Nurse Practitioner Certification Exam: Health and Medical Topics, Exams of Nursing

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Nurse Practitioner Certification Exam Test with best marking scheme  primary lesion - Correct answer lesion that develops on previously unaltered skin  lesion - Correct answer a region in an organ or tissue that has suffered damage thru injury or disease  secondary lesion - Correct answer lesion that either changes impression over time or occurs when a primary lesion is scratched it may be infected  macule - Correct answer circumscribed flat area; different color and texture from surrounding tissue, <1cm  ex.) ephelides (freckles), petechia, flat nevi (moles)  patch - Correct answer a large macule; >1cm  ex.) mongolian spot, Cafe, au lair spot  papule - Correct answer Small solid elevated lesion; <1cm  ex.) bug bite, elevated nevus (mole) or verruca (wart)  plaque - Correct answer elevation of skin; >1cm; example psoriasis lesion  pustule - Correct answer a visible accumulation of purulent fluid under skin; <1cm; examples acne and impetigo  vesicle - Correct answer a circumscribed elevation of skin contains "SEROUS FLUID: <1cm; examples, herpes simples, varicella, shingles  nodule - Correct answer solid mass of skin, is elevated or palpated >1cm; often extends deeper into dermis: examples xanthoma and fibroma  bulla - Correct answer blister, circumscribed elevation containing fluid >1cm , extends only into epidermis, examples burns, superficial blister, contact dermatitis  wheal - Correct answer elevated white or pink compressible papule or plaque, a red, axon-mediated flare often surround it, commonly associated with allergic reaction, examples PPD test and mosquito bites  cyst - Correct answer any closed cavity or sac; contains fluid or semisolid material, normal or abnormal epithelium. example sebaceous cyst  Abscess - Correct answer a localized collection of purulent fluid in a cavity formed by disintegration or necrosis of tissues >1cm  tumor - Correct answer "MASS: > few cm in diameter; firm or soft; benign or malignant  configuration: annular - Correct answer circular, begins in center and spreads to periphery  configuration: confluent - Correct answer lesions run together  configuration: grouped - Correct answer lesion cluster  configuration: gyrate - Correct answer twisted, coiled, spiral and snake like  configuration: linear - Correct answer scratch, streak, line stripe  configuration: polycyclic - Correct answer annular lesions merge  configuration: solitary or discrete - Correct answer individual and distinct lesions that remain separate  configuration: target (iris) - Correct answer resembles iris of eye; lesion with concentric rings of color  configuration: zosteriform - Correct answer linear arrangement along nerve route  comedones - Correct answer open are called black heads (openings capped with a blackened skin debris); and closed are called white head (obstructed)  treatment of squamous cell carcinoma - Correct answer biopsy and surgical excision (MOHS)  seborrheic keratoses - Correct answer benign, not painful lesion, beigh, brown, or black plaques, stuck on appearance, 3-20cm  basal cell carcinoma - Correct answer MOST common skin cancer; slow growing; grows 1-2 cm in years; waxy, pearly appearance (may be shiny red), central depression or rolled edge; may have telangiectatic vessels  treatment of basal cell carcinoma - Correct answer shave/punch biopsy and surgical excision  malignant melanoma - Correct answer mortality rate highest of all skin cancers; mediate age of diagnoses 40, may spread to any organ ABCDE  what does ABCDE - Correct answer asymmetry, border irregularity, color variation, diameter >6cm, elevation, enlargement. treatment is biopsy and surgical excision  eczema - Correct answer chronic skin condition characterized by intense pruritus, acute flare ups: red shiny, thickened patches, inflamed/scabbed and erythema, scaling, dry leathery lichenification treated with topical steroids, rubbed ins ell: clobetasol cream  allergic contact dermatitis - Correct answer acute or chronic condition characterized by inflammation at the site of contact with chemical allergens (redness, pruritus, scabbing, sharp defined borders) treat with topical steroids , do not scrub with soap and water, prednisone taper if severe  psoriasis - Correct answer benign hyperproliferative inflammation of the skin that can be acute or chronic. (HIV: may present as a first sign of HIV infection (explosive event); itching red, precisely defined plaques with silvery scales, fine pitting of the nails, (auspitz sign: droplets of blood when scales removed) treatment is topicals for scalp (tar, salicylic acid shampoo and topical steroids (betamethasone) UVB light exposure.  