A 30 year old female stopped by the primary care office near work on the way back from lunch. She experienced a sudden onset of hives on her back and stomach that is progressively spreading. She stated, “my chest feels tight, my tongue feels numb and I am having difficulty breathing. I did have asthma as a child.” Which the most appropriate intervention by the APN? (Points : 3.75) Prescribe 50mg Benadryl (diphenhydramine) PO now and recheck in 24 hours Order a stat chest x-ray Administer nebulized albuterol mixed with saline and repeat PRN Give epinephrine 1:1,000 intramuscularly immediately Question 2. 2.A 65 year old male presented for a yearly physical exam with complaints of nausea, trembling and fatigue. A 12 lead ECG revealed new onset atrial fibrillation with a heart rate of 60 beats per minute. Current medications included: Lanoxin (digoxin), Lasix (Furosemide) and Aspirin. The patient stated, “Should I go straight to the ER with the way I am feeling?” Which of these interventions is most appropriate by the APN? (Points : 3.75) Call 911 with a referral to the emergency department Discontinue Lanoxin (digoxin) and admit to the hospital for further diagnostic tests Order a stat TSH, electrolyte panel, and digoxin level Refer to a cardiologist immediately Question 3. 3.A 40 year old male client with Down’s syndrome presented to his primary care APN with complaints of difficulty at work. He stated, “I can’t remember what I need to do and the boss keeps yelling at me. I have done this job for many years, I don’t know how to do anything else.” Physical exam: no abnormalities noted with heart rate 70 beats per minute, respirations 18 breaths per minute, oxygen saturation 98% on room air, blood pressure 148/84, and CBC with differential and serum chemistries with electrolytes normal. (Points : 3.75) Order stat CT scan of the head Consult with physician specializing in adults with developmental disabilities Consider the finding normal and recommend recheck in 3 months Call employer for detailed record of client’s actions Question 4. 4.Advance practice nurses secure the right to practice legally from which collection of documents? (Points : 3.75) State laws in which the practitioner resides Nurse Practice Act of the state where the practitioner is licensed Approval by the board of executives at the state board of nursing where the practitioner resides Successful passage of national certification exam from the American Nurses’ Credentialing Center Question 5. 5.Which statement best describes the mechanism of action for RhoGAM? (Points : 3.75) Destroys maternal antibodies for Rh positive fetal red blood cells Stimulates manufacturing of maternal antibodies to decrease risk for hemolysis with a Rh negative fetus Promotes the destruction of maternal antibodies against Rh negative fetal blood cells Increases manufacturing of maternal antibodies to destroy Rh positive and negative fetal blood antigens Question 6. 6.Which client should the APN in the emergency department assess first? (Points : 3.75) A 25 year old male with a 4 inch long and 0.5 inch wide laceration on his left upper arm suffered after fight A 40 year old male with electrical burns on his hands and face from a work site accident A 30 year old female complaining of pain when urinating and intermittent nausea A 2 year old with a history of possibly swallowing a dime Question 7. 7.A 15 year old male with Down’s Syndrome presented to his primary care clinic for a required physical to join the wrestling team. The mother expressed concerns regarding injuries and special needs due to his disability. Which statement if the appropriate response by the APN? (Points : 3.75) “Your son can play wearing traditional protective gear and has no limitations “He must be cleared of cervical instability and then he can play some sports preferably those with less contact.” “I can perform the physical however based on legal concerns I will not certify your son healthy to wrestle.” “I will need to refer your son to a neurologist for further evaluation to assure he is healthy for wrestling.” Question 8. 8.A client is admitted to the emergency department for first and second degree burns on the face, neck, anterior chest and hands. What is the next best action by the APN? (Points : 3.75) Cover the secondary burns with dry sterile dressings Assess for dyspnea or stridor Begin intravenous infusion of Normal Saline at at 175 ml/hour Administer 4mg Morphine Sulfate intravenously Question 9. 9.Which client should the APN assess first in the emergency department? (Points : 3.75) 78 year old with history of CVA 8 years earlier admitted 12 hours earlier for rule out dementia 40 year old admitted 4 hours earlier with exacerbation of sickle cell crisis who received their last dose of Dilaudid (hydromorphone HCl) 30 minutes earlier 20 year old admitted 8 hours prior after a motor vehicle accident with complaints of severe headache and occasional nausea 18 year old female admitted 1 hour earlier after a possible rape, awaiting a consult with social work. Question 10. 