Download NSG 6440 Week 4 APEA Predictor Exam – Pre-Predictor Exam Questions and Answers and more Exams Advanced Education in PDF only on Docsity!
NSG 6440 Week 4 APEA Predictor Exam – Pre-Predictor Exam
Questions and Answers Latest Update
1. A 15 years old high school student with a mild sore throat and low-grade fever
that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the following is the LEAST appropriate intervention?
a. Palpate the lymph nodes and spleen
b. Examine the posterior oropharynx for petechiae
c. Obtain a CBC, throat culture, and heterophil antibody
test.
d. d. Obtain an urinalyses and serum for LFTs and
amylase Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus. Common is people 15-24 years of age. Common signs and symptoms following incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally a petechial rash occurs in less than 15% of patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and lymphocytosis are usually detected in the CBC.
2. A 32 years old male patient complaint of urinary frequency and burning on
urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be: a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day b. ciprofloxacin (Cipro) for 3-5 days c. Trimethoprim-Sulfamethoxazole for 3 days d. 750 mg ciprofloxacin as a one-time dose Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication to treat urinary tract infections in most patients. In the case of community resistance to TMPS
20%^, another medication should be substituted. In men, the appropriate length of time is 7-10 days. Women may be treated for 3 days for uncomplicated UTI
3. Which agent is most effective for the treatment of nodulocystic acne?
a. Benzoyl peroxide (Benzac)
b. Retinoic acid (Retin A)
c. Topical
tetracycline d. Isotretinoin) Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment with severe inflammatory acne. Guidelines for its use must be clearly understood by the patient. A woman of childbearing age must use an effective method of contraception because isotretinoin is teratogenic. There are many restrictions in prescribing this medication because of the teratogenic effects is given during pregnancy. Therefore, it is a pregnancy category X.
4. An 18 y/o woman is taking a combined hormonal oral contraceptive. She
should be instructed to use a backup method for the prevention of pregnancy a. Throughout the week of placebo pills b. If prescribed topiramate (Topamax) for the treatment of migraines. c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection d. if she forgets to take a single dose of the contraceptive Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), topiramate (Topamax) and oxcarbazepine (Trileptal) reduce the effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or levonorgestrel- releasing intrauterine devices would be a better method of contraceptive for patients taking anticonvulsants. Most commonly used antibiotics have not been proven to reduce the effectiveness of contraceptives. Rifampin is an exception, and additional …. Be used by women taking this drug and using oral contraceptives, transdermal, or vaginal ring preparations. Additional backup contraception should be used if taking antifungal agents. No additional protection is needed thought the week of placebo pills. Missing one single dose of contraceptive does not require additional protection, missing more than one doses does.
5. A 44 years old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dl
(6.5 mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25 mg/dL (65 mmol/L), and triglycerides= 344 mg/dL (8.94 mmol/L). What agent have the greatest effect on improving her lipid profile and reducing morbidity and mortality associates with dyslipidemia?
an example of an ethical dilemma. Failure to participate in the provision of care to the patient based on the NP’s beliefs is neither against the law nor a violation of the standards of practice
8. A patient presents with pruritic lesions on both knees. There are visible silver scales.
How Should this condition be managed? a. Topical antifungal cream or ointment b. Oral antibiotics c. Topical corticosteroids cream d. Topical anti-fungal/ steroid cream Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely defined plaques with silvery scales. Auspitz sings is another common finding. Topical agents containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also be ordered.
9. Antidepressant discontinuation syndrome is less likely if the patient
a. Is male
b. Is less than 35 y/o
c. Has taken an SSRI with a short half
life d. Gradually tapers SSRI use Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care office in association with SSRI discontinuation, because SSRIs are the most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti- depressant medication is sometimes associated with an antidepressant discontinuation syndrome; in early reports it was referred to as a “withdrawal reaction. Symptoms of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Tapering is recommended by experts.
10. Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one
of the following drug classes?
a. Alpha adrenergic antagonist
b. Anti-androgen agents
c. Tricyclic antidepressant (TCA)
d. Sulfonamides
Explanation: tricyclic antidepressant should not be used by men with benign prostatic hyperplasia because of the increased risk of urinary retention secondary to the anticholigergic effects of TCAs.
11. Which of the following is the best response to a woman who has just admitted
she is a victim of spousal abuse?
a. What was if you did to make him angry?
Macrovascular complications: Coronary artery disease, Cerebrovascular disease, Peripheral vascular disease
14. A 6 y/o presents w/ complaints of sore throat and fever for 2 days. He has multiple
vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. What is the most likely diagnosis? a. Viral pharyngitis b. Herpangina
c. Epiglottitis
d. Tonsillitis
Explanation: Herpangina is a viral infection common in toddlers and young children caused by Coxsackie virus. The clinical findings of numerous, small (1-2 mm) ulcerations on the tonsils and uvula are typical of herpangina. The ulcerations can be very painful but usually resolve in 7 to 10 days. Treatment is symptomatic.
