Review Quizzes Flashcards by Kelly Edwards

A 43 year old male presents to the primary care clinic with complaints of a cough that has persisted for 6 weeks. How with the APRN classify this patient’s cough? *
A. Acute cough
B. Subacute cough
C. Chronic cough
D. Chronic obstructive pulmonary disease

Feedback: Rationale: coughs may be classified as acute (lasting <3 weeks), subacute (lasting 3 to 8 weeks), and chronic (persisting beyond 8 weeks).1 Most coughs are acute and self-limited; 90% are caused by viral upper

How well did you know this?

Not at all

Perfectly

Which statement below regarding chronic cough is true? *
A. A postinfectious cough, by definition, lasts no longer than 8 weeks;
B. Chest radiographs are abnomal in postinfectious cough
C. Intervention is usually required for postinfectious cough to resolve
D. All of the above

A. A postinfectious cough, by definition, lasts no longer than 8 weeks;
Feedback: Rationale: A postinfectious cough, by definition, lasts no longer than 8 weeks; chest radiograph findings are normal, and the cough eventually resolves, generally without intervention.

How well did you know this?

Not at all

Perfectly

The pathogenic triad of chronic cough in immunocompetent nonsmoking adults includes all but the following: *
A. Use of ace inhibitors
B. GERD
C. upper airway cough syndrome
D. corticosteroid-responsive eosinophilic airway diseases

How well did you know this?

Not at all

Perfectly

Which of the following processes are not involved in pathophysiology that produces a cough? *
A. A neural receptor along the respiratory tree is stimulated
B. An afferent signal is transmitted to the “cough center” of the brain
C. The cough begins with a deep inspiration to approximately 50% of the vital capacity
D. The glottis rapidly closes and the abdominal and intercostal muscles contract, increasing the intrapleural pressures to 300 to 400 mm Hg

D.
the pressures are usually 100 - 200

How well did you know this?

Not at all

Perfectly

A sudden onset of cough in the supine position with an associated sour taste in the mouth
suggests: *
A. esophageal reflux
B. upper airway cough syndrome
C. a virus or common cold
D. none of the above

How well did you know this?

Not at all

Perfectly

A loud hacking cough during the daytime that is nonproductive, leads to exhaustion, and is
associated with emotional stress may suggest: *
A. Allergic rhinitis
B. Use of lisinopril
C. Psychogenic cough
D. Asthma

C.
A loud hacking cough during the daytime that is nonproductive, leads to exhaustion, and is associated with emotional stress may suggest psychogenic cough.

How well did you know this?

Not at all

Perfectly

Ace inhibitors can cause a nonproductive cough more commonly in all of the following groups
except: *
A. Women
B. Nonsmokers
C. Persons of Chinese ethnicity
D. Person’s older than age 50

D. Asians, non-smokers, and Women seem to be more prone to the cough side effect of ACE inhibitors for reasons that are not clear

How well did you know this?

Not at all

Perfectly

Which physical examination finding is typical in in a patient with cough from COPD? *
A. Inspiratory wheezes
B. Fine crackles
C. Course rhonchi
D. Expiratory wheezes

How well did you know this?

Not at all

Perfectly

An APRN is evaluating a patient with persistent cough. The patient’s chest radiograph is
normal. Which condition cannot be ruled out as the cause of the cough? *
A. Bronchiectasis
B. Sarcoidosis
C. Acute Bronchitis
D. Malignant lung cancer

C. Acute bronchitis
A normal chest film would exclude a malignancy, and bronchiectasis, and sarcoidosis. Acute bronchitis often presents no changes on imaging.

How well did you know this?

Not at all

Perfectly

An APRN suspects that her patient has asthma. The patient’s pulmonary function test is
normal. What should the APRN do? *
A. Tell the patient “you don’t have asthma because your PFT was normal”
B. Order a methacholine challenge test
C. Repeat the pulmonary function test
D. Prescribe Advair and see if the patient’s symptoms improve

B
Pulmonary function testing (PFT) and oxygen saturation levels may suggest a diagnosis of COPD, asthma, or restrictive lung disease. Intermittent asthma may occur with a normal PFT, and if no other cause is suspected then a challenge may be indicated.

How well did you know this?

Not at all

Perfectly

A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pre-travel vaccinations?

country specific guidelines are provided by individual embassies
malaria vaccine is the most important vaccine for worldwide travel
requirements should be reviewed at least 4 to 6 weeks prior to travel
There are at least five required vaccines for entry into certain countries

Feedback: Patients seeking immunizations prior to international travel should have these reviewed at least four to six weeks prior so that anybody responses and completion of vaccines series may occur. Country specific guidelines may be found on the CDC website. Malaria is not prevented by vaccine, but by prophylactic antimalarial drugs. There are only two vaccines that are required

How well did you know this?