pityriasis rosea - Correct answer mild acute inflammatory disorder more common in females (50%> males) during spring and fall; pruritic rash found on trunk and proximal extremities; initial lesion is 2-10cm "herald Patch" generalized rash presents within 1-2 weeks' ;lesions follow a christmas tree pattern (follows cleavage lines on the trunk) eruption can last 4-8 weeks. ***serologic test for syphyllis should be done if lesions are NOT itching, lesions are present on palmar or plantar surfaces (this was on our exam)**and lesions are few and perfect  treatment of pityriasis rosea - Correct answer oral antihistamines, topical antipruritic, cool compresses, topical steroids, uvb light, oral erythroymycin  xanthelasma - Correct answer yellow plaques as a result of fat build up under the skin, usually near the inner canthus; hyperlipidemia is the underlying cause; treated with surgical excision, argon and carbon dioxide laser ablation, chemical cauterization, eletro-desication and cryotherapy. Signs and symptoms include: usually located in medial side of upper eyelids, does not affect function of eyelids, but ptosis can occur, more common in woman, peak onset 40-50, uncontrolled diabetes is common cause of secondary hyperlipidemia. Can do lipid panel, biopsy to rule in or rule out  lyme disease - Correct answer  rocky mountain spotted fever - Correct answer  small pox definition - Correct answer infectious disease unique to humans, caused by virus variants, localizes in blood vessels of the skin mouth and throat  signs and symptoms of small pox - Correct answer Sudden onset flu like symptoms, rash appears as flat , red spots/lesions that turn into blisters within 2 days filled with clear fluid and later with pus***pain is excruciating**  what is the hallmark distribution of small pox, which is the primary way of diagnosing - Correct answer 1st lesions appear in oral mucosa/face or forearms 2nd. centrifugal distribution (trunk and spreads out) with greatest concentration on face, distal extremities 3rd on any one part of body, all lesions are in the same stage of development 4th scabs lead to pitted scars.  how to treat small pox - Correct answer 1. small pox vaccine before infection 2. no cure once infected 3. supportive therapy and antibiotics to treat secondary bacterial infections 4. isolation of infected person to prevent spreading to others  Antrax definition - Correct answer acute disease caused b the bacterium "bacillus anthraces" (referred to as spores) but are not fungal spores. 2. anthrax spores can be produced in vitro and used as biological weapon 3. disease is mostly lethal; affects humans and animals 4. spores are transported by clothing, shoes, body of dead animals that die of anthrax  what are the signs and symptoms of anthrax?  Cutaneous form - Correct answer 1. cutaneous (95% cases) a. occurs on exposed areas on arms and hands, followed by face and neck b. pruritic papule leading to ulcer surround vesicles. c. develops into black necrotic central eschar with edema d. after 1-2 weeks, eschar dries, loosens and separates, leaving a permanent scar e. regional lymphadenopathy  signs of symptoms of anthrax inhalation form - Correct answer 5% of cases. follows deposition of spore-bearing particles into alveolar spaces, clinical presentation shows a biphasic pattern. (A) prodromal phase: non-specific flu-like symptoms, dyspnea, malaise, myalgia (B) Fulminant phase: fever, diaphoresis and septic shock  lab testing and treatment for anthrax - Correct answer gram stain of specimen. vaccine exist for those at risk such military. Antibiotics: penicillin, cipro, doxycycline and report to health deparment  Warts definition - Correct answer 1. benign epidural neoplasm caused by HPV 2. transmitted by