CEA Week 1 Exam

Progression to Acute Myelogenous Leukemia (AML) is a risk for untreated or poorly responsive: Pancytopenia Myelodysplastic syndrome Macrocytic anemia Aplastic anemia

Myelodysplastic syndrome Rationale Long-term treatment goals include supportive care, preventing disease progression and/or development of AML.

Where can Crohn's disease be located within the GI tract and how does it present (continuous or patchy)? In the esophagus and stomach only Patchy inflammation throughout the small bowel and colon In the colon only and patchy In the colon continuous throughout

Patchy inflammation throughout the small bowel and colon Rationale Crohn's disease, unlike UC, is a patchy inflammation that can be found throughout the small bowel and colon.

Which of the following states represents an example of postrenal failure? Contrast-induced nephropathy after an angiogram Overuse of furosemide Blood clot obstructing a Foley catheter after a transurethral prostatectomy Hypotension after overdosing on lisinopril

Blood clot obstructing a Foley catheter after a transurethral prostatectomy Rationale Obstruction to flow is an example of post-renal failure. CIN and furosemide use are examples of intrarenal failure, and hypotension represents prerenal failure.

An elderly patient diagnosed with end-stage lung cancer has been refusing meals, opting instead for ice cream only. The family is concerned about the patient not getting enough nutrition. The NP: order a U/A and CBC prescribe methylphenidate for appetite stimulation explains loss of appetite is common at the end of life screens the patient for depression

explains loss of appetite is common at the end of life Rationale Death is an uncomfortable topic, and must be handled tactfully. Factual re-orientation to the terminal state of a patient's condition may be appropriate when unrealistic expectations for their longevity have been voiced. The reasonable choice in this case is to describe the normalcy of what the patient is experiencing with their loss of appetite and their terminal state. Testing the patient for depression has really no clinical bearing on this particular time nor does prescribing methylphenidate. Ordering a UA and CBC would suggest a concern of a urinary tract infection, and that is not a likely scenario to describe the patient's existing condition. Support the patient as his advocate by helping the man enjoy the ice cream he requested.

Elevated calcium levels may suggest which of the following? Effective bisphosphonate therapy Vitamin D deficiency Bone cancer Calcitonin deficit

Bone cancer Rationale Bone cancer should always be worked up with a patient with otherwise unidentified hypercalcemia. Calcitonin aids calcium to shift into the bone, thereby decreasing serum calcium. Vitamin D elevation would be a cause of hypercalcemia, not deficiency. Ineffective bisphosphonate therapy would cause hypercalcemia to not be decreased as intended.

A 35-year-old woman presents with allergic rhinitis, experiencing significant nasal congestion, sneezing, and itchy eyes. She has tried over-the-counter antihistamines with limited relief. What is the most appropriate next step in management? Oral decongestants Referral to an allergist for immunotherapy Intranasal corticosteroids Nasal saline irrigation

Intranasal corticosteroids

What is the standard treatment for women with uncomplicated urinary tract infection in a geographical area with more than 20% resistance? Nitrofurantoin 100mg BID x 5 days Amoxicillin 875mg BID x 7 days Ciprofloxacin 500mg BID x 7 days Sulfamethoxazole/Trimethoprim 800/160mg BID x 3 days

Nitrofurantoin 100mg BID x 5 days Rationale In female patients with uncomplicated UTI with more than 20% resistance geographically, Nitrofurantoin 100mg BID x 5 days is the correct answer.

The best laboratory test to distinguish iron deficiency anemia from other anemias is: serum ferritin level. transferrin saturation. iron binding capacity. mean corpuscular volume.

serum ferritin level Rationale TIBC and Ferritin are the most useful tools for distinguishing iron deficiency anemia. Ferritin is the most useful as it directly reflects the iron stores available.

The suggested International Normalized Ratio (INR) range in a patient being treated for atrial fibrillation is: 1.0-2.0 4.0-5.0 2.0-3.0 3.0-4.0

2.0-3.0 Rationale Remember that for international normalized ratio, the patient is their own normalization with an INR of 1.0 as the standard of untreated blood, so with an INR of 2.0, think of the patient as twice as thin for their blood as their normal. Protime can also be used to evaluate bleeding time for warfarin patients, but has in general been replaced many years ago by the INR as the standard measurement, where PTT (partial thromboplastin time) or Anti-Xa are more useful for evaluating bleeding times related to Heparin therapy.

Pheochromocytoma is best diagnosed by which of the following tests: Adrenal CT/MRI 24-hour urine for catecholamines/metanephrines and plasma metanephrines Blood pressure values and adrenal CT/MRI Plasma metanephrines with blood pressure values

24-hour urine for catecholamines/metanephrines and plasma metanephrines Rationale Pheochromocytoma is a catecholamine-producing tumor. Must have diagnostics that reveal increased levels of catecholamines. A negative test virtually excludes pheochromocytoma.

A 13-year-old female who is diagnosed with iron deficiency anemia is being treated with ferrous sulfate. Proper treatment typically leads to the resolution of anemia within: 2 weeks. 3 months. 8 months. 4 weeks.

3 months Rationale Due to the time it takes for the underlying deficit to be corrected as well as the growth of new red blood cells to mature, 3 months are typically needed to show recovery with treatment for iron deficiency.

A 38-year-old male presents to the ER with complaints of abdominal pain, intermittent diarrhea, and has a positive occult blood. A stool culture is done which does not show any organism growth. His CRP and fecal calprotectin are elevated, and a colonoscopy is performed with biopsy which shows changes consistent with Crohn's disease, which are mild. What of the following represent the first line of treatment for this illness? 5-ASA, antibiotics, corticosteroids Anti-TNF NSAID's and acetaminophen Immunomodulators

5-ASA, antibiotics, corticosteroids Rationale 5-ASA, Abx, and corticosteroids are typically used in the acute first-line phase of treatment of Crohn's disease. With either a mono or multi therapy after the acute phase with immunomodulators and/or anti-TNF

An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The patient follows a carbohydrate-counting diet and walks 30 minutes 5 times weekly. Current fasting blood glucose = 116 mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the American Diabetes Association, the nurse practitioner would recommend that the next follow-up appointment be scheduled for: 2 months. 6 months. 1 year. 9 months

6 months Rationale Based off of the ADA recommendation, this patient should be evaluated in six months. They are actually showing good control and excellent compliance with diet and exercise management strategies. If there compliance was worse or they were not controlled with their A1c, this would likely be a three month follow up.

