FNP General Flashcards
Which is a findings below is considered within normal limits?
A. A diastolic murmur and an 18-year-old
B. An INR of two in a patient taking warfarin
C. Cholesterol level of 205 and a 15-year-old
D. Blood pressure of 160/70 and a 75-year-old
B. An INR(International normalized ratio) is considered the best measure of clotting status and outpatient. Depending on the reason for anticoagulation, a common target is 2.0 Dash 3.0. Diastolic memories are always considered abnormal regardless of age. Cholesterol levels and adolescents should be less than 170 MG/DL (according to national heart, lung and blood Institute, NHLBI). Blood pressure of 160/75 constitutes isolated systolic hypertension, and, so this is abnormal.
A three-year-old child presents with hematuria, petechiae, and a platelet count of 50,000 (normal equals 150,000 -450,000/mL). The rest of his CBC is normal. He had an upper respiratory infection about two weeks ago. On exam today, he is found to have petechiae and bruises. The most likely diagnosis is
A.Polycythemia vera
B. Acute lymphocytic leukemia ALL
C. Von Willebrand‘s disease
D. Idiopathic thrombocytopenia purpura ITP
D.
The child’s platelet count as below normal. The term used to describe this is thrombocytopenia. I TP is the most common type found in children between the ages of two and four years. Nosebleeds and bleeding gums, especially with brushing of the teeth, our common. Generally, children are monitored closely for decreasing platelet counts and bleeding after I TPS identified, but this usually results in several weeks without treatment. The underlying cause is unknown, hence the name idiopathic. A common historical finding as an upper respiratory infection within the previous four weeks of the onset of ITP.
The most common place for indirect inguinal hernia’s to develop Is A. The internal inguinal ring B. The external inguinal ring C. Hesselbach‘s triangle D. Femoral ring
A.
The internal in queen your ring is the most common site for development of an indirect and we need a hernia these can occur in men and women. The most are probably congenital, symptoms may not be obvious until later in life. Indirect hernias are more common on the right side direct inguinal hernia’s occur through Hesselbach’s triangle.
The rubella vaccine is contraindicated in pregnant women because
A. It can cause rubella in the mother
B. It can cause rubella in the infant
C. It does not cross the placenta
D.Neurological toxicity may occur in the mother
B.
The rubella vaccine is contra indicated in pregnant patients because it crosses the placenta. Pregnant women should be advised to avoid pregnancy for 28 days after immunization with MMR. It should not be given during pregnancy. However, CDC has collected data on women who have accidentally received the immunization while pregnant and there have been no documented injury to the offspring. The vaccine is safe for women who are breast-feeding even though the rubella virus is excreted in the breastmilk
The most appropriate time to begin screening for renal neuropathy in a patient with type one diabetes is
The most appropriate time to begin screening for renal neuropathy in a patient with type one diabetes is
A. At diagnosis
B. Once annually after diagnosis
C. 2 to 3 years after diagnosis
D.Five years after diagnosis
D.
Patients with type one diabetes should be screened for Reno neuropathy five years after diagnosis. Since neuropathy takes several years to develop, it is highly improbable that a newly diagnosed patient will have neuropathy secondary to diabetes. Neuropathy develops in about 30% of patients with diabetes. Diabetic neuropathy is defined as the presence of diabetes and more than 300 MG/D of albuminuria on at least two occasions separated by 3 to 6 months.
A two year old with sickle cell anemia SCA should receive which immunizations?
A. All routine childhood immunizations at an accelerated rate
B. All routine childhood immunizations at a decelerated rate
C. I’ll routine childhood immunizations at the usual time
D.Immunization should be limited in this group
C.Children with sickle cell anemia should receive all the routine childhood immunizations at the usual time for administration, including annual flu immunization. Sickle cell crisis arise when children become ill. Unfortunately, children with SCA are more prone to sickle cell crisis when illness occurs, so, decreasing the likelihood of illness by immunization decreases the likelihood of sickle cell crisis.
A 43-year-old patient who has been diagnosed with hepatitis B has the following laboratory values. How should they be interpreted based on these values?
HCV IgG (-), RIBA (radio immuno blot assay (-)
A. The patient has hepatitis B and hepatitis C
B. The patient does not have hepatitis C
C. The patient could have hepatitis C
D.The results are in determinant
B
This patient does not have hepatitis C. This patient has a negative hepatitis C IgG. Currently, this is the screen. The RIBA was not necessary to perform, but, it confirms that this patient has a true negative screen for hepatitis C. If the HCV IGG had been positive, the RIBA would have been necessary to perform. There is no laboratory information that helps conclude that this patient has hepatitis B, except the history and the stem of the question.
