Questions And Answers PDF Format: For More Information – Visit link below: https://www.certsgrade.com/ Version = Product CERTSGRADE High Grade and Valuable Preparation Stuff Nursing AANPCB-FNP American Academy of Nurse Practitioners Certification Board: Family Nurse Practitioner Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/ Latest Version: 6.0 Question: 1 As you formulate a plan of care for an adult patient with chronic kidney disease (CKD), you understand that, according to guidelines, initiating treatment with an erythropoiesis-stimulating agent (ESA) will be indicated when which of the following hemoglobin levels are noted? A. Hemoglobin < 10 g/dL B. Hemoglobin < 9.5 mg/dL C. Hemoglobin < 9.0 g/dL D. Hemoglobin < 11 g/dL Answer: A Explanation: For adult patients with CKD, guidelines recommend initiating treatment with an ESA when hemoglobin levels are less than 10 g/dL. Guidelines recommend considering treatment with an ESA for dialysis and non-dialysis adult patients when hemoglobin levels are less than 10 mg/dL. In general, treatment should target a hemoglobin level not exceeding 11.5 mg/dL. Question: 2 A 23-year-old patient presents to clinic for her well woman exam (WWE). She forgot to schedule her WWE last year and is now stating that she has not experienced any menstrual bleeding for the previous six months. Home pregnancy tests have been negative, and the patient denies any other symptoms. A review of her chart reveals that a levonorgestrel-containing intrauterine device (LNG-IUD — Mirena, Skyla, Kyleena, Liletta) was placed during her previous WWE two years prior. Which of the following statements is true regarding LNG-IUD? A. LNG-IUD may contribute to an increased risk of upper reproductive tract infection. B. LNG-IUD reduces menstrual volume by about 60%. C. LNG-IUD causes heavier than usual menstrual bleeding in approximately 80% of users. D. LNG-IUD induces amenorrhea in about 50% of users at the end of two years of use. Answer: D Explanation: All of the LevoNorGestrel-containing IntraUterine Devices (LNG-IUD) cause marked endometrial atrophy and thus decrease vaginal bleeding. Consequently, approximately 50% of users are amenorrheic at the end of two years of use. This endometrial atrophy prevents implantation of the fertilized ovum and is reversible with fertility returning soon after removal of the device. The progestin contained in the LNG- Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/ IUD also contributes to thickening of the cervical mucus, another mechanism of pregnancy prevention, and also helps minimize upper reproductive tract infection. In contrast, the copper IUD (Cu-IUD ParaGard) tends to cause an increase in menstrual bleeding and may contribute to an increase in upper reproductive tract infection. Its mechanism of action is not fully understood but is not believed to be abortifacient. Use of Combined Oral Contraceptives (COC) reduces menstrual volume by about 60%. Question: 3 An adult patient was found to be vitamin D deficient with a serum 25-hydroxyvitamin D level of 25 ng/mL. Which of the following treatments is the most appropriate option to incorporate into the plan of care? A. 2,000 international units of vitamin D3 by mouth daily for eight weeks B. 50,000 international units of vitamin D3 by mouth twice per week for eight weeks C. 50,000 international units of vitamin D3 by mouth once per week for 16 weeks D. 50,000 international units of vitamin D3 by mouth twice per month for six months Answer: C Explanation: For the treatment of vitamin D deficiency in adults, a dose of 50,000 International Units (IU) of vitamin D3 by mouth once per week for at least eight weeks is advised, with the extension of this course to sixteen weeks if the initial 25-hydroxyvitamin D level was below 30 ng/mL. Vitamin D3 is the preferred form of the micronutrient for the treatment of vitamin D deficiency and for the maintenance of vitamin D levels. Because vitamin D3 is stored in fat and has a long half-life, low dose vitamin D3 supplementation is not sufficient to correct a deficiency. For long-term prevention, patients should be given 50,000 IU of vitamin D3 once or twice per month plus 1,000 to 2,000 IU of vitamin D3 daily Question: 4 You are providing care for a 28-year-old male patient presenting with symptoms including fever, irritative voiding symptoms, and perineal pain. A digital rectal examination reveals a tender, boggy (sponge-like) prostate. Urinalysis reveals the presence of leukocytes in the urine. Which