Quizzes and Tests Flashcards by Kelly Edwards

What are the attributes of the patient-centered medical home?

Comprehensive care; patient-centered, coordinated care; accessible services; quality; and safety

Efficiency, time management, quality improvement, collaboration, and cost reduction

Comprehensive care, cost reduction, patient safety, and quality improvement

Planned care, quality improvement, and team-based care

Comprehensive care; patient-centered, coordinated care; accessible services; quality; and safety

How well did you know this?

Not at all

Perfectly

True or False

In the patient-centered medical home (PCMH) model, specialists are responsible for communicating their plan with primary care.

False. The PCP is responsible.

How well did you know this?

Not at all

Perfectly

When caring for individuals in long-term care facilities, the nurse practitioner’s goal of care is rehabilitation and improving functional status back to baseline.

False. In skilled / acute care this is the case. In LTC, no improvement is expected to the goal is maintain function and prevention of exacerbation.

How well did you know this?

Not at all

Perfectly

True or False

The goal of a co-management agreement document is to define the roles of each provider and communicate this information to all clinicians.

True

How well did you know this?

Not at all

Perfectly

True or False

When working in a specialty practice, it is acceptable to manage diagnoses that do not pertain to your specialty.

False. The expectation for nurse practitioners working in a specialty practice is that they will only treat the conditions for which they have been consulted.

How well did you know this?

Not at all

Perfectly

A diabetic patient presents to your office for preoperative clearance. The surgical clearance paperwork does not specifically ask for a glucose level or A1c result.

True or False

To clear the patient for surgery, you must have a recent lab result indicating good control of the patient’s glucose.

True. As the clearing provider, you must determine what labs are needed based on the patient

How well did you know this?

Not at all

Perfectly

True or False

One of the main reasons for a post-hospitalization follow-up appointment is to prevent hospital readmission.

True

How well did you know this?

Not at all

Perfectly

True or False

Because primary care offices operate independently from other practices, they do not need to participate in organizational quality improvement projects.

False.

How well did you know this?

Not at all

Perfectly

True or False

Quality measures for nurse practitioners are the same as quality measures for nurses.

False. Q-scores are related to the position, which is different from RNs

How well did you know this?

Not at all

Perfectly

True or False

The patient-centered medical home requires primary care practices to have a systematic focus on QI and safety.

True

How well did you know this?

Not at all

Perfectly

An advanced practice registered nurse (APRN) is examining a patient who has been unresponsive to treatment for a second-degree burn on the forearm and hand that occurred three weeks ago.

Which action should the APRN take first to assist this patient?

Send for a surgical consult

Refer to an orthopedic hand specialist

Refer to a wound specialist

Send to the emergency room

Refer to a wound specialist

How well did you know this?

Not at all

Perfectly

A patient with a history of epilepsy tells an advanced practice registered nurse (APRN) about experiencing increased activity and lip-smacking during seizures. The patient is compliant with the current medication regimen.

Which action should the APRN take next for this patient?

Order a STAT CT scan of the head

Change the anticonvulsant

Schedule an EEG

Consult with a neurologist

How well did you know this?

Not at all

Perfectly

A patient is in a clinic for follow-up after a renal calculi extraction. The renal stones were found to be calcium-based.

Which dietary modification should an advanced practice registered nurse (APRN) recommend?

Increase nuts in the diet

Increase fruit consumption

Limit sugary drinks

Limit coffee intake

Limit sugary drinks

How well did you know this?

Not at all

Perfectly

An advanced practice registered nurse (APRN) is part of an integrated multidisciplinary team that is working in a busy rural clinic. The team has been struggling with day-to-day operational communication, so the APRN suggests a strategy for improvement.

Which strategy should the APRN suggest to manage this problem?

Promoting timely feedback on concerns

Instituting a sign-off process for treatment plans

Adopting an integrated electronic health record

Requiring attendance at daily huddles

Promoting timely feedback on concerns

How well did you know this?

Not at all

Perfectly

A heath system wants to decrease the number of employee injuries from lifting. A project team is formed to select lifting equipment that meets the needs of several departments across the health system. An advanced practice registered nurse (APRN) leads a team to evaluate equipment from three manufacturers.

The team develops a chart to evaluate each piece of equipment and scores the equipment according to how it would operate in the following categories:

Severity: Identify all activities the equipment is expected to do.
Occurrence: For each activity, evaluate what could go wrong.
Detection: For each thing that could go wrong, evaluate what the effect would be.

According to this scenario, which quality process did the APRN implement for this project?

DMAIC

PDCA

FMEA

SMART

FMEA (failure mode effects analysis) is a tool for proactively evaluating products and identifying ways to prevent defects. It can spot problems before a piece of equipment is put into practice.

How well did you know this?

Not at all

Perfectly

When conducting a gynecologic history, what are the upper and lower ages considered normal for menstruation?

9 and 52

How well did you know this?

Not at all

Perfectly

The most common type of vulvar cancers are squamous cell carcinomas.

True. HPV plays a role in this.

How well did you know this?

Not at all

Perfectly

All women age 40 and older should have yearly mammograms

False. There are different recommendations from different agencies. All of them do recommend every other year for women 50+

How well did you know this?