Immunizations are not routinely given during the first trimester of pregnancy. Which immunization‘s may be safely given during the first trimester of pregnancy? A. Varicella and MMR B. Influenza C. Pneumococcus D. Hepatitis A and B
B
Influencer should be given during the first trimester to every pregnant patient. Life viruses should not be given during pregnancy. Therefore, MMR and Vericella should never be given to a patient known to be pregnant. There are no specific risks associated with pneumococcus and it appears to be safe when you give it in the second and third trimesters. There is no pregnancy information for hepatitis a or B immunizations, but, the general recommendation is to avoid these during pregnancy unless the patient is particularly at risk for hepatitis.
What are the most common signs and symptoms associated with mononucleosis? A. Fatigue and lymphadenopathy B. Cough and pharyngitis C. Spleno megaly and fever D. Rash and pharyngitis
A.
The most common symptoms associated with mononucleosis (mono) or adenopathy hundred percent and fatigue 9200%. Pharyngitis occurs and 65 to 85% of patients. Cough occurs less than 50%; splenomegaly occurs in 50 to 60%; fever 80 to 95%. The less common symptoms of mono is rash. It occurs in only 3 to 6% of patients.
In a three-year-old with fever, which finding my precipitate a febrile seizure?
A. A sudden decrease in body temperature after high fever
B. A worsening pneumonia
C. Initiation of an antibiotic
D.Returning to daycare prior to being fever free for 24 hours
A.
A sudden rise or fall and body temperature lowers the seizure threshold in children as well as adults. Therefore, gradually decreasing body temperature with antibiotics, consuming fluids, or removal of clothes is prudent when temperatures are greater than 101°F. Fever is most common precipitant of a febrile seizure. The most common diagnosis associated with febrile seizures is otitis media; pneumonia does not specifically increase the risk. Returning to daycare before being fever free for 24 hours increases the risk of transmission of most contagious illnesses, but, not seizure.
A 40-year-old patient has the following laboratory values. How should they be interpreted?
HBsAg (-), HBsAb (+), HBcAb (-)
A. The patient had hepatitis
B. The patient has hepatitis
C.The patient should consider immunization
D.The patient has been immunized
D
This patient has a negative hepatitis B surface antigen ( HBsAg). Therefore, he does not have hepatitis B. The patient has a negative hepatitis B core antibody ( HBcAb). Therefore, he has never had hepatitis B. The patient has a positive hepatitis B surface antibody (HBsAb). Therefore, he is considered immune. The patient is immune from immunization because his hepatitis B core antibody is negative. If the court antibody had been positive, he would be considered immune from the disease. Correct answer is D.
HIV testing during pregnancy
A. Is recommended by many learned authorities
B. Is an opt in approach
C. Is better performed in the third trimester
D.Produces many false positives
A.
Centers for disease control CDC and American College of obstetrics and gynecology ACOG, recommends an opt out approach to HIV screening and pregnant patients. Opt out means that HIV will be routinely performed unless the patient opt out. This practice has improved screening and pregnant patients and increased early intervention for HIV.
Drugs that target the Renin angiotensin aldosterone system are particularly beneficial in patients with A. Hypertension B. Chronic heart failure C. Kidney stones D. Diabetic neuropathy
D.
Examples of drugs that target the renin angiotensin aldosterone system or angiotensin converting enzyme ACE inhibitors and angiotensin receptor blocker‘s ARBS. These drugs are particularly beneficial to patients with diabetic neuropathy because they both prevent entry diabetic neuropathy. Additionally, decisions also decrease blood pressure has been shown to be renal protective. Management of glucose levels and blood pressure are especially important in preventing diabetic neuropathy.
Babies up to one year of age are called A. Newborns B. Toddlers C. Newbies D. Infants
D
The appropriate term for babies up to one year of age is infants. Newborns are usually less than one month of age. Toddlers are 2 to 3 years of age.
