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Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 3 of 25

41.

The nurse practitioner would consider high-intensity statin-dosing, such as atorvastatin 40 to 80 mg, for a 55-year-old male patient with an LDL greater than:

  • 190 mg/dL

  • 130 mg/dL

  • 170 mg/dL

  • 150 mg/dL

Correct answer: 190 mg/dL

An adult (21 years or older) with a low-density lipoprotein (LDL) of 190 mg/dL or higher is a candidate for high-intensity statin dosing.

Optimal levels of LDL cholesterol are less than 100 mg/dL, and an LDL-C of less than 130 mg/dL is considered acceptable for low-risk patients with fewer than two risk factors.

42.

How can the adult-gerontology nurse practitioner improve the quality of clinical practice?

  • Disseminate research study results to colleagues

  • Charge a fee to patients who arrive late to clinic appointments

  • Give opinions about alternative treatments to patients who are considering them

  • Schedule time to meet with pharmaceutical representatives during clinic hours

Correct answer: Disseminate research study results to colleagues 

The quality of clinical practice can be improved through discussion of research study results with colleagues.

The other answer options will not improve clinical practice.

43.

A patient presents to the clinic with a history of a dog bite approximately four hours earlier. The adult-gerontology nurse practitioner assesses the wound and notes two small puncture holes on the webbing of the left hand between the thumb and index finger. There is no purulent drainage or oozing, no erythema, and no active bleeding noted. The patient reports their last tetanus shot was approximately four years ago. 

What is the most appropriate treatment plan for this patient?

  • Irrigate copiously with sterile saline. Obtain wound C&S. Prescribe amoxicillin-clavulanate (Augmentin) 875/125 PO BID x 10 days. Follow up with patient in 48 hours. Refer to plastic surgeon.

  • Irrigate copiously with sterile saline. Prescribe doxycycline BID and metronidazole (Flagyl) BID x 10 days, administer tetanus prophylaxis. Follow up with patient in 48 hours.

  • Irrigate copiously with sterile saline. Because the wound is clean and shows no signs of infection, there is no need for antibiotic therapy. Obtain wound C&S and if positive for growth, prescribe appropriate antibiotic at that time.

  • Irrigate copiously with sterile saline. Stitch puncture holes. Administer tetanus prophylaxis. Obtain wound C&S and follow up with patient in 48 hours.

Correct answer: Irrigate copiously with sterile saline. Obtain and send C&S. Prescribe amoxicillin-clavulanate (Augmentin) 875/125 mg PO BID x 10 days. Follow up with patient in 48 hours. Refer to plastic surgeon.

The treatment plan for dog and cat bites includes:

  • Augmentin 875/125 mg PO BID x 10 days. If penicillin allergy: doxycycline BID, Bactrim DS BID plus coverage for anaerobes combined with metronidazole (Flagyl) BID or clindamycin TID.
  • Irrigate copiously with sterile saline. All bites and infected wounds need wound C&S.
  • Do not suture wounds at high risk for infection: puncture wounds, wounds more than 12 hours old (24 hours on face), infected bite wounds, cat bites.
  • Cartilage injuries (cartilage does not regenerate); refer to plastic surgeon
  • Tetanus prophylaxis (if last booster > 5 years, needs booster)
  • Follow up with patient within 24-48 hours after treatment

Instruct the patient to look out for signs of infection within the initial 12-24 hours, which may include: redness, swelling, pain, and any systemic symptoms.

44.

What is meant by 20/40 vision?

  • The patient can see at 20 feet what a person with normal vision can see at 40 feet

  • The patient can see at 40 feet what a person with normal vision can see at 20 feet

  • The patient is legally blind

  • The patient cannot differentiate colors and should be referred to an ophthalmologist

Correct answer: Patient can see at 20 feet what a person with normal vision can see at 40 feet 

The Snellen Chart is an eye chart that can be used to measure visual acuity. The definition of a Snellen test result 20/40: The top number (20) is the distance in feet at which the patient stands from the Snellen or picture eye chart (always 20 feet and never changes). The bottom number (40) is the number of feet that the patient can see when compared to a person with normal vision (20/20). The denominator, or bottom number, changes according to the patients' vision. In this instance, the patient can see at 20 feet what a person with normal vision can see at 40 feet.

45.

