Quizzes and Tests

Question 1

What are the attributes of the patient-centered medical home?

Comprehensive care; patient-centered, coordinated care; accessible services; quality; and safety

Efficiency, time management, quality improvement, collaboration, and cost reduction

Comprehensive care, cost reduction, patient safety, and quality improvement

Planned care, quality improvement, and team-based care

Answer 1

Comprehensive care; patient-centered, coordinated care; accessible services; quality; and safety

Question 2

True or False

In the patient-centered medical home (PCMH) model, specialists are responsible for communicating their plan with primary care.

Answer 2

False. The PCP is responsible.

Question 3

When caring for individuals in long-term care facilities, the nurse practitioner’s goal of care is rehabilitation and improving functional status back to baseline.

Answer 3

False. In skilled / acute care this is the case. In LTC, no improvement is expected to the goal is maintain function and prevention of exacerbation.

Question 4

True or False

The goal of a co-management agreement document is to define the roles of each provider and communicate this information to all clinicians.

Answer 4

True

Question 5

True or False

When working in a specialty practice, it is acceptable to manage diagnoses that do not pertain to your specialty.

Answer 5

False. The expectation for nurse practitioners working in a specialty practice is that they will only treat the conditions for which they have been consulted.

Question 6

A diabetic patient presents to your office for preoperative clearance. The surgical clearance paperwork does not specifically ask for a glucose level or A1c result.

True or False

To clear the patient for surgery, you must have a recent lab result indicating good control of the patient’s glucose.

Answer 6

True. As the clearing provider, you must determine what labs are needed based on the patient

Question 7

True or False

One of the main reasons for a post-hospitalization follow-up appointment is to prevent hospital readmission.

Answer 7

True

Question 8

True or False

Because primary care offices operate independently from other practices, they do not need to participate in organizational quality improvement projects.

Answer 8

False.

Question 9

True or False

Quality measures for nurse practitioners are the same as quality measures for nurses.

Answer 9

False. Q-scores are related to the position, which is different from RNs

Question 10

True or False

The patient-centered medical home requires primary care practices to have a systematic focus on QI and safety.

Answer 10

True

Question 11

An advanced practice registered nurse (APRN) is examining a patient who has been unresponsive to treatment for a second-degree burn on the forearm and hand that occurred three weeks ago.

Which action should the APRN take first to assist this patient?

Send for a surgical consult

Refer to an orthopedic hand specialist

Refer to a wound specialist

Send to the emergency room

Answer 11

Refer to a wound specialist

Question 12

A patient with a history of epilepsy tells an advanced practice registered nurse (APRN) about experiencing increased activity and lip-smacking during seizures. The patient is compliant with the current medication regimen.

Which action should the APRN take next for this patient?

Order a STAT CT scan of the head

Change the anticonvulsant

Schedule an EEG

Consult with a neurologist

Answer 12

Consult with a neurologist

Question 13

A patient is in a clinic for follow-up after a renal calculi extraction. The renal stones were found to be calcium-based.

Which dietary modification should an advanced practice registered nurse (APRN) recommend?

Increase nuts in the diet

Increase fruit consumption

Limit sugary drinks

Limit coffee intake

Answer 13

Limit sugary drinks

Question 14

An advanced practice registered nurse (APRN) is part of an integrated multidisciplinary team that is working in a busy rural clinic. The team has been struggling with day-to-day operational communication, so the APRN suggests a strategy for improvement.

Which strategy should the APRN suggest to manage this problem?

Promoting timely feedback on concerns

Instituting a sign-off process for treatment plans

Adopting an integrated electronic health record

Requiring attendance at daily huddles

Answer 14

Promoting timely feedback on concerns

Question 15

A heath system wants to decrease the number of employee injuries from lifting. A project team is formed to select lifting equipment that meets the needs of several departments across the health system. An advanced practice registered nurse (APRN) leads a team to evaluate equipment from three manufacturers.

The team develops a chart to evaluate each piece of equipment and scores the equipment according to how it would operate in the following categories:

• Severity: Identify all activities the equipment is expected to do.
• Occurrence: For each activity, evaluate what could go wrong.
• Detection: For each thing that could go wrong, evaluate what the effect would be.

According to this scenario, which quality process did the APRN implement for this project?

DMAIC

PDCA

FMEA

SMART

Answer 15

FMEA (failure mode effects analysis) is a tool for proactively evaluating products and identifying ways to prevent defects. It can spot problems before a piece of equipment is put into practice.

Question 16

When conducting a gynecologic history, what are the upper and lower ages considered normal for menstruation?

Answer 16

9 and 52

Question 17

The most common type of vulvar cancers are squamous cell carcinomas.

Answer 17

True. HPV plays a role in this.

Question 18

All women age 40 and older should have yearly mammograms

Answer 18

False. There are different recommendations from different agencies. All of them do recommend every other year for women 50+

Question 19

What is the recommended interval for Pap smear screenings for a 26-year-old woman?

Pap smears are not recommended for this age

Every three years

Every five years with HPV co-testing

Yearly

Answer 19

Every three years.

Age 21-29, every three years
Age 30 - 65, every three OR every five if co-testing
Age 21 and younger and Age older 65 - not recommended

Question 20

What is the FDA-approved age range for females to receive the quadrivalent HPV vaccine?

Ages 11 to 12

Ages 9 to 26

Ages 10 to 25

Ages 12 to 21

Answer 20

Ages 9 to 26

Question 21

What is the FDA-approved age range for females to receive the quadrivalent HPV vaccine?

