the following forms of therapeutic communication?

validation

caring

active listening

honesty

Correct answer:

validation

Validation is listening to the patient and responding congruently in order to be sure that you have the same understanding as the patient. Active listening is hearing and interpreting language, noticing nonverbal and paraverbal enhancements, and identifying underlying feelings.

Question 76

Severe cough, fever, conjunctivitis, photophobia, and Koplik’s spots are most related to which of the following?

scarlet fever

measles

rubella

roseola

Correct answer:

measles

A person with measles will present with severe cough, fever, conjunctivitis, photophobia, and/or Koplik’s spots. The rash will be bright red to purple macules and papules ofent becoming confluent

Question 77

There are two approaches to nursing research. They are which of the following?

academic and practical

direct and indirect

professional and non-professional

quantitative and qualitative

Correct answer:

quantitative and qualitative

There are two approaches to nursing research: quantitative and qualitative. Both involve rigor that produces credible data for evidence-based practice, and both make significant contributions to nursing science

Question 78

A male patient has asked you for a prescription of Viagra. After a careful history, you make the determination that he has erectile dysfunction (ED). The nurse practitioner understands that ED is:

Not a condition associated with men over age 70

Primarily psychological in origin

The persistent inability to achieve and maintain an erection adequate for sexual intercourse.

The physiologic dysfunction when smooth muscles contract, causing a lack of adequate amounts of blood in the penis to render a rigid, larger penis.

The Correct answer is:

The persistent inability to achieve and maintain an erection adequate for sexual intercourse

Erectile dysfunction is experienced by 40% of men over 40 years of age and 70% of men over 70. It involves a dysfunction in the hemodynamic mechanism of smooth muscle relaxation that increases blood flow in the penis.

Question 79

Which of the following is another term for statutory authority?

regulation

legal authority

contract authority

administrative rule

:

Correct answer:

legal authority

Statutory authority is legal authority. Elected officials (the legislature) vote on a bill such as the Nurse Practice Act. Bills that pass become law and have statutory authority.

Question 80

Which of the following is NOT true regarding healthcare issues in the United States?

Most of Americans have access to healthcare and are being adequately treated.

Of all children, 13% are uninsured.

It is estimated that 45+ million Americans are underserved because of limited access to healthcare.

Many of the working poor cannot obtain healthcare because of the high costs of insurance, fees and medications.

The Correct answer is:

Most of Americans have access to healthcare and are being adequately treated

There is a large portion of Americans who do not have access to healthcare.

Question 81

Which of the following is an orthopedic maneuver of the knee to test for damage to the meniscus?

Drawer sign

McMurray sign

Lachman sign

Goodell’s sign

Correct answer:

McMurray sign

The McMurray sign is an orthopedic maneuver of the knee to test for damage to the meniscus. If the knee locks up and the patient is unable to fully extend the affected knee, the test is positive.

Question 82

Your pregnant patient is approaching her estimated delivery date. She asks you for some information about how big her baby will be. You might tell her all of the following EXCEPT:

95% of newborns weight 7 – 10 lb.

95% of newborns are between 18 and 22 in. long.

Approximately 5% - 10% of body weight is lost in the first few days.

The weekly gain from birth to 6 months is 5 – 7 ounces per week.

Correct answer:

95% of newborns weight 7 – 10 lb.

This is not correct. 95% of newborns weight 5 – 10 lb. Approximately 5% - 10% of body weight is lost in the first few days; then birthweight is regained in 7 – 10 days.

Question 83

You have a patient who is a 22 month old male. He presents with a low-grade fever. Your initial treatment for this patient would be which of the following?

Do nothing.

Give antipyretics and observe.

Obtain a CBC.

Give prophylactic antibiotics for 3 days pending blood culture results.

Correct answer:

Give antipyretics and observe.

For children over 3 months of age who present with a low-grade fever, you would give antipyretics and observe. If fever is over 102° F, then you would obtain a CBC. If the WBC is greater than 15,000/mm3, then you would obtain a blood culture and administer IM Ceftriaxone.

Question 84

What is the reason the Standards of Nurse Practitioner Practice were established?

They are established to promote autonomous practice.

They are established to limit the liability of nurse practitioners.

They are established to regulate and control nurse practitioner practice.

They are established to protect nurse practitioners from frivolous lawsuits.

The Correct answer is:

They are established to regulate and control nurse practitioner practice.

The reason Standards of Practice exist in all healthcare related specialties (nursing, medicine, dental, etc.) is that they regulate and control practice. The purpose of Standards of Practice is to provide accountability for professionals and to help protect the public from unethical behavior and unsafe practice. The remaining answer choices are not reasons for the establishment of Standards of Nurse Practitioner Practice.

Question 85

The FNP has a menopausal woman patient who is troubled by hot flashes. The FNP tells her that they can often be reduced in number and minimized in severity with simple lifestyle changes. All of the following would be a hot flash trigger EXCEPT:

chocolate consumption

alcohol use

tight, restrictive clothing

cold baths or showers

Correct answer:

cold baths or showers

Hot baths or showers are hot flash triggers, not cold baths or showers. In addition to the other choices which are all hot flash triggers, other triggers include: spicy foods, elevated ambient temperature and humidity, and cigarette smoking.

Question 86

For which of the following would the FNP use the bell of the stethoscope?

mid-to high-pitched tones such as lung sounds

low tones such as the extra heart sounds

mitral regurgitation

aortic stenosis

Correct answer:

low tones such as the extra heart sounds

The bell of the stethoscope is used for low tones such as the extra heart sounds (S3 or S4) as well as for mitral stenosis. The diaphragm of the stethoscope is used for all of the other choices given.

Question 87

Which of the following diseases/conditions is least likely to increase susceptibility to meningitis?

hypertension

sickle cell anemia

diabetes

alcoholism

Correct answer:

hypertension

Of the choices hypertension is the least likely to increase susceptibility to meningitis. Other factors increasing susceptibility include: basilar skull fracture; indwelling CSF shunting device; debilitation or institutionalization; and contact with others who have had meningitis.

Question 88

The most likely associated symptoms of dementia include all of the following EXCEPT:

insidious onset over months or years

loss of intellectual or cognitive function

mental status changes

acute onset over hours to a few days

The Correct answer is:

Acute onset over hours to a few days

Delirium has an acute onset over hours to a few days and is a condition in which the patient exhibits reduced ability to maintain attention to external stimuli and shift attention appropriately to new stimuli. The other answer choices are all true of dementia, making them incorrect answers in this case. Dementia has an insidious onset over months or years.

Question 89

Which of the following is NOT a conceptual model for advanced practice nursing?

Benner’s model

Shuler’s model

Calkin’s model

Ford model

Correct answer:

Ford model

There is no Ford model of NP practice; however, Loretta Ford established the first pediatric nurse practitioner program.

Question 90

A good quality assurance program should do which of the following?

identify educational needs

improve the documentation of care

reduce the clinician’s overall exposure to liability

all of the above

Correct answer:

all of the above

A good quality assurance program would include all of the first three choices. These programs also look at organizational effectiveness, efficiency, and client and provider interactions

Question 91

Which of the following medications might you prescribe for a patient with acute bronchitis?

Robitussin

Guaifenesin

Ventolin

any of the above

Correct answer:

any of the above

All of the medications listed in the choices might be prescribed for a patient with acute bronchitis. You would also increase fluids and if the patient smokes, have them stop smoking, if possible.

Question 92

Which of the following drugs would NOT be a prophylactic treatment for migraine headaches?

beta-blockers

tricyclic antidepressants

prednisone

amitriptyline

Correct answer:

prednisone

Prednisone would not be a prophylactic measure for migraine headaches. It would be used, however, if the FNP suspects temporal arteritis.

Question 93

The FNP has an adult male patient in the clinic who woke up with one side of his face paralyzed. He cannot fully close his eyelid and has difficulty chewing and swallowing food on that side of his face. Which of the following is the most likely diagnosis?

Bell’s Palsy

trigeminal neuralgia

focal migraine

acute bacterial meningitis

Correct answer:

Bell’s Palsy

Bell’s Palsy is the abrupt onset of unilateral facial paralysis that is due to dysfunction of the motor branch of the facial nerve (CN 7). Facial paralysis can progress rapidly within 24 hours. Skin sensation remains intact but tear production on the affected side may stop. Most cases spontaneously resolve.

Question 94

One part of a spectrum of disease that is often found together with giant cell arteritis is which of the following?

polymyalgia rheumatica

migraine headache

blindness

brain tumor

Correct answer:

polymyalgia rheumatica

Giant cell arteritis and polymyalgia rheumatica are thought to represent two parts of a spectrum of disease and are often found together. Blindness is a serious complication of the disease.

Question 95

A 32-year-old female with interstitial cystitis (IC) is in the office. She has been newly diagnosed and you are counseling her. All of the following are important to discuss EXCEPT:

Discuss that interstitial cystitis is not a malignancy or a risk factor for a more serious disease.

Teach the patient the importance of adequate nonirritating fluid intake.

Remind her that cigarette smoking can irritate the bladder.

Discuss the measures for curative treatment.

The Correct answer is:

Discuss the measures for curative treatment

Interstitial cystitis is an incurable condition that involves painful urination, frequency, urgency and nocturia. It is chronic and can be controlled, not cured. Treatment aims are directed at relief of symptoms. The remaining answers are important as patient education information.

Question 96

Which of the following is NOT one of the stages in Erikson’s theory of psychosocial development?

trust

autonomy

initiative

loyalty

Correct answer:

loyalty

Loyalty is not one of Erikson’s stages of psychosocial development. The eight stages are: trust, autonomy, initiative, industry, identity, intimacy, generativity, and ego identity.

Question 97

Which of the following patient is most likely to qualify and be using Medicaid as their insurance?

the single mother of four dependent children, age 26

a middle aged female who works for the government, age 47

a young male factory worker, age 23

an elderly retired high school teacher, age 78

The Correct answer is:

The single mother of four dependent children, age 26

Medicaid is a federally mandated program that guarantees healthcare services to low-income families with dependent children and to low-income and disabled individuals. Government employees and factory workers are most likely insured through a commercial carrier or uninsured. An elderly teacher would have Medicare since they have paid into the federal retirement system and are over 65 years of age

Question 98

Which of the following tests is federally mandated for infants?

TSH

Lead screening

PKU

all of the above

Correct answer:

PKU

PKU (phenylketonuria) is a federally mandated test. Severe mental retardation may develop if this is not treated early.

Question 99

The continuing occurrence of new cases of a disease is known as which of the following?

prevalence rate

colonization rate

infectivity rate

incidence rate

:

Correct answer:

incidence rate

The incidence rates describe the rate of development of a disease in a group over a period of time or the continuing occurrence of new cases of disease. It differs from the prevalence rate which describes a group at a certain point in time and the number within the group that has a particular disease or problem.

Question 100

A mother brings her infant to the clinic to say that he has tearing in both eyes. The FNP also sees a mucoid discharge. Which of the following conditions/diseases might this indicate?

congenital lacrimal duct obstruction

Wilms tumor

Fifth disease

Kawasaki disease

Correct answer:

congenital lacrimal duct obstruction

Congenital lacrimal duct obstruction is a failure of the tear duct to open at birth. A thin membrane blocks the entrance of the nasolacrimal duct causing tear blockage. This is a condition that spontaneously resolves.

Quiz 6 ancc

Question 1

The nurse practitioner (NP) understands that the following is NOT true regarding the care of minors:

In most jurisdictions, minors under the age of 18 cannot receive healthcare services without permission of an adult who is a parent or legal guardian.

If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian.

In case of emergency, when no parent or guardian is available, care may be rendered.

If a 15-year-old becomes pregnant, she is an emancipated minor.

The Correct answer is:

If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian

A teen with a STD is considered an emancipated minor, and the parent or legal guardian should not be contacted. The remaining answer choices are true regarding the care of minors.

Question 2

You are conducting a health assessment with a patient. She tells you that she does not understand what will happen during the tests she will undergo the next day. Which of the following is an appropriate nursing diagnosis for this patient?

Low health literacy.

Knowledge deficit.

Patient needs further education.

Patient does not understand care plan.

Correct Answer: Knowledge deficit It is key to note that the patient does not fully understand the tests or procedures prescribed. The next step should be to provide patient education. Patients who are educated about tests and care protocols have been shown to have much higher rates of compliance, and proper education also empowers patients.

Question 3

Which of the following tests is used to measure lower esophageal sphincter (LES) tone?

Bernstein test

barium swallow radiograph

Barrett test

none of the above

Correct answer:

Bernstein test

The Bernstein test measures the LES competence. The Bernstein test is a method to reproduce symptoms of heartburn. It is usually done with other tests to measure esophageal function.

Question 4

You are treating a 48-year-old male who is suffering with alcoholism. The first most helpful approach for him is:

Inform the patient of the long-term health consequences of alcohol abuse.

Tell the patient to stop drinking.

Refer the patient to Alcoholics Anonymous.

Counsel the patient that alcohol abuse is a treatable disease.

The correct answer is:

Counsel the patient that alcohol abuse is a treatable disease

The first approach for the nurse practitioner is to counsel the patient and family that alcoholism is a lifelong but treatable disease. In addition, asking about current drinking habits and associated consequences to health with each visit is important and are appropriate next steps. Then, the remaining answer choices are also important interventions after the nurse practitioner counsels the patient and the family regarding alcoholism as a treatable disease.

Question 5

A 44-year-old Caucasian female is taking lovastatin for hyperlipidemia and complains of muscle aches in her thighs and right calf for three days without improvement. She has been on the medication for 3 months. What should the nurse practitioner do first?

Check bilirubin enzymes.

Order a CPK.

Ask about nighttime muscle cramps.

Stop lovastatin immediately.

The Correct answer is:

Order a CPK

This patient has a complaint of myalgias that could be associated with statin use. This patient should be assessed for rhabdomyolysis by measuring the creatine phosphokinase (CPK) level. If the CPK value is elevated, lovastatin should be stopped immediately. Nighttime cramps are not associated with statin usage.

Question 6

You are providing care to a female patient who is 6 months pregnant. She is suffering from hemorrhoids. Which of the following may help alleviate her discomfort?

Sleeping on her stomach.

Sleeping on her side.

Sleeping on her back.

Sleeping with the head slightly elevated.

Correct Answer: Sleeping on her side For patients who are not pregnant, sleeping on the stomach can alleviate pressure on inflamed blood vessels that lead to hemorrhoids. Pregnant patients should instead sleep on their side, as sleeping on the stomach can be uncomfortable especially in later stages of pregnancy. Warm sitz baths may also help alleviate discomfort caused by hemorrhoids.

Question 7

When assessing a client for systemic lupus erythematosus (SLE), what ophthalmologic finding would the nurse practitioner find that would be consistent with this diagnosis?

cotton-wool spots

arteriovenous (AV) nicking

retinal hemorrhages

conjunctivitis

The Correct answer is:

Cotton-wool spots

Cotton-wool spots are the most common ophthalmological problems associated with systemic lupus erythematosus (SLE). Retinal hemorrhages and AV nicking are seen in patients with hypertension. Additionally, conjunctivitis is an infection of the conjunctiva.

Question 8

According the CDC classification of overweight and obesity, a person with a BMI (kg/m2) of 27.0 would be classified as:

healthy weight

overweight

obese

extremely obese

Correct answer:

overweight

Persons with a BMI (kg/ m2) of 25 – 29.9 are classified as overweight. A person of healthy weight would have a BMI of 18.5 – 24.9.

Question 9

Which of the following statements is TRUE concerning managed care today?

Managed care is declining in favor in the healthcare system of the United States.

The proportion of managed care revenue declined over the last 10 years.

More consumers are switching from HMOs to plans where there is more choice, less control by a gate keeping provider, and no prior approval for referrals.

The monitoring of managed care plans by the American Nurses Association and the American Medical Association has contributed to their popularity.

The Correct answer is:

More consumers are switching from HMOs to plans where there is more choice, less control by a gate keeping provider, and no prior approval for referrals

Managed care now dominates healthcare in the U.S. and over 50% of revenue received by all physicians is from managed care. Managed care plans are monitored by state and federal government, not the ANA and AMA.

Question 10

An obese child's health is in danger from the weight. What will have an effect on the nutritional assessment?

Age.

Family and culture.

Medical history.

Chief complaint.

Correct answer: Family and culture Eating habits are influenced by family and culture. This can be determined in the social assessment and family interviews.

Question 11

Which of the following types of headache has a higher risk of suicide in males?

cluster headaches

migraine headaches

muscle tension headaches

temporal arteritis

Correct answer:

cluster headache

A cluster headache is a sudden onset of severe “ice-pick” headaches behind one eye that occurs several times a day. The attacks happen at the same times daily and the cause is unknown. There is a higher risk of suicide in males who have this type of headache as compared with the other types of chronic headaches

Question 12

What medication and dose can be used for abortive therapy in an adult client with symptoms of migraine headache?

ergotamine (Ergostat) 2 mg SL

ketorolac (Toradol) 100 mg IM

sumatriptan (Imitrex) 1 mg IM

amitriptyline (Elavil) 100 mg PO

The Correct answer is:

Ergotamine (Ergostat) 2 mg SL

The dosing guideline for ergotamine (Ergostat) is 2 mg by mouth, sublingually. Further, additional treatment options for a migraine headache can also include Ketorolac and Sumatriptan, as well as other medications. Depending on the patient's severity of symptoms and medical history, the following are dosing guidelines providers can use to administer Ketorolac and sumatriptan. For Ketorolac, the provider can administer the drug intravenously or intramuscularly before administering orally as a tablet. When taking Ketorolac orally, the dosing guidelines are 30-60 mg. The patient is given an initial first dose of two 20 mg tablets. After the first dose, the patient is given one 10 mg tablet every 4-6 hours for up to 5 days. The dosing for Ketorolac should not exceed 40 mg per day. Therefore, the answer choice stating "ketorolac (Toradol) 100 mg IM" is incorrect, as 100 mg is too high of a dosage. Next, Sumatriptan (Imitrex) dosing guidelines include oral (25-200 mg daily) and subcutaneous injections (6-12 mg) administration, as well as administration of the medication by a nasal spray (5-20 mg as 1 spray in each nostril and then up to 40 mg a day.) Therefore, the answer choice with the dosing of 1 mg IM for sumatriptan (Imitrex) is incorrect. Then, amitriptyline is not used for abortive therapy.

Question 13

For which of the following CPT codes is one descriptor and nothing further required for taking the history of an established patient?

99211

99212

99213

99214

Correct answer:

99212

Of the five levels of visit for an established patient, the 99212 level has the requirement of 1 descriptor for patient history.

Question 14

An elderly male has a diagnosis of left-sided congestive heart failure (CHF). The nurse practitioner would identify which of the following as a common condition associated with CHF?

ventricular dysrhythmias

peripheral vascular disease

untreated hypertension

chronic obstructive pulmonary disease

The Correct answer is:

Untreated hypertension

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

Question 15

Which of the following tests would you order to confirm a diagnosis of strep throat?

Throat culture.

Sputum culture.

CBC.

Mono test.

Correct Answer: Throat culture Throat culture is the classic diagnostic tool for strep throat. This test involves a swab of the throat. If the throat culture does not reveal strep, other tests such as the mono test may be in order

Question 16

The FNP is seeing a college-age female who participated in strenuous sports activities in high school. The FNP understands that all of the following may be a risk for this patient EXCEPT:

menorrhagia

eating disorders

delayed menses

osteoporosis

Correct answer:

menorrhagia

Menorrhagia (heavy menstrual bleeding) is not a common concern for women who take part in strenuous physical activity. Females who participate in strenuous physical activities are at risk for eating disorders, delayed menses and osteoporosis.

Question 17

You are dealing with a pregnant adolescent who is drinking alcohol. What should the nurse practitioner understand concerning this?

There is no level or time of exposure that is considered to be safe.

The risk to the fetus from alcohol exposure is greatest during the third trimester.

This is not problematic since there is not an increased risk of miscarriage.

The risk of fetal alcohol syndrome exists only if the patient consumes alcohol during the entire pregnancy.

The Correct answer is:

There is no level or time of exposure that is considered to be safe.

Fetal alcohol syndrome (FAS) occurs more commonly in infants whose mother drinks during pregnancy. This condition is preventable and no safe level of maternal alcohol ingestion during pregnancy exists. FAS can occur if alcohol is ingested at any time during the pregnancy and miscarriage is a risk. Therefore, the pregnant female does not need to drink during the entire pregnancy for FAS to occur.

Question 18

A 65 year old female patient's records indicate that her pap smears have been negative for the past 15 years. How may you alter her physical exam?

Perform a pap smear every year.

Do not perform a pap smear.

Begin testing for Chlamydia.

Perform a breast exam.

Correct answer: Do not perform a pap smear It may be possible to suspend pap smears after a patient turns 65. She must have at least 10 years of negative results to cease the screening for cervical cancer.

Question 19

You are working in an urgent care clinic within a hospital emergency department. A patient without insurance arrives who has a puncture wound caused by an unknown sharp object in a trash container. A dirty needle is suspected. The nurse practitioner should:

administer a tetanus injection only since the patient has no insurance

prescribe appropriate mediations for HIV exposure even though the patient has no resources to buy them

not mention the possibility of HIV from a contaminated needle

offer to buy the HIV medications for the patient and use your employee discount at the pharmacy

The Correct answer is:

Prescribe appropriate mediations for HIV exposure even though the patient has no resources to buy them

The standard of patient care should be followed by the nurse practitioner. This measure should not be altered depending on the patient's insurance and financial status. It is unethical to not properly inform this patient of the risks involved for being exposed to a contaminated needle. You should prescribe the medications and refer them to social services or a community resource agency for assistance. Buying the medications for the patient with an employee discount is unethical and should not be done.

Question 20

Which of the following drugs that might be prescribed for a patient with asthma and chronic obstructive pulmonary disease (COPD) is not used specifically for treatment and prevention of bronchospasm?

theophylline

Singulair

Atrovent

Spiriva

Correct answer:

Singulair

All of the medications might be used for treatment and prevention of bronchospasm except Singulair. This drug is a leukotriene receptor antagonist that inhibits the action of the inflammatory mediator (leukotriene) by blocking select receptor sites. it is a controller drug used to prevent inflammation.

Question 21

The FNP is communicating with a patient about controlling her blood sugar. The patient tells the FNP that she is afraid that she will have to take insulin shots soon. Which of the following statements would demonstrate using the therapeutic communication technique of reflection?

What would it be like for you to have to take insulin shots every day?

If that is necessary a specialist will show you just what to do.

Maybe you should be more vigilant about your diet.

Don’t worry. That’s not likely to happen.

Correct answer:

What would it be like for you to have to take insulin shots every day?

In using reflection, the FNP takes one or two words said by the patient to reflect back to the patient for consideration. By asking her, “What would it be like for you to have to take insulin shots every day?” the FNP is using reflection.

Question 22

There are many barriers to the electronic medical record. The NP understands that which of the following is NOT one of these issues?

technical matters: uncertain quality, ease of use, lack of integration

potential for streamlining and automating workflow

financial matters: maintenance, upgrades, replacement

doubts of clinical usefulness

The correct answer is potential for streamlining and automating workflow. Streamlining and automating the workflow is considered a benefit of the electronic medical record, not a barrier. Other barriers include resource issues (training and re-training), certification, security, and ethical matters.

Question 23

The mother of an infant calls and says that her son has a fever. He is also sleeping more and difficult to wake up. What is the appropriate advice?

Give the child baby aspirin.

Monitor the child overnight.

Bring the child to the emergency room.

Call in a prescription.

Correct answer: Bring the child to the emergency room A high fever and lack of responsiveness can indicate a serious condition in a infant. He should be seen as soon as possible.

Question 24

You evaluate a 52-year-old female with rheumatoid arthritis who has an abnormal hemogram. Her results include:

Hgb = 9.8 g

Hct = 32%

MCV = 86 fL

These results are most consistent with which type of anemia?

folate-deficiency anemia

iron-deficiency anemia

sickle cell anemia

anemia of chronic disease

The Correct answer is:

Anemia of chronic disease

Anemia is defined as a decrease in the oxygen-carrying capability of the blood. This condition is not a 'disease' but rather a sign or symptom of an underlying process. With anemia of chronic disease, you will find normal size red blood cells (RBCs) but low hemoglobin (Hgb) and hematocrit (Hct) levels. Mean corpuscular volume (MCV) is often normal. With folate-deficiency anemia, MCV is often elevated. With iron-deficiency anemia, MCV is often low. Sickle cell anemia results in abnormal shape of cells

Question 25

The earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers is:

age 2 years

age 3 years

age 4 years

age 5 years

The Correct answer is:

Age 5 years

Common developmental tasks for the 5-year-old child would include the ability to draw a person with a body, head, and arms and recognize most letters and print some. Further, the child knows how to skip, copy a triangle, count on fingers and knows colors.

Question 26

If a mother asks the FNP when her toddler should be toilet trained, which of the following would be the best response?

Most children should be toilet trained at about two year of age.

Do not start toilet training until the child is over three years of age.

When the child has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he is ready.

none of the above

Correct answer:

When the child has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he is ready.

A child is ready for toilet training on his own readiness scale. When he has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he will be ready. To do it any sooner will be frustrating to the child and parent.

Question 27

Which of the following suggests that a patient may be abusing alcohol?

rhinophyma, hypotension, peripheral neuropathy

telangiectasias, flat affect, thyroid dysfunction

hepatosplenomegaly, murmur, osteoarthritis

macrocytosis, tremulousness, hypertension

The Correct answer is:

Macrocytosis, tremulousness, hypertension

Findings that would cue the nurse practitioner that a patient was abusing alcohol are tremors, hypertension, rhinophyma, peripheral neuropathy, telangiectasias or hepatosplenomegaly. The patient may not exhibit all of these symptoms at one time however. Further, the patient will have macrocytosis because there is a high rate of B12 and folate deficiency among these patients.

Question 28

When choosing a blood pressure cuff for a young child, what size should it be?

2/3 upper arm.

All of the upper arm.

1/2 upper arm.

You do not use a blood pressure cuff.

Correct answer: 2/3 upper arm Children do need their blood pressure taken occasionally. The cuff should not be any larger than 2/3 the size of the child's arm. Because this varies with age, and exact size is not given

Question 29

An elderly patient presents with fever, left lower quadrant abdominal pain and diarrhea. Which of the following BEST describes the symptoms the patient is experiencing?

Acute hepatitis.

Iron deficiency anemia.

Testicular cancer.

Diverticulitis.

Correct answer: Diverticulitis Diverticulitis is when the colon secondary consists of puchlike hernias. These hernias are caused by the lack of dietary fiber.

Question 30

Communication would be a part of which of the following fundamental domains?

cognitive

psychological and social

physical

none of the above

Correct answer:

cognitive

The cognitive domain includes communication, the receptive and expressive language. It also includes perception, thinking, information processing and memory.

Question 31

A 54-year-old man presents with a 4-month history of upper abdominal pain, which he describes as intermittent and centrally located. He complains of a burning sensation in the epigastric area, most often with meals and often accompanied by mild nausea. The use of over-the-counter antacids, like Maalox and Tums, have been ineffective. The patient's clinical presentation is most consistent with:

acute colonic diverticulitis

duodenal ulcer

gastric ulcer

acute gastroenteritis

The Correct answer is:

Gastric ulcer

The clinical presentation of gastric ulceration includes pain often reported with or immediately after a meal. The associated symptoms for gastric ulceration are nausea, vomiting and weight loss. The male to female ratio for individuals with a gastric ulcer is equal. Further, the peak incidence for patients with a gastric ulcer is in the fifth and sixth decades of life.

Question 32

Of the following drugs prescribed, which is a cholinesterase inhibitor that comes in the form of a pill or syrup only?

Galantamine.

Hydrocodone.

Rivastigmine.

Donepezil.

Correct answer: Galantamine There are three cholinesterase inhibitors commonly prescribed by doctors. These are Donepezil, Galantamine and Rivastigmine. Hydrocodone is a type of medication that treats moderate to severe pain as well as cough.

Question 33

Of the following choices, which describes the Kernig sign?

Elicited with the patient lying supine and the hip flexed 90 degrees, pain presents when extension of the knee occurs.

The headache worsens when lowering the patient from sitting to supine positioning.

Neck pain occurs with passive flexion of one hip and knee, which causes flexion of the contralateral leg.

Passive neck flexion in a supine position where the patient progresses to a flexion of the knees and hips.

The Correct answer is:

Elicited with the patient lying supine and the hip flexed 90 degrees, pain presents when extension of the knee occurs

To eliminate or support the diagnosis of meningitis, the practitioner may want to assess for Kernig sign. Kernig sign is suggestive of nuchal rigidity and meningeal irritation. The Kernig sign is elicited when the patient is in a supine lying position and the hip is flexed at 90 degrees. A positive sign is present when extension of the knee results in resistance or pain is experienced in the lower back or posterior thigh.

Question 34

A patient comes to the clinic for a skin examination because of a “mole” that has been concerning her. She asks the FNP if this could be a melanoma. The FNP understands that all of the following are signs that the lesion could be a melanoma EXCEPT:

It is asymmetric with non-matching sides.

Its borders are irregular.

It is of a uniform black or brown color.

Its diameter is larger than 6 mm.

Correct answer:

It is of a uniform black or brown color.

All of the choices are correct except this one. One of the signs that a lesion may be a malignant melanoma is that the color is not uniform brown, black, red, white, or blue. Another sign is that it is an evolving lesion, either new or changing.

Question 35

In which of the following cases would the FNP refer a patient to a specialist for low back pain? A patient with:

acute neck pain

bladder dysfunction

reduced range of movement

stiffness

Correct answer:

bladder dysfunction

If the patient has a bladder dysfunction, or a limb or bowel dysfunction, prompt referral to a specialist is needed. Surgery is usually considered only if severe symptoms persist beyond 3 months.

Question 36

In males, puberty is considered precocious if it occurs before:

12 years of age

9 years of age

14 years of age

10 years of age

Correct answer:

9 years of age

In boys, puberty starts at 9 years of age. It is considered precocious puberty if it begins before 9 years of age. In girls puberty starts at 8 years of age and is considered precocious if it begins before 8 years of age.

Question 37

When the FNP is examining a 12-month-old infant, about how much growth should she expect to see in head circumference, as compared to the infant's head circumference at birth?

3 cm

6 cm

12 cm

18 cm

Correct answer:

12 cm

The typical head growth in the first year of life is 12 cm: 6 cm in the first 3 months; 3 cm in the 4th to 6th months; and 3 cm in the 6th to 12th months. Subsequent head growth is about 0.5 cm/year for 2 – 7 year olds and 0.3 cm/ year for 8 – 12 year olds.

Question 38

A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for Type II diabetes mellitus. What should be done to manage him FIRST?

Start insulin

Start metformin plus pioglitazone

Have him return tomorrow to recheck his blood glucose

Start metformin

The Correct answer is:

Start insulin

The patient can be diagnosed with diabetes if his glucose exceeds 200 mg/dL and he is symptomatic. Most oral agents will have little effect on his glucose and it should be lowered immediately. Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a chance to work. He should return to the clinic the next day for a recheck of the blood glucose and medication adjustment.

Question 39

A patient who has been prescribed Amitiza for IBS should be advised to seek immediate medical attention if she experiences which of the following?

Difficulty breathing.

Nausea.

Dry mouth.

Dizziness.

Correct Answer: Difficulty breathing Patients taking Amitiza may experience difficulty breathing within 30 to 60 minutes of taking a dose. This is often not serious. However, it is difficult to tell this from a more serious reaction. Therefore, immediate medical attention should be sought.

Question 40

You are managing a 74-year-old patient who has osteoarthritis and chronic pain. Which of the following medications increases the risk of a gastrointestinal related ulceration?

warfarin

celecoxib

pravastatin

thiazide diuretic

The Correct answer is:

Celecoxib

Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Further, NSAIDs increase the risk of upper and lower gastrointestinal ulcerations. Warfarin does not increase the risk of ulceration, but if one occurs, the risk of bleeding is increased. Statins and diuretics are not considered ulcerogenic.

Question 41

When managing the respiratory patient, the nurse practitioner knows that all of the following antimicrobial strategies help facilitate the development of resistant pathogens EXCEPT:

prescribing a broader spectrum agent

higher antimicrobial dosage

lower antimicrobial dosage

longer course of therapy

The Correct answer is:

Higher antimicrobial dosage

Factors that facilitate the development of resistant microbes include repeated exposure to a given agent, underdosing, and unnecessarily prolonged period of treatment. Shorter course high-dose therapy maximizes and exploits concentration-dependent killing by achieving higher maximum concentration and area under the curve/minimal inhibitory concentration values.

Question 42

You are counseling a mother whose child is receiving the Varicella vaccine (VZV). Which of the following statements would be appropriate?

"Your child will never have a breakout of the chickenpox."

"Mild cases of chickenpox have been reported in immunized patients."

"Children must have a varicella titer drawn before they receive this vaccine."

"The vaccine delivers killed varicella virus to the recipient."

The Correct answer is:

Mild cases of chickenpox have been reported in immunized patients

The varicella vaccine contains attenuated virus and is administered in two doses, one at age one and the other at age 4 to 6 years. The vaccine is highly protective against severe, invasive varicella, however, mild forms of chickenpox are occasionally reported after immunization. Children do not need a titer prior to receiving this vaccine.

Question 43

The FNP has a 64-year-old female patient who inquires about the Zoster vaccine for shingles. The FNP might tell her all of the following EXCEPT:

The vaccine is prepared from a live, attenuated strain of varicella-zoster virus.

Reactivation of the varicella virus is not related to a decline in varicella-zoster virus-specific immunity.

The use of zoster vaccine significantly reduces the risk of shingles.

The vaccine should be used even with a history of shingles.

Correct answer:

Reactivation of the varicella virus is not related to a decline in varicella-zoster virus-specific immunity.

This statement is incorrect. Reactivation of the varicella virus seems to be related to a decline in varicella-zoster virus-specific immunity. Therefore, the use of zoster vaccine significantly reduces shingles risk.

Question 44

In a pregnant woman if there is vaginal bleeding and cramping and the cervix remains closed it is which of the following types of spontaneous abortions?

inevitable abortion

threatened abortion

complete abortion

incomplete abortion

Correct answer:

threatened abortion

In a threatened abortion there is vaginal bleeding and cramping but the cervix remains closed. The pregnancy may be able to be salvaged.

Question 45

An 81-year-old female is in the office. She has been taking ibuprofen over-the-counter in large dosages for a long time. The nurse practitioner comprehends which side effect is likely regarding this situation?

impairment of renal function

liver failure

neuropathy

none of the above

The Correct answer is:

Impairment of renal function

The elderly patient has impaired renal function already and ibuprofen can further impair the kidneys. This in turn can result in nephrosis, cirrhosis, and congestive heart failure.

Question 46

Which of the following cognitive development factors would be the least likely to be associated with preschooler growth and development?

preconceptual thinking

conservation

animism

egocentrism

Correct answer:

conservation

Conservation of number, mass and volume is understanding that a certain aspect or quality of an object can change in appearance without changing the object itself. It is a factor in the cognitive development of school-aged children, not preschool children.

Question 47

A teenage patient comes in with a cut to the hand that requires stitches. When you check his medical records, you find that he had his immunizations for school. The immunizations include DTaP. What action should you take?

Treat the hand and give a tetanus booster.

Treat the hand and give a diphtheria booster.

Treat the hand.

Give a tetanus and diphtheria booster.

Correct answer: Treat the hand The DTaP booster is the diphtheria-tetanus-acellular pertussis vaccine. The patient is up to date on his vaccinations. It is only necessary to treat the hand.

Question 48

The FNP is advising the mother of a 2-year-old child about the child’s intake of fat in her diet. The FNP knows that the percentage of the daily total intake of fat for this child should be no more than which of the following?

10%

25%

30 - 35%

40 - 50%

Correct answer:

30 - 35%

Toddlers can have a higher fat level in their diet than older children. Thirty to thirty-five percent is acceptable for nutrition and digestive needs.

Question 49

You are providing care to a female patient who reports having 8 to 10 migraine headaches per month. Which of the following would you prescribe to help prevent migraines in this patient?

Luvox.

Demerol.

Maxalt.

Mobic.

:

Correct Answer: Luvox Some antidepressants or anti-anxiety drugs can also help prevent migraines. Luvox is one that is commonly prescribed. The other choices listed may help treat the pain associated with migraines, but will not prevent them. Given the frequency of the patient's migraines, some type of preventative medication may be appropriate.

Question 50

A 25-year-old obese Caucasian male had an acute onset of pain that descends down to the lower leg and foot. The nurse practitioner understands that this is most likely:

osteomyelitis

herniated intervertebral disk injury

lumbosacral strain

osteoporosis

The Correct answer is:

Herniated intervertebral disk injury

A herniated intervertebral disk injury results in pain that descends to the lower leg and foot. Lumbosacral strain causes pain in the back buttock, and sometimes the thigh. Osteomyelitis is usually preceded by an event that permits an infectious agent to enter the bone. Osteoporosis occurs most often in postmenopausal women.

Question 51

For alcohol withdrawal symptoms, the preferred benzodiazepine is lorazepam. This is used when there is concomitant history of:

folate-deficiency anemia

hepatic disease

seizure disorder

multiple substance abuse

The Correct answer is:

Hepatic disease

Librium or Valium are good therapeutic agents for patients with adequate hepatic function. However, lorazepam is the preferred agent for those with impaired hepatic function because of its short half life.

Question 52

Which of the following is the correct laboratory norm for Mean Corpuscular Hemoglobin Concentration (MCHC)?

100 – 200 g/dL

50 – 100 g/dL

31.0 – 37.0 g/dL

21.0 – 27.0 g/dL

Correct answer:

31.0 – 37.0 g/dL

MCHC is a measure of the average color of the RBCs in a sample of blood. It is decreased in iron deficiency anemia and thalassemia and normal in the macrocytic anemias. The normal is 31.0 – 37.0 g/dL.

Question 53

Piaget’s cognitive development theory includes all of the following EXCEPT:

sensorimotor

postoperational thinking

concrete operations

formal operations

Correct answer:

postoperational thinking

Piaget’s cognitive development theory focuses on intellectual changes which occur in a sequential manner as a result of continuous interaction with the environment. The stages are: sensorimotor (infancy); preoperational thinking; concrete operations; and formal operations (involves logic, determines possibilities, problem-solves and makes decisions).

Question 54

Which of the following osteoporosis treatments stops bone loss but does not rebuild bone?

Fosamax

Evista

Teriparatide

Miacalcin

Correct answer:

Miacalcin

Miacalcin (calcitonin salmon) stops bone loss but does not rebuild bone. It is a good choice for relief of bone pain from vertebral fractures.

Question 55

Attachment is the enduring and specific affective bond that develops over the first year of life. The underlying emotion in an insecure-avoidant attachment is which of the following?

anger

anxiety

love

confusion

Correct answer:

anger

The underlying emotion in an insecure – avoidant attachment is anger. Love is the underlying emotion in a secure attachment. Anxiety/ambivalence is the underlying emotion in an insecure – anxious attachment. Confusion/dysfunction is the underlying process in an insecure – disorganized attachment.

Question 56

The NP is discussing medications for insomnia with her elderly patient. The patient says she saw a commercial on TV about a drug that is commonly used in adults but is known to cause amnesia and oversedation in the elderly. Which drug is the patient MOST likely referring to?

Barbiturates.

Benzodiazepines.

Zolpidem.

Zaleplon.

Correct answer: Benzodiazepines Benzodiazepines have proven effective in treating insomnia in adults. However, elderly adults are not advised to take this medication as it can cause disorientation and nausea, among other things.

Question 57

Severe hypoglycemia occurs when a patient’s blood glucose is:

< 100 mg/dL

< 50 mg/dL

> 50 mg/dL

< 80 mg/dL

Correct answer:

< 50 mg/dL

Severe hypoglycemia occurs when the blood glucose is < 50 mg/dL. A patient will feel weak and may have a headache with clammy hands and anxiety. The patient may also have difficulty in concentration and thinking. Severe hypoglycemia must be corrected immediately so that it does not progress to coma.

Question 58

A patient who has been prescribed Flomax should be advised to seek immediate medical attention if he experiences which of the following?

Fast heartbeat.

Runny nose.

Weakness.

Ejaculatory problems.

Correct Answer: Fast heartbeat This is a potentially serious side effect of Flomax. Patients experiencing this should seek immediate medical attention. Less serious side effects include runny nose, drowsiness, weakness, problems ejaculating, and blurred vision.

Question 59

Which of the following would you prescribe for a male patient who has difficulty urinating due to BPH?

Luvox.

Uroxatral.

Cialis.

Flagyl.

Correct Answer: Uroxatral Uroxatral, or alfuzosin, is prescribed for men who have difficulty urinating due to BPH. Most patients experience relief of symptoms within 2-3 weeks. Alfuzosin is approved only for use in men.

Question 60

The NP is trying to determine whether her elderly patient's insominia is long term or short term. Of the following, which is NOT typically associated with short term elderly insomnia?

Depression and anxiety.

Acute stress.

Medications.

Withdrawal of sedatives.

Correct answer: Depression and anxiety There are various causes of insomnia in the elderly. While some may be the cause of short term insomnia and others long term insomnia, long term insomnia is more common in the elderly than short term.

Question 61

The FNP has a patient who desires to quit smoking. She asks the FNP if there is anything that can help her in trying to quit. The FNP understands that all of the following are true in regard to smoking cessation EXCEPT:

Bupropion, an atypical antidepressant, is used for smoking cessation.

Bupropion can be used with nicotine products such as gum or nasal sprays.

Bupropion is safe to use for persons with hypertension or seizures.

Nicotine patches should not be used with other nicotine products.

Correct answer:

Bupropion is safe to use for persons with hypertension or seizures.

This is incorrect. Bupropion (Zyban) is contraindicated in persons with hypertension or a history of seizures.

Question 62

In terms of the musculoskeletal system, which of the following joint variants is characterized by “knock-knees”?

genu valgum

genu varum

genu recurvatum

none of the above

Correct answer:

genu valgum

Genu valgum is characterized by “knock knees.” Genu varum is characterized by bowlegs. Genu recurvatum is characterized by a hyperextension or backward curvature of the knees.

Question 63

The physiologic occurrence represented by the rise of plasma glucose in the early morning hours is known as:

Somogyi effect

hypoglycemia

Dawn phenomenon

hyperglycemia

Correct answer:

Dawn phenomenon

The Dawn phenomenon is a normal physiologic event in which the plasma glucose rises in the early morning. This is because of the reduction of tissue sensitivity to insulin between 5 a.m. and 8 a.m. from physiologic spike of growth hormone.

Question 64

Connor’s Abbreviated Parent-Teacher Questionnaire is used for which of the following?

behaviors

temperament

language

global development

Correct answer:

behaviors

The Connor’s Abbreviated Parent-Teacher Questionnaire is used for behaviors. Another test of behaviors is the Achenbach’s Child Behavior Checklist (ACBCL).

Question 65

Which of the following vaccines would NOT be routinely recommended for patients with HIV?

live, attenuated oral polio vaccine

hepatitis B vaccine x 3

hepatitis A

Td every 10 years

Correct answer:

live, attenuated oral polio vaccine

The live, attenuated oral polio vaccine should be avoided because of an increased risk of paralytic polio in immunocompromised vaccine recipients. If a patient requires polio vaccination, clinicians should use the inactivated vaccine to avoid the risks of a live vaccine.

Question 66

Certain claims are made on advertisements regarding medications, such as Drug X has been known to be in use for 6 years with over 2 million doses given in North America and Great Britain. Drug X stops heartburn and upset stomach, prevents esophageal reflux and is the preferred treatment for GERD. The nurse practitioner realizes that this claim is:

Valid; there are enough users mentioned who have had success for it not to be.

Invalid; the level of significance is not mentioned to be at the 0.05 level.

Valid; the cohort and Hawthorne effects are operating.

Invalid; there are no control or comparison groups, and no statistics are stated.

The Correct answer is:

Invalid; there are no control or comparison groups, and no statistics are stated

Even if the claim details extensive use of this drug, Drug X, there must be valid statistics to provide evidence with the use of a control group that will render a level of significance.

Question 67

All of the following persons were involved in the ethologic theory of human growth and development EXCEPT:

Konrad Lorenz

Carl Rogers

Harry Harlow

Mary Ainsworth

Correct answer:

Carl Rogers

Carl Rogers was a promoter of the humanistic theory of human growth and development rather than the ethologic theory. The other choices are those who were involved in ethologic theories along with John Bowlby, Marshall Klaus and John Kennel.

Question 68

In advising a new mother who is not able to breast feed about bottle feeding the FNP would tell her all but which of the following?

The amount of formula the infant needs at 0 to 1 month is about 2 – 4 oz. every 3 to 4 hours.

The amount of formula the infant needs at 2 – 4 months is about 5 – 7 oz. every 4 to 5 hours.

Iron-fortified formulas are best.

Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies.

Correct answer:

Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies.

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

Question 69

Konrad Lorenz is best known for the theory that:

there are biologically-programmed periods (sensitive periods) predisposed for particular learning.

maternal separation and social isolation resulted in dramatic impairment of social-emotional development.

promoted rooming-in and father participation in the birth of a child.

neutral stimulus associated with a meaningful one over time leads to a “conditioned” response that can be elicited by neutral stimulus alone as though it were the meaningful one.

Correct answer:

there are biologically-programmed periods (sensitive periods) predisposed for particular learning.

Konrad Lorenz is best known for the theory that there are biologically-programmed periods (sensitive periods) predisposed for particular learning. It is one of the many ethologic theories developed in the 20th century.

Question 70

A patient has a family history of ovarian cancer and a genetic predisposition. What screening assessment is necessary?

Biopsy.

Pelvic exam.

Abdominal exam.

Breast exam.

Correct answer: Pelvic exam There is not a specific screen for ovarian cancer. A pelvic exam may be required each year. A transvaginal ultrasound is also effective.

Question 71

In the treatment of the patient with polycystic ovary syndrome (PCOS), you know that the following are measures to manage this condition EXCEPT:

Exercise and weight loss will improve this condition.

Metformin (Glucophage) improves insulin sensitivity, lowers LH, lowers androgen, and improves fertility.

Estrogen excess leads to hyperinsulinemia in these patients.

Monthly Provera 10 mg daily for 10-14 days at the end of each month is recommended.

The Correct answer is:

Estrogen excess leads to hyperinsulinemia in these patients

It is the androgen excess, and not estrogen excess, that leads to insulin resistance. In turn, the androgen excess spurs hyperinsulinemia and increases the patient’s risk for diabetes mellitus. Polycystic ovary syndrome occurs when the menstrual cycle is interrupted. Also, patients with polycystic ovary syndrome have elevated levels of androgen, which is a male hormone. With polycystic ovary syndrome, cysts emerge in the ovaries that contain fluid. The fluid causes the sacs to get bigger. Further, polycystic ovary syndrome is triggered by too much luteinizing hormone (LH) produced by the pituitary gland. The increased LH triggers the production of androgen, which in turns can cause metabolic syndrome to occur. Polycystic ovary syndrome is diagnosed based on the patient’s symptoms, blood tests to evaluate the hormone levels and in some cases ultrasonography. For females who do not want to become pregnant, combination oral contraceptive containing estrogen and progestin may be prescribed to reduce the androgen levels.

Question 72

Organized creation of beneficial change to attain unprecedented levels of performance is which of the following?

risk management

quality improvement

quality assurance

none of the above

Correct answer:

quality improvement

Quality improvement is the organized creation of beneficial change to attain unprecedented levels of performance. It differs from quality assurance in that it is continuous rather than episodic.

Question 73

A patient presents in the office 3 weeks post-myocardial infarction (MI) complaining of pericardial pain and elevated temperature. Physical examination reveals a pericardial friction rub. The nurse practitioner determines which of the following diagnostic studies are necessary?

cardiac enzymes with myoglobin

complete blood count (CBC) with differential

echocardiogram

24-hour holter monitoring

The Correct answer is:

Complete blood count (CBC) with differential

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

Question 74

What is the significance of an S4 heart sound?

It is a marker of ventricular overload or systolic dysfunction or both.

It is a marker of poor diastolic function, most often found in poorly controlled hypertension or recurrent myocardial ischemia.

It marks the end of systole and is produced by events surrounding closure of aortic and pulmonic valves.

It marks the beginning of systole and is produced by events surrounding closure of the mitral and tricuspid valves.

-

Correct answer:

It is a marker of poor diastolic function, most often found in poorly controlled hypertension or recurrent myocardial ischemia.

The S4 heart sound is a marker of poor diastolic function, most often found in poorly controlled hypertension or recurrent myocardial ischemia. It is heard late in diastole, and can sound like it is “hooked on” to the front of S1.

Question 75

A 15-year-old Caucasian male presents in the clinic with a reddened, pruritic rash. The nurse practitioner understands that the most common sites for adolescent atopic dermatitis are:

forehead, scalp, and cheeks

wrists, ankles, and cubital core

face, neck, back, and antecubital fossae

palmar creases and extensor surface of legs

The Correct answer is:

Face, neck, back and antecubital fossae

In the adolescent and the young adult population, common sites for a pruritic rash are the popliteal and antecubital fossae, face, neck, upper arms and back, dorsa of the hand, feet, fingers, and toes.

Question 76

A patient in his 50s complains about a blurred vision when reading. What is this most likely to indicate?

Miagraines.

Age.

Tumor.

Poor diet.

Correct answer: Age Eyesight typically decreases with age. Age is the most likely cause of poor nearsighted. The other answers are less likely than the aging process.

Question 77

If a clinician is doing a research study that measures the impact of a fall prevention program on the number of falls among older adults it would be which of the following types of research?

experimental research

descriptive research

historical research

correlational research

Correct answer:

experimental research

Experimental research is research aimed at determining the effect of one or more variables. The fall prevention research falls into this category. For a true experimental design to exist, the sample must be randomly selected; there must be manipulation of the independent variable by the researcher as is usually seen in intervention studies; and there must be a control group.

Question 78

An option to the injectable influenza vaccination is the nasal spray vaccine. It is important that the nurse practitioner understands to advise a patient:

Its use is limited to children younger than 6 years.

This is the preferred method of immunization for persons who are allergic to eggs or egg products.

It contains a live, attenuated virus.

It is acceptable to use during pregnancy.

The Correct answer is:

It contains live, attenuated virus

The nasal influenza virus contains influenza viruses that are sufficiently weakened as to be incapable of causing disease. However, the virus is strong enough to stimulate a protective immune response. The influenza virus vaccine is indicated for individuals aged 2 to 49 years, if the individual is healthy. The vaccine is contradicted in persons with egg allergy and pregnant women.

Question 79

Quality assurance is a system designed to evaluate and monitor quality of care. Which statement is NOT an accurate concerning quality assurance?

These programs identify components of structure, process and outcomes of care.

These programs look at organization effectiveness, efficiency and client and provider interactions.

These programs audit financial records and payroll of the organization to evaluate appropriateness of monetary distribution.

These programs promote responsibility and accountability to deliver high-quality care and assist in the evaluation and improvement of patient care.

The Correct answer is:

These programs audit financial records and payroll of the organization to evaluate appropriateness of monetary distribution

Payroll and financial records of an organization are not evaluated and viewed in a quality assurance program. These programs are set up to evaluate and monitor the care of patients by providers, ancillary staff, personnel and the facility in general.

Question 80

A woman who has been on hormone replacement therapy (HRT) is likely to have some possible improvement. Which of the following is one of these?

A decrease in the symptoms associated with menopause.

A reduction in the risk of dementia.

A reduction in the risk of osteoarthritis.

A reduction in the risk of endometrial cancer risk.

The Correct answer is:

A decrease in the symptoms associated with menopause

As with all medication, the use of HRT comes with the possibility of adverse effects. There is no decrease in the risk of dementia or osteoarthritis. There is a reduction of osteoporosis risk. Endometrial cancer risk, and not a reduction in the risk, with unopposed estrogen exists.

Question 81

Which of the following is likely to be an age-related issue for school-age children?

magical thinking

egocentrism

concern about being different

modesty

Correct answer:

modesty

Modesty emerges in older school-age children. Magical thinking and egocentrism are related to the toddler years. Concern about being different relates to adolescence.

Question 82

Assessing an elderly male you note an abnormality. Which of the following is not a common age-related change?

Arcus senilis

presbyopia

sustained nystagmus

sensitivity to glare

The Correct answer is:

Sustained nystagmus

Sustained nystagmus is indicative of a neurologic complication. The other answer choices are associated with normal age-related changes.

Question 83

A 42-year-old male is in the clinic and has been diagnosed with peptic ulcer disease (PUD). The nurse practitioner (NP) understands that which of the following would be prescribed as the initial treatment for this disease in an uncomplicated state.

doxepin (Sinequan) 25 mg at hs

pirenzepine 50 mg tid

clarithromycin 500 mg bid

omeprazole (Prilosec) 20 mg qd

The Correct answer is:

Omeprazole (Prilosec) 20 mg qd

The goal of treatment for peptic ulcer disease (PUD) includes relief of pain, healing of the ulcer, and cost-effectiveness. A proton pump inhibitor will heal 90% of duodenal ulcers after 4 weeks and 90% of gastric ulcers after 8 weeks. Doxepin and pirenzepine are anticholinergic drugs and are limited by side effects and not used in the U.S. at this time. Clarithromycin is part of the eradication therapy to treat Helicobacter pylori associated problems

Question 84

The World Health Organization has put forth some precautions for use of combined oral contraceptive pills. According to WHO which of the following medical situations would have NO restriction on use?

BMI ≥ 30

HIV

acute hepatitis

hypertension adequately controlled without vascular disease

Correct answer:

HIV

A person with HIV would fall into Category 1 which has no restriction. The other choices fall either into Category 2, the advantages outweigh the risk; Category 3, exercise caution; or Category 4, refrain from use.

Question 85

The nurse practitioner understands that the pain experienced with angina pectoris or myocardial infarction is related to severe irritation of the myocardial nerve fibers by an increase in which of the following:

lactic acid

serum potassium

serum magnesium

blood glucose

The correct answer is:

Lactic acid

When the myocardial cells are deprived of glucose from occlusion of the coronary arteries, aerobic metabolism does not occur. Therefore, lactic acid accumulates and irritates the myocardial nerve fibers. This sends pain messages to the cardiac nerves and upper thoracic posterior roots located in the left shoulder and arm

Question 86

You are treating a 48-year-old male with recurring gout. The nurse practitioner knows that all of the following are treatment options during the acute phase except:

indomethacin (Indocin) BID

colchicine 0.5mg, every hour until relief or until diarrhea occurs

naproxen sodium (Anaprox) BID PRN

probenecid

The Correct answer is:

Probenecid

Indomethacin (Indocin), colchicine and naproxen sodium (Anaprox) are all treatments for the acute phase of therapy for gout. Probenecid and allopurinol are two medications used for maintenance, control and prevention of gout, not treatment during the acute phase.

Question 87

When treating a female patient with an uncomplicated urinary tract infection but otherwise healthy, the nurse practitioner knows that the preferred therapy is:

amoxicillin

azithromycin

TMP-SMX

cephalexin

The Correct answer is:

TMP-SMX

The first line medication therapy choice for an urinary tract infection is trimethoprim-sulfamethoxazole or TMP-SMX. TMP-SMX is a combination of drugs such as Bactrim, Cotrim, or Septra.

Question 88

The FNP has a 45-year-old male patient who presents with a sudden onset of facial asymmetry and she is unable to make any facial expression on the affected side. If nothing else is found upon examination of this woman, which of the following cranial nerves is likely paralyzed?

CN II

CN III

CN VI

CN VII

Correct answer:

CN VII

Cranial nerve VII is related to facial function. Dysfunction of this nerve gives the characteristic findings of Bell’s palsy (facial asymmetry, droop of mouth, absent nasolabial fold, and impaired eyelid movement).

Question 89

Which of the following is a precursor lesion of squamous cell carcinoma?

actinic keratoses

Stevens-Johnson syndrome

erythrema multiforme

erythema migrans

Correct answer:

actinic keratoses

Actinic keratoses are precursor lesions of squamous cell carcinoma. They appear as dry, red lesions with a rough texture and are usually located in sun-exposed areas of skin such as the cheeks, nose, face, neck, arms and back. They are more common in light-skinned individuals

Question 90

The levels of E/M services recognize four types of medical decision making. Which of the following is NOT one of these four types?

low complexity

high complexity

minimal

straightforward

Correct answer:

minimal

The four types of medical decision making recognized by the levels of E/M services are: straightforward, low complexity, moderate complexity and high complexity. Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option.

Question 91

The nurse practitioner knows the following to be true of an advance directive EXCEPT:

Living wills are written documents prepared in advance in case of terminal illness or nonreversible loss of consciousness.

An advance directive must be created by an attorney for the patient in order for the advance directive to be a legal document.

The provisions of advance directives go into effect when the patient has become incompetent.

The provisions of an advance directives go into effect when the patient is declared terminally ill.

The Correct answer is:

An advance directive must be created by an attorney for the patient in order for the advance directive to be a legal document

An advanced directive is a document that states the patient’s wishes or instructions associated with medical preferences if he or she is unable to make competent decisions or is unconscious and cannot speak to consent to or refuse treatment. An advance directive can be a durable power of attorney, living will or a healthcare proxy. An attorney does not have to create an advance directive for the patient. However, the advance directive has to be notarized in some states or witnessed by one to two other competent individuals. The remaining answer choices are accurate statements regarding an advance directive.

Question 92

There is suspicious S3 heart sound. Where is this heard?

Aortic area.

Pulmonic area.

Tricuspid area.

Bicuspid area.

Correct answer: Pulmonic area The S3 heart sound is heard at the pulmonic area. It can be benign. It may also be a sign of a condition.

Question 93

In terms of the scope of practice for an NP, which of the following statements is incorrect?

The scope of practice defines a specific legal scope determined by state statutes, boards of nursing, educational preparation and common practice within a community.

General scope of practice is specified in many published professional documents.

Prescriptive authority is recognized as within the scope of practice for nurse practitioners in all 50 states.

Scope of practice is always defined by state statutes enacted by the state legislature.

Correct answer:

Scope of practice is always defined by state statutes enacted by the state legislature.

Some states define scope of practice by state statutes enacted by the state legislature. In other states, the legislature gives the board of nursing the authority to define the scope of NP practice. Either way is enforceable.

Question 94

Of the following topical corticosteroids, which one has the highest potency?

Temovate

Topicort

Elocon

Westcort

Correct answer:

Temovate

Temovate is considered a topical corticosteroid with super-high potency. Topicort is considered high potency. Elocon has midrange potency. Westcort has a low potency.

Question 95

The blink reflex in an infant will typically disappear after:

3 months

6 months

9 months

12 months

Correct answer:

12 months

The blink reflex is when the eyelids close in response to bright light. It disappears after 12 months.

Question 96

Which of the following statements about Managed Care Organizations (MCOs) is false?

MCO is an umbrella term that may include HMOs and other forms of health plans.

MCOs reimburse primary care providers on a fee-for-service basis, a capitated basis or a combination of both.

MCOs do not credential providers; that is done by the federal government.

MCOs sell a priced package of health services to their clients.

Correct answer:

MCOs do not credential providers; that is done by the federal government.

This is the false statement. MCOs do credential providers. They collect educational, license, malpractice, employment and certification data on each provider and make a judgment that a provider is or is not adequately prepared to care for the MCO’s patients.

Question 97

What is the lifetime risk to the average American man of having latent prostate cancer?

10%

3%

67%

40%

Correct answer:

40%

The average American man has a 40% lifetime risk of latent prostate cancer. He also has an approximate 10% risk of clinically significant disease and an approximate 3% risk of dying of prostate cancer.

Question 98

A mother asks if her child can come out of the car seat. You are counseling the mother on the use of seat belts for her child. You anticipate that the adult car seat belts fit correctly when the child is _____ tall and is _____ old.

40 inches

6 to 8 years

50 inches

5 to 6 years

59 inches

8 to 12 years

60 inches

13 to 15 years

-

The Correct answer is:

59 inches

8 to 12 years

Children should be in a booster seat until they are 59 inches tall or 8 to 12 years of age. Children should remain in the back seat of the car until they are age 13.

Question 99

Professional Standards of Practice exist in the nurse practitioner's workplace. Which of the following best describes these Standards of Practice?

They focus on the maximum levels of performance.

They are not necessary to legally describe standard of care, but necessary for licensure.

They are authoritative statements by which the quality of practice, service, or education can be judged.

The standards are exact for all levels of nursing.

The Correct answer is:

They are authoritative statements by which the quality of practice, service, or education can be judged

Standards of Practice focus on the minimum levels of acceptable performance as a way of providing consumers with a means of measuring the quality of care they receive. They may be generic and general, as well as precise and specific. They are used to legally describe the standard of care that must be met by a provider.

Question 100

The following abbreviation does not have a substitute meaning for the electronic medical record (EMR):

EHR

CPR

EPR

EBR

Correct answer:

EBR

The electronic medical record (EMR) is often referred to as the electronic health record (EHR), computer-based patient record (CPR) and the electronic patient record (EPR). These terms are often used interchangeably in the healthcare community. EBR is not a known abbreviation related to electronic records.

aanp test 1

Question 1

A 24-year-old graduate student is in the clinic and newly diagnosed with iron deficiency anemia. She reports she is a strict vegetarian and has strong beliefs about avoiding meat. What should you suggest as part of her dietary measures that could help with this condition?

mushrooms, oatmeal, and whole grain bread

dark green leafy vegetables and dried peas and beans

baked potatoes, beets, and broccoli

beets, broccoli, and beef

--------------------------------------------------------------------------------

Incorrect. The answer is

dark green leafy vegetables and dried peas and beans

--------------------------------------------------------------------------------

Explanation:

The Correct answer is:

Dark green leafy vegetables and dried peas and beans

The patient has iron deficiency anemia because she does not get enough dietary iron. In addition to an iron supplement, she should be encouraged to eat leafy green vegetables, like spinach, and dried peas and beans, like lentils, black beans, red beans, and white beans. It is important to instruct the patient on the importance of Vitamin C along with these foods for adequate absorption.

Question 2

Part of the well-child examination is a lead risk assessment. A positive response to any risk questions indicates risk of lead exposure. A positive response to which of the following questions would be an indicator of a risk for lead poisoning?

Does your child live in or regularly visit a house that was built before 2005?

Does your child live in a home built before 1978 that is undergoing renovations?

Does your child have a playmate that has had lead poisoning?

All of the above

Correct answer:

"Does your child live in a home built before 1978 that is undergoing renovations?"

A positive answer to this questions would be a risk indicator for lead exposure. If the home was built before 1978 and is undergoing renovations, then the child may be at risk for lead exposure.

Question 3

Which of the following statements about the role of the family nurse practitioner is incorrect?

The FNP assesses family structure and dynamics to help individuals maximize their health.

The FNP role is a combination of pediatric NP, adult NP and gerontological NP roles.

The FNP teaches family members to recognize the influences of their family health patterns.

FNPs provide a comprehensive psychosocial approach to caring for individuals.

Correct answer:

The FNP role is a combination of pediatric NP, adult NP and gerontological NP roles.

This is incorrect. The FNP role is a unique role. It is not a combination of other NP roles. Being an FNP requires mastery of a unique body of knowledge and tasks for the care of an individual within a family context

Question 4

Which of the following medications is contraindicated as a treatment for acute gouty arthritis?

aspirin

naproxen

indomethacin

naproxen sodium

Correct answer:

aspirin

Aspirin is contraindicated as a treatment for gout because it can precipitate gout. A loading dose of an NSAID, such as naproxen, 750 mg or indomethacin, 50 mg, followed by lower doses, can be helpful.

Question 5

The nurse practitioner must carry professional liability insurance. An occurrence-form type is preferred because:

The carrier will be notified of a potential claim during the policy period.

The coverage is limited and time based.

The amount of insurance money available to pay a claim increases with each renewal of the policy.

The policy proceeds are available to pay claims regardless of when the claim is reported to the carrier.

The Correct answer is:

The policy proceeds are available to pay claims regardless of when the claim is reported to the carrier

The types of professional liability, as well as general liability, insurances include occurrence form and claims-made. With the occurrence form, the liability insurance plan pays the claim based on when the loss happens and according to the timeframe the policy was in place. For instance, the nurse practitioner has professional liability insurance, which is occurrence form based. The nurse practitioner purchased the insurance coverage in 2007. The nurse practitioner has paid the premiums to keep the coverage up to date with the XYZ Corporation. A patient files a lawsuit against the nurse practitioner in July 2010 for an incident that occurred in May of 2008. If the patient wins the lawsuit, the XYZ Corporation will pay the claim, under the occurrence form plan, because the incident occurred during the timeframe when the policy was in effect (May 2008). With a claims-made policy, this policy pays claims also when the coverage is in effect. However, the claims made coverage policy will pay the claim based on the terms identified in the policy at the current time. Therefore, if an incident occurred in 2008 and a claim is filed in 2011, the incident has to be covered in the current 2011 and not the 2008 policy coverage terms, before the insurance company pays the claim. Additionally, the answer choice “the carrier will be notified of a potential claim during the policy period” is incorrect, as the carrier does not need to be informed during the policy period. This is a requirement with the claims-made type coverage. Further, the limits do not automatically increase with the occurrence form type of coverage, which makes the answer choice “amount of insurance money available to pay a claim increases with each renewal of the policy” incorrect.

Question 6

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

every week

every 4 weeks

every 3 weeks

every 2 weeks

The Correct answer is:

Every 4 weeks

The patient is in her 5th week of pregnancy. Therefore, she will see the provider every 4 weeks until she reaches her 28th week of pregnancy. Then, she will start seeing the provider every 2 weeks.

The frequency for prenatal visits, after the patient has had her initial examination, is as follows:

Time of Pregnancy Frequency of Visits

up to 28 weeks every 4 weeks

28 to 36 weeks every 2 weeks

> 36 weeks every week

Question 7

In terms of inflammatory bowel disease, which of the following statements is incorrect?

A person with ulcerative colitis has approximately a 10% chance of having a flare in 2 years after achieving disease remission.

A person with Chrohn’s disease has approximately a 40% chance of having a flare in 2 years after achieving disease remission.

With ulcerative colitis, colorectal cancer risk is greatly increased afer about a decade of disease.

With Chrohn’s disease there is an increased risk for small bowel malignancy.

Correct answer:

A person with ulcerative colitis has approximately a 10% chance of having a flare in 2 years after achieving disease remission.

This statement is incorrect. A person with ulcerative colitis has approximately a 50% chance of having a flare in 2 years after achieving disease remission. The incidence of a flare within 2 years in someone with Chrohn’s disease is less (40%).

Question 8

Which of the following is NOT a preventative measure for avoiding the ticks associated with Lyme disease?

using insect repellents

wearing long-sleeved shirts and long pants

taking a single 200 mg dose of doxycycline orally

avoiding areas with known or potential tick infestation

Correct answer:

taking a single 200 mg dose of doxycycline orally

This is not a preventative measure. After a tick bite occurs, a single 200 mg dose of doxycycline taken orally seems to be effective in reducing the Lyme disease risk.

Question 9

A Family Nurse Practitioner working in a primary care facility is treating a patient with atopic dermatitis. She knows that the most important aspect of skin care for this individual is:

frequent lubricant application

frequent bathing with antibacterial soap

year-round topical high-potency steroid application

frequent oatmeal baths

The Correct answer is:

Frequent lubricant application

Atopic dermatitis, or eczema, is one manifestation of a type I hypersensitivity reaction. Treatment options include avoiding offending agents, minimizing skin dryness by limiting soap and water exposure and the frequent consistent use of lubricants. After control of acute symptoms, a low potency topical steroid can be applied.

Question 10

Bony nodules on the distal interphalangeal joints are which of the following?

uric acid crystals

Bouchard’s nodes

Heberden’s nodes

meniscus nodes

Correct answer:

Heberden’s nodes

Heberden’s nodes are on the distal interphalangeal joints (DIP). Bouchard’s nodes are on the proximal interphalangeal joints (PIP).

Question 11

A 72 year old patient explains to the NP that she thinks she has diarrhea. Her stools are bloody and watery with mucus. Testing shows the stools are positive for blood and leukocytes. What will MOST likely be the diagnosis?

Shigella.

Adenovirus.

Campylobacter jejuni.

Salmonella.

Correct answer: Campylobacter jejuni is a bacterial diarrhea that is very common in children ages 1 - 5 but can occur at any age. Vomiting and fever are noticeable symptoms of the illness.

Question 12

A patient who has been prescribed Levsin for IBS asks when she should take her medication. Which of the following is an appropriate response to this patient?

The patient should take her medication with full meals.

The patient should take her medication on an empty stomach.

The patient should take her medication 30 to 60 minutes before a meal.

The patient should take her medication with a small snack such as crackers or milk.

Correct Answer: The patient should take her medication 30 to 60 minutes before a meal Levsin appears to work best with food, but should be taken 30 to 60 minutes before eating to give it time to enter the body. Unless otherwise directed, the patient should not take the medication on an empty stomach

Question 13

What is the main purpose of certification?

It is a requirement in all 50 states.

It is a process that measures and validates competence.

The federal government requires this for reimbursement.

all of the above

The Correct answer is:

It is a process that measures and validates competence.

Certification is a process used to measure and validate competence of a Family Nurse Practitioner in his or her specialty area. Certification is not required by all states for a Family Nurse Practitioner to practice. While Medicare requires certification in order for the Family Nurse Practitioner to independently bill, all federal organizations do not require it. Then, the answer "all of the above" is incorrect because there is one correct answer.

Question 14

In Ecology of Human Development: Experiments b Nature and Design, Urie Bronfenbrenner identified a person-place-process model. Which of the four systems that he identified has a broad-based historical, cultural, demographic and institutional context?

mesosystem

microsystem

macrosystem

exosystem

Correct answer:

macrosystem

Bronfenbrenner’s macrosystem has a broad-based historical, cultural, demographic and institutional context. Examples would include managed care and welfare reform initiatives.

Question 15

A patient you diagnosed with hypothyroidism was started on levothyroxine. At what interval should the nurse practitioner reassess her TSH?

1 to 2 weeks

2 to 4 weeks

4 to 6 weeks

6 to 8 weeks

The Correct answer is:

6 to 8 weeks

In the treatment of hypothyroidism, T4 replacement is needed in the form of levothyroxine (Synthroid or Levoxyl). The initial dosage for an adult is 75 to 125 mcg. For an elderly person, the dose is 75% less than the adult dosage. Because of the long half-life of levothyroxine, the effects of a dosage adjustment or initiation would not cause a change in TSH for approximately five to six drug half-lives, or about 6 to 8 weeks.

Question 16

The nurse practitioner (NP) has been asked to resolve a conflict between two medical assistants. One is observed as pleasant and helpful, while the other is abrasive and angry. What guideline must the NP observe in the resolution of this conflict?

Deal with issues, not personalities.

Weigh the consequences of each possible solution.

Require the medical assistants to reach a compromise.

Encourage ventilation of anger and use humor to minimize the conflict.

The Correct answer is:

Deal with issues, not personalities

The conflict must be addressed directly by the nurse practitioner. The personal characteristics of the assistants must not enter into the conflict resolution process. Compromise is only one method of conflict resolution.

Question 17

When treating a person with scabies, permethrin (Elimite) is the preferred method of treatment. Which of the following statements about this treatment is false?

The lotion must be left on for 8 to 14 hours for it to be effective.

Even with effective therapy, pruritis may still be a significant problem.

Dead mites and their waste are eliminated from the body immediately with treatment.

Lindane (Kwell) should not be used by pregnant women, children or the elderly.

Correct answer:

Dead mites and their waste are eliminated from the body immediately with treatment.

Individuals with scabies often have a significant problem with pruritis after permethrin treatment because of the presence of dead mites and their waste trapped in the skin. This debris is eliminated from the body over a few weeks.

Question 18

Bowel sounds in a healthy adult patient should sound like all but the following?

Gurgling.

Bubbling.

High pitch.

Loud splashing.

Correct Answer: Loud splashing Normal bowel sounds are high-pitched, bubbling, gurgling sounds. They may vary in intensity and volume. Loud splashing may indicate an obstruction or other condition.

Question 19

The general family systems theory explains the dynamic structure and function of the family within the context of a unified whole. All of the following statements about this theory are correct EXCEPT:

Family systems change over time.

Families have no need for homeostasis.

A change affecting one part of a family manifests itself as change in the whole family system.

All parts of the system are dependent on one another, even though each part has its own role.

Correct answer:

Families have no need for homeostasis.

This is not a correct statement in regard to the general family systems theory. Families strive for homeostasis or a predictable steady state that reflects a balance between change and stability.

Question 20

A male patient is in the office with a deep cough, which worsens at night, as well as wheezing and mucoid sputum production. A diagnosis of bronchitis is made. Which of the following is NOT a good management technique?

Tell the patient to avoid antihistamines.

Cough suppressants are encouraged in all cases.

Tell the patient to stop smoking.

Antibiotic treatment is not recommended in uncomplicated acute bronchitis.

The Correct answer is:

Cough suppressants are encouraged in all cases

Cough suppressants should be avoided except if the patient is unable to sleep due to irritating cough.

Question 21

You have a patient in the office with symptoms of aortic regurgitation. The nurse practitioner understands which of the following is characteristic of this?

an acute onset of shortness of breath in the fifth or sixth decade

a long asymptomatic period with sudden death usually during exercise

long asymptomatic period followed by exercise intolerance, then dyspnea at rest

dyspnea on exertion for a long period of time before sudden cardiac death

The Correct answer is:

Long asymptomatic period followed by exercise intolerance, then dyspnea at rest

Aortic regurgitation (AR) is characterized by the patient having a long asymptomatic period with slowing activities. Eventually, the patient develops shortness of breath. Then, left ventricle failure occurs

Question 22

Types of special communication that the nurse practitioner my engage in include all of the following EXCEPT:

triage

case management

written documentation review

opinions stated by staff

The Correct answer is:

Opinions stated by staff

Special communication is privileged and confidential and certain standards must be met. Opinions regarding a patient that are stated by staff members is not a form of special communication.

Question 23

An expected finding in a 57-year-old female with estrogen deficiency atrophic vaginitis include:

an odorous vaginal discharge

an increased number of lactobacilli

a reduced number of white blood cells

a pH greater than 5.0

The Correct answer is:

A pH greater than 5.0

During menopause, the pH shifts as the vaginal flora changes due to decreased estrogen. An odorous vaginal discharge and increased number of lactobacilli is expected in bacterial vaginosis.

Question 24

Your patient expresses concern that she will not be able to afford the medication you prescribe because she is not insured. Which of the following is an appropriate next step?

Give the patient samples of the medication.

Refer the patient to a medical social worker who can explore payment options with her.

Prescribe the patient a cheaper medication.

Reinforce that it is important that the patient take the medication.

Correct Answer: Refer the patient to a medical social worker who can explore payment options with her Patient noncompliance can be the result of financial constraints. A medical social worker can explore community resources and other options for patients who have trouble paying for their medication.

Question 25

When treating an infant with colic and instructing the mother, the nurse practitioner knows that all of the following are nonpharmacologic treatments EXCEPT:

Ensuring adequate burping during feeding.

Encouraging and provide support for the mother.

Adding cow's milk in the diet of the breastfeeding mother is helpful.

Switching to hypoallergenic formula may be helpful.

The Correct answer is:

Adding cow's milk in the diet of the breastfeeding mother is helpful

Cow's milk should be avoided. The remaining answer choices are all nonpharmacologic treatments along with reassuring parents that no physical problem is present, educating the patient regarding normal infant crying and soothing the infant by providing motion.

Question 26

The majority of breast cancers occur in which area of the breast?

beneath the nipple and areola

upper outer quadrant

lower outer quadrant

upper inner quadrant

The Correct answer is:

Upper outer quadrant

The upper outer quadrant is the most common site for breast cancer. The second most common site for breast cancer is beneath the nipple and areola.

Question 27

You are providing care to a patient who will undergo an oral glucose tolerance test in the morning. She asks if she needs to restrict her food prior to the test. Which of the following is an appropriate response to this patient?

Tell the patient that she can eat normally up until the time of the test.

Tell the patient that she should not eat or drink anything for 24 hours prior to the test.

Tell the patient that she should not eat anything or drink anything but water for 10 hours prior to the test.

Tell the patient she can eat normally until 4 hours before the test.

Correct Answer: Tell the patient that she should not eat any food or drink anything but water for at least 10 hours prior to the test Prior to an oral glucose tolerance test, the patient should not eat or drink anything but water for at least 10 hours. Because the test seeks to measure the patient's tolerance of the glucose solution, any other food or drink other than water may interfere with the test results.

Question 28

Which of the following tests is a diagnostic test?

hemoglobin test

Mantoux test

MRI scan

fasting blood glucose test

Correct answer:

MRI scan

Diagnostic tests are more specific and/or sensitive than screening tests. They give objective proof that a disease process or abnormal condition is present. Other diagnostic tests include: tissue biopsies, cultures and CT scans.

Question 29

Which of the following screening tests for colorectal cancer is used primarily to find cancer as opposed to finding polyps and cancer?

fecal immunochemical test

flexible sigmoidoscopy

double-contrast barium enema

CT colonography

Correct answer:

fecal immunochemical test

Other similar tests are the fecal occult blood test and the stool DNA test. The other choices for this question are tests that are used to find polyps and cancer.

Question 30

A nurse practitioner will likely be doing pap smears in practice. It is important to understand that the following statements are all accurate EXCEPT:

The first cervical cancer screening should begin no later than 21 years of age.

There is no reason to screen women annually if the test has been normal in the past.

Women who are 70 years old or older with three or more normal Pap tests and no history of abnormal Pap tests may choose to stop cervical cancer screening.

Screening should be done every 2 years for liquid-based Pap tests.

Correct answer:

There is no reason to screen women annually if the test has been normal in the past

This statement is incorrect. At or after age 30 years, women who have had three normal test results in a row may get screened every 2 - 3 years. However, women with certain risk factors such as DES exposure, HIV infection, or a weakened immune system should continue to be screened annually regardless of normalcy of previous tests. If a woman is overy 70 with three or more normal Pap tests and no history of abnormal Pap tests, she may choose to stop cervical cancer screening.

Question 31

The prevention measures used as a part of the management of a person with an established disease would fall under which of the following classifications?

primary

secondary

tertiary

none of the above

Correct answer:

tertiary

Tertiary prevention measures are part of the management of a person with an established disease. The goal is to minimize disease-associated complications and the negative health effects of the conditions. Medication and lifestyle modification for a person with Type 2 diabetes would be an example of a tertiary prevention measure.

Question 32

Which of the following statements is incorrect in regard to treatment of rheumatoid arthritis?

The goal of treatment of patients with RA is to reduce inflammation and pain, while preserving function and preventing deformity.

Water exercise is helpful.

Behavioral management is important.

Traditional DMARDS to minimize the risk of joint damage include both methotrexate and NSAIDs.

Correct answer:

Traditional DMARDS to minimize the risk of joint damage include both methotrexate and NSAIDs.

As helpful as NSAIDs are in symptom control, these products do not alter the underlying disease process. They are not one of the traditional disease-modifying anti-rheumatic drugs (DMARDs).

Question 33

In terms of teaching a patient about postoperative care, which of the following would be the most effective when time is limited?

providing written instructions and letting the patient and family use these as a guide

providing a list of outside sources for the patient and family to contact for information

establish the patient’s highest priority learning needs and teaching them with patient and family

ask the patient and family whether they have any questions and answer those questions

Correct answer:

establish the patient’s highest priority learning needs and teaching them with patient and family

In a limited time frame, priorities must be set. The most important teaching should be done in person with the patient and family. This does not mean that other measures such as written instructions are not helpful in addition to establishing the patient's highest priority learning needs and teaching them with patient and family.

Question 34

The CMS has developed “Documentation Guidelines for Evaluation and Management” that FNPs and other Medicare providers are expected to follow in coding patient visits. Which of the following is incorrect in terms of these guidelines?

Medical record documentation must support the level of care billed.

An FNP must distinguish between a new patient and an established patient.

History taking, examination and medical decision making are the key components in determining code selection.

A billable visit may not occur in a patient’s home.

Correct answer:

A billable visit may not occur in a patient’s home.

This is incorrect. A billable visit is a face-to-face contact between the patient and an FNP, physician assistant or physician. An encounter may occur in the provider’s office, an inpatient setting or the patient’s home.

Question 35

Which of the following lesions is a precursor of squamous cell carcinoma?

senile purpurae

lentigines

seborrheic keratoses

actinic keratoses

Correct answer:

actinic keratoses

Actinic keratoses are small rough pin-to-reddish lesions that do not heal. They are usually located in sun-exposed areas. They are squamous cell precancer skin lesions.

Question 36

Which of the following statements concerning administrative agencies are correct?

The Internal Revenue Service (IRS) promulgates and applies regulations to individual disputes concerning federal taxation.

The Food and Drug Administration (FDA) decides the costs of each medication.

The National Labor Relations Board (NLRB) decides which federal labor laws go before Congress.

The American Medical Association (AMA) decides how national labor law applies to physician offices.

The Correct answer is:

The Internal Revenue Service (IRS) promulgates and applies regulations to individual disputes concerning federal taxation

The Food and Drug Administration (FDA) promulgates regulations and applies them to individual determinations involving the manufacture, marketing, and advertising of drugs, medical devices, cosmetics, and foods. The National Labor Relations Board (NLRB) decides how national labor laws apply to individual disputes. The American Medical Association (AMA) does not involve itself with national labor laws.

Question 37

A 17-year-old female patient is being managed with Depo-Provera for the purpose of birth control. The nurse practitioner understands that the recommended length of use is usually:

no more than 2 years

as determined by her lipid response to the medication

as long as the patient desires this form of contraception

less than 1 year

The Correct answer is:

No more than 2 years

Depo-Provera is a highly reliable form of contraception and a good choice for young women and adolescents who do not wish to become pregnant for at least 18 months after discontinuing usage. Due to the U.S. Food and Drug Administration warning, prolonged use of Depo-Provera can result in loss of bone density. Therefore, it is not recommended that individuals take Dep-Provera for more than 2 years

Question 38

The patient has the right to confidentiality. The following are all accurate statements regarding patient confidentiality EXCEPT:

The individual's right to privacy is respected when requesting or responding to a request for a medical record.

HIPAA was set up by the Department of Health and Human Services and stands for Health and Insurance Portability Advisory Association.

The statute requires that the provider discuss confidentiality issues with the patient and establish consent.

The provider shall not discuss any information with anyone unless the patient has given consent to do so.

The Correct answer is:

HIPAA was set up by the Department of Health and Human Services and stands for Health and Insurance Portability Advisory Association

HIPAA stands for Health and Insurance Portability and Accountability Act, and not Advisory Association. HIPAA emerged in 1996 and the Department of Health and Human Services plays a role in governing this act. Further, HIPAA establishes national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers

Question 39

The nurse practitioner knows that intervention for patients with heatstroke includes:

total body ice packing

rehydration

withholding fluids until nausea subside

sodium and potassium supplements

The Correct answer is:

Rehydration

Heatstroke is a life-threatening emergency caused by a failure of the body's thermoregulatory system, usually in response to extreme environmental and personal factors. Interventions include cooling the patient with the use of tepid sprays, fanning the body, and aggressive rehydration.

Question 40

In terms of infant growth and development from birth to 2 years, major tasks in the cognitive development domain include all of the following EXCEPT:

presence of blink reflex in newborns

preconceptual thinking in older infants

a greater auditory acuity for high rather than low frequency sounds as infants

binocular vision

Correct answer:

preconceptual thinking in older infants

Preconceptual thinking does not take place as a cognitive development until the ages of 2 to 4. All of the other choices are cognitive developments that take place from birth to 2 years.

Question 41

A 30-year-old female comes to the clinic complaining of a small raised area on the left eyelid. The FNP diagnoses a hordeolum. The treatment for this condition would include all of the following EXCEPT:

warm compresses to the eye for 10 minutes three to four times a day

application of erythromycin ointment to the affected lid

incision and drainage if needed

intralesion corticosteroid injection if needed

Correct answer:

intralesion corticosteroid injection if needed

A hordeolum is also known as a stye and is usually caused by a staphylococcal infection of a hair follicle on the eyelid. The intralesion corticosteroid injection would not be used for a stye. It is used for a chalazion if other treatment is not successful. A chalazion is an inflammatory eyelid condition that may not involve infection but can follow hordeolum.

Question 42

Which of the following treatments would be considered a long-term control medication for asthma sufferers?

Albuterol HFA

Xopenex

Accolate

Ventolin HFA

Correct answer:

Accolate

Accolate (zafirlukast) is a leukotriene receptor antagonist that is used for long-term control of asthma in adults and children 5 – 11 years old. The other choices are all quick-relief (rescue) medications.

Question 43

When assessing cardiac status, the nurse practitioner knows that the correct ausculatory site for the aortic area is the:

left fourth interspace close to the sternum

right second interspace close to the sternum

midclavicular line, second interspace, left side

midclavicular line, fifth interspace, left side

The Correct answer is:

Right second interspace close to the sternum

The right side of the chest close to the sternal boarder at the second intercostal space is the correct area to auscultate the aortic valve. The mitral valve is heard at the fifth left intercostal space at the midclavicular line. The tricuspid valve is auscultated at the fourth left intercostal space. Then, the pulmonic valve is heard

Question 44

Prophylactic treatment for migraine headache includes the use of:

naproxen sodium

propranolol

acetaminophen

nonsteroidal anti-inflammatory drugs (NSAIDs)

The Correct answer is:

Propranolol

Migraine headaches can be prevented with propranolol. Prophylactic therapy is aimed at limiting the number and severity of future headaches. Abortive therapy is used to stop a headache.

Question 45

The standard billing form for billing third-party providers is which of the following?

E&M 1200

E&M 1500

CMS 1200

CMS 1500

Correct answer:

CMS 1500

The standard billing form is the CMS 1500. It can be purchased from the American Medical Association or from other commercial suppliers. The CMS 1500 form asks for ICD codes, CPT codes, date of service, patient identifying information and provider identifying information. A bill submitted without a CPT or ICD code will be rejected.

Question 46

A patient who has been given a nursing diagnosis of vesicular breath sounds would be expected to display which of the following?

Difficulty breathing.

High-pitched, wheezy breathing.

Low-pitched, breezy breathing.

Low-pitched, hollow breathing.

Correct Answer: Low-pitched, breezy breathing Vesicular breath sounds are low-pitched, breezy, and soft. They are associated with normal breathing and are heard when ausculating over the lung area. Though they are considered normal, it is key that these breath sounds be documented as part of an overall assessment, as they are valuable information for diagnosis.

Question 47

A 11-year-old girl is brought into the office with clinical symptoms and a diagnostic history for scabies. The nurse practitioner knows that she was probably infected:

1-3 days ago

1 week ago

2 weeks ago

3-4 weeks ago

The Correct answer is:

3-4 weeks ago

The incubation period for scabies is about 3-4 weeks after primary infection. Further, the patient with scabies will develop symptoms in 1-3 days. The classic complaint from patients with scabies is nocturnal pruritus.

Question 48

Which of the following would not be considered a body change related to menopause?

atrophied ovaries

labia and vagina become atrophic and thinner

urinary incontinence

palpable ovaries

Correct answer:

palpable ovaries

Palpable ovaries are considered an abnormal finding in menopausal women. After several years of menopause, the ovaries are atrophied and a smaller size. Ovarian cancer must be ruled out when a palpable ovary is found.

Question 49

You are counseling a 23-year-old with an abnormal pap smear. It is important you discuss the risks of cervical cancer. Which of the following is NOT a risk factor for cervical cancer?

virginal status

previous high-grade squamous intraepithelial lesion

human papillomavirus

multiple sexual partners

The correct answer is:

Virginal status

A female who has not had sexual intercourse is not at risk for developing cervical cancer. However, the remaining answer choices are risk factors for cervical cancer.

Question 50

A 25-year-old female patient comes to the clinic with a “rash” on the inner wrist area. She tells the FNP that it is extremely itchy, especially at night. The FNP tells her that she has scabies. The FNP understands that all of the following are true in regard to this disease EXCEPT:

Kwell (lindane) is the preferred treatment.

Permethrin 5% can be used as a treatment by applying to the entire body and head and washing off after 8 to 14 hours.

The entire household must be treated.

Linens and clothes must be washed in very hot water.

Correct answer:

Kwell (lindane) is the preferred treatment.

All of the choices are true except this one. Kwell may be used as an alternative treatment but it is out of favor as a treatment due to neurotoxicity.

Question 51

Participants in a research study who do not have the disease or condition that is being studied, but who are included for comparison are:

case series

case subjects

cross sectionals

controls

The Correct answer is:

Controls

Controls are commonly used in many different types of research studies. Additionally, case series refer to an observational study where patients with interesting characteristics are studied. Case subject is another term for participants. Cross sectionals are types of observational studies where a particular characteristic is studied at one time rather than over a period of time.

Question 52

With prepatellar bursitis, which of the following should be considered as a first-line-therapy?

minimizing the offending activity

applying ice to the affected area for 15 minutes at least 4 times a day

NSAIDs

bursal aspiration

Correct answer:

bursal aspiration

With prepatellar bursitis, bursal aspiration should be considered as a first-line therapy. This is because this procedure affords significant pain relief and allows the bursa to reapproximate. The therapies in the other three choices are appropriate for bursitis in other sites.

Question 53

What is the most common type of anemia worldwide?

anemia of chronic disease

pernicious anemia

iron-deficiency anemia

sickle cell anemia

The Correct answer is:

Iron-deficiency anemia

Iron deficiency anemia is the most common type of anemia in the world. It is estimated that 8 years of poor iron intake is needed in adults before chronic iron-deficiency anemia occurs. Causes of iron-deficiency anemia include menstrual blood loss, blood loss from malignancy, and other gastrointestinal related blood loss. Diet is rarely the etiology.

Question 54

Which of the following would be considered a prophylactic treatment for migraine headaches?

Imitrex

Cafergot

Tigan

Inderal

Correct answer:

Inderal

Inderal is a prophylactic treatment for migraine headaches. The other drugs are abortive treatment. Tricyclic antidepressants such as Elavil may also be used as a prophylactic treatement.

Question 55

An infant is brought in with a temperature of 99.7 F. The parents insist that this is higher than average. What is the appropriate response?

Run a CBC.

Call a consult.

Continue the assessment.

Tell the parents they are overreacting.

Correct answer: Continue the assessment An infant's body temperature typically runs a little high. 104 degrees F is considered a fever. Temperature can fluctuate with individuals, so it is important to complete the assessment.

Question 56

The FNP is educating a group of women about prevention of osteoporosis. In this class, the FNP would tell the group all but which of the following?

Primary prevention of osteoporosis includes ensuring the development of maximal adult bone density.

Calcium intake and weight-bearing exercises throughout the teen and adult years is important in achieving maximal adult bone density.

The daily calcium intake goal should be the equivalent of 1000 mg/d for premenopausal women.

The recommended minimal dose of vitamin D is 3000 IU/d daily.

Correct answer:

The recommended minimal dose of vitamin D is 3000 IU/d daily.

This statement would not be included in the talk. It is incorrect. The recommended minimal dose of vitamin D is 600 – 900 IU/d daily. Daily doses of up to 2000 IU/d are likely safe, but 3000 IU/d is too much.

Question 57

How far away should you hold the ophthalmoscope to check the red reflex?

12 inches.

6 inches.

24 inches.

8 inches.

Correct answer: 12 inches The red reflex monitors the pupil reactions. They should be observed from 12 to 16 inches away.

Question 58

The FNP is advising an older patient who has unintended weight loss on what energy-dense protein foods to eat. The FNP would recommend which of the following as part of this energy-dense protein diet?

peanut butter and eggs

carrots and other crunchy vegetables

breads and other grain products

fruits

Correct answer:

peanut butter and eggs

Peanut butter and eggs are good sources of complete proteins and are energy and nutrient dense. The other choices are not good sources of energy-dense protein.

Question 59

The kidneys are located in the retroperitoneal area. The right kidney is lower than the left, the lower half falling below the rib cage. The reason for this is:

better functioning of the kidneys

displacement by the liver

displacement by the stomach

none of the above

Correct answer:

displacement by the liver

The lower half of the right kidney falls below the rib cage because it is displaced by the liver. The kidneys are the body’s regulators of electrolytes, fluids and bicarbonate.

Question 60

Which of the following are you NOT likely to see in geriatric patients?

a decrease in the GFR

less elasticity and cilia in the lungs

less hydrochloric acid in the gastrointestinal system

decreased levels of insulin

Correct answer:

decreased levels of insulin

This is not likely to be seen in geriatric patients. You are more likely to see increased levels of insulin along with mild peripheral insulin resistance.

Question 61

An otherwise healthy adult female patient presents with a series of dry, plaque-like skin lesions. She reports that they occasionally bleed when bumped but do not otherwise itch or suppurate. Which of the following is the MOST likely diagnosis for this patient?

Psoriasis.

Hyperhydrensis supperitiva.

Keratosis pilaris.

Skin cancer.

Correct Answer: Psoriasis This patient's lesions are consistent with psoriasis. Since she is otherwise healthy, do they do not indicate an underlying health condition.

Question 62

In relation to uterine size during pregnancy, the nurse practitioner knows that the uterus is approximately tennis-ball sized at what stage of pregnancy?

6 weeks

8 weeks

12 weeks

20 weeks

The Correct answer is:

8 weeks

The uterus is the size of a lemon nongravid and is mobile, firm and nontender. By 8 weeks gestation, it has grown to the size of a tennis ball or orange. At 12 weeks, the uterus is the size of a softball or grapefruit. By 20 weeks, the uterine fundus is at the umbilicus.

Question 63

At about what age can the FNP expect to see an infant keep his back straight when pulled to sitting?

1 – 2 months

3 – 4 months

5 months

9 – 11 months

Correct answer:

5 months

At 5 months an infant will typically keep his back straight when he is pulled to a sitting position. At this age infants also bear weight on their legs when standing, play with their feet and sit with support.

Question 64

Which of the following patients has the highest risk factor for peptic ulcer disease?

a 65-year-old female who drinks 4 cups of coffee per day

a 45-year-old male who has one or two alcoholic drinks per day

a 55-year-old male who has cirrhosis as a result of alcohol abuse

none of the above

Correct answer:

a 55-year-old male who has cirrhosis as a result of alcohol abuse

This is the patient who has the greatest risk factor for peptic ulcer disease. Coffee drinking and occasional alcohol use are not risk factors for peptic ulcer disease. H. pylori is also found in individuals with asymptomatic gastritis and dyspepsia without ulceration.

Question 65

If an adult presents with the classic triad of fever, headache and stiff neck, which of the following diseases/conditions would these symptoms most likely indicate?

migraine headache

bacterial meningitis

mononucleosis

chronic epidural hematoma

Correct answer:

bacterial meningitis

Of the choices given, the most likely diagnosis would be bacterial meningitis. As with most forms of infectious disease, however, atypical presentation in older adults is common. In particular, stiff neck and fever are often absent.

Question 66

A mother brings her 3-year-old son into the clinic for a routine checkup. The mother tells the FNP that her child “acts out” a lot and that she needs help in addressing this behavior. The FNP suggests a “time out” for the child when he misbehaves. Which statement in regard to a “time out” for children is most accurate?

The “time out” should last for as many minutes as the child has misbehaved.

The child should sit still in the “time out” for as many minutes as his age in years.

The child should be allowed to read or draw during the “time out.”

“Time outs” should not be used until a child is at least old enough to have started school.

:

The child should sit still in the “time out” for as many minutes as his age in years.

A “time out” for a child should not last longer than his age in years. Since this child is three years old, his “time out” should be three minutes. He should sit still during this time, not read, draw or do any other activity

Question 67

An elderly patient presents with diarrhea. She explains to the NP that her stool is large and liquid. Testing shows that her stool shows no signs of blood or leukocytes. The NP will MOST likely give a diagnosis of what type?

Shigella.

Adenovirus.

Campylobacter jejuni.

Salmonella.

Correct answer: Adenovirus Adenovirus is a viral type of diarrhea. Symptoms include nausea, vomiting and low-grade fever, among other things

Question 68

Which of the following parts of the eye are used for color perception?

cones

rods

fundus

macula

Correct answer:

cones

The cones are for color perception. The fundus is the interior surface of the eye opposite the lens. The rods are for detecting light and for depth perception. The macula is for central vision.

Question 69

Which of the following is not a typical complication of anorexia nervosa?

amenorrhea

weight loss of > 5% of body weight

cardiomyopathy

lanugo

Correct answer:

weight loss of > 5% of body weight

This is not a typical complication because the weight loss in a person with anorexia would amount to at least 15% of body weight. Osteoporosis from prolonged estrogen depletion and stress fractures are also complications.

Question 70

A 45-year-old woman complains to the FNP that her 80-year-old mother is too demanding and that it has created a great stress in her life. According to Havighurst’s developmental tasks, this complaint reflects which of the following?

a need for independence

a need to adjust to an aging parent

establishing an explicit affiliation with one’s own age group

a need to achieve emotional independence

Correct answer:

a need to adjust to an aging parent

One of Havighurst’s developmental tasks for 30 – 60 year old persons is adjusting to an aging parent. Other tasks in this age group include: achieving adult social and civic responsibility, developing adult leisure time activities and relating oneself to one’s spouse as a person.

Question 71

A middle-aged female presents with abnormal uterine bleeding. A hormonal profile reveals increased FSH and LH levels. What is the most likely cause for these findings?

onset of climacteric

premature ovarian failure

anterior pituitary disorder

hypothalamic disorder

The Correct answer is:

Onset of climacteric

The amount of circulating estrogen begins to fall and the ovaries decline to function. The middle-aged woman may begin to experience symptoms typically associated with menopause. The body's feedback system will attempt to stimulate the ovaries and increase estrogen level. FSH and LH levels rise in response to these efforts.

Question 72

Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option. The four levels of evaluation and management services include all of the following EXCEPT:

high complexity

low complexity

straightforward

up-front

Correct answer:

up-front

There is no up-front level of E/M services. The four types of medical decision making are: straightforward, low complexity, moderate complexity and high complexity

Question 73

Title XIX of the Social Security Act is also known as which of the following?

Americans with Disabilities Act

Medicare

OSHA

Medicaid

Correct answer:

Medicaid

Title XIX of the Social Security Act is also known as Medicaid which is a federal and state matching program that offers medical assistance to low income persons, the disabled, blind or members of families with dependent children. It pays for health care, nursing home, and prescription drugs.

Question 74

You are treating a 64-year-old man who has the following PSA levels. What can be concluded about the following annual readings?

Year 1: 3.8 ng/mL Year 2: 4.5 ng/mL Year 3: 5.5 ng/mL

There is a steady increase that is worrisome.

There is a steady increase but it is not worrisome.

They are all within normal range.

None are within normal range.

The Correct answer is:

There is a steady increase that is worrisome

The prostate gland produces an antigen called prostate-specific antigen (PSA). The PSA test detects the amount of PSA in the patient’s blood. Typically, the normal range for the PSA level is below 4 ng/mL in an elderly male and below 2.5 ng/mL in a younger male. In the case of the 64-year-old patient, his PSA level during year 1 was 3.8 ng/mL, which is in the normal range. However, starting at year 2, the patient’s PSA level increased too 4.5 ng/mL, which is outside of the normal range. Then, it elevated to 5.5 ng/mL in year 3, demonstrating his PSA level is steadily increasing outside of the normal range of 4 ng/mL. This elevation in PSA levels is a sign that some condition is causing the patient’s PSA level to rise, such as prostatitis, benign prostatic hyperplasia (BPH) or even prostate cancer, for instance. Therefore, the patient should be referred for further testing, including a referral to an urologist for a prostate biopsy to rule out prostate cancer. Statistics reveal that about two thirds of elderly male individual’s develop prostate cancer, when their PSA levels are elevated more than 10 ng/ mL. Further, statistics suggest that about 25% of males who have elevated PSA levels between 4 to 10 ng/mL have a condition contributing to the increase in the PSA.

Question 75

Which of the following would NOT be a direct mechanism of transmission of infection?

touching

sexual intercourse

food

childbearing

Correct answer:

food

Transmission through food is an indirect way to transmit infection. Direct mechanisms of transmission of infection include (besides the other three choices): kissing, breastfeeding and transfusions.

Question 76

A teenage patient comes in and his chief complaint is painful urination. What will you want to determine in the interview?

Exercise.

Diet.

Family history.

Sexual activity.

Correct answer: Sexual activity Sexual activity is more likely to begin during the teen years. Different sexually transmitted diseases present with painful urination. Sexual activity will determine the tests needed to determine the condition.

Question 77

What is a normal reaction after tapping a patient's Achilles tendon in an exam?

Plantar flexion at the ankle.

Extension of leg at the knee.

Extension of the ankle.

Flexion of leg at the knee.

Correct answer: Plantar flexion at the ankle All of the answers are normal reflexes. The Achilles' tendon, however, should cause plantar flexion at the ankle. An abnormal reflex may be a sign of damaged nerves.

Question 78

A patient with sensitive skin had a TB skin test but has no symptoms. He returns with redness and swelling that appears positive. What is the next step?

Prescribe medication.

Schedule a chest x-ray.

Repeat the test.

Quarantine the patient.

Correct answer: Schedule a chest x-ray A chest x-ray shows signs of TB and is more accurate than the skin test. The skin test may appear positive if there is exposure to the illness or allergic reaction. Because the patient has no symptoms, the chest x-ray is recommended.

Question 79

When treating the patient with heartburn symptoms, the nurse practitioner understand that the drug that is most likely to produce rapid relief for a patient is:

H2 blockers

proton pump inhibitors

sucralfate

antacids

The Correct answer is:

Antacids

Antacids produce the most rapid change in gastric pH and the most rapid relief of symptoms. H2 blockers and proton pump inhibitors may take many hours before relief is realized. Therefore, H2 blockers are not adequate for immediate relief. Further, sucralfate does not affect gastric pH.

Question 80

Which of the following is a pansystolic murmur that is heard best at the apex or the apical area, radiates to the axilla and is a loud-blowing and high-pitched murmur?

tricuspid regurgitation

aortic stenosis

mitral regurgitation

none of the above

Correct answer:

mitral regurgitation

Mitral regurgitation is a pansystolic murmur that is heard best at the apex or the apical area, radiates to the axilla and is a loud-blowing and high-pitched murmur. The diaphragm of the stethoscope is used to detect mitral regurgitation.

Question 81

You are seeing a 3-year-old female child in the office. Her mother is concerned about her not being able to elevate her left arm without crying out. A clavicular fracture is suspected. Which of the following is NOT true regarding a fracture of the clavicle?

This is one of the most common fractures that occur in childhood.

The patient may avoid moving the arm on the injured side or may angle the head toward the injured side to relax the trapezius muscle.

There is usually no visible or palpable deformity upon examination and it is rarely seen on an x-ray.

The mechanisms of injury is usually a fall on the outstretched hand or direct blow to the shoulder area.

The Correct answer is:

There is usually no visible or palpable deformity upon examination and it is rarely seen on an x-ray

There is most always a visible and a palpable deformity seen and the x-ray findings will show a visible separation of the clavicular bone. Further, the remaining answer choices are all true of this type of fracture.

Question 82

What agency decides who may be called a Family Nurse Practitioner?

The American Medical Association (AMA)

The American Nurses Association (ANA)

State Boards of Nursing

The American Nurses Credentialing Center (AACN)

The Correct answer is:

State Boards of Nursing

The authority for a Family Nurse Practitioner to practice is found in state legislative statutes and in rules and regulations. The Nurse Practice Act of every state authorizes the State Boards of Nursing to establish statutory authority to define who may be called a Family Nurse Practitioner, and therefore, provide title protection. The American Medical Association (AMA) and the American Nurses Association (ANA) are professional organizations that qualified healthcare providers may become a member of. The American Nurses Credentialing Center (AACN) is an accrediting certification agency for professional nurses. These three agencies do not have the authority to decide who is called a Family Nurse Practitioner. Therefore, they are incorrect answers.

Question 83

Nurse practitioners are certified by what governing body?

state boards of nursing

an entity such as ANCC or AANP

The American Nurses Association

The state where they practice

The Correct answer is:

An entity such as ANCC or AANP

The two certifying bodies for adult and family nurse practitioners in the U.S. are the American Nurses Credentialing Center (ANCC) and American Academy of Nurse Practitioners (AANP). The state boards license the nurse practitioners in the state where they practice and most require certification in order to become licensed.

Question 84

A 33-year-old Caucasian woman is in the clinic inquiring about sexual activity during pregnancy. She is 7 months pregnant and concerned that this will place her fetus at an increased risk. The nurse practitioner has knowledge that:

This may increase the risk of cardiovascular abnormalities in the fetus.

This may stimulate labor and, therefore, should be avoided.

This may increase the risk of pre-term labor.

There is absolutely no increased risk to the fetus.

Correct answer:

This may increase the risk of pre-term labor

The lower uterine segment may be physically stimulated, therefore resulting in pre-term labor. Oxytocin is released during an orgasm and this is known to stimulate the uterus into pre-term labor as well. With the absence of complications associated with pregnancy, sexual activity is not contraindicated. Should vaginal discharge, vaginal bleeding, or membrane rupture occur, the patient should avoid sexual activity.

Question 85

Which of the following drugs is NOT a selective serotonin reuptake inhibitor (SSRI)?

Prozac

Paxil

Elavil

zoloft

Correct answer:

Elavil

Elavil is not an SSRI. It is a tricyclic antidepressant and unlike SSRIs it is not used as a first line of treatment for depression

Question 86

This extended release formula of a narcotic pain reliever was prescribed to an elderly patient. Which medication is it?

ER Oxycodone.

Ibuprofen.

Naproxen.

Morphine 30 mg.

Correct answer: ER Oxycodone ER Oxycodone and Morphine 30 mg are the only two narcotic pain relievers listed. Morphine 30 mg is a short-acting drug and works like ER Oxycodone in that it treats moderate to severe pain.

Question 87

You are treating a pregnant female and she inquires about HIV testing. The nurse practitioner has the understanding that:

It is better performed in the third trimester

It is an "opt-in" approach.

It produces many false positives.

It is recommended by the ACOG.

The Correct answer is:

It is recommended by the ACOG

The American College of Obstetrics and Gynecology (ACOG) recommends an "opt-out" approach to HIV screening in pregnant patients. This means that HIV will be routinely preformed unless the patient refuses.

Question 88

You are treating a patient who suspects she was given something by her date because she feels "funny" now and "doesn't remember much about last night." You suspect flunitrazepam (Rohypnol). You know that it has been associated with:

amnesia

agitation

increased appetite

hallucination

The Correct answer is:

Amnesia

Flunitrazepam is a benzodiazepine known as the date rape drug. Because it can result in amnesia, sexual assault can often occur without the victim's knowledge. While not available for prescription use in North America, it is commonly prescribed as a sleep aid in other countries and is known as a street drug in the U.S.

