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ANCC FNP Exam Review questions LEIK part 2 Answered 100% Complete
The posterior fontanel should be completely closed by: - ANSWER-3 months On auscultation of the chest, a split s2 is best heard at: A: 2 ICS, right st... [Show More] ernal border B: 2 ICS, Left sternal border C: 5th ICS, midclavicular line D: 4 ICS, left sternal border - ANSWER-2nd ICS left sternal border The most common type of skin malignancy in the united states is: A: squamous cell skin cancer B: Basal cell carcinoma C: Melanoma D: dysplastic nevi - ANSWER-Basal Cell Carcinoma All of the following patients have an increased risk of developing adverse effects from metformin (Glucophage) except: A: pts with renal disease B: pts with hypoxia C: Obese pts D: pts who are alcoholics - ANSWER-obese patients Which of the following classes of drugs is implicated with blunting the signs and symptoms of hypoglycemia in diabetics? A; CCB B: Diuretics C: Beta Blockers D: ARB - ANSWER-Beta blockers All of the following factors increase the risk of mortality for patients diagnosed w/ bacterial pneumonia except: A: alcoholism B: very young/old C: Multiple lobar involvement D: hypertension - ANSWER-Hypertension The bacterium responsible for the highest mortality for pts with community-acquired pneumonia is: A: streptococcus pneumoniae B: mycoplasma pneumoniae C: Moraxella catarrhalis D: Haemophilus influenzae - ANSWER-Streptococcus pneumoniae What is the least common pathogen found in CAP? A: moraxella catarrhalis B: Streptococcus pneumoniae C: pseudomonas aeruginosa D: mycoplasma pneumonia - ANSWER-Pseudomonas Aeruginosa The following statements are true about Wilms' tumor EXCEPT: A: the most frequent clinical sign is a palpable abdominal mass B: it is a congenital tumor of the kidneys C: microscopic or gross hematuria is sometimes present D: the tumor commonly crosses the midline of the abdomen when it is discovered. - ANSWER-the tumor commonly crosses the midline of the abdomen when it is discovered. a 40-year old cashier complains of periods of dizziness and palpitations that have a sudden onset. The EKG shows P waves before each QRS complex and a heart rate of 170beats/min. A carotid massage decreases the heart rate to 80bpm. These findings best describe? A: ventricular tachycardia B: paroxysmal atrial tachycardia C: afib D: vfib - ANSWER-Paroxysmal atrial tachycardia Which of the following drug classes is indicated for initial tx of an uncomplicated case of helicobacter pylori- negative peptic ulcer? A: PPI B: H2 receptor antagonists C: antibiotics D: antacids - ANSWER-H2 Receptor antagonists Which of the following is correct regarding the best site to listen for mitral regurgitation ? A it is best heard in the apical area during S2 B: it is best heard at the base during S1 C: it is best heard at the apex during S1 D: it is best heard at the base during S2. - ANSWER-it is best heard at the apex during S1 Orchitis is caused by which of the following?> A: mumps virus B: measles virus C: chlamydia trachomatis D: chronic UTI that are not treated adequately - ANSWER-Mumps Virus all of the following drugs interfere with the metabolism of oral contraceptives except: A: tetracycline B: rifampin C: phenytoin (Dilantin) D: ciprofloxacin - ANSWER-Ciprofloxacin which of the following is the most common cause of nongonococcal urethritis? A: ecoli B: chlamydia trachomatis C: neisseria gonorrhoeae D: mycoplasma genitalium - ANSWER-Chlamydia trachomatis A 35-year old sexually active man presents with a 1-week hx of fever and pain over the left scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to touch. He denies flank pain, nausea, and vomiting. He reports that the pain is lessened when he uses scrotal-support briefs. The urinalysis shows 2+ blood and a large number of leukocytes. What is the likely diagnosis? A: acute UTI B: acute pyelonephritis C: acute orchitis D: acute epididymitis - ANSWER-Acute epididymitis a kindergarten teacher is dx'd with acute streptococcal pharyngitis. On exam, her throat is a bright-red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The urinalysis shows a large amount of white blood cells and is positive for nitrites. The patient has a sulfa allergy and thinks she is also allergic to PCN. Which of the following is the best tx chocie? A: augmentin 500mg PO BID B: Levaquin 250mg PO Daily C: Bactrim DS po BID D: Biaxin (clarithromycin) 500mg PO BID - ANSWER-Levaquin 250mg PO daily A split s2 heart sound is best heard at which of the following areas? A: the aortic area B: The pulmonic area C: The tricuspid area D: the mitral area - ANSWER-The pulmonic area a 20-year old white man is being seen for a physical exam by the nurse practitioner. He complains of pruritic macerated areas in his groin that have been present for the past 2 weeks. Which of the following is the most likely? A: Tinea Cruris B: Tinea Corporis C: tinea capitis D: Tinea Pedis - ANSWER-Tinea cruris an adolescent females areola, nipples, and breast tissue develop and become elevated as one mound. which of the following is the correct tanner stage for this phase of breast development? - ANSWER-Tanner stage III women with PCOS have an increased risk for.. - ANSWER-heart disease and endometrial cancer a 13-year old boy wants to be treated for his acne. He has a large number of closed and open comedones on his face. The patient has been treating himself with OTC benzoyl peroxide and topical salicylic acid products. Which of the following would be recommended next? A: isotretinoin (Accutane) B: tetracycline C: Retin-A 0.25% gel D: careful face washing with medicated soap at bedtime - ANSWER-Retin-A 0.25% gel Systemic lupu erythematosus is more common among patients from all of the following ethnic and racial backgrounds except: A: african american B: Asian C: Hispanic D: caucasian - ANSWER-Caucasian An older man is diagnosed with conductive hearing loss in the left ear by the NP. What is the expected result when performing a Rinne test on this patient? - ANSWER-BC>AC which of the following conditions is associated with 3 stages of rashes? A: fifth disease B: erythema infectiosum C: varicella D: Rocky MTN spotted fever - ANSWER-Fifth disease The following findings are considered benign lesions of the skin except: A: lentigo B: seborrheic keratosis C: Actinic keratosis D: Rosacea - ANSWER-Actinic keratosis what is the treatment for C-diff - ANSWER-Flagyl 500mg TID for 10 days all of the following conditions are contraindications for bupropion except: A: anorexia nervosa and bulimia B: seizure disorders C: peripheral neuropathy D: Brain injury - ANSWER-peripheral neuropathy [Show Less]
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LEIK FNP Practice Questions and Answers Latest Updated Graded A+
A 72-year-old woman has been on hydrochlorothiazide 12.5 mg for many years to control her Stage II hypertension. Her blood pressure (BP) at this visit is 1... [Show More] 68/96. She is currently complaining of pain on her right hip and on both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times day (TID) to 800 mg TID. She is still in pain and would like something stronger. Which of the following statements is the best explanation of the effects of ibuprofen (Motrin) on her disease? A) It increases the chances of adverse effects to her health B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic C) It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics D) None of the statements are true - ANSWER-B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic. NSAIDs and ASA inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to ischemia. NSAIDs and diuretics can cause acute prerenal failure by decreasing renal blood flow. 2. All of the following are infections that affect mostly the labia and vagina except: A) Bacterialvaginosis B) Candidiasis C) Trichomoniasis D) Chlamydia trachomatis - ANSWER-D) Chlamydia trachomatis Infections that commonly affect the labia and vagina include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis commonly affects the cervix, endometrial lining , fallopian tubes, and pelvic cavity. The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for: A) Cholecystitis B) Acute appendicitis C) Inguinal hernia D) Gastriculcer - ANSWER-B) Acute appendicitis. Signs and symptoms of an acute abdomen include invol- untary guarding, rebound tenderness, boardlike abdomen, and a positive obtu- rator and psoas sign. A positive obturator sign occurs when pain is elicted by internal rotation of the right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs with passive extension of the thigh while the patient is lying on his/her side with knees extended, or when pain occurs with active flexion of his/her thigh at the hip. Treatment for mild preeclampsia includes all of the following except: A) Bed rest except for bathroom privileges B) Close monitoring of weight and blood pressure C) Close follow-up of urinary protein, serum creatinine, and platelet count D) A prescription of methyldopa (Aldomet) to control blood pressure - ANSWER-D) A prescription of methyldopa (Aldomet) to control blood pressure Recommended care for women diagnosed with preeclampsia includes bed rest with bath- room privileges, weight and BP monitoring, and closely following urine protein and serum protein, creatinine, and platelet counts. Oral medications are not used as first-line treatment. All of the following services are covered under Medicare Part A except: A) Inpatienthospitalizations B) Medicines administered to a patient while hospitalized C) Nursing home care D) Surgeons - ANSWER-C) Nursing home care Medicare A coverage includes inpatient hospitalization and skilled care given in a certified skilled nursing facility. Most nursing home care is custodial care (help with bathing, dressing, using a bathroom, and eating). This care is not covered by Medicare A. A 28-year-old student is seen in the school health clinic with complaints of a hacking cough that is productive of small amounts of sputum and a runny nose. He does not take any medications, denies any allergies, and has no significant medical history. Physical examination reveals a low-grade temperature of 99.9 degrees Fahrenheit, respirations of 16/min, a pulse of 90 beats per minute, and diffuse fine crackles in the base of the lungs. A chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe of the right lung. The total white blood cell count is 10,500/uL. What is the most likely diagnosis? A) Streptococcal pneumonia B) Mycoplasma pneumonia C) Acute bronchitis D) Legionnaires disease - ANSWER-B) Mycoplasma pneumonia Mycoplasma pneumonia is the organism most com- monly seen in children and young adults. It is easily spread from droplets, from sneezing and coughing, in close proximity. Diagnosis is based on symptoms and x-ray results of infiltrates in lower lobes. A 39-year-old migrant worker presents to the clinic 2.5 days after a purified protein derivative (PPD) test. What minimum size of induration would be considered posi- tive for this patient? A) 3 mm B) 5 mm C) 10 mm D) 15 mm - ANSWER-C) 10 mm The PPD is administered on the volar aspect of the lower arm and read 48 hours after the test is given. The PPD result must have induration and measure 10 mm or greater to be positive in a low-risk patient. Induration (firmness with palpation) must be present. If the site has erythema but no induration, result would be negative. Color is not important. All of the