AGNP 2 Flashcards
4
When should statin therapy be initiated for prevention?
- patients with ASCVD
- LDL > 190
- adults 40-75 with ASCVD score > 7.5%
- adults 40-75 with diabetes
What is the Waddell sign used to evaluate?
evaluate lumbar back pain
positive sign might indicate psychogenic root cause of the back pain
A 22-year-old patient presents to the office with complaints of frequent bowel movements over the past week. She reports her stools look like jelly and sometimes have blood in them. Since her last visit six months ago, she has lost approximately 15 lbs without trying. Her past medical history includes ankylosing spondylitis and anxiety. What is the most likely diagnosis?
a. Traveler’s Diarrhea
b Viral Gastroenteritis
c Crohn’s Disease
d Ulcerative Colitis
Ulcerative Colitis
Ulcerative colitis (UC) is an inflammatory bowel disease that affects only the colon. Patients will present with bloody diarrhea, often with mucus. Abdominal pain, weight loss, and fatigue are all common symptoms of UC as well. Another key clue in this question is her history of ankylosing spondylitis - this condition is found in 15-40% of patients with UC.
What test is used to confirm a diagnosis of human immunodeficiency virus (HIV)?
a Enzyme-linked immunosorbent assay (ELISA) test
b Rapid plasma reagin (RPR) test
c Nucleic acid test (NAT)
d Antinuclear antibody (ANA) test
c Nucleic acid test (NAT)
The nucleic acid test (NAT) is the preferred confirmatory test in those with suspected human immunodeficiency virus (HIV) infections. The ELISA test is an initial tool to help screen for HIV in exposed individuals. The rapid plasma reagin (RPR) test is a screening for syphilis. The antinuclear antibody (ANA) is used to screen for autoimmune disorders.
When assessing for a rotator cuff, the nurse practitioner can use all of the following tests except:
a Drop arm test
b Painful arc test
c Empty can test
d Apprehension test
The painful arc test is performed by having the patient abduct their arm away from their side toward the head. A positive test is pain between 60-120 degrees and typically indicates impingement syndrome. The drop arm test, empty can test, and apprehension test can all be associated with a rotator cuff tear.
A middle aged patient presents to the clinic for a follow up after requiring lithotripsy for several kidney stones. When reviewing the report from the urologist, it is noted that the patient had stones composed of calcium oxalate specifically. The patient be educated to avoid all of the following foods to ideally prevent these stones from occurring again except:
a Chocolate
b Spinach
c Broccoli
d Rhubarb
e Tangerines
c Broccoli
Calcium oxalate stones are the most common type of kidney stone. When a patient consumes too many foods that are high in oxalate, it is difficult for the kidneys to filter it out efficiently which leads to the oxalate binding with calcium. This binding then leads to the formation of kidney stones. Foods high in oxalate include items such as chocolate, spinach, rhubarb, beans, tangerines, coffee, cranberries, etc
A 25-year-old female patient comes to the clinic for contraceptive counseling. She asks the nurse practitioner if taking a combined oral contraceptive increases the risk of cancer. How should the nurse practitioner respond?
“Combined oral contraceptives may increase your risk of endometrial and ovarian cancer.”
“The risk of colorectal cancer is increased with this type of birth control.”
“There is no increased risk of cancer when taking a combined oral contraceptive.”
“Studies have shown that there is a slight increase in the risk of cervical cancer and breast cancer with combined oral contraceptives.”
“Studies have shown that there is a slight increase in the risk of cervical cancer and breast cancer with combined oral contraceptives.”
With the use of combined oral contraceptives, there is a slight increase in the risk of cervical and breast cancer, but the benefits outweigh the risks in the majority of cases. Studies have shown that there is a lowered risk of developing endometrial, ovarian, and colorectal cancer with combined oral contraceptive use.
what’s a supplement used for cardiac health in patients?