Which of the following blood lead levels (BLL) would likely require chelation therapy? >100 mcg/dL < 80 mcg/dL 35 mcg/dL 75 mcg/dL

>100 mcg/dL Rationale Treatment for patients with lead poisoning includes removing exposure and chelation therapy for most patients with a BLL >80 mcg/dL and all patients with a BLL >100 mcg/dL.

Your patient presents with pale, waxy legs, weak peripheral pulses, and states he is having difficulty walking great distances due to the pain in his calves. The most appropriate non-invasive test to evaluate his leg vascular flow quality is which of the following exams? Exercise stress test Angiogram of the leg with runoff Ankle Brachial Index (ABI) Bilateral popliteal blood pressures

Ankle Brachial Index (ABI) Rationale ABI is the most effective way to evaluate vascular flow in a non-invasive way, and the angiogram of the leg with runoff is the best invasive way. Bilateral popliteal blood pressures would not show discretion between upper and lower body if both equally low, and exercise stress tests are not used as a diagnostic tool for claudication or PAD.

Which of the following findings is typically a sign of acute appendicitis? Positive Murphy's sign A positive Rovsing's sign Positive Prehn's sign A negative psoas sign

A positive Rovsing's sign Rationale A positive Rovsing's sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen. Prehn's sign is used to determine if the patient has testicular torsion or epididymitis. Murphy's sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. The psoas sign, also known as Cope's sign or Obraztsova's sign, is used to detect for pathology in the abdomen and commonly is associated with appendicitis.

Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis? Salicylic acid (aspirin) Misoprostol (Arthotec) Indomethacin (Indocin) Allopurinol (Zyloprim)

Allopurinol (Zyloprim) Rationale Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid in the body. It inhibits the enzyme xanthine oxidase, which is involved in the metabolism of purines (substances that contribute to uric acid formation). Allopurinol is commonly used as a long-term maintenance therapy to prevent recurrent gout attacks and to reduce the risk of complications associated with chronic hyperuricemia, such as tophi (deposits of urate crystals in joints and other tissues).

Your patient is on rivaroxaban, a potent novel oral anticoagulant, and presents to the urgent care in no apparent distress with a right nare that is bleeding through the current self-packed gauze. This has been persistent for the past 30 minutes without any evidence of stopping. Which is the most appropriate next action? Attempt blind cautery with silver nitrate sticks around the packing Consult anesthesia for intubation Apply direct manual compression to the bridge of the nose and consult ENT Remove the current nasal packing to evaluate further

Apply direct manual compression to the bridge of the nose and consult ENT Rationale First order of operation is to assess for killer bleeds and attempt hemostasis. Direct pressure is the best option of these provided. Blind cautery would not likely be useful since the packing is in the way and should not be removed. There is no evidence to suggest a need to intubate the patient at this time.

Nonpharmacologic therapy for Raynaud's disease include: Use of hot soaks Avoidance of cold Isometric exercise Ginkgo biloba

Avoidance of cold Rationale Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure which causes the patient to have extremely pale/white vasoconstricted digits followed by a over-dilated vasoplegic response causing purplish painful revascularization. Avoidance of cold is the most effective non-pharmacologic way to mitigate this event from occurring. Pharmacologic therapy would include the use of medications such as calcium channel blockers.

A patient with a known intrinsic factor autoantibody is at risk for developing which of the following conditions? Liver disease B12 deficiency and pernicious anemia Iron deficiency anemia Bone marrow suppression and pancytopenia

B12 deficiency and pernicious anemia Rationale Causes of B12 deficiency include malabsorption and intrinsic factor deficiency. Intrinsic factor deficiency is a result of gastric resection or IF autoantibody.

Adult patient with left lower quadrant abdominal pain dx with diverticulitis. No allergies. Following is tx of choice: Bactrim Keflex Medrol Prednisone

Bactrim Rationale Medrol and Prednisone are options that might be considered for management of inflammatory bowel disease such as Crohn's or ulcerative colitis, but for diverticulitis, a medication that has broad coverage including gram-negative coverage, should be considered. Sulfamethoxazole/Trimethoprim (Bactrim) is the most appropriate choice for this patient.

An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0. The patient goes to a clinic for INR determination, and the result is 1.4. Which of the following would likely decrease the effects of warfarin (Coumadin)? Red meat Grapefruit Red Wine Broccoli

Broccoli Rationale It's important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist, and therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K. Leafy green vegetables such as broccoli and spinach are notorious for increasing vitamin K levels, and therefore inhibiting the anticoagulation effect of warfarin. It's also important to remember that with the direct oral anticoagulants category, vitamin K is not affected, and therefore no dietary restrictions are required for this class of medications such as apixaban, rivaroxaban, and edoxaban, which is a distinct benefit over warfarin as noted above. Also, with warfarin it is important to remember that the effects are based on the free drug, not the protein bound drug level, so patients who have considerable protein stores will require more warfarin than those who are emaciated or have low protein levels chronically. With respect to this particular question, red wine and grapefruit do not have an effect of lowering the INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically causes warfarin levels to rise through the CYP 450 system, and red wine causes the INR to increase by thinning the blood and and red meat is not likely to have a considerable impact, although it might have some impact if the protein stores are otherwise low prior to initiating the red meat in the diet. Broccoli is the only option that has vitamin K and should be an obvious choice for this question.

Which of the following suggest a diagnosis of glomerulonephritis? CD4 count of 50 with hematuria Absence of albuminuria WBC casts in urine Elevated WBCs on urinalysis

CD4 count of 50 with hematuria Rationale HIV is a common cause of glomerulonephritis. CD4 count of 50 suggests poor HIV control and hematuria is a common finding of glomerulonephritis.

A 45-year-old man presents with a 2-day history of a red, swollen, and painful lower leg. Examination reveals erythema and warmth suggestive of cellulitis. He has no known allergies. What is the most appropriate initial antibiotic treatment? Clindamycin Doxycycline Trimethoprim-sulfamethoxazole Cephalexin

Cephalexin Rationale Cephalexin is an antibiotic commonly used in the treatment of skin and soft tissue infections, including cellulitis. Cephalexin belongs to the class of first-generation cephalosporin antibiotics. It works by interfering with the bacteria's cell wall formation, leading to cell death.