direct contact 3. several types  Common wart : verruca vulgaris - Correct answer flesh-colored papule with rough surface treated with salicylic acid, liquid nitrogen, electrocautery  filiform warts (digitate) - Correct answer finger-like appearances with various projections. Treated with tretinoin cream, liquid nitrogen and electrocautery  flat warts - Correct answer pink or light yellow. Treated with tretinoin cream, liquid nitrogen and electrocautery  plantar warts - Correct answer roughened surface, slightly raised and may be painful. Treated with salicylic acid c, compound W freeze off (OTC-cyro) blunt dissection, laser therapy  genital warts - Correct answer pale pink with several projections and broad base (think cauliflower) treated with 20% podophyllin resin (pododerm) podofilox (condylox) cryosurgery, trichloroacetic acide release of hormone activated by vaginal contact, prevents ovulation, thickens cervical mucus, inhibits sperm penetration  what are some of advantages of Nuva Ring - Correct answer discreet, can not be felt by partner, once a month insertion, shorter and lighter periods, improves acne, depression and cramps  what are some disadvantages of Nuva Ring - Correct answer similar to O.C.; also diaphragms, cervical caps or shields can not be used as back up methods while using rings, may worsen depression if previously diagnosed, no protection STDS, can't be used in pt >35 or uncontrolled HTN, or smoke >15 cigarettes daily  how long is a NovaRing left in place for - Correct answer 21 days, if ring slips out, must be re-inserted within three hours or must use back up  the patch - Correct answer a transdermal contraceptive patch that releases synthetic estrogen and progesterone ; failure rate <1-2%; prevents ovulation  What are advantages of the patch - Correct answer administered once a week, can be worn for three weeks, easily reversible, sexual activity not interrupted  what are disadvantages of the patch - Correct answer site reactions, similar to OC's, reduced effectiveness in woman >90Kg or 198 lbs, reduce effectiveness with concurrent use of antibiotics, antifungals, anticonvulsants, St John's wart, Seriously increased cardiovascular risks b/c it releases 60% more estrogen then O.C's, do not use woman>35  how should you use patch - Correct answer patch applied on first day of cycle or on first sunday after, patch removed seven days later and then add new patch, after the third week, you wait 7 days (patch free) before re-applying patch, if patch stays off for more than 24 horus, you must restart a 4 week cycle along with using back up  what is repo-provera (DMPA)? - Correct answer long-acting progestin by IM injection, failure rate <1%,  how does DMPA work (Depo) - Correct answer supresses follicle stimulating hormone (FSH) and luteining hormone (LH), thus blocking LH surge which inhibits ovulation, thickens mucus and thins endometrium lining  what are advantages of DePO - Correct answer highly effective, prolonged amenorrhea, reduces pain associated with endometriosis, no estrogen side effects, reduction risk of PID, endometrial and ovarian cancers  what are disadvantages of Depo? - Correct answer amenorrhea, delayed return of fertility of (up to one year) and must have injection every three months  what are some undesirable effects of depo - Correct answer lipid changes, decreases HDL , reduction in bone density with long term use, anaphylactic reactions may occur  what are some prescriptive guidelines for Depo - Correct answer pregnancy test if longer than 2 weeks since three month period ended, there is a two week grace period when injection is given every three months, do no massage injection site, use back up methods for first two weeks unless administer by doc 5  Implanon (implant contraception) - Correct answer it is a single thin flexible rod which contains etonogestrel with low diffusion of progestin from rod, failure rate 0.01%  what are some advantages of implanon - Correct answer continuous protection for three years, no estrogen side effects, few serious system complications occur, absent menses or decreased anemia, decreased cramps, decreased risk for endometrial cancer  what are some disadvantages of implanon - Correct answer requires informed consent, irregular periods, implant may be slightly visible initially, initials expenses higher  IUD - Correct answer an artificial device with metal wrapping or chemically-impregnated surface to prevent pregnancy  what are the two types of IUD - Correct answer 1. copper releasing (ParaGuard) a t shaped plastic devise wrapped with fine copper and can remain in uterus for 10 years. 