Study Aid For Final Exam Questions And Verified Answers |100% Correct| 2023-2024 Graded A+, Exams of Nursing

Download Study Aid For Final Exam Questions And Verified Answers |100% Correct| 2023-2024 Graded A+ and more Exams Nursing in PDF only on Docsity! Study Aid For Final Exam Questions And Verified Answers |100% Correct| 2023-2024 Graded A+  A 14-year-old girl is concerned about not having started her period. In looking over her records, the FNP notes that the patient is below the 5th percentile for height and weight and has a history of recurrent respiratory infections. Which differential diagnosis for the patient is least suspicious on the list? Pneumoni a Asthma Turner's syndrome Cystic fibrosis  Which of the following is not considered a tetanus prone wound? Laceration Gunshot wound Puncture Frostbite  A daughter brings in her 86-year-old mother with a concern about driving safety. Which of the following is not a concern for driving safety? Gets lost easily Drives too slowly Has difficulty in making left-hand turns Takes too long to get to destination  A college freshman who learned the testicular examination procedure in a health class 2 days ago comes to the College Clinic "upset about my privates." Further questioning elicits the following description: the testicle "feels like the candy called gummy worms." The exam confirms that there is a palpable area in the left scrotum that is not pain. This most likely represents a diagnosis of: Testicular cancer Epididymitis Varicocele Hydrocele  A 7-year-old boy is brought in by his mother; there are molluscum contagiosum lesions in his genital area. This finding raises the index of suspicion about: Deer tick bite Improper cleaning after using the toilet Excessive masturbation Sexual abuse  What subjective fact from a 14-year-old girl is most consistent with a diagnosis of a binge episode in bulimia? "I ate two slices of pizza and a side salad for dinner." "The candy apples were so good at the fair that I ate two." "I ate two bags of marshmallows in less than an hour." "This morning I had an egg, grits, bacon, and toast for breakfast."  A patient is complaining of having difficulty sleeping. He states that when he lies down he gets a feeling of having an electric current in his legs. This description is consistent with: Insomnia Restless leg syndrome Myoclonic seizure Chronic fatigue syndrome  Which clinical finding is least diagnostic of ovulation for a couple attempting to use natural family planning? Positive ovulation on an ovulation predictor kit Stretchy cervical mucus Basal body temperature elevation Pasty, thick cervical mucus  Which of the following complaints, in addition to facial pain, is most indicative of TMJ disorder? A. "My food gets caught in my throat when I swallow." "My husband says I grind my teeth at night." "I have a partial plate." "My teeth hurt when I chew hard candies."  Which finding on a Tzanck smear confirms herpes? Intracellular nonmotile parasites Presence of WBCs Multinucleated giant cells Coated epithelial cells  Which of the following examination findings is consistent with the diagnosis of Hirschsprung's disease? Large fecal mass palpable in abdomen but no stool in rectal vault Large amount of stool in rectal vault Fluid wave of Cluster headaches Migraine with aura Tension headache Migraine without aura  A 2-year-old child has a sudden onset of stridor. There is no history of a viral illness, fever, or vomiting. The child's mother states that the child was well in the morning. What would be of highest suspicion on your differential diagnosis? Neoplastic tumor Epiglottitis FB aspiration Croup  Which skin lesion necessitates immediate intervention? New 3 mm brown mole with an irregular red border that itches Waxy papule 3 cm in diameter that appears "stuck on" the face Multiple flat moles scattered along the upper back—black-brown with smooth rounded edges D. Brown mole on thigh—5 mm symmetrical, unchanged in many years  John Carlisle, a 65-year-old patient of the clinic, tells the FNP that he just had a nice retirement party. He has sold hardware for 40 years in the same family-owned store, which will now be closed. The NP asks what his future plans are. Which response would justify clarification, given the expected developmental task for this age group? His promise to help a young neighbor develop a business plan for a small plant nursery His plan to teach his grandsons how to fish and build a bird house His plan to "lay up in a hammock under the trees all day—no more work—not even the simplest exercise" His determination to lose 10 pounds prior to a scheduled cruise  Which comment by an older woman would lead the FNP to include macular degeneration in a list of differential diagnoses? "There is good direct vision but objects at the sides seem blurred." "I can't see anything in front of me but my side vision is good." "My eyes feel as if they have a film over them darkening my vision." "I see little flecks that appear to be dancing in front of my eyes."  Which patient is at least risk for a diagnosis of blepharitis? Male with pronounced rosacea Female contact lens wearer Female who occasionally wears artificial eyelashes Female patient with seborrhea  A patient has been diagnosed with tennis elbow. This implies pain at what location?  Which of the following rashes is found in scarlet fever? Rash evolving from pink macules to red papules and finally to petechiae Rash is bright red and maculopapular, with a fine sandpaper-like texture Petechial lesions distributed on the trunk and extremities Annular erythematous rash with scaling on the leading edge  A review of a patient chart indicates that she has been on a very low calorie diet in an attempt to lose weight. For which serious complication should the woman be evaluated? Elevated prothrombin time Gallstones Gastric cancer Ventricular arrhythmias  Which of the following elements in the history would make an elderly patient most susceptible to falling in the near future? Taking two medications at a time Routine activities Walking 2 miles 3 times a week Initiation of a new medication within past 2 weeks  Which of the following historical factors in a patient with sickle cell disease typically is the presenting symptom of a patient in crisis? Decreased hearing Extremity pain Nosebleeds Menorrhagia  A 17-year-old ballet student presents with concerns about not having a menstrual period in the past 3 months. She has been training especially rigorously for a special audition and has lost 13 pounds in the process. She is now 5'7" tall and weighs 105 pounds. The initial action by the FNP should be: Serum FSH BMI and fat percentage Thyroid function tests Pregnancy test  The use of 10% potassium hydroxide in wet mount slides assists in diagnosing: Herpes and condyloma acuminata Bacterial vaginosis and Candida albicans Gonorrhea and syphilis