Your patient has a Le Fort III fracture and is admitted for close monitoring. Which of the following represent a potential complication of this type of fracture? Cerebrospinal fluid leak Sternocleidomastoid impingement Loss of bowel tone Tetany

Cerebrospinal fluid leak Rationale Due to the complexity of these fractures, CSF leaks are most common among Le Fort III fractures than other types. None of the other listed options are specifically complications of any type of Le Fort fracture.

A 49-year-old male presents to your service with symptoms of fever 102.3, jaundice, and abdominal pain. Imagining reveals a biliary obstruction. Which diagnosis is most likely for this patient? Choledocholithiasis Cholangitis Cholangiocarcinoma Acute cholecystitis

Cholangitis Rationale The most likely cause for this patients' symptoms is cholangitis, which has a typically presentation of fever, jaundice, and abdominal pain. The most common cause of this is a biliary stone causing obstruction and allowing for ascending of bacteria and infection

A geriatric female presents with complaints of dyspnea and fatigue. All blood work is normal except for Hgb of 9.0 g/dL, Hct of 33%, and guaiac positive stool. The patient also reports a bowel pattern of alternating constipation and diarrhea, and frequent laxative use. Which diagnostic tests should be ordered? CT scan of abdomen Upper GI series Colonoscopy MRI scan of abdomen

Colonoscopy Rationale This patient requires a colonoscopy to evaluate for the cause of occult bleeding.

A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea. On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is the most likely diagnosis? Congestive heart failure Pulmonary embolism Acute myocardial infarction Chronic obstructive pulmonary disease

Congestive Heart Failure Rationale Of the available options, the most accurate response is congestive heart failure as it is signifying both a right ventricular back up with jugular venous extension and crackles on lung assault, which are suggestive of left ventricular back up. it is possible the patient may have an acute myocardial infarction that precipitated this, however, a patient has not described that, rather is only describing dyspnea on exertion and orthopnea, which both speak to a state of fluid overload. The only appropriate response of these available is congestive heart failure.

Your patient with a recent fall from the edge of the bathtub who developed a hip fracture should be worked up with which of the following exams? PET scan Serum haptoglobin Whole body CT scan DEXA scan

DEXA scan Rationale Due to a minimal mechanism of action for this fall, it is surprising the patient suffered a fracture. A DEXA scan would be valuable to evaluate for bone density issues and a potential diagnosis such as osteoporosis or osteopenia. PET scan is for tumor evaluation but is not typically ordered without a diagnosis of a nodule or lesion of concern. Serum haptoglobin does not have any correlation with this, as it is used for hemolytic anemia workup.

Patients presenting with globe rupture should be sent to immediate surgery due to which of the following reasons? Delay in surgery can increase incidence of choroidal hemorrhage Loss of vision is worse if surgery is immediate Rapid surgery can increase incidence of endophthalmitis Pain associated to the traumatic event is less when surgery is performed immediately

Delay in surgery can increase incidence of choroidal hemorrhage Rationale Delay in surgery can increase the incidence of both choroidal hemorrhage as well as endophthalmitis. Loss of vision is likely less if surgical intervention is immediate for the same reasons as above and pain due to the trauma itself has no bearing on surgical timing.

Evidence-based health screening is utilized with an understanding of the limits of interpreting the results. In this context, the term sensitivity refers to the ability of a test to: Detect an abnormal condition when it exists Detect the prevalence of a given condition Provide reproducible results Identify the specific condition

Detect an abnormal condition when it exists Rationale Detecting an abnormal condition when it DOES exists is by definition sensitivity. Specificity refers to the ability to rule out those who do NOT have that abnormal condition.

Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following? Aplastic anemia Myelodysplastic syndrome Thrombocytopenia Disseminated intravascular coagulation

Disseminated intravascular coagulation Rationale DIC is a systemic process that has potential to result in thrombosis and hemorrhage often due to overactivation of coagulation and fibrinolysis.

A 27-year-old woman presents with frequent headaches, galactorrhea, and amenorrhea. MRI of the brain reveals a pituitary adenoma. What is the most appropriate initial treatment? Radiation therapy Dopamine agonists Corticosteroids Surgery

Dopamine agonists Rationale Dopamine agonists are commonly used to initially counteract the effects of pituitary adenomas. Surgery or radiation may be used as an eventual destination therapy, however, the question specifically asked about the initial management.

Which of the following is not one of the four Ds of epiglottitis? Dysphonia Dystonia Drooling Dysphagia

Dystonia Rationale Dystonia is not one of the four Ds of epiglottitis. It's an extrapyramidal symptom.

A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools a day. She also reports mild cramping. Which labs would be helpful in further workup of a diagnosis? ESR, fecal occult, Stool culture CBC, CMP D-Dimer Fecal calprotectin

ESR, fecal occult, Stool culture Rationale ESR, Fecal occult, and stool culture would be the biggest benefit to determine the potential cause of her symptoms.

Patients who have been identified as having angioedema due to bradykinin-mediated allergy should be notified not to take any further dosing of which of the following medications? Naproxen sodium Enalapril Aspirin Ibuprofen

Enalapril Rationale Bradykinin-mediated angioedema is usually caused by ACE Inhibitors, not NSAIDS such as ibuprofen, aspirin, and naproxen.

Your patient was diagnosed with strep pharyngitis due to symptoms and exudative pharyngitis by appearance only and started on amoxicillin yesterday. Rapid strep test was negative and awaiting a throat culture to be read at this time. The patient has since developed a widespread rash across their entire torso and extending down their extremities. The patient also has associated splenomegaly. What is the most likely cause of this rash? Keratosis pilaris in response to penicillin Pityriasis rosea due to immune response Epstein Barr virus drug rash due to penicillin administration Lichens planus due to immune response

Epstein Barr virus drug rash due to penicillin administration Rationale It is common to have a rash after a missed mononucleosis diagnosis and treat the patient with penicillin due to a presumed strep pharyngitis. The rest of these options do not explain this morphology.

The patient undergoing a cardiac arrest after a recent fracture should be considered for which of the following potential causes of pulseless electrical activity? Fat embolism Hyponatremia Pericarditis Hyperglycemia

Fat embolism Rationale Fat embolism should be considered in any recent fracture for a patient who is now in cardiac arrest. It is not likely a diagnosis that will be able to be fixed in a cardiac arrest, unfortunately. Hyperglycemia and Hyponatremia are not causes of pulseless electrical activity, and pericarditis does not cause PEA unless a tamponade state is present.

