Nursing exam predictor study guide

Nursing exam predictor study guide A 37-year-old female patient with a history of a single episode of depression and frequent complaints of PMS is being treated for hypothyroidism. Today she complains of poor concentration and fatigue. Initially, the NP should: Question her further Which of the following is an example of secondary prevention? Annual influenza vaccination A 35-year old female with a history of mitral valve prolapse is scheduled for routine dental cleaning. According to the 2007 American Association’s guideline for endocarditis prophylaxis, what would you advise this patient? She does not need prophylaxis for any dental procedure b. A patient recovering from a recent stroke is starting anticoagulant therapy. The nurse practitioner should teach the patient to avoid all of the following EXCEPT: b. milk and milk products A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should start aggressive antibiotic therapy A positive drawer sign support a diagnosis of cruciate ligament injury A 50-year-old patient with diabetes complains of pain bilaterally in her lower legs while walking. The pain disappears at rest. What else would you expect to identify on her lower extremities. b. peripheral artery insufficiency A 16-year-old athlete complains of pain underneath his heel every time he walks. There is a verrucous surface level with the skin of the heel. What pharmacologic interventions should the nurse practitioner prescribe for this patient? salicylic acid plasters A -year-old with Type I diabetes has had itching and burning lesions between her toes for 6 months. Scrapings of the lesion confirm the diagnosis of tinea pedis. What is the best treatment option for this patient? prescribe an anti-fungal powder for application between her toes and in her shoes and a topical prescription strength anti-fungal cream for other affected areas. Monitor for a secondary bacterial infection. c. Prescribe an oral anti-fungal for 4 to 12 weeks. Monitor liver enzymes, BUN and creatinine at one week, 2 weeks, and every month thereafter. d. Prescribe a prescription strength antifungal/steroid combination cream. Monitor for a secondary bacterial infection. What is an appropriate drug for prophylactic treatment of migraine headaches in a 21-year-old female? Sumatriptan (Imitrex) b. propranolol (Inderal) c. ibuprofen (Motrin) d. dihydroergotamine (DHE) Which of the following are the classic features of ulcerative colitis? RLQ pain, frequently accompanied by a palpable mass, fever, and leukopenia Massive painful hematemesis, occasionally accompanied by melena Rapidly progressive dysphagia to solid foods, anoriexia, and weight loss out of proportion to the dysphagia Remission and exacerbations of bloody diarrhea, tenesmus, fecal incontinence, abdominal pain, and . Which drugs below would be expected to produce the least amount of hypokalemia? Furosemide (Lasix) hydrochlorothiazide (HCTZ) and spironolactone (Aldactone) Spironolactone (Aldactone) hydrochlorothiazide (HCTZ) What information should patients with diabetes and their families receive about hypoglycemia? Hypoglycemia is very rare Hypoglycemia requires professional medical treatment Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly Hypoglycemia occurs only as a result of overdose of insulin A 60-year-old male patient with a past history of glaucoma and frequent sinusitis presents today with hypertension. On his last 2 visits to the clinic his blood pressures were 150-160/90-98. The nurse practitioner decides to treat the hypertension with long-acting propranolol (Inderal). Before prescribing it, the nurse practitioner should ask: whether he smokes or consumes alcohol on a daily basis what other medications have been prescribed for him if he takes a daily antihistamine if other family members are hypertensive Which of the following is NOT associated with Type 2 diabetes mellitus? Gestational diabetes, birth of a macrosomic infant Hispanic, African-American, or Native American descent Alcohol or other drug abuse Obesity, hypertension, hypertriglyceridemia A 35-year-old male presents with a severe unilateral headache over his left eye. He says it started about one hour ago and has rapidly gotten worse. He gives a history of similar headaches over the past 2 years. Physical examination is negative except for left eye lacrimation. What is the most likely diagnosis? c. Cluster headache d. Classic migraine headache A 16-year-old sexually active female present to the clinic. She has never had vaccination for hepatitis A or B, she has had one MMR immunization, and her last tetanus vaccination was 4 years ago. Which vaccination would be contraindicated without further testing? c. MMR A 15-year-old male presents with abdominal pain that began in the peri-umbilical area then localized to the right lower quadrant. He complains of nausea, vomiting, anorexia, and low-grade fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis? d. Acute appendicitis A 25-year-old hypertensive patient has a BMI of 16. His blood pressure is 165/100. There is an audible bruit in his left upper abdominal quadrant. He probably has: Essential hypertension Secondary hypertension Which of the following is the most common presenting sign of substance abuse in adolescents? d. changes in behavior Therapeutic international normalized ratio (INR) for a patient takein warfarin (Coumadin) for chronic atrial fibrillation is expected to be increased A 199-year-old female reports that she is having “panic attacks.” The NP knows that panic attacks are characterized by d. sudden onset of intense fear or terror A 25-year-old complains of fever and throat