(Test Bank) Tiffeny'S Comprehensive AANP Review Part 1

Leik,Barkley,Fitzgerald, 1

Nursing

Test Bank

1st Edition

• $15.00 $50.00

---

Description

Test Bank for Tiffeny'S Comprehensive AANP Review Part 1, The downloadable file consists of 324 pages, and the total size of the file is 1.95 MB. Purchase now only for highly discounted price.

Author(s): Leik, Barkley, Fitzgerald

---

---

Study Note Preview

Tiffeny's Comprehensive AANP Review (LEIK/Barkley/Fitzgerald) pt. 1* >>Aldosterone antagonists tx (3) Example (1) Adverse effects (2) Black box warning {{Correct Ans - Hirsutism, htn, severe heart failure spironolactone (Aldactone) Galactorrhea, hype rkalemia Increase risk of benign and malignant tumors >>Indicators that a headache can be the presenting symptom of a serious illness and may require neuroimaging include all of the following except: A]. headaches that occur periodically in clusters. B.] increasing frequency and severity of headaches. C.] headache causing confusion, dizziness, and/or lack of coordination. D.] headache causing awakening from sleep. {{Correct Ans - A. headaches that occur periodically in clusters. >>Occurs from high lev els of serotonin accumulating in the body due to the introduction of a new drug (drug interaction) and an increase in the dose. Acute onset with rapid progression. Signs and symptoms are sudden onset of high fever, muscular rigidity, mental status changes, hyperrefl exia/clonus, and uncontrolled shivering. Look for dilated pupils (mydriasis). Higher risk if combining two drugs that both block serotonin (i.e., selective serotonin reuptake inhibitors [SSRIs], monoamine oxidase inhibitors [MAOIs], tricyclic an tidepressants [TCAs], triptans, tryptophan). If switching to another drug affecting serotonin, wait a minimum of 2 weeks. Potentially life -threatening reaction. {{Correct Ans - Acute Serotonin Syndrome >>how long does it take a patient to seroconvert to HI V? {{Correct Ans - 3 weeks to 6 months >>The test of choice to confirm and assess developmental dysplasia of the hip (DHH) in a 3 month old is: {{Correct Ans - ultrasound of the hip. >>A patient who has been treated for hypothyroidism presents for her annu al exam. Her TSH is 4.1 (normal = 0.4 - 3.8). She feels well. How should she be managed? {{Correct Ans - Repeat the TSH in 2 -3 weeks. >>Rare life -threatening idiopathic reaction from typical and atypical antipsychotics. These drugs affect the dopaminergic s ystem of the brain. Usually develops following initiation or an increase in dose. Signs and symptoms are sudden onset of high fever, muscular rigidity, mental status changes, fluctuating blood pressure, and urinary incontinence. {{Correct Ans - Malignant Neuroleptic Syndrome >>75 year -old patient has osteoarthritis and pain. Which of the following medications increases the risk of a GI related ulceration? {{Correct Ans - Celecoxib Celecoxib is an NSAID. All NSAIDs increase the risk of upper and lower GI ulce rations. Other lower GI complications include perforation, stricture, anemia, and hypoalbuminemia. >>A 19 y/o man presents with a cc of a red, irritated rt eye for the past 48 hrs with eyelids that were stuck together this morning when he awoke. exam reve als injected palpebral and bulbar conjunctiva and reactive pupils; vision screen with the Snellen chart eval reveals 2 -/30 in the right eye, left eye and both eyes; and purulent eye discharge in on the right. this presentation is most consistent with: a. suppurative conjunctivitis b. viral conjunctivitis c. allergic conjunctivitis d. mechanical injury {{Correct Ans - a. suppurative conjunctivitis >>A 62 year old male presents with chills, fever, dysuria, urinary frequency, diffuse low back pain and an exqu isitely tender, boggy prostate