Download Risk Factors and Management of Eczema in Patients and more Exams Nursing in PDF only on Docsity!
ANCC Practice Questions & Answers
In the early stages of iron deficient anemias, blood studies show: (a) macrocytic normochromic (b) microcytic hypochromic (c) normochromic normocytic (d) pancytopenic hypocytic - ANS-(a) normochromic normocytic A 14-year-old, male patient has some general concerns about eczema, as his twin brother was recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a personal history of allergic rhinitis, and a history of: (a) asthma (b) bee allergy (c) otitis media (d) psoriasis - ANS-(a) asthma A patient has hyperactive reflexes of the lower extremities. The adult-gerontology primary care nurse practitioner assesses for ankle clonus by: (a) firmly applying a low-pitched tuning fork to the lateral malleolus. (b) flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the percussion hammer. (c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. (d) stroking the lateral aspect of the sole from the heel to the ball of the foot with the sharp end of the percussion hammer. - ANS-(c) sharply dorsiflexing the foot and maintaining this position while supporting the knee. A 70-year-old, female patient is having her yearly evaluation. The adult-gerontology primary care nurse practitioner gives which physical examination finding the highest priority for immediate treatment? (a) Atrophy of vaginal rugae. (b) Cystocele present. (c) Palpable ovary. (d) Pessary in place. - ANS-(c) Palpable ovary.
The adult-gerontology primary care nurse practitioner reminds a 16-year-old, male patient who just received his driver's license to wear a seat belt at all times when in a car. The patient replies that he does not need to wear a seat belt, because nothing will happen to him if he is involved in an automobile collision. According to the health belief model, what chief component does the patient lack? (a) Enabling factors. (b) Motivation. (c) Perceived role conflict. (d) Perceived severity. - ANS-(d) Perceived severity. The adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure? (a) Comorbidities and length of exposure. (b) Location and event intensity. (c) Mode of transmission and incubation. (d) Premorbid conditions and surveillance rates. - ANS-(c) Mode of transmission and incubation. When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner: (a) concludes that the study proves the hypothesis. (b) excludes the discussion section, because the conclusion contains this information. (c) recommends incorporating the results directly into clinical practice. (d) uses the methodology section to support the validity of the study. - ANS-(d) uses the methodology section to support the validity of the study. A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: (a) asks the child to provide a copy of the patient's advance directive document. (b) assures the child that the nurse practitioner can disclose requested information. (c) informs the child that he or she must come to the clinic to discuss the parent's case.
(c) relies on the patient's self-report. (d) waits until the patient's chart is available. - ANS-(a) contacts the patient's adult child. The adult-gerontology primary care nurse practitioner conducts a small group class on weight management. The nurse practitioner anticipates that the patient who may have the greatest difficulty implementing the counseling is the: (a) extroverted patient raising his or her grandchildren. (b) introverted patient who does not speak in the group. (c) personable patient who lives with his or her children. (d) worried patient whose son is serving in military conflict. - ANS-(d) worried patient whose son is serving in military conflict. The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse practitioner's most appropriate approach is to treat the cold symptoms and: (a) advise the patient to stop smoking. (b) prescribe bupropion (Zyban). (c) raise the issue of smoking cessation at the next visit. (d) recommend that the patient select a low nicotine cigarette. - ANS-(a) advise the patient to stop smoking. The adult-gerontology primary care nurse practitioner plans to provide smoking cessation education at a community center to older adults and their families. The nurse practitioner designs the program based on knowledge that older adult smokers: (a) are likely to be optimistic about their ability to quit. (b) are more likely to be successful at quitting than younger smokers. (c) have a decreased risk of morbidity and mortality than do younger smokers. (d) receive more instruction to quit from health care providers than younger smokers. - ANS-(b) are more likely to be successful at quitting than younger smokers.
