FNP Leik Practice test #1 with 100% correct answers.

Which of the following findings is assoc. with thyroid hypofunction? A. Graves Disease B. Eye Disorder C. Thyroid storm D. Myxedema D. Myxedema Myxedema or myxedema coma is seen in patients with severe hypothyroidism. It refers to the skin changes (thickened skin) seen in chronic severe hypothyroidism. It is a medcial emergency with mortality rates exceeding 20%. It is tx with very high doses of thyroid hormone. A thyroid storm occurs when there is the extreme elevation of thyroid hormone. Thyroid storm is life-threatening; if left untreated, the mortality rate is about 90%. Call 911 if suspected. Graves Disease is associated with thyroid hyperfunction A 14 y/o boy is brought in by his mother, who reports that her son has been complaining for several months of recurrent bloating, stomach upset and occasional loose stools. She reports that he has difficulty gaining wt. and is short for his age. She has noticed that his symptoms worsen after eating large amounts of crackers, cookies, and bread. She denies seeing blood in the boy's stool. Which of the following conditions is most likely? A. Amebiasis B. Malabsorption C. Chron's D. Celiac Disease D. Celiac Disease Celiac Disease is also known as celiac sprue Patients should avoid gluten, which causes malabsorption (diarrhea, gas, bloating, and abd pain). Foods to avoid are wheat, rye, and barley. Oats do not damage mucosa in celiac disease. Antifiadins IgA and IgG are elevated in almost all patients (90%) A 67 y/o female patient presents with a 3 day old cat bite that has become swollen, reddened and painful to touch. The NP notes there is purulent drng at the site of the bite. Which medication will the nurse practitioner prescribe? A. Gentamycin B Tetanus toxoid C. Rabies prophylaxis D. Amoxicillin -Clavulante(Augmentin) D. Amoxicillin -Clavulante(Augmentin) The patient present with symptoms associated with Pasteurella multocida, which is an anerobic gram-negative coccobacillus found in the oropharynx of healthy cats, dogs, and other animals. The dx of the bacteria can be made with a gram stain culture; however, a broad spectrum antibiotic that targets Pasteurella, as well as other gram-positive and gram neg bacteria, is preferred for prescribed prophylaxis. Amox-Clav is a recommended antibiotic for prophylactic tx. Aminoglycosides such as gentamycin have demonstrated poor activity against P. multocida. Tetanus toxoids is necessary only if the patient has received their last tetanus vaccine greater than 5 years prior. Rabies is unnecessary unless there is a possibility of exposure after a risk assessment. A 14 year old girl with short stature, swollen hands and feet, and a webbed neck presents to the clinic. Upon assessment she is found to be at Tanner stage I. Which test will the NP order to confirm diagnosis? A. CT scan B. Karotype C. Prolactin level D. Xray of the hand B. Karotype A 67 y/o woman with a 30 pack a year hx of smoking presents for a routine annual physical examination. She c/o being easily short of breath and is frequently fatigued. Physical examination reveals diminished breath sound, hyprresonance, and hypertrophied respiratory accessory muscles. Her CBC reveals elevated HCT and her PFT results show increased total lung capacity. Which dx is most correct? A. Bronchogenic carcinoma B. COPD C. Chronic bronchitis D. CHF B. COPD COPD is a progressive lung disease that includes emphysema and chronic bronchitis. The most common risk factor is long-term cigarette smoke (80-90%). Another cause is alpha-1 trypsin deficiency and chronic fume exposure. The three cardinal symptoms of COPD are dyspnea, chronic cough, and sputum production. The lungs are hyperinflated which changes the shape of the chest and diaphragm, making the mechanics of breathing more difficult Excess mucus and obstructed airflow from progressive thickening and stiffening of the airways finish breath sound. COPD creates a high hematocrit percentage because of chronic hypoxemia. An elderly male presents to the clinic for a routine physical examination. The NP notes multiple rough, scaly patches on the patients forearms and face and back of his ears. Which dx is most likely: A. seborrheic keratosis B. Senile purpura C. Lentigines D. Senile actinic keratosis D. Senile actinic keratosis Senile actinic keratosis is considered the most common precancerous lesion of squamous cell carcinoma in older adults. Actinic keratosis is a rough, scaly patch on the skin that dev. from years of exposure to the sun. It is most commonly found on the face, lips, ears, back of hands, forearms, scalp, or neck. Sinle purpura presents as bright, puple-colored patches located on the forearms and hands and are benightn. Lintigines, also known as liver sparts are brown-colored macules located on the hands and forearms of older adults and are benign. Seborrheic keratoses are soft, wartlike benign lesions that fequently appear on the back and trunk of older adults. The NP is assessing a 69 y/o male with a hx of IV drug use as a young adult. He presents with fatigue and nausea. Which screening will the NP recommend for this pt A. cxr B. Urine specimen C. Hep C D. Electroencephalogram C. Hep C The CDC recommends Hep C screening in adults born from 1945 through 1965. Hep C is transmitted by sharing needles and can become a chronic infection. IV drug users and persons w/in this age group are considered high risk for Hep C. Given the hx, cxr, ua , and electroencephalogram would not be indicated. The NP is performing an assessment of a 6 month old. What motor skills are expected at this age? A. palmar grasp of objects B. sits up C. stands independently D. moves from one piece of furniture to another E. feeds self without assistance A. palmar grasp of objects