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751. During an initial prenatal exam, the APRN notes that a client is positive for chlamydia, negative for PID, and has a thick mucoid discharge at the cervix. What management plan is indicated?. Initialize therapy with doxycycline Vibramycin). Treat the client and all sexual partners. Determine if the client is allergic to penicillin (Pen V). Treat pain associated with the symptoms.

752. The use of which of the following medications can precipitate acute renal failure in a patient with bilateral renal artery stenosis?. corticosteroids. angiotensin II receptor antagonists. beta-adrenergic antagonists. cephalosporins.

753. A 13 years old African American teenager presents to the clinic with a chief complaint of hair loss with small bold spots. Which question about grooming best demonstrates the APRN knowledge of cultural practice in this group?. Do you straighten your hair?. What shampoo do you use?. Do you wear a head covering?. Are you using hair pomade?.

754. A 19- years old male college student presents with sprained ankle incurred while playing basketball, Which instructions should the APRN advise patient to implement after injury?. Use ice pack for 20 min then discontinue for 30 min and repeat for 24-48 hours. Alternate heat and cold packs, 20 mins each, for the first 24-48 hours. Apply heat for the first 12 hours, then ice packs after weight-bearing activities. Keep ice packs on ankle for the first 12 hours, then heat after weight-bearing activities.

755. A 4-year-old was brought into the clinic by her mother, who reports that she pulled her arms upward to pick her up, and now the child will not use her right arm. A nursemaid's elbow is suspected. Which statement below is correct?. Her arm is slightly flexed and held close to her body. The child is crying because her arm hurts. She will need to be admitted to the hospital for fracture reduction. Her elbow is held straight at her side, and her fingers are in a fist.

756. Pregnant at 24 weeks gestation is seen by the APRN. The pregnant is concerned about receiving an influenza vaccination, which she read on the internet that is mercury poisoning. Which information supported by evidence-based findings should the APRN provide?. Mercury is a preservative found in multi-dose influenza vials. Mercury-free vaccinations are available that do not contain thimerosal. There is no scientific evidence of mercury problems in vaccine. Hand washing is as protective against influenza as the vaccine.

757. Which action demonstrates a nurse taking action to promote health and prevent disease?. Educating a client about the advantage of a heart-healthy diet during a home visit. Administering medications to a cardiac client in the hospital. Making a home visit to a client who is recovering from a heart attack. Providing CPR during a heart attack.

758. What pharmacological agent should the APRN prescribe to achieve the best results initially in the management of patients with erosive reflux esophagitis?. Barrier paste medications, such as sucralfate (Carafate). Proton pump inhibitors, such as omeprazole (Prilosec). The H2 antagonist, such as famotidine (Pepcid). Promotility agents, such cisapride (Propulsid).

759. The APRN prescribe lipid lowering medication and diet modifications for a patient three months ago, On review of the latest patient related data which findings requires the APRN to take action?. New onset insomnia from calf pain. Intermittent episodes of constipation. Reduction in low density lipoprotein of 65%. Elevation of liver transaminases of 5% ?.

760. A 67 years old female patient presents to the clinic with a glossy red tongue, angular stoma, and dry, cracking lips. Her weight is within normal limits and her skin is dry and intact. A decrease in which laboratory finding is most consistent with this clinical presentation?. Albumin. Iron binding Capacity. B Vitamins. Vitamin C.

761. In the abortive therapy of migraine headaches what condition precludes the use of sumatriptan?. Migraine accompanied by severe nausea and vomiting. Migraine in a patient with poorly controlled hypertension. Headache that is concurrent with a menstrual period. Headache in a patient with a history of epilepsy.

762. When a middle age male client performs range of motion with his left arm the APRN notes that he is able to flex the arm without difficulty, however he is unable o abduct the arm without causing pain. If the APRN passively abducts the arm it falls back in place when released. What do these findings suggest?. Rotator cuff lesions. Shoulder dislocation. Crepitation. Tennis Elbow.