Not at all

Perfectly

What is the recommended interval for Pap smear screenings for a 26-year-old woman?

Pap smears are not recommended for this age

Every three years

Every five years with HPV co-testing

Yearly

Every three years.

Age 21-29, every three years
Age 30 - 65, every three OR every five if co-testing
Age 21 and younger and Age older 65 - not recommended

How well did you know this?

Not at all

Perfectly

What is the FDA-approved age range for females to receive the quadrivalent HPV vaccine?

Ages 11 to 12

Ages 9 to 26

Ages 10 to 25

Ages 12 to 21

Ages 9 to 26

How well did you know this?

Not at all

Perfectly

What is the FDA-approved age range for females to receive the quadrivalent HPV vaccine?

Ages 11 to 12

Ages 9 to 26

Ages 10 to 25

Ages 12 to 21

Ages 9 to 26

How well did you know this?

Not at all

Perfectly

A family history of breast cancer is a risk factor for developing breast cancer. What is another established risk factor for developing breast cancer?

First live birth at age 26

Smoking

Menarche at age 13

A history of benign breast biopsy

If a patient requires a biopsy due to a mammogram or other reason, then this is considered a risk factor even if the biopsy is normal.

How well did you know this?

Not at all

Perfectly

What is a recommended medication course for chlamydia trachomatis?

Doxycycline 1 g PO QD x 5 days

Azithromycin 1 g PO once

Ceftriaxone 250 mg IM once

Erythromycin 150 mg PO QID x 3 days

A one time dose of azithromycin 1 gram is the treatment recommendation.

You co-treat confirmed gonorrhea for probable chlamydia not ruled out. Treat gonorrhea with 250 or 500mg ceftriaxone IM.

How well did you know this?

Not at all

Perfectly

A 21-year-old woman meets with an advanced practice registered nurse (APRN) for a Pap smear, and there is blood in the specimen. This is the first time this result has occurred.

Which recommendation should the APRN include in this patient’s plan of care?

Order a reanalysis of the results

Obtain a CBC

Repeat Pap smear as soon as possible

Schedule a follow-up Pap smear in three months

If Pap smear results are unsatisfactory for any reason, such as insufficient cells, obstruction with solution particles, or blood in specimen, the Pap smear should be repeated in three months.

How well did you know this?

Not at all

Perfectly

A 35-year-old multiparous woman presents to a clinic for an annual physical. An advanced practice registered nurse (APRN) obtains the patient’s general health history and menstrual history. The patient's last pelvic exam with cytology and HPV co-testing was three years ago, which was found to be normal. Which action should the APRN include in this plan of care? Repeat cytology and HPV co-testing in five years Repeat cytology in one year with no need to repeat HPV co-testing Repeat cytology and HPV co-testing in two years Repeat HPV co-testing in one year with no need to repeat cytology

Repeat cytology and human papillomavirus (HPV) co-testing should be performed every five years. Since this was last done three years ago, it needs to be repeated in two years.

A 32-year-old woman’s Pap smear test results show atypical squamous cells of undetermined significance (ASCUS). An advanced practice registered nurse (APRN) is performing a colposcopy and notes an area of sharply delineated acetowhite epithelium. Which action should this APRN take? Perform a diagnostic conization Perform a punch biopsy Perform a radical trachelectomy Perform a repeat cervical cytology

The area of sharply delineated acetowhite epithelium noted on a colposcopy is considered a hallmark sign of cervical neoplasia and is considered a grossly abnormal cervix. Any patient with a grossly abnormal cervix should have a punch biopsy performed.

A 52-year-old woman presents to an advanced practice registered nurse (APRN) for complaints of hot flashes, irritability, and difficulty falling asleep. The APRN notes a T score of −2.0 on the woman's bone density scan. Which action should the APRN recommend for this patient? Begin a high-protein, low-carbohydrate diet Start walking and weight-bearing exercises Supplement 2,000 to 3,000 mg of calcium twice daily Increase potassium and decrease vitamin D intake

A bone densitometry T score of −2.0 indicates low bone density or osteopenia. Walking and weight-bearing exercises both help to increase bone mineral mass and reduce the risk of fracture-causing falls.

2, An advanced practice registered nurse (APRN) examines a patient with unexplained infertility. Lab results reveal a progesterone level of <5 ng/mL. Which treatment should the APRN prescribe for this cause of infertility? Danazol 800 mg tablets #30/5 refills; one tablet daily starting on the first day of menstrual cycle Human chorionic gonadotropin hormone 10,000U IM; single-dose once a day using prefilled syringe Clomiphene citrate 50 mg tablets #5; one tablet daily for five days starting on day three of the menstrual cycle Doxycycline 100 mg tablets #20; one tablet twice daily for 10 days

The progesterone level indicates a problem with luteal function. Clomiphene citrate is a fertility drug to correct any luteal insufficiency in women with unexplained infertility. Clomiphene is usually started on day 3, 4, or 5 of the menstrual cycle at a dose of 50 mg (one pill) once daily for five days. The first day of bleeding is called cycle day 1.

How can poor nutrition and vitamin deficiencies affect the fetus? Neural defects and endocrine changes Infantile torticollis Metabolic changes and distended scalp veins Breech presentation

Folic acid deficiencies can cause neural defects, and poor nutrition can result in endocrine changes.