diagnostic test should also be ordered? A. Urethral culture B. Prostate-specific antigen (PSA) testing C. Urine culture D. Urodynamic and imaging studies Answer: C Explanation: Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/ Fever, irritative voiding symptoms, and perineal pain are consistent with a potential diagnosis of acute bacterial prostatitis. Other symptoms may include fever, chills, malaise, and arthralgia. The best diagnostic test to confirm this diagnosis is a urine culture to identify a causative organism. Urodynamic and imaging studies have limited usefulness for a chronic bacterial prostatitis diagnosis but can be considered to assess for obstruction secondary to prostatic enlargement. Testing for Prostate-Specific Antigen (PSA) levels is not specifically recommended for diagnosis of acute bacterial prostatitis, as in this setting, PSA has little to no diagnostic value. Prostatic massage to obtain a urethral swab for culture is contraindicated in acute prostatitis. Question: 5 A 25-year-old male patient presents with a diffuse rash involving palms and soles, swollen lymph glands, fatigue, malaise, and a low-grade fever. What further diagnostic testing is indicated? A. Fluorescent treponemal antibody absorption (FTA-ABS) test B. Polymerase chain reaction (PCR) test C. Taking a urethral swab for culture and sensitivity D. Scraping a sample of tissue for viral culture Answer: A Explanation: The symptoms described are suggestive of secondary syphilis. The Fluorescent Treponemal Antibody ABSorption (FTA-ABS) test is confirmatory for antibodies to Treponema pallidum, the spirochete that causes the disease. This test is only useful after 3 to 4 weeks post-exposure. Screening tests for syphilis include the Venereal Disease Research Laboratory (VDRL), the rapid immunochromatographic test, and the rapid plasma reagin (RPR). VDRL is not specific for syphilis. A second test should be performed if the screening test is positive to confirm the diagnosis. Other confirmatory tests besides the FTA-ABS include the Treponema Pallidum Particle Agglutination assay (TPPA), Enzyme ImmunoAssay (EIA), and MicroHemagglutination Assay (MHA-TP). Darkfield microscopy can identify syphilis in a sample of fluid or tissue from an open sore. Urethral swab cultures are diagnostic for gonorrhea. Diagnostic testing for genital herpes includes the Polymerase Chain Reaction (PCR) test for the presence of viral DNA. Tissue samples for viral culture are related to testing for Human PapillomaVirus (HPV) infection. Question: 6 A 62-year-old Asian male presents to your office with a complaint of urinary dribbling after voiding and urge incontinence. He denies any recent fever or signs of infection and denies any history of groin or urogenital injury. The patient states he was treated for gonorrhea infection approximately 15 years ago. The physical examination does not reveal any additional physical findings. Your patient is most likely experiencing symptoms as a result of which of the following conditions? A. Detrusor overactivity B. Urinary tract infection (UTI) C. Urethral stricture Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/ D. Pelvic floor weakness Answer: C Explanation: Urethral stricture or obstruction is primarily a urological complication found in males; males are affected 30:1 compared to females. Stricture may result from infection, such as sexually transmitted infection; injuries, such as falling off the saddle of a bike; and post-surgical procedures, such as cystoscopy or transurethral resection of the prostate. Urethral obstruction is more common in older men. Treatment of urethral stricture requires urological referral. Males experiencing symptoms as a result of urethral stricture typically complain of urinary dribbling postvoid coupled with urge incontinence. Pelvic floor weakness contributes to stress incontinence. Detrusor overactivity and UTI contribute to urge incontinence. Question: 7 A 32-year-old heterosexual male presents with symptoms of acute epididymitis. Which of the following diagnostic tests should be ordered? A. Syphilis and human immunodeficiency virus (HIV) testing B. A voiding cystourethrogram and abdominal ultrasonography C. Radiologic studies D. Gonorrhea and chlamydia testing Answer: D Explanation: Acute epididymitis manifests with a history of acute-onset irritative voiding symptoms, fever, and an acutely painful, enlarged epididymis. In heterosexual men younger than 35 years of age, epididymitis is typically caused by