pain. The tonsils have exudate bilaterally. The patient describes having an anaphylactic reaction to penicillin in the past. What antibiotic should the NP prescribe if she believes the causative agent is bacterial? amoxicillin (Amoxil) erythromycin A diagnostic finding of Hodgkin’s lymphoma is the presence of b. Reed-Sternberg cells With a history of ankle sprain, the nurse practitioner would most likely elicit a history of d. ankle inversion Certification for nurse practitioners is offered through: c. national certifying organizations Simple cases of impetigo and folliculitis are usually successfully treated with: systemic antibiotics topical antibiotics A 43-year-old has chronic gout. He comes to the clinic for the 3rd time in as many months for treatment of an exacerbation. Dietary counseling should include avoidance of all of the following EXCEPT: c. green, leafy vegetables A 57-year-old patient presents for an annual physical exam. He reports having 3 attacks of acute gout during the past year. He does not take any medication except NSAIDs during the attacks which help “a little bit.” The NP would appropriately recommend c. avoidance of dietary purine sources A 43-year-old male presents with a large and painful furuncle, the 3rd one in the past 6 months. The NP should _?_ all of the following EXCEPT: b. prescription of a prophylactic antibiotic A 64-year-old female has sudden onset of right eye pain, blurred vision, and dilated pupil. The most likely diagnosis is acute: b. angle-closure glaucoma A 25-year-old patient presents with complaints of pain and burning in the vulvar area. Upon examination, the NP notices vesicles with an erythematous base arranged ina group on the patient’s labia major. The most likely diagnosis is: d. herpes simplex II An 85 – year-old is diagnosed with shingles. The patient states that she became “miserable” yesterday when the symptoms started. What pharmacologic interventions should the nurse practitioner offer this patient? c. Oral acyclovir (Zovirax) for 7-10 days, NSAIDs, and topical capsaicin cream after resolution of the lesions A 16-year-old presents to the clinic for a scheduled immunization. The patient is unaccompanied by an adult. The NPs action is based on the knowledge that: a minor must have the informed consent of a parent or guardian to receive an immunization The mechanism by which nurses are held accountable for practice, based on the quality of nursing car ein a given situation inaccordance with established standards of practice, is: c. peer review A 52- year-old female has a firm, non-tneder, one centimeter mass in the RLQ of her breast. There are no palpable axillary lymph nodes. A mammogram the month before her examination was netative. The most appropriate nurse practitioner action today is to: c. schedule an ultrasound of the breast Which of the following is NOT a characteristic of the S3 heart sound? d. An S3 is fairly common in children, young adults, and females in the last trimester of pregnancy A characteristic of elders which affects the pharmacotherapeutics of drug therapy in that population is an increase in: d. percent of body fat The AUDIT questionnaire is useful to assess: alcohol use disorders A 32- year-old mother and her 10-year-old child each have a 10 cm round, reddened patch on the trunk. There is central clearing in the lesion. Different lesions run parallel to each other in a Christmas tree pattern. The mother has been treating the “ringworm” with an anti-fungal cream for 7 days without success. The NP best response is: b. No medication will help this to clear. It must clear on its own and may take 4-8 weeks . For the general adult population, total dietary fat intake should be no more than what percent of total calories? c. 30% A 23-year-old female college student is being evaluated by the nurse practitioner for immunization status. She has documentation of completion of IPV, DTaP, and MMR series. She states “I got a shot when I was 12 years old, but none since.” Which vaccine(s) should she receive today? d. Td and HBV Which of the following patients is most likely to have a diagnosis of Type 2 diabetes mellitus? b. A 49-year-old male with impotence and HbAIC 10.0% Which of the following findings is consistent with otitis externa? d. pain The most effective primary prevention of skin cancer is to educate the public about: d. limiting exposure to natural solar radiation Which of the following is NOT a symptom of irritable bowel syndrome? d. Weight loss An 18-year-old woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the prevention of pregnancy: b. if prescribed topiramate (Topamax) for the treatment of migraines A 50-year old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis? uterine fibroids normal peri-menopause c. endometrial cancer d. cervical cancer Which agent is most effective for the treatment of nodulocystic acne? d. isotretinoin (Accutane) Which of the following signs and symptoms is typical of hyperthyroidism? heat intolerance An 83-year-old man has a resting hand tremor. What disease process is this type of tremor is most commonly associated with? Multiple sclerosis (MS) Parkinson’s disease diabetic neuropathy A young female reports onset of right flank pain 2 days ago that is now severe. Last night she discovered a “burning rash” in the same area. The NP identifies popular fluid-filled lesions that are confluent and follow a linear distribution along the T-8 dermatome. The NP would appropriately order: c. an oral antiviral d. a topical steroid cream Expected spirometry redings when the patient has chronic emphysema include: d. increased total lung capacity (TLC) Right-sided heart failure is characterized