AANP FNP TEST REVIEW EXAM (QUESTIONS AND ANSWERS)

AANP FNP TEST REVIEW EXAM (QUESTIONS AND ANSWERS) ADA screening for DM in Children - CORRECT ANSWER--symptomatic children (polyuria, polydipsia, polyphagia, blurred vision) regardless of risk factors -asymptomatic children after puberty or 10 years of age or older if overweight or obese (>85th percentile). Plus 1 of the following: *T2DM in 1st or 2nd degree relative *high risk racial/ethnic group *signs of insulin resistance (HTN, dyslipidemia, acanthosis nigricans, PCOS, SGA) *maternal hx of DM or GDM during the child's gestation Statistics - CORRECT ANSWER-- leading causes of death: Heart disease, cancer, lung disease - leading cause of cancer death: lung - leading cause of death in adolescents: accidents - most common cancer: skin. - in males: prostate. in females: breast suicide: males more successful, women more attempts. highest rate is older white males. Osgood-Schlatter: - CORRECT ANSWER-knee pain in young adults, overuse. Repetitive stress pain, tenderness, swelling at the tendon's insertion site. The tibial tuberosity. Rule out avulsion fracture if there is an acute onset and order a lateral xray. RICE. Usually stops when the growth stops. If patient has right sided weakness, etc. the CVA occurred where - CORRECT ANSWER-left side initial evaluation of symptoms of acute prostatitis - CORRECT ANSWER-Urinalysis and urine culture A 65-year-old woman presents for a follow-up examination after a new patient visit. She has not seen a healthcare provider for several years. She is a smoker and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the nurse practitioner should start the patient on: 1. bile acid sequestrant. 2. a statin drug. 3. a cholesterol absorption inhibitor. 4. low-dose aspirin. - CORRECT ANSWER-A statin drug Ortolani's Click - CORRECT ANSWER-a click is heard or felt as dislocation is reduced (developmental dysplasia of hip) (good until one year) Which of the following laboratory tests should a nurse practitioner order when the suspected diagnosis is temporal arteritis? - CORRECT ANSWER-Erythrocyte sedimentation rate (ESR) What are narrow therapeutic index drugs? - CORRECT ANSWER-1. Warfarin sodium (Coumadin): monitor INR 2. Digoxin (lanoxin): monitor digoxin level, EKG, electrolytes(potassium, magnesium, calcium) 3. Theophylline: monitor blood levels 4. Carbamazepime (Tegretol) and Phenytoin (Dilantin): Monitor blood levels 5. Levothyroxine: Monitor TSH 6. Lithium: Monitor blood levels, TSH (risk of hypothyroidism) Otitis Externa tx - CORRECT ANSWER-Fluoroquinolone & Polymyxin B cortisporin drops An elderly male patient complains of a new-onset, left-sided temporal headache accompanied by scalp tenderness and indurated temporal artery. The NP suspects temporal arteritis. What screening test would you order to assist with diagnosis? - CORRECT ANSWER-sedimentation rate (expect to be very elevated) Basal Cell Carcinoma - CORRECT ANSWER-Pearly domed nodule with overlaying telangiectatic vessels. Could be plaque, papule, possible central ulceration and crusting. Dx: Biopsy Tx: Normal, healthy woman of reproductive age - CORRECT ANSWER-white, clear, flocculent(physiologic leukorrhea), no complaints, pH 3.8-4.2 (toward acidic), no odor, microscopic shows lactobacilli (gram+bacteria) Multiple infections from bacteria and fungus? - CORRECT ANSWER-Screen for HIV Screening Tests - CORRECT ANSWER-- sensitivity: detect those WITH the disease. higher the sensitivity is higher the false positives - Specificty: detect those who DONT have the disease. erythromycin for chlamydia eye infection in infants - CORRECT ANSWER-... to assess pts ability to think abstractly a nurse pract could ask the patient - CORRECT ANSWER-the meaning of a common proverb The most commonly prescribed medication for mild systemic lupus erythematosus (SLE) is: 1. azathioprine (AZA). 2. belimumab (Benlysta). 3. ibuprofen (Advil). 4. cyclophosphamide (Cytoxan). - CORRECT ANSWER-ibuprofen (advil) A 17-year-old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the most appropriate diagnostic tests to order would be: - CORRECT ANSWER-follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH). Barlow's Maneuver - CORRECT ANSWER-Feeling of a slip as the femoral head slips away from the acetabulum (toward the butt) (good until 6 mo) Candida vulvovaginitis - CORRECT ANSWER-etiology: candida albican (80-90%) white, curdy, "cottage-cheese" like, sometimes increased, itching/burning discharge, pH <4.5, odor is usually absent, microscopic shows mycelia, budding yeast, pseudohyphae w/KOH prep. Treatment: oral diflucan or vaginal miconazole or terconazole PSEUDOHYPHAE, CLOTRIMAZOLE CREAM Proton Inhibitors - CORRECT ANSWER-Increased risk of fractures(postmenopausal women), Pneumonia, Clostridium difficile infection, hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, and kidney disease Bacterial Conjunctivitis tx - CORRECT ANSWER-Eye drops or ointment: Polytrim, trimethoprim, polymyxin, macrolide A patient with an elevated WBC (>11k) accompanied by neutrophilia (>70%) and the presence of bands is what kind of shift and prognosis? - CORRECT ANSWER--Shift to the left -Serious bacterial infection Actinic Keratosis - CORRECT ANSWER-Rough flat, dry crusty, erythematous papules or plaques. Scaly patch of red brown skin caused by years of SUN exposure. Precursor to squamous cell carcinoma. Dx. Biopsy. Tx: topical 5 fluroracil 5-FU, cryotherapy. A patient with macular degeneration has deficit vision in? - CORRECT ANSWERCentral vision Dacyrocystitis - CORRECT ANSWER-Typical symptoms of acute tear duct infection include: Pain, redness and swelling of the lower eyelid at the inner corner of the eye Excessive tearing Pus or discharge from the eye Fever Tx: lacrimal sac massage- rub down towards mouth. oral clindamycin (topical tobramycin or moxifloxacin if mild-purulent drainage, no redness) Pre-DM in children values - CORRECT ANSWER-A1C: 5.7% to 6.4% Fasting: 100-125 2 hour GTT: 140-199 Primary Prevention - CORRECT ANSWER-- individual actions: eating nutritious diet, exercise, seatbelts, gun safety. IMMUNIZATIONS squamous epithelial cells with stippling appearance, no lactobacilli and many WBCs is - CORRECT ANSWER-wet mount that shows BV trigeminal neuralgia manifests - CORRECT ANSWER-electric shock facial pain The most common sign of cervical cancer is: 1. postcoital bleeding. 2. strong odor from vaginal discharge. 3. itching in the vaginal area. 4. molluscum contagiosum. - CORRECT ANSWER-postcoital bleeding To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: - CORRECT ANSWER-the meaning of a common proverb. Auspitz sign - CORRECT ANSWER-droplets of blood when scales removed = psoriasis Bacterial vaginosis - CORRECT ANSWER-etiology: unclear, likely polymicrobial, associated with G. vaginalis, M. hominid, others. thin, homogeneous, white, gray, adherent, often increased, discharge is foul odor(fishy), itching is occasionally present, pH 5-7(alkaline- no active bacilli in vagina), "fishy" smell, microscopic > 20 clue cells/HPF, few or no WBCs. Treatment: metronidazole topical, oral Flagyl, clindamycin vaginal cream, oral tinidazole (Tindamax) CLUE CELLS, METRONIDAZOLE GEL OR ORAL, CLINDAMYCIN CREAM Omeprazole (Prilosec) - CORRECT ANSWER-interacts with with Warfarin (Coumadin), diazepam (Valium), Carbamazepine (Tegretol), Pheytoin (Dilantin), ketocanazole (Nizoral) Viral Conjunctivitis tx - CORRECT ANSWER-Antihistamine, decongestant drops (Trigluridine in herpes conjunctivitis) What is the common presentation of a navicular fracture? - CORRECT ANSWERTenderness at the "N spot," which is defined as the proximal dorsal portion of the navicular (see the image below). This is the most important physical finding. Melanoma - CORRECT ANSWER-ABCDE: asymmetry, border irregularity, color variation, diameter greater than .6 mm, elevation above skin level. Type 2 DM in children values - CORRECT ANSWER-A1C: >6.5% Fasting: >126 2 hour GTT: >200 Random: >200 Central clearing lesion after camping trip flu like symptoms with muscle aches for several days is? and treated by? - CORRECT ANSWER-Lyme disease; doxycycline Wilms tumor - CORRECT ANSWER-(Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. the headache of an intracranial tumor - CORRECT ANSWER-focal neurological signs and pain worse in supine position socioeconomic status - CORRECT ANSWER-not important during employment physical with 21 yo with bruising on breasts The nurse practitioner prescribes amitriptyline (Elavil) for a patient with neuropathic pain secondary to diabetes mellitus. On follow-up, the patient complains of urine retention and dry mouth. The practitioner would: 1. discontinue amitriptyline and begin ibuprofen (Motrin). 2. refer to physical therapy. 3. start methocarbamol (Robaxin). 