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FAMILY NURSE PRACTITIONER LABS
ANCC EXAM PREPARATION -
QUESTIONS AND ANSWERS.
Hgb male - \13.5 to 17.5 g/dL Hgb female - \12.0 to 15.5 g/dl female male - \36% to 46 % 41% to 53% MCV (size of RBC) - \80 to100 fL >100 fl (macrocytic anemia) such as B12 deficiency (due to pernicious anemia) or folate deficiency <80 (microcytic anemia) such as iron deficiency or thalassemia trait Platelet count
. - \140 − 415 × 103/mL Thrombocytopenia increased risk of bleeding Thrombocytosis increased risk of clotting, emboli Total WBC count - \4.0 − 10.5 × 103/mL Elevation usually due to bacterial infection Neutrophils (or segs) - \56%-62%
70% usually due to bacterial infections Bands . - \Also called "shift to the left" Elevation due to serious bacterial infection Bands are immature neutrophils
Lymphocytes - \Elevation due to viral infections Eosinophils - \Elevation in allergies and parasitic infections Reticulocytes - \Elevated after acute hemorrhage, hemolysis Thyroid Stimulating Hormone (TSH) - \Elevated - Hypothyroidism (>5.5 mU/L) Very low - Hyperthyroidism (0.4 mU/L) International Normalized Ratio (INR) - \Atrial Fibrillation/Thrombosis PE: 2.0-3.0 times normal Bioprosthetic Valves: 2.0-3. Prosthetic Valves 2.5-3. alpha or beta thalassemia trait (or minor), - \normal to high ferritiniron and normal to "below normal" TIBC/transferrin levels. The gold standard test to diagnose thalassemia - \hemoglobin electrophoresis. Where is the best location to listen for the S3 heart sound? - \pulmonic area L n. A good example of a disease with no screening test - \ovarian cancer. Therefore, screening all women for this cancer is currently not recommended. reportable disease. - \Tuberculosis Lyme disease, meningococcemia, Rocky Mountain spotted fever, measles, rubella, diphtheria, chlamydia, gonorrhea, HIV, two different names that are used interchangeably osteoarthritis - \degenerative joint disease (DJD) two different names that are used interchangeably
ringworm two different names that are used interchangeably vitamin B12 or cobalamin - \two different names that are used interchangeably cyanocobalamin (chemical two different names that are used interchangeably scarlet fever or
. - \two different names that are used interchangeably scarlet fever or . two different names that are used interchangeably otitis externa . - \two different names that are used interchangeably swimmer's ear two different names that are used interchangeably condyloma acuminata - \two different names that are used interchangeably genital warts two different names that are used interchangeably tic douloureux or - \two different names that are used interchangeably trigeminal neuralgia two different names that are used interchangeably tinea cruris - \two different names that are used interchangeably
jock itch two different names that are used interchangeably tinea capitis - \two different names that are used interchangeably ringworm of the scalp two different names that are used interchangeably thalassemia minor - \two different names that are used interchangeably thalassemia trait two different names that are used interchangeably giant cell arteritis - \two different names that are used interchangeably temporal arteritis two different names that are used interchangeably asthma or - \two different names that are used interchangeably reactive airway disease (infants and children) two different names that are used interchangeably psoas sign or - \two different names that are used interchangeably iliopsoas muscle sign two different names that are used interchangeably light reflex or
. - \two different names that are used interchangeably Hirschsprung test two different names that are used interchangeably
Angiotensin-converting enzyme inhibitors - \first line drugs except for patients with a comorbidity such as diabetes mellitus or microalbuminuria. These are the drugs of choice for people with diabetes because of their renal-protective properties. . Beta blockers are - \hypertension and migraine. Beta blockers are contraindicated in - \contraindicated in patients with chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sarcoidosis, or chronic bronchitis. Acute otitis externa - \superficial infection of the skin in the ear canal. It is more common during warm and humid conditions such as swimming and summertime. The most common bacterial pathogen is pseudomonas (gram negative). does not involve the middle ear or the tympanic membrane and does not cause tinnitus (as seen in Ménière's disease). Grade I - \very soft murmur that is difficult to hear. Grade II
. - \is a murmur that is mild to moderately loud. Grade III - \is a loud murmur that is easy to hear. Grade IV - \the first time a thrill is palpated. Grade V - \when the murmur can be heard with the stethoscope partly off the chest. Grade VI - \when the murmur is so loud that it can be heard with the stethoscope off the chest. A loud heart murmur that is easily heard when the stethoscope is placed on the chest is which of the following? - \Grade III No thrill is present - \less than 4
