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Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

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21.

All of the following must be present to diagnose metabolic syndrome except:

  • Elevated liver enzymes

  • Abdominal obesity

  • Hypertension

  • Hyperlipidemia

Correct answer: Elevated liver enzymes 

Metabolic syndrome is the name for a group of risk factors that raises the risk for heart disease and other health problems, such as diabetes and stroke.

Risk factors include:

  • Abdominal obesity (greater than 40 inches in men and greater than 35 inches in women)
  • Hypertension
  • Hyperlipidemia
    • Fasting plasma glucose (>100 mg/dL)
    • Elevated triglycerides (>150 mg/dL)
    • Decreased HDL (<40 mg/dL)

At least three of the above metabolic risk factor characteristics must be present to be diagnosed with metabolic syndrome.

22.

A patient newly diagnosed with hypertension is being prescribed hydrochlorothiazide (HCTZ). The adult-gerontology nurse practitioner should educate the patient on the possible side effects, which include:

  • Hyperglycemia and hyperuricemia

  • Gynecomastia and GI upset

  • Ankle edema and headaches

  • Dry cough and angioedema

Correct answer: Hyperglycemia and hyperuricemia

Thiazide diuretics, such as HCTZ, can cause the following side effects:

  • "Hyper"
    • Hyperglycemia (be careful with diabetics)
    • Hyperuricemia (can precipitate gout attack)
    • Hypertriglyceridemia and hypocholesteremia (check lipid profile)
  • "Hypo"
    • Hypokalemia (potentiates digoxin toxicity, increases risk of arrhythmias)
    • Hyponatremia (hold diuretic, restrict water intake, replace K+ loss)
    • Hypomagnesemia

Gynecomastia and GI upset are common side effects of aldosterone receptor antagonist diuretics (i.e., spironolactone). Ankle edema and headaches may be seen with calcium-channel blockers. A dry cough and angioedema are associated with ACEIs and ARBs.

23.

What statement is not correct in regards to the USPSTF screening recommendations for cervical cancer?

  • Women younger than 21 years of age should be screened only if sexually active.

  • A baseline Pap smear/cytology should begin at age 21 years in all females.

  • Screen every three years until age 65 years.

  • May screen every five years with combination of cytology plus HPV testing beginning at age 30 years.

Correct answer: Women younger than 21 years of age should be screened only if sexually active.

The U.S. Preventive Services Task Force (USPSTF) cervical cancer screening guidelines include:

  • Baseline Pap smear/cytology at age 21 years
  • Screen every three years until age 65 years
  • Do not screen women younger than 21 years, even if sexually active (cervical cancer is rare before age 21 years)
  • Another option starting at age 30 years is to screen with combination of cytology and HPV testing every five years
  • Hysterectomy with removal of cervix: If hysterectomy with cervical removal was not due to cervical intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening
  • Women older than 65 years who had adequate prior screening: Do not screen if history of adequate prior screening and is not otherwise at high risk for cervical cancer

Risk factors include multiple sex partners (defined as greater than four lifetime partners), younger age onset of sex (immature cervix easier to infect), immunosuppression, and smoking.

24.

Never prescribe the use of ketorolac (Toradol) for longer than:

  • 5 days 

  • 7 days 

  • 14 days 

  • 28 days 

Correct answer: 5 days 

Ketorolac is an NSAID that is used for the short-term treatment of moderate to severe pain in adults. It is usually used before or after medical procedures or after surgery. Toradol should not be used for longer than 5 days (injection or tablets). Long-term use of this medicine can damage your kidneys or cause bleeding.

25.

A positive Whiff test indicates:

  • Bacterial vaginosis (BV)

  • Candidal vaginitis

  • Trichomonal vaginitis

  • Atrophic vaginitis

Correct answer: Bacterial vaginosis (BV) 

A positive result on the Whiff test occurs when a strong, fish-like odor is released after one to two drops of KOH (potassium hydroxide) are added to a slide or cotton swab soaked with the vaginal discharge, indicating BV. PO Metronidazole (Flagyl) is prescribed for this condition BID x 7 days.

26.

When discussing birth control options, the nurse practitioner explains that the diaphragm and contraceptive sponge: 

  • when used with spermicidal gel, block sperm from entry into the uterus

  • do not carry a risk of TSS (toxic shock syndrome) because they are both disposable 

  • block sperm entry into the vaginal canal 

  • offer complete protection from STDs

Correct answer: when used with spermicidal gel, block sperm from entry into the uterus 

The diaphragm and contraceptive sponge are barrier methods of birth control. The diaphragm must be used with spermicidal gel. After intercourse, leave the diaphragm inside the vagina for at least 6 to 8 hours (it can remain in the vagina for up to 24 hours). Additional spermicide application is needed before every act of intercourse. Apply the spermicidal gel inside the vagina without removing the diaphragm. 

The contraceptive sponge uses spermicides to prevent conception; it covers the cervix, and the spermicide in the sponge prevents pregnancy by killing sperm, stopping them from reaching and fertilizing an egg.

