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ANCC FNP Board Questions/149 Questions and Answers
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ANCC FNP Board Questions/149 Questions and Answers
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ANCC FNP Board Questions/149Questions and Answers
A middle-age female patient presents to the clinic with a recurrence of mild
hidradenitis suppurativa after topical therapies failed. Which first-line
treatment is recommended? - -Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line
treatment for hidradenitis suppurativa.
__________________________________________________
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in
apocrine gland-bearing skin. It is a chronic, disabling disorder that
progresses, often causing keloids, contractures, and immobility. It is
characterized by comedone-like follicular occlusion, chronic and relapsing
inflammation, mucopurulent discharge, and progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical
presentation includes nodules and sinus tracts (inflamed or noninflamed),
abscesses, and scarring found in the axilla, genitofemoral area, perineum,
gluteal area, and inframammary area in women.
Recommended treatments include antibiotics, steroids, retinoids, dapsone,
and anti-tumor necrosis factor agents. A dermatology consultation should
also be considered.
First-line treatment is a 12-week course of an oral tetracycline (Sumycin)
such as doxycycline. For patients who do not respond to doxycycline, the
next recommended step is a combination of twice-daily clindamycin (Cleocin)
and rifampicin (Rifadin) for 10-12 weeks. If treatment fails, acitretin
(Soriatane, for males and nonfertile females) or dapsone (Aczone) may be
considered by a dermatologist. In patients with moderate to severe
hidradenitis suppurativa, adalimumab (Humira) may possibly be considered.
-When providing culturally competent health care services to an American
Indian elder, the nurse practitioner understands which is traditionally true? -
-The "Medicine Wheel" is used by many for the purpose of health and healing
The "Medicine Wheel" is traditionally used and contains four directions;
north, south, east, and west. Traditionally each tribe has different meanings
for each direction and they may represent the season of the year or stage of
life. It is aimed at providing a holistic view of life.
________________________________________
An understanding of different cultural preferences leads to cultural
competence in healthcare. Some patients may value traditional culture and
,preferences as it relates to healthcare. These individual preferences should
be included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to
health care integrating the person, lifestyle, environment, family, and
religion. Patients adhering to these traditional cultural practices often feel
that illness is due to a lack of harmony with the physical body, mind, spirit,
and emotions. Patients may seek care from western medicine for specific
ailments while also consulting with traditional healers for spiritual guidance.
Healthcare providers should seek to understand relevant cultural factors and
assess each individual's healthcare literacy in order to provide culturally
competent care.
-The nurse practitioner sees an older adult patient in the clinic with the
primary report of hearing loss and a sensation of fullness in the right ear. The
nurse practitioner suspects conductive hearing loss. Which could contribute
to this? - -Cerumen, commonly called earwax, is a combination of secretions
and sloughed epithelial cells that protects the ears from infection, water, and
insects. It is normally expelled from the ear canal through natural jaw
movement. When this self-cleaning process fails, cerumen can become
impacted. Cerumen impaction occludes the ear canal and can press against
the tympanic membrane, resulting in conductive hearing loss.
_________________________________________
Conductive hearing is the transition of sound from the external and middle
ear to the inner ear. Conductive hearing loss is caused by problems in the
external and middle ear that interfere with the transmission of sound and its
conversion to mechanical vibration. Causes of conductive hearing loss
include obstruction of the external auditory canal by cerumen, foreign
bodies, debris from otitis externa, and large exocytosis and osteomas.
Sensorineural hearing loss involves difficulty converting mechanical
vibrations to electrical potential in the cochlea or in auditory nerve
transmission to the brain. It is mostly caused by permanent damage in the
organ of Corti. It can be caused by age-related hearing loss, noise trauma,
medications, autoimmune diseases, mechanical trauma, Meniere disease,
infection, and neoplasm (acoustic neuroma).
Approximately one-third of older adults between the ages of 61 and 70 years
have hearing loss. More than 90% of adults older than 85 years of age have
hearing loss. The most common type of hearing loss is age-related and
sensorineural. All adults older than 60 years of age should be screened for
hearing loss at periodic health examinations.
-An otherwise healthy adult patient presents to the clinic with a diagnosis of
community-acquired pneumonia and no recent antibiotic therapy. Which is
the best option for treatment? - -Amoxicillin
, High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line
therapy for adults without comorbidities.
_____________________________________________
Community-acquired pneumonia (CAP) is pneumonia not acquired in a
hospital or long-term care facility. Patients with suspected CAP should
receive a chest X-ray for diagnosis. The Pneumonia Severity Index should be
used to assist in decisions regarding the need for hospitalization in patients
with CAP.
According to the American Thoracic Society (ATS) and the Infectious
Diseases Society of America (IDSA) 2019 guidelines, the initial treatment of
CAP for most patients is amoxicillin or doxycycline. Macrolides are an option
for treatment, but are no longer recommended routinely as first-line
treatment, given increased macrolide resistance. This is a change from the
2007 ATS/IDSA guidelines. Respiratory fluoroquinolones and
amoxicillin/clavulanate should be used in patients who fail first-line
medications, have significant comorbidities, have had recent antibiotic
therapy, are allergic to alternative agents, or have a documented infection
with highly drug-resistant pneumococci.
-A patient presents to the clinic for conception counseling. She recently
stopped taking oral contraceptives and would like to become pregnant.
Which statement about conception safety after stopping oral contraceptives
is correct? - -
-You have a 35-year-old female patient who is complaining of wrist pain. She
is an administrative assistant who does a great deal of computer work in her
job. You will test her for carpal tunnel syndrome. When you tap at the volar
surface of the wrist you are performing which of the following tests? - -
Tinel's sign
-A gastrinoma located on the pancreas or the stomach which secretes
gastrin, stimulating high levels of acid production in the stomach is which of
the following? - -Zollinger-Ellison syndrome
-A 16-year-old male is in the office. He has a insect bite on his left forearm
and you suspect a brown recluse spider bite. What medical management
would you provide? - -ice pack and elevation of the area
-In addition to being overweight, the American Diabetes Association
recommends type 2 diabetes mellitus testing in adults who: - -have an HDL
level of < 35 mg/dL
-Which of the following found on an ECG would confirm atrial fibrillation? - --
absent P waves
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