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AGNP BOARD EXAM: Hematology Prescription (17 Questions with Answers and Explanations)
AGNP BOARD EXAM: Hematology Prescription (17 Questions with Answers and Explanations) AGNP BOARD EXAM: Hematology Prescription (17 Questions with Answers ... [Show More] and Explanations) Question: Folic acid (vitamin B9) is used to treat: microcytic anemia. anemia of chronic disease. macrocytic anemia. Correct normochromic anemia. Explanation: Folic acid (vitamin B9) is used to treat macrocytic anemia secondary to folic acid deficiency. Folic acid is necessary for purine and pyrimidine synthesis, and is required for nucleoprotein synthesis and maintenance in erythropoiesis. It stimulates WBC and platelet production in folate deficiency anemia. Question: When taking corticosteroids for the treatment of immune thrombocytopenia, stopping them abruptly could result in: hypertension. hyperkalemia. Cushing's syndrome. an adrenal crisis. Correct Explanation: Corticosteroids should not be stopped suddenly after prolonged use. This can result in adrenal crisis because of the body's inability to secrete enough cortisol to make up for the withdrawal. Nausea, vomiting, and shock are the reported side effects of adrenal crisis. Cushing's syndrome is just the opposite. It results from excessive amounts of cortisol. Question: The most common side effect of ferrous sulfate is: headache. dizziness. fatigue. constipation. Correct Explanation: The most common side effect of ferrous sulfate is constipation. Headache, dizziness and fatigue may be signs and symptoms of anemia. Question: Another name for vitamin B12 is: biotin. cyanocobalamin. Correct riboflavin. thiamin. Explanation: Another name for vitamin B12 is cyanocobalamin. Biotin is vitamin B7; riboflavin is vitamin B2; and thiamin is vitamin B1. Question: Folic acid (vitamin B9) is: beneficial in the treatment of pernicious anemia. administered only in conjunction with vitamin B12. may correct neurologic manifestations of anemia. a water-soluble vitamin. Correct Explanation: Folic acid (vitamin B9) is a water-soluble vitamin and is excreted when stores are adequate. It can be administered orally, intramuscularly, intravenously, or subcutaneously. Doses of folic acid above 0.1 mg daily may obscure pernicious anemia. This condition is discovered when hematologic remission occurs as neurologic manifestations remain progressive. Administration of folic acid alone is improper therapy for pernicious anemia and other megaloblastic anemias in which vitamin B12 is deficient. Question: After correcting a decreased hemoglobin in a patient who has iron deficiency anemia, oral iron supplementation should be continued for at least: 2 weeks. 4 weeks. 8 weeks. 12 weeks. Correct Explanation: To replete iron stores, treat for 3 to 6 months after hemoglobin has normalized. Initial treatment of iron deficiency anemia is usually with oral iron (ferrous sulfate, ferrous gluconate, or ferrous fumarate). The reticulocyte count should peak at 1 to 2 weeks, hemoglobin after 2 to 4 months, and replacement of iron stores after 6 months. Question: Folic acid is also known as: vitamin B1. vitamin B6. vitamin B9. Correct vitamin B12. Explanation: Folic acid is also known as vitamin B9. Vitamin B12 is also known as cyanocobalamin; vitamin B1 is thiamin; and vitamin B6 is pyridoxine. Question: Which one of the following actions is LEAST likely to improve GI symptoms in a patient who is taking iron by mouth? Switching to a lower elemental iron-containing pill Taking the iron supplementation in a liquid form Taking iron supplementation just before bed Correct Taking iron supplementation with food Explanation: Taking an iron supplement with food will decrease absorption of the iron taken by mouth. Up to 10% of patients may have gastrointestinal intolerance when taking iron supplementation for iron deficiency anemia. Gastrointestinal symptoms may be minimized by switching to a formulation with lower elemental iron content per pill, taking a liquid formulation, or taking pills with food. Question: Iron-containing medications should: be stored in a dark area. be properly secured from children. Correct be taken with food. be avoided in pregnancy. Explanation: The Consumer Product Safety Commission requires that iron-containing medicines and vitamins be packaged in child-resistant containers. Parents should always properly resecure safety closures. Taking an iron supplementation with food will decrease the absorption of the iron and greatly diminish its benefit for the treatment of iron deficiency anemia. Question: The administration of iron is the primary treatment for iron deficiency anemia (IDA). IDA is a: microcytic anemia. Correct anemia of chronic disease. macrocytic anemia. G6PD deficiency. Explanation: The administration of iron is indicated in the treatment of iron deficiency anemia evidenced by microcytic, hypochromic red blood cells. The primary treatment for anemia of chronic disease (ACD) is treatment of the underlying disorder. Iron may be administered in ACD as a supplemental therapy. Examples of macrocytic anemia are folate deficiency and vitamin B12 deficiency. G6PD is a hemolytic anemia that is typically normochromic and normocytic. If a patient develops G6PD and becomes symptomatic, treatment may include folic acid as a supportive therapy. Question: Patients taking corticosteroids long-term for the treatment of immune thrombocytopenia should be instructed to: consume their normal diet. limit sodium intake. Correct limit potassium. decrease protein intake. Explanation: Patients placed on long-term corticosteroid therapy should be instructed to limit their sodium intake to avoid retention of excessive fluid. They should increase their potassium and protein intake since potassium tends to be excreted and protein is needed to maintain healing. Question: Which food should be avoided when taking corticosteroids for the treatment of lymphoma? Orange juice. Grapefruit juice. Correct Bananas. Apples. Explanation: Grapefruit and grapefruit juice inhibit the action of CYP3A4 enzymes, which are necessary to metabolize prednisone. Without the action of these enzymes, prednisone levels increase. If grapefruit or grapefruit juice is ingested, the side effects of prednisone will be more pronounced. Question: Patients taking supplemental iron should be advised to take tetracycline antibiotics at least: 30 minutes before or after the iron. 1 hour before or after the iron. 2 hours before or after the iron. Correct 6 hours before or after the iron. Explanation: An oral tetracycline should be administered at least 2 hours before or after taking iron supplementation. The combination of oral iron tends to interfere with the absorption of tetracycline. Tetracyclines include demeclocycline, doxycycline (Vibramycin) and minocycline (Minocin). Question: The common side effect of corticosteroids that is LEAST likely to require medical attention is: jitteriness Correct fever. purpura. weight gain. Explanation: Corticosteroids are associated with a greater risk of infection, and fever should be monitored and reported. Weight gain may indicate the development of Cushing syndrome. Glucocorticoid-associated purpura often affects the sun-exposed areas of the dorsum and forearm and should be reported to the prescriber. A common side effect of corticosteroids that usually does NOT warrant medical attention is jitteriness. The other answer choices would require medical attention, especially if steroids have been used for a prolonged period. Question: Cyanocobalamin (vitamin B12) is primarily stored in the: fat tissue. gastrointestinal tissue. liver. Correct subcutaneous tissue. Explanation: Absorbed cyanocobalamin (vitamin B12) is transported via specific B12 binding proteins, transcobalamin I and II, to the various tissues. The liver is the main organ for vitamin B12 storage. Question: Cyanocobalamin (vitamin B12) is best absorbed via the: intranasal route. intramuscular route. Correct oral route. sublingual route. Explanation: Cyanocobalamin (vitamin B12) is best absorbed via intramuscular or subcutaneous routes. Cyanocobalamin is quantitatively and rapidly absorbed from intramuscular and subcutaneous sites of injection; the plasma level of the compound reaches its peak within 1 hour after intramuscular injection. Question: Neurologic manifestations related to vitamin deficiency must be corrected with: biotin (vitamin B7). cyanocobalamin (vitamin B12). Correct riboflavin (vitamin B2) thiamin (vitamin B1). Explanation: Neurologic manifestations of vitamin deficiency should be corrected with cyanocobalamin (vitamin B12). Vitamin B12 deficiency that is allowed to progress for longer than 3 months may produce permanent degenerative lesions of the spinal cord. Doses of folic acid greater than 0.1 mg/day may result in hematologic remission in patients with vitamin B12 deficiency. However, neurologic manifestations will not be prevented with folic acid, and if not treated with vitamin B 12, irreversible damage will result. [Show Less]
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AGNP BOARD EXAM Hematology Assessment (24 Questions with Answers and Explanations)
AGNP BOARD EXAM Hematology Assessment (24 Questions with Answers and Explanations) AGNP BOARD EXAM Hematology Assessment (24 Questions with Answers and Ex... [Show More] planations) Question: If a newborn develops a cephalohematoma, the newborn is at an increased risk for: infection. jaundice. Correct caput succedaneum. erythema toxicum. Explanation: Cephalohematomas are characterized by bleeding between the bone and the periosteum. Because of breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. They do not increase the risk for infections. Caput succedaneum is an edematous area on the head from pressure against the cervix. Erythema toxicum is a benign rash of unknown cause that consists of blotchy red areas. Question: A twelve-month-old was recently diagnosed with Acquired Immunodeficiency Syndrome (AIDS). The mother asks the nurse practitioner: "How could my child have acquired AIDS?" The best response from the nurse practitioner should be that: "Children under two years of age usually acquire AIDS: by sharing car seats with an HIV infected toddler." because the child may have been sexually abused by someone who was HIV positive." perinatally through an HIV infected mother." Correct through casual contact with an HIV infected individual in a day care center." Explanation: Perinatally is the acquired mode for infants. Children usually over five years of age acquire AIDS through sexual abuse. HIV does not survive in the environment and there is no evidence to date to support the fact That AIDS is acquired through casual contact or by sharing car seats with HIV infected seats. Question: Which ethnicity is associated with glucose-6-phosphate-dehydrogenase (G-6-PD) deficiency? American Indian black Correct Asian Hispanic Explanation: Glucose-6-phosphate-dehydrogenase (G-6-PD) deficiency is a condition in which red blood cells break down when the body is exposed to certain drugs (aspirin, antimalaria drugs) or the stress of infection. G-6-PD is most prevalent in people of Mediterranean and African descent, and specifically common in Saudi Arabian, African, and black patients. Question: The blood lead level that requires further testing and monitoring in children is: 3 mcg/dL. 5 mcg/dL. Correct 7 mcg/dL. 9 mcg/dL. Explanation: In children, a blood lead level of 5 mcg/dL or 0.24 µmol/L or greater requires further testing and monitoring. The source of lead must be found and removed. A lead level greater than 45 mcg/dL or 2.17 µmol/L in a child's blood usually indicates the need for chelation. Question: Which of the following foods contains the LEAST amount of folic acid? Dairy Correct Green leafy vegetables Liver Fruits Explanation: Dairy foods such as cheese, milk and yogurt do not contain folic acid unless they have been specifically fortified to include this vitamin. Foods high in folic acid include green leafy vegetables, meat from animal sources, fruits, nuts, liver, and foods containing yeast. Question: Which assessment finding is consistent with pernicious anemia? Facial palsy Nuchal rigidity Priapism Peripheral neuropathy Correct Explanation: Pernicious anemia is associated with B12 deficiency. Vitamin B12 deficiency may lead to nerve damage attributable to pathology in the peripheral and optic nerves, posterior and lateral columns of the spinal cord (subacute combined degeneration), and in the brain. This can cause tingling and numbness in the hands and feet, muscle weakness, and loss of reflexes. Patients may feel unsteady and experience equilibrium problems and ataxia. Vitamin B12 deficiency can cause weakened bones and may lead to hip fractures. Vitamin B 12 deficiency does not cause facial palsy; however, vitamin B12 has been used in the treatment of Bell's Palsy. Nuchal rigidity and priapism are not associated with vitamin B12 deficiency. Question: The infant with the lowest risk of developing elevated levels of bilirubin is the one who: is feeding poorly or whose feedings are delayed for several hours. has developed a cephalhematoma. is the second birth to an Rh negative mother. breast feeds within the first hour of life. Correct Explanation: The infant who is fed early will be less likely to retain meconium and reabsorb bilirubin from the intestines back into the circulation. Additionally, lack of adequate intestinal flora hinders excretion of conjugated bilirubin so by feeding soon after birth, this speeds up the development of bacteria and creation of good intestinal flora. The other choices are all examples of situations that increase the risk for jaundice in the newborn. Question: Patients who develop pica have a deficiency in: folic acid. lead. magnesium. iron. Correct Explanation: Pica is characterized by an appetite for substances that are nonnutritive, such as ice, starch, or clay. This finding is associated with iron deficiency anemia. Note: Pica is considered an eating disorder in the DSM-5 criteria. Question: Which of the following symptoms is associated with iron deficiency anemia? Atrophic glossitis Correct Oral candida Melanoglossia Transient lingual papillitis Explanation: Atrophic glossitis occurs when a large number of papillae are lost, resulting in changes to the tongue’s color and texture. This type of glossitis typically turns the tongue dark red and is a symptom of iron deficiency anemia. Oral candida is a white paste on the tongue. The most common type of oral candida is Candida albicans fungus. Melanoglossia is a medical condition in which the tongue becomes blackened. This is usually caused by a bacterial infection or allergic reaction. Transient lingual papillitis is a common painful inflammatory condition affecting one or several fungiform papillae on the tongue. Question: Folic acid deficiency is an example of which type of anemia? Normocytic Macrocytic Correct Microcytic Hemolytic Explanation: Macrocytic anemia is characterized by larger than normal red blood cells. Vitamin B12 and folate deficiencies are examples of macrocytic anemias. Normocytic anemia is caused by acute blood loss, chronic disease, or failure to produce adequate red blood cells. Chronic renal failure (decreased production of erythropoietin) or liver failure causes normocytic anemia. Microcytic anemia usually occurs in iron deficiency anemia. Hemolytic anemia can be autoimmune, hereditary or mechanical. It can result (because of cell fragmentation) in a microcytic anemia, a normochromic anemia, or (because of premature release of immature red blood cells from the bone marrow), a macrocytic anemia. Question: Which situation would put the patient at the LEAST risk for developing lead toxicity? Being a plumber Residing in a home built before 1988 Correct Having a history of gout Living near a busy highway. Explanation: Risks for lead toxicity may include an occupation as a plumber, having a history of gout, living near a busy highway or hazardous waste dump, and residing in a home built before 1978. Question: Which patient is most likely to carry the alpha thalassemia anemia trait? A 45-year-old black man A 32-year-old Filipino man Correct A 24-year-old Italian woman A 19-year-old Greek woman Explanation: Alpha thalassemia minor is a disease that occurs among the Asian population. Beta thalassemia is commonly found in patients of Mediterranean descent (Italian, Greek). Question: Hemophilia type A is a deficiency of factor: VIII. Correct IX. XI. IV. Explanation: Hemophilia is an inherited disorder in which a person lacks adequate clotting factors. Type A is a lack of clotting factor VIII (90% of cases). Type B is a lack of clotting factor IX. Type C is a lack of clotting factor XI. Question: A child with sickle cell anemia presents with a history of sudden onset of rapid breathing with left upper quadrant (LUQ) tenderness upon palpation. The child is most likely experiencing a (an): aplastic crisis. sequestration crisis. Correct vaso-occlusive crisis. hemarthrosis crisis. Explanation: Sequestration occurs when RBC's are trapped or sequestered in the spleen causing it to enlarge; therefore, there would be tenderness in the LUQ and the child may have tachypnea as well. Aplastic crisis occurs when RBC production is decreased. Symptoms include pallor, decreased hemoglobin and decreased RBCs. Vaso-occlusion usually involves pain but no increase in spleen size. Hemarthrosis is usually seen in hemophilia and where there is joint involvement, but not spleen involvement. Question: The nurse practitioner differentiates physiologic jaundice from pathologic jaundice by assessment of the: degree of jaundice of the skin. timing of the onset of the jaundice. Correct maternal history of drugs/medications. level of bilirubin in the blood. Explanation: Physiologic jaundice is identified after 24 hours. Pathologic jaundice is identified before the infant is 24 hours of age. The fetus produces more red blood cells (RBCs) than the normal adult or child has, with a hematocrit of up to 60% being normal. At birth, structural and functional changes take place which enable the fetus to breathe room air, bringing the baby's paO2 up to the normal child-adult range. Thus, the excess RBCs are no longer needed for O2 carrying capacity, and they begin to break down. This is a normal, physiologic change that occurs at birth. The breakdown of these RBCs releases bilirubin into the blood stream. So, a rise in bilirubin within 24-48 hours of life is normal. If something causes an excessive number of RBCs to break down (such as ABO or Rh incompatibility, birth trauma or infection) or impairs the baby's ability to excrete bilirubin out of the GI tract (NPO status, delayed stooling, meconium ileus), the bilirubin level can rise to dangerous levels, requiring treatment to prevent buildup in the brain, (kernicterus) which can cause brain damage and death. The other choices are not specific to either type. Question: A symptom of severe hemorrhagic shock (Class IV) does NOT include: tachycardia. hypotension. tachypnea. hypertension. Correct Explanation: Severe hemorrhagic shock (Class IV) refers to a medical condition in which rapid fluid loss results in multiple organ failure due to inadequate circulating volume and subsequent inadequate perfusion. Symptoms of severe hemorrhagic shock include tachycardia, hypotension, decreased or no urinary output, loss of consciousness, cold and pale skin, and tachypnea. Question: An assessment finding in a patient diagnosed with von Willebrand disease is: hypopigmentation. café au lait spots. ecchymosis. Correct hyperpigmentation. Explanation: Von Willebrand disease is a group of congenital bleeding disorders caused by a deficiency of the protein von Willebrand factor (vWF). Defective vWF interaction between platelets and the vessel wall impairs primary hemostasis. Symptoms include: bruising (ecchymosis), menorrhagia, recurrent epistaxis, petechiae, and hemorrhage. Café au lait spots, hypopigmentation, and hyperpigmentation are not associated with von Willebrand. Question: The nurse practitioner should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on which of the following statements? Leukemia is a fatal disease even though chemotherapy provides increasingly longer periods of remission. Research to find a cure for childhood cancers is very active. A majority of children go into remission and remain symptom free when treatment is completed. Correct It usually takes several months of chemotherapy to achieve a remission. Explanation: The majority of children diagnosed with the most common form of leukemia, acute lymphoblastic leukemia, go into remission and remain symptom free when treatment is complete and will have an 85% disease free survival rate. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. The research statement is true, but it does not address the parent's concern. About 95% of children achieve remission within the first month of chemotherapy. Question: The parents of a child with sickle cell anemia are asking for information about future pregnancies. The nurse practitioner should respond by telling them that with any future pregnancy they will have a: 1 in 4 chance of producing a child with sickle cell trait. 1 in 4 chance of producing a child with sickle cell anemia. Correct 1 in 2 chance of producing a child with neither sickle cell disease nor trait. 1 in 2 chance of producing a child with the sickle cell anemia. Explanation: Sickle cell anemia is an autosomal recessive condition, meaning since the parents do not have the disease then each must have the trait. Therefore, since both parents are carriers each pregnancy carries a 25% chance (1 in 4) that the child will have the disease. Question: Which one of the following does NOT produce anemia of chronic disease? Systemic lupus Rheumatoid arthritis Osteomyelitis Osteoporosis Correct Explanation: Mild to moderate normochromic, normocytic anemia is associated with chronic disease. Anemia has been identified as a risk factor for osteoporosis, however, osteoporosis does not cause anemia. Anemia of chronic disease is associated with diseases such as systemic lupus, rheumatoid arthritis, and osteomyelitis. Question: An example of a vaso-occlusive crisis of the pulmonary vasculature seen in patients with sickle cell anemia is: acute chest syndrome. Correct pulmonary embolism. pneumonia. pulmonary edema. Explanation: Acute chest syndrome is a vaso-occlusive crisis of the pulmonary vasculature commonly seen in patients with sickle cell anemia. It is often precipitated by a respiratory infection and symptoms include: fever, cough, excruciating pain, sputum production, shortness of breath, or low oxygen levels. Question: The most common malignancy diagnosed in children is: chronic myelogenous leukemia (CML). chronic lymphocytic leukemia (CLL). acute lymphocytic leukemia (ALL). Correct acute myeloid leukemia (AML). Explanation: Acute lymphocytic leukemia (ALL) is the most common type of malignancy in children. Thirteen percent of all leukemias and 75% of all pediatric cases affect children ages 2-10 years, with most cases diagnosed by 4 years of age. Question: When educating a patient about iron replacement, the provider advises to take the supplement: with vitamin C. Correct with a glass of milk. on a full stomach. on an empty stomach. Explanation: Taking iron supplements with vitamin C enhances absorption. Question: A possible assessment finding in patients taking oral iron supplements for anemia is: steatorrhea. hematochezia. constipation. Correct beeturia. Explanation: Constipation is a common side effect of iron supplements. Iron causes dysbiosis (microbes imbalance), which slows peristalsis. This results in longer bowel retention, which causes more water uptake and leads to dry feces, resulting in constipation. Steatorrhea is a greasy, foul-smelling stool associated with cystic fibrosis. Hematochezia is a passage of fresh blood through the anus and is commonly associated with lower gastrointestinal bleeding. Beeturia is red-colored feces after consuming beets. It occurs due to insufficient metabolism of a red pigment. [Show Less]
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AGNP BOARD EXAM QUESTIONS Health Promotion Assessment (51 Questions with Answers and Explanations).