2 progesterin-releasing (mirena) t shaped also known as levonorgestrel releasing intrauterine system (LNG-IUS) can remain in uterus for 5 years, typical 1st failure rate is 1- 3%  how does IUD work - Correct answer immobilizes sperm, speeds ovum transport, inhibits fertilziation, causes lysis of blastocyst and prevents implantation  what are some advantages of IUD - Correct answer progesterin releasing may decrease menstrual loss or dysmenorrhea, can prevent asherman's syndrome (Intrauterin adhesions, scarring or synechiae is an acquired uterine condition.  what are some disadvantages of IUD - Correct answer pain and cramping may occur (40% removal rate due to pain), increase in bleeding may result in anemia, spontaneous abortion in up to 50% cased if IUD left in uterus, etctopic pregnancies occur in 5% of cases  what are some undesirable effects of IUD - Correct answer expulsion of IUD (up to 10% in first year), lost IUD string, pregnancy, PID (rate is highest in first 6 weeks after insertion)  what are some absolute contraindications for using IUD - Correct answer active, recent or recurrent pelvic infection, pregnancy, risk of PID, undiagnosed irregular uterine bleeding  what are some prescriptive guidelines for IUD - Correct answer requires informed consent, may be inserted at anytime of cycle, but expulsion is greater during menses, may insert 4-8 weeks postpartum, make sure patients know to check strings, monitor for bleeding, fever, chills  diaphragm /cervical cap - Correct answer flexible dome shape cup constructed of latex rubber that prevents pregnancy by blocking the transport of sperm through cervical os; typical first year failure rate ***18% not .18  when used with spermicidal gel or cream destroys the cell membrane of sperm - Correct answer diaphragm/cervical cap  what are advantages of diaphragm/cervical cup - Correct answer may provide protection against some STD's when used with spermicidal gel (nonoxynol-9), safe and easy to use, inserted before inters coarse, provides immediate protection  what are some undesirable effects of diaphragm/cervical cap - Correct answer skin irritation may occur secondary to latex or spermicide, increased risk of UTIs and vulvovaginitis; allergic reaction, or inability to insert product  what are some management and prescriptive guidelines for diaphragm/cervical cap use? - Correct answer check for holes and tears, should be re-fitted with weight gain or loss of 20 pounds or more, avoid oil-based lubricants because it destroys latex, must be left  symptothermal method - Correct answer uses both BBT and cervical mucus techniques for contraception  lactational method of contraception - Correct answer relies on breastfeeding for family planning, which often delays the onset of ovulation and menstruation for about 6 months  intrauterine pregnancy - Correct answer 40 week process in which an embryo grows and develops into infant in uterus, first trimester to 12 weeks, second trimester to 13-27 weeks and last trimester 28-40 weeks  symptoms of first trimester - Correct answer amenorrhea, nausea, vomiting, fatigue, breast tenderness, urinary frequence  symptoms of second trimester - Correct answer fetal movement, abdominal discomfort, changes in skin pigmentation, syncopal episodes  symptoms of third trimester - Correct answer abdominal growth, braxton hicks , return of urine frequency with discount of presenting part, increased respiratory effort until decent  physical examination of first trimester - Correct answer breast enlargement, Goodell's sign (softening of cervix), chadwick sign (cervix cyanosis), Hegar's sign (softening of cervicouterine junction, fetal heart tones 10-12 weeks  physical examination of second trimester - Correct answer striae may appear, funds palpable at umbilicus at 20 weeks and grows 1cm per week after, leopold maneuvers after 20 weeks (four steps to determine fetal