*** Dunphy/Davis Edge - Gastrointestinal

Caroline has a 13-year-old daughter who has had 2 recent infestations of lice. She asks you what she can do to prevent this. You respond: 1. "After two days of no head lice, her bedding is lice-free." 2. "Boys are more susceptible, so watch out for her brother also." 3. "After several infestations, she is now immune and is no longer susceptible." 4. "Don't let her share hats, combs, or brushes with anyone."

"Don't let her share hats, combs, or brushes with anyone."

A mother brings in her 4-year-old child, who she states has acute abdominal pain and a rash. Which of the following do you initially rule out? 1. Rocky Mountain spotted fever. 2. Measles. 3. Appendicitis. 4. A food allergy.

3. Appendicitis.

Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil shape, marked photophobia, and redness around the iris. What is your initial diagnosis? 1. Conjunctivitis. 2. Iritis. 3. Subconjunctival hemorrhage. 4. Acute glaucoma.

2. Iritis.

A mother brings in her 4-year-old child, who she states has acute abdominal pain and a rash. Which of the following do you initially rule out? 1.Rocky Mountain spotted fever. 2.Measles. 3.Appendicitis. 4.A food allergy.

3. Appendicitis.

Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) would you expect to be decreased? 1.Sedimentation rate. 2.Liver enzyme levels. 3.Vitamin A, B complex, and C levels. 4.Bilirubin level.

3. Vitamin A, B complex, and C levels.

Marge, age 36, is planning to go skiing with her fiancé. He has warned her about frostbite, and she is wondering what to do if frostbite should occur. You know she's misunderstood the directions when she tells you which of the following? 1. "I should remove wet footwear if my feet are frostbitten." 2. "I should rub the area with snow." 3. "I should apply firm pressure to the area with a warm hand." 4. "I should place my hands in my axillae if my hands are frostbitten."

"I should rub the area with snow."

You're teaching Mitch, age 18, about his tinea pedis. You know he doesn't understand your directions when he tells you which of the following? 1. "I should dry between my toes every day." 2. "I should wash my socks with bleach." 3. "I should use an antifungal powder twice a day." 4. "I should wear rubber shoes in the shower to prevent transmission to others."

"I should wear rubber shoes in the shower to prevent transmission to others."

Mandy, 44, was given a diagnosis of flu 1 day ago and wants to start on the "new flu medicine" right away. What do you tell her? 1. "The medication is effective only if started within the first 72 hours after symptoms begin." 2. "If you treat a cold, it goes away in 7 days; if you don't treat it, it goes away in 1 week." 3. "The medicine has not proven its effectiveness." 4. "I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

"I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

Deanna, age 6, was bitten by a friend's dog. Her mother asks you if the child needs antirabies treatment. You tell her: 1. "If the dog is a domestic pet that has been vaccinated, the wound should be cleaned and irrigated." 2. "Antirabies treatment must be started immediately." 3. "Rabies can be contracted only through the bites of wild animals." 4. "Wait until you have observed the animal for 2 weeks to determine if it is rabid."

"If the dog is a domestic pet that has been vaccinated, the wound should be cleaned and irrigated."

Susan states that her fiancé has been frostbitten on the nose while skiing and is fearful that it will happen again. What do you tell her? 1. "Don't worry—as long as he gets medical help in the first few hours after being frostbitten again, he'll recover." 2. "Once frostbitten, he should not go out skiing again." 3. "If it should happen again, massage the nose with a dry hand." 4. "Infarction and necrosis of the affected tissue can happen with repeated frostbite."

"Infarction and necrosis of the affected tissue can happen with repeated frostbite."

Thomas, age 35, uses a high-potency corticosteroid cream for a dermatosis. He also currently has tinea corporis. You tell him the following regarding the cream: 1. "You must use this for an extended period of time for it to be effective." 2. "It will work better if you occlude the area." 3. "It may exacerbate your concurrent tinea corporis." 4. "Be sure to use it daily."

"It may exacerbate your concurrent tinea corporis."

Dennis, age 62, has benign prostatic hyperplasia (BPH). He tells you that he voids at least 4 times per night and that he has read about a preventive drug called terazosin hydrochloride (Hytrin) that might help him. What do you tell him? 1. "It's not a preventive drug, but it relaxes smooth muscle in the prostate and bladder neck." 2. "It changes the pH of the urine and prevents infections caused by urinary stasis." 3. "It relaxes the urethra." 4. "It shrinks the prostate tissue."

"It's not a preventive drug, but it relaxes smooth muscle in the prostate and bladder neck."

Client teaching is an integral part of successfully treating pediculosis. Which of the following statements would you incorporate into your teaching plan? 1. "It's okay to resume sharing combs, headsets, and so on after being lice-free for one month." 2. "Soak your combs and brushes in rubbing alcohol for eight hours." 3. "Itching may continue for up to a week after successful treatment." 4. "Spraying of pesticides in the immediate environment is essential to prevent

"Itching may continue for up to a week after successful treatment."

Ashley, age 6 months, has a Candida infection in the diaper area. What do you suggest to the parent? 1. "Use rubber or plastic pants to contain the infection and prevent it from getting to the thighs." 2. "Keep the area as dry as possible." 3. "Use baby powder with cornstarch." 4. "Keep Ashley away from other babies until the infection is cleared up."

"Keep the area as dry as possible."

Mimi, age 52, asks why she should perform a monthly breast self-examination (BSE) when she has her mammograms on schedule. You respond: 1. "If you are faithful about your annual exams and mammograms, that is enough." 2. "More breast abnormalities are picked up by mammograms than by clinical exams or BSE." 3. "More than 90% of all breast abnormalities are first detected by self-examination." 4. "Self-examinations need to be performed only every other month."

"More than 90% of all breast abnormalities are first detected by self-examination."

Your 24-year-old client whose varicella rash just erupted yesterday asks you when she can go back to work. What do you tell her? 1. "Once all the vesicles are crusted over." 2. "When the rash is entirely gone." 3. "Once you have been on medication for at least forty-eight hours." 4. "Now, as long as you stay away from children and pregnant women."

"Once all the vesicles are crusted over."

Joseph, a 55-year-old man with diabetes, is at your office for his diabetes follow-up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Joseph receive today regarding the care of his feet? 1. "Wash your feet with cold water only." 2. "See a podiatrist every two years, inspect your own feet monthly, and apply lotion to your feet daily." 3. "Go to a spa and have a pedicure monthly." 4. "See a podiatrist yearly; wash your feet daily with warm, soapy water and towel dry between the toes; inspect your feet daily for any lesions; and apply lotion to any dry areas."

"See a podiatrist yearly; wash your feet daily with warm, soapy water and towel dry between the toes; inspect your feet daily for any lesions; and apply lotion to any dry areas."

Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael? 1. "Dilute the oral medication with one tablespoon of water for easier digestion." 2. "Take the medication with meals so that it's absorbed better." 3. "Swish and swallow the medication." 4. "Apply the medication only to the lesions."

"Swish and swallow the medication."

Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated from otitis media. His father asks about repair of the eardrum. How do you respond? 1. "The eardrum, in most cases, heals within several weeks." 2. "We need to schedule Aaron for a surgical repair." 3. "He must absolutely stay out of the water for 3 to 6 months." 4. "If the eardrum is not healed in several months, it can be surgically repaired."

"The eardrum, in most cases, heals within several weeks."

When counseling on health behavior change, the advanced practice registered nurse (APRN) would say which of the following? 1. "Stop smoking. Here is a pamphlet." 2. "Why are you still smoking?" 3. "What are your thoughts about quitting smoking at this time?" 4. "You should quit smoking; it isn't good for your health."

"What are your thoughts about quitting smoking at this time?"

You are attempting to elicit a history from Mr. Barnes during his first visit to your office. He is becoming increasingly angry and belligerent. He says, "Can't you hurry up? Dr. Smith never takes this long! Why are all these questions necessary?" You respond: 1. "I'm sorry, Mr. Barnes, but I need these questions answered." 2. "I want to provide the best possible care for you, Mr. Barnes." 3. "Perhaps your wife can assist with some of these questions." 4. "You seem very upset, Mr. Barnes. Could you share with me what is bothering you?"

"You seem very upset, Mr. Barnes. Could you share with me what is bothering you?"

Sandy asks what she can do for Dolores, her 90-year-old mother, who takes a bath every day and who has extremely dry skin. You respond: 1. "After bathing every day, use a generous amount of moisturizer." 2. "Use a special moisturizing soap every day." 3. "Your mother does not need a bath every day." 4. "Increase your mother's intake of fluids."

"Your mother does not need a bath every day."

When you are assessing the internal structure of the eye of your 59-year-old patient, the absence of a red reflex may indicate: 1. A cataract or hemorrhage into the vitreous humor. 2. Acute iritis. 3. Nothing; this is a normal finding in older adults. 4. Diabetes or long-standing hypertension.

1. A cataract or hemorrhage into the vitreous humor.

The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is: 1. A congenital cataract. 2. Retinoblastoma. 3. Persistent hyperplastic primary vitreous. 4. Retinal detachment.

1. A congenital cataract.

In a young child, unilateral purulent rhinitis is most often caused by: 1. A foreign body. 2. A viral infection. 3. A bacterial infection. 4. An allergic reaction.

1. A foreign body.

You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? 1. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). 2. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec). 3. Amoxicillin (Amoxil) and omeprazole (Prilosec). 4. Clarithromycin (Biaxin) and metronidazole (Flagyl).

1. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl).

As a general rule, when treating hypothermia, at what rate do you want to warm the patient's temperature? 1. 1-2°C an hour. 2. 0-1°C an hour. 3. 0.5°C an hour. 4. 2-3°C an hour.

1-2°C an hour.

Dottie brings in her infant, who has gastroesophageal reflux. What do you tell her about positioning her infant? 1. "Always position infants on their back to prevent sudden infant death syndrome." 2. "Rotate your infant between lying on the back and on the stomach." 3. "Your infant should be placed on the left side." 4. "Place your infant in whatever position she remains quiet."

1. "Always position infants on their back to prevent sudden infant death syndrome."

Dottie brings in her infant, who has gastroesophageal reflux. What do you tell her about positioning her infant? 1."Always position infants on their back to prevent sudden infant death syndrome." 2."Rotate your infant between lying on the back and on the stomach." 3."Your infant should be placed on the left side." 4."Place your infant in whatever position she remains quiet."

1. "Always position infants on their back to prevent sudden infant death syndrome."

Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated from otitis media. His father asks about repair of the eardrum. How do you respond? 1. "The eardrum, in most cases, heals within several weeks." 2. "We need to schedule Aaron for a surgical repair." 3. "He must absolutely stay out of the water for 3 to 6 months." 4. "If the eardrum is not healed in several months, it can be surgically repaired."

1. "The eardrum, in most cases, heals within several weeks."

Icterus due to hyperbilirubinemia is seen when the serum level of bilirubin is greater than? 1. 2.5 mg/dL. 2. 1.0 mg/dL. 3. 2.0 mg/dL. 4. 0.5 mg/dL.

1. 2.5 mg/dL.

Icterus due to hyperbilirubinemia is seen when the serum level of bilirubin is greater than? 1.2.5 mg/dL. 2.1.0 mg/dL. 3.2.0 mg/dL. 4.0.5 mg/dL.

1. 2.5 mg/dL.c

You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? 1.A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). 2.Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec). 3.Amoxicillin (Amoxil) and omeprazole (Prilosec). 4.Clarithromycin (Biaxin) and metronidazole (Flagyl).

1. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl).

What would you expect to see on an abdominal series that would lead toward a diagnosis of small-bowel obstruction? 1. Air-fluid levels. 2. A lead pipe colon. 3. Free air under the diaphragm. 4. Steeple sign.

1. Air-fluid levels.

What would you expect to see on an abdominal series that would lead toward a diagnosis of small-bowel obstruction? 1.Air-fluid levels. 2.A lead pipe colon. 3.Free air under the diaphragm. 4.Steeple sign.

1. Air-fluid levels.

The metabolism of which drug is not affected in Marsha, age 74? 1. Alcohol. 2. Anticonvulsants. 3. Psychotropics. 4. Oral anticoagulants.

1. Alcohol.

Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis? 1. Allergic rhinitis. 2. Viral rhinitis. 3. Nasal polyps. 4. Nasal vestibulitis from folliculitis.

1. Allergic rhinitis.

What is the best diagnostic test to confirm the diagnosis of celiac disease? 1. Anti-tTG IgA. 2. Anti-dsDNA. 3. Colonoscopy. 4. Anti-CCP protein.

1. Anti-tTG IgA.

What is the best diagnostic test to confirm the diagnosis of celiac disease? 1.Anti-tTG IgA. 2.Anti-dsDNA. 3.Colonoscopy. 4.Anti-CCP protein.

1. Anti-tTG IgA.

A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis? 1. Appendicitis. 2. Cholecystitis. 3. Constipation. 4. Gastroenteritis

1. Appendicitis.

A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis? 1.Appendicitis. 2.Cholecystitis. 3.Constipation. 4.Gastroenteritis.

1. Appendicitis.

Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect: 1. Appendicitis. 2. Gastroenteritis. 3. Acute pancreatitis. 4. Rocky Mountain spotted fever.

1. Appendicitis.

Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect: 1.Appendicitis. 2.Gastroenteritis. 3.Acute pancreatitis. 4.Rocky Mountain spotted fever.

1. Appendicitis.

Treatment for achalasia may include: 1. Balloon dilation of the lower esophageal sphincter. 2. Beta blockers. 3. A fundoplication. 4. An esophagogastrectomy.

1. Balloon dilation of the lower esophageal sphincte

A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively worse. He also notes nausea without vomiting, dry mouth, and double vision. On exam you notice his pupillary reflex is absent. The patient states he lives on the street and eats mostly canned goods that he scavenges from a grocery store dumpster. What is the likely cause of the patient's symptoms? 1. Botulism. 2. Salmonella. 3. Lyme disease. 4. Vitamin C deficiency.

1. Botulism.

A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively worse. He also notes nausea without vomiting, dry mouth, and double vision. On exam you notice his pupillary reflex is absent. The patient states he lives on the street and eats mostly canned goods that he scavenges from a grocery store dumpster. What is the likely cause of the patient's symptoms? 1.Botulism. 2.Salmonella. 3Lyme disease. 4.Vitamin C deficiency.

1. Botulism.

Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? 1. Cheese. 2. Leafy green vegetables. 3. Raw fruits and vegetables. 4. Dried beans.

1. Cheese.

The screening guidelines for colon cancer recommend which of the following for the general population? 1. Colonoscopy starting at age 50. 2. Colonoscopy starting at age 45. 3. Fecal occult blood test (FOBT) and rectal exam starting at age 50. 4. Fecal occult blood test (FOBT) and rectal exam starting at age 45.

1. Colonoscopy starting at age 50.

The screening guidelines for colon cancer recommend which of the following for the general population? 1.Colonoscopy starting at age 50. 2.Colonoscopy starting at age 45. 3.Fecal occult blood test (FOBT) and rectal exam starting at age 50. 4.Fecal occult blood test (FOBT) and rectal exam starting at age 45.

1. Colonoscopy starting at age 50.

To differentiate among the different diagnoses of inflammatory bowel diseases, you look at the client's histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? 1. Crohn disease. 2. Ulcerative colitis. 3. Infectious colitis. 4. Ischemic colitis.

1. Crohn disease.

To differentiate among the different diagnoses of inflammatory bowel diseases, you look at the client's histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? 1.Crohn disease. 2.Ulcerative colitis. 3.Infectious colitis. 4.Ischemic colitis.

1. Crohn disease.

In a 2-month-old infant with vomiting and diarrhea, the most effective way of determining a fluid deficit is to check for: 1. Decreased peripheral perfusion. 2. Hyperventilation. 3. Irritability. 4. Hyperthermia.

1. Decreased peripheral perfusion.

In a 2-month-old infant with vomiting and diarrhea, the most effective way of determining a fluid deficit is to check for: 1.Decreased peripheral perfusion. 2.Hyperventilation. 3.Irritability. 4.Hyperthermia.

1. Decreased peripheral perfusion.

Samantha, age 28, is 100 lb overweight and wants to have a gastroplasty performed. In discussing this with her, you explain that by having this procedure she may: 1. Develop diarrhea. 2. Lose too much weight. 3. Develop hemorrhoids. 4. Vomit after she eats.

1. Develop diarrhea.

Samantha, age 28, is 100 lb overweight and wants to have a gastroplasty performed. In discussing this with her, you explain that by having this procedure she may: 1.Develop diarrhea. 2.Lose too much weight. 3.Develop hemorrhoids. 4.Vomit after she eats.

1. Develop diarrhea.

What is the most common cause of epistaxis? 1. Digital trauma. 2. Warfarin. 3. Vitamin C deficiency. 4. Hemophilia A.

1. Digital trauma.

Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do you suspect? 1. Epiglottitis. 2. Group A beta-hemolytic streptococcal pharyngitis. 3. Tonsillitis. 4. Diphtheria.

1. Epiglottitis.

What is the most common bacterial cause of traveler's diarrhea? 1. Escherichia coli. 2. Campylobacter jejuni. 3. Salmonella. 4. Shigella

1. Escherichia coli.

What is the most common bacterial cause of traveler's diarrhea? 1.Escherichia coli. 2.Campylobacter jejuni. 3.Salmonella. 4.Shigella.

1. Escherichia coli.

Regular ocular pressure testing is indicated for older adults taking: 1. High-dose inhaled glucocorticoids. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Angiotensin-converting enzyme (ACE) inhibitors. 4. Insulin

1. High-dose inhaled glucocorticoids.

A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2 days. He states there is a streak of bright blood along his stool every time he has a bowel movement. The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test but has no noticeable rectal bleeding or lesions. What is the likely diagnosis? 1.Internal hemorrhoid. 2.External hemorrhoid. 3.Bleeding peptic ulcer. 4.Rectal fissure.

1. Internal hemorrhoid

A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2 days. He states there is a streak of bright blood along his stool every time he has a bowel movement. The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test but has no noticeable rectal bleeding or lesions. What is the likely diagnosis? 1. Internal hemorrhoid. 2. External hemorrhoid. 3. Bleeding peptic ulcer. 4. Rectal fissure.

1. Internal hemorrhoid.

Cydney has been given a diagnosis of ascariasis. Which symptoms would you expect to see? 1. Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea. 2. Nocturnal perianal and perineal pruritus. 3. Diarrhea, cramps, and malaise. 4. Ascites and facial and extremity edema.

1. Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea.

Which of the following statements about macular degeneration is not true? 1. Macular degeneration is characterized by gradual loss of peripheral vision. 2. Macular degeneration is the leading cause of blindness in people younger than 60. 3. Tobacco use is a risk factor for macular degeneration. 4. There are 2 different types of macular degeneration: wet and dry.

1. Macular degeneration is characterized by gradual loss of peripheral vision.

Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected? 1. Maxillary sinus. 2. Ethmoid sinus. 3. Sphenoid sinus. 4. Frontal sinus.

1. Maxillary sinus.

A 75-year-old African American male presents to your family practice office complaining of visual impairment. He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past 6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is 23 mm Hg. What is his most likely diagnosis? 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Cataracts. 4. Macular degeneration.

1. Open-angle glaucoma.

A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in management of this patient's GERD? 1. Order an endoscopy. 2. Order a Helicobacter pylori blood test. 3. Try adding ranitidine to the patient's regimen. 4. Try adding bismuth to the patient's regimen.

1. Order an endoscopy.

A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in management of this patient's GERD? 1.Order an endoscopy. 2.Order a Helicobacter pylori blood test. 3.Try adding ranitidine to the patient's regimen. 4.Try adding bismuth to the patient's regimen.

1. Order an endoscopy.

Which of the following is not a cause of conductive hearing loss? 1. Presbycusis. 2. Cerumen impaction. 3. Otitis media. 4. Otosclerosis.

1. Presbycusis.

Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? 1. Prescribe nasal steroids and oral decongestants. 2. Prescribe antibiotic ear drops. 3. Prescribe systemic antibiotics. 4. Refer Max to an ear, nose, and throat specialist.

1. Prescribe nasal steroids and oral decongestants.

Mattie, age 64, presents with blurred vision in 1 eye and states that it felt like "a curtain came down over my eye." She doesn't have any pain or redness. What do you suspect? 1. Retinal detachment. 2. Acute angle-closure glaucoma. 3. Open-angle glaucoma. 4. Cataract

1. Retinal detachment.

A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the club. These symptoms are most characteristic of which of the following? 1. Sensorineural loss. 2. Conductive loss. 3. Tinnitus. 4. Vertigo.

1. Sensorineural loss.

You are trying to differentiate between functional (acquired) constipation and Hirschsprung disease in a neonate. Distinguishing features of Hirschsprung disease include which of the following? 1. Small ribbonlike stools. 2. Obvious abdominal pain. 3. Female gender. 4. Small weight gain.

1. Small ribbonlike stools.

What is the most common bacterial pathogen associated with acute otitis media? 1. Streptococcus pneumoniae. 2. Haemophilus influenzae. 3. Streptococcus pyogenes. 4. Moraxella (Branhamella) catarrhalis.

1. Streptococcus pneumoniae.

What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive treatment and referral? 1. There is a change in the child's hearing threshold to greater than 25 dB. 2. The child has become a fussy eater. 3. The child's speech and language skills seem slightly delayed. 4. Persistent rhinitis is present.

1. There is a change in the child's hearing threshold to greater than 25 dB.

Which of the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? 1. Trigeminal neuralgia. 2. Temporomandibular joint (TMJ) syndrome. 3. Goiter. 4. Preauricular adenitis.

1. Trigeminal neuralgia.

Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? 1. Ursodiol (Actigall). 2. Ibuprofen (Advil). 3. Prednisone (Deltasone). 4. Surgery is the only answer.

1. Ursodiol (Actigall)

A 75-year-old male presents for a routine physical. He is obese and has no abdominal pain or recent injuries or problems. He has no complaints. He lies supine for his abdominal exam. He is nontender to palpation and has a normal exam. When he sits up you see a large mass protrude from his abdomen. It is central to his abdomen and inferior to his rib cage. It disappears when he is sitting up fully. What is the patient's diagnosis? 1. Ventral (epigastric) hernia. 2. Inguinal hernia. 3. Femoral hernia. 4. Umbilical hernia.

1. Ventral (epigastric) hernia.

A 75-year-old male presents for a routine physical. He is obese and has no abdominal pain or recent injuries or problems. He has no complaints. He lies supine for his abdominal exam. He is nontender to palpation and has a normal exam. When he sits up you see a large mass protrude from his abdomen. It is central to his abdomen and inferior to his rib cage. It disappears when he is sitting up fully. What is the patient's diagnosis? 1.Ventral (epigastric) hernia. 2.Inguinal hernia. 3.Femoral hernia. 4.Umbilical hernia.

1. Ventral (epigastric) hernia.

A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no decrease in extraocular movements. The patient has a sibling that just started day care recently. He also has bilateral preauricular lymph nodes that are inflamed. What is the patient's diagnosis? 1.Viral conjunctivitis. 2.Bacterial conjunctivitis. 3.Allergic conjunctivitis. 4.Blepharitis.

1. Viral conjunctivitis.

Which is the most common presenting symptom of gastric cancer? 1. Weight loss. 2. Dysphagia. 3. Hematemesis. 4. Gastrointestinal bleeding.

1. Weight loss.

April, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthi. She is concerned that they may be cancerous skin lesions. You tell her that they are probably: 1. Xanthelasmas. 2. Pingueculae. 3. The result of arcus senilis. 4. Actinic keratoses.

1. Xanthelasmas.

The metabolism of which drug is not affected in Marsha, age 74? 1.Alcohol. 2.Anticonvulsants. 3.Psychotropics. 4.Oral anticoagulants.

1. Alcohol

Treatment for achalasia may include: 1. Balloon dilation of the lower esophageal sphincter. 2. Beta blockers. 3. A fundoplication. 4. An esophagogastrectomy.

1. Balloon dilation of the LES

Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? 1.Cheese. 2.Leafy green vegetables. 3.Raw fruits and vegetables. 4.Dried beans.

1. Cheese

What is the recommended treatment to eradicate a Helicobacter pylori infection? 1.Ranitidine, amoxicillin, and clarithromycin for 2 weeks. 2.Amoxicillin, clarithromycin, and omeprazole for 2 weeks. 3.Bismuth, amoxicillin, and clarithromycin for 2 weeks. 4.Bismuth, doxycycline, metronidazole, and ranitidine.

2. Amoxicillin, clarithromycin, and omeprazole for 2 weeks.

Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? 1.Ursodiol (Actigall). 2.Ibuprofen (Advil). 3.Prednisone (Deltasone). 4.Surgery is the only answer.

1. Ursodiol (Actigall)

Which is the most common presenting symptom of gastric cancer? 1.Weight loss. 2.Dysphagia. 3.Hematemesis. 4.Gastrointestinal bleeding.

1. Weight loss

Cydney has been given a diagnosis of ascariasis. Which symptoms would you expect to see? 1.Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea. 2.Nocturnal perianal and perineal pruritus. 3.Diarrhea, cramps, and malaise. 4.Ascites and facial and extremity edema.

1.Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea.

Margaret, age 29, is of medium build and 5 ft 4 in tall. You estimate that she should weigh about: 1. 105 lb. 2. 110 lb. 3. 120 lb. 4. 130 lb.

120 lb.

What is the recommended treatment to eradicate a Helicobacter pylori infection? 1. Ranitidine, amoxicillin, and clarithromycin for 2 weeks. 2. Amoxicillin, clarithromycin, and omeprazole for 2 weeks. 3. Bismuth, amoxicillin, and clarithromycin for 2 weeks. 4. Bismuth, doxycycline, metronidazole, and ranitidine.

2. Amoxicillin, clarithromycin, and omeprazole for 2 weeks.

Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you she is sure it is going to be malignant. How do you respond? 1. "Don't worry. Gastric ulcers are not cancerous." 2. "About 95% of gastric ulcers are benign." 3. "You have about a 50% chance of having gastric cancer from your ulcer." 4. "Even if it is cancer, surgery is 100% successful."

2. "About 95% of gastric ulcers are benign."

Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? 1. "Occasionally he accumulates blood in the gut." 2. "There is an interruption of the normal clotting mechanism." 3. "Long-term alcohol abuse has made his vessels very friable." 4. "His bone marrow has been affected."

2. "There is an interruption of the normal clotting mechanism."

Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? 1."Occasionally he accumulates blood in the gut." 2."There is an interruption of the normal clotting mechanism." 3."Long-term alcohol abuse has made his vessels very friable." 4."His bone marrow has been affected."

2. "There is an interruption of the normal clotting mechanism."

Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? 1. A throat culture. 2. A Monospot test. 3. A rapid antigen test. 4. A Thayer-Martin plate test.

2. A Monospot test

Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect: 1. Bell palsy. 2. A lesion affecting the trigeminal nerve. 3. A stroke—brain attack, cerebrovascular accident (CVA). 4. Shingles.

2. A lesion affecting the trigeminal nerve.

Tom has just been diagnosed with celiac disease. Which of the following might you tell him? 1. There is a new pharmaceutical cure for celiac disease. 2. A strict gluten-free diet is the only treatment for celiac disease. 3. Your children will not be at a higher risk for developing this disease. 4. The presence of celiac disease is decreasing dramatically in the United States.

2. A strict gluten-free diet is the only treatment for celiac disease.

Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the tongue that you suspect to be cancerous. You document your finding as: 1. A superficial, translucent, subepithelial, vesicle-like lesion in the oral mucosa. 2. A white, painless, firm, ulcerated lesion with indurated borders. 3. An abnormal white coating of the dorsal surface of the tongue. 4. A round, smooth, firm lump on the lateral side of the tongue.

2. A white, painless, firm, ulcerated lesion with indurated borders.

Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect: 1. Dental abscess. 2. Acute rhinosinusitis. 3. Chronic rhinosinusitis. 4. Nasal tumor.

2. Acute rhinosinusitis.

The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: 1. Amoxicillin (Amoxil). 2. Amoxicillin and potassium clavulanate (Augmentin). 3. Azithromycin (Zithromax). 4. Prednisone (Deltasone).

2. Amoxicillin and potassium clavulanate (Augmentin).

You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? 1.Cirrhosis. 2.Inflammation of the kidney. 3.Inflammation of the spleen. 4.Peritonitis.

2. Inflammation of the kidney.

A 62-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She states that her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has: 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Herpetic conjunctivitis. 4. Diabetic retinopathy.

2. Angle-closure glaucoma.

Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is: 1. Ciprofloxacin (Cipro). 2. Azithromycin (Zithromax). 3. Amoxicillin (Amoxil). 4. Cephalexin (Keflex).

2. Azithromycin (Zithromax)

Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result from the pancreatic inflammatory process, which is known as Grey Turner sign? 1. Left-sided pleural effusion. 2. Bluish discoloration over the flanks. 3. Bluish discoloration around the umbilicus. 4. Jaundice.

2. Bluish discoloration over the flanks.

Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result from the pancreatic inflammatory process, which is known as Grey Turner sign? 1.Left-sided pleural effusion. 2.Bluish discoloration over the flanks. 3.Bluish discoloration around the umbilicus. 4.Jaundice.

2. Bluish discoloration over the flanks.

Which manifestation is noted with carbon monoxide poisoning? 1. Circumoral pallor of the lips. 2. Cherry-red lips. 3. Cyanosis of the lips. 4. Pale pink lips.

2. Cherry-red lips.

Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? 1. Campylobacter jejuni. 2. Clostridium botulinum. 3. Clostridium perfringens. 4. Staphylococcus.

2. Clostridium botulinum.

Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? 1.Campylobacter jejuni. 2.Clostridium botulinum. 3.Clostridium perfringens. 4.Staphylococcus.

2. Clostridium botulinum.

Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: 1. Constipation. 2. Colorectal cancer. 3. Irritable bowel syndrome. 4. Acute appendicitis.

2. Colorectal cancer.

Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: 1.Constipation. 2.Colorectal cancer. 3.Irritable bowel syndrome. 4.Acute appendicitis.

2. Colorectal cancer.

Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an: 1. Inguinal hernia. 2. Epigastric hernia. 3. Umbilical hernia. 4. Incisional hernia.

2. Epigastric hernia.

Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an: 1.Inguinal hernia. 2.Epigastric hernia. 3.Umbilical hernia. 4.Incisional hernia.

2. Epigastric hernia.

Mallory brings her 4-week-old infant to the office because she noticed small, yellow-white, glistening bumps on her infant's gums. She says they look like teeth, but she is worried that they may be cancer. You diagnose these bumps as: 1. Bednar aphthae. 2. Epstein pearls. 3. Buccal tumors. 4. Exostosis.

2. Epstein pearls.

A 65-year-old man presents complaining of a left-sided, deep, throbbing headache and mild fatigue. On examination, the client has a tender, tortuous temporal artery. You suspect giant cell arteritis (GCA), or temporal arteritis. What is the least invasive procedure to help with diagnosis? 1. Magnetic resonance imaging (MRI) of the head. 2. Erythrocyte sedimentation rate (ESR). 3. Electroencephalogram (EEG). 4. Otoscopy.

2. Erythrocyte sedimentation rate (ESR).

Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? 1. Enterococci. 2. Escherichia coli. 3. Klebsiella. 4. Staphylococci.

2. Escherichia coli.

Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? 1.Enterococci. 2.Escherichia coli. 3.Klebsiella. 4.Staphylococci.

2. Escherichia coli.

You are the nurse practitioner caring for Martha, a 47-year-old accountant. You have made a diagnosis of acute sinusitis based on Martha's history and the fact that she complains of pain behind her eye. Which sinuses are affected? 1. Maxillary. 2. Ethmoid. 3. Frontal. 4. Sphenoid.

2. Ethmoid.

You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have: 1. Yogurt. 2. Foods containing whey. 3. Prehydrolyzed milk. 4. Oranges.

2. Foods containing whey

Hepatitis D is an RNA virus that requires a coinfection with which of the following strains of hepatitis in order to replicate? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis E.

2. Hepatitis B.

Hepatitis D is an RNA virus that requires a coinfection with which of the following strains of hepatitis in order to replicate? 1.Hepatitis A. 2.Hepatitis B. 3.Hepatitis C. 4.Hepatitis E.

2. Hepatitis B.

Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? 1. Age. 2. Infection. 3. Pain. 4. Length of time between exacerbations.

2. Infection.

Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? 1.Age. 2.Infection. 3.Pain. 4.Length of time between exacerbations.

2. Infection.

You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? 1. Cirrhosis. 2. Inflammation of the kidney. 3. Inflammation of the spleen. 4. Peritonitis.

2. Inflammation of the kidney.

A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and he has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headache? 1. Tension. 2. Migraine. 3. Cluster. 4. Temporal arteritis.

2. Migraine.

A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? 1. Viral pharyngitis. 2. Mononucleosis. 3. Streptococcal pharyngitis. 4. Upper respiratory infection.

2. Mononucleosis.

Marjorie, age 37, has asthma and has been told she has nasal polyps. What do you tell her about them? 1. Nasal polyps are usually precancerous. 2. Nasal polyps are benign growths. 3. The majority of nasal polyps are neoplastic. 4. They are probably inflamed turbinates, not polyps, because polyps are infrequent in clients with asthma.

2. Nasal polyps are benign growths.

Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using? 1. Antibiotics. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Oral contraceptives. 4. Antifungals.

2. Nonsteroidal anti-inflammatory drugs (NSAIDs).

Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using? 1.Antibiotics. 2.Nonsteroidal anti-inflammatory drugs (NSAIDs). 3.Oral contraceptives. 4.Antifungals.

2. Nonsteroidal anti-inflammatory drugs (NSAIDs).

Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look "sunken in." What do you suspect? 1. Hypothyroidism. 2. Normal age-related changes. 3. Cushing syndrome. 4. A detached retina.

2. Normal age-related changes.

Erica, age 39, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102°F. The nurse practitioner diagnosed her with influenza (flu). What is your next course of action? 1. Order amoxicillin (Amoxil) 500 mg every 12 hours for 7 days. 2. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. 3. Order a complete blood count (CBC). 4. Consult with your collaborating physician.

2. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive.

Marcie just returned from Central America with traveler's diarrhea. Which is the best treatment? 1. Metronidazole (Flagyl). 2. Supportive care. 3. Quinolone antibiotics. 4. Gastric lavage.