An 84-year-old patient arrives at the office for an initial visit. The patient questions the need for colorectal screening, since 10 years have passed since the last colonoscopy. The adult-gerontology primary care nurse practitioner recommends: (a) a colonoscopy. (b) a fecal DNA test. (c) flexible sigmoidoscopy. (d) watchful waiting. - ANS-(d) watchful waiting. To evaluate for heart failure, which diagnostic test does the adult-gerontology primary care nurse practitioner order for a patient with swelling in the lower extremities? (a) Ankle-brachial index. (b) Brain natriuretic peptide test. (c) D-dimer assay. (d) Spirometry study. - ANS-(b) Brain natriuretic peptide test. Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which laboratory values does the adult-gerontology primary care nurse practitioner obtain? (a) Liver function studies. (b) Platelet count. (c) Renal function studies. (d) White blood cell count. - ANS-(a) Liver function studies. A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight, abdominal pain, and a long-term history of multiple sexual partners. The patient's physical examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test confirms active hepatitis B? (a) Antibody. (b) Enzyme-linked immunosorbent assay. (c) Immune globulin G. (d) Surface antigen. - ANS-(d) Surface antigen. For two to three months, a 78-year-old patient has not been taking levothyroxine (Synthroid) as prescribed. The patient now has symptoms of increasing constipation, lethargy, and weakness. The adult-gerontology primary care nurse practitioner anticipates that laboratory tests will show that the patient's: (a) T4 level decreased, and TSH level increased.
(a) Autonomy and patient safety are rarely competitive considerations. (b) Decisions regarding a health care representative are a family group decision. (c) Family members are not integral components in care planning. (d) Trust and rapport with patients are key to patient satisfaction in decisions for care. - ANS-(d) Trust and rapport with patients are key to patient satisfaction in decisions for care. The adult-gerontology primary care nurse practitioner working in an urban community health center recognizes that asthma-related health issues commonly result in higher morbidity and mortality for persons with: (a) alcohol dependency. (b) lower socioeconomic status. (c) persistent social isolation. (d) recent immigrant status. - ANS-(b) lower socioeconomic status. During an annual health visit, a 15-year-old female patient is found to have grown 5 in (12.7 cm) over the past year. She has not reached menarche. Her mother is concerned because the patient's sister reached menarche at age 11 and the mother reached menarche at age 12. Examination reveals that the patient's breasts are enlarged, with the areolae forming a mound above the general contour of each breast, and that the left breast is larger than the right. Axillary hair is absent and the pubic hair is dark, coarse, curly, dense, and similar in pattern to that of an adult female. These findings are consistent with a diagnosis of: (a) hypothyroidism. (b) normal development. (c) polycystic ovary syndrome. (d) Turner syndrome. - ANS-(b) normal development. A pale, thin 54-year-old male patient reports a two-month history of numbness in his feet. Past medical history includes hypertension and a subtotal gastrectomy. An examination reveals a decreased vibratory sensation and position sense. Blood tests indicate a hematocrit of 27%, mean corpuscular volume of 105 fL, mean corpuscular hemoglobin of 45 pg, and reticulocytes of 1.5%. The diagnosis is: (a) chronic simple anemia. (b) folate deficiency anemia. (c) iron deficiency anemia.
(d) vitamin B12 deficiency anemia. - ANS-(d) vitamin B12 deficiency anemia. Upon referral from a gynecologist, an adult nurse practitioner evaluates an 89-year-old female nursing home resident for vaginal bleeding. The patient has a history of occasional periods of confusion and memory loss. The gynecologist recommended dilation and curettage and the patient consented to the procedure after the gynecologist answered her questions, but the patient's daughter protests. The nurse practitioner's ethical duty is to support the: (a) daughter, because she might file a lawsuit over unsatisfactory care. (b) daughter, because the patient is occasionally confused and incapable of granting informed consent. (c) nursing home administration, which may choose to support either the patient or the daughter. (d) patient, who has given informed consent. - ANS-(d) patient, who has given informed consent. A 16-year-old patient has been diagnosed with mononucleosis and has a positive throat culture for group Alpha-hemolytic streptococcal infection. The medication of choice for this patient is: (a) amoxicillin (Amoxil). (b) doxycycline (Vibramycin). (c) erythromycin (E-Mycin). (d) trimethoprim-sulfamethoxazole (Bactrim). - ANS-(c) erythromycin (E-Mycin). A 70-year-old patient reports fatigue and a nonproductive cough with pain on inspiration and expiration. The patient denies a sore throat, fever, nasal congestion, or postnasal drip. Examination reveals a well-developed patient in no acute distress who is afebrile and has respirations of 32 breaths/min. The patient's lungs have diminished breath sounds. The heart rate is 70 beats/min, regular with no murmur. There is no edema of the extremities. An adult nurse practitioner orders: (a) a chest x-ray. (b) a lung perfusion scan. (c) over-the-counter treatments for symptomatic relief. (d) pulmonary function tests. - ANS-(a) a chest x-ray.
