FNP Board Review: Bits and pieces
Terms in this set (90)
Primary prevention measures include:
activities provided to individuals to prevent the onset or acquisition of a given disease. to spare individuals suffering, burden and cost associated with a clinical condition
Examples of primary prevention:
education, use of car restraints, fall prevention education, immunizations
Active immunization through use of
Passive immunization through the use of
immune globulin (only provides temporary protection)
Secondary prevention measures:
include activities provided to identify and treat symptomatic persons who have risk factors for a given disease or in preclinical disease
examples of secondary prevention include:
screening examinations for a given disease or in
Cervical exam, pap smear
If anaphylactic reaction history is to Neomycin avoid the immunization:
IPV, MMR, Varicella
If anaphylactic reaction history is to streptomycin, polycyxin B, neomycin avoid the immunization:
IPV, Vaccinia (small pox)
If anaphylactic reaction history is to Baker's yeast avoid the immunization:
If anaphylactic reaction history is to egg avoid the immunization:
Influenza vaccine (nasal spray, injected)
If anaphylactic reaction history is to gelatin avoid the immunization:
With HIV infections, live virus vaccines usually not given with:
CD4 T lymphocyte cell counts less than 200 cell/uL.
A 6-month-old infant is brought to the clinic for a well-child visit. The developmental assessment should include evaluation of the infant's ability to:
a. Pick up small objects with the thumb and forefinger.
b. Say "no-no" and "bye-bye."
c. Sit up, with and without support.
d. Pull-up to a standing position.
sit up, with and without support
A 15-year-old female comes in for routine treatment of acne vulgaris. She has been using benzoyl peroxide facial scrubs with no improvement. Numerous open and closed comedones are seen on exam, as well as numerous papules and a few pustules. No cysts or scarring are noted. The preferred treatment regimen would be:
a. Isotretinoin (Accutane) in the morning and minocycline hydrochloride (Minocin) 100 mg b.i.d.
b. Erythromycin 1% gel (E-Mycin) gel in the morning and 0.025% tretinoin (Retin-A) cream at bedtime
c. Tretinoin (Retin-A) 1% cream at bedtime
d. Oral erythromycin 250 mg t.i.d.
erythromycin 1% gel (E-mycin) gel in the morning and 0.025% tretinoin (retin-A) cream at bed time
The differential diagnosis of gastroesophageal reflux (GERD) in an infant (> 2 months old) would include all of the following except:
b. Hirschsprung's disease
c. Urinary tract infection
Hirschprung's disease presents with constipation and abdominal dissension rather than vomiting or spitting up
A 62-year-old nulliparous diabetic female presents with complaint of watery vaginal discharge without itching or irritation. You notice no discharge, erythema, or lesions on pelvic exam. Your initial work-up should include all except:
a. Microscopy with KOH for fungal elements and spores
b. CA 125
c. Pap smear and transvaginal ultrasound
d. Microscopy for clue cells
Pap smear and transvaginal ultrasound.
An older patient is taking carbidopa-levodopa (Sinemet) for Parkinson's disease. He develops depression. Which of the following medications to treat depression would be contraindicated for this patient?
a. Monoamine oxidase inhibitor (MAOI)
b. Serotonin selective reuptake inhibitor (SSRI)
c. Tricyclic antidepressant
monoamine oxidase inhibitor.
these are contraindicated in combination with levodopa
A mother brings her 2-year-old child in for a sick visit. The child's face looks as though it has been slapped. What is the most likely cause?
a. High fever
c. Fifth's disease
slapped cheek appearance with a sick appearing child is likely to be Fifth's disease
A 10-year-old boy complains of a sore throat, fever, and fatigue for 2 days. Findings include pharyngitis, anterior cervical adenopathy, and an oral temperature of 101.6 ° F (38.6 ° C). Which of the following tests should be ordered at this time?
a. Antistreptolysin O titer
b. Cytomegalovirus titer
c. Culture for streptococcal infection
d. Monospot and complete blood count
Culture for streptococcal infection
this can be used instead of or in combination with quick strep test
Initial symptoms of acute glomerulonephritis most commonly seen by the clinician include:
a. Generalized edema and anorexia
b. Periorbital edema and hematuria
c. Fever and hypotension
d. Flank pain and pyuria
periorbital edema and hematuria
Latoya, 22, presents for her annual Pap smear and mentions that she has had a yellowish, irritating vaginal discharge with dysuria and dyspareunia for 7- 10 days. If she is a reliable patient, what is generally recommended in regard to her Pap smear when an infection is present?
a. Obtain Pap smear; infectious process will not interfere with accuracy of cervical cytology results.
b. Assess and treat for infectious process first and defer Pap smear for 3- 6 months.
c. Treat infectious process and refer for colposcopy to assess for cervical pathology.
d. Obtain Pap smear and cultures for sexually transmitted infections; await results before treating.