A 33-year-old woman presents with intermittent palpitations, anxiety, and heat intolerance. Her thyroid function tests reveal low TSH and high free T4. What is the most likely diagnosis? Thyroiditis Graves' disease Hypothyroidism Hyperthyroidism

Hyperthyroidism Rationale Clinical findings of hyperthyroidism are described well in this scenario. TSH will be low since there is no need to stimulate more T3/T4 since there's already an overage of its presence, and the T3/T4 will be elevated.

While evaluating your patient who presented with a panic attack, the patient states their reason for the panic attack was they found out they are going to die from skin cancer because their sister is a CNA and found melanoma on their skin. You perform a skin survey to find a 9mm seborrheic keratosis as the source of the concern. Which of the following is the most appropriate response to the patient? Your 5-year survival will be determined by early, aggressive treatment to avoid metastasis. Removal of the lesion will require us to perform a local wide excision to guarantee negative borders. Unfortunately, this is a cancerous lesion and poses a medium to high risk of malignancy. Fortunately, this is a benign lesion and poses no risk of malignancy.

Fortunately, this is a benign lesion and poses no risk of malignancy. Rationale Seborrheic keratoses are non-cancerous lesions, although if an untrained observer were to evaluate a large, brown, irregular seborrheic keratosis, it is quite conceivable they would misdiagnose it as a melanoma.

A 75-year-old patient has just been discharged to a nursing facility following hospitalization for an exacerbation of chronic heart failure. The patient's condition is classified as stage C, which involves known structural heart disease with previous or present symptoms of failure. If the patient is adherent to current clinical guidelines, the nurse practitioner who is visiting can expect treatment to include which of the following medications? Hydrochlorothiazide (HCTZ), lisinopril (Zestril), amlodipine (Norvasc) Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg) Furosemide (Lasix), prazosin (Minipress), propranolol (Inderal) Hydrochlorothiazide (HCTZ), metoprolol (Lopressor), losartan (Cozaar)

Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg) Rationale Goal directed therapy for reducing chronic symptoms of heart failure, and hopefully improving ejection fraction in a patient with heart failure with reduced ejection fraction should include carvedilol (Coreg) furosemide (Lasix) or another loop diuretic, and an ACE inhibitor/ARB or ARB/ARNI such as sacubitril/valsartan (Entresto). Calcium channel blockers are contraindicated and heart failure such as amlodipine (Norvasc).

Patients presenting to urgent care with hematuria and RBC casts in their urine should be considered for which diagnosis? Acute tubular necrosis Glomerulonephritis Pyelonephritis Nephrotic syndrome

Glomerulonephritis Rationale GN is commonly diagnosed with proteinuria, hematuria, and RBC casts in their urine. Pyelonephritis commonly has WBC casts present on urinalysis. ATN does not typically have any of these features of casts. Nephrotic syndrome tends to have proteinuria, but no RBCs or casts present.

Which of the following treatments is most successful for patients with chronic fatigue syndrome? High carbohydrate diet Graded exercise program CNS stimulants Antiviral therapy

Graded Exercise Program Rationale A graded exercise program (GEP) for chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a structured approach to physical activity aimed at gradually increasing exercise tolerance and improving overall function. Here are key components and considerations for implementing a GEP: Individualized Assessment: Before starting a GEP, it's crucial to conduct a thorough assessment of the individual's current physical capabilities, symptom severity, and any specific limitations or concerns related to CFS. Goal Setting: Establish clear and realistic goals with the patient, focusing on improving function, reducing symptom severity, and enhancing quality of life rather than aiming for rapid fitness gains. Structured Program: Develop a structured exercise plan tailored to the individual's baseline fitness level and tolerance. The program typically involves incremental increases in exercise intensity, duration, or frequency over time. Pacing: Emphasize the importance of pacing activities to avoid overexertion and exacerbation of symptoms. Encourage regular breaks during activity and gradual progression based on symptom response.

Your patient arrives the urgent care complaining of a swollen throat and vocal changes. Which of the following statements made by the patient brings an index of suspicion of angioedema? I do not take any ibuprofen since it gives me an upset stomach This seems to be getting better already getting out of the cold I have never had this happen before I have been taking my lisinopril for the past week as prescribed

I have been taking my lisinopril for the past week as prescribed Rationale Use of ACE Inhibitors and NSAIDS is a common precipitating factor in angioedema. The rest do not suggest any relationship to angioedema.

What is the definitive treatment for uncomplicated skin abscess on the arm? Incision and drainage Prescription of gram-negative antibiotic coverage NSAID pain relief and warm compresses Doxycycline IV q 3 days

Incision and drainage Rationale The definitive treatment for an uncomplicated skin abscess is to open and drain the contents. The body will then re-approximate by secondary intention once the contents have been evacuated. Gram-negative coverage is not recommended for an area typically associated with gram-positive flora.

The patient with a sebaceous cyst on the arm that is now draining is noted to have unilateral cellulitic streaking ascending proximally from the abscess site. Which of the following represents the most appropriate treatment in this scenario? Oral antibiotics without incision and drainage Incision and drainage plus IV vancomycin or other anti-MRSA coverage Incision and drainage plus metronidazole PO Incision and drainage without antibiotic coverage

Incision and drainage plus IV vancomycin or other anti MRSA coverage Rationale The presence of cellulitis requires the abscess to be treated with incision and drainage, plus the cellulitis to be treated with IV antibiotics.

Your patient has a diagnosis of Hashimoto's and is on Levothyroxine 75 mcg daily. Her recent TSH was elevated at 15 uU/mL. Your next best action is to: Increase Levothyroxine to 100 mcg daily Repeat anti-thyroperoxidase antibodies (anti-TPO) Decrease Levothyroxine to 50 mcg daily Assess for symptoms and recheck TSH in 8 weeks

Increase Levothyroxine to 100 mcg daily Rationale When the TSH is elevated the patient needs more thyroid hormone. Once diagnosed with Hashimoto's there is no clinical need/benefit to repeating antibodies.

Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was identified on the EKG. Which region of the heart is most likely involved? Lateral Wall Anterior Wall Inferior Wall Septal Wall

Inferior Wall Rationale The inferior wall, fed by the right coronary artery is commonly associated with these symptoms. Remember right equals rate as it is the blood supply for the SA and AV nodes in most patients. Dyspepsia is common in RCA territory injury due to vagal stimulation not typical of other areas.