Ages 11 to 12

Ages 9 to 26

Ages 10 to 25

Ages 12 to 21

Answer 21

Ages 9 to 26

Question 22

A family history of breast cancer is a risk factor for developing breast cancer. What is another established risk factor for developing breast cancer?

First live birth at age 26

Smoking

Menarche at age 13

A history of benign breast biopsy

Answer 22

A history of benign breast biopsy

If a patient requires a biopsy due to a mammogram or other reason, then this is considered a risk factor even if the biopsy is normal.

Question 23

What is a recommended medication course for chlamydia trachomatis?

Doxycycline 1 g PO QD x 5 days

Azithromycin 1 g PO once

Ceftriaxone 250 mg IM once

Erythromycin 150 mg PO QID x 3 days

Answer 23

A one time dose of azithromycin 1 gram is the treatment recommendation.

You co-treat confirmed gonorrhea for probable chlamydia not ruled out. Treat gonorrhea with 250 or 500mg ceftriaxone IM.

Question 24

A 21-year-old woman meets with an advanced practice registered nurse (APRN) for a Pap smear, and there is blood in the specimen. This is the first time this result has occurred.

Which recommendation should the APRN include in this patient’s plan of care?

Order a reanalysis of the results

Obtain a CBC

Repeat Pap smear as soon as possible

Schedule a follow-up Pap smear in three months

Answer 24

If Pap smear results are unsatisfactory for any reason, such as insufficient cells, obstruction with solution particles, or blood in specimen, the Pap smear should be repeated in three months.

Question 25

A 35-year-old multiparous woman presents to a clinic for an annual physical. An advanced practice registered nurse (APRN) obtains the patient’s general health history and menstrual history. The patient’s last pelvic exam with cytology and HPV co-testing was three years ago, which was found to be normal.

Which action should the APRN include in this plan of care?

Repeat cytology and HPV co-testing in five years

Repeat cytology in one year with no need to repeat HPV co-testing

Repeat cytology and HPV co-testing in two years

Repeat HPV co-testing in one year with no need to repeat cytology

Answer 25

Repeat cytology and human papillomavirus (HPV) co-testing should be performed every five years. Since this was last done three years ago, it needs to be repeated in two years.

Question 26

A 32-year-old woman’s Pap smear test results show atypical squamous cells of undetermined significance (ASCUS). An advanced practice registered nurse (APRN) is performing a colposcopy and notes an area of sharply delineated acetowhite epithelium.

Which action should this APRN take?

Perform a diagnostic conization

Perform a punch biopsy

Perform a radical trachelectomy

Perform a repeat cervical cytology

Answer 26

The area of sharply delineated acetowhite epithelium noted on a colposcopy is considered a hallmark sign of cervical neoplasia and is considered a grossly abnormal cervix. Any patient with a grossly abnormal cervix should have a punch biopsy performed.

Question 27

A 52-year-old woman presents to an advanced practice registered nurse (APRN) for complaints of hot flashes, irritability, and difficulty falling asleep. The APRN notes a T score of −2.0 on the woman’s bone density scan.

Which action should the APRN recommend for this patient?

Begin a high-protein, low-carbohydrate diet

Start walking and weight-bearing exercises

Supplement 2,000 to 3,000 mg of calcium twice daily

Increase potassium and decrease vitamin D intake

Answer 27

A bone densitometry T score of −2.0 indicates low bone density or osteopenia. Walking and weight-bearing exercises both help to increase bone mineral mass and reduce the risk of fracture-causing falls.

Question 28

2, An advanced practice registered nurse (APRN) examines a patient with unexplained infertility. Lab results reveal a progesterone level of <5 ng/mL.

Which treatment should the APRN prescribe for this cause of infertility?

Danazol 800 mg tablets #30/5 refills; one tablet daily starting on the first day of menstrual cycle

Human chorionic gonadotropin hormone 10,000U IM; single-dose once a day using prefilled syringe

Clomiphene citrate 50 mg tablets #5; one tablet daily for five days starting on day three of the menstrual cycle

Doxycycline 100 mg tablets #20; one tablet twice daily for 10 days

Answer 28

The progesterone level indicates a problem with luteal function. Clomiphene citrate is a fertility drug to correct any luteal insufficiency in women with unexplained infertility. Clomiphene is usually started on day 3, 4, or 5 of the menstrual cycle at a dose of 50 mg (one pill) once daily for five days. The first day of bleeding is called cycle day 1.

Question 29

How can poor nutrition and vitamin deficiencies affect the fetus?

Neural defects and endocrine changes

Infantile torticollis

Metabolic changes and distended scalp veins

Breech presentation

Answer 29

Folic acid deficiencies can cause neural defects, and poor nutrition can result in endocrine changes.

Question 30

You receive the lab results of a 20-week gestation patient and note the sodium level is 131 mEq/L. What is an appropriate action?

Prescribe Na+ supplementation tablets

Nothing, because this is an expected change in pregnancy

Nothing, because this is a normal sodium value

Immediately send the patient to the emergency department

Answer 30

Nothing, because this is an expected change in pregnancy

Sodium levels decrease by 2–4 mEq/L in pregnant women. Since this sodium level is at the very low end of normal, you may want to monitor closely with repeat testing.

Question 31

Regardless of maternal age, __________ is an indication for genetic counseling and prenatal diagnosis.

Answer 31

Multiple fetal loss

Question 32

A woman at 10 weeks gestation presents to your office with a blood pressure of 154/88.

True or False

This patient meets criteria for the diagnosis of pregnancy induced hypertension.

Answer 32

False. HTN before 20 weeks is chronic hypertension.

Question 33

True or False

Gestational diabetes is a risk factor for developing preeclampsia.

