ANCC FNP Board |149 Questions and answers

A middle-age female patient presents to the clinic with a recurrence of mild hidradenitis suppurativa after topical therapies failed. Which first-line treatment is recommended? Tetracycline Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treatment for hidradenitis suppurativa. __________________________________________________ Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing skin. It is a chronic, disabling disorder that progresses, often causing keloids, contractures, and immobility. It is characterized by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent discharge, and progressive scarring. Arthropathy associated with hidradenitis may be present. Typical presentation includes nodules and sinus tracts (inflamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area, perineum, gluteal area, and inframammary area in women. Recommended treatments include antibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor agents. A dermatology consultation should also be considered. First-line treatment is a 12‑week course of an oral tetracycline (Sumycin) such as doxycycline. For patients who do not respond to doxycycline, the next recommended step is a combination of twice-daily clindamycin (Cleocin) and rifampicin (Rifadin) for 10-12 weeks. If treatment fails, acitretin (Soriatane, for males and nonfertile females) or dapsone (Aczone) may be considered by a dermatologist. In patients with moderate to severe hidradenitis suppurativa, adalimumab (Humira) may possibly be considered. When providing culturally competent health care services to an American Indian elder, the nurse practitioner understands which is traditionally true? The "Medicine Wheel" is used by many for the purpose of health and healing The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west. Traditionally each tribe has different meanings for each direction and they may represent the season of the year or stage of life. It is aimed at providing a holistic view of life. ________________________________________ An understanding of different cultural preferences leads to cultural competence in healthcare. Some patients may value traditional culture and preferences as it relates to healthcare. These individual preferences should be included in the interview and treatment plan for patients. Traditionally, the American Indian culture values a holistic approach to health care integrating the person, lifestyle, environment, family, and religion. Patients adhering to these traditional cultural practices often feel that illness is due to a lack of harmony with the physical body, mind, spirit, and emotions. Patients may seek care from western medicine for specific ailments while also consulting with traditional healers for spiritual guidance. Healthcare providers should seek to understand relevant cultural factors and assess each individual's healthcare literacy in order to provide culturally competent care. The nurse practitioner sees an older adult patient in the clinic with the primary report of hearing loss and a sensation of fullness in the right ear. The nurse practitioner suspects conductive hearing loss. Which could contribute to this? Cerumen, commonly called earwax, is a combination of secretions and sloughed epithelial cells that protects the ears from infection, water, and insects. It is normally expelled from the ear canal through natural jaw movement. When this self-cleaning process fails, cerumen can become impacted. Cerumen impaction occludes the ear canal and can press against the tympanic membrane, resulting in conductive hearing loss. _________________________________________ Conductive hearing is the transition of sound from the external and middle ear to the inner ear. Conductive hearing loss is caused by problems in the external and middle ear that interfere with the transmission of sound and its conversion to mechanical vibration. Causes of conductive hearing loss include obstruction of the external auditory canal by cerumen, foreign bodies, debris from otitis externa, and large exocytosis and osteomas. Sensorineural hearing loss involves difficulty converting mechanical vibrations to electrical potential in the cochlea or in auditory nerve transmission to the brain. It is mostly caused by permanent damage in the organ of Corti. It can be caused by age-related hearing loss, noise trauma, medications, autoimmune diseases, mechanical trauma, Meniere disease, infection, and neoplasm (acoustic neuroma). Approximately one-third of older adults between the ages of 61 and 70 years have hearing loss. More than 90% of adults older than 85 years of age have hearing loss. The most common type of hearing loss is age-related and sensorineural. All adults older than 60 years of age should be screened for hearing loss at periodic health examinations. An otherwise healthy adult patient presents to the clinic with a diagnosis of community-acquired pneumonia and no recent antibiotic therapy. Which is the best option for treatment? Amoxicillin High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults without comorbidities. _____________________________________________ Community-acquired pneumonia (CAP) is pneumonia not acquired in a hospital or long-term care facility. Patients with suspected CAP should receive a chest X-ray for diagnosis. The Pneumonia Severity Index should be used to assist in decisions regarding the need for hospitalization in patients with CAP. According to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) 2019 guidelines, the initial treatment of CAP for most patients is amoxicillin or doxycycline. Macrolides are an option for treatment, but are no longer recommended routinely as first-line treatment, given increased macrolide resistance. This is a change from the 2007 ATS/IDSA