NP board exam review: Class book 207 Questions with Verified Answers,100% CORRECT

NP board exam review: Class book 207 Questions with Verified Answers A patient has hyperactive reflexes of the lower extremities. The adult-gerontology acute care nurse practitioner assesses for ankle clonus by: - CORRECT ANSWER sharply dorsiflexing and maintaining the foot in this position, while supporting the knee. A 15-year-old patient with type 1 diabetes mellitus reports elevated blood glucose levels in the morning. The adult-gerontology acute care nurse practitioner determines that the patient's hyperglycemia is due to the dawn phenomenon and - CORRECT ANSWER increases the insulin dosage at bedtime A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace), is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is intravenous - CORRECT ANSWER ceftriaxone A patient who has been in the intensive care unit for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to - CORRECT ANSWER The right answer was replenish volume by infusing a 0.9% sodium chloride solution Cytology is evaluated with - CORRECT ANSWER fine needle biopsy What is the single best predictor of one's health status? - CORRECT ANSWER health literacy Patient Health Questionnaire (PHQ-9) - CORRECT ANSWER common depression screening tool, self rank 9 signs and symptoms over last 2 weeks on scale of 0-3 CAGE-AID - CORRECT ANSWER C-have you ever felt that you ought to cut down on your drinking or drug use? A-have people annoyed you by criticizing your drinking or drug use? G-have you ever felt bad or guilty about your dirnking or drug use? E-Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover? (e.g. eye opener) Ramsay Sedation scale - CORRECT ANSWER Awake: 1: anxious, agitated, restless 2: cooperative, oriented, tranquil 3: responsive to commands only Sleeping: 4:response to light glabellar tap ro loud auditory stimulus 5: sluggish response to light glabellar tap or loud auditory stimulus 6: no response to light glabellar tap or loud auditory stimulus Brief pain inventory - CORRECT ANSWER Assess impact of pain on daily life What is a good assessment tool for chronic pain such as with cancer patients? - CORRECT ANSWER Brief pain inventory Go review MMSE - CORRECT ANSWER What physical activity is good for Parkinson's patients? - CORRECT ANSWER Tai chi What is salsa dancing good for? - CORRECT ANSWER Coordination What is benchmarking? - CORRECT ANSWER Comparison and measurement of a healthcare organization's services against other national healthcare organizations HIPAA title I - CORRECT ANSWER protects health insurance coverage for workers and their families when they change or lose their jobs i.e. cobra HIPAA title II - CORRECT ANSWER administrative simplification provisions, standards for electronic healthcare transactions and national identifiers for providers, health insurance, and employers Who enforces HIPAA? - CORRECT ANSWER Office of civil rights Levels of facial fracture - CORRECT ANSWER 1. floating pallet 2. mandible 3. Face What is a tertiary facility - CORRECT ANSWER Provides specialized care i.e. level 1 trauma 2 goals of healthy people 2020 - CORRECT ANSWER increase quality and years of healthy life and eliminate health disparities among Americans Infections that require reporting to health department (5) - CORRECT ANSWER gonorrhea, chlamydia, syphilis, HIV, TB Who sets standards of coding (E&M) ? - CORRECT ANSWER medicare What are examples of 3rd party payers? - CORRECT ANSWER Medicare, Medicaid, commercial insurers, HMOs, schools providing insurance Medicare A - CORRECT ANSWER covers