Exam 2 Acute Care

Extreme tenderness and involuntary guarding at McBurney's point is a significant finding for possible: Acute gastroenteritis Acute appendicitis Acute diverticulitis Acute cholecystitis

Acute appendicitis

If cervical stenosis is met when performing IUD insertions, which of the following should be used to overcome resistance? 12 - 15 cm 3 - 6 cm 9 - 12 cm 6 - 9 cm

6 - 9 cm

What is your treatment for Atrophic Vulvovaginitis? Diflucan (Fluconazole) 150mg PO x 1 Flagyl (Metronidazole) 2g PO x 1 Premarin cream 0.5g PV 1-3 x wk Clindamycin 2% 5g applicator PV x 7 days

Premarin cream 0.5g PV 1-3 x wk

If cervical stenosis is met when performing IUD insertions, which of the following should be used to overcome resistance? 12 - 15 cm 6 - 9 cm 9 - 12 cm 3 - 6 cm

6 - 9 cm

A patientwith acute anxiety will experience the fastest relief of symptoms when he is treated with? A benzodiazepine A TCA An SSRI A beta blocker

A benzodiazepine

Syphilis may present as: Discharge Painful lesions Dysuria A rash

A rash Secondary syphilis can present as a rash, more commonly on the palms of the hands or soles of the feet. Lesions are usually painless. It usually does not produce significant dysuria or discharge.

You are seeing a new 10 year old patient in your primary care clinic. You believe the patient has symptoms congruent with bipolar disorder. However, you also know that the usual age of onset of symptoms with bipolar disorder is: Childhood Third decade Adolescence Between 15 and 30 years old

Between 15 and 30 years old The usual age of onset of bipolar disease symptoms as between 15- 30 years old. Onset of symptoms almost never occurs in patients older than 65 or younger than 15 years old.

A 26-year-old female patient has been diagnosed with gonorrhea. However should she be managed? Ceftriaxone and azithromycin Cefixime and azithromycin Ceftriaxone only Penicillin G

Ceftriaxone and azithromycin Usual treatment for gonorrhea/Chlamydia includes ceftriaxone 250 mg IM in conjunction with 1 g azithromycin by mouth.

CNS stimulants cause increase alertness, excitation, and sometime euphoria. Stimulant drugs include the following: Naloxone, Benzodiazepines and Alcohol Benzodiazepines, Cocaine and Amphetamines Cocaine, Amphetamine and Ecstasy Ectasy, Cocaine and Alcohol

Cocaine, Amphetamine and Ecstasy

A patient who has been taking an NSAID for osteoarthritis pain has newly diagnosed peptic ulcer disease. What is the initial step in treating this patient? Discontinue the NSAID Order prostaglandin therapy Prescribe a proton pump inhibitor Recommend an H2 receptor antagonist

Discontinue the NSAID

A 24-year-old patient presents to clinic with intermittent nausea and vomiting for the past 5 days. She feels fine otherwise. She is afebrile. Her vital signs are within normal limits. What should the nurse practitioner ordered initially? Electrolytes and qualitative beta hCG Metabolic panel and potassium level CBC and urine for ketones Electrolytes and quantitative beta hCG

Electrolytes and qualitative beta hCG Pregnancy must be ruled out for this patient. The other concern is her electrolyte status, especially her potassium level as it tends to drop with vomiting

Which factors increase the risk of renal stones? (Select all that apply.) Excess antacid use Vitamin D excess Strenuous exercise Snow skiing Surgical menopause

Excess antacid use Strenuous exercise Surgical menopause

An asymptomatic pregnant woman has a positive leukocyte esterase and positive nitrites on a urine dipstick screening. What will the provider do next? Admit to the hospital Obtain a urine culture Prescribe trimethoprim-sulfamethoxazole Order a renal ultrasound

Obtain a urine culture

A 29-year-old postpartum female reports that she is having difficulty with concentration, sleep, and has feelings of guilt. She states that she feels sad most of the time. The symptoms have been present since the birth of her baby about one month ago. She can be diagnosed with: Dysthymia Hypothyroidism Postpartum depression Minor depressive disorder

Postpartum depression Post partum depression is diagnosed with depression begins within the first month after delivery.

An older male patient reports gross hematuria but denies flank pain and fever. What will the provider do to manage this patient? Obtain a urine culture Monitor blood pressure closely Refer for cystoscopy and imaging Perform a 24-hour urine collection

Refer for cystoscopy and imaging

A patient who has a history of diverticular disease has left-sided pain and reports seeing blood in the stool. What is an important intervention for these symptoms? Ordering a CBC and stool for occult blood Referring the patient for a lower endoscopy Prescribing an antispasmodic medication Reminding the patient to eat a high-fiber diet

Referring the patient for a lower endoscopy

Which class of antidepressants is first line to treat obsessive compulsive disorder? SNRI TCA MAOI SSRI

SSRI

The provider is counseling a patient who has stress incontinence about ways to minimize accidents. What will the provider suggest initially? Voiding every 2 hours during the day Referral to a physical therapist Increasing fluid intake to dilute the urine Taking pseudoephedrine daily

Voiding every 2 hours during the day

An 8-month-old girl is brought by her grandmother to see the nurse practitioner because of intermittent, random episodes of vomiting, abdominal bloating, currant jelly stools, and irritability with poor appetite. The infant is stranding in the 10th percentile on the growth chart and appears lethargic. During the abdominal exam, a sausage like mass is palpated on the right side of the abdomen. The infant's presentation is highly suggestive of which condition? Lactose intolerance Intussusception Inflammatory bowel disease Irritable bowel syndrome

Intussusception The classic triad of intussusception is currant jelly stools, a sausage like mass, and pain. A sausage-shaped abdominal mass may be palpated on the right side of the abdomen.

