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Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 5 of 25

81.

The "SOAPE" mnemonic is a helpful tool for correctly following the nursing process. What does the "P" stand for?

  • Plan

  • Pain

  • Physical exam

  • Patient symptoms

Correct answer: Plan 

The SOAPE nursing process:

  • S: Look for subjective evidence
  • O: Look for objective evidence
  • A: Diagnosis or assessment
  • P: Treatment plan
  • E: Evaluate response to the treatment/intervention or Evaluate the situation

82.

Which of the following antibiotics is classified as a Category B drug?

  • Rocephin (ceftriaxone) 

  • Biaxin (clarithromycin) 

  • Bactrim DS (trimethoprim-sulfa) 

  • Doxycycline 

Correct answer; Rocephin (ceftriaxone) 

Rocephin is a third generation cephalosporin and is considered an FDA pregnancy category B drug. 

Biaxin is a macrolide antibiotic and is in FDA pregnancy category C. Bactrim DS is a sulfonamide and is also in FDA pregnancy category C. Doxycycline is a tetracycline and considered a pregnancy category D drug. 

The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical agent if it is used as directed by the mother during pregnancy. 

  • Category A = Adequate, well-controlled studies failed to demonstrate a risk to the fetus in the first trimester and no evidence of risk in the later trimesters. 
  • Category B = Animal studies have shown an adverse effect on the fetus, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
  • Category C = Animal studies have shown an adverse effect on the fetus, but there are no adequate and well-controlled studies in humans, and potential benefits may warrant use of the drug in pregnant women despite potential risks.
  • Category D = There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
  • Category X = Studies in animals or humans have demonstrated fetal abnormalities, so the risks involved clearly outweigh the potential benefits.

83.

In a medical malpractice lawsuit, the plaintiff must prove certain elements of a case. All of the following are elements that must be proven for the plaintiff to win the case except:

  • Physical harm occurred

  • A duty is owed

  • A duty was breached

  • The breach caused an injury

Correct answer: Physical harm occurred 

Elements of a medical malpractice lawsuit include:

  • A duty is owed (a legal duty exists)
  • The duty was breached (i.e., not following standard of care)
  • The breach caused an injury (proximate cause)
  • Damage occurred (damage can be from physical harm, but can also be from emotional/mental harm, etc.)

84.

A 67-year-old woman complains of the gradual onset of paresthesia in her feet and hands that is slowly getting more severe. She has pallor, pale conjunctiva, glossitis, and chronic fatigue. Her CBC reveals Hg 10g/dL, hematocrit 34%, and MCV = 104 fL. 

What is the next step in determining this patient's diagnosis?

  • Order vitamin B12 and folate levels

  • Order TIBC, ferritin, serum iron levels

  • Order a peripheral smear

  • Order a Schilling test

Correct answer: Order vitamin B12 and folate levels

This patient has pernicious anemia, a macrocytic anemia. Classic findings include numbness in hands and/or feet, pallor, glossitis (inflammation of the tongue), fatigue, and MCV >100 fL. The initial step is to always check both vitamin B12 and folate levels when evaluating MCV greater than 100 fL (even if the patient is not exhibiting neurological symptoms). A patient can be deficient in both B12 and folate. The hemoglobin and hematocrit will go up with folate supplementation only (even if still deficient in B12). Untreated B12 deficiency anemia results in permanent neurologic sequelae (neuropathy, brain damage). 

TIBC, ferritin, and serum iron levels should be checked with an MCV less than 80. The Schilling test is no longer commonly used but can be included in working up a patient with macrocytic anemia when testing for pernicious anemia. A peripheral smear is also helpful when checking/treating the patient with pernicious anemia.

85.

A score of 5 on the Mini Cognitive Assessment Test (Mini-Cog) is highly suggestive of: 

  • No cognitive deficit 

  • Delirium 

  • Dementia

  • Mild cognitive deficit 

Correct answer: No cognitive deficit 

The "Mini-Cog" Test is a three-minute tool to screen for cognitive impairment in older adults in the primary care setting. It involves a three-item word recall and a clock drawing test. A score of 0 to 2 is suggestive of dementia. A score of 3 to 5 indicates a low likelihood of dementia (5 is the best score, indicative of no cognitive deficit). 

86.

A homeless, drug-addicted female presents to the ED with abdominal pain. She is uninsured. The patient is triaged and treated just as the other patients who have health insurance. 

This is an example of:

  • Justice

  • Dignity

  • Veracity

  • Accountability

Correct answer: Justice 

Justice is defined as the quality of being fair and acting with a lack of bias; the fair and equitable distribution of societal resources. In this instance, although low-income individuals do not pay some types of taxes to the government, they still have equal access to public services that are supported by taxes.