hospitalizations, SNFs, home health, hospice if associated with hospitalizations Medicare B - CORRECT ANSWER Covers provider services, outpatient, labs and diagnostics, supplemental requiring premium, medicare pays 80% of bill Medicare C - CORRECT ANSWER A+B = C; medicare advantage, receive services under one provider e.g. HMO, PPO Medicare D - CORRECT ANSWER limited prescription coverage, monthly premium, includes copay, need to enroll when first eligible What is required for a NP to be able to bill medicare? - CORRECT ANSWER Hold a state license, be certified by a professional body, hold at least a MSN degree What is an important goal of CQI/QA? - CORRECT ANSWER monitoring outcomes of care Who dictates the level of prescriptive authority? - CORRECT ANSWER state practice acts Who allows NPs to admit to the hospital? - CORRECT ANSWER joint comission Nonmaleficence - CORRECT ANSWER duty to do no harm utilitarianism - CORRECT ANSWER the right act is the one that produces the greatest good for the greatest number BEneficence - CORRECT ANSWER the duty to prevent harm and promote good justice - CORRECT ANSWER the duty to be fair fidelity - CORRECT ANSWER the duty to be faithful veracity - CORRECT ANSWER the duty to be truthful autonomy - CORRECT ANSWER the duty to respect the individual's thoughts and actions What two ethical principles are often in conflict? - CORRECT ANSWER Beneficence and autonomy What is a quazi experiment? - CORRECT ANSWER An experiment that lacks either a comparison group or randomization Sensitivity vs specificity - CORRECT ANSWER Sensitivity is positive and specificity is negative What lab value contraindicates use of sux? - CORRECT ANSWER Hyperkalemia What common liver met site can cause a fever? - CORRECT ANSWER Liver What is a left shift? - CORRECT ANSWER Bandemia What is the most common type of headache - CORRECT ANSWER Tension What blood test tests for syphillus? - CORRECT ANSWER VDRL What qualifies a migraine sufferer to have prophylactic therapy? - CORRECT ANSWER Attacks more than 2-3 times per month What is the black box warning on amitriptyline for? - CORRECT ANSWER QT prolongation What is a normal urine sodium? - CORRECT ANSWER 10-20 In a patient with hyponatremia, urine sodium >20 indicates - CORRECT ANSWER renal salt wasting In a patient wiht hyponatremia, urine sodiu <10 indicates - CORRECT ANSWER renal retention of sodium to compensate for loss Common causes of isotonic hyponatremia - CORRECT ANSWER hyperlipidemia, hyperproteinemia Edema, CHF, liver disease, and advanced renal failure can contribute to what kind of hyponatremia? - CORRECT ANSWER Hypervolemic, hypotonic hyponatremia Hypertonic hyponatremia - CORRECT ANSWER usually from HHNK, somolality is high and the Na is low Potassium in acid/base imbalances - CORRECT ANSWER acidosis => increased K alkalosis => decreased K Treatment (IV fluids) of hyopvolemic hypernatremia - CORRECT ANSWER NS followed by 1/2 saline What does hypokalemia look like on an EKG? - CORRECT ANSWER decreased amplitude, broad T waves, PVCs, V tach, or V-fib What is a normal calcium? Normal ionized? - CORRECT ANSWER 8.5-10.5 mg/dl; 4.5-5.5 What is different about an ionized cal from a regular cal? - CORRECT ANSWER ionized is not effected by albumin level Does acedemia increase or decrease calcium? - CORRECT ANSWER increase What causes hypocalcemia? - CORRECT ANSWER hypoparathyroidism, hypomagnesmia, pancreatitis, renal filure, severe trauma, multiple blood transfusions What ECG change can be caused by hyperthyroidism - CORRECT ANSWER a fib What electrolyte imbalance can vitamin D intoxication cause? - CORRECT