Trichomonas and Chlamydia 12  A patient who has had a myocardial infarction and has an ejection fraction of 35% but is able to work full time and continues to attend exercise classes three times a week has which level of NYHA classification? Stage II heart failure Stage IV heart failure Stage I heart failure Stage III heart failure  A 10 years old child says, "I am worried because my friend is not telling her mother the truth" The APRN should identify that this statement is consistent with which stage of psychosexual development? Phallic Latenc y Genita l Anal  The APN is examining a 9 year old who complains of pain and stiffness in the knees, hands, and feel that worsens in the morning and after naps. The child's eyes are irritated, and the mother is worried about the child having swollen glands and intermittent fevers that are accompanied by a transient maculopapular rash. The APN should refer the child for which type of evaluation? Lyme disease Mononucleosi s Juvenile Arthritis Food Allergies  The APRN is conducting a preadmission physical examination of an older adult who is scheduled for surgery in two days. Which factor put the client at greatest risk for a prolonged hospital stay Multiple medications. Urinary incontinence' Cognitive impairment Two fall in 5 months  Pregnant at 24 weeks gestation is seen by the APRN. The pregnant is concerned about receiving an influenza vaccination, which she read on the internet that is 15  A 13 years old African American teenager presents to the clinic with a chief complaint of hair loss with small bold spots. Which question about grooming best demonstrates the APRN knowledge of cultural practice in this group? Do you straighten your hair? What shampoo do you use? Do you wear a head covering? Are you using hair pomade?  The APRN is providing prenatal counseling to a couple whose only child has cystic fibrosis (CF). What information should the APRN explain to the couple about the risk of having other children with CF? Because the couple had one child with cystic fibrosis, other children have reduced risk of manifesting the disease. Other children may have incomplete penetrance of the cystic fibrosis trait, and phenotypically be less likely to exhibit disease. Cystic fibrosis is a multifactorial genetic disorder, so there is a low risk of subsequent children having the disease. Each child has the same risk of inheritance of cystic fibrosis because it is transmitted in an autosomal recessive gene.  The APN is assessing a 7- years old girl with right ear pain due to cerumen impaction. The APN expects which results from tuning fork conduction test of the right ear? Weber test cause lateralization of sound to the right ear. 16 Rinne's air conduction test is heard longer on the right ear Vibratory sensation of right mastoid prominence is prominent. Rinne's air conduction test heard best in to the left ear.  The APN is examining a child with suspected pyelonephritis. What symptoms are expected findings for this client? Right lower quadrant pain, vomiting, and diarrhea Tachycardia, rash, and bilateral flank pain Fever, anorexia, and dysuria Oliguria, amber-colored urine and constipation.  Researchers compared meal frequency and physical activity of 80 pregnant women, 40 who experienced preterm labor and 40 who did not experience preterm labor, women wo experienced preterm labor were 3.57 times more likely to skip meals than those who did not experience preterm labor. Amount of walking was significantly less in the preterm labor group that it was in the group without preterm labor. Based on the findings of this study what action should the APRN take when teaching prenatal patients self-care during pregnancy? Obtain a diet history for the past week from each of the prenatal patients Encourage patients who are in their first trimester to trail for a walking marathon. Determine the patient's attitudes about diet and exercise during pregnancy Describe the benefits of eating small, frequent meals throughout the day  A 70 years old male complains of blurring in his right eye without pain or erythema and tells the APRN that he feels like a dark veil is covering his eye. Which action should the APRN implement? Schedule a dilated eye examination with his optometrist. Irrigate the affected eye with sterile normal saline Prescribe antibiotic eye drops, four times a day for 7 days. Refer immediately for an ophthalmologist appointment  What information should the APRN include in a newborn education class for parents of uncircumcised male infants? Cleanse the ureteral area daily with an antiseptic solution Avoid foreskin manipulation and cleanse penis and coronal area daily Retract the foreskin daily until he is able to perform his own hygiene. Apply zinc oxide (Desitin) to lubricate foreskin for retraction.  A 3 days old newborn is spitting up large amounts of Similac (A nonfat cow's milk formula, made by Ross Laboratories) after each feeding. What formula 17 option should the APRN recommended that the parents use to feed this child? Enfamil, a nonfat cow's milk formula, by Mead-Johnson 20  A mother reports that her toddler has developed a "runny nose on the side" the child has no fever, is eating well, and is playing actively. The APRN should provide which primary differential diagnosis? Upper respiratory infection Seasonal allergic rhinitis A cold Obstruction  A mother who is breastfeeding reports that her 10 week old infant is overly fussy and more frequently during the night. Which finding should the APRN address as the etiology for the infant's symptoms Routine includes two glasses of red wine each evening Dietary cravings during a smoking cessation program Maternal diet change to high fiber and fresh vegetables Sore nipples and curd- like patches in the infant's mouth  A first grade boy complains of a sudden onset of pain in his left eye. He was on the and says, "I got a dirt in my eye" How should the APRN check for a corneal abrasion? Determine if the pupils are equal, round, and reactive to ligt. Using the otoscope, check for the presenceof foreign bodies. Use an aphthalmoscope to check for presence of a red reflex Applying fluorescein stain, examine the eye with a wood's lamp  When performing a functional assessment on an 82 years old patient with a recent which question is most important for the APRN to How many times a day do you have a bowel movement Do you have any thyroid medication Do you wear glasses Are you able to dress yourself  The APRN is examining a 6 months old infant for well baby check up. Which findings indicates that the fontanels are normal at this infant growth? Anterior closed, posterior closed Anterior open, posterior closed Anterior open, posterior open Anterior closed, posterior open 21  The APN is gathering data for the differential diagnosis of acute diarrhea of an 8 month old male infant. Which client history should the APN obtain as best targets celiac disease? Have any new foods been added to his diet? Are any ancestors from South Africa 22 Has he had problems with diarrhea in the past? Do any siblings have food allergies?  