n n n n n n n n
024 ACTUAL EXAM 220 QUESTIONS AND CORRECT DETAILE
n n n n n n n
D ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALR
n n n n n n
EADY GRADED A+
n n
Anpatientntellsnthe nnurse npractitionernthatnshenrecentlynstartedntakingnthe nsupplementnSt.nJohn'snwortnaft
ernreadingnaboutnitsnbenefitsnonline.nWhichnof nthe nfollowingnmedications,nifnbeingnactivelynconsumed,nmu
stnbe nimmediatelynstopped?
A. Benadryl
B. Famotidine n(Pepcid)
C. Metformninn(Glucophage)
D. Sumatriptann(Imitrex) n-nanswer-D.nSumatriptann(imitrex)
Sumatriptann(Imitrex) n(D)nisnanmedicationnusedntontreatnmigrainesnandnbelongsntonandrugnclassnknownnasns
erotoninnagonists.nWhennusedninnconjunctionnwithnSt.nJohn'snwort,nitnmaynincrease nthenrisknof nserotoninnsy
ndrome,nanpotentiallynlife-threateningncondition.
Whichnof nthe nfollowingnisnnotnansymptomnofnbothnmajorndepressive ndisordernandnpost-
traumaticnstressndisorder?
A. Difficultynconcentrating
B. Hypervigilance
C. Insomnia
D. Irritabiltyn-nanswer-B.nHypervigilance
Innadditionntondifficultynconcentrating,ninsomnia,nandnirritability,nmajorndepressivendisordern(MDD)nmay
n alson include nsymptomsn of ndepressed nmood, n anhedonia,n weightn lossn orn gain, n andn lown energy. n However
,nhypervigilance n(B) nisnnotnansymptomnassociatednwithnthisndiagnosis.
Anpatientnwithntype n1ndiabetesnpresentsnfornanfollow-
upnvisit.nHe nhasnbeennstable nonnhisnmedicationnregimennbutnisnworriednbecausenhe nisnbetweennjobsnandnw
illnbe nwithoutnhealthninsurancencoveragenfornanfewnmonths.nHe nasksnif nthere nare nlessnexpensiveninsulinnop
tionsntongetnhimnthroughnthisntime.nWhichnofnthenfollowingnwouldnbengoodnoptionsnfornthisnpatient,ngivenn
hisncircumstance?
Incorrect
A. Insulinnaspartn70/30
B. Insulinndetemir
,C. Insulinnisophane
D. Insulinndegludecn- nanswer-InsulinnIsophane
The nleastnexpensiveninsulinntypenlistedninnthisnquestionnisninsulinnisophane n(C)n(neutralnprotamine nHaged
ornninsulin).nThere nare nalsonoftennpharmacy-
specificncouponsnthatncannbenusednonninsulin,nsonhelpingnpatientsnapplynfornandnnavigatenthese nprograms
n cann be n instrumentaln innmanagingn theirn diabetes. nAnothern inexpensiven option n isn regularn insulin.Insulin n a
nalogsn(glargine,ndetemir,ndegludec,nlispro,nandnaspart)narensignificantlynmorenexpensiventhannhumannins
ulinn(isophane, nregular).nInsulinsnmodifiednbynmanufacturers,nespeciallynwhennsoldnasnbrand-
name nmedications,ntendntonbe nmore nexpensivenduentonthisnmodification.nWhile nanalogsnoffernalternatenle
ngthsnofnactionnandnconvenience, nthere nisnnonwell-
n documented nclinicaln evidence nthatnpatientn outcomes nare nimproved nwithndifferingn brands. nTherefore, n m
aintainingnanpatient'snbloodnglucose nlevelnthroughnoutcome-
focusedntreatmentnisnmore nvaluable nthannanprocess-focusednplannbasednonnmedication.
An40-year-
oldnwomannwithntypen2ndiabetesnpresentsntonthenclinicnwithnconcernsnofnspikingnbloodnsugarnbetweennlunchna
ndndinner.nShe nstatesnshe nisnonnanrapid-actingninsulinnslidingnscale nandnlong-
actingninsulin.nWhichnchange nshouldnbe nimplementedntonhelpnpreventnorncurbnthisnglycemicnspike?
