APEA Pre-Predictor Exam – FNP Board Review | 2026/ 2027 Update | 200 Questions and Correct Answers | Complete Exam Material

APEA Pre-Predictor Exam – FNP Board Review | 2026/ 2027 Update | 200 Questions and Correct Answers | Complete Exam Material 2026/2027 | QUESTIONS & CORRECT ANSWERS | 100% VERIFIED STUDY MATERIAL 200 Questions • 3-Hour Limit • Case-Based Scenarios • Board Ready Specialties Included: Pediatrics • Women’s Health • Adult/Gerontology • Pharmacology • Pathophysiology • Clinical Management Exam Overview Exam Structure • 200 High-Yield Questions • Multiple-Choice + Clinical Scenarios • Timed: 3 Hours • Identifies Knowledge Gaps • Designed for Board-Style Mastery Core Domains • Advanced Pathophysiology • Advanced Pharmacology • Advanced Physical Assessment • Clinical Management • Diagnostic Reasoning Introduction The Premium Predictor Exam is designed for students in the final stages of their certification preparation. This comprehensive, high-difficulty exam mirrors the exact style, complexity, and structure of board-certification testing. Scoring above 80% predicts first-attempt success, helping learners pinpoint weaknesses and master essential concepts with confidence. 1/ 17 2/ 17 Answer Format All questions are presented in bold for clarity. Correct answers appear in bold green, followed by a concise, clinically focused rationale in italic, emphasizing: Advanced clinical reasoning Diagnostic accuracy Pharmacologic relevance Provider-level judgment This format reinforces the decision-making skills required to excel on predictor exams and certification boards. First-Pass Effect 1. CYP450 metabolizes the drug in the liver to release the drug to the body where it 1. What cytochrome metabolizes a medication drug during can be used. the FIRST-PASS Effect? 2. Active 2. CYP450 enzyme is the most . 3. True 3. It can either be induced or inhibited (T/F) Pharmacokinetics 1. What are age-related changes? (Distribution, Metabolism, Excretion)? 1. Increase in fat-to-water ratio, decrease in liver function, decrease in GFR Pharmacology: Cardiac Glycosides 1. What order of line of treatment is Digoxin? 2. Signs of Digoxin Overdose 3. Laboratory tests 4. Treatment 1. Second and Third 2. N/V, Hyperkalemia, Confusion, visual color changes 3. Digoxin level, CMP, EKG 4. Digoxin-specific antibodies Pharmacology: Warfarin (Coumadin) 1. Category for pregnancy. 2. Target INR for patients without mitral prosthetic valves? With prosthetic valves? 3. Referral to for initiation and stabilization of warfarin dose. 4. How often do you check for consistently stable INR? 5. How often do you check for single out-of-range INR? 6. What do you educate the patient to do if the INR less than 5 with no significant bleeding risk? 7. If one dose is missed, what do you do? 8. What kind of foods to avoid messing up the INR? 1. X 2. 2.0-3.0, 2.5-3.5 3. Cardiologist or anticoagulation clinic 4. Check every 2-4 weeks up to 12 weeks. 5. Continue warfarin dose, retest INR in 1-2 weeks. 6. Omit one dose, recheck INR. 7. Take the dose as soon as possible. Do not double dose. 8. Vitamin K foods Pharmacology: Direct Oran Anticoagulants (DOAC) 1. Why are DOACs better than Warfarin? 2. Example of DOACs? 3. How long does it take for platelet function to return to normal after a patient stops taking Plavix? 1. Less monitoring and less side effects 2. Apixaban (Eliquis) 3. 10 days 3/ 17 Pharmacology: Thiazide Diuretics 1. Examples 2. Contraindication 3. Adverse effects 4. Patients with osteoporosis receive an extra benefit from thiazide diuretics by reducing excretion (T/F) 1. HCTZ, Chlorthalidone 2. Sulfa allergy 3. Hykpokalemia, increases uric acid and increases LDL 4. Calcium, True Pharmacology: Potassium-Sparing Diuretics 1. Examples 2. Contraindication 3. Adverse effects 4. Do not combine with which cardiac drugs to prevent hyperkalemia? 1. Triamterene, Amiloride 2. Hyperkalemia 3. Elevates K+ levels 4. ACEIs and ARBs Pharmacology: Loop Diuretics 1. Examples 2. Contraindication/Allergy 3. Adverse effects 4. Which toxicity with loop diuretics can occur? 1. Furosemide 2. Sulfa Allergy 3. Hypokalemia, Hyponatremia, hypomagnesemia 4. Ototoxicity Pharmacology: ACEIs and ARBs 1. Examples 2. Black Box Warning/Contraindications 3. Adverse Effects 4. ACEIs are first-line therapy for 5. ACEIs and ARBs protect the kidneys. But if severe CKD, should you continue ACEIs and ARBs? Why? 1. Lisinopril, Losartan 2. Pregnancy 3. Dry cough, Hyperkalemia, Angioedema 4. Heart Failure w/ left ventricular dysfinction (HFrEF) 5. No, because severe CKD and ACEIs and ARBs will lead to increased risk of hyperkalemia. Pharmacology: CCBs 1. Two types and Examples of both types 2. Cardiac contraindications for Nondihydropyridines 3. Why does pedal edema occur with dihydropyridines? 1. Dihydropyridines: Amlodipine, Nifedipine Nondihydropyridines: Verapamil, Diltiazem 2. Heart block and Heart Failure 3. Vasodilation Pharmacology: BBs 1. Contraindications 2. Adverse Effets 1. Asthma, COPD 2. Bronchospasm Pharmacology: Tetracyclines 1. Examples: 2. Avoid use during pregnancy and breastfeeding due to of teeth. 3. Sensitivity to what? 1. Doxycycline 2. Permanent Discoloration 3. Photosensitivity Pharmacology: Macrolides 1. Examples: 2. Type of toxicity 3. Which is the most tolerated macrolide from GI side effects of Nausea and vomiting? 1. Azithromycin, Erythromycin 2. Hepatotoxicity 3. Azithromycin Pharmacology: Cephalosporins 1. Examples of each of the First, Second and Third Generation 2. First line of treatment against gonorroheal infections? 3. Avoid ceftriaxone in hyperbilirubinemia infants because it can cause 1. First: Cephalexin (Keflex), Second: Cefuroxime, Third: Cefdinir 2. Ceftriaxone (3rd Generation) 3. Kernicterus Pharmacology: PCNs 1. Examples 2. Avoid using amoxicillin for patients with mononucleosis because it can lead to a 1. PCN, Amoxicillin, Augmentin 2. Rash Pharmacology: Fluoroquinolones 1. Examples 2. Complications 3. Avoid in which population 4. Patients should avoid sun exposure due to with thix ABX (T/F) 1. Ciprofloxacin, Levofloxacin 2. Achilles-Tendon Rupture, Torsades de Pointes, Abnormal bone development 3. Pregnant women and growing children 4. Phototoxicity; True 4/ 17 FDA Controlled Substances Act 1. Schedule 1 Drugs are legal to prescribe (T/F) 2. Schedule II drugs require a new prescription written every month (T/F) 3. Testosterone is what scheduled drug number? 