10.Which client should the APN assess first in the emergency department? (Points : 3.75) Client admitted 1 hour prior, NPO for rule out acute pancreatitis and complaining of pain Client with cirrhosis admitted 2 hours ago with confusion, coughing, and hematemesis 70 year old with chronic renal failure admitted 6 hours prior with a possible hip fracture after falling 30 year old drug overdose admitted 112 hours prior with a urine output of 200ml in 8 hours Question 11. 11.In order to be an effective counselor concerning sexuality for a pregnant mother, an APN must first? (Points : 3.75) Have in-depth knowledge about the client and her needs Complete an in-depth study of the sexual behaviors of pregnant females Interview the spouse concerning sexual desires Be aware of her own feelings, values, and attitudes toward sex Question 12. 12.After the occurrence of a potential bioterrorism disaster, what is the best initial action by the APN acting as leader of the disaster response team? (Points : 3.75) Call for additional emergency management personnel Set up a command area near the disaster site Begin to triage victims Assess the scene to determine area safety Question 13. 13.The mother of a 14 year old boy is concerned her son is developing at a slower pace than other boys his age. He has small testes with no pubic or facial hair. The physical exam is unremarkable except for the identifed areas of concern. What is the appropriate response by the APN? (Points : 3.75) Assure the mother her son is developing as expected Suggest a referral to a pediatric endocrinologist for further evaluation Recommend a recheck with possible hormone levels if no improvement in 6 months Admit to the hospital for further diagnostic tests and evaluation Question 14. 14.Which is the best choice by an APN for the initial management of a second degree burn on the left forearm? (Points : 3.75) Irrigate with chlorhexidine and apply a dry dressing Debride the wound and apply a saline wet to dry dressing Irrigate the wound with normal saline and apply Silvadence cream to the effected area twice daily Administer 800mg Motrin (ibuprophen) PO and cover the wound with a sterile dressing Question 15. 15.Which statements are accurate regarding licensure for an advanced practice nurse? (select all that apply) (Points : 3.75) The national certification exam ensures a minimum level of competency to practice All 50 states require passage of the national certification exam to treat clients as an advance practice nurse Licensure is required to claim status as an advance practice nurse and treat clients under the direction of a physician Once licensed as an advanced practice nurse, any governmental agency may review the status of the license Licensure as an advanced practice nurse requires verification of educational training from an accredited graduate program Question 16. 16.A 55 year old male presented to a walk in clinic at a local pharmacy complaining of chest pain radiating to the lower jaw. He is pale, diaphoretic with a blood pressure of 90/40 and a heart rate of 50 beats per minute. What is the next best action by the APN? (Points : 3.75) Assess the lungs bilaterally Obtain a 12 lead electrocardiogram Administer a 81mg Aspirin PO stat Call 911 Question 17. 17.Which statements regarding protocol agreements are true? (select all that apply) (Points : 3.75) A protocol agreement can protect an APN from certain lawsuits A protocol agreement with a physician is a requirement for the APN to practice in the United States If an APN is sued for negligence, the physician engaged in the protocol agreement is not held liable Protocol agreements should be reviewed annually by the physician and the APN. A protocol agreement with a physician is no a requirement for an APN in this country Question 18. 18.Which of these clients do not require parental consent for treatment by an APN? (select all that apply) (Points : 3.75) 16 year old female asking for help with dysmenorrhea 17 year old male needing treatment for chlamydia 14 year old female asking for a serum pregnancy test 15 year old female asking for birth control pills 16 year old male showing signs and symptoms of type 1 diabetes Question 19. 19.A 40 year old landscape worker presented to the ED with a snake bite from a coral snake on the right index finger. The bite occurred 15 minutes earlier. The client reported no difficulty breathing or swallowing only severe discomfort at the bite site. What is the most appropriate action by the APN? (Points : 3.75) Apply a tourniquet to the right upper extremity Refer the client to a hematologist Consult with the neurologist on staff Call the regional poison control center for treatment recommendations Question 20. 