



















































Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
A patient tells the nurse practitioner that she recently started taking the supplement St. John's wort after reading about its benefits online. Which of the following medications, if being actively consumed, must be immediately stopped? A. Benadryl B. Famotidine (Pepcid) C. Metformnin (Glucophage) D. Sumatriptan (Imitrex) - correct answer>>D. Sumatriptan (imitrex) Sumatriptan (Imitrex) (D) is a medication used to treat migraines and belongs to a drug class known as serotonin agonists. When used in conjunction with St. John's wort, it may increase the risk of serotonin syndrome, a potentially life-threatening condition. Which of the following is not a symptom of both major depressive disorder and post traumatic stress disorder? A. Difficulty concentrating B. Hypervigilance C. Insomnia D. Irritabilty - correct answer>>B. Hypervigilance
Typology: Exams
1 / 59
This page cannot be seen from the preview
Don't miss anything!
A patient tells the nurse practitioner that she recently started taking the supplement St. John's wort after reading about its benefits online. Which of the following medications, if being actively consumed, must be immediately stopped? A. Benadryl B. Famotidine (Pepcid) C. Metformnin (Glucophage) D. Sumatriptan (Imitrex) - correct answer>>D. Sumatriptan (imitrex) Sumatriptan (Imitrex) (D) is a medication used to treat migraines and belongs to a drug class known as serotonin agonists. When used in conjunction with St. John's wort, it may increase the risk of serotonin syndrome, a potentially life-threatening condition. Which of the following is not a symptom of both major depressive disorder and post- traumatic stress disorder? A. Difficulty concentrating B. Hypervigilance C. Insomnia D. Irritabilty - correct answer>>B. Hypervigilance In addition to difficulty concentrating, insomnia, and irritability, major depressive disorder (MDD) may also include symptoms of depressed mood, anhedonia, weight loss or gain, and low energy. However, hypervigilance (B) is not a symptom associated with this diagnosis. A patient with type 1 diabetes presents for a follow-up visit. He has been stable on his medication regimen but is worried because he is between jobs and will be without health insurance coverage for a few months. He asks if there are less expensive insulin options to get him through this time. Which of the following would be good options for this patient, given his circumstance? Incorrect A. Insulin aspart 70/ B. Insulin detemir
Insulin isophane D. Insulin degludec - correct answer>>Insulin Isophane The least expensive insulin type listed in this question is insulin isophane (C) (neutral protamine Hagedorn insulin). There are also often pharmacy-specific coupons that can be used on insulin, so helping patients apply for and navigate these programs can be instrumental in managing their diabetes. Another inexpensive option is regular insulin.Insulin analogs (glargine, detemir, degludec, lispro, and aspart) are significantly more expensive than human insulin (isophane, regular). Insulins modified by manufacturers, especially when sold as brand-name medications, tend to be more expensive due to this modification. While analogs offer alternate lengths of action and convenience, there is no well-documented clinical evidence that patient outcomes are improved with differing brands. Therefore, maintaining a patient's blood glucose level through outcome-focused treatment is more valuable than a process-focused plan based on medication. A 40-year-old woman with type 2 diabetes presents to the clinic with concerns of spiking blood sugar between lunch and dinner. She states she is on a rapid-acting insulin sliding scale and long-acting insulin. Which change should be implemented to help prevent or curb this glycemic spike? A. Add a dose of mealtime insulin aspart (Novolog) at lunch B. Add insulin detemir (Levemir) at night C. Increase her insulin glargine (Lantus) D. Prescribe a dose of neutral protamine Hagedorn insulin with dinner - correct answer>>A. Add a dose of mealtime insulin aspart (Novolog) at lunch Insulin aspart (Novolog) (A) is a rapid acting insulin that is commonly dosed with meals and as a sliding scale regimen based on a patient's glucose prior to eating (preprandial).