following are correct statements regarding the role of the person named in a durable power of attorney except: A) The agent's decisions are legally binding B) The agent can make decisions in other areas of the patient's life such as financial issues C) The agent can decide for the patient who is on life support when that life support can be terminated D) The patient's spouse has a right to override the agent's decisions - ANSWER-D) The patient's spouse has a right to override the agent's decisions The person named in a durable power of attorney (the agent) is designated by the patient to make all medical decisions, as well as any decisions regarding the patient's private affairs in the event that the patient becomes incompetent and unable to make his/her own decisions. No one has the ability to override the agent's decision. All of the following are true statements regarding Munchausen syndrome except: A) It is considered a mental illness B) The patient has a medical illness that causes an anxiety reaction and denial C) The patient fakes an illness in order to gain attention from health care providers D) The patient has an inconsistent medical history along with a past history of frequent hospitalizations - ANSWER-B) The patient has a medical illness that causes an anxiety reaction and denial Munchausen syndrome is a psychiatric disorder in which the patient fakes a medical illness or disorder to gain attention from health care provid- ers. These patients commonly use the emergency department frequently to gain attention. Which of the following antihypertensive medications should the nurse practitioner avoid when treating patients with emphysema? A) Calcium channel blockers B) Angiotensin-converting enzyme (ACE) inhibitors C) Beta-blockers D) Diuretics - ANSWER-C) Beta-blockers Beta-blockers should be avoided in patients with a history of emphysema. Studies have shown evidence of a reduction in forced expiratory volume in 1 second (FEV1), increased airway hyperresponsiveness, and inhibition of bronchodilator response to beta agonists in patients receiving non-selective beta- blockers and high doses of cardioselective beta-blockers. A 30-year-old chef complains of pruritic hives over her chest and arms but denies difficulty swallowing or breathing. She reports a family history of allergic rhinitis and asthma. Which of the following interventions is most appropriate? A) Perform a complete and thorough history B) Prescribe an oral antihistamine such as diphenhydramine 25 mg PO QID C) Give an injection of epinephrine 1:1000 intramuscularly stat D) Call 911 - ANSWER-A) Perform a complete and thorough history Prior to prescribing medications, a complete and thorough history must be performed to determine possible causes of hives. The patient denied difficulty with swallowing and breathing, so there was no medical emergency to require calling 911. Which of the following findings is most likely in young primigravidas with pregnancy-induced hypertension? A) Abdominal cramping and constipation B) Edema of the face and the upper extremities C) Shortness of breath D) Dysuria and frequency - ANSWER-B) Edema of the face and the upper extremities Common signs and symptoms of pregnancy-induced hypertension include edema of the face and the upper extremities, weight gain, blurred vision, elevated BP, proteinuria, and headaches. Which of the following symptoms is associated with B12 deficiency anemia? A) Spoon-shaped nails and pica B) An abnormal neurological exam C) A vegan diet D) Tingling and numbness of both feet - ANSWER-D) Tingling and numbness of both feet Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symptoms of B12 deficiency anemia may include tingling or numbness in fingers and toes, difficulty walking, mood changes or depression, memory loss, disorientation, and dementia. A second triple screen on a 35-year-old primigravida reveals abnormally low lev- els of the alpha fetoprotein and estriol and high levels of human chorionic gonad- otropin. Which of the following interventions is the best choice for this patient? A) Order an ultrasound B) Order a computed tomography (CT) scan of the abdomen C) Order a 24-hour urine for protein clearance D) Assess for a history of illicit drug or alcohol use - ANSWER-A) Order an ultrasound Abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultrasound should be ordered to further evaluate the fetus for characteristics of Down syndrome and/or fetal demise. All of the following are true statements about diverticula except: A) Diverticula are located in the colon B) A low-fiber diet is associated with the condition C) Most diverticula in the colon are infected with gram-negative bacteria D) Supplementingwithfibersuchaspsyllium(Metamucil)isrecommended - ANSWER-C) Most diverticula in the colon are infected with gram-negative bacte- ria Diverticuli in the colon can be infected with both gram-negative and gram- positive bacteria. Patients who are diagnosed with gonorrhea should also be treated for which of the following infections? A) Chancroid B) Chlamydia trachomatis C) Herpes genitalis D) PID (pelvic inflammatory disease) - ANSWER-B) Chlamydia trachomatis When diagnosed with gonorrhea, the patient should also be treated for Chlamydia trachomatis. Kyphosis is a late sign of: A) Old age B) Osteopenia C) Osteoporosis D) Osteoarthritis - ANSWER-C) Osteoporosis Kyphosis is a curvature of the spine that causes a rounding of the back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis) contributes to this curvature in the spine. Symptoms that may occur with severe cases of kyphosis include difficulty breathing, fatigue, and back pain. A 35-year-old primigravida who is at 28 weeks of gestation is expecting twins. What would you would expect her alpha fetoprotein (AFP) values to be? A) Normal B) Higher than normal C) Lower than normal D) None of the above - ANSWER-B) Higher than normal Alpha fetoprotein is produced in the fetal and maternal liver. Higher levels of alpha fetoprotein are commonly seen in multiple gestations due to the growing fetuses and enlargement of the livers. Which of the following antihypertensive medications has beneficial effects for an elderly White female with osteoporosis? A) Calcium channel blocker B) Angiotensin-converting enzyme (ACE) inhibitor C) Beta-blocker D) Diuretic - ANSWER-A) Calcium channel blocker Calcium channel blockers act by blocking the cal- cium channels in the heart muscle and the blood vessels, thereby keeping more calcium in the bones. The Lachman maneuver is used to detect which of the following? A) Knee instability B) Nerve damage of the knee due to past knee injuries C) The integrity of the patellar tendon D) Tears on the meniscus of the knee - ANSWER-A) Knee instability The Lachman maneuver is a test performed to assess for knee instability. Knee instability indicates a tear of the anterior cruciate ligament. When an adolescent male's penis grows more in length than width, at which of the following Tanner stages is he classified? A) Tanner Stage II B) Tanner Stage III C) Tanner Stage IV D) Tanner Stage V - ANSWER-B) Tanner Stage III Tanner Stage III in males consists of penis lengthening and darker, coarse pubic hair, which begins to curl Fetal TORCH infections can cause microcephaly, mental retardation, hepatospleno- megaly, and intrauterine growth retardation. The acronym TORCH stands for: A) Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes B) Toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes zoster C) Tetanus, ophthalmic infections, roseola, cancer, and head abnormalities D) Toxins, other infections, roseola, candidiasis, and head abnormalities - ANSWER-A) Toxoplasmagondii, other infections, rubella, cytomegalovirus, and herpes The acronym TORCH stands for Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes. Although several of the conditions listed in the other answer options can also cause fetal problems, they are not included in the TORCH acronym. Human papilloma virus (HPV) infection of the larynx has been associated with: A) Laryngeal neoplasia B) Esophageal stricture C) Cervical cancer D) Metaplasia of esophageal squamous cells - ANSWER-A) Laryngeal neoplasia HPV infection of the larynx has been associated with laryngeal neoplasia; HPV infection of the cervix is associated with cervical cancer. Mr. Brown is a 65-year-old carpenter complaining of morning stiffness and pain in both his hands and right knee upon awakening. He feels some relief after warming up. On exam, the nurse notices the presence of Heberden's nodes. Which of the fol- lowing is most likely? A) Osteoporosis B) Rheumatoid arthritis C) Degenerative joint disease D) Reiter's syndrome - ANSWER-C) Degenerative joint disease Heberden's nodes are commonly seen in degenerative joint disease. Heberden's nodes are bony nodules located on the distal interphalangeal joints (DIPs). What does a positive posterior drawer sign in a 10-year-old soccer player signify? A) An abnormal knee B) Instability of the knee C) A large amount of swelling on the knee D) An injury of the meniscus - ANSWER-B) Instability of the knee The drawer sign is performed on the knee or ankle to assess for knee instability. The affected knee will have more laxity when compared to the unaffected knee. A multigravida who is at 28 weeks of gestation has a fundal height of 29 cm. Which of the following is the best recommendation for this patient? A) Advise the mother that her pregnancy is progressing well B) Order an ultrasound of the uterus C) Refer her to an obstetrician for an amniocentesis D) Recommend bed rest with bathroom privileges - ANSWER-A) Advise the mother that her pregnancy is progressing well From 20-35 weeks' gestation, fundal height should equal weeks gestation. If greater than 2 cm within the gestational week of pregnancy, further testing should be performed to evaluate fetal growth A multigravida who is at 34 weeks of gestation wants to know at what level her uterine fundus should be. The best answer is to advise the mother that her fun- dus is: A) Midway between the umbilicus and the lower ribs B) At the level of the umbilicus C) From 33 to 35 cm D) From 32 to 34 cm - ANSWER-C) From 33 to 35 cm After 20 weeks gestation, fundal height in centimeters should measure approximately the same as the number of weeks of gestation Which of the following laboratory tests is used in primary care to evaluate renal function? A) Electrolyte panel B) Creatinine C) Alkaline phosphatase D) Blood urea nitrogen (BUN) to creatinine ratio - ANSWER-B) Creatinine Serum creatinine is measured to evaluate renal function. Creatinine is the end product of creatine metabolism. Creatinine clearance is not affected by fluid or dietary intake of meat. All of the following are false statements regarding acute gastritis except: A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the disorder B) Chronic lack of dietary fiber is the main cause of the disorder C) The screening test for the disorder is the barium swallow test D) The gold standard to evaluate the disorder is a colonoscopy - ANSWER-C) The screening test for the disorder is the barium swallow test The gold standard for diagnosing gastric disease is biopsy of gastric and/or duodenal tissue by upper endoscopy. Chronic use of NSAIDs disrupts the production of prostaglandins, which decreases blood supply and then breaks down the protective layer of the mucosa, which leads to gastric disease. Signs and symptoms of depression include