×

Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 10 of 25

181.

What is the gold standard test for diagnosing hearing loss?

  • Audiometry

  • Weber test

  • Rinne test

  • Tympanogram

Correct answer: Audiometry 

Audiometry using a soundproof booth performed by a professional audiologist is the gold standard for diagnosing hearing loss.

The other answer choices are screening tests for hearing loss.

182.

What is the most common laboratory test used in the primary care setting to evaluate a patient's estimated glomerular filtration rate (eGFR)?

  • Serum creatinine

  • Alkaline phosphatase

  • Urinalysis (UA)

  • BUN-to-creatinine ratio (BUN:Cr)

Correct answer: Serum creatinine 

When renal function decreases, the creatinine level will increase. The GFR can be estimated by using the serum creatinine in a prediction equation. The more damaged the kidneys, the lower the eGFR value. The GFR is the amount of fluid filtered by the glomerulus within a certain unit of time and is used to evaluate renal function and to stage chronic kidney disease. Normal eGFR is greater than 90 mL/min; in renal failure, the eGFR is less than 15 mL/min.

183.

Which of the following is not considered a sentinel event?

  • Anorexia caused by an oral prescription of Adderall

  • Accidental retention of a foreign object during a surgical procedure

  • Suicide of a patient receiving 1:1 care

  • Unexpected death of a full-term infant

Correct answer: Anorexia caused by an oral prescription of Adderall 

A sentinel event is defined by The Joint Commission (TJC) as any unanticipated event in a health care setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness. Sentinel events specifically include loss of a limb or gross motor function and any event for which a recurrence would carry a risk of a serious adverse outcome. They are identified under TJC accreditation policies to help aid in root-cause analysis and to assist in the development of preventative measures. TJC tracks events in a database to ensure events are adequately analyzed and undesirable trends or decreases in performance are caught early and mitigated.

Anorexia is not considered a serious patient event. GI side effects, such as anorexia, nausea/vomiting, and abdominal pain, are not life-threatening.

184.

A patient is seen in the primary care setting for complaints of a rash over the torso, upper back, and upper arms. The patient reports the rash developed quickly and that it has been bothering him for several days. Upon examination, the nurse practitioner observes multiple bright-red and pruritic lesions that have evolved into vesicular lesions. The rash appears to be asymmetrically distributed over the upper back and upper arms but follows a pattern on the torso. Some of the lesions have ruptured, leaving bright-red moist areas that the patient reports being painful, with a burning and stinging sensation. Other lesions have crusted over and become lichenified as a result of chronic scratching. 

What is the most likely diagnosis?

  • Contact dermatitis

  • Superficial candidiasis

  • Tinea versicolor

  • Actinic keratosis

Correct answer: Contact dermatitis 

This is a classic case of contact dermatitis, which is characterized as an inflammatory skin reaction caused by direct contact with an irritating external substance. Contact dermatitis can present as a single lesion or as a generalized rash. There are two types: irritant and allergic. Common offenders are poison ivy (Rhus dermatitis), nickel, latex rubber, chemicals, etc. The rash is acute in onset, occurring within minutes to several hours after skin contact. The shape may follow a pattern (i.e., at the waistline if the patient is allergic to nickel from a pant button), or have asymmetric distribution.

185.

The ability of a test to detect a person who is healthy (or to detect a person without disease) is known as:

  • Specificity

  • Sensitivity

  • Primary prevention

  • Determinant

Correct answer: Specificity 

Specificity is characterized by the proportion of persons without disease who are correctly identified by a screening test or case definition as not having disease. Sensitivity, then, is the proportion of persons with disease who are correctly identified by a screening test or case definition as having disease.

A determinant is simply any factor, whether event, characteristic, or other definable entity, that brings about change in a health condition. Primary prevention is concerned with preventing the onset of disease.

186.

The tandem gait is a neurological exam that tests:

  • The cerebellum

  • The sensory system

  • Motor movements

  • Spinal nerves

Correct answer: The cerebellum

The cerebellum is the area of the brain that controls coordination and balance. Thus, clinical manifestations of cerebellar disorders include imbalance and incoordination. 

Tandem gait is a test to help diagnose cerebellar disorders (i.e., ataxia) and refers to the patient walking in a straight line with one foot in front of the other. This simple test is said to be positive if the patient is unable to perform tandem walking, loses balance, and falls.

187.

First-line treatment in the diagnosis of essential tremor is:

  • Propranolol

  • Selegiline (Eldepryl)

  • Carbidopa-levodopa (Sinemet)

  • Benztropine (Cogentin) 

Correct answer: Propranolol

Essential tremor is a neurological disorder that causes rhythmic shaking usually seen in the arms or the hands and may progress to include the head. The exact etiology is unknown, and it can occur in children and adults. Treatments can help manage this condition, but there is no known cure. Propranolol is first-line treatment, given daily. Contraindications to this medication include asthma, COPD, second- to third-degree heart block, and bradycardia. Patients should be referred to a neurologist for evaluation and treatment.