An 83 year old is diagnosed with diverticulitis. The most common complaint is Rectal bleeding Bloating and crampiness Left lower quadrant pain Frequent belching and flatulence

Left lower quadrant pain

A pregnant patient is found to have positive leukocytes and positive nitrates in her urine. She is asymptomatic. What medication should be given? Trimethoprim-sulfamethoxazole Doxycycline Pyridium Nitrofurantoin

Nitrofurantoin Patient's urinalysis indicates UTI. Nitrofurantoin would be a good choice to treat patient, it is generally considered safe during pregnancy. Doxycycline is not considered safe during pregnancy.

In a private NP clinic, patient presents with Trichomonas. State law requires reporting of STD to the public health department. The patient asks the NP not to reported because her husband works in the public health department. How show this be managed by the NP? Report it to the public health department as required by law Report it to the public health department but don't divulge all the details Tell the patient that it will not be reported, but report it anyways Respect the patient's right privacy and not report it

Report it to the public health department as required by law If state law requires it, it should be reported. Patient names or other identifying data are not part of the reporting process, so the patient should not worry about being identified and associated with this finding.

The uterus should sound to ______ cm when measuring for Mirena IUD insertion to allow for the arms to open and proper alignment to occur. 6 cm; measured and documented in the chart. 6 cm; measured and forgotten about. 3 cm; measured and documented in the chart. 3 cm; measured and forgotten about.

3 cm; measured and documented in the chart.

The mother of a 3-day-old newborn reports that her infant nurses every 3-4 hours during the day and sleeps 6 hours at night. What will the provider recommend? Pumping her breasts to maintain her milk supply so that baby will have extra milk later after the initial newborn period. Ensuring that her infant nurses for 15 to 20 minutes each time on one breast only, switching to the other breast at the next feeding Awakening the baby every 3-4 hours to nurse if the baby is not gaining weight Continuing this schedule until the baby is 6 months old, then the interval between feedings can be increased

Awakening the baby every 3-4 hours to nurse if the baby is not gaining weight

A patient has a history of diverticular disease and asks what can be done to minimize acute symptoms. What will the practitioner recommend to this patient? Taking an anticholinergic medication Consuming a diet high in fiber Avoiding saturated fats and red meat Using bran to replace high-fiber foods

Consuming a diet high in fiber

Which medications may increase the prevalence of GERD? (Select all that apply.) Calcium antagonists Aspirin Oral contraceptives Hormone replacements Benzodiazepines

Calcium antagonists Aspirin Benzodiazepines

A 30-year-old male patient has a positive leukocyte esterase and nitrites on a random urine dipstick during a well patient exam. What type of urinary tract infection does this represent? Unresolved Uncomplicated Isolation Complicated

Complicated

All of the following are true statements about diverticula except: Most diverticula in the colon are infected with gram negative bacteria Supplementing with fiber, such as psyllium (Metamucil), is recommended Diverticula are located in the colon A low fiber diet is associated with the condition

Most diverticula in the colon are infected with gram negative bacteria

A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract infection. After treatment for the UTI, what testing is indicated for this patient? Voiding cystourethrogram 24-hour urine collection to evaluate for glomerulonephritis No testing if hematuria is resolved Bladder scan

No testing if hematuria is resolved

A female patient is coming to your clinic complaining of nausea. You go to urine pregnancy test and it is negative. however the patient still thinks she is pregnant. You know that since she has been contemplating pregnancy, she should initiate folic acid.. Now At the diagnosis of pregnancy In the third trimester In the second trimester

Now Folic acid has been found to significantly decrease the incidence of neural tube defects. It should be supplemented at a dosage of 0.4 mg daily for all women of childbearing age before becoming pregnant.

A 54-year-old female presents with small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. With diagnosis is least likely? Endometrial carcinoma Ovarian cancer Endometrial hyperplasia Uterine polyps

Ovarian cancer Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others. Postmenopausal bleeding is an uncommon presentation of ovarian cancer, but can present this way. Other pathologies are usually evaluated before considering ovarian pathology.

A patient has a recent episode of vomiting and describes the vomitus as containing mostly gastric juice. What does this symptom suggest? Small bowel obstruction Gastritis Peptic ulcer Bile duct obstruction

Peptic ulcer

The provider is evaluating a patient for potential causes of urinary incontinence and performs a postvoid residual (PVR) test which yields 30 mL of urine. What is the interpretation of this result? The patient may have overflow incontinence. The patient probably has a UTI. This represents incomplete emptying. This a normal result.

This a normal result.

A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which diagnostic test will the provider order? Abdominal ultrasound MRI of the abdomen Abdominal CT with contrast Plain abdominal radiographs

Abdominal ultrasound

50-year-old male comes to in see the nurse practitioner for evaluation. He complains of fever, chills, pelvic pain, dysuria. He should be diagnosed with: Urinary tract infection Acute bacterial prostatitis Nonbacterial prostatitis Chronic bacterial prostatitis

Acute bacterial prostatitis Acute bacterial prostatitis should always be considered first in male patient to present with these symptoms. Chronic bacterial prostatitis presents with a more subtle presentation. UTIs far less common in men than women and is usually associated with anal intercourse or being uncircumcised. Nonbacterial prostatitis presents like chronic prostatitis except urine and prostate secretion cultures are negative.

The classic symptoms of ectopic pregnancy are: Abdominal pain, vaginal discharge, fever Amenorrhea, vaginal discharge, Abdominal pain Abdominal pain, nausea, vaginal bleeding Shoulder pain, bleeding, menorrhea

Amenorrhea, vaginal discharge, Abdominal pain The majority reports these symptoms with the follow %: 99% Abdominal pain, Amenorrhea 74%, vaginal bleeding 55%.

A 24 year old female with pain and tenderness in the right lower abdominal quadrant. Pelvic exam and UA are normal. WBC is elevated. Urine pregnancy test is negative. What is part of the differential diagnosis? UTI Pelvic inflammatory disease Ectopic pregnancy Appendicitis

Appendicitis

A 21-year-old college student has recently been informed that he has HPV infection on the shaft of his penis. With the following methods can be used to visualize subclinical HPV lesions on the penile skin? Perform a KOH exam Order a serum herpes virus titer Scrape out some of the affected skin and send it to culture and sensitivity Apply acetic acid to the penile shaft to look for acetowhite changes

Apply acetic acid to the penile shaft to look for acetowhite changes Lesions of HPV infection will turn white with application of acetic acid. Routine use of this procedure to detect mucosal changes due to HPV is not recommended because results do not influence clinical management (per CDC).