30 cm D. 31 cm - correct answer>>D. 31 cm After 20 weeks gestation, the fundal height should be measured with a measuring tape in centimeters and should match the gestational age. It can be > or < 2 centimeters and still be within normal limits. A fundal height of 26-30 cm is a normal finding in a patient who is 28 weeks gestation. A result of 31 cm (D) is larger than expected and should be further evaluated with an ultrasound. A 4-year-old boy presents with ear pain and an erythematous, bulging tympanic membrane on examination. The nurse practitioner diagnoses him with acute otitis media. Which of the following are the three most common bacterial pathogens associated with acute otitis media in children? A. Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pneumoniae B. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus C. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae D. Nontypeable Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae - correct answer>>C. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae Acute otitis media is commonly encountered by primary care nurse practitioners. Typically, children present with otalgia and have a bulging tympanic membrane on examination. Many times, children also have a preceding viral upper respiratory infection, resulting in the colonization of bacteria in the middle ear and leading to a bacterial infection. Ear infections can be caused by bacterial and viral pathogens. The most common bacterial pathogens isolated from middle ear fluid are nontypeable Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (C). The most common viral pathogens include respiratory syncytial virus, coronaviruses,
influenza viruses, and adenoviruses. Treatment for acute otitis media should be targeted to combat the most common bacterial causes, including amoxicillin (penicillin), amoxicillin-clavulanate (penicillin and combination beta-lactam and beta-lactamase inhibitor), and an oral second-generation cephalosporin (e.g., cefuroxime) in the case of a child with a penicillin allergy. A 6-year-old patient presents to the clinic accompanied by his mother, who reports concerns regarding her child's progressive urinary issues. The patient's mother states that she and the child's father recently divorced, and the child alternates weekly between her house and his father's house. She reports he experiences episodes of urinary incontinence and holds his stomach as if he is in pain. He frequently asks to use the bathroom but is scared of urination once he is there. Which of the following is the most likely diagnosis? A. Adjustment disorder B. Constipation C. Regression D. Urinary tract infection - correct answer>>D. Urinary tract infection The most likely diagnosis is a urinary tract infection (D). His clinical presentation includes abdominal pain, urinary frequency, and dysuria, which are signs of cystitis in children, which is considered a lower urinary tract infection (UTI). Pyelonephritis is a complicated form of UTI that may present with persistent fever, flank pain, or vomiting. A 12-year-old girl presents to the clinic with her parent, who is concerned about the C- shaped appearance of the girl's spine. The degree of curvature in her spine is 35 degrees. Which of the following is appropriate to educate the parent? A. "Your daughter's spine has a mild curve but does not require treatment and will likely resolve on its own." B.
bacterial pharyngitis in children and adolescents. Children typically present with the abrupt onset of pharyngitis, fever, headache, abdominal pain or nausea, and vomiting. Physical exam findings include throat erythema, palatal petechiae, enlarged or erythematous tonsils, enlarged anterior cervical lymph nodes, and a scarlatiniform rash. The gold standard for testing a patient with suspected group A streptococcal pharyngitis is a rapid antigen detection test (C). These tests provide quick, highly specific results and are readily available in most care centers. Because the sensitivity of the rapid antigen detection tests is a little lower, 70-90%, if a child initially tests negative, a confirmatory throat culture should be sent as a follow-up. All of the following are potential secondary causes of hyperparathyroidism except: A. Chronic kidney disease B. Neck radiation exposure C. Parathyroid adenoma