2. Supportive care.

Marcie just returned from Central America with traveler's diarrhea. Which is the best treatment? 1.Metronidazole (Flagyl). 2.Supportive care. 3.Quinolone antibiotics. 4.Gastric lavage.

2. Supportive care.

Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It started approximately 2 days ago and is still present. What kind of headache is she describing? 1. Classic migraine. 2. Tension headache. 3. Sinus headache. 4. Cluster headache.

2. Tension headache.

While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are abnormally narrow. What are you examining? 1. The nasolabial folds. 2. The openings between the margins of the upper and lower eyelids. 3. The thyroid gland in relation to the trachea. 4. The distance between the trigeminal nerve branches.

2. The openings between the margins of the upper and lower eyelids.

Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer's ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? 1. Start using a cotton-tipped applicator to dry the ears after swimming. 2. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. 3. Use a hair dryer on the highest setting to dry the ears. 4. Stop swimming

2. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming.

Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you she is sure it is going to be malignant. How do you respond? 1."Don't worry. Gastric ulcers are not cancerous." 2."About 95% of gastric ulcers are benign." 3."You have about a 50% chance of having gastric cancer from your ulcer." 4."Even if it is cancer, surgery is 100% successful."

2."About 95% of gastric ulcers are benign."

Icterus due to hyperbilirubinemia is seen when the serum level of bilirubin is greater than? 1. 2.5 mg/dL. 2. 1.0 mg/dL. 3. 2.0 mg/dL. 4. 0.5 mg/dL.

2.5 mg/dL.

Tom has just been diagnosed with celiac disease. Which of the following might you tell him? 1.There is a new pharmaceutical cure for celiac disease. 2.A strict gluten-free diet is the only treatment for celiac disease. 3.Your children will not be at a higher risk for developing this disease. 4.The presence of celiac disease is decreasing dramatically in the United States.

2.A strict gluten-free diet is the only treatment for celiac disease.

You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have: 1.Yogurt. 2.Foods containing whey. 3.Prehydrolyzed milk. 4.Oranges.

2.Foods containing whey.

Julia, age 18, asks you how many calories of fat she is eating when 1 serving has 3 g of fat. You tell her: 1. 12 cal. 2. 18 cal. 3. 27 cal. 4. 30 cal.

27 cal.

A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no mastoid tenderness. What is the next step? 1. Symptom management and reassurance that symptoms will resolve with time. 2. Computed tomography (CT) of the head. 3. Amoxicillin 80 to 90 mg/kg/d. 4. Augmentin 45 mg/kg/d.

3. Amoxicillin 80 to 90 mg/kg/d.

Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What can you advise her to do? 1. Use a cotton-tipped applicator daily to remove all moisture and potential bacteria. 2. Wash daily with soap and water. 3. Apply mineral oil to counteract dryness. 4. Avoid topical corticosteroids.

3. Apply mineral oil to counteract dryness.

Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael? 1. "Dilute the oral medication with one tablespoon of water for easier digestion." 2. "Take the medication with meals so that it's absorbed better." 3. "Swish and swallow the medication." 4. "Apply the medication only to the lesions."

3. "Swish and swallow the medication."

A patient asks how to avoid contracting pharyngitis and tonsillitis. Which piece of advice is not appropriate for this patient? 1. "Replace your toothbrush as soon as you develop a sore throat." 2. "Use condoms or dental dams when performing oral sex." 3. "Take antibiotics when well to avoid future infections." 4. "Avoid low-humidity environments."

3. "Take antibiotics when well to avoid future infections."

Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is: 1. Eye discomfort. 2. Slow progression. 3. A ciliary flush. 4. No change in or slightly blurred vision.

3. A ciliary flush.

When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, the nurse practitioner should document this finding as: 1. Conductive deafness. 2. Perceptive deafness. 3. A normal finding. 4. Nerve damage.

3. A normal finding.

Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? 1. A labyrinthectomy. 2. Pharmacological therapy. 3. A vestibular neurectomy. 4. Wearing an earplug in the ear that has the most hearing loss.

3. A vestibular neurectomy.

Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? 1.A labyrinthectomy. 2.Pharmacological therapy. 3.A vestibular neurectomy. 4.Wearing an earplug in the ear that has the most hearing loss.

3. A vestibular neurectomy.

All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? 1. Anticholinergics, such as scopolamine (Donnatal). 2. Antidopaminergic agents, such as prochlorperazine (Compazine). 3. Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). 4. Tetrahydrocannabinols, such as dronabinol (Marinol).

3. Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan).

Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? 1. As a healthy adult with several problems. 2. As having a glycemic event. 3. As having metabolic syndrome. 4. As having multiple organ dysfunction.

3. As having metabolic syndrome

Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? 1.As a healthy adult with several problems. 2.As having a glycemic event. 3.As having metabolic syndrome. 4.As having multiple organ dysfunction

3. As having metabolic syndrome.

Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless, white, slightly raised patches in her mouth. This is probably caused by: 1. Herpes simplex. 2. Aphthous ulcers. 3. Candidiasis. 4. Oral cancer.

3. Candidiasis.

Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: 1. Appendicitis. 2. Crohn's disease. 3. Cholecystitis. 4. Irritable bowel syndrome.

3. Cholecystitis.

Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: 1.Appendicitis. 2.Crohn's disease. 3.Cholecystitis. 4.Irritable bowel syndrome.

3. Cholecystitis.

A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110, blood pressure 150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient? 1. Sigmoidoscopy. 2. Abdominal series. 3. Computed tomography (CT) scan with oral contrast. 4. Abdominal ultrasound.

3. Computed tomography (CT) scan with oral contrast.

A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110, blood pressure 150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient? 1.Sigmoidoscopy. 2.Abdominal series. 3.Computed tomography (CT) scan with oral contrast. 4.Abdominal ultrasound.

3. Computed tomography (CT) scan with oral contrast.

Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient that the best cure for cataracts is: 1. Medications. 2. Dietary supplements. 3. Corrective lens surgery. 4. Optical devices

3. Corrective lens surgery.

Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal infection of the bowel? 1. Giardiasis. 2. Amebiasis. 3. Cryptosporidiosis. 4. Escherichia coli.

3. Cryptosporidiosis.

Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal infection of the bowel? 1.Giardiasis. 2.Amebiasis. 3.Cryptosporidiosis. 4.Escherichia coli.

3. Cryptosporidiosis.

Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will: 1. Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. 2. Drink at least 2000 mL of fluids per day. 3. Decrease her dietary fiber for 1 month. 4. Take stool softeners as prescribed.

3. Decrease her dietary fiber for 1 month.

When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? 1. Eat foods higher in carbohydrates. 2. Eat 3 large meals plus 3 snacks per day. 3. Eat foods with a moderate fat and protein content. 4. Drink fluids with each meal.

3. Eat foods with a moderate fat and protein content.

At the clinic, you are assessing Kyle, a 4-month-old baby, for the first time and notice that both eyes are turning inward. What is this called? 1. Pseudostrabismus. 2. Strabismus. 3. Esotropia. 4. Exotropia.

3. Esotropia.

Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? 1. Acute otitis media. 2. Chronic otitis media. 3. External otitis. 4. Temporomandibular joint (TMJ) syndrome

3. External otitis.

Ellie, age 42, has a seizure disorder and has been taking phenytoin (Dilantin) for years. Which supplement should she also be taking if no other problems exist? 1. Vitamin B12. 2. Iron. 3. Folic acid. 4. Calcium.

3. Folic acid.

Ellie, age 42, has a seizure disorder and has been taking phenytoin (Dilantin) for years. Which supplement should she also be taking if no other problems exist? 1.Vitamin B12. 2.Iron. 3.Folic acid. 4.Calcium.

3. Folic acid.

A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that "some foods get stuck" and she has been having "heartburn" at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis? 1. Esophageal varices. 2. Esophageal cancer. 3. Gastroesophageal reflux disease (GERD). 4. Peptic ulcer disease (PUD).

3. Gastroesophageal reflux disease (GERD).

You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this finding? 1. Grade 1. 2. Grade 2. 3. Grade 3. 4. Grade 4.

3. Grade 3.

Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you she will: 1. Avoid coffee, alcohol, chocolate, peppermint, and spicy foods. 2. Eat smaller meals. 3. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime. 4. Stop smoking.

3. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime.

Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you she will: 1.Avoid coffee, alcohol, chocolate, peppermint, and spicy foods. 2.Eat smaller meals. 3.Have a snack before retiring so that the esophagus and stomach are not empty at bedtime. 4.Stop smoking.

3. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime.

Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly improved over last week's symptoms. Which stage of viral hepatitis do you suspect? 1. Incubation. 2. Prodromal. 3. Icteric. 4. Convalescent.

3. Icteric.

Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly improved over last week's symptoms. Which stage of viral hepatitis do you suspect? 1.Incubation. 2.Prodromal. 3.Icteric. 4.Convalescent.

3. Icteric.

You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with: 1. Anxiety and panic attacks. 2. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Infection by Helicobacter pylori. 4. A family history of peptic ulcers.

3. Infection by Helicobacter pylori

You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with: 1.Anxiety and panic attacks. 2.Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). 3.Infection by Helicobacter pylori. 4.A family history of peptic ulcers.

3. Infection by Helicobacter pylori.

Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she: 1. Needs to begin the hepatitis B series as soon as possible. 2. Needs to be tested again because one reading is not indicative of immunity. 3. Is permanently immune to hepatitis B. 4. Has an acute hepatitis B infection.

3. Is permanently immune to hepatitis B.

You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his right lower quadrant. Which sign did you elicit? 1. Rovsing sign. 2. Psoas sign. 3. Obturator sign. 4. McBurney sign.

3. Obturator sign.

You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his right lower quadrant. Which sign did you elicit? 1.Rovsing sign. 2.Psoas sign. 3.Obturator sign. 4.McBurney sign.

3. Obturator sign.

Kevin, age 26, has AIDS and presents to the clinic with complaints of a painful tongue covered with what look like creamy white, curdlike patches overlying erythematous mucosa. You are able to scrape off these "curds" with a tongue depressor, which assists you in making which of the following diagnoses? 1. Leukoplakia. 2. Lichen planus. 3. Oral candidiasis. 4. Oral cancer.

3. Oral candidiasis.

Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her normal-appearing auricle, eliciting severe pain. This leads you to suspect: 1. Otitis media. 2. Otitis media with effusion. 3. Otitis externa. 4. Primary otalgia.

3. Otitis externa.

Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? 1. A gastric ulcer. 2. Gastritis. 3. Pelvic inflammatory disease. 4. Pancreatitis.

3. Pelvic inflammatory disease.

Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? 1.A gastric ulcer. 2.Gastritis. 3.Pelvic inflammatory disease. 4.Pancreatitis.

3. Pelvic inflammatory disease.

A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient's sclera of the right eye only and takes up less than 50% of the eye. The patient's remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment? 1. Topical steroids and close follow-up with an ophthalmologist. 2. Sending the patient to the emergency department for immediate ophthalmology consult. 3. Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. 4. Cold compresses and frequent handwashing.

3. Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.

A 75-year-old female presents to your office complaining of dizziness and hearing loss. The patient states she awoke yesterday with dizziness, which she described as feeling the room spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts longer than bone conduction. What is the next step in helping this patient's symptoms? 1. Order a computed tomography (CT) scan to rule out acoustic neuroma. 2. Start her on high-dose Augmentin. 3. Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks. 4. Immediate referral to an ear, nose, and throat (ENT) specialist.

3. Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks.

You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: 1. Gentamicin ophthalmic ointment. 2. Ciprofloxacin ophthalmic drops. 3. Supportive measures and lubricating drops (artificial tears). 4. Oral erythromycin for 14 days.

3. Supportive measures and lubricating drops (artificial tears).

Which gastrointestinal disease below could theoretically be completely eradicated with a total colectomy? 1. Crohn's disease. 2. Irritable bowel syndrome. 3. Ulcerative colitis. 4. Celiac disease.

3. Ulcerative colitis.

Which gastrointestinal disease below could theoretically be completely eradicated with a total colectomy? 1.Crohn's disease. 2.Irritable bowel syndrome. 3.Ulcerative colitis. 4.Celiac disease.

3. Ulcerative colitis.

Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) would you expect to be decreased? 1. Sedimentation rate. 2. Liver enzyme levels. 3. Vitamin A, B complex, and C levels. 4. Bilirubin level.

3. Vitamin A, B complex, and C levels.

Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she: 1.Needs to begin the hepatitis B series as soon as possible. 2.Needs to be tested again because one reading is not indicative of immunity. 3.Is permanently immune to hepatitis B. 4.Has an acute hepatitis B infection.

3. Is permanently immune to hepatitis B.

Which of the following is the most common cause of acute pancreatitis? 1.Gallstone obstruction of the pancreatic duct. 2.Alcoholism. 3.Hypertriglyceridemia. 4.Gallstone obstruction of the pancreatic duct and alcoholism.

4. Gallstone obstruction of the pancreatic duct and alcoholism.

All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? 1.Anticholinergics, such as scopolamine (Donnatal). 2.Antidopaminergic agents, such as prochlorperazine (Compazine). 3.Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). 4.Tetrahydrocannabinols, such as dronabinol (Marinol).

3.Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan).

Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will: 1.Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. 2.Drink at least 2000 mL of fluids per day. 3.Decrease her dietary fiber for 1 month. 4.Take stool softeners as prescribed.

3.Decrease her dietary fiber for 1 month.

When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? 1.Eat foods higher in carbohydrates. 2.Eat 3 large meals plus 3 snacks per day. 3.Eat foods with a moderate fat and protein content. 4.Drink fluids with each meal.

3.Eat foods with a moderate fat and protein content.

Which of the following is not a complication of untreated group A streptococcal pharyngitis? 1. Glomerulonephritis. 2. Rheumatic heart disease. 3. Scarlet fever. 4. Hemolytic anemia.

4. Hemolytic anemia.

Which of the following is not true regarding hepatitis C? 1. The greatest rate of infection in the general population is seen in people born between 1945 and 1965. 2. Many hepatitis C infections are asymptomatic. 3. Hepatitis C is seen more frequently in men than women. 4. If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer.

4. If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer.

How soon after a facial laceration should sutures be removed? 1. 4 to 6 days. 2. 3 to 4 days. 3. 7 to 10 days. 4. 10 to 14 days.

4 to 6 days.

Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond: 1. "Do not donate blood until one year after diagnosis." 2. "Abstain from sex altogether." 3. "There is no possibility of transmission through razors or toothbrushes." 4. "Abstain from sex during your period."

4. "Abstain from sex during your period."

Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond: 1."Do not donate blood until one year after diagnosis." 2."Abstain from sex altogether." 3."There is no possibility of transmission through razors or toothbrushes." 4."Abstain from sex during your period."

4. "Abstain from sex during your period."

Anson tells you he thinks his antacids are causing his diarrhea. You respond: 1. "Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel." 2. "Antacids contain sorbitol or mannitol, which are sugars that aren't absorbed and can cause fluid to be drawn into the bowel." 3. "Antacids contain caffeine, which decreases bowel transit time." 4. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

4. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

Mandy, 44, was given a diagnosis of flu 1 day ago and wants to start on the "new flu medicine" right away. What do you tell her? 1. "The medication is effective only if started within the first 72 hours after symptoms begin." 2. "If you treat a cold, it goes away in 7 days; if you don't treat it, it goes away in 1 week." 3. "The medicine has not proven its effectiveness." 4. "I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

4. "I'll start you on oseltamivir (Tamiflu) today. It may shorten the course of the disease and perhaps lessen the severity of your symptoms."

Your client's 2-month-old daughter is admitted with gastroenteritis and dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the child's diarrhea, how do you respond? 1. "She must be lactose intolerant from the formula, and this is altering the fluid balance." 2. "Her body's telling you that it's time to introduce some solids into her system." 3. "The virus is causing irritation of the gastrointestinal lining, which causes diarrhea." 4. "The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients."

4. "The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients."

Your client's 2-month-old daughter is admitted with gastroenteritis and dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the child's diarrhea, how do you respond? 1."She must be lactose intolerant from the formula, and this is altering the fluid balance." 2."Her body's telling you that it's time to introduce some solids into her system." 3."The virus is causing irritation of the gastrointestinal lining, which causes diarrhea." 4."The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients."

4. "The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients."

Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond: 1. "You should have two to three stools per day." 2. "You should defecate once a day." 3. "You should have at least three stools per week." 4. "There is no such thing as a 'normal' pattern of defecation."

4. "There is no such thing as a 'normal' pattern of defecation."

Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond:1. "You should have two to three stools per day." 2."You should defecate once a day." 3."You should have at least three stools per week." 4."There is no such thing as a 'normal' pattern of defecation."

4. "There is no such thing as a 'normal' pattern of defecation."

Mr. Clark, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle glaucoma. While performing a new client history and physical, you note that he is taking other medications. Which medication would you be most concerned about? 1. Aspirin therapy as prophylaxis for heart attack. 2. Ranitidine (Zantac) for gastroesophageal reflux disease. 3. Alprazolam (Xanax), an anxiolytic. 4. Atenolol (Tenormin), a beta blocker for high blood pressure.

4. Atenolol (Tenormin), a beta blocker for high blood pressure.

Which of the following is the most common cause of acute pancreatitis? 1. Gallstone obstruction of the pancreatic duct. 2. Alcoholism. 3. Hypertriglyceridemia. 4. Gallstone obstruction of the pancreatic duct and alcoholism.

4. Gallstone obstruction of the pancreatic duct and alcoholism.

Which of the following is not true regarding hepatitis C? 1.The greatest rate of infection in the general population is seen in people born between 1945 and 1965. 2.Many hepatitis C infections are asymptomatic. 3.Hepatitis C is seen more frequently in men than women. 4.If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer.

4. If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer.

You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you she will: 1.Decrease her fat intake. 2.Increase her fiber intake. 3.Continue her daily use of aspirin. 4.Increase her fluid intake.

4. Increase her fluid intake.

you are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you she will: 1. Decrease her fat intake. 2. Increase her fiber intake. 3. Continue her daily use of aspirin.

4. Increase her fluid intake.

Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: 1. Bacterial conjunctivitis. 2. Viral conjunctivitis. 3. Allergic conjunctivitis. 4. Iritis

4. Iritis

You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do you rule out? 1. Peritonitis. 2. A liver or spleen abscess. 3. A liver or spleen metastatic tumor. 4. Irritable bowel syndrome.

4. Irritable bowel syndrome.

Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is true? 1. The offending organism is a bacterium, and Jonathan should be treated with antibiotics. 2. Convalescence is usually only a few days, and Jonathan should be back to normal in a week. 3. Mononucleosis is rarely contagious. 4. Jonathan should avoid contact sports and heavy lifting.

4. Jonathan should avoid contact sports and heavy lifting.

How would you describe the cervical lymphadenopathy associated with asymptomatic human immunodeficiency virus (HIV) infection? 1. Movable, discrete, soft, and nontender lymph nodes. 2. Enlarged, warm, tender, and firm but freely movable lymph nodes. 3. Hard, unilateral, nontender, and fixed lymph nodes. 4. Nontender, mobile, and firm but not hard lymph nodes.

4. Nontender, mobile, and firm but not hard lymph nodes.

An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know to be complications of this disease, you explain to her that she needs: 1. Antibiotics. 2. A biopsy of the rash. 3. Immediate hospitalization. 4. Ophthalmological consultation.

4. Ophthalmological consultation.

Which of the following is not recommended for hoarseness? 1. Vocal rest. 2. Tobacco cessation. 3. Decrease in caffeine use. 4. Oral steroids.

4. Oral steroids.

You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication? 1. Achilles tendon rupture. 2. Peripheral neuropathy. 3. Nephrotoxicity. 4. Stevens-Johnson syndrome.

4. Stevens-Johnson syndrome.

You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency room. Which of the following symptoms would indicate that an airway obstruction is imminent? 1. Reddened face. 2. Screaming. 3. Grabbing her throat. 4. Stridor.

4. Stridor.

Which of the following medications/drugs are not known to cause heartburn or dyspepsia? 1. Alcohol. 2. Motrin. 3. Prednisone. 4. Tylenol.

4. Tylenol.

Which of the following medications/drugs are not known to cause heartburn or dyspepsia? 1.Alcohol. 2.Motrin. 3.Prednisone. 4.Tylenol.

4. Tylenol.

Which of the following is not a risk factor for cholecystitis? 1. Female gender. 2. Obesity. 3. Sickle cell anemia. 4. Younger age.

4. Younger age.

Which of the following is not a risk factor for cholecystitis? 1.Female gender. 2.Obesity. 3.sickle cell anemia. 4.Younger age.

4. Younger age.

You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do you rule out? 1.Peritonitis. 2.A liver or spleen abscess. 3.A liver or spleen metastatic tumor. 4.Irritable bowel syndrome.

4. IBS

Anson tells you he thinks his antacids are causing his diarrhea. You respond: 1."Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel." 2."Antacids contain sorbitol or mannitol, which are sugars that aren't absorbed and can cause fluid to be drawn into the bowel." 3."Antacids contain caffeine, which decreases bowel transit time." 4."Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

4."Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

The remodeling of a scar can take how long? 1. 6 months. 2. 3 months. 3. 1 month. 4. 2 weeks.

6 months.

If a screening test used on 100 individuals known to be free of breast cancer identified 80 individuals who did not have breast cancer while missing 20 of the individuals, the specificity would be: 1. 80%. 2. 60%. 3. 40%. 4. 20%.

80%

12—10 The metabolism of which drug is not affected in Marsha, age 74? A Alcohol B Anticonvulsants C Psychotropics D Oral anticoagulants

A

12—17 Rebound tenderness may indicate: A peritoneal inflammation. B. ventral hernia. C. portal hypertension. D. Crohn's disease

A

12—9 Sigrid, age 82, has irritable bowel, chronic constipation, and diverticulitis. Which pharm agent do you recommend? A Bulking agENTS B Stool softeners C Laxatives D Lubricants

A

Which of the following patients would not be a candidate for outpatient treatment of influenza? 1. A 62-year-old male with a history of myocardial infarction 5 years ago. 2. A 2-year-old female with a history of a congenital heart defect. 3. A 72-year-old male without a past medical history. 4. A 15-year-old female with a history of recent outpatient knee surgery.

A 2-year-old female with a history of a congenital heart defect.

Which of the following patients is health literate? 1. A 62-year-old female who speaks the language of her provider, has Medicare for insurance, and can drive. 2. A 70-year-old patient with dementia. 3. A 22-year-old migrant worker who only speaks Spanish. 4. A 45-year-old college graduate with no health insurance.

A 62-year-old female who speaks the language of her provider, has Medicare for insurance, and can drive.

When you are assessing the internal structure of the eye of your 59-year-old patient, the absence of a red reflex may indicate: 1. A cataract or hemorrhage into the vitreous humor. 2. Acute iritis. 3. Nothing; this is a normal finding in older adults. 4. Diabetes or long-standing hypertension.

A cataract or hemorrhage into the vitreous humor.

Sharon, a 47-year-old bank teller, is seen by the nurse practitioner in the office for a red eye. You are trying to decide between a diagnosis of conjunctivitis and iritis. One distinguishing characteristic between the two is: 1. Eye discomfort. 2. Slow progression. 3. A ciliary flush. 4. No change in or slightly blurred vision.

A ciliary flush.

The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is: 1. A congenital cataract. 2. Retinoblastoma. 3. Persistent hyperplastic primary vitreous. 4. Retinal detachment.

A congenital cataract.

In a young child, unilateral purulent rhinitis is most often caused by: 1. A foreign body. 2. A viral infection. 3. A bacterial infection. 4. An allergic reaction.

A foreign body.

Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect: 1. Bell palsy. 2. A lesion affecting the trigeminal nerve. 3. A stroke—brain attack, cerebrovascular accident (CVA). 4. Shingles.

A lesion affecting the trigeminal nerve.

Certain characteristics differentiate research from quality improvement. Which of the following is an example of research? 1. Client satisfaction being evaluated relative to existing practice. 2. An intervention—well supported in the literature—being implemented and evaluated. 3. A standardized assessment tool (eg, risk assessment for falls) being implemented and evaluated. 4. A new intervention being implemented and compared with current practice to determine which is better.

A new intervention being implemented and compared with current practice to determine which is better.

When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, the nurse practitioner should document this finding as: 1. Conductive deafness. 2. Perceptive deafness. 3. A normal finding. 4. Nerve damage.

A normal finding.

Which of the following is the best method for evaluating the efficacy of a new clinical intervention? 1. A case report. 2. A descriptive study. 3. A randomized controlled trial. 4. A correlational study.

A randomized controlled trial.

The nurse practitioner (NP) tells Samantha, age 52, that she has an acrochordon on her neck. What is the NP referring to? 1. A nevus. 2. A skin tag. 3. A lipoma. 4. A wart.

A skin tag.

Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? 1. A labyrinthectomy. 2. Pharmacological therapy. 3. A vestibular neurectomy. 4. Wearing an earplug in the ear that has the most hearing loss.

A vestibular neurectomy.

Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the tongue that you suspect to be cancerous. You document your finding as: 1. A superficial, translucent, subepithelial, vesicle-like lesion in the oral mucosa. 2. A white, painless, firm, ulcerated lesion with indurated borders. 3. An abnormal white coating of the dorsal surface of the tongue. 4. A round, smooth, firm lump on the lateral side of the tongue.

A white, painless, firm, ulcerated lesion with indurated borders.

94. Dottie brings in her infant who has gastroesophageal reflux. What do you tell her about positioning her infant? A. "Always position infants on their back to prevent sudden infant death syndrome." B. "Rotate your infant between lying on the back and on the stomach." C. "Your infant should be place on the left side." D. "Place your infant in whatever position she remains quiet."

A. "Always position infants on their back to prevent sudden infant death syndrome."

44. The majority of the population of the U.S. has antibodies against which type of hepatitis? A. A B. B C. C D. D

A. A

111. To differentiate among the different diagnoses to inflammatory bowel disease, you look at the client's histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? A. Crohn's disease B. Ulcerative colitis C. Infectious colitis D. Ischemic colitis

A. Crohn's disease

37. Nora, age 78, has terminal cancer and is wasting away. What should you order to stimulate her appetite? A. Megestrol (Megace) B. Sertraline (Zoloft) C. Vitamin C D. Alprazolam (Xanax)

A. Megestrol (Megace)

43. Which physical examination maneuver for diagnosing appendicitis is done by deep palpation over the left lower quadrant with resultant pain the right lower quadrant? A. Rovsing's sign B. Psoas sign C. Obturator sign D. McBurney's sign

A. Rovsing's sign

4. Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? A. Ursodiol (Actigall) B. Ibuprofen (Advil) C. Prednisone (Deltasone) D. Surgery is the only answer

A. Ursodiol (Actigall)

115. You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? A. a proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl) B. bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec) C. Amoxicillin (Amoxil) and omeprazole (Prilosec) D. Clarithromycin (Biaxin) and metronidazole (Flagyl)

A. a proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl)

13. The metabolism of which drug is not affected in Marsha, age 74? A. alcohol B. anticonvulsants C. psychotropics D. oral anticoagulants

A. alcohol

114. Which area(s) of Jill's GI tract may be affected by her Crohn's disease? A. all areas from the mouth to the anus B. the colon C. the sigmoid colon D. the small intestine

A. all areas from the mouth to the anus

11. Rebound tenderness at McBurney's point would alert you to A. appendicitis B. peritonitis C. a spleen injury D. irritable bowel syndrome

A. appendicitis

97. Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect A. appendicitis B. gastroenteritis C. acute pancreatitis D. rocky mountain spotted fever

A. appendicitis

1. Treatment for achalasia may include A. balloon dilation of the lower esophageal sphincter B. beta blockers C. a fundoplication D. an esophagogastrectomy

A. balloon dilation of the lower esophageal sphincter

98. When George tells you that his feces are foul smelling, you suspect which of the following? A. blood in the stool B. ingestion of a low-fat diet C. prostate cancer D. appendicitis

A. blood in the stool

33. One of the alarm signs or symptoms of IBS that requires prompt investigation is A. blood or pus in the stool B. weight gain C. hyperkalemia D. first onset in the teen years

A. blood or pus in the stool

56. Sigrid, age 82, has irritable bowel, chronic constipation, and diverticulitis. Which pharmacological agent do you recommend? A. bulking agents B. stool softeners C. laxatives D. lubricants

A. bulking agents

41. Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? A. cheese B. leafy green vegetables C. raw fruits and vegetables D. dried beans

A. cheese

85. In a 2 month old infant with vomiting and diarrhea, the most effective way of determining a fluid deficit is to check for A. decreased peripheral perfusion B. hyperventilation C. irritability D. hyperthermia

A. decreased peripheral perfusion

39. A common complication of viral gastroenteritis in children is A. dehydration B. GI bleeding C. peritonitis D. bacterial sepsis

A. dehydration

82. In counseling Maria, age 24, who is healthy, you advise her to limit her intake of sugar to prevent A. dental caries B. obesity C. diabetes D. hyperactivity

A. dental caries

69. Samantha, age 28, is 100 lb overweight and wants to have a gastroplasty performed. In discussing this with her, you explain that by having this procedure she may A. develop diarrhea B. lose too much weight C. develop hemorrhoids D. vomit after she eats

A. develop diarrhea

26. Which type of hepatitis is transmitted by the fecal-oral route, sewage, contaminated water, shellfish, and possibly blood? A. hepatitis A B. hepatitis B C. hepatitis C D. hepatitis D

A. hepatitis A

2. You assess for Cullen's sign in Dan, age 62, after surgery. Cullen's sign may indicate A. intra-abdominal bleeding B. a ventral hernia C. appendicitis D. jaundice

A. intra-abdominal bleeding

64. Cydney has been given a diagnosis of ascariasis. Which symptoms would you expect to see? A. low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea B. nocturnal perianal and perineal pruritis C. diarrhea, cramps, and malaise D. ascites and facial and extremity edema

A. low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea

32. Rebound tenderness may indicate A. peritoneal inflammation B. a ventral hernia C. portal hypertension D. Crohn's disease

A. peritoneal inflammation

10. You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do you rule out? A. peritonitis B. a liver or spleen abscess C. a liver or spleen metastatic tumor D. irritable bowel syndrome

A. peritonitis

100. Sam, age 43, has ulcerative colitis and is on a low-residue diet. Which foods do you recommend that Sam avoid? A. potato skins, potato chips, and brown rice B. vegetable juices and cooked and canned vegetables C. ground beef, veal, pork, and lamb D. white rice and pasta

A. potato skins, potato chips, and brown rice

106. Striae most commonly occur with A. pregnancy B. excessive weight gain C. diabetes D. ascites

A. pregnancy

71. Which of the following signs of symptoms indicates biliary obstruction with liver disease? A. pruritis B. increased abdominal girth C. right upper quadrant pain D. easy bruising

A. pruritis

91. You are trying to differentiate between functional (acquired) constipation and Hirschsprung's disease in a neonate. Distinguishing features of Hirschsprung's disease include which of the following? A. small ribbonlike stools B. obvious abdominal pain C. female gender D. small weight gain

A. small ribbonlike stools

53. A second-generation cephalosporin is to be given to your patient undergoing colorectal surgery. You know that the dosing recommendation to prevent an incisional surgical site infection (SSI) is A. three doses prior to surgery B. one dose prior to surgery C. a weekly course of therapy D. therapy beginning after surgery

A. three doses prior to surgery

12. Which is the most common presenting symptom of gastric cancer? A. weight loss B. dysphagia C. hematemesis D. GI bleeding

A. weight loss

83. When percussing the abdomen, hyperresonance is present A. when there is gaseous distention B. over a distended bladder C. over adipose tissue D. over fluid or a mass

A. when there is gaseous distention

23. You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you that she can have A. yogurt B. foods containing whey C. prehydrolyzed milk D. oranges

B. foods containing whey

Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect: 1. Dental abscess. 2. Acute rhinosinusitis. 3. Chronic rhinosinusitis. 4. Nasal tumor.

Acute rhinosinusitis.

What would you expect to see on an abdominal series that would lead toward a diagnosis of small-bowel obstruction? 1. Air-fluid levels. 2. A lead pipe colon. 3. Free air under the diaphragm. 4. Steeple sign.

Air-fluid levels.

All of the following statements about the US Preventive Services Task Force (USPSTF) are true except? 1. All of the recommendations made by the USPSTF are strong recommendations. 2. This is a private sector group without government ties. 3. This group makes recommendations about preventive medicine. 4. All of the USPSTF recommendations are considered mandatory in primary ca

All of the recommendations made by the USPSTF are strong recommendations.

Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis? 1. Allergic rhinitis. 2. Viral rhinitis. 3. Nasal polyps. 4. Nasal vestibulitis from folliculitis.

Allergic rhinitis.

The purpose of a block grant is to: 1. Provide more comprehensive services for Medicaid recipients. 2. Encourage individuals to obtain their own health insurance so they will not need government assistance. 3. Allow states to have greater flexibility in providing services to the poor. 4. Decrease the proportion of state taxes allocated to pay for Medicaid.

Allow states to have greater flexibility in providing services to the poor.

Maryann, age 28, presents to the clinic because of a rapid onset of patchy hair loss. The skin within these oval patches of hair loss is very smooth. Tapered hairs that resemble exclamation points are seen at the margin of a patch of hair loss. Based on these findings, you suspect Maryann has: 1. Alopecia areata. 2. Trichotillomania. 3. Tinea capitis. 4. Androgenetic alopecia.

Alopecia areata.

An emancipated minor is a client who is younger than age 18 but who is considered a competent adult with the authority to accept or refuse medical treatment. How do you determine if the 16-year-old you are seeing is an "emancipated minor"? 1. No 16-year-old would be considered an emancipated minor. 2. Although definitions vary among states, the term usually implies that the minor has entered into a valid marriage, is a member of the military, or has been granted this status by a court. 3. The client claims that he is free from all parental control. 4. The client is accompanied by an older friend who states that he or she is the client's guardian and will accept legal responsibility.

Although definitions vary among states, the term usually implies that the minor has entered into a valid marriage, is a member of the military, or has been granted this status by a court.

The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: 1. Amoxicillin (Amoxil). 2. Amoxicillin and potassium clavulanate (Augmentin). 3. Azithromycin (Zithromax). 4. Prednisone (Deltasone).

Amoxicillin and potassium clavulanate (Augmentin).

