ANCC Questions and Answers with Complete Solutions

What is the first line treatment for temporal arteritis? High-dose steroids because it's an inflammatory response Why is an anecdotal or expert opinion lowest on the research hierarchy? Can be a single person or a group of experts giving an opinion, but there is no research 00:03 01:22 What is the screening test for temporal arteritis? Elevated ESR and CRP as well Which condition causes bilateral stiffness lasting 30 minutes or more located in the shoulders, neck, hips, and torso; more common in women 50 and closely related to temporal arteritis? Polymyalgia rheumatica (PMR) Are routine eye exams covered by Medicare part B? No In trigeminal neuralgia, which cranial nerve is affected? V What is the treatment for trigeminal neuralgia? Anticonvulsants (phenytoin) and muscle relaxants (gabapentin, topiramate) Who monitors and disciplines the nurse practitioners? BON What presents as an abrupt onset of facial paralysis due to dysfunction of the motor branch of the facial nerve (7)? Bell's Palsy - Additional sx: Tear production on the affected side stops - Causes: viral, autoimmune, pressure from tumor or vessel What presents as idiopathic and severe one-sided headache marked by recurrent, brief, lacerating pain behind one eye accompanied by tearing and clear rhinitis? Cluster Headache - Presents in males 30-40 yrs of age - Higher rate of suicide r/t intense pain - Tx: high dose 100% Oxygen 12L/min for 15 minutes, sumatriptan by intranasal or IM What is reliability? Repeatable, reproducible, consistent Symptoms of tension headache? Band-like tightness headache, dull and constant, tensing of neck muscles What does the dependent variable depend on? Independent variable What is described by transient episode of neurological dysfunction caused by focal ischemia without acute infection of the brain? TIA (mini stroke or minor stroke) What does the FAST mnemonic stand for? Face drooping, arm weakness, speech difficulty, time to call 911 What is the term for brain damage that presents with the patients no difficulty comprehending speech but has extreme difficulty in motor aspect of speech? Broca's aphasia - May only be able to speak 4 words - Patient understands but difficulty expressing What is apraxia? Difficulty w/ purposeful movement Is suspected child abuse reportable? Always reportable How do you illicit tinel's sign? Tap on anterior wrist - median nerve - Evaluates carpal tunnel syndrome What disease of conditions assess Phalen's sign (flex wrist and hold dorsal side of hands together)? Carpal Tunnel Syndrome (affects median nerve) What is EMTALA? Emergency Medical Treatment and Active Labor Act- stabilize patient before transfer Can be caused by embolism, thrombus, or hemorrhage and results in permanent neurological damage from ischemia to affected brain tissues? CVA or Stroke What is COBRA? Insurance after you leave a job paid for by self, gap-insurance, 18 months, you pay the premium that former employer was paying for What is cranial nerve XI? Spinal accessory, shrug the shoulders What can result from shingles in the cranial nerve V of the ophthalmic branch? Postherpetic neuralgia - Corneal blindness can result The name for the nodes on the PIP joints secondary to arthritis? Bouchard's nodes (DIP are Heberden's *remember PIP comes before DIP because proximal is closest to the body just like B in bouchards comes before H in heberdens) What is the most sensitive screening test for thyroid function? TSH What do you call the genetic defect called trisomy 21? Down syndrome - Face appears flat, ears are low-set, upward slanting eyes - Average lifespan is 60 yrs What presents as a small head, shortened palpebral fissures, flat nasal bridge, smooth philthrum? Fetal alcohol syndrome What is covered in Medicare part D? Rx - only the drugs on the formulary list Which type of cancer has increased risk w/ cryptorchidism? testicular cancer - Even if it has been repaired, then risk is still increased What disease is described as injected red conjunctiva, w/ profuse purulent