15. A patient has Kawasaki syndrome. Which characteristics would be
UNUSUAL? a. Age > 15 years b. Fever > 101 F (38.3 C)
c. Exudative pharyngitis
d. Painful rash
explanation: Kawasaki disease is an acute febrile vasculitis syndrome that evolves inflammation of the blood vessels. This condition often causes cardiac complication in children by damaging the coronary arteries is most prevalent in children of Asian ethnicity. Diagnosis of Kawasaki disease requires presentation of fever and 4 of the following criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy.
16. According to the JNC 8 guideline hypertension in a 40 y/o can be diagnosed when
blood pressure exceeds a. 140/ b. 130/ c. 125/ d. 150/ Explanation: According to JNC 8 guidelines, hypertension is a sustained elevation of systolic BP greater than or equal to 140 mmHg or diastolic BP greater or equal than 90mmHg, taken from 2 or more readings on 2 different occasions after an initial screening.
17. A 48 y/o female complains of pain and stiffness in her right hip and knee that is
mild on awakening in the morning, get worse as the day progresses and is relived with hot baths and ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are notably absent. What is the most likely diagnosis? a. Rheumatoid arthritis (RA) b. Gout c. Osteoarthritis (OA)
d. Refer the family to the National Domestic Violence hotline. Explanation: An awareness of all the unique presentations of child abuse, subjective or objective, physical, sexual, or neglect, is essential for NPs. Objective findings, such as broken bones, burns, and bruises, may be as a result of an intentional injury from physical abuse or from an unintentional injury as a result of neglect. Both must be considered. Repeated visits to the emergency department, frequent or suspicious injuries, or bilateral or multiple healing fractures are often indicators of physical abuse. Once the diagnosis of child abuse has been made, the primary role of the NP is to ensure the child is safe. If the NP suspect that a child is undergoing abuse, it’s critical to report it—and to continue reporting each separate incidence if it continues to recur.
19. A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing
up of the legs followed by periods of lethargy. On physical examination, a “sausage-like” mass in the upper right quadrant of the distended abdomen. Which of the following is the most likely diagnosis? a. Intussusception b. Volvulus c. Crohn’s disease d. Foreign body in the GI tract explanation: Intussusception is one of the most common causes of abdominal obstruction in children prior 2 years of age; is best described as a portion of the intestine which telescopes into a more distal intestinal segment. The classic triad of intussusception include crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools. The patient may pull up his knees with crying. The patient may develop vomiting with bilious emesis. Progressive lethargy/altered level of consciousness and pallor is common. The etiology of this lethargic presentation is not known, but it tends to occur in younger infants. As intussusception progresses, a palpable, sausage-shape mass may develop. Some hypothesize that this is due to release of endogenous opioids or endotoxins released from ischemic bowel. Intussusception in a child presenting with lethargy is often difficult to diagnose since other causes of lethargy such as dehydration, hypoglycemia, sepsis, toxic ingestion, post-ictal state, etc., must also be considered. Ultrasound is the preferred diagnostic test. Enemas is considered the first line of treatment prior surgery. Volvulus occurs more frequently in middle-aged and elderly men. Cronos’s is most often diagnosed between 13 – 30 years of age.
20. A middle-aged female complains of insomnia, night sweats, feeling intensely hot,
emotional lability, extreme nervousness and impatience. The LEAST likely cause of her symptoms is
a. Thyrotoxicosis
b. Menopausal vasomotor instability
c. Alcohol or another drug
withdrawal d. New onset type 2 diabetes mellitus Explanation: New onset diabetes produces elevated serum glucose levels less than 200 mg/dL (7.0 mmol/L) and usually no clinical signs or symptoms. At higher levels, the patient may report lethargy, fatigue, weakness, weight loss, and polydipsia, polyuria, and/or polyphagia. Complaints of insomnia, night sweats, feeling intensely hot, emotional lability, and extreme nervousness may
For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).
24. A 3 y/o has enlarged, warm, tender cervical lymph nodes,
indicating: a. Infection proximal to the nodes
b. A possible cancer diagnosis
c. Shorty nodes, a common normal variant in children
d. An infectious process distal to the nodes
explanation: size of lymph nodes is important. Nodes > 1 cm are significant and should be asses carefully. Nodes > 5 cm are almost always neoplastic. Tenderness of a node usually suggest
inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection.
25. The NP examines a 2-month-old with unequal gluteal and thigh skin folds. What
should the NP do next?
a. Send the infant for x-ray of the hips
b. Send the infant for ultrasound of the
hips c. Perform Ortolani and Barlow test d. Examine the infant for unequal arm length Explanation: Gluteal and thigh skin fold asymmetry may indicate congenital hip dysplasia. X- ray studies are not useful before 3 months-of-age because the femoral head has not completely ossified.
