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Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 6 of 25

101.

Glucosamine has been found to be a useful supplement in the treatment of which of the following conditions?

  • Arthritis

  • Migraine headache

  • Diabetes and elevated cholesterol

  • Cancer

Correct answer: Arthritis 

Glucosamine is a sugar naturally produced by the body. It is one of the building blocks of cartilage. Cartilage covers and protects the ends of the bones, allowing them to move smoothly against each other. Glucosamine has been made into a natural supplement that is used for osteoarthritis, as it has been found to have a beneficial effect on cartilage growth and repair, as well as anti-inflammatory properties.

102.

Select the phrase that best indicates that the nurse practitioner is knowledgeable in providing cultural and spiritually competent care.

  • Do you have a religious preference or practice that is important to you?

  • I understand that you practice Hinduism, so you don't eat pork, correct?

  • As a Seventh-Day Adventist, I know you don't drink alcohol or smoke. That's great.

  • I see your religious preference is Buddhist. Let's discuss your vegetarian diet.

Correct answer: Do you have a religious preference or practice that is important to you?

It is important to understand various cultures and religions as a provider of health care. In many cases, people rely on their cultural, spiritual, and religious influences as a part of daily living. A critical part of this knowledge begins with the provider understanding their own thoughts and biases around culture and religion in order to know how it may impact interactions with others. Asking a patient about their cultural or religious preferences or practices allows the patient to offer their interpretation versus using assumption-based questions that may or may not be indicative of the individual. Use of Leininger's Theory on transcultural nursing is a framework supportive of providing "culturally congruent care". 

103.

All of the following statements are accurate of the dawn phenomenon except:

  • It is a rare phenomenon that occurs only in diabetics.

  • It involves an increase in fasting blood glucose early in the morning.

  • It is due to an increase in insulin resistance.

  • It is caused by the physiological spike in growth hormone, glucagon, epinephrine, and cortisol.

Correct answer: It is a rare phenomenon that occurs only in diabetics.

All individuals have the "dawn phenomenon," whether they have diabetes or not; it is a normal physiological event. It is characterized by an elevation in the fasting blood glucose that occurs daily early in the morning. This is due to an increase in insulin resistance between 4:00 and 8:00 am caused by the physiological surge of growth hormone, glucagon, epinephrine, and cortisol. 

Diabetics do not have normal insulin responses to adjust for the dawn phenomenon and may see their fasting glucose rise. The rise in glucose is mostly because the body is making less insulin and more glucagon (beta cells in the pancreas) than it needs. The less insulin made by the pancreas, the more glucagon the pancreas makes as a result. Glucagon signals the liver to break down glycogen into glucose; this is why high fasting blood glucose levels are common in people with type 2 DM.

104.

What is the youngest age at which the influenza vaccine can be administered (injection)?

  • 6 months

  • Birth

  • 1 year

  • 3 months 

Correct answer: 6 months

The seasonal influenza vaccine should be given starting at the age of 6 months. Start giving the influenza injection at the end of October each year (fall to winter season), as it takes two weeks after the shot for an individual to develop antibodies. As long as influenza viruses circulate, vaccination should continue to be offered, even into January or later. Most seasons, influenza activity peaks in January or later.

105.

A 14-year old male athlete undergoing a rapid growth spurt complains of a tender bony mass over the anterior tubercle of the left knee. The pain is worsened when he jumps, squats, kneels, and climbs stairs, and improves with rest and avoiding aggravating activities.

What is the most likely diagnosis?

  • Osgood-Schlatter disease

  • Stress fracture

  • Patellar tendinitis

  • Osteochondritis dissecans (OCD)

Correct answer: Osgood-Schlatter disease 

This is a classic presentation of Osgood-Schlatter disease. It is a common cause of knee pain in young athletes caused by overuse of the knee. Repetitive stress on the patellar tendon by the quadriceps muscle causes pain, tenderness, and swelling at the tendon's insertion side (the tibial tuberosity). It usually affects only one knee, but can be bilateral, and is most common during rapid growth spurts in teenage males who are physically active. The condition resolves when growth stops. Treatment involves following RICE (rest, ice, compress, elevate) and Tylenol or NSAIDs for pain as needed. Rule out fracture if there is acute onset of pain posttrauma.

106.

What is a potential drug interaction that exists between potassium and angiotensin-converting enzyme inhibitors (ACEIs)?