B. sits up The Np is manging a stable middle-aged adult with emphysema. In addition to reinforcing smoking cessation and medication schedules, which annual intervention will the nurse practitioner recommend? A. Pneumococcal polysaccaride (PPSV23) B. Live attenuated influenza vaccine (LAIV) C. Quadrivalent inactivated influenza vaccine (QIV) D. Pneumococcal conjugace vaccine (PCV13) C. Quadrivalent inactivated influenza vaccine (QIV) An older adult with a chronic respiratory disease should receive an annual QIV, which is appropriate to administer to patients six mo and older. The LAIV is administered via nasal spray for patients aged 2 to 49. PPSV23 and PCV13 are both for pneumococcal protection. PPSV23 si recommended for individuals aged 65 and adults aged 19 to 64 who smoke. PCV13 is recommended for children younger than two years. During a sports participaton exam of a 14-year-old high school athlete, the NP notices a split on the S2 component of the heart sound during deep inspiration. She notes that it disappears upon expiration. The heart rate is regular, and no murmurs are auscultated. Which of the following is correct: A. This is an abnormal finding and should be evaluated further by a cardiologist B. A stress test should be ordered C. This is a normal finding in some young athletes D. an EKG should be performed C. This is a normal finding in some young athletes. It is common to hear a split S2 heart sound over the pulmonic area of the heart with inspiration.As long as it disappears with expiration, with no other abnormal symtoms, this a a normal finding. The sound is caused by the splitting of the aortic and pulmonic components Which finding will the NP expect to see in a 13 y/o male with Cushing's syndrome? A. Excess estrogen B. Delayed puberty C. Pseudogynecomastia D. Accelerated growth in height B. Delayed puberty Which life style factor is associated with secondary polycythemia? A. obesity B. Smoking C. Alcohol abuse D. Sedentary lifestyle B. Smoking Secondary polycythemia vera is associated with chronic hypoxia. Hypoxia causes an increase in erythropoetin, which stimulates the production of mature red blood cells from the bone marrow. there is a high incidence of secondary polycythemia in chronic cigarette smokers compared with the general population, as they often experience hypoxia. Obesity, alcohol abuse and a sedentary lifestyle are not associated with secondary polycythemia vera. Which test will confrim a dx of prostate cancer? A. PSA B. Digital rectal exam C. CBC with dif D. Tissue biopsy D. Tissue biopsy biopsy and pathology exam of prostate tissue is used to confirm a dx of prostate cancer. CBC is not used to diagnose prostate cancer. A mass can be palpated with DRE however this does not confirm a dx of prostate cancer. PSA is a screening test for prostate cancer, but it is not used to confirm a final dx. A 60 y/o female truck driver presents to the op urgent care cinic of a hospital complaining of the worsening of her low back pain the past few days. Pain is accompanied by n/t in the perineal area. She describes the pain as "sharp and burning" and points to the left buttock. She reports that the pain started on the mid-buttock of the left leg and recently started to go down the lateral aspect of the leg toward the top of the foot. During the physical exam, the ankle jerk and the knee jerk reflex are 1+ on the affected leg and 2+ on the other leg. The pedal, posterior tibialis, and popliteal pulses are the same on both legs. Which of the following tests should the NP consider for this patient? A. order an MRI of the lumbosacral spine ASAP B. Write an RX for ibuprofen 800 mg qid with a muscle relaxant and advise the pt to follow up with her primary care prover within 3 days. C. Refer the pt to an orthopedic surgeon D. Ordering an imaging study of the spine is premature because the majority of low back cases resolve within 10 to 12 weeks A. order an MRI of the lumbosacral spine ASAP The pt has new onset numbness of the perineal area(saddle anesthesia), the sciatica is worsening, and the deep tendn reflexes of the lower ext are decreased on the affected side Rule out cauda equine syndrome and order an MRI (prefered test). The MRI can detect nerve root compression, herniated disk, cancer, and spinal stenosis (narrowing of the spinal canal). In addition the pt needs to follow up with a neurologist as soon as possible. When assessing a pt using the snellen chart the NP records the visual acuity as 20/80. What does this assessment mean? A. The pt can see at 20 feet what a person with normal vision sees at 80 feet. B. The pt can see at 80 feet what a person with normal vison sees at 20 feet. C. The pt has experienced a 20% decrease in acuity in one eye and an 80% decrease in the opposite eye.. D. The patient has presbyopia. A. The pt can see at 20 feet what a person with normal vision sees at 80 feet. The bottom number is the distance at which a person with normal eyesigt can read the same line. A pt with 20/80 vision can see at 20 feet what a person with normal vision can see at 80 feet. Presbyopia is caused by loss of elasticity of the lenses which make it difficulty to focus on close objects. An obese 28 year old female pt is seen in the office with acne, hirsutism, and oligmenorrhea. Bood is drawn for a few androgen index (FAI), and results reveal a 9.8 level. The dx is PCOS which puts the pt at additional risk for which conditions (select all that apply) A. CHF B. Metabolic syndrome C. Infertility D. Type 2 DM E. Endometriosis B. Metabolic syndrome C. Infertility D. Type 2 DM A dx of PCOS carries with it a risk of developing CHD, type 2 DB, metabolic syndrom and infertility because of the high levels of androgens in the body. Endometriosis and chf are not complications of PCOS