ANCC Practice 122 Questions with 100% correct answers.

In the early stages of iron deficient anemias, blood studies show: (a) macrocytic normochromic (b) microcytic hypochromic (c) normochromic normocytic (d) pancytopenic hypocytic (a) normochromic normocytic A 14-year-old, male patient has some general concerns about eczema, as his twin brother was recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a personal history of allergic rhinitis, and a history of: (a) asthma (b) bee allergy (c) otitis media (d) psoriasis (a) asthma A patient has hyperactive reflexes of the lower extremities. The adult-gerontology primary care nurse practitioner assesses for ankle clonus by: (a) firmly applying a low-pitched tuning fork to the lateral malleolus. (b) flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the percussion hammer. (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. (d) stroking the lateral aspect of the sole from the heel to the ball of the foot with the sharp end of the percussion hammer. (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. A 70-year-old, female patient is having her yearly evaluation. The adult-gerontology primary care nurse practitioner gives which physical examination finding the highest priority for immediate treatment? (a) Atrophy of vaginal rugae. (b) Cystocele present. (c) Palpable ovary. (d) Pessary in place. (c) Palpable ovary. The adult-gerontology primary care nurse practitioner reminds a 16-year-old, male patient who just received his driver's license to wear a seat belt at all times when in a car. The patient replies that he does not need to wear a seat belt, because nothing will happen to him if he is involved in an automobile collision. According to the health belief model, what chief component does the patient lack? (a) Enabling factors. (b) Motivation. (c) Perceived role conflict. (d) Perceived severity. (d) Perceived severity. The adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure? (a) Comorbidities and length of exposure. (b) Location and event intensity. (c) Mode of transmission and incubation. (d) Premorbid conditions and surveillance rates. (c) Mode of transmission and incubation. When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner: (a) concludes that the study proves the hypothesis. (b) excludes the discussion section, because the conclusion contains this information. (c) recommends incorporating the results directly into clinical practice. (d) uses the methodology section to support the validity of the study. (d) uses the methodology section to support the validity of the study. A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: (a) asks the child to provide a copy of the patient's advance directive document. (b) assures the child that the nurse practitioner can disclose requested information. (c) informs the child that he or she must come to the clinic to discuss the parent's case. (d) tells the child that the nurse practitioner can discuss the information only with the patient. (d) tells the child that the nurse practitioner can discuss the information only with the patient. The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to: (a) evaluate standards, risks, benefits, and outcomes. (b) identify how to anticipate and resolve similar future situations. (c) investigate the need for disciplinary action. (d) obtain agreement of all parties with a chosen solution. (a) evaluate standards, risks, benefits, and outcomes. To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: (a) charges a fee for patients who arrive late to clinic appointments. (b) disseminates research study results to colleagues. (c) expresses opinions about alternative therapies with patients who consider such treatments. (d) schedules time during clinic hours to meet with pharmaceutical representatives. (b) disseminates research study results to colleagues. One effect of using electronic health record applications, such as telemedicine and portable monitoring systems, has been to: (a) create stand-alone clinics. (b) decrease billable visits. (c) increase risks to patients. (d) open access to care. (d) open access to care. The adult-gerontology primary care nurse practitioner evaluates an 80-year-old patient with cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole-trimethoprim (Bactrim). The patient's previous medical record is unavailable. Before prescribing the medication, the nurse practitioner: (a) contacts the patient's adult child. (b) queries the other staff members. (c) relies on the patient's self-report. (d) waits until the patient's chart is available. (a) contacts the patient's adult child. The adult-gerontology primary care nurse practitioner conducts a small group class on weight management. The nurse practitioner anticipates that the patient who may have the greatest difficulty implementing the counseling is the: (a) extroverted patient raising his or her grandchildren. (b) introverted patient who does not speak in the group. (c) personable patient who lives with his or