Not at all

Perfectly

The nurse practitioner is establishing a plan for routine health maintenance for a new patient who is 80 years old. The patient has never smoked and has been in good health. What will the Nurse practitioner include in routine care for this patient? Select all that apply

annual hypertension screening
Baseline abdominal aorta ultrasound
colonoscopy every 10 years
One time hepatitis B vaccine
pneumovax vaccine if not previously given
yearly influenza vaccine

annual hypertension screening
pneumovax vaccine if not previously given
yearly influenza vaccine

She is past the colonoscopy age (50-74), and AAA ultrasound is for men who ever smoked, Hep B is a three dose series

How well did you know this?

Not at all

Perfectly

A pregnant woman reports not having had any vaccinations as a child but requests vaccines
during her pregnancy. Which vaccines may be given? Select all that apply

human papillomavirus HPV
Inactivated influenza
live attenuated influenza
measles months and rubella MMR
tetanus diphtheria and ancellular pertussis Tdap
varicella

Inactivated influenza, TdaP, and Hep B are the major vaccines given during pregnancy if needed. A TdaP is usually given every pregnancy.

The MMR, live vaccines, shingles, and varicella should not be given!

How well did you know this?

Not at all

Perfectly

A 76 year old patient is being seen in the clinic to establish care. She reports smoking for 20 years but quit 15 years ago with no current respiratory complaints but also not seeing a medical provider in many years. Which priority screening would the FNP recommend based on USPSTF guidelines?

Colonoscopy
Lung cancer screening
Osteoporosis screening
Pulmonary function tests

The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.

How well did you know this?

Not at all

Perfectly

You are a nurse practitioner working at an addiction clinic. Today, a 45-year-old male presents to your clinic with the chief complaint, “I am about to lose my family; I have to stop drinking.” You understand that it is important to fully screen this patient and you decide to use a tool to do so. The most common tool used in screening for alcohol abuse in this particular patient age group and setting is:

CAGE
CRAFFT
AUDIT
COWS

CAGE is the most sensitive and specific (better than AUDIT). CRAFFT is for teenagers / pediatrics while COWS is for opiates

How well did you know this?

Not at all

Perfectly

a 70-year-old male presents to clinic for routine annual physical. He reports a 30 year pack a day cigarette smoking history but no current respiratory complaints. Which screening would be most appropriate for this patient?

Pulmonary function test
Colonoscopy
AAA
bone density

AAA
Feedback: U.S. Prevent Svcs recommends 1x screen for AAA by US in: Men 65-75 w/ HX of smoke >100 cigs lifetime or Men ≥60 with fam HX of AAA in parent/sibling
bone densit

How well did you know this?

Not at all

Perfectly

According to MyPlate guidelines, How much of your plate should be filled with Fruits and
Veggies?
1/4
1/2
3/4
1/8

1/2 should be veggies, 1/4 protein, 1/4 grains

How well did you know this?

Not at all

Perfectly

What would the FNP consider a priority vaccination for a patient presenting in the clinic for a
routine physical prior to starting college as a freshman?
Influenza
HPV
Varicella
Meningococcal

Meningococcal
College students, especially those living in residence halls, are prone to contracting the disease because of their close proximity to each other

How well did you know this?

Not at all

Perfectly

A 55 year old patient who is currently undergoing chemotherapy for breast cancer presents to
the clinic requesting the shingles vaccine. What would the FNP do in this instance?

administer the Shingrix vaccine today
recommend no vaccines until she has finished her chemotherapy
ask her to return in a few weeks to ensure she is well enough for the vaccine instruct her that she is not an appropriate candidate for this vaccine

Administer the Shingrix vaccine today
The recently approved Shingrix vaccine is a recombinant protein and can be given to patients with cancer even if they are receiving or have recently received radiation or chemotherapy. Patients with lymphoma or leukemia also are eligible for the recombinant vaccine but not the non-Shingrix vaccine!

How well did you know this?

Not at all

Perfectly

What is Hemoccult testing used to evaluate?
GI tumors (especially colorectal)
Inflammatory Bowel Disease (UC or Crohn’s)
Hemorrhoids
all of the above

GI tumors and colorectal cancer are the usual uses for hemoccult as IBS and IBD may not cause bleeding, and hemorrhoids can be usually visualized without testing

How well did you know this?

Not at all

Perfectly

Paget Disease

Bone pain
Increased bone turn over and blood flow
May be warm / tender due to increased blood vessels in bone
Bone may be deformed on x-ray (bow shaped)
Elevated ALP or N-telopeptide level are diagnostic

Treat with biphosphanates and calcitonin

How well did you know this?

Not at all

Perfectly

Herben v Bouchard Nodes

Bouchard - Closer to knuckle, can occur on both (osteo and rhuematoid)
Herbden - On joint closer to fingernail, occurs more often in OA

How well did you know this?