all of the following except: A) Anhedonia and changes in appetite B) Decreased energy and irritability C) Apathy and low self-esteem D) Apraxia and fatigue - ANSWER-D) Apraxia and fatigue Apraxia is a disorder of the nervous system in which the brain is affected and the patient is unable to move the arms/legs when asked to do so. Common signs of depression include anhedonia (loss of interest in activities that the patient finds pleasurable), unintentional weight loss or gain, fatigue, change in appetite, insomnia or hypersomnia, feelings of guilt and worthlessness, and recurrent thoughts of suicide. Which of the following is an accurate description of eliciting for Murphy's sign? A) Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle B) Bend the patient's hips and knees at 90 degrees, then passively rotate hip exter- nally, then internally C) Ask the patient to squat, then place the stethoscope on the apical area D) Press into the abdomen deeply, then release it suddenly - ANSWER-A) Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle Murphy's sign is positive if pain occurs when performing RUQ palpation while the patient takes a deep inspiration, causing the patient to abruptly stop the deep breath due to pain. As the liver is palpated, it will descend and push up against the inflamed gallbladder and cause sharp pain (cholecystitis). A 28-year-old multipara who is at 32 weeks of gestation presents to your office complaining of a sudden onset of small amounts of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely? A) Placenta abruptio B) Placenta previa C) Acute cervicitis D) Molar pregnancy (hydatidiform mole) - ANSWER-B) Placenta previa Placenta previa occurs when abnormal implantation of the placenta occurs. A common symptom of placenta previa is painless, bright red bleeding. Epidemiologic studies show that Hashimoto's disease occurs most commonly in: A) Middle-aged to older women B) Smokers C) Obese individuals D) Older men - ANSWER-A) Middle-aged to older women Hashimoto's disease commonly occurs in middle-aged to older women. A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except: A) Hot flashes B) Irregular menstrual periods C) Severe vaginal atrophic changes D) Cyclic mood swings - ANSWER-C) Severe vaginal atrophic changes As women reach menopause, changes that may occur include hot flashes, irregular menstrual periods, and cyclic mood swings. Vaginal changes, such as dryness and thinning, may also begin to occur A 63-year-old patient with a 10-year history of poorly controlled hypertension presents with a cluster of physical exam findings. Which of the following indicate target organ damage commonly seen in hypertensive patients? A) Pedal edema, hepatomegaly, and enlarged kidneys B) Hepatomegaly, AV nicking, bibasilar crackles C) Renal infection, S3, neuromuscular abnormalities D) Glaucoma, jugular vein atrophy, heart failure - ANSWER-B) Hepatomegaly, AV nicking, bibasilar crackles With long-term, uncontrolled hypertension, organ damage may occur. Organs commonly affected include: brain (stroke), eyes (retinopathy, AV nicking, bleeding, blindness), heart (heart dis- ease, left ventricular hypertrophy, MI, and/or CHF), and kidneys (renal failure, proteinuria). A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threatened abortion? A) Vaginal bleeding and cramping are present, but the cervix remains closed B) Vaginal bleeding and cramping are present along with a dilated cervix C) The fetus and placenta are all expelled D) The products of conception and the placenta remain inside the uterus along with a dilated cervix - ANSWER-A) Vaginal bleeding and cramping are present, but the cervix remains closed Threatened abortion is defined as vaginal bleeding and cramping with- out the presence of cervical dilation. A 30-year-old female who is sexually active complains of a large amount of milk- like vaginal discharge for several weeks. A microscopy slide reveals a large amount of squamous epithelial cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at 6.0. What is most likely? A) Trichomonas infection B) Bacterial vaginosis C) Candidal infection D) A normal finding - ANSWER-B) Bacterial vaginosis Bacterial vaginosis is a bacterial infection of the vagina. Signs and symptoms include copious off-white to gray discharge with foul odor without vaginal erythema or irritation. Wet prep will show positive for clue cells. When performing a wet prep, the "whiff test" will be positive for a strong "fishy" odor when vaginal discharge is mixed with one drop of KOH. The Pap smear result on a 20-year-old sexually active student who uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up action? A) The NP needs to do cervical cultures to verify the presence of gonorrhea B) Prescribe metronidazole vaginal cream for the patient over the phone C) Call the patient and tell her she needs a repeat Pap smear in 6 months D) Advise the patient to use a Betadine douche at bedtime x 3 days - ANSWER-A) The NP needs to do cervical cultures to verify the presence of gonor- rhea Cultures should be taken at the time of the Pap smear, as the patient may not return for later diagnostic testing. While performing a Pap smear on a postmenopausal patient, several areas of flat white skin lesions that are irregularly shaped are found on the patient's labia. The patient reports that the lesions are extremely itchy and have been present for several years without much change. Which condition is best described? A) Chronic scabies infection B) Lichen sclerosus C) Chronic candidal vaginitis D) A physiologic variant found in some older women - ANSWER-B) Lichen sclerosus Lichen sclerosus is a disease of the skin, in which white spots appear on the skin and change over time. It is most commonly seen in the genital and rectal areas, but can appear in other areas. The spots are usually shiny and smooth and can eventually spread into patches. The skin appears thin and crinkled. Then the skin tears easily, and bright red or purple bruises are common. Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms The heart sound S2 is caused by: A) Closure of the atrioventricular valves B) Closure of the semilunar valves C) Opening of the atrioventricular valves D) Opening of the semilunar valves - ANSWER-B) Closure of the semilunar valves The heart sound S2 is caused by closure of the semilunar valves. A pelvic exam on a woman who is 12 weeks pregnant would reveal that her uterus is located at which of the following areas? A) Between the umbilicus and the suprapubic bone B) Just rising above the suprapubic bone C) Between the suprapubic bone and the xiphoid process D) Between the umbilicus and the xiphoid proces - ANSWER-B) Just rising above the suprapubic bone At 12 weeks gestation, the uterus measures approximately the size of a grapefruit, which would be felt just above the suprapubic bone on bimanual exam. All of the following are covered under Medicare Part B except: A) Persons age 65 years or older B) Durable medical equipment C) Mammograms annually starting at age 50 D) Anesthesiologist's services - ANSWER-D) Anesthesiologist's services Medicare Part B covers: 1) outpatient physician visits, labs, x-rays; 2) durable medical equipment; 3) mammograms/colonoscopy after age 50 years annually; 4) rehabilitation. Anesthesiologist's services are covered by Medicare Part A. All of the following patients are at higher risk for suicide except: A) A 66-year-old White male whose wife of 40 years recently died B) A high school student with a history of bipolar disorder C) A depressed 45-year-old female with family history of suicide D) A 17-year-old teen who has only 1 close friend in school - ANSWER-D) A 17-year-old teen who has only one close friend in school Risk factors for suicide include: 1) elderly white males (especially after the death of a spouse); 2) past history of suicide; 3) family history of suicide; 4) plans for use of a lethal weapon such as a gun or knife; 5) female gender has a higher attempt rate, but males have a higher success rate; 6) personal history of bipolar disorder or depression. A 70-year-old male patient complains of a bright red spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on is Bayer aspirin 1 tablet a day. Which of the following is most likely? A) Corneal abrasion B) Acute bacterial conjunctivitis C) Acute uveitis D) Subconjunctival hemorrhage - ANSWER-D) Subconjunctival hemorrhage Subconjunctival hemorrhage is a benign disorder that occurs from an increase in intraocular pressure that may be caused by coughing, vomiting, forceful exerrtion in labor during childbirth, straining while having a bowel movement, weight lifting, or lifting a heavy object. Which of the following is appropriate follow-up for this 70-year-old patient? A) Referral to an optometrist B) Referral to an ophthalmologist C) Advise the patient that it is a benign condition and will resolve spontaneously D) Prescribe an ophthalmic antibiotic solution - ANSWER-C) Advise the patient that it is a benign condition and will resolve spontaneously A subconjunctival hemorrhage is a benign disorder that resolves without any treatment Jason, an 8-year-old with type 1 diabetes, is being seen for a 3-day history of fre- quency and nocturia. He denies flank pain and is afebrile. The urinalysis result is negative for blood and nitrites but is positive for a large amount of leukocytes and ketones. He has a trace amount of protein. Which of the following is the best test to order initially? A) Urine for culture and sensitivity B) 24-hour urine for protein and creatinine clearance C) 24-hour urine for microalbumin D) An intravenous pyelogram - ANSWER-A) Urine for culture and sensitivity An 8-yea [Show Less]
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Leik Review with Complete Solutions
