Leik 2021/ExamEdge FNP Review Questions and Answers 2023

Leik 2021/ExamEdge FNP Review Questions and Answers 2023 A nurse practitioner working in a community health clinic sees a male patient who expresses concern about starting a homosexual relationship with a new partner. Which of the following is the best plan to follow during this visit? (Select all that apply.) Contact the patient's partner to schedule HIV testing Educate the patient about using barrier devices during sex Prescribe daily oral PrEP Draw a blood sample for a combination HIV antigen/antibody test Schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP Educate the patient about using barrier devices during sex; draw a blood sample for a combination HIV antigen/antibody test; schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP Education on using barriers during sexual activity (e.g., condom/dental dams) is important. Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is not appropriate ethically or legally to contact the partner; however, it would be appropriate for the patient to encourage his partner to get tested. An older adult male presents with complaints of sharp flank and back pain. The patient has difficulty answering questions because of severity of pain. Blood pressure is 90/60 mmHg. The patient has a 20-pack-year smoking history. Abdomen is distended upon palpitation. Which diagnosis is most likely? Congestive heart failure Infective endocarditis Dissecting abdominal aortic aneurysm Acute myocardial infarction Dissecting abdominal aortic aneurysm. Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp, excruciating pain located in the abdomen, back, or flank area, accompanied by a distended abdomen and hypotension. Older male adults with a smoking history and hypertension are at higher risk. Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and swollen feet and ankles. Patients with infective endocarditis present with fever, chills, and malaise, along with the presence of a new murmur. Acute myocardial infarction generally presents with a gradual onset of intense and heavy chest discomfort that feels like a squeezing, tightness, and heavy pressure in the chest. Mrs. Harris a 67-year-old woman who is in the early stages of Alzheimer disease. She suffers from mild dementia. In this type of Alzheimer dementia which of the following would you use as the mainstay treatment? Vitamin E 1000 IU twice daily cholinesterase inhibitors NSAIDS Selgiline 5 mg twice daily cholinesterase inhibitors The mainstay treatment for mild to moderate stage Alzheimer-type dementia is the use of cholinesterase inhibitors. These include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They have a clear, although minor and time-limited benefit. When listening to your 86-year-old patient's heart murmur, you note that it is so loud that it can be heard with the stethoscope completely off the chest. How do you grade the murmur? IV/VI. I/VI. V/VI. VI/VI. VI/VI. Grading heart murmurs follows this system: I/VI: Heart murmur makes faint sound and may not be heard when patient changes position. II/VI: Heart murmur is quiet but can be heard as soon as the stethoscope is placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI: Heart murmur is loud and accompanied by a palpable thrill. V/VI: Heart murmur is very loud and can be heard with the stethoscope partially off the chest. VI/VI: Heart murmur is very loud and can be heard with the stethoscope completely off the patient's chest. Which of the following persons would not be a candidate for the antipneumococcal vaccine? a 65-year-old healthy female living with her family a 35-year-old patient with HIV infection a 58-year-old male resident of a nursing home a 55-year-old female living alone a 55-year-old female living alone The antipneumococcal vaccine is not indicated for an otherwise healthy person who is under the age of 65 unless there are other health factors involved. Living alone has no bearing on the need for the vaccine. The vaccine is indicated for persons with HIV infection, persons living in nursing homes, and all adults 65 years or older regardless of health status. Which of the following diseases is more likely to cause chronic pelvic pain rather than acute pelvic pain? ectopic pregnancy PID ovarian cysts interstitial cystitis interstitial cystitisInterstitial cystitis is more likely to cause chronic pelvic pain rather than acute pelvic pain as in the other choices. Other causes of chronic pelvic pain include: endometriosis, leiomyomas, and malignancy. You have a 58-year-old male patient with possible pancreatic cancer. You will not order an abdominal ultrasound for diagnosis because it is limited by which of the following? previous history of pancreatic disease patient's age the presence of intestinal gas size of tumor the presence of intestinal gas The usefulness of abdominal ultrasound is limited by the presence of intestinal gas. Abdominal CT scan is more helpful in identifying pancreatic cancer. A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for Type II diabetes mellitus. What should be done to manage him FIRST? Start insulin Start metformin plus pioglitazone Have him return tomorrow to recheck his blood glucose Start metformin Start insulin Most oral agents will have little effect on his glucose and it should be lowered immediately. Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a chance to work. He should return to the clinic the next day for a recheck of the blood glucose and medication adjustment. Utilization review can best be described as which of the following? a system of monitoring and assessing for high-risk areas and procedures the process of evaluating the appropriateness of inpatient hospitalization the process used for accreditation the process used for case management the process of evaluating the appropriateness of inpatient hospitalization A utilization review is the process of evaluating the appropriateness of inpatient hospitalization. Proof of the medical necessity for the patient's hospitalization is done mainly through chart reviews. If the reviewer and payor do not agree, the claim can be denied, resulting in denial of payment to the health facility. John is a patient with acute renal failure. His inability to regulate electrolytes might be evidenced by all but which of the following conditions? hyperkalemia hyperlipidemia hypocalcemia hypernatremia hyperlipidemia This patient's inability to regulate electrolytes might be evidenced by hyperkalemia, hypernatremia, hyponatremia, hypokalemia, hypermagnesemia, hyperphosphatemia, and hypocalcemia. Hyperlipidemia is abnormally elevated levels of any or all lipids and/or lipoproteins in the blood. Which of the following statements about evaluation and follow-up of a patient with IBD is least accurate? Most patients follow a cyclic course of remission and flare-up. An estimated 50% to 65% of patients with Crohn's disease undergo surgery at some point in their lives for intestinal resection or colectomy. Overall mortality for ulcerative colitis is between 35% and 40%. Ulcerative colitis patients have a risk for serious complications such as hemorrhage and perforation. Overall mortality for ulcerative colitis is between 35% and 40%. This is not accurate. The overall mortality for ulcerative colitis is much lower - between 12% and 15%. This is because of risk for serious complications such as hemorrhage, perforation, and toxic megacolon. A patient who has been prescribed miconazole for athlete's foot asks how long he should use the medication. Which of the following is an appropriate response to this patient? The patient should use the medication for 3 days. The patient should use the medication for 1 month. The patient should use the medication until symptoms are gone. The patient should use the medication for 2 weeks. The patient should use the medication for 1 month Patients who are using miconazole for athlete's foot should apply the medication once or twice a day for 1 month. Patients should not exceed the recommended amount or duration of miconazole. Mary is concerned because her 12-year-old son shows no signs of puberty. You would tell her that the average age of onset for males is which of the following? 10 - 12 years 13 - 16 years 10.5 - 16 years 10.5- 13 years 10.5 - 16 years You can reassure this mother that her son is not behind schedule in reaching puberty. The average age of onset for males is 10.5 - 16 years. After completing a physical examination, you suspect that a 16-year old girl has acute appendicitis. She presents with acute abdominal pain and you order a white blood cell (WBC) count with differential and an x-ray of the abdomen. You receive the laboratory report back first and are still waiting on the x-ray. By looking at the laboratory report, which of the following values would you expect to see in a patient with acute appendicitis? total WBCs 1200 mm³ neutrophils 4% bands 1% lymphocytes 44% total WBCs of 500mm³ neutrophils 10% bands 2% lymphocytes 39% total WBCs 16,000 mm³ neutrophils 67% bands 8% lymphocytes 23% None of the above would indicate acute appendicitis. total WBCs 16,000 mm³ neutrophils 67% bands 8% lymphocytes 23% You would expect a "left shift." This includes leukocytosis (elevated WBCs), neutrophilia (an absolute neutrophil count (ANC) of greater than 7000 neutrophils/mm. ANC is calculated by multiplying the percentage of neutrophils by the total WBC in mm. Therefore, the following answer choice is correct, as the absolute neutrophil count is greater than 7000 mm³ if you multiplied 0.67 by 16,000. This would be 10,720 neutrophils/mm³. Which of the following is a prenatal diagnostic test rather than a prenatal screening test? ultrasound NIPT maternal serum