Assess and treat for infectious process first and defer Pap smear for 3- 6 months.
(pap smear more likely to be accurate after inflammatory process has been cleared)
How often should blood levels of anticonvulsant medications be routinely checked for a patient with a clinically controlled seizure disorder?
a. Every 3 months
c. When adjusting dosage and there has been a change in seizure frequency
d. If neurologic sequelae appear, such as intention, facial tics, or slurred speech
When adjusting dosage and there has been a change in seizure frequency
Which of the following statements indicates a client's understanding of what should be done to care for the client's diabetes mellitus when he or she is ill?
a. "I should take my usual dose of insulin."
b. "I should avoid eating sweets, especially when I'm sick."
c. "I should check for ketones if my blood sugar is over 150."
d. "I should alter my regular insulin, but take my usual NPH insulin."
"I should take my usual dose of insulin."
Which of the following statements about Duvall's theory of the stages in family development is true?
a. The stages cannot overlap.
b. The stages are based on the age and school placement of the firstborn child.
c. There are four stages.
d. Marriage is strongest during the fourth stage.
The stages are based on the age and school placement of the firstborn child.
The family nurse practitioner has just diagnosed a 27-year-old with Lyme disease. What is the appropriate management?
a. Bactrim 400 mg b.i.d. for 14- 21 days
b. Amoxicillin 100 mg t.i.d. for 10 days
c. Doxycycline 100 mg b.i.d. for 14- 21 days
d. Keflex 500 mg q.i.d. for 14 days
Doxycycline 100 mg b.i.d. for 14- 21 days
You examine a patient you suspect has a meniscus injury. To assess for this injury, you examine the patient supine and the knee fully flexed. The tibia is externally rotated and mild varus or valgus stress is placed on the knee. This test is called:
a. Lachman's test
c. Anterior drawer
d. Thompson test
Mc Murray test
used to check for injury to the meniscus
A 12-year-old boy is brought in by his parents for increasing behavior problems in school and in the neighborhood. Which of the following descriptions would prompt your referral for a possible conduct disorder?
a. Disregards the rights of others b. Shows remorse for misconduct c. Easily distracted, forgetful, does not complete tasks
d. Mood swings, agitation, restlessness
Disregards the rights of others
this is characteristic of conduct disorder
You order a PPD on a 7-year-old who has a parent with suspected TB. The PPD result is 7 mm in duration. Your treatment plan is:
a. Counsel family about TB and repeat PPD in 3 months.
b. Order a chest x-ray (CXR) and begin medication if CXR is suggestive of pulmonary disease. c. Order a chest x-ray (CXR) and refer patient to begin treatment with INH.
d. Begin INH.
Order a chest x-ray (CXR) and begin medication if CXR is suggestive of pulmonary disease.
(because child is a close contact of someone who may have TB, induration >5 is considered positive PPD
A 12-year-old male with a recent history of otitis media presents with 1 day of acute right facial weakness, including flattening of the forehead furrows, inability to completely close the ipsilateral eye, flattening of the nasolabial fold, and drooping of the mouth. What is the most likely diagnosis?
a. Bell's palsy
b. Acoustic neuroma
c. Recurrence of otitis
d. Trigeminal palsy
(it affects the motor branch of the facial nerve, altering facial movements)
Which of the following helps you differentiate croup from bronchiolitis?
b. Presence of fever
(Croup affects children 7 months - 3years; bronchiolitis is a disease of infants, newborns to 2 years, with peak incidence at 6 months, both have little or no fever, can cause tachypnea and can cause wheezing.