Infections of Vagina/Labia - ANSWER-bv, candidiasis, trichomoniasis Infections of cervix, endometrium - ANSWER-Chlamydia Trachomatis effects cervix, end... [Show More] ometrium, fallopian tubes and pelvic cavity Sx/Sym of Acute Abdomen - ANSWER-positive obturator/Psoas Obturator Sign - ANSWER--pain elicited on internal rotation of right hip from 90 degrees hip/knee flexion. -acute abdomen/appendicitis Psoas Sign - ANSWER--acute abdomen/appendicitis -when pain occurs with passive extension of the thigh while the patient is lying on the side knees extended, or when pain occurs w/ active flexion of thigh at hip Medicare Part A - ANSWER-Inpatient Hospitalization and skilled care given in a certified SNF. Mycoplasma Pneumonia - ANSWER-most common in children and young adults spread thru droplets, sneezing, coughing. dx based on symptoms and xrays with lower lobe infiltrates PPD - ANSWER-Must have an induration of 10mm or > to be + Must be indurated not just red Durable Power of Attorney - ANSWER-agent is designated by pt to make all medical decisions as well as private affairs in the event the pt becomes unable to make decisions. no one has the ability to override the agents decisions. Beta Blockers - ANSWER-avoided in emphysema -reduction in forced expiratory volume in 1 second (FEV1) increased airway hyperresponsiveness and inhibits bronchodilator resonse to beta agonists in non-selective BBs & high doses of cardioselective BBs Sx/Sym of Pregnancy Induced Hypertension - ANSWER--edema of the face & upper extremities -wt gain, blurred vision, elevated BP, proteinuria, HA B12 Deficiency-- B12 Anemia - ANSWER--can cause nerve cell damage if not treated -Sym B12 deficiency includes: tingling/numbness in fingers and toes, difficulty walking, mood changes/depression, memory loss, disorientation, dementia Alpha Feta Protein (AFP) - ANSWER-Produced in maternal and fetal liver, commonly seen in multiple gestations due to the growing fetuses, and enlargment of liver... Calcium Channel Blockers - ANSWER-CCBs act by blocking calcium channels in heart muscle and blood vessels, and keeping more calcium in bones Lachman Maneuver - ANSWER-Test performed to assess for knee instability, indicates a tear in the ACL TORCH - ANSWER-Toxoplasma Gondii, other infections, rubella, cytomegalovirus, herpes. Heberdens Nodes - ANSWER-DJD, distal interphalangeal joints. Drawer Sign - ANSWER--performed on the knee or ankle to assess for instability. affected knee will have more laxity when compared with unaffected. Evaluate Renal Function - ANSWER-Serum creatinine evaluates renal function. End product of creatine metabolism. not affected by fluid or dietary intake of meat. Chronic Use of NSAIDs - ANSWER-disrupts production of prostaglandins, decreases blood supply & breaks down protective layer of the mucosa leading to gastric disease Common Signs of depression - ANSWER-anhedonia (loss of interest), unintentional weight loss/gain, fatigue, change in appetite, insomnia and hypersomnia, feelings of guilt, worthlessness, suicide. Murphy's Sign - ANSWER-+ if pain occurs when performing RUQ Palpation while pt takes a deep inspiration. causing pt to stop deep breath. As liver is palpated it will descend and push up against the inflamed gall bladder and cause sharp pain (cholecystitis) Placenta Previa - ANSWER--abnormal implantation of the placenta. symptoms are painless, bright red bleeding Vaginal Atrophic Changes - ANSWER--menopause, hotflashes, irregular periods, cyclic mood swings. Vaginal changes such as dryness and thinning occur. Target organ damage in HTN - ANSWER-long term uncontrolled hypertension. organs affected include: brain (stroke), eyes (retinopathy, AV nicking, bleeding and blindness), heart (heart disease, left ventricular hypertrophy, MI and/or CHF), kidneys (renal failure, proteinuria) Bacterial Vaginosis - ANSWER--bacterial infection of vagina, copious off-white to gray d/c w/ foul odor w/out vaginal erythema or irritation. Wet prep will show + clue cells. Wet prep with "whiff test" will be positive for strong "fishy" odor when vaginal d/c mixed with KOH Lichen Sclerosus - ANSWER-disease of skin, white spots appear on skin and change over time. commonly seen in genital and rectal areas, shiny and smooth and spreads into patches. skin appears thin and crinkled. tears easily, bright red and purple bruises common. skin becomes scarred. Heart Sounds: S1 & S2 - ANSWER-s1 closure of mitral/tricuspid valve s2 closure of semi-lunar: aortic and pulmonic 12 Weeks Gestation - ANSWER--uterus measures the size of grapefruit, felt just above the suprapubic bone on bimanual exam. Medicare Part B - ANSWER-Covers outpatient physician visits, labs and xrays. Durable medical equipment. mammograms/colonoscopy after age 50, rehab. Anesthesia is Part A Risk Factors for Suicide - ANSWER-1. elderly white male (esp after lose of spouse) 2. past hx of suicide 3. family hx 4. plans for use of letal weapon such as gun/knife 5. females have higher attempt rate, males > success 6. personal hx of bipolar disorder or depression Subconjunctival Hemorrhage - ANSWER--benign disorder occurs from an increase in intraocular pressure, caused by coughing, vommitting, bearing down with childbirth or BM, heavy lifting. What is Tonometry - ANSWER-used to measure intraocular pressure (IOP) the eye screen for glaucoma. Normal range for IOP 10-22 mmHg. Rocky Mountain Spotted Fever - ANSWER-bite from tick infected with Rickettsia rickettsii. mortality 1-7% if untreated. Atopic Dermatitis - ANSWER--lesions occur in a linear fashion -many different stages including papules/vessicles, w/ weeping, drainage and or crusting. Lesions commonly found on scalp, face, forearms, wrists, elbows and backs of knees. -commonly pruitic aka excema S1, S2 and S3 heart sounds - ANSWER-- heard with CHF, the inability of the heart to pump sufficient amount of blood to the organs to meet bodys requirement. common to hear all 3 on exam. Signs and Symptoms include fatigue, sob w/ activity, and edema of lower extremities. G6PD Deficiency Anemia - ANSWER-Glucose-6-phosphate dehydrogenase (G6PD) is hereditary. occurs when RBCs break down and hemolyze. due to missing or lack of enzyme needed to help RBCs work efficiently. Certain foods and medications trigger the reaction. Meds like antimalarial, aspirin, nitrofurantin, NSAIDS, quinidine, quinine, sulfa meds. Priapism - ANSWER-urologic emergency, painful erection not related to sex. if untreated can cause erectile dysfunction and penile necrosis. Assoc with Sickle Cell anemia, leukemia, spinal cord injury and some pharmas. RH Positive Red Blood Cells - ANSWER-mothers autoantibodies can attack the fetus's RH-positive red blood cells, and cause destruction of these. can cause severe anemia & complications in fetus. preventable with admin of RhD immunoglobulin, to an RH negative mother at 28 wks and after birth of newborn. Folic Acid Supplements - ANSWER-in pregnancy to prevent risk of neural tube defects. Pheochromocytoma - ANSWER-adrenal gland tumor w/increased production of adrenaline and non-adrenaline which can cause an increase in bp Renovascular Stenosis - ANSWER-narrowing of one or both arteries leading to the kidneys, it can cause severe hypertension and reversible kidney damage. Coarctation of the Aorta - ANSWER-congenital heart defect, narrowing of the aorta that causes the heart to work harder to get blood to flow through the narrow passageway to other organs, causes increase in BP Chlamydia trachomatis - ANSWER-Fitz-Hugh-Curtis is a complication of having pelvic inflammatory disease, caused by a vaginal infection such as gonnorhea or chlamydia. Causes inflammation and infection in the pelvic cavity. Left untreated can cause adhesions stretching from peritoneum to the liver. TB for a High Risk Population - ANSWER-5 mm induration considered positive for high risk population. Varicella in HIV - ANSWER-contraindicated inevitable abortion - ANSWER-vaginal bleeding with pain and cervical dilation and/or effacement. threatened abortion - ANSWER-is defined as vaginal bleeding w/ absent or minimal pain and closed long and thick cervix. incomplete abortion - ANSWER-moderate to diffuse bleeding. passage of tissue and painful uterine cramping or contractions. Acute pelvic inflammatory disease - ANSWER-sudden onset of inflammation and pain that affects the pelvic area, cervix, uterus, and overies. caused by infection. Rubella - ANSWER-contraindicated in pregnancy Medicare part B - ANSWER-covers: outpatient, physician visits, labs, xrays, durable medical equipment, mammograms, colonoscopy after age 50 annually and rehabilitation Ishihara Chart - ANSWER-test for color blindness Sx and Sym of Left Sided Heart Failure - ANSWER-Tachypnea, labored breathing, rales/crackles in the lower bases of the lungs, which can develop into pulmonary edema. Food migraine triggers - ANSWER-aspartame, tyramine, nitrites, msg and/or red wine. foods thought to cause a change in the blood vessels and increased blood flow to the brain. Prophylaxis for dental work - ANSWER-recommended for pts at high risk for bacterial endocarditis: prosthetic valve, previous history of endocarditis, congenital heart defects. Sx and Sym of Measles - ANSWER-fever over 101, coryza, cough, conjunctivitis, rash and Kopliks spots on buccal mucosa Treponema pallidum - ANSWER-gram-negative spirochete bacterium causes syphilis Elisa Test for HIV - ANSWER-Needs to be confirmed with Western Blot New Onset of AFib - ANSWER-thyroid disease, prior to decreasing or stopping meds should do baseline blood work Pre-eclampsia classic triad - ANSWER-Hypertension, Edema, proteinuria Cushing Syndrome - ANSWER-Elevated serum cortisol levels Presumptive Signs of Pregnancy - ANSWER-amenorrhea, breast tenderness, n/v, fatigue, increased urinary freq Probable Signs of Pregnancy - ANSWER-Signs detected by examiner: enlarged uterus Hegars Sign: softening of lower portion of the uterus Positive Signs of Pregnancy - ANSWER-Audible fetal heart tones, cardiac activity on ultrasound [Show Less]
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Leik - FNP review Questions and Answers Solved 100% Correct
Labs to order if Digoxin overload suspected - ANSWER-electrolytes, creatinine, and serial EKG's First line for atrial fibrillation - ANSWER-Coumadin. ... [Show More] INR of 5 to 8 without bleeding - ANSWER-hold for 1 to 2 doses, then recheck every 2 to 3 days until normal. Those taking thiazides may also find relief with - ANSWER-osteoporosis. it stimulates formation of osteoclasts. Those taking thiazides can have which adverse effects - ANSWER-hyperglycemia, hypokalemia, increased lipids, increased uric acid. Thiazides may worsen what conditions - ANSWER-diabetes, gout, HPL, and electrolyte imbalances If a patient is allergic to sulfa what diuretic should they avoid - ANSWER-thiazides. instead, use triamterene or amiloride Chlorhtalidone is longer acting and more potent than HCTZ. true or false? - ANSWER-true who are loop diuretics prescribed to - ANSWER-edema from heart failure, cirrhosis, renal disease, hypertension. black box warning for loop diuretics - ANSWER-extreme diuresis Adverse effects of loop diuretics - ANSWER-hypovolemia, loss of electrolytes, pancreatitis, jaundice, rash, ototoxicity What are aldosterone antagonists like spironolactone used for? - ANSWER-hirsutism, hypertension, severe heart failure Adverse effect of spironolactone - ANSWER-galactorrhea and hyperkalemia. black box warning for spironolactone - ANSWER-increase of benign and malignant tumors. beta blockers are first line for - ANSWER-post-myocardial infarction beta blockers are used for - ANSWER-migraine prophylaxis, angina, arrythmias, hyperthyroidism cardioselective beta blockers include - ANSWER-atenolol and metropolol beta blockres may cause what complication in diabetics - ANSWER-they mask the hypoglycemic response. what are contraindications of beta blockers - ANSWER-asthma, copd, bronchitis, emphysema, bradycardia A patient with an ace develops a cough. What should you do? - ANSWER-stop and switch to an ARB for same renal protective effects. what to monitor when giving captopril - ANSWER-CBC. it may cause neutropenia, leukopenia, and agranulocytosis the prescriber should be careful not to mix the calcium channel blocker verapamil with what antibiotics - ANSWER-erythromycin and clarithromycin. Contraindications of giving calcium channel blockers - ANSWER-av block, bradycardia, congestive heart failure grapefruit juice when taken with calcium channel blockers can cause toxicity. true or false? - ANSWER-true drug interactions with calcium channel blockers - ANSWER-intraconazole, macrolides when are alpha blockers given - ANSWER-hypertension with co-existing BPH terazosin dosing - ANSWER-1 mg PO at bedtime a good alternative for gram positive infections in those who are penicillin allergic is - ANSWER-macrolides. Clindamycin is associated with what infection - ANSWER-C. diff Initial treatment of COPD - ANSWER-antichollinergics. ipratropium bromide what antibiotics are pregnancy category D - ANSWER-doxycycline, minocycline, tetracycline tetracyclines will not impact effectiveness of birth control pills. true or false? - ANSWER-false 1st line for chlamydial infections and atypical bacteria - ANSWER-doxycyline common side effect of minocycline - ANSWER-dizziness and vertigo taking expired tetracycline may result in what medical conditions - ANSWER-nephropathy and fanconni syndrome Macrolides are generally category - ANSWER-B which macrolide are pregnancy category C - ANSWER-clarithromycin and telithromycin Those with myasthenia gravis should not take which antibiotic? - ANSWER-erythromycin and telithromycin. telithromycin has a black box warning azithromycin may interact with what atrial fibrillation medication? - ANSWER-coumadin doxycycline has a common instruction not to take with food . why is this? - ANSWER-it binds with iron, calcium, magnesium, and zinc. The instructions should really say not to take with dairy minocycilne may decrease the efficacy of contraceptives. true or false. - ANSWER-true adverse effects of macrolide and tetracyclines include - ANSWER-ototoxicity, GI distress, and twisting of points a patient has a history of jaundice. which macrolide antibiotic is contraindicated? - ANSWER-telithromycin, or ketek macrolide can cause what cardiac anomaly - ANSWER-prolonged QT and twisting of points Which generation cephalosporins have the broadest spectrum - ANSWER-3rd generation extended spectrum which generation of cephalosporins have the lowest gram negative coverage - ANSWER-3rd generation Cephalosporins appropriate for cellulitis and mastitis include - ANSWER-Cephalexin, keflex. Cephalosporins appropriate for sinusitis and otitis media include - ANSWER-Cefuroxime, cefprozil, and ceflacor. 