You receive the lab results of a 20-week gestation patient and note the sodium level is 131 mEq/L. What is an appropriate action? Prescribe Na+ supplementation tablets Nothing, because this is an expected change in pregnancy Nothing, because this is a normal sodium value Immediately send the patient to the emergency department

Nothing, because this is an expected change in pregnancy Sodium levels decrease by 2–4 mEq/L in pregnant women. Since this sodium level is at the very low end of normal, you may want to monitor closely with repeat testing.

Regardless of maternal age, __________ is an indication for genetic counseling and prenatal diagnosis.

Multiple fetal loss

A woman at 10 weeks gestation presents to your office with a blood pressure of 154/88. True or False This patient meets criteria for the diagnosis of pregnancy induced hypertension.

False. HTN before 20 weeks is chronic hypertension.

True or False Gestational diabetes is a risk factor for developing preeclampsia.

True

True or False The leading cause of infant mortality in the United States is birth occurring before 37 weeks gestation.

True Premature birth causes 45% of infant death

rue or False In studies, most antihistamines do not appear to be linked to birth defects.

True

True or False Prophylactic oral oseltamivir is recommended for pregnant patients who have had close contact with someone infected with influenza.

True.

A 37-week gestation woman presents to your office for back pain with sciatica. She denies any injuries or falls, and her exam is essentially normal. What is the most appropriate treatment plan? Instruct her to take OTC ibuprofen Prescribe methocarbamol and naproxen Order an Xray of the lumbar spine and physical therapy Instruct her to take OTC acetaminophen and apply topical menthol

Back pain with sciatica is common in pregnancy, and since there is no mechanism of injury or abnormalities on exam, over-the-counter acetaminophen and topical menthol are appropriate.

True or False A milk bleb is a tiny amount of visible milk under the skin due to a blocked nipple pore.

True The duct opening is blocked by a piece of skin, causing a back up

True or False A lactating mother should dump milk for eight hours after consuming ibuprofen.

False

True or False A score of more than 10 on the Edinburgh Postnatal Depression Screen suggests depression may be present.

True

How is the estimated date of confinement calculated from the first day of the last menstrual period (FDLMP)? Add nine months and subtract seven days from the FDLMP. Count back three months from the FDLMP, add one year, and subtract seven days. Add nine months and seven days to the FDLMP. Add nine months to the FDLMP.

The estimated date of confinement (EDC) or "due date" may be determined by adding nine months and seven days (or 40 weeks) to the first day of the last menstrual period.

hoGAM [Rho(D) Immune Globulin (Human)] is clinically indicated for an Rh-negative pregnant woman in which of the following situations? Prophylactically at 28 weeks of pregnancy Any time laboratory blood work is done on the mother When pregnancy is confirmed At 12 weeks gestation

Prophylactically at 28 weeks of pregnancy

A 24-weeks-gestation pregnant woman presents to your office with new onset hypertension, with a blood pressure of 154/88. Her urine is negative for protein, but her serum creatinine level is rising. True or False This patient meets the criteria for preeclampsia.

True

True or False Glucophage is contraindicated for gestational diabetes.

False. Metformin and Insulin are the safest diabetes meds in pregnancy.

True or False Pregnant women should receive the influenza nasal spray vaccine

False

True or False During pregnancy, most aches and pains can be managed with acetaminophen, but a short course of narcotic medications for severe pain or serious injuries is considered safe.

True

True or False Depression screening is suggested for all pregnant and postpartum women.

True

A lactating mother presents to your office with acute bronchitis. She has been up all night coughing and is exhausted. She is requesting codeine cough syrup that has helped her in the past. What is an appropriate response to the mother's request? Provide an alternative prescription for dextromethorphan and explain that codeine is not safe for lactating mothers. Prescribe the codeine as requested. Prescribe benzonatate instead. Explain that she can take codeine, but she must "dump" milk for at least four hours.

Provide an alternative prescription for dextromethorphan and explain that codeine is not safe for lactating mothers

A lactating mother presents to your office with a red, painful, swollen area on her right breast, chills, and a fever of 101.6°F. What is an appropriate treatment plan for this patient? Azithromycin 500 milligrams (mg) for one dose, then 250 mg per day for four days Culture the breast milk Clindamycin 300 mg PO TID for 10–14 days Amoxicillin 500 mg TID

Clindamycin 300 mg PO TID for 10–14 days is a recommended treatment course for lactation mastitis.

True or False Ectopic pregnancy is most likely to occur between the sixth and twelfth weeks of gestation.

True

A patient presents to an advanced practice registered nurse (APRN) for a prenatal checkup for a second pregnancy. The patient developed gestational diabetes with the first pregnancy. Which lab test should the APRN perform for this patient? Human placental lactogen Corticotropin-releasing hormone Human chorionic gonadotropin Prolactin level

Human placental lactogen antagonizes the cellular action of insulin and decreases maternal glucose utilization, which increases glucose availability to the fetus. This may play a role in the pathogenesis of gestational diabetes.

