NP board exam review: Class book 207 Questions with Verified Answers
A patient has hyperactive reflexes of the lower extremities. The
... [Show More] adult-gerontology acute care nurse practitioner assesses for ankle clonus by: - CORRECT ANSWER sharply dorsiflexing and maintaining the foot in this position, while supporting the knee.
A 15-year-old patient with type 1 diabetes mellitus reports elevated blood glucose levels in the morning. The adult-gerontology acute care nurse practitioner determines that the patient's hyperglycemia is due to the dawn phenomenon and - CORRECT ANSWER increases the insulin dosage at bedtime
A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace), is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is intravenous - CORRECT ANSWER ceftriaxone
A patient who has been in the intensive care unit for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to - CORRECT ANSWER The right answer was replenish volume by infusing a 0.9% sodium chloride solution
Cytology is evaluated with - CORRECT ANSWER fine needle biopsy
What is the single best predictor of one's health status? - CORRECT ANSWER health literacy
Patient Health Questionnaire (PHQ-9) - CORRECT ANSWER common depression screening tool, self rank 9 signs and symptoms over last 2 weeks on scale of 0-3
CAGE-AID - CORRECT ANSWER C-have you ever felt that you ought to cut down on your drinking or drug use?
A-have people annoyed you by criticizing your drinking or drug use?
G-have you ever felt bad or guilty about your dirnking or drug use?
E-Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover? (e.g. eye opener)
Ramsay Sedation scale - CORRECT ANSWER Awake:
1: anxious, agitated, restless
2: cooperative, oriented, tranquil
3: responsive to commands only
Sleeping:
4:response to light glabellar tap ro loud auditory stimulus
5: sluggish response to light glabellar tap or loud auditory stimulus
6: no response to light glabellar tap or loud auditory stimulus
Brief pain inventory - CORRECT ANSWER Assess impact of pain on daily life
What is a good assessment tool for chronic pain such as with cancer patients? - CORRECT ANSWER Brief pain inventory
Go review MMSE - CORRECT ANSWER
What physical activity is good for Parkinson's patients? - CORRECT ANSWER Tai chi
What is salsa dancing good for? - CORRECT ANSWER Coordination
What is benchmarking? - CORRECT ANSWER Comparison and measurement of a healthcare organization's services against other national healthcare organizations
HIPAA title I - CORRECT ANSWER protects health insurance coverage for workers and their families when they change or lose their jobs i.e. cobra
HIPAA title II - CORRECT ANSWER administrative simplification provisions, standards for electronic healthcare transactions and national identifiers for providers, health insurance, and employers
Who enforces HIPAA? - CORRECT ANSWER Office of civil rights
Levels of facial fracture - CORRECT ANSWER 1. floating pallet
2. mandible
3. Face
What is a tertiary facility - CORRECT ANSWER Provides specialized care i.e. level 1 trauma
2 goals of healthy people 2020 - CORRECT ANSWER increase quality and years of healthy life and eliminate health disparities among Americans
Infections that require reporting to health department (5) - CORRECT ANSWER gonorrhea, chlamydia, syphilis, HIV, TB
Who sets standards of coding (E&M) ? - CORRECT ANSWER medicare
What are examples of 3rd party payers? - CORRECT ANSWER Medicare, Medicaid, commercial insurers, HMOs, schools providing insurance
Medicare A - CORRECT ANSWER covers hospitalizations, SNFs, home health, hospice if associated with hospitalizations