her children. (d) worried patient whose son is serving in military conflict. (d) worried patient whose son is serving in military conflict. The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse practitioner's most appropriate approach is to treat the cold symptoms and: (a) advise the patient to stop smoking. (b) prescribe bupropion (Zyban). (c) raise the issue of smoking cessation at the next visit. (d) recommend that the patient select a low nicotine cigarette. (a) advise the patient to stop smoking. The adult-gerontology primary care nurse practitioner plans to provide smoking cessation education at a community center to older adults and their families. The nurse practitioner designs the program based on knowledge that older adult smokers: (a) are likely to be optimistic about their ability to quit. (b) are more likely to be successful at quitting than younger smokers. (c) have a decreased risk of morbidity and mortality than do younger smokers. (d) receive more instruction to quit from health care providers than younger smokers. (b) are more likely to be successful at quitting than younger smokers. An 84-year-old patient arrives at the office for an initial visit. The patient questions the need for colorectal screening, since 10 years have passed since the last colonoscopy. The adult-gerontology primary care nurse practitioner recommends: (a) a colonoscopy. (b) a fecal DNA test. (c) flexible sigmoidoscopy. (d) watchful waiting. (d) watchful waiting. To evaluate for heart failure, which diagnostic test does the adult-gerontology primary care nurse practitioner order for a patient with swelling in the lower extremities? (a) Ankle-brachial index. (b) Brain natriuretic peptide test. (c) D-dimer assay. (d) Spirometry study. (b) Brain natriuretic peptide test. Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which laboratory values does the adult-gerontology primary care nurse practitioner obtain? (a) Liver function studies. (b) Platelet count. (c) Renal function studies. (d) White blood cell count. (a) Liver function studies. A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight, abdominal pain, and a long-term history of multiple sexual partners. The patient's physical examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test confirms active hepatitis B? (a) Antibody. (b) Enzyme-linked immunosorbent assay. (c) Immune globulin G. (d) Surface antigen. (d) Surface antigen. For two to three months, a 78-year-old patient has not been taking levothyroxine (Synthroid) as prescribed. The patient now has symptoms of increasing constipation, lethargy, and weakness. The adult-gerontology primary care nurse practitioner anticipates that laboratory tests will show that the patient's: (a) T4 level decreased, and TSH level increased. (b) T4 level increased, and TSH level decreased. (c) T4 level increased, and TSH level is unchanged. (d) T4 level is unchanged, and TSH level decreased. (a) T4 level decreased, and TSH level increased. A 68-year-old patient has sustained an unintended weight loss of 15 lb (6.8 kg) over the last two months but reports feeling well. The patient's problems include depression, tobacco abuse, obesity, and dyslipidemia. His or her medications are sertralizine (Zoloft), simvastatin (Zocor), and famotidine (Pepcid). The adult-gerontology primary care nurse practitioner performs which THREE actions? (a) Adds a probiotic. (b) Conducts a depression screening. (c) Decreases the dosage of the statin medication. (d) Obtains a chest x-ray. (e) Orders a thyroid-stimulating hormone. (b) Conducts a depression screening. (d) Obtains a chest x-ray. (e) Orders a thyroid-stimulating hormone. Preparing to implement an incontinence reduction program at a nursing home, the adult-gerontology primary care nurse practitioner reviews several studies. Place the studies in sequential order of the strength of evidence for this population from strongest to weakest. (a) A case report of an experimental incontinence reduction program in older adults. (b) A consensus statement from the urologic association regarding the use of scheduled toileting. (c) A systematic review of nonrandomized trials concerning the use of vaginal estrogen. Strongest evidence: (c) a systematic review ...then: (b) a consensus statement Weakest evidence: (a) a case report What factors does the adult-gerontology primary care nurse practitioner need to consider when discussing advanced care planning with a patient? (a) Autonomy and patient safety are rarely competitive considerations. (b) Decisions regarding a health care representative are a family group decision. (c) Family members are not integral components in care planning. (d) Trust and rapport with patients are key to patient satisfaction in decisions for care. (d) Trust and rapport with patients are key to patient satisfaction in decisions for care. The adult-gerontology primary care nurse practitioner working in an urban community health center recognizes that asthma-related health issues commonly result in higher