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APEA 3P EXAM PREP1–WOMEN’S HEALTH WITH VERIFIED QUESTIONS AND ANSWERS WITH RATIONALE
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APEA 3P EXAM PREP1–WOMEN’S HEALTH WITH VERIFIED QUESTIONS AND ANSWERS WITH RATIONALE
APEA 3P EXAM PREP1–WOMEN’S HEALTH WITH VERIFIED QUESTIONS AND ANSWERS WITH RATIONALE A 16-year-old female is diagnosed with primary dysmenorrhea. Sh... [Show More] e has taken over-the-counter ibuprofen in 800-mg increments every 8 hours during menses for the past 3 months, with minimal relief of symptoms. What intervention will provide greatest relief of dysmenorrhea symptoms? Flurbiprofen during menses Combined oral contraceptives Daily multivitamin with B12 supplementation 30 minutes of regular exercise daily B. NSAIDs and hormonal contraceptives represent the mainstay of pharmacologic treatment for dysmenorrhea. NSAIDs produce an 80-86% response rate when used for dysmenorrhea. The general recommendation is that when one agent (NSAIDs or hormonal contraceptives) does not produce relief of symptoms, the other agent should be tried. Hence, the best choice is oral contraceptives. Both agents should be considered for women who are symptomatic with one agent only. A 22-year-old female states that she has multiple sexual partners and inconsistently uses barrier protection. Which form of birth control should the nurse practitioner avoid prescribing in this patient? Intrauterine device Progestin-only pill Diaphragm Oral contraceptives A. Multiple sexual partners place the patient at increased risk for infection with sexually transmitted diseases. The patient is at very high risk of developing pelvic inflammatory disease (PID) when there is an implanted foreign body. An example of this is an intrauterine device (IUD). The risk is also increased with a diaphragm, but, because it is not implanted for long periods at a time, the risk of PID is less than with an IUD. Three of the following interventions are appropriately used to prevent osteoporosis after menopause. Which one is NOT? Avoidance of corticosteroids Performance of weight-bearing activities for 40 mins at least 5 days/week Estrogen replacement therapy Adequate calcium & vitamin D intake C. Prevention of osteoporosis may be optimized by elimination of risk factors and engaging in interventions that maximize bone density. Good nutrition from infancy throughout adulthood is a major component of good bone health. Others include engaging in weight-bearing exercises, adequate intake of calcium and vitamin D, smoking cessation, limiting alcohol consumption to moderate amounts, and avoidance when possible of medications that may decrease bone density (corticosteroids, anticonvulsants). Osteoporosis occurs at accelerated rates in women who are post-menopausal. The lack of estrogen can produce rapid bone loss due to bone resorption. Estrogen replacement is not used to prevent or treat osteoporosis. A patient who is scheduled for pelvic exam with PAP smear should be advised to avoid douching, sexual intercourse, and tampon use before her exam. For how long should she be advised to avoid these activities for optimal evaluation? 24 hours 48 hours 36 hours 1 week B. The general recommendation is to avoid these activities and any vaginal medication for 48 hours prior to the PAP smear. Douching and tampon use can remove superficial cells, which are the ones collected and used as representative samples on PAP smear. Sexual intercourse should be avoided because there can be specimen contamination by the male partner. With vaginal medications or creams, either can serve as a barrier to epithelial cell sampling. When collecting cervical cells for a PAP smear, when are the endocervical cells typically collected? After the ectocervical specimen with a broom After the ectocervical specimen with a brush Before the ectocervical specimen with a broom Before the ectocervical specimen with a brush B. Ectocervical specimens are collected first to minimize any bleeding that can occur when the endocervical cells are sampled. The brush is considered a superior tool for the collection of endocervical specimens because it produces the highest yield of endocervical cells, and thus, is a good reflection of the health of the cervix. Alternatively, a cervical broom can be used to collect endocervical cells and ectocervical cells simultaneously. It is rotated for 5 turns before the samples are placed on the slide. This may be used in pregnant women. The first step in evaluating a breast lump is: history and physical exam. mammogram. ultrasound. Incorrect MRI. A. Although most patients will need further work-up of a breast mass, historical information is critically important in directing the health care provider to the next step. Historical information that should be ascertained is the location of the lump, how and when it was first noticed, whether there is nipple discharge, and whether it changes in size related to menses. Other historical information is the patient’s personal and family history of breast cancer and/or history of breast biopsies. A patient who takes oral contraceptive pills is at increased risk of: gallbladder disease. depression. hypothyroidism. varicose veins. A. One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease should not take oral contraceptives (OC) since they will increase estrogen exposure and theoretically, formation of gallstones. Depression, hypothyroidism and varicose veins are not increased by use of oral contraceptives. A 14-year-old female has never menstruated. She and her mother are concerned. What is most important for the NP to assess? Stature Tanner stage Anemia Family history of amenorrhea B. Tanner staging, or sexual maturity ratings, are predictable changes that occur with puberty. These should be assessed. In females, breasts and pubic hair signify specific pubertal changes that constitute maturation. These are not age specific, but at 14 years, a Tanner Stage 3 or more would be characteristic of expected maturation. Menses should follow soon. After a vaginal exam, a patient received a prescription for metronidazole 500 mg twice daily for 7 days. What was her likely diagnosis? Bacterial vaginosis Syphilis Chlamydia Gonorrhea A. Bacterial vaginosis can be treated with metronidazole orally. The most effective dose is 500 mg twice daily for 7 days. This is generally well tolerated as long as the patient avoids alcohol. Alcohol in the presence of metronidazole can produce a disulfiram reaction. Another medication used to treat bacterial vaginosis is tinidazole. It may provide more effective coverage if metronidazole fails because it has a longer half-life. A 54-year-old female presents with a small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. What diagnosis is least likely? Endometrial carcinoma Ovarian cancer Endometrial hyperplasia Uterine polyps B. Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others. Postmenopausal bleeding (PMB) is an uncommon presentation of ovarian cancer, but can present this way. In women with PMB, likely causes of uterine pathology should be evaluated before considering ovarian pathology. In early menopause, the most common etiology is atrophy of the endometrium or vaginal mucosa. This patient has been postmenopausal for approximately 2 years. Other common causes of PMB are polyps, fibroids, and endometrial hyperplasia. Athletic amenorrhea increases the risk of: osteoporosis. an eating disorder. covert hypothyroidism. breast cancer. A. Athletic amenorrhea is a secondary cause of amenorrhea that is observed in females who engage in excessive amounts of exercise. Excessive exercise can produce significant loss of body fat. Since estrogen is produced by the body’s fat tissue, there is a subsequent loss in the ability to produce adequate amounts of estrogen. When this occurs, infertility, vaginal and breast atrophy, and osteopenia are very likely. [Show Less]
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APEA 3P EXAM PREP2 –SEXUAL HEALTH WITH RATIONALE
APEA 3P EXAM PREP2 –SEXUAL HEALTH WITH RATIONALE A 24-year-old female presents with abdominal pain. What additional finding supports a diagnosis of p... [Show More] elvic inflammatory disease (PID)? Dysuria Vaginal discharge Positive RPR Cervical motion tenderness - D. PID is difficult to diagnose and often goes unrecognized because of the varied presenting signs and symptoms in women who have it. Delay in diagnosis contributes to inflammatory sequelae in the upper reproductive tract. Consequently, PID is usually diagnosed on imprecise clinical findings. The CDC recommends that healthcare providers maintain a low threshold for diagnosis of PID. Presumptive treatment should be initiated in sexually active women if they are experiencing pelvic or low abdominal pain (without another identifiable source of illness), and if one or more of the following criteria are present on pelvic exam: cervical motion tenderness, uterine tenderness, or adnexal tenderness. A male patient presents with dysuria and penile discharge. He states that his female partner has an STD, but he is not sure which one. Which of these should be part of the differential? Bacterial vaginosis and trichomonas Chlamydia and gonorrhea HIV and herpes Syphilis and chlamydia - B. Bacterial vaginosis and HIV are not associated with dysuria or penile discharge in male patients. Herpes produces lesions that are painful. HIV is not specifically associated with dysuria. Syphilis produces a painless lesion. Chlamydia and gonorrhea are usually associated with dysuria and discharge. Trichomonas is often asymptomatic in males, but can produce dysuria. A patient being treated for trichomoniasis receives a prescription for metronidazole. What instructions should she be given? Take this medication with food Do not take this medication if you are pregnant Take this medication on an empty stomach Alcohol should be avoided when taking this medication - D. Metronidazole may be associated with a disulfiram reaction when mixed with alcohol. Advice that should be given to all patients who take metronidazole is to avoid alcohol entirely while this medication is being taken. Additionally, alcohol should be avoided for 24 hours after the last dose of medication. The disulfiram reaction is characterized by fever, abdominal pain, nausea, vomiting, and headache. This reaction is called the "Antabuse" reaction. The risk of HIV transmission is increased: when other STDs are present. in females. when patients are aware of their HIV status. in patients with diabetes. - A. There are several risk factors for HIV transmission. Viral load is likely the greatest risk factor. The presence of STDs increases the risk of HIV transmission. Specifically, the presence of chlamydia increases the risk of acquiring HIV by 5 times. Lack of circumcision increases the risk of transmission. A patient requests screening for HIV after a sexual exposure. What are CDC's recommendations for screening for this patient? There are no recommendations for screening. She should be screened today, with repeat screening at 4-6 weeks, and 3 months. She should be rescreened in 6-12 months She only requires screening if she develops symptoms of HIV - B. She does require further screening because a negative initial result does not insure that she is not infected. This signifies that she has not seroconverted at this time. The period within 3 months after exposure is termed the "window period" and a negative screen must be confirmed. If a 4th generation assay is used and the screen is negative 3 months after the last exposure, and there is no concern for coinfection with hepatitis C at the time of HIV exposure, she is considered to be negative. HIV screening should be performed in any patient who develops symptoms consistent with HIV after an exposure. A 27-year-old asymptomatic male presents with generalized lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following choices, what test should be performed? HIV test RPR Lymph node biopsy Sedimentation rate - A. During asymptomatic HIV infection, patients often have persistent generalized lymphadenopathy (PGL). PGL is defined as enlarged lymph nodes involving at least two noncontiguous sites other than inguinal nodes. The lymphatic tissue serves as a primary reservoir for HIV. Studies of lymph nodes in patients at the asymptomatic phase demonstrate high concentrations of HIV. A 23-year-old female who is homeless presents to the free clinic. She should be screened for: TB, HIV, and hepatitis. pregnancy, headaches, and STDs. urinary tract infection and STDs. diabetes, HIV, and neuropathy. - A. The most common diseases in the homeless population are not seen in the same proportion in the general population. These include hepatitis, HIV, STDs, pregnancy in females, TB, skin and foot problems, and late immunizations, especially tetanus. When given the opportunity, screenings and treatment should take place when appropriate. A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulval itching and discharge. He is asymptomatic. How should they be treated? She should receive metronidazole; he does not need treatment. They both should receive metronidazole. She should be treated with ceftriaxone; he should receive ciprofloxacin [Show Less]