763. Mr. K comes in with complaints of: “A sudden onset of “tearing” chest pain that radiates to his shoulders, abdomen and back.” You immediately suspect: Aortic dissection. Myocardial infarction. Unstable angina. Pericarditis.

764. A patient with metastatic cancer is preparing to make decisions about end of life and is completing a durable medical power of attorney, which description is best for the APRN to provide?. It is a hospital form that is required of all people that are entering a hospital. It will identify someone that can make decisions for your health care if you are in a coma or vegetative state. It is not a legal document, but it will help the healthcare provider know exactly what medical treatments you want. It allows you to document your wishes regarding life-sustaining treatment if you can't speak for yourself.

765. A 15 years old female adolescent is brought to the clinic by her mother because has never experienced menarche. On examination, the APRN palpates enlarged breast buds, and observes early pubic hair growth and an intact hymen. What cause of delayed development in this female should the APRN conclude?. Intact Hypothalamic pituitary gonadal axis with delayed maturation. Central nervous system disorder that elevates GnRH levels. Disruption of hypothalamic-pituitary- gonadal axis causing PSH/LH deficiencies. Systemic condition that delays the closure of the epispheal plates.

766. Which of the following is most likely to be found in the laboratory data of a person with infectious mononucleosis?. lymphocytosis with atypical lymphocytes. presence of antinuclear antibody. macrocytic anemia. neutrophilia.

767. The APRN is instructing the parents about the use of antipyretics for their toddler who has a febrile upper respiratory infection. Which information is most important for the ARNP to recommend the parents to do. Give acetaminophen and antihistamine preparations at night before hour of sleep. Alternate acetaminophen and Ibuprofen per label for core temperatures over 102.2 F. Offer liquids and any foods that the child will accept and tolerate during fever. For core body temperature over 104 F, give toped bath and watch for reactions.

768. A 24 years old is seen the APRN because pernicious anemia. Which high folic acid foods should the APRN teach the client to eat?. Cottage cheese, skim milk, and yogurt. Brussels sprouts, lima beans, and potatoes. Carrots, salmon, and avocados. Cereals, nuts and green vegetables.

769. In which clinical trial could a placebo be used for the control group?. A double blinded study for controlling blood glucose in Type I Diabetes. An efficacy study of new chemotherapy for those with ovarian cancer. A controlled study of three drugs used to treat urinary tract infections. A comparison study of four transdermal agents using for smoking cessation.

770. Which ethical principle reflects respect for all persons and their self- determination?. Autonomy. Beneficence. Veracity. Justice.

771. Which pathophysiologic characteristic should the APRN identify in an older patient who is manifesting signs of Alzaimer's disease?. Intracranial pressure greater than 30 mmHg. Obstruction of cerebrospinal fluid (CSF) flow. Senile plaques and neurofibrillatory tangles. Marked degeneration of the basal ganglia.

772. The APN is gathering data for the differential diagnosis of acute diarrhea of an 8 month old male infant. Which client history should the APN obtain as best targets celiac disease?. Have any new foods been added to his diet?. Are any ancestors from South Africa. Has he had problems with diarrhea in the past?. Do any siblings have food allergies?.

773. A 19 years old presents to the college campus clinical and asks the APRN if she should be concerned if she contracts gonorrhea. What response should the APRN provide?. Inquire if she and her partner use condoms during intercourse. Determine if her male partner has severe burning with urination. Explain that untreated gonorrhea can cause infertility in women. Ask the patient if she has a purulent or foul vaginal discharge.

774. You are treating Mrs. X for primary Hypothyroidism with a replacement thyroid hormone. Her TSH results today are : 0.3 mIU/L (0.4-2.5 mIU/L); what should you do?. Reduce her hormone replacement medication dose. Order a pituitary scan for possible tumor. Order a thyroid scan for possible tumor. Increase her hormone replacement medication dose.