During a clinic visit, a woman known to rely on advertising claims for a wide variety of alternative therapies tells the family nurse practitioner that her husband is limiting his daily fluid intake to one glass of liquid to keep from passing blood in his urine. Which of the following responses by the nurse practitioner would be most appropriate?
a. "Your husband can become dehydrated with small amounts of fluid."
b. "Your husband needs to be seen for a kidney evaluation as soon as possible."
c. "Tell me how you think this is helping your husband."
d. Nothing, because the family nurse practitioner does not see the woman's husband.
"Tell me how you think this is helping your husband."
(this response validates that you understand what she believes but need to understand more why this makes sense to her. It opens communication that may lead to a therapeutic intervention.)
Initial treatment for lateral epicondylitis includes all of the following except:
b. Tennis elbow band
c. Cortisone injection
d. Physical therapy
(The initial treatment doesn't include using a cortisone injection in the area. This is considered a second line treatment)
In a female with vitamin B12 deficiency, you would expect which laboratory profile?
a. Hgb 10.6, MCV < 80
b. Hgb 10.6, MCV > 100
c. CBC normal between episodes of hemolysis
d. Decreased hgb and hct, normal MCV
Hgb 10.6, MCV >100
(this is macrocytic anemia as in B12 deficiency)
A sexually active patient with multiple partners presents with fever, adenopathy, rash, myalgias, headache, pharyngitis, and hepatosplenomegaly. You suspect:
b. Primary herpes simplex, type 1 infection
c. Disseminated gonorrhea
d. Primary HIV infection
Primary HIV infection
Which of the following liver function tests would you expect to be elevated in the presence of bone disease?
a. GGT (gamma-glutamyl trans peptidase)
b. ALT (alanine aminotransferase) c. Amylase
d. ALP (alkaline phosphatase)
ALP (alkaline phosphatase)
(this is found in liver, intestine, bone and placenta. It elevates in bone diseases such as bony metastasis and Paget's disease)
Jane, a 35-year-old corporate lawyer, presents with a 3-month history of abdominal pain, bloating, a stool pattern that varies from constipation to frequent loose stools over the course of the week, and occasional blood on the toilet paper, especially on days when she strains to eliminate stool or has several diarrhea-type stools. What is your diagnosis?
a. Crohn's disease
b. Irritable bowel syndrome
c. Acute gastroenteritis
d. Ulcerative colitis
Irritable Bowel Syndrome
(these are classic symptoms of IBS)
Medicare part A pays for which of the following services?
a. Outpatient services
b. Inpatient services
c. Homecare services
d. Prescription services
You discover the practice you have recently joined plans to bill your services as "incidental to." You are aware that:
a. Payment would be at 85% of the physician fee.
b. This type of billing can only be used in a rural setting.
c. This type of billing can only be used in a hospital setting.
d. This would be Medicare fraud, as you are the only provider in the office.
This would be medicare fraud, as you are the only provider in the office
(incident to billing allows for 100% of physician fee if all criteria are met. Location does not have an impact on "incident to" billing.)
You have just graduated from your NP program and are investigating malpractice insurance. You are aware that there are several different types of coverage. You select a policy that covers any claim that results from an incident that occurs during the term of the policy, regardless of how long it takes before the claim is made. This is referred to as a: a. Claims made policy
b. Tail policy
c. Occurrence policy
d. nurse practitioner policy
(covers any claim that results from an incident during the term of the policy regardless of how long it takes before the claim is made)
The cost common prescription drug- herb interaction occurs with herbal preparations and:
b. Ace inhibitors
d. Oral diabetes agents
(the most common prescription drug-herb interaction is between Warfarin and a variety of common herbal products, including garlic, gingko, and St. Johns' wort)
Legislative authority for nurse practitioner practice is regulated by:
a. The professional certifying organization, with a vote of the membership
b. The board of medicine in each state jurisdiction, with consent of the board of nursing
c. A legally designated authority that implements regulations such as state boards of nursing
d. The federal government's Bureau of the Health Professions
A legally designated authority that implements regulations such as state boards of nursing
(authority for NP practice is found in state legislative statutes and in rules and regulations)
A 65-year-old male presents with the following complaints for the past 6 months: difficulty starting/ stopping stream of urine, hesitancy, dribbling, weakening force/ size of stream, and sensation of full bladder after urinating. He reports his symptoms are worsening, causing him to wake up 2- 3 times per night to urinate. Patient is afebrile. Digital rectal exam reveals: prostate gland is non-tender, firm, smooth, and rubbery. Symmetrical enlargement with obliteration of midline median sulcus is noted. These symptoms are consistent with which urologic condition?
