AANP FNP CERTIFICATION LATEST () WITH 200 REAL EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) GRADED A

AANP FNP CERTIFICATION LATEST () WITH 200 REAL EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) GRADED A 3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - ANSWER- Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - ANSWER- Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - ANSWER- Mini mental exam 4 month old with strabismus, mom is worried...... - ANSWER- tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - ANSWER- Growth chart 6 month old closed anterior fontanel. - ANSWER- XRAY Abnormal cells on PAP, what do you do next? - ANSWER- Refer for Colposcopy CAGE ACRONYM - ANSWER- Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia - ANSWER- Fever Anemia Hypotensio n Cranial nerves responsible for extraocular eye movements - ANSWERCN 3,4,6 Definition of metabolic syndrome - ANSWER- cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - ANSWER- wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - ANSWER- Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - ANSWER- Anterior septum Definitive diagnosis of acute bacterial prostatitis - ANSWER- urinalysis and culture GERD treatment - ANSWER- H2 is first line, give hs Grade 3 cells on Pap, treatment? - ANSWER- LEEP excision Fingernail hematoma treatment? - ANSWER- drill hole and drain blood? Increased risk of ectopic pregnancy - ANSWER- Salpingitis, or history of abortion, PID, Koplick spots - ANSWER- Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots - ANSWER- Measles (rubeola). Grains of salt lesions inside mouth in Measles Legg-Calve-Perthes Disease - ANSWER- Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - ANSWER- Pancreatitis Low HGB, Low HCT, High MCV indicates what? - ANSWERMacrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - ANSWER- Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - ANSWER- Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - ANSWER- Meniscus tears Lachman's Test - ANSWER- pivot shift test (ACL tear) Newborn with foot turned in, what do you do? - ANSWER- refer to orthopedist Osgood-Schlatter disease - ANSWER- Knee pain. inflammation or irritation of the tibia at its point of attachment with the patellar tendon Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? - ANSWER- Alzheimer's Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - ANSWER- Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - ANSWER- Tinea Corporis Pt presents with "bag of worms:, indicates? - ANSWER- Varicocele Pt with atopic dermatitis, look for what other diseases? - ANSWERAsthma Pt with bleeding after menopause - ANSWER- endometrial biopsy, need to screen for cancer Pt with hx of PID, increased rick for? - ANSWER- Infertility Pt with HIV took high potency anti viral treatments and CD4 is 400, what does this indicate? - ANSWER- This is good. Want higher than 350 Pt with hx of htn and stroke, now having memory loss. What does this indicate? - ANSWER- Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - ANSWER- slap cheek, PVB19, rash hands / feet Fetal death and birth defects -High fever, pink flat or raised rash Quick assessment of patients fall risk? Timed Get up and Go - ANSWER- Timed Get up and Go Red beefy tongue? - ANSWER- pernicious anemia Rotator cuff injury presentation - ANSWER- disturbs sleep, arm weakness, dull ache Shingles near eye - ANSWER- immediate referral to ophthalmology Signs and symptoms of Roseola (6ths disease) ? - ANSWER- Viral infection Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage -Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash -Seizures may occur during this period. -On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs. Treatment for chronic alcoholism: - ANSWER- 12 step program Treatment for Gonorrhea? - ANSWER- Rocephin 250mg IMx1 plus Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Report to health department Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - ANSWER- IUD Basal cell cancer - ANSWER- Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - ANSWER- Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - ANSWER- Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area -a pre squamous cell carcinoma occurs on sun-damaged skin biopsy cryo or 5fu cream subungual hematoma tx - ANSWER- Make a hole and drain the blood Moderate acne treatment - ANSWER- Without inflammation: Topical retinoid Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered) PLUS ADD Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne) Minocycline- long term use has been linked with pseudotumor cerebri Oral contraceptives for hormone related Spironolactone heart murmur with holosystolic or pan systolic Heart mumur with mid systolic - ANSWER- MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH Coarctation of Aorta - ANSWER- COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs. -congenital cardiac condition characterized by a narrowing of the aorta - Murmur Grade III - VI - ANSWER- Loud murmur easily heard JVD caused by - ANSWER- -tension pneumothorax, -Rt. sided heart failure, -cardiac tamponade, -traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - ANSWER- endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles. Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - ANSWER- PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment - ANSWER- Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - ANSWER- 5 mm in an immunocompromised patient or close contact 10 mm in immigrant, health care workers, drug user 15 mm in a patient who lives in an area where TB is very rare. what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - ANSWER- Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) - ANSWER- HTN retinopathy intraocular pressure (IOP) - ANSWER- Fluid pressure inside the eye; measured with tonometry Rovsing sign - ANSWER- pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - ANSWER- Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma - ANSWER- SDH migraine headache - ANSWER- -paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4-12 hours, abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate Vitamin B12 - ANSWER- Folate shares a close relationship with this other B Vitamin. Vitamin B12 - ANSWER- Cognitive deficits, glossitis, pernicious anemia, Folate shares a close relationship with this other B Vitamin. 88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. - ANSWER- be changed to NSAID, SED rate is a sign of inflammation Which medication causes low sperm count for a patient - ANSWERSSRI grandiosity - ANSWER- Exaggerated belief in or claims about one's importance or identity. Bipolor ADHD - ANSWER- A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity. pt. pap's smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? - ANSWER- HPV test if not done. Refer for colposcopy Chlamydia trachomatis - ANSWER- Doxycycline (+ ceftriaxone for gonorrhea coinfection) Genital warts treatment - ANSWER- Cryotherapy OR Podophyllotoxin cream - OR Imiquimod (Aldara cream) HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. - ANSWER- tell the pt. that he is qualified to be diagnosed with AIDS according to CDC Most common cause of death in children - ANSWER- motor vehicle Tanner 2 - ANSWER- Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 - ANSWER- Tanner 4- female nipples and areola become elevated from breast, secondary mound Male penis grows wider grows in length, darker scrotum dementia history of stroke, HTN, What type of Alzheimer. - ANSWER- vascular pt. expericieng memory loss, and increase in confusion and she has a presbycusis - ANSWER- a gradual loss of sensorineural hearing that occurs as the body ages a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - ANSWERUltrasound Romberg test - ANSWER- cerebellar -ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds Direct Coombs test - ANSWER- r/o bilirubin preeclampsia treatment - ANSWER- bed rest, laying on her side Molluscum contagiosum treatment - ANSWER- Currettage, liquid nitrogen pyloric stenosis - ANSWER- non bilious vomiting, olive like firm mass palpated on right upper quadrant horizontal nystagmus that stops when eye is close to midline in a college student - ANSWER- Ménière's disease ? Nystagmus test - ANSWER- the involuntary jerking of the eyes as a person gazes to the side eating, painful lump noted on the jaw that comes and go. - ANSWERsialolithiasis). Endometriosis Pelvic inflammatory disease Etopic Pregnancy: Risk Factors - ANSWER- Previous ectopic pregnancy Prior fallopian tube surgery Previous pelvic or abdominal surgery Certain sexually transmitted infections (STIs) Which among the list can cause increase in respiration - ANSWEROptions include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration - ANSWERhypercapnia Osteoporosis Risk Factors (ACCESS) - ANSWER- A-lcohol Use C-orticosteroid Use C-alcium low E-strogen low S-moking S-edentary lifestyle/s ACCESS leads to OSTEOPOROSIS to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct - ANSWER- VITAMIN D 600-800, CALCIUM . age older than 35 years history of infertility use of assisted reproductive technology, such as in vitro fertilization (IVF) cigarette smoking peppermint, fatty, spicy, citrus foods, hormones, obesity, , smoking, theophylline pregnancy chocolate CCB, BB anticholi Common causes of GERD - ANSWER- risk factorsOSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION. LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH Carotid bruit - ANSWER- abnormal flow of blood through the carotid artery Carotid bruit - ANSWER- abnormal flow of blood through the carotid artery due to atherosclerotic disease Common causes of GERD - ANSWER- risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil alcohol, nergic, Zeprexa. What lab and intervention to put in place - ANSWERCAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose medial aspect of a joint in an attempt to create a gap in the lateral joint Varus Stress Test - ANSWER- application of a lateral force to the Weber test - ANSWER- Sensorineural loss Weber test(top of head) no laterization, normal finding, does not lateralize to either ear, bilateral hearing loss, if hear better in left ear, right sensorineural loss Weber test - ANSWER- Sensorineural loss Weber test (top of head) no laterization- normal, does not lateralize to either ear- bilateral hearing loss, if hear better in left ear, right sensorineural loss. SUN- sensorial lateralize unaffected ear CAFFE- Conductive lateralize to affected ear Assessment on patient with ascites - ANSWER- Dullness Assessment on patient with ascites - ANSWER- Dullness to percussion line, thereby testing the stability of the lateral aspect of the joint LCL Varus Stress Test - ANSWER- TEST LCL (lateral-vaRus) McMurrays- Meniscus CLICK application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL German Measles (Rubella) - ANSWER- Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots. patient with IOP of 32mmHg, what do you expect during fundoscopic exam - ANSWERpatient with IOP of 32mmHg, what do you expect during fundoscopic exam - ANSWER- increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence - ANSWER- anticholinergics/oxybutynin, impamine/tricyclic/antidepressant Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH BPH and urge incontinence - ANSWER- TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - ANSWER- a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - ANSWER- telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS intussusception - ANSWER- telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS CURRENT JELLY STOOL IBS (irritable bowel syndrome) - ANSWER- An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. due to Small intestinal bacterial overgrowth, or SIBO IBS (irritable bowel syndrome) - ANSWER- SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool. Caused by: Small intestinal bacterial overgrowth, or SIBO TX fiber, avoid gas foods, antispasmodics, decrease life stress Osteoporosis treatment - ANSWER- TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth Statins increase bone mineral density Osteoporosis treatment - ANSWER- TX BIOPHOSPHATES alendronate, Fosamax, CALCIUM 500 mg, vitamin D food and supplementation, testosterone, WT BEARING EXERCISE CAUCASIAN and ASIAN affected most RISK PPI, STATIN, STEROIDS, THYROID, Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth BONE DENSITY 2.5 Retinoblastoma - ANSWER- white reflection in child's pupil for staph aureus infection (skin) with pus - ANSWER- MRSA- TX Bactrim or tetracyclines? hyperparathyroidism - ANSWER- high calcium Hyperthyroidism treatment - ANSWER- methimazole, PTUpropylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers Mammography Screening - ANSWER- -Age 45 - 54 yearly mammogram -55 and older every 2 years Fifth's Disease (Erythema Infectiosum) - ANSWER- B19: lytic infection, respiratory transmission Sx: flushed rash/fever in kids Px: fever, get better in a week pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - ANSWER- TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. of treatment (PREGO). EXAM Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion chlamydia in pregnancy - ANSWER- Azithromycin 1 gm PO x1 or ON EXAM EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) papilledema - ANSWER- optic disc swollen w/ blurred edges due to increased ICP EXAM Allergic Conjunctivitis - ANSWER- "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD - ANSWER- COPD- Gold 1-2- SABA or SAMA ON COPD long term is OXYGEN CN IX Glossopharyngeal - ANSWER- - Shoulder shrug/ ROMBERG test EXAM CN V Trigeminal - ANSWER- Herpes. CORNEAL ABRASION. EXAM actinic keratoses - ANSWER- Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM CN VIII Vestibulocochlear - ANSWER- ears 8 EXAM CN VII Facial - ANSWER- BELLS EXAM ACEI contraindicated - ANSWER- pregnancy Safe to give varicella/MMR - ANSWER- Do not give 12 mo. EXAM QUESTION Acne Vulgaris - ANSWER- common acne. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide. Acne Rosacea - ANSWER- - chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM Cataracts - ANSWER- is on EXAM in elderly night vision issues. Opaque Kawasaki disease - ANSWER- - acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM Erythema migrans - ANSWER- Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi Symmetrical involvement. Longer stiffness than OA. Joint space rheumatoid arthritis - ANSWER- Early morning stiffness, sausage via ELISA, confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM Rocky Mountain Spotted Fever - ANSWER- Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline. EXAM joints. narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has BOUCHARDS, SWAN NECK IS DESCRIPTION ON EXAM Osteoarthritis - ANSWER- Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen. EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike. EXAM Osteoporosis - ANSWER- OSTEOPOROSIS = WEIGHT BEARINGwalking, lifting weights etc. bones are forced against gravity. EXAM Fibromyalgia polymyalgia - ANSWER- Fibro- 11/18 points. Widespread pain for at least three months. EXAM. polymyalgia Tx prednisone 12 months. Must taper off. RISK for Temporal arteritis, DX BX, elevated ESR Addison's - ANSWER- Addison's- deficient in cortisol (think low sodium, blood sugar, but Increase K. You must give cortisol. (Diagnosis Plasma Cortisol 5 mcg/dl @ 0800.) EXAM Serotonin syndrome - ANSWER- Acute Serotonin Syndrome- Dilated pupils, high fever, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening. EXAM Fundal Height - ANSWER- Fundal Height 12 weeks above symphysis pubis. EXAM TOPICS Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US. Psoriasis - ANSWER- Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds. (Koebner phenomenon- new psoriatic plaques form over skin trauma) (Auspitz sign- pinpoint bleeding when plaques are removed). TREATMENT: Topical steroids, Tar preps (mild). For (severe) do antiTNF, or immunologic. D Dacrocystitis - ANSWER- Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents. Acne Rosacea - ANSWER- Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM Parathyroid hormone - ANSWER- PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM Diabetic Retinopathy - ANSWER- Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED HTN Retinopathy - ANSWER- Hypertensive RetinopathyCopper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM Wilms Tumor - ANSWER- Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM Primary Amenorrhea - ANSWER- Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics. Aphthous stomatitis - ANSWER- Cancer sores. Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash. Temporal arteritis - ANSWER- Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids. Atopic Dermatitis (eczema) - ANSWER- Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. "small vesicles that rupture leaving painful, bright-red, weepy lesions" they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM demarcated, cheeks, shins. Erysipelas - ANSWER- Group A strep, painful, Upper dermis, clear Tinea Corporis - ANSWER- ring like itchy rash, slowly enlarge central clearing"-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending Cellulitis - ANSWER- Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS. TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d. MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim. Varicella Zoster - ANSWER- "contagious 48 h. before, until all lesions crusted over" low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. "initially on trunk, then scalp and face" TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM Impetigo - ANSWER- Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM Scarlet fever- scarlantina - ANSWER- "sandpaper textured-pink rash with sore throat" strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM Lichen planus - ANSWER- LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM Spider bite - ANSWER- fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam Pityoris rosea - ANSWER- Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM Corneal abrasion - ANSWER- Corneal Abrasions- Round/Irregular. Was on EXAM. Acute Angle Closure Glaucoma - ANSWER- acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM Conductive - ANSWER- Conductive: Lateralization to bad ear. RinneBC AC. Rinne (1st mastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAM Koplik spots - ANSWER- Koplik Spots- "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM OE - ANSWER- Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing Sensorineural - ANSWER- Sensorineural: Lateralization to good ear. Rinne- AC BC. OME - ANSWER- Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC AC. PRECEDES OR USUALLY FOLLOWS AOM. SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM Sinusitis - ANSWER- TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE Meiniers disease - ANSWER- VERTIGO TINNITUS, HEARING LOSS. nystagmas Mono - ANSWER- test heterophile antibody test. ON EXAM MR. ASS - ANSWER- (Systolic Murmur) Only systolic murmurs will radiate to a location on the exam. Mitral Regurg - ANSWER- (Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL. first. AGING ADULT EXAM Involves the inner ear. Symmetrical progressive. Human speech lost Presbycusis - ANSWER- sensorineural loss without lateralization. Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb. All diastolic murmurs are pathological. Grades Murmurs - ANSWER- Ibarely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM MVP - ANSWER- MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC. S3- HF, S4-LVH stiffening, - ANSWER- S3- HF, Kentucky, early diastole. Abn 35. Bell EXAM S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop" EXAM Isolated Systolic HTN - ANSWER- CCB CVI - ANSWER- CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM blood pressure - ANSWER- BP - ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is 120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM. PAD/ PVD - ANSWER- PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM Thiazide diuretics - ANSWER- no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM Statin - ANSWER- Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM Pulses paradoxus - ANSWER- Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM Emphysema - ANSWER- Emphysema Lungs- PercussionHYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM Acute Bacterial Pneumonia- CXR - ANSWER- middle lobe. ON EXAM OSA - ANSWER- does not include Microglossia which is an absent tongue congenital. EXAM TB - ANSWER- fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three "consecutive days". TB is usually upper lobes. TPO - ANSWER- TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM hyperthyroid - ANSWER- Hyperthyroid- Low TSH, high "FREE" T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then. A1C 9 - ANSWER- If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM Parathyroid - ANSWER- For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM cushings - ANSWER- Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must draw cortisol levels in the morning. Fructosamine test - ANSWER- checks sugar for past 2-4 weeks. triglycerides - ANSWER- causes pancreatitis 500. If 500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM Pancreatitis - ANSWER- diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback "boring" epigastric pain. Fever, n/v. EXAM TOPICS Polycythemia vera - ANSWER- slow growing blood cancer. blood too thick, clots. bone marrow to many RBC. risk bleed , anemia, CBC CCB - ANSWER- BLE edema- walk around Kava Kava - ANSWER- anxiety and insomnia, don't mix w sedating benzos. Bipolar med - ANSWER- lithium- monitor TSH, toxicity bind to TH cause hypothyroidism. Depression med acute Anxiety/ panic med GAD med - ANSWER- depression SSRI panic benzo, Xanax, ativan GAD SSRI SNRI- Buspar, Effexor, Cymbalta- Taper OFF SNRI/ Benzo Discontinuation - ANSWER- Buspar, Effexor, Cymbalta and Benzo Taper OFF Metformin - ANSWER- Metformin - monitor BUN, Creatinine. contraindicated renal and liver disease ARF creatinine up and GFR down. affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea flatulence CT: hold 24 hr before and 48hr after Thiazide GLUT- - ANSWER- Glyceridemia Lipidemia Uricacidemia Triglyceridemia HYPO-Kalemia ACE/ARB contraindications - ANSWER- pregnancy Renal failure Renal Stenosis METABOLIC SYNDROME - ANSWER- METABOLIC SYNDROME NO THIAZIDES,CCB (HF) NO TZD ACTOS (Pioglitazone) GIVE Metformin, ACE or ARB- kidney protective, BB- causes hypoglycemia, Triglyceride 300 what do we do first? Triglyceride in 300 plus risk for what do we do? - ANSWERLifestyle modification Pancreatitis, Niacin then add, fenofibrates Serotonin syndrome ss - ANSWER- hyper rigidity, fever, myoclonus, dilated pupils, AMS, hyper reflexes, from SSRI or mix w MAOI and TCA NSAID contraindicated in - ANSWER- HF and ARF increase BP impair renal prostaglandin and sodium retention strabismus - ANSWER- misalignment of eyes, abnormal after 6 months macular degeneration - ANSWER- loss of central vision retinal detachment - ANSWER- floaters, curtain, flashes Xanthelasmas - ANSWER- sharply demarcated yellowish deposit of cholesterol underneath the eye Red reflex absent - ANSWER- retinoblastoma (leukorrhea) , cataracts, glaucoma. Will have white reflex Mono, return to play and Dx - ANSWER- 4-6 weeks when spleenolmegaly resolves Mono spot/ Heterophile Viral stomatitis - ANSWER- ulcer on cheek (Aphthous)- viral canker sore cholesteatoma - ANSWER- chronic sinusitis or OM. cauliflower, foulsmell, hearing loss. erodes bones in face affects facial CN 7. Benign- risk hearing loss refer SURGERY Acute Closed Angle Glaucoma Vs Open Angle - ANSWER- Acute: Sudden pain, halos, cupping, dilated, cloudy , IOP, HA, refer ED Open (primary) : CN 2, gradual loss peripheral vision first Papilledema - ANSWER- Swollen, optic disc, increase cup to disc ratio, HA, ICP, HTN, Herpetic keratitis - ANSWER- ocular herpes - blurr vision, Acyclovir (cheapest) - ANSWER- 200mg 5 x day Pt on PPI, has osteoporosis has a cough, - ANSWER- refer for EGD r/o Barrett's. allergic rhinitis - ANSWER- blue pale turbinate clear drainage. Tx inhaled corticosteroids Sialolithiaisis - ANSWER- painful lump, calculi or salivary stones. sub mandibular gland whartons; duct. Roseola infantum- Sixth disease - ANSWER- viral, young children, high Fever 3-4 days followed by maculopapular rash inflammation of eye; gritty feeling, conjunctivitis, sharp pain, and photophobia- AVOID SUN REFER OPTHO Tx acyclovir Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection? - ANSWER- CD4 