guidelines. Respiratory fluoroquinolones and amoxicillin/clavulanate should be used in patients who fail first-line medications, have significant comorbidities, have had recent antibiotic therapy, are allergic to alternative agents, or have a documented infection with highly drug-resistant pneumococci. A patient presents to the clinic for conception counseling. She recently stopped taking oral contraceptives and would like to become pregnant. Which statement about conception safety after stopping oral contraceptives is correct? You have a 35-year-old female patient who is complaining of wrist pain. She is an administrative assistant who does a great deal of computer work in her job. You will test her for carpal tunnel syndrome. When you tap at the volar surface of the wrist you are performing which of the following tests? Tinel's sign A gastrinoma located on the pancreas or the stomach which secretes gastrin, stimulating high levels of acid production in the stomach is which of the following? Zollinger-Ellison syndrome A 16-year-old male is in the office. He has a insect bite on his left forearm and you suspect a brown recluse spider bite. What medical management would you provide? ice pack and elevation of the area In addition to being overweight, the American Diabetes Association recommends type 2 diabetes mellitus testing in adults who: have an HDL level of < 35 mg/dL Which of the following found on an ECG would confirm atrial fibrillation? -absent P waves -irregular ventricular rate As an FNP you understand that all of the following statements about chronic heart failure are accurate EXCEPT: -The preponderance is in females until the age of 75, then there is equal occurrence in males and females. -Patients who are underweight have a greater risk of CHF. The FNP has a 45-year-old male patient with BPH who has poison ivy. The FNP plans to prescribe Benadryl for this. What is a possible adverse effect with the use of Benadryl for this patient? urinary retention You are testing a client suspected of having Parkinson's disease. You support the client's elbow with his forearm extended in your hand and grasp his wrist, flexing the forearm. You find rigid resistance to this motion. This is considered which of the following? cogwheeling The complex network of nerve fibers that innervate the organs within the abdomen like the gastrointestinal tract, pancreas, and gall bladder is the enteric nervous system Aplastic anemia would be classified as which of the following? normocytic anemia Charles Darwin wrote On the Origin of Species about human evolution. He also is known for which of the following? developing the "baby journal" as a systematic method to document observed behavioral development Your patient has AIDS. He is in the hospital suffering from an infection. He presented with severe watery diarrhea, abdominal cramps, nausea, malaise and has an electrolyte imbalance. Which of the following opportunistic infections do these symptoms best describe? cryptosporidiosis Cryptosporidiosis presents with severe watery diarrhea - sometimes as many as 30-40 stools per day. The patient also has abdominal cramps, nausea, malaise and tests will show an electrolyte balance. A patient with sensitive skin had a TB skin test but has no symptoms. He returns with redness and swelling that appears positive. What is the next step? Schedule a CXR The nurse practitioner should not cross certain boundaries with patients. Which of the following would not be considered crossing one of these boundaries? Not sharing personal information with the patient The United States Preventive Services Task Force recommends screening older patients for depression: at each primary care visit Which of the following types of hepatitis is transmitted by fecal and oral route from contaminated food? Hep A Which of the following is a normal physiologic change during pregnancy? -Cardiac output increases by 1/3 by the last two trimesters. -Decreased systolic and diastolic pressure occurs in the first trimester. -There is decreased peristalsis from progesterone effects. If a patient is diagnosed with left-heart failure, which of the following medications would the nurse practitioner more than likely use for treatment? Lasix When counseling patients who smoke cigarettes, which of the following is NOT good management advice? For asymptomatic adults, instruct the patient on how it is easier to stop now than when symptomatic. According to Prochaska and DiClemente, the 5 stages of preparation for patient change would include which of the following? Action Paul is a 67-year-old male patient with type 2 diabetes. In managing this patient's care which of the following lab tests would you have done for Paul every 3 - 6 months? A1c Which of the following would be considered one of the stages of Pertussis? Convalescent You are testing a 35-year-old male patient for Addison's disease. You perform the test for ACTH stimulation. If this patient has primary adrenal insufficiency he will have which of the following responses to this test? no response You want to prescribe a drug with a rapid onset for a patient who is being treated for anxiety. Which of the following drugs for treating anxiety has the most rapid onset of action? diazepam - Diazepam has a rapid onset of action and a relatively sustained effect. You have a patient with a "port wine" stain that is located on half of her facial area. You understand that this can be a sign of which of the following? Sturge-Weber Syndrome- The flat, large, dark ink to purple stain-like lesions occurring in irregular shapes and sizes are nevus flammeus or "port wine" stains. A large lesion located on half the facial area may be a sign of trigeminal nerve involvement and Sturge-Weber Syndrome (a neurological disorder). A patient with stable angina would exhibit which of the following? no change in duration of symptoms during the preceding 6 weeks Which of the following is most likely when there is no p wave present on an electrocardiogram? A.Fib Lispro insulin has an onset which starts at which of the following? 