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100 Cards in this Set

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The FNP has a 40-year-old female patient who tells him that she has been losing weight in the past two months but has not changed her eating habits. She says that she is irritable and anxious and has trouble getting to sleep. Upon examination the FNP finds a diffusely enlarged thyroid gland without nodules and tachycardia. Of the following which is the most likely diagnosis for these symptoms?

Grave’s disease


thyroid cancer


hyperprolactinemia


pheochromocytoma




Hide ExplanationExplanation:Correct Answer:Grave’s diseaseGrave’s disease is an autoimmune disorder of the thyroid gland causing hyperfunction and production of excess thyroid hormones. There is a higher incidence in females (8:1 ratio). In later stages of Grave’s disease there can also be exophthalmos (protruding eyeballs).

In a 37-year-old female patient with dysuria, nausea, and urinary frequency, which bacterial count by clean catch method supports a diagnosis of a urinary tract infection?

>5,000


>15,000


>50,000


>100,000




Hide ExplanationExplanation:The correct answer is:>100,000The urinary tract is sterile and no bacteria should be present. When a specimen is collected via clean catch method, the tolerance for organisms is less that 100,000. It is expected that some bacteria from external genitalia will be collected. If the level is greater than 100,000, a urinary tract infection can be correctly diagnosed.

What is Not part of the test for pronator drift?

Patient can be sitting or standing for the test.




Patient's eyes are closed.




Patient's arms are extended and palms supine.




Patient's arms are tapped down.




Hide ExplanationExplanation:Correct Answer:Patient's arms are tapped down.When testing for pronator drift, the patient is asked to hold both arms fully extended at shoulder level in front of them with palms upwards, and to hold the position. Closing the eyes accentuates the effect, because the brain is deprived of visual information about the position of the body and must rely on proprioception. If the patient is unable to maintain the position the result is positive.

In terms of the infectious period for the influenza virus, which of the following statements is false?

Children remain infectious for 10 or more days after the onset of symptoms.




Adults pass the illness on 5 days before the onset of symptoms.




In an immunocompetent adult, the influenza virus has a short incubation period, with a range of 1 to 4 days.




People who are immunocompromised can remain infectious for up to 3 weeks.




Hide ExplanationExplanation:Correct Answer:Adults pass the illness on 5 days before the onset of symptoms.All of the statements are true except this one. Adults pass the illness on one day before the onset of symptoms and continue to remain infectious for approximately 5 days after the onset of the illness.

Jarisch-Herxheimer reaction is a reaction that occurs in approximately 30% of patients treated for which of the following diseases?

gonorrhea


primary syphilis


herpes simplex


chlamydia




Hide ExplanationExplanation:Correct answer:primary syphilis Jarisch-Herxheimer reaction is a reaction that occurs in approximately 30% of patients treated for primary syphilis. It occurs in approximately 70% of those treated for secondary syphilis within 24 hours of treatment.

A patient has a history of drug use. An exam shows that he is losing weight and his glands are swollen. He is also experiencing fever and fatigue. What test would you run?

CTA scan.


ANA.


HIV antibody test.


CPK test.




Hide ExplanationExplanation:Correct answer:HIV antibody testThe patient has risk factors for HIV. He also shows early signs of the condition. An HIV antibody test would be wise.

Which of the following diagnostic studies would you order for a patient who you suspect may have West Nile Virus to confirm this diagnosis?

CSF with IgM antibody for WNV


nasopharyngeal cultures


throat culture


ASO titer




Hide ExplanationExplanation:Correct answer:CSF with IgM antibody for WNV West Nile virus first appeared in the United States in 1999. It is a viral infection causing febrile illness, rash, arthritis, myalgias, weakness, lymphadenopathy, and meningoencephalitis. CSF with IgM antibody for WNV is confirmative.

You have an adult type 2 diabetic client. You are telling him what his goals should be in terms of laboratory test results. All of the following would be appropriate goals EXCEPT:

LDL cholesterol: < 100 mg/dL




A1C: < 7%




preprandial capillary plasma glucose (fasting): 50 – 80 mg/dL




peak postprandial capillary plasma glucose (2 hours after meal: < 180 mg/dL




Hide ExplanationExplanation:Correct Answer:preprandial capillary plasma glucose (fasting): 50 – 80 mg/dLThe appropriate goal for preprandial capillary plasma glucose (fasting) is 70 – 130 mg/dL. Blood pressure should also be under control.

Which of the following is the correct way to measure skin turgor?

Grasp loose skin anywhere on the body and quickly release.




Grasp the skin on the back of the hand, lower arm, or abdomen with two fingers. Tent up the skin for a few seconds, then release.




Tap areas of loose skin with one finger.




Depress the nail bed and see how long it takes for blood to return.




Hide ExplanationExplanation:Correct Answer: Grasp the skin on the back of the hand, lower arm, or abdomen with two fingers. Tent up the skin for a few seconds, then release Skin turgor measures the amount of fluid in the skin. Normal skin will return to its untented condition in a few seconds. The skin on the back of the hand, lower arm, and abdomen are the sites for testing skin turgor. Skin turgor tests can be an important source of data when assessing a patient for dehydration.

Dementia can be difficult to diagnose in some patients. The DSM-IV Cognitive Criteria for Dementia diagnosis requires:

Multiple cognitive deficits including memory impairment.




Memory impairment only.




Multiple cognitive deficits, memory impairment, one or more of the following: aphasia, apraxia, agnosia, or disturbance of executive function.




One or more of the following: aphasia, apraxia, agnosia, or disturbance of executive function




Hide ExplanationExplanation:Correct answer:Multiple cognitive deficits, memory impairment, one or more of the following: aphasia, apraxia, agnosia, or disturbance of executive functionDementia should be distinguished from other conditions such as Alzheimer's. The GNP will use the DSM-IV Criteria to make a diagnosis. The DSM-IV criteria for dementia requires multiple cognitive deficits, memory impairment, one or more of the following: aphasia, apraxia, agnosia, or disturbance of executive function.

A patient comes in with a consistent cough. What about his background makes the cough suspicious?

Osteoporosis.


Obesity.


Exercise.


Asbestos exposure.




Hide ExplanationExplanation:Correct answer: Asbestos exposure Asbestos exposure is linked to lung cancer. A patient with this history should be examined carefully to rule out lung cancer.