A patient with urolithiasis is more likely to: Demonstrate RBC casts Have chills and fevers Be of male gender Have frequent UTIs

Be of male gender Males are more likely than females to have urolithiasis. There is no increased incidence of stone formation among patients with frequent UTIs. Patients with your urolithiasis may exhibit fever and chills of infection if associated with a very large stone, but this is not the usual case. RBC casts are formed in the renal tubules, this generally indicates glomerular injury, not urolithiasis.

You suspect that the patient you are seeing as HIV. which with the following is a sensitive screening test for human immunodeficiency virus? HIV antibody test ELISA test Combination HIV-1 and HIV-2 antibody immunoassay with P 24 antigen Western blot test

Combination HIV-1 and HIV-2 antibody immunoassay with P 24 antigen The CDC recommends screening for combination antigen/antibody near as 8 with PT 24 antigen. Previously the ELISA was used as a screening test, and a Western blot was a confirmatory test. However they tested only for HIV antibody. The CDC recommends testing everyone between the ages of 13-64 years for HIV at least once as part of a routine health care. If risk factors are present, the patient should be tested for HIV annually. For sexually active gay and bisexual man, the CDC recommends more frequent testing, perhaps every 3-6 months.

A patient has sudden onset of right upper quadrant and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings? Acute acalculous cholecystitis Infectious cholecystitis Common bile duct obstruction Chronic cholelithiasis

Common bile duct obstruction

A female patient who is 45-year-old states that she is having urinary frequency. She describes episodes of "having to go right now" and not being able to wait. Her urinalysis results are within normal limits. What this part of the differential? Stress incontinence Asymptomatic bacteriuria Lupus Diabetes

Diabetes Patients with diabetes can present with polyuria. In assessment of patient's risk factors should be done with strong consideration even to checking glucose level. Other possible diagnoses include urge incontinence and vaginitis. A urinalysis would show bacteriuria.

A pregnant woman at 30 weeks gestation has proteinuria. What will the provider do next? Reassure her that this normal at this stage of pregnancy Evaluate her blood pressure Monitor serum glucose for gestational diabetes Perform a 24-hour urine collection

Evaluate her blood pressure

What is included in your treatment plan for #4? Flagyl (Metronidazole) 2g PO x 1 of patient only and no report to the county Rocephin (Ceftriaxone) 250mg IM with partner treatment and report to the county Flagyl (Metronidazole) 2g PO x 1 with partner treatment and report to the county Rocephin (Ceftriaxone) 250mg IM of patient only and no report to the county

Flagyl (Metronidazole) 2g PO x 1 with partner treatment and report to the county

A woman who is currently pregnant reports that she has had three previous pregnancies: twins delivered at 35 weeks gestation (both living), one at 38 weeks gestation (living), and one miscarriage at 16 weeks gestation. How will this be recorded as her G/TPAL in her electronic medical record? G4P:1213 G4P:2113 G4P:1113 G5P:1213

G4P:1113 G/TPAL T = refers to term births, after 37 wks gestation P = refers to premature births A = refers to abortions (refers to the total # of spontaneous or induced abortions or miscarriages, except ectopic pregnancies, prior to 20 wks. If a fetus is aborted after 20 wks, spontaneously or electively, then it is counted as a premature birth and P will increase but L will not. L = refers to living children

Which is the most common cause of pancreatitis in the United States? Hyperlipidemia Ethyl alcohol Trauma Gallstones

Gallstones

What choice below is most commonly associated with pancreatitis? Appendicitis and renal stones Hypertriglyceridemia and cholecystitis Gallstones and alcohol abuse Viral infection and cholecystitis

Gallstones and alcohol abuse

Chancroid considered a cofactor for transmission of: Trichomonas Chlamydia Gonorrhea HIV

HIV Chancroid is an STD. It is spread by sexual contact or by contacting pus from an infected lesion. The ulcers usually. Painful and then, but usually not painful in women. It is a cofactor in the transmission of HIV.

A 27-year-old asymptomatic male presents with generalized lymphadenopathy. He has multiple sexual partners and infrequently uses condoms. Of the following choices, what tests should be performed? HIV test Comprehensive metabolic panel Lymph node biopsy RPR

HIV test Asymptomatic HIV infections often have persistent generalized lymphadenopathy.

A sexually active adolescent male has a warty growth on the shaft of his penis. It is painless. This is likely: Trichomonas Syphilis HPV Herpes

HPV This is not a clinical presentation of trichomonas because this produces a discharge. Syphilis produces a painless lesion that presents as an ulceration with a hard edge and clean yellow base. Herpes produces lesions but are usually painful. HPV produces warty growths as described above.

A patient present with abdominal pain and has the following laboratory findings. Would does this mean? HBsAg positive anti-HBc positive IgM Anti-HBc positive anti-HBs negative He has immunity to hepatitis B More data is needed He has no immunity to hepatitis B He has acute hepatitis B

He has acute hepatitis B A positive hepatitis B surface antigen and a positive IgM means that this patient has acute hepatitis B. The first serological marker to be positive is the surface antigen. It can become positive as soon as 3-4 weeks after exposure to hepatitis B. Positive IgM indicates acute infection.