Question 89

When counseling a patient with allergic rhinitis, you prescribe Cromolyn. The nurse practitioner understands that its mechanism of action is a (an):

mast cell stabilizer

vasoconstrictor

leukotriene modifier

anti-immunoglobulin E antibody

The Correct answer is:

Mast cell stabilizer

Cromolyn is a mast cell stabilizer in a nasal spray that is effective at preventing symptoms of allergic rhinitis. This drug does not acutely relieve symptoms. Instead, it takes around a week of use to achieve symptom relief.

Question 90

In doing a neurological examination, the Romberg test would be associated with which of the following?

mental status

cerebellar system

sensory system

motor exam

Correct answer:

cerebellar system

The Romberg test is based on the premise that a person requires at least two of the three following senses to maintain balance while standing: proprioception (the ability to know one's body in space); vestibular function (the ability to know one's head position in space); and vision (which can be used to monitor changes in body position).

Question 91

Which of the following drugs is a selective serotonin reuptake inhibitor (SSRI)?

buproprion

sertraline

alprazolam

Dexedrine

Correct answer:

sertraline

Sertraline (Zoloft) is an SSRI. The others are not. Other SSRIs include: fluoxetine (Prozac), and paroxetine (Paxil).

Question 92

Which of the following developmental milestones is not properly matched with its average age or age range?

unfists: 3 – 4 months

babbling vowels: 5 – 6 months

points to named pictures when asked “show me:” 30 months

transfers objects: 4 – 7 months

Correct answer:

points to named pictures when asked “show me:” 30 months

This developmental milestone is not matched correctly with its average age of accomplishment. The average age for pointing to named pictures when asked “show me” is 18 – 24 months.

Question 93

A patient has a history of a GI bleed. She comes in complains of abdominal pain in the interview. What test should be run?

Blood glucose.

CBC.

CEA test.

Stool hematest.

Correct answer: Stool hematest GI bleeding After a physical exam, order a stool hematest. A stool hematest will reveal if there is blood in the GI tract.

Question 94

According to guidelines, which of the following might be considered least important in determining the level of visit to bill for evaluation and management of a patient (not counseling)?

examination

time

history taking

medical decision making

Correct answer:

time

Time is a minor consideration in determining the level of visit to bill, according to guidelines, if a clinician is billing an office visit for evaluation and management. If a visit is primarily counseling, however, time matters and should be documented.

Question 95

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

poor fluid consumption

constipation

medication related

inactivity

The Correct answer is:

Constipation

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

Question 96

A patient who has recently been prescribed Savella for fibromyalgia should be made aware of all but which of the following potential side effects?

Risk of abnormal bleeding.

Constipation.

Diarrhea.

Insomnia.

Correct Answer: Diarrhea Diarrhea is not among the common reported side effects of Savella. Constipation and insomnia are commonly reported. Savella does elevate the risk of abnormal bleeding, which is a potentially more serious side effect.

Question 97

The nurse practitioner knows that it is developmentally important to do what during the physical examination of an adolescent female?

Discuss only the major areas of abnormality.

Verbally affirm normalcy.

Verbally address problems of sexually transmitted diseases.

Maintain a comfortable silence.

The Correct answer is:

Verbally affirm normalcy

During the adolescent years there is a need to discuss the physical changes that the patient is undergoing. Further, verbal affirmation of normalcy is necessary to decrease anxiety.

Question 98

The nurse practitioner knows that all of the following are nonpharmacologic treatments for a patient with acute glomerulonephritis EXCEPT:

Avoid high-potassium foods.

Treat them as inpatient until edema and hypertension are under control.

Restrict protein in presence of azotemia and metabolic acidosis.

Encourage increased fluid intake.

Encourage increased fluid intake

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

Question 99

Which of the following drugs is a cholinesterase inhibitor that comes in the form of a pill, syrup or drug-releasing skin patch?

Galantamine.

Hydrocodone.

Rivastigmine.

Donepezil.

Correct answer: Rivastigmine There are three cholinesterase inhibitors commonly prescribed by doctors. These are Donepezil, Galantamine and Rivastigmine. Hydrocodone is a type of medication that treats moderate to severe pain as well as cough.

Question 100

Asking the patient to slide the tongue from side to side in an exam tests which nerve?

Vagus.

Trigeminal.

Hypoglossal.

Trochlear.

Correct answer: Hypoglossal The hypoglossal nerve controls the tongue. Listening to annunciation, looking at the tongue, and having the patient move it from side to side is how it is assessed. It is important to examine to tongue for any lesions that may cause the patient to hold the tongue in a certain way.

Test 6 aanp

 Question 1 

Olecranon bursitis is located in which of the following places? 

   shoulder 

  knee 

   elbow 

  heel 

Explanation: 

Correct answer:

elbow

 

Olecranon bursitis is located in the elbow. There is pain and swelling behind the elbow. It is often described as a ball or sac hanging from the elbow. Risk factors include prolonged pressure or trauma to the elbow.

 

 Question 2 

Which of the following are you most likely to do to treat a patient who has temporal arteritis? 

  ice pack on forehead 

  100% oxygen 

  administer Tegretol 

   refer to ER or ophthalmologist 

 

Correct answer:

refer to ER or ophthalmologist

 

Arteritis is a systemic inflammatory process of the medium and large arteries of the body. If the temporal artery is involved, it is called temporal arteritis. Permanent blindness may occur if it is not diagnosed and treated early.

 

 Question 3 

A 64-year-old Caucasian male has the following lipid level results:

Total cholesterol    240 mg/dL

LDL                      140 mg/dL

HDL                       35 mg/dL

Triglycerides          201 mg/dL

What class of medications will normalize his lipid elevations and decrease his risk of a cardiac event? 

  fibric acids 

  bile acid sequestrants 

  niacin 

   statins 

The Correct answer is:

Statins

The only medication class that lowers elevated lipid levels and has proven efficacy in lowering the risk of cardiac events, even for primary prevention, is statin medications. Further, statin therapy has been shown to reduce overall mortality due to cardiovascular deaths

Question 4 

Which of the following statements about herpes zoster (shingles) is least accurate? 

  More than 66% of those affected are older than 50 years. 

  Only 5% of cases occur in children younger than 15 years. 

   Herpes zoster occurs equally in males and females. 

   Radiotherapy is a protective factor for the disease. 

Correct answer:

Radiotherapy is a protective factor for the disease.

 

All of the statements are accurate except this one. Radiotherapy is a factor increasing susceptibility for the disease.

 

 Question 5 

The nurse practitioner (NP) understands that the following is NOT true regarding the care of minors: 

  In most jurisdictions, minors under the age of 18 cannot receive healthcare services without permission of an adult who is a parent or legal guardian. 

   If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian. 

  In case of emergency, when no parent or guardian is available, care may be rendered. 

   If a 15-year-old becomes pregnant, she is an emancipated minor. 

The Correct answer is:

If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian

A teen with a STD is considered an emancipated minor, and the parent or legal guardian should not be contacted.  The remaining answer choices are true regarding the care of minors. 

 

Question 6 

While examining a patient you hear a high-pitched diastolic murmur at the second ICS at the right side of the sternum. You know that this indicates which of the following? 

   aortic regurgitation 

  aortic stenosis 

   mitral stenosis 

  mitral regurgitation 

 

Correct answer:

aortic regurgitation

 

A high-pitched diastolic murmur which is best heard at the second ICS at the right side of the sternum indicates aortic regurgitation. Aortic stenosis produces a harsh and noisy murmur and radiates to the neck.

 

Question 7 

Which of the following statements about end-of-life care is least accurate? 

   Withholding or withdrawing artificial nutrition or hydration from terminally ill or permanently unconscious patients is illegal. 

   Oral statements made by a patient may be legally valid advance directives. 

  Only a few states require “clear and convincing evidence” of a patient without decision-making capabilities that it is his or her wish to forego life-sustaining treatment. 

  There is no legal requirement to notify risk management personnel before life-sustaining medical treatment can be stopped. 

 

Correct answer:

Withholding or withdrawing artificial nutrition or hydration from terminally ill or permanently unconscious patients is illegal.

 

This is the least accurate statement. Just like any other therapy, fluids and nutrition may be withheld if it is the patient’s or surrogate’s wish.

 

Question 8 

In the latent stage of syphilis which of the following is the most common sign?

 

   painless chancre 

  maculopapular rash on palms and soles that is not pruritic 

   no symptoms 

  valvular damage 

 

Correct answer:

no symptoms

 

Syphilis has four stages: primary, secondary, latent, and tertiary. The latent stage is characterized by being asymptomatic

 

Question 9 

You are seeing an uncircumcised client that presents with a complaint of not being able to retract the foreskin over the glans penis. What is the likely diagnosis? 

   phimosis 

  paraphimosis 

   lateral phimosis 

  Peyronie's disease 

 

The Correct answer is:

Phimosis

Phimosis results in the patient's inability to retract the foreskin from behind the glans penis. This condition occurs at any age and is the result of poor hygiene and chronic infection.

 

Question 10 

When counseling a patient with the human herpes virus 2 (HHV-2), the nurse practitioner knows that what percentage of sexually active adults has serological evidence of this disease? 

  5% 

  10% 

   15% 

   25% 

 

The Correct answer is:

25%

The human herpes virus 2 (HHV-2) causes painful ulcerated lesions and lymphadenopathy.  Approximately 25% of adults who are sexually active have serological evidence of this disease, although only a small percentage of these persons have symptoms. 

 

Question 11 

Which of the following is NOT a live attenuated virus vaccine? 

  MMR 

   Varicella Zoster 

   injectable tri-valent influenza vaccine 

  FluMist 

 

Correct answer:

injectable tri-valent influenza vaccine

 

The injectable trivalent influenza vaccine (TIV) does not contain live virus and is not shed. There is no risk of transmitting an infectious agent to household contacts. The other choices are vaccines with live attenuated viruses.

 

 Question 12 

Kurt Lewin’s model of change management can best be described as which of the following? 

  preparation, change and continuity 

  grounding, amending and permanence 

   training, exchanging and connection 

   unfreezing, moving and refreezing 

Correct answer:

unfreezing, moving and refreezing

 

The unfreezing stage involves getting to a point of understanding that change is necessary and getting ready to move away from the current comfort zone. Moving is moving towards a new way of being. Refreezing is about establishing stability once the changes have been made.

 

Question 13 

Nurse practitioners are always reimbursed for their services as primary care providers under all but which of the following? 

  Medicare 

   Federal Employees Health Benefits Program 

   Managed Care Organizations

 

  TRICARE 

Correct answer:

Managed Care Organizations

 

Managed Care Organizations frequently have excluded NPs from being designated as primary care providers carrying their own caseloads. Thus, in many MCOs, the only option for NPs is that of being a salaried employee.

 

Question 14 

The knee joint includes four bones. Which of the following is NOT one of these bones?

 

  distal femur 

   distal tibia 

   patella 

  proximal fibula 

 

Correct answer:

distal tibia

 

The distal tibia is not one of the bones of the knee. The knee joint includes the distal femur, the patella, the proximal fibula, and the proximal tibia.

 

Question 15 

In terms of etiology of disease, incidence rates can best be described as which of the following? 

  a group at a certain point in time and the number within a group that has a particular disease or problem 

  interventions at the clinical stage of disease, directed at treatment and rehabilitation 

   the rate of involvement of causative agents 

   the rate of development of a disease in a group over a period of time 

Correct answer:

the rate of development of a disease in a group over a period of time

 

Incidence rates describe the rate of development of a disease in a group over a period of time. They also describe the continuing occurrence of new cases of disease.

 Question 16 

Your patient has an extensive infection of several adjacent hair follicles that form a mass with multiple drainage points. You understand that this patient has which of the following? 

  folliculitis 

   carbuncle 

  furuncle 

  none of the above 

Correct answer:

carbuncle

 

A carbuncle occurs when there is an extensive infection of several adjacent hair follicles that form a mass with multiple drainage points. Folliculitis is a minor inflammation of hair follicles with or without pustules. A furuncle (abscess or boil) is a more extensive infection of a hair follicle.

 

Question 17 

A 23-year-old female who is breastfeeding is inquiring about alcohol use during lactation. The nurse practitioner understands that: 

  Because of its high molecular weight, relatively little alcohol is passed into breast milk. 

  Infant intoxication may be seen with as little as one to two maternal drinks. 

   Drinking a glass of wine or beer will enhance the let-down reflex. 

   Maternal alcohol use causes a reduction in the amount of milk ingested by the infant. 

 

The Correct answer is:

Maternal alcohol use causes a reduction in the amount of milk ingested by the infant 

Alcohol has a low molecular weight and is highly lipid soluble. These characteristics allow it to have easy passage into breast milk. Even in small amounts, alcohol ingestion by a nursing mother can cause a smaller amount of milk produced, reduction in the let-down reflex and less rhythmic and frequent sucking by the infant, resulting in a smaller volume of milk ingested.

 

Question 18 

A 42-year-old Caucasian male has newly diagnosed hypertension and has received a prescription for ramipril. He is otherwise healthy and on no other medications. Which laboratory test would be important to monitor him? 

  PT with INR

 

   potassium level 

   ALT/AST 

  calcium level 

The Correct answer is:

Potassium level

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. Further, this medication causes retention of potassium. Therefore, the patient's potassium level should be measured about one month after initiating therapy and again after dosage changes. The remaining answer choices, PT with INR, ALT/AST and calcium level, are not specific laboratory tests for ACE inhibitor therapy. 

 

Question 19 

Which of the following is the gold standard diagnostic test for thalassemia minor? 

  blood smear 

  serum ferritin 

   hemoglobin electrophoresis 

  none of the above 

 

Correct answer:

hemoglobin electrophoresis

 

Hemoglobin electrophoresis is the gold standard diagnostic test for thalassemia minor. in beta thalassemia it is abnormal. There is an elevated Hgb.A2, and Hgb F.

 

Question 20 

What dietary regimen would be appropriate for an elderly client with chronic obstructive pulmonary disease? 

  high caloric, low protein, high carbohydrate 

   low caloric, low protein, high carbohydrate 

   high caloric, high protein, low carbohydrate 

  low caloric, high protein, low carbohydrate 

The Correct answer is:

High caloric, high protein, low carbohydrate

 

By eating a high protein, high caloric and low carbohydrate diet, the patient with chronic obstructive pulmonary disease is able to meet his or her nutritional needs. Additionally, a patient with chronic obstructive pulmonary disease, who retains carbon dioxide, should avoid high carbohydrate foods because carbohydrates metabolize into carbon dioxide (CO2) as a waste product.

 Question 21 

The type of nursing research that examines events of the past to enhance self-understanding is called: 

  phenomenology 

   historical research 

   grounded theory 

  ethnographic research 

Correct answer:

historical research

 

Historical research examines events of the past to enhance self-understanding. It is a type of qualitative research that focuses on the collection of data through interviews, observations and focus groups to enhance understanding about a particular area of interest in nursing.

 

Question 22 

Which of the following conditions is most likely to be found in a person with acute cholecystitis? 

  fever 

  jaundice 

   vomiting 

  palpable internal joint 

The Correct answer is:

Vomiting

Acute cholecystitis symptoms include vomiting, right upper abdomen pain, and nausea. Fever, jaundice and a palpable internal joint are not seen in patients with cholelithiasis. Cholelithiasis is defined as a condition in which there is the formation of calculi or gallstones. 

 

Question 23 

A 8-year-old male child is called back into the office because his stool specimen for ova and parasites (O & P) came back positive. The nurse practitioner knows what regarding enterobiasis? 

   The parasite causes pruritus around the anus because the females exit at night to lay eggs on the skin. 

  This parasite is a protozoan and the source is usually contaminated water and it is spread by fecal-oral contamination. 

   The parasite is in the soil and enters the body through the feet. 

  Eggs of this parasite enter the body by ingestion of dirt or from unwashed vegetables that contain the eggs in the dirt. 

The correct answer is:

The parasite causes pruritus around the anus because the females exit at night to lay eggs on the skin

This infestation is also known as "pinworms" which reside in the intestine. Hookworm larvae reside in the soil and enter the body through the feet. When dirt is ingested, there is a risk of contacting roundworm. Giardiasis from Giardia lamblia results from ingesting this organism through contaminated water or fecal-oral transmission.

 

Question 24 

In terms of Medicare, which of the following statements about hospital privileges is incorrect? 

  Every hospitalized patient covered by Medicare must be under the care of a physician. 

  The federal government includes licensed doctors of medicine, osteopathy, podiatry and chiropractic in its definition of physician. 

   Hospitalized patients may be under the care of a clinical psychologist. 

   Doctors of medicine or osteopathy may not delegate tasks for hospitalized patients to other qualified health care personnel. 

 

Correct answer:

Doctors of medicine or osteopathy may not delegate tasks for hospitalized patients to other qualified health care personnel.

 

This is the incorrect statement. Doctors of medicine or osteopathy may delegate tasks for hospitalized patients to other qualified health care personnel “to the extent recognized under State law or a State’s regulatory mechanism.” NPs who deliver care to hospitalized patients presumably fall under the delegation rule.

 

Question 25 

The FNP calculates a patient’s BMI to be 23. Which category would this patient fall into? 

   normal weight 

  underweight 

   overweight 

  obese 

 

Correct answer:

normal weight

 

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

 

Question 26 

Which of the following is NOT a risk factor for osteoporosis? 

  alcohol abuse 

   active lifestyle 

   advancing age 

  history of bone fracture 

 

Correct answer:

active lifestyle

 

An inactive lifestyle, not an active lifestyle would be a risk factor for osteoporosis. All of the other choices are risk factors along with: female gender, family history, and low estrogen levels in women, among other things.

 

Question 27 

Which of the following is a system of controlled oversight and authorization of services and benefits provided to patients? 

  clinical ladder 

   case management 

   triage 

  clinical guidelines 

 

The Correct answer is:

Case management

Case management is a special type of communication that is a necessity for healthcare providers. It is the process of interviewing and teaching patients and for sharing or clarifying information with others involved in the patient's care

 

Question 28 

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

 

  Tagament 

  Nizoral 

   Diflucan 

   Oxipurinol

 

Correct answer:

Oxipurinol

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

 

Question 29 

You are treating a 48-year-old male who is suffering with alcoholism. The first most helpful approach for him is: 

  Inform the patient of the long-term health consequences of alcohol abuse. 

  Tell the patient to stop drinking. 

   Refer the patient to Alcoholics Anonymous. 

   Counsel the patient that alcohol abuse is a treatable disease. 

 

The correct answer is:

Counsel the patient that alcohol abuse is a treatable disease

The first approach for the nurse practitioner is to counsel the patient and family that alcoholism is a lifelong but treatable disease. In addition, asking about current drinking habits and associated consequences to health with each visit is important and are appropriate next steps. Then, the remaining answer choices are also important interventions after the nurse practitioner counsels the patient and the family regarding alcoholism as a treatable disease. 

 

 Question 30 

You are discussing medication therapy in a 39-year-old man who has just been diagnosed with gastroesophageal reflux disease (GERD). Which medication on his medication list do you know exacerbates the symptoms of GERD? 

  metformin 

  ferrous sulfate 

   verapamil 

  viagra 

The Correct answer is:

Verapamil

The lower esophageal sphincter is opened and closed by muscles. Verapamil is a calcium channel blocker and calcium is needed for muscle contractions. Gastroesophageal reflux disease can be exacerbated in this case so verapamil should be avoided in this patient. 

 

Question 31 

You suspect anemia in an 88-year-old female patient, particularly vitamin B12 deficiency. Which of the following lab indices is more indicative of a B12 deficiency? 

   macrocytosis 

  leukocytosis 

   thrombocytosis 

  microcytosis 

The Correct answer is:

Macrocytosis

A vitamin B12 deficiency produces a form of anemia known as pernicious anemia. It is more common in older adults and characterized by macrocytosis, where red blood cells are larger than expected. Leukocytosis describes large numbers of white blood cells. Thrombocytosis refers to an increased number of platelets. Microcytosis, small red blood cells, is seen in iron deficiency anemia or thalassemia. 

 Question 32 

A 36-year-old mentally challenged and disabled man has been diagnosed with prostate cancer and it is determined he needs surgery. Consent for this surgery should be obtained from: 

   the patient's court-appointed guardian 

  the administrator of the group home where the patient lives 

   the patient himself 

  the client's mental health physician 

 

The Correct answer is:

The patient's court-appointed guardian

Since this patient's mental capacity to consent is questionable, alternatives must be sought. If this patient has a court-appointed guardian, that person is the decision maker. If no guardian exists, the nurse practitioner would have to evaluate the patient's family dynamics and state and federal laws to determine if a close relative is appropriate to consent for this surgical procedure. Also, a group home employee cannot consent for this as they have no legal authority. 

 

Question 33 

NSAID and corticosteroid use are potent risk factors in which of the following types of peptic ulcer disease? 

   gastric ulcer 

  duodenal ulcer 

   nonerosive gastritis 

  chronic type B gastritis 

 

Correct answer:

gastric ulcer

 

NSAID and corticosteroid use are a potent risk factors for gastric ulcers. Cigarette smoking is also a risk factor. Nearly all gastric ulcers found in patients without H. Pylori infection are caused by NSAID use.

 

Question 34 

When a patient tells you that she has no family anymore since her sister and her husband died last year and you reply, “That must make you very sad,” you are using which of the following types of therapeutic communication? 

  trust 

  honesty 

   validation 

   empathy 

 

Correct answer:

empathy

 

Empathy is an emotional linkage between two or more people through which feelings are communicated. It involves trying to imagine what it must be like to be in another person’s situation.

Question 35 

The amount of cream or ointment needed to treat a dermatologic condition on one leg for one time is which of the following? 

   6 g 

  3 g 

   10 g 

  12 g 

 

Correct answer:

6 g

 

The amount of cream or ointment needed to treat a dermatologic condition on one leg for one time is 6 g. Prescribers often write prescriptions for an inadequate amount of topical medication creating a situation in which treatment fails because of an inadequate length of therapy.

 

 Question 36 

As part of a nonpharmacologic treatment for a second-degree burn, you would do all of the following EXCEPT: 

  Remove all rings to avoid a tourniquet effect. 

   Apply ice to the site. 

   Gently cleanse with a mild detergent. 

  Cover the burn area with a thin layer of silver sulfadiazine cream. 

Correct answer:

Apply ice to the site.

 

Do NOT apply ice to the site. In addition to the other three choices you may flush a chemical burn copiously with water and debride any broken blisters and dead skin.

 

Question 37 

Which of the following injuries shows no specific radiographic findings? 

   tennis elbow 

  finger fractures 

   Jones fracture 

  Boxer’s fractures 

 

Correct answer:

tennis elbow

 

Tennis elbow as well as nursemaid’s elbow show no specific radiographic findings. Finger fractures may reveal crush injuries. Jones fractures reveal a fracture to the fifth metatarsal. Boxer’s fractures reveal a fracture of the fifth metacarpal, which frequently is medially angulated.

Question 38 

A 67-year-old man is in the clinic with frequent dizziness while standing. Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases:

 

  more than 20 points any time after rising 

  more than 20 points within one minute after rising 

   any degree drop if the patient becomes weak or dizzy 

   more than 20 points within three minutes after rising 

 

The Correct answer is:

More than 20 points within three minutes after rising

Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving to an upright position. It can be evaluated from lying to sitting or from sitting to standing. Also, if the systolic reading does not drop but the diastolic drops by 10 mm Hg or more, postural hypotension can be diagnosed. 

 

Question 39 

You have a 50-year-old male patient complaining of hearing loss. One of the tests you do involves placing the tuning fork on the forehead and asking the patient where it is heard best. This is known as which of the following? 

  Rinne test 

   Weber test 

   tympanogram 

  audiogram 

 

Correct answer:

Weber test

 

The Weber test involves placing the tuning fork on the forehead or front teeth. The patient then indicates where it is heard best. The Rinne test involves placing the tuning fork alternately on the mastoid bone and in front of the ear canal. The other choices are tests that do not involve a tuning fork.

 

Question 40 

Which of the following would NOT be considered one of the general principles of medical record documentation? 

  The rationale for ordering diagnostic and other ancillary services should be documented or easily inferred. 

  The patient’s progress, response to and changes in treatment, and revision of diagnosis should be documented. 

   Health risk factors do not appear in documentation, only in practice. 

  The medical record should be complete and legible. 

 

Correct answer:

Health risk factors do not appear in documentation, only in practice.

 

Appropriate health risk factors should be identified in documentation. Past and present diagnoses should also be accessible to the treating and/or consulting physician

 

Question 41 

A physician or nurse practitioner who specializes in the care of hospitalized patients is called a(n): 

  specialist 

  primary care provider 

   hospitalist 

  adjunct provider 

 

Correct answer:

hospitalist

 

Traditionally, a patient who needed to be admitted to a hospital was admitted through the patient’s primary care provider, who coordinated the care of the patient. This tradition has been challenged by the realization that this model is not too efficient. More hospitalists (physicians and nurse practitioners who specialize in the care of hospitalized patients) are taking over this aspect of practice.

 

Question 42 

An 18-year-old female comes to the clinic complaining of a sore throat and fatigue that has persisted for several months. She also has some upper abdominal pain. The FNP’s examination reveals enlarged cervical nodes, erythema of the pharynx and red tonsils. The most likely diagnosis is: 

  rhinitis medicamentosa 

   acute mononucleosis 

   acute sinusitis 

  allergic rhinitis 

Correct answer:

acute mononucleosis

 

Mononucleosis is an infection by the Epstein-Barr virus that is transmitted through saliva by intimate oral contact. The classic triad to look for is pharyngitis, cervical lymphadenopathy and fatigue.

 

Question 43 

You are examining a male infant, age 9 months, and notice an undescended testicle on the right side. When counseling the mother, the nurse practitioner understands the following to be true of cryptorchidism EXCEPT: 

  This is where the testis does not descend with massage of the inguinal area. 

   You cannot exam the infant in a warm room. 

   Increased risk of testicular cancer occurs if testicles are not removed from the abdomen. 

  Surgical correction within the first year of life is necessary if it does not spontaneously descend. 

 

The Correct answer is:

You cannot exam the child in a warm room

In order to see if the muscle will relax and the testicle will descend, the infant should be sitting and the exam room should be warm to relax the muscles when massaging the inguinal canal. Another option is to examine the infant during or after a warm bath. 

 

Question 44 

Which of the following is NOT one of the Jones criteria for pelvic inflammatory disease (PID)? 

   lower back pain 

  cervical motion tenderness 

   adnexal tenderness 

  lower abdominal tenderness 

Correct answer:

lower  back pain

 

The Jones criteria are the major criteria for PID. Only one of the criteria is necessary to diagnose and treat for PID. All of the choices are one of the Jones criteria except lower back pain

 

Question 45 

Which of the following would NOT be a breach of patient confidentiality? 

   discussing a patient’s condition with the nurse assistant assigned to the patient 

  discussing a patient’s condition with family members 

   giving a patient’s name and address to a vendor 

  talking about a patient within earshot of others 

Correct answer:

discussing a patient’s condition with the nurse assistant assigned to the patient

 

All of the choices would be a breach of patient confidentiality except this one. Other breaches include: releasing medical information about a patient without prior written permission, leaving a telephone message on a patient’s answering machine, leaving patient records within view of others, and discarding unshredded duplicate records.

Question 46 

Osteoporosis is indicated by a bone density score of which of the following? 

   less than -2.5 

  between -1 and -2.5 

   greater than -1

 

  none of the above 

 

Correct answer:

less than -2.5

 

Interpretation of bone density testing is based on a T score, which refers to the number of standard deviations above or below the average value in young adults of the same gender. Osteoporosis is a bone density indicated by a T score less than -2.5. It is also indicated by the presence of fragility fractures, irrespective of the bone density test results.

 

Question 47 

A 16-year-old male is in the office. He has a insect bite on his left forearm and you suspect a brown recluse spider bite. What medical management would you provide? 

   ice pack and elevation of the area 

  active and passive range of motion (ROM) to the area 

   avoidance of antihistamines 

  warm moist soaks to the affected area 

 

The Correct answer is:

Ice pack and elevation of the area

Ice packs are preferred to heat to decrease the edema. The area should be immobilized and tetanus toxoid given. Antihistamines may reduce the swelling and relieve site itching

 

 Question 48 

You have a 58-year-old female patient who is post-menopausal and whom you have diagnosed as having an ovarian cyst. The cyst is 3 cm and the client has no other risk factors. Which of the following actions would you take for this patient? 

  Refer for emergency care. 

   Recheck her at 6 weeks. 

   Refer to a surgeon. 

  Do nothing. 

Correct answer:

Recheck her at 6 weeks.

 

If the patient is post-menopausal, the cyst is smaller than 5 cm, and the patient does not have any other risk factors, you would recheck her in 6 weeks, and then again at 3 months, and then 6 months. Refer the patient if there is any increase in size of the mass.

 

Question 49 

A 70-year-old male comes to the FNP with a raised, red lesion in his oral cavity. He tells the FNP that he is afraid that it is cancer. Besides evaluating the lesion the FNP evaluates the man’s risk for oral cancer. These risks include all of the following EXCEPT: 

   poor diet 

  alcohol abuse 

   tobacco abuse 

  advanced age 

 

Correct answer:

poor diet

 

Poor diet is not a risk factor for oral cancer. Alcohol and tobacco use and advanced age are risks.

 

Question 50 

The Health Insurance Portability and Accountability Act of 1996 (HIPPA) protects the privacy of patients and their health care records. All of the following are basic requirements of the privacy rule EXCEPT: 

  Providers and their staff are restricted to conveying the minimum necessary information about patients. 

  If a provider wants to release patient information for marketing purposes, the patient must authorize the use of the information in writing. 

   Providers may not disclose health information to oversight agencies, such as CMS without patient authorization. 

  Individuals have no right to psychotherapy notes, information compiled in anticipation of civil or criminal litigation and certain clinical laboratory information. 

 

Correct answer:

Providers may not disclose health information to oversight agencies, such as CMS without patient authorization.

 

This is not a requirement of the privacy rule. Providers may disclose health information to oversight agencies, such as CMS without patient authorization.

 

Question 51 

A 38-year-old male patient complains of a sudden onset of severe “ice pick” pains behind one eye. The headache is accompanied by tearing, a clear runny nasal discharge and a drooping eyelid. What type of headache does he have? 

  muscle tension headache 

  migraine headache 

   cluster headache 

  temporal arteritis 

Correct answer:

cluster headache

 

Cluster headaches are severe headaches with lancinating pain behind one eye that occurs several times a day, usually at the same times every day. Their cause is unknown and they are more common in adult males in their 30s and 40s.

 

Question 52 

Human papillomavirus (HPV) is considered the causal agent in what percentage of cervical cancers worldwide? 

  75.5% 

  89.2% 

   90.9% 

   99.8% 

 

 Correct answer:

99.8%

 

Human papillomavirus (HPV) is now considered the causal agent in 99.8% of cervical cancers worldwide. HPV strains 16, 18, 31, 33, 39, and 42 are strongly associated with cervical cancer.

 

Question 53 

Psoriasis is an inherited skin disorder. All of the following are typical treatments for psoriasis EXCEPT: 

  Psoralen drugs 

  methotrexate 

   Goeckerman regimen 

   systemic penicillin 

 

Correct answer:

systemic penicillin

 

Topical steroids and tar preparations (Psoralen drugs) are used for psoriasis. Systemic drugs such as methotrexate are used for severe forms of the disease as is the Goeckerman regimen. Systemic penicillin would not be used as this is a drug that is used for infections, not for psoriasis, a condition where the squamous epithelial cells undergo rapid mitotic division producing psoriatic plaque.

 

Question 54 

When assessing a rash near the eye and side of the temple, the nurse practitioner understands that herpes keratitis has what signs and/or symptoms? 

  blindness, painful swollen hair follicle 

  small nodule that moves under the skin of the eyelid 

   acute onset of eye pain, photophobia and blurred vision in the affected eye 

  a yellow triangular thickening of the conjunctiva 

 

The Correct answer is:

Acute onset of eye pain, photophobia and blurred vision in the affected eye

Herpes keratitis is caused by a herpes virus infection, usually shingles, and it causes these signs and symptoms. A stye or hordeolum is a painful acute bacterial infection of a hair follicle on the eyelid that does not result in blindness. A chalazion results in a movable nodule. Then, pterygium presents with a yellow triangular thickening of the conjunctiva. 

 

Question 55 

Medications may produce anxiety as a side effect. Of the following, which medication is least likely to have this effect? 

  corticosteroids 

  bronchodilators 

   antihistamines 

   antibiotics 

Correct answer:

antibiotics

 

Antibiotics are the least likely of the choices to produce anxiety as a side effect. Besides the other three choices, anticholinergics, antihypertensives, antipsychotics, antidepressants, amphetamines, and anesthetics may also produce anxiety.

 

Question 56 

Which of the following best defines a hospitalist? 

   a physician or nurse practitioner who specializes in the care of hospitalized patients 

  a member of a hospital accreditation board 

   any physician or nurse practitioner who has hospital privileges 

  none of the above 

 

Correct answer:

a physician or nurse practitioner who specializes in the care of hospitalized patients

 

To increase efficiency, physicians and nurse practitioners can specialize in the care of hospitalized patients. These clinicians are called hospitalists.

 

Question 57 

A 45-year-old African-American male reports chest pain that is sudden and severe. Also, the male patient describes the pain as "tearing."  You notice that the pain is accompanied by a decrease in peripheral pulses. You understand that this may indicate a diagnosis of: 

  pericarditis 

   aortic dissection 

   acute MI 

  angina 

The Correct answer is:

Aortic dissection

Aortic dissection almost invariably begins with sudden onset of severe chest pain that is tearing or ripping in quality and is accompanied by absent or decreased peripheral pulses and neurologic deficits. The pain of angina and acute myocardial infarction (MI) is usually described as "pressure" by the patient. Pericarditis produces pain that is more gradual in its onset.

 

Question 58 

A woman who has been on hormone replacement therapy (HRT) is likely to have some possible improvement. Which of the following is one of these? 

   A decrease in the symptoms associated with menopause. 

  A reduction in the risk of dementia. 

   A reduction in the risk of osteoarthritis. 

  A reduction in the risk of endometrial cancer risk. 

The Correct answer is:

A decrease in the symptoms associated with menopause

As with all medication, the use of HRT comes with the possibility of adverse effects. There is no decrease in the risk of dementia or osteoarthritis. There is a reduction of osteoporosis risk. Endometrial cancer risk, and not a reduction in the risk, with unopposed estrogen exists. 

 

Question 59 

Which of the following vaccines is NOT a live attenuated vaccine? 

  MMR 

  varicella 

   Salk polio 

  varicella zoster 

 

Correct answer:

Salk polio

 

An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable (or "live"). Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent. The Salk polio vaccine is not a live attenuated vaccine.

 

Question 60 

A positive Homan’s sign is associated with which of the following? 

   deep vein thrombosis 

  superficial thrombophlebitis 

   peripheral vascular disease 

  Raynaud’s phenomenon 

Correct answer:

deep vein thrombosis

 

Deep vein thrombosis (DVT) occurs when a thrombus develops in the deep venous system of the legs or pelvis. On physical exam of a patient with DVT, a positive Homan’s sign (lower leg pain on dorsiflexion of the foot) is noted

 

Question 61 

You are advising your patient with diabetes about exercise and diet. You would tell this patient all of the following EXCEPT: 

   Exercising heavily will decrease the risk of hypoglycemia in the evening and at bedtime.

 

  Skipping a meal will increase the risk of hypoglycemia in the evening and at bedtime. 

   Eat simple carbohydrates before or during exercise and complex carbohydrates after exercise. 

  Exercise increases glucose utilization. 

Correct answer:

Exercising heavily will decrease the risk of hypoglycemia in the evening and at bedtime.

 

This is not correct. Exercising heavily will increase the risk of hypoglycemia in the evening and at bedtime and should be avoided. In older diabetics preexisting CHD should be ruled out before starting an exercise program by administering a stress test.

 

 Question 62 

Some employers offer the NP the opportunity for bonuses. If a bonus is based on the number of patient visits per year it is which of the following types of bonus formulas? 

  quality-based 

  profit-based 

   patient satisfaction-based 

   productivity-based 

Correct answer:

productivity-based

 

A formula based on the number of patient visits per year is a productivity-based formula. This type of formula makes good business sense under a fee-for-service arrangement.

 

Question 63 

What type of headache is typically described as "pressing" in quality? 

  migraine headache 

   tension-type headache 

   cluster headache 

  simple stress headache 

The Correct answer is:

Tension-type headache

Tension-type headache is pressing, nonpulsatile pain, mild to moderate in intensity and usually bilateral in location. Migraine headache is described as pulsating quality, usually unilateral, with associated nausea and photophobia. Cluster headache is often behind one eye, steady and intense. Simple stress headache is a fictitious term, which makes it an incorrect answer choice

 

Question 64 

Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option. The four levels of evaluation and management services include all of the following EXCEPT: 

  high complexity 

  low complexity 

   straightforward 

   up-front 

 

Correct answer:

up-front

 

There is no up-front level of E/M services. The four types of medical decision making are: straightforward, low complexity, moderate complexity and high complexity

 

Question 65 

Which of the following is NOT one of the basic requirements/allowances of the HIPAA privacy rule? 

  Providers releasing patient information for marketing purposes must explain to the patient how the information will be used, to whom it will be disclosed, and the time frame. 

  Providers and their staff are restricted to conveying the “minimum necessary information” about patients. 

   Providers may disclose health information to oversight agencies. 

   In general, providers may disclose psychotherapy notes without patient consent. 

Correct answer:

In general, providers may disclose psychotherapy notes without patient consent.

 

There are special rules for psychotherapy notes. In general, patient authorization is required in order to disclose psychotherapy notes to carry out treatment, payment or healthcare operations.

 

 Question 66 

Lead is primarily absorbed through which of the following body systems? 

  neurologic 

   integumentary 

   respiratory and gastrointestinal 

  integumentary and lymphatic 

 

Correct answer:

respiratory and gastrointestinal

 

Lead is absorbed primarily through the respiratory and gastrointestinal systems. After lead is absorbed into the bloodstream most of it is bound to red blood cells.

 

Question 67 

Which of the following statements about collaborative agreements is incorrect? 

  It is a written document between a physician and a nurse practitioner. 

   It is never submitted to the board of nursing. 

   It outlines the nurse practitioner’s role and responsibility to the clinical practice. 

  It must be signed by both the physician and the nurse practitioner. 

Correct answer:

It is never submitted to the board of nursing.

 

All of the choices are true statements except this one. The collaborative agreement is usually submitted to the board of nursing.

 

Question 68 

A 16-year-old female patient inquires about douching. You are counseling on birth control, safe sexual practices and hygiene. What instruction regarding douching should the nurse practitioner include?

 

  Hypoallergenic douches include flavored or perfumed types. 

  Douching during menstruation is a safe effective practice. 

   Douching removes natural mucus and upset normal vaginal flora. 

  Daily douching is important if the patient has copious vaginal discharge. 

 

The Correct answer is:

Douching removes natural mucus and upsets normal vaginal flora

Douching is never necessary because it upsets the normal vaginal flora and disrupts pH. Douching is contraindicated during menstruation due to "retrograde menstruation," a potential precursor to endometriosis. Further, a patient with copious vaginal discharge needs to be evaluated for an infection. 

Question 69 

The ability to conduct a cultural assessment to collect relevant cultural data regarding the patient’s presenting problem as well as accurately conducting a culturally-based physical assessment is called: 

  cultural diversity 

  cultural awareness 

   cultural skill 

  cultural desire 

 

Correct answer:

cultural skill

 

Cultural skill is the ability to conduct a cultural assessment to collect relevant cultural data regarding the patient’s presenting problem as well as accurately conducting a culturally-based physical assessment. It is part of the “ASKED” mnemonic to promote becoming culturally competent.

 

Question 70 

You have a patient complaining of severe pain in the great toe in which you observe erythema. He tells you that this happened quite quickly and got to the point of being severe in just a few hours. You suspect acute gout. Which of the following tests is the only confirmatory test for acute gout?

 

   joint aspiration 

  serum uric acid 

   creatinine, BUN 

  24-hour urine for urate and creatinine 

 

Correct answer:

joint aspiration

 

Joint aspiration is the only confirmatory test for acute gout. It can find MSU crystal in phagocytes or free in tophi, seen under a polarized microscope. The other tests are of limited value in acute gout.

 

 Question 71 

Of the following prostaglandin inhibitors, which one is a proprionic acid?

 

   Naproxen 

  Mefenamic acid 

   Indomethacin 

  Diflunisal 

Correct answer:

Naproxen

 

Naproxen is a proprionic acid along with Ibuprofen and naproxen sodium. Mefenamic acid is a fenamate and the other two choices are acetic acid/salicylic acids.

Question 72 

Which of the following types of research is most likely to be considered a philosophy as well as a research method? 

   phenomenology 

  quasi experimental research 

   longitudinal research 

  cross-sectional research 

Correct answer:

phenomenology

 

Phenomenology is both a philosophy and a research method. The purpose is to describe experiences as they are lived and to capture the “lived experience” of study participants

 

 Question 73 

Which of the following is a secondary prevention measure? 

  educating a diabetic about exercise and diet 

  immunizations 

   bicycle helmets 

   mammogram 

 

Correct answer:

mammogram

 

All screening tests are secondary prevention measures. A mammogram and breast exam are secondary prevention measures. 

 

Question 74 

A mother brings her 8-year-old son to your office. She tells you that he has had no immunizations but she would like him to have all of the necessary immunizations now. Which of the following immunizations would NOT be necessary for this child?

 

   PCV (3 doses) 

  Td (3 doses primary, then every 10 years) 

   IPV (3 doses) 

  MMR (2 doses) 

Correct answer:

PCV (3 doses)

 

PCV (pneumococcal conjugate vaccine) is not given after age 7 years. All of the other immunizations should be given along with Hepatitis B (3 doses).

Question 75 

When you say something to a patient such as, “Let me be sure that I understand what you are saying,” this is which of the following forms of therapeutic communication?

 

   validation 

  caring 

   active listening 

  honesty 

Correct answer:

validation

 

Validation is listening to the patient and responding congruently in order to be sure that you have the same understanding as the patient. Active listening is hearing and interpreting language, noticing nonverbal and paraverbal enhancements, and identifying underlying feelings.

 

Question 76 

Severe cough, fever, conjunctivitis, photophobia, and Koplik’s spots are most related to which of the following? 

  scarlet fever 

   measles 

   rubella 

  roseola 

 

Correct answer:

measles

 

A person with measles will present with severe cough, fever, conjunctivitis, photophobia, and/or Koplik’s spots. The rash will be bright red to purple macules and papules ofent becoming confluent

 

Question 77 

There are two approaches to nursing research. They are which of the following? 

  academic and practical 

  direct and indirect 

   professional and non-professional 

   quantitative and qualitative 

Correct answer:

quantitative and qualitative

 

There are two approaches to nursing research: quantitative and qualitative. Both involve rigor that produces credible data for evidence-based practice, and both make significant contributions to nursing science

 

Question 78 

A male patient has asked you for a prescription of Viagra. After a careful history, you make the determination that he has erectile dysfunction (ED). The nurse practitioner understands that ED is: 

  Not a condition associated with men over age 70 

  Primarily psychological in origin 

   The persistent inability to achieve and maintain an erection adequate for sexual intercourse. 

  The physiologic dysfunction when smooth muscles contract, causing a lack of adequate amounts of blood in the penis to render a rigid, larger penis. 

 

The Correct answer is:

The persistent inability to achieve and maintain an erection adequate for sexual intercourse

Erectile dysfunction is experienced by 40% of men over 40 years of age and 70% of men over 70. It involves a dysfunction in the hemodynamic mechanism of smooth muscle relaxation that increases blood flow in the penis. 

 

Question 79 

Which of the following is another term for statutory authority? 

  regulation 

   legal authority 

   contract authority 

  administrative rule 



Correct answer:

legal authority

 

Statutory authority is legal authority. Elected officials (the legislature) vote on a bill such as the Nurse Practice Act. Bills that pass become law and have statutory authority.

 

Question 80 

Which of the following is NOT true regarding healthcare issues in the United States?

 

   Most of Americans have access to healthcare and are being adequately treated. 

  Of all children, 13% are uninsured. 

   It is estimated that 45+ million Americans are underserved because of limited access to healthcare. 

  Many of the working poor cannot obtain healthcare because of the high costs of insurance, fees and medications. 

The Correct answer is:

Most of Americans have access to healthcare and are being adequately treated

There is a large portion of Americans who do not have access to healthcare. 

 

Question 81 

Which of the following is an orthopedic maneuver of the knee to test for damage to the meniscus? 

  Drawer sign 

   McMurray sign 

  Lachman sign 

  Goodell’s sign 

Correct answer:

McMurray sign

 

The McMurray sign is an orthopedic maneuver of the knee to test for damage to the meniscus. If the knee locks up and the patient is unable to fully extend the affected knee, the test is positive.

 

 Question 82 

Your pregnant patient is approaching her estimated delivery date. She asks you for some information about how big her baby will be. You might tell her all of the following EXCEPT:

 

   95% of newborns weight 7 – 10 lb. 

  95% of newborns are between 18 and 22 in. long. 

   Approximately 5% - 10% of body weight is lost in the first few days. 

  The weekly gain from birth to 6 months is 5 – 7 ounces per week. 

 

Correct answer:

95% of newborns weight 7 – 10 lb.

 

This is not correct. 95% of newborns weight 5 – 10 lb. Approximately 5% - 10% of body weight is lost in the first few days; then birthweight is regained in 7 – 10 days.

 

 Question 83 

You have a patient who is a 22 month old male. He presents with a low-grade fever. Your initial treatment for this patient would be which of the following?

 

  Do nothing. 

   Give antipyretics and observe. 

   Obtain a CBC. 

  Give prophylactic antibiotics for 3 days pending blood culture results. 

Correct answer:

Give antipyretics and observe.

 

For children over 3 months of age who present with a low-grade fever, you would give antipyretics and observe. If fever is over 102° F, then you would obtain a CBC. If the WBC is greater than 15,000/mm3, then you would obtain a blood culture and administer IM Ceftriaxone.

 

Question 84 

What is the reason the Standards of Nurse Practitioner Practice were established? 

  They are established to promote autonomous practice. 

  They are established to limit the liability of nurse practitioners. 

   They are established to regulate and control nurse practitioner practice. 

  They are established to protect nurse practitioners from frivolous lawsuits. 

 

The Correct answer is:

They are established to regulate and control nurse practitioner practice.

The reason Standards of Practice exist in all healthcare related specialties (nursing, medicine, dental, etc.) is that they regulate and control practice. The purpose of Standards of Practice is to provide accountability for professionals and to help protect the public from unethical behavior and unsafe practice. The remaining answer choices are not reasons for the establishment of Standards of Nurse Practitioner Practice. 

 

Question 85 

The FNP has a menopausal woman patient who is troubled by hot flashes. The FNP tells her that they can often be reduced in number and minimized in severity with simple lifestyle changes. All of the following would be a hot flash trigger EXCEPT: 

  chocolate consumption 

  alcohol use 

   tight, restrictive clothing 

   cold baths or showers 

Correct answer:

cold baths or showers

 

Hot baths or showers are hot flash triggers, not cold baths or showers. In addition to the other choices which are all hot flash triggers, other triggers include: spicy foods, elevated ambient temperature and humidity, and cigarette smoking.

 

Question 86 

For which of the following would the FNP use the bell of the stethoscope? 

  mid-to high-pitched tones such as lung sounds 

   low tones such as the extra heart sounds 

   mitral regurgitation 

  aortic stenosis 

Correct answer:

low tones such as the extra heart sounds

 

The bell of the stethoscope is used for low tones such as the extra heart sounds (S3 or S4) as well as for mitral stenosis. The diaphragm of the stethoscope is used for all of the other choices given.

 

Question 87 

 Which of the following diseases/conditions is least likely to increase susceptibility to meningitis?

 

   hypertension 

  sickle cell anemia 

   diabetes 

  alcoholism 

 

 Correct answer:

hypertension

 

Of the choices hypertension is the least likely to increase susceptibility to meningitis. Other factors increasing susceptibility include: basilar skull fracture; indwelling CSF shunting device; debilitation or institutionalization; and contact with others who have had meningitis.

 

Question 88 

The most likely associated symptoms of dementia include all of the following EXCEPT: 

  insidious onset over months or years 

  loss of intellectual or cognitive function 

   mental status changes 

   acute onset over hours to a few days 

The Correct answer is:

Acute onset over hours to a few days

Delirium has an acute onset over hours to a few days and is a condition in which the patient exhibits reduced ability to maintain attention to external stimuli and shift attention appropriately to new stimuli. The other answer choices are all true of dementia, making them incorrect answers in this case. Dementia has an insidious onset over months or years. 

 

Question 89 

Which of the following is NOT a conceptual model for advanced practice nursing? 

  Benner’s model 

  Shuler’s model 

   Calkin’s model 

   Ford model 

Correct answer:

Ford model

 

There is no Ford model of NP practice; however, Loretta Ford established the first pediatric nurse practitioner program. 

 

Question 90 

A good quality assurance program should do which of the following? 

  identify educational needs 

  improve the documentation of care 

  reduce the clinician’s overall exposure to liability 

   all of the above 

Correct answer:

all of the above

 

A good quality assurance program would include all of the first three choices. These programs also look at organizational effectiveness, efficiency, and client and provider interactions

 

Question 91 

Which of the following medications might you prescribe for a patient with acute bronchitis? 

  Robitussin 

  Guaifenesin 

   Ventolin 

   any of the above 

 

Correct answer:

any of the above

 

All of the medications listed in the choices might be prescribed for a patient with acute bronchitis. You would also increase fluids and if the patient smokes, have them stop smoking, if possible.

 

Question 92 

Which of the following drugs would NOT be a prophylactic treatment for migraine headaches? 

  beta-blockers 

  tricyclic antidepressants 

   prednisone 

  amitriptyline 

 

Correct answer:

prednisone

 

Prednisone would not be a prophylactic measure for migraine headaches. It would be used, however, if the FNP suspects temporal arteritis. 

 

Question 93 

The FNP has an adult male patient in the clinic who woke up with one side of his face paralyzed. He cannot fully close his eyelid and has difficulty chewing and swallowing food on that side of his face. Which of the following is the most likely diagnosis? 

   Bell’s Palsy 

  trigeminal neuralgia 

   focal migraine 

  acute bacterial meningitis 

 

Correct answer:

Bell’s Palsy

 

Bell’s Palsy is the abrupt onset of unilateral facial paralysis that is due to dysfunction of the motor branch of the facial nerve (CN 7). Facial paralysis can progress rapidly within 24 hours. Skin sensation remains intact but tear production on the affected side may stop. Most cases spontaneously resolve.

Question 94 

One part of a spectrum of disease that is often found together with giant cell arteritis is which of the following? 

   polymyalgia rheumatica 

  migraine headache 

   blindness 

  brain tumor 

 

Correct answer:

polymyalgia rheumatica

 

Giant cell arteritis and polymyalgia rheumatica are thought to represent two parts of a spectrum of disease and are often found together. Blindness is a serious complication of the disease.

 

Question 95 

A 32-year-old female with interstitial cystitis (IC) is in the office. She has been newly diagnosed and you are counseling her. All of the following are important to discuss EXCEPT: 

  Discuss that interstitial cystitis is not a malignancy or a risk factor for a more serious disease. 

  Teach the patient the importance of adequate nonirritating fluid intake. 

   Remind her that cigarette smoking can irritate the bladder. 

   Discuss the measures for curative treatment. 

The Correct answer is:

Discuss the measures for curative treatment

Interstitial cystitis is an incurable condition that involves painful urination, frequency, urgency and nocturia. It is chronic and can be controlled, not cured. Treatment aims are directed at relief of symptoms. The remaining answers are important as patient education information. 

 

Question 96 

Which of the following is NOT one of the stages in Erikson’s theory of psychosocial development? 

  trust 

  autonomy 

   initiative 

   loyalty 

 

Correct answer:

loyalty

 

Loyalty is not one of Erikson’s stages of psychosocial development. The eight stages are: trust, autonomy, initiative, industry, identity, intimacy, generativity, and ego identity.

 

Question 97 

Which of the following patient is most likely to qualify and be using Medicaid as their insurance? 

   the single mother of four dependent children, age 26 

  a middle aged female who works for the government, age 47 

   a young male factory worker, age 23 

  an elderly retired high school teacher, age 78 

The Correct answer is:

The single mother of four dependent children, age 26

Medicaid is a federally mandated program that guarantees healthcare services to low-income families with dependent children and to low-income and disabled individuals. Government employees and factory workers are most likely insured through a commercial carrier or uninsured. An elderly teacher would have Medicare since they have paid into the federal retirement system and are over 65 years of age

 

Question 98 

Which of the following tests is federally mandated for infants? 

  TSH 

  Lead screening 

   PKU 

  all of the above 

 

Correct answer:

PKU

 

PKU (phenylketonuria) is a federally mandated test. Severe mental retardation may develop if this is not treated early.

 

Question 99 

The continuing occurrence of new cases of a disease is known as which of the following?

 

  prevalence rate 

  colonization rate 

   infectivity rate 

   incidence rate 



Correct answer:

incidence rate

 

The incidence rates describe the rate of development of a disease in a group over a period of time or the continuing occurrence of new cases of disease. It differs from the prevalence rate which describes a group at a certain point in time and the number within the group that has a particular disease or problem.

 

Question 100 

A mother brings her infant to the clinic to say that he has tearing in both eyes. The FNP also sees a mucoid discharge. Which of the following conditions/diseases might this indicate? 

   congenital lacrimal duct obstruction 

  Wilms tumor 

   Fifth disease 

  Kawasaki disease 

Correct answer:

congenital lacrimal duct obstruction

 

Congenital lacrimal duct obstruction is a failure of the tear duct to open at birth. A thin membrane blocks the entrance of the nasolacrimal duct causing tear blockage. This is a condition that spontaneously resolves. 

 

 quiz 9 aanp

Question 1 

Which of the following statements about folic acid deficiency anemia is incorrect? 

   There is a decreased physiologic need for folate in pregnancy. 

   The most common cause is inadequate dietary intake and overcooking vegetables. 

  A deficiency in folate results in RBC changes that manifest as macrocytic anemia. 

  Drugs that interfere with folate absorption include phenytoin, and methotrexate. 

 

Correct answer:

There is a decreased physiologic need for folate in pregnancy.

 

This statement is incorrect. The opposite is true. There is an increased physiologic need for folate in pregnancy as well as in chronic illness.

 

Question 2 

Lead poisoning remains a serious public health problem. Which of the following is the least likely to present a lead hazard? 

  lead-glazed pottery 

  lead-soldered vessels used for cooking 

   fumes from burnt casings of batteries 

   paint in a home built in 1995 

Correct answer:

paint in a home built in 1995

 

This is the least likely source to present a lead hazard. Lead-based paint has not been available in the USA for more than 30 years. Therefore, a home built in 1995 would not contain lead-based paint.

 

 Question 3 

An elderly patient presents with a flat, nonpalpable colored spot, 4 mm in size. What is the medical term for this spot? 

  Bulla. 

  Tumor. 

   Pustule. 

   Macule. 

 

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

 

Question 4 

When counseling a menopausal woman with many risk factors for osteoporosis, the nurse practitioner knows that which of the following are preventative measures she should be instructed on regarding osteoporosis? 

   smoking cessation and weight bearing exercise 

  optimal caloric intake and Vitamin E supplements 

   exercise, weight gain and a high fat diet 

  organic supplements and adequate Vitamin B12 intake 

The Correct answer is:

Smoking cessation and weight bearing exercise

Although the mechanism is not known, research has shown that cigarette smoking accelerates skeletal bone loss. Therefore, smoking cessation is important in the prevention of osteoporosis as well as other diseases and conditions. Exercise is necessary at least 30 minutes, three times a week, to maintain bone density and it has been shown to decrease the incidence of hip fractures. Walking increases hip and spine density. Further, Vitamin D and calcium intake along with smoking cessation prevents osteoporosis. 

 

Question 5 

In terms of elder abuse, which of the following statements is false? 

  Only infants are more likely to sustain serious injury from physical abuse than the elderly. 

  Only one in fourteen elder abuse cases is reported. 

   90% of abusers of older adults are reported to be family members. 

   Approximately 5% of older adults are neglected or abused in the United States. 

 

Correct answer:

Approximately 5% of older adults are neglected or abused in the United States.

 

This statement is false. Approximately 10% of older adults are neglected or abused in the United States. Health care providers are responsible for reporting any suspected abuse or neglect to the appropriate state protective agency.

Question 6 

What percentage of the usual and customary fee paid to physicians is reimbursed to the FNP by Medicare? 

  100% 

  95% 

   90% 

   85% 

 

Correct answer:

85%

 

Today, nurse practitioners can be reimbursed directly by Medicare. Medicare reimburses NPs 85% of the usual and customary fee that is paid to a physician for the same visit.

 

Question 7 

What is palpated when examining the thyroid? 

  Carotid. 

  Greater trochanter. 

  Sternocleidomastoid. 

   Isthmus. 

 

Correct answer: Isthmus A physical exam of the thyroid usually requires palpation to determine size and hardness. Palpate the Isthmus. It should not palpate if the thyroid is not enlarged. 

Question 8 

Which of the following drugs for treating anxiety has the most rapid onset of action? 

   diazepam 

  clonazepam 

   alprazolam 

  oxazepam 

 

Correct answer:

diazepam

 

Diazepam (Valium) has a rapid onset of action and a relatively sustained effect. The other choices all have a slow onset of action and a relatively or highly sustained effect.

 

Question 9 

A 16-year-old male comes to the clinic and tells the FNP that he awoke with severe scrotal pain in the left testicle. He has felt nauseated and has had abdominal pain since this happened. What is the likely cause of this teenager’s pain and nausea? 

  testicular cancer 

  priapism 

   testicular torsion 

  chronic prostatitis 

Correct answer:

testicular torsion

 

The likely cause of this patient’s symptoms is testicular torsion. This condition may be spontaneous or associated with physical activity or trauma. The salvage rate is 100% if corrected within the first six hours and 0% if done after 24 hours.

Question 10 

There are different psychosocial periods in adolescence. In which period would achievement of identity and intimacy in relationships take place? 

  pre-adolescence 

  early adolescence 

   middle adolescence 

   late adolescence 

Correct answer:

late adolescence

 

Late adolescence takes place between 18 and 21 years. During this period vocation and career choices become important. Achievement of identity and intimacy in relationships are hallmarks of this period.

 

Question 11 

Which of the following factors is least likely to put a woman at a higher for breast cancer? 

  first degree relative who had breast cancer 

   shorter exposure to estrogen (as in late menarche with early menopause) 

   obesity 

  high-dosed radiation 

Correct answer:

shorter exposure to estrogen (as in late menarche with early menopause)

 

Mammography is a secondary prevention measure. It is recommended at age 40 and older. Women at higher risk for breast cancer include all of the choices except this one. Longer exposure to estrogen (as in early menarche with late menopause) puts a woman at higher risk.

 

Question 12 

Which of the following is NOT a factor in putting a woman at a higher risk of breast cancer? 

  genetics 

  first degree relative with breast cancer 

  longer exposure to estrogen 

   thin stature 

 

Correct answer:

thin stature

 

This is not a factor that puts a woman at a higher risk of breast cancer. Obesity is a factor, however, since adipose tissue can synthesize small amounts of estrogen.

 

Question 13 

A 79 year old patient with HTN was prescribed NSAIDs for pain by her previous doctor. The NP states that she cannot prescribe NSAIDs due to the patient's HTN. What would be the risk of prescribing an NSAID? 

   Decreased effectiveness of diuretics. 

  Fluid retention. 

   Hypoxia. 

  Ulcer and bleeding risk. 

Correct answer: Decreased effectiveness of diuretics Prescribing medications to patients with various diseases could put the patient at risk for additional conditions. For example, a patient with CHF cannot be prescribed NSAIDs because they may cause fluid retention. 

Question 14 

In patients with depression, the maximum recommended dose of Cymbalta is which of the following? 

  30 mg/day. 

   60 mg/day. 

  120 mg/day. 

   40 mg/day. 

 

Correct Answer: 60 mg/day The maximum recommended dose of Cymbalta for depression is 60 mg/day. This may be given either as one 60 mg dose or as two 30 mg doses (taken at different times during the day). It may be advisable to start patients on a smaller dose for the first week, with gradual increase to the full dosage. 

 

Question 15 

A 35-year-old Caucasian female is in the office with rosacea. She is asking about treatment options. What is the recommended treatment for her? 

  topical 5-fluorouracil 

   low-dose tetracycline 

  oral ketoconazole 

   Dilantin 

The Correct answer is:

Low-dose tetracycline

Treatment with systemic low-dose tetracycline is a very effective measure for rosacea. Further, topical treatment with metronidazole or a low-dose steroid cream may also be helpful. In some cases, ketoconazole, the antifungal cream and not an oral form, is used to treat rosacea. Topical 5-fluorouracil is used to treat actinic keratosis.

 

 Question 16 

Nursing theory is of two types: nursing grand theories and middle range nursing theories. Which of the following persons promoted the nursing grand theory of enhancing the body’s reparative processes by manipulation of noise, nutrition, hygiene, light, comfort and hope?

   Nightingale 

  Benner and Wrubel 

   Orem 

  King 

Correct answer:

Nightingale

 

Nursing grand theories are abstract, connect and relate the concepts of person, environment, nursing and health. Nightingale’s concept was that of enhancing the body’s reparative processes by manipulation of noise, nutrition, hygiene, light, comfort and hope.

 

Question 17 

Which of the following tests would you order to confirm a diagnosis of Hepatitis B? 

  Albumin level. 

  Liver function. 

  Prothombin time. 

   Hepatitis B surface antigen. 

Correct Answer: Hepatitis B surface antigen This test can confirm a diagnosis of Hepatitis B. A positive result indicates an active infection. The other tests listed are used to monitor liver damage caused by Hepatitis B

Question 18 

According to the Tanner staging, when a female has breast buds with areolar enlargement she is in which Tanner stage? 

  stage 1 

   stage 2 

   stage 3 

  stage 4 

Correct answer:

stage 2

 

According to the stages of breast development in females (Tanner staging) when a girl has breast buds with areolar enlargement, she is in Tanner stage 2. There are five Tanner stages in all.

 

Question 19 

The Trans-theoretical Model of Change sets forth six predictable stages of change. Which of the following is NOT one of these? 

  pre-contemplation 

  preparation 

  maintenance 

   post-contemplation 

Correct answer:

post-contemplation

 

The Trans-theoretical Model of Change assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to action and maintenance. The six stages are: pre-contemplation, contemplation, preparation, action, maintenance and termination. 

Question 20 

The FNP has a 35-year-old male patient who has been smoking since he was 15 years old. She wants to make a brief intervention using the “5 As.” The “5 As” are which of the following? 

   ask, advise, assess, assist, arrange 

  ask, advocate, assess, assist, arrange 

  ask, advise, assess, aid, arrange 

   ask, advise, assist, arrange, advocate 

 

Correct answer:

ask, advise, assess, assist, arrange

 

The “5 As” should be employed with all tobacco users, including individuals with no current desire to quit because this can serve as a motivating factor in future attempts to quit tobacco use. The “5 As” are: Ask about tobacco use; Advise to quit; Assess willingness to make an attempt to quit; Assist in quit attempt; Arrange follow-up.

 

Question 21 

Of the fundamental domains of human growth and development, which one includes fine and gross motor abilities? 

  psychological and social domain 

  cognitive domain 

   physical domain 

   none of the above 

Correct answer:

physical domain

 

Fine and gross motor abilities fall into the physical domain. Also parts of the physical domain are: genetic factors, physical stature and appearance, nutritional status, and physical health and well- being.

 

Question 22 

A patient comes in with a consistent cough. What about his background makes the cough suspicious? 

  Osteoporosis. 

  Obesity. 

  Exercise. 

   Asbestos exposure. 

 

Correct answer: Asbestos exposure Asbestos exposure is linked to lung cancer. A patient with this history should be examined carefully to rule out lung cancer. 

 

 Question 23 

A 10-year-old boy has a tick embedded in his scalp. The mother brings him to you for removal. What is the correct technique to safely remove the tick and help prevent Lyme Disease? 

  use petroleum jelly 

  use a hot match 

   pull it off with tweezers 

   use isopropyl alcohol 

The Correct answer is:

Pull it off with tweezers

The person removing the tick with tweezers should take care and not crush the tick because it may contain infectious organisms. After the removal of the tick, the skin should be cleansed with antibacterial soap and water. This area should be monitored for 30 days for erythema migrans. 

 

Question 24 

You are providing care to a female patient who reports having 1 to 2 migraines per month. She asks if there are any dietary changes she can make to help prevent her migraines. Which of the following is an appropriate response to this patient. 

  The patient should eat a vegan diet. 

   The patient should eat a well-balanced diet and note if any foods trigger her headaches. 

   The patient should eat a very low-fat diet. 

  The patient should avoid all dairy. 

 

Correct Answer: The patient should eat a well-balanced diet and note if any foods trigger her headaches There is no "migraine diet." However, many patients have success in preventing or alleviating their migraines by eating a well balanced diet and exercising regularly. Because some foods may trigger migraines, the patient should also note if she experiences migraines after eating specific foods, and then avoid those foods or limit her consumption. 

Question 25 

A mother comes into the office with her 2-year-old child who attends daycare. The child is pulling at her ears, running a fever, and has bright red bulging tympanic membranes bilaterally. The nurse practitioner knows that with acute otitis media (AOM) the risk factors include: 

  Chinese race, previous otitis media, many siblings 

  Summer season, full-time day care, premature at birth 

   higher socioeconomic level, full-time day care, allergies 

   second-hand smoke, attending day care, American Indians and Eskimos 

Second-hand smoke, attending day care, American Indians and Eskimos

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

 

Question 26 

Which of the following statements about DEA registration for prescribing controlled substances is incorrect? 

  The NP must use a DEA number on prescriptions for scheduled drugs. 

   The state cannot require a separate controlled substances license. 

   The DEA number is a method of minimizing unauthorized prescribing. 

  Federal registration is based on the applicant’s complying with state and local laws. 

Correct answer:

The state cannot require a separate controlled substances license.

 

This is incorrect. The state can require a separate controlled substances license. If the state requires a separate controlled substances license, an NP must obtain that license and submit a copy with the application for a DEA number.

 

Question 27 

Which of the following characteristics would be unusual in a patient with uncomplicated gallbladder disease?

 

  guarding 

  positive Murphy's sign 

   nausea 

   fever 

The Correct answer is:

Fever

Fever is an unusual symptom in a patient with uncomplicated gallbladder disease. This may be seen in an episode of acute cholecystitis. A positive Murphy's sign is usually elicited when the gallbladder is inflamed.

 Question 28 

The nurse practitioner understands that after starting vitamin B12 therapy for a patient, what would be expected at a 2 week follow-up visit?

 

  reduced RBCs, WBCs, and platelets 

  increased macrocytosis and anisocytosis 

   increased hemoglobin/hematocrit and reticulocyte count 

  ferritin level of 40 ng/ml 

The Correct answer is:

Increased hemoglobin/hematocrit and reticulocyte count

With vitamin B12 therapy, the nurse practitioner will see an increase in the hemoglobin/hematocrit and reticulocyte count. Other improvements will include improved appetite and decrease in neurological symptoms, such as gait disturbances, weakness, and paresthesias. 

 

Question 29 

A 35-year-old patient with hypertension has taken 25 mg of hydrochlorothiazide daily for the past 4 weeks. His blood pressure has decreased from 155/95 to 145/90. How should the nurse practitioner proceed? 

  Increase the hydrochlorothiazide to 50 mg daily. 

   Add a drug from another class to the daily 25 mg hydrochlorothiazide. 

   Stop the hydrochlorothiazide and start a drug from a different class. 

  Continue the hydrochlorothiazide at 25 mg daily. 

 

The Correct answer is:

Add a drug from another class to the daily 25 mg hydrochlorothiazide

This patient exceeds the target blood pressure and the minimum threshold of 140/90 mm Hg. It is not acceptable to continue the current dose. Increasing the hydrochlorothiazide to 50 mg daily will not result in a decrease in blood pressure, only an increase in potassium loss. Adding a medication from a different class allows for combined effects. 

Question 30 

What is the intent of the National Practitioner Data Bank (NPDB)? 

  To investigate adverse actions that involves licensure, clinical privileges, and professional society membership. 

   To improve the quality of healthcare by encouraging state licensing boards, professional societies, and facilities to identify and discipline those who engage in unprofessional behavior. 

   To notify the state board of nursing and medicine of any unprofessional behavior by a provider that is reported to them. 

  To list doctors with outstanding care. 

The Correct answer is:

To improve the quality of healthcare by encouraging state licensing boards, professional societies, and facilities to identify and discipline those who engage in unprofessional behavior

The National Practitioner Data Bank (NPDB) is an electronic database that retains information regarding providers, such as physicians, nurse practitioners and other health care professionals. The NPDB has information relating to the payments a provider has made associated with judgments and medical liabilities. Further, the NPDB contains information regarding negative actions associated with licenses and medical privileges. The NPDB is an application that only stores information about providers. The NPDB does not investigate adverse actions that involve licensure, clinical privileges, and professional society membership nor does it notify the state board of nursing and medicine of any unprofessional provider behavior.

Question 31 

Which of the following drugs is a calcium channel blocker?

  Capoten 

  Lopressor 

   Norvasc 

  Inderal 

Correct answer:

Norvasc

 

Calcium channel blockers block the calcium channels in the arterioles resulting in systemic vasodilation, which results in decreasing PVR. Calcium channel blockers include: Norvasc, Procardia SL, Calan and Cardizem CD.

 

 Question 32 

In terms of informed consent, which of the following statements is incorrect? 

   A 17-year-old married female does not have the right to accept or reject treatment by a healthcare provider; this must be done by the parent or legal guardian. 

  The clinician has the duty to explain relevant information to the patient so that the patient can make an appropriate decision. 

   It must be documented in the medical records that the relevant information has been provided. 

  Informed consent does not absolve the NP from allegations of malpractice should it occur.  

 

Correct answer:

A 17-year-old married female does not have the right to accept or reject treatment by a healthcare provider; this must be done by the parent or legal guardian.

 

All of the statements are correct except this one. A 17-year-old married female is an emancipated minor and has the right to accept or reject treatment by a healthcare provider.

Question 33 

Treatment options in cluster headache include the use of: 

  the triptans 

  nonsteroidal anti-inflammatory drugs (NSAIDs) 

   oxygen 

   all of the above 

The Correct answer is:

All of the above

Cluster headaches is also known as migrainous neuralgia. Cluster headaches are most common in middle-aged men. Treatment includes reduction of triggers, such as tobacco and alcohol use, and initiation of prophylactic therapy and appropriate abortive therapy, such as the triptans, nonsteroidal anti-inflammatory drugs (NSAIDs) and oxygen. 

 

Question 34 

Which of the following facts about immunizations for children is NOT correct? 

  MMR is not recommended before the age of 12 months. 

   Give the influenza vaccine before 6 months so that it is entirely effective. 

   DTaP is the only form of DTP vaccine used in this country. 

  DT is for infants/children younger than 7 years of age who are unable to tolerate the pertussis component. 

Correct answer:

Give the influenza vaccine before 6 months so that it is entirely effective.

 

This is not correct. A child under the age of 6 months has an immature immune system. The influenza vaccine would not be effective before the age of 6 months.

 

 Question 35 

What type of insurance coverage does the clinic need that is purchased by an organization to address employee job-related injuries? 

  business interruption insurance 

  directors and officers insurance 

   workers' compensation insurance 

  professional liability insurance 

 

The Correct answer is:

Workers' compensation insurance

Professional liability insurance is acquired to protect the organization from lawsuits by clients arising from negligent acts of employees. Business interruption coverage is usually purchased in tandem with fire insurance and it will reimburse an organization for losses sustained from a catastrophic event. Workers' compensation is the line of coverage that protects employees after on-the-job injuries. 

 

Question 36 

Into which domain of human growth and development does home environment fall? 

  physical domain 

  physiological domain 

   cognitive domain 

   psychological and social domain 

Correct answer:

psychological and social domain

 

The psychological and social domain includes home environment and other social contexts. It also includes temperament and personality, interpersonal relationships and moral development.

 

Question 37 

The Family Nurse Practitioner knows that when she prescribes a topical medication, the greatest rate of absorption is expected when it is applied to the: 

  chest region or back 

  forearms 

   face and neck 

  palms of the hands and soles of the feet 

The Correct answer is:

Face and neck

Certain body parts, notably the face, neck, axillae, and genital area, are quite permeable, and allow greater absorption of the medication. Less permeable areas are the extremities, trunk and the palms of the hands and soles of the feet. 

Question 38 

A geriatric nurse practitioner is dealing with the physiologic changes that would affect responses to pharmacologic agents she is prescribing to her elderly patient. As the individual ages, this nurse practitioner knows that what is happening to affect this process? 

  There is decreased percentage of body fat. 

   There is decreased albumin concentration necessary for metabolism. 

   There is increased gastric emptying. 

  There is increased glomerular filtration rate. 

There is decreased albumin concentration necessary for metabolism

Albumin, a form of protein, is necessary for metabolism of medications because they are protein bound. Albumin decreases with age and these low levels decrease the number of protein-binding sites, therefore, increasing the amount of free drug in the plasma. This could result in a drug overdose in elderly patients. Fat content does not affect medication elimination or processing. Gastric emptying and glomerular filtration decrease with age

 

Question 39 

A 50 year old patient comes in for a check up. His wife mentions that he does not see cars in his periphery while driving. He has not had an eye exam in three years. What test may you choose to run? 

  Biopsy. 

   Tonometry. 

   Blinking reflex. 

  CT scan. 

Correct answer: Tonometry The patient is at an age where glaucoma may appear. Tonometry measure eye pressure and will show if it is high. A full visual exam is necessary to diagnose glaucoma.

 

Question 40 

A 78-year-old woman who presents with incontinence, is prescribed Detrol. She has the most common type of incontinence among the elderly population. What type of incontinence is it? 

   Urge. 

  Stress. 

   Functional. 

  Transient. 

 

Correct answer: Urge There are pharmalogical and non-pharmacological aids that assist with alleviating this type of incontinence. Behavioral therapy such as gentle bladder stretching and pharmacological care such as being prescribed VESIcare and Detrol have proven effective. 

Question 41 

Which of the following is NOT a risk factor for osteoporosis? 

  alcohol abuse 

   active lifestyle 

   advancing age 

  history of bone fracture 

 

Correct answer:

active lifestyle

 

An inactive lifestyle, not an active lifestyle would be a risk factor for osteoporosis. All of the other choices are risk factors along with: female gender, family history, and low estrogen levels in women, among other things.

 Question 42 

Enuresis is involuntary urination after a child has reached the age when bladder control is usually attained. Management of primary nocturnal enuresis includes all of the following EXCEPT: 

  limiting fluid intake before bedtime 

  double voiding before bedtime 

   avoiding punishment 

   withholding verbal praise so as not to call attention to the problem 

Correct answer:

withholding verbal praise so as not to call attention to the problem

 

Verbal praise is an excellent means of motivational therapy for a child with primary nocturnal enuresis. Other means of motivational therapy include a reward system and keeping a dryness calendar.

 

Question 43 

Medical records must be kept safe. It is essential that each healthcare organization establish an effective procedure for safeguarding them. The following are all true statements regarding medical records EXCEPT: 

  Medical records should be stored in a secure, restricted-access location. 

  Competent medical records personnel should review every record before it is examined by the patient or patient representative. 

   An original medical record should be sent with the patient to specialist appointments and for their attorney to review as necessary. 

  Anyone who is not an authorized employee or staff member should not be allowed to examine a medical record. 

 

The Correct answer is:

An original medical record should be sent with the patient to specialist appointments and for their attorney to review as necessary

An original medical record should never be sent with the patient to a specialist’s appointment. The original medical record remains on the facility’s premises unless the organization has received a Subpoena Duces Tecum, court order or a subpoena and a court order to bring the medical record to a court of law. Alternatively, if the medical record has reached the state and federal law’s identified retention period, the original medical record can be stored offsite or destroyed.

 

If the patient needs information from the medical record to take to the specialist, the nurse practitioner’s office can make a copy of what is needed for the referral and send the photocopies of the medical. This process holds true for an attorney. The attorney will only receive copies of the original medical record. Or, if the patient signs appropriate consent forms, the attorney can come to the medical office and review the original medical record.

 

Also, the healthcare provider, nurses or any other staff cannot take original medical records home or to another facility to complete charting or other documentation in the medical record. All charting has to be completed in the facility where the original medical exists. By removing the original medical record from the facility, it can be lost, accidentally destroyed or even stolen, for instance. This can lead to breaches of confidentiality and privacy laws, not to mention it is hard to reproduce an original medical record if it is lost.

 

In the case of office space restrictions, some physician offices and hospitals may not have sufficient amounts of space to store all of their medical records. Therefore, storage or retention of the original medical records becomes an issue. There are many options to storing medical records including storing them offsite, microfilming, scanning the medical records and storing them on CD ROM’s, disks and more. In this case, the nurse practitioner will need to review state and federal laws, as the laws govern how medical records can be retained and the compliance guidelines required if the physical, original medical record has to be stored offsite. Certain medical record documents are permanently kept, such as records of surgical procedures and master patient indexes. Then, depending on state laws, diagnostic images, for instance x-ray films, can be kept for 5 years before the images are archived or destroyed. Destruction of medical records are also dictated by federal and state laws. Some destruction methods include shredding the medical record, for example. 

 

Question 44 

Those systems that form outside the family and reflect functional needs not met within the family are called: 

  exosystems 

  endosystems 

   suprasystems 

  econosystems 

Correct answer:

suprasystems

 

Suprasystems form outside the family and reflect functional needs not met within the family. Relationships with teachers, schools, religious and civic organizations, the healthcare system and friends are examples of suprasystems that meet needs not met by interactions within the family system.

 

Question 45 

A mother brings her 7-year-old daughter to the clinic after the child received a bad sunburn. The treatment for this condition will include all of the following EXCEPT: 

   a hot shower or bath 

  acetaminophen or ibuprofen for pain 

   topical emollients 

  removal from sunlight exposure 

 

Correct answer:

a hot shower or bath

 

The FNP should not recommend a hot shower or bath. On the contrary cool water or saline compresses to the affected areas is typical treatment. The mother should also be educated as to measures to prevent it from happening again.

 

Question 46 

The nurse practitioner's standards of practice are established for what purpose? 

   They are meant to regulate and control nurse practitioner practice. 

  They limit liability of nurse practitioners. 

   They protect nurse practitioners from frivolous lawsuits. 

  They are set up to promote autonomous practice. 

The Correct answer is:

They are meant to regulate and control nurse practitioner practice 

For all professionals (nurses, physicians, dentists, etc.) the standards of practice are set up to regulate and control practice. Their purpose is to provide accountability for the professionals and to help protect the public from unethical and unsafe practice. 

 Question 47 

Which of the following sexually transmitted male genitourinary infections is most likely to be treated with patient-applied podofilox 0.5% solution or imiquimod 5% cream? 

  balanitis 

  gonococcal urethritis 

   genital warts 

  lymphogranuloma venereum 

Correct answer:

genital warts

 

Genital warts are verruca-form lesions caused by the human papillomavirus. Treatment options include patient-applied podofilox 0.5% solution or imiquimod 5% cream. They can also be treated with liquid nitrogen or cryoprobe, trichloroacetic acid, podophyllin resin or surgical removal.

Question 48 

In relation to structural functional theory, which of the following is NOT an example of a suprasystem?

 

   relationships with family 

  relationships with friends 

   relationships with religious organizations 

  relationships with the healthcare system 

The Correct answer is:

Relationships with family

A suprasystem forms OUTSIDE of the family and reflect functional needs that are not met within the family. Examples of a suprasystem include relationships with all of the following: friends, religious organizations, the healthcare system, schools, teachers, civic organizations and other groups.

 Question 49 

A pregnant patient presents with abdominal pain. What test should you use to determine the cause? 

   Ultrasound. 

  CBC. 

   MRI 

  CT scan. 

Correct answer: Ultrasound An ultrasound will not damage a fetus. It is part of prenatal care. The other imaging answers may harm the fetus and are not recommended for pregnant women.

 

Question 50 

The stethoscope is placed slightly off the chest of an elderly patient who is suspected of having a murmur. The sound produced is very loud and accompanied by palpable thrill. Which of the following murmur grades does this describe? 

  III/VI. 

  IV/VI. 

   V/VI. 

   II/VI. 

Correct answer: V/VI Each of the preceding murmur grades is defined below: III/VI - Moderately loud IV/VI - Loud with palpable thrill V/VI - Very loud and heard with the stethoscope partially off the chest; palpable thrill II/VI - Quiet but heard as soon as the stethoscope is placed on the chest 

 

Question 51 

All of the following are accurate regarding documentation EXCEPT: 

   You should document your criticism of a fellow healthcare provider's clinical decision in the patient's medical record. This will protect you if your treatment needs to be defended later. 

  You should use standard abbreviations in the medical record so that subsequent readers will have no doubt as to your meaning and intent. 

  You should document a patient's noncompliant medical behavior in the medical record. 

   You should document telephone conversations with the patient and/or family in the medical record and be particularly specific about recording medication changes. 

The Correct answer is:

You should document your criticism of a fellow healthcare provider's clinical decision in the patient's medical record. This will protect you if your treatment needs to be defended later.

Ridiculing another provider in the patient's medical record is never appropriate. It will allow the plaintiffs' lawyers an avenue to find wrongdoing. The nurse practitioner should deal with the provider directly, preferably in person.

 

Question 52 

When creating a plan of care for a patient diagnosed with fibromyalgia, which of the following is NOT among the medications you would consider? 

  Duloxetine. 

  Pregabalin. 

   Gabapentin. 

   Levetiracetam. 

Correct Answer: Levetiracetam Levetiracetam, or LEV, is an antiepileptic drug (AED) and is not indicated for fibromyalgia. It may in fact pose serious risk of drug interaction with pregabalin (Lyrica), which is a common treatment for fibromyalgia. Gabapentin and Duloxetine may also be prescribed for patients with fibromyalgia

 

Question 53 

You are treating a female patient with pyelonephritis with fluoroquinolone. The nurse practitioner knows that with fluoroquinolone use, length of antimicrobial therapy during uncomplicated pyelonephritis is typically: 

  3 days 

   7 days 

   14 days 

  20 days 

 

The Correct answer is:

7 days

First line therapy includes TMP-SMX or fluoroquinolones. The dosage should be at least 7 days to eradicate the uropathogen. Short-course therapy is not recommended.

 

Question 54 

The FNP has a pregnant patient who is diagnosed with chlamydia trachomatis. Which of the following treatments is preferred for this woman? 

   azithromycin 1 gm PO single dose 

  doxycycline 100 mg BID x 7 days 

  Cipro 500 mg x one dose 

   erythromycin base QID x 7 days 

Correct answer:

azithromycin 1 gm PO single dose

 

For pregnant women erythromycin base QID x 7 days was the preferred treatment. However the CDC recommendation at the present time for a pregnant patient who is diagnosed with chlamydia trachomatis is azithromycin 1 gm PO single dose.

 

Question 55 

Which of the following is NOT consistent with the description of benign prostatic hyperplasia (BPH)? 

   boggy gland on palpation 

  gland has a rubbery consistency 

   gland size is larger than 2.5 cm X 3 cm 

  chronic incomplete bladder emptying 

The Correct answer is:

Boggy gland on palpation

The diagnosis of benign prostatic hyperplasia (BPH) is based on numerous components of the evaluation. On rectal examination, the prostate has a rubbery consistency, enlarged, greater than 2.5 cm X 3 cm and in many cases has lost the median sulcus or furrow. The patient usually complains of symptoms of chronic incomplete bladder emptying, as well. 

 Question 56 

Which of the following symptoms would the FNP see in a child with moderate dehydration? 

   2 – 4 second capillary refill 

  markedly decreased skin turgor with tenting possible 

   low to normal pulse 

  parched mucous membranes 

 

Correct answer:

2 – 4 second capillary refill

 

A 2 – 4 second capillary refill is what the FNP would find in a child with moderate dehydration. He would also find slightly to moderately decreased skin turgor, slightly decreased tears, slightly increased pulse, normal blood pressure, dry mucous membranes and decreased urine output.

 

Question 57 

The most common form of urinary incontinence in elderly persons is which of the following? 

  stress incontinence 

  transient incontinence 

   urge incontinence 

  urethral obstruction 

Correct answer:

urge incontinence

 

Urge incontinence is the most common form of urinary incontinence in elderly persons. Behavioral therapy, including a voiding schedule and gentle bladder stretching are helpful.

 

Question 58 

An adult patient presents with painful red nodules and pustules under his arm. He tells the FNP that some of the lumps have started to drain pus. The FNP is most likely to diagnose which of the following? 

   Hidradenitis Suppurativa 

  impetigo 

   meningococcemia 

  herpes zoster 

Correct answer:

Hidradenitis Suppurativa

 

Hidradenitis Suppurativa is a bacterial infection of the sebaceous glands of the axilla (or groin) by Gram-positive Staphylococcus aureus. It is marked by flare-ups and resolution. It can be confirmed by a C&S of the purulent discharge.

 

Question 59 

What is the leading cause of death for adolescents?

   motor vehicle crashes 

  leukemia 

   heart disease 

  home accidents 

Correct answer:

motor vehicle crashes

 

The leading cause of death for adolescents is motor vehicle crashes. The leading cause of death for all ages and genders is heart disease. The most common cause of cancer deaths is lung cancer.

 

Question 60 

Which of the following drugs has been demonstrated to have use in preventing dementia? 

  Aricept 

  Exelon 

   Cognex 

   none of the above 

 

Correct answer:

none of the above

 

All of the drugs mentioned in the first three choices can be used either alone or together to have a minor and time-limited effect in dementia care. The use of these products and others to prevent dementia are currently not supported.

 Question 61 

When assessing a patient with a headache, the nurse practitioner knows that there are certain "red flags". The mnemonic SNOOP is often used for assessing these red flags. What is the "N" in SNOOP? 

  Never shine the light in the patient's eyes. 

   Neurologic signs and symptoms 

   New onset of a different headache 

  Numbness and tingling 

The Correct answer is:

Neurologic signs and symptoms

In SNOOP ,"S" is for Systemic symptoms. Then, the "N" is for Neurologic signs and symptoms. Next, the "O" is for Onset that is sudden and abrupt. Further, "O" is for Onset age >50. Finally, the "P" is for Previous headache history. 

 Question 62 

A patient with a history of which of the following has a high risk of developing colon cancer? 

   Polyps. 

  Auras. 

   Ulcers. 

  GERD. 

 

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

 

Question 63 

Regarding workforce policy, which of the following is an accurate statement? 

  There are no options for the advanced practice nurses to work outside the primary care role. 

   Employment patterns of nurse practitioners are of special interest to health workforce analysts because of the presumed connection between the employment opportunities for nurse practitioners and the supply of primary care physicians. 

   There is a decrease in the number of nurses with educational preparation as advanced practice nurses. 

  Only half of the nurse practitioners are employed in healthcare or nursing. 

 

The Correct answer is:

Employment patterns of nurse practitioners are of special interest to health workforce analysts because of the presumed connection between the employment opportunities for nurse practitioners and the supply of primary care physicians

There are many options for the nurse practitioner (NP) outside of primary care. There is an increase in the number of nurses educated as NPs now than ever and most are employed in nursing or healthcare workplaces.

 

Question 64 

Which of the following drugs is a Category C drug in terms of pregnancy? 

  Accutane 

   ciprofloxacin 

   amoxicillin 

  insulin 

Correct answer:

ciprofloxacin

 

Ciprofloxacin (Cipro) is a Category C drug. This means that there may be evidence of fetal risk in animals, and there is insufficient human evidence of the drug's safety in pregnancy.  The drug should only be prescribed if the benefits  outweigh the potential risk of using the drug. Accutane is a Category X drug (proven fetal risk outweighs the benefits); amoxicillin is a Category B drug (animal studies show no risk but no human data available OR adequate human studies show no risk, although some adverse effects have been demonstrated in animals); and insulin is a Category A drug (animal and human data show no risk to pregnant women). 

 

Question 65 

It is important that the nurse remembers patients' specific care. What is the standard procedure? 

  Inform patient, let them remember. 

  Keep detail on private sticky notes at nurses' station. 

   Document everything in patients' files. 

  Not necessary to note patients' care. 

 

Correct answer: Document everything in patients' file It is a requirement that every practitioner carefully note patients' files. Malpractice is the result of improperly documented files.

 

Question 66 

Which of the following statements about Medicare Part B is incorrect? 

  It covers all medically necessary services. 

  It is financed by general federal revenues and by Part B monthly premiums. 

   It covers 80% of the approved amount after the annual deductible. 

   Services covered include hospitalization costs. 

Correct answer:

Services covered include hospitalization costs.

 

This is incorrect. Hospital costs are covered in Medicare Part A. Payment for hospitalization is based on projected costs of caring for a patient with a given problem.

 

Question 67 

A sexually active female complains of embarrassing vaginal odor that is worse after intercourse. She also has a vaginal discharge that is thin and of milk-like consistency. Examination shows no redness or irritation. The FNP might suspect which of the following? 

  Candida vaginitis 

  polycystic ovary syndrome 

   bacterial vaginitis 

  Trichomonas vaginitis 

 

Correct answer:

bacterial vaginitis

 

Bacterial vaginitis is caused by anaerobic bacterial overgrowth that is due to unknown reasons or develops secondary to pregnancy terminations or PID. It is not an STD. Vaginal discharge has a fish-like odor, is off-white to gray, and of milk-like consistency.

 

Question 68 

All of the following are recommended nutritional supplements EXCEPT:

 

  fluoride supplements to reduce susceptibility to dental caries

 

  Vitamin K, 1 mg IM, given at birth to all newborns to prevent hemorrhagic disease of the newborn 

   iron from fortified cereal, started by 6 months of age in all infants to replace iron stores 

   oral Vitamin A 10,000 units/day, recommended for mothers who are breastfeeding their infants until they are ingesting whole milk 

The Correct answer is:

Oral Vitamin A 10,000 units/day, recommended for breastfed infants until they are ingesting whole milk

Vitamin D, not A, is recommended for mothers who are breastfeeding their infants at 200units/day until they are ingesting whole milk. The remaining answer choices are recommended nutritional supplements. 

 

 Question 69 

Which of the following is NOT a risk factor in heat stroke? 

   lack of exercise 

  obesity 

   age (very young or very old) 

  alcohol intake 

Correct answer:

lack of exercise

 

This is not a factor in heat stroke. Obesity, age, alcohol use, certain medications that alter adrenergic activity and oral decongestants are all risk factors for heat stroke. Good hydration with non-alcoholic fluids, particularly water, along with dressing lightly, helps to minimize heat stroke risk.

 

 Question 70 

How often would you screen a sexually active 21 year old patient for Chlamydia? 

  Every two years. 

  Every three years. 

   Every four years. 

   Every year. 

 

Correct answer: Every year Sexually active patients should be screened regularly for sexually transmitted diseases. Chlamydia is often without symptoms and should be regularly screened at least once a year.

Question 71 

When treating a patient who has an extremely high P.T. level from Coumadin (warfarin) usage, the nurse practitioner understands that which of the following is the antidote: 

   Vitamin K 

  Vitamin C 

   Vitamin A 

  Vitamin D 

The Correct answer is:

Vitamin K

The antidote for Coumadin (warfarin) toxicity is Vitamin K. It is often given in an injection form to patients with extremely elevated P.T. levels. Dietary sources of Vitamin K include green leafy vegetables.

 

Question 72 

There are theories of how and why a person changes or stays the same over time. One debate on theory involves nature vs. nurture. Which of the following theorists is part of the nature position on human growth and development? 

  John Locke 

   Arnold Gesell 

   John B. Watson 

  B.F. Skinner 

Correct answer:

Arnold Gesell

 

Arnold Gesell promoted the maturational-organismic theory that is a nature position (emphasis on heredity and maturational process). This theory has a biological basis and the organizing principle of the theory is structure (closed system of transformational rules governing thought).

 

Question 73 

During a health assessment with a male patient, he tells you that he has not had a bowel movement in three days, although he usually has one each day. He says that the new medication he is taking makes it more difficult to pass feces. Which of the following is an appropriately worded nursing diagnosis for this patient? 

  Patient is constipated. 

  Elimination, altered. 

   Elimination, fecal, altered. 

   Elimination, fecal, altered, r/t change in medication. 

 

Correct Answer: Elimination, fecal, altered, r/t change of medication It is key to indicated not only that the patient's elimination pattern is altered, but that the patient notes that this change has occurred along with the change in his medication. You must also specify that it is fecal elimination that is altered so that appropriate remedies, and evaluation of the patient's medication, can be undertaken.

 

 Question 74 

In males, which Tanner stage is characterized by the penis thickening? 

  Stage II 

  Stage III 

   Stage IV 

  Stage V 

 

Correct answer:

Stage IV

 

Tanner Stage IV is when the penis thickens. Stage I is prepuberty; Stage II is when the testis begins to enlarge; Stage III is when the penis elongates; and Stage V is the adult pattern.

 Question 75 

You are counseling a patient who is on metformin for diabetes. You know that metformin has all of the following effects EXCEPT: 

  enhanced fibrinolysis 

   increased LDL cholesterol production 

   improved insulin-mediated glucose uptake 

  modest weight loss with initial use 

The Correct answer is:

Increased LDL cholesterol production

 

Metformin is a biguanide that helps stabilize diabetes where insulin resistance is a factor. It does not increase LDL production. The remaining choices are benefits of metformin usage.

remaining choices are benefits of metformin usage.

 Question 76 

In treating the diabetic patient, the nurse practitioner (NP) sees it necessary to prescribe a pioglitazone (Actos) or rosiglitazone (Avandia). When managing the patient on these medications, the NP knows that the primary action of these medications is to: 

   increase glucose uptake into the muscle and fat 

  increase postprandial uptake of glucose into the intestine 

   decrease hepatic glucose output 

  increase secretion of insulin from the pancreas 

 

Correct answer:

increase glucose uptake into the muscle and fat

These medications are insulin sensitizers, which increase the glucose uptake in the muscle and fat. The alpha-glucosidase inhibitors increase postprandial glucose uptake in the intestine. Metformin is used to decease hepatic glucose output. Oral sulfonylureas increase insulin secretion in the pancreas. 

Question 77 

The following component should be included in a history of a patient who is new to your clinic: 

  interval history, past medical history, family medical history, dietary habits, substance use, sexual practices 

   past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices 

   general history on the physical examination for is sufficient; there is no need of interview 

  past medical and surgical history, family medical and surgical histories, psychosocial history, diet and exercise habits, chemical use, sexual practices, review of systems 

The Correct answer is:

Past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices

Past medical and surgical histories, family medical history, psychosocial history, physical activity, tobacco and substance use, sexual practices are all areas that are necessary to investigate a new patient's health.

 

Question 78 

When evaluating the carotids, with correct procedure for auscultating is: 

   Use the bell of the stethoscope. 

  Position the client at a 30-degree angle, and press firmly with bell of the stethoscope. 

   Use the diaphragm of the stethoscope. 

  Place the stethoscope 1 inch off the area above the sternocleidomastoid muscle. 

The correct answer is to use the bell of the stethoscope.  The correct procedure is to listen for carotid bruits with the bell of the stethoscope, which brings out low-frequency sounds and filters out high-frequency sound. The bell should be placed very lightly on the neck with just enough pressure to seal the edge. 

 Question 79 

In treating von Willebrand Disease (VWD) desmopressin acetate is used to treat bleeding complications in Type I of the disease; however, it is contraindicated in which other type of this disease? 

  Type 2M 

   Type 2B 

   Type 2N 

  Type 3 

Correct answer:

Type 2B

 

Desmopressin acetate is used to treat bleeding complications or as preoperative preparation for Type I; however it is contraindicated in Type 2B. Type 2B was previously known as Type II B.

 

Question 80 

Which of the following is NOT part of the standard plan of care for an adult patient with Fifth Disease? 

  Rest. 

  Fluids. 

   Antibiotics. 

  OTC analgesics. 

Correct Answer: Antibiotics Fifth Disease is not treated with antibiotics. Most patients do fine with home care. This care should include rest and plenty of fluids. Over the counter analgesics can be used for associated fever and pain. 

 

Question 81 

The nurse practitioner will often have to treat systemic anaphylaxis. What is the most common clinical manifestation of this? 

  persistent vertigo 

  nausea and vomiting 

   headache 

   urticaria 

The Correct answer is:

Urticaria

Anaphylaxis is typically manifested as systemic IGE-mediated reaction in response to exposure to an allergen. It is characterized by urticaria, angioedema, widespread vasodilation and bronchodilation.

 

Question 82 

You are subpoenaed to appear for a deposition in a negligence case concerning a nurse. Which statement of advice from an attorney would NOT be appropriate? 

  "Be sure to be truthful and remember, it is OK to say 'I don't know' or 'I don't remember' if you have to." 

   "Take as much time as you need to think about what you are going to say before you respond. Don't let the other lawyer put words in your mouth." 

   "Chew gum discreetly to calm your nerves and dress for dinner because depositions usually take all day and you may not have time to change." 

  "Review the medical record of the patient in question and other pertinent material before appearing." 

The Correct answer is:

"Chew gum discreetly to calm your nerves and dress for dinner because depositions usually take all day and you may not have time to change" 

A professional appearance boosts credibility of a witness and it is not appropriate to chew gum. The nurse practitioner should review documents and be prepared prior to the deposition. Questions about the nurse practitioner's professional work history are usually asked, so a copy of the curriculum vitae is a useful tool to bring

Question 83 

Which of the following would NOT be considered one of the general principles of medical record documentation? 

  The rationale for ordering diagnostic and other ancillary services should be documented or easily inferred. 

  The patient’s progress, response to and changes in treatment, and revision of diagnosis should be documented. 

   Health risk factors do not appear in documentation, only in practice. 

  The medical record should be complete and legible. 

Correct answer:

Health risk factors do not appear in documentation, only in practice.

 

Appropriate health risk factors should be identified in documentation. Past and present diagnoses should also be accessible to the treating and/or consulting physician

 

 Question 84 

You are seeing an 18-year-old woman in the office with a "pimple" on her left eyelid. Upon examination, you find a 2.5 mm pustule on the lateral boarder of the eyelid. This is most consistent with: 

  cellulitis 

   chalazion 

  blepharitis 

   hordeolum 

The Correct answer is:

Hordeolum

A hordeolum, or stye, is caused by staphylococcal infection of a hair follicle. Cellulitis is a serious complication of a hordeolum and severe edema and redness would be present. A chalazion is characterized by a hard, nontender swelling of the upper or lower lid. 

 

Question 85 

Which of the following statements about tendonitis and its treatment is false? 

   With rotator cuff involvement, the likelihood of concurrent bursitis is low. 

  When the hand or wrist is affected, splinting and NSAIDs are reasonable first-line therapies. 

   Achilles tendonitis may necessitate treatment with a posterior splint. 

  There is a 10% risk of tendon rupture with recurrent Achilles tendonitis. 

Correct answer:

With rotator cuff involvement, the likelihood of concurrent bursitis is low.

 

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

 

Question 86 

The cranial nerve(s) associated with the gag reflex and the soft palate is(are) which of the following? 

  CN 3, 4 & 6 

   CN 9 & 10 

   CN 12 

  CN 2 

Correct answer:

CN 9 & 10

 

CN 9 & 10 are the Glossopharyngeal Vagus nerves. They are associated with the gag reflex, the symmetrical soft palate, uvula and voice quality.

 

Question 87 

A 33-year-old female has been previously diagnosed with primary dysmenorrhea and now presents in the office with symptoms including pain. She has tried over the counter ibuprofen and naproxen with no results. How should the nurse practitioner treat or manage her? 

   oral contraceptives 

  B vitamins 

   encourage regular exercise 

  prescription strength naproxen 

 

The Correct answer is:

Oral contraceptives

The primary treatments for dysmenorrhea include NSAIDs and hormonal contraceptives. The general recommendation is to use one agent and add the other if one does not work alone. Both should be considered for women who are symptomatic with one agent only

 Question 88 

You are working with a dermatologist and treating patients with acne. When prescribing tretinoin (Retin-A), a nurse practitioner should advise the patient to:

 

   Use a sunscreen because the drug is photosensitizing. 

  Add a sulfa-based cream to enhance anti-acne effects. 

   Expect much improvement in the acne lesions after 1 week of use. 

  Use it with benzoyl peroxide to minimize irritating effects. 

The Correct answer is:

Use a sunscreen because the drug is photosensitizing

Tretinoin (retinoic acid) takes 6 weeks of therapy before noting improvement. It should not be used with benzoyl peroxide or sulfa-based products. It can cause a severe photosensitive reaction, therefore, the sun should be avoided or sunscreen used.

 

Question 89 

The most common cancer death in females is which of the following? 

   lung cancer 

  leukemia 

   breast cancer 

  colon cancer 

 

Correct answer:

lung cancer

 

Lung cancer is the most common type of cancer death in females as well as males. 

 

Question 90 

Which of the following findings is often found in a person with stage 2 Lyme disease? 

  macrocytic anemia 

  conductive hearing loss 

   atrioventricular heart block 

  peripheral neuropathic symptoms 

 

The Correct answer is:

Atrioventricular heart block

 

Lyme disease has three stages, which are stage 1, stage 2 and stage 3. In stage 2 Lyme disease, also known as early disseminated infection, the infectious organism spreads or disseminates into the blood. A potential complication for stage 2 Lyme disease is Lyme carditis, which is exhibited by the presence of abnormal heart rhythms, or an atrioventricular block. Further, in stage 2 Lyme disease, a classic rash may reappear with multiple lesions and arthralgias. Additionally, fatigue, myalgia, and headaches may occur.

Question 91 

The nurse practitioner in a small physician owned office wants to evaluate a patient with pernicious anemia who is receiving treatment. The best laboratory test he could order after one month of therapy is: 

  a Schilling test 

  a reticulocyte count 

   a serum ferritin 

   hemoglobin and hematocrit

 

 

The Correct answer is:

Hemoglobin and hematocrit

With pernicious anemia treatment, the hematocrit rises 4% to 5% per week and is usually normal within one month. Hemoglobin values usually stabilize at this time as well. A Schilling test is unnecessary and will not show significant findings. Reticulocytosis occurs rapidly, with a peak at 7 to 10 days into therapy. Serum ferritin is usually not affected with pernicious anemia. 

 

Question 92 

You are assessing a 2 week old infant for reflexes. Which of the following is NOT an expected reflex in this age infant? 

  Moro reflex 

  Stepping reflex 

   Tonic Neck reflex 

   Vertical reflex 

The Correct answer is:

Vertical Reflex

The moro reflex (startle reflex) results when a sudden loud noise causes symmetric abduction and extension of the arms followed by adduction and flexion of the arms over the body. The stepping reflex occurs when the baby is upright and the dorsal foot is placed on the table causing a simulated stepping motion. The tonic neck reflex (fencing reflex) results when the infant turns the head to one side with the jaw over the shoulder causing the arm and leg on the side where the head is turned to extend. There is no vertical reflex. 

 

Question 93 

What is the best way to understand the chief complaint? 

  Ask direct questions. 

  Ask closed questions. 

   Ask indirect questions. 

   Ask open-ended questions. 

Correct answer: Ask open-ended questions Open ended questions allow patients to describe symptoms in their own words. This will give a better idea of what the patient is experiencing and prevent any leading. 

 

Question 94 

Which of the following persons developed the first standardized measurement of intelligence? 

  G. Stanley Hall 

   Alfred Binet 

   Arnold Gesell 

  Sigmund Freud 

Correct answer:

Alfred Binet

 

Alfred Binet would be considered a proponent of the nature side of the nature vs. nurture debate. He developed the first standardized measurement of intelligence. The intention was to identify “mentally defective” children needing specialized education.

 

 Question 95 

There is a greater recognition of the use by patients of complementary and alternative modalities and medicines (CAM) today than ever before.  Which of the following is an inaccurate statement regarding the practice environment involving CAM? 

  Research suggests that 40-50% of patients are currently utilizing some form of complementary or alternative therapy. 

   There is a wealth of evidenced based research that supports CAM. 

   Nurse practitioners, as providers, need to learn about common CAM treatments and about how some herbal products interact with prescription medications. 

  The National Center for Complementary and Alternative Medicine is a federal government's lead agency for scientific research on CAM. 

The Correct answer is:

There is a wealth of evidenced based research that supports CAM

There is a dearth of research supporting such treatment modalities. 

 

Question 96 

Which of the following herbal over-the-counter medicines is NOT used for anxiety and/or depression? 

  Kava kava 

  St. John’s Wort 

   Valerian root 

   none of the above 

Correct answer:

none of the above

 

All of the choices except this one are herbal remedies for anxiety and/or depression. St. John’s Wort acts like MAOI, SSRI, or TCA. Kava kava has action at GABA receptors similar to benzodiazepines. Valerian root also has action similar to benzodiazepines

 Question 97 

Which of the following medications is NOT appropriate to prescribe for the management of genital herpes? 

  Zovirax. 

   Diflucan. 

   Valtrex. 

  Famvir. 

 

Correct Answer: Diflucan Diflucan, or flucanazole, is an oral medication prescribed for the treatment of vaginal yeast infections. The other choices are suppressive medications prescribed for the management of genital herpes. 

 

Question 98 

Which of the following standards of the Standards of Professional Nursing Practice has the competency for the nurse practitioner to participate in peer review as appropriate? 

  Standard 13, Collaboration 

   Standard 14, Professional Practice Evaluation 

   Standard 15, Resource Utilization 

  Standard 16, Environmental Health 

 

The Correct answer is:

Standard 14, Professional Practice Evaluation

Standard 14 reads: "The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations." 

 Question 99 

A 32-year-old healthy pregnant female has asymptomatic bacteriuria. How should this be managed? 

  prescribe amoxicillin 

  prescribe ciprofloxin 

   prescribe nitrofurantoin 

  order force fluids only 

The Correct answer is:

Prescribe nitrofurantoin

Since the patient is at risk for developing pyelonephritis, a pregnant patient with asymptomatic bacteriuria should be treated with nitrofurantoin. Ciprofloxacin is a quinolone and this class should be avoided during pregnancy. Amoxicillin, while safe, does not cover E.coli, the most common urinary pathogen. 

 

 Question 100 

The nurse practitioner (NP) understands that the research process is similar to the processes that the NP use to provide patient care in that both are decision-making processes. The steps of these processes in the correct order are: 

  Notification, subject selection, consent verification and study implementation 

  Study scope, literature review, study protocol and study design 

   Research construction, research compilation, research conclusion, research implementation 

   Assessing, planning, implementing and evaluating 

 

The Correct answer is:

Assessing, planning, implementing and evaluating

When conducting research, the nurse uses the process steps of assessing, planning, implementing and evaluating. During the assessing stage of the research, the nurse identifies the problem and performs a literature review. The nurse practitioner also identifies any variables that may need to be later measured in the study.  With planning, the nurse performs research to create a hypothesis, determine measurements for the variables of the study and then decide how the sample for the study is selected. The nurse practitioner then collects the data. During the evaluation or evaluating stage, the nurse practitioner analyzes or evaluates the data, makes a conclusion about the findings and determines how to communicate the findings. 