Not at all

Perfectly

RA v OA

OA - pain / stiffness first thing that lessens after 30 mins

RA - pain / stiffness first thing that lasts longer, usually 2 hours

How well did you know this?

Not at all

Perfectly

Addison Disease

Adrenal underproduction of ACTH
Malaise, dizziness, cramps, hyper-pigment of skin, salt loss, weight loss
Hypotension and hypoglycemia can occur

Hydrocortisone PO matching diurnal pattern - 20-30mg per day total

How well did you know this?

Not at all

Perfectly

Addison Crisis

Severe symptoms from lack of corticoids during times of stress Needs IV steroids Severe hyponatremia and hyperkalemia can occur and renal failure

Diabetes Second Line Med

ASCVD patient - SGLT2i (-flozin) or DDP4i (-gliptin) HF/Renal patient - SGLT2i (-flozin) **avoid TZDs (-glitazone)** Weight Issue - GLP1 (-tide) or SGLT2i (-flozin) Cost Issues - Sulfonyurea or TZD

Urinary Incontinence Types

Stress - loss of urine associated with increased intra-abdominal pressure Urge - involuntary loss of urine preceded by strong urge to void Mixed - Urge and Stress Overflow - Incomplete emptying

General Anxiety Disorder Med

Buspirone has been shown to be very effective Escitalopram is also effective

A heavy smoker is in the ER complaining of generalized fatigue. He claims that he is always out of breath and has no more energy. His only medications are bronchodilators, which he rarely uses. Auscultation reveals enhanced resonance of voice sounds in his left chest. What is the most likely cause of this physical finding? * A. Asthma B. Pneumonia C. Emphysema D. Pneumothorax

B Egophony is an increased resonance of voice sounds when a medical professional auscultates the lungs. It is most pronounced in patients with pneumonia and fibrosis. There is enhanced transmission of high frequency noise across fluid. Similarly, bronchophony and whispered pectoriloquy can be used to assess the lungs.

A 35-year old primigravida comes to an antenatal clinic for her first obstetric visit. Her LMP was five weeks ago. She has a known case of HIV diagnosed 6 years ago and is adherent to her triple drug ART regimen with an undetectable viral load. At 35 weeks her viral load is still undetectable and she gives birth via normal vaginal delivery at 39 weeks. At discharge ART regimens for the mother and child are finalized. Which of the following recommendations about breastfeeding in HIV positive mothers is most accurate? * A. There is no significant risk of HIV transmission via breastfeeding in mothers under 30 years of age. B. In resource rich settings the benefits of breastfeeding outweigh the risk of HIV transmission C. Maternal antibodies in breastmilk will protect the infant from HIV infection D. The risk of HIV transmission from breastmilk makes breastfeeding unadvisable

D. There is a 15% chance of HIV transmission via breastmilk

A 43 year old IV drug user who has been on ART treatment complains of continuous diarrhea that is watery, epigastric pain and difficulty swallowing. His CBC shows a hemoglobin of 7.0 mg/dl, total leukocyte count of 2900cmm and a platelet count of 70,000. A CD4+ cell count was requested and it came out to be 90/cmm. Which of the following laboratory investigations would best help with the further evaluation of his diarrhea? A. Stool tests for oocysts of cryptosporidium B. Blood cultures for progressive disseminated histoplasmosis C. Microscopy for pseudohyphae of Candida albicans D. A stool for ova and parasites test for giardiasis

A. Stool tests for oocysts of cryptosporidium The scenario is indicative of diarrhea due to cryptosporidium which is a protozoan and responsible for causing severe diarrhea in AIDS. This is seen when CD4+ cell counts lower than 100 per cubic mm.

A 45 year old patient with a history of alcohol use disorder has developed weakness, fatigue, loss of appetite, weight loss and physical exam reveals ascites, hepatosplenomegaly, spider nevi, clubbing, and dupuytren contracture. His ALT/AST ratio is 2.7 and hemoglobin is 8.8 mg/dL. His MCV is 104 and ultrasonography detects nodularity and increased echogenicity of the liver. Which of the following would confirm a diagnosis of the suspected condition in this patient? *

Biopsy of the Liver

A 38-year-old woman presents to the clinic with a painful, tender keratinized lesion on the sole of her right foot. She says that the lesion developed two months ago and is slowly enlarging. She now has difficulty bearing weight on her affected foot. Her past medical history is significant for type II diabetes mellitus managed on rosiglitazone. Her last menstrual period was three weeks ago. She is sexually active with three partners, and inconsistently uses condoms. Vital signs are within normal limits. The examination of the foot shows a hyperkeratotic lesion with a dark center. The palpation of the lesion causes immense pain. What cancer is linked with the etiology of this lesion? A. Basal Cell Carcinoma B. Melanoma C. Cervical Cancer D. Burkitt's lymphoma

C This lesion is most likely a plantar wart. However, with skin contact, the HPV can be transferred to any part of the body. HPV tends to cause genital warts, flat warts, and palmoplantar warts. HPV is linked to cervical cancer.

