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Nursing AANP Family Nurse Practitioner (AANP-FNP) Sample Questions (Q52-Q57):NEW QUESTION # 52
There are signs of jaundice in the newborn that you are examining. What will you use to determine the approximate level of jaundice in this newborn?
- A. White's rule
- B. Azabo's rule
- C. Kramer's rule
- D. George's rule
Answer: C
Explanation:
To determine the approximate level of jaundice in a newborn, Kramer's rule is commonly used. This method provides an estimation of bilirubin levels based on the extent of yellow discoloration observed in different parts of the infant's body.
Kramer's rule involves visually inspecting the newborn's skin and correlating the level of jaundice based on the anatomic progression of skin yellowing. The examination should be conducted in natural light, which provides the most accurate assessment of skin color. To perform the evaluation, a healthcare provider presses on the skin to blanch it and then observes the color as the skin returns to its normal state. This blanching technique helps differentiate the yellow color of the skin caused by jaundice from the underlying skin pigmentation.
The progression of jaundice according to Kramer's rule is typically graded as follows: - Grade 1: Yellowing of the skin appears only on the face, particularly the forehead and nose. - Grade 2: The yellow color extends down to the chest and abdomen. - Grade 3: Jaundice is visible on the arms and thighs. - Grade 4: The lower extremities (legs and feet) also show yellow discoloration.
Each grade corresponds to higher levels of bilirubin in the bloodstream, with the extent of body involvement suggesting more severe jaundice. For example, if jaundice is observed only on the face (Grade 1), it suggests a lower level of bilirubin compared to jaundice that has progressed to the legs and feet (Grade 4).
It is important to note that while Kramer's rule provides a quick and non-invasive way to estimate the severity of jaundice, it is not definitive. For accurate measurement of bilirubin levels, laboratory tests such as a serum bilirubin test are necessary. Moreover, in cases where the clinical assessment and the severity of jaundice are uncertain, or if the newborn shows signs of illness, further diagnostic evaluation and intervention may be required.
NEW QUESTION # 53
A 68 year old male patient is dehydrated with nausea and vomiting. The abdominal pain radiates to the back. He has a normal diet and family support. What is the best differential diagnosis?
- A. Peptic ulcer disease.
- B. Diverticulitis.
- C. Pancreatitis.
- D. Large bowel obstruction.
Answer: C
Explanation:
Peptic ulcer disease is one potential diagnosis for a patient with abdominal pain, nausea, and vomiting. However, the typical presentation often includes localized pain in the upper abdomen without radiation to the back. The symptoms can be worsened by meals, and alleviated by antacids, which does not fully align with the patient's symptoms as described.
Pancreatitis is another possible diagnosis, particularly fitting in this case due to the age of the patient and the nature of the symptoms. Pancreatitis often presents with severe pain that radiates to the back, coupled with nausea and vomiting. The fact that the patient's diet is normal and not a contributing factor, along with the reported dehydration, supports the likelihood of pancreatitis. Pancreatitis can be caused by gallstones, alcohol use, and other medical conditions, but it can also occur idiopathically, particularly in older adults.
Diverticulitis typically presents with pain in the lower left quadrant of the abdomen, occasionally accompanied by nausea and a change in bowel habits, but less commonly with vomiting and back pain. The patient's symptoms do not strongly suggest diverticulitis, particularly in the absence of changes in bowel habits or localized left-sided pain.
Large bowel obstruction could present with abdominal pain, nausea, and vomiting, but would more likely also involve changes in bowel movements, such as inability to pass gas or stools, and abdominal distension. The description of pain radiating to the back is less characteristic for large bowel obstruction.
Given the age of the patient, the symptomatology of severe pain radiating to the back, and the associated nausea and vomiting without specific dietary triggers, pancreatitis emerges as the most likely diagnosis. It is important to consider this condition seriously due to the potential complications and the need for prompt treatment to manage symptoms and prevent further damage to the pancreas. Further diagnostic tests such as serum amylase and lipase, and imaging studies like abdominal ultrasound or CT scan, would be warranted to confirm the diagnosis and assess the severity of the condition.
NEW QUESTION # 54
An 80-year-old patient presents with a history of infection. He is obese and his chief complaint is fatigue and thirst. What test should be run?
- A. Hemoglobin.
- B. Serum cholesterol.
- C. Blood glucose.
- D. Serum albumin.
Answer: C
Explanation:
The correct test to run for an 80-year-old patient who presents with fatigue, thirst, obesity, and a history of infection is a blood glucose test. This recommendation is based on several factors that align with the common symptoms and risk factors associated with diabetes mellitus, particularly type 2 diabetes.
First, the age of the patient is a significant factor. Glucose intolerance increases with age, making older patients more susceptible to diabetes. As individuals age, their insulin sensitivity typically decreases, and pancreatic function may deteriorate, both of which can contribute to elevated blood glucose levels.
Second, the patient's obesity further compounds the risk. Obesity is a well-known risk factor for the development of type 2 diabetes. Excess body fat, especially in the abdominal area, is linked to decreased insulin sensitivity, meaning that the body needs more insulin to help glucose enter cells. This state of insulin resistance is a precursor to diabetes.
