Final Exam Questions 6 Flashcards
- You are working as a new NP in your local town and are seeing multiple teenagers for sports physicals. You know that the most commonly used illicit drug is which of the following?
a. Marijuana
b. Cocaine
c. Methamphetamine
d. Ecstasy
a. Marijuana
Rationale: Marijuana is the most common drug used teenagers. The other are all used but not as common
- Which of the following statements regarding bulimia nervosa is FALSE?
a. The most common methods used to purge include vomiting, laxative use, and exercise.
b. Bulimia nervosa can lead to hypernatremia and hyperkalemia.
c. Most bulimic individuals will present as average weight or slightly above average.
d. Cognitive behavioral therapy and the use of SSRIs are good treatment options for most patients.
b. Bulimia nervosa can lead to hypernatremia and hyperkalemia.
Rationale: Bulimia can lead to problems with hyponatremia and hyperkalemia. All of the other options are true
- A mother brings her 15-year-old son in with complaints of skipping school, failing multiple classes, and defiant behaviors with his parents and teachers. What disorder should the NP screen for?
a. Substance abuse
b. ADHD
c. Child abuse
d. Bipolar disorder
a. Substance abuse
Rationale: Skipping school, failing classes, difficulty with relationships, minor crimes, depressed affect,
complaints of abdominal pain, chest pain, palpitations, sore throat, chronic cough, persistent nasal
drainage, headaches, and other unexplained physical complaints are clues to possible substance abuse in adolescents.
- Which of the following statements regarding pharmacological screening for substance abuse in adolescents is FALSE:
a. Widespread drug testing in school is not recommended
b. Parental request and consent is sufficient for involuntary screening of a minor
c. Drug screening is recommended in an obtunded adolescent in the ER
d. Informed consent must be obtained from the adolescent patient prior to drug testing
b. Parental request and consent is sufficient for involuntary screening of a minor
Rationale: Drug screening should be reserved for situations where the concerns for the practical and ethical issues of testing are outweighed by the concern for behavioral dysfunction. The AAP recommends testing only in certain situations (i.e., in an obtunded patient in the ER). The provider should discuss the plan for drug screening with the patient, explain the reasoning for it, and obtain informed consent. Parental request and consent are not considered sufficient for involuntary screening of minors. There is no solid evidence that widespread drug testing in school is sufficient.
- A 16-year-old female is brought to the clinic by her mother with reports of 2 syncopal episodes in the past week. The NP notices the patient is wearing bulky clothing, she is underweight compared to her normal weight at the last visit, her HR is 45, and her skin is cool to the touch. The NP is concerned for which eating disorder?
a. Bulimia nervosa
b. Binge-eating disorder
c. Anorexia nervosa
d. Avoidant/restrictive food intake disorder (ARFID)
c. Anorexia nervosa
Rationale: Weight loss from a normal body weight is considered an obvious red flag for an eating disorder. In anorexia nervosa, body temperature decreases, and the hands and feet may be blue and cool. The patient can develop bradycardia and may experience syncopal episodes. Syncope may develop in bulimia nervosa due to dehydration, but GI problems are the most prominent complaints. Binge-eating disorder is mainly found in overweight or obese patients. ARFID is the restriction of food intake, but no body image issues or fear of gaining weight. Patients with anorexia nervosa tend to wear bulky clothing to hide their weight loss.
- 55-year-old female with a history of a valve replacement presents for a wellness exam. She is currently on Warfarin and tells the intake nurse “I have started taking over the counter St. John’s Wart for depression.” Which of the following statements is true?
a. “St. John’s Wart will increase Warfarin levels
b. “St. John’s Wart will decrease Warfarin levels”
c. “St. John’s Wart is safe to take no matter what medications you take”
d. “St. John’s Wart is not recommended for the treatment of depression”
b. “St. John’s Wart will decrease Warfarin levels”
Rationale: St. John’s Wart is used for depression and can potentially induce cytochrome P450 system.
Inducing Cytochrome P450 can decrease levels of alprazolam, warfarin, statins, and ethinyl estradiol. It can also increase activity of P-glycoprotein transport system.
- Which characteristics below are most often associated with alcohol use disorder (alcoholism)?
a. Being the life of the party, everyone’s favorite guest, loved by everyone.
b. Excessive riches and fame, expensive cars, and resort properties.
c. Strong family life, high-paying job, recent promotion.
d. Depression, high alcohol tolerance, blackouts, disruption in social roles, legal troubles.
d. Depression, high alcohol tolerance, blackouts, disruption in social roles, legal troubles.
Rationale: Alcohol use disorder involves the repetitive and excessive use of alcohol, often to relieve anxiety, depression, or some other form of emotional distress. This overuse of alcohol often continues despite disruptions in the patient’s personal life, family life, and career. It often leads to alcohol-related legal troubles and high-risk behaviors. The patient will often drink to the point of blacking out and awake with very limited memory of what they have done.
- A five-year-old female child and her mother come to the clinic for a recent diagnosis of anxiety disorder. What would the NP explain to the patient and mother about the most successful treatment option for anxiety?
a. Selective serotonin reuptake inhibitors SSRIs
b. Cognitive behavioral therapy (CBT)
c. Admission to the children hospital
d. Hydroxyzine PRN
b. Cognitive behavioral therapy (CBT)
Rationale: Cognitive-behavioral therapy (CBT) has the greatest evidence regarding the successful treatment of anxiety. CBT aims to desensitize a child to the stimulus that is creating anxiety. The key goal of CBT is to help the child to face the stressors producing anxiety that causes distress or dysfunction by experiencing a reduction in anxiety and resuming normal daily functioning.