(b) activated, so it may cause a mild case of influenza. (c) inactivated, and this is unable to cause influenza. (d) live attenuated, so it may cause a mild case of influenza. - ANS-(c) inactivated, and this is unable to cause influenza. An institutional review board rejects an adult nurse practitioner's research proposal on the grounds that the: (a) chosen statistics were not optimal to meet research objectives. (b) literature review was insufficient to develop the research question. (c) proposed budget did not cover the cost of the study. (d) subject's rights were not clearly protected. - ANS-(d) subject's rights were not clearly protected. A patient informs an adult nurse practitioner, "I want to stop smoking." The nurse practitioner responds: (a) "Do you have any ideas about how you would like to quit smoking?" (b) "Does your health insurance cover smoking cessation?" (c) "I will develop a plan for you to stop smoking." (d) "Quitting smoking is the most important thing you can do for your health." - ANS-(a) "Do you have any ideas about how you would like to quit smoking?" An adult nurse practitioner is responsible for billing codes that are selected and submitted to third party payors when: (a) a certified coder has selected the code. (b) a change has occurred in the insurance carrier. (c) a misprint has appeared in the coding book. (d) the evaluation and management criteria have changed. - ANS-(a) a certified coder has selected the code. Many patients view illness as a distortion in the balance of some aspect of their lives, and believe that folk medicine can remedy this. When encountering such beliefs, an adult nurse practitioner's appropriate action is to:
(a) discuss these remedies and include them in the management plan. (b) educate these patients about evidence-based practice that is specific to their present condition. (c) promote scientifically proven treatment measures. (d) refer the patient to a homeopathic specialist. - ANS-(a) discuss these remedies and include them in the management plan. An adult nurse practitioner is designing a research study to investigate the efficacy of a patient education tool for adults with low literacy levels. Which action reflects the nurse's inclusion of ethical principles in the research plan? (a) Ensuring that the participants understand their right to withdraw from the study at any time, without incurring penalties (b) Explaining the study in scientific, medical, and nursing terms so as not to patronize the participants (c) Testing the study's informed consent form on nursing doctoral candidates at a local university to validate its clarity (d) Using large print in the content of the study's informed consent form - ANS-(a) Ensuring that the participants understand their right to withdraw from the study at any time, without incurring penalties An adult nurse practitioner evaluates a patient who has been a victim of domestic violence. After the office visit, law enforcement authorities contact the nurse practitioner, requesting information regarding any visible injuries observed during the visit. The nurse practitioner's response is to: (a) call the patient to obtain consent. (b) provide the written record, as requested. (c) refer the request to the office manager. (d) require a court order for release. - ANS-(b) provide the written record, as requested. An adult nurse practitioner witnesses a coworker's injury due to a chemical spill. To which regulatory agency is this incident reported? (a) Agency for Toxic Substances and Disease Registry
(c) a thiazide diuretic. (d) an angiotensin-converting enzyme inhibitor. - ANS-(c) a thiazide diuretic. Initial measures to prevent deformity and maintain function for the knee during an acute inflammatory reaction secondary to injury include: (a) a hot daily shower followed by a short period of exercise. (b) application of a splint to the joint followed by application of heat. (c) cautious performance of active range-of-motion exercises. (d) total immobilization of the joint and performance of isometric exercises. - ANS-(d) total immobilization of the joint and performance of isometric exercises. A 34-year-old truck driver reports a sharp pain in the lower back that worsens with ambulation. The symptoms began after a strenuous three-day driving trip. During an examination, the patient has difficulty walking on the heels and shows weakness in the extensors of the big toes. The initial differential diagnosis is: (a) compression fracture. (b) L-1 root irritation. (c) L-5 root irritation. (d) ruptured disc. - ANS-(c) L-5 root irritation. The gerontological nurse practitioner performs a speculum examination for a 71-year- old female patient without symptoms, and finds a thin, whitish, nonodorous mucoid discharge high in the patient's vagina. The nurse practitioner's most appropriate intervention is to: (a) explain to the woman that the discharge is normal. (b) prescribe estrogen cream, twice a week. (c) prescribe a topical antifungal medication, applied vaginally each night for one week. (d) recommend the daily use of a vaginal lubricant, for three days. - ANS-(a) explain to the woman that the discharge is normal. Temporal arteritis requires immediate treatment in order to prevent: (a) blindness in the affected eye. (b) facial nerve palsy. (c) transient ischemic attack.
