NR574 UPDATED PRACTICE EXAM QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔high titer IgG antibodies to anti-double-stranded DNA (anti-dsDNA) are - ✔✔specific
for SLE diagnosis.
✔✔"SOAP BRAIN MD" is used for? - ✔✔Diagnostic criteria for SLE must include at
least 4 of the criteria listed, which can be remembered by the mnemonic
✔✔SOAP BRAIN MD mnemonic for SLE stands for? - ✔✔S - serositis (pleuritis,
pericarditis, peritonitis)
O - oral ulcers (painless)
A - arthralgia/arthritis
P - photosensitivity
B - blood disorder (anemia, thrombocytopenia, hemolytic anemia)
R - renal involvement (nephritic or nephrotic disorders)
A- ANA+
I - immunologic phenomenon (anti-SM, Anti-dsDNA, Ro, La, Anti-histone)
N - neurologic phenomenon (altered mental status, seizures, stroke, headache)
M - malar rash
D - discoid rash
✔✔Lorenzo is newly admitted with pancytopenia, fever, joint pain, and a malar rash.
The nurse practitioner suspects SLE. Which of the following tests is most useful in
diagnosing this condition? - ✔✔antinuclear antibody
✔✔Jean-Louis was admitted with a diagnosis of acute kidney injury (AKI). He does not
have a history of previous renal dysfunction but does have a history of SLE The
urinalysis reveals significant proteinuria. Which of the following diagnostic tests is
required when lupus nephritis is suspected? - ✔✔Renal Biopsy
✔✔rheumatoid arthritis (RA) - ✔✔arthritis with swelling, stiffness, pain, and degener-
ation of cartilage in joints caused by chronic soft tissue inflammation; may result in
crippling deformities; an autoimmune disease
✔✔rheumatoid arthritis clinical manifestations. - ✔✔Common symptoms include warm,
tender, swollen joints, and joint stiffness.-swan neck deformity- hyperextension of PIP
with flexion of DIP (distal interpha- langeal) -Boutonniere deformity-firm nontender
nodules that adhere to the periosteum, tendons, or bursae-fatigue, malaise, fever,
anorexia, weight loss, and depression-ulnar deviation
✔✔Juan has a history of rheumatoid arthritis and is taking methotrexate7.5mg once per
week. He reports an acute increase in pain and swelling from baseline for the last 2
days, primarily affecting both hands and both knees. The nurse practitioner suspects an
,acute RA flare. What is the most appropriate intervention? - ✔✔Prednisone 40 mg daily
then taper over two weeks
✔✔Antiphospholipid Syndrome (APS) - ✔✔
✔✔Clinical Manifestations of antiphospholipid syndrome - ✔✔DVT PEpregnancy
morbidity migraines strokes/TIA livedo reticularis
✔✔differentials of fibromyalgia - ✔✔Fibromyalgia presents with a multitude of gener-
alized symptoms making the differential diagnosis quite broad.-systemic lupus
erythematosus (SLE),-Sjogren's syndrome,
-gluten sensitivity, -hypothyroidism,-polymyalgia rheumatica,-mixed connective tissue
disease, -multiple sclerosis,
-myasthenia gravis.
✔✔Lo-Wei has fibromyalgia and complains of poorly controlled pain, in- creased
fatigue, and difficulty sleeping. She has a body mass index (BMI)of 31 and a history of
depression. She reports that she has been frequently forgetting to take her medications
(duloxetine and gabapentin). Which of the following are the most appropriate
interventions for Lo-Wei? - ✔✔medication compliance, exercise program, and sleep
hygiene program
✔✔A 28-year-old woman is seen in a sexually transmitted disease clinic and is
diagnosed with Chlamydia trachomatis. An HIV antibody test is ordered. Which one of
the following statements is TRUE regarding laboratory-based HIV antibody tests that
are approved for use by the United States Food and Drug Administration? - ✔✔Recent
inocculation with the influenza vaccine is a known cause of a false-positive result
✔✔Heparin-induced thrombocytopenia (HIT) - ✔✔Development of IgG antibodies
against heparin- bound platelet factor 4 (PF4). Antibody- heparin-PF4 complex acti-
vates platelets leading to thrombosis and thrombocytopenia.