Third, the symptoms of fatigue and thirst are classic signs of diabetes. Fatigue in diabetes can result from the body's inability to properly use glucose for energy due to insulin resistance or lack of insulin production. Thirst is a result of high blood sugar levels, which cause dehydration by pulling excess water into the urine as the body attempts to remove the surplus glucose.
Lastly, the history of infection could also be relevant. In people with undiagnosed or poorly controlled diabetes, high blood sugar levels can impair the immune system, making infections more frequent or severe.
Therefore, measuring the blood glucose levels will provide critical information about whether the patient's symptoms might be related to diabetes. Monitoring and managing blood glucose is essential for diagnosing diabetes and preventing its complications. Other tests like serum cholesterol, serum albumin, and hemoglobin might be useful for a complete metabolic profile and assessment, but given the specific presentation and risk factors described, the blood glucose test is the most immediately relevant and informative in this scenario.
NEW QUESTION # 55
As an FNP you would recognize that your patient with herpangina should be treated for as long as he or she is symptomatic. How long would you expect the course of this disease would be?
- A. 3 - 5 days
- B. 2 - 3 weeks
- C. within one month
- D. 10 days
Answer: A
Explanation:
Herpangina is typically a self-limiting disease, characterized primarily by small, painful ulcers and sores (lesions) in the mouth. These symptoms are often accompanied by fever, a sore throat, and sometimes a runny nose or cough, collectively known as coryza. As an acute viral illness, herpangina is most commonly caused by Coxsackievirus A, a type of enterovirus. The virus spreads primarily through contact with respiratory droplets or the fecal-oral route, making it more prevalent among young children, who are less likely to maintain good hygiene.
The typical duration for herpangina is relatively short. Symptoms generally appear suddenly and can be quite severe, but they resolve quickly, usually within 3 to 5 days. This rapid resolution of symptoms is due to the body's immune response effectively combating the virus. During this period, supportive care is essential to help manage symptoms and ensure hydration, especially since painful mouth sores can make eating and drinking uncomfortable.
Treatment for herpangina focuses primarily on symptom relief. This can include the use of over-the-counter pain relievers such as acetaminophen or ibuprofen to reduce fever and alleviate pain. Additionally, mouthwashes or sprays that numb pain can help relieve the discomfort caused by mouth ulcers. It is important for caregivers to monitor fluid intake to prevent dehydration. Since herpangina is caused by a virus, antibiotics are not effective and are not prescribed.
The expected course of herpangina being 3 to 5 days is typical for uncomplicated cases. However, it is crucial for healthcare providers, including FNPs (Family Nurse Practitioners), to educate patients and caregivers about the signs of potential complications, such as dehydration or more severe infections, which could extend the duration of the illness or require more intensive medical care. Regular follow-up during the period of illness can help ensure that the patient is recovering as expected and maintaining adequate hydration and nutrition.
NEW QUESTION # 56
Mr. Garcia comes to the clinic and tells the FNP that he has lumps under his arms that have started to drain pus. These lumps are red and painful. The FNP is most likely to diagnose which of the following?
- A. hidradenitis suppurativa
- B. herpes zoster
- C. psoriasis
- D. axillary herpes
Answer: A
Explanation:
From the symptoms described by Mr. Garcia, the Family Nurse Practitioner (FNP) would likely diagnose him with hidradenitis suppurativa. This condition is characterized by the presence of painful, red lumps under the skin, such as in the armpits or groin, that can eventually start to drain pus.
Hidradenitis suppurativa is a chronic skin condition involving the inflammation and infection of the sweat glands, especially those located in the axillary (underarm) and inguinal (groin) regions. It is not caused by poor hygiene but is instead associated with follicular occlusion, which leads to the trapping of sweat, bacteria, and debris in the gland. This causes an inflammatory response, resulting in the painful lumps and abscesses seen in this condition.
The lumps are typically recurrent and can vary in severity. Over time, they can lead to the development of sinus tracts and scarring. The exact cause of hidradenitis suppurativa is not well understood but is believed to be influenced by genetic factors, hormonal changes, and immune system issues.
Contrary to the explanation provided, hidradenitis suppurativa is not primarily a bacterial infection but can become secondarily infected with bacteria such as Staphylococcus aureus. Treatment often involves antibiotics to control any secondary infection, along with other medications to reduce inflammation and manage pain. In severe cases, surgical intervention may be necessary to remove affected tissue.
Culture and sensitivity (C&S) tests of the purulent discharge can help in identifying any secondary bacterial infection and determining the most effective antibiotics to use in treatment. Managing hidradenitis suppurativa requires a comprehensive approach that may also include lifestyle changes, such as weight management and smoking cessation, which can help reduce flare-ups.
It is important for patients with hidradenitis suppurativa to receive a correct diagnosis and appropriate treatment plan to manage symptoms and prevent complications. Regular follow-up with healthcare providers is crucial to effectively manage this chronic and often distressing condition.
NEW QUESTION # 57
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