You are sharing with your client the idea that he needs to get some counseling to deal with his severe stress because it is affecting his physiological condition. Which of the following hormonal changes occurs during severe stress? 1. A decrease in catecholamines. 2. An increase in cortisol. 3. A decrease in antidiuretic hormone. 4. A decrease in aldosterone.

An increase in cortisol.

Eileen, a 42-year-old woman, comes to your office with a chief complaint of fatigue, weight loss, and blurred vision. Eileen has a past medical history that is negative for any chronic medical problems. You obtain a fasting chemistry panel, lipid profile, complete blood count (CBC), and hemoglobin A1c (HbA1c). The results of the blood work show Eileen's blood sugar elevated at 356 mg/dL, total cholesterol elevated at 255, high-density lipoprotein (HDL) cholesterol low at 28, low-density lipoprotein (LDL) cholesterol elevated at 167, triglycerides 333, and HbA1c 12. On questioning Eileen further, you discover that both her grandmothers had adult-onset diabetes mellitus. You diagnose type 2 diabetes mellitus. Your treatment plan should include a cholesterol-lowering agent, an agent that lowers blood sugar, and which other class of medication? 1. Angiotensin-converting enzyme (ACE) inhibitor. 2. Diuretic. 3. Weight loss medication. 4. Beta blocker

Angiotensin-converting enzyme (ACE) inhibitor.

When George tells you that his feces are foul smelling, you suspect which of the following? A. Blood in the stool B. Ingestion of a low-fat diet C. Prostate cancer D. Appendicitis

Answer A A distinct foul odor to the stool may indicate blood in the stool, ingestion of a high-fat diet, or colon cancer.

You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? A. Bismuth subsalicylate (Pepto-Bismol), tetracycline (Tetracap) or amoxicillin (Amoxil), and metronidazole (Flagyl) B. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec) C. Amoxicillin (Amoxil) and omeprazole (Prilosec) D. Clarithromycin (Biaxin) and metronidazole (Flagyl)

Answer A All of the drugs listed are used in the eradication of Helicobacter pylori. Traditional 14-day " triple therapy " with bismuth subsalicylate (Pepto-Bismol), tetracycline (Tetracap) or amoxicillin (Amoxil), and metronidazole (Flagyl) has consistently produced eradication rates of approximately 90% and is the least expensive therapy

Nora, age 78, has terminal cancer and is wasting away. What should you order to stimulate her appetite? A. Megestrol (Megace) B. Sertraline (Zoloft) C. Vitamin C D. Alprazolam (Xanax)

Answer A Although depression might be a contributing factor to Nora ' s wasting away, megestrol (Megace) can produce weight gain by stimulating appetite and food intake and by decreasing the nausea and vomiting that usually accompany terminal cancer.

The metabolism of which drug is not affected in Marsha, age 74? A. Alcohol B. Anticonvulsants C. Psychotropics D. Oral anticoagulants

Answer A Although drug metabolism by the liver is usually impaired in older adults, the metabolism of alcohol is unchanged.

Which area(s) of Jill ' s gastrointestinal tract may be affected by her Crohn ' s disease? A. All areas from the mouth to the anus B. The colon C. The sigmoid colon D. The small intestine

Answer A Although the colon is the major site of gastrointestinal involvement in Crohn ' s disease (inflammatory bowel disease), the disease can affect all areas from the mouth to the anus

Sigrid, age 82, has irritable bowel, chronic constipation, and diverticulitis. Which pharmacological agent do you recommend? A. Bulking agents B. Stool softeners C. Laxatives D. Lubricants

Answer A Bulking agents such as psyllium preparations or methylcellulose preparations are used for irritable bowel, chronic constipation, and diverticulitis

Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? A. Cheese B. Leafy green vegetables C. Raw fruits and vegetables D. Dried beans

Answer A Cheese, bread, pasta, rice, pretzels, and yogurt all help to thicken stools. Leafy green vegetables, raw fruits and vegetables, and dried beans may all loosen stools.

To differentiate among the different diagnoses of inflammatory bowel diseases, you look at the client ' s histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? A. Crohn ' s disease B. Ulcerative colitis C. Infectious colitis D. Ischemic colitis

Answer A Crohn ' s disease would show transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. Ulcerative colitis would show acute inflammatory infiltrates, depleted goblet cells, negative cultures, and involvement of the rectum. Infectious colitis, because of the toxic products released, may induce periportal inflammation, mild hepatomegaly, and low-grade liver enzyme abnormalities, but usually without trophozoites in the liver.

Which type of hepatitis is transmitted by the fecal-oral route, sewage, contaminated water, shellfish, and possibly blood? A. Hepatitis A (HAV) B. Hepatitis B (HBV) C. Hepatitis C (HCV) D. Hepatitis D (HDV)

Answer A Hepatitis A (HAV) is transmitted by the fecal-oral route, sewage, contaminated water and shellfish, and possibly by blood

You are trying to differentiate between functional (acquired) constipation and Hirschsprung ' s disease in a neonate. Distinguishing features of Hirschsprung ' s disease includes which of the following? A. Small ribbonlike stools B. Obvious abdominal pain C. Female gender D. Small weight gain

Answer A Hirschsprung ' s disease is common in male infants, results in small ribbonlike stools, usually has no accompanying abdominal pain unless there is obstruction, and may be accompanied by failure to thrive.

One of the alarm signs or symptoms of irritable bowel syndrome that requires prompt investigation is A. blood or pus in the stool. B. weight gain. C. hyperkalemia. D. first onset in the teen years.

Answer A One of the alarm signs or symptoms of irritable bowel syndrome that requires prompt attention is blood or pus in the stool

Sam has ulcerative colitis and is on a lowresidue diet. Which foods do you recommend that Sam avoid? A. Potato skins, potato chips, and brown rice B. Vegetable juices and cooked and canned vegetables C. Ground beef, veal, pork, and lamb D. White rice and pasta

Answer A Potato skins, potato chips, fried potatoes, brown rice, and whole-grain pasta products should be avoided if a client with ulcerative colitis is on a lowresidue diet that was ordered to reduce intestinal motility and allow the bowel to rest

Which of the following signs or symptoms indicates biliary obstruction with liver disease? A. Pruritus B. Increased abdominal girth C. Right upper quadrant pain D. Easy bruising

Answer A Pruritus indicates that biliary obstruction is present with the liver disease. Increased abdominal girth indicates ascites is present from portal hypertension or hypoalbuminemia

Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? A. Ursodiol (Actigall) B. Ibuprofen (Advil) C. Prednisone (Deltasone) D. Surgery is the only answer.

Answer A Ursodiol (Actigall) is an oral bile acid that dissolves gallstones. For dissolution, 8 - 10 mg/kg per day is given in two to three divided doses; for prevention, 300 mg twice per day is given

Which is the most common presenting symptom of gastric cancer? A. Weight loss B. Dysphagia C. Hematemesis D. Gastrointestinal bleeding

Answer A Weight loss is usually the presenting symptom of gastric cancer, followed by dysphagia

Which of the following findings is NOT associated with diverticulitis? A. Left lower quadrant abdominal pain B. A history of irritable bowel syndrome C. A tender mass in the left lower quadrant D. An elevated temperature

Answer B A history of irritable bowel syndrome has no association with diverticulitis. A client with diverticulitis would have left lower quadrant abdominal pain, a tender mass in the left lower quadrant, and an elevated temperature

Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for A. constipation. B. colorectal cancer. C. irritable bowel syndrome. D. acute appendicitis.

Answer B A middle-aged or older client with an abrupt change in defecation pattern must be evaluated for colorectal cancer

Tom has just been diagnosed with celiac disease. Which of the following might you tell him? A. There is a new pharmaceutical cure for celiac disease. B. A strict gluten-free diet is the only treatment for celiac disease. C. Your children will not be at a higher risk for developing this disease. D. The presence of celiac disease is decreasing dramatically in the United States

Answer B A strict gluten-free diet is the only treatment for celiac disease. There is no pharmaceutical cure. Patients with first- or second-degree relatives affected by celiac disease are at higher risk for developing it.

Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him it ' s a ventral hernia, also known as A. inguinal hernia. B. epigastric hernia. C. umbilical hernia. D. incisional hernia.

Answer B A ventral hernia, also known as an epigastric hernia, occurs along the midline between the xiphoid process and the umbilicus

Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you that she is sure it is going to be malignant. How do you respond? A. " Don ' t worry, gastric ulcers are not cancerous. " B. " About 95% of gastric ulcers are benign. " C. " You have about a 50:50 chance of having gastric cancer from your ulcer. " D. " Even if it is cancer, surgery is 100% successful. "

Answer B About 95% of gastric ulcers are benign, even though some of these seem to look malignant on x-ray

You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have A. yogurt. B. foods containing whey. C. prehydrolyzed milk. D. oranges.

Answer B Advise clients who are lactose intolerant to avoid foods containing whey. Whey is a lactose-rich ingredient found in some foods; therefore, labels need to be read on all foods for clients who are lactose intolerant

How do diphenoxylate (Lomotil) and loperamide (Imodium) help relieve diarrhea? A. They reduce bowel spasticity and acid secretion in the stomach. B. They decrease the motility of the ileum and colon, slowing the transit time and promoting more water absorption. C. They increase motility to assist in removing all of the stool. D. By decreasing the sensations of the gastric nerves, they send a message to the brain to slow down peristalsis.

Answer B Diphenoxylate (Lomotil) and loperamide (Imodium), like all opiates and opium derivatives, help to relieve diarrhea by decreasing the motility of the ileum and colon, slowing the transit time, and promoting more water absorption

Steve, age 79, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid? A. Apples B. Peppermint C. Cucumbers D. Popsicles

Answer B Food substances that reduce the lower esophageal sphincter pressure or irritate the gastric mucosa include alcohol, caffeinated beverages, chocolate, citrus fruits, decaffeinated coffee, fatty foods, onions, peppermint and spearmint, tomatoes, and tomato-based products

Hyperactive bowel sounds (borborygmi) are present in which of the following conditions? A. Cirrhosis B. Laxative use C. Late mechanical bowel obstruction D. Pancreatic cancer

Answer B Hyperactive bowel sounds (borborygmi) are present with laxative use, early mechanical bowel obstruction, gastroenteritis, and brisk diarrhea

A concern with older patients having abdominal surgery is A. older patients have an increased peristalsis, and bowel sounds must be checked very frequently. B. older adults have a diminished response to painful stimuli that may mask abdominal health problems. C. because older adults are prone to diarrhea after surgery, you must be vigilant about skin breakdown. D. because of liver enlargement, postoperative medications are processed faster.

Answer B Older adults have a diminished response to painful stimuli that may mask abdominal health problems

One of the alarm signs or symptoms of irritable bowel syndrome (IBS) that requires prompt investigation is A. blood or pus in the stool. B. weight gain. C. hyperkalemia. D. first onset in the teen years.

Answer: A One of the alarm signs or symptoms of irritable bowel syndrome that requires prompt attention is blood or pus in the stool. Other warning signs and symptoms are first onset in a person over age 50, weight loss, progressive dysphagia, dehydration, evidence of steatorrhea, recurrent vomiting, fever, anemia, hypokalemia, and a strong family history of colon cancer.

Sidney has ulcerative colitis and asks you about a Koch pouch. You respond, A. " It ' s a method of bowel training for clients with chronic diarrhea. " B. " It ' s a name for a continent ileostomy. " C. " It ' s a packet of daily pills to take to relieve diarrhea. " D. " It ' s like a sanitary pad and it ' s used to contain any rectal leakage. "

Answer B Performed for clients with ulcerative colitis, a Koch pouch (continent ileostomy) is the surgical removal of the rectum and colon and construction of an internal ileal reservoir, nipple valve, and stoma, allowing for intermittent drainage of ileal contents

Martin has had an ileostomy for ulcerative colitis. Which self-care measures do you teach him to relieve food blockage? A. Lie in a supine position. B. Massage the peristomal area. C. Take a hot shower or tub bath. D. Drink cold fluids.

Answer B Self-care measures to teach a client with an ileostomy how to relieve food blockage include massaging the peristomal area, which may stimulate peristalsis and fecal elimination; assuming a kneechest position to reduce intra-abdominal pressure; taking a warm shower or tub bath to relax the abdominal muscles; and drinking warm fluids or grape juice to produce a mild cathartic effect

Which modality(ies) is(are) the most effective in patients with metabolic syndrome? A. Specific vitamin and mineral supplements B. Diet and exercise C. Specific pharmacological therapy D. Eliminating alcohol and smoking from their lifestyle

Answer B Several studies show that intensive lifestyle changes in the form of diet and exercise can go miles in reducing death and events in high-risk patients.

Rose, your client with gastroesophageal reflux disease, has many other concurrent conditions. She wants to know if there are any medications she should NOT take. You tell her to avoid A. antibiotics. B. NSAIDs. C. oral contraceptives. D. antifungals.

Answer B The client with gastroesophageal reflux disease should avoid taking NSAIDs because they tend to aggravate the already-irritated gastric mucosa.

Duodenal and gastric ulcers have many of the same manifestations. Which is more common with gastric ulcers rather than duodenal ulcers? A. Epigastric or abdominal pain B. Vomiting C. Possibility of perforation D. Obstruction of the gastrointestinal tract

Answer B Vomiting is more common with gastric ulcers than duodenal ulcers. Stools are more often altered with duodenal ulcers. The possibility of perforation and obstruction of the gastrointestinal tract is present in both types of ulcers

Nausea is difficult to discern in a young child. What question might you ask to determine if the child has nausea? A. " Are you sick to your tummy? " B. " Are you hungry? " C. " Are you eating the way you normally eat? " D. " Are you nauseous? "

Answer B. " Are you hungry? " To elicit information concerning nausea in a young child, ask the child about hunger because a young child cannot usually differentiate between hunger and mild nausea.

A palpable spleen 2 cm or less below the left costal margin in a 2-year-old child is A. indicative of splenomegaly. B. a sign of internal hemorrhaging. C. normal. D. a sign of infection.

Answer C A palpable spleen 2 cm or less below the left costal margin is a normal finding in a child younger than age 3 and may be a normal finding in an older child. Other symptoms would have to be present to warrant further evaluation

Which procedure enlarges the opening between the stomach and duodenum to improve gastric emptying? A. Billroth I B. Total gastrectomy C. Pyloroplasty D. Vagotomy

Answer C A pyloroplasty surgically enlarges the opening between the stomach and duodenum to improve gastric emptying. A Billroth I is a gastroduodenostomy

By what age do abdominal respirations cease in a child? A. 2 years B. 5 years C. 7 years D. 13 years

Answer C Abdominal respirations cease by age 7 years. The absence of abdominal respirations in children younger than age 7 indicates peritoneal inflammation.

You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with A. anxiety and panic attacks. B. long-term use of NSAIDs. C. infection by Helicobacter pylori . D. a family history of peptic ulcers.

Answer C Although stress-related conditions such as anxiety and panic attacks and long-term use of NSAIDs may contribute to and aggravate peptic ulcer disease, about 90% of the cases of peptic ulcers have been found to be caused by infection with the bacteria Helicobacter pylori

Which of the following treatments for ulcerative colitis is contraindicated? A. A high-calorie, nonspicy, caffeine-free diet that is low in high-residue foods and milk products B. Corticosteroids in the acute phase C. Antidiarrheal agents D. Colectomy with permanent ileostomy in severe cases

Answer C Antidiarrheal agents are contraindicated in the presence of ulcerative colitis because they may precipitate colonic dilation

Which laxative is safe for long-term use? A. Mineral oil B. Bisacodyl (Dulcolax) C. Methylcellulose (Citrucel) D. Magnesium hydroxide (milk of magnesia)

Answer C Bulk-forming agents such as methylcellulose (Citrucel) are the only laxatives that are safe for long-term use

Sandra has celiac disease. You place her on which diet? A. A low-fat diet B. A low-residue diet C. A gluten-free diet D. A high-protein diet

Answer C Clients with celiac disease have an allergy to gliadin, a component of gluten; therefore, they are placed on a gluten-free diet in which wheat and other grains containing analogues to wheat gluten, such as oats, barley, and rye, must be avoided

Olive has an acute exacerbation of Crohn ' s disease. Which laboratory test value(s) would you expect to be decreased? A. Sedimentation rate B. Liver enzyme levels C. Vitamins A, B complex, and C levels D. Bilirubin level

Answer C Folic acid and serum levels of most vitamins, including A, B complex, C, and the fat-soluble vitamins, are decreased in Crohn ' s disease as a result of malabsorption

In the ABCs of irritable bowel syndrome, the B stands for A. bloody stool. B. bad odor to stool. C. bloating or visible distention. D. bowel attack.

Answer C In the ABCs of irritable bowel syndrome, the A is for abdominal pain or discomfort — typically in the lower abdomen but could be anywhere; the B is for bloating or visible distention; the C is for constipation — hard, difficult to evacuate, or infrequent stools; the D is for diarrhea — loose, watery, or frequent stools; and the E is for extrabowel symptoms such as fatigue, headache, backache, muscle pain, urinary frequency, and sleep disturbance.

Dottie brings in her infant who has gastrointestinal reflux. What do you tell her about positioning her infant? A. Always position infants on their back to prevent sudden infant death syndrome. B. Rotate your infant between lying on the back and on the stomach. C. The infant should be placed on the left side. D. Place the infant in whatever position the infant remains quiet.

Answer C Infants with gastrointestinal reflux should be placed on their left side to prevent aspiration. They should be fed a formula thickened with rice cereal while being held in an upright position and kept in an elevated prone position for 1 hour after feeding so that gravity helps prevent reflux

Mona is breastfeeding her 5-day-old daughter, who has just been found to have physiological jaundice with a bilirubin level of more than 20 mg/dL. You should tell Mona that she A. should stop breastfeeding altogether. B. can continue breastfeeding. C. should discontinue breastfeeding for 24 hours. D. should alternate breast milk with formula for every other feeding.

Answer C No treatment is necessary for physiological jaundice unless the bilirubin level exceeds 20 mg/dL. In this case, the breastfeeding should be discontinued for 24 hours because this will result in a decreased bilirubin level.

Once gastric cancer has been diagnosed, which test should be ordered to accurately determine the correct staging? A. Computed tomography B. Magnetic resonance imaging C. Endoscopic ultrasound D. Ranson ' s test

Answer C Once gastric cancer has been diagnosed, accurate staging can be determined by an endoscopic ultrasound.

Marisa, age 42, has celiac disease. She is prone to osteopenic bone disease as a result of impaired calcium absorption because of A. increased calcium absorption by the small intestine. B. increased absorption of the fat-soluble vitamin D. C. the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids. D. decreased magnesium absorption.

Answer C Osteopenic bone disease may occur in celiac disease because there is decreased calcium absorption by the small intestine, decreased absorption of the fat-soluble vitamin D, and binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids.

Sara is taking polyethylene glycol (GoLYTELY) in preparation for a barium enema. What do you teach her about the medication? A. Drink the solution at room temperature. B. Take the medication with food so that it will be absorbed better. C. Take the medication in the early evening so as not to interfere with sleep. D. Drink all of the solution in one sitting.

Answer C Polyethylene glycol (GoLYTELY) should be taken in the early evening so as not to interfere with sleep because the first bowel movement begins within 1 hour and continues until the sigmoid colon is clear.

Rose has gastroesophageal reflux disease. You know she misunderstands your teaching when she tells you that she will A. avoid coffee, alcohol, chocolate, peppermint, and spicy foods. B. eat smaller meals. C. have a snack before retiring so that the esophagus and stomach are not empty at bedtime. D. stop smoking.

Answer C She should not have a snack before retiring. Clients with gastroesophageal reflux disease should be instructed to avoid coffee, alcohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop smoking; remain upright for 2 hours after meals; elevate the head of the bed on 6 - 8 in. blocks; and refrain from eating for 3 hours before retiring

Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes, slight hypertension, dyslipidemia, and central obesity. You diagnose her as having A. a cardiovascular emergency. B. a glycemic event. C. metabolic syndrome. D. multiple organ dysfunction.

Answer C Susan has a constellation of symptoms known as metabolic syndrome. The World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (NCEPATP III), and International Diabetes Federation (IDF) have slightly different criteria for this diagnosis.

Which organ structure produces and secretes bile to emulsify fats? A. Salivary glands B. Pancreas C. Liver D. Gallbladder

Answer C The liver produces and secretes bile to emulsify fats. The salivary glands moisturize food and release enzymes that initiate the digestion process

Which type of hernia usually occurs at a previous surgical incision site? A. Umbilical B. Congenital C. Hiatal D. Ventral

Answer D An incisional or ventral hernia may develop at a previous surgical incision site. An umbilical hernia may be congenital or acquired as the tissue around the umbilical ring weakens

Anson tells you that he thinks his antacids are causing his diarrhea. You respond, A. " Antacids contain fructose that may not be totally absorbed and results in fluid being drawn into the bowel. " B. " Antacids contain sorbitol or mannitol, sugars that aren ' t absorbed and can cause fluid to be drawn into the bowel. " C. " Antacids contain caffeine, which decreases bowel transit time. " D. " Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel. "

Answer D Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that result in an osmotic draw of fluid into the bowel. Fructose, sorbitol, and caffeine are not usually contained in antacids

Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond, A. " Do not donate blood until 1 year after diagnosis. " B. " A vaccine is available to prevent transmission. " C. " There is no possibility of transmission through razors or toothbrushes. " D. " Abstain from sex during your period. "

Answer D Because the hepatitis C virus is transmitted in blood, including menstrual blood, clients should abstain from sex during menstruation.

Which of the following pharmacologic agents used to treat constipation may cause flatulence and bloating and requires adequate fluid intake? A. Stool softeners B. Saline laxatives C. Lubricants D. Bulking agents

Answer D Bulking agents such as psyllium preparations may cause flatulence and bloating and requires adequate fluid intake.

Sally had an ileostomy performed for inflammatory bowel disease. What type of fecal output can Sally expect? A. Hard, formed stool B. Semisoft stool C. Semisoft to very soft stool D. A continuous, soft-to-watery effluent

Answer D Fecal output from an ileostomy is a malodorous, continuous, soft-to-watery effluent material that contains intestinal enzymes, which are very irritating to the skin around the stoma

The most common cause of mechanical bowel obstruction in all ages is A. volvulus. B. intussusception. C. cancer. D. a hernia.

Answer D Hernias account for more cases of mechanical bowel obstruction in all ages than do volvulus, intussusception, or cancer

Your client ' s 2-month-old daughter is admitted with gastroenteritis and dehydration after 2 days of vomiting and diarrhea. When she asks you what is causing the diarrhea, how do you respond? A. " She must be lactose intolerant from the formula, and this alters the fluid balance. " B. " Her body ' s telling you that it ' s time to initiate some solids into her system. " C. " The virus is causing irritation of the gastrointestinal lining, which causes an increase in gastrointestinal motility. " D. " The infectious agent invaded the gastrointestinal mucosa and affected the balance of water and electrolytes. "

Answer D In 80% of the cases, gastroenteritis is viral in nature. This viral infection causes diarrhea by stimulating the secretion of electrolytes into the intestine

Patients with irritable bowel syndrome (IBS) are more likely to have which of the following organic gastrointestinal disease? A. Thyroid dysfunction B. Colorectal cancer C. Celiac sprue D. Lactose malabsorption

Answer D Patients with irritable bowel syndrome are 22% - 26% more likely to have lactose malabsorption in addition to irritable bowel syndrome

Tenesmus refers to A. projectile vomiting. B. severe lower abdominal pain. C. constipation. D. a persistent desire to empty the bowel or bladder

Answer D Tenesmus is the spasmodic contraction of the anal or bladder sphincters, producing pain and the persistent desire to empty the bowel or bladder via involuntary, ineffectual straining efforts

The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every A. 3 years, beginning at age 40. B. other year. C. 2 years, beginning at age 45. D. 5 years, beginning at age 50

Answer D The American Cancer Society (ACS) recommends a flexible sigmoidoscopy for colon cancer screening in persons at average risk beginning at age 50 every 5 years, or a colonoscopy every 10 years, or a double-contrast barium enema every 5 years, or a CT colonography (virtual colonoscopy) every 5 years.

The most important diagnostic test for celiac disease is A. confirming malabsorption by laboratory tests. B. a barium enema. C. a peroral biopsy of the duodenum. D. a gluten-free diet trial with an accompanying improvement in mucosal histological response.

Answer D The diagnosis of celiac disease is classically established by a trial period of a gluten-free diet with an accompanying improvement in the mucosal histological response

Simon states that he is worried because he has a bowel movement only every third day. You respond, A. " You should have two to three stools per day. " B. " You should defecate once a day. " C. " You should have at least three stools per week. " D. " There is no such thing as a ' normal ' pattern of defecation. "

Answer D There is no such thing as a " normal " pattern of defecation. Patterns of defecation vary widely and may in part be affected by dietary habits, fluid intake, bacteria in the stool, psychological stress, or voluntary postponement of defecation.

Which of the following statements about cirrhosis is true? A. Biliary cirrhosis is the most common type of cirrhosis in the United States. B. Alcoholic cirrhosis occurs only in malnourished alcoholics. C. Cirrhosis is reversible if diagnosed and treated at an early stage. D. Women tend to develop cirrhosis more quickly with less alcohol intake than men.

Answer D Women tend to develop cirrhosis more quickly with less alcohol intake than men, which suggests that a smaller, leaner body mass and enhanced absorption are both factors in the development of alcoholic cirrhosis

Treatment for achalasia may include A. balloon dilation of the lower esophageal sphincter. B. beta blockers. C. a fundoplication. D. an esophagogastrectomy

Answer: A Achalasia is an absence of peristalsis of the esophagus and a high gastroesophageal sphincter pressure. After initial noninvasive treatments, clients may require a balloon dilation of the lower esophageal sphincter. Calcium channel blockers, not beta blockers, may be used to decrease symptoms of dysphagia. A fundoplication is done for a hiatal hernia. An esophagogastrectomy is performed for esophageal cancer.

You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? A. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl) B. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec) C. Amoxicillin (Amoxil) and omeprazole (Prilosec) D. Clarithromycin (Biaxin) and metronidazole (Flagyl)

Answer: A All of the drugs listed are used in the eradication of Helicobacter pylori. Traditional 14-day "triple therapy" with a proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl) has consistently produced eradication rates of approximately 95% and is the least-expensive therapy.

Which type of hepatitis is transmitted by the fecal-oral route, sewage, contaminated water, shellfish, and possibly blood? A. Hepatitis A (HAV) B. Hepatitis B (HBV) C. Hepatitis C (HCV) D. Hepatitis D (HDV)

Answer: A Hepatitis A (HAV) is transmitted by the fecal-oral route, sewage, contaminated water and shellfish, and possibly by blood. Hepatitis B (HBV) is transmitted by the percutaneous route (permucosal) through infected blood and body fluids and sexual contact. Hepatitis C (HCV) is transmitted by the percutaneous route in the community, and a large percentage of those infected have no known risk factors. Hepatitis D (HDV) is transmitted by the percutaneous route, but most cases have coinfection with HBV. Hepatitis E (HEV) is transmitted by the fecal-oral route.

Which physical examination maneuver for diagnosing appendicitis is done by deep palpation over the left lower quadrant (LLQ) with resultant pain in the right lower quadrant (RLQ)? A. Rovsing's sign B. Psoas sign C. Obturator sign D. McBurney's sign

Answer: A All these are physical examination maneuvers for diagnosing appendicitis. If pain is elicited during the examination, appendicitis is suspected. Rovsing's sign is deep palpation over the LLQ with sudden, unexpected pain in the right lower quadrant. Psoas sign is pain when the patient is instructed to try to lift the right leg against gentle pressure applied by the examiner or pain when the client is placed in the left lateral decubitus position and the right leg is extended at the hip. The obturator sign occurs when the client with the right hip and knee flexed experiences pain when the examiner slowly rotates the right leg internally, which stretches the obturator muscle. McBurney's sign is pain elicited when pressure is applied to McBurney's point, which is located halfway between the umbilicus and the anterior spine of the ilium.

Nora, age 78, has terminal cancer and is wasting away. What should you order to stimulate her appetite? A. Megestrol (Megace) B. Sertraline (Zoloft) C. Vitamin C D. Alprazolam (Xanax)

Answer: A Although depression might be a contributing factor to Nora's wasting away, megestrol (Megace) can produce weight gain by stimulating appetite and food intake and by decreasing the nausea and vomiting that usually accompany terminal cancer. High doses of vitamin C have been used in some studies and possibly promote a sense of well-being and reduced pain. This may or may not improve the patient's appetite. Alprazolam may help with her anxiety, but may or may not improve her appetite. The best stimulate for her appetite is megestrol.

The metabolism of which drug is not affected in Marsha, age 74? A. Alcohol B. Anticonvulsants C. Psychotropics D. Oral anticoagulants

Answer: A Although drug metabolism by the liver is usually impaired in older adults, the metabolism of alcohol is unchanged.

Which area(s) of Jill's gastrointestinal tract may be affected by her Crohn's disease? A. All areas from the mouth to the anus B. The colon C. The sigmoid colon D. The small intestine

Answer: A Although the colon is the major site of gastrointestinal involvement in Crohn's disease (inflammatory bowel disease), the disease can affect all areas from the mouth to the anus.

Cydney has been given a diagnosis of ascariasis. Which symptoms would you expect to see? A. Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea B. Nocturnal perianal and perineal pruritus C. Diarrhea, cramps, and malaise D. Ascites and facial and extremity edema

Answer: A Ascariasis is the most common intestinal helminth (parasitic worm). It causes pulmonary manifestations such as low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea because the larvae are transmitted to the lungs from the vascular system. The larvae burrow through alveolar walls, migrating up the bronchial tree to the pharynx, and then down the esophagus back to the intestines. Nocturnal perianal and perineal pruritus occur with enterobiasis (pinworm infection). Diarrhea, cramps, and malaise are common with trichinosis. Ascites and facial and extremity edema are common with trichuriasis.

Sigrid, age 82, has irritable bowel, chronic constipation, and diverticulitis. Which pharmacological agent do you recommend? A. Bulking agents B. Stool softeners C. Laxatives D. Lubricants

Answer: A Bulking agents, such as psyllium preparations or methylcellulose preparations, are used for irritable bowel, chronic constipation, and diverticulitis. Stool softeners, such as docusate sodium, are frequently used for the prevention of constipation but most likely are not effective for chronic use. Saline laxatives, such as magnesium hydroxide, are indicated for intermittent use in chronic constipation and as a bowel preparation. Stimulant irritant laxatives, such as bisacodyl, senna, and cascara, are used in acute constipation and should not be used for chronic constipation. Lubricants, such as mineral oil, are used in intermittent chronic constipation.

Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? A. Cheese B. Leafy green vegetables C. Raw fruits and vegetables D. Dried beans

Answer: A Cheese, bread, pasta, rice, pretzels, and yogurt all help to thicken stools. Leafy green vegetables, raw fruits and vegetables, and dried beans may all loosen stools.

To differentiate among the different diagnoses of inflammatory bowel diseases, you look at the client's histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? A. Crohn's disease B. Ulcerative colitis C. Infectious colitis D. Ischemic colitis

Answer: A Crohn's disease would show transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. Ulcerative colitis would show acute inflammatory infi ltrates, depleted goblet cells, negative cultures, and involvement of the rectum. Infectious colitis, because of the toxic products released, may induce periportal inflammation, mild hepatomegaly, and low-grade liver enzyme abnormalities, but usually without trophozoites in the liver. Ischemic colitis seen on colonoscopy reveals segmental infl ammatory changes most often in the rectosigmoid and the splenic fl exure, where there is more collateral circulation.

You assess for Cullen's sign in Dan, age 62, after surgery. Cullen's sign may indicate A. intra-abdominal bleeding. B. a ventral hernia. C. appendicitis. D. jaundice.

Answer: A Cullen's sign is a bluish periumbilical color that may indicate intra-abdominal bleeding. The other conditions listed do not produce this.

Samantha, age 28, is 100 lb overweight and wants to have a gastroplasty performed. In discussing this with her, you explain that by having this procedure she may A. develop diarrhea. B. lose too much weight. C. develop hemorrhoids. D. vomit after she eats

Answer: A Diarrhea is a common problem after a gastroplasty because of the induced malabsorption. Clients usually do not end up losing too much weight because sometimes the only foods they can tolerate are high-caloric foods (simple sugars) such as ice cream. Losing weight will probably help a hemorrhoid problem. While Samantha may vomit after she eats, the problem of diarrhea is much more common.

When percussing the abdomen, hyperresonance is present A. when there is gaseous distention. B. over a distended bladder. C. over adipose tissue. D. over fluid or a mass

Answer: A Hyperresonance is present when there is gaseous distention. Dullness occurs over a distended bladder or adipose tissue and when there is fluid or a mass present.

Which of the following signs or symptoms indicates biliary obstruction with liver disease? A. Pruritus B. Increased abdominal girth C. Right upper quadrant pain D. Easy bruising

Answer: A Pruritus indicates that biliary obstruction is present with the liver disease. Increased abdominal girth indicates ascites is present from portal hypertension or hypoalbuminemia. Right upper quadrant pain may indicate hepatitis, cholecystitis, hepatocellular carcinoma, or abscess. Easy bruising may indicate splenomegaly secondary to portal hypertension with platelet sequestration or coagulopathy secondary to decreased synthesis of clotting factors

Rebound tenderness at McBurney's point would alert you to A. appendicitis. B. peritonitis. C. a spleen injury. D. irritable bowel syndrome

Answer: A Rebound tenderness at McBurney's point, located midway between the umbilicus and the anterior iliac crest in the right lower quadrant, would alert you to appendicitis. The other conditions may elicit tenderness on palpation, but not rebound tenderness.

Rebound tenderness may indicate A. peritoneal inflammation. B. a ventral hernia. C. portal hypertension. D. Crohn's disease.

Answer: A Rebound tenderness is present when there is pain on release of pressure to the abdomen and is a reliable indicator of peritoneal inflammation. Rebound tenderness is elicited when you release your hand pressure on palpation. The other conditions listed may elicit pain when you press down on your hand during palpation

In counseling Maria, age 24, who is healthy, you advise her to limit her intake of sugar to prevent A. dental caries. B. obesity. C. diabetes. D. hyperactivity

Answer: A Reducing sugar intake is one of the preventive measures to take against dental caries. Other measures include regular brushing and flossing. Sugar has not been correlated with hyperactivity, and simple sugars do not cause diabetes. Dietary fat, rather than sugar, is the culprit in obesity.