775. The APRN is examining an elderly female client and notices that she has a motor dysfunction in her hip region. Which procedure should the APRN consider to perform to further assess for hip dysfunction?. Abduct and internally rotate each hip while the client is supine. Have the client balance first on one foot and then the other. Flex the hip and knee while lying flat with other leg extended. Ask the patient to stand and bend over the examination table.

776. A 35 year old archaeologist comes to your office for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description which of the following is not a risk factor for melanoma in this patient?. age. Hair color. Heavy sun exposure. Actinic lentigines.

777. Carlos is a 19-year-old Hispanic college student living in the United States (US); he is in Puerto Rico (PR) visiting his family. Before coming to P.R., he went camping with his friends. He comes into your office because he feels like he is getting a cold and he found a red spot shaped like a target on his left thigh. He has no medical conditions; he is not sexually active. What is the most probable diagnosis?. Lyme disease. Psoriatic arthritis. Gonococcal arthritis. Rocky Mountain fever.

778. An 16 year old teen has a chief complaint of a “sore throat and swollen glands” for the past 3 days. Her physical examination includes a temperature of 101ºF, exudative pharyngitis, and tender anterior cervical lymphadenopathy. Right and left upper quadrant abdominal tenderness is absent. The most likely diagnosis is: Infectious mononucleosis. Streptococcus pharyngitis. Viral pharyngitis. Bronchitis.

779. A cross sectional design was used to compare the sleep quality of third trimester pregnant women with non-pregnant women. Findings indicated that pregnant suffer significantly more from poor sleep quality than non-pregnant women and that sleep quality of pregnant woman was related to stress and depression. Based on the findings of this study, which intervention should the APRN working in a women's health clinic implement?. Develop a counseling program for depressed pregnant women. Evaluate sleep quality and depression of all pregnant woman. Replicate the study using the clinic's population. Screen all woman.

780. For uncomplicated genital gonococcal infections, The CDC recommends which drug treatment regimen?. Azithromycin (Zithromax) 250 mg PO daily x 5 days. Doxycycline (Vibraycin) 100 mg PO BID x 14 days. Bactrim 160 mg x 3 weeks. Ceftriaxone 125 mg IM single dosis.

781. What information should the APRN advice when performing nutritional counseling to the mother of a 9 month old infant?. Give servings that equal the size of the children palm. Offer popcorn as a low fat snack. Provide 5 to 8 small meals a day. Decrease water intake to improve solid food intake.

782. An older female patient who was exposed to tuberculosis (TB) arrived at the clinic with an acute viral upper respiratory infection (URI) and was given a purified protein derivate test. The PPD was negative 72 hours later. Which treatment plan should the APRN prescribe?. Sputum for acid fast bacillus analysis times 3. Return visit in one year for annual TB skin testing. Schedule patient for anterior posterior chest x ray. Repeat the PPD test in 1 week after URI resolves.

783. Susan is 17 years old and comes to your office with a history of a mildly pruritic painful 3 cm round vesicular lesion on her right upper lip. The lesion has a small amount of serous fluid and Tzank smear is positive for giant multinucleated cells. This lesion is most likely caused by: Herpes virus. Allergic reaction. Streptococci. S. aureus.

784. A mother reports that her toddler has developed a "runny nose on the side" the child has no fever, is eating well, and is playing actively. The APRN should provide which primary differential diagnosis?. Upper respiratory infection. Seasonal allergic rhinitis. A cold. Obstruction.

785. An 17 years old male who has been taking Bactrim for sinusitis presents to the emergency Department with a temperature of 103 F, malaise and hemorrhagic bullae on his lips, mouth and most of his body. Which admitting diagnosis should the APRN make?. Erysipelas Cellulitis. Erythema Multiform Minor. Stevens Johnson Syndrome. Rocky Mountain Spotted Fever.

786. An older Caucasian adult is at highest risk for poverty substandard house, institionalization based on documented probabilities?. A 70 years old rural female with Alzaimer's disease. A 75 years old urban female with osteoarthritis. A 70 years old urban male with coronary artery disease. A 75 years old rural male with a left hemispheric stroke.

787. When performing a functional assessment on an 82 years old patient with a recent which question is most important for the APRN to. How many times a day do you have a bowel movement. Do you have any thyroid medication. Do you wear glasses. Are you able to dress yourself.

788. Cullen and Turner sign are commonly associated with: Acute pancreatitis. Cholecystitis. Cirrhosis. Myocardial infarction.

789. You are examining a 6 month old infant. The patient is up-to date with his immunizations. What immunizations does your patient need today?. HepB, DTap, PCV 13, IPV. Hib, MMR, VAR, HPV. Tdap, HPV, MMR. Hep B, DTap, Hib, PCV 13, IPV.

790. Albert is a 68 year old African American diagnosed with Hypertension. Which type of medication is recommended to control his BP?. Calcium Channel Blockers (CCBs). Beta-blockers (BBs). Angiotensin II -receptor blockers (ARBs). Beta-blockers (BBs).

791. The APRN is assessing the primitive reflexes of a new born who is 6 hours old. Which reflex should the APRN investigate further?. Palmar grasp. Moro reflex. Stepping reflex. Placing reflex.

792. A 9 year old child with purulent rhinorrhea and nasal congestion for 14 days is diagnosed with acute sinusitis. Which of the following treatments is most recommended?. Antibiotic. Use of aerosol for 1 week. Systemic antihistamines. Saline wash.

793. A new patient who recently visited the woods in North Carolina complains of a new onset of fever and a red rash that started 2 days ago. The rash first appeared on the wrist and the ankles and included the palm of the hands. The patient reports that it is spreading toward his trunk. The patient's eyes are not injected and no enlarged nodes are palpated on his neck. There is no desquamation of the skin. Which of the following diagnosis is most likely?. Rocky Mountain spotted fever. Meningococcemia. Kawasaki disease. Fifth disease.

794. A 20 years old college student comes to the campus health center with a chief complaint of "Strep Throat". In addition to the painful sore throat, the student symptoms include head ache and fatigue, the APRN performs complete neuro and ENT examination, as well as auscultation of heart and lungs, and palpation of the abdomen. What findings should the APRN expect to confirm based on the client's history?. Palatal petechial rash caused by the untreated bacterial upper respiratory tract infection. Liver enlargement that is likely to persist beyond one month due to concomitant hepatitis. Adenopathy of the posterior cervical nodes secondary to the streptococcal infection. Enlarged tonsils and splenomegaly characteristic of infectious viral mononucleosis.

795. For a menopausal woman, what is the main advantage of administering progestin concurrently with estrogens?. Relief of depression and insomnia in women with postmenopausal symptoms. A reduction in endometrial cancer risk in women who have not had a hysterectomy. A reduction in cardiovascular risk in women with a family history of heart disease. Improvement in the bone density in women with a family history of osteoporosis.

796. A woman at 20 weeks gestation has a positive urine screen for Group B Streptococus. What action should the APRN take?. Consult with obstetrician about hospitalized IV penicillin therapy. Implement the protocol for a 10 day course of antibiotics. Notify the pediatrician of the Group B streptococcal infection. Teach the client about signs and symptoms of preterm labor.

797. When managing depression in older adults, all of the following should be considered except: start at the highest dose possible of antidepressant and then titrate down once symptoms resolve. encourage psychotherapy in addition to pharmacotherapy. utilize electroconvulsive therapy for severe depression. conduct a medication review to minimize potential drug-drug interactions.

799. Which of these statements is not true regarding aging skin?. Skin loses sensation and immune response. The amount of cell layers in the skin decreases. Skin is not as resistant to the development of pressure ulcers. No warning signs may precede pressure ulcer formation.

800. The use of which of the following medications is associated with the least risk of postural hypotension in the older adult?. nifedipine. furosemide. clonidine. lisinopiril.

801. Anticipated age-related changes that can result in less drug effect include: loss of beta-2 receptor sites. lower gastrointestinal (GI) pH. increased renin-angiotensin production. increased GI motility.