Exam 2 Test Bank
A 28-year-old male nurse of Hispanic descent reports a history of a cold that resolved 2 weeks ago except for a dry cough and pain over his right cheek that worsens when he bends down. The patient denies fever. He tells the employee health nurse practitioner that he is very allergic to both cephalexin (Keflex) and erythromycin. The patient's vital signs are temperature of 99.2°F, pulse of 72 beats/min, and respirations of 12 breaths/min. Which of the following conditions is most likely? A) Acute sinusitis B) Acute bronchitis C) Fever secondary to the previous viral URI (upper respiratory infection) D) Hay fever
A) Acute sinusitis Acute sinusitis symptoms include cough, facial pain, and lowgrade fever.
All of the following agents are used to control the inflammatory changes seen in the lungs of asthmatics except: A) Albuterol inhaler (Proventil) B) Triamcinolone (Azmacort) C) Montelukast (Singulair) D) Cromolyn sodium inhaler (Intal)
A) Albuterol inhaler (Proventil) Albuterol is a short-acting bronchodilator that is used for immediate relief of shortness of breath in patients with asthma. It works by opening the air passages but does not have any steroidal/anti-inflammatory effect such as triamcinolone (Azmacort), nor an effect such as a leukotriene blocker (Singulair). Steroids and leukotrienes help the inflamed channels to remain open and clear but take longer to get into the system to work.
A 13-year-old girl has a throat culture that is positive for strep throat. She reports that her younger brother was recently diagnosed with strep throat and treated. The patient has a severe allergy to penicillin and reports that erythromycin makes her very nauseated. Which of the following antibiotics is the best choice? A) Azithromycin (Zithromax) B) Cephalexin (Keflex) C) Cefuroxime axetil (Ceftin) D) Levofloxacin (Levaquin)
A) Azithromycin (Zithromax) If the patient has a severe penicillin allergy, there is a 10% chance of cross-reactivity to cephalosporins (especially first generation). Because the patient is a child, the levofloxacin is contraindicated. Nausea is a common adverse reaction to erythromycin (it is not an allergic reaction). The best option is to use azithromycin because of its minimal GI adverse effects. Azithromycin has fewer drug interactions compared with other macrolides.
Which of the following tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia? A) Hemoglobin electrophoresis B) Bone morrow biopsy C) Peripheral smear D) Reticulocyte count
A) Hemoglobin electrophoresis Patients with the diagnosis of beta thalassemia and/or sickle cell anemia would be screened using hemoglobin electrophoresis to identify the blood disorder.
A small abscess on a hair follicle on the eyelid is called: A) Hordeolum B) Pterygium C) Pinguecula D) Ptosis
A) Hordeolum Hordeolum is a common, painful, acute bacterial infection of the hair follicle on the eyelid. It is a focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola or styes) or, less frequent the meibomian glands (internal hordeola). Histologically, hordeola represent focal collections of polymorphonuclear leukocytes and necrotic debris (i.e., abscesses). Pinguecula is a thickening of the bulbar conjunctiva, located on the inner and outer margins of the cornea. Pterygium is a thickening of the conjunctiva located on the nasal or temporal cornea. Pinguecula and pterygium are both caused by the UV light of long-term sun exposure. Sunglasses with UV protection are recommended to prevent damage to the conjunctiva. Ptosis is the drooping of the upper eyelid.
A second triple screen on a 35-year-old primigravida reveals abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin. Which of the following interventions is the best choice for this patient? A) Order an ultrasound B) Order a computed tomography (CT) scan of the abdomen C) Order a 24-hour urine for protein clearance D) Assess for a history of illicit drug or alcohol use
A) Order an ultrasound Abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultrasound should be ordered to further evaluate the fetus for characteristics of Down syndrome and/or fetal demise.
A test called the visual fields by confrontation is used to evaluate for: A) Peripheral vision B) Central distance vision C) Narrow-angle glaucoma D) Accommodation
A) Peripheral vision The visual fields by confrontation test is used to evaluate peripheral vision. The Snellen chart is used to measure central distance vision. A tonometer is used to assess for glaucoma. The ophthalmoscope is used to assess for cataracts.
A 10-year-old boy who was recently accepted onto his school's soccer team has a history of exercise-induced asthma. He wants to know when he should use his albuterol inhaler. The nurse practitioner would advise the patient to: A) Premedicate 10 to 15 minutes before starting exercise B) Wait until he starts to exercise before using the inhaler C) Premedicate 30 minutes before starting exercise D) Wait until he finishes his exercise before using his inhaler
A) Premedicate 10 to 15 minutes before starting exercise Exercise-induced asthma is best controlled by using the Proventil inhaler (bronchodilator) approximately 10 to 15 minutes before exercise, to prevent vasospasm of the bronchioles and shortness of breath with exercise. The effects of these bronchodilators usually last approximately 4 hours. They also work quickly to open up the bronchioles if an acute attack/shortness of breath occurs.