A 58-year-old man presented to the hospital with right-sided decreased hearing for two years. His wife mentions he has started snoring recently. He has been a smoker for the last 25 years and smokes up to 20 cigarettes/day. The provider decides to perform a nasendoscopy. Which key anatomical area is the pathology most likely to be situated in? * A. Right Middle Meatus B. The roof of the nasal cavity C. Right vallecula D. Postnasal space

D In a patient with recent-onset unilateral hearing loss and nasal obstruction with a social history of smoking one must rule out a nasopharyngeal pathology most likely a malignancy.

A 49-year-old woman admitted to the hospital complaining of severe kidney injury after being stabbed by a thief. She was diagnosed with acute kidney failure and was referred to the hemodialysis center. Later on, she decided to undergo a kidney transplantation procedure. After the procedure was done, the doctor prescribed cyclosporine for her as prophylaxis to avoid organ rejection. Still, after a month, she came to the hospital complaining of some flu-like symptoms and fever. The doctor noticed that the previously prescribed drug is not efficient in reducing immunity. What is the next preferred step to avoid rejection? * A. Prescribe tacrolimus B. Increase the dose of cyclosporine C. Prescribe amoxicillin D. Prescribe paracetamol

A Tacrolimus is efficient more than ten folds when compared to cyclosporine. • Calcineurin inhibitors' dosages should be monitored cautiously as an increase in its blood concentration could cause many complications like kidney failure.

A 28-year-old primigravida presented to the antenatal clinic for a routine check-up. She has been exposed to someone with chickenpox but has not developed any skin lesions. She has no varicella-zoster antibodies. What would be the best possible treatment for her? * A. Chickenpox vaccine B. Immunoglobulins C. Antivirals D. No medication is required

B An immunocompromised patient, when exposed to someone with chickenpox, is given immunoglobulins unless he develops the disease. • An immunocompromised patient, when exposed to someone with chickenpox, is given antivirals when he develops the disease. • When a pregnant patient is exposed to someone with chickenpox, and she has not developed the disease. Her varicella-zoster antibodies are checked. If she has antibodies, no further treatment is required. • If a pregnant patient is exposed to someone with chickenpox and she has developed skin lesions, then antivirals are given.

A 55-year-old male with a 75 pack-year history of smoking presents to the clinic to establish primary care and discuss age-appropriate screening options for cancer. His pulse rate is 78/min, blood pressure is 140/80 mmHg, and saturation at room air is 96%. Air entry is decreased bilaterally with occasional rhonchi and crepitations on chest auscultation. He is advised by the primary care provider to undergo a low dose CT scan (LDCT) for screening. Which of the following are the criteria for undergoing this screening test for this patient? A. All adults between ages 55 and 80 years B. Adults more than 40 years of age with a 20 pack-year smoking history C. Adults aged 55 to 80 years with a 30 pack-year smoking history D. Adults less than 60 years of age who are active smokers and have no other risk factors

C recommendations are for patients more than 55 years of age with an additional risk factor such as family history, occupational exposure to carcinogens, or personal history of chronic obstructive pulmonary disease (COPD). According to the National Lung Screening Trial, patients aged 55 to 80 years with a 30 pack-year history of smoking who are active smokers or quit within the last 15 years qualify for annual low-dose CT screening. Patients with a life-limiting condition should not be screened.

A preventative medicine task force is trying to identify and combat peripheral arterial disease among the rural population they serve. They seek information regarding a rapid, low cost, and sensitive tool to detect this disease that can be used at health fairs scheduled to take place in the rural town centers. Which of the following would be the best screening tool for this situation? Doppler ultrasound 5-minute treadmill test Ankle-brachial pressure index (ABI) Pedal pulse palpation

In a study of over 18,000 men, the presence of bilateral dorsalis pedis and posterior tibial pulses ruled out peripheral arterial disease (PAD) with enough reliability for the authors to conclude it could be used as an appropriate initial screening tool for PAD.

Pedal pulse palpation

A 35-year-old woman with a history of gestational diabetes at age 23 is seen for an annual physical exam. Based on the American Diabetes Association (ADA) recommendations for screening for type 2 diabetes in those with a prior history of gestational diabetes, what is the maximum recommended testing interval for screening this patient for diabetes?

Every 3 years. Gestational diabetes often heralds Type 2 DM later in life.

A 63-year-old female patient presents for an annual exam. She has a history of a hysterectomy 10 years ago in Germany, but us not sure why she had the hysterectomy. She had an abnormal pap smear and a cold knife cone 2 years before she had the hysterectomy but never had followed up with that clinician. She has not been sexually active for the last 3 years. She denies any vaginal bleeding or pain, denies any unusual vaginal discharge or odor. She does not have insurance, so she does not want any test done that is not needed. What is the best next step?

