Barkley FNP Exam 2023/2024
Which of the following is not a part of the usual management options for patients with an acute presentation of
... [Show More] cholecystitis?
Intravenous crystalloids and broad spectrum antibiotics Daily non-steroidal anti-inflammatory drugs Nasogastric intubation
Gastrointestinal surgical consult - Daily non-steroidal anti-inflammatory drugs
Why?
While non-steroidal anti-inflammatory drugs (NSAIDs) can be utilized in managing the pain associated with acute cholecystitis, the patient's level of pain determines the type of pain management medications he or she is given. Hence, a daily regimen is not necessarily indicated for management of cholecystitis. Treatment of acute cholecystitis usually requires surgical intervention. All the other choices are utilized in the treatment of patients acutely ill with cholecystitis.
A new patient comes to your facility seeking your assistance recovering from a myocardial infarction. In his life, he has dealt with legal ordeals with his family. Even for the treatment he receives from you, he has a written statement of his intent regarding medical treatment. Of the following choices, which is the best description of this document?
Patient self-determination statement Advanced directive
Living will
Healthcare directive - Advanced directive Why?
This medical patient has an advanced directive. This directive is a set of instructions specifying what actions should be taken for the patient's health in the event the patient is no longer able to make decisions due to illness or incapacity. A healthcare directive is a type of advanced directive but one that may include a living will and/or specifications regarding durable power of attorney in one or two separate documents. A living will is a written compilation of statements in document format that specifies which life-prolonging measures one does and does not want to be taken if he/she becomes incapacitated.
Further, a living will includes naming a proxy or agent who will have durable power of attorney. There is no such thing as a patient self-determination statement, but the Patient Self-Determination Act applies to the idea of advanced directives as, the bill requires that all patients entering a hospital should be advised of their right to execute an advanced directive.
A patient is prescribed nitroglycerin to alleviate symptoms of chest discomfort that occur especially during activity, such as exercise, but also sometimes at rest. The patient's electrocardiogram is normal on today's reading. For which of the following conditions is the patient most likely being treated?
Chest wall pain Myocardial infarction Stable angina
Prinzmetal's angina - Prinzmetal's angina
After being laid off six months ago, your patient, Martin, is doing everything he can to save money. He has, on occasion, kept food past its expiration date rather than buy more. Now he comes to you and presents with signs of a bacterial infection. You decide to prescribe a beta-lactam antibiotic. Which of the following medications should you not prescribe?
Bactrim Amoxicillin Keflex
Penicillin - Bactrim
Reggie, a 30-year-old male, comes to your clinic complaining of a skin infection on his arm. "It's as big as a grape," he says in great surprise, pointing at it. You note that the infection is pus-filled and localized around a hair follicle. Which of the following organisms is the most likely cause of this infection?
Enterobacter Staphylococcus pyogenes Escherichia coli
Staphylococcus aureus - Staphylococcus aureus
Which of the following contraceptive methods, if prescribed to a female patient, should you recommend that she does not massage the injection site after administration?'
Depo-Provera Intrauterine device Implanon
Ortho-Evra - Depo-Provera
The nurse practitioner is reading an interesting article that outlines a new protocol for the management of chronic obstructive pulmonary disease. She notices that the article was published in a well-known, peer-reviewed journal. Concerning the efficacy of the new protocol, which of the following is most important to consider before the practitioner adapts this new protocol to her practice?
T-test R-value
Standard deviation P-value - P-value
Mary, a 40-year-old female, comes to your clinic complaining of painful, swollen joints. She says that she often feels weak and has lost the desire to eat. You ask her about the intensity of her pain, and she replies that it is "dreadful in the morning, but it gets better as the day goes on." Which of the following single treatments would be least effective in her overall treatment plan in chronic management?
Steroids
Gold salt injections Acetaminophen
Methotrexate - Acetaminophen
why? Based on the patient's joint pain that improves as the day progresses, she is most likely experiencing rheumatoid arthritis. Therefore, acetaminophen is the least appropriate prescription. Although this medication may help alleviate some of the patient's pain, this medication is a regular part of osteoarthritis management rather than for the management of rheumatoid arthritis. Methotrexate, steroids, and gold salt injections, on the other hand, are all regular parts of rheumatoid arthritis management.
