ANCC Exam Questions and Answers. Graded A+

ANCC Exam Questions and Answers In the early stages of iron deficient anemias, blood studies show: (a) macrocytic normochromic (b) microcytic hypochromic (c) normochromic normocytic (d) pancytopenic hypocytic - Correct answer (a) normochromic normocytic" "A 14-year-old, male patient has some general concerns about eczema, as his twin brother was recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a personal history of allergic rhinitis, and a history of: (a) asthma (b) bee allergy (c) otitis media (d) psoriasis - Correct answer (a) asthma" "A patient has hyperactive reflexes of the lower extremities. The adult-gerontology primary care nurse practitioner assesses for ankle clonus by: (a) firmly applying a low-pitched tuning fork to the lateral malleolus. (b) flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the percussion hammer. (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. (d) stroking the lateral aspect of the sole from the heel to the ball of the foot with the sharp end of the percussion hammer. - Correct answer (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee." "A 70-year-old, female patient is having her yearly evaluation. The adult-gerontology primary care nurse practitioner gives which physical examination finding the highest priority for immediate treatment? (a) Atrophy of vaginal rugae. (b) Cystocele present. (c) Palpable ovary. (d) Pessary in place. - Correct answer (c) Palpable ovary." "The adult-gerontology primary care nurse practitioner reminds a 16-year-old, male patient who just received his driver's license to wear a seat belt at all times when in a car. The patient replies that he does not need to wear a seat belt, because nothing will happen to him if he is involved in an automobile collision. According to the health belief model, what chief component does the patient lack? (a) Enabling factors. (b) Motivation. (c) Perceived role conflict. (d) Perceived severity. - Correct answer (d) Perceived severity." "The adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure? (a) Comorbidities and length of exposure. (b) Location and event intensity. (c) Mode of transmission and incubation. (d) Premorbid conditions and surveillance rates. - Correct answer (c) Mode of transmission and incubation." "When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner: (a) concludes that the study proves the hypothesis. (b) excludes the discussion section, because the conclusion contains this information. (c) recommends incorporating the results directly into clinical practice. (d) uses the methodology section to support the validity of the study. - Correct answer (d) uses the methodology section to support the validity of the study." "A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: (a) asks the child to provide a copy of the patient's advance directive document. (b) assures the child that the nurse practitioner can disclose requested information. (c) informs the child that he or she must come to the clinic to discuss the parent's case. (d) tells the child that the nurse practitioner can discuss the information only with the patient. - Correct answer (d) tells the child that the nurse practitioner can discuss the information only with the patient." "The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to: (a) evaluate standards, risks, benefits, and outcomes. (b) identify how to anticipate and resolve similar future situations. (c) investigate the need for disciplinary action. (d) obtain agreement of all parties with a chosen solution. - Correct answer (a) evaluate standards, risks, benefits, and outcomes." "To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: (a) charges a fee for patients who arrive late to clinic appointments. (b) disseminates research study results to colleagues. (c) expresses opinions about alternative therapies with patients who consider such treatments. (d) schedules time during clinic hours to meet with pharmaceutical representatives. - Correct answer (b) disseminates research study results to colleagues." "One effect of using electronic health record applications, such as telemedicine and portable monitoring systems, has been to: (a) create stand-alone clinics. (b) decrease billable visits. (c) increase risks to patients. (d) open access to care. - Correct answer (d) open access to care." "The adult-gerontology primary care nurse practitioner evaluates an 80-year-old patient with cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole-trimethoprim (Bactrim). The patient's previous medical record is unavailable. Before prescribing the medication, the nurse practitioner: (a) contacts the patient's adult child. (b) queries the other staff members. (c) relies on the patient's self-report. (d) waits until the patient's chart is available. - Correct answer (a) contacts the patient's adult child." "The adult-gerontology primary care nurse practitioner conducts a small group class on weight management. The nurse practitioner anticipates that the patient who may have the greatest difficulty implementing the counseling is the: (a) extroverted patient raising his or her grandchildren. (b) introverted patient who does not speak in the group. (c) personable patient who lives with his or her children. (d) worried patient whose son is serving in military conflict. - Correct answer (d) worried patient whose son is serving in military conflict." "The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse practitioner's most appropriate approach is to treat the cold symptoms and: (a) advise the patient to stop smoking. (b) prescribe bupropion (Zyban). (c) raise the issue of smoking cessation at the next visit. (d) recommend that the patient select a low nicotine cigarette. - Correct answer (a) advise the patient to stop smoking." "The adult-gerontology primary care nurse practitioner plans to provide smoking cessation education at a community center to older adults and their families. The nurse practitioner designs the program based on knowledge that older adult smokers: (a) are likely to be optimistic about their ability to quit. (b) are more likely to be successful at quitting than younger smokers. (c) have a decreased risk of morbidity and mortality than do younger smokers. (d) receive more instruction to quit from health care providers than younger smokers. - Correct answer (b) are more likely to be successful at quitting than younger smokers." "An 84-year-old patient arrives at the office for an initial visit. The patient questions the need for colorectal screening, since 