They both carry a risk (although rare) of TSS and do not offer complete protection from STDs.

27.

Pulsus paradoxus is most likely to be associated with which of the following conditions?

  • Severe acute asthma

  • Pneumonia

  • Pleural effusion

  • Cystic fibrosis

Correct answer: Severe acute asthma 

Acute severe asthma is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and corticosteroids. Symptoms include chest tightness, rapidly progressive dyspnea, dry cough, use of accessory muscles, fast and/or labored breathing, and extreme wheezing. It is a life-threatening episode of airway obstruction and is considered a medical emergency. Complications include cardiac and/or respiratory arrest.

Normally, the pulsus paradoxus (i.e., the difference in systolic blood pressure between inspiration and expiration) does not exceed 15 mmHg. In patients with severe asthma, a pulsus paradoxus of greater than 25 mmHg usually indicates severe airway obstruction.

28.

How does a patient with a Baker's cyst typically present?

  • They will have pressure/pain behind the knee

  • They will have limited elbow range of motion

  • They will have nerve impingement

  • They will have destruction of the joint space

Correct answer: They will have pressure/pain behind the knee 

A Baker's cyst is a type of bursitis that is located behind the knee (popliteal fossa). The bursae are protective, fluid-filled synovial sacs located on the joints that act as a cushion and protect the surrounding structures. Generally, a baker's cyst will present in a physically active patient (a runner) as a ball-like mass behind one knee that is soft and smooth. The cyst often causes a bulge and a feeling of tightness, and the pain can get worse with full flexion or extension during activity. If the cyst ruptures, there will be an inflammatory reaction with swelling, redness, and tenderness over the affected area. Treatment involves following RICE, taking NSAIDs as needed and, if large and painful, drainage of the cyst.

29.

HMG COA reductase inhibitors (statins) are known to increase the risk of which of the following conditions?

  • Rhabdomyolysis

  • Raynaud's phenomenon 

  • Deep vein thrombosis (DVT)

  • Metabolic syndrome 

Correct answer: Rhabdomyolysis 

HMG COA reductase inhibitors, commonly known as statins, are best at lowering LDL and can moderately increase HDL. High-dose statins (simvastatin and lovastatin) will increase the risk of rhabdomyolysis (acute breakdown of skeletal muscle), which can cause acute renal failure. If this complication is suspected, refer the patient to a physician or ED.

30.

The American Nurses Association (ANA) revised the Code of Ethics for Nurses in 2015.

Identify the statement that is true under this revision.

  • Nurses may not delegate assessment responsibilities.

  •  Nurses have discretion to delegate evaluation responsibilities.

  • The ANA code is a negotiable standard.

  • Nurses are not able to delegate interventions.

Correct answer: Nurses may not delegate assessment responsibilities.

In 2015, the American Nurses Association adopted updates to the Code of Ethics for Nurses to include new language with interpretive statements. The code is clear that it is not negotiable and nurses may not delegate evaluation or assessment responsibilities, although there is room for them to delegate some interventions.

31.

Which of the following antihistamine medications should the nurse practitioner avoid when treating elderly patients?

  • Diphenhydramine (Benadryl)

  • Loratadine (Claritin)

  • Cetirizine (Zyrtec)

  • Azelastine (Astelin)

Correct answer: Diphenhydramine (Benadryl)

Avoid using Benadryl when treating elderly patients, if possible, as it has a higher incidence of sedation. 

Claritin is a good choice, and Zyrtec is very effective for acute and chronic urticaria. Astelin is an antihistamine nasal spray and is indicated for allergic rhinitis and vasomotor rhinitis.

32.

A nurse practitioner is speaking with a patient who keeps missing their appointments for diabetes management.

Select the best question for the provider to use to elicit how the patient interprets their medical status or illness.

  • What kind of treatment do you think you need?

  • Are you having transportation problems?

  • Do you have fears about your illness? 

  • Do you feel your condition is severe? 

Correct answer: What kind of treatment do you think you need?

The best option is an open-ended question. This type of questioning, where more than a yes/no answer is required, is in line with Arthur Kleinman's culture-infused "illness narrative". Getting at the heart of what things are associated with the disease can assist and help a provider properly assess and treat patients. It will allow the provider to better understand patient actions based on their interpretation of the illness.

Asking closed-ended questions in this case has the provider making presumptions about the reasons why a patient is doing or not doing something. It also limits the potential response and interaction that could be gained by open-ended discussion.

33.

In the patient with HIV, the adult-gerontology nurse practitioner should initiate prophylactic treatment for PCP (pneumocystis carinii pneumonia) when the CD4 lymphocyte count falls below:

  • 200 copies/mL

  • 400 copies/mL

  • 500 copies/mL

  • 300 copies/mL

Correct answer: 200 copies/mL

Pneumocystis jirovecii pneumonia (previously known as pneumocystis carinii pneumonia or PCP) is a potentially life-threatening infection that occurs in immunocompromised individuals. HIV-infected patients with a low CD4 count (below 200 copies/mL) are at the highest risk of PCP. Trimethoprim-sulfamethoxazole (TMP-SMX), or Bactrim DS, one tablet daily, is the treatment of choice for opportunistic infections, such as PCP. If the patient has a severe allergy to sulfa, the next step is dapsone 100 mg daily or atovaquone suspension. 