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APEA 3P EXAM PREP3 –NEPHROLOGY WITH RATIONALE
APEA 3P EXAM PREP3 –NEPHROLOGY WITH RATIONALE A hea l thy 32-year-o l d female has le f t f l ank pa in and nausea. What is the most l i ke ly d iag... [Show More] nos is? Ur inary t rac t in fec t i on Rena l s tone Cholecys t i t i s Pye lonephr i t i s The most common presenta t ion o f acu te uncompl ica ted pye lonephr i t i s inc ludes fever , f lank pa in , and nausea and vomi t i ng. Somet imes pat ient s p resent w i th symptoms o f pe lv ic i nf lammatory d isease (PID) . In th is p resenta t ion , abdomina l pa in is common too . Fever is so s t rong ly cor re la ted wi th acute pye lonephr i t i s tha t i t i s unusua l not to have fever . Rena l s tone pa t ien ts may have th is presenta t ion , bu t fever is usua l ly NOT present . I t i s un l ikel y tha t cho lecys t i t i s wou ld present w i th le f t -s i ded f lank pa in . The ga l l b ladder is on the r igh t s ide o f the body. The inc idence o f pyel onephr i t i s i s : l eas t common in young adu l ts . l ess common than ur i nary t rac t in fec t ions . a lways assoc ia ted wi th u r inary t rac t in f ect ions . more l i ke ly in e lderl y ma les . The inc idence o f pyel onephr i t i s in the US is much less common than ur inary t rac t in fec t ions (UTI s ) . I t i s less l i kel y in males , bu t i s most common in females aged 15-29 years ; and even more common dur ing pregnancy. Fac tors assoc ia ted wi th pye l onephr i t i s a re f requent sexua l in te rcourse, UTI w i th in the l as t year , p resence of d iabetes , and presence o f s t ress incont inence wi th in the prev ious 30 days . A 79-year-o ld female pa t ien t w i th u r inary f requency is found to have a UTI . What med ica t ion cou l d produce ar rhy thmias in her? Doxycyc l ine Amoxic i l l in Cipro f loxac in Macrodant in Cipro f loxac in is a qu ino lone ant ib io t ic . A l l qu ino lones have the po ten t ia l to produce pro longat ion o f the QT in te rva l . I t shou ld be prescri bed wi th caut ion i n o lder adu l ts . Mrs. Jackson compla i ns o f u r inary inconti nence when she laughs or sneezes. What shou ld be used f i rs t l ine to t rea t her symptoms? Kege l exerc ises Prescr ibe oxybutyn in Avo id ca f fe ine and al coho l Min imize f lu ids a t nigh t t ime This pa t ien t has s t r ess incont inence. The f i rs t - l ine approach wi th these pat ien ts is to a t tempt to s t reng then the pe lv ic f loor musc les . Appropr ia te per formance o f Kege l exerc ises is key . Prescr ib ing an an t icho l inerg ic might worsen incont inence because i t w i l l cause ur inary re ten t ion . Avo id ing ca f fe ine and a lcoho l i s especi a l l y he lp fu l fo r peop le wi th u rge incont inence, bu t cou ld have a min imal benefi t fo r th is pa t ien t . However , th is does not address the under ly ing prob lem, weak pe lv ic musc les . Min imiz ing f lu ids at n igh t t ime wi l l he lp i f noc tur ia is a prob lem. A 76-year-o ld male presents w i th u re thral i r r i ta t i on a f te r vo id ing . I f sexua l ly t ransmi t ted d iseases and ur inary t rac t i nfec t ion are ru led out , what is another et io logy? Acute bac ter ia l p rosta t i t i s Chron ic p ros ta t i t i s Epid idymi t is Asymptomat ic bac ter i ur ia Chron ic p ros ta t i t i s can produce these symptoms. Somet imes thi s i s accompanied by per inea l pa in , but the pa t ien t may have a normal p ros ta te exam. Acute bacter ia l p ros ta t i t i s pa t ien ts w i l l p resent w i th fever , ch i l l s . Examinat ion o f the pros ta te g land r evea ls a tender , boggy pros ta te g land. Ep id idymi t is can produce scro ta l pa in, no t dysur ia o r i r r i ta t ion wi th vo id ing. Asymptomat ic bacter iu r ia is asymptomat ic . These pa t ients don ’ t know they have th is because they have no symptoms . A 25-year-o ld male pat ien t w i th subacute bac ter ia l ep id idymit i s shou ld be t rea ted in i t ia l l y w i th an ora l qu ino lone doxycyc l ine . NSAIDs on ly . i ce and scro ta l suppor t . In a 25-year-o ld male wi th subacute bac t er ia l ep id idymi t is , the most l i ke ly organ ism is Ch lamyd ia. There fore , un t i l cu l tu res are back , he shou ld be t reated empi r ica l l y w i th doxycyc l ine 100 mg BID fo r 10 days . Qu ino lones shou ld spec i f i ca l l y be avo i ded i f the suspec ted agent is gonor rhea because o f r i s ing res is tance. NSAIDs, i ce , and scro ta l suppor t w i l l he lp the pat ien t ’s symptoms but no t t rea t the under ly ing cause. A 73-year-o ld male pat ien t repor ts tha t he is exper ienc ing a weakened ur inary s t ream, u r inary f requency, and urgency. He is wak ing up once o r tw ice n igh t ly to u r ina te . How shoul d the nurse prac t i t i oner p roceed? Dig i ta l rec ta l exam (DRE) on ly DRE, ur ina lys is , PSA PSA on ly PSA, DRE, BUN, Cr Many tes ts can be used to eva lua te an o l der pa t ien t w i th suspected ben ign pros ta t ic hyper t rophy (BPH) . The va lue of d ig i ta l rec ta l exam (DRE) is to eva lua te the s ize , cons is tency and assess fo r ma l ignancy o f the pros ta te g land. Ur ina lys is is done t o de tec t b lood or infec t ion , bu t hematuri a i s common in pat ien ts w i th BPH. The pros ta te spec i f i c an t igen (PSA) is done as a screen ing tes t fo r p ros ta te cancer in symptomat ic men. Th is pa t ien t has mul t ip le symptoms which cou ld ind ica te pa tho logy in the prosta te g land as the et io logy o f h is symptoms (weakened ur inary s t ream, ur inary f requency and urgency, and noctur ia ) . A serum crea t in ine can be part o f the in i t ia l sc r een ing . Th is wou ld he lp iden t i f y b ladder ou t le t obs t ruc t ion, rena l , o r p re - renal d isease. A b lood urea n i t rogen (BUN) i s no t necessary to eva lua te th is pa t ient ' s symptoms. Cipro f loxac in g iven to t rea t a u r inary t rac t in fec t ion wou ld be cont ra ind ica ted i n a : pregnant pa t ien t . 