A. Addnandose nofnmealtime ninsulinnaspartn(Novolog) natnlunch
B. Addninsulinndetemirn(Levemir) natnnight
C. Increase nherninsulinnglargine n(Lantus)
D. Prescribe nandose nof nneutralnprotamine nHagedornninsulinnwithndinnern- nanswer-
A.nAddnandose nofnmealtime ninsulinnaspartn(Novolog) natnlunch
Insulinnaspartn(Novolog) n(A)nisnanrapidnactingninsulinnthatnisncommonlyndosednwithnmealsnandnasnansliding
scale nregimennbasednonnanpatient'snglucosenpriorntoneatingn(preprandial).nItnisnthe nappropriate ninsulinnto
addnasnanmealtime ndosenwhennpatientsnexperiencenbloodnglucosenspikesnbetweennmealsnbecausenofnits
short-actingnproperties.nPeakntimenactionnofninsulinnaspartnisn2nhoursnwithninitialneffectnwithinnthenfirstn30
minutes,nmakingnitnannidealnchoicentoncontrolnexpectednpostprandialnglycemicnspikes
Whichnof nthe nfollowingnconditionsnisnassociatednwithnannincreasednrisknfornconductivenhearingnloss?nA.Aco
usticnneuroma
B.Ménière ndisease
n C.Otitisnmedia
D.Presbycusisn-nanswer-C.nOtitisnmedia
Causesnof nconductivenhearingnlossnare notitisnmedian(C),notitisnexterna,nforeignnobjectsninnthenearncanal,nim
pactednearnwax,ntumors,ncongenitalnanomalies,ndiscontinuitynofnmiddle nearnbones,ncholesteatoma,nandnty
mpanicnmembrane nrupture.nSoundnnormallyntravelsndownnthe nearncanalntonvibrate nthe neardrum
,(tympanicnmembrane).nThe neardrumnisnconnectedntonthreenmiddlenearnbonesn(malleus,nincus,nandnstapes
),nwhichntransmitnthe nsoundnintontheninnernearn(cochlea).nThencochleanisnthenorgannthatnchangesnsoundnvi
brationsnintonannerve nsignalnthatntravelsntonthe nbrain.nThenfourntypesnofnhearingnlossnarenconductive,nsens
orineural,nmixed,nandnretrocochlear. nConductive nhearingnlossnoccursnwhennsoundncannotneffectivelynreac
hnthe ninnernearndue ntonissue ninnthe nouternearnandnmiddle near.
An23-year-
oldnpatientnwhonisnpregnantnatn28nweeksngestationnpresentsntonthenclinicnfornanroutinenprenatalncheckup.n
Whichnfundalnheightnmeasurementnwouldnwarrantnanmore nconclusive nassessmentnwithnannultrasound?
A.26ncm
B.29ncm
C.30ncm
D.31ncmn-nanswer-D.n31ncm
Aftern20nweeksngestation,nthenfundalnheightnshouldnbenmeasurednwithnanmeasuringntapeninncentimeters
n andn shouldnmatchn then gestationaln age. nItn cannben >n orn< n 2n centimeters n andn stilln be nwithin nnormaln limits.n
Anfundalnheightnof n26-
30ncmnisnannormalnfindingninnanpatientnwhonisn28nweeksngestation.nAnresultnof n31ncm
(D) nisnlargernthannexpectednandnshouldnbe nfurthernevaluatednwithnannultrasound.
An4-year-
oldnboynpresentsnwithnearnpainnandnannerythematous,nbulgingntympanicnmembranenonnexamination.nThen
nurse npractitionerndiagnosesnhimnwithnacute notitisnmedia.nWhichnofnthenfollowingnare nthe nthree nmostnco
mmonnbacterialnpathogensnassociatednwithnacute notitisnmedianinnchildren?
A.Moraxellancatarrhalis,nStaphylococcusnaureus,nStreptococcusnpneumoniaenB.Nontypeabl
e nHaemophilusninfluenzae,nMoraxellancatarrhalis,nStaphylococcusnaureusnC.Nontypeable nH
aemophilusninfluenzae, nMoraxellancatarrhalis,nStreptococcusnpneumoniae
D.Nontypeable nHaemophilusninfluenzae,nStaphylococcusnaureus,nStreptococcusnpneumoniae n-nanswer-
C.nNontypeable nHaemophilusninfluenzae, nMoraxellancatarrhalis,nStreptococcusnpneumoniae
Acute notitisnmedianisncommonlynencounterednbynprimaryncarennursenpractitioners.nTypically,nchildrennpre
sentnwithnotalgianandnhave nanbulgingntympanicnmembranenonnexamination.nManyntimes,nchildrennalsonha
ve nanprecedingnviralnuppernrespiratoryninfection,nresultingninnthe ncolonizationnofnbacterianinnthenmiddlenea
rnandnleadingntonanbacterialninfection.nEarninfectionsncannbe ncausednbynbacterialnandnviralnpathogens.