2nd generations. ceftin, cefzil, and ceclor Cephalosporins appropriate for gram negative infections like neisseria gonorrhae include - ANSWER-ceftriaxone, cefizime, and cefdinir. cephalosporins and penicillins will never kill what bacteria - ANSWER-MRSA First line for otitis media - ANSWER-amoxicillin first line for sinusitis - ANSWER-amox clav first line for syphillis - ANSWER-benzathine penicillin first line for gonorrhea - ANSWER-cefitriaxone first line for MRSA - ANSWER-bactrim or clindamycin for 5 to 10 days never use what antibiotic in mononucleosis - ANSWER-amoxicillin dicloxacillin is for penicillinase producing staph skin infections like - ANSWER-impetigo and mastitis avoid use of what drugs with the quinolone due to risk of cardiac adverse effects - ANSWER-amiodarone, macrolides, TCA's, antipsychotics, or electrolyte imbalances children can have the quinolones. True or false? - ANSWER-false, not for those under 18. giving antacids or sucralfate with the quinolones helps to reduce adverse effects. True or false. - ANSWER-false, it actually reduces efficacy due to binding those with myasthenia gravis can take quinolone. True or false? - ANSWER-false. travelers diarrhea - ANSWER-ciprofloxacin 500 mg BID x 3 cutaneous anthrax - ANSWER-ciprofloxacin 500 mg BID 7 to 10 days Bioterrorism related inhalation - ANSWER-cipro 500 mg BID x 60 days first line for pseudomonas pneumonia - ANSWER-ciprofloxacin. per the CDC, stop using cipro to treat what - ANSWER-gonorrheal infection sulfonamides are active against - ANSWER-gram negative sulfa type drugs include - ANSWER-Cox-2, bactrim, furosemide, HCTZ, dapsone, glyburide, glipizide. Those with G6Pd would not take what antibiotic - ANSWER-sulfonamides Contraindications for sulfonamides - ANSWER-3rd trimester pregnancy, G6PD, sulfa allergy Patients with a UTI on coumadin should not be treated with what antibiotic - ANSWER-Bactrim, due to risk of bleeding The typical male presenting with G6PD presents with jaundice and was treated with what - ANSWER-a sulfa drug. like Bactrim, a cox 2, HCTZ dextromethorphan is contraindicated within how many days of MAOI - ANSWER-14 what is given for PCP in HIV patients - ANSWER-Bactrim a topical sulfa drug for burns - ANSWER-sulfadiazine first line NSAID for those at high risk for GI bleed - ANSWER-Cox 2 Aspirin irreversibly supresses platelet function for - ANSWER-7 days patient with tinnitus taking aspirin - ANSWER-discontinue No need to taper prednisone if - ANSWER-patient is not on chronic steroids Superpotent - class 1 - ANSWER-clobetasol, temovate potent - ANSWER-halocinomide, halog moderate - ANSWER-triamcinolone, kenalog least potent - ANSWER-hydrocortisone topical steroid occlusion - ANSWER-for severe psoriatic plaques. apply super potent agent like clobetasol and cover in plastic. should not be used greater than 2 weeks. HPAA axis dysfunction septic joint - ANSWER-do not inject steroids digoxin eye issue - ANSWER-halo, blurred, yellow to green. needs eye exam ethambutal and linezolid eye issue - ANSWER-optic neuropathy, needs eye exam corticosteroid eye issue - ANSWER-cataract, glaucoma, optic neuritis. needs eye exam quinolone eye issue - ANSWER-retinal detachment. viagra, cialis, levitra eye issue - ANSWER-ischemic neuropathy, blurred vision, cataracts [Show Less]
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LEIK FNP (Actual) Exam with Complete Solutions
An elderly male of Mediterranean descent has a routine complete blood count (CBC) done for an annual physical. The following are his lab test results: hemo... [Show More] globin of 13.0 g/dL, a hematocrit of 39%, and an MCV of 72 fL. His PSA result is 3.2 ng/mL. The urinalysis shows no leukocytes and few epithelial cells. Which of the following laboratory tests are indicated for this patient? A) Serum iron, serum ferritin, total iron binding capacity (TIBC), and the red cell differential width (RDW). B) Serum B12 and folate level with a peripheral smear. C) CBC with white cell differential and urinalysis. D) Urine culture and sensitivity with microscopic exam of the urine - ANSWER-A large ethnic group from Southeast Asia is the Filipinos (from the Philippine Islands). Alpha thalassemia is more common in this ethnic group compared with beta thalassemia, which is more common in people of Mediterranean descent. alpha-thalassaemia and beta-thalassaemia traits are two commonly encountered haemoglobinopathies in South East Asia. Both present with hypochromia and microcytosis. How to answer ? - ANSWER-You must go through three steps to answer this question correctly: First step: A hemoglobin of less than 13.5 g/dL in males (but not in females) is indicative of anemia. An MCV of 72 fL is indicative of microcytic anemia (norm 80-100 fL). Second step: The MCV will direct you in the differential diagnosis (microcytic, normocytic, or macrocytic). Third step: The differential diagnosis for microcytic anemia is iron deficiency and alpha/beta thalassemia trait/minor for the exams. In iron-deficiency anemia, the following results are found: decrease---- and elevated --- - ANSWER-Decreased (serum ferritin and serum iron levels). Elevated (TIBC/transferrin levels and the RDW). The gold standard test to diagnose any anemia involving abnormal hemoglobin (thalassemia, sickle cell, - ANSWER-HGB electrophoresis In alpha or beta thalassemia trait or minor, the following results are found: Normal to high ------ and normal ------ - ANSWER-Normal to high (serum ferritin and serum iron levels) Normal (TIBC/transferrin levels) Remember iron deficiency... Decreased (serum ferritin and serum iron levels). Elevated (TIBC/transferrin levels and the RDW). Alpha thalassemia - ANSWER-Filipinos Beta thalassemia - ANSWER-Mediterranean The red cell distribution width (RDW) is a measure of the variability in size of RBCs (or anisocytosis). An elevated RDW is indicative of ..... Anemia - ANSWER-Iron deficiency According to the HIPAA of 1996, which of the following examples demonstrates noncompliance? A) The sign-in sheet on the front desk is covered so that other patients' names are not visible to new patients. B) The medical assistant calls the patient who is in the waiting room using his/her first name. C) A patient's chart that is hanging on the door of the examination room is turned backward. D) The nurse practitioner calls the daughter of an elderly diabetic patient and leaves a detailed message on her answering machine regarding her mother's laboratory results. III. - ANSWER-Correct Answer: Option D D) The nurse practitioner calls the daughter of an elderly diabetic patient and leaves a detailed message on her answering machine regarding her mother's laboratory results. Option b ok- can use or first name Option D demonstrates two examples of HIPAA noncompliance. First, there is no mention that the patient gave consent for her daughter to have access to her medical information. Second, the NP did not follow the "minimum necessary requirement" rule when she left a detailed message on the daughter's answering machine. 2) The best action in this case is for the NP to call the elderly patient's home and to leave only her name, the name of the clinic, and phone number that the patient can call back. "Will performing this action prevent the disease or the social condition from happening?" If it does, then it is considered as .........prevention (if it does not, then it is ........prevention). - ANSWER-Does then primary of not then secondary Primary Prevent Disease/Injury/Condition) - ANSWER-Youth violence prevention (e.g., youth recreational center for high-risk inner-city youth, mentoring teens, teaching teens better communication skills). Bullying prevention (e.g., antibullying school programs). Personal safety promotion (e.g., seatbelts, airbags, helmets). Disease prevention (e.g., immunizations, using sunscreen). Healthy lifestyle promotion (e.g., sleep 7-8 hours/night, avoid sunlight 10 a.m. to 4 p.m., healthy diet, exercise). Promotion of OSHA laws (e.g., workplace Secondary Prevention (Detect Disease/Condition as Early as Possible) - ANSWER-Any laboratory test to screen for a disease (e.g., CBC for anemia, TSH for thyroid disease). U.S. Preventive Services Task Force (USPSTF) screening recommendations (e.g., mammograms, PSA, purified protein derivative [PPD]). Screening for high-risk behavior (e.g., asking a patient about the number of sexual partners), screening for suicide risk (e.g., assess suicide risk, check for signs and symptoms of depression). Personal actions to detect cancer (e.g., BSE, GSE). Tertiary Prevention (Limiting Further Harm and Disability) - ANSWER-All types of rehabilitation (e.g., cardiac rehab, PT, OT, speech therapy, addiction/drug rehab). Support groups (e.g., breast cancer patients, alcoholics with Alcoholics Anonymous). Exercise for an obese person (if the person is healthy, then it is primary prevention). An 18-year-old female presents in the college health clinic complaining of a strong odor in her vagina. She reports that she had an abortion about 3 weeks ago and recently completed her prescription of antibiotics. The NP performs a vaginal speculum exam and notes a large amount of grayish to off-white discharge coating the patient's vaginal walls. It has a milk-like consistency. During microscopy, the slide reveals mature squamous epithelial cells with numerous bacteria noted on the cell borders. The vaginal pH is at 6.0. Which of the following conditions is most likely? A) Trichomoniasis B) Bacterial vaginosis C) Candida vulvovaginitis D) Hormonal changes - ANSWER-BV 1) The vaginal pH is alkaline (pH of 6.0). 2) Rule out Candida because it is classified as a yeast organism (not a bacteria). 3) Rule out Trichomonas because it is a protozoa or unicellular flagellated organism. 