20.A 20 year old presented to the emergency department with a confirmed brown recluse spider bite on the right hand. The bite occurred approximately 24 hours earlier and has now become edematous, erythematous and draining a purulent, foul smelling liquid. The wound is painful and extremely wam on palpation. What is the appropriate action by the APN? (Points : 3.75) Immediate referral to a soft tissue surgeon Begin Keflex (cephalexin) PO and refer to an infectious disease specialist Call the poison control center and obtain most current recommended treatment regimen Order Magnetic Resonance Imaging (MRI) of the wound Question 21. 21.A 40 year old presented to a primary care office approximately 30 minutes after a sting by a bee. The client stated, “I was scared since the last time I was stung by a bee I had difficulty breathing”. The site of the bite is painful with slight bleeding and edema. What is the next best response by the APN? (Points : 3.75) “Are you short of breath right now?” “Please describe what happened the last time you were stung.” “What were you doing when you were stung?” “Have you taken any medications since you were stung?” Question 22. 22.A 20 year old male presented to the emergency department (ED) with an acute exacerbation of asthma. Initial treatment was nebulized Proventil (Albuterol) and 100% oxygen via a non-rebreather. A recheck 30 minutes post treatment revealed a lethargic client with a heart rate of 90 beats per minute, respiratory rate of 18 breaths per minute, temperature of 99.8 degrees Fahrenheit, and a blood pressure of 10268. The results of an arterial blood gas (ABG) showed a pH of 7.32, PaCO2 of 47mm Hg, HCO3 24, and a PaO2 of 86%. The most appropriate action by the APN would be? (Points : 3.75) Prepare for intubation with signs of impending respiratory failure Admit to the intensive care unit (ICU) and order a consult with a pulmonologist Treat with intravenous and inhaled steroids and recheck ABG in 30 minutes Begin intravenous Aminophylline and order a d-dimer STAT Question 23. 23.A 16 year old client presented to the ED with circumoral cyanosis and bilateral wheezes on auscultation. The client appeared anxious and is leaning forward with the upper extremities flared out. After initiating oxygen via 2 Liters nasal cannula, an ABG revealed pH 7.36, pCO2 52 mmHg, HCO3 of 26 mEq/L and PaO2 of 60 mm Hg. What is the next best intervention by the APN? (Points : 3.75) Administer Ativan (Lorazepam) 2mg IV Order Proventil (Albuterol) 2 puffs followed with Prednisone 20mg PO for one dose Refer to a pulmonologist immediately Switch oxygen delivery to 55% via Venturi Mask Question 24. 24.An 80 year old male client presented the ED complaining of acute, severe abdominal pain that came on suddenly in the middle of the night. Three years prior he suffered a myocardial infarction (MI) and has been on Lopressor (Metoprolol) 50mg PO twice daily since that time. The abdominal assessment revealed a non-tender abdomen on palpation with no pulsatile masses. Heart rate 110 beats per minute, blood pressure 80/50, respirations 28 breaths per minute, oxygen saturation 88% on 2 liters nasal cannula and hemeoccult positive in the stool. What should the APN consider the most likely diagnosis? (Points : 3.75) Ruptured appendix Mesenteric ischemia Esophageal varices Peritonitis Question 25. 25.The APN is called to examine a client who was ready for discharge after resolution of gastrointestinal bleeding as a sequelae to peptic ulcer disease but has now spiked a temperature of 102.4 degrees Farenheit with slight abdominal discomfort. No nausea or vomiting were reported. The client had been in the hospital for 2 days with no complaints and the bleeding resolved with IV fluids and proton pump inhibitors. What should the APN include in the diagnostic tests? (select all that apply) (Points : 3.75) CBC with differential Barium swallow CT scan of the abdomen Abdominal ultrasound Liver biopsy Electrolyte panel Arterial blood gas Question 26. 26.Which complaint paired with acute abdominal pain would necessitate an immediate referral by the APN to a gastric surgeon? (Points : 3.75) Vomiting nearly every hour since the onset of the abdominal pain 6 hours prior Vomiting beginning 8 hours post onset of severe abdominal pain Vomiting starting 4 hours prior to the onset of the abdominal pain Lack of vomiting with severe abdominal pain of 2 hours duration Question 27. 27.A 48 year old female was presented to the ED by paramedics after a serious motor vehicle accident intubated, unresponsive, with IV Normal Saline and Dopamine at 5 mcg/kg/min infusing. The client’s son meets her at the ED and states, “My mother has a living will and all treatment should be stopped now. This is not what she wanted.” What is appropriate response by the APN? (Points : 3.75) “I must evaluate the client to determine if the living will is applicable in this situation.” “We will not go any further until we see the living will.” “Do you have power of attorney to make this decision?” “We will continue care until the risk management unit can arrive to speak with you.” Question 28. 