You are advising a patient for an exercise regimen for osteoarthritis of the knee. The nurse practitioner has knowledge that all of the following are recommended except:

straight-leg raises without weights, advance to using weights as tolerated




frequent high impact aerobics




non-weight-bearing or limited weight-bearing aeorbic activity




quadriceps sets




Hide ExplanationExplanation:The Correct answer is:Frequent high impact aerobicsHigh impact activities should be avoided in the patient with osteoarthritis of the knee. The patient should also avoid squatting and kneeling frequently. The remaining answer choices are recommended exercises for this condition.

Which of the following ranges of RBCs (in 1 mL of plasma) would be normal for a male?





30% to 40%


25% to 40%


35% to 50%


37% to 49%




Hide ExplanationExplanation:Correct Answer:37% to 49%The proportion of RBCs in 1 mL of plasma is 37% to 49% for males. It is 36% to 46% for females.

The nurse practitioner knows that when assessing a burn, the type that results in the surface being raw and moist is:a first-degree burna second-degree burna third-degree burna fourth-degree burnHide ExplanationExplanation:Correct Answer:a second-degree burnA first degree burn results in affected skin that blanches with ease. A third-degree burn results in the affected area being white and leathery. A fourth-degree burn is a full-thickness burn extending to the muscle or bone.

a first-degree burn


a second-degree burn


a third-degree burn


a fourth-degree burn




Hide ExplanationExplanation:Correct Answer:a second-degree burnA first degree burn results in affected skin that blanches with ease. A third-degree burn results in the affected area being white and leathery. A fourth-degree burn is a full-thickness burn extending to the muscle or bone.

The nurse practitioner knows that when a 66-year-old male patient has suspected acute colonic diverticulitis, imaging studies are warranted. Which of the following abdominal imaging studies is MOST appropriate to support this diagnosis?

CT Scan of the abdomen


Flat and Upright X-ray


Abdominal Ultrasound


Barium Enema




Hide ExplanationExplanation:The Correct answer is:CT Scan of the abdomenAn abdominal CT scan is helpful in identifying findings consistent with the condition, acute colonic diverticulitis, including bowel wall thickening. Complications including fistulas and abscess can also be identified with this diagnostic modality.

A patient is bitten by a cat and comes in to be treated. Before treatment, who/what will need to be consulted?

The cat's owner.


Vaccination records.


Blinking reflex.


Pathology.




Hide ExplanationExplanation:Correct Answer:Vaccination records.Vaccinations should be included in the medical records. The patient may need a tetanus shot or other vaccine to prevent disease. The cat's owner should also be consulted.

If the FNP is giving the Mini-mental exam (MME) to an elderly patient, which subject area is being tested when the FNP asks the patient to spell a word backwards?attention and calculationorientationrecallsentence writingHide ExplanationExplanation:Correct answer:attention and calculation The MME is a brief screening exam to assess for dementia. Five subject areas are tested. The area tested by asking the patient to spell a word backwards is attention and calculation.

attention and calculation


orientation


recall


sentence writing




Hide ExplanationExplanation:Correct answer:attention and calculation The MME is a brief screening exam to assess for dementia. Five subject areas are tested. The area tested by asking the patient to spell a word backwards is attention and calculation.

You are prescribing a high-fiber diet for a patient with diverticulosis. You would recommend all of the following foods as high in fiber EXCEPT:

bran flakes


brown rice


eggs


kidney beans




Hide ExplanationExplanation:Correct answer:eggs Eggs are not high in fiber. In fact they are recommended for low-residue diets.

The FNP has a female patient who suffers from hyperthyroidism. Which of the following would NOT be a characteristic of hyperthyroidism?

tachycardia


weight loss


excessive energy release


cold intolerance




Hide ExplanationExplanation:Correct Answer:cold intoleranceCold intolerance is characteristic of hypothyroidism. Heat intolerance is a characteristic ofhyperthyroidism, along with smooth, silky skin, fine hair with frequent loss and thin nails that break with ease (among a host of other things).

All but which of the following tests are used to confirm a diagnosis of congestive heart disease?

EKG.


chest X-ray.


CBC.


Coronary angiogram.




Hide ExplanationExplanation:Correct Answer: CBCA complete blood count will not reveal congestive heart failure. A blood gas test may indicate difficulty breathing, but congestive heart failure is more likely to be diagnosed with chest x-ray, EKG, and angiogram.

When you are prescribing an antihypertensive agent for a patient with asthma you would avoid prescribing which of the following?

beta blocker


calcium channel blocker


alpha blocker


central alpha agonist




Hide ExplanationExplanation:Correct answer:beta blocker You would avoid prescribing a beta blocker for a patient who has asthma, as well as for patients with COPD. Beta blockers are not cardioselective.

You have diagnosed impetigo in a pre-school-age child. In terms of treatment for this condition which of the following statements is least accurate?

When there are a few lesions, topical therapy with mupirocin (Bactobran) is indicated.




Bacitracin and neomycin are more effective topical treatments and are highly recommended for impetigo.




Mupirocin and oral erythromycin are superior to penicillin as a treatment for impetigo.




Ratapamulin (Altabax) ointment is a newer, effective, but expensive therapeutic option.




Hide ExplanationExplanation:Correct answer:Bacitracin and neomycin are more effective topical treatments and are highly recommended for impetigo. This statement is false. Bacitracin and neomycin are less effective topical treatments and are not recommended for impetigo. When there are numerous lesions, patients should receive oral antimicrobials.

Jim is a 67-year-old patient who you suspect has macular degeneration. You may use which of the following tests to check the central vision of the patient?

Snellen charts


lit lamp examination


amplitude of accommodation


Amsler grid




Hide ExplanationExplanation:Correct answer:Amsler grid Macular degeneration is a gradual change in the pigment in the macula (area of central vision) resulting in blindness. You will check central vision with the Amsler Grid test. If macular degeneration is present, the lines in the center of the grid appear distorted.

You are advising your 55-year-old female patient with diabetes about exercise and diet. You would tell her all but which of the following?

Eat simple carbohydrates before or during exercise and complex carbohydrates after exercise.




Skipping a meal will increase the risk of hypoglycemia in the evening and at bedtime.




Exercising heavily will decrease the risk of hypoglycemia in the evening and at bedtime.




Exercise increases glucose utilization.




Hide ExplanationExplanation:Correct answer:Exercising heavily will decrease the risk of hypoglycemia in the evening and at bedtime. This is the only statement that is not accurate. Exercising heavily will increase the risk of hypoglycemia in the evening and at bedtime and should be avoided.