A patient's recent blood work indicates acute kidney injury. You know that acute kidney injury can be caused from: Heart failure exacerbation GERD Increase in metoprolol dose atrial fibrillation

Heart failure exacerbation Heart failure exacerbation and cause decreased perfusion to the kidneys, leading to acute kidney injury. Changes in medications or nephrotoxic can cause acute kidney injury, metoprolol is not one of them. While patients with atrial fibrillation can have decreased cardiac output, it is often compensated to preserve renal perfusion

A patient has fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient's symptoms? Hospitalization for emergent treatment Empiric treatment with antibiotics Supportive care with close follow-up Prescribing ursodeoxycholic acid

Hospitalization for emergent treatment

A 44-year-old female who is undergoing treatment for infertility complains of not having had a menstrual period for a few months. The night before, she started spotting and is now having cramp-like pains in her pelvic area. Her blood pressure is 160/80, pulse 110, she is afebrile. Her labs revealed mild anemia, mild leukocytosis. On exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is dilated to 3 cm. Which of the following is most likely? Acute pelvic inflammatory disease Incomplete abortion Inevitable abortion Threatened abortion

Inevitable abortion Inevitable abortion is defined and vaginal bleeding with pain, cervical dilation and/or cervical effacement. threatened abortion is defined as vaginal bleeding with absent or minimal pain and closed cervix. Incomplete abortion involves moderate or diffuse bleeding with the passage of tissue and painful uterine cramping or contractions.

A 50-year-old male patient reports that he has a sensation of scrotal heaviness. He reports that the sensation is worse at the end of the day. He denies pain. What is likely etiology of these symptoms? Strangulated hernia Inguinal hernia Epididymitis Hydrocele

Inguinal hernia Inguinal hernias are common in males. typical symptom reported by man with an inguinal hernia is scrotal heaviness, especially at the end of the day. If pain is severe, it may indicated strangulated hernia. This is a medical emergency. Epididymitis can produce scrotal pain, not usually heaviness. Hydrocele results in fluid in the scrotum.

Which with the following is contraindicated in the care of a pregnant woman with placenta previa? Echocardiogram Pelvic ultrasound Intravaginal ultrasound Abdominal ultrasound

Intravaginal ultrasound No type of vaginal exam should be performed and the patient diagnosed with placenta previa. Intravaginal ultrasound and pelvic exams are contraindicated

A pregnant woman who is overweight has no previous history of hypertension or diabetes. Her initial screening exam reveals a blood pressure of 140/90, she is asymptomatic. And a fasting blood glucose of 128 mg/dL. What will the practitioner do? Monitor blood pressure and fasting blood glucose closely. Do 2 hr GTT (glucose tolerance test) early, before 24 weeks. Initiate insulin therapy Refer the patient to a high-risk pregnancy specialist Prescribe an antihypertensive medication

Monitor blood pressure and fasting blood glucose closely. Do 2 hr GTT (glucose tolerance test) early, before 24 weeks.

14-year-old girl with amenorrhea was tested for pregnancy and has a positive result. The patient tells a nurse practitioner that she is seriously considering terminating the pregnancy. She tells the NP that she wants to be referred to a Planned Parenthood clinic. The NP's personal believes in religious beliefs are pro-life. Which with the following is the best action for the NP? NP should excuse herself from the case NP should tell the patient about her personal believes and advise her against getting an abortion NP should advise patient that a peer who is working with NP can help answer the patient's questions more thoroughly NP should refer patient to an obstetrician

NP should advise patient that a peer who is working with NP can help answer the patient's questions more thoroughly In general, discussing personal beliefs are considered unprofessional behavior. respecting the patient's right to choose is an example of supporting patient of autonomy

A 3-month-old male infant has edema and painless swelling of the scrotum. On physical examination, the provider is able to transilluminate the scrotum. What will the provider recommend? A short course of empiric antibiotic therapy Observation and reassurance that spontaneous resolution may occur A Doppler ultrasound to evaluate the scrotal structures Immediate referral to a genitourinary surgeon for repair

Observation and reassurance that spontaneous resolution may occur

The daughter of an elderly, confused female patient reports that her mother is having urinary incontinence several times each day. What will the provider do initially? Perform a bladder scan to determine distention and retention Tell the daughter that this is expected given her mother's age and confusion Obtain a urine sample for urinalysis and possible culture Order serum creatinine and blood urea nitrogen tests

Obtain a urine sample for urinalysis and possible culture

An adult patient has intermittent, crampy abdominal pain with vomiting. The provider notes marked abdominal distention and hyperactive bowel sounds. What will the provider do initially? Prescribe an antiemetic and recommend a clear liquid diet for 24 hours Obtain upright and supine radiologic views of the abdomen Schedule the patient for a barium swallow and enema Admit the patient to the hospital for consultation with a surgeon

Obtain upright and supine radiologic views of the abdomen

A patient is in the clinic with a 36 hrs history of diarrhea and moderate dehydration. Interventions should include: IV rehydration Oral rehydration with gatorade or tea Resumption of usual fluid intake Oral rehydration with an electrolyte replenishment solution

Oral rehydration with an electrolyte replenishment solution

A patient has acute renal colic, nausea, and vomiting and a urinalysis reveals hematuria, but is otherwise normal. A radiographic exam shows several radiopaque stones in the ureter which are less than 1 mm in diameter. What will the primary provider do initially to manage this patient? Order a narcotic pain medication and increased oral fluids Obtain a consultation with a urology specialist Prescribe desmopressin and a corticosteroid medication Prescribe nifedipine and hospitalize for intravenous antibiotics

Order a narcotic pain medication and increased oral fluids

The classic presentation of placenta previa is: Painless vaginal bleeding after the 20th week Painful bleeding in the third trimester Painless bleeding in the first trimester Painful vaginal bleeding before the 30th week

Painless vaginal bleeding after the 20th week Painless vaginal bleeding is associated with placenta prevue if occurs after the 20th week. Bleeding is likely at this time because the lower uterine segment develops and uterine contractions occur. At this time, the cervix dilates and effaces. Placenta can become detached and bleeding can occur.

Hyperemesis gravidarum is: Morning sickness Indicative of multiple gestations Persistent, intractable vomiting during pregnancy Always associated with hydatiform mole

Persistent, intractable vomiting during pregnancy Hyperemesis gravidarum is a severe form of nausea and vomiting that occurs during pregnancy. A common definition used to define hyperemesis gravidarum is persistent vomiting that produces a weight loss exceeding 5% of prepregnancy body weight.