Pap smear with HPV test. A history of a cold knife cone indicates some sort of pre-cancerous condition prior to the hysterectomy and a lack of any follow up indicates a need for a PAP and HPV.

A 66-year-old man with a history of 40 pack-year smoking presents to the clinic for a routine medical examination. He has no active symptoms. His routine chest X-ray shows a solitary pulmonary nodule. Which of the following is the next best step in the evaluation of this patient?

a PET CT is the best diagnostic test that is minimally invasive

An 87-year-old woman is brought to the office for a routine appointment. The patient has an extensive bruise to the side of her face, which she attributes to “being clumsy and falling”. Which of the following possible patient factors is the strongest indicator to contact Adult Protective Services in this case? Residence with a first-degree relative Extensive medication list Wheelchair-bound A strong “independent streak” to her personality

Wheelchair bound. Factors making elderly abuse more common include functional impairment, poor physical health, and residence in a nursing home.

A 40-year-old female of Japanese descent presents to the clinic wanting to know if she should be screened for diabetes because her second cousin was recently diagnosed with diabetes mellitus. The patient's body mass index (BMI) is 23 kg/m2, her blood pressure is 135/85 mmHg, her triglycerides level is 200 mg/dL, and her high-density lipoprotein (HDL) level is 40 mg/dL. Which of the following warrants screening for diabetes mellitus according to the American Diabetes Association Standards of Care published in January 2020?

Her BMI. In persons of Asian ancestry, a BMI of 23 or more should be screened for DM.

A 21-year-old female presents to the office for a health maintenance visit. She has no complaints at the moment. Her medical and surgical histories are insignificant. Her family history is significant for breast cancer in her mother and hypertension in her father. The physical exam is unremarkable. The clinician counsels her about starting cervical cancer screening. She states that she had received the human papillomavirus (HPV) vaccine and, for that reason, wants the screening to be delayed. What is the appropriate response?

HPV vaccination does not change the recommendations for screening guidelines. Pap smear screening with HPV testing should begin at age 21.

An 18-year-old male college student is brought to the emergency department with fever, headache, and confusion. He lives in a dormitory at a boarding school. He has no significant past medical history. His vital signs reveal temperature 39 C, blood pressure 105/77 mmHg, respiratory rate 22/min, and pulse 98/min. Physical examination shows mild neck stiffness, photophobia, and petechiae on his shins bilaterally. A vaccine with which of the following properties is most likely to have prevented this patient's disease? Live attenuated antigen Conjugated capsular polysaccharide (CPS) Activated antigen Antibiotic-enhanced

The conjugation of a bacterial CPS to a protein induces stronger antibody responses. The use of this vaccine has eliminated all Hib disease, providing strong evidence that the conjugate vaccine is highly effective.

A 35-year-old G2P1001 woman at 36 weeks and 5 days gestation presents to the clinic for a prenatal follow-up visit. Since her last visit, the patient denies any major issues including vaginal discharge, vaginal bleeding, contractions, or decreased fetal movement. Her vital signs on arrival are within normal limits, with blood pressure noted to be 122/76 mmHg. Her prenatal course has been uncomplicated thus far. She is currently taking prenatal vitamins. Which of the following is the next best step in the management of this patient? A. Counsel patient regarding signs and symptoms of early labor, and schedule next prenatal visit in 4 weeks B. Schedule the patient for induction of labor at term 39 weeks if the patient does not go into spontaneous la- bor during the next 2 weeks C. Obtain group b streptococcus screening D. Tdap vaccination

C A is incorrect because prenatal visits occur every week past 36 weeks. B is incorrect because induction is only scheduled at 40 weeks. D is incorrect because she should have gotten a TdaP at her first visit.

Which of the following is NOT a recommendation of the Advisory Committee on Immunization Practices (ACIP) for the use of HPV vaccine? A. HPV vaccination is routinely recommended for all boys and girls at age 11 or 12 years. B. Catch-up vaccination is recommended for all persons 13 through 26 years of age who are not adequately vaccinated. C. Adults age 27 through 45 years who are not adequately vaccinated may receive HPV vaccine based on shared clinical decision-making. D. HPV vaccine should be offered to all unvaccinated adults 65 years and older.

D ACIP does not recommend HPV vaccination for unvaccinated adults aged 65 and older. The HPV vaccine is not licensed for use in adults over age 45.

A 2-month-old child is being seen for a check-up. If pneumococcal conjugate vaccine (PCV13) is started today, the routine schedule for PCV13 would be a dose today and then doses at: A. 3 months, 4 months, and 6 months of age B. 4 months, 6 months, and 12 through 15 months of age C. 6 months, 12 months, and 18 months of age D. 9 months and 12 through 15 months of age

B. The CDC recommends PCV13 for all infants as a series of 4 doses. Doses are given at 2, 4, 6, and 12 to 15 months of age.