1. False; Illegal 2. True 3. III Screening Tests 1. What is Sensitivity focused on? 2. What is Specificity focused on? 1. Sensitivity is focused on indentifying those who DO have the disease (True Positive). 2. Specificity is focused on detecting those that DO NOT have the disease (True Negative). Health Promotion: Ty pes of Prevention 1. What is Primary Prevention? 2. What is Secondary Prevention? 3. What is Tertiary Prevention? 1. Prevention of disease and reducing risk factors (Individual actions, Promoting healthy lifestyle) 2. Early Detection with Screening exams (Screenings and Interventions to deal post-full recovery of a disease) 3. Reduce Impact of Current Disease USPSTF Recommendations - Aspirin 1. At what age is a HCP to initiate a low-dose aspirin use for CVD patients? 1. 50-59 years old with 10% CVD risk USPSTF Recommendations - Breast Cancer 1. When do we start screenings? and how often? 2. If a patient has BRCA1 or BRCA2 gene, when you start screening for breast cancer? 1. 50 Years of age, every 2 yers 2. 40 years of age USPSTF Recommendations - Cervical Cancer 1. Aged 21-29 years should receive what screening? How often? 2. Aged 30-65 years should receive what screening? How often? 3. If prior hysterectomy, 1. Cervical cytology alone every 3 years 2. Cervical Cytology alone every 3 years, of Cervical Cytology with HPV every 5 years 3. No screening needs to be done. USPSTF Recommendations - Colorectal Cancer 1. When do we start screenings? 2. How often should someone get a colonoscopy? 1. Age 45 years 2. Every 10 years USPSTF Recommendations - Lung Cancer 1. When do we start screening for patients with a - pack-year smoking history? 2. What screening exam do you use? 1. 50 years old; 20-pack-year smoking history 2. Low-dose annual CT scan USPSTF Recommendations - Prostate Cancer 1. When do we start screening? 2. Ethnic race at risk 1. 55-69 years old 2. African USPSTF Recommendations - ABD Aortic Aneurysm 1. Abdominal Aortic Aneurysm test and onset of screening? 1. ABD ultrasound; 65-75 years old Vaccines & Administrations - Hepatitis B Vaccine 1. Total of how many doses? When? 2. Requires a minimum of weeks between doses one and two? 1. Three doses (0, 1st and 6th month) 2. 4 Weeks Vaccines & Administrations - Influenza 1. Two types of Influenza Vaccines 2. LAIV Contraindications 3. All types of Influenza Vaccine should be avoided if patient has allergic to gelatin (T/F) 1. Inactivated and Recombinant vs. Live Attenuated (LAIV) 2. Pregnancy and chronic pulmonary disease 3. True 5/ 17 Vaccines & Administrations - Tetanus Vaccines (Tdap and Td) 1. How often do we administer for lifetime? 2. Infants and children younger than 7 years should receive what form of tetanus vaccine? 3. For dirty and contaminated wounds, give a if the last dose was more than how many years ago? 1. Every 10 years 2. DTaP 3. Tetanus booster; more than 5 years ago Vaccines & Administrations - Pneumococcal Vaccine 1. Second dose should be given at the latest of years after prior dose. 1. 5 years Vaccines & Administrations - Shingles Vaccine 1. Given to adults who are at least years old and older. 2. You can use Zostavax if the patient is to Shingrix (Recombinant Zoster Vaccine). 3. Zostavax is a live virus vaccine (T/F) 4. Avoid in patients who are 1. 50 years or older 2. Allergic 3. True 4. Pregnant and immunocompromised Vaccines & Administrations - Varicella Vaccine 1. Varicella (and MMR) are live vaccines (T/F) 2. Avoid giving to 1. True 2. Pregnant or immunosuppressed patients HEENT - Corneal Ulcers 1. Patient Symptoms 2. Look for on the cornea by using a or slit lamp exam and fluorescein dye test. (Primarily prefer Fluorescein dye test) 3. Most common cause is 4. Refer to 1. Foreign body sensation, tearing and photophobia 2. Whitish Lesion; Penlight; (Primarily prefer Fluorescein dye test) 3. Infection 4. ED HEENT - Herpes Keratitis 1. Patient Symptoms 2. What kind of lines are found on the corneal surface? 3. If infection due to shingles is caused by infection of the trigeminal nerve, what is it called? 4. Refer to 1. Severe eye pain, tearing, photophobia, blurred vision 2. Fernlike lines 3. Herpes Zoster Ophthalmicus 4. ED HEENT - Acute Angle-Closure Glaucoma 1. Patient symptoms 2. Patients with this type of glaucoma see of lights. 3. Cornea appears 4. There is of the optic nerve. 5. Refer to 1. Sudden and acute severe eye pain, Headache, N/V. 2. Halos 3. Cloudy 4. Cupping 5. ED HEENT - Multiple Sclerosis (Optic Neuritis) 1. Reports loss of visual acuity over hours to days (T/F) 2. What two visions are affected? 3. May be accompanied by other neurological symptoms such as 4. Complains of daily fatigue that worsens as the day goes on (T/F) 5. Refer to 1. True 2. Color and Central Vision 3. Parenthesia, Aphasia 4. True 5. Neurologist HEENT - Orbital Cellulitis 1. Acute onset of eyelids and eyeballs. 2. Unable to perform full ROM of . 3. Look for history of . 4. Refer to 1. Swollen eyelids and bulging eyeballs 2. Extraocular muscles 3. Infection (Rhinosinusitis or upper respiratory infection) 4. ED 6/ 17 HEENT - Retinal Detachment 1. Sudden onset of associated with looking through a -feel. 2. Sudden flashes of . 3. Refer to 1. Floaters; Curtain 2. Flashes of Light 3. ED HEENT - Auricular Hematoma 1. Direct blunt trauma to the ear that can cause bleeding in the . 2. This should be drained as soon as possible (T/F) 1. Auricular Cartilage 2. True HEENT - Acoustic Neuroma (Vestibular Schwannoma) 1. Presents with unilateral or bilateral hearing loss? 2. Complains of movements. 3. Caused by of the acoustic nerve. 4. Refer to 5. If trigeminal nerve is compressed, can lead to symptoms of 1. Unilateral Hearing Loss 2. Unsteady 3. Tumor 4. Neurologist 5. Facial numbness and pain HEENT - Cholesteatoma 1. There is of tympanic membrane. 2. What kind of mass is found? 3. Tympanic membrane can be intact, and yet have the behind the TM. 4. The mass is not cancerous (T/F) 5. Mass can erode to bones and damage which nerve? 6. Refer to 1. Perforation 2. White-Cauliflower like mass 3. White mass 4. True 5. CN VII - Facial Nerve 6. Otolaryngologist HEENT - Battle Sign (Basilar Skull Fracture) 1. Which skull bone is most often fractured? 2. Search for what kind of drainage that is indicative of cerebrospinal fluid? 