A pregnant patient is found to have a urinary tract infection. What is the appropriate course of action? Prescribe nitrofurantoin Prescribe ciprofloxacin Prescribe TMP/SMX Prescribe no antibiotics

Prescribe nitrofurantoin Nitrofurantoin is considered probably safer to use during pregnancy. It provides coverage for most common UTI pathogens. TMP/SMX is a full of acid antagonist and may be associated with increased risk of congenital malformation. Ciprofloxacin is not to be used first line for any simple UTI, and may not be safe during pregnancy. In some occasions it could still be given if benefits outweigh risks.

A woman comes into clinic due to migraines with aura, but also requests oral contraceptives to prevent pregnancy. Which type of contraceptive will the provider recommend? Contraceptive implant Progestin-only contraception Combination oral contraceptive Transdermal combination product

Progestin-only contraception

A 31-year-old female patient presents with fatigue, fever, worsening unilateral low back pain for the past 5 days. Her pain is 5 out of 10 on the pain scale which has been unresponsive to ibuprofen. she denies abdominal pain, but is anorexic and nauseous. She denies vaginal discharge. Urinalysis demonstrates hematuria, the presence of WBC casts, leukocytes, nitrates. Which should be included in differential diagnosis? UTI Pelvic inflammatory disease Renal stones Pyelonephritis

Pyelonephritis The patient's complaint of unilateral low back pain is likely secondary to pyelonephritis. The presence of WBC casts in the urine strongly suggest a renal origin for pyuria. A patient who presents with this scenario has to be considered to have pyelonephritis until proven otherwise. Most women with PID have bilateral abdominal tenderness, usually in the lower quadrants. Purulent vaginal discharge and fever also common.

A 20-year-old male has epididymitis. His most common complaint will be: Scrotal pain Burning with urination Penile discharge Testicular pain

Scrotal pain The most common complaint for epididymitis is scrotal pain. Usually develops over a period of days. Burning with urination is possible if the underlying cause is a urinary tract infection. However, this is more common in older males. Testicular pain is not a common complaint with epididymitis. Penile discharge may occur with gonorrhea or Chlamydia infections.

A patient has intermittent left-sided lower abdominal pain and fever associated with bloating and constipation alternating with diarrhea. The provider suspects acute diverticulitis. Which tests will the provider order? (Select all that apply.) Stool for occult blood CT scan of abdomen and pelvis Rigid sigmoidoscopy Plain abdominal radiographs Barium enema examination

Stool for occult blood CT scan of abdomen and pelvis

A 25-year-old female presents with lower abdominal pain. Which finding would indicate the etiology as pelvic inflammatory disease? Abnormal CMP Temperature greater than 101°F Hematuria Presence of hyphae

Temperature greater than 101°F Symptoms of PAD include elevated temperature, abnormal cervical or vaginal discharge, presence of abundant WBC, elevated sedimentation rate or C-reactive protein. The CDC recommends empiric treatment of PID if lower abdominal pain or pelvic pain is present concurrently with cervical motion tenderness or uterine/adnexal tenderness

A 30-year-old woman complains of having had no period for the last 12 weeks. She is sexually active and her partner has been using condoms inconsistently. The patient has had history of irregular menstrual cycles and severe dysmenorrhea. The urine pregnancy test result is positive. Which of the following is true statement regarding this pregnancy? Hegar's sign is present during this period of pregnancy Quickening starts during this period The fundus of the uterus should be at the level of the symphysis pubis The cervix should be dilated about half an inch at this time of gestation

The fundus of the uterus should be at the level of the symphysis pubis

A 19-year-old student who is on prescription combined oral contraceptive pills is being seen for lower GI pain. The nurse practitioner has obtained a Pap smear and is about to perform the bimanual exam. She gently remove the plastic speculum from the vagina. While the NP is performing the bimanual vaginal exam, the patient complaints of slight discomfort during palpation of the ovaries. Which with the following is a true statement? The fallopian tubes and ovaries are not sensitive to light or deep palpation The ovaries are sensitive to deep palpation but they should not be painful. The uterus and ovaries are not important organs of reproduction The uterus and ovaries are both sensitive to any Palpation

The ovaries are sensitive to deep palpation but they should not be painful. Unilateral adnexal pain accompanied by cervical motion tenderness and purulent endocervical discharge suggestive of PID

Which description is more typical of a patient with acute cholecystitis? The patient is ill appearing and febrile The elderly patient is more likely to exhibit Murphy's sign The patient rolls from side to side on the exam table Most are asymptomatic until a stone blocks the bile duct

The patient is ill appearing and febrile A patient with acute cholecystitis usually c/o abd pain in upper right quadrant or epigastric pain. Many also have nausea. The patient lies still on the exam table as this condition is associated with peritoneal inflammation that is worse with movement. Elderly are less likely to exhibit Murphy's sign. Asymptomatic patients have cholelithiasis.

A patient is in clinic for evaluation of sudden onset of abdominal pain. The provider palpates a pulsatile, painful mass between the xiphoid process and the umbilicus. What is the initial action? Schedule the patient for an aortic angiogram Perform an ultrasound examination to evaluate the cause Transfer the patient to the emergency department for a surgical consult Order a CBC, type and crossmatch, electrolytes, and renal function tests

Transfer the patient to the emergency department for a surgical consult

A 16-year-old female patient is being treated for her first UTI. She had an allergic reaction with hives after taking sulfa as a child. Which of the following antibiotics would be contraindicated? Trimethoprim-sulfamethoxazole Cephalexin Nitrofurantoin Ampicillin

Trimethoprim-sulfamethoxazole

17-year-old boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like "a bag of worms" are noted underneath the scrotal skin. The testicle is not swollen or reddened. The most likely diagnosis is: Testicular torsion Varicocele Chronic orchitis Chronic epididymitis

Varicocele Palpation of varicose veins, described as "a bag of worms", is a classic symptom of varicocele.