10 years have passed since the last colonoscopy. The adult-gerontology primary care nurse practitioner recommends: (a) a colonoscopy. (b) a fecal DNA test. (c) flexible sigmoidoscopy. (d) watchful waiting. - Correct answer (d) watchful waiting." "To evaluate for heart failure, which diagnostic test does the adult-gerontology primary care nurse practitioner order for a patient with swelling in the lower extremities? (a) Ankle-brachial index. (b) Brain natriuretic peptide test. (c) D-dimer assay. (d) Spirometry study. - Correct answer (b) Brain natriuretic peptide test." "Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which laboratory values does the adult-gerontology primary care nurse practitioner obtain? (a) Liver function studies. (b) Platelet count. (c) Renal function studies. (d) White blood cell count. - Correct answer (a) Liver function studies." "A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight, abdominal pain, and a long-term history of multiple sexual partners. The patient's physical examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test confirms active hepatitis B? (a) Antibody. (b) Enzyme-linked immunosorbent assay. (c) Immune globulin G. (d) Surface antigen. - Correct answer (d) Surface antigen." "For two to three months, a 78-year-old patient has not been taking levothyroxine (Synthroid) as prescribed. The patient now has symptoms of increasing constipation, lethargy, and weakness. The adult-gerontology primary care nurse practitioner anticipates that laboratory tests will show that the patient's: (a) T4 level decreased, and TSH level increased. (b) T4 level increased, and TSH level decreased. (c) T4 level increased, and TSH level is unchanged. (d) T4 level is unchanged, and TSH level decreased. - Correct answer (a) T4 level decreased, and TSH level increased." "A 68-year-old patient has sustained an unintended weight loss of 15 lb (6.8 kg) over the last two months but reports feeling well. The patient's problems include depression, tobacco abuse, obesity, and dyslipidemia. His or her medications are sertralizine (Zoloft), simvastatin (Zocor), and famotidine (Pepcid). The adult-gerontology primary care nurse practitioner performs which THREE actions? (a) Adds a probiotic. (b) Conducts a depression screening. (c) Decreases the dosage of the statin medication. (d) Obtains a chest x-ray. (e) Orders a thyroid-stimulating hormone. - Correct answer (b) Conducts a depression screening. (d) Obtains a chest x-ray. (e) Orders a thyroid-stimulating hormone." "Preparing to implement an incontinence reduction program at a nursing home, the adult-gerontology primary care nurse practitioner reviews several studies. Place the studies in sequential order of the strength of evidence for this population from strongest to weakest. (a) A case report of an experimental incontinence reduction program in older adults. (b) A consensus statement from the urologic association regarding the use of scheduled toileting. (c) A systematic review of nonrandomized trials concerning the use of vaginal estrogen. - Correct answer Strongest evidence: (c) a systematic review ...then: (b) a consensus statement Weakest evidence: (a) a case report" "What factors does the adult-gerontology primary care nurse practitioner need to consider when discussing advanced care planning with a patient? (a) Autonomy and patient safety are rarely competitive considerations. (b) Decisions regarding a health care representative are a family group decision. (c) Family members are not integral components in care planning. (d) Trust and rapport with patients are key to patient satisfaction in decisions for care. - Correct answer (d) Trust and rapport with patients are key to patient satisfaction in decisions for care." "The adult-gerontology primary care nurse practitioner working in an urban community health center recognizes that asthma-related health issues commonly result in higher morbidity and mortality for persons with: (a) alcohol dependency. (b) lower socioeconomic status. (c) persistent social isolation. (d) recent immigrant status. - Correct answer (b) lower socioeconomic status." "During an annual health visit, a 15-year-old female patient is found to have grown 5 in (12.7 cm) over the past year. She has not reached menarche. Her mother is concerned because the patient's sister reached menarche at age 11 and the mother reached menarche at age 12. Examination reveals that the patient's breasts are enlarged, with the areolae forming a mound above the general contour of each breast, and that the left breast is larger than the right. Axillary hair is absent and the pubic hair is dark, coarse, curly, dense, and similar in pattern to that of an adult female. These findings are consistent with a diagnosis of: (a) hypothyroidism. (b) normal development. (c) polycystic ovary syndrome. (d) Turner syndrome. - Correct answer (b) normal development." "A pale, thin 54-year-old male patient reports a two-month history of numbness in his feet. Past medical history includes hypertension and a subtotal gastrectomy. An examination reveals a decreased vibratory sensation and position sense. Blood tests indicate a hematocrit of 27%, mean corpuscular volume of 105 fL, mean corpuscular hemoglobin of 45 pg, and reticulocytes of 1.5%. The diagnosis is: (a) chronic simple anemia. (b) folate deficiency anemia. (c) iron deficiency anemia. (d) vitamin B12 deficiency anemia. - Correct answer (d) vitamin B12 deficiency anemia." "Upon referral from a gynecologist, an adult nurse practitioner evaluates an 89-year-old female nursing home resident for vaginal bleeding. The patient has a history of occasional periods of confusion and memory loss. The gynecologist recommended dilation and curettage and the patient consented to the procedure after the gynecologist answered her questions, but the patient's daughter protests. The nurse practitioner's ethical duty is to support the: (a) daughter, because she might file a lawsuit over unsatisfactory care. (b) daughter, because the patient is occasionally confused and incapable of granting informed consent. (c) nursing home administration, which may choose to support either the patient or the daughter. (d) patient, who has given informed consent. - Correct answer (d) patient, who has given informed consent." "A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is: (a) amoxicillin (Amoxil). (b) doxycycline (Vibramycin). (c) erythromycin (E-Mycin). (d) trimethoprim-sulfamethoxazole (Bactrim). - Correct answer (c) erythromycin (E-Mycin)." "A 70-year-old patient