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Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 7 of 25

121.

Which of the following is not considered an ethical concept?

  • Advocacy

  • Beneficence 

  • Justice 

  • Nonmaleficence

Correct answer: Advocacy 

Beneficence (the obligation to help and promote good), justice (the quality of being fair and lacking bias), and nonmaleficence (the obligation to avoid harm) are all ethical concepts.

Although advocacy is an important aspect of the nurse practitioner's role, it is not one of the ethical concepts.

122.

In the patient with thyroid disease, the goal is a TSH level of less than:

  • 5.0 mU/L

  • 6.0 mU/L

  • 4.0 mU/L

  • 3.0 mU/L

Correct answer: 5.0 mU/L

Normal TSH (thyroid-stimulating hormone) levels range from 0.5 to 5.0 mU/L. In the patient with thyroid disease, the goal is a TSH of less than 5.0 mU/L. TSH should be checked every 6 to 8 weeks when monitoring the patient's response to treatment (levothyroxine). Once TSH is stable, rechecking is necessary only every 6 to 12 months, as the patient is at the right dose of levothyroxine (Synthroid).

123.

The most common risk factor for cancer is:

  • Aging and advancing age

  • Familial genetics

  • Tobacco

  • Hormonal influences

Correct answer: Aging and advancing age 

Growing older is the most common risk factor for cancer. Up to 60% of newly diagnosed adult malignancies occur in older adults (age 65 years or older).

Other common risk factors for cancer include tobacco, sun exposure, radiation exposure, chemicals and other substances, some viruses and bacteria, hormonal influences, family history, alcohol consumption, poor diet, sedentary lifestyle, and being overweight.

124.

Which of the following medications is indicated for the treatment of obsessive-compulsive disorder (OCD)?

  • Paroxetine (Paxil)

  • Duloxetine (Cymbalta)

  • Diazepam (Valium)

  • Olanzapine (Zyprexa)

Correct answer: Paroxetine (Paxil) 

First-line treatment for OCD is selective serotonin reuptake inhibitors (SSRIs); Paxil is in this drug class and is a common antidepressant used to treat OCD and major depression. Paxil should not be discontinued abruptly, but rather the patient should be gradually weaned. 

Cymbalta is an SNRI, indicated for both depression and neuropathic pain. Valium is a benzodiazepine and is used only for severe alcohol withdrawal and seizures. Zyprexa is an atypical antipsychotic and treats schizophrenia, psychotic disorders, and bipolar disorder.

125.

An English-speaking nurse practitioner encounters a patient whose first language is not English.

Select the option the provider should use to communicate with the patient:

  • Utilize a professional language interpretation service

  • Ask a fluent English-speaking family member to provide interpretation

  • Find an employee in the clinic who speaks the patients language to provide interpretation

  • Refer the patient to an appropriate provider who can speak the patient's language fluently

Correct answer: Utilize a professional language interpretation service

The most appropriate and best practice action is to utilize a professional language interpretation service for translation during patient visits. In general, a vetted and certified medical interpreter is appropriate due to the importance of a patient understanding medical information in their preferred language in order to participate in their plan of care and make appropriate medical decisions.

Utilizing a family member or a non-certified person can present challenges with appropriate and full interpretation of medical terminology and, in some cases, can be a breach of HIPAA. There is no need to refer a patient to another provider due to language, as interpretive services can be accessed via virtual, telephone, or face to face.

126.

This type of murmur is best auscultated at the apex of the heart and radiates to the axilla:

  • Mitral regurgitation 

  • Mitral stenosis 

  • Aortic regurgitation 

  • Aortic stenosis 

Correct answer: Mitral regurgitation 

Mitral regurgitation (a pansystolic murmur) is heard best at the apex of the heart or the apical area and radiates to the axilla. It is a loud blowing and high-pitched murmur and is best heard using the diaphragm of the stethoscope.

127.

Percussion over the liver and spleen produces which of the following sounds?

  • Dullness

  • Tympany

  • Resonance

  • Hollowness

Correct answer: Dullness 

Percussion over the liver and spleen produces a dull sound (due to the density of these organs).

Tympany is heard when there is air in underlying structures that are percussed (intestines, stomach, etc.). Resonance and hollowness indicate a need for further assessment and would be a cause of concern.

128.

Which of the following statements is true of depression?

  • Patients starting to recover from depression may commit suicide.

  • Frail elderly are at higher risk of death from SSRIs.

  • Antipsychotics may cause suicidal ideation and/or suicidal plans in patients younger than 24 years of age.

