Download APEA Pearls for FNP Boards: Questions and Answers on Common Medical Conditions and more Exams Nursing in PDF only on Docsity!
APEA Pearls to help pass FNP boards Title
Questions and Answers.
4 indications for cxr with acute cough - CORRECT ANSWER abnormal VS rales, consolidation
75 years old fever Who gets PPSV23 vaccine?? - CORRECT ANSWER -single dose 65 or older -single dose 19-64 if chronic illness, smoker, group home -Immunocompromised receive another dose at 5 YEAR interval -ALWAYS get dose at 65 even if received earlier doses as long as 5 Years has passed!! Bacteria responsible for most pneumonia deaths - CORRECT ANSWER Strep pneumonae (Gram -) Three most common bacteria - CAP - CORRECT ANSWER S. Pneumoniae Mycoplasma pneumoniae (walking pneumonia) Chlamydophila pneumoniae Best initial antibiotics for pneumonia if no antibiotic exposure in last 3 months - CORRECT ANSWER Doxycycine or Macrolide (Azithromycin or Clarithromycin) ----because they cover for atypicals Best initial antibiotics for pneumonia if comorbidities or antibiotics in 90 days - CORRECT ANSWER -Resp quinolone (levofloxacin, gemifloxacin, moxifloxacin) or IF ALLERGY -Beta-lactam (PCN or cephalosporin) PLUS macrolide How long course of antibiotics for pneumonia - CORRECT ANSWER 3 days longer than s/s of infection. Pneumonia severity index??? - CORRECT ANSWER CRB- -Confusion
-RR >
-BP low -Age > What confirms COPD on PFTs??? - CORRECT ANSWER FEV1/FVC <70% COPD staging - CORRECT ANSWER Bigger number more severe What med is crucial for COPD patient - CORRECT ANSWER SABA!! Where are beta1 receptors - CORRECT ANSWER Heart Where are beta2 receptors - CORRECT ANSWER Lungs What is the maintenance drug of choice for all levels of asthma? - CORRECT ANSWER Inhaled corticosteroid. What classifies persistent asthma? - CORRECT ANSWER >2 days /wk symptoms; nighttime sx >3 x month How do postitive PPD readings differ for immunocompromixed patients? - CORRECT ANSWER smaller size of induration positive if immunocompromized (>15 mm if healthy, >5mm if HIV) What does Baciille Calmette Guerin vaccine protect against? - CORRECT ANSWER BCG vaccine for TB. Given in other countries. At what age should you do a f/u CXR after treatment for pneumonia - CORRECT ANSWER Anyone over 40 Possible sequelae of long term inhaled steroid use - CORRECT ANSWER cataract formation osteoporosis rising A1C What cardiac class is bad for COPD /Asthma - CORRECT ANSWER -lol; Beta Blockers...opposite affect of SABA and LABAs
What do the TIBC and RDW look like in Iron deficiency anemia - CORRECT ANSWER TIBC and RDW increased (spitting out small pale cells) Hgb 8/1%; Hct 24%; MCV 74; MCH 26 - CORRECT ANSWER Iron deficiency anemia Foods other than meat rich in iron - CORRECT ANSWER dried peas and beans; dark green leafy veggies When will iron deficient patient start to feel better after placed on supplement - CORRECT ANSWER in a few days Replacement dose of Fe for anemia - CORRECT ANSWER 150-200 mg/d of elemental iron What lab value represents adequate iron supplementation has occurred (supplements can stop?) - CORRECT ANSWER serum ferritin (normal iron stores) How do labs for anemia of chronic disease differ from IDA? - CORRECT ANSWER Normocytic, normochromic...but can be also Microcytic/ Hypochromic. Serum iron is decreased, but TIBC and Serum Ferritin are normal...Fe will not HELP!!! Thalassemia - CORRECT ANSWER hereditary; microcytic, hypochromic...premature hemolysis. Will have normal Fe, TIBC, Ferritin, and RDW!!! DO NOT GIVE FE!!!! Pernicious anemia - CORRECT ANSWER B12 deficiency often ABSORPTION problem..not dietary deficiency! Macrocytic What other nutrient should you check with a B12? - CORRECT ANSWER Folate!! Elevated levels of MMA and homocystiene indicate what ???? - CORRECT ANSWER Sensitive measures of B12 deficiency...B12 needed for metabolism of these MCV>100 - CORRECT ANSWER Pernicious anemia