The nurse practitioner knows that with acute sinusitis all of the following are true EXCEPT:

There are four paranasal sinuses that can become infected.




This is an infection of the sinuses that only involves Gram-positive bacteria.




The most common bacteria involved is Streptococcus pneumoniae.




Most often the patient complains of facial pressure that worsens when bending down.




Hide ExplanationExplanation:The correct answer is:This infection of the sinuses only involves Gram-positive bacteria The infection that causes sinusitis involves both Gram-positive and Gram-negative bacteria and is not isolated only to Gram-positive bacteria. Further, the most common bacteria causing sinusitis is streptococcus pneumoniae. Also, sinusitis can be caused by other bacteria, such as Streptococcus pyogenes. A patient with acute sinusitis complains of pain in the nose, along with symptoms of congestion, bad breath, green or yellow discharge and swelling over the sinus that has the infection. With acute sinusitis, the maxillary sinus, frontal sinus, ethmoid sinus or sphenoid sinus can become infected.

In the management of Parkinson Disease (PD), surgical intervention such as deep brain stimulation surgery can be helpful to manage disease-related symptoms:

that are related to memory loss




to ease the tremors and bradykinesia




when medication therapy is not tolerated or helpful




as a last resort when all other options have been exhausted




Hide ExplanationExplanation:Correct Answer:when medication therapy is not tolerated or helpfulDeep brain stimulation surgery for Parkinson Disease is helpful in making the "off" state more like movement in the "on" state, and is helpful in the reduction of levodopa-induced dyskinesias. As with other therapies, expert consolation should be sought, and all options should be thoroughly discussed with the patient before pursuing surgical intervention.

The FNP has a 25-year-old male patient who is a jogger. He presents with a ball-like mass behind one knee. The FNP tells him that he has a Baker’s cyst. The treatment for this condition may include all but which of the following?

X-ray of knee


RICE


drainage of bursa if large


C&S to rule out infection




Hide ExplanationExplanation:Correct Answer:X-ray of kneeThere would be no need for an X-ray of the knee. The FNP would recommend RICE (rest, ice, compression and elevation), and if the bursa is large, drainage with syringe. If the synovial fluid is cloudy, the FNP may order C&S to rule out infection.

The disease that is characterized by cough, maldigestion, and excessive sodium chloride excretion in sweat and saliva is which of the following?

pertussis


multiple sclerosis


cystic fibrosis


muscular dystrophy




Hide ExplanationExplanation:Correct answer:cystic fibrosis Cystic fibrosis is a multisystem disorder characterized by cough, maldigestion, and excessive sodium chloride excretion in sweat and saliva. It is the most common genetic disorder of the white population.

A 75 year old patient who is hypertensive comes in with a sudden, extreme jump in blood pressure. What is the probable cause?

Temperature.


Cholesterol.


Sodium.


Depression.




Hide ExplanationExplanation:Correct answer: Sodium Sensitivity to sodium increases with age. An elderly patient with hypertension will have a greater effect from eating sodium than a younger patient. African American patients also show greater sodium sensitivity.

You are prescribing Estropipate as the Hormone Replacement Therapy for your elderly patient. Which of the following is a brand name for this drug?

Menest.


Ogen.


Provera.


Aygestin.




Hide ExplanationExplanation:Correct Answer:Ogen.Menest is the brand name for Esterified estrogen and Ogen, Estropipate. Provera is the brand name for Medroxyprogesterone acetate and Aygestin, Norethindrone acetate.

A 21 year old female patient admits to being sexually active in an assessment. What will you recommend the physical exam include?

Abdominal exam.


Respiratory exam.


Pelvic exam.


Breast exam.




Hide ExplanationExplanation:Correct answer:Pelvic exam A pelvic exam is recommended at the age of 21, unless symptoms are present prior to that age.

Which of the following is NOT an advantage of the contraceptive pill after more than five years of use?

decrease in the risk for DVT




risk of ovarian cancer decreases by 40%




decreased incidence of dysmenorrhea and cramps




risk of endometrial cancer decreases by 50%




Hide ExplanationExplanation:Correct answer:decrease in the risk for DVT There is no decrease in the risk for DVT after taking the contraceptive pill for more than five years. In fact, anyone with a history of DVT should not be taking oral contraceptives.

Which of the following is most likely to cause chronic pelvic pain rather than acute pelvic pain?

PID


leiomyomas


ovarian cyst


renal calculi




Hide ExplanationExplanation:Correct answer:leiomyomas Of the choices given leiomyomas are the most likely to cause chronic rather than acute pelvic pain. Other causes of chronic pelvic pain include: endometriosis, malignancy of the uterus, ovary, or colon; adhesions; and interstitial cystitis.

A mother brings her 8-year-old son to your office. She tells you that he has had no immunizations but she would like him to have all of the necessary immunizations now. Which of the following immunizations would NOT be necessary for this child?

PCV (3 doses)


Td (3 doses primary, then every 10 years)


IPV (3 doses)


MMR (2 doses)




Hide ExplanationExplanation:Correct answer:PCV (3 doses) PCV (pneumococcal conjugate vaccine) is not given after age 7 years. All of the other immunizations should be given along with Hepatitis B (3 doses).

You are educating a client who needs to take insulin shots after she tells you that she is having trouble injecting herself. Your continued education for this client includes asking her to state in her own words the key concepts of what you are saying is which of the following?

teach-back


learner verification


summarization


feedback




Hide ExplanationExplanation:Correct answer:teach-back Educators of patients should employ teach-back methods for effective teaching. This means asking clients to state in their own words (teach back) key concepts, decisions, or instructions just discussed.

Type 2 diabetes mellitus testing should be considered in all adults who are overweight and have additional risk factors. All of the following are additional risk factors to consider EXCEPT:

history of cardiovascular disease


women with polycystic ovarian syndrome


member of a high risk population


history of hypotension




Hide ExplanationExplanation:Correct answer:history of hypotension This is not one of the additional risk factors for type II diabetes. All of the other choices are additional risk factors along with: physical inactivity, first-degree relative with diabetes, women who delivered an infant weighing over 9 pounds, women who have had gestational diabetes, hypertension, HDL cholesterol level of < 35 mg/dL, triglyceride level > 250 mg/dL, impaired glucose tolerance and other clinical conditions associated with insulin resistance.