CoQ10
What a 3 preferred meds you can give for htn in pregnancy?
methyldopa
labetolol
nifedipine
Which of the following patients would be the most appropriate to start on a SNRI (serotonin and norepinephrine reuptake inhibitor) for a new diagnosis of depression?
a A 45 year old male patient with uncontrolled hypertension
b A 15 year old female patient who is being treated for migraines with Imitrex (Sumatriptan)
c A 33 year old female patient who is being treated for fibromyalgia with Gabapentin (Neurontin)
d A 29 year old male patient who was recently also diagnosed with Hepatitis B
A 33 year old female patient who is being treated for fibromyalgia with Gabapentin (Neurontin)
SNRIs are known to potentially increase blood pressure and therefore should be avoided in those with uncontrolled hypertension already. Concurrent use of the triptan drug class and SNRIs may lead to the development of serotonin syndrome. SNRIs are also processed in the liver, and if a patient has a liver condition, it may cause the drug to clear slowly. There is no contraindication for using Gabapentin (Neurontin) with a SNRI. SNRIs can be used to also help treat the neuropathic pain associated with fibromyalgia.
A 72 year old female presents to the clinic after having jaw pain while eating lunch this afternoon. She states she’s been especially tired and has had some blurry vision recently and attributes this to a nagging headache near her left eye. After performing a thorough physical assessment, which of the following steps should the nurse practitioner take next?
a Refer to an ophthalmologist for a biopsy
b Order inflammatory markers (erythrocyte sedimentation rate and c-reactive protein)
c Refer to ER for a CT scan to rule out a potential brain bleed or brain tumor
d Prescribe the patient Sumatriptan (Imitrex) for his migraine and tell the patient to call back if does not improve
a Refer to an ophthalmologist for a biopsy
Jaw claudication, or pain in the jaw with chewing, headache, and blurry vision is suspicious for temporal arteritis. We would want to refer this patient for a temporal artery biopsy as this is the only way to make a definitive diagnosis.
A post menopausal woman who had a hysterectomy is interested in starting hormone replacement therapy. The nurse practitioner understands that combination hormone replacement therapy will not put our patient at risk for what?
a Breast cancer, Stroke
b Stroke, Dementia
c Endometrial cancer, Osteoporosis
d Osteoporosis, Delirium
Dementia, Ovarian Cancer
Endometrial cancer, Osteoporosis
Combination hormone replacement therapy involves replacing both estrogen and progesterone. Combination therapy has been shown to decrease the risk of osteoporosis and fractures. Hormone replacement therapy can increase the risk of breast cancer, stroke, and dementia due to the increased exposure to estrogen and progesterone. In women without a hysterectomy, estrogen-only hormone replacement therapy can increase the risk of endometrial cancer. Combination therapy has a lower risk for this and is typically used only in women who have not had a hysterectomy. However, since the patient has a history of a hysterectomy, she is not at risk for developing endometrial cancer either way.
What herbal supplements can make asthma symptoms worse?
Echinacea
An 89 year old patient presents to the office accompanied by his daughter. He has not been into the office in over three years but to your knowledge, has no significant past medical history. He appears agitated and overall withdrawn at the visit today, and his daughter reports that he has stopped paying bills and is repeatedly checking to ensure the doors are locked at home. She states he will wander around the house for hours and accuse family members of stealing his personal belongings. Based on this information, which of the following would be the most appropriate medication for this patient?
a Donepezil (Aricept)
b Olanzapine (Zyprexa)
c Quetiapine (Seroquel)
d Dicycloverine (Bentyl)
This patient has stereotypical symptoms of Alzheimer’s disease. Donepezil (Aricept), a cholinesterase inhibitor, has been shown to help patients with Alzheimer’s disease by improving cognitive function and their ability to complete activities of daily living, as well as improve some psychiatric symptoms. Other examples of cholinesterase inhibitors include Rivastigmine (Exelon) and Galantamine (Razadyne). Quetiapine (Seroquel) and Olanzapine (Zyprexa) are not routinely recommended and should only be used to treat the symptoms of hallucinations, delusions, or paranoia when alternative options have proven unsuccessful. Dicycloverine (Bentyl), commonly used to treat irritable bowel syndrome, would not be appropriate for this patient’s symptoms and belongs to the anticholinergic drug class, making it even less appropriate for an elderly patient.