 

quiz 10 aanp

Question 1 

A young female, who breastfeeds her infant, is in the office with a painful, tender, warm and reddened area on her right breast. Mild axillary lymphadenopathy exists as well. You diagnose mastitis. What is an appropriate treatment option? 

   Stop breastfeeding immediately. 

  Antibiotic therapy with Macrodantin 100 mg QID. 

   Antibiotic therapy with Augmentin 875/125 mg BID or IV therapy. 

  Avoid analgesics such as ibuprofen and acetaminophen that could cause breastfeeding issues. 

Antibiotic therapy with Augmentin 875/125 mg BID or IV therapy

Breastfeeding should be continued or milk should be expressed to shorten the duration of symptoms. Macrodantin will not cover the organisms usually present with mastitis, such as S. aureus. With mastitis, analgesic such as ibuprofen and acetaminophen are recommended that are compatible with breastfeeding. 

 

Question 2 

The nurse practitioner (NP) is dealing with a patient who needs to have a durable power of attorney for healthcare. The NP knows that all of the following are true of this document EXCEPT: 

  The document must be flexible enough to carry out the patient's wishes throughout the course of an illness. 

   They are not limited to the circumstances of terminal illness. 

   The durable power of attorney is not binding and legal. 

  The document is often accompanied by a durable power of attorney over financial issues as well. 

The Correct answer is:

The durable power of attorney is not binding and legal

A durable power of attorney for healthcare is a legal and binding document that allows the patient to determine who will make decisions when the patient is unable to make them. The remaining answer choices are true of the durable power of attorney. 

 

Question 3 

An obese elderly patient with Type II diabetes is prescribed a "first line of defense" treatment to regulate the disease. Which of the following is the patient MOST likely prescribed? 

  Sulphonylureas 

   Metformin 

  Thiazolidinedions 

  Insulin. 

 

Correct answer: Metformin Metformin is ideal for patients who are elderly and obese. It is also considered a "first line of defense" drug. 

 

Question 4 

Which of the following would a NP prescribe to her 67 year old patient suffering from insomnia? 

  Only nap once a week. 

   Avoid napping. 

   Only nap twice a week. 

  Only nap three times a week. 

 

Correct answer: Avoid napping When treating a patient suffering from insomnia non-pharmacologically, the NP encourages the patient to stay on a regular routine that includes going to bed and waking up at the same time each day. Napping during the day may prevent the patient from being able to do this

 Question 5 

Medicaid is a federal program administered by the states. All of the following statements regarding Medicaid are true EXCEPT: 

  Medicaid pays NPs 70% to 100% of the fee-for-service rates set for physicians by state Medicaid agencies. 

   Federal law controls the rates paid by Medicaid. 

  Medicaid reimbursement generally is lower than the rate paid by commercial insurers. 

  Many states have applied to the federal government for a Medicaid waiver in order to administer Medicaid in ways that differ from federal laws and regulations. 

 

Correct answer:

Federal law controls the rates paid by Medicaid.

 

This is incorrect. Federal law does not control the rates paid by Medicaid. State law controls the rates paid by Medicaid

Question 6 

The theory that explains current family situations in terms of past relationships and family histories is which of the following? 

  Maslow’s hierarchy of needs 

   Piaget’s cognitive development theory 

  Erikson’s stages of psychosocial development 

   Bowen’s family systems theory 

Correct answer:

Bowen’s family systems theory

 

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

 Question 7 

A 52-year-old female patient who wears a right lower leg brace weighs 100 lb, is 65 inches tall, and her vital signs are normal. She has developed post-polio symptoms. The nurse practitioner understands she needs to: 

   Avoid exposure to cold or chilling, which may cause a loss of strength in the affected muscle. 

  Reduce the amount of time using the brace for joint support to prevent further loss of strength. 

   Exercise all muscle groups vigorously to prevent disuse syndrome. 

  Gain weight to prevent further disability. 

 

The Correct answer is:

Avoid exposure to cold or chilling, which may cause a loss of strength in the affected muscle

In addition to avoiding gaining weight and exercising to the point of muscle pain, regular health maintenance visits are necessary. Cold temperatures can cause a loss of muscle strength in the affected muscle groups and should be avoided. The brace should be used along with periodic evaluation of muscle strength and function. 

 

 Question 8 

An adult patient admits to drinking alcohol on the weekends. He does, however, say in the interview that he is thinking about cutting back on his drinking. What other statement would indicate that the patient is possibly an alcoholic? 

   His friend tell him he drinks too much. 

   He wants to cut out drinking on the weekends to reduce calories. 

  He drinks one beer a night. 

  He does not drink to alleviate stress. 

Correct answer: His friend tell him he drinks too much A patient who feels guilty about drinking and is told to cut down by his friends or family may be an alcoholic. Using the CAGE strategy will help determine the risk of alcoholism. 

 

Question 9 

An elderly patient presents with a fever, chills, myalgia and erythema migrans. The patient is exhibiting symptoms of what stage of Lyme Disease? 

   1 

  2 

   3 

  None of these. 

 

Correct answer: 1 There are three stages of Lyme Disease. Stage 1 is known for: fever, chills, myalgia and erythema migrans Stage 2 is known for: fatigue, migratory arthralgia and cranial nerve palsies Stage 3 is known for: memory, sleep and mood problems 

 

Question 10 

What reflex of the eyes would you test on a two month old infant? 

  Step reflex. 

   Plantar flexion reflex. 

  Babinski reflex. 

   Red reflex. 

Correct answer: Red reflex The red reflex is the only reflex of the eye listed. This should be done within the first two months of a child's life. It will determine if there are any problems with the back of the eyes.

 

Question 11 

A patient admits to fatigue in an interview. The exam reveals that his blood pressure is 145/90. What might you screen for? 

  Hepatitis. 

   Diabetes. 

   STD. 

  Anemia. 

Correct answer: Diabetes High blood pressure should always be investigated. Fatigue and high blood pressure could indicate diabetes. A glucose test should be ordered. 

 

Question 12 

Which of the following nurse practitioner roles provided the model for other emerging nurse practitioner specialties? 

   pediatric nurse practitioner 

  family nurse practitioner 

   geriatric nurse practitioner 

  adult nurse practitioner 

Correct answer:

pediatric nurse practitioner

 

The first NP program established in 1964 through the collaborative effort of Loretta Ford and Henry K. Silver provided the model for other emerging nurse practitioner specialties. The role of the NP continues to expand.

Question 13 

The healthcare delivery system has made a shift in the provision of non acute care from the hospital to the ambulatory care setting and home. Nursing research previously conducted in hospitals: 

  remains relevant in the new settings because the care patients receive is the same 

   should be applied directly to patient care provided in the new settings 

   may no longer be applicable to the healthcare delivery 

  now becomes applicable to all in-patient hospital care providers 

The Correct answer is:

May no longer be applicable to the healthcare delivery

Such a drastic change in the healthcare delivery has occurred and this makes studies no longer applicable to nursing care.

 

Question 14 

 Which of the following is one of the most common causes of failure to thrive in an infant?

 

   improper feeding 

  hypothyroidism 

   cystic fibrosis 

  celiac disease 

 

Correct answer:

improper feeding

 

Improper feeding is one of the most common causes of failure to thrive. It can be for economic reasons, lack of education, psychologic, or feeding intolerance.

 

 Question 15 

Which of the following is a relative contraindication for oral contraceptives? 

  coronary artery disease 

   smoking, if younger than 35 years 

  undiagnosed genital bleeding 

  migraine with focal aura 

 

Correct answer:

smoking, if younger than 35 years

 

Smoking, if younger than 35 years, is a relative contraindication for oral contraceptives. If over the age of 35, it is an absolute contraindication.

 

Question 16 

Seizures in newborns almost always reflect significant nervous system pathology. When the newborn has rigid posturing of the extremities and trunk during the seizure, he is having which of the following types of seizure? 

  myoclonic 

   tonic 

  multifocal 

  focal 

Correct answer:

tonic

 

A tonic seizure is indicated by rigid posturing of the extremities and trunk. A myoclonic seizure is characterized by focal or generalized jerking of the extremities. A focal seizure is twitching of muscle groups, including the face. A multifocal seizure is similar to focal, but involves multiple muscle groups.

 

 Question 17 

There are a number of healthcare issues that should concern the FNP. All of the following are true in terms of current healthcare issues EXCEPT: 

  There is increasing emphasis on culturally competent care and evidence-based practice. 

  New emphasis on genetic research makes medical ethics a growing concern. 

   Causes of infant mortality have changed from primarily noninfectious causes to primarily infectious and nutritional causes. 

  There is an increasing concern over drug-resistant organisms and pandemic flu. 

Correct answer:

Causes of infant mortality have changed from primarily noninfectious causes to primarily infectious and nutritional causes.

 

This statement is not true. The opposite is true. Causes of infant mortality have changed from primarily infectious and nutritional causes to primarily noninfectious causes such as congenital anomalies and perinatal events. 

 

Question 18 

You have a 45-year-old male patient who presents with fever and chills. He has splinter hemorrhages on his nailbeds and violet-colored painful nodes on his fingers. When you do a cardiac exam you find that a heart murmur is present. Which of the following is most likely to be a diagnosis for this patient?

 

  congestive heart failure 

   myocardial infarction 

  Raynaud’s phenomenon 

   bacterial endocarditis 

 

Correct answer:

bacterial endocarditis

 

Bacterial endocarditis (BE) is an infection of the valves and inner lining of the heart (called the endocardium). It happens when bacteria from the skin, mouth, intestines, or urinary tract enter the bloodstream (usually during a dental or medical procedure) and infect the heart.

 

Question 19 

How often must hospitals check the National Practitioner Data Bank before granting clinical privileges to nurse practitioners? 

  every year 

   every two years 

   every three years 

  none of the above 

Correct answer:

every two years

 

Hospitals must check the NPDB data ever two years before granting clinical privileges. Certain agencies may also check the NPDB data. The general public does not have access to the NPDB data.

 

Question 20 

A 70 year old patient has tremors. What is the likely cause? 

  Age. 

  Wear and tear. 

   Depression. 

   Pathology. 

 

Correct answer: Pathology Age does take its toll on the body. It is important to know the difference between normal aging and abnormal symptoms. Tremors are not a natural part of aging and indicate a pathology related cause. 

 

Question 21 

You have a 40-year-old male patient who is a heavy smoker. You recommend a program for him to help him stop smoking. He says that it would be nice to be able to quit, but right now he is not ready. He is in which stage of the trans-theoretical model of change? 

  preparation 

   pre-contemplation 

  termination 

  action 

Correct answer:

pre-contemplation

 

This patient is in the pre-contemplation stage of change. He is not yet able to even think about changing.

 

Question 22 

In terms of neural tube defects, which of the following statements is least accurate? 

  Spina bifida and anencephaly are the most common of the neural tube defects. 

   Myelomeningocele results from failure of the neural tube to close spontaneously.

 

  At least 70% of people with a myelomeningocele have normal intelligence.

 

   The mortality rate for myelomeningocele is 50% with most deaths occurring before 2 years of age. 

 

Correct answer:

The mortality rate for myelomeningocele is 50% with most deaths occurring before 2 years of age.

 

This is the least accurate statement. Myelomeningocele accounts for most congenital abnormalities of the central nervous system. The mortality rate for myelomeningocele is 10% to 15% with most deaths occurring before 4 years of age.

Question 23 

You are providing patient education to a female patient who has been diagnosed with genital herpes. Which of the following is NOT part of appropriate patient education for this patient? 

  The patient should abstain from all sexual activity during an outbreak. 

   The patient should use condoms or other barriers even when she does not have an outbreak. 

   The patient should permanently abstain from all sexual activity. 

  The patient should disclose her diagnosis to sexual partners. 



Correct Answer: The patient should permanently abstain from all sexual activity People with genital herpes can have normal sex lives. The patient should be educated to use barriers to prevent infecting her partners and to avoid sex during outbreaks. She should also be encouraged to disclose her diagnosis to sex partners.

 

Question 24 

A young female patient is in the clinic complaining of tenderness and burning of her vulva. A pelvic exam is performed and she is notably reddened, edematous, and excoriated. The nurse practitioner does a wet prep with saline and KOH and finds pseudohyphae and spores. The diagnosis for this client is: 

  gonorrhea 

  bacterial vaginosis 

   chlamydial infection 

   vulvovaginal candidiasis 

The Correct answer is:

Vulvovaginal candidiasis

The yeast and spores on the wet prep with KOH are diagnostic for candidal infection. Bacterial vaginosis would reveal clue cells and a positive amine odor. Then, chlamydia and gonorrhea requires a cervical culture to be diagnosed

 

 Question 25 

 The term which is defined as more than one abstract idea or term symbolizing the association or interaction of two or more concepts is which of the following?

 

  model 

  phenomenon 

   proposition 

   construct 

 Correct answer:

construct

 

A concept is intended to represent an abstract ides. A construct is similar to a concept; however, a construct is not just an abstraction. A construct consists of more than one abstract idea or term and symbolizes the association or interaction of two or more concepts.

 

 Question 26 

Which of the following is a tertiary prevention measure? 

  cardiac rehab 

  speech therapy 

   education for pre-existing disease 

   all of the above 

 

Correct answer:

all of the above

 

All of the choices are tertiary prevention measures. Tertiary prevention involves rehabilitation and avoidance of further bodily damage.

 

Question 27 

There is a nurse practitioner (NP) that works in an HIV practice. When talking to a patient, she learns that the patient's sister lives next door to the NP. She sees this lady on her way to the mailbox and states that she met her brother today. The neighbor replies, "Don't you work in an HIV clinic?" How is this situation described? 

  This is not a breach of confidentiality. 

   This is malpractice. 

  The nurse practitioner has no liability. 

   This is breach of confidentiality. 

The Correct answer is:

This is breach of confidentiality

There has definitely been a breach of confidentiality with this situation. The neighbor's brother is a patient of the nurse practitioner (NP) and the NP is bound by law not to disclose health information to anyone without first obtaining permission. Even though the NP did not acknowledge that the brother was her patient, it was implied. 

 

Question 28 

An FNP is preparing a campaign for teachers in an inner city middle school. The purpose is to decrease and eventually eliminate aggressive behavior. Which of the following would be the best method for presenting the information to the teachers? 

  preparing a manual 

  lecturing to the teachers 

   panel presentation and small discussion groups 

  preparing videos for presentation during lecture 

 

Correct answer:

panel presentation and small discussion groups

 

Adult learning theory says that the older the learner, the more self-direction is needed. Since adults are “doers” an interactive session is most effective.

 

Question 29 

Principles of structural functional theory adapted from Friedman and others include all of the following EXCEPT: 

  Families are social systems with instrumental and expressive functions. 

  In optimally functioning families, members take on predictable roles that meet the needs of its members. 

   Families are composed of small numbers with characteristics of small-group behavior. 

   Individuals adopt norms and values solely from outside the family system. 

 

Correct answer:

Individuals adopt norms and values solely from outside the family system.

 

This is incorrect. Individuals adopt norms and values, as well as cultural traditions as part of the process of family socialization.

 

Question 30 

Which of the following tests would NOT be used to test for hearing? 

  Weber test 

  Rinne test 

   Snellen test 

  all of the tests 

Correct answer:

Snellen test

 

The Snellen test is used to measure central distance vision. The Weber test and the Rinne test are used to measure hearing

 

 Question 31 

In doing anthropometric measurements for an obese child, the FNP would likely find all of the following EXCEPT: 

  BMI is equal or greater than the 95th percentile for age and gender. 

   Skin-fold thickness per calibrated caliper measurements is at or above the 95th percentile for age, sex and race. 

   Percent of ideal body weight is greater or equal to 120%. 

  Weight for height ratio is greater than the 95th percentile on CDC growth charts. 

Correct answer:

Skin-fold thickness per calibrated caliper measurements is at or above the 95th percentile for age, sex and race.

 

This is incorrect. The skin-fold thickness per calibrated caliper measurements would be at or above the 85th percentile for age, sex and race. 

 

Question 32 

Which of the following laboratory procedures is most useful for helping with diagnosis of fungal infections? 

   KOH slide 

  Pap smear 

   Tzanck smear 

  Gram stain 

Correct answer:

KOH slide

 

The KOH (potassium hydroxide) slide is useful for helping with the diagnosis of fungal infections (hair, skin, nails). KOH is also used for the “Whiff Test” for bacterial vaginosis. A strong fish-like odor is released after one to two drops are added on the slide.

 

Question 33 

During a well-child exam a 4-year-old girl has a pure-tone audiometry revealing 24 decibels (dB) in the left ear and 48 dB in the right ear. The nurse practitioner interpret this as: 

  within normal limits for age 

   normal hearing in the left ear and moderate hearing loss in the right ear 

   inconclusive findings because pure tone audiometry is not accurate in children age 5 and younger 

  mild hearing loss in the left ear and normal hearing in the right ear 

The Correct answer is:

Normal hearing in the left ear and moderate hearing loss in the right ear

Pure tone audiometry is appropriate after age 3 years. Further, 0-25 dB = normal, 26-40 dB = mild hearing loss, and 41-55 dB = moderate hearing loss.

 

Question 34 

A 16 year old patient comes in complaining of weight loss, frequent urination, and excessive thirst. There is a history of Type 1 diabetes in the family. What test should be run? 

   Fasting blood glucose. 

  Serum cholesterol. 

   Serum albumin. 

  Vitamin B12. 

Correct answer: Fasting blood glucose Fasting blood glucose will help determine if the patient has diabetes. The family history increases the patient's risk of diabetes. The complaints could indicate diabetes.

Question 35 

A 16-year-old mildly obese adolescent presents requesting a letter stating she should not participate in gym class because of her asthma. The most appropriate response is to: 

  Excuse her from outdoor activities only as to avoid pollen exposure. 

  Write the note to excuse her from indoor activities only to avoid dust mite exposure. 

   Write the note because gym class participation could trigger asthma symptoms. 

   Remind her that with appropriate asthma care, she can participate in gym class and that exercise is part of a healthy lifestyle. 

The Correct answer is:

Remind her that with appropriate asthma care, she can participate in gym class and that exercise is part of a healthy lifestyle

Asthma is a common chronic disorder that is complex but treatable. Exercise is a necessary part of a healthy lifestyle, especially for a developing teen that is overweight. With the use of a short-acting beta2 agonist inhaler, this condition can be controlled and managed during activity. 

 

Question 36 

When treating a patient with oral Vitamin B12, which drug interaction will result in deceased absorption of vitamin B12? 

  aminoglycosides 

  colchicine 

   potassium supplements 

   all of the above 

 

The Correct answer is:

All of the above

In addition to colchicine, aminoglycosides and potassium supplements, ascorbic acid may destroy the vitamin B12 supplement within one hour of ingestion. Therefore, these drugs should not be taken concomitantly with oral vitamin B12. 

Question 37 

Which of the following would be considered a reversible cause of dementia? 

  high fever 

  infections 

   metabolic derangements 

   none of the above 

Correct answer:

none of the above

 

None of the other choices are reversible causes of dementia. Dementia is not reversible! Delirium is reversible and the first three choices are reversible causes for delirium.

 Question 38 

The FDA has approved three NSAIDS for primary dysmenorrhea. Which of the following is one of these NSAIDS? 

  ibuprofen 

  indomethacin 

   naproxen sodium 

   all of the above 

Correct answer:

all of the above

 

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

 

Question 39 

A patient comes to the clinic with a burn on her arm caused by spilling boiling water on it. The FNP knows that it is important to estimate the body surface area (BSA) affected by the burn. She also knows that a person’s palmar surface represents a BSA of which of the following? 

   1% 

  2% 

   3% 

  4% 

Correct answer:

1%

 

With burns of any sort, it is necessary and important to estimate the BSA affected by the burn. A helpful guide in estimating the BSA is that a person’s palmar surface represents a BSA of 1% throughout the life span.

 

 Question 40 

The descriptors for the levels of evaluation and management (E/M) services recognize seven components that are used in defining the levels of E/M services. Which of the following is NOT one of these components? 

  history 

  counseling 

   time 

   expense 

Correct answer:

expense

 

Expense is not one of the seven components used in defining the levels of E/M services. The seven components are: history, examination, medical decision making, counseling, coordination of care, nature of presenting problem and time.

Question 41 

You are counseling the mother of four children who have been diagnosed with pediculosis humanus capitis infestation. With the management of this condition, the nurse practitioner knows to advise the mother of all of the following EXCEPT: 

  All carpets and furniture must be vacuumed and cleaned thoroughly. 

   Children may return to school or day care a week after treatment. 

   Seal up all unwashable items, such as stuffed animals and large comforters for 10 days. 

  The hair must be combed with a fine-toothed comb after treating to remove adherent nits. 

 

The Correct answer is:

Children may return to school or day care a week after treatment

The children may return to school or day care the day after treatment. 

 

Question 42 

What is a CAM modality or medicine? 

  an untested drug 

  a consistent and accepted modality or medicine 

   a generic drug 

   a complementary or alternative modality or medicine 

 

Correct answer:

a complementary or alternative modality or medicine

 

Research suggests that 40 – 50% of patients are currently using a form of complementary or alternative therapy. NPs as providers need to learn about common CAM treatments and particularly how some herbal products interact with prescription drugs. 

 

Question 43 

You are treating a patient with asthma in the clinic. They tell you they received a new medication in an emergency room when they were out of town visiting family. Which of the following should be avoided in a patient with asthma? 

  naproxen 

  topical hydrocortisone 

   amlodipine 

   timolol ophthalmic drops 

The Correct answer is:

Timolol ophthalmic drops

Timolol ophthalmic solution drop is a beta blocker which is known to precipitate asthma exacerbation in patients. Even though it is administered in the eye, there is considerable absorption through the mucous membranes, resulting in systemic effects. The remaining answer choices have no specific contraindications for patients with asthma. 

 

Question 44 

 The theoretical concept that says that a person who feels susceptible to a disease and believes that he will benefit from changing his behavior is more likely to perform the healthier behavior is which of the following concepts?

 

  the self-efficacy theory 

   the health belief model 

   the systems theory 

  the family systems theory 

Correct answer:

the health belief model

 

The theoretical concept that says that a person who feels susceptible to a disease and believes that he will benefit from changing his behavior is more likely to perform the healthier behavior is the health belief model. This model attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals.

 Question 45 

Marketing refers to determining the needs and desires of the prospective consumer and designing NP services to meet those needs. The key elements of marketing include the four Ps which are: 

  product, price, place, and prescription 

  profession, place, price and production 

   product, price, place and promotion 

  profession, price, place and prescription 

 

Correct answer:

product, price, place and promotion

 

The key elements of marketing include the four Ps. These are: product (the unique role of the NP); price (cost advantage in the NP-delivered care); place (competitive advantage of a practice site or after-hours services); and promotion (processes devoted to negotiating a position in practice).

 

 Question 46 

Which of the following would NOT be a barrier to therapeutic communication? 

  probing 

  interpreting 

   changing the subject 

   seeking clarification 

Correct answer:

seeking clarification

 

Seeking clarification involves either stating that what a patient said was misunderstood or asking the patient to repeat the conversation or basic idea of the message. It is a good therapeutic communication technique. The other choices are not.

 

Question 47 

At what age would you expect a child to jump up and down? 

  12-14 months 

  16 months 

   18 months 

   24-28 months 

Correct answer:

24-28 months

 

You would expect a child to be able to jump up and down by the age of 24-28 months. At this age the child should also be able to run about and kick a ball, as well as build a block tower of six cubes.

 

 Question 48 

All of the following are considered components of family functioning EXCEPT: 

  stable and safe physical environment 

  adequate financial resources 

   appropriate supervision 

   being a member of a “traditional” family 

 

Correct answer:

being a member of a “traditional” family

 

This is not considered a component of family functioning. Modern day has seen a variation in family structure that does not necessarily affect family functioning. Family functioning is more directly related to healthy growth and development than is family structure. Components of family functioning include provision of a stable and safe physical environment as well as financial and emotional resources necessary to provide supportive and nurturing care with appropriate supervision and guidance.

 

 Question 49 

All of the following are characteristic of irritable bowel syndrome EXCEPT: 

  no detectable structural abnormalities 

  absence of rectal bleeding 

   fever with weight loss 

  no elevation of CRO or ESR 

Correct answer:

fever with weight loss

 

With IBS there is usually no fever or weight loss. This is more common in inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.

 

Question 50 

A middle aged postmenopausal woman is in the office with questions regarding hormone therapy. You explain to her that hormone therapy users may experience:

 

   an increase in breast cancer rates with long-term use 

  a 10% increase in bone mass 

   no change in the occurrence of osteoporosis 

  reduction in high-density lipoprotein cholesterol 

The Correct answer is:

An increase in breast cancer rates with long-term use

Postmenopausal hormone therapy can help reduce the risk of postmenopausal fracture by 50% by minimizing further bone loss. The benefits must be balanced against the noted increased risk of breast cancer and other problems. 

 

Question 51 

The concept that defines what a nurse practitioner can do in that role is known as which of the following? 

  standard of care 

   scope of practice 

   ethical principle 

  moral principle 

Correct answer:

scope of practice

 

The NP’s scope of practice, outlined in the nurse practice act, identifies who the NP is, what the NP can do in that role, and where the NP can legally provide care. Actions that exceed the legal boundaries of practice in a particular state are considered to be violations of the nurse practice act.

 

 Question 52 

The FNP has a patient with seasonal allergic rhinitis. The FNP would most likely tell this patient to avoid the allergen by staying indoors except for: 

  in the morning 

   after a rain shower 

   during the night 

  The patient should stay indoors all day during allergy season. 

Correct answer:

after a rain shower

 

After a rain shower, the air is relatively cleansed of offending allergens. Pollen counts are generally the highest early in the morning because these substances are released during the night.

 

Question 53 

You are examining the testicles of a 25-year-old patient. When touching the right inner thigh of this patient the testicle is elevated toward the body on that side. This is known as which of the following?

 

  priapism 

   cremasteric reflex 

   blue dot sign 

  phimosis 

 

Correct answer:

cremasteric reflex

 

The cremasteric reflex happens when the testicle is elevated toward the body in response to stroking the ipsilateral inner thigh. This is the thigh on the same side as the testicle.

 

 Question 54 

The nurse practitioner will work at several different job sites over the course of her career. One such site is a federally qualified health center (FQHC). Which of the following is NOT true regarding this type of facility? 

   Clinics and facilities can be called a federally qualified health center if they accept Medicare and Medicaid and work toward public health service. 

  They originated from community health centers and migrant health centers established under the Public Health Service Act. 

   Services covered in these centers are health screenings, diagnostic tests immunizations, annual physical examinations and preventive health education. 

  They were established in 1992 to provide health promotion and preventive services and access to primary care services for Medicare beneficiaries. 

 

The Correct answer is:

Clinics and facilities can be called a federally qualified health center if they accept Medicare and Medicaid and work toward public health service

Clinics and facilities must meet certain requirements and receive a federal grant in order to be called federally qualified health centers. 

 

Question 55 

The majority of breast cancers occur in which area of the breast?

 

  beneath the nipple and areola 

   upper outer quadrant 

   lower outer quadrant 

  upper inner quadrant 

The Correct answer is:

Upper outer quadrant

The upper outer quadrant is the most common site for breast cancer. The second most common site for breast cancer is beneath the nipple and areola. 

Question 56 

Certain foods are known to be potential dietary triggers influencing the onset or severity of migraine symptoms. When counseling a patient on these, which is NOT considered a trigger? 

  onions 

  ripened cheeses 

   vanilla ice cream 

  caffeinated beverages 

The Correct answer is:

Vanilla ice cream

Vanilla ice cream is not on the list as triggers for a migraine headache. However, "chocolate" is. Also included as trigger foods are onions, caffeinated beverages, ripened cheeses, sour cream, sausage, bologna, salami, pepperoni, hot dogs, pizza, chicken liver, herring, pickled foods, monosodium glutamate, yeast products, nuts or nut butters, various beans, figs, raisins, papayas, avocados, red plums, citrus foods, bananas, alcoholic beverages and aspartame

 

Question 57 

Your patient is taking a hiking trip in a wooded area with friends. She asks you how she can protect herself from Lyme disease during this trip. You would tell her which of the following will help?

 

  Wear light colored clothing so ticks are easily detected. 

  Wear long pants tucked into socks.

 

   Wear long-sleeved shirt tucked into waist. 

   all of the above 

 

Correct answer:

all of the above

 

All of the first three choices will help to prevent Lyme disease. This is an infection caused by Borrelia burgdorferi, a spirochete. It is the most common arthropod-borne disease in the United States.

 

Question 58 

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

   alprostadil 

  Muse 

   taldalafil 

  vardenafil 

Correct answer:

alprostadil

 

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

 

 Question 59 

A 24-year-old sexually active female comes to the clinic complaining of lower abdominal pain and cramping. She tells the FNP that she has not had a period for about 7 weeks. The pain worsens when the woman is lying down on her back. The FNP might suspect which of the following conditions/diseases? 

  ovarian cancer 

  Candida vaginitis 

   ectopic pregnancy 

  atrophic vaginitis 

Correct answer:

ectopic pregnancy

 

The most likely of the choices is an ectopic pregnancy. Risk factors include: a history of PID, tubal ligation and older age. This is the leading cause of death for women in the United States in the first trimester of pregnancy.

 

Question 60 

The fact that an adult nurse practitioner is not legally authorized to care for children is an example of defining which of the following? 

   scope of practice 

  standards of practice 

   ethical standards 

  civil responsibilities 

 

Correct answer:

scope of practice

 

The scope of practice is determined by state statutes, boards of nursing, educational preparation, and common practice within a community. Broad variation exists from state to state.

 

Question 61 

The Centers for Disease Control and Prevention (CDC) recommends screening all women for sexually transmitted diseases between the ages of: 

  12 and 16 

  16 and 20 

   20 and 24 

  24 and 30 

Correct answer:

20 and 24

 

The CDC recommends screening all women for sexually transmitted diseases between the ages of 20 and 24. This would be considered a secondary prevention measure to detect disease early to minimize bodily damage.

 

Question 62 

Which of the following would be the most important source of information to determine whether a patient is suffering from Alzheimer’s disease (AD)? 

  mental status examination 

  CBC 

   MRI 

   clinical history 

 

Correct answer:

clinical history

 

With AD, you would be interested in the symptoms and the progression of symptoms characteristic of AD. Therefore, of all the choices, the clinical history would be most informative.

 

Question 63 

When counseling the mother of a toddler on lead toxicity and poisoning, what should the nurse practitioner understand that is most likely to lead to this condition? 

  If the toddler lives near an electric generating plant, he or she is at risk. 

  If the toddler is developmentally disabled, he or she is at risk. 

   If the toddler lives in a 15-year old home with copper plumbing, he or she is at risk. 

   If the toddler lives in a 100-year old home that is being remodeled, he or she is at risk. 

 

The Correct answer is:

If the toddler lives in a 100-year old home that is being remodeled, he or she is at risk

The toddler is at risk if he or she is exposed to lead-based paint. This paint has not been available in the United States in 30 years. Also, copper pipes are not a risk to the toddler as lead-lined pipes are. A toddler living near a lead factory would be at risk, not one living near a electric generating plant. A developmental disability does not increase lead toxicity risk.

Question 64 

The FNP has an adult patient with diabetes whose blood pressure is 145/95. Which stage of hypertension does this indicate? 

  normal 

  pre-hypertension 

   Stage II 

   Stage I 

Correct answer:

Stage I

 

Stage I hypertension is characterized by a systolic pressure of 140 – 159 mm Hg and a diastolic pressure of 90 – 99 mm Hg. The treatment recommendation for this stage is usually a thiazide diuretic and for those with diabetes, either ACE inhibitors or ARBs, because of their renal protective properties.

 

 Question 65 

There are different psychosocial periods in adolescence. In which period would achievement of identity and intimacy in relationships take place? 

  pre-adolescence 

  early adolescence 

   middle adolescence 

   late adolescence 

 

Correct answer:

late adolescence

 

Late adolescence takes place between 18 and 21 years. During this period vocation and career choices become important. Achievement of identity and intimacy in relationships are hallmarks of this period.

 

Question 66 

An elderly lady with rheumatoid arthritis (RA) is in the office and placed on prednisone 5 mg PO qd. In educating her about this medication, which of the following is important for the nurse practitioner to include? 

  The medication should be taken about 30 minutes before eating. 

  When the symptoms of arthritis subside, she will be able to stop this medication. 

   Increased fluid intake is important for the prevention of renal damage by the use of steroids. 

   It is important to continue the medication as prescribed, even if the redness and swelling decreases or goes away. 

The Correct answer is:

It is important to continue the medication as prescribed, even if the redness and swelling decreases or goes away

The client should be informed that the symptoms will decrease when the medication is effective, but the client should maintain her dose as prescribed. The medication is not influenced by fluids and should be taken with food to avoid gastrointestinal upset. 

 

Question 67 

Regarding the scientific method for conducting research which uses the null hypothesis, the nurse practitioner knows this is statistically based and the correct format for the null hypothesis is: 

  Group "A" is less than group "B". 

  Group "A" is greater than group "B". 

   There is a 95% probability that group "A" is different from group "B". 

   There is no significant difference between the two groups. 

 

The Correct answer is:

There is no significant difference between the two groups

 

The research hypothesis may take the other forms. 

 

Question 68 

Which of the following types of pneumonia has a gradual onset, with symptoms that include a low grade fever, sore throat, cough, wheeze and chest pain with cough? 

  bacterial pneumonia 

  viral pneumonia 

   community acquired pneumonia 

   atypical pneumonia 

Correct answer:

atypical pneumonia

 

Atypical pneumonia is an infection of the lungs by atypical bacteria. It is more common in children and young adults. It is also known as “walking pneumonia.”

 

Question 69 

Which of the following would not be a first-line test for a female with cholecystitis? 

  CBC 

  pregnancy test 

   urinalysis 

   serum amylase and lipase levels 

 

Correct answer:

serum amylase and lipase levels

 

Serum amylase and lipase levels would not be first line diagnostic tests. They might be indicated for further testing in a patient with a certain history or physical examination findings.

 

Question 70 

A 9-year-old African-American child is brought to the clinic by his mother. She tells the FNP that the child has patchy white spots on his scalp with “black dots” and his scalp appears scaly and is itchy. The FNP knows that these are signs of which of the following diseases/conditions? 

  tinea pedis 

   tinea corporis 

  tinea cruris 

   tinea capitis 

Correct answer:

tinea capitis

 

Tinea infections are infections of superficial keratinized tissue (skin, hair and nails) by tinea yeast organisms. Tinea capitis is more common in dark-skinned children and is characterized by patchy alopecia with “black dots” (broken hair shafts) and fragile hair shafts. Children also have fine scales on the scalp and the scalp is frequently itchy. 

 Question 71 

The nurse practitioner is aware that hepatitis B is a public health concern. He has the understanding that which of the following groups needs routine hepatitis B (HBsAg) screening? 

  college students 

  hospital laboratory workers 

   pregnant women 

  recipients of hepatitis B vaccine series 

The Correct answer is:

Pregnant women

Infants who become infected with HBV have a 25% lifetime chance of developing hepatocellular carcinoma or cirrhosis. This is why pregnant women should be screened for HBV at the first prenatal visit, regardless of their vaccine history. 

 

Question 72 

Which of the following medications would you prescribe for a patient who suffers from recurrent gout as a maintenance treatment? 

  Indocin 

  Anaprox DS 

   colchicine 

   Zyloprim 

 

Correct answer:

Zyloprim

 

Of the choices given, Zyloprim is the only maintenance medication. The other choices are associated with the acute phase of gout

 

 Question 73 

You are prescribing Zithromax for a child who weighs 66 lb. The initial dose is 10 mg/kg per day. This dose amounts to which of the following? 

   300 mg/day 

  660 mg/day 

   330 mg/day 

  600 mg/day 

 

Correct answer:

300 mg/day

 

Since the initial recommended dose is 10 mg/kg per day, you first need to convert the child’s weight to kg. This is done by dividing 66 lb by 2.2 kg. (There are 2.2 kg to each lb). The result is 30, which is then multiplied by 10 mg to give you a dose of 300 mg/day.

 Question 74 

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

   3% 

  6% 

   9% 

  12% 

 

Correct answer:

3%

 

A person’s palmar surface represents a BSA of 1% throughout his life span. Therefore, a burn that is 3 times the palmar surface represents a BSA of 3%.

 

Question 75 

When should an infant be able to lift his head and hold his head erect?

   1 – 2 months 

  3 - 4 months 

   5 - 6 months 

  6 - 8 months 

Correct answer:

1 – 2 months

 

At 1 – 2 months an infant should be able to lift his head and hold it erect. He should also be regarding faces, following objects through a visual field, smiling spontaneously and recognizing his parents.

 

Question 76 

You are conducting an assessment with a 40 year old male patient. He notes that he has lost 5 pounds in the last month, though he has not been dieting. He also says that he is urinating more frequently, though this may be because he is drinking so much water due to being thirsty all the time. He also reports being frequently tired. This patient should be further assessed for which of the following? 

  Hypoglycemia. 

   Hyperglycemia. 

   Myocardial infarction. 

  Anemia. 

Correct Answer: Hyperglycemia This patient's symptoms are consistent with hyperglycemia. Further tests, including a blood glucose test, should be ordered in order to arrive at a correct diagnosis. The patient may also report that cuts and sores heal more slowly. 

 

Question 77 

A 32-year-old Asian man presents with sneezing, postnasal drip, sore throat, and watery eyes. He states he has been doing yard work for the last couple of days. What do these symptoms suggest? 

  acute bronchitis 

  atypical pneumonia 

   influenza 

   allergic rhinitis 

The Correct answer is:

Allergic rhinitis

The symptoms presented are classic for allergic rhinitis. The signs and symptoms of acute bronchitis include a cough and colored sputum. An individual with atypical pneumonia would present with a fever and cough. Then, a patient with influenza would present with an acute onset of fever, chills, and malaise. 

 

Question 78 

Which of the following is a system of controlled oversight and authorization of services and benefits provided to patients? 

  clinical ladder 

   case management 

   triage 

  clinical guidelines 

The Correct answer is:

Case management

Case management is a special type of communication that is a necessity for healthcare providers. It is the process of interviewing and teaching patients and for sharing or clarifying information with others involved in the patient's care. 

 

Question 79 

Your patient has a yellow, triangular thickening of the bulbar conjunctiva which you have diagnosed as a pinguecula. The bulbar conjunctiva is which of the following? 

  mucosal lining inside the eyelids 

  mucosal lining inside the mouth 

   roof of the mouth 

   mucosal lining covering the eyes 

Correct answer:

mucosal lining covering the eyes

 

The bulbar conjunctiva is the mucosal lining covering the eyes. The mucosal lining inside the eyelids is the palpebral conjunctiva.

Question 80 

 You have a 20-year-old patient complaining of headache, fatigue, and sore throat. Upon examination you observe a macular red rash on his trunk and upper arms. He tells you that this rash occurred a few days after he began to have a sore throat and headache. Your most likely diagnosis of the following choices would be:

 

  Fifth disease 

   mononucleosis 

   measles 

  roseola 

Correct answer:

mononucleosis

 

A patient with mononucleosis is likely to have a macular/popular red, morbilliform rash on the trunk and upper arms. It may also involve the face. The patient complains of headache, fatigue, and sore throat before the rash occurs.

 Question 81 

All of the following statements about Lyme disease are accurate EXCEPT:

 

   It is the least common arthropod-borne disease in the United States. 

  It is transmitted by prolonged attachment of 2 days of more by and infected tick.

 

   Prevalence is associated with increased deer population in endemic areas. 

  Lyme disease is a multisystem disorder. 

Correct answer:

It is the least common arthropod-borne disease in the United States.

 

This is not correct. Lyme disease is the most common arthropod-borne disease in the United States. it is caused by Borrelia burgdorferi, a spirochete.

 

 Question 82 

Which test is the most important diagnostic lab value to diagnose iron deficiency anemia? 

  serum folate level 

   serum ferritin level 

   red blood cell (RBC) count 

  direct Coombs 

 

The Correct answer is:

Serum ferritin level

Serum ferritin levels correlate with the total body iron stores because it is the major iron storage protein. Its value is reduced in iron deficiency anemia. Serum folate measures the folic acid level. Direct Coombs measures in vivo RBC coating by immunoglobulins.

 

Question 83 

Which family theory explains current family situations in terms of past relationships and family histories? 

  cognitive development theory 

   Bowen family systems theory 

   family systems theory 

  communications theory 

Correct answer:

Bowen family systems theory

 

The Bowen family systems theory connects one’s past family experiences with current behaviors. It also suggests that multiple factors interacting across time influence family functioning and identifies the interactions among biological, genetic, psychological and sociological factors that influence human behaviors.

Question 84 

Which of the following would NOT be an indication for hospitalization of an adult with community-acquired pneumonia? 

   respiratory rate less than 20 breaths per minute 

  age older than 60 years 

   altered mental status 

  failure to respond to outpatient treatment within 72 hours 

 

Correct answer:

respiratory rate less than 20 breaths per minute

 

This is not an indication for hospitalization for an adult with community-acquired pneumonia. The other choices are indications along with: not having resources for self-care at home; severe underlying disease such as heart failure; and severe electrolyte abnormality.

 

Question 85 

When counseling a patient with allergic rhinitis, you prescribe Cromolyn. The nurse practitioner understands that its mechanism of action is a (an): 

   mast cell stabilizer 

  vasoconstrictor 

   leukotriene modifier 

  anti-immunoglobulin E antibody 

The Correct answer is:

Mast cell stabilizer 

Cromolyn is a mast cell stabilizer in a nasal spray that is effective at preventing symptoms of allergic rhinitis. This drug does not acutely relieve symptoms. Instead, it takes around a week of use to achieve symptom relief. 

 

Question 86 

Your patient has experienced a TIA. You understand that there are certain risk factors for TIAs that include all of the following EXCEPT: 

  atherosclerosis 

   peptic ulcer disease 

   cardiac valve problems 

  oral contraceptive use 

Correct answer:

peptic ulcer disease

 

Risk factors for TIA include: carotid artery and other forms of atherosclerosis; structural cardiac problems, such as valvular problems that lead to increased risk of embolization; and hypercoagulable conditions, such as oral contraceptive use.

 

Question 87 

Which of the following is an appropriate plan of care for a patient who has been diagnoses with mononucleosis? 

  Hospitalization with IV fluids. 

  A short course of high-dose antibiotics. 

   Oral antibiotics. 

   Rest and home care. 

Correct Answer: Rest and home care The standard care protocol for mono is rest and self-care at home. OTC painkillers such as Tylenol may be used for symptom management. Fluids and rest are key to recovery. 

Question 88 

During a health assessment with a male patient, he tells you that he has not had a bowel movement in three days, although he usually has one each day. He says that the new medication he is taking makes it more difficult to pass feces. Which of the following is an appropriately worded nursing diagnosis for this patient? 

  Patient is constipated. 

  Elimination, altered. 

   Elimination, fecal, altered. 

   Elimination, fecal, altered, r/t change in medication. 

Correct Answer: Elimination, fecal, altered, r/t change of medication It is key to indicated not only that the patient's elimination pattern is altered, but that the patient notes that this change has occurred along with the change in his medication. You must also specify that it is fecal elimination that is altered so that appropriate remedies, and evaluation of the patient's medication, can be undertaken. 

 Question 89 

Which of the following types of communication would NOT be considered therapeutic interaction? 

   opinion 

  value-free 

   advice-free 

  reassurance-free 

Correct answer:

opinion

 

The purpose of therapeutic interaction with patients is to allow them the autonomy to make choices when appropriate. Therapeutic communication should be just facts without opinion. It should be value-free, advice-free and reassurance-free.

 

Question 90 

A patient presents in the office with some abnormal findings. The nurse practitioner (NP) suspects a rheumatological disorder, possibly systemic lupus erythematous (SLE). The NP knows that the frequent occurring symptoms of SLE are: 

   fever, arthralgia, arthritis and skin rashes 

  generalized hair growth

   green areas on the fingers 

  Swelling across the back

The Correct answer is:

Fever, arthralgia, arthritis and skin rashes

The clinical symptoms, such as fever, arthralgia or joint pain and arthritis, may all be present in patients diagnosed with systemic lupus erythematosus (SLE). A butterfly rash and lymphadenopathy occur in less than half the cases. Pulmonary effusion, hepatomegaly, splenomegaly, and Raynaud's syndrome occur in less than a third of the patients with SLE. In addition, patients with SLE may experience alopecia, and not hair growth, with flare-ups with this condition. Then, red areas, and not green areas, may emerge on the fingers and palms of the hands.

 

 Question 91 

A 56-year-old Caucasian female is in the office inquiring about menopause. What is the best way to define menopause and counsel her? 

  Menopause is the last menstrual period. 

   Menopause is the completion of 12 months of amenorrhea after the last menstrual period. 

   Menopause is indicated by a FSH level of 30 and estradiol level of 30. 

  Menopause does not cease the ability for natural reproduction. 

 

The Correct answer is:

Menopause is the completion of 12 months of amenorrhea after the last menstrual period 

Standardized developed definitions for menopause events were created in 2001 by the Stages of Reproductive Aging Workshop. These standards state that menopause is defined as the completion of 12 months of amenorrhea after the last menstrual period. Due to the fact that FSH levels are variant, it is not the best indicator of menopause.

 

Question 92 

In terms of adult/geriatric screening recommendations, which of the following is NOT a generally accepted recommendation? 

  periodic TSH in women 

  periodic skin exam in older adults with sun exposure 

   routine screening for testicular cancer 

  digital rectal exam annually for men older than 40 

 

Correct answer:

routine screening for testicular cancer

 

No evidence supports routine screening of asymptomatic men for testicular cancer. The old recommendation was for clinical exam every 3 years for men ages 20 – 39 and annually for those over age 40.

 Question 93 

The expected date of delivery for a woman who has had her last menstrual period on July 5, 2011 is which of the following? 

   April 12, 2012 

  March 12, 2012 

   March 5, 2012 

  April 5, 2012 

Correct answer:

April 12, 2012

 

The FNP would use Naegele’s rule to calculate the expected date of delivery. She would subtract 3 months from July and add 7 days to the date (5th) of the last period. This would put the date of delivery at April 12, 2012.

 

Question 94 

A patient who has been prescribed Adderall should be educated to notify his healthcare provider if he experiences which of the following side effects? 

  Nausea. 

  Headache. 

   Teeth grinding. 

  Difficulty sleeping. 

 

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

Question 95 

All of the following are signs of delirium in your patient EXCEPT: 

  altered level of consciousness from baseline 

  memory impairment 

   perceptual disturbance 

   loss of cognitive function 

 

Correct answer:

loss of cognitive function

 

Loss of cognitive function is not associated with delirium which has an acute onset. It is associated with dementia, which is defined as chronic loss of intellectual or cognitive function of sufficient severity to interfere with social or occupational function.

 

 Question 96 

The FNP has a 39-year-old female patient who wants to get the flu vaccine. She asks the FNP about getting the nasal-spray vaccine instead of a shot, since she has an aversion to needles. The FNP knows that all of the following are true about the nasal-spray flu vaccine EXCEPT: 

  It contains weakened live influenza viruses instead of killed viruses. 

   The viruses in the nasal-spray flu vaccine can grow in the nose and throat as well as in the lower respirator tract. 

   This type of vaccine is approved for use in healthy people 2 to 49 years old. 

  It contains three different influenza viruses that are sufficiently weakened as to be incapable of causing disease. 

Correct answer:

The viruses in the nasal-spray flu vaccine can grow in the nose and throat as well as in the lower respirator tract.

 

The viruses in the live attenuated influenza vaccine (LAIV) are cold adapted and temperature sensitive. As a result the viruses in the nasal-spray flu vaccine can grow in the nose and throat but not in the lower respiratory tract where the temperature is higher.

 

 Question 97 

Of the following, which type of lesion is associated with psoriasis? 

  macule 

  vesicle 

   plaque 

  wheal 

Correct answer:

plaque

 

Psoriasis has plaque-type skin lesions. They are raised lesions, > 1 cm, and may be the same or different color from the surrounding skin.

 

Question 98 

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

  delay 

   dissociation 

   deviance 

  disorder 

Correct answer:

dissociation

 

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

 

Question 99 

According to the CDC an extremely obese person would have a Body Mass Index (BMI) of: 

  greater than or equal to 18.5 

  greater than or equal to 25 

   greater than or equal to 30 

   greater than or equal to 40 

Correct answer:

greater than or equal to 40

 

An extremely obese person would have a Body Mass Index (BMI) of greater than or equal to 40. A person of healthy weight would have a BMI of 18.5 to 24.9.

 

 Question 100 

The nurse practitioner will often have to treat systemic anaphylaxis. What is the most common clinical manifestation of this? 

  persistent vertigo 

  nausea and vomiting 

   headache 

   urticaria 

 

The Correct answer is:

Urticaria

Anaphylaxis is typically manifested as systemic IGE-mediated reaction in response to exposure to an allergen. It is characterized by urticaria, angioedema, widespread vasodilation and bronchodilation. 

 

test 13 aanp

Question 1 

You have an 84-year-old female patient. Which of the following findings are you least likely to see in a patient of this age? 

  high-frequency hearing loss 

   increase in peak expiratory flow 

  decrease in the GFR 

  slower metabolism of drugs 

Correct answer:

increase in peak expiratory flow

 

As far as respiration and lung function goes in the elderly, there is less elasticity and fewer cilia in the lungs. Peak expiratory flow decreases, and residual volume increases. Total lung capacity, however, remains unchanged.

 

 Question 2 

Which of the following statements about sleep is least accurate? 

  The average newborn sleeps about 18 hours a day. 

  The elderly tend to sleep less, usually and average of 6.5 hours a day. 

   The sleep-wake cycle is controlled by the circadian rhythm located in the parathyroid gland.

 

  A sleep cycle consists of REM and NREM sleep. 

Correct answer:

The sleep-wake cycle is controlled by the circadian rhythm located in the parathyroid gland.

 

This is the least accurate statement. The sleep-wake cycle is controlled by the circadian rhythm located in the hypothalamus. Two of the neurotransmitter associated with sleep are serotonin and gamma-aminobutyric acid.

 

 Question 3 

The nurse practitioner knows that all of the following are nonpharmacologic treatments for a patient with acute glomerulonephritis EXCEPT: 

  Avoid high-potassium foods. 

   Treat them as inpatient until edema and hypertension are under control. 

  Restrict protein in presence of azotemia and metabolic acidosis. 

   Encourage increased fluid intake. 

The correct answer is:

Encourage increased fluid intake

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

 Question 4 

Your patient has been diagnosed with Bell’s palsy. The cranial nerve involved in this disease is which of the following? 

  CN V 

  CN VI 

   CN VII 

  CN VIII 

Correct answer:

CN VII

 

CN VII is the facial nerve. Dysfunction of this nerve gives the characteristic findings of Bell’s palsy (facial asymmetry, droop of mouth, absent nasolabial fold, impaired eyelid movement).

 

 Question 5 

The nurse practitioner (NP) is examining a child for a sore throat. Which of the following statements is true regarding tonsils? 

   Most cases of tonsillitis are caused by beta-hemolytic streptococcal infection. 

   Hypertrophied tonsils in children usually represent a normal finding. 

  Tonsils enlarge as the child grows older. 

  Children with large tonsils are more prone to tonsillitis than those with small tonsils. 

The Correct answer is:

Hypertrophied tonsils in children usually represent a normal finding

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

 

Question 6 

A patient presents with a severe itching, hives, and sore throat. Her lips begin to swell and she is wheezing. What is the appropriate action? 

  Give the patient aspirin. 

  Give the patient Benadryl. 

  Tell the patient to rest. 

   Call 911. 

Correct answer: Call 911 The patient appears to be going into anaphylactic shock. Unless in an emergency room already, call 911. The patient may also require a shot of epinephrine. 

 

Question 7 

In terms of child development, which of the following statements is most accurate?

  Attainment of developmental landmarks in one area always runs parallel with another area of development. 

  Development is independent of the maturation of the nervous system. 

  Development occurs in a foot to head direction. 

   The sequence of development is basically the same in all children but the rate varies. 

The sequence of development is basically the same in all children but the rate varies.

 

This is the most accurate statement. The other three choices are inaccurate. Attainment of developmental landmarks in one area does not always run parallel with another area of development. Development is dependent on the maturation of the nervous system. Development occurs in a head to foot direction

 

Question 8 

An infant is brought in with a temperature of 99.7 F. The parents insist that this is higher than average. What is the appropriate response? 

  Run a CBC. 

  Call a consult. 

   Continue the assessment. 

  Tell the parents they are overreacting. 

Correct answer: Continue the assessment An infant's body temperature typically runs a little high. 104 degrees F is considered a fever. Temperature can fluctuate with individuals, so it is important to complete the assessment. 

 

Question 9 

Which of the following theorists developed a model to explain why healthy people do or do not take advantage of screening programs? 

  Bandura 

   Becker 

  Maslow 

  Prochashka & DiClemente 

Correct answer:

Becker

 

Becker developed the health belief model which is used to explain why healthy people do or do not take advantage of screening programs. It involves variables such as perceptions of susceptibility and seriousness of a disease, benefits of treatment, perceived barriers to change, and expectations of efficacy.

 

 Question 10 

Which of the following is NOT one of the basic requirements/allowances of the HIPAA privacy rule? 

  Providers releasing patient information for marketing purposes must explain to the patient how the information will be used, to whom it will be disclosed, and the time frame. 

  Providers and their staff are restricted to conveying the “minimum necessary information” about patients. 

  Providers may disclose health information to oversight agencies. 

   In general, providers may disclose psychotherapy notes without patient consent. 

Correct answer:

In general, providers may disclose psychotherapy notes without patient consent.

 

There are special rules for psychotherapy notes. In general, patient authorization is required in order to disclose psychotherapy notes to carry out treatment, payment or healthcare operations

 

 Question 11 

The most common joint disease in North America is which of the following? 

   osteoarthritis 

  bursitis 

   rheumatoid arthritis 

  meniscal tear 

Correct answer:

osteoarthritis

 

Osteoarthritis is the most common joint disease in North America. It is a degenerative condition that manifests without systemic manifestations or acute inflammation. The most problematic joint involvement is in the hip and knee.

 

 Question 12 

Participants in a research study who do not have the disease or condition that is being studied, but who are included for comparison are:

 

  case series 

  case subjects 

  cross sectionals 

   controls 

The Correct answer is:

Controls

Controls are commonly used in many different types of research studies. Additionally, case series refer to an observational study where patients with interesting characteristics are studied. Case subject is another term for participants. Cross sectionals are types of observational studies where a particular characteristic is studied at one time rather than over a period of time. 

 Question 13 

An 81 year old patient with gastropathy presents to the NP with pain. The patient states at one time, earlier in life, she was given an NSAID for pain and asked if she could have it again. The NP said, "Unfortunately, due to your gastropathy condition, I am unable to offer NSAIDs as an option." At what risk would the NP be putting the patient if she prescribed an NSAID? 

  Decreased effectiveness of diuretics. 

  Fluid retention. 

  Hypoxia. 

   Ulcer and bleeding risk. 

Correct answer: Ulcer and bleeding risk Prescribing medications to patients with various diseases could put the patient at risk for additional conditions. For example, a patient with HTN cannot be prescribed NSAIDs because they may cause the decreased effectiveness of diuretics.

 

Question 14 

Which of the following is one of the factors in Bowen’s Family System Theory? 

  adequacy of growth 

   changes in social roles, such as children caring for parents 

   connecting one’s past family experiences with current behaviors 

  confrontation with death 

Correct answer:

connecting one’s past family experiences with current behaviors

 

Part of Bowen’s Family System Theory is connecting one’s past family experiences with current behaviors. Also part of the theory are: identifying multiple factors interacting across time that influence family functioning; and identifying the interactions among biological, genetic, psychological and sociological factors that influence human behaviors.

 

Question 15 

When you say something to a patient such as, “Let me be sure that I understand what you are saying,” this is which of the following forms of therapeutic communication?

 

   validation 

  caring 

  active listening 

  honesty 

 

Correct answer:

validation

 

Validation is listening to the patient and responding congruently in order to be sure that you have the same understanding as the patient. Active listening is hearing and interpreting language, noticing nonverbal and paraverbal enhancements, and identifying underlying feelings.

 

Question 16 

You are treating a 64-year-old man who has the following PSA levels. What can be concluded about the following annual readings?

Year 1:   3.8 ng/mL   Year 2:   4.5 ng/mL   Year 3:  5.5 ng/mL

 

   There is a steady increase that is worrisome. 

   There is a steady increase but it is not worrisome. 

  They are all within normal range. 

  None are within normal range. 

There is a steady increase that is worrisome

The prostate gland produces an antigen called prostate-specific antigen (PSA). The PSA test detects the amount of PSA in the patient’s blood. Typically, the normal range for the PSA level is below 4 ng/mL in an elderly male and below 2.5 ng/mL in a younger male. In the case of the 64-year-old patient, his PSA level during year 1 was 3.8 ng/mL, which is in the normal range. However, starting at year 2, the patient’s PSA level increased too 4.5 ng/mL, which is outside of the normal range. Then, it elevated to 5.5 ng/mL in year 3, demonstrating his PSA level is steadily increasing outside of the normal range of 4 ng/mL. This elevation in PSA levels is a sign that some condition is causing the patient’s PSA level to rise, such as prostatitis, benign prostatic hyperplasia (BPH) or even prostate cancer, for instance.  Therefore, the patient should be referred for further testing, including a referral to an urologist for a prostate biopsy to rule out prostate cancer. Statistics reveal that about two thirds of elderly male individual’s develop prostate cancer, when their PSA levels are elevated more than 10 ng/ mL. Further, statistics suggest that about 25% of males who have elevated PSA levels between 4 to 10 ng/mL have a condition contributing to the increase in the PSA. 

 

 Question 17 

A murmur is suspected in an elderly patient. As soon as the stethoscope is placed on the patient's chest, a quiet sound is heard. Which of the following grades is this type of murmur? 

  III/VI. 

  IV/VI. 

  V/VI. 

   II/VI. 

Correct answer: II/VI Each of the preceding murmur grades is defined below: III/VI - Moderately loud IV/VI - Loud with palpable thrill V/VI - Very loud and heard with the stethoscope partially off the chest; palpable thrill II/VI - Quiet but heard as soon as the stethoscope is placed on the chest 

 Question 18 

Which of the following is likely to cause an attack of gout? 

   alcohol binges 

  fasting 

  low-calorie diets 

   all of the above 

 

Correct answer:

all of the above

 

All of the first three choices are likely to cause an attack of gout. Generous fluid intake is important in gout patients as is a low purine diet.

 

Question 19 

The nurse practitioner will need to be aware of infectious diseases and the concerns regarding the recognition and management of them.  Which of the following is important regarding the professional role related to infectious disease recognition and management? 

  Be alert to endemic diseases. 

  Be alert to diseases that may be the result of bioterrorism. 

  Know the local health department guidelines for reporting communicable diseases. 

   All of the above 

Correct answer:

All of the above.

All of the first three choices are important regarding the professional role related to infectious disease recognition and management. They are all items for a nurse practitioner to be aware of.

 

Question 20 

Which of the following statements about acute lymphocytic leukemia is least accurate? 

   Peak incidence is at 8 – 12 years of age. 

  Males are affected more than females by a 1.3 to 1 ratio. 

  ALL accounts for 75% to 80% of all childhood leukemias. 

   There are approximately 3500 new cases each year in the United States. 

Correct answer:

Peak incidence is at 8 – 12 years of age.

 

This is the least accurate statement. Peak incidence is at 3 – 5 years of age. ALL is an abnormal proliferation of immature lymphocytes in the bone marrow. There are approximately 4 cases per 100,000 children every year.

 

Question 21 

Most of the drugs used in pregnancy are Category B drugs. The FNP has a patient in the third trimester of pregnancy. Which of the following drugs is a category C drug that should not be prescribed for this patient? 

  insulin 

  Colace 

   Sulfa drugs 

  thyroid hormone 

Correct answer:

Sulfa drugs

 

Sulfa drugs are considered Category C drugs in the third trimester because of increased risk of hyperbilirubinemia. NSAIDs are also contraindicated in the third trimester because they block prostaglandins.

 

Question 22 

When prescribing oral antibiotics to a female patient, which of the following should NOT be part of patient education? 

  The patient should be advised that antibiotics can interfere with oral contraceptives. 

  The patient should be advised that oral antibiotics can increase the risk of yeast infection. 

   The patient should be advised to stop taking oral contraceptives. 

  The patient should be advised to use a backup form of birth control. 

 

Correct Answer: The patient should be advised to stop taking oral contraceptives The patient should be advised to continue taking her oral contraceptives, but that the antibiotics may interfere with them. She should use a back-up form of birth control while on the antibiotics and for a short time after finishing her dose. 

 

Question 23 

Which of the following is a voluntary process that indicates that the clinician has met some predetermined standard for specialization?

 

  licensure 

   certification 

  education 

  none of the above 

 

Correct answer:

certification

 

Certification is a voluntary process. It does not grant the individual any legal authority to practice. Its primary purpose is to denote that the person holding the certification has met a high standard for competency in a specialty area of nursing practice.

 

Question 24 

You are treating a 24-year-old man with infectious mononucleosis with tonsillar hypertrophy, exudative pharyngitis, difficulty swallowing, and a patent airway. You know that you should prescribe: 

   prednisone 

  acyclovir 

  amoxicillin 

  ibuprofen 

 

The Correct answer is:

Prednisone

Infectious mononucleosis is an acute systemic viral illness usually caused by Epstein-Barr virus, a DNA herpes virus that typically enters the body via oropharyngeal secretions and infects B lymphocytes. Treatment includes a corticosteroid, such as prednisone 40 to 60 mg/day for 3 days. 

 Question 25 

A 22-year-old female is in the clinic. She has a newborn and is breastfeeding. When she inquires about birth control, the nurse practitioner understands that the best choice for this patient is: 

   triphasic preparation 

  1/35 preparation 

  1/50 preparation 

   progestin-only preparation 

The Correct answer is:

Progestin-only preparation

Estrogen inhibits milk production and progestin-only preparations are ideal for the breastfeeding mother because they do not contain estrogen. Without estrogen, they pose no threat to milk production.  

Question 26 

A herpes zoster infection of which cranial nerve can result in blindness?

  CN 4 

   CN 5 

   CN 6 

  CN 7 

Correct answer:

CN 5

 

CN 5 is the cranial nerve associated with ophthalmic function. If this nerve is infected with the herpes zoster organism it can result in blindness

 Question 27 

Asking the patient to slide the tongue from side to side in an exam tests which nerve? 

  Vagus. 

  Trigeminal. 

   Hypoglossal. 

  Trochlear. 

 

Correct answer: Hypoglossal The hypoglossal nerve controls the tongue. Listening to annunciation, looking at the tongue, and having the patient move it from side to side is how it is assessed. It is important to examine to tongue for any lesions that may cause the patient to hold the tongue in a certain way.

 

Question 28 

The mucosal lining covering the eyes is known as which of the following?

 

   bulbar conjunctiva 

  buccal mucosa 

   palpebral conjunctiva 

  cataract 

Correct answer:

bulbar conjunctiva

 

The bulbar conjunctiva is the mucosal lining covering the eyes. The palpebral conjunctiva is the mucosal lining inside eyelids.

 

Question 29 

You have a patient who would benefit greatly from cessation of smoking. You understand that which of the following doubles the probability that this patient will be successful? 

  nicotine replacement therapy 

  behavioral strategies 

   nicotine replacement therapy along with bupropion 

  nicotine replacement therapy along with behavioral strategies 

Correct answer:

nicotine replacement therapy along with bupropion

 

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

 

Question 30 

The factor that served as the reason for initiating the role of nurse practitioner in the mid 1960s was which of the following? 

    There was a shortage of physicians to provide for the health care needs of underserved children.

 

  The feminist movement pushed for the further involvement of nurses in patient care. 

  There was an overabundance of nurses who suggested that they are capable of doing many of the things that physicians do. 

  all of the above 

 

Correct answer:

There was a shortage of physicians to provide for the health care needs of underserved children.

 

The nurse practitioner role was initiated in the mid-1960s because of a physician shortage. Dr. Henry Silva, a pediatrician, and Dr. Loretta Ford, a nursing educator, envisioned the NP role as a means to ensure primary health care for children.

 

Question 31 

Lead screening in children is considered which of the following? 

  primary prevention 

   secondary prevention 

  tertiary prevention 

  derivative prevention 

 

Correct answer:

secondary prevention

 

Secondary prevention includes interventions at the subclinical stage, directed at early detection of the illness or problem to reduce the severity of the disease. Lead screening, genetic testing in newborns, vision and hearing screening, and mammography are some examples of secondary prevention.

 

 Question 32 

When checking the dentition of a child, you would expect the first permanent tooth to appear when?

 

  5 – 6 months 

  12 months 

  2 ½ years 

   5 – 7 years 

 

Correct answer:

5 – 7 years

 

The first permanent teeth appear at about 5 – 7 years of age (first molar). The first tooth should appear at about 5 – 6 months.

 

Question 33 

The pathogenicity of an organism is which of the following? 

   its ability to invade and multiply in a susceptible host 

   its ability to produce disease 

  the severity of disease that an organism can produce 

  its ability to produce a lasting and effective immunity 

Correct answer:

its ability to produce disease

 

The pathogenicity of an organism is its ability to produce disease. Infectivity is its ability to invade and multiply in a susceptible host. Virulence is the severity of disease that an organism can produce. Immunogenicity is its ability to produce a lasting and effective immunity.

 

 Question 34 

Bell’s palsy is an acute paralysis of which cranial nerve? 

  CN III 

  CN V 

   CN VII 

  CN XII 

 

Correct answer:

CN VII

 

Bell’s palsy is an acute paralysis of CN VII. This nerve is the facial nerve. Because Bell’s palsy can be a complication of Lyme disease, appropriate antibody testing should be obtained in a patient presenting with Bell’s palsy.

 

Question 35 

The subclinical stage in the course of a disease is which of the following? 

  stage of susceptibility 

   stage of presymptomatic disease 

  stage of clinical disease 

  stage of disability 

Correct answer:

stage of presymptomatic disease

 

The course of disease development, expression, and progression in a person over time involves several stages. The subclinical stage is the stage of presymptomatic disease.

 

 Question 36 

Which of the following concepts about family functioning and structure is least accurate? 

   The incidence of single parent families, childhood poverty and homelessness has decreased in recent years. 

  Family functioning is more directly related to healthy growth and development than is family structure. 

  One of the components of family functioning is the provision of financial and emotional resources. 

   There has been an increase in the rate of divorce and remarriage in recent years. 

Correct answer:

The incidence of single parent families, childhood poverty and homelessness has decreased in recent years.

 

This statement is not accurate. The incidence of single parent families, childhood poverty and homelessness has increased in recent years.

 

Question 37 

You have done a lipid profile for an 18-year-old female patient. You would expect that her normal triglyceride level will be in which of the following ranges? 

  30 – 102 

  31 – 104 

  33 – 108 

   40 – 136 

Correct answer:

40 – 136

 

This is the normal triglyceride level for a female between 15 and 19 years of age. For this same patient, cholesterol should be between 124 and 209; LDL between 61 and 141; and HDL between 36 and 76.

 

Question 38 

The NP does not believe it is best to prescribe Halcion to her 70 year old patient. Taking Halcion would MOST likely have what adverse effect in a patient of this age? 

   Impairment of psychomotor performance. 

   Confusion. 

  Depression. 

  Fatigue. 

Correct answer: Impairment of psychomotor performance Various medications are likely to cause greater adverse reactions in the elderly population. Impairment of psychomotor performance and sedation are common in the elderly with Halcion use

Question 39 

With a 55-year-old African-American male who has sustained an injury at the fifth thoracic vertebra (T5), the nurse practitioner understands that he will most likely not be able to: 

   achieve lower body strength and coordination for walking 

  have adequate upper body strength to drive a car 

  maintain the upper body coordination required for eating 

  perform coordinated movements with his hands, such as writing 

The Correct answer is:

Achieve lower body strength and coordination for walking

T5 injuries do not affect the coordination or capacity of the upper body, arms, and hands, as the lower body is paralyzed. The client should be able to do all the activities listed except walk. 

 

Question 40 

Which of the following statements about otitis media with effusion is least accurate? 

  Patients typically have a sense of fullness in the ear. 

   The patient will have a popping or crackling sound in the ear with yawning. 

   Antibiotic therapy is indicated. 

  Symptoms are variable ranging from none to severe. 

 

Correct answer:

Antibiotic therapy is indicated.

 

This is not accurate. Antibiotic therapy is not routinely indicated for serous otitis media. Antibiotics are necessary for acute otitis media.

 

Question 41 

Which of the following types of murmurs in children is NOT an innocent murmur? 

  pulmonary flow murmur of the newborn 

   carotid bruit 

   systolic regurgitant murmur 

  venous hum 

Correct answer:

systolic regurgitant murmur

 

A systolic regurgitant murmur begins with S1 and usually lasts throughout systole. It is caused by blood flow from a chamber that is at a higher pressure throughout systole than the receiving chamber.

 

 Question 42 

In the management of Parkinson Disease (PD), surgical intervention such as deep brain stimulation surgery can be helpful to manage disease-related symptoms: 

  that are related to memory loss 

   to ease the tremors and bradykinesia 

   when medication therapy is not tolerated or helpful 

  as a last resort when all other options have been exhausted 

 

The Correct answer is:

When medication therapy is not tolerated or helpful

Deep brain stimulation surgery for Parkinson Disease is helpful in making the "off" state more like movement in the "on" state, and is helpful in the reduction of levodopa-induced dyskinesias. As with other therapies, expert consolation should be sought, and all options should be thoroughly discussed with the patient before pursuing surgical intervention. 

 

Question 43 

A 20-year-old college student is in the clinic with complaints of weakness. She is 15% below ideal body weight. She reports doing well in her classes, drinking alcohol every night and coffee throughout the day. She is bradycardic and gets dizzy when she stands up. What other findings may be seen in this patient? 

  sleep apnea 

   amenorrhea 

   hypertension 

  mitral regurgitation 

 

The Correct answer is:

Amenorrhea

This patient has anorexia nervosa and is far below ideal body weight. She exhibits evidence of poor nutrition and health. More than 90% of patients with anorexia are amenorrheic. Hypotension is more common than hypertension and many patients with anorexia also exhibit mitral valve prolapse, not regurgitation. 

 

Question 44 

A patient at high risk refuses a DRE from a female nurse. What is the best question to ask? 

  Do you understand the seriousness of prostate cancer? 

  Why don't you want to take care of yourself? 

   Would you allow a male to examine you? 

  Are you afraid of the exam? 

 

Correct answer: Would you allow a male to examine you? Digital rectal exams (DRE) can make patient uncomfortable. Some patients are uncomfortable with a women performing the procedure. Likewise, some men are not comfortable with men performing the exam. It is important to always consider the patient's comfort.

 

Question 45 

A child with suppurative conjunctivitis is in the office for treatment. The nurse practitioner has knowledge that all of the following ophthalmic preparations can be used to cure this EXCEPT: 

  ciprofloxacin 

   penicillin 

  bacitracin-polymyxin B 

  erythromycin 

The Correct answer is:

Penicillin

A patient with a presumptive diagnosis of suppurative conjunctivitis requires antimicrobial therapy. Penicillin is not in an ophthalmic form and is not indicated as an oral or injectable form.

Question 46 

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

   third degree 

   second degree 

  first degree 

  partial thickness 

 

Correct answer:

third degree

 

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

 

Question 47 

A female patient is in the office for her annual gynecological exam and she is inquiring about breast self-exam (BSE). Since she has bilateral breast implants, she "does not know what to feel for." The most appropriate response would be: 

  Acknowledge the difficulty of breast self-exam with implants. 

  Explain the need for regular mammograms for patients with implants. 

   Suggest she involve her sexual partner in assessing her breasts. 

   Review the steps of breast self-exam until she feels comfortable with this process. 

The Correct answer is:

Review the steps of breast self-exam until she feels comfortable with this process

This patient should be informed about the normal feel of implants and become knowledgeable about the normal feel of her breasts. Mammography is not a substitute for breast self-exam. The remaining answer choices are good suggestions, but not the most appropriate. 

 

 Question 48 

Which of the following signs and symptoms has the lowest likelihood of representing acute coronary syndrome secondary to coronary artery disease? 

   chest discomfort reproduced by palpation 

  pulmonary edema 

   left arm pain or discomfort 

  transient mitral regurgitation murmur 

Correct answer:

chest discomfort reproduced by palpation

 

Chest discomfort reproduced by palpation without any of the high or intermediate-likelihood features accompanying it has the lowest likelihood of representing acute coronary syndrome secondary to coronary artery disease. The other choices represent signs and symptoms with a high likelihood of representing acute coronary syndrome secondary to coronary artery disease.

 Question 49 

The following statement is TRUE regarding reimbursement for nurse practitioners: 

   As a salaried employee, the nurse practitioner may be credited to the collaborating physicians, giving her a "ghost" provider status. 

  Nurse practitioners are reimbursed for their services under all plans except federally funded school-based clinics. 

   The nurse practitioner has no restrictions by the Health Care Financing Agency. 

  There is no risk for fraud and abuse charges with state and national policy for nurse practitioner billing procedures. 

The Correct answer is:

As a salaried employee, the nurse practitioner may be credited to the collaborating physicians, giving her a "ghost" provider status

Nurse practitioners are reimbursed for their services provided at federally funded school-based clinics. The nurse practitioner has considerable restrictions by the Health Care Financing Agency and there is much risk for fraud and abuse when dealing with incorrect billing for providers.

 

Question 50 

A 65-year-old female patient comes to the clinic complaining of bowel and bladder incontinence and a numbness of the buttocks area. The FNP might suspect that his patient has which of the following diseases/conditions? 

  supraspinatus tendonitis 

  osteoarthritis 

   rheumatoid arthritis 

   cauda equina syndrome 

Correct answer:

cauda equina syndrome

 

This condition involves acute pressure on a sacral nerve root that results in inflammatory and ischemic changes to the nerve. It is considered a surgical emergency since the patient needs sacral spine decompression to avoid permanent nerve damage. This patient should be referred to the ER.

 

Question 51 

When assessing for an urinary tract infection in a geriatric patient, it is important for the nurse practitioner to know: 

  There is always a fever present. 

  It is an uncommon finding in catheterized patients. 

   Elderly people may or may not demonstrate symptoms other than mental status change with this type of infection. 

  Dysfunctional voiding pattern or infrequent voiding are not contributing factors to the development of a urinary tract infection. 

 

The Correct answer is:

Elderly people may or may not demonstrate symptoms other than mental status change with this type of infection

Geriatric patients with a urinary tract infection usually do not have a fever. It is common in patients with catheters and dysfunctional voiding pattern and infrequent voiding are contributing factors in the development of a urinary tract infection. 

 

Question 52 

Margaret Mahler developed the neo-Freudian theory of psychological birth of the infant. Which of the following phases of Mahler’s “psychological birth” takes place at about 24 – 36 months? 

   consolidation 

   rapprochement 

  differentiation and practicing 

  symbiosis 

Correct answer:

consolidation

 

According to Mahler consolidation is part of the separation-individuation phase that takes place from 6 to 36 months of age. Consolidation takes place from 24 – 36 months of age. It is defined by the increased ability to cope with separations through symbolic play.

 

Question 53 

Abortive treatment for migraine headaches would include all of the following EXCEPT:

 

  Cafergot 

  NSAIDs 

   Imitrex 

   Inderal 

Correct answer:

Inderal

 

All of the choices are abortive treatments for migraine headaches except this one. Inderal is a prophylactic treatment taken daily or BID. Tricyclic antidepressants such as Elavil might also be used as a prophylactic treatment.

 

Question 54 

Which of the following is a precursor lesion of squamous cell carcinoma? 

   actinic keratoses 

   Stevens-Johnson syndrome 

  erythrema multiforme 

  erythema migrans 

Correct answer:

actinic keratoses

 

Actinic keratoses are precursor lesions of squamous cell carcinoma. They appear as dry, red lesions with a rough texture and are usually located in sun-exposed areas of skin such as the cheeks, nose, face, neck, arms and back. They are more common in light-skinned individuals.

Question 55 

The FNP is instructing a patient with gout about the high-purine foods to avoid. She would tell him to avoid all but which of the following foods? 

  beans 

   pasta 

   scallops 

  asparagus 

Correct answer:

pasta

 

Foods high in purines should be avoided by those who suffer gout attacks. Pasta is low in purines, not high. All of the other choices are high purine foods along with others that include: organ meats, game meats, spinach and more.

 

Question 56 

Which of the following is NOT an absolute contraindication to postmenopausal estrogen therapy? 

   seizure disorder 

  unexplained vaginal bleeding 

  acute liver disease 

   neruo-ophthalmologic vascular disease 

Correct answer:

seizure disorder

 

All of the choices are absolute contraindications to postmenopausal estrogen therapy except seizure disorders. In the case of seizure disorders, estrogen therapy can be used with caution, considering if the benefit outweighs the risk.

 

 Question 57 

A 30-year-old female heterosexual patient who has had a mastectomy tells the FNP that she feels mutilated and “less of a woman” because of the operation. Which of the following responses is most appropriate? 

  Many women have had mastectomies and are every bit the woman they were before the operation. You are too. 

  Don’t think about the operation; just be happy that you are on the road to recovery. 

   You should be happy that you’re alive; not worrying about how you look. 

   You’re feeling like the mastectomy has affected your body image in a negative way and that maybe men will not find you so attractive. 

Correct answer:

You’re feeling like the mastectomy has affected your body image in a negative way and that maybe men will not find you so attractive.

 

This is a therapeutic response. It is restating and clarifying what the patient has said. The other responses are barriers to effective therapeutic communication.

 

Question 58 

If your patient has Class II heart failure as set out in the New York Heart Association (NYHA) functional classes for heart failure, which of the following symptoms is likely?

 

  no dyspnea with exertion 

   dyspnea with maximal exertion 

  dyspnea with minimal exertion 

  dyspnea at rest 

Correct answer:

dyspnea with maximal exertion

 

The NYHA ranks heart failure into four classes. Dyspnea with maximal exertion is ranked as Class II heart failure.

 

 Question 59 

The influenza vaccine should not be given to a person with a history of anaphylactic reaction to which of the following? 

  baker's yeast 

   neomycin 

  streptomycin 

   egg 

 

Correct answer:

egg

 

Persons with a history of anaphylactic reaction to eggs should not be given the influenza vaccine, either nasal spray or injected. A person with a history of anaphylactic reaction to baker’s yeast should not be given the Hepatitis B vaccine. A person with a history of anaphylactic reaction to neomycin should not be given the IPV, MMR or varicella vaccine. A person with a history of anaphylactic reaction to streptomycin should not be given the IPV or smallpox vaccine.

Question 60 

The theory that holds that nursing care must be congruent with the client’s culture is the theory of which of the following? 

  Watson 

   Leininger 

   Orem 

  Roy 

 

Correct answer:

Leininger

 

Madeline Leininger’s theory of cultural care diversity and universality states that nursing care must be congruent with the client’s culture. To achieve congruence, the nurse functions within the areas of cultural care preservation, cultural care negotiation, and cultural care repatterning.

 

 Question 61 

“Healthcare providers” under HIPAA include all but which of the following? 

  skilled nursing facilities 

   retirement homes 

   home health agencies 

  hospice programs 

 

Correct answer:

retirement homes

 

Retirement homes are not considered “healthcare providers” under HIPAA. “Healthcare providers” under HIPAA include: hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities, home health agencies, hospice programs, nurse practitioners, certified nurse-midwives, clinical nurse specialists, psychologists, clinical social workers, certified registered nurse anesthetists and physicians and physician assistants.

 

Question 62 

Organized creation of beneficial change to attain unprecedented levels of performance is which of the following? 

  risk management 

   quality improvement 

   quality assurance 

  none of the above 

Correct answer:

quality improvement

 

Quality improvement is the organized creation of beneficial change to attain unprecedented levels of performance. It differs from quality assurance in that it is continuous rather than episodic

 

Question 63 

Which of the following statements about structural functional theory of families is the least accurate? 

   Rank order within families is not a component of structure. 

  Families are social systems. 

   In optimally functioning families, members take on predictable roles. 

  Disease or ill health can interfere with the family’s ability to carry out its internal functions. 

Correct answer:

Rank order within families is not a component of structure.

 

All of the statements are accurate except this one. Internal family subsystems function as a microcosm of society, reflecting the larger sphere of human needs. Rank order within families is a component of structure, such as the ordering of children by birth in the family.

 

Question 64 

What is the lifetime risk to the average American man of having latent prostate cancer? 

  10% 

  3% 

   67% 

   40% 

 

Correct answer:

40%

 

The average American man has a 40% lifetime risk of latent prostate cancer. He also has an approximate 10% risk of clinically significant disease and an approximate 3% risk of dying of prostate cancer.

 

Question 65 

An adolescent female with breast budding and sparse straight pigmented pubic hair along the medial border of the labia is at what Tanner stage of sexual maturity? 

  Stage I 

   Stage II 

   Stage III 

  Stage IV 

 

The Correct answer is:

Stage II

The five stages of sexual maturity for both males and females is called Tanner Staging. Stage II is where there is straight, pigmented pubic hair and breast budding. The areolar size increases during the 2nd stage as well

 

Question 66 

In relation to structural functional theory, which of the following is NOT an example of a suprasystem?

 

   relationships with family 

  relationships with friends 

   relationships with religious organizations 

  relationships with the healthcare system 

 

The Correct answer is:

Relationships with family

A suprasystem forms OUTSIDE of the family and reflect functional needs that are not met within the family. Examples of a suprasystem include relationships with all of the following: friends, religious organizations, the healthcare system, schools, teachers, civic organizations and other groups.

 

Question 67 

A 17-year-old with nodulocystic acne is employed as a fry cook at a restaurant. What would you do to help him manage his acne? 

  benzoyl peroxide plus erythromycin 

   refer to a dermatologist for possible prescription of isotretinoin (Accutane) 

   a change in occupation 

  Retin-A plus minocycline 

Correct answer:

refer to a dermatologist for possible prescription of isotretinoin (Accutane)

Nodulocystic acne is the most severe form of acne vulgaris characterized by nodules and cysts. These can be palpated under the skin. Topical agents are not effective as a treatment and occupation is irrelevant. Referral to a dermatologist is indicated. 

 

Question 68 

You are doing a well-child examination and the child is 3-years-old. The nurse practitioner has an understanding that head circumference should be measured up until what age? 

  12 months 

  15 months 

   24 months 

  36 months 

The Correct answer is:

24 months

Head circumference is routinely measured at each periodic well-child visit until he has reached 2 years of age. During the first 24 months of life, the head grows most quickly, and its growth should be measured for adequacy. This should be recorded on a growth chart so that changes can be evaluated and appropriate growth can be determined. The CDC charts show head growth up to 36 months, but the standard recommendations for routine measurements generally specify the first 24 months. 

 

Question 69 

An 18-year-old female comes to the clinic complaining of a sore throat and fatigue that has persisted for several months. She also has some upper abdominal pain. The FNP’s examination reveals enlarged cervical nodes, erythema of the pharynx and red tonsils. The most likely diagnosis is: 

  rhinitis medicamentosa 

   acute mononucleosis 

   acute sinusitis 

  allergic rhinitis 

Correct answer:

acute mononucleosis

 

Mononucleosis is an infection by the Epstein-Barr virus that is transmitted through saliva by intimate oral contact. The classic triad to look for is pharyngitis, cervical lymphadenopathy and fatigue.

 

Question 70 

Which of the following generalized allergic reactions is considered the most serious?

 

  urticaria 

  angioedema 

   anaphylaxis 

   extravascular lesions 

Correct answer:

anaphylaxis

 

Anaphylaxis is an acute systemic reaction manifested by sudden onset of pruritis, generalized flush, urticaria, respiratory distress, and vascular collapse. It results from an antigen exposure in a sensitized person.

 

 Question 71 

You are conducting an assessment with a patient who reports heavy menstrual bleeding and pelvic pain. A pelvic exam reveals that her uterus is larger than normal. She is not pregnant. Which of the following procedures would you order to confirm a diagnosis of uterine fibroids? 

  Uterine biopsy. 

  External sonogram. 

   Hysterosonogram. 

  Pelvic X-ray. 

Correct Answer: Hysterosonogram This procedure, in which the uterus is filled with saline and a transvaginal pelvic ultrasound is performed, is often used to diagnose uterine fibroids. If the patient reports other complaints, such as bowel or urinary problems, she may require other tests to rule out other causes. 

 

Question 72 

All of the following statements about Kurt Lewin’s model of change management are accurate EXCEPT: 

  The first stage of the model is to prepare for a change. 

   The second stage is all about unfreezing and getting motivated for change. 

   Change is not an event but a process. 

  The final stage of the model is establishing stability. 

Correct answer:

The second stage is all about unfreezing and getting motivated for change.

 

This is not an accurate statement. The second stage (change/transition) is about making the changes that are needed after the first stage of unfreezing. 

 

Question 73 

Risk factors for oral cancer include all of the following EXCEPT: 

   recent trauma to the mouth 

  smoking 

   alcohol abuse 

  human papillomavirus type 16 

Correct answer:

recent trauma to the mouth

 

This is not a risk factor for oral cancer. The risk factors include advancing age, tobacco and alcohol abuse and most recently, they include chronic infection with human papillomavirus type 16.

 

Question 74 

A 34-year-old female with multiple sclerosis (MS) is in the office. She is now under your care after relocating from another state to live with relatives who can help her. The nurse practitioner understands that which of the following is NOT part of her management plan:

 

  Physical and occupational therapy. 

  Complex treatment regimen must be coordinated with a neurologist. 

   Acute exacerbations should be treated with prednisone 60-80 mg/day for 1 week, taper over 2-3 weeks. 

   Corticosteroids are often used for maintenance. 

 

The Correct answer is:

Corticosteroids are often used for maintenance

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

 

Question 75 

Which of the following is NOT true of the plan of care for a pregnant patient who has been diagnosed with trichomoniasis? 

   The patient should not take Flagyl under any circumstances. 

  The patient may be prescribed Flagyl if she is past the first trimester of pregnancy. 

   The patient does not need to be immediately treated if she does not display symptoms. 

  The patient should be educated that the infection may lead to a lower birth rate. 

Correct Answer: The patient should not take Flagyl under any circumstances Many healthcare professionals feel that patients who are in the first trimester of pregnancy should not take Flagyl for trichomoniasis. However, patients past this point may take Flagyl. Patients who are asymptomatic do not need to be treated, but those with symptoms should be. Trichomoniasis can lead to low birth weight in babies born to infected mothers. 

 

Question 76 

The Rinne test is part of the evaluation of which of the following cranial nerves?

 

  CN IX 

   CN VIII 

   CN III 

  CN I 

Correct answer:

CN VIII

 

CN VIII is the auditory or vestibulocochlear nerve. When this nerve does not function properly, hearing or balance is impaired. The Rinne test is part of the evaluation of CN VIII.

 

 Question 77 

Of the following qualitative designs which one uses interviews and inductive analysis to seek understanding of lived experience? 

  historical 

  grounded theory 

   phenomenologic 

  experimental 

 

 Correct answer:

phenomenologic

 

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

 Question 78 

A mother brings her 8-month-old child to the FNP because she thinks that the child is behind in developmental milestones. The FNP tells her that an 8-month-old child should typically be doing all but which of the following? 

  sitting without support 

   placing cubes in a cup 

   making hand-to-hand transfers 

  imitating “bye-bye” 

Correct answer:

placing cubes in a cup

 

The 8-month-old child should be doing all of the activities in the choices except this one. Placing cubes in a cup is something that a 12 – 15-month-old child would do. Other milestones for the 6 – 8-month-old child are having stranger and separation anxiety, pulling feet into the mouth, closing lips in response to dislike of food, rolling back-to-stomach and stomach-to back, chaining together syllables such as “dada,” recognizing “no,” and coughing or snorting to attract attention.

 Question 79 

At what age should a healthy older adult be vaccinated with the pneumovax vaccine? 

  60 years old 

   65 years old 

   55 years old 

  70 years old 

Correct answer:

65 years old

 

You should start vaccinating healthy older adults at the age of 65 years. The patient only needs one dose per lifetime if he or she is healthy.

 

Question 80 

You are managing a 74-year-old patient who has osteoarthritis and chronic pain. Which of the following medications increases the risk of a gastrointestinal related ulceration? 

  warfarin 

   celecoxib 

   pravastatin 

  thiazide diuretic 

The Correct answer is:

Celecoxib

Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Further, NSAIDs increase the risk of upper and lower gastrointestinal ulcerations. Warfarin does not increase the risk of ulceration, but if one occurs, the risk of bleeding is increased. Statins and diuretics are not considered ulcerogenic.

 

Question 81 

If there is no reliable history of chicken pox, when can the varicella vaccine be given? 

  after 12 years of age 

  after 5 years of age 

   after 1 year of age 

  after 3 months of age 

Correct answer:

after 1 year of age

 

If there is no reliable history of chicken pox, the varicella vaccine can be given after 1 year of age. Children less than 12 years of age need only one dose. Older children need two doses one month apart.

 

Question 82 

When a nurse practitioner seeks to obtain clinical privileges with a healthcare organization the process is known as which of the following? 

  certification 

   licensure 

   credentialing 

  collaborative agreement 

credentialing

 

Credentialing refers to documentation that the NP has met the agency’s specified criteria for hospital privileges. Some institutions require proof of skill before they allow the NP to perform certain procedures.

 

Question 83 

You are analyzing the results of a blood glucose test. The patient is an adult female. Her blood glucose reading is 60 mg/dL. Which of the following is true of this patient's blood glucose reading? 

  It is far too high. 

  It is in the normal range. 

   It is slightly elevated. 

   It is lower than normal. 

Correct Answer: Lower than normal The mean blood glucose level in adult humans is 72mg/dL. Blood glucose below 70mg/dL can be harmful and is indicative of hypoglycemia. Further diagnostic tests should be run to arrive at a correct diagnosis. 

 Question 84 

 Which of the following types of injuries is most likely to reveal specific radiographic findings?

 

   Jones fracture 

  nursemaid’s elbow 

   gamekeeper’s thumb 

  tennis elbow 

 

 Correct answer:

Jones fracture

 

Jones fractures are foot fractures. They are associated with a painful, swollen lateral foot with pain elicited on palpation of the fifth metatarsal. Radiographic findings show this fracture.

 

Question 85 

You have a 55-year-old African-American female urgently brought to the clinic with angioedema. It is reported the angioedema started less than an hour ago. You notice that she is breathing without difficulty. What is the most likely cause of this?

 

  penicillin 

  metformin 

   ramipril 

  aspirin 

The Correct answer is:

Ramipril

Angioedema is common in African-American patients who take ACE inhibitors. It is an unpredictable event but once it occurs the medication must be discontinued and never prescribed again. Swelling of the lips, face, eyelids, tongue, and larynx characterizes angioedema.  Question 86 

Which of the following is NOT part of the ethical decision making process for the nurse practitioner? 

  Moral concepts such as advocacy, accountability, loyalty, caring, compassion, and human dignity are the foundations of ethical behavior. 

  Duty to help others, beneficence, is a foundational component of ethical behavior. 

   Ethical behavior incorporates respect for the individual and his or her autonomy. 

   The ethical behavior of nurses has been defined for professional nursing in an American Practice Act policy statement. 

 

The Correct answer is:

The ethical behavior of nurses has been defined for professional nursing in an American Practice Act policy statement 

The ethical behavior of nurses was defined by the American Nurses Association and not the American Practice Act. The remaining answer choices are part of ethical decision-making process of a nurse practitioner

 

Question 87 

An infant will not smile responsively until about which of the following ages?

 

   1 – 1 ½ months 

  2 – 3 ½ months 

   3 – 4 months 

  4 ½ – 5 months 

Correct answer:

1 – 1 ½ months

 

In terms of social skills, a child of 1 – 1 ½ months should be able to smile responsively. At about 5 months of age the child will even smile at his mirror image.

 

Question 88 

A person with a blood pressure reading of 150/95 mm Hg is classified as which of the following? 

  normal 

  stage 2 hypertension 

   prehypertension 

   stage 1 hypertension 

 

Correct answer:

stage 1 hypertension

 

Stage 1 hypertension is characterized by a systolic pressure of 140-159 or a diastolic pressure of 90-99 or both. Hypertension is due to an increase in peripheral arterial resistance.

 

Question 89 

There is a greater recognition of the use by patients of complementary and alternative modalities and medicines (CAM) today than ever before.  Which of the following is an inaccurate statement regarding the practice environment involving CAM? 

  Research suggests that 40-50% of patients are currently utilizing some form of complementary or alternative therapy. 

   There is a wealth of evidenced based research that supports CAM. 

   Nurse practitioners, as providers, need to learn about common CAM treatments and about how some herbal products interact with prescription medications. 

  The National Center for Complementary and Alternative Medicine is a federal government's lead agency for scientific research on CAM. 

 

The Correct answer is:

There is a wealth of evidenced based research that supports CAM

There is a dearth of research supporting such treatment modalities

 Question 90 

There is a difference in minor depression and major depression. The nurse practitioner understands that this is:

 

   the number of symptoms present 

  presence of suicidal ideations 

   the length of time symptoms have lasted 

  the severity of symptoms 

The Correct answer is:

The number of symptoms present

Major depression is diagnosed when at least 5 symptoms out of 9 are identified by the practitioner. Minor depression is characterized by 2 to 4 of the nine symptoms and these symptoms must be present for at least 2 weeks nearly every day. 

 

Question 91 

You are examining a patient who has a cardiac murmur. Which of the following is most likely to be found if this patient’s murmur is associated with aortic stenosis? 

  Grade 1-3/6 early to mid systolic murmur 

  Grade 2-3/6 systolic ejection murmur 

    Grade 1-3/4 high-pitched blowing diastolic murmur

 

   Grade 1-4/6 harsh systolic murmur 

Correct answer:

Grade 1-4/6 harsh systolic murmur

 

Aortic stenosis causes a Grade 1-4/6 harsh systolic murmur. It is usually in a crescendo-decrescendo pattern and it is heard best at the second right intercostal space.

 

 Question 92 

You have a client with GERD. Which of the following statements indicates that she has NOT understood how to manage the condition? 

  I should eat smaller meals. 

  I should elevate the head of my bed. 

   I should avoid tight clothes. 

   I should avoid exercise. 

 

Correct answer:

I should avoid exercise.

 

The person with GERD should exercise daily. She should also stop smoking and lose weight if more than 130% of ideal body weight, among other things.

Question 93 

Your 30-year-old female patient is suffering from primary dysmenorrhea. You will prescribe the treatment of choice for this condition which is which of the following?

 

   NSAID 

  acetaminophen 

   aspirin 

  magnesium 

 

Correct answer:

NSAID

 

NSAIDs are the treatment of choice for primary dysmenorrhea. You would tell the patient to take NSAIDs 2 days or more before onset of menses, at regular intervals around the clock until no longer necessary. You would advise her to take them with food to avoid GI upset.

 

 Question 94 

In terms of treating seizure disorders, the FNP understands that all of the following are true in regard to using antiepileptic drugs EXCEPT: 

  Utilize the least number of medications. 

   Begin with a combination of drugs for more rapid resolution. 

   Maintain a maximum level of alertness with the fewest number of seizures. 

  Obtain a baseline of physical status. 

 

Correct answer:

Begin with a combination of drugs for more rapid resolution.

 

A clinician would not begin treatment for seizures with a combination of drugs. He or she would begin with a single drug so as to be able to assess side effects more easily.

 

 Question 95 

You are treating a 48-year-old male who is suffering with alcoholism. The first most helpful approach for him is: 

  Inform the patient of the long-term health consequences of alcohol abuse. 

  Tell the patient to stop drinking. 

   Refer the patient to Alcoholics Anonymous. 

   Counsel the patient that alcohol abuse is a treatable disease. 

The correct answer is:

Counsel the patient that alcohol abuse is a treatable disease

The first approach for the nurse practitioner is to counsel the patient and family that alcoholism is a lifelong but treatable disease. In addition, asking about current drinking habits and associated consequences to health with each visit is important and are appropriate next steps. Then, the remaining answer choices are also important interventions after the nurse practitioner counsels the patient and the family regarding alcoholism as a treatable disease.

 

Question 96 

Which of the following are elements of a broad-based risk management program?

 

  System of contract review that helps to avoid assuming liabilities that should be borne by others. 

  Hazardous materials compliance program as part of a comprehensive safety and security system. 

   Early-warning/incident reporting program to identify elements of risk. 

   All of the above. 

 

The Correct answer is:

All of the above

These and other elements combine to produce a program of systematic risk identification, analysis, treatment, and evaluation, with the overall goal of loss prevention. 

 

 Question 97 

You are managing a patient who has a cat bite. The nurse practitioner knows that which of the following medications should be prescribed? 

  topical bacitracin 

  topical hydrocortisone 2.5% 

   oral amoxicillin clavulanate (Augmentin) 

  oral acyclovir 

The Correct answer is:

Oral amoxicillin clavulanate (Augmentin)

The most common infective agents with a cat bite are Pasteurella multocida and Staphylococcus aureus. The agents of choice for treatment are Augmentin, cefuroxime or doxycycline. The other answer choices would be ineffective and unnecessary. 

 Question 98 

A seizure with the typical onset of 3 – 15 years that is characterized by an awake state with abnormal motor, sensory, autonomic, or psychic behavior is which of the following? 

   simple partial or focal 

  myoclonic 

   tonic-clonic 

  absence 

 

Correct answer:

simple partial or focal

 

Simple partial or focal seizures are characterized by an awake state with abnormal motor, sensory, autonomic, or psychic behavior. Movement can affect anY part of the body. It can be localized or generalized.

 

Question 99 

During an abdominal exam, what is an abnormal finding? 

   The liver is tender. 

  The spleen is not palpable. 

   There are bowel sounds. 

  There is tympany. 

 

Correct answer: The liver is tender The liver should not be tender in a normal abdominal assessment. The other answers can be normal in abdominal exams. 

 

 Question 100 

 You are testing a client suspected of having Parkinson’s disease. You support the client’s elbow with his forearm extended in your hand and grasp his wrist, flexing the forearm. You find rigid resistance to this motion. This is considered which of the following?

 

   cogwheeling 

  Myerson’s sign 

   Wilson’s sign 

  pill rolling 

Correct answer:

cogwheeling

 

Cogwheeling is resistance to passive movement. It is best felt in the elbow, wrist, and neck.

quiz 12 aanp

Question 1 

The U.S. Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS) have regulations governing research activities on human subjects. The principal investigator is responsible for: 

  securing a signed research consent form from each participant 

  appearing before the Institutional Review Board to present the study and secure approval to proceed with the subject recruitment at the facility 

   report back to the Institutional Review Board if a subject is injured during the course of the study 

   all of the above 

The Correct answer is:

All of the above

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

 

Question 2 

A 72 year old patient explains to the NP that she thinks she has diarrhea. Her stools are bloody and watery with mucus. Testing shows the stools are positive for blood and leukocytes. What will MOST likely be the diagnosis? 

  Shigella. 

   Adenovirus. 

   Campylobacter jejuni. 

  Salmonella. 

Correct answer: Campylobacter jejuni is a bacterial diarrhea that is very common in children ages 1 - 5 but can occur at any age. Vomiting and fever are noticeable symptoms of the illness. 

 

Question 3 

Which of the following systemic corticosteroids would be considered of medium potency? 

  Betamethasone, 0.6 -0.75 mg 

  hydrocortisone, 20 mg

  dexamethasone, 0.75 mg 

   prednisone, 5 mg 

 

Correct answer:

prednisone, 5 mg

 

Prednisone, 5 mg would be considered a medium potency corticosteroid. Other medium potency corticosteroids include: methylprednisolone, 4 mg; triamcinolone, 4 mg; and prednisolone, 5 mg.

Question 4 

The nurse practitioner knows that medical management for a brown recluse spider bite includes: 

  Prescribe cephalexin (Keflex) 500 mg PO tid x 7 days. 

   Prescribe amoxicillin-clavulanate (Augmentin) 250 mg PO tid x 14 days if there are signs of infection. 

   Have the patient return to the clinic for follow-up in 2 weeks. 

  Approximate the edges of the wound together with suture. 

Correct answer:

Prescribe amoxicillin-clavulanate (Augmentin) 250 mg PO tid x 14 days

Amoxicillin-clavulanate (Augmentin) is an excellent choice for empiric treatment of animal bites if there are signs of infection. Cephalexin is not indicated due to resistant strains of Pasteurella multocida, an organism present in dog and cat bites. An infected bite should be followed up daily until the infection clears. Open wound management is indicated, but not suturing.

 Question 5 

The FNP has diagnosed a patient as having herpes keratitis. He refers the patient to an ophthalmologist. The FNP understands that the ophthalmologist will treat the patient with which of the following? 

   Zovirax 

  steroid ophthalmic drops 

   support therapy only 

  none of the above 

Zovirax

 

The ophthalmologist will treat the patient with Zovirax or Valtrex BID until the problem is resolved. The ophthalmologist would not treat the patient with steroid ophthalmic drops because this would worsen the condition.

 Question 6 

You have an African-American male patient who is 42 years old. His older brother has been diagnosed with prostate cancer recently, and he asks when he should begin prostate cancer screening. You would tell him which of the following? 

  He is too young to begin screening. 

   He should not worry about screening because being of the African-American race reduces his risk. 

  He should have begun screening when he was 21 years old.

 

   He should begin immediately because he has a higher risk of prostate cancer. 

He should begin immediately because he has a higher risk of prostate cancer.

 

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

 Question 7 

 In terms of billing for Medicare patients which of the following statements is incorrect?

 

   There are no consequences for selecting an inappropriate code for a patient visit if done unintentionally. 

  Each CPT code has corresponding levels of required history taking, physical examination and medical decision making. 

  NPs are responsible for ensuring that the billing for their services matches the level of care given. 

   The consequence of selecting an inappropriate code may include loss or restriction of the NP’s license by the board of nursing. 

There are no consequences for selecting an inappropriate code for a patient visit if done unintentionally.

 

NP’s are expected to know how to bill correctly. Ignorance is a poor defense. There may be consequences for selecting an inappropriate code if auditors find that more errors were made in overcoding than undercoding visits.

 

 Question 8 

A short-acting anticholinergic medication can be used alone or in combination with a short-acting beta agonist to manage symptoms of which disease?

 

  benign prostatic hyperplasia 

  tachyarrhythmias 

   chronic obstructive pulmonary disease 

   glaucoma 

Chronic obstructive pulmonary disease

First line treatment for patients with chronic obstructive pulmonary disease who have intermittent symptoms of shortness of breath is an anticholinergic alone or in combination with a beta agonist. These medications both improve lung function. 

 

Question 9 

For patients with fibromyalgia, the recommended initial dose of Lyrica is which of the following? 

  100 mg/day. 

  300 mg/day. 

   1000 mg/day. 

   150 mg/day. 

Correct Answer: 150 mg/day The initial dose of Lyrica for neuropathic pain associated with fibromyalgia is 150 mg/day. This is given in 50 mg doses, three times per day. Patients may build up to larger doses as needed, with the maximum dose not to exceed 300 mg/day. 

 

Question 10 

Depression is a common mental disorder among the general population. Which of the following patients are more likely to experience depression?

 

   A patient who has had a stroke. 

  A patient who has lost a finger. 

   A patient who has a femur fracture. 

  A patient who has had a lumbar discectomy. 

The Correct answer is:

A patient who has had a stroke

Central nervous system diseases are associated with higher rates of depression. These include stroke, dementia, multiple sclerosis, and Parkinson's disease. Depression worsens the outcome of physical illness. 

Question 11 

“Tennis elbow” is a painful condition that arises as a result of injury to the extensor tendon at the lateral epicondile. Therapy in the first 3 to 4 weeks should be conservative and includes all but which of the following? 

  avoidance of the precipitating activity 

  application of appropriate splints 

   arm cast 

  NSAIDs 

Correct answer:

arm cast

 

An arm cast should be used only if symptoms persist. Use of an arm cast limits arm movement even further. Local corticosteroid injection may be helpful if symptoms persist beyond 6 to 8 weeks or are particularly severe.

 

Question 12 

The learning theory that views learning as the product of stimulus and response and is not concerned with individual internal factors in the learner is which of the following? 

   behaviorist theory 

  cognitive theory 

   humanistic theory 

  affective theory 

behaviorist theory

 

The behaviorist theory focuses on modifying the stimulus or changing the reinforcement that occurs after the response. This theory values detailed measurable instructional objectives and immediate, positive reinforcement.

 

 Question 13 

Bowel sounds in a healthy adult patient should sound like all but the following? 

  Gurgling. 

  Bubbling. 

  High pitch. 

   Loud splashing. 

 

Correct Answer: Loud splashing Normal bowel sounds are high-pitched, bubbling, gurgling sounds. They may vary in intensity and volume. Loud splashing may indicate an obstruction or other condition. 

 

Question 14 

The family theory stating that family members maintain involvement in relationships on the basis of rewards and costs is which of the following? 

  interactionist perspective 

  family ecologic perspective 

  family stress perspective 

   social exchange perspective 

social exchange perspective

 

The social exchange perspective holds that family members maintain involvement in relationships on the basis of rewards and costs. Other common family theories include: structural-functional; family systems; developmental perspective; interactionist perspective; family ecologic perspective; and family stress perspective.

Question 15 

The FNP has an 87-year-old patient who lost his wife three months ago and now lives alone. He tells the FNP that he is happy that his family comes to visit him often and takes him out to dinner sometimes because he can no longer drive. This patient is exhibiting: 

  dependency on others 

  despair at not having the ability to go anywhere without someone driving him 

   positive adaptation to his loss by enjoying what his family does for him 

  an unhealthy grief response 

 

Correct answer:

positive adaptation to his loss by enjoying what his family does for him

 

This man is adjusting to the changes that have occurred as a result of the loss of his wife. The patient is not totally dependent on others since he lives alone. He is not exhibiting any despair or unhealthy response to grief.

 

Question 16 

You have a young patient who has a blood lead level of 14 mg/dL. You would do all of the following for this patient EXCEPT: 

   Assess risk factors and rescreen the patient every 6 months. 

  Perform complete medical assessment with KUB and long bone X-ray examination. 

  Rescreen the patient every month. 

   none of the above 

Correct answer:

Assess risk factors and rescreen the patient every 6 months.

 

You would assess risk factors and rescreen the patient every 6 months. You should also provide education for the family including diet, and education about cleaning and ways to protect the child from lead hazards.

 

 Question 17 

A 30-year-old female comes to the clinic complaining of a small raised area on the left eyelid. The FNP diagnoses a hordeolum. The treatment for this condition would include all of the following EXCEPT: 

  warm compresses to the eye for 10 minutes three to four times a day 

  application of erythromycin ointment to the affected lid 

   incision and drainage if needed 

   intralesion corticosteroid injection if needed 

intralesion corticosteroid injection if needed

 

A hordeolum is also known as a stye and is usually caused by a staphylococcal infection of a hair follicle on the eyelid. The intralesion corticosteroid injection would not be used for a stye. It is used for a chalazion if other treatment is not successful. A chalazion is an inflammatory eyelid condition that may not involve infection but can follow hordeolum. 

