AANP Exam 3| 155 Questions with Answers,100% CORRECT

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AANP Exam 3| 155 Questions with Answers Mens Health Priapism - CORRECT ANSWER painful erection for 204 hours, ischemi form is medical/surgical emergency Testicular cancer - CORRECT ANSWER ha... rd fixed, nodule, heaviness or aching, one testicle larger than other, hydrocele from tumor, painless asymptomatic until Metz, DX gold standard testicular biopsy, US of testes, refer to urology, for surgical removal (orchiectomy) Prostate Cancer - CORRECT ANSWER most common cancer in men, new onset of low back pain, rectal perianal area, obstructive voiding symptoms, weak stream, nocturia, risk factor obese and family history, >50 years old, DX routine screening not recommended Torsion of the appendix testes - CORRECT ANSWER blue dot sign, blue colored round mass located on testicular surface, polyp like structure attached to testicular surface, infarction and necrosis of the appendix due to torsion, refer to ER Testicular torsion - CORRECT ANSWER abrupt onset extremely painful and swollen red scrotum, n/v, affected testes higher and closer to body, the cremasteric reflex is missing, > not corrected in <6 hours permanent damage, if not corrected in 24 hours becomes gangrene, common in males with bell clapper deformity, TX call 911, US doppler preferred test, manual reduction or surgery, elevated PSA, biopsy of prostate tissue, PSA level with DRE TX refer to urologist, individualize screen per risk factors Varicocele - CORRECT ANSWER enlargement of the veins within the scrotum, bag of worms, testicular tumor can cause infertility, DX US of scotum, TX surgical removal or varicosities Hydrocele - CORRECT ANSWER fluid filed sac around testicle, swelling of scrotum, asymptomatic, DX will glow with transillumination, US of scrotum, TX refer to urologist Direct inguinal hernias - CORRECT ANSWER are found in the Hesselbachs triangle indirect inguinal hernia - CORRECT ANSWER are common on the right side internal ring Cryptorchidism - CORRECT ANSWER a testicle that has not moved into the bag of skin below the penis before birth, maybe one or two, increases risk of testicular cancer BPH - CORRECT ANSWER gradual development of urinary obstruction, weak urinary stream, postvoid dribbling, occasional urinary retention, DX PSA is elevated, prostate enlarged, TX alpha adrenergic antagonist-terazosin/Hytrin-first for patients with HTN, Flomax, or Proscar shrinks prostate by 50% Chronic bacterial prostatis - CORRECT ANSWER >6 weeks infection, gradual onset, asymptomatic or UTI,caused by E.coli, suprapubic or perineal pain, irritative voiding, dysuria, nocturia, frequency, DX boggy prostate, urine and prostatic fluid cultures, three tubes, PSA elevated, TX Bactrim, fluoroquinolone Acute prostatis - CORRECT ANSWER infections ascends to urinary tract, E.coli, sudden onset of high fever, chills, suprapubic pain perineal discomfort, radiates to back to rectum, UTI, symptoms, DX DRE reveals tender prostate warm and boggy, CBC shows leukocytosis, pyuria, urine culture, TX Ceftriaxone tetracycline, macrolide, fluoroquinolone, refer if septic shock Acute bacterial epididymitis - CORRECT ANSWER bacteria ascend the urethra, urethritis, reaching epididymitis, rule out testicular torsion, E coli, swollen red scrotum, unilateral testicular tenderness with urethral discharge, hydrocele with symptoms of UTI, fever, green colored purulent or serous clear discharge, Prehn's sign positive with relief of srotal elevation, DX leukocytosis pyuria, hematuria, Urine culture, test for gonorrhea/chlamydia TX ceftriaxone, doxycycline, or fluoroquinolone Erectile dysfunction - CORRECT ANSWER d/t vascular insufficiency, neuropathy, medications, smok,ing alcohol, TX first line TX [hosphodiesterase type 5 inhibitor, Viagra Levitra Peyronie's disease - CORRECT ANSWER inflammatory disorder of the penis with firbrotic plaques on the tunica albuginea, penile pain during erection, palpable nodules cause deformity penile erections, may resolve or require surgery, TX refer to urologist Balanitis - CORRECT ANSWER candidal infection of the glans penis, diabetic or immunocompromised men, TX topical azole cream, treat partner too Phimosis - CORRECT ANSWER foreskin cannot be pushed back d/t edema, seen in neonates Womens health Dominant breast/breast cancer - CORRECT ANSWER mass one side feels hard, irregular, immobile, located tail of spence, skin color peau d orange (resembles orange peel), dimpling retraction, painless, bloody nipple discharge, DX order mammogram, refer to breast surgeon Paget's disease of breast - CORRECT ANSWER chronic red scaly rash