You are following up with a 24-year-old male patient who was recently in a motor vehicle collision at a high rate of speed. A CT head is performed revealing a pyramidal fracture involving the lateral walls of the maxillary sinuses and inferior orbital rim. Which classification of fracture is this? Le Fort II Le Fort I Le Fort III Le Fort IV

Le Fort II Rationale Le Fort II fracture lines pass through the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim, and nasal bones

A 55-year-old woman presents with fatigue, hair loss, and cold intolerance. Her thyroid function tests reveal high TSH and low free T4. What is the most appropriate treatment? Levothyroxine Radioactive iodine Beta-blockers Methimazole

Levothyroxine Rationale All of these are clinical features of hypothyrodism. The only appropriate answer to augment thyroid levels is levothyroxine. Methimazole and radioactive iodine both directly antagonize thyroid levels and are used in the treatment of hyperthyroidism. Beta blockers, namely propranalol is used for the symptom management of hyperthyroidism (tremors, tachycardia, anxiety).

An older adult has a follow-up fasting lipid panel 6 months after making therapeutic lifestyle changes. LDL=205mg/dL (Normal=<100mg/dL), HDL=44mg/dL, and triglycerides=180mg/dL (Normal-<150mg/dL). The patient is placed on statin therapy. Two months later, the patient presents for follow-up and complains of body aches. In addition to creatine phosphokinase (CPK), which of the following tests should the nurse practitioner order? Creatine phosphokinase (CPK) electrophoresis BUN and creatinine Liver transaminase (AST and ALT) levels Serum calcium levels

Liver transaminase (AST and ALT) levels Rationale Due to the potential liver function test elevation found with statin use, LFTs of AST/ALT should be checked routinely after initiation of therapy.

Your patient presents to the Urgent Care with periorbital and peripheral edema and has evidence of macroalbuminuria. Which state is described by this clinical presentation? Acute tubular necrosis Nephrotic syndrome Acute kidney disease Chronic kidney disease

Nephrotic syndrome Rationale Nephrotic syndrome is not a disease, but rather a clinical state described above.

At a follow up from a hospitalization, an adult patient presents with ankle edema. Which of the following medications is the most likely cause of the edema? Metformin HCTZ Norvasc Nebivolol

Norvasc Rationale The most common side effects of calcium channel blockers include constipation and lower extremity edema. The other options do not have any relationship specifically with edema, in fact, hydrochlorothiazide specifically reduces edema via diuresis.

Multimodal analgesia involves the use of multiple agents to avoid reliance on which particular class of medication? Opioids NSAIDS Muscle relaxants Topical analgesia agents

Opioids Rationale Multimodal analgesia is a concept of care designed to reduce the reliance and risks of overuse of opioids.

A 30-year-old woman presents with a history of recurrent herpes simplex virus (HSV) infections on her lips. She wants to know how to manage future outbreaks. What is the most appropriate initial management for recurrent HSV? Immunotherapy Daily oral antiviral prophylaxis Oral antivirals at the onset of symptoms Topical antibiotics during outbreaks

Oral antivirals at the onset of symptoms Rationale Antiviral medications such as acyclovir, valacyclovir, and famciclovir are commonly prescribed to reduce the severity and duration of HSV outbreaks. Managing HSV involves a comprehensive approach that includes antiviral therapy for acute episodes, preventive strategies for recurrent outbreaks, and supportive care to alleviate symptoms.

After confirming your patient is hypercortisolemic, a critical part of the diagnostic workup is to do which next? Order MRI of brain Refer to surgery Order adrenal MRI Order ACTH level

Order ACTH level Rationale ACTH level helps to determine if it is pituitary-mediated vs adrenal. Once that is confirmed, then imaging will be ordered

Your patient presents with painless lymph node swelling, weight loss, night sweats, and asks what is wrong with him. Which of the following represents a most appropriate intervention to confirm a diagnosis of lymphoma? Examine the patient Order a core needle biopsy Consult pulmonology Order a CBC and TSH

Order a core needle biopsy Rationale This question is asking for an intervention. Although examining the patient is useful, it is an evaluation tool, as is ordering routine lab work. Pulmonology is not an appropriate consultation for this patient; rather, hematology or oncology would be best suited to evaluate and work up this patient. A diagnostic needle biopsy is the most definitive intervention to gain a diagnosis for a suspected lymphoma.

A 73 y.o. M presents to the ED with complaints of large output hematemesis since early this morning. He endorses chronic alcohol use and his PMH is positive for peptic ulcer. Which of the following symptoms indicate a potentially severe GI bleed and likely need for immediate PRBC transfusion? Orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities Fatigue and SOB Hypertension, fatigue, and SOB Headaches, SOB, and vertigo

Orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities Rationale Symptoms of severe blood loss include Orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities.

Which of the following treatments is not recommended for a patient with a new diagnosis of rheumatoid arthritis? Prednisone burst, then taper to a lower daily maintenance dose Methotrexate daily Adalimumab daily Oxycontin PRN for mild pain

Oxycontin PRN for mild pain Rationale Patients with RA may be controlled with any of the above regimens except use of opioids for a new diagnosis with a high abuse potential, as this does not safely balance the risk and benefit of treatment.

Which of the following distinguishes plantar fasciitis from other common foot problems? Edema and point tenderness over the calcaneus Pain with the initial step after rising in the morning Burning and cramping of the middle toes Resolution of symptoms with rest

Pain with the initial step after rising in the morning Rationale A hallmark of plantar fasciitis is severe pain upon waking or after periods of rest, which tends to improve with movement as the fascia stretches out.

Erysipelas typically presents on the face with: Vesicles on an erythematous base following a dermatome A papular erythematous malar rash Scattered ruborous macules across the cheeks Painful progressive erythema and edema

Painful progressive erythema and edema Rationale Erysipelas is a bacterial skin infection that typically presents with distinctive symptoms and tends to affect the face more commonly than other parts of the body. Symptoms: The infection usually starts suddenly and can cause symptoms such as: Red, swollen, and shiny skin Well-defined borders between affected and unaffected skin Pain and tenderness Fever and chills Blisters or sores filled with fluid (bullae) in severe cases

Which of the following is appropriate long-term treatment for B12 deficiency in a patient with a history of gastric bypass? Parenteral vitamin B6 Parenteral vitamin B12 Oral vitamin B12 Inhaled B12

Parenteral vitamin B12 Rationale Treatment for B12 deficiency includes replacement of B12 stores. Parenteral administration of B12 is preferred for patients with altered GI anatomy. Absence of intrinsic factor makes oral absorption unlikely for patients who have undergone gastric bypass and parenteral routes are necessary.

A 45-year-old man presents with epigastric pain that is relieved by eating and antacids. He also reports experiencing nausea and occasional vomiting. What is the most likely diagnosis? Irritable bowel syndrome (IBS) Gastroesophageal reflux disease (GERD) Peptic ulcer disease Cholecystitis

Peptic ulcer disease Rationale While this sounds similar to a GERD presentation, having nausea and vomiting are more consistent with PUD rather than GERD and should include a workup for H Pylori as a cause.

Your patient with a large bump on their cheek should be evaluated and ruled out for which cardiac complication-linked diagnosis? Obstructed salivary gland Perioral abscess Impacted molar Dental caries

Perioral abscess Rationale Perioral abscesses are linked to complications since the bloodstream access is so easy for pathogens. The remainder do not represent any cardiac risk.

Which of the following is not a common symptom of Meniere's disease? Vertigo Hearing loss Tinnitus Photophobia

Photophobia Rationale The classic triad of Meniere's disease is vertigo, tinnitus, and hearing loss.

An older adult female presents for her annual examination. She has been on antihypertensive medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse practitioner is concerned about the patient's cardiac health risks, due her to weight and her waist circumference. According to the AHA guidelines, which of the following goals is expected for this patient? Physical activity for 60 minutes daily, for a minimum of 6 days a week Physical activity for 30 minutes daily, for a minimum of 5 days a week Physical activity for 60 minutes daily, 7 days a week Physical activity for 30 minutes daily, 7 days a week

Physical activity for 30 minutes daily, for a minimum of 5 days a week

Your ESRD patient on hemodialysis has missed therapy two separate times this week. What potentially life-threatening lab finding would you anticipate to be acutely elevated? Sodium Potassium Chloride Calcium

Potassium Rationale ESRD patients are put on hemodialysis due to their inability to clear creatinine, BUN, and potassium.

What is the key long-term benefit of using carvedilol for patients with coronary artery disease and heart failure with reduced ejection fraction (HFrEF)? Increase in libido Reduction in cardiac output Baseline reduction of blood pressure Potential increase in ejection fraction

Potential increase in ejection fraction Rationale EF increase is a key reason for using carvedilol over metoprolol for patients with low EF states. Libido unfortunately can be negatively impacted by any beta blocker. Cardiac output should only improve with long term use, not decrease, and beta blockers may reduce blood pressure slightly, but that is not their key long-term benefit. In fact, they are not even considered for routine anti-hypertensive management per JNC-8 guidelines.

Treatment of acute poison ivy includes: SoluMedrol Sporonax Prednisone 40mg for 10 days Synalar

Prednisone 40mg for 10 days Rationale Prednisone is sometimes prescribed for severe cases of poison ivy dermatitis, especially when the rash covers a large area of the body, is particularly severe, or involves sensitive areas like the face, genitals, or eyes.

Your patient with a diagnosis of metabolic syndrome was just admitted to the ICU for pneumonia. Which of the following assessment findings suggests insulin resistance? Presence of A-V nicking on funduscopic exam Striae noted on bilateral flanks Presence of darkened, velvety creases of the groin, neck, and axilla with skin tags present Absence of acanthosis nigricans

Presence of darkened, velvety creases of the groin, neck, and axilla with skin tags present Rationale Striae are "stretch marks" and are a non-specific finding other than for possibly Cushing syndrome or normal for rapid growth through adolescence and pregnancy. AV nicking indicates hypertension. Acanthosis nigricans is defined as the presence of darkened, velvety creases of the

A 92-year-old presents with a decline in personal care and increasing forgetfulness. They had a CVA a three years ago with mild cognitive changes then which has slowly progressed. The more likely diagnosis in this case is? Lewy-body dementia Progressive vascular dementia Alzheimer's dementia Mini-strokes

Progressive vascular dementia

A 50-year-old man presents for a routine check-up and expresses concerns about prostate health. What is the most appropriate screening recommendation for prostate cancer? Digital rectal examination (DRE) every year PSA test every 5 years starting at age 40 Prostate-specific antigen (PSA) test every year starting at age 50 No screening until symptoms appear

Prostate-specific antigen (PSA) test every year starting at age 50 Rationale PSA testing is used as a screening tool to detect prostate cancer early, before symptoms develop. Prostate cancer is one of the most common cancers in men, and early detection can improve treatment outcomes.

Which of the following categories of medication are not likely to be included in the medication regimen for a patient with HIV? NNRTIs NRTIs Protease antagonists Protease inhibitors

Protease antagonists Rationale NRTIs, NNRTIs, and protease inhibitors represent the three-drug regimen for HAART therapy.

Your patient has been noticing cracking and peeling on their hands and having some vesicular rash component. Which of the following is not likely the diagnosis? Dyshidrotic eczema Palmoplantar eczema Psoriasis Pompholyx

Psoriasis Rationale Pompholyx and dishidrotic eczema are all synonyms for palmoplantar eczema which this describes precisely. Psoriasis tends to be on the extensor surfaces, not the flexor surfaces such as the palm.

Your patient has been diagnosed with stage 4 Hodgkin's lymphoma. Which is the most likely treatment strategy to be used for this patient? Radiotherapy alone Referral to hospice for comfort measures only No therapy Radiotherapy and/or chemotherapy

Radiotherapy and/or chemotherapy Rationale Patients with stage 3-4 lymphoma are likely to have a good chance at suppression if not remission with a combination of radiotherapy and chemotherapy, depending on the type of lymphoma.

Your patient has been diagnosed with HIV and wants to know the goal of treatment with "all these medications". Which of the following represents the most reasonable goal in the treatment of HIV? Reducing the CD4 count to an undetectable level Reducing viral load to an undetectable level Ability to reduce to one medication as therapy rather than multiple agents Complete healing with no need for further medications

Reducing viral load to an undetectable level Rationale HAART therapy typically requires 3 medications for most effective management of HIV/AIDS. Increasing the CD4 count as high as possible is considered the goal as well as to reduce the viral load as low as possible. It is unlikely that the patient should anticipate healing to the point of not needing medications any further given that lifelong HAART therapy is currently considered standard of care.

An adult female presents with right leg pain and rash. The patient exhibits significant swelling of the right lower extremity from the ankle to the end of the upper thigh, erythema, induration, and weeping lesions in the anterior lower leg. The patient "picked at" the affected area, and its condition progressed to the current state over a period of 1 week. Over the past 2 days, the swelling and pain have increased greatly. BP=86/50, P=104, R=24/min, and T=101.2 degrees F (38.4 degrees C); BMI=45.9. The nurse practitioner should: Refer to an infectious disease specialist Refer for immediate evaluation in the emergency dept Prescribe cephalexin (Keflex), 500mg every 6 hours Prescribe trimethoprim-sulfamethoxazole 160mg/800mg (Bactrim DS), every 12 hours

Refer for immediate evaluation in the emergency dept Rationale Immediate and comprehensive management is crucial to prevent complications and promote healing in cases of severe cellulitis or skin infections presenting in primary care settings.

A 90-year-old female is brought to the clinic by her neighbor. She states that everything is fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk. The neighbor is concerned that the patient often has no money to buy food, despite income from social security and a coal miner's pension. The nurse practitioner suspects abuse. Which of the following is the nurse practitioner obligated to do next? Tell the neighbor to check on the woman daily and report back. Document the data and report the information to risk management. Report the case to the proper authorities. Call the patient's family and inquire about the concerns.

Report the case to the proper authorities. Rationale Remember, that suspected abuse is always a reportable event and therefore should be the right answer you gravitate toward on any question that suggest that there is any type of actual or suspected elder abuse.

A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue. The patient reports a 2-week history of blackened stools, which the patient attributes to drinking berry juice. Assessment reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb = 4.5 g/dL; Hct = 16%. What is the most appropriate immediate intervention? Send to the emergency room. Order a complete blood count (CBC) with differential. Order serum iron, total iron-binding capacity (TIBC), and ferritin. Refer to a gastroenterologist.

Send to the emergency room Rationale This patient is experiencing a GI bleed and is in need of emergency treatment due to their considerably low hemoglobin.

Patients with Stevens-Johnson syndrome should be managed by which of the following mechanisms? Similarly to burn patients due to loss of fluid volume With off-floor privileges to encourage mobility and retain muscle mass With negative pressure isolation due to the contagious nature of SJS Similarly to heart surgery patients, due to the risk of hypervolemia

Similarly to burn patients due to loss of fluid volume Rationale Due to the loss of the protective skin barrier where sloughing occurs, infection risk is high and substantial insensible fluid loss means these patients need to be treated as burn victims would be. Hypervolemia is not a typical concern for the same reason, as they tend to be underfilled. Off-floor privileges would not be wise since the infection risk and pain requires close monitoring, fall risk, and analgesic requirements.

Sensitivity vs Specificity

SnNout sensitive test, when NEGATIVE, rules OUT the disease SpPin Specific test, when positive, rules IN the disease (highly specific = less false positives)

our patient has been started on sulfamethoxazole for a urinary tract infection and two days later states she feels painful blistering on her skin. Which of the following life-threatening disease states are you most concerned about? Scleroderma Vasculitis Stevens-Johnson Syndrome Erythema multiforme

Stevens-Johnson Syndrome Rationale This patient needs to be hospitalized and evaluated closely for progression and urgent management to avoid possible life-threatening end-organ dysfunction from SJS. The remaining options do not have any association to the administration of antibiotics such as sulfamethoxazole.

What is the standard treatment for women with uncomplicated urinary tract infection in a geographical area with less than 20% resistance? Ciprofloxacin 500mg BID x 7 days Amoxicillin 875mg BID x 7 days Sulfamethoxazole/Trimethoprim 800/160mg BID x 3 days Nitrofurantoin 100mg BID x 5 days

Sulfamethoxazole/Trimethoprim 800/160mg BID x 3 days Rationale In female patients with uncomplicated UTI with less than 20% resistance geographically Sulfamethoxazole/Trimethoprim 800/160mg BID x 3 days is the correct answer.

Patients with a butterfly rash on their face and symptoms of fatigue and joint pain should be worked up for which of the following disease states? Pityriasis rosea Systemic lupus erythematosus (SLE) Herpes zoster Rosacea

Systemic lupus erythematosus (SLE) Rationale This triad of symptoms is classic for SLE and should be worked up with an antinuclear antibody (ANA) as well as CBC and BMP to evaluate end-organ involvement.

How should a nurse practitioner evaluate if palliative care is effective? The illness or disease is in remission. Advanced directives have been discussed and signed. An out-of-hospital "Do not resuscitate" order is in place. The symptoms causing discomfort are lessened.

The symptoms causing discomfort are lessened Rationale Palliative care consults are performed for patients who have a near-terminal condition with a very minimal anticipated duration of life left, typically 14 days or less. It does not mean a cessation of treatment, but it does focus the treatment on their quality of life to be prioritized.

The patient has been diagnosed with hyphema after a car accident and airbag deployment. Treatment commonly includes which of the following medications? Aspirin oral tablets Ciprofloxacin ophthalmic solution Timolol ophthalmic solution Prednisone oral tablets

Timolol ophthalmic solution Rationale Beta blocker drops are useful to reduce pressure in the anterior vitreous. Prednisone PO is not typically ordered, although steroid drops are. Aspirin is typically contraindicated due to bleeding risk and there is no specific indication for an antibiotic.

Which of the following is not a domain of Social Determinants of Health as identified in Healthy People 2030? Health Care Access and Quality Economic Stability Social and Community Context Transportation Infrastructure

Transportation Infrastructure Rationale The 5 overarching domains of Social Determinants of Health are Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, Social and Community Context.

An adult female recently returned for a recheck appointment. The only remarkable laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 0.4-6 microunits/mL). The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following laboratory tests should the nurse practitioner order now? Triiodothyronine (T3) only D Triiodothyronine (T3) and free triiodothyronine (FT3) Triiodothyronine (T3) and free thyroxine (FT4) Triiodothyronine (T3) resin uptake assay

Triiodothyronine (T3) and free thyroxine (FT4) Rationale Remember that a patient with low TSH is suspicious of hyperthyroidism with a corresponding finding of elevated T3/T4 and clinical symptoms of a goiter, tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This patient is describing a sore neck as well, which is suggestive of Graves disease (hyperthyroid state).