The other answer options are medications to treat symptoms related to Parkinson's Disease.

188.

A patient that has Type 1 DM is on regular insulin and NPH insulin subcutaneously administered BID. The first dose is injected before breakfast, and the second dose is injected at bedtime. The blood sugar results from the patient's diary (fasting, before lunch, dinner, and bedtime) reveal that the lunchtime values are higher than normal.

Which insulin dose should be adjusted?

  • NPH component of the morning dose should be increased

  • Regular insulin component of the morning dose should be increased

  • NPH component of the bedtime dose should be increased

  • Regular insulin component of the bedtime dose should be increased

Correct answer: NPH component of the morning dose should be increased 

In this scenario, the NPH component of the morning dose should be increased. Regular insulin (short-acting) peaks between breakfast and lunch (in one to five hours), and most of it is gone by lunchtime. In contrast, NPH insulin peaks between 6 and 14 hours and thus will cover the postprandial spike after lunch that this patient is experiencing.

189.

What is the strongest risk factor for the development of colon cancer?

  • Age 50 and above

  • A sedentary lifestyle

  • A family history of colorectal cancer or polyps

  • Diet and obesity

Correct answer: Age 50 and above 

The great majority of people diagnosed with colon cancer are older than 50 years of age.

Other risk factors include obesity, a diet consisting of foods high in animal fats, a sedentary lifestyle, and a family history of polyps or colorectal cancer.

190.

The nurse practitioner would refer all of the following burn patients to a burn center except:

  • Second-degree burns on the lower arm

  • Burns that involve the cartilage of the ear

  • Electrical burns 

  • Severe facial burns 

Correct answer: Second-degree burns on the lower arm 

Burns are described according to the depth of injury to the dermis and are loosely classified into first, second, third, and fourth degrees. A second-degree (superficial partial-thickness) burn extends into the superficial (papillary) dermis. It appears red with clear blisters, blanches with pressure, has a moist texture, and is painful to sensation. A second-degree burn takes 2 to 3 weeks to heal. First- and second-degree burns are appropriately treated by a nurse practitioner. 

Third-degree burns, partial thickness burns over 10% total body surface area, electrical burns, or burns involving any part of the face, hands, feet, joints, or genitalia should be referred to a burn center. 

191.

A nurse practitioner experiences an accidental needlestick injury when caring for a patient who may be infected with HIV.

Identify the agency that is the best contact in this case.

  • National Clinician's Post-Exposure Prophylaxisis hotline 

  • State health department report line

  • American Association of Poison Control Centers

  • Agency for Toxic Substances and Disease Registry

Correct answer: National Clinician's Post-Exposure Prohylaxixs Hotline

Health care workers face a number of serious safety and health hazards. These hazards include bloodborne pathogens and biological hazards. It is recommended to call the National Clinician's Post-Exposure Prophylaxisis hotline at 1-888-448-4911 for potential occupational exposure to HIV. This hotline is available for job related information and advice.

The other options are not specific contacts nor relevant for the occupational situation.  

192.

All of the following statements are correct regarding claims-based professional malpractice insurance except:

  • All malpractice claims made are paid as long as the nurse practitioner is in active practice.

  • Claims made during the insured period are covered as long as the nurse practitioner is currently enrolled in the same malpractice insurance program when the lawsuit is filed against them.

  • A claim will not be covered (in the future) if the nurse practitioner does not have the same malpractice insurance company as when the lawsuit was filed.

  • Tail coverage insurance will cover the nurse practitioner for malpractice claims filed against them in the future.

Correct answer: All malpractice claims made are paid as long as the nurse practitioner is in active practice.

Claims-based professional malpractice insurance would cover claims only if the incident occurred when the nurse practitioner (NP) paid the premium and only if the NP is still enrolled with the same insurance company at the time the claim is filed in court.

When the NP retires or plans to discontinue the claims-based malpractice insurance, they can buy tail coverage, which will cover them in the future. For occurrence-based policies, any claims made against the NP on the dates that the malpractice insurance was active are still eligible for coverage even if the NP is not carrying the insurance when they are sued.

193.

What is cranial nerve V (CN V) responsible for?

  • Facial sensations and movements

  • Vision

  • Sense of smell

  • Motor impulses to the pharynx and shoulder

Correct answer: Facial sensations and movements 

The trigeminal nerve, or CN V, is the largest and most complex of the 12 cranial nerves (CNs). It supplies sensation to the face, mucous membranes, and other structures of the head. It is the motor nerve for the muscles of mastication and contains proprioceptive fibers. 