(d) trigeminal neuralgia. - ANS-(a) blindness in the affected eye. The test of choice for diagnosing iron deficiency anemia is a: (a) reticulocyte count. (b) serum ferritin level. (c) total iron binding capacity. (d) transferrin saturation level. - ANS-(b) serum ferritin level. Which profile characterizes the older adult with the highest risk for suicide? (a) Divorced, Asian, and female (b) Married, Amish, and female (c) Single, White, and male (d) Widowed, African-American, and male - ANS-(c) Single, White, and male The gerontological nurse practitioner notes a well-demarcated, dry, rough, tan-colored area that measures 1 cm on the forearm of a retired man who worked as a park ranger. The man says that the lesion has been present for years. The lesion is suggestive of: (a) actinic keratosis. (b) keratoacanthoma. (c) seborrheic keratosis. (d) senile lentigo. - ANS-(a) actinic keratosis. An 87-year-old patient, who has multiple, fluid-filled and unilateral lesions on an erythematous base that follows a dermatome, reports severe pain and burning at the site. The patient asks how long the pain will last. The gerontological nurse practitioner responds that the pain: (a) might never completely disappear. (b) will disappear in four to six weeks. (c) will disappear in six months to one year. (d) will disappear once the lesions are gone. - ANS-(a) might never completely disappear. A 69-year-old female patient reports dyspareunia. Physical examination reveals sparse hair, an introitus that admits two fingers, and a pale, dry vagina. The gerontological nurse practitioner's initial management of this problem is to prescribe:
(c) prevent or reduce associated health risks. (d) screen for liver dysfunction. - ANS-(c) prevent or reduce associated health risks. The medical history of a robust, 64-year-old patient is negative for hypertension, heart disease, and diabetes. Upon examination, the gerontological nurse practitioner detects a new grade 3 crescendo-decrescendo systolic murmur that is heard loudest at the base of the heart, with radiation to the carotid arteries. The gerontological nurse practitioner's next action is to order: (a) a C-reactive protein test. (b) a troponin level. (c) an echocardiogram. (d) an electrocardiogram. - ANS-(c) an echocardiogram. Which drug puts an older adult at the highest risk for injury after a fall? (a) Acetaminophen/ hydrocodone (Vicodin) (b) Alendronate (Fosamax) (c) Loratadine (Claritin) (d) Warfarin (Coumadin). - ANS-(d) Warfarin (Coumadin). In addition to altered mental status, which is the best early indicator of pneumonia in an older adult? (a) Cough (b) Fever (c) Malaise (d) Tachypnea - ANS-(d) Tachypnea A 65-year-old woman comes to the geriatric clinic for a routine checkup. Her history includes a 10 lb (4.5 kg) weight loss over the past two months. On physical examination, an enlarged (2 cm), radiating, nontender and rubbery lymph node is palpated on the left supraclavicular chain. The gerontological nurse practitioner's next action is to: (a) order a throat culture and monospot test. (b) order a two-step tuberculin skin test. (c) prescribe antibiotic therapy.
