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APEA predictor (questions answered) graded A+ to pass
Hemoglobin value (Hgb) Males 14-17.4 g/dl Females 12-16 g/dl Hematocrit (Hct) Males 42-52 percent Females 36-48 percent MCV 80-100 fL ... [Show More] RDW (red cell distribution width) > 14.5 percent platelet count (PLT) < 140,000/mm (increased risk for bleeding, ITP) Reticulocytes 0.5-1.5%, Circulates in the blood for about 2 days before developing into RBCs and increases with sudden loss of RBCs: decrease aplastic anemia , renal disease Increase acute bleeds, vitamin decencies iron, b12, folate Total WBC count 4,500-11,000/mm3 Increased with bacterial infections Neutrophils (or segs) >50 percent Increased bacterial infection Band forms (immature neutrophils) > 6 percent Severe bacterial infection Shift to left Eosinophils >3 percent Increased allergies and intestinal parasites TSH (thyroid stimulating hormone) > 5.0 U/L Hypothyroidism, also has low serum total T4 and low T-3 resin uptake PSA <4.0 (BPH, prostate cancer) [Show Less]
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APEA- Study Guide questions and answer latest 2023
When performing a visual acuity test the nurse practitioner notes 20/30 in the left eye and 20/40 in the right eye using the Snellen eye chart. This means:... [Show More] Refer the patient to an ophthalmologist The American psychiatric association's diagnostic and statistical manual of mental disorder defines Munchausen Syndrome by proxy: a caregiver making up or causing an illness or injury in a person under his or her care Symptoms of depression are a side effect of which neurotransmitter medication? dopamine Which lesion is dark, raised, and asymmetric with irregular border? Melanoma A 32-year-old woman presents with dull puffiness of the eyes pronounced not pitting periorbital edema this finding is suggestive of this condition? Myxedema A 42-year-old woman with a past medical history of migraine headaches is requesting prophylactic medication treatment. Which medication should the Nurse Practitioner prescribe? Amitriptyline (Elavil) A pediatric has areas of scaling on the scalp with round patches of alopecia. this clinical finding is consistent with: Tinea Capitis What is the appropriate prophylactic medication for an 18-year-old woman with a past medical history of migraine headaches? Propanolol (Inderal) Why would a combined hormonal contraceptive be contraindicated in a 36-year-old patient with a past medical history of type 2 diabetes, obesity, chronic smoking, and sedentary life: Her age and tobacco use During the breast examination of a perimenopausal woman, the NP detects a bloody spontaneous discharge from the right nipple. This indicates further evaluation. An intraductal papilloma Intraductal papilloma are usually solitary and smaller than 1 cm. They are located in large lactiferous sinuses or ducts and have a tendency to bleed. Rh negative women should receive Rho(D) immunoglobulin at what gestational time? 28 weeks When interpreting a complete blood count (CBC) lab report which of the following results describes the size of the RBCs? Mean corpuscular volume (MVC) What medication should be avoided when prescribing prophylactic therapy for headaches? Venlataxin (Effexor) What is the mechanism of action of prostaglandin E1 (PG1) in a patient with transposition of the great arteries? To produce vasodilation and adequate oxygen saturation Which of the following complaints best describes lower extremity calf pain associated with peripheral artery disease: A dull pain or cramp Which of the following conditions is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman? Gynecomastia When treating a patient with asthma who is experiencing acute wheezing which medication should be given to relieve the symptom? Short acting bronchodilator Which immunization reduces a patient's risk for infection with the virus that causes painful localized blistering rash? Shingles (herpes zoster) vaccine Headache warning signs that need prompt investigation include all of the following EXCEPT: Headache relieved with mild infrequent use of analgesics The client with iron deficiency anemia should be advised to take the iron supplement: on an empty stomach between meals Which one of the following statements is true of muchausen syndrome by proxy? Under the supervision of adults other than the abuser, the patient does not exhibit symptoms Which of the following is the most common presenting sign of substance abuse in adolescents? Changes in behavior A woman is 11 weeks pregnant and has a maternity history of one full term vaginal delivery, a set of premature triplets delivered vaginally, and a first trimester abortion. Using her TPAL system to document her maternal status: Gravida 4, Para 1314 Gravida, Term babies, Preterm Babies, Abort and Living Child The nurse practitioner palpates an enlarged right epitrochlear lymph node in a 30 year old patient. The nurse practitioner should assess the patients: right forearm and hand Anticholinergics are indicated for the treatment of: Urge incontinence A patient presents with signs of chest pain, the nurse practitioner observes jugular venous distention. Their finding is consistent with: Heart failure On examination of the neck, a dome shaped lesion in the dermis forming a benign closed firm sac attached to the epidermis is noted on a right lateral side of the neck. The type of lesion is known as : a cutaneous cyst A dark dot (black-head) may be visible on its usually either an epidermoid cyst, common on the face and neck, or pilar cyst, common in the scalp. Both may be come inflamed. BATES: pg286 [Show Less]
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3P High Stakes Exam(apea)correctly answered 2023
Horner's syndrome When examining the eyes, the right pupil reacts briskly to light, near effort, and is much smaller than the left pupil. This condition i... [Show More] s most likely: Paralysis of oculomotor cranial nerve (CN III) Dilated pupil is fixed to light and near accommodation Argyll Robertson pupils Pupil appears small and irregular shaped and accommodate but do not react to light. Seizure uncontrolled electrical activity in brain, may produce minor physical signs, thought disturbances or disturbed motor activity or combination of symptoms. Dystonia neurological disorder, causes involuntary muscle spasms & twisting of limbs. Bradykinesia impaired ability to adjust to one's body position. Femoral vein The great saphenous vein enters the deep venous system via: The Abduction (Valgus) stress test Maneuver the evaluates function of medial collateral ligament (MCL) Gray matter The thalamus and basal ganglion are located in the: Facial tics brief, repetitive, stereotyped, coordinated movement occurring at irregular intervals (repetitive winking, grimacing and shoulder shrugging) Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at high risk for developing: columnar epithelium that covers most or all of cervix vaginal adenosis, circular collar or ridge of tissue between cervix & vagina. Flexor group Group of muscles that lie anteriorly and flex the thigh Thymus, thyroid gland & anterior part of pericardium The anterior mediastinal lymph nodes drain lymphatic fluid from the: The breasts, upper part of the abdominal wall, upper part of back, pectoral region & upper limbs Axillary lymph node drainage are includes: trauma, surgery & intranasal use of cocaine or amphetamines. Possible causes of nasal septum perforation: the peau d'orange (orange peel) sign thickened skin with enlarged pores. First seen in lower portion of breast or areola. Visible sign of breast cancer. Median Nerve provides sensation to palm, palmar surface of most of thumb, second & third fingers & half of 4th digit. Ulnar Nerve Innervates half of 4th digit & 5th digit Radial Nerve innervates dorsal web space of thumb & index finger Fibrous joints Have intervening layers of fibrous tissue or cartilage holding bones together (sutures of skull) Cartilaginous joints Joints have bones connected by cartilage. (hyaline or fibrocartilage). slightly movable. Symphysis pubis & vertebrae Examples of cartilaginous joints Mechanical neck pain Aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, with associated stiffness and tightness in the upper back and shoulder, lasting up to 6 weeks. No associated radiation, paresthesias, or weakness. Headache may be present. Mechanical Neck pain-Whiplash Paracervical pain & stiffness begins day after injury. Accompanied by occipital headaches, dizziness & malaise Cervical radiculopathy nerve pain caused by pressure on the spinal nerve roots in the neck region Symptoms: sharp burning or tingling pain in neck & one arm with assiciated paresthesias. Cervical Myelopathy cervical cord compression, neck pain associated with bilateral weakness & paresthesias in both upper & lower extremities. Diastasis Recti Rectus abdominis muscles separate at midline as tension on abdominal wall increases with pregnancy 10 days to 3 months How long after exposure to syphilis will symptoms begin to present? Cervicitis Cervical erosion, erythema, discharge or irritation. Investigate for STI. Located behind the ethmoid sinuses Sphenoidal sinuses are located: Between the eyes & frontal sinuses, located above the eyes. Ethmoid sinuses are located between 24 and 28 weeks of pregnancy When should an oral glucose tolerance test b [Show Less]