by all of the following clinical findings EXCEPT: Answer: a 4th heart sound Moderate weight loss, particularly of visceral adipose tissue, in patients with Type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT: c. increased lean muscle mass d Nurse practitioner services are filed with Medicare for reimbursement and paid by Medicare Part B Which of the following drugs has a beneficial effect on benign prostatic hyperplasia? doxazosin (Cardura) A 46-year-old female has hypertension and is well managed with propranolol (Inderal). Which of the following is a beneficial secondary effect of this drug? d. migraine prophylaxis The finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of a prostate gland that is: enlarged, symmetrical, semi-firm, and non-tender enlarged, symmetrical, boggy, and exquisitely tender A 20-year-old male complains of a “skin rash” on his knees and elbows. The lesions have silvery scales and are pruritic. A positive Auspitz sign is present. What is the most likely diagnosis? d. psoriasis The daughter of a 75-year-old patient reports that her mother roams the house at night saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be the most appropriate to treat her insomnia? doxepin (Sinequan) A 65-year-old African American patient was screened at his local church for “high cholesterol.” His total cholesterol (no-fasting) was 215 mg/dL (5.6 mmol/L). What action below is most appropriate for the NP? Recommend a fasting lipid profile Swan neck and boutonniere deformities are typical clinical findings in the later presentation of: gouty arthritis rheumatoid arthritis A 13- year-old patient complains the he fell while running during football practice. Now his knee hurts and sometimes “locks.” The NP conducts McMurray’s test. Which of the following is TRUE about this test? an audible or palpable click is positive for a torn meniscus A hemoglobin AIC level is 7.2 in a patient with Type 2 diabetes mellitus. The patient is currently taking a sulfonylurea medication. Which of the following drug should be added next to the medication regime? d. Metformin (Glucophage) A patient with a diagnosis of giardiasis is being treated with metronidazole (Flagyl). What information would be important to obtain before prescribing this medication? c. if the patient drinks alcohol The nurse practitioner is performing a routine assessment of a 47-year-old female who wants to lose weight She has truncal obesity with relatively slender forearm and lower legs. Her BMI is 38. Upon review of her history, physical examination, and laboratory reports, the nurse practitioner diagnoses “Syndrome X.” This diagnosis is based on the previous findings plus all of the following EXCEPT: d. cardiac arrhythmias A 59-year-old postmenopausal woman has atrophic vaginitis. She has a history of breast cancer at age 40 years. What is the appropriate initial treatment for this patient? d. Topical conjugate estrogen cream The process by which a profession association cofers recognition that a licensed profession has demonstrated mastery of a specialist body of knowledge and skills is termed: c. certification A nurse practitioner has just diagnosed a patient as having acute hepatitis B. The principle which prohibits the nurse practitioner from notifying the patient’s spouse without permission is: d. confidentiality A 43-year-old female patient complains of dull ache around both ankles after a day’s work as a cashier. Her symptoms are relieved by sitting and elevating her legs. She reports ankle edema at the end of the day. What is the most likely cause of these problems? varicose veins Which of the following are characteristic of patients with Type 2 diabetes mellitus? 1. Beta cell destruction 2. High body mass 3. Central obesity 4. Unexplained weight loss a. 1,2,3 b. 2,3 c. 1,4 The sexual partner of a symptomatic male patient with gonorrhea should be empirically treated: c. with ceftriaxone and doxycycline (Vibramycin) A patient on oral contraceptives complains of breast fullness, tenderness, and some nausea. The patient is concerned. How should the NP manage this? b. change the pill to one containing less estrogen A 62-year-old with Type 2 diabetes mellitus complains of increased nocturia, fatigue, and weakness. His fasting blood glucose is 110 mg/dL (6.2 mmol/L), he is slightly anemic and his serum creatinine level is slightly elevated. All other laboratory tests and physical examination are within normal limits. What is the most likely diagnosis? d. renal insufficiency A 23-year-old female presents with scaly hypo-pigmented macular lesions on her trunk, shoulders, and upper arms. The lesions fluoresce under Wood’s lamp. Appropriate treatment for this condition is: Apply selenium sulfide (Versel) lotion and allow to dry for 10 minutes, then rinse off The goals of treatment for patients with alcohol abuse disorder are: c. abstinence or reduction in sue, relapse prevention and rehabilitation d. marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment Which of the following drug classes may potentiate hyperkalemia in a patient taking a potassium- sparing supplement? thiazide diuretic angiotensin-converting enzyme inhibitor A patient has laboratory studies performed which demonstrate increased TSH, decreased free T4, and T3. Which symptoms might she complain of? d. hair loss The anatomical site currently believed to be the best location for subcutaneous insulin administration is the c. abdomen Following the finding of prostate gland abnormalities on DRE, the nurse practitioner orders appropriate labs. When preparing to review lab reports with the patient, the NP know all of the following are true EXCEPT: normal