Answer 33

True

Question 34

True or False

The leading cause of infant mortality in the United States is birth occurring before 37 weeks gestation.

Answer 34

True

Premature birth causes 45% of infant death

Question 35

rue or False

In studies, most antihistamines do not appear to be linked to birth defects.

Answer 35

True

Question 36

True or False

Prophylactic oral oseltamivir is recommended for pregnant patients who have had close contact with someone infected with influenza.

Answer 36

True.

Question 37

A 37-week gestation woman presents to your office for back pain with sciatica. She denies any injuries or falls, and her exam is essentially normal. What is the most appropriate treatment plan?

Instruct her to take OTC ibuprofen

Prescribe methocarbamol and naproxen

Order an Xray of the lumbar spine and physical therapy

Instruct her to take OTC acetaminophen and apply topical menthol

Answer 37

Back pain with sciatica is common in pregnancy, and since there is no mechanism of injury or abnormalities on exam, over-the-counter acetaminophen and topical menthol are appropriate.

Question 38

True or False

A milk bleb is a tiny amount of visible milk under the skin due to a blocked nipple pore.

Answer 38

True

The duct opening is blocked by a piece of skin, causing a back up

Question 39

True or False

A lactating mother should dump milk for eight hours after consuming ibuprofen.

Answer 39

False

Question 40

True or False

A score of more than 10 on the Edinburgh Postnatal Depression Screen suggests depression may be present.

Answer 40

True

Question 41

How is the estimated date of confinement calculated from the first day of the last menstrual period (FDLMP)?

Add nine months and subtract seven days from the FDLMP.

Count back three months from the FDLMP, add one year, and subtract seven days.

Add nine months and seven days to the FDLMP.

Add nine months to the FDLMP.

Answer 41

The estimated date of confinement (EDC) or “due date” may be determined by adding nine months and seven days (or 40 weeks) to the first day of the last menstrual period.

Question 42

hoGAM [Rho(D) Immune Globulin (Human)] is clinically indicated for an Rh-negative pregnant woman in which of the following situations?

Prophylactically at 28 weeks of pregnancy

Any time laboratory blood work is done on the mother

When pregnancy is confirmed

At 12 weeks gestation

Answer 42

Prophylactically at 28 weeks of pregnancy

Question 43

A 24-weeks-gestation pregnant woman presents to your office with new onset hypertension, with a blood pressure of 154/88. Her urine is negative for protein, but her serum creatinine level is rising.

True or False

This patient meets the criteria for preeclampsia.

Answer 43

True

Question 44

True or False

Glucophage is contraindicated for gestational diabetes.

Answer 44

False. Metformin and Insulin are the safest diabetes meds in pregnancy.

Question 45

True or False

Pregnant women should receive the influenza nasal spray vaccine

Answer 45

False

Question 46

True or False

During pregnancy, most aches and pains can be managed with acetaminophen, but a short course of narcotic medications for severe pain or serious injuries is considered safe.

Answer 46

True

Question 47

True or False

Depression screening is suggested for all pregnant and postpartum women.

Answer 47

True

Question 48

A lactating mother presents to your office with acute bronchitis. She has been up all night coughing and is exhausted. She is requesting codeine cough syrup that has helped her in the past. What is an appropriate response to the mother’s request?

Provide an alternative prescription for dextromethorphan and explain that codeine is not safe for lactating mothers.

Prescribe the codeine as requested.

Prescribe benzonatate instead.

Explain that she can take codeine, but she must “dump” milk for at least four hours.

Answer 48

Provide an alternative prescription for dextromethorphan and explain that codeine is not safe for lactating mothers

Question 49

A lactating mother presents to your office with a red, painful, swollen area on her right breast, chills, and a fever of 101.6°F. What is an appropriate treatment plan for this patient?

Azithromycin 500 milligrams (mg) for one dose, then 250 mg per day for four days

Culture the breast milk

Clindamycin 300 mg PO TID for 10–14 days

Amoxicillin 500 mg TID

Answer 49

Clindamycin 300 mg PO TID for 10–14 days is a recommended treatment course for lactation mastitis.

Question 50

True or False

Ectopic pregnancy is most likely to occur between the sixth and twelfth weeks of gestation.

Answer 50

True

Question 51

A patient presents to an advanced practice registered nurse (APRN) for a prenatal checkup for a second pregnancy. The patient developed gestational diabetes with the first pregnancy.

Which lab test should the APRN perform for this patient?

Human placental lactogen

Corticotropin-releasing hormone

Human chorionic gonadotropin

Prolactin level

Answer 51

Human placental lactogen antagonizes the cellular action of insulin and decreases maternal glucose utilization, which increases glucose availability to the fetus. This may play a role in the pathogenesis of gestational diabetes.

Question 52

A 30-year-old patient is 12 hours postpartum. The patient reports extreme fatigue due to prolonged labor, a feeling of fullness in the suprapubic region, and heavy blood loss >500 mL. The attending advanced practice registered nurse (APRN) assesses the patient and determines the patient needs postpartum obstetric hemorrhage care.

Which set of steps should the APRN take to assist this patient?

Infuse oxytocin, assess for vaginal lacerations, and prepare two units of PRBCs

Move patient to labor and delivery, give carboprost, and complete labs

Increase the infusion rate of oxytocin, give methergine, and provide fundal massage

Repeat labs, transfuse with PRBCs and platelets, and consider ligation

Answer 52

Increase the infusion rate of oxytocin, give methergine, and provide fundal massage

Question 53

A patient is admitted at 14 weeks gestation for hyperemesis gravidarum. An advanced practice registered nurse (APRN) prescribes 0.9% normal saline IV, vitamin B6, diphenhydramine, and metoclopramide. The vomiting is controlled; however, the patient begins to develop involuntary facial tics and eye blinking.