Eclampsia is characterized by the findings of pregnancy-induced hypertension and preeclampsia combined with a seizure. There may also be prodromal symptoms such as severe headache plus either epigastric or right upper quadrant pain. Which of the following would not be employed in testing for eclampsia?
Twenty-four hour urine protein Fetal surveillance
Urine human chorionic gonadotropin
Complete blood count - Urine human chorionic gonadotropin Why?
Urine human chorionic gonadotropin is used to determine pregnancy, but it is not used to test for eclampsia. A complete blood count and 24-hour urine protein tests should be performed when eclampsia is first suspected. Fetal surveillance should occur in a hospital.
Mandy arrives at your clinic with her 1½-year-old toddler, Tamara, who is bow-legged. A former dancer, Mandy is distraught that her daughter may not be able to dance herself unless corrective measures are taken. Tamara is otherwise perfectly healthy. What should the nurse practitioner advise the mother concerning her child's bowlegs?
Limited walking
Wait and continue to observe Braces for the legs
Exercise and physical therapy - Wait and continue to observe
Why? Tamara is presenting with genu varum, otherwise known as bowlegs, a condition that is quite normal in toddlerhood. Since the child may grow out of it, the best advice for the nurse practitioner to provide, in this case, is to wait and continue to observe. If the condition does persist, there are a wide range of treatment options, including lifestyle restriction, nonsteroidal anti-inflammatory drugs, and physical therapy. In recalcitrant cases, surgery may be advised. However, these options are not yet necessary.
Aubrey is 36 and looking for a new form of birth control. You take her history, and learn, surprisingly, that she had a stroke when she was 20. Which of the following would greatly increase her risk for another cardioembolic event?
Depo-Provera Implanon Ortho Evra
Copper-releasing intrauterine device - Ortho Evra
A new patient tells you that he has been under the care of an endocrinologist for a number of years. In reviewing his current medications, you notice the drug fludrocortisone acetate. For which of the following conditions is this patient most likely being treated?
Hypothyroidism Cushing's syndrome Addison's disease
Hyperthyroidism - Addison's disease
Which of the following is the most accurate description of the Dubowitz tool?
The Dubowitz tool is a gestational assessment tool that evaluates an infant's reflexes, including Moro, tonic neck, grasping, rooting, and sucking.
The criteria evaluated with the Dubowitz tool are influenced by labor and birth; therefore, a second exam may be needed to pick up any changes in a newborn.
The Dubowitz tool is used to estimate gestational age by examining the physical characteristics and neuromuscular development of a newborn.
The Dubowitz tool is used to assess the physical condition of a newborn at birth. - The Dubowitz tool is used to estimate gestational age by examining the physical characteristics and neuromuscular development of a newborn.
Darlene, a 38-year-old female, comes to your office and states that she has difficulty hearing with her left ear. You conduct the Weber and Rinne tests, and the results indicate lateralization to her right ear. Furthermore, the results show that air conduction is better than bone conduction, with a ratio of 2:1, in both ears; the air conduction time of the left ear 10 seconds and the bone conduction time is 5 seconds, while the air conduction and bone conduction time of right ear is 30 seconds and 15 seconds, respectively. What is the most accurate interpretation of these results?
The patient may have right sensorineural hearing loss. The patient may have conductive hearing loss.
The patient may have left sensorineural hearing loss.
The test results are reflective of normal hearing. - The patient may have left sensorineural hearing loss.
Why?
The test results indicating sound lateralizing to the unaffected ear, the patient's right ear, and air conduction greater than bone conduction can be interpreted as sensorineural hearing loss in the left ear. Weber and Rinne tests result indicative of normal hearing are sounds heard bilaterally with air conduction longer than bone conduction. Conductive hearing loss is indicated by sound that lateralizes to the affected ear with bone conduction greater than air conduction. Right sensorineural hearing loss would be indicated by sound lateralizing to the left ear with air conduction greater than bone conduction.
