Family Nurse Practitioner Clinical Internship I (D122)

Correct answer:

B. cold compresses

Explanation:

Viral conjunctivitis, commonly caused by adenoviruses, is typically self-limiting and does not require antibiotics or steroids. Supportive treatment includes the use of cold compresses to reduce inflammation and discomfort, along with artificial tears to alleviate dryness and irritation. Since viral conjunctivitis is highly contagious, patients should also practice good hygiene to prevent spreading the infection.

Why other options are wrong:

A. antihistamine and decongestant drops Antihistamine and decongestant drops are primarily used to treat allergic conjunctivitis, not viral conjunctivitis. While they can reduce redness and irritation in allergic cases, they do not address the underlying viral infection or significantly alleviate symptoms of viral conjunctivitis.

C. hot compresses Hot compresses are typically recommended for bacterial conjunctivitis or conditions like a stye, as they help loosen debris and promote drainage. However, for viral conjunctivitis, heat may worsen symptoms by increasing inflammation and discomfort. Cold compresses are preferred to soothe irritation.

D. steroid eye drops Steroid eye drops are not recommended for viral conjunctivitis because they can suppress the immune response, potentially prolonging the infection or leading to complications such as secondary bacterial infections or worsening of viral keratitis. Steroids should only be used under specialist guidance for specific eye conditions.

Correct answer B. mitral regurgitation

Explanation:

Mitral regurgitation is characterized by a holosystolic murmur best heard at the apex and radiating to the left axilla. The soft first heart sound occurs due to incomplete mitral valve closure during systole. This condition results from mitral valve incompetence, allowing blood to flow backward into the left atrium, increasing atrial pressure and causing volume overload. Chronic mitral regurgitation can lead to left atrial enlargement, pulmonary congestion, and heart failure if left untreated.

Why other options are wrong:

A. aortic stenosis

Aortic stenosis presents with a crescendo-decrescendo systolic murmur heard best at the right upper sternal border and radiating to the carotids. It is typically associated with a harsh ejection sound rather than a soft first heart sound or a holosystolic murmur at the apex.

C. mitral stenosis

Mitral stenosis is associated with a low-pitched, diastolic rumbling murmur heard best at the apex with an opening snap. It does not present with a holosystolic murmur. Instead, it results from restricted blood flow through the mitral valve, leading to left atrial enlargement and pulmonary hypertension.

D. mitral valve prolapse

Mitral valve prolapse typically produces a mid-systolic click followed by a late systolic murmur. The murmur does not radiate to the axilla and is not holosystolic. It occurs due to abnormal mitral valve leaflet displacement into the left atrium during systole.

Correct answer D. Candidates must submit a transcript of coursework to date or a conferred degree.

Explanation:

In the AANP MSN application process, candidates are required to submit their transcript, which includes their coursework to date or a conferred degree. This is a key requirement to verify their academic qualifications and completion of a graduate-level nurse practitioner program, ensuring they meet the necessary educational standards for certification.

Why other options are wrong:

A. Candidates must provide a letter of recommendation from their program director – While letters of recommendation may be important for other applications, it is not typically a requirement in the AANP certification application process for submitting educational credentials.

B. Candidates must submit proof of clinical hours completed – Although clinical hours are essential for certification, this requirement is generally validated by the transcript and program details, rather than needing separate proof of hours.

C. Candidates must provide a personal statement about their career goals – A personal statement is not a primary requirement for submitting educational credentials in the AANP application process.

Correct answer:

B. Consult state laws, collaborate with a physician, and adhere to employer policies.

Explanation:

To ensure compliance when prescribing controlled substances, an FNP must follow state laws, collaborate with a physician if required, and adhere to their employer’s policies. States with restrictive regulations may have specific guidelines for prescribing controlled substances, and FNPs must ensure they follow these rules. Collaboration with a physician may be necessary in some jurisdictions, and employer policies can provide additional guidance.

Why other options are wrong:

A. Prescribe without consulting anyone since they are licensed. 

This is incorrect. Even though an FNP is licensed, controlled substance prescribing is often governed by specific state laws and employer policies. Failing to follow these can result in legal or professional consequences.

C. Consult only with colleagues and disregard formal regulations.

This is highly unprofessional and potentially illegal. State laws and regulations supersede informal consultations, and disregarding them can lead to serious consequences for licensure and patient safety.

D. Only follow employer policies and ignore state laws. 

This is incorrect because state laws are legally binding, and an FNP must always follow state regulations regarding prescribing controlled substances. Employer policies must also be followed, but they cannot override state law.

Correct answer D. perceptual disturbance, and suspects the use of cocaine.

Explanation:

The sensation of bugs crawling under the skin (formication) is a well-known tactile hallucination associated with stimulant use, particularly cocaine and methamphetamine. This is classified as a perceptual disturbance rather than a developmental disorder or sleep-related hallucination.

Why other options are wrong:

A. Developmental disorder, and suspects cocaine use.

Formication is not a feature of developmental disorders. Cocaine use can cause perceptual disturbances, but developmental disorders are unrelated to this symptom.

B. Hypnagogic hallucination, and suspects schizophrenia.

Hypnagogic hallucinations occur when falling asleep and are not typically associated with schizophrenia. They are generally benign and do not involve drug use or psychiatric conditions.