count and viral load A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate intervention to aid in the diagnosis of this case? - ANSWER- Ultrasound hordeolum Vs chalazion blepharitis - ANSWER- hordeolum: painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin. chalazion does not hurt Blepharitis always unilateral, Tx baby shampoo warm compress A 3-year-old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? - ANSWERSputum culture Which of the following best describes psoriatic lesions in an elderly patient? - ANSWER- Red, sharply defined plaques with silvery scales A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient? - ANSWER- Sweating Which of the following is the leading cause of cancer-related deaths in the majority of women? - ANSWER- Lung cancer Which of the following findings is typically a sign of acute appendicitis? - ANSWER- Rebound tenderness at McBurney's point A patient with macular degeneration has difficulty seeing objects: - ANSWER- In the center of the visual field. To assess a patient's ability to think abstractly, a nurse practitioner could An 88-year-old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? - ANSWER- Folstein Mini-Mental State Examination ask the patient: - ANSWER- the meaning of a common proverb. During an employment physical examination of a 21-year-old female, bruising around the areolae on the breasts is noted. An appropriate health history for these findings should include all of the following EXCEPT: - ANSWER- socioeconomic status. The best laboratory test to distinguish iron deficiency anemia from other anemias is: - ANSWER- serum ferritin level. A 17-year-old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the most appropriate diagnostic tests to order would be: - ANSWER- follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH). Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: - ANSWER- whether a patient has reversible airway obstruction. An 88-year-old patient presents with right-sided weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with a hypertension medication regimen. What is the most likely diagnosis? - ANSWER- Left-sided stroke 29-year-old male with noncomplicated Chlamydia infection may exhibit: - ANSWER- no remarkable clinical symptoms. To assess spinal function at the S1 level, which deep tendon reflex should be tested? - ANSWER- Achilles around the shoulder. An 18-year-old college student presents for an athletic physical. When asked about current medications, she mentions that she takes "some herb" she bought at a health food store for migraines and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? - ANSWER- Feverfew Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? - ANSWER- Urinalysis and urine culture A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? - ANSWER- Palpate structures Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? - ANSWER- Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, An 88-year-old patient has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: - ANSWER- lateralize to the left. and many white blood cells murmur. regurgitation include: - ANSWER- Loud, high-pitched pansystolic Assessment findings that would support a diagnosis of mitral Which of the following gastrointestinal changes is associated with normal aging? - ANSWER- Decreased production of gastric acid Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? - ANSWER- Pain worse in supine position; focal neurological signs Which of the following is NOT an indication of preeclampsia? - ANSWER- Glucosuria Which of the following laboratory tests should a nurse practitioner order when the suspected diagnosis is temporal arteritis? - ANSWERErythrocyte sedimentation rate (ESR) According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a value equal to or greater than: - ANSWER- 126 mg/dL. An 85-year-old patient relates that on the way to an annual physical examination, the patient suffered a sudden loss of vision in the right eye characterized by "a bunch of lights" and a feeling that "a curtain came down." The most likely diagnosis is: - ANSWER- Retinal detachment. A 32-year-old patient reports a 6-month history of intermittent symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? - ANSWER- Rheumatoid arthritis A 38-year-old male experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Examination reveals cough. A stat chest X-ray is normal. Which of the following tests should the nurse practitioner perform next? - ANSWER- Helical CT pulmonary A 65-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical examination, there is pain on ROM, with no weakness noted. Laboratory studies show a low hemoglobin and an elevated sedimentation rate. Which of the following is the most likely diagnosis? - ANSWER- Polymyalgia rheumatica A 20-year-old male presents with a 1-month history of a "bump on my testicle." He reports being sexually active, with frequent episodes of