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APEA 3P Exam Prep- Cardiovascular questions and answers 2023
Which patient could be expected to have the highest systolic blood pressure? A 21-year-old male A 50-year-old perimenopausal female A 35-year-old ... [Show More] patient with Type 2 diabetes A 75-year-old male D. Nearly 25% of the US population has hypertension. The greatest incidence is in older adults because of changes in the intima of vessels as aging and calcium deposition occur. Males of any age are more likely to be hypertensive than females of the same age. African American adults have the highest incidence in the general population. Among adolescents, African Americans and Hispanics have the highest rates. Hypertension occurs in 5-10% of pregnancies. Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization? Naproxen Furosemide Metformin Losartan D. Naproxen and furosemide should be stopped for 24 hours prior to the catheterization. Metformin should be stopped 48 hours prior to the catheterization. Furosemide is stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld because of the impact on renal prostaglandin production. Metformin has been implicated in lactic acidosis when combined with contrast dye in an impaired kidney. In older adults, the three most common ailments are: hearing loss, vision loss, hypertension. hearing loss, hypertension, arthritis. depression, vision loss, hypertension. arthritis, hearing loss, depression. B. Hypertension and arthritis are the two most common ailments in older adults. Hearing loss occurs in half to almost 2/3 of older adults. The most common form is known as presbycusis. There is no consensus for the frequency of screening for hearing loss in older patients, but minimally, it should be grossly evaluated at each visit and screened more thoroughly if deficits are observed. Blood pressure should be screened annually, but it is usually screened at each visit. Arthritis is not routinely screened. Mr. Holbrook, a 75-year-old male, is a former smoker with a 30-pack-year history. He has come in today for an annual exam. He walks daily for 25 minutes, has had intentional weight loss, and has a near-normal BMI. On examination, the patient is noted to have an absence of hair growth on his lower legs. Which statement is true regarding this patient? This is a normal consequence of aging. This might indicate disease in the lower extremities. It might be from exercise initiation. This is secondary to long-term smoking. B. An absence of hair growth likely indicates peripheral artery disease in this patient. It is part of normal changes of aging that hair growth will diminish, but not become absent. His lower extremity pulses should be assessed, his cardiac risk factors should be assessed (he smoked for years), and he should be questioned about leg pain when he walks. An ankle-brachial index could be measured. If < 0.9, further assessment should be done. A normal ankle-brachial index should be greater than 0.9. Less than 0.4 is considered critical. The usual clinical course of mitral valve prolapse: is benign. results in sudden cardiac death. results in chronic heart failure. is associated with multiple episodes of emboli. A. The usual course of mitral valve prolapse (MVP) is benign, and most patients who have MVP are asymptomatic. A murmur may be present and is best auscultated with the diaphragm of the stethoscope over the cardiac apex. In a minority of patients, symptoms of heart failure or sudden death may occur. When heart failure results, it is usually a result of mitral regurgitation. Embolization may occur, but, this is not common or usual in the majority of patients. An ACE inhibitor is specifically indicated in patients who have: hypertension, diabetes with proteinuria, and heart failure. diabetes, hypertension, hyperlipidemia. asthma, hypertension, diabetes. renal nephropathy, heart failure, hyperlipidemia. A. ACE inhibitors have numerous indications. Three are indicated in the first choice. ACE inhibitors are also indicated in patients who have renal insufficiency. However, ACE inhibitors can worsen renal insufficiency, so the patients must be monitored closely with lab tests for BUN, Cr, and potassium. Diabetes without proteinuria is not a specific indication for ACE inhibitors use, though they are used by some healthcare providers in this way. This is an off-label use. An older adult who has hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina? ACE inhibitor Beta blocker Diuretic Angiotensin receptor blocker B. The beta blocker slows down heart rate, depresses myocardial contractility, and decreases sympathetic stimulation. These decrease myocardial oxygen demand and improve angina symptoms. It is an excellent drug class to use to prevent symptoms of angina in patients who have underlying coronary artery disease. Calcium channel blockers are another class of medications that could be used to improve symptoms of angina. Orthostatic hypotension can be diagnosed in an older adult if the systolic blood pressure decreases: more than 20 points anytime after rising. more than 20 points within 3 minutes after rising. more than 20 points within 1 minute after rising. any degree drop if the patient becomes weak or dizzy. B. Orthostatic hypotension, also called postural hypotension, is diagnosed in older adults when the systolic blood pressure drops 20 mm Hg or more within 3 minutes of moving to a more upright position. Systolic blood pressure can be expected to decrease within one minute of moving to an upright position. Normally, the blood pressure returns to baseline within one minute of a position change and orthostatic hypotension does not occur. It is always abnormal when blood pressure decreases beyond one minute of moving to an upright position. Orthostatic hypotension can then be diagnosed. Moving to an upright position may be 1) lying to sitting or 2) sitting to standing. Additionally, if the systolic blood pressure does not meet these criteria, but the diastolic drops by 10 mm Hg or more with a position change, orthostatic hypotension can be diagnosed. Patients become symptomatic when this occurs and often report lightheadedness, weakness, dizziness, blurred vision, or decreased hearing. Which hypertensive patient is most likely to have adverse blood pressure effects from excessive sodium consumption? 21-year-old Asian American male 35-year-old menstruating female 55-year-old post menopausal female 70-year-old African American male D. Two groups of patients typically experience adverse blood pressure effects from consumption of sodium greater than 2,000 mg daily. Those patients considered to be most sodium-sensitive are elderly patients and African American patients. Thus, choice d is the best choice listed. A patient who takes HCTZ 25 mg daily has complaints of muscle cramps. He probably has: hypocalcemia. hypomagnesemia. hypokalemia. hypercalcemia. C. HCTZ is a thiazide diuretic that is potassium-wasting. Patients can become hypokalemic and experience side effects of this. A common one is muscle cramps. A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably: congenital. rheumatic. acquired calcific. unknown. A. In someone younger than 65 years, the most likely cause is congenital. The aortic valve usually consists of three cusps, but some people are born with a bicuspid aortic valve. Rheumatic heart disease is the second most common cause of aortic stenosis in this age group, but the incidence has decreased drastically in the last many decades because of the use of antibiotics to treat Streptococcal infections. In more than 90% of patients older than 65 years, acquired calcifications appear on a normal aortic valve and produce aortic stenosis. A 75-year-old patient with longstanding hypertension takes an ACE inhibitor and a thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This probably indicates: worsening hypertension. development of heart failure (HF). noncompliance with medication. acute myocardial infarction. B. The symptoms of dyspnea on exertion and peripheral edema are symptoms of HF. Long standing