Medicare B - CORRECT ANSWER Covers provider services, outpatient, labs and diagnostics, supplemental requiring premium, medicare pays 80% of bill
Medicare C - CORRECT ANSWER A+B = C; medicare advantage, receive services under one provider e.g. HMO, PPO
Medicare D - CORRECT ANSWER limited prescription coverage, monthly premium, includes copay, need to enroll when first eligible
What is required for a NP to be able to bill medicare? - CORRECT ANSWER Hold a state license, be certified by a professional body, hold at least a MSN degree
What is an important goal of CQI/QA? - CORRECT ANSWER monitoring outcomes of care
Who dictates the level of prescriptive authority? - CORRECT ANSWER state practice acts
Who allows NPs to admit to the hospital? - CORRECT ANSWER joint comission
Nonmaleficence - CORRECT ANSWER duty to do no harm
utilitarianism - CORRECT ANSWER the right act is the one that produces the greatest good for the greatest number
BEneficence - CORRECT ANSWER the duty to prevent harm and promote good
justice - CORRECT ANSWER the duty to be fair
fidelity - CORRECT ANSWER the duty to be faithful
veracity - CORRECT ANSWER the duty to be truthful
autonomy - CORRECT ANSWER the duty to respect the individual's thoughts and actions
What two ethical principles are often in conflict? - CORRECT ANSWER Beneficence and autonomy
What is a quazi experiment? - CORRECT ANSWER An experiment that lacks either a comparison group or randomization
Sensitivity vs specificity - CORRECT ANSWER Sensitivity is positive and specificity is negative
What lab value contraindicates use of sux? - CORRECT ANSWER Hyperkalemia
What common liver met site can cause a fever? - CORRECT ANSWER Liver
What is a left shift? - CORRECT ANSWER Bandemia
What is the most common type of headache - CORRECT ANSWER Tension
What blood test tests for syphillus? - CORRECT ANSWER VDRL
What qualifies a migraine sufferer to have prophylactic therapy? - CORRECT ANSWER Attacks more than 2-3 times per month
What is the black box warning on amitriptyline for? - CORRECT ANSWER QT prolongation
What is a normal urine sodium? - CORRECT ANSWER 10-20
In a patient with hyponatremia, urine sodium >20 indicates - CORRECT ANSWER renal salt wasting
In a patient wiht hyponatremia, urine sodiu <10 indicates - CORRECT ANSWER renal retention of sodium to compensate for loss
Common causes of isotonic hyponatremia - CORRECT ANSWER hyperlipidemia, hyperproteinemia
Edema, CHF, liver disease, and advanced renal failure can contribute to what kind of hyponatremia? - CORRECT ANSWER Hypervolemic, hypotonic hyponatremia
Hypertonic hyponatremia - CORRECT ANSWER usually from HHNK, somolality is high and the Na is low
Potassium in acid/base imbalances - CORRECT ANSWER acidosis => increased K
alkalosis => decreased K
Treatment (IV fluids) of hyopvolemic hypernatremia - CORRECT ANSWER NS followed by 1/2 saline
What does hypokalemia look like on an EKG? - CORRECT ANSWER decreased amplitude, broad T waves, PVCs, V tach, or V-fib
What is a normal calcium? Normal ionized? - CORRECT ANSWER 8.5-10.5 mg/dl; 4.5-5.5
What is different about an ionized cal from a regular cal? - CORRECT ANSWER ionized is not effected by albumin level
Does acedemia increase or decrease calcium? - CORRECT ANSWER increase
What causes hypocalcemia? - CORRECT ANSWER hypoparathyroidism, hypomagnesmia, pancreatitis, renal filure, severe trauma, multiple blood transfusions
What ECG change can be caused by hyperthyroidism - CORRECT ANSWER a fib
What electrolyte imbalance can vitamin D intoxication cause? - CORRECT ANSWER hypercalcemia