For uncomplicated genital gonococcal infections, The CDC recommends which drug treatment regimen? Azithromycin (Zithromax) 250 mg PO daily x 5 days Doxycycline (Vibraycin) 100 mg PO BID x 14 days Bactrim 160 mg x 3 weeks Ceftriaxone 125 mg IM single dosis  The APRN is assessing the primitive reflexes of a new born who is 6 hours old. Which reflex should the APRN investigate further? Palmar grasp Moro reflex Stepping reflex Placing reflex  The weight chart documented for a multigravida at 18 to 20 weeks gestation includes these findings: 18 weeks, 155 lbs; 19 weeks, 156 lbs; 20 weeks, 157 lbs. If the client had a normal body mass Index) before pregnancy, what should the APRN tell the client about her weight gain pattern? Inform her that her weight gain for the past 3 weeks is on target for this trimester. She needs to increase calorie intake to achieve weight goals in the 3rd trimester. Have the dietitian counsel the client about nutritional guidelines for the second trimester Advise for planned weight loss over one month by reducing carbohydrate intake.  The APRN should intervene when wish behavior is because it is a clear violation of the Health Insurance Portability Act (HIPAA)? A hospital transporter is reading a patient history and physical while waiting for a patient in a radiology department. Two visitors are discussing a hospitalized patient history of drug abuse in the gift shop near the main lobby. Two medical residents are overheard talking about a cure for AIDS outside the room of a patient with HIV infection. The staff nurse is overheard telling a patient with pancreatitis, "it's hard to quit drinking but AA helped me"  A woman at 20 weeks gestation has a positive urine screen for Group B Streptococus. What action should the APRN take? Consult with obstetrician about hospitalized IV penicillin therapy Implement the protocol for a 10 day course of 25 can cause infertility in women Ask the patient if she has a purulent or foul vaginal discharge  In the abortive therapy of migraine headaches what condition precludes the use of sumatriptan? 26 Migraine accompanied by severe nausea and vomiting Migraine in a patient with poorly controlled hypertension Headache that is concurrent with a menstrual period Headache in a patient with a history of epilepsy  A patient's complete electronical medical record (EMR) is a legal document which should convey which clinical focus? Gives insight to the quality of comprehensive hospital care Determines direction of care based on patient's health history Provides a story line of all aspects of care given and planned for a patient's needs Contains history of family and patient health and illness through a lifespan.  A 20 years old college student comes to the campus health center with a chief complaint of "Strep Throat". In addition to the painful sore throat, the student symptoms include head ache and fatigue, the APRN performs complete neuro and ENT examination, as well as auscultation of heart and lungs, and palpation of the abdomen. What findings should the APRN expect to confirm based on the client's history? Palatal petechial rash caused by the untreated bacterial upper respiratory tract infection Liver enlargement that is likely to persist beyond one month due to concomitant hepatitis Adenopathy of the posterior cervical nodes secondary to the streptococcal infection Enlarged tonsils and splenomegaly characteristic of infectious viral mononucleosis.  An elderly patient who takes Coumadin (Warfarin) daily, request advice regarding a new prescription medication for join pain due to osteoarthritis. Which over the counter medication the APRN advise the patient to take? Acetaminophen (Tylenol) Aspirin (Buffen) Ibuprofen (Motrin) Naproxen (Naprosyn)  An 17 years old male who has been taking Bactrim for sinusitis presents to the emergency Department with a temperature of 103 F, malaise and hemorrhagic bullae on his lips, mouth and most of his body. Which admitting diagnosis should the APRN make? Erysipelas Cellulitis Erythema Multiform Minor Stevens Johnson Syndrome 27 Rocky Mountain Spotted Fever  A patient presents with watery soft diarrhea after taking a prescribed antibiotic for one week, in a stool culture test which organism should be obtained by the APRN? Helicobacter Pylori 30 For core body temperature over 104 F, give toped bath and watch for reactions.  The APRN is conducting routine employee screening. A new employee ask how long it takes to get rid of marihuana in the body. The APRN should inform patient that recreational drugs such as marihuana, yield positive results for how long after used? 1 month 2 days 24 hours 2 weeks  Other than for its use in acute inflammatory conditions, what special use does intravenous indomethacin (Indocin) have? To activate uterine contractions and initiate labor in uterine inertia To improve renal blood flow in acute renal failure As an antidote for acetaminophen toxicity For promoting the closure of a patent ductus arteriosus in children  A patient presents with watery soft diarrhea after taking a prescribed antibiotic for one week, in a stool culture test which organism should be obtained by the APRN? Helicobacter Pylori Salmonella Sp Clostridium Difficile Staphylococcus aureus  For a menopausal woman, what is the main advantage of administering progestin concurrently with estrogens? Relief of depression and insomnia in women with postmenopausal symptoms A reduction in endometrial cancer risk in women who have not had a hysterectomy A reduction in cardiovascular risk in women with a family history of heart disease. Improvement in the bone density in women with a family history of osteoporosis.  The APRN is examining an elderly female client and notices that she has a motor dysfunction in her hip region. Which procedure should the APRN consider to perform to further assess for hip dysfunction? Abduct and internally rotate each hip while the client is supine Have the client balance first on one foot and then the other Flex the hip and knee while lying flat with other leg extended Ask the patient to stand and bend over the examination table. 31  Which procedures should the APRN recommend for a healthy 67 years old female patient who has not seen a health care provider for an annual physical exam in the past 5 years? 