A 45 year old diabetic female presents with c/o vaginal itching and discharge that began after douching post-menstruation approximately one week ago. Upon exam, you find thick, white discharge with a curd-like consistency and erythema generally in the vuvlvogavinal region. Under a wet mount you see the following below (budding, branching hyphae). Which of the following is an appropriate treatment for this patient? No treatment needed Rocephin (Ceftriaxone) 250mg IM x 1 and Azithromycin 1 g PO x 1 Diflucan (Fluconazole) 150mg PO x 1 Flagyl (Metronidazole) 500mg PO BID x 7 days

Diflucan (Fluconazole) 150mg PO x 1

When seen on a wet mount like the following, clue cells would indicate the treatment by which of the following? Flagyl (Metronidazole) 500mg PO BID x 7 days Diflucan (Fluconazole) 150mg PO x 1 Rocephin (Ceftriaxone) 250mg IM x 1 and Azithromycin 1 g PO x 1 No treatment needed

Flagyl (Metronidazole) 500mg PO BID x 7 days

An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention? Prescribing anti-infective agents to treat the infection Immediate referral to the emergency department Transillumination to assess for a "blue dot" sign Doppler ultrasound to assess testicular blood flow

Immediate referral to the emergency department

A physically independent 75 year old was diagnosed with mild cognitive impairment 6 months ago. She resides in an assisted living facility. she is in clinic today for scheduled visit. Her adult daughter reports that about 2 weeks ago her mother had an episode of urinary incontinence, but no episode since then. She is found to have asymptomatic bacteriuria. How should this be managed? Repeat the urinalysis in 7 days Repeat the urinalysis in 4 weeks Treat her today with one dose of an antibiotic Monitor her for symptoms of urinary tract infection

Monitor her for symptoms of urinary tract infection Approximately 30-50% of older females living in institutions have asymptomatic bacteriuria. No data support treatment of patients to prevent future problems or complications. In fact, asymptomatic bacteriuria is not usually treated unless the patient is pregnant, immunocompromised, or is undergoing a urinary procedure.

What medication may be used to treat GERD if a patient has tried over the counter ranitidine without benefit? Prescription strength ranitidine Calcium carbonate Prescription strength ranitidine Pantoprazole

Pantoprazole

A young primigravida reports to you that she is starting to feel the baby's movement in her uterus. This is considered to be rechecked the following? Positive sign Presumptive signs Possible sign Probable sign

Presumptive signs Presumptive signs or sensations that are felt by the mother, but they could also be caused by other conditions. They are some of the earliest symptoms of pregnancy, such as nausea, fatigue, breast tenderness, amenorrhea, and quickening.

A male patient complaints of dysuria. His urinalysis is positive for nitrates, leukocytes, and bacteria. What medication should be given and for how many days? Ciprofloxacin for 3 days Nitrofurantoin for 14 days Doxycycline for 7 days Trimethoprim-sulfamethoxazole for 7-10 days

Trimethoprim-sulfamethoxazole for 7-10 days

A female calls the provider to report having unprotected sexual intercourse approximately 4 days prior. Which regimen will the provider recommend? Ulipristal Acetate twice daily for 3 days Plan B One Step twice daily for 5 days Ulipristal Acetate taken one time Plan B One Step daily for 5 days

Ulipristal Acetate taken one time

A young adult male reports a gradual onset 3/10 dull pain in the right scrotum and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a bag of worms on the proximal spermatic cord. What is an important next step in managing this patient? Consideration of underlying causes of this finding Referral to an emergency department for surgical consultation Reassurance that this is benign and may resolve spontaneously Anti-infective therapy with ceftriaxone or doxycycline

Consideration of underlying causes of this finding

An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention? Immediate referral to the emergency department Doppler ultrasound to assess testicular blood flow Prescribing anti-infective agents to treat the infection Transillumination to assess for a "blue dot" sign

Immediate referral to the emergency department

A mother who has been breastfeeding her infant for several weeks develops a fever x 24 hours, malaise, breast erythema, and breast tenderness. What will the provider recommend? Ice packs and increased frequency of nursing Cessation of nursing and antibiotics initiated that covers S. aureus Increased frequency of nursing and antibiotics initiated that covers S. aureus Ice packs and cessation of nursing with breast pumping initiated

Increased frequency of nursing and antibiotics initiated that covers S. aureus

An initial pharmacological approach to the patient was diagnosed with primary dysmenorrhea could be: NSAIDs prior to the onset of menses NSAIDs at the time symptoms begin or onset of menses Combination of acetaminophen and NSAIDs Acetaminophen

NSAIDs at the time symptoms begin or onset of menses Pain associated with dysmenorrhea is likely due to prostaglandins. NSAIDs are prostaglandin synthesis inhibitors. They are usually started at the onset of menses or onset of symptoms and continued for 2-3 days depending on symptom pattern. There is no demonstrated increase in efficacy when acetaminophen is added or given alone.

Hegar's sign is considered a: Presumptive sinus pregnancy Problem in pregnancy Probable sign of pregnancy Positive sign of pregnancy

Probable sign of pregnancy Hegar's sign is a softening of the lower portion of the uterus and is considered a probable sign of pregnancy.

A woman who is taking oral contraceptive pills (OCPs) to prevent pregnancy calls the provider to report forgetting to take the pills for 4 days. She has not had sexual intercourse during that time. What will the provider recommend? Use a morning after pill today and resume the OCPs now Stop the OCP, use an alternative method, and resume OCPs at the next cycle Resume the pills and use a backup method the remainder of the cycle Take 2 pills daily for 4 days and use an alternative method for 4 days

Resume the pills and use a backup method the remainder of the cycle

A patient has both occasional "coffee ground" emesis and melena stools. What is the most probably source of bleeding in this patient? Upper GI Hepatic Lower GI Rectal

Upper GI

After an IUD is placed, the threads should be cut so approximately ______ are visible. This should then be _________. 6 cm; measured and documented in the chart. 3 cm; measured and forgotten about. 3 cm; measured and documented in the chart. 6 cm; measured and forgotten about.

6 cm; measured and documented in the chart.

