AACN CCRN Pediatric Practice Exam 150 Questions & Answers RATIONALES., Exams of Nursing

Download AACN CCRN Pediatric Practice Exam 150 Questions & Answers RATIONALES. and more Exams Nursing in PDF only on Docsity! AANP FNP certification Question & Answers All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM - ANS III first time audible, IV first time thrill Fundal height 12 weeks - ANS Fundal Height 12 weeks above symphysis pubis. EXAM Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US 3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - ANS Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - ANS Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - ANS Mini mental exam 4 month old with strabismus, mom is worried...... - ANS tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - ANS Growth chart 6 month old closed anterior fontanel. - ANS XRAY Abnormal cells on PAP, what do you do next? - ANS Refer for Colposcopy CAGE ACRONYM - ANS Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia - ANS Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - ANS CN 3,4,6 Definition of metabolic syndrome - ANS cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - ANS wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - ANS Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - ANS Anterior septum Definitive diagnosis of acute bacterial prostatitis - ANS urinalysis and culture GERD treatment - ANS H2 is first line, give hs Grade 3 cells on Pap, treatment? - ANS LEEP excision Fingernail hematoma treatment? - ANS drill hole and drain blood? Increased risk of ectopic pregnancy - ANS Salpingitis, or history of abortion, PID, Koplick spots - ANS Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots - ANS Measles (rubeola). Grains of salt lesions inside mouth in Measles Legg-Calve-Perthes Disease - ANS Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - ANS Pancreatitis Low HGB, Low HCT, High MCV indicates what? - ANS Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - ANS Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - ANS Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - ANS Meniscus tears Lachman's Test - ANS pivot shift test (ACL tear) Newborn with foot turned in, what do you do? - ANS refer to orthopedist Osgood-Schlatter disease - ANS Knee pain. inflammation or irritation of the tibia at its point of attachment with the patellar tendon MR ASSH Coarctation of Aorta - ANS COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs. -congenital cardiac condition characterized by a narrowing of the aorta - Murmur Grade III - VI - ANS Loud murmur easily heard JVD caused by - ANS -tension pneumothorax, -Rt. sided heart failure, -cardiac tamponade, -traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - ANS endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles. Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - ANS PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI<0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment - ANS Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - ANS >5 mm in an immunocompromised patient or close contact >10 mm in immigrant, health care workers, drug user >15 mm in a patient who lives in an area where TB is very rare. what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - ANS Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) - ANS HTN retinopathy intraocular pressure (IOP) - ANS Fluid pressure inside the eye; measured with tonometry Rovsing sign - ANS pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - ANS Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma - ANS SDH migraine headache - ANS -paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4-12 hours, abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate Vitamin B12 - ANS Folate shares a close relationship with this other B Vitamin. Vitamin B12 - ANS Cognitive deficits, glossitis, pernicious anemia, Folate shares a close relationship with this other B Vitamin. 88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. - ANS be changed to NSAID, SED rate is a sign of inflammation Which medication causes low sperm count for a patient - ANS SSRI grandiosity - ANS Exaggerated belief in or claims about one's importance or identity. Bipolor ADHD - ANS A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity. pt. pap's smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? - ANS HPV test if not done. Refer for colposcopy Chlamydia trachomatis - ANS Doxycycline (+ ceftriaxone for gonorrhea coinfection) Genital warts treatment - ANS Cryotherapy OR Podophyllotoxin cream - OR Imiquimod (Aldara cream) HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. - ANS tell the pt. that he is qualified to be diagnosed with AIDS according to CDC Most common cause of death in children - ANS motor vehicle Tanner 2 - ANS Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 - ANS Tanner 4- female nipples and areola become elevated from breast, secondary mound Male penis grows wider grows in length, darker scrotum pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. - ANS vascular dementia presbycusis - ANS a gradual loss of sensorineural hearing that occurs as the body ages a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - ANS Ultrasound Romberg test - ANS cerebellar -ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds Direct Coombs test - ANS r/o bilirubin preeclampsia treatment - ANS bed rest, laying on her side Molluscum contagiosum treatment - ANS Currettage, liquid nitrogen pyloric stenosis - ANS non bilious vomiting, olive like firm mass palpated on right upper quadrant horizontal nystagmus that stops when eye is close to midline in a college student - ANS Ménière's disease ? Nystagmus test - ANS the involuntary jerking of the eyes as a person gazes to the side eating, painful lump noted on the jaw that comes and go. - ANS sialolithiasis). Etopic Pregnancy: Risk Factors - ANS Previous ectopic pregnancy Prior fallopian tube surgery measured w tonometry BPH and urge incontinence - ANS anticholinergics/oxybutynin, impamine/tricyclic/antidepressant Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH BPH and urge incontinence - ANS TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - ANS a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - ANS telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS intussusception - ANS telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS CURRENT JELLY STOOL IBS (irritable bowel syndrome) - ANS An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. due to Small intestinal bacterial overgrowth, or SIBO IBS (irritable bowel syndrome) - ANS SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool. Caused by: Small intestinal bacterial overgrowth, or SIBO TX fiber, avoid gas foods, antispasmodics, decrease life stress Osteoporosis treatment - ANS TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth Statins increase bone mineral density Osteoporosis treatment - ANS TX BIOPHOSPHATES alendronate, Fosamax, CALCIUM 500 mg, vitamin D food and supplementation, testosterone, WT BEARING EXERCISE CAUCASIAN and ASIAN affected most RISK PPI, STATIN, STEROIDS, THYROID, Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth BONE DENSITY >2.5 Retinoblastoma - ANS white reflection in child's pupil for staph aureus infection (skin) with pus - ANS MRSA- TX Bactrim or tetracyclines? hyperparathyroidism - ANS high calcium Hyperthyroidism treatment - ANS methimazole, PTU-propylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers Mammography Screening - ANS -Age 45 - 54 yearly mammogram -55 and older every 2 years Fifth's Disease (Erythema Infectiosum) - ANS B19: lytic infection, respiratory transmission Sx: flushed rash/fever in kids Px: fever, get better in a week pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - ANS TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. chlamydia in pregnancy - ANS Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM papilledema - ANS optic disc swollen w/ blurred edges due to increased ICP EXAM actinic keratoses - ANS Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM Allergic Conjunctivitis - ANS "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD - ANS COPD- Gold 1-2- SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN CN IX Glossopharyngeal - ANS - Shoulder shrug/ ROMBERG test EXAM CN V Trigeminal - ANS Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear - ANS ears 8 EXAM CN VII Facial - ANS BELLS EXAM ACEI contraindicated - ANS pregnancy Safe to give varicella/MMR - ANS Do not give <12 mo. EXAM QUESTION Acne Vulgaris - ANS common acne. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide. Acne Rosacea - ANS - chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM Cataracts - ANS is on EXAM in elderly night vision issues. Opaque Kawasaki disease - ANS - acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM Erythema migrans - ANS Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM Varicella Zoster - ANS "contagious 48 h. before, until all lesions crusted over" low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. "initially on trunk, then scalp and face" TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM Impetigo - ANS Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM Scarlet fever- scarlantina - ANS "sandpaper textured-pink rash with sore throat" strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM Lichen planus - ANS LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM Spider bite - ANS fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam Pityoris rosea - ANS Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM Corneal abrasion - ANS Corneal Abrasions- Round/Irregular. Was on EXAM. Acute Angle Closure Glaucoma - ANS acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM Conductive - ANS Conductive: Lateralization to bad ear. Rinne- BC > AC. Rinne (1st mastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAM Koplik spots - ANS Koplik Spots- "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM Sensorineural - ANS Sensorineural: Lateralization to good ear. Rinne- AC > BC. OME - ANS Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM Presbycusis - ANS sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM OE - ANS Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM Sinusitis - ANS TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE Meiniers disease - ANS VERTIGO TINNITUS, HEARING LOSS. nystagmas Mono - ANS test heterophile antibody test. ON EXAM MR. ASS - ANS (Systolic Murmur) Only systolic murmurs will radiate to a location on the exam. Mitral Regurg - ANS (Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL. Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb. All diastolic murmurs are pathological. Grades Murmurs - ANS I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM MVP - ANS MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC. S3- HF, S4-LVH stiffening, - ANS S3- HF, Kentucky, early diastole. Abn >35. Bell EXAM S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop" EXAM Isolated Systolic HTN - ANS CCB PAD/ PVD - ANS PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM CVI - ANS CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM blood pressure - ANS BP - ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM. Thiazide diuretics - ANS no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM Statin - ANS Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM Pulses paradoxus - ANS Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM Emphysema - ANS Emphysema Lungs- Percussion-HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM Acute Bacterial Pneumonia- CXR - ANS middle lobe. ON EXAM OSA - ANS does not include Microglossia which is an absent tongue congenital. EXAM TB - ANS fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three "consecutive days". TB is usually upper lobes. TPO - ANS TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM hyperthyroid - ANS Hyperthyroid- Low TSH, high "FREE" T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then. A1C > 9 - ANS If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM Parathyroid - ANS For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and this will just cause it to