Which action should the APRN take for this patient?

Insert an NG tube

Decrease diphenhydramine

Increase the IV rate

Discontinue metoclopramide

Answer 53

Metoclopramide is a phenothiazine and should be stopped immediately if there are any signs of tardive dyskinesia (involuntary movements, usually of the face).

Question 54

A patient who is at 11 weeks gestation presents to the emergency department with a laceration from a rusty fence. An advanced practice registered nurse (APRN) assesses the laceration and learns that the patient’s last Td vaccination was 12 years earlier.

Which vaccine protocol should the APRN use for this patient?

Administer Td at 27 weeks

Administer Tdap at 27 weeks

Administer Tdap at the current visit

Administer Td at the current visit

Answer 54

In circumstances where the patient has a wound requiring the vaccination, the recommendation is to administer a Tdap (a vaccine against tetanus, diphtheria, and pertussis) on the day of the visit. The vaccine would not need to be readministered later in the pregnancy.

Question 55

A patient who is 36 weeks pregnant is seeing an advanced practice registered nurse (APRN) for a follow-up visit associated with a recent diagnosis of hypertension. The patient is taking atenolol and plans to breastfeed.

Which change in medication should the APRN make for this patient?

Acebutolol

Methyldopa

Furosemide

Nadolol

Answer 55

Methyldopa is the drug of choice for the treatment of hypertension during pregnancy. Methyldopa is also considered compatible with breastfeeding.

Question 56

True or False

A urinary tract infection (UTI) should be managed inpatient in a male who appears toxic.

Answer 56

True

Question 57

What is the most emergent cause of testicular pain in a young male?

Tumor

Testicular torsion

Epididymitis

Varicocele

Answer 57

Testicular torsion

Question 58

True or False

The normal prostate is heart shaped and measures approximately 4 × 3 × 2 cm.

True

False

Answer 58

True

Question 59

Men on testosterone replacement therapy should have a testosterone blood test ________ after testosterone gel is rubbed in.

Answer 59

2 hours

Question 60

True or False

Risk factors for erectile dysfunction include hypertension, diabetes, and depression

Answer 60

True

Question 61

True or False

In a younger man without a sexually transmitted infection (STI), the presence of a urinary tract infection (UTI) is often associated with anatomic abnormality.

Answer 61

True

Question 62

A 21-year-old male presents for dysuria. He admits to recent unprotected sex with possible exposure to a sexually transmitted infection (STI). The in-office dipstick urinalysis is positive for leukocytes and nitrites. You ordered a urine culture and STI testing, but these are sent out and the results will not be available for two to three days. What is the best class of antibiotics for treatment until the results are back?

Penicillins

Lincomycins

Cephalosporins

Fluoroquinolones

Answer 62

Initial treatment with a fluoroquinolone is recommended, which can be changed if indicated by the STI and urine culture results.

Question 63

A patient presents with a low-grade fever, a heavy sensation in the testicles, and a sudden onset of severe pain that may be partially relieved by elevating the scrotum. What is the most likely diagnosis?

Hydrocele

Varicocele

Inguinal hernia

Epididymitis

Answer 63

The symptoms of epididymitis include low-grade fever, a heavy sensation in the testicles, and a sudden onset of severe pain that may be partially relieved by elevating the scrotum.

Question 64

A patient presents with pain and a lump in the testicle.

True or False

An ultrasound of the scrotum is recommended if the patient has no concerning or emergent clinical symptoms.

Answer 64

True

Question 65

True or False

A prostatic massage to express prostatic secretions is indicated if acute bacterial prostatitis is suspected.

Answer 65

True

Question 66

True or False

Benign prostatic hyperplasia is a risk factor for prostate cancer.

Answer 66

True

Benign prostatic hyperplasia does not increase the chance of prostate cancer. Prostate enlargement is a normal part of aging.

Question 67

Which benign prostatic hyperplasia medication is contraindicated in those with a sulfa allergy?

Silodosin

Sildenafil

Tamsulosin

Finasteride

Answer 67

Tamsulosin should not be used in those with a sulfa allergy.

Question 68

What lab tests should be done when monitoring testosterone supplement injections?

Testosterone and lipid level

Testosterone level

Testosterone level and a comprehensive metabolic profile

Hematocrit, prostate specific antigen, testosterone level

Answer 68

Hematocrit, prostate specific antigen, testosterone level

testosterone can stimulate the growth of preexisting prostate cancer, and prostate specific antigen should be monitored. An elevated hematocrit is the most commonly reported adverse event from testosterone supplementation. Monitoring testosterone levels is recommended, with the goal of achieving levels in the mid-normal range.

Question 69

True or False

Low testosterone levels in men are associated with increased mortality.

Answer 69

True

Question 70

True or False

Some of the major drug classes associated with erectile dysfunction include antihypertensives, antidepressants, and tranquilizers.

Answer 70

True

Question 71

True or False

A multidisciplinary approach to the treatment of male sexual dysfunction may include a psychologist, marriage counselor, sex therapist, and urologist.

Answer 71

True

Question 72

A 72-year-old male patient is speaking to an advanced practice registered nurse (APRN) about urinary hesitancy, urgency, nocturia, and frequency. Urinalysis confirms hematuria and elevated prostate specific antigen (PSA). During a digital rectal exam, the APRN notes an asymmetric prostate with a firm nodule.

Which diagnosis should the APRN make for this patient?

Prostate cancer

Benign prostatic hypertrophy

Hydrocele

Prostatitis

Answer 72

Prostate cancer presents with urinary tract abnormalities, hematuria, elevated prostate specific antigen (PSA), and an asymmetric prostate with a firm nodule.

Question 73

A 55-year-old male patient is being seen by an advanced practice registered nurse (APRN) for the inability to complete intercourse due to erectile dysfunction. The APRN completes a thorough review of the patient’s previous health history and medication usage.

What should the APRN consider as a possible cause?

History of untreated prostate cancer

Side effect of taking levofloxacin

Side effect of taking atenolol

History of treatment for HIV

Answer 73

Atenolol is a beta-blocker used to treat angina and hypertension that has a side effect of erectile dysfunction.

Question 74

A 55-year-old male patient is being seen by an advanced practice registered nurse (APRN) for the inability to complete the act of intercourse due to erectile dysfunction. The APRN suspects the patient has erectile dysfunction but is unsure whether the cause is organic or psychogenic.

Which diagnostic test should the APRN order to determine the origin of this problem?

Digital rectal exam

Sleep study

Sildenafil trial

Postage stamp test

Answer 74

A postage stamp test is conducted by placing a roll of stamps around the penis at bedtime; if the stamps are broken apart in the morning, it is determined that erection has occurred. This test has a high sensitivity for differentiating between organic (inability to have an erection) and psychogenic (psychological).

Question 75

A 30-year-old male patient who has a history of epididymitis is being seen in a clinic by an advanced practice registered nurse (APRN). The patient is concerned that this condition is reoccurring.

What should the APRN consider as a sign of this condition?

A positive cremasteric sign

A negative Prehn’s sign

A negative Murphy’s sign

A positive McBurney’s sign

Answer 75

A positive cremasteric reflex can be considered a sign of epididymitis. The cremasteric reflex is a superficial reflex found in human males that is elicited when the inner part of the thigh is stroked.

Question 76

4, A 26-year-old male patient is diagnosed with gonorrhea and is speaking with an advanced practice registered nurse (APRN) about treatment. The APRN provides a single-dose antibiotic therapy and then educates the patient about the wait period recommended before resuming sexual activity.

Which wait period should the APRN recommend?

Seven weeks

Seven days

Three weeks

Three days

Answer 76

Seven days

A seven-day wait period before resuming sexual activity is appropriate after receiving a single-dose antibiotic for gonorrhea.

Question 77

True or False

The term “cisgender” means a person whose gender identity is the same as the gender they were assigned at birth.

Answer 77

True

Question 78

rue or False

Self-identification as LGBTQIAP+ does not mean that an individual has mental illness.

Answer 78

True

Question 79

rue or False

A family nurse practitioner cannot treat a genitourinary problem in a transgender patient.

Answer 79

False

Question 80

Which baseline lab work is required for individuals beginning PEP?

Complete blood count

Serum liver enzymes

Hormone levels

Thyroid function

Answer 80

Serum liver enzymes

Question 81

What is post-exposure prophylaxis (PEP)?

Vaccines to prevent the spread of disease

Medications that prevent a patient from contracting HIV

Antiretroviral drugs

Condoms and other barrier methods

Answer 81

Antiretroviral drugs

Pre-exposure prophylaxis are medications to reduce the risk of contracting HIV

Question 82

When discussing sexual health with a male who has sex with men, what is an important component of wellness education?

Maintaining a healthy weight

Cancer screenings

Condom use

Influenza vaccine recommendations

Answer 82

Condom use

Question 83

True or False

According to the Centers for Disease Control and Prevention (CDC), PrEP should be offered to all adolescents and adults who have had sex in the last six months with inconsistent condom use.

True

False

Answer 83

True
The current recommendation by the CDC is for PrEP to be offered to anyone who has had anal or vaginal sex in the past six months with one of the following additional add-ons: sex with an HIV-positive sexual partner (especially if the partner has an unknown or detectable viral load), the patient has had a recent bacterial STI, or the patient has a history of inconsistent or no condom use with sexual partners, and HIV-positive sexual partner (especially if the partner has an unknown or detectable viral load); or a recent bacterial STI, or a history of inconsistent or no condom use with sexual partner(s).

Question 84

True or False

The term “intersex” means a person whose gender has been changed.

Answer 84

Gender reassignment is a surgery to change an individual’s gender. Intersex refers to those individuals with a disorder related to sexual development resulting in chromosomal anomaly or ambiguous genitalia.

Question 85

True or False

Many LGBTQIAP+ patients have had prior experiences with healthcare providers that have left them feeling marginalized or stigmatized.

Answer 85

True

Question 86

True or False

Older LGBTQIAP+ adults are less likely to have children or other family members who are involved in their care.

Answer 86

True

Question 87

LGBTQIAP+ patients may avoid _____ due to a history of negative interactions.

Answer 87

medical care

Question 88

Some members of the LGBTQIAP+ community have misconceptions regarding the need for preventative healthcare.

True or False

Pap smear screenings are unnecessary for lesbian women.

Answer 88

False

All women, including those who are lesbian, gay, or bisexual, need to have cancer screenings with a Pap smear test.

Question 89

True or False

When speaking to a transsexual, you should use the pronoun that corresponds to how they are dressed.

Answer 89

False.

Ask them their preference

Question 90

PEP must be initiated within ______ hours of exposure.

Answer 90

72

Question 91

An advanced practice registered nurse (APRN) is meeting a transgender patient for the first time.

Which action should the APRN take to ensure that psychosocial considerations are addressed?

Ask if they identify as female

Ask which pronoun they prefer

Inquire about prior sexual orientation best practices

Inquire about sexually transmitted diseases

Answer 91

Ask which pronoun they prefer

Question 92

An advanced practice registered nurse (APRN) is seeing a 21-year-old patient to administer an HPV vaccination. The patient states that he self-identifies as homosexual but is having problems dealing with his sexual identity.

Which intervention should the APRN provide for this patient?

Check for status of hepatitis A and B vaccination

Arrange for a psychiatric evaluation

Test for hepatitis C

Complete a depression screening

Answer 92

Complete a depression screening

A depression screening should be done, as depression and suicide are more common in LGBTQIA individuals.

Question 93

An advanced practice registered nurse (APRN) is providing care for a patient who self-identifies as part of the LGBTQIA population.

How should the APRN address the patient in this situation?

Ask the patient if they have a girlfriend or boyfriend

Address the patient in accordance to the sex they were assigned at birth

Ask the patient to provide information about themselves and see where it leads

Address the patient as “sir” and see if the patient provides a correction

Answer 93

Ask the patient to provide information about themselves and see where it leads

Question 94

An advanced practice registered nurse (APRN) is providing care for a female patient who self-identifies as bisexual. The APRN is familiar with the top health issues identified for the LGBTQIA population in the Substance Abuse and Mental Health Services Administration (SAMHSA) report.

Based on the SAMHSA report, which action should the APRN take for this patient?

Collect BMI data and provide obesity counseling

Educate regarding the importance to start engaging in physical activity

Encourage routine mammogram screening

Assess for intimate partner violence

Answer 94

Assess for intimate partner violence

Question 95

A 40-year-old gay man presents to a clinic with complaints of dysuria, frequency, and urgency. He tells an advanced practice registered nurse (APRN) that he has had unprotected anal intercourse. The APRN diagnoses the patient with a urinary tract infection and recommends a treatment that will eliminate the bacteria causing the problem.

Which bacteria is the APRN treating?

Borrelia burgdorferi

Escherichia coli

Streptococcus pyogenes

Pseudomonas aeruginosa

Answer 95

Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal tract, causes urinary tract infections.

Question 96

The timed up and go (TUG) test (CDC, 2017) is used to assess a patient’s risk of falls. Which elements would patients perform as part of the TUG test?

Reach forward beyond arm’s length while maintaining a fixed base of support in the standing position without taking steps

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

Answer 96

Stand from a seated position, walk 10 feet, turn, walk back, and sit down

Question 97

The Katz independence in activities of daily living scale is a tool commonly used to assess basic function.

True or False

A score of four indicates severe impairment.

Answer 97

False.

A score of two or less is severe.

Question 98

True or False

Cognitive impairment is best detected using a routine history and physical examination.

Answer 98

False.

A screening tool is best

Question 99

Minimally disruptive medicine is an approach to providing care for patients with complex needs.

True or False

The goal of minimally disruptive medicine is to focus on the patient’s goals for his or her health and life while lessening treatment burden.

Answer 99

True

Question 100

Due to normal decline, drug metabolism becomes compromised with age.

True or False

In general, medication doses need to be higher to be effective in older patients.

Answer 100

False.

Cardiovascular, neurocognitive, hepatic, and renal function are compromised in geriatric patients, although the extent can depend on an individual’s overall health and comorbidities. Most medications need to be given in the same or smaller doses for older patients due to decreased drug metabolism and clearance.

Question 101

A holistic approach to prescribing for older patients includes an assessment of ______

Answer 101

The ability to swallow the size of pill or tablet being prescribed

Question 102

True or False

Palliative care provides symptom relief for dying patients and should only be considered in the last stages of terminal illness.

Answer 102

False.

Palliative care is appropriate at any time during the course of a serious illness.

Question 103

True or False

A patient must be suffering from a life-limiting illness to be eligible for advance care planning.

Answer 103

False

any patient, at any stage of health, may complete advance care planning, a healthcare power of attorney, and a living will.

Question 104

At what point should families be involved in advance care planning?

When a patient can no longer make his or her wishes known

During any stage of health or disease course, and at any age

When a life-limiting illness is diagnosed

During the terminal stages of a disease

Answer 104

During any stage of health or disease course, and at any age

Question 105

Which type of visit will Medicare reimburse for advance care planning?

Sports physical

Medicare does not reimburse for advance care planning discussions

Medicare wellness visits and a hospital follow-up after an acute severe illness

Office visit for diabetic education

Answer 105

Medicare wellness visits and a hospital follow-up after an acute severe illness

Medicare reimburses for advance care planning if the following are documented in the note: an account of the discussion, who was present, explanation of forms, and the time spent in the face-to-face encounter. In general, Medicare reimburses for advance care planning during visits for routine physicals and with significant changes in health status.

Question 106

What does the concept of rational polypharmacy refer to?

The provider discussing the rationale for prescribing many medications

Only prescribing the lowest cost medications

When patients have multiple chronic and comorbid conditions necessitating the prescribing of many medications

For patients prescribed many pills, they should take only a small ration of them per day

Answer 106

When patients have multiple chronic and comorbid conditions necessitating the prescribing of many medications

Question 107

What is the purpose of the American Geriatrics Society’s Beers criteria?

An alcohol intake screening assessment for geriatric patients

Evidence-based recommendations for potentially inappropriate medication use in older adults

A test for patients’ knowledge of their medications

A list of medications older adults should never be prescribed

Answer 107

Evidence-based recommendations for potentially inappropriate medication use in older adults

Question 108

Which of the following is part of a Medicare annual wellness visit?

Medication refills

Disease planning and treatment

Education and counseling about preventive services

Diabetic education and counseling

Answer 108

Education and counseling about preventive services

Question 109

What is an appropriate strategy to minimize the burden of a patient’s treatment?

