AANP AGPCNP PSI Test 1 & 2. Questions and answers, Graded A+
An 88-year-old presents with right-side weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia an
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AANP AGPCNP PSI Test 1 & 2. Questions and answers, Graded A+
An 88-year-old presents with right-side weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis?
Left-sided or right-sided CVA? - ✔✔LEFT-SIDED CVA
Which of the following signs/symtpoms are often associated with headahces due to intracranial tumor?
1) pain worse laying down, focal neurological signs
2) Hyperflexia, personality change
3) acute onset: hours to days
4) pupillary constriction; stupor - ✔✔1) pain worse laying down, focal neurological signs
Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion?
1) Timolol
2) Gentamicin ophthalmic
3) Cromolyn optha
4) Olopatadine - ✔✔2) Gentamicin ophthalmic (Genoptic)
A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step to be taken in order to make a diagnosis?
1) Xray of shoulder
2) Palpate structures around the shoulder.
3) MRI of shoulder
4) EMG - ✔✔2) palpate structures
A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate?
1) Changing to Ortho-Novum 1/35
2) Discontinue use
3) Providing reassurance
4) Double dose-for two days - ✔✔3) provide reassurance
According to the Report of the U.S. Preventive Services Task Force, which of the following is NOT a current recommendation guideline for preventive care in elderly female patients?
1) Mammogram and clinical breast exams
2) Fecal Occult blood test and/or sig
3) Rubella serology or vaccination history
4) Pnuemo and influenza vaccines - ✔✔3) Rubella serology or vaccination history
87 y/o NH patient is drowsy and barely responsive. Temp 95, BP: 110/70, Pulse 60, R 10. The best action is to:
1) initiate passive warming
2) apply a rebreather
3) Perform fluid replacement
4) initiate active warming - ✔✔1) initiate passive rewarming
A patient is referred with DM, HTN and CAD. He is on insulin and a beta blocker. How would you educate this patient on recognizing the signs and symptoms of hypoglycemia?
1) Edema
2) Tachycardia
3) palpitations
4) sweating - ✔✔4) sweating
A 65-year-old overweight patient is diagnosed with plantar fasciitis. Initial therapy of NSAIDs, stretching, ice, and rest has proven ineffective after 3 weeks. The best follow-up plan of care would be to:
1) stop NSAID, apply a heel cup and encourage exercise and wt loss.
2) continue NSAID, apply an arch support and encourage wt loss and exercise
3) continue NSAID, xray and add a short-leg night splint
4) COntinue NSAID, xray and add a metatarsal bar - ✔✔2) continue NSAID, apply an arch support and encourage wt loss and exercise
Fundoscopic exam of Hypertensive patient.
1) nicking of arteriols and viens, and small retinol hemorrages
2) drusen bodies and pale retina
3) pale macula and swollen disk margins
4) microaneurysms and optic disc cupping - ✔✔1) nicking of arteriols and viens, and small retinol hemorrages
Which of the following is a common presenting feature of hyperthyroidism in the elderly?
1) elevated TSH
2) Thyroid enlargement
3) atrial fibrillation
4) abnormal T3 suppression - ✔✔3) atrial fibrillation
A 35-year-old lawn maintenance worker presents reporting "something in my eye" since the previous day. The eye was rinsed with over-the-counter eyewash, without relief. The patient denies visual disturbances or drainage. In formulating a plan of care, the nurse practitioner would FIRST:
1) send to ophthalmologists
2) florescreen staining
3) test visual field
4) prescribe eyedrops - ✔✔3) test visual field
A 72-year-old patient presents with dry, itchy eyes. During the course of the physical examination, the nurse practitioner notes the presence of a gray band of opacity in the cornea that encircles the iris. The band is 1.0-1.5 mm wide. This finding is most consistent with a diagnosis of a/an:
1. corneal abrasion
2. arcus senilis
3. corneal ulcer
4. herpetic infection of the eye - ✔✔2) arcus senilis
A 26-year-old presents with reports of anorexia, fatigue, weight loss, malaise, fever, night sweats, and a cough that has been present for 4 weeks. The diagnostic study to perform first would be:
1) xray
2) pulmonary function test
3) bronchoscopy
4) H & H - ✔✔1) xray (tb-night sweats)
A 44-year-old female is complaining of frequent anxiety attacks with chest discomfort and fatigue. On physical examination, her lungs are clear bilaterally. There are a midsystolic click and a grade II/VI systolic murmur at the apex. Further evaluation would include which of the following?