4) The odor and discharge are not due to hormonal changes in an 18-year-old female. BV (CAN) - ANSWER-Bacterial vaginosis (BV) has an alkaline pH (vagina normally has an acidic pH of 4.0). BV is not considered an STD (it is caused by an imbalance of vaginal bacteria). The sex partner does not need to be treated. It is a vaginosis (not a vaginitis). BV does not cause inflammation (the vulvovagina will not be red or irritated). The microscopy slide will have very few WBCs and a large number of clue cells. ****Alkaline, not std, clue cell (remember by CAN) Candida WTC RI WP-HS NGI - ANSWER-vaginal discharge in Candida infection is of a white color with a thick and curd-like consistency. It frequently causes redness and itching in the vulvovagina due to inflammation. microscopy in candidiasis will show a large number of WBCs, pseudohyphae, and spores ("spaghetti and meatballs"). Candida yeast is normal flora of the gastrointestinal (GI) tract and in some women's vaginas. Trichomonas infection (or trichomoniasis) CBG RI STD - ANSWER-Vaginal dc copious, bubbly, and green in color. It causes a lot of inflammation resulting in itching and redness of the vulvovagina. It is considered a sexually transmitted infection. The sex partner also needs treatment. A previously healthy 30-year-old complains of an acute onset of fever and chills accompanied by a productive cough with purulent sputum and a loss of appetite. The patient denies receiving an antibiotic in the previous 3 months. The NP diagnoses community-acquired pneumonia (CAP). The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) treatment guidelines recommend which of the following as the preferred first-line treatment for this patient? A) Macrolides B) Antitussives C) Cephalosporins D) Fluoroquinolones with gram-positive bacteria activity - ANSWER-Macrolide According to the IDSA and the ATS treatment guidelines, outpatient treatment of CAP in healthy patients (no comorbidities) are the macrolides (azithromycin, clarithromycin, or erythromycin). Macrolide (ACE) - ANSWER-azithromycin, clarithromycin, or erythromycin Which of the following antibiotics is preferred treatment for healthy adults diagnosed with uncomplicated CAP? A) Azithromycin (Zithromycin) 500 mg on day 1, then 250 mg daily for 4 days. B) Dextromethorphan with guaifenesin (Robitussin diabetes mellitus [DM]) 1 to 2 teaspoons PO QID as needed C) Cephalexin (Keflex) 500 mg PO QID × 10 days D) Levofloxacin (Levaquin) 500 mg PO daily × 7 days - ANSWER-Azithromycin Possible side effects that may be seen in a patient who is being treated with hydro-chlorothiazide for hypertension are: A) Dry cough and angioedema B) Swollen ankles and headache C) Hyperuricemia and hyperglycemia D) Fatigue and depression - ANSWER-C Example B is caused by calcium channel blockers (CCBs). Look for a hypertensive patient with swollen ankles (not associated with heart failure) and headache. Example C is caused by the thiazide diuretics (hyperuricemia and hyperglycemia) Example D is caused by beta-blockers. Look for a patient with hypertension who complains of increased fatigue and depression (avoid if possible in depressed patients). CDC Mortality Statistics: Disease causing the most deaths overall: ______disease. Cancer with the highest mortality: ______ cancer. - ANSWER-heart [Show Less]
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FNP Leik System Review Exam (Chapter 4 Preventive Health) with Complete Solutions
Sensitivity - ANSWER-(SNOUT) Negative results rules out the disease. Sensitivity test are good at identifying the positive markers of disease. So good that... [Show More] it is more prone to report false positives. So a negative result is more definitive Specificity - ANSWER-(SPIN) Positive results rules in the disease. Specificity tests are good at identifying the negative marker of a disease. So good that is more prone to report false negatives. So a positive result is more definitive. Primary Prevention - ANSWER-Prevent the disease in its entirety. Examples include healthy diet, exercise, safety (helmets/seatbelts), immunizations, and job safety Secondary Prevention - ANSWER-Early detection of a disease. Examples include screening tests Tertiary Prevention - ANSWER-Rehabilitation of a disease. Examples include support groups, education for pts with pre-existing disease, drug side effect safety, medical equipment safety, any type of rehab like PT or OT Breast Cancer Screening Guidelines (USPSTF) - ANSWER-Onset = 50yo. Biannual. Stop at age 74yo. No SBE. Breast Cancer Screening Guidelines (ACA) - ANSWER-Onset = 40yo. Annual. No stop age. Cervical cancer screening guidelines - ANSWER-Onset=21yo (immunocompromised individuals start at onset of sexual activity). Every 3 years Pap w/ no HPV test until 30yo. Pap and HPV test after 30 yo and can begin screening every 5 years. Stop at age 65yo. Complete hysterectomy means no Pap unless pt has history of cervical cancer or high grade lesion. Colorectal cancer - ANSWER-Onset 50yo. 1) colonoscopy q 10 years if wnl, 2) sigmoidoscopy q 5 years if wnl, 3) annual FOBT with 3 stool samples. Stop age 75 yo. Prostate cancer - ANSWER-USPSTF does not recommend screening with PSA but it based on individual pt. Lipid screening - ANSWER-Onset 18-35/45yo screen if at increased risk of heart disease. Males >35yo and Females >45yo Flu vaccine - ANSWER-LAIV - Live virus can only be given to healthy non-pregnant 2 -49 yo w/o recent hx of asthma (Peds). Cautioned or C/I in pts with egg, gentamicin or gelatin allergy and kids receiving aspirin therapy (Reye's syndrome). TIV (trivalent inactivated vaccine) is approved for >6months. Tetanus vaccine - ANSWER-Q 10 years. Booster for dirty wounds if last TDAP/Td is > 5 years old. >7yo receive Td/TDAP. Avoid in egg allergy and Gullian Barre. 5 doses of DTAP aka Pediarix (2,4,6,15 months and 5 yo) First TDAP is at age 11-12yo. Td is the booster every 10 years or if someone has never had TDAP (came out in 2005) then they should have a one time dose of TDAP and then continue with Td boosters. Pneumococcal vaccine - ANSWER-PCV 23 given one time at age 65 yo in healthy adults and for persons who are 2 years and older and at high risk for pneumococcal disease (e.g., those with sickle cell disease, HIV infection, or other immunocompromising conditions). PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma. One time booster given 5 years after first dose (So non-healthy pts will receive 2 doses of PSV23 over their lifetime). PCV 13 is for <5 yo. When both PCV13 and PPSV23 are indicated, PCV13 should be administered first; PCV13 and PPSV23 should not be administered during the same visit. When indicated, PCV13 and PPSV23 should be administered to adults whose pneumococcal vaccination history is incomplete or unknown. Varicella Vaccine - ANSWER-60 yo. May be given to pts who have previously had shingles. May be given earlier at age 50yo. Live virus so c/I include pregnancy and immunocompromised. Chapter 5 (EENT) - ANSWER- Herpes Keratitis - ANSWER-Inflammation of the cornea. C/O abrupt severe eye pain, photophobia and blurred vision. Diagnose with fluorescein dye and black lamp. Look for fernlike lines (corneal abrasions appear more linear). Infection permanently damages corneal epithelium which may result in blindness. Acute angle closure - ANSWER-Glaucoma (Increased ICP r/t blocked drainage duct). Elderly pt c/o abrupt onset of severe eye pain, HA, N/V, halos around eyes, and decreased vision. Exam reveals mid-dilated pupil that is oval shaped, cloudy cornea, and fundoscopic exam shows cupping of the optic nerve. Tx = keep pt supine, trx to ED for acetazolamide, B blockers, and topical steroids. Sx may be required Cholesteatoma - ANSWER-Cauliflower like growth in the middle ear. Pt c/o foul smelling discharge and hearing loss. On exam, no TM or ossicles visible. PMhx of chronic OM. The mass is not cancerous but it can erode in to the bones of the face and damage CN7. Tx = ENT referral for sx, abx. Mass is usually made of epithelium and cholesterol. AKA pearl tumor. Battle's sign - ANSWER-Bruise behind the ear over the mastoid process. Hx of trauma, and indicates a fracture of the basilar skull. Golden serous discharge from ear or nose. Refer to ED for abx and imaging (CSF will be + for glucose. Mucous will be - for glucose). Cavernous sinus thrombosis - ANSWER-Blood clot in w/I cavernous sinus. This cavity houses internal carotid artery and CN III, IV, V and VI). PmHx of sinus or facial infection. Pt c/o severe HA, high fever, decreased LOC, unilateral periorbital edema, photophobia, proptosis and inability to move eye appropriately. Peritonsillar abcess - ANSWER-Pt c/o severe sore throat, difficult and painful swallowing (odonophagia) and LOCKJAW (trimus), and a hot potato voice. Unilateral swelling peritonsillar area and soft palate with displaced uvula. Tx = I&D in ED or needle aspiration Diptheria - ANSWER-Bull neck, dysphagia, and gray/yellow psuedomembrane that is not to displace (stuff is like concrete) and may obstruct airway Geographic tongue - ANSWER-Benign finding Torus Palatinus - ANSWER-Painless bony protuberance on hard palate that is benign Fishtail uvula - ANSWER-Split uvula is usually benign (rarely a sign of cleft palate) Nystagmus - ANSWER-Vertical nystagmus is always abnormal. Horizontal nystagmus that occurs on prolonged lateral gaze and resolves when eye moves toward midline is benign Papilledema - ANSWER-Optic disc swollen w blurred edges r/t increased ICP (most commonly from bleeding, brain tumor, abscess or pseudo tumor cerebri). HTN Retinopathy includes - ANSWER-result from damage and adaptive changes in the arterial and arteriolar circulation in response to the high blood pressure such as Copper/silver arterioles, av nicking, blot/flame hemorrhages, cotton wool spots, hard exudates and papilledema Copper/silver arterioles - ANSWER-Indicates sclerosis and hyalinization of the arterioles. Silver is worse than copper. Diabetic Retinopathy - ANSWER-Microaneurysms caused by new fragile arteries in the retina. Examples see cotton wool spots, flame hemorrhages and dot-blot hemorrhages. Cataracts - ANSWER-Opacity of cornea Koplik's spots - ANSWER-Small sized red papules w/ blue white centers inside the cheeks by the lower molars. They are the prodromic viral enathem of measles (Rubeola) Hairy Leukoplakia - ANSWER-Pathognomic for Epstein barr virus in immunocompromised pts Sjogren's syndrome - ANSWER-Chronic autoimmune disorder characterized by decreased function of lacrimal and salivary glands. Pt c/o dry eyes/mouth for > 3 months and/or gritty eyes. OTC eye drops and refer to ophthalmology and rheumatologist Blepharitis - ANSWER-Chronic condition. Base of eyelids are inflamed. Ithcy/irritation with some crusting. Tx is johnson's baby shampoo and may need erythromycin optho ointment Epitaxis - ANSWER-Posterior nasal bleeds can result in severe hemorrhage. Tx for anterior bleeds is tilt head forward and apply pressure over nasal bridge. Afrin nasal spray can be helpful. Strep throat - - ANSWER-Beta hemolytic streptococcus group A. Classic triad is no cough, sore throat, and enlarged cervical anterior lymph nodes. Possible fever, petechiae on hard palate. Tx = C&S or rapid strep test. PCN x 10 days. PCN alternative are Zpak or Levaquin (for pts >18yo). Sequalae includes scarlet fever, rheumatic fever and peritonsillar abscess. AOM - ANSWER-Common organisms are streptococcus pneumoniae (gram +), haemophilus influenza (gram - ), Moraxella catarrhalis (gram - ). Weber has lateralization to affected ear. Decreased mobility (flat trace line on typanogram). Tx = amoxicillin (80mcg/kg/day for peds and 500-875mg/day BID for adults). 