142) Which of the following diagnostic assessment must be considered before developing any plan of care for a 27-year-old female presenting to a family practice clinic?
a. Pregnancy test
b. Family social history
c. Hematocrit and hemoglobin
d. Blood pressure
143) An 8 y/o is sent home from s...
142 which of the following diagnostic assessment must be considered before developing any plan of care for a 27 year old female presenting to
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NSG 6440 TYPED
PRE-PREDICTOR
1) A 15 years old high school student with a mild sore throat 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?
a. Palpate the lymph nodes and spleen
b. Examine the posterior oropharynx for petechiae
c. Obtain a CBC, throat culture, and heterophil antibody test.
d. Obtain an urinalyses and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus.
Common is people 15-24 years of age. Common signs and symptoms 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.
2) A 32 years old male patient complaint of urinary frequency 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
b. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3 days
d. 750 mg ciprofloxacin as a one-time dose
Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication to
treat urinary tract infections in most patients. In the case of community resistance to TMPS
>20%^, another medication should be substituted. In men, the appropriate length of time is 7-10
days. Women may be treated for 3 days for uncomplicated UTI
3) Which agent is most effective for the treatment of nodulocystic acne?
a. Benzoyl peroxide (Benzac)
b. Retinoic acid (Retin A)
c. Topical tetracycline
d. Isotretinoin)
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment with 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
teratogenic. There are many restrictions in prescribing this medication because of the teratogenic
effects is given during pregnancy. Therefore, it is a pregnancy category X.
4) An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be
instructed to use a backup method for the prevention of pregnancy
a. Throughout the week of placebo pills
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,b. If prescribed topiramate (Topamax) for the treatment of migraines.
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,c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection
d. if she forgets to take a single dose of the contraceptive
Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine (Tegretol),
primidone (Mysoline), topiramate (Topamax) and oxcarbazepine (Trileptal) reduce the
effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or levonorgestrel-
releasing intrauterine devices would be a better method of contraceptive for patients taking
anticonvulsants. Most commonly used 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.
5) A 44 years old female patient has diabetes. Her total 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 the greatest effect on improving her lipid profile
and reducing morbidity and mortality associates with dyslipidemia?
a. Niacin (Niaspan)
b. Atorvastatin
c. Omega 3 fatty acids
d. Fenofibrates
Explanation: First and foremost, it is essential to educate individuals on a heart-healthy
lifestyle. LDL-C is one of the major culprits in the development of atherosclerotic heart disease.
The target level of LDL-C is between 50 to 70mg/dl to prevent plaque formation in the blood
vessels. Guidelines strongly recommend statin therapy because they primarily lower LDL-C
levels, but they also have the secondary effects of lowering triglyceride and increasing HDL-C
levels.
6) A 30 years old female comes into a clinic with classic signs 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
a. Failure of diligence
b. Professional liability
c. Negligence
d. Malpractice
Explanation: malpractice, a negligence tort, occurs when a health care professional’s actions fall
bellow the appropriate standard of care and hurts the patient. In this case the patient came with
sings and symptoms indicating appendicitis and the NP failed to refer the patient..
7) A NP has recently been hired to work in a fast track facility. The NP employer asked if
she has “a problem prescribing medications for emergency contraception.” The NP replies
affirmatively. This is:
a. Grounds for dismissal
b. An ethical dilemma for the NP
3
, c. Illegal according to the standards of nursing
d. Patient abandonment.
Explanation: in this instance, the NP has a difference of opinion with her employer based on her
religious or moral belief about providing emergency contraception. This situation is an example
of an ethical dilemma. Failure to participate in the 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
8) A patient presents with pruritic lesions on both knees. There are visible silver scales. How
Should this condition be managed?
a. Topical antifungal cream or ointment
b. Oral antibiotics
c. Topical corticosteroids cream
d. Topical anti-fungal/ steroid cream
Explanation: Psoriasis is characterized by erythematous papules, as well as itchy, red, precisely
defined plaques with silvery scales. Auspitz sings is another common finding. Topical agents
containing tar and salicylic acid may be used. Topical steroids, such as betamethasone, may also
be ordered.
9) Antidepressant discontinuation syndrome is less likely if the patient
a. Is male
b. Is less than 35 y/o
c. Has taken an SSRI with a short half life
d. Gradually tapers SSRI use
Explanation: Antidepressant discontinuation syndrome is most often seen in the primary care
office in association with SSRI discontinuation, because SSRIs are the 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.
10) Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one of
the following drug classes?
a. Alpha adrenergic antagonist
b. Anti-androgen agents
c. Tricyclic antidepressant (TCA)
d. Sulfonamides
Explanation: tricyclic antidepressant should not be used by men with benign prostatic
hyperplasia because of the increased risk of urinary retention secondary to the anticholigergic
effects of TCAs.
11) Which of the following is the best response to a woman who has just admitted she is
a victim of spousal abuse?
a. What was if you did to make him angry?
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