hypertension is a risk factor for HF. Acute myocardial infarction would result in acute symptoms, not development of symptoms over the past several days. Noncompliance with medication and fluid or sodium excess might result in peripheral edema and development of heart failure. A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure and not related to fosinopril? It is dry and nonproductive. It is wet and worse with recumbence. It is purulent and tachycardia accompanies it. Shortness of breath always results after coughing. B. The cough associated with fosinopril, an ACE inhibitor, is a dry, nonproductive cough that may be described as annoying. Its severity does not change with position or time of day. A cough associated with heart failure is wet, worse when lying down, and is usually described by patients as worse at night. Choice c is often associated with fever and probably reflects an infectious process like pneumonia. Which choice below would be the best choice for an 80-year-old patient whose blood pressure is 172/72 mm Hg? Chlorthalidone Amlodipine Monopril Acebutolol B. This patient has isolated systolic hypertension. According to many learned authorities, this is best treated with a long-acting calcium channel blocker, particularly the ones that end in "pine." These belong to the class of calcium channel blockers termed dihydropyridines. Thiazide diuretics are not potent enough to decrease this patient's blood pressure into normal range, and its effect is not additive when combined with calcium channel blockers. Which medication could potentially exacerbate heart failure (HF)? Naproxen Furosemide Atorvastatin Aspirin A. Naproxen is an NSAID. NSAIDs cause sodium retention and thus, water retention. A single dose of naproxen is unlikely to produce HF symptoms, but repeated subsequent doses are very likely to produce water retention sufficient to cause edema and possible shortness of breath in susceptible people. The other medications listed are unlikely to have any direct effect on cardiac output in a patient who has HF. Which patient is most likely to have mitral valve prolapse? An adolescent male with no cardiac history A 25-year-old male with exercise intolerance A 30-year-old female with no cardiac history A 65-year-old male with shortness of breath C. Mitral valve prolapse (MVP) is most commonly diagnosed in women aged 14-30 years of age. However, it can be found in children (though not usually) or in older adults. The symptoms most commonly associated with MVP are arrhythmias (both atrial and ventricular) and chest pain. However, most patients with MVP are asymptomatic. You have been asked to evaluate a heart murmur in a pregnant patient. Can a 3D echocardiogram be safely used to evaluate her? Yes, but this will not yield the best information. Yes, this is perfectly safe. No, this will emit radiation and is not safe. Yes, but the mother will be exposed to radiation B. An echocardiogram is the best test to evaluate a heart murmur whether the patient is pregnant or not. Echocardiography can be used safely in this patient because no radiation is emitted from 3D echo. The most common murmur in pregnant women is a venous hum murmur. It resolves within several weeks after delivery. It is benign. A patient is diagnosed with mild heart failure (HF). What drug listed below would be a good choice for reducing morbidity and mortality long term? Verapamil Digoxin Furosemide Metoprolol D. Metoprolol is a beta-blocker. Beta-blockers are known to reduce morbidity and mortality associated with HF. Verapamil is a calcium channel blocker. This class of medications is contraindicated because they decrease the contractility of the heart. Furosemide and digoxin will improve symptoms but not long-term outcomes. Their main benefit is in treating symptomatic patients. The lipid particle with the greatest atherogenic effect is: Cholesterol. HDL. LDL. triglycerides. C. LDL cholesterol promotes atherosclerosis via several different mechanisms. Consequently, LDL cholesterol tends to be the primary target when patients are treated pharmacologically for elevated lipid levels. Low HDL levels and elevated triglyceride levels can accelerate atherogenesis. A 77-year-old patient has had an increase in blood pressure since the last exam. The blood pressure readings are provided. If medication is to be started on this patient, what would be a good first choice (VS in image)? ACE inhibitor Beta blocker Calcium channel blocker Thiazide diuretic C. This patient is 77 years old and should have a goal blood pressure of < 150/90 mmHg according to JNC8. A thiazide diuretic is not a good first choice in this patient because it will not be potent enough to decrease blood pressure by about 20 points to get him to his goal. A long-acting calcium channel blocker is appropriate for patients who have isolated systolic hypertension and will be more likely to get this patient to goal pressure than HCTZ. Beta-blockers are no longer recommended first-line for uncomplicated hypertension. ACE inhibitors are very effective in patients who are high renin producers. Older patients tend to produce lower amounts of renin. The nurse practitioner is caring for an independent 74-year-old female who had acute coronary syndrome (ACS) about 6 weeks ago. What medications should be part of her regimen unless there is a contraindication? ASA and beta blocker ACE and beta blocker ACE, ASA, and beta blocker ACE, ASA, beta blocker, and statin D. After a myocardial event, an aspirin, ACE inhibitor, beta blocker, and statin should be dosed daily. The aspirin will provide anticoagulation; the ACE inhibitor, statin and beta blocker are associated with reduced morbidity and mortality if given soon after ACS. Mr. Smith is a 72-year-old patient who takes warfarin for chronic atrial fibrillation. His INR and CBC results are provided (CBC in the image, INR 4.0). The nurse practitioner should: stop the warfarin for the next 4 days and repeat the INR on day 5. admit to the hospital immediately. administer vitamin K and repeat INR in 2 hours. stop the warfarin today and repeat the INR tomorrow. D. An INR range of 2.0-3.0 is therapeutic for most people who take warfarin for chronic atrial fibrillation. An INR of 4.0 is elevated, and this patient could suffer a devastating bleed anywhere in the body. A patient with an INR < 5 without bleeding may have warfarin stopped temporarily. The maintenance dose should be decreased when it is safe to resume warfarin, i.e. when the INR is closer to the patient's therapeutic range. If the patient were at high risk for bleeding, was bleeding, or if the INR was greater than 4.0, vitamin K could be administered. A good history should be completed to find out the reason for the increase in INR. A high-risk client with an elevated INR would be admitted to the hospital and closely monitored, but a client with no comorbidities (no bleeding history or thrombocytopenia) and considered low risk, may be monitored as an outpatient. Five days is too long to stop warfarin without an INR check. A patient with poorly controlled hypertension and history of myocardial infarction 6 years ago presents today with mild shortness of breath. He takes quinapril, ASA, metoprolol, and a statin daily. What symptom is NOT indicative of heart failure? Fatigue Headache Orthopnea Cough B. Fatigue is a common symptom in cardiac patients, and it can represent a worsening of many cardiac diseases, such as coronary artery disease, heart failure, or valvular dysfunction. Orthopnea and cough, especially nocturnal, are classic symptoms of worsening heart failure. Headache is a nonspecific symptom and is not typical of heart failure. [Show Less]
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APEA 3P questions fully answered 2023