on rectal exam. What infection? How will you treat? {{Correct Ans - acute bacterial prostatitis Ciprofloxacin (Cipro)500mg BID Ofloxacin(Floxin) 200mg PO daily TMP -SMX sit bath TID for 30min No sex until resolved >>Longs tanding myopia, new onset presbyopia, corrected with eyeglasses, no HTN, no ocular implant; examination finding that would be expected is...? A) retinal arteries wider than veins B) equal sluggish pupillary response c) sharp disc margins D) lid ectropion {{Correct Ans - c) sharp disc margins >>Causes the most deaths worldwide______ Ca with highest mortality____ Most common cause of death for adolescents_______ Most common ca in females__ Most common ca in males______ Most common ca overall______ Mos t common gynecological cancer_______ {{Correct Ans - Heart disease Lung MVA Breast Prostate Skin Uterine& Endometrial then Ovarian >>Orientation: What is the date today? (current day, month, year) Location (name the city, county, state) Immediate recall : Recall three objects Instruct that you will be testing his/her memory. Say 3 unrelated words (pencil, apple, ball). Ask patient to repeat words Attention and calculation: Counting backward Say "starting at 100, count backward and keep subtracting 7" Backward spelling Spell the word "WORLD" backward Writing and copying: Writing a sentence Give person one blank paper and ask him/her to write a sentence Copying a figure: Draw intersecting pentagons. Ask patient to copy the pentagons Scoring: Maximum sco re is 30 correctly done. Impaired is a score of less than 19 {{Correct Ans - Folstein Mini - Mental State Exam (MMSE) >>Will have Koplik spots {{Correct Ans - measles >>Txt options for BV {{Correct Ans - flagyl po/intravaginal clindamycin po/intravaginal >>Match the female:male ratio for Migraine without aura: A. 1:3 to 1:8 B. 3:1 C. 5:4 {{Correct Ans - B. 3:1 >>A pregnant patient (first trimester) with mild persistent asthma has used inhaled budesonide (Pulmicort) BID prior to pregnancy with good results. Wh at should be done with this medication during pregnancy? 1. D/c. Use albuterol instead. 2. D/c & try Singulair (LTRA). 3. Continue @ same dose BID. 4. Continue once daily. {{Correct Ans - Cont at the same dose BID (#3) >>Sandpaper rash with sore throat {{Correct Ans - scarlet fever >>a 19 y/o woman presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope -like eye discharge and clear nasal discharge. this is most consistent with conjunctival inflammation caused by a)n): a. bacterium b. virus c. allergen d. injury {{Correct Ans - c.) allergen >>A pregnant patient has taken sertraline for the past 10 years with excellent results. She asks if this is safe to take whi le she is pregnant. How should this be answered? 1. It is safe; Category A. 2. It is safe; Category B. 3. It might be safe; Category C. 4. It is not safe; Category D. {{Correct Ans - Category C - it might be safe >>A 2 week old infant is brought to the nu rse practitioner clinic after a difficult delivery. The mother says the infant fusses when handled or picked up. On physical examination, the nurse practitioner notes decreased movement of the right arm during the Moro reflex, and crepitus on palpation of the right clavicle. The diagnosis is fracture of the clavicle. The recommended management is: A. a "figure -8" clavicle brace. B. a shoulder/trunk spica cast to immobilize the fracture for 6 weeks. C. instructions to the parents to handle the neonate gentl y. D. referral to an orthopedic surgeon. {{Correct Ans - C.) instructions to the parents to handle the neonate gently. >>A 26 year old female patient presents with cracked and sore nipples. She is breastfeeding her first child who is 4 weeks old. The nurse practitioner would be accurate to advise the patient to: A. stop breastfeeding until the nipples have healed. B. apply a vitamin E moisturizing cream after each feeding and continue to breastfeed. C. use a breast shield with each feeding. D. apply an ant ibiotic cream after each feeding. {{Correct Ans - B.) apply a vitamin E moisturizing cream after each feeding and continue to breastfeed. >>First line post -mi {{Correct Ans - Beta blocker >>With appropriately prescribed headache prophylactic therapy, the p atient should be informed to expect: A. virtual resolution of headaches. B. no fewer but less severe headaches. C. approximately 50% reduction in the number of headaches. D. that lifelong therapy is advised. {{Correct Ans - C. approximately 50% r eduction in the number of headaches. >>Babies should begin oral iron supplementation: A.when they are able to eat iron -enriched cereal. B.2 months -of-age. C.4 to 6 months -of-age. D.anytime after their teeth have erupted. {{Correct Ans - C.) 4 to 6 mon ths-of-age. >>-Name the (4) SSRIs and explain important tidbits: -Monitoring /Black Box(2): {{Correct Ans - [SSRIs] Sertraline (Zoloft) Paroxetine (Paxil) *Citalopram (Celexa) *Escitaprolam (Lexapro) [Fluoxetine (Prozac):] Longest half -life of all S SRIs (may last up to 4 weeks) and the first SSRI. [Paroxetine (Paxil):] Shortest half -life, but was reformulated to Paxil CR (to prolong half -life). [Citalopram (Celexa):] Has fewer drug interactions compared with other SSRIs. [Escitaplopram (Lexapr o):] Compound derived from citalopram (Celexa). [Duloxetine (Cymbalta):] Can treat both depression and neuropathic pain. [Monitoring:] *Black Box: -Suicidal ideation (<24hr) -Don't d/c Paxil abruptly >>SSRI Side Effects {{Correct Ans - Side Effects ■ Loss of libido, erectile dysfunctile (ED), women with sexual dysfunction, anorexia, insomnia. ■ Avoid with anorexic patients and undernourished elderly (depresses appetite more). ■ Paxil: Common side effect is ED. >>Contraindications of SSRIs {{Correct Ans- Contraindications ■ Avoid SSRIs within 14 days of taking an MAOI (serotonin syndrome). ■ Can induce mania with bipolar patients. ■ TCAs. ■ Not considered first -line treatment for depression. ■ Other uses: Post -herpetic neuralgia (chronic pain), st ress urinary incontinence. ■ Avoid if patient at high risk of suicide because may hoard pills and overdose (suicide attempt). ■ Overdose will cause fatal cardiac (ventricular arrhythmia) and neurologic effects (seizures). ■ Example: Imipramine (Tofranil) , amitriptyline (Elavil), nortriptyline (Norpramine). >>Special Considerations: Antidepressants SSRIs {{Correct Ans - ■ FDA Black Box Warnings: Increased risk of suicidal thinking and behavior in children, adolescents, and young adults. ■ Elderly patients : Consider using citalopram (Celexa) and escitalopram (Lexapro). Fewer drug interactions than other SSRIs. May prolong QT interval. ■ Patients with sexual dysfunction caused by an SSRI: Consider adding bupropion (Wellbutrin) to the SSRI prescription. ■ Depressed patient who wants to quit smoking: Consider bupropion (Zyban). Can be combined with nicotine products (patches, gum). ■ Depressed patient with peripheral neuropathy: Consider duloxetine (Cymbalta), whichis also indicated for neuropathic pain. ■ Depressed patient with post -herpetic neuralgia and chronic pain: Consider TCAs. ■ Depressed patient with stress urinary incontinence: Consider TCAs. >>Adjunct treatment for hyperthyroidism/thyrotoxicosis {{Correct Ans - Beta blocker (beta antagonists) >>A 37 -year -old woman complains of migraine headaches that typically occur after eating out in restaurants. Potential triggers that can influence the onset and severity of migraine symptoms include all of the following except: A. cheese pizza. B. pickled or fermented foods. C. freshly baked yeast products. D. baked whitefish {{Correct Ans - D. baked whitefish >>drug useful for asymptomatic viral shedding of HSV -2 {{Correct Ans - valacyclovir >>OM/sinusitis 1st to 2nd line txt Drugs? Class? {{Correct Ans - Amoxicillin Amoxicillin plus clavulanic acid (Augmemtin) PCNs >>Type 1 IgE mediated reactions {{Correct Ans - Anaphylaxis and angioedema >>Which antibiotic is considered Category B for a patient in her third trimester of pregnancy? 