FAMILY NURSE PRACTITIONER EXAM |826 QUESTIONS WITH VERIFIED CORRECT ANSWERS

Sensitivity defined as the ability of a test to detect a person who has the disease. Specificity defined as the ability of a test to detect a person who is healthy or to detect the person without the disease. Trauma to Kiesselbachs plexus will result in an anterior nosebleed The diagnostic or gold standard test for sickle cell anemia, G6PD anemia, and alpha or beta thalassemia hemoglobin electrophoresis questions asking for "action" the initial action might be to interview and gather subjective data or the history erythromycin "allergy" vs adverse reaction adverse reactio-symptoms of nausea or GI upset allergy -hives, angioedema acute mononucleosis the patient will most likely be a teen presenting with the classic triad of sore throat, prolonged fatigue, and enlarged cervical nodes. Alpha thalassemia more common among Southeast Asians such as filipinos Lupus present with malar rash(butterfly rash)Pts need to avoid or to minimize sunlight exposure(photosensitivity) treatment for polymyalgic rheumatica(PMR) first line treatment for PMR includes long-term steroids. Long term steroids are commonly used to control symptoms(pain, stiffness on shoulders, and hip girdle). PMR pts have higher risk for temporal arteritis. Gold standard exam for temporal arteritis biopsy of the temporal artery. refer pt to opthalmologist for mgt Finkelstein's test Positive in De Quervains tenosynovitis Anterior Drawer maneuver and Lachman maneuver Positive if anterior cruciate ligament (ACL) of knee damaged. The knee may also be unstable McMurray's sign Positive in meniscus injuries of the knee Damaged Joints order X-ray first, but MRI is the Gold Standard Diabetic retinopathy neovascularization, hard exudates, cotton wool spots, and micoaneurysms Hypertensive retinopathy AV nicking, silver and or copper wire arterioles Checking deep tendon reflexes absent(0), hypoactive (1) normal(2) hyperactive(3) clonus(4) define clonus Clonus is typically seen in patients with stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy. Clonus has also appeared after ingesting potent serotonergic drugs, where ingestion strongly predicts imminent serotonin toxicity (serotonin syndrome). Clonus is a series of involuntary, rhythmic, muscular contractions and relaxations. Clonus is a sign of certain neurological conditions, particularly associated with upper motor neuron lesions involving descending motor pathways, and in many cases is, accompanied by spasticity (another form of hyperexcitability).Unlike small, spontaneous twitches known as fasciculations (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex. A rare but serious adverse effect of ACE inhibitors is angioedema A common side effect of ACE inhibitors is a dry cough(10%) First line drug to treat hypertension in diabetics and patients with mild renal disease because of their renal protective properties ACE inhibitors or ARBS Penicillin amoxicillin(broad-spectrum PCN) Penicillin VK Macrolide erythromycin, azithromycin(Z-Pack), or clarithromycin(Biaxin) Cephalosporins: 1st generation(Keflex), 2nd generation(Cefaclor, Ceftin, Cefzil)3rd generation(Rocephin, Suprax, Omnicef) Quinolones with gram positive coverage levofloxacin(Levaquin), moxifloxacin(Avelox), gatifloxacin(Tequin) Quinolones ciprofloxacin(Cipro), ofloxacin(Floxin) Sulfa trimethoprim/sulfamethazole(Bactrim, Septra), nitrofurantoin(Macrobid), Tetracyclines tetracycline, doxycycline, minocycline(Minocin) NSAID ibuprofen, naproxen(aleve, Anaprox) Cox-2 inhibitors celecoxib (celebrex) Antitussives dextromorphan(Robitussin), benzonate(Tessalon Perles) Drugs allowed for pregnant or lactating women Category B Pregnancy in pain order Tylenol instead of Ibuprofen Avoid nitrofurantoin and sulfa drugs during 3rd trimester increase the risk of hyperbilirubinemia best way method of spreading viruses or bacteria is making them airborne or nebulized treatment of cutaneous anthrax Ciprofloxacin 500mg orally BID for 60 days or 8 weeks. If pt allergic to ciprofloxacin , use doxycycline 100mg BID Good