A nurse practitioner (NP) has worked at a large hospital as an RN and now, as a new NP. She has developed an NP-managed clinic for hospital employees and is employed by the hospital. The NP is described as a(n):

risk taker


nurse specialist


intrapreneur


entrepreneur




Hide ExplanationExplanation:The Correct answer is:IntrapreneurAn intrapreneur is someone who is able to carve out a specialty role within an existing organization, healthcare setting, or business setting. An entrepreneur is someone who assumes the financial and personal risks of owning their own business, which they also operate.

You have a patient who is reluctant to talk to anyone. In order to draw her out, you ask her to tell you about her family. This is using which of the following techniques for therapeutic communication?

reflection


open-ended comment


restating


focusing




Hide ExplanationExplanation:Correct Answer:open-ended commentUsing an open-ended comment or question is a therapeutic communication technique. Questions cannot be answered with a one-word answer. It allows the patient to decide what content is relevant.

Which of the following topical corticosteroids has the most potency?

hydrocortisone (0.5%, 1%, 2.5%)


Mometasone furoate 0.1% (Elocon ointment)


Desoximetasone 0.25% (Topicort)


Clobetasol propionate 0.05% (Temovate)




Hide ExplanationExplanation:Correct answer:Clobetasol propionate 0.05% (Temovate) This topical corticosteroid has super-high potency. It is the most potent of any of the topical steroids listed in the choices. Hydrocortisone has low potency; Elocon ointment has mid-range potency; Topicort has high potency.

In treating eczema with corticosteroids, tachyphylaxis may occur. Tachyphylaxis can best be described as which of the following?

progressive loss of effectiveness


burning sensation


numbness


toxic effect




Hide ExplanationExplanation:Correct answer:progressive loss of effectiveness Tachyphylaxis may occur when treating eczema with corticosteroids. This is a progressive loss of effectiveness. To minimize this, use for 10 days and then allow 4 treatment-free days.

Which nursing diagnosis does not indicate possible suicide?

Impaired verbal communication.


Low self-esteem.


Risk of violence against self.


Social isolation.




Hide ExplanationExplanation:Correct answer: Impaired verbal communication A at risk of suicide can have multiple nursing diagnoses. Impaired verbal communication is not necessarily associated with suicide. The other answers are associated with suicide.

A patient with hypertension is in the office and you have prescribed Losartan. Losartan, if taken with which of the following other drugs, can put a patient at risk for developing a renal calculi?

Cimetidine


Ketoconazole


Fluconazole


Oxypurinol




Hide ExplanationExplanation:Correct Answer:Oxypurinol Losartan is an angiotensin II Receptor Antagonist prescribed for the treatment of hypertension. This drugblocks the material in the body that constricts or narrows the blood vessels, then relaxes the blood vessels, allowing the blood to flow more freely and results in a lowered blood pressure. The common side effects of Losartan are dizziness, diarrhea, muscle cramps, heartburn, stuffy nose, pain in the leg, knee or the back. Some serious side effects include chest pain, difficulty breathing and swelling in the face, throat or tongue.Losartan, if taken with certain other drugs, can cause a potential drug interaction. For example, when Losartan is taken with Cimetidine, Losartan increases the serum level of Cimetidine. Then, if Losartan is taken with Fluconazole, Fluconazole reduces the efficacy of Losartan. When Losartan is taken with Oxypurinol, the patient has an increased risk of developing renal calculi. Further, if the patient drinks grapefruit juice with Losartan, grapefruit juice causes a delay in the absorption and decreases the serum levels of the Losartan.

Which of the following types of hearing loss is usually permanent and may be progressive?

hearing loss from cerumen impaction


hearing loss from otitis


sensorineural hearing loss


foreign body resulting in hearing loss




Hide ExplanationExplanation:Correct answer:sensorineural hearing loss Presbycusis and sensorineural hearing loss are usually permanent and may be progressive. Temporary hearing alterations are reversible when related to minor problems such as congestion, otitis, cerumen, or foreign body obstruction that are responsive to treatment.

A person who has been prescribed three daily medications for asthma – an antiinflammatory agent, a long-acting bronchodilator, and an oral glucocorticoid is most likely to have which category of asthma?

severe persistent


moderate persistent


mild persistent


mild intermittent




Hide ExplanationExplanation:Correct answer:severe persistent Severe persistent asthma involves continual symptoms which limit activity. For this stage of asthma three daily medications are usually prescribed, along with a short-acting beta-agonist.

You are going to prescribe a short-acting oral antidiabetic agent for your patient. Which of the following drugs would be a short-acting agent?

Chlorpropamide


Glipizide


Nateglinide


Glimepiride




Hide ExplanationExplanation:Correct Answer:NateglinideNateglinide is a short-acting oral antidiabetic agent. It has a quick onset but should not be taken if a meal is skipped.

During a pap smear, the nurse practitioner notices that the patient's cervix and vagina has a bluish discoloration. This is known as:

Hegar's sign


Braxton Hicks sign


Chadwick's sign


Goodell's sign




Hide ExplanationExplanation:The correct answer is:Chadwick's signChadwick's sign occurs at 6 to 8 weeks' gestation. Further, with Chadwick's sign, the pregnant female's cervix and vagina has a bluish discoloration. Additionally, Hegar's sign is the softening of the lower uterine segment. Braxton Hicks sign consists of uterine contractions. Then, Goodell's sign is the softening of the cervix that is seen as early as 4 weeks gestation.

Which of the following statements by a client with molluscum contagiosum indicates that further teaching is necessary?

“Lesions usually subside without treatment in 2 – 3 weeks.”




“If I have the lesions removed, they may produce scarring.”




“Lesions can be spread by contact with another person.”




“Condoms should be used for sexual intercourse.”




Hide ExplanationExplanation:Correct answer:“Lesions usually subside without treatment in 2 – 3 weeks.” This is incorrect. “Lesions usually subside without treatment in 6 – 9 months.” The patient should be referred to a dermatologist if multiple lesions are unresponsive to treatment.

Which of the following drugs is NOT a preferred antimicrobial for treatment of Lyme disease?





doxycycline


cefuroxime


neomycin


amoxicillin




Hide ExplanationExplanation:Correct answer:neomycin Neomycin is an aminoglycoside. Aminoglycosides are not a preferred treatment for Lyme disease.

