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Cranial Nerve VIII ✔✔Acoustic (Hearing and balance) Cranial nerve IX ✔✔Glossopharyngeal- swallowing and rise of the palate, gag reflex Cranial Nerve XI ✔✔Spinal Accessory (upper trapezius) Deep tendon reflex ✔✔Ankle- S1 primarily Knee- Lumbar 2,3, Supinator(brachioradialis)-C5, BicepTriceps-C6, Stroke risk scale ✔✔CHADS C-Congestive heart failure H-Hypertension A-Age >75 years D- Diabetes S-prior Stroke/TIA In the majority of children, the first permanent teeth start to erupt at the age of 6 years. Which of the following are the first permanent teeth to erupt in this time period? A. First Molars B. Second Molars C. Lower or upper incisors D. Canines ✔✔A. First Molars
All of the following are classified as activities of daily living (ADLs) except: A. ability to feed self B. Ability to manage bladder and bowel elimination C. Personal hygiene and grooming D. Grocery Shopping ✔✔D. Grocery shopping You note the following result on a routine urinalysis of a 37-year old primigravida who is at 30 weeks gestation. Leukocyte=trace, nitrite=negative, protein=2+, blood=negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A.HELLP syndrome B. Pregnancy-induced hypertension (pre-eclampsia) C. Eclampsia of pregnancy D. Primary hypertension ✔✔B. Pregnancy-induced hypertension (pre-eclampsia). Classic triad of symptoms of preeclampsia include hypertension, edema (weight gain), and proteinuria. The mother of a 12 month old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A. Fifth Disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes ✔✔B. Roseola Infantum (Exanthema subitum) A 70-year old male patient complains of a bright red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on Bayer aspirin, 1 tablet a day. Which of the following is most likely? A. Corneal abrasion B. Acute bacterial conjunctivitis C. Acute uveitis
B. Secondary prevention C. Tertiary prevention D. Primordial prevention ✔✔D. primordial prevention. Screening for lung cancer is not currently recommended in the general population, but it is secondary prevention. A test called the visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central vision C. Visual acuity D. Accomodation ✔✔A. Peripheral vision What is the most common cause of Cushing's syndrome? ✔✔Administration of a glucocorticoid or ACTH. Iatrogenic Cushing's syndrome is the most common type. Exogenous glucocorticoid administration produces a Cushing's Syndrome that is reversible by discontinuation of the medication. A patient with no significant medical history has vericose veins. She complains of '"aching legs". The intervention that will provide the greatest relief for her complaint is to: ✔✔Elevate her legs periodically. The intervention that will provide the greatest relief for this patient is elevating her legs periodically. This will facilitate venous return. Use of support stockings will prolong the length of time she is able to stand in place, but will not provide relief after her legs begin aching. Support stockings should be applied prior to getting out of bed. A 25-yo female patient presents for a routine well-women exam. On physical exam, the NP notes a scant nipple discharge, absence of palpable mass, and absence of lymph node enlargement. What is the most likely diagnosis? ✔✔Itraductal papilloma. Intraductal papilloma often presents as a non-tender mass with serous or bloody nipple discharge located in the ductal system near the areola. Breast cancer, although usually non-tender, may present with pain. Chest wall syndrome may present in some women as breast pain. Fibrocystic breast disease often presents with bilateral breast pain.