When examining the skin, multiple areas of circumscribed elevations of the skin filled with serous fluid measuring approximately 0.5cm were noted. These ... [Show More] types of lesions could be seen in: a. Herpes simplex or varicella The principal muscles involved when closing the mouth are innervated by which cranial nerve? a. Cranial nerve V (Trigeminal) The structure that creates a channel for the vertebral artery is known as the: Transverse Foramen Which of the following is NOT a compliant patient with type 1 diabetes? Polycythemia When suspecting pediculosis capitis, the chief complaint is: Itching The structure that appears as the large swelling posteriorly on the superior ramus of the ischium and bears most of the weight in sitting, is known as the: Ischial tuberosity When percussing the posterior chest, which one of the following techniques would be omitted? Percuss areas over the scapulae On examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of: A tonic pupil During the type of seizure activity, the patient experiences partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and unilateral neurologic deficit is present during the postictal period. This type of seizure activity is referred to as a: focal seizure that becomes generalized A female patient complains of weakness in both arms when transferring the wet clothes from the washer and placing them in the dryer. This finding could be suggestive of which type of weakness pattern? Symmetric To palpate the right ovary when performing the bimanual vaginal exam, the abdominal hand should be on the right lower quadrant and the pelvic hand needs to be: In the right lateral fornix A serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking is referred to as: Delirium Which of the following screening tests for hearing loss can detect both sensorineural and conductive hearing loss? Weber test Located on the anterior aspect of the distal femur, the patella slides on this groove during flexion and extension of the knee. The name of this groove is the: Trochlear groove A 86-year-old man with uncontrolled hypertension presents with sudden, intense left lower abdominal pain that radiates to the back. The pain is associated with a tearing sensation. These findings are MOST likely associated with: An abdominal aortic aneurysm (AAA) Ophthalmoscopic examination reveals dark specks noted between the fundus and the lens. These specks are most likely: Vitreous floaters When performing the first Leopold maneuver on a pregnant woman, if the buttocks and head are not easily palpated at the fundus, the fetus is said to be in: Transverse lie When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of his body. This motion of the shoulder girdle would be an example of: Flexion To locate the twelfth rib, palpate: Between the spine and the lateral chest Walking on the toes and heels may reveal: Distal muscular weakness in the legs When performing a bimanual exam of the vagina, the examiner should lubricate the index and middle fingers of a gloved hand. From a standing position, the fingers should be inserted into the vagina while exerting pressure primarily Posteriorly During pregnancy, which hormone results in increased blood viscosity? Erythropoietin Resting tremors refer to those tremors that disappear: With voluntary movement A patient presents with complaints of bright red stools over the past week. This symptom could be consistent with: Cancer of the sigmoid colon Mydriasis is a term used to describe: Dilation of the pupils [Show Less]
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APEA 3P Exam Prep- Sexual Health correctly answered 2023
A patient being treated for trichomoniasis receives a prescription for metronidazole. What instructions should she be given? Take this medication with f... [Show More] ood 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 24-year-old female presents with abdominal pain. What additional finding supports a diagnosis of pelvic 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 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. They both should be treated with azithromycin and doxycycline. B. Metronidazole is considered the drug of choice to treat males and females. Even though he is asymptomatic, he needs treatment too. Neither partner should resume sexual intercourse until both have been treated. Tinidazole can also be used for treatment. 2 grams of either agent may be given as a single-dose treatment. Alcohol should be avoided for 24 hours if metronidazole is taken; 72 hours if tinidazole is taken. How long should a patient be treated with antibiotics if he has prostatitis secondary to an STD? 3 days 5 days 7-10 days 14 days or longer D. The prostate gland does not absorb antibiotics very readily. Consequently, antibiotics must be given for 2-6 weeks to enable the gland to achieve high enough concentrations to treat and effectively eradicate the organism causing prostatitis. Treatment can be expensive depending on the antibiotic used. A 30-year-old male who is sexually active complains of pain during bowel movements. The digital rectal examination is negative for hemorrhoids, but the prostate gland is tender. What should be suspected? Acute bacterial prostatitis Prostate cancer Benign prostatic hyperplasia Trichomoniasis A. This patient probably has acute bacterial prostatitis. A common presenting symptom is prostate tenderness, especially with bowel movements. A common cause in a 30-year-old male who is sexually active is infection with chlamydia or gonorrhea. He should be screened for sexually transmitted diseases. If these are negative, a urinary pathogen is the likely cause. Which of the following statements regarding HIV is correct? There are few conditions that cause depletion of CD4 cells other than HIV. CD4 cell counts vary greatly in immunocompetent individuals A normal CD4 count is < 200/mm3 CD4 counts are the first abnormality seen in patients with HIV A. HIV specifically attacks the number of circulating CD4 cells. There is little variability in CD4 counts in immunocompetent adults. There are a number of factors that will cause minor fluctuation in counts. These include things like seasonal and diurnal variations, infections, and steroid intake. The normal CD4 cell count ranges from 800-1050/mm3. Every year after infection with HIV, the CD4 cell count decreases by about 50/mm3 per year. There is great variation in individual decreases. Some patients experience very little decrease in counts, other patients experience great decreases in counts. Oral antiretroviral agents slow down the CD4 decreases. A 26-year-old HIV-positive patient presents with photophobia and a temperature of 103.2° F. He complains of a headache. On exam, he is unable to demonstrate full extension of the knee when his hip is flexed. Which choice below is the most likely diagnosis? Pneumocystis infection Meningitis Septic bursitis Septic arthritis B. The inability to demonstrate full extension of the knee when the hip is flexed is a positive Brudzinski's sign. This is present in patients who have meningitis. It is not present in patients who have septic bursitis or septic arthritis. HIV-positive patients are more likely to exhibit pneumonia secondary to pneumocystis infection, but he has no respiratory symptoms. Which of the following describes the most common clinical presentation of trichomonas in a male? No clinical symptoms Urethritis Burning with urination Testicular pain A. Trichomonas produces classic symptoms in females of itching and discharge. In males, there are usually no symptoms. Less than 10% of time, men present with symptoms. However, when symptoms occur in males, they include urethritis with clear or mucopurulent urethral discharge and dysuria. Metronidazole can be used to treat this in symptomatic and asymptomatic patients. Prostatodynia, also known as prostatitis, is an inflammation of the prostate gland. Sometimes males with trichomonas infections present with prostatodynia, but this is not the usual presentation. In a private NP clinic, a patient presents with trichomonas. State law requires reporting of STDs to the public health department. The patient asks the NP not to report it because her husband works in the public health department. How should this be managed by the NP? Respect the patient’s right to privacy and not report it Tell the patient that it won’t be reported, but report it anyway Report it to public health as required by law. Report it to public health but don’t divulge all the details C. If state law requires reporting of the STD, it should be reported. Patient names or other identifying data are not part of the reporting process, so the NP’s patient should not worry about being identified and associated with this finding. If the NP does not report it, the NP has violated state law. If the NP reports it but doesn’t tell the patient, the NP is not being honest with the patient. Reporting data to public health with deliberate elimination of required illness details is inaccurate reporting and doesn’t meet state law. Which risk factor has the greatest impact on HIV transmission? Viral load Type of sexual activity Presence of other STDs Patient gender A. Viral load at the time of infection is the greatest risk factor in contracting HIV. It also is the greatest predictor of prognosis. High levels of viremia correspond to higher rates of infection. There are equal rates of transmission in sexual intercourse between same and opposite sex couples. The presence of STDs at the time of infection does increase risk of transmission, but not to as great an extent as viral load. A female patient has been diagnosed with chlamydia. How should this be managed? Treat with azithromycin Treat with ceftriaxone by injection Treat with doxycycline Treat for gonorrhea also A. Chlamydia is commonly treated with a single dose of azithromycin (1 gram). This patient should be screened for other STDs now, including hepatitis B, C and HIV. According to the 2015 STD guidelines, this patient should not be treated for gonorrhea unless this is diagnosed too. A 26-year-old female patient has been diagnosed with gonorrhea. How should she be managed? Ceftriaxone only Ceftriaxone and azithromycin Cefixime and azithromycin Penicillin G B. In 2015, the CDC released its most recent guidelines for management of STDs. Cefixime is no longer recommended as a cephalosporin for treatment of gonorrhea because of cephalosporin-resistant strains of gonorrhea. 