You are providing patient education to a patient who has recently been diagnosed with diverticulitis. He asks what changes he can make to his diet to better manage the disease. Which of the following is NOT a recommended dietary change for this patient?

Decrease his fiber intake.




Eat more whole grains.




Avoid highly processed foods.




Eat more roughage, such as cabbage and broccoli.




Hide ExplanationExplanation:Correct Answer:Decrease his fiber intakeDecreasing fiber can worsen diverticulitis attacks. Patients with the condition should consume high fiber and whole grain foods and avoid highly processed foods. When working with geriatric patients, it is important to note that an individual may not be responsible for preparing his or her own meals. During the initial assessment, find out who does the patient's meal prep. If a caregiver does meal preparation for the patient, involve him or her in dietary planning so that appropriate foods can be provided for the patient.

Which of the following sexually transmitted male genitourinary infections is most likely to be caused by the human papillomavirus?g

genital warts


gonococcal urethritis


balanitis


chancroid




Hide ExplanationExplanation:Correct answer:genital warts Genital warts (condyloma acuminate) are caused by the human papillomavirus. They present as verruca-form lesions or they can be subclinical or unrecognized.

Marissa is a 22-year-old female patient suffers from bulimia nervosa. She is experiencing depression which you want to treat. Which of the following antidepressants would you NOT use for Marissa?f

fluoxetine


bupropion


sertraline


paroxetine




Hide ExplanationExplanation:Correct answer:bupropion Bupropion (Wellbutrin) should not be used for patients with bulimia nervosa. It can induce further binging or seizures in patients with BN.

A 5-year-old school age child is in the clinic with varicella. The nurse practitioner has knowledge that the following is the best approach to relieve discomfort in a child with varicella:

aspirin


acetaminophen


alcohol rub


ibuprofen




Hide ExplanationExplanation:The Correct answer is:AcetaminophenAspirin should be avoided in children, especially when they have a viral illness due to Reye syndrome. Ibuprofen is not the best answer choice as it increases the risk of necrotizing fascitis when used in the varicella patient. Then, an alcohol rub will irritate the patient's lesions and exacerbate pain.

You are conducting an assessment with a 32 year old female patient who has presented with difficulty breathing, fatigue, and swollen feet. She has had several bronchial infections this year. Which of the following pieces of information would help you confirm a diagnosis of mitral stenosis for this patient?

The patient had a miscarriage three years ago.




The patient's mother suffered from cardiomyopathy.




The patient had rheumatic fever as a small child.




The patient is vegetarian.




Hide ExplanationExplanation:Correct Answer: The patient had rheumatic fever as a child This is a key piece of information in this patient's diagnosis. Mitral stenosis typically results from rheumatic fever or strep. The symptoms of mitral stenosis can be similar to other cardiac ailments, so knowing the patient's illness history can help an NP make the appropriate differential diagnosis.

As an NP you understand that Whipple’s triad consists of all of the following EXCEPT:

lethargy


low plasma glucose


parasympathetic and sympathetic symptoms


relief with ingestion of carbohydrates




Hide ExplanationExplanation:Correct Answer:lethargyWhile lethargy is a symptom of hypoglycemia, it is not part of Whipple’s triad. The triad consists of the other three choices. The use and significance of the criteria have evolved over the last century as our understanding of the many forms of hypoglycemia has increased and our diagnostic tests and imaging procedures have improved.

You are prescribing oral iron therapy for your 29-year-old female patient with anemia. You will inform the patient of certain drug interactions when taking oral iron. Which of the following is NOT one of these drugs that interact with oral iron therapy?

tetracycline


colchicine


thyroid hormones


fluoroquinolones




Hide ExplanationExplanation:Correct answer:colchicine Colchicine is a drug that interacts with oral vitamin B12 therapy; not iron therapy. It decreases absorption of vitamin B12. Antacids, caffeine, fluoroquinolones,tetracycline, some antihypertensives, thyroid hormones, and histamine-2 receptor antagonists interact with oral iron therapy.

An 76-year-old Asian female who is active has osteoarthritis in her left hip. She complains of daily pain that comes and goes. According to the American College of Rheumatology, what medication is considered first line treatment?

acetaminophen


ibuprofen


propoxyphene


naproxen




Hide ExplanationExplanation:The Correct answer is:AcetaminophenOsteoarthritis is a chronic musculoskeletal condition and the drug of choice is acetaminophen, up to 1000 mg four times daily. Hepatotoxicity is a risk and liver functions must be monitored. Since ibuprofen and naproxen have greater side effects, they are not recommended. Further, an avulsion fracture would need to be ruled out so this patient needs an x-ray performed.

Your patient is a female whom you are treating for severe acne. She has been taking isotretinoin and has been using an effective contraception method to prevent pregnancy. When this patient discontinues the use of isotretinoin she should continue to use an effective contraceptive method for how long?

one year


one month


one week


six months




Hide ExplanationExplanation:Correct answer:one month For women of childbearing age, an effective contraceptive method should be used one month before, during treatment, and one month after discontinuation of treatment with isotretinoin. Before initiating treatment, a pregnancy test should be done to assure that the patient is not pregnant.

Your patient is a 22-year-old pregnant female with impetigo. Your treatment for this patient will include which of the following medications?

Penicillin VK


Augmentin


Vancocin


SMP/TMZ




Hide ExplanationExplanation:Correct answer:Penicillin VK Penicillin VK or erythromycin are the drugs of choice for pregnant and lactating women. Ten-day treatment is usually adequate.

Malcom is a 51-year-old patient with epididymitis. Which of the following findings in your examination of this patient would NOT be consistent with this diagnosis?

scrotum is normal


painful urination


erythema is present


genitalia are extremely tender to touch




Hide ExplanationExplanation:Correct Answer:scrotum is normalThis finding is not consistent with a diagnosis of epididymitis. The scrotum is not normal; it would be swollen. There would be urethral discharge. The elevation of the scrotum above the symphysis pubis would improve the pain.

An elderly patient appears distraught and explains in an interview that there are no friends or family nearby. What is this patient at risk for?

Heart disease.


Chest pain.


Headache.


Depression.




Hide ExplanationExplanation:Correct answer: Depression Lack of socialization is evident in the interview. Loss of socialization contributes to depression. This patient is at risk for depression.