According to the ANA, the role of the NP who provides primary health care is the: ✔✔Direct nursing care role. The NP with a traditional nursing care role is a primary health care provider. Increasing numbers of nurse practitioners are assuming indirect roles such as educator, administrator, researcher, and consultant. An 8-mo male presents with hemarthrosis of both knees and hematuria. The parents give no history of trauma, but say " he has always bruised easily" The most likely diagnosis is: ✔✔A type of hemophilia. Hemophilia is usually diagnosed within the first year of life. It commonly presents with hemarthrosis, bleeding into soft tissue, hematuria, and prolonged bleeding times. The nurse practitioner is following a child with juvemile rheumatoid arthritis (JRA) who has been previously diagnosed and is being managed for the disease by a pediatric rheumatologist. The mother asks for information about the child's long-term prognosis. The appropriate reply is that: ✔✔most children with JRA achieve complete remission by adulthood, but its effects might cause lifelong limitations. Although the active disease does not continue into adulthood, the contractures, growth retardation, bone deformities, and visual impairment associated with JRA may lead to lifelong functional impairments. A comprehensive treatment program involving physical therapy, occupational therapy, nutrition, education, and regular opthalmologic care can limit residual functional limitations. Approximately 70% of the organisms found in canine oral and nasal fluids, and consequently in fresh dog bite wounds, are: ✔✔Staphylococcus and Pasteurella multocida. All of these organisms are found in canine oral and nasal fluids, and cultured from fresh dog bite wounds, but the most common (70%) are Staph and Pasteurella multocida. Education of women with fibrocystic breast disease should include which of the following statements? ✔✔Caffeine may trigger breast pain. Avoidance of all methylxanthines (eg coffee, tea, chocolate) has been shown to reduce breast pain in women with fibrocystic breast disease. It is usually a benign condition, not a precursor of malignancy. Mammography is recommended once at age 35 years, at least every 1-2 years after age 40, and then annually beginning at age 50 years. Oral contraceptives may help reduce cyclical pain and swelling.
Which activities are NOT characteristic of preschool children? ✔✔Always follow rules during playground games. Since preschoolers are just beginning to learn moral behaviors, they often cheat to win. While most preschoolers toilet independently, accidents occasionally occur and bed-wetting is not unusual. The use of a security item such as a blanket is common. A 38-yo pregnant patient at 18 weeks gestation, complains of feeling light-headed when standing. Which of the following is an appropriate response by the NP? ✔✔Blood pressure normally decreases during pregnancy and can cause this symptom. Blood pressure normally decreases during pregnancy, reaching the lowest point during the second or third trimesters and rising there after. Patient education to rise slowly from sitting or lying is important. Low blood glucose may be the etiology, but an oral glucose tolerance test at this point is not indicated. A fasting blood glucose could be ordered, however, an electrocardiogram is not indicated. An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure? ✔✔Weight gain. Early signs of heart failure include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension. A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the most likely diagnosis and the most appropriate action? ✔✔Scarlet fever; treat with antibiotics. This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia lines. A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? ✔✔6 weeks.
The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of 4-6 weeks before checking the patient's TSH. A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about: ✔✔testicular self- examination. Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. The treatment of choice for chronic bacterial prostatitis (CBP) is: ✔✔a flouroquinolone twice daily for 3 weeks to 4 months. The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with Bactrim-DS is only about 30-40%. A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the most likely underlying conidition predisposing her to recurring candidal vaginitis? ✔✔Diabetes. A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this patient. Which of the following is NOT a characteristic of the S3 heart sound? ✔✔The sound is high- pitched and occurs just prior to the S1 heart sound. The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is produced by rapid ventricular filling and is best auscultated in the mitral area. It is a common finding with right-sided heart failure, rapid growth, and the last trimester of pregnancy. Following the finding of prostate gland abnormalities on DRE, the NP orders the appropriate labs. Whem preparing to review lab reports with the patient, the nurse practitioner knows all of the following are true EXCEPT: ✔✔normal PSA is 10ng/ml or less. Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated with BPH. A 10 or greater PSA level suggests prostate cancer. Positive serum acid phosphatase is associated with malignancy of the prostate gland with bone metasasis.