15 minutes Which of the following would be considered correct for a fungal infection which is a common skin tissue issue that is typically seen on the extremities, trunk or face? ringworm Your patient has "swimmer's ear." She has no other associated conditions. Your management of this patient will include which of the following? application of local heat to outer ear for pain relief A mother brings in her 7-year-old child with a red rash on his cheeks and ears. You diagnose Fifth disease. You might recommend all of the following for this child EXCEPT: isolation A patient has recently been diagnosed with Addison's disease. How often should this patient's electrolytes be monitored? every 3-4 months for the first year of therapy You are doing a gynecologic assessment of your 25-year-old female patient. Which of the following specimens would you collect last during this examination? Papanicolaou testing A patient is diagnosed as dehydrated, anxious, and isolated. What should you give the highest priority? Dehydration. According to the structural functional theory of assessment and intervention, which of the following statements is false? Suprasystems form within the family to reflect functional needs. A mother brings her 5-year-old child to the clinic with a ringlike pruritic rash with some central clearing on the arms and legs. The FNP knows that this is which of the following conditions? tinea corporis Bactrim should NOT be prescribed to which of the following patients? 1 month old child In treating a patient with eczema, which of the following would you use if the patient has acute, weeping lesions? Burow's solution During the process of implantation, the fetus in the above picture (4 weeks) would have finger-shaped growths that grow to help anchor the embryo to the uterine lining. Which of the following would be considered the correct name for these growths? Chorionic villi The FNP has a pregnant patient whose uterus is grapefruit size. At what stage of pregnancy is this patient most likely to be? 12 weeks The most common cause of secondary hypertension is which of the following? renal conditions The effect of a goitrogen could likely be: hyperthyroidism An injury to one of the ligamentous structures of the body is termed a(n): sprain - A sprain is an injury to one of the ligamentous structures of the body. A 34-year-old female with multiple sclerosis (MS) is in the office. She is now under your care after relocating from another state to live with relatives who can help her. The nurse practitioner understands that which of the following is NOT part of her management plan: Corticosteroids are often used for maintenance. Which of the following statements about endometriosis is least accurate? The FNP can manage the patient with endometriosis independently. For a healthcare professional to obtain blood at the request of law enforcement officials without a patient's consent which of the following must be present? -The suspect must be under arrest. -A delay in drawing blood would lead to destruction of evidence. -The test is performed in a reasonable manner. ***all of the above A CT would allow for a better diagnosis (with "slices") of the patient by which of the following ways? -Forms a full three-dimensional computer model of the inside of the patient. -It is easier for the physician to pinpoint a problem because of the narrow "slices" that the scanner uses. The Romberg test is used to evaluate which of the following? cerebellar system- Tandem gait is also used for testing the cerebellar system. Your patient has a superficial skin lesion that is elevated. It is less than 1 cm in diameter and it is filled with serous fluid. Which of the following skin lesions is this? vesicle The nurse practitioner will need to be aware of infectious diseases and the concerns regarding the recognition and management of them. Which of the following is important regarding the professional role related to infectious disease recognition and management? Be alert to endemic diseases. Be alert to diseases that may be the result of bioterrorism. Know the local health department guidelines for reporting communicable diseases. ****All of the above In which quadrant of the abdomen would you find the body of the pancreas? Left Upper Quad A 35-year-old female patient tells you that she has not had a period in over 3 months. She tells you that until now she has been quite regular with her periods. This condition is which of the following? secondary amenorrhea The Family Nurse Practitioner has the duty to disclose certain information to the patient as part of the informed consent process. Which of the following is not an exception to this duty? The patient is 80-years-old or older and unable to comprehend the complex medical facts. Holly is a30-year-old female client with systemic lupus erythematosus. You are telling Holly what to do to improve symptoms. In the course of this education you would include all but which of the following statements? get plenty of sunlight - You would tell her to protect against sunlight. In terms of business organization types for nurse practitioner practice, which of the following has its own identity and is a separate legal entity? corporation If a nurse practitioner is providing care for pediatric patients, why is it especially important to have adequate professional liability insurance coverage? The statute of limitations is often put on hold (or tolled) until the minor reaches legal age status. Then, the timeframe within which the child or parent can file a lawsuit is extended.