250 mg ceftriaxone should be given IM in conjunction with 1 gram azithromycin by mouth when gonorrhea is diagnosed. Treatment failure should be reported to CDC. A 32-year-old female was exposed to HIV after sexual intercourse. When do the majority of patients seroconvert if they are going to do so? 1 week Within 4 weeks Within 4-6 weeks Within 3 months D. Seroconversion within 3 months is likely to occur in patients who are immunocompetent. Seroconversion may be delayed up to 6 months in patients who concurrently acquired hepatitis C at the time of HIV exposure. A male with gonorrhea might complain of: dysuria. a penile lesion. abdominal pain. fatigue. A. In males, gonorrhea can have a varied presentation. Gonorrhea produces a purulent inflammation of the mucous membranes, urethral discharge, and dysuria. It can be diagnosed with a urethral culture, a urine screen, or nucleic acid tests. Urine screens are first choice in males; vaginal swabs are preferred in females. Urine screens are used in adolescents or pediatric patients because of ease of specimen collection. The greatest risk of transmitting HIV is during: the acute phase. the time that detectable antibody is present. high viral load periods. late infection phase. C. The period of time that risk of transmission is greatest is when the viral load is high. Many times this is before a patient has been diagnosed; thus he is capable of transmitting this disease without knowledge that he is doing so. The highest viral load may occur during the earliest stages of HIV and before there is detectable antibody. A 35-year-old patient is HIV positive. Which finding on an oral swab may be indicative of thrush? Epithelial cells Yeast Spores Red blood cells B. The visualization of yeast in saliva usually indicates Candida species. Yeast are commonly seen in patients who have thrush, vaginitis secondary to yeast, or intertrigo. While thrush is uncommon in adults, it is not uncommon in patients who are immunocompromised, such as a patient with HIV. A 25-year-old female presents with lower abdominal pain. Which finding would indicate the etiology as a pelvic inflammatory disease? Presence of hyphae Hematuria Temperature > 101°F Normal sedimentation rate C. Symptoms of pelvic inflammatory disorder (PID) include oral temperature > 101° F (38.8° C), abnormal cervical or vaginal mucopurulent discharge, presence of abundant WBCs on microscopy or vaginal secretions, elevated sedimentation rate or C-reactive protein. The CDC recommends empiric treatment for PID if lower abdominal pain or pelvic pain is present concurrently with cervical motion tenderness or uterine/adnexal tenderness. An example of primary prevention is: using a condom to prevent infection with an STD. diagnosis of chlamydia prior to symptom development. treatment of chlamydia concurrently with gonorrhea. early treatment of sexual partners. A. Primary prevention refers to preventing an event prior to its occurrence. Using a condom to prevent infection from an STD is primary prevention. Early diagnosis refers to secondary prevention. Tertiary prevention refers to an intervention that has the potential to prevent worsening of the disease. Chancroid is considered a cofactor for transmission of: HIV. gonorrhea. chlamydia. trichomoniasis. A. Chancroid is an STD caused by Haemophilus ducreyi. It is spread by sexual contact or by contacting pus from an infected lesion. This is common in tropical countries but can occur in the US. The ulcer is usually very painful in men, but not usually painful in women. The ulcer begins as a papule, fills with pus, and becomes an open, eroded area. Chancroid is a cofactor in the transmission of HIV. In patients with HIV, the chancroid heals much more slowly than in patients who are immunocompetent. A patient with newly diagnosed genital herpes would appropriately receive a prescription for: cryotherapy. ceftriaxone. Imiquimod. famciclovir. D. Genital herpes is a viral infection affecting the mucous membranes. Some learned authorities consider this to be the most common STD in the United States. Herpes is treated with an oral antiviral agent like valacyclovir, acyclovir, or famciclovir. It is initially prescribed for 7-14 days. Shorter dosing periods may be given after the initial infection has been treated. Suppressive therapy is initiated when patients have multiple outbreaks. The oral antiviral agents are dosed daily for suppressive therapy and given for at least 1 year. A 21-year-old female presents with six 0.5-cm human papillomavirus (HPV) lesions on her vulva. An appropriate treatment option for this patient would be: acetic acid. Colposcopy podophyllin. acyclovir. C. This patient has HPV. This is a viral infection that increases a woman’s risk of cervical cancer. In males, HPV causes an increased risk of cancer of the anus and penis. Warts that are produced are painless and usually appear within weeks of infection. There are several topical treatments for HPV, including imiquimod, podophyllin, and trichloroacetic acid (TCA). One of these agents may be applied to warts. Treatments are generally well tolerated. TCA may cause burning. Warts will slough off after one or more treatments. There are no oral antiviral agents indicated for the treatment of HPV. Syphilis may present as: a discharge. a rash. a painful lesion. dysuria. B. Secondary syphilis can present as a rash on the body, but more commonly as a rash on the palms of the hands or soles of the feet. This can persist for up to 6 weeks. It will resolve without treatment, however, the patient will still be infected with syphilis. Primary syphilis is characterized by a chancre. This is a painless lesion that can persist for 1-5 weeks. It will resolve without treatment. [Show Less]
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APEA 3P EXAM Prep Neuro correctly solved graded A+
A patient who is 82 years old is brought into the clinic. His wife states that he was working in his garden today and became disoriented and had slurred sp... [Show More] eech. She helped him back into the house, gave him cool fluids, and within 15 minutes his symptoms resolved. He appears in his usual state of health when he is examined. He states that although he was scared by the event, he feels fine now. How should the nurse practitioner proceed? Prescribe an aspirin daily. Re-examine him tomorrow. Send him to the emergency department. Order an EKG. This patient likely suffered a transient ischemic attack. He needs urgent evaluation with head CT and/or MRI, ECG, lab work (CBC, PTT, lytes, creatinine, glucose, lipids and sedimentation rate); possible magnetic resonance angiography, carotid ultrasound, and/or transcranial Doppler ultrasonography. He is at increased risk of stroke within the first 48 hours after an event like this one. On initial evaluation, the most important determination to be made is whether the etiology of the stroke or TIA is ischemic or hemorrhagic. After this determination, treatment can begin. Unfortunately, this determination cannot be made in the clinic. The patient needs urgent referral to a center where this evaluation and possible treatment can be performed. The most common presenting sign of Parkinson’s disease is: muscular rigidity. tremor. falling. bradykinesia. Approximately 70% of patients with Parkinson’s disease have tremor as the presenting symptom. The tremor typically involves the hand but can involve the legs, jaw, lips, tongue. It seldom involves the head. Muscular rigidity and bradykinesia are two less common presenting signs. When should medications be initiated in a patient who is diagnosed with Parkinson’s disease? As soon as the disease is diagnosed When symptoms interfere with life’s activities When nonpharmacologic measures have been exhausted After MRI and CT have ruled out stroke or tumor The medications used to treat patients who have Parkinson’s disease do not prevent the progression of the disease. Therefore, it is not necessary to start medications until symptoms interfere with the