AGNP BOARD EXAM QUESTIONS Health Promotion Assessment (51 Questions with Answers and Explanations). AGNP BOARD EXAM QUESTIONS Health Promotion Assessment ... [Show More] (51 Questions with Answers and Explanations). Question: According to the U.S. Preventive Services Task Force, older adults should be screened for colorectal cancer with sigmoidoscopy every: year. 2 years. 5 years. Correct 10 years. Explanation: The Task Force recommends screening with colonoscopy every 10 years, sigmoidoscopy every 5 years with high-sensitivity fecal occult blood tests (FOBTs) every 3 years, or FOBTs every year beginning age 50 years through age 75 years. Recommends against routine screening for adults ages 76 to 85 years, due to moderate certainty that the net benefit is small. Question: Which topic should be a priority when providing anticipatory guidance to an 8-year-old child? Screening for scoliosis Advising the parent to protect the child from sunburn with sunscreen Recommending that the child receive another varicella vaccine now Assessing child care arrangements for before and after school Correct Explanation: School age children may not want to go to daycare, but are not old enough to stay home unsupervised. Help the parent to problem solve. Scoliosis is screened in 10-12-year-old children. Applying sunscreen should start at an earlier age than 8 years. Varicella vaccine is first given between 12 and 15 months and repeated at 4-6 years (before entering elementary school - kindergarten). Question: All of the following strategies are useful for assessing older adults at high risk for falls except: reviewing the medication history. obtaining a functional history. assessing immunization history. Correct conducting an environmental assessment. Explanation: Strategies for assessing older adults at high risk for falls include: obtaining a detailed fall history, medication review, and history of relevant risk factors (such as acute and chronic medical problems). Other assessments should include: gait, balance, mobility, and lower extremity joint function, neurologic function, lower extremity muscle strength, cardiovascular status, visual acuity, and examination of the feet and footwear. A functional and environmental assessment as well as implementing multifactorial / multicomponent interventions to address identified risks will help to prevent falls. Question: Higher level self-care functioning activities are referred to as: activities of daily living. instrumental activities of daily living. Correct necessary activities of daily living. required activities of daily living. Explanation: Activities of daily living (ADLs) consist of basic self-care abilities: bathing, dressing, toileting, transferring, continence, and feeding. Higher level functions are referred to as the instrumental activities of daily living (IADLs) and include: using the telephone, shopping, preparing food, laundry, and taking medicine. Question: Which of the following would help a 9-year-old develop a sense of industry? Providing large plastic blocks for him to build things Helping him make a collection of several objects Correct Encouraging running for short distances Explaining the workings of his heart Explanation: The school age child likes to collect things and keep them as memoirs. Large plastic blocks are characteristic of preschoolers and would not accomplish this task. Running short distances is a more appropriate activity for this child. Explaining how the heart works requires more cognitive abilities than a 9-year-old may have. Question: Which technique would be least effective in gaining the cooperation of a toddler during a physical exam? Tell the child that another child the same age was not afraid. Correct Allow the child to hold and touch the equipment when possible. Permit the child to sit on the parent's lap during the examination. Give the child immediate praise for holding still or doing what was asked. Explanation: Telling the child that another child the same age was not afraid would not be an effective technique as a toddler is unable to process that concept. The other choices are appropriate techniques. Question: The first sign of puberty in a male is: increased vertical height. a change in voice. testicular enlargement. Correct facial hair. Explanation: Puberty begins sexual maturity. It is a process that usually occurs between ages 10 and 14 for girls, and ages 12 and 16 for boys. It causes physical changes, and affects boys and girls differently. In boys, puberty usually begins with the testicles and penis getting bigger. Then hair grows in the pubic area and armpits. Question: At what age would a baby first be expected to locate an object hidden from view? At 4 months of age At 9 months of age Correct At 13 months of age At 20 months of age Explanation: Around 9 months of age, infants are first able to find an object hidden from view, also known as object permanence. The other choices are not age appropriate. Question: The 10 minute geriatric screener is a tool used to assess: smoking habits. alcohol consumption. functionality. Correct dementia. Explanation: The 10-Minute Geriatric Screener is a tool used for functional assessment in the older adult and assesses: vision, hearing, leg mobility, urinary incontinence, nutrition and weight loss, memory, depression, and physical disability. Question: Part of the nutritional assessment includes anthropometric measurements. These measurements include all of the following except: height and weight. blood pressure, pulse, and respiration. Correct body mass index (BMI). basal metabolic rate (BMR). Explanation: Anthropometric measurements are a set of noninvasive, quantitative techniques for determining an individual's body fat composition by measuring, recording, and analyzing specific dimensions of the body: height, weight, BMI, BMR, distribution of body fat, and skin fold thickness. Vital signs are considered physiologic measurements. Question: The first sign of puberty in females is: appearance of body odor. increased energy and appetite. occurrence of first menses. appearance of breast buds. Correct Explanation: Breast buds are the first sign of puberty in girls. Body odor comes later as the apocrine glands develop. Menses first occurs about 1 year following the appearance of breast buds. Increased energy and appetite do not relate to the signs of puberty. Question: Sarcopenia is: cancer of the muscle sheath. loss of lean body mass and strength with aging. Correct atrophy of voluntary muscles. loss of bone production. Explanation: Sarcopenia is loss of lean body mass and strength associated with aging. The mechanism responsible for muscle loss is not fully understood. Nonetheless, there is a substantial body of evidence that strength training in older adults can slow or reverse this process. Question: When palpating the carotid pulse, it is important to: place the fingers on the upper third of the neck. palpate both carotids simultaneously. position the patient in the lying or sitting positions. Correct position the patient's chin on the chest. Explanation: The carotid artery should be palpated gently and while the patient is sitting or lying down. The patient's chin should be elevated to allow easy palpation and yet not enough to tighten the neck muscles. Stimulating its baroreceptors with low palpation can provoke severe bradycardia or cause cardiac arrest in some sensitive persons. Also, carotid arteries should never be palpated at the same time. This may limit blood flow to the head, possibly leading to fainting or cerebral ischemia. A carotid pulse is palpable between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage Question: Which activity would be most appropriate to promote the growth and development of a 3-year-old boy with hemophilia who is one week post hemarthrosis episode of his left knee? Allow the child to play with building blocks. Allow the child to ride a tricycle. Correct Allow the child to play with a toy telephone. Allow the child to ride in a motorized car. Explanation: Generally, within one week of post bleeding into the knee (hemarthrosis) range of motion activities would begin. The tricycle would be a fun way for a 3 year old to exercise his left knee. Building blocks and the motorized riding car are appropriate for this age group but would not exercise his knee. The toy telephone is an appropriate toy for a preschool child, but is not appropriate for a toddler and would not be beneficial to his rehabilitation. Question: Of the five percussion notes, which one produces a drum-like sound heard over air filled structures during the abdominal examination? Tympany Correct Dullness Flatness Hyperresonance Explanation: The five percussion notes include: tympany, dullness, flatness, resonance, and hyperresonance. Tympanic or tympanitic, are drum-like sounds heard over air filled structures during the abdominal examination. Hyperresonant (pneumothorax) sounds similar to percussion of puffed up cheeks. Normal resonance/resonant is the sound produced by percussing a normal chest. A dull (consolidation) sound is similar to percussion of a mass such as a liver. Stony dull or flat sounds are produced on percussion from the pleximeter with no contribution from the underlying area. Question: According to U.S. Preventive Services Task Force, an adult aged 60 years should be screened for colorectal cancer with colonoscopy: annually. every 2 years. every 5 years. every 10 years. Correct Explanation: The Task Force recommends screening for colorectal cancer with colonoscopy every 10 years, sigmoidoscopy every 5 years with high-sensitivity fecal occult blood tests (FOBTs) every 3 years, or FOBTs every year beginning age 50 years through age 75 years. It recommends against routine screening for adults ages 76 to 85 years. Question: Several interventions have been known to prevent falls in the older adult. These interventions include all of the following except: minimizing medications. managing hypotension. managing footwear and foot problems. discouraging exercise programs. Correct Explanation: Identifying risks and preventing falls in the older adult can be better managed by initiating multifactorial and multicomponent interventions. These interventions include the following: minimize medications, provide individually tailored exercise programs, treat vision impairment, manage postural hypotension, manage heart rate and rhythm abnormalities, supplement with vitamin D, manage foot and footwear problems, modify the home environment, and provide education and information on fall prevention. Question: Basic self-care activities are referred to as: activities of daily living. Correct instrumental activities of daily living. necessary activities of daily living. required activities of daily living. Explanation: Activities of daily living (ADLs) consist of basic self-care abilities: bathing, dressing, toileting, transferring, continence, and feeding. Higher level functions are referred to as the instrumental activities of daily living (IADLs) and include: using the telephone, shopping, preparing food, laundry, and taking medicine. Question: The most appropriate approach to use when teaching a preschooler safety education would be to: teach using a calm, understanding voice. teach parents by introducing one concept at a time. Correct teach the child, giving concrete rationales when questions are asked. teach the child and parents with activities that last approximately one hour. Explanation: Safety education of the preschooler should be directed at both the child and parents. Preschoolers are most capable of understanding one concept at a time and safety teaching is most appropriate in this format. School-age children are capable of understanding concrete rationales whereas Preschoolers are not at that cognitive level. The average 5-year-old has an attention span of about 30 minutes; an hour long activity will lose the preschooler's attention and interest making safety teaching ineffective. Question: The goal of palliative care is to: initiate discussions for end-of-life decisions. relieve pain. avoid elder abuse. relieve suffering and improve quality of life. Correct Explanation: The goal of palliative care is to relieve suffering and improve the quality of life for patients with advanced illnesses; and help families through specific knowledge and skills, including communication with patients and family members; management of pain and other symptoms; psychosocial, spiritual, and bereavement support; and coordination of an array of medical and social services. Question: Which one of the following is an appropriate type of play for a 6-month-old infant? Pat-a-cake and peek-a-boo Correct Ball rolling and hide and seek game Pots and pans with wooden spoons Push-pull toys Explanation: Pat-a-cake and peek-a-boo are the most age appropriate for this 6-month old. Ball rolling, hide and seek, and pots and pans need more object permanence so it is more appropriate for the 9 month old. The push pull toys require the child to be walking or at least standing. Question: When obtaining information from an adolescent who has likely been sexually abused, the most appropriate action initially is to: notify the parent. call child protective services. ask open-ended questions. Correct tell the adolescent that his/her story will be believed. Explanation: It is most appropriate to begin the visit with asking open-ended questions to encourage the adolescent to talk about the situation. Once this information is obtained and determined or suspected to be sexual abuse, child protection should become involved. Parents may be the abusers so delay calling them until more information is collected. The adolescent can be assured that his/her story would be believed but the open-ended questions would be the first response in this situation and would provide an opportunity for the adolescent to discuss the situation more openly. Question: Which one of the following would be an abnormal finding in a 6-month-old? Presence of a positive Babinski reflex Extrusion reflex occurs when feeding Correct Able to voluntarily grasp objects Rolls from abdomen to back at will Explanation: Extrusion reflex disappears around 4 months and would be considered abnormal in a 6-month-old. The other choices are signs of normal growth and development in a 6-month-old infant. Question: In which of the following situations would a one-year-old child be at risk for lead poisoning? Ceiling tiles have just been replaced in the child's home. Refinishing of all painted woodwork has occurred recently in the child's home. Correct The family moved into a twenty-year- old brick house. The family moved from a trailer home to a new apartment complex. Explanation: Painted woodwork may contain lead, especially in older homes and during refinishing, the paint would have to be scraped off, placing it in easy reach of a one year-old. Ceiling tiles are not a source of lead or lead paint. Any house built after 1978 is considered "lead free" because at that time paint no longer contained lead. Mobile homes generally do not contain lead. Question: According to the most recent recommendation from U.S. Preventive Services Task Force, screening healthy older adult men for prostate cancer by prostate specific antigen should occur: annually. every 2 years. every 5 years. never. Correct Explanation: The Task Force states that evidence is insufficient to balance the benefits and harms of screening for men <75 years; recommends against screening men =75 years. Question: During the concrete operational period of middle childhood, which of the following is the expected cognitive development? The child is: able to follow directions but unable to verbalize the actions involved in a process. able to use thought processes to experience events and actions and make judgments based on what they reason. Correct able to view from an egocentric outlook that is rigidly developed around the actions to be completed. able to progress from conceptual thinking to perceptual thinking when making judgments. Explanation: During the middle childhood stage, children develop an understanding of the relationship between things and ideas and make judgments about them based on reason (conceptual thinking). Additionally, they develop an understanding of the relationship between things and ideas. They are able to follow directions, reverse a process and verbalize actions involved in the process. Egocentrism is not characteristic of the school age child. This concept is seen in the earlier stages of infant, toddler and preschool growth and development. During the school age years, children progress from making judgments on what they see (perceptual thinking) to making judgments on what they reason (conceptual thinking). Question: Toilet training is most appropriately initiated when the child: is 18-months-old. wakes up dry from a nap. Correct is 24- months- old. exhibits the ability to sit on the potty for 10-15 minutes. Explanation: Toilet training is not specific to an age. It is most appropriately initiated when the child shows signs of readiness. When the child shows signs of bladder and/or bowel control, (wakes up dry from naps, pulls off diaper when wet or dirty, complains of wet, dirty diaper), the child is ready to begin toilet training. The ability to sit on the potty may show parental readiness rather than child readiness for toilet training. The child must show physical and cognitive signs of readiness. Question: According to the 2008 U.S. Preventive Services Task Force, older adults should be screened for colorectal cancer yearly using high-sensitivity fecal occult blood tests (FOBTs) between: 50 and 60 years of age. 50 and 75 years of age. Correct 55 and 80 years of age. 65 and 85 years of age. Explanation: The Task Force recommends screening for colorectal cancer with colonoscopy every 10 years, sigmoidoscopy every 5 years with high-sensitivity fecal occult blood tests (FOBTs) every 3 years, or FOBTs every year beginning age 50 years through age 75 years. Recommends against routine screening for adults ages 76 to 85 years, due to moderate certainty that the net benefit is small. Question: Which one of the following statements indicates a developmental delay? A 9-month-old infant responds consistently to the sound of his name A 6-week-old infant smiles in response to the mother's face A 6-month-old infant's eyes appear crossed Correct A 2 1/2-month-old infant is not reaching for or grasping objects Explanation: It is normal for a baby's eyes to wander or cross during the first month 1-2 months of life. If a baby's eyes appear misaligned consistently beyond the first couple of months, the problem could be strabismus or amblyopia, "lazy eye". A referral to an ophthalmologist is warranted. These conditions can be successfully treated if detected early. The other choices are appropriate for the ages and should not be of a concern. Question: A 6-month-old presents today for a well child visit. He is sitting in his mother's lap. Assessment should begin with: eliciting reflexes. palpating the liver and spleen sizes. auscultating the heart and lungs. Correct examining the head and eyes. Explanation: When assessing a quiet infant, auscultate the heart and lungs first. The other parts of the exam may cause the infant to cry making auscultation of heart and breath sounds difficult to hear. Question: Which one of the following statements is true about immunity? Passive immunity develops in response to an infant receiving immunizations. Infants acquire active immunity from the mother which lasts 6 to 7 months. Infants acquire active immunity in response to infections and immunizations. Correct Maternal antibodies that pass to the infant ensure active immunity up to 12 months age. Explanation: Infants acquire long-term active immunity from exposure to certain diseases (antigens) and vaccines. Active immunity develops in response to immunizations. The infant's passive immunity is acquired from the mother and dissipates around 6 months of age. Question: Which one of the following statements made by a mother indicates that her 5-month-old infant is ready for solid foods? I find that she really has to be encouraged to eat. She has just started to sit up without support. Correct When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow. She is in the 50th percentile on the growth chart. Explanation: The child's age, appetite, and growth rate are all factors that help determine when to feed solid foods. According to the American Academy of Pediatrics (AAP), semi-solid foods are a significant change and should not be introduced until 6 months of age. This age usually coincides with the neuromuscular development necessary to eat solid foods. Before feeding solid foods, the baby should be able to: swallow and digest semi-solid foods and sit up well (an important step in order to be able to stay seated in a high chair to feed). Maintain neck and head control while seated (a necessity in order to turn his or her head to signal when he is finished eating), able to open his or her mouth and move the tongue and lips well, (allowing the movement of food around the mouth) and demonstrate an interest in food and eating solid foods. Question: According to the most recent recommendation from U.S. Preventive Services Task Force, healthy women older than 65 years of age should be screened for cervical cancer: annually. every 2 years. every 5 years. no longer. Correct Explanation: The Task Force recommends against routine screening for cervical cancer for women older than age 65 if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer, based on fair evidence. Question: Which one of the following positions is the most accurate regarding infant car seat placement? The car seat should: be rear-facing in the back seat until the infant is 12 months and 20 pounds. Correct be forward-facing in the back seat until the infant is 12 months and 20 pounds. be rear-facing in the front seat until the infant is 12 months and 20 pounds. be forward-facing in the front seat until the infant is 12 months and 20 pounds. Explanation: Infant car seats must be positioned in the back seat of the car, preferably in the middle of the back seat, until the infant is 12 mos. AND 20 pounds. Question: When assessing a normal 5-year-old, the last site to assess would be the: heart. lungs. throat. Correct abdomen. Explanation: The throat and mouth are considered invasive sites and should be performed last. Question: The assessment finding that would necessitate a need for additional follow-up in a preschooler would be if the child: is able to dress independently. rides a tricycle. has an imaginary friend. has a hundred word vocabulary. Correct Explanation: At age 3, almost all of a child's speech should be understandable; between 3 and 5 years, the preschooler should have a vocabulary of 500 - 1200 words and speak in complete sentences. If language skills are not developed, the child should be referred. The other choices are usual for the preschooler. Question: A characteristic finding in the elderly population is: the increase in diastolic blood pressure after the sixth decade. a tendency toward developing postural hypertension. the development of heart rhythm changes leading to syncope. Correct the susceptibility to hyperthermia. Explanation: Characteristic findings in the elderly population include: postural hypotension, abnormal heart rhythms such as atrial or ventricular ectopy which could lead to syncope, changes in temperature regulation leading to susceptibility to hypothermia. Question: At what age is it considered normal for a child to pick up objects using the palm of the hand only? At 2 months of age At 6 months of age Correct At 12 months of age At 18 months of age Explanation: Picking up objects using the hand only is called the palmer grasp and is normal in children ages 4-6 months. At 9 months, the child uses the thumb and pointer finger to pick up objects and this is called the pincer grasp. A 12- month- old would be able to use the entire hand and fingers to pick up items. At 2 years old, children have full dexterity and movement. Question: In the older adult, the term "Sixth Vital Sign" assesses: incontinence. functional status. Correct sensorium. muscle strength. Explanation: Because of its importance to the health of older adults and the order of the nurse practitioner's assessment, assessing functional status is referred to as the “Sixth Vital Sign.” Question: According to the U.S. Preventive Services Task Force, older adults should be screened for colorectal cancer with high-sensitivity fecal occult blood tests (FOBTs) every: year. Correct 2 years. 