The optic nerve (CN II) is responsible for vision. CN I (olfactory) is responsible for smell, and CN XI (spinal accessory) is responsible for motor impulses to the pharynx and shoulder.

194.

Which of the following hormones induces ovulation?

  • Luteinizing hormone (LH)

  • Follicle-stimulating hormone (FSH)

  • Progesterone

  • Estradiol

Correct answer: Luteinizing hormone (LH)

LH is secreted by the anterior pituitary gland, which induces ovulation of the dominant follicle. The follicle migrates to the fimbriae of the fallopian tube.

FSH stimulates the follicles into producing estrogen. Progesterone is the predominant hormone during the last two weeks of the menstrual cycle.

195.

What does an absent cremasteric reflex indicate?

  • Testicular torsion

  • Prostate cancer

  • Testicular cancer

  • Priapism

Correct answer: Testicular torsion 

The cremasteric reflex is assessed to evaluate testicular pain in the case of testicular torsion. The examiner strokes or gently pinches the skin in the upper medial thigh, causing cremasteric muscle contraction (the testicle on the same side should rise). This reflex is missing in testicular torsion, when the spermatic cord (which provides blood flow to the testicle), rotates and becomes twisted. A majority of cases occur between the ages of 10 and 20 years.

196.

Presbycusis is best described as:

  • Age-related hearing loss

  • Vision impairment resulting from deterioration of the macula

  • Cloudiness and opacity of the lens of the eye(s)

  • Deterioration of articular cartilage

Correct answer: Age-related hearing loss 

This is a common physiologic change that occurs as the body ages. It is a sensorineural type of hearing loss (inner ear) that occurs at about the age of 50 years. High-frequency hearing is lost first as degenerative changes in the ossicles take place, as well as atrophy of the hair cells. 

Macular degeneration is characterized by vision impairment resulting from deterioration of the macula. Cloudiness and opacity of the lens of the eye(s) describes cataracts. Articular cartilage deterioration could signal osteoarthritis.

197.

Some nurse practitioners bill directly for their services. In terms of reimbursement, who is considered the third-party payer?

  • The insurance company

  • The patient

  • The health care provider

  • The state government

Correct answer: The insurance company

The third-party payer is an entity that pays the medical claims on behalf of the insured. These include health insurance companies, health plans (health maintenance organizations [HMOs], preferred provider organizations [PPOs]), Medicaid, and Medicare. The first party is the patient. The second party is the health care provider.

198.

Which of the following is not a common condition in geriatrics?

  • Tinea versicolor

  • Chronic constipation

  • Alzheimer's disease

  • Urinary tract infection (UTI)

Correct answer: Tinea versicolor 

Tinea versicolor is a common fungal skin infection caused by yeasts Pityrosporum orbiculare or Pityrosporum ovale, and is characterized by lighter or darker patches on the chest or back. This infection, which prevents the skin from tanning evenly, occurs most often in adolescence and early adulthood. 

Chronic constipation, Alzheimer's disease, and UTIs are more common in the geriatric population.

199.

In diagnosing systemic lupus erythematosus (SLE), which laboratory finding is most indicative of this disease? 

  • Antinuclear antibodies (ANA)

  • Urinalysis (UA) positive for proteinuria 

  • Elevated sedimentation rate 

  • Rheumatoid factor (RF) 

Correct answer: Antinuclear antibodies (ANA) 

SLE is a multisystem autoimmune disease that is more common in women (9:1) of African and Hispanic descent and characterized by remissions and exacerbations. Organ systems affected include the skin, kidneys, heart, and blood vessels. The ANA test is often positive in patients with SLE. Other types of autoantibody testing recommended for these patients include antiphospholipid antibodies, anti-Sm antibodies, and anti-DNA antibodies. Refer patients with suspected SLE to a rheumatologist. 

The elevated sedimentation rate is a nonspecific finding of inflammation. The RF factor is often positive in the diagnosis of rheumatoid arthritis. A positive urinalysis for proteinuria is seen in SLE, but is not diagnostic; it would simply prompt further testing.

200.

When prescribing anticoagulation therapy to a patient (i.e., warfarin sodium or Coumadin), the patient should be advised to avoid excessive intake of which of the following vitamin-rich foods?

  • Spinach

  • Carrots

  • Oranges

  • Beans and legumes

Correct answer: Spinach 

Vitamin K is one nutrient that can decrease warfarin's effectiveness. It is important to educate a patient to be consistent on how much vitamin K they take in on a daily basis. Have them keep a daily intake of foods rich in vitamin K such as green leafy vegetables (kale/collard greens, spinach, cabbage). The patient should avoid consuming large amounts of vitamin K-rich foods.

×