�………………………………...….50 APEA 3P Exam Prep –Cardiovascular…………………………………...…63 APEA 3P Exam Prep- Women's Health…………………………………….97 APEA 3P Exam Prep- Nephrology/GU…………………………………….115 APEA 3P Exam Prep- GI………………………………………………...…129 APEA 3P Exam Prep- Men's Health……………………………………..…165 APEA 3P Exam Prep- Dermatology……………………………………..…175 APEA 3P High Stakes Exam Questions………………………………….…197 APEA 3P Pre Predictor Exam…………………………………………….…224 APEA 3P Test Bank Questions 1…………………………………………….306 APEA 3P Test bank Questions 2……………………………………...……..315 APEA 3P Final Exam Review……………………………………………….335 APEA 3P Final Exam 2023/2024……………………………………………363 APEA 3P EXAM PREP- HEALTH PROMOTION A 58-year-old patient has an annual exam. A fecal occult blood test was used to screen for colon cancer. Three were ordered on separate days. The first test was positive; the last two were negative. How should the nurse practitioner proceed? Rescreen in one year. Perform a fourth exam. Examine him for hemorrhoids. Refer him for a colonoscopy. A fecal occult blood test is performed multiple times on different days because tumors don’t consistently excrete blood. The reason multiple tests are performed is to increase the likelihood of identifying blood. The patient needs to have a colonoscopy performed for examination of the colon. The standard of practice is to refer all positive colon cancer screens for colonoscopy. A criterion for medication choice in an older adult is: long half-life to prevent frequent dosing. dosing of 3-4 times daily. pill color and shape for easy identification. half-life less than 24 hours. Many factors go into prescribing for older adults. Some important safety criteria include established efficacy, low adverse event profile, and half-life less than 24 hours with no active metabolites. Active metabolites would produce a longer effect of the drug in the patient. Dosing of a medication three to four times daily invites dosing and medication errors. Once- or twice-daily dosing is ideal. Pill color and shape is never a criterion for prescribing. Patients who are cognitively able will recognize the color, shape, and size of pills they take on a regular basis. What should the nurse practitioner recommend to any elder taking medications? Have someone check your medications prior to taking them Never take your medicine on an empty stomach Keep a list of all of your medications with you. Have a pharmacist review your list once a year A list of current medications should be kept with each patient and carried with him, especially when healthcare visits are scheduled. Many older adults can take medications without supervision. Many medications should be taken without food (thyroid supplementation for example). A pharmacist can evaluate the list of medications for drug-drug interactions, but the pharmacist will not know the diagnoses and other reasons for choosing the medications. What temperature should be set on a water heater in the home of an older adult to prevent burn injury? Less than 110 degrees Less than 120 degrees Less than 130 degrees Less than 140 degrees Hot water heaters are common sources of burns in homes of older adults and very young patients. Many safety organizations in the United States believe that burns can be prevented if hot water heaters are set to less than 120° F. What is the recommendation from American Cancer Society for assessment of the prostate gland in a man who is 45 years old and of average risk for development of prostate cancer? He should have: screening starting at 50 years of age. prostate-specific antigen (PSA) now. PSA and digital rectal exam now. digital rectal exam only. At age 50 years, males of average prostate cancer risk should have a PSA measurement with or without a digital rectal exam (DRE). If they are deemed to be of high risk because of a family history (first-degree relative with prostate cancer before age 65 years) or race (African American), screening discussions should take place at age 40-45 years. If the initial PSA is 2.5 ng/mL, annual testing should take place. If the initial PSA is 2.5 ng/mL, test every 2 years. A 75-year-old adult asks for the pneumonia vaccine. His immunization record indicates that he had one at age 65 and another a year later. What is the recommendation of the CDC about how the NP should handle his request? Revaccination is recommended now Revaccination is recommended every 5 years after age 65 years Do not revaccinate this patient at this time He should have received one at age 70 years The recommendation of CDC is NOT to revaccinate this patient. After initial vaccination with PCV13 at age 65 years and subsequent vaccination with PPSV23 1 year later, no revaccination is recommended in this patient. A patient who has been treated for hypothyroidism presents for her annual exam. Her TSH is 4.1 (normal 0.4- 3.8). She feels