A 30-year-old patient is 12 hours postpartum. The patient reports extreme fatigue due to prolonged labor, a feeling of fullness in the suprapubic region, and heavy blood loss >500 mL. The attending advanced practice registered nurse (APRN) assesses the patient and determines the patient needs postpartum obstetric hemorrhage care. Which set of steps should the APRN take to assist this patient? Infuse oxytocin, assess for vaginal lacerations, and prepare two units of PRBCs Move patient to labor and delivery, give carboprost, and complete labs Increase the infusion rate of oxytocin, give methergine, and provide fundal massage Repeat labs, transfuse with PRBCs and platelets, and consider ligation

Increase the infusion rate of oxytocin, give methergine, and provide fundal massage

A patient is admitted at 14 weeks gestation for hyperemesis gravidarum. An advanced practice registered nurse (APRN) prescribes 0.9% normal saline IV, vitamin B6, diphenhydramine, and metoclopramide. The vomiting is controlled; however, the patient begins to develop involuntary facial tics and eye blinking. Which action should the APRN take for this patient? Insert an NG tube Decrease diphenhydramine Increase the IV rate Discontinue metoclopramide

Metoclopramide is a phenothiazine and should be stopped immediately if there are any signs of tardive dyskinesia (involuntary movements, usually of the face).

A patient who is at 11 weeks gestation presents to the emergency department with a laceration from a rusty fence. An advanced practice registered nurse (APRN) assesses the laceration and learns that the patient's last Td vaccination was 12 years earlier. Which vaccine protocol should the APRN use for this patient? Administer Td at 27 weeks Administer Tdap at 27 weeks Administer Tdap at the current visit Administer Td at the current visit

In circumstances where the patient has a wound requiring the vaccination, the recommendation is to administer a Tdap (a vaccine against tetanus, diphtheria, and pertussis) on the day of the visit. The vaccine would not need to be readministered later in the pregnancy.

A patient who is 36 weeks pregnant is seeing an advanced practice registered nurse (APRN) for a follow-up visit associated with a recent diagnosis of hypertension. The patient is taking atenolol and plans to breastfeed. Which change in medication should the APRN make for this patient? Acebutolol Methyldopa Furosemide Nadolol

Methyldopa is the drug of choice for the treatment of hypertension during pregnancy. Methyldopa is also considered compatible with breastfeeding.

True or False A urinary tract infection (UTI) should be managed inpatient in a male who appears toxic.

True

What is the most emergent cause of testicular pain in a young male? Tumor Testicular torsion Epididymitis Varicocele

Testicular torsion

True or False The normal prostate is heart shaped and measures approximately 4 × 3 × 2 cm. True False

True

Men on testosterone replacement therapy should have a testosterone blood test ________ after testosterone gel is rubbed in.

2 hours

True or False Risk factors for erectile dysfunction include hypertension, diabetes, and depression

True

True or False In a younger man without a sexually transmitted infection (STI), the presence of a urinary tract infection (UTI) is often associated with anatomic abnormality.

True

A 21-year-old male presents for dysuria. He admits to recent unprotected sex with possible exposure to a sexually transmitted infection (STI). The in-office dipstick urinalysis is positive for leukocytes and nitrites. You ordered a urine culture and STI testing, but these are sent out and the results will not be available for two to three days. What is the best class of antibiotics for treatment until the results are back? Penicillins Lincomycins Cephalosporins Fluoroquinolones

Initial treatment with a fluoroquinolone is recommended, which can be changed if indicated by the STI and urine culture results.

A patient presents with a low-grade fever, a heavy sensation in the testicles, and a sudden onset of severe pain that may be partially relieved by elevating the scrotum. What is the most likely diagnosis? Hydrocele Varicocele Inguinal hernia Epididymitis

The symptoms of epididymitis include low-grade fever, a heavy sensation in the testicles, and a sudden onset of severe pain that may be partially relieved by elevating the scrotum.

A patient presents with pain and a lump in the testicle. True or False An ultrasound of the scrotum is recommended if the patient has no concerning or emergent clinical symptoms.

True

True or False A prostatic massage to express prostatic secretions is indicated if acute bacterial prostatitis is suspected.

True

True or False Benign prostatic hyperplasia is a risk factor for prostate cancer.

True Benign prostatic hyperplasia does not increase the chance of prostate cancer. Prostate enlargement is a normal part of aging.

Which benign prostatic hyperplasia medication is contraindicated in those with a sulfa allergy? Silodosin Sildenafil Tamsulosin Finasteride

Tamsulosin should not be used in those with a sulfa allergy.

What lab tests should be done when monitoring testosterone supplement injections? Testosterone and lipid level Testosterone level Testosterone level and a comprehensive metabolic profile Hematocrit, prostate specific antigen, testosterone level

Hematocrit, prostate specific antigen, testosterone level testosterone can stimulate the growth of preexisting prostate cancer, and prostate specific antigen should be monitored. An elevated hematocrit is the most commonly reported adverse event from testosterone supplementation. Monitoring testosterone levels is recommended, with the goal of achieving levels in the mid-normal range.

True or False Low testosterone levels in men are associated with increased mortality.

True

True or False Some of the major drug classes associated with erectile dysfunction include antihypertensives, antidepressants, and tranquilizers.