5 years. 10 years. Explanation: The Task Force recommends screening for colorectal cancer with colonoscopy every 10 years, sigmoidoscopy every 5 years with high-sensitivity fecal occult blood tests (FOBTs) every 3 years, or FOBTs every year beginning age 50 years through age 75 years. Recommends against routine screening for adults ages 76 to 85 years, due to moderate certainty that the net benefit is small. Question: According to the most recent recommendation from U.S. Preventive Services Task Force, an adult aged 65 should be screened for breast cancer: annually. every 2 years. Correct every 5 years. never. Explanation: The Task Force recommends screening for breast cancer with mammography every 2 years for women ages 50-74 and cites insufficient evidence for women 75 years and older. Question: Which of the following is considered an extrinsic risk factor for falls in the older adult? Postural hypotension Psychoactive medications Correct Previous falls Fear of falling Explanation: There are many risk factors that contribute to falling. They are classified as intrinsic and extrinsic. Extrinsic factors include: lack of handrails, poor stair design, lack of bathroom grab bars, dim lighting or glare, obstacles and tripping hazards, psychoactive medications, slippery or uneven surfaces, and improper use of assistive device. Intrinsic factors include: advanced age, previous falls, muscle weakness, gait and balance problems, poor vision, postural hypotension, chronic conditions (i.e. Parkinson’s, dementia, diabetes), and fear of falling. The risk for falls can be reduced or minimized by first focusing on modifiable risk factors which include: lower body weakness, difficulties with gait and balance, use of psychoactive medications, postural dizziness, poor vision, problems with feet/shoes, and home hazards. Question: The formula used to guide "time out" as a disciplinary method is: Length of "time out" is related to the severity of the behavior The length of "time out" is determined by using one minute per year of the child's age Correct Use "time out" in children over the age of 6 years The length of the "time out" should not exceed 4 minutes Explanation: It is important to structure "time out" in a time frame that allows the child to understand why he or she has been removed from the environment. Usually allowing one minute for each year of age is an appropriate guideline. Relating time to a behavior is not appropriate especially in young children who do not understand the concept of time. Using "time-out" discipline is more appropriate for the toddlers and preschool age children. Negative behavior should never be reinforced with a positive action or reward. Question: Which one of the following choices would NOT be recommended for effective communication for an older adult? Allow time for open ended questions and reminiscing Use brief screening instruments Face the patient and speak in high tones Correct Adjust pace and content of the interview to the stamina of the patient Explanation: Facing the patient when communicating with the older adult is an effective technique. However, a low tone should be used rather than a high tone. The other choices are effective methods of communicating with the older adult. Additional techniques may include: providing a well-lit, moderately warm setting with minimal background noise; carefully assessing symptoms for clues to underlying disorders; and making sure written instructions are in large print and easy to read. Question: To assess for strabismus in a child, use the: Snellen eye chart. cover-uncover test. Correct ophthalmoscope. test for pupillary reaction. Explanation: The cover-uncover test assesses coordination of eye muscle movement when one eye is covered. It is always assessed bilaterally. Strabismus is identified when the covered eye is found to deviate from its forward focus. Snellen eye chart assesses visual acuity; ophthalmoscope is used to visually assess the fundus of the eye. Pupillary reaction tests the ability of the eyes to react to light and accommodate. Question: An infant weighed 8 pounds at birth. According to the principles of normal growth and development, how much should he weigh at 12 months of age? 16 pounds 24 pounds Correct 29 pounds 32 pounds Explanation: Normal infants double their birth weight at 6 months and triple their birth weight at one year of age. So 8 x 3 = 24 pounds. Question: Which of the following is the most age appropriate play for an 8-year-old girl? Dress up A board game Correct Experiment with make-up Assemble a puzzle with 50 large pieces Explanation: School-age children like the competitiveness of board games. Dress up is a preschool activity, experimenting with make-up is an adolescent activity and school age children like small puzzle pieces where as preschoolers like large puzzle pieces. Question: When assessing a preschooler's mouth, the number of deciduous teeth seen should be: Up to 10. 11 to 15. 16-20. Correct up to 32. Explanation: Children get their first 20 deciduous teeth between the ages of 6 months and 5 years. Permanent teeth begin to erupt around 6 years of age when the deciduous teeth begin to fall out. All 32 permanent teeth usually erupt by late adolescence. Question: Which of the following milestones is developmentally appropriate for a 2-month-old infant when pulled to a sitting position? The infant shows persistent head lag when the trunk is lifted. The infant is completely able to support the head when the trunk is lifted. The infant is able to hold the head in a straight line. The infant is briefly able to hold the head erect. Correct Explanation: Persistent head lag in a 2-month-old may be indicative of developmental delay. 2-month-old infants should be able to hold the head erect only briefly when pulled to a sitting position. It is not until 4 months that an infant can hold the head in a straight line when pulled to a sitting position. Additionally, a 2-month-old infants' neck muscles are becoming stronger, but the infant is not fully able to support the neck when the trunk is lifted. Question: During the first 6 months of life, an infant will: grow 1 cm in length per month. gain 1.5 pounds per month. Correct regain weight lost after birth within 2 months. have a 1-inch increase in head circumference per month. Explanation: Infants gain an average of 1.5 pounds each month for the first 6 months and grow 1 inch/month not 1cm/month. Head circumference grows 1 cm/month for the first year. Infants increase their head circumference by 12 centimeters during the first year of life as they start with an average of 35 centimeters and end up with an average of 47 centimeters. They regain birth weight by the 10th day of life. Question: A five year old will engage in what type of play? Parallel play Solitary play Team play Cooperative play Correct Explanation: Cooperative, group, or organized play is typical for children in this setting. At this age, they should learn to share and take turns without becoming frustrated. Team play is seem more in the school age child. Parallel and solitary play is seen in younger children. [Show Less]
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AGNP BOARD EXAM QUESTIONS Prescription Gastroenterology (85 Questions, Answers and Explanations)
AGNP BOARD EXAM QUESTIONS Prescription Gastroenterology (85 Questions with Answers and Explanations) Question: A 45-year-old woman has been taking oral o... [Show More] meprazole (Prilosec) 40 mg twice daily for the treatment of gastroesophageal reflux. To discontinue the medication the nurse practitioner would: advise the patient to stop the medication. reduce the dose by 50% every other day. reduce the dose by 50% weekly. Correct reduce dose by 50% every month. Explanation: For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec) 40 mg daily or twice daily), reduce the dose by 50% every week until the patient is on the lowest dose of the medication. For patients on twice daily dosing, the initial reduction can be accomplished by decreasing the dosing to once in the morning before breakfast. Once the patient has completed a week at the lowest dose, the medication can be discontinued. Question: Patients receiving long-term proton pump inhibitors (PPIs) are at increased risk for fractures and: lower extremity edema. extraesophageal symptoms. myocardial infarction. Correct muscle spasms. Explanation: Analysis of patients taking PPIs for long periods of time showed an increased risk of myocardial infarctions. This is thought to be related to reduced nitric oxide in the blood vessel walls. The FDA suggests that providers consider periodically obtaining magnesium levels in patients while they are on a PPI. Increased risk of myocardial infarction has not been associated with histamine receptor blockers. Question: Ondansetron (Zofran) dosage should be adjusted in patients: with renal insufficiency. who are pregnant. who are > 65 years old. with hepatic impairment. Correct Explanation: Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment of nausea and vomiting. Dose limitations are recommended for patients with severe hepatic impairment (Child-Pugh class C); use with caution in mild-moderate hepatic impairment; clearance is decreased and half-life increased in hepatic impairment. No dosage adjustment is recommended with renal insufficiency, pregnancy or in advanced age. Question: The antiemetic that does NOT have potential to cause QT prolongation is: promethazine (Phenergan). Correct chlorpromazine (Thorazine). ondansetron (Zofran). prochlorperazine (Compazine). Explanation: Antihistamines such as promethazine and diphenhydramine do not cause QT prolongation. Dopamine and serotonin antagonists are both associated with QT prolongation. Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are dopamine antagonists. Ondansetron (Zofran) is a serotonin antagonist. If a patient has suspected QT interval prolongation or is taking other medications with which the QT interval prolongation could be additive, a 12-lead EKG is recommended before treatment is initiated. Question: Promethazine (Phenergan), a 1st generation antihistamine, is contraindicated in the presence of: motion sickness. sedation. asthma. Correct seasonal allergic rhinitis. Explanation: Promethazine (Phenergan) is contraindicated in patients with hypersensitivity reaction to promethazine, other phenothiazines, or any component of the formulation; coma; lower respiratory tract symptoms, including asthma; children younger than 2 years of age; intra-arterial or subcutaneous administration. Question: Oral metoclopramide is contraindicated in the patient diagnosed with: migraines. epilepsy. Correct diabetes. renal impairment. Explanation: Metoclopramide (Reglan) is contraindicated in situations when gastrointestinal (GI) motility may be dangerous, including mechanical GI obstruction, perforation, or hemorrhage; pheochromocytoma; history of seizure disorder (e.g., epilepsy); and concomitant use with other agents likely to increase extrapyramidal reactions. Caution is advised in patients with renal impairment; dosage adjustment may be needed. Question: Hyperosmotic agents and saline laxatives should be avoided or used with caution in patients who have: chronic constipation. liver disease. heart failure. Correct hypothyroidism. Explanation: Hyperosmotic agents and saline laxatives may seriously alter fluid and electrolyte balance. This increases the risk for dehydration and electrolyte disturbances, especially hypokalemia. Therefore, the risks versus the benefits should be considered prior to use in patients with heart failure. Question: Corticosteroids, used in the treatment of ulcerative colitis, usually do NOT: increase the rate of infection. reduce the effectiveness of vaccines. increase the effectiveness of antibiotics. Correct increase the risk of developing osteoporosis. Explanation: Corticosteroids usually do NOT increase the effectiveness of antibiotics; they reduce their effectiveness. Because they suppress the immune system, they increase the rate of infection, reduce the effectiveness of vaccines and increase the risk of osteoporosis and fractures due to loss of calcium with corticosteroids. Question: The plasma elimination half-life of esomeprazole (Nexium) is: 1-1.5 hours. Correct 2-3 hours. 3.5-5 hours. 6-8 hours. Explanation: The plasma elimination half-life of esomeprazole (Nexium) is approximately 1 to 1.5 hours. Less than 1% of the parent drug is excreted in the urine. Approximately 80% of an oral dose of esomeprazole is excreted as inactive metabolites in the urine, and the remainder is found as inactive metabolites in the feces. Question: Proton pump inhibitors (PPIs), such as pantoprazole (Protonix), block gastrointestinal acid secretion by: converting cations to anions and pumping from parietal cell to the secretory canaliculus. prohibiting the pumping of hydrogen ions into the parietal cell. inhibiting the hydrogen-potassium ATPase transport enzyme. Correct inhibiting the sodium-potassium ATPase transport enzyme. Explanation: The recognition that H-K-ATPase was the final step of acid secretion culminated in the development of a class of drugs, the proton pump inhibitors (PPIs), which are targeted at inhibiting this enzyme. They are most effective when the parietal cell is stimulated to secrete acid postprandially, a relationship that has important clinical implications for timing of administration. Because the amount of H-K-ATPase present in the parietal cell is greatest after a prolonged fast, PPIs should be administered before the first meal of the day. Question: A 7-10 day regimen of ciprofloxacin (Cipro) plus metronidazole (Flagyl) is indicated for the outpatient treatment of: bacterial vaginosis. uncomplicated diverticulitis. Correct Clostridium difficile. gastroenteritis. Explanation: A 7-10 day course of oral ciprofloxacin (Cipro) plus metronidazole (Flagyl) is appropriate for the outpatient management of uncomplicated diverticulitis. This regimen provides adequate coverage of common gastrointestinal flora of gram-negative rods and anaerobes. Question: Ranitidine (Zantac), a histamine receptor antagonist, is contraindicated in: children. pancreatitis. phenylketonuria (PKU). Correct Zollinger-Ellison disease. Explanation: Some H2-blockers contain aspartame. Aspartame is converted to phenylalanine and must be used with caution in patients with PKU. The Pepcid AC brand of famotidine chewable tablets contains 1.4 mg of phenylalanine per 10-mg dose. The Pepcid RPD brand of famotidine oral dispersible tablets contains 1.05 mg of phenylalanine per 20-mg dose. The Zantac brand of ranitidine EFFERdose tablets contains 2.81 mg of phenylalanine per 25-mg dose and 16.84 mg of phenylalanine per 150-mg dose. Question: A patient who has been taking a proton pump inhibitor for the last 6 months reports persistent diarrhea for the past 3 weeks. The nurse practitioner should consider: colitis. gastroparesis. bacterial gastroenteritis. Clostridium difficile. Correct Explanation: The US Food and Drug Administration (FDA) has issued a safety alert encouraging providers to consider a diagnosis of Clostridium difficile-associated disease in PPI users with persistent diarrhea. Given the potential risk of Clostridium difficile infection, the FDA has also recommended that providers prescribe the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated. Question: Histamine receptor antagonists (H2RA), such as famotidine (Pepcid), inhibit acid secretions by: blocking the parietal cells (acid-producers) from responding to histamine. Correct blocking transport of histamine across the ATPase Pump. antagonizing the release of histamine from the enterochromaffin-like cells (ECL cells). antagonizing hydrogen ions from responding to histamine. Explanation: H2 blockers inhibit the parietal cells in the stomach lining from responding to histamine. This reduces the amount of acid produced by the stomach. H2RA blockers include: famotidine (Pepcid); ranitidine (Zantac), and nizatidine (Axid). Question: The length of treatment for oral metoclopramide should NOT exceed: 4 weeks. 8 weeks. 10 weeks. 12 weeks. Correct Explanation: Avoid treatment with metoclopramide for longer than 12 weeks in all but rare cases in which therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia. Oral metoclopramide is indicated for adults only. Question: A 42-year-old patient is being treated with 40 mg of famotidine (Pepcid) daily for the treatment of duodenal ulcers. The best time for the patient to take this medication is: on an empty stomach, 1 hour prior to breakfast. with breakfast. prior to the largest meal of the day. at bedtime. Correct Explanation: Oral dosage forms of famotidine (suspension, tablets, chewable tablets, and oral disintegrating tablets) used to treat duodenal ulcers are typically administered once a day at bedtime. BID dosing is also accepted. Question: Topical steroid cream, used in the treatment of hemorrhoids, should be applied twice daily for no more than: 3 days. 5 days. 7 days. Correct 10 days. Explanation: Topical steroid cream may be used to relieve pruritus and reduce the size of hemorrhoids. It should be applied to the site twice daily for no more than 7 days to avoid potential thinning of perianal and anal mucosa and reduce the risk of injury. Question: The drug of choice for the prevention of postoperative nausea and vomiting (PONV) is: droperidol (Inapsine). chlorpromazine (Thorazine). ondansetron (Zofran). Correct promethazine (Phenergan). Explanation: Ondansetron (Zofran) has a limited side effect profile and doesn’t adversely affect the postoperative course. The manufacturer recommends administering preoperatively for the prevention of postoperative nausea and vomiting. Although droperidol (Inapsine), chlorpromazine (Thorazine) and promethazine (Phenergan) are indicated for the treatment of nausea and vomiting, they are not indicated for the prevention of post operative nausea and vomiting. Promethazine has a more extensive side effect profile than Zofran. Question: Long-term use of histamine receptor antagonists (H2RA), such as ranitidine (Zantac), has been associated with: hypermagnesemia. vitamin B12 deficiency. Correct iron deficiency. hypocalcemia. Explanation: Long-term H2RA use, for the treatment of gastroesophageal reflux, is associated with B12 deficiency. Proton pump inhibitors are associated with hypomagnesemia, calcium malabsorption, vitamin B12 and iron deficiency. H2RA blockers include: famotidine (Pepcid); ranitidine (Zantac), and nizatidine (Axid). Question: Due to potential for extrapyramidal symptoms, oral metoclopramide (Reglan) should NOT be administered concomitantly with: sertraline (Zoloft). Correct hydralazine (Apresoline). hydromorphone (Dilaudid). lamotrigine (Lamictal). Explanation: Concomitant use of drugs that can cause extrapyramidal symptoms should be avoided unless absolutely necessary. These drugs include some antipsychotics (Abilify), selective serotonin reuptake inhibitors (i.e. Zoloft), selective norepinephrine reuptake inhibitors (Cymbalta), and norepinephrine-dopamine reuptake inhibitors (Wellbutrin). Hydralazine (Apresoline) is a vasodilator/nitrate; hydromorphone (Dilaudid) is an opioid; lamotrigine (Lamictal) is an antiepileptic. Question: Prior to the initiation of long-term treatment with a proton pump inhibitor (PPI) and periodically during therapy, the nurse practitioner should monitor serum: potassium. sodium. magnesium. Correct calcium. Explanation: Hypomagnesemia due to reduced intestinal absorption has been described with PPI use. It is recommended that serum magnesium levels be obtained prior to starting a PPI when patients are expected to be on the medication for long periods of time, or in patients who take PPIs in conjunction with other medications associated with hypomagnesemia (e.g., digoxin or diuretics). Question: Drug classes used as antiemetics do NOT include: benzodiazepines. glucocorticoids. antidepressants. Correct cannabinoids. Explanation: As single agents, the benzodiazepines are relatively weak antiemetic agents. Glucocorticoids are effective and well-tolerated antiemetics for chemotherapy-induced emesis. The modest antiemetic activity of this class of agents, combined with their relatively unfavorable side effect profile (vertigo, xerostomia, hypotension, dysphoria), especially in older patients, has limited their clinical utility. Antidepressants are not utilized as antiemetics. Question: Patients who take corticosteroids for Crohn's disease should be instructed to notify the nurse practitioner if pain develops in the: wrist. elbow. hip. Correct lower back. Explanation: The long term use of corticosteroids may lead to avascular necrosis of the hip joints that may require surgery. Hip or knee pain in people taking corticosteroids requires prompt medical attention. Question: Corticosteroids, used in the treatment of ulcerative colitis, are produced by the: pituitary gland. hypothalamus. adrenal glands. Correct pancreas. Explanation: Corticosteroids are produced by the adrenal glands in the cortex. Oral and parenteral corticosteroids are used to manage more severe exacerbations. These are ineffective as maintenance therapy to keep ulcerative colitis in remission. Question: Metoclopramide, for the treatment of gastroesophageal reflux, should be administered orally: 30 minutes after meals and at bedtime. 30 minutes prior to meals and at bedtime. Correct with meals. with a full glass of water before bed. Explanation: Metoclopramide (Reglan), an antiemetic for the treatment of gastroesophageal reflux and other nausea/vomiting producing diseases, should be administered 30 minutes prior to meals and at bedtime when administered orally in tablet, elixir or orally disintegrating tablets. Question: The brand name of omeprazole is: Prevacid. Prilosec. Correct Protonix. Probenecid. Explanation: The brand name for omeprazole is Prilosec. The generic name for Prevacid is lansoprazole. The generic name for Protonix is pantoprazole. Probenecid is used to treat gout. Question: Which medication may be used in infants for the treatment of functional constipation? Senna (Senokot) Mineral oil Bisacodyl (Dulcolax) Polyethylene glycol 3350 (MiraLax) Correct Explanation: Polyethylene glycol 3350 (MiraLax) is an osmotic laxative and is considered safe for use in infants. Mineral oil is contraindicated in infants due to an increased risk for aspiration. Senna (Senokot) and bisacodyl (Dulcolax) are stimulant laxatives and not recommended in this age group for the treatment of functional constipation. Question: Patients should be advised to remove the scopolamine patch if an adverse reaction occurs, such as: constipation. confusion. Correct drowsiness. mydriasis. Explanation: Confusion may indicate the beginnings of toxic psychosis caused by scopolamine and the drug should be stopped if confusion occurs. Constipation, drowsiness and mydriasis are all side effects of scopolamine. However, they are not considered an adverse reaction. Constipation can be alleviated with increased fluids. Drowsiness and mydriasis usually resolve within a few days. Question: For patients who didn’t respond to an initial course of triple therapy for Helicobacter pylori, an alternate regimen should be prescribed. It would include a proton pump inhibitor (PPI) and: amoxicillin and clarithromycin. amoxicillin and cephalexin. metronidazole and clarithromycin. metronidazole and tetracycline. Correct Explanation: For patients who didn’t respond to an initial course of triple therapy for Helicobacter pylori, tetracycline may be more effective than metronidazole. The recommended regimen contains amoxicillin, omeprazole, and bismuth salts plus either metronidazole or tetracycline. Clarithromycin should not be used unless resistance testing confirms the H. pylori strain is susceptible to the drug. Antibiotics previously taken for prior treatment should generally be avoided. Question: In the patient with an allergy to penicillin, treatment of Helicobacter pylori would include a proton pump inhibitor plus: amoxicillin and clarithromycin. amoxicillin/clavulanate and tetracycline. metronidazole and clarithromycin. Correct amoxicillin and cephalexin. Explanation: The regimen most commonly recommended for first-line treatment of Helicobacter pylori is triple therapy with a proton pump inhibitor (PPI), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for 7 to 14 days. In patients with a known allergy to amoxicillin, metronidazole should be prescribed. Question: The brand name of pantoprazole is: Prevacid. Prilosec. Protonix. Correct Probenecid. Explanation: The brand name of pantoprazole is Protonix. It is classified as a proton pump inhibitor. The brand name of omeprazole is Prilosec. The generic of Prevacid is lansoprazole. Probenecid is used to treat gout. Question: In patients with severe renal failure, the dosage of histamine receptor antagonists (H2RA) should be reduced by: 25%. 