What do you do if a patient's calcium level is >12? - CORRECT ANSWER NS infusion with loop diuretics
what does respiratory acidosis result from? - CORRECT ANSWER decreased alveolar ventilation
Anion gap equation - CORRECT ANSWER NA - (Chloride + bicarb)
Normal anion gap - CORRECT ANSWER 12+/- 5
Clinical symptoms in respiratory alkalosis are related to what physiological process? - CORRECT ANSWER decreased cerebral blood flow
What is the hallmark sign of metabolic acidosis? - CORRECT ANSWER Low HCO3
Examples of causes for metabolic acidosis with increased anion gap - CORRECT ANSWER DKA, alkoholic KA, lactic acidosis, drug or chemical anion
Examples of causes for metabolic acidosis with normal anion gap - CORRECT ANSWER diarrhea, illeostomy, renal tubular acidosis, recovery from DKA
When is giving HCO3 indicated in metabolic acidosis? - CORRECT ANSWER When significant hyperkalemia is present
Common causes of metabolic acidosis - CORRECT ANSWER NG suctioning, vomitting
Rule of 9's - CORRECT ANSWER arm = 9
leg = 9
thorax = 18
head=9
peri=1
Equation for burn fluid resuscitation - CORRECT ANSWER 4 ml x kg x TBSA
Examples of crystalloid fluids - CORRECT ANSWER NS
D5
LR
Example of common colloid - CORRECT ANSWER albumin
In burn patients, when do you prophylactically intubate? - CORRECT ANSWER Facial burns
singed nares or eyebrows
dark soot/mucous from nares and/or mouth
What acid/base imbalance is expected during resuscitation from burns? - CORRECT ANSWER metabolic acidosis
What electrolyte abnormality should be monitored for 24-48 hrs after burn injury - CORRECT ANSWER hyperkalemia
What electrolyte abnormality should be monitored for at 72 hrs post burn injury? - CORRECT ANSWER hypokalemia
In a human bite, what do you cover for and what is a common abx to use? - CORRECT ANSWER staph and anaerobes, augmentin, 3-7 days
Most common cause of cellulitis - CORRECT ANSWER strep A
Abx for CA-MRSA - CORRECT ANSWER bactrim, doxy, clinda
Abx for A strep - CORRECT ANSWER bactrim + beta lactam
Doxy + beta lactam
clinda
Examples of beta lactams - CORRECT ANSWER amoxicillin, keflex, cephelosporin
Alternative to narcan? - CORRECT ANSWER Stadol
What overdose is tinnitus a symptom of? - CORRECT ANSWER ASA
What is the drug of choice in organophosphate toxicity? - CORRECT ANSWER atropine
Treatment of serotonin syndrome - CORRECT ANSWER dantrolene sodium, clonazepam, cooling blankets
Does cocaine cause mydriasis or miosis? - CORRECT ANSWER mydriasis - dilated
Does heroin cause mydriasis or miosis? - CORRECT ANSWER miosis - pinpoint
Standard transplant therapy - CORRECT ANSWER CNI + antimetabolite + steroid
Calcineurin inhibitor examples - CORRECT ANSWER tacrolimus, cyclosporine
antimetabolite examples - CORRECT ANSWER azathioprine, cellcept
MTOR inhibitor - CORRECT ANSWER sirolimus
Actinic keratosis (picture) and treatment - CORRECT ANSWER liquid nitrogen
Squamous cell carcinoma (picture) and treatment - CORRECT ANSWER biopsy and surgical excision (Mohs)
Seborrheic keratosis (picture) and treatment - CORRECT ANSWER benign, liquid nitrogen
Basal cell carcinoma (picture) treatment - CORRECT ANSWER most common, shave/punch bx and surgical excision
Malignant melanoma (picture) and treatment - CORRECT ANSWER biopsy and surgical excision
ABCDE of malignant melanoma - CORRECT ANSWER Asymetry
Border irregularity
color variation
diameter >6 cm
elevation, enlargement
How does SIADAH work? - CORRECT ANSWER ADH is released independent of osmolality or volume dependent stimulation causing inappropriate water retention. It is hyponatremic euvolemia.
