ANCC FNP Board Exam Study Guide Part 1 Question with complete solution 2023

ANCC FNP Board Exam Study Guide Part 1 Question with complete solution 2023Treatment for chronic bronchitis -Chronic bronchitis is a type of COPD that is characterized by inflammation of the bronchi, causing excess mucus; characteristics of chronic bronchitis include diagnosis after age 35, obesity, copious amounts of purulent sputum, elevated Hct level -Treat with SABA (albuterol), inhaled anticholinergics (ipratropium) -Normal Findings of Lungs: Lower lobes vesicular breath sounds (soft and low) Upper lobes; Bronchial breath sounds louder Actinic keratosis -Older to elderly fair-skinned adults -numerous dry, round, pink to red-colored, slow-growing lesions that do not heal -lesions common on sun-exposed areas (cheeks, nose, face, arms, back) -precancerous precursor of squamous cell carcinoma -frequent sunburns as child places person at higher risk -diagnosed with biopsy -treat with cryotherapy (small number) or 5-FU(5% fluorouracil) cream (large number) follow up with derm. Seborrheic keratosis -soft, round, wart-like fleshy growths on trunk (mostly on back) -can range in color from light tan to black -appear to be pasted on -asymptomatic -benign Fingernail hematoma treatment -Trephination - make hole in nail through drilling or piercing and allow blood to drain Hypothyroid -Primary - elevated TSH; low T4; low or normal T3 -Subclinical - elevated TSH; normal T4; normal T3 -Common cause is Hashimoto's (autoimmune) - Hashimoto and Hypo both have O -Symptoms are variable - may include fatigue -Treatment - levothyroxine (Synthroid) daily in AM on empty stomach -Starting dose of levothyroxine (Synthroid) is 25-50mcg -Check TSH every 6-8 weeks to monitor treatment Hyperthyroid -Primary - low TSH; high T4; normal or high T3 -Subclinical - low TSH; normal T4; normal T3 -Most common cause is Grave's Disease (autoimmune) - Grave and Hyper both have R -Common symptoms - female; rapid weight loss; increased heart rate; tremors; sweating; irritability; anxiety; hyperactivity; insomnia; diarrhea; amenorrhea; hypertension; exophthalmos; heat intolerance; goiter -Treatment - Propylthiouracil (PTU); Methimazole (Tapazole); Radioactive iodine (causes hypothyroid for life, contraindicated in pregnancy) -Thyroid Storm (thyrotoxicosis) - acute worsening of symptoms; may be caused by stress or infection; look for LOC, fever, abdominal pain; life-threatening; immediate hospitalization needed Increased risk of ectopic pregnancy -Risk factors - previous ectopic, salpingitis, tubal surgery, current IUD use, previous cervicitis, history of PID -Symptoms - abdominal pain (worsens when supine or with jarring), vaginal bleeding, amenorrhea, low grade fever, pain referred to right shoulder (may indicate rupture) Hypertension Meds Part 1 -African-American with or without diabetes - initial choices include thiazide diuretic or CCB -Non-Black with or without diabetes - initial choices include thiazide diuretic, CCB, ACE, or ARB -Thiazide diuretic - "ide"; excellent synergist; avoid in sulfa allergy; favorable in osteopenia/osteoporosis; side effects include hyperglycemia (caution in diabetics), hyperuricemia (gout attack), hypertriglyceridemia and hypercholesteremia (check lipid profile), hypokalemia (potentiates digoxin toxicity and increases risk for arrhythmia), hyponatremia (hold diuretic, restrict fluid, replace K+); lowers BP only 2-8 points -ACE inhibitor - "pril" and ARB - "sartan" - use in high renin states; drug of choice in diabetics (protects kidneys); pregnancy category C/D; side effects include dry/hacking cough (more with ACE), hyperkalemia, angioedema (rare, life-threatening); contraindicated in moderate to severe kidney disease; do not use ACE and ARB together. Hypertension Meds Part 2 -Beta blocker - "lol"; good as add-on medication, not uncomplicated HTN; avoid abrupt discontinuation, wean slowly to avoid rebound HTN; contraindications include asthma, COPD, chronic bronchitis, emphysema, second and third-degree heart block (okay with 1st degree), sinus bradycardia; do not use Propranolol for HTN -Calcium channel blocker - "pine"; first