Which type of pneumococcal vaccine is indicated for a 19-year-old woman with HIV infection who has never received pneumococcal vaccine? PCV13 PPSV23 Both PCV13 and PPSV23 Neither vaccine is recommended

A 19-year old with HIV should receive both PCV13 and PPSV23. Administer 1 dose of PCV13 first, then 2 doses of PPSV23. Give the first dose of PPSV23 at least 8 weeks after PCV13. Give the 2nd dose of PPSV23 at least 5 years after the 1st.

Risk factors for the development of meningococcal disease include

Persistent complement component deficiency and functional or anatomic asplenia increase one’s risk of invasive meningococcal disease.

Persons who should receive meningococcal conjugate vaccine booster doses every 5 years include those

With functional or anatomic asplenia With terminal complement component issues Those who work in labs with Neisseria meningitides

The most common complication of herpes zoster:

post-herpetic neuralgia

ACIP recommends zoster vaccine for adults without contraindications who are: 40 years of age or older. 50 years of age or older. 60 years of age or older. 70 years of age or older.

50 years or older

Which statement is accurate and included in the inactivated seasonal influenza Vaccine Information Statement? Adults 65 years of age and older should receive 2 doses of influenza vaccine each season. Children 6 months through 8 years of age might need two doses during one year. Persons who have had a severe allergic reaction to eggs should not be given influenza vaccine. Pregnant women and persons who are immunosuppressed should not receive influenza vaccine.

Children 6 months through 8 years of age might need two doses during one year.

Which inflammatory mediator is responsible for bronchoconstriction, coronary vasoconstriction, and peripheral vasodilation? *

Prostaglandins

What is the hallmark exam finding for myxedema coma?

Pretibial edema

Which finding is characteristic of a heat stroke? * Core body temperature rises above 104°F Core body temperature rises above 106°F Core body temperature raises above 102° F Core body temperature rises above 110°F

Core body temp rises above 104

If a patient discloses that they have been sexually assaulted in the past 24 hours, the provider should:

Defer an examination and refer them to the ED. If the assault happened within the last five days, they should be referred to the ED for exam and evidence preservation.

A patient has Meniere's disease with frequent attacks. About what drug does the NP plan to teach the patient?

Meclizine 12.5 - 25 mg up to 3-4 times per day

A patient presents to the clinic complaining of fullness in his right ear with decreased hearing. He denies pain or fever. What condition does the FNP suspect?

Otitis Media with Effusion

Main causes of acute viral GI illness

Norovirus Rotovirus

A 65 year old female patient presents to the clinic complaining of abdominal pain, n/v, distention, &constipation for the past few days. The FNP auscultates high-pitched (aka "tinkling") bowel sounds. What condition does the FNP suspect?

Bowel obstruction

10. What is the most common cause of pancreatitis?

Gallbladder disease

10. What is the most common cause of pancreatitis?

Gallbladder disease

S: DZ is a 34 year old male with no significant past medical history. He lives at home with his wife two children, ages 6 and 10. No known drug allergies. He presents to an urgent care clinic with a 2 day history of fever and sore throat. On exam he is noted to have dry mucous membranes, enlarged lymph nodes, and a sore throat with exudative patches on the tonsils. O: Rapid Antigen Detection Tests (+) for GAS What is the most appropriate treatment for this patient?

Amoxicillin 500mg twice a day

Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except: A. Bacitracin-polymyxin B B. Ciprofloxacin C. Erythromycin D. Penicillin

D Bacterial conjunctivitis is most often treated with ophthalmic antibiotic eyedrops or ointments such as Bleph (sulfacetamide sodium), Moxeza (moxifloxacin), Zymar (gatifloxacin), Romycin (erythromycin), Polytrim (polymyxin/trimethoprim), Ak-Tracin, Bacticin (bacitracin), AK-Poly-Bac, Ocumycin, Polycin-B, Polytracin

When prescribing oxybutynin (ditropan) for the patient with overactive bladder symptoms, which disorder in the patient's medical history must the family nurse practitioner consider before prescribing? Cough Narrow angle Glaucoma Diabetes Gallstones

Narrow angle glaucoma

The family nurse practitioner is taking a history of a patient who has been diagnosed with renal calculi. What information in the history would the family nurse practitioner identify as a precipitating factor in the development of renal calculi? Drinking 6-8 oz of milk daily History of fractured femur and prolonged bed rest Increased incidence of UTI's over the past 3 years High intake of citrus fruits and carbohydrates

Long-term bed-rest-induced renal stone formation was found to be induced by increased urinary calcium and subsequent crystal formation of calcium oxalate and calcium phosphate.