reports fatigue and a nonproductive cough with pain on inspiration and expiration. The patient denies a sore throat, fever, nasal congestion, or postnasal drip. Examination reveals a well-developed patient in no acute distress who is afebrile and has respirations of 32 breaths/min. The patient's lungs have diminished breath sounds. The heart rate is 70 beats/min, regular with no murmur. There is no edema of the extremities. An adult nurse practitioner orders: (a) a chest x-ray. (b) a lung perfusion scan. (c) over-the-counter treatments for symptomatic relief. (d) pulmonary function tests. - Correct answer (a) a chest x-ray." "An adult nurse practitioner is educating a female patient about her newly diagnosed phobia. The nurse practitioner explains that phobias differ from other anxiety disorders in that phobias: (a) are innate and can be prevented. (b) are related to specific trigger experiences. (c) occur at a later age. (d) often involve depressive symptoms. - Correct answer (b) are related to specific trigger experiences." "A 78-year-old male patient comes to the ambulatory care clinic and reports an inability to void. The adult nurse practitioner has difficulty inserting a urinary catheter due to an obstruction. The nurse practitioner's action is to: (a) obtain consent from the patient to perform prostatic massage. (b) perform a suprapubic aspiration to relieve bladder distention. (c) prescribe an oral loop diuretic. (d) refer the patient to a urologist for further treatment. - Correct answer (d) refer the patient to a urologist for further treatment." "A patient comes to the clinic with reports of acute pain and loss of vision in the right eye. The adult nurse practitioner informs the patient that these symptoms require: (a) assessment with a split lamp. (b) examination with an otoscope. (c) immediate referral to an ophthalmologist. (d) treatment with several ophthalmologic agents. - Correct answer (c) immediate referral to an ophthalmologist." "A 45-year-old patient with diabetes comes to the clinic for an annual appointment. The patient declines a parenteral influenza vaccination because a friend "came down with the flu after receiving the vaccination." The adult nurse practitioner explains that the vaccination is: (a) a polysaccharide, so it may cause a mild case of influenza. (b) activated, so it may cause a mild case of influenza. (c) inactivated, and this is unable to cause influenza. (d) live attenuated, so it may cause a mild case of influenza. - Correct answer (c) inactivated, and this is unable to cause influenza." "An institutional review board rejects an adult nurse practitioner's research proposal on the grounds that the: (a) chosen statistics were not optimal to meet research objectives. (b) literature review was insufficient to develop the research question. (c) proposed budget did not cover the cost of the study. (d) subject's rights were not clearly protected. - Correct answer (d) subject's rights were not clearly protected." "A patient informs an adult nurse practitioner, "I want to stop smoking." The nurse practitioner responds: (a) "Do you have any ideas about how you would like to quit smoking?" (b) "Does your health insurance cover smoking cessation?" (c) "I will develop a plan for you to stop smoking." (d) "Quitting smoking is the most important thing you can do for your health." - Correct answer (a) "Do you have any ideas about how you would like to quit smoking?"" "An adult nurse practitioner is responsible for billing codes that are selected and submitted to third party payors when: (a) a certified coder has selected the code. (b) a change has occurred in the insurance carrier. (c) a misprint has appeared in the coding book. (d) the evaluation and management criteria have changed. - Correct answer (a) a certified coder has selected the code." "Many patients view illness as a distortion in the balance of some aspect of their lives, and believe that folk medicine can remedy this. When encountering such beliefs, an adult nurse practitioner's appropriate action is to: (a) discuss these remedies and include them in the management plan. (b) educate these patients about evidence-based practice that is specific to their present condition. (c) promote scientifically proven treatment measures. (d) refer the patient to a homeopathic specialist. - Correct answer (a) discuss these remedies and include them in the management plan." "An adult nurse practitioner is designing a research study to investigate the efficacy of a patient education tool for adults with low literacy levels. Which action reflects the nurse's inclusion of ethical principles in the research plan? (a) Ensuring that the participants understand their right to withdraw from the study at any time, without incurring penalties (b) Explaining the study in scientific, medical, and nursing terms so as not to patronize the participants (c) Testing the study's informed consent form on nursing doctoral candidates at a local university to validate its clarity (d) Using large print in the content of the study's informed consent form - Correct answer (a) Ensuring that the participants understand their right to withdraw from the study at any time, without incurring penalties" "An adult nurse practitioner evaluates a patient who has been a victim of domestic violence. After the office visit, law enforcement authorities contact the nurse practitioner, requesting information regarding any visible injuries observed during the visit. The nurse practitioner's response is to: (a) call the patient to obtain consent. (b) provide the written record, as requested. (c) refer the request to the office manager. (d) require a court order for release. - Correct answer (b) provide the written record, as requested." "An adult nurse practitioner witnesses a coworker's injury due to a chemical spill. To which regulatory agency is this incident reported? (a) Agency for Toxic Substances and Disease Registry (b) American Association of Poison Control Centers (c) Occupational Safety and Health Administration (d) State health department - Correct answer (c) Occupational Safety and Health Administration" "When interviewing a female adolescent patient about her sexual history, an adult nurse practitioner's most effective strategy is to: (a) acknowledge the patient's feelings about the information. (b) conduct the history as part of the physical examination. (c) maintain an open attitude about the information that is divulged. (d) suggest that the patient reschedule the appointment and bring a friend. - Correct answer (c) maintain an open attitude about the information that is divulged." "The practical application of findings from a set of studies is known as: (a) critical analysis. (b) data implementation. (c) guideline development. (d) research utilization. - Correct answer (d) research utilization." "An adult nurse practitioner is encouraging an older adult patient to reminisce about successful life accomplishments. Which theoretical framework is the nurse practitioner using? (a) Erikson's model of psychosocial development (b) Maslow's hierarchy of needs theory (c) Rogers' science of unitary human beings (d) Roy's adaptation model - Correct answer (a) Erikson's model of psychosocial development [Note: Stage, Ego Integrity vs. Despair]" "An adult nurse practitioner evaluates a new patient, an African American with hypertension who has been taking lisinopril (Prinivil). To optimize the patient's response, a more effective pharmacological treatment is: (a) a beta-blocker. (b) a direct-acting vasodilator. (c) a thiazide diuretic. (d) an angiotensin-converting enzyme inhibitor. - Correct answer (c) a thiazide diuretic." "Initial measures to prevent deformity and maintain function for the knee during an acute inflammatory reaction secondary to injury include: (a) a hot daily shower followed by a short period of exercise. (b) application of a splint to the joint followed by application of heat. (c) cautious performance of active range-of-motion exercises. (d) total immobilization of the joint and performance of isometric exercises. - Correct answer (d) total immobilization of the joint and performance of isometric exercises." "A 34-year-old truck driver reports a sharp pain in the lower back that worsens with ambulation. The symptoms began after a strenuous three-day driving trip. During an examination, the patient has difficulty walking on the heels and shows weakness in the extensors of the big toes. The initial differential diagnosis is: (a) compression fracture. (b) L-1 root irritation. (c) L-5 root irritation. (d) ruptured disc. - Correct answer (c) L-5 root irritation." "The gerontological nurse practitioner performs a speculum examination for a 71-year-old female patient without symptoms, and finds a thin, whitish, nonodorous mucoid discharge high in the patient's vagina. The nurse practitioner's most appropriate intervention is to: (a) explain to the woman that the discharge is normal. (b) prescribe estrogen cream, twice a week. (c) prescribe a topical antifungal medication, applied vaginally each night for one week. (d) recommend the daily use of a vaginal lubricant, for three days. - Correct answer (a) explain to the woman that the discharge is normal." "Temporal arteritis requires immediate treatment in order to prevent: (a) blindness in the affected eye. (b) facial nerve palsy. (c) transient ischemic attack. (d) trigeminal neuralgia. - Correct answer (a) blindness in the affected eye." "The test of choice for diagnosing iron deficiency anemia is a: (a) reticulocyte count. (b) serum ferritin level. (c) total iron binding capacity. (d) transferrin saturation level. - Correct answer (b) serum ferritin level." "Which profile characterizes the older adult with the highest risk for suicide? (a) Divorced, Asian, and female (b) Married, Amish, and female (c) Single, White, and male (d) Widowed, African-American, and male - Correct answer (c) Single, White, and male" "The gerontological nurse practitioner notes a well-demarcated, dry, rough, tan-colored area that measures 1 cm on the forearm of a retired man who worked as a park ranger. The man says that the lesion has been present for years. The lesion is suggestive of: (a) actinic keratosis. (b) keratoacanthoma. (c) seborrheic keratosis. (d) senile lentigo. - Correct answer (a) actinic keratosis." "An 87-year-old patient, who has multiple, fluid-filled and unilateral lesions on an erythematous base that follows a dermatome, reports severe pain and burning at the site. The patient asks how long the pain will last. The gerontological nurse practitioner responds that the pain: (a) might never completely disappear. (b) will disappear in four to six weeks. (c) will disappear in six months to one year. (d) will disappear once the lesions are gone. - Correct answer (a) might never completely disappear." "A 69-year-old female patient reports dyspareunia. Physical examination reveals sparse hair, an introitus that admits two fingers, and a pale, dry vagina. The gerontological nurse practitioner's initial management of this problem is to prescribe: (a) a local, topical antifungal cream. (b) a topical hormonal cream. (c) a water-soluble lubricating jelly. (d) daily douching. - Correct answer (b) a topical hormonal cream." "An older patient, who has chronic obstructive pulmonary disease, develops a fever and changes in sputum production. The gerontological nurse practitioner prescribes: (a) a corticosteroid. (b) an antibiotic. (c) an inhaled bronchodilator. (d) nebulizer treatments. - Correct answer (b) an antibiotic." "The charge nurse at a nursing home consults a gerontological nurse practitioner about a resident with dementia who fell two weeks ago. The patient's x-ray on the day of the fall was negative, but the resident continues to limp and exhibits increasing agitation. The nurse practitioner advises the charge nurse to: (a) administer the prescribed pain medication to the resident. (b) apply heat to the affected hip and monitor the resident's ambulation. (c) initiate physical therapy for the resident. (d) obtain another x-ray of the affected hip and pelvis. - Correct answer (d) obtain another x-ray of the affected hip and pelvis." "Which patient has the greatest nutritional risk? (a) A patient who has dementia and is living with family (b) A patient who has hypothyroidism and is 30% overweight (c) A patient who has multiple dental caries and lives alone (d) A patient who is wheelchair-bound from a stroke and receives live-in care - Correct answer (c) A patient who has multiple dental caries and lives alone" "The primary reason for reassessing patients' alcohol use is to: (a) advise about safe levels of consumption. (b) evaluate the risk for peripheral neuropathy. (c) prevent or reduce associated health risks. (d) screen for liver dysfunction. - Correct answer (c) prevent or reduce associated health risks." "The medical history of a robust, 64-year-old patient is negative for hypertension, heart disease, and diabetes. Upon examination, the gerontological nurse practitioner detects a new grade 3 crescendo-decrescendo systolic murmur that