patient's quality of life. Levodopa is often used initially at the lowest dose that helps a patient manage symptoms. It can be titrated upward as needed. Orthostatic hypotension is a common side effect of levodopa, so blood pressure should be monitored closely. A 72-year-old patient with history of polymyalgia rheumatica complains of new onset, unilateral headache and visual changes. Her neurologic exam is otherwise normal. Her CT results are WNL. ESR is 75 (Normal: 0-29). VS: BP 140/82, HR 67, RR 18, T 100. What is the most likely reason for her symptoms? Transient ischemic attack Temporal arteritis Meningitis CVA Polymyalgia rheumatica (PMR) is a chronic inflammatory condition that produces morning stiffness in the neck, shoulders, and hips. Its peak incidence is 70-80 years old. PMR is commonly associated with temporal arteritis, also known as giant cell arteritis. Temporal arteritis is a chronic vasculitis of the medium and large vessels. Temporal arteritis is characterized by new onset unilateral temporal headache, abrupt onset of visual disturbances, elevated sedimentation rate, jaw claudication, and unexplained fever. This is best diagnosed by temporal artery biopsy. She should be referred to neurology for evaluation today. What recommendation should be made to an older adult who is diagnosed with mild dementia? Driving will probably not increase your risk of an accident. The healthcare provider should recommend that the patient stop driving today. The healthcare provider should recommend assessment of driving to determine risk of an accident. The patient may continue to drive as long as he feels comfortable. Dementia independently increases the risk of motor vehicle accidents if the patient drives. The healthcare provider should discuss this with the patient and a family member if a family member is present during the older adult’s evaluation. Depending on the degree of impairment, the healthcare provider could recommend stopping driving, or recommend that an assessment be done. The assessment is usually completed by either an occupational or physical therapist or someone trained to assess this. A person with 20/60 vision: is legally blind. will have difficulty reading a newspaper. will be unable to see the big “E” on the eye chart. has better vision than someone with 20/80 vision. Using the Snellen nomenclature for describing visual acuity (example 20/80), the first number represents the test distance. In most cases this is 20 feet. The second number represents the distance at which the average eye can see the letters on a specific line of the chart. In other words, the examinee can see at 20 feet what an average eye (20/20) can see at 80 feet. 20/80 is a measure of distant vision, not near vision such as reading a newspaper. The big “E” represents 20/200 vision. 20/200 is considered legally blind by most standards. A patient reports a history of transient ischemic attack (TIA) 6 months ago. His daily medications are lisinopril, pravastatin, and metformin. After advising him to quit smoking, what intervention is most important in helping to prevent stroke in him? Auscultation of carotid arteries at each visit Taking low dose aspirin daily Assessing hemoglobin A1C every 3-6 months Encouraging smoking cessation at each visit Antiplatelet therapy, usually aspirin, inhibits the enzyme cyclooxygenase and reduces thromboxane A2 production, which stimulates platelet aggregation. Thus, risk of ischemic stroke is reduced. The dosage of aspirin needed to prevent an event is debatable. Most studies found that 75-150 mg daily was as effective in preventing stroke as was higher doses. Lower doses of aspirin are associated with less GI toxicity and fewer side effects. A 75-year-old is diagnosed with essential tremor. What is the most commonly used medication to treat this? Carbidopa Long-acting propanolol Phenobarbital Gabapentin Tremor is the most common of all movement disorders and essential tremor is the most common cause of all tremors. It is characterized by rhythmic movement of a body part, commonly the hands or head. Beta blockers are the most commonly used medication class to treat essential tremor. Propanolol is the most commonly used medication, but other beta blocking agents are used as well. Both gabapentin and phenobarbital are used, but, not nearly as often. Carbidopa is used in patients with Parkinson’s disease. A patient who had an embolic stroke has recovered and is performing all of her activities of daily living. Taking aspirin for stroke prevention is an example of: primary prevention. secondary prevention. tertiary prevention. quaternary prevention. The patient is taking aspirin to prevent recurrent stroke. Research demonstrates that taking an aspirin daily can significantly reduce the risk of subsequent strokes and MI. Secondary prevention means that the intervention is performed to prevent another occurrence of the deleterious event. If she had never had a stroke but took aspirin daily for prevention of stroke, that would be primary prevention. Taking aspirin at home during the course of having an MI is an example of tertiary prevention. There is no reference in the literature to quaternary prevention. [Show Less]
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APEA 3P Exam Prep- GI question with complete solution 2023
The relationship between colon polyps and colon cancer is those polyps: eventually, all become malignant. have a slow progression to colon cancer. ... [Show More] 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 patient has been diagnosed with hepatitis B. The most commonly reported risk factor is: drinking contaminated 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 belching and flatulence. 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 are no potential 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 with standing Muscle cramps Hair loss B. This patient does not meet the strict criteria for an eating disorder, but it should be suspected. The other laboratory values are not the cause of her dizziness with standing. This is likely due to a low hemoglobin. She needs treatment for a probable iron deficiency anemia and elicitation of history to help identify the cause of her low hemoglobin. A 45-year-old patient has the following laboratory values. How should they be interpreted (Labs in image)? The patient has hepatitis. The patient had hepatitis. The patient should consider immunization. The results are indeterminate A. This patient has a positive hepatitis B surface antigen (HBsAg). Therefore, he has hepatitis B. A positive anti-HBc is found in patients who either have hepatitis now or who have had it. The surface antibody (anti-HBs) would be expected to be negative in a patient with a positive surface antigen (HBsAg) because these two markers will not be positive at the same time. A 37-year-old has routine blood work performed during an annual exam. On exam, he has a tender, enlarged liver. How should the nurse practitioner proceed (Labs in image)? Repeat the liver enzymes today. Order a hepatitis panel. Have patient return in one week for recheck. Order a CBC. B. The differential for a patient with elevated liver enzymes can reflect many different etiologies. Since the liver is tender and liver enzymes are elevated, a likely etiology is hepatitis. The size and consistency of the liver should be ascertained. The spleen should be assessed. If it is palpable, it is enlarged also. Hepatitis panel should be performed and strong consideration given to referral to gastroenterology. Repeating liver enzymes might be considered if the rest of the exam was normal and the lab values were the only abnormal values. The results of a CBC will not change the differential. The patient’s abnormal labs and exam make this urgent, and waiting a week will delay diagnosis and possible treatment. Many older adults have cachexia. What characterizes this? Anorexia and weight loss Weakness and fatigue Illness and loss of muscle mass Starvation and weight loss C. Cachexia is common in older adults and is associated with increased mortality. It is described as a syndrome of underlying illness that is accompanied by loss of muscle mass. Illnesses associated with cachexia are malignancies, renal disease, COPD, and chronic heart failure. Other matters are associated with cachexia and may contribute to loss of muscle mass. These include loss of appetite, insulin resistance, and increased catabolism of bodily proteins. A 70-year-old patient states that he had some bright red blood on the toilet tissue this morning after a bowel movement. He denies pain. What is the LEAST likely cause in this patient? Hemorrhoids Diverticulitis Colon cancer Anal fissure D. Nearly 1 in 3 patients in this age group with acute