ANCC FNP EXAM ACTUAL EXAM | ALL
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES | ALREADY
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VERIFIED ANSWERS
A 35-year-old man with no PMH is admitted to the primary care clinic with
eye problems for the last 5 days. He stated that 8 days ago, he had upper
respiratory symptoms, including a runny, stuffy nose, tearing, and throat
pain. His symptoms resolved a few days later, but then he started
developing problems in his left eye. He states that his left eye has felt itchy,
swollen, and red for the last 5 days and has had a persistent watery
discharge. He denies any pain to the eye, vision problems, or problems
with pupillary reaction. The patient's temperature = 98.3 degrees F, HR =
80, RR = 16, and BP = 110/70. Physical exam of the eye reveals the
picture shown below. Which of the following is the next best step in
management?
A. Cold compresses
B. Ayclovir
C. Topical azithromycin ointment
D. Topical erythromycin ointment and oral azithromycin ---------CORRECT
ANSWER-----------------Correct Answer: A. Cold compresses
Adenovirus is the most common cause of viral conjunctivitis. Typically, this
involves an exposure to another individual with the virus, and patients
begin complaining of upper respiratory symptoms (such as coughing,
congestion, and runny nose) for a few days. Then, the patient notes watery,
red, itchy eyes with diffuse hyperemia. The other eye may become affected
a few days later. Typically, vision is intact, and pupil size and reaction to
light is normal as well. There is rarely pain in the eye or systemic
symptoms. The symptoms usually regress within a few weeks, and
treatment is supportive, including the use of cold compresses, ocular
decongestants, and artificial tears. The presence of a watery, itchy, and red
eye after an upper respiratory infection indicates a likely viral conjunctivitis,
most likely caused by adenovirus.
,Incorrect Answers:
B. Herpes zoster ophthalmicus occurs when the varicella zoster virus
reactivates in the ophthalmic division of the trigeminal nerve. Most patients
with herpes zoster ophthalmicus present with a periorbital vesicular rash
distributed according to the affected dermatome. Poor nutrition, lack of
sleep, and stress are aggravators that may activate the disease. Patients
typically present with influenza-like prodromal symptoms for a week leading
up to the disease, and pain and tingling in the dermatomal distribution
occur before the appearance of the dermatomal rash itself. The rash
presents with vesicles, and patients complain of unilateral eye pain and
watery discharge. Treatment is with acyclovir. The patient's lack of a
dermatomal, vesicular rash makes this answer choice unlikely.
C. Staphylococcus aureus is the most common cause of bacterial
conjunctivitis. Like viral conjunctivitis, preservation of visual acuity and
pupillary reaction occurs.
A geriatric client is complaining of difficulty hearing. He relates that the
problem seems to have gotten worse over the past few years. What finding
would support a diagnosis of presbycusis?
A. Complain that they can hear voices, but everyone mumbles
B. Rinne test air conduction greater than bone conduction
C. History of long term use of tetracycline antibiotics for chronic infections
D. Family history of chronic hearing loss ---------CORRECT ANSWER--------
---------Correct Answer: A. Complain that they can hear voices, but
everyone mumbles
In presbycusis, the ability to hear high frequency sounds is diminished.
Patients with presbycusis have difficulty distinguishing consonant sounds,
so words such as shoe and true are heard as "oo".
Incorrect Answers:
B. The Rinne test is normal if air conduction > bone conduction. An
abnormal Rinne test, with bone>air conduction, is consistent with
conductive loss, particularly if the Weber test also lateralizes to that
side.However, these classifications are not useful in diagnosis of
presbycusis as it is multifactorial and the pathophysiology is complex.
C. D. Tetracyclines are not ototoxic, and family history may or may not
contribute to the problem.
Vital Concepts:
,In presbycusis, the ability to hear high frequency sounds is diminished.
Patients with presbycusis have difficulty distinguishing consonant sounds,
so words such as shoe and true are heard as "oo".
References:
Zerwekh, JoAnn G, and Jo C. Claborn. Adult Nurse Practitioner
Certification Review. Philadelphia: Saunders, 2004.
Fitzgerald. Nurse practitioner certification examination and practice
preparation. 2010.
Maria T. Codina Leik. Adult-Gerontology Nurse Practitioner Certification
Intensive Review: Fast Facts and Practice Questions, Second Edition
Paperback - August 12, 2013
A 12-year-old male patient present for evaluation of a painful pimple on his
eyelid. On exam, you find a 3 mm fluctuant pustule on the margin his right
eyelid with no exudate. What is this likely to be?
A. Chalazion
B. Molluscum contagiosum
C. Hordeolum
D. Blepharitis ---------CORRECT ANSWER-----------------Correct Answer: C.
Hordeolum
A hordeolum is also known as a stye. It is a painful infection of the
meibomian gland, so located at the margin of the eyelid. It is treated with
warm compresses for 10 minutes TID and erythromycin ointment may also
be added.
Incorrect Answers:
A. A chalazion is a subcutaneous nodule that results from blockage of the
meibomian gland, but are generally not due to infection. May be associated
with a hordeolum.
B. Molluscum contagiosum are small nodules with a central umbilication
that may appear on the face or eyelids. They are caused by a virus and
should not be painful.
D. Blepharitis is inflammation of the eyelid margin.
Vital Concepts:
A hordeolum is also known as a stye. It is a painful infection of the
meibomian gland, so located at the margin of the eyelid. It is treated with
warm compresses for 10 minutes TID and erythromycin ointment may also
be added.
, The nurse practitioner observes lid lag in a client with:
A. Myasthenia gravis
B. Hyperthyroidism
C. Hordeolum
D. Chalazion ---------CORRECT ANSWER-----------------Correct Answer: B.
Hyperthyroidism
Lid lag is seen in hyperthyroidism. It is due to sympathetic overactivity. If
the lid margin falls above the limbus so that some sclera is visible,
hyperthyroidism may be present.
Incorrect Answers:
A. Ptosis is a drooping lid margin that falls at the pupil or below and may
indicate myasthenia gravis.
C. A localized infection of the small glands around the eyelashes in the hair
follicle at the lid margin is called Hordeolum.
D. A Chalazion is an inflammation or cyst of the meibomian glands, which
lie within the posterior portion of the eyelid.
Vital Concepts:
Lid lag is seen in hyperthyroidism. It is due to sympathetic overactivity. If
the lid margin falls above the limbus so that some sclera is visible,
hyperthyroidism may be present.
A 7-year-old is found to have a white mass behind the tympanic membrane
on the left side during routine physical exam. Audiogram confirms
conductive hearing loss in the left ear. He has no history of previous ear
surgery, and you do not appreciate any retraction of the tympanic
membrane. What is the diagnosis?
A. Congenital cholesteatoma
B. Primary acquired cholesteatoma
C. Secondary acquired cholesteatoma
D. Glomus tympanicum ---------CORRECT ANSWER-----------------Correct
Answer: A. Congenital cholesteatoma
A white mass behind the tympanic membrane in an otherwise
asymptomatic child is most consistent with a congenital cholesteatoma.