Michelle, 33, visits your clinic for an evaluation of her sickle cell anemia prognosis. Using your knowledge of the anemia and its diagnosis, what is the most reasonable test that you would perform to determine Michelle's prognosis?
Peripheral smear Schilling test Electrophoresis
Measure hemoglobin levels - Electrophoresis Why?
A cellulose acetate and citrate agar gel electrophoresis are used to confirm the hemoglobin genotype and is the best prognostic test for a sickle cell anemic patient. Although a peripheral smear is also used in regard to sickle cell anemia, it is used to show the classic distorted sickle-shaped red blood cells, which would provide a diagnosis, not a prognosis. The Schilling test determines whether or not a B12 deficiency exists and would be more commonly associated with pernicious anemia. Finally, although measuring hemoglobin levels would certainly be appropriate for an individual with sickle cell anemia as hemoglobin levels often decrease, it would not be used for a proper prognosis.
Jackie has a two-day history of an eye infection. Her signs and symptoms include erythema on the right eyelid, localized pain, and tearing. A physical examination reveals the presence of a small, tender mass on the infected eyelid. Which of the following is the most likely diagnosis of Jackie's condition?
Chalazion Blepharitis Hordeolum
Bacterial conjunctivitis - Hordeolum
The patient's erythema, localized pain, and a small, tender mass on the affected eyelid indicate a hordeolum.
To ensure that your research methods are providing the intended data, you choose three parameters that you wish to test for and construct three questions as each. After collecting the results, you look for variance within each group of three answers. Which of the following research principles have you appealed to in verifying your research?
Sensitivity Reliability Validity
Internal consistency - Internal consistency
Why?
Internal consistency measures the reliability of inquiries (or instruments) by grouping together various instruments all aimed at achieving the same response. By asking the same three questions three different ways, you have tested whether each instrument is providing the appropriate information. An instrument's validity is tested by ensuring that the variable itself is tested accurately and yields the intended information. Sensitivity measures the proportion of actual positives to false positives (e.g., a pregnancy test that is 99% sensitive after a trial of 1000 uses indicates that about 990/1000 tests were accurate). Reliability gauges if an instrument will measure results the same way over time; test questions repeated over multiple administrations indicate high reliability when they elicit the same response from the same test takers.
You saw Alexander and Maya through the birth of their son, David. Now, three months later, they say they are ready to resume sexual intercourse. They do not want to conceive, but they are against using contraceptive measures, as it conflicts with their religious views. Of the choices, which provides the longest period in which a couple could engage in intercourse with minimalized risk of conception?
Basal body temperature graph Calendar method
Lactational amenorrhea method
Cervical mucus test - Lactational amenorrhea method Why?
The lactational amenorrhea method can last up to six months. The calendar method, basal body temperature method, and cervical mucus test are all dependent on brief intervals between a female's menstrual cycle, giving, at best, a few weeks at a time in which a couple could have intercourse while avoiding pregnancy.
Carla, 27, just left a difficult marriage and is back on the dating singles' scene. Mindful of sexually transmitted diseases, she inquires about the vaccines for hepatitis B, Recombivax
HB and Engerix-B. She asks about the schedule of the vaccinations. After the vaccinations are first administered, when should she receive her next two doses?
Six months and then 12 months One month and then six months One month and then two months
One month and then 12 months - One month and then six months
Why?
Hepatitis B is one of the few sexually transmitted diseases that can be prevented. For maximum effectiveness, the hepatitis B vaccines need to be administered at one month and six months after the first administration.
Martin, 22, has been seeing you for migraine treatment. During the visit, you notice his strange stance. You ask about it, and he reluctantly admits to a recent onset of testicular pain. You tell him it is in his best interest to tell you what is wrong so you can help him. He informs you that he has also experienced thick discharge from his penis along with painful urination. Based on these symptoms, you suspect chlamydia. Which of the following tests would best confirm your suspicion?