is heard loudest at the base of the heart, with radiation to the carotid arteries. The gerontological nurse practitioner's next action is to order: (a) a C-reactive protein test. (b) a troponin level. (c) an echocardiogram. (d) an electrocardiogram. - Correct answer (c) an echocardiogram." "Which drug puts an older adult at the highest risk for injury after a fall? (a) Acetaminophen/ hydrocodone (Vicodin) (b) Alendronate (Fosamax) (c) Loratadine (Claritin) (d) Warfarin (Coumadin). - Correct answer (d) Warfarin (Coumadin)." "In addition to altered mental status, which is the best early indicator of pneumonia in an older adult? (a) Cough (b) Fever (c) Malaise (d) Tachypnea - Correct answer (d) Tachypnea" "A 65-year-old woman comes to the geriatric clinic for a routine checkup. Her history includes a 10 lb (4.5 kg) weight loss over the past two months. On physical examination, an enlarged (2 cm), radiating, nontender and rubbery lymph node is palpated on the left supraclavicular chain. The gerontological nurse practitioner's next action is to: (a) order a throat culture and monospot test. (b) order a two-step tuberculin skin test. (c) prescribe antibiotic therapy. (d) refer the patient to a surgeon for a lymph node biopsy. - Correct answer (d) refer the patient to a surgeon for a lymph node biopsy. [Note: Virchow's nodes, or "Troisier's sign", considered a sign of abdominal metastasis.]" "Which type of urinary incontinence is lessened by pelvic floor exercises? (a) Functional (b) Overflow (c) Stress (d) Transient - Correct answer (c) Stress" "The purpose of a Long-Term Care Ombudsman Program is: (a) implementing quality assurance activities. (b) performing comprehensive resident assessments. (c) preserving the rights of nursing home residents. (d) providing training requirements for nursing assistants. - Correct answer (c) preserving the rights of nursing home residents." "Which factor is associated with the highest risk of falls in older persons living in the community? (a) A history of previous falls (b) Living alone (c) Osteoporosis (d) Use of an assistive device - Correct answer (a) A history of previous falls" "An older adult patient complains of recent lapses in memory and decreased alertness. The patient's laboratory test results indicate a mild, macrocytic anemia. Which additional test does the adult-gerontology acute care nurse practitioner order to confirm a diagnosis? (a) A reticulocyte count (b) A serum folate level (c) An erythrocyte sedimentation rate (d) Iron studies - Correct answer (b) A serum folate level" "An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply, after "spending down" to qualify? (a) Medicaid (b) Medicare (c) The American Association of Retired Persons (d) The United States Social Security Administration - Correct answer (a) Medicaid" "A 70-year-old patient with acute systolic heart failure denies any functional limitations, is able to walk five blocks before tiring, and is euvolemic. Which medication is the first-line therapy for this patient? (a) Amlodipine (Norvasc) (b) Digoxin (Lanoxin) (c) Furosemide (Lasix) (d) Lisinopril (Zestril) - Correct answer (d) Lisinopril (Zestril) [Note: ACE-I's are first line therapy for asymptomatic and symptomatic heart failure, unless presenting with dyspnea at rest, in which case a diuretic would be first line.]" "A 15-year-old patient with type 1 diabetes mellitus reports elevated blood glucose levels in the morning. An adult-gerontology acute care nurse practitioner determines that the patient's hyperglycemia is due to the dawn phenomenon and: (a) increases the insulin dosage at bed time. (b) reduces the insulin dosage at bed time. (c) tests the blood glucose level at 3:00 AM every morning. (d) tests the blood glucose level in the evening. - Correct answer (a) increases the insulin dosage at bed time." "Which research design has the greatest strength in determining if an intervention is effective? (a) Case control (b) Clinical trial (c) Cohort (d) Cross-sectional - Correct answer (b) Clinical trial" "A 55-year-old man who has no history of diabetes mellitus, heart disease, hypertension, or thrombotic events is diagnosed with paroxysmal atrial fibrillation. Based on national stroke prevention guidelines, the recommended antithrombotic management for this patient is: (a) aspirin (Bayer). (b) aspirin with dipyridamole (Aggrenox). (c) clopidogrel (Plavix). (d) warfarin (Coumadin). - Correct answer (a) aspirin (Bayer)." "An adult-gerontology acute care nurse practitioner who specializes in cardiology is asked to give a presentation on lipid-lowering drugs. A major drug company that markets a lipid-lowering medication plans to pay the presenter an honorarium, but asks the nurse practitioner to limit his or her remarks to its drug. This situation presents a: (a) breach of contract. (b) conflict of interest. (c) personal choice. (d) reasonable request. - Correct answer (b) conflict of interest." "A 32-year-old patient who underwent an open splenectomy for a ruptured spleen, is preparing for discharge. An adult-gerontology acute care nurse practitioner reviews the potential complications with the patient. The nurse practitioner emphasizes which instruction to the patient? (a) Continue antibiotics for 14 days (b) Follow up with primary care provider for vaccinations (c) No international travel for five years (d) No weight lifting restrictions - Correct answer (b) Follow up with primary care provider for vaccinations" "A 65-year-old female patient has a confirmed diagnosis of terminal liver disease. The patient's advance directive designates comfort measures, only. An adult-gerontology acute care nurse practitioner's action is to: (a) discuss the patient's decision with the patient's family members. (b) persuade the patient to participate in a hepatitis clinical trial. (c) reconfirm the patient's end-of-life decision. (d) refer the patient for a psychological evaluation. - Correct answer (c) reconfirm the patient's end-of-life decision." "A hospital requires adult-gerontology acute care nurse practitioners to submit credentialing applications for the purpose of: (a) authorizing clinical roles and responsibilities. (b) delineating therapeutic and diagnostic services. (c) monitoring the nurse practitioner's clinical activities. (d) verifying education, licensure, and experience. - Correct answer (d) verifying education, licensure, and experience." "Assessment of which endocrine system response to sepsis-induced hypotension is essential in guiding subsequent therapy? (a) Adrenal (b) Pancreatic (c) Pituitary (d) Thyroid - Correct answer (a) Adrenal" "Generally healthy patients, who are diagnosed with acute bronchitis, inappropriately ask for which category of drugs? (a) Antibiotics (b) Beta-agonists (c) Corticosteroids (d) Xanthines - Correct answer (a) Antibiotics" "What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number? (a) The Affordable Care Act (b) The Balanced Budget Act (c) The Civilian Health and Medical Program of the Uniformed Services (d) The (Consolidated) Omnibus Budget and Reconciliation Act - Correct answer (b) The Balanced Budget Act" "A 19-year-old male patient arrives at the emergency department exhibiting symptoms of lower abdominal pain that radiates to the groin, and that the patient rates as an 8 on a scale of 1 to 10. That patient states that the pain came on suddenly, while he was playing football with friends. The patient's physical examination reveals positive bowel sounds in all quadrants; a soft, non-tender abdomen; no rebounding and no guarding; and no palpable mass in the abdomen or groin. Examination of the patient's genitalia reveals a unilateral cremasteric reflex. What is the adult-gerontology acute care nurse practitioner's leading differential diagnosis, based on the patient's presentation? (a) Appendicitis (b) Epididymitis (c) Inguinal hernia (d) Testicular torsion - Correct answer (d) Testicular torsion" "An exception to the practice of maintaining patient confidentiality is when: (a) a family member of the patient gives consent. (b) a family member of the patient is paying for the treatment. (c) the patient is unresponsive. (d) the patient plans to hurt someone. - Correct answer (d) the patient plans to hurt someone." "When reading a systematic review, an adult-gerontology acute care nurse practitioner ensures that the review: (a) describes the intended audience. (b) describes the study inclusion criteria. (c) is published in a peer-reviewed journal. (d) is written by experts in the field. - Correct answer (b) describes the study inclusion criteria." "An adult-gerontology acute care nurse practitioner needs to communicate the findings of HIV to a patient. The nurse practitioner enters the patient's room and the spouse is at the bedside. To discuss the diagnosis, the nurse practitioner: (a) asks the nurse to step into the room. (b) asks the spouse to step out of the room. (c) speaks with the patient and spouse together. (d) speaks with the spouse privately. - Correct answer (b) asks the spouse to step out of the room." "When discharging an 85-year-old patient who has a diagnosis of stasis dermatitis, an adult-gerontology acute care nurse practitioner includes instructions to: (a) keep legs elevated while seated. (b) maintain systolic blood pressure greater than 120 mm Hg. (c) soak legs in warm water daily. (d) wear compression stockings of 65 mm Hg below the knee. - Correct answer (a) keep legs elevated while seated." "A patient is brought to the emergency department after being found unresponsive in a car. The patient's spouse arrives at the hospital to find the patient comatose, on mechanical ventilation, and brain death has been established. The spouse informs the staff that the patient has an advance directive and did not want to be kept alive, artificially. The spouse struggles with the decision to remove the patient from life support. The adult-gerontology acute care nurse practitioner: (a) consults the ethics committee to help with the decision-making process. (b) discusses with the spouse that removing the patient is the right thing to do. (c) encourages the spouse to have a family meeting to make the decision as a group. (d) reviews the patients advance directive with the spouse. - Correct answer (d) reviews the patients advance directive with the spouse." "To improve the health of a population, an acute care nurse practitioner's intervention is to: (a) join a professional nursing organization and run for an organizational office. (b) maintain current certification as an acute care nurse practitioner. (c) participate in hospital grand rounds. (d) report any unusual pattern of infections to the local health department. - Correct answer (d) report any unusual pattern of infections to the local health department." "A patient, who is allergic to penicillin, requires antibiotic treatment for community-acquired pneumonia. The patient has a limited income, lacks health insurance, and is about to be discharged from the hospital. An acute care nurse practitioner's intervention is to: (a) consult social services for assistance. (b) order an aerosol antibiotic. (c) transfer the patient to an extended care facility. (d) write a prescription for an antibiotic. - Correct answer (a) consult social services for assistance." "A patient is scheduled for elective orthopedic surgery. During the preadmission physical examination, the acute care nurse practitioner detects an asymptomatic pulsatile mass in the middle upper abdomen. The nurse practitioner's most appropriate action is to: (a) obtain a kidney-urethra-bladder x-ray. (b) obtain a renal arteriogram. (c) obtain an abdominal ultrasound. (d) proceed with the patient's elective surgery. - Correct answer (c) obtain an abdominal ultrasound." "Which musculoskeletal disease primarily involves the distal joints, hips, knees, and spine, and is characterized by the development of Heberden and Bouchard nodes? (a) Gout (b) Osteoarthritis (c) Osteoporosis (d) Rheumatoid arthritis - Correct answer (b) Osteoarthritis" "An acute care nurse practitioner is deciding whether to recommend a long-term medication regimen that will help a patient manage disease symptoms but may also introduce problematic side effects. This decision reflects which ethical principle? (a) Autonomy (b) Beneficence (c) Fidelity (d) Justice - Correct answer (b) Beneficence" "An acute care nurse practitioner is evaluating a 78-year-old patient for an aortic valve replacement. Laboratory results indicate a low serum albumin level. The nurse practitioner prescribes a high-protein diet and evaluates the patient's response by: (a) assessing the total serum protein level. (b) calculating the body fat percentage. (c) obtaining a complete blood count. (d) obtaining a serum prealbumin level. - Correct answer (d) obtaining a serum prealbumin level." "A female patient is receiving adjuvant chemotherapy for breast cancer and has been given information about her treatment regimen, expected side effects, and symptom management. Which symptom, if occurring two weeks after treatment, warrants a prompt call to the acute care nurse