well. How should she be managed? Continue her current dosage of thyroid replacement. Increase her replacement. Decrease her replacement. Repeat the TSH in 2-3 weeks. When an abnormal TSH is received, especially when a patient is not symptomatic, it should be repeated. Sometimes there are periods of transient hypothyroidism, lab error, and missed doses that can cause changes in TSH levels. A 20-year-old student has an MMR titer that demonstrates an unprotective titer for rubella. She is HIV positive. Her CD4 cell count is unknown. Which statement is true? She should not receive the MMR immunization because she is at low risk for the disease. MMR is safe to give but she does not need this. She is at risk for MMR but should not be immunized. She should receive this. The immunization is not alive. This patient is at risk for rubella because she does not have a sufficient titer. The MMR immunization is an attenuated virus. Though an attenuated immunization is weakened, it is still considered live and so is contraindicated in anyone who may be immunocompromised. Since her CD4 cell count is unknown, she should not receive this immunization yet. She may be able to receive this immunization if her CD4 count is normal. What choice below would be beneficial to a 76-year-old who takes daily oral steroids for COPD and now takes a daily aspirin for primary prevention of myocardial infarction? Screen for infection with H. pylori Daily proton pump inhibitor (PPI) Antacids PRN heartburn Daily use of low dose famotidine Aspirin does increase the risk of gastrointestinal bleeding, especially if it is given in combination with oral steroids. Most learned authorities and ACOVE (Assessing Care of Vulnerable Elders) agree that when two or more risk factors for GI bleed are present, aspirin should not be added without some form of protection for the GI tract (misoprostol or a daily PPI). In considering all the risks for GI bleed, the most significant ones are age 75 years, history of GI bleeding, warfarin use, daily NSAID use, and chronic steroid use. A patient who is 62 years old asks if she can get the shingles vaccine. She has never had shingles but states that she wants to make sure she doesn’t get it. What should the nurse practitioner advise? The immunization will protect you from acquiring shingles. You are not old enough to receive the immunization. The immunization is offered only to those who have had shingles. You are eligible to receive it but you still may get shingles. Patients must be at least 50 years old to receive the shingles immunization. It is generally well tolerated but provides protection from shingles in 50-64% of patients. The incidence of postherpetic neuralgia is decreased up to 65% after immunization. The patient still may develop shingles after receiving the immunization. The vaccine may be offered regardless of whether the patient has history of shingles. However, since it is a live vaccine, it may be contraindicated because of steroid use or immune status. Which pharmacokinetic factor is influenced by a decrease in liver mass in an older adult? Absorption Distribution Metabolism Elimination As the liver decreases in mass and potentially has a decrease in blood flow, drug metabolism is decreased. Consequently, lower doses of medications in older adults may be as efficacious as higher doses in their younger counterparts. Production of enzymes in the cytochrome P450 system may be decreased, which further impacts metabolism. An older adult has osteopenia. Her healthcare provider has recommended calcium 500 mg three times daily. What is the most common side effect of calcium supplementation? Stomach upset Diarrhea Constipation Mild nausea initially Constipation is the most common side effect of calcium supplementation. To improve tolerance, the nurse practitioner can suggest 500 mg daily for a week, then 500 mg twice daily for a week, then three times daily. The patient should be encouraged to increase the intake of fruits, vegetables, fluid, and fiber. Weightbearing exercise and vitamin D intake should be encouraged to improve bone density. Screening for abdominal aortic aneurysm should take place: once for all males aged 65-75 who have ever smoked. once for all men and women who have hypertension. annually after age 75 years for males and females. only if the patient has smoked and has hypertension. The prevalence of abdominal aortic aneurysm (AAA) is greater in men than women. American Heart Association and USPSTF recommend screening males once between the ages of 65-75 years if they have ever smoked. Smoking increases the risk of AAA. The USPSTF does not recommend routinely screening for AAA in women or screening for AAA in men who have never smoked. Screening may be considered in men aged 65-75 years if they have a first-degree relative who required repair of AAA.