2nd line agents are Augmentin, Ceflin and Cefzil. PCN alternatives include Macrolides, Bactrim or Levaquin. Bullous myringitis - ANSWER-AOM with blisters (bulla) on TM. Hordeolum (aka stye) - ANSWER-Acute bacterial infection of a hair follicle on the eyelid. Pt c/o itching w painful pustule. Tx abx and warm compress (Remember Horders live in a pig stye) Chalazion - ANSWER-Chronic inflammation of the meibomian gland (aka sweat gland of the eyelid). Gradual onset of superficial nodule which is non tender. Tx if nodule does not self resolves than refer for sx. Pinguecula - ANSWER-Yellow triangular thickening of the bulbar conjunctiva caused by UV light damage (Penguins no volar far from the bulbar) Pterygium - ANSWER-Same as pinguecula but it extends on the nasal and temporal cornea. Tx for both include weak steroids, sunglasses and sx (pterodactyl extend their wings) Subconjunctival hemorrhage - ANSWER-Blood is trapped underneath the conjunctiva and sclera second to broken arterioles from coughing, sneezing, heavy lifting and vomiting. Self limiting. Resolves in 1 to 3 weeks Primary open angle glaucoma - ANSWER-Most common type. R/t blockage of the aqueous humor inside of the eye. Gradual onset. CN2 undergoes ischemic changes and permanent damage occurs. Pt c/o peripheral vision loss and then central vision loss. Anterior uveitis - ANSWER-(iritis) Pt c/o red sore eyes w/o purulent discharge. Higher prevelance in autoimmune disorders (RA, lupus, ankylosing spondylitis), sarcoidosis, and syphilis. Ciliary flushing. Age-related macular degeneration (AMD) - ANSWER-Caused from gradual damage to the pigment of the macula Typical pt = elderly smoker. Pt c/o gradual or sudden onset of central vision loss. Straight lines may appear distorted. Peripheral vision in intact. Otitis externa - ANSWER-Common organisms = pseudomonas aeruginosa, staphylococcus aureus. Otolagia with tragus manipulation. Tx = corticosporin otic suspension QID X7 days. Prophylaxis is ETOH and vinegar Infectious mononuoleosis - ANSWER-Epstien Barr Virus. Peak age is 15-24 yo. Classic triad is fatigue, acute pharyngitis, and lymphadenopathy (esp posterior cervical nodes). Abdominal pain may be r/t hepatomegaly/spenomegaly. CBC may reveal lymphocytosis (>50%). Monospot (aka heterophile antibody test) will be + (if initially negative but symptoms walk and talk like mono then repeat in 2 weeks b/c first test may have been too soon for antibodies to peak). Tx US abdomen, no contact sports or heavy lifting until oregonmegaly resolves (about 4 weeks after symptoms start. Repeat US needed to prove resolution of organomegaly. Chapter 6 - ANSWER- Rocky mountain spotted fever - ANSWER-Abrupt onset of high fever (103-105F), HA, myalgias, conjunctival injection, n/v, arthralgia and petechiae on day 3 on symptoms (so will look a lot like a high fever flu until the spots come on day 3). Petechiae erupt on hands and feet and move toward trunk. Tick born illness from Rickettsia rickettsia. Tx = Doxy, draw anitbodies, and biopsy skin lesion. RMSF is most common NOT in the Rockies (60% of cases are in TN,NC,AR,MO and OK) and occur in the spring and early summer Actinic keratosis - ANSWER-Precancerous lesion of squamous cell carcinoma Meningococcemia - ANSWER-Bacterium Nesseria meningitides results in sepsis (very deadly). Abrupt onset of petechiae or hemorrhagic rash in axilla, flanks, wrist and ankles. Tx = IV abx, lumbar puncture, C&S, CT/MRI of brain, Rifamin prophylaxis for close contacts Erythema migrans - ANSWER-Tick born illness from Borrelia burgdorferi. Creates classic "bulls eye rash" ( Rember "BB" (Borrelia burgdoferi) for target practice) which appears 3 - 30 days after deer tick bite. Rash is hot t touch, has a rough texture, and is commonly found in the belt-line, axillary area, behind knees and in groin. Flu-like symptoms. Tx = Doxy. Alts = amox and cefuroxime. Draw serum antibodies. Most common in the northeast and great lakes Shingles infection of the trigeminal nerve - ANSWER-Threatens vision. Ractivation of the herpes zoster virus on the ophthalmic branch of CN5. Melanoma - ANSWER-Can occur anywhere including retina or nailbeds (very aggressive usually). Risk factors are blistering sun burns as a kid, family history in 10% of cases, increasing # of nevi, and fairskin/light eyed. Basal cell carcinoma - ANSWER-Pearly/waxy skin lesion w/ atrophic or ulcerated center with will not heal Acral lentiginous melanoma - ANSWER-Most common type of melanoma in AA and Asians. Dark brown/black lesions are found on nailbeds, palms, and plantar surfaces. Steven Johnson Syndrome - ANSWER-Lesions start as a bulls eye. HIV pts have a 40 fold increased risk of SJS to Bactrim Psoriasis - ANSWER-Squamous epithelial cells undergo rapid mitiotic division and abnormal maturation which creates a classic silvery plaque on extensor surfaces (such as scalp, back of elbows/knees, sacrum and intergluteal folds. Koebner phenomenon = new plaque in areas of skin trauma. Ausptiz's sign = pinpoint areas of bleeding when plaque is removed. Acute cellulitis - ANSWER-Infection of the deep dermis. Usually caused by gram +. Purulent cellulitis is usually S. aureus. Nonpurulent is usually streptococci. Dog/cat bites = Pasteurella multicoda (gram negative) Erysipelas is group B strep. Tx = Non MRSA non purulent dicloxacillin, Keflex or Clindamycin. Give Td booster if last vaccine was > 5 years ago. Recurrent cellulitis consider mupirocin to nares or declonization. Clenched fist injuries - ANSWER-High risk of infection to joints/bones/fascia etc. Refer to ED Bite injuries - ANSWER-AugmentinX10days (PCN alt = clindamycin + fluoroquinolone). C&S all wounds. Do not suture. Refer any cartilage injuries (cartilage does not grow back). Td booster is last one was > 5 years ago. Rabies vaccine may be needed. F/U w/I 24-48 hrs. What wounds should be referred? - ANSWER-Closed fist injuries, cartilage damage, cosmetic damage, compromised hosts Hidradenitis suppurativa - ANSWER-Bacterial infection of the sebaceous glands in the axila or groin. Most commonly s. aureus. Can be chronic which results in heavy scarring and sinus tracts. Tx = C&S, augmentin, dicloxacillin. Mupirocin ointment to nares and fingernails BIDx2 weeks. Abx soap and no deodorant Impetigo - ANSWER-Gram + strep pyogenes or s. aureus. Bullous and non bullous Classic sign = honey colored crusts. Tx = C&S wound. Keflex or dicloxacillin. PCN alt = Macrolides Varicella Zoster - ANSWER-Gold standard = viral culture (PCR to ZDV). Aclyclovir = tx Post herpetic neuralgia - ANSWER-Most common in elderly and immunocompromised. Tx with TCA (low dose), anticonvulsants (Depakote, gapapentin) and lidocaine. Paronychia - ANSWER-Infection of the culticle caused by S. aureus strep or pseudomonas. Chronic cases are associated w co- existing onychomycosis Pityriasis Rosea - ANSWER-Herald patch appears 2 weeks before full break out. Oval salmon color pruritic lesion with fine scale follow skin folds (or Christmas tree pattern). Self limiting in about 4 weeks. If high risk of STDs then r/o syphilis (use RPR). Tinea infections - ANSWER-(Dermatophytoses) Gold standard is KOH slide for psuedohyphae and spores. Tx is -azoles and allymines. For tinea capitis and tinea pedis oral tx (griseofulvin)is required for 6 - 12 weeks. Monitor Lfts during tx and teach pts to stay away from other hepatotoxic substances like tylenol, ETOH, statins. Acne vulgaris - ANSWER-Step up tx. Mild (some open/cold comedones and small pustules) requires TOPICAL tx (Retinol, macrolide cream or benzoyl peroxide). Moderate acne (larger pustules and more frequent) require oral abx (Doxy - tetracyclines can be given to >13yo) or OCP. Severe acne (cystic acne) refer to derm for Accutane Rosacea - ANSWER-No cure. Tx symptoms. Chronic small acne around nose, mouth and chin. Many have ocular symptoms like dry eyes and blepharitis. Tx = Metronidazole gel, azelaic acid and low dose doxy. Sequalae can be hyperplasia of tissue on nose and cheeks Chapter 7 Cardiac - ANSWER- CHF symptoms - ANSWER-Acute or gradual onset or dyspnea, fatigue, dry cough, edema in extremities, weight gain, bibasilar crackles and S3 Bacterial endocarditis - ANSWER-Flu-like symptoms. New onset murmur and abrupt onset of CHF symptoms. Subungual hemorrhages (under the nail splinter hemorrhage), petechiae on palate, painful violet colored nodules on fingers and feet (Osler's nodes), and tender red spots on palms/feet (Janeway lesions).Elevated CBC and sed rate (>20mm/hr). Tx IV abx, pan cultures Bacterial endocarditis prophylaxis - ANSWER-No longer recommended for MVP or GI/GU incisions (unless existing infection such as an UTI before cystoscopy). Give endocarditis prophylaxsis to pts w/ hx of bacterial endocarditis, prosthetic valves, some congenital heart disease and heart transplant. Basically bacterial endocarditis is a gram + (vividans strep and S. aureus most commonly) and you basically gotta protect against their "home turf." Amoxicillin 2 g PO and 50mg/kg/day for Peds S1 (Systole) - ANSWER-Lub of "Lub-dub." Closure or AV valves (mitral and tricuspid). S2 (Diastole) - ANSWER-Dub of "Lub-dub." Closure of aortic and pulmonic valves (aka semilunar valves). S3 - ANSWER-Pathognomic for CHF occurs in early diastole (S1,S2,S3). AKA as ventricular gallop or S3 gallop. Sounds like "SLOSH-ing-in" or "KEN-tuck-y." Maybe a normal variant in kids/younger adults if there are no s/s of heart/valve disease. Always abnormal in >35yo. Fluid overload forces ventricle to dilate abnormally. Best heard w/ Bell in L lateral recumbent position over apex. S4 - ANSWER-Stiff left ventricle and usually indicates LVH. Maybe a normal variant in some elderly pts if there are no other s/s of heart/valve disease. S4 occurs during late diastole (S4,S1,S2). AKA atrial gallop or extra atrial kick. Sounds like "a-STIFF-wall" or "ten-NES-see." Best heard in L lateral recumbent position over apex. Summation gallop - ANSWER-All heart sounds (S1,S2,S3,S4) are present. Very loud diastolic gallop. Always pathologic. Benign split - ANSWER-S2 normal finding if it appears during inspiration and disappears during expiration. Splitting of the aortic and pulmonic valves. Best heard over the pulmonic area. Ausculatory areas (Precordial points) - ANSWER-Aortic = 2ICS RSB, Pulmonic=@2ICS LSB, Erb's point = 3ICS LSB, Tricupsid=4ICS LSB, Mitral=5ICS MCL, Epigastic = Midline under xiphoid process. Systolic murmurs - ANSWER-MR. Peyton Manning AS MVP. S1 is louder than S2. Mitral regurgitation radiates to axilla and aortic stenosis radiates to neck. Diastolic murmurs - ANSWER-ARMS. Always pathologic. Grade 1 Murmur - ANSWER-Soft murmur that can only be heard in optimal conditions (may be intermittent) Grade 2 Murmur - ANSWER-Mild to moderate Grade 3 Murmur - ANSWER-Loud murmur (easily heard when stethoscope is placed on chest) Grade 4 Murmur - ANSWER-Feel a thrill (Four is Feel) with loud murmur Grade 5 Murmur - ANSWER-Thrill & loud murmur that can be heard w edge of stethoscope off chest Grade 6 Murmur - ANSWER-Thrill is easily palpated. Heard w/ no stethoscope. When does afib require anticoagulation? - ANSWER-CHADS2 score > 2 requires anticoagulation. What does CHADS2 stand for? - ANSWER-C=CHF, H=HTN, A=age>75yo, D=diabetes, S2 (stroke or TIA) INR range for afib - ANSWER-INR 2.0- 3.0 Afib diagnostic test - ANSWER-EKG Afib tx - ANSWER-Correct baseline irritants (electrolytes, thyroid, caffeine or drugs). Warfarin or others for anticoagulation, CCB, B blockers, or digoxin for rate control. Amiodarone as antiarrhythmic. Consistent one serving/day of high vitamin K foods. Paroxysmal atrial tachycardia(PAT or PVST) - ANSWER-Usually has underlying cause like digoxin toxicity, ETOH, increased TSH, caffeine or illicit drugs. 150-250 bpm. P wave with peaked QRS. Tx= Valsalva (hold breath, ice water, carotid massage), then rate control (amio or BB) and then cardioversion Pulsus Paradoxus - ANSWER-Apical pulse can be heard but radial pulse can not be felt. Pulmonary or cardiac condition compress the chambers of the heart (creates impaired diastolic filling). Decreased systolic pressures of >10mmHg during inspiration. How to diagnose pulsus paradoxus - ANSWER-Listen for S1 Korotkoff sound and note when it disappears only during inspiration but is present during expiration. Then listen for S1 korotkoff sound is present in both inspiration and expiration. If the difference is >10mmHg then suspect cardiac tamponade, severe COPD, or constrictive pericarditis. [Show Less]