A 25-year-old male patient with a sub acute bacterial epididymitis should be treated initially with A.An oral quinolone B. Doxycycline C. Anti-inflammatories and analgesics D. ICE and squirrel support
B
In a 25-year-old male with subacute bacterial epididymitis, the most likely organism is chlamydia. Therefore, until cultures are back, he should be treated empirically with doxycycline 100 mg b.i.d. for 10 to 14 days or longer. Quinolone should specifically be avoided if the suspected agent is gonorrhea because of rising resistance. Anti-inflammatory agents, ICE, and scrotal support will help the patient symptoms but not treat the underlying cause.
In a viable pregnancy
A. Fetal heart tones can be heard at 4 to 6 weeks
B. Heart rates can exceed 240 bpm
C. Fetal heart tones are audible at about 9 to 12 weeks
D. The fetus begins to aspire at 6 to 8 weeks
C
Fetal heart tones can be heard as early as 9 to 12 weeks of a Doppler is used. Transvaginal ultrasound can identify movement of the heart at 5 to 6 weeks.
Nagele’s rule estimates A. The age of the fetus B. Days past conception C. Timing of prenatal interventions D. Date of confinement EDC
D
Girls rule estimates a woman’s due date based on the date of the last menstrual period. Three months are subtracted by the last menstrual period, seven days and one year are added. This predicts her due date. This is based on a pregnancy lasting 281 to 282 days.
A seven-year-old enters the nurse practitioner clinic. There is no evidence that he has received any immunizations. What should be administered today?
A. Hepatitis B, T dap, HIB, IPV, MMR
B. TD, HIB, IPV, varicella
C. Hepatitis B, tdap, IPV, varicella, MMR
D. Hepatitis B, IPV, vericrlla, MMR
C.
This child will be placed on CDC‘s catch-up schedule a copy can be downloaded from CDC‘s website. Because of his age, he does not need an HIB immunization. He does need all of the immunizations listed in Choice c.
A patient who is at high risk for skin cancer should
A.Examine his skin monthly for changes
B. Be examined by a dermatologist quarterly
C. Use emollient regularly
D.Eat foods high in vitamin C
A
Patients should be examined periodically for evidence of skin cancer by a professional examiner NP, MD or PA. The frequency and type of examiner depends on the risk level, and personal and family history of the patient. However, a patient should examine his own skin regularly for changes. Once he has began to examine his skin, research demonstrates that he will identify early changes and can make his provider aware of them.
Naegele’s rule is calculated by adding seven days to the last menstrual period end A. Subtracting three months B. Adding three months C. Subtracting four weeks D.Adding six weeks
A
Naegele’s rule is an excepted means of predicting gestational age of the fetus. This is based on an average length of pregnancy of 280 days. If the maternal history is not reliable, ultrasound becomes the standard.
A female patient has the following characteristics. Which one represents the greatest risk factor for development of type two diabetes? A. BMI 28 B. Lack of exercise C. Mediterranean decent D.Lack of regular healthcare
A.
A BMI of 26 or higher in parts an increased risk of type two diabetes. Mediterranean dissent does not impart a specific respect her for type two diabetes, but African-American, Asian American, and Hispanic races increase the risk of diabetes.
A six month old child comes into the clinic for immunizations. Which item below allows the delay in getting immunizations today?
A.Child is on antibiotics
B. Child has otitis media with a temperature of 103°F
C. Mom is pregnant
D.Child has a family member on chemotherapy
B.
A six-month-old with acute otitis media and a temperature of 103°F is considered moderately ill. Persons with moderate or severe illnesses, with or without fever, can be vaccinated as soon as they are recovering and not considered acutely ill. Antibiotics would not be considered a contraindication for any routine immunizations today. Pregnancy and the mother would not contra indicate any immunizations today. Life vaccines would be contra indicated if a family member was on chemotherapy, however, a six month old will not be receiving any live vaccines.
The major difference between varicose veins and atherosclerosis is A. Limbs affected B.Gender affected C. Vessels affected D. Degree of pain
C.
Varicose veins and atherosclerosis are very different disease processes. While differences can be found in gender affected, the major difference between the two diseases is the vessel affected; atherosclerosis affects the arteries, varicose vein‘s affect the veins. Well there is a pre-dialectician for the lower extremities in varicose veins, peripheral artery disease PAD is most common in the lower extremities to. Varicose veins are especially common in women 2:1; PAD is more common in men to: one after age 70 years. Pain is a subjective measure.