resembling eczema starts on nipple and spreads to areola, itching, pain, burning sensation, skin lesion enlarges incl crusting, ulceration and bleeding at the nipple Inflammatory breast cancer - CORRECT ANSWER recent or acute onset red swollen warm area in breast of younger woman, mimics mastitis, no lump, may pit, turn orange, appear bruised, rare but aggressive breast cancer Fibrocystic breast - CORRECT ANSWER engorged and painful breasts symptoms 2 weeks before menses and at worst before cycle, resolves after menses, DX multiple, mobile rubbery cystic masses on both breasts, TX stop caffeine, take vitamin E BRCA1/2 - CORRECT ANSWER associated hereditary breast/ovarian cancer, family hx is high risk, men are higher risk, TX patient positive with BRCA mutation should be referred to breast specialist, MRI and mammogram, high risk in Jews, refer to counseling and mutation testing Ovarian cancer - CORRECT ANSWER palpate ovary in 1 year post menopausal woman, risk factors incl family hx, Jewish descent, BRCA 1/2 mutation, lynch syndrome, breast cancer, >55 age, endometriosis, first child at age 30, nulliparity(never completed pregnancy past 20 weeks) DX pelvic exam, transvaginal US, biopsy, CA 124, TX chemotherapy, referral surgical oncology eval and tx Pap testing - CORRECT ANSWER begins at 21 and every three years til 30 then every 5 years if co-testing for HPV. UPSTF recommendations - CORRECT ANSWER recommends that at age 30 with with HPV testing every 5 years, HIV positive women can screen before 21 y/o, stop PAP screening at 65. Loop electrosurgical excision procedure (LEEP) - CORRECT ANSWER is a device used like a scalpel cut thru cervix to treat cervical cancer Potassium hydroxide slide - CORRECT ANSWER KOH aids in diagnosing fungal infections hair, nails, and skin, KOH works by causing lysis of the squamous cell which makes it easier to see the hyphae and spores, vaginal specimens do not require KOH Whiff test - CORRECT ANSWER test for BV, fish odor is released after dropping KOH on slide Polycystic ovarian syndrome - CORRECT ANSWER Hormone abnormality marked by annovulation, infertility excessive androgen production and insulin resistance, high risk for type 2 diabetes, dyslipidemia, metabolic syndrome, endometrial hyperplasia, obesity and cancer, infertility, sleep apnea, hirsutism, acne, amenorrhea, Post menopause with bleed/PCOS - CORRECT ANSWER -high risk for endometrial cancer, DX transvaginal US, testosterone, FSH, fasting glucose, TX low dose contraceptives, spironolacton for hirsutism, metformin Osteoporosis - CORRECT ANSWER <-2.5 Osteopenia - CORRECT ANSWER -1.5 to -2.4 Persistent infection - CORRECT ANSWER vaginal and urinary tract infections screened for diabetes prostaglandins - CORRECT ANSWER responsible for dysmenorrhea Adolescents Acetaminophen poisoning - CORRECT ANSWER stage 1 n/v, lethargy malaise, stage 2 RUQ pain, elevate LFT, PT, INR, nephrotoxicity, pancreatitis, deaths occur in 72 to 96 hours TX Antidote is N-acetylcysteine IV testicular cancer - CORRECT ANSWER hard fixed nodule, HEAVINESS or aching, one testicle larger than other, hydrocele from tumor, painless asymptomatic until Metz DX Gold standard testicular biopsy, US of testes, refer to urology, for surgical removal (orchiectomy) Hodgkin's lymphoma - CORRECT ANSWER cancer of b cells (Reed Sternberg cells) pruritic, painless supraclavicular lymph nodes with fever (pel-ebstein sign), night sweats, fever, pain with Alcohol Drinks, young adults Death adolescents - CORRECT ANSWER MVA, suicide, homicide Tanner 2-female - CORRECT ANSWER breast bud areola develops Tanner 2-male - CORRECT ANSWER testes scrotum start to enlarge, scrotum gets darker Tanner 4-female - CORRECT ANSWER nipples and areola become elevated from breast, secondary mound Tanner 4- male - CORRECT ANSWER penis grows wider grows in length, darker scrotum Menarche - CORRECT ANSWER starts at age 12, irregular periods for several months up to 2 years Dysmenorrhea - CORRECT ANSWER TX heating pads, NSAIDS Emancipated minor - CORRECT ANSWER minors give full consent without parental involvement, 1. legally married, 2. active duty armed forces Right to consent confidentiality - CORRECT ANSWER 1. contraception, 2. Tx STD's 3. Diagnosis and management of pregnancy Primary amenorrhea - CORRECT ANSWER no menarche at 15, chromosomal disorder (turner syndrome), Secondary amenorrhea - CORRECT ANSWER no menses for three cycles or 6 months, d/t pregnancy, ovarian disorder, stress, anorexia, PCOS DX pregnancy test, prolactin level, TSH, FSH, LH, bone density TX educate caloric intake calcium and vit D 1200 to 1500 daily, refer to pediatric endocrinologist Anorexia