and sent for culture and sensitivity. What action should the nurse practitioner take today? ✔✔Start Clarithromycin (Biaxin) 500mg 2 times a day for 10 to 14 days. Most treatment guidelines for outpatient pna in non-smokers without co-morbidity and 60 years of age or younger, recommend erythromycin or another macrolide like Biaxin. Pcn s indicated for patient swith pneumococcal pna and ciprofloxacin is recommended for Legionella species. A 38 year old patient is being treated the by the NP for heavy vaginal bleeding secondary to multiple uterine leiomyomas. Her uterus is greater than 12 weeks gestational size, her hematocrit is 28%, and she has not responded to hormonal therapy. Which of the following would be the most appropriate intervention at this time? ✔✔Obtain a gynecological consultation Gynecological consultation is recommended for a patient with a uterus greater that 12 weeks gestational size, significant anemia (hct <30),. o a normal endometrial biopsy with failure to respond to hormonal therapy. What maternal situation is considered an absolute contraindication to breastfeeding? ✔✔Early HIV detection There are few absolute contraindications to breastfeeding. HIV infection and IV drug abuse are 2 contraindications. A 21 yo college student presents to the sudent health center with copious, markedly purulent discharge from her left eye. The nurse practitioner should suspect: ✔✔gonococcal conjunctivitis. A purulent and copious discharge should alert the nurse practitioner to the likely possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic treatment and immediate referral to an opthalmologist for evaluation. Babies should begin oral iron supplementation: ✔✔ 4 - 6 months of age. Generally, full term infants who are breadt-fed have sufficient stores of iron to last through the first 4-6 months of life. Earlier supplementation may be m=necessary for premature infants, infants who are breastyfed exclusively beyond the first 6 months of age, and infants who begin drinking cow's milk prior to 1 year of age. Which item is NOT implicated in erectile dysfunction (ED)? ✔✔Urinary tract infection (UTI) Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can result in ED> Many medications can cause ED, particularly the antihypertensives (Vasotec) and the
antidepressants (Paxil). Other activities like heavy smoking, drug abuse, and alcoholism can also lead to ED. Expected spriometry readings when the patient has chronic emphysema include: ✔✔Increased total lung capacity (TLC). Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and total lung capacity is increased with emphysema. RV, VC, and FEV-1 spirometry readings are the same whether COPD is due to chronic emphysema or chronic bronchitis, however, TLC is normal or only slightly increased with chronic bronchitis. Physical exam findings consistent with emphysema include all of the following EXCEPT: ✔✔pallor and cyanosis of the mucosa and nailbeds. Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_. Emphysema (Type A COPD, the "pink puffer") is not associated with pallor or cyanosis. Increased AP dianeter produces a "barrel chest". The normal chest is elliptical whereas the barrel chest is round. The muscles of the thorax appear thin and wasted while the accessory muscles of respiration are hypertrophied. Breath sounds are minished and cough is weak and ineffective. Which laboratory test is useful in the diagnosis of spontaneous abortion? ✔✔Serial quantitative beta-huma chorionic gonadotropin levels. Serial quantitative beta-human chorionic gonadotropin levels are the most useful for diagnosing spontaneous abortion. The levels progressively decline. The most acceoted recommendation regarding skin cancer prevention is: ✔✔avoidance of excessive sun exposure. Avoidance of excessive sun exposure is the most accepted recommendation for prevention of skin cancer. All the other items are recommended by particular groups, but are not as widely accepted. Clinicians should remain alert for suspicious lesions in fair-skinned men and women
65 years, those with atypical moles, those with > 50 moles. These groups have a substantially increased risk for melanoma. What prophylaxis medication is recommended for the patient under 35 years of age with a positive ppd? ✔✔isoniazid (INH)