87.

What is the current US Preventive Services Task Force (USPSTF) screening recommendation for breast cancer?

  • Mammogram every two years from age 50 years to age 74 years

  • Mammogram annually from age 40 years to age 74 years

  • Mammogram every two years from age 45 years to age 74 years

  • The USPSTF does not recommend routine screening of women for breast cancer

Correct answer: Mammogram every two years from age 50 years to age 74 years

The USPSTF recommends biennial (every two years) screening mammography for women aged 50-74 years. Women aged 75 years or older should not receive routine screening, and mammography should be individualized to patient situation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. The USPSTF recommends against teaching breast self-examination. 

The American Cancer Society recommends starting routine screening at age 40 years.

88.

If an apical/apex murmur occurs during S1, it is:

  • Mitral regurgitation

  • Mitral stenosis

  • Aortic regurgitation

  • Aortic stenosis

Correct answer: Mitral regurgitation  

In mitral regurgitation, a systolic murmur is heard best at the apex of the heart or the apical area; the murmur occurs during S1 and radiates to the axilla. The sound of the murmur is described as loud blowing and high pitched (using the diaphragm of the stethoscope). 

If an apical/apex murmur occurs during S2, it is mitral stenosis. In aortic stenosis, the systolic murmur radiates to the neck and is best heard at the second ICS at the right side of the sternum. With aortic regurgitation, a diastolic murmur is best heard at the second ICS at the right side of the sternum.

89.

The adult-gerontology primary care nurse practitioner conducts a Folstein mini-mental state exam (MMSE) on a 77-year-old male patient to screen for dementia. The NP gives the patient a piece of blank paper and says, "Take this paper in your right hand, fold it in half, and put it on the floor."

What "activity" of the MMSE is being performed?

  • Language and praxis

  • Attention and calculation

  • Orientation

  • Recall

Correct answer: Language and praxis 

The MMSE is a questionnaire used to evaluate an individual for confusion and dementia; it is the most popular screening test for dementia and the most commonly used test for Alzheimer's disease. The above is an example of a 3-stage command, which is part of the language and praxis component of the MMSE.

Asking the patient to count and/or spell a simple word such as "WORLD" backward is an example of attention and calculation. Asking the patient today's date and current location exhibits orientation, while asking the patient to repeat three unrelated words that you said earlier in the conversation is an example of recall.

90.

A facility that consists of homelike dwellings that accommodate from 8 to 10 older adult residents is known as a:

  • Green house

  • Group home

  • Subsidized senior housing

  • Skilled nursing facility

Correct answer: Green house 

Green houses consist of homelike dwellings that accommodate from 8 to 10 older adult residents. The Green House Model was created by geriatric specialist Dr. William Thomas in 2004 and is an "alternative to traditional long-term care facilities."

91.

All of the following statements are accurate regarding physical and emotional changes in the adolescent except:

  • Suicide is the most common cause of mortality among adolescents in the United States.

  • Adolescents begin thinking in more abstract ways.

  • It is common at this stage to see the adolescent begin to psychologically separate from their parent(s).

  • Privacy is very important to the adolescent and should be respected.

Correct answer: Suicide is the most common cause of mortality among adolescents in the United States.

According to the CDC, suicide is the second most common cause of mortality among adolescents in the United States. The number one cause of mortality in this age group is motor vehicle crashes.

The other answer choices are correct statements in regards to adolescents.

92.

Puberty is considered to "start" at what Tanner stage?

  • Tanner stage 2 (II)

  • Tanner stage 1 (I)

  • Tanner stage 3 (III)

  • Tanner stage 4 (IV)

Correct answer: Tanner stage 2 (II)

Tanner stage I is prepuberty, while Tanner stage II is when puberty begins. In girls, breast development begins and, in boys, the testes begin to enlarge with increased rugation of the scrotum.

93.

Of the following statements, which is accurate regarding caring for the aging population?

  • Adults aged 85 years or older are the most rapidly growing segment of the elderly age group.

  • Elderly men outnumber elderly women.

  • With increasing age, the need for personal assistance with everyday activities decreases.

  • Stroke is the leading cause of death in the older adult population.

Correct answer: Adults aged 85 years or older are the most rapidly growing segment of the elderly age group.

Health care for the aging population accounts for one-third of physician resources and one-quarter of medication use in the United States. The "oldest-old" age group (aged 85 and older) is projected to increase by 2030 to 9.6 million as more people live longer. Heart disease is the leading cause of death, and stroke is the fifth leading cause, according to the CDC. Elderly women outnumber elderly men and are much more likely than men to live alone. As people age, the need for personal assistance with everyday activities increases.