communication rules Ask open ended questions, do not reassure patients, avoid angering the patient, and respect the patients culture. Eriksons Stages of Psychosocial Development Stage 1: Infancy -- Age 0 to 1 Crisis: Trust vs. Mistrust Stage 2: Toddler -- Age 1 to 2 Crisis: Autonomy (Independence) vs. Doubt (or Shame) Stage 3: Early Childhood -- Age 2 to 6 Crisis: Initiative vs. Guilt Stage 4: Elementary and Middle School Years -- Age 6 to 12 Crisis: Competence (aka. "Industry") vs. Inferiority Stage 5: Adolescence -- Age 12 to 18 Crisis: Identity vs. Role Confusion Stage 6: Young Adulthood -- Age 19 to 40 Crisis: Intimacy vs. Isolation Stage 7: Middle Adulthood -- Age 40 to 65 Crisis: Generativity vs. Stagnation Stage 8: Late Adulthood -- Age 65 to death Crisis: Integrity vs. Despair Important primary vs secondary "Will performing this action prevent the disease or the social condition from happening? If it does, then it is considered as primary prevention(if it doesn, then it is secondary) breast self exam and genital self exam considered secondary prevention tertiary prevention involves not only rehabilitation, but also includes actiivities that will help to prevent complications from disease treatment, such as patient education about medication side effects or the proper use of equipment such as cane. Support groups for a disease /condition are all considered as part of a tertiary prevention activity. Primary prevention (prevent y/condition)-youth violence prevention, bullying prevention, presonal safety promotion, disease prevention-immunization, using suncreen, healthy lifestyle promotion, promotion of OSHA lawas-workplace safety, EPA laws-clean water, anipollution laws secondary prevention (Detect tion as Early as Possible) any lab test to screen disease, US preventive Services Task Force-screening rec-mammograms, PSA, PPD, screening for high risk behaviour-suicide, depression, personal action to detect cancer Tertiary prevention (Limiting Further harm and disability) All types of rehabilitation-cardiac, pt/ot, speech therapy , addition/drug rehab, support groups, exercise for an obese person clue cells mature squamous epithelial cells with numerous bacteria noted on the cell borders(bacterial vaginosis) Bacterial Vaginosis has a alkaline pH(vagina normally has an acidic pH of 4.0) BV is the only vaginal condition with the only alkaline pH for the exam. BV is not considered an STD(it is imbalance of vaginal bacteria-sex partner does not need to be treated. The microscopy slide will have very few WBC and large number clue cells. Candida vaginal discharge white in color with a thick and curd like consistency. it frequently causes redness and itching in the vulvovagina due to inflammation microscopy in candidiasis will show a large number of WBC, pseudohyphae, and spores(saghetti and meatballs candida yeast normal flora of gastrointestinal tract and in some womens vaginas trichomonas infection vaginal discharge is copious, bubbly, and green in color. It causes a lot of inflammation resulting in itching and redness of the vulvvagina. It is considered a sexually transmitted infection. The sex partner needs treatment. Gold standard of diagnosis for BV, candida vaginitis, and trichomoniasis for the exam microscopy is the gold standard. treatment for strep throat penicillin VK PO for 10 days. If pt is PCN allergy, macrolides can be used instead. mortality most common cause of death prevalence most common cause of a certain disease in a population torus palatinus is a benign growth of bone(an exostosis) located midline on the hard palate and covered with normal oral skin. It is painless and does not interfere with function. geographic tongue has multiple fissures and irrecgular smoother areas on its surface that makes it look like a topographic map. The paitent may complain of soreness on the tongue after eating or drinking acidic or hot foods leukoplakia is a benign variant. It appears as a slow growing white plaque that has a firm to hard surface that is slightly raised on the tongue or inside the mouth. It is considered a precancerous lesion. It