Which bacterium is the most common pathogen seen in otitis externa infections? A) Pseudomonas aeruginosa B) Streptococcus pyogenes C) Haemophilus influenzae D) Moraxella catarrhalis
A) Pseudomonas aeruginosa The most common bacterium is Pseudomonas. The second most common bacterium is Staphylococcus aureus. Polymyxin and neomycin combination ear drops (Cortisporin) are the first-line treatment for otitis externa. Other ear drops that are also effective are the quinolone ear drops (ofloxacin, ciprofloxacin topical drops).
The bacterium responsible for the highest mortality in patients with communityacquired pneumonia is: A) Streptococcus pneumoniae B) Mycoplasma pneumoniae C) Moraxella catarrhalis D) Haemophilus influenzae
A) Streptococcus pneumoniae Community-acquired pneumonia (CAP) is the sixth most common cause of death in the United States and the leading cause of death from infectious diseases. It is associated with significant morbidity and mortality, and poses a major economic burden to the health care system. S. pneumoniae is the leading cause of CAP.
When evaluating the blood pressure on both the arms and legs of an infant who has a diagnosis of coarctation of the aorta, which of the following is the correct finding? A) The blood pressure is higher in the arms than in the legs B) Only the diastolic blood pressure is higher in the legs than in the arms C) The blood pressure is higher in the legs than the arms D) The blood pressure is lower in both arms than in the legs
A) The blood pressure is higher in the arms than in the legs In coarctation of the aorta, blood pressure is higher in the arms than in the legs due to the narrowing in the aorta. Blood pressure must rise to get adequate blood flow to the lower extremities; therefore, the blood pressure above the coarctation rises to compensate for this.
During a sports physical, you note that the vision of an 18-year-old male athlete is 20/30 in both eyes. Which of the following statements is true? A) The patient can see at 20 ft what a person with normal vision can see at 30 ft B) The patient can see at 30 ft what a person with normal vision can see at 20 ft C) The patient cannot engage in contact sports D) The patient needs to be referred to an ophthalmologist
A) The patient can see at 20 ft what a person with normal vision can see at 30 ft The Snellen factions, 20/20, 20/30, and so forth, are a measure of sharpness (acuity) of sight. The numerator (top number) represents the test distance, 20 ft. The denominator (bottom number) represents the distance at which the average eye can see the letters on a certain line of the eye chart. When vision results are 20/30 in both eyes, this means that the patient can see at 20 ft what a person with normal vision can see at 30 ft.
All of the following are factors important in determining the peak expiratory flow volume except: A) Weight B) Height C) Age D) Gender
A) Weight Peak expiratory flow volume is determined by using height, gender, and age
Which of the following individuals is more likely to be affected by alpha thalassemia anemia? A) 53-year-old Greek patient B) 25-year-old Chinese patient C) 62-year-old Russian patient D) 38-year-old African American patient
B) 25-year-old Chinese patient Alpha thalassemia minor/trait or disease is more prevalent among Asians such as Chinese and Filipinos. Beta thalassemia minor/trait or disease is more common in the countries in the Mediterranean area, such as Greece and Italy.
The mother of a 4-week-old infant is concerned that her infant's eyes are crossed for a few seconds occasionally. The nurse practitioner would: A) Recommend referral to a pediatric ophthalmologist B) Advise the mother that this is a normal finding in infants up to 2 months of age C) Recommend that multivitamin supplements be given to the infant daily D) Educate the mother on how to patch the infant's eye every 4 hours
B) Advise the mother that this is a normal finding in infants up to 2 months of age Infants' eyes commonly cross over at times, and this is a normal finding up to 2 months of age.
What is the best procedure for evaluating a corneal abrasion? A) Tonometry B) Fluorescein stain C) Visual field test D) Funduscopy
B) Fluorescein stain Fluorescein stain is an eye stain used to detect abrasions or foreign objects in the cornea of the eye. Orange dye (fluorescein) is used to stain the eye and a blue light is used to detect/visualize any foreign bodies or abrasions in the eye. Visual field test assesses vision. Tonometry measures the pressure inside the eye. The funduscopic exam is performed with an ophthalmoscope to visualize the inside of the eye.
The mother of a 7-year-old boy tells the family nurse practitioner that his teacher has complained to her of her son's frequent episodes of daydreaming. The mother reports that sometimes when her son is at home, he seems not to hear her, seeming to "blank out" for a short period of time. Which of the following is most likely? A) A partial seizure B) An absence seizure (petit mal seizure) C) A grand mal seizure D) An atonic seizure (drop attack)
B) An absence seizure (petit mal seizure) A petit mal seizure is a brief seizure that usually lasts less than 15 seconds. During the seizure, the child may appear not to be listening, to have "blanked out," or to be daydreaming.
A 20-year-old patient has recently been diagnosed with migraines. The nurse practitioner is educating the patient about factors that are known to trigger migraine headaches. Which of the following is incorrect advice? A) Avoid foods with high tyramine content B) Avoid foods with high potassium content C) Get enough sleep D) Avoid fermented foods
B) Avoid foods with high potassium content Foods that are high in potassium are not associated with migraines. Each of the other responses—foods high in tyramine content (blue cheese, smoked meats, salami, beer, soy, fava beans), change in sleep patterns, and fermented foods—are all possible migraine triggers. Other triggers include skipping meals/fasting, hormonal fluctuation, environmental factors, stress, overexertion, visual triggers such as eyestrain/bright glaring lights, and others.