The majority of the population of the United States has antibodies against which type of hepatitis? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

Answer: A The majority of the population in the United States has antibodies against hepatitis A virus (HAV). Besides immunity, there is also a vaccine available for Hepatitis A and B. Co-infection with hepatitis D can be prevented through hepatitis B vaccination. The trial for a vaccine for Hepatitis C should be completed in 2016.

A second-generation cephalosporin is to be given to your patient undergoing colorectal surgery. You know that the dosing recommendation to prevent an incisional surgical site infection (SSI) is A. three doses prior to surgery. B. one dose prior to surgery. C. a weekly course of therapy. D. therapy beginning after surgery

Answer: A Three-dose cefmetazole administration is significantly more effective for prevention of incisional surgical site infection (SSI) than singledose administration for clients undergoing colorectal surgery. Use of prophylactic antibiotics in elective colorectal surgery is essential. The incidence of incisional SSI among clients undergoing colorectal surgery may be as high as 30% to 50% without prophylactic antibiotics.

Which oral medication might be used to treat a client with chronic cholelithiasis who is a poor candidate for surgery? A. Ursodiol (Actigall) B. Ibuprofen (Advil) C. Prednisone (Deltasone) D. Surgery is the only answer

Answer: A Ursodiol (Actigall) is an oral bile acid that dissolves gallstones. For dissolution, 8 to 10 mg/kg per day is given in two to three divided doses; for prevention, 300 mg twice per day is given. The safety of its use after 24 months has not been established. NSAIDs such as ibuprofen (Advil) may be very irritating to the gastrointestinal mucosa. Steroids such as prednisone (Deltasone) may mask an infection as well as irritate the gastric mucosa.

Duodenal and gastric ulcers have many of the same manifestations. Which is more common with gastric ulcers rather than duodenal ulcers? A. Epigastric or abdominal pain B. Vomiting C. Possibility of perforation D. Obstruction of the gastrointestinal tract

Answer: A Vomiting is more common with gastric ulcers than duodenal ulcers. Stools are more often altered with duodenal ulcers. The possibility of perforation and obstruction of the gastrointestinal tract is present in both types of ulcers. Approximately half of the clients report relief of pain with food or antacids (especially with duodenal ulcers). Many clients deny the relationship of meals to the pain. Two-thirds of clients with duodenal ulcers and one-third with gastric ulcers have nocturnal pain that awakens them.

Which is the most common presenting symptom of gastric cancer? A. Weight loss B. Dysphagia C. Hematemesis D. Gastrointestinal bleeding

Answer: A Weight loss is usually the presenting symptom of gastric cancer, followed by dysphagia. Hematemesis occurs in 10% to 15% of all clients with gastric cancer. Gastrointestinal bleeding is uncommon with gastric cancer, although it is common with colorectal cancer.

Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you that she is sure it is going to be malignant. How do you respond? A. "Don't worry. Gastric ulcers are not cancerous." B. "About 95% of gastric ulcers are benign." C. "You have about a 50% chance of having gastric cancer from your ulcer." D. "Even if it is cancer, surgery is 100% successful."

Answer: B About 95% of gastric ulcers are benign even though some of these seem to look malignant on x-ray. The other choices are poor responses. As a clinician, one should never offer false hope or promise unpredictable outcomes.

For an uncomplicated Salmonella infection, the antibiotic of choice is which of the following? A. Ampicillin (Polycillin) B. Amoxicillin (Amoxil) C. Trimethoprim-sulfamethoxazole (Bactrim) D. No antibiotic is indicated.

Answer: D Antibiotic therapy is not indicated for an uncomplicated salmonellosis because it is generally a self-limiting illness.

Maura had a less than 8% value on her Schilling test. What medication do you anticipate that Maura might need? A. Folic acid B. Vitamin B 12 C. Thyroid medication D. Hormone replacement therapy

Answer: B A Schilling test is a timed urine test that evaluates the ability to absorb vitamin B 12 from the gastrointestinal tract. It is used to diagnose pernicious anemia and malabsorption syndromes. The normal values range from 10% to 40%. A value less than 7% indicates pernicious anemia and some gastric lesions

Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for A. constipation. B. colorectal cancer. C. irritable bowel syndrome. D. acute appendicitis.

Answer: B A change in defecation pattern must be evaluated for colorectal cancer. Constipation may be part of the pattern between constipation and diarrhea in many conditions; for example, irritable bowel syndrome may result in either. Fecal stasis may be a factor in acute appendicitis, BUT an abrupt change in defecation patterns must be evaluated for possible colorectal cancer.

When George tells you that his feces are foul smelling, you suspect which of the following? A. Blood in the stool B. Ingestion of a low-fat diet C. Prostate cancer D. Appendicitis

Answer: B A distinct foul odor to the stool may indicate blood in the stool, ingestion of a high-fat diet, or colon cancer. Foul-smelling stool may also indicate Crohn's disease, malabsorption, intestinal infection, chronic pancreatitis, and celiac disease.

A false-positive result with the fecal occult blood test can result from A. ingestion of large amounts of vitamin C. B. a high dietary intake of rare-cooked beef. C. a colonic neoplasm that is not bleeding. D. stool that has been stored before testing.

Answer: B A false-positive result from a fecal occult blood test can result from a high dietary intake of rare cooked beef or fruits and vegetables that contain peroxidases. Oral iron preparations have also been shown to produce a false-positive result in some, but not all, studies. False-negative results can occur in clients who ingest large amounts of vitamin C or have a colon neoplasm that is not bleeding. A false-negative result can also occur if the stool has been stored before testing.

Signs and symptoms of diverticulitis are vast. Which of the following findings is NOT associated with diverticulitis? A. Left lower quadrant abdominal pain B. A history of irritable bowel syndrome C. A tender mass in the left lower quadrant D. An elevated temperature

Answer: B A history of irritable bowel syndrome has no association with diverticulitis. A client with diverticulitis would have left lower quadrant abdominal pain, a tender mass in the left lower quadrant, and an elevated temperature.

While you are obtaining Henry's history, he tells you that he had a portacaval shunt done in the past. What does this imply? A. A history of liver cancer B. A history of alcohol abuse C. A congenital biliary problem D. Heavy tobacco use

Answer: B A portacaval shunt is the surgery often performed for bleeding esophageal varices. They are associated with alcoholic cirrhosis and portal hypertension, commonly the result of a history of alcohol abuse (other causes include viral hepatitis, excess iron in the liver, and blood clots). Bleeding esophageal varices occur when the small esophageal veins become distended and rupture from increased pressure in the portal system. A portacaval shunt is not done for the other conditions listed.

Tom has just been diagnosed with celiac disease. Which of the following might you tell him? A. There is a new pharmaceutical cure for celiac disease. B. A strict gluten-free diet is the only treatment for celiac disease. C. Your children will not be at a higher risk for developing this disease. D. The presence of celiac disease is decreasing dramatically in the United States.

Answer: B A strict gluten-free diet is the only treatment for celiac disease. There is no pharmaceutical cure. Patients with first- or second-degree relatives affected by celiac disease are at higher risk for developing it. The prevalence of celiac disease in the United States has increased dramatically. Approximately 1% of today's U.S. residents are affected by it.

Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? A. Enterococci B. Escherichia coli C. Klebsiella D. Staphylococci

Answer: B Escherichia coli is the pathogen most often responsible for traveler's diarrhea (infectious diarrhea). Other causes may include viruses, other bacteria, protozoa, or parasites. The other conditions may result in diarrhea, but because Harvey just came back from Mexico, his traveler's diarrhea is most likely caused by E. coli.

You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have A. yogurt. B. foods containing whey. C. prehydrolyzed milk. D. oranges.

Answer: B Advise clients who are lactose intolerant to avoid foods containing whey. Whey is a lactose-rich ingredient found in some foods, so labels need to be read on all foods for clients who are lactose intolerant. To control symptoms, dietary lactose should be reduced or restricted by using lactose-reduced and lactose-free dairy products or by eating lactose-rich food in small amounts or in combination with low-lactose or lactose-free foods. Fermented dairy products, such as aged or hard cheeses and cultured yogurt, are easier to digest and contain less lactose than other dairy products. Most stores carry milk that has been pretreated with lactase, making it more than 70% lactose free. This reduced-lactose milk is also known as prehydrolyzed milk. Lillian can eat oranges.

Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? A. "Occasionally he accumulates blood in the gut." B. "There is an interruption of the normal clotting mechanisms." C. "Long-term alcohol abuse has made his vessels very friable." D. "His bone marrow has been affected."

Answer: B Because of Marvin's alcoholism and his resulting dietary insufficiencies, there is an inadequate amount of vitamin K in the liver for the thrombin to convert fibrinogen to fibrin; thus, the sequence of coagulation is disrupted. An accumulation of blood in the gut would not affect coagulation. Large numbers of spider angiomas are associated with liver cirrhosis. Excessive drinking also widens blood vessels and increases blood flow to the skin; hence, it can lead to thread veins, a reddened "drinker's nose," and rosacea. While the K vitamins play an important role in bone metabolism and in the optimization of bone health, the reverse is not true; bone marrow does not affect the amount of vitamin K.

Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? A. Campylobacter jejuni B. Clostridium botulinum C. Clostridium perfringens D. Staphylococcus

Answer: B Clostridium botulinum is an anaerobic, gram-positive bacillus that produces toxins. The primary source is canned foods. Campylobacter jejuni is found primarily in eggs and poultry but may be found in domestic animals. Clostridium perfringens is found in soil, feces, air, and water. Outbreaks are caused most often by contaminated meat. Staphylococcus is a common cause of food poisoning. It is caused by the ingestion of an enterotoxin found in improperly handled or stored foods.

You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? A. Cirrhosis B. Inflammation of the kidney C. Inflammation of the spleen D. Peritonitis

Answer: B Costovertebral angle tenderness occurs when one hand is "thumped" with the ulnar edge of the other fist over the 12th rib at the costovertebral angle on the back and tenderness or sharp pain occurs. It indicates inflammation of the kidney (and possible associated renal calculi, renal artery or vein occlusion, and perirenal abscess). Cirrhosis, inflammation of the spleen, and peritonitis may elicit pain when percussion is done on the abdomen

Martha has a Cushing's ulcer. What might have precipitated this? A. Her house burned down when she was not at home. B. She was in a bad auto accident in which she sustained a head injury. C. She spent the weekend deep-sea diving. D. She was on an overseas airline flight that lasted more than 24 hours.

Answer: B Cushing's ulcers are stress ulcers that occur after a head injury or intracranial disease. They are also called von Rokitansky-Cushing syndrome. A Cushing's ulcer may also occur after a severe burn.

How do diphenoxylate (Lomotil) and loperamide (Imodium) help relieve diarrhea? A. They reduce bowel spasticity and acid secretion in the stomach. B. They decrease the motility of the ileum and colon, slowing the transit time and promoting more water absorption. C. They increase motility to assist in removing all of the stool. D. By decreasing the sensations of the gastric nerves, they send a message to the brain to slow down peristalsis.

Answer: B Diphenoxylate (Lomotil) and loperamide (Imodium), like all opiates and opium derivatives, help to relieve diarrhea by decreasing the motility of the ileum and colon, slowing the transit time, and promoting more water absorption. Anticholinergics such as atropine (Donnatal) and other belladonna alkaloids (Donnagel) reduce bowel spasticity and acid secretion in the stomach.

Jonas, age 34, had a Billroth II (hemigastrectomy and gastrojejunostomy with vagotomy) performed 1 week ago and just started eating a bland diet. What do you suspect when he complains of epigastric fullness, distention, discomfort, abdominal cramping, nausea, and flatus after eating? A. Obstruction B. Dumping syndrome C. Metabolic acidosis D. Infectious colitis

Answer: B Dumping syndrome may occur 1 to 3 weeks after gastric surgery when the client starts to consume larger meals. Food enters the intestine faster and in larger quantities than before the surgery, causing the client to experience epigastric fullness, distention, discomfort, abdominal cramping, nausea, and increased flatus 10 to 30 minutes after eating. While any abdominal surgery may result in adhesions that might possibly cause an obstruction, the symptoms that Jonas is experiencing are classic symptoms of "dumping syndrome." All the distractors are extreme possibilities, but the symptoms are classic for dumping syndrome.

Marcie just returned from Central America with traveler's diarrhea. Which is the best treatment? A. Metronidazole (Flagyl) B. Supportive care C. Quinolone antibiotics D. Gastric lavage

Answer: B Enterotoxigenic Escherichia coli (ETEC) is the most common cause of traveler's diarrhea that occurs from contaminated food or water. It is usually self-limiting, requiring no treatment other than supportive care. It is common in developing countries. Traveler's diarrhea caused by E. coli used to be frequently treated with a 3- to 5-day course of a quinolone antibiotic such as ciprofl oxacin (Cipro). Metronidazole may be used for Clostridium difficile and for Entamoeba histolytica (Amebiasis). Quinolone antibiotics may also be used for Salmonella if associated with a fever or systemic disease. Gastric lavage may be used for Clostridium botulinum .

Which of the following antibiotics causes more episodes of nausea and/or vomiting than the others? A. Azithromycin B. Erythromycin C. Penicillin D. Tetracycline

Answer: B Erythromycin is the antibiotic that causes the most cases of gastrointestinal (GI) upset such as nausea or vomiting. Other medications that commonly cause nausea and vomiting are opiates, estrogen, ipecac, digitalis, chemotherapy, and theophylline. While all antibiotics may cause nausea and/or vomiting, erythromycin causes more GI upset than any other antibiotic.

Steve, age 79, has gastroesophageal refl ux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid? A. Apples B. Peppermint C. Cucumbers D. Popsicles

Answer: B Food substances that reduce the lower esophageal sphincter pressure or irritate the gastric mucosa include alcohol, caffeinated beverages, chocolate, citrus fruits, decaffeinated coffee, fatty foods, onions, peppermint and spearmint, tomatoes, and tomato-based products. Nonfood substances that irritate gastroesophageal refl ux disease include anticholinergic drugs, beta-adrenergic blocking agents, calcium channel blockers, diazepam, estrogens, nicotine, and theophylline.

Which protozoal infection is the most common intestinal infection in the United States that also occurs worldwide? A. Salmonellosis B. Giardiasis C. Botulism D. Shigellosis

Answer: B Giardiasis, a protozoal infection of the upper small intestine, is caused by Giardia lamblia. It is the most common intestinal protozoal infection in the United States that also occurs worldwide. Clostridium botulinum, which causes botulism, is an enterotoxin, whereas Salmonella, causing salmonellosis, and Shigella, causing shigellosis, are both bacteria.

Hyperactive bowel sounds (borborygmi) are present in which of the following conditions? A. Cirrhosis B. Laxative use C. Late mechanical bowel obstruction D. Pancreatic cancer

Answer: B Hyperactive bowel sounds (borborygmi) are present with laxative use, early mechanical bowel obstruction, gastroenteritis, and brisk diarrhea. Cirrhosis, a late mechanical bowel obstruction, and pancreatic cancer may all produce decreased bowel sounds.

After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured? A. An enzyme-linked immunosorbent assay titer B. A urea breath test C. A rapid urease test ( Campylobacter -like organism) D. A repeat endoscopy

Answer: B If the patient is treated empirically for an ulcer, follow-up is only indicated if symptoms recur. A urea breath test is the easiest, least expensive, and most reliable test for Helicobacter pylori, which causes peptic ulcers. Its average sensitivity is 100%, and its specifi city is 95%. An enzymelinked immunosorbent assay titer, a rapid urease test ( Campylobacter -like organism [CLO]) test, and an endoscopy may also be used. The CLO test and endoscopy require biopsy specimens and are therefore more invasive.

What is the most common cause of melena? A. Colon cancer B. Upper gastrointestinal bleeding C. Drug abuse D. Smoking

Answer: B Melena is defi ned as black, tarry stools that test positive for occult blood. The most common cause of melena is upper gastrointestinal (GI) bleeding, but bleeding in the small bowel or the right colon can also produce melena. It is the action of gastric acid and intestinal secretions that reduces bright red blood to black, tarry stools. To produce melena, about 100 to 200 mL of blood must be present. Because of GI transit time, it is possible for melena to continue for several days after the acute bleeding has stopped.

A concern with older patients having abdominal surgery is A. older patients have an increased peristalsis, and bowel sounds must be checked very frequently. B. older adults have a diminished response to painful stimuli that may mask abdominal health problems. C. because older adults are prone to diarrhea after surgery, you must be vigilant about skin breakdown. D. because of liver enlargement, postoperative medications are processed faster.

Answer: B Older adults have a diminished response to painful stimuli that may mask abdominal health problems, and they may have difficulty assuming some positions necessary for the physical examination, so positions may need to be modified to meet their needs. As people age, many of their body systems slow down and become less efficient. In the gastrointestinal tract, there is a reduction of saliva, stomach acid, gastric motility, and peristalsis that causes problems with swallowing, absorption, and digestion. These changes, along with a general reduction of muscle mass and tone, also contribute to constipation. The liver becomes smaller, and liver function declines, making it harder to process medications.

Sidney, age 33, has ulcerative colitis and asks you about a Koch pouch. How do you respond? A. "It's a method of bowel training for clients with chronic diarrhea." B. "It's a name for a continent ileostomy." C. "It's a packet of daily pills to take to relieve diarrhea." D. "It's like a sanitary pad, and it's used to contain any rectal leakage."

Answer: B Performed for clients with ulcerative colitis, a Koch pouch (continent ileostomy) is the surgical removal of the rectum and colon and construction of an internal ileal reservoir, nipple valve, and stoma, allowing for intermittent drainage of ileal contents.

Martin, age 38, has had an ileostomy for ulcerative colitis. Which self-care measures do you teach him to relieve food blockage? A. Lie in a supine position B. Massage the peristomal area C. Take a hot shower or tub bath D. Drink cold fluids

Answer: B Self-care measures to relieve food blockage in a client with an ileostomy include massaging the peristomal area, which may stimulate peristalsis and fecal elimination; assuming a knee-chest position to reduce intra-abdominal pressure; taking a warm shower or tub bath to relax the abdominal muscles; and drinking warm fl uids or grape juice to produce a mild cathartic effect.

Which laboratory value would you expect to be increased in the presence of significant diarrhea? A. Serum potassium B. Serum sodium C. Serum chloride D. Bicarbonate

Answer: B Serum chloride level is increased with significant diarrhea when the diarrhea causes sodium loss that is greater than chloride loss. However, when there is severe diarrhea and vomiting, serum chloride levels may be decreased. Serum potassium and chloride levels are decreased as a result of loss through stool, and bicarbonate level is decreased in a metabolic acidotic state.

Which modality(ies) is(are) the most effective in patients with metabolic syndrome? A. Specific vitamin and mineral supplements B. Diet and exercise C. Specific pharmacological therapy D. Eliminating alcohol and smoking from their lifestyle

Answer: B Several studies show that intensive lifestyle changes in the form of diet and exercise are most effective in patients with metabolic syndrome. Exercise, for example, is a strong deterrent for developing diabetes and heart disease. Some easy fixes in the diet are staying away from high-fructose corn syrup and trans fats, which are two of the biggest metabolic syndrome antagonists. Patients need to understand the association of what goes in the mouth and what goes on with their blood chemistry. Teaching must help patients understand and manage all the factors that put them in the metabolic danger zone. Clinicians need to address vitamin and mineral supplements that patients take, although typically they will not affect the metabolic syndrome. Eliminating alcohol and smoking is always beneficial but is not a modality that is effective in patients with metabolic syndrome. Diet and exercise remain the most important factors.

Rose, a client with gastroesophageal reflux disease, has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend that she refrain from using? A. antibiotics. B. NSAIDs. C. oral contraceptives. D. antifungals.

Answer: B The client with gastroesophageal reflux disease should avoid taking NSAIDs because they tend to aggravate the already-irritated gastric mucosa. Antibiotics, oral contraceptives, and antifungals do not affect GERD

Sylvia, age 59, has acute hepatitis. She tells you that it is from a drug overdose. Which drug do you suspect? A. Flagyl B. Acetaminophen C. Sumatriptan D. Hydrocortisone

Answer: B The following drugs may cause acute hepatitis: acetaminophen, allopurinol, aspirin in high doses, captopril, carbamazepine, isoniazid, ketoconazole, methyldopa, NSAIDs, procainamide, and sulfonamides. The other drugs do not cause liver damage.

Melva, age 63, presents with an exacerbation of acute pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? A. Age B. Infection C. Pain D. Length of time between exacerbations

Answer: B The most important factor in determining long-term negative outcomes for pancreatitis is the presence of infection. Despite best practices, mortality associated with severe acute pancreatitis remains approximately 20% to 25% because of systemic complications. The older the patient, the greater the possibility of a negative outcome. Certainly if a patient has many frequent exacerbations without much time between them, he/she also has a possibility of a negative outcome. Pain should not factor into this outcome. Regardless, an infection remains the single most important factor in affecting long-term negative outcomes.

Which procedure enlarges the opening between the stomach and duodenum to improve gastric emptying? A. Billroth I B. Total gastrectomy C. Pyloroplasty D. Vagotomy

Answer: C A pyloroplasty surgically enlarges the opening between the stomach and duodenum to improve gastric emptying. A Billroth I is a gastroduodenostomy. A total gastrectomy is removal of the entire stomach and is rarely performed. It results in an anastomosis connecting the esophagus to the duodenum or jejunum. A vagotomy severs a portion or all of the vagus nerves to the stomach.

Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be A. appendicitis. B. irritable bowel syndrome. C. cholecystitis. D. Crohn's disease.

Answer: C A rapid onset of severe right upper quadrant (RUQ) abdominal cramping pain with nausea and vomiting is a classic presentation of acute cholecystitis; 90% to 95% of clients with acute cholecystitis also have gallstones. Other symptoms include low-grade fever, epigastric tenderness, guarding, and pain on inspiration during palpation of the RUQ (Murphy's sign). Pain associated with appendicitis would typically be near the navel progressing to the right lower quadrant. In irritable bowel syndrome (IBS) and Crohn's disease, the pain and cramping are more diffuse in the abdomen and are not usually accompanied by nausea and vomiting. The pain with IBS originates over some area of the colon, with the lower left quadrant (LLQ) being most often affected. The seven F s of cholecystitis are fair, fat, forty, female, fertile, fat intolerant, and flatulent.

Sally, age 21, is to undergo a tonsillectomy. She has heard about taste changes after a tonsillectomy. What do you tell her? A. "As the tongue is responsible for sweet, sour, salty, and bitter taste abilities, they will all be affected somewhat." B. "You will have some alterations, but we'll have to wait and see how you are affected personally." C. "You may notice a slight difference initially, but there are no lasting changes in taste." D. "About half of the patients have some permanent alterations in the sense of taste."

Answer: C Although some clients report a signifi cant subjective drop in taste function following surgery, none have ongoing taste dysfunction. Sweet, sour, salty, and bitter taste abilities may be temporarily affected, but there is no lasting change in taste seen after a tonsillectomy.

You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with A. anxiety and panic attacks. B. long-term use of NSAIDs. C. infection by Helicobacter pylori . D. a family history of peptic ulcers.

Answer: C Although stress-related conditions such as anxiety and panic attacks and long-term use of NSAIDs may contribute to and aggravate peptic ulcer disease, about 90% of the cases of peptic ulcers have been found to be caused by infection with the bacteria Helicobacter pylori. Research studies have been inconclusive regarding the hereditary factor for gastric and duodenal ulcers.

Which of the following treatments for ulcerative colitis is contraindicated? A. A high-calorie, nonspicy, caffeine-free diet that is low in high-residue foods and milk products B. Corticosteroids in the acute phase C. Antidiarrheal agents D. Colectomy with permanent ileostomy in severe cases

Answer: C Antidiarrheal agents are contraindicated in the presence of ulcerative colitis because they may precipitate colonic dilation. Sulfasalazine (Azulfi dine) is often prescribed for its antibiotic and anti-infl ammatory effects; however, it interferes with folate metabolism, and therefore folate supplements may be required. A high-calorie, non-spicy, caffeine free diet that is low in high-residue foods and milk products; corticosteroids in the acute phase; and a colectomy with permanent ileostomy in severe cases are all treatments for ulcerative colitis.

105. Melva, age 63, presents with an exacerbation of acute pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? A. age B. infection C. pain D. length of time between exacerbations

B. infection

Which laxative is safe for long-term use? A. Mineral oil B. Bisacodyl (Dulcolax) C. Methylcellulose (Citrucel) D. Magnesium hydroxide (milk of magnesia)

Answer: C Bulk-forming agents such as methylcellulose (Citrucel) are the only laxatives that are safe for long-term use. They contain natural vegetable fiber that is not absorbed. This creates bulk and draws water into the intestine, thus softening the stool. Mineral oil reduces the absorption of the fat-soluble vitamins A, D, E, and K and may cause damage to the liver and spleen because of systemic absorption. Irritant or stimulant laxatives, such as bisacodyl (Dulcolax), work by stimulating the motility and secretion of the intestinal mucosa. Osmotic and saline laxatives and cathartics, such as magnesium hydroxide (milk of magnesia), when used over the long term, may suppress normal bowel reflexes.

Ellie, age 42, has a seizure disorder and has been taking phenytoin (Dilantin) for years. Which supplement should she also be taking if no other problems exist? A. Vitamin B 12 B. Iron C. Folic acid D. Calcium

Answer: C Clients taking phenytoin (Dilantin) should also be taking 0.4 to 1 mg/day of folic acid because Dilantin promotes a folate deficiency. Phenytoin may also contribute to demineralization of the bone, so the serum calcium levels should also be checked. If demineralization is detected, then vitamin D should be added. Vitamin B 12 and iron are not affected by phenytoin.

Sandra has celiac disease. You place her on which diet? A. A low-fat diet B. A low-residue diet C. A gluten-free diet D. A high-protein diet

Answer: C Clients with celiac disease have an allergy to gliadin, a component of gluten; therefore, they are placed on a gluten-free diet in which wheat and other grains containing analogues to wheat gluten, such as oats, barley, and rye, must be avoided.

Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect that she has which protozoal infection of the bowel? A. Giardiasis B. Amebiasis C. Cryptosporidiosis D. Escherichia coli

Answer: C Cryptosporidiosis, a protozoal infection of the bowel, is common in immunocompromised clients. It causes villous atrophy and mild infl ammatory changes and may secrete an enterotoxin. Giardiasis and amebiasis are also protozoal infections affecting the intestine, but because the question mentioned that Martina has AIDS, the answer must be cryptosporidiosis. Escherichia coli is a gram-negative bacterium.

Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly improved over last week's symptoms. Which stage of viral hepatitis do you suspect? A. Incubation B. Prodromal C. Icteric D. Convalescent

Answer: C During the incubation period of viral hepatitis, there are no subjective or objective complaints. During the prodromal stage, there is anorexia, nausea, vomiting, malaise, upper respiratory infection (nasal discharge and pharyngitis), myalgia, arthralgia, easy fatigability, fever (hepatitis A virus), and abdominal pain. In the icteric stage of viral hepatitis, there is jaundice, dark urine, and light colored stools. There are continued prodromal complaints with gradual improvement. During the convalescent stage, there is an increased sense of well-being; the appetite returns; and the jaundice, abdominal pain, and fatigability abate.

Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) would you expect to be decreased? A. Sedimentation rate B. Liver enzyme levels C. Vitamins A, B complex, and C levels D. Bilirubin level

Answer: C Folic acid and serum levels of most vitamins, including A, B complex, C, and the fat-soluble vitamins, are decreased in Crohn's disease as a result of malabsorption. The sedimentation rate, liver enzymes, and bilirubin levels are all increased.

Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you that she will A. take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. B. drink at least 2,000 mL of fluids per day. C. decrease her dietary fiber for 1 month. D. take stool softeners as prescribed.

Answer: C For the client who has just had a hemorrhoidectomy, teaching would include advising the client to maintain an adequate intake of dietary fiber to maintain stool bulk; to take a sitz bath after each bowel movement for 1 to 2 weeks after surgery to promote relaxation and aid with discomfort; to drink at least 2,000 mL of fluids per day; to take stool softeners as prescribed (for short-term relief only); and to exercise regularly to maintain stool bulk, softness, and regularity.

Shelby has recently been diagnosed with pancreatitis. Which of the following objective findings, also known as Grey Turner's sign, can result from the pancreatic inflammatory process? A. Left-sided pleural effusion B. Bluish discoloration over the flanks C. Bluish discoloration over the umbilicus D. Jaundice

Answer: C Grey Turner's sign is a bluish discoloration over the flanks. Cullen's sign is a bluish discoloration around the umbilicus. Other findings that can result from the pancreatic inflammatory process include left-sided pleural effusion, jaundice caused by impingement on the common bile duct, and an epigastric mass secondary to pseudocyst development.

The most common cause of elevated liver function tests is A. hepatitis. B. biliary tract obstruction. C. chronic alcohol abuse. D. a drug-induced injury.

Answer: C Hepatocellular damage from chronic alcohol abuse is the most frequent cause of an elevated liver function test (LFT) in adults. Other causes include biliary tract obstruction, hepatitis, drug-induced injuries, vascular changes caused by anoxia, and congestive heart failure; however, chronic alcohol abuse remains the number one cause of abnormal LFTs.

In the ABCs of irritable bowel syndrome, the B stands for A. bloody stool. B. bad odor to stool. C. bloating or visible distention. D. bowel attack.

Answer: C In the ABCs of irritable bowel syndrome, the A is for abdominal pain or discomfort—typically in the lower abdomen but could be anywhere; the B is for bloating or visible distention; the C is for constipation—hard, difficult to evacuate, or infrequent stools; the D is for diarrhea—loose, watery, or frequent stools; and the E is for extra bowel symptoms, such as fatigue, headache, backache, muscle pain, urinary frequency, and sleep disturbance.

The most common causes of upper gastrointestinal hemorrhage are A. esophagitis and carcinomas. B. erosive gastritis and peptic ulcer disease. C. peptic ulcer disease and esophageal varices. D. carcinomas and arteriovenous malformations.

Answer: C The most common causes of upper gastrointestinal hemorrhage, in descending order, are peptic ulcer disease, esophageal varices, esophagitis, erosive gastritis, carcinomas, and arteriovenous malformations.

Lipids are broken down in which area of the gastrointestinal tract? A. Esophagus B. Stomach C. Small intestine D. Large intestine

Answer: C Lipids are broken down in the small intestine by the pancreatic lipases. Carbohydrates, proteins, and nucleic acids are also broken down in the small intestines by various enzymes. The esophagus is involved in the processes of swallowing and peristalsis to move substances from the mouth to the stomach. The stomach continues the digestive process that began in the mouth and allows the intestines, pancreas, gallbladder, and liver to prepare to complete the digestive process. The main exocrine product of the stomach is gastric juice —a mixture of mucus, hydrochloric acid, and digestive enzymes. Gastric juice is mixed with food in the stomach to promote digestion. The large intestine performs the vital functions of converting food into feces, absorbing essential vitamins produced by gut bacteria, and reclaiming water from feces.

All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? A. Anticholinergics such as scopolamine (Donnatal) B. Antidopaminergic agents such as prochlorperazine (Compazine) C. Antidopaminergic and cholinergic agents such as metoclopramide (Reglan) D. Tetrahydrocannabinols such as dronabinol (Marinol)

Answer: C Metoclopramide (Reglan) is used for diabetic gastroparesis and postoperative nausea and vomiting. It works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure. Anticholinergics work at the site of the labyrinth receptors and the chemoreceptor trigger zones—that is, the vomiting center. Antidopaminergic agents work at the chemoreceptor trigger zone. The site and mechanism of tetrahydrocannabinols are unknown.

Once gastric cancer has been diagnosed, which test should be ordered to accurately determine the correct staging? A. Computed tomography B. Magnetic resonance imaging C. Endoscopic ultrasound D. Ranson's test

Answer: C Once gastric cancer has been diagnosed, accurate staging can be determined by an endoscopic ultrasound. Ranson's criteria are a classification system to assess the severity of pancreatitis. A CT or MRI has nothing to do with staging.

Marisa, age 42, has celiac disease. She is prone to osteopenic bone disease as a result of impaired calcium absorption because of A. increased calcium absorption by the small intestine. B. increased absorption of the fat-soluble vitamin D. C. the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids. D. decreased magnesium absorption.

Answer: C Osteopenic bone disease may occur in celiac disease because there is decreased calcium absorption by the small intestine, decreased absorption of the fat-soluble vitamin D, and binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids. Clients should be identified as having celiac disease before menopause so that therapy to increase bone mass can be instituted before clients develop osteopenia.

Sara, age 59, is taking polyethylene glycol (GoLYTELY) in preparation for a barium enema. What do you teach her about the medication? A. Drink the solution at room temperature. B. Take the medication with food so that it will be absorbed better. C. Take the medication in the early evening so as not to interfere with sleep. D. Drink all of the solution in one sitting.

Answer: C Polyethylene glycol (GoLYTELY) should be taken in the early evening so as not to interfere with sleep because the first bowel movement begins within 1 hour and continues until the sigmoid colon is clear. The solution should be chilled to enhance palatability, taken on an empty stomach, and administered in 8-oz servings every 10 minutes until 1 gallon is consumed.

The most common viral infection causing diarrhea in the United States is A. enteric adenovirus. B. a Norwalk-like virus. C. rotavirus. D. Giardia lamblia .

Answer: C Rotavirus causes 15% to 35% of all the cases of diarrhea in the United States. It is followed by enteric adenovirus and Norwalk-like viruses. Giardia lamblia is a parasite that causes a high incidence of diarrhea in day-care centers.

Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you that she will A. avoid coffee, alcohol, chocolate, peppermint, and spicy foods. B. eat smaller meals. C. have a snack before retiring so that the esophagus and stomach are not empty at bedtime. D. stop smoking.

Answer: C She should not have a snack before retiring. Clients with gastroesophageal refl ux disease should be instructed to avoid coffee, alcohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop smoking; remain upright for 2 hours after meals; elevate the head of the bed on 6- to 8-in blocks; and refrain from eating for 3 hours before retiring.