The nurse practitioner is treating a 79-year-old patient for a hip fracture after a fall he had in his home. The NP knows that the risk of death from complications such as pneumonia increases in elderly patients with hip fractures. What percentage of elderly die from complications?

  • Up to 20%

  • Up to 40%

  • Up to 60%

  • Up to 80%

Correct answer: Up to 20%

Hip fractures are a major cause of morbidity and mortality in the elderly. They are most often caused by a seemingly insignificant fall, with 90% of incidences occurring in those aged 65 or older. Up to 20% of elderly with hip fractures die from complications such as pneumonia.

46.

Select the abdominal test used to identify signs of possible appendicitis. 

  •  McBurney's point 

  • Murphy's sign

  • Markle test

  • Carnett's test

Correct answer: McBurney's point 

McBurney's point is used to indicate if there is a sign of possible appendicitis. Tenderness or pain is elicited with palpation in the area located between the superior iliac crest and right lower quadrant of the abdomen.

Murphy's sign is used for cholecystitis or gallbladder disease and Carnett's and Markle tests are used for an acute abdomen and peritonitis.

47.

Identify the area and maneuver to perform a reflex assessment to test for the Babinski's sign. 

  • Stroke the plantar surface of the foot at the lateral border from the heel to the large toe

  • Passively bend the neck of the patient toward the upper chest area

  • Tap the patellar tendon bilaterally

  • Hold the foot in dorsiflexion position and tap the Achilles tendon

Correct answer: Stroke the plantar surface of the foot at the lateral border from the heel to the large toe

The Babinski's sign is tested by stroking the plantar surface of the foot at the lateral border from the heel to the large toe. A positive sign is indicated if the toes spread out and separate during the maneuver and, in all patients except infants, this is abnormal.

Bending the neck passively toward the chest is the Brudzinski's sign, which is a neurologic maneuver. Tapping the patellar tendon is performed to test the quadriceps reflex and should elicit a knee-jerk response. Holding the foot in the dorsifelex position and tapping the Achilles tendon is the Achilles reflex and should elicit an ankle-jerk response. 

48.

What is the most important concept for an inter-professional healthcare team to remember?

  • That the focus should be on providing excellent care for patients

  • That the focus should be on individual contributions

  • That they should read literature to know best practice

  • That they should value others' opinions

Correct answer: That the focus should be on providing excellent care for patients 

The inter-professional team should remember that their focus is to provide excellent care for patients and not to highlight their own abilities.

The other answer options are important when working in a team, but providing excellent care for patients is the priority.

49.

Upon request, you provide evidence to the Chief Nursing Officer of the hospital about the safety of adult-gerontology nurse practitioners performing fine needle biopsies in patients with tumors. What research study would provide the strongest level of evidence?

  • A systematic review

  • An experimental study

  • Retrospective chart review 

  • A randomized control trial (RCT)

Correct answer: A systematic review

The levels of evidence rankings are: 

  • Meta analysis and/or systematic reviews (Cochrane/Medline/CINAHL/PubMed
  • RCTs (used for testing medical treatment effectiveness, subjects assigned at random to either a control or treatment group)
  • Experimental studies (control group, intervention group, randomization)
  • Cohort/case control studies
  • Retrospective chart reviews
  • Expert/specialty society opinions

50.

Of the following statements, which is accurate in regards to cataracts?

  • Cataracts increase sensitivity to the glare of car lights.

  • Up to 80% of older adults are affected by cataracts.

  • African American males aged 65 years and above have an increased risk of developing cataracts.

  • Cataracts are the most common cause of blindness in the United States.

Correct answer: Cataracts increase sensitivity to the glare of car lights.

A cataract is a clouding and opacity of the lens in the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Cataracts cause gradual onset of decreased night vision, sensitivity to the glare of car lights (driving at night), halos around lights, and hazy, blurred vision. The color of the lens is white to gray. The red reflex disappears, and when tested, an opaque gray is seen instead of the normal red-orange glow.

Up to 20% of older adults, aged 65-74 years, are affected; however, cataracts can appear at any age from birth (congenital cataracts) through adulthood to the elderly. The patient's race does not increase their tendency to develop this condition. However, African Americans are 30% less likely to have surgical removal of cataracts than European Americans. In developing countries, cataracts are the most common cause of blindness, while macular degeneration is the most common cause of blindness in the United States.

51.