In order to establish pregnancy, a pregnancy test of the urine or blood is routinely performed. How early can this be done with reliable results? A. Within three days after conception B. Within seven days after conception C. 1 to 2 weeks after conception D. 35 days after last menses
C
Weather performed on urine or blood, the presence of the beta subunit of human cholinergic gonadotropin hCG is evaluated to identify pregnancy. This can be found in great quantities in the first morning urine or at any time in a serum sample of pregnant women. Both tests are highly sensitive, however if the pregnancy is very early and a first morning urine is not used, the urine test may be negative in a pregnant woman. In this instance, the serum specimen will indicate pregnancy.
Which of the following symptoms is typical of GERD? A. Chest pain B. Cough C. Sore throat D. Pyrosis
D
Typical symptoms of GERD include pyrosis heartburn. The other symptoms listed are considered atypical symptoms of GERD. Patient to present with atypical symptoms of GERD, especially if older than 50 years, should be considered for endoscopy
A side effect of DTaP that should be reported is
A. Temperature of 103°F
B. Vomiting
C. Nonstop crying three hours or more
D. Injection site soreness lasting greater than two days
A
Nonstop crying for three hours or more and occurring within 48 hours of the immunization is not a specific contra indication, but careful consideration must be given to the benefits and risks of the vaccine under the circumstances. The temperature that should cause concern, but is not a contraindication to a subsequent dose of MMR is 105°F within 48 hours of immunization. Vomiting and injection site soreness are not contraindications or concerns after MMR
A 70-year-old African-American male complains of pain in his back and trunk. Cardiovascular disease is ruled out. He has a normocytic normochromic anemia with hypercalcemia. A likely diagnosis is A. Multiple myeloma B. Lymphoma C. Leukemia D.Prostate cancer
A
Multiple myeloma is a neoplastic Proliferation in the bone marrow which results in skeletal distraction. It is more common in older patients; the average age of diagnosis is 66 years. Common clinical findings are pain in the long bones, especially those of the trunk and back. A company in findings are anemia, usually normocytic/normochromic, hypercalcemia, and renal insufficiency.
A patient who is found to be pregnant has asymptomatic bacteriuria. What is the likely pathogen? A Klebsiella B. E. coli C. Staph saprophyticus D.No pathogen
B
A pregnant patient with asymptomatic bacteriuria should be treated with an anabiotic because she is at risk for developing Pyelonephritis. Nitrofurantoin is safe for you starting pregnancy and has a very good coverage of the most common urinary tract pathogen‘s, including E. coli.
A patient with testicular torsion will have a
A. Positive cremasteric reflex on the affected side
B. Negative cremasteric reflex on the affected side
C. Positive cremasteric reflex bilaterally
D. Negative cremasteric reflex bilaterally
B
A patient with testicular torsion will have a negative cremasteric reflex and a high riding testes. There can also be profound testicular swelling and an acute onset of scrotal pain.
A contraindication to giving MMR is
a. Family history of any adverse event after a dose
B. Fever of 104°F within 72 hours of immunization
C. Seizures within seven days of immunization
D.Encephalopathy within seven days after immunization
D
Encephalopathy within seven days after MMR is an absolute contraindication. Fever of 105°F or greater within 48 hours and seizures within three days after immunization are not a specific contraindication, but benefits shit outweigh risks before giving a second dose. A family history of any adverse event after an MMR immunization does not contra indicate any immunization.
A patient with a positive history of a tick bite about two weeks ago and erythema migraines has a positive ELISA for borrelia . The Western blot is positive. How should this be managed?
A. He should receive doxycycline for Lyme disease
B. He should receive penicillin for syphilis
C. He does not have Lyme disease or syphilis
D. He needs additional testing to confirm Lyme disease
A
The first serological test for Lyme disease is the ELISA. If this is positive, it should be confirmed. In this case, it was confirmed by a western blot and it is positive. This patient can be diagnosed with Lyme disease. The appropriate treatment for erythema migraines is doxycycline, amoxicillin, or cefuroxime for 21 days. All three medications were found to be of equal efficiency.
A 17-year-old female is found to be pregnant. What is the least likely risk to her fetus? A. Toxoplasmosis B. Hepatitis B and C C. Down syndrome D.Chlamydia
C
Routine prenatal screening is important for all pregnant women. Based on her age and the likelihood of multiple partners, she should be screamed for STDs to include HIV and hepatitis B and C and chlamydia. Down syndrome is more likely in an older pregnant woman. Toxoplasmosis is contracted after exposure to feces of cats and under cooked meats.