D. Vitamin D deficiency - correct answer>>C. Parathyroid adenoma Secondary hyperparathyroidism occurs when an issue external to the parathyroid lowers calcium levels. This can be due to chronic kidney disease (especially end-stage kidney disease), a vitamin D deficiency, or neck radiation exposure. Primary causes of hyperparathyroidism are due to an issue with the parathyroid itself, such as a parathyroid adenoma (C). A patient recently diagnosed with primary adrenal insufficiency (Addison disease) requests additional education on this condition. Which of the following teaching statements is inaccurate? A. "If a potential Addisonian crisis goes untreated, it may lead to severe hypotension and organ failure" B. "It is necessary to keep your IM hydrocortisone injection with you at all times"
"You may experience electrolyte imbalances such as hyperkalemia and hyponatremia" D. "Your symptoms are related to an increase in a substance called cortisol in your blood" - correct answer>>D. "Your symptoms are related to an increase in a substance called cortisol in your blood" Your symptoms are related to an increase in a substance called cortisol in your blood (D) is an inaccurate statement, as Addison disease is a condition characterized by adrenal insufficiency, meaning the body is unable to produce sufficient amounts of the hormone cortisol. A 72-year-old woman presents to the clinic with jaw pain when eating for 1 day. She reports feeling tired and having some blurry vision, a new nagging headache near her left eye, and a fever. Which of the following is the best next step? A. Order inflammatory markers B. Prescribe the patient sumatriptan (Imitrex) C. Refer to an ophthalmologist for a biopsy D. Refer to the ED to rule out a potential brain bleed - correct answer>>C. Refer to an ophthalmologist for a biopsy Jaw claudication, or pain in the jaw with chewing, headache, fever, and blurry vision, is suspicious for temporal arteritis. Referral to an ophthalmologist for a biopsy (C) will confirm this diagnosis. A 33-year-old patient recovering from a left rotator cuff repair performed 2 weeks ago reports for a follow-up visit. Before seeing the nurse practitioner, she is told to remove her shirt and undergarments and is given a gown and a sheet for modesty. She is assured that she is seeing a female nurse practitioner today who is aware of her Afghani
DTaP vaccination is not guaranteed to prevent pertussis, it should help lessen the severity of symptoms. Postexposure prophylaxis of azithromycin is recommended in children who are in close contact with an infected person or at high risk for severe pertussis. The nurse practitioner is suspicious of possible papilledema after obtaining a thorough history from a patient. Which statement made by the patient raises the index of suspicion for this pathology? A. "I was sitting at my desk this afternoon and suddenly developed eye pain" B. "My vision has been getting worse over the last few months but has improved with new glasses" C. "My vision suddenly became blurry, and I saw flashing lights and floaters" D. "While getting ready for work this morning, I began to experience flickering vision that lasted only a few seconds" - correct answer>>D. "While getting ready for work this morning, I began to experience flickering vision that lasted only a few seconds" Papilledema is described as a sudden onset of vision changes, including blurred or double vision, flickering, and loss of vision lasting seconds at a time (D). Upon examination of the eye, the nurse practitioner may see that the margins of the disk are blurred, and the central cup cannot be visualized due to disk swelling. Headaches are also a common finding. Papilledema should be considered an emergency, as it can indicate increased intracranial pressure or a dangerously high blood pressure. A 23-year-old man presents to the office with concerns of yellow/green penile discharge and pain with urination. The patient reports a poor hydration status, multiple new sexual partners over the past year, and occasional use of condoms. The vital signs are as follows: weight 180 lbs, blood pressure 120/60 mm Hg, pulse 68 bpm, and temperature 98.4°F orally. A nucleic acid amplification test is positive for gonorrhea and negative for chlamydia. What is the best treatment plan for this patient? A.