chorionic villus sampling chorionic villus sampling Chorionic villus sampling is a diagnostic test. The other choices are screening tests that separate those who "might" from those who "probably don't" have the specific condition being tested for. Screening tests are NOT diagnostic. Which of the following statements about bronchiolitis is least accurate? The majority of cases are caused by the respiratory syncytial virus. The peak incidence in children is between 3 and 6 years of age. Small airways become obstructed. Risk factors include low socioeconomic status. The peak incidence in children is between 3 and 6 years of age. The peak incidence in children is between 3 and 6 years of age is the least accurate statement. Bronchiolitis is an acute inflammation of the bronchioles resulting in obstruction of the small airways. The peak incidence in children is between 3 and 6 months of age. Your patient is a 9-year-old female child who is 4 feet 4 inches and weighs 110 lb. This child has a body mass index over the 95th percentile and is therefore overweight. You understand that all of the following are true in regard to the management and treatment of obesity in children EXCEPT: Promote prevention in infancy through parent education regarding nutritional needs and feeding strategies. Discuss moderate modification of diet while increasing exercise. Establish a goal for younger children to include weight reduction. Use behavior modification strategies. Establish a goal for younger children to include weight reduction. The goal for younger children is weight maintenance rather than weight reduction while linear growth catches up. For adolescents treated after their growth spurt, the goal may include weight reduction. The FNP is calculating the BMI for a female patient who wants to lose weight. If the patient is 5 feet 6 inches and weighs 200 lbs. what is her BMI to the nearest tenth? 23.2 33.2 32.3 30.3 32.3 The BMI is calculated by dividing the weight in pounds by the height in inches squared and multiplying that by 703.200÷ 662 = 200 ÷ 4,356 = 0. * 703 = 32.2768, or 32.3 rounded to the nearest tenthThis puts the woman in the obese category. When would Aldactone be contraindicated? When the patient has hyperkalemia (serum potassium of greater than 5.5 mEq/L. When the patient has renal insufficiency (serum creatinine greater than 2.0 mg/dL. If the patient has type 2 diabetes mellitus with microalbuminuria. All of the above All of the above The nurse practitioner would need to evaluate the patient prior to ordering Aldactone.The following would be considered contraindications for ordering Aldactone:When the patient has hyperkalemia (serum potassium of greater than 5.5 mEq/L.When the patient has renal insufficiency (serum creatinine greater than 2.0 mg/dL.If the patient has type 2 diabetes mellitus with microalbuminuria. In diagnosing a toothache (pulpitis), the nurse practitioner has knowledge that all of the following are correct except: Systemic manifestations do not occur from dental caries and pulpitis. You should inquire about fever and chills. Dental caries are the most frequent type of injury that causes pulpitis. There is diverse flora involved in the infectious process, including gram-positive anaerobes and bacteroides. Systemic manifestations do not occur from dental caries and pulpitis. Many patients present in the clinic setting with a toothache or related symptoms. Systemic manifestations often occur and they include lymphadenopathy, malaise, fever, and pain. The remaining answer choices are true regarding this condition. Louis is a 67-year-old male patient with open-angle glaucoma. Your follow-up for Louis should include which of the following? Caution the person to avoid exercise. Monitor a high-protein, low-fat diet. Monitor for side effects of beta blocker use. Follow up IOP and visual field changes every six weeks. Monitor for side effects of beta blocker use. Monitor for side effects of drugs, especially with non-cardioselective beta blocker use. Even with topical use, bronchoconstriction may be a side effect of these drugs. Which of the following factors would increase the susceptibility of a person for glaucoma? corticosteroid therapy mental illness history of pneumonia history of heart disease corticosteroid therapy There are many factors that increase a patient's susceptibility to glaucoma. Corticosteroid therapy is one of them. Others include: eye inflammation or trauma; neoplasm; neovascularization; and increasing age. The highest incidence of AOM (acute otitis media) is in which of the following age groups? 10 - 12 years 7 - 8 years 4 - 6 years 6 months to 3 years 6 months to 3 years Acute otitis media is an infection of the middle ear cavity with bacterial pathogens secondary to temporary Eustachian tube dysfunction. The highest incidence of AOM is from ages 6 months to 3 years.