Practice Questions

Question 1

A 66yr old comes to clinic for severe SOB, fever, & a persistent, productive cough. The patient has type 2 DM, & HPLD. CXR revelas lung infiltrates. BCx + for strep pneumoniae. Which of the following drugs should be used to treat the condition? a. clarithromycin b. azithromycin c. moxifloxacin d. doxycycline

Answer 1

C * - give FQ to pts >60yr & comorbidities If <60yr & no comorbidities macrolides

Question 2

A 36yr old presents with c/o moderate SOB & a “chronic, phlegmy” cough. PE reveals a normal AP chest diameter & normal percussion. Which of the following CXR findings is most consistent with the patient’s condition? a. lung infiltrates b. hyperinflated lungs c. pleural effusion d. air pockets

Answer 2

B. Dx consistent w/chronic bronchitis. CXR that shows hyperinflated lungs would confirm dx. Air pockets indicative of PTX.

Question 3

Your 24 yr old pt has been in SICU x 3 days. Today his total Ca level = 2.6 mmol/dL & serum osmo of 282. Additionally, you note broad T waves w/prominent U waves. Based on your suspicion, which of the following is most appropriate to order? a. acetazolamide b. loop diuretic w/ 3% NS c. K replacement d Ca gluconate

Answer 3

C. ECG findings of hypokalemia

Question 4

Patient presents w/RLQ pain, 1-2 episodes of vomiting and + Psoas sign. What dx is confirmatory for appendicitis? a. ABD US & WBC 10-20 b. CT abd & elevated amylase c. abd US & elevated amylase d. CT abd & elevated amylase & lipase

Answer 4

A** key is elevated WBC, CT can also dx

Question 5

Most critical symptom for diagnosing peritonitis/bowel perforation? a. guarding b. rigidity c. distension d. rebound tenderness

Answer 5

B.

Question 6

31yr old w/blowing murmur occurring during S1 and galloping additiona heart sound. Murmur is heard best at base of heart. What is the murmur?

Answer 6

-mitral regurg

Question 7

Which of the following lipid panels shows 3 out of 4 abnormal values? a. TC 205, LDL 150, HDL 30, TG 300 b. TC 150, LDL 99, HDL 35, TG 145 c. TC 180, LDL 136, HDL 25, TG 160 d. TC 102, LDL 50, HDL 60, TG 102

Answer 7

c

Question 8

What grade murmur do you first hear a thrill?

Answer 8

IV

Question 9

On PE, you note a moderately loud murmur with no thrill. What grade is this?

Answer 9

III

Question 10

Patient has low diastolic rumble murmur in the left lateral position with no radiation. What murmur is this?

Answer 10

mitral stenosis

Question 11

Patient presents with suspected mitral regurgitation. What finding would confirm this?

Answer 11

S3

Question 12

Patient presents with suspected mitral regurgitation. What finding would confirm this?

Answer 12

-differentiate between ischemia & infarction

Question 13

Patient presents w/ 14hrs of CP to ED. What is the best course of action?

Answer 13

-take to cath lab (outside 6hr fibrinolytic window)

Question 14

62 year old M presents w/angina after his daily walk. Lipid panel reveals LDL 250, HDL 25, chol 350 & TG 250. As the ACNP, you prescribe niacin. How would you explain the MOA to the patient?

Answer 14

niacin lowers LDL and increases HDL

Question 15

What abx do you use of UC?

Answer 15

-IV Cipro & Flagyl * no abx necessary without signs of systemic toxicity

Question 16

What causes GI Bleed in elderly?

Answer 16

-thin gastric membranes

Question 17

What is the number one cause of death in dementia patients?

Answer 17

-PNA (aspiration)

Question 18

CN that are both mother & sensory?

Answer 18

-V -trigeminal -VII-facial -IX-glossopharyngeal -X-vagus

Question 19

CN associated with mastication?

Answer 19

V-trigeminal

Question 20

What CSF values are characteristics are bacterial meningitis?

Answer 20

inc opening pressure inc protein dec glucose inc WBC

Question 21

Your patient is 3 days post appendectomy and develops dysphagia, drooling and expiratory stridor. What is likely dx?