Ceftriaxone (Rocephin) 1 g intramuscular; retest in 3 months B. Ceftriaxone (Rocephin) 500 mg intramuscular and azithromycin (Zithromax) 1 g oral; no test of cure is indicated C. Ceftriaxone (Rocephin) 500 mg intramuscular and azithromycin (Zithromax) 1 g oral; retest in 3 months D. Ceftriaxone (Rocephin) 500 mg intramuscular; no test of cure is indicated - correct answer>>D. Ceftriaxone (Rocephin) 500 mg intramuscular; no test of cure is indicated The CDC recently updated the treatment guidelines for gonorrhea and chlamydia. For individuals weighing < 150 kg, gonorrhea infections are to be treated with a single intramuscular dose of ceftriaxone (Rocephin) 500 mg (D). For individuals weighing ≥ 150 kg, 1 g ceftriaxone intramuscular in a single dose should be administered. A patient who is appropriately treated does not require a test of cure. Specific to chlamydia, for individuals weighing <150 kg, chlamydia (confirmed or suspected) should be treated with doxycycline 100 mg orally twice daily for 7 days Which of the following headaches typically presents with bilateral pain rather than unilateral pain? A. Cluster headache B. Migraine headache C. Temporal arteritis D. Tension headache - correct answer>>D. Tension headache
Major depressive disorder C. Post-traumatic stress disorder D. Schizophrenia - correct answer>>C. Post-traumatic stress disorder According to the the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, post-traumatic stress disorder (PTSD) (C) is characterized by a specific set of symptoms that persist for more than 1 month following exposure to actual or threatened death, serious injury, or sexual violence. Symptoms may include flashbacks, nightmares, dissociation, avoidance of people or places that trigger memories of the event, trouble concentrating, hypervigilance, feeling on-edge, and sleep disturbances. Given the patient's presentation, this is the only diagnosis listed that would appropriately capture her symptoms. Individual therapy is highly recommended for those experiencing PTSD. Cognitive behavioral therapy, cognitive processing therapy , and prolonged exposure are the American Psychiatric Association's most strongly recommended interventions. Medications may also be considered in the treatment plan. Selective serotonin reuptake inhibitors are typically the first class of medications used in the treatment of PTSD, though exceptions may occur based on individual needs and circumstances. A 6-year-old patient presents to the clinic with his parent, who reports several blister- like lesions on his child's abdomen. The child reports the lesions are pruritic and intermittently painful. Physical exam reveals large blisters filled with clear-yellow fluid. Which of the following is the most likely diagnosis? A. Bullous impetigo B. Herpes zoster C. Nonbullous impetigo D.
Varicella - correct answer>>A. Bullous impetigo This patient's clinical presentation is consistent with bullous impetigo (A), which is a superficial skin infection that most commonly affects children. Bullous impetigo is characterized by large fluid-filled blisters (bullae) with clear-yellow fluid that most commonly develop on the trunk. A 22-year-old man presents to the clinic for a follow-up after starting a low-dose tretinoin (Retin-A) cream. He states that he has noticed a decrease in blackheads but reports an increase in pustules along his jawline. Which of the following is the best next step in treatment? A. Increase the tretinoin dosage and follow up in 8 weeks B. Instruct him to continue the tretinoin and start him on tetracycline C. Instruct him to continue the tretinoin cream and start him on oral isotretinoin D. Instruct him to stop his tretinoin and start him on doxycycline (Vibramycin) - correct answer>>A. Increase the tretinoin dosage and follow up in 8 weeks Initial treatment of acne vulgaris consists of topical agents, such as topical retinoids like tretinoin (Retin-A). Tretinoin cream can cause skin irritation, so it should be started at the lowest dose. The nurse practitioner may also advise the patient to start the cream every other night to minimize skin irritation. The goal is to slowly increase to daily use and eventually increase the dose as the patient tolerates it. Since the patient has seen some improvement, the nurse practitioner should increase the tretinoin dosage and follow up in 8 weeks (A). fter the death of her mother, a young adolescent begins fulfilling previous duties held by her mother, including cooking meals and ensuring her siblings complete their school work. This is an example of which of the following? A.
and treatment. A test of cure is not required if the CDC-recommended treatment regimen is prescribed and completed in full by the patient. The nurse practitioner is seeing an 18-year-old patient in the office who was recently diagnosed with polycystic ovary syndrome. Her parents are extremely worried about this diagnosis and ask if their daughter is at higher risk for other problems given this new diagnosis. Which of the following comorbidities is associated with polycystic ovary syndrome? A. Hyperthyroidism B. Nonalcoholic fatty liver disease C. Skin cancer D. Type 1 diabetes - correct answer>>B. Nonalcoholic fatty liver disease Nonalcoholic fatty liver disease (B) occurs when there is an excess buildup of fatty tissue in the liver. It is common in those diagnosed with polycystic ovary syndrome (PCOS) due to the associated symptoms of obesity and hyperandrogenism. A 39-year-old woman presents to the clinic with increasing left foot pain. She reports no injury to the area but states the pain has been worsening over time. Upon physical exam, the first metatarsophalangeal joint is observed to deviate inward, causing a clear deformity of the foot. Which of the following angles observed on X-ray is regarded as the cutoff for a diagnosis of hallux valgus? A.
15° angle B. 1° angle C. 20° angle
5° angle - correct answer>>C.
20° angle The hallux abductus angle is the angle found between the hallux and the first metatarsal. Angles > 20° (C) measured on X-ray are abnormal and indicative of hallux valgus. Hallux valgus (also known as a bunion) is a common cause of foot deformities. It can be caused by arthritis, biomechanical abnormalities, neuromuscular diseases, genetic conditions, or trauma. An adult patient with a medical history of hypertension, hyperlipidemia, and mitral valve prolapse is due for a dental procedure. Which of the following orders should be initiated by the nurse practitioner? A. Amoxicillin (Amoxil) 1 hour before the procedure B. Amoxicillin (Amoxil) 24 hours before the procedure C. Amoxicillin-clavulanate (Augmentin) 1 hour before and for 2 days after the procedure D. This patient does not require endocarditis prophylaxis - correct answer>>D. This patient does not require endocarditis prophylaxis Patients with mitral valve prolapse do not need prophylactic treatment for infective endocarditis (D). While this was previously a standard practice, it is no longer indicated as the risk of antibiotic-associated adverse effects exceeds any perceived benefit from prophylactic antibiotic therapy. Patients who should receive prophylactic antibiotics
prior to dental procedures include those with a history of infective endocarditis, those with a prosthetic valve, and transplant patients with a valvulopathy. For those patients, it is appropriate to administer amoxicillin (Amoxil) approximately 1 hour before the procedure. A 71-year-old man with a history of Parkinson disease presents to the clinic with worsening bradykinesia throughout the day despite continued treatment with
Educate the patient that he does not need a TDaP booster because the nail was not rusty and it has not been 10 years since his last booster B. Order a TD only booster because the nail was not rusty C. Order a TDaP booster because it has been 6 years since his last one D. Refer him to the emergency department for an immunoglobulin because it has been more than 5 years since his last TDaP - correct answer>>C. Order a TDaP booster because it has been 6 years since his last one The Centers for Disease Control and Prevention (CDC) recommends a TDaP booster every 5 years (C) in those over 7 years old who have come into contact with a potentially contaminated object, even a clean nail. Any puncture wound is still a risk for Clostridium tetani, even if the object was not rusty. In the absence of injury, it is recommended that adults receive a tetanus booster every 10 years. Which test is the most specific for diagnosing an acute gout flare? A. Serum uric acid levels B. Synovial fluid aspiration C. Ultrasound D. X-ray - correct answer>>B. Synovial fluid aspiration There are many diagnostic testing modalities that can be suggestive of an acute gout flare. However, the most specific test for diagnosis is synovial fluid aspiration (B).
A 17-year-old athlete presents to the clinic for her annual sports physical examination. She reports fluctuations in her heart rate that she has noted on her fitness tracker. She reports no symptoms. You order an ECG due to a significant family history of cardiovascular disease. While connected to the ECG, you note the R-R interval is reduced when the patient breathes in and is prolonged when she breathes out. Which of the following is the most likely diagnosis for this patient? A. Pulsus paradoxus B. Pulmonary flow murmur C. Respiratory sinus arrhythmia D. Sinus bradycardia - correct answer>>C. Respiratory sinus arrhythmia The most likely diagnosis for this patient is respiratory sinus arrhythmia (C). Respiratory sinus arrhythmia is defined as an increase in HR with inspiration and decrease in HR with expiration, as detected on this patient's ECG. Pulsus paradoxus (A) is defined as a drop in systolic blood pressure of > 10 mm Hg with inspiration and is often seen with life-threatening pericardial disease A 16-year-old boy presents to the clinic with his parents for a follow-up on diagnostic test results that suggest a serious health condition. The nurse practitioner presents an explanation of the test results, the health condition, treatment options, and potential care plans to the patient and his parents. Which of the core concepts of patient- and family-centered care is the nurse practitioner demonstrating? A. Collaboration B. Dignity and respect C.