Development of a child is usually assessed in four areas. Which of the following is NOT one of these areas?

personality


gross motor skills


fine motor skills


social skills




Hide ExplanationExplanation:Correct answer:personality Personality is not one of the four areas assessed for child development. The areas include the other three choices along with language.

A patient who has been prescribed azithromycin for a respiratory infection should be advised that all but which of the following are potential side effects?

Feelings of nervousness.


Mild skin rash.


Blurred vision.


Decreased sense of taste.




Hide ExplanationExplanation:Correct Answer:Blurred vision.Blurred vision is not a documented side effect of azithromycin. Patients may experience feelings of nervousness, insomnia, decreased sense of smell and taste, and ringing in the ears. Mild skin rash may also occur. These are not considered serious. If the skin rash spreads or turns purple, immediate medical attention should be sought.

Your patient has warts that have not responded to other treatment. You decide to use a treatment option that needs 4 – 6 weeks to granulate the tissue of treatment-resistant warts. This treatment is which of the following?

laser therapy


keratolytic agents


liquid nitrogen


imiquimod




Hide ExplanationExplanation:Correct answer:laser therapy Laser therapy needs 4 – 6 weeks to granulate the tissue and is best reserved for treatment-resistant warts. It is used to dissect lesions.

Which of the following tests is considered the gold standard for diagnosing endometriosis?

MRI


pelvic ultrasound


laparoscopy


none of the above




Hide ExplanationExplanation:Correct answer:laparoscopy Laparoscopy is considered the gold standard for diagnosing endometriosis. It enables direct visualization of endometrial implants.

After thorough examination and testing of your elderly patient, it is determined that she has T1 breast cancer. What does this mean?T

Tumor more than 2 cm but not more than 5 cm in greatest dimension.


Tumor more than 5 cm in greatest dimension.


No evidence of primary tumor.


Tumor 2 cm or less in greatest dimension.




Hide ExplanationExplanation:Correct answer: Tumor 2 cm or less in greatest dimension T0 - No evidence of primary tumor. T1 - Tumor 2 cm or less in greatest dimension. T2 - Tumor more than 2 cm but no more than 5 cm in greatest dimension. T3 - Tumor more than 5 cm in greatest dimension.

A patient begins bleeding after a medical procedure. What is the correct course of action?

Use appropriate intervention.


Contact doctor.


Contact superior.


Hold pressure.




Hide ExplanationExplanation:Correct Answer:Contact doctor.Bleeding after a medical procedure is a collaborative problem. It is not a nursing diagnosis, which means nursing intervention does not apply. The doctor needs to be contacted.

Mr. Johnson has been diagnosed with Tinea unguium. This is an infection of the _____.

Scalp.


Beard.


Nails.


Elbows.




Hide ExplanationExplanation:Correct Answer:Nails. Tinea capitis: Fungal infection of scalpTinea barbae: Fungal infection of beardTinea unguium: Fungal infection of nailsTinea versicolor: Typically multicolored fungal infection of torso and neck

A patient who has been prescribed simvastatin should be educated about all but which of the following potential side effects?

Decreased sex drive.


Yellowing of the skin or eyes.


Muscle pain.


Weakness.




Hide ExplanationExplanation:Correct Answer:Decreased sex drive. Decreased sex drive is not a documented side effect of simvastatin. Potential side effects do include yellowing of the skin or eyes, muscle pain, and weakness. All should be considered potentially serious and immediate medical attentions should be sought.

Which of the following are characteristics associated more with Chlamydia-caused conjunctivitis than other causes?

associated with cold sores


may follow a viral infection


copious amounts of purulent discharge


genitourinary symptoms also present




Hide ExplanationExplanation:Correct answer:genitourinary symptoms also present This is the only choice that is specifically related to Chlamydia-caused conjunctivitis. This type of conjunctivitis can lead to blindness and is associated with genital infection.

You are assessing the vision of Mr. Franklin, a 70-year-old patient. You know that in this assessment you may find a number of changes. One change that you are NOT likely to see would be which of the following?

arcus senilis


glaucoma


cataracts


increase in tear production




Hide ExplanationExplanation:Correct answer:increase in tear production There are many age-related vision conditions that may be found in an elderly patient. Some of them are: presbyopia, arcus senilis, cataracts, and glaucoma. There is not likely to be an increase in tear production. However, it is common to find a decrease in tear production.

Martin is a 48-year-old male patient who is complaining of a red and irritated area in the groin. You understand that this is which of the following?

tinea corporis


tinea cruris


tinea unguium


tinea manuum




Hide ExplanationExplanation:Correct answer:tinea cruris Tinea is a fungal infection caused by an organism known as dermatophyte, which is capable of colonizing keratinized tissues. Tinea cruris (jock itch) is a fungal infection of the groin areas, including genitalia, pubic area, and perineal and perianal skin.

You are educating a group of menopausal women about hormone replacement therapy (HRT). In talking about the risks and benefits of HRT which of the following statements is NOT correct?

HRT is related to an increased risk of breast cancer.




HRT is related to an increased risk for coronary artery disease.




HRT is related to a decrease in deep vein thrombosis (DVT).




HRT is related to an increased risk of stroke.




Hide ExplanationExplanation:Correct answer:HRT is related to a decrease in deep vein thrombosis (DVT). This statement is NOT true. HRT is related to an increase in DVT. Recent studies have shown that it is also related to an increased risk of breast cancer, heart disease and stroke.

Nurse Annie is examining a patient diagnosed with hypothyroidism. He has been prescribed a synthetic hormone to help regulate his hormone levels. What is one of the risks Annie will monitor the patient for during future follow ups?

Increased appetite.


Possible night sweats.


Cardiac problems.


Leg cramps.




Hide ExplanationExplanation:Correct Answer:Cardiac problems.Patients treated for types of thyroidism have an increased risk for angina or cardiac symptoms. This is usually due to the increased amount of synthetic hormones introduced to the body. Patients on treatment for thyroidism are usually monitored for any heart related illness and should report any symptoms that may occur.

In terms of treatment for warts, which of the following treatment options needs 4 – 6 weeks to granulate the tissue and is best reserved for treatment-resistant warts?

liquid nitrogen


keratolytic agents


laser therapy


imiquimod




Hide ExplanationExplanation:Correct Answer:laser therapyLaser therapy needs 4 – 6 weeks to granulate the tissue and is best reserved for treatment-resistant warts. It is used to dissect lesions.

Jackie is a 35-year-old female patient who presents with an acute onset of painful red nodules and pustules under her left axilla. She reports that they have begun to drain a pus-like liquid. Your most likely diagnosis of the following is:

impetigo


pityriasis rosea


hidradenitis suppurativa


psoriasis




Hide ExplanationExplanation:Correct answer:hidradenitis suppurativa Hidradenitis suppurativa is a bacterial infection of the sebaceous glands of the axilla by Gram-positive S. aureus. It is marked by flare-ups and resolution.

A patient who has loss of urine with activity that causes increase in intra-abdominal pressure, such as coughing, sneezing or exercise has which of the following types of urinary incontinence?

urge incontinence


stress incontinence


urethral obstruction


transient incontinence




Hide ExplanationExplanation:Correct answer:stress incontinence Stress incontinence is the most common form of incontinence in women; it is rare in men. It is caused by a weakness of the pelvic floor and urethral muscles. It is characterized by a loss of urine with activity that causes increase in intra-abdominal pressure, such as coughing, sneezing or exercise.

As an FNP you would understand that the education of adults in medical practice will differ from the education of children because adults learn differently. This theory of adult educations is which of the following?

andragogy


experiential learning


pedagogy


active learning




Hide ExplanationExplanation:Correct answer:andragogy Andragogy is the theory of adult education that is based on the recognition that adults learn differently from the way children learn; and that their instruction should therefore be different. Adults bring rich experience to the learning situation and are generally independent learners.

The FNP would counsel a person considering bariatric surgery for weight loss with all of the following statements EXCEPT:
The average weight loss with the gastric band procedure is 40 – 60% of body weight.



About 95% of patients lose a great deal of weight without major complications and maintain this loss long-term.




With gastric bypass, the expected weight loss is approximately 70 – 80% of excess body weight.




About 5% have major unresolved problems over time.




Hide ExplanationExplanation:Correct answer:About 95% of patients lose a great deal of weight without major complications and maintain this loss long-term. This is incorrect. About 80% of patients lose a great deal of weight without major complications and maintain this loss long-term. With gastric bypass, expert consultation on micronutrient supplementation should be sought to avoid anemia and other health problems.

The Wagner Ulcer Grade Classification Scale categorizes dysvascular ulcers based on wound depth and the presence of infection. On this scale a grade of 4 would indicate which of the following?
superficial ulcer not involving subcutaneous tissue



deep ulcer with osteitis, abscess, or osteomyelitis




gangrene of digit




gangrene of foot requiring disarticulation




Hide ExplanationExplanation:Correct answer:gangrene of digit A grade of 4 on the Wagner Ulcer Grade Classification Scale indicates gangrene of a digit. The scale has ratings of 0 (no open lesion) to 5 (gangrene of foot requiring disarticulation). This scale is most commonly associated with the assessment of diabetic foot ulcers.

Which of the following patients has the highest risk factor for peptic ulcer disease?
a 65-year-old female who drinks 4 cups of coffee per day



a 45-year-old male who has one or two alcoholic drinks per day




a 55-year-old male who regularly uses NSAIDs




none of the above




Hide ExplanationExplanation:Correct answer:a 55-year-old male who regularly uses NSAIDs This is the patient who has the greatest risk factor for peptic ulcer disease. Coffee drinking and occasional alcohol use are not risk factors for peptic ulcer disease. H. pylori is also found in individuals with asymptomatic gastritis and dyspepsia without ulceration.

Which of the following would not be considered primary prevention of disease and/or injury?
wearing seatbelts

immunizations


mammogram


health education




Hide ExplanationExplanation:Correct answer:mammogram Mammograms are secondary prevention. Secondary preventive measures are meant to detect disease early to minimize bodily damage.

Marian is a 52-year-old female who has MI symptoms. You know that which of the following is an absolute contraindication to thrombolytic therapy in this patient?a history of poorly controlled hypertensionmultiple pregnanciesany prior intracranial hemorrhageactive peptic ulcerHide ExplanationExplanation:Correct answer:any prior intracranial hemorrhage Any prior intracranial hemorrhage is an absolute contraindication for thrombolytic therapy in a patient with MI symptoms. All of the other choices are relative contraindications.
a history of poorly controlled hypertension

multiple pregnancies


any prior intracranial hemorrhage


active peptic ulcer




Hide ExplanationExplanation:Correct answer:any prior intracranial hemorrhage Any prior intracranial hemorrhage is an absolute contraindication for thrombolytic therapy in a patient with MI symptoms. All of the other choices are relative contraindications.

A patient has abnormally high white blood cell count. Which test would you order to confirm or rule out a diagnosis of leukemia?
CTA scan.

DEXA scan.


MRI.


Bone marrow test.




Hide ExplanationExplanation:Correct Answer:Bone marrow test.A high white blood cell count may indicate that a patient has leukemia. A bone marrow test will show any leukemia cells that are present.

In uncomplicated diverticulitis, which of the following medications is the antibiotic of choice?
amoxicillin-clavulanate ER



combination of metronidazole and


ciprofloxacin




moxifloxacin




all of the above




Hide ExplanationExplanation:Correct Answer:all of the aboveAll of the above are acceptable treatment options in uncomplicated diverticulitis.

Surgical intervention in the management of benign prostatic hypertrophy (BPH) should be considered with all of the following EXCEPT:
recurrent complicated urinary tract infections

acute tubular necrosis


urinary bladder stones


failure on medication therapy




Hide ExplanationExplanation:Correct Answer:acute tubular necrosisWhen lifestyle modification and medication therapy fail, surgical intervention should be considered. Also, recurrent urinary tract infections, recurrent or persistent gross hematuria, bladder stones, or renal insufficiency would warrant surgery.

Zoey is assessing a patient wound on their leg that has not healed with typical treatment. What is the next step in the patient's care plan?

Use a moist, sterile saline gauze.

Wrap with dry sterile gauze dressing.


Cover with a moist, alcohol soaked pads.


Refer the patient to a wound care specialist.




Hide ExplanationExplanation:Correct answer:Refer the patient to a wound care specialistSince Zoey has acknowledged that the wound is not healing with regular treatment, the next step in the patient's care plan is to refer him to a wound healing specialist. The specialist will be able to better assess the wound and increase the patient's chances of healing faster.

After thorough testing, the ANP decided it is best to treat his patient with a Protease Inhibitor. Which of these is an example of a Protease Inhibitor?

Minocycline.