a sexually transmitted gonorrheal or chlamydial infection. A urethral swab or nucleic acid amplification test (NAAT) should be performed to rule out these infections. If the patient has systemic symptoms, such as fever or myalgia, a blood culture should be considered. The performance of, or referral for, syphilis and human immunodeficiency virus (HIV) testing may be indicated if testing is positive for a sexually transmitted organism, such as Chlamydia trachomatis or Neiserria gonorrhoeae. A voiding cystourethrogram and abdominal ultrasonography are recommended for infants with bacteriuria and epididymitis in whom anatomical abnormalities are more common. Radiologic studies are recommended in children who have bacteriuria and acute epididymitis to evaluate for structural abnormalities (found in >50% of these patients). These tests are not indicated for adults. Question: 8 Performance of McMurray's test is indicated for the physical assessment of a patient who is experiencing pain in which area of the body? Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/ A. The shoulder B. The wrist C. The abdomen D. The knee Answer: D Explanation: McMurray's test is used to assess a patient who is complaining of pain in the knee. McMurray's test assesses the menisci, the C-shaped fibrocartilage pads located between the femoral condyles and the tibial plateaus. The medial meniscus is tested with the hip flexed and the knee externally rotated as the examiner moves the knee from full flexion to extension. To test the lateral meniscus, the knee is internally rotated during the procedure. A snap heard or felt during this maneuver suggests a tear of the tested meniscus. Question: 9 When conducting an assessment related to a potential developmental disability, you understand that Klinefelter syndrome is most often characterized by which of the following factors? A. Language impairment in females B. Attention deficit disorder in females C. Language impairment in males D. Attention deficit disorder in males Answer: C Explanation: Klinefelter syndrome is a group of conditions that affects males who are born with at least one extra X chromosome. This condition occurs in approximately 1 in 1,000 live births. Only males are affected by Klinefelter syndrome with developmental issues, most commonly language impairment. Physical habitus is consistent with low testicular volume, hip and breast enlargement, reduced facial and body hair, and higher risk of osteoporosis. Treatment includes testosterone replacement and fertility treatment. Language impairment, not attention deficit disorder, is most frequently associated with Klinefelter syndrome. Question: 10 A patient with a six-year history of osteoporosis has returned to the clinic to receive an annual intravenous dose of zoledronic acid (Zometa, Reclast). Which symptoms, if reported, would require immediate attention prior to administering the medication? A. An unusual or unpleasant aftertaste B. Pain in the thigh or groin area C. Dysphagia, dry mouth Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/ D. Feeling sad or discouraged Answer: B Explanation: Zoledronic acid is a biphosphonate and can be administered every year (via intravenous infusion) to treat osteoporosis or every 2 years to prevent osteoporosis. Although rare, pain in the thigh or groin area may be indicative of low-trauma atypical femoral fractures (often precedes these fractures) and is associated with long-term use of bisphosphonates (>5 years). As the most vigorous response to bisphosphonates occurs during the first 5 years of treatment and confers fracture risk reduction after treatment has been discontinued, a drug holiday may be recommended after 5 to 10 years of therapy. Common side effects that may occur and usually do not need medical attention include, in part, an unusual or unpleasant aftertaste, dysphagia, dry mouth, and feeling sad or discouraged as well as abdominal or back pain, constipation or diarrhea, frequent urge to urinate, anorexia, joint pain, redness or swelling, nasal congestion, and trouble sleeping. Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/ For More Information – Visit link below: http://www.certsgrade.com/ PRODUCT FEATURES Discount Coupon Code: CERTSGRADE10 100% Money Back Guarantee 90 Days Free updates Special Discounts on Bulk Orders Guaranteed Success 50,000 Satisfied Customers 100% Secure Shopping Privacy Policy Refund Policy Powered by TCPDF (www.tcpdf.org) Visit us athttps://www.certsgrade.com/pdf/aanpcb-fnp/