choice for ISH (isolated systolic HTN); side effects include headaches (vasodilation), ankle edema (vasodilation, benign), heart block/bradycardia (depresses cardiac muscle and AV node), reflex tachycardia (nifedipine); contraindicated in 2nd and 3rd degree heart block, bradycardia, CHF Hypertension Meds Part 3 -Heart Failure: ACEI or ARB as first-line, plus BB, plus diuretic -DM: ACE/ARB first line, IF African American, can start with CCB or Thiazide -CKD: ACE/ARB first line, can add CCB or Thiazide -Stroke Hx: ACE/ARB first line, add CCb or Thiazide as second-line drugs. -African American even with DM Thiazides and CCBs. -Bilateral Renal artery stenosis: ACE AND ARB will WORSEN or cause acute renal failure. CONTRAIN Risk factors for post-menopausal osteoporosis -older women; white/Asian descent; thin; small body frame; chronic steroids; androgen deficiency; hypogonadism; anorexia; bulimia; gastric bypass; celiac disease; hyperthyroidism; ankylosing spondylitis; RA; low calcium intake; vitamin D deficiency; inadequate physical activity; alcohol/caffeine intake; smoking Legg-Calves-Perthes -Osteonecrosis of the capital femoral epiphysis due to interrupted vascular supply -Common in ages 3-12 (pre-pubescent) -More common in males -Pain in hip or referred to medial aspect of knee (may be present for 2-3 weeks before complaints) -Limp -Positive Trendelenburg's Test (asking child to stand on affected side causes pelvic tilt - affected side lower) Cranial Nerves III, IV, VI to assess Extra Ocular Movement (EOM) -III - oculomotor - eye movements, pupillary constriction, accommodation -IV - trochlear - movement of superior oblique muscle -VI - abducens - movement of lateral rectus muscle -Mnemonic - LR6SO4 (lateral rectus - VI, superior oblique - IV) Dementia – executive function -Ability to manage a calendar How to treat chlamydia in pregnant woman -Azithromycin 1g PO single dose or Amoxicillin 500mg PO TID x 7 days -Test of cure 3 weeks after completion of treatment Untreated gonorrhea -Women - PID, abscess, ectopic pregnancy, infertility, can pass to baby during delivery -Men - epididymitis, infertility -Both - can spread to blood and cause disseminated gonococcal infection (DGI) which is characterized by arthritis, tenosynovitis, and/or dermatitis and may be life-threatening; increases risk for HIV Dacrocystitis -infection of lacrimal sac/tear duct usually caused by blockage -common in infants, adults over 40 also have higher risk of developing -symptoms - thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery eye/excess tears -treatment - lacrimal sac massage (downward toward mouth) 2-3 times daily; systemic antibiotics 7-10 days Erysipelas -subtype of cellulitis involving upper dermis and superficial lymphatics -usually caused by Group A Strep -symptoms - single large lesion, hot, indurated, red, clear demarcated margins, usually found on lower legs (shins) or cheeks, fever, chills Retinoblastoma -rare type of cancer -diagnosed by noting white pupil or pupil with white spots on it (leukocoria) - hallmark sign -may affect one or both eyes Carotid bruit -caused by carotid stenosis (cholesterol plaque accumulation) Murmur that radiates to the neck -Aortic stenosis Murmurs1 -All diastolic murmurs are abnormal -First time thrill is palpable is grade IV -MR ASS – Mitral Regurg, Aortic Stenosis – Systolic -MR Peyton Manning AS MVP – Mitral Regurg, Physiologic Murmur, Aortic Stenosis, Mitral Valve Prolapse -MS ARD – Mitral Stenosis, Aortic Regurg – Diastolic -rIght-sided – louder on Inspiration · lEft-sided – louder on Expiration -aoRtic – Right side -puLmonic – Left side Murmurs2 -Mitral Regurg – pansystolic/holosystolic; heard best at apex; radiates to left axilla; loud blowing/high-pitched; usually result of congenital condition, rheumatic heart disease, acute endocarditis, MVP, calcified annulus; symptoms include CHF, fatigue, dyspnea, bacterial endocarditis; LV/LA enlarged on XR; Afib common on EKG -Aortic Stenosis – midsystolic; best heart at 2nd ICS on right side; radiates to neck; harsh/noisy; patients should avoid physical overexertion (increased risk of sudden death); complications