3. Referral to 1. Parietal 2. Clear, golden fluid drainage 3. ED HEENT - Avulsed Tooth 1. Considered a dental . 2. If a young child, determine if the avulsed tooth is a . 3. Rinse tooth in what solution? 4. Refer to 1. Dental Emergency 2. Primary Tooth 3. Normal Saline 4. Dentist HEENT - Peritonsillar Abscess 1. Patient symptoms 2. What kind of voice? 3. Accompanied by generalized symptoms of 4. Referral to 1. Severe sore throat, and odynophagia (pain on swallowing) 2. "Hot potato" voice 3. Fever, malaise and chills 4. ED HEENT - Diptheria 1. Patient symptoms 2. What kind of neck? 3. Very contagious (T/F) 4. Refer to 1. Sore throat and fever 2. Bull's Neck 3. True 4. ED HEENT Anatomy 1. Fundi: Veins are smaller than arteries (T/F) 2. Macula: Responsible for what type of vision? 3. Tympanic Membrane: What color is the TM supposed to be? 4. Kiesselbach’s Plexus: Where is this located? 5. Salivary Glands: What are the three? 6. What is used to measure for presence of fluids in middle ear? 1. False, arteries are smaller than veins. 2. Central vision 3. Off-white to gray color 4. Anterior Inferior aspect of nose 5. Parotid, Submandibular, and Sublingual salivary glands 6. Tympanogram HEENT - Age-Related Changes 1. Presbyopia: What is this? 1. Decreased ability to read small print at close range. (Poor near vision) 7/ 17 HEENT - Noteworthy Abnormal Findings 1. Blepharitis: What is this? And what is it associated with? How to treat? 2. Leukoplakia: White to light gray patch on tongue, cheek or mouth. Rule out . 3. Aphthous Stomatitis (Canker Sores): What are these and how are they treated? 4. Mumps (Parotitis): What is this? 1. Inflammation of the edges of the eyelids. Associated with seborrheic dermatitis. Warm compress and Shampoo with warm warter. 2. Oral Cancer 3. Painful shallow ulcers; Magic mouthwash 4. Parotid glands become swollen and tender. HEENT - Papilledema 1. Optic disc appears with edges due to increased . 2. This can be secondary to what conditions/diseases? 1. Swollen, blurred, increased ICP 2. Bleeding, brain tumor, brain abscess HEENT - Hypertensive Retinopathy 1. Hypertensive retinopathy is seen as AV nicking (T/F) 2. What type of hemorrhages are seen with this? 1. True 2. Retinal hemorrhages HEENT - Diabetic Neuropathy 1. What kind of aneurysms are seen with this? 2. What are the fluffy white patches called when found on the retina due to these conditions? 1. Microaneurysms 2. Cotton-Wool Spots HEENT - Cataracts 1. What do cataracts look like? 2. What are the differences between the two types? 3. Symptoms 1. Opacity if the lens of the eye 2. Nuclear cataracts are center and cortical cataracts are found on the sides. 3. Blurred vision and light glare HEENT - Koplik’s Spots 1. What are these? 2. What is this indicative of? 1. Small red papules with white centers in cheeks. 2. Indicative of Measles (Rubeola) HEENT - Hairy Leukoplakia 1. This is leukoplakia that appears only on the . 2. Pathognomonic for which infection? 3. Caused by which virus? 1. Tongue 2. HIV Infection 3. Epstein-Barr Virus HEENT - Cheilosis 1. Painful skin fissures at the corner of the due to excessive moisture. 2. Secondary to infection of what two organisms? 3. Nutritional deficiency of Vitamin . 4. Diagnostic Test 5. Treatment according to type of organism 1. Mouth 2. Candida and S. Aureus 3. Vitamin B 4. Check KOH or C&S 5. Fungal: Topical anti fungal ointment; Bacterial: Mupirocin ointment HEENT - Terminology 1. Hyperopia 2. Myopia 3. Ambylopia: When does it usually start and who to refer? 4. Miosis 5. Ptosis 6. Entropion 7. Ectropion 1. Farsightedness 2. Nearsightedness 3. Lazy eye, starts in infancy. 4. Excessive construction of pupil 5. Drooping of upper eyelid 6. Eyelid turned inward 7. Eyelid turned outward HEENT - Vision & Hearing Test 1. Color blindness should be assessed with with chart? 2. Legal blindness is defined as 20/ . 3. For children, by age years, visual acuity should be 20/20 bilaterally. 4. If 20/30 for children by 6 years, refer to . 1. Normal finding for Weber Test 2. Normal finding for Rinne Test 3. Weber Test: Lateralization to good ear is loss. Lateralization to bad ear is loss. 4. Rinne Test: SENSE. L. is AC BC. Conductive is BC AC 1. Ishihara Chart 2. 20/200 3. 6 years 4. Ophthalmologist 1. No lateralization (Lateralization = hearing sound in only one ear or sound is louder in one ear.) 2. AC lasts longer than BC. 8/ 17 HEENT - Treatment Plan for Corneal Abrasion, Herpes Keratitis and Contact Lens Related-Keratitis 1. Treatment Plan 2. Pain prescription (T/F) Check visual acuity, flush eye with NS, do not patch eye HEENT - Hordeolum 1. What is this? 2. Treatment plan 3. What happens if infection spreads? 1. Abscess of hair follicle in upper or lower eyelids. 2. Hot compress 3. Refer to eye doctor for I&D. HEENT - Chalazion 1. What is this? 2. How many weeks will this resolve? 2. Treatment Plan 1. Inflammation of Meibomian gland of eyelids 2. 2-8 weeks 3. Referral to eye doctor for I&D HEENT - Pinguecula & Pterygium 1. Pinguecula is a raised yellow-to-white small round growth in the conjuctiva of eye 1. What is Pinguecula? next to the cornea. 2. What is Pterygium? 2. Pterygium is a yellow-triangular wedged-shape thickening of conjunctiva 3. Referral plan for both Pinguecula and Pterygium? 3. Refer to ophthalmologist 4. Recommend usage of what due to photosensitivity? 4. Sunglasses HEENT - Subconjunctival Hemorrhage 1. When should this resolve? How many weeks? 2. Can be caused by pressure from sneezing, coughing or local trauma (T/F) 3. Treatment plan 1. 1-3 Weeks 2. True 3. Watchful waiting and reassurance of patient HEENT - Primary Open-Angle Glaucoma 1. Acute or Gradual onset? 2. Increased IOP of how many mmHg? 3. Usually asymptomatic in early stages (T/F) 4. Treatment plan: Check IOP using . 5. Normal range of IOP is? 6. If IOP is greater than 30 mmHg, refer to immediately! 7. Medications 8. Contraindications to Medications 1. Gradual Onset 2. Greater than 22 mmHg 3. True 4. Tonometer 5. 8-21 mmHg 6. ED 7. Beta-blocker eye drops and Latanoprost 8. BBs have contraindications to those who have COPD, asthma, and Heart failure due to bronchoconstriction HEENT - Primary Angle-Closure Glaucoma 1. Gradual or Acute? 2. If not treated immediately, can lead to permanent damage of which cranial nerve? 