A 25-year-old female presents with lower abdominal pain. Which finding would indicate the etiology as pelvic inflammatory disease? Abnormal CMP Hematuria Temperature greater than 101°F Presence of hyphae

Temperature greater than 101°F

A patient with an eating disorder might exhibit evidence of: Thyroid disease Sexual abuse Anxiety disorders Sleep disorders

Anxiety disorders In patients with eating disorders, it is common to identify affective disorders, anxiety disorders, or substance abuse issues. Obsessivecompulsive disorder is also commonly observed. There is no evidence of patients with eating disorders exhibit a higher incidence of sleep disorders, or had been sexually abused. Thyroid disease should always be assessed in patients with eating disorders, but this does not represent the reason for weight loss when eating disorder is present.

When prescribing medications to an 80-year-old patient, the provider will Consult the Beers list to help identify potentially problematic drugs. Ensure that the patient does not take more than five concurrent medications. Begin with higher doses and decrease according to the patient's response. Review all patient medications at the annual health maintenance visit

Consult the Beers list to help identify potentially problematic drugs.

You are seeing a patient and considering serotonin syndrome as a potential differential diagnosis. The patient is taking an SSRI. Which of the other medications the patient is taking may cause serotonin syndrome? Pravastatin Dextromethorphan Niacin Loratadine

Dextromethorphan Necessary rind dextromethorphan can cause serotonin syndrome. This is a potentially life threatening condition.

A 38-year-old patient diagnosed with bipolar disease has taken lithium for many months. His mood has stabilized. He was told to report frequent urination while taking lithium. What might be the underlying cause of his frequent urination? Blood sugar elevation Diabetes insipidus Urinary tract infection Elevated lithium level

Diabetes insipidus The most common side effect of lithium therapy is nephrogenic diabetes insipidus. Polyuria and polydipsia secondary to nephrogenic diabetes insipidus occur in about 20% of patients who take lithium.

A patient is coming to the clinic complaining of feeling depressed. You know that a typical symptom of depression is: Snoring Difficulty falling asleep Early morning wakening Keeping late-night hours reading

Early morning wakening Sleeping difficulty is a common complaint among patients with depression. Patients with difficulty falling asleep or often anxious. Frequent wakening and early morning wakening are complaints by many patients with depression.

Most patients who has acute hepatitis A infection: Have a self limiting illness Develop fulminant disease Become acutely ill Develop subsequent cirrhosis

Have a self limiting illness

A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The provider determines that these symptoms occur in relation to many events and concerns. What other things will the provider question this patient about? Headaches and bowel habits Ability to manage social situations Occupational performance Body image and eating habits

Headaches and bowel habits

A patient is coming in to your urgent care and notes that he has been on edge lately and needs help. You read in his chart that he is bipolar. The patient states that he recently purchased at $10,000 grand piano. He does not play the piano. This behavior is typical during: Hypomania Depression Mania Psychosis

Mania

An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. She appears somewhat confused, according to her daughter, who is concerned that she is developing dementia. The provider learns that the woman still drives, volunteers at the local hospital, and attends a book club with several friends once a month. What is the initial step in evaluating this patient? Obtain a CBC, serum electrolytes, BUN, and glucose Referring the patient to a neurologist for evaluation for AD Ordering a CBC, serum ferritin, and TIBC Referring the patient to a dietician for nutritional evaluation

Obtain a CBC, serum electrolytes, BUN, and glucose

A patient has nausea associated with chemotherapy. Which agent will be prescribed? Meclizine Scopolamine Ondansetron Diphenhydramine

Ondansetron

A college student is brought to the emergency department by a roommate who is concerned about symptoms of extreme restlessness, nausea, and vomiting. The provider notes elevations of the pulse and blood pressure and pupillary dilation, along with hyperactive bowel sounds. The provider suspects withdrawal from which substance? Opioids Cocaine Alcohol LSD

Opioids

A pregnant patient complains of urinary frequency and dysuria. Her urinalysis is positive for nitrates, leukocyte esterase, and bacteria. Will course of action is most appropriate? Prescribe an antibiotic only Order a urine culture only Order urine culture and begin antibiotics Repeated the urinalysis

Order urine culture and begin antibiotics The findings of the urinalysis along with symptoms of dysuria are consistent with UTI. Empiric antibiotic should be initiated and culture ordered. Pregnant female start high risk of developing pyelonephritis if UTI is left untreated.

Which of the following would be usual in a patient with biliary colic? Positive Murphy's sign Pain in upper abdomen in response to eating fatty foods Presence of gallstones on imaging study Presence of gallstones and unpredictable abdominal pain

Pain in upper abdomen in response to eating fatty foods Biliary colic refers to discomfort produced by contraction of the gallbladder, which often occurs in response to eating.

A patient is coming in to see you at your urgent care with vague symptoms. You note that she has been at your urgent care multiple times over the last several weeks complaining of vague symptoms. You note that she seems to respond poorly to medical treatment that has been given to her. What should be considered when obtaining a history from her? Physical abuse or depression Anemia or depression Hepatitis or HIV Depression or HIV

Physical abuse or depression Patient's who have been victims of violence or more likely to utilize health care and to have a poor response to treatment. If the patient is suspected to have been a victim of violence, they should also be screened for anxiety, depression, and PTSD.

A patient is diagnosed with panic disorder and begins taking a selective serotonin reuptake inhibitor medication. Six weeks later, the patient reports little relief from symptoms. What will the provider do next to manage this patient? Change the medication to buspirone Discontinue the medication Refer to a mental health provider Increase the medication dose

Refer to a mental health provider

Which medications are useful in treating both obsessive-compulsive disorder and PTSD? (Select all that apply.) Benzodiazepines Buspirone Selective serotonin reuptake inhibitors Serotonin-norepinephrine reuptake inhibitors Tricyclic antidepressants

Selective serotonin reuptake inhibitors Serotonin-norepinephrine reuptake inhibitors Tricyclic antidepressants

A 86-year-old male reports feeling anhedonia for the last month. What should be part of the nurse practitioner's initial assessment? Mania Suicidal ideation Libido Depression

Suicidal ideation Anhedonia is the loss of pleasure interest in things that have always brought pleasure or interest. It is a red flag for depression. Screening for depression is necessary, however, suicidal ideation should be the priority assessment.

