random practice test questions

Question 1

What medication class is metformin/glucophage?

Answer 1

biguanides

Question 2

What is the mechanism of action of the biguinides? (metformin)

Answer 2

limits the conversion of glycogen to glucose by the liver and reduces insulin receptors resistance

Question 3

Risk factors for a person to develop HHS include?

Answer 3

infection

people who are dehydrated (dependent elderly who can’t get their own drinks despite feeling thirsty)

Question 4

In HHS is the problem an insulin deficit or a fluid deficit?

Answer 4

a fluid volume deficit

Question 5

Is the main treatment of HHS fluid replacment or insulin?

Answer 5

fluid replacement

Question 6

Which thyroid hormone is responsible for calcium and phosphate regulation?

Answer 6

Calcitonin

Question 7

The INITIAL intervention in the symptomatic patient with hyperthyroidism is:

Answer 7

beta blocker

Question 8

An intubated ventilated PNA patient with Na 130, euvolemia, adequate UOP, and urine sodium 50. What is the cause of the hyponatremia?

Answer 8

SIADH

*SIADH is caused by head trauma AND lung problems, ventilator therapy

Question 9

For stroke patients who are NOT a candidate for tPA, what is the appropriate BP?

Answer 9

SBP<220 or DBP<110

*permissive HTN if they mount a HTN response

Question 10

Per ACCN exam, what is the target glucose level in acute stroke?

Answer 10

<145

Question 11

An acute inflammatory polyneuropathy is a characteristic of

Answer 11

Gullian barre syndrome

Question 12

Relapsing/remitting MS is characterized by what clinical course?

Answer 12

relapse over 1-2 weeks, lasts 4-8 weeks, returns to baseline

Question 13

Accurate dilantin levels may be affected by:

Answer 13

low albumin levels

*free dilantin levels measure unbound dilantin

*serum dilantin measued by bound to albumin

Question 14

The incomplete spinal cord injury syndrome that results in arms motor loss but spares the legs is

Answer 14

central cord syndrome

Question 15

What clinical finding in SCI is a poor prognostic sign because it is a hallmark of complete spinal cord injury?

Answer 15

priapism

Question 16

What is the timeframe for Subacute SDH ?

Answer 16

48 hours - 2 weeks

Question 17

Gnawing epigastric pain that is worse at night and relieved by vomiting, worse one hour after eating. Whats the dx?

Answer 17

duodenal ulcer

Question 18

What patients are at greatest risk for acalculous cholecystitis?

Answer 18

critical illness and sepsis

*they die because they are too sick for OR

Question 19

Central vision loss is caused in old people by

Answer 19

macular degeneration

Question 20

A patient with a history of heart failure arrives at the emergency department exhibiting shortness of breath and lower extremity swelling. Both of the patient’s symptoms are a result of:

a decrease in plasma oncotic pressure.
an increase in capillary hydrostatic pressure.
an increase in capillary membrane permeability.
an obstruction of lymphatic drainage.

Answer 20

an increase in capillary hydrostatic pressure

Question 21

When discharging an 85-year-old patient who has a diagnosis of stasis dermatitis, an adult-gerontology acute care nurse practitioner includes instructions to:

keep legs elevated while seated.
maintain systolic blood pressure greater than 120 mm Hg.
soak legs in warm water daily.
wear compression stockings of 65 mm Hg below the knee.

Answer 21

keep legs elevated while seated

Question 22

A 70-year-old patient with acute systolic heart failure denies any functional limitations, is able to walk five blocks before tiring, and is euvolemic. Which medication is the first-line therapy for this patient?

Amlodipine (Norvasc)
Digoxin (Lanoxin)
Furosemide (Lasix)
Lisinopril (Zestril)

Answer 22

ACE-I is 1st line therapy for HF
Lisinopril (Zestril)

Question 23

A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace) is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is parenteral:

cefoxitin (Mefoxin).
ceftriaxone (Rocephin).
ciprofloxacin (Proquin).
levofloxacin (Levaquin).