This case is followed by questions and multiple-choice answers specific to the case. A 17-year-old high school student is diagnosed by the nurse practitioner with serous otitis media of the left ear. He states that his nose is always congested because of dust mite allergy. His medical history includes allergic rhinitis and asthma. What is the expected result of the Rinne test in patients who have serous otitis media of the left ear? A) Air conduction (AC) > bone conduction (BC) B) Bone conduction (BC) > air conduction (AC) C) Lateralization to the left ear D) Sound is heard by both ears The student reports a history of chronic nasal congestion. He occasionally has fits of sneezing when he is in a dusty room. The nurse practitioner is using an otoscope to examine his nasal tissue. The inferior nasal turbinates appear swollen and pale. Which of the following medications is considered first-line treatment for allergic rhinitis? A) Azelastine (Astelin) one to two sprays in each nostril twice a day B) Saline nasal spray one to two sprays in each nostril four times a day as needed C) Cetirizine (Zyrtec) one 5-mg tablet PO at bedtime D) Budesonide (Rhinocort) one to two sprays in each nostril twice a day
B) Bone conduction (BC) > air conduction (AC) The sound is heard louder by bone conduction versus air conduction (BC>AC) in serous otitis media and other types of conductive hearing loss. This is because when the affected ear is filled with fluid, the tympanic membrane cannot move in response to the sound waves due to the fluid trapped inside the middle ear. Because the sound waves are blocked, the sound is heard better by bone conduction. D) Budesonide (Rhinocort) one to two sprays in each nostril twice a day The first-line treatment for allergic rhinitis is topical glucocorticoid nasal sprays such as budesonide (Rhinocort). It will decrease swelling and open the Eustachian tubes so that the middle ear can drain. The other medications (cetirizine, azelastine, nasal saline) are not considered first-line agents for allergic rhinitis, but they can be added if the symptoms are not well controlled. Azelastine (Astelin) is a topical antihistamine. Cetirizine (Zyrtec) is a second-generation systemic antihistamine. Do not combine it with azelastine (Astelin) because both are antihistamines and taken concurrently will cause excessive drowsiness. Topical nasal steroid sprays, cetirizine, and nasal saline sprays are sold over the counter. But azelastine (Astelin) is available only by prescription.
An infant who does not have a history of reactive airway disease and allergy has both inspiratory and expiratory wheezing accompanied by fever and profuse clear nasal discharge. Which of the following is most likely? A) Tracheobronchitis B) Bronchiolitis C) Croup D) A small foreign body is lodged on the left main bronchus
B) Bronchiolitis Symptoms of tracheobronchitis include prominent dry, nonproductive cough; later, coughing up phlegm is common. Bronchiolitis is a viral infection caused by respiratory syncytial virus (RSV), which is commonly seen during the winter/spring months in infants and young children. Typical signs/symptoms include fever and inspiratory/expiratory wheezing with clear drainage. Croup is a viral infection with a classic "barking" cough; the patient may have a runny nose, but typically no fever. When a child swallows a foreign object, choking, wheezing, and shortness of breath may occur, but no fever or clear drainage are present.
Which cranial nerve (CN) is being evaluated when Rinne testing is done? A) CN VII B) CN VIII C) CNs IX and X D) CN XI
B) CN VIII The acoustic nerve, cranial nerve VIII, is being evaluated when the Rinne test is performed. The Rinne test is performed by placing the base of a vibrating tuning fork against the patient's mastoid bone to evaluate bone conduction. Ask the patient to tell you when the sound is no longer heard. Then place the tuning fork in the front of the ear to evaluate air conduction. The air conduction should be twice as long as bone conduction.
Which cranial nerves (CNs) innervate the extraocular muscles of the eyes? A) CNs II, III, and VI B) CNs III, IV, and VI C) CNs IV, V, and VII D) CNs V, VI, and VIII
B) CNs III, IV, and VI Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) innervate the extraocular muscles. They are tested by inspecting the eyelids for drooping, and inspecting pupil size for equality and their direct and consensual response to light and accommodation.
Which of the following infections can cause a "barky" cough? A) Epiglottitis B) Croup C) Bronchiolitis D) Common cold
B) Croup The "barky" cough of croup is harsh, loud, and worse at night. Other symptoms are fever, hoarse or raspy voice, and stridor. A warm steamy room (let hot water run in shower with door closed) or a mist humidifier help. Croup is caused by several types of viruses, but parainfluenza types 1, 2, and 3 are the most common viruses.
