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Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 4 of 25

61.

When differentiating Crohn's disease (CD) from ulcerative colitis (UC), which of the following statements is accurate?

  • Fistula formation and anal disease occur only with CD.

  • Hematochezia is common with CD.

  • Remissions and relapses are uncommon in UC.

  • UC may affect any part of the GI tract.

Correct answer: Fistula formation and anal disease occur only with CD.

Both CD and UC are inflammatory bowel diseases. CD may affect any part of the GI tract, from the mouth (canker sores), small to large intestine, rectum, and anus. UC affects only the colon/rectum. A classic sign of UC is bloody stools that are covered with pus and mucus (hematochezia). Remissions and relapses are very common in both conditions; relapses are often accompanied by systemic symptoms (fatigue, low-grade fever, weight loss). Only CD is associated with fistula formation and anal disease.

62.

An asthmatic patient is seen in the clinic with complaints of sudden-onset respiratory distress. He is tachypneic and using accessory muscles to breathe. He cannot complete a full sentence, is diaphoretic, agitated, and has circumoral cyanosis. Minimal breath sounds are audible when auscultating his lungs.

Which of the following is the best initial intervention to follow?

  • Provide the patient with supplemental oxygen

  • Give a nebulizer treatment

  • Administer epinephrine IM

  • Call 911

Correct answer: Provide the patient with supplemental oxygen 

With asthmatic exacerbations, the first intervention is to provide the patient with supplemental oxygen after checking the oxygen saturation. Then, give a nebulizer treatment, repeating every 20 minutes (for three doses). If the patient is unable to use inhaled bronchodilators, give epinephrine IM. If there is a lack of breath sounds or wheezing after the nebulizer treatment regime, this is an indication that the treatment is not helping and 911 should be called. An EpiPen should be given immediately for impending respiratory arrest.

63.

Kava-kava and valerian root are natural supplements used for:

  • Anxiety/insomnia

  • Depression

  • Smoking cessation

  • Substance abuse

Correct answer: Anxiety/insomnia 

Kava-kava and valerian root are used as alternative treatments for anxiety and insomnia. Do not mix with benzodiazepines, hypnotics, or any CNS depressants.

64.

The nurse practitioner is treating a 60-year-old female with an SSRI (selective serotonin reuptake inhibitor) for depression. When should the nurse practitioner consider switching to a different antidepressant if the patient reports no response to the SSRI?

  • 4 to 8 weeks

  • 8 to 12 weeks

  • 2 to 6 weeks

  • 1 to 4 weeks

Correct answer: 4 to 8 weeks 

SSRIs are first-line therapy for depression for elderly patients because they have fewer side effects than other agents. Patients should be advised that antidepressant effects may take from 4 to 8 weeks (up to 12 weeks) to manifest. After initiation, follow up in 2 weeks to check for compliance and side effects; wait at least 4 to 8 weeks before changing medication.

65.

Which biological theory of aging suggests that aging is the result of a slow and complicated process in the body in which proteins, DNA, and other structural molecules develop inappropriate and erroneous attachments to one another, causing accumulated damage?

  • Cross-linkage theory

  • Free radical theory

  • Wear-and-tear theory

  • Immunity theory

Correct answer: Cross-linkage theory 

The cross-linkage theory suggests that aging is the result of accumulated damage from errors involving cross-linked proteins. Cross-linking of new proteins causes advanced glycation end-products, affecting collagen in the lungs, arteries, and tendons. An example is stiffened joints and dry, sagging, less elastic skin. Unsaturated fats and metal ions (e.g., aluminum, zinc, magnesium) may exacerbate cross-linking.

66.

Which of the following is a true statement regarding the Mantoux test?

  • A Mantoux test is considered positive in a person with no risk factors if there is an induration of 15 mm or greater.

  • A Mantoux test result that is reddened, 10.5 mm in size, and smooth and soft upon palpation is considered positive.

  • A Mantoux test that is bright red, soft, and not indurated is considered positive.

  • To administer the Mantoux test, inject 1 mL of tuberculin subdermally. The test should be read 48 to 72 hours later.

Correct answer: A Mantoux test is considered positive in a person with no risk factors if there is an induration of 15 mm or greater.

The Mantoux test (TB skin test or PPD) is a screening tool for tuberculosis. Erythema alone is not an important criterion. The area must be indurated (firm texture) and of the correct size to be positive for TB. If a PPD result is a bright-red color but is not indurated, it is a negative result. To administer, inject 0.1 mL of tuberculin subdermally, and read 48 to 72 hours later. Persons with no known risk factors for TB with an induration of 15 mm or greater is a positive result.

67.

In which year did the American Nurses Association (ANA) Division of Gerontological Nursing first publish the scope of practice for this specialty?

  • 1981

  • 1987

  • 1998

  • 2008

Correct answer: 1981

The scope of practice for gerontological nurses was first published in 1981 and revised in 1987. In 1998, the ANA offered certification for geriatric nurse practitioners and gerontologic clinical nurse specialists. In 2008, the new specialty called the "adult-gerontologic" nurse was introduced to replace "gerontologic" nursing programs by 2015, per the Consensus expert panel. The first group to take the new certification exam was the December 2012 graduates from the AGNP programs.