Susan, age 59, has no specifi c complaints when she comes in for her annual examination. She does, however, have type 2 diabetes, slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? A. As a healthy adult with several problems B. As having a glycemic event C. As having metabolic syndrome D. As having multiple organ dysfunction

Answer: C Susan has a constellation of symptoms known as metabolic syndrome. The World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (NCEPATP III), and International Diabetes Federation (IDF) have slightly different criteria for this diagnosis. They all, however, include hypertension, dyslipidemia, and central obesity. If her DM is out of control, she would have a "glycemic event." Eventually, she may end up with multiple organ dysfunction. You might consider that she is headed toward that result. While Susan may look fairly healthy, she is not

Which organ structure produces and secretes bile to emulsify fats? A. Salivary glands B. Pancreas C. Liver D. Gallbladder

Answer: C The liver produces and secretes bile to emulsify fats. The salivary glands moisturize food and release enzymes that initiate the digestion process. The pancreas secretes substances that regulate blood sugar levels, store carbohydrates, and inhibit insulin and glucagon secretion. The gallbladder stores and concentrates bile.

Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she A. needs to begin the hepatitis B series as soon as possible. B. needs to be tested again because one reading is not indicative of immunity. C. is permanently immune to hepatitis B. D. has an acute hepatitis B infection.

Answer: C The marker for permanent immunity, hepatitis B surface antibodies in the serum, will be present 4 to 10 months after exposure and immunity to hepatitis B. Hepatitis B surface antigen is the earliest indicator of the presence of an acute infection and is present 4 to 12 weeks after exposure. This marker is also indicative of a chronic infection.

You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his right lower quadrant. Which sign did you elicit? A. Rovsing's sign B. Psoas sign C. Obturator sign D. McBurney's sign

Answer: C The obturator sign is elicited when, with the patient's right hip and knee flexed, the examiner slowly rotates the right leg internally, which stretches the obturator muscle. Pain over the right lower quadrant (RLQ) is considered a positive sign. Rovsing's sign is pain elicited with deep palpation over the left lower quadrant (LLQ) with sudden resultant pain in the RLQ. This causes tenderness over the RLQ and is considered a positive finding. Psoas sign is pain when the patient is instructed to try to lift the right leg against gentle pressure applied by the examiner or by placing the patient in the left lateral decubitus position and extending the patient's right leg at the hip. An increase in pain is considered positive and is an indication of the inflamed appendix irritating the psoas muscle. McBurney's sign is pain elicited when pressure is applied to McBurney's point, which is located halfway between the umbilicus and the anterior spine of the ilium.

Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? A. A gastric ulcer B. Gastritis C. Pelvic inflammatory disease D. Pancreatitis

Answer: C The pain associated with pelvic inflammatory disease can be palpated in both the right and left lower quadrants. Pain in the left upper quadrant may signify a gastric ulcer, gastritis, pancreatitis, splenic abscess, or pleurisy.

The proper order of assessing the abdomen is A. palpation, percussion, auscultation, and inspection. B. inspection, palpation, auscultation, and percussion. C. inspection, auscultation, percussion, and palpation. D. percussion, auscultation, inspection, and palpation.

Answer: C The proper order of assessing the abdomen is inspection, auscultation, percussion, and palpation. It is important to inspect the abdomen first before percussion or palpation to avoid causing any discomfort that might alter the client's position. Auscultation is important before percussion and palpation because both of these techniques can increase peristalsis, which would give a false interpretation of bowel sounds on auscultation.

When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? A. Eat foods higher in carbohydrates B. Eat three large meals plus three snacks per day C. Eat foods with a moderate fat and protein content D. Drink fluids with each meal

Answer: C To help clients with dumping syndrome, suggest that they eat foods with a moderate fat and protein content. These foods tend to leave the stomach more slowly and do not draw fluid into the intestine. Also suggest that they reduce the amount of carbohydrates consumed, eat six small meals per day, and take fluids between meals and not at mealtime.

You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do you rule out? A. Peritonitis B. A liver or spleen abscess C. A liver or spleen metastatic tumor D. Irritable bowel syndrome

Answer: D A peritoneal friction rub, which sounds like a rough, grating sound, occurs over organs with a large surface area in contact with the peritoneum when there is peritoneal inflammation (peritonitis). When a peritoneal friction rub is heard over the lower right rib cage, it may be caused by an abscess or tumor of the liver. When heard over the lower left rib cage in the left anterior axillary line, it may indicate infection of the spleen or an abscess or tumor of the spleen. Irritable bowel syndrome does not produce a friction rub.

Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an A. inguinal hernia. B. epigastric hernia. C. umbilical hernia. D. incisional hernia.

Answer: D A ventral hernia, also known as an epigastric hernia, occurs along the midline between the xiphoid process and the umbilicus. The fibers along the linea alba are brought together in a patchwork-type closure; the defect exists within this decussation. As these fibers weaken, the contents can herniate through the abdomen. Epigastric hernias are three times more likely to occur in men than women. Umbilical hernias that develop in adulthood occur through a weakening in the abdominal wall around the umbilical ring. Incisional hernias can occur anywhere along a surgical incision into the abdomen. An inguinal hernia may be indirect or direct. Indirect inguinal hernias result when tissue herniates through the internal inguinal ring, which extends the length of the spermatic cord. A direct inguinal hernia occurs when the transversus abdominis and internal oblique muscles are attached, forming a high arch on the inferior border that results in a faulty shutter mechanism

Which type of hernia usually occurs at a previous surgical incision site? A. Umbilical B. Congenital C. Hiatal D. Ventral

Answer: D An incisional or ventral hernia may develop at a previous surgical incision site. An umbilical hernia may be congenital or acquired as the tissue around the umbilical ring weakens. Conditions resulting in umbilical hernias include pregnancy, including multiple pregnancies with prolonged labor; obesity; and ascites. Intra-abdominal hiatal hernia is caused by obesity, coughing, constipation, smoking, poor posture, and heavy lifting.

Anson tells you that he thinks his antacids are causing his diarrhea. You respond, A. "Antacids contain fructose, which may not be totally absorbed and results in fluid being drawn into the bowel." B. "Antacids contain sorbitol or mannitol, which are sugars that aren't absorbed and can cause fluid to be drawn into the bowel." C. "Antacids contain caffeine, which decreases bowel transit time." D. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

Answer: D Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that result in an osmotic draw of fluid into the bowel. Fructose, sorbitol, and caffeine are not usually contained in antacids. Fructose is present in apple juice, pear juice, grapes, honey, dates, nuts, figs, and fruit-fl avored soft drinks. Sorbitol or mannitol is present in apple juice, pear juice, sugarless gums, and mints. Caffeine is present in coffee, tea, cola drinks, and over-the-counter analgesics.

81. You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? A. cirrhosis B. inflammation of the kidney C. inflammation of the spleen D. peritonitis

B. inflammation of the kidney

Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond, A. "Do not donate blood until 1 year after diagnosis." B. "Abstain from sex all together" C. "There is no possibility of transmission through razors or toothbrushes." D. "Abstain from sex during your period."

Answer: D Because the hepatitis C virus is transmitted in blood, including menstrual blood, clients should abstain from sex during menstruation. Clients should not donate blood, and there is a possibility of transmission through razors, toothbrushes, and tattoo instruments. You might also test Tina to see which genotype her hepatitis C is to see if she is a candidate for Harvoni.

Which of the following pharmacologic agents used to treat constipation may cause flatulence and bloating and require adequate fluid intake? A. Stool softeners B. Saline laxatives C. Lubricants D. Bulking agents

Answer: D Bulking agents such as psyllium preparations may cause flatulence and bloating and require adequate fluid intake. Saline laxatives may cause dehydration and electrolyte imbalance. Lubricants such as mineral oil may cause lipid pneumonia if aspirated. Stool softeners when combined with irritant laxatives may be hepatotoxic.

Clients with celiac sprue usually have A. a large-in-stature appearance. B. accelerated maturity. C. polycythemia. D. steatorrhea.

Answer: D Celiac disease, also known as celiac sprue, may begin during early childhood or adulthood. Clients with sprue usually have steatorrhea, abdominal bloating and cramps, and diarrhea. Clients with celiac disease are often small in stature and have delayed maturity. The malabsorption that results may cause defi ciencies such as anemia

Sally had an ileostomy performed for inflammatory bowel disease. What type of fecal output can Sally expect? A. Hard, formed stool B. Semisoft stool C. Semisoft to very soft stool D. A continuous, soft-to-watery effluent

Answer: D Fecal output from an ileostomy is a malodorous, continuous, soft-to-watery effluent material that contains intestinal enzymes that are very irritating to the skin around the stoma. Stomas farther along the large colon will have more formed stools, and a sigmoid colostomy will result in stools that are almost normal in consistency.

The most common cause of mechanical bowel obstruction in all ages is A. volvulus. B. intussusception. C. cancer. D. a hernia.

Answer: D Hernias account for more cases of mechanical bowel obstruction in all ages than do volvulus, intussusception, or cancer.

You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you she will A. decrease her fat intake. B. increase her fiber intake. C. continue her daily use of aspirin. D. increase her fluid intake.

Answer: D Increasing fluid intake has not been shown to decrease the risk of colorectal cancer. Current recommendations to aid in preventing colorectal cancer include decreased fat, increased fiber consumption, and the daily use of aspirin. The daily use of aspirin has been shown to decrease the incidence of colorectal cancer, as well as dramatically decrease the incidence of metastasis.

Patients with irritable bowel syndrome (IBS) are more likely to have which of the following organic gastrointestinal diseases? A. Thyroid dysfunction B. Colorectal cancer C. Celiac sprue D. Lactose malabsorption

Answer: D Patients with irritable bowel syndrome are 22% to 26% more likely to have lactose malabsorption in addition to irritable bowel syndrome. The percentage of patients who also have thyroid dysfunction is 6%; colorectal cancer, 0% to 0.51%; and celiac sprue, 4.7%.

Sam, age 43, has ulcerative colitis and is on a low-residue diet. Which foods do you recommend that Sam avoid? A. Potato skins, potato chips, and brown rice B. Vegetable juices and cooked and canned vegetables C. Ground beef, veal, pork, and lamb D. White rice and pasta

Answer: D Potato skins, potato chips, fried potatoes, brown rice, and whole grain pasta products should be avoided if a client with ulcerative colitis is on a low-residue diet that was ordered to reduce intestinal motility and allow the bowel to rest. The other choices are not low-residue foods.

The Centers for Disease Control (CDC) recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every A. 3 years, beginning at age 40. B. other year. C. 2 years, beginning at age 45. D. 5 years, beginning at age 50.

Answer: D Regular screening, beginning at age 50, is the key to preventing colorectal cancer. The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer using high-sensitivity fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 50 and continuing until age 75. People at higher risk of developing colorectal cancer should begin screening at a younger age and may need to be tested more frequently. The decision to be screened after age 75 should be made on an individual basis. Beginning at age 50, for colon cancer screening of persons at average risk the American Cancer Society (ACS) recommends a flexible sigmoidoscopy every 5 years, a colonoscopy every 10 years, a double-contrast barium enema every 5 years, or a CT colonography (virtual colonoscopy) every 5 years. If the flexible sigmoidoscopy or the barium enema is positive, a colonoscopy should be done. The multiple stool take-home test (fecal occult blood test [FOBT]) should be done every year. One test done in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

Tenesmus refers to A. projectile vomiting. B. severe lower abdominal pain. C. constipation. D. a persistent desire to empty the bowel or bladder.

Answer: D Tenesmus is the spasmodic contraction of the anal or bladder sphincters, producing pain and the persistent desire to empty the bowel or bladder via involuntary, ineffectual straining efforts. Rectal tenesmus is often experienced in ulcerative colitis.

Which of the following is a hospital-based nosocomial infection that has seen a serious rise in the past decade? A. Pneumonia B. Hepatitis B C. Staphylococcus infection D. Clostridium difficile colitis

Answer: D The rate of Clostridium difficile colitis has increased 109% in the past decade. The fatality rate among C. difficile colitis patients has climbed as well. Awareness of this must be heightened if we are to help control the public health ramifications of this important and morbid nosocomial infection. While the other answers may be serious infections, C. difficile is the nosocomial infection that has increased the most.

The most important diagnostic test for celiac disease is A. confirming malabsorption by laboratory tests. B. a barium enema. C. a peroral biopsy of the duodenum. D. a tTG-IgA test followed by a biopsy of the small intestine.

Answer: D There are several serologic tests available that screen for celiac disease antibodies, but the most important diagnostic test is called a tTG-IgA test. If test results suggest celiac disease, it is recommended that a biopsy of the small intestine be done to confirm the diagnosis. Laboratory tests may confi rm malabsorption, but they are not diagnostic of celiac disease. A barium enema may show dilation of the small intestine, but in mild celiac disease, the enema results may be normal. A peroral biopsy showing the gross absence of duodenal folds on endoscopy is a clue to the presence of celiac disease, but it is not diagnostic because this symptom may also occur in tropical sprue, intestinal lymphoma, Zollinger-Ellison syndrome, and other diseases.

Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond, A. "You should have two to three stools per day." B. "You should defecate once a day." C. "You should have at least three stools per week." D. "There is no such thing as a 'normal' pattern of defecation."

Answer: D There is no such thing as a "normal" pattern of defecation. Patterns of defecation vary widely and may in part be affected by dietary habits, fluid intake, bacteria in the stool, psychological stress, or voluntary postponement of defecation. Defecating every third day could be the routine pattern for Simon.

Which of the following statements about cirrhosis is true? A. Biliary cirrhosis is the most common type of cirrhosis in the United States. B. Alcoholic cirrhosis occurs only in malnourished alcoholics. C. Cirrhosis is reversible if diagnosed and treated at an early stage. D. Women tend to develop cirrhosis more quickly with less alcohol intake than men.

Answer: D Women tend to develop cirrhosis more quickly with less alcohol intake than men, which suggests that a smaller, leaner body mass and enhanced absorption are both factors in the development of alcoholic cirrhosis. Alcoholic cirrhosis, also known as Laënnec's, portal, fatty, or micronodular cirrhosis, is the most common type of cirrhosis in the United States. Alcoholic cirrhosis is often associated with nutritional and vitamin deficiencies but occurs in well-nourished individuals as well as alcoholics. Cirrhosis is the irreversible end stage of liver injury and may be caused by a variety of insults.

A Gram stain of a lesion reveals large, square-ended, gram-positive rods that grow easily on blood agar. Which diagnosis does this finding confirm? 1. Dermatophyte infection. 2. Tuberculosis (scrofuloderma). 3. Sarcoidosis. 4. Anthrax.

Anthrax.

Jill, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? 1. Aspirin. 2. Ibuprofen. 3. Opioids. 4. Antihistamines.

Antihistamines.

70. Hyperactive bowel sounds (borborygmi) are present in which of the following conditions? A. cirrhosis B. laxative use C. late mechanical bowel obstruction D. pancreatic cancer

B. laxative use

Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What can you advise her to do? 1. Use a cotton-tipped applicator daily to remove all moisture and potential bacteria. 2. Wash daily with soap and water. 3. Apply mineral oil to counteract dryness. 4. Avoid topical corticosteroids.

Apply mineral oil to counteract dryness.

Mr. Jones, age 44, is admitted to the emergency department complaining of chest pain. Which of the following actions would be the best way to establish a therapeutic relationship with Mr. Jones? 1. Asking several quick and specific questions in rapid succession to establish the exact nature of this emergent clinical situation. 2. Asking open-ended questions to elicit pertinent clinical data. 3. Reassuring the client that he is in good hands, in a well-equipped emergency department, and that everything will be okay. 4. Asking the client about his anxiety level.

Asking open-ended questions to elicit pertinent clinical data.

An effective method for assessing a client's retention and understanding of educational materials is: 1. Asking the client to restate what you have reviewed. 2. Providing a pathophysiology book for your client to take home and read. 3. Repeating your explanations of disease pathophysiology. 4. Objective testing.

Asking the client to restate what you have reviewed.

Which condition is not included in the atopic triad? 1. Aspirin sensitivity. 2. Asthma. 3. Allergic rhinitis. 4. Eczema.

Aspirin sensitivity.

Because of the potential for exploitation of older adults, the geriatric population is designated a vulnerable one when it comes to obtaining informed consent for serving as a research subject. Safeguards you should adhere to when conducting research on a geriatric population include which of the following? 1. Assessing the competence of the individual before obtaining consent. 2. Obtaining permission from the family or staff. 3. Stressing how important the research is and why their participation and perspective, as older adults, are important. 4. Determining if the research is exempt, in which case you do not need to obtain consent to participate.

Assessing the competence of the individual before obtaining consent.

The ABCDEs of melanoma identification include which of the following? 1. Asymmetry: one half does not match the other half. 2. Border: the borders are regular; they are not ragged, notched, or blurred. 3. Color: pigmentation is uniform. 4. Diameter: the diameter is 5 mm.

Asymmetry: one half does not match the other half.

Mr. Clark, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle glaucoma. While performing a new client history and physical, you note that he is taking other medications. Which medication would you be most concerned about? 1. Aspirin therapy as prophylaxis for heart attack. 2. Ranitidine (Zantac) for gastroesophageal reflux disease. 3. Alprazolam (Xanax), an anxiolytic. 4. Atenolol (Tenormin), a beta blocker for high blood pressure.

Atenolol (Tenormin), a beta blocker for high blood pressure.

A 20-year-old female presents to your urgent care clinic complaining of a cat bite. The patient recently adopted a cat. She was playing with the cat yesterday when the cat bit her on the arm. What antibiotic should be prescribed to prevent infection? 1. Augmentin. 2. Amoxicillin. 3. Bactrim. 4. No antibiotic is necessary.

Augmentin.

67. Martin, age 38, has had an ileostomy for ulcerative colitis. Which self-care measures do you teach him to relieve food blockage? A. lie in a supine position B. massage the peristomal area C. take a hot shower or tub bath D. drink cold fluids

B. massage the peristomal area

What is the most important thing a person can do to maintain healthy skin and hopefully reduce wrinkles? 1. Keep well hydrated. 2. Use sunscreen with a sun protection factor (SPF) of at least 45. 3. Avoid smoking. 4. Use mild defatted or glycerin soap.

Avoid smoking.

Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is: 1. Ciprofloxacin (Cipro). 2. Azithromycin (Zithromax). 3. Amoxicillin (Amoxil). 4. Cephalexin (Keflex).

Azithromycin (Zithromax).

12—45 Rose, your client with gastroesophageal reflux disease, has many other concurrent conditions. She wants to know if there are any medications she should not take. You tell her to avoid: A. antibiotics. B. nonsteroidal anti-inflammatory drugs. C. oral contraceptives. D. antifungals.

B

12—5 A false-positive result with the fecal occult blood test can result from: A. ingestion of large amounts of vitamin C. B. a high dietary intake of rare-cooked beef. C. a colonic neoplasm that is not bleeding. D. stool that has been stored before testing.

B

12—7 Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? A Enterococci B Escherichia coLI C Kiebsiella D Staphylococci

B

Which skin cancer that arises from skin cells, characteristically occurs on body areas exposed to the sun, most commonly presents as a pearly nodule with fine telangiectasias over the surface and a border that appears rolled, and is the most common skin cancer? 1. Actinic keratosis. 2. Basal cell carcinoma. 3. Squamous cell carcinoma. 4. Melanoma.

Basal cell carcinoma.

22. Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you that she is sure it is going to be malignant. How do you respond? A. "Don't worry. Gastric ulcers are not cancerous." B. "About 95% of gastric ulcers are benign." C. "You have about a 50% chance of having gastric cancer from your ulcer." D. "Even if it is cancer, surgery is 100% successful."

B. "About 95% of gastric ulcers are benign."

104. A concern with older patients having abdominal surgery is A. older patients have an increased peristalsis, and bowel sounds must be checked very frequently B. older adults have a diminished response to painful stimuli that may mask abdominal health problems C. because older adults are prone to diarrhea after surgery, you must be vigilant about skin breakdown D. because of liver enlargement, postoperative medications are processed faster

B. older adults have a diminished response to painful stimuli that may mask abdominal health problems

30. How do you respond when Andrea, who is taking her newborn home from the hospital, asks you when her baby's umbilical cord stump will fall off? A. "Within 7 days." B. "In 10 to 14 days." C. "In 14 to 21 days." D. "In 21 to 30 days."

B. "In 10 to 14 days."

9. Sidney, age 33, has ulcerative colitis and asks you about a Koch pouch. How do you respond? A. "It's a method of bowel training for clients with chronic diarrhea." B. "It's a name for a continent ileostomy." C. "It's a packet of daily pills to take to relieve diarrhea." D. "It's like a sanitary pad, and it's used to contain any rectal leakage."

B. "It's a name for a continent ileostomy."

84. Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? A. "Occasionally he accumulates blood in the gut." B. "There is an interruption of the normal clotting mechanisms." C. "Long-term alcohol abuse has made his vessels very friable." D. "His bone marrow has been affected."

B. "There is an interruption of the normal clotting mechanisms."

34. Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? A. Campylobacter jejuni B. Clostridium botulinum C. Clostridium perfringens D. Staphylococcus

B. Clostridium botulinum

109. Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? A. Enterococci B. E. coli C. Klebsiella D. Staphylococci

B. E. coli

36. Which protozoal infection is the most common intestinal infection in the U.S. that also occurs worldwide? A. Salmonellosis B. Giardiasis C. Botulism D. Shigellosis

B. Giardiasis

Candidiasis may occur in many parts of the body. James, age 29, has it in the glans of his penis. What is your diagnosis? 1. Balanitis. 2. Thrush. 3. Candidal paronychia. 4. Subungual Candida.

Balanitis.

Treatment for achalasia may include: 1. Balloon dilation of the lower esophageal sphincter. 2. Beta blockers. 3. A fundoplication. 4. An esophagogastrectomy.

Balloon dilation of the lower esophageal sphincter.

Sandra, age 69, is complaining of dry skin. What do you advise her to do? 1. Every day, when bathing, vigorously use a washcloth to exfoliate the upper layers of the stratum corneum. 2. Bathe or shower with lukewarm water and use a mild soap or skin cleanser. 3. Use a dehumidifier. 4. Decrease the oral intake of fluids.

Bathe or shower with lukewarm water and use a mild soap or skin cleanser.

66. Rose, a client with GERD, has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend that she refrain from using? A. antibiotics B. NSAIDs C. oral contraceptives D. antifungals

B. NSAIDs

96. Shelby has recently been diagnosed with pancreatitis. Which of the following objective findings, also known as Grey Turner's sign, can result from the pancreatic inflammatory process? A. left-sided pleural effusion B. bluish discoloration over the flanks C. bluish discoloration over the umbilicus D. jaundice

B. bluish discoloration over the flanks

40. Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for A. constipation B. colorectal cancer C. IBS D. acute appendicitis

B. colorectal cancer

12—44 Rose has gastroesophageal reflux disease. She asks you what size can do to help alleviate the problem. You suggest all the following except: A. avoiding coffee, alcohol, chocolate, peppermint, and spicy foods. B. eating smaller meals. C. having a snack before retiring so. that the esophagus and stomach are not empty at bedtime. D. stopping smoking.

C

12—8 The most common causes of upper gI hemorrhage are: A. esophagitis and carcinomas. B. erosive gastritis and peptic ulcer disease. C PEPTIC ulcer disease AND esophageal varices. D. carcinomas and AVM.

C

2—3 You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with: A anxiety and panic attacks. B long-term tise of nonsteroidal anti-inflammatory drugs. C infection by Helicobucter pylon. D a family history of peptic ulcers.

C

99. Which modality(ies) is(are) the most effective in patients with metabolic syndrome? A. specific vitamin and mineral supplements B. diet and exercise C. specific pharmacological therapy D. eliminating alcohol and smoking from their lifestyle

B. diet and exercise

21. Jonas, age 34, had a Billroth II (hemigastrectomy and gastrojejunostomy with vagotomy) performed 1 week ago and just started eating a bland diet. What do you suspect when he complains of epigastric fullness, distention, discomfort, abdominal cramping, nausea, and flatus after eating? A. obstruction B. dumping syndrome C. metabolic acidosis D. infectious colitis

B. dumping syndrome

78. Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an A. inguinal hernia B. epigastric hernia C. umbilical hernia D. incisional hernia

B. epigastric hernia

90. Which of the following antibiotics causes more episodes of nausea and/or vomiting than the others? A. azithromycin B. erythromycin C. penicillin D. tetracycline

B. erythromycin

95. An infant who is ruminating should be diagnosed and treated for A. cystic fibrosis B. esophagitis C. Meckel's diverticulum D. intussusception

B. esophagitis

42. A false-positive results with the fecal occult blood test can result from A. ingestion of large amounts of vitamin C B. a high dietary intake of rare-cooked beef C. a colonic neoplasm that is not bleeding D. stool that has been stored before testing

B. a high dietary intake of rare-cooked beef

80. Signs and symptoms of diverticulitis are vast. Which of the following findings is NOT associated with diverticulitis? A. left lower quadrant abdominal pain B. a history of IBS C. a tender mass in the left lower quadrant D. an elevated temperature

B. a history of IBS

8. While you are obtaining Henry's history, he tells you that he had a portacaval shunt done in the past. What does this imply? A. a history of liver cancer B. a history of alcohol abuse C. a congenital biliary problem D. heavy tobacco use

B. a history of alcohol abuse

29. Tom has just been diagnosed with celiac disease. Which of the following might you tell him? A. there is a new pharmaceutical cure for celiac disease B. a strict gluten-free diet is the only treatment for celiac disease C. your children will not be at a higher risk for developing this disease D. the presence of celiac disease is decreasing dramatically in the U.S.

B. a strict gluten-free diet is the only treatment for celiac disease

86. After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured? A. an enzyme-linked immunosorbent assay titer B. a urea breath test C. a rapid urease test (Campylobacter-like organism) D. a repeat endoscopy

B. a urea breath test

35. Sylvia, age 59, has acute hepatitis. She tells you that it is from a drug overdose. Which drug do you suspect? A. flagyl B. acetaminophen C. sumatriptan D. hydrocortisone

B. acetaminophen

102. Steve, age 79, has GERD. When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid? A. apples B. peppermint C. cucumbers D. popsicles

B. peppermint

6. Martha has a Cushing's ulcer. What might have precipitated this? A. her house burned down when she was not at home B. she was in a bad auto accident in which she sustained a head injury C. she spent the weekend deep-sea diving D. she was on an overseas airline flight that lasted more than 24 hours

B. she was in a bad auto accident in which she sustained a head injury

52. Marcie just returned from Central America with traveler's diarrhea. Which is the best treatment? A. metronidazole (Flagyl) B. supportive care C. quinolone antibiotics D. gastric lavage

B. supportive care

58. How do diphenoxylate (Lomotil) and loperamide (Imodium) help relieve diarrhea? A. they reduce bowel spasticity and acid secretion in the stomach B. they decrease the motility of the ileum and colon, slowing transit time and promoting more water absorption C. they increase motility to assist in removing all of the stool D. by decreasing the sensations of the gastric nerves, they send a message to the brain to slow down peristalsis

B. they decrease the motility of the ileum and colon, slowing transit time and promoting more water absorption

45. What is the most common cause of melena? A. colon cancer B. upper GI bleeding C. drug abuse D. smoking

B. upper GI bleeding

88. Maura had a less than 8% value on her Schilling test. What medication do you anticipate that Maura might need? A. folic acid B. vitamin B12 C. thyroid medication D. hormone replacement therapy

B. vitamin B12

65. Duodenal and gastric ulcers have many of the same manifestations. Which is more common with gastric ulcers rather than duodenal ulcers? A. epigastric or abdominal pain B. vomiting C. possibility of perforation D. obstruction of the GI tract

B. vomiting

Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result from the pancreatic inflammatory process, which is known as Grey Turner sign? 1. Left-sided pleural effusion. 2. Bluish discoloration over the flanks. 3. Bluish discoloration around the umbilicus. 4. Jaundice.

Bluish discoloration over the flanks

Shelby, age 14, has a blister on her arm that is filled with clear fluid. It is the result of contact with a hot iron. How do you document this? 1. Bulla. 2. Wheal. 3. Cyst. 4. Pustule.

Bulla.

Mildred, age 72, presents to the clinic with a blistering rash that is generalized but located mostly in skin folds and on flexural areas. She describes the course of the rash as beginning with pruritic urticarial papules that coalesced into plaques that turned dark red in about 2 weeks, followed by the development of vesicles and bullae. She tells you that the lesions are moderate to severely pruritic. During your exam, you determine the bullae are very tense and do not rupture when pressure is applied. Her daily medications include an angiotensin-converting enzyme (ACE) inhibitor, a loop diuretic, and a nonsteroidal anti-inflammatory drug (NSAID). What is your diagnosis? 1. Dermatitis herpetiformis. 2. Pemphigus vulgaris. 3. Bullous drug eruption. 4. Bullous pemphigoid.

Bullous pemphigoid.

Ingestion of which of the following objects always requires surgical or endoscopic removal? 1. Button batteries. 2. Coins. 3. Sharp objects. 4. Food bolus.

Button batteries.

12—40 Sandra has celiac disease. You place her on which diet? A. A low-fat diet B. A low-residue diet C. A gluten-free diet D. A high-protein diet

C

16. Sally, age 21, is to undergo a tonsillectomy. She has heard about taste changes after a tonsillectomy. What do you tell her? A. "As the tongue is responsible for sweet, sour, salty, and bitter taste abilities, they will all be affected somewhat." B. "You will have some alterations, but we'll have to wait and see how you are affected personally." C. "You may notice a slight difference initially, but there are no lasting changes in taste." D. "About half of the patients have some permanent alterations in the sense of taste."

C. "You may notice a slight difference initially, but there are no lasting changes in taste."

73. By what age do abdominal respirations cease in a child? A. 2 years B. 5 years C. 7 years D. 13 years

C. 7 years

Justin, an obese 42-year-old, cut his right leg 3 days ago while climbing a ladder. Today his right lower leg is warm, reddened, and painful, without a sharply demarcated border. What do you suspect? 1. Diabetic neuropathy. 2. Cellulitis. 3. Peripheral vascular disease. 4. A beginning stasis ulcer.

Cellulitis.

5. All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? A. Anticholinergics such as scopolamine (Donnatal) B. Antidopaminergic agents such as prochlorperazine (Compazine) C. Antidopaminergic and cholinergic agents such as metoclopramide (Reglan) D. Tetrahydrocannabinols such as dronabinol (Marinol)

C. Antidopaminergic and cholinergic agents such as metoclopramide (Reglan)

When palpating the skin over the clavicle of Norman, age 84, you notice tenting, which is: 1. Indicative of dehydration. 2. Common in thin older adults. 3. A sign of edema. 4. Indicative of scleroderma.

Common in thin older adults.

Which of the following statements about case management is true? 1. Case management oversees the client throughout acute care hospitalization. 2. Case management is organized around a system of interdisciplinary resources and services. 3. Case management depends on physician-driven leadership to oversee the illness episode. 4. Case management is applicable to the rehabilitative portion of the illness episode.

Case management is organized around a system of interdisciplinary resources and services.

76. You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his right lower quadrant. Which sign did you elicit? A. Rovsing's sign B. Psoas sign C. Obturator sign D. McBurney's sign

C. Obturator sign

72. Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? A. a gastric ulcer B. gastritis C. PID D. pancreatitis

C. PID

Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless, white, slightly raised patches in her mouth. This is probably caused by: 1. Herpes simplex. 2. Aphthous ulcers. 3. Candidiasis. 4. Oral cancer.

Candidiasis.

63. Which of the following treatments for ulcerative colitis is contraindicated? A. a high-calorie, nonspicy, caffeine-free diet that is low in high-residue foods and milk products B. corticosteroids in the acute phase C. antidiarrheal agents D. colectomy with permanent ileostomy in severe cases

C. antidiarrheal agents

107. A mother brings in her 4 year old child, whom she states has acute abdominal pain and a rash. Which of the following do you initially rule out? A. rocky mountain spotted fever B. measles C. appendicitis D. a food allergy

C. appendicitis

27. Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes, slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? A. as a healthy adult with several problems B. as having a glycemic event C. as having metabolic syndrome D. as having multiple organ dysfunction

C. as having metabolic syndrome

113. In the ABCs of IBS, the B stands for A. bloody stool B. bad odor to stool C. bloating or visible distention D. bowel attack

C. bloating or visible distention

112. Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be A. appendicitis B. IBS C. cholecystitis D. Crohn's disease

C. cholecystitis

108. The most common cause of elevated liver function tests is A. hepatitis B. biliary tract obstruction C. chronic alcohol abuse D. a drug-induced injury

C. chronic alcohol abuse

46. Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect that she has which protozoal infection of the bowel? A. giardiasis B. amebiasis C. cryptosporidiosis D. E. coli

C. cryptosporidiosis

17. Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you that she will A. take a sitz bath after each bowel movement for 1-2 weeks after surgery B. drink at least 2,000 mL of fluids per day C. decrease her dietary fiber for 1 month D. take stool softeners as prescribed

C. decrease her dietary fiber for 1 month

62. When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? A. eat foods higher in carbs B. eat three large meals plus three snacks per day C. eat foods with a moderate fat and protein content D. drink fluids with each meal

C. eat foods with a moderate fat and protein content

18. Once gastric cancer has been diagnosed, which test should be ordered to accurately determine the correct staging? A. CT B. MRI C. endoscopic ultrasound D. Ranson's test

C. endoscopic ultrasound

68. Ellie, age 42, has a seizure disorder and has been taking phenytoin (Dilantin) for years. Which supplement should she also be taking if no other problems exist? A. vitamin B12 B. iron C. folic acid D. calcium

C. folic acid

75. Rose has GERD. You know that she misunderstands your teaching when she tells you that she will A. avoid coffee, alcohol, chocolate, peppermint, and spicy foods B. eat smaller meals C. have a snack before retiring so that the esophagus and stomach are not empty at bedtime D. stop smoking

C. have a snack before retiring so that the esophagus and stomach are not empty at bedtime

103. Sandra has celiac disease. You place her on which diet? A. a low-fat diet B. a low-residue diet C. a gluten-free diet D. a high-protein diet

C. a gluten-free diet

61. Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly improved over last week's symptoms. Which stage of viral hepatitis do you suspect? A. incubation B. prodromal C. icteric D. convalescent

C. icteric

89. You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with A. anxiety and panic attacks B. long-term use of NSAIDs C. infection by Helicobacter pylori D. a family history of peptic ulcers

C. infection by Helicobacter pylori

116. The proper order of assessing the abdomen is A. palpation, percussion, auscultation, and inspection B. inspection, palpation, auscultation, and percussion C. inspection, auscultation, percussion, and palpation D. percussion, auscultation, inspection, and palpation

C. inspection, auscultation, percussion, and palpation

20. Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she A. needs to begin the hepatitis B series as soon as possible B. needs to be tested again because one reading is not indicative of immunity C. is permanently immune to hepatitis B D. has an acute hepatitis B infection

C. is permanently immune to hepatitis B

15. Which organ structure produces and secretes bile to emulsify fats? A. salivary glands B. pancreas C. liver D. gallbladder

C. liver

28. Which laxative is safe for long-term use? A. mineral oil B. bisacodyl (Dulcolax) C. methylcellulose (Citrucel) D. magnesium hydroxide (milk of magnesia)

C. methylcellulose (Citrucel)

38. A palpable spleen 2 cm or less below the left costal margin in a 2 year old child is A. indicative of splenomegaly B. a sign of internal hemorrhaging C. normal D. a sign of infection

C. normal

117. The most common causes of upper GI hemorrhage are A. esophagitis and carcinomas B. erosive gastritis and peptic ulcer disease C. peptic ulcer disease and esophageal varices D. carcinomas and arteriovenous malformations

C. peptic ulcer disease and esophageal varices

24. Which procedure enlarges the opening between the stomach and duodenum to improve gastric emptying? A. Billroth I B. total gastrectomy C. pyloroplasty D. vagotomy

C. pyloroplasty

93. The most common viral infection causing diarrhea in the U.S. is A. enteric adenovirus B. a Norwalk-like virus C. rotavirus D. Giardia lamblia

C. rotavirus

19. Which laboratory value would you expect to be increased in the presence of significant diarrhea? A. serum potassium B. serum sodium C. serum chloride D. bicarbonate

C. serum chloride

54. Lipids are broken down in which area of the GI tract? A. esophagus B. stomach C. small intestine D. large intestine

C. small intestine

7. Sara, age 59, is taking polyethylene glycol (GoLYTELY) in preparation for a barium enema. What do you teach her about the medication? A. drink the solution at room temperature B. take the medication with food so that it will be absorbed better C. take the medication in the early evening so as not to interfere with sleep D. drink all of the solution in one sitting

C. take the medication in the early evening so as not to interfere with sleep

51. Marisa, age 42, has celiac disease. She is prone to osteopenic bone disease as a result of impaired calcium absorption because of A. increased calcium absorption by the small intestine B. increased absorption of the fat-soluble vitamin D C. the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids D. decreased magnesium absorption

C. the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids

87. Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) would you expect to be decreased? A. sedimentation rate B. liver enzyme levels C. vitamins A, B complex, and C levels D. bilirubin level

C. vitamins A, B complex, and C levels

Which manifestation is noted with carbon monoxide poisoning? 1. Circumoral pallor of the lips. 2. Cherry-red lips. 3. Cyanosis of the lips. 4. Pale pink lips.