Enzyme-linked immunosorbent assay Papanicolaou stain
Viral culture
Enzyme immunoassay - Enzyme immunoassay
Why?
Enzyme immunoassay is the preferred method used to test for chlamydia. It is low-cost and only takes between 30 to 120 minutes for results. Enzyme-linked immunosorbent assay is used not in diagnosing chlamydia but rather in diagnosing AIDS. Both Papanicolaou and Tzanck stains are used in the diagnosis of herpes. Chlamydia is a bacterial infection, so a viral culture would not be effective during its diagnosis.
A patient comes to your office and says, "I feel so nervous that I think I'm going out of my mind! I also can't stop shaking, and my heart races all the time." You learn that she smokes cigarettes, but the patient denies any previous health problems, including hypertension or diabetes. Of the choices, what would be the most reasonable diagnosis in this situation?
Hypothalamic deficiency of thyrotropin-releasing hormone Grave's disease
Pituitary deficiency of thyroid-stimulating hormone Hashimoto's thyroiditis - Grave's disease
Why?
Graves' disease is the most common presentation of hyperthyroidism and occurs when the thyroid gland overproduces the hormone thyroxine as a result of a mistaken immune system attack. Symptoms include anxiety, difficulty sleeping, and a rapid or irregular heartbeat, among others. The other choices are related to hypothyroidism rather than hyperthyroidism.
A patient comes to your office and complains of "the worst flu" he has ever experienced. The patient presents with extreme weakness, muscle fatigue, cramps, and cold intolerance, but also constipation and weight gain. You also notice the patient's dry skin, brittle nails, and puffy eyes. "Must be some kind of allergy, or this dry weather here in L.A.," the patient adds. After performing some lab tests, the patient shows elevated levels of thyroid- stimulating hormone, T4 is low, and resin T3 uptake is decreased. What is the patient's diagnosis?
Subacute thyroiditis Grave's disease Hyperthyroidism
Hypothyroidism - Hypothyroidism
You tell a young woman that you want to prescribe oral contraceptives to treat her acne. She tells you that her previous treatment of topical antibiotics had some extremely unpleasant side-effects and asks what some of the negative side effects of this therapy are. Which of the following is a side effect specifically associated with oral contraceptives?
Redness to cheeks Mild swelling
Generalized hyperpigmentation
Superficial itching - Generalized hyperpigmentation
Why?
Oral contraceptives may cause brownish blotches or melasma (hyperpigmentation) on the skin. Swelling, redness, and superficial itching may be side-effects of topical acne treatments but are not side-effects of oral contraceptives.
What is the purpose of the reporting system established by The Patient Safety and Quality Improvement Act?
List medical errors of healthcare providers and allocate liability List patients with pre-existing conditions to healthcare providers Provide patients information about healthcare provider error rates
Resolve patient safety and health care quality issues - Resolve patient safety and health care quality issues
You are doing a Well Child Check on a 7-year-old Caucasian boy. His temperature and other vital signs are normal, but you note only a small height gain since the last visit. The boy
remains slightly shorter than his peer group. His father mentions that the boy has been limping, and the child tells you that he feels moderate pain in his knee and sometimes in his groin. Further examination reveals limited passive internal rotation and abduction of the hip joint with mild guarding. His father cannot recall, nor do you see, overt evidence of any recent trauma. Which of the following is the most likely diagnosis?
Septic arthritis
Legg-Calve-Perthes disease Osgood-Schlatter disease
Hass' disease - Legg-Calve-Perthes disease
A patient with obsessive compulsive disorder comes to your office after recently having sex with a prostitute. The patient presents with no findings indicative of any STDs, but he wants to know which symptoms he should be aware of, particularly in regards to HIV. Which of the following is traditionally not one of the early signs and symptoms of HIV infection?
Fever Dysuria Weight loss
Night sweats - Dysuria Why?
Flu-like symptoms can present during seroconversion, the process by which a HIV infected person's body develops antibodies to the disease; however, dysuria is not associated with this process or the early stages of this disease. The early stages of HIV can often be asymptomatic but can also be indicated by a constellation of symptoms that include night sweats, fever, and weight loss, among others.