All of the following are findings on a chest radiography indicative of tuberculosis (TB) except:

  • Black color in the hilum

  • Cavitations in the upper lobe

  • Lymphadenopathy

  • Fibrosis and calcifications

Correct answer: Black color in the hilum

A radiograph of a lung infected by Mycobacterium tuberculosis, the causative agent in TB, shows the upper lobe (which is the most common location of a TB infection) with cavitation (black round holes), fibrosis (scarring), lymphadenopathy and granulomas on the hila of the lungs, and pulmonary infiltrates (fluid) in active TB disease. 

Black color in the hilum (above the clavicles) is associated with emphysema.

52.

Of the following carcinomas, which is the leading cause of mortality in the United States, according to the Centers for Disease Control and Prevention (CDC)?

  • Lung cancer

  • Breast cancer

  • Prostate cancer

  • Skin cancer

Correct answer: Lung cancer 

The cancer causing the most overall deaths for both males and females is lung cancer. About 1 in 4 cancer deaths are caused by lung cancer. Most patients with lung cancer are 45 years of age or older, and smoking is the most common risk factor, causing 80% of cases. Non-small cell lung carcinoma is the most common type.

Breast cancer is the most common cancer in females, and the most common cancer in males is prostate cancer. The highest prevalence of cancer overall is skin cancer.

53.

In the patient diagnosed with primary genital herpes, all of the following are appropriate first episode treatment options except:

  • Acyclovir (Zovirax) BID for 5 days

  • Acyclovir (Zovirax) five times/day for 7 to 10 days

  • Valacyclovir (Valtrex) TID for 7 to 10 days

  • Famciclovir (Favier) BID for 7 to 10 days

Correct answer: Acyclovir (Zovirax) TID for 5 days 

Treatment duration is 7 to 10 days for treating primary genital herpes infection. For breakouts or flare-up treatment, the duration is five days. Acyclovir, famciclovir, or valacyclovir can be used.

54.

First-line medication for type 2 DM is:

  • Metformin (Glucophage)

  • Glipizide (Glucotrol)

  • Basal insulin

  • Pioglitazone (Actos)

Correct answer: Metformin (Glucophage)

Metformin is first-line medication for type 2 DM. If the patient is on metformin 500 mg daily and A1C is high (> 7%), raise the dose to metformin 500 mg BID. If A1C is still high (> 7%), increase the dose to 1,000 mg BID. If the patient is taking the maximum dose of metformin (1 g BID), several drug classes can be added such as sulfonylurea (glipizide) 5 mg PO daily or pioglitazone (Actos). If a patient cannot tolerate metformin and A1C is high, the patient can be started on basal insulin. Or, if the patient is already on two oral drugs and A1C is high (9 or higher), start the patient on basal insulin.

55.

The nurse practitioner is making recommendations for healthy eating using the "MyPlate" system. Which of the following statements made by the patient indicates the need for further teaching?

  • "I should increase my intake of solid fats."

  • "I should exercise at least 150 minutes per week."

  • "I should limit my sodium intake to less than 3 g/day."

  • "I should eat seafood twice a week, especially cold-water fish."

Correct answer: "I should increase my intake of solid fats." 

According to the "MyPlate" system, patients should be encouraged to reduce their intake of solid fats and added sugars (SoFAS) because studies show that they comprise up to 35% of daily total caloric intake. Solid fats come from animal fats and lard (some fried foods, baked goods).

The other answer choices demonstrate a thorough understanding by the patient of the "MyPlate" recommendations.

56.

Home health care provides which of the following?

  • Care given by medical professionals in the home setting

  • Constant supervision of community-dwelling older adults

  • Short-term relief for the long-term primary health caregiver (usually a family member) of an older adult who is taken care of in a private home

  • Financial assistance to families taking care of older adults

Correct answer: Care given by medical professionals in the home setting

Home health care is care delivered in a home setting. Higher-skilled care is provided by RNs and LPNs, while ADL and IADL assistance is given by CNAs. Home health care may be temporary or permanent.

Community-dwelling older adults who need constant supervision can be enrolled in adult day care. Respite care provides short-term "relief" or a break for the long-term primary health caregiver (usually a family member), that can range from a few hours to a few days. An alternate caregiver (nurse or aide) is hired to care for the patient temporarily. Home health care does not provide financial assistance to families taking care of older adults.