32 Papanicolau smear, sigmoidoscopy, thyroid screen Papanicolau smear, thyroid exam, chemistry screen Papanicolau smear, mammogram, stool for blood Mammogram, chemistry screen, sigmoidoscopy  A 67 years old female patient presents to the clinic with a glossy red tongue, angular stoma, and dry, cracking lips. Her weight is within normal limits and her skin is dry and intact. A decrease in which laboratory finding is most consistent with this clinical presentation? Albumin Iron binding Capacity B Vitamins Vitamin C  While conducting a routine health screening the mother of 7 years old reports that her child is having difficulty adjusting to pre-school. The APRN noted several café-au-lait pigmented areas on the child's trunk. What presumptive diagnosis should the APRN make? Neurofibromatosis Fetal alcohol syndrome Multiple sclerosis Williams syndrome  The APRN asks a female patient about the "What does a vacuum do? And she replies, "It will break the windows". What conclusion should be documented according this patient's response? Normal mental status for age Impaired concentration Impaired memory Impaired thinking  A client at 12 weeks gestation comes to the ante partum clinic complaining of excessive nausea and vomiting. Based on the following laboratory values: hematocrit 36%, hemoglobin 12 g/dl, fasting serum glucose 73 mg/dl, human chorionic Gonadotropin (HCG) 290, 00 mLu/ml. What test should the APRN prescribe? Glycosylated Hemoglobin Amniocentesis Chorionic Villi sampling Ultrasound 35 depression. Based on the findings of this study, which intervention should the APRN working in a women's health clinic implement? 36 Develop a counseling program for depressed pregnant women Evaluate sleep quality and depression of all pregnant woman. Replicate the study using the clinic's population Screen all woman  A freshman in collage presents to the woman's requesting the "morning after pill", the young woman reports that she was engaged in consensual intercourse this morning when the condom broke. A review of the client's PMH reveals no contraindications to estrogen use, on the information, what actions should the APRN take? Provide the client with information about natural family planning so that this situation can be avoided in the future Prescribe post-coital contraception with instructions to take the medication immediately after is obtained Advise the client to wait until her next period is due, and if late, return to postcoital c ontraception. Request a pregnancy test and then prescribe postcoital contraception (such as Plan B) to be taken within the next week. X  What pharmacological agent should the APRN prescribe to achieve the best results initially in the management of patients with erosive reflux esophagitis? Barrier paste medications, such as sucralfate (Carafate) Proton pump inhibitors, such as omeprazole (Prilosec) The H2 antagonist, such as famotidine (Pepcid) Promotility agents, such cisapride (Propulsid)  At a parenting class, a mother has concerns that her child does not seen to have any close friends. Which age do children begin to develop friendships? Two years Twelve mounts Eighteen months Three years  Woman who is gravida 2, para 1 has been in labor for 10 hours and arrives in to the clinic experiencing intensifying contractions that are occurring every 2 minutes. The APN determines that the patient cervix is 100% effaced, dilated and the fetal head is in the right occipital posterior (ROP). The APn starts a saline lock when client begins screaming for pain medication. Which action should the APN implement first? Reposition the patient laterally Reinforce relaxation techniques and controlled breathingObtain a precipitation tray and call for transport to L&D Apply an external Fetal monitor. 37  The APRN prescribe lipid lowering medication and diet modifications for a patient three months ago, On review of the latest patient related data which findings requires the APRN to take action? New onset insomnia from calf pain Intermittent episodes of constipation Reduction in low density lipoprotein of 65% Elevation of liver transaminases of 5% ?  When a middle age male client performs range of motion with his left arm the APRN notes that he is able to flex the arm without difficulty, however he is unable o abduct the arm without causing pain. If the APRN passively abducts the arm it falls back in place when released. What do these findings suggest? Rotator cuff lesions Shoulder dislocation Crepitation Tennis Elbow  The nursing staff in a busy care wishes to adopt a new procedure that is recognizes as a best practice on a healthcare related web page on the internet. What step should the nurses take before initiating a change in the current unit policy? Ask the healthcare professionals if they agree with this change in nursing practice on the unit Verify the legitimacy of the practice by determining the source of this web page. Teach the experienced nurses how to implement the new procedure first. Validate the procedure by conducting a study that compares the old with the new.  A client at 39 weeks gestation comes to the clinic and tells the APRN that her bag of waters has ruptured. Which finding provides the best determination that the client's membranes are ruptured? Contractions occurring 3 minutes apart. A positive Fern test An elevated serum white count Nitrazine paper that turns blue when placed in vagina.  Which pathophysiologic characteristic should the APRN identify in an older patient who is manifesting signs of Alzaimer's disease? Intracranial pressure greater than 30 mmHg Obstruction of cerebrospinal fluid (CSF) flow Senile plaques and neurofibrillatory tangles Marked 40 absorption Decreased heat production Decreased percentage of body water 41  Julie, a 72-year-old female, comes to see you because of complaints of memory loss, extreme drowsiness, and dizziness. Which of the following drugs would most likely lead to these side effects? Paromomyc in Furosemide Phenytoin Doxazosin  Which of the following types of drugs should elderly patients take 1 hour before or 4 hours after other medications? Beta-blockers Antacids Benzodiazepines Diuretics  Which of these is least representative of typical chest X-ray findings of pneumonia in the elderly population? Bacterial pneumonia presenting with bronchopneumonia Aspiration pneumonia localized to the right middle lobe Viral pneumonia showing diffuse involvement Bacterial pneumonia presenting with lobar pneumonia  You are considering prescribing furosemide to an elderly patient, believing it to be the drug best-suited for treatment. After looking over the patient's recent lab tests, however, you notice decreased serum albumin levels. Which of the following choices would be the best course of treatment at this time? Treat the underlying cause of decreased albumin Decrease the dosage of furosemide Switch to torsemide Start the patient on metolazone  Which of the following most closely resembles an instrumental activity of daily living for the geriatric population? Going to work Paying bills Going to the bathroom Reading the newspaper  Alice, an 87-year-old female, arrives at your clinic complaining of fatigue during the day. After looking up some of her symptoms on the Internet, she thinks she 42 may have hypersomnia. In evaluating Alice's medical history, which of the following would you be least likely to associate with hypersomnia? 