When to do a Urine Dipstick v. Urine Culture / Sensitivity

In uncomplicated UTIs or non-recurring UTI, a simple dipstick can confirm UTI. A C/S should be done in complicated UTI, patient with fever, recurrent, suspected urinary stone, or congenital defects.

Pyelonephritis follow up

Patients should return for a post-antibiotic urine culture and sensitivity (7-10 days)

Back pain red flag

Fever

Cellulitis arm symptoms

swollen lymph nodes fever and chills Erythema

A patient presents to the NP's office and states that there was a deer tick crawling on her one month ago. She was sick with a cold recently and is concerned that perhaps she has contracted Lyme disease. The NP gets the following results from the serology studies: Lyme AB screen: 1.38 (a positive Lyme antibody screen is > or = to 1.10) A Western blot IGG and IGM is done. All bands are negative or non-reactive. The NP correctly offers the following information:

The patient does not have Lyme disease, so no therapy is needed. The appropriate Western blot bands are required to qualify as a positive result. No positive or reactive bands means a negative result. In addition, the complaints of a cold are not consistent with more common symptoms of Lyme infection

A woman who is obese and has a neck circumference of 16.5 cm presents to the clinic for a wellness check. Which test is necessary to assess for complications of obesity in this patient based on this finding?

Polysomnography - a sleep study to assess for OSA.

A 24-year-old black woman is found to have bilateral hilar adenopathy on a routine chest-ray. Based on this finding, which of the following is the best diagnosis?

Sarcoiidosis

A 50 year old male patient presents to the clinic complaining of fever, nausea, vomiting, rapid onset of abd. pain that radiates to the midback, and epigastric area or upper abdomen, anorexia. He also reports that the Pain is often relieved by leaning forward. What diagnosis does the FNP consider based on these symptoms?

Pancreatitis

Which cholesterol lowering medication class causes severe flushing and should have aspirin or NSAIDs administered before taking the medication?

Nicotinic Acid

You examine Jane, a 24 y/o female who has an acute asthma flare following a 3 day hx of UPR sxs (clear nasal discharge, dry cough, no fever). She has a hx of moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PEF). She is using budesonide (Pulmicort) and albuterol as directed and continues to have difficulty with coughing and wheezing. At home her PEF is 55% of personal best. In the office, her forced expiratory volume at 1 sec (FEV1) is 65% of predicted. Her medication regime should be adjusted to include:

Prednisone decreases your immune system's response to reduce symptoms such as swelling and allergic-type reactions. Prednisone and other systemic steroids may be used to treat asthma attacks and help people gain better asthma control. The recent history of an URI suggests a short term use of oral steroids can mitigate the issue, if her symptoms persist then consider adding a LABA (move to step 3)

A 68 year old female patient presents to the clinic with a suspected exacerbation of Heart Failure. What diagnostic testing will the FNP consider ordering?

Chest x-ray, EKG, CBC, CMP, BNP, lipids

A patient reporting dyspnea and chest pain along with occasional chills and night sweats has a chest radiograph that shows bilateral hilar lymphedenopathy or BHL and pulmonary and filtrates. The nurse practitioner suspects which classification of sarcoidosis?

Stage 2. 1-BHL only, 2-BHL+Infiltrates, 3-Infiltrates only, 4-fibrosis

A woman was recently diagnosed with osteoarthritis. During patient education, the woman is informed that the following conditions or actions can cause or worsen primary osteoarthritis:

Overuse of joints, aging, obesity Secondary is worsened by diabetes or a congenital abnormality

A woman was recently diagnosed with osteoarthritis. During patient education, the woman is informed that the following conditions or actions can cause or worsen primary osteoarthritis:

Overuse of joints, aging, obesity Secondary is worsened by diabetes or a congenital abnormality

In Alzheimer's disease, donepezil is used to increase which chemical in the brain?

Acetylcholine

Mrs. M has rheumatoid arthritis. on reviewing an x-ray of her hip, you notice that there is a marked absence of articular cartilage. what mechanism is responsible for this?

Lysomal degradation of the cartilage

M. age 34 presents with sxs resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome? musculoskeletal pain difficulty sleeping depression fatigue

Muscoskeletal pain

J. age 76 has been given dxes of osteoporosis confirmed with a dual-energy x-ray absorptiometry (DEXA) scan. you have educated her about the importance of increasing calcium and vitamin D in her diet and starting a low impact wt bearing exercise program. you are also going to start her on medical management. J. ask you about a drug called a "SERM" that she has heard has been shown in studies to prevent vertebral fx. which of the following pharmacological tx for osteoporosis is classified as a selective estrogen receptor modulator (SERM)?

Raloxifene

Questionwhat do affects older individuals, particularly women and is characterized by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs of systemic infection such as malaise, wt loss, sweats, and low-grade fever?