  • Hyperkalemia

  • Bradycardia

  • Hypotension

  • Gynecomastia

Correct answer: Hyperkalemia

There are numerous interactions possible when combining different drugs. For example, an ACEI and potassium, when taken together, may result in hyperkalemia. Thus, the nurse practitioner must be very careful when prescribing multiple drugs to patients.

107.

In which Kubler-Ross stage of dying does the dying person recognize that denial can no longer be maintained?

  • Anger stage

  • Bargaining stage

  • Depression stage

  • Acceptance stage

Correct answer: Anger stage

The anger stage is the second stage of grief and dying, according to Kubler-Ross. Once the dying person accepts that the diagnosis is correct, they may become very angry. Feelings of rage or resentment may overcome the person, and the anger may be directed at others as well. The person may ask, "Why me?" The identification of this stage has aided the care of dying patients, as Kubler-Ross recommended that doctors and loved ones should not respond to the anger of the dying person with avoidance or returned anger, but instead through support.

108.

Of the following drugs, which should be avoided in the third trimester of pregnancy, from week 30 of gestation until delivery?

  • Naproxen sodium (Aleve)

  • Acetaminophen (Tylenol)

  • Saline nasal drops

  • Colace

Correct answer: Naproxen sodium (Aleve) 

Aleve is an NSAID and should be avoided during the last three months of pregnancy. NSAIDs inhibit prostaglandin synthesis and may cause premature closure of the ductus arteriosus if administered to a woman in her third trimester of pregnancy.

109.

An elderly man who has a diagnosis of chronic obstructive pulmonary disease develops a fever, changes in sputum production, increased wheezing, and dyspnea. What should the nurse practitioner prescribe?

  • An antibiotic

  • A corticosteroid

  • An inhaled bronchodilator

  • Supplemental oxygen therapy

Correct answer: An antibiotic 

Patients with COPD are at higher risk of developing Haemophilus influenzae pneumonia. In the COPD patient with acute onset fever, purulent sputum, increased wheezing, and dyspnea, prescribe an antibiotic. Bactrim DS, doxycycline, or Ceftin BID for 10 days are all treatment options. For severe infection, Augmentin or respiratory quinolones for 3 to 7 days are indicated. 

Often, inhaled bronchodilators, corticosteroids, and supplemental oxygen therapy are all treatments used as maintenance therapy for the patient with COPD.

110.

A 52-year-old woman is told by her nurse practitioner that she is beginning menopause. All of the following are possible findings except:

  • A palpable ovary 

  • Hot flashes 

  • Irregular menstrual periods 

  • Cyclic mood swings 

Correct answer: A palpable ovary 

During menopause, hot flashes, irregular menstrual periods, and cyclic mood swings are common. The ovaries become atrophied; a palpable ovary in a menopausal woman is always abnormal, and the NP should rule out ovarian cancer. Order a pelvic/intravaginal ultrasound and refer to a gynecologist. 

111.

Chronic use of NSAIDs can cause damage to all of the following organ systems except:

  • Musculoskeletal system

  • Renal system

  • Gastrointestinal system 

  • Cardiovascular system

Correct answer: Musculoskeletal system

NSAIDs are indicated in the treatment of muscle and/or joint pain and inflammation. Thus, the musculoskeletal system is not damaged by the use of these drugs. 

NSAIDs can cause damage to the cardiovascular, gastrointestinal, and renal systems if overused.

112.

First-line medication for stable heart failure (HF) is:

  • An angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)

  • A calcium channel blocker (CCB) or thiazides

  • A beta-blocker (BB) plus diuretics

  • An alpha-adrenergic blocker or thiazides

Correct answer: An angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)

For stable HF, an ACEI or ARB is first-line treatment.

Initiation of a BB plus a diuretic and others can be used as needed after starting an ACEI or ARB first. CCBs or thiazides are generally second-line drugs (can start with these only if the patient is African American). Alpha-blockers are not first-line drugs for hypertension unless the patient has a preexisting BPH.

113.

Puberty begins at which of the following Tanner stages?

  • Stage II

  • Stage I

  • Stage III

  • Stage IV

Correct answer: Stage II

The Tanner scale (also known as the Tanner stages) is a scale of physical development in children, adolescents, and adults. The scale defines physical measurements of development based on external primary and secondary sex characteristics (size of the breasts, genitals, testicular volume, and pubic hair development). Tanner stage I is considered prepuberty, while Tanner stage II is characterized by the onset of puberty (testes begin to enlarge in boys, and breasts begin to develop in girls).

114.