This patient takes warfarin for prevention of emboli secondary to chronic atrial fibrillation. According to the NHLBI and ACCP, warfarin is the standard of care when anticoagulation is required for this condition. Warfarin is a drug with a narrow therapeutic index. This means that fluctuation in its level (increased or decreased) can potentiall cause big changes in its therapeutic effect. Consequently, warfarin levels are checked frequently to maintain therapeutic levels. If changes such as medication substitutions occur, warfarin levels should be checked in 3-7 days. Levels should be checked minimally every 4-6 weeks once regulation has occurred. While it is important NOT to omit doses of warfarin, this is the least important of all the choices because the effect of warfarin lasts beyond 24 hours. Which of the following medication or medication class that does NOT have dizziness or vertigo as potential adverse side effects? ✔✔Meclizine (Antivert) Dizziness is associated with a sensation of body movement when there is no body movement occurring. (The person is spinning and the room is not). Vertigo is the sensation that the person is still and the room is spinning. There is no associated muscle weakeness or visual disturbance with either of these conditions. The most common causes are related to drug ingestion, hypotension, inner or middle ear pathology, and positional vertigo. Dizziness is an adverse reaction associated with certain antibiotics (gentomycin and strptomycin) and high-dose salicylates. Vertigo is associated with certain inner ear pathology such as labyrinthitis and Meniere's disease. Meclizine is a long-acting antihistamine which is used to treat chronic vertigo. A PPD is considered positive at 5 millimeters or more for which population? ✔✔Confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with a chest X-ray suggestive of TB A PPD greater than or equal to 10 mm is considered positive for injecting drug users known to be HIV negative, occupants of long-term care facilities, age less than 4 years, groups with a high prevalance for TB, the medically underserved, and healthcare workers. A PPD is considered positive at 15mm or more in those with no known risk factors. Considering mortality statistics for the adolescent age group. education targeted toward this group should first focus on: ✔✔alcohol abuse. Alcohol is the most commonly used psychoactive substance in the United States today. It has been used by about 90% of adolescents by 16 years of age. Motor vehicle accidents related to driving under the influence of alcohol are the leading cause of death in the 15-24 year old age group.
A patient with moderate persistent asthma will probably be most effectively managed with daily: ✔✔inhaled steroids and long acting bronchodilators. A patient with moderate persistent asthma has symptoms daily. He is best managed with daily medications of inhaled corticosteroids and long acting bronchdilators. Oral leukotriene blockers may be added to this regimen. A child has just scalded her index finger with hot water at home. The mother calls the NP within 5 minutes of the injury. All of the following are appropiate instructions for the mother regarding the care of the patient with a 2nd degree burn EXCEPT: ✔✔Applying butter, cooking oil, or lanolin for pain relief. Flushing first or second degree burn with cool water is appropriate to prevent further thermal injury and to provide pain relief. Oil should NEVER be applied to a burn injury. Consider consultation for burns in patients who are under 10 years of age and over 50 years of age. Physician referral is recommended for all 3rd degree burns, for 2nd and 3rd degree burns involving more than 10% of the body surface area, any deep thickness burns involving more than 2% of the body surface area, and burns involving the face. What is the recommended treatment for cat scratch disease? ✔✔usually self-limiting and presents with lymphadenopathy that goes away on it's own; severe cases may benefit from azithromycin What is the most common cause of traveler's diarrhea? ✔✔e coli What bacteria is responsible for causing cat scratch disease? ✔✔bartonella henselae What are the 4 different components of tetralogy of fallot? ✔✔overriding aorta, pulmonary stenosis, right ventricular hypertrophy, and a ventricular septal defect What does the murmur auscultated in tetralogy of fallot sound like? ✔✔systolic murmur best heard at the left upper sternal border What does the murmur auscultated in a ventricular septal defect sound like? ✔✔systolic murmur best heard at the left lower sternal border