94.

Which cranial nerve is responsible for the gag reflex?

  • CN X (vagus)

  • CN VII (facial)

  • CN XII (hypoglossal)

  • CN XI (spinal accessory)

Correct answer: CN X (vagus)

Cranial nerve X is the vagus nerve. The pharyngeal reflex, or gag reflex, is a reflex contraction of the back of the throat, elicited by touching the roof of the mouth, the back of the tongue, the area around the tonsils, the uvula, and the back of the throat. It, along with other aerodigestive reflexes such as reflexive pharyngeal swallowing, prevents objects in the oral cavity from entering the throat except as part of normal swallowing and helps prevent choking.

95.

What is the youngest age that a person can receive the influenza vaccine?

  • 6 months

  • At birth

  • 12 months

  • 2 years of age

Correct answer: 6 months 

The youngest age at which the influenza vaccine can be administered is 6 months. A person should receive the influenza vaccine yearly from 6 months of age on.

96.

A twenty-year-old male expresses the desire to marry.

Based on Erik Erikson's Stages of Psychosocial Development, what stage is this patient in?

  • Intimacy vs. Isolation

  • Love and Belonging

  • Generativity vs. Stagnation

  • Ego Integrity vs. Despair

Correct answer: Intimacy vs. Isolation

Erik Erikson's Stages of Psychosocial Development summarizes a total of eight stages. Three of these stages apply to adults ages 18 and above: Intimacy vs. Isolation, Generativity vs. Stagnation and Ego Integrity vs. Despair. Intimacy vs. Isolation describes expected development in which relationships and friendships, including marriage, are important. Love and Belonging is one of the stages in Abraham Maslow's Hierarchy of Needs.  

97.

The leadership style that best describes the leader as flexible and adjusting to fit the changing needs of an organization is:

  • Situational leadership

  • Democratic leadership

  • Servant leadership

  • Transformational leadership

Correct answer: Situational leadership 

This type of leadership style was developed and studied by Ken Blanchard and Paul Hersey, and refers to when the leader or manager of an organization must adjust their style to fit the development level of the followers they are trying to influence. This type of leader can establish rapport easily and bring out the best in people. The result is that staff members are engaged with the goals of the organization and are more productive.

98.

Of the following, which model recognizes that care is influenced by many cultural features, all of which shape one's worldview?

  • The Sunrise Model

  • Culturally Competent Model of Care

  • Purnell's Model for Cultural Competence

  • The Equality Health Cultural Care Model

Correct answer: The Sunrise Model 

Madeleine Leininger is known as the founder of transcultural nursing and credited with the construct of "culturally congruent care." Leininger's Sunrise model is likely the most frequently used to frame culturally competent nursing care and research. The Sunrise model recognizes that care is influenced by a variety of cultural features: technology, religiosity, spirituality, kinship and social structures, cultural values and beliefs and practices, legal and political systems, economics, and education, all of which shape one's worldview.

99.

Which of the following individuals is least likely to have an alcohol abuse problem?

  • A construction worker who drinks two bottles of beer when playing pool with his friends

  • A college student who drinks a glass of wine in the morning after waking to avoid feeling shaky

  • A nurse who drinks on the weekends when she is off but feels she should be drinking less

  • A wife who gets annoyed when her husband tries to talk with her about her drinking habit

Correct answer: A construction worker who drinks two bottles of beer when playing pool with his friends

Of the answer choices, the construction worker is least likely to have an alcohol abuse problem, as there is a lack of risk factors, and there is no description of any negative effects on the construction worker's daily functioning, social environment, or mental state. 

The CAGE test is a quick screening test for identification of alcohol abuse:

  • C: Do you feel the need to cut down?
  • A: Are you annoyed when your spouse/friend comments about your drinking?
  • G: Do you feel guilty about your drinking?
  • E: Do you need to drink early in the morning?

Alcohol limits for women are one drink/day and for men, two drinks/day.

100.

Diphenhydramine (Benadryl) should be avoided in the elderly because of its potential to cause:

  • Sedation

  • Delirium

  • Hallucinations

  • Hypotension

Correct answer: Sedation

The Beers Criteria provides guidance and rationale for certain medications to avoid in persons over 65 years old. Diphenhydramine, doxylamine and chlorpheniramine are examples of antihistamines that should not be used due to their sedating effects that can cause dizziness and increase the risk of falls. One of the recommended alternatives is Claritin (loratadine).

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