✔✔Features of HIT - ✔✔ThrombocytopeniaTimingType of heparin type of patient
thrombosis
✔✔HIT Thrombocytopenia (plt count) - ✔✔platelet count of <100,000 or decrease in
platelet count by >50% from pre treatment value
✔✔What is the time frame that a patient will start showing signs of HIT? - ✔✔within 5-14
days after starting heparin can occur sooner if pt has received heparin within the last 3
months
✔✔what type of heparin is HIT more commonly associated with? - ✔✔unfractionated
heparin
,✔✔diagnosis of HIT - ✔✔>50% drop in platelet count from baselineIncludes antibody
immunoassay (ELISA) and functional platelet activation assays (serotonin release
assay [SRA] & heparin-induced platelet activation assay [HIPA])
✔✔Management of HIT - ✔✔stop heparin give alternative anticoagulant do not give
platelet transfusions do not give warfarin until plt count returns to baseline level
-if warfarin was given, give vit k to restore INR to normal evaluate for thrombus-
particularly DVT
✔✔When heparin is stopped after dx of HIT, what anticoagulant should be used? -
✔✔argatroban (Acova)-used specifically to tx HITbivalirudin (angiomax) fondaparinux
(arixtra) rivaroxaban (xarelto)
✔✔what anticoagulant should not be given to a patient with HIT? - ✔✔Warfarin
✔✔IF warfarin was given to a patient with HIT, what should you do? - ✔✔stop the
medication, give vitamin K and wait until INR returns to baseline number.
✔✔The adult gerontology acute care nurse practitioner (AGACNP) is com- pleting a
preoperative assessment on Ava, a 28-year-old female client whois recovering from a
non-emergent cholecystectomy. - ✔✔The following abnormal findings are noted : white
blood cells (WBC) 7.4 x 109/L; hemoglobin (Hgb)14.4 gm/dL; hematocrit (Hct)
✔✔8%; Platelets 40 x 109/L. The remaining CBCparameters and a comprehensive
metabolic panel are normal. Ava denies recent illnesses, bleeding, or history of bleeding
disorders or medication use except for omeprazole which she has been taking for more
than 6 months. Which of the following is the most likely diagnosis in the differential? -
✔✔Immune thrombocytopenia
✔✔Sunil was involved in a motor vehicle crash (MVC) two days ago. He had an
immediate exploratory laparotomy and repair of a grade 2 liver laceration. He was
directly admitted to the intensive care unit (ICU), post-operatively. While assessing
Sunil, the AGACNP notices oozing of blood from his central and arterial line sites, along
with bleeding from the surgical site. What is the most appropriate next action? -
✔✔Order a CBC, aPTT, PT/INR, fibrinogen, and D-dimer
✔✔Leonard is admitted with pneumonia. When evaluating his morning labs, the
AGACNP noticed that his platelets have decreased from 170 x 109/L to 60 x109/L.
Leonard has been receiving enoxaparin for deep vein thrombosis (DVT) prophylaxis
and the 4Ts score strongly suggests HIT. Which of the following should be performed
first? - ✔✔Discontinue all sources of heparin
, ✔✔Disseminated Intravascular Coagulation (DIC) - ✔✔Complex, acquired disorder in
which clotting and hemorrhage simultaneously occur
intravascular activation of coagulation with loss of localization arising from different
causes that can originate from and cause damage to the microvasculature, which if
sufficiently severe, can produce organ dysfunction.
✔✔Risk factors of DIC - ✔✔Sepsis, Cardiac arrest, Trauma, Obstetric complications
(amniotic fluid embolism, eclampsia, retained placenta), Cancer, Hypersensitivity
reactions (blood transfusion reaction, anaphylaxis)
✔✔Clinical presentation of DIC - ✔✔In the hospital setting, tell-tale signs of DIC are
common manifestations of vascular thrombosis and bleeding:-Microvascular thrombosis
(common occult cause of organ failure in DIC)-Macrovascular thrombosis (DVT, PE)
-Bleeding (petechiae, purpura, or distal extremity necrosis, sudden bleeding from
wounds, surgical sites, or intravenous lines, shock, internal hemorrhage (gastroin-
testinal (GI), intracranial, etc.)