nervosa - CORRECT ANSWER onset during adolescence, irrational preoccupation with fear of gaining weight, patient engages in restriction (diet, exercise) or binge eating and purging (laxatives, enemas, diuretics, vomiting) DX weight loss >10% body wt loss or <18.5 BMI low pulse v/s unstable, hypotension, lanugo, stress fractures, swollem feet (low albumin) dizzy, bloating Deprovera - CORRECT ANSWER increase risk of bone loss Gynecomastia - CORRECT ANSWER excessive growth of breast tissue in males, one or both breasts, resolve spontaneously, round rubbery mobile under areola of both breasts TX eval tanner stage, check for drug use, rule out etiology, rechecl in 6 months Pseudo gynecomastia - CORRECT ANSWER bilateral enlarged breast is d/t fatty tissue (adipose tissue), common in obese boys, soft tissue nontender no breast bud or disc like breast tissue is palpable DX clinical presentation Adolescent idiopathic scoliosis - CORRECT ANSWER lateral curvature of the spine accompanied by spinal rotation, painless, asymptomatic, rapid worsening of curvature is indicative of secondary cause, DX Adams forward bend test, checl height, measure cobb angle, full spine xray to measure degree of curve, TX if <20 degrees observe and monitor, >20 bracing (Milwaukee brace) >40 surgical correction, Harrington rod used on spine, refer to pediatric orthopedist Osgood-schlatter - CORRECT ANSWER occurs during growth spurt and affects superior tibia, when quadriceps exert stress on the patellar tendon (tibial tubercle), anterior knee pain increases over time TX resolves spontaneously rule out avulsion fracture, if acute order later xray of knee, avoid aggravating activities, RICE Ethical Guidelines and advanced practice law Beneficence - CORRECT ANSWER obligation to help patient, to remove harm, to prevent harm, promote good, "do not harm" Ex. Educating patient about new prescription, how to take, encourage to stop smoking, calling surgeon to get prescription stronger Nonmalificence - CORRECT ANSWER obligation to avoid harm, protect a patient from harm, prescribing a medication that is not contraindicated to patient Utilitarianism - CORRECT ANSWER obligation to act in way that's useful to or brenefits the majority, outcome is what matters with utilitarianism, use resource to benefit the most, Ex. WIC is only for women and babies because if would cost society more if these patients were hurt by inadequate food intake Justice - CORRECT ANSWER quality of being fair without acting with a lack of bias, fair suitable distribution of resources, ex. homeless man admitted to ED without insurance, treated the same as a mam with insurance Dignity - CORRECT ANSWER quality or state of being worthy of ethical and respectful tx respect for human dignity is important aspect of medical ethics, persons religious, personal, cultural beliefs are considered dignified tx. Ex. using hospital gowns to cover patient front to back, Foley catheters should not be visible to visitors not to embarrass patient Fidelity - CORRECT ANSWER obligation to maintain trust in relationship-keeping promise, dedications and loyalty to pt, Ex. NP should try her best to develop trust with patient Confidentiality - CORRECT ANSWER obligation to protect patient's identity, personal information, test results, medical records, conversations, and other health information is right is protected by HIPPA Autonomy - CORRECT ANSWER obligation to ensure mentally competent patients have right to make their own health decisions and express tx preferences Accountability - CORRECT ANSWER NP are responsible for their own actions and choices and do not blame others for their mistakes Ex. Patient diagnosed with pleurisy but when goes to ED is diagnosed with MI, no error is held accountable for her decision veracity - CORRECT ANSWER obligation to present information honestly and trustfully, in order for patient to make informed decision, do not withhold "bad news" Ex. Patient mammogram results are in, but son does not want patient to know, no must tell patient Paternalism - CORRECT ANSWER one person interferes or overrules the autonomy of another Ombudsman - CORRECT ANSWER person who acts as intermediary between patient and organization, ombudsman investigates and mediates complaint from both sides and attempts to reach fair conclusion Guardian ad litem - CORRECT ANSWER person assigned by court to act in the best interest of the child/frail vulnerable patient TPA - CORRECT ANSWER organization that does processing of claims and administrative paperwork for another company Medicare A - CORRECT ANSWER pay for inpatient services (hospice) Medicare B - CORRECT ANSWER pays for outpatient