s/s of pernicious anemia - CORRECT ANSWER dementia, neuopathy, weakness, elderly, vegans, alcholics, bariatric patients B12 supplementation - CORRECT ANSWER Vit B12 IM every day for one week----then weekly x4----than monthly for life when do monocytes elevate? - CORRECT ANSWER after 24 hours of illness what does it mean if polys and lymphocytes are close numerically? - CORRECT ANSWER think "viral" Another name for Neutrophils - CORRECT ANSWER segs or polys What if polys are high on WBC - CORRECT ANSWER bacterial what do bands mean? - CORRECT ANSWER bone marrow thinks you are SICK! Sending out immature cells for backup What if wbc count normal, but shift to left or right?? - CORRECT ANSWER May be early in infection, or pt immunosuppressed. what is a shift to the left? - CORRECT ANSWER increase in number of bands or "baby" neutrophils in blood smear..indicative of active infection What is the major concerning sequelae from pseudotumor cerebri? - CORRECT ANSWER loss of vision characteristics of migraine - CORRECT ANSWER unilateral crescendo 4-72 hours n/v; photophobis acute treatment for migraine?? - CORRECT ANSWER triptans--arterial constriction; expensive...do not overuse or will become ineffective prophylaxis for migraines - CORRECT ANSWER Topiramat; depakote; beta-blockers
What cranial nerve might cause hearing loss and vertigo? - CORRECT ANSWER VIII-vestibulocochlear pneumonic for cranial nerves (dirty) - CORRECT ANSWER oh, oh, oh, to touch and feel vaginas get vinny all hot CNI - CORRECT ANSWER olfactory You have one nose, so the olfactory nerve is CN I CNII - CORRECT ANSWER Optic ---checked with snellen chart You have two eyes, so the optic nerve is CN II, which functions to produce vision. what does 20/200 vision mean? - CORRECT ANSWER at 20 ft...the person can see what a normal person can see at 200 feet. CNIII - CORRECT ANSWER oculomotor---eye movements, pupillary constriction, accommodation CNIV - CORRECT ANSWER Trochlear ---movemnt of superior oblique muscle CNV - CORRECT ANSWER Trigeminal-sensation to face, cheek, and teeth. Motor---mastication CNVI - CORRECT ANSWER Abducens--lateral rectus muscle movement CN VII - CORRECT ANSWER Facial: facial muscles and taste---think Bells palsy CN VIII - CORRECT ANSWER Vestibulocochlear---hearing balance awareness of position The number 8 resembles an ear, so CN VIII, the vestibulocochlear/acoustic nerve is a sensory nerve for hearing. CN IX - CORRECT ANSWER Glossopharyngeal--sensation to tongue, pharynx and tympanic membrane
CN X - CORRECT ANSWER Vagus---parasympathetic CN XI - CORRECT ANSWER Spinal accessory ---sternocleidomastoid/trapezius 11 looks like pair of arms /shoulders... test...shoulder shrug... CN XII - CORRECT ANSWER Hypoglossal motor fibers of tongue...stick out tongue The saying The tongue licks the wound is a reminder that when the hypoglossal nerve (CNXII) is damaged, the tongue deviates to the same side of a lesion to the cranial nerve. (eg, if the tongue deviates to the right, the right side of CNXII is damaged). Gram + bugs - CORRECT ANSWER staph strep enterococcus What are the beta lactams? - CORRECT ANSWER pcns, cephalosporins The rules with PCN allergy?? - CORRECT ANSWER NEVER give cepholasporing if pt had anaphalaxis or hives with PCN. If morbilliform rash...may give. Does augmentin cover atypical pathogens?? - CORRECT ANSWER NO! Doxy or macrolide!!! What does PCN cover? - CORRECT ANSWER All gram + except MRSA, MSSA What does Augmentin cover? - CORRECT ANSWER Gram +, Gram -, B- lactamase ...but NOT MRSA OR MSSA!! What history would make you suspect a pathogen that produces beta lactamase - CORRECT ANSWER antibiotic in last 90 days Tetracyclines - CORRECT ANSWER Gram -, Atypicals, MRSA!!! Doxy Minocycline