Diverticulitis - \inflamed and infected diverticula. It is more common in older or elderly adults. small pouch-like structures along the clonic wall. They are caused by chronic lack of fiber in the diet treatment is fiber supplementation such as psyllium (Metamucil) or methylcellulose (Citrucel) that is taken two to three times a day with 8 ounces of water. can be a life-threatening infection; if the diverticula rupture, the result will be an acute abdomen. Rocky Mountain spotted fever. - \A rash starts on the wrist and ankles; spreading centrally is a classic sign of Which of the following is the best treatment plan to follow? - \Refer the patient to an infectious disease specialist immediately. . Rocky Mountain spotted fever is treated with - \doxycycline or chloramphenicol. what happens with Rocky Mountain spotted - \Thrombocytopenia and ITP, an autoimmune disorder, result from the breakdown of platelets in the spleen. ITP is self-limiting and is usually precipitated by a viral infection. Erythema migrans (a targetlike red rash) - \seen during the early stage of the infection. treated with a 21-day course of doxycycline. Roseola infantum (or exanthema subitum) - \involves an abrupt onset of high fever, up to 105o Fahrenheit (F), lasting from 3 to 5 days. The infant feeds and behaves normally. After the fever diminishes, a rash appears on the trunk/abdomen and then resolves spontaneously after a few days. sometimes associated with febrile seizures. It is caused by herpes virus type 6 and type 7. The teen presented in the case ranges from the age of 14 to 16 years. The - \The teen is usually due for a Td booster (the last series of the DTaP is given at around 3 to 4 years of age or at preschool). Therefore, teens are due for their first 10-year booster of tetanus. Primary Prevention (prevention of disease/injury) -
\Tertiary prevention is any type of rehabilitation such as cardiac rehab, physical therapy, or speech therapy. It also consists of educational or support groups for people with pre- existing conditions such as Alcoholics Anonymous (or a group of people meeting to deal with a common problem), and education for patients with pre-existing disease (i.e., diabetes, hypertension) about how to avoid drug interactions, proper use of wheelchair or medical equipment, and so forth. inflammatory bowel disorder which causes abdominal pain , diarrhea and wt loss. Affects all the layers of the bowels. Distinguishes it from ulcerative colitis ilium involvement bloody diarrhea and frequent vomiting and diarrhea - \Chrohn's Disease involves mucosa and submucosa affects the colon colectomy is curative in ulcerative colitis bloody diarrhea and frequent vomiting and diarrhea - \ulcerative colitis duodenal ulcer or gastric ulcer - \Positive helicobacter pylori test passive rotation of the right hip from 90 degree - \positive obturator yellowing but sclera is bright and clear - \carotenemia central antiemtic affect useful for improving first line for gastroparesis - \reglan metoclopramide pathogen with grossly blood diarrhea - \shigella watery stools - \e.coli parasitic cause of diarrhea which causes boating and watery diarrhea. Explosive watery diarrhea , malodorous, greasy - \giardia viral cause of watery diarrhea - \norovirus frequent watery stools and and cramping - \c diff
dx of IBS - \rome III criteria celiac disease testing - \tissue transglutaminase antibody testing lactose intolerance - \hydrogen breath testing involves gastrin- secreting which leads to peptic ulcers - \Zollinger Ellison Syndrome upper endoscopy - \Acute gastritis gold standard for dx antichlolinergic agents, beta adrenergic receptors, calcium blocker, diphenhydramine, H2 antagonist, levodopa , opioid , PPI TCA - \medications that delay gastric emptying are contraindicated during pregnancy - \Benazepril is an ACE inhibitor patients who have renal insufficiency. - \NSAIDs are contraindicated late systolic click - \characteristic of MVP. no audible click, audible diastolic murmur best heard in the mitral listening point - \mitral stenosis systolic murmur - \MR It should be measured annually. - \How often should blood pressure be measured in a child who is 3 years old? 10 years of age. - \A child's resting heart rate can be expected to be between 60 and 100 beats per minute once he reaches the sensitivity and specificity is 98% and 92%, favoring a diagnosis of heart failure. - \When the BNP level is 80 pg/mL or greater,
\PSA
check for drug interaction - \simvastatin and amlopindine do not give calcium channel blocker. decrease contractility of the heart - \medication should be avoided with heart failure celecoxib. NSAID holds on to sodium , which follows water - \medication should be avoided with heart failure noise in the turbulent blood blow an interruption - \heart murmurs
\aortic
\mitral dont open properly - \stenotic don't close properly - \regurgitant stet place in chest the loudest put in the carotid junction - systolic murmer - \where? systole or diastole "a pearly domed nodule with a telangiectatic vessel lesions can be treated with a topical agent like 5-fluorouracil, - \Basal cell carcinoma premalignant lesion that develops on sun-damaged skin a result of solar damage to the skin the face, bald scalp, and forearms. - \actinic keratosis 5-FU is a topical agent that can be used to treat basal cell carcinoma (BCC) - \Topical 5-fluorouracil (5-FU) is used to treat nodulocystic acne. - \isotretinoin