morbidity and mortality for persons with: (a) alcohol dependency. (b) lower socioeconomic status. (c) persistent social isolation. (d) recent immigrant status. (b) lower socioeconomic status. During an annual health visit, a 15-year-old female patient is found to have grown 5 in (12.7 cm) over the past year. She has not reached menarche. Her mother is concerned because the patient's sister reached menarche at age 11 and the mother reached menarche at age 12. Examination reveals that the patient's breasts are enlarged, with the areolae forming a mound above the general contour of each breast, and that the left breast is larger than the right. Axillary hair is absent and the pubic hair is dark, coarse, curly, dense, and similar in pattern to that of an adult female. These findings are consistent with a diagnosis of: (a) hypothyroidism. (b) normal development. (c) polycystic ovary syndrome. (d) Turner syndrome. (b) normal development. A pale, thin 54-year-old male patient reports a two-month history of numbness in his feet. Past medical history includes hypertension and a subtotal gastrectomy. An examination reveals a decreased vibratory sensation and position sense. Blood tests indicate a hematocrit of 27%, mean corpuscular volume of 105 fL, mean corpuscular hemoglobin of 45 pg, and reticulocytes of 1.5%. The diagnosis is: (a) chronic simple anemia. (b) folate deficiency anemia. (c) iron deficiency anemia. (d) vitamin B12 deficiency anemia. (d) vitamin B12 deficiency anemia. Upon referral from a gynecologist, an adult nurse practitioner evaluates an 89-year-old female nursing home resident for vaginal bleeding. The patient has a history of occasional periods of confusion and memory loss. The gynecologist recommended dilation and curettage and the patient consented to the procedure after the gynecologist answered her questions, but the patient's daughter protests. The nurse practitioner's ethical duty is to support the: (a) daughter, because she might file a lawsuit over unsatisfactory care. (b) daughter, because the patient is occasionally confused and incapable of granting informed consent. (c) nursing home administration, which may choose to support either the patient or the daughter. (d) patient, who has given informed consent. (d) patient, who has given informed consent. A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is: (a) amoxicillin (Amoxil). (b) doxycycline (Vibramycin). (c) erythromycin (E-Mycin). (d) trimethoprim-sulfamethoxazole (Bactrim). (c) erythromycin (E-Mycin). A 70-year-old patient reports fatigue and a nonproductive cough with pain on inspiration and expiration. The patient denies a sore throat, fever, nasal congestion, or postnasal drip. Examination reveals a well-developed patient in no acute distress who is afebrile and has respirations of 32 breaths/min. The patient's lungs have diminished breath sounds. The heart rate is 70 beats/min, regular with no murmur. There is no edema of the extremities. An adult nurse practitioner orders: (a) a chest x-ray. (b) a lung perfusion scan. (c) over-the-counter treatments for symptomatic relief. (d) pulmonary function tests. (a) a chest x-ray. An adult nurse practitioner is educating a female patient about her newly diagnosed phobia. The nurse practitioner explains that phobias differ from other anxiety disorders in that phobias: (a) are innate and can be prevented. (b) are related to specific trigger experiences. (c) occur at a later age. (d) often involve depressive symptoms. (b) are related to specific trigger experiences. A 78-year-old male patient comes to the ambulatory care clinic and reports an inability to void. The adult nurse practitioner has difficulty inserting a urinary catheter due to an obstruction. The nurse practitioner's action is to: (a) obtain consent from the patient to perform prostatic massage. (b) perform a suprapubic aspiration to relieve bladder distention. (c) prescribe an oral loop diuretic. (d) refer the patient to a urologist for further treatment. (d) refer the patient to a urologist for further treatment. A patient comes to the clinic with reports of acute pain and loss of vision in the right eye. The adult nurse practitioner informs the patient that these symptoms require: (a) assessment with a split lamp. (b) examination with an otoscope. (c) immediate referral to an ophthalmologist. (d) treatment with several ophthalmologic agents. (c) immediate referral to an ophthalmologist. A 45-year-old patient with diabetes comes to the clinic for an annual appointment. The patient declines a parenteral influenza vaccination because a friend "came down with the flu after receiving the vaccination." The adult nurse practitioner explains that the vaccination is: (a) a polysaccharide, so it may cause a mild case of influenza. (b) activated, so it may cause a mild case of influenza. (c) inactivated, and this is unable to cause influenza. (d) live attenuated, so it may cause a mild case of influenza. (c) inactivated, and this is unable to cause influenza.