✔✔what are Lymphomas? - ✔✔are solid tumors of the immune system, or lymphoid
tissue, such as the lymph nodes, spleen, thymus, etc.
✔✔What are the two categories of lymphomas? - ✔✔Hodgkin lymphoma (HL) and non-
Hodgkin lymphoma (NHL).
✔✔Hodgkin's lymphoma - ✔✔Hodgkin lymphoma (HL), formerly known as Hodgkin's
disease, is a lymphoid neoplasm of mature B-cell lymphocytes.
✔✔Risk factors for Hodgkin's Lymphoma - ✔✔The incidence is much higher in males,
Caucasians, and young adulthood.Human immunodeficiency virus (HIV) clients are at
high risk. family history of HL. prior infection with the Epstein-Barr Virus (EBV), the
pathogen causing mononucleosis, exposure to benzene.
✔✔What are the 2 types of Hodgkin's lymphoma - ✔✔nodular lymphocyte predomi-
nance Hodgkin lymphoma (NLPHL) & classical Hodgkin's Lymphoma (cHL)
✔✔nodular lymphocyte predominance Hodgkin lymphoma (NLPHL) - ✔✔5% of HL
cases characterized by the presence of lymphocyte-predominant cells affected cells
sometimes referred to as "popcorn cells" due to their similarity in appearance popcorn
cells are variants of Reed-Sternberg cells most common in young adulthood (30-50
years) and males slow-growing good prognosis for recovery highly curable with a slight
risk of transforming into aggressive non-Hodgkin lymphoma
✔✔classic Hodgkins lymphoma (cHL) - ✔✔most common of all HL cases (95%)
characterized by the presence of Hodgkin and Reed- Sternberg cells in affected lymph
nodesfour (4) subtypes: nodular sclerosis, lymphocyte-rich, mixed cellularity, and
lympho- cyte- depleted
SOLUTIONS GUARANTEE A+
✔✔high titer IgG antibodies to anti-double-stranded DNA (anti-dsDNA) are - ✔✔specific
for SLE diagnosis.
✔✔"SOAP BRAIN MD" is used for? - ✔✔Diagnostic criteria for SLE must include at
least 4 of the criteria listed, which can be remembered by the mnemonic
✔✔SOAP BRAIN MD mnemonic for SLE stands for? - ✔✔S - serositis (pleuritis,
pericarditis, peritonitis)
O - oral ulcers (painless)
A - arthralgia/arthritis
P - photosensitivity
B - blood disorder (anemia, thrombocytopenia, hemolytic anemia)
R - renal involvement (nephritic or nephrotic disorders)
A- ANA+
I - immunologic phenomenon (anti-SM, Anti-dsDNA, Ro, La, Anti-histone)
N - neurologic phenomenon (altered mental status, seizures, stroke, headache)
M - malar rash
D - discoid rash
✔✔Lorenzo is newly admitted with pancytopenia, fever, joint pain, and a malar rash.