Tyrone, a 17-year-old amateur boxer, is rushed to the emergency room with a 40-hour history of abdominal pain. Despite the pain, he continued to train for an upcoming boxing match. Last night, however, the pain became so severe, it forced him to stop. On exam, you note that there is right lower quadrant guarding with rebound tenderness, pain with his right thigh extension, and pain with rotation of his flexed right thigh. The patient says he has been experiencing nausea. Considering the length of time since the signs began, which of the following should the nurse practitioner be most concerned about?
High fever Appendiceal abscess Peritonitis
Perforation - Perforation
A 63-year-old female comes to the office wearing high-heeled shoes. She states, "I feel as though I'm standing on a pebble," and complains of a shooting pain between her toes. What is the most likely diagnosis?
Polymyalgia rheumatica Plantar fasciitis Costochondritis
Morton's neuroma - Morton's neuroma
A 34-year-old male is complaining of pain in his wrist. He says that he is a tailor and that he sews for nearly eight hours a day, and the pain is especially bad by the time he gets home at night. The nurse practitioner (NP) taps a specific nerve on the flexor surface of the patient's wrist to determine if a tingling sensation radiates from the wrist to the hand. Which nerve did the NP tap?'
Ulnar Medial Radial
Median - Median
You have just diagnosed a 67-year-old patient with pneumonia. The patient also has two other chronic conditions: diabetes mellitus type 2 and metabolic syndrome. According to the latest guidelines of the Infectious Diseases Society of America and American Thoracic Society, which treatment would be best for this patient?
Moxifloxacin Doxycycline Clarithromycin
Azithromycin - Moxifloxacin
Why?
According to the guidelines of the Infectious Diseases Society of America and American Thoracic Society, a patient who has pneumonia along with multiple comorbidities should be treated with a fluoroquinolone, such as moxifloxacin. Patients with no comorbidities who are under the age of 60 can be effectively treated with a macrolide, such as doxycycline, azithromycin, and clarithromycin.
Janet is a 30-year-old Greek journalist seeing you for a complete physical assessment before accepting a long-term post in the Middle East. She says that she is feeling healthy, but upon reviewing her blood work, you notice smaller-than-normal erythrocytes and decreased ? hemoglobin chains. Given the most likely diagnosis, which of the following is not an expected finding?
Low mean cell hemoglobin concentration Decrease in alpha or beta hemoglobin chains Low serum ferritin
Normal total iron-binding capacity - Low serum ferritin Why?
Thalassemia is a genetic condition that presents with abnormal hemoglobin production, leading to hypochromic levels of microcytic erythrocytes and anemia.
Patients with thalassemia will also have normal total iron-binding capacity and normal ferritin levels.
Unlike iron deficiency anemia, patients with uncomplicated thalassemia will present with normal levels of serum ferritin.
Which of the following conditions is best evidenced by papilledema? Hypertension
Vascular hemorrhage and perforation Diabetes
Heart failure - Hypertension
A 55-year old male patient presents to your office complaining of severe pain that is centered in his right eye. Moreover, he also has nasal decongestion in his right nostril. You learn that his symptoms have been occurring several times each week for the past month. Which of the following is the most likely diagnosis?
Tension headaches Trigeminal neuralgia Migraine headaches
Cluster headaches - Cluster headaches
Seven-year-old Colin comes to your office. His parents explain that he has been bed-ridden with bronchitis for the past five days. His father tells you that Colin was limping yesterday but was able to get out of bed much more easily than the previous four days. Colin tells you that he feels some pain in his left hip. An examination indicates Colin's temperature is normal. While holding the hip in flexion with slight abduction and external rotation, you do not detect any limitation in Colin's range of motion. When you try the log roll test, you detect involuntary muscle guarding on the left side but no swelling or redness in the hip. Of the following, which is the most likely diagnosis?
Septic arthritis Toxic synovitis
Slipped capital femoral epiphysis
Juvenile rheumatoid arthritis - Toxic synovitis [Show Less]