ANCC FNP Exam Question and Answers

caused by too much insulin (or missing a meal or snack) in the evening, which results in hypoglycemia in the ear morning (2-3am). the body compensates by secreting glucagon (from the liver) and epinephrine, which results in high blood glucose levels in the morning. Cushing's syndrome ~Ans~ caused by prolonged exposure to high levels of cortisol (excess androgens, not estrogen) associated with delayed puberty and growth failure in children and adolescents Gynecomastia gold standard for diagnosing Hashimoto's thyroiditis ~Ans~ Thyroid peroxidase (TPO) levels normal TOP 35 symptoms of low iodine ~Ans~ weight gain, lethargy, and goiter Thiazolidinediones (TZDs) ~Ans~ not to be used with patients who have a history of bladder cancer or heart failure Diabetic Ketoacidosis (DKA) ~Ans~ A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available what to do thiazide diuretics do to blood sugar? ~Ans~ associated with hyperglycemia Pheochromocytoma ~Ans~ a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine symptoms: hypertension, diaphoresis (including sweaty palms), headaches, tachycardia, hyperglycemia, hypermetabolism, and weight loss Alarming findings of GERD (ALARMS) ~Ans~ ALARMS Anemia (iron deficiency) loss of weight (involuntary) anorexia (persistent) recent onset of progressive symptoms in absence of increasing risks and with previously helpful therapy melena (tarry/blood stools) or hematemesis (vomiting bright red blood) swallowing difficulty (dysphagia [difficulty swallowing], odynophagia [painful swallowing]) 1st line GERD treatment ~Ans~ Acid suppression PPI- taken once a day prior to first meal of the day for maximum effect H2RA- alternative to PPI lifestyle therapies for GERD ~Ans~ weight loss in overweigh or obesity avoiding trigger foods (chocolate, acidic foods, mint), eating within 2-3 hours of bedtime HOB elevation Hep A ~Ans~ fecal contaminated food or water next steps if positive- liver function test Hep B ~Ans~ sexual contact Hep C ~Ans~ injection drug use acute pyelonephritis symptoms ~Ans~ acute onset of high fever, chills, N/V, dysuria, frequent urination, and unilateral flank pain flank pain described as a deep ache Acute Kidney Injury symptoms ~Ans~ abrupt onset of oliguria, edema and weight gain (fluid retention) and complains of lethargy, nausea and loss of appetite oliguria ~Ans~ urinary output 400mL/day serum creatinine ~Ans~ male: 0.7 - 1.3 mg/dL female: 0.6 - 1.1 mg/dL GFR value ~Ans~ normal- 90mL/min CKD- 60 for at least 3 months 15- kidney failure gold standard test for measuring protein excretion of the kidneys ~Ans~ 24 hour urine for protein cystitis ~Ans~ urinary bladder inflammation cause of UTI ~Ans~ E.coli what age groups are UTIs likely to progress to pyelonephritis ~Ans~ kids under 3 and pregnant women older females UTI symptoms ~Ans~ symptoms can be subtle, but onset of new incontinence can be a sign of UTI Urine dipstick of UTI ~Ans~ -nitrites and leukocytes (can be from contamination) -only helpful if symptomatic Urine C&S ~Ans~ 100.000 Meds for uncomplicated UTI ~Ans~ Nitrofurantoin (Macrobid) TMP-SMX (Bactrim) Fosfomycin Alternatives- cipro, levo increase fluid intake to 2-3 L/day treatment for complicated UTI ~Ans~ cipro Nitrofurantoin ~Ans~ macrobid long term is associated with lung problems, chronic hepatitis, and neuropathy contraindicated with renal insufficiency baseline CXR, LFT, and neurologic exam should be obtained and pt monitored closely AKI ~Ans~ abrupt decline in GFR bacterial cause of acute pyelonephritis ~Ans~ E.coli Uncomplicated Pyelonephritis tx ~Ans~ fluoroquionolones for 7 days nephrolithiasis ~Ans~ kidney stones (renal calculi) what are majority of kidney stone made up of? ~Ans~ calcium oxalate groups in complicated UTI ~Ans~ males, poorly controlled diabetes, pregnant women, children, elderly, immunocompromised, recurrent UTI or reinfections, anatomic abnormalities Wilm's tumor ~Ans~ congenital tumor of the kidney that should never be palpated microscopic or gross hematuria might be present the nontender and smooth mass rarely crosses the midline of the abdomen stress incontinence ~Ans~ the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing acute prostatitis ~Ans~ Acute inflammation of the prostate usually due to bacteria symptoms: abruptly with sudden onset of high fever, chills, and complaints of suprapubic and/or back pain Oxybutynin ~Ans~ medication to trial for older woman with urinary incontinence kegel exercises ~Ans~ recommended for women who have stress incontinence Terazosin (Hytrin) ~Ans~ for BPH first line medication with suspected UTI in kids under 2 yeas ~Ans~ Bactrim, cephalosporins, amox-clav seborrheic keratosis ~Ans~ a benign skin growth that has a waxy or "pasted on" look Lentigines (liver spots) ~Ans~ a lentigo is a well bordered brown to black macule, usually less than 1 cm in diameter. senile purpura ~Ans~ discoloration due to increasing capillary fragility senile actinic keratosis ~Ans~ Red-tan scaly plaques that increase over the years to become raised and roughened. May have silvery-white scale. Occur on sun-exposed surfaces. Premalignant and may develop into squamous cell carcinoma. Rocky Mountain Spotted Fever ~Ans~ Caused by Rickettsia rickettsii Sx: rash on palms and soles (migrating to wrists, ankles, then trunk), HA, fever. Endemic to East Coast (in spite of its name).