19-year-o ld female . pat ien t w i th hyper tens ion . pat ien t w i th pye lonephr i t i s . Cipro f loxac in is a qu ino lone ant ib io t ic and is cont ra ind ica t ed in pa t ien ts who are pregnant o r younger than 18 years o l d because o f po ten t i a l p rob lems wi th bone and car t i lage f ormat ion . There is no cont ra ind ica t ion i n a pa t ien t w i th hyper tens ion . A qu ino lone might be a good cho ice in a pa t ient w i th pye lonephr i t i s and wou ld no t be cont ra ind ica ted . An example o f a d rug tha t ta rgets the ren in -ang io tens in -a ldos terone sys tem is a(n) : ACE inh ib i to r . beta b locker . ca lc ium channe l b locker . d iure t ic . Examples o f d rugs that ta rget the ren in - ang io tens in -a ldos terone sys tem are ang io tens in -conver t i ng enzyme (ACE) inh i b i to rs and ang io tensi n receptor b lockers (ARBs) . These drugs are par t icul a r l y benef ic ia l to pat ien ts w i th d iabet ic nephropathy because they may prevent and t rea t d iabet ic nephropathy . Addi t iona l ly , these agents lower b lood pressure , wh ich has been shown to be renopro tec t ive . Management o f g lucose leve ls and hyper tens ion is espec ia l l y impor tan t in p reventi ng d iabet ic nephropathy , bu t so is aggress ive management of hyper l ip idemia . Test icu la r to rs ion can produce: pen i le e ry thema. scro ta l edema. scro ta l e ry thema. pen i le edema. Test icu la r to rs ion i s an emergency because the tes t ic le is depr ived o f normal b lood supp ly . I f b lood supp ly is no t rees tab l ished wi th in 12 hours , i r revers ib le damage i s cer ta in to occur . Idea l ly , i schemia i s reso lved wi th in 4-6 hours . The pen is i s no t a f fec ted duri ng tes t icu la r to rs i on. Bes ides tes t icu la r to rs ion , ep id idymi t is , t rauma, and an ingu ina l hern ia a re o ther common causes o f sc r ota l pa in . How long shou ld a female pa t ien t w i th an uncompl ica ted UTI be t rea ted wi th an ora l an t ib io t ic? 3days 5 days 7 days Three days o f t rea tment w i th an appropr i ate an t ib io t ic is as e f f i cac ious as 7 - 10 days o f t rea tment. Three-day t rea tment i s assoc ia ted wi th fewer s ide ef fec ts , be t te r adherence, and fewer adverse reac t ions . A pat ien t has a u r inary t rac t in fec t ion . What f ind ings on uri ne d ips t ick bes t descr ibe a typ ica l ur inary t rac t in f ec t i on? Pos i t i ve leukocytes Pos i t i ve n i t ra tes Pos i t i ve leukocytes , pos i t i ve n i t r i tes Pos i t i ve n i t ra tes and hematur ia Class ic f ind ings in a ur inary t rac t in fec t ion (UTI ) a re pos i t i ve leukocytes and n i t r i tes . Leukocytes ind ica te the presence o f wh i te ce l ls in the u r ine . Ni t ra tes are a normal f ind ing in a u r ine spec imen. N i t r i tes are no t normal in the ur ine . Pos i t i ve n i t r i tes ind ica te that an organ ism in the ur ine is consuming n i t ra tes f or nu t r i t ion . Hematur ia ind ica tes the presence o f red b lood ce l ls in the ur ine . This is common in the presence o f a UTI . Which med ica t ion shou ld be avo ided in a pat ien t w i th a su l fa a l le rgy? Sul fony lu rea Sul famethoxazo le Naproxen Cefazo l in Sul famethoxazo le is the su l fa component i n Bac t r im DS. I t i s con t ra ind ica ted in pat ien ts w i th a su l f a a l le rgy . There is no a l le rg ic po ten t ial w i th the ant ihyperg lycemic agents known as the sul f ony lu reas . Naproxen and cefazo l in have no cont ra ind icat ions i f a pa t ien t has a su l fa a l le rgy . Some HIV pro tease i nh ib i to rs have the su l fony l a ry lamine chemica l g roup tha t i s respons ib le fo r the a l le rg ic reac t ion. A female pa t ien t who i s 45 years o ld s tates tha t she is hav i ng ur inary f requency. She descri bes ep isodes o f “ h av ing to go r igh t now ” and no t be ing ab le to wa i t . Her u r i na lys is resu l ts a re p rov ided. What is par t o f the d i f fe ren t ia l? Diabetes Lupus Stress incont inence Asymptomat ic bac ter i ur ia Pat ien ts w i th d iabetes can present w i th po lyur ia . An assessment o f the pat ien t ’s r i sk fac tors shou ld be done wi th s t rong cons idera t i on g iven to check ing g lucose leve ls . I f th is is norma l , o ther d iagnoses to cons ider a re urge incont inence and vag in i t i s . The pat i en t ’s med ica t ions shou ld be reviewed fo r med ica t ions produc ing urgency, l i ke d iure t ics or herba l supp lements . [Show Less]
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APEA 3P EXAM PREP4-HEALTH PROMOTION WITH RATIONALE
APEA 3P EXAM PREP4-HEALTH PROMOTION WITH RATIONALE A 58-year-old patient has an annual exam. A fecal occult blood test was used to screen for colon canc... [Show More] er. Three were ordered on separate days. The first test was positive; the last two were negative. How should the nurse practitioner proceed? Rescreen in one year. Perform a fourth exam. Examine him for hemorrhoids. Refer him for a colonoscopy. A fecal occult blood test is performed multiple times on different days because tumors don’t consistently excrete blood. The reason multiple tests are performed is to increase the likelihood of identifying blood. The patient needs to have a colonoscopy performed for examination of the colon. The standard of practice is to refer all positive colon cancer screens for colonoscopy. A criterion for medication choice in an older adult is: long half-life to prevent frequent dosing. dosing of 3-4 times daily. pill color and shape for easy identification. half-life less than 24 hours. Many factors go into prescribing for older adults. Some important safety criteria include established efficacy, low adverse event profile, and half-life less than 24 hours with no active metabolites. Active metabolites would produce a longer effect of the drug in the patient. Dosing of a medication three to four times daily invites dosing and medication errors. Once- or twice-daily dosing is ideal. Pill color and shape is never a criterion for prescribing. Patients who are cognitively able will recognize the color, shape, and size of pills they take on a regular basis. What is the recommendation from American Cancer Society for assessment of the prostate gland in a man who is 45 years old and of average risk for development of prostate cancer? He should have: screening starting at 50 years of age. prostate-specific antigen (PSA) now. PSA and digital rectal exam now. digital rectal exam only. At age 50 