C. Hypnopompic hallucination, and suspects schizophrenia.

Hypnopompic hallucinations occur when waking up and are also not indicative of schizophrenia. Tactile hallucinations like formication are more closely linked to substance use rather than sleep-related phenomena.

Correct answer C. sexual dysfunction.

Explanation:

Sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI), is commonly associated with sexual dysfunction as a side effect. Patients may experience decreased libido, difficulty achieving orgasm, or erectile dysfunction. It is important for the nurse practitioner to educate patients about this potential side effect, as it can affect adherence to the medication.

Why other options are wrong:

A. agranulocytosis – Agranulocytosis is a rare and serious side effect of certain medications, but it is not commonly associated with sertraline. SSRIs like sertraline do not typically cause agranulocytosis.

B. hypernatremia – While hypernatremia can occur with some medications, it is not a common side effect of sertraline. Sodium levels may be altered in some cases, but it is not a primary concern for this drug.

D. weight loss – Weight changes can occur with SSRIs, but they are more commonly associated with weight gain rather than weight loss. Sexual dysfunction remains a more prominent side effect for education.

Correct answer C: long latency period between exposure and disease development

Explanation:

One of the most challenging aspects of identifying occupational exposure to a disease is the long latency period between initial exposure and the onset of symptoms. Many occupational diseases, such as asbestosis, mesothelioma, and certain chemical-induced cancers, take years or even decades to develop. This delay complicates the ability to establish a clear link between workplace exposure and disease, making prevention and compensation efforts more difficult. Additionally, by the time symptoms appear, workers may no longer be employed in the same industry, further obscuring the association.

Why other options are wrong:

A. confidentiality of the information within company records

While confidentiality concerns can sometimes limit access to employee health records, this is not the primary challenge in determining occupational exposure. Regulations such as the Occupational Safety and Health Administration (OSHA) standards allow for controlled access to necessary data in occupational health investigations. Additionally, aggregated data and epidemiological studies can often circumvent individual privacy concerns while still identifying occupational health risks.

B. inaccuracy of occupational disease reporting

Although underreporting and misclassification of occupational diseases can be an issue, it does not pose as significant a challenge as the long latency period. Many occupational diseases are not immediately reported due to lack of awareness or misdiagnosis, but systematic data collection and occupational health surveillance programs help mitigate this problem. Furthermore, reporting inaccuracies can often be corrected over time, whereas a long latency period is an inherent biological limitation.

D. reliance on workers' memories

While workers’ recollections of their exposure history can be unreliable, this issue is often addressed through workplace records, industrial hygiene reports, and exposure assessments. Employers are required to maintain records of hazardous exposures, and occupational health professionals use multiple data sources to reconstruct exposure histories. Therefore, while memory recall can be a limitation, it is not as significant a challenge as the long latency period.

Correct answer A. hepatitis 

Explanation:

Hepatitis B is a significant risk factor for liver cancer, particularly hepatocellular carcinoma. In many parts of Asia, including Vietnam, hepatitis B virus (HBV) infection is endemic, and chronic infection often leads to liver disease and cancer. Given the patient's family history of liver cancer and their Vietnamese ethnicity, the nurse practitioner should consider them at high risk for HBV infection and related complications. Screening and vaccination, if necessary, are critical preventive measures.

Why other options are wrong:

B. malaria Malaria is a mosquito-borne infectious disease common in tropical and subtropical regions, including parts of Vietnam. However, it does not have a known direct link to liver cancer. While severe malaria can affect liver function, it does not predispose a person to hepatocellular carcinoma.

C. tularemia Tularemia is a bacterial infection caused by Francisella tularensis and is not associated with liver cancer. It is transmitted through contact with infected animals, insect bites, or contaminated environments, but it does not pose a long-term cancer risk.

D. tyrosinemia Tyrosinemia is a rare metabolic disorder that affects the breakdown of tyrosine, leading to liver dysfunction and, in severe cases, hepatocellular carcinoma. However, it is a genetic disorder typically diagnosed in infancy or childhood rather than as a risk factor related to family history of liver cancer in adulthood.

Correct answer B. Let's discuss the risks of potentially changing your medications.

Explanation:

The psychiatric-mental health nurse practitioner should first engage in a discussion about the potential risks and benefits of altering the patient’s medication regimen before considering research participation. Bipolar disorder can be highly sensitive to medication changes, and informed decision-making is crucial in balancing the patient's mental stability with potential research benefits.

Why other options are wrong:

A. All drug treatments are too risky for you at this time in your illness. 

This response is overly dismissive and does not take into account the individual circumstances of the patient. While experimental drugs do carry risks, a blanket statement discouraging all treatment options is inappropriate.

C. We will have to see if you meet the inclusion criteria for this research study.

While eligibility is an important factor, the first step should be discussing the potential impact of changing medications rather than focusing solely on study criteria. The patient's well-being must be prioritized before research participation is considered.

D. You will have only a small chance of receiving the experimental drug. 

While this may be true in studies with placebo groups, the main concern at this stage should be the risks and benefits of participating rather than the probability of receiving the experimental medication.