68.

The principal agency of the U.S. Department of Health and Human Services (DHHS) designated to carry out provisions of the Older Americans Act of 1965 is the:

  • Administration on Aging (AOA)

  • National Council on Aging (NCOA)

  • Adult Protective Services (APS)

  • American Geriatrics Society (AGS)

Correct answer: Administration on Aging (AOA)

An agency of the U.S. Department of Health and Human Services, the AOA works to ensure that older Americans can stay independent in their communities, mostly by awarding grants to states, First Nation/Native American tribal organizations, and local communities to support programs authorized by Congress in the Older Americans Act. Its mission is "to develop a comprehensive, coordinated, and cost-effective system of home and community-based services that helps elderly individuals maintain their health and independence in their homes and communities."

69.

When evaluating the function of the pancreas and assessing for pancreatic damage, all of the following laboratory tests are helpful except:

  • Albumin

  • Lipase

  • Amylase

  • Serum blood glucose

Correct answer: Albumin 

Albumin is a protein made by the liver that makes up about 60% of the total protein in the blood and plays many roles in the body; it is used to evaluate liver disease.

The pancreas makes the enzymes amylase and lipase. Lipase is involved in many biological processes ranging from metabolism of triglycerides to inflammation. The pancreas makes amylase to hydrolyze dietary starch into disaccharides and trisaccharides, which are then converted by other enzymes to glucose to supply the body with energy.

70.

The Eighth Joint National Committee (JNC 8) treatment goals for hypertension have been grouped by age, race, and disease (CKD and DM).

Under JNC 8, African Americans, including those with DM, should be treated with:

  • Thiazide diuretics or calcium channel blockers (CCBs)

  • Angiotensin-converting enzyme inhibitors (ACEIs) or calcium channel blockers (CCBs)

  • Angiotensin receptor blockers (ARBs) or thiazide diuretics

  • Loop diuretics or beta-blockers

Correct answer: Thiazide diuretics or calcium channel blockers (CCBs)

JNC 8 recommends treating African Americans with HTN with thiazide diuretics or CCBs.

71.

Medicines for Raynaud's phenomenon include:

  • Calcium channel blockers (CCBs)

  • Nonselective beta-blockers

  • Imitrex

  • Caffeine

Correct answer: Calcium channel blockers (CCBs)

Raynaud's phenomenon is a reversible vasospasm of the peripheral arterioles on the fingers and toes; the cause is unknown, and females are affected more than males at a ratio of 8:1. This condition is associated with an increased risk of autoimmune disorders. Color changes on the fingertips or toes can range from white (pallor) to blue (cyanosis) to red (reperfusion) with associated numbness and tingling.

Treatment involves medications such as nifedipine (Adalat) or amlodipine (Norvasc), both CCBs. Patients should avoid: touching cold objects and cold weather, stimulants (such as caffeine), the use of vasoconstricting drugs (Imitrex, pseudoephedrine/decongestants, amphetamines), as well as nonselective beta-blockers such as propranolol. In addition, smoking cessation should be strongly encouraged.

72.

Which stage of development is the female in when the breast bud and areola start to develop?

  • Tanner Stage 2 (II)

  • Tanner Stage 1 (I)

  • Tanner Stage 3 (III)

  • Tanner Stage 4 (IV)

Correct answer: Tanner Stage 2 (II)

Tanner Stages for Girls:

  • Stage I: Prepubertal pattern
  • Stage II: Breast bud and areola start to develop
  • Stage III: Breast continues to grow with nipples/areola (one mound/no separation)
  • Stage IV: Nipples and areola become elevated from the breast (a secondary mound)
  • Stage V: Adult pattern

73.

Human papillomavirus (HPV) strains 16 and 18 are associated with which of the following conditions?

  • Cervical cancer

  • Genital warts (condyloma acuminata)

  • Herpes simplex virus (HSV)

  • Palmar and plantar warts

Correct answer: Cervical cancer 

HPV high-risk oncogenic types are 16 and 18. Approximately 70% of cervical cancers worldwide are due to types 16 and 18, according to the CDC. If an HPV testing shows one or both strains, the next step is to refer the patient for colonoscopy and biopsy.

HPV types that are low-risk cause warts in the cervix, vagina, vulva, penis, anus, and rectum. Other strains can cause noncancerous warts of the hands and/or feet.

74.

An older woman presents to the emergency department with complaints of sudden onset of dyspnea, cough, and mild chest pain. She is anxious, tachycardic, and pale, and reports she just returned home from a car trip several hours away. She has a history of atrial fibrillation. 

Based on the above data, what tests should the nurse practitioner order?

