APEA Practice Questions

What characteristic should make the nurse practitioner suspect that a pneumonia is secondary to DRSP?
Recent ABX exposure *

What characteristic best distinguishes asthma from COPD?
Presence of inflammation

A 70 year old smoker presents with right unilateral wheezing. A chest x-ray demonstrates right enlarged hilar nodes. What should be done next?
Order CT chest with contrast

A 74 year old patient has symptoms of depression. Treatment with sertraline is being considered. Which studies might be most important to order?
B12, Folate, TSH

A patient who was on Lisinopril developed a cough. What finding in this patient supports a diagnosis of ACE inhibitor related cough?
Cough started 4 days after lisinopril was begun.

A 24 year old college student (otherwise healthy, non-smoker) has community acquired pneumonia. She has taken amoxicillin with clavulanate for the past 3 days. Her fever persists. How should she be managed?
Stop amoxicillin with clavulanate and start azithromycin.

A young adult who has asthma has used low dose steroid inhaler twice daily with good control for the past 3 months. In the last two weeks, he has had daily symptoms of cough and chest tightness. What plan would help alleviate his symptoms?
Add a LABA twice daily

What patient is most likely to harbor an atypical pathogen?
A 48 year old who has teenagers in the household *

A patient who has moderate persistent asthma takes fluticasone twice daily but is still having symptoms. What medication listed below will be of little benefit in management of this patient’s wheezing and cough? Select all that apply.
Theophylline & Tiotropium

Mr. Boudreaux, a 78 year old male smoker, has Stage II COPD. He has received a prescription for ipratropium. What problem is likely after he begins the ipratropium? Medical History: Dysrhythmias, Cataracts, Osteoporosis, Glaucoma, HTN, Pre-DM
Increased intraocular pressure

A 30 year old female patient with moderate persistent asthma has a temperature of 102°F, bilateral wheezes, mild SOB, and purulent sputum. How should she be managed today? Meds: Fluticasone/salmeterol BID, Albuterol PRN, Amlodipine 5 mg, levothyroxine 88 mcg daily, metformin 1000 mg BID
Treat as pneumonia with levofloxacin, use nebulized albuterol every 4-6 hours as needed for wheezing

A pregnant 30 year old female patient with moderate persistent asthma has a temperature of 102°F, bilateral wheezes, mild SOB, and purulent sputum. How should she be managed today? Meds: Fluticasone/salmeterol BID, Albuterol PRN, Amlodipine 5 mg, levothyroxine 88 mcg daily, metformin 1000 mg BID
Do not use levofloxacin *

What might be the significance of white cell casts?

What inhaled medication combo creates the greatest risk of sudden death in an asthma patient?
Formoterol, albuterol *

An 80 year old patient with COPD has been diagnosed with pneumonia. She is allergic to ciprofloxacin. What is the most appropriate antibiotic for his treatment?
Azithromycin plus Amoxicillin-clavulanate
(I guessed) *

A 34 year old non-smoker (who is otherwise healthy) has been diagnosed with acute bronchitis. His symptoms have persisted for the past 4 days. What’s an appropriate treatment for him?
Treat symptomatically

A patient has had long standing iron deficiency anemia (for > 1 year). What is his RDW likely to be?
Much less than 15% *

Short acting bronchodilator use is associated with greater risk of arrhythmias in new users. Which arrhythmia(s)?
Atrial fibrillation, atrial flutter (I guessed) *

What lab test probably should not be ordered if a patient is taking an iron supplement daily for anemia?
Serum iron level

A 24 year old patient was diagnosed 2 weeks ago with mild persistent asthma. She returns today and states that she stopped her inhaler about a week ago because it made her “mouth burn”. What’s the likely reason for this complaint?
She probably has thrush.

What laboratory test describes the size of a patient’s RBCs?

A patient’s Hgb = 10.2 g, HCT = 30.6%. Which findings are consistent with iron deficiency anemia? Norms: MCV: 80-100; MCH: 26-30
MCV: 75; MCH: 25

A 78 year old patient with IDA (suspected to be due to poor diet; stool negative for occult blood 4 weeks ago) has taken 200 mg elemental iron for the past 4 weeks. What action is appropriate today? Normal Range HgB: 12-15 g/dL; 4 weeks ago 10.0 g/dL; Today 10.2 g/dL Normal Range HCT: 37-51%; 4 weeks ago 31%; Today 31.8%
Measure reticulocyte count

A 44 year old presents with suspected BPPV. What historical finding is most likely?
Symptoms are reproducible with head movement.

