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Apea test questions and answer with
verified solutions
Qs where would the murmur associated w/mitral regurgitation best be auscultated? - n Ans✔ mitral listening point Qs A pt. with a positive hx of a tick bite 2 weeks ago and erythema migrans has a positive ELISA for borrelia burgdorferi. The Western blot is positive. How should he be managed? - n Ans✔ he should receive Doxycycline for Lyme disease Qs a pt. has/seborrheic dermatitis. Which vehicle would be most appropriate to use in the hairline area to treat this? - n Ans✔ foam Qs A microscopic exam of the sample taken from a skin lesion indicates hyphae. What type of infection might this indicate? - n Ans✔ fungal Qs
A pt. has been dx w/MRSA. she is allergic to sulfa. Which medication could be used to treat her? - n Ans✔ doxycycline Qs A 15-year-old male has worked this summer as a lifeguard at a local swimming pool. He complains of itching in the groin area. He is dx with tinea cruris. The NP is likely to identify
- n Ans✔ well marginated half moon shape macules on the inner thigh Qs A pt. exhibits petechiae on both lower legs w/o other complaints. How should the NP proceed? - n Ans✔ order a CBC Qs A pt. has been dx w/scabies. What is the medication of choice to treat this? - n Ans✔ permethrin and good hand hygiene Qs A pt. has been in the sun for the past few weeks and has developed darkened skin and numerous 3-6 mm light-colored, flat lesions on his trunk. What is the likely etiology? - n Ans✔ tinea vesicolor
Qs most common place for basal cell carcinoma - n Ans✔ face Qs A 74-year-old is dx w/shingles. The NP is deciding how to best manage her care. What should be prescribed? - n Ans✔ an oral antiviral agent Qs the American Cancer Society uses an ABCDE Mneumonic to help pt.'s develop awareness of suspicious skin lesions what do they represent? - n Ans✔ A= asymetry B=border C=color D=diameter E=enlarging or elevated Qs characteristic of shingles - n Ans✔ single dermatome affected
Qs an example of a premalignant lesion that develops on sun-damaged skin is: - n Ans✔ actinic keratosis Qs A patient w/Diabetes has right anterior shin edema, erythema, warmth, and tenderness to touch. This developed over the past 3 past. There is no visible pus. What is the most likely diagnosis to consider? - n Ans✔ cellulitis Qs A pt. was burned w/hot water. He has several 2-3 cm fluid-filled lesions. What are theses termed? - n Ans✔ bullae Qs A wound has the following characteristics; partial thickness loss of dermis, a shallow open ulcer w/red/pink bed, and no evidence of sloughing. What stage of pressure ulcer does this describe? - n Ans✔ stage II Qs A pt. present w/plaques on the extensor surface of the elbows, knees, and back. The plaques are erythematous and thick, silvery scale are present. This is likely: - n Ans✔
Ans✔ a fasting glucose > or equal to 126 and confirmed on a previous day. Qs the most appropriate screen for diabetic nephropathy - n Ans✔ urinary albumin to creatinine ration and eGFR Qs Difference between varicose vein and arteriosclerosis - n Ans✔ Is the affected vessel Arteriosclerosis affects arteries whereas varicose veins affects veins Qs A patient has poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI) - n Ans✔ 5th ICS, left of MCL Qs A 43 year old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past two years. This murmur is probably - n Ans✔ mitral stenosis Qs
A patient who has diabetes presents with pain in his lower legs when he walks and pain resolution with rest. When specifically asked about his pain in his lower leg, he likely will report pain - n Ans✔ in the calf muscle Qs A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as "sloughing of skin" and hospitalization. Which medication is contraindicated in this patient? - n Ans✔ hydrochlorothiazide Qs A 75 year old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. the NP replies: - n Ans✔ shortness of breath and syncope Qs A 74 year old patient has PAD. Which item listed below is an important nonmodifiable risk factor for PAD? - n Ans✔ diabetes Qs Benazepril should be d/c immediately if - n Ans✔ pregnancy occurs
Patient taking ACE inhibitors should avoid? - n Ans✔ potassium supplements Qs Grade 3 murmur indication for a referral - n Ans✔ a fixed split Qs Group of meds used to treat HF - n Ans✔ fosinopril, HCTZ, verapamil Qs Mr. Smith is a 72-year-old patient who takes warfarin for chronic A-fib. INR today is 4.0. the NP should: - n Ans✔ stop the warfarin today and repeat INR tomorrow Qs According to the NHLBI, which characteristic is a coronary heart disease risk equivalent, that is, which risk factor places the pt. as a CHD risk similar to a hx of CHD - n Ans✔ diabetes mellitus Qs