When are pregnant women screening for gestational diabetes? ✔✔week 24- 28 What is round ligament pain? ✔✔a deep, sharp, stabbing or stretching sensation that begins or worsens with movement and can be unilateral or bilateral. This is a normal and benign part of pregnancy What are the components of the fetal biophysical profile? ✔✔nonstress test (heart rate monitoring), amniotic fluid analysis, fetal movements, fetal tone, and fetal breathing How is the fetal biophysical profile performed? ✔✔via ultrasound and fetal heart rate monitoring When is the fetal biophysical profile often performed? ✔✔in the third trimester, often after week 28 - 32 What is a normal kick count in pregnancy? ✔✔at least 10 kicks in a consecutive two hour period How much weight should an underweight woman gain in pregnancy? ✔✔ 28 - 40 pounds How much weight should a normal weight woman gain in pregnancy? ✔✔ 25 - 35 pounds How much weight should an overweight woman gain in pregnancy? ✔✔ 15 - 25 pounds How much weight should an obese woman gain in pregnancy? ✔✔ 11 - 20 pounds Underweight and normal weight woman should be gaining how much weight per week in their second and third trimesters? ✔✔1 pound Overweight and obese women should be gaining how much weight per week in their second and third trimesters? ✔✔0.5 pounds
What is the biggest risk associated with scabies? ✔✔secondary infection due to itching What do scabies look like on the skin? ✔✔red papular bumps that have s shaped burrows on them; may have fluid coming from them Sickle cell anemia is what type of anemia? ✔✔normocytic How is sickle cell anemia diagnosed? ✔✔hemoglobin electrophoresis Which age group is rheumatic fever most common in? ✔✔children ages 5- 15 What are the major symptoms of rheumatic fever? ✔✔carditis, arthritis, chorea, erythema marginatum (rash), subcutaneous nodules What are the minor symptoms of rheumatic fever? ✔✔fever, elevated ESR, prolonged PR interval How do we treat rheumatic fever? ✔✔refer to the hospital What is chorea? ✔✔abnormal involuntary movements What are the main s/s of rubeiola (measles) ✔✔Koplick spots + the 3 c's - cough, coryza, conjunctivitis GABHS infection puts individuals at the highest risk of developing what sequelae? ✔✔peritonsillar abscess, glomerulonephritis, rheumatic fever
The medical term for tennis elbow ✔✔lateral epicondylitis What is the leading cause of death in anorexia? ✔✔suicide Erikson stage from birth to 18 months ✔✔trust vs mistrust Erikson stage from 18 months to 3 years ✔✔autonomy vs shame and doubt Erikson stage from 3-5 years ✔✔initiative vs guilt Erikson stage from 5-13 years ✔✔industry vs inferiority Erikson stage from 13-21 years ✔✔identity vs role confusion Erikson stage from 21-39 years ✔✔intimacy vs isolation Erikson stage from 40-65 years ✔✔generativity vs stagnation Erikson stage for 65 and older ✔✔ego integrity vs despair Macrobid/nitrofurantoin is contraindicated in which patients? ✔✔those with renal insufficiency Treatment options for complicated UTI ✔✔cipro or levo x 5-7 days Treatment options for uncomplicated UTI ✔✔bactrim x 3 days, macrobid x 5 days, fosfamycin 1g one time dose
Olecranon bursitis is pain in which region of the elbow? ✔✔the posterior elbow; will also have swelling and warmth Lateral epicondylitis manifests as what type of elbow pain? ✔✔weak grip and pain with gripping, pain with rotation of the wrist and forearm The medical term for golfer's elbow ✔✔medial epicondylitis How does the pain in lateral vs. medial epicondylitis differ? ✔✔lateral epicondylitis is worse with supination of the hand and medial epicondylitis is worse with pronation of the hand involves tapping a finger along the problem nerve ✔✔tinel sign asking the patient to place both elbows on a table while keeping both forearms vertical and flexing both wrists ✔✔phalen sign Which nerve runs on the side of the thumb ✔✔median nerve Which nerve runs on the side of the pinky finger ✔✔ulnar nerve What is ankylosing spondylitis? ✔✔an inflammatory condition affecting the spine causing chronic back pain and stiffness that improves with exercise and enthesitis What is the treatment for ankylosing spondylitis? ✔✔refer to rheumatology for possible DMARDs What are the s/s of polymyalgia rheumatica? ✔✔chronic pain in the proximal joints (shoulders and hips) bilaterally with stiffness lasting for more than 45 minutes