Cherry-red lips.

A 50-year-old female diabetic patient presents to your urgent care center complaining of chest discomfort. Which of the following symptoms would lead you to believe her chest pain is related to gastroesophageal reflux rather than a cardiac etiology? 1. Chest pain radiates to the jaw and left arm. 2. Chest pain is worse with walking. 3. Chest pain started while eating spicy food. 4. Chest pain is associated with nausea.

Chest pain started while eating spicy food.

Marian's husband, Stu, age 72, has temporal arteritis. She tells you that his physician wants to perform a biopsy of the temporal artery. She asks if there is a less invasive diagnostic test. What test do you tell her is less invasive? 1. Computed tomography (CT) scan. 2. Magnetic resonance imaging (MRI). 3. Electroencephalogram (EEG). 4. Color duplex ultrasonography.

Color duplex ultrasonography.

What intervention would not be included in the definition of secondary health promotion? 1. Computed tomography (CT) scan of the head for all car accident victims. 2. Preventive mammography. 3. Testicular self-examination. 4. Routine immunizations.

Computed tomography (CT) scan of the head for all car accident victims.

A 16-year-old male presents to your office. He was sent by an orthopedist. He has recently had surgical fixation of a humerus fracture. The patient has been going to physical therapy and has been developing a rash on his arm after therapy that disappears shortly after returning home. He does not have the rash prior to therapy. The patient denies fevers and chills, and his incision is well healed, with no signs of infection. Of note, the patient has been experiencing more hand edema than the average patient and has had edema wraps used at the end of therapy to help with his swelling. The wraps are made of a synthetic plastic material. The rash the patient gets is erythematous and blotchy, not raised; it is on the operative upper extremity. What is the most likely diagnosis? 1. Contact dermatitis. 2. Atopic dermatitis. 3. Seborrheic dermatitis. 4. Psoriasis.

Contact dermatitis.

The term collaboration is best defined as: 1. Interdisciplinary teamwork. 2. A protocol arrangement with a physician. 3. Case management. 4. Cooperation with another to achieve mutual goals while not losing sight of one's own interests.

Cooperation with another to achieve mutual goals while not losing sight of one's own interests.

Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient that the best cure for cataracts is: 1. Medications. 2. Dietary supplements. 3. Corrective lens surgery. 4. Optical devices.

Corrective lens surgery.

You are examining a patient in the emergency department following a closed head injury and you notice their pupils do not constrict when bright light is shone into them. To what cranial nerve would this suggest damage? 1. Cranial nerve (CN) III. 2. Cranial nerve (CN) II. 3. Cranial nerve (CN) IV. 4. Cranial nerve (CN) VI.

Cranial nerve (CN) III.

The Affordable Care Act (ACA) passed in 2010 has a number of provisions, including the establishment of health exchanges. The purpose of a health insurance exchange is to: 1. Create an online marketplace for the sale and purchase of health insurance for consumers. 2. Require each state to sell health insurance policies to consumers. 3. Reduce the overall out-of-pocket cost of health insurance to the consumer. 4. Require small businesses with 50 employees or less to buy health insurance coverage for their employees.

Create an online marketplace for the sale and purchase of health insurance for consumers.

A lab value that is commonly decreased in older adults is: 1. Creatinine clearance. 2. Serum cholesterol. 3. Serum triglycerides. 4. Blood urea nitrogen.

Creatinine clearance.

To differentiate among the different diagnoses of inflammatory bowel diseases, you look at the client's histological, culture, and radiological features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect? 1. Crohn disease. 2. Ulcerative colitis. 3. Infectious colitis. 4. Ischemic colitis.

Crohn disease.

Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal infection of the bowel? 1. Giardiasis. 2. Amebiasis. 3. Cryptosporidiosis. 4. Escherichia coli.

Cryptosporidiosis

12—39 Clients with sprue usually have: A a large-in-stature appearance. B accelerated maturity. C polycythemia. D steatorrhea.

D

The ABCDEs of skin cancer can help you diagnose a cancerous skin lesion. Which of the following definitions does not accurately describe the corresponding letter of the acronym? 1. A = asymmetry. 2. B = boarder irregularity. 3. C = color. 4. D = diameter greater than 8 mm.

D = diameter greater than 8 mm

50. Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond A. "Do not donate blood until 1 year after diagnosis." B. "Abstain from sex all together." C. "There is no possibility of transmission through razors or toothbrushes." D. "Abstain from sex during your period."

D. "Abstain from sex during your period."

48. Anson tells you that he thinks his antacids are causing his diarrhea. You respond A. "Antacids contain fructose, which may not be totally absorbed and results in fluid being drawn into the bowel." B. "Antacids contain sorbitol or mannitol, which are sugars that aren't absorbed and can cause fluid to be drawn into the bowel." C. "Antacids contain caffeine, which decreases bowel transit time." D. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

D. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

59. Your client's 2 month old daughter is admitted with gastroenteritis and dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the child's diarrhea, how do you respond? A. "She must be lactose intolerant from the formula, and this alters the fluid balance." B. "Her body's telling you that it's time to initiate some solids into her system." C. "The virus is causing irritation of the GI lining, which causes diarrhea." D. "The infectious agent invaded the stomach lining and affects the balance of water and nutrients."

D. "The infectious agent invaded the stomach lining and affects the balance of water and nutrients."

31. Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond A. "You should have two to three stools per day." B. "You should defecate once a day." C. "You should have at least three stools per week." D. "There is no such thing as a 'normal' pattern of defecation."

D. "There is no such thing as a 'normal' pattern of defecation."

60. The CDC recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every A. 3 years, beginning at age 40 B. other year C. 2 years, beginning at age 45 D. 5 years, beginning at age 50

D. 5 years, beginning at age 50

When caring for clients from a different culture, which of the following is an important piece of assessment data? 1. Determining the ultimate decision maker. 2. Making decisions based on your general knowledge about the cultural background of the client. 3. Determining the family's perception of the cause of the client's problem. 4. Understanding that clients from other cultures expect their health care provider to be an authority figure.

Determining the ultimate decision maker.

Which of the following initiatives does not fall under the National Prevention Strategy? 1. Diabetes management. 2. Tobacco-free living. 3. Healthy eating. 4. Mental and emotional well-being.

Diabetes management.

In the outpatient office setting, the most common reason for a malpractice suit is failure to: 1. Properly refer. 2. Diagnose correctly in a timely fashion. 3. Obtain informed consent. 4. Manage fractures and trauma correctly.

Diagnose correctly in a timely fashion.

79. For an uncomplicated Salmonella infection, the antibiotic of choice is which of the following? A. Ampicillin (Polycillin) B. Amoxicillin (Amoxil) C. Trimethoprim-sulfamethoxazole (Bactrim) D. No antibiotic is indicated

D. No antibiotic is indicated

When performing a sports physical exam on Kevin, a healthy 16-year-old boy, which question in the history is important to ask Kevin or his guardian? 1. Did anyone in your family ever have sudden cardiac death? 2. Does anyone in your family have elevated cholesterol levels? 3. Did you ever have any injury requiring stitches? 4. Does anyone in your family have a history of asthma?

Did anyone in your family ever have sudden cardiac death?

Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on his leather jacket. He recalls having a slightly similar rash last year when he wore his jacket. The annular lesions are on his neck and both arms. They are erythematous, sharply circumscribed, and both flat and elevated. His voice seems a little raspy, although he states that his breathing is normal. What is your first action? 1. Order a short course of systemic corticosteroids. 2. Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously. 3. Start daily antihistamines. 4. Tell Tom to get rid of his leather jacket.

Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.

Susie, age 5, comes to the clinic for a well-child visit. She has not been in since she was 2. Her immunizations are up to date. What immunizations would you give her today? 1. None; wait until she is 6 years old to give her her booster shots. 2. Diphtheria, tetanus, and pertussis (DTaP); Haemophilus influenzae type B (Hib); and measles, mumps, and rubella (MMR). 3. Diphtheria, tetanus, and pertussis (DTaP) and inactivated polio vaccine (IPV). 4. Diphtheria, tetanus, and pertussis (DTaP); inactivated polio vaccine (IPV); and measles, mumps, and rubella (MMR).

Diphtheria, tetanus, and pertussis (DTaP); inactivated polio vaccine (IPV); and measles, mumps, and rubella (MMR).

12—65 Once gastric cancer has been diagnosed, which test should be ordered to accurately determine the correct staging? Computed tomography Magnetic resonance imaging Endoscopic ultrasound Ranson's test

Endoscopic ultrasound

110. Sally has an ileostomy performed for inflammatory bowel disease. What type of fecal output can Sally expect? A. hard, formed stool B. semisoft stool C. semisoft to very soft stool D. a continuous, soft-to-watery effluent

D. a continuous, soft-to-watery effluent

118. The most common cause of mechanical bowel obstruction in all ages is A. volvulus B. intussusception C. cancer D. a hernia

D. a hernia

47. Tenesmus refers to A. projectile vomiting B. severe lower abdominal pain C. constipation D. a persistent desire to empty the bowel or bladder

D. a persistent desire to empty the bowel or bladder

3. The most important diagnostic test for celiac disease is A. confirming malabsorption by laboratory tests B. a barium enema C. a peroral biopsy of the duodenum D. a tTG-IgA test followed by a biopsy of the small intestine

D. a tTG-IgA test followed by a biopsy of the small intestine

57. Which of the following pharmacologic agents used to treat constipation may cause flatulence and bloating and require adequate fluid intake? A. stool softeners B. saline laxatives C. lubricants D. bulking agents

D. bulking agents

74. Which of the following is a hospital-based nosocomial infection that has seen a serious rise in the past decade? A. pneumonia B. hepatitis B C. staphylococcus infection D. clostridium difficile colitis

D. clostridium difficile colitis

92. You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you she will A. decrease her fat intake B. increase her fiber intake C. continue her daily use of aspirin D. increase her fluid intake

D. increase her fluid intake

49. Patients with IBS are more likely to have which of the following organic gastrointestinal diseases? A. thyroid dysfunction B. colorectal cancer C. celiac sprue D. lactose malabsorption

D. lactose malabsorption

101. Mona is breastfeeding her 5 day old daughter, who has just been found to have physiological jaundice with a bilirubin level of more than 20 mg/dL. You should tell Mona that she A. should stop breastfeeding altogether B. can continue breastfeeding C. should discontinue breastfeeding for 24 hours D. should alternate breast milk with formula for every other feeding

D. should alternate breast milk with formula for every other feeding

77. Clients with celiac sprue usually have A. a large-in-stature appearance B. accelerated maturity C. polycythemia D. steatorrhea

D. steatorrhea

55. Which type of hernia usually occurs at a previous surgical incision site? A. umbilical B. congenital C. hiatal D. ventral

D. ventral

25. Which of the following statements about cirrhosis is true? A. biliary cirrhosis is the most common type of cirrhosis in the U.S. B. alcoholic cirrhosis occurs only in malnourished alcoholics C. cirrhosis is reversible if diagnosed and treated at an early stage D. women tend to develop cirrhosis more quickly with less alcohol intake than men

D. women tend to develop cirrhosis more quickly with less alcohol intake than men

The study of the way diseases are spread through groups and what causes and helps spread these diseases is called? 1. Epidemiology. 2. Pathology. 3. Physiology. 4. Kinesiology.

Epidemiology.

Which presentation is most concerning for skin cancer? 1. Dark pigmentation of 1 solitary nail that has developed quickly and without trauma. 2. A 1-mm blue, round, nonpalpable discoloration of the skin that has been present since birth without change. 3. A 5-mm black mole with round, regular boarders. 4. A 2-mm brown mole that is raised 1 mm but round and regular.

Dark pigmentation of 1 solitary nail that has developed quickly and without trauma.

Advanced practice registered nurses (APRNs) are affected by laws and rules, although these vary by state. Which of the following is affected by state laws and regulations? 1. Delegation of authority by physicians. 2. How many clients you must see every hour. 3. Universal health care law. 4. Making no more than 5 referrals for 1 client

Delegation of authority by physicians.

You are examining Barbara, age 27, who presents with multiple dry, dusky red, well-localized plaques with a "stuck-on" appearance. They are 5 to 20 mm in diameter and located on her face, scalp, and external ears. You note there is atrophy, telangiectasia, depigmentation, and follicular plugging present. On examination of the scalp, there are areas of total hair loss. There is depigmented scarring of the concha of the ear. Your most likely diagnosis is: 1. Seborrheic dermatitis. 2. Discoid lupus erythematosus. 3. Psoriasis. 4. Tinea capitis.

Discoid lupus erythematosus.

It is important to do which of the following before negotiating a contract? 1. Do your homework. 2. Hire a lawyer. 3. Plan a signing-of-contract dinner. 4. Stand your ground.

Do your homework.

Documentation in your patient's chart is important for all the following reasons except? 1. Documentation is only important for recording your side of the visit so you can reduce your liability in the event of a lawsuit. 2. Documentation allows you to communicate your findings to another provider. 3. Documentation allows you to remember the office visit so you can best treat the patient in the future. 4. Documentation allows you to create a record of the visit and record your patient's findings and treatment plans.

Documentation is only important for recording your side of the visit so you can reduce your liability in the event of a lawsuit.

A patient on which of the following medications is at risk of sun poisoning? 1. Doxycycline. 2. Lexapro. 3. Labetalol. 4. Percocet.

Doxycycline.

Which of the following should be used with all acne medications? 1. Sunscreen. 2. Oily makeup. 3. Plain soap. 4. A light alcohol wipe once a week.

Sunscreen.

Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do you suspect? 1. Epiglottitis. 2. Group A beta-hemolytic streptococcal pharyngitis. 3. Tonsillitis. 4. Diphtheria.

Epiglottitis.

Mallory brings her 4-week-old infant to the office because she noticed small, yellow-white, glistening bumps on her infant's gums. She says they look like teeth, but she is worried that they may be cancer. You diagnose these bumps as: 1. Bednar aphthae. 2. Epstein pearls. 3. Buccal tumors. 4. Exostosis.

Epstein pearls.

Which disease usually starts on the cheeks and spreads to the arms and trunk? 1. Erythema infectiosum (fifth disease). 2. Rocky Mountain spotted fever. 3. Rubeola. 4. Rubella.

Erythema infectiosum (fifth disease).

Helen, age 39, comes to your clinic for generalized joint pain, especially in the knees and hands. She tells you that the pain is moderate, spreading, and symmetrical. She reports having had a sore throat and low-grade fever for a few days and then developing a rash, described as warm erythema of the cheeks, which lasted about 4 days before disappearing. You ask her if the rash on the cheeks included the nasolabial folds or circumoral skin, and she tells you that it did not cover these areas. Two days later, she developed a nonspecific macular eruption that preceded the joint pain. Her rash faded within 2 weeks, but she tells you that it comes and goes if she bathes in hot water or spends time in the sunlight. Your patient's symptoms are most consistent with a diagnosis of: 1. Rubella. 2. Erythema infectiosum. 3. Rheumatoid arthritis. 4. Scarlet fever.

Erythema infectiosum.

t the clinic, you are assessing Kyle, a 4-month-old baby, for the first time and notice that both eyes are turning inward. What is this called? 1. Pseudostrabismus. 2. Strabismus. 3. Esotropia. 4. Exotropia.

Esotropia.

How often should you receive a Tdap booster when no injury history is present? 1. Every 10 years. 2. After 18 you don't need a booster unless you have a laceration. 3. Every 20 years. 4. Every 5 years.

Every 10 years.

Your client is convinced her illness has been caused by the ill will of a family member. Her description of her illness is an example of her: 1. Explanatory reasoning. 2. Lack of understanding of scientific medicine. 3. Delusional ideation. 4. Cultural bias.

Explanatory reasoning.

Negligence is the predominant legal theory of malpractice liability. Negligence includes: 1. Failure to give necessary care. 2. Failure to discharge. 3. Failure to share information with family. 4. Failure to provide shelter and food.

Failure to give necessary care.

As a primary care provider, which of the following topics is not typically important for adults aged 20 to 40? 1. Focusing on increasing lifespan. 2. Career development. 3. Self-image. 4. Family relationships.

Focusing on increasing lifespan.

Ellie, age 42, has a seizure disorder and has been taking phenytoin (Dilantin) for years. Which supplement should she also be taking if no other problems exist? 1. Vitamin B12. 2. Iron. 3. Folic acid. 4. Calcium.

Folic acid.

An 81-year-old patient presents for a physical. She recently had a fall and now has problems walking up her stairs. The only restroom in the house is on the second floor. She also has a flight of stairs outside her house she has to navigate in order to reach street level, and this is difficult for her. Where does this information belong in your chart note? 1. Functional health patterns. 2. Review of systems. 3. Plan. 4. Assessment.

Functional health patterns.

A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that "some foods get stuck" and she has been having "heartburn" at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis? 1. Esophageal varices. 2. Esophageal cancer. 3. Gastroesophageal reflux disease (GERD). 4. Peptic ulcer disease (PUD).

Gastroesophageal reflux disease (GERD).

There are advantages to owning your own practice. However, there are also barriers to the ability to do this. These barriers include which of the following? 1. Getting and keeping a collaborating physician, if required by law; getting on managed care panels; and getting privileges at hospitals. 2. Getting privileges at hospitals, getting referrals from hospital emergency departments, and lack of knowledge. 3. Inability to find a collaborating physician, inability to find clients, and lack of empathy. 4. Lack of legal authority to admit clients to nursing homes, to order home care, and/or to direct hospice services, and lack of ability to manage client care without clear medical oversight and supervision.

Getting and keeping a collaborating physician, if required by law; getting on managed care panels; and getting privileges at hospitals.

Techniques used to enhance a client's adherence to a treatment plan include: 1. Stressing the dangers of missing medications. 2. Giving clear written instructions and simplifying the drug regimen. 3. Allowing plenty of time between follow-up visits so the client has time to adjust to the regimen. 4. Explaining the importance of the regimen to the family.

Giving clear written instructions and simplifying the drug regimen.

You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this finding? 1. Grade 1. 2. Grade 2. 3. Grade 3. 4. Grade 4.

Grade 3

Herbert, a 69-year-old man, comes to your office complaining of nocturia. On questioning Herbert, you find that for the past 3 months he has been getting up at least 5 times a night to void. He came in to seek help today because of his wife's insistence that he be checked out. When you perform the digital rectal exam, you find that his prostate protrudes 3 to 4 cm into the rectum. What grade would you assign to Herbert's prostate enlargement? 1. Grade 1. 2. Grade 2. 3. Grade 3. 4. Grade 4.

Grade 3.

Most health maintenance organizations (HMOs) use a reimbursement mechanism called capitation. This means that the: 1. HMO reimburses the provider on a fee-for-service basis. 2. HMO reimburses the provider a predetermined fee per client per month based on the client's age and sex. 3. Fee paid to the provider fluctuates with the treatment. 4. Provider is reimbursed by each individual client or family.

HMO reimburses the provider a predetermined fee per client per month based on the client's age and sex.

A mother complains that her newborn infant, while lying on his side, appears red on the dependent side of the body and pale on the upper side. When she picks up the baby, this coloring disappears. You explain to her about which of the following? 1. A temporary hemangioma. 2. Hyperbilirubinemia. 3. Harlequin sign. 4. Mongolian spots.

Harlequin sign.

While counseling Mr. Brown, a patient newly diagnosed with diabetes, the advanced practice registered nurse (APRN) hands him a pamphlet on foot care. She notices that he puts it away, saying he will read it later. What might this behavior indicate? 1. Being overly dependent on others. 2. Having a low literacy level. 3. Having a high level of motivation. 4. Memorization of the information that is being taught.

Having a low literacy level.

Dan, age 57, has just been given a diagnosis of herpes zoster. He asks you about exposure to others. You tell him: 1. Once he has been on the medication for a full 24 hours, he is no longer contagious. 2. He should stay away from children and pregnant women who have not had chickenpox. 3. He should wait until the rash is completely gone before going out in crowds. 4. He should be isolated from all persons except his wife.

He should stay away from children and pregnant women who have not had chickenpox.

Which of the following statements about health promotion is false? 1. Health promotion is a benefit to add to your practice if you have time. 2. Health promotion helps to prevent diseases. 3. Health promotion includes early screening to detect diseases. 4. Health promotion includes helping to restore health after a patient has had an illness.

Health promotion is a benefit to add to your practice if you have time.

In a burn trauma, which blood measurement rises as a secondary result of hemoconcentration when fluid shifts from the intravascular compartment? 1. Hemoglobin. 2. Sodium. 3. Hematocrit. 4. Blood urea nitrogen (BUN).

Hematocrit.

Elizabeth, age 83, presents with a 2-day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules at that site. What do you suspect? 1. Varicella. 2. Herpes zoster. 3. Syphilis. 4. Rubella.

Herpes zoster.

Regular ocular pressure testing is indicated for older adults taking: 1. High-dose inhaled glucocorticoids. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Angiotensin-converting enzyme (ACE) inhibitors. 4. Insulin.

High-dose inhaled glucocorticoids.

Which of the following is not a risk factor for the development of sinusitis? 1. Asthma. 2. Smoking. 3. Deviated septum. 4. History of tonsillectomy.

History of tonsillectomy.

Marvin is a gay man who is ready to "come out." What is the last step in the process of coming out? 1. Testing and exploration. 2. Identity acceptance. 3. Identity integration and self-disclosure. 4. Awareness of homosexual feelings.

Identity integration and self-disclosure

Which of the following doesn't fall under the umbrella of health promotion as a nurse practitioner? 1. Information about online dating. 2. Exercise programs. 3. Immunizations. 4. Nutrition support.

Information about online dating.

Which of the following is not one of the generalized patterns of nursing care included in the Circle of Caring model? 1. Intelligence. 2. Patience. 3. Advocacy. 4. Courage.

Intelligence.

Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil shape, marked photophobia, and redness around the iris. What is your initial diagnosis? 1. Conjunctivitis. 2. Iritis. 3. Subconjunctival hemorrhage. 4. Acute glaucoma.

Iritis.

Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: 1. Bacterial conjunctivitis. 2. Viral conjunctivitis. 3. Allergic conjunctivitis. 4. Iritis.

Iritis.

A patient presents to your primary care clinic with diarrhea. What about the diarrhea would be concerning for a parasitic infection? 1. It presented 8 hours after eating rare fish. 2. It has lasted longer than 7 days. 3. The patient describes it as "rice water." 4. It is bloody.

It has lasted longer than 7 days.

For which patient would you administer the human papillomavirus (HPV) vaccination? 1. Susie, age 7. 2. Janice, age 17, who had a baby 6 months ago and is breastfeeding. 3. Alice, age 18, who is allergic to yeast. 4. Jill, age 25, who is pregnant.

Janice, age 17, who had a baby 6 months ago and is breastfeeding.

Which of the following individuals should get the shingles (herpes zoster) vaccine? 1. Jerry, who has a mild upper respiratory tract infection and is allergic to neomycin. 2. Tim, who has been on prolonged use of high-dose steroids for his chronic obstructive pulmonary disease (COPD). 3. Joan, whose husband recently had shingles and who is trying to get pregnant. 4. Joe, who has a stressful job.

Joe, who has a stressful job.

Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is true? 1. The offending organism is a bacterium, and Jonathan should be treated with antibiotics. 2. Convalescence is usually only a few days, and Jonathan should be back to normal in a week. 3. Mononucleosis is rarely contagious. 4. Jonathan should avoid contact sports and heavy lifting.

Jonathan should avoid contact sports and heavy lifting.

Lee brings her 13-year-old son to your clinic. He has been complaining of a rash on the buttocks, anterior thighs, and posterolateral aspects of his upper arms. He tells you it is mildly pruritic and looks like "gooseflesh." On examination, the rash appears as small, pinpoint, follicular papules on a mildly erythematous base. You explain to Lee that the benign condition is likely to resolve by the time her son reaches adulthood, and it is known as: 1. Comedones of acne. 2. Molluscum contagiosum. 3. Keratosis pilaris. 4. Atopic dermatitis.

Keratosis pilaris.

In which of the following scenarios is antibiotic treatment necessary following an injury to the skin? 1. Laceration requiring sutures from a knife cut while cutting an avocado. 2. Laceration requiring sutures on the foot of a diabetic. 3. Laceration requiring sutures on the hand of someone who has not had a tetanus booster in the last 5 years. 4. "Road rash" abrasion from a bicycle accident.

Laceration requiring sutures on the foot of a diabetic.

Eric, age 52, has gout. What do you suggest? 1. Using salicylates for an acute attack. 2. Limiting consumption of purine-rich foods. 3. Testing his uric acid level every 6 months. 4. Decreasing fluid intake.

Limiting consumption of purine-rich foods.

A biopsy of a small, yellow-orange papulonodule on the eyelid will probably show: 1. Fragmented, calcified elastic tissue. 2. Mature sebaceous glands. 3. Lipid-laden cells. 4. Endothelial swelling and an infiltrate rich in plasma cells.

Lipid-laden cells.

A 3-year-old patient presents to your pediatric office with her mother. She has recently been started in day care. Her mother noted slight perioral erythema on the right side of the patient's mouth prior to bed last night. The patient awoke today with 3 small, superficial, honey-colored vesicles where the erythema was last night. The patient has no surrounding erythema. She had no difficulty eating this morning and is active and energetic and doesn't appear lethargic or fatigued. She is also afebrile. How would you treat this child? 1. Local debridement and mupirocin for 5 days. 2. Oral Keflex for 7 days. 3. Topical compress with Burow solution and follow-up in 2 to 3 days. 4. Local debridement and topical compress with Burow solution and close follow-up.

Local debridement and mupirocin for 5 days.

Which of the following statements about macular degeneration is not true? 1. Macular degeneration is characterized by gradual loss of peripheral vision. 2. Macular degeneration is the leading cause of blindness in people younger than 60. 3. Tobacco use is a risk factor for macular degeneration. 4. There are 2 different types of macular degeneration: wet and dry.

Macular degeneration is characterized by gradual loss of peripheral vision.

Which of the following nonverbal communication techniques is important in the establishment of rapport with a client? 1. Taking notes only while the client is talking. 2. Making direct eye contact with the client, with periodic breaks to take or check notes. 3. Having a desk between you and the client. 4. Wearing jeans in the clinical setting to ensure your comfort.

Making direct eye contact with the client, with periodic breaks to take or check notes.

Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected? 1. Maxillary sinus. 2. Ethmoid sinus. 3. Sphenoid sinus. 4. Frontal sinus.

Maxillary sinus.

Which of the following statements about Medicaid is true? 1. Medicaid is a federal plan created to provide care for indigent persons. 2. Medicaid pays for family planning services, dental care, and eyeglasses. 3. Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration. 4. Medicaid is a program for the indigent financed jointly by the federal and state governments.

Medicaid is a program for the indigent financed jointly by the federal and state governments.

A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and he has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headache? 1. Tension. 2. Migraine. 3. Cluster. 4. Temporal arteritis.

Migraine

Which of the following refers to an aspect of a patient's health that can be changed or affected by a health intervention? 1. Modifiable risk factor. 2. Nonmodifiable risk factor. 3. Adjustable risk factor. 4. Changeable risk factor.

Modifiable risk factor.

Which treatment is considered the gold standard in tissue-conserving skin cancer removal? 1. Cryosurgery. 2. Simple excision. 3. Photodynamic therapy. 4. Mohs micrographic surgery (MMS).

Mohs micrographic surgery (MMS).

A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? 1. Viral pharyngitis. 2. Mononucleosis. 3. Streptococcal pharyngitis. 4. Upper respiratory infection.

Mononucleosis.

Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? 1. A throat culture. 2. A Monospot test. 3. A rapid antigen test. 4. A Thayer-Martin plate test.

Monospot test

Health behaviors can be difficult to change. Which of the following is most important in influencing behavioral change? 1. Motivation. 2. Health beliefs. 3. Cognitive knowledge. 4. Social supports.

Motivation.

Marjorie, age 37, has asthma and has been told she has nasal polyps. What do you tell her about them? 1. Nasal polyps are usually precancerous. 2. Nasal polyps are benign growths. 3. The majority of nasal polyps are neoplastic. 4. They are probably inflamed turbinates, not polyps, because polyps are infrequent in clients with asthma.

Nasal polyps are benign growths.

Martha, age 82, has an asymptomatic carotid bruit on the left side. What do you recommend? 1. Acetylsalicylic acid, or aspirin (ASA), therapy. 2. Coumadin therapy. 3. Surgery. 4. No treatment at this time.

No treatment at this time.

Sally, an advanced practice registered nurse (APRN), sees Mr. Bell, who is suffering from congestive heart failure. She increases his diuretic but makes no note of his potassium and orders no replacement potassium. Mr. Bell returns a week later for routine laboratory testing. His potassium level is found to be low; however, Mr. Bell has no complaints. Sally orders a potassium supplement to begin immediately as well as a follow-up potassium level measurement. Is Sally guilty of malpractice? 1. Yes, because she breached a standard of care. 2. No, because no harm came to the client. 3. No, because she took remedial action. 4. Yes, because she was negligent.

No, because no harm came to the client.

How would you describe the cervical lymphadenopathy associated with asymptomatic human immunodeficiency virus (HIV) infection? 1. Movable, discrete, soft, and nontender lymph nodes. 2. Enlarged, warm, tender, and firm but freely movable lymph nodes. 3. Hard, unilateral, nontender, and fixed lymph nodes. 4. Nontender, mobile, and firm but not hard lymph nodes.

Nontender, mobile, and firm but not hard lymph nodes.

Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look "sunken in." What do you suspect? 1. Hypothyroidism. 2. Normal age-related changes. 3. Cushing syndrome. 4. A detached retina.

Normal age-related changes.

A nurse practitioner is practicing based on the rule-based actions he was taught in school and doesn't understand when/where those rules may be inappropriate. Which following statement best describes this skill level? 1. Novice. 2. Advanced beginner. 3. Proficient. 4. Expert.

Novice.

What must you do as an advanced practice registered nurse (APRN) before billing for visits? 1. Establish a collaborative agreement with a physician. 2. Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer. 3. Provide evidence of continuing medical education. 4. Obtain a Drug Enforcement Administration (DEA) number.

Obtain a provider number and familiarize yourself with the rules and policies of the third-party payer.

A 70-year-old client with herpes zoster has a vesicle on the tip of the nose. This may indicate: 1. Ophthalmic zoster. 2. Herpes simplex. 3. Kaposi sarcoma. 4. Orf and milker's nodules.

Ophthalmic zoster.

An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know to be complications of this disease, you explain to her that she needs: 1. Antibiotics. 2. A biopsy of the rash. 3. Immediate hospitalization. 4. Ophthalmological consultation.

Ophthalmological consultation.

Kevin, age 26, has AIDS and presents to the clinic with complaints of a painful tongue covered with what look like creamy white, curdlike patches overlying erythematous mucosa. You are able to scrape off these "curds" with a tongue depressor, which assists you in making which of the following diagnoses? 1. Leukoplakia. 2. Lichen planus. 3. Oral candidiasis. 4. Oral cancer.

Oral candidiasis.

Which of the following is not recommended for hoarseness? 1. Vocal rest. 2. Tobacco cessation. 3. Decrease in caffeine use. 4. Oral steroids.

Oral steroids.

A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in management of this patient's GERD? 1. Order an endoscopy. 2. Order a Helicobacter pylori blood test. 3. Try adding ranitidine to the patient's regimen. 4. Try adding bismuth to the patient's regimen.

Order an endoscopy

Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her normal-appearing auricle, eliciting severe pain. This leads you to suspect: 1. Otitis media. 2. Otitis media with effusion. 3. Otitis externa. 4. Primary otalgia.