30%. 50%. Correct 75%. Explanation: The dose of all the H2RAs is generally reduced by 50% in patients with severe renal failure. The plasma half-life is prolonged and total clearance is reduced in the elderly population due to a decrease in renal function. The elimination half-life is 3.1 hours. H2RA blockers include: famotidine (Pepcid); ranitidine (Zantac), and nizatidine (Axid). Question: The bioavailability and time to peak of oral ondansetron (Zofran) in the treatment of noncancerous nausea and vomiting are: 30% and 2 hours. 50% and 1 hour. 60% and 2 hours. Correct 80% and 1 hour. Explanation: Bioavailability of oral ondansetron (Zofran) is 50% to 70% due to some first-pass metabolism. In cancer patients (adults), it demonstrates 85% to 87% bioavailability possibly related to changes in metabolism. The time to peak is about 2 hours. Question: The generic name for Dramamine is: doxylamine. diphenhydramine. brompheniramine. dimenhydrinate. Correct Explanation: The generic name of Dramamine is dimenhydrinate. Dramamine is classified as an antihistamine. It may be used to treat allergies or dizziness. The brand name for doxylamine is Unisom; diphenhydramine is Benadryl; brompheniramine is Bromax. Question: Which of the following agents is NOT typically used to treat symptoms of pain and bloating associated with diarrhea-predominant irritable bowel syndrome (IBS)? Dicyclomine (Bentyl) Peppermint oil Linaclotide (Linzess) Correct Hyoscyamine (Levsin) Explanation: Antispasmodics and peppermint oil may be prescribed as needed and/or prophylactically in the event of an anticipated stressor for short-term relief of symptoms associated with diarrhea-predominant irritable bowel syndrome (IBS). While these agents provide relief of symptoms, they typically do not affect disease-induced alterations in bowel patterns. Linaclotide (Linzess) works to increase intestinal fluid secretion and motility. It is indicated for treatment of constipation-predominant IBS, not diarrhea-predominant IBS. Question: The duration of action of meclizine (Antivert) is: 2 hours. 4 hours. 6 hours. 8 hours. Correct Explanation: Meclizine (Antivert) is a first generation antihistamine, used in the treatment of nausea/vomiting, vertigo and motion sickness. The duration of meclizine (Antivert) is approximately 8-24 hours. The onset of action is about 1 hour with a half-life of 6 hours. Question: Quadruple therapy for the treatment of peptic ulcer disease caused by Helicobacter pylori consists of: reflux precautions, proton pump inhibitor, bismuth subsalicylate and an antibiotic. bismuth subsalicylate, a proton pump inhibitor and two antibiotics. Correct an antacid, bismuth subsalicylate, proton pump inhibitor and an antibiotic. two proton pump inhibitors and two antibiotics. Explanation: Bismuth-containing quadruple therapy consists of a proton pump inhibitor (PPI) combined with bismuth subsalicylate (524 mg four times daily) and two antibiotics (e.g., metronidazole 250 mg four times daily and tetracycline 500 mg four times daily) given for 14 days. Question: The brand name for esomeprazole is: Flexium. Nexavar. Protonix. Nexium. Correct Explanation: The brand name for esomeprazole is Nexium. Nexium and Protonix are proton pump inhibitors. The generic name for Protonix is pantoprazole. Nexavar is an antiangiogenic agent. Flexium is an OTC gel used for the treatment of muscle and joint pain. Question: The brand name of prochlorperazine maleate is: Cyclivert. Thorazine. Phenergan. Compazine. Correct Explanation: The brand name of prochlorperazine maleate is Compazine. The generic name for Cyclivert is cyclizine; Thorazine is chlorpromazine; Phenergan is promethazine. Question: Scopolamine (Transderm-Scop) is indicated for the treatment of nausea and vomiting associated with: chemotherapy. gastroenteritis. hyperemesis gravidarum. motion sickness. Correct Explanation: Scopolamine base (Transderm-Scop) is indicated for the treatment of motion sickness and postoperative nausea and vomiting. It has been used in chemotherapy-induced nausea and vomiting, but this is an off-label use. It is not used in hyperemesis gravidarum. The risks versus the benefits must be considered for use in pregnancy. There is no indication for use in gastroenteritis. Question: Triple therapy for treatment of peptic ulcer disease caused by Helicobacter pylori consists of: reflux precautions, proton pump inhibitor and an antibiotic. dietary modifications, bismuth subsalicylate and two antibiotics. an antacid, proton pump inhibitor and an antibiotic. a proton pump inhibitor and two antibiotics. Correct Explanation: Triple therapy for the treatment of Helicobacter pylori consists of a proton pump inhibitor (PPI) and two antibiotics. The regimen most commonly recommended for first-line treatment of Helicobacter pylori is triple therapy with a proton pump inhibitor (PPI), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for 7 to 14 days. Question: The brand name of metoclopramide, an antiemetic, is: Megace. Renagel. Reglan. Correct Metolazone. Explanation: The brand name of metoclopramide is Reglan. It is an antiemetic. The brand name of metolazone, a diuretic, is Zaroxolyn. The generic name of Renagel, a phosphate binder, is sevelamer. Megestrol is the generic name of Megace. It is a progestin and is used to stimulate appetite. Question: A patient who has failed two courses of therapy for Helicobacter pylori should: be admitted for intravenous therapy. receive quadruple therapy for 3 months' duration. receive reinforced education about compliance with medications. Correct be considered for enrollment in a trial study. Explanation: It is important to reinforce the need for compliance with medications for a patient who has failed two attempts at treatment of Helicobacter pylori. Non-compliance is often the cause of treatment failure. Intravenous therapy and enrollment in a trial study are not recommended. Although quadruple therapy may be a viable option, it would not extend for 3 months. Question: Ondansetron (Zofran) is available as: intramuscular and intravenous solutions only. oral disintegrating tablets and an intravenous solution only. oral elixir and disintegrating tablets only. oral elixir, tablets, soluble film, disintegrating tablets, intramuscular and intravenous solution. Correct Explanation: Ondansetron (Zofran) is available in oral elixir, oral tablets, oral soluble film, oral disintegrating tablets, intramuscular and intravenous solution. Question: The first-line regimen for the treatment of Helicobacter pylori is a proton pump inhibitor (PPI) plus: amoxicillin and clarithromycin. Correct amoxicillin/clavulanate and tetracycline. clarithromycin and tetracycline. amoxicillin and cephalexin. Explanation: The regimen most commonly recommended for first-line treatment of Helicobacter pylori is triple therapy with a proton pump inhibitor (PPI), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for 7 to 14 days. Question: [Show Less]
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AGNP BOARD EXAM QUESTIONS EYE EAR NOSE THROAT Prescription (102 Questions,Answers and Explanati
AGNP BOARD EXAM QUESTIONS EYE EAR NOSE THROAT Prescription (102 Questions,Answers and Explanation). Question: Oral tetracycline (Sumycin), for the treatm... [Show More] ent of acute frontal sinusitis, should be administered: with milk. with meals. on an empty stomach. Correct with an antacid. Explanation: Tetracycline (Sumycin) should be administered on an empty stomach (i.e., 1 hour prior to, or 2 hours after meals) to increase total absorption and with adequate amount of fluid to reduce the risk of esophageal irritation and ulceration. It should be administered at least 1 to 2 hours prior to, or 4 hours after, an antacid containing aluminum and magnesium cations. It may chelate with tetracycline (Sumycin) and reduce its total absorption. Serum concentrations may be decreased if taken with dairy products. Question: The brand name for sulfacetamide ophthalmic is: AzaSite. Bleph-10. Correct Besivance. Garamycin. Explanation: The brand name of sulfacetamide ophthalmic is Bleph-10. AzaSite is the brand name of azithromycin. Besifloxacin is the generic name for Besivance. The generic name of Garamycin is gentamicin sulfate. Question: The generic name for Polytrim ophthalmic is: trimethoprim and polymyxin B. Correct bacitracin/polymyxin B. azithromycin. besifloxacin. Explanation: The generic name for Polytrim is trimethoprim and polymyxin B. Polycin is the brand name for bacitracin/polymyxin B. The brand name for azithromycin is AzaSite. Besifloxacin brand name is Besivance. Question: Which of the following does NOT cause a drug-disease interaction when using a decongestant/antihistamine medication such as Naphazoline/pheniramine (Naphcon-A)? Cardiovascular disease Angle-closure glaucoma Prostatic hypertrophy Hypothyroidism Correct Explanation: Contraindications/cautions when using naphazoline/pheniramine (Naphcon-A) include angle-closure glaucoma, MAOI inhibitor use within 14 days, cardiovascular disease, hypertension, diabetes mellitus, prostatic hypertrophy and urinary tract obstruction. Question: The maximum daily dose of acetaminophen for ages 12 years and older is: 1200 milligrams/day. 2000 milligrams/day. 3000 milligrams/day. 4000 milligrams/day. Correct Explanation: Acetaminophen generally is safe to use. In high doses, however, it can cause liver damage. Doses of 4000 mg (4 grams) per day should not be exceeded in patients 12 years and older. Maximum dose in neonates is 60 mg/kg/day and 75 mg/kg/day in infants and children. Question: For treatment of blepharitis, patients should be instructed to apply erythromycin ointment to the affected eye using: a 0.5 inch ribbon 3 times daily for 5 days. a 0.5 cm ribbon 3 times daily for 5 days. a 1-inch ribbon 5 times daily for 7 days. a 1-cm ribbon 5 times daily for 7 days. Correct Explanation: Patients should be instructed to apply a 1-cm ribbon of erythromycin ophthalmic ointment up to 6 times daily for up to 10 days. Question: Ophthalmic cromolyn inhibits the degranulation of sensitized mast cells. It is indicated in the treatment of: acute conjunctivitis. vernal conjunctivitis. Correct fungal keratitis. herpes keratoconjunctivitis. Explanation: Ophthalmic cromolyn is a mast cell stabilizer used to prevent or control allergic conditions. It is indicated in the treatment of vernal keratoconjunctivitis, vernal conjunctivitis, and vernal keratitis. Vernal conjunctivitis is long-term inflammation of the outer lining of the eyes. It is due to an allergic reaction. Question: The most effective treatment for eradication of group A streptococcus in those who are apparent carriers is: a single dose of intramuscular penicillin (Bicillin). oral rifampin (Rifadin) for 4 days. oral clindamycin (Cleocin) for 10 days. Correct a single dose of intramuscular ceftriaxone (Rocephin). Explanation: The most effective treatment for eradication of group A streptococcus in those who are carriers is oral clindamycin (Cleocin) for 10 days. A single dose of intramuscular penicillin (Bicillin) plus 4 days of oral rifampin (Rifadin) is also effective. Question: The generic name for Dramamine is: doxylamine. diphenhydramine. brompheniramine. dimenhydrinate. Correct Explanation: The generic name of Dramamine is dimenhydrinate. Question: For empiric treatment of patients with acute bacterial rhinosinusitis (ABRS) who are allergic to penicillin, the best alternative first-line therapy is: azithromycin (Zithromax). clarithromycin (Biaxin). doxycycline (Vibramycin). Correct metronidazole (Flagyl). Explanation: Doxycycline (100 mg orally twice daily or 200 mg orally daily) is a reasonable alternative for first-line therapy and can be used in patients with penicillin allergy. A respiratory fluoroquinolone (levofloxacin 500 mg orally or moxifloxacin 400 mg orally once daily) is another alternative for penicillin-allergic patients. However, fluoroquinolones should be reserved for those who have no alternative treatment options, because the serious adverse effects associated with fluoroquinolones generally outweigh the benefits for patients with acute sinusitis. Macrolides (clarithromycin or azithromycin), trimethoprim-sulfamethoxazole, and second- or third-generation cephalosporins are not recommended for empiric therapy because of high resistance rates of S. pneumoniae. Question: Dosing of oseltamivir (Tamiflu) for adults and adolescents with active influenza is administered orally: based on weight twice daily for 5 days. 75 mg daily x 5 days. 75 mg twice daily x 5 days. Correct 75 mg twice daily x 10 days. Explanation: Dosing of oseltamivir (Tamiflu) for adults and adolescents with active influenza is 75 mg twice daily for 5 days. No dosage adjustment is necessary in the morbidly obese patient. Prophylactic dosing of oseltamivir (Tamiflu) for adults and adolescents who have been exposed to influenza is 75 mg by mouth daily x 10 days. Question: The vasoconstrictive properties of alpha-1 agonist medications make them beneficial for the treatment of: benign prostatic hypertrophy. closed-angle glaucoma. sinus congestion. Correct hypertension. Explanation: Because of their properties as vasoconstrictive agents, alpha-1 agonists are used to reduce edema and inflammation within the sinus cavities. Alpha-1 agonist medications are also known as decongestants. Common decongestant drugs include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin) nasal. Question: The use of oral acyclovir (Zovirax) in older adults is more likely to cause: confusion and hallucinations. Correct constipation and hypertension. headache and peripheral edema. increased liver enzyme activity. Explanation: Older adults are more likely to have renal or CNS adverse events when receiving acyclovir (Zovirax). With respect to CNS adverse events observed during clinical practice, somnolence, hallucinations, confusion, and coma are reported more frequently in older adults. The most frequently reported side effects are malaise, headache, nausea, vomiting and diarrhea. Cardiovascular side effects have not been reported. Increased liver enzyme activity may occur with parenteral administration. Question: Cephalosporins are classified as: macrolides. beta-lactam antibiotics. Correct non beta-lactam antibiotics. aminoglycosides. Explanation: Beta-lactam antibiotics are among the most commonly prescribed drugs, grouped together based upon a shared structural feature, the beta-lactam ring. Beta-lactam antibiotics include penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors. Question: The onset of action of oxymetazoline (Afrin) is: 5 minutes. 10 minutes. Correct 30 minutes. 60 minutes. Explanation: Oxymetazoline (Afrin) has an onset of action of 10 minutes and a duration of action of 12 hours. Oxymetazoline is a decongestant that shrinks blood vessels in the nasal passages. Indicated for short-term temporary relief of nasal congestion. Do not use in larger or smaller amounts or for longer than recommended. Overuse may cause rebound congestion. Recommended dosing is 2-3 sprays in each nostril every 10-12 hours as needed. Question: Erythromycin (Ilotycin) ophthalmic ointment is classified as a(n): aminoglycoside. macrolide. Correct fluoroquinolone. sulfonamides. Explanation: Erythromycin (Ilotycin) ophthalmic ointment is classified as a macrolide. Ofloxacin ophthalmic is a fluoroquinolone. Gentamicin ophthalmic is an aminoglycoside. Sulfacetamide ophthalmic is a sulfonamide. Question: A common side effect of amoxicillin in children is: nausea. joint pain. abdominal pain. Correct headache. Explanation: The most common side effects in children who take amoxicillin are abdominal pain or cramps, black tarry stools, diarrhea, chest pain and bleeding gums. Hypersensitivity reactions are a major problem with the use of penicillins such as amoxicillin (Amoxil). Symptoms of hypersensitivity reactions include adverse reaction resulting in nausea, vomiting, pruritus, urticaria, wheezing, laryngeal edema and ultimately, cardiovascular collapse. Question: The first-line antibiotic for acute otitis media in a child with a potential for beta-lactam resistance is: amoxicillin (Amoxil). amoxicillin-clavulanate (Augmentin). Correct azithromycin (Zithromax). trimethoprim-sulfamethoxazole (TMP-SMX). Explanation: Amoxicillin-clavulanate (Augmentin) is the first-line therapy for children with acute otitis media who are treated with antibiotics and are at increased risk for beta-lactam resistance. Trimethoprim-sulfamethoxazole (TMP-SMX) may be useful in regions where pneumococcal resistance to TMP-SMX is not a concern, but TMP-SMX should not be used if group A Streptococcus (S. pyogenes) is suspected. While macrolide or lincosamide antibiotics may be beneficial in patients with penicillin allergy, resistance is common and they may not be effective. Question: The ophthalmic preparation that is NOT available over the counter is: hydroxypropyl cellulose (Lacrisert), a lubricant. Correct propamidine (Brolene), an antimicrobial. xylometazoline-antazoline (Otrivine-Antistin), an antihistamine. sodium cromoglicate (Opticrom), a mast-cell stabilizer. Explanation: Hydroxypropyl cellulose (Lacrisert) is a prescription strength lubricant. Propamidine (Brolene) an antimicrobial, xylometazoline-antazoline (Otrivine-Antistin), an antihistamine, and sodium cromoglicate (Opticrom), a mast-cell stabilizer can all be purchased over-the-counter. Question: Refractory blepharitis is best treated with: oral antibiotics. Correct topical corticosteroid therapy. antibiotic/steroid ophthalmic drops. topical antibiotics. Explanation: Blepharitis that is unresponsive to topical antibiotics or corticosteroids alone may benefit from oral antibiotic therapy. Blepharitis that involves the cornea with visual impairment should also be treated with oral antibiotics. Tetracyclines are the drug of choice as they inhibit the lipase production from Staphylococcus epidermidis strains that are known to cause blepharitis. Question: A serious adverse reaction to clindamycin (Cleocin) is: esophageal ulcerations. nephrotoxicity. Clostridium difficile-related colitis. Correct photosensitivity. Explanation: A serious adverse reaction to clindamycin (Cleocin) is diarrhea and Clostridium difficile-related colitis. Nephrotoxicity has been seen with vancomycin (Vancocin). Doxycycline (Doryx) has been associated with esophageal ulcerations and photosensitivity. Question: Which of the following is NOT a potential adverse effect of sulfacetamide ophthalmic (Bleph-10) for the treatment of acute conjunctivitis? Acute renal insufficiency Correct Agranulocytosis Toxic epidermal necrolysis Fulminate hepatic necrosis Explanation: Concerns related to adverse effects of sulfonamides, including ophthalmic preparations, include blood dyscrasias (i.e. agranulocytosis), dermatologic reactions (i.e. toxic epidermal necrolysis) and hepatic necrosis (i.e. fulminant hepatic necrosis). Acute renal insufficiency hasn't been indicated as a potential adverse reaction. Question: The preferred class of oral antibiotic therapy for blepharitis with visual impairment is: tetracyclines. Correct macrolides. quinolones. penicillins. Explanation: The preferred class of antibiotics to treat blepharitis with visual impairment is tetracyclines. Tetracyclines are the drug of choice as they inhibit the lipase production from Staphylococcus epidermidis strains that are known to cause blepharitis. Question: Ocular steroids indicated for the treatment of allergic conjunctivitis can be used in patients with: ocular hypertension. epithelial herpes simplex. herpes zoster keratitis. Correct open-angle glaucoma. Explanation: Ocular steroids indicated for the treatment of allergic conjunctivitis, such as dexamethasone (Maxidex), are also indicated for treatment of herpes zoster keratitis. Ocular steroids are contraindicated in patients with ocular hypertension, epithelial herpes simplex, and open-angle glaucoma. Question: The brand name for meclizine is: Antivert. Correct Atarax. Cyclivert. Sominex. Explanation: The brand name for meclizine is Antivert. The generic name of Atarax is hydroxyzine; Cyclivert is cyclizine; Sominex is diphenhydramine. Question: Oxymetazoline nasal spray, a nasal decongestant, is manufactured under the brand name: Afrin. Correct Astelin. AsthmaNefrin. Omnaris. Explanation: Oxymetazoline is a decongestant nasal spray manufactured under several brand names, including Afrin, Neo-Synephrine 12 Hour Spray and Sinex. All are available over the counter. Azelastine (Astelin) is a nasal antihistamine. AsthmaNefrin is an inhaled bronchodilator. Ciclesonide (Omnaris) is a nasal corticosteroid. Question: The most effective method to minimize dizziness associated with the administration of otic solutions is to: apply a cotton ball to the ear canal after administration of the drops. push the tragus in over the canal after instilling the drops for 2-3 minutes. warm the suspension by holding in the hand for 1-2 minutes. Correct use a wick for application of the drops. Explanation: Instillation of cold fluids in the ear may cause dizziness. To minimize dizziness, warm the suspension by holding the bottle in the hand for 1-2 minutes. Question: Intranasal antihistamines are indicated in the treatment of: epistaxis. nasal congestion. rhinosinusitis. vasomotor rhinitis. Correct Explanation: Intranasal antihistamines are indicated in the treatment of seasonal allergic rhinitis, perennial allergic rhinitis and vasomotor rhinitis. Epistaxis and nasopharyngitis are the most commonly reported adverse reactions. Intranasal antihistamines are not indicated for nasal congestion. Question: Due to potential drug-drug interactions, therapy should be monitored when a patient is receiving erythromycin (Eyemycin) ointment and: cyclosporine ophthalmic (Restasis). dexamethasone ophthalmic (Maxidex). lovastatin (Mevacor). warfarin (Coumadin). Correct Explanation: Erythromycin (Eyemycin) ophthalmic ointment may increase the serum concentration of Vitamin K antagonists, such as warfarin (Coumadin). Question: When prescribing polymyxin B sulfate/bacitracin zinc (Polycin-B), patients should be instructed to: discontinue at 3 days, even if conjunctivitis persists. discontinue as soon as symptoms resolve. discontinue if blurred vision occurs immediately after use. complete therapy, even if symptoms resolve. Correct Explanation: Patients with bacterial conjunctivitis should respond in 1 to 2 days with a decrease in discharge, redness, and irritation. However, therapy should be continued for 7-10 days depending upon severity. Blurred vision is a common occurrence after the administration of an ointment. Question: Ceruminolytics are safe to use in patients with history of: conductive hearing loss. Correct infections. perforations. tympanostomy tubes. Explanation: Ceruminolytics are safe to use in patients with conductive hearing loss. Conductive hearing loss may be related to cerumen impaction. They should not be used if the patient has a recent history of infection, perforation, or otologic surgery. Ceruminolytics should be avoided if tympanic membrane damage is suspected. If a patient has a history of drainage from the ear, ear pain, or frequent ear infections, the tympanic membrane may be impaired and ceruminolytics should not be employed. Question: Polymyxin B/trimethoprim ophthalmic is NOT indicated for: adult bacterial conjunctivitis. pediatric bacterial conjunctivitis. blepharoconjunctivitis. ophthalmia neonatorum. Correct Explanation: Polymyxin B/trimethoprim ophthalmic is NOT indicated in the treatment of ophthalmia neonatorum as it does not treat the most common bacterial causes, including Neisseria gonorrhea and Chlamydia trachomatis. Chlamydial conjunctivitis may be treated with erythromycin drops or oral erythromycin. Gonococcal conjunctivitis should be treated with IV Penicillin G, topical bacitracin or erythromycin. Topical 1% silver nitrate, 0.5% erythromycin, and 1% tetracycline are considered equally effective for prophylaxis of ocular gonorrhea infection. Question: A common side effect of azelastine (Optivar) ophthalmic drops used for allergic conjunctivitis is: ocular edema. elevated blood pressure. a bitter taste. Correct dizziness. Explanation: The most frequently occurring side effects of azelastine (Optivar), an antihistamine/mast cell stabilizer combination, include headaches, transient burning/stinging, and bitter taste. Question: If ocular steroids are to be used for more than 10 days, monitoring should include: blood pressure. ocular pressure. Correct BUN. capillary blood sugar. Explanation: If ophthalmic steroids are used for more than 10 days there is an increased risk for Intraocular pressure; therefore this should be monitored. Question: Oxymetazoline (Visine-LR) is an ophthalmic: antihistamine. decongestant. Correct mast cell stabilizer. antihistamine/mast cell stabilizer. Explanation: Oxymetazoline (Visine-LR) is an ophthalmic vasoconstrictor or decongestant used to reduce hyperemia in the eye by causing vasoconstriction. Question: Potential adverse reactions of glucocorticoid nasal sprays do NOT include: epistaxis. nasal septal perforation. nasopharyngitis. sialorrhea. Correct Explanation: Sialorrhea (excessive salivation) has not been associated with nasal glucocorticoid use. Epistaxis and nasopharyngitis are the most commonly reported adverse reactions. Nasal septal perforation has been reported and may be related to spraying the nasal spray into the septum, rather than away from it. Question: The mechanism of action of trifluridine (Viroptic), an ophthalmic antiviral, used in the treatment of herpes simplex conjunctivitis is: stimulation of alpha adrenergic receptors. interference with viral replication by inhibiting thymidylate synthetase. Correct inhibition of leukocyte migration. increase in cell wall permeability and inhibition of nucleic acid and protein synthesis. Explanation: Trifluridine (Viroptic), an ophthalmic antiviral, works by interfering with viral replication through the inhibition of thymidylate synthetase. It is not a cure for the infection, but treatment of an outbreak can speed up healing and decrease swelling in the eye to lower the risk of complications. Question: After the administration of olopatadine (Pataday) ophthalmic for allergic conjunctivitis, contact lenses should not be inserted for at least: 5 minutes. 