a. Prostate cancer
c. Benign prostatic hyperplasia
d. Acute bacterial prostatitis
benign prostatic hyperplasia
Of the following, the test of choice for screening pregnant women at 26 weeks for gestational diabetes is: a. 3-hour GTT following a 100 g glucose load b. Hemoglobin A1 C c. Random serum screen d. Serum screen after a 50 g glucose load
serum screen after a 50 g glucose load is current standard diagnostic
All of the following provide quick relief of after-birth uterine pain for a multiparous woman in the postpartum period except:
b. Empty bladder
c. Prone position
d. Suckling of the newborn
suckling of the newborn
(this would increase uterine pain as suckling stimulates the uterus to contract)
At 34 weeks' gestation, a woman presents to the clinic, stating: "I have bloody fluid leaking from my vagina today." She is not experiencing any other symptoms. Initial management would include all of the following except:
a. Digital examination to determine cervical dilatation
b. Speculum exam to view the cervix
c. Microscopy exam to determine vaginal ferning
d. Ultrasound determination of amniotic fluid volume
digital examination to determine cervical dilatation
(never insert finger blindly into the vagina when a pregnant patient reports vaginal bleeding as this action could rupture membranes or perorate a potentially prolapsed placenta.
A woman who is Rh negative is given Rh-immune prophylaxis during this pregnancy. She should be advised that, for future pregnancies, she will:
a. Be tested with each subsequent pregnancy b. Not need future testing
c. Only be tested if this baby is Rh positive
d. Only be tested if this baby is Rh negative
be tested with each subsequent pregnancy
A 38-year-old Black woman presents for her first prenatal visit at 10 weeks. Her blood pressure is 144/ 98. A repeat BP is 146/ 100. She has trace amounts of protein in her urine and says her rings feel tight. Your initial clinical impression would be:
a. Chronic hypertension
b. Chronic hypertension with superimposed preeclampsia
d. Normotensive for the first trimester
(it is too early to develop preeclampsia and the blood pressure readings are note notrmotensive)
You are prescribing ferrous sulfate for a patient with iron deficiency anemia. Which of the following is an appropriate patient instruction?
a. Take the ferrous sulfate with other medications.
b. Take the ferrous sulfate with meals.
c. Take on an empty stomach.
d. Do not take with vitamin C.
Take on an empty stomach
(this increases absorption)
In evaluating a CBC, the earliest laboratory abnormality in iron deficiency anemia is:
a. Low platelet count
b. Low MCH
c. Low hemoglobin level
d. Increased RDW
(Red cell distribution width or RDW is a parameter that measures variation in red blood cell size or red blood cell volume.)
Mr. C is a 77-year-old patient who presents for his annual checkup; PMH includes COPD, HTN, and anemia. You diagnose anemia of chronic disease. Anemia of chronic disease is which type of anemia?
(anemia of chronic disease is normocytic anemia)
A common physical exam finding in patients with pernicious anemia includes:
b. Decreased reflexes
c. Retinal hemorrhages
d. Beefy-red, shiny tongue
beefy-red, shiny tongue
A 24-year-old woman of Asian descent presents for evaluation. She has no complaints. Her CC results are HgB: 9.1 g; hct: 28%; RBC: 6 million; MCV: 68 fl; RDW: 13%. The most likely diagnosis is:
a. Vitamin B12 deficiency
b. Alpha-thalassemia minor
c. Anemia of chronic disease
d. Fanconi anemia
(usually asymptomatic, with high prevalence in persons originating from south east asia.)