Respiratory Fluoroquinolones --3rd gen - CORRECT ANSWER Levofloxacin---the idiot's antibiotic! Kill everything except MRSA. SAVE AS LAST RESORT Resp Fluoroquinolones--4th gen. - CORRECT ANSWER moxifloxacin, gemifloxacin, gatifloxacin Gram+, Gram-, Atypicals, Beta lactamase, DRSP DO NOT USE BELOW THE BELT!! What is the most effective fasting time for lipid panel?? - CORRECT ANSWER Most accurate after 12 hour fast. What are the CHD equivalents when deciding whether or not to treat hyperlipidemia? - CORRECT ANSWER Diabetes symptomatic CAD PAD AAA What cardiac class may cause exercise intolerance - CORRECT ANSWER Beta Blockers -lol slows heart rate. What diuretic bp med should not be given to a patient with hx of severe reaction to bactrim - CORRECT ANSWER HCTZ...has a sulfonamide ring!!! Where would the PMI be felt in a pt. with hert failure? - CORRECT ANSWER 5th intercostal space to LEFT of midclavicular line. The most common arrhythmia from valvular heart disease is... - CORRECT ANSWER Atrial fibrillation Microscopic exam of tinea would show? - CORRECT ANSWER hyphae what is the process of screening for Lyme disease?? - CORRECT ANSWER H&P first! ELISA then confirm with Western blot if positive.
skin lesion which is a solid mass up to 1 cm is described as a - CORRECT ANSWER papule. lesion flat and small like a freckle - CORRECT ANSWER macule fluid filled lesion less than 1 cm - CORRECT ANSWER vesicle fluid filled lesion >1cm - CORRECT ANSWER bullae What is koilondychia - CORRECT ANSWER spooning of the nails.. common with chronic anemia...always screen with a cbc What area of the body has the greatest percutaneous absorption??? - CORRECT ANSWER genitals What is the earliest detectable glycemic abnormality in a patient with type 2 diabetes - CORRECT ANSWER postprandial hyperglycemia precedes fasting hyperglycemia Target blood pressure for diabetic - CORRECT ANSWER less than 130/80!!! How should ACE be managed as treatment for proteinuria in diabetic?? - CORRECT ANSWER Effect should be seen in 6-8 weeks. Titrate ACE upward til urine protein <500 or pt. has bad side effects from ARB or ACE. Second agent can be added if max dose reached without success. Monitor K and CRE levels with dose changes What are the ADA goal for diabetic lipid values?? - CORRECT ANSWER HDL >50 in women; >40 men LDL< Trigs < no rec for total Chol How do you dose T4? - CORRECT ANSWER Wt in kg. x 1.6 to calcluate daily requirement. Prescribe this unless elderly or with existing CAD. Dose lower. Triad for mono - CORRECT ANSWER fever, lymphadenopathy, pharyngitis
b. BPH c. bladder CA d. Renal CA - CORRECT ANSWER A. localized tumors in prostate are not associated with hematuria. often have no s/s. How soon after a diagnosis of acute prostatitis can a PSA be accurate? - CORRECT ANSWER 4 weeks....infection or inflammation can cause a shharp rise in PSA values. Elective PSA should be deferred for four weeks. Earlier checks will result in elevated levels not associated with cancer...causing unnecessary patient anxiety. What is the recommendation of the American Cancer Society for initial screening of an AA male for prostate CA? - CORRECT ANSWER Discussions starting at 40-45 years....AA males and those with first degree relative with prostate CA before age 65 are HIGH RISK. What is the PSA threshold? - CORRECT ANSWER 4.0 ng/mL A carotid bruit in an elderly patient indicates what? - CORRECT ANSWER Indicates artery disease in other places. Those with carotid bruit have double stroke risk. Other vessels should be evaluated. MORE LIKELY TO DIE OF CARDIOVASCULAR DISEASE THAN CEREBROVASCULAR DISEASE How long will it take to evaluate the effectiveness on acetylcholinesterase inhibitor drugs like donezepil used in Alzheimer's? - CORRECT ANSWER 6-12 months. Eval includes family report. MMSE, ADL assessment, and side effects. What are the presenting symptoms, treatment for temporal arteritis? - CORRECT ANSWER Dx with biopsy. Chronic vasculitis...new onset HA, abrupt visual disturbance, jaw claudication, unexplained fever or anemia, elveated sed rate. Avg. age of onset 72 yo. Which fingers are not affected by carpal tunnel? - CORRECT ANSWER Fifth finger (pinky) Anosmia...what cranial nerve should be evaluated. - CORRECT ANSWER I-olfactory (1 nose!)