10 minutes. Correct 20 minutes. 30 minutes. Explanation: After instilling olopatadine (Pataday) ophthalmic drops, wait at least 10 minutes before inserting contact lenses. Do not insert contacts if eyes are red. Question: The duration of action of meclizine (Antivert) is: 2 hours. 4 hours. 6 hours. 8 hours. Correct Explanation: Meclizine (Antivert) is a first generation antihistamine, used in the treatment of nausea/vomiting, vertigo and motion sickness. The duration of meclizine (Antivert) is approximately 8-24 hours. The onset of action is about 1 hour with a half-life of 6 hours. Question: A common side effect of oral phenylephrine (Sudafed), a decongestant, is: anxiety. Correct blurred vision. hypotension. peripheral vasoconstriction. Explanation: The side effects of phenylephrine (Sudafed), an oral decongestant, include anxiety, headache, nausea, dry mouth, dizziness, insomnia, elevated blood pressure, and CNS stimulation. Question: Polycin-B is the brand name for: polymyxin and trimethoprim. polymyxin B, gramicidin, and neomycin. polymyxin B and chloramphenicol. polymyxin B and bacitracin. Correct Explanation: Polycin-B is the brand name for polymyxin B and bacitracin. Polytrim is the brand name for trimethoprim and polymyxin B. Neosporin eye drops contain polymyxin B, gramicidin and neomycin. Question: Naphazoline/pheniramine (Naphcon-A) is indicated in the treatment of: allergic conjunctivitis. Correct viral conjunctivitis. trachoma. hordeolum. Explanation: Naphazoline/pheniramine (Visine-A) is a combination decongestant/antihistamine used in the treatment of allergic conjunctivitis. It is used as a decongestant for reducing eye redness and an antihistamine for relieving itchy/watery eyes, as is seen in allergic conjunctivitis. Question: An example of a drug that is a cholinergic agonist is: epinephrine. atropine. Correct ephedrine. dopamine. Explanation: Atropine is considered a cholinergic agonist. Cholinergic agonists mimic the action of acetylcholine. The remainder of the choices are adrenergic antagonists, which act to inhibit the action of catecholamines at the adrenergic receptors. Question: Bacitracin (Ocu-Tracin) ophthalmic ointment inhibits bacterial cell wall synthesis by: inhibiting RNA-dependent protein synthesis at the chain elongation step. binding to 30S ribosomal subunit. preventing the transfer of mucopeptides into the growing cell wall. Correct inhibiting DNA-gyrase in susceptible organisms. Explanation: Bacitracin (Ocu-Tracin) ophthalmic ointment inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall. Question: Which risk factor would NOT prohibit the nurse practitioner from prescribing prednisolone acetate (Pred Forte)? Recent history of cataract surgery Epithelial herpes simplex keratitis [Show Less]
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AGNP BOARD EXAM QUESTIONS Assessment Eye, Ear, Nose and Throat (166 Questions, Answers and Expla
AGNP BOARD EXAM QUESTIONS Assessment Eye, Ear, Nose and Throat (166 Questions with Answers and Explanations). Question: Ophthalmoscopic examination of th... [Show More] e fundus reveals small, rounded, slightly irregular red spots embedded in the retina. These findings are consistent with: superficial retinal hemorrhages. preretinal hemorrhages. microaneurysms. deep retinal hemorrhages. Correct Explanation: Deep retinal hemorrhages appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause. Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundi and are seen in hypertension, papilledema, and occlusion of the retinal vein. Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel. Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy. Question: The whispered voice test allows the examiner to screen for: low frequency hearing loss. high frequency hearing loss. general hearing loss. Correct conductive hearing loss. Explanation: The whispered voice test for auditory acuity and allows the examiner to screen for general hearing loss. In the elderly who have presbycusis, high frequency hearing loss is present. Since consonants are higher frequency sounds than vowels, these sounds are often missed. Question: On examination of the tympanic membrane, a red bulging ear drum is detected. This is consistent with: acute otitis externa. chronic otitis externa. acute otitis media. Correct a serous effusion. Explanation: A red bulging tympanic membrane may be found in a patient who has acute otitis media. In acute otitis externa, the canal may be swollen, narrow, moist and pale with tenderness on touching. The ear drum is intact. In chronic otitis externa, the skin of the canal may be thickened, red, and pruritic. The ear drum is usually unaffected. With serous effusion the ear drum appears amber and there usually is no bulging of the eardrum. Question: One of the refractive errors of vision that presents with symptoms of blurriness and improved with corrective lens, is known as: hyperopia. myopia. strabismus. astigmatism. Correct Explanation: Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus correctly on the retina. This causes blurriness. Question: Miosis is a term used to describe: the shape of the pupils. constriction of the pupils. Correct dilation of the pupils. symmetry of the pupils. Explanation: Miosis refers to constriction of the pupils, mydriasis refers to dilation. Miosis is not associated with the shape or symmetry of the pupils. Question: Otosclerosis is an example of a(n): conductive hearing loss. Correct sensorineural hearing loss. mixed hearing loss. acquired hearing loss. Explanation: Otosclerosis is a hereditary disorder of the labyrinthine capsule in which abnormal bone growth occurs around the ossicles resulting in fixation of the stapes. The stapes does not vibrate which reduces sound transmission to the inner ear. This produces a conductive hearing loss. Question: Drooping of the upper eyelid is termed: an epicanthal fold. ptosis. Correct a retracted lid. ectropion. Explanation: Ptosis is a drooping of the upper eyelid and can be caused by myasthenia gravis, damage to the oculomotor nerve, or to the sympathetic nerve supply (Horner's syndrome). A weakened muscle, relaxed tissues, and the weight of herniated fat may cause senile ptosis. Ptosis can also be congenital. An epicanthal fold is a vertical fold of skin that lies over the medial canthus. A retracted lid is seen as a wide eyed stare. Ectropion is seen when the lower lid turns outward and exposes the palpebral conjunctiva. Question: When a light beam shines into one pupil causing pupillary constriction in that eye, the term used is: indirect reaction to light. consensual reaction to light. optic radiation. direct reaction to light. Correct Explanation: The pupils of both eyes respond identically to a light stimulus regardless of which eye has been stimulated. The direct response describes light entering one eye that produces constriction of the pupil of that eye. A consensual response describes constriction of the unstimulated pupil. These reactions should be compared in both eyes and if there is a difference, further investigation is warranted. Optic radiation is a term used to describe the tract that nerve impulses follow through the retina, optic nerve, and optic tract. Question: Where in the mouth would reddened areas, nodules, or ulcerations that are suspicious of malignancy be present? Mucous membranes Tongue Correct Gums Palate Explanation: Reddened areas, nodules, or ulcerations noted on the sides and undersurface of the tongue and the floor of the mouth would be suggestive of cancer. Cancer of the tongue is the second most common cancer of the mouth; the lip is number one. Question: An example of a cause of conductive hearing loss in children would be: prolonged use of tobramycin. the presence of a peanut in the ear for three weeks. Correct congenital rubella syndrome. maternal history of Herpes infection. Explanation: Conductive hearing loss is the most common type in children. It occurs when the transmission of sound through the external or middle ear is blocked. It may be temporary or permanent, unilateral or bilateral. It may also be caused by physical abnormalities present from birth, but more commonly, it begins during childhood as the result of middle ear infections, perforation of the eardrum, impacted earwax or objects present in the ear canal. The other choices are examples of sensorineural hearing losses. Question: A man with a history of long-term use of chewing tobacco presents with a mouth lesion that is suspicious for malignancy. Oral assessment findings describe: a smooth circular pustule lesion on the base of the gum. a soft, solitary papule lesion located apical to the molar. a small, shallow, sore lesion at the base of the gums. an ulcerated lesion with indurated margins on the lateral tongue. Correct Explanation: Oral malignant lesions present as ulcerated with indurated margins and are not usually circular or smooth. A dental abscess presents as a soft, solitary papule located apical to the molar. Canker sore is a small, shallow sore at the base of the gum. Question: Mydriasis is a term used to describe: the shape of the pupils. constriction of the pupils. dilation of the pupils. Correct symmetry of the pupils. Explanation: Miosis refers to constriction of the pupils, mydriasis refers to dilation. Miosis is not associated with the shape or symmetry of the pupils. Question: Ophthalmoscopic examination of the retina reveals AV tapering. This appears as if the: vein "winds" down on either side of the artery. Correct vein is twisted on the distal side of the artery. vein crosses beneath the artery. vein stops abruptly on either side of the artery. Explanation: When the arterial walls lose their transparency, changes appear in the arteriovenous crossings. Decreased transparency of the retina probably contributes to AV nicking and AV tapering. In tapering, the vein appears to taper or "wind" down either side of the artery. In AV nicking, the vein appears to stop abruptly on either side of the artery. In the normal eye, the vein appears to cross beneath the artery. With banking, the vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance. Question: Causes of sensorineural hearing loss include all of the following except: aging. loud noises over prolonged periods of time. perforated tympanic membrane. Correct acoustic neuroma. Explanation: A perforated tympanic membrane is an example of a cause of a conductive hearing loss. Sensorineural hearing loss involves disorders of the cochlear nerve, cochlea, and an interruption in the neuronal impulse transmission to the brain. Causes include: exposure to loud noises, inner ear infections, acoustic neuroma, aging, and congenital and/or familial disorders. Question: All of the following diseases may be associated with the appearance of a strawberry tongue except: scarlet fever. folic acid and B-12 deficiencies. rubeola. Correct Kawasaki syndrome. Explanation: There are five medical reasons for the appearance of strawberry tongue: Kawasaki disease, scarlet fever, folic acid and vitamin B-12 deficiencies, bacterial toxic shock syndrome, and a geographic tongue. Rubeola does not present with a strawberry tongue. Koplik's spots are diagnostic of rubeola and they appear as clustered white lesions on the buccal mucosa. Question: Janeway lesions of the palms and soles appear as: painful, red, raised lesions. small, nontender, erythematous nodules. Correct hemorrhagic vesiculopustular eruptions. hemorrhagic petechiae. Explanation: Janeway lesions present as small, nontender, erythematous macular or nodular lesions on the palms or soles. Osler nodules are painful, red, raised lesions on the hands and feet. Both Janeway lesions and Osler nodules are indicative of infective endocarditis. Hemorrhagic vesiculopustular eruptions can be associated with gonococcemia. Hemorrhagic petechiae are suggestive of meningococcemia. Question: Which of the following screening tests for hearing loss can detect both sensorineural and conductive hearing loss? Weber Test Correct Rinne Test Whispered Voice Test bilateral hearing loss. Explanation: The Weber hearing screening test can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). Question: Examination of the nose and paranasal sinuses reveal local tenderness, pain, fever, and rhinorrhea. These symptoms are suggestive of: chronic sinusitis of the frontal and maxillary sinuses. allergic rhinitis. upper respiratory infection. acute sinusitis of the frontal and maxillary sinuses. Correct Explanation: With examination of the nose and paranasal sinuses, the presence of local tenderness, together with symptoms such as pain, fever, and nasal discharge, suggest acute sinusitis involving the frontal or maxillary sinuses. Chronic sinusitis usually lasts longer than 3 months and presents with some of the same symptoms as acute sinusitis. This may include thick yellow or green rhinorrhea, facial pain, headaches, and dizziness. Question: The mouth of a ten-month-old infant has white patches on the mucosa that cannot be removed. These patches are consistent with: stomatitis. thrush. Correct Koplik spots. measles. Explanation: Oral thrush is a condition in which the fungus, Candida albicans, accumulates on the lining of the mouth. Oral Candida infections like thrush, are also common side effects of antibiotic therapy due to alterations of the normal bacterial flora. Thrush appears as white patches on the mucosa and does not wipe off. White patches do not appear with stomatitis or measles. Koplik spots are small, white spots with a bluish center on a reddened background that occur on the inside of the cheeks early in the course of measles. Question: In patients who have allergic rhinitis, the nasal mucosa appears: erythematous. pale. Correct green. yellow. Explanation: Rhinitis is inflammation of the nasal mucosa. Normally, the nasal mucosa appears somewhat redder than the oral mucosa. With allergic rhinitis, it appears pale, bluish, or a darker red than normal. In viral rhinitis, it tends to appear erythematous and swollen. A yellow or green color may be due to the appearance of exudate in the nasal cavity. Question: Assessment of a 4 year-olds visual acuity resulted in 20/30 in the left eye and 20/40 in the right eye using the Snellen eye chart. This means: his vision is normal for his age. Correct his vision is abnormal and further testing is warranted. the patient may not be able to read so he should be tested with the picture or "E" eye charts. he has astigmatism. Explanation: Expected visual acuity in a 4 year old is 20/40. At age 5 years, it is expected to be 20/30. By age 6 years, vision should be 20/20 bilaterally. Question: Round or oval shaped lesions surrounded by erythematous mucosa and noted on an area of the oral mucosa may be: leukoplakia. aphthous ulcers. Correct Koplik's spots. ulcerative gingivitis. Explanation: Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and are surrounded by a halo of reddened mucosa. They are usually painful. Leukoplakia presents as thickened white patches anywhere on the oral mucosa. Koplik's spots appear in the early stages of measles (rubeola). They appear as small white specks that resemble grains of salt on a red background on the buccal mucosa. They are not usually painful. Ulcerative gingivitis is a painful form of gingivitis that is characterized by the development of ulcers in the interdental papillae. If untreated they can become necrotizing along the gum margins and appear as erythematous ulcers. Question: A deviated trachea could be caused by all of the following except: pneumothorax. pneumonectomy. pneumonia. Correct atelectasis. Explanation: Tracheal deviation results from unequal intrathoracic pressure within the chest cavity. When the deviation occurs, the trachea will follow the direction of less pressure. Tracheal deviation can be caused by pneumothorax, atelectasis, pleural effusion, some cancers within the pleural cavity, and pleural fibrosis. Pneumonia is not associated with tracheal deviation. Question: When examining the conjunctiva and sclera, have the patient look upward and then: cover one eye while visualizing the sclera and conjunctiva of the uncovered eye. depress both lower lids with your thumbs, exposing the sclera and conjunctiva. Correct look for excessive tearing or dryness in the conjunctiva sac. note the position of the lids in relation to the eyeballs and color of the sclera. Explanation: When examining the conjunctiva and the sclera, the best way to expose these structures is to have the patient look upward and depress both lower lids with your thumbs. Covering one eye while visualizing the other eyes checks for visual acuity. Observing for excessive tearing or dryness assesses the lacrimal apparatus. Checking the position of the lids may identify variations and abnormalities in the eyelids. Question: A sixty-year-old complains of a progressive bilateral hearing loss over the past four months. He has difficulty understanding spoken words and has become sensitive to loud noises. These symptoms are consistent with: otosclerosis. mastoiditis. presbycusis. Correct Meniere's disease. Explanation: Presbycusis is the most common hearing problem in people over 50 years of age. Presbycusis is an ongoing loss of hearing linked to changes in the inner ear. Patients have a hard time hearing what others are saying or may become sensitive to loud noises. Hearing loss is usually bilateral. Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear) and generally results from inadequately treated otitis media. Otosclerosis is a sensorineural hearing loss because of reduced sound transmission to the middle ear. Meniere's disease is a disorder of the middle ear due to impaired absorption of endo endolymph. Question: In order to visualize the opening of Stensen's duct, examine the: dorsal surface of the tongue. area beneath the mandible at the angle of the jaw. buccal mucosa opposite the second molar. Correct small openings along the sublingual fold under the tongue. Explanation: The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to an opening on the buccal mucosa opposite the second molar. If blood comes out through Stensen's duct when it is palpated, this could suggest parotid cancer. If pus is expelled, it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears erythematous and enlarged. The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. Question: A condition that involves optic nerve damage and visual field changes is termed: retinoblastoma. cataracts. glaucoma. Correct pterygium. Explanation: Glaucoma is a leading cause of blindness in the United States. Glaucoma is a condition that produces optic nerve damage and visual field changes. The risk of glaucoma increases with age but can occur in anyone in any age-group. Retinoblastoma is a rapidly developing tumor and is the most common malignant tumor of the eye in children. A cataract is an opacity of the lens and may be seen through the pupil. Pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea and may interfere with vision but does not cause blindness. Question: Sudden bilateral and painless visual loss is rare but can be associated with all the following except: cholinergics. anticholinergics. steroids. chemical exposure. Correct Explanation: Certain medications are associated with sudden bilateral, painless visual loss. These medication classes include cholinergic, anticholinergics, and steroids. Exposure to chemicals or radiation could result in bilateral painful visual loss. Question: When examining pupillary equality, the left pupil is slightly greater than the right pupil. This condition is termed: miosis. anisocoria. Correct mydriasis. conjugate. Explanation: Anisocoria is a condition characterized by an unequal size of the eye's pupils by a difference of 0.4 mm or between the eye's pupils. Miosis refers to constriction of the eye while mydriasis refers to dilation. Conjugate is used to describe symmetrical eye gaze. Question: Redness, bleeding, pain, and swelling of the gums is most likely: stomatitis. gingivitis. Correct leukoplakia. aphthous ulcers. Explanation: Swelling, pain, erythema, and bleeding of the gums are symptoms of gingivitis. Stomatitis refers to inflammation of the mouth. Leukoplakia presents as thickened white patches anywhere in the oral mucosa. Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and surrounded by a halo of reddened mucosa Question: A condition of the sclera that appears as localized ocular inflammation of the episcleral vessels is most likely: scleroderma. episcleritis. Correct [Show Less]
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AGNP BOARD EXAM Endocrinology Assessment (48 Questions with Answers and Explanations)