1. Amoxicillin -clavu lanate 2. Levofloxacin 3. TMP -SMX 4. Doxycycline {{Correct Ans - 1. Amoxicillin -clavulanate Levofloxacin (C) impairs bone/cartilage in fetus TMP -SMX *Never use in 1st or 3rd * impairs folic acid & decreases amniotic fluid Doxy (D) -skeletal deformit ies >>Which medication or medication class used in the treatment of heart failure (HF) is NOT associated with decreased mortality? A. ACE inhibitors B. Diuretics C. Beta -adrenergic blockers D. Digoxin (Lanoxin) {{Correct Ans - D.) Digoxin (Lanoxin) >>early symptoms of HIV infection {{Correct Ans - fever, night sweats, weight loss (flu -like symptoms) or presence of opportunistic infection >>Purple colored to dark red painful skin lesions all over body. Im fat with high fever headache level of consciousness changes. {{Correct Ans - Meningococcemia >>grapefruit size swelling **prehn's sign (+), lifting testes alleviates pain common in men <35 yo due to chlamydia after 35, due to bacterial ascension {{Correct Ans - epididymitis Diagnostic: -STD testing -urine culture -scrotal US [Under 35yo......] Rocephin 250mg IM once PLUS doxycycline 100mg daily x10 days OR azithromycin 1gm once [Over 35yo....] TMP/SMZ BID x10 days OR Cipro 250mg BID x10 days >>common causative organisms of acute suppurative con junctivitis include all of the following except: a. staphylococcus aureus b. haemophilus influenzae c. streptococcus pneumoniae d. pseudomonas aeruginosa {{Correct Ans - d. pseudomonas aeruginosa >>Gonorrhea is gram ( ) and produces avoid what drugs? Trea t with? {{Correct Ans - (-) beta lactamase ceftriaxone 250mg IM SD plus doxycycline 100mgx10days >>Peferred treatment for warts during pregnancy {{Correct Ans - Cryotherapy and trichloroacetic acid (TCA) >>Urology changes in Eldery {{Correct Ans - -drop i n renal flow (10%per decade after 30/40) -GFR diminishes -increase risk for dehydration due to reduced hormonal response to to vasopressin -decrease in bladder tone, elasticity, and capacity >>Risk factors for cluster headaches include all of the foll owing except: A. over 65 years of age. B. heavy alcohol use. C. heavy tobacco use. D. male gender. {{Correct Ans - A. over 65 years of age >>Of all the SSRIs, ______ is more likely to cause erectile dysfunction. {{Correct Ans - Paxil >>FYI If potentially suicidal, be careful when refilling or prescribing certain medications that may be fatal if patient overdoses (i.e., benzodiazepines, hypnotics, narcotics, amphetamines, TCAs, etc.). Give the smallest amount and lowest dose possible. {{Correct Ans - ■ If po tentially suicidal, be careful when refilling or prescribing certain medications that may be fatal if patient overdoses (i.e., benzodiazepines, hypnotics, narcotics, amphetamines, TCAs, etc.). Give the smallest amount and lowest dose possible. >>A 44 year old man who admits to drinking "a few beers now and then" presents for examination. After obtaining a health history and performing a physical examination, you suspect he is a heavy alcohol user. Your next best action is to: A. obtain liver enzymes. B. ad minister the CAGE questionnaire C. confront the patient with your observations. D. advise him about eh hazards of excessive alcohol use. (Ch. 14 Fitzgerald) {{Correct Ans - B. administer the CAGE questionnaire >>PrEP concerning HIV {{Correct Ans - preexpos ure prophylaxis for HIV prevention daily oral PrEP (combo) of tenofovir disoproxil fumarate (TDF) 300mg and emtricitabine (FTC) 200mg (Truvada) given to high risk: men w/men heterosexually active injection drug uses assess every 3 months ***renal funct ion at baseline*** >>BB adverse effects (5) {{Correct Ans - Bronchospasm Bradycardia Depression, fatigue (careful in elderly) Erectile dysfunction Blunts hypoglycemic response (Diabetics) >>ACEI CI: {{Correct Ans - Potassium supplements Potassium spari ng diuretic >>Which of the following is not a component of the CAGE questionnaire? A. Have you ever felt you should cut down on your drinking? B. Have you been annoyed by people criticizing your drinking C. Have you ever felt guilty about your drinking D. Have you ever engaged in a violent act while drinking? (Ch. 14 Fitzgerald) {{Correct Ans - D. Have you ever engaged in a violent act while drinking >>Which of the following is considered a non -inflammatory disease process? A.Osteoarthritis (OA) B.Rheu matoid arthritis (RA) C.Systemic lupus erythematosis (SLE) D.Psoriatic arthritis {{Correct Ans - A.) Osteoarthritis (OA) >>Which of the following patients most warrants screening for hypothyroidism? A.A young adult female with postpartum depression last ing 2 weeks B.A patient taking a thyroid replacement preparation C.A 40 year old male with unexplained tremors D.An elderly female with recent onset of mental dysfunction {{Correct Ans - D.) An elderly female with recent onset of mental dysfunction >>When evaluating a patient with acute headache, all of the following observations would indicate the absence of a more serious underlying condition except: A.] onset of headache with exertion, coughing, or sneezing. B.] history of previous identical headache . C.] supple neck. D.] normal neurological examination results. {{Correct Ans - A. onset of headache with exertion, coughing or sneezing >>What is characteristic of abruptio placenta? Select all that apply 1. Abrupt onset of vaginal bleeding 2. Abdominal a nd/or back pain 3. Scant bloody vaginal discharge 4. May occur in 2nd/3rd trimester {{Correct Ans - all >>txment options in suppurative conjunctivitis include all of the following ophthalmic preparations except: a. polymyxin B plus trimethroprim b. levof loxacin c. polymyxin d. azithromycin {{Correct Ans - c. polymyxin >>The nurse practitioner performs a routine physical examination of a 3 year old child. A hard, painless mass is palpated in the abdomen, along with lymph node enlargement and lower limb pa resis. Blood and imaging studies provide markers for neuroblastoma. What information is correct to give to the parents? A.The diagnosis must be confirmed by tissue biopsy or by bone marrow aspiration plus urine or serum catecholamine levels. B.Neuroblas toma is the final diagnosis based on physical examination and blood and imaging markers. C.Signs and symptoms, along with the blood imaging markers, define the tumor as stage D, metastasis beyond lymph nodes. D.The prognosis is poor, based on the likelih ood that there is metastasis to the bone. {{Correct Ans - A.) The diagnosis must be confirmed by tissue biopsy or by bone marrow aspiration plus urine or serum catecholamine levels. >>Cardiac drug class that are 1st line for diabetics and pts with mild to moderate renal disease {{Correct Ans- ACEI/ARBS >>[FYI] Patients starting to recover from depression may commit suicide (from increase in psychic energy). Monitor closely. {{Correct Ans - ... >>Nurse practitioners are permitted to perform male circumcisio ns in some states but not in others. This is related to: A.standards of practice. B.scope of practice. C.prescriptive authority. D.reimbursement. {{Correct Ans - B.) scope of