The incubation period for scabies is about 3-4 weeks after primary infection. Patients with subsequent infections with scabies will develop symptoms in 1-3 days. - \patient with a primary case of scabies was probably infected: he word used to describe a gradual and progressively poorer clinical response to a treatment or medication "just doesn't work anymore." - \Tachyphylaxis the face - \The most common place for basal cell carcinoma to be found is the: Doxycycline - \MRSA with sulfa allergic lower leg wound that appears infected. It is red, warm to touch and edematous. He had an acute onset of pain, symptoms, and low grade fever The erythema noted in erysipelas is well demarcated and raised above the level of the skin. - \Erysipelas tend to have a more gradual course with development of symptoms over several days. - \cellulitis Koplik's spots - \The spots are white and granular and are circled by an erythematous ring. The spots are pathognomonic for measles. There is an exanthem associated with measles. It typically is described as cranial to caudal in progression. The lesions become confluent and last for approximately 4 days before fading begins. A characteristic finding is the "herald" or "mother" patch found on trunk. This looks like a ringworm and precedes the generalized "Christmas tree" pattern rash. - \Pityriasis rosea (PR) Fluoroquinolones tetracyclines, sulfa drugs ydrochlorothiazide, diltiazem, selective serotonin reuptake inhibitors, antihistamines, ibuprofen, and naproxen. - \antibiotics may increase the likelihood of photosensitivity? ulcerative colitis most common in women aged 15-40 years old. They are typically found in pretibial locations and can be associated with infectious agents, drugs, or systemic inflammatory
likely resolve this if used twice daily for 7-14 days. A diagnosis of diabetes should be considered if this is resistant to treatment or if it recurs. - \Intertrigo This is a common viral exanthem found in young children caused by the Human Herpes Virus 6B. It is characterized by high fever for 3 days followed by the abrupt cessation of fever and the appearance of a maculopapular rash. This usually resolves in a few days. The child may return to school or daycare when he has been fever free for 24 hours. - \roseola or exanthem subitum. typical in tinea pedis, tinea cruris, and tinea corporis. - \Hyphae mature capillary proliferations that are more common in middle and older adults. They blanch with pressure and are usually 0.1-0.4 cm in diameter. They are commonly found on the trunk as multiple lesions. Because they are a proliferation of capillaries, they will bleed significantly if they rupture. The bleed is not life threatening, but, in older adults who take aspirin, the bleeding will be worse. Pressure should be held over the ruptured area until bleeding stops. These are not precursors of skin malignancies. - \Cherry angiomas Clubbing of fingers is most often associated with chronic hypoxia as seen in cigarette smokers and patients with COPD or lung cancer. Other causes are cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic heart disease. - \Rounding of the distal phalanx describes clubbing
would be ideal for discovering the cause of this situation looks at "what happened"? e study of choice to determine the cause of a cluster of adult leukemia cases found in an isolated area of a rural state? Both groups would be analyzed for characteristics or risk factors that were present in the "case" group but not the "control" group. This is an observational stud - \A case control study gradual development of scrotal pain There is no scrotal edema. This is more typical in hydrocele. Common precipitants are sexual activity, heavy physical exertion as described in the question, and bicycle or motorcycle riding. In sexually active males under age 35 years, a common cause is an STD. - \The typical presentation of an adult male with epididymitis
gallbladder disease One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease should not receive oral contraceptives (OC) since they will increase estrogen exposure and theoretically, formation of gallstones. - \A patient who takes oral contraceptive pills is at increased risk of: ne of the major components of gallstones is estrogen. A patient with underlying gallbladder disease should not receive oral contraceptives (OC) since they will increase estrogen exposure and theoretically, formation of gallstones. Patients who are less than 6 months post-partum should avoid OCs until they are 6 months post-partum because OCs can decrease the quantity of breast milk produced. Hypertension is a contraindication to OC use because of the increased risk of stroke - \precautions for oral contraceptive pill use? Patients with folic acid deficiency and/or vitamin B12 deficiency are more likely to be elderly, in poor health, and have poor diets. Both may also be seen in patients who consume excessive amounts of alcohol. Nothing in history indicates this as the etiology.