Which of the following is considered an objective finding in patients who have a case of suppurative otitis media? A) Erythema of the tympanic membrane B) Decreased mobility of the tympanic membrane as measured by tympanogram C) Displacement of the light reflex D) Bulging of the tympanic membrane
B) Decreased mobility of the tympanic membrane as measured by tympanogram Acute suppurative otitis media is an acute infection affecting the mucosal lining of the middle ear and the mastoid air system. Suppurative stage: The tympanic membrane bulges and ruptures spontaneously through a small perforation in the pars tensa. Ear discharge is usually present. Diagnosis is usually made simply by looking at the eardrum through an otoscope. The eardrum will appear red and swollen, and may appear either abnormally drawn inward or bulging outward. Using the tympanogram with the otoscope allows a puff of air to be blown lightly into the ear. Normally, this should cause movement of the eardrum. In an infection, or when there is fluid behind the eardrum, this movement may be decreased or absent.
Abrupt loss of consciousness accompanied by generalized tonic-clonic seizures followed by a postictal period characterize what type of seizure disorder? A) Absence seizure B) Grand mal seizure C) Atonic seizure D) Myoclonic seizure
B) Grand mal seizure Grand mal seizure is the older term for generalized tonic-clonic seizure. It starts with abrupt loss of consciousness and stiffening of the muscles (tonic phase). After about a minute, the muscles start to jerk for 1 to 2 minutes (clonic phase). Cessation of muscle twitching signals the start of the postictal period. During this period, the person may be asleep (and gradually wake up) or may become agitated or confused. Do not insert anything in the mouth such as tongue blades. Help the person lay on the floor on his or her side.
What is the gold-standard test for alpha thalassemia minor and sickle cell anemia? A) Ferritin B) Hemoglobin electrophoresis C) Total iron-binding capacity (TIBC) D) Folate level
B) Hemoglobin electrophoresis Alpha thalassemia and sickle cell anemia are both conditions that affect the hemoglobin molecule. The gold-standard test for these types of diseases (hemoglobinopathies) is the hemoglobin electrophoresis.
A kindergarten teacher is diagnosed with acute streptococcal pharyngitis. On exam, her throat is a bright-red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The urinalysis shows a large amount of white blood cells and is positive for nitrites. The patient has a sulfa allergy and thinks she is also allergic to penicillins. Which of the following is the best treatment choice? A) Amoxicillin-clavulanic acid (Augmentin) 500 mg PO BID B) Levofloxacin (Levaquin) 250 mg PO daily C) Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet PO BID D) Clarithromycin (Biaxin) 500 mg PO BID
B) Levofloxacin (Levaquin) 250 mg PO daily Streptococcal pharyngitis and urinary tract infection are both covered by using Levaquin, which is a fluoroquinolone. Amoxicillin-clavulanic acid (Augmentin) and trimethoprim- sulfamethoxazole (Bactrim) would not be used because of the patient's allergies. Fluoroquinolones can be used in patients aged 18 years or older.
A 4-year-old boy diagnosed with acute otitis media returns in 48 hours with a possible rupture of the tympanic membrane (TM) of the right ear. The mother reports seeing pus and a small amount of blood on the pillow that morning. The child states that his ear is no longer painful. During the ear exam, the otoscope is used to visualize the TM, which has a perforation on the lower edge that is draining a small amount of purulent discharge. All of the following topical ear medications should be avoided in patients with perforation of the TM except: A) Gentamycin ear drops B) Ofloxacin ear drops C) Tobramycin ear drops D) Neomycin sulfate ear drops
B) Ofloxacin ear drops Ofloxacin ear drops are not considered to be ototoxic. However, aminoglycoside otic drops (gentamycin, tobramycin) are ototoxic and should not be used to treat otitis media or perforation of the tympanic membrane (TM). In addition, ear drops with alcohol, benzocaine, or olive oil should be avoided in patients with TM perforation. Swimming or water inside the ear should be avoided until the TM is healed. Topical therapy with topical quinolone drops may be equivalent to oral therapy, but some experts prefer oral antibiotic therapy, such as amoxicillin or amoxicillin-clavulanate (Augmentin) for 10 days, to treat TM perforations.
A toddler with congenital heart disease is seen for a 1-week history of facial and lowerextremity edema accompanied by shortness of breath. The child's mother reports that the child's appetite has been poor. The chest x-ray reveals that the child has congestive heart failure (CHF). Which of the following heart sounds are found in patients with CHF? A) S1 and S2 B) S1, S2, and S3 C) S1, S2, and S4 D) Still's murmur and S4
B) S1, S2, and S3 Congestive heart failure (CHF) is the inability of the heart to pump a sufficient amount of blood to the organs to meet the body's requirements. It is common to hear S1, S2, and S3 heart sounds on exam. Common signs and symptoms of CHF include fatigue, shortness of breath with activity, and edema of lower extremities.
The cover/uncover test is a screening tool for: A) Color blindness B) Strabismus C) Visual acuity D) Cataracts
B) Strabismus The cover/uncover test screens for strabismus. Color blindness is evaluated by using the Ishihara tool. To use the Ishihara chart, the child must be familiar with reading numbers and be able to follow instructions. Visual acuity (distance vision) is evaluated using the Snellen chart. Cataracts are screened by using the red reflex test. Use the direct ophthalmoscope (set at "0") and shine the light into both the eyes at about 18 inches away from the patient. Instruct the patient to stare in one direction forward (and avoid moving the eyes). Turn off the room light. In someone with advanced cataracts, the red reflex will show a white reflection instead of the normal orange to red color.