  • Females make more attempts to commit suicide and have a higher success rate than males.

Correct answer: Patients starting to recover from depression may commit suicide.

Due to an increase in psychic energy, patients starting to recover from depression may commit suicide. This patient population should be monitored closely.

Frail elderly are at higher risk of death from antipsychotics, while SSRIs may cause suicidal ideation and/or suicidal plans in patients younger than 24 years of age. While it is true that females make more attempts to commit suicide than males, males have a higher success rate.

129.

Identify the complication most likely associated with anorexia nervosa.

  •  Osteopenia 

  •  Poor exercise habits

  • Confidence in appearance

  • Obesity with BMI over 31 

Correct answer: Osteopenia 

Osteopenia is a common complication in patients with anorexia nervosa. This is due to estrogen depletion caused from amenorrhea associated with this disease.

Obesity is not a complication as a low BMI (under 18.5) is usually evident due to chronic weight loss. Poor exercise habits and confidence in appearance are not complications. In fact, complications usually include excessive exercise and a distorted view of their body image.

130.

Which type of non-Alzheimer's dementia is most often associated with sleep disturbances, visual hallucinations, short-term memory loss, fluctuations in alertness and cognition, muscle rigidity, and tremors?

  • Dementia with Lewy bodies (DLB)

  • Wernicke-Korsakoff dementia

  • Parkinson's disease

  • Frontotemporal dementia (Pick's disease)

Correct answer: Dementia with Lewy bodies (DLB) 

DLB most often causes sleep disturbance, visual hallucinations, executive function impairment, plus parkinsonism features (muscle rigidity, tremors) with fluctuations in alertness and cognition.

Frontotemporal dementia may cause marked changes in personality and social withdrawal and is characterized by difficulty using and understanding language. Parkinson's disease may involve impaired decision-making and difficulty concentrating, learning new information, understanding complex language, as well as inflexibility and short- or long-term memory loss. Wernicke-Korsakoff dementia (Wernicke's encephalopathy) is due to chronic thiamine deficiency due to chronic alcohol abuse that leads to brain damage. It is characterized by confusion, disorientation, indifference, and horizontal movement nystagmus (both eyes).

131.

In the United States, sickle cell anemia is most commonly seen in which of the following groups of people?

  • African Americans

  • European Americans

  • Hispanic Americans

  • Asian Americans

Correct answer: African Americans

Sickle cell anemia is a genetic hemolytic anemia (autosomal recessive). Almost one out of every 500 African Americans in the United States has this disease, and more than 2 million carry the trait. There is a higher prevalence in people from Africa, the Mediterranean, the Middle East, and some areas of India.

132.

The nurse practitioner is seeing a patient who believes his illness is directly related to an unhealthy balance in various aspects of his life, and that folk medicine can cure illness. When creating a plan of care for this patient, what is the most appropriate action the nurse practitioner should implement?

  • Discuss the patient's remedies and include them in the plan of care

  • Encourage evidence-based treatment measures

  • Refer the patient to a doctor of natural medicine (DNM)

  • Educate the patient about the importance of including scientifically proven treatment into the plan of care

Correct answer: Discuss the patient's remedies and include them in the plan of care 

Each person interprets and implements their cultural and religious beliefs and practices uniquely; therefore, the nurse practitioner should make no assumptions and assess as needed before creating a plan of care and implementing it.

133.

Admission criteria for hospice includes all of the following except:

  • Physician certifies that the patient has a life expectancy of less than 12 months

  • Physician must write an order for hospice care

  • Patient must give consent to be admitted to a hospice program

  • Patient must agree not to use life-sustaining equipment during the hospice time period

Correct answer: Physician certifies that the patient has a life expectancy of less than 12 months 

Hospice admission criteria:

  • Physician must write an order for hospice care (also must sign death certificate)
  • Physician certifies that a patient has a life expectancy of less than 6 months
  • Patient must give consent to be admitted to hospice
  • Patient must agree not to use life-sustaining equipment if a life-threatening event occurs during the hospice time period

Patients enter hospice care voluntarily and may elect to stop the services at any time. A terminally ill patient who is eligible for hospice admission but who is emotionally not ready for it and refuses hospice (even if the family wants it) does not meet the criteria for hospice admission.

134.

Pinpoint areas of bleeding in the skin when scales from a psoriatic plaque are removed is known as:

  • Auspitz sign

  • Koebner phenomenon

  • Guttate psoriasis

  • Herald patch

Correct answer: Auspitz sign 

The Auspitz sign is characterized as pinpoint bleeding when the outer scales are removed of psoriatic plaques and is a classic finding in psoriasis.

