Family and Adult-Gero Nurse Practitioner Certification Questions Book (3rd Edition) Book Update
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Page
# Question
# Correct
Answer Correction
11 22 C Question is missing the following lab values:
Total Cholesterol = 240 mg/dL
LDL Cholesterol = 140 mg/dL
HDL Cholesterol = 35 mg/dL
Triglycerides = 129 mg/dL
29 11 C Question is missing the following lab values:
Total Cholesterol = 200 mg/dL
LDL Cholesterol = 120 mg/dL
HDL Cholesterol = 45 mg/dL
Triglycerides = 309 mg/dL
Glycosylated Hemoglobin (Hgb A1c) = 9.2%
135 5 B Question should read:
A male patient complains of dysuria. His urinalysis is positive for nitrites, leukocyte esterase, and bacteria. What medication should be given and for how many days?
228 53 A No corrections to rationale.
234 96 C No corrections to rationale.
235 103 C No corrections to rationale.
450
41
D
Rationale should read:
The chest circumference is not routinely measured at well-child visits, but is assessed if there is concern about the circumference of either the head or the chest. An exception to this observation can occur in premature infants where the head grows very rapidly. Normally, the head exceeds the chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24 months the head and chest circumference should be about equal and by 2 years of age the chest should be larger than the head. The chest circumference is measured at the nipple line.
59 11 C Question is missing the following lab values:
WBC = 6 thousand cells x 106uL
RBC = 4.0 x 106 cells/mL
Hemoglobin = 10.8 grams/dL
Hematocrit = 32.4%
MCV = 71.2 fL
MCH = 21 pg
260 104 B Question should read:
A 19-year-old female presents with a temp of 100.8°F and lower abdominal pain that began about 12 hours ago. She denies vaginal discharge. Which choice below is the least likely cause of her symptoms?
401 85 C Question should read:
A 19-year-old female presents with a temp of 100.8°F and lower abdominal pain that began about 12 hours ago. She denies vaginal discharge. Which choice below is the least likely cause of her symptoms?
212 105 B Question should read:
A nurse practitioner is taking care of a patient who has chronic perennial allergic rhinitis. The patient has health insurance. The NP has become aware that the patient is not using her prescribed allergy medication. Instead, the patient is giving the medication to her husband because he does not have insurance. What should the NP do?
235 105 B Rationale should read:
The nurse practitioner has an ethical duty to the prescriber/patient relationship to treat the patient accordingly. The nurse practitioner exhibits beneficence and non-maleficence by prescribing the patient the medication and getting her assurance that she will use the medication for her own symptoms. If the NP abruptly stops prescribing the medication for the patient, then maleficence and a breach of duty is evident. The patient has a diagnosis of chronic perennial allergic rhinitis of which she needs medication. The legally defensible action of the nurse practitioner is to treat the patient, educate her on the risks and benefits of the medication and the risks of sharing her medications with others. Should the NP knowingly prescribe the medication, possibly even prescribing more than is warranted to “help” the patients husband, then the NP has violated veracity, standards of practice, and ethics in prescribing and is now medically liable. The NP has now knowingly diverted medications to someone in whom an assessment and diagnosis has not been made.
348 60 C Question should read:
A nurse practitioner is taking care of a patient who has chronic perennial allergic rhinitis. The patient has health insurance. The NP has become aware that the patient is not using her prescribed allergy medication. Instead, the patient is giving the medication to her husband because he does not have insurance. What should the NP do?
373 60 C Rationale should read:
The nurse practitioner has an ethical duty to the prescriber/patient relationship to treat the patient accordingly. The nurse practitioner exhibits beneficence and non-maleficence by prescribing the patient the medication and getting her assurance that she will use the medication for her own symptoms. If the NP abruptly stops prescribing the medication for the patient, then maleficence and a breach of duty is evident. The patient has a diagnosis of chronic perennial allergic rhinitis of which she needs medication. The legally defensible action of the nurse practitioner is to treat the patient, educate her on the risks and benefits of the medication and the risks of sharing her medications with others. Should the NP knowingly prescribe the medication, possibly even prescribing more than is warranted to “help” the patients husband, then the NP has violated veracity, standards of practice, and ethics in prescribing and is now medically liable. The NP has now knowingly diverted medications to someone in whom an assessment and diagnosis has not been made.
156 54 C Question should read:
A 50-year-old non-pregnant female presents for an annual exam. She complains of fatigue and weight gain. She has the following lab results. What should the NP order next?
