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Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 9 of 25

161.

The medical term for "canker sore" is:

  • Aphthous stomatitis

  • Vermillion border

  • Sialadenitis

  • Sialadenosis

Correct answer: Aphthous stomatitis 

Aphthous stomatitis is the medical term for canker sore, which is characterized as a painful shallow ulcer on the soft tissue of the mouth that usually heals within 7 to 10 days. The patient who presents with this condition should be prescribed "magic mouthwash," a combination of liquid diphenhydramine, viscous lidocaine, and a glucocorticosteroid, and advised to swish, hold, and spit every four hours as needed until resolved.

Vermillion border is the edges of the lips. Sialadenitis and sialadenosis are terms used to describe an infection of a salivary gland.

162.

What is the ideal therapy used to prolong life in patients with chronic obstructive pulmonary disease (COPD)?

  • Continuous oxygen use

  • Short-acting beta-agonists (SABAs)

  • Nocturnal oxygen use

  • Smoking cessation

Correct answer: Continuous oxygen use

Though SABAs, anticholinergics, corticosteroids, and smoking cessation are all treatment options to help with symptoms and management of COPD, continuous oxygen is used to support improvement over nighttime-only oxygen use.

163.

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 most likely diagnosis?

  • Shingles infection of the trigeminal nerve

  • Sjogren's syndrome

  • Anterior uveitis

  • Bacterial conjunctivitis

Correct answer: Shingles infection of the trigeminal nerve 

This is a sight-threatening condition (can result in corneal blindness) caused by the reactivation of the varicella zoster virus (VZV) that remained dormant in the trigeminal nerve root ganglion (CN V) following exposure or clinical manifestation of chickenpox. It can also be referred to as herpes zoster ophthalmicus. This is more common in elderly patients or in patients who are immunosuppressed. Patients report sudden eruption of multiple vesicular lesions (ruptures into shallow ulcers with crusts) that are located on one side of the scalp, forehead, and the sides and tip of the nose. The eyelid on the same side is swollen and red. Common complaints include photophobia, eye pain, and blurred vision. 

Sjogren's syndrome is a chronic autoimmune disorder characterized by decreased function of the lacrimal and salivary glands; complaints of chronic "dry eyes" and that both eyes have a sandy or gritty sensation are common. Anterior uveitis presents with eye pain with conjunctival redness (between the cornea and sclera) that is a complication of autoimmune disorders. Bacterial conjunctivitis presents with mucopurulent drainage caused by a bacteria that results in red, itchy, and painful eye(s).

164.

What is the most appropriate approach in treating a patient with cold symptoms who reports smoking a pack of cigarettes a day?

  • Advise the patient to stop smoking

  • Prescribe nicotine patches or gum

  • Raise the issue of smoking at the next visit once the cold has resolved

  • Prescribe bupropion (Zyban)

Correct answer: Advise the patient to stop smoking 

Tobacco use is the most common cause of preventable death. Smoking cessation should be discussed at every visit with patients who are smokers.

Nicotine gum and Zyban are options for smoking cessation if the patient is interested, but the nurse practitioner must first assess the patient's readiness to quit and provide patient education and behavioral counseling.

165.

The ability of a screening test to correctly identify a person with a disease is referred to as:

  • Sensitivity

  • Specificity

  • Morbidity

  • Mortality

Correct answer: Sensitivity 

Sensitivity refers to the ability of a screening test to correctly identify a person with the disease.

Specificity refers to the ability of a screening test to correctly identify a person without disease (a healthy individual). Morbidity refers to an illness or any departure from physical and/or mental health, and mortality indicates death.

166.

Which of the following findings on a thyroid scan may indicate thyroid cancer?

  • Cold spot

  • Hot spot

  • Complex cyst

  • Simple cyst

Correct answer: Cold spot 

A thyroid scan shows metabolic activity of the thyroid gland. Cancer is characterized as a single painless nodule that is firm, fixed, or irregular. Risk factors include being male, and a history of neck irradiation in childhood. A cold spot on the thyroid scan means that area of the scan (or thyroid) is not metabolically active. It is a worrisome finding, indicative of cancer, and follow-up of a fine needle aspiration biopsy is indicated to rule out cancer. 

A hot spot is a metabolically active nodule with homogenous uptake and usually a benign finding.

167.

Carpal tunnel syndrome (CTS) is caused by compression of which of the following nerves?

  • Median nerve

  • Ulnar nerve

  • Radial nerve

  • Palmar digital nerve

Correct answer: Median nerve 

Carpal tunnel syndrome is commonly caused by activities that require repetitive wrist/hand motion. Compression of the median nerve occurs from swelling of the carpal tunnel. Hypothyroidism, pregnancy, and obesity also increase the risk of CTS. Characteristic symptoms include burning, tingling, and numbness in the thumb, index finger, and middle finger areas. Phalen's sign is a diagnostic test for this condition and is performed by engaging in full flexion of the wrist for one full minute. A positive finding is tingling of the median nerve over the hand evoked by passive flexion of the wrist.