3. Symptoms of glaucoma 4. Treatment plan 1. Acute Onset 2. Permanent damage of CN II 3. Cloudy pupil, dilated pupil, sever eye pain with headache and N/V. 4. Refer to ED HEENT - Age-Related Macular Degeneration 1. Loss of vision. 2. Painful or painless? 3. Refer to 1. Central Vision 2. Painless 3. Ophthalmologist HEENT - Sjögren's Syndrome 1. Chronic autoimmune disorder characterized by decreased function of which two glands? 2. This can occur alone or with disorder. 3. Treatment plan 4. Referral to 1. Lacrimal and salivary glands 2. Autoimmune 3. Eye drops 4. Rheumatologist HEENT - Allergic Rhinitis 1. Treatment plan - First-Line 2. If only partial relief from first-line treatment, what do you administer? 3. What do you use if the patient is congested? 4. Sudafed is contraindicated for which patient population? 5. Non-sedating once daily antihistamines are recommended (T/F) 6. To prevent Rhinitis Medicamentosa, what do you do? 1. Topical nasal steroid sprays 2. Antihistamines 3. Decongestants (Sudafed) 4. Infants and young children 5. True 6. Stop using nasal decongestants before three days. 9/ 17 HEENT - Streptococcal Pharyngitis/Tonsillopharyngitis ( Strep Throat) 1. The most common pathogen is viral (T/F) 2. Viral infection symptoms are without fever. 3. Bacteria that cause Strep throat is 4. Classic symptoms of Bacterial Strep Throat 5. Bacterial strep throat does not have a cough (T/F) 6. What color of tonsillar exudate? 7. Diagnostic tests 8. First-line medication (Bacterial) 9. If you received ABX recently, use which antibiotic? 10. If allergic to PCN, which medication? 11. Symptomatic treatment includes 12. Complications include 13. What does scarlet fever look like? 1. True 2. Cough, Sore throat, stuffy nose, rhinitis with clear mucus, watery eyes 3. Streptococcus pyogenes 4. Fever, Sore throat, Enlarged cervical lymph nodes 5. True 6. Yellow-to-green color 7. Rapid antigen detecting test (RADT) 8. Oral PCN 9. Augmentin 10. Azithromycin (Macrolide) 11. Gargle with salt water, throat lozenges and drink more fluids 12. Scarlet Fever, Acute rheumatic fever, Peritonsillar abscess 13. Sand-paper rash and strawberry tongue HEENT - Infectious Mononucleosis 1. Infection caused by what virus? 2. Classic triad of symptoms with Mono 3. Exudate color (Different from Strep Throat) 4. Diagnostic tests 5. Which organs may be bigger than normal due to Mono? 6. If a patient has Splenomegaly or Hepatomegaly, what should you avoid? 7. Limit physical activity for weeks to reduce . 8. Avoid amoxicillin in these patients as it will lead to a . 1. Epstein-Barr Virus 2. Fever, Sore throat, Posterior cervical lymphadenopathy 3. White-to-grey exudate 4. Monospot and CBC (Lymphocytosis) 5. Hepatomegaly or Splenomegaly 6. Vigorous palpation or Sports activity 7. 4 weeks; Splenic rupture 8. Rash HEENT - Acute Otitis Media 1. An acute infection of the cavity. 2. Most have -ear effusion. 3. Most common organisms 4. What is the more painful form of AOM when there are blisters (bullae) present on the already-bulging and red TM? 5. Treatment - First-line 6. If no response to treatment in 48-72 hours, what medication? 7. Middle Ear Effusion can persist for how many weeks after treatment of AOM? 8. Middle Ear Effusion's tympanic membrane should be red (T/F) 1. Middle Ear cavity 2. Middle Ear Effusion 3. Streptococcus pneumonia, Haemophilus influenza 4. Bullous Myringitis 5. Amoxicillin 6. Augmentin 7. 8 Weeks 8. False; MEE should not have a red tympanic membrane. HEENT - Otitis Externa (Swimmer's Ear) 1. Most common infective organisms 2. How to determine if it is Otitis Externa? 3. Treatment 4. Immunocompromised patients will get 1. Pseudomonas aeruginosa & S. Aureus 2. Tragal pain 3. Cortisporin Otic 4 gtt or Fluoroquinolone ear drops 4. Topical as well as systemic ABX (Fluoroquinolone) HEENT - Acute Bacterial Rhinosinusitis 1. What does the posterios pharynx most likely have? 2. Sinuses: Tender to of which sinuses? 3. If mild and uncomplicated, what is the treatment? 4. If severe, what is the treatment? 5. If allergic to PCN? 6. If patient has cough, which medication? 7. Who should you not give Tessalon Perles to because they are toxic for this population? 8. Complications that warrant ED refferal 1. Purulent dark-yellow to green postnasal drip 2. Palpation of frontal and maxillary sinuses 3. Symptomatic treatment 4. Augmentin 5. Levofloxacin (Anaphylaxis or Angioedema allergy) or Cefdinir (Skin rash allergy) 6. Tessalon Perle's prescription 7. Children younger than 10 years 8. Mastoiditis, Periorbital cellulitis, Meningitis HEENT - Vertigo 1. Which maneuvers should be done to test for Vertigo? 1. Dix-Hallpike and Epley Maneuver HEENT - Vertigo Differential Diagnoses - Meniere's Disease 1. Triad of symptoms 2. Initial treatments involve 3. Persistent attacks should be referred to 1. Vertigo, tinnitus and unilateral hearing loss 2. Lifestyle changes 3. . ENT specialist 10 / HEENT - Vertigo Differential Diagnoses - BPPV 1. Gold-standard is the 2. Treatment 3. Avoid sleeping on the side of the affected ear for several days (T/F) 1. Dix-Hallpike manuever 2. Meclizine PO 3. True HEENT - Vertigo Differential Diagnoses - Labrynthitis 1. Caused by inflammation of the vestibular nerve (CN VIII) due to 2. If mild symptoms, do not give vestibular suppressants PRN as it will delay recovery. Only use for severe (T/F) 1. Viral or bacterial infection 2. True Integumentary - Danger - Anaphylaxis 1. Anaphylaxis is an -mediated reaction 2. Immediate treatment is with 3. Immediately call 1. IgE 2. Epinephrine 3. 911 Integumentary - Rocky Mountain Spotted Fever 1. Patient symptoms 2. When does the rash occur? 3. First-line treatment is 1. Fever, N/V, Myalgia, Arthralgia 2. 2 to 5 days after onset of fever 3. Doxycycline Integumentary - Early Lyme Disease (Erythema Migrans) 1. What does the rash look like? 2 Accompanied with what kind of symptoms? 3. How to prevent this? 1. Bulls-eye target rash 2. Flu-like symptoms 3. DEET-containing repellent on skin and permethrin on clothing Integumentary - Meningococcemia (Meningitis) 1. Caused by which bacteria? 2. Can very rapidly lead to death (T/F) 3. Risk is for those who live close together in close- quarters (T/F) 4. CDC recommends cavvincation for . 5. Symptoms: 1. Neisseria meningitidis 2. True 3. True 4. Adolescents 5. Sore throat, changes in LOC, stiff neck, fever Integumentary - Melanoma 1. How large in diameter must they be? 2. Melanoma in the nail beds is very aggressive (T/F) 3. Risk factors of Melanoma 1. 