years, males of average prostate cancer risk should have a PSA measurement with or without a digital rectal exam (DRE). If they are deemed to be of high risk because of a family history (first-degree relative with prostate cancer before age 65 years) or race (African American), screening discussions should take place at age 40-45 years. If the initial PSA is > 2.5 ng/mL, annual testing should take place. If the initial PSA is < 2.5 ng/mL, test every 2 years. A 75-year-old adult asks for the pneumonia vaccine. His immunization record indicates that he had one at age 65 and another a year later. What is the recommendation of the CDC about how the NP should handle his request? Revaccination is recommended now Revaccination is recommended every 5 years after age 65 years Do not revaccinate this patient at this time He should have received one at age 70 years The recommendation of CDC is NOT to revaccinate this patient. After initial vaccination with PCV13 at age 65 years and subsequent vaccination with PPSV23 1 year later, no revaccination is recommended in this patient. What should the nurse practitioner recommend to any elder taking medications? Have someone check your medications prior to taking them Never take your medicine on an empty stomach Keep a list of all of your medications with you. Have a pharmacist review your list once a year A list of current medications should be kept with each patient and carried with him, especially when healthcare visits are scheduled. Many older adults can take medications without supervision. Many medications should be taken without food (thyroid supplementation for example). A pharmacist can evaluate the list of medications for drug-drug interactions, but the pharmacist will not know the diagnoses and other reasons for choosing the medications. What temperature should be set on a water heater in the home of an older adult to prevent burn injury? Less than 110 degrees Less than 120 degrees Less than 130 degrees Less than 140 degrees Hot water heaters are common sources of burns in homes of older adults and very young patients. Many safety organizations in the United States believe that burns can be prevented if hot water heaters are set to less than 120° F. A patient who has been treated for hypothyroidism presents for her annual exam. Her TSH is 4.1 (normal = 0.4- 3.8). She feels well. How should she be managed? Continue her current dosage of thyroid replacement. Increase her replacement. Decrease her replacement. Repeat the TSH in 2-3 weeks. When an abnormal TSH is received, especially when a patient is not symptomatic, it should be repeated. Sometimes there are periods of transient hypothyroidism, lab error, and missed doses that can cause changes in TSH levels. A 20-year-old student has an MMR titer that demonstrates an unprotective titer for rubella. She is HIV positive. Her CD4 cell count is unknown. Which statement is true? She should not receive the MMR immunization because she is at low risk for the disease. MMR is safe to give but she does not need this. She is at risk for MMR but should not be immunized. She should receive this. The immunization is not alive. This patient is at risk for rubella because she does not have a sufficient titer. The MMR immunization is an attenuated virus. Though an attenuated immunization is weakened, it is still considered live and so is contraindicated in anyone who may be immunocompromised. Since her CD4 cell count is unknown, she should not receive this immunization yet. She may be able to receive this immunization if her CD4 count is normal. What choice below would be beneficial to a 76-year-old who takes daily oral steroids for COPD and now takes a daily aspirin for primary prevention of myocardial infarction? Screen for infection with H. pylori Daily proton pump inhibitor (PPI) Antacids PRN heartburn Daily use of low dose famotidine Aspirin does increase the risk of gastrointestinal bleeding, especially if it is given in combination with oral steroids. Most learned authorities and ACOVE (Assessing Care of Vulnerable Elders) agree that when two or more risk factors for GI bleed are present, aspirin should not be added without some form of protection for the GI tract (misoprostol or a daily PPI). In considering all the risks for GI bleed, the most significant ones are age > 75 years, history of GI bleeding, warfarin use, daily NSAID use, and chronic steroid use. A patient who is 62 years old asks if she can get the shingles vaccine. She has never had shingles but states that she wants to make sure she doesn’t get it. What should the nurse practitioner advise? The immunization will protect you from acquiring shingles. You are not old enough to receive the immunization. The immunization is offered only to those who have had shingles. You are eligible to receive it but you still may get shingles. Patients must be at least 50 years old to receive the shingles immunization. It is generally well tolerated but provides protection from shingles in 50-64% of patients. The incidence of postherpetic neuralgia is decreased up to 65% after immunization. The patient still may develop shingles after receiving the immunization. The vaccine may be offered regardless of whether the patient has history of shingles. However, since it is a live vaccine, it may be contraindicated because of steroid use or immune status. Which pharmacokinetic factor is influenced by a decrease in liver mass in an older adult? Absorption Distribution Metabolism [Show Less]
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APEA 3P EXAM PREP5 -DERMATOLOGY WITH QUESTIONS AND ANSWERS WITH RATIONALE