During a sports physical exam, a 16-year-old patient is noted to have a few beats of horizontal nystagmus on extreme lateral gaze that disappear when the eyes move back toward midline. Which statement best describes this clinical finding? A) It is caused by occult bleeding of the retinal artery B) This is a normal finding C) It is a sign of a possible brain mass D) This is a borderline result and requires further evaluation
B) This is a normal finding Horizontal nystagmus is a normal variation on physical exam. Full movement of the eyes is controlled by the integrated function of cranial nerves III (oculomotor), IV (trochlear), and VI (abducens). Holding the patient's chin to prevent movement of the head, ask the patient to watch your finger as it moves through the six cardinal fields of gaze. Then ask the patient to look to the extreme lateral (temporal) positions. A few horizontal nystagmic beats are within normal limits (WNL).
A 12-year-old girl is complaining of a 2-week history of facial pressure that worsens when she bends over. She complains of tooth pain in her upper molars on the right side of her face. On physical exam, her lung and heart sounds are normal. Which of the following is the most likely diagnosis? A) An acute dental abscess B) Chronic sinusitis C) Acute sinusitis D) Severe allergic rhinitis
C) Acute sinusitis Signs and symptoms of acute sinusitis include headache, facial pain that worsens with bending over, eye/ear pressure and pain, aching in upper jaw/teeth, reduced smell and taste, cough (especially at night due to the nasal drainage), sore throat, bad breath, and fatigue.
The Rinne and the Weber tests are used to assess which of the following cranial nerves (CNs)? A) CNs III, IV, and VI B) CN VII C) CN VIII D) CNs IX and X
C) CN VIII The Rinne and Weber tests are used to assess cranial nerve VIII (acoustic nerve). The patient's hearing is tested by air conduction (Rinne and Weber) and bone conduction (Rinne only).
Which cranial nerve (CN) is being evaluated when patients are instructed to shrug their shoulders? A) CN IX B) CN X C) CN XI D) CN XII
C) CN XI Cranial nerves (CNs) IX through XII are the glossopharyngeal, vagal, spinal accessory, and hypoglossal, respectively. CN XI tests for spinal accessory. The procedure to test trapezius muscle strength is to have the patient shrug the shoulders against resistance. To test sternocleidomastoid muscle strength, have the patient turn the head to each side with resistance.
An asthmatic exacerbation is characterized by all of the following symptoms except: A) Tachycardia B) Severe wheezing C) Chronic coughing D) Tachypnea
C) Chronic coughing A patient experiencing respiratory distress from an asthmatic exacerbation presents with tachypnea (>20 breaths/min), tachycardia or bradycardia, cyanosis, and anxiety. The patient appears exhausted, fatigued, and diaphoretic and uses accessory muscles to help with breathing. Physical exam reveals cyanosis and "quiet" lungs with no wheezing or breath sounds audible. A "chronic" cough is not a symptom of an acute exacerbation but is commonly present in people with asthma Although cough usually accompanies dyspnea and wheezing, it may present in isolation as a precursor of typical asthmatic symptoms, or it may remain the predominant or sole symptom of asthma. Cough-variant asthma is a type of asthma in which the main symptom is a dry, nonproductive cough.
While assessing for a cardiac murmur, the first time that a thrill can be palpated is at: A) Grade 2 B) Grade 3 C) Grade 4 D) Grade 5
C) Grade 4 A fine vibration, felt by an examiner's hand on a patient's body over the site of an aneurysm or on the precordium, results from turmoil in the flow of blood and indicates the presence of an organic murmur of grade 4 or greater intensity. A thrill can also be felt over the carotids if a bruit is present and over an arteriovenous fistula in the patient undergoing hemodialysis.
What is the best diagnostic test for thalassemia? A) CBC B) MCV C) Hemoglobin electrophoresis D) Bone marrow biopsy
C) Hemoglobin electrophoresis The gold standard for diagnosis of thalassemia (or sickle cell anemia) is the hemoglobin electrophoresis.
All of the following pharmacological agents are used to treat inflammation in the lungs of asthmatic patients except: A) Nedocromil sodium (Tilade) two sprays QID B) Cromolyn sodium inhaler (Intal) two puffs QID C) Long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours D) Fluticasone inhaler (Flovent) two puffs BID
C) Long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours Theophylline is used to control inflammation of the lungs. Nedocromil sodium (Tilade), cromolyn sodium (Intal), and fluticasone inhaler (Flovent) help to treat inflammation.
Lead poisoning can cause which type of anemia? A) Mild macrocytic anemia B) Normocytic anemia C) Microcytic anemia D) Mild hemolytic anemia
C) Microcytic anemia Anemias can be classified according to the mean corpuscular volume (MCV) into microcytic, normocytic, and macrocytic anemias. A microcytic anemia is defined by an MCV of less than 80 fL. The differential diagnosis of a microcytic anemia includes iron-deficiency anemia (IDA), thalassemias; anemia of chronic disease (ACD); and sideroblastic anemias, including lead poisoning. Lead causes anemia by mimicking healthful minerals such as calcium, iron, and zinc. It is absorbed by the bones, where it interferes with the production of red blood cells. This absorption can also interfere with calcium absorption, which is needed to keep the bones healthy.