 

Question 18 

When assessing a patient with acute chest pain, the most life threatening dysrhythmia experienced by a patient with an acute MI is: 

  atrial fibrillation 

  third-degree heart block 

   ventricular tachycardia 

   ventricular fibrillation 

The Correct answer is:

Ventricular fibrillation

The most life-threatening dysrhythmia is ventricular fibrillation, although the other dysrhythmias occur after a myocardial infarction (MI). The majority of out-of-hospital deaths from a MI are caused by ventricular fibrillation. 

 

 Question 19 

When counseling a menopausal woman with many risk factors for osteoporosis, the nurse practitioner knows that which of the following are preventative measures she should be instructed on regarding osteoporosis? 

   smoking cessation and weight bearing exercise 

  optimal caloric intake and Vitamin E supplements 

  exercise, weight gain and a high fat diet 

   organic supplements and adequate Vitamin B12 intake 

 

The Correct answer is:

Smoking cessation and weight bearing exercise

Although the mechanism is not known, research has shown that cigarette smoking accelerates skeletal bone loss. Therefore, smoking cessation is important in the prevention of osteoporosis as well as other diseases and conditions. Exercise is necessary at least 30 minutes, three times a week, to maintain bone density and it has been shown to decrease the incidence of hip fractures. Walking increases hip and spine density. Further, Vitamin D and calcium intake along with smoking cessation prevents osteoporosis.

 

Question 20 

Principles that are evidence-based and written by expert panels and/or specialty organizations such as the American Cancer Society are known as which of the following? 

  standards of practice 

  scope of practice 

   clinical guidelines 

  collaborative principles 

Correct answer:

clinical guidelines

 

Clinical guidelines are written by expert panels and/or specialty organizations. They are evidence-based and act as treatment guidelines. A few examples of diseases with treatment guidelines include hypertension, hyperlipidemia, and pneumonia.

Question 21 

In Erikson’s stages of psychosocial development, failure in the stage of generativity leads to which of the following? 

  feelings of shame and doubt 

  mistrust 

   stagnation 

   role confusion 

 

Correct answer:

stagnation

 

Erikson’s stages of psychosocial development theory maintains that how well individuals accomplish developmental tasks will determine their success in accomplishing other tasks as they get older. Failure in the stage of generativity leads to stagnation.

 

 Question 22 

In interacting with a patient, which of the following phrases should NOT be used? 

   “Tell me about . . .” 

  “What are your thoughts . . .?” 

  “What are you feeling?” 

   “If it were me I would . . .” 

Correct answer:

“If it were me I would . . .”

 

Some phrases should not be used in communicating with patients. “If it were me I would . . .” is one of them. Useful phrases are those that promote therapeutic interaction and keep it open, genuine and patient-centered.

 

Question 23 

Which of the following is NOT a conceptual model for advanced practice nursing? 

  Benner’s model 

   Shuler’s model 

  Calkin’s model 

   Ford model 

Correct answer:

Ford model

 

There is no Ford model of NP practice; however, Loretta Ford established the first pediatric nurse practitioner program. 

 

 Question 24 

A 65-year-old female has come to the clinic complaining of a scaly red rash on one of her nipples that will not go away. She tells the FNP that it has become crusty and sometimes bleeds. Examination shows a discharge from the nipple and a small lump. Which of the following diseases/conditions is likely to be diagnosed? 

  breast cancer 

  fibrocystic breast 

   Lymphogranuloma Venereum 

   Paget’s disease of the breast 

Correct answer:

Paget’s disease of the breast

 

Paget’s disease of the breast is often reported by older females. The disease presents as a scaly rash resembling eczema on the nipple or the nipple and areola that does not heal. It can eventually have crusting, ulceration and/or bleeding and is sometimes itchy. 

 Question 25 

You have a patient in the office with symptoms of aortic regurgitation. The nurse practitioner understands which of the following is characteristic of this? 

  an acute onset of shortness of breath in the fifth or sixth decade 

  a long asymptomatic period with sudden death usually during exercise 

   long asymptomatic period followed by exercise intolerance, then dyspnea at rest 

  dyspnea on exertion for a long period of time before sudden cardiac death 

The Correct answer is:

Long asymptomatic period followed by exercise intolerance, then dyspnea at rest

Aortic regurgitation (AR) is characterized by the patient having a long asymptomatic period with slowing activities. Eventually, the patient develops shortness of breath. Then, left ventricle failure occurs. 

Question 26 

Your patient has an anxiety disorder. You will prescribe benzodiazepine therapy for this patient. Which of the following drugs would fall into this class of medication? 

  Luvox 

  Lexapro 

   Zoloft 

   Klonopin 

Correct answer:

Klonopin

 

Klonopin is a benzodiazepine therapy. All of the other drugs are SSRI/SNRI therapy (antidepressants).

 Question 27 

Which of the following characteristics is least associated with Still’s murmur, a vibratory murmur? 

  can be described as a “twanging string” 

   usually detected at 8 – 14 years of age 

   intensity may increase with fever 

  not accompanied by a thrill 

Correct answer:

usually detected at 8 – 14 years of age

 

Still’s murmur is usually detected at 3 – 6 years of age. It is heard best at the middle left sternal border or between the left lower sternal border and apex when the patient is in the supine position.

Question 28 

Which of the following skin conditions affects mainly men 30 years of age and older?

 

  nevi 

  melanoma 

   seborrheic keratosis 

  actinic keratosis 

 

Correct answer:

seborrheic keratosis

 

Seborrheic keratosis affects mainly men 30 years of age and older. It is the proliferation of immature keratinocytes and melanocytes. They are beige, brown, or black plaques with a velvety or warty surface.

 

Question 29 

Which of the following statements in regard to interpreting developmental landmarks and milestones is least accurate? 

  Loss of developmental milestones previously achieved is a significant finding in any developmental assessment. 

  Early attainment of gross motor skills is not a significant indicator of advanced intellectual development. 

   Early attainment of gross motor skills usually precludes a diagnosis of mental retardation. 

   Language and fine motor skills are not indicators of intellectual development. 

Correct answer:

Language and fine motor skills are not indicators of intellectual development.

 

This statement is inaccurate. Language and fine motor skills are sensitive indicators of intellectual development.

 

 Question 30 

As an NP you must follow certain ethical principles. If you make a decision for the patient based on the rationale that it is in the patient’s best interest you are violating the ethical principle of:

 

   autonomy 

  beneficence 

   paternalism 

  justice 

Correct answer:

autonomy

 

Autonomy refers to the potential to be self-determining. Paternalism is the term used when the health care provider makes a decision for a patient based on the rationale that it is in the patient’s best interest. It is a barrier to patient autonomy.

 Question 31 

An elderly woman is brought to the clinic by her daughter with whom she lives. The daughter tells the FNP that her mother gets very excited, confused and sometimes even combative every evening. It is most likely that this patient is suffering from which of the following? 

  delirium 

   sundowning 

   TIAs 

  none of the above 

sundowning

 

“Sundowning” is seen in both delirium and dementia patients. Starting at dusk (or sundown) the patient becomes very agitated, confused and combative. These symptoms resolve in the morning.

 Question 32 

Which of the following statements about dysphagia is least accurate? 

   It can be attributed to normal aging. 

  It may be a structural or neuromuscular problem. 

   It may present as difficulty swallowing solids or liquids. 

  It may present as chest pain. 

Correct answer:

It can be attributed to normal aging.

 

This is the least accurate statement. Dysphagia is not attributed to normal aging. It is a difficulty in swallowing and having food pass from the mouth down the esophagus to the stomach.

 

Question 33 

You have a 3-year-old patient with scabies. You prescribe permethrin 5% (Elimite) for the patient. You would tell the parent of this child all of the following in regards to using this medication EXCEPT: 

  Precede the treatment with a warm bath. 

   Apply cream to the entire body while the skin is wet from shower or bath. 

   Leave the cram on 8 to 12 hours and then remove by showering. 

  One ounce of the cream is sufficient for one application.

Correct answer:

Apply cream to the entire body while the skin is wet from shower or bath.

 

This is not proper procedure for application of the medicine. The child should be dried thoroughly and the skin temperature should be cooled down before applying the cream. A single application of the cream is usually effective.

 

 Question 34 

The interval between the receipt of an infection and the maximal communicability of the host is which of the following? 

   generation time 

  immunity period 

   transmission rate 

  carrier time

 

Correct answer:

generation time

 

Generation time is the interval between receipt of infection and the maximal communicability of the host. It is applied to both subclinical and clinical infections, and is used to describe and analyze the spread of infectious disease.

 

 Question 35 

A mother of a child with scabies is asking about the condition. The nurse practitioner knows to advise her that: 

  Casual contact with an infected person is likely to result in infestation. 

  The scabies mites can live for many weeks away from the host. 

   The bedding used by an infected person must be destroyed. 

   Close personal contact with an infected person is usually needed to contract this disease. 

The Correct answer is:

Close personal contact with an infected person is usually needed to contract this disease

Scabies is a communicable skin disease caused by a host-specific mite, generally requiring close personal contact to result in contagion. Contact with unwashed bedding and clothing from an affected person can result in the infection. The bedding can be washed in hot water or placed in a clothes dryer to eliminate the scabies mites. The mites do not survive longer than 3 or 4 days away from a host. 

Question 36 

Of the following drugs prescribed, which is a cholinesterase inhibitor that comes in the form of a pill or syrup only? 

   Galantamine. 

  Hydrocodone. 

   Rivastigmine. 

  Donepezil. 

 

Correct answer: Galantamine There are three cholinesterase inhibitors commonly prescribed by doctors. These are Donepezil, Galantamine and Rivastigmine. Hydrocodone is a type of medication that treats moderate to severe pain as well as cough

 Question 37 

A patient who has been prescribed nifedipine for kidney stones should be advised not to take the medication with which of the following? 

  Milk. 

  Coffee. 

   Food. 

   Grapefruit juice. 

Correct Answer: Grapefruit juice Grapefruit juice interferes with the ability of the liver to break down nifedipine. Patients can take this medication with food or without, and with other beverages. 

 

Question 38 

A patient's chief complaint is abdominal pain. What could mistakenly be associated with abdominal pain ? 

  Digestive upset. 

   Chest pain. 

   Headache. 

  Appendicitis. 

Correct answer: Chest pain Chest pain can be confused with abdominal pain. When a patient presents with abdominal pain, It is important to rule out heart conditions in the assessments. 

 

 Question 39 

About how many viral illnesses per year are common in infants and toddlers?

 

   up to 10 

  2 

   up to 15 

  3 

Correct answer:

up to 10

 

Frequent (up to 10) viral illnesses per year are common in infants and toddlers. This is especially true for upper respiratory illnesses.

 Question 40 

Which of the following pharmacologic agents should the nurse practitioner use in the elderly hypertensive patient who has a new onset of congestive heart failure (CHF)? 

  rehabilitation heat therapy 

  muscle relaxants 

   ACE inhibitors 

  intensive radiation blockers 

 

The Correct answer is:

ACE inhibitors

There are several types of medications used to treat congestive heart failure (CHF), such as beta-blockers, diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers. The ACE inhibitors have been shown to prolong life in patients with congestive heart failure (CHF) by improving overall cardiac function. Rehabilitation heat therapy and muscle relaxants are used for treating conditions other than CHF, such as osteoarthritis.

Question 41 

In terms of the psychosocial development of infants, the New York Longitudinal Study (NYLS) defined nine dimensions of temperament. Which of the following is NOT one of them? 

  activity 

   synchrony 

   approachability 

  mood 

 

Correct answer:

synchrony

 

According to the NYLS, the nine dimensions of temperament are: activity, rhythmicity, approachability, adaptability, intensity, threshold of arousal, mood, distractibility and attention. Synchrony is not one of them. This is part of the parent-infant interaction and attachment.

Question 42 

When a pregnant woman’s uterine fundus first rises above the symphysis pubis, the woman is about how many weeks pregnant? 

   12 weeks 

  16 weeks 

   20 weeks

 

   24 weeks 

 

Correct answer:

12 weeks

 

At 12 weeks the uterine fundus first rises above the symphysis pubis. Fetal heart tones are heard by Doppler by 10 – 12 weeks.

Question 43 

The highest risk of Kawasaki disease is in which of the following ethnic groups? 

   Asian 

  Mediterranean 

  African-American 

   Hispanic 

Correct answer:

Asian

 

The highest risk of Kawasaki disease is among Asian children, especially those of Japanese or Korean ethnicity. It is the leading cause of acquired heart disease in the United States.

 

 Question 44 

You have recommended speech therapy for a stroke patient. This is which of the following types of prevention? 

  prophylactic 

  primary 

   secondary 

   tertiary 

 Correct answer:

tertiary

 

Tertiary prevention is any type of rehabilitation such as cardiac rehab, physical therapy, or speech therapy. Tertiary prevention in general is rehabilitation and avoidance of further bodily damage

 

Question 45 

An adult patient suffered head trauma. There is a positive reaction to the startle reflex. What type of assessment is necessary? 

  Dietary. 

   Neurological. 

   Cardiac. 

  Digestive. 

 

Correct answer: Neurological The startle reflex is an infant reflex. In adults, it can be a sign of brain damage. A neurological assessment is necessary.

 

Question 46 

What reflex should not be present in a five month old at an assessment? 

  Moro reflex. 

  Plantar grasp. 

   Blinking reflex. 

   Stepping reflex. 

Correct answer: Stepping reflex The Stepping reflex should only be apparent in the first three months. The other answers are still normal for an infant of five months. The presence of this reflex requires investigation.

 Question 47 

The nurse practitioner understands that the most common class of medications used to treat a patient with systolic dysfunction post-myocardial infarction is: 

   ACE inhibitors 

  thiazide diuretics 

   beta blockers 

  loop diuretics 

The correct answer is:

ACE inhibitors

Angiotensin-converting–enzyme (ACE) inhibitors are commonly used in patients with systolic dysfunction because they reduce morbidity and mortality. Also, ACE inhibitors improve symptoms of fatigue, shortness of breath, and exercise intolerance. While the loop diuretics improve symptoms, they do not alter long-term prognosis with systolic dysfunction. Further, beta blockers can potentially worsen systolic dysfunction and should not be used as solo agents in this treatment. 

 

Question 48 

Which of the following is NOT a tertiary prevention measure? 

  cardiac rehabilitation 

  Alcoholics Anonymous 

   pain management program 

   testing for STDs 

Correct answer:

testing for STDs

 

Testing for STDs is a secondary prevention measure, i.e., one that is used for detection of disease early enough to minimize bodily damage. Tertiary prevention is rehabilitation and avoidance of further bodily damage. Examples of tertiary prevention include pain management programs, cardiac rehabilitation, and support groups.

 Question 49 

At what age would you begin cholesterol screening for someone with hereditary risk factors? 

   20 

  30 

   40 

  50 

Correct answer: 20 Cholesterol screening is important. A twenty year old patient should be screened for cholesterol if there is a family history of heart disease. Other risk factors may require early or more frequent screening. 

 

 Question 50 

You have the job of monitoring patients who have certain high-cost or chronic conditions to help the hospital to best manage the health care costs of these patients. This is known as which of the following? 

   case management 

  risk management 

   utilization review 

  accreditation 

Correct answer:

case management

 

Case management is the process of monitoring patients who have certain high-cost or chronic conditions to help third party payers and/or hospitals best manage the health care costs associated with the condition. Case management is very useful for third part payers and hospitals.

 

 Question 51 

 Which of the following would be considered a primary hyperlipidemia?

 

  caused by hypothyroidism 

  related to medication use 

   related to fat intake 

   genetic form 

Correct answer:

genetic form

 

Hyperlipidemia (also called dyslipidemia) is either primary (genetic forms) or secondary. Secondary forms are related to fat, calorie, and alcohol intake; medication use; or caused by metabolic diseases such as hypothyroidism, diabetes mellitus or nephrosis.

 

Question 52 

In terms of translational science, the distribution of the intervention to health care providers or to the public by way of research reports or clinical guidelines is known as which of the following? 

  early translation 

   dissemination 

   late translation 

  clinical trial 

Correct answer:

dissemination

 

The first stage of translational research is referred to as early translation. If this stage proves beneficial it can move into late translation and then into dissemination, which involves the broader distribution of the intervention (e.g., new drug, medical device, educational materials) to health care providers or to the public, by way of research reports, clinical guidelines, professional education and training, or by informing changes in policy.

Question 53 

Which of the following drugs has been demonstrated to have use in preventing dementia? 

  Aricept 

  Exelon 

   Cognex 

   none of the above 

Correct answer:

none of the above

 

All of the drugs mentioned in the first three choices can be used either alone or together to have a minor and time-limited effect in dementia care. The use of these products and others to prevent dementia are currently not supported.

 Question 54 

The person designated by a patient in a power of attorney for healthcare to make his future health care decisions in the event that he becomes mentally incompetent is known as which of the following? 

  next of kin 

   guardian ad litem 

   proxy 

  all of the above 

 

Correct answer:

proxy

 

A proxy is the person designated by a patient to make his future health care decisions via a power of attorney for health care, in the event that he becomes mentally incompetent. It may or may not be the patient’s next of kin.

 

Question 55 

Most men with a gonococcal infection will have: 

  dysuria 

   no symptoms 

   blood-tinged semen 

  proctitis 

Correct answer:

no symptoms

 

Most men with gonococcal infection have no symptoms. In women, presentation typically includes dysuria with a milky to purulent, occasionally blood-tinged, vaginal discharge.

 

 Question 56 

Which of the following lesions in the older adult are precancerous skin lesions that are small rough, pink-to-reddish and are located in sun-exposed areas? 

   actinic keratoses 

  seborrheic keratoses 

   senile purpura 

  lentigines 

Correct answer:

actinic keratoses

 

Actinic keratoses are small rough pink-to reddish lesions that do not heal. They are located in sun-exposed areas such as the cheeks, nose, back of neck, arms, chest, etc. They are more common in light-skinned individuals. They are precancerous skin lesions.

 

 Question 57 

Which of the following gastrointestinal diseases/conditions can be described as a gastrinoma located on the pancreas or the stomach which secretes gastrin, which stimulates high levels of acid production in the stomach resulting in development of multiple and severe ulcers in the stomach and duodenum? 

  Crohn’s disease 

   Zollinger-Ellison syndrome 

   colon cancer 

  irritable bowel syndrome 

Correct answer:

Zollinger-Ellison syndrome

 

Zollinger-Ellison syndrome is characterized by a gastrinoma located on the pancreas or the stomach which secretes gastrin, which stimulates high levels of acid production in the stomach resulting in development of multiple and severe ulcers in the stomach and duodenum. The patient will have complaints of epigastric to mid-abdominal pain. Stools may be a tarry color. Screening is by serum fasting gastrin level.

 Question 58 

A patient who lost his job six weeks ago comes to you complaining that he is sad most of the time and has difficulty concentrating. He also complains of headaches. This is affecting his job search. This patient is most likely suffering from which of the following? 

  dysthymic disorder 

   adjustment disorder 

   major depression 

  bipolar disorder 

Correct answer:

adjustment disorder

 

Adjustment disorder is a less severe form of depression in which symptoms occur within 3 months of an identifiable stressor such as a job loss. It is characterized by mild sadness, inability to concentrate, excess worry, and somatic complaints.

 

Question 59 

All of the following are necessary for the NP to be granted a DEA license for prescribing controlled substances EXCEPT: 

  the NP has no felony record 

   the NP has practiced for at least 5 years 

   the NP has a practice site 

  state law must permit NPs to prescribe controlled substances 

Correct answer:

the NP has practiced for at least 5 years

 

There is no minimum time requirement for granting of a DEA license for prescribing controlled substances. All of the other choices are requirements for granting of the license.

 

Question 60 

Illnesses caused by organisms that attack and invade vulnerable persons are communicable or infectious diseases. Which of the following statements about these types of diseases is inaccurate? 

  The involve identification of the causative agents. 

  They rely on microbiology principles in understanding the life cycle of the organism. 

  They focus on intervention at vulnerable phases in the course of the disease. 

   It is unnecessary to focus on the life cycle of the organism. 

Correct answer:

It is unnecessary to focus on the life cycle of the organism.

 

This is the inaccurate statement. Communicable or infectious diseases do focus on the life cycle of the organism.

 

Question 61 

A child of 24 – 36 months usually sleeps for how long each night? 

  12 – 14 hours 

   10 – 12 hours 

   8 – 10 hours 

  7 or 8 hours 

Correct answer:

10 – 12 hours

 

A child of 24 – 36 months of age sleeps on an average of 10 – 12 hours. By 5 – 10 years of age the child sleeps 8 – 10 hours.

 

Question 62 

Which of the following is NOT a type of managed care plan? 

  Health Maintenance Organization 

  Preferred Provider Organization 

   Point of Service Plan 

   Indemnity Plan 

 

Correct answer:

Indemnity Plan

 

There are four common types of managed care plans. They are: Health Maintenance Organizations (HMOs); Preferred Provider Organizations (PPOs); Point of Service Plans (POSs); and integrated delivery systems.

 

Question 63 

The patient right of confidentiality has exceptions when society determines that the need for information outweighs the principle of confidentiality. Which of the following is NOT one of these exceptions? 

   when a parent demands to view a record regarding an adolescent's treatment for STDs 

  in cases of suspected child abuse 

   to attorneys involved in litigation 

  release of records to insurance companies 

The Correct answer is:

When a parent demands to view a record regarding an adolescent's treatment for STDs

STD treatment for the adolescent is protected confidential material. The remaining answer choices are all examples of exceptions. Others include subpoenas, summonses, answering court orders, meeting state requirements for mandatory reporting of diseases or when the patient reveals an intent to harm himself or someone else. 

 

 Question 64 

A 29-year-old Caucasian male calls your office. He tells you he just came in from the woods and discovered a tick on his upper right thigh. He reports self-removal of the tick and now the area is slightly red. What should you advise him to do? 

  He should come to the office for a ceftriaxone (Rocephin) injection. 

  He should be prescribed doxycycline. 

   He needs no treatment. 

  He needs a topical scrub to prevent Lyme Disease. 

The Correct answer is:

He needs no treatment

To develop Lyme Disease from a tick bite, many factors must be present. The tick must belong to Ixodes species and must have been attached for at least 48 hours before the disease can spread. There is no need for prophylactic treatment in this case because the tick has not been present long enough. 

 Question 65 

You are counseling a mother who has her 7-month-old infant in the office with the complaint of "spitting up his formula." The nurse practitioner (NP) knows this to be a common thing for infants but the mother conveys she has "put him on goat's milk." The NP is concerned because she knows that goat's milk places the infant at risk of developing: 

  scurvy 

  rickets 

   megaloblastic anemia 

  botulism 

The Correct answer is:

Megaloblastic anemia

This condition can develop secondary to folic acid deficiency. Goat's milk does not contain the appropriate level of folic acid needed for the infant. Scurvy is caused by a lack of ascorbic acid and rickets is a result of a diet lacking in Vitamin D. Botulism is food poisoning due to an endotoxin produced by the bacillus Clostridium botulinum. 

 

Question 66 

A nurse practitioner is HIV positive and she is employed in a privately owned clinic. She performs wellness exams on ambulatory adults. What is required of this professional? 

  She is under obligation to inform the patient of her HIV status if she performs invasive procedures. 

   She is under no obligation to inform anyone of her HIV status. 

   She is obligated to inform her employer of her HIV status. 

  She is obligated to inform her patients of her HIV status. 

The Correct answer is:

She is under no obligation to inform anyone of her HIV status

The nurse practitioner's health information is protected health information, just as her patient's health information is protected. She is not under obligation to inform anyone of her HIV status, including her employer, the patient, or the State Board of Nursing. As long as the performance of her job does not impose unnecessary health risks to anyone, she is protected by this law.

 

 Question 67 

A patient who has been prescribed methimazole for hyperthyroidism should be advised to notify his doctor immediately if he experiences which of the following? 

  Nausea. 

  Stomach upset. 

   Easy bruising. 

  Mild rash. 

Correct Answer: Easy bruising Rarely, methimazole can cause blood disorders. Easy bruising is a sign of this. The patient should notify his doctor immediately. The other effects listed are mild and usually not cause for concern, though if they persist or increase the patient should notify his doctor. 

 

Question 68 

 The CDC recommends STD screening for all sexually active adults and for which of the following?

 

  females over the age of 65 

  males over the age of 65 

   males age 20 to 40 

   females age 20 – 24 

Correct answer:

females age 20 – 24

 

The CDC recommends STD screening for all sexually active adolescents and females age 20 to 24 years. Multiple sexual partners and inconsistent condom use are risk factors of STD.

 Question 69 

With prepatellar bursitis, which of the following should be considered as a first-line-therapy? 

  minimizing the offending activity 

  applying ice to the affected area for 15 minutes at least 4 times a day 

   NSAIDs 

   bursal aspiration 

Correct answer:

bursal aspiration

 

With prepatellar bursitis, bursal aspiration should be considered as a first-line therapy. This is because this procedure affords significant pain relief and allows the bursa to reapproximate. The therapies in the other three choices are appropriate for bursitis in other sites.

 

Question 70 

When counseling patients who smoke cigarettes, which of the following is NOT good management advice? 

   For asymptomatic adults, instruct the patient on how it is easier to stop now than when symptomatic. 

  For teens, instruct on bad breath and stained teeth. 

   For parents, instruct on increased respiratory infections among the children of smokers. 

  For pregnant women, instruct on the increased rate of spontaneous abortion. 

The Correct answer is:

For asymptomatic adults, instruct the patient on how it is easier to stop now than when symptomatic

For symptomatic adults, you should instruct on heart disease risk, risks of lung cancer, and facial wrinkles. For new smokers, you should instruct that it is easier to stop now than after smoking a while.

Question 71 

Which of the following would be a factor that makes a woman more susceptible to premature labor?

 

  age of 33 years 

  age at first pregnancy 19 years of age 

   UTI 

  Caucasian race 

Correct answer:

UTI

 

Of the choices, having a UTI is the factor that would increase a woman’s risk of premature labor. There are a host of other factors some of which are: smoking more than 11 cigarettes daily; exposure to job-related teratogens and strenuous activity; less than a high school education; and previous premature labor.

Question 72 

The FNP has an elderly patient who has decided not to take any further action to treat her advanced pancreatic cancer. She wants to enjoy what time she has left. She tells the FNP that she hopes that she has made a good decision. What is the best thing that this FNP can say to the patient in regard to her decision? 

  You have given this a lot of thought so your decision is probably right. 

   Not knowing about how a decision will affect one’s life can be worrisome. 

   You can always change your mind. 

  Why don’t you seek further guidance in this decision? 

Correct answer:

Not knowing about how a decision will affect one’s life can be worrisome.

 

Of the choices given, this is the best statement that the FNP could make. It recognizes the patient’s feelings. The other statements deny the patient’s feelings.

 

 Question 73 

When assessing a 6-year-old girl with fever, abdominal tenderness, and an abnormal urinalysis, the mother tells you the child had a recent "strep" infection about 3 weeks ago and did not finish her antibiotics. The nurse practitioner should suspect:

 

  an antibiotic reaction 

  sepsis 

   gastroenteritis 

   acute glomerulonephritis 

The Correct answer is:

Acute glomerulonephritis

The symptoms of glomerulonephritis are fever, abdominal or flank pain, edema of the face, hands and feet, abrupt onset of hematuria, oliguria, or anuria. It is most commonly seen in children with a history of recent Group A beta hemolytic streptococcal infection, such as pharyngitis or impetigo. The symptoms do not indicate an antibiotic reaction or sepsis. Further, gastroenteritis usually causes nausea and/or vomiting.

 

Question 74 

You are testing a 75-year-old male with the Mini-Mental Exam (MME). You will be testing him with all of the following EXCEPT: 

  orientation 

  attention and calculation 

   writing a 100 word paragraph 

  copying a design 

Correct answer:

writing a 100 word paragraph

 

There are five subject areas tested in the MME. They are orientation; attention and calculation; recall; writing a short sentence; and copying a design.

 

 Question 75 

A 34-year-old African-American male comes to the clinic after taking an undetermined amount of street heroin. Before you transfer this patient to a psychiatric treatment facility, what is the drug of choice you should use for opioid overdose?

 

  Clonidine (Catapres) 

  naltrexone HCl (ReVia) 

   methadone (Dolophine) 

   Naloxone (Narcan) 

The Correct answer is:

Naloxone (Narcan) 

Naloxone (Narcan) is a narcotic antagonist that is used for the reversal of narcotic depression, including respiratory depression. Naltrexone is a narcotic detoxification adjunct. Clonidine (Catapres) is a central alpha agonist for hypertension. Methadone is used to treat opioid addiction and not an overdose.

 

 Question 76 

A 35-year-old male comes to the clinic with a skin lesion which he tells the FNP came from a tick bite he got on a recent camping trip. The FNP suspects early Lyme disease. The FNP knows that this disease is caused by which of the following organisms? 

   Borrelia burgdorferi 

  Rickettsia rickettsii     

   Sarcoptes scabiei 

  Neisseria meningitides 

Correct answer:

Borrelia burgdorferi

 

Early Lyme disease (erythrema migrans) is a skin lesion caused by the bite of an Ixodes tick infected with Borrelia burgdorferi. If it is left untreated, the infection becomes systemic and affects multiple organ systems.

 Question 77 

Folic acid requirements are increased during all of the following EXCEPT: 

  pregnancy 

  childhood 

   recovery from illness 

   hypertension 

Correct answer:

hypertension

 

Folic acid need is increased in times of accelerated tissue growth and repair, such as in childhood, pregnancy, recovery from serious illness and recovery from hemolytic anemia. The folic acid requirements increase from the baseline of twofold to fourfold. Although studies indicate that folic acid helps to prevent high blood pressure, the need for folic acid is not increased in someone with hypertension.

 

Question 78 

You are testing a 5-year-old child for visual acuity. You use the Snellen chart. The child should be standing at what distance from the chart? 

  5 feet 

  10 feet 

   15 feet 

   20 feet 

Correct answer:

20 feet

 

You should obtain visual acuity (V/A) and binocular vision by age 4 to 5 years. The child using the Snellen chart should be at 20 feet when reading it. A failed test is V/A 20/40 or greater in either eye, or if there is a two-line discrepancy between the eyes.

 

 Question 79 

Which of the following statements about fibromyalgia is incorrect? 

  It is four to seven times more common in women than in men. 

  The diagnosis of fibromyalgia is supported by the presence of tender points in specific locations. 

   Biochemical changes noted in the central nervous system in a person with fibromyalgia include high serotonin levels and decreased levels of substance P. 

  Fibromyalgia affects at least 2% of the general population. 

Correct answer:

Biochemical changes noted in the central nervous system in a person with fibromyalgia include high serotonin levels and decreased levels of substance P.

 

This is an incorrect statement. Biochemical changes noted in the central nervous system in a person with fibromyalgia include low serotonin levels and elevated levels of substance P. These changes likely contribute to the diffuse hypersensitivity to pain.

 

Question 80 

The anterior fontanels will usually close at which age? 

   9 months – 2 years 

  5 months – 1 year 

   1 – 2 months 

  3 – 4 months 

Correct answer:

9 months – 2 years

 

The posterior fontanels will close first at about 1 – 2 months. The anterior fontanels close at about 9 months – 2 years.

 

 Question 81 

A 45-year-old African-American male reports chest pain that is sudden and severe. Also, the male patient describes the pain as "tearing."  You notice that the pain is accompanied by a decrease in peripheral pulses. You understand that this may indicate a diagnosis of: 

  pericarditis 

   aortic dissection 

  acute MI 

   angina 

The Correct answer is:

Aortic dissection

Aortic dissection almost invariably begins with sudden onset of severe chest pain that is tearing or ripping in quality and is accompanied by absent or decreased peripheral pulses and neurologic deficits. The pain of angina and acute myocardial infarction (MI) is usually described as "pressure" by the patient. Pericarditis produces pain that is more gradual in its onset. 

Question 82 

What is included when taking the medical history of an infant? 

   Prenatal history. 

  Parent occupation. 

  Daycare. 

   Home. 

Correct answer: Prenatal history Prenatal history is important to note when taking the medical history of an infant. The other answers are part of the social assessment. 

 

 Question 83 

The following are all ethical concepts for NPs except for:

 

  beneficence (the duty to help others) 

  accountability ( responsible for own actions) 

   accomplishment (sense of self worth) 

   confidentiality ( the right to keep records private) 

The Correct answer is:

Accomplishment (sense of self worth)

Confidentiality, accountability and beneficence are all ethical concepts along with non-malfeasance (duty to do no harm), human dignity (respect of the patient), and compassion (concern for the patient). Self worth, personal accomplishment are concepts related to the nurse practitioner's ego and are not ethical concepts.

 

Question 84 

Which of the following would NOT be a complication of Lyme disease? 

   Lyme gastritis 

  Lyme carditis 

   Lyme meningitis 

  Lyme encephalitis 

Correct answer:

Lyme gastritis

 

This is not a complication of Lyme disease. Complications can include: Lyme carditis; Lyme meningitis; Lyme encephalitis; Lyme arthritis; and facial nerve paralysis.

 

Question 85 

In terms of secondary skin lesions, which of the following types of lesions are permanent skin changes as a result of newly formed connective tissue?

 

  lichenification 

  crust 

   scar 

  scale 

Correct answer:

scar

 

A scar is a permanent skin changes as a result of newly formed connective tissue. A lichenification is induration and thickening of skin; a crust is a dry mass of exudate; and a scale is a dry, greasy fragment of dead skin.

 

Question 86 

A patient in the clinic is found to have 2 palpable, tender, left pre-auricular nodes that are about 0.5 cm in diameter. You expect to find what in this patient? 

  ulceration on the tongue 

  ear infection 

   sore throat 

   conjunctivitis 

The correct answer is conjunctiviitis.  The eyes are drained by the pre-auricular lymph nodes and they can be palpated near the ear. These swell in response to eye infections, allergies, or foreign bodies in the eye.

 

Question 87 

All of the following are true regarding developmental theory EXCEPT: 

  The pace of development varies among individuals. 

   Stress does not impact development. 

  All development is patterned, orderly, and predictable with both a purpose and a direction. 

   Development is continuous throughout life, although the degree of change in many areas decreases after adolescence. 

The Correct answer is:

Stress does not impact development

Physical and mental stress during periods of critical developmental change, such as puberty, may make a person particularly susceptible to outside stressors.

 

 Question 88 

In assessing the vision of a toddler which of the following tests might be done? 

  Snellen test 

   determine ability to follow an object 

   Jaeger test 

  blink reflex 

Correct answer:

determine ability to follow an object

 

The FNP should determine the toddler’s ability to follow an object as part of a vision screening for a toddler or older infant. The FNP might also perform a corneal light reflex test, perform a cover/uncover test and assess red reflex. 

 

Question 89 

Which of the following foods is NOT a dietary trigger that influences the severity of migraine symptoms? 

   pears 

  avocados 

   bananas 

  citrus foods 

Correct answer:

pears

 

Pears are not one of the dietary triggers that influence the severity of migraine symptoms. The other choices are triggers along with such things as: ripened cheeses; sausage; pizza; herring; and many more.

 

 Question 90 

Which of the following is most consistent with the diagnosis of anxiety? 

  diminished cognitive ability 

  nausea 

   consistent early morning wakening 

   difficulty initiating sleep 

The Correct answer is:

Difficulty initiating sleep

Anxiety is a normal human emotion that is an important part of fear response. It can also be protective and heighten an individual's senses when an individual encounters a dangerous situation. The remaining answer choices are not consistent with anxiety but difficulty initiating sleep is. 

 

Question 91 

In terms of issues of confidentiality and the right to consent without parental involvement, which of the following persons would NOT be considered an emancipated minor in the United States? 

   a 15-year-old who wants to be treated for painful urination 

  a 16-year-old who has enlisted in the Army 

   a 14-year-old who is married 

  a 15-year-old single mother who has one child 

Correct answer:

a 15-year-old who wants to be treated for painful urination

 

An emancipated minor can give full consent, sign contracts and other legal documents as an adult would. The criteria for an emancipated minor in the United States are: any minor who is married, any minor who is a parent, and any minor who is enlisted in the U.S. military. The 15-year-old who wants to be treated for painful urination is not an emancipated minor.

 

Question 92 

In diagnosing a toothache (pulpitis), the nurse practitioner has knowledge that all of the following are necessary except:

 

   Systemic manifestations do not occur from dental caries and pulpitis. 

  You should inquire about fever and chills. 

   Dental caries are the most frequent type of injury that causes pulpitis. 

  There is diverse flora involved in the infectious process, including gram-positive anaerobes and bacteroides. 

The Correct answer is:

Systemic manifestations do not occur from dental caries and pulpitis

Many patients present in the clinic setting with a toothache or related symptoms. Systemic manifestations often occur and they include lymphadenopathy, malaise, fever, and pain. The remaining answer choices are true regarding this condition. 

 Question 93 

Which of the following statements does NOT apply to the general systems theory of family development? 

  Within the family system are boundaries that are open, closed or operate at random. 

  A change affecting one part of a family manifests itself as change in the whole family system. 

   Families pass through eight chronological stages from beginning family to old age. 

  Families strive for homeostasis that reflects a balance between change and stability. 

Correct answer:

Families pass through eight chronological stages from beginning family to old age.

 

This is not part of the general systems theory of family development. It is part of the developmental theory established by Duvall. It holds that success in one task sets the stage for success in subsequent tasks

 

 Question 94 

The NP has diagnosed her elderly patient with shigella. Which of the following medications would she MOST likely prescribe her? 

  Metronidazole. 

  Erythromycin. 

   Ampicillin. 

   Trimethoprim-sulfamethoxazole. 

 

Correct answer: Trimethoprim-sulfamethoxazole The preceding drugs are typically used in treating the following: - Campylobacter jejuni: Erythromycin - Salmonella: Ampicillin - Shigella: Trimethoprim-sulfamethoxazole - Giardia lamblia: Metronidazole 

 

Question 95 

The FNP has a patient with peripheral vascular disease. During examination of this patient the FNP can expect to find all of the following EXCEPT: 

  cool skin 

  decreased pulses 

  hairless, shiny skin on the affected area 

   decreased capillary refill time 

decreased capillary refill time

 

In a patient with PVD (peripheral vascular disease) the FNP would not find a decreased capillary refill time; he would find an increased capillary refill time. In addition to the other choices, the FNP is likely to find: hyperpigmentation on the affected area; atrophic changes due to chronic poor circulation; and bruits over partially blocked arteries.

 

Question 96 

Which of the following statements about tuberculosis is incorrect? 

   Tuberculosis occurs only in the lungs. 

  Transmission of tuberculosis is by respiratory droplets. 

  The majority of cases in the United States are reactivated infections. 

   A TB infection is controlled by an intact immune system. 

 

Correct answer:

Tuberculosis occurs only in the lungs.

 

This statement is incorrect. The most common site of infection is the lungs (85%), but infection can also occur in the kidneys, brain, lymph nodes, adrenals, bone and more.

 

Question 97 

In a trial, an expert witness will establish the standard of care for a nurse practitioner. The expert's opinion is based on:

 

  facility policies and procedures 

  national norms for the specialty 

  professional literature 

   all of the above 

The Correct answer is:

All of the above

With respect to nursing specialties, the standard of care is usually a national one. Therefore, an expert witness may reference facility policies, books and journals to provide an opinion on nursing standard of care. Also, for a trial, physician input may be sought. In some cases, physicians may even be allowed to testify about the standard of care. 

 

Question 98 

A 15-year-old Caucasian male presents in the clinic with a reddened, pruritic rash. The nurse practitioner understands that the most common sites for adolescent atopic dermatitis are:

 

  forehead, scalp, and cheeks 

  wrists, ankles, and cubital core 

   face, neck, back, and antecubital fossae 

  palmar creases and extensor surface of legs 

 

The Correct answer is:

Face, neck, back and antecubital fossae

In the adolescent and the young adult population, common sites for a pruritic rash are the popliteal and antecubital fossae, face, neck, upper arms and back, dorsa of the hand, feet, fingers, and toes.

 

 Question 99 

Osteoporosis is indicated by a bone density score of which of the following? 

   less than -2.5 

  between -1 and -2.5 

   greater than -1

 

  none of the above 

Correct answer:

less than -2.5

 

Interpretation of bone density testing is based on a T score, which refers to the number of standard deviations above or below the average value in young adults of the same gender. Osteoporosis is a bone density indicated by a T score less than -2.5. It is also indicated by the presence of fragility fractures, irrespective of the bone density test results.

 

Question 100 

Which of the following medications would be used as a topical treatment for fibromyalgia? 

  trazodone 

   capsaicin 

   nortriptyline 

  pregabalin 

Correct answer:

capsaicin

 

Topical treatments such as capsaicin are often helpful treatment adjuncts for a person with fibromyalgia. Medications such as trazodone can be helpful in improving sleep latency and duration. Tricyclic antidepressants such as nortriptyline have been shown to minimize symptoms. Pregabalin (Lyrica) are approved by the FDA for pain reduction in fibromyalgia.

 

 quiz 11 aanp

Question 1 

Erythema migrans in Lyme disease has a pattern of a ring. This is indicated by which of the following terms? 

   annular 

   confluent 

  coalescent 

  reticular 

 

Correct answer:

annular

 

Annular is the term used for the ring pattern of skin lesions. This is typical of the skin condition in Lyme disease.

 

 Question 2 

Which of the following is NOT one of the three major requirements under the Occupational Safety and Health Act (OSHA)? 

  Wear protective wear when at risk for blood and other body fluid handling. 

  Collect hazardous waste in separate, clearly marked trash cans. 

   Properly dispose of hazardous waste. 

   Do not pay remuneration for referral or business reimbursable by a federal healthcare program. 

Correct answer:

Do not pay remuneration for referral or business reimbursable by a federal healthcare program.

 

This is not part of OSHA. It refers to anti-kickback statutes. OSHA is concerned with building safety and safe clinical practices.

 

 Question 3 

Which of the following does not play a significant role in the development of varicose veins? 

   diabetes mellitus 

   wearing constricting garments 

  weakness of the walls of the vein 

  pregnancy 

 

Correct answer:

diabetes mellitus

 

Diabetes does not play a significant role in the development of varicose veins. An inherited venous defect of either a valvular incompetence or a weakness in the walls of the vessel likely plays a significant role. In addition, situations that cause high venous pressure, such as wearing constricting garments and pregnancy, contribute to their development.

 

Question 4 

Which of the following are you most likely to consider for a 3-month-old infant with developmental dysplasia of the hip? 

  open reduction 

   Pavlik harness 

   spica cast 

  preliminary traction 

Correct answer:

Pavlik harness

 

A Pavlik harness permits a relaxed motion of the hip while maintaining a flexed and abducted position for natural development of joint space, until the capsule tightens in about 6 weeks. After age 6 months the other choices may be considered.

 Question 5 

In which of the following situations might there be an exception to guaranteed confidentiality of a patient? 

   in cases of suspected child abuse 

  when next of kin requests a patient’s records 

   when discussing the patient with another medical professional not involved in the care of the patient 

  none of the above 

 

Correct answer:

in cases of suspected child abuse

 

There are exceptions to guaranteed confidentiality when society determines that the need for information outweighs the principle of confidentiality. These situations include: when records are released to insurance companies; to attorneys involved in litigation; in answering court orders, subpoenas or summonses; in meeting state requirements for mandatory reporting of diseases or conditions; in cases of suspected child abuse; or if a patient reveals an intent to harm someone.

 

Question 6 

Which of the following procedures would you recommend for a patient with a kidney stone that has not passed on its own? 

  Lorthotomy. 

   Lithotrispy. 

   Laparoscopy. 

  Lithotomy. 

Correct Answer: Lithotrispy This procedure uses shock waves to break up kidney stones. They can then pass more easily on their own. This procedure is used when kidney stones have not passed after what the healthcare practitioner deems a sufficient amount of time. 

 

Question 7 

The FNP is communicating with a patient about controlling her blood sugar. The patient tells the FNP that she is afraid that she will have to take insulin shots soon. Which of the following statements would demonstrate using the therapeutic communication technique of reflection? 

   What would it be like for you to have to take insulin shots every day? 

   If that is necessary a specialist will show you just what to do. 

  Maybe you should be more vigilant about your diet. 

  Don’t worry. That’s not likely to happen. 

 

Correct answer:

What would it be like for you to have to take insulin shots every day?

 

In using reflection, the FNP takes one or two words said by the patient to reflect back to the patient for consideration. By asking her, “What would it be like for you to have to take insulin shots every day?” the FNP is using reflection.

 

Question 8 

Knowledge concerning health literacy is part of the nurse practitioner practice environment. This is where the patient and family understand and act on health information. Which of the following is TRUE regarding health literacy? 

  Health literacy is now recognized as a small contributor to health outcome. 

  The Institute of Medicine (IOM) has launched efforts to help nurse practitioners and physicians teach patients. 

   The Institute of Medicine (IOM) and the Agency for Health Care Research and Quality (AHRQ) have launched efforts to quantify and offer solutions to the problems that result from inadequate health literacy. 

  None of the above are correct. 

 

The Correct answer is:

The Institute of Medicine (IOM) and the Agency for Health Care Research and Quality (AHRQ) have launched efforts to quantify and offer solutions to the problems that result from inadequate health literacy. 

Health literacy is now recognized as one of the largest contributors to health outcome. The IOM and AHRQ are organizations who are making efforts to solve the problems of health literacy

 

 Question 9 

Which of the following options for the business structure of a practice involves every person being liable for the debts and legal liabilities of other persons in the entity? 

   partnership 

   limited liability company 

  sole proprietorship 

  corporation 

 

Correct answer:

partnership

 

In a partnership, which is a business relationship involving two or more individuals or business entities, each partner is liable for the debts and legal liabilities of the other partners. Partners share profits, decision making, administration and workload in some way agreeable to all partners.

 

 Question 10 

Contraindications to cows’ milk-based formulas include all of the following EXCEPT: 

  milk protein sensitivity 

   soy protein allergy 

  lactose intolerance 

  galactosemia 

Correct answer:

soy protein allergy

 

Soy protein allergy would be a contraindication to the use of soy protein isolate formulas. All of the other choices would be contraindications for use of cows’ milk-based formulas.

 

Question 11 

The leading cause of death in the 45 to 54 year age group is which of the following? 

  heart disease 

   suicide 

   malignant neoplasms 

  cerebrovascular disease 

Correct answer:

malignant neoplasms

 

Malignant neoplasms are the leading cause of death in the 45-54 year age group. Heart disease is second.

 

Question 12 

When treating a patient with atypical depression, the nurse practitioner is aware that the following class of drugs is most likely to precipitate a hypertensive crisis:

 

   monoamine oxidase (MAO) inhibitor 

   phenothiazines 

  narcotic analgesics 

  barbiturates 

The correct answer is:

Monoamine oxidase (MAO) inhibitor

Patients who eat tyramine-rich foods while taking an monoamine oxidase (MAO) inhibitor drug are at risk for hypertensive crisis. Examples of these tyramine-rich foods that have undergone an aging process are cheese, wine, beer, salami, and yogurt. Further, the catecholamines from these foods are released from the nerve endings, thus causing a hypertensive crisis. The remaining answer choices identify drugs that cause low blood pressure. 

 

Question 13 

The care giver of an elderly patient with Alzheimer's informs the NP that the patient requires community resources to help with her care. Who would the NP MOST likely refer the care giver to? 

  Physical therapist. 

   Geropsychiatrist. 

  Clinical psychologist. 

   Social worker. 

 

Correct answer: Social worker Of the options listed, the social worked would typically be the most skilled in securing community resources for the patient. The other specialists can help in areas such as patient behavioral issues and patient physical activity. 

 Question 14 

An 81 year old male patient complains of abdominal pain and slimy stools. Testing shows leukocytes and blood in the stools. What diagnosis will the NP MOST likely make? 

  Shigella. 

  Adenovirus. 

   Campylobacter jejuni. 

   Salmonella. 

Correct answer: Salmonella Salmonella is a type of diarrhea that can occur at any age. Stools are characterized with a "rotten" or "egg" odor.

 

Question 15 

Which of the following types of headaches typically lasts several weeks to months? 

  tension headaches 

   cluster headaches 

   migraine headaches without aura 

  migraine headaches with aura 

 

Correct answer:

cluster headaches

 

Cluster headaches have a tendency to occur daily in groups or clusters. The clusters usually last several weeks to months, then disappear form months to years.

 

Question 16 

Enuresis is involuntary urination after a child has reached the age when bladder control is usually attained. Management of primary nocturnal enuresis includes all of the following EXCEPT: 

  limiting fluid intake before bedtime 

  double voiding before bedtime 

   avoiding punishment 

   withholding verbal praise so as not to call attention to the problem 

 

Correct answer:

withholding verbal praise so as not to call attention to the problem

 

Verbal praise is an excellent means of motivational therapy for a child with primary nocturnal enuresis. Other means of motivational therapy include a reward system and keeping a dryness calendar.

 

 Question 17 

 Your patient complains of eye pain that has come on suddenly and tells you that light bothers him and his vision seems blurred. Your examination reveals a rash on the side of the temple and on the tip of his nose. This is which of the following diseases?

 

  hordeolum 

  chalazion 

   herpes keratitis 

  primary open-angle glaucoma 

 

Correct answer:

herpes keratitis

 

Herpes keratitis is damage to the corneal epithelium caused by the herpes virus, commonly shingles. The patient usually has acute onset of eye pain, photophobia, and blurred vision in the affected eye.

 

 Question 18 

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

   Diet and exercise. 

  Diet. 

   Exercise. 

  Depression. 

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

Question 19 

A preschooler is in the office with her mother. The mother is concerned because the child has begun to stutter. The nurse practitioner (NP) knows that she should do what? 

  Give the child verbal exercises to perform at home. 

   Reassure the mother that stuttering is normal in a preschooler. 

  Refer the child to a speech pathologist. 

  Encourage the mother to correct the child when she stutters. 

Correct answer:

Reassure the mother that stuttering is normal in a preschooler

It is normal for preschoolers to repeat whole words or phrases as if stuttering. It is inappropriate to refer to a speech pathologist. Further, patients should not correct or criticize a child who does this. Verbal exercises would not help and could contribute to low self-esteem. 

 

Question 20 

Precocious puberty in girls is defined as the onset of secondary sexual characteristics before the child is how many years old? 

  10 years old 

  9 years old 

   8 years old 

  6 years old 

Correct answer:

8 years old

 

Precocious puberty in girls has long been defined as the onset of secondary sexual characteristics before the child’s 8th birthday. In boys, it is before the 9th birthday.

 

 Question 21 

Of the following anti-diabetic agents, which one is a biguanide? 

  Diabinese 

   Glucophage 

   Acarbose 

  Prandin 

Correct answer:

Glucophage

 

Glucophage is a biguanide. It decreases gluconeogenesis and decreases peripheral insulin resistance.

 

 Question 22 

Of the models and theories related to health care, which one is used to explain why healthy people do or do not take advantage of screening programs? 

  Maslow’s Hierarchy of Needs 

  Trans-theoretical Model of Change 

   Self-efficacy Theory Model 

   Health Belief Model 

Correct answer:

Health Belief Model

 

The Health Belief Model involves variables such as perceptions of susceptibility and seriousness of a disease, benefits of treatment, perceived barriers to change, and expectations of efficacy. It is used to explain why healthy people do or do not take advantage of screening programs.

 Question 23 

You are seeing a 22-year-old female in the office with elbow pain. A diagnosis of lateral epicondylitis is made based on this knowledge: 

  pain that is worse with elbow flexion 

  reduced joint range of motion (ROM) 

   decreased hand grip strength 

  electric-like pain elicited by tapping over the median nerve 

The Correct answer is:

Decreased hand grip strength

With lateral epicondylitis (tennis elbow), the patient will complain of pain over the lateral epicondyle that increases with resisted wrist extension, especially with the elbow. Hand grip is often weak on the affected side. The remaining answer choices are not descriptive of this condition. 

 

Question 24 

 You have done a cholesterol screening for a young female patient, aged 12. Which of the following results would NOT be considered normal for this child?

 

  cholesterol = 188 

   LDL = 155 

   HDL = 40 

  triglycerides = 100 

 

Correct answer:

LDL = 155

 

A result of LDL = 155 is not considered normal for a 12-year-old female. LDL should range between 70 – 140.

 

Question 25 

 Which of the following medications or treatments is least likely to be prescribed for head lice?

 

  permethrin 1% cream rinse 

  nit removal with a fine tooth comb 

   Lindane 1% shampoo 

  soaking brushes and combs in Nix shampoo 

Correct answer:

Lindane 1% shampoo

 

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

 

 Question 26 

Your patient has moderate COPD. Which of the following medications are you least likely to prescribe for him at this stage of the disease? 

  Atrovent 

   extended-release theophylline 

   Ventolin 

  triamicinolone 

Correct answer:

extended-release theophylline

 

For moderate COPD regular treatment with one or more of the following is indicated: anticholinergic bronchodilator such as Atrovent; inhaled beta2-selective agonist such as Ventolin; and inhaled corticosteroid such as triamicinolone. Extended-release theophylline is used in severe COPD to improve respiratory muscle performance.

 

 Question 27 

You have called a patient back in after a pap smear for re-evaluation. Her results showed reactive cellular changes. The nurse practitioner has knowledge that this is associated with:

 

  drying artifact 

  use of oral contraceptives 

   inflammation 

  use of estrogen vaginal cream 

The Correct answer is:

Inflammation 

Reactive cellular changes are most often associated with inflammation. Other associated causes are radiation, IUD use, atrophic vaginitis, and diethylstilbestrol exposure in utero. Birth control pills and estrogen vaginal creams do not cause reactive changes.

 

Question 28 

Which of the following pharmacological treatments for allergic rhinitis is not an intranasal corticosteroid? 

  beclomethasone 

   cromolyn sodium 

   budesonide 

  fluticasone 

 

Correct answer:

cromolyn sodium

 

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

 

Question 29 

The nurse practitioner understands that after starting vitamin B12 therapy for a patient, what would be expected at a 2 week follow-up visit?

 

  reduced RBCs, WBCs, and platelets 

  increased macrocytosis and anisocytosis 

   increased hemoglobin/hematocrit and reticulocyte count 

  ferritin level of 40 ng/ml 

The Correct answer is:

Increased hemoglobin/hematocrit and reticulocyte count

With vitamin B12 therapy, the nurse practitioner will see an increase in the hemoglobin/hematocrit and reticulocyte count. Other improvements will include improved appetite and decrease in neurological symptoms, such as gait disturbances, weakness, and paresthesias

 

 Question 30 

Which of the following organizations can exclude NPs from being designated as primary care providers? 

   MCOs 

  Medicare 

   TRICARE 

  Federal Employees Health Benefits Program 

 

Correct answer:

MCOs

 

Managed care organizations (MCOs) frequently have excluded NPs from being designated as primary care providers carrying their own case loads. Thus, in many MCOs, the only option for NPs is that of being a salaried employee.

 

Question 31 

The mean weight gain of a female in puberty (10 – 14 years) is which of the following? 

  52 lbs 

   38 lbs 

   30 lbs 

  55 lbs 

 

Correct answer:

38 lbs

 

The weight gain for a female during puberty (10 to 14 years) is between 15 and 55 lbs. The mean weight gain is 38 lbs. Males gain 15 – 65 lbs during puberty (11 – 16 years) and the mean weight gain is 52 lbs.

 

Question 32 

The diagnosis of hypertension (HTN) should be established on the basis of: 

  at least five readings one month apart 

  one reading taken in three different positions 

   one reading of 140 mm Hg systolic and 90 mm Hg diastolic or above 

   at least three hypertensive readings one week apart 

The correct answer is:

At least three hypertensive readings one week apart 

The diagnosis of hypertension (HTN) from a single measurement of blood pressure (BP) elevation should not be done. A minimum of three readings with an average systolic BP of 140 mm Hg and diastolic of 90 mm Hg establishes the diagnosis. An average of two or more readings should be taken at each of the two or more visits following an initial screening. 

 

Question 33 

An increase in creatinine from 1 to 2 mg/dL is typically seen with what percentage loss in renal function? 

  10% 

  25% 

   50% 

  75% 

The Correct answer is:

50%

Creatinine is the end product of creatinine metabolism, which arises from skeletal muscle. Because creatinine excretion by a healthy kidney is very efficient, measurement of creatinine is used as a surrogate marker of kidney function. That much of an elevation is consistent with a 50% loss of renal function. 

 Question 34 

Which of the following is NOT true regarding healthcare issues in the United States?

 

   Most of Americans have access to healthcare and are being adequately treated. 

  Of all children, 13% are uninsured. 

  It is estimated that 45+ million Americans are underserved because of limited access to healthcare. 

   Many of the working poor cannot obtain healthcare because of the high costs of insurance, fees and medications. 

 

The Correct answer is:

Most of Americans have access to healthcare and are being adequately treated

There is a large portion of Americans who do not have access to healthcare. 

 

Question 35 

You observe that a patient's muscle strength is perfectly normal when tested. What grade would you give it? 

  0 of 5. 

  2 of 5. 

   3 of 5. 

   5 of 5. 

 

Correct answer: 5 of 5 Muscle strength is observed and graded on a five-point scale. Five is normal. Anything below five is weaker than normal. 

Question 36 

 A patient who comes to you displaying rapid speech and frequent change of topic, restlessness and selective inattention is suffering from which of the following?

 

  mild anxiety 

  panic anxiety 

   moderate anxiety 

  severe anxiety 

Correct answer:

moderate anxiety

 

Moderate anxiety involves a narrowed focus of perception. The patient would show selective inattention and hesitation; diminished problem solving; rapid speech with frequent change of topic; and muscle tension and restlessness.

 

Question 37 

The fee paid by a managed care organization (MCO) to a healthcare provider, per patient, per month, for care of an MCO member is which of the following? 

  “incident to” services 

   capitation 

   fee for service 

  none of the above 

Correct answer:

capitation

 

Capitation is the fee paid by a managed care organization (MCO) to a healthcare provider, per patient, per month, for care of an MCO member. Capitated fees for primary care vary, based on a patient’s age and sex. An NP wishing to provide care for a Medicare patient enrolled in an MCO applies to the MCO for admission to the organization’s provider panel.

 

Question 38 

Charles Darwin wrote On the Origin of Species about human evolution. He also is known for which of the following? 

  developing the first standardized measurement of intelligence 

   developing the “baby journal” as a systematic method to document observed behavioral development 

   developing the maturational-organismic theory 

  none of the above 

 

Correct answer:

developing the “baby journal” as a systematic method to document observed behavioral development

 

In addition to writing On the Origin of Species, Charles Darwin is known for the first use of a “baby journal” as a systematic method to document observed behavioral development. Alfred Binet developed the first standardized measurement of intelligence. Arnold Gesell developed the maturational-organismic theory. 

 

Question 39 

A patient on levothyroxine for hypothyroidism presents in the clinic with complaints of chest pain after only taking this medication 3 weeks. What would be the appropriate thing to do?

 

   Decrease dose of levothyroxine, order an ECG, and consult with your collaborating physician. 

  Prescribe an anxiolytic agent. 

   Schedule the patient for a sedimentation rate test. 

  Discontinue levothyroxine because chest pain is a contradiction to its continuance. 

 

The Correct answer is:

Decrease dose of levothyroxine, order an ECG, and consult with your collaborating physician

Decreasing the dose of levothyroxine and evaluating the client's cardiac status are appropriate interventions in this situation as well as involving the collaborating physician. It would be inappropriate to stop thyroid replacement. An anxiolytic may be helpful but is not the sole necessary intervention.

Question 40 

The FNP has a patient who will be undergoing chemotherapy. She confides to the FNP that this is causing her quite a bit of worry. Which of the following statements would NOT be considered appropriate therapeutic communication for this patient? 

  Tell me what you would like to know about your treatment. 

  Tell me what the doctor told you and maybe I can be more helpful. 

   What will it be like for you when you go for your chemotherapy? 

   Don’t worry, I will have the doctor come in and explain what is going to happen. 

 

Correct answer:

Don’t worry. I will have the doctor come in and explain what is going to happen.

 

This is not therapeutic communication. The FNP is making light of the patient’s fears and dismissing them by telling her not to worry.

Question 41 

Treatment of a patient with heatstroke may include all of the following EXCEPT: 

  use of tepid sprays 

  fanning 

   rapid cooling by ice packing 

  appliance of cold packs to selected areas 

 

Correct answer:

rapid cooling by ice packing

 

Rapid cooling by ice packing is discouraged because this can stimulate cutaneous vasoconstriction, inhibiting heat loss. Also, rehydration should be aggressive but with careful monitoring.

Question 42 

Upon evaluation of a 56-year-old Caucasian female who presents with stress incontinence, she asks questions regarding etiology and management. The nurse practitioner has knowledge that factors that contribute to this condition include: 

   pelvic floor weakness 

  urinary tract infection 

   detrusor overactivity 

  urethral stricture 

 

The Correct answer is:

Pelvic floor weakness

Stress incontinence is a result from weakness of the pelvic floor and urethral muscles and is more common form of incontinence in women. If a urinary tract infection (UTI) is present, it should be treated but is not the cause of this condition. Urge incontinence is a result of detrusor overactivity. Additionally, a urethral obstruction is caused by a stricture. 

 

Question 43 

Which of the following would not be considered a body change related to menopause? 

  atrophied ovaries 

  labia and vagina become atrophic and thinner 

   urinary incontinence 

   palpable ovaries 

 

Correct answer:

palpable ovaries

 

Palpable ovaries are considered an abnormal finding in menopausal women. After several years of menopause, the ovaries are atrophied and a smaller size. Ovarian cancer must be ruled out when a palpable ovary is found.

 

Question 44 

Research on human subjects requires adherence to ethical principles and protection of human rights. These ethical principals include which of the following? 

  freedom from harm 

  freedom from exploitation 

   right to self-determination 

   all of the above 

Correct answer:

all of the above

 

All of the choices are correct. Ethical principles for research on human subjects include: freedom from harm, freedom from exploitation, the right to self-determination, the right to full disclosure, the right to fair treatment and the right to privacy

 

Question 45 

You are examining a 5-month old infant. You would expect to see all of the following in this infant EXCEPT: 

  loss of tonic neck reflex 

   able to release an object on request 

   raises head and chest with arms extended 

   able to show displeasure by facial expressions

Correct answer:

able to release an object on request

 

You would not expect the child to be able to release an object on request. This happens around 9 months of age

 

Question 46 

Which of the following statements is incorrect in regard to treatment of rheumatoid arthritis? 

  The goal of treatment of patients with RA is to reduce inflammation and pain, while preserving function and preventing deformity. 

  Water exercise is helpful. 

   Behavioral management is important. 

   Traditional DMARDS to minimize the risk of joint damage include both methotrexate and NSAIDs. 

 

Correct answer:

Traditional DMARDS to minimize the risk of joint damage include both methotrexate and NSAIDs.

 

As helpful as NSAIDs are in symptom control, these products do not alter the underlying disease process. They are not one of the traditional disease-modifying anti-rheumatic drugs (DMARDs).

Question 47 

The NP explains to her patient that the medication she is prescribing for his hyperlipidemia can result in a 10 to 25% decrease in his LDL, 15 to 35% increase in his HDL and 20 to 50% decrease in his Triglycerides. Which of the following is he prescribing? 

  Lipitor. 

  Gemfibrozil. 

   Nicotinic acid. 

  Colestipol. 

 

Correct answer: Nicotinic acid The expected outcomes of the preceding medications are as follows: Lipitor: LDL: 20-60% decrease HDL: 5-15% increase Triglyceride: 10-40% decrease Gemfibrozil: LDL: 5-15% decrease HDL: 14-20% increase Triglyceride: 20-50% decrease Nicotinic acid: LDL: 10-25% decrease HDL: 15-35% increase Triglyceride: 20-50% decrease Colestipol: LDL: 10-20% decrease HDL: 3-5% decrease Triglyceride: May increase 

 

Question 48 

The type of contract that is required in some states to specify the ways in which the NP and physician agree to work together is which of the following?

 

  independent contractor agreement 

   collaborative practice agreement 

   scope of practice agreement 

  none of the above 

Correct answer:

collaborative practice agreement

 

Collaborative practice agreements are required in some states. This agreement specifies the ways in which the NP and physician agree to work together, capitalizing on the professional roles of both for the mutual benefit of the patient.

Question 49 

In the course of inspecting the oral cavity of a 50-year-old male who is a heavy smoker you find a lesion that you suspect may be malignant. It is most likely that this lesion is:

 

  painful and red 

  flat, white, and painful 

   tender, mobile, and raised 

   painless and firm 

Correct answer:

painless and firm

 

An oral cancer is usually characterized by a relatively painless, firm ulceration or raised lesion. The lymphadenopathy associated with oral cancer consists of immobile nodes that are non-tender when palpated.

Question 50 

A 13-year-old male presents with tragal tenderness. He has a history of frequent swimming. Swimmer's ear is diagnosed. What other symptom might he have?

 

  hearing loss 

  fever 

   otic itching 

  kyphosis 

The Correct answer is:

Otic itching

Otitis externa is another name for swimmer's ear. It represents an infection of the external canal. This is characterized by tragal tenderness with light touch of the tragus on the affected side. It is treated with a topical agent along with keeping the ear canals out of water until the condition is resolved. 

 

 Question 51 

 You have an adult female patient who complains of fatigue, palpitations and lightheadedness. She is tall in stature and thin. Upon examination you detect a normal sinus rhythm with an S2 “click” followed b a systolic murmur. The diagnosis will most likely be which of the following?

 

  atrial fibrillation 

  paroxysmal atrial tachycardia 

   congestive heart failure 

   mitral valve prolapse 

Correct answer:

mitral valve prolapse

 

Mitral valve prolapse is more common in tall and thin adult females. It is characterized by a normal sinus rhythm with an S2 “click” followed b a systolic murmur. It is diagnosed by a cardiac ultrasound. These patients have a higher risk of thromboemboli and infective endocarditis.

Question 52 

Which of the following types of headache has a higher risk of suicide in males? 

   cluster headaches 

  migraine headaches 

  muscle tension headaches 

   temporal arteritis 

Correct answer:

cluster headache

 

A cluster headache is a sudden onset of severe “ice-pick” headaches behind one eye that occurs several times a day. The attacks happen at the same times daily and the cause is unknown. There is a higher risk of suicide in males who have this type of headache as compared with the other types of chronic headaches.

 

 Question 53 

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

  2+ 

   3+ 

   5+ 

  2 

 

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

Question 54 

In terms of accreditation, which of the following statements is NOT true? 

  The Joint Commission on Accreditation of Healthcare Organizations has accredited and monitored hospital practice through an accreditation program. 

   The accreditation program is mandatory for health plans and medical groups. 

   Through accreditation, committees set standards and conduct site visits. 

   Clinics and medical practices are not routinely accredited.

Correct answer:

The accreditation program is mandatory for health plans and medical groups.

 

This is not true. The accreditation program is voluntary for health plans and medical groups as well as for clinics. However, health plan accreditation is becoming a business necessity and clinics and medical practice accreditation may become a standard in the future.

 

Question 55 

In examining a pregnant woman, if the FNP finds that the uterus is about grapefruit size, she knows that it is most likely that the woman is in what week of pregnancy? 

  8th 

  16th 

   12th 

  20th 

 

Correct answer:

12th

 

At 12 weeks the uterus is about softball or grapefruit size. It is rising above symphysis pubis and the uterine fundus is palpable through the abdominal wall.

 

Question 56 

You are treating an elderly patient with stasis ulcerations. In counseling on the etiology and management of this, the nurse practitioner knows that the most frequent cause is: 

   venous insufficiency 

  diabetes mellitus 

   fungal dermatitis 

  arterial insufficiency 

The Correct answer is:

Venous insufficiency

Stasis ulcers are most commonly caused by venous insufficiency and less commonly caused by arterial insufficiency, diabetes mellitus, and fungal infections. Poor venous return causes lower extremity edema, which in turn leads to decreased tissue perfusion and resulting risk of ulcer. 

 

Question 57 

Mammography routine screening should begin for women who have no increased risk of breast cancer at what age?

 

  30-years-old 

  35-years-old 

   40-years-old 

  45-years-old 

The Correct answer is:

40-years-old

A mammography is a screening tool that identifies breast cancer. The National Institutes of Health (NIH) and the American Cancer Society recommends the starting age for an annual mammography screening at 40.

 

Question 58 

Which of the following tests is considered the gold standard for diagnosing endometriosis?

 

  MRI 

  pelvic ultrasound 

   laparoscopy 

  none of the above 

 

Correct answer:

laparoscopy

 

Laparoscopy is considered the gold standard for diagnosing endometriosis. It enables direct visualization of endometrial implants.

Question 59 

The person who brings a malpractice suit against the nurse practitioner must prove all of the following EXCEPT: 

  duty 

   acceptance of risk 

   proximate cause

  damages 

Correct answer:

acceptance of risk

 

This is not part of what a plaintiff must prove in a malpractice suit. The plaintiff has the burden of proving the following four elements: duty, breach of duty, proximate cause, and damages.

 

Question 60 

A patient with sensitive skin had a TB skin test but has no symptoms. He returns with redness and swelling that appears positive. What is the next step? 

  Prescribe medication. 

   Schedule a chest x-ray. 

   Repeat the test. 

  Quarantine the patient. 

 

Correct answer: Schedule a chest x-ray A chest x-ray shows signs of TB and is more accurate than the skin test. The skin test may appear positive if there is exposure to the illness or allergic reaction. Because the patient has no symptoms, the chest x-ray is recommended.

 

 Question 61 

The optimum daily intake of calcium for a woman who is 30 years old is which of the following? 

  1200 mg 

  800 mg 

   1500 mg 

   1000 mg 

Correct answer:

1000 mg

 

For women between the ages of 25 to 50 years the optimal daily intake of calcium is 1000 mg. After 50 years, women who are postmenopausal need 1500 mg per day.

 Question 62 

The nurse practitioner is treating a middle-aged female who has a history of duodenal ulceration. The patient is also currently positive for a Helicobacter pylori infection. The Family Nurse Practitioner would prescribe which of the following to prevent recurrence?

 

  a proton pump inhibitor 

  instant relief antacids around the clock 

   antimicrobial therapy 

  a histamine 2 receptor antagonist 

The Correct answer is:

antimicrobial therapy

There are several treatment options for a peptic ulcer, including antacids, proton pump inhibitor and Histamine-2 (H2) blockers. Since the patient has a history of duodenal ulceration and has tested positive for a Helicobacter pylori infection, the patient may be prescribed an antibiotic to treat the bacterial infection and a proton pump inhibitor to reduce the acid production. A peptic ulcer is a sore that forms in the stomach or duodenum lining and penetrates the lining with stomach acid, along with the juices produced during digestion. A duodenal ulcer is the more common form of a peptic ulcer with up to 90% of the patients diagnosed with it having the Helicobacter pylori infection as the bacterial cause

 

 Question 63 

You have a patient who has recurrent, repetitive, and intrusive thoughts that are extremely difficult for her to control. This patient has which of the following disorders? 

  panic disorder 

   obsessive-compulsive disorder 

   social phobia 

  generalized anxiety disorder 

Correct answer:

obsessive-compulsive disorder

 

Patients with obsessive-compulsive disorder (OCD) have recurrent, repetitive, and intrusive thoughts and/or behaviors that are extremely difficult or impossible to control. They are unreasonable, excessive, and interfere significantly with a person’s ability to function.

 

Question 64 

Any condition or substance such as hyperthyroidism or caffeine that irritates or overstimulates the heart can cause which of the following conditions? 

   hypertension 

   atrial fibrillation 

  PVD 

  DVT 

 

Correct answer:

atrial fibrillation

                 

Atrial fibrillation is caused by any condition or substance that irritates or overstimulates the heart. Examples are hyperthyroidism, cocaine, caffeine, or alcohol. 

 

Question 65 

In using warfarin as a long-term therapy in patients with DVT which of the following statements is incorrect? 

  Warfarin acts against coagulation factors II, VII, IX and X. 

   Prothrombin time is used as a measure of the efficacy of warfarin. 

   INR prolongation is seen in about 5 to 6 days after the first warfarin dose. 

  Approximately 2 – 10% of patients taking warfarin develop hemorrhage. 

Correct answer:

INR prolongation is seen in about 5 to 6 days after the first warfarin dose.

 

This is incorrect. INR prolongation is seen in about 48 - 72 hours after the first warfarin dose. INR is the international normalized ration. The INR range during warfarin therapy should be 2.0 to 3.0.

 

Question 66 

The part of the joint anatomy that acts as padding and is filled with synovial fluid is which of the following? 

  articular cartilage 

   bursae 

   ligaments 

  synovial space 

Correct answer:

bursae

 

The bursae are present on the anterior and posterior areas of a joint. They act as padding and are filled with synovial fluid.

 

Question 67 

An elderly patient appears distraught and explains in an interview that there are no friends or family nearby. What is this patient at risk for? 

  Heart disease. 

  Chest pain. 

   Headache. 

   Depression. 

Correct answer: Depression Lack of socialization is evident in the interview. Loss of socialization contributes to depression. This patient is at risk for depression.

 

Question 68 

The FNP has a patient who has been diagnosed with a serious illness. The patient demands to know from the  the FNP why she is the one to have this disease. She vehemently states that she is too young to have to contend with a serious illness. Which of the following stages of grief is this patient demonstrating? 

  depression 

   denial 

   anger 

  bargaining 

Correct answer:

anger

 

This patient is displaying the anger stage of grief. The five stages of grief include: denial, anger, bargaining, depression and acceptance.

 

Question 69 

For a healthcare professional to obtain blood at the request of law enforcement officials without a patient’s consent which of the following must be present? 

  The suspect must be under arrest. 

  A delay in drawing blood would lead to destruction of evidence. 

   The test is performed in a reasonable manner. 

   all of the above 

Correct answer:

all of the above

 

All of the first three choices are factors that must be present. Two other conditions must also be present: the likelihood that the blood drawn will produce evidence for criminal prosecution; and the test is reasonable and not medically contraindicated.

Question 70 

A 60-year-old male comes to the clinic complaining of a sudden onset of severe frontal headache with eye pain. He tells the FNP that his vision is blurred and his eyes are tearing. He also sees halos around lights. Which of the following conditions would the FNP most likely suspect? 

   primary closed-angle glaucoma 

  primary open-angle glaucoma 

   subconjunctival hemorrhage 

  macular degeneration 

 

Correct answer:

primary closed-angle glaucoma

 

Primary closed-angle glaucoma is a sudden blockage of aqueous humor causing markedly increased IOP causing ischemia and permanent loss of vision. The symptoms reported by the patient point to primary closed-angle glaucoma more than any of the other choices.

 

Question 71 

When treating Peyronie's disease, which of the following should be considered for the initial treatment?

 

   trial of vitamin E 

  oxybutynin (Ditropan) 

   circumcision 

  surgery 

 

The Correct answer is:

Trial of Vitamin E

In Peyronie's disease, inflammation of the penis causes fibrous tissue to contract and distort the shape of the penis. With severe curvature of the penis, sexual functioning is impaired, as an erection is painful and in some cases hindered. The initial treatment for Peyronie’s disease can include vitamin E, which helps reduce the thickened fibrous tissue and promote healing. Additional treatment options are Para-aminobenzoate, corticosteroids and radiation therapy. Surgery is not recommended unless the distortion of the penis is severe. Surgically removing the scar tissue can lead to erectile dysfunction.

Question 72 

A nurse practitioner (NP) has worked at a large hospital as an RN and now, as a new NP. She has developed an NP-managed clinic for hospital employees and is employed by the hospital. The NP is described as a(n): 

  risk taker 

   nurse specialist 

   intrapreneur 

  entrepreneur 

The Correct answer is:

Intrapreneur

An intrapreneur is someone who is able to carve out a specialty role within an existing organization, healthcare setting, or business setting. An entrepreneur is someone who assumes the financial and personal risks of owning their own business, which they also operate. 

 

 Question 73 

The nurse practitioner is treating a patient in a long-term facility whose roommate has been diagnosed with active tuberculosis. The patient should be started on chemoprophylaxis: 

  within 72 hours after PPD skin test results are obtained 

  only if PPD skin test results are positive 

   within 3 months if the repeated skin test is positive 

   as soon as possible and initiated at the time of the screening skin testing 

The Correct answer is:

As soon as possible and initiated at the time of the screening skin testing

Chemoprophylaxis is initiated at the time of the screening skin testing. This testing should be repeated in 3 months if initial test results are negative. If the second skin testing is negative, chemoprophylaxis can be stopped.

 Question 74 

The nurse practitioner (NP) is examining a 2-month-old infant in the office and suspects infantile colic. A complete physical examination reveals no abnormalities. What further study might the NP order? 

  blood culture 

  CBC and differential 

   chest radiograph 

   none of the above 

 

The Correct answer is:

None of the above

Once careful evaluation has been done and no evidence of other problems are noted, it is important to explain to the parents that no medication is available to treat the condition. The parents need to be informed that the colic most often resolves with no problems by age 3 months and no testing is necessary. 

 

 Question 75 

The following are all reasons to keep a child out of school or daycare EXCEPT for which of the following? 

  diarrhea with blood or mucus 

  purulent conjunctivitis 

   streptococcal pharyngitis, until 3 days after initiation of treatment 

  impetigo, until 24 hours after initiation of treatment 

 

The Correct answer is:

Streptococcal pharyngitis, until 3 days after initiation of treatment

The child may go back to school 24 hours after initiation of treatment for streptococcal pharyngitis. The remaining answer choices are all correct. Other childcare exclusions are: (1) pediculosis, until after the first treatment is given, (2) scabies, until after treatment is given, (3) varicella, until all lesions are crusted over, (4) pertussis, until after 5 days of antibiotics therapy, (5) hepatitis A, until 1 week after illness began and (6) tuberculosis, until no longer infectious.

 

Question 76 

A 5-year-old girl (weight 18 kg) is diagnosed with bilateral otitis media. Her last ear infection was 6 months ago, and she had no known drug allergies. An appropriate medication to prescribe would be: 

  corticosteroid otic solution 3 gtt both ears x 10 days 

   amoxicillin 75-90 mg/kg/day bid x 10 days 

   doxycycline 250 mg 1 tsp PO tid x 10 days 

  ampicillin 40-50 mg/kg/day tid x 7 days 

The Correct answer is:

Amoxicillin 75-90 mg/kg/day bid x 10 days

The recommended treatment for otitis media in a child is amoxicillin 75-90 mg/kg/day or for this child at 18 kg, 250 mg/5ml, 2.75 tsp bid x 10 days. The other medications are not appropriate for the treatment of acute otitis media. 

 

Question 77 

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

  Coronary bypass surgery. 

   Angioplasty. 

   Cardiac catherization. 

  Heart transplant. 

 

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

 

Question 78 

 The telescoping of part of the bowel into another part of the bowel is known as which of the following?

 

  Meckel’s diverticulum 

  incarcerated inguinal hernia 

  Hirschsprung’s disease 

   intussusception 

Correct answer:

intussusception

 

Intussusception is the telescoping of part of the bowel into another. It results in decreased blood flow. Ischemia and infarction of the intestine may occur if it is not treated. Ileocolic intussusception is most common.

 

Question 79 

You are using the CAGE questionnaire to evaluate a client and manage their disease process. The nurse practitioner knows the major advantage of this is: 

  sensitivity 

  specificity 

   brevity 

  interpretation 

The Correct answer is:

Brevity

CAGE stands for Cut, Annoyed, Guilty, and Eye opener. This is used in screening for alcohol abuse. It consists of 4 questions related to the patient's history. The "C" is for asking if the patient felt the need to cut down. The "A" is to ask if the patient was annoyed by criticism about his drinking. The "G" is for being guilty about the drinking. The "E" is for eye opener and if the patient has a need for this. The majority of alcoholics will respond to yes to at least 2 of these questions. 

 

Question 80 

Which of the following statements would be incorrect in terms of a patient’s right to informed consent? 

  A patient has a right to consent to care being given. 

   A patient does not have the right to refuse care. 

   Informed consent involves disclosure of material risks of care. 

   Informed consent requires that there be no coercion in getting a patient to consent to care.

Correct answer:

A patient does not have the right to refuse care.

 

A patient has a right to consent to the care being given and a right to refuse care that is offered. The FNP has a legal responsibility to give a patient enough information about risks and benefits of care being offered so that the patient can make an informed decision to accept or refuse care.

 

Question 81 

In Urie Bronfenbrenner’s person-place-process model of human growth and development which system would include home and school? 

  exosystem 

  macrosystem 

   microsystems 

  mesosystem 

Correct answer:

microsystems

 

Microsystems include the immediate settings within which a child spends time during development. Home and school fall into this system.

 Question 82 

Which of the following would be considered a high daily dose of the inhaled corticosteroid Flunisolide 250 mcg/puff? 

  >1250 mcg 

  >750 mcg 

   >500 mcg 

   >2000 mcg 

 

Correct answer:

>2000 mcg

 

A high daily dose of the inhaled corticosteroid Flunisolide 250 mcg/puff would be >2000 mcg. A low daily dose of this medication would be 500 – 1000 mcg; a medium daily dose would be 1000 – 2000 mcg.

 

Question 83 

Which of the following skin conditions would be most indicative of Kawasaki disease? 

  smooth round papules 5 mm in size 

  Koplik’s spot 

   honey-colored crusted lesions 

   bright red and swollen skin palms and soles 

Correct answer:

bright red and swollen skin palms and soles

 

This is the condition most indicative of Kawasaki disease. You may also see strawberry tongue and bright red conjunctivitis with no exudate.

 

Question 84 

All of the following are significant risks for a woman for developing a urinary tract infection EXCEPT: 

  drinking excessive caffeinated beverages 

  frequent sexual activity 

   frequent constipation 

   taking showers instead of baths 

 

The Correct answer is:

Taking showers instead of baths

No risks for the development of urinary tract infection occurs for adult women while taking a shower.  However, bubble baths are risk factors for urinary tract infections in children. Then, the remaining answer choices, such as frequent constipation, frequent sexual activity and drinking excessive caffeinated beverages, represent risk factors for developing urinary tract infections.

Question 85 

A female patient who has been treated for a recurrent vaginal yeast infection should be educated to do all but which of the following? 

  Wear cotton underwear. 

   Douche daily. 

   Avoid douches and douche sprays. 

  Wear loose-fitting pants. 

 

Correct Answer: Douche daily Patients with recurrent yeast infections should avoid douching. It can force bacteria into the vagina and irritate vaginal tissues. This patient should be educated to wear loose fitting pants and cotton underwear and to avoid douching and douche sprays.

 

Question 86 

Which of the following is an absolute contraindication for fibrinolysis in ST segment elevation myocardial infarction? 

  history of chronic hypertension 

   prior intracranial hemorrhage 

   pregnancy 

  active peptic ulcer 

Correct answer:

prior intracranial hemorrhage

A history of prior intracranial hemorrhage is an absolute contraindication for fibrinolysis in ST segment elevation myocardial infarction. The other choices are relative contraindications.

 

Question 87 

A mother brings in her 2-year-old male child who is hoarse and has a “strange-sounding cough.” She tells you that the child has recently had a bad cold and that the cough came on suddenly the previous night. He does not have a fever. Which of the following is the most likely diagnosis?

 

  epiglottis 

  bacterial tracheitis 

   spasmodic croup 

  laryngotracheitis 

Correct answer:

spasmodic croup

 

Spasmodic croup occurs in children aged 3 months to 3 years. It may be postviral and occurs suddenly, usually at night. The child has a barking cough but no fever.

 

 Question 88 

A patient who has recently been prescribed Savella for fibromyalgia should be made aware of all but which of the following potential side effects? 

  Risk of abnormal bleeding. 

  Constipation. 

   Diarrhea. 

  Insomnia. 

Correct Answer: Diarrhea Diarrhea is not among the common reported side effects of Savella. Constipation and insomnia are commonly reported. Savella does elevate the risk of abnormal bleeding, which is a potentially more serious side effect. 

 

Question 89 

Which of the following would be considered a clinical manifestation of anaphylaxis? 

  urticaria 

  hypotension 

  headache 

   all of the above 

Correct answer:

all of the above

 

All of the choices are clinical manifestations of anaphylaxis. Other indicators are: upper airway edema; dyspnea and wheezing; itch without rash; angioedema; flush; dizziness and syncope; GI symptoms; substernal pain; and seizure

 

 Question 90 

The stage of group dynamics in which group members try to establish their own personal identities, and conflict over goals is dominant is which of the following?

 

  forming 

  performing 

   norming 

   storming 

Correct answer:

storming

 

In the storming stage there is normally some anxiety as members try to create an impression and to test each other, thereby establishing their own identities. During this stage, competition over the leadership role and conflict over goals are dominant.

 Question 91 

You are educating a man on the use of sildenafil (Viagra) and understand that patient education includes: 

  This medication helps almost all men regain erectile function. 

   With the use of the medication, sexual stimulation is also needed to achieve an erection. 

  It will take approximately 1 hour before a spontaneous erection will occur. 

  This medication works great for problems with libido. 

The Correct answer is:

With the use of the medication, sexual stimulation is also needed to achieve an erection.

Viagra does not help all men who experience erectile dysfunction (ED). The half-life of Viagra is approximately 4 to 5 hours. While the effectiveness of Viagra occurs around 1 hour post ingestion, it does not lead to a spontaneous erection. The medication does not increase sex drive or libido. 

 Question 92 

Your patient is complaining of facial pain that she says begins on the side of her mouth and then shoots up toward her ear. You suspect which of the following? 

  cluster headaches 

  facial migraine 

   trigeminal neuralgia 

  herpes zoster 

Correct answer:

trigeminal neuralgia

 

Trigeminal neuralgia is a recurrent unilateral facial pain syndrome. It most often affects the maxillary division of the trigeminal nerve. Patients complain of pain on one side of the face and may have a small degree of numbness.

 

 Question 93 

Which of the following is NOT one of the principles of structural functional family theory? 

  Families are social systems. 

  In well functioning families members take on predictable roles. 

   Individuals in the family adopt norms, values and cultural traditions. 

   Families are composed of large numbers with characteristics of large-group behavior. 

Correct answer:

Families are composed of large numbers with characteristics of large-group behavior.

 

This is not one of the principles of structural functional family theory. It is actually opposite. Families are composed of small numbers with characteristics of small-group behavior.

 

 Question 94 

For treating a simple skin infection, the nurse practitioner knows that which of the following is an appropriate first line therapy?

 

  metoprolol 

   cephalexin 

  inderal 

  verapamil 

The Correct answer is:

Cephalexin

Two first generation antibiotics used to treat skin and skin structure infections are cephalexin and cefadroxil. These antibiotics do not cover organisms that produce beta-lactamase. 

 Question 95 

You are prescribing an acid suppression drug for your patient who suffers from GERD. Which of the following is NOT an acid suppression drug? 

   Prilosec 

  Tagamet 

   Axid 

  Pepcid 

 

Correct answer:

Prilosec

 

Prilosec is a proton pump inhibitor. All of the other choices are acid suppressants.

 

 Question 96 

Which of the following drugs is NOT a selective serotonin reuptake inhibitor (SSRI)? 

  Prozac 

  Paxil 

   Elavil 

  zoloft 

 

Correct answer:

Elavil

 

Elavil is not an SSRI. It is a tricyclic antidepressant and unlike SSRIs it is not used as a first line of treatment for depression.

 

 Question 97 

Which of the following is NOT correct concerning electronic prescriptions, commonly known as e-prescriptions? 

   Electronic prescriptions are transmittable through one technical device at present. 

  Electronic prescriptions can enhance patient safety and compliance, improve prescribing accuracy and cut costs. 

   The DEA currently inhibits the use of electronic prescriptions for controlled substances. 

  Electronic prescribing systems are securely linked to pharmacies and major health plans. 

The Correct answer is:

Electronic prescriptions are transmittable through one technical device at present

There are many systems available and the e-prescriptions can be delivered through a variety of devices. Hand held devices, tablet formatted computers, desktop computers, laptop computers and personal digital assistants all can deliver electronic prescriptions. 

 

 Question 98 

Which of the following drugs would more likely be prescribed for stress incontinence rather than urge incontinence? 

  Ditropan 

  Santura 

   Enablex 

   Premarin 

Correct answer:

Premarin

 

Hormone therapy is sometimes prescribed for stress incontinence. Conjugated estrogen (Premarin) or Progestin (Medroxyprogesterone) (if the uterus is present) may be prescribed.

 

 Question 99 

Which of the following is most likely to cause chronic pelvic pain rather than acute pelvic pain? 

  PID 

   leiomyomas 

   ovarian cyst 

  renal calculi 

Correct answer:

leiomyomas

 

Of the choices given leiomyomas are the most likely to cause chronic rather than acute pelvic pain. Other causes of chronic pelvic pain include: endometriosis, malignancy of the uterus, ovary, or colon; adhesions; and interstitial cystitis.

 

Question 100 

The nurse practitioner knows that it is developmentally important to do what during the physical examination of an adolescent female?

 

  Discuss only the major areas of abnormality. 

   Verbally affirm normalcy. 

   Verbally address problems of sexually transmitted diseases. 

  Maintain a comfortable silence. 

 

The Correct answer is:

Verbally affirm normalcy

During the adolescent years there is a need to discuss the physical changes that the patient is undergoing. Further, verbal affirmation of normalcy is necessary to decrease anxiety. 

quiz 14 aanp

Question 1 

The most common complication, and the cause of most pertussis-related deaths is which of the following? 

  heart failure 

   secondary bacterial pneumonia 

  viral pneumonia 

  none of the above 

 

Correct answer:

secondary bacterial pneumonia

 

Infants are at the highest risk for having pertussis-associated complications. The most common complication, and the cause of most pertussis-related deaths, is secondary bacterial pneumonia.

 

Question 2 

The FNP has a 6-year-old male patient with impetigo. She prescribes antibiotic therapy for the child and tells his mother that he should not return to school until: 

  one week after initiation of antibiotic therapy 

  3 days after initiation of antibiotic therapy 

   24 hours after initiation of antibiotic therapy 

  the impetigo has resolved 

Correct answer:

24 hours after initiation of antibiotic therapy

 

The treatment of impetigo is important to minimize risk of infectious transmission. Children with impetigo should be kept out of school or day care for 24 hours after initiation of antibiotic therapy. Family members should also be checked for lesions.

 

Question 3 

You are discussing sleep with an aging adult. It is important the nurse practitioner understands: 

  Increased delta or stage IV sleep occurs with age. 

  Decreased sleep latency occurs with age. 

   An aging adult has decreased rapid-eye-movement (REM) sleep. 

  There are decreased nocturnal awakenings with the older adult. 

The Correct answer is:

An aging adult has decreased rapid-eye-movement (REM) sleep

REM sleep is associated with skeletal muscle atonia and dreaming. It occurs in three of four regular spaced 10 to 15 minute cycles and starts 120 minutes after the onset of sleep. With age, REM decreases. Delta sleep, or stage IV, is a deep sleep and also decreases with age. Nocturnal awakening and sleep latency increases with age. 

 

Question 4 

While assessing a patient, a NP noticed symptoms that appeared similar to those of a patient with Alzheimer's. Rather than immediately treating the patient, the NP ordered more testing. Which symptom did the NP LEAST likely observe? 

  Decreased response time. 

   Increased risk for falls. 

   Increased cognitive performance. 

  Decreased memory. 

Correct answer: Increased cognitive performance The opposite is true. Patients experiencing symptoms of Alzheimer's of lack of sleep, generally battle with decreased cognitive performance. 

 Question 5 

At which stage of group dynamics can the group be considered as having matured? 

   performing 

  norming 

   adjournment 

  storming 

Correct answer:

performing

 

At this stage the roles of individual members are accepted and understood. It can be said that the group has matured and it is at this point that it becomes effective.

Question 6 

All of the following are nonpharmacologic treatment options for people with rheumatoid arthritis to complement their medication routine except:

 

  dietary modification and increase in fluid intake to >3 liters/day

 

   gain weight to prevent further bone loss 

   complete bed rest during an acute attack 

  do not exercise a hot inflamed joint 

 

The Correct answer is:

Gain weight to prevent further bone loss

Obese patients with rheumatoid arthritis (RA) would benefit from weight loss or maintaining their current weight in order to prevent joint overload. Further, the answer choices, dietary modification and increase in fluid intake to >3 liters/day, engage in complete bed rest during an acute attack and avoiding exercise with a hot inflamed joint, are all good measures to help with rheumatoid arthritis (RA) symptoms.

 Question 7 

When treating a patient with suspected cancer, the nurse practitioner understands that the most common cancer deaths in males and females is directly related to: 

  colon cancer 

   lung cancer 

  brain cancer 

  leukemia 

 

The Correct answer is:

Lung cancer

Lung cancer is the leading cause of mortality in males and females diagnosed with the condition than any other cancer type. One of the major causes of lung cancer is cigarette smoking. Patients with lung cancer may show symptoms of coughing that is persistent. In some patients, they cough up blood or have streaks of blood in the sputum. Other symptoms of lung cancer are fatigue, pain in the chest, weight loss and weakness.

 Question 8 

A 52-year-old male patient presents in the office and you notice a yellowish plaque on his upper eyelid that is painless. What should the nurse practitioner look for? 

  liver function studies 

   lipid levels 

   sedimentation rate 

  vision in the affected eye 

The Correct answer is:

Lipid levels

The yellowish painless plaque on the patient's upper eyelid is descriptive of xanthelasma. Additionally with xanthelasma, the plaque is slightly raised and well-circumscribed on the upper eyelid. Further, one or both eyelids may be affected. Xanthelasma is often associated with lipid disorders but may occur independent of any systemic or local disease. However, xanthelasma does not affect vision.

Question 9 

An adult female comes to your clinic complaining of a rash on her hands. You ask her if there have been any changes in detergent, lotion, etc. that come in contact with her hands. She tells you that she changed her brand of dish detergent recently and that she washes all her dishes by hand. Which of the following would you diagnose for this patient?

 

   contact dermatitis 

   atopic dermatitis

  scabies 

  psoriasis 

Correct answer:

contact dermatitis

 

Contact dermatitis is a cutaneous reaction to an external substance such as an irritant or allergen. It appears as an asymmetric distribution of red, raised, and/or inflamed rash, or rash only on exposed areas. 80% of cases are due to universal irritants such as soap and detergent.

Question 10 

Patient medical records play a critical role in utilization review and quality assurance. The nurse practitioner understands that all of the following are correct statements regarding quality assurance EXCEPT: 

  Patients' records are a primary source of data for such utilization review and other quality assurance activities. 

   State laws, statutes, and regulations do not vary on utilization review and quality assurance principles. 

   Accreditation organizations have standards related to quality assurance and utilization review. 

  Many states have enacted laws protecting the confidentiality of medical records used in utilization management and quality assurance functions. 

The Correct answer is:

State laws, statues, and regulations do not vary on utilization review and quality assurance principles

State laws vary widely on utilization review. Additionally, statues and regulations mandating quality assurance activities vary in terms of level of detail.

 

Question 11 

Excluding NPs from being designated as primary care providers, as has been done in some managed care organizations, results in all of the following EXCEPT: 

   The NP must work independently of the primary care physician. 

  The NP becomes a “ghost” provider. 

   Job security can be threatened since the NP cannot document services provided and revenue generated. 

  All of the above 

Correct answer:

The NP must work independently of the primary care physician.

 

As a result of excluding NPs from being designated as primary care providers, the only option for NPs is to become a salaried employee. As a salaried employee, the NP contributions are often not visible and may be credited to the collaborating physician.

Question 12 

A pregnant patient is concerned about genetic abnormalities. When is it too late to perform a CVS test? 

   11 weeks. 

  6 weeks. 

   5 weeks. 

  2 weeks. 

 

Correct answer: 11 weeks Chorionic villus sampling (CVS) can identify genetic abnormalities. It uses the placenta and should not be done after 10 weeks. 

 Question 13 

Which of the following are you least likely to recommend as a nonpharmacologic treatment for hyperlipidemia? 

  smoking cessation 

   decreased use of soy products 

   increased physical activity 

  moderation of alcohol intake 

Correct answer:

decreased use of soy products

 

Rather than decreasing soy products, a person with hyperlipidemia should increase his intake of soy products. Diet changes would also be made.

Question 14 

 Bony nodules on the proximal interphalangeal joints are none as which of the following?

 

  Heberden’s nodes 

   Bouchard’s nodes 

   degenerative joint nodes 

  none of the above 

Correct answer:

Bouchard’s nodes

 

Bouchard’s nodes are bony nodules on the proximal interphalangeal joints. Heberden’s nodes are bony nodules on the distal interphalangeal joints.

Question 15 

 Of the following, which is an early stage of Lyme disease?

 

   erythema migrans 

  tinea versicolor 

   fragile bulla 

  “sandpaper” rash 

 

Correct answer:

erythema migrans

 

Erythema migrans involves red target lesions that expand and grow in size. It is an early stage of Lyme disease.

Question 16 

Which of the following drugs used for peripheral vascular disease is a neuropathic analgesic? 

  Keflex 

  Dynapen 

   Cipro 

   Tegretol 

Correct answer:

Tegretol

 

Tegretol is a neuropathic analgesic. The other drugs are not. Other neuropathic alagesics are Neurontin and Elavil.

Question 17 

Which of the following screening and assessment tests used in child health supervision is NOT used exclusively for developmental screening and assessment for infants and/or toddlers? 

  Denver II 

   HOME scale 

  Ages and Stages Questionnairre 

  First Step 

Correct answer:

HOME scale

 

The HOME scale is not used exclusively for infants/toddlers. It is the Home Observation for Measurement of the Environment scale. It has infant, preschool and elementary school versions.

 

Question 18 

You are considering prescribing birth control to a 21-year old who has previously been using condoms. Which of the following is a contraindication to combined oral contraception (COC)? 

  cigarette smoking 

  a personal history of untreated hepatitis C 

   presence of factor V Leiden mutation 

  first-degree relative with breast cancer 

The Correct answer is:

Presence of factor V Leiden mutation

The known thrombotic mutation, factor V Leiden, can lead to venous thromboembolism and combined oral contraceptives are not to be used. The World Health Organization (WHO) has published four categories of precautions for use of combined oral contraception (COCs) and category 4 "Refrain From Use" lists the factor V Leiden. Cigarette smoking in those over 35 is a contraindication but a personal history of hepatitis C and a relative with breast cancer are not contraindications. 

Question 19 

Quality assurance is a system designed to evaluate and monitor quality of care. Which statement is NOT an accurate concerning quality assurance? 

  These programs identify components of structure, process and outcomes of care. 

  These programs look at organization effectiveness, efficiency and client and provider interactions. 

   These programs audit financial records and payroll of the organization to evaluate appropriateness of monetary distribution. 

  These programs promote responsibility and accountability to deliver high-quality care and assist in the evaluation and improvement of patient care. 

The Correct answer is:

These programs audit financial records and payroll of the organization to evaluate appropriateness of monetary distribution

Payroll and financial records of an organization are not evaluated and viewed in a quality assurance program. These programs are set up to evaluate and monitor the care of patients by providers, ancillary staff, personnel and the facility in general. 

 

Question 20 

It is common for the nurse practitioner (NP) to deal with anxiety and depression in the clinic setting. To treat and understand these conditions, the NP knows that presentation includes:

 

  dry mouth 

  feeling elated 

   energetic 

   psychomotor agitation 

The Correct answer is:

Psychomotor agitation

There are many signs and symptoms of anxiety and depression, which are are often seen together in a patient presenting for primary care. Psychomotor agitation with fidgeting and irritability is often found in patients with these disorders. Being energetic and feeling elated are more common diagnostic criteria of bipolar disorder. Other symptoms are changes in appetite and sleep, fatigue, decrease of self-worth, problems with concentration, loss of interest in usual things and thoughts of death. 

Question 21 

A 67-year-old man is in the clinic with frequent dizziness while standing. Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases:

 

  more than 20 points any time after rising 

  more than 20 points within one minute after rising 

   any degree drop if the patient becomes weak or dizzy 

   more than 20 points within three minutes after rising 

The Correct answer is:

More than 20 points within three minutes after rising

Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving to an upright position. It can be evaluated from lying to sitting or from sitting to standing. Also, if the systolic reading does not drop but the diastolic drops by 10 mm Hg or more, postural 

 

Question 22 

Which of the following pathogens is the most common cause of fatal community-acquired pneumonia? 

  M. pneumoniae 

  H. influenzae 

   Legionella spp. 

   S. pneumoniae 

Correct answer:

S. pneumoniae

 

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

Question 23 

Which of the following conditions is most likely to be found in a person with acute cholecystitis? 

  fever 

  jaundice 

   vomiting 

  palpable internal joint 

The Correct answer is:

Vomiting

Acute cholecystitis symptoms include vomiting, right upper abdomen pain, and nausea. Fever, jaundice and a palpable internal joint are not seen in patients with cholelithiasis. Cholelithiasis is defined as a condition in which there is the formation of calculi or gallstones. 

 

Question 24 

Which of the following statements about communication in the nursing profession is least accurate?

 

  Communication should have objective and purpose. 

  Credibility is very important. 

   Messages should convey something of value to the receiver. 

   The organizational climate is not important in most communication. 

 

Correct answer:

The organizational climate is not important in most communication.

 

This is the least accurate statement. The organizational climate is important in most communication. This includes appropriate timing and physical setting to convey the desired meaning of the communications.

 

Question 25 

Which of the following is an example of objective data used for diagnosis? 

  Patient complains of dizziness. 

   Patient's blood pressure is 180/90. 

   Patient's blood pressure is elevated. 

  Patient is hypertensive. 

 

Correct Answer: Patient's blood pressure is 180/90 Objective data must be measurable and verifiable. It is key to collect both objective and subjective data to form correct differential diagnoses and then to determine the correct diagnosis and course of further testing or treatment for a patient. The ability to synthesize both objective and subjective data is a key skill for NPs. 

Question 26 

When counseling a male patient on impotence, the nurse practitioner understands the following to be true:

 

  It is caused by infections only. 

  It is not the result of vascular problems. 

   It can be caused by antihypertensives. 

  It is not the result of multicausal factors. 

The Correct answer is:

It can be caused by antihypertensives

Impotence is caused by many different things and is not specifically caused only by an infection. It can be caused by antihypertensives, like nonselective beta-blockers, that decrease vascular resistance and central effect. Other known causes are infections, vascular disorders, trauma, and psychological disorders. 

Question 27 

You are treating a 60-year-old depressed female and started an SSRI. When should another antidepressant be tried if there is no response? 

  5-10 days 

  2-4 weeks 

   4-6 weeks 

   8-12 weeks 

The Correct answer is:

8-12 weeks

Most authorities agree that if there is no response by 8-12 weeks at a maximum therapeutic dose, a different antidepressant should be tried. The time frame is adequate to achieve effectiveness. 

 

Question 28 

When treating a 26-year-old Caucasian female for secondary amenorrhea, it is important for the nurse practitioner to have knowledge that:

 

  Approximately 30% of patients with secondary amenorrhea have associated genetic abnormality. 

   Pregnancy is the most common cause of secondary amenorrhea. 

   It is commonly seen in Turner syndrome. 

  It is often cause by a sexually transmitted disease. 

The Correct answer is:

Pregnancy is the most common cause of secondary amenorrhea

Secondary amenorrhea is a minimum of 3 missing cycles or 6 months of cessation of menses after menarche is established. The most common cause of secondary amenorrhea is pregnancy with other causes being polycystic ovary disease, hypothalamic amenorrhea, thyroid dysfunction and hyperprolactinemia being others. Approximately 30% of the patients with primary amenorrhea, not secondary amenorrhea, have associated genetic abnormalities. Further, primary amenorrhea, and not secondary amenorrhea, is commonly seen in Turner syndrome. Sexually transmitted disease does not cause this. 

Question 29 

Your patient has a squamous cell carcinoma. You understand that this presents as which of the following? 

  scar-like lesion, whitish/yellow, smooth and shiny 

   firm to hard erythematous, scaly nodule 

   blue, brown, or black waxy papule 

  none of the above 

Correct answer:

firm to hard erythematous, scaly nodule

 

Squamous cell carcinoma usually presents as firm to hard, erythematous, scaly or ulcerated nodules. Squamous cell carcinomas are isolated, keratotic, eroded, ulcerated lesions that grow rapidly.

Question 30 

You are providing care to a female patient who reports having 1 to 2 migraines per month. She asks if there are any foods she should avoid. Which of the following foods are NOT known to trigger migraines in some people? 

  Dairy. 

  Bleu cheese. 

   Lean red meat. 

  Red wine. 

 

Correct Answer: Lean red meat Lean meat and poultry are not known to trigger migraines. Dairy, especially full-fat dairy, can trigger migraines for some people. Cheeses containing tyramine, including bleu cheese, can also be triggering. Alcohol, especially red wine and beer, may also be trigger foods for some people. The patient should note any specific triggers she has as well and avoid or limit those foods. 

 

 Question 31 

As an NP you understand that the anatomy of the skin involves three layers and that the fat and sweat glands are located in which of the following layers? 

  epidermis 

  dermis 

   bottom epidermis 

   subcutaneous 

Correct answer:

subcutaneous

 

The skin has three layers: epidermis (top and bottom), dermis, and subcutaneous. The subcutaneous layer includes fat, sweat glands, and hair follicles.

Question 32 

When recommending cardiopulmonary conditioning for a patient, you would calculate the target heart rate for 30 minutes of exercise. If a patient is 50 years old what would his target heart rate be? 

  170 

  153 

   136 

  119 

 

Correct answer:

136

 

The target heart rate that should be sustained is found by subtracting the patient’s age from 220 and multiplying the result by 0.8. In this case 220 - 50 = 170; and 170 x 0.8 = 136.

Question 33 

Which of the following is NOT a normal physiologic change during pregnancy? 

  Cardiac output increases by 1/3 by the last two trimesters. 

   Plasma volume decreases by 50% by the end of the third trimester. 

   Decreased systolic and diastolic pressure occurs in the first trimester. 

  There is decreased peristalsis from progesterone effects. 

Correct answer:

Plasma volume decreases by 50% by the end of the third trimester.

 

This would not be a normal physiologic change during pregnancy. Plasma volume increases by 50% by the end of the third trimester. Hemoglobin and hematocrit are decreased because of the hemodilution from increased plasma volume. And the heart is displaced upward and to the left in the late second to third trimester.

 

 Question 34 

Which of the following is a pansystolic murmur that is heard best at the apex or the apical area, radiates to the axilla and is a loud-blowing and high-pitched murmur? 

  tricuspid regurgitation 

   aortic stenosis 

   mitral regurgitation 

  none of the above 



Correct answer:

mitral regurgitation

 

Mitral regurgitation is a pansystolic murmur that is heard best at the apex or the apical area, radiates to the axilla and is a loud-blowing and high-pitched murmur. The diaphragm of the stethoscope is used to detect mitral regurgitation. 