Answer 23

ceftriaxone (rocephin)

*cipro and levaquin are fluoroquinolones and can cause QT prolongation

*sotalol (beta blocker) can also cause QT prolongation

Question 24

. What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?

The Affordable Care Act
The Balanced Budget Act
The Civilian Health and Medical Program of the Uniformed Services
The Omnibus Budget and Reconciliation Act

Answer 24

The nonphysician practitioner (NPP) component of the Balanced Budget Act of 1997

the act also standardized NPP reimbursement at 85% of the physician’s Medicare fee schedule regardless of where that service was provided

Question 25

a patient is at increased risk for acalculous cholecystitis if they have:

Answer 25

biliary stasis (NPO, surgery, trauma, critical illness/sepsis because not using GI track)

Question 26

A patient with malobsorption related weight loss, mucoid diarrhea, vitamin B12 deficiency, and right lower quadrant abd pain might have:

Answer 26

Crohn's disease

Question 27

A patient with bloody stools which may lead to iron deficiency anemia (from bleeding), uses a nicotiene patch to limit disease symptoms, has a disease that is limited to the colon, may lead to perianal fissures, increases risk for adenocarcinoma of the bowel:

Answer 27

ulcerative colitis

Question 28

A rash with an annular shape, scales, erythematous base, raised borders with clearing in the center, found in the groin, fungus, is:

Answer 28

tinea cruris

Question 29

Bulls eye rash characteristic of Lyme disease is called: (it can also be seen without lyme disease)

Answer 29

erythema migrans

Question 30

Which skin condition is often seen with Steven Johnsons syndrome, has a positive Nikolsky's sign, and taget like lesions?

Answer 30

erythema multiforme MAJOR \*can be caused in response to medications Stevens-johnsons syndrome AKA erythema multiforme major

Question 31

A patient has a dark brown lesion that is one cm across and has a stuck on appearance. It is raised, has a warty texture, and well defined boarders. What is it and is it an emergency?

Answer 31

seborrheic keratosis not an emergency at all, benign lesion removal is cosmetic

Question 32

Actinic keratosis is found in sun exposed areas and needs to be treated because it can turn into

Answer 32

squamous cell carcinoma

Question 33

A common skin finding in a patient with insulin resistance and hyperinsulinemia, an area of darker thickened skin found in folds of obese patients is:

Answer 33

acanthosis nigricans

Question 34

Who is more at risk for malignant skin lesions? young or old smoker or non smoker HIV or not HIV pale/fair or dark skin

Answer 34

more at risk for malignant skin lesions old smoker HIV pale/fair skin

Question 35

What is the triad of symptoms associated with necrotizing fasciitis?

Answer 35

pain out of proportion to exam erythema swelling \*may also have weaping

Question 36

On the test, the most effective evidence based treatment that has shown to improve outcomes for necrotizing fasciitis is:

Answer 36

surgical debridement

Question 37

A pearly white or waxy bump, often with visible blood vessels, on your face, ears or neck. The bump may bleed and develop a crust. In darker skinned people, this type of cancer may be brown or black. \*slow growing CA

Answer 37

basal cell carcinoma

Question 38

What is the diagnostic criteria for SIRS?

Answer 38

temp \>38 c _or_ \<36 c HR\>90 RR\>20 (_or_ paCO2\<32 indicating hyperventilating) WBC \<4 or \>12 _or_ total bandemia \>10% of WBC \*must meet two or more criteria to dx SIRS\*

Question 39

What is the diagnostic criteria for sepsis?

Answer 39

temp \>38 c _or_ HR\>90 RR\>20 (_or_ paCO2 WBC 12 _or_ total bandemia \>10% of WBC suspected or present source of infection \*SIRS + source of infection\*

Question 40

Septic Shock Criteria

Answer 40

Severe Sepsis with Hypotension, despite adequate fluid resuscitation

Question 41

What is the diagnostic criteria for SEVERE sepsis?