practitioner? (a) Alopecia (b) Fatigue (c) Fever (d) Nausea - Correct answer (c) Fever" "Which medication is used with caution in older adults due to the potential for confusion and delirium? (a) Fluoxetine (Prozac) (b) Haloperidol (Haldol) (c) Lorazepam (Ativan) (d) Phenelzine (Nardil) - Correct answer (c) Lorazepam (Ativan)" "After undergoing a successful autologous bone marrow transplant for multiple myeloma, a 55-year-old male patient comes to the clinic for his followup appointment. The patient reports that a skin lesion has changed in appearance. The acute care nurse practitioner responds by: (a) consulting dermatology to evaluate the lesion. (b) inspecting and excising the lesion. (c) prescribing a topical steroid preparation. (d) recommending reevaluation in two weeks. - Correct answer (a) consulting dermatology to evaluate the lesion." "An 83-year-old patient arrives in the emergency department in severe respiratory distress. The patient verbalizes a desire not to be intubated nor to have cardiopulmonary resuscitation performed. The patient states that a neighbor has a copy of the patient's recently signed living will. The acute care nurse practitioner leaves the bedside momentarily and returns to find the physician preparing to intubate. The nurse practitioner's initial action is to: (a) assist the physician with intubation. (b) call the patient's neighbor to deliver a copy of the living will. (c) locate a previous patient record to find a copy of the living will. (d) notify the physician of the conversation with the patient. - Correct answer (d) notify the physician of the conversation with the patient." "A 24-year-old male patient with a closed head injury has been intubated for 12 days. The patient's parents have repeatedly refused consent for a tracheostomy and long-term care placement. On multiple occasions, the surgeon has discussed the risks and benefits of the surgery with them. Addressing the parents, the acute care nurse practitioner states: (a) "I understand you have reservations about the placement of a tracheostomy." (b) "Please know that not many patients die while undergoing a tracheostomy." (c) "Without a tracheostomy, we can't transfer your son to another facility." (d) "You know, your son will die if a tracheostomy is not placed." - Correct answer (a) "I understand you have reservations about the placement of a tracheostomy."" "Before initiating a new antihypertensive drug therapy, an acute care nurse practitioner uses which evidence-based practice approach? (a) Discussing the medication choices with a collaborating physician (b) Discussing the medication's side effects with a colleague (c) Reviewing the confidence intervals of related research (d) Reviewing the institutional formulary - Correct answer (c) Reviewing the confidence intervals of related research" "Which is an accurate statement regarding the formal evaluation of quality of care? (a) Continuous quality improvement (CQI) programs focus on individual incidents. (b) Health care regulatory agencies have not identified an effective means to measure quality. (c) Hospitals do not receive payment for services if quality of care evaluations are not performed. (d) The Joint Commission mandates that hospitals implement CQI programs. - Correct answer (d) The Joint Commission mandates that hospitals implement CQI programs." "While providing a history, a patient requests that an acute care nurse practitioner disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship? (a) Autonomy (b) Beneficence (c) Confidentiality (d) Empathy - Correct answer (c) Confidentiality" "A 57-year-old male patient arrives at the emergency department with substernal chest pain. An electrocardiogram reveals ST segment depression in leads V3 and V4. Before administering nitrates, an acute care nurse practitioner assesses the patient's use of: (a) angiotensin-converting enzyme inhibitors. (b) aspirin. (c) beta-blockers. (d) phosphodiesterase inhibitors. - Correct answer (d) phosphodiesterase inhibitors." "For an 84-year-old patient who undergoes surgery, the most accurate predictor of mortality and patient outcome is: (a) a low score on a Mini-Mental State Examination. (b) an impaired functional status. (c) the availability of social support. (d) the patient's chronological age. - Correct answer (b) an impaired functional status." "An acute care nurse practitioner performs a cardiac assessment on a patient with a confirmed mitral valve prolapse. During which activity does the nurse practitioner expect the patient's murmur to diminish? (a) Inhaling (b) Sitting (c) Squatting (d) Standing - Correct answer (c) Squatting" "A 21-year-old patient is admitted to the intensive care unit with a severe closed head injury. The patient's family is becoming louder and more insistent about seeing the patient. To establish a therapeutic relationship with the family, an acute care nurse practitioner's initial action is to: (a) acknowledge the family's anxiety. (b) arrange for a meeting with a social worker. (c) escort the family to a conference room. (d) gently direct the family to maintain composure. - Correct answer (a) acknowledge the family's anxiety." "Which drug is associated with increased lipoprotein levels? (a) Furosemide (Lasix). (b) Hydrochlorothiazide (HCTZ). (c) Spironolactone (Aldactone). (d) Triamterene (Dyrenium). - Correct answer (b) Hydrochlorothiazide (HCTZ)." "What is the main reason for administering a progestational medication to perimenopausal women who use estrogen? (a) Preventing hot flashes. (b) Preventing osteoporosis. (c) Promoting growth of the uterine lining. (d) Decrease the risk of endometrial hyperplasia. - Correct answer (d) Decrease the risk of endometrial hyperplasia." "The family nurse practitioner asks a patient to perform rapid, alternating movements of the hands to evaluate: (a) cerebellar functioning. (b) cognitive functioning. (c) reflex arc functioning. (d) stereognostic functioning. - Correct answer (a) cerebellar functioning." "A 38-year-old patient who is Vietnamese tells the family nurse practitioner that his or her parent died in his or her 40s from liver cancer. The nurse practitioner assesses that the patient is at risk for: (a) hepatitis B. (b) malaria. (c) tularemia. (d) tyrosinemia. - Correct answer (a) hepatitis B." "A 55-year-old male patient who is Chinese has a follow-up appointment after cardiac bypass surgery. The patient brings his father with him into the examination room. The family nurse practitioner provides culturally sensitive care by: (a) asking the patient's father