ANSWER hypercalcemia What do you do if a patient's calcium level is >12? - CORRECT ANSWER NS infusion with loop diuretics what does respiratory acidosis result from? - CORRECT ANSWER decreased alveolar ventilation Anion gap equation - CORRECT ANSWER NA - (Chloride + bicarb) Normal anion gap - CORRECT ANSWER 12+/- 5 Clinical symptoms in respiratory alkalosis are related to what physiological process? - CORRECT ANSWER decreased cerebral blood flow What is the hallmark sign of metabolic acidosis? - CORRECT ANSWER Low HCO3 Examples of causes for metabolic acidosis with increased anion gap - CORRECT ANSWER DKA, alkoholic KA, lactic acidosis, drug or chemical anion Examples of causes for metabolic acidosis with normal anion gap - CORRECT ANSWER diarrhea, illeostomy, renal tubular acidosis, recovery from DKA When is giving HCO3 indicated in metabolic acidosis? - CORRECT ANSWER When significant hyperkalemia is present Common causes of metabolic acidosis - CORRECT ANSWER NG suctioning, vomitting Rule of 9's - CORRECT ANSWER arm = 9 leg = 9 thorax = 18 head=9 peri=1 Equation for burn fluid resuscitation - CORRECT ANSWER 4 ml x kg x TBSA Examples of crystalloid fluids - CORRECT ANSWER NS D5 LR Example of common colloid - CORRECT ANSWER albumin In burn patients, when do you prophylactically intubate? - CORRECT ANSWER Facial burns singed nares or eyebrows dark soot/mucous from nares and/or mouth What acid/base imbalance is expected during resuscitation from burns? - CORRECT ANSWER metabolic acidosis What electrolyte abnormality should be monitored for 24-48 hrs after burn injury - CORRECT ANSWER hyperkalemia What electrolyte abnormality should be monitored for at 72 hrs post burn injury? - CORRECT ANSWER hypokalemia In a human bite, what do you cover for and what is a common abx to use? - CORRECT ANSWER staph and anaerobes, augmentin, 3-7 days Most common cause of cellulitis - CORRECT ANSWER strep A Abx for CA-MRSA - CORRECT ANSWER bactrim, doxy, clinda Abx for A strep - CORRECT ANSWER bactrim + beta lactam Doxy + beta lactam clinda Examples of beta lactams - CORRECT ANSWER amoxicillin, keflex, cephelosporin Alternative to narcan? - CORRECT ANSWER Stadol What overdose is tinnitus a symptom of? - CORRECT ANSWER ASA What is the drug of choice in organophosphate toxicity? - CORRECT ANSWER atropine Treatment of serotonin syndrome - CORRECT ANSWER dantrolene sodium, clonazepam, cooling blankets Does cocaine cause mydriasis or miosis? - CORRECT ANSWER mydriasis - dilated Does heroin cause mydriasis or miosis? - CORRECT ANSWER miosis - pinpoint Standard transplant therapy - CORRECT ANSWER CNI + antimetabolite + steroid Calcineurin inhibitor examples - CORRECT ANSWER tacrolimus, cyclosporine antimetabolite examples - CORRECT ANSWER azathioprine, cellcept MTOR inhibitor - CORRECT ANSWER sirolimus Actinic keratosis (picture) and treatment - CORRECT ANSWER liquid nitrogen Squamous cell carcinoma (picture) and treatment - CORRECT ANSWER biopsy and surgical excision (Mohs) Seborrheic keratosis (picture) and treatment - CORRECT ANSWER benign, liquid nitrogen Basal cell carcinoma (picture) treatment - CORRECT ANSWER most common, shave/punch bx and surgical excision Malignant melanoma (picture) and treatment - CORRECT ANSWER biopsy and surgical excision ABCDE of malignant melanoma - CORRECT ANSWER Asymetry Border irregularity color variation diameter >6 cm elevation, enlargement How does SIADAH work? - CORRECT ANSWER ADH is released independent of osmolality or volume dependent stimulation causing inappropriate water retention. It is hyponatremic euvolemia. How does diabetes insipidus