The nmostncommonnbacterialnpathogensnisolatednfromnmiddle nearnfluidnare nnontypeable nHaemophilusninfl
uenzae,nMoraxellancatarrhalis,nandnStreptococcusnpneumoniae n(C).nThenmostncommonnviralnpathogensnin
clude nrespiratorynsyncytialnvirus,ncoronaviruses,ninfluenzanviruses,nandnadenoviruses.nTreatmentnfornacut
e notitisnmedianshouldnbentargetedntoncombatnthe nmostncommonnbacterialncauses,nincludingnamoxicillinn(p
enicillin),namoxicillin-clavulanate n(penicillinnandncombinationnbeta-lactamnandnbeta-
n lactamase n inhibitor), n andn ann oraln second-
generationncephalosporinn(e.g.,ncefuroxime) ninnthe ncase nof nanchildnwithnanpenicillinnallergy.
, An6-year-
oldnpatientnpresentsntonthenclinicnaccompaniednbynhisnmother,nwhonreportsnconcernsnregardingnhernchild'
snprogressive nurinarynissues.nThenpatient'snmothernstatesnthatnshenandnthe nchild'snfathernrecentlyndivorce
d,nandnthe nchildnalternatesnweeklynbetweennhernhousenandnhisnfather'snhouse.nShenreportsnhenexperience
snepisodesnof nurinarynincontinence nandnholdsnhisnstomachnasnifnhenisninnpain.nHenfrequentlyn asksntonusenth
e nbathroomnbutnisnscarednofnurinationnonce nhenisnthere.nWhichnof nthenfollowingnisnthenmostnlikelyndiagnos
is?
A.Adjustmentndisorder
n B.ConstipationnC.Regr
ession
D.Urinaryntractninfectionn-nanswer-D.nUrinaryntractninfection
The nmostnlikelyndiagnosisnisnanurinaryntractninfectionn(D).nHisnclinicalnpresentationnincludesnabdominalnpai
n,nurinarynfrequency,nandndysuria,nwhichnarensignsnofncystitisninnchildren,nwhichnisnconsiderednanlowernuri
naryntractninfectionn(UTI).nPyelonephritisnisnancomplicatednformnofnUTInthatnmaynpresentnwithnpersistentn
fever,nflanknpain,nornvomiting.
An12-year-oldngirlnpresentsntonthe nclinicnwithnhernparent,nwhonisnconcernednaboutnthe nC-
shapednappearance nofnthe ngirl'snspine.nThendegreenofncurvature ninnhernspine nisn35ndegrees.nWhichnofnthenfo
llowingnisnappropriate ntoneducate nthe nparent?
A."Yourndaughter'snspine nhasnanmildncurvenbutndoesnnotnrequire ntreatmentnandnwillnlikelynresolve nonnitsno
wn."
B."Yourndaughter'snspinenhasnanmildncurve,nsonwenwillnwatchnandnwaitntonseenif nitnworsens.nIfnso,ntreatment
n willn be n necessary."
C."Yourndaughter'snspine nhasnmoderate ncurvature,nsonwe nwillnneedntonplace nherninnanbrace nasntreatment."
D."Yourndaughter'snspine nhasnseverencurvature,nsonwe nwillnneedntonrefernhernfornsurgerynasnsoonnasnpossi
ble.n-nanswer-
C.n"Yourndaughter'snspinenhasnmoderatencurvature,nsonwenwillnneedntonplace nherninnanbrace nasntreatment.
"
Scoliosisnisnancomplex nspinalndeformityndefinednasnancurveninnthe nspinenofnatnleastn10ndegrees.nAncurvatur
e nofn25nton40ndegreesnisnconsiderednmoderatenscoliosis,nandnmostncasesnrequire nbracingnforncorrectionn(C
).nBracesnare nofferednforntreatmentninnpatientsnwhonarenskeletallynimmature nandnhave ncurvesn> n30ndegre
esnatnthe nfirstnvisit.nBracingnisnconsiderednineffective nifnthencurvature nisn> n45ndegreesnbecausenthenpatientn
hasnreachednthe nthresholdnfornsurgicalnintervention.nInnmale npatients,nthenbracenisnwornnuntilntheynstopng
rowing,nandninnfemale npatients,nthenbracenisnwornnmorenthann1.5nyearsnpostmenarchnornuntilnthenpatientn
hasngrownn< n1ncmnovernthe npreviousn6nmonths.