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ANCC AGPCNP
Practice Questions
with Accurate
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A 19-year-old woman has recently been diagnosed with acute hepatitis B. She is sexually active and is monogamous. She reports that her partner uses condoms inconsistently. What would you recommend for her male sexual partner who was also tested for hepatitis with the following results: HBsAg (−), anti- HBc (−), anti-HBs (−), anti-HCV (−), anti-HAV (+)? A.Hepatitis B vaccination B.Hepatitis B immunoglobulin C.Hepatitis B vaccination and hepatitis B immunoglobulin D.No vaccination is needed at this time correct answer C.Hepatitis B vaccination and hepatitis B immunoglobulin HBsAg is a marker of infectivity. If positive, it indicates either an acute or chronic hepatitis B infection, so the partner does not have acute or chronic hepatitis B infection. Anti-HBs is a marker of immunity and because this is negative, it indicates that the partner is not immune to hepatitis B. Antibody to hepatitis B core antigen (anti-HBc) is a marker of acute, chronic, or resolved hepatitis B virus (HBV) infection; it may be used in pre-vaccination testing to determine previous exposure to HBV. The hepatitis B panel results for the individual in this question (negative HBsAg, anti-HBc, and anti-HBs) indicate the partner is susceptible (not immune), has not been infected, and is still at risk of future infection—and thus needs vaccine. Hepatitis B immunoglobulin contains antibodies that provide "instant" immunity against hepatitis B, but its action lasts for several days only. It is not a vaccine. It is given to infants and others who are at high risk of becoming infected and are not immune. The hepatitis B vaccine stimulates the body to make its own antibodies, which are permanent. A total of three doses are needed to gain full
immunity against hepatitis B. Interpretation of the negative anti-HCV screening test indicates that the partner is not infected with Hepatitis C. The positive anti-HAV indicates that the individual is immune (either from previous disease or from vaccination) to Hepatitis A. A 20-year-old woman reports that for several years, she has had random episodes of palpitations and shortness of breath that resolve spontaneously. She denies chest pain, arm pain, and syncope. Her past medical and family histories are negative for coronary artery disease, stroke, or lung disease. During the cardiac exam, the nurse practitioner notices a grade 3/6 murmur that is accompanied by a midsystolic click, which is best heard at the apical area. The apical pulse is 78 beats/min, blood pressure is 120/ mmHg, and temperature is 98.6°F. The cardiac exam is highly suggestive of which of the following conditions? a. Mitral valve prolapse (MVP) b. Aortic stenosis c. Atrial septal defect d. Pulmonary regurgitation correct answer a. Mitral valve prolapse A systolic murmur that is accompanied by a midsystolic click located at the apical area is a classic finding of MVP. Most cases of MVP are asymptomatic. To detect MVP, order an echocardiogram with Doppler imaging. A 22-year-old presents for her annual gynecological exam and testing. The Pap smear result shows ASC- US. Which of the following is the best management for this patient? a. Check for high-risk HPV b. Repeat Pap in 12 months c. Refer patient for colposcopy d. Refer patient for endometrial biopsy correct answer b. Repeat pap in 12 months The appropriate follow-up for a 22-year-old with a Pap smear result of ASC-US is to perform a repeat Pap smear in 12 months. HPV testing is not recommended for this age group with ASC-US. A colposcopy is not recommended for ASC-US, as most cases clear spontaneously in young women. An endometrial biopsy is not appropriate follow-up for ASC-US, since it does not involve the endometrium.