Elderly pt. at increased risk for stroke..Daily ASA is an example of what kind of prevention? - CORRECT ANSWER PRIMARY....would be secondary if history of stroke. When should you consider imaging for low back pain in a pt without red flags or hx or cancer, advanced age, or hx of trauma? - CORRECT ANSWER 4 weeks at earliest In what part of the hip does osteoarthritis cause pain? - CORRECT ANSWER The anterior hip. Finkelstein test - CORRECT ANSWER DeQuervians tenosynovitis What is first line drug for osteo arthritis pain not relieved by nonpharm methods?? - CORRECT ANSWER Tylenol 650mg qid! Less risk than nsaids. Try first According to Ottawa ankle rules..when should you image a sprain? - CORRECT ANSWER midfoot pain/bone tenderness, bone tenderness at base of the 5th metatarsal or unable to bear weight for 4 steps Should you routinely screen TSH in pregnant women? - CORRECT ANSWER Only if hx of hypothyroidism, family hx, or s/s. NP scope of practice is influenced by a number of factors. Which of the following does not? a.code of ethics b.state and federal laws c.Court of law d.Educational preparation - CORRECT ANSWER c. Court of law it is established legally, ethically, and by boards of nursing and professional organizations. It sets the boundaries and indicates what is permitted legally, etc. It is NOT influenced by court of law and varies from state to state. Who determines NPs legal authority to practice in any state? - CORRECT ANSWER The state legislature of the state. rules and regs may be promulgated by state boards of nursing that reflect scope of practice of nurse practitioners specific to that state.
rust colored sputum - CORRECT ANSWER strep pneumo....most deadly cause of pneumonia What antibiotic should be used to treat uncomplicated pneumonia in an otherwise healthy patient without recent antibiotic exposure? - CORRECT ANSWER a macrolide (azithromycin/clarithromycin) or a tetracycline (doxy). They cover atypical pathogens and provide coverage for non- DRSP. What risk factor has the greatest impact on HIV transmission. - CORRECT ANSWER viral load! When do the majority of patients exposed to HIV seroconvert if they are going to do so? - CORRECT ANSWER within 3 months How long should a female patient with an uncomplicated UTI be treated with antibiotics - CORRECT ANSWER 3 days What should be done in the case of a pregnant woman with hypothyroidism? - CORRECT ANSWER Low T4 can affect fetal growth TSH levels should be monitored frequently. Needs can increase as much as 50% How should you treat a patient diagnosed with Gonorrhea? - CORRECT ANSWER Treat both gonorrhea and chlamydia. They are so often found together. What class of drugs should be avoided in CHF? - CORRECT ANSWER ca channel blockers (verapamil) can cause bradycardia...reduce contractility...worsen heart failure Where do direct and indirect inguinal hernias occur??? - CORRECT ANSWER direct-hesselbach's triangle indirect-internal inguinal ring What is Medicare Part A? - CORRECT ANSWER hospital insurance; also covers some skilled nursing facilities
. No enrollment fee for most and they are charged montlhly premium based on number of eligible quarters they contributed.