45 Acyclovir Ibuprofen Amitriptyli ne  Which of the following is least true regarding the physiologic changes and findings in the immune systems of the elderly? Innate immunity functions decline while adaptive immune responses remain constant Decreased thymic hormone production results in a decreased number of functioning T-cells Decreased antibody production and response to antigens occurs Vaccine-induced antibody response wanes  The most common trigger for delirium is: alcohol withdrawal fecal impaction head trauma acute infection  Older adults are at greater risk of subdural hematoma, even with minor head trauma due to: lower bone density in the skull relatively fragile blood vessels. decreased adipose tissue reserves. age-related reduction in circulating clotting factors  Potential noncognitive reasons for behavioral issues observed in older adults include all of the following except: ADHD pain infection depressio n  When managing depression in older adults, all of the following should be considered except: start at the highest dose possible of antidepressant and then titrate down once symptoms resolve encourage psychotherapy in addition to pharmacotherapy. utilize electroconvulsive therapy for severe depression conduct a medication review to minimize potential drug-drug interactions.  When considering end-of-life decisions, which of the following statements is false? Advanced directives include living wills and do not resuscitate 46 (DNR) orders. A video or audiotaped discussion may include advanced directives Advanced directives are legally binding in all states 47 Advanced directives are only recognized when the patient is hopelessly and terminally ill.  All of the following are typical physiologic changes in the central nervous system of the elderly population except: Decreased beta-adrenergic responsiveness b. Increased alpha responses Decreased dopamine receptors Increased muscarinic parasympathetic responses  Which of the following is attributed to decreased renal function in the elderly with regard to prescription medication? Decreased drug metabolism Inhibited drug absorption Impaired drug elimination Limited drug distribution  When considering the properties of a drug in the body, which of the following does not change as a person ages? excretion biotransformatio n pharmacodynami cs absorption  When making a home visit to a bedridden 89 year old man, you note that he is cachectic and dehydrated but cognitively intact. He states he is not receiving his medications regularly and that his granddaughter is supposed to take care of him but mentions, "She seems more interested in my Social Security check." The patient is unhappy but asks that you not "tell anybody" because he wants to remain in his home. The most appropriate action would be to: talk with he patient's granddaughter and evaluate her ability to care for the patient visit the patient more frequently to ensure that his condition dies not deteriorate honor the patient's wishes because a competent patient has the right to determine care. report the situation to the appropriate state agency  The use of which of the following medications is associated with the least risk of postural hypotension in the older adult? nifedipine furosemide clonidine lisinopiril  The NP is asked to evaluate a 77 year old woman who recently had an 50 use of ear protection when exposed to loud noises. avoid using hearing aids for a prolonged period of time. regular cerumen removal 111- Age related changes in an elderly adult include all of the following except: 51 total body water decreases by 10% to 15% between ages 20 and 80 years. body weight as fat increases from 18% to 36% in men and from 33% to 45% in women increase in serum albumin increase in gastric pH 112- A general principle of drug absorption in an elderly adult is best described as: amount of absorption is decreased rate of absorption is changed drug absorption is altered but predictable. bioavailability is altered 113- Anticipated age-related changes that can result in less drug effect include: loss of beta-2 receptor sites lower gastrointestinal (GI) pH. increased renin-angiotensin production increased GI motility. 114- When prescribing a diuretic, the NP considers that the older adult: has diminished ability to conserve sodium has increased ability to excrete potassium has continued response to a thiazide despite increasing creatinine often develops allergic reaction to these products 115- Age-related changes in the gastrointestinal system include all of the following except: decreased gastric acid production decreased GI motility increased GI surface area decreased gastric emptying 116- A general principle of drug absorption in an elderly adult is best described as: amount of absorption is decreased rate of absorption is changed drug absorption is altered but predictable. bioavailability is altered 117- Anticipated age-related changes that can result in less drug effect include: loss of beta-2 receptor sites lower gastrointestinal (GI) pH. increased renin-angiotensin production 52 increased GI motility. 55 increased renal mass to compensate for decreased function 125- When dosing warfarin in older adults it is important to consider: a lower dose is needed due to lower serum albumin a lower dose is needed due to higher serum albumin a higher dose is needed due to lower serum albumin a higher dose is needed due to lower serum albumin 126- An NP learns that a 90-year-old patient is chronically constipated and has frequent problems with acid reflux. The NP notes a weight loss of 20 pounds in this patient in the previous 6 months. Which of the following drugs that this patient is taking is cause for concern? Quinidine Naproxen Calcium citrate Calcium channel blocker 127- An NP is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea. Using the Beers criteria, which of the following medications should the NP recommend for this patient? Loratadine (Claritin) Hydroxyzine (Vistaril) Diphenhydramine (Benadryl) Chlorpheniramine maleate (Chlorphen 12) 128- An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65- year-old patient with recent onset of reactive airways disease who reports symptoms occurring every 1 or 2 weeks. At a follow- up appointment several months later, the patient reports no change in frequency of symptoms. The NP's initial action should be to: order spirometry to evaluate pulmonary function. prescribe a systemic corticosteroid to help with symptoms. ask the patient to describe how the medications are taken each day. give the patient detailed information about the use of metered-dose inhalers. 