a. Diphtheria, tetanus, acellular pertussis (DTaP) b. Diphtheria and tetanus (DT) c. Tetanus diphtheria (Td) d. Tetanus, diphtheria, acellular pertussis (Tdap) correct answer d. Tetanus, diphtheria, acellular pertussis (Tdap) The Centers for Disease Control and Prevention (CDC) recommends that one of the tetanus boosters be replaced with the Tdap (once in a lifetime). Thereafter, the Td form of the vaccine is indicated every 10 years. The DTaP and DT forms of the tetanus vaccine are not given after the age of 7 years. Puncture wounds are at higher risk for tetanus because Clostridium tetani bacteria are anaerobes (deep puncture wounds are not exposed to air compared with superficial wounds). A 55-year-old male presents with a swollen, painful right testicle and burning on urination. Examination reveals edematous scrotum with tenderness and a positive Prehn's sign. The patient states he is heterosexual and has been in a monogamous relationship for the past 5 years. He denies practicing anal intercourse. The nucleic acid amplification test (NAAT) is negative. Which medication will the nurse practitioner prescribe? a. Ceftriaxone 250 mg IM b. Levofloxacin 500 mg PO × 10 days c. Doxycycline 100 mg PO BID × 10 days d. Ceftriaxone 250 mg IM and ofloxacin 300 mg PO BID × 10 days correct answer b. Levofloxacin 500 mg PO × 10 days. The results of the NAAT indicate the patient is negative for chlamydia and gonorrhea. In an older male, acute epididymitis, caused by enteric organisms (generally gram-negative Escherichia coli ), is the probable diagnosis. Levofloxacin 500 mg orally once a day for 10 days is the treatment of choice. Epididymitis is diagnosis for most commonly gram-negative E. coli. Ceftriaxone 250 mg IM in addition to Doxycycline 100 mg orally twice a day for 10 days is recommended for patients with epididymitis caused by chlamydia and gonorrhea. Ceftriaxone 250 mg IM in addition to ofloxacin 300 mg orally twice a day for 10 days is indicated for patients with acute epididymitis most likely caused by sexually transmitted chlamydia and gonorrhea, as well of the probability of enteric organisms obtained by men who practice anal sex.
A 55-year-old patient who is on a prescription of clindamycin for a dental infection presents to the nurse practitioner with complaints of watery diarrhea for the past 4 days. She complains of abdominal cramping and bloating with diarrheal stools up to 10 times a day. She denies seeing blood or pus in her stool. There is no history of recent travel. The patient has been taking over-the-counter medicine with no relief. Which of the following antibiotics is indicated for this infection? a. Ciprofloxacin (Cipro) 400 mg PO BID × 7 days b. Metronidazole (Flagyl) 500 mg PO TID × 10 days c. Levofloxacin (Levaquin) 750 mg PO daily × 7 days d. Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet PO BID × 10 days correct answer b. Metronidazole (Flagyl) 500 mg PO TID × 10 days First-line treatment for a mild case of Clostridium difficile colitis is metronidazole (Flagyl) 500 mg PO TID for 10 days. Discontinuation of the offending antibiotic (if possible) or switching to another antibiotic class is recommended. The role of probiotic supplementation is controversial. Complications are pseudomembranous colitis, toxic megacolon, and fulminant colitis. A 68-year-old patient recently prescribed caridopa-levodopa (Sinemet) tells the nurse practitioner that he has been bloated and experiencing difficulty with bowel movements. Which medication will the nurse practitioner consider incorporating into the treatment plan? a. Senna b. Methylnaltrexone c. Magnesium citrate d. Polyethylene glycol correct answer d. Polyethylene glycol Levodopa, an antiparkinsonian drug, can cause constipation in an older patient. The first-line treatment for the patient's constipation is osmotic laxatives such as polyethylene glycol. Senna is a stimulant laxative that is a second-line treatment for constipation in an older adult. Methylnaltrexone is a peripherally acting mu-opioid antagonist that acts on the gastrointestinal tract to decrease opioid- induced constipation. Magnesium-based laxatives (e.g., magnesium citrate) taken over the long term should be avoided because of the potential of toxicity.
