ANCC FNP Board Exam Study Guide Part 1 Questions and Correct Solutions(RATED A)

ANCC FNP Board Exam Study Guide Part 1 Questions and Correct Solutions(RATED A)Treatment for chronic bronchitis -ANSWER -Chronic bronchitis is a type of COPD that is characterized by inflammation of the bronchi, causing excess mucus; characteristics of chronic bronchitis include diagnosis after age 35, obesity, copious amounts of purulent sputum, elevated Hct level -Treat with SABA (albuterol), inhaled anticholinergics (ipratropium) -Normal Findings of Lungs: Lower lobes vesicular breath sounds (soft and low) Upper lobes; Bronchial breath sounds louder Actinic keratosis -ANSWER -Older to elderly fair-skinned adults -numerous dry, round, pink to red-colored, slow-growing lesions that do not heal -lesions common on sun-exposed areas (cheeks, nose, face, arms, back) -precancerous precursor of squamous cell carcinoma -frequent sunburns as child places person at higher risk -diagnosed with biopsy -treat with cryotherapy (small number) or 5-FU(5% fluorouracil) cream (large number) follow up with derm. Seborrheic keratosis -ANSWER -soft, round, wart-like fleshy growths on trunk (mostly on back) -can range in color from light tan to black -appear to be pasted on -asymptomatic -benign Fingernail hematoma treatment -ANSWER -Trephination - make hole in nail through drilling or piercing and allow blood to drain Hypothyroid -ANSWER -Primary - elevated TSH; low T4; low or normal T3 -Subclinical - elevated TSH; normal T4; normal T3 -Common cause is Hashimoto's (autoimmune) - Hashimoto and Hypo both have O -Symptoms are variable - may include fatigue -Treatment - levothyroxine (Synthroid) daily in AM on empty stomach -Starting dose of levothyroxine (Synthroid) is 25-50mcg -Check TSH every 6-8 weeks to monitor treatment Hyperthyroid -ANSWER -Primary - low TSH; high T4; normal or high T3 -Subclinical - low TSH; normal T4; normal T3 -Most common cause is Grave's Disease (autoimmune) - Grave and Hyper both have R -Common symptoms - female; rapid weight loss; increased heart rate; tremors; sweating; irritability; anxiety; hyperactivity; insomnia; diarrhea; amenorrhea; hypertension; exophthalmos; heat intolerance; goiter -Treatment - Propylthiouracil (PTU); Methimazole (Tapazole); Radioactive iodine (causes hypothyroid for life, contraindicated in pregnancy) -Thyroid Storm (thyrotoxicosis) - acute worsening of symptoms; may be caused by stress or infection; look for LOC, fever, abdominal pain; life-threatening; immediate hospitalization needed Increased risk of ectopic pregnancy -ANSWER -Risk factors - previous ectopic, salpingitis, tubal surgery, current IUD use, previous cervicitis, history of PID -Symptoms - abdominal pain (worsens when supine or with jarring), vaginal bleeding, amenorrhea, low grade fever, pain referred to right shoulder (may indicate rupture) Hypertension Meds Part 1 -ANSWER -African-American with or without diabetes - initial choices include thiazide diuretic or CCB -Non-Black with or without diabetes - initial choices include thiazide diuretic, CCB, ACE, or ARB -Thiazide diuretic - "ide"; excellent synergist; avoid in sulfa allergy; favorable in osteopenia/osteoporosis; side effects include hyperglycemia (caution in diabetics), hyperuricemia (gout attack), hypertriglyceridemia and hypercholesteremia (check lipid profile), hypokalemia (potentiates digoxin toxicity and increases risk for arrhythmia), hyponatremia (hold diuretic, restrict fluid, replace K+); lowers BP only 2-8 points -ACE inhibitor - "pril" and ARB - "sartan" - use in high renin states; drug of choice in diabetics (protects kidneys); pregnancy category C/D; side effects include dry/hacking cough (more with ACE), hyperkalemia, angioedema (rare, life-threatening); contraindicated in moderate to severe kidney disease; do not use ACE and ARB together.