if he has any questions regarding his son's care. (b) asking the patient's father to leave the room due to confidentiality issues. (c) performing the examination without commenting to the patient's father. (d) performing the examination, then telling the patient's father the examination findings. - Correct answer (a) asking the patient's father if he has any questions regarding his son's care." "A difficult aspect of determining occupational exposure to disease is the: (a) confidentiality of the information within company records. (b) inaccuracy of occupational disease reporting. (c) long latency period between exposure and disease development. (d) reliance on workers' memories. - Correct answer (c) long latency period between exposure and disease development." "The family nurse practitioner exhibits professional leadership by: (a) adding clinical protocols to the nurse practitioner scope of practice. (b) comparing the workplace roles of the registered nurse and the nurse practitioner. (c) creating a task force to address scope-of-practice concerns. (d) lobbying to eliminate continuing education requirements. - Correct answer (c) creating a task force to address scope-of-practice concerns." "To comply with regulations for third-party payor reimbursement and documentation, a family nurse practitioner correlates: (a) evaluation and management code with history, examination and medical decision making. (b) health outcomes with physical examination findings and plan of care. (c) medication orders and treatment plan with electronic billing. (d) patient privacy with informed consent. - Correct answer (a) evaluation and management code with history, examination and medical decision making." "The family nurse practitioner examines a patient who has sustained a non-work-related injury that interferes with the patient's ability to perform his or her job. The patient does not qualify for medical disability and has a reasonable chance of engaging in a suitable occupation with proper therapy. The nurse practitioner recommends that the patient apply for: (a) Family and Medical Leave Act benefits. (b) home health services. (c) Social Security benefits. (d) vocational rehabilitation services. - Correct answer (d) vocational rehabilitation services." "A 45-year-old patient who is an opera singer reports progressive hoarseness for the last four weeks. The hoarseness began after a three-hour opera performance. The patient does not smoke and reports no weight loss, upper respiratory infection, dysphagia, or shortness of breath. The family nurse practitioner manages this patient by: (a) ordering a computed tomography scan of the head. (b) ordering an immediate lateral neck x-ray. (c) prescribing systemic antibiotics and cool mist inhalations. (d) requesting a referral for evaluation of the larynx. - Correct answer (d) requesting a referral for evaluation of the larynx." "A patient who sustained a myocardial infarction comes to the clinic for a refill of atorvastatin (Lipitor). The family nurse practitioner explains that the medication is prescribed for: (a) cancer prevention. (b) primary prevention. (c) secondary prevention. (d) tertiary prevention. - Correct answer (d) tertiary prevention." "Which health promotion strategy is most appropriate for adolescents who are obese? (a) Individual-based behavior modification. (b) Motivational interviewing. (c) Parents should regulate meals. (d) Presenting video case studies. - Correct answer (b) Motivational interviewing." "Treatment of viral conjunctivitis includes the use of: (a) antihistamine/decongestant drops. (b) antihistamine/mast cell stabilizer drops. (c) cold compresses. (d) steroid eyedrops. - Correct answer (c) cold compresses." "A 60-year-old patient with diabetes has a blood pressure reading of 150/96 mmHg. After three months of increased exercise and decreased calories, the patient has lost 10 lb (4.54 kg). The patient's follow-up blood pressure is 142/94 mmHg. Which medication does the family nurse practitioner prescribe? (a) Enalapril (Vasotec). (b) Furosemide (Lasix). (c) Hydrochlorothiazide (HydroDIURIL). (d) Propranolol (Inderal). - Correct answer (a) Enalapril (Vasotec)." "A patient who had a total gastrectomy one year ago complains of a sore mouth, indigestion, and tingling in the lower extremities. Which test is ordered by the family nurse practitioner? (a) Blood urea nitrogen level. (b) Complete blood count. (c) Liver function study. (d) Thyroid function study. - Correct answer (b) Complete blood count." "A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and mild euphoria shows symptoms associated with the use of: (a) benzodiazepine (Alprazolam). (b) cocaine. (c) morphine (MS Contin). (d) oxycodone (OxyContin). - Correct answer (b) cocaine." "A 40-year-old patient has had a generalized, nonpruritic skin eruption with intermittent exacerbations over the past 10 years. Currently, a well-circumscribed erythematous plaque appears over the patient's left gluteal fold area. The lesion is covered with scales and has some fissuring. The family nurse practitioner makes a diagnosis of: (a) atopic dermatitis. (b) ichthyosis. (c) psoriasis. (d) tinea corporis. - Correct answer (c) psoriasis." "During cardiac auscultation, a soft first heart sound with a holosystolic apical murmur that radiates to the left axilla suggests: (a) aortic stenosis. (b) mitral regurgitation. (c) mitral stenosis. (d) mitral valve prolapse. - Correct answer (b) mitral regurgitation." "After determining that a patient has a lead level of 16 mcg/dL, the family nurse practitioner: (a) advises the parent to avoid giving the patient bottles of whole milk. (b) consults with a physical therapist for muscle strengthening. (c) observes for signs of diminished reflexes on the physical exam. (d) orders an increase of iron supplements to 6 mg/kg per day divided in two doses. - Correct answer (c) observes for signs of diminished reflexes on the physical exam." "Clinical practice guidelines are designed to: (a) be used in every patient situation. (b) increase variations in clinical care. (c) mandate practice decisions. (d) serve as a handbook to best practice. - Correct answer (d) serve as a handbook to best practice." "The family nurse practitioner participates in a hospital-based quality improvement project. The nurse practitioner reviews four charts per month of a nurse practitioner colleague to ensure diabetes protocols are met. This process is a: (a) core competency. (b) force field analysis. (c) peer review. (d) risk analysis. - Correct answer (c) peer review." "