PSA is 10 mg/ml or less An obese 43-year-old has recurrent superficial fungal skin infections over the past 2 years. Today, she presents with intertriginous candida. Her skin is macerated from frequent rubbing and scratching. The plan of care for this patient should include: recommended screening for diabetes mellitus and HIV infection Which statement is true regarding dental health? a diet high in sugar has no effect on dental caries individuals with dentures should visit the dentist every 2 years A 51-year-old post-menopausal female, requests guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT: d. weight loss When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action? order abdominal x-rays order abdominal ultrasound Which of the following is NOT an appropriate treatment for chronic bacterial prostatitis (CBP) d. nitrofurantoin (Macrobid) The first step when taking a patient history is the c. introductory information Characteristics of prescription and OTC drug use in the elder population include all of the following EXCEPT: high incidence of drug reactions multiple prescribers and polypharmacy The nurse practitioner wants to assess intactness of a patient’s cerebellar function. Which of the following clinical tests will provide information relative to cerebellar function? kinesthesia stereognosis Romberg A 57-year-old patient with known diverticulosis presents with fever, leukocytosis, and bright red rectal bleeding. The nurse practitioner’s least appropriate action at this time is: d. education regarding low fiber diet A 41-year-old woman presents with multiple painful vesicular lesions in the vulvar area She has been with the sexual partner for 21 years. Which of the following is the MOST likely diagnosis? c. herpes simplex d. chlamydia The differential diagnoses for transient episodes of dizziness would appropriately include all of the following EXCEPT: c. allergic rhinitis Which of the following is NOT a common early sign of benign prostatic hyperplasia (BPH)? d. increased force of urine flow The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The LEAST likely diagnosis is: acute otitis media (AOM) A 16-year-old presents for a sports physical for football. The nurse practitioner auscultates a diastolic murmur. It is a grade II/IV. He has no history of a murmur. The patient denies symptoms. What is the most appropriate action for the NP? refer this patient to a cardiologist What is the most common causative pathogen found in cystitis, pyelonephritis, and prostatitis? Escherichia coli The most common symptoms of a transient ischemic attack (TIA) include: nausea, vomiting, syncope, incontinence, dizziness, and seizure weakness in an extremity, abruptly slurred speech or partial loss of vision, and sudden gait changes A characteristic of delirium that is typically absent in dementia is: acute onset of confusion in a previously alert and oriented patient gradual loss of short-term memory loss of language skills long-term memory gaps filled in with confabulation A 48-year-old female presents with a chief complaint of insomnia. On further investigation, she reports fatigue, nervousness and agitation during the daytime, and feeling hot most of the time. Which of the following would NOT be included in the differential diagnosis? d. Parkinson’s disease The nurse practitioner correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals an increased reticulocyte count a mean corpuscular volume (MCV 100) hemoglobin (Hgb) 14.0 an increase total iron binding capacity (TIBC) A 16-year-old sexually active student presents with complaints of a greenish-gray frothy vaginal discharge and vaginal itching. The nurse practitioner should suspect: bacterial vaginosis (BV) trichomoniasis syphilis gonorrhea A 37-year-old female is found to have a negative rubella titer. How long after immunization should she avoid pregnancy? 28 days A 60-year-old male diabetic presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which has resolved. His temperature is 102 degrees F and pulse is 100 bpm. The nurse practitioner’s most appropriate initial action is to: start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days order mandibular x-rays and question the patient about physical abuse start an oral antibiotic, mouth swishes with an oral anti-infectives, and an analgesic d. initiate an IM/IV antibiotic and consider hospital admission A 44-year-old male Caucasian patient’s blood pressures are consistently 170 mm Hg systolic and 100-119 mm Hg diastolic. He has no significant medical history and is of normal weight. His lab tests and EKG are normal. What is the most appropriate action at this time? d. Prescribe and ACE inhibitor and a low dose thiazide diuretic A 65-year old diabetic patient has periorbital cellulitis secondary to a sinus infections, What course of action should the nurse practitioner take? d. Consider collaboration with a physician regarding antibiotic treatment, culture and subsequent action A 15- year-old swim team member presents with mild “swimmer’s ear.” Vital signs are normal. What is the most appropriate therapy for this patient? Oral amoxicillin-clavulanate (Augmentin) Oral cefaclor (Ceclor) Keep the ear canals dry at all times until the condition resolves on its own d. hydrocortisone-bacitracin-polymyxin B (Corisporin) otic suspension Which of the following is true concerning sensitivity and specificity? Assessment techniques must be highly sensitive and highly specific to be useful Sensitivity relates to the reliability of a technique to give a positive result when the finding is present. Specificity relates to the reliability of a technique to successfully rule out a finding.