What cranial nerve allows you to stick tongue out and move side to side - CORRECT ANSWER XII-Hypoglossal What cranial nerve allows you to close eyes tightly, wrinkle forehead, and smile? - CORRECT ANSWER VII-Facial CN partly responsible for speaking and tongue movement? - CORRECT ANSWER X-Vagus Which mitral valve disorder results from redundancy of the mitral valve's leaflets?? - CORRECT ANSWER MVP What is kava kava? - CORRECT ANSWER herb used to treat anxiety, fibro, hyperactivity and ADD. HEPATOTOXICITY possible ...monitor liver function. A common early finding in patients with chronic aortic regurg is... - CORRECT ANSWER LV hypertrophy Test of choice for dysplasia of hip in 3 month old... - CORRECT ANSWER Ultrasound...xray not useful b/c hip bones still not ossified at this age. What is the presentation clinically of MVP? - CORRECT ANSWER benign, assymptomatic. Most common valve problem in adults. CLICK What workup needs to be done for fatigue and malaise? - CORRECT ANSWER CBC, BMP, TSH, UA What is the triad of normal pressure hydrocephalus? - CORRECT ANSWER gait difficulty, cognitive disturbance, urinary incontinence What is a case control study? - CORRECT ANSWER looks at "what happened"...ideal for discovering cause and effect. Groups would be analyzed to find out what risk factors were present in the "case" groups (those with outcome being studied) vs the control groups...those without those outcomes What class of meds is used to treat ISH? - CORRECT ANSWER Calcium channel blockers...amlodipine, felodipine, etc
"2 drugs today" What are HTN treatment goals for most patients?? - CORRECT ANSWER <140/ HTN treatment goal for pt. with diabetes or chronic kidney disease - CORRECT ANSWER <130/ How should you treat a patient newly diagnosed with Stage 1 HTN? - CORRECT ANSWER Lifestyle modifications What antiHTN classes are contraindicated in pregnancy - CORRECT ANSWER ARB, ACEI ATPIII recommendations for diabetics? - CORRECT ANSWER TC-NO REC LDL < HDL >40 Males; >50 females Trigs < ATPIII recs for general population? - CORRECT ANSWER TC < LDL < HDL 30- Trigs < Rubeola - CORRECT ANSWER Measles; Fever, malaise...3 Cs (conjunctivitis, coryza, and cough) Koplick spots ---1-3mm whitish, bluish, or gray "grains of sand" appear on buccal mucosa, hard and soft palate BEFORE RASH. Rash starts on head and spreads down. Fifth disease - CORRECT ANSWER slapped cheek...lacy macular rash Rubella - CORRECT ANSWER marked lymphadenopathy, maculopapular rash like measles rash. macules on soft palate Chicken pox - CORRECT ANSWER vesicular lesions on erythematous base appearing in crops...no school until lesions all crusted over Ho do you manage CAP in kids? - CORRECT ANSWER suspect DRSP! Gram -
HIGH dose Amox 90-100mg/kg/day OR 2nd or 3rd gen cephalosporin IF PCN allergy....clarithromycin dont give Hep B vaccine if anaphalaxis with .... - CORRECT ANSWER baker's yeast Dont give what vaccines if anaphalaxis with neomycin? - CORRECT ANSWER IPV, mmr, varicella dont give what vaccines of anaphalaxis with gelatin? - CORRECT ANSWER varicella zoster, MMR Kernig sign - CORRECT ANSWER Pt lying supine , hip flexed at 90 degrees-- +when extension of knee from this position elicits resistance or pain in lower back or posterior thigh (meningitis) What is the most common cause of stroke? - CORRECT ANSWER cerebral ischemia First line oral antibiotic for bite? - CORRECT ANSWER augmentin. Most common cause of stasis ulcers? - CORRECT ANSWER venous insufficiency What interventions are commonly needed with MVP? - CORRECT ANSWER Usually none...recommend physical activity. Mostly as symptomatic A murmur that becomes softer as pt. moves from supine to standing... - CORRECT ANSWER physiologic. benign. Mid-systolic murmur gets louder as pt. moves from supine to standing... - CORRECT ANSWER think hypertrophic cardiomyopathy!! How does grade III systolic murmure compare to S1 other heart sounds?? - CORRECT ANSWER Louder than S2, softer than s S3 heart sound - CORRECT ANSWER heard in early diastole; noted in presence if ventricular overload, heard best with bell