Tenofovir.


Indinavir.


Alatrofloxacin.




Hide ExplanationExplanation:Correct answer:IndinavirTenofovir - Nucleotide Reverse; Transcriptase Inhibitor; Indinavir - Protease Inhibitor; Alatrofloxacin - Quinolone; Minocycline - Tetracycline

You are conducting an assessment with a patient and notice several flat, colored areas on the skin. These are not large, nor are they raised or textured. These should be charted as which of the following?

Papules.

Macules.


Plaques.


Pustules.




Hide ExplanationExplanation:Correct Answer: Macules Macules are small, flat, colored areas of skin. They are sometimes the result of other skin conditions, such as acne. They should be charted.

Maura is a 65-year-old female patient who has just started to have pain in her fingers in the morning which disappears. She experiences pain after she has been working with her hands. You have determined that the pain is not from participating in sports or overuse of the fingers. She has no metabolic disorder and has had no joint trauma from injury. Your diagnosis will most likely be which of the following?
rheumatoid arthritis

osteoarthritis


tendinitis


gout




Hide ExplanationExplanation:Correct answer:osteoarthritis Osteoarthritis is a degenerative joint disease with progressive loss of articular cartilage in moveable joints. It results from both mechanical and biologic events that lead to degradation of articular cartilage and subchondral bone in joints. It presents with a gradual onset of pain, tenderness, and stiffness that worsens with activity. Morning stiffness is common, but disappears after an hour or less.

Which of the following lab results for your adult male patient would be out of the normal range?
hematocrit: 40%

hemoglobin: 11.0 g/dL


MCV: 90 fL


MCHC: 32 g/dL




Hide ExplanationExplanation:Correct answer:hemoglobin: 11.0 g/dL The normal range for hemoglobin in males is 13.0 to 18.0 g//dL. All of the other results are within the normal range.

Which of the following is NOT a tertiary prevention measure?
cardiac rehabilitation

Alcoholics Anonymous


pain management program


testing for STDs




Hide Explanation Explanation: Correct answer: testing for STDs Testing for STDs is a secondary prevention measure, i.e., one that is used for detection of disease early enough to minimize bodily damage. Tertiary prevention is rehabilitation and avoidance of further bodily damage. Examples of tertiary prevention include pain management programs, cardiac rehabilitation, and support groups.

Your patient is a 14-year-old female whom you have diagnosed as suffering from anorexia nervosa. You are educating her parents about anorexia. You would NOT tell the parent which of the following?
Approximately 90% of patients are female.



The maximum frequency of occurrence is 13 – 14 years of age.




It is associated with depression in 65% of cases.




It is associated with OCD in 26% of cases.




Hide ExplanationExplanation:Correct answer:The maximum frequency of occurrence is 13 – 14 years of age. This is not an accurate statement. The maximum frequency of occurrence is 17 – 18 years of age. About 85% of cases have onset usually at 14 – 18 years of age.

Which of the following would you expect to see from a patient who is leaking cerebrospinal fluid?
Thick, bloody nasal discharge.

Thin, yellowish green nasal discharge.


Thin, clear nasal discharge.


Thin, pinkish nasal discharge.




Hide ExplanationExplanation:Correct Answer: Thin, clear nasal discharge Cerebrospinal fluid is clear. A patient with clear, thin nasal discharge should be further assessed for a cerebrospinal fluid leak.

Which of the following drugs is a neuropathic analgesic?
Cefalexin

Gabapentin


Ciprofloxacin


Dicloxacillin




Hide ExplanationExplanation:Correct Answer:GabapentinGabapentin is a neuropathic analgesic. The other drugs are not. Other neuropathic analgesics are carbamazepine and amitriptyline.

What is a cue that a patient is ready for a wellness diagnosis?
Function is not effective.

Desire for progress.


Family desire for progress.


Severe diagnosis.




Hide ExplanationExplanation:Correct Answer:Desire for progress.There are two cues that indicate a patient is ready for a wellness diagnosis. One is effective function. The other is a desire for progress or wellness.

A patient who has been prescribed azithromycin should be advised that all but which of the following are potential side effects?
Feelings of nervousness.

Decreased sense of taste.


Blurred vision.


Ringing in the ears.




Hide ExplanationExplanation:Correct Answer:Blurred vision.Blurred vision is not a documented side effect of azithromycin. Patients may experience feelings of nervousness, insomnia, decreased sense of smell and taste, and ringing in the ears. These are not considered serious.

If your patient has angle-closure glaucoma you will find which of the following symptoms?
slow development

no pain


normal pupil


halos around light




Hide ExplanationExplanation:Correct Answer:halos around lightAngle-closure glaucoma symptoms include seeing halos around light. They also include severe unilateral ocular pain, blurred vision, lacrimation, photophobia, frontal ipsilateral headaches, nausea and vomiting.

You are counseling a patient with Type II diabetes. The nurse practitioner understands that the macronutrient with the most influence on postprandial glucose levels is:
fat

carbohydrate


fiber


protein




Hide ExplanationExplanation:The Correct answer is:CarbohydrateThe macronutrient that has the greatest impact on postprandial glucose levels is carbohydrates. Protein and fiber have little effect on plasma glucose response. Fat is associated with increased risk of cardiovascular disease and does not affect postprandial glucose levels.

Mrs. Anderson suffers from psoriasis. Your physical examination of Mrs. Anderson is likely to reveal which of the following?
patches of hair loss

pitting of nails


thick keratotic scaling


inflammation of the oral cavity




Hide ExplanationExplanation:Correct Answer:thick keratotic scaling This is a symptom associated with psoriasis, a common benign, skin disease with scaling papules and plaques in characteristic distribution. The distribution of the scaling is usually symmetrical and involves the scalp, extensor surfaces, and areas subject to trauma.

The diagnosis of hypertension (HTN) should be established on the basis of:
at least five readings one month apart
one reading taken in three different positions
one reading of 140 mm Hg systolic and 90 mm Hg diastolic or above
at least two hypertensive readings on two separate days
Hide ExplanationExplanation:Correct Answer:at least two hypertensive readings on two separate daysThe diagnosis of hypertension (HTN) from a single measurement of blood pressure (BP) elevation should not be done. A minimum of two readings with an average systolic BP of 140 mm Hg and diastolic of 90 mm Hg establishes the diagnosis. An average of two or more readings should be taken at each of the two or more visits following an initial screening.