APEA 3P EXAM PREP5 -DERMATOLOGY WITH QUESTIONS AND ANSWERS WITH RATIONALE The best way to evaluate jaundice associated with liver disease is to observe:... [Show More] blanching of the hands, feet, and nails. thesclera, skin,andlips. the lips, oral mucosa, and tongue. tympanic membrane and skin only. B. Looking at the sclera allows the examiner to see jaundice most easily and reliably. Jaundice may also appear in the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin. Jaundice in adults usually is a result of liver disease, but it can be due to excessive hemolysis of red blood cells. In infants, the usual cause is hemolysis of red blood cells, as is seen in physiologicjaundice. The most common place for a basal cell carcinoma to be found is the: scalp. Face. Ear. Anterior shin.B. The most common presentation of basal cell carcinoma (BCC) is on the face. This is probably because BCC occurs secondary to sun damage. The most common sun exposure occurs on the face. In fact, 70% of BCC occurs on the face; 15% occurs onthetrunk. Impetigo is characterized by: honey-colored crusts.silvery scales. marble-like lesions. wheals with pus. A. Impetigo is a superficial bacterial infection of the skin characterized by honeycolored crusts. Another form of impetigo is characterized by the presence of bullae.These infections are treated with topical antibiotics, good hygiene, and frequent hand washing. It is usually caused by Staphylococcus or Group A Streptococcus. A patient was burned with hot water. He has several 2-3 cm fluid-filled lesions. What arethesetermed? Vesicle sBullae Cysts Wheals B. Bullae are fluid-filled lesions that are greater than 6 mm in diameter. These are common in patients who have a superficial partial-thickness burn. Vesicles are also fluid filled, but they are smaller than 5 mm in diameter. A cyst is enclosed in a sac that can contain fluid or gelatinous material. Wheals are erythematous, irregular raised areas on the skin. All of these are termed primary lesions. A topical treatment forbasal cell carcinoma is: sulfacetamide lotion. 5-fluorouracil. tetracycline lotion. trichloroacetic acid. B. Several treatments exist for basal and squamous cell carcinoma. The majority are simple procedures like cryotherapy, electrodessication, surgical excision, and a topical treatment like 5-fluorouracil (5-FU). The other agents listed are not used to treat basal or squamous cell carcinoma. 5-FU works by inhibiting DNA synthesis. It iseffective if used for superficial basal cell carcinomas. It is available in cream and solutionandis usually applied twicedaily for 3-6 weeks. A 74-year-old male patient has sustained a laceration to his foot. His last tetanus shot was more than 10 years ago. He has completed the primary series. What shouldberecommended? Tetanustoxoidonly Tetanus and diphtheria only Hisprimary series willprotect him. Tetanus,diphtheria, and acellularpertussis (Tdap) D. More than 10 years has elapsed since this patient’s last tetanus shot. He needs another one. Tdap is specifically indicated for adolescents, older adults, healthcareproviders, and third trimester pregnant patients who have completed a primary series. Tetanus toxoid is indicated in the rare adult or child who is allergic to the aluminum adjuvant in the Tdimmunization. 7- A patient presents with small vesicles on the lateral edges of his fingers and intense itching. On close inspection, there are small vesicles on the palmar surface of thehand. What is this called? Seborrheic dermatitis Dyshidrotic dermatitisHerpes zoster Varicella zoster B. This dermatitis is intensely pruritic and involves the palms and soles and lateral aspects of the fingers. Over a couple of weeks, the vesicles desquamate. Recurrences are common. Seborrheic dermatitis affects only hairy areas of the body.The vesicles might raise suspicion of a viral infection, but this is not present in this case. [Show Less]
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APEA 3P EXAM PREP6 –GL WITH VERIFIED QUESTIONS AND ANSWERS WTH RATIONALE
APEA 3P EXAM PREP6 –GL WITH VERIFIED QUESTIONS AND ANSWERS WTH RATIONALE Mrs. Lovely, an 84-year-old, complains of fecal incontinence. A likely cause ... [Show More] is: inactivity. constipation. poor fluidconsumption. medication-related. B. Underlying constipation is a common cause of fecal incontinence in older adults. However, typically it is multifactorial. Risk factors include: age > 80 years, impaired mobility, and neurologic disorders including dementia. Inactivity and poor fluid consumption may contribute to constipation but are not causes of fecal incontinence. A 79-year-old withappendicitisisunlikely to exhibit: generalized abdominal pain. initial WBC elevation. UTI symptoms. low-gradefever. B. Very young children and elderly adults are not likely to have initial WBC elevations. Consequently, appendicitis can be easily missed in these populations. Generalized abdominal pain is typical initially. UTI symptoms in older adults can manifest as lower abdominal pain and are a common presentation in this age group. Low-grade fever is common too. The relationship between colon polyps and colon cancer is those polyps: eventually, all become malignant. have a slow progression to colon cancer. have a rapid progression to colon cancer. have no relationship to colon cancer. B. Colon polyps are usually slow-growing and take a long time to progress to cancer. This is the reason that a colonoscopy does not need to be repeated annually. While not all polyps grow slowly, this is the usual progression. A 5-year-old has been diagnosed with pinworms. He lives with his mother. There are no other members of the household. How should his mother be managed? Reassure the mother that if she develops symptoms, she will need to be treated. Visually assess the mother’s rectum for redness or presence of worms. Have the mother collect a stool specimen and send it to the laboratory. Perform the “scotch tape” test and look at the collection under the microscope. D. The diagnosis of pinworms (Enterobiasis) is made by using a piece of scotch tape on a tongue depressor. It is touched against the patient’s rectum. The greatest yield of eggs will occur during the nighttime or early AM. Eggs will be found here if they are present. Worms and eggs are rarely found in stool specimens, so this is not a good plan. When the scotch tape is examined under a low power microscope, the eggs will be easily visualized since they are large and bean shaped. The finding of an adult worm would confirm the diagnosis. These are large enough to be seen with the naked eye. If the mother is symptomatic, she should be treated with or without a rectal exam. It is very likely she is infected. A patienthasbeendiagnosed withhepatitis B.The mostcommonlyreportedrisk factor is: drinkingcontaminated water. eating contaminated food. exposure to blood. sexual exposure. D. Hepatitis B is transmitted by blood and body fluids. While exposure to infected blood or blood products would significantly increase the risk of infection in unvaccinated people, this is much less likely than becoming infected via sexual exposure or IV drug use. Hepatitis A is transmitted via fecal-oral routes. Drinking contaminated water and eating contaminated food implicate hepatitis A as the etiologic agent. The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and: E. coli. Enterovirus. Yersinia. Shigella. D. Shigella will be shed continuously in the stool and should be easily identified on stool culture. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. Generally, these three pathogens are easily identified if they are present. Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called bubonic plague. E. coli is a typical colonic pathogen. An 83-year-old patient is diagnosed with diverticulitis. The most common complaint is: rectal bleeding. bloating and cramping. left lower quadrant pain. frequent belchingandflatulence. C. Diverticular disease is more common in older adults. About 70% of patients diagnosed with diverticulitis have left lower quadrant pain. Rectal bleeding may have varied etiologies, such as rectal carcinoma or hemorrhoids. Bloating and cramping are often found in patients with diverticular disease (diverticulosis) but not specifically diverticulitis. Belching and flatulence are not specifically associated with diverticulosis. What is true regarding older adults who are overweight? This is clearly associated with increased mortality in older adults. Mortality in older adults related to overweight states declines over time. BMI is a good way to assess nutritional status in older adults. There arenopotential metabolic or functional benefits to weight loss in older adults. B. Overweight and obese states are not as important in predicting mortality in older adults as they are in their younger counterparts. After age 65 years (some studies demonstrate after age 70), weight is less significant in decreasing risk for mortality than in younger adults. There are some benefits to weight loss in the obese older adults. One of them is better balance and decreased risk for falls. Others include less sleep apnea, decreased risk of diabetes, and decreased rates of shortness of breath with respiratory and cardiac diseases. What medication used to treat patients who have GERD provides the fastest relief of heartburn symptoms? Calcium carbonate Ranitidine Amantadine Pantoprazole A. Calcium carbonate is an antacid. It provides rapid changes in gastric pH. This provides relief that can be noticed immediately. The increase in pH lasts for about 30 minutes and corresponds with resolution of symptoms. However, as pH decreases within 30 minutes, symptoms may return. Ranitidine is an H2 blocker. It provides relief in 1-2 hours. This usually lasts for about 6-12 hours. Amantadine is an antiviral not used to treat GERD. Pantoprazole is a proton pump inhibitor. This provides relief after several hours or days of daily consumption. An 84-year-old presents with a stated involuntary weight loss. He states that he’s lost about 6 pounds in the last 6 or 8 weeks. What statement below is NOT part of the assessment? The weight loss should be measured today and again in the next few weeks. A laboratory evaluation should be performed. Evaluate his dietary intake. Evaluate his upper and lower extremity muscle mass. D. Involuntary weight loss in older adults is often due to malignancy or disease. The initial assessment of an older adult who reports involuntary weight loss is to document the weight loss. If prior measurements are part of the patient’s chart, this would be helpful. Laboratory assessment should also be performed. Consideration should be given to performing a CBC, TSH, and metabolic panel. Also consider chest and abdominal X-rays. If all are normal, he should be monitored and reweighed on the same scale for comparison. A dietary consult should be ordered. However, even with negative initial findings, a significant number of patients are later found to have disease or malignancy A patient has a positive hepatitis B surface antibody. This means he: has acute hepatitis B. has chronic hepatitis B. is immune to hepatitis B. needs immunization to hepatitis B. C. The hepatitis B surface antibody indicates immunity to hepatitis B virus. Specifically, if this patient comes in contact with hepatitis B virus, he will not become infected with hepatitis B. The presence of hepatitis B surface antibody indicates immunity from immunization or actual infection. It also indicates recovery if the patient was infected. A patient with a suspected inguinal hernia should be examined: in the prone position. standing. side-lying. with patient squatting. B. The patient should be examined while he is standing. He should be asked to bear down, cough, or strain during the exam. Though hernias are far more common in males, they can be found in females too. In males, the patient should be asked to stand. The examiner should put his 2nd or 3rd finger through the scrotum and into the external ring. When the patient is asked to cough, a “silky” feel will butt up against the examiner’s finger, and the hernia can be easily felt. A 15-year-old is about 10% below her ideal body weight. Laboratory studies were performed. Which complaint might be common in this patient (Labs in image)? Headaches Dizziness withstanding Muscle cramps [Show Less]
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APEA 3P EXAM PREP7 -PROFESSIONAL ISSUES WITH RATIONALE
APEA 3P EXAM PREP7 -PROFESSIONAL ISSUES WITH RATIONALE A nurse practitioner is working in a minor care area of an emergency department. An illegal immi... [Show More] grant has a puncture wound caused by an unknown sharp object in a trash container. A dirty needle is suspected. The nurse practitioner: Should administer a tetanus injection only since the patient has no medical insurance. Should prescribe appropriate medications for HIV exposure even though the nurse practitioner knows the patient can’t afford them. Should not mention the possibility of HIV exposure from a dirty needle to the patient. Can offer to buy the HIV medications for $50 with their professional discount at the pharmacy next door. The standard of care followed by the nurse practitioner should not depend on whether the patient has insurance or not. It is unethical to not properly inform the patient of risks he may have been exposed to from the puncture wound. Offering to buy the medications for the patient is noble but is not a sustainable practice. The nurse practitioner should prescribe the medications as for anyone with possible HIV exposure and refer to social services or a community referral agency that can help this patient acquire the appropriate medications. A nurse practitioner has agreed to