ANCC Adult NP Board Exam with correct solution 2024

Potent Inhibitors: CYP450 System - answer-Macrolides (erythromycin, clarithromycin, telithromycin) Antifungals (ketoconazole, fluconazole, itraconazole) Cimetidine (Tagamet) Citalopram (Celexa) Protease inhibitors (saquinavir, indinavir, nelfinavir) Grapefruit juice Narrow Therapeutic Index Drugs - answer-■Warfarin sodium (Coumadin): monitor INR. ■ Digoxin (Lanoxin): monitor digoxin level, EKG, electrolytes (potassium, magnesium, calcium). ■ Theophylline: monitor blood levels. ■ Carbamezapine (Tegretol) and phenytoin (Dilantin): monitor blood levels. ■ Levothyroxine: monitor TSH. ■ Lithium: monitor blood levels, TSH (risk of HYPOthyroidism). Beers Criteria - answer-Antipsychotics: Quetiapine, clozapine, and pimavanserin may be used with caution. Rivaroxaban and dabigatran: Higher bleeding risk than warfarin and other direct oral anticoagulants. Tramadol: Risk of hyponatremia from syndrome of inappropriate antidiuretic hormone secretion. Opioids: Do not combine with benzodiazepines or gabapentinoids, as they increase the risk of severe respiratory depression. s/sx of digoxin toxicity - answer-Initial symptoms are GI (nausea/vomiting), hyperkalemia, and bradydysrhythmias (atrioventricular [AV] blocks) or tachydysrhythmias (ventricular tachycardia/fibrillation or atrial tachycardia with 2:1 block). Others include confusion and visual changes (yellowish-green-tinged color vision). Digoxin therapeutic range - answer-0.5-2 mg Warfarin INR range issues - answer-Consistently Stable INR Check every 2 to 4 weeks up to every 12 weeks. Single Out-of-Range INR If patient has stable INR and has a single out-of-range INR ≤0.5 below or above therapeutic INR (2-3), experts suggest continuing current warfarin dose; retest INR within 1 to 2 weeks. INR <5 With No Significant Bleeding Risk Omit one dose and/or reduce maintenance dose slightly; recheck INR. DOACs: Antidotes - answer-idarucizumab and andexanet alfa: reverse the anticoagulant effects of dabigatran and FXa inhibitors, respectively. Fresh frozen plasma and prothrombin complex concentrate can also be used for rapid reversa 2017 ACC/AHA stages of hypertension - answer-Normal BP: Systolic <120 mmHg and diastolic <80 mmHg Elevated BP: Systolic 120 to 129 mmHg and diastolic <80 mmHg Stage 1: Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg Stage 2: Systolic ≥140 mmHg or diastolic ≥90 mmHg Thiazide diuretics contraindication - answer-Sulfa allergy (Caution with gout, diabetes) Also loop diuretics contraindicated with sulfa allergy Patients with both ____, and ______ receive an extra benefit from thiazides. - answer-hypertension, osteoporosis Potassium sparing diuretics black box warning - answer-Hyperkalemia, which can be fatal; higher risk with renal impairment, diabetes, elderly, severely ill With severe__________ disease, all ACEIs, ARBs, and aliskiren are contraindicated because of high risk of hyperkalemia. - answer-renal /CKD Loop Diuretics Adverse Effects - answer-Electrolytes (hypokalemia, hyponatremia, hypomagnesemia, and low levels of chlorine) Hypovolemia and hypotension (dizziness, lightheadedness) Pancreatitis, jaundice, and rash Ototoxicity (worsens aminoglycoside ototoxicity effect if combined) cardioselective beta blockers - answer-metoprolol, atenolol Non-cardioselective beta blockers - answer-Propanolol, cardivalol -Blocks both beta 1 + beta 2 receptors (in lungs) -Don't give to person w/ resp illness including asthma, emphysema, chronic bronchitis -If block beta 2 receptors → causes bronchoconstriction, increased airway resistance → creates bigger problem than already have if resp problem Beta blockers will blunt the _________ effect, warn diabetics. - answer-Hypoglycemic Alpha blockers - answer-Terazosin (Hytrin): Can lower BP and treat BPH Doxazosin (Cardura): Can lower BP and treat BPH Tamsulosin (Flomax): For BPH treatment Alfuzosin (Uroxatral): For BPH treatment Silodosin (Rapaflo): For BPH treatment Prazosin (Minipress): Alpha-blocker for hypertension but not for BPH; off-label use for PTSD-related nightmares/sleep dysfunction Hypertension in pregnancy - answer-"Hypertensive Moms Love Nifedipine" Hydralazine Methyldopa Labetalol Nifedipine Tetracyclines Indications - answer-eg: Doxycycline, minocycline. Acne, chronic bronchitis, Lyme disease, Rocky Mountain spotted fever, "walking" pneumonia, prophylaxis for traveler's diarrhea Macrolides - answer-erythromycin, clarithromycin, azithromycin **pregnancy safe **many drug interactions (less with azithromycin) Macrolide indications - answer-gram-positive cocci (except enterococci), staph aureus MSSA, Streptococcus pyogenes, and atypical bacteria (e.g., mycoplasma, chlamydia) --first line for: Pneumonia, chlamydia Tetracycline adverse effects - answer-Yellow/brown discoloration of teeth, hepatotoxicity, photosensitivity, photosensitivity, suprainfection/superinfection First generation cephalosporins - answer-Activity against gram-positive cocci bacteria (e.g., group A streptococcus/Streptococcus pyogenes, S. aureusMSSA, S. pneumoniae) Not effective against beta-lactamase-producing strains and MRSA Poor anaerobic coverage; risk of cross-reactivity if allergic to penicillin Cefazolin Cephalexin Cefadroxil Second generation cephalosporins - answer-Considered as "broad spectrum" antibiotics. Used to treat infections caused by gram positive bacteria . (sinusitis, otitis media) Cefuroxime axetil(Ceftin) PO BID ENT:Sinusitis, OM Cefprozil(Cefzil) PO BID Resp: CAP, exac chronic Bronchitis Cefaclor (Ceclor) PO BID others: AOM, sinusitis, skin infections Third Generation Cephalosporins - answer-Less activity against gram positive infections compared to the first generation cephalosporins. Better covereage for gram negative bacteria(Neisseria gonorrheae infections) and against enteric bacteria 3rd gen Ceph Ceftriaxone (Rocephine)IM STD:Gonorrhea cervicitis, urethritis, PID Cefixime (Suprax) daily to BID ENT: AOM in children, acute sinusitis, OM Cefdinir(Omnicef) daily to BID GU: pyelonephritis, CAP first-line treatment for gonorrheal infections - answer-Ceftriaxone (Rocephin) 500mg IM MRSA skin infections (boils, abscesses) - answer-Do not use cephalosporins. First-line therapy is trimethoprim-sulfamethoxazole (Bactrim DS) or clindamycin. Treat for at least 5 to 10 days. Avoid using _________ for patients with mononucleosis (causes a generalized rash not related to allergy); - answer-amoxicillin Floroquinolones - answer-Abx class used for GU issues like UTI's, prostatitis and urethritis = ____. Levaquin for pneumonia (>65, comorbidities) Ciprofloxacin (Cipro) PO twice a day Ofloxacin (Floxin) PO twice a day Broad-spectrum quinolones: Levofloxacin (Levaquin) PO daily Moxifloxacin (Avelox) PO daily Gemifloxacin (Factive) PO daily **watch for achilles tendon rupture Sulfanomides (Bactrim) indications - answer-Prophylaxis/treatment of PCP (HIV patients) MRSA cellulitis Urinary tract infections, pyelonephritis Bactrim contraindications - answer-late pregnancy sulfa allergy ** watch for SJS!! Pregnant women (or suspected pregnancy) with a UTI can be treated with - answer-beta-lactams, nitrofurantoin, and fosfomycin. Clindamycin indications - answer-Infections of the skin, skin structure, bone/joints, lower respiratory tract infections, intra-abdominal infections, sepsis, bacterial vaginosis (clindamycin vaginal cream). Abrupt discontinuation - answer-Venlafaxine (Effexor): Sweating, agitation, dizziness, nausea, fatigue, tremor, restlessness Paroxetine (Paxil): Nausea, vomiting, diarrhea, headaches, vivid dreams, insomnia Gabapentin (Neurontin):Agitation, confusion, disorientation, sweating, insomnia, GI effects Steriods (long term)Weakness, severe fatigue, nausea, vomiting, anorexia, diarrhea Baclofen (Lioresal): Muscle cramps/spasms, rigidity, confusion, seizures, psychotic mania/paranoid states Clonidine (Catapres): Acute rebound hypertension, sudden death Propranolol (Inderal): Acute rebound hypertension, angina, MI, or sudden death Benzodiazepines: Seizures, anxiety, insomniaOpioidsPain, anxiety, restlessness, diarrhea Topical steroid classification - answer-Group 1 (superpotent) to Group 7 (least potent) Superpotent (Group 1): Clobetasol (Temovate), halobetasol propionate (Ultravate) High potency (Group 2): Halcinonide (Halog) High potency (Group 3): Mometasone furoate (Elocon) Medium potency (Group 4): Hydrocortisone valerate ointment (Westcort) Lower-mid potency (Group 5): Desonide gel (Desonate) Low potency (Group 6): Alclometasone dipropionate (Aclovate) Least potent (Class 7): Hydrocortisone base <2% (Cortaid, Cortizone 10) Avoid using diltiazem and verapamil (nondihydropyridine CCBs) in patients with - answer-Heart Failure (may worsen) Treponema pallidum secondary infection - answer-include painless chancre, maculopapular rash of the palms and soles, lymphadenopathy, and condyloma lata Positive Kernig's sign: - answer-resistance to leg extension after flexing the thigh on the body; sign of meningitis Colon cancer screening - answer-Ages 50-75 FOBT (fecal occult blood test) annually at 50y, or at 40y if 1st degree relative Colonoscopy q 10y Sigmoidoscopy q 5y with FOBT q 3y HPV subtypes assoc. w/ vulvar cancer - answer-16, 18, 31 In patients with AIDS, which of the following vaccines is contraindicated? Td Hepatitis B and mumps Varicella Td and oral polio - answer-Varicella A patient diagnosed with irritable bowel syndrome (IBS) tells the nurse practitioner that over the past few months, she has been experiencing frequent bouts of constipation. Which prescription will the nurse practitioner add to the treatment plan? Amitriptyline (Elavil) 50 mg PO once daily Lubiprostone (Amitiza) 8 mcg PO BID Alosetron (Lotronex) 0.5 mg PO BID × 4 weeks Dicyclomine (Bentyl) 20 mg PO every 6 hours, 30 to 60 minutes before meals - answer-Lubiprostone (Amitiza) 8 mcg PO BID Anterior drawer sign - answer-Anterior cruciate ligament injury Posterior drawer sign - answer-PCL injury Finkelstein's test - answer-stretching or lengthening of the thumb tendon to assess the possibility of de Quervain's disease, or tenosynovitis of the thumb tendon McMurray Test - answer-compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus. Click and knee pain is positive test Lachman's Test - answer-pivot shift test causes pain- ACL injury Mulder test - answer-A test for Morton's neuroma. Done by grasping the first and fifth metatarsals and squeezing the forefoot. Positive test is hearing a click along with a patient report of pain during compression. Pain is relieved when the compression is stopped. Uric acid level that confirms gout? - answer->6.7 painful arc tests for - answer-rotator cuff tendinopathy S4 heart sound - answer-coincides with atrial contraction in late diastole and "a" wave in jugular venous pressure curve; due to increased resistance to ventricular filling following vigorous atrial contraction S2 splitting - answer-aortic valve closes BEFORE the pulmonary valve. Seen in athletic individuals. Typically happens on INSPIRATION. Lower pressure, causes blood to go to right side of heart. Mitral regurgitation murmur - answer-pansystolic murmur, loudest at the apex with radiation to the axilla mitral valve prolapse - answer-Improper closure of the valve between the heart's upper and lower left