57.

A patient presents with complaints of seasonal nasal congestion with clear mucus drainage and postnasal drip. The patient has been coughing, especially at night, and reports nasal itching and frequent sneezing. The adult gerontology nurse diagnoses seasonal allergic rhinitis.

What is first-line treatment for this condition?

  • Topical steroid nasal spray

  • Oral decongestants

  • Oral antihistamines

  • Combination nasal steroid and antihistamine spray

Correct answer: Topical steroid nasal spray 

Topical steroid nasals spray (i.e., Flonase, Nasacort) is first-line treatment for seasonal allergic rhinitis. If this provides only partial relief, another option is topical antihistamine nasal spray azelastine (Astelin). If still partial or no relief, consider a combination product (azelastine and fluticasone nasal spray). In addition, use of decongestants and oral antihistamines PRN may help. Ideally, eliminate environmental allergens.

58.

A patient with a diagnosis of asthma has FEV1 readings between 60-80% of expected volume, reports waking up at night two to three times per week, and uses Advair BID and albuterol PRN. This patient is considered to have an asthma classification of:

  • Step 3

  • Step 4

  • Step 2

  • Step 1

Correct answer: Step 3

Asthma classification, stepwise approach and treatment guidelines (12 years and above) are as follows:

  • Step 1: Intermittent asthma (FEV1 >80% predicted)
    • Daytime symptoms less than 2 days/week; nighttime awakenings less than two per month
    • SABA: Albuterol (Ventolin) metered-dose inhaler as needed
  • Step 2: Mild persistent asthma (FEV1 >80% predicted)
    • Daytime symptoms more than two days/week, but not daily. Nighttime awakenings 3-4/month
    • Albuterol (Ventolin) metered-dose inhaler as needed, 
      • PLUS: Preferred treatment: Low-dose inhaled corticosteroid (ICS)
      • Alternative: Cromolyn/nedocromil, leukotriene receptor antagonist, or theophylline
  • Step 3: Moderate persistent asthma (FEV1 60%-80% of predicted daily symptoms)
    • Nighttime awakenings more than one per week (but not nightly)
    • Albuterol PRN
      • PLUS: Preferred treatment: Low-dose ICS plus LABA (i.e., Advair) or medium-dose ICS
  • Step 4: Severe persistent asthma (FEV1 <60% predicted)
    • Symptoms of asthma throughout the day; nocturnal awakenings nightly
    • Albuterol PRN
      • PLUS: Preferred treatment: Medium-dose ICS plus LABA
  • For Steps 3 and 4, alternative treatment is medium dose ICS plus LTRA (Montelukast, zafirlukast), theophylline, or zileuton

59.

The nurse practitioner is assessing a patient's gait. Upon assessment, it is noted that the patient has a large gap between their feet when standing with their knees together, and the NP makes a mental note that the patient has knock-knees.

What is the medical term for this finding? 

  • Genu valgum

  • Genu varum

  • Genu recurvatum

  • Valgus stress

Correct answer: Genu valgum

This condition is known as genu valgum. The opposite is genu varum, or bowlegs, and genu recurvatum is a hyperextension or backward curvature of the knees. All of these findings are normal, benign variants and are not indicative of damage of any kind or require further assessment. 

The valgus stress test is a test for damage to the medial collateral ligament (MCL) of the knee.

60.

A patient calls the clinic worried because she has missed a day of her oral contraceptive pills. What instructions should the nurse practitioner give to the patient?

  • Take two pills now and continue with the same pill pack.

  • Take two pills the next two days to catch up and finish the birth control pack (use condoms for the current pill cycle).

  • Missing one dose is not going to increase your chances of getting pregnant. Continue the remainder of the birth control pack as prescribed.

  • Throw out the remainder of the pill pack and start over with a new pack that same day.

Correct answer: Take two pills now and continue with the same pill pack.

If one day of oral contraceptive pills is missed, or if a new pack was started one day late, the patient is still protected from pregnancy but should take two pills now and continue with the same pill pack ("doubling up"). The patient should take the rest of the pack as normal and extra contraception (condoms) is not necessary.

If two consecutive days of pills are missed, the patient should be advised to take two pills the next two days to catch up and finish the birth control pack. An alternative form of birth control (condoms) should be used for the remainder of the current pill cycle.

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