Polymyalgia rheumatica

S. age 50, presents with Paget's disease that has been stable for several yrs. recently, his serum alkaline phosphatase level has been steadily rising. you determine that it is time to start him on:

Biphosphonates

bone mineral density (BMD) testing is recommended by the National Osteoporosis foundation for which fo the following clt populations to assess whether they are at high risk for osteoporosis? all women age 65 and older regardless of risk factors all men age 65 and older regardless of risk factors all women in their 30s for baseline all women of menopausal age

all women age 65 and older regardless of risk factors. younger women with risk factors should be screened

J. age 49 has recently begun a rigorous wt-lifting regimen. she presents in your office with a shoulder dislocation. which of the following clinical manifestations make you suspect an anterior shoulder dislocation over a posterior dislocation?

Inability to shrug the shoulder is suggestive of anterior dislocation

H., age 59 has Paget's disease of the bone. it was dx as a result of routine blood work during his annual physical, which showed an increased serum alkaline phosphate level. you know that the most serious complication of Paget's disease is:

Osteosarcoma

B.W. is a 34-year-old male who complains that his left knee has been painful for three days and is getting progressively worse. He describes the pain as throbbing and rates the pain as a 7/10. ROS is positive for fever. He denies fatigue, weight loss, and rash. PMH is unremarkable. He denies past GI or GU infection. Surgical history includes previous arthroscopic surgery to left knee two years ago. Social histroy includes smoking 2 packs/day. On exam, the left knee is erythematous, warm and edematous. Which diagnosis is most probable?

Septic arthritis

The wife of the client diagnosed with meningitis asks the nurse, "I am so scared. What is meningitis?" Which statement would be the most appropriate response by the nurse Practitioner?

"This is a bacterial infection of the meninges, causing inflammation."

What is the treatment for ALS?

Liver function tests Riluzole/antiglutamate Neurology consult

Which disease may present in the following progression timeline? Progressive weakness develops days to weeks. Lost deep tendon reflexes may lead to eye problems/affects all body parts. Autonomic instability 5% 20% have residual weakness Peaks at 3 weeks

GBS

Which type of dementia is characterized by: Gradual onset with moderate progression. Cognitive symptoms include memory, visuospatial, hallucinations, and fluctuations. Motor symptoms are typically parkinson's like

Lewy Body Dementia

which condition is characterized by: chronic, inflammatory joint disease that causes buttocks pain, joint pain/swelling,which primarily affects the spine and SI joints; however, larger peripheral joints can also be affected

Ankylosing spondylitis

Which tests should be monitored regularly to monitor for complications of chronic renal disease.

Parathyroid hormone levels serum lipids Vitamin D levels

Which tests should be monitored regularly to monitor for complications of chronic renal disease.

Parathyroid hormone levels serum lipids Vitamin D levels

Which diagnosis might the FNP consider with these findings: FBS >100, waist circumference >35, HTN >130/85, High Triglycerides >160, Low HDLs <50

Metabolic Syndrome

The nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should:

Perform a dipstick urine test for UTI

A patient reports having urinary frequency and discomfort associated with urination. After a careful physical examination and history to determine the cause, the NP should prescribe a medication from which drug class?

Antispasmodics

A patient has a UTI and will begin treatment with an antibiotic. The patient reports moderate to severe suprapubic pain. The NP should prescribe:

Phenazopyridine

A 65 year old patient presents to clinic with symptoms of Impaired memory, Low energy, Impaired ability to concentrate and Social withdrawal. What diagnosis does the FNP consider?

Depression

A 40 yr old woman is dx with a first episode of moderate depression. What medication would be a good initial choice for her?

Escitalopram 10mg/day

Acute adrenal insufficiency is the most serious complication of:

Addison Disease

Which diagnosis will the FNP consider for the following symptoms: secondary hypertriglyceridemia, coarse, dry skin, menorrhagia, hyporeflexia with a characteristic slow relaxation phase, the "hung-up" reflex, coarse hair with tendency to break easily, thick dry nails, constipation

Hypothyroid

A 19-year-old boy comes in for a follow-up of exudative tonsillitis with a streptococcus positive throat culture. He states that his throat feels much better but this morning his urine had a pink tinge and was very foamy. What does the FNP suspect is happening with this patient?

Glomerulonephritis

The FNP diagnoses a 42-year-old male with glomerulonephritis. Which potential complications will be monitored?

Hypertension

The nurse practitioner is reviewing the laboratory values of a 28-year-old male patient who presents to the office to establish care with a primary care provider. The lab results from the previous week indicate an A1C of 7.2. The nurse practitioner obtains a fasting blood sugar in the office of 142. The patient denies any significant past medical history and states that he "feels fine." The nurse practitioner recognizes that:

The patient has diabetes and further testing is needed to investigate, especially since he is only 26.

24. The most common comorbidities that occur with type 2 diabetes mellitus are:

Hypertenion, obesity, hyperlipidemia

Review Quizzes Flashcards

(118 cards)