How does diabetes insipidus work? - CORRECT ANSWER ADH deficiency causes pituitary or hypothalamus damage
In SIADH, what would you expect serum osmo, urine osmo, urine sodium to be? - CORRECT ANSWER serum osmo: low <280
urine osmo: up >100
urine sodium: >20
What is a pheochromocytoma? - CORRECT ANSWER excess catecholamine (epi and norepi) release characterized by paroxysmal or sustained HTN. Almost always related to tumor in adrenal medulla
S/s of phenochromocytoma - CORRECT ANSWER HTN labile
diaphoresis
hyperglycemia
severe HA
palpitations
sweating
tremor
tachycardia
weight loss
postural hypotension
How do you confirm a pheochromocytoma - CORRECT ANSWER assay of urine catecholamines and
CT of adrenals
Medication given perioperatively while removing phnochromocytoma - CORRECT ANSWER phentolamine IV
What are you hearing in S1? - CORRECT ANSWER Mitral/tricuspid valves close, A/P open
What are you hearing in S2? - CORRECT ANSWER Aortic/pulmonic closure, M/t open
S3 is heard in? Sounds like? - CORRECT ANSWER CHF, pregnancy, fluid overload
Ken-tuck-y
S4 is heard in? Sounds like? - CORRECT ANSWER MI, left ventricular hypertrophy, chronic HTN, stiff entricular states; Ten-ne-ssee
Describe a grade III/VI murmur - CORRECT ANSWER moderately loud, easily heard
Descrive a graDE IV/VI murmur - CORRECT ANSWER loud, associated with thrill
Is mitral stenosis a systolic or diastolic murmur? - CORRECT ANSWER diastolic
Is aortic regurg a systolic or diastolic murmur - CORRECT ANSWER diastolic
is mitral regurg a systolic or diastolic murmur - CORRECT ANSWER systolic
is aortic stenosis a systolic or diastolic murmur - CORRECT ANSWER systolic
Where is the apex of the heart? - CORRECT ANSWER 5th ICS
where is the base of the heart? - CORRECT ANSWER 2nd-3rd ICS
What causes dependent edema? - CORRECT ANSWER Increased capillary hydrostatic pressure
How do you rule out cushing's syndrome? - CORRECT ANSWER AM/PM cotisol levels
What are the criteria of metabolic syndrome? - CORRECT ANSWER at least 3 of the following:
1. Waist >=40 or 35
2. BP >=130/85
3. Triglycerides >=150
4. FBG >=100
5. HDL <40/<50
Top 4 killers in adults (in order) - CORRECT ANSWER CAD
Cancer
lower respiratory
CVA
What is a normal AOC - CORRECT ANSWER 5.5-7%
Metformin can cause which acid/base inbalance - CORRECT ANSWER metabolic acidosis
Starting insulin dose - CORRECT ANSWER 0.1u/kg/day giving 2/3 in AM and 1/3 at night
Somogyi efect - CORRECT ANSWER hypo overnight and hyper in AM - treat by omitting bedtime dose
dawn phenomenon - CORRECT ANSWER progressively higher overnight - increase at bedtime dose
Hyperthyroid - CORRECT ANSWER grave's disease
overdrive
test TSH first
TSH low
T3 high
methimazole or propylthiouracil
Hypothyroid - CORRECT ANSWER hashimoto's thyroiditis
sluggish
TSH elevated
T4 low or low normal
hyponatremia
hypoglycemia
What can exacerbate a thyroid storm - CORRECT ANSWER ASA
Cushing's syndrome - CORRECT ANSWER ACTH hypersecretion by the pituitary
adrenal tumor
chronic steroids
central obesity, moon face, etc
hyper-glycemia, natremia
hypo kalemia
treat-underlying cause, surgical
Addison's disease - CORRECT ANSWER Deficient in cortisol, androgens, and aldosterone
autoimmune destruction of the adrenal gland
hyperpigmentation of buccal mucosa
hypo-glycemia, natremia
hyperkalemia
steroid replacement
Gluco and mineral ocorticoids - CORRECT ANSWER hydrocortisone
fludrocortisone
JNC8 recommendations for medications in HTN non african americans - CORRECT ANSWER thiazide
CCB
ACEI
ARB
JNC8 recommendations for medications in HTN african americans - CORRECT ANSWER thiazide (unless DM, then get ACEI or ARB)
CCB