lower gastrointestinal bleeding have bleeding secondary to diverticulitis. Nearly 1 in 5 have colorectal cancer or polyps, though, polyps usually do not bleed. Patients who have anal fissures often complain of a tearing pain during bowel movements. Regardless of the etiology, this patient needs referral for a colonoscopy to identify the cause of bleeding. He is at high risk for colon cancer because of his age. The appropriate recommendation is referral to gastroenterology for colonoscopy. A patient has received a prescription for metronidazole for treatment of C. difficile. What should be avoided in this patient? Excess fluids Vitamin B12 Grapefruit juice Alcohol D. Patients should always be cautioned against alcohol ingestion (in any form) if they take metronidazole. Alcohol can (and usually does) produce a disulfiram reaction. This is characterized by abdominal cramps, nausea, vomiting, headache, and elevated body temperature. Precautions should remain until 72 hours after the last dose of metronidazole. Older adults frequently complain of constipation. Which medication listed below does NOT increase the likelihood of constipation in an older adult? Diltiazem Hydrochlorothiazide Calcium supplements Metformin D. Diarrhea, not constipation, is a common side effect of metformin. Constipation is a common complaint in older adults because of medications they routinely consume and many diseases they often have. Some examples of medications that can cause constipation are opiate analgesics, NSAIDs, and antacids. Some diseases and conditions that can produce constipation are hypothyroidism, colon cancer, electrolyte abnormalities, immobility, and change in diet due to inability to chew food properly. Which set of symptoms is most likely in a patient infected with C. difficile? Headache, diarrhea, body aches Body aches, fever, abdominal cramps Fever, headache, diarrhea Diarrhea, abdominal pain, nausea or vomiting D. The classic symptoms that patients with C. difficile experience are diarrhea, abdominal pain, and nausea or vomiting. This patient should be treated because symptoms are present. If no symptoms or mild symptoms are present, treatment can be delayed until symptoms develop or worsen. All patients who are infected do not exhibit symptoms. They do not need treatment. A 56-year-old male patient has been diagnosed with an inguinal hernia. What symptom would make the nurse practitioner suspect an incarcerated hernia? Dilated scrotal veins Change in skin color Constipation Pain D. [Show Less]
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APEA 3P Exam Prep- Dermatology question with answers 100% correct
APEA 3P Exam Prep- Dermatology question with answers 100% correctImpetigo is characterized by: honey-colored crusts. silvery scales. marble-like ... [Show More] lesions. wheals with pus. A. Impetigo is a superficial bacterial infection of the skin characterized by honey-colored 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 are these termed? Vesicles Bullae 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. The best way to evaluate jaundice associated with liver disease is to observe: blanching of the hands, feet, and nails. the sclera, skin, and lips. 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 physiologic jaundice. 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 on the trunk. A topical treatment for basal 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 is effective if used for superficial basal cell carcinomas. It is available in cream and solution and is usually applied twice daily 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 should be recommended? Tetanus toxoid only Tetanus and diphtheria only His primary series will protect him. Tetanus, diphtheria, and acellular pertussis (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, healthcare providers, 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 Td immunization. 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 the hand. What is this called? Seborrheic dermatitis Dyshidrotic dermatitis Herpes 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. A 71-year-old female presents with a vesicular rash that burns and itches. Shingles is diagnosed. An oral antiviral: should be started within 72 hours of the onset of symptoms. must be started within 96 hours of the onset of the rash. can be started at any time after the appearance of the rash. will nearly eliminate the risk of postherpetic neuralgia. A. This patient has been diagnosed with shingles. This can produce painful neuritis. Shingles is treated with an oral antiviral agent, preferably within 72 hours of onset of the symptoms. Treating shingles with an oral antiviral agent shortens the severity and duration of shingles. It may also help decrease the incidence of post-herpetic neuralgia. A patient presents with plaques on the extensor surface of the elbows, knees, and back. The plaques are erythematous and thick, silvery scales are present. This is likely: plaque psoriasis. guttate psoriasis. atopic dermatitis. Staph cellulitis. A. Plaque psoriasis is seen initially in young adults and is characterized as described above. The thick, silvery scale is pathognomic and is usually asymptomatic, but some patients will complain of pruritus. A clinical finding that will help establish a diagnosis is the pitting of fingernails. This occurs in about 50% of patients with psoriasis. The plaques are commonly distributed on the scalp, and extensor surface of the elbows, knees, and back. This is a chronic skin disorder. An example of a premalignant lesion that develops on sun-damaged skin is: actinic keratosis. basal cell carcinoid. squamous cell carcinoma. molluscum contagiosum. A. Actinic keratoses (AK) are a result of solar damage to the skin. They are most common on the face, bald scalp, and forearms. Patients who present with AK usually have multiple of them. A characteristic that helps identification of AK is an area of erythema that surrounds the lesion. AK is sometimes easier felt than seen. A patient has been in the sun for the past few weeks and has developed darkened skin and numerous 3-6 mm light-colored, flat lesions on his trunk. What is the likely etiology? Tinea corporis Tinea unguium Tinea versicolor Human papilloma virus C. Tinea versicolor is typically visualized during the spring and summer months when a patient has become darkened after sun exposure. The areas that are infected do not tan and so become very noticeable. The chest and back are common areas to observe tinea versicolor. There can be 100 or more in some infections. This can be treated with topical selenium sulfide or an oral antifungal agent. A patient with a primary case of scabies was probably infected: 1-3 days ago. 1 week ago. 2 weeks ago. 3-4 weeks ago. D. The incubation period for scabies is about 3-4 weeks after primary infection. Patients with subsequent infections with scabies will develop symptoms in 1-3 days. The classic symptom is itching which is worse at night, coupled with a rash that appears in new areas over time. A patient presents to the minor care area of the emergency department after being bitten by a dog. The patient states that the dog had a tag around his neck and had been seen roaming around the neighborhood for days before the patient was bitten. The dog did not exhibit any odd behavior. How should this be managed? If the bites are only minor, do not mention rabies prophylaxis to the patient. Give the patient tetanus immunization only. Don’t call animal control. Clean the wounds, provide tetanus and rabies prophylaxis. Report the bite to animal control and administer appropriate medical care. D. All 50 states require reporting of animal bites to animal control or the state’s appropriate authority for reporting animal bites. It sounds unlikely that the dog could be infected with rabies, but rabies prophylaxis must be considered after all history and information has been gathered. A wound has the following characteristics; partial thickness loss of dermis, a shallow open ulcer with red/pink bed, and no evidence of sloughing. What stage of pressure ulcer does this describe? Stage I Stage II Stage III Stage IV B. Stage I is characterized by intact skin and non-blanchable redness of a localized area (usually over a bony prominence). Compared to adjacent tissue, the area may be painful, firm, soft, warmer or cooler. Stage II is characterized by partial-thickness loss of dermis presenting as a shallow open ulcer or a red-pink wound bed, absent sloughing. It may also present as an intact or open/ruptured serum-filled blister. Stage III is characterized by full-thickness tissue loss with or without visible subcutaneous fat; bone, tendon, and muscle are not exposed. Sloughing may be