Answer 21

Epiglottitis

Question 22

Your patient is 79M Japanese immigrant. What TB induration measurement is diagnostic? a. 3mm b. 7mm c. 11mm

Answer 22

c

Question 23

Your asthmatic patient is on a SABA & ICS. She has no secretions but her sxs are still not well controlled. What do you order next? a. ipratropium bromide b. montekulast c. salmeterol d. metaproteronol

Answer 23

C. add LABA

Question 24

Asthmatic patient is on already on a SABA but has had multiple trips to ER in past 3 months. What is next course of action?

Answer 24

-add LCS

Question 25

Which med decreases mortality in COPD?

Answer 25

-LABA-ICS combo ( Advair: Salmeterol + Fluticasone)

Question 26

A patient presents with night sweats, dry cough & weight loss. You suspect TB. Which of the following is diagnostic?

Answer 26

-AFB x 3

Question 27

38yr old F immobilized for 4 months. Examining her before releasing her you note dyspnea & tachycardia. You suspect PE, but V/Q scan indeterminate. What is next diagnostic test?

Answer 27

Pulmonary angiography

Question 28

What confirms the dx of PNA?

Answer 28

-consolidation of the lungs (on CXR)

Question 29

Elderly woman with hx of lung dysfunctions comes to your office. She presents with a number of respiratory sxs. Her most severe complaint is HA. Which is the most likely respiratory symptom based on HA?

Answer 29

acute bronchitis

Question 30

Your patient has RA and her corticosteroids are not working. What is the next step in treatment?

Answer 30

methotrexate

Question 31

Your patient stepped on a nail and does not know his tetanus status. Do you give Td or Tdap?

Answer 31

Tdap

Question 32

An HIV patient presents with petechiae on his LE and leg weakness. What test should be done?

Answer 32

CMV

Question 33

28yr old F presents w/fever, malaise, rash across the back & splinter hemorrhages. Hgb 10. Positive ANA. UA proteinuria and elevated ESR. What is the suspected dx?

Answer 33

SLE

Question 34

Clinical presentation of felty syndrome?

Answer 34

-RA + joint swelling + enlarged spleen + leukopenia

Question 35

57yr odl with PMH of CAD presents with c/o bilateral knee pain that is progressively worse throughout the day. You suspect OA. Which med is contraindicated?

Answer 35

-Celebrex (contraindicated in ARF/heart disease)

Question 36

Which of the following meds is NOT indicated in the management of closed angle glaucoma?

Answer 36

alpha 2 agonist

Question 37

52yr old F is concerned with hormonal replacement therapy. What are the associated SE?

Answer 37

-gallstones, blood clots, CVA

Question 38

Hormonal replacement therapy has been shown to improve what diagnosis?

Answer 38

osteoporosis

Question 39

What labs should be monitored in taking NSAIDs?

Answer 39

K+, Cr

Question 40

SE of tamoxifen?

Answer 40

-Hot flashes -menopausal sxs: vag dryness, hair thinning/loss, menstrual irregularities - pancytopenia -inc risk of DVT/CVA

Question 41

Elderly patient takes an herbal root to help fight colds, however has a history of renal insufficiency. Which herbal med could exacerbate his diagnosis?

Answer 41

-echinacea -causes nephrotoxicity

Question 42

First line treatment for MS flare?

Answer 42

-steroids

Question 43

Most important medical history to ask to a patient with hemoptysis?

Answer 43

-amount of blood, previous episode, dyspnea

Question 44

Which of the following displays a current or recent Hep A infection? a. antibody specific to IgG b. antibody specific to IgM c. Hep A core antibody d. hep A surface antigen

Answer 44

b

Question 45

Which of the following displays a current or recent Hep A infection? a. antibody specific to IgG b. antibody specific to IgM c. Hep A core antibody d. hep A surface antigen

Answer 45

b

Question 46

Cross-sectional research is an example of what type of research? a. experimental b. qualitative c. non-qualitative d. non experimental

Answer 46

d

Question 47

50% nephron loss=

Answer 47

diminished renal reserve

Question 48

75% nephron loss=

Answer 48

renal insufficiency

Question 49

90% renal loss=

Answer 49

ESRD

Question 50

when discharging an 85 yr old pt w/stasis dermatitis, the ACNP includes instructions to: a. keeps legs elevated whilte seated b. maintain SBP \>120 C. soak legs in warm water daily d. wear compression stockings of 65mmHg below the knee