JNC8 recommendations for meds in HTN in adults with CKD - CORRECT ANSWER ACEI
ARB
What is the difference between SVT and ST on an EKG - CORRECT ANSWER no p wave in SVT
First degree block strip - CORRECT ANSWER
Second degree block strip - CORRECT ANSWER
What kind of allergy do you screen for before giving a thiazide? - CORRECT ANSWER Sulfa
What do ACEI and ARBs do besides cause lower BP? - CORRECT ANSWER vasodilation and block sodium and water retention
What is malignant hypertension - CORRECT ANSWER fundoscopic chnages including flame shaped retinal hemorrhages, soft exudates and papilledema
Treatment of prinzmetals - CORRECT ANSWER CCB, vasospastic so give CCB becaue related to calcium influx
Goals for LDL, HDL and TG in DM and/or CAD patients? - CORRECT ANSWER LDL <70
HDL >40
TG <150
Common pharmacotherapy for angina - CORRECT ANSWER nitrates, BB, CCBs
Normal lipid profile - CORRECT ANSWER
Adults with a LDL of what should get statin therapy - CORRECT ANSWER >=190
Where is a lateral MI shown on the ECG? - CORRECT ANSWER I,aVL
Where is an inferior MI shown on the ECG? - CORRECT ANSWER II, III, aVF
Where is an anterior MI shown on an ECG? - CORRECT ANSWER V leads or V3 and V4
Where is a septal infart seen on ECG? - CORRECT ANSWER V1, V2
Which troponin is cardioselective? - CORRECT ANSWER Troponin I
When do you see leukocytosis in a MI? - CORRECT ANSWER second day
Drug therapy in acute MI - CORRECT ANSWER ASA, NTG, morphine, lasix, BB, ACEI
Normal INR
Normal APTT
Normal PT
Normal PTT - CORRECT ANSWER 0.8-1.2
28-38
11-16
60-90
What is the door to TPA goal? - CORRECT ANSWER 30 minutes
Are legs shiny and hairless in PVD or CVI? - CORRECT ANSWER PVD
ST changes in pericarditis - CORRECT ANSWER ST elevation
temporary T wave inversion
PR segment depression highly indicative of pericarditis
What is the drug of choice for pericarditis? - CORRECT ANSWER NSAIDS, maybe steroids if NSAIDS fail
How do you identify a GI bleed of an unknown cause? - CORRECT ANSWER GI angio
Common causes of PUD - CORRECT ANSWER h pylori
meds
duodenal ulcers in young and gastric in old
smoking
Pain in PUD - CORRECT ANSWER relieved with eating in duodenal
worse with eating gastric
PUD 1st-3rd line treatment - CORRECT ANSWER HS
HS BID
PPI
Common h pylori regimens - CORRECT ANSWER flagyl BID and/or amoxicillin, prilosec BID, clarithro BID x7 days then anti ulcer for 3-7 weeks
Hepatitis A incubation period - CORRECT ANSWER 2-6 weeks
Murphy's sign - CORRECT ANSWER for cholecystitis
deep pain on inspiration while fingers are placed under the right rib cage
Grey turner's sign
cullen's sign - CORRECT ANSWER flank discoloration
umbilical discoloration
Where is pain generally in diverticulitis? - CORRECT ANSWER LLQ
How does cholecystitis present? - CORRECT ANSWER sudden steady, severe pain in epigastrum or right hypochondrium, vomitting provides relief, precipitated from a fatty meal
What imaging test is the gold standard for cholecystitis? - CORRECT ANSWER ultrasound
What abnormal lab values could cause acute pancreatitis? - CORRECT ANSWER hypercalcemia, hyperlipidemia
Gold standard imaging for acute pancreatitis? - CORRECT ANSWER CT scan
Serum amylase and lipase in acute pancreatitis? - CORRECT ANSWER amylase 50-180
lipase 14-280
Ranson's criteria - CORRECT ANSWER prognosis of acute pancreatitis -
5-6 40% mortality
>7 appx 100% mortality
George washington got lazy after he broke CABE
>55 yo
WBC >16K
glucose >200
LDH > 350
AST >250
Hct drop >10
BUN >5 increase
calcium <8
arterial 02 <60
base deficit >4
est fluid sequestration >6K
What is the hallmark symptom of ulcerative colitis? - CORRECT ANSWER bloody diarrhea