work? - CORRECT ANSWER ADH deficiency causes pituitary or hypothalamus damage In SIADH, what would you expect serum osmo, urine osmo, urine sodium to be? - CORRECT ANSWER serum osmo: low <280 urine osmo: up >100 urine sodium: >20 What is a pheochromocytoma? - CORRECT ANSWER excess catecholamine (epi and norepi) release characterized by paroxysmal or sustained HTN. Almost always related to tumor in adrenal medulla S/s of phenochromocytoma - CORRECT ANSWER HTN labile diaphoresis hyperglycemia severe HA palpitations sweating tremor tachycardia weight loss postural hypotension How do you confirm a pheochromocytoma - CORRECT ANSWER assay of urine catecholamines and CT of adrenals Medication given perioperatively while removing phnochromocytoma - CORRECT ANSWER phentolamine IV What are you hearing in S1? - CORRECT ANSWER Mitral/tricuspid valves close, A/P open What are you hearing in S2? - CORRECT ANSWER Aortic/pulmonic closure, M/t open S3 is heard in? Sounds like? - CORRECT ANSWER CHF, pregnancy, fluid overload Ken-tuck-y S4 is heard in? Sounds like? - CORRECT ANSWER MI, left ventricular hypertrophy, chronic HTN, stiff entricular states; Ten-ne-ssee Describe a grade III/VI murmur - CORRECT ANSWER moderately loud, easily heard Descrive a graDE IV/VI murmur - CORRECT ANSWER loud, associated with thrill Is mitral stenosis a systolic or diastolic murmur? - CORRECT ANSWER diastolic Is aortic regurg a systolic or diastolic murmur - CORRECT ANSWER diastolic is mitral regurg a systolic or diastolic murmur - CORRECT ANSWER systolic is aortic stenosis a systolic or diastolic murmur - CORRECT ANSWER systolic Where is the apex of the heart? - CORRECT ANSWER 5th ICS where is the base of the heart? - CORRECT ANSWER 2nd-3rd ICS What causes dependent edema? - CORRECT ANSWER Increased capillary hydrostatic pressure How do you rule out cushing's syndrome? - CORRECT ANSWER AM/PM cotisol levels What are the criteria of metabolic syndrome? - CORRECT ANSWER at least 3 of the following: 1. Waist >=40 or 35 2. BP >=130/85 3. Triglycerides >=150 4. FBG >=100 5. HDL <40/<50 Top 4 killers in adults (in order) - CORRECT ANSWER CAD Cancer lower respiratory CVA What is a normal AOC - CORRECT ANSWER 5.5-7% Metformin can cause which acid/base inbalance - CORRECT ANSWER metabolic acidosis Starting insulin dose - CORRECT ANSWER 0.1u/kg/day giving 2/3 in AM and 1/3 at night Somogyi efect - CORRECT ANSWER hypo overnight and hyper in AM - treat by omitting bedtime dose dawn phenomenon - CORRECT ANSWER progressively higher overnight - increase at bedtime dose Hyperthyroid - CORRECT ANSWER grave's disease overdrive test TSH first TSH low T3 high methimazole or propylthiouracil Hypothyroid - CORRECT ANSWER hashimoto's thyroiditis sluggish TSH elevated T4 low or low normal hyponatremia hypoglycemia What can exacerbate a thyroid storm - CORRECT ANSWER ASA Cushing's syndrome - CORRECT ANSWER ACTH hypersecretion by the pituitary adrenal tumor chronic steroids central obesity, moon face, etc hyper-glycemia, natremia hypo kalemia treat-underlying cause, surgical Addison's disease - CORRECT ANSWER Deficient in cortisol, androgens, and aldosterone autoimmune destruction of the adrenal gland hyperpigmentation of buccal mucosa hypo-glycemia, natremia hyperkalemia steroid replacement Gluco and mineral ocorticoids - CORRECT ANSWER hydrocortisone fludrocortisone JNC8 recommendations for medications in HTN non african americans - CORRECT ANSWER thiazide CCB ACEI ARB JNC8 recommendations for medications in HTN african americans - CORRECT ANSWER thiazide (unless DM, then get ACEI or ARB) CCB JNC8 recommendations