TSH 7 mlU/L (0.4-3.8 mlU/L)
180 54 C Rationale should read:
The patient presents with an elevated TSH as well as symptoms suggestive of hypothyroidism. In the presence of an elevated serum TSH, the next step is to repeat the TSH measurement along with a serum free T4. If the TSH remains elevated and the serum free T4 is low, this is consistent with primary hypothyroidism, and replacement therapy would be initiated. If the serum TSH is still high but the serum free T4 value is within the normal range, this indicates subclinical hypothyroidism. Replacement of T4 is generally not initiated in subclinical hypothyroidism until the TSH is > 10. There is no indication (i.e. nodule or thyromegaly) in this scenario to justify the need for a thyroid ultrasound. Hypothyroidism may be associated with an increased risk of cardiovascular disease, including hyperlipidemia. However, this would not be helpful in determining a diagnosis of hypothyroidism.
315 148 B Question should read:
A 50-year-old non-pregnant female presents for an annual exam. She complains of fatigue and weight gain. She has the following lab results. What should the NP order next?
TSH 7 mlU/L (0.4-3.8 mlU/L)
337 148 B Rationale should read:
The patient presents with an elevated TSH as well as symptoms suggestive of hypothyroidism. In the presence of an elevated serum TSH, the next step is to repeat the TSH measurement along with a serum free T4. If the TSH remains elevated and the serum free T4 is low, this is consistent with primary hypothyroidism, and replacement therapy would be initiated. If the serum TSH is still high but the serum free T4 value is within the normal range, this indicates subclinical hypothyroidism. Replacement of T4 is generally not initiated in subclinical hypothyroidism until the TSH is > 10. There is no indication (i.e. nodule or thyromegaly) in this scenario to justify the need for a thyroid ultrasound. Hypothyroidism may be associated with an increased risk of cardiovascular disease, including hyperlipidemia. However, this would not be helpful in determining a diagnosis of hypothyroidism.
278 66 D Rationale should read:
This child’s platelet count is decreased. The term used to describe this is thrombocytopenia. Acute lymphocytic leukemia (ALL) is often characterized by low platelet count and other red or white cell abnormalities. The peak incidence occurs between 2-5 years of age. The most common presenting signs of ALL are bleeding, fever, and lymphadenopathy. Idiopathic thrombocytopenia (ITP) is the most common type found in children between the ages of 2-4 years and is preceded by a recent (less than 4 weeks) upper respiratory infection. The nonblanchable rash over the joints probably represents petechiae, a common manifestation of thrombocytopenia and can be seen with both ITP and ALL. Nosebleeds and bleeding gums, especially with brushing of teeth, are also common with thrombocytopenia; however if the thrombocytopenia is mild, there may no presenting symptoms. The CBC is otherwise normal in ITP, unlike ALL. The underlying cause is unknown, hence the name idiopathic. Septic arthritis would be characterized by an elevated white count. Von Willebrand's disease (VWD) is a common autosomal dominant bleeding disorder that may include easy bruising or prolonged bleeding, but is characterized by a normal platelet count.
181 56 C Rationale should read:
A patient with meningitis may experience a positive Kernig or Brudzinski sign. A positive Kernig sign will elicit pain with knee extension when flexing the patient’s hip 90 degrees. A positive Brudzinski sign causes flexion of the patient’s hips and knees when flexing the neck. Patients who have septic bursitis or septic arthritis will not have a positive Kernig sign. HIV-positive patients are more likely to exhibit pneumonia secondary to pneumocystis infection, but he has no respiratory symptoms.
278 65 A
Rationale should read:
The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and Shigella. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. All three pathogens are identifiable with culture if present. Pts with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after exposure and will usually resolve in 5-7 days. Shigella is very contagious and is shed continuously in the stool during active illness and for weeks after symptoms have resolved. Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called bubonic plague. E. coli is a typical colonic pathogen.
423 76 D Rationale should read:
The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and Shigella. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. All three pathogens are identifiable with culture if present. Pts with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after exposure and will usually resolve in 5-7 days. Shigella is very contagious and is shed continuously in the stool during active illness and for weeks after symptoms have resolved. Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called bubonic plague. E. coli is a typical colonic pathogen.
151 28 B Question should read:
The most effective way to decrease neural tube defects is to prescribe folic acid. For a woman with normal risks, how much is needed daily prior to becoming pregnant?
101 11 D Question should read:
A pregnant patient in her second trimester is found to have positive leukocytes and positive nitrites in a second voided urine specimen. She is asymptomatic. This patient should be prescribed:
102 11 D Rationale should read:
This patient has asymptomatic bacteriuria. In pregnant women, this should be confirmed with a second voided urine before prescribing medication. Asymptomatic bacteriuria during pregnancy increase the risk of pyelonephritis and has been associated with preterm birth and low birth weight infants, as well as other negative outcomes. Therefore, she should be treated empirically with antimicrobial therapy. Nitrofurantoin (Macrobid) is the best choice listed for this patient. Nitrofurantoin should be used cautiously in the first trimester, when other options are not available. It is contraindicated in at 38-42 weeks due to the possibility of hemolytic anemia in the neonate. Other options include beta-lactams (e.g. Penicillins, Cephalosporins). The shortest course possible should be prescribed Doxycycline (Doryx) and trimethoprim-sulfamethoxazole (Bactrim DS) are not considered safe during pregnancy and should be avoided.
209 88 C Question should read:
A pregnant patient, in her first trimester, is found to have a urinary tract infection. What is the appropriate course of action?
233 88 C
Rationale should read:
In 2016, FDA eliminated pregnancy categories for prescription medications. Over-the-counter medications still contain the pregnancy categories A-X. Amoxicillin-clavulanate (Augmentin), cephalexin (Keflex) (e.g. Beta-lactam antibiotics) and Nitrofurantoin (Macrobid) are considered probably safe for use during pregnancy. It provides coverage for the most common urinary tract pathogens. Bactrim is a folic acid antagonist and may be associated with an increased risk of congenital malformations. Ciprofloxacin is a fluoroquinolone (old category C) and may not be safe during pregnancy. Use of this medication during pregnancy may increase the risk of fetal harm (impaired bone and cartilage formation in the fetus). However, it may be given if the benefits outweigh the risks. A pregnant patient with bacteriuria is at high risk for the development of pyelonephritis and preterm labor if bacteriuria is left untreated.
216 125 A Question should read:
A pregnant patient with urinary frequency is found to have a UTI. The most appropriate treatment choice for this patient is:
238 125 A Rationale should read:
Medication safety during pregnancy is of utmost concern. In 2016, FDA eliminated pregnancy categories letter categories: A,B,C,D, and X. Cefpodoxime (Vantin) is a beta-lactam with a broad spectrum of coverage and is considered safe during pregnancy. The optimal duration of treatment of acute cystitis during pregnancy is uncertain, however, the shortest course of the safest antibiotic is best to minimize the risk of exposure to the fetus. Amoxicillin is probably as safe as nitrofurantoin but has a lower efficacy against typical urinary tract pathogens. Doxycycline is associated with fetal tooth discoloration and so it should be avoided. Ciprofloxacin is not recommended during pregnancy due to potential problems with bone and cartilage formation.
119 17 D
Question and choices should read:
According to the DSM-5 criteria, which criterion is NOT part of the diagnostic criteria for anorexia nervosa?
120 17 D Rationale should read:
Muscle wasting is NOT part of the diagnostic criteria for anorexia nervosa. It is, however, considered a medical complication which can occur in many organ systems of the patient with anorexia nervosa. A few other medical complications may include muscle wasting, seizures, anemia, electrolyte imbalances, osteoporosis, amenorrhea, and hypotension. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of anorexia nervosa requires: a restriction of energy intake that leads to a low body weight, given the patient’s age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected; an intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite being underweight, and; a distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s low body weight.
441 17 D Question and choices should read:
- A 7-year-old boy who was previously unimmunized received his first tetanus, diphtheria, and acellular pertussis (TDaP), Hepatitis A, Hepatitis B, inactivated polio (IPV), measles, mumps, and rubella (MMR), and Varicella vaccinations one month ago. He returns today for his second series of immunizations. He should receive:
- Hepatitis A, Hepatitis B, TDaP, Hib, IPV, and MMR
- Hepatitis B, TDaP, IPV, MMR, and Varicella
- IPV only
- Hepatitis B, TD, IPV, and MMR
442 17 D Rationale should read:
The minimum length of time between Hepatitis B, DTaP/DT, IPV, and MMR is 1 month or 4 weeks. Therefore, he can receive all of these today. Children ages 7 through 10 who aren't fully vaccinated against pertussis, including children never vaccinated or with an unknown vaccination status, should get a single dose of the TDaP vaccine and follow-up with TD 4 weeks later. Note, if the child is unable to tolerate the pertussis component of the TDaP, he can receive the DT instead at the same intervals. The minimum length of time between varicella immunizations is 3 months if he is younger than 13 years of age and the second dose of Hepatitis A is not due until 6 months later. HIB is not administered to children older than 59 months (5 years).
263 120 A
Question should read:
A diagnosis of Type 2 diabetes mellitus can be made:
387 3 D Question should read:
A diagnosis of Type 2 diabetes mellitus can be made:
- if risk factors plus a family history of diabetes are present.
- with Hgb A1C of 6.3%.
- if glucose values of 110, 119, and 115 mg/dL are observed on different days.
- following fasting glucose values of 126 and 130 mg/dL on different days.