Beta thalassemia minor is considered a: A) Macrocytic anemia B) Normocytic anemia C) Microcytic anemia D) Hemolytic anemia
C) Microcytic anemia Beta thalassemia minor is a genetic disorder in which the bone marrow produces small, pale, red blood cells in which mild hypochromic, microcytic anemia occurs.
A 13-year-old boy's peak expiratory flow results indicate 60% to 80% of the predicted range. How would you classify his asthma? A) Mild intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe asthma
C) Moderate persistent asthma The Global Initiative for Asthma has four clinical classifications of severity: intermittent (normal FEV1 between exacerbations, FEV1 >80%), mild persistent (FEV1 >80%), moderate persistent (FEV1 60%- 80%), and severe persistent (FEV1 <60%). Daily symptoms with more than one nighttime episode of symptoms per week, 60% to 80% FEV1, and greater than 30% FEV1 variability and need for short-acting beta-2 agonist for symptom control, are classified as moderate persistent severity in patients older than 12 years of age.
Acute bronchitis is best characterized by: A) Fever and wheezing B) Purulent sputum and fever C) Paroxysms of coughing that are dry or produce mucoid sputum D) A gradual onset and fatigue
C) Paroxysms of coughing that are dry or produce mucoid sputum A cough is the main symptom of acute bronchitis. It may be dry at first (does not produce mucus) and after a few days may bring up mucus from the lungs (productive cough). The mucus may be clear, yellow, or green. Small streaks of blood may be present.
A 6-year-old girl who attends preschool part time is brought to the clinic by her mother as a walk-in patient. The mother reports that her daughter has recently begun swim lessons. The symptoms began as redness on the left eye and spread to the second eye within 2 days. The child's eyes are watery and crusted in the morning when she wakes up. Her vital signs are temperature of 98.8°F, pulse of 90 beats/min, and respirations of 16 breaths/min. The eye exam reveals bilateral injected conjunctiva. When the lower eyelid is examined, the nurse practitioner notes that it is pink with a cobblestone appearance. There is ipsilateral preauricular adenopathy. All of the following treatment measures are appropriate except: A) Prescribe a topical ophthalmic vasoconstrictor to be used two times per day as needed for up to 3 days to reduce redness B) Write a note excusing the child from school because she should not attend until the symptoms resolve C) Prescribe ophthalmic topical antibiotic eye drops, two to three drops to be applied in each eye QID for 7 days D) Advise use of cool compress over closed eyes as needed for comfort, washing hands often with soap and water, and to avoid rubbing eyes or sharing towels
C) Prescribe ophthalmic topical antibiotic eye drops, two to three drops to be applied in each eye QID for 7 days Treatment for viral keratoconjunctivitis (pink eye) is symptomatic. Cold compresses and slightly chilled artificial tears may help with the itching. Educate the parent and/or child to avoid touching the eyes with hands, avoid sharing towels, to perform frequent handwashing, and use tissues if touching the eyes. Viral keratoconjunctivitis is usually caused by an adenovirus (but other viruses can also cause it). It is contagious for 10 to 12 days after onset of symptoms and is a self-limiting condition. It can be transmitted through swimming pools, fomites, and by hands. Children should not attend school until symptoms resolve.
Which of the following is indicated for the prophylactic treatment of migraine headache? A) Ibuprofen (Motrin) B) Naproxen sodium (Anaprox) C) Propranolol (Inderal) D) Sumatriptan (Imitrex)
C) Propranolol (Inderal) Propranolol (Inderal) is a beta-blocker. Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line agents for migraine prevention. The goal of preventive therapy is to improve patients' quality of life by reducing migraine frequency, severity, and duration, and by increasing the responsiveness of acute migraines to treatment. A full therapeutic trial may take 2 to 6 months. Ibuprofen (Motrin), naproxen sodium (Anaprox), and sumatriptan (Imitrex) are all medications used to treat symptoms of migraine headache.
Which of the following pathogenic bacteria are commonly found in the lungs of older children and adults with cystic fibrosis? A) Streptococcus pneumoniae B) Chlamydia pneumoniae C) Pseudomonas aeruginosa D) Staphylococcus aureus
C) Pseudomonas aeruginosa P. aeruginosa is a common chronic lung infection seen in older children and adults with cystic fibrosis. This infection is difficult to eliminate and sometimes is the cause of death.
What is the least common pathogen found in community-acquired atypical pneumonia? A) Moraxella catarrhalis B) Streptococcus pneumoniae C) Pseudomonas aeruginosa D) Mycoplasma pneumonia
C) Pseudomonas aeruginosa P. aeruginosa is an uncommon cause of communityacquired pneumonia. It is more common in patients with cystic fibrosis and hospitalized patients. In mild cases, it can be treated with ciprofloxacin (Cipro) or levofloxacin (Levaquin), which are fluoroquinolones. P. aeruginosa is resistant to several antibiotics and it can be tricky to treat. Many patients need hospitalization.