\What type of anemias is he most likely to exhibit Having multiple chronic illnesses? Lymphoma It is characterized by enlarged lymph nodes and may be accompanied by fever, cough, night sweats, and fatigue - \lymph nodes in his axillary and inguinal areas that are palpable but non-tender. He states that he feels well today. What should be included in a differential diagnosis for this patient? Glossitis is an inflammation of the tongue with a change in its usual color. It may be tender also. This is commonly observed in patients who have B12 deficiency anemia (pernicious anemia). - \patient with pernicious anemia may be observed to have: The finding of metamyelocytes is an ominous one. These represent immature white cells that are usually present only in the bone marrow. The examiner should consider a diagnosis of leukemia. A definitive diagnosis can only be made after a bone marrow aspiration and examination. Many adult patients are asymptomatic for months before diagnosis. Splenomegaly and hepatomegaly are common because of an excess of neutrophils produced by a diseased bone marrow. - \he laboratory identifies metamyelocytes Increased follicle stimulating hormone ollicle stimulating hormone (FSH) begins to rise during menopausal transition. This stage of menopause begins with variation in menstrual cycle length and ends 12 months after the final menses. If the patient is older than 45 years and menstrual cycle
Hyperthyroidism - \A patient has fatigue, weight loss, and a TSH of .05. What is his likely diagnosis? AM fasting Long acting insulin mimics the amount of insulin the pancreas produces at a steady rate throughout the day and night. Adjustments in doses of long-acting insulin are typically based on the AM fasting glucose values. - \Which blood sugars are important to review in order to increase the dose of insulin? Type II diabetes is diagnosed after a random fasting glucose > 126 mg/dL and confirmed on a subsequent day. ther diagnostic criteria include a random blood glucose > 200 mg/dL with polyuria, polydypsia, or polyphagia; or an A1C > 6.5% (and confirmed on a subsequent day) - \glucose values that equal or exceed 126 mg/dL on different days constitute a diagnosis of diabetes less than 130/80. - \A patient with newly diagnosed Type 2 diabetes asks what his target blood pressure should be. The most correct response is: 80-120 mg/dL Correct - \What is the AM fasting glucose goal for a 75 year-old patient who has diabetes? the most common form of hyperthyroidism There will be elevated levels of thyroid hormones like T3 and/or T Patients become symptomatic with palpitations, elevated blood pressure, inability to sleep, restlessness, and heat intolerance - \Grave's disease he effect can be realized as early as 6-8 weeks after starting an ACE inhibitor or ARB. - \A diabetic patient with proteinuria (approximately 1 g/d) has been placed on an ACE inhibitor. How soon can the anti-proteinuric effect of the ACE inhibitor be realized in this patient? A 45 year-old female patient has a screening TSH performed. Her TSH value is 13 mU/L. It was repeated in one week and found to be 15 mU/L. What explains this finding? - \This patient has hypothyroidism because her TSH exceeds 5 mU/L. the earliest glycemic abnormality is postprandial glucose elevation. Early in the pathogenesis of diabetes, glucose levels increase to abnormal levels after eating - \What is the earliest detectable glycemic abnormality in a patient with Type 2 diabetes?
There are 2 reasons to order a TSH and T4 in ambulatory patients for screening; if pituitary or hypothalamic disease is known or suspected, or if the patient is receiving medications or has specific diseases that can affect TSH secretion. Examples of drugs and disorders that can increase TSH secretion are metoclopramide, amiodarone, adrenal insufficiency, pituitary adenoma, and generalized thyroid hormone resistance. In hospitalized patients, TSH should not be used as a sole means to evaluate thyroid disease because many different factors in seriously ill euthyroid patients can affect TSH secretion. - \The earliest glycemic abnormality is postprandial glucose elevation. Early in the pathogenesis of diabetes, glucose levels increase to abnormal levels after eating. SH only Corr - \What is the most sensitive laboratory assay for screening and identifying the vast majority of ambulatory patients with primary hypothyroidism? dizziness and weakness. - \n older adult with a hypoglycemic episode is more likely to exhibit 15 - 50 days - \What is the typical incubation period for Hepatitis A? 4.5 - 5.7 x 106/μl (male) 3.9 - 5.0 x 106/μl (female - \RBC < 30 - \esr the most frequent immunoglobulin elevated is IgG. - \multiple myeloma, The epithelioid cells suggest that it is a granuloma. The hemoptysis suggests that the granuloma has eroded enough parenchyma and involved a bronchus. A granulomatous infection along with hemoptysis is typical - \typical for tuberculosis. the clinical history demonstrates the symptoms as well as the progression that is characteristic of Alzheimer's Disease - \What would be the best source of information in order to determine a diagnosis of Alzheimer's disease?? Dementia of the Alzheimer's type usually consists of a gradual decline in memory. At least 1 of the following will also be found: agnosia, aphasia, or apraxia. Agnosia causes the inability of patients to recognize themselves, other familiar objects, or people. Aphasia is the development of a speech problem. Patients become