All of the following are symptoms of Bell's palsy except:

  • Bilateral facial paralysis

  • Difficulty chewing

  • Dysphagia

  • Inability to fully close eyelid(s)

Correct answer: Bilateral facial paralysis 

Bell's palsy is a condition that causes temporary weakness or paralysis of the muscles in the face. It can occur when the nerve that controls the facial muscles (CN VII) becomes inflamed, swollen, or compressed. The condition causes a unilateral (one side only) paralysis in which the affected side droops or becomes stiff. Skin sensation remains intact, but tear production on the affected side may cease. In addition, it may be difficult to chew or swallow food on the same side, and the patient may be unable to fully close the eyelid(s). Most cases resolve spontaneously. Although it can occur at any age, the condition is more common among people between the ages of 16 and 60.

115.

All of the following ethnic groups have a high prevalence of stroke except:

  • Asian Americans

  • African Americans

  • Hispanic Americans

  • Native Americans/Alaskan Natives

Correct answer: Asian Americans 

A stroke can be caused by either a blocked blood vessel or bleeding in the brain, leading to permanent neurological damage as a result of ischemia to the affected brain tissues. The most common risk factors for stroke are hypertension and atrial fibrillation. People of African American descent, Hispanic descent, and Native American/Alaskan Native descent have a high prevalence of stroke.

116.

All of the following diagnoses should be considered in the older patient who presents with unexplained bruises and petechiae except:

  • Malnutrition

  • Idiopathic thrombocytopenic purpura (ITP)

  • Elder abuse

  • Anticoagulant use

Correct answer: Malnutrition

With the older patient that is experiencing unexplained bruising and petechiae, the nurse practitioner should consider ITP, anticoagulant use, and/or elder abuse and create a plan of care accordingly.

117.

All of the following examples demonstrate compliance with the Health Insurance Portability and Accountability Act (HIPAA) except:

  • The NP calls the patient and leaves a detailed message on voicemail regarding the patient's lab results

  • A staff member not involved in the patient's care calls the attending NP and wants to discuss the patient's progress. The NP does not release information to the staff member.

  • The sign-in sheet at the receptionist's desk is covered so that new patients entering can only see a blank line for them to fill in their name

  • Putting a patient's chart on the patient's door box but turning it backward 

Correct answer: The NP calls the patient and leaves a detailed message on the voicemail regarding the patient's lab results 

Regarding leaving laboratory results on voicemail, it is a HIPAA violation unless the patient has given specific consent such as, "you can leave the lab results on my voicemail at the following phone number(s)." If not, then call with your name and contact information only, requesting a return call.

The other answer choices are examples of HIPAA compliance.

118.

Which of the following findings is of highest priority when assessing a 60-year-old female during an annual examination?

  • A palpable ovary

  • Vaginal rugae atrophy

  • Vaginal dryness

  • Cystocele present

Correct answer: A palpable ovary 

A palpable ovary is an abnormal finding in the adult female who has undergone menopause and would indicate the need for further testing; an intravaginal ultrasound should be ordered. This finding could indicate ovarian cancer. 

Vaginal rugae atrophy, vaginal dryness, and cystocele are all normal changes that may occur with menopause and would not be a major cause of concern. Topical estrogen vaginal cream may be prescribed if needed.

119.

Which heart sound is associated with heart failure (CHF)?

  • S3

  • S4

  • Split S1

  • S2

Correct answer: S3

The S3 heart sound is associated with a failing heart; it is heard on early diastole and is sometimes mistaken as a split S1. This is a pathognomonic sign and is a very good and specific indicator of heart failure. It is important to note, however, that S3 in healthy pregnant women may appear in the 3rd trimester due to high cardiac output (physiologic finding). 

S4 is indicative of left ventricular hypertrophy (LVH) but can be considered a normal finding in some elderly due to the slight stiffness of the left ventricle. All benign murmurs occur during systole (S2). 

120.

Which of the following hemoglobin A1C levels indicates prediabetes?

  • 5.7%

  • 6.5%

  • 7.2%

  • 5.2%

Correct answer: 5.7%

Prediabetes is characterized by a glycosylated hemoglobin (A1C) between 5.7% and 6.4%, fasting glucose of 100 to 125 mg/dL, or a two-hour oral glucose tolerance test (OGTT) of 140 to 199 mg/dL.

Diagnostic criteria for Type 2 diabetes mellitus is an A1C equal to or greater than 6.5%, fasting glucose equal to or greater than 126 mg/dL, symptoms of hyperglycemia plus random blood glucose equal to or greater than 200 mg/dL, or two-hour plasma glucose greater than or equal to 200 mg/dL during an OGTT with a 75-g glucose load.

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