discharge, swollen eye lids, and presents 2-5 days after birth? Gonococcal opthalmia neonatorum - Tx: apply erythromycin ointment 1cm ribbon per eye, immediately after birth (prophylaxis) What condition associated w/ vaginal birth shows 4-10 days after birth w/ eyelids become edematous, with red, profuse watery discharge that becomes purulent? Chlamydia opthalmia neonatorum - Appears initially watery then purulent and 4-10 days after birth How is infant mortality defined? The # of deaths 12 mos of age in 1,000 live births What is defined as unexplained and sudden death in healthy infants 12 mos. Sudden infant death syndrome (SIDS) - Back to sleep, avoid thick blankets, How much weight are newborns expected to lose during the first 5-7 days of life? 10% What is covered by medicare part A? Inpatient services for 65 yrs or ESRD at any age and hospitalizations, skilled nursing care included, hospice included, rehab included (NOT ASSISTED LIVING) Most common type of spots seen in children; appears as blue to black patches of colored skin usually in the lumbosacral area Mongolian spots - Disappears by 2-3 years of age - May be mistaken as child abuse Do you need to confirm child abuse before reporting? No, report suspected child abuse, no need to confront caregiver What condition presents w/ 2-3cm papules, white, on the forehead, and resolves spontaneously? Milia - Caused by retention of sebaceous filaments What is faun tail nevus? Tufts of hair in the lumbosacral area, coccyx region - Rule out spina bifida - Conduct neurological exam and u/s What do you need to rule out when you see cafe au lait spots? Flat light brown spots 2-5mm patches, if there are 6 or more spots then rule out... neurofibromatosis Are routine dental exams covered by Medicare part B? No At what are age children expected to have 20/20 vision? 6 yrs of age When do you refer for strabismus? If a child is 6 mos old - Red flags: absent of red reflex, presence of white reflex What is leukocoria? Presence of a white reflex -may be indicative of retinoblastoma When is lead screening done in children? 12-24 months - For high risk may need to check periodically Why do you need to give vitamin D drops for breast-fed infants? 400 IU because breast milk does not have vitamin D Why do you avoid giving cows or goats milk in the first year of life? Causes GI bleeding and IDA What is described as diffuse edema of the scalp that crosses the midline? Caput succadeneum - Caused by intrauterine and vaginal pressure from prolonged labor Edema of the scalp that does not cross the midline or suture lines? Cephalohematoma - Order x-ray of the skull to rule out fracture What is HITECH? Meaningful use of data It is not typing everything into the computer There are incentives for meaningful use of data. When do you give first dose of MMR vaccine? 12 months What vaccine do you give at birth? Hepatitis B Why is CPOE (computerized physician order entry) advantageous? Reduces errors from poor handwriting What is congenital narrowing of a portion of the aorta? Coarctation of the aorta up to 30% of infants with this have turner syndrome - Compare the brachial and femoral pulses simultaneously, absence of the femoral pulse is diagnostic When is the Ortolani test positive? Positive if there is a click or clunk sound - Tests for developmental dysplasia of the hip - Produced when the trochanter is temporarily displaced from the hip socket What presents as an asymptomatic mass that extends from the flank toward the midline? Wilms tumor or nephroblastoma - Smooth, non-tender mass, and never crosses the midline - Most common renal malignancy in children Which abdominal malignancy in children crosses the midline? Neuroblastoma - painful, abdominal mass, fixed, firm irregular and crosses midline What is considered a medical emergency that presents as acute or rapid onset of high fever, chills, and hot potato voice, and hyperextended neck with open mouth breathing? Epiglottitis - Give prophylaxis (rifampin) for close contacts - Reportable disease What presents in children as deep eye pain aggravated