chambers. A systolic murmur that is accompanied by a midsystolic click located at the apical area is a classic finding of MVP. Most cases of MVP are asymptomatic. To detect MVP, order an echocardiogram with Doppler imaging. aortic stenosis murmur - answer-"mid-systolic ejection murmur best heard at the 2nd right intercostal space" Mitral stenosis murmur - answer-"early to mid diastolic low pitch rumble murmur best heard at apex in left lateral decubitus position. May also have presystolic murmur." Aortic regurgitation murmur - answer-A high-pitched diastolic murmur (use diaphragm of the stethoscope) best at 3rd ICS better end expiration leaning forward Widened Pulse Pressure Austin Flint Murmur Heart Murmur Grading - answer-Grade I: A very soft murmur heard only under optimal conditions Grade II: A mild to moderately loud murmur Grade III: Loud murmur that is easily heard once the stethoscope is placed on the chest. Grade IV: A louder murmur. First time that a thrill is present. A thrill is like a "palpable murmur." Grade V: Very loud murmur heard with edge of stethoscope off the chest. Thrill is more obvious. Grade VI: Murmur is so loud that it can be heard even with the stethoscope off the chest. The thrill is easily palpated. pulsus paradoxus (Kussmaul's pulse) - what is it, and what is it a sign of? - answer-Pulsus paradoxus is most likely to be seen with status asthmaticus. With inspiration, systolic pressure drops because of the increased pressure (positive pressure). Some pulmonary risks of having increased pressure include asthma and emphysema. Cardiac causes for pulsus paradoxus include tamponade, pericarditis, and cardiac effusion. Bell of stethoscope is used for - answer-soft, low-pitched sounds: S3, S4, and mitral stenosis Which of the following diseases is associated with a high risk of giant cell arteritis? History of transient ischemia attacks (TIAs) Frequent migraine headaches with focal neurologic findings Polymyalgia rheumatica (PMR) Systemic lupus erythematosus (SLE) - answer-Polymyalgia rheumatica (PMR) Ankle-Brachial Index (ABI) - answer-Ankle SBP divided by Arm SBP Ankle slightly greater than brachial Normal reading= 1.0-1.2 second degree heart block - answer-AV block in which only some atrial electrical impulses are conducted to the ventricles Third degree heart block - answer-AV block in which electrical impulses from the atria fail to reach the ventricles; also called complete heart block (CHB) paroxysmal atrial tachycardia - answer-Signs and symptoms of paroxysmal atrial tachycardia include a rapid, regular heart rate that begins and ends very quickly. The atria are beating at a very fast rate, but it is not life-threatening. balanitis - answer-inflammation of the skin covering the glans penis, caused by bacteria, fungi, or a virus (commonly caused by candida suppurative otitis media - answer-inflammation of the middle ear with pus formation Navicular fracture (Scaphoid bone fracture) - answer-Pain on the anatomic snuffbox and axial loading of the thumb. Hx of falling on outstretched hand (Hyperextension of the wrist). Initial xrays are "normal" while a f/u xray in 2 weeks will show scaphoid fx r/t callus bone formation. High risk of avascular necrosis and nonunion. Refer to hand surgeon s/s: decreased grip strength and ROM; dull/deep aching pain pneumonia causative agents - answer--Usually viral cause (RSV), then S. pneumoniae, then atypicals (Chlamydiphila pneumoniae, Mycoplasma) Reportable diseases - answer-HIV; syphilis; tuberculosis; diphtheria; hepatitis A, B, and C; measles; mumps; pertussis; Lyme disease; Rocky Mountain spotted fever Maslow's Hierarchy of Needs - answer-physiological, safety, love/belonging, esteem, self-actualization Malignant Neuroleptic Syndrome - answer-Rare life-threatening idiopathic reaction from typical and atypical antipsychotics. These drugs affect the dopaminergic system of the brain. Usually develops following initiation or an increase in dose. Signs and symptoms are sudden onset of high fever, muscular rigidity, mental status changes, fluctuating blood pressure, and urinary incontinence. atypical antipsychotics - answer-Olanzapine (obesity) Clozapine (agranulocytosis) Respiradone (increase prolactin) Haloperidol - answer-typical antipsychotic tricyclic antidepressants - answer-Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine. TCAs indications - answer-- Primary: nerve pain, sleep (low doses) - Secondary: depression, anxiety Normal folate level - answer-3.1 to 17.5 ng/mL normal B12 levels - answer->250 G6PD deficiency anemia - answer-E/PP: *X-linked recessive, absence or defect of G6PD enzyme -> inability to tolerate oxidative stress -> hemolysis. Triggered by viral infections, aspirin, fava beans, sulfa drugs, malaria drugs* CM: sudden severe anemia, jaundice in infancy WU: G6PD enzyme assay P: varies but generally good as long as person avoids triggers R: no need Tx: avoid triggers! IV fluids, blood transfusion Reiter's syndrome - answer-urethritis, conjunctivitis, arthritis non-infectious (but often follows infections), HLA-B27, polyarticular Tx with abx, NSAIDs ankylosing spondylitis - answer-Diagnosis includes MRI and x-ray to assess for changes in joints and bones. HLA-B27 is a genetic marker present in 95% of those with the disorder. C-reactive protein and ESR are indicators of inflammation; however, they are not present in all AS patients. a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae Women with PCOS have higher androgen levels with insulin resistance. They are at higher risk of certain diseases such as: - answer-endometrial cancer, infertility, type 2 diabetes, heart disease, obesity, nonalcoholic fatty liver disease, and sleep apnea. First line treatment of gonorrhea - answer-The first-line treatment for gonorrhea-positive culture is ceftriaxone 500 mg IM for patients who weigh ≤150 kg and 1 gram IM for patients who weigh ≥150 kg. If the patient has a cephalosporin allergy, the recommended alternative is 240 mg IM plus azithromycin 2 g PO Gonorrhea treatment - answer-Gonorrhea TX: IM Ceftriaxone Cover Chlamydia with: azithromycin : 1 g orally as a single dose doxycycline : 100 mg orally twice daily for 7 days Erikson's Psychosocial Stages - answer-1. Trust vs. Mistrust (birth-1 year) 2. Autonomy vs. Shame and Doubt (2-3 years) 3. Initiative vs. Guilt (3-6 years) 4. Industry vs. Inferiority (6-11 years) 5. Identity vs. Identity Diffusion (12-18 years) 6. Intimacy vs. Isolation (early adulthood: 19-mid 20s) 7. Generativity vs. Stagnation/Self-Absorbtion (middle age: late 20s-50s) 8. Integrity vs. Dispair (old age: 60s and beyond) Sprain Grades - answer-grade I: mild pain, no laxity, weight bearing grade II: feel or hear pop, positive talar tilt grade III: severe pain, swelling, dicoloration Osgood-Schlatter disease - answer-inflammation or irritation of the tibia at its point of attachment with the patellar tendon Paget's disease - answer-tinnitus, bone pain, elnargement of bone, thick bones Fibromyalgia diagnostic criteria - answer-chronic pain for more than 3 months at least 11 of 18 mapped tender points tender points are widely distribulted - some from each quadrant persistant fatigue non-refreshing sleep, and awakens with morning stiffness Tennis elbow (lateral epicondylitis) - answer-inflammation of the tendon insertion of the extensor carpi radialis brevis muscle. It is associated with lateral tenderness at the insertion site. Pain worsens with grasping or twisting movements. Colles fracture - answer-fracture of the distal