unprotected intercourse with multiple partners. Which condition should be suspected? - ANSWER- Cancer of the testicles A nurse practitioner is evaluating a 40-year-old patient suspected of having a pulmonary embolus. The patient complains of anxiety and angiography diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: - ANSWER- testicular torsion. A 10-month-old presents with a rash, runny nose, and cough. Examination reveals a cluster of tiny white papules with an erythematous base on the buccal mucosa. What does this suggest? - ANSWER- Measles A 72-year-old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3:00 A.M., is reluctant to go out although she has family members living nearby, and feels a continual urge to sleep. She cannot discuss her late husband practitioner's diagnosis should be: - ANSWER- heart failure. reveals cardiomegaly with vascular redistribution. The nurse without crying. Differential diagnoses would include: - ANSWERdepression, unresolved grief, and hypothyroidism. Trigeminal neuralgia manifests itself primarily with: - ANSWERelectric-shock-like unilateral facial pain. A 65-year-old male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical examination, the patient is tachycardic, positive for jugular venous distention, and positive for S3, with a systolic murmur. Chest X-ray Which of the following criteria differentiates a TIA from a stroke? - ANSWER- Absence of residual symptoms A 66-year-old patient presents with bilateral otitis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 × 4. The patient should be evaluated for: - ANSWER- HIV infection. A 14-year-old patient who fell on an outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on X-ray. The most likely working diagnosis is: - ANSWERradial head fracture. A 2-month-old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (non-beet-red) macular rash in the diaper area, sparing the inguinal folds. No satellite lesions are noted. The infant's diaper rash is most likely caused by: - ANSWER- contact dermatitis. A 17-year-old female has never had her menses. She is at Tanner stage III of sexual development. Her physical examination is completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? - ANSWER- Primary amenorrhea A 47-year-old patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. The patient does not currently take any medications. The most likely differential diagnoses would include: - ANSWER- gastritis and peptic ulcer disease. A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T = 100°F (37.8°C). The patient does not appear toxic and can tolerate fluids. An appropriate plan should include: - ANSWER- clear liquids and oral antibiotics. Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? - ANSWERGentamicin ophthalmic (Genoptic) The most common bacteria responsible for pneumonia in older adults residing in the community is: - ANSWER- Streptococcus pneumoniae. A 70-year-old male presents with paresthesia of the lower extremities. On examination, the patient appears pale and shows a decreased vibratory sense. Laboratory tests reveal elevated indirect bilirubin; Hct = 30%; mean corpuscular volume (MCV) = 120 µm3 [normal = 87-103 µm3]. The most likely diagnosis is: - ANSWER- pernicious anemia. - ANSWER- doxycycline (Doryx). severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: Which class of antihypertensive agents has been associated with acute renal failure and is contraindicated in patients with bilateral renal artery A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate? - ANSWER- Providing reassurance The parent of a 13-year-old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The nurse practitioner should advise the parent that the development of fever may: - ANSWER- lower the seizure threshold. stenosis? - ANSWER- Angiotensin-converting enzyme (ACE) inhibitors After a 3-week camping trip, an 11-year-old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: - ANSWERoxygen. A common rule to follow when prescribing many medications for the elderly is to: - ANSWER- start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: - ANSWERreevaluate the patient in 10 days. membrane; T = 103°F (39.4°C). Assessment also reveals a grade II/VI An 18-month-old child presents with a bulging, immobile tympanic hydrocortisone suppositories. The management of choice for polymyalgia rheumatica includes: - ANSWER- prednisone. A 40-year-old male presents with a 2-week history of rectal pain and itching. He reports a past history of constipation and finding spots of bright red blood on toilet paper several times a week. Rectal examination reveals a tender, swollen, bluish, ovoid mass. The stool guaiac test is negative. Which of the following actions should the nurse practitioner take? - ANSWER- Prescribe bulk-forming agents and An 18-year-old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? - ANSWER- Amoxicillin-Clavulanate (Augmentin) Which of the following