services (ambulance emergency only) Medicare C - CORRECT ANSWER pays for both Medicare D - CORRECT ANSWER is for medications drug benefit Medicaid - CORRECT ANSWER provides insurance for low income individuals and families who meet poverty criteria HMO - CORRECT ANSWER Patients assigned PCPC (gatekeeper), copay per visit, PCP must approve referral PPO - CORRECT ANSWER not assigned PCP, can visit any PCP, more expensive than HMO Medicare B - CORRECT ANSWER does not reimburse for dentures, glasses, or hearing aids,or ambulance transportation COBRA - CORRECT ANSWER is law that allows person to keep insurance after quit job Medical home - CORRECT ANSWER primary healthcare delivery of PT/OT speech, communicate thru phone, video chat, or email. State nurse practice act - CORRECT ANSWER "right to practice" enacted into law by state legislature State board of nursing - CORRECT ANSWER responsible for enforcing state nurse practice act Title protection - CORRECT ANSWER titles protected by law Situational leadership - CORRECT ANSWER flexible, can adjust his or her leadership style Standard of profession nursing practice - CORRECT ANSWER developed by professional societies Collaborative practice agreements - CORRECT ANSWER written agreement between supervising physician and NP Transformational leadership - CORRECT ANSWER ability to communicate vision to staff Laissez-faire Leadership - CORRECT ANSWER minimal supervision or direction of staff Authoritarian Leadership - CORRECT ANSWER like control and structure Democratic Leadership - CORRECT ANSWER likes more staff meeting for input from staff Servant leadership - CORRECT ANSWER likes to work along staff Malpractice - CORRECT ANSWER duty is owed, duty was breached, breach caused injury, damage occurred Problem focus visit - CORRECT ANSWER chief complaint, HPI, no ROS or past family/social history NPI - CORRECT ANSWER contains 10 numbers/digits ICD 10 code - CORRECT ANSWER diagnosis codes CPT codes - CORRECT ANSWER bill outpatient office procedures and services Incident to - CORRECT ANSWER billing is used for Medicare patients and refers to billing follow up visit performed by non-physician provider billed under physicians NPI#, nonphysician is paid 100% vs the rate of an NP who receives 85% Insurance - CORRECT ANSWER considered third party Nursing Research Review Primary prevention - CORRECT ANSWER prevent disease or injury before it ever occurs (diet, exercise, gun locks, seatbelt, bike helmets, education eating well, OSHA, EPA, BUILD YOUTH CENTER, habitat for humanity, ASA who have risk, not smoking, immunization) Secondary Prevention - CORRECT ANSWER reduce the impact of a disease by detecting or treating the disease to halt or slow progress (regular exams, screening tests, (paps, CBC, CAGE, interview for depression or sex partners, test for Hep C) low dose aspirins exercise to prevent further attacks, modify work so injured people can work safely Tertiary prevention - CORRECT ANSWER soften the impact of ongoing illness or injury lasting effects, manage long term effects of chronic illness/permanent impairments (cardiac stroke rehab, diabetes, depression, arthritis, support groups, vocational rehab) Control group - CORRECT ANSWER subjects in an experiment who do not receive treatment Prospective study - CORRECT ANSWER studies done in the present to the future data obtained in present and periodically measured in the future Retrospective study- - CORRECT ANSWER ex post facto studies done on events that have already occurred (chart reviews, recall of events) Longitudinal study - CORRECT ANSWER long term study that follows same group or subjects over many years of observe measure and compare same variables over time Ex. Framingham Heart study followed group to monitor CVD Cohort study - CORRECT ANSWER group individuals share common characteristics such as gender job, ethnicity, studying causative factors or risk factors. Ex study of nurse's long term who taken oral contraceptives Cross sectional study - CORRECT ANSWER compares differences and similarities between two or more groups of people or phenomena and collects data at one point in time experimental study - CORRECT ANSWER use randomization with subject selection Correlational studies - CORRECT ANSWER (observational) search for relationship between minimum of two variables Deductive logic - CORRECT ANSWER used in quantitative studies Inductive - CORRECT ANSWER used in qualitative studies Institutional review boards IRBs - CORRECT ANSWER ensure rights, safety and welfare of human research subjects, purpose to protect the rights of human subjects enrolled in a study Normal curve - CORRECT ANSWER