Answer 50

a

Question 51

A young female patient arrives at the ED w/vaginal discharge. after performing a pelvic examination, the ACNP documents which finding? a. cervical motion tenderness b. + bowel sounds C. pink vaginal mucosa d. positive rectal tone

Answer 51

a

Question 52

Temporal arteritis requires immediate tx in order to prevent: a. blindness in the affected eye b. facial nerve palsy c. TIA d. trigeminal neuralgia

Answer 52

a

Question 53

A 15 yr old pt w/type 1 DM reports elevated BG levels in the am. The ACNP determines that the pt's hyperglycemia is due to the dawn phenomenon and: a. increases the insulin dosage at bedtime b tests the BG at 3 am every morning c. tests the BG in the evening d. reduces the insulin dosage at bedtime

Answer 53

a

Question 54

A 78yr old male pt w/HF develops bilateraly UTI secondary to indwelling catheter. The patient has a known history of allergy to PCN & sulfonamides. THe appropriate abx choice is: a. cephalexin (keflex) b. ciprofloxacin (cipro) c. doxycyline (vibramycin) d. tetracycline (sumycin)

Answer 54

b

Question 55

A patient w/hx of afib, who has maintained SR w/ sotalol (Betapace) is hospitalized for acute pyelonephritis. The appropriate abx regimen for this pt is IV: a. cefoxitin (mefoxin) b. ceftriaxone (rocephin) c. ciprofloxacin (cipro) d. levofloxacin (levaquin)

Answer 55

b

Question 56

A patient has fully recovered from septic shock d/t bacteremia. The patient has been accepted to a long-term acute care facility for continuation of abx therapy. The ID physician has not seen the patient in 2 days. The ACNP : a. contacts the MD to determine appropriate duration of abx therapy b. notifies medical staff services that the physician has not seen the pt c. waits for the MD to come see the pt d. writes transfer orders for the pt

Answer 56

a.

Question 57

An 80 yr old pt has macular degeneration and is seen on the surgical unit for postop care after a repair of a hip fx. To prepare the patient for discharge, the ACNP: a. gives illustrative pictures that instruct the pt on body alignment during activity b. has the patient watch a video about surgeries and pre-op care for hip fx's c. provides the pt w/an audio tape for care of hip fx's and ROM activities d. provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery

Answer 57

d

Question 58

When serving as a nurse researcher, the ACNP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? a. confidentiality b. justice c. nonmaleficience d. right to self-determination

Answer 58

c

Question 59

What procedure does the ACNP perform to evaluate cytology, only, in the tumor? a. core bx b. excisional bx c. fine needle aspiration d. incisional bx

Answer 59

c

Question 60

A patient who has been in the ICU for 17d develops hypernatremic hyperosmolality. The patient weights 132 lbs (59.9kg), is intubated and receiving mechanical ventilation. The serum osmo = 320. Clinical signs include tachycardia & hypotension. The ACNP's initial tx is: a. reduce Serum osmo by infusing D51/4NS b. reduce serum Na concentration by infusing 0.45% NaCl solution c. replenish volume by infusing 0.9% NaCl d. replenish volume by infusing D5W

Answer 60

c \*clinical signs --\> need isotonic solution to replace volume

Question 61

A 70 yr old pt w/acute systolic HF denies any functional limitations, is able to walk 5 blocks before tiring & is euvolemic. which med is 1st line therapy for this pt? a. amlodipine (norvasc) b. digoxin (lanoxin) c. furosemide (lasix) d. lisinopril (zestril)

Answer 61

d

Question 62

An 80yr old male w/ dementia requires long-term care placement. To which funding agency does the patient apply for after "spending down" to quality? a. American association of retired persons b. medicaid c. medicare d. U.S social security administration

Answer 62

b

Question 63

Goals set forth in "healthy people 2020" by US Department of Health & Human services include the: a. eliminattion of health disparities b. empowerment of health care delivery systems c. increase in life span of older adults d. treatment of acute diseases

Answer 63

a

Question 64

Which clinical scenario does the ACNP evaluate for quality improvement process change? a. new case of necrotizing fasciitis in an immunocompromised pt b. projected increase in the # of influenza cases requiring hospitalization c. an expected rate of VAP in pulmonary disease patients d. an increased incidence of postop sternal wound infections

Answer 64

d