for meds in HTN in adults with CKD - CORRECT ANSWER ACEI ARB What is the difference between SVT and ST on an EKG - CORRECT ANSWER no p wave in SVT First degree block strip - CORRECT ANSWER Second degree block strip - CORRECT ANSWER What kind of allergy do you screen for before giving a thiazide? - CORRECT ANSWER Sulfa What do ACEI and ARBs do besides cause lower BP? - CORRECT ANSWER vasodilation and block sodium and water retention What is malignant hypertension - CORRECT ANSWER fundoscopic chnages including flame shaped retinal hemorrhages, soft exudates and papilledema Treatment of prinzmetals - CORRECT ANSWER CCB, vasospastic so give CCB becaue related to calcium influx Goals for LDL, HDL and TG in DM and/or CAD patients? - CORRECT ANSWER LDL <70 HDL >40 TG <150 Common pharmacotherapy for angina - CORRECT ANSWER nitrates, BB, CCBs Normal lipid profile - CORRECT ANSWER Adults with a LDL of what should get statin therapy - CORRECT ANSWER >=190 Where is a lateral MI shown on the ECG? - CORRECT ANSWER I,aVL Where is an inferior MI shown on the ECG? - CORRECT ANSWER II, III, aVF Where is an anterior MI shown on an ECG? - CORRECT ANSWER V leads or V3 and V4 Where is a septal infart seen on ECG? - CORRECT ANSWER V1, V2 Which troponin is cardioselective? - CORRECT ANSWER Troponin I When do you see leukocytosis in a MI? - CORRECT ANSWER second day Drug therapy in acute MI - CORRECT ANSWER ASA, NTG, morphine, lasix, BB, ACEI Normal INR Normal APTT Normal PT Normal PTT - CORRECT ANSWER 0.8-1.2 28-38 11-16 60-90 What is the door to TPA goal? - CORRECT ANSWER 30 minutes Are legs shiny and hairless in PVD or CVI? - CORRECT ANSWER PVD ST changes in pericarditis - CORRECT ANSWER ST elevation temporary T wave inversion PR segment depression highly indicative of pericarditis What is the drug of choice for pericarditis? - CORRECT ANSWER NSAIDS, maybe steroids if NSAIDS fail How do you identify a GI bleed of an unknown cause? - CORRECT ANSWER GI angio Common causes of PUD - CORRECT ANSWER h pylori meds duodenal ulcers in young and gastric in old smoking Pain in PUD - CORRECT ANSWER relieved with eating in duodenal worse with eating gastric PUD 1st-3rd line treatment - CORRECT ANSWER HS HS BID PPI Common h pylori regimens - CORRECT ANSWER flagyl BID and/or amoxicillin, prilosec BID, clarithro BID x7 days then anti ulcer for 3-7 weeks Hepatitis A incubation period - CORRECT ANSWER 2-6 weeks Murphy's sign - CORRECT ANSWER for cholecystitis deep pain on inspiration while fingers are placed under the right rib cage Grey turner's sign cullen's sign - CORRECT ANSWER flank discoloration umbilical discoloration Where is pain generally in diverticulitis? - CORRECT ANSWER LLQ How does cholecystitis present? - CORRECT ANSWER sudden steady, severe pain in epigastrum or right hypochondrium, vomitting provides relief, precipitated from a fatty meal What imaging test is the gold standard for cholecystitis? - CORRECT ANSWER ultrasound What abnormal lab values could cause acute pancreatitis? - CORRECT ANSWER hypercalcemia, hyperlipidemia Gold standard imaging for acute pancreatitis? - CORRECT ANSWER CT scan Serum amylase and lipase in acute pancreatitis? - CORRECT ANSWER amylase 50-180 lipase 14-280 Ranson's criteria - CORRECT ANSWER prognosis of acute pancreatitis - 5-6 40% mortality >7 appx 100% mortality George washington got lazy after he broke CABE >55 yo WBC >16K glucose >200 LDH > 350 AST >250 Hct drop >10 BUN >5 increase calcium <8 arterial 02 <60 base deficit >4 est fluid sequestration >6K What is the hallmark symptom of ulcerative colitis? - CORRECT ANSWER bloody diarrhea How do