168.

Which of the following statements is accurate of experimental studies?

  • They use randomization with subject selection.

  • They search for relationships between a minimum of two variables.

  • Recruitment of subjects is by convenience sample.

  • Researchers observe and collect pertinent information but do not manipulate or change the environment.

Correct answer: They use randomization with subject selection.

An important criterion of an experimental study is the use of random sampling and random assignment of research subjects. There is at least one control group and at least one intervention or treatment group (manipulation). 

Correlational studies search for relationships between a minimum of two variables. A quasi-experimental study recruits subjects by convenience sample (there is no randomization of the research subjects). In descriptive studies, researchers observe and collect pertinent information but do not manipulate or change the environment (also known as observational studies).

169.

Which of the following is a strength of phenomenological research?

  • The results emerge from the data

  • It depends on the subject's communication skills

  • Researchers have very good interpretation skills

  • The subjects do not need to be articulate

Correct answer: The results emerge from the data

Phenomenological research is a type of qualitative research. Qualitative research looks in-depth at non-numerical data. Phenomenological research involves trying to understand the essence of a phenomenon by examining the views of individuals who have experienced that specific phenomenon. Data is most commonly gathered via long, in-depth interviews with subjects. After the researcher is done with the interviews, they will go through and search for patterns. This type of research provides a rich and detailed description of the human experience, and the results emerge from the data, instead of being imposed by a structured statistical analysis. 

Limitations include subjects who may not be articulate about their experiences or have poor communication skills. Another weakness is that this type of research requires a researcher's interpretation.

170.

Delirium is a common disorder in geriatrics. All of the following are typical manifestations of this condition except:

  • There is a loss of learned cognitive and physical/motor skills

  • It is a reversible process

  • It has an acute onset

  • It is often caused by prescription medications and/or polypharmacy

Correct answer: There is a loss of learned cognitive and physical/motor skills 

Delirium is a reversible, temporary process often associated with prescription medications (i.e., opioids, sedatives, hypnotics, antipsychotics, polypharmacy), substance abuse, drug-drug interactions, medical conditions, infections, and even electrolyte imbalances, heart failure or renal failure. This process generally comes on suddenly, and management involves treating the underlying condition (illness, infection, or metabolic derangement), and delirium will resolve. 

Most patients with delirium have associated cognitive deficits but, once treated, these deficits resolve. Dementia, an irreversible brain disorder, involves the loss of learned cognitive and physical/motor skills.

171.

Which of the following is not considered an activity of daily living (ADL)?

  • Clothing shopping

  • Bowel and bladder management

  • Preparing meals and self-feeding

  • Brushing teeth

Correct answer: Clothing shopping 

ADL are self-care activities that are necessary for "independent" living depending on the person's environment and include eating, personal hygiene, ambulation, and bowel and bladder management.

Clothing and grocery shopping are IADLs (instrumental or sometimes referred to as intermediate activities of daily living) and are associated with the use of "instruments" or finance.

172.

Which of the following best describes Leininger's Sunrise Model?

  • Philosophy that health care is influenced by various factors and supports culturally competent nursing

  • Support for military veterans with PTSD

  • Ensures the rights of human subjects during research

  • Provides cost-effective education and resources for the LGBTQIA+ community

Correct answer: Philosophy that health care is influenced by various factors and supports culturally competent nursing

Leininger's Theory of Culture Care Diversity and Universality was founded by Madeline Leininger. The theory encompasses a definition of culture and the "sunrise model", which is used to support culturally competent nursing.

The Institutional Review Boards (IRBs) ensure the rights of human subjects during research. The veterans administration supports military veterans with PTSD and the National LGBTQIA+ Health Education Center provides education and resources toward increasing cost-effective health care for the LGBTQIA community.

173.

The nurse practitioner must document that three components have been met in order to bill for patient visits using E&M (evaluation and management) codes. All of the following components must be documented except:

  • Provided follow-up care

  • Patient history

  • Patient examination

  • Complexity of medical decision making

Correct answer: Provided follow-up care 

E&M codes are used to bill for patient visits. If a bill is missing this code, the health care provider will not be reimbursed for the time they spent with the patient. E&M codes are based on the history, examination, and medical decision-making (complexity) that takes place. The provider must document that these three components have been met (or exceeded). The complexity and time spent with the patient are assigned codes by the CPT system. 

174.

Which of the following hematological changes occurs as a result of aging?

  • There is an increase in platelet responsiveness

  • The lifespan of the RBC shortens

  • There is a decrease in the total number of circulating leukocytes

  • The GI tract absorbs vitamin B12 and folate more quickly

Correct answer: There is an increase in platelet responsiveness 

There are no changes in the RBC lifespan, the blood volume, or the total number of circulating leukocytes. There is a higher risk of thrombi and emboli due to increased platelet responsiveness, and a higher risk of iron and folate-deficiency anemia due to decreased efficiency of the GI tract to absorb vitamin B12 and folate.