4 days ago, 79-year-old female lost her husband of 55 years. She presents today with her daughter because she believes that she is "going crazy." She reports that she often hears her husbands voice though she realizes that he has died. She has not slept well since his death and hasn't been eating much. She has taken her usual medications for hypertension, osteoporosis, osteoarthritis, and hypothyroidism. She has no history of psychiatric illness. Should the NP manage this? Tell her that this is a normal response and will resolve Prescribe a benzodiazepine for relief of anxiety Encourage her daughter to consider assisted living placement Prescribe an antidepressant and follow-up in one to 2 weeks

Tell her that this is a normal response and will resolve This imagined hearing or seeing of the deceased person is referred to as "searching behavior" and is not indicative of a psychiatric illness. It is a common response after the death of a lot of the 1, especially after 55 years of marriage. This patient and her daughter should be educated regarding the stages of grief and a variable length of each of those stages.

A female patient with the complaint of dysuria has a urine specimen that is positive for leukocytes and nitrates. There is blood in the specimen. The most appropriate diagnosis is: UTI or chlamydia Urinary tract infection UTI with hematuria Asymptomatic bacteriuria No answer text provided.

UTI with hematuria The presence of leukocytes and nitrates in the urine indicates likely infection in the bladder, and more likely from a gram-negative pathogen such as Escherichia coli. The presence of blood is common when patient's has a UTI. A diagnosis of chlamydia cannot be made based on the symptoms and urinalysis results.

A patient's CBC demonstrated anemia. Which diagnosis is likely based on this patient's laboratory values? MCV 74.1 fL (normal 80-95) MCH 24 pg (normal 27-31) MCHC 33% (normal 32-69) RDW 12% (normal 11-14.5) iron deficiency anemia anemia of chronic disease vitamin B12 deficiency anemia thalassemia

thalassemia

A patient reports anal pruritis and occasional bleeding with defecation. An examination of the perianal area reveals external hemorrhoids around the anal orifice as the patient is bearing down. The provider orders a colonoscopy to further evaluate this patient. What is the treatment for this patient's symptoms? Referral for possible surgical intervention A high-fiber diet and increased fluid intake Daily laxatives to prevent straining with stools Infiltration of a local anesthetic into the hemorrhoid

A high-fiber diet and increased fluid intake

A pregnant patient has asymptomatic bacteriuria. What is the likely pathogen? Escherichia coli Staph aureus Klebsiella No pathogen

Escherichia coli Of pregnant patient with asymptomatic bacteriuria should be treated with antibiotics because she is at high risk of developing pyelonephritis and/or preterm labor. The most common pathogen is Escherichia coli.

Most patient who have an acute hepatitis B infection: Have varied clinical presentations Are acutely ill Are females Develop subsequent cirrhosis

Have varied clinical presentations

A 40 year old female patient returns to your clinic to review her pap smear results from the previous week. You tell her the test is abnormal with "atypical squamous cells of undetermined significance and HPV positive". What is the appropriate next step of the following? Repeat cytology immediately Repeat cytology in 1 year Perform or refer out for colposcopy Repeat cytology in 2-4 months

Perform or refer out for colposcopy

An initial pharmacological approach to the patient was diagnosed with primary dysmenorrhea could be: NSAIDs Tramadol Acetaminophen Combination of acetaminophen and NSAIDs

NSAIDs

What is the best treatment for H. pylori-related peptic ulcer disease? H2RA, bismuth, metronidazole, and tetracycline for 10 to 14 days PPI, amoxicillin, and clarithromycin for 10 days PPI and clarithromycin for 14 days H2RA and clarithromycin for 14 days

PPI and clarithromycin for 14 days

A female patient and her male partner are diagnosed with trichomonas. She has complaints of vulvall itching and discharge. He is asymptomatic. How should they be treated? They both should be treated with azithromycin and doxycycline They both should receive metronidazole She should be treated with ceftriaxone, he should receive ciprofloxacin She should receive metronidazole, he does not need treatment

They both should receive metronidazole Metronidazole is the drug of choice to treat male in females for Trichomonas. Even though he is asymptomatic, he should receive treatment. Neither partner should resume sexual intercourse until both have been treated and usually 5-7 days after.

A 3-day-old, full-term female infant who is breastfeeding develops some jaundice. The transcutaneous bilirubin(TcB) reading in the office is in the intermediate risk zone. What will the provider tell the mother? To use a breast pump to increase her milk supply and increase baby to breast and return to clinic within 5 days for reassessment To supplement feedings with extra water and return to clinic within 5 days for reassessment To switch to formula and return to clinic within 5 days for reassessment To decrease the frequency of breastfeeding and return to clinic within 5 days for reassessment

To use a breast pump to increase her milk supply and increase baby to breast and return to clinic within 5 days for reassessment

A patient who has diabetes has symptoms consistent with renal stones. Which type of stone is most likely in this patient? Uric acid Citrate Oxalate Cysteine

Uric acid

A 65 year old female presents with c/o vaginal soreness and dysuria that has been intermittent for several years. She notes the pain is worse after intercourse with her husband of 30 years, with whom is in an monogamous relationship. She denies vaginal discharge and has not had a pap smear since her total hysterectomy ten years ago. She currently only takes a multivitamin. Your wet mount reveals few lactobacilli and increased parabasal cells. What is your likely diagnosis? Trichomonas vaginalis Vaginal candidiasis Atrophic vulvovaginitis Bacterial Vaginosis

Atrophic vulvovaginitis

Clue cells are found in patients who have: Pneumonia Leukemia Epidermal fungal infections Bacterial vaginosis

Bacterial vaginosis Clue cells are hallmark sign of bacterial vaginosis and can be seen in a microscopic exam.

A patient develops acute diarrhea and then comes to clinic two weeks later reporting profuse watery, bloody diarrheal stools 6 to 8 times daily. The provider notes a toxic appearance with moderate dehydration. Which test is indicated to diagnose this cause? Stool collection for 24-hour stool pH Qualitative and quantitative fecal fat C. difficile toxin Wright stain of stool for white blood cells

C. difficile toxin