is the bell curve N - CORRECT ANSWER total number of subjects n - CORRECT ANSWER subgroup Loretta Ford - CORRECT ANSWER created 1st NP program Metanalysis - CORRECT ANSWER combines data from multiple studies resulting in higher statistical power and single conclusion, gold standard for research evidence in EBM Systematic review - CORRECT ANSWER literature review that identifies selects, analyzes research articles concerning health condition disease or practice Randomized control trial (experimental study) - CORRECT ANSWER subjects assigned to control or treatment group, experimental study (double blind design (no one know who is being treated) Experimental study - CORRECT ANSWER experiment involves random subject selection, one placebo one controlled and one intervention, see above RCT Quasi experiment - CORRECT ANSWER convenience sampling instead of random sampling Cohort study - CORRECT ANSWER used to investigate risk factors of a disease, death or other conditions, subjects observed for long time, no intervention, goal is to find risk factors not causation (can be a prospective study of now to future) Case report - CORRECT ANSWER detailed report of one patient with disease or unusual condition, that includes demographics, sign or symptoms, diagnosis, response to treatment Case series - CORRECT ANSWER series of case reports involve several individuals who are given similar treatment opinions/editorials - CORRECT ANSWER biased and not based on solid evidence, weakest evidence sensitivity - CORRECT ANSWER the ability of a test to detect a person who has the disease TRUE POSITIVE Specificity - CORRECT ANSWER the ability of a test to detect a person who is healthy or detect the person without the disease TRUE NEGATIVE Horizontal transmission - CORRECT ANSWER ex. sex transmitting HIV Vertical transmission - CORRECT ANSWER mother transmitting, HIV to fetus Endemic - CORRECT ANSWER baseline particular disease Epidemic - CORRECT ANSWER rapid increase involving large number Pandemic - CORRECT ANSWER large are countries continents Drugs beta blockers - CORRECT ANSWER contraindicate in asthma/copd/emphysema, masks signs of hypoglycemia, bradycardia, exercise intolerance, fatigue CCB - CORRECT ANSWER side effect is edema in ankles, arrhythmias, hypotension, h/a, dizziness, constipation, flushing, weakness, migraine, prophylaxis, drug reaction with grapefruit, preferred for isolated systolic hypertension ARB/ACEI - CORRECT ANSWER lower Hgb levels in pts with chronic disease preferred in CHF/diabetes patients, assess renal function, avoid in renal stenosis, hypotension, hyperkalemia Atorvastatin - CORRECT ANSWER perform liver function tests, side effect myalgias, myopathy , rhabdomyolysis. Contraindicated with grapefruit juice Thiazides - CORRECT ANSWER largest studied drug, lowers potassium, increase gout, increase digoxin toxicity spironolactone - CORRECT ANSWER side of gynecomastia Diuretic side effects - CORRECT ANSWER hyperglycemia, hyperuricemia, hypertriglyceridemia, hypokalemia, hyponatremia, hypomagnesemia butterburr - CORRECT ANSWER for headaches Ginko bilba - CORRECT ANSWER help with memory, circulatory disorders, contraindicated with aspirin/warfarin Saw Palmetto - CORRECT ANSWER for BPH St John Wort - CORRECT ANSWER for depression and menopause symptoms Kava Kava/valerian root - CORRECT ANSWER anxiety or insomnia affects liver Gingseng - CORRECT ANSWER reduce stress, weight loss, sexual dysfunction, lower blood sugars ginger - CORRECT ANSWER anti-inflammatory feverfew - CORRECT ANSWER migraines and menstrual cramps echinacea - CORRECT ANSWER builds immunity Aspirin - CORRECT ANSWER effects on platelets irreversible 15-20 days, monitor for bleeding, tinnitis, tarry stools, GI irritation NSAIDS - CORRECT ANSWER affect GI, renal, cardio, blunts diuretics Ponstel (mefenamic acid) - CORRECT ANSWER is an NSAID for menstrual pain Macrobid/nitrofurantoin - CORRECT ANSWER long term use associated with lung, hepatitis, renal insufficiency, and neuropathy Metformin - CORRECT ANSWER affects liver enzymes, weight loss, avoid in alcohol drinkers, watch for lactic acidosis, diarrhea and flatulence Steroids - CORRECT ANSWER side effects osteopenia, cataracts Potentially inappropriate drugs for elderly - CORRECT ANSWER benadryl, glipizide, glyburide, benzodiazepines, thioridazine, mesoridazine, seroquel, zyprexa, elavil, trofanil, nsaids, ambien, reglan, mineral oil, PPIs potentially inappropriate drugs for pregnant females - CORRECT ANSWER tetracyclines, sulfa is iffy, fluoroquinolones, ACE, NSAID, asa, any hormonal drugs, accutane, proscar [Show More]

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