True

True or False A multidisciplinary approach to the treatment of male sexual dysfunction may include a psychologist, marriage counselor, sex therapist, and urologist.

True

A 72-year-old male patient is speaking to an advanced practice registered nurse (APRN) about urinary hesitancy, urgency, nocturia, and frequency. Urinalysis confirms hematuria and elevated prostate specific antigen (PSA). During a digital rectal exam, the APRN notes an asymmetric prostate with a firm nodule. Which diagnosis should the APRN make for this patient? Prostate cancer Benign prostatic hypertrophy Hydrocele Prostatitis

Prostate cancer presents with urinary tract abnormalities, hematuria, elevated prostate specific antigen (PSA), and an asymmetric prostate with a firm nodule.

A 55-year-old male patient is being seen by an advanced practice registered nurse (APRN) for the inability to complete intercourse due to erectile dysfunction. The APRN completes a thorough review of the patient's previous health history and medication usage. What should the APRN consider as a possible cause? History of untreated prostate cancer Side effect of taking levofloxacin Side effect of taking atenolol History of treatment for HIV

Atenolol is a beta-blocker used to treat angina and hypertension that has a side effect of erectile dysfunction.

A 55-year-old male patient is being seen by an advanced practice registered nurse (APRN) for the inability to complete the act of intercourse due to erectile dysfunction. The APRN suspects the patient has erectile dysfunction but is unsure whether the cause is organic or psychogenic. Which diagnostic test should the APRN order to determine the origin of this problem? Digital rectal exam Sleep study Sildenafil trial Postage stamp test

A postage stamp test is conducted by placing a roll of stamps around the penis at bedtime; if the stamps are broken apart in the morning, it is determined that erection has occurred. This test has a high sensitivity for differentiating between organic (inability to have an erection) and psychogenic (psychological).

A 30-year-old male patient who has a history of epididymitis is being seen in a clinic by an advanced practice registered nurse (APRN). The patient is concerned that this condition is reoccurring. What should the APRN consider as a sign of this condition? A positive cremasteric sign A negative Prehn's sign A negative Murphy's sign A positive McBurney's sign

A positive cremasteric reflex can be considered a sign of epididymitis. The cremasteric reflex is a superficial reflex found in human males that is elicited when the inner part of the thigh is stroked.

4, A 26-year-old male patient is diagnosed with gonorrhea and is speaking with an advanced practice registered nurse (APRN) about treatment. The APRN provides a single-dose antibiotic therapy and then educates the patient about the wait period recommended before resuming sexual activity. Which wait period should the APRN recommend? Seven weeks Seven days Three weeks Three days

Seven days A seven-day wait period before resuming sexual activity is appropriate after receiving a single-dose antibiotic for gonorrhea.

True or False The term "cisgender" means a person whose gender identity is the same as the gender they were assigned at birth.

True

rue or False Self-identification as LGBTQIAP+ does not mean that an individual has mental illness.

True

rue or False A family nurse practitioner cannot treat a genitourinary problem in a transgender patient.

False

Which baseline lab work is required for individuals beginning PEP? Complete blood count Serum liver enzymes Hormone levels Thyroid function

Serum liver enzymes

What is post-exposure prophylaxis (PEP)? Vaccines to prevent the spread of disease Medications that prevent a patient from contracting HIV Antiretroviral drugs Condoms and other barrier methods

Antiretroviral drugs Pre-exposure prophylaxis are medications to reduce the risk of contracting HIV

When discussing sexual health with a male who has sex with men, what is an important component of wellness education? Maintaining a healthy weight Cancer screenings Condom use Influenza vaccine recommendations

Condom use

True or False According to the Centers for Disease Control and Prevention (CDC), PrEP should be offered to all adolescents and adults who have had sex in the last six months with inconsistent condom use. True False

True The current recommendation by the CDC is for PrEP to be offered to anyone who has had anal or vaginal sex in the past six months with one of the following additional add-ons: sex with an HIV-positive sexual partner (especially if the partner has an unknown or detectable viral load), the patient has had a recent bacterial STI, or the patient has a history of inconsistent or no condom use with sexual partners, and HIV-positive sexual partner (especially if the partner has an unknown or detectable viral load); or a recent bacterial STI, or a history of inconsistent or no condom use with sexual partner(s).

True or False The term "intersex" means a person whose gender has been changed.

Gender reassignment is a surgery to change an individual's gender. Intersex refers to those individuals with a disorder related to sexual development resulting in chromosomal anomaly or ambiguous genitalia.

True or False Many LGBTQIAP+ patients have had prior experiences with healthcare providers that have left them feeling marginalized or stigmatized.

True

True or False Older LGBTQIAP+ adults are less likely to have children or other family members who are involved in their care.

True

LGBTQIAP+ patients may avoid _____ due to a history of negative interactions.

medical care

Some members of the LGBTQIAP+ community have misconceptions regarding the need for preventative healthcare. True or False Pap smear screenings are unnecessary for lesbian women.

False All women, including those who are lesbian, gay, or bisexual, need to have cancer screenings with a Pap smear test.

True or False When speaking to a transsexual, you should use the pronoun that corresponds to how they are dressed.

False. Ask them their preference

PEP must be initiated within ______ hours of exposure.