Koebner phenomenon is also associated with psoriasis and is new psoriatic plaques that formed over areas of skin trauma. Guttate psoriasis is a severe form of psoriasis resulting from a beta-hemolytic Streptococcus group A infection (usually due to "strep" throat). A herald patch is a classic finding of pityriasis rosea, a skin condition that may be caused by a viral infection.

135.

An HIV infection is the most powerful risk factor for the development of which of the following diseases?

  • Active tuberculosis

  • Asthma

  • COPD 

  • Chronic bronchitis 

Correct answer: Active tuberculosis 

All HIV-infected individuals should receive TB testing. People living with HIV are 20 to 30 times more likely to develop TB than those without HIV. In addition, persons with HIV infection with CD4 fewer than 500 are at very high risk for active TB disease after initial exposure (primary TB).

136.

A 70-year-old male presents with complaints of right eye pain, blurry vision, and sensitivity to light that began upon waking up this morning. The right eyelid is swollen and erythematous. In addition, the adult-gerontology nurse practitioner notes a crusty, small round rash on the right side of the scalp and forehead that extends to the sides and tip of the nose. 

Based on these findings, what is the priority in initial treatment for this patient?

  • Referral to ophthalmologist or emergency department the same day

  • Prescribe antiviral therapy

  • Prescribe pain medication for pain management

  • Prescribe corticosteroids and topical anesthetics

Correct answer: Referral to ophthalmologist or emergency department the same day

If shingles infection of the trigeminal nerve (herpes zoster ophthalmicus) is suspected, refer the patient to the emergency department or an ophthalmologist STAT. Sequelae include corneal blindness, corneal scarring, and chronic pain. 

Antiviral therapy, pain management (including topical anesthetics), and corticosteroids are all part of the treatment plan, but generally, these will be prescribed by either the ophthalmologist or the ED/PCP.

137.

Which of the following benzodiazepines is long-acting?

  • Clonazepam (Klonopin)

  • Alprazolam (Xanax)

  • Lorazepam (Ativan)

  • Midazolam (Versed) IV

Correct answer: Clonazepam (Klonopin)

Benzodiazepines are a class of drugs that work on the central nervous system, acting selectively on GABA-A receptors. They are similar in pharmacologic action but have different potencies, and some work better in treatment of particular conditions. They are used as sedatives, hypnotics, anxiolytics, anticonvulsants, and muscle relaxants. 

Klonopin is long-acting, while IV Versed is ultra-short acting; Xanax and Ativan are medium-acting benzodiazepines.

138.

A "thumb spica cast" is used to stabilize which type of fracture?

  • Wrist fracture 

  • Radial fracture 

  • Ulnar fracture 

  • Medial tibial stress fracture 

Correct answer: Wrist fracture

The scaphoid bone is located on the radial aspect of the wrist (same side as the thumb). In patients with this type of fracture, a thumb spica cast is used to stabilize and help heal the bone. It is applied below the elbow and extends to the hand. Surgery may be needed because this type of injury tends to have a higher rate of nonunion.

139.

The last stage in Maslow's Hierarchy of Needs is:

  • Self-actualization

  • Self-esteem

  • Love and belonging

  • Safety needs

Correct answer: Self-actualization 

There are five stages in the original model of Abraham Maslow's Hierarchy of Needs. Basic physiological needs are at the bottom, as they first must be met before one can progress to the highest stage (self-actualization). 

  1. Lowest level/basic needs: Physiological/biological needs
  2. Safety needs
  3. Love and belonging
  4. Self-esteem
  5. Self-actualization (highest level/final stage)

140.

The nurse practitioner is seeing a 69-year-old woman who is concerned about urine leakage when she coughs, sneezes, laughs, or exercises. The patient worries that it is interfering with daily activities. The nurse practitioner recommends kegel exercises as an initial intervention.

How frequently should she encourage the patient to perform the kegels?

  • Perform one set of 10 kegels three times a day

  • Perform one set of 20 kegels once a day

  • Perform one set of 30 kegels two times a day

  • Only perform kegels before bedtime, as many as possible

Correct answer: Perform one set of 10 kegels three times a day

Help the patient identify her pelvic floor muscles by explaining they are the muscles used to stop the flow of urine midstream. The patient should be instructed to tighten her pelvic floor muscles for a count of 10, then relax them for a count of 10, and should aim to do this in sets of 10 each time, three times a day.

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