6 mm or larger 2. True 3. Tanning beds, exposure to UV light Integumentary - Basal Cell Carcinoma 1. Appearance looks like a waxy or skin lesion. 2. Result of long-term daily exposure 1. Pearly 2. Sun Integumentary - Actinic Keratosis 1. This is a lesion of swamous cell carcinoma. 2. Treatment includes what kind of cream? 1. Precancerous 2. Fluorouracil Cream 5% Integumentary - Subgungual Hematoma 1. By heating up a needle to puncutre the nail bed to allow the blood to escape from 1. How is this treated? under the nail. 2. Why must you treat this rapidly? 2. Can lead to tissue bed ischemia from all the blood colleciton. Integumentary - Urticaria 1. Most urticaria is self-limited (T/F) 2. If associated with angioedema or progresses to anaphylaxis, it can be life-threatening (T/F) 1. True 2. True Integumentary - Seborrheic Keratoses 1. These are primarily found in the 2. Appearance 1. Back 2. Soft, wartlike fleshy growths 11 / Integumentary - Xanthelasma 1. These are raised and yellow-colored soft plaques that are located: 2. If the patient is younger than 40 years of age, consider 1. Eyelids or under the brow 2. HLD Integumentary - Cherry Angioma 1. These are lesions due to a nest of in the skin. 2. These always blanch (T/F) 3. No treatment is necessary (T/F) 1. Malformed arterioles 2. True 3. True Integumentary - Lipoma 1. These are soft, fatty cystic tumors that are usually painless and are located in the layer of the skin. 2. They are asymptomatic unless they become too or are irritated and . 3. Surgical is an option. 1. Subcutaneous 2. Large; Ruptured 3. Surgical excision is an option Integumentary - Acanthosis Nigricans 1. These are associated with what three conditions? 1. Diabetes, Obesity and Metabolic Syndrome Integumentary - Acrochordon 1. Another term for Acrochordon? 2. If these are twisted and/or traumatized, what happens? 1. Skin Tags 2. They become necrotic and drop off the skin. Integumentary - Psoriasis 1. How does this uniquely present? 2. Treatment 3. Treatment, if symptoms are severe 1. Fine silver-white scales across body 2. Topical steroids 3. Methotrexate or Cyclosporine Integumentary - Eczema 1. Rashes are usually found on the 2. Treatment includes 1. Cheeks, trunk and knees or elbows 2. Topical steroids Integumentary - Cellulitis 1. Caused by which bacteria? Integumentary - Folliculitis 1. Treatment includes Integumentary - Erysipelas 1. Treatment includes 2. Appearance 1. MRSA 1. Mupirocin/Bactroban ointment 1. Hospitalization 2. One large hot and indurated skin lesion Integumentary - Dog and Cat Bites 1. The dirtiest bite of them all is . 2. Cat bites have a higher risk infection than dogs (T/F) 3. Treatment medication (First-Line) 4. If PCN allergy, 5. copiously 6. Do not wounds caused by bites 1. Human bite 2. True 3. Augmentin 4. Doxycycline, Bactrim PLUS Metrinadozle 5. Irrigate. 6. Do not suture wounds Integumentary - Early Lyme Disease 1. Diagnostic tests include 2. Treatment ABX includes 1. ELISA, then Western Blot Test 2. Doxycycline BID Integumentary - Varicella-Zoster Virus Infections 1. Primary infection is called 2. Reactivation of the infection is known as 3. Chickenpox is most infectious to days before trash forms. 4. Shingles is most infectious until all lesions have over. 5. Gold-Standard test for VZV is a . 6. Medications include 1. Chickenpox 2. Shingles 3. 1-2 days before 4. Crusted 5. PCR 6. Acyclovir or Valcyclovir 12 / Integumentary - Scabies 1. Rash appears like a 2. Use a wet mount slide to look for 3. Treatment Medication 4. When do you apply Permethrin? 5. When is it safe to remove the medication after application? 6. Avoid using what kind of lotion as it will lead to ? 7. All bedding and clothing should be washed and dried on the hottest of settings (T/F) 1. Snake-like or linear burrows 2. Mites or eggs 3. Permethrin 5% 4. Right after bathing or showering 5. 8-14 hours 6. Lindane Lotion 1%, Neurologic toxicity 7. True Integumentary - Tinea Infections 1. All Tinea infections are anti-fungals except . 2. Tinea capitis is treated with 1. Tinea Capitis 2. Griseofulvin Integumentary - Burns 1. Difference between Superficial Thickness Burns and Partial-Thickness Burns 2. Treat Partial-thickness burns with 3. Who should not use Silver Sulfadiazene cream? Integumentary - Rule of Nines 1. Kids 2. Adults 1. Partial-Thickness Burns lead to blisters 2. Silver Sulfadiazene Creams 3. Pregnant or breastfeeding woman 1. Arms 9%, Legs 14%, Trunk 18% 2. Arms, Head: 9%; Legs/Trunk: 18% Cardiovascular - Acute Coronary Syndrome 1. Clinical presentations range from what 3 conditions? 2. Must last longer than minutes 3. Pai from chest may radiate to where? 4. Best diagnostic test 5. All patients suspected of having ACS should be given which medication? 6. Call 1. STEMI, N-STEMI, and unstable angina 2. 15 minutes 3. Jaw, neck, arms, scapular back 4. 12-lead ECG 5. Aspirin 6. 911 Cardiovascular - Stable and Unstable Angina 1. Stable angina is relieved by what non-pharmacological intervention? 2. Unstable angina is precipitated with 1. Rest and NTG 2. Miminal activity Cardiovascular - Infective Carditis 1. Also known as 2. Risk factors include 3. Most commonly caused by what two organisms 4. Common manifestations 5. Diagnostic test for suspected I.E. 1. Bacterial endocarditis 2. Valvular abnormalities, arrhythmias, IV drug use and hemodialysis 3. MSSA and MRSA 4. Fever, subungual hemmorhages, petechiae on palate, painful violet-colored nodes, Roth spots (Retinal hemmorhages) 5. Transthoracic echocardiogram Cardiovascular - Heart Murmurs Grading System 1. Grade I 2. Grade II 3. Grade III 4. Grave IV 5. Grade V 6. Grade VI 1. A very soft murmur only heard in optimal conditions 2. A mild to moderately loud murmur 3. Loud murmur that is easily heard once stethoscope if on place 4. A louder murmur. 5. Very loud murmur heard with edge of stethoscope off chest 6. Murmur is so lod that it can be even heard when stethoscope is off the chest. Cardiovascular - Pathological Murmurs 1. All diastolic murmurs are . 2. All benign murmurs occur during . 1. S3 is a sign of . 2. S4 is a sign of . 