AGNP BOARD EXAM Endocrinology Assessment (48 Questions with Answers and Explanations) AGNP BOARD EXAM Endocrinology Assessment (48 Questions with Answers ... [Show More] and Explanations) Question: The earliest recognizable clinical manifestation(s) of cystic fibrosis in an infant is: History of poor intestinal absorption Foul smelling, frothy, greasy stools Meconium ileus Salty taste on the skin Correct Explanation: The signs and symptoms of cystic fibrosis (CF) vary from person to person and over time. Sometimes there will be few symptoms and other times, symptoms may become more severe. One of the first signs of CF that parents may notice is that their baby's skin tastes salty when kissed, or the baby doesn't pass stool when first born. Most of the other signs and symptoms of CF happen later. They're related to how CF affects the respiratory, digestive, or reproductive systems of the body. Question: If a newborn is suspected of having congenital hypothyroidism, which clinical manifestation would be evident? Prematurity Hyperthermia Hyperactivity Enlarged anterior fontanel Correct Explanation: Infants with congenital hypothyroidism are usually born at term or after term. Most practitioners now depend on the screening test in newborns to diagnose this condition since the symptoms or signs take time to develop. The symptoms of congenital hypothyroidism may include some of the following: puffy face, coarse facial features, enlarged anterior fontanel, thick protruding tongue, poor feeding, constipation or reduced stooling, prolonged jaundice, decreased activity with hypotonia, hypothermia and cool and pale skin, goiter, birth defects (e.g., heart valve abnormality), poor weight gain due to poor appetite, and swollen hands, feet and genitals. Question: The appearance of breast development in girls before the age of 8 years is termed: amenorrhea. gynecomastia. adrenarche. precocious puberty. Correct Explanation: Puberty that begins before age 8 in girls and before age 9 in boys is considered precocious puberty. Amenorrhea is the absence of menstruation. Gynecomastia is swelling of the breast tissue in boys or men. Adrenarche is the early presence of pubic hair in girls aged 5-8 years old. Question: A butterfly-shaped gland located in the middle of the neck below the larynx and above the clavicles is the: parathyroid gland. thyroid gland. Correct hypothalamus gland. thymus gland. Explanation: The thyroid gland is a butterfly-shaped gland located in the middle of the neck below the larynx and above the clavicles. The parathyroid glands are small endocrine glands located in the neck behind the thyroid gland. The thymus gland is rectangular and located in the mediastinum of the thoracic cavity anterior and superior to the heart and posterior to the sternum. The hypothalamus is located in the brain. Question: When auscultating the enlarged thyroid with a stethoscope, a bruit is suggestive of: a carotid aneurysm. a normal finding. hyperthyroidism. Correct a thyroid malignancy. Explanation: A systolic or continuous bruit auscultated with a stethoscope over an enlarged thyroid may be heard in hyperthyroidism. This is not a normal finding. A bruit is not usually associated with a thyroid malignancy. Question: During assessment of the thyroid, a fixed, firm, nontender large mass is noted. These findings describe: a cyst. a nodule. Correct a goiter. hyperplasia. Explanation: A thyroid nodule presents as a fixed, firm, nontender large mass. Thyroid cysts are fluid-filled. A goiter causes visible swelling at the base of the neck. Hyperplasia is an abnormal increase in the volume of a tissue or organ caused by the formation and growth of new normal cells Question: A hormonal disorder in adults resulting from the overproduction of growth hormones is known as: gigantism. prolactinoma. acromegaly. Correct congenital adrenal hyperplasia. Explanation: Gigantism refers to an abnormally high linear growth due to the excessive action of insulin-like growth factor I (IGF-I) while the epiphyseal growth plates are open during childhood. Acromegaly is the same disorder of IGF-I excess but occurs after the growth plate cartilage fuses in adulthood. Excessive growth hormone is almost always caused by a noncancerous (benign) pituitary tumor. A prolactinoma is a benign tumor (adenoma) of the pituitary gland that produces excessive prolactin resulting in decreased levels of some sex hormones. The term congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. Question: Hyperpigmentation of the skin and mucous membranes can be seen in patients who: acquired immunodeficiency syndrome (AIDS). Addison's Disease. Correct Cushing's Disease. diabetes. Explanation: Hyperpigmentation of skin and mucous membranes is usually seen in patients who have Addison's Disease. Hairy leukoplakia can be seen in patients who have AIDS. Cushing's disease can present with any of the following skin lesions: striae, skin atrophy, purpura, ecchymosis, telangiectasias, acne, moon facies, buffalo hump, or hypertrichosis. Diabetes may produce any of these skin conditions: necrobiosis lipoidica diabeticorum, diabetic bullae, diabetic dermopathy, granuloma annulare, acanthosis nigricans, candidiasis, neuropathic ulcers, eruptive xanthomas, and peripheral vascular disease. Question: Women with hyperthyroidism often experience: oligomenorrhea. Correct normal menstruation. amenorrhea. menorrhagia. Explanation: Women diagnosed with hyperthyroidism usually present with oligomenorrhea or infrequent menstrual periods. Menstruation is normal vaginal bleeding. Amenorrhea is an absence of menstruation. Menorrhagia is prolonged or heavy vaginal bleeding. Question: A 20-year-old with acanthosis nigricans should be evaluated for: acute renal failure. diabetes mellitus. Correct alcohol-induced cirrhosis. hypothyroidism. Explanation: Acanthosis nigricans is a skin condition characterized by dark velvety patches in the body folds and creases. It is typically noted in patients who are obese or who have diabetes. Question: Which one of the following groups of symptoms would be more consistent in a child with type 2 diabetes mellitus? Blood glucose levels on two separate occasions between 75 mg/dL and 110 mg/dL, weight loss, and frequent urination Complaints of being hungry all the time, hyperactivity, and frequent urination Blood glucose levels on two separate occasions greater than 126 mg/dl, enuresis, and complaints of being tired Correct Polyphagia, polydipsia, and polyuria Explanation: Classic S/S of type 2 diabetes mellitus include: non-fasting blood glucose levels >200 (especially with other symptoms of diabetes), overweight, fatigue, frequent infections, and enuresis. Polyphagia, polydipsia, and polyuria are classic signs and symptoms of type 1 diabetes mellitus. Question: A 30-year-old woman is taking phenytoin (Dilantin) for seizures. She has recent hair loss and anorexia but is craving salty foods. Her lab results show abnormally high cortisol levels. These symptoms suggest: hyperparathyroidism. Addison's disease. Correct anorexia nervosa celiac disease. Explanation: Addison's disease, also known as primary adrenal insufficiency and hypercortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce adequate steroid hormones. Classic symptoms of Addison's disease include fatigue, anorexia, chronic diarrhea, salt craving, mucosal pigmentation, and hair loss. Lab tests for adrenal function shows a subnormal rise in cortisol levels. Question: Based on the 2-hour glucose tolerance test (GTT), a positive result for gestational diabetes is: 120 mg/dL. 150 mg/dL 180 mg/dL 200 mg/dL Correct Explanation: Gestational diabetes mellitus (GDM) is diagnosed based on a glucose tolerance test (GTT) of 200 mg/dL or higher. GDM can be diagnosed based on the same criteria used to diagnose types 1 and 2 DM: a fasting blood glucose concentration of >126 mg/dL on two separate occasions or a random blood glucose concentration of >200 mg/dL on two separate occasions. Question: Which of the following is NOT a complaint of patients with type 1 diabetes? Polydipsia Polyuria Polyphagia Polycythemia Correct Explanation: Polycythemia results in an increased level of red blood cells in the bloodstream and is not directly associated with diabetes. Causes of polycythemia include hypoxia, sleep apnea, and certain tumors. The 3 P's of type 1 diabetes include polydipsia, polyuria, and polyphagia. Question: Hypofunctioning of the thyroid gland would lead to all the following disorders except: myxedema. Grave's disease. Correct hypothyroidism. Hashimoto's thyroiditis. Explanation: Hypofunctioning of the thyroid gland leads to an insufficient production of thyroid hormones. This results in a hypometabolic state leading to a decrease in oxygen consumption by the tissues and decreased heat production. Disorders related to hypofunctioning of the thyroid gland include primary hypothyroidism, myxedema, Hashimoto's thyroiditis, iodine deficiency, and myxedema coma. Grave's disease results in hyperfunctioning of the thyroid gland. Question: The most common cause of death in children diagnosed with cystic fibrosis is: heart failure. respiratory failure. Correct liver failure. renal failure. Explanation: The cause of death in more than 90% of patients diagnosed with cystic fibrosis is chronic pulmonary disease caused by bacterial and viral pathogens. This leads to a host inflammatory response. Question: When assessing the thyroid gland, the nurse practitioner palpates for abnormalities while asking the patient to: cough. turn the neck. stick out tongue. swallow water. Correct Explanation: Proper posterior assessment of the thyroid is performed by palpating between the cricoid cartilage and the suprasternal notch. One hand is used to slightly retract the sternocleidomastoid muscle; the other hand palpates the thyroid. The patient is asked to swallow a sip of water during palpation, while the examiner feels for the upward movement of the thyroid gland. Abnormalities include asymmetry, masses, erythema, or deviation of the trachea. Question: A patient has an enlarged thyroid gland with an audible bruit. The examiner should suspect: hypothyroidism. a thyroid malignancy. hyperthyroidism. Correct thyroiditis. Explanation: In a patient who has hyperthyroidism, the examiner could expect an enlarged thyroid gland. Often a localized or continuous bruit is audible over the lateral lobes of the thyroid gland. Question: Myxedema is a symptom commonly found in patients diagnosed with: Addison's disease. hypothyroidism. Correct thyroid nodule. adrenal insufficiency. Explanation: Myxedema is a deposition of mucopolysaccharides in the dermis that results in swelling of the affected area, giving the skin a waxy appearance. One manifestation of myxedema in the lower limb is pretibial myxedema, a hallmark of Graves' disease, an autoimmune form of hyperthyroidism. Myxedema can also occur in Hashimoto's thyroiditis and other longstanding forms of hypothyroidism. Myxedema is not associated with Addison's disease, thyroid nodule, or adrenal insufficiency. Question: A 13-year-old girl presents with complaints of insomnia and hyperactivity along with gradual weight loss despite a good appetite. She has warm, flushed, and moist skin and unusually fine hair. These manifestations are indicative of which one of the following conditions? Hypothyroidism Hyperthyroidism Correct Cushing's Syndrome Addison's Disease Explanation: Symptoms of hyperthyroidism in children may include: anxiousness, irritability and/or nervousness, poor, restless sleep, increased activity/fidgetiness, hyperactivity, increased appetite with or without weight loss, increased number of bowel movements per day, decreased or poor school performance, difficulty concentrating that may be diagnosed as "late-onset" attention deficit disorder, and a feeling of a “lump” in the throat. These symptoms are not seen in the other choices. Question: Children with type 1 diabetes mellitus usually present with which one of the following symptoms? Obesity High cholesterol levels Polyuria Correct Hypoglycemia Explanation: The classic symptoms of type 1 diabetes are polyuria, polydipsia, polyphagia, and unexplained weight loss. Obesity and elevated cholesterol are more consistent with type 2 diabetes mellitus. Hypoglycemia is usually not seen. Question: A six-year-old has a history of diabetes mellitus type I and is now experiencing cellulitis of the right lower leg. The child presents with deep, rapid, and unlabored respirations, fruity odor, and dry skin. These are symptoms of: Hypoglycemia Sepsis Stevens Johnson Syndrome Ketoacidosis Correct Explanation: These are signs of diabetic ketoacidosis (DKA) and can occur in diabetic patients with infections. DKA is characterized by elevated blood glucose (usually higher than 240 mg/dl) and ketonuria. The respiratory pattern is consistent with Kussmaul breathing and are signs of hyperglycemia. Hypoglycemia, Stevens Johnson Syndrome, and sepsis are not consistent with these symptoms. Question: Which electrolyte is regulated by the parathyroid gland? Calcium Correct Sodium Potassium Melatonin Explanation: The parathyroid glands are four tiny glands in the neck that control the body's calcium levels. The adrenal gland regulates sodium and potassium. The pineal gland produces melatonin. Question: Which of the following is NOT considered a benign tumor of the pituitary gland? Craniopharyngioma Correct Prolactinoma Gonadotropin-secreting adenoma Thyrotropin-secreting adenoma Explanation: Craniopharyngiomas develop in the area of the brain near the pituitary gland and are derived from pituitary gland embryonic tissue. They are most common in children and in adults in their 50s and 60s. Almost all pituitary tumors are benign glandular tumors called pituitary adenoma. Examples include: prolactin-producing adenomas (prolactinomas), gonadotropin- and growth hormone-secreting adenomas, and thyrotropin-secreting adenomas. Question: Which of the following is NOT associated with Hashimoto’s thyroiditis? Weight loss Correct Cold intolerance Hair loss Decreased sweating Explanation: Cold intolerance, hair loss, and decreased perspiration are associated with Hashimoto's hypothyroidism. Weight loss is usually noted in patients with hyperthyroidism. Question: A common clinical term used to refer to women with an excess growth of terminal hair in a male pattern is: androgenetic alopecia. alopecia. hirsutism. Correct vellus hair. Explanation: Although hirsutism is broadly defined as excess hair, the common clinical use of the term refers to women with excess growth of terminal hair in a male pattern. Vellus hair is short, thin, slight-colored, and barely noticeable thin hair that develops on most of the body during childhood. Androgenetic alopecia is a genetically determined disorder characterized by the gradual conversion of terminal hairs into indeterminate, and finally vellus, hairs. Alopecia is a condition in which hair is lost from some or all areas of the body. It often results in bald spots. Question: Which hemoglobin A1C level is typically used to diagnose type 2 diabetes? 5% 5.50% 6% 6.50% Correct Explanation: Hemoglobin A1C levels between 5.7% and 6.4% are reflective of impaired glucose metabolism. Type 2 diabetes is diagnosed when the A1C is 6.5 % or greater. Question: A sweat test is used to help diagnose: Graves' disease. hypothyroidism. cystic fibrosis. Correct Crohn's disease. Explanation: A sweat test measures the amount of sodium and chloride in sweat and is used to assist in diagnosing cystic fibrosis. Patients with cystic fibrosis have 2 to 5 times the normal amount of sodium and chloride in their sweat. Question: Hyperfunctioning of the thyroid gland could lead to all the following disorders except: Grave's disease. thyrotoxicosis. myxedema. Correct toxic goiter. Explanation: Hyperfunctioning of the thyroid gland leads to a hypermetabolic state causing an increase in metabolic function, increased oxygen consumption by tissues, and heat production. Disorders include: Grave's disease, toxic goiter, thyroid storm (thyrotoxicosis). Myxedema is seen in hypofunctioning of the thyroid gland. Question: Symptoms of underdeveloped ovaries, web-like neck, and short stature are associated with: polycystic ovarian syndrome (PCOS). prolactinoma. Klinefelter syndrome. Turner syndrome. Correct Explanation: Symptoms of Turner syndrome include short stature, delayed growth, low-set ears, web-like neck, and in girls, underdeveloped ovaries. Symptoms of polycystic ovarian syndrome (PCOS) include infertility, unwanted hair growth, weight gain, and fatigue. Prolactinoma symptoms include infertility, irregular menstrual periods, acne, and unwanted hair growth. Klinefelter syndrome is characterized by hypogonadism, gynecomastia in late puberty, elevated urinary gonadotropin levels, and behavioral concerns in boys. Question: A life-threatening symptom of parathyroid hormone (PTH) deficiency, hypoparathyroidism, is: dystonia. myoclonia. tetany. Correct chorea. Explanation: A lack of parathyroid hormone (PTH) leads to decreased blood levels of calcium (hypocalcemia) and increased levels of blood phosphorus (hyperphosphatemia). Muscle cramps involving the lower back, legs, and feet are common in patients with hypoparathyroidism and hypocalcemia. Tetany develops if hypocalcemia is severe. In some patients, laryngospasm and bronchospasm may be life threatening. Question: A 29-year-old woman with systemic lupus erythematosus (SLE) complains of facial swelling. She has been on a prolonged course of corticosteroids. On assessment, moon face appearance is noted. She has most likely developed: Cushing syndrome. Correct Addison's disease. Sjögren syndrome. Syndrome X. Explanation: Risk factors for Cushing syndrome include prolonged use of corticosteroids. Classical presentation and assessment include “moon face” or “buffalo hump” appearance. Question: A finding NOT identified in boys diagnosed with Klinefelter syndrome is: a low testosterone level. micro-orchidism. gynecomastia. a high sperm count. Correct Explanation: Klinefelter syndrome is a chromosomal condition that affects male physical and cognitive development. Signs and symptoms vary among patients. Low testosterone level, micro-orchidism, gynecomastia, facial hair, baldness, and low sperm count are all associated with Klinefelter syndrome. Question: Thyrotoxicosis is most commonly associated with: hyperthyroidism. Correct hypothyroidism. thyroid nodules. nontoxic goiter. Explanation: Hyperthyroidism occurs due to excessive production of thyroid hormone by the thyroid gland. Thyrotoxicosis is a result of high levels of thyroid hormones and therefore includes hyperthyroidism. A thyroid nodule is an abnormal growth of thyroid cells that forms a lump within the thyroid gland; the majority are benign. A nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. Question: A 9 year old girl had a history of tuberculosis when she was 6 years old. She presents with recent weight loss and anorexia. Along with her presenting symptoms, which one of the following assessment findings would be most indicative of Addison's disease? Thin, fragile skin and multiple bruises Hyperpigmentation and low blood pressure Correct Blurred vision, headaches and enuresis Constipation Explanation: The symptoms of Addison's disease can include any or all of the following: loss of appetite and weight loss, nausea, vomiting or diarrhea, muscle weakness, low blood pressure, salt cravings, dehydration and hypoglycemia, increased pigmentation of the skin, particularly around scars and bony areas, and irregular or no menstrual periods in women. Tuberculosis (TB), an infection that can destroy the adrenal glands, accounts for less than 20 percent of cases of Addison's disease in developed countries. When adrenal insufficiency was first identified by Dr. Thomas Addison in 1849, TB was the most common cause of the disease. As TB treatment improved, the incidence of adrenal insufficiency due to TB of the adrenal glands greatly decreased. Question: What is the earliest recognizable clinical manifestation(s) of cystic fibrosis in a child? Clubbing, frequent respiratory infections, and rectal prolapse Correct Pigeon breast, protruding tongue, and exophthalmos Meconium ileus, abdominal distention, and hyperplasia of the lungs Hypoglycemia, hyperthermia, and tachycardia Explanation: Cystic fibrosis is one of the most common genetic disorders in Caucasian children in the United States and is usually diagnosed at an early age. However, if it is not diagnosed in infancy, some of the symptoms seen in children include: not growing or gaining weight appropriately, frequent lung infections, persistent cough, and wheezing. Other symptoms may also develop in childhood such as: clubbing, rectal prolapse, and polyps in the nose or sinuses. The other choices are not seen in cystic fibrosis. Question: Fruity breath odor correlates with assessment for: salicylate toxicity. diabetic ketoacidosis. Correct urinary tract infection. acute pancreatitis. Explanation: Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and ß-hydroxybutyrate. Ketoacidosis is most common in untreated type 1 diabetes mellitus. A fruity odor is often present on the breath of a patient with diabetes. This is a result of acetone, a direct byproduct of the spontaneous decomposition of acetoacetic acid. Question: Hyperplasia of the thyroid gland is caused by a deficiency of: phosphorus. iron. magnesium. iodine. Correct Explanation: Hyperplasia of the thyroid gland (goiter) results from an iodine-deficient diet, which causes overgrowth of the thyroid gland. Question: Symptoms of Graves' disease include: weight gain. bradycardia. anemia. proptosis. Correct Explanation: Proptosis is defined as a bulging of the eyes, which is a symptom of hyperthyroidism or Graves’ disease. Weight gain, bradycardia, and anemia are associated with hypothyroidism. Question: A general term for an enlarged thyroid is: exophthalmos. a goiter. Correct lymphadenopathy. acromegaly. Explanation: A general term for an enlarged thyroid is goiter. In the presence of goiter, thyroid function can be increased, decreased, or normal. Exophthalmos is a term used to describe an abnormal protrusion of the eye often seen in patients who have thyroid disease. Lymphadenopathy is used to describe swollen or enlarged lymph nodes. Acromegaly is a condition characterized by an increase in growth hormones producing enlargement of bones and soft tissues. Question: The presence of pubic hair in girls between the age of 5 and 8 years is termed: hypertrichosis. thelarche. adrenarche. Correct adrenal hyperplasia. Explanation: Adrenarche is the early presence of pubic hair in girls aged 5 to 8 years. Hypertrichosis is an abnormal amount of hair growth over the body. Thelarche is the onset of female breast development. Adrenal hyperplasia is the excess production of male sex hormones that results in short height, early puberty and in females, abnormal genital development. Question: Breastfeeding is contraindicated for an infant diagnosed with which one of the following conditions? Congenital hypothyroidism Phenylketonuria (PKU) Galactosemia Correct Tay Sachs Disease Explanation: Galactosemia is the lack of a specific enzyme in the liver that breaks down galactose into glucose. Some infants may inherit a gene that allows for some galactose metabolism. However, if the baby has “classic galactosemia” in which the baby has no galactose metabolizing enzymes, the baby will need to be weaned abruptly, and then fed a lactose free formula. Breast feeding is not contraindicated in the other conditions. Question: A common symptom noted in patients who have a thyroid goiter is: a frequent cough. Correct decreased oral secretions. fatigue. gastric reflux. Explanation: A thyroid goiter is an enlarged thyroid gland. Because of the anatomic relationship of the thyroid gland to the trachea, larynx, superior and inferior laryngeal nerves, and esophagus, abnormal growth may cause a variety of compressive syndromes. These symptoms may include: wheezing, cough, globus hystericus, dysphagia, and vocal cord dysfunction and hoarseness. Compression of the venous outflow results in facial plethora and dilated neck and upper thoracic veins. Other symptoms include waking up from sleep with the sensation of being unable to breathe or feeling that food is stuck in the throat. Question: Which of the following is NOT a symptom of polycystic ovarian syndrome (PCOS)? Acne Insomnia Correct Infertility Hirsutism Explanation: Symptoms of polycystic ovarian syndrome (PCOS) include acne, infertility, obstructive sleep apnea, obesity, metabolic syndrome, and hirsutism. Question: A common arrhythmia associated with hyperthyroidism is: first-degree heart block. atrial fibrillation. Correct ventricular tachycardia. sinus bradycardia. Explanation: Hyperthyroidism is associated with atrial fibrillation, systolic murmur, and cardiac failure. Symptoms of hypothyroidism include sinus bradycardia, mild hypertension (diastolic), and narrowed pulse pressure. Supraventricular tachycardia may be associated with hyperthyroidism, however, ventricular tachycardia is not. Question: Bilateral exophthalmos suggests: the presence of a goiter. Hashimoto's thyroiditis. Grave's disease. Correct hypothyroidism. Explanation: Exophthalmos is an abnormal protrusion of the eye. When it presents bilaterally, it is suggestive of Grave's disease, a form of hyperthyroidism. Unilateral exophthalmos may be due to Grave's disease or to a tumor or inflammation of the orbit. Hashimoto's thyroiditis, hypothyroidism, and goiter do not present with exophthalmos. Question: When a patient presents with myxedema coma, which one of the following groups of symptoms may be present? Hypothermia, thickening of the tongue, and disorientation Correct Dehydration, tachycardia, and tachypnea Diarrhea, hyperactive peristalsis, and abdominal distention Seizures, hyperthermia, and conjunctivitis Explanation: Myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood (hypothyroidism). Myxedema coma is considered a life-threatening complication of hypothyroidism and represents the far more serious side of the spectrum of thyroid disease. Some of the symptoms seen with myxedema are: hypothermia, severe mental changes including hallucinations, disorientation, seizures, and ultimately, deep coma, significant edema, swollen eyes, thickening of the tongue, difficulty breathing, and constipation. Question: Examination of the hair reveals a sparse amount with a coarse appearance. This finding may be seen in patients who have: hypothyroidism. Correct hyperthyroidism. type 2 diabetes. celiac disease. Explanation: Sparse, coarse, and thin hair is more characteristic of hair seen in patients with hypothyroidism. Fine silky hair may be seen in patients who have hyperthyroidism. In celiac disease and type 2 diabetes, alopecia may be seen. [Show Less]