175.

When performing the MMSE (mini-mental state exam) on an elderly patient for suspected dementia, the nurse practitioner asks the patient to explain the meaning of the proverb "Beauty is in the eye of the beholder."

In doing this, what is the NP assessing?

  • The patient's abstract thinking

  • The patient's orientation

  • The patient's short-term memory

  • The patient's recall

Correct answer: The patient's abstract thinking 

When asking about proverbs, the nurse practitioner is assessing the patient's ability to understand abstract concepts. The MMSE is a screening tool to test cognitive performance to more accurately identify confusion, dementia, mental illness, and Alzheimer's.

176.

What is the gold-standard test for assessing any type of joint damage?

  • MRI

  • X-ray

  • CT with contrast

  • CT without contrast

Correct answer: MRI

The best imaging test for cartilage, meniscus, or tendon damage is the MRI. A plain x-ray will show bony changes or narrowing of joint space (indicative of osteoarthritis), but not soft tissue. A CT will show more detail of other structures in order to rule them out if necessary, but the gold-standard test is the MRI.

177.

A 16-year-old male reports the sudden onset of severe testicular pain with a severely swollen red scrotum, with complaints of nausea and vomiting. Upon assessment, the affected (left side) testicle is higher than the right, and the cremasteric reflex is absent. 

What is the most likely diagnosis?

  • Testicular torsion

  • Acute bacterial epididymitis

  • Acute prostatitis

  • Peyronie's disease

Correct answer: Testicular torsion 

This is a classic example of testicular torsion, which is considered a medical emergency. This occurs when the spermatic cord (from which the testicle is suspended) twists, cutting off the testicle's blood supply. The principal symptom is testicular pain. The preferred test for diagnosis is the Doppler ultrasound with color flow study. Permanent testicular damage results if not correct within the first six hours. Treatment can be either manual reduction or surgery with testicular fixation using sutures.

178.

When an adolescent male's penis grows more in length than width, at which of the following Tanner stages is he classified?

  • Tanner Stage 3 (III)

  • Tanner Stage 2 (II)

  • Tanner Stage 4 (IV) 

  • Tanner Stage 5 (V)

Correct answer: Tanner Stage 3 (III)

Tanner Stages for Boys

Stage I: Prepubertal pattern

Stage II: Testes and scrotum start to enlarge (scrotal skin starts to get darker/more rugae)

Stage III: Penis grows longer (length) and testes/scrotum continues to become larger

Stage IV: Penis becomes wider and continues growing in length (testes are larger with darker scrotal skin and more rugae)

Stage V: Adult pattern

179.

The adult-gerontology nurse practitioner is assessing a 62-year-old woman's breasts during an annual gynecological exam. There is a scaly, red-colored rash resembling eczema on the right nipple that extends to the areolar skin. The patient reports itching in the area and that the rash has been there for several months. The patient was prescribed a steroid cream by her dermatologist, but it has not seemed to help much. The nurse practitioner suspects Paget's disease.

Based on this diagnosis, which is the best treatment plan for the patient?

  • Order a mammogram and refer patient to a breast surgeon

  • Prescribe a more potent steroid cream and schedule her for follow-up in one month

  • Order fine-needle biopsy of the breast

  • Advise the patient to stop using harsh soaps and/or chemicals on her breasts

Correct answer: Order a mammogram and refer patient to a breast surgeon 

A scaly, reddened rash on the breast that does not resolve after a few weeks of medical treatment may indicate breast cancer. The patient needs a mammogram and a referral to a breast surgeon for evaluation and treatment. Paget's disease of the breast, also known as ductal carcinoma in situ, is a rare type of cancer of the nipple-areola complex that begins as a rash that resembles eczema and slowly enlarges, evolving to include crusting, ulceration, and/or bleeding of the nipple. It is often initially misdiagnosed because its early symptoms are similar to those caused by some benign skin conditions.

180.

Which of the following foods are known to have high magnesium content?

  • Spinach, whole grains, and pumpkin seeds

  • Potatoes, apricots, and brussels sprouts

  • Aged cheese, red wine, and chocolate

  • Citrus fruit, black beans, and red meat 

Correct answer: Spinach, whole grains, and pumpkin seeds

Magnesium is an abundant mineral in the body and is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation. Green leafy vegetables, legumes, nuts, seeds, and whole grains are all good sources of magnesium. 

Potatoes, apricots, brussels sprouts, and citrus fruits are good sources of potassium. 

Aged cheese, red wine, and chocolate have a high tyramine content and should be enjoyed in moderation as they can increase blood pressure and lead to migraine headaches.

Black beans and red meat are high in iron content.

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