Evaluate functional status and ability to carry out the prescribed treatment.

Prescribe continuous physical therapy for strengthening.

Focus care on preventative services instead of difficult treatments.

Stop all treatments.

Answer 109

Evaluate functional status and ability to carry out the prescribed treatment.

Question 110

True or False

Dementia screenings are not necessary until patients exhibit signs of memory impairment.

Answer 110

False

It is necessary to perform a screening specifically for memory impairment because dementia symptoms are not always apparent with routine physical exams.

Question 111

True or False

In geriatric patients, a new symptom should be considered a drug side effect or drug-drug interaction until proven otherwise.

Answer 111

True

Question 112

True or False

In palliative care the patient may still receive life-prolonging and curative treatment.

Answer 112

True

Question 113

True or False

Routine physical exams and Medicare annual wellness visits are the same.

Answer 113

False

The purpose of a Medicare annual wellness visit is to provide a personalized plan of preventative services that does not include a physical exam.

Question 114

True or False

Advance directive conversations must occur in the hospital, hospice, or long-term setting.

Answer 114

False

Question 115

During a neurological screening as part of a Medicare wellness exam, the daughter of a 76-year-old patient reports to an advanced practice registered nurse (APRN) that her mother has had a change in consciousness and an increase in lethargy over the last two days. The APRN suspects a problem and conducts further assessments to confirm the diagnosis.

Which diagnosis should the APRN suspect?

Vitamin B12 deficiency

Thiamine deficiency

Pneumonia

Diabetes

Answer 115

Pneumonia

A urinary tract infection or pneumonia are suspected in older adults with changes in consciousness, such as confusion and lethargy.

Question 116

A 65-year-old female patient is being seen by an advanced practice registered nurse (APRN) for a routine visit. The APRN focuses on the health maintenance tasks appropriate for the patient’s age.

Which task should the APRN complete for this patient?

Order an initial screening colonoscopy

Administer haemophilus influenzae type B vaccine

Administer a Prevnar 13 vaccine

Order an annual Pap smear

Answer 116

The Prevnar 13 vaccine is used to prevent infection caused by pneumococcal bacteria and is recommended at age 65.

Question 117

An advanced practice registered nurse (APRN) is examining a 92-year-old patient for new complaints associated with a urinary tract infection. The APRN is creating a plan of action to treat this patient while not overly adding to the pill burden.

Which action should the APRN take for this patient?

Recommend splitting pills

Change the medication to liquid form

Recommend a once-a-day medication treatment

Spread the dosage over q8h

Answer 117

Recommend a once-a-day medication treatment

Question 118

An advanced practice registered nurse (APRN) is seeing a 96-year-old patient. The patient reports taking six and one-half pills every day. The APRN decides to respond to that information by taking a course of action recommended by the goals of geriatric care.

Which action should the APRN take for this patient?

Have the patient take the medications with an increased amount of water

Ensure the patient’s pills are in childproof bottles

Create a six-bulleted chart to help the patient monitor medications

Determine how to delete or combine the half pill

Answer 118

Determine how to delete or combine the half pill

Question 119

A patient with a terminal illness explains to an advanced practice registered nurse (APRN) that family from out of town will be visiting, and they have questions about planning for the patient’s care. During a previous visit, the APRN provided the patient with a medical orders for life-sustaining treatment (MOLST) form.

Which information about this form should the APRN emphasize with this patient?

One form needs to be completed for in-hospital use and a separate form for community care.

The form is used by the patient to select treatment choices and their health agent.

The selections on the form cannot be changed once they are completed.

The instructions on the form are activated after it is signed by both the patient and the patient’s family.

Answer 119

The form is used by the patient to select treatment choices and their health agent.

A MOLST form covers all aspects of advanced care planning to include life-sustaining interventions, the name of the identified health agent, the name of the physician, the patient’s signature, and the clinician’s signature, which is required to activate the form.

Question 120

True or False

Only women should be screened for intimate partner violence.

Answer 120

False

Question 121

The victims of sexual assault almost always have associated immediate and long-term effects, termed the rape trauma syndrome. What are the two phases of rape trauma syndrome?

Treatment phase and chronic sequelae phase

Denial and acceptance phases

Shock phase and depression phase

Acute/disorganization phase and the integration and resolution phase

Answer 121

Acute/disorganization phase and the integration and resolution phase

Acute/disorganization phase starts immediately after the experience and can last from days to weeks. Victims may appear calm, although they commonly express shock, disbelief, fear, guilt, and shame. In the integration and resolution phase, victims begin to accept the assault, but psychological and emotional problems may persist.

Question 122

True or False

Prescription opioids taken for longer periods of time or in higher dosages can increase the risk of opioid use disorder, overdose, and death.

Answer 122

True

Question 123

You prescribed Percocet 5-325 mg 1-2 tablets every 4-6 hours as needed for pain. What is the maximum daily morphine milligram equivalent (MME) dose for this prescription?

60 MME

75 MME

90 MME

105 MME

Answer 123

90 MME

To calculate the MME based on this prescription you first determine the total number of tablets the patient could take per day, and multiply the total number of possible tablets per day by the number of milligrams in each tablet. This will give you the total number of milligrams possible per day (6 doses of two tablets). Next, multiply that number (total number of possible milligrams per day) by the conversion factor for the opioid in question. In this case, the medication is Percocet which contains the opioid oxycodone. The conversion factor for oxycodone is 1.5 MME/milligram.

Question 124

True or False

Through motivational interviewing, you can directly persuade a patient to give up substance abuse.

Answer 124

False

The motivation to quit comes from the patient, not outside persuasion. With motivational interviewing, you guide the patient to recognizing and resolving ambivalence.

