When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD):
A. Hemoglobin <12 g/dl, MCV decreased, MCH decreased
B. Hemoglobin >12 g/dl, MCV increased, MCH increased
C. Hemoglobin <12 g/dl, MCV normal, MCH normal
D. Hemoglobin >12 g/dl, MCV decreased, MCH increased
Hemoglobin <12 g/dl, MCV normal, MCH normal
Rationale: Hemoglobin (Hgb): <12 g/dL (120 g/L) women <13 g/dL (130 g/L) men Rarely <10 g/dL (100 g/L) Mean corpuscular volume: 80-96 mcm3 (normocytic) Mean corpuscular hemoglobin Normochromic (normal color) RBC distribution width: normal
Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except:
A. Sore throat
B. Fever
C. Weight loss
D. Headache
C. Weight loss
In AR disorders, carriers have:
A. Two mutated genes; two from one parent that cause disease
B. A mutation on a sex chromosome that causes a disease
C. A single gene mutation that causes the disease
D. One copy of a gene mutation but not the disease
D. One copy of a gene mutation but not the disease
Rationale: Individuals who have an AR disorder have two mutated genes, one on each allele of the chromosome. Parents of an affected person are called carriers because each parent carries one copy of the mutation on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease. In pedigrees with an AR inheritance patterns, males and females will be equally affected because the gene mutation is on an autosome. Goolsby page 28
The major impact of the physiological changes that occur with aging is :
A. Reduced physiological reserve
B. Reduced homeostatic mechanisms
C. Impaired immunological response
D. All of the above
D. All of the above
Men have faster and more efficient biotransformation of drugs and this is thought to be due to:
A. Less obesity rates than women
B. Prostate enlargement
C. Testosterone
D. Less estrogen than women
C. Testosterone
The cytochrome p system involves enzymes that are generally Inhibited by drugs :
A. Inhibited by drugs
B. Induced by drugs
C. Inhibited or induced by drugs
D. Associated with decreased liver perfusion
C. Inhibited or induced by drugs
Functional abilities are best assessed by :
A. Self-report of function
B. Observed assessment of function
C. A comprehensive head-to-toe examination
D. Family report of function
B. Observed assessment of function
Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data?
•Hemoglobin and Hematocrit
•Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)
•Serum ferritin and serum iron
•Total iron binding capacity and transferrin saturation
Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)
The pathophysiological hallmark of ACD is:
•Depleted iron stores
•Impaired ability to use iron stores
•Chronic uncorrectable bleeding
•Reduced intestinal absorption of iron
Impaired ability to use iron stores
The main focus of treatment of patients with ACD is:
•Replenishing iron stores
•Providing for adequate nutrition high in iron
•Management of the underlying disorder
•Administration of monthly vitamin B12 injections
Management of the underlying disorder
In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA?
•Serum iron
•Total iron binding capacity
•Transferrin saturation
•Serum ferritin
Serum ferritin
The first step in the genomic assessment of a patient is obtaining information regarding:
•Family history
•Environmental exposures
•Lifestyle and behaviors
•Current medications
•Family history
Essential parts of a health history include all of the following except:
•Chief complaint
•History of the present illness
•Current vital signs
•All of the above are essential history components
Current vital signs
Vital signs are part of the physical examination portion of patient assessment, not part of the health history
Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients?
•Clinical practice guideline
•Clinical decision rule
•Clinical algorithm
•Clinical recommendation
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain situations, settings, and/or patient characteristics.
A woman with an X-linked dominant disorder will:
•Not be affected by the disorder herself
•Transmit the disorder to 50% of her offspring (male or female)
• Not transmit the disorder to her daughters
•Transmit the disorder to only her daughters
•Transmit the disorder to 50% of her offspring (male or female)
Which of the following would be considered a "red flag" that requires more investigation in a patient assessment?
•Colon cancer in family member at age 70
•Breast cancer in family member at age 75
•Myocardial infarction in family member at age 35
•All of the above
Myocardial infarction in family member at age 35
Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as:
•Variable expressivity related to inherited disease
•Dysmorphic features related to genetic disease
•De novo mutations of genetic disease
•Different penetrant signs of genetic disease
In order to provide a comprehensive genetic history of a patient, the NP should:
Aa. Ask patients to complete a family history worksheet
B. Seek out pathology reports related to the patient's disorder
C. Interview family members regarding genetic disorders
D. All of the above
ANS: D
Asking the patient to complete a family history worksheet prior to the appointment saves time in the visit while offering the patient an opportunity to contribute to the collection of an accurate family history. Reviewing the family information can also help establish family rapport while verifying medical conditions in individual family members. If a hereditary condition is being considered but family medical information is unclear or unknown, requesting medical records and pathology or autopsy reports may be warranted.
According to the Genetic Information Nondiscrimination Act (GINA):
•Nurse Practitioners should keep all genetic information of patients confidential
•NPs must obtain informed consent prior to genetic testing of all patients
•Employers cannot inquire about an employee's genetic information
•All of the above
Employers cannot inquire about an employee's genetic information