An advanced practice registered nurse (APRN) is meeting a transgender patient for the first time. Which action should the APRN take to ensure that psychosocial considerations are addressed? Ask if they identify as female Ask which pronoun they prefer Inquire about prior sexual orientation best practices Inquire about sexually transmitted diseases

Ask which pronoun they prefer

An advanced practice registered nurse (APRN) is seeing a 21-year-old patient to administer an HPV vaccination. The patient states that he self-identifies as homosexual but is having problems dealing with his sexual identity. Which intervention should the APRN provide for this patient? Check for status of hepatitis A and B vaccination Arrange for a psychiatric evaluation Test for hepatitis C Complete a depression screening

Complete a depression screening A depression screening should be done, as depression and suicide are more common in LGBTQIA individuals.

An advanced practice registered nurse (APRN) is providing care for a patient who self-identifies as part of the LGBTQIA population. How should the APRN address the patient in this situation? Ask the patient if they have a girlfriend or boyfriend Address the patient in accordance to the sex they were assigned at birth Ask the patient to provide information about themselves and see where it leads Address the patient as "sir" and see if the patient provides a correction

Ask the patient to provide information about themselves and see where it leads

An advanced practice registered nurse (APRN) is providing care for a female patient who self-identifies as bisexual. The APRN is familiar with the top health issues identified for the LGBTQIA population in the Substance Abuse and Mental Health Services Administration (SAMHSA) report. Based on the SAMHSA report, which action should the APRN take for this patient? Collect BMI data and provide obesity counseling Educate regarding the importance to start engaging in physical activity Encourage routine mammogram screening Assess for intimate partner violence

Assess for intimate partner violence

A 40-year-old gay man presents to a clinic with complaints of dysuria, frequency, and urgency. He tells an advanced practice registered nurse (APRN) that he has had unprotected anal intercourse. The APRN diagnoses the patient with a urinary tract infection and recommends a treatment that will eliminate the bacteria causing the problem. Which bacteria is the APRN treating? Borrelia burgdorferi Escherichia coli Streptococcus pyogenes Pseudomonas aeruginosa

Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal tract, causes urinary tract infections.

The timed up and go (TUG) test (CDC, 2017) is used to assess a patient's risk of falls. Which elements would patients perform as part of the TUG test? Reach forward beyond arm's length while maintaining a fixed base of support in the standing position without taking steps Stand from a seated position, walk 10 feet, turn, walk back, and sit down Hold each position for 10 seconds: standing with legs side by side, then place the instep of one foot touching the big toe of the other foot, next standing heel to toe, and finally standing on one foot Cross their arms over their chest and repeatedly stand up as many times as they can in 30 seconds

Stand from a seated position, walk 10 feet, turn, walk back, and sit down

The Katz independence in activities of daily living scale is a tool commonly used to assess basic function. True or False A score of four indicates severe impairment.

False. A score of two or less is severe.

True or False Cognitive impairment is best detected using a routine history and physical examination.

False. A screening tool is best

Minimally disruptive medicine is an approach to providing care for patients with complex needs. True or False The goal of minimally disruptive medicine is to focus on the patient's goals for his or her health and life while lessening treatment burden.

True

Due to normal decline, drug metabolism becomes compromised with age. True or False In general, medication doses need to be higher to be effective in older patients.

False. Cardiovascular, neurocognitive, hepatic, and renal function are compromised in geriatric patients, although the extent can depend on an individual's overall health and comorbidities. Most medications need to be given in the same or smaller doses for older patients due to decreased drug metabolism and clearance.

A holistic approach to prescribing for older patients includes an assessment of ______

The ability to swallow the size of pill or tablet being prescribed

True or False Palliative care provides symptom relief for dying patients and should only be considered in the last stages of terminal illness.

False. Palliative care is appropriate at any time during the course of a serious illness.

True or False A patient must be suffering from a life-limiting illness to be eligible for advance care planning.

False any patient, at any stage of health, may complete advance care planning, a healthcare power of attorney, and a living will.

At what point should families be involved in advance care planning? When a patient can no longer make his or her wishes known During any stage of health or disease course, and at any age When a life-limiting illness is diagnosed During the terminal stages of a disease

During any stage of health or disease course, and at any age

Which type of visit will Medicare reimburse for advance care planning? Sports physical Medicare does not reimburse for advance care planning discussions Medicare wellness visits and a hospital follow-up after an acute severe illness Office visit for diabetic education

Medicare wellness visits and a hospital follow-up after an acute severe illness Medicare reimburses for advance care planning if the following are documented in the note: an account of the discussion, who was present, explanation of forms, and the time spent in the face-to-face encounter. In general, Medicare reimburses for advance care planning during visits for routine physicals and with significant changes in health status.