26. A very active 35 years old male has painful hemorrhoid, but he does not want
hemorrhoidal surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most appropriate recommendation is for him to select food that are:
a. Low in fiber such as milk and other dairy products
b. High in simple carbohydrates such as white bread and mashed
potatoes c. High in fiber such as bran, complex carbohydrates and fresh fruit d. High protein such a meat, poultry and fish Explanation : Hemorrhoid disease is the most common reason patients seek evaluation by a colon and rectal surgeon. The majority of hemorrhoids can be managed nonoperatively with medical management or office-based procedures. Patients should benefit from minimizing straining and avoiding constipation. Bulking of the stool facilitates this and can be accomplished by increasing dietary fiber and fluid intake. Stool softeners may also be used.
27. Correct instructions to give new parent who are transporting their newborn infant is
a. A rear-facing infant car seat secured in the backseat is required until the infant weight 20 lbs. b. The infant car set may be secured in the back or front seat, but must rear-facing c. The infant car seat may be front facing when the infant is 1 year old d. A rear or front-facing infant car seat must be secured in the back seat until the infant weight 20 lbs.
rotated with the proximal hand resting on the join line. The knee is flexed and then quickly straightened. If an audible or palpable click occurs during the this test, the outcome is positive for medial meniscal injury.
29. A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels
heavy but denies pain. On examination, the NP notes transillumination of the scrotum. What is the most likely diagnosis? a. Hydrocele b. Orchitis c. Testicular torsion d. Indirect inguinal hernia Explanation: Hydrocele is common in newborns and usually disappears without treatment within the first year. Older men can develop hydroceles, sometimes due to inflammation or injury. Hydroceles are usually painless, but may become large and inconvenient. An ultrasound may be needed to diagnose the condition.
30. A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of
this information, it is essential for the NP to teach him about a. Testicular self-examination b. Protection of the testes during sports activities c. Risk of testicular torsion d. Practicing safer sex Explanation: Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer.
31. A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He
is instructed in lifestyle modification, and drug initialed. Two month later, he returns and report that he still has symptoms. The next steps are to.
a) Refer for surgical interventions such as partial or complete fundoplication.
b) Refer for endoscopy, namometry, and/or PH testing
c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications.
d) Review proper proton pump inhibitor dosing time and adherence with the
patient. Explanation: poor adherence is an importance cause of inadequate acid suppression and refractory GERD. Determining adherence to proton pump inhibitor (PPI) therapy and superficially timing in relation to meals, should be sought first alarm features such as iron deficiency anemia, unexplained weight loss, and persistent vomiting would precipitate the need for further diagnostic testing. Diagnostic testing
procedures should proceed any surgical intervention like fundoplication.
32. A 51 –year- old post-menopausal female, request guidance regarding osteoporosis
risk. The NP would be correct to recommend all of the following EXCEPT
a. Moderate weight bearing exercise 3 times per week
b. 1200 – 1500 mg calcium daily
c. Avoidance of alcoholic
beverages d. Weight loss
diabetes mellitus may have all of the following beneficial effects EXCEPT:
a. Improved insulin sensitivity
b. Increased glucose uptake and utilization by the
cells c. Increase lean muscle mass’ d. Improved lipid profile Explanation: Regular, consistent exercise is an essential part of diabetes and prediabetes management. The ADA recommends that people with diabetes perform at least 30 minutes, 5
days/wk of a moderate-intensity aerobic physical activity. The ADA also encourages people with type 2 diabetes to perform resistance training 3Xwk in the absence of contraindications. Exercise contributes to weight loss, which further decreases insulin resistance. The therapeutic benefits of regular physical activity may result in a decreased need for diabetes medications to reach target blood glucose goals. Regular exercise may also help reduce triglyceride and low-density lipoprotein (LDL) cholesterol levels, increase high-density lipoprotein (HDL), reduce BP, and improve circulation. Patients who use insulin, sulfonylureas, or meglitinides are at increased risk for hypoglycemia when they increase physical activity.
35. A 12 y/o presents with eat pain or 36 hours duration. The NP diagnoses acute otitis
media because the
a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly
b. Tympanic membrane is retracted against boy landmarks
c. Bony landmarks are obscured, and the tympanic membrane is mildly
erythematous, dulls and immobile.
d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact
Explanation: Serous otitis media typically presents with a flat or bulging and tympanic membrane with a fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may be immobile and retracted against the bony landmarks when the eustachian tube is swollen or congested as with the common cold or allergies. Narrowing of the external canal with erythema and extreme tenderness of the canal wall is indicative of otitis externa.
36. The NP should instruct the mother of an infant with thrush to:
a. Take oral nystatin since she is breastfeeding
b. Stop breast feeding until the thrush has resolved
c. administer antifungal medication to the infant prior to
feeding d. sterilized pacifiers and bottle nipples explanation : Most bouts of oral thrush occur for no apparent reason. However, regularly sterilization of pacifiers, bottles-feed and other mouth toys used by the baby may help to prevent some bouts.
37. A 26 y/o patient, 18 weeks pregnant with twins, has been healthy and has
followed recommendations of her nurse midwife. She is in the office to discuss results