129- Painless vision change that includes central vision distortion is an age-related change in the senses reported by the older adult. It is known as: Hyposmia Presbycusi s 56 Presbyopi a Age-related maculopathy Chronic glaucoma 57 130- This age-related change that results in near vision blurriness is a change in the senses sometimes reported by the older adult. Hyposmia Presbycusi s Presbyopi a Age-related maculopathy Chronic glaucoma 131- A 76 year old woman is being treated for senile cataracts. The granddaughter who is accompanying the patient expresses concern that one day she may also develop cataracts. You explain that she can reduce the risk of senile cataracts by avoiding all of the following except: tobacco use. alcohol abuse ocular corticosteroid therapy sunlight exposure 132- All of the following are consistent with normal age related vision changes except: need for increased illumination. increasing sensitivity to glare. washing out of colors gradual loss of peripheral vision 133- A nurse practitioner (NP) is considering a possible drug regimen for an 80-year-old patient who reports being forgetful. To promote adherence to the regimen, the NP should: select drugs that can be given once or twice daily. provide detailed written instructions for each medication. order medications that can be given on an empty stomach. instruct the patient to take a lower dose if side effects occur. 134- A 75-year-old patient who lives alone will begin taking a narcotic analgesic for pain. To help ensure patient safety, the NP prescribing this medication should: assess this patient's usual sleeping patterns. ask the patient about problems with constipation. obtain a baseline creatinine clearance test before the first dose. perform a thorough evaluation of cognitive and motor abilities. 60 Macrolide. Cephalosporin. Fluoroquinolone Penicillin. 61 142- Physical examination findings in otitis externa include: Tympanic membrane immobility. Increased ear pain with tragus palpation. Tympanic membrane erythema. Tympanic membrane bullae. 143- Diagnostic approaches commonly used to identify malignant otitis externa include all of the following except: CT scan. X-ray imaging. Radionucleotide bone scanning. Gallium scanning 144- Expected findings in Acute Otitis Media (AOM) include: Prominent bony landmarks. Tympanic membrane immobility. Itchiness and crackling in the affected ear. Submental lymphadenopathy. 145- A 45 year old man presents to the clinic with otitis externa. Likely causative pathogens include all of the following except: Fungal agents P. aeruginosa S. aureus M. catarrhalis 146- All of the following are consistent with normal age-related vision changes EXCEPT: Need for increased illumination Increasing sensitivity to glare Washing out of colors A gradual loss of peripheral vision 147- Tinnitus is a Perception of abnormal hearing or head noises, and its prevalence increases with age. True Fals e 148- Which of the following best describes hearing loss associated with 62 presbycusis? rapidly progressive, often asymmetric, and in all frequencies 65 Nail hypertrophy. Brittle nails. Fingernails respond more readily to therapy than toenails. 155- The use of lindane (Kwell) to treat scabies is discouraged because of its potential for: Hepatotoxicity. Neurotoxicit y. Nephrotoxicit y. Pancreatitis. 156- Which of the following do you expect to find in the assessment of the person with urticarial? Eosinophilia. Low erythrocyte sedimentation rate. Elevated thyroid-stimulating hormone level. Leukopenia. 157- A 58-year-old woman presents with a sudden left-sided headache that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, and the eyeball is firm. The vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely diagnosis is: unilateral herpetic conjunctivitis open-angle glaucoma angle-closure glaucoma Anterior uveitis. 158- When caring for a patient with angle-closure glaucoma, the most appropriate next action is: prompt referral to an ophthalmologist to provide analgesia and repeat the evaluation when the patient is more comfortable to instill a corticosteroid ophthalmic solution To patch the eye and arrange for follow-up in 24 hours. 159- What are the most common causes of dry eyes? Decreased tear production. Increased tear evaporation. Imbalance in tear composition. Laser eye surgery. All are corrects. 66 160- The Rinne test is able to test for and distinguish between conductive hearing loss (CHL) and sensorineural hearing loss (SNHL), while the Weber test assesses for the presence of CHL only. True 67 False 161- A 19 year old 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): bacterium . virus. allergen. injury 162- Characteristics of onychomycosis include all of the following except: It is readily diagnosed by clinical examination. Nail hypertrophy. Brittle nails. Fingernails respond more readily to therapy than toenails. 163- The use of lindane (Kwell) to treat scabies is discouraged because of its potential for: Hepatotoxicity. Neurotoxicit y. Nephrotoxicit y. Pancreatitis. 164- Which of the following do you expect to find in the assessment of the person with urticarial? Eosinophilia. Low erythrocyte sedimentation rate. Elevated thyroid-stimulating hormone level. Leukopenia. 165- Which of the following is the best treatment option for cellulitis when risk of infection with a methicillin-resistant pathogen is considered low? Dicloxacillin. Amoxicillin. Metronidazol e. Trimethoprim-sulfamethoxazole. 166- Which of the following statements is most accurate regarding cellulitis? Insect bites, abrasion, or other skin trauma can be the origin of cellulitis. Cellulitis most often occurs on the chest and abdomen. Necrosis is a common complication of cellulitis. 70 173- A 78-year-old resident of a long-term care facility complains of generalized itchiness at night that disturbs her sleep. Her examination is consistent with scabies. Which of the following do you expect to find on examination? 71 Excoriated papules on the interdigital area Annular lesions over the buttocks Vesicular lesions in a linear pattern Honey-colored crusted lesions that began as vesicles 174- When advising the patient about scabies contagion, you inform her that: Mites can live for many weeks away from the host. Close personal contact with an infected person is usually needed to contract this disease. Casual contact with an infected person is likely to result in infestation. Bedding used by an infected person must be destroyed. 175- First-line treatment of impetigo with less than 5 lesions of 1-2 centimeters in diameter on the legs in a 9-year-old girl is: Topical mupirocin. Topical neomycin. Oral cefixime. Oral doxycycline 176- You see a 28-years old man who is having an anaphylactic reaction following a bee sting and is experiencing trouble breathing. Your initial response is to administer: Oral antihistamine. Injectable epinephrine. Supplemental oxygen. 