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AGNP BOARD EXAM: Dermatology Prescription (100 Questions with Answers and Explanations)
AGNP BOARD EXAM: Dermatology Prescription (100 Questions with Answers and Explanations) AGNP BOARD EXAM: Dermatology Prescription (100 Questions with Answ... [Show More] ers and Explanations) Question: Systemic ivermectin (Stromectol), classified as an antiparasitic,: is primarily excreted in the urine. crosses the blood-brain barrier. has a high concentration in the liver. Correct is not well absorbed. Explanation: Systemic ivermectin (Stromectol) is well absorbed and is primarily excreted in the feces. It is distributed and highly concentrated in the liver and adipose tissue. It is primarily bound to albumin, with a half-life elimination of 18 hours. Time to peak serum is about 4 hours. Question: Topical permethrin (Elimite) in the treatment of scabies should be left in place for a minimum of: 30 minutes. 2 hours. 6 hours. 8 hours. Correct Explanation: Patients should massage permethrin cream (Elimite) thoroughly into the skin from the neck to the soles of the feet, including areas under the fingernails and toenails. Thirty grams is usually sufficient for an average adult. The hairline, neck, temples, and forehead may be infested in infants and geriatric patients. In these populations, permethrin should also be applied to the scalp and face, sparing the eyes and mouth. The cream should be removed by washing (shower or bath) after 8 to 14 hours. Question: The mechanism of action of clindamycin (Cleocin), used in the treatment of cellulitis, is to: block synthesis of folic acid by bacteria and inhibit replication. uncouple mitochondrial oxidative metabolism and inhibit cell growth. block the dissociation of peptidyl tRNA from ribosomes. inhibit protein synthesis by preventing ribosomal translocation. Correct Explanation: Sulfa agents block synthesis of folic acid by bacteria and thus inhibit bacterial replication. First-generation cephalosporins inhibit cell wall synthesis of bacteria. Antifungals uncouple mitochondrial oxidative metabolism and inhibit cell growth. Macrolides inhibit bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Other antibacterials are bacteriostatic or bactericidal and inhibit protein synthesis by preventing ribosomal translocation. Question: Tretinoin topical (Retin-A) is indicated for the treatment of acne vulgaris and: acne rosacea. dermatomyositis. inflammatory keratosis pilaris. mottled hyperpigmentation. Correct Explanation: Tretinoin topical (Retin-A) is indicated for the treatment of acne vulgaris, palliation of fine wrinkles, mottled hyperpigmentation and facial skin roughness. Question: The brand name of oral isotretinoin is: Duac. Absorica. Correct Accolate. Accupril. Explanation: The brand names of oral isotretinoin include Absorica, Amnesteem, Claravis, and Zenatane. The generic name for Duac is clindamycin/benzoyl peroxide, used in the treatment of acne. The generic name for Accolate is zafirlukast. It is a leukotriene inhibitor used in the treatment of asthma. The generic name for Accupril is quinapril; it is an ACE inhibitor. Question: Benzoyl peroxide (Benzac wash) is classified as a topical: antibiotic. astringent. antimicrobial. Correct acetic acid-based cleanser. Explanation: Benzoyl peroxide is a topical antimicrobial used in the treatment of acne. When applied to the skin, benzoyl peroxide works by reducing the amount of acne-causing bacteria and by causing the skin to dry and peel. Question: The generic name for Elidel is: permethrin. pimecrolimus. Correct tacrolimus. urea topical. Explanation: The generic name for Elidel is pimecrolimus. Elidel is a dermatologic agent used in the treatment of atopic dermatitis. The brand name of permethrin is Nix or Elimite. It is an antiparasitic used in the treatment of lice. The brand name for tacrolimus is Prograf. It is an immunosuppressive drug used after transplant. The brand name of urea topical is Keralac and it is used in the treatment of hyperkeratosis. Question: Which of the following conditions is NOT a side effect of long-term use of topical steroids? Cutaneous atrophy Glaucoma Hypotrichosis Correct Telangiectasia Explanation: Cutaneous and systemic side effects can occur, particularly with super potent and potent drugs, or extensive use of lower potency agents with or without occlusion. Treatment with topical corticosteroids should be restricted to the lowest and shortest duration of therapy required to achieve the desired effect. Cutaneous atrophy, telangiectasia, hypertrichosis, striae, purpura, hypopigmentation, glaucoma, and suppression of the hypothalamic-pituitary axis are side effects that may occur with topical corticosteroid use. Question: Patients using fluorouracil (Carac) for the treatment of actinic keratosis should be advised to expect: hypopigmentation. eczema. pustular formation. vesiculation. Correct Explanation: When fluorouracil (Carac) is applied to a lesion, erythema followed by vesiculation, desquamation, erosion and re-epithelialization occurs. Local reactions and alterations in skin appearance may persist for several weeks after discontinuation. Question: Tetracycline (Sumycin) is used in the treatment of skin and skin structure infections caused by: Bartonella bacilliformis. Klebsiella species. Escherichia coli. Staphylococcus aureus. Correct Explanation: Tetracycline (Sumycin) is indicated for the treatment of skin and skin structure infections caused by Staphylococcus aureus or Staphylococcus pyogenes (commonly found in post burn infections). Question: The most appropriate therapy for patients with chronic paronychia is a: systemic antifungal. systemic glucocorticoids. topical steroid. Correct topical antibiotic. Explanation: Chronic paronychia appears to be an eczematous process that can be complicated by secondary Candida infection. Avoidance of environmental triggers is an essential component of treatment. Patients should wear gloves during wet work and should avoid contact with irritating substances. Topical treatment consists of the application of a medium or high-potency topical corticosteroid. If patients do not improve with these measures, a course of topical antifungal therapy may be combined with topical steroid. Question: The use of tetracycline in children younger than 9 years with a bacterial skin infection, may cause: dental enamel hyperplasia. hypopigmentation. serum sickness. reduced bone growth. Correct Explanation: Pediatric use may cause bone growth retardation, tissue hyperpigmentation, enamel hypoplasia, or permanent tooth discoloration; use of tetracyclines should be avoided during tooth development (children <8 years of age) unless other drugs are not likely to be effective or are contraindicated. Question: Daily doses of oral corticosteroids, such as prednisone, should be administered: early in the morning. Correct at noon. with dinner. at bedtime. Explanation: The maximal activity of the adrenal cortex is between 2 am and 8 am, and it is minimal between 4 pm and midnight. Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity (am) for single dose administration. Therefore, it is recommended that prednisone be administered in the morning prior to 9 am. Question: The mechanism of action of sulfa agents, in the treatment of cellulitis, is to: block synthesis of folic acid by bacteria and inhibit replication. Correct uncouple mitochondrial oxidative metabolism and inhibit cell growth. block the dissociation of peptidyl tRNA from ribosomes. inhibit protein synthesis by preventing ribosomal translocation. Explanation: Sulfa agents block synthesis of folic acid by bacteria and thus inhibit bacterial replication. First-generation cephalosporins inhibit cell wall synthesis of bacteria. Antifungals uncouple mitochondrial oxidative metabolism and inhibit cell growth. Macrolides inhibit bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Other antibacterials are bacteriostatic or bactericidal and inhibit protein synthesis by preventing ribosomal translocation. Question: Topical salicylic acid, a keratolytic: can be used for genital warts. should be applied once weekly. is safe for use on the face. should not be used in areas with poor blood circulation. Correct Explanation: Topical salicylic acid should not be used on irritated skin or on any area that is infected or reddened; on moles, birthmarks, warts with hair growing from them, genital warts or warts on the face or mucous membranes; or for patients with diabetes or with poor blood circulation. Application is once or twice daily for up to 12 weeks. Question: Retapamulin (Altabax), used in the treatment of impetigo, is NOT: a topical antibiotic. effective against Streptococcus pyogenes. to be applied intranasally or to mucosa. Correct for use in children. Explanation: Retapamulin (Altabax) is for external use only and is not for intranasal, intravaginal, ophthalmic, oral, or mucosal application. It is a topical antibiotic, bacteriostatic agent used for the treatment of impetigo due to Staphylococcus aureus (methicillin-susceptible isolates only) or Streptococcus pyogenes in adults and patients 9 months and older. Question: Initial treatment for irritant contact dermatitis is a: low-potency topical steroid. Correct medium-potency topical steroid. high-potency topical steroid. super high-potency topical steroid. Explanation: Low-potency corticosteroids are indicated for the initial treatment of irritant contact dermatitis. Additionally, the patient should be advised to avoid future exposure to the irritant. Moisturizers without fragrance, antibacterials, or urea are preferred as these substances often cause sensitization. Question: The brand name of clindamycin and benzoyl peroxide topical for the treatment of acne is: Cleocin T. Desonate. Duac. Correct Benzamycin. Explanation: The brand names for the topical combination of clindamycin and benzoyl peroxide include Acanya, BenzaClin, Duac, and Onexton. Benzamycin is the brand name for benzoyl peroxide and erythromycin. Cleocin T is the brand name for clindamycin topical. Desonate is the brand name for desonide, a topical steroid. Question: Dosage reductions should be considered when prescribing first-generation cephalosporins for patients with: hepatic insufficiency. diabetes. cardiomyopathy. renal insufficiency. Correct Explanation: All cephalosporins require dose adjustments in the presence of severe renal failure. BUN and creatinine should be checked at baseline and periodically, especially if the patient is an older adult. First generation cephalosporins are excreted in the urine >90% unchanged. The half-life of the drug is increased in patients with severe renal disease. Question: Diclofenac (Solaraze), a topical anti-inflammatory, is used in the treatment of: actinic keratosis. Correct acne vulgaris. contact dermatitis. eczema. Explanation: [Show Less]
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AGNP BOARD EXAM CARDIOVASCULAR PRESRIBING (113 Questions with Answers and Explanations)
AGNP BOARD EXAM CARDIOVASCULAR PRESRIBING (113 Questions with Answers and Explanations) AGNP BOARD EXAM CARDIOVASCULAR PRESRIBING (113 Questions with Answ... [Show More] ers and Explanations) Question: Signs and symptoms of digitalis toxicity include: constipation and muscle spasms. bradycardia and tinnitus. headache and dizziness. blurred vision and persistent diarrhea. Correct Explanation: Signs and symptoms of digitalis toxicity include: confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhea, fast heart beat, and visual changes (blurred vision, blind spots, green-yellow color disturbances, halo effect). Regardless of route of administration, digoxin levels should be checked at 12-24 hours after the last dose. However, depending on the clinical situation, wait at least 6-8 hours after the last dose to check levels. Question: A side effect of beta-blockers that is more common in children than adults is: decreased appetite. muscle weakness. vivid dreams. a cough that produces mucus. Correct Explanation: Side effects of beta-blockers that are more common in children than adults may include a mucus-producing cough, difficulty breathing, or tightness in the chest. Beta-blockers are not recommended as initial therapy in children due to potential adverse outcomes including increased bronchial obstruction and airway reactivity in children with asthma. Question: Spironolactone (Aldactone) is highly protein bound and has a duration of: 6 hours. 12 hours. 24 hours. 48 hours. Correct Explanation: Spironolactone (Aldactone) is greater than 90% protein bound, has a half-life elimination of 1.4 hours and a duration of 48-72 hours. It is classified as an aldosterone receptor antagonist. This class blocks the effects of aldosterone, which increases sodium reabsorption by the kidneys. Question: Nonselective beta-blockers block the stimulation of: beta-1 receptors in the heart. beta-2 receptors in the lungs. both beta-1 receptors in the heart and beta-2 receptors in the lungs. Correct neither beta-1 receptors in the heart nor beta-2 receptors in the lungs. Explanation: Nonselective beta-blockers (i.e., propranolol [Inderal]) block the stimulation of both beta-1 receptors in the heart and beta-2 receptors in the lungs. Selective beta-blockers (i.e. metoprolol [Lopressor]) specifically block beta-1 receptors, but may also block beta-2 receptors at higher doses. Because they also block beta-2 receptors in the lungs, nonselective beta-blockers are contraindicated in patients with asthma or chronic obstructive pulmonary disease. Question: Dabigatran (Pradaxa), an anticoagulant, is also classified as a: direct factor Xa inhibitor. direct thrombin inhibitor. Correct indirect thrombin inhibitor. factor V inhibitor. Explanation: Dabigatran (Pradaxa) is a direct thrombin inhibitor (DTI). Medications in this class inactivate circulating and clotting thrombin (factor IIa). They prevent thrombin (central to the generation of a thrombus) from attaching fibrinogen to fibrin. DTIs bind directly to thrombin and do not require a cofactor such as antithrombin to exert their effect. They can inhibit both soluble thrombin and fibrin-bound thrombin. Key advantages of using DTIs instead of heparin is that they: produce a more predictable anticoagulant effect due to their lack of binding to other plasma proteins; exert an antiplatelet effect; and do not cause immune-mediated thrombocytopenia. Question: The brand name for candesartan cilexetil is: Atacand. Correct Avandia. Benicar. Cozaar. Explanation: The brand name for candesartan cilexetil is Atacand. The generic name for Avandia is rosiglitazone; Benicar is olmesartan medoxomil (an ARB); Cozaar is losartan. Candesartan, olmesartan and losartan are classified as angiotensin receptor blockers (ARBs) and are used in the treatment of hypertension. Notice that they all end in "sartan." Rosiglitazone is a thiazolidinedione and is used in the treatment of diabetes. Question: Gemfibrozil (Lopid), for the treatment of hypertriglyceridemia, is classified as a: bile acid sequestrant. nicotinic acid. fibric acid. Correct statin. Explanation: Gemfibrozil (Lopid) is a fibric acid. It is indicated in the treatment of hypertriglyceridemia and mixed dyslipidemia. Fibric acid derivatives, also known as fibrates, are the recommended treatment for very high triglyceride levels (>500 mg/dL). Fibrates lower serum triglyceride levels by reducing the liver's production of VLDL (triglyceride-carrying particle circulating in the blood) and by speeding up the removal of triglycerides from the blood. Gemfibrozil should not be used concurrently with statins. Question: In patients with normal renal function, the diuretic that has the greater antihypertensive effect is: osmotic diuretics. thiazide diuretics. Correct loop diuretics. potassium-sparing diuretics. Explanation: Among patients with normal renal function, thiazide diuretics, particularly chlorthalidone (Thalitone), have a greater antihypertensive effect than the loop diuretics. This may be related to the longer duration of action of thiazides compared to most loop diuretics. Diuretics lower blood pressure, at least initially, by inducing sodium and fluid loss. Other thiazide diuretics include hydrochlorothiazide (Microzide) and methyclothiazide. Question: An adverse effect of statin therapy for the treatment of hyperlipidemia is: hypertension. myalgia. Correct hypoglycemia. edema. Explanation: Statins may cause myalgia. The pain may be experienced as a soreness, fatigue or weakness in the muscles. The pain can be a mild discomfort, or it can be severe enough to make daily activities difficult. Other common side effects include diarrhea, arthralgia and nasopharyngitis. Question: Nitroglycerin sublingual (Nitrostat) tablets should be stored: in a dark bottle, with the patient carrying all tablets at all times. in a dark container in the refrigerator, with only a small quantity kept with the patient. Correct in a tightly capped medicine bottle at room temperature. in a tightly sealed bag or container in a purse or wallet. Explanation: Nitroglycerin sublingual (Nitrostat) tablets are both heat- and light-sensitive. They should be stored in a tightly capped dark bottle in the refrigerator. Only a small supply should be carried by the patient. Nitroglycerin tablets in an opened bottle should be discarded after 12 months. Question: Patients taking warfarin (Coumadin) therapy should: increase intake of vitamin K-enriched foods. avoid intake of vitamin K-enriched foods. maintain a consistent intake of vitamin K-enriched foods. Correct decrease intake of vitamin K-enriched foods. Explanation: Patients who are anticoagulated with warfarin (Coumadin) generally are sensitive to fluctuations in vitamin K intake. Adequate INR control requires a consistent intake of vitamin K. The goal of monitoring vitamin K intake is to maintain a moderate, constant level of intake rather than to eliminate vitamin K from the diet. Reducing vitamin K intake can cause the INR to increase, and increasing vitamin K can cause the INR to decrease, making it more difficult to control. Question: Non-dihydropyridine calcium channel blockers (i.e. verapamil) may be safely used in patients with: heart failure. bradycardia. second-degree AV block. chronic stable angina. Correct Explanation: Non-dihydropyridine CCBs (non-DHP CCB; i.e. verapamil [Calan] and diltiazem [Cardizem]) have negative chronotropic and inotropic effects. Therefore, they slow down heart rate and decrease force of ventricular contractions. Non-DHP CCBs are contraindicated in patients with heart failure who have reduced ejection fraction, sick sinus syndrome, and second- or third-degree atrioventricular block. Since non-DHP CCBs increase myocardial blood flow by dilating coronary arteries, they are beneficial in patients with chronic stable angina. Additionally, they can be given for rate control (tachycardia) or for the control of angina (chronic, stable) when left ventricular systolic function is normal. In general, the long-acting form of Non-DHP CCBs are recommended over the short-acting forms. Question: The generic name for Lopressor is: atenolol. metoprolol tartrate. Correct carvedilol. bisoprolol. Explanation: The generic name of Lopressor is metoprolol tartrate. The brand name for atenolol is Tenormin; carvedilol is Coreg; and bisoprolol is Zebeta. All of these drugs are classified as beta-blockers and end in "lol". Question: A patient is taking isosorbide dinitrate (Isordil) at 8 am, 2 pm and 9 pm and reports that the medication is no longer effective. The nurse practitioner knows that: this is the correct time interval and the dose should be increased. the dosing interval should be changed to allow a 14-hour nitrate-free interval. Correct the dosing interval should be every 12 hours. the patient should be switched to transdermal delivery for better efficacy. Explanation: Patients on continuous nitrates such as isosorbide (Isordil) may develop tolerance. A nitrate-free period of 12-14 hours per day should be considered to improve efficacy and prevent tolerance. The same holds true whether the nitrates are administered orally or transdermally. Question: Of the angiotensin receptor blockers (ARBs) used in the treatment of hypertension, the one with the longest biological half-life at 24 hours is: irbesartan (Avapro). losartan (Cozaar). olmesartan (Benicar). telmisartan (Micardis). Correct Explanation: Telmisartan (Micardis) has a biological half-life of 24 hours. Irbesartan (Avapro) has a half-life of 11-15 hours; olmesartan (Benicar) 13 hours; and losartan (Cozaar) 6-9 hours. These are all classified as angiotensin receptor blockers (ARBs) used in the treatment of hypertension. Question: A patient who has warfarin (Coumadin) toxicity should be treated with: charcoal. platelets. vitamin K. Correct prothrombin. Explanation: The antidote for a warfarin (Coumadin) overdose is vitamin K. Warfarin acts by inhibiting the synthesis of vitamin K-dependent clotting factors, including Factors II, VII, IX, and X, and the anticoagulant proteins C and S. The onset of anticoagulant action for oral warfarin (Coumadin) is 24-72 hours. The half-life elimination of warfarin (Coumadin) is 20-60 hours. Question: Clopidogrel (Plavix), an anticoagulant, may be coadministered with: aspirin (Ecotrin). Correct fluoxetine (Prozac). omeprazole (Prilosec). ibuprofen (Motrin). Explanation: Clopidogrel (Plavix) can be coadministered with antiplatelet medications (i.e., aspirin). Clopidogrel is often combined with aspirin to treat myocardial infarctions or unstable angina, and to prevent blood clots. Selective serotonin reuptake inhibitors (SSRIs; fluoxetine [Prozac]) and serotonin norepinephrine reuptake inhibitors (SNRIs; duloxetine [Cymbalta]) affect platelet activation. The concomitant administration of SSRIs and SNRIs with clopidogrel may increase the risk of bleeding. Coadministration of clopidogrel and NSAIDs (i.e., ibuprofen [Motrin]) increases a patient's risk for gastrointestinal bleeding. Avoid concomitant use of clopidogrel with omeprazole (Prilosec) or esomeprazole (Nexium). In clinical studies, omeprazole was shown to significantly reduce the antiplatelet activity of clopidogrel bisulfate when given concomitantly or 12 hours apart. Question: Which of the following drugs blocks the action of aldosterone in order to produce diuresis? Furosemide (Lasix) Hydrochlorothiazide (Microzide) Spironolactone (Aldactone) Correct Bumetanide (Bumex) Explanation: Spironolactone (Aldactone) is a potassium-sparing diuretic. Potassium-sparing diuretics enhance the action of thiazide and loop diuretics and counteract potassium loss by these agents. They block the action of aldosterone and cause the kidney to release fluid to produce diuresis while retaining potassium. Question: The lipid-lowering agent that has been proven most effective in raising high-density lipoprotein levels is: the statin class. the bile acid sequestrant class. nicotinic acid. Correct fibric acid. Explanation: Nicotinic acid (Niacin) has the highest potential for raising high-density lipoproteins (15-30%). Unfortunately, no improvement in cardiovascular outcomes has been documented when niacin is used with or without a statin. Consequently, the FDA has removed this as an indication on the product label. Other lipid-lowering agents may raise high-density lipoprotein at rates of: statins 5-15%; bile acid sequestrants 3-5%; fibric acids 10-20%. Question: A patient taking spironolactone (Aldactone) has a serum potassium of 5.8 meq/L. The nurse practitioner should: discontinue spironolactone (Aldactone) immediately. discontinue the spironolactone (Aldactone) and administer kayexalate. hold spironolactone (Aldactone) until hyperkalemia is resolved. Correct discontinue spironolactone (Aldactone) and begin a thiazide diuretic. Explanation: While on spironolactone (Aldactone), potassium levels should be monitored. If serum potassium increases to greater than 5.5 mEq/L or renal function worsens, further doses of Aldactone should be held until potassium is less than 5 mEq/L. Once hyperkalemia/renal insufficiency has resolved and is steady for at least 72 hours, consider restarting Aldactone at a reduced dose. Question: The mechanism of action of angiotensin-converting enzyme (ACE) inhibitors in lowering blood pressure is to: block the formation of angiotensinogen in the liver. convert angiotensin I to angiotensin II in the myocardium. inhibit the enzyme that converts angiotensin I to angiotensin II in the serum. Correct inhibit the conversion of angiotensin enzyme production by the kidneys. Explanation: Angiotensin-converting enzyme inhibitors (ACE inhibitors) slow (inhibit) the activity of the angiotensin-converting enzyme, which decreases the production of angiotensin II. Angiotensin I is formed from angiotensinogen, a protein produced by the liver and released into the blood. Angiotensin II, a vasoconstrictor, is formed from angiotensin I by angiotensin-converting enzyme (ACE). By blocking the production of angiotensin II, blood vessels dilate, and blood pressure is reduced. Question: The diuretic that blocks the reabsorption of sodium and water in the loop of Henle to produce diuresis is: furosemide (Lasix). Correct hydrochlorothiazide (Microzide). spironolactone (Aldactone). triamterene (Dyrenium). Explanation: The diuretic that blocks the reabsorption of sodium and water in the loop of Henle to produce diuresis is known as a loop diuretic. Furosemide (Lasix) is a loop diuretic. Hydrochlorothiazide (Microzide) inhibits sodium and water reabsorption, but this does not occur in the loop of Henle. Spironolactone (Aldactone) and triamterene (Dyrenium) are potassium-sparing diuretics. They antagonize aldosterone-specific mineralocorticoid receptors, primarily in the distal convoluted tubule. They decrease sodium and water reabsorption and increase potassium retention. Question: A 2-year-old child has a history of heart failure. To increase the force of ventricular contraction and decrease heart rate, the most appropriate drug choice is: captopril (Capoten). enalapril (Vasotec). diltiazem (Cardizem). digoxin (Lanoxin). Correct [Show Less]