A college student is brought to the primary care clinic with a stiff neck, photophobia, severe headache, and changes in mental status. The nurse practitioner suspects meningitis and evaluates for which additional data to confirm this diagnosis? a. Cerebrospinal fluid with high levels of glucose b. Positive Kernig sign c. Negative Brudzinski sign d. Negative Babinski reflex correct answer b. Positive Kernig sign Acute bacterial meningitis presents with nuchal rigidity, light sensitivity, petechiae, severe headache, mental status changes, and, in some cases, nausea and vomiting. Meningitis is highly contagious, and droplet precautions should be implemented. A lumbar puncture with large numbers of white blood cells (WBCs), elevated levels of protein, and low glucose levels are indicative of meningitis. A positive Kernig sign (resistance to leg strengthening due to inflammation of lumbar nerve roots) is a test to assess for meningeal irritation. The Brudzinski sign would also be positive, not negative. A Babinski reflex (plantar reflex) should be negative in adults. A nurse practitioner assesses a patient who is experiencing severe otalgia and has a temperature of 100.7°F. The Rinne test result shows that BC < AC, and the Weber exam shows lateralization in the affected ear. The nurse practitioner notes blisters on an erythematic tympanic membrane (TM). Which of the following conditions is most likely? a. Acute otitis media (AOM) b. Otitis media with effusion c. Bullous myringitis d. Otitis externa correct answer c. Bullous myringitis Bullous myringitis is a severe type of AOM with painful blisters (bullae) on a reddened TM. The patient may exhibit conductive hearing loss, otalgia, muffled hearing, and a low-grade fever. With otitis media with effusion, the TM may bulge or retract, but it is not red. It may follow AOM and be caused by chronic allergic rhinitis. Otitis externa (swimmer's ear) is more common in the warm and humid seasons. There is external otalgia, swelling, discharge, pruritus, and hearing loss if the canal is blocked with pus.
A nurse practitioner is discussing urinary incontinence with a 78-year-old female patient and her caregiver. Which treatment would be most helpful for this patient? a. Kegel exercises b. PT c. Trial of oxybutynin d. Terazosin correct answer c. Trial of oxybutynin Oxybutynin is an appropriate medication to trial for older women with urinary incontinence. The other option is imipramine, a tricyclic antidepressant (TCA). Kegel exercises are recommended for women who have stress incontinence; the highest incidence is in women between 45 and 49 years. Physical therapy for gait training and strengthening is for functional incontinence. Terazosin or tamsulosin would be prescribed for men with benign prostatic hyperplasia (BPH). A nurse practitioner sees a patient for a skin assessment and finds a small number of rough, scaly patches on the patient's face, lips, ears, and neck. Which is the most appropriate treatment for this condition? a. Cryopexy b. Radiation c. 5-Fluorouracil cream d. Cryotherapy correct answer d. Cryotherapy The patient has a small number of actinic keratosis lesions on their head, so cryotherapy is the best plan. If the patient had larger numbers of lesions all over their body, 5-fluorouracil cream would be the most appropriate intervention. Cryopexy is the treatment for a retinal detachment. There is no need for radiation, because actinic keratosis is a precursor to squamous cell carcinoma but is not cancerous. A patient diagnosed with irritable bowel syndrome (IBS) tells the nurse practitioner that over the past few months, she has been experiencing frequent bouts of constipation. Which prescription will the nurse practitioner add to the treatment plan? a. Amitriptyline (Elavil) 50 mg PO once daily
d. None of the above correct answer c. The patient can take any of the pills in the sulfonylurea class The patient can take any of the pills in the sulfonylurea class. Available evidence does not support existence of cross-reactivity between the sulfonamide antimicrobials (e.g., sulfamethoxazole) and the nonantimicrobial sulfonamides (e.g., furosemide, thiazide diuretics, sulfonylurea hypoglycemics, protease inhibitors, and carbonic anhydrase inhibitors). This is due to the differences in their sulfa metabolites. The exception is sulfasalazine, a disease- modifying antirheumatic drug (DMARD), which can cause a cross-reaction. A patient presents to the primary care clinic with complaints of headache, nonproductive cough, and fatigue for the past 2 weeks. The nurse practitioner auscultates crackles and wheezing. A chest x-ray shows patchy infiltrates. The patient does not have comorbidities or recent use of antibiotics. What is the most appropriate treatment for this patient? a. Azithromycin (Z-Pak) daily × 5 days b. Levofloxacin (Levaquin) 750 mg PO × 5-7 days c. Amoxicillin-clavulanate (Augmentin) 1,000/62.5 mg PO BID × 5-7 days d. Moxi.oxacin (Avelox) 400 mg PO daily × 5-7 days correct answer a. Azithromycin (Z-Pak) daily × 5 days The patient presents with signs and symptoms of Mycoplasma pneumoniae (atypical pneumonia). Because this patient does not have any comorbidities or antibiotic resistance, the most appropriate treatment would be azithromycin (Z-Pak) daily × 5 days. Patients with risk of possible comorbidity (e.g., chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia) and/or those at risk for antibiotic resistance should receive monotherapy with a fluoroquinolone (e.g., levofloxacin or moxifloxacin) or combination therapy of amoxicillin-clavulanate plus a macrolide or doxycycline. Monotherapy with amoxicillin-clavulanate would not be appropriate. A patient presents with a wedge-shaped, superficial, yellow, triangular mass on the nasal side of the left eye. The patient denies pain or vision changes. PERRLA is normal. Which diagnosis is most likely? a. Pinguecula b. Chalazion c. Hordeolum d. Pterygium correct answer d. Pterygium
The patient has a pterygium, which is a yellow, triangular thickening of the conjunctiva that extends across the cornea on the nasal side. Pinguecula is a yellowish, raised growth on the conjunctiva next to the cornea. A chalazion is a chronic inflammation of the meibomian gland. A hordeolum, or stye, is an abscess of a hair follicle and sebaceous gland on the eyelid. A patient presents with proptosis and abnormal extraocular movement with pain. Which diagnosis is most likely? a. Hordeolum b. Anterior uveitis c. Orbital cellulitis d. Corneal abraision correct answer c. Orbital cellulitis. Orbital cellulitis has an acute onset with a swollen eyelid and bulging eyeballs (proptosis). There is pain upon movement and an inability to perform smooth pursuit movements upon examination. Assess for a history of an upper respiratory infection. A corneal abrasion has an acute onset of eye pain and tearing; patients often report that it "feels like there is something in the eye." Anterior uveitis (iritis) causes eye pain with conjunctival redness; there is no purulent discharge, and it may cause blindness if not treated. A hordeolum (common stye) is a contagious external infection of a hair follicle in the upper or lower eyelid. A patient recently returned from a trip to Africa and is experiencing 10 to 12 loose stools every day. The patient takes metformin every morning and otherwise is in good health. Which medication will the nurse practitioner prescribe to treat the diarrhea? a. Levofloxacin daily b. Ofloxacin BID c. Trimethoprim-sulfamethoxazole BID d. Ciprofloxacin in a single dose correct answer d. Ciprofloxacin in a single dose The patient most likely has traveler's diarrhea, given the history of a recent return from another country. The patient's treatment should be based on functional impact of symptoms and not frequency of symptoms, which is not indicated in the question. The patient likely has moderate acute traveler's
The patient is most likely presenting with a complication from a pelvic inflammatory disease called Fitz- Hugh-Curtis syndrome. Signs and symptoms include right upper quadrant pain and pain on palpation, normal liver function, and "violin string" adhesions revealed on laparoscopy exam. Reiter's syndrome is more common in men and is a secondary reaction to certain bacteria such as chlamydia. Treatment is supportive, and the syndrome spontaneously resolves. Stevens-Johnson syndrome is an adverse reaction to an antibiotic that produces a severe rash and flu-like symptoms. A Jarisch-Herxheimer reaction is an acute response from syphilis or other spirochete treatment in the first 24 hours and produces acute fever, chills, headache, and myalgia. A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week. The patient's forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner upgrades the patient to the next stage of treatment, which includes: a. Budesonide with formoterol b. Budesonide with montelukast c. Cromolyn or nedocromil d. Fluticasone with salmeterol correct answer a. Budesonide with formoterol. The patient has moved from step 2 to step 3 on the asthma classification scale. Therefore, a low-dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been discontinued in the United States. All of the following are true statements regarding the tetanus and diphtheria vaccine, except: a. Fever occurs in up to 80% of the patients b. A possible side effect is induration on the injection site c. A tetanus and diphtheria toxoid vaccine is given every 10 years d. The DPT and DT should not be given beyond the seventh birthday correct answer a. Fever occurs in up to 80% of the patients
Side effects of the Td vaccine include induration at the injection site. Td or Tdap is given in adults every 10 years. The DPT and DT should not be given beyond 7 years of age. Fever may occur, but studies do not support 80% of patients having fever. All of the following findings are associated with labyrinthitis or vestibular neuritis, except: a. Acoustic nerve damage b. Symptoms provoked by changes in head position c. Vertigo with nausea and vomiting d. Nystagmus correct answer a. Acoustic nerve damage Labyrinthitis is also known as vestibular neuritis. It is caused by viral or postviral inflammation that affects the vestibular portion of cranial nerve VIII (acoustic nerve). It is usually a self-limiting disorder. The other symptoms listed are common with labyrinthitis and are made worse with moving the head, sitting up, rolling over, or looking upward. Treatment is corticosteroids (methylprednisone), antivirals (valacyclovir), and antihistamines such as meclizine (Antivert) or dimenhydrinate (Dramamine). All of the following findings are associated with the secondary stage of an infection by the organism Treponema pallidum, except: a. Condyloma acuminata b. Maculopapular rash of the palms and soles c. Lymphadenopathy d. Condyloma lata correct answer a. Condyloma acuminata Findings consistent with the diagnosis of syphilis, caused by the T. pallidum organism, include painless chancre, maculopapular rash of the palms and soles, lymphadenopathy, and condyloma lata. Condyloma acuminate (genital warts) are caused by the human papillomavirus (HPV) and spread to others by skin- to-skin contact. All of the following medications have drug interactions with levothyroxine (Synthroid), except:
c. Clindamycin topical solution (Cleocin- T) d. Minoxidil (Rogaine) correct answer b. Tetracycline (Sumycin) First-line treatment for acne vulgaris includes over-the-counter medicated soap and water with topical antibiotic gels. The next step in treatment would be the initiation of oral tetracycline. An 18-year-old patient who wears contact lenses presents to the clinic with eye pain, redness, and excessive tearing in the right eye. The patient tells the nurse practitioner she frequently sleeps with her contact lenses on because she forgets to take them out. During slit-lamp testing, the nurse practitioner notes there is an oval-shaped lesion in the right cornea. Which medication will the nurse practitioner prescribe? a. Oral steroid b. Oral antibiotic c. Topical steroid d. Topical antibiotic correct answer d. Topical antibiotic Sleeping with contact lenses on is an unhygienic practice that may result in contact lens keratitis. Symptoms include eye pain, redness, excessive tearing, and a lesion on the cornea. Topical antibiotics are the first line of treatment for the condition. Oral steroids, antibiotics, and topical steroids are not used as the first line of treatment for contact lens keratitis. An 80-year-old woman complains about her "thin" and dry skin. Which of the following is the best explanation for her complaint? a. Genetic predisposition b. Loss of subcutaneous fat and lower collagen content c. Atrophy of sebaceous glands d. Damage from severe sun exposure correct answer b. Loss of subcutaneous fat and lower collagen content An 84-year-old female presented to the clinic 2 weeks ago with vague reports of fatigue, red maculopapular rash, and low-grade fever. Upon further examination, there was no lymphadenopathy,
sore throat, atypical white blood cells (WBC), or splenomegaly. During the follow-up exam 2 weeks later, the patient is diagnosed with Guillain-Barré syndrome. What was the original diagnosis? a. Mononucleosis b. Influenza c. Meningitis d. Measles correct answer a. Mononucleosis In older adults, reactive infectious mononucleosis presents atypically, not with the classic triad of fever, pharyngitis, and lymphadenopathy. Influenza (virus) presents with a sore throat, fever, chills, and runny nose. Meningitis presents with high fever, severe headache, photophobia, and neck stiffness. Measles presents with a fever, reddish-brown rash, lethargy, cough, and photophobia. Measles may occur in unvaccinated infants, but it may also affect older adults. An adult patient was walking on the beach when a nail punctured through their shoe. The patient has a swollen, diffuse pinkish-red, warm foot. Which gram-negative pathogen is the most likely the cause of this infection? A.Pseudomonas aeruginosa B.Vibrio vulnificus C.Pasteurella multocida D.Staphylococcus aureus correct answer a. Pseudomonas Aeruginosa Puncture wounds of the foot may become infected with Pseudomonas aeruginosa (gram negative) by the foam material from sneakers, ultimately causing cellulitis. Vibrio vulnificus is a gram-negative bacterium that causes infections from consuming raw oysters or clams. Pasteurella multocida is a gram- negative pathogen that is present in dog and cat bites. Staphylococcus aureus is a gram-positive bacterium that causes a purulent form of cellulitis such as methicillin-resistant Staphylococcus aureus (MRSA), especially in the lower leg (85%). An adult presents to the health center with a fever of 104.2°F, vomiting, and petechiae on the hands and feet progressing to the trunk over the past 3 days. Which medication will the nurse practitioner prescribe? a. Ceftriaxone 2 grams IV every 12 hours
b. Lidocaine 5% patch c. Zostavax vaccine d. Gabapentin TID correct answer c. Zostavax vaccine The treatment plan for an elderly patient who is immunocompromised and diagnosed with shingles is acyclovir × 10 days, a lidocaine patch, and gabapentin TID for postherpetic neuralgia (PHN). Because the patient is immunocompromised, she should not receive Zostavax (live virus vaccine). An elderly patient is brought to the primary clinic clutching a spoon. Her caregiver states, "I'm worried about her. She uses that spoon to eat, then combs her hair with it, and she even tries to write with it." Which of the following is a true statement regarding this possible dementia diagnosis? a. A CT scan is the best imaging test for dementia b. The most common cause of dementia is Lewy bodies c. A high score on the Mini-Cog indicates severe dementia d. This is one of the few types of dementia that has a possible genetic component correct answer d. This is one of the few types of dementia that has a possible genetic component The patient is demonstrating utilization behavior commonly seen in frontotemporal dementia (FTD). Most dementias do not have a known genetic component; however, 10% to 15% of people with FTD, formally called Pick's disease, have a family history. The best brain imaging test to use for screening dementia and cognitive impairment is an MRI scan of the brain. The most common cause of dementia is Alzheimer's disease (60%-80%). Lewy bodies are the second most common cause of dementia. The lower the score on the Mini-Cog or Folstein's Mini-Mental State Examination (MMSE), the greater the level of dementia. An elderly patient was burned when a large pot of boiling water fell off the stove. According to the Lund- Browder chart, the patient has reddened skin and several bullae on approximately 4% of the abdominal area. The patient is allergic to sulfa products. Which intervention will the nurse practitioner implement? a. Treat with benzocaine spray b. Gently rupture blisters c. Treat with silver sulfadiazine
d. Treat with bacitracin zinc correct answer d. Treat with bacitracin zinc The patient has a partial-thickness (second-degree) burn because the patient is older than 50 years old and the total body surface area (TBSA) burned was less than 5%. The treatment is bacitracin zinc and nonadherent dressings. Silver sulfadiazine cream should be avoided because of the patient's allergy to sulfa products. Treating with benzocaine spray or aloe vera gel is the treatment for superficial-thickness (first-degree) burns. Blisters should not be ruptured, because it may increase the risk of infection, especially in elderly patients. If a known sulfa allergy is present, which cross-sensitivity should the nurse practitioner be aware of when prescribing medications? (Select all that apply.) a. Thiazides b. Loop diuretics c. Silver sulfadiazine d. Atenolol e. Protease inhibitors correct answer A, B, C, E Patients with sulfa allergies may be sensitive to thiazides, loop diuretics, silver sulfadiazine (used in treating burns), and some protease inhibitors (e.g., darunavair, fosamprenavir), which are used in the treatment of HIV. Atenolol has not been proven to have any contraindications or cross-sensitivity when prescribed with sulfa-containing medications. In an adolescent with scoliosis, what degree of spinal curvature requires a referral for surgical correction? a. 10 to 20 degrees b. 20 to 30 degrees c. 30 to 40 degrees d. >40 degrees correct answer d. >40 degrees