position)  physical exam of third trimester - Correct answer lightening may occur up to 3-4 weeks prior to labor, loss of mucus plug, bloody show prior to labor by one week, increased braxton hicks/rupture of membranes  pregnancy tests - Correct answer urine or serum; quantitative titiers or serum Hcg, ultrasound  what trimester is Chorionic villus sampling done (CVS) - Correct answer first trimester  what semester do you perform an amniocentesis and when? - Correct answer 15-20 weeks if family history of chromosomal abnormalities or advanced material age  what other screening test are done in second trimester - Correct answer triple or quad screen (multiple marker test) and ultrasound for fetal survey at 18-20 weeks; and one hour GTT at 20 weeks if family history of diabetes or pt weighs more than 200 pounds  third trimester screening - Correct answer RhoGam for un-sensitized Rh-negative mothers at 28 weeks, Hgb/Hct at 28-36 weeks; non stress test (NST) biophysical profile (BPP) as needed for assessment of fetal well being  scheduling for prenatal visits - Correct answer 0-28 weeks: every four weeks  28-36 weeks: every two weeks  36 weeks to delivery: every week  Naegele's rule - Correct answer establishment of estimated date of confinement (EDC) based on last normal menstrual period (LNMP)= 1 year-3 months+7 days  labs done on return OB visits - Correct answer routine, plus urine for protein, glucose, ketones at each visit (looking for preeclampsia)  95% of ectopic pregnancies occur in - Correct answer fallopian tubes  symptoms of ectopic pregnancies - Correct answer abnormal uterine bleeding, abdominal or pelvic pain, lower back or shoulder p win, hemodynamic changes in vital signs (shock-rupture)  physical exam of ectopic pregnancy - Correct answer tender adenexa ( appendages of uterus= ovaries, fallopian tubes, and ligaments that hold uterus in place); positive cervical motion tenseness, uterine enlargement with hegar's sign (softening and consistency of cervix), positive peritoneal signs if rupture  abortion - Correct answer pregnancy termination at any time prior to viability (20 weeks) either through spontaneous or expulsion or medical/surgical removal  approximately what percentage of pregnancies are abortions - Correct answer 15%  what causes abortion in first trimester - Correct answer chromosomal abnormalities  what causes abortion in second trimester - Correct answer cervical incompetence, infection or uterine abnomalities  management of spontaneous abortion - Correct answer refer, bed rest, abstinence, labs  management of induced or elective abortion - Correct answer vacuum D and C up to 12 sees, D &E 13-14 weeks to 20-22 weeks, hysterectomy/hysterotomy  medical management : for up to 49 days of pregnancy - Correct answer first trimester: abortion pill mifepristone (mifeprex) also known as RU 486 and in second trimester: prostaglandin (misoprostol)  PIH Pregnancy induced hypertension - Correct answer BP>140/90 or rise in systolic >30 or diastolic over 15mmHg above baseline on at least two occasions with readings six hours apart (occurs about 12% cases)  what are predisposing factors to PIH - Correct answer pre-existing hypertension, diabetes, renal or cardiovascular disease, lupus or autoimmune disorders, multiple gestation, primigravida (1st pregnancy) family history of PIH or preeclampsia, maternal age (young or more mature)  what test besides labs would you do for PIH - Correct answer NST 32- 34 weeks or pen, ultrasound prn to check for lag of fetal growth  management of PIH - Correct answer rest, fetal surveillance,  what is preecclampsia - Correct answer PIH+proteinuria+generalized edema after 20 weeks  what is eclampsia - Correct answer preeclampsia+seizure activity  What is HELLP syndrome? - Correct answer Hemolysis Elevated Liver and Low Platelet count  what are symptoms of preeclampsia - Correct answer sudden weight gain(>6 pounds in month or 2 pounds per week, progression frond digital or modal facial edema to generalized edema, frontal or occipital headaches, visual disturbances; reflexes WNL progress to 3-4+ with worsening condition; lagging fundal height  management of preeclampsia - Correct answer strict bed rest with worsening condition in left lateral recumbent position, fetal