How do you treat a UC flare? - CORRECT ANSWER mesalamine suppositories for 3-12 weeks in combo with prednisone
Psoas sign
obturator sign
positive rovsing's sing - CORRECT ANSWER -pain with right thigh extension
-pain with internal rotation of flexed right thigh
-RLQ pain when pressure is applied to the LLQ
What is the typical s/s of MCA infarct? - CORRECT ANSWER hemiplegia
A pneumonic for cranial nerves? - CORRECT ANSWER On old olympus towering tops a fin and german viewed some hops
CN 1
CN 2
CN 3 - CORRECT ANSWER olfactory-smell
optic-vision
oculomotor-most EOMs, opening eyelids, pupillary constriction
CN IV
CN V
CN VI - CORRECT ANSWER T-orchlear-down and inward eye movement
-trigeminal-muscles of mastication, sensation of face, scalp, cornea, mucus membranes and nose
-abducens - lateral eye movement
CN VII
CN VIII
CN IX - CORRECT ANSWER -facial-mouth, eyes, taste anterior 2/3, saliva, tears, puffing cheeks
-acoustic-hearing and equilibrium
-glossopharyngeal-phonation, gag reflex, carotid reflex, swallowing, taste posterior
CN X
CN XI
CN XII - CORRECT ANSWER -vagus-talking, swallowing, general sensation fro mthe arotid body, carotid reflex
-spinal accessory - movement of trapezius and sternomastoid muscles (shrug)
-hypoglossal-moves the tongue
Vertebrobasilar vs carotid TIA - CORRECT ANSWER -verte-vertigo, ataxia, dizziness, visual, field, deficits, weakness, confusion
-aphasia, dysarthria, altered LOC, weakness, numbness, etc
What are s/s of sudden increased ICP? - CORRECT ANSWER AMS, HA, vomitting
Left hemisphere involvement of CVA vs Right hemisphere involvement of CVA - CORRECT ANSWER opposite hemiparesis
-left: aphasia, dysarthria, difficulty reading/writing
-right: right visual field changes, spatial disorientation
What is a normal MAP?
What MAP do you want on a CVA patient to prevent vasospasms? - CORRECT ANSWER 70-105
110-130
3 H's of increased ICP - CORRECT ANSWER hypotension
hypoxemia
hypercapnea
What differentiates a simple partial from complex partial seizure? - CORRECT ANSWER followed by impaired level of consciousness
What is CPP and what is the goal? - CORRECT ANSWER MAP-ICP; goal 70's
Goal ICP in CVA? - CORRECT ANSWER <20
What are some indications for ICP monitors? - CORRECT ANSWER GSC <8 and/or a bleed
What is myasthenia gravis? - CORRECT ANSWER autoimmune
reduction of the number of acetylcholine receptor sites at the neuromuscular junction
weakness worse after exercise and better after rest
How do you differentiate between a myasthenia gravis crisis and a choinergic crisis? - CORRECT ANSWER Tensilon test
In MS, what would you see in the CSF? - CORRECT ANSWER elevated IgG
How do you evaluate for MS besides exam and labs? - CORRECT ANSWER MRI brain
What is Guillain-Barre Syndrome - CORRECT ANSWER demyelination of peripheral nerves resulting in progressive symmetrical ascending paralysis
Lab findings in GB - CORRECT ANSWER CSF protein elevated especially immunoglobulin G
CBC early leukocytosis w/ left shift
LP, MRI, and CT sometimes used
What is the most common cause of meningitis? - CORRECT ANSWER strep pneumoniae
What are the 5 most common disorders caused by strep P.? - CORRECT ANSWER meningitis
sinusitis
otitis media
bronchitis
CAP
Why, in meningitis, does the CSF have an increase in pressure, protein, and WBCs but a decrease in glucose? - CORRECT ANSWER The protein eats up the glucose
What abx do you give for meningitis? - CORRECT ANSWER Pen G, vanco, third gen cephalosporin or quinolone until C&S back
What is cushing's triad and what does it mean? - CORRECT ANSWER Widening pulse pressure, decrease RR, decrease HR; decompensation in head trauma [Show Less]