Question 35 

Before deciding to provide a detailed reference on a former employee, it would be important for the Family Nurse Practitioner to consider which of the following? 

  If the comments are perceived as negative and the former employee becomes aware of them, the nurse could be subjected to a lawsuit for defamation. 

  If the employee exhibits unsafe patient care practices, it may be wiser to risk legal action from the employee than to subject future patients to this unsafe practitioner. 

  The requirements of the human resources department should be determined. 

   all of the above 

The Correct answer is:

All of the above

If the human resources department has established guidelines for the handling of references, it would be wise to follow them. It is also an effective mechanism to deflect potentially problematic queries by passing requests to the department most equipped to circumspect about particular released information. Without protective state legislation, employers should be prudent about sharing comments on former employees' work histories. 

Question 36 

Your patient has an intense and brief sharp stabbing pain on one cheek that is aggravated by cold food, cold air and chewing. Of the following which is most likely the cause?

 

  migraine 

   trigeminal neuralgia 

   temporal arteritis

 

  cluster headache 

Correct answer:

trigeminal neuralgia

 

Trigeminal neuralgia (Tic Douloureux) is a unilateral headache caused by impingement or inflammation of the trigeminal nerve (CN5). It is rare before age 35 and peaks at age 60.

 

Question 37 

Sigmund Freud developed a stage theory of psychosocial development. At which age does a person reach the genital stage? 

  preschool 

  school age 

   adolescence 

  post-adolescence 

 

Correct answer:

adolescence

 

Adolescence is the genital stage according to Freud. The stages are: infancy – oral; toddler – anal; preschool – phallic; school age – latency; and adolescence – genital.

Question 38 

Gross painless hematuria is the most common presenting sign of bladder cancer. Persistent microscopic hematuria is the only finding in about what percentage of individuals presenting with bladder cancer? 

   20% 

  25% 

   35% 

  50% 

Correct answer:

20%

 

Persistent microscopic hematuria is the only finding in about 20% of individuals presenting with bladder cancer. Irritative voiding symptoms and urinary frequency without fever are reported occasionally. Abdominal mass is palpable only with advanced disease.

 

 Question 39 

Which of the following diseases/conditions has symptoms of fever, fatigue and weight loss; bleeding gums, nosebleeds, pallor, easy bruising, and petechiae in addition to bone pain? 

  acute hemorrhage 

   acute leukemia 

   Hodgkin’s lymphoma 

  neutropenia 

Correct answer:

acute leukemia

 

Acute leukemia is a cancer of the hematopoietic progenitor cells. The patient can have fever, fatigue and weight loss; bleeding gums, nosebleeds, pallor, easy bruising, and petechiae in addition to bone pain.

 

Question 40 

You are seeing an uncircumcised client that presents with a complaint of not being able to retract the foreskin over the glans penis. What is the likely diagnosis? 

   phimosis 

  paraphimosis 

   lateral phimosis 

  Peyronie's disease 

 

The Correct answer is:

Phimosis

Phimosis results in the patient's inability to retract the foreskin from behind the glans penis. This condition occurs at any age and is the result of poor hygiene and chronic infection. 

 

Question 41 

Madeline Leininger envisioned blending the disciplines of nursing and anthropology to enable a cultural perspective for nursing. This is known as which of the following? 

  ethnocentric nursing 

   transcultural nursing 

   enculturation 

  cultural transference 

 Correct answer:

transcultural nursing

 

Transcultural nursing is a term coined by Leininger. It involves blending nursing and anthropology in both theory and practice to enable a cultural perspective for the professional practice of nursing. It helps nurses to provide care that is culturally competent.

Question 42 

You have initiated treatment for your patient with fibromyalgia syndrome (FMS). You should do a follow-up visit: 

  within 48 hours 

  within 1 week 

   in 2 weeks 

   in a month 

 

Correct answer:

in a month

 

A follow-up visit in one month is appropriate for this patient. This should continue monthly until improvement in symptoms is noticed.

Question 43 

An example of a secondary prevention measure for a 55-year-old healthy and physically active female is which of the following? 

  yearly flu shot 

  recommending the use of bicycle helmets 

   educating her about skin cancer from sun exposure 

   doing a mammogram and Pap smear 

Correct answer:

doing a mammogram and Pap smear

 

Secondary prevention measures include activities provided to identify and treat asymptomatic persons who might be at risk for a particular disease or condition. Doing a mammogram and Pap smear is a secondary prevention measure. All of the other choices are primary prevention measures.

Question 44 

When counseling a mother on her newborn that presents with a concerning skin lesion, the nurse practitioner has knowledge that: 

  Erythema toxicum or infant acne is extremely rare and should be referred to a specialist. 

  Milia or prickly heat rash only occurs in warm regions of the world. 

   A Mongolian spot is a blue to black-colored patch or stain that is commonly located on the face of Caucasian children. 

   Strawberry hemangiomas are raised vascular lesions with a bright red color and up to 95% involute spontaneously. 

 

The Correct answer is:

Strawberry hemangiomas are raised vascular lesions with a bright red color and up to 95% involute spontaneously 

Erythema toxicum is common and there is no need for referral as it resolves spontaneously. Milia rash occurs with overheating of the infant in all regions of the world. Mongolian spots are common in African American, Asian, Hispanic, and Native American infants and are usually in the lumbosacral area. 

Question 45 

There are still many health care disparities in the United States. A setting with a shortage of personal health services is known as which of the following? 

  underrepresented minorities 

  disadvantaged 

   vulnerable 

   medically underserved community 

Correct answer:

medically underserved community

 

A medically underserved community is considered to be a setting with a shortage of personal health services. Underrepresented minorities are racial and ethnic populations whose representation among the health professions is lower than their proportion of the general population. Disadvantaged means inhibited from knowledge, skills and abilities to participate in the healthcare system as a provider or recipient. Vulnerable mean that a person is open to physical, emotional and/or socioeconomic harm.

 

Question 46 

A person with which type of skin would need longer periods of sun exposure to produce vitamin D? 

  light skin 

  freckled skin 

   medium complexion 

   darker skin 

Correct answer:

darker skin

 

In terms of vitamin D synthesis, a person with darker sin would need longer periods of sun exposure to produce vitamin D. A deficiency of vitamin D in pregnancy results in infantile rickets.

 

Question 47 

Which of the following statements about tendonitis and its treatment is false? 

   With rotator cuff involvement, the likelihood of concurrent bursitis is low. 

  When the hand or wrist is affected, splinting and NSAIDs are reasonable first-line therapies. 

  Achilles tendonitis may necessitate treatment with a posterior splint. 

   There is a 10% risk of tendon rupture with recurrent Achilles tendonitis. 

 

Correct answer:

With rotator cuff involvement, the likelihood of concurrent bursitis is low.

 

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

 

Question 48 

During an assessment of a patient, which of the following does NOT indicate depression? 

  Weight change. 

   New interests. 

   Loss of energy. 

  Loss of appetite. 

 

Correct answer: New interests Depressed people tend to withdraw and loss interest in their passions. The other answers are indicators that a patient is suffering from depression. 

Question 49 

Your adult female patient comes to you complaining of varicose veins. After confirming the diagnosis you would recommend which of the following? 

  refrain from elevating the leg 

  high sodium diet

 

   Vasotec 

   elastic compression stockings up to the knee 

Correct answer:

elastic compression stockings up to the knee

 

For varicose veins you might recommend elastic compression stockings up to the knee. You would also recommend weight loss if necessary and prescribe hydrochlorothiazide when there is fluid retention.

Question 50 

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

  Partial hysterectomy. 

   Myomectomy. 

   Fibroid embolization. 

  Uterine ablation. 

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

 

Question 51 

Which of the following managed care systems is most associated with capitation? 

  PPO 

   HMO 

   POS 

  fee-for-service 

Correct answer:

HMO

 

Health maintenance organizations have access to services that is based on a fixed monthly fee per enrollee. Control for utilization is maintained by the HMO.

 

Question 52 

Which of the following characteristics would be most associated with “atypical” pneumonia? 

  There is usually a sudden onset. 

  Fever and chills are common. 

   Lung exam shows dullness, with signs of consolidation. 

   Pleuritic pain is rare. 

 

Correct answer:

Pleuritic pain is rare.

 

This is the characteristic of the choices that is most associated with “atypical” pneumonia. Atypical pneumonia usually has a gradual onset. Fever and chills are rare; and there are often minimal abnormal findings in a lung exam.

Question 53 

In terms of spontaneous abortions, where there is vaginal bleeding and cramping but the cervix remains closed, it would be considered a: 

   threatened abortion 

  inevitable abortion 

   complete abortion 

  incomplete abortion 

Correct answer:

threatened abortion

 

When there is vaginal bleeding and cramping but the cervix remains closed it is a threatened abortion. It is possible in this case that the pregnancy can be salvaged. In an inevitable abortion the cervix is dilated. In a complete abortion the placenta and fetus are expelled completely. In an incomplete abortion placental products remain in the uterus and the cervix remains dilated.

 

 Question 54 

A 12-year-old female patient with Strep pharyngitis has received a prescription for amoxicillin. She has not improved in 72 hours. What course of action is acceptable? 

  A macrolide antibiotic should be prescribed. 

  The antibiotic should be changed to a first generation cephalosporin. 

   The patient should wait another 24 hours for improvement. 

   A penicillin or cephalosporin with beta lactamase coverage should be considered. 

Correct answer:

A penicillin or cephalosporin with beta lactamase coverage should be considered 

According some clinical studies, after the administration of antibiotics, such as amoxicillin, the patient diagnosed with streptococcal pharyngitis should have improvement in symptoms within 48-72 hours. If not, the provider may need to prescribe the patient a different antibiotic. With the 12-year-old female patient, since a streptococcal organism was diagnosed and amoxicillin was ineffective, the prescriber should consider that the patient has a resistant streptococcal organism and beta lactamase coverage is necessary.

Question 55 

A father brings in his teenage son. He is sure that the boy is sick because he is lethargic even though he is in bed 8 hours a night. The boy says that he is tired. When asked if he is sleeping the full 8 hours, he says that he does not fall asleep immediately. What is a probable explanation? 

  He has a cold. 

   He is sleep deprived. 

   He is taking drugs. 

  He is faking for attention. 

Correct answer: He is sleep deprived Many teenagers need close to nine hours of sleep a night. Additionally, their natural sleep patterns are later, and he probably is awake later than his father believes. Sleep deprivation is common among teenagers. 

Question 56 

Persons who are allergic to latex products are often allergic to all of the following EXCEPT: 

   apples 

  kiwi 

   bananas 

  avocado 

The Correct answer is:

Apples

It has been noted that those persons with latex allergy also often have a cross-allergy to kiwi, bananas and avocado. Apples pose no cross-allergy threat, making this the right answer in this case. 

 

Question 57 

Racial and ethnic populations whose representation among the health professions is lower than their proportion of the general population indicates which of the following? 

  health disparity 

  vulnerability 

   underserved minorities

 

   underrepresented minorities

 

Correct answer:

underrepresented minorities

 

Underrepresented minorities consist of racial and ethnic populations whose representation among the health professions is lower than their proportion of the general population. Underserved minorities are those whose access to healthcare is limited.

 

Question 58 

It has been determined that an elderly patient is suffering from long term insomnia. Which of the following is LESS likely to be considered a long term cause of the condition? 

  Nocturia. 

   Environmental changes. 

   Congestive heart failure. 

  Alcohol and substance abuse. 

 

Correct answer: Environmental changes There are various causes of insomnia in the elderly. While some may be the cause of short term insomnia and others long term insomnia, long term insomnia is more common in the elderly than short term. 

 

Question 59 

According to the CMS guidelines, medical decision making has three components. Which of the following is NOT one of these components? 

  making a diagnosis 

   counseling patient 

   choosing treatment options 

  reviewing data 

Correct answer:

counseling patient

 

Medical decision making has three components: making a diagnosis, choosing treatment options and reviewing data. While clinicians are expected to document patient counseling and coordination of services, there are no specific guidelines for this documentation.

 Question 60 

You are treating a patient with a persistent cough. Which of the following is NOT an accurate statement regarding when to consult or refer this patient? 

  Refer if patient is at high risk for malignancy. 

   Refer if patient refuses to stop smoking. 

   Refer to a pulmonologist if bronchoscopy is indicated. 

  Refer if cough is accompanied by blood for at least 2-3 days after there has been treatment initiated for a respiratory infection. 

The Correct answer is:

Refer if patient refuses to stop smoking

The patient's refusal to stop tobacco use is not a reason for referral or consultation, but a reason to counsel. 

Question 61 

Excessive thick scaling on the scalp of younger infants is which of the following? 

  erythema toxicum 

  milaria 

   seborrheic dermatitis 

  nevus flammeus 

 

Correct answer:

seborrheic dermatitis

 

Seborrheic dermatitis (cradle cap) is excessive thick scaling on the scalp of younger infants. It is treated by softening and removal of the thick scales on the scalp with mineral oil left on the scalp for 10 to 15 minutes before shampooing and scrubbing off the scales

Question 62 

At about what age does the Moro reflex disappear in an infant? 

  1 – 2 months 

   4 – 6 months 

   6 – 12 months 

  12 – 24 months 

Correct answer:

4 – 6 months

 

The Moro Reflex is the startle reflex. Sudden loud noise causes symmetric abduction and extension of the arms followed by adduction and flexion of the arms over the body. It disappears by 4 to 6 months.

 

Question 63 

The Global Initiative for Chronic Obstructive Lung Disease (COPD) guidelines specify which medications are indicated for certain stages of COPD. Which is indicated for all stages of the disease? 

  an inhaled corticosteroid 

   a short-acting inhaled bronchodilator 

   theophylline 

  guaifenesin 

 

The Correct answer is:

A short-acting inhaled bronchodilator

Albuterol and pirbuterol are beta 2 agonists that are bronchodilator. They are indicated as rescue drugs for treatment of acute bronchospasm for any of the stages of chronic obstructive lung disease.

 

Question 64 

Which type of seizure is characterized by unusual sense of smell or taste, visual or auditory hallucinations, and stomach upset followed by a vague stare and facial movements, muscle contraction and relaxation? 

  tonic-clonic (grand mal) 

  myoclonic 

   complex partial 

  absence (petit mal) 

The Correct answer is:

Complex partial

The onset age of complex partial seizures occurs at any age. Patients with complex partial seizures have aura that is characterized by unusual sense of smell or taste, visual or auditory hallucinations, stomach upset followed by muscle contraction and relaxation and autonomic signs. This can progress to loss of consciousness. 

Question 65 

In advising a pregnant woman, which of the following would be incorrect?

  Always wear a seat belt (below the uterine fundus). 

  Avoid exercise in hot and humid weather. 

   Relax in a hot tub or sauna when stressed. 

  Eat no raw shellfish or raw meat. 

Correct answer:

Relax in a hot tub or sauna when stressed.

 

The FNP would not advise a pregnant woman to use a hot tub or sauna. She would be advised not to use them.

Question 66 

Part of the job of an FNP is educating parents on safety measures for children. Which type of car seat or restraint is recommended for toddlers and preschoolers? 

  seat belt 

  booster 

   rear-facing convertible 

   forward-facing convertible, combination 

 

Correct answer:

forward-facing convertible, combination

 

Toddlers and preschoolers (children 1 year old and weighing at least 20 lb) can ride in a convertible, combination, forward-facing seat. It is best to ride rear-facing as long as possible, however.

Question 67 

As a nurse practitioner, you understand that rabies has a nearly 100% fatality rate. Which of the following characteristics is evidence of this? 

  communicability 

  immunogenicity 

   pathogenicity 

   virulence 

 

Correct answer:

virulence

 

Virulence is defined as the severity of disease that an organism can produce, measured by criteria such as number of days in bed or the frequency of serious sequelae including death. Rabies virus is highly virulent (nearly 100% fatality rate); poliovirus is moderately virulent; varicella and rhinovirus are of low virulence (almost zero fatality rate).

Question 68 

In the course of examining a 6 month old infant for a well-baby checkup you note that he has persistent fisting. You understand that this indicates which of the following? 

  The child is right on schedule for development. 

   This is a warning sign of a possible developmental problem. 

   This is not average for a 6 month old infant but is no cause for concern. 

  Fisting is expected for a child of this age. 

Correct answer:

This is a warning sign of a possible developmental problem.

 

Persistent fisting is a warning sign of a possible developmental problem. Other warning signs for a child of this age are: persistence of hand regard; failure to follow 180° (for both near and far objects); and preference of one hand.

 Question 69 

The usefulness of abdominal ultrasound to identify pancreatic cancer is limited by: 

  patient’s age 

   the presence of intestinal gas 

   technician’s skill 

  size of the tumor 

Correct answer:

the presence of intestinal gas

 

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

Question 70 

A professional designation such as "family practice nurse" is protected by law. This is called: 

  scope of practice 

   title protection 

   certification 

  licensure 

 

Correct answer:

title protection

 

Professional designation such as "family practice nurse" is protected by law. It cannot be used by anyone who does not meet the educational criteria for a family practice nurse. Laws such as this help protect the public from unlicensed persons. This is called title protection.

 

Question 71 

Treatment options for adult seizure patients include al of the following medications EXCEPT: 

  gabapentin 

  phenytoin 

   carbamazepine 

   aminophylline 

The Correct answer is:

Aminophylline

Numerous standard seizure therapies exist including gabapentin, phenytoin, carbamazepine, ethosuximide, lamotrigine, topiramate, valproic acid and clonazepam. However, aminophylline is not used to treat seizures.

 Question 72 

Title XIX of the Social Security Act is also known as which of the following? 

  Americans with Disabilities Act 

  Medicare 

   OSHA 

   Medicaid 

Correct answer:

Medicaid

 

Title XIX of the Social Security Act is also known as Medicaid which is a federal and state matching program that offers medical assistance to low income persons, the disabled, blind or members of families with dependent children. It pays for health care, nursing home, and prescription drugs.

Question 73 

The FNP has a pregnant patient whose uterine is grapefruit size. At what stage of pregnancy is this patient most likely to be? 

   12 weeks 

   16 weeks 

  10 weeks 

  8 weeks 

Correct answer:

12 weeks

 

At 12 weeks the uterus is softball or grapefruit size. It rises above the symphysis pubis and the uterine fundus is palpable through the abdominal wall.

Question 74 

Which of the following persons developed the first standardized measurement of intelligence? 

  G. Stanley Hall 

   Alfred Binet 

   Arnold Gesell 

  Sigmund Freud 

Correct answer:

Alfred Binet

 

Alfred Binet would be considered a proponent of the nature side of the nature vs. nurture debate. He developed the first standardized measurement of intelligence. The intention was to identify “mentally defective” children needing specialized education.

Question 75 

Of the following choices which condition is most likely to have a positive Gram stain, positive U/A and hyperperfusion on ultrasound? 

  testicular torsion 

  testicular tumor 

   UTI 

   epididymitis 

 

Correct answer:

epididymitis

 

Epididymitis is an infectious process of the epididymis. Of the choices it is the most likely to have a positive Gram stain, positive U/A, and hyperperfusion on ultrasound. The symptoms have a gradual onset worsening over time.

 Question 76 

All of the following are factors that would protect a person from the possibility of gastroenteritis EXCEPT: 

  normal bacterial flora of the intestine 

  acidity of the stomach 

   normal motility of the GI tract 

   taking antacids 

 

Correct answer:

taking antacids

 

Loss of normal gastric acidity, such as in those taking antacids or H2-receptor antagonists, is a factor that increases susceptibility to gastroenteritis. Gastric surgery, increased age, and poor physical condition are also factors contributing to susceptibility.

Question 77 

When managing the patient on Lithium therapy, which of the following would be least important for the nurse practitioner to evaluate? 

  urinalysis, electrolytes 

   alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase 

   thyroid-stimulating hormone, triiodothyronine, thyroxine 

  blood urea nitrogen, creatinine 

The Correct answer is:

Alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase

It is not important to evaluate liver function before initiating treatment with lithium. However, lithium has adverse side effects on renal, cardiac, and thyroid function. Baseline electrolytes are also important to obtain.

 

 Question 78 

You need to assess cerebellar function in an exam. Which of the following is appropriate? 

   Patient quickly alternates moving fingers to and from the nose. 

  Patient sits and resist force on the arms. 

   Patient slowly walks a straight line in a darkened room. 

  Patient sits and resist force on the legs. 

 

Correct answer: Patient quickly alternates moving fingers to and from the nose A stroke can affect cerebellar function. A patient quickly alternates moving fingers to and from the nose to assess cerebellar function. This movement should be smooth. 

 

Question 79 

Which type of hernia is responsible for 99% of all groin hernias in children younger than 3 year of age? 

  epigastric 

  umbilical 

   inguinal 

  femoral 

Correct answer:

inguinal

 

Inguinal hernias are responsible for 99% of all groin hernias in children younger than 3 years of age. Inguinal hernias are more common in boys and one-third of inguinal hernias are diagnosed before 6 months of age.

Question 80 

You have prescribed Cymbalta for a patient with depression. The patient should be advised to contact a healthcare professional immediately if she experiences which of the following? 

  Dry mouth. 

  Drowsiness. 

   Fast heart rate. 

  Vivid dreams. 

Correct Answer: Fast heart rate Cymbalta has some uncommon but potentially serious side effects. If the patient experiences a fast heart rate, she should notify a healthcare practitioner immediately. Other side effects, such as dry mouth, drowsiness, and vivid dreams, are common but not typically a cause for concern unless they interfere with daily living or do not abate. 

 

Question 81 

Patients taking all but which of the following should be advised of the potential for addiction or dependency? 

  Xanax. 

  Vicodin. 

   Tramadol. 

   Naproxen. 

Correct Answer: Naproxen Naproxen is not known to carry a risk of dependency or addiction. Pain killers such as Tramadol and Vicodin, as well as anti-anxiety drugs such as Xanax, can carry these risks. Patients should be made aware of this risk and should be educated about how to step off medications when they are no longer needed to avoid withdrawal symptoms. 

 

Question 82 

 Learning is evaluated by determining whether the objectives for client education are met. Evaluation that occurs while the educational activity is ongoing is which of the following?

 

  summative 

  abstract 

   review 

   formative 

 

 Correct answer:

formative

 

Formative evaluation occurs while the educational activity is ongoing and enables adjustments to be made to optimize the likelihood that learning will occur. Summative evaluation occurs at the end of the educational activity.

Question 83 

You are examining a 2 year old child at a well baby checkup. You will assess development in which of the following areas? 

  gross motor 

  fine motor 

   language 

   all of the above 

Correct answer:

all of the above

 

Development is typically assessed in four areas. These areas are: gross motor, fine motor, language, and social skills. The most widely used developmental assessment tool is the Denver II.

Question 84 

 Which of the following statements best describes the obturator sign in terms of abdominal diseases?

 

   Rotate right hip through full range of motion. Positive if pain with movement or flexion of the hip. 

  Instruct patient to raise heels then drop them suddenly. Positive if pain is elicited. 

   With abdominal palpation, the abdominal muscles reflexively become tense and firm. 

  Deep palpation of the left lower quadrant of the abdomen results in referred pain to the right lower quadrant. 

Correct answer:

Rotate right hip through full range of motion. Positive if pain with movement or flexion of the hip.

 

The obturator sign in the supine position is used for suspected acute appendicitis or any suspected retroperitoneal area acute process. It is done by rotating the right hip through full range of motion. It is positive if there is pain with movement or flexion of the hip.

 Question 85 

Before starting any research project, the FNP must conduct a literature review. The purposes of a literature review include all of the following EXCEPT: 

  what is known and not known about a subject 

   the expected impact of the research 

   gaps and inconsistencies in the literature about a subject 

  unanswered questions about the subject 

Correct answer:

the expected impact of the research

 

Although the expected impact of the research may be a consideration for the FNP it is not one of the purposes of a literature review. The literature review is critical to all evidence-based practice projects.

Question 86 

Which of the following does NOT increase a person’s risk for cataracts? 

  cigarette smoking 

  eye trauma 

   allergies 

  exposure to ultraviolet B rays 

Correct answer:

allergies

 

Factors increasing susceptibility to cataracts include: eye trauma; eye disease; diabetes; aging; cigarette smoking; and recreational or occupational exposure to ultraviolet B rays. Allergies are not a factor.

Question 87 

Which of the following tests is federally mandated for infants? 

  TSH 

  Lead screening 

   PKU 

  all of the above 

Correct answer:

PKU

 

PKU (phenylketonuria) is a federally mandated test. Severe mental retardation may develop if this is not treated early.

 

Question 88 

Piaget’s cognitive development theory includes all of the following EXCEPT: 

  sensorimotor 

   postoperational thinking 

   concrete operations 

  formal operations 

 

Correct answer:

postoperational thinking

 

Piaget’s cognitive development theory focuses on intellectual changes which occur in a sequential manner as a result of continuous interaction with the environment. The stages are: sensorimotor (infancy); preoperational thinking; concrete operations; and formal operations (involves logic, determines possibilities, problem-solves and makes decisions).

Question 89 

 Nurse practitioner acts identify who the NP is, what the NP can do in that role, and where the NP can legally provide care. This is known as which of the following?

 

  standards of care 

  ethical principles 

   scope of practice 

  all of the above 

 Correct answer:

scope of practice

 

The NP’s scope of practice, outlined in the nurse practice act, identifies who the NP is, what the NP can do in that role, and where the NP can legally provide care. Actions that exceed the legal boundaries of practice in a particular state are considered to be violations of the nurse practice act.

 

Question 90 

At about what age would you expect an infant’s rooting reflex to disappear? 

  1 month 

  1 – 2 months 

   3 – 4 months 

  12 months 

Correct answer:

3 – 4 months

 

The rooting reflex of an infant appears when the corner of the infant’s mouth is stroked. The infant turns toward the stimulus and sucks. This reflex disappears by 3 to 4 months.

 

Question 91 

A 21 year old female presents with tachycardia and dilated pupils. You notice that her mood appears joyful, not scared. What do you need to address in the assessment? 

  Heart disease. 

  Diet. 

   Exercise. 

   Drug use. 

 

Correct answer: Drug use The feelings of euphoria may be a sign of drug use. Drugs, such as cocaine, in the system can interact with different treatments. It is essential that you ask the patient about any drugs she has taken. 

Question 92 

Your patient is terminally ill and suffering greatly. A decision is made by the patient and agreed to by healthcare providers to stop chemotherapy treatment for this patient. This is considered which of the following? 

  withholding treatment 

   withdrawing treatment 

   letting die 

  none of the above 

 

Correct answer:

withdrawing treatment

 

Withdrawing treatment involves removing or stopping a treatment already started. Withholding treatment means never starting a given treatment.

 Question 93 

A young female patient presents in the office with painful genital lesions. She has been sexually active and has not used condoms. When counseling her, you include all of the following EXCEPT:

 

  Stop having sexual intercourse until the lesions are no longer infectious. 

  Sitz baths and cool compresses may offer some relief. 

   Safe sex with condom use does not reduce the risk of transmission as viral shedding occurs along a wide area of the groin and perineal region. 

   There are no pharmacological treatment options. 

 

The Correct answer is:

There are no pharmacological treatment options

There are pharmacological treatment options for genital lesions. Oral antivirals, such as acyclovir (Zovirax) and famciclovir (Famvir), can be used to prevent and/or lessen severity of breakouts. 

 

Question 94 

The document that focuses on reducing the health disparities in the general population of the United States with 10-year national objectives is which of the following? 

  HIPPA 

   Healthy People 2020 

   OBRA 

  COBRA 

Correct answer:

Healthy People 2020

 

Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to: encourage collaborations across sectors; guide individuals toward making informed health decisions; and measure the impact of prevention activities.

Question 95 

Which of the following statements about acute pyelonephritis is least accurate? 

  75% of cases are due to E. coli organism. 

   Recent diagnosis of PUD is a risk factor. 

   The most common route of infection is ascension from the bladder.

 

  Urinary catheters are a risk factor. 

Correct answer:

Recent diagnosis of PUD is a risk factor.

 

This is the least accurate statement. Risk factors include urinary tract abnormalities or instrumentation, stones, catheters, diabetes or other immunocompromised states, recent pyelonephritis, BPH, pregnancy, and fecal incontinence. Also recent lower UTIs present a risk factor.

 Question 96 

In terms of determining the reliability of a research instrument, which type uses the measure that items of an instrument correlate well with other items on the instrument? 

  test-retest 

  inter-rater 

   internal consistency 

  content correlation

Correct answer:

internal consistency

 

The measure that items of an instrument correlate well with other items on the instrument is internal consistency. It is one of the criteria for determining reliability of a research instrument.

 

Question 97 

A 35-year-old Caucasian female is in the office with rosacea. She is asking about treatment options. What is the recommended treatment for her? 

  topical 5-fluorouracil 

   low-dose tetracycline 

   oral ketoconazole 

  Dilantin 

The Correct answer is:

Low-dose tetracycline

Treatment with systemic low-dose tetracycline is a very effective measure for rosacea. Further, topical treatment with metronidazole or a low-dose steroid cream may also be helpful. In some cases, ketoconazole, the antifungal cream and not an oral form, is used to treat rosacea. Topical 5-fluorouracil is used to treat actinic keratosis.

 

Question 98 

For male,s approximately how long does it take to go from Tanner stage 2 to stage 5 for genital development? 

   4 years 

  6 years 

   8 years 

  3 years 

Correct answer:

4 years

 

It takes males approximately 4 years to move from stage two to stage five of the Tanner stages of genital development.

quiz 26 aanp

Question 1 

There are many types of managed care systems. The type of system in which discounted fees for service are offered instead of capitation is which of the following? 

   preferred provider organization 

  health maintenance organization 

   fee-for-service plan 

  health insurance purchasing cooperative 

preferred provider organization

 

Preferred provider organizations (PPOs) involve discounted fees for service instead of capitation. If a patient selects a provider outside the network, the difference between the discounted fee and the normal fee is assumed by the client through co-pays or deductible payments.

 

 Question 2 

The FNP has a patient who she suspects has macular degeneration. The FNP may use which of the following tests to check the central vision of the patient? 

  Snellen chart 

   Amsler grid 

   amplitude of accommodation 

  slit lamp examination 

Correct answer:

Amsler grid

 

Macular degeneration is a gradual change in the pigment in the macula (area of central vision) resulting in blindness. The FNP will check central vision with the Amsler Grid test. If macular degeneration is present, the lines in the center of 

 

Question 3 

You are providing care to a female patient who is 6 months pregnant. She is suffering from hemorrhoids. Which of the following may help alleviate her discomfort? 

  Sleeping on her stomach. 

   Sleeping on her side. 

   Sleeping on her back. 

  Sleeping with the head slightly elevated. 

Correct Answer: Sleeping on her side For patients who are not pregnant, sleeping on the stomach can alleviate pressure on inflamed blood vessels that lead to hemorrhoids. Pregnant patients should instead sleep on their side, as sleeping on the stomach can be uncomfortable especially in later stages of pregnancy. Warm sitz baths may also help alleviate discomfort caused by hemorrhoids. 

Question 4 

At which age does a child develop a pincer grasp? 

  3 months 

   6 months 

   9 months 

  12 months 

Correct answer:

9 months

 

A child develops a pincer grasp which is a fine motor skill around the age of 9 months. The child should also be able to pull himself or herself up to stand, as well as crawl and bear weight well.

 

 Question 5 

Which of the following statements about pulmonary tuberculosis (TB) is false? 

   About 75% of individuals exposed to the causative organism of TB become infected. 

  TB is a chronic bacterial infection. 

   TB is transmitted through aerosolized droplets. 

  The stage of TB known as primary TB is usually symptom-free. 

Correct answer:

About 75% of individuals exposed to the causative organism of TB become infected.

 

This statement is false. About 30% of individuals exposed to the causative organism of TB become infected. In an immunocompetent host, when the organism is acquired, an immune reaction ensues to help contain the infection within granulomas.

 

Question 6 

An elderly patient presents with a flat, nonpalpable colored spot, 4 mm in size. What is the medical term for this spot? 

  Bulla. 

   Tumor. 

  Pustule. 

   Macule. 

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

 

Question 7 

Which of the following measures would be directed particularly against the reservoirs of infection? 

   insect spraying 

  water purification 

   immunization 

  improved nutrition 

Correct answer:

insect spraying

 

Measures directed against the reservoirs of infection include: insect spraying, isolation and quarantine. Water purification is a measure to interrupt the transmission of organisms. Immunization and improved nutrition are measures that reduce host susceptibility. 

 

Question 8 

A brief cultural assessment in the CONFHER model would include all of the following EXCEPT: 

  communication 

   occupation 

  nutrition 

  education 

Correct answer:

occupation

 

The CONFHER model includes: communication, orientation, nutrition, family relationships, health beliefs, education, and religion. It does not include occupation.

 Question 9 

A 24-year-old female presents with a headache. She describes throbbing pain behind one eye, light sensitivity, nausea and vomiting, and recurrence right before menstruation. The nurse practitioner suspects which of the following? 

  temporal arteritis 

   cluster headache 

  trigeminal neuralgia 

   migraine without aura 

The Correct answer is:

Migraine without aura

The symptoms and aggravating factor indicate migraine without aura. A cluster headache, more common in middle-aged men, involves piercing pain with tearing, rhinorrhea, ptosis, and often, miosis on one side. Temporal arteritis involves warmness over an artery and scalp tenderness at the temporal area. Trigeminal neuralgia involves a very brief intense sharp stabbing pain. 

 

Question 10 

You are providing care to a patient who has been diagnosed with diverticulosis. Which of the following is NOT an appropriate strategy for this patient to take to manage the constipation that sometimes accompanies this condition? 

   The patient should use OTC chemical laxatives. 

  The patient should increase the fiber in her diet. 

   The patient should incorporate wheat germ into her diet. 

  The patient should avoid chemical laxatives. 

Correct Answer: The patient should avoid OTC chemical laxatives These medications can irritate the colon. The patient should instead incorporate wheat germ and more fiber into her diet. 

 

Question 11 

The nurse practitioner understands that when treating a child on long-term antihistamine therapy there will be a need for supplements due to decreased absorption of: 

   iron 

  magnesium 

   niacin 

  calcium 

The correct answer is:

Iron 

Antihistamines block the absorption of iron, vitamin B12, and folate. Iron, a mineral, helps the body make myoglobin, located in the muscles and hemoglobin, located in the red blood cells. Additionally, the iron helps the body to store and move oxygen.

Question 12 

The classic triad of symptoms for appendicitis includes: 

   abdominal pain, vomiting, and fever 

  abdominal pain, constipation, and lethargy 

   abdominal pain, diarrhea, and confusion 

  abdominal pain, lethargy, and confusion 

 

Correct answer:

abdominal pain, vomiting, and fever

 

The classic triad of symptoms for appendicitis includes abdominal pain, vomiting, and fever. Right-sided abdominal pain is present. Nausea is common, with vomiting almost always following the onset of pain. And fever is present.

 

 Question 13 

The FNP has a patient who is a new mother and complains of sore nipples. What advice should the FNP give this mother? 

  stop breastfeeding 

   the problem will resolve on its own 

   supplement breastfeeding with formula 

  use formula at nighttime feedings 

Correct answer:

the problem will resolve on its own

 

The best advice is to tell this mother that sore nipples are a common problem and that it will resolve itself. The FNP should not advise any of the other choices.

 

Question 14 

During a physical exam, what will help indicate pain? 

   Face. 

  Voice. 

   Hands. 

  Words. 

 

Correct answer: Face Patients do not always cry out when they are in pain. Monitoring facial expressions will give an accurate physical exam. 

Question 15 

Which of the following statements about the MMR vaccine is false? 

  The MMR vaccine is safe to use during lactation. 

   The MMR vaccine is a live, attenuated vaccine. 

   The recommended schedule for early childhood immunization is two immunizations one month apart. 

  Systemic reaction to the MMR vaccine is rare. 

 

Correct answer:

The recommended schedule for early childhood immunization is two immunizations one month apart.

 

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

 

 Question 16 

Of the following choices, which is most consistent with findings in patients with Parkinson Disease (PD)? 

  masklike facies and continued cognitive function 

   tremor at rest and bradykinesia 

  excessive muscle spasms and exaggerated gait 

  relaxed posture and poor muscle tone 

 

The Correct answer is:

Tremor at rest and bradykinesia

The diagnosis of Parkinson Disease (PD) is made by clinical evaluation. Further, this condition consists of a combination of six cardinal features: bradykinesia (slowness in the execution of movement), tremor at rest, rigidity, flexed posture, loss of postural reflexes, and masklike facies.

 Question 17 

You might prescribe all of the following for a patient with sickle cell anemia EXCEPT: 

  folic acid 

   iron 

   oxygen for hypoxia 

  pain reliever 

Correct answer:

iron

 

You would not prescribe iron for a patient with sickle cell anemia. It increases Hgb S production. Hgb S deforms the RBCs into a sickle shape, the sickle cells hemolyze, and clusters of sickle cells occlude small blood vessels.

Question 18 

Which of the following osteoporosis treatments stops bone loss but does not rebuild bone? 

  Fosamax 

  Evista 

   Teriparatide 

   Miacalcin 

Correct answer:

Miacalcin

 

Miacalcin (calcitonin salmon) stops bone loss but does not rebuild bone. It is a good choice for relief of bone pain from vertebral fractures.

 

 Question 19 

Medical records must be kept safe. It is essential that each healthcare organization establish an effective procedure for safeguarding them. The following are all true statements regarding medical records EXCEPT: 

  Medical records should be stored in a secure, restricted-access location. 

  Competent medical records personnel should review every record before it is examined by the patient or patient representative. 

   An original medical record should be sent with the patient to specialist appointments and for their attorney to review as necessary. 

  Anyone who is not an authorized employee or staff member should not be allowed to examine a medical record. 

The Correct answer is:

An original medical record should be sent with the patient to specialist appointments and for their attorney to review as necessary

An original medical record should never be sent with the patient to a specialist’s appointment. The original medical record remains on the facility’s premises unless the organization has received a Subpoena Duces Tecum, court order or a subpoena and a court order to bring the medical record to a court of law. Alternatively, if the medical record has reached the state and federal law’s identified retention period, the original medical record can be stored offsite or destroyed.

 

If the patient needs information from the medical record to take to the specialist, the nurse practitioner’s office can make a copy of what is needed for the referral and send the photocopies of the medical. This process holds true for an attorney. The attorney will only receive copies of the original medical record. Or, if the patient signs appropriate consent forms, the attorney can come to the medical office and review the original medical record.

 

Also, the healthcare provider, nurses or any other staff cannot take original medical records home or to another facility to complete charting or other documentation in the medical record. All charting has to be completed in the facility where the original medical exists. By removing the original medical record from the facility, it can be lost, accidentally destroyed or even stolen, for instance. This can lead to breaches of confidentiality and privacy laws, not to mention it is hard to reproduce an original medical record if it is lost.

 

In the case of office space restrictions, some physician offices and hospitals may not have sufficient amounts of space to store all of their medical records. Therefore, storage or retention of the original medical records becomes an issue. There are many options to storing medical records including storing them offsite, microfilming, scanning the medical records and storing them on CD ROM’s, disks and more. In this case, the nurse practitioner will need to review state and federal laws, as the laws govern how medical records can be retained and the compliance guidelines required if the physical, original medical record has to be stored offsite. Certain medical record documents are permanently kept, such as records of surgical procedures and master patient indexes. Then, depending on state laws, diagnostic images, for instance x-ray films, can be kept for 5 years before the images are archived or destroyed. Destruction of medical records are also dictated by federal and state laws. Some destruction methods include shredding the medical record, for example. 

 Question 20 

You have a patient who is reluctant to talk to anyone. You wish to draw her out and so ask her to tell you about her family. This is using which of the following techniques for therapeutic communication?

 

  reflection 

   open-ended comment 

   restating 

  focusing 

Correct answer:

open-ended comment

 

Using an open-ended comment or question is a therapeutic communication technique. Questions cannot be answered with a one-word answer. It allows the patient to decide what content is relevant.

 

 Question 21 

Your 70-year-old female patient complains of pain when she walks. The pain, she says, is relieved when she sits or lies down. She tells you that this pain has become gradually worse and now she finds it difficult to walk very far. You diagnosis is likely to be which of the following? 

   peripheral vascular disease 

  superficial thrombophlebitis 

   deep vein thrombosis 

  Raynaud’s phenomenon 

Correct answer:

peripheral vascular disease

 

Peripheral vascular disease (PVD) is a gradual narrowing or occlusion of the medium to large arteries resulting in permanent ischemic damage to an extremity. Skin may be cool, and there may be decreased-to-absent pulses (popliteal, dorsal pedis, and posterior tibialis), among other signs.

 Question 22 

A patient who has been prescribed Flomax should be advised to seek immediate medical attention if he experiences which of the following? 

   Fast heartbeat. 

  Runny nose. 

   Weakness. 

  Ejaculatory problems. 

 

Correct Answer: Fast heartbeat This is a potentially serious side effect of Flomax. Patients experiencing this should seek immediate medical attention. Less serious side effects include runny nose, drowsiness, weakness, problems ejaculating, and blurred vision. 

 

Question 23 

All of the following are sources of legal risks for the nurse practitioner EXCEPT: 

  patients 

   peer review 

   procedures 

  quality of medical records 

The Correct answer is:

Peer review

According to the American Nurses Credentialing Center, patients, procedures and quality of medical records are all sources of legal risk and liability for nurse practitioners. 

Question 24 

The nurse practitioner is seeing a 28-year-old female who took L-thyroxin prior to becoming pregnant. Now that the diagnosis of pregnancy is made, what should be done? 

  She should be switched to a supplement with a category B rating. 

   She should continue it and have monthly TSH levels evaluated. 

   She can continue it during pregnancy without concern. 

  It should be discontinued during pregnancy. 

 

Correct answer:

She should continue it and have monthly TSH levels evaluated

L-thyroxin is used to treat hypothyroidism. It is safe during pregnancy, so it can be continued. However, during pregnancy, the patient's TSH levels needs to be monitored. If the patient's TSH levels rise to a hypothyroid state, the fetal growth can be affected. 

 

Question 25 

Electronic patient records raise specific legal concerns, many of which are concepts of the evolving status of traditional rights and responsibilities associated with ownership and control of patient information. All of the following are accurate statements regarding legal issues related to electronic patient records EXCEPT: 

  A computerized medical record system must be designed, installed, and maintained to preserve both the confidentiality and the integrity of patient health information. 

  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has standards related to patient record confidentiality and integrity set up for organizations to adhere to. 

   When medical record data is transmitted across state lines, it is always the state where the patient was treated in which the law applies. 

  Computerization of patient data increases the risk of unauthorized disclosure of medical information. 

The Correct answer is:

When medical record data is transmitted across state lines, it is always the state where the patient was treated in which the law applies

During the transfer process, it is not always clear which state's law applies or which courts will have jurisdiction if a dispute arises over disclosure of an individual's health information. 

 

 Question 26 

Which of the following best describes anisocoria? 

  a fine tremor of the hand with unknown cause 

  a unilateral headache caused by impingement 

   a unilateral pain in the temporal area 

   a condition in which the two pupils are not of equal size 

Correct answer:

a condition in which the two pupils are not of equal size

 

Anisocoria can best be described as a condition in which the two pupils are not of equal size. A fine tremor of the hand with unknown cause is benign familial tremor. A unilateral headache caused by impingement is trigeminal neuralgia. A unilateral pain in the temporal area is temporal arteritis. 

 

Question 27 

Your 20-year-old female patient has bulimia. You might manage her condition by all of the following EXCEPT: 

   MAO inhibitors 

  SSRIs 

   TCAs 

  cognitive behavioral therapy 

Correct answer:

MAO inhibitors

 

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

 

Question 28 

There is a 19-year-old female patient in the office and it is determined she has iron deficiency anemia. If this anemia has occurred in the past 3-4 months, what might be expected? 

  a multititude of white and red blood cells 

   the red blood cells are small 

   a decreased total iron binding capacity 

  an elevated serum ferritin 

 

The Correct answer is:

The red blood cells are small

Iron deficiency anemia happens when the reserve of iron stored in the body are decreased and in some cases depleted. The iron helps the body make red blood cells. With iron deficiency anemia, the individual may experience weakness, have shortness of breath and the skin is pale. When the iron stores in the body are completely gone, the red blood cells may appear small as well as the quantity of the red blood cells are very few. Further, serum ferritin is a measure of the iron in storage. Then, the total iron binding capacity is always increased in a patient with iron deficiency anemia.

Question 29 

The nurse practitioner's standards of practice are established for what purpose? 

   They are meant to regulate and control nurse practitioner practice. 

  They limit liability of nurse practitioners. 

   They protect nurse practitioners from frivolous lawsuits. 

  They are set up to promote autonomous practice. 



The Correct answer is:

They are meant to regulate and control nurse practitioner practice 

For all professionals (nurses, physicians, dentists, etc.) the standards of practice are set up to regulate and control practice. Their purpose is to provide accountability for the professionals and to help protect the public from unethical and unsafe practice. 

 

Question 30 

Which of the following statements are NOT true concerning entries in the medical record? 

  Maintaining a complete medical record is important to comply with licensing and accreditation requirements. 

  Medical record entries should be made in clear and concise language that can be understood by healthcare professionals who treat the patient. 

   Allegations of improper care can always be defended without documentation in a medical record if staff witnessed the care. 

  Maintaining a complete medical record enables the healthcare provider to establish that a patient has received adequate care. 

The Correct answer is:

Allegations of improper care can always be defended without documentation in a medical record if staff witnessed the care

Some courts have dismissed claims involving incomplete records. However, some cases have been decided without documentation of the allegation in the medical record. 

 Question 31 

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

  interaction with OTC cough medicine 

   water intoxication 

   increased vasopressor effect 

  noncompliance with therapy 

The Correct answer is:

Water intoxication

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

 

Question 32 

The test done to assess for meningeal irritation where the FNP bends the patient’s neck toward the chest to see if the patient reflexively flexes the hips and knee is which of the following tests? 

  Kernig sign 

  Romberg test 

   Brudzinski sign 

  Snellen test 

 

Correct answer:

Brudzinski sign

 

The test done to assess for meningeal irritation where the FNP bends the patient’s neck toward the chest to see if the patient reflexively flexes the hips and knee is the Brudzinski sign. It is positive if the patient reflexively flexes the hips and knee to relieve pressure and pain (due to inflammation of the lumbar nerve roots).

Question 33 

Which of the following statements about acute myelogenous leukemia (AML) is least accurate? 

   It accounts for 75% of all childhood leukemias. 

  There is a relatively constant incidence of AML from birth through adolescence. 

   The ratio of AML to ALL (acute lymphocytic leukemia) is 1:4. 

  It is an abnormal proliferation of immature myeloid stem cells in the bone marrow. 

 

Correct answer:

It accounts for 75% of all childhood leukemias.

 

This is the least accurate statement. AML accounts for 15% to 20% of childhood leukemia. ALL accounts for 75% to 80% of all childhood leukemias.

Question 34 

Which of the following is least likely to exacerbate edema in your patient? 

  laxative abuse 

  corticosteroids 

   calcium agonists 

   diuretics 

Correct answer:

diuretics

 

Diuretics are indicated for marked peripheral edema, pulmonary edema, CHG, and inadequate dietary salt restriction. Abuse of diuretics, however, can lead to edema.

 

 Question 35 

In terms of liver function tests, the normal serum AST (also known as SGOT) is which of the following? 

   5 – 50 u/L 

  50 – 100 u/L 

   2.0 or higher 

  5.0 or higher 

Correct answer:

5 – 50 u/L

 

Serum AST for adults to elderly has a normal range of 5 – 50 u/L. It is present in the liver, heart muscle, skeletal muscle, kidney, and lung. It is not specific for liver injury because it is also elevated in other conditions.

Question 36 

You have received the results of a platelet count test for a patient. It indicates that her platelet count is 13,000/mm3. Which of the following is true of this patient, based on these results? 

  Her platelet count is far too high. 

  Her platelet count is low but within the acceptable range. 

   The patient is at risk for serious bleeding. 

  The patient's platelet count is normal. 

 

Correct Answer: The patient is at risk for serious bleeding This patient's platelet count is lower than 20,000/mm3, the threshold for concern for serious bleeding. It will be a key next step to discover why the patient's platelet count is so low and take immediate steps both to reduce her risk of injury and to address the underlying cause of the low count. 

 

 Question 37 

Sometimes when evaluating a patient with acute appendicitis, appendiceal rupture occurs. The clinical findings most consistent with this occurrence include all of the following EXCEPT: 

  fever that is greater than 102°F 

   abdominal pain for less than a 24 hour duration 

   marked leukocytosis on CBC with WBC greater than 20,000mm³ 

  palpable abdominal mass 

The Correct answer is:

Abdominal pain for less than a 24 hour duration

Appendiceal perforation is usually associated with fever greater than 102,  a marked leukocytosis with total WBC count often exceeding 20,000 mm³, peritoneal inflammation, symptoms lasting longer than 24 hours and an ill-defined right lower quadrant abdominal mass. 

 

Question 38 

The nurse practitioner must be sensitive to cultural influences on health and health promotion. Which of the following is NOT true regarding cultural healthcare considerations?

 

  Ethnicity is based on race, tribe, or nation with which a person identifies and this influences beliefs and behaviors. 

  Family structure and values have an impact on the health encounter. 

   Traditional health beliefs should be allowed even if they compromise the patient's well-being or the well-being of their family. 

  More comprehensive care can be provided if the nurse practitioner is aware of the cultural traditions surrounding their patient. 

The Correct answer is:

Traditional health beliefs should be allowed even if they compromise the patient's well-being or the well-being of their family

Traditional health beliefs that compromise a patient's well-being should be instructed upon and corrected for the safety of the family. An example would be giving small amounts of home-made "moonshine" as a cough suppressant to small children. This should be avoided due to lead toxicity.

Question 39 

A mother is asking questions regarding giving her 4-month-old infant fruit juice. The nurse practitioner understands that the following statements are accurate concerning fruit juice EXCEPT: 

   Fruit juice is an excellent replacement for infant formula if an infant is allergic to cow's milk. 

  Juice should not be given before 6 months of age and intake should be limited to 1 to 2 ounces. 

   Pureed fruit should be given instead of juice if possible. 

  Fruit juice should not replace breast milk or infant formula in the diet because it is high in carbohydrate and low in the other nutrients. 

The Correct answer is:

Fruit juice is an excellent replacement for infant formula if an infant is allergic to cow's milk

Fruit juice is not an excellent alternative to infant formula. If an infant is allergic to cow’s milk, the nurse practitioner can suggest to the mother other acceptable alternatives, such as feeding the infant soy-milk formula. Further, fruit juice should only be given to infants who are 6 months old and older. Therefore, the nurse practitioner should inform the mother that the 4-month-old is not at an appropriate age to drink fruit juice.

 

 Question 40 

The resistance of a group to invasion and spread of an infection because a large portion of the group is immune is known as which of the following? 

  generation immunity 

  reservoir immunity 

   herd immunity 

  direct immunity 

Correct answer:

herd immunity

 

Herd immunity is the resistance of a group to invasion and spread of an infectious agent because a large portion of the group is immune. It decreases the likelihood of an epidemic in the area.

 

Question 41 

First generation antihistamines readily cross the blood-brain barrier. Which of the following drugs is a first generation antihistamine? 

  loratadine 

   diphenhydramine 

   desloratadine 

  levocetirizine 

Correct answer:

diphenhydramine

 

Diphenhydramine (Benadryl) is a first generation antihistamine. Another first generation antihistamine is chlorpheniramine (Chlor-Trimeton). The other choices are all second generation antihistamines.

 

Question 42 

You are taking the medical history of a patient who is suspected of having Addison’s disease. Which of the following data in his history is most likely to support this diagnosis? 

  weight gain 

   salt cravings 

   hyperglycemia 

  increased libido 

Correct answer:

salt cravings

 

Of the choices, this is the one most likely to support Addison’s disease. Weight loss, hypoglycemia and decreased libido would also support the diagnosis.

Question 43 

A toddler is brought in with a low grade fever, infection of the upper airway, and hoarseness. What test may be ordered if the clinical exam is not conclusive? 

   X-ray. 

  CBC. 

   Spinal tap. 

  Throat culture. 

Correct answer: X-ray The toddler's symptoms may indicate croup. The clinical exam typically confirms this. An X-ray of the lateral neck may be ordered. 

 Question 44 

Your patient with benign prostatic hypertrophy (BPH) is taking zinc as a supplement to improve the condition. He has been taking this for 6 weeks so far. Which of the following should also be added in this case? 

  vitamin B12 

  potassium 

   caffeine 

   copper 

Correct answer:

copper

 

If zinc is taken for more than one month, copper at 1 to 2 mg/day should be added. Zinc depletes the body’s stores of copper.

Question 45 

The levels of E/M services recognize four types of medical decision making. Which of the following is NOT one of these four types? 

  low complexity 

  high complexity 

   minimal 

  straightforward 

Correct answer:

minimal

 

The four types of medical decision making recognized by the levels of E/M services are: straightforward, low complexity, moderate complexity and high complexity. Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option.

 Question 46 

In terms of fee-for-service Medicare payments, the fee schedule is determined using a system called a resource-based relative value scale (RBRVS). There are three components to a relative value. Which of the following is NOT one of these components? 

   Geographic practice cost index component 

  Practice expense component 

   Work component 

  Malpractice component 

Correct answer:

Geographic practice cost index component

 

The three components to a relative value are: a practice expense component; a work component; and a malpractice component. Each component is adjusted geographically, using three separate geographic practice cost indexes.

Question 47 

Which of the following statements about the MMR vaccine is incorrect? 

   The MMR is not safe to use during lactation. 

  Its use in pregnant women is discouraged. 

   Systemic reaction to the MMR vaccine is rare. 

  The MMR vaccine is typically well tolerated with rare reports of transient adverse reactions. 

 

Correct answer:

The MMR is not safe to use during lactation.

 

This is incorrect. The MMR is safe to use during lactation. Its use in pregnant women is discouraged because of the possible risk of passing the virus on to the unborn child. This risk exists in theory but has not been noted in ongoing observation

Question 48 

Part of becoming a nurse practitioner is the licensure process. The following statements are related to the history and development of the licensure process and all are correct EXCEPT: 

  In the early 1900s, the first nursing statutes were actually nurse registration acts. 

   The healthcare reform movement of the 1990s forced the nursing profession to increase professional accountability. 

  Nurse Practice Acts have evolved over time. 

   Applicants for licensure as an advanced practice nurse do not need a license as a registered nurse. 

 

The Correct answer is:

Applicants for licensure as an advanced practice nurse do not need a license as a registered nurse

Applicants do need a license as a registered nurse to obtain one as an advance practice nurse. Additionally, they must hold current national certification in the appropriate advance practice nurse specialty. 

 

Question 49 

The FNP has a 64-year-old female patient who inquires about the Zoster vaccine for shingles. The FNP might tell her all of the following EXCEPT: 

  The vaccine is prepared from a live, attenuated strain of varicella-zoster virus. 

   Reactivation of the varicella virus is not related to a decline in varicella-zoster virus-specific immunity. 

   The use of zoster vaccine significantly reduces the risk of shingles. 

  The vaccine should be used even with a history of shingles. 

Correct answer:

Reactivation of the varicella virus is not related to a decline in varicella-zoster virus-specific immunity.

 

This statement is incorrect. Reactivation of the varicella virus seems to be related to a decline in varicella-zoster virus-specific immunity. Therefore, the use of zoster vaccine significantly reduces shingles risk.

 

 Question 50 

In Maslow’s hierarchy of needs which one ranks highest? 

  safety and security 

  love and belonging 

   self-actualization 

  self-esteem 

Correct answer:

self-actualization

 

Self-actualization is the highest level of Maslow’s hierarchy of needs. Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others and interested fulfilling their potential. 

 

Question 51 

A 16-year-old male is in the office. He has a insect bite on his left forearm and you suspect a brown recluse spider bite. What medical management would you provide? 

   ice pack and elevation of the area 

  active and passive range of motion (ROM) to the area 

   avoidance of antihistamines 

  warm moist soaks to the affected area 

 

The Correct answer is:

Ice pack and elevation of the area

Ice packs are preferred to heat to decrease the edema. The area should be immobilized and tetanus toxoid given. Antihistamines may reduce the swelling and relieve site itching. 

 

Question 52 

Fractures of the basilar area of the skull can present with bruising over the mastoids. This bruising is known as which of the following? 

  Adam’s sign 

  Christmas tree bruise 

   Koplik’s sign 

   Battle’s sign 

Correct answer:

Battle’s sign

 

Battle’s sign is a bruising over the mastoid area that is a sign of fractures of the basilar area of the skull. Look for clear golden fluid draining from the nose and/or ear.

Question 53 

A mother brings her 2-year-old girl to you. After careful assessment, you diagnose bronchiolitis. Which choice would NOT be part of patient management?

 

  nebulized bronchodilators 

   antibiotics 

  oral steroids 

   antipyretics 

The Correct answer is:

Antibiotics

Bronchiolitis is a common viral infection and antibiotics are not effective. Since it is characterized by wheezing, bronchodilators, especially nebulized, are a good choice for treatment. Oral steroids are controversial in bronchiolitis but are commonly used when significant edema in the small airways is suspected. Antipyretics to treat symptoms of fever, and not the bronchiolitis, are necessary in most cases.

 Question 54 

A person who has been prescribed three daily medications for asthma – an antiinflammatory agent, a long-acting bronchodilator, and an oral glucocorticoid is most likely to have which category of asthma? 

   severe persistent 

  moderate persistent 

   mild persistent 

  mild intermittent 

Correct answer:

severe persistent

 

Severe persistent asthma involves continual symptoms which limit activity. For this stage of asthma three daily medications are usually prescribed, along with a short-acting beta-agonist.

 

 Question 55 

 Which of the following is the preferred treatment fro pregnant or lactating women who have Lyme disease?

 

  doxycycline 100 mg bid x 10 to 21 days OR 

  tetracycline 250 to 500 mg qid x 10 to 21 days 

   erythromycin 250 mg qid x 10 to 21 days 

   amoxicillin 250 to 500 mg tid x 10 to 21 days 

Correct answer:

amoxicillin 250 to 500 mg tid x 10 to 21 days.

 

The therapeutic plan for pregnant, lactating females and children younger than 8 years is different from others. The pharmacologic treatment for them is amoxicillin 250 to 500 mg tid x 10 to 21 days.

 

Question 56 

Your patient has chills, fever, and vaginal discharge along with a tender uterus upon examination. She tells you that she has just had an abortion. Your diagnosis is most likely to be which of the following? 

  Mittelschmerz 

   endometritis 

   ovarian cyst 

  leiomyoma 

 

Correct answer:

endometritis

 

This patient most likely has endometritis. This is an inflammation or irritation of the lining of the uterus (the endometrium). It is not the same as endometriosis.

 

 Question 57 

An adult patient presents with the acute onset of diffused pink-to-red skin on the site of a skin trauma. He tells the FNP that the area has enlarged over the last few days. The skin is indurated, swollen and tender. Which of the following is the most likely diagnosis? 

  candidiasis 

  contact dermatitis 

   actinic keratoses 

   acute cellulitis 

 

Correct answer:

acute cellulitis

 

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

 

Question 58 

In managing a patient with a substance abuse problem, the patient tells you, "I wish I had never used cocaine, it has ruined my life." What is the most appropriate response by the nurse practitioner? 

  "Things will work out, don't you worry." 

  "You shouldn't be so hard on yourself. You can change." 

   "You should think before you do something." 

   "It sounds like you've thought a lot about your cocaine use." 

 

The Correct answer is:

"It sounds like you've thought a lot about your cocaine use" 

The nurse practitioner's statement is open ended. It allows for the patient to discuss and clarify his feelings. Further, the remaining statements are inappropriate responses. 

 

Question 59 

In which of the following cases would the FNP refer a patient to a specialist for low back pain? A patient with: 

  acute neck pain 

   bladder dysfunction 

   reduced range of movement 

  stiffness 

 

Correct answer:

bladder dysfunction

 

If the patient has a bladder dysfunction, or a limb or bowel dysfunction, prompt referral to a specialist is needed. Surgery is usually considered only if severe symptoms persist beyond 3 months.

 Question 60 

A 8-year-old male child is called back into the office because his stool specimen for ova and parasites (O & P) came back positive. The nurse practitioner knows what regarding enterobiasis? 

   The parasite causes pruritus around the anus because the females exit at night to lay eggs on the skin. 

  This parasite is a protozoan and the source is usually contaminated water and it is spread by fecal-oral contamination. 

   The parasite is in the soil and enters the body through the feet. 

  Eggs of this parasite enter the body by ingestion of dirt or from unwashed vegetables that contain the eggs in the dirt. 

The correct answer is:

The parasite causes pruritus around the anus because the females exit at night to lay eggs on the skin

This infestation is also known as "pinworms" which reside in the intestine. Hookworm larvae reside in the soil and enter the body through the feet. When dirt is ingested, there is a risk of contacting roundworm. Giardiasis from Giardia lamblia results from ingesting this organism through contaminated water or fecal-oral transmission. 

 

Question 61 

There are a number of theories of aging. Which of the following theories holds that the aging process decreases T cells so there is a rise in the incidence of infection? 

  Activity theory 

   Immune theory 

   Free-radical theory 

  Wear-and-tear theory 

Correct answer:

Immune theory

 

The immune theory holds that the aging process affects the immune system and decreases T cells so there is a rise in the incidence of infection. It is one of the biologic theories of aging.

 

 Question 62 

A female patient just saw her sister battle, and survive, ovarian cancer. She is concerned that she may have a genetic predisposition. What test can you order to confirm or disprove her suspicions? 

   BRCA2. 

  CA-125. 

   PSA. 

  CT scan. 

Correct answer: BRCA2 The breast cancer gene 2 (BRCA2) is also related to ovarian cancer. The breast cancer gene 1 is another genetic factor, as is HNPCC. A genetic profile of the patient and her sister will identify this risk factor. 

 

Question 63 

The theory that outlines eight consecutive stages in the family life cycle that offers a predictive overview of the activities that occur in families over time is called the: 

   developmental theory 

  family systems theory 

   self-efficacy theory 

  none of the above 

 

Correct answer:

developmental theory

 

The developmental theory outlines eight consecutive stages in the family life cycle that offers a predictive overview of the activities that occur in families over time. It serves as a basis for anticipatory guidance when assessing and teaching families.

 Question 64 

Long-term care insurance is a relatively new concept designed to meet the needs of the growing elderly population. Which of the following statements about long-term care is least accurate? 

  The likelihood of older adults requiring long-term care at some point in time in their lives is approximately 50%. 

  The average stay for long-term care is about 19 months. 

   Long-term care insurance generally provides coverage for approved care in nursing facilities and assisted living. 

   Long-term care insurance was developed by the federal government to meet the long-term and chronic health care needs of older adults. 

Correct answer:

Long-term care insurance was developed by the federal government to meet the long-term and chronic health care needs of older adults.

 

This statement is not accurate. Long-term care insurance was developed by private insurance companies to meet the long-term and chronic health care needs of older adults. It is designed to pay for long-term health services when multiple chronic health problems occur that require custodial care not covered by Medicare or other insurance.

Question 65 

It is considered precocious puberty in a male if puberty starts before what age? 

   9 years 

  10 years 

   12 years 

  13 years 

Correct answer:

9 years

 

For boys, puberty starts at 9 years. It is considered precocious puberty if it begins before 9 years and delayed puberty if no testicular growth is seen by 14 years.

Question 66 

Which of the following is NOT a normal stooling pattern for infants/children? 

   Breastfed babies stool less often. 

  Neonates stool more often than four times per day. 

   Four-month-olds produce two stools per day. 

  Four-year-olds produce one stool per day. 

 

Correct answer:

Breastfed babies stool less often.

 

This is not correct. Breastfed babies may stool after every feeding. Bottle-fed babies stool less often.

 

Question 67 

Patients with which of the following conditions should not be prescribed Cipro? 

   Mysathenia gravis. 

  Multiple sclerosis. 

   Fibromyalgia. 

  Interstitial cystitis. 

 

Correct Answer:

Myasthenia gravis

Patients with this condition should not take Cipro. It may cause the condition to become worse. 

 

 Question 68 

 You are explaining to a 67-year-old female patient with osteoporosis which foods are the best dietary sources for calcium. Which of the following foods would have the lowest content of calcium?

 

  collard greens, cooked 

   cottage cheese (low-fat) 4 oz 

    oysters, raw (13 – 19)

 

  Swiss cheese, 1 oz. 

 Correct answer:

cottage cheese (low-fat) 4 oz

 

Cottage cheese (low-fat) 4 oz has about 78 mg of calcium. All of the other choices have much more. The optimum calcium intake for women older than 65 years is 1500 mg.

Question 69 

A patient that has been transferred into your care from another provider presents with a history of migraine headaches. She is on Tylenol with codeine for treatment of these headaches but nothing for abortive therapy. The nurse practitioner understands that a good agent to prescribe the patient for abortive therapy is: 

  ketorolac (Toradol) 100 mg IM 

  amitriptyline (Elavil) 100 mg PO 

   sumatriptan (Imitrex) 6 mg IM 

   ergotamine (Ergostat) 2 mg SL 

The Correct answer is:

Ergotamine (Ergostat) 2 mg SL

Ergotamine sublingual at 2 mg is the correct dose for abortive therapy for migraine headaches. With Ketorolac, dosing guidelines indicates administration of 30-60 mg for pain. However, Ketorolac does not help with abortive therapy. Sumatriptan is given subcutaneously (SC) or by mouth (PO), not IM. Also, sumatriptan is a good medication for abortive migraine therapy. Amitriptyline is not used in abortive therapy.

Question 70 

A pregnant patient presents with abdominal pain. What test should you use to determine the cause? 

   Ultrasound. 

  CBC. 

   MRI 

  CT scan. 

 

Correct answer: Ultrasound An ultrasound will not damage a fetus. It is part of prenatal care. The other imaging answers may harm the fetus and are not recommended for pregnant women. 

Question 71 

The most common cancer death in females is which of the following? 

   lung cancer 

  leukemia 

   breast cancer 

  colon cancer 

 

Correct answer:

lung cancer

 

Lung cancer is the most common type of cancer death in females as well as males. 

Question 72 

Which of the following would NOT be recommended by the FNP as a measure to prevent colonic diverticulosis and diverticulitis? 

  regular aerobic exercise 

   foods low in uric acid 

   adequate hydration 

  a high-fiber diet 

Correct answer:

foods low in uric acid

 

Foods low in uric acid are what is recommended for those suffering from gout. The other three choices are recommendations for preventing colonic diverticulosis and diverticulitis. They help to increase bowel motility and tone.

 

Question 73 

Your patient is a newly arrived immigrant from China. He speaks English, but has a limited vocabulary. He does not understand certain medical terms. This is a concern for which of the CONFHER model aspects? 

  orientation 

  education 

   communication 

  health beliefs 

Correct answer:

communication

 

Communication includes language, dialect, nonverbal, and social customs. You should be concerned with the patient’s ability to understand common health terms.

 

 Question 74 

The blisters that you will find with second-degree burns are known by which of the following terms? 

  wheals 

   bullae 

   pustules 

  purpura 

 

Correct answer:

bullae

 

Bullae are fluid-filled lesions, ≥ 1 cm. They are blisters. These are found with second-degree burns.

 

 Question 75 

What is the leading cause of death for all ages and genders in the United States? 

  cancer 

   heart disease 

   accidents 

  congenital abnormalities 

Correct answer:

heart disease

 

Heart disease is the leading cause of death in all ages and genders. The leading cause of death for adolescents is motor vehicle crashes. The leading cause of death in infants younger than 12 months is congenital anomalies and the leading cause of death in children 12 months to 9 years is unintentional injuries.

Question 76 

You prescribe a short-acting anticholinergic medication that can be used alone or in combination with a short-acting beta agonist that the patient has already. What disease are you trying to manage? 

  benign prostatic hyperplasia 

  glaucoma 

   chronic obstructive pulmonary disease 

  tachyarrhythmias 

 

The Correct answer is:

Chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease who have intermittent symptoms need a first line treatment for shortness of breath which is an anticholinergic alone or in combination with a beta agonist. Both these medications will improve lung function. 

 

 Question 77 

The patient has the right to confidentiality. The following are all accurate statements regarding patient confidentiality EXCEPT: 

  The individual's right to privacy is respected when requesting or responding to a request for a medical record. 

   HIPAA was set up by the Department of Health and Human Services and stands for Health and Insurance Portability Advisory Association. 

   The statute requires that the provider discuss confidentiality issues with the patient and establish consent. 

  The provider shall not discuss any information with anyone unless the patient has given consent to do so. 

The Correct answer is:

HIPAA was set up by the Department of Health and Human Services and stands for Health and Insurance Portability Advisory Association

HIPAA stands for Health and Insurance Portability and Accountability Act, and not Advisory Association. HIPAA emerged in 1996 and the Department of Health and Human Services plays a role in governing this act. Further, HIPAA establishes national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers. 

 

Question 78 

In a child who is developing normally, which of the following gross motor skills are you likely to see first? 

  lifts shoulders while prone 

   rolls over 

  has head control 

   moves head side to side 

 

Correct answer:

moves head side to side

 

An infant who is developing normally will move his head from side to side at 2 weeks of age. The other three choices are skills learned from 2 months to 4 months in the average infant.

 

 Question 79 

Which of the following patients has the highest risk factor for peptic ulcer disease? 

  a 65-year-old female who drinks 4 cups of coffee per day 

   a 45-year-old male who has one or two alcoholic drinks per day 

   a 55-year-old male who has cirrhosis as a result of alcohol abuse

  none of the above 

Correct answer:

a 55-year-old male who has cirrhosis as a result of alcohol abuse

 

This is the patient who has the greatest risk factor for peptic ulcer disease. Coffee drinking and occasional alcohol use are not risk factors for peptic ulcer disease. H. pylori is also found in individuals with asymptomatic gastritis and dyspepsia without ulceration.

 

Question 80 

You are treating a female patient with an acute urinary tract infection (UTI). The nurse practitioner understands that she must discuss risk factors. The risk factor for UTI in women include: 

  obesity 

   hot tub use 

  wearing pantyhose 

   low lactobacilli colonization 

 

The Correct answer is:

Low lactobacilli colonization

Lactobacilli produce hydrogen peroxide and lactic acid, providing the periurethral area and vagina with a pH that inhibits bacterial growth, blocks potential sites of attachment and is toxic to uropathogens. A normal component of periurethral flora protects against urinary tract infection (UTI). Douching, obesity, use of hot tubs, and wearing pantyhose have not been shown to increase UTI risk. 

 

Question 81 

 All of the following are part of the structural functional theory of families EXCEPT:

 

   Families are social systems that form interdependent and independent relationships.

 

  Suprasystems form outside of the family and reflect needs not met within the family. 

   Internal family subsystems function as a microcosm of society. 

   Families pass through eight stages of development. 

Correct answer:

Families pass through eight stages of development.

 

This is not one of the tenets of structural functional family theory. It is a part of a developmental theory proposed by Duvall

 Question 82 

Which of the following would NOT be considered one of the four major factors influencing healthcare delivery services? 

  payers 

  insurers 

   patients 

  suppliers 

Correct answer:

patients

 

The four major factors influencing healthcare delivery services are: payers (including individual healthcare consumers); insurers; providers; and suppliers. Patients who receive the healthcare services are not considered a factor.

Question 83 

Which of the following statements about chronic myelogenous leukemia is least accurate? 

  It is rare in children. 

   The median age at onset is 21 years. 

   It progresses from chronic to accelerated and then to the blast phase. 

  It accounts for 1 – 5% of all childhood leukemias. 

Correct answer:

The median age at onset is 21 years.

 

The median age at onset for chronic myelogenous leukemia is 45 years. It is rare in children but if it is seen in children it is almost always before 2 years of age.

 Question 84 

For alcohol withdrawal symptoms, the preferred benzodiazepine is lorazepam. This is used when there is concomitant history of: 

  folate-deficiency anemia 

   hepatic disease 

   seizure disorder 

  multiple substance abuse 

The Correct answer is:

Hepatic disease

Librium or Valium are good therapeutic agents for patients with adequate hepatic function. However, lorazepam is the preferred agent for those with impaired hepatic function because of its short half life. 

 

Question 85 

Licensure for nurse practitioners is mandatory for which of the following reasons? 

  to protect the nurse practitioner 

  to establish a scope of practice 

   to protect against malpractice 

   to protect the public 

Correct answer:

to protect the public

 

The purpose of licensure is to protect the public by ensuring a minimum level of professional competence. It is not to protect the nurse or nurse practitioner.

Question 86 

If a 74 year old patient with CHF is prescribed Metformin, what could be the possible outcome?

 

  Decreased effectiveness of diuretics. 

  Fluid retention. 

   Hypoxia. 

  Ulcer and bleeding risk. 

Correct answer:

Hypoxia

Prescribing medications to patients with various diseases could put the patient at risk for additional conditions. For example, a patient with gastropathy cannot be prescribed NSAIDs because they may cause increased ulcer and bleeding risk.

 Question 87 

Hypothyroidism is least likely to be a cause of abnormal uterine bleeding in which of the following age groups?

 

  over 45 years of age 

  35 – 45 years of age 

   25 – 35 years of age 

   14 – 25 years of age 

 

Correct answer:

14 – 25 years of age

 

Hypothyroidism is the least likely to be a cause of abnormal uterine bleeding in the 14 – 25 year old age group. It is also not likely in those under 14 years of age.

 

Question 88 

When treating a male patient with orchitis, the nurse practitioner has knowledge that the most common causative agent for this is: 

   mumps 

  rubeola 

   arbovirus 

  echovirus 

The Correct answer is:

Mumps

The mumps virus is responsible for causing orchitis. Arbovirus and echovirus are implicated in meningitis and encephalitis. Rubeola is associated with complications of otitis media, croup, encephalitis, and pneumonia. 

Question 89 

Which of the following is the most frequent type of hearing loss in the elderly? 

   presbycusis 

  cerumen impaction 

   ototoxicity 

  noise trauma 

 

Correct answer:

presbycusis

 

Presbycusis is the most frequent type of hearing loss among the elderly. Annual hearing tests should be conducted after age 65 years.

Question 90 

You have prescribed a monoamine oxidase inhibitor (MAOI) for your patient with depression. You would tell this patient to avoid which of the following foods?

 

  those high in calorie 

  those high in glucose 

   those high in tyramine 

  those high in potassium

 

Correct answer:

those high in tyramine

 

Persons taking MAOIs should avoid foods with high tyramine. These include: aged cheese, red wine, chocolate, and fermented foods such as beer.

 

 Question 91 

With the geriatric client, which assessment tool should the nurse practitioner use to evaluate balance and gait problems? 

  Index of Independence of Activities of Daily Living Scale 

   Tinetti Balance and Gait Evaluation 

   Lawton & Brody Balance and Coordination Scale 

  Instrumental Activities of Daily Living Scale 

 

The Correct answer is:

Tinetti Balance and Gait Evaluation

The Tinetti scale and gait evaluation is an activity-based test that asks the patient to perform tasks, such as sitting and rising from a chair, turning, and bending. The Index of Independence o Activities of Daily Living helps to identify daily activities with which the patient needs assistance. The Instrumental Activities of Daily Living Scale assesses complex tasks. 

Question 92 

The second-most common cause of hearing loss is which of the following? 

  TM perforation 

   noise trauma 

   ototoxicity 

  cerumen impaction 

Correct answer:

noise trauma

 

Noise trauma is the second most common cause of hearing loss. Sounds louder than 85 dB are potentially damaging to the cochlea, especially with prolonged exposure.

 Question 93 

According to the National Asthma Education and Prevention Program Expert Panel Report 3 (NAEPP EPR-3) all of the following are goals of asthma care EXCEPT: 

  minimal or no chronic symptoms such as cough and wheeze 

   no limitations on activities 

  no or minimal side effects while optimal medications are given 

   fully reverse impaired lung function 

Correct answer:

fully reverse impaired lung function

 

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

Question 94 

When counseling a patient who currently has a testicular torsion, the Family Nurse Practitioner educates him on the best treatment approach. Which of the following is recommended as the first treatment option? 

   orchiopexy 

  avoidance of further testicular trauma 

   use of a scrotal support device 

  avoiding frequent sexual activity 

The Correct answer is:

Orchiopexy

Testicular torsion is a urological emergency caused by a twisting of the testis and spermatic cord around a vertical axis.  The first approach before using a supportive device is surgery. Surgery (orchiopexy) is performed to untwist the testis allowing both testes to be brought down and tacked lower in the scrotum to avoid subsequent torsion. Avoiding further trauma after the surgical procedure, a scrotal support device may be helpful to relieve the discomfort but will not prevent recurrence. Avoidance of sexual activity will not prevent testicular torsion. 

Question 95 

You are seeing a mother and her 12-month-old child in the office for a well-child examination. An example of a primary prevention measure for a 12-month-old healthy infant would be: 

  doing a routine urinalysis at the well-child exam 

  educating the mother on home care and treatment of the child's active diaper dermatitis rash 

   administering the first dose of the measles, mumps, and rubella vaccine (MMR) 

  administering the first dose of the  meningococcal vaccine (MCV) 

The Correct answer is:

Administering the first dose of the measles, mumps, and rubella vaccine (MMR)

The measles, mumps, and rubella vaccine is an immunization, which is a primary prevention measure. The vaccine is first given at 12 months of age. A urinalysis is not part of the 12 month well-child exam unless clinically indicated. Educating and treating active diaper dermatitis is a tertiary measure. The meningococcal vaccine is not administered until 2 years of age

 

Question 96 

 In terms of marketing the nurse practitioner role, the elements of marketing include the four Ps. All of the following are one of the four Ps EXCEPT:

 

  product 

  price 

   potential 

  place 

 Correct answer:

potential

 

This is not one of the four Ps of marketing the NP role. The four Ps include: product, price, place, and promotion.

Question 97 

Treatment options for lymphogranuloma venereum include all but which of the following? 

  tetracycline 

  doxycycline 

   erythromycin 

   penicillin 

Correct answer:

penicillin

 

Penicillin is not one of the treatment options for lymphogranuloma venereum, which is an STI caused by Chlamydia trachomatis types L1 to L3. As with all STIs a critical part of care is discussion of prevention strategies, such as condom use.

Question 98 

A parent brings a 3 year old in for a follow-up appointment. The child was treated for bronchitis earlier. What sign in the parent interview could indicate the child is showing an emergent condition? 

  The child is drinking fluids. 

  The child has gained weight. 

   The child is lethargic. 

  The child is active. 

Correct answer: The child is lethargic Lethargy could indicate that the child is still sick or developing an emergent condition. The other answers are positive indicators that the child's health is improving. 

 Question 99 

The normal stomach pH is which of the following? 

  7 

  9 

   5 

   2 

Correct answer:

2

 

The normal stomach pH is about 2, which kills many swallowed bacteria and viruses. Gastric acid production is about 1 to 2 mEq/hr in a resting empty stomach. This increases to 30 to 50 mEq/hr after a meal

Question 100 

Which of the following is indicative of elder abuse? 

  burns or abrasions 

  threatening behavior by caregiver 

   financial discrepancies 

   all of the above 

Correct answer:

all of the above

 

The most common form of elder abuse is neglect. It can include physical abuse, psychological abuse, financial abuse, and sexual abuse.

quiz 27 aanp

Question 1 

The cause of the highest mortality among teenagers in the U.S. is: 

  smoking 

   motor vehicle or unintentional injuries 

  suicide 

  congenital heart disease 

 

The Correct answer is:

Motor vehicle or unintentional injuries

The number one cause of mortality in this age group is motor vehicle accidents or unintentional injuries. The second is death from suicide. 

 Question 2 

Which organization accredits various entities and has standards concerning medical record confidentiality? 

  National Committee for Quality Assurance (NCQA) 

   Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 

  American Medical Association (AMA) 

  Department of Health, Education and Welfare (HEW) 

 

The Correct answer is:

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

JCAHO requires entities to develop a process to protect confidentiality of medical record information among other things. NCQA accredits managed care entities and has their own standards of confidentiality. The American Medical Association and the Department of Health and Education and Welfare are not involved with medical record confidentiality. 

Question 3 

You are educating the parent of a teenage girl who has been diagnosed with anorexia nervosa. You would NOT tell the parent which of the following? 

   Approximately 90% of patients are female.

 

   The maximum frequency of occurrence is 13 – 14 years of age. 

  It is associated with depression in 65% of cases. 

  It is associated with OCD in 26% of cases. 

Correct answer:

The maximum frequency of occurrence is 13 – 14 years of age.

 

This is not an accurate statement. The maximum frequency of occurrence is 17 – 18 years of age. About 85% of cases have onset usually at 14 – 18 years of age.

 

Question 4 

A patient with fatigue, migratory arthralgia and cranial nerve palsies. These symptoms are consistent with what stage of Lyme Disease? 

  1 

   2 

   3 

  None of these. 

 

Correct answer: 2 There are three stages of Lyme Disease. Stage 1 is known for: fever, chills, myalgia and erythema migrans Stage 2 is known for: fatigue, migratory arthralgia and cranial nerve palsies Stage 3 is known for: memory, sleep and mood problems 

 Question 5 

 Which of the following tests is used to diagnose macular degeneration?

 

  Weber test 

  Rinne test 

  Snellen chart 

   Amsler grid 

 

Correct answer:

Amsler grid

 

Central vision is tested using the Amsler grid for persons suspected of having macular degeneration. If the lines in the center of the grid are distorted this is a positive sign of macular degeneration.

Question 6 

Which of the following conditions in the patient’s past medical history is least likely to be associated with congestive heart failure (CHF)? 

  renal disease 

   cancer 

  hypertension 

  severe anemia 

 

Correct answer:

cancer

 

Cancer is not normally associated with CHF. A past medical history of any of the following may be associated with CHF: CAD, COPD, renal disease, diabetes, hypertension, previous MI, valvular disease, severe anemia, and more.

Question 7 

Which of the following types of hepatitis is NOT transmitted via blood and body fluids? 

  Hepatitis C 

   Hepatitis A 

  Hepatitis D 

  Hepatitis B 

Correct answer:

Hepatitis A

 

Hepatitis A is not transmitted by blood and body fluids. It is transmitted through a fecal-oral route.

 

 Question 8 

The New York Longitudinal Study defines nine dimensions of temperament. Which of the following traits is included in these nine dimensions? 

   sociability 

  synchrony 

  morality 

   sensitivity 

 

Correct answer:

sensitivity

 

Sensitivity is one of the nine dimensions of temperament. The others are: activity, rhythmicity, approach (or withdrawal), adaptability, intensity, mood, distractibility and attention span.

 

Question 9 

You have a patient with back pain but you suspect malingering. In order to rule this out, you use Waddell’s signs. All of the following are part of this standardized group of nonorganic physical signs EXCEPT: 

  axial loading 

   regionalization 

   reproducing pain 

  simulation 

 

 Correct answer:

reproducing pain

 

Reproducing pain is done in Magnuson’s test for malingering. Waddell’s signs include all of the other three choices plus: overreaction, distraction and tenderness.

Question 10 

The theory that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior is which of the following? 

  Systems Theory 

   Self-Efficacy Theory 

  Health Belief Model 

  Family Systems Theory 

 

Correct answer:

Self-Efficacy Theory

 

The Self-Efficacy Theory holds that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior. This concept was put forth by Albert Bandura in the 1970s.

Question 11 

If an adult presents with the classic triad of fever, headache and stiff neck, which of the following diseases/conditions would these symptoms most likely indicate? 

  migraine headache 

   bacterial meningitis 

   mononucleosis 

  chronic epidural hematoma 

Correct answer:

bacterial meningitis

 

Of the choices given, the most likely diagnosis would be bacterial meningitis. As with most forms of infectious disease, however, atypical presentation in older adults is common. In particular, stiff neck and fever are often absent.

Question 12 

You are caring for an elderly patient who has had a cerebrovascular accident (CVA) and has urinary incontinence. The family should be taught to: 

  insert a Foley catheter 

   establish a scheduled voiding pattern 

   restrict fluid intake 

  reposition the patient often to reduce the discomfort of urgency 

The Correct answer is:

Establish a scheduled voiding pattern

The patient needs a reestablished pattern for regularity to assist in maintaining bladder control. A Foley catheter would expose the patient to infection and fluids should not be restricted. 

Question 13 

Which of the following responses in a physical exam could indicate damage or inflammation of the spinal cord? 

  Weak reflexes. 

  Peripheral neuropathy. 

   Hyper flexion. 

  Gag reflex. 

Correct answer: Hyper flexion Hyper flexion indicates that the nerves are hyperactive. This is typically indicative of problems in the spinal cord. Weak reflexes can indicate peripheral neuropathy. 

 

Question 14 

After talking to you about his smoking and drinking, your client tells you that he will think about changing his habits but he is not ready yet. You help him to examine the benefits and obstacles that would be associated with his change. This stage in the transtheoretical model of change is which of the following? 

  maintenance 

  preparation 

   contemplation 

  precontemplation 

 Correct answer:

contemplation

 

Contemplation involves considering a behavioral change in the foreseeable future, possibly within 6 months. The role of the NP includes continuing consciousness raising, providing information, praising for considering, and exploring ways to reduce barriers and obstacles to change.

Question 15 

Madeline Leininger envisioned blending the disciplines of nursing and anthropology in both theory and practice to enable a cultural perspective for the professional practice of nursing. Her theory is known as which of the following? 

  enculturation 

  cultural blindness 

   transcultural nursing 

  melting pot theory 

Correct answer:

transcultural nursing

 

Madeline Leininger promoted the theory of transcultural nursing. Although not all advanced practice nurses practice the full scope of transcultural nursing as a specialization, all are encouraged to provide care that is culturally competent.

 

Question 16 

You have an adult patient of Scottish descent who reports that she has noticed a red, acne-like area around her nose and mouth. She tells you that it comes and goes. Your most likely diagnosis of the following choices would be: 

  cheilosis 

   rosacea 

   cystic acne 

  tinea barbae 

Correct answer:

rosacea

 

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

 

Question 17 

You are seeing a 3-year-old female child in the office. Her mother is concerned about her not being able to elevate her left arm without crying out. A clavicular fracture is suspected. Which of the following is NOT true regarding a fracture of the clavicle? 

  This is one of the most common fractures that occur in childhood. 

  The patient may avoid moving the arm on the injured side or may angle the head toward the injured side to relax the trapezius muscle. 

   There is usually no visible or palpable deformity upon examination and it is rarely seen on an x-ray. 

  The mechanisms of injury is usually a fall on the outstretched hand or direct blow to the shoulder area. 

The Correct answer is:

There is usually no visible or palpable deformity upon examination and it is rarely seen on an x-ray

There is most always a visible and a palpable deformity seen and the x-ray findings will show a visible separation of the clavicular bone. Further, the remaining answer choices are all true of this type of fracture. 

Question 18 

According to Duvall, families pass through eight chronological stages, and success in one task sets the stage for success in subsequent tasks. Which of the following is NOT one of Duvall’s stages of development? 

  family with old age and retirement 

  launching center family 

   childbearing family 

   prenatal family 

Correct answer:

prenatal family

 

This is not a stage of Duvall’s theory of families. His stages are: beginning family, childbearing family, family with preschool children, family with schoolchildren, family with teenagers, launching center family, family with middle-aged parents and family with old age and retirement.

Question 19 

Which of the following herbal over-the-counter medicines is NOT used for anxiety and/or depression? 

  Kava kava 

  St. John’s Wort 

   Valerian root 

   none of the above 

Correct answer:

none of the above

 

All of the choices except this one are herbal remedies for anxiety and/or depression. St. John’s Wort acts like MAOI, SSRI, or TCA. Kava kava has action at GABA receptors similar to benzodiazepines. Valerian root also has action similar to benzodiazepines. 

Question 20 

Which of the following is a modifiable environmental factor affecting the health and health care of patients? 

  climate 

   altitude 

   air pollution 

  none of the above 

Correct answer:

air pollution

 

Air pollution is one of the factors affecting health that can be modified. Other modifiable factors include: water fluoridation, water contamination, crime, poverty and transportation.

 Question 21 

 A milder form of Stevens-Johnson syndrome that produces pink-to-red targetlike lesions, wheals, and blisters, with no mucosal involvement is which of the following?

 

   erythema multiforme 

  actinic keratosis 

   erythema migrans 

  shingles 

Correct answer:

erythema multiforme

 

Erythema multiforme is a milder form of Stevens-Johnson syndrome that produces pink-to-red targetlike lesions, wheals, and blisters, with no mucosal involvement. The clinician should look for a history of antibiotic and other drug treatment such as sulfa drugs, penicillins, and other drugs.

 

Question 22 

A good quality assurance program should do which of the following? 

  identify educational needs 

  improve the documentation of care 

   reduce the clinician’s overall exposure to liability 

   all of the above 

 

Correct answer:

all of the above

 

A good quality assurance program would include all of the first three choices. These programs also look at organizational effectiveness, efficiency, and client and provider interactions.

Question 23 

An elderly male has a diagnosis of left-sided congestive heart failure (CHF). The nurse practitioner would identify which of the following as a common condition associated with CHF? 

  ventricular dysrhythmias 

  peripheral vascular disease 

   untreated hypertension 

  chronic obstructive pulmonary disease 

 

The Correct answer is:

Untreated hypertension

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

Question 24 

When treating the patient with heartburn symptoms, the nurse practitioner understand that the drug that is most likely to produce rapid relief for a patient is: 

  H2 blockers 

  proton pump inhibitors 

   sucralfate 

   antacids 

The Correct answer is:

Antacids

Antacids produce the most rapid change in gastric pH and the most rapid relief of symptoms. H2 blockers and proton pump inhibitors may take many hours before relief is realized. Therefore, H2 blockers are not adequate for immediate relief. Further, sucralfate does not affect gastric pH. 

Question 25 

You want to test a child for color-blindness. You would use which of the following? 

  Snellen chart 

   Ishihara chart 

   Kawasaki chart 

  Snellen picture chart 

Correct answer:

Ishihara chart

 

The Ishihara chart is used for screening color blindness. The Snellen Chart is used for screening central distance vision if the child knows the alphabet; if not the Snellen picture chart is used.

 

Question 26 

 Which of the following would NOT be considered a good strategy for improving access to health care?

 

   Train more specialists and fewer primary care providers. 

  Establish community health centers. 

    Increase the number of minority providers.

 

  Establish migrant health centers. 

Correct answer:

Train more specialists and fewer primary care providers.

 

This would not be a good strategy for improving access to health care. More primary care providers are needed in order to improve access for those underserved populations.

 

Question 27 

In terms of human growth and development in infancy, which of the following would be a normal finding? 

   Head circumference is approximately 2 cm larger than chest during the first year of life. 

  During childhood the chest is usually 10 – 12 cm larger than head circumference. 

   The posterior fontanel is always palpable at birth. 

  The size of the anterior fontanel should be no larger than 7 -8 cm in diameter. 

Correct answer:

Head circumference is approximately 2 cm larger than chest during the first year of life.

 

This would be a normal finding. The other choices are not. During childhood the chest is usually 5 - 7 cm larger than head circumference. The posterior fontanel is rarely palpable at birth. The size of the anterior fontanel should be no larger than 4 -5 cm in diameter.

 

Question 28 

Which of the following statements about pityriasis rosea is accurate? 

  Pityriasis is mainly a disorder of those with Mediterranean heritage. 

  It occurs in men more than in women. 

   There is no racial predilection. 

  It is most common in those over 65 years of age. 

Correct answer:

There is no racial predilection.

 

This is the accurate statement. Pityriasis is mainly a disorder of fair-skinned persons. It occurs in women more than in men. It is common in ages 10 to 35

Question 29 

You are treating a patient with acute sinusitis. You understand that the “gold standard” first line medication for this condition is which of the following? 

  cephalosporins 

  trimethoprim sulfamethoxazole 

   Ceftin 

   amoxicillin 

Correct answer:

amoxicillin

 

Acute sinusitis is an infection of the sinuses by Gram-positive and Gram-negative bacteria. For treating acute sinusitis, amoxicillin is the “gold standard” for any age group.

Question 30 

Which of the following statements about the approaches to healthcare issues is incorrect? 

  Reducing health disparities is a major concern. 

   There is decreasing emphasis on culturally competent care and evidence-based practice. 

   More than 45 million Americans are underserved because of limited access to care. 

  Causes of infant mortality have changed over the years. 

 

Correct answer:

There is decreasing emphasis on culturally competent care and evidence-based practice.

 

This is incorrect. The opposite is true. There is increasing emphasis on culturally competent care and evidence-based practice.

 

 Question 31 

 Which of the following is the least likely risk factor for suicide?

 

   black race 

  male 

   increasing age 

  physical illness 

 

Correct answer:

black race

 

Being of a white race is more likely to be a factor in suicide. Besides the other three choices risk factors include: substance abuse, living alone, and less education.

 

 Question 32 

A 78-year-old woman who presents with incontinence, is prescribed Detrol. She has the most common type of incontinence among the elderly population. What type of incontinence is it? 

   Urge. 

  Stress. 

   Functional. 

  Transient. 

 

Correct answer: Urge There are pharmalogical and non-pharmacological aids that assist with alleviating this type of incontinence. Behavioral therapy such as gentle bladder stretching and pharmacological care such as being prescribed VESIcare and Detrol have proven effective. 

 

Question 33 

 Which of the following is the leading cause of cancer deaths in women?

 

  breast cancer 

   lung cancer 

   colon cancer 

  pancreatic cancer 

Correct answer:

lung cancer

 

Lung cancer is the leading cause of cancer deaths in women. Breast cancer is the second leading cause.

Question 34 

Which of the following danger signals of pregnancy and childbirth is characterized by a patient who is older than 25 years, multipara and in the third trimester of pregnancy complaining of severe headaches, edema of the face and hands, abdominal pain, nausea and/or vomiting and fatigue and having elevated liver enzymes and low platelets? 

  eclampsia 

  placenta previa 

   abruptio placentae 

   HELLP syndrome 

Correct answer:

HELLP syndrome

 

HELLP syndrome is a rare but serious complication of pregnancy. It is characterized by all of the conditions in the question as well as hemolysis, elevated liver enzymes and low platelets (HELLP).

 Question 35 

You are prescribing a high-fiber diet for a patient with diverticulosis. You would recommend all of the following foods as high in fiber EXCEPT: 

  bran flakes 

  brown rice 

   eggs 

  kidney beans 

Correct answer:

eggs

 

Eggs are not high in fiber. In fact they are recommended for low-residue diets.

 

Question 36 

You are seeing an 18-year-old woman in the office with a "pimple" on her left eyelid. Upon examination, you find a 2.5 mm pustule on the lateral boarder of the eyelid. This is most consistent with: 

  cellulitis 

  chalazion 

   blepharitis 

   hordeolum 

 

The Correct answer is:

Hordeolum

A hordeolum, or stye, is caused by staphylococcal infection of a hair follicle. Cellulitis is a serious complication of a hordeolum and severe edema and redness would be present. A chalazion is characterized by a hard, nontender swelling of the upper or lower lid. 

Question 37 

The FNP is seeing a college-age female who participated in strenuous sports activities in high school. The FNP understands that all of the following may be a risk for this patient EXCEPT: 

   menorrhagia 

  eating disorders 

   delayed menses 

  osteoporosis 

Correct answer:

menorrhagia

 

Menorrhagia (heavy menstrual bleeding) is not a common concern for women who take part in strenuous physical activity. Females who participate in strenuous physical activities are at risk for eating disorders, delayed menses and osteoporosis.

Question 38 

A young woman comes in with a new rash on her hands and face. What question will help determine what type of rash this is? 

  Has your weight changed? 

   Have you changed cosmetics? 

   How much water do you drink daily? 

  When where you born? 

 

Correct answer: Have you changed cosmetics? Cosmetics do affect the skin. Changing or adding any new cream, even natural creams, can cause allergic reactions. Always ask about cosmetics with rashes.

 

 Question 39 

You have a 55-year-old male patient who has a history of sickle cell anemia. He has come to you because he has had an erection that lasted over 4 hours. You understand that this condition is known as which of the following? 

  erectile dysfunction 

  epididymis 

   transillumination 

   priapism 

 

Correct answer:

priapism

 

Priapism is a continuous penile erection of at least 4 hours or longer unrelated to sexual desire or stimulation. Persons with a history of sickle cell anemia or other blood clotting disorders may suffer from this. It may also be the result of taking drugs for erectile dysfunction.

 

Question 40 

A 32 year old female patient reports feeling achy and nauseous for three weeks. She also says her urine is very dark. Her temperature is 100.7F. She has a long-term history of multiple male sexual partners. This patient should be further assessed for which of the following? 

  Syphilis. 

  Hepatitis A. 

   Hepatitis B. 

  Hepatitis C. 

 

Correct Answer: Hepatitis B This patient's symptoms are consistent with Hepatitis B. Her sexual history also puts her at elevated risk for the disease, which is sexually transmitted. Further testing should be undertaken to confirm the diagnosis. 

Question 41 

In managing the client with fibromyalgia, the nurse practitioner includes what teaching instruction? 

   Take ibuprofen (Motrin) for pain and amitriptyline (Elavil) 1-2 hours before bedtime 

  Avoid stretching exercises and daily low impact aerobics. 

  Apply heat or massage "trigger points" to reduce pain. 

   Diagnostic studies, such as ESR and CBC, are important tools to assess treatment and disease progression. 

Correct answer:

Take ibuprofen (Motrin) for pain and amitriptyline (Elavil) 1-2 hours before bedtime

For patients with fibromyalgia, the nurse practitioner should include in the patient teaching that daily, slow, low-impact aerobics as well as heat and massage is encouraged for pain reduction and better physical functioning. Further, medication treatment options include tricyclic antidepressants at a low dose, such as amitriptyline (Elavil), which helps reduce symptoms associated with fibromyalgia. Other medications such as muscle relaxants, for example cyclobenzaprine (Flexeril), pain relievers and anticonvulsant drugs, such as Lyrica may also be helpful in reducing symptoms associated with fibromyalgia. Further, diagnostic testing is not a treatment option for fibromyalgia. The diagnosis of fibromyalgia is based on the patient having pain in 11 or more of the areas identified as tender points, along with other symptoms of fibromyalgia.

Question 42 

What is the purpose of the National Practitioner Databank?

 

   It was established to scrutinize members of the healthcare profession and list any malpractice claims that exist against them. 

  It was established to allow insurance companies ease in credentialing members for their provider networks. 

   It was established to assure reimbursement for nurse practitioners who are providers of Medicare, Medicaid, and other federal insurance programs. 

  It was established to regulate the prescribing practices of nurse practitioners and physicians. 

The Correct  answer is:

It was established to scrutinize members of the healthcare profession and list any malpractice claims that exist against them.

The National Practitioner Databank was established by the Health Care Quality Improvement Act of 1986. Currently, very few nurse practitioners are listed in this database. 

Question 43 

Which of the following medications would you prescribe for a 36 year old female with hypothyroidism? 

  Tapazole. 

   Synthroid. 

   PTU. 

  Propylthiouracil. 

 

Correct Answer: Synthroid Also known as levothyroxine, Synthroid is commonly prescribed for hypothyroidism. The other choices listed are commonly prescribed for hyperthyroidism. 

 

Question 44 

A 5-year-old school age child is in the clinic with varicella. The nurse practitioner has knowledge that the following is the best approach to relieve discomfort in a child with varicella:

 

  aspirin 

   acetaminophen 

   alcohol rub 

  ibuprofen 

 

The Correct answer is:

Acetaminophen

Aspirin should be avoided in children, especially when they have a viral illness due to Reye syndrome. Ibuprofen is not the best answer choice as it increases the risk of necrotizing fascitis when used in the varicella patient. Then, an alcohol rub will irritate the patient's lesions and exacerbate pain. 

Question 45 

Which of the following is least likely to be associated with a varicocele in your patient? 

  It is found in the left scrotum. 

   It is present only in the supine position. 

   Surgery is curative. 

  Scrotal support can be helpful for relief of discomfort. 

 

Correct answer:

It is present only in the supine position.

 

This is the least likely presentation to be associated with a varicocele. A varicocele is present while the man is standing. It disappears in the supine position

 

Question 46 

You believe that if one family member is dysfunctional, the rest of the family is affected negatively. This theory is known as which of the following? 

  self-efficacy theory 

   health belief model 

  comparative model 

   family systems theory 

 

Correct answer:

family systems theory

 

The family systems theory holds that families develop at a different rate. If one family member is dysfunctional, the rest of the family is affected negatively. It is derived from the systems theory.

Question 47 

It has become more necessary for advanced practice nurses to assume emergency roles during a time of mass casualties from natural disasters and terrorist attacks. All of the following are true EXCEPT: 

   The International Nursing Coalition for Mass Casualty Education is an organization established to fund supplies for victims of a disaster. 

  The International Nursing Coalition for Mass Casualty Education educates nurses to respond safely and effectively to mass casualty incidents. 

   All nurse practitioners are expected to prepare themselves to play a larger role in delivery of care during a time of disaster. 

  Other countries have had more experience dealing with terrorism than the U.S. 

Correct answer is:

The International Nursing Coalition for Mass Casualty Education is an organization established to fund supplies for victims of a disaster.

The purpose of this organization is to improve the ability of all nurses to respond safely and effectively to mass casualty incidents through identifying existing and emerging roles of nurses and ensuring appropriateness of education. They do not offer supplies or funding for victims. The other answers are accurate. 

 

Question 48 

Which of the following parts of Medicare pays 80% of durable medical equipment such as wheelchairs and walkers? 

  Part D 

  Part A 

   Part B 

  Medicare does not pay for durable medical equipment. 

 

Correct answer:

Part B

 

Medicare Part B pays for medically necessary services or supplies (outpatient). This includes durable medical equipment such as wheelchairs and walkers

Question 49 

A patient recently diagnosed with fibromyalgia is about to start taking Lyrica for the condition. She also takes LEV for epilepsy. This patient should be carefully watched for which of the following? 

   Suicidal thinking or behavior. 

  Intestinal bleeding. 

   Symptoms of stroke. 

  Increased risk of bleeding. 

 

Correct Answer: Suicidal thinking or behavior Lyrica is know to have a possible drug interaction with antiepileptic drugs (AEDs), including LEV. The patient should be carefully watched for suicidal thoughts or behaviors, which may result from this interaction. Changes in behavior or worsening of suicidal thoughts should also be noted in these patients. 

 Question 50 

The FNP is working in a college clinic and sees a student complaining of high fever, headache, stiff neck and vomiting. She has purple color lesions on her body. Which of the following diseases/conditions would the FNP most likely suspect? 

  Stevens-Johnson syndrome 

  erythema multiforme 

   meningococcemia 

  Lyme disease 

 

Correct answer:

meningococcemia

 

The highest incidence of meningococcemia is in college students residing in dormitories. Vaccine is recommended for this population. Meningococcemia is a serious life-threatening infection spread by respiratory droplets. It has a 20% mortality, but if treated early, the mortality is less than 5%.

Question 51 

Most kidney stones are composed of which of the following? 

  uric acid 

   calcium 

   cystine 

  struvite 

 

Correct answer:

calcium

 

Most urinary and kidney stones are composed of calcium (80%). Uric acid accounts for about 5%, and cystine, 2%, with struvite accounting for even less.

 

 Question 52 

A vegan complains of GI problems. The patient does not take vitamin supplements. What test should be run? 

  Blood glucose. 

  Vitamin C. 

   Serum albumin. 

   Vitamin B12. 

 

Correct answer: Vitamin B12 Some vegans have trouble maintaining Vitamin B12 levels. A blood test for B12 is necessary, particularly if there is GI trouble

 

Question 53 

Which of the following medications is NOT appropriate to prescribe for the management of genital herpes? 

  Zovirax. 

   Diflucan. 

   Valtrex. 

  Famvir. 

 

Correct Answer: Diflucan Diflucan, or flucanazole, is an oral medication prescribed for the treatment of vaginal yeast infections. The other choices are suppressive medications prescribed for the management of genital herpes. 

Question 54 

For which of the following conditions/diseases would the FNP test by using the Phalen’s sign? 

  Bell’s Palsy 

   carpal tunnel syndrome 

  osteoporosis 

   glaucoma 

Correct answer:

carpal tunnel syndrome

 

Carpal tunnel syndrome is a median nerve compression that is due to swelling of the carpal tunnel. The Phalen’s sign is full flexion of the wrist for 60 seconds. If the patient’s symptoms are reproduced, it is a positive finding.

 

Question 55 

Lack of which of the following skills in a school-age child would be most likely to cause concern? 

  formal operational thought 

  inability to assert his or her independence 

   inability to reverse a process or action 

  lack of awareness of his or her body image 

Correct answer:

inability to reverse a process or action

 

The only skill of the three that may cause concern is the inability to reverse a process or action, for instance, the understanding that if 1 + 1 = 2, then 2 – 1 =1. All of the other skills are attributable to later development.

Question 56 

Your pregnant patient has been complaining of heartburn. You would tell her to do all of the following EXCEPT: 

  eat small, frequent meals 

  eat papaya or raw almonds after meals 

   avoid fried or spicy foods 

   use antacids containing baking soda, aluminum, or high sodium content 

 

Correct answer:

use antacids containing baking soda, aluminum, or high sodium content

 

Antacids with magnesium hydroxide or magnesium trisilicate may be used. Antacids with baking soda, aluminum, or high sodium content should be avoided.

 

Question 57 

Which of the following statements about calcium channel blockers (CCBs) is incorrect? 

   Vasotec is the most commonly used CCB. 

  CCBs depress heart muscle and the AV node. 

   Bradycardia is a contraindication to the use of CCBs. 

  Norvasc is a CCB drug. 

 

Correct answer:

Vasotec is the most commonly used CCB.

 

Vasotec (enalapril) is an ACE inhibitor drug, not a CCB. CCBs block calcium channels in the arterioles resulting in systemic vasodilation, which results in decreasing PVR. They depress heart muscle and the AV node. 

Question 58 

Which of the following is the best definition for positive predictive value (PPV)? 

  a more systematic evaluation using a standardized or generally accepted method leading to recommendations for intervention 

  the proportion of those with an abnormality who are correctly identified through screening (true positives) 

   the proportion of those individuals correctly screened as positive of all those who actually have an abnormality 

  the proportion of those without an abnormality who are correctly identified as negative through screening (true negatives) 

Correct answer:

the proportion of those individuals correctly screened as positive of all those who actually have an abnormality

 

The positive predictive value (PPV) is defined as the proportion of those individuals correctly screened as positive of all those who actually have an abnormality. A more systematic evaluation using a standardized or generally accepted method leading to recommendations for intervention is assessment. The proportion of those with an abnormality who are correctly identified through screening (true positives) is sensitivity. The proportion of those without an abnormality who are correctly identified as negative through screening (true negatives) is specificity.

 

 Question 59 

A 16-year-old male patient presents in the clinic with abdominal pain, worse with ambulation, nausea, and fever. Next, the nurse practitioner would test the obturator and iliopsoas muscle to evaluate for which of the following?

 

  cholecystitis 

   acute appendicitis 

   inguinal hernia 

  gastric ulcer 

The Correct answer is:

Acute appendicitis 

Acute appendicitis is common in this age group and the symptoms are indicative of the condition. The obturator and iliopsoas muscles are sensitive when 

Question 60 

Which of the following is NOT true about a durable power of attorney for health care? 

  It is not limited to the circumstances of terminal illness. 

   It is not binding except in certain circumstances. 

   It is often accompanied by a durable power of attorney over financial issues as well. 

  It is flexible enough to carry out the patient’s wishes throughout the course of an illness. 

Correct answer:

It is not binding except in certain circumstances.

 

This is incorrect. A durable power of attorney for health care is always binding.

Question 61 

The incubation period for Hepatitis A is which of the following? 

  45 - 160 days 

  7 – 10 days 

   30 – 40 days 

   15 – 50 days 

Correct answer:

15 – 50 days

 

Hepatitis A is transmitted through the fecal-oral route in contaminated food and water. Its incubation period is 15 – 50 days. Hepatitis B and D have incubation periods of 45 – 160 days.

 

Question 62 

A 67-year-old diabetic has been taking oral antihyperglycemic medication. The patient is still having poor glycemic control. You make the decision to start insulin therapy. He weighs 60 kg. What should you order as an initial starting dose?

 

  6 units short-acting insulin at breakfast, continue oral medication 

  6 units intermediate insulin at bedtime, stop oral medication 

   6 units long-acting before breakfast, stop oral medication 

   12 units long-acting insulin at bedtime, continue oral medication 

The Correct answer is:

12 units long-acting insulin at bedtime, continue oral medication

The American Diabetic Association (ADA) algorithm for initiation and adjustment of therapy (2006) suggests an intermediate or long-acting insulin to be started at bedtime or morning as a once daily dose. According to the ADA, the starting dose is either 10 units or 0.2 units per kilogram. For this 67-year-old diabetic patient, the nurse practitioner starts him on 12 units, based on the calculation of 0.2 units per kilogram (0.2 X 60 kg). Oral medication should be continued except for discontinuing sulfonylureas or meglitinides. 

 

Question 63 

Which of the following would NOT be considered a risk factor for gastroesophageal reflux disease (GERD)?

 

  hiatal hernia 

  esophageal clearance 

   gastric outlet obstruction 

   underweight 

 

Correct answer:

underweight

 

Being underweight is not a risk factor for GERD. Obesity is a risk factor.

 

 Question 64 

Type 2 diabetes mellitus testing should be considered in all adults who are overweight and have additional risk factors. All of the following are additional risk factors to consider EXCEPT: 

  history of cardiovascular disease 

  women with polycystic ovarian syndrome 

   member of a high risk population 

   history of hypotension 

 

Correct answer:

history of hypotension

 

This is not one of the additional risk factors for type II diabetes. All of the other choices are additional risk factors along with: physical inactivity, first-degree relative with diabetes, women who delivered an infant weighing over 9 pounds, women who have had gestational diabetes, hypertension, HDL cholesterol level of < 35 mg/dL, triglyceride level > 250 mg/dL, impaired glucose tolerance and other clinical conditions associated with insulin resistance.

 

Question 65 

The FNP has a pregnant patient who is diagnosed with chlamydia trachomatis. Which of the following treatments is preferred for this woman? 

   azithromycin 1 gm PO single dose 

  doxycycline 100 mg BID x 7 days 

   Cipro 500 mg x one dose 

  erythromycin base QID x 7 days 

 

Correct answer:

azithromycin 1 gm PO single dose

 

For pregnant women erythromycin base QID x 7 days was the preferred treatment. However the CDC recommendation at the present time for a pregnant patient who is diagnosed with chlamydia trachomatis is azithromycin 1 gm PO single dose

 Question 66 

If the FNP is testing the visual acuity of a 3-year-old child, which of the following results would be considered in the normal range? 

  40/40 

  20/20 

   20/40 

  all of the above 

Correct answer:

20/40

 

Visual acuity for toddlers is normally 20/40. A visual acuity of 20/20 would be exceptional for a toddler. Visual acuity of 40/40 would indicate less than normal visual acuity.

 

Question 67 

You are counseling a 23-year-old with an abnormal pap smear. It is important you discuss the risks of cervical cancer. Which of the following is NOT a risk factor for cervical cancer?

 

   virginal status 

  previous high-grade squamous intraepithelial lesion 

   human papillomavirus 

  multiple sexual partners 

The correct answer is:

Virginal status

A female who has not had sexual intercourse is not at risk for developing cervical cancer. However, the remaining answer choices are risk factors for cervical cancer. 

 

Question 68 

Orthopedic referral would most likely be made in which of the following grades of sprain? 

  Grade IV 

   Grade III 

   Grade II 

  Grade I 

Correct answer:

Grade III

 

Orthopedic referral would be made in the most serious grade of sprain which is Grade III. There is no Grade IV sprain. Grade III sprains have a complete ligamentous tear, complete ankle instability, significant swelling and moderate to severe ecchymosis.

Question 69 

The FNP has an adult patient who presents with a rash on the hands and neck that consists of bright red weepy lesions. The FNP diagnoses eczema. Which of the following should be avoided in the treatment of this disease? 

  topical steroids 

  skin lubricants 

   hot water baths 

  systemic oral antihistamines 

Correct answer:

hot water baths

 

In treating patients with eczema, the FNP should advise that patient to avoid drying the skin. Hot water baths, harsh detergents, chemicals and wool clothing should be avoided. Medications for this disease include topical steroids, systemic oral antihistamines and skin lubricants such as Eucerin, Keri lotion and baby oil.

Question 70 

Your 65-year-old female patient has developed a scaly red-colored rash on the nipple. She tells you that she thought it would just “go away” but that instead it has enlarged and now there is some nipple discharge. You understand that this is which of the following diseases? 

   Paget’s disease 

  breast cancer 

  fibrocystic breast 

   sign of STD 

Correct answer:

Paget’s disease

 

Paget’s disease of the breast (ductal carcinoma in situ) occurs when the woman develops a chronic scaly red-colored rash resembling eczema on the nipple that does not heal and slowly enlarges over time. The skin lesion slowly evolves to include crusting, ulceration, and/or bleeding. Some women complain of itching. Nipple discharge and/or a lump may be present.

Question 71 

A 39-year-old Caucasian male is started on Aldactone 50 mg PO qd. He has a longstanding history of hypertension. The nurse practitioner knows that she should instruct him to call the clinic if which symptoms are experienced? 

  Decreased reflex response, nausea, and vomiting. 

  Muscle twitching, numbness of the limbs, and depression. 

   Increased irritability, abdominal cramping, and lower extremity weakness. 

  Weight gain, excessive thirst, and fever. 

 

The Correct answer is:

Increased irritability, abdominal cramping, and lower extremity weakness

Aldactone is a potassium-sparing diuretic and the patient should be instructed on the side effects of this medication. Signs or symptoms, such as lower extremity weakness, may indicate hyperkalemia. Aldactone can place the patient at increased risk for hyperkalemia. The remaining answer choices have no relevance to Aldactone side effects or mechanism of action. 

Question 72 

At what age would you schedule a female patient for a mammogram as part of a routine screening? 

  25 

  30 

   40 

  55 

Correct answer: 40 Mammograms become part of routine screenings as after patients reach 40 or older. This number may vary slightly by institution. A mammogram is typically given every year or two, depending on the risk factors

 

 Question 73 

You have a patient diagnosed with acute bronchitis. Which of the following types of drugs are you NOT likely to prescribe? 

  antitussives 

  mucolytics 

   antibiotics 

  guaifenesin 

Correct answer:

antibiotics

 

Acute bronchitis requires symptomatic treatment only. No antibiotics should be prescribed. Acute bronchitis is characterized by paroxysms of dry coughing and wheezing, and can last up to 4 to 6 weeks.

Question 74 

You are conducting an assessment with a male patient who is complaining of chills and chest pain. He has had a cough for two weeks, which produces yellow-green sputum. His temperature is 101F. All but which of the following are possible diagnoses for this patient? 

   Pertussis. 

  Viral pneumonia. 

   Bacterial pneumonia. 

  Upper respiratory infection. 

 

Correct Answer: Pertussis This patient's symptoms are not in keeping with pertussis, which has a hacking cough and low-grade fever. This patient's temperature is too high, and the chest pain and productive cough are more indicative of pneumonia or upper respiratory infection. Sputum cultures may be needed to correctly diagnose this patient. 

Question 75 

It is important that medical personnel be familiar with the source and use of pharmaceutical drugs. What are the two more common ways drugs are prescribed to be taken? 

  Dissolved or crushed. 

   Orally or intravenously. 

   In food or drink. 

  Give the option to take or not to take. 

Correct answer:

Orally or intravenously

Drugs given orally is the most common method. However, intravenously given drugs are absorbed quicker. 

 

 Question 76 

Conforming to a standard of what is considered right and good is which of the following? 

  ethics 

  behavior 

   morality 

   autonomy 

 

 Correct answer:

morality

 

Ethics is the study of standards of conduct and moral judgment. It is the study of morality. Morality is conforming to a standard of what is considered right and good.

Question 77 

The FNP has a pregnant patient who is Rh negative and whose baby is Rh positive. The treatment for the infant antepartum includes which of the following? 

   transfusion with Rh negative blood 

  phototherapy 

   transfusion of packed red blood cells 

  administration of gamma globulin 

 

Correct answer:

transfusion with Rh negative blood

 

Once a diagnosis has been established, antenatal treatment includes transfusion of the fetus with Rh negative blood. All of the other choices are parts of postpartum interventions.

 

Question 78 

Certification for nurse practitioners is granted by all of the following EXCEPT: 

  AANP 

   Nurse Practice Act 

  ANCC 

   NCC 

Correct answer:

Nurse Practice Act

 

The Nurse Practice Act of each state defines nursing, including advanced practice nursing, but it is not a certification organization as are the other three choices. Another organization is the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP).

 

Question 79 

The theorist who developed a theory of basic needs and human potential is which of the following? 

  Carl Rogers 

   Mary Ainsworth 

   Abraham Maslow 

  Charles Darwin 

Correct answer:

Abraham Maslow

 

Abraham Maslow developed the theory of basic needs and human potential derived from the study of healthy, creative individuals. The hierarchy of needs includes: physiologic; safety, security and stability; affiliation, acceptance and love; ego, self-worth, confidence, competence and success; and self-actualization.

Question 80 

In educating a client who has recurrent episodes of gout, you would tell him all of the following EXCEPT: 

  avoid alcohol binges 

  avoid fasting 

  avoid low-calorie diets 

   limit fluid intake 

 

Correct answer:

limit fluid intake

 

You would encourage generous fluid intake for a person with gout. This helps to avoid kidney stones.

Question 81 

Which of the following is NOT part of the triad involved with preeclampsia? 

  hypertension 

  proteinuria 

   anemia 

  edema 

Correct answer:

anemia

 

Anemia is not part of the triad of symptoms involved with preeclampsia. This condition can cause multi-organ failure and death. It may start at or after 20 weeks of gestation up to the postpartum period.

Question 82 

The nurse practitioner understands that Title XIX of the Social Security Act (Medicaid) is: 

  Medical assistance for those persons 65 years of age and older only. 

  Medical assistance for low income persons. 

   Medical assistance for disabled persons. 

   Both B and C 

 

The Correct answer is:

Both B and C

Medicaid is an insurance program designed for the low income person, the disabled, the blind, or members of families with dependent children. It is not set up for those over 65 years of age only. 

Question 83 

When treating a patient with reactive arthritis (also known as Reiter syndrome), the nurse practitioner knows that in a sexually active man this will include: 

  oral steroid therapy 

  immunosuppressive medications 

   antimicrobial therapy 

  antirheumatic medications 

The Correct answer is:

Antimicrobial therapy

Treatment includes the use of anti-inflammatory drugs such as NSAIDs and an antibiotic such as tetracycline. The other answer choices are not warranted for the treatment of reactive arthritis or Reiter's syndrome. 

 Question 84 

Your patient complains of feeling facial pressure that worsens when he bends over. He also tells you that he has pain in his molars and a frontal headache. The most likely diagnosis for this patient is: 

   acute sinusitis 

  rhinitis medicamentosa 

   otitis externa 

  otitis media 

Correct answer:

acute sinusitis

 

Acute sinusitis is an infection of the sinuses by Gram-positive and Gram-negative bacteria. The patient usually complains of unilateral facial pressure that worsens when bending down, along with pain in the upper molar teeth, and possible frontal headache.

 Question 85 

A 14 year old boy is brought in after experiencing a seizure. He does not have a history of seizures. He says that he was given some drugs, but he is not sure what they were. What is the most likely cause? 

  Marijuana. 

  Stroke. 

   Cocaine. 

  Epilepsy. 

 

Correct answer: Cocaine Given the boy's age and medical history, it is less likely that he has epilepsy. Cocaine is more likely to cause a seizure than marijuana because it is a stimulant. A drug test will confirm. 

 

Question 86 

Levodopa is used in patients with Parkinson disease. All of the following are true in regard to using this medication EXCEPT: 

  It is a metabolic precursor of dopamine. 

  It has more adverse effects as the disease progresses. 

   Most patients who take levodopa for more than 5 to 10 years develop dyskinesia. 

   It tends to be more effective as the disease progresses. 

 

Correct answer:

It tends to be more effective as the disease progresses.

 

Levodopa, a metabolic precursor of dopamine, continues to be used to minimize symptoms of Parkinson disease. The drawback is that it tends to be less effective and has more adverse side effects as the disease progresses.

 Question 87 

If a male is not at high risk for prostate cancer, at what age should screening with PSA and digital rectal exam begin?

  40 

   50 

   60 

  65 

Correct answer:

50

 

PSA screening and digital rectal exams should start at age 50 except with those males with high-risk factors. These factors include: men of African American race and those with a first degree relative with a history of prostate cancer.

Question 88 

The FNP is evaluating the T-score of a female patient. The FNP understands that the National Osteoporosis Foundation recommends treatment when a T-score for a person without other major risk factors is: 

  better than -1 

  between -1 and -2.5 

  less than -1.5 

   less than -2.0 

 

Correct answer:

less than -2.0

 

The National Osteoporosis Foundation recommends treatment when a T-score for a person without other major risk factors is less than -2.0. It recommends treatment for those with a major risk factor such as osteoporotic fracture, cigarette smoking or weight less than 127 lbs when the T-score is less than -1.5.

 Question 89 

You have a 65-year-old female patient who has chronic asthma. She has had a recent more severe recurrence of the asthma. Which of the following would NOT be a recommendation or treatment for this patient? 

   reduce fluid intake 

  Proventil HFA 

  Vanceril 

   no smoking 

 

Correct answer:

reduce fluid intake

 

You would not advise a person who is having an exacerbation of asthma to reduce fluid intake. On the contrary, you would recommend that the patient maintain hydration and increase fluids during an exacerbation.

 

 Question 90 

You are counseling a mother whose child is receiving the Varicella vaccine (VZV). Which of the following statements would be appropriate? 

  "Your child will never have a breakout of the chickenpox." 

   "Mild cases of chickenpox have been reported in immunized patients." 

  "Children must have a varicella titer drawn before they receive this vaccine." 

   "The vaccine delivers killed varicella virus to the recipient." 

The Correct answer is:

Mild cases of chickenpox have been reported in immunized patients

The varicella vaccine contains attenuated virus and is administered in two doses, one at age one and the other at age 4 to 6 years. The vaccine is highly protective against severe, invasive varicella, however, mild forms of chickenpox are occasionally reported after immunization. Children do not need a titer prior to receiving this vaccine. 

 

Question 91 

In which of Erickson’s stages of development does failure in generativity lead to stagnation? 

   middle-age 

  older adulthood 

  young adult 

   adolescence 

 

Correct answer:

middle-age

 

Erickson, in his stages of psychosocial development, maintains that how well individuals accomplish developmental tasks will determine their success in accomplishing other tasks as they get older. Generativity is mastered in middle age. If not, it leads to stagnation.

 

Question 92 

Which of the following best defines and describes the nurse practitioner certification process? 

  It is a government process that allows a nurse practitioner to gain credentials necessary to obtain maximum reimbursement. 

   It is a process by which a non-governmental agency or association certifies that a nurse practitioner licensed to practice has met standards that are specified. 

   A process set up to assure the physician that the NP has mastery of the body of knowledge necessary to perform the job. 

  It is a required process used instead of licensure in some states that assures the public that the nurse practitioner has the appropriate skills to practice. 

 

The Correct answer is:

It is a process by which a non-governmental agency or association certifies that a nurse practitioner licensed to practice has met standards that are specified

The purpose of certification is to assure the public that an individual has mastered a body of knowledge and has acquired the skills necessary to function in a particular specialty. It is not government affiliated and does not relate to reimbursement. Certification is a required process in most states but does not replace licensure.

Question 93 

In terms of infection diseases, when the organism invades the host at a particular site, multiplies, and acts as a parasite but does not produce infection, immune response, or disease this is known as which of the following? 

  infection 

   colonization 

  carrier state 

   disease 

 

Correct answer:

colonization

 

Colonization is taking place when the organism invades the host at a particular site, multiplies, and acts as a parasite but does not produce infection, immune response, or disease. Infection is the colonization and multiplication of an organism in the host. Carrier state is the persistence of an organism in a host. Disease is the stage when an infection produces signs, and/or symptoms.

 

 Question 94 

A diabetic, overweight patient tells you that he has decided to start an exercise program and has joined a health club to accomplish this. This patient is in which stage of the five stages of change? 

  precontemplation 

  contemplation 

   preparation 

  maintenance 

 

Correct answer:

preparation

 

This patient intends to make a change in behavior and has taken some steps in that direction. He is in the preparation stage. The role of the NP is to provide positive reinforcement and offer practical assistance, support, and encouragement.

Question 95 

Which of the following would NOT be a characteristic of hyperthyroidism? 

   cold intolerance 

  weight loss 

  excessive energy release 

   tachycardia 

Correct answer:

cold intolerance

 

Cold intolerance is characteristic of hypothyroidism. Heat intolerance is a characteristic of hyperthyroidism, along with smooth, silky skin, fine hair with frequent loss and thin nails that break with ease (among a host of other things).

Question 96 

An 81-year-old female is in the office.  She has been taking ibuprofen over-the-counter in large dosages for a long time. The nurse practitioner comprehends which side effect is likely regarding this situation? 

   impairment of renal function 

  liver failure 

   neuropathy 

  none of the above 

The Correct answer is:

Impairment of renal function

The elderly patient has impaired renal function already and ibuprofen can further impair the kidneys. This in turn can result in nephrosis, cirrhosis, and congestive heart failure. 

 

Question 97 

Which of the following body fluids is considered a material with doubtful risk of HIV transmission? 

  semen 

   saliva 

   vaginal fluids 

  pleural fluid 

Correct answer:

saliva

 

Saliva is the only choice that is of doubtful risk of HIV transmission. Fluids with known risk include blood, bloody fluids, semen, vaginal fluids, and concentrated HIV materials in research labs.

Question 98 

Nurse practitioners are at risk for which of the following professional mishaps? 

  business 

  clinical 

   both business and clinical 

  none of the above 

 

Correct answer:

both business and clinical

 

Nurse practitioners are at risk for two categories of professional mishap: clinical and business mishap. There can, however, be an overlap between clinical and business problems.

 Question 99 

A 70-year-old Caucasian woman comes to the clinic with complaints of severe aching in her legs after standing for 15 minutes. With further evaluation, you make other assessments that support the tentative diagnosis of chronic venous insufficiency. What are they? 

  shiny skin on the extremities and a dusky red appearance on dependency 

  decreased hair growth and pallor of the extremities upon elevation 

  pedal pulses 1+ and ulceration involving the toes 

   pitting edema of 3+ of the lower extremities and cyanosis on dependency 

 

The correct answer is:

Pitting edema of 3+ of the lower extremities and cyanosis on dependency 

These findings are indicative of chronic venous insufficiency. The remaining answer choices are descriptive of chronic arterial insufficiency. 

 

Question 100 

A 16-year-old male comes to the clinic and tells the FNP that he awoke with severe scrotal pain in the left testicle. He has felt nauseated and has had abdominal pain since this happened. What is the likely cause of this teenager’s pain and nausea? 

  testicular cancer 

  priapism 

   testicular torsion 

   chronic prostatitis 

Correct answer:

testicular torsion

 

The likely cause of this patient’s symptoms is testicular torsion. This condition may be spontaneous or associated with physical activity or trauma. The salvage rate is 100% if corrected within the first six hours and 0% if done after 24 hours. 

 

quiz 28 aanp

Question 1 

Concerning the long term care environment, the U.S. Congress updated regulations that govern the provision of services in this environment. What is important for the nurse practitioner to understand concerning the long term care environment? 

  Residents have specific rights, such as information about their physical condition, medical benefits, and associated costs. 

  Nursing assistants working in these facilities must be formally trained and certified. 

  New sanctions are available to reviewers to impose on facilities with deficiencies. 

   All of the above 

The Correct answer is:

All of the above

There are layers of regulatory requirements in long term care and most of them are from the federal government. Nurse practitioners working in this environment need to be aware of the rules and regulations concerning compliance. 

Question 2 

Which of the following would NOT be considered one of the general principles of medical record documentation? 

  The rationale for ordering diagnostic and other ancillary services should be documented or easily inferred. 

   The patient’s progress, response to and changes in treatment, and revision of diagnosis should be documented. 

   Health risk factors do not appear in documentation, only in practice. 

  The medical record should be complete and legible. 

-

Explanation: 

Correct answer:

Health risk factors do not appear in documentation, only in practice.

 

Appropriate health risk factors should be identified in documentation. Past and present diagnoses should also be accessible to the treating and/or consulting physician.

 

 Question 3 

The Wood's lamp is used to evaluate skin lesions. You are examining a patient and when the light is shown on the patient's skin, you see a green-yellow fluorescence which indicates: 

  keratinized cells 

  lichenification 

   bacterial colonies 

   presence of fungi 

 

The Correct answer is:

Presence of fungi 

These fungal lesions will be visualized as green-yellow fluorescence when viewed with the Wood's lamp in a dimly lit room.

 

Question 4 

Which of the following health theorists developed the theory that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior? 

   Albert Bandura 

   Marshall Becker 

  John Watson 

  B.F. Skinner 

 

Correct answer:

Albert Bandura

 

Albert Bandura’s self-efficacy theory states that a person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior. He started a major program of research examining the influential role of self-referent thought in psychological functioning.

 

 Question 5 

You are treating a 25-year-old woman with pelvic inflammatory disease (PID) and she has previously had a severe hive-form reaction to cephalosporins. What is your treatment option for her? 

  Carteolol 

  Metipranolol 

   Oral ofloxacin and oral metronidazole 

  Timolol 

 

The Correct answer is:

Oral ofloxacin and oral metronidazole

When treating pelvic inflammatory disease (PID), an infectious disease that causes endometritis, salpingitis, and oophoritis, the nurse practitioner knows that many organisms are causative. If cephalosporins are not an option, such as the patient who had a severe allergic reaction to cephalosporin, a fluoroquinolone with added metronidazole is an effective treatment regimen. Further, Carteolol, Timolol and Metipranolol are beta-blockers, which are used to treat other conditions such as glaucoma. 

 

 Question 6 

A 50 year old Caucasian female comes in with a broken arm. Medical history shows that the this is her third broken bone in six months. She is calm and shows no signs of victimization. She is not exactly sure how she broke her arm when falling. What is she at risk for? 

   Osteoporosis. 

   High blood pressure. 

  Head injury. 

  Appendicitis. 

 

Correct answer: Osteoporosis Women are at a greater risk of developing osteoporosis. This risk is higher for Caucasians and increases with age. The patient may have osteoporosis.

 

Question 7 

Which of the following factors is more closely related to open-angle glaucoma? 

  pupil dilated and nonreactive to light 

   bilateral symptoms 

   unilateral red eye 

  cloudy cornea 

 

Correct answer:

bilateral symptoms

 

Bilateral symptoms occur in open-angle glaucoma. Unilateral symptoms occur in closed-angle glaucoma.

 Question 8 

All of the following are recommended nutritional supplements EXCEPT:

 

  fluoride supplements to reduce susceptibility to dental caries

 

  Vitamin K, 1 mg IM, given at birth to all newborns to prevent hemorrhagic disease of the newborn 

   iron from fortified cereal, started by 6 months of age in all infants to replace iron stores 

   oral Vitamin A 10,000 units/day, recommended for mothers who are breastfeeding their infants until they are ingesting whole milk 

The Correct answer is:

Oral Vitamin A 10,000 units/day, recommended for breastfed infants until they are ingesting whole milk

Vitamin D, not A, is recommended for mothers who are breastfeeding their infants at 200units/day until they are ingesting whole milk. The remaining answer choices are recommended nutritional supplements. 

 

Question 9 

A mother who is pregnant brings her three children in the clinic with generalized pruritic rash that, after careful consideration, you decide is scabies. The ages of the children are 2, 5, and 6.  All of the following are treatment options for this condition EXCEPT:

 

  permethrin (Elimite) 5% cream overnight 

   topical steroids bid to severely pruritic areas 

   lindane 1% cream overnight 

  oral antihistamines such as diphenhydramine (Benadryl) for itching 

The Correct answer is:

Lindane 1% cream overnight

Lindane is contraindicated in children and pregnant women. The remaining answer choices are safe and effective for this family. 

Question 10 

School age children begin to develop permanent teeth. At what age would the first premolar be likely to erupt? 

  8 - 9 years 

  7 - 8 years 

   11 - 12 years 

   10 - 11 years 

Correct answer:

10 – 11 years

 

The first premolars are most likely to erupt between 10 and 11 years. Central incisors erupt between 7 and 8 years; lateral incisors between 8 and 9 years; and cuspids between 11 and 12 years.

 

Question 11 

In terms of infant/child growth and development which of the following statements is the least accurate? 

   There is one period of rapid growth – adolescence. 

  Assessment of growth is determined by routine monitoring of height, weight, head circumference, dental development and the appearance of secondary sex characteristics. 

   Growth of most body tissues parallels physical growth which is most rapid in the first 2 years. 

  Lymph tissue growth is rapid in the preschool and early school-age years. 

Correct answer:

There is one period of rapid growth – adolescence.

 

This is inaccurate. There are two periods of rapid growth – infancy and adolescence. In between, growth is steady but slower.

 

Question 12 

A 23-year-old thin Caucasian female presents in the clinic with a new diagnosis of Crohn's disease. She has recently started medication prescribed by her gastroenterologist and asks you to tell her what else to do. You know that proper nonpharmacological management of this condition includes all of the following EXCEPT:

 

  Avoid dairy products that contain lactose if they exacerbate symptoms. 

   A  low protein is recommended. 

   Stress management is important, including relaxation techniques. 

  A low-roughage diet is recommended during acute exacerbations. 

 

Correct answer:

A low protein diet is recommended.

 

A diet high in protein and vitamins, particularly B12, is recommended for the patient with Crohn's disease. 

 

Question 13 

In terms of human growth and development, there are three fundamental domains. They include all of the following EXCEPT: 

  physical 

  cognitive 

   psychological and social 

   biological 

 

Correct answer:

biological

 

The biological domain is not one of the three fundamental domains in human growth and development. It may be included in the physical domain but it is not a domain on its own.

 

Question 14 

You have calculated the BMI of your patient as 39.8. You understand that this means that this patient is in which of the following classes? 

  overweight 

  Class I obesity 

   Class II obesity 

  Class III obesity 

Correct answer:

Class II obesity

 

Class II obesity is when BMI is 35 – 39.9. Normal BMI is 18.5 – 25.

Question 15 

A female patient is in the clinic being treated for gonorrhea. State law requires reporting of STDs to the public health department. The patient asks you not to report it because her husband works in the public health department. How should the nurse practitioner handle this situation?

 

  Respect the patient's right to privacy and not report it. 

  Report it to the public health department but do not divulge all the details. 

   Report it to the public health department as required by law. 

  Tell the patient that it won't be reported, but report it anyway. 

The Correct answer is:

Report it to the public health department as required by law

If your state law requires this, it should be reported. If the nurse practitioner does not report it, she has violated the state law. She should also be honest with the patient. Reporting data to the public health department with elimination of required details does not meet the requirements of the state law. 

 

 Question 16 

The system designed to evaluate and monitor the effectiveness and efficiency of patient care is which of the following? 

  performance assessment 

  risk management 

   code of ethics 

   quality assurance 

Correct answer:

quality assurance

 

Quality assurance is the system designed to evaluate and monitor the effectiveness and efficiency of patient care. Quality assurance programs promote responsibility and accountability to deliver high-quality care, assist in the evaluation and improvement of patient care, and provide for an organized means of problem solving.

Question 17 

You have an otherwise healthy 34-year-old female in the clinic for a follow-up on abnormal lab work. Her calcium level was quite elevated and she was called in. Which of the following is the most likely etiology for hypercalcemia?

 

  hyperthyroidism 

   hyperparathyroidism 

   hyperpituitarism 

  hypothyroidism 

 

The correct answer is:

Hyperparathyroidism

One cause for elevated serum calcium levels, or hypercalcemia, is hyperparathyroidism. Additional conditions that can cause elevated calcium in the blood are some bone disorders, high consumption of Vitamin D and some cancers that trigger the cancer cells to make too much protein, which elevates the amount of calcium into the blood stream.

 

Question 18 

Which of the following features is common to Hirschsprung’s disease?

 

   onset at birth 

  stool in ampulla 

   encopresis 

  no enterocolitis 

 

Correct answer:

onset at birth

 

The onset of Hirschsprung’s disease is at birth. The ampulla is empty upon rectal examination. Encopresis is uncommon and enterocolitis is possible.

 

Question 19 

When a patient tells you that she has no family anymore since her sister and her husband died last year and you reply, “That must make you very sad,” you are using which of the following types of therapeutic communication? 

  trust 

  honesty 

   validation 

   empathy 

Correct answer:

empathy

 

Empathy is an emotional linkage between two or more people through which feelings are communicated. It involves trying to imagine what it must be like to be in another person’s situation

 

Question 20 

The nurse practitioner knows that all of the following are options for further evaluation if a patient has an abnormal Papanicolaou (Pap) screening EXCEPT:

 

  cryotherapy 

  colposcopy 

   Loop Electrosurgical Excision Procedure (LEEP) 

   Thyroglobulin 

The Correct answer is:

Thyroglobulin

Thyroglobulin is not indicated. An elevated thyroglobulin level is seen in patients who have thyroid cancer or other conditions related to the thyroid gland. The remaining answer choices are options for further evaluation if the patient has an abnormal Pap smear. The Papanicolaou test or Pap test is a cervical cytology test. It is used as a screening tool for cervical cancer. Abnormal results from the Pap test may warrant further evaluation or the removal of a sample of the abnormal tissue for further evaluation. Procedures used for this further evaluation of the abnormal cells detected by the Pap test or the tissue sample removal may include loop electrical excision procedure, cryotherapy and colposcopy, for example.

 Question 21 

A nurse practitioner wants to make a change in the state's law concerning the dispensing of prescription medications by nurse practitioners. Who would this case need to be taken to? 

  state board of nursing 

  state board of pharmacy 

   nursing specialty organization 

   state legislature 

The Correct answer is:

State legislature

Healthcare policy within the states is codified or enacted into law by the respective state legislature. The boards should have significant input in the process, such as providing the research data and expert "testimony" that the legislature needs to make informed decisions. However, boards, such as the state nursing boards, do not have the governing power to pass state laws.

 

 Question 22 

Which of the following theories of research explores the relationship between two or more variables? 

  descriptive research 

   correlational research 

   experimental research 

  quasi experimental research 

Correct answer:

correlational research

 

Correlational research explores the relationship between two or more variables. It is a form of quantitative research.

 

Question 23 

At what stage of pregnancy is the uterine fundus at the level of the umbilicus? 

  8 weeks 

  12 weeks 

   16 weeks 

   20 weeks 

Correct answer:

20 weeks

 

At 20 weeks (5 months) of pregnancy the uterine fundus is at the level of the umbilicus. Also the fetal heart tones are heard with a fetoscope or stethoscope.

 

Question 24 

Your patient has an extensive infection of several adjacent hair follicles that form a mass with multiple drainage points. You understand that this patient has which of the following? 

  folliculitis 

   carbuncle 

   furuncle 

  none of the above 

Correct answer:

carbuncle

 

A carbuncle occurs when there is an extensive infection of several adjacent hair follicles that form a mass with multiple drainage points. Folliculitis is a minor inflammation of hair follicles with or without pustules. A furuncle (abscess or boil) is a more extensive infection of a hair follicle.

Question 25 

A 35 year old patient with RA is taking methotrexate. What function will you want to monitor on a follow-up? 

   Liver. 

  Heart. 

   Brain. 

  Kidney. 

Correct answer: Liver Methotrexate can cause liver problems. Patients need to monitor their liver function with blood tests. A problem with liver function is an indication to change medications. 

 

Question 26 

You are conducting an assessment with a female patient who has come in complaining of fatigue and frequent leg cramps. She says that she has gained several pounds lately, though this may be because it is so difficult to exercise when she is tired and weak much of the time. Her skin is rough and pale. The patient should be further evaluated for which of the following? 

  Hyperthyroidism. 

   Grave's disease. 

  Type 1 diabetes. 

   Hypothyroidism. 

 

Correct Answer: Hypothyroidism Hypothyroidism occurs when the thyroid does not produce enough thyroid hormone. Patient may be extremely sensitive to cold and experience muscle cramps, fatigue, and weakness. Hair may be coarse and dry and skin may be dry, rough, and pale. 

 

Question 27 

A 70-year-old male patient with a history of heavy cigarette smoking complains of gradually worsening dyspnea over several years that is now limiting his physical activity. His cough produces large amounts of yellow sputum. The most likely diagnosis is: 

  bacterial pneumonia 

    COPD 

   atypical pneumonia 

  acute bronchitis 

 

Correct answer:

COPD

 

COPD includes both emphysema and chronic bronchitis. Most patients have a mixture of both. Chronic smoking is a risk factor for this disease.

 

Question 28 

A 42-year-old Caucasian male is in good health and presents with complaints of pain in his left heel. He reports that the first few steps out of bed in the morning are extremely painful and he has no history of trauma. What is the likely etiology of this pain? 

  calcaneal spur 

  tendinitis 

   arthritis of the foot 

   plantar fasciitis 

The Correct answer is:

Plantar fasciitis

Plantar fasciitis is inflammation of the ligaments in the plantar fascia, a thick white tissue that begins at the heel and extends under the foot to the toes. It supports the foot during walking. Individuals at increased risk include runners, dancers, and people who stand for long periods

Question 29 

You are treating a 39-year-old female with an anal fissure. The nurse practitioner knows that all of the following are true regarding the management of this except: 

  A stool softener is necessary to prevent stool withholding. 

  Topical anesthetics are good for comfort measures. 

   Hydrocortisone cream should be prescribed bid to tid. 

   There is no need for topical antibiotic ointment. 

The Correct answer is:

There is no need for topical antibiotic ointment

A stool softener, topical anesthetics and hydrocortisone cream are used to treat an anal fissure. Additional treatment options for an anal fissure may include the use of botulinum toxin, nitroglycerin therapy and topical antibiotic ointment. 

Question 30 

The lowest incidence of SIDS is in which of the following populations? 

  African-Americans 

  Caucasians 

   Native Americans 

   Asians 

Correct answer:

Asians

 

SIDS is the most common cause of death in children under one year of age. The highest incidence is in African-Americans and Native Americans; while the lowest incidence is in Asians.

 

Question 31 

A 12-year-old female comes to the clinic with her mother complaining that one hip seems to be higher than the other, but she has no pain. Upon exam, you discover a lateral curvature of the spine. The Adams Forward Bend Test shows asymmetry of the spine. Which of the following would be the most likely diagnosis for this patient? 

  Osgood-Schlatter disease 

   Idiopathic scoliosis 

  Turner’s syndrome 

  none of the above 

Correct answer:

Idiopathic scoliosis

 

Of the choices given the most likely diagnosis is idiopathic scoliosis. There is a lateral curvature of the spine and it is more common in girls. The screening test is the Adam’s Forward Bend Test.

 

Question 32 

According to the Fontaine Classification of Peripheral Vascular Disease, which of the following clinical features is not likely to be found until stage 4? 

  rest ischemia 

  intermittent claudication 

   ulceration 

  all of the above 

Correct answer:

ulceration

 

Peripheral vascular disease is a chronic or acute entity consisting of obstruction or narrowing of the major arteries, commonly affecting the lower extremities and most frequently a result of atherosclerosis. Ulceration or gangrene is found in stage 4.

 

Question 33 

Which of the following is the most common cause of stasis ulcers? 

  diabetes mellitus 

  fungal infections 

   venous insufficiency 

  arterial insufficiency 

Correct answer:

venous insufficiency

 

Stasis ulcers are most commonly caused by venous insufficiency. They are far less commonly caused by arterial insufficiency, diabetes mellitus and fungal infections.

 

Question 34 

In the nurse practitioner (NP) practice, the NP will treat geriatric patients. Part of preventive practice involves testing the elderly for falls. The "get up and go" test used to assess a geriatric patient evaluates the patient for: 

  lower extremity strength 

  mental acuity 

   driving safety 

   risk for falls 

The Correct answer is:

Risk for falls

The "get up and go" test is used to evaluate musculoskeletal function. The patient is asked to rise from a seated position, ambulate across the room, then turn around and return to the chair. Additionally, the "get up and go" test should be used to assess patients who report a fall and present without an injury. 

 Question 35 

You have a client with acne and you have educated this person on what to do and what not to do. Which of the following statements indicates that the person needs additional teaching? 

   I can expect improvement with treatment within one week. 

  I should wash my skin twice a day with a gentle soap. 

   I should use a moisturizer since my skin is not oily. 

  I should not pick at the acne lesions. 

Correct answer:

I can expect improvement with treatment within one week.

 

This statement indicates that the person did not understand how long it takes to see improvement. This client should be warned that improvement will not be noted until after 4 to 6 weeks of treatment.

 

 Question 36 

Which of the following would be an absolute contraindication for estrogen replacement therapy?

 

  endometriosis 

   recent myocardial infarction 

   hypertension 

  gallstones 

 

Correct answer:

recent myocardial infarction

 

A recent myocardial infarction is an absolute contraindication for estrogen hormone replacement therapy. The other choices are all relative contraindications.

 

 Question 37 

Which of the following foot care recommendations for a diabetic person is incorrect? 

   Trim nails in a rounded shape. 

  Never go barefoot. 

   Check feet daily. 

  Report redness or skin breakdown promptly to health care provider. 

Correct answer:

Trim nails in a rounded shape.

 

Patients with diabetes should pay special attention to foot care since problems with the feet are the main cause of amputations in the United States. Nails should not be trimmed in a rounded shape; they should be trimmed squarely to avoid ingrown toenails.

 

Question 38 

In a 74-year-old Caucasian male who has had Type II Diabetes for ten years, a hypoglycemic episode is more likely to exhibit: 

   dizziness and weakness 

  contusions 

   symptoms of compulsive reactions 

  delusional hyperactivity 

 

The Correct answer is:

Dizziness and weakness

Older adults are more likely to have deleterious consequences than younger adults. Younger adults present with tremors, sweating and adrenergic symptoms. Then, older adults tend to have neurological symptoms, like dizziness and weakness. 

 

Question 39 

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

 

  age and weight 

   smoking history and diet 

  coffee intake and weight 

  age and gender 

The Correct answer is:

Smoking history and diet

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

 

Question 40 

An elderly patient with hypertension is said to have the condition because of coarctation of the aorta. What test would confirm this? 

   CT angiography. 

  24-hour urinary metanephrine and normetanephrine. 

   Doppler flow study; magnetic resonance angiography. 

  Estimated GFR. 

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

 

Question 41 

A patient has anosmia. What is this condition and which cranial nerve is involved? 

   cranial nerve I  - inability to smell 

  cranial nerve II  -  inability to taste 

   cranial nerve III  -  inability to blink 

  cranial nerve IV  -  inability to hear 

The Correct answer is:

Cranial nerve I - inability to smell

The cranial nerve I involves the olfactory nerve and it is rarely tested. However, cranial nerve lesions do occur. Anosmia would be a clinical manifestation of this. 

 

Question 42 

The nurse practitioner in a small physician owned office wants to evaluate a patient with pernicious anemia who is receiving treatment. The best laboratory test he could order after one month of therapy is: 

  a Schilling test 

  a reticulocyte count 

   a serum ferritin 

   hemoglobin and hematocrit

The Correct answer is:

Hemoglobin and hematocrit

With pernicious anemia treatment, the hematocrit rises 4% to 5% per week and is usually normal within one month. Hemoglobin values usually stabilize at this time as well. A Schilling test is unnecessary and will not show significant findings. Reticulocytosis occurs rapidly, with a peak at 7 to 10 days into therapy. Serum ferritin is usually not affected with pernicious anemia. 

Question 43 

What do you expect to find in the cerebral spinal fluid (CSF) when evaluating a patient who has aseptic or viral meningitis? 

  low opening pressure 

  glucose at about 30% serum levels 

   low protein level 

   predominance of lymphocytes 

The Correct answer is:

Predominance of lymphocytes

To eliminate or support a diagnosis of meningitis, a lumbar puncture to evaluate cerebral spinal fluid is often done. Pleocytosis, defined as a white blood cell (WBC) count of more than 5 cells/mm of CSF, is an expected finding in meningitis caused by bacterial, viral, tubercular, fungal, or protozoan infection. An elevated CSF opening pressure is also a nearly universal finding, not a low one. Normal glucose levels and normal or high protein levels are also noted findings with meningitis. 

 

 Question 44 

A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for Type II diabetes mellitus. What should be done to manage him FIRST?

 

   Start insulin 

  Start metformin plus pioglitazone 

   Have him return tomorrow to recheck his blood glucose 

  Start metformin 

The Correct answer is:

Start insulin

The patient can be diagnosed with diabetes if his glucose exceeds 200 mg/dL and he is symptomatic. Most oral agents will have little effect on his glucose and it should be lowered immediately. Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a chance to work. He should return to the clinic the next day for a recheck of the blood glucose and medication adjustment. 

 

Question 45 

A high absolute reticulocytes count in your patient might indicate all of the following EXCEPT: 

  autoimmune hemolysis 

  sickle cell anemia 

   Rh isoimmunization 

   thalassemia 

Correct answer:

thalassemia

 

Thalassemia is not indicated by a high absolute reticulocytes count. All of the other choices may be possible along with G6PD deficiency.

 

Question 46 

 Your patient is describing his stresses. You say, “You mentioned your job. Can you tell me more about it?” This is known as which of the following?

 

  clarifying 

  acknowledging 

   focusing 

  reflection 

Correct answer:

focusing

 

Your statement is a technique of therapeutic communication. It is focusing the client on one topic. It assists him in pursuing an idea or feeling and eliminates peripheral communication.

 

Question 47 

You are seeing a 2-year-old male child in the clinic with community acquired pneumonia (CAP). When managing this patient, you know that what percentage of children have an episode of pneumonia by age 5? 

  less than 10% 

   10% 

   20% 

  30% 

The correct answer is:

20%

Pneumonia is considered to be a disease that primarily affects older adults and the chronically ill. However, about 20% of children develop pneumonia by age five. 

Question 48 

 Which of the following is NOT one of the Jones criteria for pelvic inflammatory disease?

 

   upper abdominal rigidity 

  lower abdominal tenderness 

   cervical motion tenderness 

  adnexal tenderness 

Correct answer:

upper abdominal rigidity

 

The Jones criteria are the major criteria for PID. Upper abdominal rigidity is not one of these criteria.

 

Question 49 

A person who believes that he can succeed in performing an action that will result in a positive outcome is more likely to perform the healthier behavior. This is part of which of the following theories? 

   self-efficacy theory 

  health belief model 

   systems theory 

  hierarchy of needs 

Correct answer:

self-efficacy theory

 

This is part of Albert Bandura’s self-efficacy theory. Bandura’s theory emphasizes the role of observational learning, social experience, and reciprocal determinism in the development of personality.

 

 Question 50 

Which of the following is NOT a screening guideline for hyperlipidemia?

  complete lipid profile every 5 years starting at the age of 20 

  over age 40, screen every 2 – 3 years 

   total cholesterol should be < 169 mg/dL 

  preexisting hyperlipidemia patients – screened annually or more often 

 

Correct answer:

total cholesterol should be < 169 mg/dL

 

This is not correct. Total cholesterol should be < 199 mg/dL. Borderline is between 200 and 239 mg/dL; high is > 240 mg/dL. 

 

Question 51 

There are challenges to using electronic prescriptions, known as e-prescriptions. The nurse practitioner understands that the following is NOT one of them: 

  financial cost and return on investment 

   change management 

  controlled substances 

   drug formulary adherence 

 

The Correct answer is:

Drug formulary adherence

Financial cost and return on investment, change management, and controlled substances are all challenges with e-prescriptions as is state regulatory restrictions. Drug formulary adherence is thought to be a benefit of e-prescriptions.

 

Question 52 

The Patient Self-Determination Act (PSDA) was passed by the U.S. Congress in 1990. Which of the following policy changes did it result in? 

   Federally funded managed care organizations (MCOs) are required to inform subscribers about their rights under state law to create "advance directives." 

  Hospitalized patients are obligated to select a surrogate decision-maker to make care decisions for them if they become incapacitated. 

   Home health agencies are required to have "do not resuscitate" (DNR) order on file for all terminally ill patients. 

  Hospitals are mandated to assist every patient to create a "living will." 

The Correct answer is:

Federally funded managed care organizations (MCOs) are required to inform subscribers about their rights under state law to create "advance directives" 

MCOs are one group of healthcare organizations that are impacted by this law. Now, all subscribers must be provided with the stated information at the time of enrollment. Advance directive documents are never mandatory. 

 

 Question 53 

You have diagnosed a child with scoliosis. Her parent wants to know more about the disease. You would tell this parent all of the following EXCEPT: 

  It affects 2% to 4% of children between 10 and 16 years of age. 

  Scoliosis is most prevalent during the prepubertal growth spurt. 

   In cases with curves greater than 30 degrees, boys outnumber girls by 10 to 1. 

  Infantile scoliosis occurs before 3 years of age. 

Correct answer:

In cases with curves greater than 30 degrees, boys outnumber girls by 10 to 1.

 

This is not accurate. The opposite is true. In cases with curves greater than 30 degrees, girls outnumber boys by 10 to 1. Girls progress more often than boys, and need treatment more than boys.

 

Question 54 

Your patient comes to you complaining of a skin problem. Your examination reveals silvery-white scaling papules and plaques that are symmetrical. The patient’s nails are pitted. Your diagnosis would be which of the following? 

  eczema 

   psoriasis 

  seborrheic dermatitis 

  none of the above 

Correct answer:

psoriasis

 

Psoriasis is a silvery-white scaling that is usually symmetrical. It involves scalp, extensor surfaces, and areas subject to trauma. It may also involve pitting of the nails.

 

Question 55 

Your patient has episodes of intense fear with a feeling of impending doom. He tells you that these feelings occur without warning. This type of anxiety disorder is known as which of the following? 

  generalized anxiety disorder 

  acute stress disorder 

   obsessive-compulsive disorder 

   panic disorder 

Correct answer:

panic disorder

 

Panic disorder is characterized by episodes of recurrent and intense fear or feeling of impending doom that occur without apparent warning. Physical symptoms include palpitations, shortness of breath and tachycardia.

Question 56 

When assessing a rash near the eye and side of the temple, the nurse practitioner understands that herpes keratitis has what signs and/or symptoms? 

  blindness, painful swollen hair follicle 

  small nodule that moves under the skin of the eyelid 

   acute onset of eye pain, photophobia and blurred vision in the affected eye 

  a yellow triangular thickening of the conjunctiva 

The Correct answer is:

Acute onset of eye pain, photophobia and blurred vision in the affected eye

Herpes keratitis is caused by a herpes virus infection, usually shingles, and it causes these signs and symptoms. A stye or hordeolum is a painful acute bacterial infection of a hair follicle on the eyelid that does not result in blindness. A chalazion results in a movable nodule. Then, pterygium presents with a yellow triangular thickening of the conjunctiva. 

 

Question 57 

A 70 year old patient with CHF requires pain medication. The NP would not prescribe NSAIDs. The NP would be putting the patient at risk for what if she were to prescribe an NSAID? 

  Decreased effectiveness of diuretics. 

   Fluid retention. 

  Hypoxia. 

  Ulcer and bleeding risk. 

Correct answer: Fluid retention Prescribing medications to patients with various diseases could put the patient at risk for additional conditions. For example, a patient with CHF cannot be prescribed Metformin because it may cause hypoxia. 

 

 Question 58 

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

   Social. 

   Medical. 

  Family history. 

  Review of systems. 

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

 

Question 59 

In the treatment of acne vulgaris, which of the following medications is an antimicrobial against P. acnes, and an anti-inflammatory and is indicated in treatment of mild to moderate inflammatory acne vulgaris but is less effective than oral antibiotics and is often given in combination with benzoyl peroxide? 

  tretinoin 

  azelaic acid 20% cream 

   erythromycin (topical antibiotic) 

  Accutane 

Correct answer:

erythromycin (topical antibiotic)

 

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

 

Question 60 

When treating a patient who has an extremely high P.T. level from Coumadin (warfarin) usage, the nurse practitioner understands that which of the following is the antidote: 

   Vitamin K 

  Vitamin C 

   Vitamin A 

  Vitamin D 

The Correct answer is:

Vitamin K

The antidote for Coumadin (warfarin) toxicity is Vitamin K. It is often given in an injection form to patients with extremely elevated P.T. levels. Dietary sources of Vitamin K include green leafy vegetables. 

 

Question 61 

When prescribing drugs for the elderly which of the following would NOT be in your plan?

 

  Allow an adequate trial period before discontinuing the drug.

 

   Begin with more than the usual adult dose since absorption may take longer.

 

   Make changes infrequently. 

  Keep the number of pills needed to achieve the dose low. 

Correct answer:

Begin with more than the usual adult dose since absorption may take longer.

 

This is not something that you would do for an elderly patient. You would begin with less than the usual adult dose. Then you might increase the dose but slowly

 

Question 62 

Which of the following ECG results is most consistent with pathologic Q waves? 

  myocardial ischemia 

   myocardial infarction 

   atrial fibrillation 

  premature contraction 

 

Correct answer;

myocardial infarction

 

Myocardial infarction shows a pathologic Q wave. Pathologic Q waves in V3 and V4 indicate anterior MI; failure to have R wave progression is associated with LBBB and anterior wall infarction.

 

Question 63 

Which of the following drugs used for HIV is NOT a protease inhibitor? 

   Retrovir 

  Fortovase 

   Crixivan 

  Norvir 

 

Correct answer:

Retrovir

 

Retrovir (zidovudine) is a nucleoside analog. It is administered with a protease inhibitor for patients with HIV infection.

Question 64 

A patient who has been prescribed Tagamet for GERD should be advised to seek immediate medical attention if he experiences which of the following side effects? 

  Headache. 

   Diarrhea. 

  Stomach cramps. 

   Swelling of the tongue. 

Correct Answer: Swelling of the tongue This indicates a rare but serious allergic reaction to Tagamet. Immediate medical attention should be sought.

 

 Question 65 

Part B of Medicare covers all of the following EXCEPT: 

   skilled nursing facilities 

  mammograms 

   rehab 

  wheelchairs 

 

Correct answer:

skilled nursing facilities

 

Part B of Medicare does not cover skilled nursing facilities. Part A covers this, but does not cover custodial, long-term care, or nursing homes.

 

 Question 66 

The FNP understands that there are many age-related changes and conditions that result in changes of the senses. A decline in the sense of smell, usually gradual, that results in loss of fine taste discrimination is called: 

  cerumen impaction 

  age-related maculopathy 

   presbyopia 

   hyposmia 

Correct answer:

hyposmia

 

Hyposmia is a decline in the sense of smell that results in loss of fine taste discrimination. It is accelerated by tobacco use.

 

 Question 67 

When an organism invades the host at a particular site, multiplies and acts as a parasite but does not produce infection, immune response or disease it is known as: 

   colonization 

  infection 

   carrier state 

  none of the above 

 

Correct answer:

colonization

 

Colonization occurs when an organism invades the host at a particular site, multiplies and acts as a parasite but does not produce infection, immune response or disease. Infection is colonization and multiplication of an organism in the host, typically producing an immune response but no signs or symptoms. The carrier state is persistence of an organism in a host.

 

Question 68 

Of the following Fontaine classifications of peripheral vascular disease which stage is characterized by intermittent claudication?

 

  Stage 1 

   Stage 2 

   Stage 3 

  Stage 4 

 

Correct answer:

Stage 2

 

According to the Fontaine classification of peripheral vascular disease, stage 2 is characterized by intermittent claudication. Stage 1 is silent; stage 3 is characterized by rest ischemia; and stage 4, by ulceration or gangrene

Question 69 

A 25 year old patient is newly married and has plans to become pregnant. When checking her list of medications, you notice one has a black box warning. Which medication is it most likely to be? 

  Bacrtim. 

   Accutane. 

   Augmentin. 

  Ceclor. 

Correct answer: Accutane Accutane is prescribed for severe acne. The medication comes with a black box warning and may cause birth defects. The other answers are antibiotics that should not still be in her system and affect a pregnancy. 

Question 70 

A 42-year-old male is in the clinic and has been diagnosed with peptic ulcer disease (PUD). The nurse practitioner (NP) understands that which of the following would be prescribed as the initial treatment for this disease in an uncomplicated state. 

  doxepin (Sinequan) 25 mg at hs 

  pirenzepine 50 mg tid 

   clarithromycin 500 mg bid 

   omeprazole (Prilosec) 20 mg qd 

The Correct answer is:

Omeprazole (Prilosec) 20 mg qd

The goal of treatment for peptic ulcer disease (PUD) includes relief of pain, healing of the ulcer, and cost-effectiveness. A proton pump inhibitor will heal 90% of duodenal ulcers after 4 weeks and 90% of gastric ulcers after 8 weeks. Doxepin and pirenzepine are anticholinergic drugs and are limited by side effects and not used in the U.S. at this time. Clarithromycin is part of the eradication therapy to treat Helicobacter pylori associated problems. 

 

Question 71 

When prescribing oral antibiotics to a patient, which of the following should NOT be part of patient education? 

   The patient should be told to stop taking the medication once he feels better. 

  The patient should be told to take the entire course of the medication. 

   The patient should be told about any potential side effects of the medication. 

  The patient should be warned about possible drug interactions. 

Correct Answer: The patient should be told to stop taking the medication once he feels better It is important that the patient takes the whole course of antibiotics to ensure effectiveness. Patients should also be advised of any side effects or drug interactions.

 

Question 72 

In terms of the scope of practice for an NP, which of the following statements is incorrect? 

  The scope of practice defines a specific legal scope determined by state statutes, boards of nursing, educational preparation and common practice within a community. 

  General scope of practice is specified in many published professional documents. 

   Prescriptive authority is recognized as within the scope of practice for nurse practitioners in all 50 states. 

   Scope of practice is always defined by state statutes enacted by the state legislature. 

Correct answer:

Scope of practice is always defined by state statutes enacted by the state legislature.

 

Some states define scope of practice by state statutes enacted by the state legislature. In other states, the legislature gives the board of nursing the authority to define the scope of NP practice. Either way is enforceable.

Question 73 

You have agreed to participate in the Medicare health insurance program and work for a small privately owned physician office. Medicare paid 80% of the charges billed for a clinic visit when the patient was seen by the nurse practitioner. What could your employer do about the remaining 20% that is owed to the facility? 

  The facility, on behalf of the nurse practitioner, can collect 100% if billing the incident to the supervision Medical Doctor. 

  The facility can resubmit the bill for the additional payment on behalf of the nurse practitioner. 

   The facility can bill the patient for a percentage of the remaining amount on behalf of the nurse practitioner. 

  The facility is prohibited from billing the patient in this case. 

 

The Correct answer is:

The facility can bill the patient for a percentage of the remaining amount on behalf of the nurse practitioner

The nurse practitioner is a "participating" provider because he or she agreed to accept assignments. An assignment between Medicare and the nurse practitioner is an agreement to accept the Medicare Approved Amount (MAA) as payment in full and not to further charge Medicare recipients a higher rate. The facility, on behalf of the nurse practitioner, can bill the patient for a percentage of the remaining bill that Medicare did not pay. 

 Question 74 

Your 25-year-old female patient comes to you saying that she suspects she suffers from PMS because she has severe mood swings about a week before menstruation that resolve after menstruation and these moods are affecting her relationship with her husband. She also has headaches at this time. Which of the following diagnostic studies are you least likely to do for this patient?

 

  TSH 

  Self-rating Scale for PMS 

   ultrasound 

  prolactin blood test 

Correct answer:

ultrasound

 

The ultrasound is the least likely test to do at this point for this patient. You might do all of the tests in the other choices, and might also consider CBC, glucose and serum chemistries, liver function tests, and renal function if lethargy is present

 

Question 75 

In Erikson’s stages of psychosocial development, when failure leads to feelings of inferiority, which need is not being met? 

  trust 

   industry 

   identity 

  intimacy 

Correct answer:

industry

 

Erickson identified eight stages of psychosocial development. They are: trust, autonomy, initiative, industry, identity, intimacy, generativity and ego identity. When failure leads to feelings of inferiority, it is the need for industry that is not being met.

 

Question 76 

A 44-year-old Caucasian female is taking lovastatin for hyperlipidemia and complains of muscle aches in her thighs and right calf for three days without improvement. She has been on the medication for 3 months. What should the nurse practitioner do first? 

  Check bilirubin enzymes. 

   Order a CPK. 

   Ask about nighttime muscle cramps. 

  Stop lovastatin immediately. 

The Correct answer is:

Order a CPK

This patient has a complaint of myalgias that could be associated with statin use. This patient should be assessed for rhabdomyolysis by measuring the creatine phosphokinase (CPK) level. If the CPK value is elevated, lovastatin should be stopped immediately. Nighttime cramps are not associated with statin usage. 

Question 77 

The nurse practitioner knows that the influenza vaccination is recommended annually for certain high risk groups. Which of the following would have the GREATEST need for this vaccine?

 

  dialysis patients 

  healthcare employees 

   adults with chronic disease 

   residents of long-term care facilities 

 

The Correct answer is:

Residents of long-term care facilities

The outbreak of influenza may affect 60% of those in long-term care and the mortality rates related to this are high. All of the other groups are in need of the vaccine, but not the priority or greatest risk

Question 78 

When a parent inquires about the varicella-zoster immune globulin, what should the nurse practitioner tell him or her? 

   "This uses pooled blood product with an excellent safety profile." 

  "This is a synthetic product that is well tolerated." 

   "This blood product comes from a single donor." 

  "This blood product has been known to actually transmit chickenpox to the child." 

 

The Correct answer is:

"This uses pooled blood product with an excellent safety profile"

Varicella immune globulin, as with all forms of immune globulin, provides temporary, passive immunity to infection. This product is a pooled blood product but has an excellent safety profile. The product is not synthetic, comes from more than one donor and does not transmit the virus to the child.

 

 Question 79 

The FNP has a menopausal woman patient who is troubled by hot flashes. The FNP tells her that they can often be reduced in number and minimized in severity with simple lifestyle changes. All of the following would be a hot flash trigger EXCEPT: 

  chocolate consumption 

  alcohol use 

   tight, restrictive clothing 

   cold baths or showers 

Correct answer:

cold baths or showers

 

Hot baths or showers are hot flash triggers, not cold baths or showers. In addition to the other choices which are all hot flash triggers, other triggers include: spicy foods, elevated ambient temperature and humidity, and cigarette smoking.

 

Question 80 

Which of the following lab results for your adult male patient would be out of the normal range?

 

   hemoglobin: 10.0 g/dL 

  hematocrit: 40% 

   MCV: 90 fL 

  MCHC: 32 g/dL 

Correct answer:

hemoglobin: 10.0 g/dL

 

The normal range for hemoglobin in males is 13.0 to 18.0 g//dL. All of the other results are within the normal range

 

Question 81 

Which of the following persons is most at risk for Osgood-Schlatter (OS) disease? 

  15-year-old female 

  7-year-old female 

   5-year-old male 

   14-year-old male 

Correct answer:

14-year-old male

 

OS disease is most common in athletic adolescent s and accounts for approximately 28% of musculoskeletal conditions seen in a primary care office. It is very common in children ages 10 – 14 who are participating in sports on a regular basis. It is more common in males than females.

 

Question 82 

A 28-year-old woman complains of a sore throat when seen in the clinic. The nurse practitioner notices on examination a midline bony growth on the hard palate of the mouth. The patient denies any changes or pain and it is not red, tender, or swollen. She reports a history of this since childhood. Which of the following conditions is most likely? 

  geographic tongue 

   hairy leukoplakia 

   torus palatinus 

  acute glossitis 

The Correct answer is:

Torus palatinus

Torus palatinus is a growth on the hard palate inside the mouth or on the lower area of the jaw. The growth emerges during childhood and remains as the individual reaches adulthood. If several bony growths are present in the patient’s mouth, the nurse practitioner should evaluate the patient for Gardner’s syndrome. The remaining answer choices hairy leukoplakia, geographic tongue and acute glottis are not the best answer choices as these are tongue disorders. With geographic tongue, the tongue has yellow areas or white sections on the tongue that are rough. Then, other areas of the tongue are smooth with a red coloration. Then, hairy leukoplakia is a tongue disorder that develops on the tongue and is often associated with AIDS. Acute glossitis is inflammation of the tongue.

 

Question 83 

When comparing the possibility of lumbosacral strain (LBS) to herniated nucleus pulposa (HNP) which symptom more likely indicates HNP? 

  minimal pain initially and increasing over time 

  radiation to buttocks and thigh 

   stiffness 

   radicular pain below the knee 

 Correct answer:

radicular pain below the knee

 

Radicular pain below the knee is associated with HNP. Other symptoms of HNP include: numbness or paresthesia; sleep disturbance; difficulty getting comfortable; pain with defecation; and negative genitourinary symptoms.

 

Question 84 

A mother brings to the clinic her 6-year-old son who was bitten on the hand by a raccoon. The nurse practitioner cleaned the wound. What would the next action be? 

  contact local animal control authorities 

   administer rabies immune globulin (RIG) and human diploid cell vaccine (HDCV) 

   administer tetanus antitoxin 

  teach the family how to do hourly soaks to the hand using normal saline and peroxide 

The Correct answer is:

Administer rabies immune globulin (RIG) and human diploid cell vaccine (HDCV)

Any bite associated with an animal that may harbor rabies (skunks, bats, raccoons, foxes, coyotes, rats) should be treated with both active and passive rabies immunization. The tetanus antitoxin would also be indicated if the patient was not currently up to date

 

Question 85 

When evaluating a 25-year-old Asian female with acute opioid withdrawal, you will expect to see: 

  somnolence 

  hypothermia 

   hypertension 

  constipation 

The Correct answer is:

Hypertension

During opioid withdrawal, the patient will have an elevated blood pressure. Additionally, patients, during opioid withdrawal, experience tachycardia, diarrhea, rhinorrhea, lacrimation, restlessness, myalgia, and nausea in addition to hypertension. Although very distressing, this condition is not life threatening. 

Question 86 

Active listening involves all of the following EXCEPT: 

  facing the client 

   establishing eye contact 

   touching the client often for reassurance 

  having relaxed body posture 

Correct answer:

touching the client often for reassurance

 

Touching the client often for reassurance would not be an appropriate component of active listening. A reassuring touch may be appropriate but must be used judiciously

 Question 87 

What is TRUE regarding overweight older adults and their state of health? 

  BMI is a good way to assess nutritional states in the elderly. 

  There are no potential metabolic or functional benefits to weight loss in the elderly. 

   There is clearly associated increased mortality with overweight older adults. 

   Mortality in the elderly related to overweight states decline over time. 

The Correct answer is:

Mortality in the elderly related to overweight states decline over time

Overweight and obese states are not as important in predicting mortality in the elderly as they are in their younger counterparts. After age 65, a person's weight is less significant in deceasing the risk of mortality than it was in young adulthood. 

Question 88 

Which of the following statements about migraine headaches is least accurate? 

  There is a higher incidence in children and younger adults.

 

   There is an equal occurrence in boys and girls. 

  There is a greater occurrence in women than in men. 

   The peak prevalence around age 35 is in women. 

Correct answer:

The peak prevalence around age 35 is in women.

 

This is the least accurate statement. The peak prevalence around age 35 is in men. The peak prevalence around age 40 is in women.

Question 89 

When the FNP is examining a 12-month-old infant, about how much growth should she expect to see in head circumference, as compared to the infant's head circumference at birth? 

  3 cm 

  6 cm 

   12 cm 

  18 cm 

 

Correct answer:

12 cm

 

The typical head growth in the first year of life is 12 cm: 6 cm in the first 3 months; 3 cm in the 4th to 6th months; and 3 cm in the 6th to 12th months. Subsequent head growth is about 0.5 cm/year for 2 – 7 year olds and 0.3 cm/ year for 8 – 12 year olds.

 

Question 90 

An acutely ill male with gastroenteritis is in the office and he states "I can't quit vomiting." You have ruled out other serious illnesses and are treating his symptoms. A good over the counter pharmacologic management of nausea and vomiting includes: 

  promethazine (Phenergan) 25 mg for adults and children over 6 years 

   trimethobenzamide (Tigan) 10 mg PO prn for adults 

   emetrol 15-30 ml PO in adults 

  hydroxyzine (Vistaril) 1 mg IM for adults and children 12 and older 

The Correct answer is:

Emetrol 15-30 ml PO in adults 

This is the correct dose of Emetrol for adults. Promethazine 15 -25mg can be given to children 12 and older and to adults. Trimethobenzamide is dosed 200 mg, not 10 mg and hydroxyzine is for adults, dosed at 25 mg to 100 mg. One thing to note is since the patient is unable to stop vomiting, the best prescription approach is to give the patient an IM injection of an antiemetic medication to stop the vomiting. Then, the nurse practitioner can prescribe the patient oral medication to be taken by mouth. Or, the nurse practitioner can prescribe promethazine (Phenergan) suppository for use rectally.

 

Question 91 

Which of the following is most consistent with a diagnosis of pediculosis pubis infestation?

 

  lethargy 

   nausea 

  fever 

   intense itching 

Correct answer:

intense itching

 

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

 

 Question 92 

A patient who has recently started taking Cymbalta for depression complains of drowsiness with the drug. Which of the following is an appropriate response to this patient? 

  Tell the patient to continue taking the drug in the morning. The drowsiness will pass with a few weeks. 

   Tell the patient to start taking the drug at mid-day with a full meal. 

  Tell the patient to try taking the drug on an empty stomach. 

   Tell the patient to try taking the drug at bedtime, so that she can sleep when the drug makes her drowsy. 

 

Correct Answer: Tell the patient to try taking the drug at bedtime, so that she can sleep when the drug makes her drowsy Drowsiness is a common side effect of Cymbalta. Some patients may benefit from taking the drug close to bedtime. This allows the patient to sleep when the drug makes him or her drowsy, rather than having to fight daytime drowsiness. 

 

Question 93 

Which of the following would NOT be considered a maladaptive coping behavior for anxiety? 

  excessive eating 

   prayer 

  self-injury 

  All of the above are maladaptive coping behaviors. 

Correct answer:

prayer

 

Prayer is one of the adaptive coping behaviors for anxiety; it is not maladaptive as are drugs and/or alcohol abuse, physical abuse, excessive eating, social isolation, and self-injury. Other adaptive behaviors include: exercise, relaxation techniques, and problem solving

 

 Question 94 

Which of the following medications listed below could potentially exacerbate congestive heart failure (CHF) in a susceptible individual? 

  furosemide 

  metformin 

   metoprolol 

  acetaminophen 

The Correct answer is:

Metoprolol

Metoprolol is a cardioselective beta blocker. It could potentially exacerbate CHF in a susceptible individual. This medication can slow the heart rate and cause the patient with congestive heart failure (CHF) to have an inability to compensate for decreased cardiac output. Now beta-blockers are considered to be standard of care and a necessary part of the medication regimen. This transformation occurred as a result of numerous studies supporting improved outcomes in patients with mild to moderate CHF.

Furosemide may actually improve shortness of breath in a patient with CHF. Metformin and acetaminophen will have no effect on cardiac output in a patient with CHF. 

 Question 95 

You have a patient whom you suspect has rubella. You would expect to see which of the following types of rash on this patient?

 

   pinpoint to 1 cm oval or round pink macules and/or papules

 

   bright red to purple macules and papules 

  bright red confluent lacy rash 

  sandpaper-like red papules 

Correct answer:

pinpoint to 1 cm oval or round pink macules and/or papules

 

Rubella is marked by pinpoint to 1 cm oval or round pink macules and/or papules. The rash begins on the face and neck and spreads rapidly to the trunk and extremities.

Question 96 

A patient who has tested positive for strep throat may be prescribed all but which of the following medications? 

  Penicillin. 

   Amoxicillin. 

  Cephalexin. 

   Warfarin. 

Correct Answer: Warfarin Warfarin is not an antibiotic. Antibiotics are the standard course of care of strep throat. Unless the patient has a documented allergy, any of the other choices listed may be prescribed for treatment of strep. 

 

Question 97 

When lymph nodes are referred to as shotty, the nurse practitioner understands that they are: 

   small and pellet-like 

   discrete and cystic 

  tender, mobile, and >5 mm 

  irregular, soft, and fixed to surrounding tissue 

The correct answer is:

Small and pellet-like

Shotty lymph nodes are small, pellet-like nodes that are movable, cool, nontender and discrete. These lymph nodes range in size up to 3 mm in diameter. 

Question 98 

Which of the following stages of change in the transtheoretical model of change involves mainly the actions of the NP and not the client? 

   precontemplation 

   contemplation 

  maintenance 

  empowerment 

 Correct answer:

precontemplation

 

Precontemplation does not involve considering a behavioral change. The role of the NP includes relationship building, consciousness raising, and personalizing risk factors based on objective findings.

Question 99 

A 50 year old patient comes in for a yearly physical. What new testing procedure should be done? 

  Endoscope. 

   Occult blood. 

   Cholesterol. 

  RBC count. 

 

Correct answer: Occult blood Occult blood tests are used to screen for correctal cancer. This should be done regularly at age 50. Cholesterol and RBC should already be part of a physical exam. 

Question 100 

 The AANP has written standards for the process of care. As part of the assessment of health status, which of the following would NOT be included?

 

  obtaining a relevant health and medical history 

  performing a physical examination based on age and history 

   synthesizing and analyzing the collected data 

   identifying health and medical risk factors 

 

Correct answer:

synthesizing and analyzing the collected data

 

Synthesizing and analyzing the collected data would be a part of the diagnosis process. All of the other choices are part of the assessment process along with performing or ordering preventive and diagnostic procedures based on the patient’s age and history. 

 

quiz 29 aanp

Question 1 

A patient comes in complaining of anxiety. At the interview, the patient explains that he was given steroids to treat inflammation. Medical records confirm the steroid use. What is a side effect of steroids? 

  Weight loss. 

   Chills. 

   Anxiety. 

  Loss of appetite. 

 

Correct answer: Anxiety Corticosteroids are known to cause anxiety and other emotional distress. This side effect is possibly the reason for the patient's chief complaint. The full assessment should still be completed. 

Question 2 

Severe cough, fever, conjunctivitis, photophobia, and Koplik’s spots are most related to which of the following? 

  scarlet fever 

   measles 

   rubella 

  roseola 

Correct answer:

measles

 

A person with measles will present with severe cough, fever, conjunctivitis, photophobia, and/or Koplik’s spots. The rash will be bright red to purple macules and papules ofent becoming confluent.

 

 Question 3 

Under a capitated system of reimbursement, NPs and physicians are paid a set fee per patient per month for all services agreed to by contract. Capitated fees for primary care vary based upon which of the following? 

  diagnosis and prognosis 

   age and sex of the patient 

   complexity of management of services 

  the type of service rendered 

Correct answer:

age and sex of the patient

 

Capitated fees for primary care vary, based upon the patient’s age and sex. If an FNP has agreed to provide all primary care services for a patient, then the FNP must provide an unlimited number of primary care visits.

 

Question 4 

 Malpractice is the failure of a professional to exercise that degree of skill and learning commonly applied by the average prudent, reputable member of the profession. There are four elements of malpractice. Which of the following is NOT one of these elements?

 

  duty 

   standard of care 

   relationship 

  breach of duty 

Correct answer:

relationship

 

Relationship is not one of the four elements of malpractice. It is a part of the “duty” element of malpractice. The four elements are: duty, breach of duty, causation and damages (injury).

 Question 5 

Communication theory emphasizes all of the following EXCEPT: 

  interaction of individuals that includes both verbal and nonverbal communication 

  emotional support, shared information, and instruction 

   that messages are not time-bound 

  that communication conveys values and beliefs between members and the external environment 

 

Correct answer:

that messages are not time-bound

 

On the contrary, communication theory emphasizes that messages are time-bound. They must be appreciated within the context of the sender

Question 6 

Which of the following is the proper schedule for administering hepatitis B vaccine to those patients over 10 years old? 

  once for college-bound persons living in a dorm 

   annually if high-risk 

  every 10 years 

   3 doses over 6 months 

Correct answer:

3 doses over 6 months

 

Hepatitis B is a contagious liver disease that results from infection with the hepatitis B virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. The best way to prevent hepatitis B is to be vaccinated. Hepatitis B vaccine is administered to pre-adolescents, adolescents, and adults in a total of three doses over 6 months.

 Question 7 

 Which of the following ECG leads shows the electrical activity of the lateral heart?

 

  Lead aVR 

   Lead aVF 

   Lead AVL 

  Lead V1 

 

Correct answer:

Lead AVL

 

Lead AVL shows the electrical activity of the lateral heart. Lead aVR shows inverted PQRST. Lead aVF shows electrical activity of the inferior heart. Lead V1 shows electrical activity of the anterior heart.

 

Question 8 

The FNP has a 20-year-old patient whose cystic acne has not responded to the treatments prescribed for her. The FNP considers the use of isotretinoin for this patient. The FNP understands that all of the following are true statements about this medication EXCEPT: 

  It likely inhibits sebaceous gland function. 

   The usual course of treatment is 4 – 6 months. 

   Isotretinoin is not teratogenic. 

  Women must use two types of highly effective contraception while on this drug. 

Correct answer:

Isotretinoin is not teratogenic.

 

This is incorrect. Isotretinoin (Accutane) has a potent teratogenicity. The FNP and the patient must be educated in the use of this drug and fully aware of adverse reactions and its teratogenicity.

 

 Question 9 

A patient with a history of which of the following has a high risk of developing colon cancer? 

   Polyps. 

  Auras. 

   Ulcers. 

  GERD. 

 

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

 

Question 10 

Bell’s palsy occurs more often in which of the following populations? 

  adolescents 

  young adults 

   men over 50 

  women over 50 

Correct answer:

men over 50

 

Bell’s palsy is more common in men over 50. It is more common in women under 50.

 

 Question 11 

The ability of a patient and family to understand and act on health information is called: 

  complementary modality 

  alternative modality 

   health literacy 

  health disparity 

 

Correct answer:

health literacy

 

Health literacy is the ability of a patient and family to understand and act on health information. It is now recognized as one of the largest contributors to health outcome. 

 

Question 12 

The abnormal herniations of mucosa through the muscle layer of the colon wall are known as which of the following? 

  polyps 

   diverticula 

   melena 

  none of the above 

Correct answer:

diverticula

 

Diverticula are abnormal herniations of mucosa through the muscle layer of the colon wall. Asymptomatic diverticular disease is referred to as diverticulosis. Diverticulitis represents inflammation caused by infection.

 

 Question 13 

You are educating a group of parents on the dangers of choking in young children. You would tell them all but which of the following? 

   Use cribs with wide slats. 

  Tie up all cords. 

   No balloons prior to age three. 

  Do not feed small, round, hard foods to children less than 2 – 3 years of age.

Correct answer:

Use cribs with wide slats.

 

You would not tell them to use cribs with wide slats. You would tell them to use cribs with slat spacing of 2 and 3/8 inches or less.

 

Question 14 

Which of the following parts of the eye are used for color perception? 

   cones 

  rods 

   fundus 

  macula 

 

Correct answer:

cones

 

The cones are for color perception. The fundus is the interior surface of the eye opposite the lens. The rods are for detecting light and for depth perception. The macula is for central vision.

 

Question 15 

The U.S. Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS) have regulations governing research activities on human subjects. The nurse practitioner understands that the principle investigator is responsible for: 

  Securing a signed consent form allowing the research. 

  Going before the Institutional Review Board to present the study and gain approval to proceed with subject recruitment. 

  Reporting to the Institutional Review Board if a subject is injured during the course of the study. 

   All of the above. 

The Correct answer is:

All of the above

All of the answers are basic requirements for conducting research at healthcare facilities.  The U.S. Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS) govern the use of human subjects for research purposes. Then, the Institutional Review Board is responsible for approving and reviewing the study. 

 

 Question 16 

When the heart is unable to maintain an output adequate to meet the metabolic demands of the body this is known as which of the following? 

   congestive heart failure 

  angina 

   myocardial infarction 

  tachycardia 

 

Correct answer:

congestive heart failure

 

Congestive heart failure occurs when the heart is unable to maintain an output adequate to meet the metabolic demands of the body. The 6-year mortality rate is 80% for men and 65% for women.

 

 Question 17 

When counseling a patient with the human herpes virus 2 (HHV-2), the nurse practitioner knows that what percentage of sexually active adults has serological evidence of this disease? 

  5% 

  10% 

   15% 

   25% 

The Correct answer is:

25%

The human herpes virus 2 (HHV-2) causes painful ulcerated lesions and lymphadenopathy.  Approximately 25% of adults who are sexually active have serological evidence of this disease, although only a small percentage of these persons have symptoms. 

 

Question 18 

Which of the following statements about treatment of reactive arthritis is false? 

  Treatment includes the use of anti-inflammatory drugs such as NSAIDs. 

  When reactive arthritis occurs with urethritis, the use of an antibiotic such as a tetracycline shortens the duration of symptoms. 

   Early antimicrobial treatment of infectious urethritis seems to increase a patient’s risk of developing reactive arthritis. 

  No change in symptoms is usually seen with antibiotic use if infectious diarrhea was the precipitating event. 

Correct answer:

Early antimicrobial treatment of infections urethritis seems to increase a patient’s risk of developing reactive arthritis.

 

This statement is false. Early antimicrobial treatment of infections urethritis seems to limit a patient’s risk of developing reactive arthritis.

 Question 19 

Before prescribing an exercise program for any patient, you should conduct a thorough history and physical examination and evaluate for all of the following EXCEPT: 

  fatigue, shortness of breath, chest pain 

   cardiac murmurs, clicks, hums 

   current dietary regimen 

  current medications 

 

The Correct answer is:

Current dietary regimen

 

The ANCC exercise recommendation for adults list answer choices fatigue, shortness of breath, chest pain, cardiac murmurs, clicks, hums and current dietary regimen as pertinent findings that could effect amount of exercise prescribed. Current dietary regimen is not a factor related to amount of exercise to prescribe but a factor related to diet prescription and recommendation. 

 

Question 20 

According to Erikson’s stages of development, the stage in which failure leads to feelings of shame and doubt is which of the following? 

   autonomy 

  trust 

   initiative 

  industry 

Correct answer:

autonomy

 

Erikson’s stages of psychosocial development maintain that how well individuals accomplish developmental tasks will determine their success in accomplishing other tasks as they get older. A person who fails to achieve autonomy will have feelings of shame and doubt.

Question 21 

Which of the following heart sounds is caused by the increased resistance from a stiff left ventricle? 

  S1 systole 

  S2 diastole 

   S3 heart sound 

   S4 heart sound 

Correct answer:

S4 heart sound

 

The S4 heart sound is caused by the increased resistance from a stiff left ventricle. It usually indicates left ventricular hypertrophy. It may be considered as a normal finding in some elderly patients with no heart disease.

 

Question 22 

As a practicing NP you know that the leading cause of death for all ages and genders is which of the following? 

   heart disease 

  motor vehicle crashes 

   cancer 

  unintentional injuries 

Correct answer:

heart disease

 

Heart disease is the leading cause of death for all ages and genders. Motor vehicle crashes are the leading cause of death in adolescents. Cancer is the second leading cause of death for all ages and genders; and unintentional injuries are the leading cause of death for children aged 12 months to 9 years.

 

Question 23 

The most common cause of secondary hypertension is which of the following? 

  heredity 

  environmental factors 

   sympathetic nervous system 

   renal conditions 

Correct answer:

renal conditions

 

The most common causes of secondary hypertension are renal conditions, e.g., renal artery stenosis and renal failure. The other choices are factors in primary hypertension

 

Question 24 

A patient who has been given a nursing diagnosis of vesicular breath sounds would be expected to display which of the following? 

  Difficulty breathing. 

  High-pitched, wheezy breathing. 

   Low-pitched, breezy breathing. 

  Low-pitched, hollow breathing. 

 

Correct Answer: Low-pitched, breezy breathing Vesicular breath sounds are low-pitched, breezy, and soft. They are associated with normal breathing and are heard when ausculating over the lung area. Though they are considered normal, it is key that these breath sounds be documented as part of an overall assessment, as they are valuable information for diagnosis. 

 

 Question 25 

The most likely associated symptoms of dementia include all of the following EXCEPT: 

  insidious onset over months or years 

  loss of intellectual or cognitive function 

   mental status changes 

   acute onset over hours to a few days 

The Correct answer is:

Acute onset over hours to a few days

Delirium has an acute onset over hours to a few days and is a condition in which the patient exhibits reduced ability to maintain attention to external stimuli and shift attention appropriately to new stimuli. The other answer choices are all true of dementia, making them incorrect answers in this case. Dementia has an insidious onset over months or years. 

 

Question 26 

A male patient has asked you for a prescription of Viagra. After a careful history, you make the determination that he has erectile dysfunction (ED). The nurse practitioner understands that ED is: 

  Not a condition associated with men over age 70 

  Primarily psychological in origin 

   The persistent inability to achieve and maintain an erection adequate for sexual intercourse. 

   The physiologic dysfunction when smooth muscles contract, causing a lack of adequate amounts of blood in the penis to render a rigid, larger penis. 

The Correct answer is:

The persistent inability to achieve and maintain an erection adequate for sexual intercourse

Erectile dysfunction is experienced by 40% of men over 40 years of age and 70% of men over 70. It involves a dysfunction in the hemodynamic mechanism of smooth muscle relaxation that increases blood flow in the penis.

 

Question 27 

One of the symptoms associated with Parkinson’s disease is micrographia. This can be described as which of the following? 

  diminished initiation of swallowing 

  impaired upward gaze 

   progressively smaller handwriting 

  postural hypotension 

Correct answer:

progressively smaller handwriting

 

Micrographia can be described as progressively smaller handwriting. It is one of the symptoms associated with Parkinson’s disease. Other associated symptoms include: dysphagia, dysphonia, autonomic dysfunction, and depression.

 

Question 28 

 In terms of risk management, which of the following would NOT be a high-risk patient?

 

  a 45-year-old disabled male with multi-system failure 

   a low-functioning 23-year-old female with Down syndrome

 

   a 65-year-old female who takes two drugs for hypertension 

  a 19-year-old cocaine addict 

Correct answer:

a 65-year-old female who takes two drugs for hypertension

 

Certain patient characteristics should alert the FNP to be aware of risk management strategies. High-risk patients include those with the following characteristics: multisystem failure, low intelligence, polypharmacy, noncompliant behavior, positive review of systems, substance abuse and litigiousness. A 65-year old female who takes only two drugs would not be considered high risk.

 

 Question 29 

There are theories of how and why a person changes or stays the same over time. One debate on theory involves nature vs. nurture. Which of the following theorists is part of the nature position on human growth and development? 

  John Locke 

   Arnold Gesell 

   John B. Watson 

  B.F. Skinner 

 

Correct answer:

Arnold Gesell

 

Arnold Gesell promoted the maturational-organismic theory that is a nature position (emphasis on heredity and maturational process). This theory has a biological basis and the organizing principle of the theory is structure (closed system of transformational rules governing thought). 

 

Question 30 

All but which of the following conditions may delay a diagnosis of pneumonia? 

  COPD. 

  Congestive heart failure. 

   Myocardial infarction. 

  Influenza. 

 

Correct Answer: Myocardial infarction A diagnosis of pneumonia may be delayed because the symptoms of the condition are similar to may other conditions. Patients who have congestive heart failure or COPD may have the characteristic cough and wheeze, while influenza may result in coughing, fever, and chills. Myocardial infarction may involve chest pain, but is unlikely to mimic pneumonia

Question 31 

A 33-year-old female has been previously diagnosed with primary dysmenorrhea and now presents in the office with symptoms including pain. She has tried over the counter ibuprofen and naproxen with no results. How should the nurse practitioner treat or manage her? 

   oral contraceptives 

  B vitamins 

   encourage regular exercise 

  prescription strength naproxen 

The Correct answer is:

Oral contraceptives

The primary treatments for dysmenorrhea include NSAIDs and hormonal contraceptives. The general recommendation is to use one agent and add the other if one does not work alone. Both should be considered for women who are symptomatic with one agent only. 

 

 Question 32 

Which cranial nerve (CN) is associated with hearing problems or balance impairment? 

  CN III 

  CN V 

   CN VII 

   CN VIII 

Correct answer:

CN VIII

 

CN VIII is the auditory or vestibulocochlear nerve. When this nerve does not functioin properly, hearing or balance is impaired. The Rinne test is part of the evaluation of this CN.

 

Question 33 

A person with a mild hearing loss would have a problem at a dB level of which of the following? 

  71 – 90 dB 

  56 – 70 dB 

   41 – 55 dB 

   26 – 40 dB 

Correct answer:

26 – 40 dB

 

A person with a mild hearing loss would have a problem at a dB level of 26 – 40 dB. 20 dB is whispered voice. 40 dB is likened to a refrigerator humming.

 

Question 34 

The following are recommended immunizations for healthy young adults: 

   influenza, measles, rubella, hepatitis B, and tetanus 

  tetanus, influenza, varicella, pneumovax, and hepatitis B 

   pneumovax, rubella, and influenza 

  measles, mumps, and rubella, varicella, and hepatitis B 

The Correct answer is:

Influenza, measles, rubella, hepatitis B, and tetanus

 

Five to twenty percent of young adults are susceptible to measles and/or rubella. Hepatitis B and influenza vaccines are recommended for the student population. In addition, a tetanus vaccine is recommended every 10 years, especially in young adults who participate in outdoor sports. 

 

Question 35 

The first-line intervention for anterior epistaxis is which of the following? 

  nasal packing 

   simple pressure to the area superior to the nasal alar cartilage 

   cautery 

  topical thrombin 

Correct answer:

simple pressure to the area superior to the nasal alar cartilage

 

Anterior epistaxis is usually the result of localized nasal mucosa dryness and trauma. Most episodes can be easily managed with simple pressure – with firm pressure to the area superior to the nasal alar cartilage. If this action is ineffective, then other secondary measures such as those mentioned in the other choices may be used.

 

Question 36 

The nurse practitioner (NP) understands that the research process is similar to the processes that the NP use to provide patient care in that both are decision-making processes. The steps of these processes in the correct order are: 

  Notification, subject selection, consent verification and study implementation 

  Study scope, literature review, study protocol and study design 

   Research construction, research compilation, research conclusion, research implementation 

   Assessing, planning, implementing and evaluating 

The Correct answer is:

Assessing, planning, implementing and evaluating

When conducting research, the nurse uses the process steps of assessing, planning, implementing and evaluating. During the assessing stage of the research, the nurse identifies the problem and performs a literature review. The nurse practitioner also identifies any variables that may need to be later measured in the study.  With planning, the nurse performs research to create a hypothesis, determine measurements for the variables of the study and then decide how the sample for the study is selected. The nurse practitioner then collects the data. During the evaluation or evaluating stage, the nurse practitioner analyzes or evaluates the data, makes a conclusion about the findings and determines how to communicate the findings

 

Question 37 

Several research studies based on the transactional model of development emerged in the 1980s. One of these models was the Kauai longitudinal study from birth to adulthood to explore perinatal risk and environmental factors on subsequent developmental outcomes and resiliency. Which of the following researchers conducted this study? 

  Alan Sroufe 

   Michael Rutter 

  Lawrence Kohlberg 

   Emmy Werner 

Correct answer:

Emmy Werner

 

The transaction model was first described in 1975 as a “continuum of reproductive risk and caretaking casualties” by Arnold Dameroff and Michael Chandler. Emmy Werner produced the Kauai longitudinal study from birth to adulthood to explore perinatal risk and environmental factors on subsequent developmental outcomes and resiliency based on the transactional model

 

 Question 38 

Which of the following drugs or types of drugs is least likely to be prescribed as therapy for anorexia nervosa? 

  antidepressants 

  benzodiazepines 

  cyproheptadine 

   antihypertensive 

Correct answer:

antihypertensive

 

This is the least likely drug to be prescribed specifically for anorexia nervosa. Antidepressants may have an effect because of the high rate of comorbid depression in anorexia nervosa patients. Benzodiazepines are also sometime used to reduce anxiety associated with eating. Cyproheptadine (Periactin) can be used before meals to enhance appetite and reduce anxiety.

 

Question 39 

In the treatment of the patient with polycystic ovary syndrome (PCOS), you know that the following are measures to manage this condition EXCEPT: 

  Exercise and weight loss will improve this condition. 

  Metformin (Glucophage) improves insulin sensitivity, lowers LH, lowers androgen, and improves fertility. 

   Estrogen excess leads to hyperinsulinemia in these patients. 

   Monthly Provera 10 mg daily for 10-14 days at the end of each month is recommended. 

The Correct answer is:

Estrogen excess leads to hyperinsulinemia in these patients

It is the androgen excess, and not estrogen excess, that leads to insulin resistance. In turn, the androgen excess spurs hyperinsulinemia and increases the patient’s risk for diabetes mellitus. Polycystic ovary syndrome occurs when the menstrual cycle is interrupted. Also, patients with polycystic ovary syndrome have elevated levels of androgen, which is a male hormone. With polycystic ovary syndrome, cysts emerge in the ovaries that contain fluid. The fluid causes the sacs to get bigger. Further, polycystic ovary syndrome is triggered by too much luteinizing hormone (LH) produced by the pituitary gland. The increased LH triggers the production of androgen, which in turns can cause metabolic syndrome to occur.  Polycystic ovary syndrome is diagnosed based on the patient’s symptoms, blood tests to evaluate the hormone levels and in some cases ultrasonography. For females who do not want to become pregnant, combination oral contraceptive containing estrogen and progestin may be prescribed to reduce the androgen levels.

 

 Question 40 

Bronchiolitis is a common illness in early childhood. Treatment of bronchiolitis in children usually consists of treatment with: 

   supportive therapy 

  corticosteroids 

   ribavirin 

  bronchodilators 

Correct answer:

supportive therapy

 

In most children, bronchiolitis runs a course of 2 to 3 weeks of mild upper respiratory symptoms. Supportive therapy is usually sufficient. The use of corticosteroids, ribavirin and bronchodilators remains controversial with little evidence of efficacy

 

Question 41 

Which of the following would indicate that your patient with conjunctivitis caused by chlamydia has an advanced infection? 

  profuse tearing 

  itchy eyes 

   photophobia 

  crusty discharge 

Correct answer:

photophobia

 

Photophobia is an indicator of advanced infection in conjunctivitis cased by chlamydia. Symptoms that chlamydia is the cause include pre-auricular lymphadenopathy and genitourinary symptoms.

 

 Question 42 

Of the following food-based allergies, which is the most common in both adults and children? 

  allergy to milk products 

  allergy to soy products 

   allergy to peanut products 

  allergy to egg products 

The Correct answer is:

Allergy to peanut products

Food allergens that occur more common in children but are often absent in adulthood are  allergies to milk, soy, and egg products. Peanut, shellfish, fish, and tree nut allergies tend to manifest in childhood and persist into adulthood. 

 

Question 43 

Which of the following statements about the role of the family nurse practitioner is incorrect? 

  The FNP assesses family structure and dynamics to help individuals maximize their health. 

   The FNP role is a combination of pediatric NP, adult NP and gerontological NP roles. 

   The FNP teaches family members to recognize the influences of their family health patterns. 

  FNPs provide a comprehensive psychosocial approach to caring for individuals. 

Correct answer:

The FNP role is a combination of pediatric NP, adult NP and gerontological NP roles.

 

This is incorrect. The FNP role is a unique role. It is not a combination of other NP roles. Being an FNP requires mastery of a unique body of knowledge and tasks for the care of an individual within a family context.

 

Question 44 

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

   cerebral ischemia 

  cerebral hemorrhage 

   venous insufficiency 

  subdural hemorrhage 

The Correct answer is:

Cerebral ischemia

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

 

Question 45 

Those systems that form outside the family and reflect functional needs not met within the family are called: 

  exosystems 

  endosystems 

   suprasystems 

  econosystems 

Correct answer:

suprasystems

 

Suprasystems form outside the family and reflect functional needs not met within the family. Relationships with teachers, schools, religious and civic organizations, the healthcare system and friends are examples of suprasystems that meet needs not met by interactions within the family system.

Question 46 

You are assessing a 82-year old male patient with suspected BPH. What should the nurse practitioner consider? 

  BPH affects 30% of men his age. 

   The prostate size does not correlate well with symptom severity. 

  He is at low risk for prostate cancer. 

  Limiting his fluid intake would help him relieve the symptoms. 

The Correct answer is:

The prostate size does not correlate well with symptom severity

A small prostate can cause significant symptoms for some men. Benign prostatic hyperplasia (BPH) is a common disorder in older men, with 30% of men 30-years-old and older affected. Also, aging men are at high risk for prostate cancer. Limiting fluid intake would not be a good option because this can yield more concentrated and perhaps irritating urine, leading to increased symptoms. 

 

Question 47 

Which of the following treatments would be considered a long-term control medication for asthma sufferers? 

  Albuterol HFA 

  Xopenex 

   Accolate 

  Ventolin HFA 

Correct answer:

Accolate

 

Accolate (zafirlukast) is a leukotriene receptor antagonist that is used for long-term control of asthma in adults and children 5 – 11 years old. The other choices are all quick-relief (rescue) medications.

 

 Question 48 

You are teaching a diabetic client how to test his blood glucose each day. This is which of the following types of learning? 

  affective 

   psychomotor 

   cognitive 

  none of the above 

 Correct answer:

psychomotor

 

This learning involves psychomotor skills. Learning about the disease process would be cognitive; and learning the significance of glycemic control would be affective.

 

Question 49 

When creating a plan of care for a patient diagnosed with fibromyalgia, which of the following is NOT among the medications you would consider? 

  Duloxetine. 

  Pregabalin. 

   Gabapentin. 

   Levetiracetam. 

 

Correct Answer: Levetiracetam Levetiracetam, or LEV, is an antiepileptic drug (AED) and is not indicated for fibromyalgia. It may in fact pose serious risk of drug interaction with pregabalin (Lyrica), which is a common treatment for fibromyalgia. Gabapentin and Duloxetine may also be prescribed for patients with fibromyalgia. 

 

 Question 50 

A patient is having a seizure with rigid extension of her arms and legs and sudden jerking movements with loss of consciousness. She is having which of the following types of seizure? 

  myoclonic 

   tonic-clonic 

   simple partial 

  complex partial 

Correct answer:

tonic-clonic

 

A tonic-clonic (grand mal) seizure is characterized by rigid extension of her arms and legs and sudden jerking movements with loss of consciousness. The onset of this type of seizure can happen at any age. In adults, a new onset may be found in patients with a brain tumor, post head injury or alcohol withdrawal.

 

Question 51 

The legal authority to practice as a nurse practitioner in any state is determined by: 

  state board of nursing 

  federal guidelines 

   certification board 

   state legislature 

The Correct answer is:

State legislature

The state legislative establishes statutes that allows the State Boards of Nursing to determine the scope of practice for a nurse practitioner. Further, the certification boards like ANCC and AANP "certify" that a nurse practitioner has met the requirements set by the certifying body

 

 Question 52 

The general principles for the documentation of services would include all of the following EXCEPT: 

  Past and present diagnoses should be accessible to the treating and/or consulting physician. 

  Appropriate health risk factors should be identified. 

   The patient’s progress should be documented. 

   The CPT and ICD-9-CM codes reported on the health insurance claim form or billing statement do not need supporting documentation in the medical record. 

Correct answer:

The CPT and ICD-9-CM codes reported on the health insurance claim form or billing statement do not need supporting documentation in the medical record.

 

This is incorrect. The CPT and ICD-9-CM codes reported on the health insurance claim form or billing statement should be supported by documentation in the medical record. In addition to the other three choices which are correct, the medical record should be complete and legible and if not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred.

 

Question 53 

A 7-year-old Caucasian male child presents to the clinic for a nosebleed. After examination, it is concluded that anterior epistaxis is present. The nurse practitioner has knowledge that it is usually caused by:

 

   localized nasal mucosa trauma 

  a foreign body 

   hypertension 

  bleeding disorders 

 

The Correct answer is:

Localized nasal mucosa trauma

A nosebleed is usually the result of localized nasal mucosa dryness and trauma and is rarely a result of other causes. It can be easily managed with simple pressure. If this action is not effective, nasal packing and cautery may be necessary. 

 

 Question 54 

Which of the following drugs is a category X drug for pregnant women? 

  sulfa drugs 

  tetracyclines 

  fluoroquinolones 

   methotrexate 

Correct answer:

methotrexate

 

Methotrexate is a category X drug. Category X drugs have shown fetal risks which outweigh the benefits

 

Question 55 

A mother brings her 8-year-old son to your office. She tells you that he has had no immunizations but she would like him to have all of the necessary immunizations now. Which of the following immunizations would NOT be necessary for this child?

 

   PCV (3 doses) 

  Td (3 doses primary, then every 10 years) 

   IPV (3 doses) 

  MMR (2 doses) 

Correct answer:

PCV (3 doses)

 

PCV (pneumococcal conjugate vaccine) is not given after age 7 years. All of the other immunizations should be given along with Hepatitis B (3 doses).

 

Question 56 

The nurse practitioner (NP) has been asked to resolve a conflict between two medical assistants. One is observed as pleasant and helpful, while the other is abrasive and angry. What guideline must the NP observe in the resolution of this conflict? 

   Deal with issues, not personalities. 

  Weigh the consequences of each possible solution. 

   Require the medical assistants to reach a compromise. 

  Encourage ventilation of anger and use humor to minimize the conflict. 

The Correct answer is:

Deal with issues, not personalities 

The conflict must be addressed directly by the nurse practitioner. The personal characteristics of the assistants must not enter into the conflict resolution process. Compromise is only one method of conflict resolution. 

 

Question 57 

Research based on the transactional model of human growth and development emerged in the 1980s. Which of the following researchers did epidemiological studies of children of mentally ill parents to examine risk and protective factors influencing subsequent psychopathology? 

   Michael Rutter 

  Emmy Werner 

   Alan Sroufe 

  none of the above 

Correct answer:

Michael Rutter

 

The transaction model of development was first described in 1975 as a “continuum of reproductive risk and caretaking casualties by Arnold Sameroff and Michael Chandler. Michael Rutter did the epidemiological studies of children of mentally ill parents to examine risk and protective factors influencing subsequent psychopathology.

 

Question 58 

The patient and his family have a right to assume that information given to the NP will not be disclosed. This means all of the following EXCEPT: 

  Verbal information is covered by confidentiality. 

  Written information is covered by confidentiality. 

  The individual’s right to privacy is respected when responding to a request for a patient’s medical record. 

   The NP must respect confidentiality but it does not have to be formally discussed with the patient. 

Correct answer:

The NP must respect confidentiality but it does not have to be formally discussed with the patient.

 

This is not correct. Confidentiality requires that the provider discuss confidentiality issues with patients. They must establish consent, and clarify any questions about disclosure of information.

 Question 59 

Which child can stack a maximum of 5 blocks? 

  a 9-month-old girl 

  a 12-month-old boy 

   a 2-year-old 

   a child older than 3 years 

The Correct answer is:

A 2-year old

Common developmental tasks for the 2-year-old include stacking 5 blocks, following 2 step commands and using 2 word phrases. This development occurs at the same rate in boys and girls. 

 

Question 60 

A 45 year old male comes in for a routine physical. He has a medical history of ulcers and other digestive problems. In the interview, he lists daily aspirin as a safeguard against a heart attack. How is this significant? 

  Aspirin is not effective against heart attack. 

  It is not significant. 

   45 is too young for a heart attack. 

   Aspirin can exacerbate ulcers and digestive disorders. 

Correct answer: Aspirin can exacerbate ulcers and digestive disorders Aspirin may be helpful when fighting heart attack, but it has risks. Aspirin can exacerbate ulcers and digestive disorders. This can cause GI bleeding and possibly certain cancers. 

 

Question 61 

A young mother expresses concern after bringing her child in for colic for the third time. What should you address in the interview? 

  Colic is not common and must be monitored closely. 

   Colic is common and will stop as the baby grows. 

   Colic can be dangerous and antibiotics are necessary for every bout of colic. 

  Colic should only appear once. 



Correct answer: Colic is common and will stop as the baby grows Many babies get colic. While it is uncomfortable and should be monitored it is also common. The condition typically stops as they get older. 

 

Question 62 

A diet often recommended for hypertension management is the DASH diet. Which of the following is NOT true of this diet? 

  It is high in calcium. 

   It is very low in protein. 

   It is high in magnesium. 

  It is high in potassium. 

 

Correct Answer: It is very low in protein The DASH diet is effective for some hypertension patients. It focuses on foods that are high in magnesium, potassium, and calcium. 

 

Question 63 

Your patient has been in an automobile accident. Her teeth hit the steering wheel resulting in a fracture of the front teeth that  involved the enamel, dentin, and pulp with pink tissue seen in the fracture. You understand that this is which of the following types of tooth fracture?

 

  Ellis I 

  Ellis II 

   Ellis III 

  avulsed 

Correct answer:

Ellis III

 

An Ellis III tooth fracture is a full-thickness fracture of the tooth. It involves the enamel, dentin, and pulp. Pink tissue or blood is seen in the fracture. Avulsion involves the tooth being removed from the socket

 

 Question 64 

The FNP has a 70-year-old female patient who has been diagnosed with giant cell arteritis. The FNP understands that all of the following are true about this disease and its treatment EXCEPT: 

  Her symptoms may be accompanied by respiratory tract symptoms. 

  Approximately 50% of patients with giant cell arteritis experience visual symptoms. 

   Transient repeated episodes of blurred vision are usually reversible. 

   Sudden loss of vision is almost always reversible. 

Correct answer:

Sudden loss of vision is almost always reversible.

 

Sudden loss of vision is almost always permanent. Treatment for giant cell arteritis helps minimize the risk of blindness.

 

Question 65 

The FNP is doing a well-child exam on a 6-year-old boy. The FNP can expect that all of the following developmental milestones are likely to be exhibited in this child EXCEPT: 

  catches a ball 

  knows his age 

   knows his right from his left hand 

   draws persons with at least 16 parts 

Correct answer:

draws persons with at least 16 parts

 

All of the choices are developmental milestones likely to be exhibited by a 6-year-old child except this one. A child of this age will typically draw a person with 6 – 8 parts. At the age of 7 or 8 years, a child will typically draw a person with at least 16 parts.

 Question 66 

The FNP is doing a routine physical examination for a patient who had cardiac bypass surgery about a year ago. The patient tells the FNP that she never directly looks at the scar from the surgery because it upsets her. What is the best statement for this FNP to make in this situation? 

  Tell the patient to look away as the FNP examines the scar. 

  Tell the patient that there is nothing wrong with having a scar from a successful surgery. 

   Say, “You don’t want to look at the scar?” and wait for a response. 

  Ask the patient why it upsets her to look at the scar. 

Correct answer:

Say, “You don’t want to look at the scar?” and wait for a response.

 

The best action is to restate to the patient. This provides her an opportunity to clarify further and encourages discussion of her feelings.

 

Question 67 

Which of the following is NOT a typical physiologic change during pregnancy? 

   Cardiac output decreases by one-third by the last two trimesters. 

  The heart is displaced upward and to the left in the late second to third trimester. 

  Decreased systolic and diastolic pressure occurs in the first trimester. 

   The thyroid can enlarge by as much as 15%. 

 

Correct answer:

Cardiac output decreases by one-third by the last two trimesters.

 

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

Question 68 

Erikson’s stage of development in which failure leads to despair is which of the following? 

  generativity 

   ego identity 

   intimacy 

  industry 

Correct answer:

ego identity

 

Failure to achieve ego identity leads to despair according to Erikson. Erikson’s eight stages of development are: trust, autonomy, initiative, industry, identity, intimacy, generativity, and ego identity.

 Question 69 

The health problems most associated with elder abuse include all of the following EXCEPT: 

  arthritis 

  depression 

   stroke 

   hypertension 

Correct answer:

hypertension

 

Hypertension is not normally one of the health problems associated with elder abuse. The health problems most of associated with abuse are dementia, depression, stroke, and arthritis.

Question 70 

The FNP has a female adult patient who tells him that she has lost a large amount of weight in a short amount of time, has become irritable and anxious and often experiences insomnia. Upon examination the FNP finds a diffusely enlarged thyroid gland without nodules, and tachycardia. Of the following which is the most likely diagnosis for these symptoms? 

   Grave’s disease 

  thyroid cancer 

   hyperprolactinemia 

  pheochromocytoma 

Correct answer:

Grave’s disease

 

Grave’s disease is an autoimmune disorder of the thyroid gland causing hyperfunction and production of excess thyroid hormones. There is a higher incidence in females (8:1 ratio). In later stages of Grave’s disease there can also be exophthalmos (protruding eyeballs).

 

Question 71 

Appendicitis is uncommon in which of the following groups? 

  young adults 

  adolescents 

  school age children 

   infants 

Correct answer:

infants

 

Appendicitis is uncommon in infants and the elderly. The peak age of patients with acute appendicitis is 10 to 30 years old.

 

Question 72 

The nurse practitioner is assessing a 24-year-old female patient with asthma. What is a common clinical manifestation of  asthma? 

   nocturnal exacerbation 

  chronic hypoxemia 

   diffuse crackles 

  pruritus 

The Correct answer is:

Nocturnal exacerbation

Nocturnal exacerbation is a common clinical sign of asthma. Additionally, nocturnal exacerbation is linked to the variation in circulating catecholamines and vagal tone. Chronic hypoxemia and diffuse crackles are seen in the client with chronic bronchitis. Pruritus is often seen in clients with contact allergic reactions. 

 

 Question 73 

What percentage of the usual and customary fee paid to physicians is reimbursed to the FNP by Medicare? 

  100% 

  95% 

   90% 

   85% 

Correct answer:

85%

 

Today, nurse practitioners can be reimbursed directly by Medicare. Medicare reimburses NPs 85% of the usual and customary fee that is paid to a physician for the same visit.

 

Question 74 

Which of the following does NOT place an obese patient at a higher risk for a stroke? 

  Smoking. 

  High blood pressure. 

   Weight loss. 