28.While obtaining consent for an exploratory laparotomy, the client stated, “I am a Jehovah’s Witness and we do not believe in blood transfusions. I will not consent to a blood transfusion.” What is the appropriate response by the APN? (Points : 3.75) “This procedure has a great risk of significant blood loss. I am unable to move forward without your consent.” “You may need a blood transfusion. I suggest you speak with the physician before refusing this possible life saving treatment.” “I would suggest you consider an autologous blood transfusion which should not violate your religious beliefs.” “I understand your right to choose. I have reviewed the risks for the procedure and would ask that you sign this informed consent checking the box indicating refusal of a blood transfusion.” Question 29. 29.Which statement is accurate regarding reimbursement through Medicare for services provided by an APN? (Points : 3.75) Part A covers outpatient care and part B provides reimbursement for inpatient care Medicare reimbursement can be obtained for ANP services at 85% of physician reimbursement for provided in collaboration with a physician State laws guiding Medicaid dispersal directly effect Medicare reimbursement for the APN The APN can only receive Medicare reimbursement for primary care services and not in hospital fees. Question 30. 30.A newly licensed ANP accepted a position at a major tertiary care facility. The liability coverage offered in the employment package contains claims-made malpractice insurance coverage as part of the compensation. What is the best action by the new APN? (Points : 3.75) No further coverage is needed and any incident should be protected Refuse company coverage and negotiate for payment of a liability plan chosen by the APN Request tail coverage and an occurrence based policy as additional terms of the employment contract Hire an attorney specializing in workplace contracts to review the document before accepting the position Question 31. 31.When obtaining informed consent the APN knows the client must understand: (select all that apply) (Points : 3.75) Nature and purpose of the treatment Knowledge of the diagnosis Anticipated costs Alternatives for treatment Benefits of the treatment Risks of the treatment Adverse effects of the treatment Question 32. 32.A 70 year old client receiving palliative care in hospice stated, “I don’t want a CT scan of my head. I do not understand how this will improve my comfort.” When the APN explains the CT scan will not impact palliative care for care, which ethical duty is being implemented? (Points : 3.75) Veracity Autonomy Justice Beneficence Question 33. 33.Which statement is accurate when explaining the National Practitioner Data Bank? (Points : 3.75) This Data Bank is a professional registry for APN’s A governmental resource of current and past legislation pertinent the APN A collection of volutary listings for APN’s based on professional area of licensure and expertise A compilation of legal actions levied against advanced practice nurses and physicians. Question 34. 34.Which choices are goals of pain management in palliative care? (Points : 3.75) prevention of pain alleviation of all pain establishing the cause of pain determination of effective pain managment regimens support of family care givers Question 35. 35.Which statements about hospice care are accurate? (select all that apply) (Points : 3.75) Hospice is available to terminally ill clients Medicare guidelines for referral to hospice care specific that life expectany of the client should be less than 6 months Medicare guidelines for referral to hospice care specific that life expectancy of the client should be less than 1 year Referrals to hospice care can only initiated by a physician Medicare will not pay for in home hospice care Question 36. 36.Which client is considered an appropriate referral to hospice? (Points : 3.75) A 45 year old female with metastatic breast cancer admitted with liver and brain metastasis unable to stand, speak or eat. A 65 year old male admitted for exacerbation of COPD A 33 year old male with human immunodeficiency virus (HIV) infection with Kaposi’s sarcoma A 58 year old male admitted for insertion of a automated implantable cardiac defibrillator (AICD) Question 37. 