radius at the wrist Navicular fracture (Scaphoid bone fracture) - answer-Pain on the anatomic snuffbox and axial loading of the thumb. Hx of falling on outstretched hand (Hyperextension of the wrist). Initial xrays are "normal" while a f/u xray in 2 weeks will show scaphoid fx r/t callus bone formation. High risk of avascular necrosis and nonunion. Refer to hand surgeon s/s: decreased grip strength and ROM; dull/deep aching pain Tzanck cells - answer-What is the name of the free floating, rounded spinous cells that are typically found in the vesicle of a patient with pemphigus? Amsel Criteria for BV - answer-1. Adherent vaginal discharge 2. PH >4.5 3. clue cells 4. + whiff test Epidydimitis treatment - answer-Levofloxacin 500 mg orally once a day for 10 days is the treatment of choice polymyalgia rheumatica - answer-geriatric inflammatory disorder of the muscles and joints characterized by pain and stiffness in the neck, shoulders, upper arms, and hips and thighs tx: steroids (oral) systemic lupus erythematosus (SLE) - answer-autoimmune disease in which immune system attacks connective tissue throughout body such as in joints and skin. Also photosensitivity The ANA test is usually positive in lupus patients. Other types of autoantibody testing recommended for these patients, in addition to ANA tests, are antiphospholipid antibodies, antibodies to double-stranded DNA, and anti-Smith (Sm) antibodies. Patients with suspected lupus should be referred to a rheumatologist. The ESR and CRP are nonspecific findings of inflammation and are elevated in patients with autoimmune diseases, infections, and others. DVT diagnostic tests - answer-D Dimer ESR Venous Duplex Venogram Morton's Neuroma - answer-A Morton's neuroma is located between the third and fourth metatarsal heads where the nerve is the thickest because it receives branches from both the medial and the lateral plantar nerves Schilling test - answer-a diagnostic analysis for pernicious anemia Dilantin (phenytoin) adverse effects - answer-normal range: 10-20. Over that: sedation, nystagmus, gingival hyperplasia, measles-like rash, Stevens-Johnson Syndrome, toxic epidermal necrolysis (TEN), teratogenic effects, cardiac dysrhythmias, hypotension Bacterial Meningitis labs - answer-High opening pressure WBC >100 PMNs >80% Lymphocytes <20% Protein high >100 Glucose Low less than 30 Bacterial Meningitis treatment - answer-If thousands of neutrophils are present in CSF start with IV ceftriaxone, vancomycin, steroids Fitz-Hugh-Curtis syndrome - answer-Perihepatic inflammation & fibrosis; Complication of Chlamydia infection Aldera - answer-for the treatment of condyloma accumulate (imiquimod Butalbital - answer-Schedule III. Treatment of tension HA refractory to acetaminophen Dextromethorphan - answer--Antitussive (antagonizes NMDA glutamate receptors). -Synthetic codeine analog. Has mild opioid effect when used in excess. -Naloxone can be given for overdose. Mild abuse potential. -May cause serotonin syndrome if combined with other serotonergic agents Bactrim instructions - answer-take with full glass of water Gemfibrozil (Lopid) - answer-Fibric acid derivative Chronic Paronychia - answer-Chronic infetion of lateral or posterior nail folds usually due to Candida albicans. Effects woman more than men and people who constantly immerse hands in water. Redness and swelling around the nail fold and nail plate. Occasionally with pus formation. Permethrin Instructions - answer-Apply for at least 8 hours Guillian-Barre Syndrome (GBS) - answer-Clinical (ascending flaccid paralysis with h/o recent URI, diarrhea, or immunization for flu or Hep B), confirmed with nerve conduction studies. vitamin D supplementation reduces the risk of - answer-falls desvanlafaxine SE - answer-nausea