good drug to reduce morbidity and mortality in mild HF - n Ans✔ metoprolol Qs A pt. taking atorvastatin newly diagnosed with dyslipidemia complaints of fatigue, weakness, and muscle aches in his lower back, arms, legs for the past 3 days. it is not improved with rest How should this be evaluated? - n Ans✔ Stop the atorvastatin immediately Qs symptom not indicative of HF - n Ans✔ headache Qs What class of meds is preferred to normalized lipid levels and reduce risk of cardiac events - n Ans✔ HMG CoA reductase inhibitors Qs Highest sensitivity in diagnosing HF - n Ans✔ BNP Qs
A 40-year-old African-American pt. has a b/p of 175/100 and 170/102. What is a reasonable plan of care for this pt today? - n Ans✔ initiate amlodipine 5mg daily Qs Usual course of treatment for mitral valve prolapse - n Ans✔ is benign Qs A 50-year-old patient with hypertension has taken HCTZ 25mg daily for the past 4 weeks. Her b/p has decreased from 155/95 to 145/90. How should the NP proceed? - n Ans✔ add another drug from another class to the daily 25mg HCTZ Qs A patient with mitral valve prolapses reports chest pain and frequent arrhythmias. In the absence of other cardiac anomalies, the drug of choice to treat her symptoms is: - n Ans✔ metoprolol Qs which hypertensive pt. is most likely to have adverse b/p effects from excessive sodium consumption? - n Ans✔ a 70-year-old African American
Qs a 38-year-old male pt. presents for his annual exam. He reports nervousness and weight loss but denies any change in his dietary intake or exercise level. Based on this findings and the following lab values: TSH 0.01, free T4 6, free T3 205. what is the most likely dx? - n Ans✔ Hyperthyroidism Qs a pt. has two fasting glucose values of 121 and 136 that were measured on 2 separate days in the same week. This pt: - n Ans✔ should have an Hgb A1C performed Qs a diabetic pt. w/albuminuria has been placed on an ACE inhibitor. How soon can the antiproteinuric effect of the ACEi be realized for this pt. - n Ans✔ 6-8 weeks Qs how does hyperthyroidism affect b/p - n Ans✔ by producing an increase in systolic and diastolic readings Qs Symptoms least likely associated with DMT fatigue, constipation, athletes foot, impetigo - n
Qs a 40-year-old pt. with newly dx of T2DM asks what his target b/p should be. the most correct answer is: - n Ans✔ less than 140/ Qs the following values TSH 14, free T4 0.1 is indicative of? - n Ans✔ hypothyroidism Qs diabetic medication associated with diarrhea and flatulence - n Ans✔ metformin Qs A 45-year-old female pt has fatigue for the past 3 months and a 10-lbs weight gain. She previously had regular menses occurring about every 30 days, but in the last 3 months her menses have varied between 30-45 days. Her TSH value is 13. It was repeated 1week later and found to be 15. What explains this finding? - n Ans✔ hypothyroidism Qs A pt. who is taking who is taking a long-acting insulin basal insulin has elevated blood sugars. Which blood sugars are important to review in order to increase the dose of insulin? - n
Ans✔ AM fasting Qs A pt. has a TSH value of 13.1 today. The NP has decided to initiate replacement with levothyroxine 88mcg daily. When should the NP recheck pt's TSH levels - n Ans✔ 6 weeks Qs A pt. presents with consistently elevated blood glucose before his evening meal. What choice below represents an insulin change that would improve his evening glucose? current AM regimen 22u NPH, 12u short-acting insulin Current PM regimen 10u NPH, 8u short-acting insulin - n Ans✔ 24u NPH insulin in AM Qs A 30-year-old female pt. with complaints of fatigue undergoes a screening TSH. Her TSH is 8 what should be done next? - n Ans✔ repeat the TSH and add T Qs A 65-year-old diabetic has been on oral antihyperglycemic agents and is still having poor glycemic control. His AM fasting glucose range from 140-160. You decide to add insulin. He weighs 127 kg. What should the NP order as an initial starting dose? - n Ans✔
Ans✔ aspirin Qs yellowish, triangular nodule near the iris - n Ans✔ is a pinguecula Qs a 93-year-old demented pt. has been recently treated w/an URI but drainage from the right nostril persists. What should the NP suspect? - n Ans✔ presence of foreign body Qs A 70-year-old pt. has begun to have hearing loss. She relates that her elderly parents had difficulty hearing. Which complaints below is typical of presbycusis? - n Ans✔ inability to hear consonants Qs