include angina, syncope, CHF; cardiomegaly occurs late; EKG usually normal; usually audible S4; usually congenital; rheumatic fever 2nd most common cause; monitor with echo; surgical valve replacement if worsens -Mitral Valve Prolapse – systolic; heard best at apex; more common in women ages 14-20; symptoms include palpitations, chest pain, dyspnea, dizziness, numbness; first finding is midsystolic “click”; EKG usually normal. Rule out marfans syndrome in tall thin female with hypermobile joints. Arm span greater than height etc. Murmurs3 Mitral Stenosis – low-pitched diastolic; rumbling; heard best at apex; “opening snap”; etiology is rheumatic fever; 4 stages (1 – long asymptomatic period followed by gradual reduction in exercise tolerance, 2 – pulmonary congestion, 3 – pulmonary HTN, 4 – severe low CO); symptoms include dyspnea, Afib, hemoptysis, RV hypertrophy; loud S1; may radiate toward axilla Aortic Regurg – diastolic; high-pitched; blowing; best heard at 2d ICS on right side of sternum; symptoms include angina, CHF, dizziness, chest pain; etiology includes rheumatic heart disease, congenital deformity, aortic root abnormalities, syphilis; PMI displaced downward and left; water-hammer pulse Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. This is indicative of: -Loss of executive function -Executive function includes the ability to manage a calendar, organizing, planning (getting things started), multitasking, processing/storing information Patient with atopic dermatitis would be at risk for what other conditions? -asthma, allergic rhinitis, multiple allergies -atopic dermatitis (eczema) is marked by extremely pruritic rashes on hands, flexural folds (antecubital/popliteal space), and neck; rash is exacerbated by stress and environmental factors; rash appears as multiple small vesicles that rupture and leave painful, bright red, weepy lesions that become lichenified from chronic itching; fissures can form and can be infected with bacteria -treatment - topical steroids (1st line); systemic oral antihistamines; skin lubricants; hydrating baths Patient with history of PID has increased risk for? -infertility -cervical motion tenderness indicates PID -treat symptomatic PID even if Neisseria gonorrhoeae (GC) and chlamydia tests are negative -follow up with vaginal bimanual exam in 2-3 days to make sure symptoms are improving Treatment for gonorrhea -Ceftriaxone (Rocephin) 250mg IM x 1 dose plus Azithromycin (Zithromax) 1gm oral or Doxycycline (Vibramycin) 100mg BID x 7 days Old lady with weakness on 2 HTN meds, 2 DM meds, vitamins -polypharmacy -hypotension -hypoglycemia Wilm’s tumor -nephroblastoma -asymptomatic abdominal mass that extends from flank toward midline -nontender, smooth mass that rarely crosses midline of abdomen -higher incidence in black, female children -peak age 2-3 -most common renal malignancy in children -when performing PE, palpate gently to avoid rupturing renal capsule -initial test is abdominal ultrasound Baby with UTI – follow up? · renal and bladder ultrasound (RBUS) for all infants 2-24 months for first febrile UTI Definitive diagnosis of acute bacterial prostatitis -UA and culture (treat empirically until results are back) -Under age 35, treat like gonorrhea or chlamydia - Rocephin 250mg IM plus doxycycline 100mg PO BID x 10 days -Over age 35, unlikely STD in nature, treat with Cipro PO BID or Levaquin PO daily x 4-6 weeks -Avoid vigorous palpation and massage of prostate - can lead to septicemia AV nicking -HTN stiffens vessels -arteries indent and displace veins -considered "mild" retinopathy Cotton wool spots on fundoscopic exam -can be caused by HTN, DM, or other causes - microinfarct occurs -considered "moderate" retinopathy High triglycerides and pancreatitis -high risk of acute pancreatitis with triglycerides greater than 500 -normal level is less than 150 -if triglycerides are greater than 500, treat with niacin or fibrate or Niaspan to lower triglycerides; if less than 500, consider lifestyle modifications first -once triglycerides are under control, switch target to lowering LDL -recommend low fat diet, weight loss, and increased physical activity