practice. >>txment options in acute and recurrent allergic conjunctivitis in clude all of the following except: a. cromolyn ophthalmic drops b. oral antihistamines c. ophthalmological antihistamines d. corticosteroid ophthalmic drops {{Correct Ans - d. corticosteroid ophthalmic drops >>The mother of a 2 week old infant with hypospa dias requests circumcision for her infant. The nurse practitioner's best response to this mother should be to: A.arrange a surgical consult for the circumcision. B.explain why an infant with hypospadias should not be circumcised. C.explain the benefit s and risks of infant circumcision. D.refer her to a physician. {{Correct Ans - B.) explain why an infant with hypospadias should not be circumcised. >>You examine a 24 -year -old woman with mitral valve prolapse (MVP). Her physical examination finding may include: a. pectus excavatum b. obesity c. petite stature d. hyperextensible joints {{Correct Ans - a. pectus excavatum >>1st line for MRSA skin infections ....2 options {{Correct Ans - Bactrim DS BID or clindamycim TID 5-10 days >>Captopril....associated with? Monitor? {{Correct Ans - Agranulocytosis, neutropenia, leukopenia Monitor CBC >>Name 4 ACEI {{Correct Ans - Lisinpril (Zestril, Prinivil) Benazepril (Lotensin) captopril (Capoten) enalapri (Vasotec) "Pril" >>Nicotine precautions {{Correct Ans - Patient cannot smoke while on nicotine patches. Do not use with other nicotine products (e.g., gum, inhaler); patient will overdose with nicotine. Nicotine overdose can cause acute myocardial infarctions, hypertension, agitation in susceptible patients. Can be combined with bupropion (Zyban). >>Syphilis 1st line treatment? Drug? Class? {{Correct Ans - benzathine penicillin G IM PCN >>ARBs/ ACEIs adverse effects {{Correct Ans - Angioedema Anaphylactoid response Cough Hyperkalemia >>Which of the followi ng contains the greatest amount of alcohol? A. 12 oz (360 ml) beer (9 proof) B. 4 oz (120 mL) wine (22 proof) C. 3.5 oz (105mL) mixed drink (30 proof) D. 3 oz (90mL) liquor (80 proof) (Ch. 14 Fitzgerald) {{Correct Ans - D. 3 oz (90mL) liquor (80 proof) >>Kava -kava and valerian root are natural supplements used for ________ and ________. Do not _____ {{Correct Ans - insomnia/anxiety Mix >>Bupropion (Zyban) r/t smoking {{Correct Ans - decreases cravings to smoke. Can be combined with nicotine products. Patie nts can still smoke while on bupropion. Eventually loses desire to smoke and finally quits. >>Match the female:male ratio for Tension -type headache: A. 1:3 to 1:8 B. 3:1 C. 5:4 {{Correct Ans - C. 5:4 >>A 78 year old man has a diagnosis of emphysema. It is imperative that the nurse practitioner teach him to: A.use oxygen at home during the night. B.call the office at the first sign of infection. C.limit intake of high protein foods. D.be immunized annually with the polyvalent pneumococcal vaccine. {{Co rrect Ans - B.) call the office at the first sign of infection. >>A risk factor for MVP includes a history of: a. rheumatic fever b. rheumatoid arthritis c. Kawasaki disease d. Marfan syndrome {{Correct Ans - d. Marfan syndrome >>acne tx steps {{Correct A ns- begin with topical retinoid and benzoyl peroxide. Add topical antibiotics including erythromycin and clindamycin. may need to add oral antibiotic. For severe acne use Accutane >>the most common virological cause of conjunctivitis is: a. coronaviru s b. adenovirus c. rhinovirus d. human papillomavirus {{Correct Ans - b. adenovirus >>_______ We'll see lobar infiltrates. Productive cough with large amount of green to rust colored sputum. Leukocytosis. Treatment includes macrolides first line or tetracy cline. With comorbidities, use levaquin or amoxicillin with a macrolide. {{Correct Ans - CAP >>Additional findings in MVP include: