[Margaret_A._Fitzgerald]_Nurse_Practitioner_Certif(z-lib.org).pdf

This preview shows page 1 out of 576 pages.

Unformatted text preview: 6042_FM_i-xiv 06/02/17 11:32 AM Page i NURSE PRACTITIONER Certification Examination and Practice Preparation FIFTH EDITION 6042_FM_i-xiv 06/02/17 11:32 AM Page ii 6042_FM_i-xiv 06/02/17 11:32 AM Page iii NURSE PRACTITIONER Certification Examination and Practice Preparation FIFTH EDITION Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC, FNAP President, Fitzgerald Health Education Associates, LLC North Andover, Massachusetts Family Nurse Practitioner Greater Lawrence Family Health Center Lawrence, Massachusetts 6042_FM_i-xiv 06/02/17 11:32 AM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2017 by F. A. Davis Company Copyright © 2017 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Senior Acquisitions Editor: Susan Rhyner Content Project Manager: Amanda Minutola Design & Illustration Manager: Carolyn O’Brien Electronic Project Editor: Sandra Glennie As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that apply in each situation. The reader is advised always to check product and prescribing information for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Names: Fitzgerald, Margaret A., author. Title: Nurse practitioner certification examination and practice preparation / Margaret A. Fitzgerald. Description: Fifth edition. | Philadelphia, PA : F.A. Davis Company, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016053464 | ISBN 9780803660427 Subjects: | MESH: Nursing Care—methods | Family Nursing | Nurse Practitioners | Certification | Examination Questions Classification: LCC RT120.F34 | NLM WY 18.2 | DDC 610.73076—dc23 LC record available at Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-6042-7/17 0 + $.25. 6042_FM_i-xiv 06/02/17 11:32 AM Page v Dedication With much admiration and great affection, I dedicate this book to the patients of the Greater Lawrence (MA) Family Health Center, an urban federally qualified health center, where I have been practiced as a family NP, providing primary and urgent care to multigenerational families, for the past three decades. We have shared good news and sad news, times of great joy and sorrow, as well as the beauty and amazement of the everyday. You have been a great inspiration so I strive to be a better clinician, teacher and person. 6042_FM_i-xiv 06/02/17 11:32 AM Page vi 6042_FM_i-xiv 06/02/17 11:32 AM Page vii Contributors Kara L. Ashley, M.Ed. Northeast Association of Learning Specialists Victor Czerkasij, MA, MS, FNP-BC Associate Lecturer Fitzgerald Health Education Associates, LLC Clinical Practice, Skin Cancer and Cosmetic Dermatology, PC Cleveland, Tennessee Adult and Pediatric Dermatology Dalton, Georgia Carolyn Buppert, NP, JD The Law Offices of Carolyn Buppert Boulder, Colorado Kahlil Ahmadi Demonbreun, DNP, RNC-OB, WHNP-BC, ANP-BC Instructor College of Nursing Medical University of South Carolina Clinical Practice, Women’s Health Nurse Practitioner Palmetto Primary Care Physicians Charleston, South Carolina Susan Feeney, DNP, NP-C, FNP-BC Senior Lecturer Fitzgerald Health Education Associates, LLC Clinical Practice, Wright and Associates Family Healthcare Amherst, New Hampshire Family Nurse Practitioner Program Coordinator, University of Massachusetts Worcester Graduate School of Nursing, Worcester Massachusetts Jordan Hopchik, DNP, RN, FNP-BC, CGRN Gastroenterology Nurse Practitioner Philadelphia VA Medical Center Louise McDevitt, MS, ACNP-BC, ANP-BC, FNP-BC, FAANP Senior Lecturer Fitzgerald Health Education Associates, LLC Clinical Practice, Grace Cottage Family Practice Townshend, Vermont Assistant Clinical Instructor University of Vermont Medical School and Graduate School of Nursing Family Nurse Practitioner Program Burlington, Vermont Sally K. Miller, PhD, AGACNP, AGPCNP, FNP-BC, FAANP Senior Lecturer Fitzgerald Health Education Associates, LLC Clinical Practice, Nevada Health Center Las Vegas, Nevada Clinical Professor Drexel University College of Nursing and Health Professions Philadelphia, Pennsylvania Monica N. Tombasco, MS, MSNA, FNP-BC, CRNA Senior Lecturer Fitzgerald Health Education Associates, LLC Emergency Medicine Nurse Practitioner Huggins Hospital, Wolfeboro, NH Certified Registered Nurse Anesthetist Catholic Medical Center, Manchester, New Hampshire Christy M. Yates, MS, FNP-BC, NP-C, AE-C Senior Lecturer Fitzgerald Health Education Associates, LLC Clinical Practice, Family Allergy and Asthma Louisville, Kentucky Scharmaine Lawson-Baker, DNP, FNP-BC, FAANP Advanced Clinical Consultants New Orleans, Louisiana vii 6042_FM_i-xiv 06/02/17 11:32 AM Page viii 6042_FM_i-xiv 06/02/17 11:32 AM Page ix Acknowledgments This book represents a sum of the efforts of many people. I thank my family, especially my husband, and business partner, Marc Comstock, for their support and patience as they lived through this experience. I thank the staff of Fitzgerald Health Education Associates for sharing me with this project for many months. To the contributing authors, your insight has helped increase the value and helpfulness of this publication. I thank the patients and staff of the Greater Lawrence (MA) Family Health Center, where I have practiced for more than 30 years, as they continue to serve as a source of inspiration as I developed this book. Gracias. I thank Susan Rhyner, Amanda Minutola, and the F.A. Davis staff for their ongoing encouragement. Last but not least, I thank the thousands of nurse practitioners who, over the years, have participated in the Fitzgerald Health Education Associates Nurse Practitioner Certification courses. Your eagerness to learn, thirst for knowledge, dedication to success, and commitment to excellence in healthcare provision continue to inspire me. I am privileged to be part of your professional development. ix 6042_FM_i-xiv 06/02/17 11:32 AM Page x 6042_FM_i-xiv 06/02/17 11:32 AM Page xi Preface The scope of practice of the nurse practitioner is wide, encompassing the care of the young, the old, the sick, and the well. This book has been developed to help the nurse practitioner develop the knowledge and skills to successfully enter nurse practitioner (NP) practice and earn certification, an important landmark in professional achievement. This book represents a perspective on learning and practice developed during my years of practice at the Greater Lawrence (MA) Family Health Center and as an NP and professional speaker. In addition, my experiences through the years of helping thousands of NPs achieve professional success through conducting Fitzgerald Health Education Associates NP Certification and Advance Practice Update Courses influenced the development and presentation of the information held within. This book is not intended to be a comprehensive clinical text; rather, it is meant to be a source to reinforce learning and a guide for the development of the information base and critical thinking skills needed for safe, entry-level NP practice. The reader is encouraged to answer the questions given in each section and then check on the accuracy of the response. The discussion section is intended to enhance learning through highlighting the essentials of primary care NP practice. The numerous tables can serve as a quick-look resource not only as the NP prepares for entry to practice and certification but also in the delivery of ongoing care. —MARGARET A. FITZGERALD, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC, FNAP President Fitzgerald Health Education Associates, LLC North Andover, Massachusetts Family Nurse Practitioner Greater Lawrence (MA) Family Health Center Lawrence, Massachusetts xi 6042_FM_i-xiv 06/02/17 11:32 AM Page xii 6042_FM_i-xiv 06/02/17 11:32 AM Page xiii Contents Introduction Understanding Test Design and Theory I-1 Chapter 1 Health Promotion and Disease Prevention Chapter 2 Neurological Disorders Chapter 3 Skin Disorders Chapter 4 Eye, Ear, Nose, and Throat Problems Chapter 5 Cardiac Disorders Chapter 6 Respiratory Disorders Chapter 7 Gastrointestinal Disorders Chapter 8 Male Genitourinary System Chapter 9 Musculoskeletal Disorders Chapter 10 Peripheral Vascular Disease Chapter 11 Endocrine Disorders Chapter 12 Renal and Urinary Tract Disorders Chapter 13 Hematological and Select Immunological Disorders Chapter 14 Psychosocial Disorders Chapter 15 Female Reproductive and Genitourinary Systems Chapter 16 Older Adults Chapter 17 Pediatrics Chapter 18 Childbearing Chapter 19 Professional Issues 1 25 47 81 109 133 159 197 217 261 275 309 325 339 369 399 425 493 515 Index 529 xiii 6042_FM_i-xiv 06/02/17 11:32 AM Page xiv 6042_Intro_I1-I8 06/02/17 11:32 AM Page I-1 Introduction: Understanding Test Design and Theory A Foundation for Success Certification tests are intimidating for every examination candidate. In addition to anxiety over content mastery, certification examinations take place outside of the familiar clinical or classroom setting, and differ greatly from the assessments that a student encounters in an academic program. As a result, preparing for and taking these standardized tests requires a shift in approach and preparation for the examination that is different from the one that successfully saw you through your graduate program. Purchasing this book and immersing yourself in high-yield test preparation is one of the best steps you can make in being successful on the nurse practitioner (NP) boards. But an equally critical step is familiarizing yourself with the basics of test design and theory, to strategically understand how board examinations are written to approach the assessment of a candidate. Knowing the strategy of the examination is just as important as knowing the content being assessed on the examination. Primary Care Mind-Set Keep in mind that the purpose of the NP boards is to determine whether you possess and can apply the knowledge base needed to be a safe, entry-level NP. When studying for the family or adult-gerontology examinations, remember that this practice is set in primary care, physically distanced from an acute care facility. These are not specialty, subspecialty, or acute care examinations. Adopting this mind-set from the outset is a primary step in preparing for this critically important examination. Consider that standardized tests differ from teachergenerated tests: they are global in focus, rather than limited to a particular course, and rely heavily on the ability to form associations, rather than recall specific details. Moreover, more than 50% of the questions on standardized tests will ask you to apply your knowledge in a manner of context fundamentally different from the one in which you studied in order to test your critical thinking and clinical application skills. Despite the major differences between assessment in the context of a graduate program and standardized tests, roughly four of every five test takers who engage in focused, purposeful study pass the examination on their first attempt. Part of effective test preparation involves “demystifying” test design, learning how to “unlock” questions, engaging in preparation that is most effective for your individual learning style, and knowing what to expect on examination day. These steps are just as important as the robust clinical knowledge base that you need to access and apply when answering questions. The content and review program provided in this text will help you secure the broad and deep knowledge base needed to be a safe, entrylevel primary care nurse practitioner. Higher-Order Thinking Expect that your certification examination will emphasize questions that stress higher-order thinking skills such as analysis, synthesis, and evaluation of concepts and relationships. Anticipate few questions that focus on facts, details, and particulars. The testing body is expecting you to think as a competent, entry-level nurse practitioner and employ adaptive expertise as you approach your test, just as you would apply your clinical expertise in the examination room. NP certification candidates who are experienced adaptive experts use conceptual knowledge, including pathophysiology, pharmacology, and principles of assessment, diagnosis, intervention, and evaluation, as the basis for thinking but are open to flexibility of thought in relationship to a new context. On the certification examination, this is an important mind-set to maintain, as many questions will present you with a brief patient scenario, unlike the one you typically experience in clinical practice. Moreover, on test day, you do not have the ability to ask additional questions that could help to bring the “answer” into focus. Therefore, you need to think as an adaptive expert: Based on the strong conceptual foundation, how do I apply what I know in this new context? I-1 6042_Intro_I1-I8 06/02/17 11:32 AM Page I-2 I-2 INTRODUCTION ■ Understanding Test Design and Theory Unlocking the Question The multiple-choice question is the bane of many a test taker. In recent years, some educators are moving away from the traditional multiple-choice test in favor of questions that encourage students to interact with the test material in a more dynamic way. Nevertheless, the multiple-choice question is a standard instrument used in most high-stakes tests, such as the NP boards. The multiple-choice question is more easily tackled if you understand: • How it is designed • What it is attempting to measure • Effective strategies for decoding and answering the question Keep in mind that practice questions are a helpful way to demonstrate—but not build—your practice base. Work first on increasing and securing your clinical knowledge base prior to moving to practice questions. When using this book, it is important to study the didactic content and complete the practice questions. Multiple-choice questions are made up of multiple parts: • A stem (scenario, context) • Interrogatory (essential question, action) • Answer choices Multiple-choice tests do not lend themselves to plentiful extraneous detail. Stem scenario or context is there to support, not confuse, you in your analysis. Typical answer choices consist of one best answer, one (obviously) wrong answer, and two partially correct answers. Note that partially correct answers can cause you to second-guess yourself. Effective test takers will learn to differentiate between partially correct (the “sometimes” or “yes . . . but”) and the most common, best answer. On high-level tests, the difference between the best answer and the distractor answers will not always be clear. You will be asked to weigh options, interpret data, and arrive at the correct action within the context or scenario of the test question. There could be many times when you feel that a question has more than one good answer choice. In these cases, take another look at the question and then choose the response most specific to the given situation. Sometimes questions that relate to presentation of disease have more than one applicable answer. The response with the most common presentation is likely to be correct. For example, an adult with bacterial meningitis can present with nuchal rigidity and papilledema. Because nuchal rigidity is seen in most adults with this diagnosis, and papilledema is found far less often, nuchal rigidity is a better choice. Childhood development questions often have more than one correct response. A 4-month-old is expected to roll stomach to back and smile. Smiling is a developmental milestone achieved by age 2 months, whereas rolling is typically not seen until an infant is 4 months old. Rolling stomach to back is the best response. Remember: Test questions are designed to have one best, but perhaps not perfect, answer. Although there are some test items that assess factual knowledge, such as identifying an anatomical landmark, the majority of the test questions are seeking to measure higherorder thinking and reasoning skills. These items are testing your clinical judgment and expertise. Most items test your ability to assess or develop a plan of intervention for a clinical situation. You should expect to apply clinical decisionmaking skills to the test question. Make sure you think through each question. In particular, bear in mind how the pathophysiology of the condition affects the presentation and treatment. In clinical practice, you would likely gather more information than is given in a scenario in one of the test questions. During the certification examination, you have to decide on the best response given the information in front of you by applying sound clinical judgment. Remember: Multiplechoice tests do not lend themselves to plentiful extraneous detail. Decide whether extra information found in a particularly long answer is pertinent to the question and not simply a distractor. When keeping in mind major information about presenting issues, pharmacology, and best practices, it can be easy to lose sight of important little words—words such as but, however, despite, except, and if. These are common cuing words that tell you that things may not always be as simple as they appear. These words can indicate a shift, a possible contradiction or contraindication, and a conditional situation or scenario. Pay attention to these words. A careful test taker can use these words to construct a strategy for answering the question. For example, in a question that reads, “All of the following are symptoms of ‘X’ except,” you can treat this as a mini true/false question. You will be given three or four “true” choices and one “false” choice. That false choice is your answer. On a related note, be wary of options that include extreme words, such as “always,” “never,” “all,” “best,” “worst,” and “none.” Seldom is anything absolute in healthcare. Sometimes identifying the verb in the question can help you determine the purpose of the question. In addition, look at the information presented and then ask yourself, “Is this question a test of the ability to gather subjective or objective information? Is this question a test of the ability to develop a working diagnosis or to plan a course of intervention, or evaluation of response to care?” This thinking helps focus your thought process as you choose the answer. Read each question and all responses thoroughly and carefully so that you mark your option choice only after you are sure you understa...
View Full Document

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture