Additional Quizzes Flashcards
A young woman is complaining of tenderness and burning of her vulva. On exam, the vulva is edematous and excoriated. The FNP performs a wet mount preparation of vaginal secretions. It reveals pseudohyphae and spores. What is the diagnosis for this patient?
vulvovaginal candidiasis
chlamydial infection
bacterial vaginosis
gonorrhea
vulvovaginal candidiasis
Feedback: Pseudohyphae and spores on the wet mount with potassium hydroxide are diagnostic for candida infection.
young woman presents with complaints of irritation in the vaginal area. This is the first time this has occurred. On exam, the cervix is inflamed and friable. Flagellated protozoa are seen on the wet mount. What is the most likely diagnosis?
trichomoniasis
cervicitis
chlamydial infection
bacterial vaginosis
trichomoniasis
Feedback: Flagellated protozoan confirms the diagnosis of trichomoniasis.
21-year-old female patient presents for her first well-woman exam. She has never been sexually active. Her family history and past medical history are negative for any gynecologic diseases. Her menses occur every 28 days, lasting 5 days, with a relatively moderate flow and no significant dysmenorrhea. Her physical exam should include which tests?
Pap smear
Cultures for gonorrhea and chlamydia
stool hemoccult
baseline mammogram
Pap smear
A young adult patient presents with a history of vaginal itching and heavy white discharge. The patient denies a history of sexual activity. On exam, the FNP finds a red, edematous vulva and white patches on the vaginal walls. The discharge has no odor. What finding would the FNP suspect in the patient’s history?
vegetarian diet
recent diarrhea
early menopause
recent antibiotic use
recent antibiotic use
Feedback: Almost half of all vaginal infections are caused by candida. The majority of women who develop this infection have recently taken antibiotics.
A 46-year-old female patient is being seen in the clinic by the FNP. She was last seen 2 weeks ago for an upper respiratory tract infection and was treated with amoxicillin 250mg PO TID x 10days. She completed her medication last week, but now complains of vaginal itching and thick white discharge. She states that she has never experienced such intense itching. She is in a mutually monogamous relationship. Her LMP was 2 weeks ago. Her partner had a vasectomy. Wet mount shows negative whiff test, rare clue cells, positive lactobacilli, positive hyphae, positive spores, few WBCs, and no trichomonads. She is leaving tomorrow for a week long cruise. She is not taking any medications and has no known drug allergies. The FNP should prescribe which of the following?
metronidazole 500mg PO BID x 7days
clindamycin vaginal cream one applicator full vaginally at HS x 7days
fluconazole 150mg 1 tab PO x1 dose
terconazole vaginal cream 1 applicator @ HS x 7 days.
fluconazole 150mg 1 tab PO x1 dose
Feedback: Fluconazole is approved for a single-dose oral treatment of uncomplicated vulvovaginal candidiasis. It is the most convenient treatment for this patient who will is unlikely to be compliant with vaginal creams given the upcoming travel.
A 25-year-old patient presents with complaints of malodorous vaginal discharge, which is white and watery. She douches with vinegar and water every 2 weeks. She uses a diaphragm for contraception and has been sexually active with her boyfriend for two years, using condoms for STD prevention. Her LMP was 1 week ago, and there are no noted changes in her normal menstrual pattern. Her wet mount shows a positive whiff test, clue cells too numerous to count, no lactobacilli, no hyphae, no spores. What is the diagnosis and treatment for this patient?
chlamydia: doxycycline 100mg PO BID x 10days
candida albicans: terconazole vaginal cream 1 applicator HS x 7days
HSV type 2: acyclovir 200mg PO q4h X 5days
bacterial vaginosis: metronidazole vaginal gel 1 applicator HS x 5 days.
bacterial vaginosis: metronidazole vaginal gel 1 applicator HS x 5 days.
Feedback: Metronidazole vaginal gel is the treatment of choice for bacterial vaginosis in the non-pregnant female. The presence of clue cells, and the associated malodorous discharge and absence of lactobacilli are markers for the diagnosis of bacterial vaginosis.
A 41-year-old patient is seen for her 6-week postpartum exam by the FNP. She is breastfeeding without difficulty and plans to continue for a year. She wants to begin using contraception and plans no further pregnancies. Which of the following is not an appropriate choice for this patient?
Depo-Provera 150mg IM Q 3 months
IUD
Progestin only oral contraceptive
Combination OC
Combination OC
Feedback: Combination OCs are not recommended for breastfeeding mothers because of the effect of estrogen on milk supply. Progestin only OCs, IUDs, and Depo-Provera are acceptable methods of contraception for breastfeeding mothers.
Which two patients should have a Pap smear test performed by the FNP?
An 18-year-old female who reports sexual activity with multiple partners.
A 45-year-old female patient who denies sexual activity but has two children.
A 21-year-old female who denies sexual activity.
A 16-year-old patient who denies sexual activity.
A 45-year-old female patient who denies sexual activity but has two children.
A 21-year-old female who denies sexual activity.
What finding is considered a normal surface characteristic of the cervix?
Small, yellow, raised round area on the cervix.
Red patches with occasional white spots.
Friable, bleeding tissue at the opening of the cervical os.
Irregular granular surface with red patches.
Small, yellow, raised round area on the cervix.
Feedback: A nabothian cyst is a small, white or yellow, raised round area on the cervix and is considered to be a normal variant.
The FNP is reviewing the lab results of a 28-year-old patient recently seen for a pap smear. Classification is high-grade squamous intraepithelial lesion, endocervical cells seen, and adequate smear. The FNP phones the patient and tells her which of the following?
Your pap smear was normal. Follow up in one year or sooner if problems arise.
Your pap smear shows invasive cancer. I would like you to see a gynecologic oncologist for treatment.
Your pap smear shows abnormal tissue that needs to be evaluated. Please schedule an appointment for a colposcopy.
Your pap smear shows a minor abnormality. Sometimes this can signify a disease process that is just beginning. Please schedule a follow up pap smear in 4 months.
Your pap smear shows abnormal tissue that needs to be evaluated. Please schedule an appointment for a colposcopy.
Feedback: The pap smear is a screening test for cervical cancer and precancerous states. The diagnostic test needed to confirm the diagnosis of a high-grade lesion is a colposcopy with guided biopsies.
The FNP is reviewing the lab results of a 61-year-old patient recently seen for a pap smear. Results are: atrophic changes, scent endocervical cells, and adequate smear. She has been treated for breast cancer with mastectomy and tamoxifen. She has never received hormone replacement therapy. What is appropriate for the FNP to tell the patient?
Your pap smear is slightly abnormal. I would recommend the use of some estrogen vaginal cream nightly for 3 weeks, then return to the office to have the pap smear repeated.
Your pap smear is normal but shows some mild thinning of the tissue. This is to be expected in someone who is postmenopausal and not on hormones. It does not pose a threat to your health. Please return to the office in 1 year for your annual exam or sooner if needed.
Your pap smear shows that you don’t have enough endocervical cells. Please make an appointment for endocervical curettage.
Your pap smear is abnormal. This could signify a disease state of the cervix. Please schedule a colposcopy at your earliest convenience.
Your pap smear is normal but shows some mild thinning of the tissue. This is to be expected in someone who is postmenopausal and not on hormones. It does not pose a threat to your health. Please return to the office in 1 year for your annual exam or sooner if needed.
Feedback: Atrophic changes on the cervix of a postmenopausal woman are to be expected, as is the paucity of endocervical cells. Because of her past medical history, she is not a candidate for HRT, and the pap smear results are not abnormal.
An adult patients LMP was 2 months ago. She has had and IUD in place for the last 4 months. She is complaining of nausea, fatigue, breast tenderness, and abdominal bloating. Physical exam reveals the following: Abdomen- no abnormalities noted; Pelvic- cervix with positive Chadwick’s sign, IUD strings protruding from cervix; Uterus- enlarged and non-tender; Adnexa- non-tender, without masses and no CMT. What would be the likely diagnosis?
Uterine fibroid
Ovarian cancer
Dislodged IUD
Pregnancy
Pregnancy
he FNP is talking with a young woman who has been diagnosed with herpes simplex type 2. In discussing her care, it would be important for the FNP to include what information?
The initial lesions are usually worse than lesions that occur in outbreaks at later time.
Her sexual partner will not contract the virus if she does not have sex when the lesions are present.
This condition can be treated and cured if she takes all of the antibiotics for two weeks.
If she becomes pregnant in the future, she will need to have a cesarean section.
The initial lesions are usually worse than lesions that occur in outbreaks at later time.
The initial outbreak is usually the worst. HSV can be transmitted even when lesions are not present, there is no cure. Vaginal delivery is allowed if no lesions are present at the time of labor.
Which is NOT a criterion for the diagnosis of bacterial vaginosis?
Positive amine (whiff) test.
Presence of clue cells.
Vaginal pH greater than 4.5.
Presence of pseudohyphae.
Presence of pseudohyphae.
Feedback: The criteria for diagnosis of bacterial vaginosis are the characteristic milky homogenous discharge, pH greater than 4.5, amine odor with addition of potassium hydroxide, and presence of epithelial cells studded with coccobacilli that obscure borders (clue cells). Pseudohyphae are present in candidiasis.
How does progesterone affect the GI system during pregnancy?
Causes nausea and vomiting early in pregnancy
Causes hypertrophy and bleeding of the gums
Delays gastric emptying time and decreases intestinal peristalsis
Causes diarrhea caused by increased intestinal peristalsis
Delays gastric emptying time and decreases intestinal peristalsis
Feedback: Progesterone affects the GI system by decreasing smooth muscle tone, delaying gastric emptying, and decreasing intestinal peristalsis.
During pregnancy, what is estrogen responsible for?
Hyperpigmentation
Facilitating implantation
Reducing smooth muscle tone
Decreased uterine contractility
Hyperpigmentation
estrogen is responsible for stimulation of the melanin-stimulating hormone, resulting in hyperpigmentation. The other factors are related to progesterone.
What is a positive sign of pregnancy?
Softening of the cervix
Fetal heartbeat
Enlargement of the uterus and abdomen
Mother’s perception of fetal movement
Fetal heartbeat
What are the normal cardiovascular physiologic responses to pregnancy?
Increase HR, increased cardiac output, decreased blood volume, and systolic murmur
Increased HR, decreased cardiac output, increased blood volume, and systolic murmur
Increased HR, increased cardiac output, increased blood volume, and systolic murmur
Decreased HR, increased cardiac output, increased blood volume, and diastolic murmur
ncreased HR, increased cardiac output, increased blood volume, and systolic murmur
Feedback: During pregnancy, a hyperdynamic state is caused by an increase in blood volume, which results in a slightly increased heart rate and increased cardiac output. Systolic ejection murmurs are common and are caused by increased flow across the pulmonic and aortic valves.
During the regular prenatal visits, what assessment data other than vital signs and weight are determined with each visit?
Fundal height, fetal heart rate, urine dip for protein and glucose, and presence of edema
Urinalysis, glucose screen, fundal height, and fetal heart rate
Presence of/changes in Chadwick’s sign, CBC, and blood glucose screening
Pelvic measurements, fundal height, urinalysis, and CBC
Fundal height, fetal heart rate, urine dip for protein and glucose, and presence of edema
Feedback: Fundal height, fetal heart rate, urine dip and assessment of edema are performed with each prenatal visit. The other assessments are not done at every visit.
The recommended office visit interval for a low-risk patient at 28 weeks of pregnancy is every:
4 weeks until 36 weeks
week for the remainder of the pregnancy
2 weeks until 36 weeks
6 weeks until 38 weeks
2 weeks until 36 weeks
The interval for prenatal visits for low-risk women is every 4 weeks until 28 weeks, every 2 weeks from 28-36 weeks, and weekly after 36 weeks.
At an initial prenatal visit occurring in the first trimester, which blood test is NOT recommended?
Antibody screen
Rubella
Maternal serum alpha-fetoprotein
Hepatitis B surface antigen
Maternal serum alpha-fetoprotein
Feedback: Routine laboratory tests include CBC, blood type and Rh, antibody screen, HBSAg, syphilis screen, and rubella immune titer. The MSAFP is done between 15 and 20 weeks and is time-sensitive.
The FNP teaches a prenatal patient that a significant source of toxoplasmosis is:
Rare red meat
Fresh fruits
Raw oysters
Raw vegetables
Rare Red Meat
The FNP would note which finding as a possible sign of preeclampsia?
Urinary urgency at night
Edema in all extremities and a puffy face
Stomach cramps
Clear fluid discharge from the nipple
Edema in all extremities and a puffy face
Which is an abnormal complaint in the second trimester of pregnancy?
Frequent uterine contractions
Frequent fetal movement
Calf cramps
Heartburn
Frequent uterine contractions
Feedback: Contractions can represent preterm labor and should always be evaluated to rule out early cervical change.
Which is an abnormal complaint in the third trimester of pregnancy?
leukorrhea
headache with blurred vision
urinary frequency
uterine contractions
headache with blurred vision
Feedback: Headache associated with visual changes can represent early symptoms of pre-eclampsia and warrants further evaluation.
The FNP is assessing a patient who has a positive pregnancy test. Laboratory data indicate that the mother’s blood type is O positive and the father’s blood type is AB negative. What risk is associated with this pregnancy?
The mother may build up antibodies to the infants blood if the infant is blood type B, which will be significant in future pregnancies.
The mother is Rh positive, if the infant is Rh negative, there is an increased incidence of the infant building up antibodies.
Because the mother is O and the father is AB, there is an increased risk of ABO incompatibility leading to jaundice in the newborn.
Type O blood is the dominant characteristic. The baby’s blood type will be O and there are no associated risks.
Because the mother is O and the father is AB, there is an increased risk of ABO incompatibility leading to jaundice in the newborn.
There is an increased risk of ABO incompatibility if the mother is type O and the father is AB, A, or B.
A young adult female, G2P1A0L1, 10 weeks gestation with intrauterine pregnancy is seen for her first intake and history visit. She knows when she conceived and denies any vaginal bleeding or abdominal pain. The patient has a soft, non-tender fundus that measures 14cm; adnexal exam negative for masses or tenderness, no FHR audible with doppler. What is the most likely diagnosis seen on ultrasound?
Multiple gestation
Fibroid uterus
Ectopic pregnancy
14-week viable IUP
Multiple gestation pregnancies will cause the uterus to enlarge faster than normal. FHR may be inaudible with the doppler due to the 10 weeks gestation. At 10 weeks, the fundus should not be above the pubic bone.
Ten days after delivery, a patient is diagnosed with mastitis. Which of the following should the FNP expect to find on physical exam?
Tender, hard, hot, reddened area on the breast.
Dimpled skin on breasts and firm nodules around the areola.
Decreased milk production, inverted nipples, and firm, inflamed breast tissue.
Soft, tender palpable masses with cracked bleeding nipples.
Tender, hard, hot, reddened area on the breast.
Feedback: A tender, hard, hot and reddened area on the breast over the affected area is typically found with mastitis. The patient with mastitis can also be febrile with flu-like symptoms.
A new first-time mother is being evaluated for a complaint of breast pain. Her infant is 3-weeks-old and she is breastfeeding. The infant is gaining weight and seems satisfied after feeding. On exam, the FNP finds red, irritated nipples on both breasts but no masses or tenderness to the breasts themselves. What is the most important part of the FNPs continued evaluation?
Mammogram of the breast.
Exam of the infant’s mouth.
STAT CBC
Analysis of the milk.
Exam of the infant’s mouth.
Feedback: Nipple irritation in breastfeeding mothers is often caused by candida albicans. The source is usually the infant’s mouth (thrush).
.Which immunization is contraindicated in pregnancy?
Polio
Hepatitis B
MMR
Tetanus
MMR
The patient comes in for her first prenatal visit. She is healthy and has no history that would contribute to complications to the pregnancy. She asks the FNP what she can take for occasional headaches caused by eyestrain and allergies. Which of the following would be appropriate for the FNP to recommend?
Ibuprofen 200mg Q4-6 hours, not to exceed 600mg in 24 hours
Naproxen 220mg Q 8-12 hours
Aspirin 60mg Q6 hours, not to exceed 300mg in 24 hours
Acetaminophen 650mg Q4-6 hours, not to exceed 4000mg in 24 hours
Acetaminophen 650mg Q4-6 hours, not to exceed 4000mg in 24 hours
Acetaminophen is a risk category drug B, problems have not been documented. Aspirin is a risk category D. NSAIDs are also a risk category B, but have been associated with prolonging pregnancy and prematurely closing the fetal ductus arteriosus because of antiprostaglandin effects.
Which medication would be considered safe to use in all trimesters of pregnancy?
metronidazole
tetracycline
isotretinoin
ACE inhibitors
metronidazole
For the patient who wants to breastfeed and take oral contraceptives, what is the pill of choice?
1/35 preparation
Triphasic preparation
Progestin-only preparation
1/50 preparation
progestin-only preparation
Feedback: Estrogen inhibits milk production. Progestin only pills are ideal for breastfeeding because they do not contain estrogen and will not impact milk production.
A pregnant patient in the last trimester complains of a constant back ache aggravated by walking, moving, and bending. The pain does not radiate to either leg. In addition to rest, massage, and physiotherapy, which of the following medications is approved?
Acetaminophen
Codeine
Naproxen
Aspirin
Acetaminophen
Feedback: Acetaminophen is the best option for this patient. Naproxen and Aspirin are contraindicated during pregnancy. Codeine, although used at times during pregnancy, is not indicated for this patient.
A 45-year-old male presents with a several-week history of scrotal pain that worsens with coughing, lifting and straining. He states that his scrotum feels “full” at the end of the day. What would the FNP be suspicious of?
Spermatocele
Inguinal hernia
Epididymitis
Testicular torsion
Inguinal hernia
Feedback: An inguinal hernia presents with the stated symptoms, along with a bulge in either the groin or scrotum that becomes more obvious when standing.
A 65-year-old male presents with a history of well-controlled hypertension and diabetes mellitus. He is a non-smoker. He has been married for 35 years and is monogamous with his partner. He reports that his relationship with his wife is good. He complains of new-onset erectile dysfunction (ED). What is the first line therapy for ED?
Relationship counseling
Oral phosphodiesterase-5 inhibitors
Intraurethral injections of alprostadil
Use of a vacuum device
Oral phosphodiesterase-5 inhibitors
Oral phosphodiesterase-5 inhibitors are safe, effective, and a reasonable choice for first line therapy for ED. This class includes commonly known medications such as sildenafil, vardenafil, tadalafil, and avanafil. Patients should be educated on proper use and potential side effects prior to use.
Which of the following is a common cause of erectile dysfunction?
The use of antihypertensives.
Dietary supplements
Masturbation
It is a natural part of aging.
The use of antihypertensives.
Feedback: Erectile dysfunction can be commonly caused by the use of antihypertensives, particularly thiazide diuretics and beta blockers.
A male patient presents with a complaint of sexual dysfunction. The FNP understands that sexual dysfunction is an impairment of:
Erection only
Emission only
Ejaculation only
Erection, emission, or ejaculation
Erection, emission, or ejaculation
Feedback: In sexual dysfunction, erection, emission, or ejaculation may not be functioning because of multifactorial causes such as medications, vascular disorders, neuropathy, and trauma.
What are the common symptoms of benign prostatic hyperplasia (BPH)?
Dribbling, hesitancy, loss of stream volume and force, and recurrent urinary tract infections
Dysuria, urgency, frequency, nocturia, and suprapubic heaviness or discomfort
Obstructive symptoms such as a weak urine stream, abdominal straining to void, hesitancy, incomplete bladder emptying, and terminal dribbling
Acute onset of fever, chills, flank pain, head ache, malaise, CVA tenderness, and possibly hematuria
Obstructive symptoms such as a weak urine stream, abdominal straining to void, hesitancy, incomplete bladder emptying, and terminal dribbling
Feedback: Obstructive symptoms are common in BPH. The other symptoms are associated with different diagnoses.
Which of the following is correct regarding short-acting phosphodiesterase-5 inhibitors, such as sildenafil or vardenafil?
They work best in combination with a large fatty meal.
They should be taken 30 minutes to 1 hour before intercourse.
They are the only class of medications that is effective for treating ED.
They work in all men.
they should be taken 30 minutes to 1 hour before intercourse.
Feedback: Phosphodiesterase-5 inhibitors should be taken 30-60 minutes prior to intercourse. Fatty foods interfere with absorption.
What are the common side-effects of phosphodiesterase-5 inhibitors?
Erection lasting longer than 4 hours.
Headaches, flushing, and dyspepsia.
Nausea and vomiting.
Rash, itching, and loss of appetite.
Headaches, flushing, and dyspepsia.
Feedback: Common side effects include headache and flushing caused by vasodilation.
What is an important contraindication to phosphodiesterase-5 inhibitors?
SSRIs
Beta blockers
Nitrates
Thiazide diuretics
Nitrates
A patient has been taking doxazosin 2 mg PO daily for 3 weeks for treatment of BPH. He returns to the clinic and is complaining of feeling dizzy when he stands up. Which action would the FNP take?
Determine BP when lying, sitting, and standing.
Order urinalysis to determine hematuria and presence of bacteria.
Review with patient his symptoms over the last 3 weeks.
Perform digital rectal exam to determine whether prostate is smaller than previously noted.
Determine BP when lying, sitting, and standing.
A 74-year-old male patient has BPH and stage one hypertension. Which of the following medications would be the most appropriate selection to treat both disorders?
tamsulosin
finasteride
doxazosin
tadalafil
doxazosin
Feedback: Doxazosin is indicated as a treatment in both BPH and hypertension because of its favorable side effect.
A 28-year-old man presents with complaints of fever, low back pain, perineal pain, and intense pain on voiding. Rectal exam reveals a tender, swollen, firm, warm prostate. Based on the patient’s symptoms, what is the treatment of choice?
ceftriaxone 250mg IM x1 followed by doxycycline 100mg PO BID x 10 days
tetracycline 250mg PO qid x 10 days
amoxicillin 500mg PO tid x 14 days
erythromycin 250mg PO q6h x 24 days
ceftriaxone 250mg IM x1 followed by doxycycline 100mg PO BID x 10 days
In the age group at risk for STI, this is the initial treatment. Although it is explicitly written in the textbook and guidelines that a course of flouroquinolones is the course of treatment when STI is not suspected. Fuck these professors.
A 70-year-old man complains of scrotal pain with dysuria and frequency that has been increasing over the last 2 weeks. Physical exam reveals extreme scrotal tenderness and swelling, urethral discharge, and testes normal in size and position. Urinalysis reveals pyuria. What is the treatment of choice for this patient?
Nitrofurantoin 100mg PO QID x 14 days
Levofloxacin 750mg PO QD x 10 days
Doxazosin 1mg PO qd x 10 days
Oxybutynin 5mg PO TID x 10 days
Levofloxacin 750mg PO QD x 10 days
Feedback: The patient is presenting with classic symptoms of epididymitis. The treatment of choice is a fluoroquinolone, such as levofloxacin or ciprofloxacin.
Finasteride is prescribed for a 50-year-old man who is experiencing a problem with urination secondary to an enlarged prostate. The FNP would teach the patient that while he is taking this medication it is important to:
Increase fluid intake
Restrain from sexual activity
Take special precautions around women of childbearing age
Increase intake of folic acid
Take special precautions around women of childbearing age
Feedback: Finasteride has some risk to women of childbearing age. It is important that women of childbearing age are not exposed to the sperm of a patient taking finasteride. These women and pregnant women should avoid handling crushed tablets. Exposure can cause fetal anomalies.
A patient is diagnosed with BPH. Which medication should be recognized by the FNP as likely to aggravate this condition?
glyburide
oral buspirone
inhaled ipratropium
ophthalmic timolol
inhaled ipratropium
Feedback: BPH is a common cause of urinary retention in older men. Inhaled ipratropium is an atropine-like bronchodilator used to treat chronic bronchitis, its anticholinergic properties may aggravate urinary retention.
Which of the following statements is true regarding the cultural humility framework? Select all that apply.(1 Point)
It invites respectful questions.
The framework and terminology is interchangeable with cultural competence.
It urges learners to be aware of the their own beliefs, values, and biases.
It embraces the reality that no one person is a representative of any given culture.
It urges learners to be aware of the their own beliefs, values, and biases.
It embraces the reality that no one person is a representative of any given culture.
Which of the following statements is true regarding implicit bias?(1 Point)
Implicit biases develop during adulthood.
Implicit biases are not conflicting with one’s own personal beliefs.
Knowledge of one’s own implicit biases allows for awareness of how biases can affect the care they provide.
Implicit biases are conscious and intentional responses to people or situations.
Knowledge of one’s own implicit biases allows for awareness of how biases can affect the care they provide.
Feedback: Implicit biases form during childhood in response to prevailing family and societal values. It is common for implicit biases to be in conflict with stated values and beliefs. Implicit biases are unconscious, automatic, and pervasive responses to people or situations.
An example of work processes that impact sexual and gender minority is:(1 Point)
clearly posted non-discrimination statements
access to all-gender restrooms
inclusive intake forms and interviewing tools
use of normalizing statements
inclusive intake forms and interviewing tools
Health disparities that occur disproportionately in gay men include all of the following except:(1 Point)
depression
eating disorders
intimate partner violence
access to education
access to education
.Anal dysplasia screening is a consideration among men who have sex with men as well as women who have anal sex. Which of the following is true regarding this consideration?(1 Point)
Anal dysplasia screening should be conducted on an annual basis.
Universal anal dysplasia screening should be included in the care of all men who have sex with men.
Practices who implement anal dysplasia screening should have a referral program.
The CDC has a consensus guideline for the frequency of anal dysplasia screening.
Practices who implement anal dysplasia screening should have a referral program.
Feedback: Currently there is no consensus guideline for the implementation of anal screening guidelines. If a practice implements anal screening, they should have a referral program in place.
A 21-year-old female patient presents for her annual wellness exam. Her sexual history reveals all female partners, and no history of penetrative intercourse. The FNP is aware that:(1 Point)
This patient does not meet the USPSTF guidelines for cervical cancer screening because she has never had penetrative sex.
This patient should have a pap smear for cervical screening, according to the USPSTF guidelines.
Health promotion and screening should be based upon a person’s sexual orientation.
The incidence of STIs and HPV is lower in women who sleep with women.
This patient should have a pap smear for cervical screening, according to the USPSTF guidelines.
Feedback: It is recommended that all women begin cervical cancer screening at age 21, regardless of sexual activity. Health promotion and screening activities are related to behavior regardless of sexual orientation. There is clear evidence that HPV, HSV, and syphilis can be transmitted between female partners.
Which of the following is a health disparity that is unique to transgender people?(1 Point)
access to quality education
housing instability
higher burden of depression
substance abuse
housing instability
Feedback: In a recent study of transgender health, 69% reported being homeless at least once.
Which of the following statements is true regarding gender dysphoria?(1 Point)
Gender dysphoria is most common during adolescence.
Gender dysphoria can be seen in children as young as age 4.
The role of the primary care provider regarding gender dysphoria is to refer the child for counseling.
gender identity disorder is the DSM-5 diagnosis for gender dysphoria
Gender dysphoria can be seen in children as young as age 4.
Gender dysphoria can worsen with the onset of puberty. It can be seen in children as young as age 4. The primary role of the care provider is to serve as an advocate for the child and to educate the family that forcing the child to express gender in a way that is not comfortable for them can be harmful to their health. In 2013 gender dysphoria was eliminated terminology from the DSM-5.
The FNP is providing care to a newborn who has intersex genitalia. What is the urgent clinical concern?(1 Point)
Ensuring that the parents have adequate support.
Referring the newborn for genital surgery.
Ruling out congenital adrenal hyperplasia.
Honoring the parent’s wishes and beliefs related to decision making.
Ruling out congenital adrenal hyperplasia.
Feedback: The urgent clinical concern for a provider caring for a newborn with intersex genitalia is to rule out congenital adrenal hyperplasia. This is the most common cause of atypical genitalia and can be life-threatening.
What intervention will the provider implement when prescribing medications to an 80-year-old patient?
Beginning with higher doses and decrease according to the patient’s response
Reviewing all patient medications at the annual health maintenance visit
Consulting the Beers list to help identify potentially problematic drugs
Ensuring that the patient does not take more than five concurrent medications
Consulting the Beers list to help identify potentially problematic drugs
An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. She appears somewhat confused, according to her daughter, who is concerned that she is developing dementia. The provider learns that the woman still drives, volunteers at the local hospital, and attends a book club with several friends once a month. What is the initial step in evaluating this patient?
Ordering a CBC, serum ferritin, and TIBC
Referring the patient to a dietician for nutritional evaluation
Referring the patient to a neurologist for evaluation for AD
Obtaining a CBC, serum electrolytes, BUN, and glucose
Obtaining a CBC, serum electrolytes, BUN, and glucose
Initial eval for infection, dehydration, or other imbalances. A urine analysis may also be useful for UTI.
When using the “Five Wishes” approach to documenting patient preferences for end-of-life care, the provider will document which types of preferences? (Select all that apply.)
A specific list of treatments the patient does not want
The people designated to make care decisions for the patient
The level of sedation versus alertness the patient desires
How much information to give various family members
OpA directive to avoid calling 911 at the time of deathtion 5
The level of sedation versus alertness the patient desires
How much information to give various family members
OpA directive to avoid calling 911 at the time of deathtion 5
The Five Wishes approach addresses the type of care a patient wants as a disease progresses and is less defensive than the traditional advance directive which indicates the type of care a patient does not want. Calling 911 may be done without requiring resuscitation if the patient has an appropriate advanced directive in place.
A patient who is near death is exhibiting signs of agitation, anxiety, and intractable pain. When discussing palliative sedation with this patient’s family, what will be discussed? (Select all that apply.)
The need for informed consent from the patient and family
The chance that refractory symptoms will be alleviated
The fact that this is an intervention of last resort
The possibility that this measure may hasten death
The likelihood that the patient will develop dependence on the drugs
The need for informed consent from the patient and family
The chance that refractory symptoms will be alleviated
The fact that this is an intervention of last resort
The possibility that this measure may hasten death
The FNP is seeing a 68-year-old patient for their annual wellness exam. The FNP knows that screening for hearing deficits includes which of the following:
Referral to an audiologist
Whisper test
Otoacoustic emissions
Behavioral Audiometry Evaluation
Whisper test
Feedback: Hearing impairments affect up to 1/3 of persons over age 65. Hearing deficits can be screened for by the whisper voice test.
A 71-year-old male patient presents for his annual wellness exam, accompanied by his son. The FNP understands that which of the following factors is the least important when screening for cognitive decline:
Family or caregiver concerns
Patient history
Clinician observations
Age
Age
Feedback: Evaluation of cognition is based upon an algorithm developed by the Alzheimer’s association that is based upon patient history, concerns of family or caregivers, and clinical observations. The incidence of dementia increases with age. According to the AAFP, prevalence increases by 5% in persons aged 71-79. Although age is a factor, it is not the most important factor for this patient.
The largest category of psychiatric disorders in elderly patients is:
Panic disorder
Generalized anxiety disorder
Depression
Eating disorders
Depression
Feedback: Depression remains the largest category of psychiatric disorders in older adults and is associated with significant morbidity and mortality.
The FNP is screening an 84-yer-old female patient for nutritional deficits using the MNA-SF tool. The FNP understands that a score of 12 on the screening tool indicates:
Malnutrition
Risk for malnutrition
Normal nutritional status
Option 4
Normal nutritional status
A score of 12-14 on the MNA-SF indicates normal nutritional status.
The four-stage balance test is used to assess a patient’s risk of falls. Which elements would patients perform as part of this screening tool?
Stand from a seated position, walk 10 feet, turn, walk back, and sit down
Hold each position for 10 seconds: standing with legs side by side, then place the instep of one foot touching the big toe of the other foot, next standing heel to toe, and finally standing on one foot
Cross their arms over their chest and repeatedly stand up as many times as they can in 30 seconds
Reach forward beyond arm’s length while maintaining a fixed base of support in four positions without losing balance
Hold each position for 10 seconds: standing with legs side by side, then place the instep of one foot touching the big toe of the other foot, next standing heel to toe, and finally standing on one foot
Feedback: The four-stage balance test has the patient stand in four different positions that get progressively harder to maintain. Lower scores indicate balance issues and increased risk of falls.
The FNP understands that all of the following factors contribute to the process of aging, except:
A decrease in hormone production
A decline in cell-mediated immunity
A decrease in free radicals of oxygen
A decrease in the production of B-cells and T-cells
A decrease in free radicals of oxygen
A 69-year-old female patient is being seen for her annual wellness exam. She complains of an increasing number of purple spots on the dorsal surface of her hands. The patient denies any recent falls or injuries. The FNP understands that the patient is likely experiencing:
xerosis
lentigos
senile purpura
bullous pemphigoid
senile purpura
The FNP is assessing the skin and nails of a 76-year-old patient. The FNP notes that the patient’s nails have a spoon like appearance. Which of the following laboratory tests would the FNP order?
Arterial blood gases
CBC
Liver function tests
Serum electrolytes
CBC
A 74-year-old female patient is brought in by her daughter for evaluation. The patient is a widow and has lived on her own since her husband died 4 years ago. The daughter states that her mother has been increasingly forgetful, sleeping more than normal, agitated, and recently suffered a fall in the bathroom. The daughter also states that her mother has not eaten the meals that she left for her 3 days prior. The FNP should consider which of the following as a priority?
CT scan or MRI
Screening for cognitive impairment.
Urinalysis with culture
Nutritional Assessment
Urinalysis with culture
Strategies for achieving minimally disruptive medicine include all of the following, except:
Goal setting
Shared decision-making
Increasing the number of provider visits
Collaboration with community and therapy
Increasing the number of provider visits
An older adult patient with a history of forgetfulness will need to take multiple drugs after discharge from the hospital. What provider action will most successfully promote medication adherence in a forgetful patient?
Ask the patient to share the medication teaching with a neighbor or friend soon after discharge.
Give the patient detailed written information about each drug.
Schedule medications to be taken at the same times as much as possible.
Make sure the patient understands the actions and side effects of each drug.
Schedule medications to be taken at the same times as much as possible.
A patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which action should the prescriber take initially?
Fax the renewal order to the pharmacy.
Arrange to schedule an appointment with the patient.
Verify the patient’s adherence to the prescribed drug regimen.
Determine the patient’s current medication dosage and pain level.
Arrange to schedule an appointment with the patient.
A patient has taken a narcotic analgesic for chronic pain for several months. At a follow-up appointment, the provider notes that the patient has been taking more than the prescribed dosage. The patient has normal vital signs, is awake and alert, and reports mild pain. What does the provider suspect is responsible for the patient’s response?
This patient exhibits a negative placebo effect with a reduced response to the drug.
This patient has developed tachyphylaxis because of repeated exposure to the drug.
This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.
This patient has increased hepatic enzyme production as a result of prolonged exposure to the drug.
This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for analgesic effect.
What is the provider’s ideal goal of drug rehabilitation?
Abstinence from the drug
Decreasing episodes of relapse
Minimizing drug cravings
Reduction of drug use
Abstinence from the drug
The FNP understands that which of the following patient populations should be screened for intimate partner violence:
Unmarried women
Adolescents
Patients with a history of multiple partners
All patients
All patients
Identify the name of the screening checklist that can be used by the FNP to guide the encounter when sexual abuse is suspected. Include the Algorithm and what each letter stands for.
RADAR; Remember to ask, Ask directly and clearly, Document all information; Assess safety; Review options.
Identify the 4 tools that the CDC recommends for screening for intimate partner violence.
HITS, OVAT, STaT, WAST
A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pretravel vaccines?
Requirements should be reviewed at least 4 to 6 weeks prior to travel.
There are at least five required vaccines for entry into certain countries.
Malaria vaccine is the most important vaccine for worldwide travel.
Country-specific guidelines are provided by individual embassies.
Requirements should be reviewed at least 4 to 6 weeks prior to travel.
The FNP is seeing a patient who just returned from a mission trip to Nicaragua. The patient is experiencing mild abdominal cramping and diarrhea. Which of the following antibiotics would the FNP prescribe to this patient?
Cipro
Augmentin
Doxycycline
Biaxin
Cipro
Identify the 3 purposes of the care provided to patients who have experienced sexual assault.
Provide acute medical care, Gather evidence, Transition to long-term care for psychological recovery
Culturally competent care is a critical element of healthcare. Which of the following comments regarding the impact of the Chinese culture on decision-making in healthcare is false?
The Chinese culture is traditionally patriarchal.
In general, families are private and do not share personal matters.
The opinions of elders are not respected.
When a woman marries, she becomes a part of the man’s family, when it comes to decision making.
The opinions of elders are not respected.
A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation?
Care coordination for chronic diseases
Standards for minimum cash reserves
Bonuses based on achievement of benchmarks
Strict requirements for financial reporting
Bonuses based on achievement of benchmarks
Which is the least important barrier to collaborative advanced nursing practice?
Prescriptive authority
Reimbursement privileges
Legal scope of practice
Political activism
Political activism
The FNP understands the following about quality improvement (QI): (select two responses)
QI needs to be realistic and achiveable
QI involves large-scale projects for best outcomes
QI is action research
QI generates new ideas and knowledge
QI avoids replicating strategies used by others
QI uses existing tools and evidence to change and improve nursing practice
QI needs to be realistic and achiveable
QI uses existing tools and evidence to change and improve nursing practice
What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients?
Costs of ambulatory care
The ratio of providers to patients
Ease of access to care
Associations with area hospitals
Ease of access to care
Which assessments of care providers are performed as part of the value-based purchasing (VBP) initiative? (Select all that apply.)
Monitoring mortality rates of all patients with pneumonia
Appraising costs per case of care for Medicare patients
Evaluating available evidence to guide clinical care guidelines
Requiring advanced IT standards and minimum cash reserves
Other
Monitoring mortality rates of all patients with pneumonia
Appraising costs per case of care for Medicare patients
Which assessment question would the FNP ask when engaging in the new model for primary care? (Select all that apply.)
“Are you experiencing any side effects from your newly prescribed medications?”
“Do you have any questions about the lab tests that have been ordered for you?”
“Are you ready to discuss some of the community resources that are available?”
“Are you ready to discuss the results of your laboratory tests?”
“Do you anticipate any problems with adhering to your treatment plan?”
“Do you have any questions about the lab tests that have been ordered for you?”
“Are you ready to discuss some of the community resources that are available?”
“Are you ready to discuss the results of your laboratory tests?”
“Do you anticipate any problems with adhering to your treatment plan?”
To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid Service have implemented which policy?
Requirements for written discharge instructions for patients and caregiver
Reduction of payments for patients readmitted within 30 days after discharge
Mandates for communication among primary caregivers and hospitalists
Penalties for failure to perform medication reconciliations at time of discharge
Reduction of payments for patients readmitted within 30 days after discharge
According to multiple research studies, which intervention has resulted in lower costs and fewer rehospitalizations in high-risk older patients?
Inclusion of extended family members in the outpatient plan of care
Frequent posthospital clinic visits with a primary care provide
Telephone follow-up by the pharmacist to assess medication compliance
Coordination of posthospital care by advanced practice health care providers
Coordination of posthospital care by advanced practice health care providers
What is the purpose of Level II research?
To demonstrate the effectiveness of an intervention or treatment
To describe relationships among characteristics or variables
To evaluate the nature of relationships between two variable
To define characteristics of interest of groups of patients
To describe relationships among characteristics or variables
Level I research is conducted to define the characteristics of groups of patients. Level III research evaluates the nature of the relationships between variables. Level IV research is conducted to demonstrate the effectiveness of interventions or treatments.
Which is the most appropriate research design for a Level III research study?
Randomized clinical trials
Epidemiological studies
Qualitative studies
Experimental design
Experimental design
What is the purpose of clinical research trials in the spectrum of translational research?
Determination of the basis of disease and various treatment options
Adoption of interventions and clinical practices into routine clinical care
Exploration of fundamental mechanisms of biology, disease, or behavior
Examination of safety and effectiveness of various interventions
Examination of safety and effectiveness of various interventions
Which patient should have pulmonary function testing as part of the presurgical exam?
A patient older than 60 years of age
A patient with a history of pneumonia in the last 2 years
A patient undergoing major intrathoracic surgery
A patient with diabetes and morbid obesity
A patient undergoing major intrathoracic surgery
Which factors determine which diagnostic tests should be performed in a presurgical clearance evaluation? (Select all that apply.)
Patient’s age
Type of anesthetic agent planned
Previous surgeries
Patient’s comorbidities
Surgeon’s preference
Patient’s age
Type of anesthetic agent planned
Patient’s comorbidities
Surgeon’s preference