Question 125

True or False

There is a large body of research on protective factors that prevent substance misuse in young adults.

Answer 125

False

Question 125

True or False

There is a large body of research on protective factors that prevent substance misuse in young adults.

Answer 125

False

Question 126

True or False

Patients with intellectual impairment are not considered competent and cannot participate in their care decision-making.

Answer 126

False

Question 127

True or False

For a patient living in poverty, a nurse practitioner earns trust through his or her credentials, because credentials are tangible evidence of knowledge and achievement.

Answer 127

False

Relationships are key for those with limited resources, and providers must earn trust by listening to the patient and recognizing the patient as a person. For patients in poverty, credentials do not have much significance.

Question 128

True or False

Documented and undocumented immigrants receive healthcare with the same standards of care as U.S. citizens.

Answer 128

False.

U.S. citizens receive healthcare at a much higher standard than that of documented and undocumented immigrants.

Question 129

True or False

The yellow fever vaccine requires a booster every five years.

Answer 129

Every 10 years

Question 130

What is an appropriate drug regimen for treating traveler’s diarrhea?

Ciprofloxacin and loperamide

Azithromycin and meclizine

Primaquine and doxycycline

Amoxicillin and scopolamine

Answer 130

Ciprofloxacin and loperamide

Question 131

True or False

Reactions to sexual assault may include problems with sexual behavior and functioning.

Answer 131

True

Question 132

True or False

As a prescriber, you must write for stronger doses of pain medication for patients who report high levels of pain on a pain scale.

Answer 132

False

Question 133

True or False

Compared to lower opioid dosages, higher opioid dosages have not been shown to decrease chronic pain more effectively and are associated with increased overdose risk.

Answer 133

False.

They have ben shown to increase risk but not reduce pain better.

Question 134

True or False

Buprenorphine is an opioid agonist that can produce euphoria. Treating opioid use disorder with buprenorphine substitutes one addiction for another.

Answer 134

False

Question 135

True or False

Patients may have secondary conditions such as pain, fatigue, obesity, and depression as a result of having a disabling condition.

Answer 135

True

Question 136

True or False

To screen for intimate partner violence, a patient just needs to be asked whether it is occurring, which is better than using a screening tool.

Answer 136

False

Question 137

True or False

Patients with Medicaid and private insurances always have reasonable medication co-pays.

Answer 137

False

Question 138

True or False

Various employee protection laws have agricultural exclusions, resulting in insufficient on-the-job protections for many migrant farmworkers.

Answer 138

True

Question 138

True or False

Various employee protection laws have agricultural exclusions, resulting in insufficient on-the-job protections for many migrant farmworkers.

Answer 138

True

Question 139

What is a health risk associated with prolonged sitting during long-distance travel?

Deep vein thrombosis

Sciatica

Traveler’s diarrhea

Yellow fever

Answer 139

DVT

Question 140

True or False

The CDC provides travel notices in three categories: Level 1 Watch, Level 2 Alert, and Level 3 Warning.

Answer 140

True

Question 140

True or False

The CDC provides travel notices in three categories: Level 1 Watch, Level 2 Alert, and Level 3 Warning.

Answer 140

True

Question 141

A 75-year-old patient asks to have all medications changed to generics because of financial concerns and a desire to not overburden the adult child who owns the home where the patient is now staying. An advanced practice registered nurse (APRN) examines the patient and notes a finding that could indicate abuse.

Which of these findings would indicate abuse?

Diffuse alopecia

Positive vulnerable elder assessment

Bruises on bilateral upper arms

Weight loss of 1 kg (2.2 lb) since exam three months before

Answer 141

Bruises on bilateral upper arms

Question 142

A patient presents to an advanced practice registered nurse (APRN) because of frequent headaches that started about two years before. After reviewing the patient’s medical records, the APRN notes that the patient has already had several diagnostic tests performed. The patient has tried nonnarcotic medications with little effect.

Which action should the APRN take to assist this patient?

Refer to a local substance abuse center for assistance with pain management

Prescribe a short-acting opioid at a low dose

Recommend long-acting medication for breakthrough pain

Schedule a urine drug screen in two weeks after prescribing opioid therapy

Answer 142

Prescribe a short-acting opioid at a low dose

Question 143

A 40-year-old female patient seeks medical attention from an advanced practice registered nurse (APRN) for increasing anxiety that is only reduced by ingesting alcoholic beverages. The patient reports caring for two school-age children in addition to an adult parent who was recently diagnosed with a cognitive disorder.

Which response should the APRN give to this patient?

“Alcohol can cause rebound anxiety.”

“A prescription for medical marijuana may be helpful.”

“The time of day when alcohol is ingested may need to be changed.”

“Edible forms of marijuana might be better than alcohol.”

Answer 143

“Alcohol can cause rebound anxiety.”

Question 144

An advanced practice registered nurse (APRN) is preparing to discharge a patient from the hospital who was originally admitted for tuberculosis and initiation of therapy. The patient is homeless and unable to pay for the treatment.

Which action should the APRN take to assist this patient?

Provide the medication to the patient at no cost

Arrange for the health department to provide the medication

Provide the patient with contact information for the drug company

Order QuantiFERON-TB for the patient prior to discharge

Answer 144

Arrange for the health department to provide the medication

Question 145

advanced practice registered nurse (APRN) is assessing an older adult who is a Cambodian refugee. The APRN notes ecchymosis on the chest, upper arms, neck, and back and accurately identifies the cause of the condition.

Which activity caused this condition in the patient?

Medicinal herb ingestion

Elder abuse

Cupping

Coining

Answer 145

Coining