What does the concept of rational polypharmacy refer to? The provider discussing the rationale for prescribing many medications Only prescribing the lowest cost medications When patients have multiple chronic and comorbid conditions necessitating the prescribing of many medications For patients prescribed many pills, they should take only a small ration of them per day

When patients have multiple chronic and comorbid conditions necessitating the prescribing of many medications

What is the purpose of the American Geriatrics Society's Beers criteria? An alcohol intake screening assessment for geriatric patients Evidence-based recommendations for potentially inappropriate medication use in older adults A test for patients' knowledge of their medications A list of medications older adults should never be prescribed

Evidence-based recommendations for potentially inappropriate medication use in older adults

Which of the following is part of a Medicare annual wellness visit? Medication refills Disease planning and treatment Education and counseling about preventive services Diabetic education and counseling

Education and counseling about preventive services

What is an appropriate strategy to minimize the burden of a patient's treatment? Evaluate functional status and ability to carry out the prescribed treatment. Prescribe continuous physical therapy for strengthening. Focus care on preventative services instead of difficult treatments. Stop all treatments.

Evaluate functional status and ability to carry out the prescribed treatment.

True or False Dementia screenings are not necessary until patients exhibit signs of memory impairment.

False It is necessary to perform a screening specifically for memory impairment because dementia symptoms are not always apparent with routine physical exams.

True or False In geriatric patients, a new symptom should be considered a drug side effect or drug-drug interaction until proven otherwise.

True

True or False In palliative care the patient may still receive life-prolonging and curative treatment.

True

True or False Routine physical exams and Medicare annual wellness visits are the same.

False The purpose of a Medicare annual wellness visit is to provide a personalized plan of preventative services that does not include a physical exam.

True or False Advance directive conversations must occur in the hospital, hospice, or long-term setting.

False

During a neurological screening as part of a Medicare wellness exam, the daughter of a 76-year-old patient reports to an advanced practice registered nurse (APRN) that her mother has had a change in consciousness and an increase in lethargy over the last two days. The APRN suspects a problem and conducts further assessments to confirm the diagnosis. Which diagnosis should the APRN suspect? Vitamin B12 deficiency Thiamine deficiency Pneumonia Diabetes

Pneumonia A urinary tract infection or pneumonia are suspected in older adults with changes in consciousness, such as confusion and lethargy.

A 65-year-old female patient is being seen by an advanced practice registered nurse (APRN) for a routine visit. The APRN focuses on the health maintenance tasks appropriate for the patient's age. Which task should the APRN complete for this patient? Order an initial screening colonoscopy Administer haemophilus influenzae type B vaccine Administer a Prevnar 13 vaccine Order an annual Pap smear

The Prevnar 13 vaccine is used to prevent infection caused by pneumococcal bacteria and is recommended at age 65.

An advanced practice registered nurse (APRN) is examining a 92-year-old patient for new complaints associated with a urinary tract infection. The APRN is creating a plan of action to treat this patient while not overly adding to the pill burden. Which action should the APRN take for this patient? Recommend splitting pills Change the medication to liquid form Recommend a once-a-day medication treatment Spread the dosage over q8h

Recommend a once-a-day medication treatment

An advanced practice registered nurse (APRN) is seeing a 96-year-old patient. The patient reports taking six and one-half pills every day. The APRN decides to respond to that information by taking a course of action recommended by the goals of geriatric care. Which action should the APRN take for this patient? Have the patient take the medications with an increased amount of water Ensure the patient's pills are in childproof bottles Create a six-bulleted chart to help the patient monitor medications Determine how to delete or combine the half pill

Determine how to delete or combine the half pill

A patient with a terminal illness explains to an advanced practice registered nurse (APRN) that family from out of town will be visiting, and they have questions about planning for the patient’s care. During a previous visit, the APRN provided the patient with a medical orders for life-sustaining treatment (MOLST) form. Which information about this form should the APRN emphasize with this patient? One form needs to be completed for in-hospital use and a separate form for community care. The form is used by the patient to select treatment choices and their health agent. The selections on the form cannot be changed once they are completed. The instructions on the form are activated after it is signed by both the patient and the patient’s family.

The form is used by the patient to select treatment choices and their health agent. A MOLST form covers all aspects of advanced care planning to include life-sustaining interventions, the name of the identified health agent, the name of the physician, the patient’s signature, and the clinician’s signature, which is required to activate the form.

True or False Only women should be screened for intimate partner violence.

False

The victims of sexual assault almost always have associated immediate and long-term effects, termed the rape trauma syndrome. What are the two phases of rape trauma syndrome? Treatment phase and chronic sequelae phase Denial and acceptance phases Shock phase and depression phase Acute/disorganization phase and the integration and resolution phase

Acute/disorganization phase and the integration and resolution phase Acute/disorganization phase starts immediately after the experience and can last from days to weeks. Victims may appear calm, although they commonly express shock, disbelief, fear, guilt, and shame. In the integration and resolution phase, victims begin to accept the assault, but psychological and emotional problems may persist.

True or False Prescription opioids taken for longer periods of time or in higher dosages can increase the risk of opioid use disorder, overdose, and death.

True

You prescribed Percocet 5-325 mg 1-2 tablets every 4-6 hours as needed for pain. What is the maximum daily morphine milligram equivalent (MME) dose for this prescription? 60 MME 75 MME 90 MME 105 MME

90 MME To calculate the MME based on this prescription you first determine the total number of tablets the patient could take per day, and multiply the total number of possible tablets per day by the number of milligrams in each tablet. This will give you the total number of milligrams possible per day (6 doses of two tablets). Next, multiply that number (total number of possible milligrams per day) by the conversion factor for the opioid in question. In this case, the medication is Percocet which contains the opioid oxycodone. The conversion factor for oxycodone is 1.5 MME/milligram.