While checking for the red reflex on a 3-year-old boy during a well-child visit, the nurse practitioner notes a white reflection on the child's left pupil. Which of the following conditions should be ruled out? A) Unilateral strabismus B) Unilateral cataracts C) Retinoblastoma of the left eye D) Color blindness of the left eye
C) Retinoblastoma of the left eye Retinoblastoma is a congenital tumor of the retina. It usually affects only one eye (rarely both eyes are involved). During infancy, the tumor is a small size and it continues to grow with the child. This rare cancer is diagnosed by noting a pupil that appears white or has white spots on it. One or both eyes may be affected. It is often first noted in photographs, because a white glow is present in the eye instead of the usual "red eye" that results from the flash.
Which of the following laboratory tests would you order for an older diabetic man with the following complete blood count (CBC) results: hemoglobin = 11 g/dL, hematocrit = 38%, mean corpuscular volume (MCV) = 105 fL, and normal reticulocyte count? A) Serum ferritin and a peripheral smear B) Hemoglobin electrophoresis C) Serum folate acid and B12 level D) Schilling test
C) Serum folate acid and B12 level The patient has macrocytic anemia (MCV 102). The differential diagnoses are B12 deficiency and folate deficiency anemia. Initial test is the serum folate and B12 level. Other tests for macrocytic/megaloblastic anemias are the peripheral smear, methylmalonic acid, and homocysteine level. If B12 deficiency, order anti-parietal antibodies to check for pernicious anemia.
During a sports physical exam of a 14-year-old high school athlete, the nurse practitioner notices a split of the S2 component of the heart sound during deep inspiration. She notes that it disappears upon expiration. The heart rate is regular and no murmurs are auscultated. Which of the following is correct? A) This is an abnormal finding and should be evaluated further by a cardiologist B) A stress test should be ordered C) This is a normal finding in some young athletes D) An echocardiogram should be ordered
C) This is a normal finding in some young athletes It is common to hear a split S2 heart sound over the pulmonic area of the heart with inspiration. As long as it disappears with expiration, with no other abnormal symptoms, this is a normal finding. The sound is caused by splitting of the aortic and pulmonic components.
A mother brings her 4-year-old daughter, who just started attending preschool, to the health clinic. She tells the nurse practitioner that her child is complaining of burning and itching that started in the left eye. Within 2 days it involved both eyes, and the child developed a runny nose and sore throat. During the physical exam, the child's eyes appear injected bilaterally with no purulent discharge. The throat is red, the inferior nasal turbinates are swollen, and lymph nodes are palpable in front of each ear. Which of the following is most likely? A) Herpes keratitis B) Corneal ulcer C) Viral conjunctivitis D) Bacterial conjunctivitis
C) Viral conjunctivitis The causative organisms of viral conjunctivitis (pink eye) include adenovirus and other virus types. It can present with or without cold symptoms. Patient complains of itchy red eyes and may have clear discharge accompanied by preauricular lymphadenopathy. Does not affect vision. If a contact lens wearer, assume bacterial infection and obtain culture of eye discharge.
Which of the following cranial nerves (CNs) is evaluated when a wisp of cotton is lightly brushed against the corner of the eye? A) CN II B) CN III C) CN IV D) CN V
D) CN V Cranial nerves (CNs) are assessed as follows: CN II (optic)— distance vision, near vision; CNs III, IV, VI (oculomotor, trochlear, abducens) —extraocular movements (EOMs), visual fields of gaze; CN V (trigeminal; three branches are V1 [ophthalmic], V2 [maxillary], V3 [mandibular])—motor portion, clench jaws; sensory portion, corneal reflex/facial sensation. The procedure to test CN V includes inspection for muscle atrophy and tremors, palpation of jaw muscles for tone and strength when the patient clenches teeth, testing of superficial pain and touch sensation in each branch, and testing of temperature sensation if there are unexpected findings to pain or touch. A wisp of cotton is used to test the corneal reflex.
The Romberg test is done to check for problems with balance. Which area of the brain is responsible for balance? A) Frontal lobe B) Temporal lobe C) Midbrain D) Cerebellum
D) Cerebellum The Romberg test evaluates the cerebellum and the vestibular system (inner ear), which are responsible for balance. This test is performed by having the client stand up straight with feet together and with arms straight down the side of the body. Next the patient is instructed to close his or her eyes and stand still for at least 20 seconds. The test is positive if patient cannot maintain balance with eyes closed.