177- An impetigo lesion that becomes deeply ulcerated is known as: Cellulitis. Erythema. Ecthyma. Empyema. 178- Jason is a healthy 18-year-old who presents for primary care. According to his immunization record, he received two dose of HBV vaccine 1 month apart at age 14 years. Which of the following best describes his HBV vaccination needs? He should receive a single dose of HBV vaccine now. A three-dose HBV vaccine series should be started during today's visit. He has completed the recommended HBV vaccine series. He should be tested for HBsAb and further immunization recommendations should be made according to the best results. 72 179- For which of the following patients should an NP order varicella antibody titers? A healthcare worker who reports having had varicella as a child 75 Checking FEV1 (force expired volume at 1 second) to FVC (forced vital capacity) ratio. Ordering fecal occult blood test (FOBT). 186- Which of the following is an example of a primary prevention activity in a 76- year-old woman with osteoporosis? ensuring adequate illumination in the home bisphosphonate therapy calcium supplementation use of a back brace 187- Tertiary prevention measures for a 69 years-old woman with hearth failure include: Administering pneumococcal vaccine. Adjusting therapy to minimize dyspnea. Surveying skin for precancerous lesions. Reviewing safe handling of foods. 188- A middle age man with chronic obstructive pulmonary disease who is about to receive injectable influenza vaccine should be advised that: It is more than 90% effective in preventing influenza. Its use is contraindicated in the presence of psoriasis vulgaris. Localized reactions such as soreness and redness at the site of the immunization is fairly common. A short, intense, flu-like syndrome typically occurs after immunization. 189- A woman who is pregnant and is planning to breastfeed tells the primary care NP that she has never had chickenpox. The NP should: administer the Varivax vaccine today. administer the varicella-zoster immune globulin. recommend the Varivax vaccine as soon as possible after her baby is born. instruct her to receive the Varivax vaccine after her baby has been weaned. 190- Risk associated with chronic hepatitis B include all of the following, except: Hepatocelular carcinoma. Cirrhosis. Continued infectivity. Systemic hypertension 191- The primary care NP performs a physical examination on an 89-year-old patient who is about to enter a skilled nursing facility. The patient reports having had 76 chickenpox as a child. The NP should: obtain a varicella titer. administer the Varivax vaccine. 77 give the patient the Zostavax vaccine. plan to prescribe Zovirax if the patient is exposed to shingles. 192- Which of the following is usually viewed as the most cost-effective form of healthcare? Primary prevention Secondary prevention Tertiary prevention Cancer-reduction measures 193- Which of the following products provides passive immunity? hepatitis B immune globulin (HBIG) measles, mumps, and rubella (MMR) vaccine pneumococcal conjugate vaccine live attenuated influenza vaccine (LAIV) 194- Which of the following should not receive vaccination against influenza? a 4-month-old infant who was born at 32 weeks of gestation a 28-year-old woman who is breastfeeding a 2 week old. a 24-year-old woman who is 8 weeks pregnant a 19-year-old with a history of hive-form reaction to eating eggs 195- The primary care NP sees a 5-year-old child for a prekindergarten physical examination. The child's parents do not have immunization records, and a local record search does not provide proof of vaccinations, although the parent thinks the child may have had some vaccines several years ago. The NP's initial action will be to: perform serologic tests for measles, rubella, and tetanus antigens. administer TdaP, MMR, Varivax, PCV13, hepatitis A, hepatitis B, and IPV vaccines. administer DTaP, Hib, hepatitis A, hepatitis B, MMR, Varivax, IPV, RV, and PCV13 vaccines. ask the parent to look for immunization records and schedule an appointment for vaccines when those are found. 196- The primary care NP sees a 6-month-old infant for a routine physical examination and notes that the infant has a runny nose and a cough. The parents report a 2-day history of a temperature of 99° F to 100° F and two to three loose stools per day. Other family members have similar symptoms. The infant has had two sets of immunizations at 2 and 4 months of age. The NP should: administer the 6-month immunizations at this visit today. schedule an appointment in 2 weeks for 6-month immunizations. 80 203- At least how many months apart should hepatitis A doses of vaccines be administered? 81 At least 1 month apart At least 3 months apart At least 6 months apart At least 12 months apart 204- Sharon, age 16, has just received her first meningococcal conjugate vaccine. How long should she ideally wait before receiving the booster dose? Eight weeks Six months One year The patient does not require a booster dose. 205- When treating a child prone to seizures, a nurse practitioner should primarily keep which childhood anatomical feature in mind? Smaller circulating blood volume Large tongue compared to the oropharynx A thin cranium Large head in comparison to body proportion 206- A newborn is born weighing 9 lb. After 2 weeks, what would be the expected weight of the newborn? Eight lb Eight lb 5 oz Nine lb Nine lb 10 oz 207- Kasey, age 7 months, is brought to the clinic by her concerned parents. They have been talking to other parents in their parenting group and need reassurance that Kasey is keeping up developmentally. As you observe Kasey, you notice that she responds to her name, consistently babbles, crawls around on the floor, and is able to pick up objects. Which of the following additional milestones would also be expected in a child her age? Supports weight on feet Holds head steady Equal coordination of hands Plays independently 208- Isaac, age 6 months, has been brought to your practice by his parents for a routine check-up. As you enter the interview phase, you would know all of these methods would be well-suited for the interview except: Carefully phrasing potential health and safety concerns to respect the cultural practices 82 of Isaac's parents 85 Coarctation of the aorta Tetralogy of Fallot Pulmonary stenosis 214- Which of the following diagnostics is likely to indicate a diagnosis of rheumatic fever? Electrocardiogram Aldosterone level Echocardiogra m Throat culture 215- How would you best auscultate to confirm a venous hum? Have the patient lay supine; auscultate the left upper sternal border. Have the patient stand; auscultate between the left lower sternal border and the apex. Have the patient sit up; auscultate the right upper sternal border. Have the patient turn his or her head; auscultate the apex. 216- What feature best distinguishes the characteristic murmur of patent