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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
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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
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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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