A 65-year-old woman with osteoporosis presents with acute onset of severe back pain after lifting a heavy object. What is the most likely diagnosis? Herniated disc Degenerative disc disease Vertebral compression fracture Lumbar strain

Vertebral compression fracture Rationale A vertebral compression fracture can occur after lifting a heavy object. Symptoms of a vertebral compression fracture may include sudden onset of back pain, which can be severe and worsen with movement or weight-bearing. There may also be limited spinal mobility and height loss.

All the following are symptoms of hypocalcemia except: Abdominal pain Tetany Visual field deficits Paresthesia in fingers and toes

Visual field deficits Rationale Visual field deficits is a potential symptom of pituitary adenoma. All other options are symptoms related to hypocalcemia.

A 65-year-old man presents for follow-up of his well-controlled hypertension and expresses concerns about maintaining bone health. He is a smoker and has a sedentary lifestyle. What is the most appropriate initial recommendation to reduce his risk of osteoporosis? Weight-bearing exercise and smoking cessation Hormone replacement therapy Calcium and vitamin D supplementation Start bisphosphonates

Weight-bearing exercise and smoking cessation Rationale Physical activity and smoking cessation, when possible, should always be the first-line therapy before the addition of medications. Hormone replacement therapy is not indicated for males for this, and bisphosphonates, calcium, and vitamin D supplementation are all good second-line agents to help if needed after the first-line agent of physical activity and smoking cessation should be considered.

In a mass casualty situation with presumed anthrax exposure, the drug of choice for prophylaxis is: tetracycline (Achromycin). doxycycline (Doryx). chloramphenicol (Chloromycetin). amoxicillin (Amoxil).

doxycycline (Doryx). Rationale When dealing with prophylactic exposure, the most appropriate medication for anthrax would be doxycycline per the CDC guidelines.

A patient has moderate osteoarthritis. Which of the following dietary supplements could be recommended to reduce pain and joint space narrowing? garlic glucosamine cinnamon red yeast rice

glucosamine Rationale Glucosamine is a building block for cartilage, the flexible tissue that cushions the joints. Taking glucosamine supplements may help maintain or improve cartilage structure and function.

A patient is taking warfarin, 4 mg daily for atrial fibrillation. The patient's current International Normalized Ratio (INR) is 5.5 mg/dL. The nurse practitioner would: increase the warfarin to 5 mg daily. decrease the warfarin to 3 mg daily. hold the warfarin for 4 days and then recheck the INR. hold the warfarin for 1 day and then recheck in two days.

hold the warfarin for 1 day and then recheck in two days. Rationale As warfarin has a long half life, it typically takes several days to see meaningful change in levels of dose change. The INR of 5.5 is supratherapeutic and must be reduced for the risk of bleeding. Of these options, the only one that offers a reduction/cessation and and a recheck of the level is to hold the warfarin for one day and recheck the INR in 2 days.

An adult patient presents with tachycardia and nervousness. The patient is currently taking levothyroxine (Synthroid), 75 mcg daily. The nurse practitioner orders a thyroid-stimulating hormone (TSH) and anticipates having to: lower the dose to 50 mcg daily. continue the same daily dose. raise the dose to 100 mcg daily. add atenolol, 50 mg daily.

lower the dose to 50 mcg daily. Rationale The patient is presenting with symptoms of hyperthyroidism, and since they are being supplemented with levothyroxine for hypothyroidism, it's suggestive that they are overdosing and their dose should be decreased. The only option that is appropriate is to lower the dose to 50 mcg daily, and although adding a 50 mg daily dose of propranolol may be helpful to manage symptoms for a hyperthyroid patient, this hyperthyroid presentation is related to overmedication. To evaluate this more directly, the patient should have a TSH and T3/T4 level drawn and it is likely we would find the TSH is low, T3 and T4 are elevated.

An adult female with a BMI of 31 has pain and weakness in her legs, buttocks, and upper thighs after prolonged walking or standing. She has osteoporosis of the hips. The patient obtains short-term relief by leaning forward (stooping) when grocery shopping or sitting. The suspected diagnosis is: arterial insufficiency lumbar spinal stenosis peripheral vascular disease herniated disc

lumbar spinal stenosis Rationale Lumbar spinal stenosis is a condition involving narrowing of the spinal canal or spaces within the spine. This can put pressure on the nerves that travel through the spine. It commonly occurs in the lumbar (lower back) or cervical (neck) spine.

A geriatric patient with anemia, back pain, osteoporosis, and elevated erythrocyte sedimentation rate should be evaluated for: renal dystrophy. Paget's disease. multiple myeloma. cauda equina syndrome.

multiple myeloma Rationale Multiple myeloma is a type of cancer that affects plasma cells in the bone marrow. Symptoms can include: Bone pain: Often in the back, hips, or ribs Weakness or fatigue: May be caused by anemia Infections: People with multiple myeloma are more likely to get infections like pneumonia, bronchitis, sinusitis, and urinary tract infections Kidney problems: Myeloma protein can damage the kidneys, which may lead to kidney failure Bruising or bleeding: High levels of protein in the blood can make it easier to bruise and cause nosebleeds Other symptoms: Confusion, dizziness, stroke-like symptoms, loss of appetite, weight loss, nausea, vomiting, constipation, frequent urination, and shortness of breath

An 87-year-old female has a history of ovarian cancer. She recently completed the tenth of 26 chemotherapy treatments. She informs the nurse practitioner that she plans to stop chemotherapy; she has lived a good life and is ready to die. She is alert and very active, and lives with her son. The family is determined that the patient will complete the chemotherapy. The nurse practitioner's most appropriate action is to: encourage treatment. support the patient's decision. refer the family for counseling. follow the family's requests.

support the patient's decision. Rationale Good nursing practice supports advocacy at all times for the patient, even when the patient's family disagrees. Supporting their decision to self-direct their care is your primary obligation.

The management of COPD in the elderly is best guided by: radiologic imaging. arterial blood gases. spirometry. symptomatology.

symptomatology Rationale Symptomatology is what guides COPD management since the severity and frequency of symptoms will warrant changes and additions to medications as exacerbations present. Although very useful tool for chronic management and baseline status, spirometry does not typically dictate therapy, rather diagnose the disease state itself. Our blood gases may be used for clinically correlate severity during an exacerbation, and radiologic imaging may showcase severity of stable chronic finding such as somatic, lung tissue or bullae.