1. Abnormal 2. Systole 1. CHF 2. LVH Cardiovascular - Heart Failure Classes 1. Class I 2. Class II 3. Class III 4. Class IV 1. No limitations on physical activity 2. Ordinary physical activity resutls in fatigue 3. Marked limitation in physical activity 4. Symptoms present at rest 13 / Cardiovascular - Heart Failure 1. Presence of an gallop. 2. Labs include 3. Diagnostic tests include 4. Treatment includes 1. S3 2. Cardiac markers, CBC, CMP 3. Echocardiogram with doppler study 4. Diuretics, ACEI or ARB and a beta-blocker. Cardiovascular - DVT 1. What sign is lower leg pain on dorsiflexion indicative of DVT, even though it is low sensitivity? 2. Diagnostic Test: 1. Homan's Sign 2. Ultrasound doppler Respiratory - Community-Acquired Pneumonia 1. First-Line Agent 2. Alternative agent 3. With comorbidity combo-pharm 4. With comorbidity monotherapy 5. Most common pathogens 1. Amoxicillin (or Doxycycline) 2. Azithromycin 3. Beta-Lactam (Augmentin or Cephalosporin) + Macrolide or Doxycycline 4. Fluoroquinolones 5. S. Pneumoniae and Haemophilus Influenzae Respiratory - Atypical Pneumonia 1. Common pathogens 2. Treatment 1. Mycoplasma Pneumoniae 2. Azithromycin or Fluorquinolone Respiratory - Acute Bronchitis 1. Acute viral of the bronchi or upper airway (T/F) 2. Treatment is symptomatic since it is viral (T/F) 1. True 2. True Respiratory - Pertussis 1. Also known as the 2. Caused by what bacterial organism? 3. A coughing fit that lasts for at least 4. Labs 5. Treatment plan - First Line 1. Whooping Cough 2. Bordella pertussis 3. 14 days 4. Nasopharyngeal swab and PCR and ELISA test 5. Macrolides Genitourinary - Bladder Cancer 1. Presents with painful hematuria (T/F) 2. Order what three things? 1. Painless Hematuria; False 2. UA, Urine C&S, urine cytology Genitourinary - Interstitial Cystitis 1. Symptoms 2. Medications 3. What helps with pain? 4. Recurrent UTIs; if allergic to sulfa? 1. Dysuria, Frequency, nocturia 2. Macrobid or Bactrim 3. Pyridium; expected orange urine color 4. Macrobid or Bactrim; Keflex Genitourinary - Nephrolithiasis 1. NSAIDs 1. Medications to help with pain 2. Alpha-blocker or CCB 2. Medications to relax ureter muscles? 3. Calcium oxalate foods such as spinach, rhubarbs, okra, beets, chocolate, tea and 3. Avoid high- foods such as meats. Treatment for Epididymitis 1. Age 35 years 2. Age 35 years 3. Treat pain with 1. Doxycycline and Ceftriaxone 2. Fuoroquinolone 3. NSAIDs 2 / A 15 years old high school student with a mild sore throat Obtain an urinalyses and serum for LFTs and amylase and low-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the following is the LEAST appropriate intervention? Palpate the lymph nodes and spleen Examine the posterior oropharynx for petechiae Obtain a Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar CBC, throat culture, and heterophil antibody test. virus. Common is people 15-24 years of age. Common signs and symptoms Obtain an urinalyses and serum for LFTs and amylase following incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally a petechial rash occurs in less than 15% of patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and lymphocytosis are usually detected in the CBC A 32 years old male patient complaint of urinary frequency . trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day and burning on urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be: a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate b. ciprofloxacin (Cipro) for 3-5 days medication to treat urinary tract infections in most patients. In the case of c. Trimethoprim-Sulfamethoxazole for 3 days community resistance to TMPS 20%^, another medication should be substituted. d. 750 mg ciprofloxacin as a one-time dose In men, the appropriate length of time is 7 10 days. Women may be treated for 3 days for uncomplicated UTI Which agent is most effective for the treatment of Isotretinoi n nodulocystic acne? Benzoyl peroxide (Benzac) Retinoic acid (Retin A) Topical tetracycline Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment with Isotretinoin severe inflammatory acne. Guidelines for its use must be clearly understood by the patient. A woman of childbearing age must use an effective method of contraception because isotretinoin is 1 There are many restrictions in prescribing this medication because of the teratogenic effects is given during pregnancy. Therefore, it is a pregnancy category X. An 18 y/o woman is taking a combined hormonal oral If prescribed topiramate (Topamax) for the treatment of migraines. contraceptive. She should be instructed to use a backup method for the prevention of pregnancy a. Throughout the week of placebo pills Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine If prescribed topiramate (Topamax) for the treatment of (Tegretol), primidone (Mysoline), topiramate (Topamax) and oxcarbazepine migraines. (Trileptal) reduce the effectiveness of contraceptives. Depo-medroxyprogesterone If prescribed amoxicillin/clavulanate (Augmentin) for a acetate injections or levonorgestrel-releasing intrauterine devices would be a better sinus infection method of contraceptive for patients taking anticonvulsants. Most commonly used if she forgets to take a single dose of the contraceptive antibiotics have not been proven to reduce the effectiveness of contraceptives. Rifampin is an exception, and additional ..... Be used by women taking this drug and using oral contraceptives, transdermal, or vaginal ring preparations. Additional backup contraception should be used if taking antifungal agents. No additional protection is needed thought the week of placebo pills. Missing one single dose of contraceptive does not require additional protection, missing more than one doses does. A 44 years old female patient has diabetes. Her total Atorvastati n cholesterol (TC) is 250 mg/dl (6.5 mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25 mg/dL (65 mmol/L), and triglycerides= 344 mg/dL (8.94 mmol/L). What agent have Explanation: First and foremost, it is essential to educate individuals on a heart- the greatest effect on improving her lipid profile and healthy lifestyle. LDL-C is one of the major culprits in the development of reducing morbidity and mortality associates with atherosclerotic heart disease. The target level of LDL-C is between 50 to 70mg/dl to dyslipidemia? prevent plaque formation in the blood vessels. Guidelines strongly recommend Atorvastatin statin therapy because they primarily lower LDL-C levels, but they also have the Niacin (Niaspan) secondary