Normal CD4 T-cell counts are 500-1,500 cells/mL.

34.

The US Preventive Services Task Force (USPSTF) recommends screening for major depressive disorder (MDD) starting at age:

  • 12 to 18 years

  • 18 to 21 years

  • 9 to 13 years

  • 21 to 25 years

Correct answer: 12 to 18 years

The USPSTF recommends screening for MDD in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children aged 11 years or younger.

35.

When educating your patient on the increased risks of chronic use of NSAIDs, you discuss all of the following except:

  • Increased risk of ankylosing spondylitis

  • Increased cardiovascular risk

  • Increased risk of renal damage

  • Increased risk of GI bleeding

Correct answer: Increased risk of ankylosing spondylitis 

NSAIDs increase cardiovascular risk, in addition to the risk of renal damage and GI bleeding. 

Experts state that dramatic response to NSAIDs is helpful in diagnosing ankylosing spondylitis, which is a chronic inflammatory disorder that affects mainly the spine and the sacroiliac joints.

36.

What is the drug of choice for treatment of both uncomplicated and complicated gonorrheal infection?

  • Ceftriaxone (Rocephin) 250 mg IM x one dose

  • Doxycycline (Monodox, Doryx) 100 mg PO BID x 14 days

  • Metronidazole (Flagyl) 500 mg PO BID x 14 days

  • Azithromycin (Zithromax, Zmax) 1 g orally x one dose

Correct answer: Ceftriaxone (Rocephin) 250 mg IM x one dose 

First-line therapy for both uncomplicated and complicated gonorrheal infection is Rocephin 250 mg IM x one dose. In addition, always cotreat for chlamydia as well, even if the chlamydial test result is negative. 

It is important to note, however, that the inverse is not true; if chlamydia, do not give prophylaxis against gonorrhea unless indicated.

37.

Rocky Mountain Spotted Fever (RMSF) is caused by a bite by which of the following?

  • Dog tick

  • Mosquito

  • Flea

  • Brown recluse spider

Correct answer: Dog tick

RMSF is caused by the bite of a dog tick (wood tick) that is infected with the parasite Rickettsia rickettsii. Patients present with acute onset of high fever, chills, severe headache, nausea/vomiting, myalgia, and arthralgia followed by a rash 2 to 5 days later consisting of petechiae often seen on wrists, forearms, and ankles and progresses toward the trunk. It is most commonly seen in males, First Nations/Native Americans, and people aged 40 or older. More than 60% of cases occur in five states (NC, OK, AK, TN, MO). Using a DEET-containing repellent on skin and permethrin on clothing and gear can repel ticks.

38.

Malignant neuroleptic syndrome (MNS) is a rare, life-threatening idiopathic reaction that can develop from initiating or increasing dosage of which of the following class(es) of drugs?

  • Typical and atypical antipsychotics

  • Anticonvulsants

  • SSRIs and SNRIs

  • Atypical antidepressants and MAOIs

Correct answer: Typical and atypical antipsychotics 

MNS is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs, including olanzapine, risperidone, quetiapine, and haloperidol. Symptoms include high fever, profuse sweating, unstable BP, stupor, muscular rigidity, and autonomic dysfunction.

39.

Allopurinol (Zyloprim) is prescribed to a patient for the treatment of gout. What instructions should the nurse practitioner give the patient in regard to this medication?

  • Limit the use of vitamin C

  • Take the medication on an empty stomach

  • A rash is a normal side effect of the medication

  • The patient will notice the effects immediately 

Correct answer: Limit the use of vitamin C

Instruct the patient not to take large doses of vitamin C while prescribed allopurinol because kidney stones may occur. In addition, the NP should monitor the patient's CBC as it can cause bone marrow suppression. 

The patient should be instructed to take allopurinol with a meal or with a glass of milk.  A rash is a sign of hypersensitivity, so the patient should notify the NP immediately should a rash develop. A full therapeutic effect usually takes one week or longer.

40.

You are seeing a new 60-year-old patient who is currently taking olanzapine (Zyprexa) for diagnosed bipolar disorder. Which of the following should be closely monitored with use of this medication?

  • BMI and weight

  • Fasting blood glucose and lipid profiles

  • Blood levels to check for toxicity

  • INR

Correct answer: BMI and weight

Olanzapine (Zyprexa) is an atypical antipsychotic and common side effects include obesity and diabetes type 2. Because of this, it is imperative to check BMI and weight at least every three months. 

Haldol elevates lipids/triglycerides, so fasting blood glucose and lipid profiles should be routinely monitored with this medication. Lithium is a metal and can easily become toxic if doses are not in therapeutic range. Lithium blood levels should be closely monitored for this reason.

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