Otitis externa.

Sandra, a 27-year-old nurse, states that she does not want to get the hepatitis B virus vaccine because of its adverse effects. You tell her that the most common adverse effect is: 1. Fatigue. 2. Headache. 3. Pain at the injection site. 4. Elevated temperature.

Pain at the injection site.

Which of the following demonstrates a subjective finding? 1. Pain level. 2. Pulse rate. 3. Eye color. 4. Extremity edema.

Pain leve

Which of the following has/have not been linked to the use of isotretinoin? 1. Elevated liver transaminases. 2. Depression, psychosis, and suicidality. 3. Benign intracranial hypertension. 4. Pancreatitis.

Pancreatitis.

An eczematous skin reaction may result from: 1. Penicillin. 2. Allopurinol (Zyloprim). 3. Oral contraceptives.

Penicillin.

Emily, a healthy 26-year-old woman, asks you how she can prevent bone loss as she ages. She is concerned because both her maternal grandmother and now her mother have severe osteoporosis. What guidance would you give to Emily? 1. Drink all the soda you like—it has no effect on your bone density. 2. It has not been proved that smoking affects bone loss. 3. Replace estrogen when you reach menopause. 4. Perform aerobic exercise at least 3 times a week

Perform aerobic exercise at least 3 times a week

A 4-year-old male presents to your pediatric clinic with his mother complaining of an itchy rash, mostly between his fingers. This has been going on for multiple days and has been getting worse. The patient recently started at a new day care. On physical exam, the patient is afebrile and has multiple small (1-2 mm) red papules in sets of 3 located in the web spaces between his fingers. He also has signs of excoriation. What is the treatment for this problem? 1. Permethrin lotion for the patient and also his family members. 2. Cold compresses and hydrocortisone cream 1% twice a day. 3. Over-the-counter Benadryl cream. 4. Ketoconazole cream.

Permethrin lotion for the patient and also his family members.

You are seeing your client for the first time, and he says, "I like that you are a physician assistant." You tell him you are a nurse practitioner, and he asks you how the two are different. Your best answer is: 1. A nurse practitioner has much more training than a physician assistant (PA). 2. Nurse practitioners cannot practice independently. 3. Physician assistants do not have the breadth of knowledge nurse practitioners have. 4. Physician assistants are health care professionals who are authorized by the state to practice medicine under the license of a physician, whereas nurse practitioners have an independent base of knowledge—ie, advanced nursing knowledge—and independent licensure to practice.

Physician assistants are health care professionals who are authorized by the state to practice medicine under the license of a physician, whereas nurse practitioners have an independent base of knowledge—ie, advanced nursing knowledge—and independent licensure to practice.

Michael, a 25-year-old military reservist, presents to your clinic for a rash that began on his chest and has since developed into smaller lesions that are more concentrated on the lower abdomen and pubic area. In obtaining a history of the present illness, he reports that he had an upper respiratory infection 1 month before the rash developed. He tells you it started with 1 large oval-shaped lesion on his left chest, and 1 to 2 weeks later he developed numerous smaller lesions on the lower abdomen and groin. It has been 2 weeks since the smaller lesions developed, and he tells you he is concerned that the rash isn't improving. As you examine the patient, you note that the lesions are salmon-colored and have a thin collarette of scale within them. The original lesion is still present. You suspect Michael has: 1. Guttate psoriasis. 2. Tinea versicolor. 3. Secondary syphilis. 4. Pityriasis rosea.

Pityriasis rosea.

A dark-field microscopic examination is used to diagnose: 1. Scabies. 2. Leprosy. 3. Syphilis. 4. Candida infections.

Syphilis.

As a nurse practitioner, which of the following would not be an example of primary health promotion? 1. Posting health articles on your social media account. 2. Speaking to patients at each visit about strategies for maintaining/attaining a healthy life. 3. Lecturing at local community centers about diabetes. 4. Organizing a 5K running event for the patients in your practice.

Posting health articles on your social media account.

Which of the following is not a cause of conductive hearing loss? 1. Presbycusis. 2. Cerumen impaction. 3. Otitis media. 4. Otosclerosis.

Presbycusis.

Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? 1. Prescribe nasal steroids and oral decongestants. 2. Prescribe antibiotic ear drops. 3. Prescribe systemic antibiotics. 4. Refer Max to an ear, nose, and throat specialist.

Prescribe nasal steroids and oral decongestants.

Erica, age 39, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102°F. The nurse practitioner diagnosed her with influenza (flu). What is your next course of action? 1. Order amoxicillin (Amoxil) 500 mg every 12 hours for 7 days. 2. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. 3. Order a complete blood count (CBC). 4. Consult with your collaborating physician.

Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive.

The Agency for Healthcare Research and Quality (AHRQ) was established to: 1. Mandate treatment protocols. 2. Dictate health care policy based on voluminous research. 3. Promote evidence-based practice. 4. Develop cost-effective interventions.

Promote evidence-based practice.

The primary purpose of an institutional review board (IRB) is to: 1. Protect human subjects. 2. Evaluate the scientific merit of proposed research. 3. Oversee and coordinate the research efforts of an institution. 4. Oversee and coordinate the research efforts of an individual.

Protect human subjects.

Mr. Swanson, age 67, presents to the clinic for his annual health exam. He asks you if there is anything he can do to prevent the painful, blistering sores that develop on his lip in the summertime when he plays golf. You explain to Mr. Swanson that the way to prevent the development of these lesions is to: 1. Protect the lips from sun exposure with a blocking agent, such as zinc oxide, or a lip balm that contains a broad-spectrum sunscreen. 2. Apply acyclovir 5% cream 5 times a day for 4 days. 3. Take acyclovir 500 mg 1 tablet 5 times a day for 5 days. 4. Wear a visor.

Protect the lips from sun exposure with a blocking agent, such as zinc oxide, or a lip balm that contains a broad-spectrum sunscreen.

You are working in an emergency department as an advanced practice registered nurse (APRN). An adolescent boy is brought in, unconscious, with a head injury after being struck by a car. He has no identification, and there is no parent or adult with him. What should you do? 1. Provide the appropriate medical treatment even if it involves surgery. 2. Do everything except order a blood transfusion, even if it is indicated, because you do not know the client's religious preferences. 3. Call the hospital attorney before instituting any care. 4. Contact all local police stations in an attempt to identify the client and find his parents before instituting treatment.

Provide the appropriate medical treatment even if it involves surgery.

Which of the following strategies can help foster client compliance? 1. In-depth client education. 2. High-frequency medication dosing. 3. Providing positive feedback and reinforcement. 4. Monitoring serum drug levels to assess therapeutic range.

Providing positive feedback and reinforcement.

A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was recently on spring break and spent every night in the hot tub at her hotel. On physical exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly where her bathing suit covered her buttocks. What is the most likely pathogen causing these lesions? 1. Pseudomonas aeruginosa. 2. Klebsiella. 3. Staphylococcus aureus. 4. Streptococcus. Rationales

Pseudomonas aeruginosa.

Jim, age 59, presents with recurrent, sharply circumscribed red papules and plaques with powdery white scale on the extensor aspects of his elbows and knees. What do you suspect? 1. Actinic keratosis. 2. Eczema. 3. Psoriasis. 4. Seborrheic dermatitis.

Psoriasis.

Which of the following statements about psoriasis is not true? 1. Psoriatic lesions are often silvery scales that form over erythematous plaques. 2. Psoriatic lesions often occur in the folds of the elbows and behind the knees. 3. People with psoriasis have a greater risk of depression than the average population. 4. Psoriasis has a genetic component.

Psoriatic lesions often occur in the folds of the elbows and behind the knees.

Which of the following is not a modifiable risk factor? 1. Weight. 2. Stress level. 3. Race. 4. Physical activity level.

Race.

The research function of the advanced practice registered nurse (APRN) may be operationalized as both a consumer of research findings and a researcher. Being a consumer of research findings involves a number of activities, including: 1. Reading the literature, analyzing its clinical applicability, and using new interventions. 2. Organizing and conducting a research study. 3. Data collection.

Reading the literature, analyzing its clinical applicability, and using new interventions.

You suspect a platelet abnormality in a 40-year-old woman who presents to your clinic with: 1. Red to blue macular plaques. 2. Multiple freckle-like macular lesions in sun-exposed areas. 3. Numerous small, brown, nonscaly macules that become more prominent with sun exposure. 4. Red, flat, nonblanchable petechiae.

Red, flat, nonblanchable petechiae.

Mr. Griffin, age 85, has been given a diagnosis of bowel cancer, and surgery is indicated. He is mentally alert; however, he is refusing to give consent for the procedure. You respond by: 1. Ordering a psychiatric consultation. 2. Having your collaborating physician talk with the client. 3. Respecting his wishes. 4. Talking with his family.

Respecting his wishes.

Which of the following is not a subjective finding? 1. Headache. 2. Respiratory rate. 3. Shortness of breath. 4. Ankle pain.

Respiratory rate.

Mattie, age 64, presents with blurred vision in 1 eye and states that it felt like "a curtain came down over my eye." She doesn't have any pain or redness. What do you suspect? 1. Retinal detachment. 2. Acute angle-closure glaucoma. 3. Open-angle glaucoma. 4. Cataract.

Retinal detachment.

When caring for a client who speaks a language different from yours, the ideal strategy is to: 1. Use gestures to convey the meaning of words and use a foreign language dictionary of medical terms. 2. Rely on family members to interpret. 3. Review the case first with an interpreter before beginning the clinical visit. 4. Use a pad and pencil to pass information back and forth with an interpreter.

Review the case first with an interpreter before beginning the clinical visit.

What bacterium causes Rocky Mountain spotted fever? 1. Rickettsia rickettsii. 2. Borrelia burgdorferi. 3. Orientia tsutsugamushi. 4. Centruroides exilicauda.

Rickettsia rickettsii.

During a camping trip, Jim, age 35, abruptly developed fever, headache, and joint pain. A few days after the onset of the fever, a blanchable macular rash began on his wrists and ankles and quickly spread to the palms and soles before becoming generalized. The rash is now petechial. You suspect Jim has: 1. Rocky Mountain spotted fever. 2. Flea bites. 3. Kawasaki disease. 4. Lyme disease.

Rocky Mountain spotted fever

As an advanced practice registered nurse (APRN), you begin a new job in a small practice with 2 other physicians. You have been hired to be a partner in the practice, but the eldest partner is reluctant to allow you to take on new clients. This is an example of: 1. Role stress. 2. Role strain. 3. Role insufficiency. 4. Role conflict.

Role conflict.

Mrs. Hernandez, age 79, is insisting on discharge from the skilled nursing facility where she is receiving rehabilitation after a left hip replacement. She lives alone and has very little support. You do not think she is ready for discharge. Mrs. Hernandez's insistence on discharge is an example of your client exercising her right to: 1. Self-determination. 2. Beneficence. 3. Justice. 4. Utilitarianism.

Self-determination.

A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the club. These symptoms are most characteristic of which of the following? 1. Sensorineural loss. 2. Conductive loss. 3. Tinnitus. 4. Vertigo.

Sensorineural loss.

If conflict arises during a job negotiation, you should consider: 1. Separating the issue from the person. 2. Always standing your ground. 3. Getting a legal opinion. 4. Basing your actions on the contract a friend of yours has secured in a local practice.

Separating the issue from the person.

Which human papillomavirus serotypes most commonly cause cancer? 1. Serotypes 16 and 18. 2. Serotypes 6 and 11. 3. Serotypes 3 and 10. 4. Serotypes 27 and 29.

Serotypes 16 and 18.

You are interviewing a client who becomes tearful. An appropriate response is to: 1. Ask if the client has a support person with them. 2. Sit quietly with the client and offer a tissue. 3. Offer to get a glass of water to help the client compose himself or herself. 4. Let the client have privacy and spend the time reviewing the chart and background of the client.

Sit quietly with the client and offer a tissue.

What lifestyle choice increases the risk of upper respiratory infection? 1. Smoking. 2. Alcohol use. 3. Cocaine use. 4. Multiple sexual partners.

Smoking.

A 55-year-old landscaper presents to your primary care office complaining of a small skin lesion on his face. The patient states the lesion causes no pain or other symptoms. On physical exam, you notice a small (3 mm) papule that is flesh-colored and irregular. To palpation, the lesion feels hard and like sandpaper. What type of malignancy is this patient at risk for given the appearance of this lesion? 1. Squamous cell carcinoma. 2. Melanoma. 3. Basal cell carcinoma. 4. Rosacea.

Squamous cell carcinoma.

Jan's mother has Alzheimer disease (AD). Jan tells you that her mother's recent memory is poor and that she is easily disoriented, incorrectly identifies people, and is lethargic. Jan asks you, "Is this as bad as it gets?" You tell her that her mother is in which stage of the disease? 1. Stage 1. 2. Stage 2. 3. Stage 3. 4. Stage 4.

Stage 3.

Sophie brings in her husband, Nathan, age 72, who is in a wheelchair. On his sacral area, he has a deep crater with full-thickness skin loss. Subcutaneous tissue is visible but muscle and bone are not. Which pressure ulcer stage is this? 1. Stage I. 2. Stage II. 3. Stage III. 4. Stage IV.

Stage III.

Mark, a 56-year-old man, comes to your practice seeking help quitting smoking. You prescribe varenicline (Chantix), a prescription medication, to aid with his attempt. What instructions do you give Mark regarding how to stop smoking with Chantix? 1. Start the Chantix today according to the dosing schedule and then quit smoking after the 12-week medication schedule. 2. Start the Chantix today according to the dosing schedule and then pick a date to stop smoking about 7 days after starting Chantix. 3. Pick a date to stop smoking and start Chantix that day according to the dosing schedule. 4. Start Chantix today, take it twice a day for 2 weeks, and then stop smoking.

Start the Chantix today according to the dosing schedule and then pick a date to stop smoking about 7 days after starting Chantix.

A 15-year-old female presents to your urgent care center complaining of a sore throat for 3 days. Her vital signs are as follows: temperature 102.1°F, pulse (P) 70, blood pressure (BP) 130/85, oxygen saturation 97%. The patient denies cough. On physical exam, she has pearly white exudates on the tonsils, erythema of the throat, and palpable anterior cervical chain lymphadenopathy. What is the recommended treatment? 1. Starting the patient on antibiotics. 2. Starting the patient on prednisone. 3. Awaiting culture results prior to treatment. 4. Recommending supportive treatment.

Starting the patient on antibiotics.

You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication? 1. Achilles tendon rupture. 2. Peripheral neuropathy. 3. Nephrotoxicity. 4. Stevens-Johnson syndrome.

Stevens-Johnson syndrome

Roy, age 13, was recently diagnosed with epilepsy and prescribed carbamazepine for control of his seizures. He has developed erythematous papules, dusky appearing vesicles, purpura, and target lesions that have erupted rapidly and are more centrally distributed on the face. He has hemorrhagic crusts on his lips. He tells you his skin feels tender and burns. Additionally, he has developed exudative conjunctivitis. These findings are indicative of: 1. Urticaria. 2. Pemphigus vulgaris. 3. Herpetic gingivostomatitis. 4. Stevens-Johnson syndrome (SJS).

Stevens-Johnson syndrome (SJS).

Martin, age 13, just started taking amoxicillin for otitis media. His mother said that he woke up this morning with a rash on his trunk. What is your first action? 1. Prescribe systemic antihistamines. 2. Prescribe a short course of systemic steroids. 3. Stop the amoxicillin. 4. Continue the drug; having this reaction early in the course is normal.

Stop the amoxicillin.

What is the most common bacterial pathogen associated with acute otitis media? 1. Streptococcus pneumoniae. 2. Haemophilus influenzae. 3. Streptococcus pyogenes. 4. Moraxella (Branhamella) catarrhalis.

Streptococcus pneumoniae.

You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency room. Which of the following symptoms would indicate that an airway obstruction is imminent? 1. Reddened face. 2. Screaming. 3. Grabbing her throat. 4. Stridor.

Stridor.

In relation to writing a patient encounter note, the acronym SOAP stands for which of the following words? 1. Subjective, objective, assessment, plan. 2. Symptoms, objective, assessment, pills. 3. Subjective, outward findings, assessment, plan. 4. Symptoms, objective, assessment, plan.

Subjective, objective, assessment, plan.

Sandra, age 32, comes in to the clinic. She has painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? 1. Lymphocytoma cutis. 2. Relapsing polychondritis. 3. Systemic lupus erythematosus. 4. An allergic reaction.

Systemic lupus erythematosus.

Relapse is a common phenomenon seen during behavioral changes. Useful strategies for the health care provider to institute to aid the client in a relapse situation include: 1. Using fear to reinforce the need to change. 2. Telling the client that the relapse is a learning opportunity in preparation for the next action stage. 3. Stressing the need to stay "straight." 4. Involving the family in stressing the need to stay "straight."

Telling the client that the relapse is a learning opportunity in preparation for the next action stage.

What type of reaction following an immunization is considered serious and requires reevaluation? 1. Temperature greater than 103˚F. 2. Fatigue. 3. Temperature of 100.2˚F. 4. Erythema and soreness at the injection site.

Temperature greater than 103˚F.

Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It started approximately 2 days ago and is still present. What kind of headache is she describing? 1. Classic migraine. 2. Tension headache. 3. Sinus headache. 4. Cluster headache.

Tension headache.

Between ages 7 and 18, both boys and girls are immunized against the following diseases: 1. Tetanus, diphtheria, pertussis, meningitis, and human papillomavirus. 2. Tetanus, diphtheria, pertussis, and rotavirus. 3. Tetanus, diphtheria, pertussis, meningitis, human papillomavirus, and pneumonia. 4. Tetanus, diphtheria, pertussis, meningitis, human papillomavirus, and hepatitis C.

Tetanus, diphtheria, pertussis, meningitis, and human papillomavirus.

Mary, a 70-year-old woman with diabetes, is at your office for her 3-month diabetic checkup. Mary's list of medications includes metformin (Glucophage XR) 1000 mg daily, an angiotensin-converting enzyme (ACE) inhibitor daily, and 1 baby aspirin (ASA) daily. Mary's blood work showed a fasting blood sugar (FBS) of 112 and glycosylated hemoglobin (HbA1c) of 6.5. You tell Mary that her blood work shows: 1. That her diabetes is under good control and she should remain on the same medications. 2. That her diabetes is controlled and she needs to have her medications decreased. 3. That her diabetes is not controlled and her medications need to be increased. 4. That her diabetes has resolved and she no longer needs any medication.

That her diabetes is under good control and she should remain on the same medications.

The term indemnity insurer refers to an insurer: 1. In a health maintenance organization (HMO). 2. In a preferred provider organization (PPO). 3. That pays for the medical care of the insured. 4. That pays health care providers on a per-visit, per-procedure basis.

That pays for the medical care of the insured.

Olive has an acute exacerbation of Crohn's disease. Which laboratory test value(s) would you expect to be decreased? 1. Sedimentation rate. 2. Liver enzyme levels. 3. Vitamin A, B complex, and C levels. 4. Bilirubin level.

Vitamin A, B complex, and C levels.

Mr. Brill, age 50, is a house painter who has smoked 2 to 3 packs of cigarettes per day since he was 20 years old. He comes in to the clinic complaining of a chronic cough. When you discuss his smoking behavior, he states, "I know I need to stop smoking, but I'm under too much stress right now." Mr. Brill is at which stage of change? 1. The precontemplative stage. 2. The contemplative stage. 3. The action stage. 4. The maintenance stage.

The contemplative stage.

Sandy, a 68-year-old woman, presents to your office for screening for osteoporosis. She states that her grandmother and mother both lost inches in their old age. She has been postmenopausal for the past 15 years and never took any hormone replacement medications. She is Caucasian, weighs 108 lb, and is 5 ft 1 in tall on today's measurement. When do women lose the greatest amount of bone density? 1. During adolescence. 2. The first year of menopause. 3. The first 10 years after menopause. 4. Bone loss occurs continuously at the same rate from menopause to death.

The first 10 years after menopause.

Elder abuse and neglect are increasing concerns, and it is estimated that 4% to 10% of older Americans are abused or neglected. What is the legal responsibility of the health care provider in reporting elder abuse and neglect? 1. The health care provider should discuss the suspected abuse or neglect with the client. 2. The health care provider should discuss the suspected abuse or neglect with the client's family. 3. The health care provider must report the suspected abuse or neglect to the appropriate state protective agency. 4. The health care provider must confirm the suspected abuse or neglect before reporting it to the appropriate state protective agency.

The health care provider must report the suspected abuse or neglect to the appropriate state protective agency.

The term credentialing means that: 1. An individual is permitted to practice advanced practice nursing. 2. The practitioner has met certain criteria through licensure, certification, and education. 3. An individual has completed a program of study. 4. An individual has prescriptive authority.

The practitioner has met certain criteria through licensure, certification, and education.

Which of the following statements about malignant melanomas is true? 1. They usually occur in older adult males. 2. There will usually be no family history of melanoma. 3. They are common in populations with dark skin. 4. The prognosis is directly related to the thickness of the lesion.

The prognosis is directly related to the thickness of the lesion.

Which of the following statements best describes the term patient engagement? 1. The provider is the best judge of a patient's health care needs. 2. There are shared responsibilities and accountabilities between the provider and the patient. 3. The provider is the ultimate source of information about a patient's health status. 4. Health care is ultimately the individual's responsibility.

There are shared responsibilities and accountabilities between the provider and the patient.

What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive treatment and referral? 1. There is a change in the child's hearing threshold to greater than 25 dB. 2. The child has become a fussy eater. 3. The child's speech and language skills seem slightly delayed. 4. Persistent rhinitis is present.

There is a change in the child's hearing threshold to greater than 25 dB.

Buddy, age 13, presents with annular lesions with scaly borders and central clearing on his trunk. What do you suspect? 1. Psoriasis. 2. Erythema multiforme. 3. Tinea corporis. 4. Syphilis.

Tinea corporis.

Danny, age 18, presents with a pruritic rash on his upper trunk and shoulders. You observe flat to slightly elevated brown papules and plaques that scale when they are rubbed. You also note areas of hypopigmentation. What is your initial diagnosis? 1. Lentigo syndrome. 2. Tinea versicolor. 3. Localized brown macules. 4. Ochronosis.

Tinea versicolor.

A patient presents to your primary care office for a blood pressure check. You have recently started them on an antihypertensive medication. However, on physical exam, the patient continues to have an elevated blood pressure. Which of the following symptoms would not be concerning for a hypertensive crisis? 1. Chest pain. 2. Visual changes. 3. Tinnitus. 4. Severe headache.

Tinnitus.

Which of the following statements related to statistical techniques and their usage in research is true? 1. Statistical significance and clinical significance are the same. 2. If a journal article you are writing is required to be limited in length, you should delete the descriptive statistics and keep the inferential statistics. 3. Correlational coefficients imply causality. 4. To determine the appropriate statistical test to use, consider sample size, level of measurement, and data type.

To determine the appropriate statistical test to use, consider sample size, level of measurement, and data type.

Mrs. Smith, age 85, lost her husband 6 months ago. Since that time, she has been overwhelmed and has had difficulty coping. Today, she is in your office, tearful, weak, and discouraged. Her mobility is also becoming increasingly limited because of her need for a hip replacement. She is indecisive, expresses fear about the surgery, and tells you she does not want the surgery. Your best action is to: 1. Treat the client's psychological problems and provide support. 2. Respect the client's wishes. 3. Consider placing the client in an assisted living facility. 4. Explain to the client that she is depressed and will feel better after the surgery.

Treat the client's psychological problems and provide support.

Jennifer, agSusan states that her fiancé has been frostbitten on the nose while skiing and is fearful that it will happen again. What do you tell her? 1. "Don't worry—as long as he gets medical help in the first few hours after being frostbitten again, he'll recover." 2. "Once frostbitten, he should not go out skiing again." 3. "If it should happen again, massage the nose with a dry hand." 4. "Infarction and necrosis of the affected tissue can happen with repeated frostbite."e 32, is pregnant and has genital warts (condylomata) and would like to have them treated. What should you order? 1. Benzoyl peroxide. 2. Podophyllin (Podocon-25). 3. Trichloroacetic acid. 4. Corticosteroids.

Trichloroacetic acid.

Which of the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? 1. Trigeminal neuralgia. 2. Temporomandibular joint (TMJ) syndrome. 3. Goiter. 4. Preauricular adenitis.

Trigeminal neuralgia.

Harvey, age 55, comes to the office with a blood pressure (BP) of 144/96 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the examination, it remains 144/96. What should your next action be? 1. Start him on an angiotensin-converting enzyme (ACE) inhibitor. 2. Start him on a diuretic. 3. Have him monitor his blood pressure at home. 4. Try nonpharmacological methods and have him monitor his blood pressure at home.

Try nonpharmacological methods and have him monitor his blood pressure at home.

A 27-year-old female comes in to your primary care office complaining of a perioral rash. The patient noticed burning around her lips a couple days ago that quickly went away. She awoke from sleep yesterday and noticed a group of vesicles with erythematous bases where the burning had been before. There is no burning today. She is afebrile and has no difficulty eating or swallowing. What test would confirm her diagnosis? 1. Tzanck smear. 2. Potassium hydroxide (KOH) prep. 3. Exam under a Wood lamp. 4. Sterile culture sent for aerobic and anaerobic bacteria.

Tzanck smear.

Which of the following headache descriptions does not match the accompanying diagnosis? 1. Worst headache of your life = subarachnoid hemorrhage. 2. Headache associated with aura = migraine headache. 3. Unilateral temporal headache with associated pulsatile sensation = tension headache. 4. Headache associated with loss of consciousness = intracranial pressure change.

Unilateral temporal headache with associated pulsatile sensation = tension headache.

Louis, age 52, presents with pruritus with no rash present. He has hypertension, diabetes, and end-stage renal disease (ESRD). Which of the following would be included in the differential diagnosis? 1. Uremia from chronic renal disease. 2. Contact dermatitis. 3. Lichen planus. 4. Psoriasis.

Uremia from chronic renal disease.

Harry is taking his entire family to Central America and is wondering about protection against bites from malaria-causing mosquitoes. What advice do you give him? 1. Use an insect repellent with diethyltoluamide (DEET) for the entire family, applying it sparingly to small children. 2. Make sure the family is in well-screened or indoor areas from dusk to dawn. 3. Use an insect repellent with diethyltoluamide (DEET) for adults and permethrin for children, and stay inside from dusk to dawn. 4. Stay inside from dusk to dawn, and use an insect repellent with permethrin.

Use an insect repellent with diethyltoluamide (DEET) for adults and permethrin for children, and stay inside from dusk to dawn.

Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer's ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? 1. Start using a cotton-tipped applicator to dry the ears after swimming. 2. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. 3. Use a hair dryer on the highest setting to dry the ears. 4. Stop swimming.

Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming.

Prescriptive authority for advanced practice registered nurses (APRNs): 1. Is permitted only under protocol. 2. Is mandated by law in more than 40 states. 3. Varies by state. 4. Includes the ability to prescribe controlled substances.

Varies by state.

A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no decrease in extraocular movements. The patient has a sibling that just started day care recently. He also has bilateral preauricular lymph nodes that are inflamed. What is the patient's diagnosis? 1. Viral conjunctivitis. 2. Bacterial conjunctivitis. 3. Allergic conjunctivitis. 4. Blepharitis.

Viral conjunctivitis.

A 22-year-old African American female presents to your family practice office complaining of progressive skin discoloration. She is adopted and has no known family history of skin problems. The patient notes nonpalpable patches of skin loss and blanching of her forehead and both hands and feet. It has developed over a period of 6 months and appears to have stopped. It is not pruritic, and there is no erythema or sign of infectious etiology. What is the most likely diagnosis? 1. Vitiligo. 2. Alopecia. 3. Addison disease. 4. Tinea versicolor.

Vitiligo.

12—48 Duodenal and gastric ulcers have many of the same manifestations. Which is more common with gastric ulcers rather than duodenal ulcers? Epigastric or abdominal pain Vomiting Possibility of perforation Obstruction of the gastrointestinal tract

Vomiting

You are teaching Harvey, age 55, about the warts on his hands. What is included in your teaching? 1. Treatment is usually effective, and most warts will not recur afterward. 2. Because warts have roots, it is difficult to remove them surgically. 3. Warts are caused by the human papillomavirus. 4. Shaving the wart may prevent its recurrence.

Warts are caused by the human papillomavirus.

Which is the most common presenting symptom of gastric cancer? 1. Weight loss. 2. Dysphagia. 3. Hematemesis. 4. Gastrointestinal bleeding.

Weight loss.

When teaching your client about medication you are prescribing, the most important point(s) to discuss initially is(are): 1. The action of the drug and its adverse effects. 2. Whether to take the drug on a full or empty stomach. 3. What it is for, how much to take, and when to take it. 4. What to do if the client experiences any adverse effects.

What it is for, how much to take, and when to take it.

Which of the following describes a situation in which medical information may be passed on without client consent? 1. When the client has a gunshot wound. 2. When a potential employer asks for it. 3. When certifying absence from work. 4. When talking to another health care provider.

When the client has a gunshot wound.

It is important to prepare for your interview as an advanced practice registered nurse (APRN). You should be prepared to answer which of the following? 1. How old you are and how many children you have because your childcare responsibilities might affect how you are able to do your job. 2. Whether you are prepared to advertise the practice using your own funds as well as other things you can bring to the practice. 3. What you can bring to the practice and whether you will be able to see clients in a 10- to 15-minute block of time to make yourself revenue-producing. 4. Why you should be hired, how many clients per day you will see, what you can bring to the practice, your willingness to work evenings and/or weekends and to take calls, and how independent you are in your practice.

Why you should be hired, how many clients per day you will see, what you can bring to the practice, your willingness to work evenings and/or weekends and to take calls, and how independent you are in your practice.

The best way you, as an individual advanced practice registered nurse (APRN), can make a difference or real impact is by: 1. Reading about issues in the newspaper. 2. Writing letters to the editor supporting APRNs. 3. Thinking positively about the work you do. 4. Supporting a Democratic candidate.

Writing letters to the editor supporting APRNs.

Denial of provider status is something that seriously impedes a nurse practitioner's ability to practice. If that occurs, some steps one can take include: 1. Requesting that your clients lobby on your behalf, going to the newspapers, and reapplying. 2. Requesting that your physician colleagues intervene on your behalf and writing critical letters to the organization in question. 3. "Bashing" the organization to others, reapplying, and contacting an attorney. 4. Writing letters to the organization's president and chief executive officer (CEO), activating others to lobby on your behalf, and reapplying after a 6-month period.

Writing letters to the organization's president and chief executive officer (CEO), activating others to lobby on your behalf, and reapplying after a 6-month period.

April, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthi. She is concerned that they may be cancerous skin lesions. You tell her that they are probably: 1. Xanthelasmas. 2. Pingueculae. 3. The result of arcus senilis. 4. Actinic keratoses.

Xanthelasmas.

You have seen a client who has tested positive for syphilis. You have treated the client; tested the client for other potential sexually transmitted diseases, including human immunodeficiency virus (HIV); counseled the client about safe sexual practices; and scheduled the client to return at 3 and 6 months for repeat serologic testing. The tests at those times demonstrated that no further syphilis was present. Should you have taken any other action? 1. No, you have treated the client appropriately. 2. Yes, you must report the case to the local health authorities. 3. Yes, you need to notify all sexual contacts. 4. Yes, you must follow up on the client's HIV status.

Yes, you must report the case to the local health authorities.

Which of the following statements does not belong in the past medical history portion of your chart note? 1. Your patient had lab work at their last appointment that was negative. 2. Your patient had a cholecystectomy 3 years prior. 3. Your patient's father passed away from lung cancer. 4. Your patient has an allergy to penicillin.

Your patient had lab work at their last appointment that was negative.