A 55 year old patient was diagnosed with pneumonia 7 days ago and was started on levofloxacin. He has had normal temperature for the past 2 days but complains that he feels tired and is still coughing. How should this be handled?
Have him continue to rest for another 3-5 days

Osteoporosis is a possible side effect of inhaled steroids. What other side effect(s) may be seen with chronic steroid use?
Cataracts *

What do thalassemia and iron deficiency anemia have in common?
Both produce microcytic, hypochromic anemias

A patient’s Hgb = 10.0g, HCT = 30.6%. Which findings are consistent with a normocytic normochromic anemia? Norms: MCV: 84-102; MCH: 29-35
MCV: 93; MCH: 29

A 45 year old patient has suspected B12 and folate deficiencies. What typical symptoms might he exhibit?
Paresthesias, unexplained weakness

What laboratory test describes the hemoglobin content of a patient’s RBCs?

A 75 year old patient has suspected B12 and folate deficiencies. What typical symptoms might be exhibit?
Unexplained weakness, cognitive changes

A patient exhibits petechiae and purpura on his feet. This is probably due to:
Low platelet count

A 30 year old NP who is a recent graduate has a job interview. She feels very anxious and has a noticeable tremor at the time of her interview. What type tremor is this?
Physiologic tremor

A patient has recently developed IDA and is not taking iron supplements. Compared to his pre-anemic state, what is his TIBC likely to be?
Increased *

A 35 year old diabetic patient has the following lab values. Is he likely to be symptomatic? RBC – Patient 3.9; Norms 4.2-4.9 HGB – Patient 11.5 g/L; Norms 12-15 g/L HCT – Patient 34.6; Norms 37-51
No, because of his lab values *

A patient’s Hgb. = 10.6g, Hct = 32%. Which findings are consistent with B12 deficiency? Norms: MCV: 80-100; MCH: 28-32
MCV: 110; MCH: 30

Which patient is most likely to have a secondary headache?
48 year old female

What are the two most common presenting symptoms of brain tumor in adults?
Headache, seizure *

The mechanism of action for “triptans” in patients who have migraine headache is:
cerebral artery constriction *

What disease/condition has the potential to produce a drug-disease interaction secondary to triptan use?

A 79 year old patient has been diagnosed with depression. She lives alone, drives, and is able to manage her own affairs. She had a prior history of depression about 10 years ago. Current Medications: Amlodipine, Baby aspirin daily, Atorvastatin, Metformin This 79 year old patient has been started on 25 mg sertraline daily. An important prescribing consideration is that sertraline:
may increase her risk of bleeding.

When would a peripheral smear be especially helpful in evaluation of a patient with suspected anemia?
If the patient has a mixed anemia

A 72 year old female describes an intermittent facial pain along the right side of her face and head. It is sharp, piercing and started last night. Her neurologic exam is WNL. Which statement is correct?
This is trigeminal neuralgia involving the 5th cranial nerve.

A premalignant lesion of the esophagus that is secondary to GERD is termed:
Barrett’s esophagus

The diagnosis that must be considered in a patient who presents with a severe headache of recent onset with neck stiffness and fever is: A. migraine headache. B. subarachnoid hemorrhage. C. glaucoma. D. meningitis. D A 6 year old African-American …

Multiple organ dysfunction syndrome (MODS) can be caused by: a. septic shock. b. prolonged tissue hypoxia. c. uncontrolled systemic inflammation. d. all of the above. d. all of the above. A person is unresponsive to verbal stimuli, has a heart …

1. A 68-year-old patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia? The patient was oriented and alert when admitted The patient’s speech …

A patient is in end-stage renal failure. What are the signs and symptoms that the nurse is likely to find while assessing neurologic function? Select all that apply. – Restless leg syndrome – Nocturnal leg cramps – Asterixis (hand-flapping tremor) …

A nurse is caring for an 89-year-old client admitted with pneumonia. He has an IV of normal saline running at 100 mL/hr and antibiotics that were initiated in the emergency department 3 hours ago. He has oxygen at 2 liters/nasal …

You have a patient who presents with black, tarry, coffee ground appearance vomit. You expect a hematemesis analyses to show? A) higher pH B) lower pH C) neutral D) very high pH B hematemesis will come from a GI source …

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