ductus arteriosus? A holosystolic thrill at the left lower sternal border A "machinery" noise at the left upper sternal border An ejection murmur with radiation to the left interscapular area A click at the left upper sternal border that decreases with inspiration and increases with expiration 217- Which of these heart sounds would most strongly indicate a cardiac disorder in a pediatric patient? S 1 S 2 S 3 S 4 218- Key immunizations to offer during adolescence include all the following except: Meningococcal Measles, mumps, and rubella Tetanus, diphtheria, and attenuated pertussis Human papillomavirus 219- As a nurse practitioner, you know that the eating disorder mortality rate is about 86 10% but that a complication from the eating disorder, and not the eating disorder itself, is frequently listed as the cause of death. Which cause of death is most likely to be listed as the cause of an individual who dies from an eating disorder? Asphyxia Organ failure 87 Anemia Dehydration 220- A Tanner sexual maturity rating of 3 in a male indicates which of the following? A penis that is adult in shape and appearance with adult pattern pubic hair A rough, red scrotum with sparse, fine pubic hair An elongated penis with darker, curlier pubic hair Development of glans and rugae on the penis and curly, sparse pubic hair 221- Which type of diet practiced by adolescents warrants the closest monitoring by parents? Vegetarian High- protein Lactose- free Pescetaria n 222- When implementing the Guidelines for Adolescent Preventive Services in a Well Child Check with a 16-year-old female, which piece of information would you be most likely to share with her parent? She mentions that she is depressed and wonders if life is worth living. She had unprotected sex with her boyfriend last month and is late for her period. She has three best girlfriends and they have all started experimenting with marijuana. She thinks her mother's new boyfriend is "creepy. 223- The acronym SAFETEENS provides a checklist of preventive care topics for nurse practitioners. Going by this checklist, which of the following is not a significant concern in preventive care? Sexual abstinence Suicide School performance Involvement in hobbies 224- After which Tanner stage do males usually begin spermarche or nocturnal emissions? Stage 1 Stage 2 Stage 3 Stage 4 90 Molars Incisor s 91 Canines 232- All of the following are school age fears the nurse practitioner should expect when interviewing a child: Pain Death Isolatio n Loss of control 233- During a physical exam on a 17-year-old female, you note a sore throat, parotid gland enlargement, and dental erosion. You begin to suspect a possible eating disorder. Which of the following findings would most strongly indicate bulimia nervosa in this patient? Amenorrhe a Russell's sign Lanugo Thinning hair 234- A 3-year-old male patient presents for a well-child checkup. While interviewing his parents, you learn that the patient's family comes from a workingclass neighborhood in downtown Los Angeles. All of the following laboratory exams are especially indicated at this age except: Hemoglobin and hematocrit Vitamin D level Cholester ol Lead level 235- At what age does taking a blood pressure reading usually become a part of a child's physical examination? At 2 years At 3 years At 4 years At 5 years 236- Which of the following values most likely indicates the normal visual acuity of a 5-year-old child? Vision is 20/80 Vision 92 is 20/50 Vision is 20/30 Vision is 20/20 237- A concerned father says that his daughter recently turned 5 years old, and he has noticed she is beginning to stutter. The nurse practitioner tells the father that his daughter's condition is probably normal, but you will be watching with him to see if it persists or if she avoids speaking. As 95 exam that is commonly performed in conjunction with the exam you are performing on your patient? Klisic Barlow Ortolani' s Galeazzi 243- What is the name of the condition in which the foreskin is not retractable over the tip of the penis? Epispadias Chordee Hypospadias Phimosis 244- You are consulting a mother who is worried about her 8-month-old male infant. She states that he has a fever, and she wants to give him ibuprofen. You recommend giving him 90 mg of ibuprofen every 6 hours. Based on the above treatment guidelines, what is the most likely weight of this infant? 7.5 kg 8.18 kg 9 kg 10 kg 245- Johnny, age 3, is brought into the clinic by his parents, who state that he has been unable to perform certain skills that he used to be able to perform. They also say that his ability to use language has started to deteriorate, and he does not want to play with the other children at school. Which of the following conditions would be the most likely diagnoses? Autistic disorder Asperger's syndrome Rett's disorder Childhood disintegrative disorder 246- By what age would not knowing what to do with common objects be first considered a developmental delay? At 1 year At 2 years At 3 years At 4 years 96 247- Dan and Kara bring their toddler son, Ian, to your office because they are worried about his feeding habits. They explain that they still have to feed him because he is unable to use utensils- 97 even a spoon-on his own. As the practitioner, you know that at what earliest age would Ian have to be for this issue to be a developmental concern? Twelve months old Fifteen months old Seventeen months old Twenty months old 248- Two 2 year olds are playing in a sandbox. They are both scooping and pouring sand, occasionally glancing over at each other but not interacting. How would the nurse practitioner best characterize this type of play? This behavior is abnormal, as by now they should want to play together. These children are participating in associative play, which is not expected in this age group. This behavior demonstrates parallel play, which is common in this age group. This is active play and is typical in this age group. 249- What is the average age by which toddlers achieve daytime control of bowel and bladder movements? By 18 months of age By 2 years of age By 2.5 years of age By 3 years of age 250- According to the normal stage of primitive reflex development, which of the following reflexes is expected to nQ1 disappear by about 12 months of age? The head turning towards anything that strokes the cheek or mouth The arms spreading or contracting in response to loss of balance Sucking in response to objects touching the roof of the mouth Toes fanning out in response to stroking of the sole 251- Which of the following standardized tests may be performed by parents with no formal training? Denver Developmental Screening Test II Ages and Stages Questionnaire Bayley Scales of Infant Development Newborn Behavioral Assessment Scale 252- A 9-month-old infant presents to the clinic fussy, with decreased appetite and a fever of 102.3