12—85 You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylon and plan to treat her empirically. What medications should you order? A. Bismuth subsalicylate (Pepto-Bismol) , tetracycline (Achromycin) or amoxicillin (Amoxil) , and metronidazole (Flagyl) B. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Priosec) C. Amoxicillin (Amoxil) and omeprazole (Prilosec) D. Clarithromycin (Biaxin) and metronidazole (Flagyl)

a

12-32 Which protozoal infection is the most common intestinal infection in the United States that also occurs worldwide? A. Salmonellosis B. Giardiasis C. Botulism D. Shigellosis

b

12—29 Steve. age 79, has GERD. When teaching him how to reduce his loiz'er esophageal sphincter pres sure, which substances do you recommend that tie avoid? A. Apples B. Peppermint C. Cucumbers D. Popsicles

b

12—47 Matt, aged 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? A. Campylobacter jejuni B. Clostridium botulinum C. Clostridium perfringens D. Staphylococcus

b

12—51 Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: A. constipation. B. colorectal cancer. C. irritable bowel syndrome. D. acute appendicitis.

b

12—58 Which of the following antibiotics causes mor episodes of nausea and/or vomiting than the others? A. Azithromycin (Zithromax) B. Erythromycin (E-Mycin) C. Penicillin (Pen-Vee K) D. Tetracycline (Achromycin)

b

12—66 Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you that she is sure that it is going to be malignant. How do you respond? A. "Don't worry, gastric ulcers are not gastric cancer." B. "About 95 % of gastric ulcers are benign." C. "You have about a 50/50 chance of having gastric cancer from your ulcer." D. "Even if it is cancer, surgery is 100% successful."

b

12—74 Which of the following findings is not associated with diverticulitis? Left lower quadrant abdominal pain A history of irritable bowel-syndrome A tender mass in the left lower quadrant An elevated temperature

b

I 2—26 How do diphenoxylate (Lomotil) arid loperamide (Imodium) help relieve diarrhea? A. They reduce bowel spasticity and acid secretion in the stomach. B. They decrease the motility of the ileum and colon, slowing the transit time and promoting more water absorption. C. They increase motility to assist in removing all of the stool. D. By decreasing the sensations of the gastric nerves, they send a message to the brain to slow down peristalsis.

b

1 2—59 All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger-zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? A. Anticholinergics such as scopolamine (Donnatal) B. Antidoparninergic agents such as prochlorperazine (Compazine) C. Antidopaminergic and cholinergic agents such as metoclopramide (Reglan) D. Tetrahydrocannabinols such as dronabinol (Marinol)

c

12—27 Sara is taking polyethylene glycol (GoLYTELY) in preparation for a barium enema. What do you teach her about the medication? A. Drink the solution at room temperature. B. Take the medication with food so that it will be absorbed better. C. Take the medication in the early evening so as not to interfere with sleep. D. Drink all of the solution in one sitting.

c

12—28 Which laxative is safe for long-term use? A. Mineral oil B. Bisacodyl (Dulcolax) C. Methylcellulose (Citrucel) D. Magnesium hydroxide (milk of magnesia)

c

12—33 Which laboratory value would you expect to be increased in the presence of significant diarrhea? A. Serum potassium B. Serum sodium C. Serum chloride D. Bicarbonate

c

12—34 Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect that she has which protozoal infection of the bowel? A. Giardiasis B. Amebiasis C. Cryptosporidiosis D. Escherichia coli

c

12—31 Murcie just returned from Central America with traveler's diarrhea. Which antibiotic do you order? Ampicillin (Polycillin) Tetracycline (Achromycin) Ciprofloxacin (Cipro) Azithromycin (Zithromax)

cipro

1 2—90 For an uncomplicated Salmonella infection, the antibiotic of choice is: A. ampidilhin (Polycillin). B. amoxicillin (Amoxil). C. trimethoprim-sulfarnethoxazole (Bactrim). D. No antibiotic is indicated

d

12-62 Sally had an ileostomy performed for inflammatory bowel disease. What type of fecal output can Sally expect? A. Hard, formed stool B. Semisoft stool C. Semisoft to very soft stool D. A continuous soft to watery effluent

d

12—21 You auscultate Julie's Abdomen and hear a. peritoneal friction rub. Which condition do you rule out? A. Peritonitis B. A liver or spleen abscess C. A liver or spleen metastatic tumor D. Irritable bowel syndrome

d

12—23 When George tells you that his feces are foul-smelling, you may suspect all of the following except: A. blood in the stool. B. ingestion of a high-fat diet C. colon cancer. D. appendicitis.

d

12—24 Simon states that he is worried because he has a bowel movement only every third day. You respond: A. "You should have 2 to 3 stools per day." B. "You should defecate once a day." C. "You should have at least 3 stools per week." D. "There is no such thing as a 'normal' pattern of defecation."

d

12—25 Anson tells you that he thinks his antacids are causing his diarrhea. You respond. A. "Antacids contain fructose that may not be totally absorbed and results in fluid being drawn into the bowel." B. "Antacids contain sorbitol or mannitol, sugars that aren't absorbed and can cause fluid [O be drawn into the bowel." C. "Antacids contain caffeine, which decreases bowel transit time." D. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel"

d

12—72 The most important diagnostic test for celiac disease is: A confirming malabsorption by laboratory tests. B barium enema. C peroral biopsy of the duodenum. D gluten-free diet trial with an accompanying improvement in mucosal histologic response.

d

12—99 More than 50% of older adults have all of the following conditions except: A. hiatal hernia. B. diverticulosis. C. constipation. D. colonic polyps.

d

12—97 The most common cause of mechanical bowel obstruction in all ages is: A. volvulus. intussusception. cancer. a hernia.

hernia

12—64 All of the following are common signs of gastric cancer except: weight loss. dysphagia. hematemesis. gastrointestinal bleeding.

gastrointestinal bleeding.

12—89 The most common viral infection causing diarrhea in the United States is: enteric adenovirus. a Norwalk-like virus. rotavirus. Giardia lamblia.

rotavirus

12—71 Marisa, age 42, has celiac disease. She is prone to osteopenic bone disease as a result of impaired calcium absorption because of: A. increased calcium absorption by the small intestine. B. increased absorption of the fat-soluble vitamin D. C. the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids. D. decreased magnesium absorption.

the binding of calcium and magnesium in the intestinal lumen by unabsorbed dietary fatty acids.

triad of symptoms associated with Meniere's disease vertigo, hearing loss, and tinnitus

vertigo, hearing loss, and tinnitus

Which of the following is not a risk factor for cholecystitis? 1. Female gender. 2. Obesity. 3. Sickle cell anemia. 4. Younger age.

Younger age.

Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect? 1. A gastric ulcer. 2. Gastritis. 3. Pelvic inflammatory disease. 4. Pancreatitis.

Pelvic inflammatory disease.

Which of the following medications/drugs are not known to cause heartburn or dyspepsia? 1. Alcohol. 2. Motrin. 3. Prednisone. 4. Tylenol.

Tylenol.

Which of the following is the most common cause of acute pancreatitis? 1. Gallstone obstruction of the pancreatic duct. 2. Alcoholism. 3. Hypertriglyceridemia. 4. Gallstone obstruction of the pancreatic duct and alcoholism.

Gallstone obstruction of the pancreatic duct and alcoholism.

Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for: 1. Constipation. 2. Colorectal cancer. 3. Irritable bowel syndrome. 4. Acute appendicitis.

Colorectal cancer.

Marcie just returned from Central America with traveler's diarrhea. Which is the best treatment? 1. Metronidazole (Flagyl). 2. Supportive care. 3. Quinolone antibiotics. 4. Gastric lavage.

Supportive care.

The metabolism of which drug is not affected in Marsha, age 74? 1. Alcohol. 2. Anticonvulsants. 3. Psychotropics. 4. Oral anticoagulants.

Alcohol.

What is the best diagnostic test to confirm the diagnosis of celiac disease? 1. Anti-tTG IgA. 2. Anti-dsDNA. 3. Colonoscopy. 4. Anti-CCP protein.

Anti-tTG IgA.

A mother brings in her 4-year-old child, who she states has acute abdominal pain and a rash. Which of the following do you initially rule out? 1. Rocky Mountain spotted fever. 2. Measles. 3. Appendicitis. 4. A food allergy.

Appendicitis.

. Cydney has been given a diagnosis of ascariasis. Which symptoms would you expect to see? 1. Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea. 2. Nocturnal perianal and perineal pruritus. 3. Diarrhea, cramps, and malaise. 4. Ascites and facial and extremity edema.

Low-grade fever, productive cough with blood-tinged sputum, wheezing, and dyspnea

Margie, age 52, has an extremely stressful job and was just given a diagnosis of gastric ulcer. She tells you she is sure it is going to be malignant. How do you respond? 1. "Don't worry. Gastric ulcers are not cancerous." 2. "About 95% of gastric ulcers are benign." 3. "You have about a 50% chance of having gastric cancer from your ulcer." 4. "Even if it is cancer, surgery is 100% successful."

"About 95% of gastric ulcers are benign."

Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond: 1. "Do not donate blood until one year after diagnosis." 2. "Abstain from sex altogether." 3. "There is no possibility of transmission through razors or toothbrushes." 4. "Abstain from sex during your period."

"Abstain from sex during your period."

What is the most common cause of epistaxis? 1. Digital trauma. 2. Warfarin. 3. Vitamin C deficiency. 4. Hemophilia A.

Digital trauma.

Which gastrointestinal disease below could theoretically be completely eradicated with a total colectomy? 1. Crohn's disease. 2. Irritable bowel syndrome. 3. Ulcerative colitis. 4. Celiac disease.

Ulcerative colitis.

Dottie brings in her infant, who has gastroesophageal reflux. What do you tell her about positioning her infant? 1. "Always position infants on their back to prevent sudden infant death syndrome." 2. "Rotate your infant between lying on the back and on the stomach." 3. "Your infant should be placed on the left side." 4. "Place your infant in whatever position she remains quiet."

"Always position infants on their back to prevent sudden infant death syndrome."

Anson tells you he thinks his antacids are causing his diarrhea. You respond: 1. "Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel." 2. "Antacids contain sorbitol or mannitol, which are sugars that aren't absorbed and can cause fluid to be drawn into the bowel." 3. "Antacids contain caffeine, which decreases bowel transit time." 4. "Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

"Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel."

Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks you why he has bleeding problems. How do you respond? 1. "Occasionally he accumulates blood in the gut." 2. "There is an interruption of the normal clotting mechanism." 3. "Long-term alcohol abuse has made his vessels very friable." 4. "His bone marrow has been affected."

"There is an interruption of the normal clotting mechanism."

Simon, age 72, states that he is worried because he has a bowel movement only every third day. You respond: 1. "You should have two to three stools per day." 2. "You should defecate once a day." 3. "You should have at least three stools per week." 4. "There is no such thing as a 'normal' pattern of defecation."

"There is no such thing as a 'normal' pattern of defecation."

Sally, age 21, is to undergo a tonsillectomy. She has heard about permanent taste changes after a tonsillectomy. What do you tell her? 1. " As the tongue is responsible for sweet, sour, salty, and bitter taste abilities, they will all be affected somewhat." 2. "You will have some alterations, but we'll have to wait and see how you are affected personally." 3. "You may notice a slight difference initially, but there are no lasting changes in taste." 4. "About half of the patients have some permanent alterations in the sense of taste."

"You may notice a slight difference initially, but there are no lasting changes in taste."

You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her empirically. What medications should you order? 1. A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl). 2. Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec). 3. Amoxicillin (Amoxil) and omeprazole (Prilosec). 4. Clarithromycin (Biaxin) and metronidazole (Flagyl).

A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl).

A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no mastoid tenderness. What is the next step? 1. Symptom management and reassurance that symptoms will resolve with time. 2. Computed tomography (CT) of the head. 3. Amoxicillin 80 to 90 mg/kg/d. 4. Augmentin 45 mg/kg/d.

Amoxicillin 80 to 90 mg/kg/d.

What is the recommended treatment to eradicate a Helicobacter pylori infection? 1. Ranitidine, amoxicillin, and clarithromycin for 2 weeks. 2. Amoxicillin, clarithromycin, and omeprazole for 2 weeks. 3. Bismuth, amoxicillin, and clarithromycin for 2 weeks. 4. Bismuth, doxycycline, metronidazole, and ranitidine.

Amoxicillin, clarithromycin, and omeprazole for 2 weeks.

A 62-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She states that her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has: 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Herpetic conjunctivitis. 4. Diabetic retinopathy.

Angle-closure glaucoma.

You auscultate Julie's abdomen and hear a peritoneal friction rub. Which condition do you rule out? 1. Peritonitis. 2. A liver or spleen abscess. 3. A liver or spleen metastatic tumor. 4. Irritable bowel syndrome.

Irritable bowel syndrome.

A client is experiencing severe upper abdominal pain and jaundice. Which finding on the cholescintigraphy should indicate to the nurse that the client has​ cholelithiasis? A. Obstruction of the cystic duct by a gallstone B. Viral infection of the gallbladder C. Accumulation of fat in the wall of the gallbladder D. Accumulation of bile in the hepatic duct

Answer: A ​Rationale: Cholelithiasis is almost always caused by a gallstone lodged in the cystic duct. Accumulation of bile in the hepatic duct would not lead to cholecystitis. Neither the accumulation of fat nor a viral infection leads to cholecystitis.

The nurse is teaching a client with cholelithiasis about lifestyle modification. Which statement made by the client indicates that the​ nurse's teaching has been​ successful? A. ​"I will walk three times a week for 20 minutes each​ day." B. "I will eliminate salt from my​ diet." C. "I can fry food as long as I use olive oil instead of vegetable​ oil." D. "I will use more ground beef in my meal​ preparation."

Answer: A ​Rationale: Obesity is commonly associated with the development of gallbladder disease. A balanced diet and exercise will help keep the​ client's weight within normal limits. There is no reason to eliminate salt from the diet. Ground beef is high in fat and should be limited. Frying adds additional fat and should be avoided.

A client is experiencing pain and nausea related to biliary colic. Which statement should the nurse make to manage this​ client's symptoms?​ (Select all that​ apply.) A. "Medication will help with the nausea and​ vomiting." B. "Intravenous fluids will ensure that you are well​ hydrated." C. "It's important for you to be comfortable so that you can​ rest." D. ​"Pain medication will be​ prescribed." E. "A bland diet helps with​ nausea."

Answer: A, B, C, D Rationale: Clinical therapies for treating biliary colic include administering​ analgesics, getting adequate​ rest, correcting fluid and electrolyte​ imbalances, and administering antiemetics.

The nurse prepares discharge teaching for a client recovering from a cholecystectomy. Which topic should the nurse include in this​ teaching? (Select all that​ apply.) A. Surgical incision care B. Manifestations of postoperative complications C. Pain control measures D. Activity level E. High-fat diet

Answer: A, B, C, D ​Rationale: The nurse will instruct the client on the prescribed activity​ level, manifestations of postoperative complications that must be reported to the healthcare​ provider, pain control​ measures, and surgical incision care. A​ low-fat, not​ high-fat, diet must be followed by this client after discharge.

A client is recovering from a laparoscopic cholecystectomy. Which nursing action should the nurse use to reduce this​ client's risk of​ infection? (Select all that​ apply.) A. Monitor vital​ signs, including​ temperature, every 4 hours. B. Administer antibiotics as prescribed. C. Coach to take deep breaths every 1dash2 hours while awake. D. Assess the abdomen every 4 hours. E. Place in Fowler position.

Answer: A, B, C, D ​Rationale: To reduce the risk of​ infection, the nurse will monitor vital​ signs, including​ temperature, every 4​ hours, because changes may be the first sign of infection. Assessment of the abdomen can reveal signs of a surgical wound infection.​ Turning, breathing, and incentive spirometry help prevent postsurgical atelectasis and subsequent pneumonia. Antibiotics are used to control infection. Fowler position may enhance the​ client's comfort but will have no effect on postsurgical infection.

A client with acute cholecystitis is experiencing nausea and vomiting. Which nursing action should the nurse use to address this​ client's nutritional​ status? (Select all that​ apply.) A. Counseling regarding​ low-fat menu choices B. Administering antiemetics as prescribed C. Assessing height and weight D. Advising to consume a​ low-protein diet E. Reviewing serum electrolytes

Answer: A, B, C, E ​Rationale: Assessing height and​ weight, reviewing serum​ electrolytes, counseling on​ low-fat menu​ choices, and administering antiemetics as prescribed are all nursing actions that address the​ client's nutritional status. A​ high-protein, not​ low-protein, diet is used to treat cholecystitis.

A client with cholelithiasis is not a surgical candidate at this time. Which pharmacologic treatment should the nurse expect to be prescribed for this​ client? (Select all that​ apply.) A. Ursodiol B. Chenodiol C. Antibiotics D. Antipyretics E. Cholestyramine

Answer: A, B, C, E ​Rationale: Pharmacologic treatment for gallstones is used for clients who refuse surgery or for whom surgery is contraindicated. Medications used in the treatment of gallstones include​ ursodiol, chenodiol,​ antibiotics, cholestyramine, and opioid analgesics. Antipyretics are a pharmacologic treatment for​ fever, not cholelithiasis itself.

Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she: 1. Needs to begin the hepatitis B series as soon as possible. 2. Needs to be tested again because one reading is not indicative of immunity. 3. Is permanently immune to hepatitis B. 4. Has an acute hepatitis B infection.

Is permanently immune to hepatitis B.

The nurse evaluates a​ client's understanding of discharge teaching following a laparoscopic cholecystectomy. Which client statement indicates teaching has been​ effective? (Select all that​ apply.) A. ​"I will take my pain medicine on an empty stomach to get the maximum​ benefit." B. "I will be sure to get up and walk every​ hour." C. "I can have some hot chocolate with my​ breakfast." D. ​"I will increase the protein in my diet by drinking whole​ milk."

Answer: A, B, D ​Rationale: Clients from a laparoscopic cholecystectomy are often treated in day​ surgery, but discharge instructions should be similar to those for other clients who have had abdominal surgery.​ Therefore, they should be informed to be sure to increase their activity level when they return home. Clients should take pain medications with food to diminish irritation to the stomach lining. The client should follow a diet low in fat and high in​ fat-soluble vitamins.​ Therefore, including hot chocolate and whole milk would not be appropriate food choices.

A client with right upper quadrant abdominal pain asks why so many tests are being scheduled. Which is the reason that the nurse should give to this​ client? (Select all that​ apply.) A. To identify possible complications B. To determine if gallstones are present C. To prevent recurrence D. To determine the location of gallstones E. To diagnose the disorder

Answer: A, B, D, E ​Rationale: Diagnostic tests are used to identify the presence and location of​ gallstones, identify possible complications of the​ gallstones, and help differentiate gallbladder disorders from other disease processes. Diagnostic tests do not prevent the formation of gallstones but can give information necessary for treatments that prevent recurrence.

A​ middle-aged female client who is obese has been experiencing right upper quadrant abdominal pain for the past several hours. For which risk factors of gallstone development should the nurse assess this client during the health​ history? (Select all that​ apply.) A. Excess cholesterol B. Inflammation of the gallbladder C. Biliary colic D. Biliary stasis E. Abnormal bile composition

Answer: A, B, D, E ​Rationale: The formation of gallstones occurs when several factors are​ present, including abnormal bile​ composition, biliary​ stasis, inflammation of the​ gallbladder, and excess cholesterol. Excess cholesterol in bile is associated with​ obesity, a​ high-calorie and​ high-cholesterol diet, and drugs that lower serum cholesterol levels. Biliary colic is the pain described in cholelithiasis. This pain is localized to the epigastrium and the right upper quadrant of the abdomen. Biliary colic does not lead to the formation of gallstones.

The nurse is providing dietary teaching to a client with a history of gallstones. Which diet should the nurse​ recommend? (Select all that​ apply.) A. High protein B. Low sodium C. Low fat D. High vitamin C E. High carbohydrate

Answer: A, C Rationale: A​ low-carbohydrate, low-fat,​ high-protein diet reduces symptoms of cholecystitis. While fasting and very​ low-calorie diets are​ contraindicated, a moderate reduction in caloric intake and increased activity levels promote weight loss.

The nurse is preparing health promotion teaching for a client with gallbladder disease. Which topic should the nurse include in the teaching​ session? (Select all that​ apply.) A. Role of a​ high-cholesterol diet on gallstone formation B. Role of hypolipidemia on gallstone formation C. Importance of a​ low-cholesterol diet D. Dangers of rapid weight loss E. Importance of a​ high-fiber diet

Answer: A, C, D, E ​Rationale: Clients should be taught about the role of​ obesity, hyperlipidemia, and a​ high-cholesterol diet on gallstone​ formation; the importance of a​ high-fiber, low-fat, and​ low-cholesterol diet to reduce the incidence of gallbladder​ disorders; and the dangers of rapid weight loss. Hypolipidemia does not promote gallstone formation.

A client scheduled for a cholecystectomy asks what caused the gallstones to develop. Which risk factor should the nurse list when responding to this​ client? (Select all that​ apply.) A. American Indian ethnicity B. Male sex C. Family history of gallstones D. Obesity E. Hyperlipidemia

Answer: A, C, D, E ​Rationale: The risk factors for developing gallbladder disorders include​ age, family history of​ gallstones, American Indian​ ethnicity, obesity,​ hyperlipidemia, female​ sex, pregnancy, diabetes​ mellitus, cirrhosis, ileal​ disease, and sickle cell disease. Men have a lower risk of developing gallbladder disorders.

A pregnant client of American Indian heritage experiences mild gastric distress and nausea after eating large meals and constant sharp abdominal pain. Which additional information should the nurse collect during the​ interview? (Select all that​ apply.) A. History of chronic diseases B. Expected due date C. Length of time the symptoms last and when they occur D. Smoking history E. Other symptoms F. Current diet

Answer: A, C, E, F ​Rationale: The nurse should note current​ manifestations, including right upper quadrant​ (RUQ) abdominal​ pain, and its character and relationship to​ meals, duration, and​ radiation; nausea and​ vomiting; other​ symptoms; duration of​ symptoms; risk factors or previous history of​ symptoms; chronic diseases such as​ diabetes, cirrhosis, or​ IBD; current​ diet; and use of oral contraceptives or possibility of pregnancy.

A client with acute cholecystitis is experiencing jaundice. Which should the nurse consider as the reason for the​ jaundice? A. Viral infection of the gallbladder B. Obstruction of the cystic duct by a gallstone C. Accumulation of bile in the hepatic duct D. Accumulation of fat in the wall of the gallbladder

Answer: B ​Rationale: When acute cholecystitis is accompanied by​ jaundice, partial common duct obstruction is​ likely, which is usually due to stones or inflammation.

A client asks what causes gallstones to form. Which factor should the nurse explain as being present when these stones are​ formed? (Select all that​ apply.) A. Rapid weight gain B. Abnormal bile composition C. Excess cholesterol D. Inflammation of the gallbladder E. Biliary stasis

Answer: B, C, D, E ​Rationale: Gallstones are formed due to abnormal bile​ composition, an inflammation of the​ gallbladder, biliary​ stasis, and excess cholesterol. Rapid weight​ loss, not weight​ gain, is a factor that contributes to the formation of gallstones.

Which is a risk factor for gallbladder​ disease? A. Male gender B. Hypocalcemia C. Rapid weight loss D. Hypolipidemia

Answer: C ​Rationale: Rapid weight​ loss, hyperlipidemia​ (not hypolipidemia), and female​ (not male) gender are risk factors for gallbladder disease. Hypocalcemia is not a risk factor.

Rose, a client with gastroesophageal reflux disease (GERD), has many other concurrent conditions. In teaching Rose about medications to avoid, what do you recommend she refrain from using? 1. Antibiotics. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Oral contraceptives. 4. Antifungals.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

A client who is morbidly obese is diagnosed with acute cholelithiasis. Which nonpharmacologic therapy should the nurse expect to be prescribed for this​ client? A. Parenteral nutrition B. ​Fat-soluble vitamins C. Bile salts D. Withholding all oral intakes and inserting a nasogastric tube

Answer: D ​Rationale: During an acute attack of​ cholecystitis, food should be eliminated and a nasogastric tube inserted to relieve nausea and vomiting. Parenteral nutrition is not indicated at this time. Once the client is eating​ again, dietary fat intake may be​ limited, especially if the client is obese. If bile flow is​ obstructed, fat-soluble vitamins​ (A, D,​ E, and​ K) and bile salts may need to be administered but this would be considered a pharmacologic therapy.

The nurse is planning an educational program about development and prevention of gallstones for a community group. Which population should the nurse identify to be most at risk for developing​ gallstones? A. Young adult Asian American women B. Middle-aged Caucasian American men C. African American clients D. Women over the age of 40

Answer: D ​Rationale: Genetic considerations and risk factors vary depending on the nature of the inflammatory disorder. Female​ sex, being over the age of​ 40, American​ Indians, and Mexican Americans are most at risk for gallstones. Family history is also associated with increased risk.

The nurse is teaching a client with cholelithiasis about a new prescription for ursodiol. Which client statement indicates to the nurse that the teaching was​ successful? A. "If I take this for a long time it might damage my​ liver, so I will need checkups of my liver​ function." B. "There is a good chance I will experience​ diarrhea, so I might need my dosage​ reduced." C. "This medicine should take away the orange color from my​ skin." D. "I might have some slight diarrhea or​ constipation, but that is a normal side effect of the​ medicine."

Answer: D ​Rationale: Ursodiol is a bile acid. It is used to dissolve gallstones in clients who cannot have surgery to remove gallstones. Ursodiol is also used to prevent the formation of gallstones in clients who are overweight or who are losing weight very quickly. It works by decreasing the production of cholesterol and by dissolving the cholesterol in bile so that it cannot form stones. Ursodiol is generally well tolerated but can cause diarrhea or constipation.

All of the following medications are used for the control of nausea and vomiting. Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower esophageal sphincter pressure? 1. Anticholinergics, such as scopolamine (Donnatal). 2. Antidopaminergic agents, such as prochlorperazine (Compazine). 3. Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan). 4. Tetrahydrocannabinols, such as dronabinol (Marinol).

Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan).

Bobby, age 6, has constant periumbilical pain shifting to the right lower quadrant, vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect: 1. Appendicitis. 2. Gastroenteritis. 3. Acute pancreatitis. 4. Rocky Mountain spotted fever.

Appendicitis

You suspect appendicitis in Andrew, who is 18. With his right hip and knee flexed, you slowly rotate his right leg internally to stretch a muscle. He states that it is painful over his right lower quadrant. Which sign did you elicit? 1. Rovsing sign. 2. Psoas sign. 3. Obturator sign. 4. McBurney sign.

Obturator sign.

A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis? 1. Appendicitis. 2. Cholecystitis. 3. Constipation. 4. Gastroenteritis.

Appendicitis.

Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? 1. As a healthy adult with several problems. 2. As having a glycemic event. 3. As having metabolic syndrome. 4. As having multiple organ dysfunction.

As having metabolic syndrome.

A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively worse. He also notes nausea without vomiting, dry mouth, and double vision. On exam you notice his pupillary reflex is absent. The patient states he lives on the street and eats mostly canned goods that he scavenges from a grocery store dumpster. What is the likely cause of the patient's symptoms? 1. Botulism. 2. Salmonella. 3. Lyme disease. 4. Vitamin C deficiency.

Botulism.

Ruby has a colostomy and complains that her stools are too loose. What food(s) do you suggest to help thicken the stools? 1. Cheese. 2. Leafy green vegetables. 3. Raw fruits and vegetables. 4. Dried beans.

Cheese.

Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be: 1. Appendicitis. 2. Crohn's disease. 3. Cholecystitis. 4. Irritable bowel syndrome.

Cholecystitis.

. Matt, age 26, recently returned from a camping trip and has gastroenteritis. He says that he has been eating only canned food. Which of the following pathogens do you suspect? 1. Campylobacter jejuni. 2. Clostridium botulinum. 3. Clostridium perfringens. 4. Staphylococcus.

Clostridium botulinum

he screening guidelines for colon cancer recommend which of the following for the general population? 1. Colonoscopy starting at age 50. 2. Colonoscopy starting at age 45. 3. Fecal occult blood test (FOBT) and rectal exam starting at age 50. 4. Fecal occult blood test (FOBT) and rectal exam starting at age 45.

Colonoscopy starting at age 50.

A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110, blood pressure 150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient? 1. Sigmoidoscopy. 2. Abdominal series. 3. Computed tomography (CT) scan with oral contrast. 4. Abdominal ultrasound.

Computed tomography (CT) scan with oral contrast.

Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you she will: 1. Take a sitz bath after each bowel movement for 1 to 2 weeks after surgery. 2. Drink at least 2000 mL of fluids per day. 3. Decrease her dietary fiber for 1 month. 4. Take stool softeners as prescribed.

Decrease her dietary fiber for 1 month.

In a 2-month-old infant with vomiting and diarrhea, the most effective way of determining a fluid deficit is to check for: 1. Decreased peripheral perfusion. 2. Hyperventilation. 3. Irritability. 4. Hyperthermia.

Decreased peripheral perfusion.

Samantha, age 28, is 100 lb overweight and wants to have a gastroplasty performed. In discussing this with her, you explain that by having this procedure she may: 1. Develop diarrhea. 2. Lose too much weight. 3. Develop hemorrhoids. 4. Vomit after she eats.

Develop diarrhea.

When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you suggest he encourage her to do? 1. Eat foods higher in carbohydrates. 2. Eat 3 large meals plus 3 snacks per day. 3. Eat foods with a moderate fat and protein content. 4. Drink fluids with each meal.

Eat foods with a moderate fat and protein content.

Marty, age 52, notices a bulge in his midline every time he rises from bed in the morning. You tell him that it is a ventral hernia, also known as an: 1. Inguinal hernia. 2. Epigastric hernia. 3. Umbilical hernia. 4. Incisional hernia.

Epigastric hernia

A 65-year-old man presents complaining of a left-sided, deep, throbbing headache and mild fatigue. On examination, the client has a tender, tortuous temporal artery. You suspect giant cell arteritis (GCA), or temporal arteritis. What is the least invasive procedure to help with diagnosis? 1. Magnetic resonance imaging (MRI) of the head. 2. Erythrocyte sedimentation rate (ESR). 3. Electroencephalogram (EEG). 4. Otoscopy.

Erythrocyte sedimentation rate (ESR).

Harvey just came back from Mexico. Which pathogen do you suspect is responsible for his diarrhea? 1. Enterococci. 2. Escherichia coli. 3. Klebsiella. 4. Staphylococci.

Escherichia coli.

What is the most common bacterial cause of traveler's diarrhea? 1. Escherichia coli. 2. Campylobacter jejuni. 3. Salmonella. 4. Shigella.

Escherichia coli.

You are the nurse practitioner caring for Martha, a 47-year-old accountant. You have made a diagnosis of acute sinusitis based on Martha's history and the fact that she complains of pain behind her eye. Which sinuses are affected? 1. Maxillary. 2. Ethmoid. 3. Frontal. 4. Sphenoid.

Ethmoid.

Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? 1. Acute otitis media. 2. Chronic otitis media. 3. External otitis. 4. Temporomandibular joint (TMJ) syndrome.

External otitis.

You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she misunderstands the teaching when she tells you she can have: 1. Yogurt. 2. Foods containing whey. 3. Prehydrolyzed milk. 4. Oranges.

Foods containing whey.

Rose has gastroesophageal reflux disease (GERD). You know she misunderstands your teaching when she tells you she will: 1. Avoid coffee, alcohol, chocolate, peppermint, and spicy foods. 2. Eat smaller meals. 3. Have a snack before retiring so that the esophagus and stomach are not empty at bedtime. 4. Stop smoking.

Have a snack before retiring so that the esophagus and stomach are not empty at bedtime.

Which of the following is not a complication of untreated group A streptococcal pharyngitis? 1. Glomerulonephritis. 2. Rheumatic heart disease. 3. Scarlet fever. 4. Hemolytic anemia.

Hemolytic anemia.

Hepatitis D is an RNA virus that requires a coinfection with which of the following strains of hepatitis in order to replicate? 1. Hepatitis A. 2. Hepatitis B. 3. Hepatitis C. 4. Hepatitis E.

Hepatitis B.

Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly improved over last week's symptoms. Which stage of viral hepatitis do you suspect? 1. Incubation. 2. Prodromal. 3. Icteric. 4. Convalescent.

Icteric.

Which of the following is not true regarding hepatitis C? 1. The greatest rate of infection in the general population is seen in people born between 1945 and 1965. 2. Many hepatitis C infections are asymptomatic. 3. Hepatitis C is seen more frequently in men than women. 4. If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer.

If hepatitis is asymptomatic it doesn't cause cirrhosis or liver cancer.

You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you she will: 1. Decrease her fat intake. 2. Increase her fiber intake. 3. Continue her daily use of aspirin. 4. Increase her fluid intake.

Increase her fluid intake.

You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with: 1. Anxiety and panic attacks. 2. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Infection by Helicobacter pylori. 4. A family history of peptic ulcers.

Infection by Helicobacter pylori.

Melva, age 63, presents with an acute exacerbation of pancreatitis, and you are going to admit her to the hospital. Which is the most important factor in determining a negative long-term outcome for her? 1. Age. 2. Infection. 3. Pain. 4. Length of time between exacerbations.

Infection.

You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect? 1. Cirrhosis. 2. Inflammation of the kidney. 3. Inflammation of the spleen. 4. Peritonitis.

Inflammation of the kidney.

A 25-year-old male presents complaining of hematochezia. The patient states he has noticed this for 2 days. He states there is a streak of bright blood along his stool every time he has a bowel movement. The patient has no pain with his bowel movements. He admits to eating a poor diet. The patient has no abdominal pain, nausea, or vomiting. On physical exam the patient has a positive fecal occult blood test but has no noticeable rectal bleeding or lesions. What is the likely diagnosis? 1. Internal hemorrhoid. 2. External hemorrhoid. 3. Bleeding peptic ulcer. 4. Rectal fissure.

Internal hemorrhoid.

Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: 1. Bacterial conjunctivitis. 2. Viral conjunctivitis. 3. Allergic conjunctivitis. 4. Iritis.

Iritis

A 75-year-old African American male presents to your family practice office complaining of visual impairment. He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past 6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is 23 mm Hg. What is his most likely diagnosis? 1. Open-angle glaucoma. 2. Angle-closure glaucoma. 3. Cataracts. 4. Macular degeneration.

Open-angle glaucoma.

A 25-year-old male presents with "bleeding in my eye" for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient's sclera of the right eye only and takes up less than 50% of the eye. The patient's remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment? 1. Topical steroids and close follow-up with an ophthalmologist. 2. Sending the patient to the emergency department for immediate ophthalmology consult. 3. Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks. 4. Cold compresses and frequent handwashing.

Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.

You are trying to differentiate between functional (acquired) constipation and Hirschsprung disease in a neonate. Distinguishing features of Hirschsprung disease include which of the following? 1. Small ribbonlike stools. 2. Obvious abdominal pain. 3. Female gender. 4. Small weight gain.

Small ribbonlike stools.

A 75-year-old female presents to your office complaining of dizziness and hearing loss. The patient states she awoke yesterday with dizziness, which she described as feeling the room spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts longer than bone conduction. What is the next step in helping this patient's symptoms? 1. Order a computed tomography (CT) scan to rule out acoustic neuroma. 2. Start her on high-dose Augmentin. 3. Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks. 4. Immediate referral to an ear, nose, and throat (ENT) specialist.

Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks.

You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: 1. Gentamicin ophthalmic ointment. 2. Ciprofloxacin ophthalmic drops. 3. Supportive measures and lubricating drops (artificial tears). 4. Oral erythromycin for 14 days.

Supportive measures and lubricating drops (artificial tears).

Your client's 2-month-old daughter is admitted with gastroenteritis and dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the child's diarrhea, how do you respond? 1. "She must be lactose intolerant from the formula, and this is altering the fluid balance." 2. "Her body's telling you that it's time to introduce some solids into her system." 3. "The virus is causing irritation of the gastrointestinal lining, which causes diarrhea." 4. "The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients."

The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients."

While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are abnormally narrow. What are you examining? 1. The nasolabial folds. 2. The openings between the margins of the upper and lower eyelids. 3. The thyroid gland in relation to the trachea. 4. The distance between the trigeminal nerve branches.

The openings between the margins of the upper and lower eyelids.

A 75-year-old male presents for a routine physical. He is obese and has no abdominal pain or recent injuries or problems. He has no complaints. He lies supine for his abdominal exam. He is nontender to palpation and has a normal exam. When he sits up you see a large mass protrude from his abdomen. It is central to his abdomen and inferior to his rib cage. It disappears when he is sitting up fully. What is the patient's diagnosis? 1. Ventral (epigastric) hernia. 2. Inguinal hernia. 3. Femoral hernia. 4. Umbilical hernia.

Ventral (epigastric) hernia.