by eye movement that is accompanied by high fever and chills? Orbital cellulitis Usually preceded by sinus infection specially ethmoid sinus infection - Affected eye will presents w/ eye bulging - Refer to ER can be life-threatening -EOM will be abnormal What is the pre-contemplation stage in the stages of changes? When patient is in denial, does not acknowledge that there is a problem. What presents w/ an onset of high-fever, up to 104 degrees F, large lymph nodes in neck, swollen hands and feet, conjunctival injections, desquamation of hands and feet, strawberry tongue? Kawasaki disease - Vasculitis, sequelae may occur years later - F/u for several years - Tx: high dose ASA At what age will a child copy a cross? 4 What presents w/ large head circumference, mental retardation, long face with prominent forehead, jaw, and large ears? Fragile X Syndrome - Autism is common What is the job of the BON? Monitor and discipline; if there are complaints or suspicions of going outside scope of practice then BON will intervene Common acute viral illness caused by the cocsackie virus? Hand foot mouth disease - Contagious - Wash your hands What causes fifth disease? Parvovirus B19 - Slapped cheek appearance What do you call honey-colored, crusted lesions? Impetigo What do you do when you observe molloscum contagiosum in the genital area? Report What presents w/ koplik spots? Measles or Rubeola What reflex do you test for in testicular torsion? cremasteric reflex - Test the ipsilateral or same side where the patient complains of inner thigh pain What is the mature minor rule? 15-17 years of age, not emancipated - Capable of understanding the consequences of a decision - Right to refuse or request a treatment When a minor asks for oral contraceptive pills, do they need parental consent? No - However if requesting permanent, then yes Knee pain, swelling and tenderness at the tubercule tuberosity and occurs during a growth spurt? Osgood schlatter When do you perform adams forward bend test? Scoliosis Whats presented in females as complete or absence of the second sex chromosome? Turner - Lymphedema of the hands and feet - Short and webbed neck - High arched palate Your patient complains of fatigue and started levothyroxine 50mcg QD 2 weeks ago. What is your next step? Wait. Educate it takes 4-6 weeks for sx to improve. Recheck TSH at that time. What are characteristics of patients at risk for osteoporosis? Thin, small/petite, Caucasian/ASIAN, female, smoker, postmenopausal What is presbyopia? How do you know a patient has it? Farsightedness - difficulty seeing objects up close. Patients will hold items in outstretched hands. What is normal blood pressure? 120/80 What is the goal BP for someone 60 yrs? 140/90 What is the criteria for high intensity treatment of hyperlipidemia? And what would you prescribe? Heart disease (angina), DM, high LDL, low HDL - RX: atorvastatin (Lipitor) 40 to 80 mg or rosuvastatin (crestor) 20 to 40 mg What interacts with statins? And what can it lead to? Atorvastatin + niacin or vitamin B 3 can lead to drug induced hepatitis or rhabdomyolysis (think liver damage w/ sx of fatigue, anorexia, JAUNDICE, DARK COLORED URINE) What drugs are preferred for isolated systolic HTN? Calcium channel blockers and thiazides diuretics What is the goal for someone with DM or CKD? Does it change with age? 140/90 What is the BP goal for someone 60 yrs? 150/90 What are the preferred HTN drugs for after MI? Beta blocker, ACE, ARB What is the preferred HTN drug for DM? What does it offer? ACE/ARB (renal protection) What is the preferred HTN drug for African American? Thiazide or CCB What is the preferred HTN drug for Non-black with no co-morbids? ACE/ARB, CCB, THIAZIDE What drugs can cause heart burn? BB, CCB, alpha agonists Thiazide diuretics Give examples, contraindications, what lab values does it affect and how, ideal patients. "-ide" e.g. HCTZ Contraindicated: sulfa allergy, caution in gout, DM Causes high: glucose, Uric acid, lipids Causes low: K, Na, Mg Ideal patients: osteoporosis/penia (decrease calcium loss and