The cause of pernicious anemia is:
a. RBC enzyme deficiency
b. Dietary deficiency of vitamin B12
c. A combination of micronutrient deficiencies caused by malabsorption
d. Lack of production of intrinsic factor by the gastric mucosa
lack of production of intrinsic factor by the gastric mucosa
The expected change in visual fields in a patient with glaucoma is:
a. Loss of central vision
b. Enhanced peripheral vision
c. Loss of peripheral vision
d. Enhanced central vision
loss of peripheral vision
A 2-year-old girl is brought to the clinic by her grandmother for a runny nose with unilateral greenish drainage and a low-grade fever for 2 weeks with decreased appetite for the last week. Which physical finding would be particularly worrisome and indicate the need for further evaluation?
b. Unilateral nasal drainage
c. Sporadic, loose cough
d. Decreased appetite
unilateral nasal drainage
(any patient with unilateral nasal drainage should be evaluated for a foreign body in the nares, including tumors, as URI symptoms will produce bilateral nasal drainage)
To help differentiate an S3 from other heart sounds, the family nurse practitioner listens closely to identify its timing. At what point in the cardiac cycle does S3 occur?
a. Early systole
b. Late systole
c. Early diastole
d. Late diastole
(S4 is heard late in diastole)
The six cardinal positions of gaze-testing Extraocular movements involve what cranial Nerves?
III, IV, & VI
III is oculomotor: eyelid movement, rotating eyeball,
IV is trochlear: handling of eye muscles & turning
the eye, motor
VI is abducens: Turns the eye laterally: motor
What is Bruckner's test?
useful for detecting strabismus.
20 inches away from child in darkened room, looks at both eyes through ophthalmoscope and notes symmetry of red reflexes bilaterally
When should a child with strabismus be referred?
immediately to an ophthalmologist
What is the most common intraocular tumor of childhood?
can be unilateral or bilateral
What is leukocoria?
"Cat's eye reflex" White pupil seen when observing for red reflex. Noted with retinoblastoma
What are the common causative organisms of conjunctivitis?
infants: chylamydia trachomatis & neisseria gonorrhoeae
adult: staph aureus
can also be viral, allergic, non specific, irritative, & autoimmune
What are rare causes of conjunctivitis?
Fungal, parasitic, TB, syphilis, kawasaki disease, gout, Graves disease, psoriasis, Steven's johnson syndrome or Reiter syndrome
What is open angle glaucoma?
most common form in US 90% of all cases; optic neuropathy with progressive peripheral visual field loss followed by a central field loss usually (not always) in the presence of elevated intraocular pressure; can be primary or chronic; painless
What is angle-closure glaucoma (aka acute or narrow angle glaucoma)?
Narrowing or closure of the anterior chamber angle resulting in aqueous humor drainage, leading to elevated intraocular pressure and damage to the optic nerve. severe pain
What is a cataract?
progressive, painless clouding (opacity or discoloration) of the lens of the eye resulting in localized or generalized partial vision loss and blindness. Leading cause of blindness worldwide
90% due to aging
when is screening for cataracts done?
What is Hyphema?
Hemorrhage into the anterior chamber of the eye, can result in permanent vision loss
What is mitosis?
Types of hearing loss
What is conductive hearing loss
decreased hearing via air conduction, common in children
What is sensorineural hearing loss
bone conduction is impaired, malfunction of cochlea (cochlear portion of Cn VIII) common in elderly
What is presbycusis?
Hearing loss due to the aging process, non pathologic, high frequency hearing loss
acute otitis medial incidence
Predominant age: 6-24 months; declines >7 years; rare in adults. Male>females. increased incidence in fall and winter months
otitis media with effusion incidence?
Nearly 90% of children age 6 months to 4 years have at least one episode
CDC guidelines for antibiotic therapy with acute otitis media?
amoxicillin 80-90 mg/kg/day in divided doses x 5-7 days for children > 2 years with no complications
and a 10 day course for children <2 years
adult: 500 mg po 3xs daily
what is atopy?
the genetic tendency to develop classic allergic diseases
non sedating antihistamines are?
What causative agent that might lead to pharyngitis is of the greatest concern?
Group A beta-hemolytic streptococcus: potential of rheumatic sequelae (scarlet fever, rheumatic fever, glomerulonephritis)
What is the most common bacterial cause of pharyngitis?