effects of lowering triglyceride and increasing HDL-C levels. Omega 3 fatty acids Fenofibrates 3 / t A 30 years old female comes into a clinic with classic signs Malpractic e and symptoms of appendicitis. The NP fails to refer the patient to a surgeon. The appendix ruptures and the woman die. This is an example of Failure of diligence Explanation: malpractice, a negligence tort, occurs when a health care Professional liability professional's actions fall bellow the appropriate standard of care and hurts the Negligence patient. In this case the patient came with sings and symptoms indicating Malpractice appendicitis and the NP failed to refer the patient. A NP has recently been hired to work in a fast track facility. An ethical dilemma for the NP The NP employer asked if she has "a problem prescribing medications for emergency contraception." The NP replies affirmatively. This is: a. Grounds for dismissal Explanation: in this instance, the NP has a difference of opinion with her employer An ethical dilemma for the NP based on her religious or moral belief about providing emergency contraception. Illegal according to the standards of nursing This situation is an example of an ethical dilemma. Failure to participate in the Patient abandonment. provision of care to the patient based on the NP's beliefs is neither against the law nor a violation of the standards of practice A patient presents with pruritic lesions on both knees. Topical corticosteroids cream There are visible silver scales. How Should this condition be managed? . Topical antifungal cream or ointment Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, Oral antibiotics red, precisely defined plaques with silvery scales. Auspitz sings is another common Topical corticosteroids cream finding. Topical agents containing tar and salicylic acid may be used. Topical . Topical anti-fungal/ steroid cream steroids, such as betamethasone, may also be ordered. Antidepressant discontinuation syndrome is less likely if Gradually tapers SSRI use the patient Is male Is less than 35 y/o Explanation: Antidepressant discontinuation syndrome is most often seen in the Has taken an SSRI with a short half life primary care office in association with SSRI discontinuation, because SSRIs are the Gradually tapers SSRI use most commonly prescribed class of antidepressant medications. Interruption of treatment with an anti-depressant medication is sometimes associated with an antidepressant discontinuation syndrome; in early reports it was referred to as a "withdrawal reaction. Symptoms of antidepressant discontinuation syndrome can include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. Tapering is recommended by experts. Patient with benign prostatic hyperplasia (BPH) should be Tricyclic antidepressant (TCA) taught to avoid which one of the following drug classes? . Alpha adrenergic antagonist Anti-androgen agents Explanation: tricyclic antidepressant should not be used by men with benign Tricyclic antidepressant (TCA) prostatic hyperplasia because of the increased risk of urinary retention secondary to Sulfonamides the anticholigergic effects of TCAs. Which of the following is the best response to a woman I am concerned about your safety who has just admitted she is a victim of spousal abuse? What was it that you did to make him angry? Explanation: The first step is to establish trust in the therapeutic relationship. withou You must seek refuge immediately trust future collaboration, intervention and client outcome cannot be accomplished I am concerned about your safety to facilitate appropriate and safe behavior. The experience of abuse is a traumatic I am going to call a shelter for you psychological crisis that must be addressed as such. The healthcare providers must emphasize the fact that the victim has not done anything wrong and they must also emphasize the fact that the victim's life and the lives of their children can be in danger if the abuse is not addressed. It will not disappear with a lack of action. An order of protection against the perpetrator is often recommended. For which patient group does the US Preventive Services pregnant woman Task Force recommend routine screening for asymptomatic bacteriuria Explanation: an increased incidence of bacteriuria is found in all the population pregnant woman . listed. However, bacteriuria in pregnant women increases the mother ...... Also Children increased is the risk of a pre-term delivery, which then increases perinatal and fetal Patients with diabetes morbidity and mortality. The recommended it patients over the age of 70 What diabetic complications result from hyperglycemia? Retinopathy select all that apply Hypertension resistant to treatment Retinopathy Accelerated atherosclerosis Hypertension resistant to treatment Peripheral neuropathy 4 / it A 6 y/o presents w/ complaints of sore throat and fever for Herpangin a 2 days. He has multiple vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. Explanation: Herpangina is a viral infection common in toddlers and young children What is the most likely diagnosis? a. Viral pharyngitis caused by Coxsackie virus. The clinical findings of numerous, small (1-2 mm) b. Herpangina ulcerations on the tonsils and uvula are typical of herpangina. The ulcerations can Epiglottitis be very painful but usually resolve in 7 to 10 days. Treatment is symptomatic. Tonsillitis A patient has Kawasaki syndrome. Which characteristics Age 15 years would be UNUSUAL? Age 15 years . Fever 101 F (38.3 C) explanation: Kawasaki disease is an acute febrile vasculitis syndrome that evolves Exudative pharyngitis inflammation of the blood vessels. This condition often causes cardiac complication Painful rash in children by damaging the coronary arteries is most prevalent in children of Asian ethnicity. Diagnosis of Kawasaki disease requires presentation of fever and 4 of the following criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. According to the JNC 8 guideline hypertension in a 40 y/o 140/9 0 can be diagnosed when blood pressure exceeds 140/90 130/90 . 