is due to chrnoic irritation of the skin or to precancerous changes on the tongue and inside the cheeks. It causes include poorly fitting dentures, chewing tobacco, and using other types of tobacco. refer for biopsy oral hairy leukoplakia(OHL) of the tongue is a painless white patch that appears corrugated. It is located on the lateral aspects of the tongue and is associated with HIV and AIDS infection. It is caused by Epstein-Barr virus infection of the tongue. It is considered a premalignant lesion. initial workup for ovarian cancer is the intravaginal ultrasound and the CA 125 risk factor for ovarian cancer early menarch or late menarche, nulliparity, endometriosis, PCOS, and family history of ovarian cancer. Women with BRCA 1 and 2 mutations are also at higher risk for both brest and ovarian cancer. Tanner Stages Girls Stage I-Prepubertal pattern Stage II-Breast bud and areola starts to develop Stage III-Breast continues to grow with nipples/areola(one mound/no separation) Stage IV- Nipples and areoola become elevated from the breast (a secondary mound) Stage V-Adult pattern Tanner stage Boys Stage I - Prepubertalpattern StageII-Testeswith scrotum starts to enlarge(scrotal skin starts to get darker/more ruggae) Stage III-Penis grows longer(length) and testes/scrotum continues to become larger Stage IV-Penis become wider and continues growing in length(testes are larger with darker scrotal skin nd more ruggae) Stage V-Adult pattern scabies classic location of the rashes (finger webs, waist, penis) High risk groups are health care givers, or any erson working with large populations such as schools, nursing homes, group homes, or prisons. Spread skin to skin Rash of Scarletina has sandpaper like texture and is accompanied by a sore throat, strawberry tongue, and skin desquamination(peeling) of the palms and soles. It is not pruritic. Impetigo rashes initially appear as papules that develop into bullae that rupture easily, becoming superficial, bright red weeping rashes with honey-colored exudate that becomes crusted as it dries. The rashes are very pruritic and are located on areas that are easily traumatized, such as the face, arms or legs. Insect bites, acne lesions, and varicella lesion scan also become secondarily infected, resulting in impetigo. Cutaneous larva migrans(creepin eruption) rrashes are shaped like red raised wavy lines(serpinginous or snakelike) that are alone of=r few. appears maculopapular larva migrans the areaas of body that are commonly exposed directly to contaminated soil and sand such as soles of the feet, extremities or buttocks. are most common location treatment for larva migrans systemic treatment with either ivermectin once a day for 1-2 days or albendazole for 3 days first line treatment for AOM and sinusitis Amoxicillin 500mg po TID( for 10 days. Second line of abx is Augmentin BID or cefdinir(omnicef)BID S3 heart sounds indication of heart failure. The best place to listen for the S3 heart sound is the pulmonic area(the pulmonic area is near the ventricles). for pulmonary TB a sputum culture is the gold standard. incorrect answers are statements that are judgmental, ressuring to the patient, vague, disrespectful, or do not address the issue of suicide(or homicide) in a direct manner. First line treatment for depression SSRI. Second line tx TCAs. TCAs are also used as prophylactic treatment of migraine headaches, chronic pain, and neuropathic pain such as post herpatic neuralgia. Ex: amitriptyline(elavil), nortriptyline(Pamelor) do not give suicidal pt TCAs because of high risk of hoarding and overdosing. Overdose of TCAs can be fatal(cardiac and CNS toxicity) SSRI SSRI are firrst line treatment for OCD, generalized anxiety discorder, panic disorder, social anxiety disorder(extreme shyness) and premenstrual mood disorder(fluoxetine or Prozac) Examples of SSRI: citalopram(Celexa), ecitalopram(lexapro), fluoxetine(Prozac, sertraline (Zoloft), paroxetine (Paxil) CAGE mnemonic is a creening tool used to screen patients for possible alcohol abuse. Scoring two out of 4 is highly suggestive of alcohol abuse.