Answer 41

temp \>38 c _or_ HR\>90 RR\>20 (_or_ paCO2 WBC 12 _or_ total bandemia \>10% of WBC suspected or present source of infection sepsis + Organ Dysfunction, Hypotension, or Hypoperfusion\* \*SBP\<90 or \<40 of baseline, lactic acidosis\*

Question 42

What is the most likely causative organism for subacute bacterial endocarditis is:

Answer 42

staphylococcus aureus

Question 43

If a patient lost 750ml of blood post-op. According to the american college of surgeons, if you are going to replace with crystalloid how much do you give to replace 750ml loss of blood?

Answer 43

2250ml LR/NS because you replace 3:1

Question 44

When is surgery or vascular procedure indicated for patient with AAA due to increased risk for rupture?

Answer 44

if your aneurysm is causing symptoms, or is larger than about 2 inches (roughly 5.0 to 5.5 centimeters), or is enlarging under observation of serial CT q 6-12 months

Question 45

Dysfunction of which of the following organs is key to the development of MODS? kidney liver GI tract endothelium

Answer 45

endothelium because vascular endothelium connects multiple organs

Question 46

What is a common reason for organ dysfunction in MODS?

Answer 46

microvascular thrombi

Question 47

If a patient is hypoperfused (that is the insult) and then has microvascular thrombi which leads to MODS, what is the standard progression of organ dysfunction?

Answer 47

pulmonary failure 4-6 days post insult hepatic failure 6-10 days post insult renal failure 10-14 days post insult

Question 48

Name two reasons to start TPN

Answer 48

the patient will not be able to get any other form of nutrition for greater than 7 days the patient has mandatory bowel rest (SBO, abd surgery etc)

Question 49

The hallmark feature of RA

Answer 49

prolonged early morning stiffness that takes \> 30 minutes to go away

Question 50

Gram negative cocci include\_\_\_\_\_ and can be treated with\_\_\_\_\_\_\_.

Answer 50

gonorrhea rocephin

Question 51

You have a patient with a tylenol overdose. How many hours after ingestion of tylenol would you expect to see changes in LFTs?

Answer 51

12-24 hours after ingestion

Question 52

What is the drug of choice in a patient with amphetamine or cocaine overdose?

Answer 52

benzodiazepine

Question 53

What medication class is CONTRAINDICATED in amphetamine overdose?

Answer 53

beta blockers because you will leave the patient with an unopposed alpha response which will increase HTN and increase risk for MI.CVA.CV collapse

Question 54

To establish malpractice four things must be established:

Answer 54

you must have a duty to the patient you must have violated a standard of care that violation has to be the cause of damages _there have to be damages_

Question 55

Normal neutrophil count is what percentage of total WBC?

Answer 55

60%

Question 56

You have WBC with high neutrophil count. Neutrophils fight what?

Answer 56

Neutrophils fight bacteria

Question 57

Your patient has an elevated WBC. On the differential the lymphocytes are elevated. What is your differential?

Answer 57

lymphocytes fight virus CLL

Question 58

You have a patient with elevated WBC and increase in monocytes. What is the differential?

Answer 58

monocytes like to debride non-infectious junk so if you have MI with dead tissue monocytes will get it if you have cancer monocytes will get it

Question 59

You have a patient with elevated WBC and elevated eosinophils. What is your differential?

Answer 59

hypersensitivity reaction drug reaction allergic reaction

Question 60

Neutrophelia is any neutrophil \>70% of total WBC

Answer 60

indicates bacterial infection

Question 61

The concept of the WBC Left shift is used to describe a differential that represented a

Answer 61

bacterial infection

Question 62

Bands are immature\_\_\_\_\_. They are immature. They shouldn't be out

Answer 62

4% of total WBC are normally bands if you have bandemia you have excess immature WBC that are getting out to fight infection