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AGNP BOARD EXAM QUESTIONS Cardiovascular Assessment (107 Questions with Answers and Explanations)
AGNP BOARD EXAM QUESTIONS Cardiovascular Assessment (107 Questions with Answers and Explanations) AGNP BOARD EXAM QUESTIONS Cardiovascular Assessment (107... [Show More] Questions with Answers and Explanations) 1. Question: The preauricular nodes drain lymphatic fluid from the: palpebral conjunctiva and the skin adjacent to the ear within the temporal region. Correct eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. mouth, throat, and face. posterior part of the temporoparietal region. Explanation: The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and the skin and mucous membranes of the nose and cheek. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region. 2. Question: When auscultating the heart, the displacement of the point of maximal impulse (PMI) is greater than 10 cm lateral to the midsternal line. This finding is consistent with: right ventricular hypertrophy. left ventricular hypertrophy. Correct pulmonary stenosis. a normal PMI location. Explanation: Displacement of the PMI lateral to the midclavicular line or greater than 10 cm lateral to the midsternal line suggests left ventricular hypertrophy (LVH). 3.Question: When auscultating the heart of a 55-year-old patient, a loud murmur with a thrill is audible in the right second intercostal space that radiates to the carotid arteries. Also noted is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. This finding is consistent with: pulmonic stenosis. tricuspid regurgitation. mitral regurgitation. aortic stenosis. Correct Explanation: With aortic stenosis, the murmur is audible loudest in the right second intercostal space and radiates to the carotid arteries, down the left sternal border, or the apex. There is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. The murmur audible with pulmonic stenosis produces a soft intensity with a crescendo-decrescendo pitch. It is loudest at the second or third intercostal spaces and radiates to the left shoulder and neck. With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is pansystolic. The intensity may increase with inspiration. Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft, or if there is an atrial thrill, it can be loud. 4. Question: A disease that may present as indigestion, but is precipitated by exertion and relieved by rest is most likely: gastroesophageal reflux. inflammatory bowel disease. angina. Correct aortic stenosis. Explanation: A disease that may present as indigestion, but is precipitated by exertion and relieved by rest is most likely angina. Question: Causes of orthostatic hypotension in older adults may include all of the following except: diabetes. cardiovascular disorders. medications. impaired visual acuity. Correct Explanation: Orthostatic hypotension occurs in 20% of older adults and in up to 50% of frail nursing home residents, especially when they first arise in the morning. Causes include medications, autonomic disorders, diabetes, prolonged bed rest, volume depletion, amyloidosis, and cardiovascular disorders. Impaired visual acuity is not a cause of orthostatic hypotension but can be a resulting symptom. Question: To auscultate the heart sounds arising from the pulmonic valve in an adult patient, place the stethoscope: near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. between the 2nd and 3rd intercostal spaces at the right upper sternal border. between the 2nd and 3rd intercostal spaces at the left sternal border. Correct between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border. Explanation: Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. The aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid listening point is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB). Question: A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the neck is usually associated with: angina pectoris. a myocardial infarction. an aortic dissection. Correct pericarditis. Explanation: Assessing chest pain can be very difficult but a thorough patient history and physical exam can help the clinician determine a likely cause. A sudden sharp pain that radiates to the back or into the neck is usually associated with aortic dissection. Exertional pain can be angina pectoris. Symptoms most often seen with myocardial infarction include a retrosternal type pain that often radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm. Pain associated with pericarditis may radiate to the tip of the shoulder and to the neck and presents with a sharp knifelike pain. Any pain in the chest is cardiac until proven otherwise. Question: A 68-year-old man with uncontrolled hypertension presents with sudden, intense left lower abdominal pain that radiates to the back. The pain is associated with a tearing sensation. These findings are MOST likely associated with: cholecystitis. an abdominal aortic aneurysm (AAA). Correct perforated gastroesophageal (GI) ulcer. nephrolithiasis. Explanation: Sudden, intense left lower abdominal pain that radiates to the back with a “tearing” sensation are symptoms of abdominal aortic aneurysm (AAA). For the diagnosis of a possible rupturing AAA, outpatient CT scan, abdominal ultrasound, and angiography testing are NOT recommended. The patient should be referred to the emergency department for acute assessment and treatment. Question: A condition that usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress may be associated with: neurogenic claudication. intermittent claudication. atherosclerotic peripheral vascular disease. Raynaud's disease. Correct Explanation: Raynaud's disease may present with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress. Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen in neurogenic claudication. Question: A twelve-month-old has a history of heart failure related to his congenital heart defect. He is receiving aldactone (Spironolactone), enalapril (Vasotec), furosemide (Lasix), and acetaminophen (Tylenol). The infant's potassium level is 3.1 meq/l. Which medication is most likely decreasing his potassium level? Aldactone (Spironolactone) Furosemide (Lasix) Correct Enalapril (Vasotec) Acetaminophen (Tylenol) Explanation: Loop diuretics can produce decreased potassium levels. Lasix is a loop diuretic. Potassium levels considered WNL by most labs range between 3.5 and 5.3 meq/l; so 3.1 meq/l is considered low and may need to be adjusted. The other medications are not known for excessive potassium losses. Question: The posterior auricular lymph node is located: at the angle of the mandible. in front of the ear. at the base of the skull posteriorly. superficial to the mastoid process. Correct Explanation: The posterior auricular nodes are superficial to the mastoid process. The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly. Question: A patient complains of a tight, bursting pain in the calf that increases with walking. Elevation of the leg sometimes relieves the pain. These symptoms may be consistent with: intermittent claudication. Raynaud's disease. deep venous thrombosis. Correct superficial thrombophlebitis. Explanation: Deep venous thrombosis (DVT) is a venous disorder. The patient often describes the pain as tight, and bursting around the affected area. The pain may be accompanied by swelling and tenderness. Reynaud's disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Question: A patient complains of pain in the arch of the foot sometimes relieved by rest. Occasionally, he experiences intermittent pain in the toes, especially at rest. Exercise aggravates the pain in the arch. History reveals he smokes approximately a half pack of cigarettes per day. These symptoms may be consistent with: intermittent claudication. Raynaud's disease. deep venous thrombosis. thromboangiitis obliterans. Correct Explanation: Thromboangiitis obliterans or Buerger's disease, is defined as inflammatory and thrombotic occlusions of small arteries and also of veins, usually occurring in smokers. Symptoms include intermittent claudication especially in the arch of the foot and pain at rest in the toes or fingers. Other symptoms may include distal coldness or cyanosis. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Reynaud's disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Deep venous thrombosis (DVT) is a venous disorder and the pain is tight, and bursting often in the calf. The pain may be accompanied by swelling and tenderness. Question: In older adults, the presence of heart sound S3 suggests: hypertension. heart failure. Correct an aortic aneurysm. aortic stenosis. Explanation: In older adults, an S3 suggest dilatation of the left ventricle from heart failure or cardiomyopathy. S3 is produced when blood strikes a compliant left ventricle. It commonly accompanies fluid overload. It may be normal in children or pregnant women. Question: The posterior chest wall and portions of the arms are drained by which group of lymph nodes? Posterior mediastinal nodes Subscapular nodes Correct Parasternal nodes Intercostal nodes Explanation: The subscapular lymph nodes drain lymphatic fluid from the posterior chest wall and a portion of the upper arms. The posterior mediastinal lymph nodes drain lymphatic fluid from the esophagus and posterior part of the pericardium. The lymph nodes of the chest wall include the parasternal, intercostal and the diaphragmatic areas. The parasternal lymph nodes drain the medial half of the breasts. The posterior-lateral aspect of the chest is drained by the intercostal lymph nodes. The diaphragmatic nodes drain the upper surface of the diaphragm. Question: In older adults, the presence of heart sound S4 suggests: hypertension. Correct heart failure. an aortic aneurysm. aortic stenosis. Explanation: An S4 heart sound occurs when the atria contract and force blood into a left ventricle that is non-compliant. This can be the result of diastolic heart failure, hypertension, infraction, or others. It is known as the "atrial gallop". This is always abnormal. Question: Deep cervical lymph nodes drain lymphatic fluid from the: head and neck. Correct breasts. mouth, throat, and face. posterior part of the temporoparietal region. Explanation: The deep cervical lymph nodes drain all of the lymphatic fluid from the head and neck. Axillary lymph nodes drain most of the lymphatic fluid of the breast. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region Question: Which of the following group of symptoms would be suggestive of an infant experiencing a congenital heart defect associated with a decreased pulmonary blood flow pattern? Tissue perfusion greater than 3 seconds, bluish colored skin, and poor feeding Correct Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen saturation less than 95% Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds, and oxygen saturation greater than 95% Poor feeding, audible heart murmur, and oxygen saturation greater than 95% Explanation: Infants with defects resulting from decreased pulmonary blood flow have cyanosis because of desaturated blood entering systemic circulation and/or because of the inability to get blood to the lungs. Tetralogy of Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this category and are considered cyanotic defects. Due to the ventricular septal defect in TOF, the absence of the tricuspid valve or pulmonary valve in tricuspid and pulmonary atresia, one should hear abnormal heart sounds either due to the murmur in TOF or single heart sounds of S1 or S2 in pulmonary atresia or tricuspid atresia. Usually these infants have activity intolerance and therefore, experience failure to thrive because of their inability to consume enough formula to gain weight appropriately. Capillary refill is usually prolonged due to poor oxygenation and poor perfusion secondary to the defect as well as the O2 sats being lower than normal, sometimes even in the 80% range. Question: The tonsillar, submandibular, and submental nodes drain the lymphatic fluid from portions of the: palpebral conjunctiva and the skin adjacent to the ear within the temporal region. eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. mouth, throat, and face. Correct posterior part of the temporoparietal region. Explanation: Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The preauricular nodes drain the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain the eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. The posterior auricular lymph nodes drain the posterior part of the temporoparietal region. Question: Symptoms of acrocyanosis in the newborn include: bluish color of the tongue. bluish color of the mucous membranes. bluish color of the feet. Correct bluish color of the abdomen. Explanation: Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and typically resolve in 24 - 48 hours. A blue color around the lips and philtrum is a relatively common finding shortly after birth. The skin in the infant is usually well perfused, and the tongue and mucous membranes in the mouth are pink, a finding that assures that central cyanosis is not present. Question: A widened pulse pressure greater than or equal to 60 in an older patient is a risk factor for cardiovascular disease, stroke, and: emboli. systolic hypertension. renal disease. Correct orthostatic hypertension. Explanation: A widened pulse pressure greater than or equal to 60 in the older patients is a risk factor for cardiovascular disease, stroke, and renal disease. Question: Widened pulse pressure (PP) is defined as systolic blood pressure (SBP): dropping 20 mm Hg within 3 minutes of standing. minus diastolic blood pressure. Correct dropping 10 mm Hg within 5 minutes of sitting. minus apical heart rate. Explanation: Widened pulse pressure (PP) is defined as SBP minus diastolic blood pressure (DBP). With aging, SBP and peripheral vascular resistance increase, whereas DBP decreases. Question: The infraorbital or maxillary, buccinator, and supramandibular lymph nodes drain lymphatic fluid from the: palpebral conjunctiva and the skin adjacent to the ear within the temporal region. eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. Correct mouth, throat, and face. posterior part of the temporoparietal region. Explanation: The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and the skin and mucous membranes of the nose and cheek. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth, throat, and face. The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region. Question: To auscultate the tricuspid valve heart sounds in an adult patient, place the stethoscope: between the 2nd and 3rd intercostal spaces at the right upper sternal border. near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. located between the 2nd and 3rd intercostal spaces at the left sternal border. between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border. Correct Explanation: Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. The aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid clavicular line. The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid region is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB). Question: A child presents with fever of 102.5 °F for the past five days. Kawasaki disease is suspected if which of the following groups of symptoms is present? Strawberry tongue, pounding pulse, elevated blood pressure, and chronic hemolytic anemia Cervical lymphadenopathy, bilateral non-purulent conjunctivitis, periungual desquamation, and polymorphous rash Correct Retinopathy, petechiae, strawberry tongue, and jaundice Recent Group A beta hemolytic streptococcus pharyngitis, erythema marginatum, non-purulent conjunctivitis, and joint pain Explanation: In Kawasaki disease there is persistent fever for 5 days. In order to be diagnosed with Kawasaki disease, a child must present with 4 of the following 5 symptoms. These include: cervical lymphadenopathy, bilateral conjunctivitis, macular rash, edema of the hand and/or feet, and strawberry tongue. Pounding pulse, elevated B/P, and chronic hemolytic anemia are not consistent with Kawasaki disease. Retinopathy and jaundice are more consistent with sickle cell disease. Group A beta hemolytic strep and erythema marginatum are common with rheumatic heart disease. Question: A patient presents with chest pain that radiates to the left side of the neck and down the left arm when he chops wood. This type of pain could be suggestive of: an early onset myocardial infarction. angina pectoris. Correct costochondritis. a dissecting aneurysm. Explanation: Assessing chest pain can be very difficult but a thorough patient history and physical exam can help the clinician determine a likely cause. Exertional pain can be angina pectoris. Symptoms most often seen with myocardial infarction include a retrosternal type pain that often radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm. Pain and tenderness associated with costochondritis worsens with coughing or taking deep breaths. A sudden sharp pain that radiates to the back or into the neck is usually associated with aortic dissection. Any pain in the chest is cardiac until proven otherwise. Question: When auscultating the heart of a 50-year-old patient, a soft murmur is audible in the left second and third intercostal spaces and radiates to the left shoulder and neck. Also noted is a crescendo-decrescendo pitch to the murmur. This finding could be consistent with: pulmonic stenosis. Correct tricuspid regurgitation. mitral regurgitation. aortic stenosis. Explanation: The murmur audible with pulmonic stenosis produces a soft intensity with a crescendo-decrescendo pitch. It is loudest at the second or third intercostal spaces and radiates to the left shoulder and neck. With aortic stenosis, the murmur is audible loudest in the right second intercostal space and radiates to the carotids, down the left sternal border, or the apex. There is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is pansystolic. The intensity may increase with inspiration. Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill, it can be loud. Question: The external iliac lymph nodes drain lymphatic fluid from the following areas except the: urinary bladder. prostate. uterus. gluteal region. Correct Explanation: The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or uterus, and the upper vagina. The internal iliac lymph nodes receive lymphatic fluid from all pelvic viscera, deep part of the perineum, and the gluteal region. An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true? The child has ingested too much caffeine. A cardiology referral is prudent. This is a normal exam. Correct There is a need for an echocardiogram. Explanation: Sinus arrhythmia occurs when an irregular heart rate increases with inspiration and decreases with respiration and is considered normal in children. There is no need for an echo or referral to a cardiologist nor should the child be evaluated for caffeine intake. Question: When assessing a 3-year-old African American child, the most likely cause of black, dusky mucous membranes is related to: jaundice. pallor. erythema. cyanosis. Correct Explanation: In dark skinned children, black, dusky mucous membranes are significant for cyanosis. The mucous membranes are the best areas to identify cyanosis in African American children. Erythema is denoted as a dusky red or violet color over the body. The other choices are not characteristic of cyanosis. Question: Pain or cramping of the legs that occurs during exertion and is relieved by rest is termed: neurogenic claudication. intermittent claudication. Correct atherosclerotic peripheral vascular disease. Raynaud's disease. Explanation: Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication. Raynaud's disease usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress. Question: The patient has had an internal pacemaker in place for five years. Pacemaker failure is being considered because over the past few days, the patient has been experiencing episodes of: hiccoughs. Correct chest pain. wheezing. hypertension. Explanation: Pacemaker failure is uncommon. Most malfunctions are caused by electrode dislocation, electrode dislocation, poor contact or interference by other tissues. Symptoms include dizziness, lightheadedness, hiccoughs, sudden changes in heart rate, electric shock feeling in the chest. Chest pain is usually absent. Wheezing and hypertension are not specifically characteristic of pacemaker malfunction. Question: A heart rate of 100-180 beats per minute in an adult is considered: normal sinus rhythm. sinus tachycardia. Correct supraventricular tachycardia. ventricular tachycardia. Explanation: A normal heart rate in an adult is between 60 / 100 beats per minute. Tachycardia is over 100 beats / minute. Rates that exceed 180 beats / minute are usually supraventricular. Normal sinus rhythm is a measurement of the hearts electrical activity, not mechanical activity. Ventricular tachycardia is rapid and chaotic ventricular activity. [Show Less]
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