demineralization) Calcium channel blockers - give examples, the 2 classes, effects on VS, and contraindications, and ideal patients "-pine" * 2 classes- dihydropyridine (DHP-doesn't hurts the pulse): nifedipine and amlodopine and non-DHP (lowers HR) - diltiazem and verapamil * contraindications: HF (ankle edema, fluid retention), type 2&3 heart blocks, GERD (relaxes LES) , caution in post MI Ideal: African American with no comorbids, and ISH in elderly, migraine, AFIB ACE inhibitors/ ARBs Give examples, ideal patients, and side effects "-pril" and "-sartan" * Ideal patients: DM or CKD (renal protective) * SE: dry cough, angioedema, hyperkalemia Beta Blockers - give med examples, ideal patients and contraindications "-olol" * Ideal: POST MI, migraine prophylaxis, glaucoma, tachycardia, hyperthyroidism, pheochromocytoma * Contraindicated: asthma/ COPD — bronchospasm, bradycardia, 2-3 heart blocks Alpha 1 blockers - give examples and ideal patients, how to prescribe "-zosin" (Terazosin) - ideal patients: HTN and BPH - how to RX: can lead to orthostatic hypotension so give at bedtime low dose and titrate slowly Loop diuretics - give example, ideal patient, effects on labs E.g. furosemide First line - acute CHF Decrease K, Na, Mg Aldosterone Receptor Antagonists - give example, ideal patients, side effects, and contraindications Spironolactone - K sparing diuretic Ideal: HTN, HF, hirsutism, precocious puberty SE: gynecomastia, galactorrhea, hyperkalemia, GI upset, postmenopausal bleeding, ED Contraindications: don't combine with ACEI both increase K Sx of left sided heart failure Related to lungs - coarse tales, SOB Sx of right sided heart failure Major organs - hepatomegaly, abdominal fullness, dependent edema Risk factors for chronic venous insufficiency Obesity, pregnancy, standing for long periods of time Risk factors for DVT Any injury that reduces blood flow to part of body, major surgeries like hip replacement, clotting disorders Risk factors for pulmonary embolism Bed rest, long journeys, smoking, pregnancy obesity Peripheral vascular disease risk factors 50 and over, hyperlipidemja, smoking A positive Homan's sign is indicative of what condition? DVT Sx of PE chest pain into the arm, jaw, or neck as well as anxiety, clammy skin, irregular heartbeat, lightheadedness, and even coughing. Sx of CVI brownish discoloration of the legs, which are cool to the touch, and aching in the legs that is relieved by elevation. Sx of PVD painful cramping and coldness in the lower leg or foot as well as leg numbness of weakness, lower extremity pain w/ exercise typically in calf, hair loss, shiny appearing skin, skin cool to touch Hypertensive crisis in primary care setting what do you do? Alpha 2 adrenergic agonist (clonodine), call 911 What is the A1C goal for a pregnant pt? 6 What is the A1C goal for a T1D? 6 What is the A1C goal for T2D? 7 What is the A1C goal for 65/elderly? 8 How do you diagnose T2D? Give specific lab values. A1C 6.5 FBG 126 2h GTT 200 (Pregnancy & PCOS only) Random 200 - Confirm A1C/FBG by repeat testing (2 occasions) unless there is no other reason for hypoglycemia What is pre-diabetes? Give lab values. Prediabetes = A1C 5.7-6.4% and FBG 100-126 What is the normal range for calcium? 8.5-10.2 mg/dl Normal lipid panel ranges? Total cholesterol HDL (men/women) LDL Triglycerides Total cholesterol 200 HDL men40, women 50 LDL 100 Triglycerides 150 What is your next step if a patient has triglycerides 500 or + ? fenofibrate (tricor) What do you do if a patient has an LDL 190? high-intensity statin therapy Examples of high-intensity statins? rosuvastatin 20-40 or atorvastatin 40-80mg What is normal TSH? 0.5-5.0 mU/L Normal hemoglobin in females? Males? Females 12-16 Males 14-18 Normal hematocrit in females? Males? Females 42-52 Males 37-47 Microalbuminuria level? What is normal? 30-300 Normal = 30 What is elevated uric acid level? If elevated what do you suspect? any additional testing? uric acid elevated when 7, suspect gout, ESR/WBC will both be elevated What is elevated creatinine? Women/Men Women = 1.1 Men=1.3