An asthmatic 20-year-old woman who was seen for a viral upper respiratory infection 2 weeks ago presents to the nurse practitioner's office complaining of a recent onset of shortness of breath, inspiratory and expiratory wheezing, and chest tightness. She has been using her albuterol inhaler four to six times a day with poor relief. She is unable to speak in full sentences. When the nurse practitioner quickly evaluates the patient, she notices that the patient is pale, diaphoretic, fatigued, and using her sternocleidomastoid accessory muscles for respiration. Her respiratory rate is 32 breaths/min and pulse is 130 beats/min. Which of the following interventions is not indicated? A) Administer oxygen by nasal cannula B) Give the patient a nebulized short-acting beta 2 agonist C) Quickly assess the patient with the pulse oximeter and check breath sounds D) Initiate cardiopulmonary resuscitation (CPR) immediately
D) Initiate cardiopulmonary resuscitation (CPR) immediately Although the patient is in obvious respiratory distress, CPR is not yet warranted. This patient is at very high risk for acute respiratory failure.
Koilonychia is associated with which of the following conditions? A) Lead poisoning B) Beta thalassemia trait C) B12 deficiency anemia D) Iron-deficiency anemia
D) Iron-deficiency anemia Koilonychia is also known as spoon-shaped nails. The finger nails are thin and have a concave shape. Koilonychia is associated with severe iron-deficiency anemia.
Which of the following findings are seen in a patient with folate-deficiency anemia? A) Microcytic and hypochromic red blood cells B) Microcytic and normochromic red blood cells C) Normal size and color of the red blood cells D) Macrocytic and normocytic red blood cells
D) Macrocytic and normocytic red blood cells Vitamin B12 -deficiency adversely affects myelin, leading to neuropathy. The most common cause of B12 - deficiency anemia is pernicious anemia. Anemia resulting from vitamin B12 or folate deficiency is referred to as macrocytic or megaloblastic anemia because the red blood cells (RBCs) are larger than normal. Deficiency in folate and B12 does not affect the color of RBCs (normochromic). The RBCs have large cytoplasm because folate and B12 are necessary for normal DNA synthesis and cytoplasmic maturation. The mean corpuscular volume (MCV) measures the size of the RBCs. An MCV greater than 100 is seen in macrocytic anemias (folate or B12 -deficiency anemia). The mean corpuscular hemoglobin concentration (MCHC) is a measure of color, but number values are not used on the exam. Instead, color is described as normochromic or hypochromic.
The following measures are used for prophylaxis or treatment of migraine headaches. Which is not considered effective for migraine? A) Propranolol (Inderal) B) Resting in a quiet and darkened room C) Trimethobenzamide (Tigan) D) Moderate sodium restriction
D) Moderate sodium restriction Regarding migraine headaches, sodium restriction is not effective. But propranolol (migraine prophylaxis), trimethobenzamide (nausea), and resting in a quiet and darkened room are helpful. Pain relief medications, such as analgesics, NSAIDs, caffeine, ergots, and "triptans," can be effective treatment.
A college student is seen as a walk-in appointment in a college health clinic. She complains of the abrupt onset of sore throat, nasal congestion, runny nose, and malaise. Vital signs are a temperature of 99.8°F, pulse of 84 beats/min, and respirations of 14 breaths/min. The physical exam reveals an erythematous throat, swollen nasal turbinates, and rhinitis. The nurse practitioner suspects viral upper respiratory infection. All of the following treatments are appropriate except: A) Saline nasal spray (Ocean nasal spray) B) Pseudoephedrine (Sudafed) C) Ibuprofen (Advil) D) Oral prednisone (Medrol Dose Pack)
D) Oral prednisone (Medrol Dose Pack) Symptomatic treatments for a viral upper respiratory infection are saline nasal sprays (e.g., Ocean spray), decongestants (e.g., pseudoephedrine), nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen), increased fluid intake, and alternative herbal remedies (Echinacea, astragalus, elderberry syrup, high doses of vitamin C).
The mother of an 11-year-old boy with sickle cell anemia calls on the phone because her son woke up with a painful penile erection that will not go away. The nurse practitioner's most appropriate intervention is: A) Insert a Foley catheter and measure the child's intake and output for the next 24 hours B) Insert a Foley catheter to obtain a specimen for a urinalysis and urine for C&S (culture and sensitivity) C) Recommend an increase in the child's fluid intake D) Recommend immediate referral to the emergency department
D) Recommend immediate referral to the emergency department Priapism (painful penile erection not related to sexual activity) is a true urological emergency that may lead to permanent erectile dysfunction and penile necrosis if not treated appropriately. It can be associated with a number of medical conditions (sickle cell anemia, leukemia, or spinal cord injury) and/or some pharmacological agents
Auscultation of normal breath sounds of the chest will reveal: A) Bronchial breath sounds heard at the lower bases B) High-pitched vesicular breath sounds heard over the upper lobes C) Vesicular breath sounds heard over the trachea D) Vesicular breath sounds in the lower lobe
D) Vesicular breath sounds in the lower lobe Normal sounds of the chest wall include vesicular breath sounds in the lower lobes. Bronchial breath sounds are heard best at the second and third intercostal spaces. Tracheal breath sounds are heard over the trachea.
Peak expiratory flow (PEF) meters are used to monitor asthma by using personal best measurements. All of the following factors are used to determine the PEF except: A) Age B) Gender C) Height D) Weight
D) Weight Peak expiratory flow volume is determined by using height, gender, and age. Weight is not used in the formula.