Group A streptococcus
A 22-year-old male with history of undescended testicles presents for his first adult health maintenance examination. You will make all of these recommendations except:
a. Self testicular exam and annual clinical exam to detect testicular cancer
b. DRE and PSA level every 3- 5 years for early detection of prostate cancer
c. Use of condoms if sexually active, to prevent unintended pregnancy and sexually transmitted infection
d. BP check every 2 years to detect hypertension
DRE and PSA level every 3- 5 years for early detection of prostate cancer
(this is not recommended at age 22)
A 68-year-old man with chronic obstructive pulmonary disease (COPD) has continuous symptoms with FEV1 at 60% normal. Which medications should be considered for initial treatment?
d. An anticholinergic
A patient with a positive DNA probe test for chlamydia has no medication allergies, is on no medications, and had an LMP 3 weeks ago. You will treat her with:
a. Azithromycin 1 g p.o. in a single dose
b. Bactrim DS bid for 14 days
c. Nothing until pregnancy can be ruled out
d. Metronidazole gel 0.75% intravaginally b.i.d. for 5 days
Azithromycin 1 g p.o. in a single dose
(first line treatment and ensures compliance)
Acute otitis media can be distinguished from otitis media with effusion by:
a. Hearing loss with ear popping and crackling b. Otalgia and decreased mobility of tympanic membrane
c. Temporomandibular joint pain
D. eustachian tube obstruction
Otalgia and decreased mobility of tympanic membrane
(this occurs with otitis media note with otitis media with effusion)
A patient complains of burning during urination, frequency, and urgency. The patient's history reveals that she has recently become sexually active and is on oral contraceptives. A urine dipstick reveals leukocyte esterase and nitrite. The best course of action is to perform a pelvic exam and obtain vaginal cultures to rule out vaginitis and cervicitis followed by:
a. Placing the patient on amoxicillin 250 mg 4 times a day for 14 days
b. Placing the patient on nitrofurantoin (Macrodantin) 100 mg 4 times a day for 5 days c. Placing the patient on trimethoprim-sulfamethoxazole (Bactrim DS) 160/ 800 mg every 12 hours for 3 days
d. Obtain urine culture and sensitivity results before placing the patient on antibiotic therapy
Placing the patient on trimethoprim-sulfamethoxazole (Bactrim DS) 160/ 800 mg every 12 hours for 3 days
You diagnosed pityriasis rosea in a 12-year-old female who came to you presenting with a maculopapular scaling rash for 2 days. Upon history, her mother revealed that the patient had a large, single, bright-red patch that preceded this rash eruption by about 2 weeks. Typical additional symptoms include which of the following?
a. Fever of 102 ° F for more than 72 hours
b. Fever for 24 hours before rash, followed by rhinorrhea and cough
c. Non-pruritic rash, clear runny nose and cough
d. Absence of fever, pruritis confined to trunk and upper extremities
Absence of fever, pruritis confined to trunk and upper extremities (typical additional symptoms)
A 70-year-old man presents with anemia, recent weight loss, and heme-positive stools. He has no GI complaints. The diagnosis until proven otherwise is:
a. Ulcerative colitis
b. Peptic ulcer disease
d. Colon Cancer
(often presents in elderly in late stage with only anemia, bowel changes, heme + stools, & possible weight loss)
All of the following are symptoms of premenstrual syndrome except:
a. Difficulty concentrating
b. Psychotic episodes
c. Fatigue, lethargic
(these are not a part of PMS)
You are working in a college health clinic that offers free HIV testing. A student has had unprotected intercourse with a new partner. You advise:
a. Screening for Chlamydia and gonorrhea, and provide syphilis prophylaxis treatment
b. Review history, STI screening, HIV testing, provide hepatitis B vaccination series
c. Use of condoms for 3 months, then return for HIV testing
d. Qualitative viral RNA level to assess for HIV
Review history, STI screening, HIV testing, provide hepatitis B vaccination series
(this woman is considered high risk because of a new partner & should complete a full history, STI screening, HIV testing, and receive a Hepatitis B vaccine
The family nurse practitioner sees an active 11-year-old girl who has type I diabetes. The child plays softball and basketball, and swims on the school team. The FNP tells the child and her mother that:
a. Insulin dosing and eating patterns should not be changed during periods of frequent exercise.
b. Nocturnal hypoglycemia may occur on significantly active days.
c. Type I diabetic patients should avoid strenuous physical activity
d. Nocturnal hyperglycemia may occur on weekends
Nocturnal hypoglycemia may occur on significantly active days.
(exercise requires additional energy, so diet and insulin doses should be adjusted accordingly; nocturnal hypoglycemia may occur on days the patient is very active)