True or False Through motivational interviewing, you can directly persuade a patient to give up substance abuse.

False The motivation to quit comes from the patient, not outside persuasion. With motivational interviewing, you guide the patient to recognizing and resolving ambivalence.

True or False There is a large body of research on protective factors that prevent substance misuse in young adults.

False

True or False There is a large body of research on protective factors that prevent substance misuse in young adults.

False

True or False Patients with intellectual impairment are not considered competent and cannot participate in their care decision-making.

False

True or False For a patient living in poverty, a nurse practitioner earns trust through his or her credentials, because credentials are tangible evidence of knowledge and achievement.

False Relationships are key for those with limited resources, and providers must earn trust by listening to the patient and recognizing the patient as a person. For patients in poverty, credentials do not have much significance.

True or False Documented and undocumented immigrants receive healthcare with the same standards of care as U.S. citizens.

False. U.S. citizens receive healthcare at a much higher standard than that of documented and undocumented immigrants.

True or False The yellow fever vaccine requires a booster every five years.

Every 10 years

What is an appropriate drug regimen for treating traveler's diarrhea? Ciprofloxacin and loperamide Azithromycin and meclizine Primaquine and doxycycline Amoxicillin and scopolamine

Ciprofloxacin and loperamide

True or False Reactions to sexual assault may include problems with sexual behavior and functioning.

True

True or False As a prescriber, you must write for stronger doses of pain medication for patients who report high levels of pain on a pain scale.

False

True or False Compared to lower opioid dosages, higher opioid dosages have not been shown to decrease chronic pain more effectively and are associated with increased overdose risk.

False. They have ben shown to increase risk but not reduce pain better.

True or False Buprenorphine is an opioid agonist that can produce euphoria. Treating opioid use disorder with buprenorphine substitutes one addiction for another.

False

True or False Patients may have secondary conditions such as pain, fatigue, obesity, and depression as a result of having a disabling condition.

True

True or False To screen for intimate partner violence, a patient just needs to be asked whether it is occurring, which is better than using a screening tool.

False

True or False Patients with Medicaid and private insurances always have reasonable medication co-pays.

False

True or False Various employee protection laws have agricultural exclusions, resulting in insufficient on-the-job protections for many migrant farmworkers.

True

True or False Various employee protection laws have agricultural exclusions, resulting in insufficient on-the-job protections for many migrant farmworkers.

True

What is a health risk associated with prolonged sitting during long-distance travel? Deep vein thrombosis Sciatica Traveler's diarrhea Yellow fever

DVT

True or False The CDC provides travel notices in three categories: Level 1 Watch, Level 2 Alert, and Level 3 Warning.

True

True or False The CDC provides travel notices in three categories: Level 1 Watch, Level 2 Alert, and Level 3 Warning.

True

A 75-year-old patient asks to have all medications changed to generics because of financial concerns and a desire to not overburden the adult child who owns the home where the patient is now staying. An advanced practice registered nurse (APRN) examines the patient and notes a finding that could indicate abuse. Which of these findings would indicate abuse? Diffuse alopecia Positive vulnerable elder assessment Bruises on bilateral upper arms Weight loss of 1 kg (2.2 lb) since exam three months before

Bruises on bilateral upper arms

A patient presents to an advanced practice registered nurse (APRN) because of frequent headaches that started about two years before. After reviewing the patient’s medical records, the APRN notes that the patient has already had several diagnostic tests performed. The patient has tried nonnarcotic medications with little effect. Which action should the APRN take to assist this patient? Refer to a local substance abuse center for assistance with pain management Prescribe a short-acting opioid at a low dose Recommend long-acting medication for breakthrough pain Schedule a urine drug screen in two weeks after prescribing opioid therapy

Prescribe a short-acting opioid at a low dose

A 40-year-old female patient seeks medical attention from an advanced practice registered nurse (APRN) for increasing anxiety that is only reduced by ingesting alcoholic beverages. The patient reports caring for two school-age children in addition to an adult parent who was recently diagnosed with a cognitive disorder. Which response should the APRN give to this patient? “Alcohol can cause rebound anxiety.” “A prescription for medical marijuana may be helpful.” “The time of day when alcohol is ingested may need to be changed.” “Edible forms of marijuana might be better than alcohol.”

“Alcohol can cause rebound anxiety.”

An advanced practice registered nurse (APRN) is preparing to discharge a patient from the hospital who was originally admitted for tuberculosis and initiation of therapy. The patient is homeless and unable to pay for the treatment. Which action should the APRN take to assist this patient? Provide the medication to the patient at no cost Arrange for the health department to provide the medication Provide the patient with contact information for the drug company Order QuantiFERON-TB for the patient prior to discharge

Arrange for the health department to provide the medication

advanced practice registered nurse (APRN) is assessing an older adult who is a Cambodian refugee. The APRN notes ecchymosis on the chest, upper arms, neck, and back and accurately identifies the cause of the condition. Which activity caused this condition in the patient? Medicinal herb ingestion Elder abuse Cupping Coining

Coining