The nurse practitioner suspects SLE. Which of the following tests is most useful in
diagnosing this condition? - ✔✔antinuclear antibody
✔✔Jean-Louis was admitted with a diagnosis of acute kidney injury (AKI). He does not
have a history of previous renal dysfunction but does have a history of SLE The
urinalysis reveals significant proteinuria. Which of the following diagnostic tests is
required when lupus nephritis is suspected? - ✔✔Renal Biopsy
✔✔rheumatoid arthritis (RA) - ✔✔arthritis with swelling, stiffness, pain, and degener-
ation of cartilage in joints caused by chronic soft tissue inflammation; may result in
crippling deformities; an autoimmune disease
✔✔rheumatoid arthritis clinical manifestations. - ✔✔Common symptoms include warm,
tender, swollen joints, and joint stiffness.-swan neck deformity- hyperextension of PIP
with flexion of DIP (distal interpha- langeal) -Boutonniere deformity-firm nontender
nodules that adhere to the periosteum, tendons, or bursae-fatigue, malaise, fever,
anorexia, weight loss, and depression-ulnar deviation
✔✔Juan has a history of rheumatoid arthritis and is taking methotrexate7.5mg once per
week. He reports an acute increase in pain and swelling from baseline for the last 2
days, primarily affecting both hands and both knees. The nurse practitioner suspects an
,acute RA flare. What is the most appropriate intervention? - ✔✔Prednisone 40 mg daily
then taper over two weeks
✔✔Antiphospholipid Syndrome (APS) - ✔✔
✔✔Clinical Manifestations of antiphospholipid syndrome - ✔✔DVT PEpregnancy
morbidity migraines strokes/TIA livedo reticularis
✔✔differentials of fibromyalgia - ✔✔Fibromyalgia presents with a multitude of gener-
alized symptoms making the differential diagnosis quite broad.-systemic lupus
erythematosus (SLE),-Sjogren's syndrome,
-gluten sensitivity, -hypothyroidism,-polymyalgia rheumatica,-mixed connective tissue
disease, -multiple sclerosis,
-myasthenia gravis.
✔✔Lo-Wei has fibromyalgia and complains of poorly controlled pain, in- creased
fatigue, and difficulty sleeping. She has a body mass index (BMI)of 31 and a history of
depression. She reports that she has been frequently forgetting to take her medications
(duloxetine and gabapentin). Which of the following are the most appropriate
interventions for Lo-Wei? - ✔✔medication compliance, exercise program, and sleep
hygiene program
✔✔A 28-year-old woman is seen in a sexually transmitted disease clinic and is
diagnosed with Chlamydia trachomatis. An HIV antibody test is ordered. Which one of
the following statements is TRUE regarding laboratory-based HIV antibody tests that
are approved for use by the United States Food and Drug Administration? - ✔✔Recent
inocculation with the influenza vaccine is a known cause of a false-positive result
✔✔Heparin-induced thrombocytopenia (HIT) - ✔✔Development of IgG antibodies
against heparin- bound platelet factor 4 (PF4). Antibody- heparin-PF4 complex acti-
vates platelets leading to thrombosis and thrombocytopenia.
✔✔Features of HIT - ✔✔ThrombocytopeniaTimingType of heparin type of patient
thrombosis
✔✔HIT Thrombocytopenia (plt count) - ✔✔platelet count of <100,000 or decrease in
platelet count by >50% from pre treatment value
✔✔What is the time frame that a patient will start showing signs of HIT? - ✔✔within 5-14
days after starting heparin can occur sooner if pt has received heparin within the last 3
months
✔✔what type of heparin is HIT more commonly associated with? - ✔✔unfractionated
heparin
,✔✔diagnosis of HIT - ✔✔>50% drop in platelet count from baselineIncludes antibody
immunoassay (ELISA) and functional platelet activation assays (serotonin release
assay [SRA] & heparin-induced platelet activation assay [HIPA])
✔✔Management of HIT - ✔✔stop heparin give alternative anticoagulant do not give
platelet transfusions do not give warfarin until plt count returns to baseline level
-if warfarin was given, give vit k to restore INR to normal evaluate for thrombus-
particularly DVT
✔✔When heparin is stopped after dx of HIT, what anticoagulant should be used? -
✔✔argatroban (Acova)-used specifically to tx HITbivalirudin (angiomax) fondaparinux
(arixtra) rivaroxaban (xarelto)
✔✔what anticoagulant should not be given to a patient with HIT? - ✔✔Warfarin
✔✔IF warfarin was given to a patient with HIT, what should you do? - ✔✔stop the
medication, give vitamin K and wait until INR returns to baseline number.