(d) refer the patient to a surgeon for a lymph node biopsy. - ANS-(d) refer the patient to a surgeon for a lymph node biopsy. [Note: Virchow's nodes, or "Troisier's sign", considered a sign of abdominal metastasis.] Which type of urinary incontinence is lessened by pelvic floor exercises? (a) Functional (b) Overflow (c) Stress (d) Transient - ANS-(c) Stress The purpose of a Long-Term Care Ombudsman Program is: (a) implementing quality assurance activities. (b) performing comprehensive resident assessments. (c) preserving the rights of nursing home residents. (d) providing training requirements for nursing assistants. - ANS-(c) preserving the rights of nursing home residents. Which factor is associated with the highest risk of falls in older persons living in the community? (a) A history of previous falls (b) Living alone (c) Osteoporosis (d) Use of an assistive device - ANS-(a) A history of previous falls An older adult patient complains of recent lapses in memory and decreased alertness. The patient's laboratory test results indicate a mild, macrocytic anemia. Which additional test does the adult-gerontology acute care nurse practitioner order to confirm a diagnosis? (a) A reticulocyte count (b) A serum folate level (c) An erythrocyte sedimentation rate (d) Iron studies - ANS-(b) A serum folate level An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply, after "spending down" to qualify?
(a) aspirin (Bayer). (b) aspirin with dipyridamole (Aggrenox). (c) clopidogrel (Plavix). (d) warfarin (Coumadin). - ANS-(a) aspirin (Bayer). An adult-gerontology acute care nurse practitioner who specializes in cardiology is asked to give a presentation on lipid-lowering drugs. A major drug company that markets a lipid-lowering medication plans to pay the presenter an honorarium, but asks the nurse practitioner to limit his or her remarks to its drug. This situation presents a: (a) breach of contract. (b) conflict of interest. (c) personal choice. (d) reasonable request. - ANS-(b) conflict of interest. A 32-year-old patient who underwent an open splenectomy for a ruptured spleen, is preparing for discharge. An adult-gerontology acute care nurse practitioner reviews the potential complications with the patient. The nurse practitioner emphasizes which instruction to the patient? (a) Continue antibiotics for 14 days (b) Follow up with primary care provider for vaccinations (c) No international travel for five years (d) No weight lifting restrictions - ANS-(b) Follow up with primary care provider for vaccinations A 65-year-old female patient has a confirmed diagnosis of terminal liver disease. The patient's advance directive designates comfort measures, only. An adult-gerontology acute care nurse practitioner's action is to: (a) discuss the patient's decision with the patient's family members. (b) persuade the patient to participate in a hepatitis clinical trial. (c) reconfirm the patient's end-of-life decision. (d) refer the patient for a psychological evaluation. - ANS-(c) reconfirm the patient's end- of-life decision.
A hospital requires adult-gerontology acute care nurse practitioners to submit credentialing applications for the purpose of: (a) authorizing clinical roles and responsibilities. (b) delineating therapeutic and diagnostic services. (c) monitoring the nurse practitioner's clinical activities. (d) verifying education, licensure, and experience. - ANS-(d) verifying education, licensure, and experience. Assessment of which endocrine system response to sepsis-induced hypotension is essential in guiding subsequent therapy? (a) Adrenal (b) Pancreatic (c) Pituitary (d) Thyroid - ANS-(a) Adrenal Generally healthy patients, who are diagnosed with acute bronchitis, inappropriately ask for which category of drugs? (a) Antibiotics (b) Beta-agonists (c) Corticosteroids (d) Xanthines - ANS-(a) Antibiotics What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number? (a) The Affordable Care Act (b) The Balanced Budget Act (c) The Civilian Health and Medical Program of the Uniformed Services (d) The (Consolidated) Omnibus Budget and Reconciliation Act - ANS-(b) The Balanced Budget Act A 19-year-old male patient arrives at the emergency department exhibiting symptoms of lower abdominal pain that radiates to the groin, and that the patient rates as an 8 on a scale of 1 to 10. That patient states that the pain came on suddenly, while he was playing football with friends. The patient's physical examination reveals positive bowel sounds in all quadrants; a soft, non-tender abdomen; no rebounding and no guarding; and no palpable mass in the abdomen or groin. Examination of the patient's genitalia