- Mrs. Everly’s family asks you about ways to slow the progression of her Dementia. You share one of the best ways to keep Mrs. Everly stimulated would be to;
a. Quiz her on historical events everyday
b. Allow her to watch her favorite TV channel for 4 hours per day
c. Get her involved in a senior exercise class at the local YMCA
d. Enroll her in an online course learning to cross stitch
c. Get her involved in a senior exercise class at the local YMCA
Rationale – Physical activity assists in slowing the patient’s physical decline which decreases the demand for caregiving. Memory recall drills and computer work may lead to frustration.
- Your patient is here to see you for a follow up appointment after a hospital visit for newly diagnosed peripheral arterial disease. You review his chart and see that he is on the following medications: Aspirin 81mg, lisinopril 20mg and vitamin D. What additional medication is the most appropriate for this patient with dx of PAD?
a. Atorvastatin 80mg
b. HCTZ 25mg
c. Metoprolol 25mg
d. Plavix 75mg
a. Atorvastatin 80mg
Rationale: A high dose statin is indicated for all patients with PAD if tolerated. Medical optimization,
exercise and risk factor reduction are the mainstay treatment for PAD.
- What is the 1st line drug and dosage for treatment of hypercholesterolemia and inflammation for patients with PAD?
a. Atorvastatin 40mg
b. Atorvastatin 80mg
c. Simvastatin 20mg
d. Simvastatin 40mg
b. Atorvastatin 80mg
Rationale: All patients with PAD should be placed on a high-dose statin if the patient can tolerate it; the drug of choice is Atorvastatin 80mg 1 tablet every day.
- When treating a 9-year-old with cystic fibrosis with poor response to therapy, it is important to address all of the following except:
a. Provide palliative care information concurrently with stabilization treatment to aide in symptom management and improvement of quality of life.
b. Avoid end-of-life and poor prognosis with the child as this will cause depression and further exacerbate stress.
c. Openly discuss cultural traditions, alternative treatments, or religious beliefs regarding care choices to consider possible risks and benefits when use with conventional care.
d. Discuss with caregivers and child advance care planning wishes and directives and re-evaluate if there is change in the child’s condition as part of the full plan of care.
b. Avoid end-of-life and poor prognosis with the child as this will cause depression and further exacerbate stress.
Rationale: Palliative care allows for comfort care while still seeking treatment for chronic or potentially life limiting illness. Children as young as 3 have some concept of death. Allowing the child to openly
discuss their fears and concerns may alleviate some stress and allow them to better cope with feelings of anger and loss. Parents may not disclose remedies or practices outside the scope mainstream
treatment if they fear ridicule or disapproval by the provider. Normative discussions about medical interventions of life support and advances care help the patient and family understand the means, process, and considerations of choices outside of emergent situations and allow processing if information in less stressful circumstances.
- Which of the following patients is at highest risk for developing a post-surgical DVT/VTE?
a. A 47-year-old female undergoing a right total knee replacement, BMI of 35, current smoker and on oral estrogen for menopausal symptoms.
b. An 18-year-old female, nonsmoker, BMI of 21 undergoing extraction of wisdom teeth with Twirla patch (levonorgesterel/ethinyl estradiol transdermal) for birth control.
c. A 48-year-old male, smoker but otherwise healthy for first routine colonoscopy screening.
d. A 51-year-old male, non-smoker, with HTN and a BMI of 28 undergoing turbinate reduction as an outpatient. On lisinopril 10mg daily for HTN.
a. A 47-year-old female undergoing a right total knee replacement, BMI of 35, current smoker and on oral estrogen for menopausal symptoms.
Rationale: The 47-year-old female has the most risk factors present and is therefore at higher risk
for for developing DVT/VTE after surgery than the other patient scenarios. Orthopedic surgery is higher risk procedure (for VTE) and prolonged immobility, she is a smoker, is overweight, and on oral estrogen. All these factors increase her risk for VTE
- Your patient underwent a knee replacement surgery and subsequently has formed a DVT. He has no risk factors other than history of surgery. The NP would anticipate the length of his anticoagulant treatment course to be:
a. 3 months
b. 3-6 months
c. 1 year
d. Indefinite
a. 3 months
Rationale: Patients with major transient risk such as hospitalization or surgery as their only risk factor for DVT should be anticoagulated for 3 months. Prophylactic anticoagulation should be considered again in the future with any additional transient risk factors for venous thromboembolic events.
- Which of the following is a true statement regarding Direct-Acting Oral Anticoagulants (DOAC’s)?
a. A patient taking a DOAC medication should monitor their diet closely to ensure they limit their vitamin K intake
b. A patient with renal disease may require renal dosing adjustment
c. DOAC medications can have an unpredictable effect and require laboratory monitoring
d. The effects of DOAC medications are easily monitored
b. A patient with renal disease may require renal dosing adjustment
RATIONALE: DOAC medications (dabigatran, apixaban, rivaroxaban, edoxaban) work independently of
Vitamin K and do not require dietary monitoring of intake. They have a predictable effect and do not require laboratory monitoring. Instances that require assessment of anticoagulant effect such as overdose or emergency surgery can be difficult as each medication requires different lab studies and none are specific to each drug. In the presence of renal disease, dose adjustment is required.