  Diabetes. 

Correct answer: Weight loss An obese patient's risk would be reduced with weight loss. The other answers will increase the risk. Poor diet and lack of activity will also increase the risk. 

 

 Question 75 

You are treating a patient with rheumatoid arthritis (RA). The nurse practitioner understands that the principles of treating patients with RA include: 

   early use of disease-modifying antirheumatic drugs (DMARDs) to slow or halt joint damage 

  recognizing that joint splinting is seldom advisable 

   pain relief as the chief therapeutic goal 

  initial therapy with a NSAID, then adding other medications as necessary 

The Correct answer is:

Early use of disease-modifying antirheumatic drugs (DMARDs) to slow or halt joint damage

As helpful as NSAIDs are for symptom control, they do not offer any alteration to the underlying disease process progression. The disease-modifying antirheumatic drugs (DMARDs) help minimize the risk of joint damage and disease progression and should be started as soon as the diagnosis of rheumatoid arthritis (RA) is made. The goal of treatment with RA is to reduce inflammation and pain, while preserving function and preventing deformity. 

 

Question 76 

Which of the following systemic antihistamines is a first-generation product?

 

  Claritin 

  Clarinex 

   Zyrtec 

   Benadryl 

Benadryl

 

Benadryl is a first-generation antihistamine. First-generation antihistamines readily cross the blood-brain barrier, causing sedation. The second-generation antihistamines do not easily cross the blood-brain barrier, which results in lower rates of sedation.

Question 77 

Which of the following would NOT be a positive finding of a TB test?

 

  more than 5 mm in an HIV infected person 

  more than 5 mm in a person who has had close contact with someone with active TB 

   more than 10 mm for a healthcare worker 

   more than 10 mm for a healthy male adult 

Correct answer:

more than 10 mm for a healthy male adult

 

This would not be considered a positive TB test result for a healthy person with no other risks for exposure to TB. More than 15 mm would be a positive finding for this person and all persons.

 

 Question 78 

When assessing a patient with a headache, the nurse practitioner knows that there are certain "red flags". The mnemonic SNOOP is often used for assessing these red flags. What is the "N" in SNOOP? 

  Never shine the light in the patient's eyes. 

   Neurologic signs and symptoms 

   New onset of a different headache 

  Numbness and tingling 

The Correct answer is:

Neurologic signs and symptoms

In SNOOP ,"S" is for Systemic symptoms. Then, the "N" is for Neurologic signs and symptoms. Next, the "O" is for Onset that is sudden and abrupt. Further, "O" is for Onset age >50. Finally, the "P" is for Previous headache history. 

 

Question 79 

You have a 55-year-old female patient who has just started to have pain in her fingers which is worse in the morning and when she is working with her hands. You have determined that the pain is not from participating in sports or overuse of the fingers. She has no metabolic disorder and has had no joint trauma from injury. Your diagnosis will most likely be which of the following? 

   osteoarthritis 

  rheumatoid arthritis 

   tendonitis 

  gout 

Correct answer:

osteoarthritis

 

Osteoarthritis is a degenerative joint disease with progressive loss of articular cartilage in moveable joints. It results from both mechanical and biologic events that lead to degradation of articular cartilage and subchondral bone in joints. It presents with a gradual onset of pain, tenderness, and stiffness that worsens with activity. Morning stiffness is common.

Question 80 

A patient complains of a fluid-filled, elevated, circumscribed lesion that's 7 mm in size. Of the following, what is the medical term? 

   Bulla. 

  Tumor. 

   Pustule. 

  Macule. 

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

 

Question 81 

A parent brings in a 9-year-old child who is experiencing recurrent abdominal pain that has occurred over the past 6 months. Which of the following tests would NOT be one of the initial tests done for this patient? 

  CBC 

   ultrasound of the abdomen 

   urine analysis and culture 

  stool examination 

Correct answer:

ultrasound of the abdomen

 

Initial tests for this patient would include CBC, ESR, urine analysis and culture, and stool examination for ova and parasites and blood. Second line tests might include an ultrasound of the abdomen and screening for H. pylori.

 

 Question 82 

Regarding workforce policy, which of the following is an accurate statement? 

  There are no options for the advanced practice nurses to work outside the primary care role. 

   Employment patterns of nurse practitioners are of special interest to health workforce analysts because of the presumed connection between the employment opportunities for nurse practitioners and the supply of primary care physicians. 

   There is a decrease in the number of nurses with educational preparation as advanced practice nurses. 

  Only half of the nurse practitioners are employed in healthcare or nursing. 

The Correct answer is:

Employment patterns of nurse practitioners are of special interest to health workforce analysts because of the presumed connection between the employment opportunities for nurse practitioners and the supply of primary care physicians

There are many options for the nurse practitioner (NP) outside of primary care. There is an increase in the number of nurses educated as NPs now than ever and most are employed in nursing or healthcare workplaces. 

 

Question 83 

The Jones criteria are the major criteria for PID. Which of the following is NOT part of these criteria? 

   breast tenderness 

  lower abdominal tenderness 

  cervical motion tenderness 

   adnexal tenderness 

Correct answer:

breast tenderness

 

Breast tenderness is not part of the Jones criteria for PID. The other three choices are part of the Jones criteria. Only one of them is necessary to diagnose and treat for PID.

 

 Question 84 

A 24-year-old female is present in the clinic and a ruptured tubal pregnancy is suspected. What findings would the nurse practitioner assess for?

 

  boardlike rigidity of the uterus with abdominal distention 

  dilatation of the cervix and rapidly falling BP and pulse 

   serosanguineous vaginal fluid with grape-like vesicles 

   sharp stabbing pain in the lower abdomen with blood pressure of 92/56 

The correct answer is:

Sharp stabbing pain in the lower abdomen with blood pressure of 92/56

The ruptured fallopian tube causes a sharp, sudden, stabbing pain with lowering blood pressure. Boardlike abdominal rigidity is seen in abruptio placentae. Then, Grapelike vesicles are associated with hydtidiform mole, a gestational disease. 

 

Question 85 

If a patient suffers death related to the use of a particular medical device, the Food and Drug Administration (FDA) must be notified. Which of the following health care providers or organizations are required to report the death of a patient under the Safe Medical Devices Act of 1990? 

  Nurse family members treating patients without compensation. 

  Physicians making home visits. 

   Physician office staff. 

   Hospitals, home health agencies, and ambulatory surgery companies. 

 

The Correct answer is:

Hospitals, home health agencies, and ambulatory surgery companies

The Safe Medical Device Act of 1990 requires the reporting of adverse reactions or incidents regarding medical devices such as ventilators, thermometers, syringes, to name a few, to the medical device manufacturer.  These reportable adverse incidents can include an injury or an illness that is severe, life threatening or causes substantial long-term damage to the patient or death. If death associated with a medical device occurs, the facility has to send a report to the medical device manufacturer and the Food and Drug Administration (FDA). Further, hospitals, diagnostic and treatment outpatient organizations, nursing homes and ambulatory surgical are required to report this occurrence. Events occurring in the other settings are exempt from reporting requirements under this federal law.

 

Question 86 

If you are working OB and managing a patient after an amniocentesis, the nurse practitioner understands that she must assess for which high priority occurrence first: 

  abnormal lung sounds 

   spontaneous rupture of the membranes 

   elevated temperature 

  increased fetal activity 

The Correct answer is:

Spontaneous rupture of the membranes

The risk of damage to the membranes is a possibility and should be considered a high-priority situation. The lungs are too far out of the way to be damaged. Then, fever would not be an immediate concern. Additionally, fetal heart rate is monitored and not increased fetal activity. 

 

Question 87 

Which of the following skin lesions can best be described as an elevated superficial skin lesion less than 1 cm in diameter and filled with serous fluid? 

  macule 

  papule 

   pustule 

   vesicle 

 

Correct answer:

vesicle

 

A vesicle is an elevated superficial skin lesion less than 1 cm in diameter and filled with serous fluid. An example of a vesicle is a herpetic lesion. A pustule is an elevated superficial skin lesion less than 1 cm in diameter and filled with purulent fluid. A papule is a palpable solid lesion up to 0.5 cm. A macule is a flat nonpalpable lesion smaller than 1 cm in diameter.

Question 88 

Which of the following statements concerning administrative agencies are correct? 

   The Internal Revenue Service (IRS) promulgates and applies regulations to individual disputes concerning federal taxation. 

  The Food and Drug Administration (FDA) decides the costs of each medication. 

   The National Labor Relations Board (NLRB) decides which federal labor laws go before Congress. 

  The American Medical Association (AMA) decides how national labor law applies to physician offices. 

 

The Correct answer is:

The Internal Revenue Service (IRS) promulgates and applies regulations to individual disputes concerning federal taxation

The Food and Drug Administration (FDA) promulgates regulations and applies them to individual determinations involving the manufacture, marketing, and advertising of drugs, medical devices, cosmetics, and foods. The National Labor Relations Board (NLRB) decides how national labor laws apply to individual disputes. The American Medical Association (AMA) does not involve itself with national labor laws.

Question 89 

A patient who has been prescribed Questran for Irritable Bowel Syndrome should be advised that all but which of the following are potential side effects of the medication? 

  Constipation. 

   Diarrhea. 

   Stomach cramps. 

  Abdominal pain. 

Correct Answer: Diarrhea Questran is associated with many gastrointestinal side effects, including constipation and cramping. Diarrhea is not a known side effect. Most of these side effects subside with time. Patients should notify their healthcare provider if these symptoms worsen. 

 

Question 90 

A discrete narrowing of the aorta, just opposite the site of the ductus arteriosus is which of the following? 

  aortic stenosis 

  pulmonary stenosis 

  patent ductus arteriosus 

   coarctation of the aorta 

Correct answer:

coarctation of the aorta

 

Coarctation of the aorta is a discrete narrowing of the aorta, just opposite the site of the ductus arteriosus. It has two distinct presentations, one in the neonatal period, and one in infancy and childhood.

 

 Question 91 

A 22-year-old female suspects she is pregnant. In order to establish pregnancy, a test of the urine or blood is routinely performed. The nurse practitioner understands that this can be done with predictable results at what time? 

  within 3 days after conception 

  within 7 days after conception 

   1-2 weeks after conception 

  35 days after last menses 

Correct answer:

1-2 weeks after conception

Whether performed on urine or blood, the presence of hCG is evaluated to identify pregnancy and can be found in high quantities in the first morning urine or at any time in a serum sample. Both tests are highly sensitive, but if the pregnancy is early, the serum test is more specific. 

 

 Question 92 

Which of the following women was an outspoken opponent of the role of nurse practitioner? 

   Martha Rogers 

  Loretta Ford 

   Agnes McGee 

  Mary Breckenridge 

Correct answer:

Martha Rogers

 

Martha Rogers, who wrote An Introduction to the Theoretical Basis of Nursing, was an opponent of developing the nurse practitioner role on the basis that it would weaken and undermine the role of the nurse in health care. Her opposition led to a major division on the subject within the nursing field.

Question 93 

The survival rate for Stage IV Hodgkin’s disease is which of the following? 

  90% at 5 years 

  90% at 10 years 

   66% at 10 years 

   75% at 10 years 

 

Correct answer:

66% at 10 years

 

Stage IV Hodgkin’s disease is characterized by dissemination involving nonlymphatic organs. The survival rate is 66% at 10 years.

 

Question 94 

For the provisions of a living will to go into effect all of the following must be met with the exception of which of the following? 

  The patient has become incompetent. 

   The patient is over the age of 65. 

   The patient is declared terminally ill. 

  No further interventions will alter the patient’s course to a reasonable degree of medical certainty. 

Correct answer:

The patient is over the age of 65.

 

This is not a provision for a living will to go into effect. All of the other choices are provisions. Living wills are written documents prepared in advance in case of terminal illness or nonreversible loss of consciousness.

Question 95 

Which of the following properly describes the dosage of the treatment Anhydrous ethyl alcohol with 6.25% aluminum chloride for folliculitis? 

   Apply tid before antibiotic ointment. 

  2%, apply bid X 10 days and cover with DSD. 

   Apply to area bid-tid. 

  0.5 to 1 mg/kg/day PO in divided doses. 

Correct answer: Apply tid before antibiotic ointment The preceding medications should be administered at the following dosages: Mupirocin ointment - 2%, apply bid X 10 days and cover with DSD. Gentamicin Sulfate cream or ointment - Apply to area bid-tid. Isoretinoin - 0.5 to 1 mg/kg/day PO in divided doses. Anhydrous ethyl alcohol with 6.25% aluminum chloride - Apply tid before antibiotic ointment. 

 

Question 96 

Of the following statements about failure to thrive in children, which one is incorrect? 

   It is a diagnostic term rather than a descriptive term. 

  It generally refers to infants and children whose weight is below the 3rd percentile on the NCHS growth standards. 

   It has a multifactorial etiology. 

  Males and females are equally affected. 

Correct answer:

It is a diagnostic term rather than a descriptive term.

 

This is incorrect. Failure to thrive (FTT) is a descriptive term rather than a diagnostic term. There is no consensus on the definition for the condition. The traditional categories include: organic FTT, nonorganic FTT, and mixed etiology FTT. 

Question 97 

A urine pregnancy test is considered which of the following  signs of pregnancy?

 

  positive sign 

   probable sign 

   presumptive sign 

  affirmative sign 

 

Correct answer:

probable

 

A urine pregnancy test is considered to be a probable sign of pregnancy. It is not a positive sign.

 

 Question 98 

You are treating a 17-year-old male patient with acne vulgaris who has been on tetracycline antibiotics for two weeks. He returns to the clinic with his father and they both convey that they want to try a different medication. The adolescent does not feel that the medication is working fast enough. Your next action is to: 

  Add clindamycin therapy along with the tetracycline. 

   Counsel them that 6 to 8 weeks of treatment is necessary before significant improvement can be achieved. 

   Advise them to stop the tetracycline and refer him to a dermatologist. 

  Stop the tetracycline and give him Retin-A cream and amoxicillin. 

 

The Correct answer is:

Counsel them that 6 to 8 weeks of treatment is necessary before significant improvement can be achieved

Oral antibiotics such as tetracycline, clindamycin, azithromycin, and erythromycin are indicated for the treatment of moderate papular inflammatory acne. These agents require a period of 6 to 8 weeks to cure or control the condition. 

 

Question 99 

A rapid decrease in renal function with elevated urinary and serum creatinine are indications of which of the following conditions/diseases? 

   acute renal failure 

  Wilm's tumor 

   acute pyelonephritis 

  recurrent cystitis 

Correct answer:

acute renal failure

 

Acute renal failure is a rapid decrease in renal function with an elevated urinary and serum creatinine. The patient will likely have edema, weight gain from water retention and oliguria. The patient may also be anorexic and lethargic.

 

Question 100 

Your adult female patient tells you that she has had several headaches each of which lasts about 8 hours. They have a pulsating quality and are aggravated by climbing stairs. They keep her from doing anything productive during the headache. She often has nausea also and is bothered by light during the headache. After assessment you diagnose which of the following? 

   migraine without aura 

  cluster headache 

  tension-type headache 

   migraine with aura 

Correct answer:

migraine without aura

 

The symptoms that the patient experiences during headaches are consistent with the International Headache Society’s diagnostic criteria for migraine headache without aura. These headaches are usually a moderate to severe, throbbing, unilateral headache in the temple region or around the eye in persons with a family history of migraine.

 

aanp quiz 30

 Question 1 

An elderly patient presents with fever, left lower quadrant abdominal pain and diarrhea. Which of the following BEST describes the symptoms the patient is experiencing? 

  Acute hepatitis. 

  Iron deficiency anemia. 

  Testicular cancer. 

   Diverticulitis. 

Correct answer: Diverticulitis Diverticulitis is when the colon secondary consists of puchlike hernias. These hernias are caused by the lack of dietary fiber

Question 2 

You have a patient who has a strangulated hernia. Which of the following actions should be taken with this patient? 

  Reduce the hernia. 

   Immediately refer to surgeon. 

  Educate the patient about the signs and symptoms of hernia. 

  Apply cold compresses to the area. 

-------------------------------------------------------------------

Explanation: 

Correct answer:

Immediately refer to surgeon.

 

Strangulated hernias are a surgical emergency. They carry a risk of vascular compromise. Pain and discoloration may be present.

 

Question 3 

You wish to prescribe a low-potency topical corticosteroid for your patient. Which of the following would NOT be one of these? 

  hydrocortisone 0.5% 

   Aristocort 

   Topicort 

  Westcort 

Correct answer:

Topicort

 

Topicort is a high potency topical corticosteroid along with Synalar-HP and Lidex. All of the others are low-potency

 

 Question 4 

You are providing care to a female patient who reports having 1 to 2 migraines per month. She asks if there are any dietary changes she can make to help prevent her migraines. Which of the following is an appropriate response to this patient. 

  The patient should eat a vegan diet. 

   The patient should eat a well-balanced diet and note if any foods trigger her headaches. 

  The patient should eat a very low-fat diet. 

  The patient should avoid all dairy. 

Correct Answer: The patient should eat a well-balanced diet and note if any foods trigger her headaches There is no "migraine diet." However, many patients have success in preventing or alleviating their migraines by eating a well balanced diet and exercising regularly. Because some foods may trigger migraines, the patient should also note if she experiences migraines after eating specific foods, and then avoid those foods or limit her consumption. 

 

Question 5 

Which of the following is NOT a criterion for determining the reliability of a research instrument? 

  test-retest 

   inter-rater 

   discriminant validity 

  internal consistency 

 

Correct answer:

discriminant validity

 

Discriminant validity is a criterion for determining the validity of a research instrument. Test-retest, inter-rater and internal consistency are criteria for determining the reliability of a research instrument.

 Question 6 

Which of the following medications is the “gold standard” for treating acute sinusitis in any age group? 

  cefuroxime 

   amoxicillin 

  trimethoprim sulfamethoxazole 

  antihistamines 

 

Correct answer:

amoxicillin

 

Amoxicillin is the “gold standard” for treating acute sinusitis in any age group. In infants and children there should be close follow-up and if the child is not responding to amoxicillin, then he should be switched to a second line antibiotic.

 

Question 7 

When managing the respiratory patient, the nurse practitioner knows that all of the following antimicrobial strategies help facilitate the development of resistant pathogens EXCEPT: 

   prescribing a broader spectrum agent 

   higher antimicrobial dosage 

  lower antimicrobial dosage 

  longer course of therapy 

The Correct answer is:

Higher antimicrobial dosage

Factors that facilitate the development of resistant microbes include repeated exposure to a given agent, underdosing, and unnecessarily prolonged period of treatment. Shorter course high-dose therapy maximizes and exploits concentration-dependent killing by achieving higher maximum concentration and area under the curve/minimal inhibitory concentration values. 

 

Question 8 

You are seeing a patient for a follow-up prenatal visit and she has an abnormal "quad screen". The nurse practitioner understands that the "quad screen" is used to help detect increased risk for which of the following conditions? 

   beta-thalassemia major and fetal alcohol syndrome 

  Tay-Sachs disease and sickle cell anemia 

  Down syndrome and cystic fibrosis 

   trisomy 21 and open neural tube defects 

 

The Correct answer is:

Trisomy 21 and open neural tube defects

The "quad screen" is a quadruple screening for alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), inhibin-A, and unconjugated estriol levels. These four items increase the risk of the development of trisomy 21 (Down syndrome), trisomy 19 (Edwards syndrome), and open neural tube defects (NTDs). 

 

Question 9 

All of the following are true statements regarding the prescriptive authority of nurse practitioners EXCEPT: 

   Nurse Practitioners have the same prescriptive authority in each state. 

   There is significant variability in prescriptive authority from state to state. 

  The majority of Nurse Practitioners possess their own Drug Enforcement Administration (DEA) number. 

  Family Nurse Practitioners need protocols in place in order to have prescriptive authority. 

The Correct answer is:

Nurse Practitioners have the same prescriptive authority in each state

Nurse Practitioners' prescriptive authority is recognized within the scope of practice in all 50 states, but the rules and regulations vary significantly. The majority of nurse practitioners possess their own Drug Enforcement Administration (DEA) number. Further, nurse practitioners need protocols in place in order to have prescriptive authority in all states. 

Question 10 

Dentition is usually complete in a child by what age? 

  12 – 18 months 

  18 – 24 months 

   24 – 36 months 

  36 – 48 months 

Correct answer:

24 – 36 months

 

Dentition is complete at 24 – 36 months. There are 20 deciduous teeth. By 3 – 5 years of age a child can be responsible for brushing his or her teeth.

 

Question 11 

Which of the following is NOT a live attenuated virus vaccine? 

  MMR 

  Varicella Zoster 

   injectable tri-valent influenza vaccine 

  FluMist 

 

Correct answer:

injectable tri-valent influenza vaccine

 

The injectable trivalent influenza vaccine (TIV) does not contain live virus and is not shed. There is no risk of transmitting an infectious agent to household contacts. The other choices are vaccines with live attenuated viruses.

 

 Question 12 

When examining the nerves of the face, what should you observe? 

   Firmness of skin. 

  Wrinkle patterns. 

   Signs of drooping. 

  Pupil dilation. 

 

Correct answer: Signs of drooping A slight droop in the face, on either side, could indicate a problem with the facial nerves. Asymmetry, weakness, or lag must be noted. 

 

Question 13 

Which of the following is NOT true regarding Medicare Part A benefits? 

  If the patient paid Medicare federal taxes, this is automatic at age 65. 

   This pays for all outpatient testing and procedures. 

  This pays for inpatient hospitalizations. 

  This pays for skilled nursing facilities. 

The Correct answer is:

This pays for all outpatient testing and procedures

Medicare Part A does not pay for outpatient testing and procedures. Instead, Medicare Part B pays for outpatient testing and procedures. The remaining answer choices are associated with Medicare Part A benefits. 

 

Question 14 

Which of the following ranges of RBCs (in 1 mL of plasma) would be normal for a male?

 

  30% to 40% 

  25% to 40% 

  35% to 50% 

   37% to 49% 

Correct answer:

37% to 49%

 

The proportion of RBCs in 1 mL of plasma is 37% to 49% for males. It is 36% to 46% for females.

 

 Question 15 

You are conducting a prenatal visit with a 35-year-old Native American patient. She is currently 24 weeks pregnant. This is her first pregnancy. Her mother has Type 2 diabetes, and the patient herself has had elevated blood glucose in the past. This patient should be evaluated for which of the following? 

   Gestational diabetes. 

  Type 1 diabetes. 

  Type 2 diabetes. 

  Placental abruption. 

Correct Answer: Gestational diabetes This patient has several risk factors for gestational diabetes: family history, past history of elevated glucose, non-white race, and age over 25. Because gestational diabetes is often asymptomatic, patients with elevated risk should be evaluated for the condition. It typically does not develop until after the 20th week of pregnancy, so this patient is at a stage in her pregnancy where gestational diabetes is a risk

 Question 16 

An 76-year-old Asian female who is active has osteoarthritis in her left hip. She complains of daily pain that comes and goes. According to the American College of Rheumatology, what medication is considered first line treatment? 

   acetaminophen 

  ibuprofen 

  propoxyphene 

   naproxen 

The Correct answer is:

Acetaminophen

Osteoarthritis is a chronic musculoskeletal condition and the drug of choice is acetaminophen, up to 1000 mg four times daily. Hepatotoxicity is a risk and liver functions must be monitored. Since ibuprofen and naproxen have greater side effects, they are not recommended. Further, an avulsion fracture would need to be ruled out so this patient needs an x-ray performed. 

 

Question 17 

Which of the following statements about bronchiolitis is least accurate? 

  The majority of cases are caused by the respiratory syncytial virus. 

   The peak incidence in children is between 3 and 6 years of age. 

  Small airways become obstructed. 

   Risk factors include low socioeconomic status. 

Correct answer:

The peak incidence in children is between 3 and 6 years of age.

 

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

 

 Question 18 

It is important that the nurse remembers patients' specific care. What is the standard procedure? 

  Inform patient, let them remember. 

   Keep detail on private sticky notes at nurses' station. 

   Document everything in patients' files. 

  Not necessary to note patients' care. 

Correct answer: Document everything in patients' file It is a requirement that every practitioner carefully note patients' files. Malpractice is the result of improperly documented files

 

Question 19 

With teaching a migraine patient the potential lifestyle triggers that influences the onset of severity of migraine symptoms, the nurse practitioner knows that all of the following are triggers EXCEPT: 

  fasting or missing meals 

  odors and fragrances 

  weather or seasonal changes in the weather 

   driving fast 

 

The Correct answer is:

Driving fast

Driving fast is not one of the potential lifestyle triggers for a migraine headache. Menses, ovulation, pregnancy, illness, sleeping too much, strenuous activity, exercise, bright lights, excessive or repetitive noise, high altitudes, stress and certain medications are all listed as triggers to the onset or severity of migraine symptoms. Additional triggers to the onset or severity of migraine symptoms include the remaining answer choices weather or seasonal changes in the weather, fasting or missing meals and odors and fragrances.

Question 20 

In treating an older man with benign prostatic hypertrophy (BPH), which of the following will mostly likely to contribute to acute urinary retention? 

  lorazepam 

   amitriptyline 

   enalapril 

  lamotrigine

 

The Correct answer is:

Amitriptyline

Benign prostatic hypertrophy (BPH) is a condition where the prostate gland enlarges. This condition causes the patient to have difficulty urinating. Further, tricyclic antidepressant drugs, such as amitriptyline, Elavil, Pamelor, Sinequan and Tofranil, can further cause urine flow blockage in patients with BPH. These tricyclic antidepressant drugs have anticholinergic effects, which attributes to acute urinary retention. Other medications that may contribute to acute BPH are antihistamines and antispasmodics. Further, urinary retention is a least likely side effect of lorazepam. Then, lamotrigine (Lamictal) is an anticonvulsant drugs used to treat conditions such as diabetic nerve pain.

 

Question 21 

Which of the following is incorrect in regard to the length of pharmacological intervention in depression? 

  Therapy should be a minimum of 9 – 12 months. 

   The acute phase of treatment to bring symptoms under control and into remission lasts up to 3 months. 

   Relapse is highest after the second month of treatment. 

  Medication should be continued for a minimum of 6 months after depression remission is achieved. 

 

Correct answer:

Relapse is highest after the second month of treatment.

 

This is incorrect. Relapse is highest in the first 2 months after discontinuation of treatment. Maintenance therapy should be considered as with any chronic illness.

 

Question 22 

Which of the following statements about Managed Care Organizations (MCOs) is false? 

  MCO is an umbrella term that may include HMOs and other forms of health plans. 

  MCOs reimburse primary care providers on a fee-for-service basis, a capitated basis or a combination of both. 

   MCOs do not credential providers; that is done by the federal government. 

  MCOs sell a priced package of health services to their clients. 

Correct answer:

MCOs do not credential providers; that is done by the federal government.

 

This is the false statement. MCOs do credential providers. They collect educational, license, malpractice, employment and certification data on each provider and make a judgment that a provider is or is not adequately prepared to care for the MCO’s patients.

 

 Question 23 

The FNP is examining a 6-week old infant during a well-baby checkup. The FNP knows that at this age the infant will do which of the following? 

  have a fear of strangers 

   smile in response to persons 

  begin to have separation anxiety 

  none of the above 

Correct answer:

smile in response to persons

 

The social smile in response to persons begins at about 6 weeks. Fear of strangers begins at around 6 months and peaks about 12 months. Separation anxiety begins between 8 and 9 months and peaks around 14 months.

 Question 24 

When counseling a mother of a 14-year-old male adolescent with an enlarged nipple and breast area, it is true that: 

  Excessive growth of muscle tissue causes this condition. 

   This condition is called gynecomastia and most cases resolve spontaneously. 

  This condition is rare and only occurs in 10% of pubertal boys. 

  The male breast region frequently enlarges and this is not indicative of a serious condition. 

 

The Correct answer is:

This condition is called gynecomastia and most cases resolve spontaneously

Excessive growth of the breast tissue causes gynecomastia. Gynecomastia occurs in up to 40% of pubertal boys, and is not a serious condition. Most cases resolve spontaneously

 

Question 25 

 You understand that all of the following factors increase a person’s susceptibility to rheumatoid arthritis (RA) EXCEPT:

 

  positive family history 

  heredity 

  female gender 

   intact immune system 

Correct answer:

intact immune system

 

The factors increasing susceptibility to RA include heredity, positive family history, and being of the female gender. Protective factors include an intact immune system and male gender.

 

Question 26 

The developmental theory that identifies critical geriatric age-related stresses was promoted by which of the following? 

  Piaget 

   Bowen 

   Sadavoy 

  Erickson 

 

Correct answer:

Sadavoy

 

Sadavoy’s theory identified critical geriatric age-related stresses. These include: interpersonal loss, physical disability, loss of youthful appearance and beauty, change in social role, forced reliance on caregivers, change in living arrangements and confrontation with death.

Question 27 

A geriatric patient with cardiovascular disease is in the office being counseled on lifestyle changes. The nurse practitioner knows that which of the following is the most important to include in this discussion?

 

   "Control your hypertension, stop smoking, maintain a normal weight, and exercise regularly." 

  "Have a yearly physical examination, increase fiber in your diet, and exercise regularly." 

   "Maintain a normal level of serum blood sugar and decrease cholesterol intake." 

  "Decrease smoking, increase vitamin supplements, and increase protein intake." 

 

Correct answer:

"Control your hypertension, stop smoking, maintain a normal weight, and exercise regularly"

Controlling hypertension, cessation of smoking, maintaining a normal weight, and exercising regularly are important for the geriatric patient to decrease cardiovascular risk. The patient might be advised to work on one of these lifestyle changes at a time. Controlling hyperglycemia, high fiber intake, and vitamins all assist in maintaining a healthy lifestyle but do not help to prevent cardiovascular disease. 

 

Question 28 

 The AANP has written standards for the process of care. As part of the development of a treatment plan, which of the following would NOT be included?

 

   ordering additional diagnostic tests 

  prescribing and ordering appropriate pharmacologic and nonpharmacologic interventions 

  appropriate consultation or referral 

    making intervention based on scientific principles, theoretical knowledge and clinical expertise

 

Correct answer:

making intervention based on scientific principles, theoretical knowledge and clinical expertise

 

Making intervention based on scientific principles, theoretical knowledge and clinical expertise would be a part of the implementation of the treatment plan, not its development. All of the other choices are part of the development of a treatment plan along with developing a patient education plan.

 

Question 29 

When treating a diabetic patient with sulfonylureas, the nurse practitioner educates the patient on the most common side effect of: 

  diarrhea 

   hypoglycemia 

  angina 

  upset stomach 

The Correct answer is:

Hypoglycemia

Oral antihyperglycemic medication decreases the elevated glucose levels in patients with type 2 diabetes. The types of oral antihyperglycemic drugs are meglitinide, biguanides, thiazolidinediones and sulfonylureas, such as glyburide. Sulfonylurea drugs trigger the pancreas to make additional insulin. The side effects of sulfonylurea may include hypoglycemia or low blood sugar. The nurse practitioner can tell the patient that signs of hypoglycemia can include sweating, shaking, a rapid heart beat or confusion, to name a few.

 Question 30 

Which of the following sexually transmitted male genitourinary infections is most likely to be treated with patient-applied podofilox 0.5% solution or imiquimod 5% cream? 

  balanitis 

  gonococcal urethritis 

   genital warts 

  lymphogranuloma venereum 

Correct answer:

genital warts

 

Genital warts are verruca-form lesions caused by the human papillomavirus. Treatment options include patient-applied podofilox 0.5% solution or imiquimod 5% cream. They can also be treated with liquid nitrogen or cryoprobe, trichloroacetic acid, podophyllin resin or surgical removal.

 

Question 31 

For the patient with gastroesophageal reflux disease (GERD), the stepwise approach to management includes life style changes and medications. Which of the following is a proton pump inhibitor often prescribed for the treatment of GERD?

 

   omeprazole (Prilosec) 20 mg qd 

  ranitidine (Zantac) 150 mg bid 

  Antacids prn 

  cimetidine (Tagamet) 800 mg hs 

The Correct answer is:

Omeprazole (Prilosec) 20 mg qd

Proton pump inhibitor drugs are most often prescribed to the patient for the treatment of gastrointestinal reflux disease. The proton pump inhibitors decreases the amount of acid that is produced, thus significantly reducing the symptoms that the excessive production of acids causes.  Examples of proton pump inhibitors are omeprazole (Prilosec), lansoprazole (Prevacid) and omeprazole/sodium bicarbonate (Zegerid). Additional treatment options can include antacids, which help with the pain produced by the esophageal ulcers, as antacids decreases the amount of acid that gets to the esophagus. Then, the H2 blockers, for example ranitidine (Zantac) and cimetidine (Tagamet), are used for treating gastrointestinal reflux disease.

 

Question 32 

What does the social assessment of an elderly patient need to include that an adult assessment does not? 

  Age. 

   Security. 

  Education. 

  Records. 

 

Correct answer: Security Security is important in the assessment of elderly patients. People become more vulnerable as they age. Precautions should be taken to make sure that the patients are safe. 

 

Question 33 

An example of a primary prevention measure for an 85-year-old woman who has had hip replacement surgery would be: 

  physical rehabilitation sessions 

  x-rays to check healing progress 

   removing throw rugs in home 

  none of the above 

Correct answer:

removing throw rugs in home

 

Removing throw rugs throughout the woman’s home would be a primary prevention measure. This would help to avoid falling due to tripping on the rugs. Primary prevention measures are activities that prevent individuals from acquiring a clinical condition that would entail suffering, burden and cost.

 

Question 34 

Persons with anxiety use ego defense mechanisms to cope as the level of anxiety increases. If your patient has just had an argument with her husband and then gets angry at you for no good reason, this is known as which of the following defense mechanisms? 

  compensation 

  rationalization 

   displacement 

  dissociation 

 

Correct answer:

displacement

 

Displacement is transferring a feeling from the original person or experience to a more neutral one. The use of defense mechanisms and coping behaviors learned early in life relieve the discomfort of anxiety and provide a sense of protection.

 

Question 35 

You have a female patient who is suffering from hypothyroidism. Which of the following characteristics would be associated with this condition? 

   lethargy 

  heat intolerance 

   amenorrhea 

  tachycardia 

 

Correct answer:

lethargy

 

Of the choices given, lethargy is most associated with hypothyroidism. The other choices are associated with hyperthyroidism.

 

 Question 36 

The ASSURE model for client education includes all of the following EXCEPT: 

   analyze the learner 

   supervise the client 

  state the objectives 

  use teaching materials 

 Correct answer:

supervise the client

 

This is not part of the ASSURE model for client education. The other three choices are. Also part of this model is selecting instructional methods, requiring learner performance, and evaluating and revising.

Question 37 

You are treating an elderly lady with chronic constipation. What is the first action for patient management? 

   Add dietary fiber and increase fluids. 

  Use an oil retention enema. 

   Stop all constipating medications when possible. 

  Add sorbitol solution daily. 

 

The Correct answer is:

Stop all constipating medications when possible

The first action the nurse practitioner should take to manage the patient's constipation is to stop all medications that are known to cause constipation. Then, the nurse practitioner should re-assess the patient's symptoms at a later date. If symptoms should persist, 5 to 25 grams of dietary fiber should be added along with increasing fluid intake. Physical activity should be increased as tolerated. 

 

 Question 38 

If a mother asks the FNP when her toddler should be toilet trained, which of the following would be the best response? 

  Most children should be toilet trained at about two year of age. 

  Do not start toilet training until the child is over three years of age. 

   When the child has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he is ready. 

  none of the above 

Correct answer:

When the child has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he is ready.

 

A child is ready for toilet training on his own readiness scale. When he has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he will be ready. To do it any sooner will be frustrating to the child and parent.

 

Question 39 

The condition pictured above is which of the following 

  vitiligo 

   xanthelasma 

   seborrheic keratoses 

  melasma 

Correct answer:

xanthelasma

 

Xanthelasma are raised and yellow soft plaques that are located under the brow on the upper and/or lower lids of the eyes, usually on the nasal side. They may be a sign of hyperlipidemia if the person is younger than 40 years of age.

 

Question 40 

You are treating a 32-year-old female who is in the office with varicose veins. As part of her management, the nurse practitioner understands that which of the following does not directly contribute to the development of varicose veins? 

  pregnancy 

  heredity 

   leg crossing 

   Raynaud's disease 

The Correct answer is:

Raynaud's disease

Varicose veins are seen in 15% of the adult population and are most often found in the lower extremities. Raynaud's disease is not connected to varicosities. However, pregnancy, heredity and leg crossing are associated with this condition.

Question 41 

Part of the well-child examination is a lead risk assessment. A positive response to any risk questions indicates risk of lead exposure. A positive response to which of the following questions would be an indicator of a risk for lead poisoning? 

  Does your child live in or regularly visit a house that was built before 2005? 

   Does your child live in a home built before 1978 that is undergoing renovations? 

   Does your child have a playmate that has had lead poisoning? 

  All of the above 

Correct answer:

"Does your child live in a home built before 1978 that is undergoing renovations?"

A positive answer to this questions would be a risk indicator for lead exposure. If the home was built before 1978 and is undergoing renovations, then the child may be at risk for lead exposure. 

 

 Question 42 

 The intentional failure to perform a professional duty in reckless disregard of the consequences is which of the following?

 

   gross negligence 

   malpractice 

  negligence 

  none of the above 

Correct answer:

gross negligence

 

Gross negligence is the intentional failure to perform a professional duty in reckless disregard of the consequences. Negligence is defined as failure to exercise reasonable care. Malpractice is the failure of a professional to exercise that degree of skill and learning commonly applied by the average prudent, reputable member of the profession. Negligence and gross negligence are the predominant legal theories of malpractice liability.

 

 Question 43 

A mother is concerned that her 5 day old daughter has lost vaginal blood. What is the likely cause? 

  Abnormal hormones. 

   Injury. 

   Normal hormone fluctuation. 

  Infection. 

Correct answer: Normal hormone fluctuation The mother's hormones affects children. High hormones can result in bleeding that is normal the first week. A full assessment and exam is still necessary. 

 Question 44 

A patient with diabetes mellitus and a family history of heart disease is in your office. The nurse practitioner knows that the cardiovascular effects of hyperinsulinemia include: 

  a constricted circulating blood volume 

   less responsiveness to angiotensin II 

   greater responsiveness to angiotensin II 

  a decreased sympathetic activation 

The Correct answer is:

Greater responsiveness to angiotensin II

A major goal in the treatment of metabolic syndrome is to work with the patient to minimize the core defect of insulin resistance and decrease cardiac risk. There is a greater responsiveness to angiotensin II. Therefore, ACE inhibitors are warranted, such as lisinopril. 

 

Question 45 

You have a young adult female patient who complains of vaginal discharge, pelvic pain, and painful intercourse. She tells you that she has a new boyfriend and that because she takes the pill, they do not use condoms. You suspect that which of the following is most likely the cause of her symptoms?

 

  Chlamydia trachomatis 

   Neisseria gonorrhea 

  syphilis 

  Reiter’s syndrome 

Correct answer:

Neisseria gonorrhea

 

Neisseria gonorrhea (GC) is a gram-negative bacterium that infects the urinary and genital tracts, rectum, and pharynx. Unlike chlamydia, GC can become systemic or disseminated if left untreated.

 

Question 46 

Which of the following is considered the gold standard test for diagnosing fibromyalgia?

 

  blood work 

  MRI 

   CAT scan 

   There is no particular test that is diagnostic for fibromyalgia.

Correct answer:

There is no particular test that is diagnostic for fibromyalgia.

 

Diagnosis of fibromyalgia is made after careful consideration of the patient’s health history and physical examination. There is no particular test that is diagnostic for fibromyalgia

 

Question 47 

A middle-aged female presents with abnormal uterine bleeding. A hormonal profile reveals increased FSH and LH levels. What is the most likely cause for these findings? 

   onset of climacteric 

   premature ovarian failure 

  anterior pituitary disorder 

  hypothalamic disorder 

The Correct answer is:

Onset of climacteric

The amount of circulating estrogen begins to fall and the ovaries decline to function. The middle-aged woman may begin to experience symptoms typically associated with menopause. The body's feedback system will attempt to stimulate the ovaries and increase estrogen level. FSH and LH levels rise in response to these efforts. 

 

Question 48 

According to the Tanner staging, when a male’s penis enlarges in breadth and development of glans he is in which Tanner stage? 

  stage 2 

  stage 3 

   stage 4 

  stage 5 

Correct answer:

stage 4

 

According to the stages of genital maturity in males, this male would be in Tanner stage 4. It takes approximately 4 years to move from stage 2 to stage 5. Due to natural variation, individuals pass through the Tanner stages at different rates, depending in particular on the timing of puberty.

 

 Question 49 

You are treating a patient with acute anxiety who is having an acute attack in the office. The nurse practitioner has knowledge that the fastest relief of symptoms is: 

  a TCA 

  a beta-blocker 

   a benzodiazepine 

  an SSRI 

The Correct answer is:

Benzodiazepine

The fastest relief of anxiety symptoms will occur with a benzodiazepine. The remaining answer choices, the selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and beta blockers are agents often prescribed for the treatment of anxiety. However, medications, including the SSRIs and TCAs do not provide immediate relief. It may take them up to 2-3 weeks before an individual experiences the anxiety management properties of an SSRI or a TCA.  

Question 50 

Legal authority for a nurse practitioner to practice is granted through which of the following? 

  federal government 

  American Medical Association 

  Department of Health 

   Nurse Practice Act 

 

Correct answer:

Nurse Practice Act

 

The legal authority for NP practice is granted through the Nurse Practice Act. Each state has its own version. The right to practice is not derived from the federal government, the AMA, or the Department of Health.

 

 Question 51 

Which of the following is NOT a muscle of the temporomandibular joint? 

  masseter 

  temporalis 

   caninus 

  medial pterygoid 

Correct answer:

caninus

 

The caninus is a muscle whose fibers are inserted into the angle of the mouth. The temporomandibular muscles include the other three choices and the lateral pterygoid.

 

 Question 52 

You are assessing a child for developmental dysplasia of the hip. In doing so you position the child supine with knees fully adducted and held together. This is known as which of the following? 

  Ortolani’s sign 

   Galeazzi sign 

   Barlow’s test 

  none of the above 

 

Correct answer:

Galeazzi sign

 

The Galeazzi sign is used for children when developmental dysplasia of the hip is suspected. If one femur is shorter than the other, the result is positive.

 

Question 53 

A 21-year-old obese female is seen by the FNP. She complains of excessive facial and body hair, acne, and infrequent periods. The FNP suspects polycystic ovary syndrome (PCOS). If this is correct which of the following would NOT be expected to be seen in this patient? 

  enlarged ovaries with multiple follicular cysts 

  elevated serum testosterone 

   elevated FSH level 

  elevated androstenedione 

Correct answer:

elevated FSH level

 

If this patient does indeed have PCOS, the FSH level would be normal or low. Complications of this syndrome are heart disease, Type 2 diabetes and breast and endometrial cancer

 

Question 54 

When assessing an elderly man who cannot stick his tongue out of his mouth, the nurse practitioner suspects problems with what cranial nerve? 

  Cranial Nerve III 

  Cranial Nerve VII 

   Cranial Nerve X 

   Cranial Nerve XII 

The Correct answer is:

Cranial Nerve XII

The twelfth cranial nerve (cranial nerve XII) enables a patient to protrude out his tongue and to move it from side to side in the mouth. A patient's third cranial nerve (cranial nerve III) is responsible for eye movement. Further, the seventh cranial nerve (cranial nerve VII) allows the patient to close the eyes tightly, wrinkle the forehead, and smile. Then, the patient's tenth cranial nerve (cranial nerve X) is responsible for functions such as speaking

 

 Question 55 

The FNP has a three-year-old African-American female patient with a smooth abdominal tumor that does not cross the midline. The child has complained of abdominal pain and his parents tell the FNP that her appetite has been poor. Examination reveals hematuria and hypertension. Which of the following is the most likely diagnosis? 

  recurrent urinary tract infection 

  acute pyelonephritis 

   acute renal failure 

   nephroblastoma 

Correct answer:

nephroblastoma

 

The most likely diagnosis for this child is nephroblastoma, which is also known as Wilm’s tumor. There is a higher incidence in Black female children.

 

Question 56 

 The type of managed care system that allows for the greatest flexibility in the choice of a provider and allows the client to use certain providers at a lower cost or to use other providers at a higher cost is which of the following?

 

  HMO 

   POS 

   PPO 

  fee-for-service 

 Correct answer:

POS

 

POS stands for point of service. In this type of plan referrals are made by a primary care provider. The client is allowed to use certain providers at a lower cost or to use other providers at a higher cost

Question 57 

Which of the following statements about non-genital warts is least accurate?

 

  Human papillomavirus types 1, 2, and 4 cause most of them. 

   The virus cannot be passed by direct person-to-person contact. 

   Over a 12 – 24 month period, nearly all lesions resolve without therapy.

 

  Surgical excision is rarely indicated. 

--

The virus cannot be passed by direct person-to-person contact.

 

This is the least accurate statement. The virus is passed by direct person-to-person contact. Intervention is warranted if warts interfere with function, or if the lesions are cosmetically problematic.

 Question 58 

An option to the injectable influenza vaccination is the nasal spray vaccine. It is important that the nurse practitioner understands to advise a patient: 

  Its use is limited to children younger than 6 years. 

   This is the preferred method of immunization for persons who are allergic to eggs or egg products. 

   It contains a live, attenuated virus. 

  It is acceptable to use during pregnancy. 

The Correct answer is:

It contains live, attenuated virus

The nasal influenza virus contains influenza viruses that are sufficiently weakened as to be incapable of causing disease. However, the virus is strong enough to stimulate a protective immune response. The influenza virus vaccine is indicated for individuals aged 2 to 49 years, if the individual is healthy. The vaccine is contradicted in persons with egg allergy and pregnant women. 

 

Question 59 

All but which of the following are potential treatments for a patient with venereal warts? 

  Cryosurgery. 

  Watchful waiting. 

   IV antibiotics. 

  Laser surgery. 

 

Correct Answer: IV antibiotics Antibiotics are not effective against venereal warts, which are virally caused. Patients may be advised to use "watchful waiting," a period where no other treatment is used, in case warts go away on their own. Cryosurgery and laser surgery are also used to remove venereal warts in some patients

 

Question 60 

An adult patient presents with the acute onset of diffused pink-to-red skin on the site of a skin trauma. He tells you that the area has enlarged over the last few days. The skin is indurated, swollen and tender. Which of the following is the most likely diagnosis? 

  candidiasis 

  contact dermatitis 

   actinic keratoses 

   acute cellulitis 

 

 Correct answer:

acute cellulitis

 

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

 

 Question 61 

A college student is dehydrated with irregular heartbeat and vomiting. The family interview reveals that she frequently uses energy drinks to stay awake while studying. What question should the patient be asked? 

  Are the symptoms new? 

  When was your last medical exam? 

   How many energy drinks have you had recently? 

  How long have you been using energy drinks? 

Correct answer: How many energy drinks have you had recently? The patient relies on caffeine. This could be a caffeine overdose. It is important to discover how much caffeine she had.

 

Question 62 

Which of the following is NOT a question the NP should be able to answer regarding reimbursement? 

  What specific CPT code is used for the specific services provided? 

  What documentation in the patient's record is required for the service that is billed? 

   What is the correct way to ensure reports concerning reimbursement of the NP are accurate? 

  What resources do I need so that my services are accurately and legally billed? 

The Correct answer is:

What is the correct way to ensure reports concerning reimbursement of the NP are accurate?

Although reimbursement reports on each nurse practitioner (NP) are helpful to administrative personnel, it is not in the NPs scope of practice. There are several documents a medical office may receive from an insurance provider explaining how much was paid for a claim the medical office submitted to the insurance plan for the services rendered in treating a patient. One example of a document is the remittance advice.

Normally, a medical office and hospital employ billing specialists, medical coders and financial accountants to handle billing, reimbursement and the financial aspect of the organization. The billing specialist would file claims with the insurance company. The medical coders would assign the appropriate procedure and diagnosis codes for each patient’s visit. These codes are submitted on the medical claim that the billing specialist files with the insurance company for payment or reimbursement.

For example, the nurse practitioner performs an annual physical examination on a patient. The medical coder reviews the medical record documentation for the visit, assigns a diagnosis code to describe why the nurse practitioner performed the physical examination. Then, the medical coder assigns another code for the procedure, which is the physical examination. The codes, along with other required medical insurance information, are placed on a billing form. The billing specialist assigns a total charge on the claim of $200.00, which also includes lab tests completed in the medical office.

Then, the billing specialist electronically or manually sends the medical claim to the patient’s XYZ insurance company. The insurance company gets the claims, determines if the claim is submitted correctly, has accurate medical codes to describe the services the nurse practitioner performed (the physical examination), ensures the patient is a member of their health insurance plan, for instance. Once the insurance company goes through its processing procedure and determines the claim is appropriate to pay, the XYZ insurance company sends a remittance advice, if the claim was filed electronically, to the medical office. The remittance advice tells the medical office’s billing department what the insurance company is paying, the reasons for the amount paid or if they decided to not pay for the services provided. Then, the insurance company sends the medical office a check for $200.00.

 Question 63 

Which of the following is NOT a risk factor for osteoporosis? 

  alcohol abuse 

   active lifestyle 

   advancing age 

  history of bone fracture 

 

Correct answer:

active lifestyle

 

An inactive lifestyle, not an active lifestyle would be a risk factor for osteoporosis. All of the other choices are risk factors along with: female gender, family history, and low estrogen levels in women, among other things.

Question 64 

Medicare Part B will pay for necessary services and supplies related to a patient's healthcare. All of the following are included in this EXCEPT: 

  wheelchairs 

  walkers 

   oxygen 

   eyeglasses 

 

The Correct answer is:

Eyeglasses

Medicare Part B does not cover routine physical exams, eyeglasses, dental services, or custodial nursing homes. It does cover durable medical equipment, such as wheelchairs, oxygen and walkers.

 Question 65 

Which of the following statements about bites (human and animal) is false? 

  Human bites are the “dirtiest” bites of all. 

   Dog bites are more likely to be infected than cat bites. 

   Do not suture infected wounds or puncture wounds. 

  Treatment for the majority of bites is with amoxicillin/clavulanic (Augmentin). 

 

Correct answer:

Dog bites are more likely to be infected than cat bites.

 

This statement is false. The opposite is true. Cat bites are more likely to be infected than dog bites. For bites such as bat, raccoon or skunk bites rabies must be ruled out.

 

Question 66 

 Your patient reports that when she is in meetings at work she sometimes begins to feel as if she is going to die, with heart palpitations, shortness of breath, and profuse sweating. She feels as if she is going to faint or cause some sort of traumatic scene, until the feelings pass. She tells you that these feeling come on suddenly with no warning. You diagnose which of the following?

 

  myocardial infarction 

   posttraumatic stress disorder 

  depression 

   panic disorder 

Correct answer:

panic disorder

 

Panic disorder is characterized by sudden, intense, unpredictable anxiety attacks. It is manifested by severe debilitating physical and emotional symptoms associated with a sense of fear and impending doom.

 

 Question 67 

In terms of degenerative joint disease, where would the FNP find Heberden’s nodes? 

  on the first joint of the great toe 

  on the proximal interphalangeal joints 

   on the distal interphalangeal joints 

  on the meniscus of the knee 

 

Correct answer:

on the distal interphalangeal joints

 

Heberden’s nodes (bony nodules) would be found on the distal interphalangeal joints. Bouchard’s nodes would be found on the proximal interphalangeal joints. 

 

Question 68 

The FNP is educating an audience of parents on the prevention of disease. When she talks about immunizations she is talking about which of the following?

  tertiary prevention 

  secondary prevention 

   primary prevention 

  derivative prevention 

Correct answer:

primary prevention

 

Primary prevention includes measures to prevent disease or injury. Immunizations are therefore primary prevention, along with such things as using seatbelts, airbags and sports helmets; education for health; and exercise.

 

 Question 69 

The FNP has an African-American female patient who is 75 years old. She complains of a gradual loss of her peripheral vision. Examination indicates increased IOP. Which of the following is the most likely cause of her symptoms? 

  subconjunctival hemorrhage 

  primary closed-angle glaucoma 

   primary open-angle glaucoma 

  macular degeneration 

Correct answer:

primary open-angle glaucoma

 

Primary open-angle glaucoma has a gradual onset of increased IOP due to blockage of drainage of the aqueous humor. The optic nerve undergoes ischemic damage resulting in permanent visual loss. It is the most common type of glaucoma and is most commonly seen in elderly patients, especially those of African background or diabetics.

 

Question 70 

In terms of therapeutic communication, which of the following would NOT be a barrier to this type of communication? 

  interpreting 

   asking "why" 

  reassuring 

   reflecting 

 

Correct answer:

reflecting

 

Reflecting is a good method to use in therapeutic communication. It strengthens client confidence.

 

Question 71 

Which of the following is NOT a characteristic of primary care?

 

   referral care 

  longitudinal over time 

   coordination of patient care 

  comprehensive 

Correct answer:

referral care

 

Referral care is not a characteristic of primary care. First-contact care is one of the characteristics.

 

Question 72 

You are conducting an assessment with a patient who reports frequent diarrhea, bouts of severe abdominal pain, and occasional blood in her stool. Her bowel sounds are loud and tinkling. Which of the following is NOT a potential diagnosis for this patient? 

   Bowel obstruction. 

   Crohn's disease. 

  Colitis. 

  Celiac disease. 

 

Correct Answer: Bowel obstruction This patient's symptoms are not consistent with bowel obstruction. Her bowel sounds and diarrhea indicate hyperactivity in the bowel. This, along with the pain and blood in the stool, are consistent with Crohn's disease, celiac disease, or colitis. Further tests will be needed to determine which of these conditions, if any, are responsible for the patient's symptoms. 

 

Question 73 

You are discussing medication therapy in a 39-year-old man who has just been diagnosed with gastroesophageal reflux disease (GERD). Which medication on his medication list do you know exacerbates the symptoms of GERD? 

  metformin 

  ferrous sulfate 

   verapamil 

  viagra 

 

The Correct answer is:

Verapamil

The lower esophageal sphincter is opened and closed by muscles. Verapamil is a calcium channel blocker and calcium is needed for muscle contractions. Gastroesophageal reflux disease can be exacerbated in this case so verapamil should be avoided in this patient.

 

Question 74 

Which of the following statements is TRUE concerning managed care today? 

  Managed care is declining in favor in the healthcare system of the United States. 

  The proportion of managed care revenue declined over the last 10 years. 

   More consumers are switching from HMOs to plans where there is more choice, less control by a gate keeping provider, and no prior approval for referrals. 

   The monitoring of managed care plans by the American Nurses Association and the American Medical Association has contributed to their popularity. 

The Correct answer is:

More consumers are switching from HMOs to plans where there is more choice, less control by a gate keeping provider, and no prior approval for referrals

Managed care now dominates healthcare in the U.S. and over 50% of revenue received by all physicians is from managed care. Managed care plans are monitored by state and federal government, not the ANA and AMA. 

 

Question 75 

Which of the following statements about cervical adenitis is lease accurate? 

   Epstein-Barr virus is the most common cause. 

  The most common site is submandibular and anterior cervical. 

   It is rarely due to trauma. 

  It may be easily mistaken for a goiter or thyroid nodule. 

Correct answer:

Epstein-Barr virus is the most common cause.

 

This is the least accurate statement. Epstein-Barr virus is one of the less common causes of cervical adenitis which is enlargement of a cervical lymph node. The most common pathogens include: S. aureus, S. pyogenes (Group A Strep), and atypical mycobacteria.

 

Question 76 

Your 45-year-old male patient tells you that he has been waking up at night with an intense pain behind his left eye. He says that it lasts about an hour during which it is accompanied by lacrimation and nasal stuffiness. These symptoms are most consistent with which of the following types of headache? 

  tension headache 

  migraine without aura 

   migraine with aura 

   cluster headache 

 

Correct answer:

cluster headache

 

Cluster headaches are often located behind one eye with a steady, intense, severe pain in a crescendo pattern lasting 15 minutes to 3 hours. They most often occur with ipsilateral autonomic signs such as lacrimation, conjunctival injection, ptosis, and nasal stuffiness

 

Question 77 

You are talking to a 13-year-old female patient who is in the office for a sports physical. When communicating with this patient all of the following would be appropriate EXCEPT: 

  using open-ended questions 

  being matter-of-fact with the patient 

   asking sensitive questions using the third person 

   reminding the patient that because she is under 18 years of age, all information discussed must also be reported to the parent 

Correct answer:

reminding the patient that because she is under 18 years of age, all information discussed must also be reported to the parent

 

This is not correct. The information discussed will be confidential. However this patient should be reminded that if she is engaged in at-risk behaviors, the information may not be confidential

Question 78 

Licensing boards carry out the statutes of the state and write and administer rules and regulations for nursing practice, based on statute. Licensing boards enforce standards by all but which of the following? 

   following up on malpractice awards monitored through the National Practitioner Data Bank

 

  ensuring that qualifications are up to date 

   responding to complaints 

   testing NPs and auditing NP practice 

 

Correct answer:

testing NPs and auditing NP practice

 

Boards of nursing do not test NPs or do audits of NP practice. An NP who is sued for malpractice will not necessarily be investigated by the state board of nursing. If, however, a judge, attorney or plaintiff reports a nurse for suspected gross negligence, the board of nursing will investigate.

 

Question 79 

Osler nodes and Janeway lesions are associated with which of the following? 

  acute MI 

   bacterial endocarditis 

   acute abdominal aneurysm 

  congestive heart failure 

Correct answer:

bacterial endocarditis

 

Bacterial endocarditis involves fever, chills, and malaise associated with skin findings occurring mostly on the finger, hands, toes, and feet. These include Osler nodes (violet-colored painful nodes on the fingers or feet), and Janeway lesions (tender red spots on the palms of the hand or soles of the feet).

 

 Question 80 

A 27-year-old Caucasian female presents with nervousness, irritability, weight loss, and a TSH of 0.04. What is the likely diagnosis? 

  hypothyroidism 

  subclinical hypothyroidism 

   hyperthyroidism 

  clinical stimulating thyroxine 

Correct answer:

Hyperthyroidism

The symptoms presented are diagnostic for hyperthyroidism. For further evaluation, the patient's thyroid-stimulating hormone (TSH) level should be rechecked on a different day. Also, the patient's T4 levels should be measured

 

Question 81 

Your 50-year-old female patient tells you that she has a problem with urinary incontinence when she coughs or sneezes or even laughs. You understand that this type of urinary incontinence is classified as which of the following?

 

   stress incontinence 

  urge incontinence 

   overflow incontinence 

  functional incontinence 

Correct answer:

stress incontinence

 

Stress incontinence accounts for 80% of urinary incontinence in women younger than 60 years. It is associated with activities that result in increased intraabdominal pressure, such as coughing, sneezing, laughing, lifting, and exercising.

 

 Question 82 

The nurse practitioner must be skilled in understanding when referral is necessary. Which of the following patients would need to be referred to a gastroenterologist? 

  a patient with persistent GERD that doesn't respond to H2 blockers 

  a patient with bright red rectal bleeding 

   a patient with significant weight loss and history of frequent blood loss 

  a patient with mild nausea and dysuria 

The Correct answer is:

A patient with significant weight loss and history of frequent blood loss

These symptoms indicate referral since they are worrisome for cancer. Mild to moderate GERD that doesn't respond to H2 blockers is common, so a proton pump inhibitor could be implemented. Bright red rectal bleeding usually is related to hemorrhoids, which can be treated in primary care. Nausea and dysuria needs further evaluation and can be treated in primary care. 

 

 Question 83 

A patient being treated for dehydration may be given all but which of the following? 

  Gatorade. 

  Clear chicken broth. 

   Popsicles. 

   Ice cream. 

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

 Question 84 

Tufts of hair on a child overlying the spinal column which may be a sign of spina bifida occulta is which of the following? 

  nevus flammeus 

  milia 

   faun tail nevus 

  none of the above 

 

Correct answer:

faun tail nevus

 

Faun tail nevus occurs when there are tufts of hair overlying the spinal column usually at the lumbosacral area. The may be a sign of spina bifida occulta. An ultrasound of the lesion should be done to rule out spina bifida.

 

Question 85 

The physiologic occurrence represented by the rise of plasma glucose in the early morning hours is known as: 

  Somogyi effect 

  hypoglycemia 

   Dawn phenomenon 

   hyperglycemia 

Correct answer:

Dawn phenomenon

 

The Dawn phenomenon is a normal physiologic event in which the plasma glucose rises in the early morning. This is because of the reduction of tissue sensitivity to insulin between 5 a.m. and 8 a.m. from physiologic spike of growth hormone.

 

Question 86 

The FNP prescribes Imitrex to a patient with migraine headaches. The FNP knows that Imitrex is indicated for: 

  patients with a slowly developing headache with minimum GI distress 

  use as an preventive agent for migraine headaches 

   patients with a rapidly progressing migraine headache accompanied by significant GI upset 

  beginning migraineur tension-type headaches 

 

Correct answer:

patients with a rapidly progressing migraine headache accompanied by significant GI upset

 

Injectable products such as Imitrex have a rapid onset of action, usually within 15 to 30 minutes. These products are best suited for patients with rapidly progressing migraines accompanied by significant GI upset. Imitrex is available as a self-injector for patient administration. Imitrex only works to abort headaches that have already gone; it cannot be used to prevent headaches.

 

Question 87 

Although nurse practitioners and physician’s assistants may function similarly, there are differences between NPs and PAs. Which of the following statements about NPs in relation to PAs is incorrect? 

  A PA has a job description, while an NP has a scope of practice. 

  PAs practice medicine under the license of a physician, never independently. 

   NPs are always primary care providers. 

  NPs practice under their own licenses. 

Correct answer:

NPs are always primary care providers.

 

Some state’s laws specifically authorize nurse practitioners to be primary care providers (PCPs). Other states do not prohibit a nurse practitioner from being designated as a PCP. State law governs whether the NP can be a primary care provider. Physician’s assistants are never primary care providers.

 

Question 88 

Most drugs used in pregnancy are category B drugs. Which of the following drugs is NOT a category B drug? 

  amoxicillin 

  penicillin 

    ACE inhibitors

 

  erythromycins 

 

Correct answer:

ACE inhibitors

 

ACE inhibitors are category D drugs. Category D drugs show evidence of fetal risk and should only be used when the benefits outweigh the risk of using the drug.

 

 Question 89 

What is the purpose of the Americans with Disabilities Act (ADA)? 

  The purpose is to create a federal entitlement program for HIV positive individuals. 

  The purpose is to authorize interpreters for blind and deaf employees at all private business. 

   The purpose is to give disabled people opportunities for employment. 

  The purpose is to guarantee wheelchair access to customers and patrons of every residential and commercial building. 

The Correct answer is:

The purpose is to give disabled people opportunities for employment

The overall goal of ADA is to assist disabled people with gainful employment options. Access to wheelchair ramps and interpreters may be required as a "reasonable accommodation" to qualified people in certain defined circumstances. No across-the-board mandate exists for these types of aid to the disabled population.

 

Question 90 

Upon seeing a patient in the office that had a recent cervical whiplash injury, the nurse practitioner knows that which of the following is NOT true regarding this: 

   It is identifiable on MRI or CT, but not X-ray. 

  This occurs after a traumatic event. 

   Occipital pain and headache can occur. 

  It may be accompanied by severe pain and spasm. 

The Correct answer is:

It is identifiable on MRI or CT, but not x-ray 

Diagnostic tests, such as a MRI, CT scan or x-ray, do not show signs of a cervical whiplash injury. This type of injury commonly follows a car accident when a rear collision is involved. Loss of range of motion and delayed pain sensation are common. 

 

 Question 91 

Which of the following screening results is normal? 

   LDL = < 130 mg/dL - low risk patient 

  HDL = 35 mg/dL 

   total cholesterol = 225 mg/dL 

  triglycerides = 250 mg/dL 

Explanation: 

Correct answer:

LDL = < 130 mg/dL - low risk patient

 

This is the only result that would be considered in the normal range. Normal total cholesterol is < 199 mg/dL. Normal HDL is > 40 mg/dL. Normal triglycerides are < 150 mg/dL.

 

Question 92 

A patient is being treated for anorexia. What is an indication at the follow up that the treatment is being effective? 

  Weight loss. 

  Chest auscultation. 

   Weight gain. 

  Anemia. 

 

Correct answer: Weight gain Anorexia is typically accompanied by weight loss. Weight gain at the follow up appointment is an indication that the current treatment is effective. 

 Question 93 

The Advisory Committee on Immunization Practices (ACIP) recommends that health-care administrators consider vaccination of health-care personnel to be an important goal. Currently the immunization rate against influenza among health-care providers is: 

  90% 

  75% 

   50% 

   40% 

Correct answer:

40%

 

Currently, health-care providers have a 40% immunization rate against influenza. ACIP recommends implementation of a policy of obtaining signed statements from health-care personnel who decline influenza vaccination.

 Question 94 

The kidneys are located in the retroperitoneal area. The right kidney is lower than the left, the lower half falling below the rib cage. The reason for this is: 

  better functioning of the kidneys 

   displacement by the liver 

   displacement by the stomach 

  none of the above 

Correct answer:

displacement by the liver

 

The lower half of the right kidney falls below the rib cage because it is displaced by the liver. The kidneys are the body’s regulators of electrolytes, fluids and bicarbonate.

 Question 95 

 Your patient tells you that she had a mosquito bite on her lower leg that has now become bright red and raised. You understand that this is which of the following?

 

  acute cellulitis 

   erysipelas 

   candidiasis 

  psoriasis 

Correct answer:

erysipelas

 

Erysipelas is a subtype of cellulitis involving deeper tissue involvement caused by beta strep. The patient may complain of an insect bite that becomes infected. The plaque is usually located on the cheeks or lower legs.

 

Question 96 

Gentamicin Sulfate cream or ointment 0.1% for folliculitis is prescribed in which of the following dosages? 

  Apply tid before antibiotic ointment. 

  2%, apply bid X 10 days and cover with DSD. 

   Apply to area bid-tid. 

  0.5 to 1 mg/kg/day PO in divided doses. 

 

Correct answer: Apply to area bid-tid The preceding medications should be administered at the following dosages: Mupirocin ointment - 2%, apply bid X 10 days and cover with DSD. Gentamicin Sulfate cream or ointment - Apply to area bid-tid. Isoretinoin - 0.5 to 1 mg/kg/day PO in divided doses. Anhydrous ethyl alcohol with 6.25% aluminum chloride - Apply tid before antibiotic ointment. 

 

Question 97 

Which of the following is an indication for hospitalization for an adult with community-acquired pneumonia? 

  age older than 40 

  PO2 100 mmHg. Most patients with stage 2 hypertension will require a two drug combination.

 

Question 68 

You have a 38-year-old patient seen in the clinic for her 6 week post-partum examination by the nurse practitioner. She is breast-feeding without difficulty and plans to continue for a year. She wants to begin using a contraceptive and plans no further pregnancies. Which of the following is an inappropriate choice for this patient? 

   combination oral contraceptives 

  progestin-only oral contraceptives 

   intrauterine device 

  Depo-Provera 150 mg IM every 3 months 

The Correct answer is:

Combination oral contraceptives

Combination oral contraceptives, which include the hormones estrogen and progestin, are not recommended for breast-feeding mothers due to the potential effect on decreasing milk quantity and quality. Progestin-only oral contraceptives are approved for nursing mothers because no deleterious effects on milk quantity or quality have been shown. The intrauterine device (IUD) is also an acceptable contraceptive for breast-feeding mothers, as is Depo-Provera. 

 

Question 69 

Which of the following are you least likely to see in a menopausal or post-menopausal woman? 

  atrophic labia 

  atrophic vagina 

   dyspareunia 

   larger ovaries 

Correct answer:

larger ovaries

 

After several years of menopause, the ovaries are atrophied and a smaller size. Having a palpable ovary is considered abnormal and ovarian cancer should be ruled out.

 

 Question 70 

Which of the following tests would you order to confirm a diagnosis of Hepatitis B? 

  Albumin level. 

  Liver function. 

   Prothombin time. 

   Hepatitis B surface antigen. 

Correct Answer: Hepatitis B surface antigen This test can confirm a diagnosis of Hepatitis B. A positive result indicates an active infection. The other tests listed are used to monitor liver damage caused by Hepatitis B. 

 

Question 71 

Which of the following drugs for treatment of type 2 diabetes mellitus modulates gastric emptying and glucagon release postprandially? 

  Glipizide 

   Symlin 

  Starlix 

  Glucophage 

 

Correct answer:

Symlin

 

An amylin analogue such as Symlin modulates gastric emptying and glucagon release postprandially. An increased feeling of satiety often results in decreased caloric intake and weight loss. There is anticipated A1c reduction with intensified use.

 

Question 72 

Which of the following statements about ethical behavior is NOT true? 

  Moral concepts are the foundations of ethical behavior. 

  The ethical behavior of nurses has been defined for professional nursing in an American Nurses Association policy statement. 

   Nonmaleficence is not considered a foundational component of ethical behavior. 

  Ethical behavior incorporates respect for an individual’s autonomy. 

Correct answer:

Nonmaleficence is not considered a foundational component of ethical behavior.

 

This is not true. The duty to help others (beneficence), avoidance of harmful behavior (nonmaleficence), and fairness are all considered foundational components of ethical behavior. Moral concepts such as advocacy, accountability, loyalty, caring, compassion and human dignity are also foundations of ethical behavior.

 

Question 73 

Maslow’s hierarchy of needs includes five categories. The need for belonging, love and affection falls into which category of needs? 

  security 

   social 

   physiological 

  self-actualization 

 

Correct answer:

social

 

Social needs include needs for belonging, love and affection. Maslow considered these needs to be less basic than physiological and security needs. 

 

Question 74 

A teenager is brought in by her mother with abdominal pain in the lower right quadrant. The patient says that she is not sexually active. She also has a fever and abdominal swelling. What should you look for in the exam? 

  Grade II. 

  Tonometry. 

   Obturator sign. 

  Gag reflex. 

Correct answer: Obturator sign The patient's symptoms could indicate appendicitis or a blockage. The obturator sign is tested by asking the patient to bend the knees in such a way that will flex the obturator muscle. Pain may indicate appendicitis. 

 

Question 75 

An adult male patient with iron deficiency anemia presents in the office and gastrointestinal (GI) bleeding has been ruled out. The nurse practitioner determines that the next step is to: 

   Prescribe ferrous sulfate 300 mg PO tid and schedule the patient's return visit in 1 month for a repeat CBC, serum iron, and TIBC. 

  Administer iron dextran 50 mg IM weekly for 4 weeks. 

   Schedule the patient return in 6 months for additional stool guaiac testing. 

  Refer the patient to a hematologist. 

 

The Correct answer is:

Prescribe ferrous sulfate 300 mg PO tid and schedule the patient's return visit in 1 month for repeat CBC, serum iron, and TIBC

To replenish the depleted body iron stores, treatment with iron orally for at least six months is necessary to correct the anemia. The patient should have hemoglobin/hematocrit, iron, and Total Iron Binding Capacity (TIBC) rechecked after 1 month of therapy. The patient should be referred to a hematologist if treatment shows no improvement. Further, referring the patient to a gastrointestinal (GI) specialist or ordering a repeat stool guaiac is unnecessary because there is no indication that the condition is related to bleeding. 

 

Question 76 

When performing a physical exam, what is a normal adult response to a tap on the triceps tendon? 

  Extension of wrist. 

  Extension of leg at the knee. 

   Extension of elbow. 

  Flexion of leg at the knee. 

 

Correct answer: Extension of elbow Testing the triceps reflex is done by tapping the triceps. In a normal response, the elbow should extend. 

 

Question 77 

Which of the following is NOT considered a contraindication to DTP/DTaP vaccination? 

  anaphylaxis 

   family history of SIDS 

   fever equal or > 105° F within 48 hours of a dose 

  encephalopathy 

Correct answer:

family history of SIDS

 

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

 

Question 78 

A 17-year-old female patient is being managed with Depo-Provera for the purpose of birth control. The nurse practitioner understands that the recommended length of use is usually:

 

   no more than 2 years 

  as determined by her lipid response to the medication 

   as long as the patient desires this form of contraception 

  less than 1 year 

The Correct answer is:

No more than 2 years

Depo-Provera is a highly reliable form of contraception and a good choice for young women and adolescents who do not wish to become pregnant for at least 18 months after discontinuing usage. Due to the U.S. Food and Drug Administration warning, prolonged use of Depo-Provera can result in loss of bone density. Therefore, it is not recommended that individuals take Dep-Provera for more than 2 years.

 

 Question 79 

 Which of the following BMI measurements is consistent with a person of normal weight?

 

  17 

   19.5 

   25 

  30 

Correct answer:

19.5

 

A BMI of 19.5 is in the normal range. A BMI under 18.5 indicates the person is underweight; 25 to 29.9 indicates a person is overweight; 30 – 39.9 indicates a person is obese; and a grossly obese person has a BMI of over 40.0.

 

Question 80 

In a 78-year-old patient you would expect to find which of the following? 

  increased liver size 

   peak expiratory flow decreased 

   thinned intimal layer of arteries 

  more hydrochloric acid in the GI system 

Correct answer:

peak expiratory flow decreased

 

In this patient you would expect to see peak expiratory flow decreased and residual volume increased. Lungs are less elastic, but total lung capacity remains unchanged.

Question 81 

Tobacco use is a major health hazard. Which of the following statements in regard to identifying and treating tobacco dependence is incorrect? 

  Brief tobacco dependence treatment has been shown to be effective. 

   The combination of counseling and medication is more effective than when each is used alone. 

  Individual, group and telephone counseling increase in effectiveness with treatment intensity. 

   Generally the risk associated with medications to treat tobacco dependence is more than that associated with continued tobacco use. 

Correct answer:

Generally the risk associated with medications to treat tobacco dependence is more than that associated with continued tobacco use.

 

This statement is incorrect. Numerous effective medications are available for tobacco dependence and clinicians should encourage their use by all patients who are attempting to quit smoking. The use of these medications reliably increases long-term smoking abstinence rates. Generally, the risk associated with the use of these medications is less than that associated with continued tobacco use.

Question 82 

The nurture position theorist whose theory involves behaviorism and classical conditioning is which of the following? 

  Albert Bandura 

  John Locke 

   Abraham Maslow 

   John B. Watson 

Correct answer:

John B. Watson

 

John B. Watson promoted behaviorism. He believed in classical conditioning where a neutral stimulus associated with a meaningful one over time leads to a “conditioned” response that can be elicited by the neutral stimulus alone as though it were the meaningful one.

 

 Question 83 

When an FNP is interviewing a patient who does not speak English and she uses a translator, which of the following is most appropriate? 

  Ask questions to the translator and look at the patient when he responds. 

  Try to speak to the patient if the FNP knows a few words of the patient’s language. 

  Have the translator leave the room when conducting the physical part of the interview. 

   Ask questions to the patient by looking at him directly. 

Correct answer:

Ask questions to the patient by looking at him directly.

 

The FNP must develop a relationship with the patient, not with the translator. Looking directly at the patient to ask questions or talk to him is the most appropriate thing to do with this patient.

 

Question 84 

Which of the following is an oral medication appropriate to prescribe for a patient with a vaginal yeast infection? 

  Fem-Stat. 

  Gyne-Lotrimin. 

   Monistat. 

   Diflucan. 

 

Correct Answer: Diflucan Diflucan, or flucanazole, is an oral medication that is prescribed by the single dose for yeast infections. It may have side effects such as stomach upset, as it kills yeast throughout the body. 

 

Question 85 

In which of the following populations is the presentation of meningitis most likely to be insidious? 

  neonates 

  children 

   young infants 

   elderly 

 

 Correct answer:

elderly

 

In the elderly population the presentation of meningitis may be insidious. Signs include lethargy or obtundation; there may be no fever; and only variable signs of meningeal irritation.

 

Question 86 

Which of the following is NOT considered a communication channel? 

  auditory 

   subconscious 

   visual 

  kinesthetic 

 

Correct answer:

subconscious

 

The channel is the medium through which the sender transmits the message. The three main communication channels are auditory, visual, and kinesthetic (touch).

 

Question 87 

Which of the following communication techniques are you least likely to use with a patient who is unconscious?

 

  Talk to the patient in a normal tone of voice. 

  Engage in normal conversational topics as with any other patient. 

   Increase auditory stimuli. 

  Use touch to communicate presence. 

Correct answer:

Increase auditory stimuli.

 

You are not likely to increase environmental stimuli (especially auditory). You should assume that the patient can hear you. You should also speak to the patient before touching.

 

Question 88 

The research design that examines data related to past events to shed light on current behavior is which of the following? 

  grounded theory 

   historical 

   phenomenologic 

  nonrandom sample 

 Correct answer:

historical

 

Historical research systematically examines data related to past events to shed light on current behavior. It is one of the common qualitative research designs.

 

Question 89 

To eliminate or support the diagnosis of meningitis, lumbar puncture with CSF evaluation should be part of the evaluation of a febrile adult or child who has altered findings on neurologic exam. The FNP would expect to see all of the following results of evaluation of the CSF in a person with bacterial meningitis EXCEPT: 

   increased CSF glucose amount 

   WBC median count of 1200 cells/mm3 of CSF 

  elevated CSF protein level 

  none of the above 

 

Correct answer:

increased CSF glucose amount

 

The typical CSF response in bacterial meningitis includes a WBC median count of 1200 cells/mm3 of CSF with 90 – 95% neutrophils; reduced CSF glucose amount below the normal level of about 40% of the plasma level; and an elevated CSF protein level.

Question 90 

A mother is in the office with her two small children. They live near a large pond and both have mosquito bites. Which of the following is NOT part of the three-pronged program for protection from mosquito bites?

 

   Apply scented baby lotion to the skin for extra protection. 

  Limit exposure to infested habitats, particularly at dusk and after dark. 

   Dress the child in protective clothing, thereby limiting the access of skin to the insect. 

  Apply repellents, which may be the only feasible approach in certain circumstances. 

 

The Correct answer is:

Apply scented baby lotion to the skin for extra protection

Scented baby lotion will not repel mosquitoes. However, scented baby lotion will attract them. 

 

Question 91 

You encourage a patient who is in the office to engage in regular physical activity to allow which of the following changes in the lipid profile?

 

  increases HDL, lowers LDL 

   increases HDL and lowers VLDL and triglycerides 

   lowers HDL, VLDL, and triglycerides 

  lowers VLDL and LDL 

The Correct answer is:

Increases HDL and lowers VLDL and triglycerides

If the patient is physically capable, an adequate exercise plan should be followed in order for changes to be seen in the lipid profile. The HDL will increase and the VLDL and triglycerides will decrease if the patient is exercising vigorously.

 

Question 92 

Your patient has varicose veins. Treatment for this patient would consist of all but which of the following? 

  elastic compression stockings 

  elevation of leg when sitting 

   HCTZ with fluid retention 

   wearing restrictive garments to reduce swelling 

Correct answer:

wearing restrictive garments to reduce swelling

 

Although elastic compression stocking would be recommended, other garments should not be restrictive. The patient should also avoid prolonged weight-bearing and standing and avoid crossing legs when sitting.

 

Question 93 

Lead poisoning in children is often caused by lead-based paints found in older homes. If a child is exposed to lead, develops symptoms and has a lead level of 40 mcg/dL which of the following is the best course of action? 

  removal from the source of lead, improved nutrition and iron therapy 

  hospital admission 

   no intervention is required at this level 

   chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy 

Correct answer:

chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy.

 

Most children with lead levels of 10 – 35 mcg/dL are treated with removal from the source, improved nutrition and iron therapy. With lead levels of 36 – 50 mcg/dL, chelation with an agent such as succimer in addition to removal from the source of lead, improved nutrition and iron therapy is indicated. With lead levels above 51 mcg/cL hospital admission with expert evaluation is the most prudent course.

 

Question 94 

All of the following are examples of clinical interventions better understood through an ecological perspective EXCEPT: 

  early intervention services 

  home health care services 

   care coordination strategies 

   eating disorders 

Correct answer:

eating disorders

 

An eating disorder is an example of a clinical problem with multi-factorial etiology that is better understood through a transactional perspective. All of the other clinical interventions are better understood through an ecological perspective.

Question 95 

During your assessment of social skills in your patient who is 12 months old you would expect to see all of the following EXCEPT: 

  waves bye 

  indicates wants 

   puts on clothing 

  plays pat-a-cake 

 

Correct answer:

puts on clothing

 

A child is not able to put on clothing until about 22 months of age. The 12-month-old child should be able to play pat-a-cake, wave bye, and indicate his wants.

 

Question 96 

Which of the following is an appropriate way an nurse practitioner could use the Internet to assist in clinical practice? 

  She should have her patients search for information regarding their diagnosis and treatment options to better understand their prescribed care. 

   Direct the patient to a professional site for further education, such as the American Heart Association or the Center for Disease Control. 

   Instruct the patients to go to a site that offers alternative treatment options to compare costs to that of their current medications. 

  None of the above because the Internet is difficult for all patients to navigate. 

The Correct answer is:

Direct the patient to a professional site for further education, such as the American Heart Association or the Center for Disease Control

A great number of professional organizations and state and federal government associations have published pamphlets and e-books for the general public's use and education. The nurse practitioner should be aware of what sites materials are on and be knowledgeable of the material before directing patients to it. Having the patient search could be dangerous because there are no regulations in place to monitor material on the Internet. Having patients compare alternative treatment costs to prescribed medication is inappropriate and should be avoided. The Internet does have a place in the clinical practice of primary care, but should be used with caution and guidance.

 

Question 97 

You have a patient with Alzheimer’s disease. Her caretaker tells you that she gets very agitated in the evenings. You understand that this is common with dementia patients and is known as: 

   sundowning 

  hallucinations 

   depressive manifestation 

  metabolic derangement 

Correct answer:

sundowning

 

Sundowning is seen in both delirium and dementia. Starting at dusk/sundown, the patient becomes very agitated, confused, and combative. Symptoms resolve in the morning. 

 

Question 98 

The first-line drug for urge incontinence is which of the following? 

  pseudoephedrine 

   Ditropan 

   Detrol 

  Tofranil 

 

Correct answer:

Ditropan

 

Ditropan is a first-line drug for treatment of urge incontinence. Pseudoephedrine is used for stress incontinence. Detrol and Tofranil are also used for treatment of urge incontinence.

 

 Question 99 

In terms of acute renal failure, a BUN:Cr ratio of >20:1 with urinalysis revealing renal casts and RBCs is indicative of which of the following? 

  acute interstitial nephritis 

   acute glomerulonephritis 

   acute tubular necrosis 

  all of the above 

Correct answer:

acute glomerulonephritis

 

A BUN:Cr ratio of >20:1 with urinalysis revealing renal casts and RBCs is indicative of acute glomerulonephritis. The typical etiology of this disease is poststreptococcal infection and autoimmune diseases.

 

Question 100 

At which of the following times of pregnancy is the uterine fundus between the symphysis pubis and the umbilicus? 

  12 weeks 

   16 weeks 

   20 weeks 

  24 weeks 

 

Correct answer:

16 weeks

 

The fundal height at 16 weeks of pregnancy places the uterine fundus between the symphysis pubis and the umbilicus. At 12 weeks the uterine fundus first rises above the symphysis pubis. At 20 weeks the uterine fundus is at the level of the umbilicus. At 24 weeks the fundal height is between 23 cm and 25 cm

 

|test 3 aanp |

|Question 1  |

|The term for systems and activities designed to recognize and intervene to decrease risk of injury to patients and subsequent claims against healthcare|

|providers is which of the following?  |

|  quality control  |

|   quality improvement  |

|   risk management  |

|  case management  |

|Correct answer: |

|risk management |

|  |

|Risk management is defined as systems and activities designed to recognize and intervene to decrease risk of injury to patients and subsequent claims |

|against healthcare providers. It is based on the assumption that many injuries to patients are preventable |

|  |

|Question 2  |

|A 22-year-old female is in the office for her gynecological examination. What finding is considered a normal surface characteristic of the cervix?  |

|   red patches with occasional white spots  |

|  irregular granular surface with red patches  |

|   small, yellow and white, raised areas on the cervix  |

|  friable, bleeding tissue at the opening of the cervical  |

|The Correct answer is: |

|Small, yellow and white, raised areas on the cervix |

|A nabothian cyst or Naboth's follicle is a small yellow or white, raised, round area on the cervix. This is considered to be a normal variant. In |

|addition, the cervix should be smooth, symmetric and have a reddened circle around the opening.  The remaining answer choices are all unexpected |

|abnormal findings |

|  |

|Question 3  |

|In terms of newborn vision, which of the following statements is accurate?  |

|  Newborns have 20/100 vision.  |

|  They can focus best at distances of 12 inches.  |

|   The preferred colors are black, red, and white.  |

|  Lacrimal ducts are mature at birth.  |

|Correct. The answer is |

|Th.e preferred colors are black, red, and white. |

|  |

|This is the accurate statement. Newborns have 20/200 vision that becomes 20/20 by age 6. They can focus best at distances of 24 inches. Lacrimal ducts |

|mature by age 2 to 3 months; newborns do not have tears when crying. |

|  |

|Question 4  |

|In treating teenagers under the age of 18, the nurse practitioner will encounter emancipated minors. All of the following are considered emancipated |

|minors except for:  |

|  a 14-year-old who is married  |

|   a 15-year-old single mother who has a child  |

|  a 17-year-old who is enlisted in the U.S. army  |

|   a 16-year-old who wants to be treated for dysmenorrhea  |

|The Correct answer is: |

|A 16-year-old who wants to be treated for dysmenorrhea |

|Emancipated minors are teens who are younger than 18 years of age and have the same legal rights as adults.  The U.S. criteria for an emancipated minor|

|is any minor who is married, any minor who is a parent and any minor who is enlisted in the U.S. military |

|  |

|Question 5  |

|A young female patient tests positive for cocaine. The female is 8 weeks pregnant. While you have her in the clinic making her OB/GYN referral, it is |

|important that the nurse practitioner explains that cocaine is associated with which of the following? |

|  |

|  macrosomatia infant  |

|   abruptio placentae  |

|  maternal hypotension  |

|  postdated pregnancy  |

|The Correct answer is: |

|Abruptio placentae |

|The use of cocaine during pregnancy is associated with placental abruption, spontaneous abortion, and preterm labor. Other complications are maternal |

|elevation of blood pressure and heart rate and fetal risk for intrauterine growth retardation, distress, seizure, and death.  |

|  |

|Question 6  |

|With exposure to a known allergen, the body releases histamine. This reaction results in:  |

|  bronchodilatation, vasodilatation, and decreased vascular permeability  |

|  bronchospasm, vasodilatation, and vascular permeability  |

|   smooth muscle contraction, decreased vascular permeability, and vasoconstriction  |

|   pain, increased vascular permeability, and bronchodilatation  |

|The Correct answer is: |

|pain, increased vascular permeability, and bronchodilatation |

|The massive release of mediators triggers a series of events in target organs. With prior sensitization to the antigen, an anaphylactic reaction could |

|occur. The process known as anaphylaxis could result from injection of an antigen, ingested food or drugs, or inhaled antigens. The allergic reaction |

|results when the histamine increases blood flow, increases vascular permeability and causes vasodilation, bronchodilation, smooth muscle contraction |

|and pain. |

|  |

|Question 7  |

|You are providing patient education to a patient who has recently been diagnosed with Type II diabetes. He asks if he can still drink beer. What is the|

|appropriate response to this patient?  |

|  The patient should be told to avoid alcohol.  |

|   The patient should be told that he can have one drink a day.  |

|   The patient should be told that he can drink infrequently.  |

|  The patient should be told that his diagnosis does not require him to change his beer consumption.  |

|Correct Answer: The patient should be told that he can drink infrequently Alcohol can interfere with blood sugar. Diabetics can drink infrequently in |

|small quantities.  |

|  |

|Question 8  |

|As a means of secondary prevention the NP would suggest which of the following for a 40-year-old patient?  |

|  hepatitis A vaccine  |

|  wearing a seatbelt  |

|   AA for her alcohol problem  |

|   annual mammogram  |

|Correct answer: |

|mammogram |

|  |

|All screening laboratory tests are a means of secondary prevention. Women should have a baseline mammogram at age 35 years and an annual mammogram age |

|40 and older. |

|Question 9  |

|Which of the following would be considered a sign of malignant melanoma?  |

|  asymmetry  |

|  diameter greater than 6.0 mm  |

|   mottled gray color  |

|   all of the above  |

|  |

|Correct answer: |

|all of the above |

|  |

|There are five cardinal signs of malignant melanoma. They are asymmetry; irregular border often scalloped; mottled color with variegated display of |

|brown, black, gray, and/or pink; diameter greater than 6.0 mm; and elevation with subtle or obvious surface distortion. |

|  |

|Question 10  |

|The FNP has an 85-year-old male patient who is on several medications including an antilipid drug. The FNP understands that it is important to evaluate|

|his liver transaminases at least:  |

|  once a year  |

|   every other year  |

|   at least every six months  |

|  at least once a month  |

|Correct answer: |

|at least every six months |

|  |

|It is controversial as to whether adults who are older than 80 years should be taking antilipid drugs when they are on several medications because of |

|the possible drug interactions and liver toxicity that can result from antilipid drug metabolism. It is important, therefore, to evaluate liver |

|transaminases (ALT and AST) at least every six months |

|  |

| Question 11  |

|The FNP has an elderly patient who complains of headaches on one temple. She tells the FNP that her scalp is tender and she is having vision problems |

|in the eye that is on the same side as the headache. Your examination shows an indurated, reddened, cord-like temporal artery that is tender to touch |

|and this is located on the same side as the headache. Lab tests show that the sedimentation rate for this patient is elevated. Which of the following |

|diseases/conditions would the FNP likely diagnose?  |

|   temporal arteritis  |

|   acute bacterial meningitis  |

|  migraine headache  |

|  trigeminal neuralgia  |

|Correct answer: |

|temporal arteritis |

|  |

|When a patient has a new onset of headaches on one temple with all of the signs and symptoms mentioned in the question, temporal arteritis is likely to|

|be diagnosed. This type of headache is more common in older adults. |

|  |

|Question 12  |

|In terms of treating peripheral vascular disease, which of the following drugs would be used as a neuropathic analgesic?  |

|  Trental  |

|  Persantine  |

|   Elavil  |

|   Cipro  |

|Elavil is a tricyclic antidepressant used for neuropathic pain. It is administers at a dose of 10 – 25 mg hs. |

|  |

|Question 13  |

|Graves’ disease is an autoimmune disorder of the thyroid gland. A patient who has Graves’ disease might be prescribed any of the following medications |

|EXCEPT: |

|  |

|  propylthiouracil  |

|  methimazole  |

|   theophylline  |

|  radioactive iodine  |

|  |

|Correct answer: |

|theophylline |

|  |

|Theophylline is a medication often used for respiratory disease. The other medications might be prescribed for a patient with Graves’ disease. |

|Propylthiouracil and methimazole shrink the thyroid gland and decrease hormone production. Radioactive iodine can result in the permanent destruction |

|of the thyroid gland. |

|  |

|Question 14  |

|Which of the following types of anemia is described as an autoimmune disorder caused by the destruction of parietal cells by anti-parietal antibodies |

|resulting in cessation of intrinsic factor production?  |

|   pernicious anemia  |

|  vitamin B12 deficiency anemia  |

|   iron deficiency anemia  |

|  folic acid deficiency anemia  |

|Correct answer: |

|pernicious anemia |

|  |

|Pernicious anemia is an autoimmune disorder caused by the destruction of parietal cells by anti-parietal antibodies resulting in cessation of intrinsic|

|factor production. A person must have intrinsic factor to absorb vitamin B12 in the small intestine. It is the most common cause of B12 deficiency |

|anemia. |

|  |

|Question 15  |

|Who owns the medical record?  |

|  the patient  |

|  the healthcare facility where the care is rendered  |

|   the provider who is an employee at the healthcare facility  |

|   it varies from state to state  |

|nswer is: |

|It varies from state to state |

|As a general rule, the healthcare facility owns the medical record of a subject, but many state statutes award ownership to the provider of the care. |

|The patient is entitled to a copy of the record and not the original record.  |

|  |

| Question 16  |

|Nadia, an 8-year-old child lived in multiple foster homes until she was one year of age at which time she was adopted by a loving family. According to |

|Erickson’s theory of psychosocial development, which stage was Nadia most likely unable to complete as an infant?  |

|   trust vs. mistrust  |

|   initiative vs. guilt  |

|  industry versus inferiority  |

|  autonomy vs. shame and doubt  |

|  |

|Correct answer: |

|trust vs. mistrust |

|  |

|Since Nadia lived in several foster homes before the age of one, she may not have been able to complete the trust vs. mistrust stage of development. |

|The other choices are stages that are not related to infancy. |

|  |

| Question 17  |

|A patient comes to the clinic for a skin examination because of a “mole” that has been concerning her. She asks the FNP if this could be a melanoma. |

|The FNP understands that all of the following are signs that the lesion could be a melanoma EXCEPT:  |

|  It is asymmetric with non-matching sides.  |

|  Its borders are irregular.  |

|   It is of a uniform black or brown color.  |

|  Its diameter is larger than 6 mm.  |

|Correct answer: |

|It is of a uniform black or brown color. |

|  |

|All of the choices are correct except this one. One of the signs that a lesion may be a malignant melanoma is that the color is not uniform brown, |

|black, red, white, or blue. Another sign is that it is an evolving lesion, either new or changing. |

|  |

|Question 18  |

|There are a number of guidelines for legal coding of patient visits. Which of the following is NOT one of these?  |

|  A billable visit is a face-to-face contact.  |

|  NPs must distinguish between a new patient and an established patient for office visits.  |

|   Time is the most important factor in coding.  |

|  Medical record documentation must support the level of care billed.  |

| |

|Correct answer: |

|Time is the most important factor in coding. |

|  |

|This is incorrect. Time is the least important factor in coding. History taking, examination and medical decision making are the key components in |

|determining code selection. |

|  |

|Question 19  |

|Which of the following is considered a role expected of the nurse practitioner?  |

|  educator  |

|  change agent  |

|   researcher  |

|   all of the above  |

|Correct answer: |

|all of the above |

|  |

|In addition to the role as direct provider of health care, other roles are expected of the NP. They include the first three choices as well as: leader |

|and manager; user of nursing theory; collaborator; and evaluator. |

|  |

| Question 20  |

|Services that are rendered by health care professional employed by a physician and performed under the direct supervision of that physician are which |

|of the following?  |

|  direct services  |

|  indirect services  |

|   “incident to” services  |

|  integral services  |

|  |

|Correct answer: |

|“incident to” services |

|  |

|“Incident to” services are services rendered by health care professionals employed by a physician and performed under the direct supervision of that |

|physician. The service must be an integral part of the physician’s diagnosis or treatment. |

|  |

| Question 21  |

|Drug interactions are common with oral iron therapy. Which of the following drugs is NOT matched with its correct effect when taken with oral iron?  |

|   Levodopa: decreased iron effect  |

|  Tetracyclines: decreased tetracycline and iron effect  |

|   Antacids: decreased iron absorption  |

|  Caffeine: decreased iron absorption  |

|Correct answer: |

|Levodopa: decreased iron effect |

|  |

|When levodopa is taken with oral iron therapy there is the effect of both decreased levodopa and decreased iron. Use of these medications should be |

|separated by as much time as possible and levodopa dosage should be increased if needed |

|  |

|Question 22  |

|In the management of adolescent acne, nurse practitioners often prescribe benzoyl peroxide. What is an important instruction point regarding this |

|medication?  |

|   It can cause photosensitivity of the skin to occur.  |

|   Do not apply this product more than once daily.  |

|  Hypersensitivity can occur with repeated use.  |

|  This often causes peeling of the skin.  |

|The Correct answer is |

|It can cause photosensitivity of the skin to occur |

|A side effect of benzoyl peroxide is that it can produce sensitivity to the sun. It is important to inform patients of this side effect because they |

|are at risk of sunburn. This product can be applied twice a day, not just once. Hypersensitivity can occur with any topical agent, not just benzoyl |

|peroxide products. Benzoyl peroxide rarely causes skin peeling.  |

|  |

|Question 23  |

|Which of the following medications is NOT appropriate to prescribe for the management of hypertension?  |

|  Norvasec  |

|   Nasop.  |

|   Sectral.  |

|  Nadolol.  |

|  |

|Correct Answer: Nasop Nasop is intended for the treatment of hypotension, rather than hypertension. Norvasec is a calcium channel blocker, while |

|Sectral and Nadalol are beta blockers -- all three are appropriate for hypertension patients.  |

|  |

|Question 24  |

|You are providing care to a patient who reports that she was in a minor motor vehicle collision two days before. She did not go to the emergency room |

|after the crash because she had no pain or visible injuries. Today she is reporting pain in her chest. She also has a dry cough. She mentions that she |

|was thrown into the steering wheel during the accident, but that it happened at low speed so it seems impossible that she has broken anything. Which of|

|the following is the MOST likely diagnosis for this patient?  |

|  Pneumothorax.  |

|   Hemothorax.  |

|  Cardiac contusion.  |

|   Pericarditis.  |

|Correct Answer: Pericarditis This inflammation of the pericardium – the sac around the heart – can result from trauma. The patient's blunt trauma |

|(hitting the steering wheel), the delay in her system onset, and the symptoms themselves are most in line with pericarditis as a diagnosis. A dry cough|

|and low grade fever can also accompany pericarditis.  |

|  |

|Question 25  |

|The nurse practitioner (NP) has to counsel patients often on stress and stress management. The NP understands all of the following are true of stress |

|and stress management except:  |

|  Stress theory is based on the General Adaptation Syndrome identified by Selye who described a continuum of stress.  |

|  Large amounts of stress may be overwhelming and often lead to disease.  |

|  Small amounts of stress may add excitement and variety to life and actually increase quality of life.  |

|   Stress is the emotional, not physical, response to an increase in the environmental demands beyond the resources of an individual to cope with those|

|demands.  |

|The Correct answer is: |

|Stress is the emotional, not physical response, to an increase in the environmental demands beyond the resources of an individual to cope with those |

|demands |

|Stress also involves a physical response, not just an emotional response. The goal is to find the right balance of stress in life and not be |

|overwhelmed frequently.  |

|  |

|Question 26  |

|The FNP has an elderly patient who is complaining of a gradual onset of dyspnea, a dry cough and swollen feet and ankles. He also tells her that he has|

|gained weight. Examination reveals bibasilar crackles on the lung base and the presence of the S3 heart sound. The FNP know that these are indications |

|of which of the following?  |

|   congestive heart failure  |

|  myocardial infarction  |

|  bacterial endocarditis  |

|   acute abdominal aneurysm  |

|Correct answer: |

|congestive heart failure |

|  |

|This patient most likely has congestive heart failure. Sometimes the patient is already taking medications to prevent CHF such as diuretics, Lanoxin, |

|and antihypertensives. Precipitating factors include excessive fluid retention due to medications, acute illness, infections and other conditions. |

|  |

|Question 27  |

|An elderly patient presents with chest pain and a cough as well as fever. She explains that about one month ago she fell and although she is able to |

|walk, her hip feels "different". Further, a couple of weeks after the fall, she started having a cough, chest pain, etc. Of the following, which will |

|the NP MOST likely diagnose?  |

|   Pneumonia.  |

|  Pancreatitis.  |

|   Diabetes.  |

|  Psoriasis.  |

|  |

|Correct answer: Pneumonia Pneumonia is a common complication associated with hip fractures. Additionally, approximately 20% of the elderly suffering |

|from hip fractures, die from these complications.  |

|  |

|Question 28  |

|You are seeing a 42-year-old female for her initial examination. She has no complaints but needs a Papanicolaou test. Her blood pressure is 148/96 mm |

|Hg and her body mass index is 32. The rest of her examination is unremarkable. Your BEST action is to:  |

|   Arrange for at least two additional BP measurements during the next 14 days. |

|  |

|   Start her on an antihypertensive agent.  |

|  Give her subinguinal nitroglycerin immediately.  |

|  Advise her to exercise, diet, and reduce her sodium intake.  |

|  |

|The Correct answer is: |

|Arrange for at least two additional BP measurements during the next 14 days |

|While advising her to exercise, diet, and reduce sodium is good advice, the best action is to monitor her blood pressure to see if she needs an |

|antihypertensive agent. You would not start one today, since this is her first elevated blood pressure (BP) reading at your clinic. Subinguinal |

|nitroglycerin is not warranted.  |

|  |

|Question 29  |

|In order for a patient to have an adequate length of therapy when using a cream or ointment for a dermatologic condition, the FNP must know how much |

|medication to prescribe. If the patient is applying the medication to one leg, twice a day for a month, how much medication should be prescribed?  |

|  3 g  |

|  84 g  |

|   320 g  |

|  640 g  |

|Correct answer: |

|320 g |

|  |

|The amount of medication needed for application to one leg twice a day for a month is 320 g or 12 oz. If a prescription is written for an inadequate |

|amount of a topical medication with insufficient numbers of refills, it can create a situation in which treatment fails because of an inadequate length|

|of therapy |

|Question 30  |

|Which of the following statements concerning urinalysis is least accurate?  |

|  Epithelial cells in large amounts indicate contamination.  |

|   Normal white blood cells in urine are ≤ 20 WBCs/μL.  |

|   Protein in urine indicates kidney damage.  |

|  Red blood cells are seen in kidney stones and some lower urinary tract infections.  |

|  |

|Correct answer: |

|Normal white blood cells in urine are ≤ 20 WBCs/μL. |

|  |

|This is not accurate. Normal white blood cells in urine are ≤ 10 WBCs/μL. Presence of leukocytes in males is abnormal and indicates infection. |

|  |

| Question 31  |

|The FNP has an adult patient with diabetes whose blood pressure is 145/95. Which stage of hypertension does this indicate?  |

|  normal  |

|  pre-hypertension  |

|   Stage I  |

|  Stage II  |

| |

|Correct answer: |

|Stage I |

|  |

|Stage I hypertension is characterized by a systolic pressure of 140 – 159 mmHg and a diastolic pressure of 90 – 99 mmHg. The treatment recommendation |

|for this stage is usually a thiazide diuretic and for those with diabetes, either ACE inhibitors or ARBs, because of their renal protective properties.|

| |

|  |

|Question 32  |

|An 80-year-old patient presents with a history of infection. He is obese and his chief complaint is fatigue and thirst. What test should be run?  |

|   Blood glucose.  |

|   Serum cholesterol.  |

|  Serum albumin.  |

|  Hemoglobin.  |

|  |

|Correct answer: Blood glucose Glucose intolerance is common in older patients. Additionally, obesity and fatigue, combined with a history of infection |

|indicate that the patient is at risk for diabetes. Glucose will measure the blood sugar.  |

|  |

|Question 33  |

|If a teenager comes to the clinic with large numbers of papules and pustules and painful indurated nodules and cysts over his face, shoulder and chest |

|which of the following is the most likely diagnosis?  |

|  acne vulgaris  |

|  mild acne  |

|   moderate acne  |

|   severe cystic acne  |

|  |

|Correct answer: |

|severe cystic acne |

|  |

|Severe cystic acne has all of the conditions of other acnes but also has painful indurated nodules and cysts over the face, shoulders and chest. |

|Accutane is a drug used to treat this condition. Patients need to sign special consent forms to take the drug, since it is extremely teratogenic. |

|  |

|Question 34  |

|Raynaud disease is characterized by paroxysmal digital vasoconstriction that results in bilateral symmetrical pallor or cyanosis. Which of the |

|following persons is most likely to have primary Raynaud disease?  |

|  a 55 year old female  |

|   a 45 year old male  |

|  an 18 year old male  |

|   a 20 year old female  |

|  |

|Correct answer: |

|a 20 year old female |

|  |

|Primary Raynaud disease is most often found in women. The condition usually appears between the ages of 15 and 45 years of age. Therefore, the most |

|likely of the choices to have this disease is a 20 year old female. |

|  |

|Question 35  |

|In a 37-year-old female patient with dysuria, nausea, and urinary frequency, which bacterial count by clean catch method supports a diagnosis of a |

|urinary tract infection?  |

|  >5,000 |

|  |

|  >15,000  |

|   >50,000  |

|   >100,000  |

|  |

|The correct answer is: |

|>100,000 |

|The urinary tract is sterile and no bacteria should be present. When a specimen is collected via clean catch method, the tolerance for organisms is |

|less that 100,000. It is expected that some bacteria from external genitalia will be collected. If the level is greater than 100,000, a urinary tract |

|infection can be correctly diagnosed. |

|  |

|Question 36  |

|You are treating a patient with parenteral vitamin B12 therapy. She is 69-years-old. What should you monitor for during the first few weeks of her |

|therapy?  |

|   hypokalemia  |

|  hyperkalemia  |

|   hyponatremia  |

|  hypernatremia  |

|  |

|The Correct answer is: |

|Hypokalemia |

|Because reticulocytosis is brisk and peaks at around 5 to 7 days post-therapy initiation, you should monitor for hypokalemia. This condition is caused |

|by serum-to-intracellular potassium shifts, and is common if the anemia was severe. The risk of hypokalemia is particularly high if the patient is |

|receiving diuretic therapy.  |

|  |

|Question 37  |

|Which of the following triglyceride levels would be considered borderline high?  |

|   250 mg/dL  |

|  180 mg/dL  |

|   420 mg/dL  |

|  1100 mg/dL  |

|  |

|Correct answer: |

|250 mg/dL |

|  |

|Triglyceride levels lower than 200 mg/dL are desirable; 200 to 400 mg/dL is borderline high; 400 to 1000 mg/dL is high; and 1000 mg/dL is very high. |

|  |

|Question 38  |

|The NP is prescribing a drug for Type II diabetes that prevents simple sugars from being absorbed and digested from the gastrointestinal tract? Which |

|drug is it?  |

|  Metformin.  |

|  Insulin.  |

|   a- Glucosidase inhibitors.  |

|  Sulphyonylureas.  |

|  |

|Correct answer: a-Glucosidase inhibitors This drug is effective in obese, elderly patients who have a moderate fasting hyperglycemia. It is effective |

|at improving insulin sensitivity. |

|  |

|Question 39  |

|You have a patient who has lost his sense of smell. You understand that this is controlled by which of the following cranial nerves?  |

|   CN I  |

|   CN II  |

|  CN III  |

|  CN IV  |

|Correct answer: |

|CN I |

|  |

|CN I is the olfactory nerve. Its function contributes to the sense of smell. This patient who has lost his sense of smell has a dysfunction of this |

|cranial nerve. |

|  |

|Question 40  |

|Which of the following would you not undertake as a primary prevention measure for a female patient?  |

|  immunizations  |

|   mammogram  |

|   use of seatbelts when in an automobile  |

|  exercise  |

|Correct answer: |

|mammogram |

|  |

|A primary prevention measure is one that prevents disease or injury. A mammogram is a secondary prevention measure used to detect disease early to |