would be an appropriate alternative to erythromycin therapy in an 18-year-old patient with Mycoplasma pneumoniae infection? - ANSWER- Azithromycin (Zithromax) Initial therapy for a 3-week-old infant with uncomplicated symptoms of gastroesophageal reflux disease includes which of the following positions and change in diet? - ANSWER- Smaller, more frequent feedings while holding infant A routine laboratory assessment of a 12-year-old patient with a family history of thalassemia and anemia reveals Tanner stage II presentation the following areas EXCEPT the: - ANSWER- scalp. patient. The use of lidocaine with epinephrine is contraindicated in all of A nurse practitioner is suturing a simple laceration on an 11-year-old patient to digoxin toxicity. insulin split-dosing presents with complaints of early morning rise in A patient with type 1 diabetes mellitus who is on NPH and regular A 67-year-old patient with type 2 diabetes mellitus, congestive heart failure (CHF), and mild coronary artery disease is currently taking digoxin, 0.25 mg daily; hydrochlorothiazide, 25 mg daily; metformin, 500 mg daily; glipizide, 10 mg daily; and atorvastatin (Lipitor), 20 mg h.s. Which of the following is an accurate statement regarding this regimen? - ANSWER- The hydrochlorothiazide will predispose the A nurse practitioner orders pulmonary rehabilitation for a 75-year-old with COPD. Expected outcomes of this program include all of the following EXCEPT: - ANSWER- increased lung capacity. fingerstick blood glucose. A review of an at-home glucose test reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: - ANSWERthe Somogyi effect. and Hct = 35%. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? - ANSWERHemoglobin electrophoresis A 15-year-old patient returns for contraceptive services 2 weeks after a diagnosis of trichomonas vaginitis and treatment with 2 g of metronidazole (Flagyl). She reports that discharge and itching are gone, but she is urinating frequently, accompanied with a lot of burning. The examination results would be expected? - ANSWER- Right lower lobe crackles right pleuritic chest pain, and green sputum. Which of the following expectorants. He returns to the clinic with a fever of 103°F (39.4°C), A 14-year-old male with bronchitis is being treated with fluids and services agency. patient has not resumed sexual activity and has menstruated since her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which diagnostic test should be performed immediately? - ANSWER- Microscopic examination of urine During development of a treatment plan for an 84-year-old patient with hypothyroidism, the nurse practitioner must keep in mind the possibility of the worsening of: - ANSWER- osteoporosis. A 4-year-old girl with a history of recurrent urinary tract infections returns for follow-up after diagnosis of the most recent infection. During the physical examination, the 4-year-old tells the nurse practitioner that her brother (age 9) lies on top of her and rubs his penis near her pubic area. After completing the physical examination, the nurse practitioner must: - ANSWER- report suspicions to the appropriate child protective A 2-year-old child is diagnosed with radial head subluxation ("nursemaid's elbow"). After closed manipulation, the best indication of successful treatment is that: - ANSWER- the child quickly begins to use the affected arm. Which of the following is the most serious outcome of Barrett's esophagus? - ANSWER- Esophageal adenocarcinoma A 50-year-old male presents with a chief complaint of malaise. Further questioning reveals that his primary concern is delayed ejaculation. He is currently taking the following medications: atenolol (Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and hydrochlorothiazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be: - ANSWER- paroxetine (Paxil). The follow-up examination of a 12-month-old treated 2 weeks ago for bilateral otitis media reveals a normal left tympanic membrane and a right tympanic membrane with visible serous fluid levels and decreased mobility. An appropriate plan should include a: - ANSWER- follow-up evaluation of the ears in 2 months. A 68-year-old female presents with a new onset of left-sided throbbing headache. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. Sedimentation rate is elevated, but all other laboratory values are within normal limits. The headache is most likely due to: - ANSWER- Your answer: temporal arteritis. A 39-year-old patient was diagnosed with acute bronchitis in the emergency department and treated with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a smoking habit of 1 pack per day. The patient now presents to a nurse practitioner's office with a fever of 101.2°F (39.4°C) and a cough productive of thick, yellow-green, foul-smelling sputum. The nurse practitioner should encourage smoking cessation and prescribe: - ANSWER- Your answer: a macrolide antibiotic.