✔✔The adult gerontology acute care nurse practitioner (AGACNP) is com- pleting a
preoperative assessment on Ava, a 28-year-old female client whois recovering from a
non-emergent cholecystectomy. - ✔✔The following abnormal findings are noted : white
blood cells (WBC) 7.4 x 109/L; hemoglobin (Hgb)14.4 gm/dL; hematocrit (Hct)
✔✔8%; Platelets 40 x 109/L. The remaining CBCparameters and a comprehensive
metabolic panel are normal. Ava denies recent illnesses, bleeding, or history of bleeding
disorders or medication use except for omeprazole which she has been taking for more
than 6 months. Which of the following is the most likely diagnosis in the differential? -
✔✔Immune thrombocytopenia
✔✔Sunil was involved in a motor vehicle crash (MVC) two days ago. He had an
immediate exploratory laparotomy and repair of a grade 2 liver laceration. He was
directly admitted to the intensive care unit (ICU), post-operatively. While assessing
Sunil, the AGACNP notices oozing of blood from his central and arterial line sites, along
with bleeding from the surgical site. What is the most appropriate next action? -
✔✔Order a CBC, aPTT, PT/INR, fibrinogen, and D-dimer
✔✔Leonard is admitted with pneumonia. When evaluating his morning labs, the
AGACNP noticed that his platelets have decreased from 170 x 109/L to 60 x109/L.
Leonard has been receiving enoxaparin for deep vein thrombosis (DVT) prophylaxis
and the 4Ts score strongly suggests HIT. Which of the following should be performed
first? - ✔✔Discontinue all sources of heparin
, ✔✔Disseminated Intravascular Coagulation (DIC) - ✔✔Complex, acquired disorder in
which clotting and hemorrhage simultaneously occur
intravascular activation of coagulation with loss of localization arising from different
causes that can originate from and cause damage to the microvasculature, which if
sufficiently severe, can produce organ dysfunction.
✔✔Risk factors of DIC - ✔✔Sepsis, Cardiac arrest, Trauma, Obstetric complications
(amniotic fluid embolism, eclampsia, retained placenta), Cancer, Hypersensitivity
reactions (blood transfusion reaction, anaphylaxis)
✔✔Clinical presentation of DIC - ✔✔In the hospital setting, tell-tale signs of DIC are
common manifestations of vascular thrombosis and bleeding:-Microvascular thrombosis
(common occult cause of organ failure in DIC)-Macrovascular thrombosis (DVT, PE)
-Bleeding (petechiae, purpura, or distal extremity necrosis, sudden bleeding from
wounds, surgical sites, or intravenous lines, shock, internal hemorrhage (gastroin-
testinal (GI), intracranial, etc.)
✔✔what are Lymphomas? - ✔✔are solid tumors of the immune system, or lymphoid
tissue, such as the lymph nodes, spleen, thymus, etc.
✔✔What are the two categories of lymphomas? - ✔✔Hodgkin lymphoma (HL) and non-
Hodgkin lymphoma (NHL).
✔✔Hodgkin's lymphoma - ✔✔Hodgkin lymphoma (HL), formerly known as Hodgkin's
disease, is a lymphoid neoplasm of mature B-cell lymphocytes.
✔✔Risk factors for Hodgkin's Lymphoma - ✔✔The incidence is much higher in males,
Caucasians, and young adulthood.Human immunodeficiency virus (HIV) clients are at
high risk. family history of HL. prior infection with the Epstein-Barr Virus (EBV), the
pathogen causing mononucleosis, exposure to benzene.
✔✔What are the 2 types of Hodgkin's lymphoma - ✔✔nodular lymphocyte predomi-
nance Hodgkin lymphoma (NLPHL) & classical Hodgkin's Lymphoma (cHL)
✔✔nodular lymphocyte predominance Hodgkin lymphoma (NLPHL) - ✔✔5% of HL
cases characterized by the presence of lymphocyte-predominant cells affected cells
sometimes referred to as "popcorn cells" due to their similarity in appearance popcorn
cells are variants of Reed-Sternberg cells most common in young adulthood (30-50
years) and males slow-growing good prognosis for recovery highly curable with a slight
risk of transforming into aggressive non-Hodgkin lymphoma
✔✔classic Hodgkins lymphoma (cHL) - ✔✔most common of all HL cases (95%)
characterized by the presence of Hodgkin and Reed- Sternberg cells in affected lymph
nodesfour (4) subtypes: nodular sclerosis, lymphocyte-rich, mixed cellularity, and
lympho- cyte- depleted