participate in the Medicare health insurance program. Medicare paid 80% of the charges billed for a clinic visit. What can be done about the other 20% that is owed? The NP can bill the patient for a percentage of the remainder. The NP is prohibited from billing the patient. The NP can collect 90% if billed incident to the MD. The NP can resubmit the bill for additional payment. The NP is a “participating” provider because he agreed to accept assignments. An assignment is an agreement between Medicare and the NP to accept the Medicare Approved Amount (MAA) as payment in full and not charge Medicare recipients a higher rate. The NP can bill the patient for a percentage of the remaining bill that was not paid by Medicare. The NP may opt out of participating. The NP can be reimbursed 100% if billed incident to the MD. The name given to subjects in a research study who do not have the disease or condition being studied, but who are included in the study for comparison are: studied subjects. controls. case series. cross sectionals. Studied subjects are those members of a study who have a specific disease or condition of interest or who are receiving a specific treatment. Case series may refer to an observational study in which a group of patients with interesting characteristics are studied. Cross sectional is a type of observational study in which a particular characteristic is studied at one time rather than over time. Controls are commonly employed in many types of research studies. The research design that provides the strongest evidence for concluding causation is: randomized controlled trials. cohort studies. case control studies. prospective studies. A randomized clinical trial (RCT) is the epitome of all research designs. Subjects are randomly assigned to treatment groups. This type study provides the best evidence that the results were due to the intervention and not something else. A RCT is an experimental design, not an observational one. An older adult male with moderately severe dementia presents with his caregiver daughter. His BMI is 18. His clothes have food stains on them and he looks as though he hasn’t been bathed in days. How should the nurse practitioner handle this? The NP should comment to the daughter about his poor care. The NP should report this as potential elder abuse. The patient should be asked about his care. The daughter should be asked about the type of care he receives. This patient presents as though he is being poorly cared for and mistreated. This occurs in about 3- 8% of the adult population in the United States. There is no evidence that the patient has been physically abused, but he obviously suffers from neglect. This is a form of elder abuse, just as physical, sexual, psychological, or financial abuse is. Older adults with dementia often suffer abuse most frequently. A nurse practitioner is working in a minor care clinic. She realizes that a patient with a minor laceration does not have insurance and is using his brother’s insurance information today so that his visit will be covered. How should she proceed? She should let him know that she knows what he is doing. She should ignore this and proceed to suture his wound. She should let the clinic's business office know what is happening. She should not suture his wound and ask him to leave. The nurse practitioner cannot ignore the fact that this patient is attempting to defraud the clinic and insurance company in order to receive free care. If she does not let the business office know, she is a party to the fraud. She should let the business office know what is happening and have the patient present documents verifying that he is who he states that he is. If he cannot, he can still receive care if he is willing to pay for it. An alternative care site should be offered to him. Which study listed below is considered an experimental study? Case series Cross-sectional study Cohort study Meta-analysis Observational studies are studies in which subjects are observed. No intervention takes place with them. Examples of these are found in the first three choices. A meta-analysis takes published information from other studies and combines the information to arrive at a conclusion. Although a meta-analysis can use observational studies, these should be reported separately. A nurse practitioner examined a patient who had been injured by a cat. A 4-centimeter gaping laceration was present on the patient’s forearm. The nurse practitioner sutured the laceration. The patient subsequently became infected, needed hospital admission, and required IV antibiotics with incision and drainage. How can this situation be characterized? This is a clinical judgment with an unexpected complication. The nurse practitioner’s actions followed the standard of care. The act of suturing this type of wound represents malpractice. This is poor judgment, but not malpractice. This is malpractice. Cat bites, known to be dirty bites with a high probability of infection, should not be sutured. Malpractice is usually described as having multiple elements that all must be satisfied for malpractice to occur. There must be a duty, a breach of the duty, and subsequent injury due to the breach. Comparison of performance is based on the standard of care delivered by nurse practitioners. The Medicaid health program is: funded with premiums from participants. covers an unlimited number of adult visits. funded by both state and federal governments. basically the same from state to state. Medicaid is state-run and specific to each state. The state programs are funded by a combination of state and federal funds. Most states have limits on the number of adult visits. Some states have no limits on visits for children. Participants generally do not pay premiums like Medicare recipients pay. A liability policy that pays claims only during the period that the policy is active is termed: claims made policy. tail coverage. liability protection. bobtail coverage. Liability insurance that covers the holder only during the time of the active policy is known as a claims made policy. This kind of policy is usually less expensive than other policies that will protect the policyholder against claims not known about at the end of the policy period. Tail coverage is more expensive than other policies because it protects the healthcare provider for an extended period of time after the incident [Show Less]
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