125/85 150/100 Explanation: According to JNC 8 guidelines, hypertension is a sustained elevation of systolic BP greater than or equal to 140 mmHg or diastolic BP greater or equal than 90mmHg, taken from 2 or more readings on 2 different occasions after an initial screening. A 48 y/o female complains of pain and stiffness in her right Osteoarthritis (OA) hip and knee that is mild on awakening in the morning, get worse as the day progresses and is relived with hot baths and ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are notably absent. What Explanation: Rheumatoid arthritis is characterized by several joint deformities, is the most likely diagnosis?. usually bilaterally symmetrical. RA is characterized by inflammatory processes, Gout while OA is not. RA and OA are chronic conditions. Gout is characterized by acute Osteoarthritis (OA) exacerbations related to a defect in purine metabolism, increased uric acid Rheumatoid arthritis (RA) production, or decreased uric acid excretion. d. Osteoporosis A 7-year old female patient presents with severe injuries Inform the mother that the abuse must be reported to child protection authorities that are inconsistent with the explanation given for them. The nurse practitioner questions the mother about abuse. She admits that her husband, the child's father, beat the Explanation: An awareness of all the unique presentations of child abuse, subjective child. How should the nurse practitioner proceed? or objective, physical, sexual, or neglect, is essential for NPs. Objective findings, a. Inform the mother that the abuse must be reported to such as broken bones, burns, and bruises, may be as a result of an intentional child protection authorities. injury from physical abuse or from an unintentional injury as a result of neglect. Both Counsel the mother that if it happens again it will be must be considered. Repeated visits to the emergency department, frequent or reported to child protection service. suspicious injuries, or bilateral or multiple healing fractures are often indicators of Ask the child what she did to cause the punishment Refer physical abuse. Once the diagnosis of child abuse has been made, the primary role the family to the National Domestic Violence hotline of the NP is to ensure the child is safe. If the NP suspect that a child is undergoing abuse, it's critical to report it—and to continue reporting each separate incidence if continues to recur. A 1-month-old presents with reported recurrent diarrhea, Intussusception screaming, and drawing up of the legs followed by periods of lethargy. On physical examination, a "sausage-like" mass in the upper right quadrant of the distended explanation: Intussusception is one of the most common causes of abdominal abdomen. Which of the following is the most likely obstruction in children prior 2 years of age; is best described as a portion of the diagnosis? intestine which telescopes into a more distal intestinal segment. The classic triad of Volvulus intussusception include crampy (intermittent, also known as colicky) abdominal Crohn's disease pain, vomiting, and bloody stools. The patient may pull up his knees with crying. Foreign body in the GI tract The patient may develop vomiting with bilious emesis. Progressive lethargy/altered Intussusception level of consciousness and pallor is common. The etiology of this lethargic presentation is not known, but it tends to occur in younger infants. As intussusception progresses, a palpable, sausage-shape mass may develop. Some hypothesize that this is due to release of endogenous opioids or endotoxins released from ischemic bowel. Intussusception in a child presenting with lethargy is often difficult to diagnose since other causes of lethargy such as dehydration, hypoglycemia, sepsis, toxic ingestion, post-ictal state, etc., must also be considered. Ultrasound is the preferred diagnostic test. Enemas is considered the 1/ 4 A 12-year-old girl with breast buds vulvovaginitis, hemangiomas, benign polyps, precocious puberty, or sexual abuse. A young couple is being seen by the NP for preconception Folic acid 0.4 mg daily counseling. They express a wish for pregnancy within the next 3 month and are very eager to know what they can do Explanation: Supplementation with folic acid decreases the development of neural now to "make the baby as healthy as possible". Which of tube defects, such as spina bifida and anencephaly. Folic acid plays an essential the following should the NP encourage to decrease the role in neural tube closure. Neural tube development/closure takes place in the fist chance of neural tube defect in the fetus? weeks of embryonic life (6 weeks' gestation). U.S. Public Health Service and the Folic acid 0.4 mg daily CDC recommend that all women of childbearing age consume 0.4 mg of folic acid Maternal alpha-fetoprotein level daily to prevent tube defects. . Rubella vaccine today Vitamin E 400 IU daily A patient with a past history of documented coronary Refer to a cardiologist as soon as possible arterial blockage less than 70% complains of chest pain several time p.... which is relived with nitroglycerin. Which Explanation: The patient has at least a 70% occlusion of a major coronary artery. is the most appropriate initial action for the NP? For a patient to be considered for CABG, the coronary arteries to be bypassed must . Refer to a cardiologist as soon as possible have approximately a 70% occlusion (60% if in the left main coronary artery). Prescribe long-acting nitroglycerin Order treadmill stress test Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours A 3 y/o has enlarged, warm, tender cervical lymph nodes, Infection proximal to the nodes indicating: Infection proximal to the nodes . A possible cancer diagnosis explanation: size of lymph nodes is important. Nodes 1 cm are significant and Shorty nodes, a common normal variant in children should be asses carefully. Nodes 5 cm are almost always neoplastic. Tenderness An infectious process distal to the nodes of a node usually suggest inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency. Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection. The NP examines a 2-month-old with unequal gluteal and Perform Ortolani and Barlow test thigh skin folds. What should the NP do next? Send the infant for x-ray of the hips Explanation: Gluteal and thigh skin fold asymmetry may indicate congenital hip Send the infant for ultrasound of the hips . dysplasia. Xray studies are not useful before 3 months-of-age because the femoral Perform Ortolani and Barlow test head has not completely ossified . Examine the infant for unequal arm length