  • ABG, ECG, chest x-ray

  • Sputum culture, CBC, pulmonary function test

  • ECG, cardiac enzymes, stress test

  • Sputum culture, CBC, pulmonary function test

Correct answer: ABG, ECG, chest x-ray

Given her history, the NP should immediately suspect that she has a pulmonary embolus, or a blood clot that passed into the lung tissue. The NP should order an ABG to assess oxygenation, and an ECG and chest x-ray to rule out other causative conditions. 

Any condition that increases the risk of blood clots will increase the risk of pulmonary embolus. These patients typically have a history of atrial fibrillation, estrogen therapy, smoking, surgery, cancer, pregnancy, long bone fractures, and prolonged inactivity.

75.

What component of a vaccination makes it so effective?

  • A weakened version of a pathogen

  • Immune-boosting chemicals

  • A small, yet strengthened sample of a virus

  • Microbes which benefit an individual's gut flora

Correct answer: A weakened version of a pathogen

A vaccine is composed of a small amount of the disease-causing organism, either inert/inactive/in pieces or alive but attenuated (weakened so it can not make you sick), which is mixed in a liquid with ingredients for purity, preservation, and sterile injection (for shots).

76.

Which of the following physiologic findings is considered abnormal in the female reproductive system and indicates the need for follow-up?

  • Solid, immobile mass in breast tissue

  • Supernumerary nipples

  • Cervical ectropion

  • Breast asymmetry

Correct answer: Solid, immobile mass in breast tissue 

Hard, irregular masses that are not mobile or any type of solid tumor upon breast examination is not a normal finding and requires tissue biopsy and breast cancer follow-up. 

Cervical ectropion (bright-red bumpy tissue with an irregular surface on the cervical surface around the os) is a benign finding, made up of glandular cells (the same cells that are inside the cervical os). This tissue bleeds easier compared with the squamous epithelial cells on the surface of the cervix. Asymmetrical breasts are very common, especially during puberty, and supernumerary nipples (form a V-shaped line on both sides of the chest down the abdomen and are symmetrically distributed) are also considered a benign physiologic variant.

77.

A female patient is being seen for her annual physical exam. Once in the exam room, a nurse asks her to disrobe and put on the provided gown. When the nurse practitioner enters for the exam, the patient is still fully dressed.

What is the nurse practitioner's best course of action?"

  • Seek to understand from the patient the manner in which she desires to have a comprehensive exam 

  • Explain to the patient that she must be disrobed in order to complete a comprehensive physical assessment

  • Instruct the patient that she will not receive a thorough exam fully clothed

  • Ignore that the patient remained clothed and perform a modified physical exam

Correct answer: Seek to understand from the patient the manner in which she desires to have a comprehensive exam 

The nurse practitioner should seek to understand the rationale for the patient not being disrobed. It could be simply that the nurses' instructions were not heard or understood. The patient may have desired to meet the provider before undressing. It could also possibly be related to religious or cultural norms or even body image or abuse concerns. These are all factors that can affect health care delivery. It is imperative that the provider not make assumptions and utilize open-ended questions in seeking to understand patients.

78.

Trauma to Kiesselbach's plexus will result in:

  • An anterior nosebleed

  • Seizure activity

  • Short-term memory loss

  • Gait disturbances

Correct answer: An anterior nosebleed 

Kiesselbach's plexus is an area of the anterior part of the nasal septum that has a rich supply of blood vessels and is a common site of nosebleeds. It is named after Wilhelm Kisselbach, a nineteenth-century German otolaryngologist.

79.

Which of the following skin conditions is described as an oval-shaped maculopapular rash preceded by a herald patch?

  • Pityriasis rosea

  • Varicella zoster

  • Herpes simplex

  • Fifth disease

Correct answer: Pityriasis rosea

This is a type of skin rash. Classically, it begins with a single red and mildly scaly area known as a "herald patch." It is typically followed, days to weeks later, by a pink rash covering the body. One of the classic signs of this rash is the evergreen or pine tree-shaped presentation. The condition lasts from six to eight weeks and resolves spontaneously. Sometimes pruritus may be present, but often there are few other symptoms. While the cause is not entirely clear, it is believed to be related to a viral infection. If the patient is at high risk of STDs, rule out secondary syphilis by checking rapid plasma reagent (RPR). This rash should not be confused with rosacea.

80.

All of the following physiologic findings in the elderly patient are benign except:

  • Cholesteatoma

  • S4 heart sound

  • Torus palatinus

  • Fishtail uvula

Correct answer: Cholesteatoma 

A cholesteatoma is a "cauliflower-like" growth accompanied by foul-smelling ear discharge. Hearing loss may be present in the affected ear. Upon examination, no tympanic membrane or ossicles are visible because of destruction by the tumor. Generally, the patient has a history of chronic otitis media infection. The mass is not cancerous, but it can erode into the bones of the face and damage the facial nerve (CN VII) if left untreated. Management consists of antibiotics and surgical debridement. Referral to an otolaryngologist is indicated. 

The presence of an S4 heart sound, torus palatinus (a bony protrusion of the palate), and a fishtail uvula (a uvula that is forked or split in appearance) are all benign findings and physiologic variants that may be seen in the physical assessment of the elderly patient.

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