4. discontinue amitriptyline and begin gabapentin (Neurontin). - CORRECT ANSWERdiscontinue amitriptyline and begin gabapentin (neurontin) To assess spinal function at the S1 level, which deep tendon reflex should be tested? - CORRECT ANSWER-Achilles Herald patch + christmas tree - CORRECT ANSWER-pityriasis rosea Secondary Prevention - CORRECT ANSWER-- screening tests (pap, mammogram, CBC). Strep Pharyngitis tx - CORRECT ANSWER-PCN, amoxicillin, macrolide, cephalosporin Vitamin K Agonist Warfarin (Coumadin) - CORRECT ANSWER-Interactw with "G" hers: Garlic Ginger Gingko Ginseng Other herbs/supplemts: Feverfew green tea fish oil **Discontinue 7 days before surgery What is the gold standard test for sickle cell anemia, glucose-6-phosphage dehydrogenase (G6PD) anemia, and alpha or beta thalassemia?? - CORRECT ANSWER-Hemoglobin electrophoresis Postherpetic neuralgia - CORRECT ANSWER-Tx: Prophylaxsis TCA-Elavil Atrophic vaginitis (genitourinary syndrome of menopause GSM) - CORRECT ANSWERetiology: estrogen deficiency (after menopause). D/C scant, white-clear dryness as well sometimes urinary incontinence, itching/burning, discharge but often w/o symptoms, pH >5 (little to no lactic bacilli), odor is absent, microscopic few or absent lactobacilli. Treatment: topical and/or vaginal estrogen if symptomatic and/or recurrent UTI. (Oral estrogen as solo intervention likely inadequate) Diverticulitis: Treatment s/s: - CORRECT ANSWER-Antibiotics and clear liquids and increased fiber (some say no nuts or seeds). (7 to 10 days ABT) Ciprofloxacin (500 mg PO twice daily) plus metronidazole (500 mg PO three times daily). Amoxicillin-clavulanate (875/125 mg twice daily) is an acceptable alternative. The criteria for patients with acute uncomplicated diverticulitis to be treated in the outpatient setting include: ●Reliability to return for medical reevaluation if condition worsens ●Compliance with outpatient treatment plan ●Abdominal pain is not severe ●No higher than a low-grade fever ●Can tolerate oral intake ●No or minimal comorbid illnesses ●Available support system Approximately six weeks following the resolution of symptoms of acute diverticulitis, patients who have not had a recent colonoscopy should undergo one to exclude other possible diagnoses (such as colonic neoplasia) and to evaluate the extent of the diverticulosis. Recomendations for surgery: Patients in whom elective surgery has been recommended following a single attack of diverticulitis include younger patients (variously defined in the literature as less than 40 or 50 years of age) and those who are immunosuppressed. Neuroblastoma- - CORRECT ANSWER-painful abd mass fixed first irregular, crosses midline. Most common side is adrenal glands. Weight loss fever. HORNERS syndrome. RACOON eyes, bone pain, HYPERTENSION. 1-4 year olds. Dx ultrasound PUNT to nephro. NEURO think brain in middle crosses midline. **Urine catecholamines and anemia ADHD - CORRECT ANSWER-hyperactivity, impulsive and/or inattention. DSM-5 Criteria: *sx present before 12 years of age *sx for at least 6 months *sx in 2 different settings Medications considered 1st line if over 6 years of age TZD Pioglitazone (Actos) - CORRECT ANSWER-Black Box warning: cause or exacerbate congestive heart failure in some patients; do not. use if New York health association Class III or IV Heart failure STOP if causes dyspnea, weight gain, cough (heart failure) in order to improve longevity of patient with COPD, tx of choice is - CORRECT ANSWER-oxygen current social relationships, history of present or past traumas mental health status - CORRECT ANSWER-all important on the pe of 21 yo, for employment with bruising on breasts A 17-year-old male with rheumatoid arthritis is being treated with an NSAID and omeprazole (Prilosec). The patient complains of headache, abdominal pain, and gas. These symptoms are most likely: 1. associated with the omeprazole. 2. related to the underlying condition. 3. the result of the NSAID. 4. caused by viral gastroenteritis. - CORRECT ANSWER-associated with the omeprazole Koplick Spots - CORRECT ANSWER-white with red ring inside cheek from rubeola or mumps Tertiary Prevention - CORRECT ANSWER-- AA, support groups, education for those with the disease, rehab, exercise programs for obese Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? - CORRECT ANSWER-Pain worse in supine position; focal neurological signs