|minimize bodily damage. |

|  |

|Question 41  |

|All of the following are examples of active immunity EXCEPT:  |

|  pneumococcal conjugate vaccine (PCV)  |

|   hepatitis B immune globulin (HBIG)  |

|  hepatitis A 2 dose series immunization  |

|  immunization for the influenza virus  |

|  |

|The Correct answer is: |

|Hepatitis B immune globulin (HBIG) |

|Passive immunization occurs through the use of immune globulin (IG) whereas active immunization occurs through the use of vaccines. The remaining |

|answer choices are vaccinations |

|  |

|Question 42  |

|The cranial nerve(s) associated with the gag reflex and the soft palate is(are) which of the following?  |

|  CN 3, 4 & 6  |

|   CN 9 & 10  |

|   CN 12  |

|  CN 2  |

|  |

|Correct answer: |

|CN 9 & 10 |

|  |

|CN 9 & 10 are the Glossopharyngeal Vagus nerves. They are associated with the gag reflex, the symmetrical soft palate, uvula and voice quality. |

|  |

|Question 43  |

|One part of a spectrum of disease that is often found together with giant cell arteritis is which of the following?  |

|   polymyalgia rheumatica  |

|  migraine headache  |

|   blindness  |

|  brain tumor  |

|Correct answer: |

|polymyalgia rheumatica |

|  |

|Giant cell arteritis and polymyalgia rheumatica are thought to represent two parts of a spectrum of disease and are often found together. Blindness is |

|a serious complication of the disease. |

|  |

|Question 44  |

|In the management of hypertension, the nurse practitioner understands that the most important goal of treatments is to:  |

|   Avoid disease-related target organ damage.  |

|  Treat concomitant health problems often noted in the person with this condition.  |

|   Strive to reach recommended numeric BP measurement.  |

|  Develop a plan of care with minimal adverse effects.  |

|  |

|The Correct answer is: |

|Avoid disease-related target organ damage |

|Hypertension is a complex disease with a core defect of vascular dysfunction that leads to select target organ damage. These organs include the brain, |

|eye, heart and kidneys. The most important goal that the JNC-7 evidence-based guidance has set forth in the treatment of hypertension is the avoidance |

|of target organ damage. Other recommendations for BP goals include the remaining answer choices.  |

|  |

| Question 45  |

|The World Health Organization has put forth some precautions for use of combined oral contraceptive pills. According to WHO which of the following |

|medical situations would have NO restriction on use?  |

|  BMI ≥ 30  |

|   HIV  |

|   acute hepatitis  |

|  hypertension adequately controlled without vascular disease  |

|Correct answer: |

|HIV |

|  |

|A person with HIV would fall into Category 1 which has no restriction. The other choices fall either into Category 2, the advantages outweigh the risk;|

|Category 3, exercise caution; or Category 4, refrain from use. |

|  |

|Question 46  |

| A petit-mal seizure can best be described as which of the following? |

|  |

|  rigid extension of arms and legs with jerking movement  |

|   one or more muscle groups causing brief jerking contractions of the limbs  |

|   blank staring lasting 3 – 50 seconds  |

|  aura characterized by unusual sense of smell or taste  |

|  |

|Correct answer: |

|blank staring lasting 3 – 50 seconds |

|  |

|A petit mal or absence seizure is characterized by a blank stare lasting 3 – 50 seconds. This is accompanied by an impaired level of consciousness. The|

|usual age of onset is 3 – 15 years of age. |

|  |

| Question 47  |

|You are conducting a health assessment with a patient who presents with several symptoms and signs associated with multiple sclerosis. Which of the |

|following tests would be appropriate to order for this patient?  |

|  Metabolic panel.  |

|  Echocardiogram.  |

|   Lumbar puncture.  |

|  Blood glucose test.  |

|  |

|Correct Answer: Lumbar puncture To confirm the diagnosis of multiple sclerosis, the patient's cerebral spinal fluid should be collected and analyzed. |

|The lumbar puncture collects this fluid; none of the other tests or procedures listed do.  |

|  |

| Question 48  |

|Which of the following is least likely to be a guideline for client education? |

|  |

|  capitalizing on the patient’s preferred way of learning to increase learning  |

|  using organization and meaningful information to enhance learning  |

|   giving feedback about performance as soon as possible |

|  |

|   having the patient wait and absorb what has been learned for a while before applying it |

|  |

|Correct answer: |

|having the patient wait and absorb what has been learned for a while before applying it |

|  |

|This is not a good guideline. Applying what is learned immediately afterward helps with retention and transfer. Practice and time spent on the task |

|increases the learning of skills. |

|  |

|Question 49  |

|For low-risk children with otitis media (OM) which of the following is the first-line therapy?  |

|  polymyxin  |

|   amoxicillin  |

|   Cipro Otic  |

|  hydrocortisone  |

|  |

|Correct answer: |

|amoxicillin |

|  |

|The first-line therapy for low-risk children is amoxicillin (40 to 60 mg/kg/day). For clients with high risk factors, the dose would be increased to 80|

|to 90 mg/kg/day. |

|  |

|Question 50  |

|A patient who has been prescribed a once-daily dose of prednisone asks what the best time of day to take his medication is. Which of the following is |

|an appropriate response to this patient?  |

|  The patient should take the medication just before bed.  |

|  The patient should take the medication at whatever time is most convenient to his schedule.  |

|   The patient should take the medication after his first meal of the day.  |

|   The patient should take the medication before 9 am.  |

|  |

|Correct Answer: The patient should take the medication before 9 am Once daily doses of prednisone should be taken before 9 am. This allows the patient |

|to have the longest possible benefit from the medication during his regular daily routine.  |

|  |

|Question 51  |

|All of the following are indications that a woman may be at high risk for breast cancer EXCEPT:  |

|  having had high-dosed radiation |

|  |

|  first degree relative with breast cancer  |

|   shorter exposure to estrogen as in late menarche  |

|  obesity  |

|Correct answer: |

|shorter exposure to estrogen as in late menarche |

|  |

|Longer exposure to estrogen would increase a woman’s risk of breast cancer. This can occur from early menarche, late menopause, nulliparity, or being |

|over the age of 30 before having a child. |

|  |

|Question 52  |

|A 55 year old female patient lives in a house with a smoker. She also takes hormone replacement therapy. What does this increase her risk of?  |

|  Heart disease.  |

|  Diabetes.  |

|   Lung cancer.  |

|   Stroke.  |

|  |

|Correct answer: Stroke While secondhand smoke can increase the risk of lung cancer, the patient's age and medication create another risk. She is at a |

|greater risk of a stroke. Being overweight and a sedentary lifestyle will also increase the risk of stroke.  |

|  |

| Question 53  |

|Which of the following is NOT consistent with the description of benign prostatic hyperplasia (BPH)?  |

|   boggy gland on palpation  |

|  gland has a rubbery consistency  |

|   gland size is larger than 2.5 cm X 3 cm  |

|  chronic incomplete bladder emptying  |

|The Correct answer is: |

|Boggy gland on palpation |

|The diagnosis of benign prostatic hyperplasia (BPH) is based on numerous components of the evaluation. On rectal examination, the prostate has a |

|rubbery consistency, enlarged, greater than 2.5 cm X 3 cm and in many cases has lost the median sulcus or furrow. The patient usually complains of |

|symptoms of chronic incomplete bladder emptying, as well.  |

|  |

|Question 54  |

|A sexually active female complains of embarrassing vaginal odor that is worse after intercourse. She also has a vaginal discharge that is thin and of |

|milk-like consistency. Examination shows no redness or irritation. The FNP might suspect which of the following?  |

|  Candida vaginitis  |

|   polycystic ovary syndrome  |

|   bacterial vaginitis  |

|  Trichomonas vaginitis  |

|Correct answer: |

|bacterial vaginitis |

|  |

|Bacterial vaginitis is caused by anaerobic bacterial overgrowth that is due to unknown reasons or develops secondary to pregnancy terminations or PID. |

|It is not an STD. Vaginal discharge has a fish-like odor, is off-white to gray, and of milk-like consistency.  |

|  |

|Question 55  |

|Which of the following would be classified as an acyanotic heart defect? |

|  |

|   coarctation of the aorta  |

|  Tetralogy of Fallot  |

|   tricuspid atresia  |

|  truncus arteriosus  |

|  |

|Correct answer: |

|coarctation of the aorta |

|  |

|Acyanotic heart defects are congenital heart defects in which no deoxygenated or poorly oxygenated blood enters the systemic circulation. Coarctation |

|of the aorta is an acyanotic heart defect. The other choices are cyanotic heart defects. |

|  |

|Question 56  |

|A patient comes to the clinic with swelling behind his knee. He tells you that he has a sense of fullness behind the knee as if something is there. Of |

|the following choices, which diagnosis is most likely?  |

|  prepatellar bursitis  |

|  olecranon bursitis  |

|   trochanteric bursitis  |

|   Baker cyst  |

|Correct answer: |

|Baker cyst |

|  |

|This patient most likely has a Baker cyst. Your examination will show cystic swelling in the popliteal space. If the bursa ruptures there is acute |

|swelling of the lower leg, mimicking deep vein thrombosis |

|  |

|Question 57  |

|Which of the following patient is most likely to qualify and be using Medicaid as their insurance?  |

|   the single mother of four dependent children, age 26  |

|  a middle aged female who works for the government, age 47  |

|   a young male factory worker, age 23  |

|  an elderly retired high school teacher, age 78  |

|The Correct answer is: |

|The single mother of four dependent children, age 26 |

|Medicaid is a federally mandated program that guarantees healthcare services to low-income families with dependent children and to low-income and |

|disabled individuals. Government employees and factory workers are most likely insured through a commercial carrier or uninsured. An elderly teacher |

|would have Medicare since they have paid into the federal retirement system and are over 65 years of age.  |

|  |

| Question 58  |

|The NP explains to her patient that the medication she is prescribing for his hyperlipidemia can result in a 20 to 60% decrease in his LDL, 5 to 15% |

|increase in his HDL and 10 to 40% decrease in his Triglycerides. Which of the following is she prescribing?  |

|   Lipitor.  |

|  Gemfibrozil.  |

|   Nicotinic acid.  |

|  Colestipol.  |

| |

|Correct answer: Lipitor The expected outcomes of the preceding medications are as follows: Lipitor: LDL: 20-60% decrease HDL: 5-15% increase |

|Triglyceride: 10-40% decrease Gemfibrozil: LDL: 5-15% decrease HDL: 14-20% increase Triglyceride: 20-50% decrease Nicotinic acid: LDL: 10-25% decrease |

|HDL: 15-35% increase Triglyceride: 20-50% decrease Colestipol: LDL: 10-20% decrease HDL: 3-5% decrease Triglyceride: May increase  |

|  |

|Question 59  |

|When the FNP examines a patient with suspected hypothyroidism, he would NOT expect to find:  |

|  weight gain  |

|  coarse, dry skin  |

|   tachycardia  |

|  intolerance of cold  |

|Correct answer: |

|tachycardia |

|  |

|The FNP would not expect to find tachycardia in a patient with suspected hypothyroidism; he would be more likely to find bradycardia, especially in |

|severe cases. He may also find that the person is lethargic and has memory problems, that the person has thick, coarse hair with a tendency to break, |

|and thick, dry nails. |

|  |

|Question 60  |

| In which of the following vaginal infections are you most likely to see “strawberry cervix” from small point of bleeding on the cervical surface. |

|  |

|  atrophic vaginitis  |

|  bacterial vaginosis  |

|   candidal vaginitis  |

|   trichomonas vaginitis  |

|  |

|Correct answer: |

|trichomonas vaginitis |

|  |

|Trichomonas vaginitis is caused by a unicellular protozoan parasite with flagella that infects genitourinary tissue (both males and females). Infection|

|causes inflammation and in females causes a “strawberry cervix.” |

|  |

| Question 61  |

|A young patient is brought in after an injury to the neck. What exam is necessary?  |

|  Pelvic exam.  |

|  Vital signs.  |

|   Sensory exam.  |

|  Pharyngeal exam.  |

|  |

|Correct answer: Sensory exam The sensory exam is included in a neurological assessment. This exam is recommended if there is a risk of a spinal cord |

|injury |

|  |

|Question 62  |

|An insurance policy that pays damages that occurred during the policy’s life is which of the following?  |

|  claims made policy  |

|   occurrence policy  |

|   total coverage policy  |

|  working coverage policy  |

| Correct answer: |

|occurrence policy |

|  |

|An occurrence insurance policy pays damages that occurred during the policy’s life. The individual no longer has to be carrying the coverage at the |

|time of the litigation. |

|  |

|Question 63  |

| Approximately how many adults are functionally illiterate? |

|  |

|  5%  |

|  7%  |

|   30%  |

|   20%  |

| Correct answer: |

|20% |

|  |

|Approximately 20% of adults are functionally illiterate. This means that they cannot read or write. One should never presume literacy in an adult |

|client. |

|  |

| Question 64  |

|A patient you diagnosed with hypothyroidism was started on levothyroxine. At what interval should the nurse practitioner reassess her TSH?  |

|  1 to 2 weeks  |

|   2 to 4 weeks  |

|  4 to 6 weeks  |

|   6 to 8 weeks  |

|The Correct answer is: |

|6 to 8 weeks |

|In the treatment of hypothyroidism, T4 replacement is needed in the form of levothyroxine (Synthroid or Levoxyl). The initial dosage for an adult is 75|

|to 125 mcg. For an elderly person, the dose is 75% less than the adult dosage. Because of the long half-life of levothyroxine, the effects of a dosage |

|adjustment or initiation would not cause a change in TSH for approximately five to six drug half-lives, or about 6 to 8 weeks.  |

|  |

|Question 65  |

|The 5-year survival rate for Hodgkin’s disease in Stage II is which of the following?  |

|  65%  |

|  75%  |

|   90%  |

|  99%  |

|Correct answer: |

|90% |

|  |

|Stage II Hodgkin’s disease is characterized by two or more node groups on the same side of the diaphragm being involved. The survival rate at 5 years |

|is 90%. |

|  |

|Question 66  |

|When counseling a patient with benign prostatic hypertrophy, the nurse practitioner knows to advise: |

|  |

|   The patient to limit intake of fluids in the evening, and avoid large quantities in a short time frame.  |

|  The patient that there are no surgical options available.  |

|   The patient to void at least twice a day.  |

|  The patient to avoid certain bladder irritants such as cranberry juice, clear sodas, and blood pressure pills.  |

|  |

|The Correct answer is: |

|The patient to limit intake of fluids in the evening, and avoid large quantities in a short time frame |

|It is important to tell the patient that if severe symptoms persist, surgical options such as transurethral resection of the prostate (TURP) are |

|available. Also, the nurse practitioner should encourage the patient to void frequently. Further, the nurse practitioner should advise the patient to |

|avoid certain bladder irritants like antihistamines, anticholinergics, coffee, alcohol, decongestants, and tricyclic antidepressants.  |

|  |

| Question 67  |

|Which of the following nursing theorists is known as the mother of psychiatric nursing?  |

|  Faye Glenn Abdellah  |

|  Ernestine Wiedenbach  |

|   Hildegard Peplau  |

|  Virginia Henderson  |

|Correct answer: |

|Hildegard Peplau |

|  |

|Hildegard Peplau has been described as the mother of psychiatric nursing because her theoretical and clinical work led to the development of the |

|distinct specialty field of psychiatric nursing. Her work was influenced by Freud, Maslow, and Sullivan’s interpersonal relationship theories, and by |

|the contemporaneous psychoanalytical model. |

|  |

|Question 68  |

|There is a female patient who complains of fatigue. She has a family history of breast cancer, and has not had a breast exam in five years. What is the|

|correct course of action?  |

|  Pap smear.  |

|   Serum cholesterol.  |

|  Sensory exam.  |

|   Breast exam.  |

|  |

|Correct answer: Breast exam The patient is at risk for breast cancer because of her family history. This does not mean that she has cancer. An exam, |

|however, is recommended to rule out anything.  |

|  |

| Question 69  |

|Which of the following is the most accurate statement regarding the Vaccine for Children's Program Immunization Guidelines?  |

|   Free vaccines are available for uninsured and Medicaid-eligible children, children whose insurance do not cover vaccines, and Native American and |

|Alaskan Native children.  |

|  Most children under the age of 2 are fully immunized.  |

|   Preterm infants should be immunized on the same schedule as full term infants.  |

|  Major contraindications exist regarding the simultaneous administration of the routine vaccines.  |

| |

|The Correct answer is: |

|Free vaccines are available for uninsured and Medicaid-eligible children, children whose insurance do not cover vaccines, and Native American and |

|Alaskan Native children |

|Most children under 2 years of age and younger do not have adequate immunization, leaving them at risk for infections. Preterm infants must be |

|immunized according to their postnatal chronological age. No major contraindications exist for routine vaccines to be given simultaneously.  |

|  |

|Question 70  |

|An expected finding in a 57-year-old female with estrogen deficiency atrophic vaginitis include:  |

|  an odorous vaginal discharge  |

|  an increased number of lactobacilli  |

|   a reduced number of white blood cells  |

|   a pH greater than 5.0  |

|  |

|The Correct answer is: |

|A pH greater than 5.0 |

|During menopause, the pH shifts as the vaginal flora changes due to decreased estrogen. An odorous vaginal discharge and increased number of |

|lactobacilli is expected in bacterial vaginosis |

|Question 71  |

|If an nurse practitioner is providing care for pediatric patients, why is it especially important to have adequate professional liability insurance |

|coverage? |

|  |

|  Juries are apt to award fewer dollars to injured children because the children are eligible for a variety of social programs that cover their medical|

|expenses.  |

|  Insurers are aware of the increased risk posed by minor claimants, so the coverage is difficult to obtain.  |

|   Damages are usually higher when a child is the injured party.  |

|   The statute of limitations is often put on hold (or tolled) until the minor reaches legal age status. Then, the timeframe within which the child or |

|parent can file a lawsuit is extended.  |

|The Correct answer is: |

|The statute of limitations is often put on hold (or tolled) until the minor reaches legal age status. Then, the timeframe within which the child or |

|parent can file a lawsuit is extended  |

|This is known as a "long tail" of professional liability and there is always a time lag from the date of injury to the date a claimant files a |

|malpractice action. If the case involves an infant, the time lag could be many years due to statutes of limitation. The jurors tend to have a sympathy |

|factor, but the judgment is usually proportional to the injury. |

|  |

|Question 72  |

|All of the following persons were involved in the ethologic theory of human growth and development EXCEPT:  |

|  Konrad Lorenz  |

|   Carl Rogers  |

|   Harry Harlow  |

|  Mary Ainsworth  |

|Correct answer: |

|Carl Rogers |

|  |

|Carl Rogers was a promoter of the humanistic theory of human growth and development rather than the ethologic theory. The other choices are those who |

|were involved in ethologic theories along with John Bowlby, Marshall Klaus and John Kennel. |

|  |

| Question 73  |

|A person who tans after an initial burn is considered of which skin phototype? |

|  |

|  1  |

|  2 |

|  |

|   3  |

|  4  |

|Correct answer: |

|3 |

|  |

|Skin phototypes range from 1 to 6. A person with skin phototype 1 or 2 should NEVER sunbathe and should always use sunscreens with an SPF of greater |

|than 30. A person with skin phototype 3 has white skin and tans after an initial burn |

|  |

|Question 74  |

|Which of the following is NOT one of the learning domains for patients?  |

|   transtheoretical  |

|   cognitive  |

|  affective  |

|  psychomotor  |

|  |

|Correct answer: |

|transtheoretical |

|  |

|Patients learn in three ways. They are referred to as learning domains. They are cognitive, affective, and psychomotor. Much learning involves all |

|three domains simultaneously. |

|  |

|Question 75  |

|You are counseling a patient on the use of combined oral contraceptives (COCs) who asks many questions concerning the benefits versus the risks of |

|these agents. The nurse practitioner knows that the reduction in free androgens noted in a woman using COCs can yield an improvement in:  |

|  rheumatoid arthritis  |

|   acne vulgaris  |

|   diabetic glucose control  |

|  all of the above  |

|The Correct answer is: |

|Acne vulgaris |

|The reduction in free androgens helps with hirsutism, keeping the menstrual cycle flow regular, ovarian cyst reduction or elimination and acne. The |

|other answer choices are not affected by a reduction in androgen, which makes them incorrect. Then, all of the above, is not the right answer choice as|

|diabetic glucose control and rheumatoid arthritis are incorrect answer choices. |

|  |

|Question 76  |

|Which of the following is least likely to be a control measure directed against the reservoir of infection?  |

|  isolation  |

|   water purification  |

|   quarantine  |

|  insect spraying  |

|Correct answer: |

|water purification |

|  |

|Water purification is a measure that interrupts the transmission of organisms along with such things as milk pasteurization and barrier protection |

|during sexual intercourse. The other choices are all measures directed against the reservoirs of infection. |

|  |

|Question 77  |

|During an exam, you observe that a patient moves against the resistance of your hand with his wrist. It appears to be a little weaker than normal. What|

|grade of strength does this movement get?  |

|  2 of 5  |

|   4 of 5  |

|   1 of 5  |

|  3 of 5  |

|:  |

|Correct answer: 4 of 5 Muscle strength is graded on a five-point scale. The grades are 0 to 5, with 0 being no movement. A grade of 4 is the ability to|

|move, but the movement is weaker than normal. |

|  |

|Question 78  |

|Which of the following drugs for treating anxiety has the most rapid onset of action?  |

|   diazepam  |

|  clonazepam  |

|   alprazolam  |

|  oxazepam  |

|Correct answer: |

|diazepam |

|  |

|Diazepam (Valium) has a rapid onset of action and a relatively sustained effect. The other choices all have a slow onset of action and a relatively or |

|highly sustained effect. |

|  |

| Question 79  |

|The NP knows that good communication concepts when dealing with possible abuse involve all of the following EXCEPT:  |

|  Open-ended questions are preferred.  |

|  State things objectively and avoid being judgmental.  |

|   Avoid reassuring the patient.  |

|   Avoid offering help, let them ask for it.  |

|The Correct answer is: |

|Avoid offering help, let them ask for it |

|When communicating with the patient, the nurse practitioner should offer help to the patient, but do so by asking open ended questions. Open ended |

|questions gives the patient the opportunity to discuss his or her feelings, concerns and to clarify them, along with expressing what he or she needs |

|help with. For instance, the nurse practitioner should ask the patient, "How can I help you?" instead of "What type of object was used to hurt you?" |

|Also, the questions needs to be objective. Avoid reassurance because it stops patients from talking more about their problems.  |

|  |

|Question 80  |

|You are managing a patient who has irritable bowel syndrome (IBS). Altering the gut pain threshold in IBS is a possible therapeutic outcome with the |

|use of:  |

|   amitriptyline (Elavil)  |

|  loperamide (Imodium)  |

|   dicyclomine (Bentyl)  |

|  Metronidazole (Flagyl)  |

|  |

|The Correct answer is: |

|Amitriptyline (Elavil) |

|A low dose tricyclic antidepressant or a selective serotonin reuptake inhibitor can be helpful in altering the gut pain threshold, resulting in less |

|abdominal pain. Imodium and Bentyl are prescribed to treat diarrhea. Flagyl is not used as treatment for irritable bowel syndrome, but is used to treat|

|certain types of infectious colitis.  |

|  |

|Question 81  |

|One of the neo-Freudian theories of human growth and development is Erik Erikson’s theory of life span psychosocial development. In this theory, school|

|age children would be in which of the following groups?  |

|  autonomy vs. shame and doubt  |

|   initiative vs. guilt  |

|   industry vs. inferiority  |

|  intimacy vs. isolation  |

|Correct answer: |

|industry vs. inferiority |

|  |

|School age children would be in the “industry vs. inferiority” stage of psychosocial development. Toddlers are in the “autonomy vs. shame and doubt” |

|stage. Preschoolers are in the “initiative vs. guilt” stage. Young adults are in the” intimacy vs. isolation” stage. |

|  |

|Question 82  |

|A condition that results from dilated veins in the spermatic cord is which of the following?  |

|  hydrocele  |

|   varicocele  |

|   testicular cancer  |

|  testicular torsion  |

|Correct answer: |

|varicocele |

|  |

|A varicocele is the result of dilation of the veins in the spermatic cord. Varicoceles are caused by incompetent valves of the internal spermatic |

|venous system. They are associated with male infertility. |

|  |

|Question 83  |

|The lower incidence of epiglottitis is associated with the administration of which of the following vaccines?  |

|  MMR  |

|   Hib  |

|   DPT  |

|  IPV  |

|  |

|Correct answer: |

|Hib |

|  |

|A lower incidence of epiglottitis is associated with haemophilus influenzae with use of Hib vaccine. The incidence of decrease is 99% in children under|

|5 years of age. |

|  |

|Question 84  |

|What is the Health Care Financing Administration (HCFA)? |

|  |

|  This is a state based organization that regulates Medicaid.  |

|   This is a federal agency responsible for the management of Medicare and a portion of Medicaid.  |

|   This is a national health service system set up to coordinate international health research.  |

|  This is a major federal body responsible for financing the prevention and control of diseases.  |

|  |

|The Correct answer is: |

|This is a federal agency responsible for the management of Medicare and a portion of Medicaid |

|The Health Care Financing Administration (HCFA) is controlled by the federal government and assures quality care activities as well as manages Medicare|

|and the federal portion of Medicaid. The Center for Disease Control (CDC) is associated with prevention and control of diseases. |

|  |

|Question 85  |

|Which of the following statements about end-of-life care is most accurate?  |

|  From an insurance point of view, the end-of-life stage begins 12 months before death.  |

|  Pain management is less of a priority in end-of-life care.  |

|   Family caregivers for patients at end of life find more satisfaction than stress in their role.  |

|   The type of medical care often shifts from invasive intervention aimed at prolonging life to supportive intervention that focuses on control of |

|symptoms.  |

|  |

|Correct answer: |

|The type of medical care often shifts from invasive intervention aimed at prolonging life to supportive intervention that focuses on control of |

|symptoms. |

|  |

|This is the most accurate of the statements. The other choices are not as accurate. From an insurance point of view, the end-of-life stage begins 6 |

|months before death. Pain management is more of a priority in end-of-life care. Family caregivers may find great satisfaction in their role; however |

|they often experience stress and diminished physical health. |

|  |

|Question 86  |

| Your 22-year-old female patient is complaining of sore throat and fatigue which has lasted for quite a while. She tells you that she also has some |

|pain in her upper abdomen. Your examination reveals enlarged cervical nodes. Of the following the most likely diagnosis for this patient is which of |

|the following? |

|  |

|  diphtheria  |

|   peritonsillar abscess  |

|   acute mononucleosis  |

|  appendicitis  |

|Correct answer: |

|acute mononucleosis |

|  |

|Acute mononucleosis is an infection by the Epstein-Barr virus that is transmitted through saliva by intimate oral contact. The classic triad to look |

|for is pharyngitis, cervical lymphadenopathy, and fatigue. |

|  |

|Question 87  |

|Which of the following is a type of passive immunity?  |

|  resistance developed in response to an antigen  |

|   defense against disease acquired by the infant from the mother  |

|   immunity required when the host receives antigens through natural contact  |

|  invasion of the body by microorganisms and subsequent development of antibodies  |

|  |

|The Correct answer is: |

|Defense against disease acquired by the infant from the mother |

|A form of passive immunity is where immunoglobulins are transferred from mother to fetus across the placental membrane. Further, the remaining answer |

|choices are descriptive of active immunity.  |

|  |

|Question 88  |

|The severity of disease that an organism can produce, measured by criteria such as numbers of days in bed is which of the following?  |

|   virulence  |

|  pathogenicity  |

|   immunogenicity  |

|  infectivity  |

|Correct answer: |

|virulence |

|  |

|Virulence is the severity of disease that an organism can produce, measured by criteria such as number of days in bed or the frequency of serious |

|sequelae including death (fatality rate). |

|  |

| Question 89  |

|A patient receives another person's medication in error. This was done by an LPN in the office and did not result in a life-threatening situation for |

|the patient. What is an appropriate way for the nurse practitioner to document this?  |

|  Patient received wrong medication. Incident report was filed. LPN was disciplined.  |

|   X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified.  |

|   LPN inadvertently administered Y drug to the wrong patient. Supervisor notified. Family threatening litigation.  |

|  Patient was given X mg of Y drug in error.  |

|The Correct answer is: |

|X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified  |

|Documenting, "X mg of Y drug was administered to the patient. No adverse effects were noted. Physician notified," is the most accurate note because it |

|is factual. Also, with this noted documentation, the writer is avoiding blame or assuming liability. The other notes, identified in the remaining |

|answer choices, would be "red flags" mentioning error, litigation, and incident report. |

|  |

|Question 90  |

|The first change for a male that is associated with the onset of puberty is which of the following?  |

|  pubic hair development  |

|  penile growth  |

|   testicular enlargement  |

|  general growth spurt  |

|Correct answer: |

|testicular enlargement |

|  |

|The first change is testicular enlargement. This is followed by pubic hair development. Penile growth occurs approximately 6 – 12 months after |

|testicular enlargement; and growth spurt begins about 1 year after the first testicular change. |

|  |

| Question 91  |

|A patient who has had a TIA has been prescribed Ticlopidine. You understand that this is because the patient has an intolerance to which of the |

|following?  |

|   aspirin  |

|  eggs  |

|   dairy  |

|  warfarin  |

|  |

| Correct answer: |

|aspirin |

|  |

|Ticlopidine is reserved for patients with aspirin intolerance and requires close monitoring of CBC. This allows platelets to be inhibited even if the |

|person is intolerant to aspirin. |

|  |

| Question 92  |

|Which of the following diseases is most likely to be associated with college students living in dormitories?  |

|    meningococcemia  |

|  Hidradenitis suppurativa  |

|   acute cellulitis  |

|  candidiasis  |

| Correct answer: |

|meningococcemia |

|  |

|  |

|Meningococcemia is a serious life-threatening infection that is spread by respiratory droplets. College students living in dorms are a higher risk. It |

|is associated with 20% mortality. If treated early, however, mortality is less than 5%. |

|  |

|Question 93  |

|In which of the following diseases would you be most likely to have a BUN:Cr ratio of >20:1? |

|  |

|  acute interstitial nephritis  |

|   acute tubular necrosis  |

|   acute glomerulonephritis  |

|  none of the above  |

|Correct answer: |

|acute glomerulonephritis |

|  |

|With acute glomerulonephritis the BUN:Cr ration will be >20:1. Urinalysis will show renal casts, and RBCs. |

|  |

|Question 94  |

|The FNP has a 60-year-old female patient with varicose veins. The FNP would tell the patient that to minimize the symptoms and disease progress she |

|should do all but which of the following?  |

|  Attain and maintain a normal weight.  |

|   Buy and wear light weight support hose that can be found in department stores.  |

|  Elevate legs periodically.  |

|  Avoid wearing constricting garments such as girdle and garters.  |

|Correct answer: |

|Buy and wear light weight support hose that can be found in department stores. |

|  |

|The FNP would not tell this patient to buy and wear light weight support hose that can be found in department stores. These types of support hose do |

|not supply enough compression. The use of medium-weight to heavy-weight support hose such as Jobst stockings would be encouraged. |

|  |

|Question 95  |

|The FNP has a patient with cardiac problems who prefers canned vegetables to fresh or frozen. Which of the following nutrients should the FNP caution |

|against in regard to canned vegetables?  |

|  vitamin E  |

|   sodium  |

|  potassium  |

|  none of the above  |

|  |

|Correct answer: |

|sodium |

|  |

|Canned vegetables, even low-sodium types, have higher sodium levels than fresh or frozen vegetables. The other choices are not concerns in canned |

|vegetables. |

|  |

|Question 96  |

|You are treating a female patient with pyelonephritis with fluoroquinolone. The nurse practitioner knows that with fluoroquinolone use, length of |

|antimicrobial therapy during uncomplicated pyelonephritis is typically:  |

|  3 days  |

|   7 days  |

|  14 days  |

|  20 days  |

|The Correct answer is: |

|7 days |

|First line therapy includes TMP-SMX or fluoroquinolones. The dosage should be at least 7 days to eradicate the uropathogen. Short-course therapy is not|

|recommended.  |

|  |

|Question 97  |

|The most common presenting sign of bladder cancer is which of the following? |

|  |

|   gross painless hematuria  |

|  painful urination  |

|   frequent urination  |

|  abdominal mass  |

|  |

|Correct answer: |

|gross painless hematuria |

|  |

|Gross painless hematuria is the most common presenting sign of bladder cancer. Irritative voiding symptoms and urinary frequency without fever are |

|reported occasionally. Abdominal mass is palpable only with advanced disease. |

|  |

|Question 98  |

|In counseling a young mother about sleeping habits for toddlers, which of the following statements is true?  |

|  One to 3-year-old children usually sleep 8 hours at night and no longer take naps.  |

|   Toddlers need security objects like a stuffed animal to sleep.  |

|   A toddler is too young to have nightmares.  |

|  A toddler no longer needs rituals before bedtime.  |

|Correct answer: |

|Toddlers need security objects like a stuffed animal to sleep. |

|  |

|A child of one to 3 years old usually sleeps 10 to 12 hours a night and takes 1 to 2 naps during the day. They need rituals and consistency at bedtime |

|as well as security objects in order to get to sleep. Nightmares can start at approximately three years |

|  |

| Question 99  |

|A written document between a physician and nurse practitioner outlining the nurse practitioner’s role and responsibility is called a(n):  |

|  clinical guideline  |

|  employment contract  |

|   utilization guideline  |

|   collaborative agreement  |

|Correct answer: |

|collaborative agreement |

|  |

|A collaborative agreement is a written document between a physician and nurse practitioner outlining the nurse practitioner’s role and responsibility |

|to the clinical practice. It must be signed by both and is usually submitted to the Board of Nursing. |

|  |

| Question 100  |

|Which of the following types of research is most likely to be considered a philosophy as well as a research method?  |

|   phenomenology  |

|  quasi experimental research  |

|   longitudinal research  |

|  cross-sectional research  |

|  |

|Correct answer: |

|phenomenology |

|  |

|Phenomenology is both a philosophy and a research method. The purpose is to describe experiences as they are lived and to capture the “lived |

|experience” of study participants.  |

 Quiz 2 anp

|Question 1  |

|The nurse practitioner (NP) understands that the following is NOT true regarding the care of minors:  |

|  In most jurisdictions, minors under the age of 18 cannot receive healthcare services without permission of an adult who is a parent or legal |

|guardian.  |

|   If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian.  |

|  In case of emergency, when no parent or guardian is available, care may be rendered.  |

|   If a 15-year-old becomes pregnant, she is an emancipated minor.  |

|  |

|The Correct answer is: |

|If a 17-year-old contracts a sexually transmitted disease, the nurse practitioner must contact the parent or legal guardian |

|A teen with a STD is considered an emancipated minor, and the parent or legal guardian should not be contacted.  The remaining answer choices are true |

|regarding the care of minors.  |

|  |

| Question 2  |

|You are conducting a health assessment with a patient. She tells you that she does not understand what will happen during the tests she will undergo |

|the next day. Which of the following is an appropriate nursing diagnosis for this patient?  |

|  Low health literacy.  |

|   Knowledge deficit.  |

|  Patient needs further education.  |

|  Patient does not understand care plan.  |

|  |

|Correct Answer: Knowledge deficit It is key to note that the patient does not fully understand the tests or procedures prescribed. The next step should|

|be to provide patient education. Patients who are educated about tests and care protocols have been shown to have much higher rates of compliance, and |

|proper education also empowers patients.  |

|  |

|Question 3  |

|Which of the following tests is used to measure lower esophageal sphincter (LES) tone?  |

|   Bernstein test  |

|   barium swallow radiograph  |

|  Barrett test  |

|  none of the above  |

|  |

|Correct answer: |

|Bernstein test |

|  |

|The Bernstein test measures the LES competence. The Bernstein test is a method to reproduce symptoms of heartburn. It is usually done with other tests |

|to measure esophageal function. |

|  |

|Question 4  |

|You are treating a 48-year-old male who is suffering with alcoholism. The first most helpful approach for him is:  |

|  Inform the patient of the long-term health consequences of alcohol abuse.  |

|  Tell the patient to stop drinking.  |

|   Refer the patient to Alcoholics Anonymous.  |

|   Counsel the patient that alcohol abuse is a treatable disease.  |

|  |

|The correct answer is: |

|Counsel the patient that alcohol abuse is a treatable disease |

|The first approach for the nurse practitioner is to counsel the patient and family that alcoholism is a lifelong but treatable disease. In addition, |

|asking about current drinking habits and associated consequences to health with each visit is important and are appropriate next steps. Then, the |

|remaining answer choices are also important interventions after the nurse practitioner counsels the patient and the family regarding alcoholism as a |

|treatable disease.  |

|Question 5  |

|A 44-year-old Caucasian female is taking lovastatin for hyperlipidemia and complains of muscle aches in her thighs and right calf for three days |

|without improvement. She has been on the medication for 3 months. What should the nurse practitioner do first?  |

|  Check bilirubin enzymes.  |

|   Order a CPK.  |

|  Ask about nighttime muscle cramps.  |

|   Stop lovastatin immediately.  |

|  |

|The Correct answer is: |

|Order a CPK |

|This patient has a complaint of myalgias that could be associated with statin use. This patient should be assessed for rhabdomyolysis by measuring the |

|creatine phosphokinase (CPK) level. If the CPK value is elevated, lovastatin should be stopped immediately. Nighttime cramps are not associated with |

|statin usage.  |

|  |

| Question 6  |

|You are providing care to a female patient who is 6 months pregnant. She is suffering from hemorrhoids. Which of the following may help alleviate her |

|discomfort?  |

|  Sleeping on her stomach.  |

|   Sleeping on her side.  |

|  Sleeping on her back.  |

|  Sleeping with the head slightly elevated.  |

|  |

|Correct Answer: Sleeping on her side For patients who are not pregnant, sleeping on the stomach can alleviate pressure on inflamed blood vessels that |

|lead to hemorrhoids. Pregnant patients should instead sleep on their side, as sleeping on the stomach can be uncomfortable especially in later stages |

|of pregnancy. Warm sitz baths may also help alleviate discomfort caused by hemorrhoids.  |

|  |

|Question 7  |

|When assessing a client for systemic lupus erythematosus (SLE), what ophthalmologic finding would the nurse practitioner find that would be consistent |

|with this diagnosis?  |

|   cotton-wool spots  |

|  arteriovenous (AV) nicking  |

|  retinal hemorrhages  |

|  conjunctivitis  |

|  |

|The Correct answer is: |

|Cotton-wool spots |

|Cotton-wool spots are the most common ophthalmological problems associated with systemic lupus erythematosus (SLE). Retinal hemorrhages and AV nicking |

|are seen in patients with hypertension. Additionally, conjunctivitis is an infection of the conjunctiva.  |

|  |

|Question 8  |

|According the CDC classification of overweight and obesity, a person with a BMI (kg/m2) of 27.0 would be classified as:  |

|  healthy weight  |

|   overweight  |

|  obese  |

|  extremely obese  |

|Correct answer: |

|overweight |

|  |

|Persons with a BMI (kg/ m2) of 25 – 29.9 are classified as overweight. A person of healthy weight would have a BMI of 18.5 – 24.9.  |

|Question 9  |

|Which of the following statements is TRUE concerning managed care today?  |

|  Managed care is declining in favor in the healthcare system of the United States.  |

|  The proportion of managed care revenue declined over the last 10 years.  |

|   More consumers are switching from HMOs to plans where there is more choice, less control by a gate keeping provider, and no prior approval for |

|referrals.  |

|  The monitoring of managed care plans by the American Nurses Association and the American Medical Association has contributed to their popularity.  |

|The Correct answer is: |

|More consumers are switching from HMOs to plans where there is more choice, less control by a gate keeping provider, and no prior approval for |

|referrals |

|Managed care now dominates healthcare in the U.S. and over 50% of revenue received by all physicians is from managed care. Managed care plans are |

|monitored by state and federal government, not the ANA and AMA. |

|  |

| Question 10  |

|An obese child's health is in danger from the weight. What will have an effect on the nutritional assessment?  |

|  Age.  |

|   Family and culture.  |

|  Medical history.  |

|  Chief complaint.  |

|  |

|Correct answer: Family and culture Eating habits are influenced by family and culture. This can be determined in the social assessment and family |

|interviews.  |

|  |

|Question 11  |

|Which of the following types of headache has a higher risk of suicide in males?  |

|   cluster headaches  |

|  migraine headaches  |

|  muscle tension headaches  |

|  temporal arteritis  |

|Correct answer: |

|cluster headache |

|  |

|A cluster headache is a sudden onset of severe “ice-pick” headaches behind one eye that occurs several times a day. The attacks happen at the same |

|times daily and the cause is unknown. There is a higher risk of suicide in males who have this type of headache as compared with the other types of |

|chronic headaches |

|  |

|Question 12  |

|What medication and dose can be used for abortive therapy in an adult client with symptoms of migraine headache?  |

|   ergotamine (Ergostat) 2 mg SL  |

|  ketorolac (Toradol) 100 mg IM  |

|  sumatriptan (Imitrex) 1 mg IM  |

|   amitriptyline (Elavil) 100 mg PO  |

|The Correct answer is: |

|Ergotamine (Ergostat) 2 mg SL |

|The dosing guideline for ergotamine (Ergostat) is 2 mg by mouth, sublingually. Further, additional treatment options for a migraine headache can also |

|include Ketorolac and Sumatriptan, as well as other medications. Depending on the patient's severity of symptoms and medical history, the following are|

|dosing guidelines providers can use to administer Ketorolac and sumatriptan. For Ketorolac, the provider can administer the drug intravenously or |

|intramuscularly before administering orally as a tablet. When taking Ketorolac orally, the dosing guidelines are 30-60 mg. The patient is given an |

|initial first dose of two 20 mg tablets. After the first dose, the patient is given one 10 mg tablet every 4-6 hours for up to 5 days. The dosing for |

|Ketorolac should not exceed 40 mg per day. Therefore, the answer choice stating "ketorolac (Toradol) 100 mg IM" is incorrect, as 100 mg is too high of |

|a dosage. Next, Sumatriptan (Imitrex) dosing guidelines include oral (25-200 mg daily) and subcutaneous injections (6-12 mg) administration, as well as|

|administration of the medication by a nasal spray (5-20 mg as 1 spray in each nostril and then up to 40 mg a day.) Therefore, the answer choice with |

|the dosing of 1 mg IM for sumatriptan (Imitrex) is incorrect. Then, amitriptyline is not used for abortive therapy. |

|   |

| Question 13  |

|For which of the following CPT codes is one descriptor and nothing further required for taking the history of an established patient?  |

|  99211  |

|   99212  |

|  99213  |

|  99214  |

|  |

|Correct answer: |

|99212        |

|  |

|Of the five levels of visit for an established patient, the 99212 level has the requirement of 1 descriptor for patient history.  |

|Question 14  |

|An elderly male has a diagnosis of left-sided congestive heart failure (CHF). The nurse practitioner would identify which of the following as a common |

|condition associated with CHF?  |

|   ventricular dysrhythmias  |

|  peripheral vascular disease  |

|   untreated hypertension  |

|  chronic obstructive pulmonary disease  |

|The Correct answer is: |

|Untreated hypertension |

|Untreated hypertension causes significant increased work of the left ventricle. Further, the years of untreated high blood pressure eventually causes |

|congestive heart failure (CHF).  |

|  |

| Question 15  |

|Which of the following tests would you order to confirm a diagnosis of strep throat?  |

|   Throat culture.  |

|  Sputum culture.  |

|  CBC.  |

|  Mono test.  |

|Correct Answer: Throat culture Throat culture is the classic diagnostic tool for strep throat. This test involves a swab of the throat. If the throat |

|culture does not reveal strep, other tests such as the mono test may be in order |

|  |

|Question 16  |

|The FNP is seeing a college-age female who participated in strenuous sports activities in high school. The FNP understands that all of the following |

|may be a risk for this patient EXCEPT:  |

|   menorrhagia  |

|  eating disorders  |

|  delayed menses  |

|   osteoporosis  |

|Correct answer: |

|menorrhagia |

|  |

|Menorrhagia (heavy menstrual bleeding) is not a common concern for women who take part in strenuous physical activity. Females who participate in |

|strenuous physical activities are at risk for eating disorders, delayed menses and osteoporosis. |

|  |

|Question 17  |

|You are dealing with a pregnant adolescent who is drinking alcohol. What should the nurse practitioner understand concerning this?  |

|   There is no level or time of exposure that is considered to be safe.  |

|  The risk to the fetus from alcohol exposure is greatest during the third trimester.  |

|  This is not problematic since there is not an increased risk of miscarriage.  |

|  The risk of fetal alcohol syndrome exists only if the patient consumes alcohol during the entire pregnancy.  |

|The Correct answer is: |

|There is no level or time of exposure that is considered to be safe. |

|Fetal alcohol syndrome (FAS) occurs more commonly in infants whose mother drinks during pregnancy. This condition is preventable and no safe level of |

|maternal alcohol ingestion during pregnancy exists. FAS can occur if alcohol is ingested at any time during the pregnancy and miscarriage is a risk. |

|Therefore, the pregnant female does not need to drink during the entire pregnancy for FAS to occur.  |

|  |

|Question 18  |

|A 65 year old female patient's records indicate that her pap smears have been negative for the past 15 years. How may you alter her physical exam?  |

|  Perform a pap smear every year.  |

|   Do not perform a pap smear.  |

|  Begin testing for Chlamydia.  |

|  Perform a breast exam.  |

|Correct answer: Do not perform a pap smear It may be possible to suspend pap smears after a patient turns 65. She must have at least 10 years of |

|negative results to cease the screening for cervical cancer.  |

|  |

|Question 19  |

|You are working in an urgent care clinic within a hospital emergency department. A patient without insurance arrives who has a puncture wound caused by|

|an unknown sharp object in a trash container. A dirty needle is suspected. The nurse practitioner should: |

|  |

|   administer a tetanus injection only since the patient has no insurance  |

|   prescribe appropriate mediations for HIV exposure even though the patient has no resources to buy them  |

|  not mention the possibility of HIV from a contaminated needle  |

|  offer to buy the HIV medications for the patient and use your employee discount at the pharmacy  |

|The Correct answer is: |

|Prescribe appropriate mediations for HIV exposure even though the patient has no resources to buy them |

|The standard of patient care should be followed by the nurse practitioner. This measure should not be altered depending on the patient's insurance and |

|financial status. It is unethical to not properly inform this patient of the risks involved for being exposed to a contaminated needle. You should |

|prescribe the medications and refer them to social services or a community resource agency for assistance. Buying the medications for the patient with |

|an employee discount is unethical and should not be done.  |

|Question 20  |

|Which of the following drugs that might be prescribed for a patient with asthma and chronic obstructive pulmonary disease (COPD) is not used |

|specifically for treatment and prevention of bronchospasm?  |

|   theophylline  |

|   Singulair  |

|  Atrovent  |

|  Spiriva  |

|  |

|Correct answer: |

|Singulair |

|  |

|All of the medications might be used for treatment and prevention of bronchospasm except Singulair. This drug is a leukotriene receptor antagonist that|

|inhibits the action of the inflammatory mediator (leukotriene) by blocking select receptor sites. it is a controller drug used to prevent inflammation.|

| |

|  |

|Question 21  |

|The FNP is communicating with a patient about controlling her blood sugar. The patient tells the FNP that she is afraid that she will have to take |

|insulin shots soon. Which of the following statements would demonstrate using the therapeutic communication technique of reflection?  |

|   What would it be like for you to have to take insulin shots every day?  |

|  If that is necessary a specialist will show you just what to do.  |

|  Maybe you should be more vigilant about your diet.  |

|  Don’t worry. That’s not likely to happen.  |

|  |

|Correct answer: |

|What would it be like for you to have to take insulin shots every day? |

|  |

|In using reflection, the FNP takes one or two words said by the patient to reflect back to the patient for consideration. By asking her, “What would it|

|be like for you to have to take insulin shots every day?” the FNP is using reflection. |

|  |

|Question 22  |

|There are many barriers to the electronic medical record. The NP understands that which of the following is NOT one of these issues?  |

|  technical matters: uncertain quality, ease of use, lack of integration  |

|   potential for streamlining and automating workflow  |

|  financial matters: maintenance, upgrades, replacement  |

|   doubts of clinical usefulness  |

|The correct answer is potential for streamlining and automating workflow.  Streamlining and automating the workflow is considered a benefit of the |

|electronic medical record, not a barrier. Other barriers include resource issues (training and re-training), certification, security, and ethical |

|matters. |

|  |

|Question 23  |

|The mother of an infant calls and says that her son has a fever. He is also sleeping more and difficult to wake up. What is the appropriate advice?  |

|  Give the child baby aspirin.  |

|  Monitor the child overnight.  |

|   Bring the child to the emergency room.  |

|  Call in a prescription.  |

|  |

|Correct answer: Bring the child to the emergency room A high fever and lack of responsiveness can indicate a serious condition in a infant. He should |

|be seen as soon as possible.  |

|  |

|Question 24  |

|You evaluate a 52-year-old female with rheumatoid arthritis who has an abnormal hemogram. Her results include: |

|Hgb  =    9.8 g |

|Hct    =    32% |

|MCV  =    86 fL |

|These results are most consistent with which type of anemia?  |

|  folate-deficiency anemia  |

|  iron-deficiency anemia  |

|  sickle cell anemia  |

|   anemia of chronic disease  |

|  |

|The Correct answer is: |

|Anemia of chronic disease |

|Anemia is defined as a decrease in the oxygen-carrying capability of the blood. This condition is not a 'disease' but rather a sign or symptom of an |

|underlying process. With anemia of chronic disease, you will find normal size red blood cells (RBCs) but low hemoglobin (Hgb) and hematocrit (Hct) |

|levels. Mean corpuscular volume (MCV) is often normal. With folate-deficiency anemia, MCV is often elevated. With iron-deficiency anemia, MCV is often |

|low. Sickle cell anemia results in abnormal shape of cells |

|  |

|Question 25  |

|The earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers is:  |

|  age 2 years  |

|  age 3 years  |

|   age 4 years  |

|   age 5 years  |

|  |

|The Correct answer is: |

|Age 5 years |

|Common developmental tasks for the 5-year-old child would include the ability to draw a person with a body, head, and arms and recognize most letters |

|and print some. Further, the child knows how to skip, copy a triangle, count on fingers and knows colors.  |

|Question 26  |

|If a mother asks the FNP when her toddler should be toilet trained, which of the following would be the best response?  |

|  Most children should be toilet trained at about two year of age.  |

|  Do not start toilet training until the child is over three years of age.  |

|   When the child has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he is |

|ready.  |

|  none of the above  |

|  |

|Correct answer: |

|When the child has sphincter control, the ability to delay immediate gratification, and an understanding of the task of toilet training, then he is |

|ready. |

|  |

|A child is ready for toilet training on his own readiness scale. When he has sphincter control, the ability to delay immediate gratification, and an |

|understanding of the task of toilet training, then he will be ready. To do it any sooner will be frustrating to the child and parent. |

|Question 27  |

|Which of the following suggests that a patient may be abusing alcohol? |

|  |

|  rhinophyma, hypotension, peripheral neuropathy  |

|  telangiectasias, flat affect, thyroid dysfunction  |

|  hepatosplenomegaly, murmur, osteoarthritis  |

|   macrocytosis, tremulousness, hypertension  |

|  |

|The Correct answer is: |

|Macrocytosis, tremulousness, hypertension |

|Findings that would cue the nurse practitioner that a patient was abusing alcohol are tremors, hypertension, rhinophyma, peripheral neuropathy, |

|telangiectasias or hepatosplenomegaly. The patient may not exhibit all of these symptoms at one time however. Further, the patient will have |

|macrocytosis because there is a high rate of B12 and folate deficiency among these patients.  |

|  |

|Question 28  |

|When choosing a blood pressure cuff for a young child, what size should it be?  |

|   2/3 upper arm.  |

|  All of the upper arm.  |

|  1/2 upper arm.  |

|  You do not use a blood pressure cuff.  |

|  |

|Correct answer: 2/3 upper arm Children do need their blood pressure taken occasionally. The cuff should not be any larger than 2/3 the size of the |

|child's arm. Because this varies with age, and exact size is not given |

|  |

|Question 29  |

|An elderly patient presents with fever, left lower quadrant abdominal pain and diarrhea. Which of the following BEST describes the symptoms the patient|

|is experiencing?  |

|  Acute hepatitis.  |

|  Iron deficiency anemia.  |

|  Testicular cancer.  |

|   Diverticulitis.  |

|  |

|Correct answer: Diverticulitis Diverticulitis is when the colon secondary consists of puchlike hernias. These hernias are caused by the lack of dietary|

|fiber. |

|  |

|Question 30  |

|Communication would be a part of which of the following fundamental domains? |

|   cognitive  |

|   psychological and social  |

|  physical  |

|  none of the above  |

|Correct answer: |

|cognitive |

|  |

|The cognitive domain includes communication, the receptive and expressive language. It also includes perception, thinking, information processing and |

|memory. |

|Question 31  |

|A 54-year-old man presents with a 4-month history of upper abdominal pain, which he describes as intermittent and centrally located. He complains of a |

|burning sensation in the epigastric area, most often with meals and often accompanied by mild nausea. The use of over-the-counter antacids, like Maalox|

|and Tums, have been ineffective. The patient's clinical presentation is most consistent with:  |

|  acute colonic diverticulitis  |

|   duodenal ulcer  |

|   gastric ulcer  |

|  acute gastroenteritis  |

|The Correct answer is: |

|Gastric ulcer |

|The clinical presentation of gastric ulceration includes pain often reported with or immediately after a meal. The associated symptoms for gastric |

|ulceration are nausea, vomiting and weight loss. The male to female ratio for individuals with a gastric ulcer is equal. Further, the peak incidence |

|for patients with a gastric ulcer is in the fifth and sixth decades of life.  |

|  |

| Question 32  |

|Of the following drugs prescribed, which is a cholinesterase inhibitor that comes in the form of a pill or syrup only?  |

|   Galantamine.  |

|  Hydrocodone.  |

|   Rivastigmine.  |

|  Donepezil.  |

|  |

|Correct answer: Galantamine There are three cholinesterase inhibitors commonly prescribed by doctors. These are Donepezil, Galantamine and |

|Rivastigmine. Hydrocodone is a type of medication that treats moderate to severe pain as well as cough.  |

|  |

|Question 33  |

|Of the following choices, which describes the Kernig sign?  |

|   Elicited with the patient lying supine and the hip flexed 90 degrees, pain presents when extension of the knee occurs.  |

|  The headache worsens when lowering the patient from sitting to supine positioning.  |

|  Neck pain occurs with passive flexion of one hip and knee, which causes flexion of the contralateral leg.  |

|   Passive neck flexion in a supine position where the patient progresses to a flexion of the knees and hips.  |

|The Correct answer is: |

|Elicited with the patient lying supine and the hip flexed 90 degrees, pain presents when extension of the knee occurs |

|To eliminate or support the diagnosis of meningitis, the practitioner may want to assess for Kernig sign. Kernig sign is suggestive of nuchal rigidity |

|and meningeal irritation. The Kernig sign is elicited when the patient is in a supine lying position and the hip is flexed at 90 degrees. A positive |

|sign is present when extension of the knee results in resistance or pain is experienced in the lower back or posterior thigh.  |

|  |

|Question 34  |

|A patient comes to the clinic for a skin examination because of a “mole” that has been concerning her. She asks the FNP if this could be a melanoma. |

|The FNP understands that all of the following are signs that the lesion could be a melanoma EXCEPT:  |

|  It is asymmetric with non-matching sides.  |

|  Its borders are irregular.  |

|   It is of a uniform black or brown color.  |

|  Its diameter is larger than 6 mm.  |

|Correct answer: |

|It is of a uniform black or brown color. |

|  |

|All of the choices are correct except this one. One of the signs that a lesion may be a malignant melanoma is that the color is not uniform brown, |

|black, red, white, or blue. Another sign is that it is an evolving lesion, either new or changing. |

|  |

|Question 35  |

|In which of the following cases would the FNP refer a patient to a specialist for low back pain? A patient with:  |

|  acute neck pain  |

|   bladder dysfunction  |

|  reduced range of movement  |

|   stiffness  |

|Correct answer: |

|bladder dysfunction |

|  |

|If the patient has a bladder dysfunction, or a limb or bowel dysfunction, prompt referral to a specialist is needed. Surgery is usually considered only|

|if severe symptoms persist beyond 3 months. |

|  |

|Question 36  |

|In males, puberty is considered precocious if it occurs before:  |

|  12 years of age  |

|   9 years of age  |

|  14 years of age  |

|  10 years of age  |

|  |

|Correct answer: |

|9 years of age |

|  |

|In boys, puberty starts at 9 years of age. It is considered precocious puberty if it begins before 9 years of age. In girls puberty starts at 8 years |

|of age and is considered precocious if it begins before 8 years of age. |

|  |

|Question 37  |

|When the FNP is examining a 12-month-old infant, about how much growth should she expect to see in head circumference, as compared to the infant's head|

|circumference at birth?  |

|   3 cm  |

|  6 cm  |

|   12 cm  |

|  18 cm  |

|  |

|Correct answer: |

|12 cm |

|  |

|The typical head growth in the first year of life is 12 cm: 6 cm in the first 3 months; 3 cm in the 4th to 6th months; and 3 cm in the 6th to 12th |

|months. Subsequent head growth is about 0.5 cm/year for 2 – 7 year olds and 0.3 cm/ year for 8 – 12 year olds. |

|  |

|Question 38  |

|A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for Type II diabetes mellitus. What should be done to manage |

|him FIRST? |

|  |

|   Start insulin  |

|  Start metformin plus pioglitazone  |

|  Have him return tomorrow to recheck his blood glucose  |

|   Start metformin  |

|  |

|The Correct answer is: |

|Start insulin |

|The patient can be diagnosed with diabetes if his glucose exceeds 200 mg/dL and he is symptomatic. Most oral agents will have little effect on his |

|glucose and it should be lowered immediately. Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a chance to |

|work. He should return to the clinic the next day for a recheck of the blood glucose and medication adjustment.  |

|  |

|Question 39  |

|A patient who has been prescribed Amitiza for IBS should be advised to seek immediate medical attention if she experiences which of the following?  |

|   Difficulty breathing.  |

|  Nausea.  |

|  Dry mouth.  |

|  Dizziness.  |

|  |

|Correct Answer: Difficulty breathing Patients taking Amitiza may experience difficulty breathing within 30 to 60 minutes of taking a dose. This is |

|often not serious. However, it is difficult to tell this from a more serious reaction. Therefore, immediate medical attention should be sought.  |

|  |

|Question 40  |

|You are managing a 74-year-old patient who has osteoarthritis and chronic pain. Which of the following medications increases the risk of a |

|gastrointestinal related ulceration?  |

|  warfarin  |

|   celecoxib  |

|  pravastatin  |

|  thiazide diuretic  |

|  |

|The Correct answer is: |

|Celecoxib |

|Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Further, NSAIDs increase the risk of upper and lower gastrointestinal ulcerations. Warfarin|

|does not increase the risk of ulceration, but if one occurs, the risk of bleeding is increased. Statins and diuretics are not considered ulcerogenic. |

|  |

|Question 41  |

|When managing the respiratory patient, the nurse practitioner knows that all of the following antimicrobial strategies help facilitate the development |

|of resistant pathogens EXCEPT:  |

|  prescribing a broader spectrum agent  |

|   higher antimicrobial dosage  |

|   lower antimicrobial dosage  |

|  longer course of therapy  |

|The Correct answer is: |

|Higher antimicrobial dosage |

|Factors that facilitate the development of resistant microbes include repeated exposure to a given agent, underdosing, and unnecessarily prolonged |

|period of treatment. Shorter course high-dose therapy maximizes and exploits concentration-dependent killing by achieving higher maximum concentration |

|and area under the curve/minimal inhibitory concentration values.  |

|  |

| Question 42  |

|You are counseling a mother whose child is receiving the Varicella vaccine (VZV). Which of the following statements would be appropriate?  |

|  "Your child will never have a breakout of the chickenpox."  |

|   "Mild cases of chickenpox have been reported in immunized patients."  |

|  "Children must have a varicella titer drawn before they receive this vaccine."  |

|  "The vaccine delivers killed varicella virus to the recipient."  |

|  |

|The Correct answer is: |

|Mild cases of chickenpox have been reported in immunized patients |

|The varicella vaccine contains attenuated virus and is administered in two doses, one at age one and the other at age 4 to 6 years. The vaccine is |

|highly protective against severe, invasive varicella, however, mild forms of chickenpox are occasionally reported after immunization. Children do not |

|need a titer prior to receiving this vaccine. |

|  |

|Question 43  |

|The FNP has a 64-year-old female patient who inquires about the Zoster vaccine for shingles. The FNP might tell her all of the following EXCEPT:  |

|  The vaccine is prepared from a live, attenuated strain of varicella-zoster virus.  |

|   Reactivation of the varicella virus is not related to a decline in varicella-zoster virus-specific immunity.  |

|  The use of zoster vaccine significantly reduces the risk of shingles.  |

|  The vaccine should be used even with a history of shingles.  |

|  |

|Correct answer: |

|Reactivation of the varicella virus is not related to a decline in varicella-zoster virus-specific immunity. |

|  |

|This statement is incorrect. Reactivation of the varicella virus seems to be related to a decline in varicella-zoster virus-specific immunity. |

|Therefore, the use of zoster vaccine significantly reduces shingles risk. |

|  |

| Question 44  |

|In a pregnant woman if there is vaginal bleeding and cramping and the cervix remains closed it is which of the following types of spontaneous |

|abortions?  |

|  inevitable abortion  |

|   threatened abortion  |

|   complete abortion  |

|  incomplete abortion  |

| |

|Correct answer: |

|threatened abortion |

|  |

|In a threatened abortion there is vaginal bleeding and cramping but the cervix remains closed. The pregnancy may be able to be salvaged. |

|  |

|Question 45  |

|An 81-year-old female is in the office.  She has been taking ibuprofen over-the-counter in large dosages for a long time. The nurse practitioner |

|comprehends which side effect is likely regarding this situation?  |

|   impairment of renal function  |

|  liver failure  |

|  neuropathy  |

|  none of the above  |

|The Correct answer is: |

|Impairment of renal function |

|The elderly patient has impaired renal function already and ibuprofen can further impair the kidneys. This in turn can result in nephrosis, cirrhosis, |

|and congestive heart failure. |

|  |

|Question 46  |

|Which of the following cognitive development factors would be the least likely to be associated with preschooler growth and development?  |

|   preconceptual thinking  |

|   conservation  |

|  animism  |

|  egocentrism  |

|Correct answer: |

|conservation |

|  |

|Conservation of number, mass and volume is understanding that a certain aspect or quality of an object can change in appearance without changing the |

|object itself. It is a factor in the cognitive development of school-aged children, not preschool children. |

|  |

|Question 47  |

|A teenage patient comes in with a cut to the hand that requires stitches. When you check his medical records, you find that he had his immunizations |

|for school. The immunizations include DTaP. What action should you take?  |

|  Treat the hand and give a tetanus booster.  |

|  Treat the hand and give a diphtheria booster.  |

|   Treat the hand.  |

|  Give a tetanus and diphtheria booster.  |

|Correct answer: Treat the hand The DTaP booster is the diphtheria-tetanus-acellular pertussis vaccine. The patient is up to date on his vaccinations. |

|It is only necessary to treat the hand.  |

|  |

|Question 48  |

|The FNP is advising the mother of a 2-year-old child about the child’s intake of fat in her diet. The FNP knows that the percentage of the daily total |

|intake of fat for this child should be no more than which of the following?  |

|  10%  |

|   25%  |

|   30 - 35%  |

|  40 - 50%  |

|Correct answer: |

|30 - 35% |

|  |

|Toddlers can have a higher fat level in their diet than older children. Thirty to thirty-five percent is acceptable for nutrition and digestive needs. |

|  |

| Question 49  |

|You are providing care to a female patient who reports having 8 to 10 migraine headaches per month. Which of the following would you prescribe to help |

|prevent migraines in this patient?  |

|   Luvox.  |

|  Demerol.  |

|   Maxalt.  |

|  Mobic.  |

|:  |

|Correct Answer: Luvox Some antidepressants or anti-anxiety drugs can also help prevent migraines. Luvox is one that is commonly prescribed. The other |

|choices listed may help treat the pain associated with migraines, but will not prevent them. Given the frequency of the patient's migraines, some type |

|of preventative medication may be appropriate.  |

|  |

|Question 50  |

|A 25-year-old obese Caucasian male had an acute onset of pain that descends down to the lower leg and foot. The nurse practitioner understands that |

|this is most likely:  |

|  osteomyelitis  |

|   herniated intervertebral disk injury  |

|  lumbosacral strain  |

|  osteoporosis  |

|  |

|The Correct answer is: |

|Herniated intervertebral disk injury |

|A herniated intervertebral disk injury results in pain that descends to the lower leg and foot. Lumbosacral strain causes pain in the back buttock, and|

|sometimes the thigh. Osteomyelitis is usually preceded by an event that permits an infectious agent to enter the bone. Osteoporosis occurs most often |

|in postmenopausal women.  |

|  |

|Question 51  |

|For alcohol withdrawal symptoms, the preferred benzodiazepine is lorazepam. This is used when there is concomitant history of:  |

|  folate-deficiency anemia  |

|   hepatic disease  |

|   seizure disorder  |

|  multiple substance abuse  |

|The Correct answer is: |

|Hepatic disease |

|Librium or Valium are good therapeutic agents for patients with adequate hepatic function. However, lorazepam is the preferred agent for those with |

|impaired hepatic function because of its short half life.  |

|  |

|Question 52  |

|Which of the following is the correct laboratory norm for Mean Corpuscular Hemoglobin Concentration (MCHC)?  |

|  100 – 200 g/dL  |

|  50 – 100 g/dL  |

|   31.0 – 37.0 g/dL  |

|  21.0 – 27.0 g/dL  |

|Correct answer: |

|31.0 – 37.0 g/dL |

|  |

|MCHC is a measure of the average color of the RBCs in a sample of blood. It is decreased in iron deficiency anemia and thalassemia and normal in the |

|macrocytic anemias. The normal is 31.0 – 37.0 g/dL.  |

|  |

|Question 53  |

|Piaget’s cognitive development theory includes all of the following EXCEPT:  |

|  sensorimotor  |

|   postoperational thinking  |

|   concrete operations  |

|  formal operations  |

|  |

|Correct answer: |

|postoperational thinking |

|  |

|Piaget’s cognitive development theory focuses on intellectual changes which occur in a sequential manner as a result of continuous interaction with the|

|environment. The stages are: sensorimotor (infancy); preoperational thinking; concrete operations; and formal operations (involves logic, determines |

|possibilities, problem-solves and makes decisions). |

|  |

|Question 54  |

|Which of the following osteoporosis treatments stops bone loss but does not rebuild bone?  |

|  Fosamax  |

|  Evista  |

|   Teriparatide  |

|   Miacalcin  |

|  |

|Correct answer: |

|Miacalcin |

|  |

|Miacalcin (calcitonin salmon) stops bone loss but does not rebuild bone. It is a good choice for relief of bone pain from vertebral fractures. |

|  |

|Question 55  |

|Attachment is the enduring and specific affective bond that develops over the first year of life. The underlying emotion in an insecure-avoidant |

|attachment is which of the following?  |

|   anger  |

|  anxiety  |

|   love  |

|  confusion  |

|  |

|Correct answer: |

|anger |

|  |

|The underlying emotion in an insecure – avoidant attachment is anger. Love is the underlying emotion in a secure attachment. Anxiety/ambivalence is the|

|underlying emotion in an insecure – anxious attachment. Confusion/dysfunction is the underlying process in an insecure – disorganized attachment.  |

|  |

|Question 56  |

|The NP is discussing medications for insomnia with her elderly patient. The patient says she saw a commercial on TV about a drug that is commonly used |

|in adults but is known to cause amnesia and oversedation in the elderly. Which drug is the patient MOST likely referring to?  |

|  Barbiturates.  |

|   Benzodiazepines.  |

|   Zolpidem.  |

|  Zaleplon.  |

|  |

|Correct answer: Benzodiazepines Benzodiazepines have proven effective in treating insomnia in adults. However, elderly adults are not advised to take |

|this medication as it can cause disorientation and nausea, among other things.  |

|  |

|Question 57  |

|Severe hypoglycemia occurs when a patient’s blood glucose is:  |

|  < 100 mg/dL  |

|   < 50 mg/dL  |

|  > 50 mg/dL  |

|   < 80 mg/dL  |

|Correct answer: |

|< 50 mg/dL |

|  |

|Severe hypoglycemia occurs when the blood glucose is < 50 mg/dL. A patient will feel weak and may have a headache with clammy hands and anxiety. The |

|patient may also have difficulty in concentration and thinking. Severe hypoglycemia must be corrected immediately so that it does not progress to coma.|

| |

|  |

|Question 58  |

|A patient who has been prescribed Flomax should be advised to seek immediate medical attention if he experiences which of the following?  |

|   Fast heartbeat.  |

|  Runny nose.  |

|   Weakness.  |

|  Ejaculatory problems.  |

|  |

|Correct Answer: Fast heartbeat This is a potentially serious side effect of Flomax. Patients experiencing this should seek immediate medical attention.|

|Less serious side effects include runny nose, drowsiness, weakness, problems ejaculating, and blurred vision.  |

|Question 59  |

|Which of the following would you prescribe for a male patient who has difficulty urinating due to BPH?  |

|  Luvox.  |

|   Uroxatral.  |

|   Cialis.  |

|  Flagyl.  |

|  |

|Correct Answer: Uroxatral Uroxatral, or alfuzosin, is prescribed for men who have difficulty urinating due to BPH. Most patients experience relief of |

|symptoms within 2-3 weeks. Alfuzosin is approved only for use in men. |

|  |

|Question 60  |

|The NP is trying to determine whether her elderly patient's insominia is long term or short term. Of the following, which is NOT typically associated |

|with short term elderly insomnia?  |

|   Depression and anxiety.  |

|  Acute stress.  |

|   Medications.  |

|  Withdrawal of sedatives.  |

|  |

|Correct answer: Depression and anxiety There are various causes of insomnia in the elderly. While some may be the cause of short term insomnia and |

|others long term insomnia, long term insomnia is more common in the elderly than short term.  |

|Question 61  |

|The FNP has a patient who desires to quit smoking. She asks the FNP if there is anything that can help her in trying to quit. The FNP understands that |

|all of the following are true in regard to smoking cessation EXCEPT:  |

|  Bupropion, an atypical antidepressant, is used for smoking cessation.  |

|  Bupropion can be used with nicotine products such as gum or nasal sprays.  |

|   Bupropion is safe to use for persons with hypertension or seizures.  |

|  Nicotine patches should not be used with other nicotine products.  |

|Correct answer: |

|Bupropion is safe to use for persons with hypertension or seizures. |

|  |

|This is incorrect. Bupropion (Zyban) is contraindicated in persons with hypertension or a history of seizures.  |

|  |

| Question 62  |

|In terms of the musculoskeletal system, which of the following joint variants is characterized by “knock-knees”?  |

|   genu valgum  |

|  genu varum  |

|   genu recurvatum  |

|  none of the above  |

|  |

|Correct answer: |

|genu valgum |

|  |

|Genu valgum is characterized by “knock knees.” Genu varum is characterized by bowlegs. Genu recurvatum is characterized by a hyperextension or backward|

|curvature of the knees. |

| Question 63  |

|The physiologic occurrence represented by the rise of plasma glucose in the early morning hours is known as:  |

|  Somogyi effect  |

|  hypoglycemia  |

|   Dawn phenomenon  |

|  hyperglycemia  |

|  |

|Correct answer: |

|Dawn phenomenon |

|  |

|The Dawn phenomenon is a normal physiologic event in which the plasma glucose rises in the early morning. This is because of the reduction of tissue |

|sensitivity to insulin between 5 a.m. and 8 a.m. from physiologic spike of growth hormone. |

|  |

|Question 64  |

|Connor’s Abbreviated Parent-Teacher Questionnaire is used for which of the following?  |

|   behaviors  |

|  temperament  |

|   language  |

|  global development  |

|Correct answer: |

|behaviors |

|  |

|The Connor’s Abbreviated Parent-Teacher Questionnaire is used for behaviors. Another test of behaviors is the Achenbach’s Child Behavior Checklist |

|(ACBCL). |

|Question 65  |

|Which of the following vaccines would NOT be routinely recommended for patients with HIV?  |

|   live, attenuated oral polio vaccine  |

|  hepatitis B vaccine x 3  |

|   hepatitis A  |

|  Td every 10 years  |

|Correct answer: |

|live, attenuated oral polio vaccine |

|  |

|The live, attenuated oral polio vaccine should be avoided because of an increased risk of paralytic polio in immunocompromised vaccine recipients. If a|

|patient requires polio vaccination, clinicians should use the inactivated vaccine to avoid the risks of a live vaccine. |

| Question 66  |

|Certain claims are made on advertisements regarding medications, such as Drug X has been known to be in use for 6 years with over 2 million doses given|

|in North America and Great Britain. Drug X stops heartburn and upset stomach, prevents esophageal reflux and is the preferred treatment for GERD. The |

|nurse practitioner realizes that this claim is:  |

|  Valid; there are enough users mentioned who have had success for it not to be.  |

|   Invalid; the level of significance is not mentioned to be at the 0.05 level.  |

|  Valid; the cohort and Hawthorne effects are operating.  |

|   Invalid; there are no control or comparison groups, and no statistics are stated.  |

|The Correct answer is: |

|Invalid; there are no control or comparison groups, and no statistics are stated |

|Even if the claim details extensive use of this drug, Drug X, there must be valid statistics to provide evidence with the use of a control group that |

|will render a level of significance.  |

|  |

|Question 67  |

|All of the following persons were involved in the ethologic theory of human growth and development EXCEPT:  |

|  Konrad Lorenz  |

|   Carl Rogers  |

|   Harry Harlow  |

|  Mary Ainsworth  |

| |

|Correct answer: |

|Carl Rogers |

|  |

|Carl Rogers was a promoter of the humanistic theory of human growth and development rather than the ethologic theory. The other choices are those who |

|were involved in ethologic theories along with John Bowlby, Marshall Klaus and John Kennel. |

|  |

|Question 68  |

|In advising a new mother who is not able to breast feed about bottle feeding the FNP would tell her all but which of the following?  |

|  The amount of formula the infant needs at 0 to 1 month is about 2 – 4 oz. every 3 to 4 hours.  |

|  The amount of formula the infant needs at 2 – 4 months is about 5 – 7 oz. every 4 to 5 hours.  |

|   Iron-fortified formulas are best.  |

|   Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies.  |

|Correct answer: |

|Suggest partial hydrolysate formula if the infant is at risk for cognitive deficiencies. |

|  |

|The FNP would not tell the bottle-feeding mother this information. It is incorrect. The FNP would only suggest partial hydrolysate formula if the |

|infant is at risk for atopic diseases, for instance a strong family history of atopic disease. |

|  |

|Question 69  |

|Konrad Lorenz is best known for the theory that:  |

|   there are biologically-programmed periods (sensitive periods) predisposed for particular learning.  |

|  maternal separation and social isolation resulted in dramatic impairment of social-emotional development.  |

|   promoted rooming-in and father participation in the birth of a child.  |

|  neutral stimulus associated with a meaningful one over time leads to a “conditioned” response that can be elicited by neutral stimulus alone as |

|though it were the meaningful one.  |

|Correct answer: |

|there are biologically-programmed periods (sensitive periods) predisposed for particular learning. |

|  |

|Konrad Lorenz is best known for the theory that there are biologically-programmed periods (sensitive periods) predisposed for particular learning. It |

|is one of the many ethologic theories developed in the 20th century. |

|  |

|Question 70  |

|A patient has a family history of ovarian cancer and a genetic predisposition. What screening assessment is necessary?  |

|  Biopsy.  |

|   Pelvic exam.  |

|  Abdominal exam.  |

|  Breast exam.  |

|Correct answer: Pelvic exam There is not a specific screen for ovarian cancer. A pelvic exam may be required each year. A transvaginal ultrasound is |

|also effective. |

|  |

|Question 71  |

|In the treatment of the patient with polycystic ovary syndrome (PCOS), you know that the following are measures to manage this condition EXCEPT:  |

|  Exercise and weight loss will improve this condition.  |

|  Metformin (Glucophage) improves insulin sensitivity, lowers LH, lowers androgen, and improves fertility.  |

|   Estrogen excess leads to hyperinsulinemia in these patients.  |

|  Monthly Provera 10 mg daily for 10-14 days at the end of each month is recommended.  |

|The Correct answer is: |

|Estrogen excess leads to hyperinsulinemia in these patients |

|It is the androgen excess, and not estrogen excess, that leads to insulin resistance. In turn, the androgen excess spurs hyperinsulinemia and increases|

|the patient’s risk for diabetes mellitus. Polycystic ovary syndrome occurs when the menstrual cycle is interrupted. Also, patients with polycystic |

|ovary syndrome have elevated levels of androgen, which is a male hormone. With polycystic ovary syndrome, cysts emerge in the ovaries that contain |

|fluid. The fluid causes the sacs to get bigger. Further, polycystic ovary syndrome is triggered by too much luteinizing hormone (LH) produced by the |

|pituitary gland. The increased LH triggers the production of androgen, which in turns can cause metabolic syndrome to occur.  Polycystic ovary syndrome|

|is diagnosed based on the patient’s symptoms, blood tests to evaluate the hormone levels and in some cases ultrasonography. For females who do not want|

|to become pregnant, combination oral contraceptive containing estrogen and progestin may be prescribed to reduce the androgen levels. |

|  |

|Question 72  |

|Organized creation of beneficial change to attain unprecedented levels of performance is which of the following?  |

|  risk management  |

|   quality improvement  |

|   quality assurance  |

|  none of the above  |

|  |

|Correct answer: |

|quality improvement |

|  |

|Quality improvement is the organized creation of beneficial change to attain unprecedented levels of performance. It differs from quality assurance in |

|that it is continuous rather than episodic. |

|  |

|Question 73  |

|A patient presents in the office 3 weeks post-myocardial infarction (MI) complaining of pericardial pain and elevated temperature. Physical examination|

|reveals a pericardial friction rub. The nurse practitioner determines which of the following diagnostic studies are necessary? |

|  |

|  cardiac enzymes with myoglobin  |

|   complete blood count (CBC) with differential  |

|   echocardiogram  |

|  24-hour holter monitoring  |

|The Correct answer is: |

|Complete blood count (CBC) with differential |

|Post-myocardial infarction, also known as Dressler's syndrome, may develop 1 to 4 weeks after a myocardial infarction (MI). A post-myocardial |

|infarction is characterized by pericarditis with effusion and fever. Also, post-myocardial infarction or Dressler's syndrome is due to antigen-antibody|

|reactions. Laboratory findings for this condition include elevated white blood cell count and erythrocyte sedimentation rate.  |

|Question 74  |

|What is the significance of an S4 heart sound?  |

|  It is a marker of ventricular overload or systolic dysfunction or both.  |

|   It is a marker of poor diastolic function, most often found in poorly controlled hypertension or recurrent myocardial ischemia.  |

|  It marks the end of systole and is produced by events surrounding closure of aortic and pulmonic valves.  |

|   It marks the beginning of systole and is produced by events surrounding closure of the mitral and tricuspid valves.  |

|- |

|Correct answer: |

|It is a marker of poor diastolic function, most often found in poorly controlled hypertension or recurrent myocardial ischemia. |

|  |

|The S4 heart sound is a marker of poor diastolic function, most often found in poorly controlled hypertension or recurrent myocardial ischemia. It is |

|heard late in diastole, and can sound like it is “hooked on” to the front of S1. |

|  |

|Question 75  |

|A 15-year-old Caucasian male presents in the clinic with a reddened, pruritic rash. The nurse practitioner understands that the most common sites for |

|adolescent atopic dermatitis are: |

|  |

|  forehead, scalp, and cheeks  |

|  wrists, ankles, and cubital core  |

|   face, neck, back, and antecubital fossae  |

|  palmar creases and extensor surface of legs  |

|  |

|The Correct answer is: |

|Face, neck, back and antecubital fossae |

|In the adolescent and the young adult population, common sites for a pruritic rash are the popliteal and antecubital fossae, face, neck, upper arms and|

|back, dorsa of the hand, feet, fingers, and toes. |

|  |

|Question 76  |

|A patient in his 50s complains about a blurred vision when reading. What is this most likely to indicate?  |

|  Miagraines.  |

|   Age.  |

|  Tumor.  |

|  Poor diet.  |

|Correct answer: Age Eyesight typically decreases with age. Age is the most likely cause of poor nearsighted. The other answers are less likely than the|

|aging process.  |

|  |

|Question 77  |

|If a clinician is doing a research study that measures the impact of a fall prevention program on the number of falls among older adults it would be |

|which of the following types of research?  |

|   experimental research  |

|  descriptive research  |

|   historical research  |

|  correlational research  |

|Correct answer: |

|experimental research |

|  |

|Experimental research is research aimed at determining the effect of one or more variables. The fall prevention research falls into this category. For |

|a true experimental design to exist, the sample must be randomly selected; there must be manipulation of the independent variable by the researcher as |

|is usually seen in intervention studies; and there must be a control group. |

|  |

|Question 78  |

|An option to the injectable influenza vaccination is the nasal spray vaccine. It is important that the nurse practitioner understands to advise a |

|patient:  |

|  Its use is limited to children younger than 6 years.  |

|   This is the preferred method of immunization for persons who are allergic to eggs or egg products.  |

|   It contains a live, attenuated virus.  |

|  It is acceptable to use during pregnancy.  |

|The Correct answer is: |

|It contains live, attenuated virus |

|The nasal influenza virus contains influenza viruses that are sufficiently weakened as to be incapable of causing disease. However, the virus is strong|

|enough to stimulate a protective immune response. The influenza virus vaccine is indicated for individuals aged 2 to 49 years, if the individual is |

|healthy. The vaccine is contradicted in persons with egg allergy and pregnant women.  |

| Question 79  |

|Quality assurance is a system designed to evaluate and monitor quality of care. Which statement is NOT an accurate concerning quality assurance?  |

|  These programs identify components of structure, process and outcomes of care.  |

|   These programs look at organization effectiveness, efficiency and client and provider interactions.  |

|   These programs audit financial records and payroll of the organization to evaluate appropriateness of monetary distribution.  |

|  These programs promote responsibility and accountability to deliver high-quality care and assist in the evaluation and improvement of patient care.  |

|  |

|The Correct answer is: |

|These programs audit financial records and payroll of the organization to evaluate appropriateness of monetary distribution |

|Payroll and financial records of an organization are not evaluated and viewed in a quality assurance program. These programs are set up to evaluate and|

|monitor the care of patients by providers, ancillary staff, personnel and the facility in general.  |

|  |

| Question 80  |

|A woman who has been on hormone replacement therapy (HRT) is likely to have some possible improvement. Which of the following is one of these?  |

|   A decrease in the symptoms associated with menopause.  |

|   A reduction in the risk of dementia.  |

|  A reduction in the risk of osteoarthritis.  |

|  A reduction in the risk of endometrial cancer risk.  |

|The Correct answer is: |

|A decrease in the symptoms associated with menopause |

|As with all medication, the use of HRT comes with the possibility of adverse effects. There is no decrease in the risk of dementia or osteoarthritis. |

|There is a reduction of osteoporosis risk. Endometrial cancer risk, and not a reduction in the risk, with unopposed estrogen exists.  |

|  |

|Question 81  |

|Which of the following is likely to be an age-related issue for school-age children?  |

|  magical thinking  |

|  egocentrism  |

|   concern about being different  |

|   modesty  |

|  |

|Correct answer: |

|modesty |

|  |

|Modesty emerges in older school-age children. Magical thinking and egocentrism are related to the toddler years. Concern about being different relates |

|to adolescence.  |

|  |

|Question 82  |

|Assessing an elderly male you note an abnormality. Which of the following is not a common age-related change?  |

|  Arcus senilis  |

|  presbyopia  |

|   sustained nystagmus  |

|  sensitivity to glare  |

|The Correct answer is: |

|Sustained nystagmus |

|Sustained nystagmus is indicative of a neurologic complication. The other answer choices are associated with normal age-related changes.  |

|  |

|Question 83  |

|A 42-year-old male is in the clinic and has been diagnosed with peptic ulcer disease (PUD). The nurse practitioner (NP) understands that which of the |

|following would be prescribed as the initial treatment for this disease in an uncomplicated state.  |

|  doxepin (Sinequan) 25 mg at hs  |

|  pirenzepine 50 mg tid  |

|  clarithromycin 500 mg bid  |

|   omeprazole (Prilosec) 20 mg qd  |

|The Correct answer is: |

|Omeprazole (Prilosec) 20 mg qd |

|The goal of treatment for peptic ulcer disease (PUD) includes relief of pain, healing of the ulcer, and cost-effectiveness. A proton pump inhibitor |

|will heal 90% of duodenal ulcers after 4 weeks and 90% of gastric ulcers after 8 weeks. Doxepin and pirenzepine are anticholinergic drugs and are |

|limited by side effects and not used in the U.S. at this time. Clarithromycin is part of the eradication therapy to treat Helicobacter pylori |

|associated problems |

|  |

|Question 84  |

|The World Health Organization has put forth some precautions for use of combined oral contraceptive pills. According to WHO which of the following |

|medical situations would have NO restriction on use?  |

|  BMI ≥ 30  |

|   HIV  |

|   acute hepatitis  |

|  hypertension adequately controlled without vascular disease  |

|  |

|Correct answer: |

|HIV |

|  |

|A person with HIV would fall into Category 1 which has no restriction. The other choices fall either into Category 2, the advantages outweigh the risk;|

|Category 3, exercise caution; or Category 4, refrain from use. |

| Question 85  |

|The nurse practitioner understands that the pain experienced with angina pectoris or myocardial infarction is related to severe irritation of the |

|myocardial nerve fibers by an increase in which of the following:  |

|   lactic acid  |

|   serum potassium  |

|  serum magnesium  |

|  blood glucose  |

|The correct answer is: |

|Lactic acid   |

|When the myocardial cells are deprived of glucose from occlusion of the coronary arteries, aerobic metabolism does not occur. Therefore, lactic acid |

|accumulates and irritates the myocardial nerve fibers. This sends pain messages to the cardiac nerves and upper thoracic posterior roots located in the|

|left shoulder and arm |

|  |

|Question 86  |

|You are treating a 48-year-old male with recurring gout. The nurse practitioner knows that all of the following are treatment options during the acute |

|phase except:  |

|  indomethacin (Indocin) BID  |

|  colchicine 0.5mg, every hour until relief or until diarrhea occurs  |

|   naproxen sodium (Anaprox) BID PRN  |

|   probenecid  |

|  |

|The Correct answer is: |

|Probenecid |

|Indomethacin (Indocin), colchicine and naproxen sodium (Anaprox) are all treatments for the acute phase of therapy for gout. Probenecid and allopurinol|

|are two medications used for maintenance, control and prevention of gout, not treatment during the acute phase.  |

|  |

|Question 87  |

|When treating a female patient with an uncomplicated urinary tract infection but otherwise healthy, the nurse practitioner knows that the preferred |

|therapy is: |

|  |

|  amoxicillin  |

|  azithromycin  |

|   TMP-SMX  |

|  cephalexin  |

|  |

|The Correct answer is: |

|TMP-SMX |

|The first line medication therapy choice for an urinary tract infection is trimethoprim-sulfamethoxazole or TMP-SMX. TMP-SMX is a combination of drugs |

|such as Bactrim, Cotrim, or Septra. |

| Question 88  |

|The FNP has a 45-year-old male patient who presents with a sudden onset of facial asymmetry and she is unable to make any facial expression on the |

|affected side. If nothing else is found upon examination of this woman, which of the following cranial nerves is likely paralyzed?  |

|  CN II  |

|   CN III  |

|  CN VI  |

|   CN VII  |

|Correct answer: |

|CN VII |

|  |

|Cranial nerve VII is related to facial function. Dysfunction of this nerve gives the characteristic findings of Bell’s palsy (facial asymmetry, droop |

|of mouth, absent nasolabial fold, and impaired eyelid movement).  |

|  |

|Question 89  |

|Which of the following is a precursor lesion of squamous cell carcinoma?  |

|   actinic keratoses  |

|   Stevens-Johnson syndrome  |

|  erythrema multiforme  |

|  erythema migrans  |

|  |

|Correct answer: |

|actinic keratoses |

|  |

|Actinic keratoses are precursor lesions of squamous cell carcinoma. They appear as dry, red lesions with a rough texture and are usually located in |

|sun-exposed areas of skin such as the cheeks, nose, face, neck, arms and back. They are more common in light-skinned individuals |

|  |

|Question 90  |

|The levels of E/M services recognize four types of medical decision making. Which of the following is NOT one of these four types?  |

|  low complexity  |

|   high complexity  |

|   minimal  |

|  straightforward  |

|Correct answer: |

|minimal |

|  |

|The four types of medical decision making recognized by the levels of E/M services are: straightforward, low complexity, moderate complexity and high |

|complexity. Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option. |

|  |

|Question 91  |

|The nurse practitioner knows the following to be true of an advance directive EXCEPT:  |

|  Living wills are written documents prepared in advance in case of terminal illness or nonreversible loss of consciousness.  |

|   An advance directive must be created by an attorney for the patient in order for the advance directive to be a legal document.  |

|   The provisions of advance directives go into effect when the patient has become incompetent.  |

|  The provisions of an advance directives go into effect when the patient is declared terminally ill.  |

|The Correct answer is: |

|An advance directive must be created by an attorney for the patient in order for the advance directive to be a legal document |

|An advanced directive is a document that states the patient’s wishes or instructions associated with medical preferences if he or she is unable to make|

|competent decisions or is unconscious and cannot speak to consent to or refuse treatment. An advance directive can be a durable power of attorney, |

|living will or a healthcare proxy. An attorney does not have to create an advance directive for the patient. However, the advance directive has to be |

|notarized in some states or witnessed by one to two other competent individuals. The remaining answer choices are accurate statements regarding an |

|advance directive.  |

| Question 92  |

|There is suspicious S3 heart sound. Where is this heard?  |

|  Aortic area.  |

|   Pulmonic area.  |

|   Tricuspid area.  |

|  Bicuspid area.  |

|Correct answer: Pulmonic area The S3 heart sound is heard at the pulmonic area. It can be benign. It may also be a sign of a condition.  |

|  |

|Question 93  |

|In terms of the scope of practice for an NP, which of the following statements is incorrect?  |

|  The scope of practice defines a specific legal scope determined by state statutes, boards of nursing, educational preparation and common practice |

|within a community.  |

|  General scope of practice is specified in many published professional documents.  |

|   Prescriptive authority is recognized as within the scope of practice for nurse practitioners in all 50 states.  |

|   Scope of practice is always defined by state statutes enacted by the state legislature.  |

|Correct answer: |

|Scope of practice is always defined by state statutes enacted by the state legislature. |

|  |

|Some states define scope of practice by state statutes enacted by the state legislature. In other states, the legislature gives the board of nursing |

|the authority to define the scope of NP practice. Either way is enforceable. |

|  |

|Question 94  |

|Of the following topical corticosteroids, which one has the highest potency?  |

|   Temovate  |

|  Topicort  |

|   Elocon  |

|  Westcort  |

|Correct answer: |

|Temovate |

|  |

|Temovate is considered a topical corticosteroid with super-high potency. Topicort is considered high potency. Elocon has midrange potency. Westcort has|

|a low potency. |

|Question 95  |

|The blink reflex in an infant will typically disappear after:  |

|  3 months  |

|  6 months  |

|   9 months  |

|   12 months  |

|Correct answer: |

|12 months |

|  |

|The blink reflex is when the eyelids close in response to bright light. It disappears after 12 months. |

|Question 96  |

|Which of the following statements about Managed Care Organizations (MCOs) is false?  |

|  MCO is an umbrella term that may include HMOs and other forms of health plans.  |

|  MCOs reimburse primary care providers on a fee-for-service basis, a capitated basis or a combination of both.  |

|   MCOs do not credential providers; that is done by the federal government.  |

|  MCOs sell a priced package of health services to their clients.  |

|  |

|Correct answer: |

|MCOs do not credential providers; that is done by the federal government. |

|  |

|This is the false statement. MCOs do credential providers. They collect educational, license, malpractice, employment and certification data on each |

|provider and make a judgment that a provider is or is not adequately prepared to care for the MCO’s patients. |

|  |

| Question 97  |

|What is the lifetime risk to the average American man of having latent prostate cancer?  |

|  10%  |

|  3%  |

|   67%  |

|   40%  |

|  |

|Correct answer: |

|40% |

|  |

|The average American man has a 40% lifetime risk of latent prostate cancer. He also has an approximate 10% risk of clinically significant disease and |

|an approximate 3% risk of dying of prostate cancer. |

|Question 98  |

|A mother asks if her child can come out of the car seat. You are counseling the mother on the use of seat belts for her child. You anticipate that the |

|adult car seat belts fit correctly when the child is _____ tall and is _____ old.  |

|  40 inches |

|6 to 8 years  |

|  50 inches |

|5 to 6 years  |

|   59 inches |

|8 to 12 years  |

|  60 inches |

|13 to 15 years  |

|- |

|The Correct answer is: |

|59 inches |

|8 to 12 years |

|Children should be in a booster seat until they are 59 inches tall or 8 to 12 years of age. Children should remain in the back seat of the car until |

|they are age 13.  |

|  |

|Question 99  |

|Professional Standards of Practice exist in the nurse practitioner's workplace. Which of the following best describes these Standards of Practice?  |

|  They focus on the maximum levels of performance.  |

|  They are not necessary to legally describe standard of care, but necessary for licensure.  |

|   They are authoritative statements by which the quality of practice, service, or education can be judged.  |

|  The standards are exact for all levels of nursing.  |

|  |

|The Correct answer is: |

|They are authoritative statements by which the quality of practice, service, or education can be judged |

|Standards of Practice focus on the minimum levels of acceptable performance as a way of providing consumers with a means of measuring the quality of |

|care they receive. They may be generic and general, as well as precise and specific. They are used to legally describe the standard of care that must |

|be met by a provider.  |

|  |

|Question 100  |

|The following abbreviation does not have a substitute meaning for the electronic medical record (EMR):  |

|  EHR  |

|  CPR  |

|  EPR  |

|   EBR  |

|Correct answer: |

|EBR |

|The electronic medical record (EMR) is often referred to as the electronic health record (EHR), computer-based patient record (CPR) and the electronic |

|patient record (EPR). These terms are often used interchangeably in the healthcare community. EBR is not a known abbreviation related to electronic |

|records.  |

Quiz 15

quiz 15  aanp

Question 1 

The following are all true of tooth eruption in the child EXCEPT: 

  All 20 deciduous teeth are present by 3 years of age. 

   Shedding of the deciduous teeth begins at age 3 and continues through age 10. 

   Eruption of the first permanent teeth occurs with the first molars at age 6 years. 

  Delayed dentition is considered when no teeth have erupted by 13 months of age. 

The Correct answer is:

Shedding of the deciduous teeth begins at age 3 and continues through age 10 

Shedding of deciduous teeth begins at about 6 years of age. Additionally, the shedding of deciduous teeth continues through age 12 and not age 10. 

 

Question 2 

A 45-year-old female comes to the clinic reporting that she has had several episodes of a blue color in her fingertips accompanied by a tingling and numbness of these fingertips. The FNP diagnoses Raynaud’s phenomenon. Which of the following would the FNP NOT do for the patient suffering from this condition? 

  Tell her to stop smoking. 

  Tell her to avoid cold weather. 

   Prescribe Norvasc. 

   Prescribe Imitrex. 

Correct answer:

Prescribe Imitrex

 

Imitrex is a vasoconstricting drug. This is why it would not be prescribed for a person with Raynaud’s phenomenon.

 Question 3 

When treating the patient with COPD exacerbations, the nurse practitioner is aware that certain organisms are often associated with this process with advanced disease. Of the following, which is one?   

  Haemophilus influenzae 

  Staphylococcus aureus 

   Pseudomonas aeruginosa 

   Streptococcus pneumoniae 

The Correct answer is:

Pseudomonas aeruginosa

Common pathogens usually found in the presence of advanced disease and repeated exacerbations are Enterobacteriaceae spp. and Pseudomonas spp. Other organisms, such as Haemophilus influenzae and Streptococcus pneumoniae, are seen in the disease, but not in advanced cases. Staphylococcus aureus is not commonly seen in COPD cases. 

 

Question 4 

Your adult patient is showing a blood pressure reading of 185/115 mm Hg. You know that this is considered which of the following? 

  high normal 

  moderate hypertension 

   severe hypertension 

  very severe hypertension 

Correct answer:

severe hypertension

 

This is considered severe hypertension. Severe hypertension occurs when the systolic BP is 180 – 209 mm Hg and the diastolic BP is 110 – 199 mm Hg.

Question 5 

Which of the following statements about anxiety disorders is least accurate? 

   Panic disorders occur more frequently in men than in women. 

   Adult onset of OCD affects men and women equally. 

  Separation anxiety is a disorder unique to pediatric patients. 

  The usual onset of anxiety disorders is 25 – 30 years of age. 

Correct answer:

Panic disorders occur more frequently in men than in women.

 

This is the least accurate statement. Panic disorders occur more frequently in women than in men. Anxiety disorders such as panic attacks are one of the most common mental illnesses in the United States.

Question 6 

Which of the following stages of active labor is when the woman is most likely to be the least communicative? 

  prelabor 

   first stage 

   transition 

  third stage 

Correct answer:

transition

 

Transition is when contractions occur every 2 – 3 minutes and last 50 – 70 seconds. In transition, the woman is usually quite focused on getting through the birth process and may be distracted by the comments of others. This is the stage when she would be least communicative

 Question 7 

The FNP is treating an 18 month-old Hispanic male who has bluish black patches in the lumbosacral area. Bruising and child abuse have been ruled out. The diagnosis for this child would be which of the following? 

  Nevus flammeus 

   Mongolian spots 

  Erythema toxicum 

  seborrheic dermatitis 

Correct answer:

Mongolian spots

 

Mongolian spots occur in up to 80 to 90% of Black, Asian, Hispanic and Native American infants. They are blue to black-colored patches or stains that are commonly located in the lumbosacral area but can be located anywhere on the body. They usually fade by age 2 to 3 years.

 

Question 8 

Under the Final Rule of HIPAA all covered entities must do all of the following EXCEPT: 

   notify patients orally and face-to-face of their rights under the rules 

   appoint a privacy officer 

  conduct training for staff about policies 

  issue policies regarding handling of and protection of patient information 

 

Correct answer:

notify patients orally and face-to face of their rights under the rules

 

Under the Final Rule of HIPAA all covered entities must notify patient in writing of their rights under the rules. Patients must also authorize in writing any release of their individually identifiable information for marketing purposes.

 Question 9 

Which of the following laboratory procedures is most useful for helping with diagnosis of fungal infections of the hair, nails, or skin? 

  Tzanck smear 

   Gram stain 

  Whiff test 

   KOH slide 

 

Correct answer:

KOH slide

 

KOH (potassium hydroxide) slide is useful for helping with diagnosis of fungal infections. KOH works by causing lysis of the squamous cells, which makes it easier to see hyphae and spores.

 Question 10 

The FNP has a 65-year-old female patient who complains of severe and sharp shooting pains when she eats cold food. The pain stops when she is done eating the cold food. The FNP knows that this is which of the following types of headache? 

   trigeminal neuralgia 

  cluster headache 

   migraine headache 

  temporal arteritis 

Correct answer:

trigeminal neuralgia

 

Trigeminal neuralgia is a unilateral headache caused by impingement of the trigeminal nerve. It is rare before age 35 and peaks at the age of 60. It is more common in females. The pain of the headache lasts a few seconds and only stops when the offending activity ceases.

Question 11 

 Which of the following hypertensive drugs should NOT be used for a person with heart failure?

 

   beta blocker 

  ACE inhibitor 

   ARB 

  diuretic 

Correct answer:

beta blocker

 

Beta blockers should be avoided in a person with heart failure. Calcium antagonists (non-DHP) should also be avoided.

Question 12 

Which of the following tests is a hearing test that would be done by placing a tuning fork first on the mastoid process and then on the front of the ear, timing each area? 

  Weber test 

  Snellen test 

   Rinne test 

  McMurray test 

Correct answer:

Rinne test

 

The Rinne test is done by placing a tuning fork first on the mastoid process and then on the front of the ear, timing each area. A normal finding would be if air conduction lasts longer than bone conduction.

Question 13 

You are providing care to a female patient who is suffering from hemorrhoids. She is not pregnant. Which of the following is NOT an appropriate recommendation for this patient? 

  The patient should use OTC hemorrhoid medications such as Preparation H for 7 to 10 days. 

   The patient should take OTC pain relievers to help with discomfort. 

  The patient should take warm sitz baths to help relieve discomfort. 

   The patient should use OTC hemorrhoid medications such as Preparation H for as long as necessary. 

Correct Answer: The patient should use OTC hemorrhoid medications such as Preparation H for as long as necessary While the patient can use such treatments for 7 to 10 days at a time, it is important that she is educated not to use them indefinitely. These medications contain ingredients that can damage tissue and actually make the problem worse. She can also use warm sitz baths and OTC analgesics to help alleviate pain and discomfort. 

 Question 14 

Quality assurance is a system designed to evaluate and monitor the quality of patient care and facility management. A good quality assurance program will do all of the following EXCEPT: 

  identify educational needs 

  improve the documentation of care 

   reduce the clinician’s overall exposure to liability 

   certify that a clinician meets certain predetermined standards for the profession 

Correct answer:

certify that a clinician meets certain predetermined standards for the profession

 

A quality assurance program is not put in place to certify that a clinician meets certain predetermined standards for the profession. It provides a framework for systematic, deliberate and continuous evaluation and monitoring of individual clinical practice.

Question 15 

A patient with congestive heart failure takes Hydrochlorothiazide for edema. What might you expect to find in his blood work? 

  Increased iron levels. 

   Increase of lipoprotein levels. 

  Decreased iron levels. 

  Decrease of lipoprotein levels. 

 

Correct answer: Increase of lipoprotein levels Edema is common with congestive heart failure. Hydrochlorothiazide will reduce fluid build up. It should be monitored carefully because it can increase lipoproteins. 

 

 Question 16 

Which of the following should be considered for the first-line therapy for prepatellar bursitis to afford significant pain relief? 

  intrabursal corticosteroid injection 

   bursal aspiration 

   NSAIDs 

  applying ice to the affected area 

bursal aspiration

 

With prepatellar bursitis, bursal aspiration should be considered as a first-line therapy because this procedure affords significant pain relief and allows the bursa to reapproximate. In other sites, first-line therapy includes minimizing or eliminating the offending activity, applying ice to the affected area for 15 minutes at least four times per day, and the use of NSAIDs. Intrabursal corticosteroid injections are used if conservative measures have not worked after approximately 4 to 8 weeks.

 

Question 17 

When instructing on toilet training, the child is usually ready when all of the following occurs except for: 

  The child can pull pants up and down. 

  The child wakes up from their nap dry. 

   The child doesn't mind being wet. 

  The child is dry for periods of 2 hours. 

The Correct answer is:

The child doesn't mind being wet

One signal that the child is ready to toilet train is that the child knows the difference between wet and dry. For instance, a child who is ready to use the toilet prefers using it and having a dry diaper, training pants or underpants instead of soaked or wet training pants.  

 

Question 18 

The theory of adult education that is based on the recognition that adults learn differently from the way children learn and that their instruction should therefore be different is which of the following? 

  empowerment 

  compliance 

   pedagogy 

   andragogy 

Correct answer:

andragogy

 

Andragogy is the theory of adult education that is based on the recognition that adults learn differently from the way children learn; and that their instruction should therefore be different. Adults bring rich experience to the learning situation and are generally independent learners.

 

 Question 19 

The Trans-theoretical Model of Change sets forth six predictable stages of change. Which of the following is NOT one of these? 

  pre-contemplation 

  preparation 

   maintenance 

   post-contemplation 

Correct answer:

post-contemplation

 

The Trans-theoretical Model of Change assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to action and maintenance. The six stages are: pre-contemplation, contemplation, preparation, action, maintenance and termination. 

 Question 20 

The FNP sees a 32-year-old Hispanic woman with a tan stain on her upper cheeks and forehead. She is not pregnant. She is taking oral contraceptives. Which of the following is the most likely diagnosis? 

  vitiligo 

   lipoma 

   melasma 

  xerosis 

Correct answer:

melasma

 

Melasma is a brown-to-tan stain located on the upper cheeks and forehead in some women who have been or are pregnant or are on oral contraceptive pills. It is more common in darker-skinned women. The stains are usually permanent but may become lighter in color over time.

Question 21 

The child of 1 – 10 years requires 80 kcal/kg/day. If a child weighs 44 lb, how many calories are needed per day? 

   1600 

  3520 

   1760 

  1467 

 

Correct answer:

1600

 

To arrive at this answer, you must first convert the child’s weight to kg. 1 kg = 2.2 lb; therefore this child weighs 20 kg (44 lb ÷ 2.2). Multiply this by 80 and the result is 1600 calories.

Question 22 

The FNP is caring for a child with celiac disease. Which of the following foods would NOT be recommended for this child? 

  beans 

   wheat bread 

  corn 

  dates 

 

Correct answer:

wheat bread

 

Celiac disease is an immune-mediated systemic disease due to intestinal intolerance to gluten. Those with celiac disease should not eat wheat, oats, rye or barley, among other things

 

Question 23 

Of the following statements about herpes zoster infection (shingles) which one is false? 

  Anyone who has had chickenpox is at risk for shingles. 

   During an acute attack the varicella-zoster virus is not shed. 

  When shingles is seen in younger adults, the possibility of HIV infection should be considered. 

  The Tzanck smear can confirm a diagnosis of shingles. 

Correct answer:

During an acute attack the varicella-zoster virus is not shed.

 

This statement is false. During an acute attack the varicella-zoster virus is shed. Patients can therefore transmit this infection to others. Approximately 4% of patients with zoster develop a recurrent episode later in life.

 

Question 24 

Why is it necessary to have an expert witness in a nursing negligence case? 

  Appropriately credentialed experts have more credibility in the eyes of lay jurors. 

   Knowledge of medical or nursing facts is not considered intuitive to a lay jury. 

  Jurors are allowed to use their intuition regarding the facts they are presented with. 

  Fact witnesses are not able to present an unbiased account of the circumstances in dispute. 

 

The Correct answer is:

Knowledge of medical or nursing facts is not considered intuitive to a lay jury

Lay jurors do not know the clinical medical facts and circumstances involved in a professional negligence case. An expert witness is often necessary to educate the jurors about the medical facts and to testify regarding the standard of care to be applied.

Question 25 

 In which layer of the skin are blood vessels, sebaceous glands, and hair follicles located?

 

  topmost layer of epidermis 

   bottom layer of epidermis 

   dermis 

  subcutaneous layer 

Correct answer:

dermis

 

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

 

 Question 26 

In terms of hemoglobin, which of the following would indicate anemia in females? 

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