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LEIK FNP Professional Issues Review Exam with Complete Solutions
Beneficence - ANSWER-The obligation to help the patient. Remove harm, prevent harm, promote good. ("do no harm"). Acting in the patient's best interest. Co... [Show More] mpassionate patient care. What ethical principle Educating an obese patient on the harmful effects of obesity and recommending weight loss. - ANSWER-Beneficence What ethical principle Encouraging a patient to stop smoking and enroll in smoking cessation programs. - ANSWER-Beneficence What ethical principle : Calling the surgeon to get a prescription for stronger pain med - ANSWER-Beneficence Nonmaleficence - ANSWER-Nonmaleficence The obligation to avoid harm. Protecting a patient from harm. What ethical principle A new nurse practitioner (NP) is told to suture a laceration on a patient's face. The NP tells the physician that she has not been trained to suture facial area lacerations and therefore is unable to do it. - ANSWER-Nonmaleficence What ethical principle The NP discusses a new anticancer drug that may be more effective in treating a patient's cancer. The NP discusses the known risk versus the benefits of the new drug. The patient declines the treatment - ANSWER-Nonmaleficence Utilitarianism - ANSWER-The outcome of the action is what matters with utilitarianism. It also means to use a resource for the benefit of most (e.g., tax money). It may resemble justice, but it is not the same concept (see below). What ethical principle The Women, Infants, and Children food (WIC) program - ANSWER-Not only for pregnancy and children. It is not open to adults and elderly males. The reason may be that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (affects the brain growth, etc.). Justice - ANSWER-The lack of bias. The right to fair and equitable treatment. The fair and equitable distribution of societal resources. What ethical principle Low-income individuals do not pay some types of taxes to the government, but they still have equal access to the postal service and other public services that are supported by taxes. - ANSWER-Justice What ethical principle A homeless alcoholic male without health insurance presents to the ED for abdominal pain. The patient is triaged and treated in the same manner as the other patients who have health insurance. - ANSWER-Justice Dignity - ANSWER-Respect for human dignity is an important aspect of medical ethics. A person's religious, personal, and cultural beliefs can influence greatly what a person considers "dignified" treatmaent. What with all principle : Hospital gowns should be secured correctly so that when patients get up to walk with their backs not visible - ANSWER-Dignity Fidelity - ANSWER-Dedication and loyalty to one's patients. Keeping one's promise. What ethical principle Example: A woman with terminal breast cancer does not want the NP to reveal her poor prognosis to her mother. The patient explains to the NP that her mother is very anxious and she wants to wait until the next week before she tells her mother news. If the NP keeps the prognosis in confidence from the patient's mother, she is exercising the concept of fidelity. - ANSWER-Fidelity Confidentiality - ANSWER-Confidentiality The obligation to protect the patient's identity, personal information, test results, and medical records. What ethical principle This "right" is also protected by the Health Insurance Portability and Accountability Act (HIPAA) (release of patient information for electronic billing purposes). - ANSWER-Confidentiality What ethical principle Psychiatric and mental health medical records are protected information and require separate consent. - ANSWER-Confidentiality Paternalism - ANSWER-Making decisions for a patient (or for others) because you "believe" that it is for their best interest. The opinion (or desires) of the patient is minimized or ignored. The patient is "powerless." What ethical principle Example: A 92-year-old male does not want to be on a ventilator if he codes. The son disagrees and quietly tells the NP and physician that he wants this father to be aggressively treated with life support, if it is necessary. - ANSWER-Paternalism Autonomy - ANSWER-Mentally competent adult patients have the right to make their own health decisions and express treatment preferences. If the patient is mentally incapacitated (dementia, coma), the designated surrogate's choices are respected. A patient can decline or refuse treatment. What ethical principle Examples: An alert elderly female with periods of forgetfulness and who has breast cancer decides to have a mastectomy after discussing the treatment options with her oncologist. The woman's daughter tells the NP that she does not want her mother to have a mastectomy because she thinks her mother is too old and confused. The NP has the duty to respect the patient's forgetfulness and who has breast cancer decides to have a mastectomy after discussing the treatment options with her oncologist. - ANSWER-Autonomy Accountability - ANSWER-Health care providers are responsible for their own choices and actions and do not blame others for their mistakes. Veracity - ANSWER-The duty to present information honestly and truthfully. What ethical principle Example: An elderly woman is recently diagnosed with advanced pancreatic cancer. The patient thinks that she has a very good chance of being cured. The oncologist explains to the patient her poor prognosis. The oncologist is being truthful and honest to the patient about her prognosis. - ANSWER-Veracity American Nurses Association (ANA) Code of Ethics for Nurses - ANSWER-The ANA Code of Ethics for Nurses with Interpretive Statements (2001) contains "the goals, values and ethical precepts that direct the profession of nursing." According to the ANA, the Code "is nonnegotiable." Each nurse "has an obligation to uphold and adhere to the code of ethics." Ombudsman - ANSWER-A person who acts as an intermediary (or as a liaison) between the patient and an organization (long-term care or nursing homes, hospitals, governmental agencies, courts). The ombudsman represents the patient and works in the best interests of the patient. Guardian ad litem - ANSWER-A court-appointed guardian who is assigned by a court (and has the legal authority) to act in the best interest of the "ward." The ward is usually a person who is a child, frail, or vulnerable. Living will - ANSWER-Living Will A document that contains the patient's instructions and preferences regarding health care if the patient becomes seriously ill or is dying. It contains the patient's preferences (or not) for aggressive life-support measures. Health care providers should have a copy of the document in the patient's chart. Durable power of attorney - ANSWER-The patient designates a person (family member or a close friend) who has the legal authority to make future health care decisions for the patient in the event that the patient becomes mentally incompetent or incapacitated (i.e., comatose). Power of attorney - ANSWER-A person who is designated by the patient, and who has the legal authority to make decisions for the patient. This role is broader and encompasses not only health care decisions but also other areas of the patient's life, such as financial affairs. Accountability Act (HIPAA) * Also known as the "HIPAA Privacy Rule" - ANSWER-The law was passed by the U.S. Congress and enacted in August, 1996. The law provides protections for: "the use and disclosure of individuals' health information"—called "protected health information" by organizations subject to the Privacy Rule—called "covered entities." Covered entities - ANSWER-Any health care provider, health insurance company, health care plans, and third-party administrators (TPAs) who "electronically transmit health information" must follow the HIPAA regulations. TPA - ANSWER-third-party administrator is the organization that does the processing of claims and administrative work for another company (health insurer, health plans, retirement plans). HIPPA - ANSWER-Health providers are required to provide each patient with a copy of their office's HIPAA policy (patient to sign the form). The HIPAA form must be reviewed and signed annually by the patient. Patients have the right to review their medical files. A mental health provider has the right to refuse patients' requests to view their psychiatric and mental health records. When patients request to review their medical records, the health provider has up to 30 days to comply. Patients are allowed (under HIPAA) to correct errors in their medical records. Must keep identifying information (name, DOB, address, Social Security number) and any diagnosis/disease or health concerns private except with allowed exceptions (see list below). When is consent not needed - ANSWER-The health plan/insurance company that is paying for the medical care. A third party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor's office hires to assist in payment of their services (e.g., medical billing services). Health care operations (medical services review, sale of health care plan, audits). Collection agency for unpaid bills. Victims of abuse/neglect or domestic violence. No separate consent is needed to consult with other health care providers. Claim based policy - ANSWER-A claim is filed in court against an NP in January 2011 for an incident that occurred in January 2009. The NP remains enrolled with the same malpractice insurance company. Therefore, the claim will be covered. But if the NP has changed jobs or is retired (and does not carry tail coverage), the claim will not be covered even if the NP was insured at that time. What is "tail" insurance or "tail coverage"? When an NP with claims-based malpractice insurance retires or changes to a new job, it is advisable to buy "tail" coverage insurance. The tail coverage insurance will cover the NP for malpractice claims that may be filed against him or her in the future. Occurrence - ANSWER-This type of malpractice policy is not affected by job changes or retirement. When a claim is filed against the NP in the future, it is covered if he or she had an occurrence-based policy at the time the incident occurred. What type of malpractice [Show Less]
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