1) EKG, flat plate of the abdomen, lipid profile
2) Echocardiogram, Doppler, EKG
3) Labs and benzo's
4) EEG, Anxiety Scale, and electrolytes - ✔✔2) Echocardiogram, Doppler, EKG
A healthy 84 y/o would like to start an exercise program, what would you do before this takes place?
1) physical exam
2) EKG
3) knee xrays
4) PT Stress test - ✔✔1) Physical Exam
29 y/o has uncomplicated Chlamydia infection will exhibit:
1) green penile discharge
2) uticartia
3) unremarkable symtpoms
4) penile ulcer - ✔✔3) unremarkable symptoms
37 has suspected PE. c/o anxiety and cough, CXR normal, the next test should be:
1) spirometry
2) MRI
3) COntract venogra[hy
4) helical CT pulmonary angiograph - ✔✔4) helical CT pulmonary angiography.
A 12-lead EKG shows an undulating baseline with no visible P waves and an irregularly irregular R-R interval. This arrhythmia is:
1) atrial flutter
2) atrial fibrillation
3) second degree heart block
4) Wolff-White Syndrome - ✔✔2) atrial fibrillation
After a 3-week camping trip, a 17-year-old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes:
1) Bactrim
2) azithromycin
3) doxycycline (Doryx).
4) metronidazole - ✔✔3) doxycycline (Doryx). Rocky Mountain spotted fever (Lyme disease-test with WEstern Blot)
According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a value equal to or greater than:
1) 110 mg/dL.
2) 126 mg/dL.
3) 135
4) whatever - ✔✔2) 126 mg/dl
In the elderly, one pathophysiologic mechanism of isolated systolic hypertension involves:
1) decreased cardiac output.
2) loss of vascular tissue elasticity.
3) hyperactive baroreceptors - ✔✔2) loss of vascular tissue elasticity
A 58-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical examination, there is pain on ROM, with no weakness noted. Laboratory studies show a low hemoglobin and an elevated sedimentation rate. Which of the following is the most likely diagnosis?
1) Polymyalgia rheumatica
2) polymyositis
3) osteoarthritis
4) Fibromyalgia - ✔✔1) polymyalgia rheumatica
An 85-year-old male relates that on the way to his annual physical examination, he suffered a sudden loss of vision in his right eye characterized by "a bunch of lights" and a feeling that "a curtain came down." All of the following would be included in the differential diagnosis EXCEPT:
1) opthalmolic migraine
2) retinal detachment.
3) diabetic retinopathy.
4) TIA - ✔✔3) diabetic retinopathy
A patient with diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of self blood glucose monitoring reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of:
1) insulin resistance
2) the Somogyi effect.
3) needing more insulin in the mornings
4) Need to increase insulin at night - ✔✔2) Somogyi effect
In a healthy elder, which of the following TRADITIONALLY defines a positive urine culture?
1) ≥100,000 colonies/mL of a single organism
2) ≥10,000 colonies/mL of a single organism
3) ≥100,000 colonies/mL of a two or more organisms - ✔✔≥100,000 colonies/mL of a single organism
A 55-year-old patient exhibits a verified serum calcium level of 13 mg/dL [normal = 8.9-10.2 mg/dL]. The next step in determining the presence of pathology is to order a:
1) BUN and serum creatinine.
2) 24 hour urine
3) parathyroid hormone level.
4) thyroid panel - ✔✔3) parathyroid hormone level
An 88-year-old female presents with a 3-day history of vertigo. The patient has a past medical history of hypertension controlled with metoprolol, 50 mg daily. She reports that the presenting symptoms are constant, severe, and accompanied by nausea and vomiting. She denies experiencing diplopia, slurring of speech, chest pain, dyspnea, or diaphoresis. She exhibits mild anxiety and reluctance to change position or turn the head. BP = 126/76; P = 78; R = 16/min; and T = 98.2°F (36.8°C). HEENT examination reveals 17 beats of horizontal nystagmus on right lateral gaze; the nystagmus stops after several repetitions of the maneuver. Funduscopic, cardiac, pulmonary, abdominal, and neurologic examination results are normal. The most likely diagnosis is:
1) acoustic neuroma
2) vestibular neuritis.
3) vertibailar insufficiency
4) TIA - ✔✔2) vestibular neuritis
When initiating thyroid hormone replacement in the older adult, care must be taken to evaluate the patient's:
1) coronary status.
2) weight
3) renal function
4) mental state - ✔✔1) coronary status
Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis?
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