present but does not obscure the depth of tissue loss. The depth varies by anatomical location. Stage IV is characterized by full-thickness tissue loss with exposed bone, tendon, or muscle. Sloughing or eschar may be present on some parts of the wound bed. The depth varies by anatomical location. The nurse practitioner examines a patient who has had poison ivy (hiedra venenosa) for 3 days. She asks if she can spread it to her family members. The nurse practitioner replies: “Yes, but only before crusting has occurred.” “Yes, the fluid in the blister can transmit it.” “No, the transmission does not occur from the blister’s contents.” “No, you are no longer contagious.” C. The skin reaction seen after exposure to poison ivy (hiedra venenosa), takes place because of contact with the offending substance. In the case of poison ivy, the harmful exposure occurs from contact with oil from the plant. The eruptions seen are NOT able to transmit the reaction to other people unless oil from the plant remains on the skin and someone touches the oil. The fluid found in the blisters is NOT able to transmit poison ivy to anyone; only the oil from the plant can do that. After the oil has touched the skin, some time must pass for the reaction to occur. Therefore, reaction times vary depending on skin thickness and the quantity of oil contacting the skin. A “herald patch” is a hallmark finding in which condition? Erythema infectiosum Pityriasis rosea Seborrheic keratosis Atopic dermatitis B. Pityriasis rosea (PR) is a self-limiting exanthematous skin disorder characterized by several unique findings. It is more common in young adults. A characteristic finding is the “herald” or “mother” patch found on trunk. This looks like a ringworm and precedes the generalized “Christmas tree” pattern rash. The lesions associated with the rash are salmon-colored and oval in shape. Most cases clear in 4-6 weeks, but the plaques may last for several months. A 74-year-old woman is diagnosed with shingles. The NP is deciding how to best manage her care. What should be prescribed? An oral antiviral agent An oral antiviral agent plus an oral steroid An oral antiviral agent plus a topical steroid A topical steroid only A. An oral antiviral agent such as acyclovir, famciclovir or valacyclovir should be prescribed, especially if it can be initiated within 72 hours after the onset of symptoms. The addition of oral corticosteroids to oral antiviral therapy demonstrates only modest benefits. Adverse events to therapy are more commonly reported in patients receiving oral corticosteroids. There is no evidence that corticosteroid therapy decreases the incidence or duration of postherpetic neuralgia or improves the quality of life. Corticosteroids should be limited to use in patients with acute neuritis who have not derived benefits from opioid analgesics. An example of a first-generation cephalosporin used to treat a skin infection is: cephalexin. cefuroxime. cefdinir. cefaclor. A. Two common first-generation cephalosporins used to treat skin and skin structure infections are cephalexin and cefadroxil. These are taken two to four times daily and are generally well tolerated. These antibiotics provide coverage against Staphylococcus and Streptococcus, common skin pathogens. A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate: hyphae. yeasts. rods or cocci. a combination of hyphae and spores. A. Under microscopic exam, hyphae are long, thin and branching, and indicate dermatophytic infections. Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis. Yeasts are usually seen in candidal infections. Cocci and rods are specific to bacterial infections. A patient has been diagnosed with MRSA. She is allergic to sulfa. Which medication could be used to treat her? Augmentin Trimethoprim-sulfamethoxazole (TMPS) Ceftriaxone Doxycycline D. MRSA is methicillin-resistant Staph aureus. This is very common in the community and is typically treated with sulfa medications like TMP/SMX (Bactrim DS and Septra DS). If the patient is allergic to sulfa, this should not be used. A narrow-spectrum antibiotic that can be used is doxycycline or minocycline. It is given twice daily and is generally well tolerated. MRSA is resistant to the antibiotics in the other choices and so they should NOT be used to treat it. [Show Less]
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Very important AA-AEPA study material question and answer 2023
The diagnosis that must be considered in a patient who presents with a severe headache of recent onset with neck stiffness and fever is: . meningitis... [Show More] A 6 year old African-American child has a round alopecic patch on his scalp. There is scaling of the lesion and broken hair shafts. What is this child's diagnosis and what is the most appropriate nurse practitioner action? This is tinea capitis. The child should be started on an oral antifungal daily for 6 weeks. Which immunization(s) is(are) contraindicated in an immunodeficient individual? 1. Varicella 2. IPV 3. MMR 4. HBV 1, 3 (Varicella and MMR) Which of the following diagnostic assessments must be considered before developing any plan of care for a 27 year old female presenting to a family practice clinic? Pregnancy test The result of the Weber tuning fork test is lateralization of sound to the right ear. This finding indicates a: conduction problem in the right ear Which of the following patients is at highest risk of suicide? 70 year old male Which of the following lifestyle changes has demonstrated effectiveness in the prevention of coronary disease, hypertension, obesity, diabetes, osteoporosis, and mental health disorders? Regular physical activity A 30 year old female has varicose veins. These are: usually diagnosed on clinical presentation Which of the following is an example of Piaget's concrete logical operation? A 7 year old child maintains that a ball of clay weighs the same amount after it has been shaped into a snake. A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect: herpes zoster and consider that this patient may be immunocompromised. Which of the following findings would raise the nurse practitioner's suspicion of bulimia in a 17 year old female? Scars on her knuckles Which of the following is NOT true regarding the diagnosis of scoliosis in children? Kyphosis in the adolescent indicates scoliosis Which cranial nerves are responsible for eye movement? CN III, IV, VI A patient reports, "something flew in my eye" about an hour ago while he was splitting logs. If there was a foreign body in his eye, the nurse practitioner would expect to find all EXCEPT: A purulent discharge. A woman of childbearing age is contemplating pregnancy. By prescribing folic acid 0.4 mg daily, the nurse practitioner is practicing: primary prevention. Prescriptive authority for APRNs is: legislated and regulated at the state level. Which of the following diseases is NOT acquired transplacentally? Tuberculosis An active 45 year old male presents to your clinic today. His vital signs are normal. He has complaints of tightness in his chest after painting a room in his house yesterday. His pain disappeared quickly when he stopped. He is asymptomatic at the time of this visit. What is the appropriate action by the nurse practitioner? Order an ECG and initiate a cardiac evaluation. A first time mother asks the nurse practitioner when she should start feeding her baby cereal. The nurse practitioner replies: not before 4 to 6 months-of-age. Which of the following must be present for the diagnosis of bacterial vaginosis? . Presence of clue cells Appropriate treatment for seborrheic dermatitis includes all of the following EXCEPT: . oral and/or topical acyclovir. Which of the following therapies should a person with degenerative joint disease (DJD) NOT receive? Systemic steroids A patient requests information about foods to include in his diet while vacationing in Mexico to avoid "Montezuma's revenge." The nurse practitioner should advise him to ingest only: cooked vegetables in soup, bottled water, and wine. . The nurse practitioner is inspecting the skin on a 63-year-old patient and notes a single pearly-gray papule with a raised border, central clearing, and telangiectasias. The lesion is located on the patient's posterior neck. What is the most likely diagnosis? Basal cell carcinoma A 68 year old female presents with complaints of yellowed and thickened toenails. The nurse practitioner diagnoses onychomycosis and prescribes an oral antifungal agent. The patient asks "how long before this is cured."The nurse practitioner responds: "probably 9 to 12 months." What is the leading cause of death and unintentional injury in the elder population? Fall [Show Less]
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