37.While treating a 30 year old man for viral pneumonia, an HIV test returns positive. The man refuses to tell his wife and threatens the APN with a lawsuit if the wife finds out. What is the appropriate response by the APN? (Points : 3.75) Contact the local health department with the results Set up an appointment with the wife to discuss her husband’s HIV status Explain to the client the importance of informing his wife and the need to support his family Refer the client to an infectious disease specialist and refuse further care due to ethical concerns regarding the wife Question 38. 38.When caring for a 42 year old female with stage IV metastatic breast cancer, the client refuses further treatment and states, “I won’t to go home and be with my family” By discharing the client, which ethical principle is the APN upholding? (Points : 3.75) Nonmaleficence Beneficence Veracity Autonomy Question 39. 39.While caring for a 90 year old client suffering from respiratory and heart failure, what should the APN consider when determining futility of care? (select all that apply) (Points : 3.75) Financial burden of extending care Quality of life Stated client preference if available Stated family preference if available Recommendations by interdisciplinary care team Question 40. 40.What areas should the APN consider vital components of informed consent? (select all that apply) (Points : 3.75) The type of proposed treatment Purpose of proposed treatment Cost of proposed treatment Alternatives to the proposed treatment Prognosis with treatment Prognosis without treatment Legal cases outstanding against the physician performing the procedure Question 41. 41.When explaining the purpose of a diagnostic related group (DRG) to a nurse, the appropriate response by the APN would include: (Points : 3.75) A treatment classification system that assigns a fixed hospital payment rate A previously determined percent of cost paid by the client A classification of payment for the uninsured A graduated scale of cost based on insured and uninsured stats Question 42. 42.A new APN working at a primary care clinic asks her mentor to explain capitation. What is the appropriate response by the senior APN? (Points : 3.75) Basic fee for service provided A fixed fee paid to the provider per patient per month for those patients enrolled in that particular insurance plan Maximum amount paid by an insurer per patient for preventative healthcare Maximum amount of eligibility for coverage for in hospital treatment Question 43. 43.Which individual may issue a certificate of death? (select all that apply) (Points : 3.75) Hospital administrator Physician Coroner Advance practice nurse Medical Examiner Representative from applicable insurance provider Question 44. 44.A 20 year old male with Down’s syndrome presented for a yearly physical exam. He stated, “This paper says you will do a functional status exam. Will that hurt?” What is the appropriate response by the APN? (Points : 3.75) “This exam will require you to read and write.” “No. I will talk with you about what you do everyday, listen to your heart and lungs and talk with you about how you feel.” “We don’t do that exam in the office you will be referred for out patient services at the hospital.” “I don’t do that exam but the physician in this practice will take a look at you.” Question 45. 45.A mother presents her 4 year old to the primary care office and states,”We just found out all the paint in our old house has lead. My child has been vomiting on and off for a week and I am concerned about lead poisoning.” What is the next best intervention by the APN? (Points : 3.75) Call the poison control hotline Immediately refer the child to a pediatric gastroenterologist Order an abdominal ultrasound Obtain blood for serum lead level Question 46. 46.A 20 year old male presented to the ED after suffering a suffering multiple human bites on his right hand and forearm. What the next best intervention by the APN? (Points : 3.75) Refer for a surgical consult Irrigate the wound and leave open to air for drainage Obtain x-rays of the effected limb to ascertain depth of puncture and possible fractures Begin Keflex(Cephalexin) 500mg twice daily PO and recheck in 7 days Question 47. 47.A 50 year old plumber presented the ED after spilling drain cleaner in both eyes. He stated, “I washed both eyes out at the job site with my emergency saline kit but they still burn and are painful.” What is the next best intervention by the APN? (Points : 3.75) Refer to an opthamologist Assess visual acuity Phone the poison control hotline Administer 800mg Motrin (Ibuprophen) PO STAT Question 48.48.An APN student asked the instructor, “Could you explain the meaning of statue of limitations?” What is the correct response by the nursing instructor? (Points : 3.75) A rule which establishes the maximum time allowed for a legal suit to be filed for a particular incident. The amount of proof required to win a legal case of negligence The first date allowable for a client to file a suit claiming malpractice A rule allowing a client to add facilities and ancillary personnel to a suit claiming malpractice