you treat a UC flare? - CORRECT ANSWER mesalamine suppositories for 3-12 weeks in combo with prednisone Psoas sign obturator sign positive rovsing's sing - CORRECT ANSWER -pain with right thigh extension -pain with internal rotation of flexed right thigh -RLQ pain when pressure is applied to the LLQ What is the typical s/s of MCA infarct? - CORRECT ANSWER hemiplegia A pneumonic for cranial nerves? - CORRECT ANSWER On old olympus towering tops a fin and german viewed some hops CN 1 CN 2 CN 3 - CORRECT ANSWER olfactory-smell optic-vision oculomotor-most EOMs, opening eyelids, pupillary constriction CN IV CN V CN VI - CORRECT ANSWER T-orchlear-down and inward eye movement -trigeminal-muscles of mastication, sensation of face, scalp, cornea, mucus membranes and nose -abducens - lateral eye movement CN VII CN VIII CN IX - CORRECT ANSWER -facial-mouth, eyes, taste anterior 2/3, saliva, tears, puffing cheeks -acoustic-hearing and equilibrium -glossopharyngeal-phonation, gag reflex, carotid reflex, swallowing, taste posterior CN X CN XI CN XII - CORRECT ANSWER -vagus-talking, swallowing, general sensation fro mthe arotid body, carotid reflex -spinal accessory - movement of trapezius and sternomastoid muscles (shrug) -hypoglossal-moves the tongue Vertebrobasilar vs carotid TIA - CORRECT ANSWER -verte-vertigo, ataxia, dizziness, visual, field, deficits, weakness, confusion -aphasia, dysarthria, altered LOC, weakness, numbness, etc What are s/s of sudden increased ICP? - CORRECT ANSWER AMS, HA, vomitting Left hemisphere involvement of CVA vs Right hemisphere involvement of CVA - CORRECT ANSWER opposite hemiparesis -left: aphasia, dysarthria, difficulty reading/writing -right: right visual field changes, spatial disorientation What is a normal MAP? What MAP do you want on a CVA patient to prevent vasospasms? - CORRECT ANSWER 70-105 110-130 3 H's of increased ICP - CORRECT ANSWER hypotension hypoxemia hypercapnea What differentiates a simple partial from complex partial seizure? - CORRECT ANSWER followed by impaired level of consciousness What is CPP and what is the goal? - CORRECT ANSWER MAP-ICP; goal 70's Goal ICP in CVA? - CORRECT ANSWER <20 What are some indications for ICP monitors? - CORRECT ANSWER GSC <8 and/or a bleed What is myasthenia gravis? - CORRECT ANSWER autoimmune reduction of the number of acetylcholine receptor sites at the neuromuscular junction weakness worse after exercise and better after rest How do you differentiate between a myasthenia gravis crisis and a choinergic crisis? - CORRECT ANSWER Tensilon test In MS, what would you see in the CSF? - CORRECT ANSWER elevated IgG How do you evaluate for MS besides exam and labs? - CORRECT ANSWER MRI brain What is Guillain-Barre Syndrome - CORRECT ANSWER demyelination of peripheral nerves resulting in progressive symmetrical ascending paralysis Lab findings in GB - CORRECT ANSWER CSF protein elevated especially immunoglobulin G CBC early leukocytosis w/ left shift LP, MRI, and CT sometimes used What is the most common cause of meningitis? - CORRECT ANSWER strep pneumoniae What are the 5 most common disorders caused by strep P.? - CORRECT ANSWER meningitis sinusitis otitis media bronchitis CAP Why, in meningitis, does the CSF have an increase in pressure, protein, and WBCs but a decrease in glucose? - CORRECT ANSWER The protein eats up the glucose What abx do you give for meningitis? - CORRECT ANSWER Pen G, vanco, third gen cephalosporin or quinolone until C&S back What is cushing's triad and what does it mean? - CORRECT ANSWER Widening pulse pressure, decrease RR, decrease HR; decompensation in head trauma